Fragile X syndrome: panoramic radiographic evaluation of dental anomalies, dental mineralization stage, and mandibular angle

Fragile X syndrome (FXS) is a disorder linked to the chromosome X long arm (Xq27.3), which is identified by a constriction named fragile site. It determines various changes, such as behavioral or emotional problems, learning difficulties, and intellectual disabilities. Craniofacial abnormalities such as elongated and narrow face, prominent forehead, broad nose, large and prominent ear pavilions, strabismus, and myopia are frequent characteristics. Regarding the oral aspects, deep and high-arched palate, mandibular prognathism, and malocclusion are also observed. Objective: The purpose of this study was to evaluate the dental radiographic characteristics as described in 40 records of patients with panoramic radiography. Material and Methods: The patients were in the range of 6–17 years old, and were divided into two groups (20 subjects who were compatible with the normality standard and 20 individuals diagnosed with the FXS), which were matched for gender and age. Analysis of the panoramic radiographic examination involved the evaluation of dental mineralization stage, mandibular angle size, and presence of dental anomalies in both deciduous and permanent dentitions. Results: The results of radiographic evaluation demonstrated that the chronology of tooth eruption of all third and second lower molars is anticipated in individuals with FXS (

Tratamiento ortopédico funcional de los maxilares y ortodóntico en paciente con síndrome del cromosoma X- frágil. Reporte de caso

The Fragile-X Syndrome (FXS) is a disorder linked to X chromosome, on the long arm Xq27.3, causing several changes such as behavioral problems, intellectual disability, macroorchidism, large and prominent auricles, deep and ogival palate, mandibular prognathism, increased mandibular angle, malocclusion, and dental anomalies. The objective was to present a case of a 16-year-old patient with FXS, leukoderma, submitted to orthopedic functional maxillary treatment to correct dental crowding. In general, clinical examination, behavioral changes such as shyness, anxiety, emotional lability, sporadic disturbances of behavior associated with mild mental disabilities were remarkable. After panoramic radiographic evaluation and cephalometric tracings, it was decided to install the functional orthopedic appliance of the jaws, Indirect Flat Planes type, for later corrective orthodontic treatment. At beginning of treatment, there was a difficulty in understanding and collaborating, not only from the patient’s side but also from the mother’s. After five months, even with the improvement in stomatognathic functions, orthodontic treatment with a fixed appliance was started, which was concluded after two years. Success of functional and / or orthodontic jaw orthopedics treatment, especially in FXS, is based on behavioral approach and motivation in all stages, by the professional as well as a collaborative family environment.El síndrome X frágil (SXF) es un trastorno ligado al cromosoma X, en el brazo largo Xq27.3, que provoca diversas alteraciones como problemas de conducta, deficiencia intelectual, macroorquidia, pabellones auditivos grandes y prominentes, paladar profundo y ojival, prognatismo mandibular, maloclusión y anomalías dentarias. El objetivo de este informe fue presentar el caso clínico de una paciente de 16 años con SXF, leucodermia, que se sometió a un tratamiento ortopédico funcional de los maxilares para la corrección del apiñamiento dentario. En el examen clínico se observaron timidez, ansiedad, inestabilidad emocional, trastornos conductuales esporádicos asociados a discapacidad intelectual leve, alteraciones craneofaciales y oclusales. Luego del estudio, evaluación radiográfica panorámica y trazados cefalométricos, se decidió instalar un dispositivo ortopédico funcional de maxilar, tipo Pistas Planas Indirectas, para posterior tratamiento ortodóncico correctivo. Bien al inicio del tratamiento se observó dificultad de comprensión y colaboración por parte de la paciente y su responsable (madre) y, luego de 5 meses, aún con mejoras en las funciones estomatognáticas, se inició el tratamiento ortodóntico con dispositivo fijo, el que fue concluido luego de dos años. El éxito del tratamiento de ortopedia funcional de los maxilares y/u ortodóntico, principalmente en el SXF, se basa en el abordaje comportamental y motivación en todas las etapas del tratamiento por el profesional, así como en un ambiente familiar colaborativo

Comparative spectrophotometric study of the color stability of three dental porcelains after repeated fi rings

