DOI: 10.1111/ipd.
12526
A B ST R AC T S
6. Orthodontics/Craniofacial Growth and Development
Oral Presentation
1  |  An innovative physiologic device for the
correction of anterior open bite
M. Silva; R. Valencia; J. Kwak
Pediatric Dentistry, Universidad Tecnológica de México, México
Introduction: The management of an anterior open bite (AOB)
in the growing child represents a challenge for pediatric dentists.
If the neuromusculature is not allowed to function in a proper
manner, the open bite perpetuates in the permanent dentition.
In some cases, there is an increased risk of relapse even after
orthodontics or surgery is performed. Etiologic factors are mul-
tiple, early identification of the condition contributes to solving
these cases successfully. The physiologic modification in de-
glutition patterns, going from an infantile or visceral to a mature
or somatic swallowing pattern, requires the correct placement
of the tongue behind the maxillary incisors, at the time when the
fifth pair of cerebral nerves substitutes the seventh pair in such
function. In an artificial manner, utilizing a retainer that simu-
lates the correct position of the teeth, the muscles are redirected
into a proper function. The passive eruption of the teeth takes
place until they achieve a correct and stable position, that other-
wise would be impossible to reach, due to the constant presence
of the tongue required to seal for deglutition.
Case reports: A 10 year old girl with an AOB case attends
the clinic with a chief complaint “She has some speech and
biting problems”, her mother said. A thermoformed vacu-
umed dental guard that simulates the correct position of the
upper incisor is confectioned using play‐doh® in the patients
cast models. This creates the space into which the incisors
can erupt physiologically, bringing alveolar bone along them
closing the AOB. This forms a barrier to the tongue, prevent-
ing its presence as a functional matrix.
Comments: This simple, short term usage, low cost, easy
fabrication functional appliance, may render optimal results
when used at the appropriate time in a growing child. It is
used at home and during the night, being highly accepted by
the patient suffering from a malocclusion, with great results
and improvement in self‐confidence and quality of life.
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96   © wileyonlinelibrary.com/journal/ipd
2019 The Authors. © 2019 BSPD, IAPD and John Wiley
& Sons A/S. Published by John Wiley & Sons Ltd
2  |  Assertive management of bruxism in
children
J. H. Reffreger‐Soto
Odontopediatría, Academia Mexicana de Odontología Pediátrica,
México
Introduction: Over the years, talk about the bruxism had a
halo of some controversy, until it was achieved an agreed
definition. This conference is focused on the update of this
clinical entity, specifically in children and adolescents.
Case reports: It will review the etiology, the relationship
between neurotransmitters at the level of the central neuro-
logical system and its interactions with the cells of the mas-
ticatory muscular system and the resulting rhythmic muscle
activity, specifically the contribution of dopamine during this
process. We will also examine various diagnostic modalities
with emphasis on appropriate anamnesis, intra‐and extra‐
clinical oral examination, including temporomandibular join
evaluation. In addition, the use of complementary diagnostic
procedures, such as polysomnography, radiographic studies
and blood studies. Will be also submitted information on
prevalence and related factors. A deep relationship between
bruxism and other comorbidity such as nocturnal apnea and
other parasomnias will be discus. It will be talk about the
high influence of the stress on the development of bruxism in
children; for example the role of scholar bulling, the presence
of dysfunctional families, separated parents or even smok-
ing families. Other social factors will be mentioned such as
economic level, education, extra scholar activities and nu-
tritional habits as strongly correlated. Additionally the pres-
ence of specific syndromes like Parkinson, Rett, Prader Willi
and Huntington disease are others comorbidities correlated.
Another important factor that we will discuss is the influence
of the use of technological devices as causal factor of this
clinical entity.
Comments: Assertive management of bruxism will be sug-
gested, reviewing treatment alternatives at both neural central
and peripheral level to prevent the establishment of bruxism
Int J Paediatr Dent. 2019;29 (Suppl. 1):96–109.
ABSTRACTS
and avoid the different sequelae that may occur in oral struc-
tures, as be soft or hard tissues.
This includes adequate and assertive communication with
parents and children, the consultation on oral hygiene and nu-
trition, the use of different orthodontic and orthopedic dental
appliances and the restoration of affected dental structures.
In some cases, interdisciplinary referrals should be necessary
for psychological treatment, medication therapy, or surgical
approach.
Poster Presentation
1  |  The association between the type of bad oral
habit and the kind of malocclusion in children
M. Belfer
Pediatric Dentistry and Orthodontics, Peoples’ Friendship University of
Russia, Russia
Background: It is indeed a well‐known and scientifically
proven fact, that bad oral habits, such as prolonged use of a
pacifier or bottle/breastfeeding, thumb/foreign object suck-
ing or biting, mouth breathing and atypical swallowing, pat-
tern provoke malocclusion in children.
Aim: To evaluate the link between certain types of such hab-
its and the kind of pediatric dento‐skeletal discrepancies.
Design: A population‐based study was conducted, involving
185 children aged 2‐6  years enrolled at the Russian dental
clinics. Three age groups of children were analyzed using
questionnaire, medical records, and clinical examinations.
The acquired malocclusion was defined only if one or more
of the following factors were presented in a generally healthy
child without any congenital oral anomaly or previous den-
tal treatment: (1) Bi‐ or unilateral functional crossbite; (2)
Midline deviation; (3) Anterior open bite; (4) Cl.I, Cl.II,
Cl.III malocclusion. Bad oral habits were determined accord-
ing to the questionnaire and data from the clinical examina-
tions. The impact of each type of bad habit on the certain type
of children malocclusion was assessed using malocclusion
and bad oral habits scale.
Results: 78.4% of all children with malocclusion had a pro-
longed use of a pacifier or bottle/breastfeeding, 54.6% had
a thumb/foreign object sucking or biting habit. Statistically
significant 73.5% of patients with malocclusion had the rec-
ognized correlation between their problems with occlusion
and bad habits (r = 0.723; P = 0.003). Unilateral posterior
crossbite was mostly associated with prolonged use of a
pacifier or bottle/breastfeeding, thumb sucking, bilateral
  
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crossbite – with tongue trust and mouth breathing, anterior
open bite – with thumb/finger sucking, midline deviation –
with foreign object sucking or biting. Most parents did not
consider prolonged foreign object sucking or biting as a “bad
oral habit” (67.6%).
Conclusions: The strong association between the type of
bad oral habit and the kind of dento‐skeletal discrepancies in
children was determined. Every primary check‐up of small
children should include assessment of occlusion and medi-
cal record of oral habits. Attention must be paid to the early
malocclusion prevention through the elimination of bad oral
habits in childhood. Parental education should be the first
part of the comprehensive malocclusion prevention program.
2  |  Prediction of the craniofacial growth
according to vertical and horizontal longitudinal
ratio of the mandibular ramus on a panoramic
radiography
L. Pacheco‐De Santiago; M. Ramírez‐Ramirez; R. Valencia‐Hitte
Odontología Pediátrica, Universidad Tecnológica de México, México
Background: The prediction of craniofacial growth repre-
sents a great problem when it comes to give a diagnosis, be-
cause most of the cephalometric analysis is considered in the
child as a vertical grower. For this reason, it is common for
the dentist to limit the diagnosis of deficiencies or excesses in
the size of structures. Aim: The aim of the current study was
to evaluate the relation between the proportion of measure-
ments of the jaw in length and width and the type of crani-
ofacial growth on the panoramic radiography.
