Access and financial impacts of public orthodontic provision on global health systems: integrative review / Acesso e impactos financeiros da provisão ortodôntica pública nossistemas de saúde mundiais: revisão integrativa / Acceso e impactos financieros de la provisión pública de ortodoncia en los sistemas de salud globales: revisión integradora

Introduction:The supply of public orthodontic services is still unable to meet the demand for treatment of malocclusions. The resources available are sometimes mismanaged and significant financial impacts contribute to limited access to the services. Objective:To carry out an integrative review regarding the access and financial impacts of public orthodontic service among the various health systems worldwide, considering social inequalities and the referral and counter-referral systems for services. Methodology:A survey was conducted using the BVS (Biblioteca Virtual em Saúde / Virtual Health Library), PubMed, and Cochrane databases, including articles available from 1970 to 2019, which elucidated the guiding question "How does access work and what are the financial impacts of the provision of orthodontic services in different public health systems worldwide?". Results:211 articles were found, of which 20 were analyzed. The chronological distribution was relatively uniform. The topic 'access to orthodontic services' was most frequently reported and there was a predominance of studies addressing the provision of treatment for children and adolescents. Conclusions:There are significant financial impacts and demographics have a strong influence on access to services. The provision of orthodontic treatments by the private sector predominates, preventive approaches are scarce, and an optimization in the use of available resources is necessary. Primary Care has much to contribute in increasing access, reducing costs, and making the referral / counter-referral system effective (AU).

Introdução:A oferta de serviços ortodônticos públicos ainda não consegue suprir a demanda de tratamento de má oclusões. Os recursos disponíveis, por vezes, mal alocados e os impactos financeiros significativos contribuem para a restrição do acesso aos serviços.Objetivo:Realizar uma revisão integrativa pertinente ao acesso e aos impactos financeiros da provisão ortodôntica pública nos diversos sistemas de saúde mundiais, sob a luz das iniquidades sociais e dos sistemas de referência e contrarreferência de serviços.Metodologia:Foi realizado um levantamento nas bases de dados BVS (Biblioteca Virtual em Saúde), PubMed e Cochrane Reviews, incluindo os artigos disponíveis no período de 1970 a 2019, que elucidavam a questão norteadora "Como se dá a provisão de serviços ortodônticos nos diversos sistemas públicos de saúde mundiais?".Resultados:Foram encontrados 211 registros, dos quais 20foram analisados. A distribuição temporal foi relativamente uniforme. A temática "acesso aos serviços ortodônticos" foi mais frequentemente relatada e houve um predomínio de estudos abordando a oferta de tratamentos a crianças e adolescentes. Conclusões:Há impactos financeiros significativos e os determinantes sociais exercem forte influência sobre o acesso aos serviços. Predomina a oferta de tratamentos ortodônticos pelo setor privado, abordagens preventivas são escassas e é necessária uma otimização no uso de recursos disponíveis. A Atenção Básica tem muito a contribuir para aumento do acesso, diminuição de custos e efetivação do sistema dereferência/contrarreferência dos serviços (AU).

Introducción: La provisión de servicios públicos de ortodoncia aún no puede satisfacer la demanda de tratamientos de maloclusión. Los recursos disponibles a veces están mal asignados y los impactos financieros significativos contribuyen a restringir el acceso a los servicios.Objetivo: Realizar una revisiónintegradora pertinente al acceso y los impactos económicos de la provisión pública de ortodoncia en los diferentes sistemas de salud a nivel mundial, a la luz de las inequidades sociales y los sistemas de derivación y contrarreferencia de servicios.Metodología: Se realizó una encuesta en las bases de datos de la BVS (Virtual Health Library), PubMed y Cochrane Reviews, incluidos los artículos disponibles desde 1970 hasta 2019, que dilucidó la pregunta orientadora "¿Cómo es la prestación de servicios de ortodoncia en los diferentes sistemas públicos?".Resultados: Se encontraron 211registros, de los cuales se analizaron 20.La distribución temporal fue relativamente uniforme. El tema "acceso a servicios de ortodoncia" fue el que se informó con mayor frecuencia y hubo un predominio de estudios que abordan la provisión de tratamientos a niños y adolescentes.Conclusiones: Hay impactos económicos significativos y los determinantes sociales tienen una fuerte influencia en el acceso a los servicios. Predomina la oferta de tratamientos de ortodoncia por parte del sector privado, los abordajes preventivos son escasos y es necesario optimizar el uso de los recursos disponibles. La Atención Primaria tiene mucho que contribuir para aumentar el acceso, reducir costos e implementar el sistema de derivación / contrarreferencia de servicios (AU).

