Métodos de expansão rápida da maxila em pacientes com fissura labiopalatal ­ revisão sistemática / Methods of rapid maxillary expansion in patients with cleft lip and palate ­ a systematic review

Este estudo objetivou comparar as modificações maxilares após expansão com dois diferentes protocolos de ativação. Os artigos selecionados deveriam ser estudos clínicos em humanos, exceto relato de caso, com medidas feitas em radiografias ou em modelos de estudo, pacientes com fissura transforame incisivo bilateral ou unilateral direita ou esquerda, com mordida cruzada posterior, que não se submeteram a procedimentos cirúrgicos, exceto a labioplastia e palatoplastia na primeira infância, ou a outro tratamento ortodôntico ou ortopédico anteriormente à expansão maxilar, a qual deve ter sido realizada a partir da dentição mista ou durante o período de crescimento puberal. Com base nesses critérios de inclusão, foram selecionados 58 artigos baseados na leitura dos resumos. Após descarte dos artigos duplicados e dos demais que, com base na leitura dos resumos, não estavam de acordo com os critérios de inclusão, 11 artigos foram selecionados para leitura completa e, destes, apenas 6 preencheram todos os requisitos necessários para ser avaliados. Após a análise dos 6 artigos selecionados definitivamente, observou-se que tanto a ERM quanto ERMC-Alt são métodos eficientes na expansão maxilar. Não houve diferenças significativas quanto ao ganho de dimensão transversal da maxila entre os diferentes tipos de protocolos, tanto com disjuntores do tipo Hass ou Hyrax quanto com parafusos expansores. Concluiu-se que a expansão maxilar foi eficaz com os diferentes protocolos de tratamento. A expansão rápida maxilar promoveu o aumento das dimensões transversais da maxila tanto em pacientes com fissura labiopalatal quanto com fissura palatal, sem comprometimento labial. (AU)

This study aimed to compare maxillary changes following expansion with two different activation protocols. Only human clinical studies, except case reports, using measurements on radiographs or study casts of patients with complete unilateral or bilateral cleft lip and palate with posterior crossbite who did not undergo surgical procedures, except labioplasty and palatoplasty in the early childhood or other orthodontic or orthopaedic treatment prior to maxillary expansion, which should have been performed during mixed dentition or pubertal growth period were selected. Based on these inclusion criteria, 58 articles were found. After ruling out duplicated articles and others that did not meet the inclusion criteria by reading their abstracts, 11 studies were selected for full reading, resulting in only 6 which met all the required requisites for evaluation. After analysis of the 6 articles selected, it was observed that both RME and alt-RMEC are efficient methods for maxillary expansion. There were no significant differences regarding the increase of maxillary transverse dimension between the different types of protocol using both Hass or Hyrax expansion appliances and expanding screws. It was concluded that maxillary expansion was effective with different treatment protocols. Rapid maxillary expansion promoted increase of maxillary transverse dimensions in both patients with cleft lip and palate and those with cleft palate without lip involvement.(AU)

Plano inclinado na dentição mista ­ relato de caso / Inclined plane in mixed dentition ­ case report

Este estudo teve por objetivo relatar o caso clínico da mordida cruzada dentária anterior no início da dentição mista tratada com plano inclinado. Após o diagnóstico da mordida cruzada dentária anterior envolvendo o dente 52, em paciente do gênero feminino, com 6 anos de idade, foi esclarecido à mãe sobre as alternativas de tratamento, optando-se pela extração dentária (81), confecção e instalação do plano inclinado, confeccionado em resina acrílica autopolimerizável, devido à pouca idade da paciente e por ser uma técnica de rápido resultado e com custo baixo. Durante o tratamento foram feitas consultas semanais de checagem e ajuste oclusal para garantir que apenas o dente 52 tocasse na inclinação de 45 graus do aparelho. A manutenção do aparelho foi feita semanalmente para realizar checagem da oclusão e ajustes necessários. Após 3 semanas o aparelho foi removido. O descruzamento da mordida foi alcançado, com o dente 52 em sua inclinação e intercuspidação ideal. Concluiu-se que o plano inclinado é uma das opções do tratamento ortodôntico para correção da mordida dentária anterior, em pacientes na dentadura decídua ou mista, propiciando maior possibilidade de desenvolvimento dentoesquelético, uma vez que a maloclusão é corrigida. Por ser de baixo custo, fácil confecção, eficaz e com tempo de tratamento reduzido, poderá ser utilizado em todas as clínicas escolas do curso de Odontologia.(AU)