Design: In this observational‐retrospective and cross‐sec-
tional study in a sample of 117 cases with a panoramic and
lateral x‐ray of patients between the ages of 7 and 10 years
old, from a Dental Clinic of the Pediatric Dentistry School
from Universidad Tecnologica de Mexico were chosen. The
width and length of the mandibular ramus in the panoramic
radiograph were measured to establish the relationship be-
tween them obtaining an index.
Results: Out of the 117 records reviewed and measured, 116
(99.14%) showed that there is a close relationship between
the measurement of the mandibular ramus and the jaw length
to determine type of patient's growth.
Conclusions: It is possible to predict the craniofacial growth
biotype based on measurements of the wide and long ratio of
the mandibular ramus of pediatric patients. Obtained results
are clear to determine that, with a panoramic radiograph, you
can have a great reliability to determine the biotype of crani-
ofacial growth of the patient.
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98       ABSTRACTS
3  |  Skeletal and dentoalveolar change in class
II division I patients treated with myofunctional
therapy: A pilot study
C. Liang‐Ru; H. Hsin; Y. Yi‐Hsuan
Department of Pediatric Dentistry of Orthodontics, Taichung Veterans
General Hospital, Taiwan
Background: The etiology of malocclusion is multifactorial
and is comprised of inherited skeletal patterns (the genetic
component) and environmental factors, such as thumb suck-
ing, mouth breathing and tongue thrusting. Myofunctional
therapy is used as well as exercise based with the purpose of
correcting imbalanced orofacial muscle functions, in order to
provide more favorable environment for dentition and skel-
etal bone growth.
Aim: To evaluate the skeletal and dentoalveolar change in
class II division I in children receiving myofunctional ther-
apy, in comparison with those who did not have myofunc-
tional therapy intervention.
Design: The inclusion criteria of this study were: (1) children
with Class II division I malocclusion; (2) incisor overjet equal
to or larger than 6 mm; (3) CVM method evaluation stage III
or less; (4) history of myofascial functional problems such as
enlarged adenoid, allergic rhinitis, mouth breathing; (5) com-
plete pretreatment and one year recall lateral cephalometric
radiographs. The exclusion criteria included: (1) history of
interceptive orthodontic treatment (2) poor compliance of
appliance wearing and functional exercise (wearing <7  hr
per day or <5  days per week). The control group consists
of patients with class II division I malocclusion who met the
following criteria: (1) incisor overjet equal to or larger than
6 mm (2) no myofunctional therapy (3) no other type or in-
terceptive orthodontic treatment (4) CVM method evaluation
stage III or less (5) complete initial examination and one year
recall lateral cephalometric radiographs.
Results: Showed that there were significant differences
between two groups in the change of upper incisor inclina-
tion relative to cranial base (U1 to SN) and nasolabial angle
(NLA). The myofunctional therapy group revealed signifi-
cant decrease in upper incisor inclination and nasolabial
angle. The myofunctional group also showed decreased
mandible to cranial base angle (SNB), but the result was not
significant. This study's result suggests that myofunctional
therapy may play a main role in the orthodontic and orthope-
dic and soft tissue change in class II division I malocclusion
growing patients.
Conclusion: Long term and larger scale evaluation is needed
for further evidence.
4  |  Interceptive treatment of anterior unilateral
crossbite in a pediatric patient: Case report
S. de la Selva‐Morales; R. Portillo‐Chavolla; C. C. Barrera‐Ortega
Pediatric Stomatology, FES Iztacala, UNAM, Mexico
Introduction: Anterior crossbite is defined as an inverted
bite at the anterior section, where the upper anterior teeth are
lingually of the lower ones.
This inverted occlusion can affect one isolated tooth or sev-
eral of them. Occlusal interferences in the primary dentition,
are a frequent problem and can generate functional maloc-
clusions such as an anterior and posterior crossbites, ante-
rior open bites, deviation of the midline, alterations in the
temporomandibular joint and periodontal problems such as
tooth mobility, formation of periodontal abscesses and even
the loss of teeth.
Case reports: Female patient of 10‐year, with Angle's
molar‐relation Class II‐2 with an anterior crossbite in 21
with tooth, 31 grade I mobility, and pain when eating.
Caries according to ICDAS II of 16, 54, 12, 11, 21, 22,
63, 64, 65, 26, 36, 75, 74, 32, 31, 41, 42, 84, 85 and 46.
Treated with a removable acrylic appliance, combining a
vestibular arch, expansion screw and 15 mm lingual spring
was used to correct the anterior dental crossbite and align
the incisors. The expansion screw was activated ¼ lap per
week for 8 weeks: the spring once a month, the interceptive
treatment was concluded, and the suggestion of an orthope-
dic treatment was given.
Comments: In Pediatric Stomatology, a timely intervention
of dental malocclusions helps identify problems that can be
treated at an early stage. This malocclusion needs immediate
correction so the functional, skeletal and aesthetic complica-
tions may be avoided in the future.
ABSTRACTS
5  |  The path of the stimulus, knowledge creation,
knowledge transfer and impact of an age estimation
atlas
H. Mark; H. Liversidge
School of Dentistry, University of Dundee, UK
Background: The lack of an easy, accurate dental age es-
timation method became evident after the 2004 Tsunami.
This led to the identification of the problem, the creation of
an evidence based atlas, the analysis and evaluation and the
knowledge transfer.
Aim: To describe the creation, transfer and impact using this
example accurate dental age estimation method.
Design: The path from problem identification, knowledge
creation, knowledge synthesis, implementation and evalua-
tion relating to the atlas is documented. Methods of maxim-
ising the distribution included free access to the chart on a
website, translations into 20 languages and an app. A further
study reported on the accuracy of age estimation using the
atlas. The first 500 citations were grouped into subjects and
journals and word clouds created.
Results: The website went live in 2009, the research paper
was published in 2010 and evaluation of accuracy published
in 2014. The atlas is now incorporated into forensic anthro-
pology training courses, textbooks, and is used by most na-
tional and international Disaster Victim Identification teams.
Citation subject and journal show a broad use of the atlas.
There is wide interdisciplinary application to other fields
such as teaching in oral biology and paediatric dentistry, re-
constructing diet and age of weaning in archaeology, com-
parative anatomy and Neanderthal life history.
Conclusions: These results indicate the path of knowledge
creation and knowledge transfer of an age estimation atlas.
These results show the impact on international practice and
the diverse application of this knowledge transfer.
6  |  Early treatment of malocclusion class III in
pediatric patient: Case reports
G. Ramírez‐Martínez
Pediatric Dentistry, ENES LEON UNAM, Mexico
Introduction: Malocclusion ethnology may be caused by
genetic and/or environmental factors. In Raskosi's publica-
tion, it is mentioned that the mandibular length has the same
distance length between the Nasion‐Craneal Chair, in a seven
y/o child this length base, will grow as class III. With this
treatment, we will achieve a class I occlusion and caries‐free
teeth.
  
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Case Reports: A nine y/o patient arrived at the ENES Clinic
of Pediatric Dentistry with his father, not mentioning any pa-
thology fact in the clinical history, he only said he wanted
treatment for his class III malocclusion. Intracranial findings
were incipient carious lesions, posterior and anterior class III
with a 3 mm crossbite, and central incisors and first molars
demineralization. Steiner radiographic diagnosis showed
dental class III, severe mandibular protrusion, maxillary
retrusion, NB protrusion‐retrusion of lower incisors and NA
upper retro inclination.
