Effects of early unilateral mandibular first molar extraction on condylar and ramal asymmetry / Efectos de la extracción temprana del primer molar mandibular unilateral sobre la asimetría condilar y ramal

SUMMARY: Craniofacial symmetry is an important factor in creating a harmonious facial appearance. Genetic and external factors may cause the formation of mandibular asymmetry. The aim of this study was to evaluate vertical mandibular asymmetries in adolescents who had unilateral mandibular first permanent molar (FPM) teeth extracted at an early age. The study group consisted of 60 subjects (30 females, 30 males with a mean age of 16.18±1.04 years) who had their mandibular permanent first molar tooth extracted before the age of 12, and the control group consisted of 60 healthy subjects (30 females, 30 males with a mean age of 16.23±0.92 years). Condylar asymmetry index (CAI), ramal asymmetry index (RAI), and condylar-ramal asymmetry index (CRAI) were calculated using panoramic radiographs of the subjects. Independent samples t-test was used to evaluate the differences between groups. CAI, RAI, and CRAI values were similar between male and female subjects in both control and study groups, and no statistically significant difference was found (p>0.05). No statistically significant difference was observed between the group who had their mandibular first permanent molar teeth extracted at an early age and the control group (p>0.05). CAI values were relatively higher in both groups, but there was no significant difference between the CAI, RAI, and CRAI values between the groups.

La simetría craneofacial es un factor importante para crear una apariencia facial armoniosa. Factores genéticos y externos pueden causar la formación de asimetría mandibular. El objetivo de este estudio fue evaluar las asimetrías mandibulares verticales en adolescentes a quienes se les extrajo el primer molar permanente (FPM) mandibular unilateral a una edad temprana. El grupo de estudio consistió en 60 sujetos (30 mujeres, 30 hombres con una edad media de 16,18±1,04 años) a quienes se les extrajo el primer molar mandibular permanente antes de los 12 años, y el grupo control consistió en 60 sujetos sanos (30 mujeres, 30 hombres con una edad media de 16,23±0,92 años). El índice de asimetría condilar (CAI), el índice de asimetría ramal (RAI) y el índice de asimetría condilar-ramal (CRAI) se calcularon utilizando radiografías panorámicas de los sujetos. Se utilizó la prueba t de muestras independientes para evaluar las diferencias entre los grupos. Los valores de CAI, RAI y CRAI fueron similares entre los hombres y las mujeres tanto en el grupo control como en el de estudio, y no se encontraron diferencias estadísticamente significativas (p>0.05). No se observaron diferencias estadísticamente significativas entre el grupo al que se le extrajo el primer molar permanente mandibular a una edad temprana y el grupo control (p>0,05). Los valores de CAI fueron relativamente más altos en ambos grupos, pero no hubo diferencias significativas entre los valores de CAI, RAI y CRAI entre los grupos.

X-ray evaluation of pulp calcification in adult permanent teeth after pulpotomy / 北京大学学报(医学版)

OBJECTIVE@#To compare the clinical effects of pulpotomy with two kinds of calcium silicate materials, and to evaluate the formation of dentin bridge and pulp calcification after pulpotomy of adult permanent teeth.@*METHODS@#Patients who visited the General Department of Peking University School and Hospital of Stomatology from November 2017 to September 2019 and planned for pulpotomy on permanent premolars and molars with carious exposed pulp were selected. They were randomly divided into two groups. Bioceramic putty material iRoot BP (iRoot group, n=22) and mineral trioxide aggregate MTA (MTA group, n=21) were used as pulp capping agents, respectively. The patients were recalled after one year and two years. The clinical efficacy, dentin bridge index (DBI) and pulp calcification index (PCI) were recorded. Blinding method was used for the patients and evaluators.@*RESULTS@#There was no significant difference in gender, mean age, dentition and tooth position between the two groups (P>0.05). Seven cases were lost during the first year (4 cases in iRoot group and 3 cases in MTA group). In the iRoot group, 1 case had transient sensitivity at the time of 1-year follow-up. The cure rate of the two groups was 100% at the time of 2-year follow-up. The proportion of dentin bridge formation was 38.9% one year after operation, 55.6% two years after operation. The proportion of partial or even complete disappearance of root canal image was 5.6% before operation, 38.9% and 55.6% one and two years after operation, respectively. The difference was statistically significant by rank sum test (P < 0.05). There was no significant difference in dentin bridge formation and pulp calcification between the two groups (P < 0.05). DBI and PCI after operation was as the same as those before operation (44.4% cases of DBI and 25% cases of PCI) or gradually increased (55.6% cases of DBI and 75% cases of PCI). Spearman's nonparametric correlation analysis showed that age was positively correlated with preoperative pulp calcification index (PCI0, P < 0.05), but not with the dentin bridge index (DBI1, DBI2), pulp calcification index (PCI1, PCI2) and the degree of change (DBI2 vs. DBI1, PCI1 vs. PCI0, PCI2 vs. PCI0) 1-year and 2-year after operation (P>0.05).@*CONCLUSION@#According to this study, good clinical effects were obtained within 2-year after pulpotomy of adult permanent teeth with MTA and iRoot. In some cases, the root canal system had a tendency of calcification aggravation, and there was no statistical difference in the development of this trend between the two groups.

