Regeneración / revitalización pulpar en dientes permanentes inmaduros / Pulp regeneration / revitalization in immature permanent teeth

Introducción: El tratamiento pulpar de dientes inmaduros es un procedimiento desafi ante. Los dientes inmaduros tienen unos conductos anchos, paredes dentinarias delgadas y ápices abiertos, además de ser más propensos a la fractura y con mal pronóstico a largo plazo. La revascularización de un diente inmaduro intenta preservar los dientes el mayor tiempo posible, pero hay fracasos porque es difícil lograr una desinfección óptima del sistema de conductos radiculares. Métodos: Se realizó una búsqueda bibliográfi ca consultando las bases de datos electrónicas PubMed y Web of cience de los últimos 10 años, utilizando palabras clave y criterios de elegibilidad. Resultados: El proceso de búsqueda arrojó 635 artículos totales. Tras aplicar fi ltros, eliminar duplicados y seleccionar artículos por título y resumen, solo 27 fueron para el estudio. Conclusiones: La revitalización pulpar tiene altas tasas de supervivencia en el tratamiento de dientes permanentes inmaduros necróticos. Son necesarios ensayos clínicos aleatorios para comparar el efecto de la fi brina rica en plaquetas, el plasma rico en plaquetas y el sangrado inducido sobre la revitalización de un diente con pulpa necrótica. Uno de los principales problemas de la revitalización pulpar es la decoloración coronal. La triple pasta antibiótica es un agente antimicrobiano muy efi caz, pero las altas concentraciones podrían tener un efecto perjudicial sobre la supervivencia de las células madre. (AU)

Introduction: Treatment of affected immature teeth is a challenging procedure. Immature teeth have wide canals, thin dentin walls and open apices, in addition to being more prone to fracture and with a poor long-term prognosis. Revascularization of an immature tooth attempts to preserve the teeth as long as possible, but there are failures because it is diffi cult to achieve optimal disinfection of the root canal system. Methods: An exhaustive search was carried out by consulting the electronic databases PubMed and Web of Science of the last 10 years, using keywords and eligibility criteria. Results: The search process yielded 635 total articles. After applying fi lters, eliminating duplicates and selecting articles by title and abstract, only 27 were for the present study. Conclusions: Pulp revitalization has high survival rates in the treatment of necrotic immature permanent teeth. Randomized clinical trials are needed to compare the effect of platelet-richfi brin, platelet-rich plasma, and induced bleeding on the revitalization of a tooth with necrotic pulp. One of the main problems of pulp revitalization is coronal discoloration. Triple antibiotic paste is a very effective antimicrobial agent, but high concentrations could have a detrimental effect on stem cell survival. (AU)

Influence of zoledronic acid and pamidronate on tooth eruption in children with osteogenesis imperfecta.

INTRODUCTION: Osteogenesis imperfecta (OI) is a congenital disease comprising a heterogeneous group of inherited connective tissue disorders. The main treatment in children is bisphosphonate therapy. Previous animal studies have shown that bisphosphonates delay tooth eruption. The aim of this study is to determine whether patients with OI treated with pamidronate and/or zoledronic acid have a delayed eruption age compared to a control group of healthy children. METHODS: An ambispective longitudinal cohort study evaluating the age of eruption of the first stage mixed dentition in a group of children with OI (n = 37) all treated with intravenous bisphosphonates compared with a group of healthy children (n = 89). Within the study group, the correlation (Pearson correlation test) between the type of medication administered (pamidronate and/or zoledronic acid) and the chronology of tooth eruption is established, as well as the relationship between the amount of cumulative dose received and tooth eruption. RESULTS: The age of eruption of the study group was significantly delayed compared to the age of eruption of the control group for molars and lateral incisors (p < 0.05). Patients who received higher cumulative doses had a delayed eruption age compared to those with lower cumulative doses (p < 0.05). There is a high positive correlation between age of delayed tooth eruption and Zoledronic acid administration. CONCLUSION: Patients with OI have a delayed eruption of the 1st stage mixed dentition compared to a control group of healthy children. This delayed eruption is directly related to the cumulative dose of bisphosphonates and the administration of zoledronic ac.

Genetic variation in the glucosyltransferase-B gene of Streptococcus mutans and its relationship with caries experience in children from Córdoba, Argentina, and with strains from other countries.

