Sequential treatment and prognostic factors of traumatic root fracture in permanent anterior teeth / 口腔疾病防治

@#Root fracture is a kind of dental trauma involving dentin, cementum, pulp tissue, periodontal membrane ligament and even the surrounding alveolar bone. It occurs frequently between the ages of 10-20, mostly in the area of the maxillary anterior teeth with high aesthetic requirements. The treatment goal for root fracture in permanent teeth is to maintain the physiological and functional integrity of the tooth as much as possible and to reduce the incidence of complications. Clinicians usually classify the affected teeth according to the position of the root fracture, including the apical, mid-root, cervical-mid-root and cervical segments, since it determines the treatment plan and the prognosis of the affected teeth. CBCT examination can avoid misdiagnosis and missed diagnosis of root fracture to the greatest extent. The sequential treatment plan of root fracture after permanent anterior tooth trauma includes initial emergency treatment, pulp vitality monitoring and complication management during follow-up. Emergency treatment mainly includes local anesthesia and repositioning, if displaced, the coronal segment of the tooth as soon as possible. Then, after checking its position radiographically, adjustment occlusion and flexible splinting for 4 weeks (4 months for cervical root fracture). The process of root fracture repair includes many tissues and is affected by many clinical factors. Timely and standardized treatment and close follow-up according to the Dental Trauma Guideline guarantee a good prognosis of root fracture. The closer the root fracture line is to the apex, the higher the survival rate is. In addition to the location of the root fracture line, the prognosis is affected by many other clinical factors, such as the displacement of the coronal fragment of the root fracture, the pathological state of the dental pulp, patient age, developmental stage of the root, timely and good replacement of the root fracture, splinting method, and the presence of other dental trauma complications. Pulp vitality should be monitored regularly, and root canal therapy of the coronal segment should be carried out only when infection of the pulp is established. This article reviews the classification, diagnosis, emergency treatment, sequential follow-up treatment, and prognostic assessment of root fracture trauma to provide suggestions for clinicians to manage root fracture trauma in permanent teeth.

12-year follow-up of regenerative endodontic treatment of immature permanent upper incisors with acute abscess

Abstract This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.

Resumo Este relato de caso discute o tratamento endodôntico de uma menina de 7 anos que sofreu trauma nos incisivos centrais superiores imaturos, após queda de bicicleta. Trinta dias após o acidente, a paciente foi levada pela mãe para avaliação clínica e radiográfica com queixa principal de inchaço e sensibilidade à percussão e palpação. Foram diagnosticados abscessos apicais agudos em ambos os dentes. Foi decidido por realizar o tratamento endodôntico regenerativo. Após acessos coronários, os canais radiculares foram submetidos à protocolos de antissepsia com auxílio de irrigação com hipoclorito de sódio a 2,5% e EDTA 17%. Devido à dor e presença de secreções, foi utilizada medicação intracanal com clorexidina gel 2% por 7 dias. Na segunda sessão, os canais radiculares foram novamente submetidos aos procedimentos de antissepsia e os canais dos incisivos centrais superiores permanentes direito e esquerdo foram preenchidos com pasta antibiótica dupla (Metronidazol / Ciprofloxacina) e pasta de hidróxido de cálcio, respectivamente. Em ambas as pastas foi adicionado o óxido de zinco. Na terceira sessão, após mais 21 dias, as pastas foram removidas e as regiões periapicais foram estimuladas com lima K nº 80 para incentivar a formação de coágulos sanguíneos no interior das cavidades pulpares. Tampões cervicais de MTA foram adaptados e os dentes restaurados com cimento de ionômero de vidro resinoso. Radiografias e tomografias computadorizadas demonstraram formações radiculares completas. A paciente é acompanhada há 12 anos, com evidências clínicas e radiográficas de sucesso.

