Effect of various educational methods on increasing parents' awareness of their children's preventive orthodontic treatments

Aim: Like other fields of health, the main focus in dentistry has shifted from treatment to prevention of diseases. Parents have a vital role in deciding about their children's oral health issues. This study aims to investigate the effectiveness of four educational methods (including printed pamphlets, digital pamphlets, faceto-face education, and educational films) in increasing the awareness of parents about preventive orthodontic treatments. Methods: The study samples were selected from patients who were referred to the Pediatric Dentistry Department. 150 parents of children between 4-12 years old participated in the study. They filled out a questionnaire including demographic data and knowledge about orthodontic problems and their early treatments. Then they were divided into five groups (control, printed pamphlet, digital pamphlet, face-to-face, educational films) and after one month they repeated the test. Results: A total of 102 fathers and 48 mothers were evaluated. There was no statistical difference between different ages, sex, or income in terms of their awareness, but the awareness score between educational groups was different. There has been observed a significant increase in the awareness level of all four groups (except the control group) (P < 0.05). The highest score was seen in the video group. The difference between printed pamphlets and digital pamphlets was not significant. Conclusions: The results indicate that educational films are the most effective way of increasing awareness about preventive orthodontic treatments

Expansor de Williams: passo a passo / Williams expander: step-by-step procedures

Resumo Os apinhamentos suaves a moderados na dentição mista podem ser tratados com expansão rápida da maxila (ERM) associada à expansão lenta do arco dentário inferior. A expansão lenta no arco inferior pode ser conduzida com uma alternativa de aparelho fixo e com parafuso. O objetivo deste artigo consiste em apresentar o protocolo laboratorial e clínico do expansor de Williams. Apresentou-se um caso clínico de uma paciente do sexo feminino, 9 anos de idade, com a face simétrica do Padrão I na dentadura mista, com apinhamento moderado dos incisivos inferiores e apinhamento suave no arco superior. O tratamento foi realizado com expansão superior e inferior. No arco superior, a ERM mediante o aparelho Hyrax foi realizada. No arco inferior, procedeu-se à expansão lenta com expansor de Williams. Obteve-se uma adequada oclusão com o alinhamento dos incisivos permanentes e uma melhora do corredor bucal no sorriso. O expansor de Williams representa uma alternativa para os casos que necessitam expansão lenta do arco dentário inferior, independendo da colaboração do paciente. Quando adequadamente construído, o expansor mostra-se confortável e efetivo. (AU)

Abstract Mild to moderate crowding in the mixed dentition can be treated with rapid maxillary expansion (RME) associated with dentoalveolar expansion of the mandibular arch. Dentoalveolar expansion of the mandibular arch can be conducted with an alternative fixed and screw appliance. The aim of this study is to present the laboratory and clinical protocol of the Williams expander. A clinical report of a female patient, 9 years old, with the symmetrical face in the mixed dentition, with moderate crowding of the lower incisors and mild crowding of the upper arch, was presented. The treatment was carried out with maxillary and mandibular expansion. In the maxillary arch, RME was performed using the Hyrax device. In the mandibular arch, dentoalveolar expansion was performed with a Williams expander. Adequate occlusion was obtained with the alignment of the permanent incisors and an improvement in the buccal corridor in the smile. The Williams expander represents an alternative for cases that require dentoalveolar mandibular expansion, regardless of patient cooperation. When properly constructed, the expander is comfortable and effective.(AU)

Access and financial impacts of public orthodontic provision on global health systems: integrative review / Acesso e impactos financeiros da provisão ortodôntica pública nossistemas de saúde mundiais: revisão integrativa / Acceso e impactos financieros de la provisión pública de ortodoncia en los sistemas de salud globales: revisión integradora

Introduction:The supply of public orthodontic services is still unable to meet the demand for treatment of malocclusions. The resources available are sometimes mismanaged and significant financial impacts contribute to limited access to the services. Objective:To carry out an integrative review regarding the access and financial impacts of public orthodontic service among the various health systems worldwide, considering social inequalities and the referral and counter-referral systems for services. Methodology:A survey was conducted using the BVS (Biblioteca Virtual em Saúde / Virtual Health Library), PubMed, and Cochrane databases, including articles available from 1970 to 2019, which elucidated the guiding question "How does access work and what are the financial impacts of the provision of orthodontic services in different public health systems worldwide?". Results:211 articles were found, of which 20 were analyzed. The chronological distribution was relatively uniform. The topic 'access to orthodontic services' was most frequently reported and there was a predominance of studies addressing the provision of treatment for children and adolescents. Conclusions:There are significant financial impacts and demographics have a strong influence on access to services. The provision of orthodontic treatments by the private sector predominates, preventive approaches are scarce, and an optimization in the use of available resources is necessary. Primary Care has much to contribute in increasing access, reducing costs, and making the referral / counter-referral system effective (AU).