Treatment: Application of a Hyrax appliance with vestibular
hooks for maxillary traction with a facial mask, the father
was instructed about the use of mask from 12 to 15 hr a day,
with elastic bands of 8 lbs 3/16, also the Hyrax screw acti-
vation once a week. Shock technic was performed in upper
central incisors and first molars. Results: Class I occlusion
was achieved with 1  mm overjet, canine and molar class I
occlusion, as well as an average line having a harmonical
occlusion.
Comments: It is shown that the application of a facial mask
and maxillary expansion is an excellent method for an or-
thopedic treatment in patients with mixed dentition or early
permanent dentition; Shock therapy limits the spreading of
caries processes and healthy dental tissue.
7  |  Comprehensive dental treatment in a patient
with insufficient sex hormone and maxillofacial
skeletal dysplasia: a case report
X. Chen; J. Ling‐Li; D. Zhen‐Jiang
Department of Paediatric Dentistry, School of Stomatology, China
Medical University, China
Introduction: Sex hormones help maintain the normal devel-
opment of the skeleton by modulating osteogenesis through
binding with the sex hormone receptor. Once insufficient sex
hormones secretion and dental diseases arise, the dysplasia of
maxillofacial skeleton might happen.
Case reports: A 4‐year‐old boy presented with a complaint
of swelling and pain of several teeth for 3 years. Dental ex-
amination revealed that #65 with a deep caries, #55, #75,
#85 with pulp exposure, and other teeth were residual roots.
Due to bad oral habits of mouth breathing and masticatory
deficiencies, he shows abnormal occlusion including open
bite, dental midline discrepancies, and posterior crossbite.
Radiographic examination indicated that a supernumer-
ary tooth was located between #11 and #21. CBCT images
demonstrated the dysplasia of mandibular condylar, middle
of maxilla, nasal bone and orbital bone. Medical examina-
tion revealed that the levels of testosterone and luteinizing
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100       ABSTRACTS
hormone were significantly lower than normal. The patient
was then diagnosed with S‐ECC, supernumerary tooth, max-
illofacial skeletal dysplasia and sex hormone deficiency. A
comprehensive treatment plan was made accordingly, which
included getting rid of the bad oral habits, restoration for #65,
root canal therapy for #55, #75, #85, extraction of residual
roots, and the design of removable space maintainer. One
month before the mandibular space maintainer was applied,
the maxillary appliance was first used to correct the poste-
rior crossbite. During the following‐up, the development of
dental arch was observed carefully, and the space maintainer
needed to be termly replaced. The development of the maxil-
lofacial bone will be inspected regularly and combined surgi-
cal‐orthodontic treatment will be considered when necessary.
Regarding the issue of insufficient secretion of sex hormones,
it was recommended to go to the pediatric department for ap-
propriate treatment.
Comments: It is very important to avoid further damage to a
patient with mandibular condylar dysplasia during his treat-
ment. In this case, the maxillary space maintainer was first
designed to correct the posterior crossbite and gain the adapt-
ability and stability of temporomandibular joint. The occlusal
reconstruction with removable space maintainer and dental
treatment were hoped to effectively improve the masticatory
function, which could stimulate the development of normal
craniofacial growth.
8  |  Late spontaneous eruption of the lower
primary second molars previously diagnosed as
ankylosis: Case Report
S. Kim; G. Kim; S. Choi
Department of Dentistry, Ajou University School of Medicine, South
Korea
Introduction: Dentoalveolar ankylosis occurs more fre-
quently in primary dentition compared to permanent denti-
tion. Ankylosed primary molars may impose deleterious
impact on development of occlusion. Dentoalveolar anky-
losis can be diagnosed by clinical finding and radiographic
examination. Infraocclusion, metallic percussion sound, and
tilting of adjacent teeth are signs of ankylosis in develop-
ing dentition. We report two cases of lower primary second
molar which were once diagnosed as ankylosis but showed
late spontaneous eruption.
Case reports: Case 1. A 4‐year‐2‐month‐old girl visited
our clinic regarding unerupted lower right primary second
molar. All other primary molars were well erupted. Almost
completed root formation of the lower right second primary
molar was noted, implying ankylosis as a causative factor
for eruption failure. However, spontaneous eruption was ob-
served in following 15 months achieving stable occlusion.
Case 2. A 5‐year‐old boy visited our clinic regarding
unerupted lower left primary second molar. Partially erupted
lower left primary second molar showed significant differ-
ence in occlusal level and alveolar bone level compared to
adjacent primary first molar, which was even distally tilted.
Clinical and radiographic findings implied ankylosis of the
lower left primary second molar. However, its spontane-
ous eruption was noted in next 20 months and spontaneous
uprighting of the adjacent primary first molar was also ob-
served, establishing stable occlusion.
Comments: Late spontaneous eruption of primary molars,
once diagnosed as ankylosis, was observed in the presented
cases. Its causative factor and mechanism are still ambigu-
ous. Approach toward seemingly ankylosed primary teeth
needs to be conservative in primary dentition for its late
spontaneous eruption may occur though not often.
9  |  Cephalometric analysis for craniofacial
morphologic characteristics in Korean short‐
statured children
J. Jang; Y. Yang; J. Kim
Department of Pediatric Dentistry, Institute of Oral Bioscience, School of
Dentistry, Chonbuk National University, South Korea
Background: Short stature refers to the case that the age and
gender specific height is <−2 standard deviation or 3 percen-
tile below average. As could be expected, short‐statured chil-
dren show smaller facial structure than children with normal
growth pattern. However, growth retardation has not affected
all structures to the same extent, which results in an abnormal
facial morphology. Therefore, although studies of their crani-
ofacial morphology are essential, few studies on the facial
growth of healthy Korean short‐statured children without any
signs of syndromes or other diseases affecting growth have
been made until now.
Aim: The aim of this study was to analyze craniofacial mor-
phologic characteristics with Korean short‐statured children
compared to age‐gender calibrated reference value.
Design: Retrospective study was performed on short‐stat-
ured children with lateral cephalograms taken at Chonbuk
National University Dental Hospital between January 2013
and July 2018. Korean National Growth Charts 2017 was
used to define short‐statured children. 28 short‐statured chil-
dren with an average age of 10.9 ± 2.9 years were selected.
To analyze lateral cephalograms, 15 linear and 11 angular
measurements were chosen. Cephalic growth values were
ABSTRACTS
computed by V‐ceph software and age‐gender specific SDS
(standard deviation score) were calculated.
Results: Almost all linear measurements of the facial struc-
tures were smaller than reference value except anterior facial
height and antero‐posterior facial height ratio. Especially,
Pog‐N perpendicular, lower anterior facial height, mandib-
ular length, midfacial length showed values of SDS below
−2. In addition, anterior facial height showed values of SDS
above 2. In angular measurements, FMA showed values of
SDS above 2.
Conclusions: Short‐statured children showed smaller linear
dimensions in both mandible and maxilla and an increased
vertical dimension compared to age‐gender specific refer-
ence value. It can be concluded that short‐statured children
showed facial retrognathia with vertical growth pattern.
