ABSTRACT
Objective: The objective of the present systematic review and meta-analysis was to compare treatment with membrane associated with bone grafting and treatment exclusively with membrane in the approach of Class II furcation defects in mandibular molars. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were conducted in five databases (PubMed, Web of Science, Scopus, Ovid, and Lilacs), in Septem-ber 2021, without restriction regarding publication year or language. Studies comparing membranes associated with bone grafting and membranes exclusively in the treatment of Class II furcation lesions were included. Cross-sectional, case-control studies, and reviews were excluded. Study selection, data extraction, and risk of bias assessment (MINORS) were performed by two review authors. The certainty of the evidence (GRADE) was evaluated and meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. Results: Four hundred eighty-six references were iden-tified and four studies were included. Greater reduction in probing depth [MD = 0.32 (CI = 0.09, 0.56)] and greater clinical attachment level gain [MD = 0.41 (CI = 0.24, 0.57)] were observed when membrane and bone grafting were used. The risk of bias of included studies was low. Conclusions: This present systematic review and meta-analysis demonstrated that treatment of Class II furcation defects in mandibular molars using membrane and bone grafing is significantly more efficacious than treatment with the exclusive use of membrane.
Objetivo: El objetivo de la presente revisión sistemática y metanálisis fue comparar el tratamiento con membrana asociado a injerto óseo y el tratamiento exclusivamente con membrana en el abordaje de lesiones de furca grado II en molares mandibulares. Materiales y Métodos: Se siguió la declaración de elementos de informe preferidos para revisiones sistemáticas y metanálisis (PRISMA). Las búsquedas se realizaron en cinco bases de datos (PubMed, Web of Science, Scopus, Ovid y Lilacs), en septiembre de 2021, sin restricción de año de publicación o idioma. Se incluyeron estudios que compararon membranas asociadas con injertos óseos y membranas exclusivamente en el tratamiento de lesiones de furca de grado II. Se excluyeron los estudios transversales, de casos y controles y las revisiones. Dos revisores realizaron la selección de estudios, la extracción de datos y la evaluación del riesgo de sesgo (MINORS). Se evaluó la certeza de la evidencia (GRADE) y se realizó un metanálisis. Se proporcionaron la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Resultados: Se identificaron 486 referencias y se incluyeron cuatro estudios. Se observó una mayor reducción en la profundidad de sondaje [DM = 0,32 (IC = 0,09, 0,56)] y una mayor ganancia en el nivel de inserción clínica [DM = 0,41 (IC= 0,24, 0,57)] cuando se utilizaron injertos de membrana y hueso. El riesgo de sesgo de los estudios incluidos fue bajo. Conclusión: La presente revisión sistemática y metanálisis demostró que el tratamiento de los defectos de furca de grado II en molares mandibulares utilizando membrana e injertos de hueso es significativamente más eficaz que el tratamiento con el uso exclusivo de membrana.
Subject(s)
Humans , Bone Transplantation/methods , Furcation Defects/therapy , Periodontitis , Guided Tissue Regeneration , Membranes, ArtificialABSTRACT
Furcation involvement (FI) is the lesion and destruction of periodontium that spread to the root furcation of multi-root teeth, where periodontal pockets, loss of periodontal attachment and resorption of alveolar bone are formed. Furcation involvement is a common concomitant lesion of periodontitis. The severity of furcation involvement can directly affect the prognosis of periodontitis. However, the specificity of the anatomical structure of the root furcation greatly increases the difficulty of treatment. Therefore, early detection and treatment of furcation involvement is crucial for the prevention and control of periodontitis. This paper briefly describes the pathogenesis of furcation involvement and discusses the diagnosis, classification and treatment of this disease, which is helpful to improve the clinical diagnosis and treatment of furcation involvement.
