Diagnóstico y tratamiento multidisciplinar de un paciente con alteración respiratoria, mordida cruzada posterior y alteraciones del esmalte.
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2021
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Paciente varón de 10 años y 1 mes de edad con padres divorciados. El paciente presenta hábito de respiración oral y facies adenoidea. Intraoralmente, presenta una dentición mixta segunda fase, Clase II molar incompleta bilateral y Clase canina no valorable. Además, destaca una mordida cruzada posterior unilateral izquierda debido a una compresión dentoalveolar izquierda. A nivel dentario presenta Síndrome de hipomineralización incisivo molar e Hipomineralización del segundo molar temporal. Durante la anamnesis, la madre del paciente refirió que el paciente había sufrido dos cuadros respiratorios infecciosos uno a los 8 meses de edad y otro a los 3 años. Una revisión sistemática con la siguiente pregunta PICO fue planteada: ¿Existe relación entre alteraciones respiratorias y riesgo de desarrollo de defectos del esmalte?. Esta revisión sistemática fue publicada en la revista Científica Dental, editada por el Ilustre Colegio Oficial de Odontólogos y Estomatólogos de la I Región. Los estudios analizados en esta revisión sistemática muestran que distintos problemas respiratorios en la infancia y los fármacos empleados para su tratamiento pueden ser un posible factor etiopatogénico de las alteraciones del esmalte. A nivel cefalométrico, el paciente presenta una Clase I ósea y patrón de crecimiento meso-dólicofacial. El tratamiento propuesto comenzó con la instauración de un correcto protocolo preventivo, debido al riesgo aumentado de caries por presencia de alteraciones del esmalte. Además, se optó por una placa activa de Hawley con tornillo central de expansión para el tratamiento de la maloclusión transversal. Los índices de salud oral mejoraron durante el trascurso del tratamiento. Con respecto a la mordida cruzada posterior, se observó una mejoría en la maloclusión transversal. Sin embargo, esta mejoría no fue completa debido a la falta de cooperación en cuanto a la activación del aparato. Como conclusión, los factores intrapersonales e interpersonales tienen una gran repercusión en el grado de colaboración que presentan los pacientes infantiles. Asimismo, debido a la complejidad inherente de todo proceso diagnóstico, una anamnesis exhaustiva es un primer paso fundamental para alcanzar un correcto plan de tratamiento.
Male patient aged 10 years 1 month with divorced parents. The patient has an oral breathing habit and adenoid facies. Intraorally, he presents a second phase mixed dentition, bilateral incomplete molar Class II, and the canine Class is not assessable. In addition, a left unilateral posterior crossbite stands out due to a left dentoalveolar compression. Intraoral analysis also revealed Molar incisor hypomineralization and Hipomineralized second primary molar. During the anamnesis, the patient's mother reported that the patient had experienced two infectious respiratory episodes, one at 8 months of age and the other at 3 years. A systematic review with the following PICO question was raised: Is there a relationship between respiratory disorders and the risk of developing enamel defects? This systematic review was published in Científica Dental, edited by Ilustre Colegio Oficial de Odontólogos y Estomatólogos de la I Región. The studies analyzed in this systematic review show that different respiratory problems in childhood and the drugs used for their treatment may be a possible etiopathogenic factor of enamel alterations. Cephalometric analysis revealed skeletal Class I and a meso-dolichofacial growth pattern. The proposed treatment began with the establishment of a correct preventive protocol, due to the increased risk of caries associated with the presence of enamel alterations. In addition, an active Hawley appliance with a central expansion screw was chosen for the treatment of transverse malocclusion. Oral health indices improved over the course of treatment. Regarding the posterior crossbite, an improvement was observed in the transverse malocclusion. However, this improvement was not complete due to the lack of cooperation regarding the activation of the device. In conclusion, intrapersonal and interpersonal factors have a great impact on the degree of collaboration of pediatric patients. Likewise, due to the inherent complexity of any diagnostic process, an exhaustive anamnesis is a fundamental first step to achieve a correct treatment plan.
Male patient aged 10 years 1 month with divorced parents. The patient has an oral breathing habit and adenoid facies. Intraorally, he presents a second phase mixed dentition, bilateral incomplete molar Class II, and the canine Class is not assessable. In addition, a left unilateral posterior crossbite stands out due to a left dentoalveolar compression. Intraoral analysis also revealed Molar incisor hypomineralization and Hipomineralized second primary molar. During the anamnesis, the patient's mother reported that the patient had experienced two infectious respiratory episodes, one at 8 months of age and the other at 3 years. A systematic review with the following PICO question was raised: Is there a relationship between respiratory disorders and the risk of developing enamel defects? This systematic review was published in Científica Dental, edited by Ilustre Colegio Oficial de Odontólogos y Estomatólogos de la I Región. The studies analyzed in this systematic review show that different respiratory problems in childhood and the drugs used for their treatment may be a possible etiopathogenic factor of enamel alterations. Cephalometric analysis revealed skeletal Class I and a meso-dolichofacial growth pattern. The proposed treatment began with the establishment of a correct preventive protocol, due to the increased risk of caries associated with the presence of enamel alterations. In addition, an active Hawley appliance with a central expansion screw was chosen for the treatment of transverse malocclusion. Oral health indices improved over the course of treatment. Regarding the posterior crossbite, an improvement was observed in the transverse malocclusion. However, this improvement was not complete due to the lack of cooperation regarding the activation of the device. In conclusion, intrapersonal and interpersonal factors have a great impact on the degree of collaboration of pediatric patients. Likewise, due to the inherent complexity of any diagnostic process, an exhaustive anamnesis is a fundamental first step to achieve a correct treatment plan.