Cleidocranial dysplasia: diagnosis, surgical and orthodontic planning and interventions in a pediatric patient / Displasia cleidocraneal: diagnóstico, planificación quirúrgica y ortodóncica e intervenciones en un paciente pediátrico

Cleidocranial Dysplasia (CCD) is an autosomal dominant bone disorder caused by a defect in the CBFA1 gene and characterized by skeletal, craniofacial and orodental anomalies. This paper describes the main aspects of a case of CCD from diagnosis and planning to the first step of the interventions. An 11-year-old male patient sought the pediatric dentistry clinic of the Federal University of Paraná (Brazil) with the complaint of the prolonged retention of nearly all his primary teeth. Clinical and imaging exams led to the diagnosis of CCD and the treatment plan was outlined. The first step consisted of the extraction of 4 primary, 2 permanent and 2 supernumerary teeth from the maxilla, followed by palate separation, traction of the impacted teeth and reverse traction of the maxilla. The patient remains in treatment. Clinical follow up as well as the awareness and motivation of the family are important factors in such cases.

La displasia cleidocraneal (CCD) es un trastorno óseo, autosómico dominante, causado por un defecto en el gen CBFA1 y se caracteriza por anomalías esqueléticas, craneofaciales y bucodentales. En este trabajo se describen los principales aspectos de un caso de CCD, desde el diagnóstico y la planificación para la primera etapa de las intervenciones. Un paciente varón de 11 años de edad, concurrió a la Clínica de Odontología Pediátrica de la Universidad Federal de Paraná (Brasil) con un problema de retención prolongada de casi todos sus dientes de leche. Se describen los exámenes clínicos y de imagen dirigidos al diagnóstico de la CCD y el plan de tratamiento. La primera etapa consistió en la extracción de cuatro dientes primarios, dos dientes permanentes y dos dientes supernumerarios del maxilar, seguido de separación del paladar, tracción de los dientes afectados y tracción inversa del maxilar. El paciente permanece en tratamiento. El seguimiento clínico, así como la concientización y motivación de la familia son factores importantes en este tipo de casos.

Impact of Oral Health Status on the Oral Health-Related Quality of Life of Brazilian Male Incarcerated Adolescents.

PURPOSE: To assess the impact of oral health status on the oral health-related quality of life (OHRQoL) of incarcerated Brazilian male adolescents. MATERIALS AND METHODS: A cross-sectional survey with 102 male adolescents incarcerated at the São Francisco Juvenile Detention Facility, Piraquara, Brazil in 2010 was carried out. Dental caries, oral hygiene, periodontal status, malocclusion, dental fluorosis and dental trauma were analysed. The Oral Health Impact Profile (OHIP-14) was administered to measure OHRQoL, along with a questionnaire addressing sociodemographic variables, health-related aspects and dental experience. Descriptive statistical analysis and univariate and multiple Poisson regression with robust variance were performed. RESULTS: The prevalence of adolescents who reported an impact on OHRQoL was 64% (95% CI: 54-73) and the mean OHIP-14 score was 6.69 (SD = 8.79; median = 3.00). In the multiple regression model, the prevalence of a negative impact on OHRQoL was significantly higher among individuals with untreated caries (PR = 1.74; 95% CI: 1.10-2.77), those who reported having discomfort in the teeth or mouth (PR = 1.33; 95% CI: 1.03-1.73), using tobacco prior to internment (PR = 1.53; 95% CI: 1.04-2.24) and maintaining a stable relationship (PR = 1.31; 95% CI: 1.01-1.70) in comparison to individuals who did not exhibit these conditions. Moreover, each month of internment represented an increase in the prevalence of an impact on OHRQoL (PR = 1.03; 95% CI: 1.01-1.06). CONCLUSION: Incarcerated male adolescents reported that oral health problems exerted an influence on quality of life, with untreated caries exhibiting the greatest impact.

