ABSTRACT
Grande variedade de tratamento é indicada para dentes traumatizados, com fratura de esmalte e dentina, durante a infância e adolescência, dependente da quantidade de remanescente dentário. Dentre as possibilidades de tratamento para recuperação estética, funcional e biomecânica, materiais odontológicos que mimetizam propriedades das estruturas dentárias são almejados. Pinos de fibra de vidro tem sido cada vez mais utilizados pela capacidade de distribuir as tensões de forma favorável, minimizando o risco de fraturas em dentes com mínimo remanescente coronário, podendo ser associados à restaurações diretas e indiretas. O objetivo do presente relato de caso clínico é apresentar alternativa de tratamento com maior preservação de remanescente assegurando retenção do material restaurador, selamento do canal radicular e adequada longevidade de tratamento para dentes com fratura coronária com envolvimento de esmalte e dentina, em paciente hebiátrico.
Wide range of treatment is indicated for traumatized teeth with enamel and dentin fracture during childhood and adolescence, dependent on the amount of remaining. Among the treatment options for recovery aesthetic and functional biomechanics, dental materials that mimic properties of dental structures are desired. Glass fiber posts have been increasingly used for its ability to distribute stresses favorably, minimizing the risk of fractures in teeth with minimal remaining coronal, and may be associated with direct and indirect restorations. The purpose of this case report is to present an alternative treatment with greater preservation of remnant ensuring retention of the restorative material, sealing the root canal and adequate treatment for longevity of teeth with coronal fracture involving enamel and dentin of a hebiatric patient.
ABSTRACT
A colagem de fragmento dentário é alternativa estética e conservadora para dentes traumatizados. O objetivo deste trabalho foi realizar revisão sistemática da literatura científica de pesquisas clínicas que abordaram a colagem de fragmento dentário, compreendendo o período de 1955 até Março de 2012, associando-a a caso clínico para ilustrar técnica que parece ser adequada. Para a busca bibliográfica utilizou-se o site Pubmed/Medline com os seguintes descritores: "tooth fragment reattachment" e "dental bonding fragments". Foram obtidos 147 resumos, os quais foram lidos por dois revisores individualmente. Obtiveram-se 41 pesquisas laboratoriais, 6 pesquisas clínicas, 5 revisões de literatura e 94 casos clínicos. Porém, apenas 5 artigos foram considerados nesta revisão, de acordo com os critérios de inclusão e exclusão estabelecidos. Consideraram-se os seguintes aspectos: meio de armazenagem do fragmento, técnica de preparo do remanescente e do fragmento, materiais para a colagem e sucesso clínico. Adicionalmente, apresenta-se relato de caso clínico, de paciente de 8 anos de idade, envolvendo a colagem de fragmento após fratura coronária dos dentes 11 e 21 com acompanhamento clínico de 12 meses. Após avaliação sistemática da literatura, percebe-se que são poucos artigos que descrevem criteriosamente a técnica, abordando os critérios de interesse estabelecidos. A colagem de fragmento dentário demonstrou altas taxas de sucesso, principalmente nos primeiros 24 meses das avaliações clínicas. E parece ser eficaz quanto à manutenção da função mastigatória, à saúde periodontal e à satisfação do paciente. Além de conservadora, é fácil, rápida, de excelente resultado estético e funcional, resgatando ainda o equilíbrio emocional do paciente.
The tooth fragment reattachment is conservative and aesthetic alternative traumatized teeth. The aim of this study was realize systematic review of literature seeking clinical researches approaching of tooth fragment reattachment between the period of 1955 until 2012 march and associate it with a an clinical case, that illustrates a proper technique. For bibliographic search was used the PubMed / Medline website using the following keywords: "tooth fragment reattachment" and "dental bonding fragments." One hundread and forty seven abstracts were obtained, which were read by two reviewers, individually. Forty-one laboratorial researches, six clinical trials, five literature reviews and night-four clinical cases were obtained. However, only five were considered in this review, in accordance to the established inclusion and exclusion criteria. The following aspects were considered: medium storage of the fragment, preparation technique of dental remaining and fragment, bonding materials and clinical success. In addition, it was presented a case report of an 8 year old patient, involving the bonding of fragment after coronary fracture of teeth 11 and 21 with clinical follow up of 12 months. After systematic evaluation of the literature, it were found few articles with a careful description of the technique addressing the established interest criteria. The collage of fragments showed high success rates, especially in the first 24 months of clinical evaluations, and seems to be effective in maintenance of chewing, periodontal health and patient satisfaction. Besides being conservative, it's easy, fast, excellent both in cosmetic and functional outcome, and can also rescue the patient's emotional balance.
ABSTRACT
Background: Post design and material has very important effects on dentinal stress distribution since the post placement can create stresses that lead to root fracture. Materials and Methods: In this study we use finite element analysis (FEA) to evaluate stress distribution on endodontically treated maxillary central incisors that have been restored with different prefabricated posts. Six models were generated from the image of anatomical plate: Four metallic posts (ParaPost XH, ParaPost XT, ParaPost XP, and Flexi-Flange) and one fiberglass post (ParaPost Fiber Lux). The sixth model was a control-a sound maxillary central incisor. We used CAD software and exported the models to ANSYS 9.0. All the materials and structures were considered elastic, isotropic, homogeneous, and linear except the fiberglass post which was considered orthotropic. The values for the mechanical properties were obtained by a review of the literature and the model was meshed with 8-node tetrahedral elements. A load of 2N was applied to the lingual surface at an angle of 135°. Results: The stress results were recorded by shear stress and von Mises criteria; it was observed that there was no difference for stress distribution among the titanium posts in the radicular portions and into posts. There was higher stress concentration on the coronary portion with the titanium posts than with the glass fiber post. It seems that the metallic posts' external configuration does not influence the stress distribution. Conclusion: Fiber posts show more homogeneous stress distribution than metallic posts. The post material seems to be more relevant for the stress distribution in endodontically treated teeth than the posts' external configuration.