BACKGROUND: Caries is a worldwide distributed oral disease of multifactorial nature, with Streptococcus mutans being the most commonly isolated bacterial agent. The glycosyltransferases of this bacterium would play an essential role in the aetiology and pathogenesis of caries. AIM: We explored how the glucosyltransferase-B (gtf-B) gene variability of S. mutans from children in central Argentina correlated with their caries experience and how these strains were genetically related to those of other countries. DESIGN: Dental examinations were performed on 59 children; dmft and DMFT indexes were calculated. From stimulated saliva, S. mutans was grown and counted (CFU/mL). From bacterial DNA, the gtf-B gene was amplified and sequenced. Alleles were identified and their genealogical relationships established. Clinical, microbiological, and genetic variables were correlated with caries experience. Our sequences were included in a matrix with those from 16 countries (n = 358); genealogical relationships among alleles were obtained. Population genetic analyses were performed for countries with >20 sequences. RESULTS: The mean dmft + DMFT was 6.45. Twenty-two gtf-B alleles were identified here, which showed low genetic differentiation in the network. Caries experience was correlated with CFU/mL, but not with allele variation. Low differentiation was found among the 70 alleles recovered from the 358 sequences and among the countries analyzed. CONCLUSION: In this study, caries experience in children was correlated with the number of CFU/mL of S. mutans but not with the gtf-B gene variability. Combined genetic analyses of worldwide strains support the theory that this bacterium experienced population expansions, probably associated with agriculture development and/or food industrialization.

Evaluation of the Severity of Malocclusion in Children with Osteogenesis Imperfecta.

Occlusion is the way in which the dental arches are related to each other and depends on craniofacial growth and development. It is affected in patients with Osteogenesis Imperfecta (OI) who present altered craniofacial development. The malocclusion present in 49 patients diagnosed with different types of OI aged between 4 and 18 was studied. The control group of healthy people was matched for age, sex, and molar class. To study the mixed and permanent dentition, the American Board of Orthodontics (ABO) discrepancy Index was applied. The primary dentition was evaluated with a Temporary Dentition Occlusion Analysis proposed for this study. The OI group obtained higher scores in the Discrepancy Index than the control group, indicating a high difficulty of treatment. The most significant differences were found in types III and IV of the disease. Regarding the variables studied, the greatest differences were found in the presence of lateral open bite in patients with OI, and in the variable "others" (agenesis and ectopic eruption). The analysis of primary dentition did not show significant differences between the OI and control groups. Patients with OI have more severe malocclusions than their healthy peers. Malocclusion is related to the severity of the disease and may progress with age.

Ectopic Eruption of Maxillary First Permanent Molars: Preliminary Results of Prevalence and Dentoskeletal Characteristics in Spanish Paediatric Population.

The ectopic eruption of the maxillary first permanent molar (EEM) is a local alteration of dental eruption with a multifactorial aetiology. The aims of our study were to determine the prevalence of the EEM in children and to analyse whether there is a relationship between EEM and dento-skeletal characteristics. A total of 322 children were analysed with the Ricketts cephalometric study and descriptive and analytical statistical analysis was carried out. The prevalence of EEM was 8.7%, with no statistically significant differences regarding gender or location, but a higher prevalence in the 7-year-old age group (18.8%) and bilateral EEM was more prevalent than unilateral EEM (p < 0.05). The most frequent findings were a shortened anterior cranial base, a retroposition of the maxilla and a distal position of the upper permanent first molar in relation to the pterygoid vertical in children with EEM. No statistically significant differences were found regarding the cephalometric parameters except a decreased palatal plane in the bilateral EEM group and a distal upper incisor position in the EEM group (p < 0.05). In conclusion, the prevalence of the EEM was 8.7%, more frequently bilateral, and significantly in seven-year-old patients. Children with bilateral EEM have decreased palatal plane values and a more posterior position of the upper incisor.

Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study.

BACKGROUND: The objective of this study was to evaluate and compare the validity and accuracy of the Willems, Demirjian and Nolla methods in predicting chronological age in a Spanish ethnicity population. METHODS: A sample of 604 orthopantomographs of Spanish children aged 4 to 13 years was evaluated by two independent evaluators. Descriptive statistics were applied to calculate the chronological age and dental age, presenting the mean and standard deviation. The difference between dental age and chronological age was calculated for each method. A positive result indicated an overestimation and a negative figure indicated an underestimation. The Wilcoxon test for paired data and Spearman's correlation coefficient were applied by age groups and sex to compare the chronological age and dental age of each method (that of Willems, Demirjian and Nolla). Statistical tests were performed at a 95% confidence level. RESULTS: The interexaminer agreement was 0.98 (p = 0.00), and the intraexaminer agreement was 0.99 (p = 0.00). The Willems method significantly overestimated the age of boys (0.35 years (0.93)) and girls (0.17 years (0.88)). The Demirjian method significantly overestimated the age of boys (0.68 years (0.95)) and girls (0.73 years (0.94)). The Nolla method significantly underestimated age in boys (0.44 years (0.93)) and girls (0.82 years (0.98)). CONCLUSIONS: In the Spanish population, the use of the Demirjian method for legal and medical purposes is frequent. This study reveals that the Willems method is more appropriate due to its greater precision in estimating dental age.

