Manejo odontológico de una paciente con síndrome de Apert / Dental management of a patient with Apert syndrome

El síndrome de Apert, marcado por la acrocéfalo-sindactilia, es una condición genética que genera deformidades dentofaciales incluyendo craneosinostosis, alteraciones faciales y malformaciones en extremidades. La mutación en el gen FGFR2, ya sea heredada o resultante de mutaciones esporádicas, desencadena esta compleja condición. La relevancia de abordar el síndrome de Apert se manifiesta no sólo en las implicaciones estéticas, sino también en su impacto en la salud oral. Romper con los paradigmas odontológicos actuales implica reconocer las particularidades de estos pacientes y proporcionar una atención especializada. La necesidad de una capacitación específica para los profesionales de la salud oral es evidente, permitiendo un enfoque integral que aborde la prevención y el tratamiento de las malformaciones craneofaciales asociadas. Superar los desafíos tradicionales implica adoptar una perspectiva inclusiva y personalizada en la atención odontológica. Esto no sólo mejora la calidad de vida de los pacientes con síndrome de Apert, sino que también destaca la importancia de una atención adaptada que trascienda los límites convencionales, ofreciendo soluciones innovadoras para las complejidades bucodentales asociadas a esta condición genética (AU)

Apert syndrome, marked by acrocephalosyndactyly, is a genetic condition that generates dentofacial deformities, including craniosynostosis, facial alterations and limb malformations. Mutation in the FGFR2 gene, whether inherited or resulting from sporadic mutations, triggers this complex condition. The relevance of addressing Apert syndrome is manifested not only in the aesthetic implications, but also in its impact on oral health. Breaking with current dental paradigms involves recognizing the particularities of these patients and providing specialized care. The need for specific training for dental health professionals is evident, allowing a comprehensive approach that addresses the prevention and treatment of associated craniofacial malformations. Overcoming traditional challenges means taking an inclusive and personalized perspective on dental care. This not only improves the quality of life of patients with Apert syndrome, but also highlights the importance of tailored care that transcends conventional boundaries, offering innovative solutions for the oral complexities associated with this genetic conditio (AU)

Simplifying two-vector mechanics calculations for challenging tooth movements.

The purpose of this article was to describe a simple graphical driven method for determining the necessary two-vector mechanics (TVM) as an alternative solution to the ideal or single force. In orthodontics, some tooth movements are difficult to achieve, mainly because of the impossibility of getting the point of application for the necessary force system. Given two points in biomechanically accessible areas, adding together two vectors applied to those points will result in an equivalent force system. The method was developed based on previous research, 3,880 hypothetical cases were analyzed to determine the trends between the resulting forces and their relative locations. A graphical driven TVM method (GTVM) for establishing the necessary TVM is presented in a manner that combine different procedures from the traditional method that simplify the analysis and may allow the user to perform more complex orthodontic cases making easier to compare systems of force equivalents.

¿Participan los pacientes crónicos en su plan de tratamiento?: resultados de la encuesta nacional de salud, Chile, ENS 2016-2017 / Do chronic patients participate in decision-making about their treatment plans? Results of a national health survey, Chile, ENS 2016-2017

Introducción: el apoyo al automanejo, la participación y retroalimentación son centrales en la implementación de una atención centrada en el usuario en el marco del modelo de cuidados crónicos. Esto ha demostrado mejorar diversos resultados sanitarios. Objetivo: estimar el grado de participación de los pacientes hipertensos y diabéticos, en las decisiones sobre su plan de tratamiento en población adulta chilena. Métodos: análisis secundario de la Encuesta Nacional de Salud (ENS) 2016-2017, muestra aleatoria estratificada de hogares, multietápica por conglomerados, representativa de la población adulta chilena. Se incluyó población mayor de 15 años hipertensa o diabética bajo tratamiento. Se describen las prevalencias expandidas de la variable percepción de participación en la toma de decisio-nes sobre plan terapéutico en escala Likert de 5 niveles, según edad, sexo, zona urbana/rural y nivel educacional. Se utilizó regresión logística y OR ajustados. Resultados: el 72,3% de los diabéticos y el 71,9% de los hipertensos, refieren "nunca" haber sido consultados al preparar su plan de tratamiento. En la población hipertensa, existe una percepción de participación significativamente más baja en mujeres que en hombres (OR ajustado por edad = 0,5 (IC 95% de 0,3-0,8) no se observaron diferencias estadísticamente significativas según edad, ruralidad ni nivel educacional. Conclusiones: la población hipertensa y diabética percibe bajos niveles de participación en el diseño de su plan terapéutico y los resultados sugieren inequidad de género en hipertensos. Este estudio permitirá evaluar futuras políticas y modificaciones al modelo de cuidados crónicos en el sistema de salud chileno.

