Effects of Fixed and Removable Space Maintainers on Dental Plaque and DMFT/dft Values / Efecto de los mantenedores de espacio fijos y removibles en la placa dental y en los valores de los índices DMFT/dft

ABSTRACT: Purpose: Space maintainers are important for the health and placement of children's primary and permanent teeth. However, plaque and caries levels can be negatively affected when a dental appliance is in the mouth. This study aims to evaluate the oral health of pediatric patients that have space maintainers applied as a result of early tooth loss. Methods: This study included 100 systemically healthy patients between the ages of 4-15 years that were treated with space maintainers due to early loss of teeth. Decayed, missing, filled tooth index values and dental plaque status of the participants were recorded. Controls were performed in the 6th and 12th month. The index results were compared and evaluated statistically using ANOVA and paired-t-tests. Results: A total of 116 space maintainers, including 36 band and loops, 16 lingual arches, 21 palatal arches, 43 removable appliances, were evaluated in the study. Statistically significant differences were found between the pre-treatment and post-treatment index values (p<0.001). In the group of band and loops and removable space maintainers; the increases in DMFT/dft values of 6th month and 12th month according to initial DMFT/dft values were statistically significant (p<0.05). For plaque index, the increase in 12th month of all types of appliances were found statistically significant (p<0.001). The greatest increase in plaque index level was seen in the teeth of patients that had been treated with a lingual arch. Conclusions: Incompatible space maintainers can lead to caries, increased plaque accumulation, demineralized areas, and periodontal problems. The accumulation of plaque and difficulty of cleaning the teeth, especially in the fixed space maintainers, negatively affects the health of teeth. For this reason, good oral hygiene should be provided to patients and controls should be regularly performed.

RESUMEN: Los mantenedores de espacio son importantes para la salud y la colocación de la dentición primaria y permanente de los niños. Sin embargo, los niveles de placa y caries pueden verse afectados negativamente cuando se coloca un aparato dental en la boca. Este estudio tiene como objetivo evaluar la salud bucal de pacientes pediátricos a los que se les aplicó mantenedores de espacio como resultado de la pérdida temprana de los dientes. Métodos: Este estudio incluyó a 100 pacientes sistémicamente sanos entre las edades de 4 a 15 años que fueron tratados con mantenedores de espacio debido a la pérdida temprana de dientes. Se anotaron los valores del índice de dientes cariados, faltantes y el estado de la placa dental. Los controles se realizaron en el 6° y 12° mes. Los resultados del índice se compararon y evaluaron estadísticamente mediante ANOVA y pruebas t pareadas. Resultados: Un total de 116 mantenedores de espacio, incluyendo 36 bandas y bucles, 16 arcos linguales, 21 arcos palatinos, 43 dispositivos removibles, fueron evaluados en el estudio. Se encontraron diferencias estadísticamente significativas entre los valores de los índices en el pretratamiento y postratamiento (p<0.001). En el grupo de bandas, bucles y mantenedores de espacio removibles los aumentos en los valores de DMFT/ dft en el sexto mes y el 12º mes fueron estadísticamente significativos (p<0.05). Para el índice de placa, el aumento en el 12º mes de todos los tipos de aparatos se encontró estadísticamente significativo (p<0,001). El mayor aumento en el nivel del índice de placa se observó en los pacientes que habían sido tratados con un arco lingual. Conclusiones: los mantenedores de espacio pueden provocar caries, aumento de la acumulación de placa, áreas desmineralizadas y problemas periodontales. La acumulación de placa y la dificultad de limpiar los dientes, especialmente en los mantenedores de espacio fijos, afecta negativamente la salud dental. Por esta razón, se debe proporcionar una buena higiene bucal a los pacientes y se deben realizar controles regularmente.

Mantenedor de espacio funcional elaborado con corona de NuSmile / Elaborated functional space maintainer with zirconia NuSmile crown

La caries de la infancia temprana, al igual que otras formas de caries, se caracteriza por ser multifactorial, infecciosa y de rápida evolución. Puede presentarse como lesiones cavitadas o no cavitadas, se diagnostica principalmente en menores de seis años en la superficies de los dientes anterosuperiores, debido a que son los primeros órganos dentales en erupcionar y tienen mayor contacto con el estímulo cariogénico. En casos severos pueden llegar a ocasionar la pérdida de órganos dentales, influyendo en la salud general del paciente y repercutiendo en su autoestima y desarrollo psicosocial. Para devolver las características y funciones perdidas en ausencia de algún órgano dental, se recurre a sustituirlo mediante aparatología, mayormente en forma de un mantenedor de espacio funcional. Las necesidades estéticas individuales de cada caso generan diversas alternativas para adaptarnos a la situación del paciente (AU))