Introdução:A oferta de serviços ortodônticos públicos ainda não consegue suprir a demanda de tratamento de má oclusões. Os recursos disponíveis, por vezes, mal alocados e os impactos financeiros significativos contribuem para a restrição do acesso aos serviços.Objetivo:Realizar uma revisão integrativa pertinente ao acesso e aos impactos financeiros da provisão ortodôntica pública nos diversos sistemas de saúde mundiais, sob a luz das iniquidades sociais e dos sistemas de referência e contrarreferência de serviços.Metodologia:Foi realizado um levantamento nas bases de dados BVS (Biblioteca Virtual em Saúde), PubMed e Cochrane Reviews, incluindo os artigos disponíveis no período de 1970 a 2019, que elucidavam a questão norteadora "Como se dá a provisão de serviços ortodônticos nos diversos sistemas públicos de saúde mundiais?".Resultados:Foram encontrados 211 registros, dos quais 20foram analisados. A distribuição temporal foi relativamente uniforme. A temática "acesso aos serviços ortodônticos" foi mais frequentemente relatada e houve um predomínio de estudos abordando a oferta de tratamentos a crianças e adolescentes. Conclusões:Há impactos financeiros significativos e os determinantes sociais exercem forte influência sobre o acesso aos serviços. Predomina a oferta de tratamentos ortodônticos pelo setor privado, abordagens preventivas são escassas e é necessária uma otimização no uso de recursos disponíveis. A Atenção Básica tem muito a contribuir para aumento do acesso, diminuição de custos e efetivação do sistema dereferência/contrarreferência dos serviços (AU).

Introducción: La provisión de servicios públicos de ortodoncia aún no puede satisfacer la demanda de tratamientos de maloclusión. Los recursos disponibles a veces están mal asignados y los impactos financieros significativos contribuyen a restringir el acceso a los servicios.Objetivo: Realizar una revisiónintegradora pertinente al acceso y los impactos económicos de la provisión pública de ortodoncia en los diferentes sistemas de salud a nivel mundial, a la luz de las inequidades sociales y los sistemas de derivación y contrarreferencia de servicios.Metodología: Se realizó una encuesta en las bases de datos de la BVS (Virtual Health Library), PubMed y Cochrane Reviews, incluidos los artículos disponibles desde 1970 hasta 2019, que dilucidó la pregunta orientadora "¿Cómo es la prestación de servicios de ortodoncia en los diferentes sistemas públicos?".Resultados: Se encontraron 211registros, de los cuales se analizaron 20.La distribución temporal fue relativamente uniforme. El tema "acceso a servicios de ortodoncia" fue el que se informó con mayor frecuencia y hubo un predominio de estudios que abordan la provisión de tratamientos a niños y adolescentes.Conclusiones: Hay impactos económicos significativos y los determinantes sociales tienen una fuerte influencia en el acceso a los servicios. Predomina la oferta de tratamientos de ortodoncia por parte del sector privado, los abordajes preventivos son escasos y es necesario optimizar el uso de los recursos disponibles. La Atención Primaria tiene mucho que contribuir para aumentar el acceso, reducir costos e implementar el sistema de derivación / contrarreferencia de servicios (AU).

3D Printed Band and Loop Space Maintainer: A Digital Game Changer in Preventive Orthodontics.

Premature loss of primary molars often leads to loss of arch circumference in the primary and mixed dentition. It can lead to malpositioning and even impaction of permanent tooth, if not prevented. Space maintainers in preventive orthodontics, are imperative in maintaining arch integrity. Band and loop space maintainers are indicated whenever there is premature loss of primary molar. The conventional band and loop space maintainer is most routinely fabricated, but poses certain limitations. Three-dimensional (3D) printing in digital dentistry is one of the major developments in dentistry. It replicates the dental cast in the most accurate forms. This allows for supreme precision and minimal human errors. Besides decreasing the laboratory procedures, it has the least chance of failure or breakage. The current case report discusses 3D printing technology for the fabrication of band and loop space maintainer, which can revolutionize preventive orthodontics for children.

Baby-Risk of malocclusion assessment index: An assessment tool for preventive orthodontic treatment needs in a selected population of children in southeast of Iran.

CONTEXT: Preventive orthodontic treatments are performed in the primary or mixed dentition period and provide a proper development of occlusion to avoid dentofacial anomalies. AIMS: This study aims to evaluate the Baby-Risk of Malocclusion Assessment Index (ROMA) index regarding ease of use, reproducibility, and the epidemiological assessment of major orthodontic problems in children aged 4-6-year-old in Kerman (Iran) kindergartens. SETTING AND DESIGN: This cross-sectional study was conducted on 1000 children aged 4-6 in Kerman (Iran) kindergartens, selected by cluster sampling, and data were collected using the Baby-ROMA index. METHODS: After recording a demographic data collection form, the clinical examination of the teeth was carried out by a dental student. The data were analyzed with SPSS 18 using t-test, analysis of variance, Chi-squared test, and Mann-Whitney test at a significance level of P < 0.05. RESULTS: In this study, the most common cause of malocclusion was dental caries (7.5%), followed by crossbite (6.1%). Furthermore, 31.6% of the subjects had one type of malocclusion, and 20.5% needed monitoring the occlusion before the growth spurt, while 11.1% needed immediate orthodontic treatment (mostly 6-year-old children). Moreover, 15.3% of the subjects had systemic problems; 3.4% had craniofacial, 22% had dental, and 2% had functional problems. The prevalence of class I canine relationship in the right canines was 82.32%, with 82.5% on the left side. The prevalence of open bite was higher in females with thumb-sucking habit. CONCLUSION: The Baby-ROMA index presented good reliability and ease of use for evaluating early orthodontic treatment needs in primary and mixed dentition periods.