Luxação extrusiva de um incisivo central Permanente jovem: relato de caso clínico / Extrusive luxation of an immature permanent central incisor: clinical case report

Objetivo: O objetivo deste artigo é apresentar o relato de um caso clínico de luxação extrusiva de dente permanente com rizogênese incompleta, onde não foi necessária a realização de intervenção endodôntica. Relato de caso: Paciente de 6 anos de idade compareceu ao serviço de urgência da Policlínica Odontológica da Universidade do Estado do Amazonas (UEA) para atendimento após queda durante atividade de lazer, apresentando traumatismo direto na boca. Foi informado durante a consulta inicial que o incidente havia ocorrido há cerca de três dias, e que o atendimento imediato logo após o trauma foi realizado em um Serviço de Pronto Atendimento, porém, nenhum tipo de procedimento na cavidade oral foi realizado. Após exames clínico e radiográfico observou-se que o dente 21 apresentava deslocamento parcial para fora do alvéolo dentário no sentido axial, com alteração da oclusão, dor local à palpação e mobilidade dentária. Foi realizada profilaxia da área afetada, e anestesia do dente luxado e tecidos adjacentes. O reposicionamento do dente foi realizado em seguida, pressionando-o e tracionando-o de forma suave e contínua até a sua correta posição dentro do alvéolo. A área afetada foi limpa com gaze estéril embebida em soro fisiológico, e foi instalada uma contenção rígida confeccionada com fio ortodôntico e resina composta. Conclusão: O reposicionamento da maneira adequada do dente traumatizado dentro do alvéolo dentário, num período de tempo hábil, seguido de sua proservação, permitiram a manutenção da vitalidade do tecido pulpar, e consequentemente, o desenvolvimento do segmento radicular.

Objective: The objective of this article is to present a clinical case of extrusive luxation of an immature permanent tooth, with no endodontic management. Case report: A 6-year-old patient was provided to emergency treatment at the State University of Amazonas, as a result of a fall, with a direct trauma to the mouth. It was informed during the initial consultation that the incidente has occurred three days after. Emergency examination had been carried out by an Emergency Service; however, any type of procedure in the oral cavity was performed in ths occasion. After clinical and radiographic examinations, it was observed that tooth 21 presented partial displacement from the alveolar socket in the axial direction, with occlusion alteration, local pain to palpation and dental mobility. Cleaning of the affected area and anesthesia of the dislocated tooth and adjacent tissues were performed. Then, tooth repositioning was performed by pressing and tracing it smoothly and continuously until its correct position within the alveolar socket. The affected area was cleaned with sterile gauze soaked in saline solution, and a rigid containment made of orthodontic wire and composite resin was installed. Conclusion: A proper repositioning of the traumatized tooth within the alveolar socket, followed by its clinical followup, allowed the pulp tissue to remain vital, and consequently, the complete development of the root portion

Ratio and Rate of Induced Root Growth in Necrotic Immature Teeth / 대한소아치과학회지

The purpose of this study was to analyze the ratio and rate of apical closure when inducing root growth of necrotic immature permanent teeth using alternative triple antibiotics. 24 permanent teeth in the treatment group and 27 premolars in the control group were retrospectively studied using periapical radiographs for more than 300 days after the first visit. The difference in the growth rate between the two groups was statistically compared using the Mann-Whitney test at a significance level of 0.05. There were no statistically significant differences between the two groups in the first month and during months 1 – 3, 3 – 6, and 6 – 12. After 12 months, the cumulative rate of decrease in the apical foramen width in the treatment group was 50.59% and that in the control group was 71.82%, which revealed a significant difference between the two groups. There were significant differences in the rates of decrease in the apical foramen width after 3, 6 months, and later period in the treatment group, respectively. The cumulative rate of increase in the root dentin area presented no statistically significant differences between the treatment group and control group during the entire period of examination.

Outcome of Regenerative Endodontic Treatment for an Avulsed Immature Permanent Tooth: A Case Report / 대한소아치과학회지

Dental avulsion, defined as the complete displacement of a tooth from the alveolar bone with consequent loss of the blood and nerve supply, was reported as one of the most severe dental injuries. Avulsion can cause tissue ischemia, which leads to pulp necrosis.Apexification is a conventional treatment method that induces an apical calcified barrier in immature roots with pulp necrosis. However, root development characterized by an increase in the root thickness and length cannot be achieved by apexification.The purpose of this case report was to describe the radiographic and clinical outcomes of regenerative endodontic treatment for the avulsed and necrosed permanent tooth with an immature root after replantation in a 5-year-old girl; the treatment was performed using a mixture of ciprofloxacin, metronidazole and cefaclor, CollaTape and Biodentine.

