RESUMO A trissomia 21 (síndrome de Down) é uma condição genética decorrente da presença de três cromossomos 21. Indivíduos diagnosticados com essa síndrome apresentam maior probabilidade de desenvolver problemas sistêmicos, além de distúrbios cognitivos, de desenvolvimento e psiquiátricos. Este artigo relata o caso de uma criança com síndrome de Down em tratamento para leucemia mieloide aguda, enfatizando seu impacto na qualidade de vida. A percepção da mãe sobre a qualidade de vida relacionada à saúde (QVRS) foi mensurada pelo Pediatric Quality of Life Inventory (PedsQL), Escalas Genéricas Core e Módulo Câncer. A percepção da mãe mostrou que o funcionamento físico e funcional indicava maior impacto negativo na vida da criança. Os menores escores foram nos domínios náusea e ansiedade em relação ao procedimento. O exame intraoral revelou dentição decídua incompleta com erupção ectópica. A criança teve abordagem multidisciplinar de saúde (pediatra, hematologista, gastroenterologista, cardiologista, fisioterapeuta e dentista). Portanto, é fundamental que os profissionais de saúde, inclusive os cirurgiões-dentistas, incorporem em sua prática o conhecimento sobre as dificuldades e aspectos emocionais dessa população, proporcionando um cuidado humanizado centrado no paciente. 2 sistêmicos cognitivos psiquiátricos aguda QVRS (QVRS PedsQL, PedsQL , (PedsQL) Câncer procedimento ectópica pediatra, pediatra (pediatra hematologista gastroenterologista cardiologista dentista. dentista . dentista) Portanto cirurgiõesdentistas, cirurgiõesdentistas cirurgiões dentistas, dentistas cirurgiões-dentistas população paciente (PedsQL

ABSTRACT Trisomy 21 (Down syndrome) is a genetic condition arising from the presence of three chromosomes at position 21. Individuals diagnosed with this syndrome have a greater likelihood of developing systemic problems, as well as cognitive, developmental, and psychiatric disorders. This paper reports a case of a child with Down syndrome under treatment for acute myeloid leukemia, emphasizing its impact on quality of life. The mother’ perception on health-related quality of life (HRQoL) was measuredby the Pediatric Quality of Life Inventory (PedsQL), Generic Core and Cancer Module Scales. The mother’s perception shown that physical and functional functioning indicated a higher negative impact on the child’s life. The lowest scores were in the domains nausea and anxiety about the procedure. Intraoral examination revealed an incomplete primary dentition with ectopic eruption. The child has had a multidisciplinary health care approach (pediatrician, hematologist, gastroenterologist, cardiologist, physiotherapist and dentist). Therefore, it is essential that health professionals, including dentists, to incorporateinto their practice the knowledge on the difficulties and emotional aspects of this population, providinga patient-centered humanized care. 2 problems cognitive developmental disorders leukemia mother healthrelated related HRQoL (HRQoL PedsQL, PedsQL , (PedsQL) Scales mothers s childs procedure eruption pediatrician, pediatrician (pediatrician hematologist gastroenterologist cardiologist dentist. dentist . dentist) Therefore professionals dentists population patientcentered patient centered (PedsQL

Abstract 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. (PCCS 1235% 1235 12 35% 35 12-35 ABG. ABG . (ABG) process development andor Objective UCLP (UCLP (SAG Methodology rhBMP2, rhBMP2 rhBMP 2, 2 groups 1195 11 95 11.9 timepoints Results P=0.416. P0416 P P=0.416 0 416 (P=0.416) T1 T rhBMP- P=0.870. P0870 P=0.870 870 (P=0.870) Conclusion studied 123 1 3 12-3 (ABG 119 9 11. P041 P=0.41 41 (P=0.416 P087 P=0.87 87 (P=0.870 12- P04 P=0.4 4 (P=0.41 P08 P=0.8 8 (P=0.87 P0 P=0. (P=0.4 (P=0.8 P=0 (P=0. P= (P=0 (P= (P

