CASE REPORT
Orthodontic-surgical treatment of a class II division 1 patient. Case report
Tratamiento ortodóncico-quirúrgico de paciente clase II división 1. Presentación de un caso clínico
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Castañeda, Luis Pablo Cruz Hervert, Eduardo Llamosas Hernández, David Elías Viñas, Luis Antonio García Espinosa, Nicolás Pacheco Guerrero, Julio Morales González, Fernando Ángeles Medina" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Claudia Ivonne" "apellidos" => "Rodríguez Castañeda" ] 1 => array:2 [ "nombre" => "Luis Pablo" "apellidos" => "Cruz Hervert" ] 2 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Llamosas Hernández" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "Elías Viñas" ] 4 => array:2 [ "nombre" => "Luis Antonio" "apellidos" => "García Espinosa" ] 5 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Pacheco Guerrero" ] 6 => array:2 [ "nombre" => "Julio" "apellidos" => "Morales González" ] 7 => array:2 [ "nombre" => "Fernando" "apellidos" => "Ángeles Medina" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2395921518300151?idApp=UINPBA00004N" "url" => 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Case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e240" "paginaFinal" => "e248" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mariana Bolio Casas, Isaac Guzmán Valdivia" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Mariana" "apellidos" => "Bolio Casas" "email" => array:1 [ 0 => "mariana.bolio87@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Isaac" "apellidos" => "Guzmán Valdivia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "fn2" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Orthodontics Department, Postgraduate Studies and Research Division of the Odontology Faculty, UNAM" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento ortodóncico-quirúrgico de paciente clase II división 1. Presentación de un caso clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0090" "etiqueta" => "Figure 18" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr18.jpeg" "Alto" => 517 "Ancho" => 1006 "Tamanyo" => 68015 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Postsurgical panoramic radiograph.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">INTRODUCTION</span><p id="par0005" class="elsevierStylePara elsevierViewall">Class II division 1 is one of the most difficult to correct malocclusions. It causes an important facial disharmony characterized by a deficient projection of the mandible, which leads to a convex profile, nonaesthetic facial proportions and occlusal disharmonies creating in the patient a negative psychological impact and a functional problem.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The pathogenesis is of multifactorial origin but there are two fundamental components: genetics and extrinsic factors such as habits: digital suction, lip suction, abnormal deglutition, among others. <a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Treatment alternatives are different depending on the age of the patient and the severity of the case.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Orthognathic surgery is a good treatment approach for patients with severe skeletal discrepancies beyond the reach of conventional orthodontic treatment. Combined surgical-orthodontic treatment aims to obtain a more harmonious facial, skeletal and soft tissue relationship as well as to improve occlusal function. It has been demonstrated that facial and dental abnormalities that affect facial appearance may result in social disadvantage. Hence patients undergoing orthognathic surgery may experience psychosocial benefits and improve their selfconfidence, facial image and social adaptation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A very important factor to be considered for surgical-orthodontic treatment is the paradigm of the soft tissues. It establishes that both the objectives and limitations of modern orthodontic and orthognathic treatment and are determined by the facial soft tissues, not by teeth or bones.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As a result, the main objective of treatment happens to be the relationship and adaptations of the soft tissues, and not the ideal occlusion. It is admitted that for the patient to be able to benefit fully from treatment, ideal occlusion not always represents the fundamental aspect of a treatment plan. Functional occlusion, becomes the secondary objective of the treatment.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">CASE REPORT</span><p id="par0030" class="elsevierStylePara elsevierViewall">A female patient, 20 years of age, attended the Orthodontics Clinic of the Division of Postgraduate Studies and Research of the Odontology Faculty of the National Autonomous University of Mexico. The main reason for consultation is «When I had my wisdom teeth removed, I was told that they could perform orthognathic surgery on me but first I had to have orthodontic treatment». This, in order to correct the facial anomaly that may be observed in the profile.