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Objective: Enterococcus faecalis, Gram-positive facultative anaerobe capable of invading the dentinal tubules, is resistant to several irrigating solutionsand intracanal medications. Motivated by the antibacterial effect exhibited by garlic extract against a wide variety of Gram-positive and Gram-negativebacteria, as well as anaerobic bacteria such as Lactobacillus and E. faecalis, we aimed in this study to analyze the efficacy of garlic extract against theviability of E. faecalis from clinical isolates of nonvital primary root canals.Methods: We used MTT assay to determine the viability of E. faecalis after exposure to increasing concentrations of garlic extract (10%, 25%, 50%,and 100%) and chlorhexidine (CHX) 2% as a positive control.Results: We performed the analysis using the Kruskal–Wallis test and the post hoc test for multiple comparisons at a 0.05 significance level. At allconcentrations, garlic extracts decreased the viability of E. faecalis. We found no significant differences between the viability values for 25%, 50%,and 100% garlic extracts (p>0.05); however, they were significantly different from the 10% extract and CHX 2% (p

Introduction: Mucositis is one of the side effects induced by chemotherapy. It results in pain, discomfort, difficulties in talking, swallowing, eating, drinking, poor nutrition, systemic weakness and life-threatening infections. Probiotics contain nonpathogenic live microorganisms that give benefit to our health and help in preventing inflammation in the oral cavity. Several studies have reported the use of probiotics for oral health purposes. Objectives: The aim of this study was to analyze the effect of probiotic to oral mucositis in children with hematology cancer that underwent the chemotherapy process before gargling, 7 days after gargling, and 14 days after gargling with probiotic. Materials and Methods: The study was held in National Cancer Hospital. Eleven patients were meet the criteria. One day after the chemotherapy started, the researcher checked the patient’s oral health condition using Oral Assessment Guide (OAG). Then the patient started to gargle the probiotic twice a day for 7 days and the researcher rechecked the score of oral mucositis after 7 days and 14 days. Results: There was a significance decreasing OAG score between before gargling with 7 days and 14 days after gargling probiotics. Conclusions: Probiotics gave effects in children with leukemia during chemotherapy and could be an alternative therapy for oral mucositis.

Objective: To evaluate the oral hygiene status of children with Down syndrome using the busy book Ayo Sikat Gigi as an educational toy. Material and Methods: We ran an experimental study involving 25 educable and trainable children with Down syndrome, comprising 17 males and 8 females aged 7–12 years, who were free from other disabilities and did not use orthodontic or prosthodontic appliances. Parents were instructed to educate their children using the busy book Ayo Sikat Gigi and also to guide their children in brushing their teeth effectively at home. We evaluated the OHI-S score over two visits, one before and the other after education using the busy book Ayo Sikat Gigi over a 7 day period. The Wilcoxon test with the p-value set at 0.05 was used. Results: It was noted a statistically significant decrease in the OHI-S scores of children with Down syndrome (p

Objective: To determine the frequency distribution of gingivitis and oral hygiene in individuals with Down syndrome. Material and Methods: This study used a cross-sectional descriptive method and the subjects were 174 individuals with Down syndrome aged ≥14 years attending type C (intellectual disability) special needs schools in Jakarta. Gingivitis was measured using the gingival index, and oral hygiene was measured using the Simplified Oral Hygiene Index (OHI-S). The measurement of the two components of plaque and calculus was completed on six teeth on different surfaces, including the facial side of three maxillary teeth, the lingual side of the two posterior mandibular teeth, and the labial side of one anterior mandibular tooth. Descriptive statistics were used to calculate the absolute and relative frequencies. Results: 3.4% had no gingivitis, 47.2% had mild gingivitis, 40.8% had moderate gingivitis, and 8.6% had severe gingivitis. Regarding oral hygiene , 28.2% had good hygiene , 49.4% had fair, and 22.4% had poor hygiene . Conclusion: Individuals with Down syndrome had a frequency distribution of gingivitis mainly in the mild and moderate categories, and a majority of subjects had fair OHI-S.