Early childhood caries, like other forms of caries, is characterized by being multifactorial, infectious, and rapidly evolving. It can present as cavitated or uncavitated lesions, it is mainly diagnosed in children under six years of age on the surfaces of the anterior superior teeth, because they are the first dental organs to erupt and have greater contact with the cariogenic stimulus. In severe cases they can cause the loss of dental organs, influencing the general health of the patient and impacting on their self-esteem and psychosocial development. In order to restore the lost features and functions in the absence of any dental organ, it is resorted to by means of appliances, mostly in the form of a functional space maintainer. The individual aesthetic needs of each case generate various alternatives to adapt to the patient's situation (AU)

Influência do banda-alça na manutenção de espaço do arco inferior após a perda precoce de molares decíduos: um estudo piloto / Influence of loop band on mandibular arch space maintenance after early loss of deciduous molars: a pilot study

Objetivo: Avaliar a influência do dispositivo banda-alça na perda de espaço após exodontia precoce de molares decíduos inferiores em escolares, em um período de 3 meses. Materiais e métodos: Trata-se de um estudo piloto de ensaio clínico randomizado, com dois grupos paralelos. A amostra incluiu 25 crianças, entre 6 e 9 anos, com indicação clínica e radiográfica de exodontia unilateral de um molar decíduo inferior. Estes foram divididos em Grupo Controle (G1): sem intervenção; e Grupo Intervenção (G2): com instalação de banda-alça. Todos os pacientes foram moldados antes do procedimento de exodontia (T1) e no acompanhamento de 3 meses (T2). Um avaliador cego quanto aos grupos e tempo realizou as medidas estabelecidas nos modelos de gesso. A análise estatística foi realizada por meio dos testes T pareado e T de Student nos casos de distribuição normal dos dados e testes não-paramétricos Wilcoxon e Mann-Whitney para distribuição não normal. Resultados: Todos os participantes foram classificados como Classe I, com overjet de até 3mm e padrão facial mesocéfalo. A maioria (64%) teve o segundo molar decíduo perdido. Após 3 meses, o G1 perdeu, em média, 0,75mm a mais na distância linear do espaço de extração comparado ao G2 (P<0,05). Conclusão: Concluiu-se que, embora os dois grupos apresentaram perda de espaço, o G1 (sem intervenção) apresentou uma perda de espaço maior no período de acompanhamento de 3 meses.

Objective: To evaluate the influence of the band and loop space maintainer on space loss after the early extraction of mandibular primary molars in schoolchildren, over a period of 3 months. Materials and Methods: a pilot study of a randomized clinical trial was carried out, with two parallel groups. The sample included 25 children, aged between 6 and 9 years, with clinical and radiographic indication for unilateral extraction of a mandibular primary molar. The patients were divided into Control Group (G1): with no intervention; and Intervention Group (G2): with the installation of the space maintainer. A dental cast was obtained before the extraction procedure (T1) and at the 3-month followup (T2). An evaluator, blinded to the groups and time, performed the established measures in the dental casts. Statistical analysis was performed using Paired Sample T test and Student's T test in cases of normal data distribution, and nonparametric Wilcoxon and Mann-Whitney tests for non-normal distribution. Results: All participants were classified as Class I, with an overjet of up to 3 mm and a mesocephalic facial pattern. The majority (64%) had a lost second deciduous molar. After 3 months, the G1 lost, on average, 0.75mm more in the linear distance from the extraction space (P<0.05). Conclusion: It was concluded that, although the two groups showed space loss, G1 (without intervention) showed a greater loss of space in the 3-month follow-up period.

Avulsión dental y mantenedor de espacio estético-funcional y correctivo en Odontopediatría / Dental avulsion and esthetic-functional and corrective retainers use in Pediatric Dentistry / Avulsão dentária e mantenedor do espaço estético-funcional e corretivo em Odontopediatria

RESUMEN Se presentó el caso de un niño de 8 años que acudió al Servicio de Estomatología del Policlínico Universitario "Chiqui Gómez Lubián", de Santa Clara, provincia Villa Clara. En el mismo se observó avulsión del incisivo central superior derecho, fractura no complicada de la corona en incisivo central superior izquierdo y una marcada vestibuloversión. Se confeccionó un aparato placa Hawley de acuerdo a las características y necesidades del paciente, con el fin de lograr la recuperación estética, mantener la longitud del arco y corregir la vestibuloversión en el mismo. El aparato permitió obtener un resultado satisfactorio, que ha influido psicológicamente en el paciente al elevar su autoestima y salud bucal.

