Abordagem de incisivos centrais superiores traumatizados: relato de caso / Approach to traumati zed maxillary central incisors: case report

Introdução: O traumatismo dentário é uma ocorrência frequente durante a infância e adolescência. Geralmente, o diagnóstico acontece de forma tardia, devido à falta de conhecimento da população. Cada tipo de trauma necessita de uma conduta única e especializada. Nos casos de comprometimento pulpar, é necessário cuidado quanto à escolha da técnica a ser empregada, bem como a seleção da medicação intracanal que, por sua vez, apresenta grande interferência no sucesso do tratamento. Não obstante o avanço das técnicas de instrumentação, a troca da medicação entre as sessões nesses casos é mandatória. Relato de caso: Um paciente, sexo masculino, em idade escolar (15 anos) apresentou-se ao serviço de saúde bucal com relato de escurecimento e dores na mastigação após trauma dentário durante a infância. Os testes de vitalidade pulpar revelaram necrose pulpar, com resultado negativo no teste térmico e positivo na percussão. O exame radiológico evidenciou uma lesão apical, juntamente com reabsorção externa no elemento 21, confirmado em tomografia. O paciente foi submetido a um tratamento endodôntico. Resultado: Após o tratamento, foi solicitado novo exame tomográfico, em que se evidenciou um processo de cicatrização óssea no periápice e reabsorção por substituição na lesão cervical. Conclusão: A partir deste caso clínico, pôde-se evidenciar a importância do diagnóstico adequado, do manejo e da técnica endodôntica eficaz na resolução de problemas decorrentes de traumas dentários em pacientes jovens.

Introduction: Dental trauma is a frequent occurrence during childhood and adolescence. Generally, diagnosis happens late, due to lack of knowledge among the population. Each type of trauma requires a unique and specialized approach. In cases of pulp involvement, care must be taken when choosing the technique to be used, as well as the selection of intracanal medication, which, in turn, has a major impact on the success of the treatment. Despite advances in instrumentation techniques, changing medication between sessions in these cases is mandatory. Case report: A male patient of school age (15 years old) presented to the oral health service with reports of darkening and pain when chewing following dental trauma during childhood. Pulp vitality tests revealed pulp necrosis, with a negative result in the thermal test and positive in percussion. The radiological examination showed an apical lesion, together with external resorption in element 21, confirmed on tomography. The patient underwent endodontic treatment. Result: After treatment, a new tomographic examination was requested, which showed a process of bone healing in the periapex and resorption by replacement in the cervical lesion. Conclusion: From this clinical case, it was possible to highlight the importance of adequate diagnosis, management, and effective endodontic technique in solving problems arising from dental trauma in young patients.

Diagnóstico clínico, radiográfico e histológico de un caso de fibrosis periapical posendodóntica / Clinical, radiographic, and histologic diagnosis of a postendodontic periapical fibrosis case

Objetivo: La fibrosis periapical posendodóntica es un proceso reparativo asintomático, radiolúcido y no progresivo que se interpreta con frecuencia como una lesión patológica persistente. El diagnóstico de esta entidad suele ser dudoso y sólo puede definirse mediante la correlación de las obser- vaciones clínicas, radiográficas e histológicas. El objetivo de este informe es describir el caso de un paciente que presenta un área radiolúcida periapical persistente y asintomática en un incisivo lateral superior. Caso clínico: Luego de cuatro años y dos meses de ha- ber recibido un tratamiento endodóntico el paciente concurre a la consulta para un examen de rutina. El examen radiográfico del diente revela un área radiolúcida persistente y bien defini- da. A causa de una fractura radicular irreparable, se indicó la extracción de la pieza dentaria. Esto permitió realizar el estu- dio histológico del tejido blando que permanecía adherido en el ápice de la raíz, lo que confirmó y completó el diagnóstico de fibrosis periapical posendodóntica.(AU)

