Terapia Pulpar Vital en Diente con Fractura Coronaria Complicada

La fractura coronaria es el traumatismo dentoalveolar (TDA) más frecuente en la dentición permanente. Cuando existe exposición pulpar, se conoce como fractura coronaria complicada (FCC). Actualmente, en estos casos, se recomienda realizar terapias que permitan preservar la vitalidad del tejido pulpar, tanto en dientes maduros como inmaduros. El presente reporte describe el caso de un paciente de 9 años con FCC en diente 2.1, donde se realizó tratamiento con terapia pulpar vital (pulpotomía de Cvek), y adhesión de fragmento dentario. En los controles posteriores al TDA (1 semana, 4 meses, 1 y 2 años) el diente estaba asintomático, se observó formación de puente dentinario y continuación de desarrollo radicular con cierre apical, indicios de que el tejido pulpar se mantuvo vital. En este caso se destaca la importancia del diagnóstico, tratamiento adecuado, junto al seguimiento de un diente con desarrollo radicular incompleto.

Crown fracture is the most frequent dental traumatic injury (DTI) in permanent dentition. When there is pulp exposure, it is known as a complicated crown fracture. Currently, in these cases, it is recommended to carry out therapies that allow preserving the vitality of the pulp tissue, both in mature and immature teeth. This report describes the case of a 9-year-old patient with a complicated crown fracture in tooth 2.1, who underwent treatment with vital pulp therapy (Cvek pulpotomy), and adhesion of the dental fragment. In follow-up sessions (after 1 week, 4 months, 1 and 2 years), the tooth was asymptomatic. It was observed dentin bridge formation and the continuation of root development with apical closure, indications that the pulp tissue has remained vital. In this case, the importance of proper diagnosis and treatment is highlighted, together with the follow-up of a tooth with incomplete root development.

Caracterización del Traumatismo Dentoalveolar Concomitante a Trauma Maxilofacial en Personal Profesional de Fuerzas Armadas: Revisión Narrativa

El trauma maxilofacial es un problema de salud pública, comúnmente asociado a traumatismo dentoalveolar. Su prevalencia es alta, siendo más frecuente en poblaciones de riesgo, como personal de Fuerzas Armadas, esto por sus actividades laborales, generando gran impacto en el paciente. Caracterizar, según la literatura, el traumatismo dentoalveolar concomitante a trauma maxilofacial en el personal profesional de Fuerzas Armadas. Se realizó una revisión narrativa en cuatro bases de datos, en octubre del 2020. Se incluyeron publicaciones de máximo 5 años de antigüedad, en inglés o español, con resumen disponible, estudios primarios y revisiones sistemáticas. Se excluyó publicaciones no disponibles en texto completo y reportes de casos. Se incluyeron 15 artículos. Existe un déficit de evidencia sobre la asociación que existe entre traumatismo dentoalveolar y traumatismo maxilofacial en la población estudiada. Encontrándose que solo el 6,7 % de estos incluía en su análisis la concomitancia entre ambos tipos de traumas. Sin embargo, los diagnósticos más prevalentes consistieron en fracturas coronarias y mandibulares, respectivamente, asociadas a actividades de entrenamiento y combate. Se establece que el tipo de trauma maxilofacial más frecuente en la población profesional de Fuerzas Armadas es la fractura mandibular y en relación al traumatismo dentoalveolar, la fractura coronaria. En cuanto a la etiología, destacan las heridas de bala, explosivos y accidentes en vehículos, afectando principalmente a personal del Ejército entre 18 a 30 años. Es importante mencionar que los artículos incluidos en esta revisión que hacen referencia a la concomitancia entre el traumatismo dentoalveolar y maxilofacial son escasos y no se encuentran actualizados, por lo que, se necesita continuar investigando en esta temática.

The maxillofacial injuries are a public health issue commonly associated to dentoalveolar injuries. Its high prevalence in risk population such as the Armed Forces personnel, due to their work activities, generates a great impact on the patient. Characterize, according to the literature, dentoalveolar injuries within the maxillofacial injuries in professional Armed Forces personnel. A narrative research was conducted on October 2020 with four data bases. Only 5-year-old publications were considered both in English and Spanish, including their available summary, primary studies and systematic revisions. Publications without full access or report cases were not included. Fifteen scientific papers were included. There is a deficit of evidence between maxillofacial and dentoalveolar injuries in the target population. Only 6.7 % of the research included a joint analysis between both traumas, however the most prevalent diagnosis consisted in coronaries and mandibular fractures, in that order, associated mainly to training and combat activities. The most frequent maxillofacial injury within the Armed Forces personnel is the mandibular fracture, and in relation with dentoalveolar injuries is the coronary fracture. Regarding the etiology, gunshot wounds, explosives and car accidents are featured affecting mainly between 18 to 30 years old army personnel. It's relevant to highlight that the scientific papers included in this revision about the association between dentoalveolar and maxillofacial injuries are poor and not updated. Further research is needed in this issue.