Síndrome de Marcus-Gunn / Marcus Gunn syndrome

Introducción: El síndrome de Marcus-Gunn se manifiesta con retracción o elevación del párpado ptótico ante la estimulación del músculo pterigoideo del mismo lado y el término "guiño mandibular" es inapropiado ya que el párpado no siempre desciende. Puede producirse en la apertura bucal, masticación, avance mandibular, al sonreír, silbar, bruxar, sacar la lengua, deglutir, chupar, cantar, en la contracción esternocleidomastoidea, maniobra de Valsalva, respirar o inhalar. Es congénito y de modalidad rara y autosómica dominante. Objetivo: Contribuir al conocimiento de esta rara enfermedad y a su relación con el ámbito odontológico. Presentación del caso: Se trata de un niño de 3 años diagnosticado de síndrome de Marcus-Gunn en el periodo neonatal, por la observación de la madre de una apertura palpebral izquierda durante la succión nutritiva. No presenta otras enfermedades ni antecedentes de interés. En la exploración extraoral se advierte una ptosis palpebral derecha y apertura palpebral izquierda en los movimientos mandibulares y deglución. La intensidad del reflejo se incrementa en estados de ansiedad derivados del tratamiento dental. Conclusiones: el síndrome de Marcus-Gunn es una entidad rara en pediatría, en la cual sus hallazgos clínicos determinan el diagnóstico. Teniendo en cuenta que en ocasiones presentan alteraciones oculares, nada nos hace sospechar la presencia de una enfermedad oral específica(AU)

Introduction: Marcus Gunn syndrome manifests with retraction or elevation of the eyelid ptotico while stimulation of the pterygoid muscle on the same side and the term jaw-winking is inappropriate because the eyelid does not always goes down. It can occur during mouth opening, mastication, mandibular advancement, while smiling, whistling, bruxing, sticking out the tongue, swallowing, sucking, singing, during the sternocleidomastoid contraction, the Valsalva maneuver, breathing or inhaling. This syndrome is congenital and rare, and of autosomal dominant modality. Objective: To contribute to the knowledge of this rare disease and its relationship with the odontologic field. Presentation of the case: 3 years old boy diagnosed with Marcus Gunn syndrome in the neonatal period by the observation of the mother of a left palpebral opening during the nutritive sucking. He does not present other diseases or a background of interest. In the extraoral exploration, it is noticed a right palpebral ptosis and a left palpebral opening in the jaw movements and in swallowing. The intensity of the reflex increases in anxiety states arising from the dental treatment. Conclusions: Marcus Gunn syndrome is a rare entity in pediatrics, in which its clinical findings determine the diagnosis. Taking into account that sometimes it presents ocular alterations, nothing makes us suspect the presence of a specific oral disease(AU)

¿Existen asimetrías condilares en pacientes infantiles con mordida cruzada posterior? / Are condylar asymmetries in infantile patients with posterior cross-bite?

El objetivo de este estudio fue determinar la presencia de asimetría del cóndilo mandibular en pacientes con mordida cruzada posterior unilateral que acudieron para posible tratamiento ortodóncico, comparando la altura y el ancho mandibular de ambos cóndilos. Métodos: Se midieron las anchuras y alturas condilares derechas e izquierdas en 42 ortopantomografías de pacientes infantiles de siete, ocho y nueve años, de ambos sexos, utilizando el método de Habets. Resultados: No se encontraron diferencias estadísticamente significativas, respecto al género y tipo de dentición, tanto en la altura como en la anchura condilar en la muestra compuesta por 42 pacientes. Conclusiones: No observamos la existencia de asimetría del cóndilo en el que se desarrolla la mordida cruzada posterior en relación al contralateral en los grupos de edad estudiados

The aim of this study was to determine the presence of asymmetry of the mandibular condyle in patients with a unilateral posterior crossbite who came for possible orthodontic treatment, comparing the mandibular height and width of both condyles. Methods: Right and left condyle widths and heights were measured in 42 orthopantomographies of seven, eight and nine year old children of both sexes, using the Habets method. Results: No statistically significant differences were found regarding gender and type of dentition, both in the height and in the condylar width in the sample composed of 42 patients. Conclusions: We did not observe the asymmetry of the condyle in which the posterior crossbite was developed in relation to the contralateral bite in the age groups studied

Evaluation of the accuracy of the Nolla method for the estimation of dental age of children between 4-14 years old in Spain: A radiographic study.