Subject(s)
Humans , Molar , Furcation Defects/therapy , Periodontitis/complications , Periodontal Pocket , PrognosisABSTRACT
Introduction: Clinicians tend to encounter unfavorable situations in the treatment of teeth with severe attachment loss. Periodontal regeneration has been a successful therapeutic approach in treatments that require a long-term prognosis improvement. This case shows the benefits of combined regenerative periodontal therapy in a patient with a molar severely compromised by furcation, intrabony defects and attachment loss to the apex. Case Report: The clinical case included an endo-periodontal, class III furcation and intrabony defects in a generalized periodontitis, Stage III Grade C patient. After non-surgical periodontal treatment and re-evaluation, a full-thickness flap and surgical debridement were performed. Dental root surface was treated with EDTA and enamel matrix derivatives and the defects were filled with allograft and platelet-rich fibrin, additionally a collagen membrane was applied over the graft. After a 12-month follow-up there was a resolution of the intrabony defects and periodontal regeneration. Clinical and radiographic evaluation also showed the partial resolution of the class III furcation defect. Conclusion: Combined periodontal regeneration can be a therapeutic approach to improve the prognosis and prevent the extraction of molars severely compromised by furcation, intrabony defects and attachment loss to the apex.
Introducción: Los clínicos tienden a encontrar situaciones desfavorables en el tratamiento de dientes por pérdida de inserción severa. La regeneración periodontal ha sido un enfoque terapéutico exitoso en tratamientos que requieren una mejora del pronóstico a largo plazo. Este caso demuestra los beneficios de la terapia periodontal regenerativa combinada en un paciente con un molar gravemente comprometido por furcación, defectos intraóseos y por pérdida de inserción hasta el ápice. Reporte de caso: El caso clínico incluyó un defecto endoperiodontal, furcación clase III y defectos intraóseos en una Periodontitis estadio III generalizada grado C. Tras el tratamiento periodontal no quirúrgico y la reevaluación, se realizó un colgajo de espesor total y un desbridamiento quirúrgico. La superficie de la raíz dental se trató con EDTA y derivados de la matriz de esmalte y los defectos se rellenaron con aloinjerto y fibrina rica en plaquetas, adicionalmente se aplicó una membrana de colágeno sobre el injerto. Después de un seguimiento de 12 meses hubo resolución de los defectos intraóseos y regeneración periodontal. La evaluación clínica y radiográfica también mostró la resolución parcial del defecto de furcación de clase III. Conclusión: La regeneración periodontal combinada puede ser un abordaje terapéutico para mejorar el pronóstico y prevenir la extracción de molares severamente comprometidos por furcación, por defectos y hasta el ápice.
Subject(s)
Humans , Female , Adult , Guided Tissue Regeneration, Periodontal , Furcation Defects/therapy , Periodontitis , Regeneration , Periodontal Attachment Loss , Platelet-Rich FibrinABSTRACT
Introdução: o conhecimento das possíveis variações da cavidade pulpar torna-se necessário para aumentar o êxito nos tratamentos endodônticos, tornando relevante o reconhecimento do canal cavo inter-radicular (CCIR). Objetivo: relatar o caso de um primeiro molar inferior com ampla perda óssea na região de furca associada à presença de canal cavo inter-radicular. Relato de caso: paciente relatou o surgimento de "bolhas ao redor do dente". Ao exame clínico, constatou-se a presença de fístula associada à necrose pulpar do dente #36; não existiam sinais de doença periodontal. Radiograficamente, identificou- se extensa rarefação na região de furca e periapical. Após cuidadoso acesso, foi realizada radiografia na qual constatou-se a presença do FC comunicando a câmara pulpar à furca. Após a localização dos canais radiculares e seu preparo químico-mecânico, procederam-se trocas de hidróxido de cálcio após 240 dias, constatando-se franco reparo. Após 270 dias, obturaram-se os canais radiculares e procedeu-se ao selamento da embocadura desses e do CCIR com MTA. No controle de 360 dias, observou-se a ausência de sinais clínicos indesejáveis e neoformação óssea na região de furca. Conclusão: é de fundamental importância o conhecimento da existência do CCIR e sua relação com lesões de furca em dentes sem sinais clínicos de doença periodontal; nesses casos, a correta sanificação do sistema de canais é capaz de solucionar problemas endoperiodontais, mesmo de grandes proporções, restabelecendo a saúde do paciente e, assim, evitando tratamentos desnecessários.
