Tratamiento de luxación discal sin reducción: responsabilidad del odontopediatra / Treatment of disk displacement without reduction: the pediatric dentist´s responsibility

Actualmente, es frecuente la consulta por trastornos temporomandibulares (TTM) en la clínica odontopediátrica, siendo reconocida la múltiple causalidad de los mismos. Se presenta la resolución de una situación clínica de una paciente de 13 años de edad que acudió a la Cátedra de Odontología Integral Niños (OIN), presentando dolor muscular y articular del lado derecho, limitando la apertura bucal a 25 mm confortable y a 28 mm forzada, con desvío de la mandíbula hacia la izquierda. Refería haber sido atendida en una guardia médica el día anterior con bloqueo en apertura, luego de 8 meses de evolución, con síntomas de chasquido y doloir, sin haber realizado consulta alguna. Se indicó tratamiento sintomático y se solicitaron estudios complementarios. El diagnóstico fue de luxación discal sin reducción. Con la evaluación integral, se hallaron factores concomitantes, tales como maloclusión, hiperlaxitud, respiración bucal y parafunciones. En el abordaje terapéutico, se colocó un intermediario oclusal para reposicionamiento mandibular, se realizó tratamiento fonoaudiológico miofuncional y reeducación postural global (RPG). La paciente evolucionó favorablemente; a los 6 meses resolvió el ruido articular y al año estaba asintomática, con 37 mm de apertura, comenzando su tratamiento de ortodoncia y manteniendo controles durante 4 años. El compromiso de la familia y la participación de un equipo de trabajo, permitió la resolución integral del caso. El odontopediatra tiene la responsabilidad de alertar a padres y pacientes sobre factores de riesgo, diagnosticar TTM y orientar los tratamientos, involucrándose cuando corresponde su intervención, o derivando en forma oportuna...

Diagnóstico clínico de funciones orales: estudio comparativo de dos métodos de evaluación / CLinical diagnosis of oral functions: a comparative study of two evaluation methods

El diagnóstico funcional es fundamental en el tratamiento y pronóstico del paciente ortodóncico. Detectar deglución disfuncional o respiración bucal en etapa diagnóstica, nos permite arribar a un buen plan de tratamiento, que incluya la derivación al otorrinolaringólogoo a la fonoaudióloga en el caso de ser necesario, y favorece el pronóstico para lograr los objetivos propuestos y posibilitar la estabilidad post tratamiento. Objetivo: Comparar los resultados del diagnóstico funcional obtenidos por un mismo operador al mismo grupo de pacientes. Métodos: 22 pacientes, entre 16 y 30 años, pertenecientes a la Cátedra de Ortodoncia de la Facultad de Odontología de la Universidad deBuenos Aires. Se comparó utilizando dos mecanismos de diagnóstico: 1. Evaluación subjetiva y 2. Utilizando los test de respiración y de deglución como instrumento de evaluación. Resultados: con utilización del Test se registraron 18 pacientes con respiración nasal y 4 bucal, mientras que en la evaluación sinutilización se registraron 13 y 9 respectivamente, con diferencia estadísticamente significativa (P = 0.031). En la evaluación de la deglución con utilización del Test, de los 22 pacientes 3 presentaron deglución funcional, y 19 disfuncional, mientras que al evaluar sin utilización del Test, se registraron 8 con y 14 respectivamente, sin diferencia estadísticamente significativa, pero con un valor de p muycercano (P = 0.063). Conclusión: De los 22 pacientes, 6 no fueron correctamente diagnosticados al evaluarse su respiración y 5 no fueron correctamentediagnosticados al evaluarse su deglución, sin utilizar el Test por operadores con poca experiencia. La detección de disfunción respiratoriapresenta mayor dificultad que la de disfunción deglutoria...

