Mantenedor de espacio funcional elaborado con corona de NuSmile / Elaborated functional space maintainer with zirconia NuSmile crown

La caries de la infancia temprana, al igual que otras formas de caries, se caracteriza por ser multifactorial, infecciosa y de rápida evolución. Puede presentarse como lesiones cavitadas o no cavitadas, se diagnostica principalmente en menores de seis años en la superficies de los dientes anterosuperiores, debido a que son los primeros órganos dentales en erupcionar y tienen mayor contacto con el estímulo cariogénico. En casos severos pueden llegar a ocasionar la pérdida de órganos dentales, influyendo en la salud general del paciente y repercutiendo en su autoestima y desarrollo psicosocial. Para devolver las características y funciones perdidas en ausencia de algún órgano dental, se recurre a sustituirlo mediante aparatología, mayormente en forma de un mantenedor de espacio funcional. Las necesidades estéticas individuales de cada caso generan diversas alternativas para adaptarnos a la situación del paciente (AU))

Early childhood caries, like other forms of caries, is characterized by being multifactorial, infectious, and rapidly evolving. It can present as cavitated or uncavitated lesions, it is mainly diagnosed in children under six years of age on the surfaces of the anterior superior teeth, because they are the first dental organs to erupt and have greater contact with the cariogenic stimulus. In severe cases they can cause the loss of dental organs, influencing the general health of the patient and impacting on their self-esteem and psychosocial development. In order to restore the lost features and functions in the absence of any dental organ, it is resorted to by means of appliances, mostly in the form of a functional space maintainer. The individual aesthetic needs of each case generate various alternatives to adapt to the patient's situation (AU)

Avulsión dental y mantenedor de espacio estético-funcional y correctivo en Odontopediatría / Dental avulsion and esthetic-functional and corrective retainers use in Pediatric Dentistry / Avulsão dentária e mantenedor do espaço estético-funcional e corretivo em Odontopediatria

RESUMEN Se presentó el caso de un niño de 8 años que acudió al Servicio de Estomatología del Policlínico Universitario "Chiqui Gómez Lubián", de Santa Clara, provincia Villa Clara. En el mismo se observó avulsión del incisivo central superior derecho, fractura no complicada de la corona en incisivo central superior izquierdo y una marcada vestibuloversión. Se confeccionó un aparato placa Hawley de acuerdo a las características y necesidades del paciente, con el fin de lograr la recuperación estética, mantener la longitud del arco y corregir la vestibuloversión en el mismo. El aparato permitió obtener un resultado satisfactorio, que ha influido psicológicamente en el paciente al elevar su autoestima y salud bucal.

ABSTRACT A boy of 8 years old was seen in the dental service at the Policlínico Universitario "Chiqui Gómez Lubián", in Santa Clara, Villa Clara. Examination revealed avulsion in the right upper central incisor, uncomplicated crown fracture in left upper central incisor and an improper alignment of the teeth. Taking into account patients´ characteristics and requirements, it was fabricated a Hawley´s retainer in order to achieve a better aesthetic outcome, maintain the length of the dental arch and correct the improper alignment of the teeth. The appliance has achieved a satisfactory outcome, which has had a psychological influence on the patient by improving his self-esteem and oral health.

RESUMO Foi apresentado o caso de um menino de 8 anos que veio ao Serviço de Estomatologia do Policlínico Universitario "Chiqui Gómez Lubián", em Santa Clara, província de Villa Clara. Neste, observou-se avulsão do incisivo central superior direito, fratura não complicada da coroa em incisivo central superior esquerdo e vestibuloversão acentuada. Um dispositivo de placa de Hawley foi confeccionado de acordo com as características e necessidades do paciente, a fim de se obter recuperação estética, manter o comprimento do arco e corrigir a vestibuloversão nele. O dispositivo permitiu obter um resultado satisfatório, o que influenciou psicologicamente o paciente, elevando sua autoestima e saúde bucal.

Blood clot stability and bone formation following maxillary sinus membrane elevation and space maintenance by means of immediate implant placement in humans. A computed tomography study.

