Manejo de extrusión forzada ortodóntica: Reporte de un caso / Management and Follow-up of Orthodontic Forced Extrusion: A Case Report

El presente caso clínico se enfoca en el diagnóstico y el tratamiento de erupción forzada en un paciente con trauma dental. Objetivo: Proponer una alternativa de tratamiento multidisciplinario el cual permita incrementar estructura dentaria a través de la extrusión forzada y posteriormente rehabilitarlo en función y estética. Métodos: Se describe el caso de un paciente adulto de 78 años de sexo masculino, sano y sin antecedentes patológicos, acude a la clínica de la Especialidad de Ortodoncia y Ortopedia Dentomaxilo facial, referido por un especialista en Endodoncia, debido a fractura corono-radicular de canino superior derecho, pilar de puente fijo de tres unidades En la exploración intraoral presenta fractura cervical de la corona del canino superior derecho. Como primer paso, se realizó tratamiento endodóntico en la pieza dentaria y colocación de un aditamento intraconducto de soporte (endoposte vaciado), con el objeto de mejorar la tracción ortodóntica. Este aditamento consistió en un poste colado con perforaciones. Se procede a colocar aparatología fija en la arcada superior con técnica MBT (slot 0.022), del molar derecho hasta el canino izquierdo de cementado indirecto y pasivo (con los slots de los brackets alineados). Inmediatamente después, se colocó un arco rectangular 0.019 x 0.025 de acero inoxidable con un doblez de extrusión a nivel del canino superior derecho. En el mismo doblez, se adaptó un loop tipo helix que funcionó como apoyo para colocar la ligadura pasiva (lace back). Resultados : El tratamiento realizado en este paciente es satisfactorio, coadyuvando en su estado de salud general mejorando su autoestima. Conclusión: Aquí se aprovecharon todas las ventajas que ofrece la extrusión ortodóntica forzada, incluso en un paciente adulto mayor, logrando una tracción de cuatro milímetros, que se consiguió gracias al empleo de fuerzas extrusivas ligeras y controladas sobre el órgano dentario afectado. Con la modalidad de tratamiento descrita se puede lograr un alargamiento de corona sin la necesidad de realizar una resección ósea, lo que permite una correcta rehabilitación protésica, devolviendo la función y estética al diente lesionado y brindando un beneficio integral al paciente.

The case of an adult patient with a complicated Crown fracture of the right upper canine due to trauma is reported, diagnosing a class VII Ellis coronal fracture. There are several treatment alternatives that range from the extraction, placement of a bone graft and placement of an implant, to a forced root extrusión with bone removal to allow the biological space and subsequently be restored. In the present case, a multidisciplinary orthodontic forced extrusion treatment is performed, which allows to increase the amount of clinical remnant, preserving the periodontal support and maintaining the biologic thickness, thus achieving to maintain the root remnant with good length so that prosthetic rehabilitation is facilitated. The clinical and radiographic follow-up was 12 months. The multidisciplinary treatment involved: Root canal treatment, forced extrusion with orthodontics, fibrotomy with root planing and fixed prosthesis.

Avaliação dos efeitos da movimentação dentária induzida sobre molares de ratos submetidos à luxação extrusiva / Evaluation of the effects of induced tooth movement on rat molars submitted to extrusive dislocation

A luxação extrusiva é caracterizada pela separação parcial ou total entre raiz e ligamento periodontal (LPD), podendo causar danos ao cemento por meio da compressão radicular contra o osso alveolar, além da ruptura do feixe vásculonervoso apical. A movimentação dentária induzida (MDI) é uma resposta de caráter inflamatório do conjunto LPD e osso alveolar, mesmas estruturas envolvidas na luxação extrusiva, a um estímulo provocado por uma força ortodôntica. Uma informação escassa na literatura é o efeito provocado pela movimentação dentária induzida em dentes que foram submetidos à luxação extrusiva (LE). O objetivo deste trabalho foi avaliar o efeito da movimentação dentária induzida sobre dentes submetidos à luxação extrusiva. Para a realização deste pesquisa, foram utilizados 40 ratos machos Wistar divididos em 4 grupos: o grupo controle (GC); o grupo Luxação Extrusiva (LE); o grupo Movimentação Dentária Induzida (MDI); e o grupo LEMDI. A LE foi exercida por uma força de 1.500Cn e a MDI por uma força de 50Cn por um período de 7 dias, após o qual os animais foram eutanasiados, as peças submetidas ao processamento laboratorial e obtidas lâminas que foram coradas por meio de hematoxilina e eosina. Foi realizada uma análise descritiva considerando-se quatro áreas ao redor da raiz mésio-vestibular: A1 região da crista óssea mesial, A2 região médio- cervical da face mesial, A3 região médio-apical da face distal e A4 região cervical da face. Em cada uma destas áreas foram observados os evento: reabsorção óssea frontal e à distância, reabsorção radicular, infiltrado infamatório e hemoragia no LPD.Os resultados mostraram que a associação entre MDI e LE provocou grande destruição óssea na crista óssea na A1, moderadas reabsorções radiculares na A3, ausência de infiltrado inflamatório em todas as áreas e hemorragia exuberante do LPD nas áreas 2 e 3. Nos demais grupos, tais observações foram ausentes ou quando presentes consideradas muito discretas. Conclui-se que, uma vez que a MDI em dentes submetidos a LE aumenta as áreas de hemorragia no LPD, provoca grande perda óssea frontal na crista alveolar, a MDI deveria ser interrompida, aguardando-se o período de reparo do LPD(AU)