ABSTRACT A boy of 8 years old was seen in the dental service at the Policlínico Universitario "Chiqui Gómez Lubián", in Santa Clara, Villa Clara. Examination revealed avulsion in the right upper central incisor, uncomplicated crown fracture in left upper central incisor and an improper alignment of the teeth. Taking into account patients´ characteristics and requirements, it was fabricated a Hawley´s retainer in order to achieve a better aesthetic outcome, maintain the length of the dental arch and correct the improper alignment of the teeth. The appliance has achieved a satisfactory outcome, which has had a psychological influence on the patient by improving his self-esteem and oral health.

RESUMO Foi apresentado o caso de um menino de 8 anos que veio ao Serviço de Estomatologia do Policlínico Universitario "Chiqui Gómez Lubián", em Santa Clara, província de Villa Clara. Neste, observou-se avulsão do incisivo central superior direito, fratura não complicada da coroa em incisivo central superior esquerdo e vestibuloversão acentuada. Um dispositivo de placa de Hawley foi confeccionado de acordo com as características e necessidades do paciente, a fim de se obter recuperação estética, manter o comprimento do arco e corrigir a vestibuloversão nele. O dispositivo permitiu obter um resultado satisfatório, o que influenciou psicologicamente o paciente, elevando sua autoestima e saúde bucal.

Clinical Evaluation of Ghana Shyams TEFF (Telescopically Expanding Fixed Functional) Space Maintainer Versus Conventional Band and Loop Space Maintainer

Abstract Objective: To compare the clinical efficacy of Ghana Shyam's TEFF space maintainer with band and loop space maintainer. Material and Methods: This split-mouth randomized clinical trial was conducted on 20 children (7-9 years), requiring bilateral/contralateral space maintenance therapy. After consent, all the selected children received both space maintainers and were followed up periodically every six months up to two years for clinical assessment according to the evaluation protocol. Instructions and motivation were given to the children. OHI (S) index was recorded before cementation of appliances. The following aspects were analyzed: 1) efficiency and function; 2) dislodgement due to cement loss; 3) breakage at soldered parts; 4) carious or gingival inflammation affecting abutment teeth; 5) distortion of band; 6) being embedded in gingival tissues / gingival slopping; and 7) initial and final S-OHIS scores. Statistical analysis was done using Fisher exact test for survival time and Chi-square test for chewing efficiency. Results: At 24th-month follow-up, 14 Ghana Shyam's TEFF space maintainers and 16 band and loop space maintainers were found to be intact. Conclusion: As both space maintainers demonstrated similar mean survival time Ghana Shyam's TEFF space maintainer with the added advantage of being functional can be recommended as an effective alternative to band and loop in premature loss of primary molar clinical situations.

Direct bonded space maintainer: an alternative in clinical practice after unilateral premature loss of posterior primary tooth

Introduction: The primary dentition is extremely important, because besides the importance during chewing, acts as a guide to eruption for permanent teeth, stimulates the bone growth and helps in digestion and phonation. In cases of premature loss, it is necessary that the professional make adequate planning to space maintenance, so that it is not lost until the eruption of the permanent successor, thus avoiding the establishment of malocclusions. Objective: To describe the clinical steps for preparation and placement of a direct bonded space maintainer, as well as the follow-up until the eruption of the successor tooth. Case report: Girl, eight years old, presented an adjacent fistula to theprimary mandibular right second molar. After clinical and radiographic evaluation, tooth extraction was indicated, due to the impossibility of performing the endodontic treatment. A direct bonded space maintainer was made and installed as an alternative to the band and loop, commonly used in these cases of unilateral loss. Conclusion: The direct bonded space maintainer was a good option for the case presented, as it was able to fulfill its function until the eruption of the successor tooth. It is a good alternative in clinical practice due to the time optimization and material savings it provides.

Introdução: A dentição decídua é de extrema importância, pois exerce função mastigatória, atua como guia de erupção para os dentes permanentes, estimula o crescimento ósseo e auxilia na digestão e fonação. Em casos de perda prematura de algum dente, é necessário que o profissional faça um planejamento adequado para manutenção do espaço, de forma que este não seja perdido até a erupção do sucessor permanente, evitando assim o estabelecimento de más-oclusões. Objetivo: Descrever as etapas clínicas para confecção e instalação do aparelho mantenedor de espaço adesivo, bem como o acompanhamento até a erupção do sucessor. Relato do caso: Menina, 8 anos, apresentou fístula adjacente ao segundo molar inferior direito decíduo. Após avaliação clínica e radiográfica, foi indicada a exodontia do dente, devido à impossibilidade de realizar o tratamento endodôntico. Confeccionou-se e instalou-se o aparelho mantenedor de espaço adesivo, como uma alternativa ao banda-alça, comumente utilizado nesses casos de perda unilateral. Conclusão: O mantenedor de espaço colado foi uma boa opção para o caso apresentado, pois foi capaz de cumprir sua função até a erupção do dente sucessor, constituindo-se uma boa alternativa na prática clínica, devido à otimização do tempo e economia de material que proporciona.