OBJECTIVE: The present controlled clinical pilot study proposed to assess blood clot contraction and bone neo-formation following maxillary sinus lift (MSL) with immediate implant placement without using grafts using cone beam tomography exams. MATERIALS AND METHODS: Ten implants were placed in ten patients with a residual bone crest height ≥4 and ≤ 7 mm, in maxillary premolars or 1st or 2nd molars regions, using MSL and immediate implant placement without grafts, by means of the lateral window approach. A resorbable membrane (Bio-Gide®, Geistlich, USA) was used to close the window. Computed tomography images were taken after 15 (T1) and 180 (T2) days to assess the rate of blood clot contraction and bone neo-formation. The images were analysed by OsirixMD software. The Shapiro Wilk test was used to verify the normality hypothesis and the data were submitted to Student's paired t-test. RESULTS: The mean of bone clot height in mesial, apical and distal area referred to implant, presented 4.77 mm, 0.77 mm and 5.30 mm respectively. The mean measurements of new bone formation presented 2.95 mm, 0.44 mm and 3.45 mm. The height contraction (coagulum/new bone formation), between T1 and T2, presented 38%, 43% and 35% respectively, with a significant statistical value p < 0.05. The volume measurements at T1 presented a mean volume of 0.90 cm3 sd ± 0.60 cm3 and at T2 a mean volume of 0.75 cm3 sd ± 0.62 cm3, with a significant volume contraction between T1 and T2, p < 0.005. The mean blood clot contraction was 16.52% ± 8.60%. CONCLUSION: The present study demonstrates consistent bone formation around all assessed implants, although with significant contraction of the blood clot. The need for longitudinal studies to establish a long-term prognosis in different modalities of prosthetic rehabilitation of those implants is strongly suggested.

Methods of space maintenance for premature loss of a primary molar: a review.

AIM: This critical appraisal attempts to answer the question: What is the best method of space maintenance (SM) following premature loss of a primary molar in children under 12 years old? METHODS: A search to identify studies relevant to the PICO was conducted. Single case reports and studies prior to 1986 were excluded. The principles of GRADE were followed to appraise the evidence. RESULTS: 20 studies were identified, which evaluated 2265 space maintainers (SMs). Two studies were graded high quality, four moderate, eight low, and six very low. All studies reported on longevity outcomes and most on adverse effects. CONCLUSIONS: There was no strong evidence favouring a particular SM, the following recommendations were made: (a) strong recommendations: In cases where rubber dam cannot be used clinicians should not use Glass Fibre Reinforced Composite Resin (GFRCR) SMs. (b) Weak recommendations: Crown and Loop SMs are recommended for loss of primary first molars; GFRCR SMs (placed under rubber dam) are recommended for loss of primary second molars. Bilateral SMs may have questionable efficacy and their use where there is loss of multiple molars in the same quadrant should be weighed against the risk of unwanted tooth movements, loss of a removable SM or no space maintenance at all.

Space maintainers in the primary and mixed dentition - a clinical guide.

This paper describes different types of space maintainers and the clinical situations where they may be useful, for example, when primary teeth have been lost prematurely. It serves as a clinical guide for practitioners on the best types of space maintainers to use and on the clinical uses of space maintainers in preventing undesirable tooth movements and resulting loss of arch length.

Tratamiento ortodóncico en pacientes adultos combinando CA Clear Aligner con brackets linguales y microimplantes / Orthodontic treatment in adult patients combining CA Clear Aligner with lingual brackets and microimplants

Los pacientes adultos normalmente prefieren tratamiento ortodóncico invisible. La ortodoncia puedemejorar la estética, alinear y nivelar los dientes mejorando la salud periodontal, y también la posiciónde los dientes para recibir tratamiento protésico con un mejor pronóstico.

Adult patients normally prefer invisible orthodontic treatment. Orthodontics can improvethe aesthetics, align and level the teeth improvingthe periodontal health and also position the teeth to receive the prosthetic treatmentwith a better prognosis.

Multidisciplinary approach for replacement root resorption following severe intrusive luxation: A case report of decoronation.

Intrusive luxation is a severe trauma-related event with a high frequency of pulp necrosis and root resorption. A common complication following intrusion is tooth ankylosis, which can extend to progressive replacement root resorption. An increasing infraposition in growing individuals can also occur. Decoronation is a new conservative treatment for cases of tooth ankylosis in young patients who have not finished growing. In this surgical technique, the tooth crown is removed and the root with replacement resorption process remains inside the alveolus. This treatment allows the alveolar bone to continue to develop, thus preserving bone dimensions. The purpose of this article is to report a multidisciplinary case of a young patient with anterior open bite, dental ankylosis, and tooth infraposition affected by intrusive luxation. Decoronation was the treatment of choice for this patient. The patient was then referred to orthodontic treatment to maintain the space of the maxillary right central incisor and open bite correction. After 5 years of follow-up, good clinical and radiologic results were obtained.

Clinical Success of Fiber-reinforced Composite Resin as a Space Maintainer.