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Clinical characteristics:</span> at the facial clinical examination, in the front view the following characteristics were observed: a mesoprosope, round face, competent and thick lips and the facial midline coincides with the upper dental midline. The smile is neutral and shows nearly 100% of the clinical crowns of the upper teeth <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0005"><span class="elsevierStyleItalic">Figure 1</span></a><span class="elsevierStyleItalic">)</span>. The vertical analysis shows the lower third increased in relation to the middle third. The lateral view of the patient shows a convex profile, with an obtuse (open) nasolabial angle and a decreased occipital-cervical distance <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0010"><span class="elsevierStyleItalic">Figure 2</span></a><span class="elsevierStyleItalic">)</span>. Intraorally, the patient presented dental crowding, mismatched midlines, canine and molar relationship class II, an overjet of 6 and a 5 mm overbite <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0015"><span class="elsevierStyleItalic">Figure 3</span></a><span class="elsevierStyleItalic">)</span>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Radiographic records were taken prior to treatment, including panoramic and lateral headfilm radiographs and a CBCT <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0020"><span class="elsevierStyleItalic">Figures 4</span></a><span class="elsevierStyleItalic">and</span><a class="elsevierStyleCrossRef" href="#fig0025"><span class="elsevierStyleItalic">5</span></a><span class="elsevierStyleItalic">)</span>. In them, it was observed: 28 permanent teeth, good crownroot ratio (2:1), appropriate level of bony ridges, slight asymmetry of the mandibular ramus and no signs of TMJ disease.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The cephalometric analysis revealed a skeletal class II due to maxillary protrusion and retrognathia, transversal micrognathism, vertical excess of the maxilla, upper and lower proclination and a neutral growth pattern <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#tbl0005"><span class="elsevierStyleItalic">Table I</span></a><span class="elsevierStyleItalic">)</span>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Treatment plan:</span> once the objectives of treatment were established, a consultation was held with the Department of Maxillofacial Surgery of the Hospital Juarez in Mexico. It was suggested a sagittal surgery for mandibular advancement and an advancement genioplasty. Presurgical orthodontic treatment was planned for the surgical preparation of the patient.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Presurgical orthodontic phase:</span> extraction of lower first premolars. 0.022” x 0.028” Roth appliances were placed. Alignment and leveling is done with light archwires.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Presurgical decompensation was seen in the dental and facial features <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0030"><span class="elsevierStyleItalic">Figures 6</span></a><span class="elsevierStyleItalic">and</span><a class="elsevierStyleCrossRef" href="#fig0035"><span class="elsevierStyleItalic">7</span></a><span class="elsevierStyleItalic">)</span>. Second and third order movements were carried out with the following archwire sequence: 0.016” x 0.016” NiTi up to 0.019” NiTi x 0.025” stainless steel <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0040"><span class="elsevierStyleItalic">Figure 8</span></a><span class="elsevierStyleItalic">)</span>. Prior to surgery radiographic records were taken <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0045"><span class="elsevierStyleItalic">Figures 9</span></a><span class="elsevierStyleItalic">and</span><a class="elsevierStyleCrossRef" href="#fig0050"><span class="elsevierStyleItalic">10</span></a><span class="elsevierStyleItalic">)</span> for cephalometric tracings and surgical prediction <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0055"><span class="elsevierStyleItalic">Figure 11</span></a><span class="elsevierStyleItalic">)</span>. Measurements and analysis were performed with the Dolphin Imaging 9.0 program. Surgery of models and the fabrication of the necessary occlusal splints for the surgery were performed in a semi-adjustable articulator.</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia><elsevierMultimedia ident="fig0045"></elsevierMultimedia><elsevierMultimedia ident="fig0050"></elsevierMultimedia><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Surgical procedure:</span> the surgery was performed with the aid of the Department of Maxillofacial Surgery of the Hospital Juarez in Mexico. A bilateral sagittal osteotomy was performed advancing the mandible 10 mm with bone graft using an intermediate splint for stabilizing the mandible in the correct position <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0060"><span class="elsevierStyleItalic">Figures 12A</span></a><span class="elsevierStyleItalic">and</span><a class="elsevierStyleCrossRef" href="#fig0060"><span class="elsevierStyleItalic">12B</span></a>). An advancement genioplasty of 6 mm was also conducted <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0060"><span class="elsevierStyleItalic">Figure 12C</span></a>). At the end of the surgery, the final splint was placed and elastic chain as intermaxillary fixation <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0065"><span class="elsevierStyleItalic">Figure 13</span></a><span class="elsevierStyleItalic">)</span>.