Intervención temprana de la mordida cruzada por la pista directa de Planas: relato de siete años de seguimiento / Early Intervention of Crossbite by Planas Direct Tracks: Follow up Report After Seven Years / Intervenção precoce da mordida cruzada pela Pistas Diretas de Planas: relato de sete anos de seguimento

Resumen Introducción: entre las maloclusiones, la mordida cruzada es la de mayor prevalencia entre los niños en edad preescolar y se considera la principal depreciadora del sistema estomatognático, con un alto riesgo de desarrollar secuelas musculoesqueléticas irreparables en la edad adulta. Por lo tanto, es fundamental elegir un tratamiento eficaz que no requiera la cooperación directa del paciente y que utilice técnicas simples de ortodoncia. El objetivo de este artículo es informar la eficacia del tratamiento de rehabilitación neuroclusal (RNO) con la técnica de las pistas directas de Planas en la corrección temprana de la mordida cruzada posterior y el seguimiento de su estabilidad oclusal durante siete años. Presentación del caso: niña de 4 años de edad, que usó biberón, diagnosticada con mordida cruzada posterior funcional unilateral izquierda y desviación de la línea media. Para el tratamiento de la RNO, se realizaron los ajustes oclusales en los dientes 63, 64 y 65, y después de la desprogramación neuromuscular, se confeccionaron las pistas directas de Planas en los dientes cruzados. Después de 29 días, se corrigió la mordida y se hicieron ajustes oclusales para proporcionar una mayor armonía oclusal. Hubo monitoreamiento cada seis meses durante siete años para verificar el equilibrio y la estabilidad del tratamiento. Conclusiones: la RNO con el uso de pista directa de Planas fue eficaz para corregir la mordida cruzada posterior con una técnica simple y de bajo costo que puede ejecutar el clínico general.

Abstract Introduction: Among malocclusions, that of cross-bite is the most prevalent among preschool children and is considered to be the main depreciator of the stomatognathic system and is further linked to a high risk of developing irreversible musculoskeletal sequelae in adulthood. Thus, it is important to choose an effective treatment early on that does not require the direct cooperation of the patient and that utilizes simple orthodontic techniques in its execution. The objective of this study was to report the efficacy of the Neuroclusal Rehabilitation (RNO) treatment, with the Planas Direct Tracks technique in a case of early treatment of posterior crossbite, and the follow up of its occlusal stability for seven years. Case presentation: a 4-year-old female patient, who was bottle-fed, was diagnosed with a left unilateral functional posterior crossbite and midline deviation. For treatment of RNO, occlusal adjustments were made on the teeth 63, 64 and 65 and after neuromuscular deprogramming, the Direct Planks were made in the crossed teeth. After 29 days, the bite was corrected, and occlusal adjustments were made in order to provide greater occlusal harmony. Monitoring and evaluation took place every six months for seven years in order to verify the balance and stability of the treatment. Conclusion: the RNO treatment with the use of Planas Direct Tracks is an effective solution for the correction of posterior crossbite using a simple, low-cost technique that can be performed by general practitioners.

Resumo Introdução: entre as más oclusões, a mordida cruzada é a de maior prevalência entre as crianças em idade pré-escolar, e se considera a principal depreciadora do sistema estomatognático, com um alto risco de desenvolver sequelas musculoesqueléticas irreparáveis na idade adulta. Portanto, é fundamental escolher um tratamento eficaz que não requeira a cooperação direta do paciente e que utilize técnicas simples de ortodontia em sua execução. O objetivo deste estudo foi informar a eficácia do tratamento de Reabilitação Neuroclusal (RNO), com a técnica das Pistas Diretas de Planas na correto precoce da mordida cruzada posterior e o seguimento de sua estabilidade oclusal durante 7 anos. Apresentação do caso: paciente de sexo feminino de 4 anos de idade, que usou mamadeira, diagnosticada com mordida cruzada posterior funcional unilateral esquerda e desvio da linha média. Para o tratamento da RNO, se realizaram os ajustes oclusais nos dentes 63, 64 e 65, depois da desprogramação neuromuscular, se confeccionaram as Pistas Diretas de Planas nos dentes cruzados. Depois de 29 dias, se corrigiu a mordida e se fizeram ajustes oclusais para proporcionar uma maior harmonia oclusal. O monitoramento se realizou cada seis meses por 7 anos para verificar o equilíbrio e a estabilidade do tratamento. Conclusões: a RNO com o uso de Pista Direta Planas foi eficaz para a correção da mordida cruzada posterior com uma técnica simples, de baixo custo que pode ser realizada pelo clínico geral.