ABSTRACT Permanent canines are essential for the preservation of the stomatognathic system, as they are part of the occlusal and aesthetic function and balance. During the normal development of occlusion, canines follow a long and complex trajectory until their eruption, that is, they are more likely to suffer disturbances during this process. Removal of the permanent canine should only be considered in extreme cases, where the canine itself is not susceptible to orthodontic traction. Orthodontic traction is the most indicated treatment due to the high morphofunctional and aesthetic value of the permanent canine. The aim of this study is to report a clinical case of traction surgery of the superior permanent canine included in the maxilla. A 13-year-old female patient attended the dental clinic at the Nilton Lins University accompanied by her guardian, referred by an orthodontistfor canine traction surgery. during the examIn the clinical analysis, tooth 13 was absent from the dental arch. The patient had a computed tomography scan, where it was possible to verify the actual position of the toothimpacted with the partially erupted crown on the alveolar ridge. After planning, surgery was performed to install an orthodontic button and adapt the ligature with a 0.30 mm wire. After the 10-month follow-up period, the presence of the tooth in arch, completely erupted, was observed, showing effectiveness in the proposed treatment. Therefore, the procedure for bonding the orthodontic device was performed satisfactorily without complications or intercurrences, making it possible to continue the orthodontic treatment. The patient remains under follow-up. system balance occlusion eruption process cases maxilla 13yearold yearold year old guardian analysis 1 arch scan ridge planning 030 0 30 0.3 wire 10month month 10 followup up period observed Therefore intercurrences followup. up. 03 3 0.

RESUMO Os caninos permanentes são essenciais para a preservação do sistema estomatognático, visto que, fazem parte da função e equilíbrio oclusal e estético. Durante o desenvolvimento normal da oclusão, os caninos seguem uma longa e complexa trajetória até seu irrompimento, ou seja, estão mais propensos a sofrerem distúrbios no decorrer desse processo. A extração do canino permanente só deve ser considerada em casos extremos, onde o próprio não se encontra suscetível à tração ortodôntica. O tracionamento ortodôntico é o tratamento mais indicado devido ao alto valor morfofuncional e estético do canino permanente. Sendo assim, o objetivo deste estudo é relatar um caso clínico de cirurgia de tracionamento de canino permanente superior incluso em maxila. Paciente de 13 anos, gênero feminino, compareceu a clínica odontológica da Universidade Nilton Lins acompanhado de seu responsável, encaminhada por um ortodontista para cirurgia de tracionamento de canino. Durante o exame clínico observou-se ausência do dente 13 na arcada dentária. A paciente apresentou a tomografia computadorizada, onde foi possível verificar o real posicionamento do dente impactado com a coroa parcialmente irrompida no rebordo alveolar. Após o planejamento, realizou-se a cirurgia destinada a instalação de botão ortodôntico e adaptação da amarrilha com fio 0,30 mm. Posteriormente ao período de acompanhamento de 10 meses, observou-se a presença do dente em arco, totalmente erupcionado, mostrando efetividade no tratamento proposto. Portando, o procedimento de colagem de dispositivo ortodôntico ocorreu de forma satisfatória sem complicações ou intercorrências, tornando possível a continuidade do tratamento ortodôntico. A paciente permanece em acompanhamento. estomatognático que oclusão irrompimento seja processo extremos ortodôntica assim maxila 1 anos feminino responsável observouse observou dentária computadorizada alveolar planejamento realizouse realizou 030 0 30 0,3 mm meses arco erupcionado proposto Portando intercorrências 03 3 0,

RESUMO Os dentes supranumerários representam um desafio para clínicos e odontopediatras quanto ao diagnóstico e tratamento. São assintomáticos, podendo gerar atraso na dentição permanente, alteração do crescimento ósseo e posicionamento ectópico. Assim, o presente trabalho teve como objetivo apresentar um relato de caso de remoção cirúrgica de dentes supranumerários na região anterior da maxila de um paciente infantil, em ambiente hospitalar sob anestesia geral. O paciente do sexo feminino, 6 anos, compareceu ao consultório apresentando como queixa a presença de um dente “estranho” na região anterior. Foram realizados o exame clínico e exames de imagem com a confirmação do diagnóstico de dentes supranumerários na região do incisivo central superior direito (11) e do incisivo central superior esquerdo (21). Tendo em vista o histórico odontológico e comportamental da paciente, optou-se em realizar o tratamento cirúrgico em ambiente hospitalar, auxiliado por equipe multidisciplinar. Dessa forma, ao final dos procedimentos foi verificado que o atendimento em ambiente hospitalar é viável para maior conforto do paciente não colaborador.