Extrusive dislocation is characterized by partial or complete separation of the root and periodontal ligament (PDL), which can cause damage to the cementum by compressing the root against the alveolar bone, and rupture of the apical nervevascular bundle. Induced tooth movement (ITM) is an inflammatory response of the whole of the SMP and alveolar bone, the same structures involved in extrusive dislocation, to a stimulus caused by an orthodontic force. Little information is available in the literature on the effect caused by induced tooth movement in teeth that underwent extrusive luxation (EL). The aim of this study was to evaluate the effect of induced tooth movement on teeth submitted to extrusive dislocation. For this research 40 male Wistar rats were used, divided into 4 groups: The control group (CG); the Extrusive luxation group (EL); the Induced Tooth Movement group (ITM); and the LEMDI group. The LE was exerted by a force of 1,500Cn and the ITM by a force of 50Cn for a period of 7 days, after which the animals were euthanized, the specimens were submitted to laboratory processing and slides were obtained and stained using hematoxylin and eosin. A descriptive analysis was performed considering four areas around the mesial vestibular root: A1 mesial bone crest region, A2 mesial face midcervical region, A3 distal face mid-apical region and A4 face cervical region. In each of these areas the following events were observed: frontal and distal bone resorption, root resorption, infamatory infiltrate and hemorrhagia in the PDL. The results showed that the association between MDI and LE caused great bone destruction in the bone crest in A1, moderate root resorption in A3, absence of inflammatory infiltrate in all areas, and exuberant hemorrhage of the PDL in areas 2 and 3. In the other groups, such observations were absent or when present considered very discrete. We conclude that, since ITM in teeth submitted to EL increases the areas of hemorrhage in the PDL, causes great frontal bone loss in the alveolar ridge, ITM should be interrupted, waiting for the period of repair of the PDL(AU)

Método de extrusión dentaria unitaria con fines protésicos: caso clínico / Single tooth extrusion method for prosthetic purposes: a clinical case

La pérdida de estructura dentaria por debajo del margen gingival y de la cresta ósea alveolar, ya sea por caries, fracturas traumáticas, desgaste, reabsorción radicular o perforaciones iatrogénicas, dificulta el tratamiento protésico y requiere un abordaje multidisciplinario para conseguir resultados óptimos y estables a largo plazo. Se presenta el caso de una paciente adulta que acude a consulta con la pieza 2.3, que no permite una adecuada restauración protésica sin invadir el espacio biológico. Dentro del abanico de posibilidades terapéuticas se selecciona la extrusión dentaria unitaria guiada, para poder exponer un remanente dentario adecuado supragingival, y conseguir un adecuado efecto ferrule para la posterior rehabilitación protésica. La técnica presentada es eficaz, simple, cómoda, higiénica y útil en pacientes que no desean realizarse tratamiento de ortodoncia en ambas arcadas (AU)

Reto multidisciplinario ante fractura vertical / Multidisciplinary challenge in a patient with a vertical fracture

Resumen Introducción: La extrusión rápida ortodóntica puede usarse como alternativa para evitar extraer una pieza fracturada que no podría ser restaurada por trauma, caries extensas, problemas periodontales (dos o tres paredes), dientes con reabsorción interna y dientes con perforaciones endodónticas. Objetivo: De este caso clínico es presentar a todos los odontólogos una solución sencilla de tratamiento integral de un paciente el cual sufrió un trauma facial, causándole una fractura vertical a nivel del tercio medio radicular del incisivo central superior derecho. Método: Mediante una extrusión ortodóntica, retratamiento endodóntico y abordaje periodontal, de manera que facilite la futura rehabilitación con corona completa. El resultado de este procedimiento se logró con mucho éxito gracias a que concluimos que se trató en forma multidisciplinaria, en donde cada especialidad actúa o interviene en un momento preciso. Conclusiones: La extrusión rápida es un procedimiento en el cual una pieza que ha sufrido una fractura radicular a nivel marginal puede ser tratada sin necesidad de realizar un alargamiento de corona comprometiendo así el nivel del hueso de la pieza.

