Human diprosopus: Case report of a rare congenital abnormality.

Diprosopus is a congenital anomaly in which partial or complete duplication of craniofacial structures occurs. Because it is rare, the mortality rate is high, and information concerning this anomaly is scarce. This study describes a case of human diprosopus in a 9-year-old male individual, who has severe complications associated with the central nervous, cardiovascular, respiratory, and digestive systems. Since birth, he has been monitored in a specialized hospital environment, where he has undergone several surgeries and multidisciplinary treatments. Regarding the craniofacial aspects, he had agenesis of the corpus callosum, floor of the nasal cavity, and floor of the anterior cranial fossa, in addition to the presence of bone dysplasia, ocular hypertelorism and cleft palate with nasal and oral teratoma. Regarding dental characteristics, the patient has duplication of the maxilla, mandible, tongue, and some teeth. After complementary imaging exams, several supernumerary teeth were found, with some being impacted and in complex regions, with an indication for extraction due to the risks of impaction, irruptive deviation, root resorption, and associated cystic or tumoral lesions. Because of the numerous complications, knowledge, and preparation of the entire team is necessary for the correct management of the case.

Two-phase orthodontic treatment of a complex malocclusion: giving up efficiency in favor of effectiveness, quality of life, and functional rehabilitation?

The interceptive orthodontic treatment of patients with complex dentofacial abnormalities is frequently inefficient and produces less than ideal outcomes. Therefore, postponing therapy to a single-phase surgical-orthodontic approach might be considered a reasonable option. However, other relevant aspects of the patient's quality of life, such as possible psychosocial problems and functional impairments, should also be considered before deciding whether to intercept a severe dentofacial malocclusion while the patient is still growing, or wait and treat later. This case report describes the nonsurgical treatment of a young patient with a severe Class III open-bite malocclusion associated with a cervical cystic lymphangioma. Despite the poor interceptive therapy prognosis, a 2-phase approach was effective. A reflection about giving up efficiency in favor of effectiveness, functional rehabilitation, and the patient's quality of life is included.

Is the computed tomography exam important for planning mini-implant installation?

Background: Mini-implants are devices used to provide absolute and temporary anchorage for tooth movement. Objectives: The present study was carried out to compare the use of periapical radiographs and computed tomography (CT) for planning mini-implants performed by orthodontists. Material and Methods: Five radiographs and five CT scans of premolars and molars regions. These were analyzed by ten Orthodontists. Initially (T1), the evaluators indicated the preferred location for the insertion of a mini-implant, as well as the diameter and length of the device, using only a periapical radiograph. After 30 days (T2), the same evaluation was performed. Sixty days later (T3), the orthodontists reassessed the radiographs in association with the CT scans. Finally, after 90 days (T4), the evaluation was performed with the same exams. The comparison of the chosen diameter and length of the mini-implants was performed using the Student's t-test. The evaluation of the chosen insertion sites was analyzed by the Wilcoxon test. For both tests, the level of significance was 5%. The kappa concordance test was also performed for the intra- and inter-examiner evaluations. Results: The results of the study showed substantial or perfect intra-examiner and reasonable to perfect inter-examiner agreement. Considering the length and diameter of the mini-implants, no statistical difference was found between the groups. Regarding the insertion site, more than 20% of the treatment plans were changed when the CT scan was associated. Conclusions: The results showed that the association of a CT scan with radiography frequently leads the professional to change the insertion point for the installation of mini-implants. Key words:Orthodontic anchorage procedures. Mini Dental Implants. Bone Screws. Cone-beam computed tomography. Periapical radiography.

Patient with McCune albright syndrome: Case report and 10 Years of follow-up imaging examination.

The McCune Albright syndrome (MAS) is a rare, multi-system disease composed of the triad of polyostotic fibrous dysplasia of bone (PFDB), café-au-lait skin hyperpigmentation, and endocrine disorders. The diagnosis involves clinical, biochemical and imaging findings, with dentistry playing an important role in MAS, since many patients present DFPO in the craniofacial bones, including the maxilla and mandible, and in view of their dental needs, the correct management of these patients is not only an essential but important area to be investigated. This report presents a case of a patient with McCune Albright Syndrome, the behavior of the disease over a period of 10 years and how imaging exams such as scintigraphy and tomography were important for planning the dental treatment of this patient, since they are fundamental allies for identification and evaluation of the progression and/or stability of the disease. Key words:Craniofacial fibrous dysplasia, cone-beam computed tomography, scintigraphy, imaging diagnosis.

The "Phase Down" of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

ABSTRACT Objective: To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4. Material and Methods: The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality. Results: Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth. Conclusion: The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

Contribution of atypical chemokine receptor 2/ackr2 in bone remodeling.