ABSTRACT The diagnosis and treatment of supernumerary teeth pose a challenge for dental clinicians and pediatric dentists. These teeth are asymptomatic and may cause the delayed eruption of the permanent dentition, altered bone growth and ectopic positioning. This paper reports a case of the surgical removal of supernumerary teeth in the anterior region of the maxilla of a child under general anesthesia in a hospital setting. A six-year-old female patient visited a private dental office in the city of Garanhuns, Brazil, accompanied by her mother, who reported a tooth with a “strange shape” in the anterior region as the main complaint and also reported that her daughter’s first dental experience was negative. The clinical examination and imaging tests were performed under general anesthesia to confirm the diagnosis. In view of the patient’s dental and behavioral history, surgical treatment was performed in a hospital setting and assisted by a multidisciplinary team. Care in the hospital setting was found to be feasible, providing greater comfort for uncooperative patients.

RESUMEN: La erupción ectópica de un diente es el proceso por el cual el diente emerge en una posición anormal. La primera molar permanente es el diente que más frecuentemente presenta erupción ectópica, ya que, en su proceso de erupción, queda retenida debajo del contorno distal de la segunda molar temporal. La erupción ectópica puede ser reversible o irreversible, si es irreversible requiere tratamiento correctivo para lograr que la molar permanente erupciones correctamente en el arco. Los tratamientos pueden ser poco invasivos como el uso de separados elásticos o más invasivos con aparatos ortodóncicos tales como brass wire, k-loop, Halterman o wedging spring. El objetivo del presente artículo es presentar dos casos clínicos donde se corrige la erupción ectópica de primeros molares permanentes utilizando separadores elásticos. Conclusión: los separadores elásticos pueden usarse con éxito en casos de erupciones ectópicas moderadas o severas, no sólo en casos leves como reporta la mayoría de la literatura. El uso de esta técnica no requiere gran cooperación por parte del paciente y es de bajo costo económico.

ABSTRACT: Ectopic eruption of a tooth is the process in which a tooth emerges in an abnormal position. The first permanent molar is the tooth that most frequently presents ectopic eruption, mostly because it is retained below the distal contour of the second temporary molar. The ectopic eruption may be reversible or irreversible, the latter of which requires corrective treatment to achieve correct eruption of the permanent molar in the arch. Treatments can be minimally invasive, such as the use of interproximal wedging, or more invasive orthodontic devices, such as brass wire, k-loops, Halterman devices, or wedging springs. The aim of this case report is to present two clinical cases where the ectopic eruption of permanent first molars is corrected using elastic separators. Conclusion:The elastic separators could be used successfully in cases of moderate or severe ectopic eruptions, not only in mild cases, as reported in most of the literature. The use of this technique does not require great cooperation from the patient, and it is low in cost.

ABSTRACT Introduction: The lack of a permanent incisor not only generates an adverse effect on facial aesthetics but also alters its function, especially the incisor guidance. Upper incisors can suffer mechanical blockage or change in their eruption due to a supernumerary tooth, a blow or another factor. The treatment of choice is orthodontic-surgical. The prognosis depends on the age, tooth position, morphology, size, root maturation and traction method. Knowing the use of an orthodontic appliance, which is easy to handle and can be used from an early age, will be of valuable contribution. Objective: To show the successful use of a cantilever to enable orthodontic traction of an impacted incisor in a horizontal position. Case presentation: Eight-year-old patient with class I malocclusion, specimen 2.1 retained in a horizontal position, presence of supernumerary tooth and persistence of specimen 6.1. Extraction of the supernumerary, release of specimen 2.1 and orthodontic traction is chosen. A buccal cantilever made of a 0.020” round steel arch with two circles at each end was used to provide elasticity and anchoring. The force used was 70 g. Six months after, the occlusion plane was reached. Brackets and tubes were cemented and the sequence of arches was continued until the 0.021”x0.025” steel arch was reached in 11 months. An optimal final position is obtained, favoring root formation and apical closure. Conclusions: The use of the cantilever for orthodontic treatment of impacted permanent incisors in a horizontal position proved to be successful as well as easy to manipulate and control.