Effect of exogenous stem cells from apical papillae in the pulp revascularization treatment for the immature permanent tooth with periapical periodontitis / 中华口腔医学杂志

Objective@#To evaluate the effect of exogenous stem cells from apical papillae (SCAP) in the pulp revascularization treatment for the immature permanent tooth with periapical periodontitis in animal model.@*Methods@#After the SCAP were isolated and cultured from the Beagle dogs, stem cell properties of these cells were characterized by analyzing their colony-forming ability, the expression of mesenchymal stem cell markers and the multidifferentiation characteristics including osteogenic, adipogenic, and chondrogenic potentials. Models of young permanent tooth with periapical periodontitis were established in dogs and the infection in each of the model tooth was eliminated by root canal irrigation and intracanal medication. After that, all of the model teeth were randomly divided into 4 groups: Group 1: normal developing teeth with no treatment applied;Group 2: teeth that periapical tissues were irritated to induce blood flowing into the root canals;Group 3: teeth that peripheral blood was delivered into the root canals;Group 4: teeth that SCAP were resuspended in peripheral blood and delivered into the root canals. In Group 2-4, firm coronal seal was performed after revascularization procedure and radiographs were taken periodically in order to observe the development of roots. After a 12-week-period, alveolar samples were collected and observed histologically.@*Results@#The isolated SCAP showed clonogenic ability and multilineage differentiation ability including osteogenic, adipogenic and chondrogenic potentials. These cells also expressed the mesenchymal stem cell markers such as STRO-1 and CD146, while no cytokeratin was detected. The thickening of canal wall was observed radiographically 12 weeks after procedures of infection control and revascularization. Histologically, the newly formed tissues on the inner canal wall were found bone lacuna like structure in Group 2 and 3, and the new tissue formed in the Group 3 seemed easy to separate from the canal wall. The newly formed tissues in Group 4 were much thicker compare to those in the Group 2 and 3, and the dentine tubule like structure instead of bone lacuna was noticed although the orientation of these tubules were various.@*Conclusions@#SCAP seem to play an important role in the tissue regeneration procedure when infection is well controlled in young permanent teeth with periapical periodontitis. It is difficult to achieve real tissue regeneration due to the lack of endogenous SCAP in apical area, therefore delivering adequate exogenous SCAP isolated and cultured in vitro could be a promising approach to overcome the challenge.

A sampling survey of permanent crown-root caries in 55-74-year-old population in Guangdong Province (2015-2016) / 口腔疾病防治

Objective @#To investigate the current status of caries on permanent teeth in a population of 55-74-year-old in Guangdong Province, thus to provide scientific basis for the establishment of oral health care policies in Guangdong. @*Methods@#An equal-sized stratified multi-stage randomly sampling design was applied to obtain representative sample groups consisted of 288 Guangdong residents each, aged at either 55-64 or 65-74 years old, with a gender ratio of half to half. The caries on the crowns and roots of permanent teeth were assessed according to "The Guideline for the 4th National Oral Health Survey"; thereafter the prevalence and mean DFT (decayed and filled tooth) of permanent teeth were calculated. @*Results @#In the population of 55-64-year-old, the prevalence of crown caries was 77.08%, with a mean DFT of 2.94, and a filled rate of 21.87%; while the prevalence of root caries was 59.38%, with a mean DFT of 1.82, and a filled rate of 9.18%; and the prevalence of residual roots was 46.18%. In the population of 65-74-year-old, the prevalence of crown caries was 81.25%, with a mean DFT of 3.45, and a filled rate of 16.40%; while the prevalence of root caries was 63.19%, with a mean DFT of 2.34, and a filled rate of 9.18%; and the prevalence of residual roots was 50.35%. In the population of 55-64-year-old, the prevalence and the mean DFT of crown caries were higher in female when compared to male. And the mean DFT of root caries were higher in countryside when compared to the urban opponents. In the population of 65-74-year-old, the female had higher mean DFT score in crown caries than that in male. And the prevalence of caries of root and mean DFT of root caries were higher in countryside than that in the urban opponents.@*Conclusion@#There was a high level of crown and root caries in Guangdong adults, while the filling rate was low, most of the involved teeth were not filled.

permanent crown-root caries in 35-44-year-old population in Guangdong Province (2015-2016) / 口腔疾病防治

