The impact of the COVID-19 pandemic on dental trauma attendance: a systematic review and meta-analysis

Abstract This systematic review and meta-analysis aimed to analyze the impact of the COVID-19 pandemic on dental trauma patient attendance. The study was registered in the PROSPERO system, using the CRD42021288398 protocol. Searching was performed in PubMed, Scopus, Web of Science, Embase, Lilacs, and OpenGrey databases, using the following keywords: "Tooth injuries," "Dental trauma," "Traumatic Dental injury," and "COVID-19". We included observational studies evaluating dental trauma in the context of the COVID-19 pandemic. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Meta-analysis was performed in RevMan 5.4 software with Odds Ratios as a pooled measure of effect, with a 95% confidence interval, and using random-effects modeling. After applying the eligibility criteria, 32 studies were included for qualitative analysis, in which 10 were used to assess the frequency of dental trauma diagnoses in dental emergencies. Despite the decrease of visits during COVID-19, the analysis revealed no difference between the pandemic and pre-pandemic periods. Regarding the type of dental trauma, two of the studies revealed no differences for the periods before and during the pandemic. This study revealed that the COVID-19 pandemic has not impacted the frequency or type of dental trauma compared to previous periods.

Influence of chlorhexidine and zinc oxide in calcium hydroxide pastes on pH changes in external root surface

Abstract The objective of this study was to assess the influence of chlorhexidine (liquid and gel) and zinc oxide in calcium hydroxide (CH) pastes on root pH in simulated external resorption. One hundred human anterior teeth with a single root canal were selected. After decoronation and root canal instrumentation, the specimens were divided into 4 experimental groups and 1 control group (without intracanal paste): CH + saline (CH+S), CH + 2% chlorhexidine liquid (CH+ CHX), CH + 2% chlorhexidine gel (CH+ CHXg), and CH + 2% chlorhexidine gel + zinc oxide (CH+ CHXg+ZnO). pH was measured using a microelectrode at 3 and 24 h, and 1, 2, 3, and 4 weeks after inserting intracanal pastes. Data were analyzed statistically using an ANOVA and Tukey's test (p < 0.05). The CH+CHXg+ZnO group had the highest pH values throughout (p<0.05). The CH+S and CH+ CHX groups had the highest pH values after 1 week and the CH+ CHXg group after 2 weeks. CH+ CHXg maintained the highest pH until the fourth week compared with CH+ CHX (p < 0.05). The control group remained at a neutral pH at all evaluated times. It can be concluded that chlorhexidine solution or gel maintained the alkaline pH of CH, and chlorhexidine gel allowed a slower decrease in pH over time. CH+ CHXg+ZnO showed the highest pH values and was an effective intracanal medication for maintaining alkaline root pH in the area of resorption.

Prevalence of Dentinal Defects after Root Canal Preparations in Molars with Reciproc and WaveOne Systems

Objective: To evaluate the prevalence of dentin defects, including partial and complete cracks and fractures, after root canal preparation in molars with Reciproc and WaveOne reciprocating instruments. Material and Methods: Fifty mandibular first and second molars with mature apices were selected to endodontic in vitro instrumentation. Ten teeth were unprepared and served as the control, and the remaining forty teeth were divided into two groups, being twenty corresponding to each reciprocating system. Reciproc and WaveOne systems were used in a reciprocating working motion, under the same conditions, to prepare the two mesial canals. Roots were then sectioned 2, 4 and 6 mm from the apex, and the cut surface was observed under a microscope using 20-fold magnification and checked for the presence of fractures and incomplete cracks. Results: none of the evaluated groups presented fractures, and the control group showed no incomplete cracks. Overall evaluation showed statistical differences between these two groups and the control group (p=0.017) for the prevalence of incomplete cracks, but no significant differences were obtained between Reciproc and WaveOne groups (p>0.05). Reciproc group presented more incomplete cracks on 4-mm sections compared with the control group on the same section (p=0.0326). Conclusion: Root canal preparation with both reciprocating instruments resulted in incomplete cracks, but not fractures. At the level of 4 mm from the apex of the canals, the Reciproc system produced significantly more incomplete cracks. Considering both systems, WaveOne utilization resulted in lesser structural alterations on dentin considering the middle portion of the roots.