RESUMEN Introducción: La falta de un incisivo permanente no solo genera un efecto adverso en la estética facial, también altera la función, en especial, la guía incisiva. Los incisivos superiores pueden sufrir bloqueo mecánico o cambio en su erupción por un diente supernumerario, un golpe u otro factor. El tratamiento de elección es el quirúrgico-ortodóncico. El pronóstico dependerá de la edad, situación, posición del diente, morfología, tamaño, maduración radicular y método de tracción. Conocer el uso de una aparatología ortodóncica que sea fácil de manipular y pueda ser usada desde edades tempranas servirá de valioso aporte. Objetivo: Mostrar el uso exitoso de un cantiléver para traccionar ortodóncicamente un incisivo impactado en posición horizontal. Presentación del caso: Paciente de 8 años con maloclusión clase I, pieza 2.1 retenida en posición horizontal, presencia de supernumerario y persistencia de pieza 6.1. Se opta por extracción de supernumerario, liberación de pieza 2.1 y tracción ortodóncica. Se usó un cantiléver por vestibular confeccionado en arco de acero redondo 0.020” con dos círculos en cada extremo para brindar elasticidad y anclaje. La fuerza utilizada fue de 70 g, pasado 6 meses se alcanzó el plano de oclusión. Se cementaron brackets y tubos, se continuó con la secuencia de arcos, hasta llegar al arco acero 0.021”x0.025” durante 11 meses. Se obtiene una posición final óptima que favorece la formación radicular y cierre apical. Conclusiones: El uso del cantiléver para el tratamiento ortodóncico de incisivos permanentes impactados en posición horizontal demostró ser exitoso, fácil de manipular y controlar.

RESUMO Introdução: A reabsorção cervical invasiva (RCI) é um tipo relativamente raro de reabsorção radicular externa (RRE), no qual uma reabsorção localizada começa na região cervical do dente, abaixo da junção epitelial e acima da crista marginal. Objetivo: Descrever o caso clínico de um menino com 11 anos de idade, sem histórico de trauma dentário, apresentando apinhamento moderado e erupção ectópica do incisivo central superior. Ele realizava tratamento ortodôntico em outro local, mas sua família estava insatisfeita com os resultados. Descrição: Foi iniciado um novo tratamento, que incluiu a expansão rápida da maxila, seguida pela extração de quatro pré-molares. Durante a avaliação de rotina da radiografia panorâmica, uma imagem radiolúcida foi detectada, e uma radiografia periapical da região foi solicitada, sendo encontrada uma RCI no incisivo central superior direito. O tratamento foi finalizado com cautela e, apesar do uso de forças leves, o incisivo central estava seriamente comprometido pela RCI e, portanto, precisou ser extraído. Conclusão: Esse exemplo clínico discute a importância das radiografias de rotina para o diagnóstico precoce da RCI.

ABSTRACT Introduction: Invasive cervical resorption (ICR) is a relatively rare type of ERR (External Root Resorption), in which a localized resorption begins in the cervical area of the tooth, below the epithelial junction and above the ridge crest. Objective: Describe the clinical case of an 11-year-old boy with no dental trauma history, presenting moderate crowding and ectopic eruption of the maxillary right central incisor. He had been undergoing orthodontic treatment elsewhere, and his family was dissatisfied with the results. Description: A new treatment was indicated, which included rapid maxillary expansion followed by extraction of four premolars. During routine panoramic evaluation, a radiolucid image was detected and a periapical radiograph was requested. At this point, an ICR of the maxillary right central incisor was found. The treatment was cautiously finalized and despite the use of light forces, central incisor was severally compromised by ICR and was therefore extracted. Conclusion: This clinical example discusses the importance of routine radiographs for the early diagnoses of ICR.

RESUMO Introdução: As agenesias dentárias são frequentemente associadas a outras anomalias dentárias, tais como microdontia, atraso na erupção e ectopismo. Além disso, podem vir todas juntas em um mesmo indivíduo, pois certas mutações genéticas podem se expressar fenotipicamente de diferentes formas. A abordagem terapêutica nos casos de hipodontia de dentes anteriores não deve se pautar somente entre fechar ou abrir espaço para substituição protética. Portadores de hipodontia de incisivos laterais superiores permanentes podem apresentar os outros dentes com largura mesiodistal menor que os de pacientes com dentição normal, e podem necessitar de reanatomizações para que se obtenha uma oclusão dentária estética e funcional. Objetivo: Dessa forma, o objetivo do presente artigo é relatar um caso clínico e discutir a associação da hipodontia de incisivos laterais superiores permanentes com outras anomalias dentárias, e suas alternativas de tratamento.