Preservação alveolar e instalação tardia de implante dentário: relato de caso / Alveolar preservation and late dental implant installation: case report / Preservación alveolar e instalación tardía de implante dental: reporte de caso

Introdução. Decorrente do trauma local, durante a exodontia, ou pela falta de estímulos mastigatórios, a ausência dentária promove respostas biológicas que desencadeiam um processo de reabsorção óssea. A preservação óssea alveolar propõe minimizar a reabsorção óssea alveolar, promovendo maior biodisponibilidade óssea para a reabilitação por implantes dentários. Os implantes dentários são uma modalidade terapêutica eficaz para a reabilitação de ausências dentárias. Objetivo. relatar um caso de reabilitação por implante em alvéolo cicatrizado, após preservação alveolar. Relato de caso. Paciente A.L.L., sexo masculino, 23 anos, compareceu à clínica odontológica da UNIBRA. Ao exame físico observou-se ampla destruição coronária do elemento 25 e, ao exame radiográfico notou-se tratamento endodôntico. O tratamento proposto foi a exodontia minimamente traumática, preservação alveolar com matriz de colágeno e instalação de implante dentário em alvéolo cicatrizado. Discussão. Em desdentados, a falta de estímulos mastigatórios, promove um desequilíbrio no turnover ósseo, desencadeando um processo de reabsorção. A preservação alveolar por matriz de colágeno visa minimizar a reabsorção e fornecer maior biodisponibilidade óssea para a reabilitação por implantes. Conclusão. A preservação alveolar com a matriz de colágeno cumpriu com seu objetivo e, a reabilitação por implante dentário em alvéolo cicatrizado é uma modalidade eficaz na reabilitação de pacientes desdentados... (AU)

Introduction. Due to local trauma, during tooth extraction, or the lack of masticatory stimuli, the absence of teeth promotes biological responses that trigger a process of bone resorption. Alveolar bone promotion minimizes alveolar bone resorption, promoting high bone bioavailability for rehabilitation with dental implants. Dental implants are a treatment modality to edentulous. Objective. Report a case of implant rehabilitation in a healed socket after alveolar preservation. Case report. Patient A.L.L., male, 23 years old, attended the UNIBRA dental clinic. On physical examination, a wide coronary destruction of element 25 was observed and, on radiographic examination, endodontic treatment was noted. The proposed treatment was a minimally traumatic tooth extraction, alveolar preservation with collagen matrix and implant placement in healed sockets. Discussion. In edentulous patients, the lack of masticatory stimuli promotes an imbalance in bone turnover, triggering a resorption process. Alveolar preservation by collagen matrix aims to minimize resorption and provide greater bone bioavailability for implant rehabilitation. Conclusion. Alveolar preservation with collagen matrix fulfilled its objective, and rehabilitation by dental implant in a healed socket is an effective modality in the rehabilitation of edentulous patients... (AU)

Introducción. Por traumatismo local, durante la extracción dentaria, o por falta de estímulos masticatorios, la ausencia de dientes promueve respuestas biológicas que desencadenan un proceso de reabsorción ósea. La preservación ósea alveolar propone minimizar la reabsorción ósea alveolar, promoviendo una mayor biodisponibilidad ósea para la rehabilitación mediante implantes dentales. Los implantes dentales son una modalidad terapéutica eficaz para la rehabilitación de dientes perdidos. Objetivo. reportar un caso de rehabilitación con implantes en un alvéolo cicatrizado después de preservación alveolar. Reporte de un caso. Paciente A.L.L., masculino, 23 años, acudió a la clínica odontológica de la UNIBRA. El examen físico reveló destrucción coronaria extensa del elemento 25 y el examen radiográfico reveló tratamiento endodóntico. El tratamiento propuesto fue extracción dental mínimamente traumática, preservación alveolar con matriz de colágeno y colocación de implante dental en alvéolo cicatrizado. Discusión. En pacientes edéntulos, la falta de estímulos masticatorios promueve un desequilibrio en el recambio óseo, desencadenando un proceso de reabsorción. La preservación alveolar mediante matriz de colágeno tiene como objetivo minimizar la reabsorción y proporcionar una mayor biodisponibilidad ósea para la rehabilitación con implantes. Conclusión. La preservación alveolar con matriz de colágeno cumplió su objetivo, y la rehabilitación mediante implante dental en un alvéolo cicatrizado es una modalidad eficaz en la rehabilitación de pacientes edéntulos... (AU)

Retratamiento y reparación de una perforación radicular. Informe clínico, radiográfico e histológico / Retreatment and healing of a case of root perforation. Clinical, radiographic and histological report

Objetivo: Describir los aspectos clínicos, radiográfi- cos e histológicos del retratamiento realizado en un segundo molar superior en el que se había producido previamente una perforación radicular durante el tratamiento original. Caso clínico: Un paciente masculino de 50 años con- currió a la consulta para realizar un retratamiento endodóntico en un segundo molar superior derecho. El examen radiográfi- co reveló la presencia de un tratamiento incompleto, un área radiolúcida periapical y una perforación radicular producida por un poste roscado insertado fuera del espacio del conducto mesio vestibular. Una vez retirado el poste, se selló la perfo- ración con Biodentine y se realizó el retratamiento. Luego de dos años, el paciente regresó a la consulta con dolor a la mas- ticación, localizado en el área correspondiente al segundo mo- lar superior derecho previamente tratado. Durante el examen clínico y radiográfico se detectó la presencia de una fractura vertical en la raíz palatina. A causa del severo compromiso radicular el molar fue extraído y derivado para su análisis his- tológico. El informe del laboratorio reveló que la perforación había sido reparada por medio de la aposición de un nuevo tejido calcificado y que el remanente periodontal adherido a la raíz se encontraba dentro de los límites normales. El presente caso clínico resalta la importancia que tiene el conocimiento cabal de la anatomía del sistema de conductos radiculares con el objeto de evitar errores de procedimiento que puedan influir negativamente en el pronóstico del tratamiento (AU)

