Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2010. Vol. 15, no. 3

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    Full maxillary rehabilitation with an all-ceramic system
    (2010) Román Rodríguez, Juan Luis; Roig Vanaclocha, Ana; Fons Font, Antonio; Granell Ruiz, María; Solá Ruiz, María Fernanda; Bruguera Álvarez, August
    With the appearance of all-ceramic systems, providing a choice of framework porcelains and allowing the same material to be used for the veneer, it is now possible to select the ideal structure in terms of both function and esthetics. Silicate ceramics allow porcelain laminate veneers and crowns to be used in the anterior region, providing excellent esthetics; while for the posterior area, where function takes precedence, oxide ceramics, specifically zirconium oxide, are preferred. The IPS e.max ceramic system, heir apparent to the IPS Empress 2 system, combines the advantages of zirconium oxide ceramics (IPS e.max Zircad) with the excellent esthetic qualities of silicate ceramics (IPS e.max Press). This paper presents a clinical case requiring complete maxillary rehabilitation for esthetic purposes. An overview of some of the porcelains used in this system, analyzed from both the clinical and laboratory perspective is provided. The esthetic advantages of a single ceramic veneer, the need to select appropriate ceramics for anterior and posterior regions, and cementation and surface treatments are discussed.
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    Basaloid squamous cell carcinoma : report of five cases
    (2010) Morales Puebla, José Manuel; Toro Rojas, Mariano; Segura Saint Gerons, Rafael; Fanego Fernández, Josefina; López Villarejo, Pedro
    Objectives: To document the clinical and histopathological characteristics of basaloid squamous cell carcinoma (BSCC). To add five new cases to the literature and compare them with another published series. Cases: retrospective review of five cases with the diagnosis of BSCC of the larynx. Results: all the patients were male. They were heavy smokers and drinkers. Most of the tumours were supraglottic. Three patients presented with stage-IV disease and the other two with stage-I disease. Surgery supplemented with radiation was used in three patients, partial surgery was used in another case and radiation and associated chemotherapy in the other one. Eight neck dissections were performed, six of them were functional and the other two radical dissections. Two cases were found to have metastatic lymph nodes. There were not any distant metastases but two patients had tumoral relapse. Conclusions: BSCC has well defined histological features. Central comedonecrosis within the cells nests, cell with nuclear palisading and high-grade dysplasia in overlaying mucosa are the main characteristics.
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    Salivary and serum levels of substance p, neurokinin A and calcitonin gene related peptide in burning mouth syndrome
    (2010) Vucicevic Boras, Vanja; Savage, Neil; Brailo, Vlaho; Lukac, Josip; Lukac, Maja; Alajbeg, Iva Z
    Background: Burning mouth syndrome (BMS) is an enigmatic condition with the etiopathogenesis remaining largely obscure. However, a neuropathic basis for BMS continues to be an area of active clinical and research interest. Aim: It is becoming increasingly evident that certain oral disorders may be modulated by imbalances in certain neuropeptides such as substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) therefore we measured SP, NKA and CGRP in the saliva and sera of BMS patients as well as controls. Subjects and Methods: Salivary and serum SP, NKA and CGRP were determined in the 26 female patients with burning mouth syndrome (age range 51-78, mean 65.69 yrs), and in the 22 female controls (age range 24-82, mean 49.72 yrs). Serum and salivary SP, NKA, CGRP levels were determined by commercial competitive enzyme immunoassay kits. Statistical analysis was performed by use of descriptive statistics and analysis of variance. Results and Conclusions: No significant differences in salivary SP, NKA and CGRP as well as serum SP and CGRP between BMS patients and controls could be found. However, significantly decreased serum neurokinin A (p<0.05) in BMS patients may reflect an inefficient dopaminergic system.