ABSTRACT Introduction: Tooth agenesis is often associated with other tooth anomalies, such as microdontia, delayed eruption and ectopic eruption. Moreover, they may be found all in the same individual, as certain genetic mutations may have a variable phenotypic expression. Treatment of cases of hypodontia of anterior teeth should not involve only opening or closing space for prosthetic rehabilitation. Individuals with hypodontia of permanent maxillary lateral incisors may have teeth with a mesiodistal width smaller than that of patients with a normal dentition, and which may need reshaping to achieve an esthetic and functional occlusion. Objective: This clinical case report discusses the association of hypodontia of permanent maxillary lateral incisors with other tooth anomalies and their treatment alternatives.

SUMMARY The presence of multiple supernumerary teeth in the oral cavity is an infrequent alteration of dental development in patients who do not have an associated syndrome, that can induce various alterations such as malocclusions, delay in dental eruption, reabsorption of adjacent teeth, cyst formation, root dilacerations and giroversions. The objective of this clinical case is to report the presence of multiple supernumerary teeth, which caused the ectopic eruption and gyroversion of adjacent teeth, causing a crossbite in the oral cavity of a non-syndromic pediatric patient of the Centro Dental Docente Cayetano Heredia in 2019. The treatment performed was the simple extraction of the erupted supernumerary teeth and the complex extraction with flap of the retained ones.

RESUMEN La presencia de múltiples dientes supernumerarios en la cavidad bucal es una alteración del desarrollo dental infrecuente en pacientes que no tienen un síndrome asociado, estos pueden inducir diversas alteraciones como maloclusiones, atraso en la erupción dentaria, reabsorción de los dientes adyacentes, formación de quistes, dilaceraciones radiculares y giroversiones. El presente caso clínico tiene como objetivo reportar la presencia de múltiples dientes supernumerarios, que ocasionaron la erupción ectópica y giroversión de piezas dentarias adyacentes, provocando una mordida cruzada en la cavidad oral de un paciente pediátrico no sindromico del Centro Dental Docente Cayetano Heredia en el 2019. El tratamiento realizado fue la extracción simple de los dientes supernumerarios erupcionados y la extracción compleja con colgajo de los retenidos.

Abstract Objective: To identify the dental anomalies that can modify the occlusal characteristics and their distribution in these occlusal alterations in the skeletal patterns of children. Material and Methods: We analyzed charts, panoramic and periapical radiographs of children aged 5 to 12 years from 2009 to 2012. The facial pattern was evaluated through subjective face analysis and cephalometric data, as well as the occlusion of patients with and without (control) dental anomalies. The relationship between the presence of dental anomalies and malocclusion was analyzed by the Chi-square test with significance level of 5%. Results: 73 children (27.8%) presented dental anomalies, being 49.3% in girls and 50.7% in boys in a total of 88 teeth involved. Anomalies observed in decreasing order were: enamel hypoplasias, eruptive ectopias, agenesis, supernumerary teeth, corono-radicular dilaceration, microdontia, transposition and imperfect amelogenesis. Of these, 22.2% presented associated dental anomalies, whose ectopic eruption with enamel hypoplasia were the most frequently encountered. When comparing the control group with children with dental abnormalities it was observed a significant relationship between the presence of dental anomalies and malocclusion (p<0.05). The most frequent alteration among patients with dental anomalies was deep overbite (24.6%), followed by crowding (23.3%), posterior crossbite (14.2%), anterior open bite (12.9%) and anterior crossbite (0.3%). onclusion: Dental dysgenesis interferes with the development of occlusion and the resulting occlusal problems are distributed differently, taking into account the skeletal facial pattern in patients with and without dental anomalies.

Tooth development is a complex process whereby various genetic and environmental variables interact to achieve the final morphology and destination. Disruptions in the process lead to impaction and or ectopic eruption. Bilateral ectopic eruption of maxillary canine teeth into the incisive fossa is a rare phenomenon. This report describes bilateral permanent maxillary canine teeth erupting into the incisive fossa of the skull of an adult male African. The skull specimen was first examined physically, followed by Micro Focus X-ray Computed Tomography μCT) to determine the morphology and trajectory of the impacted and ectopically erupting teeth. Physical examination of the skull revealed a portion of the right maxillary canine tooth in the incisive fossa. μCT revealed the presence of right and left permanent maxillary canines within the palatine bone with cusps projecting into the incisive fossa. Both teeth were mature with well-developed root, root canal and crowns with distinct cusps. The root of the right impacted canine tooth was deflected at its apex. Tooth impaction is caused by mechanical disturbance in the path of the developing tooth. This information is vital to practicing maxillofacial surgeons during interpretation of the radiographs and surgical correction of disorders of the oral cavity.