Abstract Introduction: Rapid dental orthodontic extrusion may be used as an alternative to avoid the extraction of fractured teeth that might not be suitable for restauration because od trauma, extensive cavities, periodontal problems (two or three walls), teeth with internal resorption, or with endodontical perforations. Objective: Of this clinical case is to present to all dentists a simple solution of integral treatment of a patient who suffered trauma to his face causing a vertical fracture at the level of the middle third root of the right upper central incisor. Methods: Used in this case was through orthodontic extrusion, endodontic retreatment and periodontal approach, so as to facilitate future rehabilitation with a full crown. The result of this procedure was achieved with great success because we conclude that it was treated in a multidisciplinary way, where each specialty intervenes at a precise moment. Conclusions: Rapid extrusion is a procedure in which a tooth that shows a radicular fracture close to it´s margin may be treated without dental crown lengthening that would risk bone level.

Apical extrusion of bacteria following the use of reciprocating single-file and rotary multi-file instrumentation systems in oval root canals / Extrusão apical de bactérias após o uso de sistemas alternativos de instrumentação de arquivo único e rotativo de arquivo múltiplo em canais radiculares ovais

Objective: All instrumentation techniques and instruments are associated with apical extrusion during chemomechanical preparation, and this causes postoperative pain and flare-up. However, it is controversial whether reciprocal systems or rotary systems cause more apical extrusion. The objective of this in vitro study was to determine the differences in the amounts of apically extruded bacteria (AEB) associated with nickel-titanium rotary and reciprocating systems when used in oval-shaped root canals. Material and Methods: Seventy human mandibular premolar teeth with oval-shaped canals were randomly assigned to four experimental groups (15 teeth in each group) and one control group (10 teeth). The root canals were contaminated with Enterococcus faecalis and instrumented using two full-sequence rotary instruments (ProTaper Universal [PTU] and ProTaper Next [PTN]) and two reciprocating single-file instruments (Reciproc [R] and WaveOne [WO]). A 0.9% NaCl solution was used as an irrigant, and the bacterial extrusion was quantified as the number of colony-forming units for each sample. The results were statistically analyzed using the Kruskal-Wallis one-way analysis of variance and the Mann-Whitney U test, and the statistical significance level was set at p < 0.05. Results: The R system was associated with the highest amount of bacterial extrusion (p < 0.05). The PTU system caused more bacterial extrusion than the PTN and WO systems (p < 0.05). There was no significant difference between the PTN and WO systems (p > 0.05). Conclusions: All instrumentation techniques caused apical bacterial extrusion. The instrument design and preparation techniques affect the number of extruded bacteria (AU)

Objetivo: Todas as técnicas e instrumentos de instrumentação estão associados à extrusão apical durante o preparo quimomecânico, o que causa dor e surto no pós-operatório. No entanto, é controverso se sistemas recíprocos ou rotativos causam extrusão mais apical. O objetivo deste estudo in vitro foi determinar as diferenças na quantidade de bactérias apicalmente extrudadas (AEB) associadas aos sistemas rotativo e alternativo de níquel-titânio quando usadas em canais radiculares em forma oval. Material e Métodos: Setenta dentes pré-molares inferiores humanos com canais em forma oval foram divididos aleatoriamente em quatro grupos experimentais (15 dentes em cada grupo) e um grupo controle (10 dentes). Os canais radiculares foram contaminados com Enterococcus faecalise instrumentados usando dois instrumentos rotativos de seqüência completa (ProTaper Universal [PTU] e ProTaper Next [PTN]) e dois instrumentos alternativos de arquivo único (Reciproc [R] e WaveOne [WO]). Uma solução de NaCl a 0,9% foi usada como irrigante e a extrusão bacteriana foi quantificada como o número de unidades formadoras de colônias para cada amostra. Os resultados foram analisados estatisticamente usando a análise de variância unidirecional de Kruskal-Wallis e o teste U de Mann-Whitney, e o nível de significância estatística foi estabelecido em p < 0,05. Resultados: O sistema R foi associado à maior quantidade de extrusão bacteriana (p < 0,05). O sistema PTU causou mais extrusão bacteriana que os sistemas PTN e WO (p < 0,05). Não houve diferença significativa entre os sistemas PTN e WO (p > 0,05). Conclusões: Todas as técnicas de instrumentação causaram extrusão bacteriana apical. O desenho do instrumento e as técnica (AU)

Impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes en usuarios de las Unidades Comunitarias de Salud Familiar Sociedad, Morazán y periférica San Vicente, en el año 2018 / Impact on the quality of life as a result of the mortality of permanent teeth in users of the Community Units of Family Health Society, Morazán and San Vicente peripheral, in 2018