Efectividad de la Expansión Maxilar en la Corrección de Apiñamiento en Dentición Mixta. Revisión Sistemática / Effectiveness of the Maxillary Expansion in the Correction of Crowding and Mixed Dentition. Systematic Review

RESUMEN: El apiñamiento en edades tempranas, se refleja cuando el tamaño dental no coincide con la longitud de arco. De este modo, resulta importante determinar si la expansión del maxilar podría solucionar por sí solo el problema de apiñamiento en el sector anterior, teniendo en cuenta que este tratamiento es uno de los más antiguos y que comúnmente se ha enfocado en la resolución de alteraciones transversales en dientes posteriores empleándose a edades tempranas. El objetivo fue determinar si la expansión maxilar es efectiva o no, en la corrección del apiñamiento en dentición mixta mediante el análisis de la evidencia disponible. Se realizó una revisión sistemática en español e inglés, para establecer la máxima evidencia posible, con las indicaciones de la guía PRISMA. Dos artículos cumplieron con la calidad de la revisión. En el primero se estableció que el apiñamiento mejoro despues del tratamiento de expansion maxilar, con una recidiva menor en la dentición permanente. En el segundo, se encontró que el apiñamiento en los incisivos permanentes superiores fue corregido cuando se retiró el aparato expansor. Se concluyó que la evidencia actual no tiene la suficiente calidad metodológica para llevar a una toma de decisión. Se recomienda hacer ensayos clínicos aleatorizados en este tema.

ABSTRACT: Crowding at early ages is reflected when tooth size does not coincide with arch length. Thus, it is important to determine whether maxillary expansion alone could solve the problem of crowding in the anterior sector, bearing in mind that this treatment is one of the oldest and has commonly focused on solving transverse alterations in posterior teeth used at an early age. The objective was to determine whether or not maxillary expansion is effective in correcting crowding in the mixed dentition by analysing the available evidence. A systematic review was carried out in Spanish and English, to establish the maximum possible evidence, with the indications of the PRISMA guide. Two articles met the quality of the review. The first established that crowding improved after the treatment of maxillary expansion, with a minor recurrence in the permanent dentition. In the second, it was found that crowding in the upper permanent incisors was corrected when the expanding appliance was removed. The current evidence is not of sufficient methodological quality to lead to a decision. Randomized clinical trials are recommended in this area.

The Knowledge and Practice of Space Management among Dental Practitioners of Central India

Premature loss of primary teeth can result in the space loss leading to malocclusion. Space maintenance forms an integral part of preventive and interceptive orthodontics. Early interception and prevention of malocclusion in deciduous and early mixed dentition prevents the space loss, thereby, reducing or eliminating the need for later orthodontic treatment. Therefore, the present study was conducted to find out the knowledge and practice of space management among dental practitioners of Central India. Methods: A cross-sectional study was conducted among practicing dentist of Central India to find out their knowledge and practice of space management over the time period of 6 months. Ethical approval was obtained from the Ethical Committee. The questionnaire consisted of questions assessing four main categories; (a) Demographic data, (b) knowledge regarding space management, (c) practice of space maintainers. The demographic data included age, gender, educational level. Data were processed and analyzed using Excel (Microsoft Excel, Version 2013) and SPSS version 21.0 programs. Results: In our study total practicing dentist were 320 in which 190(59.37%) were male dentist and 130(40.62%) were female dentist. Participating dentist were of age <25 were 125(39.06%) and of age group 25-40 were 93(29.06%) and of age group 41-60 were 102(31.87%). 210 (65.62%) participating dentist were BDS and 110 (34.37%) participating dentist were MDS. 290(90.62%) participating dentist know when space maintainers were used. 320(100%) participating dentist know that space maintainers require special care wih brushing. 230 (71.87%) participating dentist know what type of food should be avoided when having space maintainers. 180(56.25%) dentist know how often space maintainers will be taken out. 175(54.68%) dentist know if the space maintainer was lost or broken what time is best to go to the dentist. 175(54.68%) dentist practice space management. Conclusion: Our study concluded that maximum number of practicing dentist have knowledge about space management and more than half the dentists who participated in this study practice space management in their practice.