Aim: The postendodontic periapical fibrosis is an asymp- tomatic radiolucent and non-progressive healing process that is often interpreted as a persistent pathological lesion. The diagnosis of this entity is usually uncertain, and it is only de- fined by the correlation of clinical, radiographic and histo- logical observations.The aim of this report is to describe the case of a patient with a long-term persisting asymptomatic and radiolucent area in a upper lateral incisor. Clinical case: Four years and two months after receiv- ing an endodontic treatment the patient comes to our office for a routine control. Radiographic examination revealed the presence of a persistent well defined radiolucent area. Sur- gical tooth extraction was required due to the presence of a complicated root fracture.This allowed to perform a histolog- ical study of the soft tissue attached to the apex of the ex- tracted root, which confirmed and completed the diagnosis of postendodontic periapical fibrosis (AU)

Age-Related Pattern of Dental Trauma in a Nigerian Tertiary Health Institution

Abstract Objective: To evaluate the pattern of traumatic dental injuries among children, adolescents, and adults. Material and Methods: This was a cross-sectional analytic study of children and adults who presented with dental trauma. Data utilized for this study were sociodemographic characteristics, history of the traumatic incident, presenting complaints, traumatized teeth and classification of the traumatized tissues using Ellis and Davey's classification. Results: A total of 163 participants with 307 traumatized teeth were included in the study. The participants' age ranged from 2 years to 75 years, with a mean age of 25.36 ±15.4 years. Children <10 years were the least represented (14.7%), adolescents 10-19 years accounted for 23.9%., young adults 20 to 40 years were the most represented (44.8%) and older adults >40 years (16.6%). A higher proportion of the study participants were female 83 (50.9%) and the most prevalent complaint was broken teeth (57.1%) The most prevalent aetiology of the trauma documented was fall (36.2%). The most prevalent injury type was extended crown fracture with noticeable dentinal involvement without pulp exposure. There was a statistically significant association between injury type, aetiology and age group. Conclusion: Traumatic dental injuries affect children, adolescents and adults alike. The central incisors were the most vulnerable teeth across all age groups. Age was significantly associated with the etiology of dental trauma and injury type (AU).

Terapia regenerativa en un incisivo central superior permanente inmaduro: caso clínico / Regenerative therapy in an immature permanent upper central incisor: a clinical case

Objetivo: Presentar la terapia regenerativa como una al- ternativa para la resolución de un caso de traumatismo denta- rio en un diente permanente incompletamente desarrollado. Caso clínico: Se realizó el tratamiento de un incisivo central superior con mortificación pulpar y periodontitis api- cal aguda subsecuente a trauma dental en un paciente de 8 años de edad. Se aplicó el protocolo de regeneración pulpar recomendado por la Asociación Americana de Endodoncia. Se estimuló la formación de un coágulo en el interior del con- ducto a partir de los tejidos periapicales, previa desinfección con la pasta triple antibiótica, y finalmente se colocó mineral trióxido agregado coronal a este. Se obtuvo así una matriz es- teril que permitió el crecimiento de nuevo tejido y se realiza- ron controles periódicos durante 4 años. Se constató silencio clínico. Radiográficamente, se observó la formación de tejido sobre las paredes del conducto y el cierre apical. Conclusión: La terapia regenerativa como alternativa de tratamiento, en este caso, permitió la disminución de la luz del conducto por el depósito de tejidos calcificados y el cierre del foramen apical, mejorando el pronóstico de la pieza dentaria (AU)

Aim: To present pulp regeneration therapy as an alter- native to resolve dental trauma in immature permanent teeth. Clinical case: We report a clinical case of an immature central superior incisor with pulp mortification and acute api- cal periodontitis subsequent to dental trauma, in an 8 year old patient. The pulp Regeneration protocol recommended by the American Endodontics Association was applied. We stimulated a clot formation inside the duct from periapical tissues and after disinfection with a mixture of three antibi- otics mineral trioxide aggregated was finally place coronal to the clot. Thus a sterile matrix was obtained that allowed new tissue's growth. Periodic check-up visits were carried out over a 4 years period. Clinical silence was observed. Tissue formation on duct walls and apical closure were radiograph- ically detected (AU) Conclusion: Regenerative therapy is an alternative for the treatment of immature permanent teeth, in ths clinical case it allowed the reduction of the width of the duct by the opposition of hard tissues and the closure of the apical fora- men improving the forecast of these teeth.