Sinopsis de la Situación de Salud Oral en Chile - Parte IV: Traumatismo Dentoalveolar

RESUMEN: Objetivo: Sintetizar los resultados de estudios epidemiológicos sobre Traumatismo Dentoalveolar (TDA) en la población chilena. Material y métodos: Se realizó una revisión sistemática de la literatura para identificar estudios poblacionales a nivel nacional, regional, provincial y comunal, además de datos de servicios dentales de atención primaria y secundaria sobre TDA en Chile. Resultados: Se incluyeron 2 estudios con representatividad nacional y 8 realizados en centros de atención en salud. A nivel nacional, la prevalencia de TDA a los 6 años fue de un 2.57%, y a los 12 años, 4.97%. En los estudios realizados en centros de salud, el diagnóstico más prevalente en dentición primaria fueron las lesiones de tejidos de soporte y en dentición permanente, la fractura coronaria. Fue más frecuente la afectación de un solo diente, y los incisivos centrales superiores fueron los dientes más afectados. Conclusiones: Los estudios representativos de la población en Chile son escasos, realizados hace más de una década y representativos sólo de la población de 6 y 12 años, lo cual pone de manifiesto la necesidad de mayor información epidemiológica sobre el TDA en la población chilena.

ABSTRACT: Aim: To summarize the evidence on epidemiological studies about traumatic dental injuries (TDI) in Chile. Methods: A systematic literature review was carried out in two databases to identify population studies at national, regional, provincial and community levels, as well as reports from primary and secondary dental care services, regarding TDI in Chile. Results: Two studies with national representation and eight studies from primary and secondary healthcare centers were included in the analysis. National prevalence for 6-year-old children was 2.57%, and 4.97% for 12-year-old children. While the most frequent diagnosis in primary dentition was traumatic injury involving tooth-supporting tissues, the most commonly reported diagnosis in permanent dentition was crown fracture. Single tooth affection was more frequent, and the upper central incisors were the most affected teeth. Conclusions: Data on representative studies about TDIs in Chile are scarce. Few studies, carried out more than a decade ago and only on 6- and 12-year-old children are available. There is a need for further epidemiological information about TDIs in Chile.

Traumatismo Dentoalveolar en Personas con Parálisis Cerebral. Revisión Sistemática y Metaanálisis

RESUMEN: La parálisis cerebral (PC) es un trastorno neurológico que afecta aproximadamente 2 de cada 1000 nacidos vivos. Se describe como un grupo de trastornos del desarrollo del movimiento, equilibrio y postura, que causan limitación de actividad. Algunos estudios han planteado que la PC podría aumentar el riesgo de traumatismos dentoalveolares (TDA). El objetivo de este estudio fue revisar la evidencia científica disponible sobre prevalencia y tendencias de TDA en pacientes con PC, y compararla con la prevalencia de TDA en sujetos sin PC. Se realizó una búsqueda sistemática en Pubmed, Scielo y Lilacs. Se evaluaron títulos y resúmenes, excluyendo casos clínicos, revisiones sistemáticas, artículos duplicados y/o no atingentes al tema. Se incluyeron artículos que reportan prevalencia de TDA en personas con PC y se extrajo la información sobre el tipo estudio, metodología, prevalencia, tipo de diente, de TDA más frecuente en PC y datos de prevalencia de grupo control. Se identificó un total de 32 artículos, de los cuales se seleccionaron e incluyeron 12 estudios para la revisión sistemática y de ellos cuatro se utilizaron en el metaanálisis. La prevalencia de TDA en personas con PC reportada en estos estudios mostró un rango entre 10,6-76,5 %. Los incisivos superiores fueron el tipo de diente más afectado por TDA. Sólo cuatro estudios comparan con un grupo control. La prevalencia de TDA fue mayor en sujetos con PC que en sujetos sanos (odds ratio 1,58 [95 % IC= 0,66 - 3,77]). Sin embargo, esta diferencia no fue estadísticamente significativa y los estudios incluidos presentaron una alta heterogeneidad.

ABSTRACT: Cerebral palsy (CP) is a neurological disorder that affects approximately 2 out of every 1,000 live births. It is described as a group of developmental disorders of movement, balance, and posture, which cause activity limitation. Some studies have suggested that CP may increase the risk of dental trauma injuries (DTI). The objective of this study was to review the available scientific evidence on the prevalence and trends of DTI in people with CP, and to compare it with the prevalence of people without it. A systematic search was carried out in Pubmed, Scielo and Lilacs. Titles and abstracts were evaluated, excluding clinical case reports, systematic reviews, duplicate articles and/ or not relevant to the topic. Articles reporting the prevalence of DTI in people with CP were included. It was extracted information about the study type, methodology, prevalence of DTI, type of tooth, type of DTI in CP subjects and the prevalence of DTI from the control group, when available. A total of 32 articles were identified, of which 12 studies were selected and included for the systematic review and of these four were used in the meta-analysis. The prevalence of DTI in people with CP reported in these studies showed a range between 10.6-76.5 %. The upper incisors were the type of tooth most affected by DTI. Only four studies compared the DTI prevalence with a control group. The prevalence of DTI was higher in subjects with CP than in people without it (odds ratio 1.58 [95 % CI = 0.66 - 3.77]). However, this difference was not statistically significant and the included studies were highly heterogeneous.

Post-trauma complex orthodontic approach: the impact of psychological issues of bullying on treatment decision

ABSTRACT Objective: This article aims to discuss the multidisciplinary approach required in the treatment of cases of impaction and ankylosis of permanent teeth, associated with a history of trauma, considering the psychological state of the child and family when faced with a traumatic case of bullying, by reporting the complex treatment of a central incisor needing to be orthodontically moved across the midline. Conclusion: This clinical case was a major challenge, which included complex multidisciplinary procedures. Results and stability after 26 months of retention indicated successful orthodontic space closure of two maxillary teeth, without the use of implants or prostheses, in an adolescent patient who had a history of dental trauma, alveolar bone loss, and an uncertain initial prognosis.