El diagnóstico etiopatogénico en ortopedia funcional de los maxilares / Etiopathogenic diagnosis in functional maxillary orthopedics

La ortopedia funcional de los maxilares es una especialidad odontológica que trata los problemas funcionales, morfológicos y estéticos del complejo orofacial del paciente en crecimiento. En este contexto, la ortopedia funcional se distingue por su especial interés por la investigación de las causas y posteriores acontecimientos que en el transcurso de un período de tiempo provocan la manifestación clínica de una disgnacia; esta elaboración hipotética se denomina diagnóstico etiopatogénico. A través de una serie de casos clínicos se ejemplifica este proceso de diagnóstico, involucrando antecedentes hereditarios, trauma perinatal, alteraciones posturales, trastornos funcionales deglutorios, respiratorios, fonatorios y masticatorios, así como la biotipología facial. La elaboración de una hipótesis fundamentada que nos permita explicar las causas y acontecimientos que plasmaron el estado actual de nuestro paciente, nos impulsa a investigar, indagar, reflexionar y, finalmente, arribar a un conocimiento más amplio y profundo del mismo. Finalmente, el conocimiento de las posibles causas de la disgnacia nos conduce naturalmente hacia un diseño terapéutico integral.(AU)

El diagnóstico etiopatogénico en ortopedia funcional de los maxilares / Etiopathogenic diagnosis in functional maxillary orthopedics

La ortopedia funcional de los maxilares es una especialidad odontológica que trata los problemas funcionales, morfológicos y estéticos del complejo orofacial del paciente en crecimiento. En este contexto, la ortopedia funcional se distingue por su especial interés por la investigación de las causas y posteriores acontecimientos que en el transcurso de un período de tiempo provocan la manifestación clínica de una disgnacia; esta elaboración hipotética se denomina diagnóstico etiopatogénico. A través de una serie de casos clínicos se ejemplifica este proceso de diagnóstico, involucrando antecedentes hereditarios, trauma perinatal, alteraciones posturales, trastornos funcionales deglutorios, respiratorios, fonatorios y masticatorios, así como la biotipología facial. La elaboración de una hipótesis fundamentada que nos permita explicar las causas y acontecimientos que plasmaron el estado actual de nuestro paciente, nos impulsa a investigar, indagar, reflexionar y, finalmente, arribar a un conocimiento más amplio y profundo del mismo. Finalmente, el conocimiento de las posibles causas de la disgnacia nos conduce naturalmente hacia un diseño terapéutico integral.

Public community orthodontics in Italy. Description of an experience.

AIM: To assess the reliability and simplicity of a method chosen for selecting subjects to be treated in the orthodontic system and for the acceptance of the method by the community. MATERIALS AND METHODS: 490 orthodontic patients received full dental examination. For each patient a table was prepared for the detection of malocclusion in which the occlusal characteristics according to the Norwegian Orthodontic Treatment Index (NOTI), the molar class and the teeth present were recorded. The parents of the examined children completed a questionnaire aimed at identifying their social ranking. In the same questionnaire, how many siblings the patient had was also asked. Each of the three parameters were rated alphanumerically and a score of 1 was given to each child; the sum of three scores gave the final result for the subject. Acceptance of the procedure in the general community was evaluated by the number of complaints received by the Public Relations Office (URP). RESULTS: The social classes most represented in the sample are "blue collar class" (42.2%) and "white collar class" (35.6%). There was an average of 2.1 children per family (SD=0.6). The distribution of the type and grading of the treatment need was similar throughout the different social classes. CONCLUSION: The chosen method proved reliable for two reasons: no complaints with the local URP and ease of application of the selected criteria.

Clinical association between teeth malocclusions, wrong posture and ocular convergence disorders: an epidemiological investigation on primary school children.