Trauma in Primary Teeth at a Specialized Service Center: Retrospective Cohort

Abstract Objective: To evaluate the factors associated with the occurrence of dental trauma in children up to six years of age and describe the results of clinical follow-up and possible sequelae. Material and Methods: A retrospective study was carried out with data collected from the dental records of 96 pediatric patients up to 6 years old with traumatized primary teeth who sought care from the. Pediatric Dental Trauma project of a private university in the city of Rio de Janeiro from July 2014 to July 2017, and who had clinical and radiographic follow-up for up to three months as of their initial visit. Results: 96 children (58.3% boys and 41.7% girls) included who presented 166 traumatized primary teeth. Intrusion was the most observed type of trauma and in 45.8% of cases, the care occurred one-week post trauma. The maxillary central incisors were the most affected teeth (97.6%). The prognosis of the dental elements with more than 3 months of follow-up was considered favorable, and 59.6% of the teeth did not present any clinical or radiological sequelae. Oral hygiene instruction and monitoring were the most common approaches. Conclusion: The prevalence of dental trauma in the present study was high and occurred mainly in domestic settings. The upper central incisors were the teeth that suffered the most injuries. The presence of patients at follow-up visits was an important factor for the positive result in most cases.

Fractura radicular de tercio medio: tratamiento y cinco años de seguimiento / Treatment and 5-year follow-up of root fractures in the middle third

Objetivo: Informar el tratamiento de dos piezas con fractura radicular horizontal del tercio medio, patrones de curación y seguimiento por cinco años. Caso clínico: Se presentó a la consulta una niña de 9 años de edad con traumatismo de 10 días de evolución. Examen clínico: fractura amelodentinaria restaurada en la pieza 2.2, movilidad y sensibilidad a la percusión y palpación en ambos incisivos centrales superiores. Examen radiográfico: fractura radicular horizontal de tercio medio en piezas 1.1 y 2.1. Tratamiento: inmovilización con placa removible durante 4 semanas, indicaciones de higiene y uso, y controles de seguimiento. Al primero y al cuarto mes, ambos incisivos mostraron ausencia de movilidad, reacción positiva de sensibilidad y signos radiográficos de reabsorción superficial interna y externa. A los 6 meses, el 1.1 evidenció signos de reparación con tejido conectivo, y el 2.1, signos clínicos y radiográficos de necrosis pulpar del fragmento coronario. Se realizó el tratamiento endodóntico de la pieza 2.1 hasta el nivel de la fractura con pasta a base de hidróxido de calcio, y luego de la comprobación de la formación de una barrera de tejido duro, se obturó definitivamente con gutapercha y sellador endodóntico. Cinco años después del traumatismo, ambos incisivos se mostraron asintomáticos y los estudios por imágenes evidenciaron una completa consolidación de las fracturas. Conclusión: Un diagnóstico temprano, procedimientos apropiados de tratamiento, el conocimiento de los procesos curativos y un monitoreo cuidadoso de todos los parámetros clínicos y radiográficos son claves para un enfoque correcto y conservador de las piezas dentarias con fractura radicular (AU)

Aim: To report the treatment, healing patterns and fiveyear follow-up of two permanent incisors with horizontal root fracture located in the middle third. Case report: A 9-year-old girl who came to our consultation 10 days after a dental trauma. Clinical examination: restored enamel-dentin fracture in upper left lateral incisor; mobility and sensitivity to percussion and palpation in both upper central incisors. Radiographic examination: horizontal root fracture in the middle third of both upper central incisors. Treatment: stabilization with a removable splint for 4 weeks, indications for hygiene, use of the splint and follow-up controls. At first and fourth month, central incisors presented absence of mobility, positive response to pulp testing and radiographic signs of internal and external superficial resorption. At sixth month, signs of healing with connective tissue were found on the right central incisor, while the left one showed clinical and radiographic signs of necrosis of the coronal fragment. The root canal of this segment was treated initially with a calcium hydroxide paste and, after verifying the formation of a hard tissue barrier, it was filled with gutta- percha and endodontic sealer. Five years after the trauma, both central incisors were asymptomatic and imaging studies showed complete healing of the fractures. Conclusion: Early diagnosis, appropriate treatment procedures, knowledge of healing patterns and careful monitoring of clinical and radiographic parameters are key factors for a proper and conservative approach of injured tooth with root fracture (AU)