Assessment of stem cell viability in the initial healing period in rabbits with a cranial bone defect according to the type and form of scaffold

PURPOSE: Increased bone regeneration has been achieved through the use of stem cells in combination with graft material. However, the survival of transplanted stem cells remains a major concern. The purpose of this study was to evaluate the viability of transplanted mesenchymal stem cells (MSCs) at an early time point (24 hours) based on the type and form of the scaffold used, including type I collagen membrane and synthetic bone. METHODS: The stem cells were obtained from the periosteum of the otherwise healthy dental patients. Four symmetrical circular defects measuring 6 mm in diameter were made in New Zealand white rabbits using a trephine drill. The defects were grafted with 1) synthetic bone (β-tricalcium phosphate/hydroxyapatite [β-TCP/HA]) and 1×105 MSCs, 2) collagen membrane and 1×105 MSCs, 3) β-TCP/HA+collagen membrane and 1×105 MSCs, or 4) β-TCP/HA, a chipped collagen membrane and 1×105 MSCs. Cellular viability and the cell migration rate were analyzed. RESULTS: Cells were easily separated from the collagen membrane, but not from synthetic bone. The number of stem cells attached to synthetic bone in groups 1, 3, and 4 seemed to be similar. Cellular viability in group 2 was significantly higher than in the other groups (P0.05). CONCLUSIONS: This study showed that stem cells can be applied when a membrane is used as a scaffold under no or minimal pressure. When space maintenance is needed, stem cells can be loaded onto synthetic bone with a chipped membrane to enhance the survival rate.

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)

Patron facial y espacios primates / Facial pattern and primate spaces

Hoy en día las especialidades odontológicas han adoptado una orientación preventiva en el tratamiento de sus pacientes, así la ortodoncia y la odontopediatría han centrado su interés en la prevención de maloclusiones. Por un lado durante la revisión clínica que realiza el ortodoncista evalúa el patrón facial, mientras que es tarea del odontopediatra la valoración de los espacios primate. El objetivo de este trabajo fue realizar una revisión bibliográfica sobre el patrón facial y espacios primate en niños con dentición decidua. Para lo cual se revisaron libros de odontopediatria y ortodoncia, tesis de pre y posgrado, revisiones de literatura y artículos originales regionales, nacionales e internacionales. No se encontraron muchos estudios que relacionen ambas variables directamente, sin embargo, el patrón facial, así como las características principales de la dentición decidua han sido ampliamente estudiados. (AU)

Nowadays the dental specialties have adopted a preventive orientation in the treatment of their patients, so orthodontics and pediatric dentistry have focused their interest in the prevention of malocclusions. On the one hand during the clinical review performed by the orthodontist evaluates the facial pattern, while the task of the pediatric dentist is the evaluation of the primate spaces. The objective of this work was to carry out a bibliographic review on the facial pattern and primate spaces in children with deciduous dentition. To this end, books on pediatric dentistry and orthodontics, pre and postgraduate theses, reviews of literature and original regional, national and international articles were reviewed. We did not find many studies that relate both variables directly, however, the facial pattern, as well as the main characteristics of the deciduous dentition have been widely studied. (AU)

Displasia ectodérmica en odontopediatría / Displasia ectodérmica em odontopediatria / Ectodermal dysplasia in pediatric dentistry

Ectodermal dyspasia (ED) is a hereditary disease that includes genetic and environmental changes. ED causes hypodontia, dystrophic nails, sparse hair and dental anomalies. Oral rehabilitation treatment for pediatric patients with ED is difficult because of continuous development and craniofacial growth. The aim of this study was to present a case report of oral rehabilitation in pediatric patients diagnosed with ED. A 5- year, 6-month-old girl reported to the clinic of Pediatric Dentistry in University Anhanguera UNIDERP-BR. Extraoral examination showed that the patient was an oral breather, and presented with decreased lower face height, protruding and everted lips, prominent forehead, "horse saddle" nose, lack of hair, eyelashes and eyebrows, thin and dry skin. Intraoral examination demonstrated absence of teeth: 51/52, 61/62/63, 71/72, 81/82 and tree conical teeth: 53, 73 and 83. The radiographic examination revealed agenesis of 9 primary teeth and of the buds of the following permanent teeth: 11/12/13, 21/22/23, 41/42, 31/32, we observed the presence of teeth buds of 33 and 43. Considering physical and radiographic characteristics hydrotic ectodermal was diagnosed. As clinical management, we opted for the installation of removable functional aesthetic maintainers, favoring the speech normality, swallowing, lip and lingual muscle tone and social development.