Objective@#To investigate the current status of caries on permanent teeth in adult population at the age of 35⁃44 years old in Guangdong Province, thus to provide scientific basis for the establishment of oral health care policies in Guangdong.@*Methods@#An equal⁃sized stratified multi⁃stage randomly sampling design was applied to obtain represen⁃ tative sample groups consisted of 288 Guangdong residents each, aged at 35⁃44 years old, with a gender ratio of half to half. The caries on the crowns and roots of permanent teeth were assessed according to The Guideline for the 4th National Oral Health Survey; thereafter the prevalence and mean DFT (decayed and filled tooth) of permanent teeth were calculat⁃ ed. The data obtained were analyzed using SAS9.2 package.@*Results@#In 35⁃44 year ⁃old population, the prevalence of crown caries was 71.18%, with a mean DFT of 2.76, and a filled rate of 36.78%; while the prevalence of root caries was 28.47%, with a mean DFT of 0.66, and a filled rate of 4.23%. The prevalence of caries of crown and root and mean DFT of crown caries were higher in countryside when compared to the urban opponents. And female had higher prevalence and mean DFT score in crown and root caries when compared to male. However, the mean DFT score of root caries in urban was almost the same as that in countryside.@*Conclusion@#There was a high level of crown caries in Guangdong. Although the prevalence of root caries is low, most of the involved roots was not filled.

Regenerative Endodontic Procedure in Korean Children and Adolescents: A Case Report / 치위생과학회지

Mineral trioxide aggregate (MTA) is widely used in endodontic therapy as a pulp-capping material, root or furcal perforation repair material, and for apexification and obturation of the root canal system. The purpose of this study was to formally document cases of MTA application in South Korean children and adolescents. Through this research, the practice of using MTA will be introduced and familiarized to the clinical practitioners. This study involved endodontic treatment using MTA for fractured crowns in 11- and 12-year-old. The children were followed up for 12 months until the pulp vitality was confirmed; in young permanent teeth with immature roots, the pulp is integral to the process of apexogenesis. These observational results regarding the use of MTA as an apexification material in non-vital immature permanent incisors appear to provide promising results in the search for new materials to meet existing endodontic needs.

Regenerative Endodontic Treatment as a Retreatment Option for a Tooth with Open Apex - A Case Report

Abstract: Treatment of non-vital immature teeth with apical periodontitis has always been a challenge in Endodontics. Regenerative endodontic treatment (RET) has been successfully used for the management of these cases. The aim of this study is to present a case of RET used for the retreatment of a previously endodontically treated permanent tooth with an open apex. A 14-year-old boy with a poor endodontic treatment done on his maxillary right central incisor developed symptomatic apical periodontitis. Radiographically, incomplete root development with thin dentinal walls and an open apex were evident. After accessing and removing previous filling materials, the canal was copiously irrigated with 2.5% sodium hypochlorite. A triple antibiotic paste was placed inside the canal and left for 15 days. After removal of the antibiotic mixture, bleeding was induced into the canal by passing a hand file out of the apex. A collagen membrane barrier was placed over the blood clot, followed by sealing with mineral trioxide aggregate. Access was sealed with permanent filling materials. Clinical examination at 12, 24 and 36 months revealed no symptoms. Radiographic examination showed resolution of the periapical lesion and apical closure. Sensitivity tests with cold and an electric pulp test elicited a negative response at all recall periods. On the basis of long-term results, RET may be an effective option for the retreatment of an immature permanent tooth with a failed previous treatment and periapical periodontitis.

A psychological behavior problem detection of children with permanent tooth injury / 中华行为医学与脑科学杂志