Tooth fragment re-attachment in fracture with biological width violation: case

ABSTRACT: Dento-alveolar traumas are one of the most frequent injuries to teeth, mainly affecting the upper incisors due to their exposed position in the dental arch. In such cases, esthetics, function and phonetics of anterior teeth may be compromised. Furthermore, when there is involvement of the biological width, there is often a poor prognosis. This case report describes the multidisciplinary approach to tooth fragment re-attachment in a fracture with biological width violation. The patient presented with an oblique crown fracture in the maxillary right lateral incisor, extending from the buccal to palatal side, as well as a biological width invasion. The re-establishment of the biological width was obtained by periodontal surgery to achieve clinical-crown lengthening and tooth fragment re-attachment with a glass fiber post to increase retention. After 3 years of follow-up, the rehabilitated lateral incisor remains in good condition, with satisfactory esthetic and periodontal health.

Diagnosis of alveolar and root fractures: an in vitro study comparing CBCT imaging with periapical radiographs

Abstract Objective To compare periapical radiograph (PR) and cone-beam computed tomography (CBCT) in the diagnosis of alveolar and root fractures. Material and Methods Sixty incisor teeth (20 higid and 40 with root fracture) from dogs were inserted in 60 anterior alveolar sockets (40 higid and 20 with alveolar fracture) of 15 macerated canine maxillae. Each fractured socket had a root fractured tooth inserted in it. Afterwards, each maxilla was submitted to PR in two different vertical angulation incidences, and to CBCT imaging with a small field of view (FOV) and high-definition protocol. Images were randomized and posteriorly analyzed by two oral and maxillofacial radiologists two times, with a two-week interval between observations. Results Sensitivity and specificity values were good for root fractures for PR and CBCT. For alveolar fractures, sensitivity ranged from 0.10 to 0.90 for PR and from 0.50 to 0.65 for CBCT. Specificity for alveolar fractures showed lower results than for root fractures for PR and CBCT. Areas under the ROC curve showed good results for both PR and CBCT for root fractures. However, results were fair for both PR and CBCT for alveolar fractures. When submitted to repeated measures ANOVA tests, there was a statistically significant difference between PR and CBCT for root fractures. Root fracture intraobserver agreement ranged from 0.90 to 0.93, and alveolar fracture intraobserver agreement ranged from 0.30 to 0.57. Interobserver agreement results were substantial for root fractures and poor/fair for alveolar fractures (0.11 for PR and 0.30 for CBCT). Conclusion Periapical radiograph with two different vertical angulations may be considered an accurate method to detect root fractures. However, PR showed poorer results than CBCT for the diagnosis of alveolar fractures. When no fractures are diagnosed in PR and the patient describes pain symptoms, the subsequent exam of choice is CBCT.

Uncommon disturbance of root development after tooth replantation: five-year follow-up period case report / Trastorno del desarrollo radicular poco frecuente posterior a reimplante dentario: reporte de caso con 5 años de seguimiento

To present an uncommon disturbance of root development with ingrowth of bone and periodontal tissue into the pulp space in a delayed replanted immature permanent incisor at five years of follow-up. Severe arrest of root formation with uncommon healing of an immature permanent maxillary incisor after delayed replantation is reported. Continued development of a tooth root separate from the body of the tooth was not observed. A 6-year-old girl sustained an avulsion injury to her upper left central permanent incisor. The tooth was replanted and splinted 2 hours after the accident. Patient has been monitored clinically and with radiography for 5 years. The periodontal tissues presented good healing without replacement resorption. However, severe arrest of root formation with development of hard-like tissue and internal periodontal ligament inside the pulp canal have been observed. Despite being a delayed tooth replantation, the patient has been asymptomatic, and has maintained alveolar bone volume. Clinicians must be vigilant and monitor traumatized immature teeth closely.