This study aimed to report a clinical case of anterior crossbite at the beginning of mixed dentition treated with inclined plane appliance. After diagnosis of anterior crossbite of tooth 52 in a 6-year-old girl, the mother was informed on the treatment options. It was chosen to extract tooth 81 and install an inclined plane appliance, made of self-curing acrylic resin, since the patient was young and the technique yields rapid results at low cost. Weekly visits were conducted during the treatment for follow-up and occlusal adjustments, thus ensuring that only tooth 52 reached the 45 degree inclination of the appliance. The maintenance of the appliance was performed every week for checking occlusion and making necessary adjustments. The appliance was removed after 3 weeks. The crossbite was resolved as tooth 52 tipped towards its ideal inclination and intercuspidation. It was concluded that the use of inclined plane appliance is one of the orthodontic treatment options for correcting anterior crossbite in patients with deciduous or mixed dentition, thus enabling a better dental-skeletal development as the malocclusion is corrected. Because this technique yields rapid, effective and low-cost results by using an easily-made appliance, it can be used in all clinical dental courses (AU)

Evaluation of the Maternal Perception of the Oral Health of the Inpatient Infant

Aim: To evaluate the mother's perception of the oral health of their inpatient infants in maternity or infirmary units of a public hospital. Methods: Questionnaire applications were scheduled and educational lectures were carried out on how to sanitize the infant's mouth after breastfeeding, even in the absence of primary teeth, emphasizing the importance of breastfeeding. Results: A significant number of mothers reported that they received no guidance regarding the oral health care of their infants. They had never attended lectures by dental practitioners, as well as they did not know that the use of pacifier, baby bottle and digital sucking habit could interfere with their infant's oral heath over time. Conclusions: The majority declared that they had no care with the oral health of their infants. Only five mothers of newborns reported that they performed the oral hygiene of them once a day after the first breastfeeding. The mothers showed lack of knowledge on the diseases which can affect their children during early infancy as they had no information on how to prevent them. They did not know that early caries lesions could affect the infant and that harmful oral habits can predispose to the development of malocclusions. (AU)

Dentists' actions about oral health of individuals with Down Syndrome

To investigate the knowledge and actions of dentists for treatment of individuals with Down syndrome. Methods: A questionnaire was applied to all the dentists (n=90) working at the FHS (Family Health Strategy) modules in the urban limits of Parnaíba, PI, Brazil. Four of the questions in the questionnaire were written according to the Theory of Planned Behavior Table and Likert scale (questions 6,7,9 and 15), in order to analyze the professionals' intentions. Sixteen objective questions were elaborated with the purpose of collecting information about the degree of the dentists' knowledge as regards the intention of attending courses in the patients with special needs area including DS, and interaction with other professionals and families. The option was to use a questionnaire applied to the dentists of the region, from August to November 2014. Results: It was found that most professionals were women and they considered themselves able to identify these patients. Among the professionals, 70% showed they had no difficulty in identifying the patient with DS, and 5.2% had no opinion about the subject. Only 6.6% of the professionals showed to be certain about their aptitude to attend to these patients; 70% were partially apt, that is, they were not absolutely sure about their aptness. There was a statistical relationship between the variables understanding and difficulty in the treatment. There was no statistical relationship between the variable capacity to identify, understanding of the needs and fitness variable in attendance. Conclusions: Patients with Down syndrome need more attention and care of dentists, they must also be involved in a multidisciplinary approach. Most of the professionals do not follow the procedures laid down by the Ministry of Health, but showed interest in attending a course in this area and there is a low number of SD patients being cared in Parnaíba, PI...