A displasia ectodérmica (DE) caracteriza-se por uma doença hereditária que consiste em alterações genéticas e ambientais, provocando hipodontia, unhas distróficas, cabelos escassos e anomalias dentárias. O tratamento reabilitador em pacientes pediátricos com DE se torna difícil devido ao contínuo desenvolvimento e crescimento crânio-facial dessas crianças. O presente trabalho tem como objetivo relatar um caso clínico de reabilitação oral em paciente pediátrico diagnosticado com DE. Paciente sexo feminino, com 5 anos e 6 meses de idade compareceu a clínica de Odontopediatria na UNIDERP. Ao exame físico, extra-oral, constatou-se que a paciente era respiradora bucal, e tinha como características a diminuição do terço inferior da face, lábios protusos e evertidos, fronte proeminente, nariz em "sela", escassez de pelos, cílios e sobrancelha, pele fina e seca. No exame intra-oral observou-se ausência dos elementos dentários, 51/52, 61/62/63, 71/72, 81/82, e os elementos 53, 73 e 83 apresentando aspecto conóide. Ao exame radiográfico constatou-se a agenesia de 9 dentes decíduos e dos germes dos seguintes dentes permanentes: 11/12/13, 21/22/23, 41/42, 31/32 e ainda observou-se a presença dos germes dos dentes 33 e 43. Baseado nas características físicas e radiográficas diagnosticou-se displasia ectodermica hidrótica. Como conduta clínica, optou-se pela instalação de mantenedores estéticos funcionais removíveis, favorecendo a normalidade da fala, deglutição, tonicidade muscular labial e lingual e do desenvolvimento social.

La displasia ectodérmica (DE) se caracteriza por ser una enfermedad hereditaria que consiste en alteraciones genéticas y ambientales, provocando hipodoncia, distrofia en uñas, cabello escaso y anomalías dentarias. El tratamiento de rehabilitación en pacientes pediátricos con DE es difícil debido al continuo crecimiento y desarrollo cráneo facial de estos niños. El presente trabajo tiene como objetivo relatar un caso clínico de rehabilitación oral en paciente pediátrico diagnosticado con DE. Paciente de sexo femenino, con 5 años y 6 meses de edad que compareció a la clínica de odontopediatría en la UNIDERP. Al examen físico, extra oral, se constató que la paciente era respiradora bucal, y presentaba disminución del tercio inferior de la cara, labios protruidos y evertidos, frente prominente, nariz en "silla de montar", escasez de cabello, pestañas y cejas, piel fina y seca. En el examen intraoral se observó ausencia de los siguientes dientes: 51/52, 61/62/63, 71/72, 81/82, y aspecto conoide de los dientes 53, 73 y 83. Al examen radiográfico se constató agenesia de 9 dientes primarios y de los gérmenes de los siguientes dientes permanentes: 11/12/13, 21/22/23, 41/42, 31/32, se observó la presencia de los gérmenes de los dientes 33 y 43. Con base en las características físicas y radiográficas se diagnosticó displasia ectodérmica hidrótica. Como conducta clínica, se optó por la instalación de mantenedores estéticos funcionales removibles, con el fin de favorecer la fonación, deglución, tonicidad muscular labial y lingual y el desenvolvimiento social.

Tratamiento ortodóncico en pacientes adultos combinando CA Clear Aligner con brackets linguales y microimplantes / Orthodontic treatment in adult patients combining CA Clear Aligner with lingual brackets and microimplants

Los pacientes adultos normalmente prefieren tratamiento ortodóncico invisible. La ortodoncia puedemejorar la estética, alinear y nivelar los dientes mejorando la salud periodontal, y también la posiciónde los dientes para recibir tratamiento protésico con un mejor pronóstico.

Adult patients normally prefer invisible orthodontic treatment. Orthodontics can improvethe aesthetics, align and level the teeth improvingthe periodontal health and also position the teeth to receive the prosthetic treatmentwith a better prognosis.