Conocer el Impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes de los usuarios atendidos en las Unidades Comunitarias de Salud Familiar Sociedad, Morazán y Periférica, San Vicente en el año 2018. Metodología: estudio de tipo descriptivo, observacional y transversal desarrollado en usuarios de las Unidades Comunitarias de Salud Familiar (UCSF)Sociedad, Morazán y Periférica, San Vicente, en donde se realizó una investigación con una muestra de 288 pacientes de 15 a 60 años o más. Se utilizó una guía de observación, para completar variables sociodemográficas del paciente y luego una entrevista para conocer el impacto en la calidad de vida por la mortalidad dental. Los datos fueron analizados en el programa SPSS versión 23. Resultados: El 78.46% de la población en estudio presenta un bajo nivel educativo. El promedio de pérdida dental de la población en estudio es de 8ndientes. Las principales alteraciones clínicas y funcionales derivadas de la pérdida de dientes fueron las mesializaciones, distalizaciones y extrusiones dentales. Se reporta un efecto global del índice OIDP de 38.48±2.539 muy ligero. El 60% de los usuarios presenta mortalidad dental en maxilar y el 78% en la mandíbula sin ser restituidos protésicamente. Conclusiones: Pese a la presencia muy notoria de alteraciones por mortalidad dental, la autopercepción que los usuarios tienen respecto a la gravedad que representan, repercute mínimamente en el desempeño de sus labores diarias.

To know the Impact on the quality of life as a consequence of the mortality of permanent teeth of the users treated in the Community Units of Family Health Society, Morazán and Peripheral, San Vicente in 2018. Methodology: descriptive, observational and cross-sectional study developed in users of the Community Family Health Units Society. Morazán and Peripheral, San Vicente, where an investigation was carried out with a sample of 288 patients aged 15 to 60 years or more. An observation guide was used to complete the general data of the patient and sociodemographic variables, and then, an interview to find out the impact on quality of life due to dental mortality. The data was analyzed in the SPSS program, version 23. Results: The 78.46% of the population studied have a low level of education. The dental loss average of the entire population is 8 teeth. The main clinical and functional alterations derived from tooth loss were mesializations, distalizations and dental extrusions. A global effect of the OIDP index of 38.48 ± 2,539 has a very slight reported. 60% of user's present dental mortality in the maxilla and 78% in the mandible without being prosthetically restored. Conclusions: Despite the very notorious presence of dental mortality alterations, due to dental mortality, the self-perception that users have regarding the severity they represent, minimally affects the performance of their daily tasks.

Progress on clinical application of orthodontic-implant combined therapy / 浙江大学学报·医学版

For complex implant cases, simple implantation could not achieve the desired therapeutic effect, and a multidisciplinary approach has become a general trend. Orthodontic treatment before implantation creates favorable conditions for subsequent implantation by increasing restoring three-dimensional space, improving occlusion of patients. It also stimulates the increase of autologous soft and hard tissue while biological potential of periodontal ligament is fully developed. The choice of operation time is vital to keep the level of soft and hard tissue at the implantation site, which improves the curative effect of implantation in terms of function and aesthetics. In this article, the orthodontic-implant combined therapy is briefly reviewed focusing on the three-dimensional space optimization, implant site enhancement by orthodontic extrusion and delayed orthodontic space opening.

Quantitative evaluation of debris extruded apically using reciprocating versus continuous rotation single file with rotary and hand glide path file

Chemomechanical root canal preparation (CMRCP) is an important step in root canal treatment. However, one of its negative consequences is apical extrusion of debris of the root canal system contributing to treatment failure and flare-ups. Glide path preparation (GPP) is the initial phase of CMRCP and is crucial for assessing root canal anatomy and establishing unobstructed access to the apical part of the canal. Materials and methods: Forty human mandibular permanent central and lateral incisors were selected; the debris collection apparatus was prepared and the teeth were then divided into four groups: Group 1: Rotary glide path preparation with ProGlider followed by instrumentation with Wave One files. Group 2: Rotary glide path preparation with ProGlider followed by instrumentation with One Shape files. Group 3: Hand glide path preparation with K-file followed by instrumentation with Wave One files. Group 4: Hand glide path preparation with K-file followed by instrumentation with One Shape files. The collected debris was weighed in an analytical digital balance and the collected data were statistically analyzed. Results: No significant difference was present between groups with the same method of glide path preparation or between Wave One and One Shape files. Rotary glide path preparation produced less debris than hand preparation (p≤0.05). Conclusions: Extrusion of debris was observed in all test groups. Rotary glide path preparation could be preferred in clinical practice as it is associated with less debris extrusion than the manual method.

