Achados bucais em pacientes com Síndrome de Apert

INTRODUCTION: The Apert syndrome is a rare disorder of autosomal dominant inheritance caused by mutations in the FGFR2 gene at locus 10q26; patients with this syndrome present severe syndactyly, exophthalmia, ocular hypertelorism and hypoplastic midface with Class III malocclusion, besides systemic alterations. Most investigations available on the Apert syndrome address the genetic aspect or surgical management, with little emphasis on the oral aspects. OBJECTIVE: to investigate the oral findings, including dental anomalies, ectopic eruption of the maxillary permanent first molars and soft tissue alterations, in subjects with Apert syndrome. MATERIALS AND METHODS: clinical and radiographic examination of nine patients with Apert syndrome, aged 6 to 15 years, not previously submitted to orthodontic or orthognathic treatment. RESULTS: dental anomalies were present in all patients, with one to eight anomalies per individual. The most frequent anomalies were tooth agenesis, mainly affecting maxillary canines, and enamel opacities (44.4% for both). Ectopic eruption of maxillary first molars was found in 33.3% of patients; lateral palatal swellings were observed in 88.8% of patients. CONCLUSIONS: The occurrence of typical lateral palatal swellings agrees with the literature. The high prevalence of dental anomalies and ectopic eruption may suggest a possible etiologic relationship with the syndrome.INTRODUÇÃO: A síndrome de Apert é um distúrbio raro de herança autossômica dominante causado por mutações no lócus 10q26 do gene FGFR2; pacientes com esta síndrome apresentam sindactilia severa, exoftalmia, hiperteleorbitismo e hipoplasia da face média com má oclusão de Classe III, além de alterações sistêmicas. A maior parte dos estudos disponíveis sobre a síndrome de Apert aborda o aspecto genético ou manejo cirúrgico, com pouca ênfase nos aspectos bucais. OBJETIVO: investigar os achados bucais, incluindo anomalias dentárias, irrupção ectópica dos primeiros molares permanentes superiores e alterações de tecido mole, em indivíduos com síndrome de Apert. MATERIAIS E MÉTODOS: exame clínico e radiográfico de nove pacientes com síndrome de Apert, de 6 a 15 anos de idade, não anteriormente submetidos a tratamento ortodôntico ou ortognático. RESULTADOS: anomalias dentárias estavam presentes em todos os pacientes, com uma a oito anomalias por indivíduo. As anomalias mais freqüentes foram agenesia dentária, principalmente afetando os caninos superiores, e opacidades de esmalte (44,4% para ambos). Foi observada irrupção ectópica dos primeiros molares superiores em 33,3% dos pacientes; foram observados aumentos volumétricos laterais da mucosa palatina em 88,8% dos pacientes. CONCLUSÕES: a ocorrência de aumentos volumétricos laterais típicos da mucosa palatina concorda com a literatura. A alta prevalência de anomalias dentárias e irrupção ectópica pode sugerir uma possível relação etiológica com a síndrome

Prevalence of oral habits in children with cleft lip and palate

This study investigated the prevalence of oral habits in children with clefts aged three to six years, compared to a control group of children without clefts in the same age range, and compared the oral habits between children with clefts with and without palatal fistulae. The sample was composed of 110 children aged 3 to 6 years with complete unilateral cleft lip and palate and 110 children without alterations. The prevalence of oral habits and the correlation between habits and presence of fistulae (for children with clefts) were analyzed by questionnaires applied to the children caretakers. The cleft influenced the prevalence of oral habits, with lower prevalence of pacifier sucking for children with cleft lip and palate and higher prevalence for all other habits, with significant association (P < 0.05). There was no significant association between oral habits and presence of fistulae (P > 0.05). The lower prevalence of pacifier sucking and higher prevalence of other oral habits agreed with the postoperative counseling to remove the pacifier sucking habit when the child is submitted to palatoplasty, possibly representing a substitution of habits. There was no causal relationship between habits and presence of palatal fistula

The Tissue Bioengineering in favor of the Rehabilitation of Individuals With Cleft Lip and Palate