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)

Bone Regeneration Using Bilayer Bone Augmentation around Dental Implants: A Preliminary Study by Micro-CT in Dogs

The purpose of this preliminary study was to compare the effects of the bilayer bone augmentation technique (BBA) for the treatment of dehiscence-type defects around implants and evaluate the role as a membrane of the xenogenic bone positioned as the outer layer in the BBA technique using a micro-computed tomography (micro-CT). Four standardized dehiscence defects were prepared on each mandible bilaterally in 3 dogs and 1 implant was placed per defect, where each defect was treated with autograft (AB), xenograft (XB), BBA technique, or negative control without a membrane. Two months post-regenerative surgery, sectioned bone blocks were obtained. The image acquisitions were then scanned by micro-CT. Bone volume (BV), horizontal bone width (HBW) and vertical bone height (VBH) were measured through the analyses program. The BV were 11.08 mm3, 10.42 mm3, 8.1 mm3, and 7.01 mm3 in XB, BBA, control, and AB group in sequence of high value, respectively. HBW were 1.33 mm, 1.3 mm, 1.06 mm, and 1.03 mm in XB, BBA, AB, and control group, respectively. VBH were 4.88 mm, 4.85 mm, 4.74 mm, and 4.67 mm in XB, BBA, AB, and control group, respectively. However, there was no significant difference between the 4 groups. VBH tended to be higher in sequence of control, AB, BBA, and XB group (p for trend <0.05). The results showed the usefulness of the BBA technique involving mechanical support for prolonged space maintenance of xenogenic bone, for the treatment of dehiscence-type defects around implants. However, further studies with a larger sample size are required to confirm the results.

Effects of Block Bone Substitutes Loaded with Escherichia Coli-Produced Recombinant Human Bone Morphogenetic Protein-2 on Space Maintenance and Bone Formation in Rat Calvarial Onlay Model

We aimed to evaluate the effects of onlay-type grafted human freeze-dried corticocancellous bone block (FDBB) and deproteinized bovine bone with collagen (DBBC) loaded with Escherichia coli-produced recombinant human bone morphogenetic protein-2 (ErhBMP-2) on space maintenance and new bone formation in rat calvaria. Collagen sponge (CS), FDBB, or DBBC disks (8×4 mm) with ErhBMP-2 (2.5 µg) were implanted onto the calvaria of male Sprague-Dawley rats, whereas CS with buffer was implanted onto the calvaria as controls (n=20/carrier). Rats were killed at 2 or 8 weeks post-surgery for histologic and histomorphometric analyses; total augmented area, new bone area, and bone density were evaluated. At both time-points, all ErhBMP-2 groups showed significantly higher new bone area and bone density than the control group (p<0.05). ErhBMP-2/FDBB and ErhBMP-2/DBBC groups showed significantly higher total augmented area than ErhBMP-2/CS group (8 weeks), and ErhBMP-2/FDBB group showed significantly higher new bone area and bone density than ErhBMP-2/DBBC group (p<0.05). ErhBMP-2/CS group showed the highest bone density (p<0.05). Combining ErhBMP-2 with FDBB or DBBC could significantly improve onlay graft outcomes, by new bone formation and bone density increase. Moreover, onlay-grafted FDBB and DBBC with ErhBMP-2 could be an alternative to autogenous block onlay bone graft.

Histomorphometric Evaluation of Onlay Freeze-Dried Block Bone and Deproteinized Bovine Bone with Collagen in Rat

The aim of this study was to evaluate the effect of human freeze-dried bone block (FDBB) and deproteinized bovine bone with collagen (DBBC) on bone formation when applied as an onlay graft in rat calvariums. Thirty male Sprague-Dawley rats received collagen sponge (control), FDBB, or DBBC onlay grafts trimmed into 8-mm disks measuring 4-mm height. Each graft was secured onto the calvarium surface using horizontal mattress sutures. Rats in each group were killed at 2 (n=5) or 8 (n=5) weeks postoperatively for histologic and histomorphometric analysis. The total augmented area (mm²), new bone area (mm²), and bone density (%) were measured. The FDBB and DBBC groups showed significantly more new bone formation and bone density than the control group at 2 and 8 weeks. The increased new bone area was significantly greater in the FDBB group than in the DBBC group (p<0.05). The total augmented area was significantly higher in the FDBB and DBBC groups at 2 and 8 weeks than in the control group (p<0.05), and at 8 weeks, the area was significantly decreased in the DBBC group compared to that in the FDBB group and the area at 2 weeks (p<0.05). Within the limitations of the present study, we concluded that onlay FDBB and DBBC grafts caused new bone formation through an osteoconductive mechanism. In addition, compared to FDBB, DBBC had less capacity to form new bone and maintain the space.