Aim: To describe the clinical, radiographic and histo- logical aspects of the retreatment of a second upper molar in which root perforation had occurred during the original treatment. Clinical case: A 50-year old male was referred for endo- dontic retreatment of the right second maxillary molar. Radi- ographic examination revealed the presence of an incomplete root canal treatment, a radiolucent periapical area and a root perforation produced by a threaded post placed outside of the mesiobuccal root canal. After post removal, the root perfo- ration was sealed with Biodentine and the root canals were retreated. Two years later, the patient returned to the office com- plaining of severe pain during mastication, in the area of the previously retreated right second maxillary molar. Clinical and radiographic examination revealed the presence of a ver- tical fracture on the palatal root. Since this kind of root dam- age non-restorable, the tooth was extracted and submitted to histologic analysis. The laboratory report revealed that the perforation site had healed by the apposition of new calci- fied tissue, and that the remnants of periodontal tissue which persisted attached to the root were within normal limits. This clinical case highlights the importance of thorough knowl- edge of the anatomy of the root canal system in order to avoid procedural errors which may compromise the prognosis of the treatment (AU)

Autotransplante dentário como ferramenta de tratamento para perdas precoces de molares / Dental self transplantation as a treatment tool for early molar loss / Auto trasplante dental como herramienta de tratamiento para la pérdida molar temprana

O transplante dentário autógeno é um procedimento cirúrgico que consiste na transposição de um elemento dentário do seu alvéolo para um outro, em um mesmo indivíduo. Esta abordagem é indicada para substituir elementos com prognóstico desfavorável ou reabilitar áreas edêntulas. O objetivo deste trabalho é apresentar as vantagens do transplante dentário autógeno frente a perdas dentárias precoces e os critérios necessários para indicação do mesmo, por meio de um relato de caso clínico no qual, uma paciente do gênero feminino, 16 anos foi submetida ao transplante do elemento 48 para o alvéolo do 47 por motivos de lesão cariosa com extensa destruição coronária com impossibilidade de tratamento clínico restaurador. Em acompanhamento pós-operatório de 01 ano os resultados demostraram continuidade do desenvolvimento radicular do elemento transplantado em seu novo alvéolo, estando este, sem mobilidade, livre de lesões periodontais e/ou endodônticas. Desta forma, conclui-se que as vantagens do transplante dentário autógeno incluem a possibilidade de reabilitação dentária de forma natural, imediata e de baixo custo comparado a tratamentos como implantes e próteses. E este método quando indicado corretamente e realizado sob os devidos cuidados pode alcançar excelentes resultados funcionais e estéticos, sendo uma opção viável para reabilitação de perdas dentárias precoces... (AU)

The Autogenous dental transplantation is a surgical procedure that consists of the transposition of a dental element from its socket to another, in the same individual. This approach is indicated to replace elements with an unfavorable prognosis or to rehabilitate edentulous areas. The objective of this paper is to present the advantages of autogenous dental transplantation against early tooth loss and the necessary criteria for its indication, through a clinical case report in which a 16-year-old female patient underwent transplantation element 48 for the alveolus of the 47 due to carious lesions with extensive coronary destruction with impossibility of restorative clinical treatment. In a 01-year postoperative follow-up, the results showed continuity of root development of the transplanted element in its new alveolus, which is without mobility, free from periodontal and/or endodontic lesions. Thus, it is concluded that the advantages of autogenous dental transplantation include the possibility of natural, immediate and low-cost dental rehabilitation compared to treatments such as implants and prostheses. And this method, when correctly indicated and performed with due care, can achieve excellent functional and esthetic results, being a viable option for the rehabilitation of early tooth loss... (AU)

El trasplante dentario autógeno es un procedimiento quirúrgico que consiste en la transposición de un elemento dentario de su alvéolo a otro, en el mismo individuo. Este abordaje está indicado para reemplazar elementos con pronóstico desfavorable o para rehabilitar áreas edéntulas. El objetivo de este trabajo es presentar las ventajas del trasplante dentario autógeno frente a la pérdida dentaria precoz y los criterios necesarios para su indicación, mediante el reporte de un caso clínico en el que se trasplantó a una paciente de sexo femenino de 16 años. 47 por lesiones cariosas con extensa destrucción coronaria con imposibilidad de tratamiento clínico restaurador. En un seguimiento postoperatorio de 01 año, los resultados mostraron continuidad del desarrollo radicular del elemento trasplantado en su nuevo alvéolo, que se encuentra sin movilidad, libre de lesiones periodontales y/o endodónticas. Así, se concluye que las ventajas del trasplante dental autógeno incluyen la posibilidad de una rehabilitación dental natural, inmediata y de bajo costo frente a tratamientos como implantes y prótesis. Y este método, correctamente indicado y realizado con el debido cuidado, puede lograr excelentes resultados funcionales y estéticos, siendo una opción viable para la rehabilitación de la pérdida dentaria temprana... (AU)

Feasibility analysis of immediate implant placement in the maxillary molar region / 中华口腔医学杂志