El objetivo de este trabajo fue presentar una alteración poco frecuente del desarrollo de la raíz con el crecimiento del tejido óseo y periodontal en el espacio pulpar en un incisivo permanente inmaduro reimplantado de manera tardía, a los cinco años de seguimiento.Se observó una suspensión severa de la formación de raíces con cicatrización poco común, de un incisivo maxilar permanente inmaduro después de una reimplantación tardía. No se observó el desarrollo continuo de la raíz dentaria separada del diente. Una niña de 6 años de edad sufrió una lesión por avulsión en su incisivo central superior izquierdo. El diente fue replantado dos horas después del accidente. La paciente ha sido monitoreada clínicamente y con exámenes radiológicos durante 5 años. Los tejidos periodontales presentaron buena cicatrización sin reabsorción de reemplazo. Sin embargo, se ha observado una detención severa de la formación de las raíces, con desarrollo de tejido duro y ligamento periodontal interno dentro del canal pulpar. A pesar de ser una reimplantación tardía del diente, la paciente presenta asintomática, y ha mantenido el volumen del hueso alveolar. Los médicos deben estar atentos y mantener en observación los dientes inmaduros traumatizados.

Obturación única con compuesto de trióxido mineral en diente avulsionado con reabsorción radicular: informe de un caso / Single obturation with mineral trioxide aggregate in an avulsed tooth with root resorption: report of a case

Objetivo: informar el tratamiento de un diente avulsionado con reabsorción radicular y obturado únicamente con compuesto de mineral trióxido (MTA, Angelus, Londrina, Brasil). Caso clínico: en un paciente de 17 años que presentó avulsión del 11, con tiemop extraoral mayor a 60 minutos, 6 meses después se observó reabsorción radicular externa inflamatoria comunicante con ligamento periodontal, pérdida de cresta ósea, tracto sinuoso y movilidad dental. A pesar de no haber buen pronóstico, se realizó el tratamiento de la reabsorción con medicación con hidróxido de calcio y obturación única del conducto con MTA. Se efectuó un control con tomografía de cono a los 2 años y 10 meses, el cual mostró la no continuación de la reabsorción de cresta ósea. Conclusión: el tratamiento adecuado y la obturación con MTA ofrecen la oportunidad de lograr una buena cicatrización de los tejidos perirradiculares y preservar dientes comprometidos.

Fractura radicular en piezas primarias / Root fracture in primary teeth

Los traumatismos dentarios constituyen uno de los motivos más frecuentes en la consulta odontopediátrica. Si bien las fracturas radiculares en dentición primaria son las lesiones traumáticas menos prevalentes (2-4 por ciento), son de difícil resolución y ocasionan la pérdida de dichas piezas en la mayoría de los casos. Objetivo: describir la resolución del traumatismo con fractura radicular en ambos incisivos centrales superiores primarios. Diagnóstico de la situación inicial: paciente masculino de 4 años que acude con su madre a la Cátedra de Odontología Integral Niños de la FOUBA presentando un traumatismo dental de 2 horas de evolución. Diagnóstico clínico-radiográfico: fractura radicular horizontal de tercio medio del 5.1 y 6.1 (sin reabsorción fisiológica radicular), sin desplazamiento del fragmento coronario, con laceración de labio superior y encía marginal. Secuencia de procedimientos operatorios: historia clínica con consentimiento informado; anamnesis médica y odontológica; examen clínico y radiográfico de 5.1 y 6.1 y antagonistas; limpieza de tejidos blandos con clorhexidina; impresión con alginato; confección de placa posicionadora para ferulización; prueba e instalación de la placa; indicaciones al paciente y a su madre: uso permanente durante 45 días y uso nocturno, para comer y hacer deportes 45 días más. Recomendaciones de higiene; controles inmediatos: 30 y 45 días y 3 y 6 meses. Resolución del caso: en todos los controles, ambas piezas se presentaron asintomáticas. A los 6 meses se observa la correcta cicatrización radicular y la presencia de vitalidad en ambos incisivos. Conclusiones: el tratamiento temprano y los controles posteriores son fundamentales para preservar la salud pulpar y conseguir la reparación de los tejidos duros afectados.