Intervención temprana de la mordida cruzada por la pista directa de Planas: relato de siete años de seguimiento / Early Intervention of Crossbite by Planas Direct Tracks: Follow up Report After Seven Years / Intervenção precoce da mordida cruzada pela Pistas Diretas de Planas: relato de sete anos de seguimento

Resumen Introducción: entre las maloclusiones, la mordida cruzada es la de mayor prevalencia entre los niños en edad preescolar y se considera la principal depreciadora del sistema estomatognático, con un alto riesgo de desarrollar secuelas musculoesqueléticas irreparables en la edad adulta. Por lo tanto, es fundamental elegir un tratamiento eficaz que no requiera la cooperación directa del paciente y que utilice técnicas simples de ortodoncia. El objetivo de este artículo es informar la eficacia del tratamiento de rehabilitación neuroclusal (RNO) con la técnica de las pistas directas de Planas en la corrección temprana de la mordida cruzada posterior y el seguimiento de su estabilidad oclusal durante siete años. Presentación del caso: niña de 4 años de edad, que usó biberón, diagnosticada con mordida cruzada posterior funcional unilateral izquierda y desviación de la línea media. Para el tratamiento de la RNO, se realizaron los ajustes oclusales en los dientes 63, 64 y 65, y después de la desprogramación neuromuscular, se confeccionaron las pistas directas de Planas en los dientes cruzados. Después de 29 días, se corrigió la mordida y se hicieron ajustes oclusales para proporcionar una mayor armonía oclusal. Hubo monitoreamiento cada seis meses durante siete años para verificar el equilibrio y la estabilidad del tratamiento. Conclusiones: la RNO con el uso de pista directa de Planas fue eficaz para corregir la mordida cruzada posterior con una técnica simple y de bajo costo que puede ejecutar el clínico general.

Abstract Introduction: Among malocclusions, that of cross-bite is the most prevalent among preschool children and is considered to be the main depreciator of the stomatognathic system and is further linked to a high risk of developing irreversible musculoskeletal sequelae in adulthood. Thus, it is important to choose an effective treatment early on that does not require the direct cooperation of the patient and that utilizes simple orthodontic techniques in its execution. The objective of this study was to report the efficacy of the Neuroclusal Rehabilitation (RNO) treatment, with the Planas Direct Tracks technique in a case of early treatment of posterior crossbite, and the follow up of its occlusal stability for seven years. Case presentation: a 4-year-old female patient, who was bottle-fed, was diagnosed with a left unilateral functional posterior crossbite and midline deviation. For treatment of RNO, occlusal adjustments were made on the teeth 63, 64 and 65 and after neuromuscular deprogramming, the Direct Planks were made in the crossed teeth. After 29 days, the bite was corrected, and occlusal adjustments were made in order to provide greater occlusal harmony. Monitoring and evaluation took place every six months for seven years in order to verify the balance and stability of the treatment. Conclusion: the RNO treatment with the use of Planas Direct Tracks is an effective solution for the correction of posterior crossbite using a simple, low-cost technique that can be performed by general practitioners.

Resumo Introdução: entre as más oclusões, a mordida cruzada é a de maior prevalência entre as crianças em idade pré-escolar, e se considera a principal depreciadora do sistema estomatognático, com um alto risco de desenvolver sequelas musculoesqueléticas irreparáveis na idade adulta. Portanto, é fundamental escolher um tratamento eficaz que não requeira a cooperação direta do paciente e que utilize técnicas simples de ortodontia em sua execução. O objetivo deste estudo foi informar a eficácia do tratamento de Reabilitação Neuroclusal (RNO), com a técnica das Pistas Diretas de Planas na correto precoce da mordida cruzada posterior e o seguimento de sua estabilidade oclusal durante 7 anos. Apresentação do caso: paciente de sexo feminino de 4 anos de idade, que usou mamadeira, diagnosticada com mordida cruzada posterior funcional unilateral esquerda e desvio da linha média. Para o tratamento da RNO, se realizaram os ajustes oclusais nos dentes 63, 64 e 65, depois da desprogramação neuromuscular, se confeccionaram as Pistas Diretas de Planas nos dentes cruzados. Depois de 29 dias, se corrigiu a mordida e se fizeram ajustes oclusais para proporcionar uma maior harmonia oclusal. O monitoramento se realizou cada seis meses por 7 anos para verificar o equilíbrio e a estabilidade do tratamento. Conclusões: a RNO com o uso de Pista Direta Planas foi eficaz para a correção da mordida cruzada posterior com uma técnica simples, de baixo custo que pode ser realizada pelo clínico geral.

Prediction of the Dental Arch Perimeter in a Kurdish Sample in Sulaimani City Based on Other Linear Dental Arch Measurements as a Malocclusion Preventive Measure.

The current study aimed to find a prediction equation to estimate the arch perimeter (AP) depending on various arch dimensions including intercanine width (ICW), intermolar width (IMW), interpremolar width (IPMW), and arch length (AL) in a sample of the Kurdish population in Sulaimani City. The study sample was 100 pairs of preorthodontic dental casts. Calculations of dental arch dimensions and perimeter were performed by a digital vernier. Statistical analysis was performed via using the SPSS version 25 software. The developed prediction equation for the upper arch was Y = +1.3 × (arch length) + 1 × (intermolar width), whereas the equation for the lower arch was Y = +0.9 × (intermolar width) + 0.92 × (intercanine width). Paired t-test revealed no statistical difference between predicted and real arch perimeters. Two separate prediction equations for upper and lower arches were developed based on the arch length (AL) and intermolar width (IMW) for the maxillary arch, intermolar (IMW), and inter canine widths (ICW) for the lower arch. The developed equations could have further beneficial impacts on orthodontic diagnosis and treatment planning.