Objective: To study the clinical outcomes and feasibility of immediate implantation after flap surgery and minimally invasive extraction in the maxillary molar area and to provide a reference for it. Methods: Forty-one patients (41 molars in total) with maxillary molars that could not be preserved, treated from June 2018 to June 2020 at the Department of Oral and Maxillofacial Surgery at the Affiliated Hospital of Qingdao University, were selected. There are 24 males and 17 females with the age of (49.7±1.8) years (range 18-66 years). Pre-operative cone-beam CT (CBCT) was taken for measurement and analysis. After flap surgery and minimally invasive tooth extraction, the inflammatory granulation tissues attached to the soft and hard tissues were completely scraped and clipped, followed by the preparation of the implants in the correct three-dimensional position. Torque value and implant stability quotient (ISQ) were recorded after implant placement and with non-submerged healing. CBCT examination was taken 6 months after surgery and ISQ value was checked before crown restoration. CBCT examination was also taken 1 year after the permanent restoration. The survival rate of 6 months after surgery, the success rate of 1 year after permanent restoration, and the size of jump gaps immediately after surgery, 6 months after surgery, 1 year after permanent restoration respectively, were performed. The ISQ values were compared immediately and 6 months after surgery. Results: A total of 41 implants were placed in 41 patients. Six months after surgery, the survival rate was 100% (41/41). Twelve months after permanent restoration, the success rate of the implant restoration was 100% (41/41). The torque value after implant implantation was (42.77±0.79) N·cm. The buccal and palatal jump gaps were (3.15±0.16) mm and (2.86±0.18) mm immediately after surgery, respectively. The mesial and distal jump gaps were (2.94±0.19) mm and (3.77±0.21) mm, respectively. CBCT showed that no jump gap around the implants at 6 months after surgery and 1 year after permanent restoration. The ISQ values at immediately and 6 months after surgery were (74.78±0.59) and (80.20±0.49) respectively, and the difference was statistically significant (t=-9.03, P<0.001). Conclusions: Immediate dental implantation in the correct three-dimensional position could achieve good osseointegration by means of flap surgery, minimally invasive extraction and thorough removal of inflammatory tissue on the surface of soft and hard tissues. The clinical outcomes were satisfactory.

Cuerpo extraño (fragmento de amalgama intraóseo) de la mandíbula: informe de caso / Foreign body (intraosseous bone fragment) of the mandible: report of a case

Un cuerpo extraño es un objeto o una estructura que se incluye accidental o intencionalmente en la intimidad de los tejidos orgánicos de un individuo. Puede desencadenar importantes procesos inflamatorios/ infecciosos, dependiendo de su naturaleza, requiriendo en la mayoría de los casos su extracción quirúrgica, con el fin de evitar daños al paciente. Este trabajo tiene como objetivo informar un caso de cuerpo extraño (fragmento de amalgama) incluido iatrogénicamente en la exodoncia de un molar inferior derecho en un paciente que, después de 8 años, optó por hacerse un implante en el área y descubrió la inclusión de este material, siendo necesaria su extracción quirúrgica para la posterior colocación del implante dental en la región. Los autores destacan la necesidad de realizar una minuciosa inspección y toilette de la caja alveolar en el acto de la exodoncia, para evitar incluir cuerpos extraños en el sitio quirúrgico y evitar así, una nueva intervención en el área (AU)

Foreign body is an object or structure included accidentally or intentionally in the intimacy of the organic tissues of individuals. They can trigger important inflammatory / infectious processes, depending on its nature, requiring its surgical removal in most cases, to prevent damage to the patient. This study aimed to report a case of a foreign body (fragment of amalgam) iatrogenically included in extraction of a right lower molar in a patient who, after 8 years, opted to have an implant in the area and discovered the inclusion of this material, requiring its surgical removal for subsequent placement of a dental implant in the region. The authors highlight the need to perform a thorough inspection and toilet of the alveolar box in the act of extraction, to avoid including foreign bodies in the surgical site, avoiding further intervention in the area (AU)

Removal of nonimpacted third molars alters the periodontal condition of their neighbors clinically, immunologically, and microbiologically / 国际口腔科学杂志·英文版

Considering the adverse effects of nonimpacted third molars (N-M3s) on the periodontal health of adjacent second molars (M2s), the removal of N-M3s may be beneficial to the periodontal health of their neighbors. This study aimed to investigate the clinical, immunological, and microbiological changes of the periodontal condition around M2s following removal of neighboring N-M3s across a 6-month period. Subjects with at least one quadrant containing an intact first molar (M1), M2, and N-M3 were screened and those who met the inclusion criteria and decided to receive N-M3 extraction were recruited in the following investigation. M2 periodontal condition was interrogated before M3 extraction (baseline) and at 3 and 6 months postoperatively. Improvements in clinical periodontal indexes of M2s in response to their adjacent N-M3 removal, along with changes in inflammatory biomarkers among gingival crevicular fluid (GCF) and the composition of subgingival plaque collected from the distal sites of the M2s of the targeted quadrant were parallelly analyzed. Complete data of 26 tooth extraction patients across the follow-up period were successfully obtained and subsequently applied for statistical analysis. Compared to the baseline, the periodontal condition of M2s was significantly changed 6 months after N-M3 removal; specifically, the probing depth of M2s significantly reduced (P < 0.001), the matrix metalloproteinase (MMP)-8 concentration involved in GCF significantly decreased (P = 0.025), and the abundance of the pathogenic genera unidentified Prevotellaceae and Streptococcus significantly decreased (P < 0.001 and P = 0.009, respectively). We concluded that N-M3 removal was associated with superior clinical indexes, decreased GCF inflammatory biomarkers, and reduced pathogenic microbiome distribution within the subgingival plaque. Although the retention or removal of N-M3s continues to be controversial, our findings provide additional evidence that medical decisions should be made as early as possible or at least before the neighboring teeth are irretrievably damaged.

Intentional reimplantation of left lower second molar as an alternative to extraction: a case report / Reimplante intencional del segundo molar inferior como alternativa a la extracción: reporte de caso

In patients who need endodontic re-treatment, and where the prognosis for surgical or non-surgical re-treatment is poor or treatment may be risky, one alternative is to opt for extraction of the affected tooth and replacement by an implant. However treatment by intentional reimplantation (IR) is also a possibility. The object of the present study was to present a case of a patient aged 71 years who needed endodontic re-treatment, where IR treatment was selected. The patient reported spontaneous pain which disappeared completely with the use of analgesics. This tooth had previously been treated endodontically around 1 year earlier, and no pain was reported in the first two months after treatment.Nonetheless, about 3 months before the present consultation, intensity of the symptoms had increased with a sensation of pressure in the apical-coronal direction. Cone-beam computerised tomography (CBCT) showed a periapical lesion in tooth 3.7. Based on the clinical and imaging examinations, acute apical periodontitis was diagnosed in tooth 3.7.The tooth was treated by IR. It was carefully extracted and inspected for cracks or perforations. It was treated under the microscope with root resection, and then retrograde obturation was carried out with bioceramic material. The tooth was then repositioned in its alveolus. It was immobilised for 15 days, after which the patient could return gradually to normal masticatory function. In the 6 months check-up the patient presented no pain or sensitivity to percussion. No root resorption or periapical radiolucency was observed in the periapical X-ray. We conclude that IR is an alternative to extraction followed or not by prosthetic treatment, for patients who need endodontic re-treatment. The treatment presents good levels of success, and of acceptance by the patient.