Planejamento: a chave para a obtenção de resultados estéticos e funcionais em restaurações implantossuportadas / Planning: The key to obtaining aesthetic and functional results in implant-supported restorations

Diversos fatores determinam o sucesso na obtenção dos objetivos funcionais e estéticos com restaurações implantossuportadas. O trabalho em equipe é essencial desde o momento do diagnóstico, bem como o compromisso de todos os membros envolvidos com a resolução das diversas situações que surgem diariamente na prática odontológica. Um planejamento abrangente mostra-se a chave para alcançar os resultados propostos, respeitando uma prática interdisciplinar e utilizando protocolos aceitos clinicamente e cientificamente, baseados em evidências científicas. Assim, o presente artigo apresentará a integração paciente-dentista-TPD, na busca por resultados sustentáveis em longo prazo...

Several factors determine the success of functional and esthetic outcomes with implant-supported prosthetic replacement. Team work is essential as from the time of diagnosis, along with commitment of all members involved in solving different situations daily arising in dental practice. Meticulous planning is the key to achieve the desired result, respecting an interdisciplinary practice and using clinically scientifically acceptable evidence-based protocols. Thus, this article presents a case of patient-dentist-dental hygiene technician integration in the quest for sustainable results in the long run...

Apical Third Horizontal Root Fractures in Anterior.

Horizontal root fractures are a type of traumatic dental injury. Horizontal root fractures are classified as apical third, middle third, and cervical third of the root based on the fracture line and on the degree of dislocation of the coronal fragment. The prognosis of the tooth depends on the patient’s age, stage of root growth, mobility of the coronal fragment and diastasis of the fragments. Proper clinical and radiographic examination should be done to reveal apical root fractures. Hence, the treatment plan can be decided depending on the type of fracture and extent of fracture line. This review was conducted to evaluate the apical third horizontal root fractures in order to determine the appropriate therapy.

Orthodontic extrusion of subgingivally fractured tooth using a removable appliance: An alternative treatment to reestablish biological width.

Restoration of a traumatically injured tooth presents a clinical challenge for a predictable aesthetic outcome. This case report describes a multidisciplinary approach of a subgingivally fractured permanent maxillary central incisor. A removable orthodontic appliance was used for orthodontic extrusion of root, and surgical gingival recontouring was done with electrocautery to reestablish the biological width. Form and function were restored establishing biological width and esthetics was repaired with porcelain fused to metal crown.

Reimplante dentario después de 72 horas avulsionado / Dental re-implantation 72 hours after avulsion

La reimplantación dentaria ha sido uno de los procedimientos más exigente de rigor y precisión en cuanto a las condiciones que deben existir para lograr el éxito esperado. El propósito de esta presentaciòn es mostrar la evolución y tratamiento del auto-implante del incisivo lateral superior izquierdo, 72 horas después de avulsionado. Se trata de paciente masculino de 18 años de edad, con antecedentes de salud. Acude a consulta luego de tres días de avulsionado el incisivo lateral superior izquierdo por trauma. Se le explicó al paciente el posible fracaso del tratamiento por el tiempo transcurrido, puesto que la inmediatez con que sea tratado favorece el éxito. Se le realizó el reimplante dentario y ferulizó. Se realizó el tratamiento endodóntico al diente en dos sesiones de una semana entre ellas. Se realizaron evoluciones trimestrales y luego semestrales. Casi cinco años después, la evidencia radiográfica no muestra complicaciones existentes y clínicamente presenta una apariencia normal. Los resultados obtenidos fueron satisfactorios y después de cinco años el paciente se mantiene con su diente en boca completamente asintomático(AU)

The dental re-implantation is one of the procedures demanding most rigor and precision in terms of the conditions required to achieve the expected success. Our purpose is to present the evolution and treatment of a case of auto-implantation of the upper left lateral incisor 72 hours after avulsion. The patient was a male 18 year-old with a history of ill health presents three days after avulsion of the upper left lateral incisor as a result of trauma. The patient was informed of the possible failure of the treatment due to the time elapsed. In cases such as this one, immediate treatment is essential to achieve success. Dental re-implantation and ferulization were performed. The tooth was treated endodontically on two visits one week apart. Checkups were conducted which were quarterly at first and then biannual. Almost five years later, radiographic evidence shows no complications and clinical appearance is normal. The results were satisfactory. The patient has preserved his tooth for five years and his status is totally asymptomatic(AU)