Knowledge level of physical educators regarding dental trauma in a brazilian subpopulation

To evaluate the knowledge of physical education professionals and athletes about dental trauma. The state of Paraiba Brazil has 3.9 million inhabitants and innumerable centers of physical activities.Material and Methods:The sample consisted of 103 physical education professionals and 101 gym-goers, randomly chosen, in the city of João Pessoa, Brazil. The participants filled out a specific questionnaire for each group (teachers and students) regarding their knowledge about dental trauma and how they would proceed in such situations. Descriptive statistics and the chi-square and FischerÆs exact tests were used at 1% significance to test for significant differences in the sample.Results:Most of the professionals did not have adequate knowledge about the concept of dental avulsion (77.7%), and only 14 of them reported having sought a dentist after an avulsion. Of the students, 10.9% reported having suffered any dental injury during physical activity, and only 4 of them reported having sought a dentist soon after the accident. Regarding the most appropriate means to transport an avulsed tooth, saline solution was most cited by both the physical education teachers (56.3%) and the students (60.4%).Conclusion:This study revealed a level of lay knowledge regarding dental trauma; the number of participants who knew the correct way to act in such situations was small. For most of the individuals surveyed, the dissemination of information on the subject through educational programs would contribute to knowledge on how to address dental trauma...

Tratamento endodôntico de molar com instrumento de NiTi fraturado / Endodontic treatment of molar with fractured NiTi instrument

Diversas técnicas de instrumentação têm sido propostas com a finalidade deagilizar o processo de limpeza e modelagem do canal radicular, para que o canal esteja em condições de receber o material obturador de modo rápido e ao mesmo tempo eficaz. Apesar de confirmada a eficiência clínica dos instrumentos de NiTi, fratura inesperada pode ocorrer, sem quaisquer sinais visíveis de deformação em suas lâminas de corte. Atenção deve ser dada ao fato de que, durante o preparo químico-mecânico, quer seja ele manual ou rotatório, o instrumento endodôntico está constantemente submetido a uma série de forças que podem propiciar falhas. Portanto, durante o preparo químico-mecânico um dos maiores obstáculos ao uso desses sistemas são as fraturas dentro do canal radicular, sendo que o profissional deve estar apto a minimizar os efeitos desse acidente. Este relato de caso teve por objetivos descrever e discutir um caso clínico de uma paciente, gênero feminino, 45anos, que procurou atendimento na Clínica de Endodontia do Centro Odontológico de Estudos e Pesquisas (Coesp), João Pessoa (PB), Brasil, para o tratamento endodôntico do elemento dental com periodontite apical crônica, que possuía um instrumento F2, NiTi do sistema Protaper Universal rotatório (Dentsply Ballaiges, Maillefer, Suíça) fraturado no canal mesio-vestibular da raiz mesial do elemento 36 com periodontite apical crônica. Foram utilizadas limas C+, tipo K e Flexofile(Dentsply Ballaiges, Maillefer, Suíça) para ultrapassar o instrumento F2 Protaper Universal rotatório fraturado e em seguida foi concluído o preparo químico mecânico pela técnica escalonada com recuo anatômico.

Various root canal preparation techniques have been proposed in order to improve the process of cleaning and shaping of the root canal system, leading the root canal to be able to receive the filling material. Although confirmed the clinical efficiency of NiTi instruments, unexpected fractures may occur without any visible signs of strain in their blades. Attention should be given to the fact that during the root canal preparation, the endodontic instrument is constantly subjected to a series of forces that can provide failures. Therefore, during the root canal preparation, an important obstacle of the use of these systems is the file fracture into the root canal, and the professional must beable to minimize the effects of this accident. The aim of the present study was describe and discuss a clinical case of patient, female, 45, who requested endodontic treatment at the Endodontic Clinic of the Post- graduation course at COESP – dental center of studies and researches, João Pessoa (PB), Brazil. During the endodontic treatment of a lower, right molar (36) with apical periodontitis, a F2 Protaper Niti Instrument (Dentsply Ballaiges, Maillefer, Suíça), has been fractured into the mesio-bucal root canal system. There were used, in sequence: C + files, K files and Flexofile instruments (Dentsply Ballaiges, Maillefer, Suisse) to surpass the instrument. After that, the root canal preparation was finish by step-back preparation and the root canal was filled.