RESUMO Objetivo: O presente artigo tem como objetivo discutir a abordagem multidisciplinar necessária no tratamento de casos de impacção e anquilose de dentes permanentes, associados a histórico de trauma, considerando o estado psicológico da criança e da família diante de situações traumáticas de bullying, por meio do relato do tratamento complexo de um incisivo central que precisava ser movido ortodonticamente através da linha média. Conclusão: Esse caso foi um grande desafio, que incluiu procedimentos multidisciplinares complexos. Os resultados e a estabilidade após 26 meses de contenção indicaram fechamento ortodôntico bem-sucedido do espaço de dois dentes superiores, sem o uso de implantes ou próteses, em uma paciente adolescente que apresentava histórico de trauma dentário, perda de osso alveolar e prognóstico inicial incerto.

Avulsión dental y mantenedor de espacio estético-funcional y correctivo en Odontopediatría / Dental avulsion and esthetic-functional and corrective retainers use in Pediatric Dentistry / Avulsão dentária e mantenedor do espaço estético-funcional e corretivo em Odontopediatria

RESUMEN Se presentó el caso de un niño de 8 años que acudió al Servicio de Estomatología del Policlínico Universitario "Chiqui Gómez Lubián", de Santa Clara, provincia Villa Clara. En el mismo se observó avulsión del incisivo central superior derecho, fractura no complicada de la corona en incisivo central superior izquierdo y una marcada vestibuloversión. Se confeccionó un aparato placa Hawley de acuerdo a las características y necesidades del paciente, con el fin de lograr la recuperación estética, mantener la longitud del arco y corregir la vestibuloversión en el mismo. El aparato permitió obtener un resultado satisfactorio, que ha influido psicológicamente en el paciente al elevar su autoestima y salud bucal.

ABSTRACT A boy of 8 years old was seen in the dental service at the Policlínico Universitario "Chiqui Gómez Lubián", in Santa Clara, Villa Clara. Examination revealed avulsion in the right upper central incisor, uncomplicated crown fracture in left upper central incisor and an improper alignment of the teeth. Taking into account patients´ characteristics and requirements, it was fabricated a Hawley´s retainer in order to achieve a better aesthetic outcome, maintain the length of the dental arch and correct the improper alignment of the teeth. The appliance has achieved a satisfactory outcome, which has had a psychological influence on the patient by improving his self-esteem and oral health.

RESUMO Foi apresentado o caso de um menino de 8 anos que veio ao Serviço de Estomatologia do Policlínico Universitario "Chiqui Gómez Lubián", em Santa Clara, província de Villa Clara. Neste, observou-se avulsão do incisivo central superior direito, fratura não complicada da coroa em incisivo central superior esquerdo e vestibuloversão acentuada. Um dispositivo de placa de Hawley foi confeccionado de acordo com as características e necessidades do paciente, a fim de se obter recuperação estética, manter o comprimento do arco e corrigir a vestibuloversão nele. O dispositivo permitiu obter um resultado satisfatório, o que influenciou psicologicamente o paciente, elevando sua autoestima e saúde bucal.

Resolución integral de una fractura coronorradicular complicada por traumatismo dentoalveolar: informe de un caso / Integral resolution of a complicated crown-root fracture by dentoalveolar traumatism: report of a case

Objetivo: Mostrar una alternativa de tratamiento para las fracturas coronorradiculares complicadas, que restablece la función y la estética de las piezas traumatizadas. Caso clínico: Una paciente de 16 años se presentó en la guardia del Centro Odontológico OSEP tras haber sufrido un accidente vial que le produjo un traumatismo dentoalveolar. El diagnóstico fue fractura coronaria sin exposición pulpar de la pieza dentaria 12 y fractura coronorradicular complicada de la pieza 11. El tratamiento incluyó restauración con resina compuesta de la pieza 12 y endodoncia, extrusión ortodóntica, alargamiento coronario y rehabilitación con perno de fibra de cuarzo y corona de resina compuesta de la pieza 11. Conclusiones: El tratamiento de las fracturas coronorradiculares representa un desafío para el odontólogo. Los resultados del tratamiento, en este paciente, fueron excelentes, ya que lograron devolver estética y función (AU)

Aim: To show an alternative treatment for complicated crown-root fractures, which restores function and aesthetics of the traumatized teeth. Case report: This paper reports the case of a 16-yearold girl who attends the OSEP Dental Center, stating that she had suffered a traffic accident resulting in a dentoalveolar trauma. The diagnosis was a coronary fracture without pulp exposure of tooth 12, and complicated crown-root fracture of tooth 11. Treatment included composite resin restoration of tooth 12 and endodontic, orthodontic extrusion, crown lengthening and rehabilitation with quartz fiber post and composite resin crown of tooth 11. Conclusions: The treatment of crown-root fractures poses a challenge for the dentist. The results of the treatment in this patient were excellent, and aesthetics and function were restored (AU)

Protector bucal por laminado a presión en paciente deportista / Pressure lamination technique mouthguard for athlete patient

RESUMEN: El traumatismo dentoalveolar incluye un conjunto de lesiones que afectan a los dientes y/o estructuras de soporte a consecuencia de un impacto violento directo o indirecto. Debido a que por lo general comprometen el sector anterior generan cambios físicos, fonéticos, psicológicos y dietarios, que pueden afectar significativamente la calidad de vida de pacientes afectados por este traumatismo. Los protectores bucales son considerados la principal medida para minimizar y/o evitar estos traumatismos. El presente artículo describe el tratamiento y procedimientos para realizar un protector bucal por laminado a presión en un paciente deportista con historia previa de traumatismo dentoalveolar en incisivos centrales superiores.