Hiperplasia gingival fibrosa en sitio estético: enfoque quirúrgico ante recidiva / Fibrous gingival hyperplasia in esthetic zone: surgical approach on recurrence

Objetivo: aportar evidencia clínica sobre el abordaje de lesiones hiperplásicas en sitios estéticos y enfatizar la importancia de la planificación quirúrgica para reducir al mínimo su recidiva. Caso clínico: una paciente de 65 años de edad se presentó a la consulta con lesión nodular localizada en encía vestibular de pieza 21, con un período de evolución de 18 meses. Se describe el procedimiento quirúrgico inicial llevado a cabo para su tratamiento, el diagnóstico anatomopatológico, su evolución y recidiva, y un nuevo enfoque quirúrgico para su eliminación. Conclusiones: este informe enfatiza la importancia de una completa escisión de la lesión con margen de seguridad para evitar su recidiva, como objetivo primario en el abordaje quirúrgico. En sitios estéticos, la biopsia escisional, junto con la cirugía plástica periodontal, puede ser una opción para restaurar la salud gingival y devolver la estética y función al sitio

Fracturas coronarias con exposición pulpar: reporte de tres casos clínicos en diferentes edades / Crown fractures with pulp exposure: report of three clinical cases at different ages

Los traumatismos dentarios son la causa más frecuente de daño en los dientes anteriores. Las fracturas coronarias con pulpa expuesta representan entre el 18 al 20 por ciento de las lesiones traumáticas que involucran las piezas dentarias. En esta comunicación clínica, los autores muestran un tratamiento preventivo: técnica de Cvek, que evita que los dientes afectados llegen a un tratamiento endodóntico total

Association between Trauma to Primary Incisors and Crown Alterations in Permanent Successors

The aim of this study was to determine the prevalence of sequelae in permanent teeth that had their predecessors traumatized and investigate associated factors. The study was carried out with clinical and radiographic data from 137 patient charts of the Traumatized Patient Care Program, Federal University of Santa Catarina (Brazil), totalizing 253 teeth. Data were gathered on gender, age at the time of trauma, type of trauma, type of post-trauma sequelae, trauma recurrence and crown alteration in the permanent successors. No statistically significant associations were found between permanent successor's crown alteration and gender, age at the time of trauma, post-trauma sequelae or trauma recurrence (p>0.05). Significant associations were found between severe trauma (crown fracture with pulp exposure, lateral luxation, intrusion and extrusion) in the primary incisors and permanent successor's crown alteration (p<0.05). Multivariate analysis revealed an association between severe trauma to the primary incisors and permanent successor's crown alteration (OR: 4.1 - IC: 1.7-10.1). Alterations in the crown of permanent successors are associated with severe trauma to the primary incisors, as primary teeth affected by severe trauma have a fourfold greater chance of exhibiting permanent successor crown alteration in comparison to primary teeth that had minor trauma.

O objetivo deste estudo foi determinar a prevalência de sequelas nos dentes permanentes, em crianças que tiveram o seu antecessor traumatizado e os fatores associados. O estudo foi realizado com dados clínicos e radiográficos de 173 prontuários de pacientes do Programa de Assistência ao Paciente Traumatizado, Universidade Federal de Santa Catarina (Brasil), totalizando 253 dentes. Os dados coletados foram: gênero, idade no momento do trauma, tipo de trauma, tipo de sequelas pós-trauma, recorrência de trauma e alteração na coroa dos sucessores permanentes. Não houve associação estatisticamente significativa entre alteração na coroa do sucessor permanente e gênero, idade no momento do trauma, sequela pós-trauma e recorrência de trauma (p>0,05). Foram encontradas associações significativas entre trauma grave (fratura coronária com exposição pulpar, luxação lateral, intrusão e extrusão) nos incisivos decíduos e o sucessor permanente com alteração na coroa (p<0,05). A análise multivariada revelou uma associação entre trauma grave nos incisivos decíduos e alteração no sucessor permanente (OR: 4.1- IC: 1,7-10,1). Alterações na coroa dos sucessores permanentes estão associadas com trauma grave nos incisivos decíduos. Dentes decíduos acometidos por trauma grave têm quatro vezes mais chance de apresentar alteração na coroa do permanente em comparação com trauma leve.