Evaluación de la calidad de las radiografías periapicables obtenidas en la clínica de endodoncia por alumnos de pre-grado / Evaluation of the quality of periapical x-rays obtained by students on the graduate endodontic clinic

Fue analizada la calidad de las radiografías periapicales de pacientes atendidos, en la Clínica de Endodoncia de la Universidad Federal de Paraíba, donde se verificó la influencia de la región radiografiada y de la etapa del tratamiento endodóncico. Las radiografías fueron analizadas por un especialista en radiología. Para el estudio del efecto de la etapa del tratamiento y para el estudio de la región, en relación a las fallas de la técnica radiográfica, fue utilizado el test chi?cuadrado (p = 0,05). De las 427 radiografías, 81.73% presentaron fallas, 16.9% fueron fallas de la técnica, 30.6% provenientes de errores del procesamiento, 3.7% mostraron fallas de causa indefinida y 48.7% presentaron fallas en más de una etapa de obtención. Las más frecuentes fueron: distorsión por angulación vertical insuficiente, falta de encuadramiento y posicionamiento incorrecto del punto (19.7%). Manchas marrones y radiografías rasguñadas fueron más frecuentes, siendo la imagen clara más frecuente para las causas indefinidas. No hubo diferencia significante entre las radiografías con fallas de la técnica, en relación a las etapas del tratamiento endodóncico (p = 0.188). La presencia de fallas en relación a las regiones radiografiadas fue más baja en la región de los incisivos inferiores que en la región de los caninos superiores (p < 0,05). Fallas radiográficas son posibles de suceder durante el tratamiento endodóncico, causando imágenes de calidad dudosa. Las regiones radiografiadas influencian la calidad de las radiografías, mientras que las etapas del tratamiento no la influencian y, las dificultades impuestas por el aislamiento absoluto pueden ser superadas respetando los principios técnicos radiográficos

The aim of the present research was to evaluate the quality of the periapical radiographic image of x-rays from patients at the Graduate Endodontic Clinic of the Federal University of Paraiba - Brazil. The influence of the region of the body to be radiographed and the phase of the endodontic treatment were evaluated. A radiologist evaluated the x-rays. Of the total of 427 radiographs, 81.73% failed, while 16.9% showed failures of technique, 30.6% had failures due to errors in processing, 3.7% showed failures of undefined phase and 48.7% Radiographs showed failures of more than one stage of obtainment. The most frequent failures were: distortion by insufficient vertical angle, lack of context and incorrect positioning of the film (19.7%). Brown spots and scratched radiographs were the most frequent failures. Clear images were the most common failures for the phase undefined. Chi-square test at the level of significance of 0.5% showed no statistical significant differences between radiographs with technical errors, taking into account the phases of the endodontic treatment (p = 0,188). The presence of failures on the radiographed regions was lower in the region of the lower incisors when compared to the region of upper canines (p <0.05). Radiographic failures can occur during endodontic treatment that leads the obtainment of images with poor quality. Radiographed regions influences the quality of radiographs, whereas the phases of endodontic treatment does not influence the quality of the periapical x-ray's obtainment during the endodontic treatment. In addition, the difficulties imposed by the rubber dam can be surpassed if the requirements of obtaining the radiographs are followed

Revisão sistemática sobre a capacidade de selamento apical do Resilon/Epiphany® e da guta-percha/cimento / Systematic review about capacity of Resilon/Epiphany® and gutta-percha/cement to seal the apex of the root canal

Ao se obturar o sistema de canais radiculares, deseja-se que o material obturador apresente, entre suas propriedades, biocompatibilidade, selamento e que seja estável dimensionalmente. Sabe-se que, tanto da região apical como da coronária, fluidos e micro-organismos fluem, o que pode ocasionar uma contaminação do canal radicular ou então servir de nutriente para as bactérias que possam ter ficado após o preparo químico-mecânico, levando-se, assim, ao insucesso do tratamento endodôntico. Os materiais e métodos usados para execução da obturação têm sido amplamente estudados a fim de se conseguirem os melhores resultados, o que ainda representa um grande desafio na Endodontia. O objetivo desta revisão sistemática foi avaliar os estudos comparativos entre o sistema obturador de canais radiculares Resilon/Epiphany® e a guta-percha/cimento, apontando qual deles apresentou melhor capacidade seladora. Os resultados mostraram que, em se tratando de selamento apical, o Resilon/Epiphany® pode substituir a associação guta-percha/cimento. Contudo, estudos comparativos das outras propriedades desse sistema obturador são imprescindíveis.

During the obturation procedure of the root canals system is important that the filling substance presents among its qualities biocompatibility, sealing and that it can be dimensionally stable. There is a flow of fluids and microorganisms in the apical and coronary area, that can cause the contamination of the root canal or serve as nutriment to bacteria that can have remains after chemical and mechanical preparation, this situation will lead to failure to the endodontic treatment. The materials and methods used to the execution of obturation have been largely studied in order to get better results, what still representing a great challenge in Endodontics. The main purpose of this research was to evaluate the comparative studies between the obturator system of root canals Resilon/Epiphany® and the gutta-percha/cement, pointing which of them presents best sealing capacity. The results showed that, concerning to apical sealing, Resilon/Epiphany® can substitute the association of gutta/percha convention, however comparative studies of other qualities of the system filled are indispensable.

