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Previous issue date: 2016-01-27 === Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq === PURPOSE: Present and evaluate a 3D cephalometric analysis of hard and soft tissues to
describe, compare, correlate and predict changes in measures assessed in soft tissues in
relation to bone changes resulting from double-jaw orthognathic surgery in Class III patients. Also to correlate changes observed only in soft tissues. The hypothesis is that skeletal changes may affect and are correlated to changes in facial soft tissues in different forms in several regions of the face and also differently in relation to each individual reference plane and in 3D. MATERIALS AND METHODS: Calibration of the measures was carried out using the intraclass correlation coefficient (ICC) and the absolute difference between intra and inter evaluators assessments. Cone beam tomography pre and postoperative of 23 (9 male, 14 female, average age of 28 years and 7 months) were evaluated in Dolphing Imaging 3D software. The t-Student test for paired samples was applied in order to compare the pre and postoperative values for all the analyzed measures and changes in soft tissue in relation to bone alterations. The analysis of the effect size was also applied by the Cohen?s "d" coefficient. Pearson correlation coefficient was used in order to correlate the bone movement with soft tissue changes and the latter only among themselves. The stepwise multiple regression analysis was applied to try to identify the degree of influence of each Independent Variables individually on each of the Dependent Variables. All analyzes were applied in relation to three reference planes individually and in 3D. The level of significance was set at 95%. RESULTS: The degree of correlation in intra and inter evaluators assessmens was high, with the average of Absolute Differences for the total set of each type of measurement ranging below the limits of clinical relevance of 2mm and 4 ?. Higher changes and higher correlations were identified more in the mandible than in the maxilla and more in the central region than in the peripheral face. The movements of the soft tissue correlated significantly with the
movements of the underlying skeletal bone (midle third of the face in relation to the maxilla
and inferior third of the face in relation to the mandible) and in relation to the same reference plane, although there were exceptions. Fully satisfactory values of prediction for the results of soft tissues after this type of surgery were not identified, especially in 3D. CONCLUSIONS: The results allow validation of the measures, except for Nasolabial and
Labiomentual angles. The null hypothesis could be rejected, since the skeletal changes
affected and were correlated to changes in facial soft tissues in different forms in several
regions of the face and also differently in relation to each individual reference plane and in
3D. === OBJETIVO: Propor e validar uma an?lise cefalom?trica 3D de tecidos duros e moles, aplicando-a para descrever, comparar, correlacionar e prever as altera??es ocorridas nas medidas avaliadas em tecidos moles com as altera??es ?sseas decorrentes da cirurgia ortogn?tica bimaxilar em pacientes Classe III, al?m de correlacionar as altera??es em tecidos moles entre si. A hip?tese ? que altera??es esquel?ticas podem afetar e se correlacionam ?s altera??es dos tecidos moles faciais de forma diferente em diversas regi?es da face e tamb?m de forma diferente em rela??o aos planos de refer?ncia individuais e em 3D. MATERIAL E M?TODOS: A calibra??o das medidas foi realizada utilizando-se o Coeficiente de Correla??o Intraclasse (CCI) e a Diferen?a Absoluta entre as avalia??es intra e interexaminadores. Tomografia do cone beam pr? e p?s-operat?rias de 23 pacientes (9 homens, 14 mulheres, m?dia de idade de 28 anos e 7 meses) foram avaliadas no software Dolphing Imaging 3D. Com intuito de comparar os valores pr? e p?s-operat?rios para todas as medidas analisadas e as altera??es ocorridas em tecidos moles com as altera??es ?sseas, foi
aplicado o teste t-Student para amostras pareadas. A an?lise do tamanho de efeito foi igualmente aplicada por meio do coeficiente ?d? de Cohen. A fim de correlacionar o movimento ?sseo com as altera??es de tecidos moles e estas ?ltimas apenas entre si, utilizouse o coeficiente de correla??o de Pearson. A an?lise de regress?o m?ltipla stepwise foi aplicada para tentar identificar o grau de influ?ncia de cada Vari?vel Independente individualmente sobre cada uma das Vari?veis Dependentes. Todas as an?lises foram
aplicadas em rela??o a tr?s planos de refer?ncia individualmente e em 3D. O n?vel de signific?ncia foi estabelecido em 95%. RESULTADOS: O grau de correla??o na calibragem intra e interexaminadores foi alto,
ficando as m?dias das Diferen?as Absolutas no conjunto total de cada tipo de medida abaixo dos limites de relev?ncia cl?nica de 2mm e 4?. Altera??es e correla??es maiores foram identificadas mais em mand?bula do que em maxila e mais na regi?o central do que na perif?rica da face. Os movimentos dos tecidos moles se correlacionaram mais com os movimentos esquel?ticos dos ossos subjacentes (ter?o m?dio em rela??o ? maxila e ter?o inferior em rela??o ? mand?bula) e em rela??o ao mesmo plano de refer?ncia, embora tenha
havido exce??es. N?o foram identificados valores plenamente satisfat?rios de predic??o de resultados dos tecidos moles, especialmente em 3D. CONCLUS?ES: Os resultados encontrados permitem a valida??o das medidas, exceto as de ?ngulo Nasolabial e Labiomentual. A hip?tese nula p?de ser rejeitada, uma vez que as altera??es esquel?ticas afetaram e se correlacionaram ?s altera??es dos tecidos moles faciais de forma diferente em diversas regi?es da face e tamb?m de forma diferente em rela??o aos planos de refer?ncia individuais e em 3D.
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