Cleidocranial dysplasia (CCD) is a rare autosomal dominant disorder characterized by skeletal and dental abnormalities primarily, short stature, aplasia or hypoplasia of clavicles, open fontanelles and supernumerary teeth. Heterozygous mutations of the runt related transcription factor 2 (RUNX2) gene have been found in approximately 60-70% of cases leaving a large number of cases with no defined genetic cause which led us to delve into molecular mechanisms underlying CCD and thus to detect potential target genes to be explored in these patients. In this review we also highlight very broadly the phenotypic characteristics of previously reported patients with CCD. How to cite this article: Avendano A, Cammarata-Scalisi F, Rizal MF, Budiardjo SB, Suharsini M, Fauziah E, Grande NM, Fortunato L, Plotino G, Yavuz I, Callea M. Cleidocranial dysplasia. A molecular and clinical review. Int Dent Res 2018;8(1):35-38. Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Background: Providing dental treatment for children with autism spectrum disorder (ASD) represents a challenge for dentists. In the dental care of such children, the treatment plans implemented are usually determined by several factors, including: the type of autism spectrum disorder, the degree of patient cooperation, dentist/patient communication, the required treatment, self-care skills and parental/dentist support. Purpose: The purpose of this case report was to report the dental care delivered in the cases of two pediatric patients with ASD. Case 1: A 10.7 year-old boy with a nonverbal form of ASD who was experiencing recurrent pain in his lower left posterior tooth and also presented a blackened tooth. Case 2: A 9.6 year-old boy with a nonverbal form of ASD suffering from numerous painful cavities. Case management 1: On the day of the first visit, the boy was the subject of several behavioral observations. During the day of the second visit, he underwent a brief intraoral examination at a dental unit in order to arrive at a temporary diagnosis before appropriate was decided upon treatment in consultation with his parents. The implemented treatment plans comprised dental extraction and preventive restoration under general anesthesia. Case management 2: On the first visit, the boy underwent behavioral observations followed by early intraoral examination involving physical restraint approach. During the second visit, several treatment plans such as: general anesthesia, tooth extraction, restoration, and pulp-capping treatment were formulated. Conclusion: It can be concluded that general anesthesia was considered an appropriate dental treatment plan since the two patients in question were extremely co-operative during the necessary procedures. In other words, pediatric dental care treatment plans in cases of ASD should be determined by clearly-defined criteria, specifically the benefits and risks of the treatment plans for the safety of both patient and dental care team.

The bond strength between glass ionomer and tooth structure can be improved with application of conditioner on enamel or dentin surface to remove the smear layer. The bond strength can be measured with shear bond strength testing. This study aimed to determine the difference of shear bond strength of glass ionomer cement to primary teeth dentine after conditioner application for 10", 20" and 30". Twenty seven primary mandibular incisors were randomly divided into 3 groups that were subjected to application of 10% polyacrylic acid conditioner (Dentin conditioner, GC) for 10", 20" and 30", and restoration with glass ionomer cement (Fuji IX, GP, GC). The specimens were kept in an incubator at 37ºC for 24 hours. Shear bond strength test was done by using Universal Testing Machine Shimazu AG-5000 with 50 kgf load and crosshead speed of 0.5 mm/min. Anova was used statistical evaluation. Although the results showed no statistically significant differences in the shear bond strength of the glass ionomer cement between the test groups (p>0.05), the mean bond strength decreased with increasing duration of conditioner application, so that highest mean bond strength was obtained at 10" application.

Ectodermal dysplasia is a hereditary disease characterized by a congenital dysplasia of one or more ectodermal structure and their accessory appendeges. The main feature is hypohidrosis, hypotrichosis and hypodontia. Ectodermal dysplasia appear to be ingeritaed as an x-linked recessive trait. Common manifestations include frontal bossing with prominent supraorbital ridges, nasal bridge depression, protuberant lips and defective hair follicles and eyebrows. Intraorally, common findings are hypodontia or anodontia and conical teeth. The treatment is to improve the appearance and oral function included a removable prosthesis. A 5-year-old and 9-year-old male in the same family, described in the case report of ectodermal dysplasia with removable partial dentures

Periodontal disease, dentla caries and malocclusion are frequently found in mentally retarded children. The frequency of these diseases are higher than normal children. The condition of mental retardation makes these children difficult to care for their oral hygiene. Basically there is no difference of treatment for mentally retarded children compared to normal children. Dentists should have certain sills to treat the these special children, especially in behavior management. Preventive care and behavior management are the most important considerations in achieving a successful treatment.

