Oral health care for people with disabilities in Brazil: Transition from the specialized dental services between 2014 and 2018.

OBJECTIVE: To identify changes in the dental service provision to people with disabilities (PD) in the Dental Specialties Centers (acronym CEO in Portuguese-Centro de Especialidades Odontológicas) between the first and second cycles of the Program for the Improvement of Access and Quality of CEO and analyse factors associated with any changes. METHODS: This nationwide ecological time series study adopted the CEO as the analysis unit. The 827 CEO who participated in the two program's cycles (2014 and 2018) were included. Data on the structure and the work process were considered to identify features of providing services to PD in both cycles. Latent transition analysis (LTA) was performed to identify latent status (LS) with similar features and model the transition between LS over time. Models with five variables and with two to five LS were tested, considered best conceptual interpretability and best model fit parameters: human resources structure (dentist working exclusively with PD) and work process that identified guarantee of PD treatment at the CEO, the CEO's interface with primary care, and the interface with tertiary care. Spatial analysis was performed to identify spatial patterns of LS in the Brazilian territory with choropleth maps. A multinomial logistic regression model was performed to identify factors associated with changes in the provision of CEO (improved, remained or worsened). FINDINGS: The best-fit model identified four LS: 'Better', 'Medium better', 'Medium worse' and 'Worse'. CEO remained in the LS 'Better' (94%), LS 'Medium' (5.3%) and LS 'Worse' (78.4%). It is noteworthy that the highest proportion of CEO, in both cycles, was in the LS 'Better', featured by the CEO, characterized by all the CEO guaranteeing treatment to users with PD, high proportions of professionals working exclusively with PD, and most CEO articulated with primary care and with tertiary care. However, there is a decrease in the number of postgraduate professionals specializing in this service profile (1.3%). The higher the population growth, the greater the likelihood of the CEO achieving 'improved' in the LS. Moreover, the higher the number of goals, the lower the likelihood of the CEO getting 'worse' in the LS. CONCLUSION: Advances in dental service provision were observed, with more significant transitions to the 'Better' class, with improvements mainly in the interface with primary and tertiary care. Disability will be an even more significant concern as the population ages. Initiatives that can remove barriers and empower PD are potent in the provision of oral health services.

Tratamento de má oclusão de classe III e mordida cruzada posterior bilateral através de camuflagem ortodôntica ­ relato de caso / Treatment of class III malocclusion and bilateral posterior crossbite through orthodontic camouflage ­ case report

Resumo A má oclusão de Classe III é caracterizada pela dimensão transversal insuficiente e as mordidas cruzadas são recorrentes nos pacientes com esse padrão esquelético. O objetivo deste trabalho é apresentar um caso clínico de tratamento Classe III e mordida cruzada posterior bilateral através de camuflagem ortodôntica. O paciente do sexo masculino, 18 anos e 7 meses, relatou como queixa principal a falta de oclusão entre os dentes superiores e inferiores. Apresentava má oclusão de Classe III, mordida cruzada posterior bilateral, desvio de linha média e assimetria facial. A correção da mordida cruzada foi realizada através da utilização de uma sequência de arcos ortodônticos superiores expandidos e arcos inferiores contraídos e a Classe III foi camuflada através da técnica Multiloop Edgewise Archwire (MEAW). Ao fim do tratamento, foi obtida a relação oclusal de Classe I entre os caninos, correção da mordida cruzada posterior bilateral e coincidência entre as linhas médias. A técnica MEAW mostrou eficácia na camuflagem da Classe III, assim como a sequência de arcos expandidos e contraídos na correção da mordida cruzada posterior bilateral. (AU)

Abstract Class III malocclusion is characterized by insufficient transverse size and crossbites are recurrent in patients with this skeletal pattern. The aim of this work is to present a clinical case treatment of Class III and bilateral posterior crossbite through orthodontic camouflage. Male patient, 18 years old and 7 months, reported as main complaint lack of occlusion between upper and lower teeth. He had Class III malocclusion, bilateral posterior crossbite, midline deviation, and facial asymmetry. Crossbite correction was performed using a sequence of expanded upper orthodontic arches and contracted lower arches and Class III camouflage by Multiloop Edgewise Archwire (MEAW) technique. At the end of treatment, it was obtained Class I occlusal relationship between canines, bilateral posterior crossbite correction and coincidence between the midlines. MEAW technique showed efficacy in Class III camouflage as well as the expanded and contracted arches sequence to correct bilateral posterior crossbite. (AU)

Camuflagem ortodôntica na correção da má oclusão de Classe II divisão 1ª de Angle, utilizando-se o aparelho de protração mandibular associado à técnica MEAW ­ relato de caso / Orthodontic camouflage in correction of Class II division 1 Angle malocclusion, using mandibular protraction appliance associated with MEAW technique ­ case report

Resumo O objetivo deste trabalho é relatar um caso clínico de camuflagem ortodôntica de má oclusão de Classe II divisão 1ª com retrognatismo mandibular através do Aparelho de Protração Mandibular (APM) e da técnica Multiloop Edgewise Archwire (MEAW). A paciente de 16 anos e 8 meses de idade, tinha como queixa principal o retrognatismo mandibular. No exame clínico, foi verificado o perfil convexo, incisivos superiores vestibularizados, sobremordida e sobressaliência acentuadas, mandíbula retrognática e má oclusão de Classe II divisão 1ª. O APM foi utilizado simultaneamente à técnica MEAW para camuflagem da Classe II. Ao final do tratamento, foi obtida uma melhora no perfil facial, oclusão com sobremordida e sobressaliência normais e boa intercuspidação. O APM e a técnica MEAW demonstraram eficácia na camuflagem ortodôntica da má oclusão de Classe II divisão 1ª com retrognatismo mandibular. (AU)