O objetivo deste estudo foi avaliar a estabilidade de cor de três marcas comerciais de porcelanas dentais aluminizadas durante seu processo de queima. Essas porcelanas são utilizadas para a conconfecção de dentes de prótese fixa. Para o experimento foram confeccionados 30 corpos-de-prova em forma de disco com 2 mm de espessura e 10 mm de circunferência, sendo 10 da marca AllCeram, 10 da marca Noritake Cerabien CZR e 10 da marca Vita VM7. As amostras foram queimadas 10 vezes. As leituras de cor foram feitas em espectrofotômetro de reflexão nos seguintes intervalos: após a 1a queima, após a 3a queima, após a 5a queima e após a 10a queima. As curvas de reflexão foram convertidas em valores LAB e a diferença de cor foi medida por meio do método CIELAB (ΔE). Os resultados obtidos demonstraram que existe variação de cor e que essa variação depende do número de queimas realizadas e da marca comercial utilizada.The purpose of this investigation was to quantify the color differences in CIE ΔE units produced by multiple fi rings of three all-ceramic systems used in the fabrication of prosthodontic teeth. Thirty samples of the following brands were fabricated: AllCeram, Noritake Cerabien CZR and Vita VM7. A spectrophotometer was used for refl ectance measurement of color after 1 fi ring, 3 fi rings, 5 fi rings and 10 fi rings. The results were converted into CIELAB units. Color differences (ΔE) were calculated in the CIE color space. The color differences resulting from multiple fi rings proved to be dependent on the number of fi rings and on the porcelain brand tested

Thermography in dentistry: a bibliometric review / Termografia em odontologia: uma revisão bibliométrica

Infrared thermography is an imaging exam present in the scope of diagnosis, evolutionary monitoring, and prognosis in the health area. Over the years, thermography has been studied in medicine, and it is a technique recently used in Dentistry. In this sense, the objective of this work was to carry out a literature review with a bibliometric approach to the use of thermal images for the diagnosis/monitoring of dental treatments. Studies that relate thermography to dental specialties were analyzed, considering the use of thermography as a diagnostic aid and monitoring of dental treatments in its wide range of activities. Searches were performed in the following databases: PubMed, Web of Science, Embase, Scopus, Scielo, from 1985 to 2020, with a search phrase including thermography and Dentistry specialties. The results show the trends in publications relating thermographic images to dental specialties by year of publication, journals, country, type of study, manufacturer of cameras used, resolution, and ambient temperature, totaling 119 publications in 83 journals. Temporomandibular Dysfunction and Orofacial Pain was the specialty with the highest concentration of publications relating thermography to Dentistry (27 articles). Endodontics was the second specialty (23 articles), Restorative Dentistry was the third specialty (18 articles) followed by Surgery (17 articles). It can be concluded that thermography is indicated as an auxiliary diagnostic method in Dentistry specialties. The main indications for thermography in Dentistry are in the context of diagnosis of Orofacial Pain (dysfunctions temporomandibular disorders of the muscular and articular types, noninflammatory odontalgias and neuropathies), Endodontics (inflammatory odontalgias), Implantology (osseointegration), and follow-up evolution of the postoperative surgeries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Study of the facial surface skin thermal distribution by infrared thermography: facial thermoanatomy

Pelo fato da face ser uma estrutura que envolve multissistemas, ela é considerada anatomica e funcionalmente muito complexa em sua avaliação clínica. Muitos diagnósticos de doenças que afetam a região facial são realizados por meio de métodos de imagem, entretanto, as técnicas convencionais são incompletas, pois apresentam um déficit de informações em relação aos aspectos funcionais, relativos à microcirculação regional e o sistema nervoso autônomo. Para documentação objetiva destas alterações, a termografia por imagem infravermelha tem sido proposta como método auxiliar diagnóstico. O objetivo deste estudo foi identificar, mapear e quantificar pontos de referência baseados na termoanatomia da face, a partir de gradientes térmicos, em uma população adulta. A amostra constituiu-se por 161 voluntários, ambos os gêneros, entre 26 e 84 anos (63 ±15 anos). Foram identificados 28 pontos de referência termoanatômicos fixos em 94,6% da amostra. A temperatura média desses pontos de referência termoanatômicos variou entre 33,3°C a 35,6°C, sendo que o melhor valor de corte para sua correta identificação na face foi acima de 34,5ºC. Não houve diferença estatística quando os comparou entre as hemifaces correspondentes e nem quanto à idade dos voluntários (?T = 0,11°C), exceto entre os gêneros e grupo racial (p<0,05). Concluiu-se que a face apresenta pontos termoanatômicos fixos e confiáveis em adultos, a qual a termografia tem o potencial de auxiliar na identificação de alterações a partir destes pontos.Anatomical and functional information of the structures of interest are the basis for interpretation of imaging exams. For recognizing diseases it is necessary to understand and identify the anatomical structures and its variations. Diagnosis of some facial diseases may be done through medical imaging techniques; however, the most conventional methods present lack of information regarding physiological and functional aspects such as microcirculation and autonomous nervous system. The aim of this study was to identify, map and quantify the facial thermal gradients (thermo-anatomical points) in healthy adult population. A hundred sixty-one volunteers of both gender and mean age of 63 ±15 years were included. The results showed that twenty eight thermo-anatomical points have been identified in 94.6% of the sample, with a significant difference of the temperature in gender and racial groups (p<0.05). Moreover, there was no statistically significant difference between ages and sides in healthy individuals (?T = 0.11°C). The average temperature of the points ranged from 33.3°C to 35.6°C. When the maximum temperature reached to detect a facial thermal gradient is higher than 34.5°C, the thermo-anatomical point is meant to be correctly delineated. For detection of functional changes from thermoanatomical points on the face, thermography may be used as an auxiliary diagnostic imaging method