Tratamento multidisciplinar de incisivos centrais superiores impactados / Multidisciplinary treatment of upper impacted central incisors

A impactação de incisivos centrais superiores é uma condição desafiadora para a Odontologia, necessitando, geralmente, de uma abordagem multidisciplinar. As impactações dentárias podem ser idiopáticas ou causadas por traumatismos, presença de dentes supranumerários, barreiras ósseas ou mucosas. Em casos de impactações localizadas na região anterior, o planejamento adequado torna-se fundamental para que os comprometimentos estéticos e funcionais sejam minimizados, devolvendo a harmonia ao sorriso do paciente. Este trabalho teve como objetivo abordar alguns aspectos relacionados à retenção de incisivos centrais superiores devido à presença de quatro dentes supranumerários e apresentar, por meio da descrição de um caso clínico, o tratamento multidisciplinar ortodôntico-cirúrgico. O sucesso dos resultados obtidos do tratamento deveu-se ao correto diagnóstico e planejamento do caso, à condução adequada pelas diferentes especialidades odontológicas envolvidas e à colaboração do paciente...

The impaction of maxillary central incisors is a challenging condition in Dentistry, and usually requires a multidisciplinary approach. Dental impaction can be idiopathic or caused by trauma, as well as by the presence of supernumerary teeth, hard and soft tissue. In cases of impaction located in the anterior region, proper planning is fundamental to minimize aesthetic and functional impairments restoring harmony to the patient’s smile. This study aimed to address some aspects related to the impaction of maxillary central incisors due to the presence of four supernumerary teeth as well as to present, through the description of a clinical case, a multidisciplinary ortho-surgical treatment. The success of the results of treatment was achieved due to the correct diagnosis and planning of the case, the proper conduct of the different dental specialties involved, and the cooperation of the patient...

Performance of distant diagnosis of dental caries by teledentistry in juvenile offenders.

BACKGROUND: Telehealth has been considered a practical and potentially cost-effective method of providing healthcare to the underprivileged population. The aim of this study was to determine whether a teledentistry system is a valid tool to screen for the presence of dental caries in a cohort of 102 Brazilian juvenile offenders. MATERIALS AND METHODS: Clinical examinations were performed to evaluate the decayed, missing, and filled teeth (DMFT) index and oral conditions of each adolescent, documented using a digital camera. For distant diagnosis, two methods of image transmission were tested. In the first, images were uploaded on a file-sharing service, and the link was sent via e-mail to one distant consultant. The other consultant received the images recorded on a compact disc. Both assessed the files and calculated the DMFT index for each case. The degree of agreement between the traditional examination and distant consultant assessments was measured by the kappa coefficient of agreement. Sensitivity and specificity were also calculated. RESULTS: According to the traditional clinical examination, 93.1% of the adolescents had at least one instance of dental caries with a mean DMFT index of 5.9. Kappa statistics ranged from "strong" to "almost perfect." Sensitivity ranged from 48% to 73%, and specificity was either 97% or 98%. CONCLUSIONS: Adolescent inmates could benefit from oral health screening using digital photography. Teledentistry appears to be a reliable alternative to the traditional oral examination for dental caries assessment.

Teledentistry: distant diagnosis of oral disease using e-mails.

OBJECTIVE: The purpose of this study was to evaluate the applicability of telediagnosis in oral medicine, through the transmission of clinical digital images by e-mail. SUBJECTS AND METHODS: The sample included 60 consecutive patients who sought oral medicine services at the Federal University of Paraná, in the state of Paraná, located in southern Brazil. The clinical history and oral lesion images were recorded using clinical electronic charts and a digital camera, respectively, and sent by e-mail to two oral medicine consultants. The consultants provided a maximum of two clinical hypotheses for each case, which were compared with biopsy results that served as the gold standard. RESULTS: In 31 of the 60 cases (51.7%), both consultants made the correct diagnosis; in 17 cases (28.3%), only one consultant made the correct diagnosis; and in 12 cases (20%), neither consultant made the correct diagnosis. Therefore, in 80% of cases, at least one consultant provided the correct diagnosis. The agreement between the first consultant and the gold standard was substantial (κ=0.669), and the agreement between the second consultant and the gold standard was fair (κ=0.574). CONCLUSIONS: The use of information technology can increase the accuracy of consultations in oral medicine. As expected, the participation of two remote experts increased the possibility of correct diagnosis.

