Calcitonin as a pharmacological anchorage in orthodontics.

Objective: This study aimed to evaluate the effects of salmon calcitonin administration as a pharmacological anchoring agent in orthodontics and to determine the influence of locally applied calcitonin on serum calcium levels. The secondary aim was to observe the response of dental and periodontal tissues using light microscopy. Methods: Fourteen healthy male adult Wistar rats with an average weight of 250 g had their teeth moved, seven of which received a local injection of salmon calcitonin in the furcation region of the left upper first molar. Concurrently, the remaining seven were used as controls. In the control group, saline solution was injected in the bifurcation region of tooth 26 to subject these animals to the same stress level as those of the experimental group. After 14 days, a 6 mm diameter orthodontic elastic band was inserted between teeth 26 and 27 in all animals to induce the movement of these teeth. The rats were anaesthetised and exsanguinated on day 21. In both groups, tooth movement and serum calcium levels were measured. The jaws were dissected with straight scissors, and tissue blocks containing gingiva, bone and teeth were identified, fixed and demineralised. Then, the pieces were cut into semi-serial slices, stained with hematoxylin, eosin, and Mallory's trichrome, and analysed under an Axiophot light microscope. Results: There was significantly less tooth movement in the experimental group (X̄; 0,150 mm ± 0,037) than in the control group (0,236 mm ± 0,044; P = 0,003), while there was no significant difference in serum calcium levels between the two groups (controlX̄; 9,53 mg/dl ± 1,53; experimental 10,81 mg/dl ± 1,47; P = 0,15). Conclusion: While calcitonin did not completely inhibit osteoclast activity, it promoted orthodontic anchorage, apparently, by local action.

Solitary Median Maxillary Central Incisor in Hartsfield Syndrome: A Case Report.

Hartsfield syndrome is a rare and unique clinical combination of ectrodactyly and holoprosencephaly (HPE) with or without cleft lip and palate, as well as various additional characteristics. Although several genes responsible for HPE and ectrodactyly have been identified, the genetic origin of Hartsfield syndrome remains unknown, as there are few reports in the literature. The objective of this case report is to present dentofacial abnormalities in an 11-year-old boy with Hartsfield syndrome, who presented mental retardation, hearing loss, bilateral hand and foot ectrodactyly, HPE, and solitary median maxillary central incisor (SMMCI) besides 12 dental ageneses. How to cite this article: P Reis PM, Faber J, O Rosa JS, et al. Solitary Median Maxillary Central Incisor in Hartsfield Syndrome: A Case Report. Int J Clin Pediatr Dent 2023;16(1):147-152.

Does treating proximal cavities in primary molars non-restoratively affect intra-arch space and alignment of successor teeth negatively? A 4-year longitudinal study.

Background: Removing plaque with toothbrush and toothpaste from proximal cavities in primary molars without restoring them follows sound cariological principles. But does this treatment affect space for and alignment of their permanent successors negatively? Hypothesis: There is no difference in impaction and displacement of the premolars, as well as in the D+E space in quadrants with three different statuses of the proximal surface of primary molars over a 4-year period. Methods: A total of 936 quadrants (466 maxillary and 470 mandibular quadrants) in 233 children were assessed. Treatment of cavities in the proximal surfaces of the primary molars consisted of amalgam and ART restorations using high-viscosity glass-ionomer cement, and cleaning of open large- and medium-sized cavities with toothbrush and toothpaste (UCT) under supervision for 220 days per year over 3 years. Dental casts were made at baseline, and after two, three, and 4 years. The D+E spaces were measured digitally. Status of the proximal surface of the primary molars was assessed by two calibrated examiners, and quadrants were grouped into normal anatomy, defective restoration, and proximal cavity. ANCOVA, ANOVA and LSD tests were applied. Results: There was a statistically significant difference between groups (p <= 0.001) and between evaluation times (p < 0.001), for the D+E space in both the maxilla and mandible. A sex difference related to the D+E space in the maxilla was found (p = 0.007). For boys, quadrants in the maxilla of the group 'proximal cavity' showed a significant shorter D+E space when compared to quadrants of the group 'normal anatomy' at the 3- and 4-year evaluation time. For girls the difference between the two groups was only present at the 3-year evaluation time. There was no significant difference between the D+E space in quadrants with defective restorations and those with normal anatomy in the mandible and in the maxilla. Displacement and impaction of the premolars showed no significant difference between groups. Conclusion: Primary molars with open proximal cavities that are cleaned with toothbrush and toothpaste do not result in displacement and impaction of the successor teeth, neither do primary molars with defective restorations in proximal tooth surfaces.