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    Knowledge of oral cancer and preventive attitudes of Spanish dentists. Primary effects of a pilot educational intervention
    (2010) Seoane Lestón, Juan Manuel; Velo Noya, José; Warnakulasuriya, Saman; Varela Centelles, Pablo Ignacio; González Mosquera, Antonio; Villa Vigil, Manuel Alfonso; Rodríguez Lozano, Francisco Javier; Diz Dios, Pedro
    Objective: To assess the knowledge and preventive attitudes that Spanish dentists have towards oral cancer, before and after an educational intervention. Methods: A quasi-experimental study based on a nationwide intervention. All Spanish dentists were offered an on-site course on oral cancer. An individual questionnaire was administered before and after attending the course. The main outcome measures were systematic examination of the oral cavity, promotion of healthy habits and knowledge of clinical aspects. Results: 440 GDPs entered the study. Age: 40.7±10.7, range 21-74. Professional experience: 13.9±8.9 years, range 0-45. Of those who participated in the study, 53.1% had never attended a course on oral cancer, 72.4% stated that they perform a systematic examination of the oral mucosa, 88.2% provided systematic counselling on tobacco cessation, and 54.7% reported that they did the same for alcohol. In addition, 32.3% advised patients to eat fruits and vegetables high in antioxidants. Professional experience was significantly associated with oral mucosa systematic examination (t= 2.9; p=0.003), advice on alcohol consumption (t=5.0; p=0.000), and on fruit and vegetable intake (t=5.1; p<0.001). None of these practices were specifically associated with knowledge on oral cancer. All areas of knowledge examined showed statistically significant improvement after the educational intervention. Conclusions: The intervention appears to have improved the GDP´s knowledge, confirming the importance of this national campaign.
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    Effects of polyglecaprone 25, silk and catgut suture materials on oral mucosa wound healing in diabetic rats : an evaluation of nitric oxide dynamics
    (2010) Yilmaz, Nergiz; Inal, Samet; Muglali, Mehtap; Guvenc, Tolga; Bas, Burcu
    Objectives: The purpose of this study is to investigate the effects of monocryl (Polyglecaprone 25), silk and catgut suture materials on wound healing in diabetic rats and to evaluate NO (nitric oxide) dynamics. Study desing: Fourty-eight male Wistar-Albino rats weighting 220-270 g were used in this study. The rats were categorized into 2 groups, as control group (n=24) and streptozotocin (STZ) induced diabetic group (n=24). For each group, incision wounds were created on the inner cheeck mucosa of the animals and wounds were closed primarily with three different types of sutures. These materials were sized 3-0 monocryl (polyglecaprone 25), silk and catgut sutures swaged on. Excisional biopsies were performed at 2nd, 7th, 14th and 21st day (2 rats per day) from the initial surgical procedure. Effects of these suture materials on wound healing and NOS (nitric oxide synthase) activities were compared immunohistochemically in the study. eNOS and iNOS (Endothelial and induced nitric oxide synthase) activities were classified as mild (+), moderate (++) and severe (+++). Results: Mild eNOS activities were seen in both diabetic and control groups at 2nd day specimens. Activities of silk and catgut were similar both in diabetic and control groups at 14th day, this activity in monocryl was mild. 21st day specimens revealed that monocryl has mild eNOS activity than silk and catgut sutures. iNOS activities in diabetic group were greater than control groups and the degrees of the activity in monocryl, silk and catgut sutures were mild, severe and moderate at the 7th day. At the 14th day there was no iNOS activity in diabetic monocryl group. Conclusion: All of the materials have the potential capacity to be well tolerated however monocryl seemed to have more benefical effects on wound healing in diabetic subjects.
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    Oral health survey of the adult population of the Valencia region (Spain)
    (2010) Eustaquio Raga, María Vicenta; Montiel Company, José María; Almerich Silla, José Manuel
    Objectives: Ascertain the oral health status of the adult population in the Valencia region of Spain. Study design: A cross sectional prevalence study was conducted on a sample of 1264 adults, comprising 733 individuals aged 35-44 years and 531 individuals aged 65-74 years. Data collection was carried out in 2006. In both age groups (younger adults and older adults), the clinical examinations were carried out by calibrated dentists (Kappa >0.76). Results: The caries prevalence in the group of 35-44 year-old subjects was 92.2% (DMFT=7.64). In the group of 65-74 year-old subjects, it was 98.3% (DMFT=16.38). The F/DMFT percentage of the younger adults was 66% and that of the older adults was 16.3%. The edentate percentage was 0.1% in the group of 35-44 year-old subjects and 20.7% in the group of 65-74 year-old subjects. Calculus prevalence was almost 60% among the younger adults. Nearly 22% of the younger adults and 26% older adults presented periodontal pockets, although only a minority (4.6% and 4.3%) were CPI score 4. Significant differences in the various indices were found in relation to institutionalization and socio-economic status. Conclusions: The caries prevalence (DMFT>0) found in the two age groups studied remains very high: over 90%. The worst health status is found in certain groups, such as the institutionalized elderly and adults with a low socioeconomic status.