The aim of this study was to estimate the age of subjects from their dental age by showing the different stages of tooth development using the Nolla method in a Spanish population sample considering the gender, age group, and the development of the two dental arches. The sample consisted of 604 orthopantomographs corresponding to Spanish children (male: 302 and female: 302) aged from 4 to 14 years old. The resulting chronological and dental ages were compared using Student's t-test. We obtained a good index of agreement between the evaluators and good internal consistency in the evaluation of the ages of the teeth. In general, the dental age estimates were lower than the chronological ages, obtaining an underestimation with the application of the Nolla method. In the male group, the average dental age of the maxillary teeth was 8.36 years and that of the mandibular teeth was 8.40 years, compared to the chronological age of 8.84 years in both cases. In the female group, the average dental age of the maxillary teeth was 7.76 years and that of the mandibular teeth was 7.88 years, compared to the chronological age of 8.70 years in both cases. On applying the Nolla method to our sample, a significant overestimation was observed only in children aged between 4 and 6.9 years. The Nolla method can be used as a complementary tool for estimating age in children of Spanish origin. The application of this method is more favourable in the case of individuals evaluated under the law applied to minors. In general, with this method, age is underestimated, but the calculations involved are reliable, and greater precision has been observed in male than in female. The data from this study can be used as a reference to determine the dental maturity of Spanish children and to estimate their ages.

Study of the influence of crossbite on the size of the apical area in a child population by analyzing panoramic X-ray.

BACKGROUND: The apical area is the space in the maxillary bones that contains teeth during formation and is subsequently occupied by the apices of the permanent teeth. Its dimensions are easy to perceive and determine by observing a panoramic X-ray. Our objective was to analyze the influence of crossbite on the size of the anterior and mesial apical area in Caucasian children. MATERIAL AND METHODS: Based on the ortopantomograph of 353 patients in mixed dentition and crossbite, the sizes of the apical areas of the four hemiarches were studied using the Tps Dig Version 2® computer program. These data were subjected to statistical analysis using the SPSS 22.0 for Windows program and applying the methods of descriptive statistics of quantitative variables, the Kolmogorov-Smirnov test, the non-parametric test Mann-Whitney-Wilcoxon test, and the paired Student t-test. RESULTS: In the group of boys, average values in the superior-mesial, superior-anterior, inferior-mesial and inferior-anterior apical areas of the crossbite were 173.43, 99.85, 180.32 and 87.56 respectively, with the lower values being in the hemiarch without malocclusion. In the group of girls, for the same apical areas, average values were 165.64, 94.24, 168.62 and 83.34 respectively, with all the highest values being in the hemiarch with crossbite, except for the inferior-mesial apical area. Statistically significant differences were found in the hemiarch with crossbite between both genders in the superior-anterior, inferior-anterior and inferior-mesial apical areas, with the significance being 0.001, 0.029 and 0.001 respectively, while in the hemiarch without malocclusion significance was observed in the superior-mesial, superior-anterior and inferior-mesial apical areas, with values of 0.004, 0.001 and 0.004, respectively. CONCLUSIONS: Crossbite affects the size of the anterior apical area in both arches and in both genders. The mesial apical area is influenced by this malocclusion in the jaw in boys and in the maxilla girls. Key words:Apical area, ortopantomography, crossbite.

Sexual dimorphism of primary dentition in Spanish children.

AIM: To analyse differences in the eruption of primary teeth between both sexes. MATERIALS AND METHODS: A cross-sectional study was performed in a sample of 1250 children aged between 3 and 42 months. The clinical emergence of teeth was taken to estimate average ages for primary teeth eruption. The t-test was used to analyse gender and arch differences. RESULTS: Eruption of primary teeth began at the same time in girls as in boys; although the eruptive process was longer in girls. It was observed that almost all deciduous teeth emerged earlier in boys, except for the first molar (upper and lower) and the maxillary central incisors. The differences were statistically significant for almost all the primary teeth except for the central incisors, both upper and lower. CONCLUSIONS: By comparing the timing of the eruption of primary teeth in both sexes, it was found that eruption of almost all primary teeth took place earlier in boys than in girls and that the eruption process was shorter for boys than for girls. Most of the deciduous teeth erupted earlier in the right side in both sexes. No differences were found in the sequence of eruption of primary teeth between genders.