Objective To explore the relationship between dental trauma for children and their psychological behavior characteristics.Methods By using the method of case-control study,7-11 years of age children accepting oral health examination in our department were asked to fill in the questionnaire.The children without dental trauma were selected as the control group and the children with permanent tooth injury were selected as the injury group.Each group has 57 cases.All children finished the Eysenck personality questionnaire (EPQ) and their parents finished the Achenbach child behavior capacity list (CBCL).Results (1) The average CBCL score (32.51±20.41) and scores of P and N branch capacity lists in EPQ (44.72± 11.67,48.05± 12.39) of the injury group were all higher than those of the control group (17.19± 11.67,37.64± 8.17,41.40± 8.78) (P＜0.01).(2) The detecting rate of behavior problems in injury group was also higher than that of the control group (33.33％,7.02％,P＜0.01),OR=6.63,95％ CI =2.09-21.05.Boys of the injury group had higher scores than those in the control group in seven factors (depression,social withdrawn,restlessness,violation of discipline,attack,compel and social problems) (P＜0.05),and girls of the injury group also had higher scores than those in the control group did in three factors (depression,social withdrawn and attack) (P＜0.05).(3) In the injury group,boys had higher scores in the factor of schizoid anxiety than girls did (P＜0.01),risk factors were depression (OR=0.529,95％ CI =0.292-0.959),social withdrawn (OR=2.274,95％ CI =1.311-3.944),restlessness (OR=0.426,95％ CI =0.213-0.852),violation of discipline (OR=0.426,95％ CI =0.213-0.852) and attack (OR=0.644,95％ CI =0.459-0.903).However,girls had higher scores in the factor of depression than boys (P＜0.05),their risk factor was depression (OR=0.573,95％ CI =0.357-0.919).Conclusion There is a certain correlation between tooth injury and their psychological behavior characteristics of children.

The use of platelet rich plasma in the treatment of immature tooth with periapical lesion: a case report

This study describes the treatment of an immature permanent tooth with periapical lesion which was treated with regenerative approach using platelet rich plasma (PRP). The root canal of immature human permanent tooth with periapical lesion was gently debrided of necrotic tissue and disinfected with 2.5% NaOCl, and then medicated with triple antibiotic paste comprised of ciprofloxacin, metronidazole, and tetracycline. When the tooth was asymptomatic, PRP and mineral trioxide aggregate (MTA) were placed into the root canal. Six months after PRP treatment, radiographical examination revealed resolution of the radiolucency and progressive thickening of the root wall and apical closure. Our findings suggest that PRP can be used for the treatment of immature permanent teeth with periapical lesion, as part of a regenerative endodontic treatment procedure.

The use of platelet rich plasma in the treatment of immature tooth with periapical lesion: a case report

This study describes the treatment of an immature permanent tooth with periapical lesion which was treated with regenerative approach using platelet rich plasma (PRP). The root canal of immature human permanent tooth with periapical lesion was gently debrided of necrotic tissue and disinfected with 2.5% NaOCl, and then medicated with triple antibiotic paste comprised of ciprofloxacin, metronidazole, and tetracycline. When the tooth was asymptomatic, PRP and mineral trioxide aggregate (MTA) were placed into the root canal. Six months after PRP treatment, radiographical examination revealed resolution of the radiolucency and progressive thickening of the root wall and apical closure. Our findings suggest that PRP can be used for the treatment of immature permanent teeth with periapical lesion, as part of a regenerative endodontic treatment procedure.

Regeneração endodôntica: existe um protocolo? / Endodontic regeneration: is there a protocol?

O tratamento de dentes com rizogênese incompleta e necrose pulpar representa grande desafio para a terapia endodôntica. O panorama atual recai no conceito de regeneração do tecido pulpar. A endodontia regenerativa propõe o controle da infecção do sistema de canais radiculares, com o mínimo de ação dos instrumentos, farta irrigação. Vários protocolos têm sido propostos com variáveis pequenas, sem um consenso entre os autores. O presente artigo descreve e discute os três principais protocolos e suas variáveis, especificando os pontos mais obscuros de uma terapia que é o mais excitante novo campo da Endodontia e cujos avanços proporcionarão benefícios inestimáveis para toda a população. Importa considerar que o sucesso da regeneração deve atender três principais objetivos: primeiro aeliminação dos sintomas e a evidenciação de reparo dos tecidos periapicais; segundo promover espessamento das paredes do canal e/ou a continuidade da formação radicular (desejável, mas não essencial) e terceiro, obter resposta positiva aos testes de vitalidade, que, se alcançado certamente indicará a presença de um tecido pulpar mais organizado.

Treatment of immature permanent teeth with pulpal necrosis presents a unique challenge to the endodontists. The current panorama lies in the concept of pulpal tissue regeneration. Endodontic regeneration is based on the control of endodontic infection with minimal instrumentation and plentiful irrigation of the root canal system. Different protocols have been suggested with very little differences. The aim of this article is to present the main three basic protocols and their variables, specifying the darkest points of a therapy that is the most exciting new of Endodontics and advances will provide invaluable benefits to the entire population. It considers that the success of regeneration must meet three main goals: primary: the elimination of the symptoms and the evidence of bony healing; secondary: increased root wall thickness and/or increased root length (desirable but perhaps not essential); tertiary: positive response to vitality testing (wich, if achieved, could indicate a more organized vital pulp tissue).