Programa de extrações seriadas: relato de caso / Serial extraction program: case report

O tratamento das más oclusões na dentição mista é desafiador e complexo, pois nesta fase podem ocorrer alterações em função do crescimento e desenvolvimento. Muitas destas más oclusões poderiam ser evitadas ou minimizadas por meio de procedimentos preventivos e interceptadores, que quando aplicados na época ideal favorecem o tratamento e não permitem que a má oclusão se instale. A previsão da falta de espaços para o alinhamento dentário e a verticalização dos incisivos inferiores na base óssea, e consequente estabilidade do tratamento, possibilitou um planejamento de redução de massa dentária por exodontias em estágios precoces de desenvolvimento da dentadura mista. É de suma importância obter um perfeito diagnóstico e reconhecer as limitações do programa para evitar danos teciduais e agravamento da má oclusão. Este artigo tem como objetivo apresentar um relato de caso clínico passo a passo do programa de extrações seriadas e o uso de alguns aparelhos acessórios que melhoram os resultados ao final do tratamento.

The treatment of malocclusions in mixed dentition is challenging and complex, therefore, at this stage, changes may occur due to the growth and development. Many of these malocclusions could be avoided or minimized through preventative or interceptative procedures, that when applied in the correct time, can favor treatment and prevent the malocclusions to install up. The prediction of lack of space for tooth alignment and uprighting of the lower incisors in the basal bone, with consequent stability of the treatment, enables planning a possible mass reduction by dental extractions in early stages of development of mixed dentition. It is important to establish a proper diagnosis and recognize the limitations of the technique to prevent tissue damage and worsening of malocclusion. This article aims to present a case report of the serial extraction program, step by step, and the use of some accessory devices that improve treatment outcomes.

Study of face pleasantness using facial analysis in standardized frontal photographs

OBJECTIVE: The purpose of this research was to check if the numeric facial analysis can determine facial attractiveness. METHOD: The sample consisted of frontal and lateral standard facial photographs, in natural head position, of 85 Brazilian Caucasian women, without facial plastic surgery report. The sample mean age was 23 years and 9 months. A group of 5 orthodontists, 5 layman and 5 plastic artists classified the photographs according to their own attractiveness graduation in: pleasant, acceptable and not pleasant. The numeric facial analysis was then performed using a computerized method. Linear, proportional and angular measurements were compared among groups. RESULTS: According subjective analysis the sample was consisted of 18.8% of pleasant, 70.6% of acceptable and 10.6% of not pleasant. In most measurements there were no differences among groups. Just in three of them significant statistical difference was observed and in two of them the comparison value was within decision limit. All the differences found were related to the lower third of the face and to facial pattern. CONCLUSION: On the present research, the numeric facial analysis, by itself, was not capable of detecting facial attractiveness, considering that beauty judgment seems to be very personal.

OBJETIVO: esse estudo foi desenvolvido com o propósito de verificar se a análise facial numérica realizada em fotografias frontais é sensível em detectar a atratividade da face. MÉTODOS: a amostra foi composta por fotografias faciais padronizadas, frontais e laterais, em posição natural da cabeça, de 85 mulheres brasileiras, leucodermas, com idades entre 18 e 30 anos, sem histórico de cirurgia plástica facial. A idade média da amostra foi de 23 anos e 9 meses. As fotografias foram classificadas de acordo com o grau de atratividade da face por uma banca composta de cinco especialistas em Ortodontia, cinco leigos e cinco artistas plásticos. A partir dessa classificação, os indivíduos foram divididos em três grupos: esteticamente agradáveis, esteticamente aceitáveis e esteticamente desagradáveis. Em seguida, foram realizados os traçados fotométricos por meio computadorizado. As médias das variáveis lineares, proporcionais e angulares propostas foram comparadas estatisticamente entre os grupos. RESULTADOS: pela análise subjetiva, 18,8% da amostra foram classificados como esteticamente desagradáveis, 70,6% como esteticamente aceitáveis e 10,6% como esteticamente agradáveis. Na maioria das variáveis, não observou-se diferenças entre os grupos. Em apenas três delas houve diferenças estatisticamente significativas. Todas as diferenças encontradas relacionaram-se ao terço inferior da face e ao padrão facial. CONCLUSÃO: no presente estudo, a análise facial numérica utilizada isoladamente não foi sensível na detecção de padrões de atratividade, já que os critérios de beleza parecem ser altamente subjetivos.