</p><elsevierMultimedia ident="fig0060"></elsevierMultimedia><elsevierMultimedia ident="fig0065"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Postsurgical orthodontic phase:</span> orthodontic treatment was resumed three weeks after surgery using up & down elastics for muscle control <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0070"><span class="elsevierStyleItalic">Figure 14</span></a><span class="elsevierStyleItalic">).</span> The objective of this phase was to achieve an ideal occlusion in terms of Canine Class, overjet and overbite and the coincidence of dental midlines. 0.018” x 0.025” NiTi archwires were used and the use of elastics was continued. Subsequently, 0.019” x 0.025” archwires SS were placed for closure of residual spaces and finally 0.019” x 0.025” braided archwires were placed for refinement of intercuspation through elastics.</p><elsevierMultimedia ident="fig0070"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Twenty weeks after surgery the appliances were removed. Upper and lower circumferential retainers were Indicated for use during the day and a basic Bionator appliance of nocturnal use <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRefs" href="#fig0075"><span class="elsevierStyleItalic">Figures 15 to 17</span></a><span class="elsevierStyleItalic">)</span>. Orthopantomography and lateral headfilm were taken after treatment <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0090"><span class="elsevierStyleItalic">Figures 18</span></a><span class="elsevierStyleItalic">and</span><a class="elsevierStyleCrossRef" href="#fig0095"><span class="elsevierStyleItalic">19</span></a><span class="elsevierStyleItalic">)</span>, and the changes were assessed by superimposition <span class="elsevierStyleItalic">(</span><a class="elsevierStyleCrossRef" href="#fig0100"><span class="elsevierStyleItalic">Figure 20</span></a><span class="elsevierStyleItalic">)</span>. Additionally, cephalometric values were compared with the initial X-rays.</p><elsevierMultimedia ident="fig0075"></elsevierMultimedia><elsevierMultimedia ident="fig0080"></elsevierMultimedia><elsevierMultimedia ident="fig0085"></elsevierMultimedia><elsevierMultimedia ident="fig0090"></elsevierMultimedia><elsevierMultimedia ident="fig0095"></elsevierMultimedia><elsevierMultimedia ident="fig0100"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Total treatment time was 21 months. The profile was improved increasing the aesthetics and facial harmony of the patient.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">DISCUSSION</span><p id="par0085" class="elsevierStylePara elsevierViewall">It is of the utmost importance to have an interdisciplinary approach during the planning of the surgical-orthodontic treatment for establishing objectives and obtain good results. Success in the surgical correction of dental-skeletal anomalies is determined by both the presurgical orthodontic treatment that eliminates dental compensation, and the correct surgical planning.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">After the evaluation and considering the soft tissues of the patient, the decision was made to start presurgical orthodontic treatment with the aim of achieving a good decompensation and preparing for surgery. In addition, a cephalometric prediction at the end of the presurgical phase was performed to corroborate the aims to be achieved during the surgical phase.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Sagittal osteotomies of the mandible in combination with pre- and post-surgical orthodontics are a consistent and effective method for the correction of class II division 1 malocclusions and for straightening of the facial profile. However, a negative effect of the treatment, counteracting the correction of class II, is an increase in the mandibular plane, as well as an increase of anterior face height and a decrease in posterior face height.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In this case, by assessing and comparing the initial and final cephalometric data of the patient, it was noted that there was an increase in anterior face height, a decrease in the posterior face height and an increase in the mandibular in relation to SN plane.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The performed surgical movements have demonstrated to have a good post-surgical stability in addition to improving and harmonizing the facial aesthetics. The osteotomy for mandibular advancement and the advancement genioplasty significantly improved the profile of the patient.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The duration of the postsurgical orthodontic phase depends on the degree of preparation that was achieved during the presurgical phase.