Thermographic and clinical correlation of myofascial trigger points in the masticatory muscles

A síndrome dolorosa miofascial (SDM) é uma disfunção musculoesquelética não articular caracterizada por pontos-gatilho miofasciais. Estes pontos, identificados por meio da palpação, são descritos como bandas tensas na fibra muscular, podendo apresentar dor referida à compressão. Sabe-se que os pontos-gatilho miofasciais provocam hiperatividade simpática regional de temperatura local devido à atividade vasoconstritora cutânea. Para documentação objetiva por imagem desta alteração funcional, a termografia tem sido proposta como método auxiliar diagnóstico. O objetivo deste estudo foi correlacionar os exames clínico e termográfico dos pontos-gatilho nos músculos da mastigação masseter e temporal parte anterior. A amostra constituiu-se por 26 mulheres voluntárias com 41 ± 15 anos. Os resultados demonstraram correlação diretamente proporcional entre algometria e termografia na avaliação do ponto-gatilho miofascial, onde, quanto menor a força aplicada, menor a temperatura local (p0,4ºC; p0,4ºC; p<0.001). In the thermographic assessment of MTP in the masseter and temporalis muscles, the results suggest that the parameters of thermal asymmetry (&#916;T and &#916;&#952;) show greater sensitivity and specificity in comparison to local absolute temperature values (T), even when corrected for the volunteer\'s core temperature and the temperature of the room during the exam (&#952;). Thermography can identify trigger points (referred pain) with sensitivity of 62,50% and specificity of 71,31%. The authors concluded that thermography is a noninvasive imaging method with potential for screening patients with MTP in the facial region

Fragile X syndrome: panoramic radiographic evaluation of dental anomalies, dental mineralization stage, and mandibular angle

ABSTRACT Fragile X syndrome (FXS) is a disorder linked to the chromosome X long arm (Xq27.3), which is identified by a constriction named fragile site. It determines various changes, such as behavioral or emotional problems, learning difficulties, and intellectual disabilities. Craniofacial abnormalities such as elongated and narrow face, prominent forehead, broad nose, large and prominent ear pavilions, strabismus, and myopia are frequent characteristics. Regarding the oral aspects, deep and high-arched palate, mandibular prognathism, and malocclusion are also observed. Objective: The purpose of this study was to evaluate the dental radiographic characteristics as described in 40 records of patients with panoramic radiography. Material and Methods: The patients were in the range of 6–17 years old, and were divided into two groups (20 subjects who were compatible with the normality standard and 20 individuals diagnosed with the FXS), which were matched for gender and age. Analysis of the panoramic radiographic examination involved the evaluation of dental mineralization stage, mandibular angle size, and presence of dental anomalies in both deciduous and permanent dentitions. Results: The results of radiographic evaluation demonstrated that the chronology of tooth eruption of all third and second lower molars is anticipated in individuals with FXS (p<0.05). In this group, supernumerary deciduous teeth (2.83%), giroversion of permanent teeth (2.31%), and partial anodontia (1.82%) were the most frequent dental anomalies. In addition, an increase was observed in the mandibular angle size in the FXS group (p<0.05). Conclusion: We conclude that knowledge of dental radiographic changes is of great importance for dental surgeons to plan the treatment of these individuals