Effect of maxillary median diastema on the esthetics of a smile.

INTRODUCTION: With the increasing demand for facial esthetics, patients' expectations regarding dental treatment have increased. The treatment of maxillary median diastemas (MMDs) stands out as one of the most noticeable esthetic alterations performed on patients. The objectives of the present article were to evaluate the effects of MMD and its restorations on the esthetics of a smile and to determine the differences in esthetic perceptions among 3 different groups of patients: orthodontists, prosthodontists, and laypeople. METHODS: Printed photographic images were randomly arranged in an album that contained the original photograph of the smile, 8 photographs with digitally created diastemas (0.5 mm, 1.0 mm, 1.5 mm, 2.0 mm, 2.5 mm, 3.0 mm, 4.0 mm, and 5.0 mm), and 8 with simulated restorations of these spaces. Each evaluator assigned scores to the images using a 100-mm visual analogue scale. RESULTS: Orthodontists, prosthodontists, and laypeople presented similar perceptions regarding the levels of attractiveness of the original smiles and those of smiles involving restorations of diastemas with widths of 0.5 mm and 1.0 mm. The ratings assigned to the smiles with diastemas differed significantly from those of the corresponding restored smile with the same magnitude of diastema. CONCLUSIONS: The prosthetic space closure of diastemas is better than leaving the space untreated. Restorations of MMD up to 1 mm perform similar to orthodontic closure. Larger MMDs are ideally treated with orthodontics because the restorative treatment is more invasive, leading to incremental damage to the dental tissues.

Impact of proximal cavities and primary molar absence on space in the dental arches.

BACKGROUND: A recently proposed treatment protocol for dental caries in primary teeth, called Ultra Conservative Treatment (UCT), keeps medium to large cavities open so that children can keep them clean with tooth brushing and fluoride toothpaste. However, carious lesions have been related to malocclusion and decrease of space for the eruption of the permanent successor. METHODS: This cross-sectional study evaluated dental casts of 235 schoolchildren, aged 6-7 years old of six public schools in deprived suburban areas, and with at least two cavitated dentin carious lesions. The casts were grouped according to the location of cavitated dentin lesions into non-proximal cavity (NPC), proximal cavity with buccal or lingual surface contact point to adjacent tooth (PCCP) and proximal cavity without contact to adjacent tooth (PCWC), as well as the absence of primary molars due carious lesions (PMA). The relationship between location of cavitated dentin lesions or absence of primary molars with C+D+E and D+E space was analyzed. RESULTS: Children with absence of primary molars exhibited the smallest C+D+E and D+E space in the maxilla (P < 0.001) and mandible (P < 0.001), followed by proximal cavity without buccal or lingual surface contact. No significant difference was observed between NPC and PCCP groups in upper and lower arches. DISCUSSION: PCWC are associated with minor (less than the leeway space) C+D+E and D+E space loss in both arches, and additional space loss is noted when primary molars are prematurely lost. These results may have implications for orthodontic and restorative dental care decisions in children.

Cavity treatment in primary molars and malocclusion: quasi-randomised clinical trial.

