Análisis morfométrico de la bóveda palatina y los dientes maxilares de las personas con síndrome de down, mediante tomografía computarizada de haz de cono

El síndrome de Down (SD) representa la anomalía cromosómica más frecuente. El control médico de la patología sistémica de estos pacientes y su progresiva integración social, conllevan un incremento de la demanda de atención odontológica. Recientemente, nuestro grupo ha publicado un estudio de casos y controles en el que 32 pacientes con SD recibieron tratamiento con expansores del maxilar superior; la conclusión de este trabajo fue, que la expansión ortodóncica en los pacientes con SD era un tratamiento factible y exitoso en un elevado porcentaje de casos, si se hacía una adecuada selección de los pacientes; sin embargo, además de algunos elementos de discriminación evidentes, como el grado de colaboración, intuimos que determinados criterios de selección, como los relacionados con el anclaje, todavía no estaban bien definidos en este colectivo. Objetivos Determinar la morfometría de la bóveda palatina así como la morfometría coronaria y radicular de los dientes del maxilar superior de las personas con SD, analizando imágenes en los tres planos anatómicos ortogonales obtenidas mediante tomografía computarizada de haz cónico (CBCT)

Orthodontic treatment for disabled children: a survey of parents’ attitudes and overall satisfaction

Background Many patients with disability require orthodontic treatment (OT) to achieve adequate oral function and aesthetic appearance. The cooperation of disabled patients and of their parents is central to the success of OT, as treatment can involve ethical dilemmas. The aim of this study was to analyze the motivation, expectations and overall satisfaction with OT among parents of patients with disabilities. Methods The parents of 60 disabled Spanish children with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and level of satisfaction with the outcomes. The survey consisted of 23 questions in 4 sections: attitude and adaptation, benefits, adverse effects, and level of satisfaction after completion of OT. A control group formed of the parents of 60 healthy children undergoing OT at the same institution were also surveyed. Results Parents of disabled children undergoing OT showed a high level of motivation and they are willing to collaborate in oral hygiene procedures. Adaptation to the removable appliances was poorer in disabled children but adaptation to fixed appliances was excellent. OT can provide a marked improvement in quality of life, social relationships and oral functionality in disabled children. Conclusions Among parents of disabled children undergoing OT, the perceived level of overall satisfaction was very high and expectations were often exceeded.S

Ortodoncia y ortopedia dentofacial en el síndrome de Down

Esta obra representa un amplio compendio de cómo es y qué posibilidades terapéuticas tiene el complejo dentofacial del síndrome de Down y resulta de una inestimable ayuda en la clínica y en la comprensión científica de la arquitectura craneofacial en situaciones normales y patológicas. El principal objetivo del libro es transmitir una combinación de experiencia clínica y evidencia científica en materia de ortodoncia para pacientes con necesidades especiales, confiando en que se traduzca en una mejora de la calidad asistencial que se oferta a este colectivo

Ortodoncia y ortopedia dentofacial en el síndrome de Down

Esta obra representa un amplio compendio de cómo es y qué posibilidades terapéuticas tiene el complejo dentofacial del síndrome de Down y resulta de una inestimable ayuda en la clínica y en la comprensión científica de la arquitectura craneofacial en situaciones normales y patológicas. El principal objetivo del libro es transmitir una combinación de experiencia clínica y evidencia científica en materia de ortodoncia para pacientes con necesidades especiales, confiando en que se traduzca en una mejora de la calidad asistencial que se oferta a este colectivo

Is It Useful to Determine the Temperature of Children for COVID-19 Screening in the Dental Setting?

Background: To date, the efficacy of temperature readings of children in the dental setting for COVID-19 screening has not been evaluated. The aim of this pilot study was to assess the usefulness of forehead temperature measurements in a dental clinic for COVID-19 screening in healthy children (without systemic disease) and in children with neurodevelopmental disorders. Methods: Using an infrared thermometer, we recorded the forehead temperature of 200 pediatric patients (100 healthy children and 100 children with neurodevelopmental disorders). We performed temperature measurements “before”, “during”, and “after” the dental procedure. Oropharyngeal swabs were taken of all participants to detect SARS-CoV-2. Results: Sex, age, administration of local anesthesia, and use of rotary instrumentation did not affect the temperature values. In the children with neurodevelopmental disorders with a value of 1 on the Frankl behavior scale, the temperatures were significantly higher than in those with values of 2, 3, and 4 (p = 0.032, p = 0.029, and p = 0.03, respectively). The PCR for SARS-CoV-2 was positive for two patients (one healthy and the other with a neurodevelopmental disorder), whose “before” temperatures were 36.4 °C and 36.5 °C, respectively. Conclusions: Forehead temperatures increase during dental procedures and are conditioned by the patient’s behavior. An isolated temperature reading does not identify children infected by SARS-CoV-2