Mesiodens is supernumerary teeth which is commonly found and located in midline premaxilla. The supernumerary teeth may cause clinical disorders, such as delayed eruption and malposition of permanent teeth, therefore early diagnosis and intervention is very important. Ventricular Septal Defect (VSD) is a congenital heart disease which frequently occurred in children. Dental treatment in children with heart diseases should be done carefully since there is higher risk of developing on bacterial endocarditis. Dentist should know the contraindication of dental treatment that needs prophylactic antibiotics as suggested by American Heart Association. A 6 years 8 months boy who suffered from VSD came to Pediatric Dental Clinic at Faculty of Dentistry University of Indonesia. In the examination we found impacted mesiodens with inverted position which has conical shape at regio 51. The possible etiology of mesiodens in this patient is x-linked dominant with incomplete penetration. After consultation with Pediatric Cardiologist and Oral Surgeon, the odontectomy was conduted with prophylactic cephadroxyl. There was no signs of bacterial endocarditis after the odontectomy.

The purpose of this study was to determine the influence of application time of Non Rinse Conditioner (NRC) on Compomer (Dyract, Dentsply) penetration in dentin of primary teeth. The simple was 30 mandibular primary incisors divided into 3 groups by application time (10,20, and 30 seconds). The penetration of Compomer was measured from 30 teeth using SEM (2000x mag). One way ANOVA test showed significant differences between the three application times (F=10,7074,738, p=0,001), and Tukey test also indicated significant differences between the groups (p=0,001). Longer periods of NRC application increases the application of Compomer.

Phosphoric acid etching has been widely used to achieve a strong and long lasting mechanical bonding between composite resin restoration and tooth structure. The aim of this study was to evaluate the bond strength between the enamel of permanent teeth and the composite resin restoration by measuring the shear bond strength after different durations of etching. In total 27 premolar teeth were divided into 3 groups where the enamel of the buccal surface was etched with 37% phosphoric acid for 5″, 15″, and 25″ before placing the composite resin restoration. After keeping the teeth inside an incubator for 24 hours, the shear bond strength was measured using a universal testing machine Shimazu AG-5000 at a crosshead speed of 0.5 mm/min. ANOVA was used for statistical analysis of the results, with p0.05). Conclusion: Shear bond strength of the composite resin on the permanent teeth enamel increased with increasing etching time. Significant difference was showed between 5″ and 25″ of etching time.DOI: 10.14693/jdi.v15i2.65

The mixed dentition stage of tooth development is critical as it often involves changes in the inter-molar and inter-canine widths of the dental arch, which may affect the inter-gonion width. It was hypothesized that the relationship between the inter-molar, inter-canine, and inter-gonion widths could be used to estimate the width of the dental arch, thus allowing better treatment planning. This research aimed to determine the relationship between the inter-molar, inter-canine, and inter-gonion widths in children aged 6–9 years old. This cross-sectional study used 30 study models and panoramic radiographic images of pediatric patients in Teaching Dental Hospital, Faculty of Dentistry, Universitas Indonesia. The results showed that the inter-molar and inter-gonion widths and the inter-canine and inter-gonion widths exhibited weak correlations that were not statistically significant (r = 0.277, r = 0.032, respectively). However, the inter-molar and inter-canine widths demonstrated a strong, statistically significant correlation (r = 0.580).

The neurological disorder commonly found in Down Syndrome (DS) patients are muscular hypotonia and mental retardation. Speech therapy program is designed to improve communication capability, while oral muscular exercises included in this program may improve their oral muscular tone. The aim of the study was to evaluate how the oral muscular exercises may affect the children with Down Syndrome. The data of the oral muscular exercises were obtained from the scores of the speech therapy questionnaires, while the variable of mastication muscular tone was described by the electromyography examination of the masseter and temporal muscles, and the oral function achieved from its examination scores. The regression analysis proved that the oral muscular exercises affected the mastication muscular tone not significantly with p=0,096; b=0,073 and R2=0,016. It could be concluded that the oral muscular exercises given in speech therapy program might not improve oral muscular tone in Down Syndrome patients.

Intrusion is a displacement of the tooth deeper into the alveolar socket accompanied by comminution or fracture of the alveolar socket following axis of the tooth. This case describe treatment of intrusion with open apex which obsercation until spontan eruption of the tooth. After 4 months, clinically, the intrusion tooth reeruption near incisal edge of adjacent tooth and radiographic showed lengthening the root of the tooth.