10  |  Orthodontics/craniofacial growth and
development Cranial orthosis: projecting the future
of craniofacial orthopedics
V. Grunstein‐Bistre
Pediatric Dentistry, Universidad Tecnologica de México, Mexico
Background: Intentional cranial deformation was a com-
mon practice in communities around the world, especially in
central, southeastern Mexico and Mesoamerica, where even
today it´s still a practice in primitive cultures as a form of
“art”. Researchers at the National Institute of Anthropology
and History in Mexico showed that those skulls with greater
deformation had greater naso‐maxillary protrusion and pro-
clination of upper and lower anterior teeth.1 It has been found
in several studies that postural plagiocephaly or craniosyn-
ostosis leads to significant language, psychomotor, cogni-
tive and postural disorders.2,3,4 The American Academy
of Pediatrics (2006) recommends starting treatment after
4 months of age with cranial helmets, however some special-
ists mention that the orthosis must be performed between 3
and 4 months of age.
Aim: Analyze skulls with plagiocephaly after an early cra-
nial orthosis treatment, in order to observe the cranial facial
changes.
Design: fifteen cases were taken based on a literature review
with clinical photographs of cases with plagiocephaly treated
with cranial orthosis where facial appearance was observed
before and after treatment. Results: In all cases reviewed of
plagiocephaly treated with orthosis (cranial hulls), a facial
improvement was observed, mainly with maxillomandibular
protrusion and an increase in chin neck distance.
Conclusions: The treatment of cranial orthosis encompasses
very favorable facial changes as long it is performed early,
  
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   101
at 3–4 months of age, making the orthosis a very promising
orthopedic technique of the cranial facial area.
11  |  Interdisciplinary evaluation of the
stomatognathic system and posture in a mouth‐
breathing patient: Case report
M. A. Sanchez; L. Ortega‐Oviedo; O. P. Lopez‐Soto
Posgrado de Estomatología Pediátrica, Benemérita Universidad
Autónoma de Puebla, México
Introduction: Mouth breathing is a condition that can start
in childhood, it has a multifactorial etiology, mainly due to
obstructions, or alterations in function. Consequences in-
clude craniofacial and body changes. The effects of dental
occlusion on cranial and body posture have already been de-
scribed; however, there is little scientific evidence on the ef-
fects of posture on dental occlusion.
Case reports: 11‐year‐old male with a history of rhinitis and
maxillofacial orthopedic treatment, with mouth breathing
habit. The patient attends to dental and postural assessment.
In this case, different diagnostic tests were performed: clini-
cal examination and assessment in the area of Orthodontics;
also, assessment of muscle strength by myoscanography and
dynamometry, assessment of swallowing with Payne`s tech-
nique, surface electromyography, and finally assessment of
stabilometry and baropodometry.
Comments: Since the function of the chewing muscles is
compromised when a mouth breathing habit is present, trans-
disciplinary management is important for proper diagnosis
and treatment of the patient.
12  |  A case series of surgical repositioning in
managing inverted impacted incisors of young
patients
Chia‐En Tsai; M. H. Liu; M. L. Tsiang
Department of Dentistry, Chang Gung Memorial Hospital, Taiwan
Introduction: Management of inverted impacted inci-
sors in growing patients is a great challenge to clinicians.
Conventional treatment options include combined surgical
exposure and orthodontics, extraction with prosthetic replace-
ment and extraction with tooth auto‐transplantation. All the
above modalities are associated with multiple surgical and/
or periodontal procedures, complicated orthodontic mechan-
ics, additional restorative need, compromised esthetics and
lengthy treatment. Surgical repositioning, or trans‐alveolar
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102       ABSTRACTS
auto‐transplantation, of the inverted incisor has been reported
to greatly simplify the treatment. The purpose of the report
is to present the long‐term follow‐up results of the surgical
repositioning approach.
Case reports: eight operators treated a case series of six-
teen inverted impacted maxillary incisors. All the teeth ex-
cept one had root dilaceration. After adequate space was
created, the involved incisor was uncovered and surgically
repositioned in correct direction with semi‐erupted posi-
tion. One to four months after the surgery, fixed ortho-
dontic appliance was used to bring the incisor into proper
alignment. Clinical and radiographic evaluations were
performed at scheduled follow‐ups. The average age at the
time of surgery is 9Y9M. The follow‐up period averaged
5Y4M, with range from 6M to 18Y11M. Nine subjects re-
ceived the surgical procedure under local anesthesia and
seven were under general anesthesia. All impacted incisors
were successfully aligned with good periodontal condi-
tions. One subject after been absent for three years returned
with severe caries and periodontal destruction of the tooth.
It was later resulted in the tooth loss. Pulp canal oblite-
rations were noted in 44% of the treated incisors. Three
out of all treated incisors received endodontic treatment.
75% of the repositioned incisors showed continuing root
development.
Comments: The advantages of surgical repositioning ap-
proach include only one surgical procedure at one surgical
site are required, immediate esthetic and compliance im-
provement, simple and short orthodontic therapy as com-
pared to other modalities. The disadvantages include medium
sensitive of surgical technique, risk of interfering root devel-
opment and risk of pulp vitality. The present report showed
consistent and successful results of surgical repositioning
could be obtained from multiple operators. The surgical repo-
sitioning modality may serve as an option of treating difficult
impacted incisors in growing patients.
13  |  Vertical control of a growing patient
C. Gamboa‐Solana; M. Godoy‐Franco; A. Pinzón‐Te
Masters in Pediatric Dentistry, Universidad Autónoma de Yucatán,
Mexico
Introduction: The class II division I malocclusions represent
a challenge for the professional because of the complexity in
the disharmony between jaws, joined to the functional and
esthetic results that they require. The vertical factors exert
a dominant influence on the posterior displacement of the
symphysis in dolichofacial patients. If the vertical develop-
ment of the maxilla and the alveolar process is bigger than
the glenoid and condylar forces, the symphysis will move
downward, thus opening the facial axis.
Case reports: An eight‐year‐old female patient with a clini-
cal labial incompetence, lower lip sucking habit, mouth
breathing, convex profile. Intraorally, right and left molar
class II, , anterior open bite, bilateral posterior crossbite,
Ricketts cephalometric analysis shows a class II division I by
protruded maxilla and retruded mandible,   labialized upper
right incisor and retroinclination of lower incisors , convex
profile and dolichofacial biotype. Correction was achieved
with expansion with a Hass appliance, correction of skeletal
Class II with Teuscher appliance and extraoral arch, inter-
maxillary coordination (fixed appliances) and bimaxillary
retainer.
Comments: The case objectives were improve facial profile,
correct anterior open bite, control vertical dimension, achieve
molar and canine class I relationship, improve respiratory
function with the close of the open bite. A good diagnosis is
important to provide pediatric patients a correct orthopedic
treatment according to their needs. In this case, it is important
to control and redirect the anteroposterior growth in the sagit-
tal, transverse and vertical planes.
14  |  Successful early orthopedic intervention of
class III malocclusion in a preschool patient with
severe autism spectrum disorder
S. Krämer; H. Huber; P. Barrientos
Special Care Clinic, Facultad de Odontología, Universidad de Chile,
Chile
Introduction: Patients with severe Autism Spectrum
Disorders (ASD) might have challenging behaviours in the
dental setting due to difficulties in communication and sen-
sory integration. Studies of malocclusion in children with
ASD have shown that they present a higher prevalence of
malocclusions than neurotypical children. Specifically, a
higher prevalence of posterior crossbite, increased overjet
and severe crowding has been reported.