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    Biomaterials for bone regeneration
    (2010) Pérez Sánchez, María José; Ramírez Glindon, Elena; Lledó Gil, Miguel; Calvo Guirado, José Luis; Pérez Sánchez, Cristina
    Objective: This article reviews the literature on biomaterials used for bone regeneration. Material and method: A total of seventeen bibliographic sources were found using the MEDLINE database and to avoid the variability of the search terms the thesaurus Mesh was used. Results: These materials act essentially due to their osteoconductive ability, although their osteoinductive capacity is being improved with the use of growth factors. As to their effectiveness, many differences exist between them and some even affect bone regeneration negatively. Conclusions: Biomaterials used for bone regeneration are valid when the correct material is used. As yet the osteogenic capacity of autogenous bone has not been equalled by biomaterials. Tissue engineering has caused great interest because of its many possibilities, although more studies are necessary in order to achieve the ambitious expectations when it comes to tissue or organ regeneration in the human body
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    A clinical longitudinal study 323 porcelain laminate veneers. Period of study from 3 to 11 years
    (2010) Granell Ruiz, María; Fons Font, Antonio; Labaig Rueda, Carlos; Martínez González, Amparo; Román Rodríguez, Juan Luis; Solá Ruiz, María Fernanda
    Objective: The objective of this study was to evaluate the clinical results of 323 porcelain laminate veneers over a period of 3 to 11 years. Material and Methods: This study included 70 patients, aged between 18 and 74 years. Of the 323 total veneers, 124 were of a simple design and 199 were of a functional design. The condition of the soft tissues and hygiene, in addition to the condition of the abutment teeth, the restorations and patient satisfaction were all clinically examined. In carrying out the statistical analysis, a descriptive approach was taken in analyzing the data. The Kaplan Meier method was used for statistically analyzing the survival rates of the porcelain laminate veneers. Results: Analysis of the soft tissue revealed marginal recession in 7.7% of the cases, and in 21.6% of the cases, bleeding was detected on probing. Analysis of the condition of the abutment teeth revealed secondary caries and hypersensitivity in 3.1% of the cases, and changes in pulp vitality were observed in 2.8% of the cases. In studying the condition of the restorations, marginal integrity was observed to be excellent in 98% of the cases, slight marginal pigmentation was present in 39.3% of the cases, fractures were present in 4% of the cases and decementation in 9% of the cases. The degree of patient satisfaction was considered to be excellent in 97.1% of the cases. Conclusions: Porcelain laminate veneers are a predicable treatment option that offer excellent results.
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    Etiology, risk factors and management of implant fractures
    (2010) Sánchez Pérez, Arturo J.; Moya Villaescusa, María José; Jornet García, Alfonso; Gomez, Ricardo Santiago
    Implant fracture is an infrequent and late biomechanical complication with a serious clinical outcome. In effect, such fractures pose important problems for both the patient and the dental surgeon. According to most literature sources, the prevalence of dental implant fractures is very low (approximately 2 fractures per 1000 implants in the mouth). Considering that implant placement is becoming increasingly popular, an increase in the number of failures due to late fractures is to be expected. Clearly, careful treatment can contribute to reduce the incidence of fracture. An early diagnosis of the signs alerting to implant fatigue, such as loosening, torsion or fracture of the post screws and prosthetic ceramic fracture, can help prevent an undesirable outcome. The present literature review describes the management options and discusses the possible causal mechanisms underlying such failures, as well as the factors believed to contribute to implant fracture.