BACKGROUND: As the various systems in the body are inter-connected to form a single structural unit, a pathological condition in one area can also affect other areas. There are many known correlations between the visual and motor system. The importance of visual function, particularly the paracentral peripheral field of view, in motor coordination, ambulation and the maintenance of balance has been amply demonstrated.In line with current medical principles, which are moving towards a more holistic view of the human body, this study aims to investigate, in an interdisciplinary manner, the incidence of dental malocclusions together with posture and eye convergence disorders. METHODS: Six hundred and five children attending at the 3rd, 4th and 5th years of seven Genoa primary schools were examined. Each child underwent the following examinations: (i) dental/occlusal; (ii) orthoptic; and (iii) postural. Occlusal data concerned the presence of cross-bite, midline deviation with a mandibular shift, bad habits and deep or open bite.Postural assessment involved frontal and lateral inspection, investigation during trunk flexion and ambulation, and note of any asymmetry in the lower limbs. The recorded orthoptic data included those pertaining to ocular dominance, a cover test, convergence and the Brock string test. RESULTS: A prevalence of cases with an unphysiological gait was found in patients with overjet (14.70%) or overbite (14.87%), while the percentage of patients with normal occlusion that showed an unphysiological gait was 13.08%. Also, about 93.8%-94.2% of children showed normal legs without dysmetry, with no difference in respect to the type of occlusion. Subjects with an open bite or deep bite showed a slightly different distribution of right or left dominant eyes. CONCLUSION: About 13% of children showed a pathological gait and, among them, vertical anomalies of occlusion (deep bite or open bite) were prevalent with respect to the other occlusal defects. The vertical dimension of occlusion revealed a slight relationship with the proper dominant eye. Postural, orthoptic, osteopathic and occlusal variables were often clinically associated, and therefore these disorders appear to request a multidisciplinary medical approach for their treatment.

Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for.

The aim of this investigation was to perform a review of the literature dealing with the issue of relationships between dental occlusion, body posture and temporomandibular disorders (TMD). A search of the available literature was performed to determine what the current evidence is regarding: (i) The physiology of the dental occlusion-body posture relationship, (ii) The relationship of these two topics with TMD and (iii) The validity of the available clinical and instrumental devices (surface electromyography, kinesiography and postural platforms) to measure the dental occlusion-body posture-TMD relationship. The available posturographic techniques and devices have not consistently found any association between body posture and dental occlusion. This outcome is most likely due to the many compensation mechanisms occurring within the neuromuscular system regulating body balance. Furthermore, the literature shows that TMD are not often related to specific occlusal conditions, and they also do not have any detectable relationships with head and body posture. The use of clinical and instrumental approaches for assessing body posture is not supported by the wide majority of the literature, mainly because of wide variations in the measurable variables of posture. In conclusion, there is no evidence for the existence of a predictable relationship between occlusal and postural features, and it is clear that the presence of TMD pain is not related with the existence of measurable occluso-postural abnormalities. Therefore, the use instruments and techniques aiming to measure purported occlusal, electromyographic, kinesiographic or posturographic abnormalities cannot be justified in the evidence-based TMD practice.

The "Interdisciplinary Orofacial Examination Protocol for Children and Adolescents": a resource for the interdisciplinary assessment of the stomatognatic system.

The Interdisciplinary Orofacial Examination Protocol for Children and Adolescents (Protocolo de exploración interdisciplinaria orofacial para niños y adolescents, Barcelona, 2008) is very useful in providing a fast, initial, expedient detection of possible morphological and functional disorders, and to guide the patient toward the appropriate professionals. With this tool it is possible to detect the risk factors which can negatively affect morphological and functional harmony and guide patients toward the necessary treatment as early as possible. This Protocol, developed by 4 orthodontists, 1 ENT and 3 speech language therapists, also contributes to the unification of concepts and nomenclature used by distinct specialists, thus making professional understanding easier and more dynamic.

A one-page orofacial myofunctional assessment form: a proposal.

The author presents her own proposal of a one-page orofacial myofunctional assessment and for each item on the list a brief rationale is provided. The protocol is an easy but comprehensive form that can be faxed or emailed to referral sources as needed. As science provides more objective assessment and evaluation tools, this one-page form can be easily modified.

Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome.