Deciduous tooth early loss prevalence in posterior region and indication of band-loop space maintainer / Prevalência da perda precoce de dente decíduo na região posterior e indicação de mantenedor de espaço banda-alça

Objective: To investigate the prevalence of the early unitary loss of deciduous and the need for space maintainer in the posterior region, of the band-loop type. Material and Methods: The clinical examination by two examiners of 568 children between 6 and 12 years of age in mixed dentition was performed in two municipal schools. After the diagnosis of premature loss of one or two deciduous molars (unilateral, one or both arches, respectively), without successors initiating the eruptive process in the oral cavity, the child was referred to the Clinical School of Dentistry (CSD) of State University of Piauí (UESPI) for installation of the band-handle space maintainer. Results: The prevalence of early deciduos molar loss was 4.04%, from 568 children examined, being 15 in the lower arch and 8 in the upper arch of 23 children, mean age of 10 ± 2 years with predominance of the first deciduos molars (10 in the lower arch and all 8 in the upper arch). The etiological factor of which was dental caries for all sample, according to the parents or guardians. Only 13 attended the CSD for detailed examination. After radiographic examination, it was verified that 8 did not need space maintainers because they were approximately 2/3 of the permanent successors root formation. In 5 children was placed the maintainer of space, band-handle, who are being supervised every 3 months until the eruption of the permanent successors. Conclusion: The prevalence of early molar loss was 4.04% with no statistical difference between genders. The use of space maintainers after the early loss of a deciduous tooth is a preventive measure of malocclusion, being the band-loop appliance an excellent choice after loss of the deciduous unilateral molar.(AU)

Objetivo: Investigar a prevalência a perda precoce unitária de decíduo e a necessidade de mantenedor de espaço na região posterior do tipo banda-alça. Material e Métodos: O exame clínico realizado por dois examinadores de 568 crianças de 6 a 12 anos de idade na dentição mista foi realizado em duas escolas municipais. Após o diagnóstico de perda precoce de um ou dois molares decíduos (unilateral, de uma ou ambas arcadas, respectivamente), sem que os sucessores tivessem iniciando o processo eruptivo na cavidade bucal, a criança foi encaminhada à Clínica Escola de odontologia (CEO) da Universidade Estadual do Piauí (UESPI) para instalação do mantenedor de espaço banda-alça. Resultados: A prevalência da perda precoce de molar decíduo foi de 4.04%, de 568 crianças examinadas, sendo 15 na arcada inferior e 8 na arcada superior de 23 crianças, com idade média de 10 ± 2 anos com predomínio dos primeiros molares decíduos (10 no arco inferior e todos os 8 no arco superior). O fator etiológico foi cárie dentária para toda a amostra, segundo os pais ou responsáveis.Somente 13 compareceram à CEO para exame detalhado. Após exame radiográfico constatou-se que 8 não precisavam de mantenedores de espaço pois estavam aproximadamente com 2/3 de formação radicular dos sucessores permanentes. Em 5 crianças colocou-se o mantenedor de espaço, bandaalça, que estão sendo supervisionadas a cada 3 meses até a erupção dos sucessores permanentes. Conclusão: A prevalência da perda precoce de molar decíduo foi de 4.04% sem diferença estatística entre os gêneros. O uso de mantedores de espaço após a perda precoce de dente decíduo é uma medida preventiva da má oclusão, sendo a banda-alça excelente opção após a perda do molar decíduo unilateral(AU)

Características de la oclusión dentaria en niños de 4 y 5 años / Characteristic of the occlusion in 4 and 5 years children

Se realizó un estudio observacional, descriptivo y transversal de los 86 niños de 4 y 5 años de edad, pertenecientes al quinto y sexto años de vida del Círculo Infantil Ana de Quesada de Santiago de Cuba, de octubre del 2015 a marzo del 2016, a fin de caracterizarles en cuanto a la oclusión dentaria. En la serie se obtuvo que al menos 17,4 por ciento de los niños examinados presentaban alteración en la oclusión permanente respecto a la relación de los molares temporales, con más frecuencia del sobrepase de media corona (31,4 por ciento) y menos reiteración de la oclusión de los dientes de borde a borde (con solo 9 niños). Por último, pudo concluirse que 46,6 por cientode los párvulos presentó una oclusión anómala

An observational, descriptive and cross-sectional study of the 86 4 and 5 years old children, belonging to the fifth and sixth years from Ana de Quesada child day care center in Santiago de Cuba was carried out from October, 2015 to March, 2016, in order to characterize them as for their occlusions. In the series it was obtained that at least 17,4 percent of the examined children presented changes in the permanent occlusion regarding the relationship of the temporary molars, with more frequency of the overbite of half crown (31,4 percent) and less reiteration of the occlusion of border to border teeth (just in 9 children). Lastly, it could be concluded that 46,6 percent of the children presented an anomalous occlusion