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In this case, it had a duration of 20 weeks, during which light elastics were used to counteract the proprioceptive impulses of the teeth and have a proper neuromuscular control which led to finish with an adequate dental retention which in turn contributes to the occlusal stability in the long term.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Having knowledge of the occlusal and facial changes that surgical movements produce, is the key to improving the facial harmony of patients who undergo this type of treatment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">CONCLUSIONS</span><p id="par0120" class="elsevierStylePara elsevierViewall">The decision of how to conduct an optimal treatment for a class II adult patient is based on a wide range of research including clinical, radiological, study models and photograph examinations. A detailed analysis of these photographs is a useful way of quantifying the facial features that are important for diagnosis and treatment plan.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Surgical-orthodontic treatment leads to produce harmonious facial, skeletal and soft tissue relationships and to improve occlusal function.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Sagittal osteotomies of the mandible in combination with pre- and postsurgical orthodontics is an excellent treatment alternative for adults with a class II division 1 malocclusion since occlusal sagittal relations are corrected and the hard and soft profiles are straightened in a harmonious way, which is the main objective of the treatment in patients with class II with a convex facial profile.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Malocclusions may lead to social disadvantages and affect the life of the patient. It has been proven that attractive people are considered more intelligent, socially competent, with a positive personality, have better social interactions and have a better professional development. One of the main reasons why an adult class II patient seeks treatment is dental and facial aesthetics. The more dissatisfied patients are with their facial appearance, the more likely it is for them to choose surgical treatment instead of an orthodontic treatment only.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regardless of the type of malocclusion in question, the patient's cooperation is essential to achieve the objectives and satisfactory results at a dental, facial and psychological level.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres976429" "titulo" => "ABSTRACT" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec946101" "titulo" => "Key words" ] 2 => array:3 [ "identificador" => "xres976428" "titulo" => "RESUMEN" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec946102" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "INTRODUCTION" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "CASE REPORT" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "DISCUSSION" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "CONCLUSIONS" ] 8 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec946101" "palabras" => array:4 [ 0 => "Class II division 1" 1 => "orthognathic surgery" 2 => "sagittal osteotomies of the mandible" 3 => "genioplasty" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec946102" "palabras" => array:4 [ 0 => "Clase II división 1" 1 => "cirugía ortognática" 2 => "osteotomía sagital mandibular" 3 => "mentoplastia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "ABSTRACT" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this case report was to show the correction of a class II division 1 malocclusion in an adult patient. A female patient of 20 years of age attended the Orthodontics Clinic of the Division of Postgraduate Studies and Research of the Odontology Faculty at the National Autonomous University of Mexico. Her main reason for consultation was: «When I removed the wisdom teeth I was told that I could have orthognathic surgery but first I needed braces»; this in order to correct the dentofacial disharmony. Upon facial clinical examination, the patient presented a mesofacial biotype with competent lips; vertically she presented an increased lower third. Her profile was convex with deficient chin projection. Intraorally, the patient exhibited upper and lower crowding, molar and canine class II, considerably increased overbite and overjet as well as noncoincident dental midlines. The cephalometric diagnosis showed a skeletal class II due to maxillary protrusion. It was suggested an orthodontic-surgical treatment in three phases: presurgical, surgical and postsurgical. In the presurgical phase the patient was decompensated in order to prepare her for surgery. During the surgical phase, mandibular sagittal osteotomies were performed to advance the mandible in combination with an advancement genioplasty. During the post-surgical phase, ideal occlusal relationships were achieved in terms of canine classes, overbite, overjet, dental midlines and final detailing of the case. Through the treatment, the occlusion and facial harmony of the patient were improved.