Subject(s)
Humans , Female , Adult , Dental Pulp Cavity/anatomy & histology , Endodontics , Furcation Defects/therapy , Root Canal PreparationABSTRACT
El tratamiento y pronóstico de las lesiones endoperiodontales depende del diagnóstico oportuno y preciso de la enfermedad endodóntica y/o periodontal. Cuando se trata de lesiones endodónticas primarias con involucración periodontal secundaria, la estrategia de tratamiento debe ser primeramente enfocada a la infección pulpar, al debridamiento y desinfección de los conductos radiculares. El objetivo de este estudio es demostrar la capacidad de reparación de una lesión endoperiodontal mediante terapia endodóntica no quirúrgica, sin posterior terapia periodontal. El caso es un paciente masculino de 10 años con necrosis pulpar del órgano dentario 46 con involucración periodontal mediante lesión en furca, la cual reparó completamente en tres meses tras el tratamiento endodóntico. Estos hallazgos se confirman radiográficamente y por la disminución de la profundidad sondeable en la zona de la lesión. Se concluye que en este tipo de casos, con involucración endodóntica primaria, la necesidad del tratamiento periodontal quirúrgico o no quirúrgico será determinada exclusivamente por la falta de reparación de la lesión por largos periodos de tiempo.
he treatment and prognosis of endo-periodontal lesions depend on the timely and accurate diagnosis of the endodontic and/or periodontal disease. In the case of primary endodontic lesions with secondary peri-odontal involvement, the treatment strategy should be focused primarily on the pulp infection and the debridement and disinfection of root canals. The aim of this study is to demonstrate the repair capacity of an endo-periodontal lesion treated with nonsurgical endodontic root therapy and no subsequent periodontal treatment. The case involves a 10-year-old male patient with pulpal necrosis and apical periodontitis of tooth 46; periodontal furcation involvement was also evident. The diagnosis was a primary endodontic lesion with secondary periodontal involvement. The furcation defect healed completely within three months of non-surgical root canal treatment, a fact confi rmed by X-rays and by the reduction in the probing depth in the area of the lesion. We conclude that in cases such as this, where there is primary endodontic involvement, surgical or non-surgical periodontal treatment should be considered exclusively if the periodontal lesion persists for long periods of time.
Subject(s)
Humans , Male , Child , Furcation Defects/therapy , Dental Pulp Diseases/therapy , Periodontal Diseases/therapy , Dental Pulp Necrosis/therapy , Root Canal Therapy/methods , Wound Healing/physiology , Schools, Dental , Follow-Up Studies , Mexico , Molar/injuries , Molar , Treatment OutcomeABSTRACT
Introducción: el compromiso inmunoinflamatorio gingival en áreas interradiculares establece una lesión furcal. Sus terapéuticas tienen como objetivo mantener la salud, la función y la estética del diente. Objetivo: determinar las terapéuticas empleadas en lesiones furcales y la relación con su gravedad. Método: se realizó un estudio descriptivo, con historias clínicas dadas de altas en las consultas de Periodoncia y Estomatología General Integral de la Facultad de Estomatología, del municipio Plaza de la Revolución, entre enero 2009 y mayo 2011. Los 119 molares afectados en la furca conformaron el universo que se estudió en su totalidad. Variables estudiadas: grado de afectación furcal según la clasificación de Carranza y Newman, agrupados por gravedad y su tratamiento. Para la asociación y relación entre variables cualitativas fue utilizado el Chi cuadrado. Resultados: el colgajo con implante, la hemisección y la bicuspidización fueron terapéuticas pobremente representadas con 7,6 por ciento, 2,5 por ciento y 0,8 por ciento respectivamente, mientras que en las más aplicadas estuvieron: colgajo convencional (53,1 por ciento), raspado y alisado (26 por ciento) y la exodoncia (11,8 por ciento). El raspado y alisado (90,3 por ciento) obtuvo la supremacía para los grados I y II y la exodoncia (57,1 por ciento) para los grados III y IV, p= 0,0004. Conclusiones: las terapéuticas predominantes fueron: el colgajo convencional, el raspado y alisado radicular y la exodoncia. El raspado y alisado fue la terapéutica favorecida para los grados I y II y la exodoncia lo fue en los grados III y IV.
Introduction: the destruction of the support tissues in inter-radicular areas of multi radicular tooth is known as furcation lesion. The goals of those therapies are maintaining the teeth health, function and esthetics. Objective: to determine the therapy employed in furcation lesions and its relation with their seriousness.Methods: a transversal study was carried out, with the dental records of patients discharged from the consultations of Periodontics and Integral General Dentistry of the Faculty of Dentistry of the municipality Plaza de la Revolución from January 2009 to May 2011. The universe was formed by all the 119 molars registered with furcation lesions. The studied variables were: furcation lesion degree according to the Carranza y Newman classification, grouped by seriousness and treatment. The association and relationship among qualitative variables were carried out with Chi square. Results: the flap with implant, the hemisection and the bicuspidizatión were poorly represented with 7,6 percent, 2,5 per cent and 0, 8 percent, respectively while among the most applied ones were the conventional flap (53,1 percent), root planning (26 percent) and the exodontia (11,8 per cent). Root planning obtained the supremacy (90,3 percent) in the lesions grades I and II and the exodontia (57,1 percent) was associated to grades III y IV, p= 0,0004 Conclusions: the predominant therapies were: the conventional flap, root planning and the exodontia. Root planning was the favored therapy for the grades I and II, while the dental extraction was the favored one in grades III and IV.