ABSTRACT: Traumatic dental injuries involve lesions that affect teeth and/or adjacent supporting structures as a consequence of direct or indirect violent impact. Due to As it affects the anterior teeth, in most of the cases, it provokes changes in the physical appearance, altering phonetics, psychology and the diet of the affected subject. These changes may significantly alter the quality of life of patients affected by this type of trauma. Mouthguards are considered the primary appliance for minimizing and/or avoiding dental trauma. The present article describes the treatment and procedures to perform a mouthguard by pressure lamination technique in a patient that who practices sports and with a history of trauma affecting the upper central incisors.

Retrospective Study of Traumatic Dental Injuries of Patients Treated at a Dental Trauma Clinic in Santiago, Chile / Estudio retrospectivo de Casos Atendidos en Clínica de Traumatología Dentoalveolar en Santiago, Chile

ABSTRACT: The aim of this study was to carry out a retrospective study of cases seen at the Child and Adult Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile, Santiago. A retrospective study was carried out analysing the records of patients seen at the Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile from January 2012 to March 2017. The inclusion criteria was that patient complaint was due to dental trauma. Data were tabulated indicating age and sex of the patient, cause, day, and tooth involved and the initial diagnosis of the dental trauma. Chi-square, Shapiro Wilk normality test and Mann-Whitney test were used for frequency analyses. A total of 117 dental records were analysed, 90 of these met the inclusion criteria. The age range of the sample was 5 to 60 years, and the average age was 14.3 years. Most injuries occurred in patients during the first and second decades of their life. Of the patients, 59.3 % were men and 40.7 % were women. The most frequent dental traumas were complicated and uncomplicated crown fractures, followed by root fractures. In the majority of the cases analysed, only one tooth was affected, and the tooth most frequently traumatized was the right upper central incisor, followed by the left upper central incisor. The most frequent dental trauma of the cases treated at the Child and Adult Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile, Santiago, between 2012 and 2017 were crown fractures.

RESUMEN: El objetivo fue realizar un estudio retrospectivo de los casos que acuden a la clínica de Traumatología Dentoalveolar (TDA) Pediátrica y del Adulto de la Clínica de Odontología de la Universidad de Chile. Se realizó un estudio retrospectivo analizando las fichas de pacientes atendidos en la Clínica de TDA de la Facultad de Odontología, Universidad de Chile desde enero 2012 hasta marzo 2017. El criterio de inclusión fue motivo de consulta por traumatismo dentoalveolar inmediato. Se tabularon datos consignando sexo y edad del paciente, causa, día, diente involucrado y diagnóstico inicial del TDA. Para los análisis de frecuencia se utilizó Chi-cuadrado, el test de normalidad de Shapiro Wilk y test de Mann-Whitney. Se analizaron un total de 117 fichas, donde 90 cumplieron con los criterios de inclusión. El rango de edad de la muestra fue de 5 a 60 años, con un promedio de 14,3 años. Siendo la primera y la segunda década de vida donde ocurren con mayor frecuencia los traumatismos. El 59,3 % eran hombres y 40,7 % mujeres. El TDA más frecuente fueron las fracturas coronarias complicadas y no complicadas, seguido por fracturas radiculares. En la mayoría de los casos analizados sólo un diente se encontraba afectado. El diente más frecuentemente traumatizado fue el incisivo central superior derecho, seguido por el izquierdo. Las causas más frecuentes de traumatismo fueron por caída y golpe. De los casos atendidos en la clínica de TDA de la Universidad de Chile entre 2012 y 2017 el traumatismo más frecuente es la fractura coronaria.

Tratamiento de la intrusión dentaria en un infante / Treatment of tooth intrusion in infant

Las lesiones traumáticas dentarias en los infantes son motivo de consulta de emergencia en la cual los odontólogos deben estar preparados para asumir la resolución de este problema, el objetivo del presente reporte de caso es describir la atención de emergencia de un infante de 4 años de edad quién presenta una intrusión dentaria de la pieza 5.1 y la evaluación clínica, diagnóstico, plan de tratamiento y tratamiento de emergencia. (AU)

Dental traumatic injuries in infants are of emergency consultation in which dentists should be prepared to take the resolu-tion of this problem, the objective of this case report is to describe the emergency care of a child under 4 years of age who has a dental intrusion part 5.1 and clinical assessment , diagnosis , treatment plan and emergency treatment. (AU)

Prognóstico e tratamento da avulsão dentária: relato de caso / Prognosis and treatment of tooth avulsion: a case report

A avulsão dentária é um tipo de traumatismo dentoalveolar que traz grande preocupação quanto ao prognóstico do paciente. As medidas de acondicionamento de dentes avulsionados são imprescindíveis para o sucesso do tratamento. O presente artigo propõe um relato de caso de avulsão dentária abordando as principais medidas de conservação dos elementos dentários e a importância do tempo entre a avulsão e seu reimplante no alvéolo... (AU)