Clinical Evaluation of Ghana Shyams TEFF (Telescopically Expanding Fixed Functional) Space Maintainer Versus Conventional Band and Loop Space Maintainer

Abstract Objective: To compare the clinical efficacy of Ghana Shyam's TEFF space maintainer with band and loop space maintainer. Material and Methods: This split-mouth randomized clinical trial was conducted on 20 children (7-9 years), requiring bilateral/contralateral space maintenance therapy. After consent, all the selected children received both space maintainers and were followed up periodically every six months up to two years for clinical assessment according to the evaluation protocol. Instructions and motivation were given to the children. OHI (S) index was recorded before cementation of appliances. The following aspects were analyzed: 1) efficiency and function; 2) dislodgement due to cement loss; 3) breakage at soldered parts; 4) carious or gingival inflammation affecting abutment teeth; 5) distortion of band; 6) being embedded in gingival tissues / gingival slopping; and 7) initial and final S-OHIS scores. Statistical analysis was done using Fisher exact test for survival time and Chi-square test for chewing efficiency. Results: At 24th-month follow-up, 14 Ghana Shyam's TEFF space maintainers and 16 band and loop space maintainers were found to be intact. Conclusion: As both space maintainers demonstrated similar mean survival time Ghana Shyam's TEFF space maintainer with the added advantage of being functional can be recommended as an effective alternative to band and loop in premature loss of primary molar clinical situations.

Prognóstico entre eixo de erupção dos caninos permanentes superiores e espaço para erupção dos segundos molares inferiores / Prognosis between superior permanent canines teeth eruption axis and second lower molars space for eruption

Resumo O objetivo deste estudo foi verificar a associação entre a má posição do germe dos segundos molares inferiores com o eixo de erupção dos caninos permanentes superiores na dentadura mista. A amostra foi composta por 506 radiografias panorâmicas digitais, no período intertransitório da fase de dentadura mista, na faixa etária de 7 a 12 anos, de ambos os sexos. Os caninos foram avaliados utilizando-se a divisão da porção anterior do hemiarco em cinco setores sendo o setor 1 a melhor posição para eixo de erupção correto e 5 para a pior. Para a localização do germe dos segundos molares inferiores foi utilizada a distância horizontal entre a face distal dos primeiros molares inferiores e a borda anterior do ramo da mandíbula. Os dados foram analisados por tabelas de distribuição de frequências e regressão logística, com estimação dos Odds Ratio brutos e os respectivos intervalos de confiança. Não houve associação significativa entre o sexo e o eixo de erupção de caninos permanentes superiores (p>0,05). Houve associação entre a má posição de segundos molares inferiores e o eixo de erupção de caninos. Participantes com má posição de segundos molares inferiores apresentaram 3,40 (IC 95%, 2,12-5,47) vezes mais chance de ter o eixo de erupção de caninos permanentes superiores mal posicionados. Conclui-se que houve associação entre a má posição de segundos molares inferiores e o eixo de erupção de caninos.(AU)

Abstract This study aimed to associate malposition of lower second molar germ with the upper permanent canine teeth eruption axis in the mixed dentition. The sample included 506 digital panoramic radiographies taken in the mixed dentition inter-transitional period in the age group of 7 to 10 years of both sexes. The canines were assessed by dividing the anterior portion of the hemiarch into five sectors, in which sector 1 was the best position for the correct eruption axis and 5 was the worst. For locating the lower second molar germ, a horizontal distance was used between the distal aspect of the lower first molars and the anterior margin of the mandibular ramus. The data was analyzed with frequency distribution and logistic regression tables, estimating crude Odds Ratio and respective confidence intervals. There was no significant association between sex and upper permanent canines eruption axis (p>0.05). There was association between the lower second molars malposition and canines eruption axis. Participants with malposition of lower second molars presented 3.40 (95% CI, 2.12-5.47) times more likely to present upper permanent canines eruption axis malpositioned. It was concluded that there was association between the malposition of lower second molars and the canine eruption axis. (AU)

Dilemas éticos e bioéticos na indicação da Ortodontia preventiva e interceptativa baseada em evidências / Ethical and bioethical dilemmas in evidence based preventive and interceptive Orthodontics indication

Objetivos: O objetivo do presente trabalho foi analisar, se diante da "Odontologia Baseada em Evidências", seria ético o cirurgião-dentista, independentemente de sua especialidade, realizar tratamentos ortodônticos preventivos e interceptativos em crianças e adolescentes. Metodologia: A prevalência de diferentes maloclusões nas dentições decídua, mista e permanente, as legislações relacionadas às competências do cirurgião-dentista no Brasil e os resultados de revisões sistemáticas e de meta-análises sobre a comparação da efetividade do tratamento ortodôntico em 1 ou em 2 fases foram analisados pelo prisma ético do "Querer-Poder-Dever" e pelos princípios bioéticos da "autonomia", "beneficência", "não maleficência" e "justiça". Resultados e Considerações Finais: Concluiu-se que: 1) A alta prevalência de maloclusões nas dentições decídua, mista e permanente justifica que o cirurgião-dentista queira tratar as mesmas; 2) Pela legislação brasileira, o Clínico Geral, o Odontopediatra, o Ortodontista e o especialista em Ortopedia Funcional dos Maxilares podem tratar maloclusões em crianças e adolescentes; 3) Segundo os princípios bioéticos da não maleficência, beneficência e justiça, o cirurgião-dentista ético deve indicar tratamento ortodôntico preventivo e interceptativo apenas para determinados tipos e severidades de maloclusões, ponderando aspectos psicossociais envolvidos e considerando a maturidade do paciente e a conscientização dos pais; 4) Pelo princípio bioético da autonomia, o responsável legal do paciente em crescimento e com maloclusão deve ser esclarecido sobre as evidências científicas a favor e contra o tratamento ortodôntico preventivo e interceptativo, por meio de Termo de Consentimento Informado, para poder decidir se deseja que o paciente seja submetido a esse procedimento. (AU)