Resistencia al cizallamiento de dos sistemas adhesivos autocondicionantes en dientes decíduos - estudio in vitro / Two esistance shear adhesive systems auto conditioners in deciduous teeth - study in vitro

El objetivo de este trabajo fue comparar la fuerza de adhesión de dos sistemas adhesivos dentinários en dientes deciduos. Treinta y seis dientes deciduos fueron seleccionados y almacenados en agua en temperatura ambiente por un período no superior a 6 meses después de la extracción. Los dientes fueron incluidos en resina acrílica de autocurado y desgastados hasta exponer la dentina. Los especimenes fueron seleccionados y divididos en 4 grupos (n = 9), en cada uno de ellos fue demarcada una área de 2mm de diámetro, donde se aplicaron los adhesivos: Adhese ® y Clearfil SE Bond®, para adherir conos de resina compuesta y compómero que fueron construidos para el experimento. Fueron sometidos a prueba las siguientes combinaciones: G1 = Adhese® + Filtek Z-250®, G2 = Adhese® + Dyract®, G3 = Clearfil SE Bond® + Filtek Z-250® and G4 = Clearfil SE Bond® + Dyract®. Después de 48 horas en agua destilada, se realizó la prueba de resistencia al cizallamiento (1.0 mm/minuto). Finalizada la prueba en los 4 grupos, los especimenes fueron observados en estéreo microscopio para verificar el tipo de fractura. La fuerza de adhesión varió de 3.77 a 7.90 MPa. No fueron observadas diferencias estadísticamente significantes (p > 0.05) y el tipo de fractura mas común fue la adhesiva. El mayor valor de adhesión fue encontrado en el G4 y el menor en el G1, no se observaron diferencias estadísticamente significativas entre los grupos

The aim of this study was to compare the shear bond strengths of two adhesive systems to the dentine of primary teeth. Thirty-six human non-carious primary teeth were collected and stored in water at room temperature for no longer than 6 months after extraction. The teeth were embedded in acrylic resin and the dentin was exposed (carbide paper 120, 400 and 600 grit) and the specimens were randomly assigned in four groups (n=9). A 2mm-diameter dentin bonding site was demarcated, the adhesive systems (Adhese® and Clearfil SE Bond®) were applied and resin composite and compomers cones were bonded. The following 4 combinations were tested: G1 = Adhese® + Filtek Z-250®, G2 = Adhese® + Dyract®, G3 = Clearfil SE Bond® + Filtek Z-250® and G4 = Clearfil SE Bond® + Dyract®. After 48 hours in distilled water, tensile bond strength was tested to failure (1.0 mm/minute). After measuring shear bond strengths, specimens were prepared for stereomicroscopy evaluation and identification of failure type. Shear bond strength values ranged from 3.77 to 7.90 MPa. No statistically significant differences were found among the shear bond strengths (p > 0.05) of the groups and the mode of failure was mostly adhesive. The highest shear bond strength was achieved by G4 and the lowest by G1 and no differences statistically between the groups were observed

Importância do selamento provisório no sucesso do tratamento endodôntico / Temporary restoration: importance in endodontic success

Uma revisão da literatura buscou estabelecer a importância do selamento cervical no sucesso do tratamento endodôntico, bem como subsidiar o clínico na escolha adequada do material a ser empregado. O uso de materiais temporários na endodontia é um fator importante para o sucesso do tratamento endodôntico. Nesse sentido, diferentes materiais vêm sendo empregados,classificados como a base de óxido de zinco e eugenolreforçado, a base de óxido de zinco e eugenol e sulfato de cálcioe a base de resina composta fotopolimerizável, empregando-se também para esse fim a guta-percha o cimento de fosfato de zinco, o cimento de policarboxilato e o ionômero de vidro.Dentro destes materiais, os a base de óxido de zinco e eugenole sulfato de cálcio, Cavit, Cimpat, Coltosol, Citodur, entreoutros, mostraram melhor capacidade de vedamento, mas compouca resistência aos esforços mastigatórios. Por tanto,sugere-se o selamento duplo como o procedimento de eleiçãopara a prevenção da infiltração bacteriana. Novos estudos que levem ao estabelecimento definitivo das manobras técnicas prévias à inserção do material provisório, bem como ao estudodas propriedades físicas, químicas e biológicas destes materiais são necessários