The tooth avulsion is a type of dentoalveolar trauma that brings great concern about the patient's prognosis. Measures of packaging of avulsed tooth are essential for a successful treatment. This article proposes a case of tooth avulsion addressing the main measures for the conservation of dental elements and the importance of time of avulsed tooth to their reimplantation in the socket... (AU)

Comportamiento de traumatismos dentoalveolares en niños deportistas del área "Ciro Frías", del municipio de Arroyo Naranjo / Behavior of dentoalveolar traumas among children from Ciro Frías sports area in the municipality of Arroyo Naranjo

Los traumatismos dentoalveolares constituyen una de las principales urgencias estomatológicas. Objetivo: caracterizar el comportamiento de los traumatismos dentarios en niños deportistas del área Ciro Frías. Métodos: se realizó un estudio observacional descriptivo, de corte transversal, en deportistas menores de 19 años del área Ciro Frías, del municipio Arroyo Naranjo, La Habana, desde febrero de 2011 hasta febrero de 2012. El universo estuvo constituido por 57 niños. Se utilizó un formulario de datos creado por los autores y validado por un comité de expertos; se realizó examen bucal y facial; se vaciaron los datos y se procesaron utilizando estadística descriptiva. Las variables estudiadas fueron: edad, sexo, deporte, momento del traumatismo, dientes lesionados, localización en la arcada, tipo de trauma dentario, etiología, asistencia al estomatólogo y tratamiento. Resultados: los niños que más traumatismos dentarios presentaron fueron los de 12 a 14 años (45,6 por ciento) y el sexo más afectado fue el masculino (77,2 por ciento). Los traumas ocurrieron principalmente fuera del entrenamiento (61,4 por ciento) y el deporte con más niños afectados fue el Karate (19,3 por ciento). Los dientes más dañados fueron los incisivos centrales superiores (62,9 por ciento). La fractura no complicada de la corona (32,3 por ciento) fue la lesión más acentuada. La etiología principal de los traumas fue la práctica de deportes (36,8 por ciento). El 68,4 por ciento de los niños no recibieron tratamiento. Conclusiones: predominaron los traumas en el sexo masculino, entre 12 a 14 años, fuera del entrenamiento. El deporte con más niños afectados fue el Karate. Los dientes más lesionados fueron los incisivos centrales superiores. Los traumatismos más frecuentes fueron las fracturas no complicadas de la corona y la infractura del esmalte. Las causas de traumatismos dentarios más frecuentes fueron la práctica de deportes y las caídas. Prevalecieron los niños que no asistieron a consulta estomatológica y que no recibieron tratamiento(AU)

Dentoalveolar traumas are one of the main causes of dental emergencies. Objective: characterize the behavior of dental traumas among children from "Ciro Frías" sports area. Methods: an cross-sectional observational descriptive study was conducted with children under 19 years of age from Ciro Frías sports area in the municipality of Arroyo Naranjo, Havana, from February 2011 to February 2012. The study universe was composed of 57 children. Data collection was based on a form developed by the authors and validated by an experts committee. Oral and facial examination was performed, and the information was recorded and processed using descriptive statistics. The variables studied were age, sex, sport, time of trauma, injured teeth, location in the arcade, type of dental trauma, etiology, visit to the dentist and treatment. Results: dental traumas predominated in the 12-14 age group (45,6 percent) and the male sex (77,2 percent). Most (61,4 percent) occurred outside training sessions, and karate was the sport with most injured children (19,3 percent). Upper central incisors were the most commonly affected teeth (62,9 percent). Uncomplicated crown fracture was the most common injury (32,3 percent). Sports practice was the main etiology of traumas (36,8 percent). 68,4 percent of the children injured did not receive any treatment. Conclusions: there was a predominance of the male sex, the 12-14 age group and occurrence outside training sessions. Karate was the sport with most children injured. Upper central incisors were the most commonly affected teeth. The most common traumas were uncomplicated fractures of the crown and the enamel infrastructure. The most common causes of dental traumas were sports practice and falls. There was a predominance of children not visiting the dentist and not receiving treatment(AU)

A multidisciplinary direct restorative approach for recovering crown-root fractures in young patients: a case report / Tratamento multidisciplinar restaurador direto para reabilitação de fraturas corono-radiculares em pacientes jovens: relato de caso

The aim of this article is to describe a step-by-step protocol for emergency care of a young patient with multidisciplinary direct restorative approach for recovering crown-root fractures. Fractures of maxillary incisors are a frequent consequence of trauma in children and teenagers. Glass fiber post associated with composite resin restoration represents a conservative approach for this rehabilitation. This paper presents a case of a 14-year-old male patient with a crown-root fracture in a left maxillary lateral incisor. The patient was submitted to a periodontal surgery for coronal lengthening. After that, the post luting and restoration technique was performed. Finally, a mouthguard was made for preventing new trauma. The multidisciplinary treatment described for crown-root fracture rehabilitation is simple, providing esthetics and function with a conservative approach in younger patients.

O objetivo deste artigo é descrever passo a passo, um protocolo para tratamento de emergência de pacientes jovens, com abordagem multidisciplinar e restauração direta em resina composta para a reabilitação de fraturas corono-radiculares. Fraturas de incisivos superiores são uma consequência frequente de traumas em crianças e adolescentes. Pinos de fibra de vidro associados às restaurações em resina composta representam abordagem conservadora para este tipo de situação. Este artigo apresenta caso clinico de um paciente do sexo masculino de 14 anos de idade, com fratura corono- radicular em incisivo lateral superior esquerdo. Inicialmente,o paciente foi submetido à cirurgia periodontal para aumento de coroa clínica. Depois, foi realizada cimentação do pino de fibra de vidro, seguido de restauração direta em resina composta. Por fim, um protetor bucal foi confeccionado para prevenir novo trauma. O tratamento multidisciplinar descrito para reabilitação de fraturas corono-radiculares é simples, proporcionando estética e função com uma abordagem conservadora em pacientes jovens.