Pacientes con trastorno del espectro autista en odontopediatría / Patients with autism spectrum disorder in pediatric dentistry

El trastorno del espectro autista engloba una serie de trastornos del desarrollo cerebral que pueden causar problemas importantes a nivel de socialización, comunicación y conducta. La Asociación Psiquiátrica Norteamericana los clasifica en: trastorno autista, trastorno de Asperger, trastorno desintegrativo infantil, trastorno generalizado del desarrollo no especificado y trastorno de Rett. La etiología es multifactorial; con interacción de factores genéticos y ambientales. Actualmente se desconocen cuáles son y cómo interactúan los posibles elementos ambientales sobre la susceptibilidad genética. Los trastornos del espectro autista no son fáciles de diagnosticar; y para ello se precisa la evaluación de la conducta y el desarrollo del niño. Por lo general, se detectan en torno a los 18 meses, siendo el sexo masculino el afectado en mayor proporción. La detección temprana es importante ya que los resultados de la terapia precoz proporcionan una mayor y más rápida mejoría que una intervención tardía. Estos trastornos, por sí mismos, no comprenden características orales diferentes a las encontradas en pacientes sin esta patología, no obstante, el riesgo aumenta debido a la capacidad limitada de comprensión así como de asumir responsabilidades en la salud oral, lo que puede aumentar severamente el índice de caries y enfermedad periodontal. Además, se ha encontrado una mayor incidencia de hábitos parafuncionales y autolesiones. El manejo odontológico de estos pacientes es complejo y demanda de una adecuada interacción entre el paciente y el odontólogo. Debido a que son pacientes que requieren de una atención y seguimiento especializado, es imprescindible la formación adecuada de los profesionales (AU)

The Autism Spectrum Disorders cover a range of developmental brain disorders that can cause significant problems at the level of socialization, communication and behavior. The American Psychiatric Association classifies them as: autistic disorder, Asperger's syndrome, childhood disintegrative disorder, pervasive developmental disorder not specified and Rett’s syndrome. The etiology is multifactorial with interaction of genetic and environmental factors. Currently, it is unknown which they are and how they interact with potential environmental elements on genetic susceptibility. The autism spectrum disorders are difficult to diagnose; and for this, the behavioral assessment and development of the child is required. They are usually detected around 18 months and males are being affected to a greater extent. Early detection is important because the results of early therapy provide greater and more rapid improvement than later intervention. These disorders, by themselves, do not have different oral characteristics to those found in patients without this pathology, however, the risk increases due to the limited capacity of understanding and assuming responsibilities in oral health, which can severely heighten index of caries and periodontal disease. Moreover, a higher incidence of parafunctional habits and self-harm have been found. The dental management of these patients is complex and demand proper interaction between the patient and the dentist. Because they are patients who require specialized care and monitoring is essential that professionals have a proper training (AU)

How to improve communication with deaf children in the dental clinic

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It may be difficult for hearing-impaired people to communicate with people who hear. In the health care area, there is often little awareness of the communication barriers faced by the deaf and, in dentistry, the attitude adopted towardsthe deaf is not always correct.A review is given of the basic rules and advice given for communicating with the hearing-impaired. The latter are classified in three groups – lip-readers, sign language users and those with hearing aids. The advice given varies for the different groups although the different methods of communication are often combined (e.g. sign language plus lip-reading,hearing-aids plus lip-reading).Treatment of hearing-impaired children in the dental clinic must be personalised. Each child is different, depending on the education received, the communication skills possessed, family factors (degree of parental protection, etc.), theexistence of associated problems (learning difficulties), degree of loss of hearing, age, etc (AU)

Dental treatment for disabled children in the Spanish Public Health System.

The Spanish Public Health System is stepping up its efforts to meet all the medical needs of the population. Oral health is of increasing interest for society, especially for parents who are keen for their children to have healthy teeth. Disabled children with both physical and mental disabilities do not always receive the dental care they need. The purpose of this bibliographical review is to evaluate the services provided by the Spanish Public Health System to such children. We have noted marked differences in the types of dental treatment given to these patients in the different Autonomous Communities of Spain. Some, such as Asturias, Navarra and Extremadura, offer specific care for disabled children. Others, such as Ceuta and Melilla, provide more general care.