RESUMO Caninos são elementos dentários importantes no que se refere a função, oclusão, estética. Distúrbios na erupção de caninos superiores permanentes são comuns. A erupção ectópica de um germe dentário pode ocorrer a qualquer momento, desde a sua erupção. Verifica-se ainda, que caninos superiores são mais acometidos com distúrbios de erupção que os terceiros molares. Diagnósticos de elementos dentários retidos são realizados por meio de exames clínicos e radiográficos, ou através de investigações de queixas diversas, como dor ou ortodônticas. O Cirurgião-Dentista deve estar familiarizado com as alterações funcionais e anatômicas referentes as impactações, ectopias dentárias e suas possíveis repercussões ao paciente, pois recomendações sobre as decisões a serem seguidas nos casos de impactações de caninos são determinadas através de minucioso estudo de cada caso. O objetivo do presente artigo é relatar um raro caso de canino incluso com proximidade da órbita.

ABSTRACT The canines are important teeth as regards function, occlusion and esthetics. Disturbances with the eruption of permanent maxillary canines are common. Ectopic eruption of a tooth germ can occur at any time after eruption. It has also been observed that upper canines are affected with eruption disorders more than the third molars. The diagnosis of retained teeth is performed through clinical and radiographic examination, or through the investigation of various complaints, such as pain or orthodontic problems. The dental surgeon should be familiar with the anatomical and functional changes of the impaction, ectopic teeth and the possible repercussions for the patient, because recommendations on the decisions to be taken in cases of canine impaction, are determined through a careful study of each case. The purpose of this paper is to report a rare case of a buried canine in the proximity of the orbital border.

OBJETIVO: o presente estudo tem o objetivo de avaliar, de acordo com a opinião de ortodontistas experientes, a dificuldade de se realizar a erupção forçada de caninos superiores impactados, com base em informações fornecidas por tomografia computadorizada de feixe cônico. O objetivo específico foi identificar os fatores mais importantes relacionados a essa opção de tratamento. MÉTODOS: com base em uma revisão meticulosa da literatura sobre caninos superiores impactados, selecionamos os dez principais fatores utilizados para avaliar a dificuldade em tratar dentes impactados. Trinta e seis pacientes, com um total de 50 caninos superiores impactados, foram avaliados. As variáveis para cada dente impactado foram obtidas utilizando o programa Dolphin 3D. Dez ortodontistas avaliaram as radiografias referentes aos dentes selecionados e opinaram sobre a dificuldade em alinhar dentes impactados. O grau de dificuldade foi denominado Grau de Dificuldade Subjetivo (GDS). A relação entre o valor médio de GDS de cada dente e as variáveis obtidas foi analisada por regressão linear. RESULTADOS: o valor médio de GDS foi de 6,45 ± 1,22, para todos os dentes. A regressão linear gerou um alto coeficiente de relação entre o valor médio de GDS e as variáveis idade, dilaceração, altura vertical, angulação e sobreposição horizontal (p < 0,05). CONCLUSÃO: de acordo com a opinião de ortodontistas experientes, para prever a dificuldade em se realizar a erupção forçada de caninos superiores impactados, as variáveis idade, dilaceração, angulação, sobreposição e distância vertical do plano oclusal são as mais importantes.

AIM: This study aims at examining the difficulty in performing forced eruption of impacted maxillary canines, using CBCT information and according to experienced orthodontist's opinion. The second aim was to find the most important factors related to this decision. METHODS: Based on a careful literature review on impacted maxillary canines, ten main factors were selected to assess difficulties associated with impacted teeth. Thirty six consecutive patients with 50 impacted maxillary canines were examined and variables were measured for each impacted tooth using Dolphin 3D software. Ten orthodontists assessed the radiographs of teeth and provided their opinion on the difficulty in bringing impacted teeth into occlusion named subjective degree of difficulty (SDD). The correlation established between mean SDD of each tooth and measured variables were analyzed by means of linear regression. RESULTS: Mean SDD was 6.45 ± 1.22 for all 50 teeth. Linear regression showed a high coefficient of correlation between mean SDD and age, dilacerations, vertical height, angulation and horizontal overlap (P < 0.05). CONCLUSION: To predict the difficulty of impacted maxillary canines forced eruption, according to the opinion of experienced orthodontists, the factors age, dilaceration, angulation, overlap and vertical distance from the occlusal plane are the most important variables.