Case reports: We present the case of a female patient with
severe Autism Spectrum Disorder. Her first dental ap-
pointment was at the age of 2 years and 11 months, were a
class III malocclusion with anterior crossbite and increased
overbite was diagnosed. A multidisciplinary treatment plan
was established by the pediatric dentist, orthodontist and
speech and language therapist. At the age of 3  years and
2 weeks a modified retainer was cemented under conscious
sedation using glass ionomer cement. It included a screw
positioned oriented sagittally in order to protrude the pre-
maxilla and incisors. The plan was to turn the screw once a
ABSTRACTS
week for three months. Since the parents felt unable to per-
form the turns due to the patients challenging behavior, the
family visited the special care unit on a weekly basis be-
tween October 2017 and April 2018. From April to august
2018 two turns were performed once a month. On clinical
examination, anterior crossbite was corrected, however the
patient tended to force his mandible to a protruded position,
pulling the upper incisors back into the crossbite again. In
October 2018 a new appliance was cemented with an ante-
rior bite plane to prevent the lower incisors overpassing the
upper ones. This new design allowed an effective position-
ing of the incisors, correcting again the anterior incisor re-
lationship after 6 weeks. Since December 2018 the patient
has kept a stable occlusal relationship of class I without an-
terior crossbite. The facial profile showed significant im-
provement and facial and dental midlines were coincident.
The patient is now in retention phase.
Comments: Early orthodontic treatment in patients with
Autism Spectrum Disorders can be effectively managed by
multidisciplinary teams were pediatric dentist, orthodontist
and speech and language therapist cooperate to improve the
patient's craniofacial development.
15  |  Rapid expansion and facial mask in a child
with primary snoring and maxillary hypoplasia due
to premature loss of incisors
A. Pérez; C. Fierro‐Monti; L. L. Bravo
Departamento de Pediatría Bucal, Facultad de Odontología Universidad
de Concepción, Chile
Introduction: The premature loss of the incisors is related
to the atrophy of the alveolar bone and the protrusion of the
tongue, which enhances mouth breathing associated with a
hypodevelopment of the maxilla, palatine vault and nasal
cavity. The narrowing of the airways causes respiratory sleep
disorders RSD in childhood as is primary snoring. The Rapid
Maxillary Expansion RME is easily obtained until 10 years
of age. The facial mask is able to stimulate the anteroposte-
rior growth of the maxilla and bring it to its maximum ge-
netic expression.
Case reports: Child, 6 years old, referred by otorhinolaryn-
gologist for evaluation by compressed maxilla and primary
snoring (3 weekly snoring). Without medical indication of
adenoidectomy or tonsillectomy. Upon examination, com-
pression and retrognatia of the maxilla, primary dentition,
distal step, without upper anterior incisors, the mother reports
having lost them by caries at 3 years of age. A cephalometric
analysis of Ricketts is performed. Patient with a dolichofa-
cial growth trend. Diagnosis: lack of transverse and sagittal
  
|
   103
maxillary development associated with premature loss of in-
cisors, mouth breathing and primary snoring. Treatment and
therapeutic objective: Expand and protraction of the maxilla
with a protocol of 1 mm initial and ½ mm day to complete
4  mm with a cemented splint circuit breaker (Mc Namara)
and Petit facial mask for a period of one year. The mask is
then removed and the patient`s cooperation is evaluated and
one year is left in control to, with the eruption of the maxil-
lary incisors, proceed to a new period of expansion and pro-
traction of the maxilla with the same protocol until obtaining
3  mm of over jet. After the treatment, the patient does not
present primary snoring.
Comments: The reduction in the symptoms of the RSD
could be related to the downward and forward movement of
the maxilla caused by the RME, which leads to an increase in
the nasal chambers and nasopharyngeal space and a benefit in
the position of the tongue and air flow. Craniofacial anoma-
lies, besides being a clinical sign, are also a predisposing and
perpetuating factor of pediatric RSD.
16  |  Early orthopedic treatment of class III
malocclusion, 5 years old clinical case
C. Fierro‐Monti; L. L. Bravo; A. Perez
Departamento de Pediatría Bucal, Universidad de Concepción, Chile
Introduction: Protraction facemask (PFM) has been used in
the treatment of Class III malocclusion with maxillary defi-
ciency. There is a moderate amount of evidence to show that
early treatment with a facemask results in positive improve-
ment for both skeletal and dental effects in the short term.
Clinical evidence suggests that PFM might contribute to the
morphologic adaptation of temporomandibular joint and dis-
placement of condyles, and PFM may well be a risk factor for
the development of temporomandibular disorder.
Case Reports: A 5‐year‐old male patient who consulted for
inverted bite treatment. Diagnosis: clinical and cephalometric
(McNamara, Steiner) findings determine a class III maloc-
clusion with maxillary development deficiency. The ortho-
pedic treatment was performed with a cemented splint device
(Mc Namara) and a Petit facial mask. Changes are presented
to the months of treatment and first year of follow up.
Comments: The lack of predictability of mandibular growth
would be a reason why clinicians are reluctant to orthope-
dically treat Class III malocclusion early. The PFM is used
during the growth period to stimulate it, mainly in the con-
nective tissue of the intermaxillary suture. The natural growth
of the maxilla in the suture mainly occurs until 7 years, but
the deposition of connective tissue on the bone is extended
to late periods. The literature reports that the younger the
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104       ABSTRACTS
patient is, the greater the growth of the maxilla in depth and
the greater the reaction of the bone to the orthopedic forces.
Normally, maxillary protraction is usually accompanied by
maxillary disjunction, since Class III is frequently associ-
ated with maxillary compression. The disjunction, in addi-
tion to producing transverse changes, initiates the forward
and downward movement of the maxilla, disarticulating the
maxillary sutural system and thus increasing the orthopedic
effect of the facial mask. Skeletal, dental, and facial changes
in response to early orthopedic treatment are reported to il-
lustrate the esthetics, function, and stability of treatment with
this technique.
17  |  Rapid expansion of the maxilla and
nutritional counseling in sleep bruxism
L. L. Bravo; C. Fierro‐Monti; A. Pérez
Departamento de Pediatría Bucal, Facultad de Odontología, Universidad
de Concepción, Chile
Introduction: Bruxism, repeated activity of the chewing
muscles, characterized by tightening or grinding the teeth
and/or tightening or pushing the jaw, presents two manifesta-
tions: bruxism in wakefulness and sleep bruxism (SB). Sleep
bruxism is a symptom associated with Obstructive Sleep
Apnea Syndrome (SAHOS). Its prevalence varies between
3% and 40% in children between 7 and 12 years old; being
girls most affected. The evaluation of the patient should be
done considering the symptoms, control of diet, sleep routine
and characteristics of the airway, for an adequate treatment.
Case reports: Girl, 9 years old, referred by otorhinolaryngol-
ogist after tonsillectomy due to lack of space and sleep brux-
ism. With a history of early orthopedics, a rapid expansion of
the maxilla with a circuit breaker was performed at 7 years.
Upon examination showed no transverse anomaly, increased
overjet and overbite were observed, bilateral molar class II.
The functional analysis reveals breathing, swallowing and
lingual position within normal parameters. Diagnosis: brach-
yfacial biotype, skeletal class II. Treatment and therapeutic
objectives, as the first stage is planned to maintain space in
both jaws and vestibulize the mandibular incisors, for which
a transpalatal bar and a lingual arch are cemented, in paral-
lel was referred to nutritionist for evaluation and control of
diet and otorhinolaryngologist for evaluation of aerial path-
ways. In controls subsequent to nutritional treatment, mother
reports that she no longer experiences episodes of sleep brux-
ism. It will be referred to corrective orthodontics as the sec-
ond stage of treatment.