Multidisciplinary approach for crown-root fracture treatment after trauma: case report / Abordagem multidisciplinar para tratamento de fratura corono-radicular pós-traumatismo: relato de caso

The development of an accurate diagnosis and appropriate treatment plan can be a complex task, especially in cases of dentoalveolar trauma. The authors present a case report of crown-root fracture caused by trauma and highlight the importance of a multidisciplinary approach for the treatment. An eighteen year-old boy had a bicycle accident resulting in dental trauma. The upper right first molar showed a complicated crownroot fracture and the lower left second pre-molar showed an uncomplicated crown-root fracture. Endodontic treatment, controlled tooth extrusion, periodontal surgery for recovery of biological width, and porcelain crown and onlay restorations were performed. Esthetic and functional results were achieved. At the two-year follow-up it was observed that the tooth/onlay interface of the upper right first molar was stained and the onlay of the left lower second pre-molar was fractured. Therefore, the interface stained was repaired and a porcelain crown was made for the lower second premolar. The clinical case presented herein leads to the conclusion that a multidisciplinary treatment plan is extremely important for a proper resolution in cases of dentoalveolar trauma

A elaboração de um diagnóstico preciso e de um plano de tratamento adequado pode constituir uma tarefa bastante complexa, especialmente nos casos de traumatismos dentoalveolares. O relato de caso teve por finalidade demonstrar a importância da abordagem multidisciplinar para o tratamento de fratura corono-radicular pós traumatismo. Paciente de 18 anos de idade, gênero masculino, sofreu uma queda de bicicleta resultando em traumatismos dentários. O 16 sofreu fratura corono-radicular complicada e o 35 fratura corono-radicular não-complicada. Foi realizado tratamento endodôntico, extrusão dentária controlada, cirurgia periodontal para recuperação do espaço biológico, coroa de porcelana e restauração tipo onlay. O resultado estético e funcional foi alcançado. O paciente foi acompanhado por 2 anos onde foi observado um manchamento na interface dente/onlay do 16 e fratura da onlay do 35. Foi realizado um reparo na interface do 16 e confeccionada uma coroa de porcelana para o 35. Foi possível concluir que a multidisciplinaridade do plano de tratamento é de extrema importância para uma adequada resolução dos casos de traumatismos dentoalveolares

Apexification with the use of calcium hydroxide.

After traumatic injuries the pulps of young permanent teeth often necrose. This occurs most commonly in the permanent maxillary incisors leaving the teeth with incomplete radicular development and open apices. In these cases treatment is aimed at promoting complete apical closure. At a later date a complete filling of the root canal is carried out in order to prevent inflammatory stimulators affecting the periapex. Apexification is a method of treatment intended to induce formation of a calcific barrier in an immaturely developed or pulpless tooth. The intent of apexification is to attain narrowing of the canal or closure of the apex. Apexification is indicated in young patients, for reasons such as trauma, fracture or caries involving the pulp require root canal treatment prior to the apex fully developing and closing.

Chlorhexidine does not increase immediate bond strength of etch-and-rinse adhesive to caries-affected dentin of primary and permanent teeth

The aim of this study was to evaluate the effect of 2% chlorhexidine digluconate (CHX) on immediate bond strength of etch-and-rinse adhesive to sound (SD) and caries-affected (CAD) primary dentin compared with permanent dentin. Flat dentin surfaces from 20 primary molars (Pri) and 20 permanent molars (Perm) were assigned to 8 experimental groups (n=5) according to tooth type (Pri or Perm), dentin condition (SD or CAD - pH-cycling for 14 days) and treatment (control - C or 60 s application of 2% CHX solution after acid etching - CHX). The bonding system (Adper Single Bond 2) was applied according to manufacturer's instructions followed by resin composite application (Filtek Z250). After 24 h water storage, specimens with cross-section area of 0.8 mm² were prepared for being tested under microtensile test (1 mm/min). Data were submitted to ANOVA and Tukey's post hoc test (α=0.05). Failure mode was evaluated using a stereomicroscope at ×400. Treatment with CHX did not result in higher bond strength values than no pre-treatment (C groups), independently of tooth type. Primary teeth and caries-affected dentin showed significantly lower (p<0.05) bond strength means compared with permanent teeth and sound dentin, respectively. Predominance of adhesive/mixed failure was observed for all groups. CHX did not influence the immediate bond strength to sound or caries-affected dentin of primary and permanent teeth.