Reassessment of fluctuating dental asymmetry in Down syndrome

Abstract Fluctuating dental asymmetry (FDA) is a tool to measure developmental stability that could be increased in gonosomal aneuploidies. The aim of this study was to quantify FDA in individuals with Down syndrome (DS). The study group comprised 40 individuals with DS, and a control group matched for age and sex was created. The target teeth were the maxillary central incisors (11,21), maxillary lateral incisors (12,22), maxillary canines (13,23), and maxillary first molars (16,26). Dental morphometric variables measured on CBCT images included tooth length, crown height, root length, mesio-distal diameter, crown-to-root ratio, vestibular-palatine diameter, mid mesio-distal diameter, mid buccal-palatal diameter, maximum buccal-palatal diameter, and cervical circumference. The FA2 fluctuating asymmetry index (Palmer and Strobeck, 1986) was applied. Some discrepancies in crown-to-root ratios and root length asymmetry were significantly lower in the DS individuals than in controls. Combining the crown-to-root ratio of tooth 11 versus 21, tooth 12 versus 22, and tooth 13 versus 23, we developed a predictive model with a discriminatory power between DS and controls of 0.983. Some dental morphometric variables may actually be more stable in DS individuals than in the general population. This offers a new perspective on the relationship between canalization, fluctuating asymmetry, and aneuploidy

Evaluation of Intraligamentous and Intraosseous Computer-Controlled Anesthetic Delivery Systems in Pediatric Dentistry: A Randomized Controlled Trial

Computer-controlled local anesthetic delivery systems (CDS) represent one of the resources that have progressed the most in recent years, but their efficacy and applicability in pediatric dentistry is still the subject of certain controversies. This randomized, controlled, split-mouth clinical trial assessed two CDS in children (n = 100) with deep caries in the temporary dentition that required invasive therapeutic procedures, using inferior alveolar nerve block as the gold standard. Half of the patients (n = 50) underwent the intraligamentary technique (Wand STA®) on one side of the mouth and conventional inferior alveolar nerve block on the contralateral side, while the other half (n = 50) underwent the intraosseous technique (QuickSleeper®) on one side of the mouth and conventional inferior alveolar nerve block on the contralateral side. The following were considered covariates: age, sex, type of dental procedure and the applied local anesthesia system. The outcome variables were the pain caused by the anesthesia injection, the physical reaction during the anesthesia injection, the need for anesthetic reinforcement, pain during the therapeutic procedure, the overall behavior during the visit, the postoperative morbidity and, lastly, the patient’s preference. In conclusion, we confirmed the efficacy of intraligamentary and intraosseous techniques administered using a CDS for conducting invasive dental treatments in children, their advantages compared with inferior alveolar nerve block in terms of less pain generated by the anesthesia injection and less postoperative morbidity, as well as the pediatric patients’ preference for CDS versus conventional techniques

Cranial-Vertebral-Maxillary Morphological Integration in Down Syndrome

Background: Morphological integration refers to the tendency of anatomical structures to show correlated variations because they develop in response to shared developmental processes or function in concert with other structures. The objective of this study was to determine the relationships between the dimensions of different cranial-cervical-facial structures in patients with Down syndrome (DS). Methodology: The study group consisted of 41 individuals with DS who had undergone cone-beam computed tomography (CBCT) at the Dental Radiology Unit of the University of Santiago de Compostela (Spain). In the historical archive of this same unit, 41 CBCTs belonging to individuals with no known systemic disorders or severe malformations of the maxillofacial region were selected, forming an age and sex-matched control group. Twenty-nine measurements were performed on each participant’s CBCT images, which were grouped into three blocks: atlantoaxial dimensions, craniovertebral dimensions and cephalometric dimensions. To determine whether there were significant differences between the dimensions obtained in the DS and control groups, we applied multiple analysis of variance and linear discriminant analysis tests. The analysis of the association between blocks (in pairs) was performed with the canonical correlation analysis test. Results: The dimensions evaluated in the three blocks of variables of individuals with DS differ significantly from those of nonsyndromic controls (p < 0.001). The highest discriminative capacity to identify controls and patients with DS was obtained with the cephalometric dimensions (87.5%). With regard to the association between blocks (two-by-two measurements), we found no significant relationship in the DS group. However, we confirmed a statistically significant correlation between all pairs of blocks of variables in the controls, especially between the atlantoaxial and cephalometric dimensions (p < 0.001) and between the craniovertebral and cephalometric dimensions (p < 0.001). Conclusions: Our results confirm a very poor morphological integration of the cranial-cervical-maxillary complex in individuals with DS. This finding reinforces the proposal that gene overload enhances the channeling process

Rare Disorders: Diagnosis and Therapeutic Planning for Patients Seeking Orthodontic Treatment

The available literature on the orthodontic treatment of patients with rare disorders is extremely scarce. The aim of this study was to analyze the diagnosis and orthodontic treatment of a group of 94 individuals with rare diseases, referred for orthodontic evaluation to a university special care dentistry center (University of Santiago de Compostela, Spain). We created a control group of 94 systemically healthy individuals, paired by sex and age range. For all participants, we recorded their dental and skeletal abnormalities, oromotor dysfunctions and the characteristics of their orthodontic treatment. Some of the morphological and functional abnormalities were more prevalent in the rare disorders group than in the control group, including dental agenesis, microdontia, enamel defects, maxillary hypoplasia, overbite, cleft lip/palate, mouth breathing, atypical swallowing, lingual/labial interposition, labial incompetence, modified consistency diet, bruxism, and muscle tone abnormalities. Compared with the control group, the 56 patients with rare disorders who underwent orthodontic treatment required more desensitization sessions, used mixed appliances (fixed and removable) more often and for longer periods and had more frequent complications, such as gingivitis, caries, mucosal ulcers and recurrent debonding of the device. In conclusion, for selected patients with rare disorders, it is feasible to perform orthodontic treatment, whose planning will be determined by the dental-skeletal abnormalities and oromotor dysfunctions. Although complications are more frequent, they can typically be solved without having to stop treatment