Subject(s)
Humans , Male , Female , Surgery, Oral/methods , Surgical Flaps , Furcation Defects/therapy , Dental Scaling/methods , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Furcation involvement remains a complex challenge to the dentist. The treatment option in most of the cases being extraction of tooth. As dentistry aims to maintain the dentition in a healthy and functional state, many procedures and treatment options are now available. Bisection or bicuspidization is the separation of mesial and distal roots of mandibular molars along with their coronal portion, where both segments are then retained individually. The recent trend to preserve the natural dentition to its fullest and the increased patient inclination towards this trend has forced the field of endodontic to seriously reevaluate the long dormant techniques of tooth preservation. The results are often predictable if the procedures performed are proper. In this paper a case is presented in which bicuspidization was done because the tooth was grossly carious along with furcation involvement. The tooth was resected from the furcation area so that they can be utilized as an individual tooth
Subject(s)
Humans , Male , Furcation Defects/surgery , Furcation Defects/therapy , Periodontics , Endodontics , Root Canal TherapyABSTRACT
OBJECTIVE: The objective of this work was to evaluate, using radiographic images, the behavior of four materials used to repair root perforations in dogs' teeth. Material and METHODS: Second and third premolars of 6 dogs were used. The 48 teeth were randomly divided into 4 groups (n=12) and the perforations were sealed with one of the following materials: MTA, AH Plus, Vitremer and gutta-percha. Dogs were submitted to general anesthesia, teeth were radiographed and pulp was accessed. Perforations were done, at the maximum curve of the pulp floor, sealed and the accessed coronal cavity was filled with glass ionomer cement (Vidrion R). After 90 days, the dogs were sacrificed and the last x-ray image was taken. Images were analyzed for the presence/absence of periodontal lesions at the perforation region. Data were analyzed statistically by chi-square test at 5 percent significance level. RESULTS: There were no statistically significant differences (p>0.05) among AH Plus, Vitremer and gutta-percha groups. MTA produced the smallest number of periodontal lesions (p<0.05). CONCLUSIONS: It may be concluded that none of the tested materials was able to preserve the integrity of the periodontal tissues in the furcation region, and the use of MTA resulted in the least formation of adjacent periodontal bone lesions revealed by the radiographic comparisons.
Subject(s)
Animals , Dogs , Furcation Defects/therapy , Glass Ionomer Cements/therapeutic use , Root Canal Filling Materials/therapeutic use , Tooth Root/injuries , Chi-Square Distribution , Furcation Defects , Iatrogenic Disease/prevention & control , Materials Testing , Radiography, Dental , Tooth RootABSTRACT
Los defectos en furcaciones representan un gran reto para los terapistas debido a sus características anatómicas y a su variabilidad en cuanto a la forma de respuesta al tratamiento. La pérdida de inserción se desarrolla en sentido horizontal o vertical del área. Un amplio rango de modalidades de tratamiento han sido dirigidos a mantener esta área anatómica: debridamiento mecánico no-quirúrgico y quirúrgico, plastia furcal, procedimientos de tunelización, hemisecciones, amputaciones radiculares y tratamiento regenerativos. El propósito del presente reporte de caso es mostrar la eficacia de la plastia furcal como tratamiento para lesiones de furcación Clase I.
Furcation defects represent a challenge for therapists due to their anatomical characteristics and its variability in the form of response to treatment. Consequently, loss attachment develops in horizontal and vertical direction in this area. A wide range of treatment modalities have been directed to maintain this anatomical area: non-surgical and surgical mechanical debridement, furcation plasty, tunneling procedures, hemisection, root amputation and regenerative therapy. The purpose of this report is to show the effectiveness of the furcation plasty as a treatment for Class I furcation lesions.