Objectives: The aim of this study was to analyze whether in face of "Evidence-Based Dentistry", it would be ethical for the dentist, regardless of his/her specialty, to perform preventive and interceptive orthodontic treatments in children and adolescents. Methods: Prevalence of different malocclusions in deciduous, mixed and permanent dentition, laws related to dentists' competences in Brazil, and results of systematic reviews and of meta-analyses on comparing orthodontic treatment effectiveness in 1 or 2 phases were analyzed by the ethical references of "willingness-permission-duty" and the bioethical principles of "autonomy", "beneficence", "non-maleficence" and "justice". Results and Final Considerations: It was concluded that: 1) High prevalence of malocclusions in deciduous, mixed and permanent dentition justifies dentists willingness to treat them; 2) According to Brazilian law, General Dentist, Pediatric Dentist, Orthodontist and Jaws Functional Orthopedist have legal permission to treat malocclusions in children and adolescents; 3) According to the bioethical principles of non-maleficence, beneficence and justice, the ethical dentist should only indicate preventive and interceptive orthodontic treatment for certain types and severities of malocclusions, considering psychosocial aspects involved and the patients maturity and parental awareness; 4) By the bioethical principle of autonomy, the legal representative of the growing patient with malocclusion must be informed about scientific evidence for and against preventive and interceptive orthodontic treatment by means of Informed Consent, in order to be able to decide whether he/she wishes the patient to be submitted to this procedure. (AU)

Avaliação da prevalência da perda precoce de molares decíduos na dentição mista / Assessment of primary molars early loss in mixed dentition prevalence

Objetivo: Avaliar a prevalência da perda precoce de molares decíduos na dentição mista. Método: Foi realizado estudo em crianças na faixa etária dos 6 a 12 anos. A perda do molar decíduo foi considerada precoce, quando essa ocorreu antes do estágio 6 de Nolla (coroa totalmente formada) do sucessor permanente ou um ano antes de sua esfoliação fisiológica. Foram obtidas radiografias periapicais para constatar a presença do sucessor permanente e o nível de formação radicular, bem como a necessidade de colocação de mantenedor de espaço fixo arco lingual ou botão de Nance. Para o estudo da distribuição de frequências da perda dentária precoce em relação ao gênero e dentição, foi utilizado o Teste Qui-quadrado nível de 5% de probabilidade e o teste não paramétrico, Mann-Whitney, para análise estatística adequada. Resultados: Das 315 crianças examinadas 159 (50,47%) eram do gênero masculino e 156 (49,52%) do gênero feminino. Apenas 25 (7,9%) apresentaram perdas múltiplas dentárias na região posterior, sendo 19 na arcada inferior e 6 na arcada superior. Na inferior, houve predominância de perda do primeiro e segundo molares decíduos. Não existiu diferença na associação entre os gêneros das crianças e a ocorrência de perdas múltiplas dentárias (χ² (1) = 0,03, p>0.05). Conclusão: A prevalência de perda prematura de dentes decíduos foi de 7,9% e os dentes mais acometidos foram os primeiros e segundos molares na arcada inferior. Mantenedores de espaço do tipo arco lingual foram instalados em 6 crianças, que permanecerão até que os sucessores permanentes irrompam na cavidade bucal. (AU)

Objective: To assess primary molars early loss in mixed dentition prevalence. Method: A study was carried out in children aged 6 to 12 years. Deciduous molar loss was considered early when it occurred before Nolla stage 6 (full formed crown) of the permanent successor or one year before its physiological exfoliation. Periapical radiographs were obtained to verify the presence of the permanent successor and the level of root formation, as well as the need for placement of fixed space maintainer lingual arch or Nance button. For the study of frequency distribution of early dental loss in relation to gender and dentition, we used the Chi-square test of 5% probability level and the non-parametric Mann-Whitney test for adequate statistical analysis. Results: Of the 315 children examined, 159 (50.47%) were male and 156 (49.52%) were female. Only 25 (7.9%) presented multiple dental losses in the posterior region, 19 in the lower arch and 6 in the upper arch. In the inferior one there was predominance of first and second deciduous molars loss. There was no difference in the association between genders and the occurrence of multiple dental losses (χ² (1) = 0.03, p>0.05). Conclusion: The prevalence of deciduous teeth premature loss was of 7.9% and the most affected teeth were the first and second molars in the lower arch. Lingual arch space holders were installed in 6 children, who will remain with it until the permanent successors erupt into the oral cavity. (AU)

El paciente ortodóncico en dentición mixta y los trastornos del sueño / The orthodontic patient with mixed dentition and sleep disorders

Los desórdenes respiratorios del sueño (DRS) y, principalmente, roncopatías y apneas obstructivas afectan aproximadamente al 7% de los pacientes ortodóncicos. Los DRS no solo son importantes por la cantidad de pacientes afectados, sino por la gravedad de los posibles efectos secundarios a nivel de la salud general del paciente. La obstrucción de las vías aéreas superiores (VAS) provoca alteraciones del crecimiento y deformaciones craneofaciales importantes, por lo que el tratamiento temprano y la prevención de la respiración oral es muy importante.El papel del ortodoncista es muy importante en el diagnóstico y en el tratamiento de los DRS, pero también en su prevención, realizando tratamientos que aumenten la dimensión y la permeabilidad de las VAS. El protocolo de exploración interdisciplinar en niños y adolescentes y la cefalometría de vías aéreas son importantes en el diagnóstico y deben ser tenidos en cuenta en el plan de tratamiento. Pero las pruebas más significativas, el CBCT de vías aéreas y la polisomnografía no son pruebas rutinarias por la dificultad logística y el precio de estas pruebas. En este artículo también se recomiendan los tratamientos de ortodoncia más indicados en estos casos y que tienden al aumento de la dimensión de las VAS (AU)