Abstract The objective of this work is to report a clinical case of orthodontic camouflage of Class II division 1 malocclusion with mandibular retrognathism using the Mandibular Protraction Appliance (MPA) and the Multiloop Edgewise Archwire (MEAW) technique. The female patient, 16 years and 8 months old, had as main complaint mandibular retrognathism. In the clinical examination, convex profile, buccal upper incisors, increased overbite and overjet, retrognathic mandible, and Class II division 1 malocclusion were verified. MPA was used simultaneously with the MEAW technique for Class II camouflage. At the end of the treatment, an improvement in facial profile, occlusion with normal overbite and overjet, and good intercuspation were obtained. MPA and the MEAW technique demonstrated effectiveness in orthodontic camouflage of Class II division 1 malocclusion with mandibular retrognathism. (AU)

Tratamento de má oclusão de Classe III subdivisão com mordida cruzada posterior unilateral através da técnica multiloop edgewise archwire (MEAW) ­ relato de caso / Treatment of Class III subdivision malocclusion with unilateral posterior crossbite through multiloop edgewise archwire (MEAW) technique ­ case report

Resumo O objetivo deste trabalho foi relatar um caso clínico de tratamento de má oclusão de Classe III subdivisão com mordida cruzada posterior unilateral através da técnica Multiloop Edgewise Archwire (MEAW). O paciente do sexo masculino, 19 anos de idade, relatou o prognatismo mandibular como queixa principal. Apresentava má oclusão de Classe III de Angle, mordida cruzada posterior unilateral direita, mordida de topo na região anterior, linhas médias não coincidentes e assimetria facial. Devido à recusa ao tratamento cirúrgico pelo paciente, foi proposto uma compensação ortodôntica dentoalveolar. Foi utilizada a técnica MEAW associada ao uso de elásticos intermaxilares 3/16". Ao final do tratamento, foi obtida relação oclusal de Classe I entre caninos e molares, correção da mordida cruzada posterior unilateral, coincidência entre as linhas médias. A técnica MEAW mostrou eficácia na correção da má oclusão de Classe III subdivisão e mordida cruzada posterior unilateral. (AU)

Abstract The aim of this study was to report a clinical case of treatment of Class III subdivision malocclusion with unilateral posterior crossbite using the Multiloop Edgewise Archwire (MEAW) technique. A 19-year-old male patient reported mandibular prognathism as the main complaint. He had Angle Class III malocclusion, unilateral posterior crossbite on the right side, top bite in the anterior region, non-coincident midlines and facial asymmetry. Due to the patients refusal of surgical treatment, dentoalveolar orthodontic compensation was proposed. The MEAW technique associated with 3/16" intermaxillary elastics were used. At the end of the treatment, a Class I occlusal relationship between canines and molars, correction of the unilateral posterior crossbite and coincidence between the midlines was obtained. The MEAW technique was effective in correcting Class III subdivision malocclusion and unilateral posterior crossbite. (AU)

Fechamento de espaço de molar inferior com ancoragem através de aparelho de protração mandibular ­ relato de caso / Mandibular molar space closure with anchorage through mandibular protraction appliance ­ case report

O objetivo deste trabalho é apresentar um relato de caso clínico de fechamento de espaço de molar inferior, utilizando como ancoragem o Aparelho de Protração Mandibular instalado unilateralmente. A paciente do sexo feminino, 24 anos de idade, relatou como queixa principal os múltiplos diastemas e o espaço correspondente ao primeiro molar inferior esquerdo extraído. Apresentava má oclusão de Classe I, perfil reto, selamento labial passivo, simetria facial, linhas médias coincidentes, giroversões, diastemas entre incisivos laterais e caninos nos arcos superior e inferior, entre caninos e primeiros pré-molares inferiores e espaço referente ao primeiro molar inferior esquerdo extraído. Foi proposto o fechamento do espaço através da mesialização do segundo e terceiro molar com alça de Bull, utilizando o Aparelho de Protração Mandibular (APM) como ancoragem dos dentes anteriores inferiores. A técnica Multiloop Edgewise Archwire (MEAW) com elásticos intermaxilares 1/8 força média foi utilizada para corrigir os efeitos colaterais provocados pelo uso unilateral do APM. Ao final do tratamento, foi obtido o fechamento de todos os diastemas e do espaço correspondente ao primeiro molar inferior esquerdo. O Aparelho de Protração Mandibular utilizado unilateralmente mostrou eficácia como dispositivo de ancoragem durante o fechamento de espaço do elemento posterior extraído (AU)

The aim of this work is to present a clinical case report of lower molar space closure using as anchorage Mandibular Protraction Appliance unilaterally installed. A female patient, 24 years old, reported as main complaint multiple diastemas and the space corresponding to the extracted lower left first molar. She presented Class I malocclusion, straight profile, passive labial sealing, facial symmetry, coincident median lines, gyroversions, diastemas between lateral incisors and canines in the maxillary and mandibular arches, between canines and lower first premolars and space of the extracted lower first molar. It was proposed closure of the space through mesialization of the second and third molars with Bull loop, using the Mandibular Protraction Appliance (MPA) as anchorage of lower anterior teeth. Multiloop Edgewise Archwire (MEAW) technique with 1/8 medium strength intermaxillary elastics were used to correct the side effects caused by unilateral use of MPA. At the end of treatment, all diastemas and the space corresponding to the first lower left molar were closed. The Mandibular Protraction Appliance used unilaterally proved to be effective as an anchor device during space closure of the extracted posterior element (AU)