Subject(s)
Humans , Female , Aged , Subgingival Curettage , Furcation Defects/therapy , Periodontal Diseases , Alveolar Bone Loss , Periodontal Attachment LossABSTRACT
Un defecto de furcación se produce a partir de la destrucción de los tejidos de soporte de dientes multirradiculares, permitiendo el acceso clínico o incluso la visualización del área interradicular de manera parcial o total. La etiología principal de esta destrucción tisular es la enfermedad periodontal, pero existen otras causas y factores asociados a esta alteración que en este artículo son presentados. Este artículo presenta además la forma de establecer su diagnóstico -tanto clínico como imaginológico- considerando el nivel de afectación en sentido horizontal y vertical, así como las alternativas de tratamiento según los diferentes tipos de defectos de furcación a partir de la clasificación presentada.
A furcation defect is developed when there is a destruction of the support tissues of multi-rooted tooth, as clinical access is permited or partial/total visualization of the area occurs. The main ethiology of this problem is periodontal disease, but there are considered other causes and associated factors. This article presents the way to establish the diagnosis -clinical and imaginologic- considering the level of affecting the area in horizontal and vertical directions, as well as various therapeutic plans available for the different types of furcation defects, according to the described classification.
Subject(s)
Humans , Furcation Defects , Furcation Defects/diagnosis , Furcation Defects/etiology , Furcation Defects/therapy , PrevalenceABSTRACT
OBJECTIVE: The aim of this study was to assess radiographically the effect of photodynamic therapy (PDT) as an adjunctive treatment to scaling and root planing (SRP) on induced periodontitis in dexamethasone-induced immunosuppressed rats. MATERIAL AND METHODS: The animals were divided into 2 groups: ND group (n=60): saline treatment; D group (n=60): dexamethasone treatment. In both ND and D groups, periodontal disease was induced by the placement of a ligature in the left first mandibular molar. After 7 days, ligature was removed and all animals received SRP, being divided according to the following treatments: SRP: saline and PDT: phenothiazinium dye (TBO) plus laser irradiation. Ten animals per treatment were killed at 7, 15 and 30 days. The distance between the cementoenamel junction and the height of the alveolar bone crest in the mesial surface of the mandibular left first molars was determined in millimeters in each radiograph. he radiographic values were analyzed statistically by ANOVA and Tukey's test at a p value <0.05. RESULTS: Intragroup radiographic assessment (ND and D groups) showed that there was statistically signifcant less bone loss in the animals treated with PDT in all experimental periods compared to those submitted to SRP. Intergroup radiographic analysis (ND and D groups) demonstrated that there was greater bone loss in the ND group treated with SRP compared to the D group treated with PDT at 7 and 30 days. CONCLUSION: PDT was an effective adjunctive treatment to SRP on induced periodontitis in dexamethasone-induced immunosuppressed rats.
Subject(s)
Animals , Male , Rats , Alveolar Bone Loss , Immunocompromised Host , Photochemotherapy , Periodontitis , Alveolar Bone Loss/drug therapy , Alveolar Bone Loss/therapy , Alveolar Process , Combined Modality Therapy , Dental Scaling , Dexamethasone/adverse effects , Furcation Defects/drug therapy , Furcation Defects , Furcation Defects/therapy , Glucocorticoids/adverse effects , Immunosuppressive Agents/adverse effects , Low-Level Light Therapy , Lasers, Semiconductor/therapeutic use , Mandible , Molar , Periodontitis/drug therapy , Periodontitis/therapy , Photosensitizing Agents/therapeutic use , Random Allocation , Rats, Wistar , Root Planing , Time Factors , Tolonium Chloride/therapeutic use , Tooth CervixABSTRACT
OBJECTIVES: To present a case report of management of grade II furcation involvement associatedwith a periodontal abscess of mandibular right first molar utilizing an alloplastic bone graft. DISCUSSION:The case was diagnosed as periodontal abscess with grade-II furcation involvement and was primaryperiodontal lesion with secondary endodontic involvement. Treatment included scaling, root planing &curettage and root canal treatment of the involved tooth. Periodontal flap surgery was done with bonegraft placement in the furcation area. RESULTS: Patient was evaluated after onear. Radiographicexamination showed healing of furcation defect as well as resolution of periapical inflammation. Clinicalevaluation revealed resolution of furcation involvement as well as reduction of tooth mobility.