Respiración oral y traumatismo dentoalveolar en niños de 6 a 14 años / Oral breathing and dentoalveolar trauma in children aged 6 to 14 years

Introducción: el trauma dentoalveolar corresponde a una lesión traumática de alta prevalencia, elevado costo de tratamiento y efectos negativos a nivel funcional, estético y psicológico. Existen factores predisponentes de traumatismo dentoalveolar que coinciden con ciertas características de niños respiradores orales, sin embargo, el rol de la respiración oral como factor predisponente no está claramente determinado. Objetivo: determinar la asociación entre respiración oral y trauma dentoalveolar controlando por otras covariables en niños de 6 a 14 años. Métodos: se aplicó un estudio de casos y controles 1:2. La muestra quedó constituida por 57 casos y 113 controles asumiendo un nivel de confianza del 95 por ciento, una potencia del 80 por ciento y un 10 por ciento de pérdidas. Los casos correspondieron a niños de 6 a 14 años de edad ingresados por TDA a la Unidad de Odontopediatría del Hospital Dr. Sótero del Rí", centro de referencia que atiende a una población de 1 521 144 habitantes de la capital. Los controles correspondieron a niños voluntarios sin TDA del mismo centro asistencial y grupo etario. Los datos fueron recolectados a partir de una entrevista, además de la medición clínica y observación directa para determinar el modo respiratorio. Para diferencias entre grupos se aplicó prueba de Fisher y Mann Whitney. La asociación entre respiración oral y trauma dentoalveolar se evaluó a partir de un modelo logístico considerando sexo, resalte y edad. Resultados: la prevalencia de niños respiradores orales fue mayor en los casos con un 47,4 por ciento (p < 0,05), sin embargo, no se pudo establecer una asociación significativa entre respiración oral y trauma dentoalveolar (OR:1,875; IC 95 por ciento: 0,866 - 4,058; p > 0,05) como para ninguna de las covariables del modelo. Conclusiones: respirar a través de la cavidad oral no constituiría un aumento del riesgo de sufrir un trauma dentoalveolar durante un golpe o caída en los niños estudiados(AU)

Introduction: dentoalveolar trauma is a traumatic-high prevalent injury with high costs associated with treatment and adverse effects at functional, aesthetic, and psychological levels. There are some predisposing clinical features of dentoalveolar trauma that are also present in mouth-breathing children, however the role of mouth breathing as a predisposing factor is not clearly determined. Objective: this paper aims to determine the association between mouth breathing and dentoalveolar trauma in children aged 6 to 14 years, controlling other covariates. Methods: a case-control study 1:2 was conducted. The sample was composed of 57 cases and 113 controls, assuming 95 percent of confidence level, 80 percent of power, and 10 percent losses. The cases were children aged 6 to 14 years admitted at the Pediatric Dentistry Unit in Dr. Sotero del Río Hospital because of dental trauma. This hospital assists a population of 1.521.144 inhabitants from the capital city. Controls were conducted on volunteer children of the same age group without dental trauma who are treated at the same hospital. Data were collected from interviews, clinical measurement, and direct observation to determine respiratory mode. The Fisher and Mann Whitney test was applied to find differences between the groups. The association between mouth breathing and dentoalveolar trauma was assessed through a logistical model controlling gender, overjet, and age. Results: the prevalence of mouth-breathing children was higher, which represents 47, 4 percent (p < 0. 05). However, no significant association could be made between mouth breathing and dentoalveolar trauma (OR: 1.875; IC95 percent:0.866-4.058; p > 0. 05) and neither for any of the covariates in this model. Conclusions: breathing through the oral cavity does not constitute an increased risk of dentoalveolar trauma over a bump or fall in children aged 6 to 14 years(AU)

Nível de conhecimento dos profissionais de enfermagem, educação física e Odontologia sobre traumatismo dentoalveolar do tipo avulsão / Level of knowledge of Nursing, Physical Education and Dentistry professionals on dentoalveolar trauma and avulsion

Caracterizada pelo completo deslocamento do elemento dentário de seu alvéolo, a avulsão é o traumatismo dentoalveolar que proporciona os maiores danos funcionais, estéticos e psicológicos ao indivíduo. Diversos profissionais de saúde podem estar direta ou indiretamente relacionados a esse tipo de trauma na condução de ações preventivas e/ou emergenciais. Dessa forma, avaliou-se o nível de conhecimentos de profissionais Cirurgiões-Dentistas, Educadores Físicos e Enfermeiros sobre avulsão dentoalveolar relacionado à idade, ao sexo, a experiências e informações prévias, e no caso da Odontologia, também à especialidade de atuação...

Characterized by the total displacement of the tooth from its socket, avulsion is the dentoalveolar trauma that causes the most harmful, esthetic and psychological damage to individuals. Many health professionals may be directly or indirectly involved in this type of trama when performing preventive and/or emergency procedures. This study thus aims at evaluating the level of knowledge of dental surgeons, physical education professionals and nurses regarding dentoalveolar avulsion associated with age, sex, previous experience and informationand, in the case of dentistry, the specialty practised...