Muscular hypotonia is one of the clinical signs in patients with Down syndrome. As a characteristic of patients with Down syndrome, hypotonia is clearly evident in face expression and oral dysfunction. Dentocraniofacial growth abnormalities in patients with Down syndrome may be influenced by genetic and environmental factors. Stomatognathic system musculature as an environmental factor (factor outside the bone) can affect dentocraniofacial growth by orofacial muscles activities when chewing, swallowing, breathing, and speaking. Oral dysfunctions commonly seen in patients with Down syndrome are open mouth, protruding tongue posture, difficulties when chewing, swallowing, and speaking, drooling, and mouth breathing. The purpose of this study was to observe how the mastication muscular tone affecting the facial size of Down syndrome patient. Twenty five of 14–18 years old children with Down syndrome were diagnosed by clinical characteristic and cytogenetic examination. Mastication muscular tone was described by masseter and temporalis muscle synergy and oral function, whereas the facial size consisted of facial size of lateral, anteroposterior and vertical growth. The result of regression test revealed that the degree of mastication muscular tone has a significant effect on facial size of the anteroposterior growth and facial size of vertical growth, but did not significantly influence the facial size of lateral growth.

Objective: The objective of this research is to investigate the differences in salivary secretory immunoglobulin A (sIgA) levels between children with gingivitis who have acute lymphoblastic leukemia (ALL) and are in the maintenance phase of chemotherapy and the levels in healthy children with gingivitis.Methods: This study used cross-sectional and laboratory observation methods with 19 ALL children and 19 healthy children who all had mild gingivitis. Two mL of saliva were collected and stored at −200°C. Then, salivary sIgA levels were measured using the ELISA method.Results: The results indicate an insignificant difference (p>0.05) in salivary sIgA levels between the ALL children in the maintenance phase with the level of 21.38 (7.23–107.26) and 37.26 (11.24–135.63) for the healthy children.Conclusion: There is no significant difference in salivary sIgA levels between the ALL children in the maintenance phase and the healthy children.

Objective: The objective of this study was to investigate the differences activity of salivary Streptococcus mutans bacteria in children suffer acute lymphoblastic leukemia (ALL) in phase of chemotherapy, induction, intensification/consolidation, and maintenance.Methods: This study was a laboratory observational, and cross-sectional method, conducted 19 ALL children in phase of chemotherapy, induction, intensification/consolidation, and maintenance. 2 mm of dental plaque was collected from mesiobuccal first permanent molar and incubated for 48 h at 37°C, and the bacterial activity of S. mutans measured by Cariostat.Results: Odds ratio analysis among chemotherapy phase of induction, intensification/consolidation, and maintenance is not significant (p>0.05) differences.Conclusion: The highest activity bacteria of S. mutans were found in the induction phase

Objective: This study was conducted to analyze the effects obtained with different concentrations (0.5 and 0.1%) of propolis flavonoids on in vitro biofilm formation by clinical Streptococcus mutans strains isolated from children’s dental plaque. Materials and Methods: S. mutans isolated from children’s dental plaque was assayed for biofilm formation in 96-microwell plates using crystal violet. Results: The effects on S. mutans biofilm formation were the same for propolis flavonoids administered at concentrations of 0.05 and 0.1% (p>0.01). Conclusion: A 0.05% propolis flavonoids concentration was deemed as effective as a 0.1% concentration at inhibiting S. mutans biofilm formation.

Introduction: Virgin coconut oil (VCO) is a natural antibacterial agent with the ability to kill microorganisms whose cell membranes contain lipids, including Gram-positive and Gram-negative bacteria, such as Actinomyces sp. and Prevotella spp. No study on the antibacterial effects of VCO on the chromogenic bacteria that causes dental black stains. Objective: To analyze the effects of VCO, which administered in various concentrations to Actinomyces sp. and Prevotella sp. Methods: Actinomyces sp. and Prevotella sp. were isolated from the dental plaque of a child diagnosed with black stain. Each streak of bacteria was cultured on a selective medium and confirmed visually and through Gram staining. Each bacterial culture was exposed to VCO in concentrations of 12.5%, 25%, 50%, and 100%. Afterward, viability testing with a methyl-thiazolyl-tetrazolium assay was conducted, and the results were read using an Enzyme-linked immunosorbent assay reader. Results: The administration of 12.5% VCO reduced bacterial viability; however, 25% VCO significantly reduced the viability of Actinomyces sp. and 100% VCO significantly reduced the viability of Prevotella sp. Conclusion: Actinomyces sp. is more sensitive to VCO than Prevotella sp.