Orthodontic traction of impacted canines: Concepts and clinical application

ABSTRACT Orthodontic traction of impacted canines stands as a major challenge for Orthodontics. It is a relatively frequent clinical complaint which management, more often than not, requires a multidisciplinary approach. Surgical exposure of the impacted canine, and the complex orthodontic mechanics applied to align the tooth back into the arch, may frequently lead to complications involving supporting tissues, not to mention the long treatment time and high costs imposed to patients. In face of that, it is worth highlighting the relevance of early diagnosis as to intervene efficiently and as soon as possible. This paper presents a review of the main concepts involving prevalence, etiology and classification of impacted canines, and describes the different clinical management options that would help solve the problem. It illustrates the topic by presenting a treatment delivered to a 13 year 7 months old male patient, suffering from a Class II, division 2, left subdivision, malocclusion, associated to a deep bite and a prolonged retention of a primary upper canine caused by the impaction of the permanent tooth. Corrective orthodontic therapy was associated to a rapid maxillary expansion and to the use of a high pull headgear. Impacted canine was submitted to orthodontic traction and correctly positioned back into the arch. This approach proved to be efficient in meeting both functional and aesthetic goals.

RESUMO O tracionamento de caninos impactados representa um dos grandes desafios da Ortodontia. Trata-se de um problema clínico relativamente frequente, cujo tratamento muitas vezes requer uma abordagem multidisciplinar. A exposição cirúrgica do canino impactado e a complexa mecânica ortodôntica aplicada para alinhar o dente na respectiva arcada podem, com frequência, levar a complicações nos tecidos de suporte, sem mencionar o longo tempo de tratamento e os custos elevados para o paciente. Por isso, vale a pena ressaltar a importância dos diagnósticos precoces, para que a interceptação do problema seja feita o mais cedo possível e de maneira eficaz. O presente trabalho apresenta uma revisão dos principais conceitos envolvendo a prevalência, etiologia e classificação dos caninos impactados, e descreve os vários tipos de abordagem clínica para a resolução do problema. Ao final, ilustra o tema com a apresentação de um tratamento realizado em um paciente de 13 anos e 7 meses de idade, portador de má oclusão de Classe II, divisão 2, subdivisão esquerda, associado a mordida profunda, que apresentava retenção prolongada de um canino superior decíduo, devido à impacção de seu sucessor permanente. O tratamento ortodôntico corretivo foi associado à expansão rápida de maxila e ao uso de aparelho extrabucal de tração cervical. O canino impactado foi tracionado ortodonticamente e posicionado corretamente na arcada. Essa abordagem foi eficiente para atingir as metas funcionais e estéticas propostas.

Impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes en usuarios de las unidades comunitarias de salud familiar de San Rafael Obrajuelo, La Laguna y Juayúa en el año 2018 / Impact on the quality of life as a consequence of the mortality of permanent teeth in users of the community health units of San Rafael Obrajuelo, La Laguna and Juayúa in 2018

Objetivo: Conocer el impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes. Metodología: El diseño corresponde a un estudio descriptivo, observacional y transversal; con un universo de 432 individuos, a quienes se les realizó una entrevista donde se hizo uso del índice Oral Impacts on Daily Performances (OIDP) para determinar la percepción que tienen de su salud oral relacionada con la pérdida dental. Posteriormente, se realizó un examen clínico donde se registraron dientes perdidos, mesializaciones, distalizaciones, extrusiones, ruidos articulares y uso de prótesis. Los datos fueron analizados con el programa Statistical Package for the Social Sciences (SPSS) versión 25. Se utilizó pruebas de chi-cuadrado para asociación de variables. Resultados: El promedio de pérdida dental aumentó a partir de los 34 años, siendo los mayores de 60 años los más afectados. El nivel educativo que predominó fue Primaria (28.93%). Las alteraciones clínicas más comunes fueron las mesializaciones (56.72%). La actividad diaria más afectada tras la pérdida dental fue comer y disfrutar de los alimentos (51.39%). El promedio global del OIDP resultó de 22.78 (±1.49), clasificando a la población con un nivel de calidad de vida de Sin efecto/Muy ligero. Conclusiones: Independientemente del número de dientes perdidos, la presencia de alteraciones clínicas o funcionales y las variables sociodemográficas, el nivel de calidad de vida más prevalente fue Sin efecto/Muy ligero, encontrándose diferencias significativas entre la pérdida dental y la calidad de vida (p=.000). Palabras clave: Calidad de vida, OIDP, mortalidad dental, mesializaciones, distalizaciones, extrusiones, ruidos articulares.