A Bioengenharia tecidual compila conhecimentos de grandes áreas da ciência, os quais são aplicados atualmente em tratamentos de saúde com finalidade reparadora. No HRAC/USP pacientes com fissura labiopalatina são atualmente reabilitados com uso da rhBMP-2. Diante disso, o objetivo do presente estudo foi realizar um trabalho de revisão e atualização enfatizando as características principais da rhBMP-2. O tratamento com este biomaterial tem mostrado taxas de sucesso semelhantes às do tratamento convencional obtido de osso ilíaco para este grupo de pacientes, bem como vantagens adicionais. O conhecimento sobre suas aplicações e cuidados necessários é de grande valia para profissionais e acadêmicos da área de Ciências Biológicas e da Saúde durante o seu processo de formação universitária.Tissue Bioengineering involves knowledge of several science fields, which are currently employed in reparative health treatments. At HRAC/USP, individuals with cleft lip and palate are currently rehabilitated with the use of rhBMP-2. This paper aims to present a review and update with emphasis on the main characteristics of rhBMP-2. The treatment with this biomaterial has demonstrated similar success rates as the conventional treatment obtained from the iliac bone for this group of individuals, as well as additional advantages. Knowledge on its applications and the necessary care is very important for professionals and students in the fields of Biological and Health Sciences during the university training

Accumulated knowledge and prevention practices in oral health

This text begins by reflecting on health promotion and equity/ inequity. In health, inequity is understood as a political concept that has moral implications and that is committed to social justice. A discussion follows on some issues regarding the risk and prevention of diseases, still considered a hegemonic practice, and lack of experience in oral health-care, bearing in mind the concept of vulnerability. The risk is probabilistic and involves the mathematical chances of acquiring a disease in a certain group, whereas vulnerability addresses the potential of acquiring or not acquiring a disease in a certain environment. The need for systematic studies on determinants is stressed, with the ultimate goal of improving health and reducing inequities, and with the concern and political intention of including health equity in governmental policies.Paper apresentado no “Equity, Social Inclusion and Oral Health Promotion: Major Challenges” International Symposium, held at the 18th Congress of the Brazilian Association for Oral Health Promotion (Associação Brasileira de Odontologia de Promoção de Saúde - ABOPREV), April 2013, Bauru, SP, Brazil

Outcomes of permanent canines on the cleft side after secondary alveolar grafting using different materials in complete unilateral cleft lip and palate

The prevalence of impaction of the permanent canine on the cleft side (PCCS) ranges from 12-35% after alveolar bone grafting (ABG). PCCSs usually develop above other permanent teeth in the alveolar process, gradually becoming vertical until they reach the occlusal plane. The type of cleft, hypodontia of lateral incisor on the cleft side, slower PCCS root development, and genetic factors are predictors of impaction and/or its ectopic eruption. Objective: To compare the behavior of PCCS in individuals with complete unilateral cleft lip and palate (UCLP) subjected to secondary alveolar grafting (SAG) with different materials. Methodology: This retrospective longitudinal study analyzed 120 individuals undergoing SAG with iliac crest bone, rhBMP-2, and mandibular symphysis. The individuals were selected at a single center and equally divided into three groups. Panoramic radiographs were analyzed by the Dolphin Imaging 11.95 software to measure PCCS angulation and PCCS height from the occlusal plane at two different timepoints. Results: No statistical significance was found between grafting materials (P=0.416). At T1, the PCCS height from the occlusal plane was greater for rhBMP-2 and mandibular symphysis compared to iliac crest bone. The lateral incisor on the cleft side was not related to success or lack of eruption of PCCS (P=0.870). Conclusion:Impaction rates of PCCS were similar for the materials studied. Absence of the lateral incisor on the cleft side did not prevent spontaneous eruption of PCCSs

The importance of oral microbiota control and utilization of biomaterial in secondary alveolar bone graft surgeries in patients with cleft lip and palate