Objective: Anxiety is regarded as a major problem in children undergoing dental treatment. One of the physiological responses to anxiety is an increased pulse rate. Young children respond aggressively to anxiety and are in need of psychological intervention. Pop-up books can be used as an instrument to improve their interest and to help them understand the substance of dental health education.The objective of this study was to utilize pulse rate measurements to investigate the intervention of a pop-up book in reducing anxiety. A total of 78 children aged 4–6 years were divided into two groups: An intervention group with the pop-up book Aku dan Gigiku and a control group without intervention. The pulse rates of both groups were measured. This study comprised an experimental clinical research design. The independent t-test was used to measure comparisons of decreased pulse rate between the two groups.Result: The result showed that there was a statistically significant difference in decreased pulse rate with and without the intervention of the pop-up book Aku dan Gigiku. Pop-up books are often used as an educational medium for children because they present interesting illustrations and are easy to understand.Conclusion: As a medium of dental health education, pop-up books can contribute significantly to reducing anxiety in children.

Objective: Patients generally experience some level of anxiety during dental treatments. Salivary alpha amylase (SAA) can be used as a biomarker for anxiety. This study aimed to compare SAA levels between children who had never and had undergone tooth extraction procedures with a local anesthetic injection.Methods: Thirty-seven participants aged 6–11 years who were to undergo the extraction of primary teeth at the Dental and Oral Educational Hospital, Faculty of Dentistry Universitas Indonesia, were enrolled. The subjects were divided into two groups: One group consists of 20 children who had never undergone a tooth extraction, and the other group consists of 17 children who had undergone tooth extraction. From all children, one saliva sample was collected using a portable saliva strip 10 min before (t0), shortly after (t1), and 10 min after (t2) local anesthetic injection, and the SAA activity was determined using a portable Nipro Cocoro Meter device. The SAA levels of both groups were analyzed using the Mann-Whitney U test.Results: There were significant differences in SAA levels at t0 (p=0.001), t1 (p=0.018), and t2 (p=0.021) in both groups. Anxiety is a combination of behavioral and physiological reactions. SAA release is regulated by autonomic innervation, and the SAA level increases owing to acute stress.Conclusion: Dentists should note patients’ negative dental experiences to provide more effective and less traumatic treatment.

Objective: Several studies have tried to objectively assess pain measurements. The Wong-Baker Faces Pain Scale (WBFPS) is an instrument that is commonly used to assess pain intensity in children. This study aimed to analyze the correlation between the WBFPS and salivary alpha-amylase (SAA) level during a tooth extraction procedure with a local anesthetic injection in children aged 6–11 years.Methods: Twenty-five children aged 6–11 years who were to undergo the extraction of a primary tooth at the Dental and Oral Educational Hospital, Faculty of Dentistry Universitas Indonesia, were enrolled in this study. From all children, saliva was collected using a disposable saliva strip shortly after local anesthetic injection, and the SAA activity was then determined using a portable Nipro Cocoro Meter device. The WBFPS was measured at the same time. The correlation between the WBFPS and the SAA level was analyzed using Spearman’s correlation test. The statistically significant level was set at p≤0.05.Results: There was a significant correlation between the WBFPS and SAA level (p=0.002, r=0.581).Conclusion: Our data suggest that the SAA level might be a good index for objective pain intensity assessment.

Objective: This study aimed to evaluate the effectiveness of the pop-up book Aku dan gigiku as an intervention strategy in reducing anxiety in young children before dentaltreatment.Methods: 78 children aged 4–6 years were randomly divided into two groups: An intervention group with the pop-up book intervention and a control group without the pop-up book intervention. They were placed in a waiting room, and their blood pressure was measured. The experimental design of this clinical research was statistically analyzed using independent t-tests to compare decreased blood pressure between the intervention and control groups.Results: The result of the study revealed that there was a statistically significant difference in decreased blood pressure with the intervention of the pop-up book Aku dan gigiku. As dental anxiety leads to undesirable distresses, it generates physiological changes such as blood pressure. Interventions should thus be undertaken to reduce dentalanxiety, and the pop-up book is an example of an intervention medium as it educates children and presents interesting illustrations.Conclusion: The pop-up book Aku dan gigiku thus appears to be an effective method in reducing anxiety in children aged 4–6 years when used as an intervention strategy before dental treatment.