Objective: To know the impact on quality of life as a result of the mortality of permanent teeth. Methodology: The design corresponds to a descriptive, observational and crosssectional study with a universe of 432 individuals, who were interviewed using the Oral Impacts on Daily Performances (OIDP) index to determine their oral health perceptions of tooth loss. Subsequently, a clinical examination was performed where missing teeth, mesializations, distalizations, extrusions, joint noises and use of prostheses were recorded. The data was analyzed with the Statistical Package for the Social Sciences (SPSS) version 25 program. Chi-square tests were used for variable association. Results: The average tooth loss increased from the age of 34, with the over-60s being the most affected. The level of education that prevailed was Primary (28.93%). The most common clinical alterations were mesializations (56.72%). The most affected daily activity after tooth loss was eating and enjoying food (51.39%). The overall average for OIDP was 22.78 (±1.49), classifying the population with a quality of life level of No effect/Very light. Conclusions: Regardless of the number of missing teeth, the presence of clinical or functional alterations and sociodemographic variables, the most prevalent quality of life level was No Effect/Very light, with significant differences found between tooth loss and quality of life (p=.000).

Impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes en usuarios de las unidades comunitarias de salud familiar Cuscatancingo, Nejapa y San Ramón, 2018 / Impact on the quality of life as a consequence of the mortality of permanent teeth in users of the community health units Cuscatancingo, Nejapa and San Ramón, 2018

Objetivo: Conocer el impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes de los usuarios de las UCSF de Cuscatancingo, Nejapa y San Ramón en el año 2018. Metodología: El estudio es descriptivo, observacional, trasversal; el cual se realizó en usuarios de tres UCSF durante el año 2018, en un total de 432 pacientes; seleccionados en base a los criterios establecidos. Para la obtención de datos se hizo mediante un instrumento compuesto por cédula de entrevista y guía de observación. El procesamiento y tabulación de los datos se realizó con el programa SPSS versión 25 mediante la prueba estadística del x2. Resultados: el estudio permitió caracterizar a la población según edad y sexo, así mismo determinó que la mortalidad dental presenta una tendencia ascendente con respecto a la edad notando un salto evidente a los 60 años. En cuanto a las principales alteraciones clínicas y funcionales las más prevalentes fueron: extrusiones (65.50%) y mesializaciones (59.25%), por otra parte, se identificó que el 60.87% de los pacientes se encuentran en un efecto global de OIDP de ligero a moderado. Además, al evaluar el estado protésico se encontró que en el maxilar superior (81.01%) y maxilar inferior (83.56%) no presentaban ningún tipo de prótesis. Conclusiones: existe asociación entre la mortalidad de dientes permanentes y la calidad de vida, sin embargo el sexo del paciente, el nivel educativo y la calidad de vida no se encontraron asociados

Objective: To know the impact on quality of life as a result of the mortality of permanent teeth of UCSF users of Cuscatancingo, Nejapa, and San Ramon in 2018. Methodology: The study is descriptive, observational, and transversal. It was performed on users od three UCSFs during 2018, in a total of 432 patients selected on the basis of established criteria. Data collection was done by means of an instrument composed of interview card and observation guide. The processing and, tabulation of the data was carried out with the SPSS version 25 program using the statistical test of X. Results: The study allowes to characterize the population by age and gender and it determined that dental mortality has an upward trend with respect to age noticing an obvious jump at 60 years. As for the main clinical and functional alterations, the most prevalent were: extrusions (65.50%) and mesializations (59.25%). On the other hand, 60.87% of patients were identified as having a light to moderate overall OIDP effect. In addition, when assessing the prosthetic state, it was found that in the upper jaw (81.01%) and lower jaw (83.56%) they didn´t have any kind of prosthetics. Conclusions: there is an association between permanent tooth mortality and quality of life, however patient gender, educational level and quality of life were not found associated.

Surgical extrusion of a maxillary premolar after orthodontic extrusion: a retrospective study

OBJECTIVES: Crown-root fracture and cervical caries in maxillary premolars constitute a challenge in cases of subgingival placement of restoration margins. Surgical extrusion has been practiced successfully in permanent anterior teeth. The aim of the present retrospective study was to assess the clinical outcome of surgical extrusion after orthodontic extrusion in maxillary premolars. MATERIALS AND METHODS: Twenty-one single, tapered root maxillary premolars with subgingival crown-root fracture or caries were included. Presurgical orthodontic extrusion was performed on all teeth to prevent root resorption. Extent of extrusion and rotation was determined based on crown/root ratio. The postoperative splinting period was 7 to 14 days. Clinical and radiographic examination was performed at an interval of 1, 2, and 3 months. RESULTS: After the mean follow-up of 41.9±15.2 months, failure was observed as increased mobility in 3 of 21 cases. No significant difference was observed in the outcome of surgical extrusion based on tooth type, age, sex, 180° rotation, or time for extraction. Furthermore, marginal bone loss was not observed. CONCLUSION: Surgical extrusion of maxillary premolars can be a possible therapeutic option in cases of subgingival crown-root fracture.