Tratamiento de marsupialización de un quiste odontogénico inflamatorio en un niño de 5 años con preservación de los gérmenes dentarios permanentes / Marsupialization of a inflammatory dentigerous cyst in a 5-year-old child with preservation of the permanent tooth germs

El quiste radicular ha sido catalogado como un quiste inflamatorio, como resultado de una necrosis pulpar por un proceso de caries, con una reacción inflamatoria periapical. Avanza lentamente y en los primeros estadios puede ser asintomático. Debido a esto pueden tener grandes dimensiones.A continuación, presentamos una situación de un quiste radicular inflamatorio en relación con el segundo molar temporario inferior en un paciente de 5 años de edad. La ortopantomografía muestra una gran radiolucidez unilocular con un borde bien definido en la región periapical del segundo molar temporario inferior que se extiende desde la raíz hasta el primer molar temporario con desplazamientode los gérmenes de los premolares permanentes hacia la basal mandibular del sector derecho.

Síndrome 49, XXXXY: aspectos bucales y abordaje clínico / 49, XXXXY Syndrome: oral aspects and clinical approach

El cariotipo 49 XXXXY, es una forma rara de polisomía, considerada una variante del Síndrome de Klinefelter, descripto en el año 1960, siendo muy escasa la información publicada en la literatura científica en el área de la odontología. Algunas de las características fenotípicas predominantes en este síndrome son: rasgos faciales dismórficos, microcefalia, clinodactilia, retardo mental, hipogonadismo y naomaláis esqueletales, siendo la sinostosis radiolunar la más característica. En el 100 por ciento de los casos se ha descripto retraso motor y del lenguaje y en el 50 a 100 por ciento se pueden observa paladar fisurado, malformaciones genitourinarias, hernia inguinal y defectos óseos. Uno de los aspectos bucales relevantes de los pacientes con este síndrome es la presencia de taurodoncia. El propósito de este trabajo es describir las características bucales, las anomalías dentales y su abordaje clínico en forma ambulatoria, en un paciente de 6 años de edad con síndrome de 49 XXXXY

Prótesis fija con sistema tubo-barra en odontopediatría: reporte de un caso clínico de 12 meses de seguimiento / Fixed prosthesis with tube-bar system in pediatric dentistry: a case report over 12 months of follow-up

Introducción: La pérdida prematura de incisivos primarios puede producir alteraciones estéticas, funcionales y psicológicas. La rehabilitación protésica permite reemplazar los dientes faltantes y evitar las secuelas que ello puede acarrear. Objetivo Describir la técnica y evolución clínica de una prótesis fija anterior tipo Denari durante 12 meses de seguimiento. Descripción del caso Paciente de sexo femenino de 3 años de edad que acude en busca de atención profesional posterior a la avulsión de los incisivos centrales superiores. Con la finalidad de devolver la estética del sector anterosuperior, recuperar la función oral e interferir con el hábito de interposición lingual se decidió realizar una terapia basada en prótesis parcial fija tipo Denari. Durante el año de seguimiento la prótesis fue muy bien tolerada por la paciente y sin alteración de los tejidos blandos adyacentes, destacando un aumento en el espacio interincisal, lo que demuestra el crecimiento transversal. Conclusión La prótesis dental en niños es una tarea exigente, marcada por la necesidad de adaptación a los cambios continuos que conllevan los procesos de crecimiento y maduración de complejo maxilofacial. En este contexto es que la prótesis tipo Denari con sistema tubo-barra es una excelente y estética alternativa en pacientes de corta edad en donde la prótesis va a permanecer en la boca por un largo período de tiempo, sin interferir en el crecimiento, desarrollo y función del sistema estomatognático.

Introduction: Premature loss of primary incisors may result in aesthetic, functional and psychologic problems. Prosthetic restoration allows replacing missing teeth, avoiding the unwanted consequences that their absence may carry. Objective The aim of this clinical case is to describe the technique and clinical evolution of a Denari fixed anterior prosthesis over 12 months of follow-up. Case description 3 year-old female patient sought professional attention after the avulsion of the upper central incisors. In order to restore the natural appearance of the anterior superior area, recover oral function and intervene in the habit of tongue interposition, the treatment decided upon was a partially fixed Denari prosthesis. During the follow-up year the prosthesis was very well tolerated by the patient and without altering any adjacent soft tissues. We highlight an increase in the interincisal space, which demonstrates transversal growth. Conclusion A dental prosthesis in a child is a demanding task marked by the need to adapt to the continuous changes brought about by maxillofacial growth and maturation. It is in this context that the Denari prosthesis with its tube-bar system is an excellent and esthetic alternative in young patients where the prosthesis is going to remain in place for a prolonged period without interfering in the growth, development and function of the stomatognatic system.