Objective: This study aimed to assess the antibacterial effects of 0.1% chlorine dioxide and 0.1% chlorhexidine mouthrinses on the bacterial viability of Actinomyces sp. as an agent of black stain. Methods: The authors conducted a clinical trial involving 16 children ages 6–11 with at least 8 black-stained teeth. Subjects were randomized into 2 groups and instructed to rinse with chlorine dioxide or chlorhexidine mouthrinse twice daily. At baseline and after 7 days, samples of black stain plaque were collected, and Actinomyces sp. was cultured. Its bacterial viability was evaluated using an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay. Results: After 7 days, Actinomyces sp. viability was remarkably reduced in both groups, and there was a significantly higher reduction in viability in the 0.1% chlorine dioxide group than there was in the 0.1% chlorhexidine group. Conclusion: Mouthrinse containing 0.1% chlorine dioxide has a greater antibacterial effect against Actinomyces sp. than mouthrinse containing 0.1% chlorhexidine.

Objectives: The purpose of this study was to analyze the differences in the effect of milk-based, soy-based, and protein hydrolysate formulas against Streptococcus mutans (SM) biofilm formation.Methods: Infant formula used is intended for children aged 1-3 years, and each respective type of infant formula is represented by three distinct brands.Results: Our results showed a significant difference in the effect of milk-based, soy-based, and protein hydrolysate formulas against SM biofilm formation (p=0.002).Conclusion: Cow’s milk-based formula showed the lowest SM biofilm formation.

Since the last five years, Faculty of Dentistry Universitas Indonesia has implemented an integrated curriculum as a process of change from teacher centered to student centered learning, as well as problem based learning, community based and praciticing in a small group discussion. The dental curriculum is divided separately into seven semesters for academic and followed by three semesters for clinical years. The aim of this study is to evaluare the implementation of the integrated curriculum. Evaluation of this five year program showed less than 10% of the 5th year students were able to finish their study on time. Most of the students needed more than three semesters to complete the clinical requirements; therefore, the recent curriculum should be revised.DOI: 10.14693/jdi.v16i2.93

Agenesis described as a certain developemntal disorder that is a lacking in the number of teeth present intraorally. Hypodontia is an agenesis with the absence of one or several teeth. In most of the population, the prevalence is 3,5 - 6,5% with 0,3-0,4% for a severe hypodontia (an absence of 6 teeth or more clinically). Agenesis affects permanent dentition more often than primary dentition, and the incidence of agenesis is greater in female than male patients. Agenesis might be a result of environmental and genetic factors. It is necessary to have a comprehensive treatment for a case of hypodontia, which involves restorative, orthodontic, a prosthetic treatment based on the children's growth and development. In the present case, a patient of 6 years and 5 months old girl was diagnosed with severe hypodontia. The treatment of choice included a removable orthodontic appliance for the upper jaw and a removable space maintainer for the lower jaw. The removable orthodontic appliance served as an interceptive orthodontic treatment to correct anterior crossbites, and the child will be referred to the orthodontist to treat a Class III skeletal malocclusion. The space maintainer was to be used until the patient's condition become favorable for a permanent fixed bridge or steel removable partial denture.

Down’s syndrome is caused by chromosomal aberration, namely 21 trisomy. Skeletal and neurological disorders are found in Down’s syndrome patients. Skeletal disorder may cause craniofacial growth abnormalities whereas neurological disorder may cause brain growth defects, which result in mental retardation, as well as neuromuscular disorder, which results in muscular hypotonia. The aim of this study was to prove that facial shape in Down’s syndrome patient was not only influenced by genetic factors, but also by environmental factors such as cognitive capability, oral muscular exercises and oral muscular tone. The population consisted of Down’s syndrome children aged 14 to 18 years from Sekolah Luar Biasa (Special School) in Jakarta. Samples used in the study consisted of 25 Down’s syndrome patients. Clinical and cytogenic test were conducted to ensure a diagnosis. Lateral cephalograms were made to analyze facial shape by Fourier analysis on gonion angle. Intelligence Quotient (IQ) and Social Quotient (SQ) tests, electromyography examination of the masseter and temporal muscles, oral function examination and speech therapy questionnaires to the respondents were performed. The data were analyzed using path analysis. Based on the results of the study, it could be concluded that the genetic factor is the main factor causing Down’s syndrome facial shape abnormalities. The environmental factors such as oral muscular tone, cognitive capability, and oral muscular exercises may also play a role in Down’s syndrome facial shape.

The premature loss of primary teeth will make the adjacent tooth drift due to the mesial force of the erupting posterior teeth in the growing child. To overcome this problem a space maintainer is needed. But, space maintainer needs to undergo a laboratorial process, which means needing more time and money. This paper reported a case with premature loss of maxillary first primary molar using space maintainer which can be used immediately, easy to do, and need low cost, a simple fixed space maintainer bonded with flowable resin composite.