OBJETIVOS: Apresentar um caso de comprometimento grau II de furca, lesão primariamenteperiodontal com comprometimento endodôntico secundário, em primeiro molar inferior. Otratamento constituiu de alisamento radicular, curetagem e tratamento endodôntico do dentecomprometido. Cirurgia de retalho periodontal foi efetuada, com colocação de enxerto ósseo na área da furca. RESULTADOS: o paciente foi avaliado após um ano, sendo que a imagemradiográfica demonstrou cicatrização do defeito da furca, bem como resolução da inflamaçãoperiapical. A avaliação clínica demonstrou resolução da lesão da furca, bem como reduçãoda mobilidade dentária.
Subject(s)
Humans , Female , Adult , Furcation Defects/therapy , Periodontal Abscess/therapy , Root Canal Therapy/methods , Follow-Up Studies , Periodontal Abscess , Radiography, DentalABSTRACT
The aim of this study was to analyze the relationship among the point of greatest depression on the root trifurcation floor and the furcation openings of the maxillary second molars. Sixty human extracted upper permanent second molars were analyzed and the furcation area were measured using a vertical calliper, and the values regarding the point of deepest depression were recorded. The results showed that the deepest depression in the trifurcation floor of the roots is centrally situated in 11.7 percent of the cases, whereas 88.3 percent involve mesial-buccal and distal-buccal roots. The distal furcation (F3) had the largest distance from the point of deepest depression in the trifurcation floor (A), followed by the buccal (F1) and mesial (F2) furcations when point A was below their respective openings. On the other hand, the medial furcation (F2) had the largest distance from point A, followed by distal (F3) and buccal (F1) furcations when point A was above their respective openings.
El presente estudio examinó la relación entre el punto de mayor depresión del suelo de la trifurcación de la raíz y la apertura de furcas en los segundos molares superiores. Sesenta segundos molares permanentes extraídos de humanos fueron analizados. El área de furca se midió utilizando un calibrador digital adaptado y valores sobre el punto de mayor depresión fueron registrados. Los resultados mostraron que la mayor depresión esta en el centro del suelo de las raíces en el 11,7 por ciento de los casos, mientras que 88,3 por ciento cubren las raíces mesio-vestibular y disto-vestibular. El punto de mayor depresión en el suelo de la trifurcación (A) presentó la mayor distancia desde la bifurcación distal (F3), seguido por la vestibular (F1) y mesial (F2) cuando el punto estaba por debajo de sus respectivas aperturas. Además, la bifurcación mesial (F2) presentó la mayor distancia desde el punto A, seguido por distal (F3) y vestibular (F1), cuando el punto A estaba por encima de sus respectivas aperturas.
Subject(s)
Humans , Male , Female , Furcation Defects/diagnosis , Furcation Defects/therapy , Molar/anatomy & histology , Molar/abnormalities , Molar/physiopathology , Odontometry/methodsABSTRACT
O emprego da RTG na prática clínica ainda carece de evidências na literatura. Esta revisão sistemática procurou avaliar o uso de barreiras para o tratamento de lesões de furca quando comparado ao acesso cirúrgico. Foi procurado na literatura ensaios clínicos randomizados com pelo menos 6 meses de duração e que comparassem o uso da RTG com acesso cirúrgico. Quatro estudos estavam de acordo com os critérios de inclusão. Dentre estes, o percentual de fechamento de lesões de furca de grau II com a RTG apresentado por três artigos ficou entre 0 e 30%. O emprego da RTG apresenta pouca previsibilidade e vantagens modestas no tratamento de lesões de furca de grau II em molares mandibulares. Ainda não há na literatura evidência suficiente para a avaliação da RTG em lesões de furca de graus I e III.
The use of GTR in clinical practice still lacks evidence in the literature. This systematic review evaluated the use of barriers for the treatment of furcation involvements as compared to open flap debridement (OFD). The search looked for randomized controlled clinical trials with at least 6 months of follow-up, that compared the use of GTR with OFD. Four studies met the inclusion criteria. Among them, the percent of complete closure of degree II furcation defects with GTR, presented in 3 articles varied between 0 and 30%. The use of GTR has low predictability and modest advantages in the treatment of degree II furcation defects in lower molars. The literature still lacks sufficient evident to evaluate GTR in degrees I and III furcation defects.