A case of unexpected adjacent tooth extrusion after implant fixed prosthetic treatment, who had undergone mandibular resection and reconstruction due to ameloblastoma / 대한치과보철학회지

Ameloblastoma is a benign odontogenic epithelial tumor with high recurrence rate and requires extensive resection of the surrounding tissue and reconstruction of defect site. Because of the anatomical limitation of the reconstruction site, prosthetic treatment with implants is the first recommendation. This is a case of prosthetic restoration of the reconstruction site with implant fixed prosthesis in patient who underwent mandibular resection and iliac bone reconstruction due to ameloblastoma. However 14 months after completion of implant prosthesis, adjacent natural tooth erupted unexpectedly, resulting in 1mm infra-occlusion occurred including posterior implant prosthesis and anterior natural teeth. In adults, implant infra-occlusion may occur due to residual growth after placement of the maxillary anterior implant. But this case, hypo-occlusion of molar implant and open bite of anterior natural teeth is occurred due to extrusion of adjacent tooth, is rare. Thus we report the treatment process including orthodontic treatment with intrusion of the posterior tooth, and investigate the causes of sudden, unexpected tooth extrusion.

Extrusión: una alternativa de tratamiento de la fractura corono-radicular / Extrusion: an alternative for the treatment of crown-root fracture

La extrusión dentaria o erupción forzada es una opción de tratamiento con enormes ventajas cuando nos vemos obligados a tratar fracturas corono-radiculares. Se define como el movimiento en dirección coronal a través de la aplicación de fuerzas ligeras y continuas para provocar cambios en los tejidos blandos y hueso. La extrusión dental forzada amplía las alternativas en cuanto a la rehabilitación futura del paciente, ya que se puede optar por la restauración periférica total con anclaje del resto radicular, o bien por la exodoncia posterior a la extrusión, con la consecuente mejoría de las condiciones del tejido óseo para una posterior rehabilitación implanto-asistida. Presentación de caso clínico, pieza dentaria 2.2 con fractura corono-radicular en la cual se realizó tratamiento de erupción forzada y rehabilitación protésica (AU)

Extrusion or forced eruption es a treatment option with enormous advantages when we are forced to treat crown-root fractures. It is defined as the movement in the coronal direction through the application of light and continuous forces to cause changes in the soft tissues and bone. Forced dental extrusion expands the alternatives regarding the future rehabilitation of the patient, since it is possible to choose either total peripheral restoration with anchoring of the radicular rest of the post-extrusion extraction, with the consequent improvement of bone tissue conditions for subsequent implant-assissted rehabilitation. Presentation of a case report: tooth 2.2 with a crown-root fracture in which forced eruption and prosthetic rehabilitation were performed (AU)

Considerations in the selection of method for clinical crown lengthening / 대한치과보철학회지

Clinical crown lengthening procedure would be an effective method for overcoming adverse clinical condition such as short abutment length. There are three kinds of methods in clinical crown lengthening, those are, surgical crown lengthening, orthodontic extrusion and surgical extrusion. Clinicians have to try their best to choose a proper method among those for favorable results. This report aims to review the considerations in each method with various cases and to suggest a decision flow for appropriate selection.

Factors Affecting Length of Impacted Maxillary Central Incisors after Surgical-Orthodontic Treatment / 대한소아치과학회지

The purpose of this study is to identify the factors affecting the treatment outcome after surgical-orthodontic treatment of the maxillary impacted incisors using multiple regression analysis. The study enrolled 83 patients who had surgical-orthodontic treatment in impacted maxillary central incisor between January 2005 and December 2015. Possible explanatory variables related to the prognosis of impacted incisor were age, gender, tooth developmental stage, height, position and angle of the teeth.The results of multiple regression analysis showed that as the height of the stem cell from apical papilla (SCAP) increased, the tooth length ratio increased by 0.345 units (p < 0.01). There was no statistically significant difference in gender, tooth development stage, distance and angle between the center line and the tooth, and the height of incisal tip of the tooth. In conclusion, the height of the SCAP of the impacted central incisor is factor affecting the tooth length after orthodontic traction.

Postoperative malocclusion after maxillofacial fracture management: a retrospective case study / 대한악안면성형재건외과학회지

PURPOSE: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. MATERIALS AND METHODS: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors’ department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. RESULTS: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. CONCLUSIONS: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40902-018-0167-z) contains supplementary material, which is available to authorized users.