O objetivo deste estudo foi avaliar o efeito do digluconato de clorexidina (CHX) a 2% na resistência de união imediata de adesivo convencional à dentina decídua hígida (H) e afetada pela lesão de cárie (CA) comparada à dentina permanente. Superfícies dentinárias planas de 20 molares decíduos (Dec) e 20 molares permanentes (Perm) foram divididas em 8 grupos experimentais (n=5) de acordo com o tipo de dente (Dec ou Perm), condição da dentina (H ou CA - ciclagem de pH por 14 dias) e tratamento (controle - C ou CHX - aplicação por 60 s de solução de digluconato de clorexidina a 2% após condicionamento ácido). O sistema adesivo (Adper Single Bond 2) foi aplicado de acordo com as instruções do fabricante, seguido da aplicação de resina composta (Filtek Z250). Após 24 h de armazenamento em água, espécimes com área de secção transversal de 0,8 mm² foram preparados para o teste de microtração (1 mm/min). Os dados foram submetidos à Análise de Variância e teste de Tukey para comparações múltiplas (α=0,05). Modo de falha foi avaliado usando estereomicroscópio com aumento de 400×. Tratamento com CHX não resultou em maiores valores de resistência de união do que sem pré-tratamento (C grupos), independente do tipo de dente. Dentes decíduos e dentina afetada apresentaram menores médias de resistência de união em comparação a dentes permanentes e dentina hígida, respectivamente (p<0,05). Predomínio de falha adesiva/mista foi observado para todos os grupos. CHX não influenciou a resistência de união imediata à dentina hígida ou afetada pela lesão de cárie de dentes decíduos e permanentes.

Influência de diferentes procedimentos restauradores na resistência á fratura de dentes com cavidade classe IV submetidos ao clareamento dental interno / Influence of different restorative procedures on fracture of teeth with class IV cavities submitted to internal dental bleaching

Este estudo teve o objetivo de investigar a influência de diferentes procedimentos restauradores diretos com resina composta e pinos de fibra de vidro, na resistência à fratura de dentes com cavidades Classe IV, tratados endodonticamente e submetidos ao clareamento interno. Quarenta (n=40) incisivos laterais superiores humanos hígidos foram utilizados. Todos os dentes, com exceção do Grupo controle, foram submetidos ao tratamento endodôntico e então divididos em 5 Grupos (n=8): GI: Dentes hígidos; GII: Dentes tratados endodonticamente + resina composta (RC); GIII: Dentes tratados endodonticamente + clareamento com peróxido de hidrogênio (PH) a 35% + RC; GIV: Dentes tratados endodonticamente + Clareamento com PH a 35% + pino de fibra de vidro (Everstick/StichTeck) + RC; GV: Dentes tratados endodonticamente + Clareamento PH a 35% + RC e pino de fibra de vidro (Fibrekor Post; Jeneric Pentron Inc., Wallingford, CT, USA);. Os dentes tratados endodônticamente receberam cortes na coroa simulando uma classe IV e posteriormente restaurações de resina composta. O sistema LED-LASER Whitening Lase Light Plus (DMC Equipamentos Ltda, São Carlos, SP, Brasil) foi utilizado para ativação do agente clareador. Após o processo de clareamento, a restauração provisória e o tampão cervical dos dentes submetidos ao clareamento foram removidos para que cada Grupo fosse submetido ao procedimento restaurador. Após a confecção das restaurações as mesmas foram submetidas ao teste de resistência a fratura, em máquina de ensaios (EMIC). A Análise de Variância apontou efeito significativo de Grupos sobre a resistência (p=0,041). O teste de Tukey foi aplicado nas comparações múltiplas das médias de resistência, identificando somente a média de GIII (dentes tratados endodonticamente + clareamento com PH a 35% + RC) significativamente menor do que a GI ( dentes Hígidos) (p=0,026). Concluiu-se que os dentes com cavidade classe IV, tratados endodonticamentes, submetidos ao clareamento dental interno com PH a 35% com aceleração de luz e restaurados apenas com RC, apresentam resistência a fratura comprometida quando comparado aos dentes hígidos. Quando os dentes tratados endodonticamente forem submetidos ao claremaento interno, o uso de pinos é recomendado, quando o clareamento interno não for realizado, a restauração direta pode ser realizada apenas com RC