Introduction: Self-management support, activation, participation, and feedback are core elements in chronic care models. Patients' participation in decision-making has been shown to improve health outcomes. Objective: To estimate the degree of participation of hypertensive and diabetic patients in decisions about their treatment plan in the general Chilean adult population. Methods: Secon-dary analysis of the "Encuesta Nacional de Salud (National Health Survey) (ENS) 2016-2017" multistage random stratified sample of households representative of the Chilean adult population. Hypertensive or diabetic populations older than 15 years of age that were under treatment were included. The weighted prevalence of the variable "perception of participation in decision making about their treatment plan" was described on a Likert scale of 5 levels, according to age, sex, urban/rural area, and educational level. We used logistic regression and adjusted OR. Results 72.3.5% of diabetic and 71.9% of hypertensive patients say they have "never" been asked their opinion about their treatment plan. In the hypertensive population, women perceived less participation than men (OR adjust by age =0.5 [IC 95% de 0.3-0.8]), with no significant differences observed by age, rurality, or educational level. Conclusions: Hypertensive and diabetic populations perceive low levels of participation in the design of their therapeutic plan, results also suggest gender inequity. This study contributes essential insights for the reformulation of Chilean chronic care models and may stand as a baseline to evaluate the implementation of future health policy.

Influence of 2D vs 3D imaging and professional experience on dental implant treatment planning.

OBJECTIVES: This study investigated whether professional experience and type of image examination (panoramic radiography (PAN) or cone beam computed tomography (CBCT)) could influence the pre-surgical planning for dental implant treatment. MATERIALS AND METHODS: Six dentists, from two different levels of experience (senior (Sr) and junior (Jr)) performed simulated pre-surgical planning by using PANs and after 1 month, by using CBCTs, considering implant length (IL), implant width (IW), need for bone graft (BG), and other surgical procedures (OP). Bland-Altman test and Kappa coefficient were used to identify agreements. RESULTS: Bland-Altman test showed good agreement in the plans for inter-professional (i.e., Sr vs Jr) comparisons. Bland-Altman plots displayed intra-observer agreement (i.e., differences between PAN and CBCT), showing discrepancy between imaging modalities for IL and a tendency towards selecting larger dental implant options when using PAN and smaller options with CBCT. Kappa showed almost perfect (0.81-1.0) agreement between Jr and Sr for OP (PAN and CBCT). For BG, agreement was substantial (0.61-0.80) when planning was done with PAN and CBCT. Descriptive statistics showed evidence that when Jrs used CBCT, they no longer indicated the BG they had planned when they used PAN. CONCLUSION: There were differences in the pre-surgical planning for treatment with dental implants depending on the professional experience and the type of imaging examination used. CLINICAL RELEVANCE: Variation in dental implant planning can affect treatment time, cost, and morbidity in patients.

Diagnóstico, planificación del tratamiento y endodoncia de un primer premolar inferior con dos canales mediante tomografía computarizada 3D: reporte de un caso

El tratamiento endodóntico debe considerar que los dientes presentan una morfología del sistema de canales radiculares con alta variabilidad y complejidad. por lo tanto, el conocimiento acabado de la anatomía radicular y la planificación del procedimiento utilizando sistemas imagenológicos previos a la realización del tratamiento endodóntico, como la tomografía computarizada 3D (CBTC), mejoran el pronóstico, aumentando las probabilidades de éxito. el objetivo de este reporte es mostrar la secuencia de una resolución clínica de un primer premolar inferior (diente 4.4) con una anatomía compleja, utilizando el CBTC tanto en el diagnóstico como en la planificación.

Planejamento virtual em Cirurgia Ortognática: uma mudança de paradigma / Virtual planning in Orthognathic Surgery: a shift of paradigm

Progressos tecnológicos e estudos detalhados em imagens têm permitido a utilização de planejamentos virtuais em cirurgias ortognáticas. A tomografia computadorizada com reconstrução em três dimensões e o scanner de modelos de gesso trouxeram consigo uma mudança significativa no plano de tratamento e nas cirurgias de modelos: deixam para trás o método tradicional e introduzem a era virtual em cirurgia ortognática. O objetivo deste trabalho é apresentar os benefícios do planejamento virtual em cirurgias ortognáticas, bem como apresentar seus avanços na literatura.

Technological advances and detailed studies of images has allowed the use of virtual planning in orthognathic surgery. Computed tomography with three-dimensional reconstruction and scanner casts have brought a significant change in the treatment plan and in surgical models: leave behind the traditional method and introduce the virtual era in orthognathic surgery. The objective of this paper is to present the benefits of virtual planning in orthognathic surgery, as well as presenting his advances in literature.

Plano de tratamento virtual na Ortodontia / Virtual treatment plan in Orthodontics

A Ortodontia evoluiu muito nos últimos anos com o surgimento de materiais eficientes e precisos, e com recursos auxiliares de diagnóstico. O passo seguinte é a possibilidade de planejar um tratamento de forma virtual, isto é, simular um tratamento ortodôntico de forma precisa antes mesmo de iniciá-lo clinicamente. Este trabalho explica como a simulação virtual pode ser aplicada na atualidade, auxiliando o trabalho do ortodontista e também criando uma nova ferramenta para a comunicação com o paciente.