Sleep breathing disorders (SBD) and in the first place, roncopathy and obstructive apnea, affect approximately 7% of orthodontic patients. The SBD are not only important for the number of affected patients, but also for the severity of the possible side effects at the level of general health of a patient. The upper air ways (UAW) obstruction provokes important alterations in growth and craniofacial deformations, and this is why the early treatment and prevention of mouth breathing are very important. The role of an orthodontist in diagnosis and treatment of SBD is very important, but it is also in its prevention, carrying out the treatments which increase the dimension and permeability of UAW. The protocol of interdisciplinary examination.In children and adolescents and the air ways cephalometry analysis have an important role in diagnosis and they should be taken into account in treatment planning. But the most important tests, the air ways CBCT and polysomnography, are not routine tests due to the complicated logistics and their cost. In this article, the orthodontic treatments most indicated in these cases are recommended, because they tend to increase the UAW dimension (AU)

Deciduous tooth early loss prevalence in posterior region and indication of band-loop space maintainer / Prevalência da perda precoce de dente decíduo na região posterior e indicação de mantenedor de espaço banda-alça

Objective: To investigate the prevalence of the early unitary loss of deciduous and the need for space maintainer in the posterior region, of the band-loop type. Material and Methods: The clinical examination by two examiners of 568 children between 6 and 12 years of age in mixed dentition was performed in two municipal schools. After the diagnosis of premature loss of one or two deciduous molars (unilateral, one or both arches, respectively), without successors initiating the eruptive process in the oral cavity, the child was referred to the Clinical School of Dentistry (CSD) of State University of Piauí (UESPI) for installation of the band-handle space maintainer. Results: The prevalence of early deciduos molar loss was 4.04%, from 568 children examined, being 15 in the lower arch and 8 in the upper arch of 23 children, mean age of 10 ± 2 years with predominance of the first deciduos molars (10 in the lower arch and all 8 in the upper arch). The etiological factor of which was dental caries for all sample, according to the parents or guardians. Only 13 attended the CSD for detailed examination. After radiographic examination, it was verified that 8 did not need space maintainers because they were approximately 2/3 of the permanent successors root formation. In 5 children was placed the maintainer of space, band-handle, who are being supervised every 3 months until the eruption of the permanent successors. Conclusion: The prevalence of early molar loss was 4.04% with no statistical difference between genders. The use of space maintainers after the early loss of a deciduous tooth is a preventive measure of malocclusion, being the band-loop appliance an excellent choice after loss of the deciduous unilateral molar.(AU)

Objetivo: Investigar a prevalência a perda precoce unitária de decíduo e a necessidade de mantenedor de espaço na região posterior do tipo banda-alça. Material e Métodos: O exame clínico realizado por dois examinadores de 568 crianças de 6 a 12 anos de idade na dentição mista foi realizado em duas escolas municipais. Após o diagnóstico de perda precoce de um ou dois molares decíduos (unilateral, de uma ou ambas arcadas, respectivamente), sem que os sucessores tivessem iniciando o processo eruptivo na cavidade bucal, a criança foi encaminhada à Clínica Escola de odontologia (CEO) da Universidade Estadual do Piauí (UESPI) para instalação do mantenedor de espaço banda-alça. Resultados: A prevalência da perda precoce de molar decíduo foi de 4.04%, de 568 crianças examinadas, sendo 15 na arcada inferior e 8 na arcada superior de 23 crianças, com idade média de 10 ± 2 anos com predomínio dos primeiros molares decíduos (10 no arco inferior e todos os 8 no arco superior). O fator etiológico foi cárie dentária para toda a amostra, segundo os pais ou responsáveis.Somente 13 compareceram à CEO para exame detalhado. Após exame radiográfico constatou-se que 8 não precisavam de mantenedores de espaço pois estavam aproximadamente com 2/3 de formação radicular dos sucessores permanentes. Em 5 crianças colocou-se o mantenedor de espaço, bandaalça, que estão sendo supervisionadas a cada 3 meses até a erupção dos sucessores permanentes. Conclusão: A prevalência da perda precoce de molar decíduo foi de 4.04% sem diferença estatística entre os gêneros. O uso de mantedores de espaço após a perda precoce de dente decíduo é uma medida preventiva da má oclusão, sendo a banda-alça excelente opção após a perda do molar decíduo unilateral(AU)

Avaliação das dimensões do arco dentário superior decorrentes do uso de aparelho parcial fixo 4 x 2 na fase da dentição mista / Assessment of the dimensions of an upper dental arch after using 2 x 4 fixed partial appliance in the stage of mixed dentition

