Segmented mechanics for traction of impacted maxillary canine: case report with a 3-year follow-up / Mecânica segmentada para tracionamento de canino su perior impactado: relato de caso com acompanhamento de 3 a nos

Young patients are increasingly concerned with smile aesthetics, resulting in the early visit to the dental office. It is of great importance that professionals such as orthodontists, pediatric dentists, and general practitioners are aware of the potential changes in positioning and development that may compromise aesthetics, considering they may prevent future complex orthodontic treatments. This case report describes the treatment of a patient aged 9 years and 4 months, who complained at assessment about the size and position of maxillary incisors. Clinically, the patient presented atresic maxilla and eruption of teeth 12 and 22. The poor positioning of tooth 22 alerted for the potential retention of tooth 23. A two-phase treatment was proposed, including an intercepting phase and a corrective phase. In the intercepting phase, rapid maxillary expansion (RME) was performed, which increased the room for eruption of tooth 23 and prevented the collapse of tooth 22. After the activation period, the Haas expander was locked and removed six months later. Twenty-five months after the removal, the second phase started with fixed corrective orthodontics and traction of tooth 23, for which the enamel was drilled and traction was performed using the segmented technique with a 0.019" x 0.025" Titanium Molybdenum Alloy (TMA) cantilever and anchorage in passive transpalatal arch (PTA). The use of this technique minimizes the side effects on the teeth adjacent to tooth 23 and enamel drilling prevents potential losses of the traction device by detachment. After 4 months of segmented mechanics, the devices were removed and the PTA was maintained. Twenty-six months later, the patient was 14 years and 4 months old, presenting direct subdivision Class III molar relationship, upper and lower crowding, and unsatisfactory relationship between bone bases due to the excessive mandibular growth. A new RME was performed, and after 3 months a Capelozza Pattern III fixed appliance was installed in the lower arch. Additionally, an upper fixed appliance was installed after the RME retention period. One year and 4 months later, the appliances were removed and a maxillary Hawley plate was installed with a 0.6-mm fixed mandibular intercanine arch. The follow-up lasted 3 years and 4 months and the results were maintained, preserving the occlusal and facial characteristics.

A preocupação dos pacientes jovens com a estética do sorriso está cada vez maior, ocasionando na visita precoce ao consultório odontológico. É de grande importância que os profissionais, tanto ortodontistas quanto odontopediatras e clínicos gerais, estejam atentos à possíveis alterações de posicionamento e desenvolvimento que comprometam a estética, visto que isso pode evitar tratamentos ortodônticos complexos no futuro. Este relato de caso descreve o tratamento de uma paciente de 9 anos e 4 meses que na avaliação se queixou do tamanho e posição dos incisivos superiores. Clinicamente apresentou maxila atrésica e dentes 12 e 22 em erupção. O mal posicionamento do dente 22 alertou para possível retenção do dente 23. Um tratamento em duas fases foi proposto: uma fase interceptadora e uma segunda fase corretiva. Na interceptadora foi realizada expansão rápida da maxila (ERM), aumentando o espaço para erupção do dente 23 e evitando colapso com o dente 22. Após o período de ativação, o expansor de Haas foi travado e sua remoção feita seis meses após o travamento. Passados 25 meses da remoção, iniciou-se a segunda fase, com ortodontia fixa corretiva e tracionamento do dente 23. Para o tracionamento, foi feita perfuração no esmalte e tracionamento por meio da técnica segmentada, utilizando cantilever de Titanium Molybdenum Alloy (TMA) 0,019" x 0,025" e ancoragem em barra transpalatina passiva (BTP). A utilização desta técnica minimiza efeitos colaterais aos dentes adjacentes ao 23 e a perfuração de esmalte evita possíveis perdas do dispositivo de tracionamento por descolagem. Após 4 meses de mecânica segmentada, removeu-se os dispositivos mantendo a BTP. Passados mais 26 meses, a paciente se encontrava com 14 anos 4 meses, relação molar de Classe III subdivisão direita, apinhamento superior e inferior e relação insatisfatória das bases ósseas, devido ao crescimento excessivo da mandíbula. Foi realizada nova ERM, após 3 meses instalou-se aparelho fixo Padrão III de Capelozza no arco inferior e, após o período de contenção da ERM, instalou-se o aparelho fixo superior. Após 1 ano e 4 meses, removeu-se os dispositivos e se instalou uma placa de Hawley superior, com barra fixa intercaninos de 0.6mm no arco inferior. Com acompanhamento de 3 anos e 4 meses, os resultados foram mantidos, preservando ascaracterísticas oclusais e faciais.