INTRODUCTION: The early loss of deciduous molars is a frequently encountered problem in dentistry. Various space maintainer designs were developed to prevent the loss of the space. The aim of this study was to evaluate long-term clinical performance and survival rates of fiber-reinforced composite resin (FRCR) as a space maintainer clinically. MATERIALS AND METHODS: This study was designed on 44 children who had early missed deciduous molars. Space maintainers were prepared on plaster models of patients and fixed directly to the adjacent teeth. Survival rate and whether it causes any damage to adjacent teeth were examined clinically and radio-graphically for 24 months or until failure. Kaplan-Meier survival analysis was used for the statistical analyses. RESULTS: Overall, 16.2% of space maintainers were dislodged and accepted to be failed at the end of 12 months. At the 24-month control, 52.2% success was stated with the FRCR space maintainer and because of permanent tooth eruption, 31.8% of space maintainer were taken out. The mean duration of space maintainers was measured to be 14.8 ± 3.48 months. There was no statistical significance between survival time and gender, tooth number, localization, and measured space (p > 0.05). CONCLUSION: After all 24 months follow-up, as well as esthetic properties of FRCR space maintainer, their applicability in a single seance and strength against the forces are determined as the advantages of the technique. CLINICAL SIGNIFICANCE: The FRCR space maintainers can be thought of as alternatives to metal space maintainers.

A Proposed Method for Covering a Mini-Screw Head While Maintaining Space for Ligation.

The use of mini-screws, also known as temporary anchorage devices (TADs), to obtain absolute anchorage has become very popular in orthodontics. Nevertheless, potential complications, including traumatic soft tissue lesions, accompany their use. We propose a method to cover the mini-screw head to prevent traumatic soft tissue lesions and promote patient comfort, while maintaining some separation between the composite resin and the peri-implant tissue.

[Failure in anterior rehabilitation of agenesic maxillary lateral incisors]. / Échec dans la réhabilitation antérieure en cas d'agénésies des incisives latérales maxillaires.

Agenesis of the maxillary lateral incisors poses particular problems for dentists, orthodontists and patients. Treatment of these ageneses is still highly controversial, both functionally and esthetically. The patient's smile and anterior guidance are affected and must be restored. The diagnosis is easy. Few mistakes are possible. However, managing patients with missing maxillary lateral incisors can be a challenge, commonly involving two possible treatment approaches: space opening to replace the missing lateral incisor with a prosthetic unit (denture, bridge or implant) or orthodontic space closure replacing the missing lateral incisor with the maxillary canine camouflaged to mimic the appearance of a lateral incisor. One of these two options will be adopted using multiple means...liable to trigger a multitude of possible errors. Ultimately, optimal results can only be achieved if there is excellent coordination between different practitioners in various specialties. Each clinician will have a specific role to play. Also, the patient and family are at the heart of the decision-making process, by virtue of their consent (treatment duration, financial resources) and their motivation. This multi-factorial, multi-disciplinary decision process means that treatment of the lateral incisor is an ongoing challenge for the clinician striving for the best possible result. Each case is different. No set rules exist. No single factor can be neglected if we are to avoid "failure".

A Modified Nance Palatal Arch for the Treatment of Ectopically Erupting Permanent First Molars.

Permanent teeth that remain impacted could lead to the early loss of primary teeth and cause space problems in dental arches. We present two cases of ectopic eruption of the permanent maxillary first molars treated with soft distal movements using a modified Nance palatal arch (NPAm). The wire was soldered to the band and positioned distally to serve as support for the elastic chain, which was attached to a bonded button on the occlusal surface. After a few months, the ectopic eruption was corrected, preserving the adjacent primary teeth and restoring the occlusion. An NPAm is a viable option for distalization and space recovery in the maxillary arch.

A novel approach for building up infraoccluded ankylosed primary molars in cases of missing premolars: A case report.

BACKGROUND: In cases of infraoccluded primary molars associated with agenesis of premolars, any treatment plan occasionally includes retention of the primary teeth for space preservation and future implant placement if needed. In these cases, building up the crowns to the occlusal line is necessary to prevent various clinical problems. The present case report describes in detail a novel but simple clinical approach for retention and building up of the crown of infraoccluded primary molars. CASE REPORT/TECHNIQUE PRESENTATION: The technique is presented in a 14-year-old girl with nine missing permanent teeth. Orthodontic evaluation indicated space closure for five teeth and space maintenance in the remaining four second primary molars, three of them being infraoccluded. The technique included the following clinical steps: (a) elastic separators were placed proximally to the primary molars for few days to create space; (b) proximal minimal reduction of the crown width was performed; a direct hand composite resin core was made to increase crown height facilitating the selection of a preformed metal crown (PMC). The selected PMC was filled with self-curing composite resin and placed on the primary tooth following an acid etch and adhesive procedure; excess cervical material was removed; (c) after polymerisation, the PMC was carefully removed using cutting and hand instruments, revealing the composite resin fabricated crown which was adjusted for occlusion and polished. Radiographic evaluation confirmed the result. CONCLUSION: This simple method for infraoccluded primary molars crown building up to occlusion using conventional instruments and materials, appears to be a valuable clinical tool for paediatric dentists who frequently find themselves dealing with primary teeth that need to be retained and which can produce serious clinical problems if left untreated.