Subject(s)
Furcation Defects/therapy , Guided Tissue Regeneration, Periodontal/statistics & numerical data , Guided Tissue Regeneration, Periodontal/methods , Gingival Recession , Periodontal Attachment Loss , Periodontal IndexABSTRACT
A presença de lesões de furca está associada à reabsorção óssea e perda de inserção no espaço inter-radicular, sendo uma condição que eleva consideravelmente o risco de perda dentária, principalmente na ausência de tratamento adequado. Neste contexto, algumas terapias têm como objetivo a manutenção de dentes com lesão de furca importantes no planejamento odontológico, restabelecendo uma anatomia que possibilite a remoção do biofilme dental pelo paciente na área comprometida. No entanto, o tratamento e manutenção, em longo prazo, de molares com lesões de furca classe III, é ainda um desafio para os cirurgiões-dentistas durante a terapia periodontal, já que a anatomia da região inter-radicular dificulta tanto o acesso pelo profissional quanto pelos pacientes para adequado e eficiente controle do biofilme dental. A impossibilidade de se obter apropriada descontaminação da área envolvida, durante o procedimento de raspagem radicular, inclusive por meio de acesso cirúrgico, exige dos cirurgiões-dentistas conhecimento adequado para determinação da abordagem terapêutica correta durante o tratamento de dentes com avançada perda óssea inter-radicular. O presente estudo tem como objetivo discutir os tratamentos disponíveis para lesões de furca classe III e relatar procedimentos clínicos, que podem ser realizados para o tratamento desse tipo de defeito.
The presence of furcation lesions is associated with bone resorption and lack of insertion in the inter-radicular space, and is a condition that considerably increases the risk of dental loss, particularly in the absence of adequate treatment. In this context, the object of some of the therapies is to keep teeth with furcation lesions that are important to dental planning, to re-establish an anatomy that enables the patient to remove dental biofilm from the compromised area. However, the long term maintenance and treatment of molars with Class III furcation lesions continues to be a challenge to dentists during periodontal therapy, since the anatomy of the inter-radicular region makes it difficult for both professionals and patients to gain access to perform adequate and efficient control of dental biofilm. The impossibility of obtaining appropriate decontamination of the area involved during the root scraping process, including by means of surgical access, demands that dentists have adequate knowledge to determine the correct therapeutic approach during the treatment of teeth with advance inter-radicularbone loss. The aim of the present study was to discuss the treatments available for Class III furcation lesions and relate clinical procedures that could be performed for the treatment of this type of defect.
Subject(s)
Humans , Furcation Defects/diagnosis , Furcation Defects/therapy , Patient Care PlanningABSTRACT
El objetivo de este trabajo es considerar la relevante importancia de detectar y diagnosticar las lesiones periodontales que involucran las furcaciones de las piezas dentarias multirradiculares, porque ellas condicionan el plan de tratamiento a seguir. Si bien estas lesiones responden a la misma etiología y características generales de todas las enfermedades gingivoperiodontales, conforman una situación especial debido a la particular anatomía de la región y a la ubicación de estas piezas en la arcada. Se consideran los diferentes parámetros a tener en cuenta para lograr un correcto diagnóstico que permita llegar a un plan de tratamiento preciso, condiciones esenciales ambas para lograr el éxito a largo plazo. Se llega a la conclusión que, si bien el manejo de un diente multirradicular con su furcación afectada periodontalmente sigue siendo un complejo desafío terapéutico, existen hoy múltiples recursos que bien indicados y utilizados nos posibilitan tratar con cierto éxito estas lesiones y mantener así las piezas dentarias propias que a veces, a priori, parecerían perdidas.