This study aimed to investigate the influence of restorative procedures on fracture resistance of teeth with Class IV cavities endodontically treated and submitted to internal bleaching with light source acceleration using LED-LASER system. Forty (n = 40) lateral incisors and healthy humans were used. All teeth, except for the control Group, were submitted to endodontic treatment and then divided into 5 Groups (n = 8): GI: healthy teeth, GII: endodontically treated teeth + composite, GIII: Teeth whitening endodontically treated with PH 35% + composite, GIV: Teeth whitening endodontically treated with PH 35% glass fiber post (Everstick / StichTeck) + composite, GV: Teeth whitening endodontically treated PH 35% + composite fiber and glass post (Fibrekor Post; Jeneric Pentron Inc., Wallingford, CT, USA). The crow of endodontically treated tooth was cut simulating a Class IV. The system LED LASER-Light Plus Whitening Lase (DMC Equipment Ltda, São Carlos, SP, Brazil) was used to activate the bleaching agent. After the whitening process, the buffer cervical and the temporary restoration of teeth submitted to bleaching have been removed so that each Group was subjected to the restorative procedure. After restorations the specimens were subjected to the same fracture toughness test, in a testing machine (EMIC). Analysis of Variance (ANOVA) showed significant effect on the resistance Group (p = 0.041). The Tukey test was applied in multiple comparisons for resistance means values, identifying only the mean of GIII (endodontically treated teeth bleaching with PH 35% + composite) significantly lower than GI (healthy teeth) (p = .026). It was concluded that teeth endodonticamentes treated with cavity class IV, subjected to internal dental bleaching with PH 35% and only restored with RC, have lower fracture toughness when compared to healthy teeth. When endodontically teeth were submitted to internal bleaching use of pins is recommended. And when internal bleaching is not carried out, the direct restoration can be done only with RC

Clinical management of a complicated crown-root fracture: a case report

This report describes the clinical procedures involved in the treatment of a complicated crown-root fracture in the maxillary left central incisor with a wide open apex of a 10-year-old male patient, due to fall from his own height. Post-trauma treatment comprised cervical pulpotomy and adhesive tooth fragment reattachment. After 1 year, clinical and radiograph examinations showed pulp necrosis and an associated periapical lesion. Endodontic therapy with calcium hydroxide-base intracanal dressing, root canal filling and orthodontic extrusion were performed. Extrusion was completed within approximately 16 weeks and the tooth was restored with a post-core system and a prosthetic crown. After a 3 years of follow-up, there was no evidence of apical periodontitis and the tooth was satisfactory both esthetically and functionally.

Este relato de caso apresenta os procedimentos clínicos envolvidos no tratamento de um caso de fratura corono-radicular complicada de um incisivo superior esquerdo com ápice aberto de um paciente de 10 anos de idade devido à queda da própria altura. O tratamento envolveu pulpotomia cervical e fixação do fragmento. Após 1 ano, os exames clínicos e radiográficos demonstraram necrose pulpar e lesão perirradicular associada. O tratamento endodôntico foi realizado com a utilização de pasta de hidróxido de cálcio, obturação endodôntica e extrusão ortodôntica. Após aproximadamente 16 semanas, o processo de extrusão foi finalizado e o dente restaurado com pino e coroa protética. Após acompanhamento de 3 anos, não havia evidência de lesão perirradicular e o dente estava estética e funcionalmente satisfatório.

Result of the study of oral health knowledge of school children aged 10-12 years old in Khovd province’s / Монголын Анагаах Ухаан

Subjects comprising the population of this study were recruited from 6 high schools of Khovd province. Total of 104210-12 aged children were participated in this study. Oral health education knowledge of study population was notenough. This range of age is most healthy period of permanent dentition. Therefore for these children giving informationabout healthy foods for teeth, importance of having good oral health behavior by oral health education program is veryeffective to prevent dental caries. It is necessary constitute oral health education program for children which is simple,cheap, and sufficient. Also for this oral health education program for high school children requires active participation ofschool teachers and parents.