En pacientes que necesitan de retratamiento endodóntico y el retratamiento quirúrgico o no quirúrgico tiene un pronóstico desfavorable o puede ser riesgoso, se puede optar por la extracción del diente afectado y su reemplazo por implante o se puede elegir el tratamiento mediante la técnica de reimplante intencional (RI). El objetivo del presente estudio fue presentar un caso de paciente de 71 años con necesidad de retratamiento endodóntico, donde se optó por la realización del RI. Paciente relatava dolor espontáneo que desaparecia completamente con el uso de analgésicos. Este diente ya había sido tratado endodónticamente hace alrededor de 1 año, y el paciente noreportó dolor en los primeros dos meses después del tratamiento.No obstante, hace aproximadamente 3 meses la intensidad de los síntomas aumentó, junto con la sensación de presión en el sentido ápice-corona. La tomografía computarizada cone-beam (TCCB) mostró lesión periapical en el diente 3.7. Basado en el examen clínico e imagenológico se diagnosticó periodontitis apical aguda en el diente 3.7.Para el tratamiento se realizó la técnica de RI, siendo extraído el diente cuidadosamente, e inspeccionado a fin de localizar fisuras o perforaciones. El diente fue tratado bajo microscopio y se realizó la resección de la raíz. Se realizó la obturación retrógrada con material biocerámico. Enseguida el diente fue reposicionado en su alveolo, la inmovilización fue realizada durante 15 días y la paciente logró retornar gradualmente a su función masticatoria. En el seguimiento de 6 meses la paciente no presentó dolor o sensibilidad a la percusión. En la radiografía periapical no se observó resorción radicular o radiolucencia periapical. Concluimos que el RI en pacientes que necesitan retratamiento endodóntico es una alternativa a la realización de la exodoncia seguida o no, de tratamiento protético, donde existe una buena aceptación por parte del paciente y éxito en el tratamiento.

Remoção de dente deslocado para espaço submandibular: relato de caso / Removal of displaced tooth into submandibular space: a case report

Introdução: A exodontia é um dos procedimentos mais realizados nos consultórios odontológicos, e as complicações podem surgir, principalmente, quando não existem exames de imagem no pré-operatório ou quando se usa força inadequada durante o procedimento. Dentes molares inferiores podem se deslocar para o espaço submandibular durante as exodontias, e , apesar de ser considerada uma complicação rara, o paciente pode evoluir com dor, trismo e, em casos mais graves, para infecção com envolvimento cervical. Relato de caso: O presente artigo tem como objetivo relatar o caso de um paciente com infecção crônica em região cervical após tentativa, sem sucesso, de remoção de um molar inferior cujo fragmento dentário havia sido deslocado para o espaço submandibular durante o procedimento cirúrgico. O tratamento de escolha foi a fistulectomia e a remoção cirúrgica do dente sob anestesia geral pelo acesso extraoral submandibular de Risdon, seguido de divulsionamento delicado até localização e remoção do corpo estranho deslocado. O paciente foi acompanhado clinicamente, por 3 meses, evoluindo bem, sem queixas e sem observação de recidiva do processo infeccioso. Considerações Finais: Deslocamento dentário para o espaço submandibular é um acidente, que pode ocorrer com qualquer profissional, razão por que é de extrema importância o conhecimento da prevenção e do tratamento dessa complicação... (AU)

Introduction: Exodontia is one of the most commonly performed procedures in dentistry, and complications can arise, especially when there is no preoperative imaging exams or when inadequate force is used during the procedure. Lower molar teeth may move into the submandibular space during the exodontia, and although it is considered a rare complication, the pacient may feel pain, trismus, and in more severe cases may evolve to infection with cervical involvement. Case report: This present article aims to report a case of a patient with chronic infection in the cervical region after an unsuccessful attempt of removing a lower molar, in which the dental fragment was moved to the submandibular space during the surgical procedure. The treatment of choice was a fistulectomy and the surgical removal of the tooth under general anesthesia by Risdon submandibular extraoral approuch, followed by delicate divulsion to the location and removal of the foreign body displaced. The case was followed clinically for 3 months, evolving well, without complaints and recurrence of the infectious process. Final considerations: Dental displacement to the submandibular space is an accident that can occur under any professional care, so it is extremely important to know the prevention and treatment of this complication... (AU)

Timely extraction of the first permanent molars severely affected in mixed dentition / Extracción oportuna de los primeros molares permanentes severamente afectados en dentición mixta

The aim of this study was to establish a guide for general dentists that allow identifying the ideal moment to extract the first permanent molars with poor prognosis, in the hope of obtaining a spontaneous closure of space, regarding that the first permanent molar is more susceptible to develop dental caries in children due to its early eruption in the oral cavity and molar incisor hypomineralization affects them the most. Methods: we proceed to search for the articles in databases PUBMED and SciELO, selected articles published from 1998 a 2018 were analyzed based on inclusion and exclusion criteria. Conclusion: Our review suggests that a full evaluation of the compromised first permanent molar should be performed before planning an extraction. It can be concluded that the ideal stage to extract a first permanent molar with bad prognosis is in the Demirjian stage E or D evaluated with radiographs, which is generated at a chronological age of 8 to 10.5 years, ideally in the presence of third molars.