INTRODUCTION: Bone remodeling is a tightly regulated process influenced by chemokines. ACKR2 is a decoy receptor for CC chemokines functioning as regulator of inflammatory response. In this study we investigated whether the absence of ACKR2 would affect bone phenotype and remodeling induced by mechanical loading. METHODS: An orthodontic appliance was placed between incisors and first molar of ACKR2 deficient (ACKR2-/-) and C57BL6/J (wild-type/WT) mice. Microtomography, histology and qPCR were performed to evaluate bone parameters, orthodontic tooth movement (OTM), bone cells counts and the expression of ACKR2, bone remodeling markers, CC chemokines and chemokines receptors. Bone marrow cells (BMC) from WT and ACKR2-/- mice were differentiated in osteoclasts and osteoblasts for analysis of activity and expression of specific markers. RESULTS: Mechanical stimulus induced ACKR2 production in periodontium. The expression of ACKR2 in vitro was mostly detected in mature osteoclasts and early-differentiated osteoblasts. Although ACKR2-/- mice exhibited regular phenotype in maxillary bone, the amount of OTM, osteoclasts counts and the expression of pro-resorptive markers were increased in this group. In contrast, the number of osteoblasts and related markers were decreased. OTM resulted in augmented expression of CC chemokines and receptors CCR5 and CCR1 in periodontium, which was higher in ACKR2-/- than WT mice. In vitro experiments demonstrated an augmented formation of osteoclasts and diminished differentiation of osteoblasts in ACKR2-/- mice. CONCLUSIONS: These data suggests that ACKR2 functions as a regulator of mechanically-induced bone remodeling by affecting the differentiation and activity of bone cells and the availability of CC chemokines at periodontal microenvironment. Therapeutic strategies based on increase of ACKR2 might be useful to hinder bone loss in inflammatory conditions.

Tratamento orto-cirúrgico de mordida aberta esquelética associada a múltiplas recessões periodontais e abfrações - relato de caso / Surgical-orthodontic treatment of a skeletal open bite associated with multiple periodontal recessions and abfractions - case report

O número de indivíduos adultos que vem procurando por tratamento ortodôntico nas últimas décadas é crescente. O tratamento desses pacientes, muitas vezes, apresenta dificuldades adicionais à má oclusão e, dentre as mais comuns, estão aquelas que envolvem problemas nos tecidos periodontais. Quando tais fatores estão associados à má oclusão severa, como a de etiologia esquelética, a correção ortodôntica torna-se ainda mais complexa. O objetivo do presente artigo é descrever uma abordagem interdisciplinar de uma paciente com mordida aberta esquelética e dentária severas, bem como comprometimento estético também derivado da presença de múltiplas recessões gengivais e abfrações, que resultou em importante ganho em estética facial e dentária, assim como em significativa melhora funcional.

The number of adults seeking for orthodontic treatment has consistently increased in the past decades. Treatment of these patients may be more challenging if the periodontal tissues exhibit limitations. When these factors are associated to severe skeletal malocclusions, the orthodontic treatment becomes even more complex. The purpose of the present study was to report an interdisciplinary approach implemented in the treatment of a patient with a severe skeletal open bite and a compromised aesthetic condition that was also derived from the presence of multiple periodontal recessions and abfractions, which resulted in a significant intra and extra-oral aesthetics improvement as well as in functional enhancement.

Mordida de Brodie: relato de caso / Brodie Bite: interceptive and corrective approach of a challenging malocclusion - case report

A mordida cruzada posterior completa por vestibular, conhecida como mordida de Brodie, é uma má oclusão rara e com indicação clara de abordagem interceptora. Entretanto, os desafios encontrados durante a terapia deste tipo de má oclusão são inúmeros, especialmente a elevada taxa de recidiva e as limitações mecânicas inerentes à expansão mandibular e contração maxilar. Este artigo apresenta um caso clínico que ilustra a abordagem interceptora e corretiva de uma mordida de Brodie, associada a uma má oclusão de Classe II, mordida profunda de uma criança de 7 anos de idade, com o objetivo de contribuir na terapia de casos semelhantes. Uma reflexão acerca da eficácia e eficiência da interceptação das mordidas cruzadas posteriores vestibulares é também apresentada

Posterior buccal cross bite, also called scissors bite or Brodie bite, is a rare malocclusion with clear indication of interceptive approach. However, several challenges are found during its treatment, specially the high relapse rate and the mechanical limitations of expanding mandibular arch and contracting maxillary arch. Therefore, this paper reports the orthodontic interceptive and corrective treatment of 7 year-old girl, with a Class II, deep bite, Brodie bite. A reflection about effectiveness and efficiency of such therapy was also presented.