Comportamiento de los traumatismos dentoalveolares en alumnos de las ESBU del municipio Artemisa / Behaviors of dentoalveolar traumata present in urban basic secondary schools (UBSS) pupils of Artemisa municipality

El trauma dentoalveolar (TDA) es un problema de salud pública debido a su incidencia y a las graves secuelas que puede dejar. Se realizó un estudio descriptivo, retrospectivo y de corte transversal para determinar el comportamiento de los TDA en alumnos de las escuelas secundarias bàsicas urbanas del municipio Artemisa en el período comprendido entre enero y junio de 2008. El universo fue de 2 684 alumnos y de estos, 309 constituyeron la muestra al estar afectados por algún tipo de TDA. A los afectados se le registraron las siguientes variables: escuela, edad, sexo, etiología del TDA, período en que ocurrió el TDA, arcada afectada, diente lesionado y tipo de lesión. Para recoger los datos se confeccionó un formulario y estos se procesaron estadísticamente por el sistema Excel (INSTAT). Los resultados se presentaron en tablas y gràficos. Se constató que del total de alumnos examinados, sólo el 11,5 por ciento resultó afectado, con un comportamiento homogéneo del TDA en las cuatro ESBU. Al distribuirlos por sexo, aproximadamente màs de la mitad correspondió al masculino y el intervalo de edad de mayor número de afectados fue de 11-12 años. La principal causa de TDA fueron las caídas y el mayor por ciento del total de TDA ocurrió durante el período vacacional. La arcada superior fue la màs propensa a los TDA y fueron los centrales los dientes màs afectados. La pérdida de tejido coronario representó màs de la mitad de las lesiones producidas por los TDA(AU)

The dentoalveolar trauma (DAT) becomes a public health problem due to its significant incidence and the future severe sequalae. A cross-sectional, retrospective and descriptive study was conducted to determine the behavior of DATs in pupils of urban basic secondary schools of Artemisa municipality from January to June, 2008. Sample includes 2 684 pupils and from these, 309 were the real sample who was affected by some kind of DAT. In this group the following variables were registered: school, age, sex, DAT etiology, period of DAT, involved arch, involved tooth and the kind of lesion. For data collection, we designed a form and these were statistically processed by Excel system (INSTAT). Results were showed in tables and charts. We conclude that from the total of pupils examined; only the 11,5 percent was affected with a DAT homogenous behavior in the four basic secondary schools. In distribution by sex, almost the was of male sex and the age interval with higher involvement was of 11-12. The leading cause of DAT was the teeth loss and the great percentage of DAT total occurred during vacations period. The superior arch was the more sensitive to DATs and the central teeth were the more involved. The coronary tissue loss accounted for more half of lesions produced by DATs(AU)

Avaliação da movimentação dentária induzida iniciada um e três dias pós-trauma: estudo experimental em ratos / Induced tooth movement initiated one and three days after trauma event: experimental study in rats

O objetivo deste estudo foi avaliar o efeito da movimentação dentária induzida no periodonto de dentes de ratos submetidos a uma subluxação dentoalveolar. A amostra foi composta por 40 animais, divididos em oito grupos, sendo que, em dois grupos, aplicou-se um impacto padronizado de 900cN com o objetivo de promover um trauma de subluxação e, posteriormente, realizou-se movimentação dentária induzida (MDI) iniciada um e três dias após o trauma, correspondendo, respectivamente, aos grupos 7 e 8. Os grupos controle foram compostos por um grupo com periodonto normal (grupo 1- sem trauma e sem MDI), grupo MDI (grupo 2), grupos com traumatismo dentoalveolar 1, 3, 8 e 10 dias pós-trauma (respectivamente grupos 3, 4, 5 e 6). Utilizou-se para fins experimentais o primeiro molar superior direito, que foi movimentado por um período de sete dias, com uma força de 50cN. Realizou-se a eutanásia dos animais para proceder preparo histológico convencional (hematoxilina e eosina) e análise microscópica qualitativa. As alterações periodontais em consequência do traumatismo, nos grupos 3, 4, 5 e 6, se mostraram pouco expressivas. Assim, o efeito da aplicação de uma força ortodôntica logo após um evento de subluxação (grupos 7 e 8) foi bastante similar ao encontrado no grupo movimentação (grupo 2). Concluiu-se que, não houve diferença na qualidade da resposta do tecido periodontal quando se aplicou MDI em dentes recém-traumatizados

The aim of this study was to evaluate the periodontal effect of induced tooth movement (ITM) in rat molars that had been submitted to an intrusive trauma (subluxation). The sample was composed by 40 rats that were dived into eight groups: two groups, in which were applied a standardized 900cN trauma . One and three days after trauma event (groups 7 and 8), the tooth movement was induced. The control groups were composed by group 1- normal periodontium; group 2- ITM; groups 3,4,5 and 6- dentoalveolar trauma groups corresponding, respectively, to 1, 3, 8 and 10 days after trauma. The rats’ maxillary first molars were moved mesially during a seven days period with a closed coil (50cN). The animals were sacrificed and histological procedures and microscopic descriptive analysis were performed. Qualitatively, the periodontal effect of the trauma in groups 3, 4, 5 and 6 was little expressive. Consequently, the effect of induced tooth movement right after a subluxation event (groups 7 and 8) was very similar to group 2. It can be concluded that there was no difference in the quality of periodontal events when ITM was applied to teeth that had been recently traumatized