A dentição mista é suscetível a uma diversidade de fatores que podem alterar as dimensões do arco dentário, dificultando a erupção dos dentes permanentes. Este trabalho teve como objetivo avaliar as alterações nas dimensões do arco dentário superior, decorrentes do uso de aparelho parcial fixo 4 x 2. A amostra total foi composta por 48 pacientes, dos gêneros masculino e feminino, na faixa etária de 8 a 11 anos, com boa saúde periodontal, dentição mista no período intertransitório do desenvolvimento da oclusão, com presença dos incisivos centrais, laterais e primeiros molares permanentes, ausência dos segundos molares permanentes, que apresentavam falta de espaço para irromper caninos e pré-molares, relação classe II de molar, os quais foram divididos igualmente em dois grupos. No grupo experimental (G1), 24 pacientes foram tratados na clínica de Ortodontia Preventiva da Faculdade de Odontologia da Universidade de São Paulo, com aparelho parcial fixo 4 x 2, associado a fios ortodônticos expandidos de CuNiTi e molas abertas de NiTi. O grupo controle (G2) foi composto por 24 pacientes, os quais não foram tratados e foram avaliados quanto às alterações decorrentes do crescimento, sem intervenção ortodôntica, no mesmo período de tempo do grupo experimental. Foram realizadas moldagens em alginato no início, em cada consulta de ativação e no final do tratamento ortodôntico preventivo e os modelos em gesso foram escaneados e medidos. As telerradiografias laterais foram obtidas no início (T1) e ao final (T5) do tratamento com aparelho parcial fixo 4 x 2 e suas medidas avaliadas. No grupo controle (G2), os modelos e as radiografias foram escaneados e medidos no início (T1) e ao final (T2) do período de observação. Os resultados encontrados no grupo experimental (G1) mostraram aumento médio significativo no perímetro (p= 0) e na profundidade da arcada (p= 0), no entanto não houve alteração significativa na distância intermolares (p= 0.14). Ocorreu aumento não significativo (p= 0.37) da distância da coroa do incisivo central superior à linha Sela perpendicular (Sperp), e do ângulo 1 . Plano palatino, também não significativo (p= 0.13), entre os tempos (T1 e T5). Ocorreu diminuição média significativa da distância da coroa e da raiz do molar à linha Sperp, p= 0 e p= 0.004, respectivamente, assim como do ângulo 6 . Plano palatino (p= 0.03). Após análise dos resultados, concluímos que o aparelho parcial fixo 4 x 2 promoveu aumento no perímetro e na profundidade do arco dentário, distalização de corpo do molar superior (com distalização da coroa, da raiz e com controle da inclinação) e controlou a inclinação vestibular dos incisivos superiores.

[Effectiveness of Paradontax toothpaste in patients undergoing orthodontic treatment]. / Otsenka éffektivnosti zubnoi pasty Parodontax u patsientov, nakhodiashchikhsia na ortodonticheskom lechenii.

The purpose of this study was to determine the effectiveness of toothpaste Parodontax in patients undergoing orthodontic treatment. The results showed that fixed orthodontic appliances deteriorated oral hygiene, increased the viscosity of saliva and reduced mineralizing capacity of saliva (MCS). Use of Parodontax toothpaste based on sodium bicarbonate improved OHI-S, reduced the viscosity of saliva, increased MCS and normalized oral microbiota.

Recuperação de espaço com aparelho banda mola ­ relato de caso / Space recovery with spring band unit ­ case report

A perda precoce ocorre quando um dente temporário é perdido antes do sucessor permanente ter iniciado a sua erupção. A literatura mostra que a perda prematura apresenta prevalência superior a 20%, não distinguindo gênero ou lado e arco. Cárie e trauma são as principais causas. As principais consequências são as migrações dos dentes adjacentes para o espaço originado, levando à diminuição do comprimento da arcada dentária. A perda precoce necessita de reabilitação estética e funcional até que ocorra a erupção dos dentes sucessores permanentes. Para essa reabilitação, opta-se pela confecção de aparelhos recuperadores de espaços, podendo ser fixos ou removíveis. O objetivo deste trabalho é relatar o caso de um pa-ciente de 10 anos, gênero masculino, com perda precoce do segundo molar decíduo superior direito, com os dentes adjacentes ao espaço apresentando migração dentária, originando falta de espaço para erupção do segundo pré-molar superior direito, comprometendo o correto desenvolvimento da dentição. Para resolução do problema, foi utilizado o aparelho do tipo banda mola para recuperação do espaço perdido. Após 3 meses de utilização do aparelho, o espaço foi recuperado e ocorreu a erupção precoce do segundo pré-molar superior direito. O prognóstico do caso foi favorável, restabelecendo o correto desenvolvimento da dentição, com um procedimento relativamente simples, graças ao diagnóstico precoce (AU)

The premature loss occurs when a temporary tooth is lost before permanent successor has commenced its eruption. The literature shows that the premature loss presents prevalence greater than 20%, not distinguishing gender or side and bow. It has been the main causes: caries and trauma. The main consequences are migration of adjacent teeth to the originated space, leading to decrease the length of the dental arch. The early loss requires aesthetic and functional rehabilitation until there is the eruption of permanent teeth successors to such rehabilitation this be done by making space recovery device, these can be fixed or removable. The objective of this study is to report the case of a 10-year-old patient, male, with early loss of the second deciduous molar upper right, with the teeth adjacent to the space showing tooth migration, resulting in lack of space for eruption of the second bicuspid upper right, compromising the correct development of the dentition. To solve the problem, we used the spring band type apparatus for recovering the lost space. After 3 months of using the appliance, the space was recovered and occurred early eruption of element 2 bicuspid upper right. The outcome of the case was favorable, reestablishing the correct development of the dentition, with a relatively simple procedure thanks to early diagnosis.(AU)

Preventive and interceptive orthodontic needs among Syrian children.