Subject(s)
Humans , Furcation Defects/diagnosis , Furcation Defects/etiology , Furcation Defects/therapy , Periodontal Diseases/classification , Furcation Defects/surgery , Furcation Defects/epidemiology , Platelet-Derived Growth Factor/therapeutic use , Guided Tissue Regeneration , Freeze Drying/methods , Patient Care Planning , Tooth Root/abnormalities , Bone Transplantation/methodsABSTRACT
O emprego da técnica com barreiras para a regeneração periodontal surge como uma possibilidade para o tratamento das recessões gengivais, um problema que acomete indivíduos com padrões de higiene distintos. A etiologia para ocorrência de tal problema tem sido atribuída, portanto, a fatores traumáticos durante a escovação e/ou a presença de inflamação periodontal causada pela presença de placa. Em relação ao enxerto de conjuntivo subepitelial, considerado o tratamento padrão, a técnica com barreiras evitaria a necessidade da área doadora, o que poderia reduzir a morbidade após o procedimento cirúrgico de recobrimento. Esta revisão sistemática procurou comparar o uso de barreiras para o tratamento das recessões gengivais com enxerto de conjuntivo subepitelial. O emprego da RTG com barreiras reabsorvíveis e não-reabsorvíveis mostrou resultados similares quando comparados ao enxerto conjuntivo subepitelial para o recobrimento radicular
Subject(s)
Furcation Defects/therapy , Gingival Recession , Guided Tissue Regeneration, Periodontal , Periodontal Attachment Loss , Periodontal IndexABSTRACT
One of the problems affecting the prognosis of the treatment is perforation which requires immediate and proper intervention. Dark MTA is applied as material of choice to repair perforations. The purpose of this study was to evaluate the repair of mechanical furcal perforations radiographically and clinically using white MTA and Portland cement and comparing them with dark MTA. In this experimental study, second to fourth mandibular and maxillary premolar teeth of five dogs received endodontic treatment following radiographic and clinical examinations. Then, the furcation area of the teeth was perforated and repaired with dark MTA in group 1, white MTA in group 2, Portland cement in group 3 and cotton pellet in group 4 [control]. Animals were controlled for 4 months and sacrificed using an overdose of Sodium thiopental intravenous injection after radiographic and clinical examinations. Chi-square test was used to compare groups for gingival attachment and presence of radiolucency. To compare these items between each two groups, Fisher's exact test was used. There was no statistically significant difference between dark MTA, white MTA and Portland cement groups in presence of radiolucency and gingival attachment. However, all the three groups were significantly different in radiolucency and gingival attachment from control group. Both white MTA and Portland cement revealed favourable results in repair of perforations and can be used as an alternative to dark MTA to repair perforations in the areas where esthetics is important and not important, respectively
Subject(s)
Animals , Endodontics , Furcation Defects/therapy , Glutamates , Dental Cements , Bicuspid , DogsABSTRACT
Este artículo trata e ilustra una serie de cinco lineamientos para manejar al paciente ortodóncico con complicaciones periodontales o protéticas. Uno de los pasos más importantes es generar objetivos de tratamiento realistas que se adapten a las necesidades, deseos, capacidades financieras del paciente y a las metas de los miembros del equipo. Luego, debe crearse una representación visual del resultado final bajo la forma de un encerado de diagnóstico. Esto proporciona un objetivo final de tratamiento para todo el equipo. Luego, deben identificarse los problemas periodontales y se debe determinar quién es el responsable del tratamiento de los defectos óseos. Si hay algunos dientes que no pueden recuperarse, debe establecerse el momento y la secuencia apropiada de las extracciones para facilitar las necesidades de todos los profesionales que integran el equipo. Finalmente, la posición futura de los dientes debería determinarse según sean las necesidades de rehabilitación, protésias o periodontales específicas del paciente. Si el equipo integrado por el periodoncista, el cirujano, el ortodoncista y el protesista rehabilitador siguen estos cinco lineamientos, el manejo de sus pacientes ortodónticos, periodontales, protésicos se verá simplificado, será predecible y gratificante.
Subject(s)
Adult , Middle Aged , Periodontal Diseases/therapy , Malocclusion/therapy , Orthodontics, Corrective/methods , Alveolar Bone Loss , Furcation Defects/therapy , Esthetics, Dental , Tooth Extraction/methods , Dental Implantation, Endosseous/methods , Tooth Movement Techniques/methods , Patient Care Planning , Orthodontic BracketsABSTRACT
O objetivo deste trabalho foi apresentar uma técnica para manutenção de dentes com perfuração radicular. Esta técnica envolve a remoção da raiz mésio-vestibular do primeiro molar superior esquerdo com perfuração no assoalho da câmara pulpar e vedamento da perfuração com um tampão de cimento de ionômero de vidro. O dente foi restaurado com resina composta e, para estabelecer uma união com o dente vizinho, associou-se tiras de polietileno. Essa medida visou proteger e estabilizar o remanescente do elemento 26 das cargas oclusais. O prognóstico dos dentes tratados por ressecção radicular é crítico, porém pode ser melhorado com adequada seleção do caso e tratamento periodontal, endodôntico e restaurador bem planejados.