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    Pre-operative evaluation of the volume of bone graft in sinus lifts by means of CompuDent
    (2010) Arias Irimia, Óscar; Barona Dorado, Cristina; Martínez Rodríguez, Natalia; Ortega Aranegui, Ricardo; Martínez González, José María
    Objective: This study aims to evaluate the usefulness of the CompuDent program in determining the pre-operative volume of bone graft in maxillary sinus floor lifts, and to calculate the volume of graft necessary for rehabilitation using varying lengths of implants. Study design: Based on the CompuDent program, we calculated the volume of graft necessary for 47 sinus lifts. This volume was measured in order to raise the floor of each sinus to 13.4 and 15 mm in height. Results: The average volume of graft in order to achieve a lift of 13?4 mm was 2.42 cm³ for the right maxillary sinus, with a range from 1.4 cm³ to 4.1 cm³, and 2.50 cm³ for the left maxillary sinus, with a range from 1.04 cm³ to 3.79 cm³. The average volume of graft in order to achieve a lift of 15 mm was 3.01 cm³ for the right maxillary sinus, with a range from 1.78 cm³ to 4.59 cm³, and 3.09 cm³ for the left maxillary sinus, with a range from 1.42 cm³ to 4.49 cm³. The statistical results provided by the Pearson Correlation show a significant inversely proportional correlation between the average of the heights and the volume of graft in the sinus. In addition, there is a clear correlation between the average volumes to be grafted for the respective heights 13.4 mm and 15 mm. Conclusions: The CompuDent program is an effective tool in determining the volume of bone graft given its simplicity, rapidness and possibility of standardization in all pre-surgical procedures.
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    Importance of cone beam computed tomography for diagnosis of calcifying cystic odontogenic tumour associated to odontoma : report of a case
    (2010) Marques, Yonara Maria Freire Soares; Botelho, Tessa-de Lucena; Xavier, Flávia-Caló-de Aquino; Rangel, Andrea Leão; Rege, Inara-Carneiro-Costa; Mantesso, Andrea
    The calcifying cystic odontogenic tumour (CCOT) is a rare benign cystic neoplasm not infrequently associated with odontoma. This report documents a case of CCOT associated with compound odontoma arising in the anterior maxilla in a 25-year-old woman. Conventional radiographs showed a large calcified mass with poorly visualized radiolucent margins. The extent and condition of the internal structure of the CCOT associated with odontoma was able to be determined based on radiographic findings from cone beam computed tomography. This advanced image technique proved to be extremely useful in the radiographic assessment of this particular neoplasm of the jawbones.
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    Oroantral communications : a retrospective analysis
    (2010) Hernando, J.; Gallego, Lorena; Junquera Gutiérrez, Luis Manuel; Villareal Renedo, P.M.
    Objetive. To analyze characteristics, clinical evolution and surgical techniques of oroantral communication (OAC). Study Design. We included all patients operated at the University Central Hospital (Oviedo, Spain) between 1996 and 2007. The variables assessed were age, sex, medical history, OAC size, sinus disease, surgical technique, duration of hospitalization and post-surgical evolution. Results. We analyzed 12 patients (7 men and 5 women) with an average age of 47.5 years. The most frequent cause of oroantral communication was the extraction of the first upper molar. The average size of fistula was 0.9 cm. Buccal flap repair was used in 7 patients, palatal rotation-advancement flap in 4 patients and buccal fat pad in only one patient. Suture dehiscence was observed in one patient treated with a palatal flap, but no additional surgery was required. Three OAC recurred; all of them following a buccal flap procedure. All recurrences spontaneously closed between one and four months following the procedure. Conclusion. OACs are rare complications and treatment should be individualized to avoid further complications
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    Diagnostic of craniofacial asymmetry : literature review
    (2010) Yáñez Vico, Rosa María; Iglesias Linares, Alejandro; Torres-Lagares, Daniel; Gutiérrez Pérez, José Luis; Solano Reina, Enrique
    Facial asymmetry is a common feature in many syndromes, and requires surgery as the only valid treatment option. Routine diagnostic methods (frontal RX, panoramic RX and submentovertex RX) have serious limitations mainly due to the transfer from a three dimensional image to a two dimensional plane. The feasibility of such methods is poorly supported due to inherent projection errors (image magnification, cranial rotation) and identification errors (image quality, precision and reproducibility). The use of computer tomographies represents a substantial improvement in the sense of skeletal and soft tissue structures? reproduction precision. The interpretation of this new data source makes evident the necessity of new analysis tools for extraction, manipulation and synthesization of the whole diagnostic and therapeutical potential based on more solid studies in this field.
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    A comparative study of platelet-rich plasma, hydroxyapatite, demineralized bone matrix and autologous bone to promote bone regeneration after mandibular impacted third molar extraction.