Comments: Identification and control of the associated
causal factors: knowing that bruxism may be secondary to
some causal factors such as airway obstruction or SAHOS,
the identification of environmental causes and their control
are essential in the clinical approach of the patient with brux-
ism. Both SB and SAHOS are complex conditions, which
may be associated and require an interdisciplinary manage-
ment that encompasses all the factors involved. The involve-
ment of the pediatric dentist in multidisciplinary teams is
fundamental in order to offer the best treatment and result
for his patients.
18  |  Investigations on dental age, bone age and
comparisons with chronological age in a sample of
children and adolescents from Romania
L. Vaida; A. E. Moca; B. I. Todor
Department of Dentistry, Faculty of Medicine and Pharmacy, University
of Oradea, Romania
Background: Many researches investigating the dental erup-
tion paradigm, dental age and skeletal development have been
carried out. The specialty literature describes several meth-
ods of assessing dental age, such as Demirjian`s method and
Nolla`s method.  The cervical vertebrae maturation method
and the methods using hand wrist radiography are the most
used for bone age assessment. Dental malpositions are very
often the result of dental eruption discrepancies.
Aim: Analyze several correlations between dental age, bone
age and chronological age in a sample of children and adoles-
cents in north‐west Romania.
Design: The sample included 400 children and adolescents
from north‐west Romania, aged 7–14  years, of whom 229
girls and 171 boys. The dental age was evaluated using
Demirjian's method based on the orthopantomography exam-
ination. To assess bone age, we used the “Cervical Vertebral
Maturation” (CVM), the simplified version proposed by
Bacetti et  al. (2005), based on the cephalometric analysis.
The chronological age was considered to be the one they had
at the time when radiographs were recorded. For the CVM
analysis we utilized a computerized program, orthodontic
software ‐ OnyxCeph3. All the data from the study was ana-
lyzed using IBM SPSS Statistics 20.
Results: A significant and positive correlation was detected
between dental age and bone age both in girls and in boys.
The correlation between dental age and bone age was moder-
ate for boys (P = 0.009, R = 0.311) and strong for girls (P
0.001, R  =  0.510). The correlation between dental age and
chronological age was strong for boys (P 0.001, R = 0.849)
and for girls (P 0.001, R = 0.873)
Conclusions: This study suggested that positive correla-
tions between dental age, bone age and chronological age
are higher for girls than for boys. These correlations are very
ABSTRACTS
useful when planning an orthodontic treatment. The authors
consider that studies on larger samples as well as studies that
validate or introduce adaptations of the Demirjian and CVM
methods on the Romanian population are required.
19  |  Three‐dimensional morphological analysis
of palate in mouth‐breathing subjects: A controlled
study
H. Tang; G. Wei; Y. Du
Orthodontics, Dora Pediatric Dentistry, China
Background: In recent years, mouth‐breathing in school‐
age children has been the focus of scholars in various fields,
mouth‐breathing pervades widely. Many children suffer
from some disease due to environmental pollution, such as
adenoid tonsillar hypertrophy, rhinallergosis and others, and
they gradually get used to breathe through month, leading to
maxillary apical circular arch and narrow arch, high arch of
palatal fornix, etc. However, there is still a problem about
when to carry out the early orthodontic interventions without
definite standard, and how to work in clinical practice within
lack of specific reference index.
Aim: To compare among the anatomical characteristics of
maxillary arch, identified as inter‐molar width, palatal height
and palatal volume and surface area, by three‐dimensional
analysis of digital dental casts between mouth‐breathing and
nose‐breathing subjects.
Design: To make sure the participants in Chongqing who
meet the criteria is divided into two groups, one with mouth‐
breathing and the other with nasal‐breathing and to collect
three dimensional data of dental casts according to breath-
ing mode. The data were reconstructed and measured by two
software called Minics 15.0 and Geomagic 12.0. Between‐
group differences were tested with the independent sample
Student's t‐test.
Results: 73 children (35 boys and 38 girls) were enrolled
in this study, with a mean age of 8.63  ±  0.78  years. The
inter‐molar width , palatal volume and surface area in
mouth‐breathing group were significantly smaller than
those in control group (P 0.05), but the height of palate in
mouth‐breathing group was significantly higher than that in
control group (P 0.05). The inter‐molar width and palatal
volume were positively correlated with the palatal surface
area in mouth‐breathing group (P ≤ 0.05). Meanwhile,the
inter‐molar width and the palatal height in control group
were positively correlated with the surface area of palate
(P 0.01).
Conclusions: Subjects with prolonged mouth breathing
showed a significant reduction of the inter‐molar width,
  
|
   105
palatal volume and surface,and a significant increase of the
palatal height,in which confirms to lead to a different devel-
opment of the palatal morphology.
20  |  Early orthodontics treatment of a child
with Angle Class II malocclusion after mandibular
retrusion
X. Xu; H. Tang; Y. T. Du; S. Liu
Orthodontics, Dora Pediatric Dentistry, China
Introduction: The patient was an 8.5‐year‐old girl who com-
plained of irregular dentition and required correction.
Case reports: The medical history includes a history of
chronic rhinitis accompanied by oral breathing habits. The
clinical diagnosis is Class II malocclusion with mandibular
retrusion, accompanied by crowded upper and lower denti-
tion.  Twinblock functional appliance was first used in early
correction, occlusal reconstruction was carried out to the op-
posite edge of anterior teeth, maxillary slow expansion was
used, and follow‐up was carried out once a month. After
functional correction, molar occlusion was established to
neutral relationship.  Then 2X4 technique was used to align
the incisors. The occlusion and profile of the patient were
improved after one year of treatment.
Comments: For patients with Angle Class II malocclusion
in growth and development stage, Twinblock functional ap-
pliance can effectively protract mandible, improve profile;
Timely and effective early correction intervention for denti-
tion stage, which is of great significance to children's physi-
cal and mental health.
21  |  Craniofacial anthropometry in children
with chronic renal insufficiency
J. M. Guizar‐Mendoza; E. Cortes‐Guzman; J. Bautista
Social Service and Research, Universidad De La Salle Bajio, Mexico
Background: One of the manifestations of Chronic Renal
Insufficiency (CRI) that affects children is the delay of
growth and development, with various bodily alterations that
include the craniofacial region.
Aim: To identify alterations in craniofacial and body growth
in children under 18 years of age with CRI and compare them
with established norms.
Design: A descriptive observational cross‐sectional study
was carried out in a group of patients with CRI under
18 years of age at the Regional Hospital of León Guanajuato.
 |
106       ABSTRACTS
Anthropometric measurements were carried out according to
the proposal of three authors, in order to identify craniofacial
alterations and relate them to standards.
Results: 36 patients with CRI, 12 female and 24 male. The
average age was 12 ± 3.05 years. The causes of CRI due to
structural alterations and malformations were present in 15
patients, 5 due to glomerulonephritis, 3 due to uropathies and
in 13 the cause was not identified. The average evolution with
CRI was 4.08 ± 3.17 years. Regarding the biochemical val-
ues, the patients presented hypophosphatemia and secondary
hyperparathyroidism. Total height (50%) and seated height
(58%) are below the standards for their age. The most altered
craniofacial measurements are: bizygomatic diameter, nose
width and nasion‐subnasal height. With a brachycephalic
predominance, leptin superior facial index and leptorrhine
nasal type. At the oral level, they presented a molar (56%)
and canine (59%) type II relationship.
Conclusions: CRI in children is considered a predisposing
factor for future malocclusions due to a greater tendency to
negative bone ‐ tooth discrepancy. The dynamics of the cran-
iofacial development and the normal variations in the growth
of the jaws, with the consequent dentoalveolar development,
need to be understood before carrying out any treatment in
children with CRI.
