Rehabilitación estética asistida por diseño digital de sonrisa en asimetrías dentofaciales: Reporte de caso / Aesthetic rehabilitation assisted by digital smile design for dentofacial asymmetries: Case report

RESUMEN: Tradicionalmente se ha propuesto una coincidencia entre la línea media facial y dentaria como requisito para transmitir una impresión de simetría, balance y armonía estética. Sin embargo, esta situación puede ser compleja de lograr en rostros asimétricos, impulsando el desarrollo de nuevos protocolos de análisis dentofacial para obtener resultados armónicos y conservadores integrando las estructuras anatómicas que se desvíen de las normas establecidas. Caso: El objetivo de este reporte de caso es presentar una rehabilitación estética integral en base a prótesis fija unitaria libre de metal, asistida por diseño digital de sonrisa, en un paciente con asimetría facial utilizando el concepto de flujo facial (FF) como protocolo de análisis estético dentofacial. Conclusiones: El concepto de FF establece parámetros estéticos dentro de rangos de armonía, permitiendo planificar rehabilitaciones más conservadoras. Sin embargo, faltan estudios para determinar el impacto de este análisis.

ABSTRACT: The traditional aesthetic parameters demand a coincidence between the facial and dental midlines that transmits an impression of symmetry, balance and harmony. However, the complexity of achieving this standard in faces with large asymmetries, has driven to the development of new dentofacial analysis protocols such as the concept of facial flow (FF), in order to obtain harmonic and conservative results integrating the structures that deviate from the norm. Case: The aim of this case report is to present an integral aesthetic rehabilitation based on metal-free fixed prostheses assisted by digital smile design in a patient with facial asymmetry using the concept of FF. Conclusions: The use of dentofacial aesthetic analysis protocols such as FF aids in the development of harmonic and less invasive dental treatments. However, due to the recent appearance of the FF concept, further studies are needed to reveal the implications of this analysis.

Resin cutback technique for interim implant-supported crowns.

This report describes the direct fabrication of interim implant-supported crowns in a single clinical session by applying a preheated composite resin to a clear silicone matrix made by diagnostic waxing. This technique facilitates the fabrication of custom interim restorations with appropriate soft-tissue molding and enables an inexpensive, predictable, functional, and esthetic outcome after implant surgery.

Dimenhydrinate in children with infectious gastroenteritis: a prospective, RCT.

OBJECTIVE: Vomiting is a common symptom in children with infectious gastroenteritis. It contributes to fluid loss and is a limiting factor for oral rehydration therapy. Dimenhydrinate has traditionally been used for children with gastroenteritis in countries such as Canada and Germany. We investigated the efficacy and safety of dimenhydrinate in children with acute gastroenteritis. METHODS: We performed a prospective, randomized, placebo-controlled, multicenter trial. We randomly assigned 243 children with presumed gastroenteritis and vomiting to rectal dimenhydrinate or placebo. Children with no or mild dehydration were included. All children received oral rehydration therapy. Primary outcome was defined as weight gain within 18 to 24 hours after randomization. Secondary outcomes were number of vomiting episodes, fluid intake, parents' assessment of well-being, number of diarrheal episodes, and admission rate to hospital. We recorded potential adverse effects. RESULTS: Change of weight did not differ between children who received dimenhydrinate or placebo. The mean number of vomiting episodes between randomization and follow-up visit was 0.64 in the dimenhydrinate group and 1.36 in the placebo group. In total, 69.6% of the children in the dimenhydrinate group versus 47.4% in the placebo group were free of vomiting between randomization and the follow-up visit. Hospital admission rate, fluid intake, general well-being of the children, and potential adverse effects, including the number of diarrhea episodes, were similar in both groups. CONCLUSIONS: Dimenhydrinate reduces the frequency of vomiting in children with mild dehydration; however, the overall benefit is low, because it does not improve oral rehydration and clinical outcome.

Antiemetic medications in children with presumed infectious gastroenteritis--pharmacoepidemiology in Europe and Northern America.

OBJECTIVE: To investigate the prescription pattern of antiemetic medications in 0- to 9-year-old children with infectious gastroenteritis in several industrialized countries during 2005. STUDY DESIGN: We retrospectively retrieved data from 4 national and international databases (IMS MIDAS, IMS disease analyzer, WIdO databases). RESULTS: Between 2% and 23% of children with gastroenteritis (International Classification of Diseases code A08.X or A09) received prescriptions for antiemetic medications (United States, 23%; 95% CI, 15-31; Germany, 17%; 95% CI, 15-20; France, 17%; 95% CI, 14-19; Spain, 15%; 95% CI, 10-19; Italy, 11%; 95% CI, 7-16; Canada, 3%; 95% CI, 0-16; United Kingdom, 2%; 95% CI, 1-2). The antihistamines dimenhydrinate and diphenhydramine were most frequently used in Germany and Canada, whereas promethazine was prescribed preferentially in the United States. In France, Spain, and Italy, the dopamine receptor antagonist domperidone was preferred as antiemetic treatment. Ondansetron was used in a minor proportion of antiemetic prescriptions (Germany, Canada, Spain, and Italy, 0%; United States, 3%; United Kingdom, 6%). CONCLUSION: Antiemetic drugs are frequently used in children with gastroenteritis. In different industrialized countries, prescription of antiemetic medication varies considerably. Ondansetron, the only drug with evidence-based antiemetic efficacy, plays a minor role among antiemetic prescriptions.