    (2010) Arenaz Búa, Jorge; Luaces Rey, Ramón; Sironvalle Soliva, S.; Patiño Seijas, Beatriz; García-Rozado González, Alvaro; Martín Sastre, Roberto Javier; Ferreras Granado, José; Lorenzo Franco, Fernanda; Vázquez Mahía, I.; López-Cedrún Cembranos, José Luis
    Objectives: 1) to compare mandibular bone regeneration by applying autologous bone, platelet-rich plasma and two biomaterials (synthetic calcium hydroxyapatite, and demineralized bone matrix), and thus establish the potential benefits of these biomaterials in the regeneration of postextraction alveolar bone, 2) to identify wich of them accelerates more bone regeneration and 3) to determine whether there are differences in the postoperative period (pain, swelling, trismus, infection) depending on the material used. Study Design: It consists in a prospective, controlled (with a split- mouth design) and double blinded study. We use as a model an easily reproducible non-critical bone defect: the defect that remains after extraction of mandibular impacted third molar. The study design is based on the extraction of two mandibular impacted third molars in a patient during the same surgical procedure by the same surgeon. We assessed postoperative clinical data, and short, medium and long term neoformation of alveolar bone after extraction. We compared the two sockets (right and left), which had been grafted in a different way with the various elements mentioned above. In addition, we compared the postoperative inflammatory symptoms between groups. Results: The highest acceleration in bone formation was observed in groups in which we used autologous bone and demineralized bone matrix. There were no statistically significant differences between groups regarding pain, swelling, trismus and infection throughout the postoperative period. Conclusions: According to the results of our study, autologous bone persists as the gold standard material for bone regeneration. Among the assessed biomaterials, demineralized bone matrix has yielded the best results obtained. No significant differences in the postoperative (pain, swelling, trismus and infectious events) were observed, depending on the type of material used as a graft.
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    Orthodontic management in patients with haemophilia. About two clinical cases
    (2010) Gómez Moreno, Gerardo; Cañete Sánchez, María Elena; Guardia Muñoz, Javier; Castillo Naveros, Tania; Calvo Guirado, José Luis
    The most common congenital bleeding disorder is haemophilia. It is a pathology inherited and caused by a defective or an absence of the coagulation factors, so that haemophiliacs cannot form an efficient clot. These patients have been treated with fear in the dental profession without having achieved the goals and ideals most appropriate according to the requirements of each case, which is demonstrated in the little existing literature available. However, they are currently treated as healthy orthodontic patients thanks to the advances in orthodontics. We present the cases of two brothers with mild classical haemophilia, who were treated by Mc Namara?s disjunctor. The emphasis is on importance of interconsultation with the haematologist, prevention and oral hygiene, and that of the beneficial effect of orthodontic.
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    Specific (granulomatous) oral lesions of sarcoidosis : report of two cases
    (2010) Marcoval, Joaquim; Mañá, Juan
    Sarcoidosis is a multisystemic granulomatous disease of unknown etiology that usually presents with bilateral hiliar adenopathies, pulmonary infiltrations, and ocular and cutaneous lesions. The specific cutaneous lesions, or granulomatous, are produced in from 9% to 37% of patients with systemic sarcoidosis. Nevertheless, few patients have been described having specific lesions from sarcoidosis in the oral mucous membrane. We present 2 patients with systemic sarcoidosis who developed specific sarcoidosis lesions in the oral mucous membrane. The first patient presented a plaque on the tongue of a chronic nature associated with facial lupus pernio. The second patient presented a rapidly growing nodular lesion on the lower lip that was in fact the presentation sign of the disease. Although infrequent, oral lesions may constitute the first sign of systemic sarcoidosis. For this reason the oral mucous membrane needs to be explored when there is suspicion of sarcoidosis, and systemic sarcoidosis must be included in the differential diagnosis of oral granulomatous lesions.
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    Burkitt's lymphoma : a child s case presenting in the maxilla. Clinical and radiological aspects.