22  |  Barriers and facilitators perceived in
orthodontic treatment of disabled teenagers:
qualitative pilot study
S. A. Véliz‐Méndez; M. R. Saffie; F. Hormazábal‐Sanhueza
Unidad de Malformaciones Craneofaciales, University of Chile, Chile
Background: People with disabilities are faced with different
barriers to access dental care, including access to Orthodontic
treatment. Due to the augmentation in life expectancy, they
increasingly need this type of treatment to improve their
quality of life.
Aim: To know the perception of patients, tutors and
Orthodontic Students about the barriers and facilitators to ac-
cess orthodontic care for patients with disabilities.
Design: A qualitative study was conducted through semi‐
structured interviews of 27 people, including patients with
disability, their caretakers and orthodontic students. The
patients were currently in orthodontic treatment and pre-
sented either Intellectual Disability (ID) or Autism Spectrum
Disorder (ASD). These interviews were audio recorded and
later transcribed and analyzed qualitatively.
Results: Four dimensions analysis were identified: Previous
Experience; Barriers to care, Facilitators of care and
Perception of care. The barriers mentioned in this study
were fear to the orthodontic treatment, waiting time, pain,
uncomfortable treatment, access problems, student's (clini-
cian) change during treatment, patient's behavior, lack of
orthodontic materials, teacher's experience treating people
with disability and Oral hygiene. Facilitators mentioned by
all the participants were peer acceptance, positive changes,
orthodontic materials with colors, student's patience, support
network, peer collaboration and previous experience treat-
ing people with disabilities. Factors such as the reason for
consultation, prior attention and personal motivation also af-
fected treatment perception.
Conclusions: Although there are determining elements in the
treatment of people with disabilities in all categories, the rea-
son that could explain most barriers is the lack of preparation
of the orthodontic teachers, who are training their students
according to their own experience (teacher's) and not accord-
ing to the patient`s needs.
23  |  Integral management of pediatric patients
with transversal malocclusion, presence of
mesioden and absence of higher central incisor
through iatrogenia
C. E. Sánchez; I. C. Medrano; A. González
Department of Speciality in Pediatric Dentistry, Universidad de
Guadalajara, México
Introduction: Transverse malocclusions are alterations of
the occlusion in the horizontal plane. The posterior cross-
bites refer to the transverse discrepancy between the upper
and lower arch, unilateral or bilateral, occur when the buc-
cal cusps of the premolars and upper molars occlude in the
pits, or in a more lingual position, of the lower premolars
and molars. Its etiology is diverse: genetic, environmen-
tal factors, habits, premature loss or prolonged retention
of deciduous teeth, crowding, and so on. Mesiodens is a
supernumerary tooth that appears on the palate near the
central incisors, its etiology is unknown. Occlusal and
periapical radiographs help the successful management lo-
cating the supernumerary tooth and decreasing the risk of
complications.
Case reports: Goes to the 11‐year‐old female patient consul-
tation, with the purpose of “accommodating crooked teeth”.
An analysis was made based on study models, panoramic and
lateral cranial radiography, intra and extraoral photographs.
Diagnosis: Transverse maxillary collapse, posterior and an-
terior crossbite, deviation of the midline, skeletal class III,
molar class II, and facial asymmetry. Treatment: Placement
of a Hyrax type screw of 11 mm of cord with extra‐oral trac-
tion attachments for 6 months, accompanied by the use of a
ABSTRACTS
facial mask for 1 month. Pendulum placement for the distali-
zation of molars. Orthodontic treatment starts in June 2016
with every month appointments for activation of arches, end
of treatment in August 2018 achieving a functional and aes-
thetic result. Currently the patient has an acrylic apparatus
with Hawley arch as a retainer.
Comments: After 3  years of treatment of orthopedics and
orthodontics, the goal of de‐collapsing the maxilla and un-
crossing the bite was achieved by returning the function and
harmony of the arches, as well as improving aesthetics. It
is important to make early diagnosis to achieve favorable
results.
24  |  Mandibular growth and development in
children: the austro repositioner
M. D. Austro‐Martinez; F. Chiva‐García; A. N. Silvente
Faculty of Odontology, Professors Murcia University, Spain
Introduction: The purpose of this prospective study was
to evaluate the skeletal and dentoalveolar effects of a fixed
functional appliance, the Austro Repositioner, in dolicho‐
and brachyfacial skeletal Class II patients.
Material and Methods: Thirty dolicho‐ and 30 brachyfacial
consecutive patients treated with the Austro Repositioner
were compared with untreated controls (30 dolicho‐ and 30
brachyfacials) with the same initial dentoskeletal features.
Lateral cephalograms were taken before and after 1.0  year
(SD, 0.4 year) of the therapy.
Case reports:: Significant improvements in skeletal Class
II relationships were observed in both groups. The ANB
angle decreased (3.64° in dolicho‐ and 3.22° in brachy-
facials, P 0.001) due to changes localized exclusively in
the mandible: SNB angle increased (3.36° in dolicho‐ and
3.12° in brachyfacials, P 0.001); and the total mandibular
length (Co‐Pg) increased 6.53 mm in dolicho‐and 5.82 mm
in brachyfacials (P 0.001). A favorable guidance of vertical
pattern was also achieved in both groups, and no signifi-
cant changes were registered in the upper and lower inci-
sors in either group.
Comments: The Austro Repositioner was shown to be effec-
tive for the treatment of skeletal Class II malocclusion result-
ing from the retrusion of the mandible, in both dolicho‐ and
brachyfacial patients, in the short term.
  
|
   107
25  |  Castillo‐Morales intraoral equipment of
comparison of its modifications in children with
down syndrome with facial muscle hypotonia
D. P. Castanier; S. Kang; B. Weihrauch
Dentistry School, Andes University Santiago Chile, Chile
Background: Children with Down syndrome have gener-
alized and oropharyngeal muscular hypotonia that hinders
basic oral functions, such as chewing, swallowing and pho-
nation, so it is very important to intervene at an early age
by identifying the severity and extent of the case, since with
an Orofacial regulatory therapy To stimulate the oropharyn-
geal muscles, it is possible to opt as therapy the use of in-
traoral devices, intraoral devices of Castillo ‐Morales, which
are made of a preliminary impression of the maxilla, which
is molded in acrylic. Presents stimulators designed to act as
foreign bodies and thus stimulate the tongue and upper lip,
with variations in size, shape and location, as each child has
different needs.
Aim: The aim of this review is to describe the most rec-
ommended intra‐oral devices within an orofacial regula-
tion therapy for muscular hypotonia in children with Down
Syndrome.
Design: A narrative review of the literature was carried out
with complete texts in EBSCO, PubMed and Scopus that
were subjected to inclusion and exclusion criteria. 20 articles,
2 narrative reviews, 1 systematic reviews, 6 clinical trials, 3
observational studies and 1 case report were selected.
Results: 16% of the children in this study showed muscle
hypotonia, 91% of the bibliographies analyzed recommended
the use of an intraoral plate, the Castillo‐Morales devices
were used in 93% compared to 4% of the Dr Hinz.