Profile of Brazilian scientific research in pediatric dentistry based on the 26th Annual Meeting of the SBPqO / Perfil da produção científica brasileira na Odontopediatria baseado na 26ª Reunião da SBPqO

PURPOSE: To describe the Brazilian scientific research in pediatric dentistry in 2009 based on the 26th Annual Meeting of the SBPqO (Brazilian division of the IADR). METHODS: All studies on pediatric dentistry were selected from the abstracts presented at the 26th Annual Meeting of the SBPqO in 2009. They were assessed in terms of subjects, methodology and sampling units. RESULTS: Of the 2,648 abstracts presented, 7.7% were on pediatric dentistry, thereby representing the field with the 4th greatest participation in the meeting. The Southeast was the most productive region in Brazil, accounting for 70.1% of abstracts. A wide range of subjects were addressed: dental trauma (5.4%), diagnosis of dental caries (4.9%), diet and dental caries (4.4%), endodontic medication (4.4%), developmental enamel defects (3.4%), glass ionomer cement (3.4%), and dental care for pregnant women (3.4%). The cross-sectional design was the most prevalent type of study (52.5%), followed by in vitro studies (23.5%). Only 2.5% of the abstracts were randomized controlled trials. A total of 41.7% of the studies included children aged 0 to 11 years old, while 14.7% used human deciduous teeth. CONCLUSION: Pediatric dentistry played an important role in Brazilian scientific research in 2009, presenting a broad diversity of subjects and methodological approaches.

OBJETIVO: Descrever a produção científica brasileira na Odontopediatria em 2009, baseando-se na 26ª Reunião Anual da SBPqO (divisão brasileira do IADR). METODOLOGIA: Todos os estudos na área de Odontopediatria, selecionados a partir dos resumos apresentados na reunião, foram avaliados em termos de assuntos, desenho metodológico e unidades amostrais. RESULTADOS: Dos 2648 resumos apresentados, 7,7% corresponderam aos de Odontopediatria, representando a área com a quarta maior participação. A região sudeste foi a mais produtiva do país, sendo responsável por 70,1% dos resumos. Foram abordados assuntos bastante variados, sendo os mais prevalentes: traumatismo dentário (5,4%), diagnóstico de cárie dentária (4,9%), dieta e cárie dentária (4,4%), medicações endodônticas (4,4%), defeitos de desenvolvimento de esmalte (3,4%), cimento de ionômero de vidro (3,4%) e atendimento odontológico para gestantes (3,4%). Os estudos transversais foram os mais prevalentes (52,5%), seguidos dos estudos in vitro (23,5%). Apenas 2,5% dos resumos foram estudos clínicos controlados e randomizados. Um total de 41,7% incluíram crianças de 0 a 11 anos de idade e 14,7% utilizaram dentes decíduos humanos. CONCLUSÃO: A Odontopediatria desempenhou um papel importante na produção científica brasileira em 2009, oferecendo uma ampla diversidade de temas e abordagens metodológicas.