Orthodontics has evolved in recent years with the development of efficient and accurate materials, and auxiliary resources to help diagnosis. The next step in this evolution is the ability to plan treatments virtually, so that it is possible to simulate an orthodontic treatment accurately before you even start it clinically. This paper explains how virtual simulation can be applied today, aiding the work of orthodontists, and also creating a new tool to communicate with the patient.

A influência de imagens tridimensionais no plano de tratamento ortodôntico / Orthodontic treatment plan changed by 3-D images

INTRODUÇÃO: a tomografia computadorizada de feixe cônico (TCFC) foi introduzida no final da década de 90 e estudos têm aprimorado o seu emprego na Odontologia. OBJETIVO: o objetivo desse artigo foi verificar a influência de imagens tridimensionais (3D) no plano de tratamento ortodôntico. MÉTODOS: duas situações clínicas (reabsorção cervical e deiscência óssea) foram descritas por meio de imagens 3D. RESULTADOS: a conduta ortodôntica foi redirecionada para a simplificação da mecânica e o controle das lesões durante o tratamento ortodôntico. CONCLUSÃO: imagens 3D são capazes de aumentar a acurácia do diagnóstico e redirecionar o plano de tratamento ortodôntico.

INTRODUCTION: Cone-Beam Computed Tomography (CBCT) was introduced in the 90's and studies have improved its use in dentistry. OBJECTIVE: The aim of this article was to investigate the influence of three-dimensional (3D) images in orthodontic treatment planning. METHOD: Two clinical situations (bone dehiscence and cervical resorption) were described by 3D images. RESULTS: The orthodontic treatment plan was redirected to a simplified mechanics and control of the lesions during orthodontic treatment. CONCLUSION: 3D images are able to increase diagnostic accuracy and redirect orthodontic treatment plan.

Distinção entre Dois Tipos de Lesão Dentinária na Superfície Oclusal sob Esmalte sem Cavitação / Distinction between Two Types of Dentine Lesion on the Occlusal Surface without Cavitation Enamel Under

Introdução: Embora a prevalência de cárie tenha diminuído consideravelmente, as superfícies oclusais ainda representam as áreas com maior proporção de experiência dessa lesão. Por outro lado, atualmente os clínicos e a comunidade científica têm detectado uma grande ocorrência de lesões dentinárias oclusais sob esmalte aparentemente hígido. Essas lesões têm sido denominadas de cárie oculta porque se mostram clinicamente com superfície oclusal sem cavitação e com evidente manifestação em dentina, quando da execução do exame radiográfico. Objetivo: O objetivo desse trabalho é distinguir dois tipos de lesão dentinária, sob esmalte sem cavitação, apresentando uma nova denominação, cárie semioculta, para todas as lesões dentinárias sob esmalte não cavitado, porém com mudança de coloração, visível através da inspeção visual detalhada, classificando as duas entidades distintas de cárie escondida, cárie oculta e semioculta, baseando-se no método de diagnóstico. A diferenciação entre as lesões será ilustrada através de fotografias, ressaltando os aspectos clínicos de ambas as situações.Conclusão: A introdução no meio científico dessa nova denominação é bastante relevante tendo em vista que as pesquisas mostram uma taxa relativamente alta da prevalência da cárie oculta porque consideram apenas a ausência da cavitação no esmalte, sem a observação da mudança na sua configuração e coloração. Entretanto, se verifica que a maioria dessas lesões é cárie semioculta, portanto detectáveis pela inspeção visual detalhada, e que a cárie oculta, encontrada em menor percentual, não é perceptível através da inspeção visual detalhada, mas plenamente visível através da radiografia. As evidências clínicas impõem a necessidade da constante evolução e modificação de conceitos e técnicas operatórias

Introduction: Although caries prevalence has decreased considerably, the occlusal surfaces still represent areas with higher proportion of experience of this injury. Moreover, currently the clinical and scientific community have found a high occurrence of occlusal dentin lesions in apparently healthy enamel. These lesions have been called hidden caries because they show clinically the occlusal surface without cavitation and with evident manifestation in dentin when executing radiographic examination. Objective: The aim of this work is to distinguish two types of dentinlesion, no cavitation in enamel, with a new name, almost hidden caries, for all lesions in enamel dentin cavitated not, but with color change, visible through the detailed visual inspection, classifying the twoseparate entities hidden caries, hidden caries and almost hidden caries, based on the method of diagnosis. The differentiation between the lesions will be illustrated by photographs, emphasizing the clinical aspects of both situations.Conclusion: The introduction of this new in the scientific name is very relevant given that polls show a relatively high prevalence of hidden caries because they take into account only the absence of cavitation inenamel without notice of the change in shape and color . However, it appears that the majority of these injuries is almost hidden cariestherefore detectable by detailed visual inspection, and that the hidden caries, found at a lower rate is not noticeable through visual detail, but fully visible by radiography. The clinical evidence imposes the need for constant evolution and change of concepts and surgical techniques