INTRODUÇÃO: a transposição entre canino e primeiro pré-molar superiores (Mx.C.P1) é uma anomalia de posição dentária rara, que pode causar muitos problemas ortodônticos, não só com relação à estética, mas também com relação à função do paciente. OBJETIVO: no presente artigo, relatamos o manejo ortodôntico de um caso de Mx.C.P1 associada à agenesia bilateral de incisivos laterais superiores e agenesia unilateral do segundo pré-molar inferior. MÉTODOS: o paciente foi tratado com aparelho ortodôntico fixo e extração do pré-molar inferior. RESULTADOS: o tratamento foi concluído sem a necessidade de reposição protética.

INTRODUCTION: Maxillary canine-first premolar transposition (Mx.C.P1) is an uncommon dental positional anomaly that may create many orthodontic problems from both esthetic and functional points of view. OBJECTIVE: In this report we show the orthodontic management of a case of Mx.C.P1 associated with bilateral maxillary lateral incisor agenesis and unilateral mandibular second premolar agenesis METHODS: The patient was treated with a multibracket appliance and the extraction of the lower premolar. RESULTS: treatment was completed without the need for any prosthetic replacement.

Down's syndrome or trisomy 21 is man's most frequent genetic disorder. It affects one out of 600-700 live births. It is characterized by the presence of an additional chromosome at the 21 pair which elicits generalized decrease of growth as well as intellectual disability. In scientific literature there are many reports of cranio-facial and oral manifestations of this disorder. Chief oral condition reported in this group of patients is periodontal disease. Objective: Establishment of preventive oral care for the development of periodontal disease in adolescent patients afflicted with Down's syndrome. Case presentation: 15 year old Mexican-Indian male patient with trisomy 21. The patient was bilingual, afflicted with congenital heart disease, pulmonary hypertension and nephrotic syndrome. The patient equally presented ectopic dental eruption as well as congenital dental absences, Angle's class III occlusion, anterior and posterior unilateral crossbite, oral respiration, labial eversion, fissured tongue and lips, clinodactyly and localized gingivitis. Behavior management was achieved with the «show-tell-do» technique alongside with voice control. Initial treatment consisted on sweeping brushing technique with parental assistance, use of dental floss (Dento Bacterial Plaque Control [DBPC]) (100%) as well as topical application of fluoride varnish. It was recommended to the parents they should use home applications of bioadhesive gel (Perioxidin®). After these measures, oral rehabilitation was undertaken. Conclusions: The most relevant aspect of the treatment was the decrease (40%) in bacterial plaque reported in later control visits.

El síndrome de Down o trisomía 21 es la alteración genética más frecuente en el ser humano; uno de cada 600-700 recién nacidos vivos es afectado por este síndrome. Éste se caracteriza por la presencia de un cromosoma adicional en el par 21, el cual provoca disminución generalizada en el crecimiento y discapacidad intelectual. Diversas manifestaciones craneofaciales y bucales han sido descritas en la literatura. El principal padecimiento bucal reportado en este grupo de pacientes es la enfermedad periodontal. Objetivo: Establecer cuidados bucales preventivos en el desarrollo de la enfermedad periodontal en pacientes adolescentes con síndrome de Down. Presentación del caso: Paciente indígena masculino de 15 años de edad con trisomía 21, bilingüe. Presenta cardiopatía congénita, hipertensión pulmonar y síndrome nefrótico, así como erupción ectópica y ausencias congénitas dentales, oclusión clase III de Angle, mordida cruzada unilateral anterior y posterior, respiración bucal, eversión labial, lengua y labios Asurados, clinodactilia y gingivitis localizada. El manejo de conducta se llevó a cabo a través de la técnica «decir-mostrar-hacer» y control de voz. El tratamiento inicial consistió en técnica de cepillado de barrido asistido por los padres, uso del hilo dental, CPDB (Dento Bacterial Plaque Control) (100%) y aplicación tópica de barniz de fluoruro. Se recomendó a los padres la aplicación en el hogar de un gel bioadhesivo (Perioxidin®) para la rehabilitación oral. Conclusiones: El aspecto más relevante fue la disminución de la cantidad de placa dentobacteriana reportada en controles posteriores (40%).