Avaliaçäo da adesividade do cimento ketac-cem na superfície de dentina radicular tratada com diferentes substâncias / Bond strength evaluation of the Ketac-Cem cement on root dentine surface conditioned with different substances

O presente trabalho teve como objetivo avaliar a adesividade de cimento empregado na cimentaçäo de retentor intrarradicular na superfície de dentina humana sem tratamento ou quando tratada com: irrigaçäo de tetrafluoreto de titânio 4 por cento durante 4 minutos; gel de ácido fosfórico 37 por cento por 30 segundos; irrigaçäo com 10ml de EDTA-T 17 porcento seguida de irrigaçäo com 10ml de hipoclorito de sódio a 0,5 por cento. Os resultados mostraram que o grupo cuja dentina foi tratada com ácido fosfórico apresentou a maior adesividade, sendo superior estatisticamente aos outros três grupos. O grupo do tetrafluoreto apresentou a segunda colocaçäo, sendo também superior estatisticamente aos grupos do EDTA-T/NaOCl e sem tratamento, que näo apresentaram diferenças estatísticas entre si. Concluiu-se que os espécimes tratados em gel de ácido fosfórico 37 por cento promoveram a melhor resistência adesiva do cimento de ionômero de vidro Ketac-Cem

Propriedades físicas dos cimentos endodônticos Endobalsam e N-Rickert / Physical properties of root canal sealers Endobalsam and N-Rickert

Este estudo compara os cimentos endodônticos Endobalsam e N-Rickert quanto a escoamento, tempo de trabalho, espessura da película e radiopacidade. Foi empregada a metodologia descrita na especificaçäo n§ 57 da ADA. Os resultados mostraram diferenças significantes entre o Endobalsam e o N-Rickert com relaçäo ao escoamento (46 e 44 mm, respectivamente), ao tempo de trabalho (5'00 e 5'30"), à espessura da película (40 e 75 mm) e à radiopacidade (equivalente a escada de alumínio de 4 mm e além de 10 mm). Quanto ao escoamento, ambos cumpriram com as especificaçöes da ADA. Com relaçäo ao tempo de trabalho e à espessura da película, o cimento N-Rickert mostrou valores maiores, mas näo atende a especificaçäo da ADA quanto à espessura do filme. A radiopacidade dos cimentos testados foi exigida pela ADA

Avaliaçäo do selamento, marginal apical dos cimentos endodônticos Endobalsam e N-Rickert / Assessment of the apical leakage observed with the use of the root canal sealers Endobalsam and N-Rickert

Este estudo compara a efetividade do selamento marginal apical de dois cimentos endodônticos: Endobalsam e N-Rickert. Para tal, empregaram-se 32 dentes unirradiculares, os quais foram preparados segundo a técnica de Paiva & Antoniazzi e impermeabilizados na sua superfície externa com cianocrilato de metila. Dez deles foram obturados com o cimento Endobalsam e 10, obturados com o cimento de N-Rickert; os espécimes restantes foram usados como controle. A seguir, foram submersos em corante azul de metileno, onde permaneceram por um período de 48 horas. Os resultados mostraram diferenças entre o Endobalsam e o N-Rickert quanto à qualidade do selamento apical (3,49 e 0,71 mm de penetraçäo do azul de metileno). Conclui-se que os cimentos testados apresentaram diferenças significantes entre si, apresentando altos valores de infiltraçäo os espécimes obturados com o cimento Endobalsam quando comparados com os obturados com o N-Rickert

Avaliaçäo "in vitro" da capacidade antibacteriana de cones de guta-percha utilizados na obturaçäo de canais radiculares / \"In vitro\" evaluation of the antibacterial activity of endodontic gutta-percha points used as root canal obturation

Foi avaliada "in vitro" a capacidade antibacteriana de cones de guta-percha utilizados na obturaçäo de canais radiculares. Para tal, selecionaram-se, equitativamente distribuídos, 44 cones de cada uma das seguintes marcas: Kerr, Maillefer, Dentsply e Tanari. Para a análise da capacidade antibacteriana dos referidos cones, empregou-se uma cultura de Staphylococcus aureus ATCC 25923, semeada em meio ágar infuso cérebro-coraçäo. Nenhum dos cones testados mostrou alguma atividade contra a cepa bacteriana utilizada