Avaliação da movimentação dentária induzida iniciada um e três dias pós-trauma: estudo experimental em ratos / Induced tooth movement initiated one and three days after trauma event: experimental study in rats

O objetivo deste estudo foi avaliar o efeito da movimentação dentária induzida no periodonto de dentes de ratos submetidos a uma subluxação dentoalveolar. A amostra foi composta por 40 animais, divididos em oito grupos, sendo que, em dois grupos, aplicou-se um impacto padronizado de 900cN com o objetivo de promover um trauma de subluxação e, posteriormente, realizou-se movimentação dentária induzida (MDI) iniciada um e três dias após o trauma, correspondendo, respectivamente, aos grupos 7 e 8. Os grupos controle foram compostos por um grupo com periodonto normal (grupo 1- sem trauma e sem MDI), grupo MDI (grupo 2), grupos com traumatismo dentoalveolar 1, 3, 8 e 10 dias pós-trauma (respectivamente grupos 3, 4, 5 e 6). Utilizou-se para fins experimentais o primeiro molar superior direito, que foi movimentado por um período de sete dias, com uma força de 50cN. Realizou-se a eutanásia dos animais para proceder preparo histológico convencional (hematoxilina e eosina) e análise microscópica qualitativa. As alterações periodontais em consequência do traumatismo, nos grupos 3, 4, 5 e 6, se mostraram pouco expressivas. Assim, o efeito da aplicação de uma força ortodôntica logo após um evento de subluxação (grupos 7 e 8) foi bastante similar ao encontrado no grupo movimentação (grupo 2). Concluiu-se que, não houve diferença na qualidade da resposta do tecido periodontal quando se aplicou MDI em dentes recém-traumatizados.

The aim of this study was to evaluate the periodontal effect of induced tooth movement (ITM) in rat molars that had been submitted to an intrusive trauma (subluxation). The sample was composed by 40 rats that were dived into eight groups: two groups, in which were applied a standardized 900cN trauma . One and three days after trauma event (groups 7 and 8), the tooth movement was induced. The control groups were composed by group 1- normal periodontium; group 2- ITM; groups 3,4,5 and 6- dentoalveolar trauma groups corresponding, respectively, to 1, 3, 8 and 10 days after trauma. The rats’ maxillary first molars were moved mesially during a seven days period with a closed coil (50cN). The animals were sacrificed and histological procedures and microscopic descriptive analysis were performed. Qualitatively, the periodontal effect of the trauma in groups 3, 4, 5 and 6 was little expressive. Consequently, the effect of induced tooth movement right after a subluxation event (groups 7 and 8) was very similar to group 2. It can be concluded that there was no difference in the quality of periodontal events when ITM was applied to teeth that had been recently traumatized.

Diagnóstico y tratamiento de traumatismo dento-alveolar en dentición permanente. Investigación documental / Diagnosis and treatment of dentoalveolar trauma in permanent dentition. Documentary research

Objetivo: proporcionar un documento que contenga información unificada, actualizada y con evidencia científica, con el propósito de fortalecer el abordaje del paciente con lesiones traumáticas dentoalveolares y ampliar las alternativas de tratamiento, Materiales y Métodos: La investigación se enmarca en el diseño de tipo experimental. Su ejecución inicio con una búsqueda de artículos y capítulos referentes al tema, en revistas y libros especializados en lesiones traumáticas dentoalveolares. Se revisaron bases de datos bibliográficos biomédicos en Internet y consulta directa en la biblioteca de la facultad de Odontología, Universidad de El Salvador, Biblioteca Universidad Evangélica y Universidad Alberto Masferrer, también se investigó en sitios Web y asesoría con odontólogos conocedores del tema de investigación. Concluida la recopilación de información, se procedió a seleccionarla en base a respaldo científico y grado de actualización, posteriormente se hicieron las traducciones respectivas, se analizó cada artículo y se procedió a la estructuración del trabajo final, considerando un orden lógico y apegado a los objetivos propuestos. El sistema de citas bibliográficas fue una cita corrida en el texto. Resultados: ciento sesenta artículos de revistas biomédicas y diecisiete libros referentes a lesiones traumáticas dentoalveolares, publicados por diferentes investigadores, fueron consultados, analizados y considerados para elaborar la investigación.

Objective: to provide a document that contains unified, updated information and with scientific evidence, in order to strengthen the approach to the patient with traumatic dentoalveolar injuries and expand the treatment alternatives, Materials and Methods: The research is framed in the experimental type design . Its execution began with a search for articles and chapters on the subject, in specialized magazines and books on traumatic dentoalveolar injuries. Biomedical bibliographic databases were reviewed on the Internet and direct consultation in the library of the Faculty of Dentistry, University of El Salvador, Evangelical University Library and Alberto Masferrer University, it was also investigated on websites and advice with dentists knowledgeable about the research topic. Once the information collection was concluded, it was selected based on scientific support and degree of updating, subsequently the respective translations were made, each article was analyzed and the final work was structured, considering a logical order and attached to the objectives proposed. The bibliographic citation system was a running citation in the text. Results: one hundred and sixty articles from biomedical journals and seventeen books referring to dentoalveolar traumatic injuries, published by different researchers, were consulted, analyzed and considered to prepare the research.