BACKGROUND: Orthodontic and craniofacial abnormalities have often been reported in pediatric sleep-disordered breathing (SDB). While the reversibility of these craniofacial abnormalities by means of adenotonsillectomy has yet to be established, orthodontic treatment based on oral appliances is considered to be a potential additional treatment for pediatric SDB. DISCUSSION: Oral appliances may help improve upper airway patency during sleep by enlarging the upper airway and/or by decreasing upper airway collapsibility, thereby enhancing upper airway muscle tone. Orthodontic therapy should be encouraged in pediatric OSAS, and an early approach may permanently modify nasal breathing and respiration, thereby preventing obstruction of the upper airway.

[Are you afraid of open bite?].

Treatment of open bite malocclusion is a challenge for both the orthodontist and the patient. The key to successful treatment are careful evaluation, that leads to correct diagnosis and treatment plan, as well as meticulous cooperation on behalf of the patient. There are many treatment options starting with follow up and orofacial myofunctional therapy, and concluding with orthosurgical correction. The tendency to relapse and reopening the bite must be emphasized to the patient before initiation of the orthodontic treatment. It is highly recommended in indicated cases to include orofacial myofunctional therapy in combination with the orthodontic treatment. New modalities of treatment give great promise for the future, and enable us to intrude posterior teeth using skeletal anchorage. However, it is still unknown whether these new treatment modalities will give better stability for open bite correction.

Association of orthodontic treatment needs and oral health-related quality of life in young adults.

INTRODUCTION: Our objective was to assess the effect of different orthodontic treatment needs on the oral health-related quality of life of young adults. METHODS: The study sample comprised 366 young adult orthodontic patients (153 men, 213 women; age range, 21-25 years). Each participant was assessed for orthodontic treatment need and oral health-related quality of life by using the dental health component of orthodontic treatment need index and the shortened version of oral health impact profile questionnaire. RESULTS: Orthodontic patients who had little or no, borderline, and actual need for orthodontic treatment represented 14.8%, 56%, and 29.2% of the total sample, respectively. Orthodontic treatment need significantly affected mouth aching, self-consciousness, tension, embarrassment, irritability, and life satisfaction in both sexes. Also, orthodontic treatment need significantly affected taste and relaxation in both men and women. However, pronunciation and the ability to do jobs or function effectively were not significantly associated with orthodontic treatment needs in either sex. CONCLUSIONS: These findings emphasize the impact of malocclusion on oral health-related quality of life of young adults.

Occlusal disease management system: the diagnosis process.

The goal of every dentist is to preserve the health of his or her patients' masticatory system, as well as to anticipate the long-term results when restorative treatment is provided. These goals cannot be accomplished in the presence of occlusal disease. During the routine oral examination, the signs and/or symptoms of occlusal disease must be noted and the patient educated about the need for further diagnosis and treatment. Better care can be provided to patients if occlusal disease and/or temporomandibular disorders are detected early and properly treated. Treating occlusal disease can lead to a long, healthy life of the dentition as well as to restorative success.

Orthodontic treatment needs in the western region of Saudi Arabia: a research report.