Conclusions: Castillo Morales and its various modifica-
tions (Zavaglia et  al, Carlstedt et  al., Bäckman et  al and
Korbmacher) will be adapted to the need and the stage of
dental eruption includes the use of an intraoral device that
directly stimulates neuromuscular receptors intraoral in early
stages of hypotonia detection that stimulate the development
of orofacial muscle tone.
 |
108       ABSTRACTS
26  |  See the invisible: a new position of tongue
and its functional importance after Planas direct
tracks therapeutic at early intervention
M. Izquierdo; P. Valerio
School of Dentistry of Paulista Association of Surgeon Dentists, Paulista
Association of Surgeon Dentists, Brazil
Introduction: The identification, evaluation and treatment
of the different malocclusions presented in children during
the stage of deciduous and the beginning of the mixed denti-
tion are the main object of the Pediatric Dentist who bases
his clinical vision of the problem on the consideration that
the stomatognathic system is not an isolated entity but a sys-
tem that works as the axis through which other systems are
combined and aligned. This perfect combination allows the
achievement of body balance and thus provides an integral
and harmonious development of body functions.
Based on this vision, we consider the functions of respiration,
chewing, swallowing and phonation as the most important
for the growth and development of the stomatognathic sys-
tem and those are that usually present alteration and predis-
pose the different types of malocclusions.
The purpose of this work is to identify the anatomical posi-
tion of the tongue and its possible correlation with altered
functions at the time of diagnosis of malocclusion, and to
compare with the new position achieved after the treatment
with Resin‐modified Planas Direct Tracks (PDT), consider-
ing that it can be an indicator of favorable prognosis.
Case reports: Two patients with different types of maloc-
clusions were treated with PDT, one in deciduous denti-
tion and another at the beginning of the mixed dentition. In
both cases there is a change in the surface, shape and lin-
gual position with increased oral space, posterior rotation
of the head and favorable repercussions in the relationship
of the tongue with its attached structures where it is evi-
dent that the cephalometric analyzes used for determine the
new lingual position encompasses the eight elements of the
“Octagon of Functional Priority”: head, neck, spine, TMJ,
hyoid, tongue, jaw and air passage. Additionally, in the
control appointments, the parents referred that the children
pronounce the words much better, especially the phonemes
with the “rr”.
Comments: The response of neural excitation caused by the
PDT through the change and movement of the mandibular
posture creates a change in the posture and movement of the
tongue, contributing to the objective of the treatment that will
be Planas Neuro‐occlusal Rehabilitation.
27  |  Cause and cure for obstructive sleep apnoea
(Osa) and sleep disorder breathing (Sdb): validated
and evidenced‐based oral biofunctional myology
S. Kahn; S. Wong; M. Santos
Evolutionary Biology, Stanford University, USA
Introduction: A simple (5 exercise) myology program is
proposed as an adjunctive therapy for the cure of sleep dis-
order breathing. Rationale and justifications are highlighted
with the exploration of the evolutional changes to human
anatomy and physiology that predisposed us to airway ill-
ness. Discussions are made regarding their only known cura-
tive measures and the current “choke point” interferences for
clinical successes.
Case reports: Evidence‐based and validated exercises cen-
tered on cultural behavioral norms ubiquitous throughout the
history of civilized societies are explained. Clinical exam-
ples are presented of each exercise with their short and long‐
term impacts. The program comprises of two oral postural
exercises, (1) Counting/Reading, which aids in achieving
nasal breathing at rest and (2) Meal‐Time Chewing, which
focuses on maintaining a proper oral rest position; And the
three swallowing exercises, (3) Click–air, (4) Wave‐liquid,
(5) Gum‐solid, which when applied consecutively, develop
the tonicity and biofunctional support for a therapeutic rest
position for airway sleep health.
Comments: Conclusions will outline practical applications
of this program and recommendations for future paths and
research goals serious research needed to mitigate this grow-
ing health epidemic.
28  |  Anterior crossbite correction using inverted
pediatric crowns
R. Serrano‐Piña; C. Casanova‐Cocom; A. Te Pinzon
Masters in Pediatric Dentistry, Universidad Autónoma de Yucatán,
Mexico
Introduction: Restore the oral health of a child with se-
vere early childhood caries (ECC), premature loss of clini-
cal crowns of anterosuperior dental organs, alteration in
the growth and skeletal development with anterior cross-
bite, deficient oral hygiene and a diet rich in fermentable
carbohydrates.
Case report: Patient of 4  years who attends Pediatric
Dentistry department, of FOUADY. The mother refers
“His teeth are decayed and with increased volume in the
gums” Extraoral clinical examination: no pathological signs.
Clinical intraoral examination revealed the presence of a ma-
ture biofilm, multiple caries lesions, loss of clinical crown
ABSTRACTS
in anterior teeth, radiographic evidence of pulp involvement
in various dental organs.  The diagnosis: Patient with ECC,
anterior crossbite, poor oral hygiene. An individualized treat-
ment plan is developed, considering the present risk factors.
The incisors were rehabilitated with the technique demon-
strated by Sexton and Croll to correct the anterior crossbite,
which is an abnormal labiolingual relationship between one
or more maxillary and mandibular anterior incisor teeth. Oral
hygiene was controlled with the O`leary index at each ap-
pointment, Ricketts cephalometric tracing was performed to
establish orthopedic treatment and all the dental structures
were rehabilitated.
Comments: The anterior crossbite is a challenge when pre-
sented as a sequel to severe ECC. The technique of placing
inverted nickel‐chrome crowns in the anterosuperior sector
was selected for its easy handling in pediatric patients, low
cost, rapid dental movements and dental tissue protection
after the treatment of pulpectomies in maxillary incisors.
29  |  Treatment management of sever ectopic
eruption of mandibular first permanent molars in
early mixed dentition
G. Vadiakas; E. Birpou; N. Sigalas; T. Triantafylou
Department of Pediatric Dentistry, Dental School, EKPA University of
Athens, Greece
Introduction: Ectopic eruption of first permanent molars de-
scribes the deviation of the tooth from its normal eruption
path resulting in a locked position distally to the second pri-
mary molar. The prevalence varies between 2-6%, however,
  
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   109
it occurs 25 times more often in the maxilla compared to
the mandible. Both local factors and genetic background
are implicated. The severity of the ectopic eruption ranges
from mild to very severe and is based on the clinical and ra-
diographic degree of semi-impaction of the permanent molar
and the accompanied amount of resorption of the primary
molar. Severe and very severe types of ectopically erupting
first permanent molars do not self-correct leading to prema-
ture exfoliation of the primary molar if left untreated. The
aim of the abstract is to present a case of a child with severe
ectopic eruption of mandibular first permanent molars, fo-
cusing on the treatment management.
Case report: A 7-year-old boy was referred for management
of lower first permanent molars erupting in an abnormal po-
sition. Clinical and radiographic examination revealed mul-
tiple carious teeth, severe and very severe ectopic eruption of
#46 and #36 respectively, initiating resorption of the second
primary molars. Phase I of the treatment plan included full
restorative treatment, correction of ectopic eruption of #46
with fixed appliances and monitoring for eruption of #36.
One year later, #36 remained semi-impacted in an almost
horizontal position, while the primary molar’s resorption had
progressed resulting in pulp exposure. Phase II of treatment
included extraction of #75, space regaining by distalization
and uprighting of #36 followed by space maintenance.
Comments: Severe ectopic eruption of first permanent mo-
lars should be diagnosed in time in the early mixed dentition,
followed by orthodontic correction of the molar’s position,
when possible, to avoid more extensive orthodontic treat-
ment, later on.
The authors thank Special Account for Research Grants and
National and Kapodistrian University of Athens for funding
to attend the meeting.