Mordida aberta anterior: a influência dos hábitos deletérios no crescimento facial e na oclusão dentária: relato de caso clínico / Anterior open bite: the influence of oral habits in facial growth and in dental occlusion: case report

A mordida aberta anterior (MAA), definida como o trespasse vertical negativo entre as bordas incisais dos dentes ântero-superiores e inferiores, é considerada uma das más-oclusões com maior comprometimento estético-funcional, além de gerar alterações dentárias e esqueléticas significantes. O objetivo deste trabalho foi discutir os aspectos de interesse no diagnóstico e tratamento da MAA e descrever um caso clínico utilizando a associação entre o controle do crescimento maxilar e a grade lingual. Um menino de 9 anos e 8 meses de idade procurou tratamento apresentando MAA associada a uma face hiperdivergente, mordida cruzada posterior e retrognatismo mandibular, com o histórico de sucção de chupeta até os 8 anos de idade. Inicialmente foi proposta a expansão rápida da maxila com o aparelho de Haas, seguida pelo controle do crescimento maxilar com o uso do AEB de tração alta associado à grade lingual. O tratamento foi finalizado com êxito e, ao final do período de 18 meses, observou-se a correção da MAA com melhora na relação vertical e sagital entre a maxila e a mandíbula, na estética facial e nas características oclusais.

Anterior open bite, generally referred as negative overbite between upper and lower dental arches, is one of the most compromising malocclusion from the esthetic and functional point of view and can generate significant skeletal and dental discrepancies. The objective of this work was to discuss aspects of interests in anterior open bite treatment and diagnosis and to describe a case in which an association of maxillary growth control and lingual crib was used. A boy of 9 years and 8 months old looked for treatment showing anterior open bite, hyper divergent pattern, posterior crossbite and mandibular retrognathism, with history of pacifier suction until 8 years old. Firstly maxillary rapid expansion was performed with Haas appliance following maxillary growth control with high pull headgear in association with lingual crib. The treatment was successfully finished and, after 18 months, anterior open bite was corrected, it was observed an important improvement in maxilo-mandibular vertical and sagital relationship, in facial esthetics and occlusion.

Tratamento da má oclusão de classe III com expansão rápida da maxila e uso de máscara: relato de caso clínico / Treatment o skeletal class III malocclusion with rapid maxillary expansion and facemask therapy: a case report

A má oclusão de Classe III de origem esquelética pode ser causada pelo excesso do crescimento mandibular, deficiência do crescimento maxilar ou pela associação de ambas. O estabelecimento de uma correta relação sagital entre a maxila e a mandíbula é essencial para o crescimento equilibrado da face, bem como para o restabelecimento da estética facial e da estabilidade oclusal. O objetivo deste trabalho foi discutir os aspectos de interesse no tratamento da Classe III e descrever o tratamento de um caso, utilizando a associação entre a expansão rápida da maxila e a protração maxilar. Uma menina de 6 anos e 5 meses procurou tratamento apresentando deficiência do terço médio da face, excesso mandibular, desvio funcional da mandíbula para a direita, além de mordida cruzada anterior e posterior unilateral direita. Inicialmente foi proposta a expansão rápida da maxila com o aparelho de Haas, seguida pelo avanço maxilar com a máscara facial. Ao final do período de 12 meses, utilizando a máscara facial, observou-se a correção da Classe III com a melhora na relação sagital entre a maxila e a mandíbula, implementação da estética facial e restabelecimento das características oclusais normais para a dentição mista. O tratamento foi finalizado com êxito devido ao correto diagnóstico e planejamento do caso, à correta aplicação dos princípios biomecânicos, à colaboração da paciente e ao crescimento favorável da face.

Skeletal Class III malocclusion generally results from mandibular protrusion, maxillary retrusion or a combination of both. The establishment of a correct maxilo-mandibular sagital relationship is a fundamental point to produce a balanced facial growth as well as to improve facial esthetics and oclusal stability. The objective of this work was to discuss aspect of interests in Class III treatment and to describe a case in witch an association of maxillary rapid expansion and facemask therapy was used. A 6 years and 5 months old girl looked for treatment showing midface deficiency, mandibular prognathism, functional mandibular shift to right and anterior and posterior (right side) crossbite. Firstly maxillary rapid expansion was performed with Haas appliance following maxillary advancement with facemask therapy. After 12 months of treatment an important improvement in maxilo-mandibular sagital relationship was observed, facial esthetics was improved and normal characteristics of occlusion in mixed dentition was present. The treatment was successfully finished once diagnostic and treatment plan was correctly established, biomechanical principles were correct applied and patient compliance and facial growth were favorable.