BACKGROUND: Preventing or intercepting a developing malocclusion in a public health program requires identifying or measuring the degree of malocclusion. The present study aimed to quantify the proportion of Syrian children in Damascus who would benefit from preventive and interceptive orthodontic treatment. MATERIALS AND METHODS: In total, 1096 children (431 boys and 665 girls) of grade 1 up to grade 3 from 16 government elementary schools in Damascus city were evaluated using the index for preventive and interceptive orthodontic need (IPION). On the basis of IPION, the overall scores of children were distributed into three groups - no treatment need, moderate treatment need, and definite treatment need. According to dental development, children were divided into two groups - IPION-6 and IPION-9. RESULTS: Of the enrolled children, 15.4% showed no treatment need, 26.7% showed moderate treatment need, and 57.9% showed definite treatment need. Comparison between male and female children indicated no significant effect on the overall treatment need distribution (P=0.439). The IPION groups had a significant effect on treatment distribution (6 vs. 9, P=0.038); the IPION-9 scores were significantly higher than the IPION-6 scores. CONCLUSION AND RECOMMENDATIONS: The prevalence of preventive and interceptive orthodontic needs is unsatisfactorily high in Syrian children, which emphasizes the importance of including preventive and interceptive orthodontic treatment in the local dental healthcare program.

[The evaluation of the clinical efficacy of complex treatment and preventive orthodontic and rehabilitation measures in children with spastic cerebral paralysis]. / Effektivnost' primeneniya kompleksa lechebno-profilakticheskikh ortodonticheskikh i reabilitatsionnykh meropriyatii u detei so spasticheskimi formami tserebral'nogo paralicha.

Based on the results of the comprehensive examination of 120 patients, the necessity of development and introduction of rehabilitation complex of therapeutic and preventive measures with regard to the type and severity of cerebral paralysis and patient's age in practice was shown. The main purpose of treatment and preventive measures was a complete social adaptation of children with spastic forms of cerebral paralysis, which was dependent on the integrity of speech functions. Rehabilitation measures were implemented by single multidisciplinary team with clear functional responsibilities of each member. The study determined the efficacy of treatment, preventive and rehabilitation measures in children with spastic forms of cerebral paralysis. It has been shown that the complex of treatment-and-preventive and rehabilitation measures for children with spastic forms of cerebral paralysis is positive and should be carried out continuously, from the early age to the maximum achievable level of correction of lost functions.

Antibacterial nanosilver coated orthodontic bands with potential implications in dentistry.

BACKGROUND & OBJECTIVES: Fixed orthodontic treatment, an indispensable procedure in orthodontics, necessitates insertion of dental bands. Insertion of band material could also introduce a site of plaque retention. It was hypothesized that band materials with slow-release antimicrobial properties could help in sustained infection control, prevention of dental plaque formation and further associated health risks. Considering the known antimicrobial proprieties of silver, a coating of silver nanoparticle (SNP) onto the stainless steel bands was done and characterized for its beneficial properties in the prevention of plaque accumulation. METHODS: Coatings of SNPs on conventional stainless steel dental bands were prepared using thermal evaporation technology. The coated dental bands were characterized for their physicochemical properties and evaluated for antimicrobial activity and biocompatibility. The physiochemical characterization of band material both coated and uncoated was carried out using scanning electron microscope, energy dispersive spectroscopy, atomic force microscopyand contact angle test. Biocompatibility tests for coated band material were carried using L929 mouse fibroblast cell culture and MTT [3-(4, 5-dimethyl thiazol-2-yl)-2, 5-diphenyl tetrazolium bromide] assay. Antimicrobial activity of coated band material against Gram-positive bacteria was tested. RESULTS: A stable and uniform coating of SNPs was obtained. The coated band materials were biocompatible as well as possessed distinct antimicrobial activity. INTERPRETATION & CONCLUSIONS: The SNP coated dental bands could be potential antimicrobial dental bands for future clinical use. Further studies need to be done to validate the efficiency of coated band materials in oral environments.

Dente supranumerário: revisão bibliográfica e relato de caso clínico / Supernumerary tooth: literature review and a case report

A presença de dentes supranumerários pode causar alterações funcionais e estéticas, principalmente quando localizados na região anterior da maxila, contando, ainda, com complicações na erupção do elemento dental permanente da área afetada. São definidos como dentes de desenvolvimento anormal que podem ocorrer tanto na dentição decídua como na dentição permanente, podendo ser únicos ou múltiplos, uni ou bilaterais permanecer impactados ou erupcionar na cavidade bucal e a sua etiologia permanece ainda desconhecida. A prevalência varia entre 0,8% e 3,7%, em diferentes estudos apresentados, sendo que o sexo masculino é o gênero mais prevalente. Frequentemente eles são diagnosticados em exames de rotina, uma vez que, na maior parte dos casos, são assintomáticos. Quando diagnosticados, a remoção cirúrgica está indicada para que o mesmo não venha causar interferência na dentição permanente. Este artigo apresenta o relato do caso de uma criança de 08 anos de idade que apresentava um dente supranumerário na região dos incisivos centrais superiores e o tratamento realizado foi a exodontia e, posteriormente, tratamento ortodôntico preventivo

The occurence of supernumerary teeth can cause functional and aesthetic changes, particularly when located in the anterior maxilla, as well as complications in the eruption of permanent dental element in the affected area. Such term is defined as abnormal teeth development that may occur either in the primary dentition or in permanent dentition. They can be single or multiple; unilateral or bilateral; remain impacted or erupt in the oral cavity and its etiology remains unknown. The prevalence varies between 0.8% and 3.7% in different studies, and the male is the most prevalent gender. Often they are diagnosed during routine examinations, and are asymptomatic in the majority of the cases. When diagnosed, removal surgery is indicated in order to remove any interference in the permanent dentition. This article presents a case report of a 8 years old patient who presented a mesiodens between upper central incisors and was treated by tooth extraction followed by preventive orthodontic treatment