Recovering teeth from a large dentigerous cyst: A case report.

A dentigerous cyst is an odontogenic lesion caused by the expansion of the follicle surrounding the crown of impacted, embedded or unerupted teeth. These cysts may cause destruction of the bone, displacement of adjacent teeth, resorption of their roots and prevent the eruption of cyst-associated permanent teeth. This paper discusses successful use of marsupialization combined with orthodontic treatment to treat cyst-associated impacted permanent teeth and to correct a class II open bite malocclusion.

Agenesis of maxillary second premolar--diagnosis and clinical management.

Controlling the eruption and development of dentitions is fundamental for a good oral health. The early diagnosis and adequate treatment of occasional developmental disorders are essential to achieve occlusal, functional and esthetic harmony. Abnormality is the term used for classification of alterations and is the most common developmental anomaly in humans. Even though several factors causing tooth malformations have been identified, many are still partially understood, thus requiring a more thorough study. Anyway, the available knowledge provides bases to attempt the early diagnosis of tooth abnormalities, to allow the adoption of preventive and effective therapeutic approaches.

Degradable, antibiotic releasing poly(propylene fumarate)-based constructs for craniofacial space maintenance applications.

Space maintainers (SMs) used for craniofacial reconstruction function to preserve the void space created upon bone loss and promote soft tissue healing over the defect. Polymethylmethacrylate-based SMs present several drawbacks including implant exposure, secondary removal surgeries, and potential bacterial contamination during implantation. To address these issues, a novel composite material comprising poly(propylene fumarate) (PPF) with N-vinyl pyrrolidone (NVP) as the crosslinking agent, carboxymethylcellulose (CMC) hydrogel as a porogen, and antibiotic loaded poly(lactic-co-glycolic acid) (PLGA) microparticles as antibiotic carriers and porogen was fabricated. CMC was incorporated at 40 wt % to impart rapid porosity while PLGA microparticles were incorporated at 30 or 40 wt % to release either clindamycin or colistin. This study was designed to examine the effects of PPF:NVP ratio, PLGA wt %, and the drug dose on the mass loss, temporal porosity change and drug release kinetics of the composite construct. Mass loss decreased significantly in constructs containing 3:2 PPF:NVP ratio with 30 wt % PLGA (63.2 ± 0.8%) compared to the 2:3 PPF:NVP ratio (80.3 ± 1.0% and 85.3 ± 1.3% for 30 and 40 wt % PLGA content, respectively) at 8 weeks. In formulations with 3:2 PPF:NVP ratio, incorporation of 40 versus 30 wt % PLGA significantly increased the porosity at 8 weeks under accelerated degradation conditions. Constructs released clindamycin or colistin at concentrations above the minimum inhibitory concentration for target pathogens for 45 and 77 days, respectively. This study demonstrates that the composition of PPF/CMC/PLGA constructs can be modulated to achieve properties suitable for craniofacial degradable space maintenance applications.

Multi-disciplinary management of a patient with a post-traumatised incisor presenting concurrent replacement and inflammatory resorption: a case report.

This case report describes the multidisciplinary management of a young male who presented with a Class I incisor relationship and bi-maxillary dento-alveolar protrusion on a Class I skeletal base. The occlusion was complicated by an ankylosed and moderately infra-positioned upper left permanent central incisor, an anterior crossbite, crowding, a reduced overbite and centreline discrepancy. The incisor was traumatised and avulsed when the root was immature and the tooth was reimplanted with delay. On referral for orthodontic treatment at age 11 .5 years, the upper left central incisor was experiencing ankylosis-related (osseous replacement) resorption and external root resorption simultaneously. Aside from the orthodontic aims, it was important to address the disrupted alveolar development to facilitate later prosthodontic replacement of the upper left permanent central incisor by idealising the inter-coronal and inter-radicular spaces. Treatment consisted of fixed orthodontic appliances in conjunction with the extraction of all second premolars and the upper left permanent central incisor with episodic surgical curettage. An upper Hawlix retainer was provided immediately at debond and a cantilevered resin-retained bridge was placed four months later.

Alternative approach to management of early loss of second primary molar: a clinical case report.

Preservation of space after premature loss of the second primary molar is essential to prevent mesial drifting of the permanent first molar. Various modifications of distal shoe space maintainers, which have been documented, are all nonfunctional in nature. This paper describes an innovative design of a functional distal shoe space maintainer that is intended to overcome the disadvantages of conventional non-functional space maintainers and that does not hamper the periodontal status of the abutment tooth.