Recuperação de espaço com aparelho banda mola ­ relato de caso / Space recovery with spring band unit ­ case report

A perda precoce ocorre quando um dente temporário é perdido antes do sucessor permanente ter iniciado a sua erupção. A literatura mostra que a perda prematura apresenta prevalência superior a 20%, não distinguindo gênero ou lado e arco. Cárie e trauma são as principais causas. As principais consequências são as migrações dos dentes adjacentes para o espaço originado, levando à diminuição do comprimento da arcada dentária. A perda precoce necessita de reabilitação estética e funcional até que ocorra a erupção dos dentes sucessores permanentes. Para essa reabilitação, opta-se pela confecção de aparelhos recuperadores de espaços, podendo ser fixos ou removíveis. O objetivo deste trabalho é relatar o caso de um pa-ciente de 10 anos, gênero masculino, com perda precoce do segundo molar decíduo superior direito, com os dentes adjacentes ao espaço apresentando migração dentária, originando falta de espaço para erupção do segundo pré-molar superior direito, comprometendo o correto desenvolvimento da dentição. Para resolução do problema, foi utilizado o aparelho do tipo banda mola para recuperação do espaço perdido. Após 3 meses de utilização do aparelho, o espaço foi recuperado e ocorreu a erupção precoce do segundo pré-molar superior direito. O prognóstico do caso foi favorável, restabelecendo o correto desenvolvimento da dentição, com um procedimento relativamente simples, graças ao diagnóstico precoce (AU)

The premature loss occurs when a temporary tooth is lost before permanent successor has commenced its eruption. The literature shows that the premature loss presents prevalence greater than 20%, not distinguishing gender or side and bow. It has been the main causes: caries and trauma. The main consequences are migration of adjacent teeth to the originated space, leading to decrease the length of the dental arch. The early loss requires aesthetic and functional rehabilitation until there is the eruption of permanent teeth successors to such rehabilitation this be done by making space recovery device, these can be fixed or removable. The objective of this study is to report the case of a 10-year-old patient, male, with early loss of the second deciduous molar upper right, with the teeth adjacent to the space showing tooth migration, resulting in lack of space for eruption of the second bicuspid upper right, compromising the correct development of the dentition. To solve the problem, we used the spring band type apparatus for recovering the lost space. After 3 months of using the appliance, the space was recovered and occurred early eruption of element 2 bicuspid upper right. The outcome of the case was favorable, reestablishing the correct development of the dentition, with a relatively simple procedure thanks to early diagnosis.(AU)

Rationale For Orthodontic Treatment In The Deciduous And Early Mixed Dentition - A Review.

Timing of orthodontic treatment is a controversial topic among clinicians, showing great diversity of opinions; some recommending intervention early in the occlusal development, and others arguing in favour of treatment in the late mixed or early permanent dentition. Early interceptive orthodontic treatment for elimination of different factors affecting dental arch development, growth of maxilla and mandible is well debated and has a mixed response among clinicians, possibly because of little scientific evidence that exists to support such intervention and actual benefit from such early treatment. This article aimed to review various studies and evaluate the efficacy of early orthodontic intervention and concluded that treatment in the early mixed dentition is an effective method to restore normal occlusion and eliminate the need for further orthodontic treatment.

Association between nonnutritive sucking habits and anterior open bite in the deciduous dentition of Japanese-Brazilians

OBJECTIVE: Assess the association between nonnutritive sucking habits and anterior open bite in the deciduous dentition of Japanese-Brazilian children. METHODS: 410 children of Japanese origin were assessed, 206 boys and 204 girls, between 2 and 6 years of age, in schools in São Paulo State, Brazil. Questionnaires concerning their nonnutritive sucking habits were sent to their legal guardians. Chi-square tests (p<0.05) were applied to assess the association between nonnutritive sucking habits and anterior open bite, and the logistic regression test to obtain the relative risk. RESULTS: The prevalence of sucking habits found in the sample was of 44.6% and for the anterior open bite, 4.4%. There was a statistically significant association between anterior open bite and sucking habits (O.R.=10.77), persistence of sucking habits from 2 to 4 years old (O.R.=22.06), and the persistence of sucking habits from 4 to 6 years old (O.R.=17.31). As for the interruption period of the habit, the group that had interrupted the habit for a period equal or inferior to six months showed an increased prevalence of open bite compared to the group without this habit or in which the habit was interrupted for more than six months. CONCLUSION: Japanese-Brazilian children that had sucking habits have greater chance of acquiring anterior open bite in the deciduous dentition.