A cavidade bucal é uma das portas de entrada ao nosso organismo. Pertencendo ao sistema digestório, também funciona como uma via de acesso às vias respiratórias. A fissura labiopalatina é uma anomalia que pode promover perda de continuidade nos tecidos labiais, alveolares e palatinos da maxila, necessitando de procedimentos cirúrgicos para reabilitação estética e funcional do paciente. Diante disso, o objetivo do presente estudo foi realizar um trabalho de atualização enfatizando a influência da microbiota bucal e o uso de rhBMP-2 em pacientes submetidos a cirurgia de enxerto alveolar secundário, visto que a cirurgia apresenta um período pós-operatório crítico e de grande importância para o sucesso do tratamento, o qual requer muitos cuidados tanto no que diz respeito à alimentação quanto à higienização bucal, esta com o propósito de diminuir os riscos de infecção no respectivo período. O cuidado com a higiene bucal destes pacientes é um fator importante no processo saúde/doença a partir de uma concepção holística, em prevenir não somente as alterações na cavidade bucal como evitar que esses micro-organismos residentes se tornem agentes complicadores do estado geral do paciente.The oral cavity is one of the entrance ways to the body, belonging to the digestive system, and also allows access to the respiratory pathways. Cleft lip and palate is an anomaly that may cause continuity of lip, alveolar and palatal tissues of the maxilla, requiring surgical procedures for the esthetic and functional rehabilitation of the patient. This study conducted a literature review emphasizing the influence of the oral microbiota and utilization of rhBMP-2 in patients submitted to secondary alveolar graft surgery. This surgery presents a critical postoperative recovery that is fundamental for the treatment success and requires much care both concerning feeding and oral hygiene, to reduce the risk of infection in this period. The care with oral hygiene of these patients is an important factor in the health/disease process based on a holistic approach, to prevent not only changes in the oral cavity and avoid that these microorganisms may complicate the overall status of the patient

Padrão de desoclusão em indivíduos com fissura lábio-palatina completa

OBJECTIVE: to analyze the pattern of disocclusion during excursive mandibular movements and presence or absence of occlusal interferences and occlusal pathologies (gingival recession and abfraction). METHOD: examination of 120 individuals divided into two groups, as follows: Group 1 - 90 patients with complete cleft lip and palate (study group), subdivided into 30 patients with complete left unilateral cleft lip and palate, 30 patients with complete right unilateral cleft lip and palate and 30 patients with complete bilateral cleft lip and palate; Group 2 - 30 individuals without clefts (control group). RESULTS: 58.8% of patients in Group 1 presented unilateral or bilateral canine guidance, 26.6% presented unilateral or bilateral group function and 54.4% presented lateral movements through the posterior teeth. Regarding protrusive movements, 80% presented anterior guidance and 20% presented posterior guidance. In Group 2, 69.6% of individuals presented unilateral or bilateral canine guidance, 43.2% presented unilateral or bilateral group function and only 13.3% presented lateral movements through the posterior teeth; 3.4% presented protrusion through the posterior teeth. CONCLUSIONS: there was no difference in the pattern of disocclusion between subgroups of patients with clefts. Group 2 presented predominance of bilateral group function, whereas Group 1 presented a higher prevalence of posterior guidance during lateral movements. Protrusion occurred primarily through anterior guidance in Group 2 and through the posterior teeth in Group 1. There was high prevalence of occlusal interferences at the molar area for both groups, yet with no correlation with occlusal pathologies (recession and abfraction).OBJETIVO: avaliar o padrão de desoclusão apresentado nos movimentos excursivos mandibulares e a presença ou não de interferências oclusais e patologias relacionadas à oclusão (recessão gengival e abfração). MÉTODO: exame de 120 indivíduos, divididos em 2 grupos: Grupo 1 - 90 pacientes com fissura completa de lábio e palato, subdivididos em 30 pacientes com fissura completa de lábio e palato unilateral esquerda, 30 pacientes com fissura completa de lábio e palato unilateral direita e 30 com fissura completa de lábio e palato bilateral; e Grupo 2 - 30 indivíduos sem fissuras (grupo controle). RESULTADOS: 58,8% do Grupo 1 apresentaram guia canina uni ou bilateralmente, 26,6% apresentaram desoclusão com função em grupo uni ou bilateral e 54,4% realizaram estes movimentos laterais através dos dentes posteriores; 80% dos pacientes do Grupo 1 realizava protrusão pelos dentes anteriores e 20 % pelos posteriores. Para o Grupo 2, guia canina uni ou bilateral foi observada em 69,6% dos indivíduos, 43,2% apresentaram função em grupo uni ou bilateral e somente 13,3% realizaram os movimentos laterais pelos dentes posteriores. Apenas 3,4% dos indivíduos do Grupo 2 apresentaram protrusão pelos dentes posteriores. CONCLUSÕES: não houve diferença estatisticamente significativa no padrão de desoclusão entre os subgrupos de pacientes com fissuras. O Grupo 2 apresentou predominância de função em grupo bilateral, enquanto o Grupo 1 apresentou maior prevalência de guia posterior durante os movimentos laterais. A protrusão ocorreu principalmente por guia anterior no Grupo 2 e pelos dentes posteriores no Grupo 1. Houve alta prevalência de interferências oclusais na região de molares para ambos os grupos, entretanto sem correlação com patologias oclusais (recessão e abfração)