Examination of paramolar tubercles in Turkish population using cone beam computed tomography / Estudio de los tuberculos paramolares en una población turca mediante tomografía computarizada de haz cónico

SUMMARY: Paramolar tubercle (PT) is an additional cusp occuring on buccal surface of both upper and lower permanent molars. PT is also known as parastyle when tubercle is present in upper molars, as protostylid when tubercle is present in lower molars. The aim of this study was to evaluate prevalence of PTs in Turkish population with cone beam computed tomography (CBCT). Presence of PT in molar teeth were evaluated retrospectively using CBCT images of 210 patients (102 male, 108 female) between 18-77 years old. A total of 909 teeth were analyzed. Because of various reasons some teeth were excluded and final analyze was done with 653 teeth. Prevalence of PT was found as 2.76 % (18 out of 653). Highest frequency of PT was detected 5 in #27, 4 in #17, 2 in #48 among all molar teeth respectively. In two cases; 2 PTs were on the same tooth, bilateral PT was found only in one case. PT was undetected on upper first molars. Prevalence of PTs on permanent molars is a rare phenomenon in the studied population. Use of CBCT in such anatomic variations will provide valuable and detailed information during treatment modalities. Since this pilot study represents Turkish subpopulation, comprehensive studies with increased number of cases should be undertaken to clarify the prevalence of paramolars in Turkish population. Advanced imaging techniques like CBCT will be more helpful in understanding and detecting exact morphological and anatomical variations of PTs during treatment modalities.

RESUMEN: El tubérculo paramolar (TP) es una cúspide adicional que está en la superficie vestibular de los molares permanentes superiores e inferiores. El objetivo de este estudio fue evaluar la predisposición de TP en la población turca con tomografía computarizada de haz cónico (TCHC). Presencia de TP en dientes molares se evaluaron retrospectivamente utilizando imágenes de tomografia de 210 pacientes (102 hombres, 108 mujeres) entre 18-77 años de edad. Se analizó un total de 909 dientes. Por varias razones, algunos dientes fueron excluídos y el análisis final se realizó con 653 dientes. Prevalencia de PTP se encontró en el 2,76 % (18 dientes de 653). La frecuencia más alta de TP se detectó: 5 en # 27, 4 en # 17, 2 en # 48, entre todos los dientes molares, respectivamente. En dos casos, 2 de los TP fueron observados en el mismo diente; TP bilateral sólo se encontró en un caso. El TP no fue detectado en los primeros molares superiores. La prevalencia de TP en los molares permanentes es un fenómeno poco frecuente en la población estudiada. El uso de la TCHC en tales variaciones anatómicas, proporcionará información valiosa y detallada para definir la aplicación de diferentes modalidades de tratamiento. Dado que este estudio piloto representa a una subpoblación turca, estudios exhaustivos con un mayor número de casos deben llevarse a cabo para determinar la prevalencia en la población turca total. Técnicas avanzadas de imagen como TCHC serán más útiles para detectar variaciones morfológicas y anatómicas exactas de TP durante diversas modalidades de tratamiento.

Hallazgos incidentales en ortopantomografías maxilomandibulares de pacientes adultos jóvenes / Incidental findings on panoramic radiographs of the maxilla and mandible of young adult patients

Introducción: la valoración radiográfica rutinaria en la práctica odontológicaes esencial para un adecuado diagnóstico y plan de tratamiento. Laortopantomografía o radiografía panorámica es una técnica simple, rápida, de bajo costo y a una baja dosis de radiación. Objetivos: Caracterizarlos hallazgos incidentales más comunes en radiografías panorámicas de pacientes adultos jóvenes de una clínica dental universitaria. Materialy métodos: Se realizó un estudio descriptivo, retrospectivo, de cortetransversal de radiografías panorámicas digitales, tomadas e interpretadas de manera ciega, explorando alteraciones óseas y anomalías dentales. Se realizó la caracterización de su presentación por género de los participantes. Para el análisis de datos se utilizaron pruebas no paramétricas (la prueba χ2, exacta de Fisher y binomial). Resultados: Se tomaron 98 radiografías del mismo número de pacientes, con edad promedio de 19.45 años, predominando las mujeres (69/70.40 por ciento), solteros (94/95.91 por ciento) y de zona urbana (77/78.57 por ciento). Existieron 387 alteraciones, 268 (69.25 por ciento) enmujeres, y 119 (30.74 por ciento) en hombres, con un promedio de 3.88 y 4.10 alteraciones por paciente, respectivamente. La distribución mostró en total 122 (31.52 por ciento) lesiones a nivel de senos maxilares, 124 (32.04 por ciento) en fosasnasales, 16 (4.13 por ciento) lesiones radiolúcidas u opacas, y 125 (32.29 por ciento) anomalías asociadas a retención dental. La comparación de acuerdo al género mostró diferencia (p ≤ 0.001) en la frecuencia de alteraciones, en todos los casos determinada por las mujeres, para cada sitio y tipo de lesión presentada. Conclusiones: El valor de la radiografía panorámica para detectar anomalías de estructuras orofaciales demostró en este estudio su utilidad en la práctica asistencial desde una perspectiva epidemiológica.