</p></span>" ] "es" => array:2 [ "titulo" => "RESUMEN" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este caso clínico es demostrar la corrección de una clase II división 1 en un paciente adulto. Paciente femenino de 20 años de edad que acude a la Clínica de Ortodoncia de la División de Estudios de Posgrado e Investigación de la Universidad Nacional Autónoma de México. Su motivo principal de consulta es: «Cuando me quitaron las muelas del juicio me dijeron que me podían operar pero primero tenían que ponerme brackets»; esto para poder corregir la disarmonía dentofacial que presentaba. A la exploración clínica extraoral, se observa una cara mesoprosopa con labios competentes; verticalmente presenta el tercio inferior aumentado. Su perfil es convexo con una proyección deficiente del mentón. Intraoralmente, presenta apiñamiento dental superior e inferior, relación clase II molar y canina, la sobremordida vertical y horizontal considerablemente aumentadas y líneas medias no coincidentes. Su diagnóstico cefalométrico mostró clase II esquelética por protusión maxilar. El tratamiento propuesto ortodóncico-quirúrgico, en tres fases: ortodóncica prequirúrgica, quirúrgica y ortodóncica posquirúrgica. En la fase prequirúrgica se descompensó a la paciente para prepararla para la cirugía. En la fase quirúrgica se realizó una osteotomía sagital mandibular para realizar un movimiento de avance en combinación con una mentoplastia de avance. Durante la fase posquirúrgica se lograron relaciones oclusales ideales en cuanto a las clases caninas, sobremordida, resalte, coincidencia de líneas medias y el detallado final del caso. Con el tratamiento mejoró la oclusión y la armonía facial de la paciente.</p></span>" ] ] "NotaPie" => array:3 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Graduate.</p>" "identificador" => "fn1" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">This article can be read in its full version in the following page: <span class="elsevierStyleInterRef" id="intr0005" href="http://www.medigraphic.com/ortodoncia">http://www.medigraphic.com/ortodoncia</span></p>" ] 2 => array:3 [ "etiqueta" => "2" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Professor.</p>" "identificador" => "fn2" ] ] "multimedia" => array:21 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 672 "Ancho" => 1001 "Tamanyo" => 94823 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pretreatment extraoral photographs: <span class="elsevierStyleBold">A.</span> Front view. <span class="elsevierStyleBold">B.</span> Smile.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 621 "Ancho" => 1507 "Tamanyo" => 113368 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Initial facial photographs. <span class="elsevierStyleBold">A.</span> Right profile <span class="elsevierStyleBold">B.</span> Oblique <span class="elsevierStyleBold">C.</span> Vertical proportions.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 892 "Ancho" => 2111 "Tamanyo" => 204687 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pretreatment intraoral photographs: <span class="elsevierStyleBold">A.</span> Right side. <span class="elsevierStyleBold">B.</span> Front view. <span class="elsevierStyleBold">C.</span> Left side. <span class="elsevierStyleBold">D.</span> Upper arch. <span class="elsevierStyleBold">E.</span> Lower arch.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 526 "Ancho" => 1001 "Tamanyo" => 66563 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Initial panoramic radiograph.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 646 "Ancho" => 755 "Tamanyo" => 57730 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Initial lateral headfilm.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 703 "Ancho" => 1002 "Tamanyo" => 87535 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Presurgical facial photographs: <span class="elsevierStyleBold">A.</span> Front view. <span class="elsevierStyleBold">B.</span> Smile.</p>" ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 664 "Ancho" => 1499 "Tamanyo" => 116657 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Presurgical facial photographs: <span class="elsevierStyleBold">A.</span> Right profile. <span class="elsevierStyleBold">B.</span> Oblique view. <span class="elsevierStyleBold">C.</span> Vertical proportions.</p>" ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 852 "Ancho" => 2110 "Tamanyo" => 235743 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Pre-surgical intraoral photographs <span class="elsevierStyleBold">A.</span> Right <span class="elsevierStyleBold">B.</span> Front <span class="elsevierStyleBold">C.</span> Left <span class="elsevierStyleBold">D.</span> Upper occlusal <span class="elsevierStyleBold">E.</span> Lower occlusal.</p>" ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 485 "Ancho" => 931 "Tamanyo" => 56517 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Presurgical panoramic radiograph.</p>" ] ] 9 => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 711 "Ancho" => 808 "Tamanyo" => 66928 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Presurgical lateral headfilm.