El objetivo de este estudio fue establecer una guía para odontólogos que permita identificar el momento ideal para extraer los primeros molares permanentes con mal pronóstico, con el objectivo de obtener un cierre espontáneo del espacio, teniendo en cuenta que el primer molar permanente es más susceptible a desarrollar caries en niños debido a su erupción temprana en la cavidad oral y es el más afectado por la hipomineralización. Material y Métodos: Se procedió a buscar y analizar artículos científicos de las bases de datos PUBMED y SciELO, publicados entre 1998 y 2018 en base a criterios de inclusión y exclusión. Conclusión: Nuestra revisión sugiere que se debe realizar una evaluación completa del primer molar permanente comprometido antes de planificar una extracción. Se puede concluir que la etapa ideal para extraer un primer molar permanente con mal pronóstico son los estadios E o D de Demirjian, evaluados con radiografías, que se genera a una edad cronológica de 8 a 10,5 años, idealmente en presencia de terceros molares.

The effectiveness of the cold therapy (cryotherapy) in the management of inflammatory parameters after removal of mandibular third molars: a meta-analysis

Introduction: Cold therapy (cryotherapy) is a common procedure recommended by dental surgeons after surgical removal of thirdmolars, which is an invasive intervention that often deals with an expressive inflammatory response. Objective: To investigate whether cryotherapy interferes with clinical outcomes such as pain, edema, and trismus in the postoperative period of mandibular third molar surgeries. Data Synthesis: An electronic search was conducted in the OVID, PubMed, VHL, Science Direct, Cochrane Library, and Web of Science databases, through March 2018. The eligibility criteria included clinical trials that evaluated the effect of cryotherapy in at least one of the following variables: pain, swelling, and trismus. Two independent reviewers assessed the studies. The methodological quality of each article was analyzed. The search strategy resulted in 1,088 articles. Following the selection process, 11 studies were included in the systematic review and 4 of them in the meta-analysis. High risk of bias was found in most of the studies according to the Cochrane Handbook assessment. Patients receiving cryotherapy had less edema than patients in the control group at second day follow-up (mean difference [MD]: -0.94; 95%CI [-1.49; -0.39]). There were no statistically significant results when comparing trismus between experimental and control group (MD: 0.43; 95%CI [-0.34;1.20]). There were insufficient available data to support influences in postoperative pain. Conclusions: Cryotherapy applied on thefirstday aftermandibular third molar removal can manage edema in the patients.Well-designed randomized clinical trials to test the efficacy of cryotherapy after surgical removal of third molars are needed to justify its indication (AU)

Evaluation of the waveone gold and one shape new generation in reducing enterococcus faecalis from root canal

Abstract The aim of this study was to evaluate the WaveOne Gold and One Shape New Generation systems regarding the bacterial removal from root canals infected with Enterococcus faecalis by comparing them to the conventional WaveOne and One Shape systems. Forty-eight distobuccal root canals of maxillary molars sterilized with ethylene oxide were infected with E. faecalis for 21 days, and then root canal initial bacterial sample was collected with paper cones and plated on M-enterococcus agar. The specimens were randomly divided into 4 groups according to the instrumentation: WaveOne Gold, One Shape New Generation, WaveOne and One Shape. After instrumentation, samples were collected with use of scraping and paper cones at immediate and 7 days after instrumentation. The bacterial reduction was calculated and then made intragroup analysis by Friedman test and intergroup analysis by Kruskal-Wallis with Dunn's post-hoc test, all at 5% significance. All techniques significantly reduced the number of bacteria in the root canal (p<0.05). WaveOne Gold and One Shape New Generation promoted higher bacterial reduction than WaveOne and One Shape systems (p<0.05), but no significant difference was found between WaveOne Gold and One Shape New Generation or between WaveOne and One Shape (p>0.05). Novel single-file systems promote better bacterial removal than the conventional single-file systems.

Resumo A proposta deste estudo foi avaliar os sistemas WaveOne Gold e One Shape New Generation em relação à remoção bacteriana de canais infectados com Enterococcus faecalis, comparando-os com seus sistemas convencionais WaveOne e One Shape. Quarenta e oito canais disto vestibulares de molares superiores esterilizados em óxido de etileno foram contaminados com E. faecalis por 21 dias, e então acoleta bacteriana inicial foi feita com cone de papel e plaqueadas em M-enterococcus agar. Os espécimes foram aleatoriamente divididos em quarto grupos de acordo com a instrumentação: WaveOne Gold, One Shape New Generation, WaveOne e One Shape. Após instrumentação, amostras foram coletadas utilizando limagem e cones de papel imediatamente e 7 dias após o preparo. A redução bacteriana foi calculada e então feita análise intra grupos com teste de Friedman, e entre grupos utilizando Kruskal-Wallis e teste de Dunn, todos a 5% de significância. Todas as técnicas reduziram significantemente o número de bactérias do canal radicular (p<0.05). WaveOne Gold e One Shape New Generation promoveram maior redução bacteriana que WaveOne e One Shape (p<0.05), mas nenhuma diferença significante foi encontrada entre WaveOne Gold e One Shape New Generation ou entre WaveOne e One Shape (p>0.05). Novos sistemas de lima-única promovem melhor remoção bacteriana que seus sistemas convencionais.