Background: doutine dental X-Ray assessment in dental practice isessential for proper diagnosis and treatment. Orthopantomographyor panoramic radiography is a quick, simple, low-cost, and low-doseradiation technique. Objective: To describe the most common incidentalfi ndings on the panoramic radiographs of young adult patients ata university dental clinic. Material and methods: A descriptive,retrospective, cross-sectional study was carried out, in which digitalpanoramic radiographs were taken and interpreted blindly to examinebone disorders, and dental anomalies, and the prevalence of theseaccording to the gender of the participants. Nonparametric statistics(Chi-square χ2, Fisher’s exact, and binomial tests) were used for dataanalysis. Results: 98 radiographs were taken of the same number ofpatients with a mean age of 19.45 years, most of whom were women(69/70.40%), single (94/95.91%), and from urban areas (77/78.57%). 387alterations were found, 268 (69.25%) in women and 119 (30.74%) in men,with an average of 3.88 and 4.10 alterations per patient, respectively. Thedistribution presented a total of 122 (31.52 %) lesions in the maxillarysinus, 124 (32.04 %) in the nostrils, 16 (4.13 %) radiolucent or opaquelesions, and 125 (32.29%) anomalies associated with tooth retention. Acomparison by sex revealed a diff erence (p < 0.001) in the frequency ofalterations, which was greater in women for all sites and types of lesion.Conclusions: The study showed the usefulness of panoramic radiographyin clinical practice to detect anomalies of the orofacial structure from anepidemiological perspective.

Restauración estética y funcional de un paciente con amelogénesis imperfecta / Esthetic and functional restoration of a patient with amelogenesis imperfecta

Objetivo. Describir el manejo clínico para la restauración estética y funcional de un caso con amelogénesis imperfecta. Caso clínico. Paciente femenina de 15 años que presentaba alteración en la apariencia estética de sus dientes y episodios de sensibilidad. El tratamiento consistió en procedimientos adhesivos directos e indirectos, asociados con una técnica ultraconservadora de microabrasión. Conclusión. Es posible restablecer la armonía del sistema estomatognático por medio de procedimientos mínimamente invasivos, los cuales posibilitan una estética satisfactoria contribuyendo entre otros factores a la mejora de la autoestima del paciente

Tratamiento de conductos de un densinvaginatus: reporte de un caso / Root Canal Therapy of a Dens Invaginatus: A Case Report

El diente invaginado es una malformación que resulta probablemente de un desdoblamientode la papila dental durante el desarrollo dentario. Los dens invaginatus son dientes clínicamentesignificativos, debido a la gran facilidad de afección de la pulpa. La profundidaddel defecto estructural varía de una leve ampliación del cíngulo a una invaginación quese extiende al ápice. El presente artículo relata el caso de una mujer de veintitrés años deedad, quien refiere una fístula de diez años de evolución en la mucosa en el fondo de sacoa la altura del diente lateral superior izquierdo (diente 22). Luego de la exploración clínica yradiográfica se diagnostica un dens in dente unilateral con necrosis pulpar y absceso apicalcrónico, para lo cual se realizó terapia de conductos y cirugía apical con éxito radiográficode dos años de evolución...

Invaginated tooth is a malformation likely resulting from a splitting of dental papilla duringtooth development. Dens invaginatus are clinically important teeth due to the easy affectionof the dental pulp. Invagination depth varies from a slight enlargement of the cingulum untoan extended invagination to the apex. This article reports the case of a female patient aged23, who referred fistula with ten years of evolution in tooth 22. The clinical and radiographicdiagnosis was dens in dent with necrosis and chronic suppurative periapical periodontitis.The root canal therapy and apical surgery were performed showing successfully radiographicevolution within a two-year follow-up period...