</p>" ] ] 10 => array:7 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 802 "Ancho" => 1005 "Tamanyo" => 90806 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A.</span> Digital simulation of the mandibular movements. <span class="elsevierStyleBold">B.</span> Photograph.</p>" ] ] 11 => array:7 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 1371 "Ancho" => 1503 "Tamanyo" => 341442 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A.</span> Mandibular sagittal osteotomy. <span class="elsevierStyleBold">B.</span> Bone graft placement. <span class="elsevierStyleBold">C.</span> Advancement genioplasty.</p>" ] ] 12 => array:7 [ "identificador" => "fig0065" "etiqueta" => "Figure 13" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr13.jpeg" "Alto" => 473 "Ancho" => 837 "Tamanyo" => 88195 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Occlusal splint at the end of surgery.</p>" ] ] 13 => array:7 [ "identificador" => "fig0070" "etiqueta" => "Figure 14" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr14.jpeg" "Alto" => 1030 "Ancho" => 681 "Tamanyo" => 155896 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Elastics for control.</p>" ] ] 14 => array:7 [ "identificador" => "fig0075" "etiqueta" => "Figure 15" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr15.jpeg" "Alto" => 700 "Ancho" => 1005 "Tamanyo" => 88742 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Postsurgical facial photographs: <span class="elsevierStyleBold">A.</span> Frontal view. <span class="elsevierStyleBold">B.</span> Smile.</p>" ] ] 15 => array:7 [ "identificador" => "fig0080" "etiqueta" => "Figure 16" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr16.jpeg" "Alto" => 704 "Ancho" => 1505 "Tamanyo" => 113722 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Post-treatment facial photographs: <span class="elsevierStyleBold">A.</span> Profile. <span class="elsevierStyleBold">B.</span> Oblique view. <span class="elsevierStyleBold">C.</span> Vertical proportions.</p>" ] ] 16 => array:7 [ "identificador" => "fig0085" "etiqueta" => "Figure 17" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr17.jpeg" "Alto" => 855 "Ancho" => 2109 "Tamanyo" => 201244 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Intraoral final photographs: <span class="elsevierStyleBold">A.</span> Right side. <span class="elsevierStyleBold">B.</span> Frontal view. <span class="elsevierStyleBold">C.</span> Left side. <span class="elsevierStyleBold">D.</span> Upper arch. <span class="elsevierStyleBold">E.</span> Lower arch.</p>" ] ] 17 => array:7 [ "identificador" => "fig0090" "etiqueta" => "Figure 18" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr18.jpeg" "Alto" => 517 "Ancho" => 1006 "Tamanyo" => 68015 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Postsurgical panoramic radiograph.</p>" ] ] 18 => array:7 [ "identificador" => "fig0095" "etiqueta" => "Figure 19" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr19.jpeg" "Alto" => 727 "Ancho" => 803 "Tamanyo" => 68913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Postsurgical lateral head film.</p>" ] ] 19 => array:7 [ "identificador" => "fig0100" "etiqueta" => "Figure 20" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr20.jpeg" "Alto" => 756 "Ancho" => 1506 "Tamanyo" => 129973 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Cephalometric superimposition: before surgery (black), after surgery (green). The mandibular advancement and the advancement genioplasty may be noted.</p>" ] ] 20 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table I" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normal value \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Deviation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Presurgical \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Dental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overjet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">± 2.5 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">5 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overbite \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">± 2.5 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">6 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IMPA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">90 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">± 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">107 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">U1-FH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">110 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">----------- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">120 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Horizontal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maxillary depth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">90 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">± 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">95 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Facial convexity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">2 ± 2 