BACKGROUND: An innovative caries treatment protocol for primary teeth, termed Ultra-Conservative Treatment (UCT), restores small cavities through the Atraumatic Restorative Treatment (ART) protocol and cleans medium to large open cavities with toothbrush and fluoride toothpaste. However, UCT-treated primary molars were found to exfoliate earlier than amalgam (CRT) and ART-restored cavities, which may lead to unacceptable loss of space for normal eruption of permanent successors. The null-hypothesis tested was that there is no difference between the three treatment protocols and the intra-arch distances, and index of orthodontic treatment need (IOTN) after 4 years. METHODS: Dental casts were taken at baseline (T0) and four (T4) years. The space of the premolars (D + E space), arch perimeter, anterior and total arch depth were measured using a morphometric computer programme. The presence and level of malocclusion were assessed according to the IOTN index. Dependent variables were all intra-arch distances and the IOTN while the independent variable was treatment protocol (CRT, ART and UCT). Data were analysed using linear and logistic regression. RESULTS: The sample consisted of 867 pairs of casts of 272 initial 6-7-year-olds. No difference was observed between the UCT protocol and the two restorative protocols for the intra-arch variables in both maxilla and mandible over the 4 year period. There was no difference between the UCT and the CRT and ART protocols regarding the occurrence of orthodontic treatment need (malocclusion). In conclusion, the UCT treatment protocol does not differ significantly from the traditional amalgam (CRT) and ART restorative protocols with respect to intra-arch distances and malocclusion. The earlier exfoliation of UCT-treated primary molars does not lead to a worsening of the eruption pattern of permanent successors.

Obstructive sleep apnea in adults.

INTRODUCTION: Obstructive Sleep Apnea and Hypopnea Syndrome (OSAS) is a highly prevalent disease with serious consequences for the patients' lives. The treatment of the condition is mandatory for the improvement of the quality of life, as well as the life expectancy of the affected individuals. The most frequent treatments provided by dentistry are mandibular advancement devices (MAD) and orthognathic surgery with maxillomandibular advancement (MMA). This is possibly the only treatment option which offers high probability of cure. OBJECTIVE: The present article provides a narrative review of OSAS from the perspective of 25 years of OSAS treatment clinical experience. CONCLUSION: MADs are a solid treatment option for primary snoring and mild or moderate OSAS. Patients with severe apnea who are non-adherent to CPAP may also be treated with MADs. Maxillomandibular advancement surgery is a safe and very effective treatment option to OSAS.

Obstructive sleep apnea in adults

ABSTRACT Introduction: Obstructive Sleep Apnea and Hypopnea Syndrome (OSAS) is a highly prevalent disease with serious consequences for the patients' lives. The treatment of the condition is mandatory for the improvement of the quality of life, as well as the life expectancy of the affected individuals. The most frequent treatments provided by dentistry are mandibular advancement devices (MAD) and orthognathic surgery with maxillomandibular advancement (MMA). This is possibly the only treatment option which offers high probability of cure. Objective: The present article provides a narrative review of OSAS from the perspective of 25 years of OSAS treatment clinical experience. Conclusion: MADs are a solid treatment option for primary snoring and mild or moderate OSAS. Patients with severe apnea who are non-adherent to CPAP may also be treated with MADs. Maxillomandibular advancement surgery is a safe and very effective treatment option to OSAS.

RESUMO Introdução: a Síndrome da Apneia e Hipopneia Obstrutiva do Sono (SAOS) é uma doença muito prevalente e que traz importantes consequências para a vida dos seus portadores. O tratamento da condição é relevante para a melhora do bem-estar geral e da expectativa de vida dos afetados. Os tratamentos odontológicos mais frequentes para a SAOS são os dispositivos de avanço mandibular (DAMs) e a cirurgia ortognática de avanço maxilomandibular (AMM) - essa última, possivelmente, é a única opção de tratamento com alta probabilidade de cura do problema. Objetivo: o presente artigo faz uma revisão narrativa da SAOS sob a perspectiva de 25 anos de experiência clínica no tratamento da doença. Conclusão: os DAMs são uma sólida opção de tratamento para o ronco primário e apneias leves ou moderadas. Apneias graves, em pacientes que não se adaptam ou se recusam a usar o CPAP, também podem ser tratadas com os DAMs. A cirurgia ortognática de AMM é uma alternativa segura e muito eficaz de solução da SAOS.