Extrusão ortodôntica de dentes condenados para reconstrução da arquitetura óssea tridimensional previamente à instalação de implantes osseointegrados ­ Análise crítica da literatura / Orthodontic extrusion of hopeless teeth for reconstruction of three-dimensional bone architeture prior to dental implant placement ­ a critical analysis of literature

Objetivo: o objetivo desta revisão sistemática foi investigar se a condição periodontal do defeito ao redor de dentes condenados à extração, por meio de extrusão ortodôntica para reconstrução da arquitetura óssea previamente à instalação de implantes, influencia a qualidade estética final. Material e métodos: estudos relatando extrusão ortodôntica para extração de dentes e posterior instalação de implantes, acompanhados por diferentes períodos após a instalação das próteses, foram considerados elegíveis. A busca por artigos, a extração de dados e a avaliação da estética foram realizadas por examinadores independentes. A condição periodontal inicial foi classificada em tipos, a partir das radiografias iniciais presentes nos estudos: I) sem perda óssea; II) até 75%; III) até 50%; IV) até 25%; ou V) menos de 25% de inserção remanescente. A fotografia final dos casos foi analisada de acordo com o índice de estética rosa (IER). Resultados: a busca no PubMed e Scopus resultou em 453 artigos, dois quais 394 foram excluídos pelo título e 41 por não atender aos critérios de inclusão, restando 18 artigos analisados. Não houve diferença estatisticamente significante no IER observado nos diferentes tipos de defeitos periodontais iniciais (Kruskal-Wallis, p=0,17). Conclusão: esses achados sugerem que a inserção residual existente previamente à extração de dentes por meio de extrusão ortodôntica não influencia a estética final do caso, devido à reconstrução dos tecidos gengival e ósseo, favorecendo o posicionamento ideal dos implantes.

Objective: the aim of this critical analysis of literature was to investigate if the periodontal status of defects surrounding hopeless teeth submitted to extraction by orthodontic extrusion prior to implant installation interfere at the final aesthetic outcome. Material and methods: studies describing this procedure followed by different periods after prosthesis installation were considered eligible. Search, data extraction and aesthetic evaluation were made by independent examiners. Inicial periodontal status was classified in types according inicial radiographs presented on studies: I) without bone loss; II) up to 75%; III) up to 50%; IV) up to 25%; or V) less than 25% remaining insertion. Cases' final photographs were evaluated according the pink aesthetics index (PAI). Results: the search in PubMed and Scopus resulted in 453 papers of which 394 were excluded by title and 41 for not fulfill the inclusion criteria, remaining 18 papers for analysis. No statistical significance difference on PAI was observed at different inicial periodontal defects (Kruskal-Wallis, p=0.17). Conclusion: these findings suggest that the residual insertion existent prior to tooth extraction through orthodontic extrusion do not influence the aesthetic outcome because of the reconstruction of the gingival and bone tissues, favoring an optimal site for implant positioning.

Abordagem multidisciplinar para o tratamento da reabsorção cervical externa: relato de caso / Multidisciplinary approach for the treatment of external cervical resorption: case report

Introdução: a reabsorção radicular é um processo patológico que resulta na perda de cemento, dentina e osso, sendo desencadeada por desequilíbrio entre osteoblastos e osteoclastos. O diagnóstico geralmente ocorre por meio de exame radiográfico e/ou tomográfico. Objetivo: relatar o tratamento de um caso de reabsorção cervical no dente #14 com abordagem multidisciplinar envolvendo Endodontia, Ortodontia, Periodontia e Prótese. Métodos: após realização de tomografia, verificou-se que a imagem correspondia a uma reabsorção cervical externa na raiz palatina, estendendo-se desde distal, seguindo para palatal e mesial. Após abertura e medicação intracanal, o endodontista optou por encaminhar a paciente para avaliação com ortodontista, sendo sugerida a realização de tracionamento ortodôntico, numa tentativa de expor a área da lesão. Para se atingir a posição final do dente, entre ativações de segunda e terceira ordens e ajustes oclusais, a etapa ortodôntica durou onze meses, incluindo três meses de contenção. Um mês antes de remover o aparelho ortodôntico e após um ano desde o início do tracionamento, realizou-se a obturação dos canais radiculares. Ainda com o dispositivo ortodôntico, foi realizada a cirurgia para correção do nível ósseo e gengival, que tende a acompanhar o dente, visualizando-se totalmente a área da reabsorção. Após um mês da cirurgia de aumento de coroa clínica, removeu-se o aparelho ortodôntico e realizou-se o tratamento protético com núcleo metálico fundido com liga de ouro e coroa em cerâmica com infraestrutura de zircônia. Conclusão: a partir de uma abordagem multidisciplinar, torna-se possível o tratamento de casos de reabsorções cervicais externas.

Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation

Abstract Objective The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. Material and Methods Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). Results There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. Conclusions Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.