Ortodontia na recuperação da estética após perda precoce de dente decíduo por trauma dental: relato de caso / Esthetic improvement with orthodontics after premature loss due to trauma of primary teeth: case report

O presente caso clínico tem por objetivo relatar a perda precoce do dente 51 devido a trauma e o restabelecimento estético do paciente após a recuperação do espaço perdido. Criança do sexo masculino com 4 anos de idade procurou atendimento após trauma no incisivo central superior decíduo com posterior exodontia, realizada há 8 meses. A mãe relatou incomodo causado pela ausência do elemento dental em relação à estética. No exame clínico observou-se ausência de lesões de cárie e perda de espaço devido à migração dos dentes laterais ao espaço do dente extraído. Foi proposto um recuperador de espaço removível com molas digitais e, após 45 dias, foi recuperado o espaço desejado. Na segunda etapa foi confeccionado um aparelho mantenedor de espaço estético fixo. A cor do dente 51 foi aferida clinicamente e os dentes 55 e 65 foram bandados. O modelo foi encaminhado a um laboratório para confecção de uma barra palatina soldada as bandas e um dente de acrílico na região do dente 51 foi acrescentado. Após cimentação do aparelho os responsáveis foram instruídos em relação à higiene e do acompanhamento a cada 6 meses. Os retornos do paciente ocorreram até verificarem-se sinais de erupção do dente permanente sucessor sendo, então, o aparelho removido. O paciente retornou para uma nova avaliação clínica após a completa erupção dos dentes 11 e 21 onde se verificou ausência de qualquer sequela. Conclui-se que o paciente e os pais ficaram satisfeitos com o reestabelecimento estético alcançado no tratamento quanto à estética, sendo o aparelho eficaz até a erupção do dente permanente.

This clinical case aims to report early tooth loss of the primary right maxillary central incisor due to trauma and the aesthetic reestablishment of the patient after recovery of the lost space. Male, 4 years old, after dental trauma, had the primary right maxillary central incisor extracted. The mother reported discomfort caused by the absence of the dental element in relation to aesthetics. In the examination there was no caries but there was space loss due to migration of the lateral teeth to space the extracted tooth. A removable orthodontic appliance has been proposed and, after 45 days, was recovered the loss space. In second step was made a maintainer aesthetic retainer appliance. The color of the teeth was clinically assessed and the primary maxillary second molars were banded. The model was sent to a laboratory for making a palatal bar welded bands and an acrylic tooth in the region of the primary right maxillary central incisor. After appliance cementing those responsible were instructed regarding hygiene and monitoring every six months. The patient returns occurred until there is an eruption sign of permanent tooth successor and then the aesthetic appliance was removed. The patient returned to a new clinical evaluation after complete eruption permanent successor tooth where there was absence of any sequel. We conclude that the patient and parents were satisfied with the aesthetic reestablishment until the eruption of the successor permanent tooth.

Mantenedor fixo estético-funcional como tratamento para perda precoce de dentes decíduos anteriores / Aesthetic-functional fixed appliance as treatment of premature of primary anterior teeth

A perda precoce de dentes decíduos pode acarretar dano à oclusão e outras sequelas estético-funcionais indesejáveis. Nesses casos, tão importante quanto a reabilitação do paciente, é a escolha adequada do tipo de aparelho mantenedor de espaço. Este trabalho é um relato de caso clínico no qual uma criança de três anos de idade apresentou perda precoce dos incisivos superiores decíduos onde foi instalado um aparelho mantenedor estético-funcional fixo. Em um período inicial de quatro meses de acompanhamento a mãe relatou boa aceitação quanto à adaptação e higienização do aparelho. Consultas de proservação do caso serão feitas mensalmente até o início da erupção dos incisivos permanentes.

The premature loss of primary teeth can cause damage to occlusion and other undesirable aesthetic-functional sequelaes. ln such cases, as important as the rehabilitation of the patient, is the accurate choice of space maintenance appliance. This work is a case report in which a child of three years old showed premature loss of deciduous incisors and a aesthetic-functional fixed appliance was installed. ln an initial follow-up of 4 months, the mother reported good acceptance on the adjustment and cleaning of the device. The clinical visits of proservation of the case will be scheduled monthly until the eruption of the permanent incisors.