BACKGROUND: Evaluation of self perceived and actual need for orthodontic treatment helps in planning orthodontic services and estimating the required resources and man power. In the present study, the perceptive need as evaluated by patients and the actual need to orthodontic treatment, as assessed by orthodontists, were evaluated at two types of dental practices in the city of Jeddah using the Index of Orthodontic Treatment Need (IOTN). METHODS: A consecutive sample of 743 adults seeking orthodontic treatment at two different types of dental practices in Jeddah; King Abdulaziz University, Faculty of Dentistry (KAAU) (Free treatment) and two private dental polyclinics (PDP) (Paid treatment), was examined for orthodontic treatment need using the dental health component (DHC) of the IOTN. The self-perceived need for orthodontic treatment was also determined using the aesthetic component (AC) of the IOTN. The IOTN score and the incidence of each variable were calculated statistically. AC and DHC categories were compared using the Chi-Square and a correlation between them was assessed using Spearman's correlation test. AC and DHC were also compared between the two types of dental practices using the Chi-Square. RESULTS: The results revealed that among the 743 patients studied, 60.6% expressed no or slight need for treatment, 23.3% expressed moderate to borderline need and only16.1% thought they needed orthodontic treatment. Comparing these estimates to professional judgments, only 15.2% conformed to little or no need for treatment, 13.2% were assessed as in borderline need and 71.6% were assessed as in need for treatment (p < 0.001). Spearman's correlation test proved no correlation (r = -.045) between the two components. Comparing the AC and the DHC between the KAAU group and PDP group showed significant differences between the two groups (p < 0.001). CONCLUSION: Patient's perception to orthodontic treatment does not always correlate with professional assessment. The IOTN is a valid screening tool that should be used in orthodontic clinics for better services especially, in health centers that provide free treatment.

An evaluation of the use of digital study models in orthodontic diagnosis and treatment planning.

The purpose of the present study was to determine the diagnostic and treatment planning value of digital models when compared with plaster study casts. In addition, the level of orthodontic experience of the examiner was assessed to determine whether this would have an influence on the decision-making process. Thirty randomly selected orthodontic patients from the Department of Orthodontics at the University of Alabama were selected for the study. From the 30 record sets, seven were selected attempting to mirror cases required for presentation to the American Board of Orthodontics. The seven evaluators were divided into two groups on the basis of their level of orthodontic experience. Initially, each evaluator assessed each patient record. Each evaluator was given a standardized questionnaire which recorded the evaluator's diagnosis based on use of the digital study models (T1). Regardless of whether the evaluator requested a review of the plaster study casts, the evaluator was given the plaster study casts. The evaluator then, using the plaster casts, filled out another identical questionnaire (T2). A chi-square test was used to determine any group differences in the frequency of changed diagnostic characteristics, treatment mechanical procedures, or proposed treatment plans after evaluating plaster study models. The statistical significance selected was P = .05 level of significance. The results showed that 12.8% of diagnostic characteristics, 12% of treatment mechanic procedures, and 6% of proposed treatment plans changed after T2. The results of the present study indicate that in the vast majority of situations digital models can be successfully used for orthodontic records.

Orthodontic therapy and third party in Europe.

This paper is an attempt to individuate some principles and guidelines apt to regulate the relationship between orthodontists and financing third parties, applicable to most western European Countries. The concepts of orthodontic treatment need, orthodontic treatment request and orthodontic screening are discussed, alongside with a short overview of some of the most common indexes to assess the severity of the malocclusion and/or the treatment priority. The screening method introduced by the Danish Ministry of Health is presented; its importance lies in the fact that for the first time a direct correlation between health risk and individual malocclusions is recognized and assessed. In the discussion, it is stressed how the screening system tightly depends on the chosen general model for orthodontic care. Different models of orthodontic care organization as presently used in many European countries are presented and shortly discussed; among these, the Norwegian model is described more in details, because of its simplicity. Eventually, some guidelines considered necessary in order to achieve satisfactory standards of quality and efficiency are presented and discussed.

Mordidas cruzadas posteriores: etiología, diagnóstico y tratamiento / Posterior crossbites: etiology, diagnosis and treatment

Las mordidas cruzadas posteriores son anomalías transversales frecuentes en niños, que rara vez se autocorrigen. Los factores desencadenantes, aparentemente inofensivos, como por ejemplo contactos prematuros o hábitos, deben ser corregidos en forma temprana, porque de lo contrario llevan a la persistencia de las mismas. Es importante destacar la necesidad de realizar un diagnóstico precoz, identificando las diferentes etiologías de las mordidas cruzadas, e implementar las medidas terapéuticas indicadas para cada caso, con la finalidad de permitir una óptima maduración del complejo neuromuscular y una máxima expresión del potencial de crecimiento