Transplante dentário autólogo realizado no mesmo paciente em etapas diferentes do seu desenvolvimento / Autogenous tooth transplantation in the same patient in different phases on your growing

Comprovadamente, os molares permanentes são os elementos dentários extraídos mais precocemente, podendo ocasionar graves problemas na oclusão dentária, além de dificultar a reabilitação posterior desses pacientes devido a migrações dentárias. O transplante dentário autógeno é definido como a reposição de um elemento dentário, perdido ou ausente, por outro elemento dentário do próprio paciente, constituindo-se em um recurso adicional para minimizar tais problemas. O objetivo deste trabalho é relatar dois casos de transplantes dentários autógenos, realizados no mesmo paciente do gênero masculino, em períodos de vida diferentes, encaminhado ao Serviço de Cirurgia Oral do Hospital de Força Aérea do Galeão /RJ... (AU)

Arguably, the permanent molars, the teeth are extracted earlier and may cause serious problems in dental occlusion also hindering the subsequent rehabilitation of these patients due to dental migrations. The autogenous tooth transplantation is defined as the replacement of a lost or missing tooth, second tooth from the patient, thus becoming an additional resource to minimize such problems. The aim of this paper is to report two cases of autogenous tooth transplants, performed on the same patient males in different periods of life, referred to the Oral Surgery Department of the Força Aérea do Galeão Hospital / RJ.... (AU)

Remoção de terceiro molar superior deslocado para o espaço bucal / Removal of upper third molar displaced to the buccal space

Os autores descrevem um caso clínico de deslocamento de germe dentário de terceiro molar superior esquerdo para o espaço bucal em um paciente de 13 anos de idade. A localização do dente em posição profunda com envolvimento do corpo adiposo do bucinador dificultou a sua localização, ainda não descrita, nas condições em questão, na literatura. Com a Tomografia Computadorizada de Feixe Cônico (TCFC), foi possível localizar o dente deslocado e planejar a sua remoção. Os riscos e benefícios das extrações de germes de terceiros molares precisam ser avaliados devido ao grande risco de deslocamentos... (AU)

The authors describe a case of displacement of left upper third molar tooth germ to the buccal space in a patient 13 years old. The deep position of the tooth with involvement of the fat body of the buccinator made it difficult its location, still not described, under the concerned conditions, in the literature. With the cone beam computed tomography (CBCT), it was possible determine the location of the tooth and plan his removal. The risks and benefits of third molar tooth germ extraction should be evaluated because there is a greater chance of displacement... (AU)

Caracterización de la Impactación de Segundos Molares Mandibulares Permanentes en una Población Sudamericana / Characterization of Permanent Mandibular Second Molars Impaction in a Southamerican Population

El objetivo de este estudio fue describir las características epidemiológicas de segundos molares mandibulares permanentes impactados unilateralmente en una muestra de la ciudad de Medellín, Colombia. Se trató de un estudio retrospectivo en el cual se evaluaron radiografías panorámicas de 6785 pacientes, de las cuales se analizaron un total de 28 radiografías en la muestra final. Fueron correlacionados el segundo molar mandibular impactado (grupo de estudio) y el contralateral no impactado (grupo control) con respecto a tres ángulos de referencia (intermolar, del plano oclusal e interplanar), el sexo y lado de impactación. Se encontró una prevalencia de 3,5 por cada 1000 radiografías evaluadas. El lado de mayor impactación fue el derecho; dos de los tres ángulos analizados (intermolar e interplanar) fueron los que arrojaron las diferencias más grandes entre el grupo de estudio y el grupo control. No se encontraron diferencias estadísticamente significativas según el sexo. Se concluyó que la prevalencia de segundos molares mandibulares permanentes impactados es baja, siendo mayor en el lado derecho, sin diferencias por sexo, y de preferencia el uso del ángulo interplanar como medida para la evaluación del riesgo de impactación (>7,9°).

The objective of this study was to describe the epidemiological characteristics of unilateral permanent mandibular second molars impacted, in a sample from Medellín, Colombia. It was a retrospective study in which we evaluated panoramic radiographs of 6785 patients, for a total of 28 radiographs analyzed in the final sample. The mandibular second molar impacted (study group) and the contralateral not impacted (control group) were correlated, with respect to three reference angles (intermolar, of the oclussal plane and interplanar), sex and impaction side. We found a prevalence of 3.5 for every 1000 radiographs evaluated. The most frequent side of impaction was the right side; two of the three angular measurements (intermolar and interplanar) had the biggest differences between the study and control group. We did not find significant statistical differences between males and females. It was concluded that the prevalence of impacted permanent mandibular second molars is low, there is a highest impaction in the right side, there are no differences between genders, and the use of the interplanar angle is preferable as a measurement to predict the impaction of permanent mandibular second molars (>7.9°).

Selective alveolar corticotomy to intrude overerupted maxillary first molars: analysis of pulp vitality / Corticotomía alveolar selectiva para la intrusión de los primeros molares superiores extruidos: análisis de la vitalidad pulpar

The excessive and prolonged orthodontic treatment might result in loss of pulp vitality. Selective alveolar corticotomy is an alternative to accelerate the orthodontic treatment in adults. This study aimed to evaluate the impact of selective alveolar corticotomy associated with orthodontic intrusion on pulp vitality of overerupted maxillary first molars. Six individuals with extruded maxillary first molars were randomly selected to undergo corticotomy as coadjuvant therapy for intrusion. Pulp vitality was evaluated with thermal (Endo-Ice and Heated gutta-percha) and electric tests before the surgical procedure and after intrusion (90 days). The intrusion of all teeth was obtained (mean 2.26 ± 0.52 mm), and all teeth responded positively to pulp vitality tests before and after intrusion. This suggests that selective alveolar corticotomy did not promote pulp damage, and can be considered an effective and safe auxiliary method to intrusion of overerupted maxillary molars.