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Decreases 0.2 mm/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">8.5 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Facial depth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">87<span class="elsevierStyleSup">o</span> ± 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Increases 0.3<span class="elsevierStyleSup">o</span>/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">87 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mandibular corpus length \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">65 ± 2.5 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Increases 1.6 mm/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">71 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Vertical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mandibular plane \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">26<span class="elsevierStyleSup">o</span> ± 4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Decreases 0.3<span class="elsevierStyleSup">o</span>/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">25 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maxillary height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">53<span class="elsevierStyleSup">o</span> ± 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Increases 0.5<span class="elsevierStyleSup">o</span>/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">60 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lower face height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">47<span class="elsevierStyleSup">o</span> ± 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">---------- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">42 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">Maxilla-mandible \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ANB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">5 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">----------- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">9 <span class="elsevierStyleSup">o</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">2 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">----------- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">6 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1653618.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Cephalometric values.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ortiz M, Lugo V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 0 | 5 |
| 2024 October | 275 | 32 | 307 |
| 2024 September | 295 | 53 | 348 |
| 2024 August | 192 | 50 | 242 |
| 2024 July | 207 | 17 | 224 |
| 2024 June | 176 | 25 | 201 |
| 2024 May | 141 | 36 | 177 |
| 2024 April | 200 | 24 | 224 |
| 2024 March | 187 | 10 | 197 |
| 2024 February | 233 | 26 | 259 |
| 2024 January | 245 | 19 | 264 |
| 2023 December | 211 | 34 | 245 |
| 2023 November | 274 | 63 | 337 |
| 2023 October | 258 | 66 | 324 |
| 2023 September | 211 | 8 | 219 |
| 2023 August | 141 | 17 | 158 |
| 2023 July | 181 | 16 | 197 |
| 2023 June | 203 | 30 | 233 |
| 2023 May | 278 | 13 | 291 |
| 2023 April | 226 | 39 | 265 |
| 2023 March | 225 | 27 | 252 |
| 2023 February | 149 | 23 | 172 |
| 2023 January | 148 | 10 | 158 |
| 2022 December | 174 | 20 | 194 |
| 2022 November | 207 | 19 | 226 |
| 2022 October | 185 | 24 | 209 |
| 2022 September | 135 | 21 | 156 |
| 2022 August | 139 | 22 | 161 |
| 2022 July | 115 | 11 | 126 |
| 2022 June | 128 | 23 | 151 |
| 2022 May | 169 | 22 | 191 |
| 2022 April | 136 | 16 | 152 |
| 2022 March | 173 | 17 | 190 |
| 2022 February | 172 | 29 | 201 |
| 2022 January | 192 | 30 | 222 |
| 2021 December | 126 | 26 | 152 |
| 2021 November | 221 | 26 | 247 |
| 2021 October | 457 | 38 | 495 |
| 2021 September | 172 | 31 | 203 |
| 2021 August | 204 | 18 | 222 |
| 2021 July | 152 | 13 | 165 |
| 2021 June | 213 | 14 | 227 |
| 2021 May | 312 | 10 | 322 |
| 2021 April | 491 | 78 | 569 |
| 2021 March | 325 | 27 | 352 |
| 2021 February | 187 | 35 | 222 |
| 2021 January | 226 | 26 | 252 |
| 2020 December | 147 | 31 | 178 |
| 2020 November | 210 | 26 | 236 |
| 2020 October | 133 | 14 | 147 |
| 2020 September | 71 | 10 | 81 |
| 2020 August | 101 | 15 | 116 |
| 2020 July | 128 | 11 | 139 |
| 2020 June | 68 | 17 | 85 |
| 2020 May | 76 | 32 | 108 |
| 2020 April | 74 | 18 | 92 |
| 2020 March | 61 | 15 | 76 |
| 2020 February | 55 | 14 | 69 |
| 2020 January | 58 | 14 | 72 |
| 2019 December | 80 | 17 | 97 |
| 2019 November | 51 | 11 | 62 |
| 2019 October | 58 | 8 | 66 |
| 2019 September | 75 | 10 | 85 |
| 2019 August | 48 | 10 | 58 |
| 2019 July | 28 | 5 | 33 |
| 2019 June | 94 | 20 | 114 |
| 2019 May | 148 | 30 | 178 |
| 2019 April | 113 | 25 | 138 |
| 2019 March | 86 | 8 | 94 |
| 2019 February | 43 | 7 | 50 |
| 2019 January | 33 | 1 | 34 |
| 2018 December | 25 | 7 | 32 |
| 2018 November | 34 | 4 | 38 |
| 2018 October | 51 | 12 | 63 |
| 2018 September | 24 | 7 | 31 |
| 2018 August | 23 | 0 | 23 |
| 2018 July | 16 | 1 | 17 |
| 2018 June | 21 | 2 | 23 |
| 2018 May | 19 | 2 | 21 |
| 2018 April | 17 | 0 | 17 |
| 2018 March | 8 | 0 | 8 |
| 2018 February | 9 | 2 | 11 |
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