    (2010) Valenzuela Salas, B.; Dean Ferrer, Alicia; Alamillos Granados, Francisco
    Burkitt´s lymphoma (BL) is a neoplasm which, despite its very aggressive behaviour is potentially curable. It typically affects the paediatric population. BL belongs to the non-Hodgkin lymphomas group, and is the first human tumour undoubtedly related to a viral origin (Epstein-Barr virus). Two main clinical subtypes are recognized: endemic or African type, and sporadic type; HIV associated BL constitutes a third type. Although common in endemic BL, maxillary involvement is rare in sporadic cases. This, together with the clinical lack of specificity associated to this location, makes diagnosis difficult. New chemotherapeutic protocols achieve a high survival rate. Most important prognostic factors are location and tumour stage. We report a paediatric case of BL presenting in the maxilla, with a review and a description of the characteristics of the disease.
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    Screening for hypertension in a primary care dental clinic
    (2010) Fernández Feijoo, Javier; Núñez Orjales, José Luis; Limeres Posse, Jacobo; Pérez Serrano, Esther; Tomás Carmona, Inmaculada
    Objective: The aim of this study was to record blood pressure in patients during their visit to a dental clinic, with the aim of identifying those who have high blood pressure and are unaware of it, as well as those who are aware of their condition but do have their blood pressure under adequate control. Study design: We designed a cross-sectional study which included 154 patients who were seen for a dental checkup at the Primary Dental Care of the Gallician Health Service (SERGAS). All participants completed a standardized medical questionnaire after measuring their systolic blood pressure (SBP) and diastolic blood pressure (DBP), which was conducted using the protocol established by the Spanish Society of Hypertension-Spanish League for the Fight Against Hypertension (HTA). Results: In 45 patients (29%), the figures for blood pressure were recorded as SBP?140 mmHg and/or DBP ?90 mmHg, indicating that they may have hypertension. Only 12 of them had been previously diagnosed with hypertension, but did not have their blood pressure under adequate control. The remaining 33 had no history of hypertension and were referred to a family physician, but only 19 saw their doctor; 11 of these patients were given non-pharmacological treatment, 6 were prescribed drug treatment and no type of treatment was indicated for the other two patients. Conclusions: By screening for hypertension, especially among patients who are more than 40 years old, the dentist can play an important role in the early diagnosis.
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    Cri du chat syndrome : a critical review
    (2010) Rodríguez Caballero, Ángela; Torres-Lagares, Daniel; Rodríguez Pérez, Antonio; Serrera Figallo, María Angeles; Hernández Guisado, J. M.; Machuca Portillo, Guillermo
    A new syndrome was identified in 1963, when Lejeune et al. reported a genetic disease resulting from a partial or total deletion on the short arm of chromosome 5 (5p-) and named it the cri du chat syndrome (CdCS). This term makes reference to the main clinical feature of the syndrome, a high-pitched monochromatic cat-like crying, that usually disappears in the first years of life. CdCS is one of the most common chromosomal deletion syndromes in humans, with an incidence of 1:15.000-1:50.000 live-births. Our purpose was to review different aspects of this syndrome (concept, epidemiology, aetiology, clinical features, diagnostic methods and prognosis) emphasizing both: the breakthrough in this field introduced by new cytogenetic and molecular techniques, and the orofacial manifestations most frequently reported. The main orofacial anomalies registered were mandibular microretrognathia, high palate but rarely cleft, variable malocclusion (frequently anterior open-bite), enamel hypoplasia, poor oral hygiene, generalized chronic periodontitis, and retardation of tooth eruption, although there is not enough evidence to support any clear association between these pathologies and the CdCS.
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    Oro-facial aspects of leprosy : report of two cases with literature review
    (2010) Ghosh, Sujoy; Gadda, Rohit Bhailal; Vengal, Manoj; Pai, Keerthilatha M.; Balachandran, Chandrasekharan; Rao, Raghavendra; Kudva, Ranjini
    Leprosy is a chronic infectious disease affecting primarily the skin, peripheral nerves, respiratory system and the eyes. Leprosy induces various types of clinical presentation affecting the patient´s immune response. Cellmediated immunity is considered to be the crucial defence against the disease and the magnitude of this immunity defines the extent of the disease. The article presents two case reports of manifestations of leprosy in the oro-facial region, with a brief review of various other important oro-facial manifestations of leprosy. The first report deals with granulomatous nodules in the palate while the second report presents bilateral facial palsy in leprosy patients. Both the reports gain importance due to rare oral manifestation in a borderline leprosy patient in the first case, while the second case presents a rare bilateral Bell´s sign. The role of the dental profession and especially the Oral Medicine specialist is of great importance in early diagnosis of oral lesions.