El tratamiento de ortodoncia prolongado puede provocar la pérdida de la vitalidad pulpar. La corticotomía alveolar selectiva es una alternativa para acelerar el tratamiento de ortodoncia en adultos. El objetivo del presente estudio fue evaluar el impacto de corticotomía alveolar selectiva asociada a la intrusión dental con ortodoncia en la vitalidad pulpar de los primeros molares superiores extruidos. Seis individuos con primeros molares superiores extruidos fueron seleccionados al azar para someterse a corticotomía como terapia adyuvante para la intrusión dental. La vitalidad pulpar se evaluó en ensayos térmicos (Endo-ice y gutapercha climatizada) y eléctrica antes del procedimiento quirúrgico y después de la intrusión (90 días). Se obtuvo la intrusión de todos los dientes (media 2,26 ± 0,52 mm) y todos los primeros molares respondieron positivamente a las pruebas de vitalidad pulpar, antes y después de la intrusión. Los resultados sugieren que la corticotomía alveolar selectiva no promueve daño pulpar y se puede considerar un método eficaz y seguro para ayudar a la intrusión de molares extruidos.

Pérdida prematura del primer molar permanente en niños de la escuela primaria "Antonio López". México. 2016 / First permanent molar premature lost in children of the "Antonio López" primary school. México. 2016

Introducción: el primer molar permanente es un diente fundamental al determinar el patrón de masticación durante toda la vida y desempeñar un papel primordial para desarrollar y mantener una oclusión apropiada. Objetivo: describir la pérdida prematura del primer molar permanente. Materiales y Métodos: se realizó estudio observacional, descriptivo, transversal en la escuela primaria "Antonio López Coloma" del Consejo popular México, del municipio Colón, provincia Matanzas, en el periodo comprendido de enero a marzo del 2015 en 169 niños las edades 6 a 11 años. Se estudiaron variables como: edad sexo, y localización del molar ausente. Resultados: el 3% de los estudiados perdió el primer molar permanente, el 40 % de niños con 11 años tuvo pérdida de este diente, las féminas representaron el 60 % de los estudiados. Conclusiones: los estudiados en la edad de 11 años con predominio del sexo femenino presentaron pérdida prematura del primer molar permanente, en los que resaltó el primer molar inferior izquierdo (AU).

Introduction: The first permanent molar is a fundamental tooth to determine the mastication pattern during the whole life, it is vital to develop and maintain a proper occlusion. Objective: describing the premature loss of the first permanent molar. Materials and Methods: an observational, descriptive and transversal study was carried out in the primary school Antonio López Coloma in the area of Mexico neighborhood in Colon municipality, Matanzas province, in the period from January to March 2015, in 169 children 6 to 11 years old. They were study variable, age, sex and the location of the missing tooth. Results: the 3 % of the students lost the first permanent molar, the 40 % of 11 years old boys loss this tooth. The girls represented the 60 % of the studied. Conclusions: The investigated mainly the female sex in the age of 11 lost the first permanent molar very early. The left lower first molar had the highest incidence (AU).

Does Third Molar Surgery Alter Cardiac Parameters? A Retrospective Study

Objective: To investigate perioperative changes in the cardiac parameters of anxiety, which are blood pressure and heart rate, in patients undergoing surgical extraction of third molars. Material and Methods: Patients who reported anxiety before scheduled procedures were monitored for cardiac parameters before, during and after the surgery. The obtained data were analyzed to determine if there is a certain pattern of change within these values in systemically healthy patients. Alterations in selected parameters with regard to duration and difficulty of operation were also studied. IBM SPSS Statistics was used for data analysis. Repeated-measures of analysis of variance (ANOVA), paired samples t-test and Kruskal-Wallis tests were applied and a significance level of 5% was assessed. Results: Difficulty was categorized as minimally, moderately or very difficult in 9, 28 and 3 patients respectively. Mean operation time was 36.18 minutes with a range of 8 to 91 minutes. Operation time showed no variations with different levels of difficulty (p = 0.268). No statistical differences in any of the parameters listed above could be identified. Conclusion: Despite the common belief that dental procedures initiate anxiety, this study reveals that physiological parameters of anxiety show no significant changes over the course of third molar surgery, likewise difficulty and duration of surgery do not cause noteworthy changes in these parameters.

Extrações atípicas em ortodontia / Atypical extractions in orthodontics

Desde os primórdios da ortodontia discute-se sobre a necessidade de extrações dentárias em algumas situações ortodônticas como apinhamento, discrepância cefalométrica acentuada, entre outras. O objetivo desta revisão de literatura foi relatar casos de extrações atípicas em ortodontia, suas indicações, vantagens, desvantagens e prognóstico deste tipo de tratamento. Feito u minúsculo diagnóstico, extrações atípicas podem ser indicadas em casos discrepância cefalométrica acentuada e/ou discrepância de modelo negativa (≥10 mm), em casos que a discrepância de Bolton é compatível com a discrepância de modelos, quando o objetivo é solucionar o apinhamento na região em que ele ocorre ou ainda quando há dentes já comprometidos proteticamente. Quando são realizadas em incisivos inferiores, em geral, causam menor influência sobre o perfil facial uma vez que não é feita retração anterior. Além disso um único incisivo pode ser extraído ao invés de dois prés molares uma vez que não é feita retração anterior. Além disso um único incisivo pode ser extraído ao invés de dois prés molares. Nesses casos a linha média dentária maxilar fica alinhada com a linha média facial e na direção do centro da coroa do incisivo inferior, não comprometendo a estética. A função também não é prejudicada desde que caninos e molares estejam em Classe I, exista guia anterior imediata e guias funcionais, protrusiva e lateralidades, balanceadas. O prognóstico de extrações atípicas é favorável, já que a literatura reporta casos de acompanhamento a longo prazo, 10 anos.(AU)