Bypass de instrumento endodôntico fraturado: relato de caso / Bypass of a fractured endodontic instrument: case report

Introdução: Mesmo com toda evolução tecnológica desses instrumentos, com o desenvolvimento das limas de liga de níquel-titanio (NiTi) e sistemas mecanizados, as fraturas podem ocorrer durante o preparo químico/mecânico. Existem três abordagens mais regulamente aplicadas para solucionar essa intercorrencia: tentativa de remoção do instrumento com ultrassom, tentativa de ultrapassálo (bypass) ou a obturação do segmento. Objetivo: Relatar um caso da técnica de bypass em instrumento fraturado no canal radicular. Descrição do caso: Paciente, sexo feminino, 47 anos, brasileira, sem condições sistêmicas associadas, foi encaminhada à clínica do Curso de Odontologia da UNIFENAS, Divinópolis, Minas Gerais, Brasil, para resolução de fratura de instrumento no canal mésio- vestibular do primeiro molar superior direito (16). Optou-se pelo tratamento pela técnica de bypass, que envolveu as seguintes etapas: anestesia, abertura, utilização de lima C-Pilot #08 para ultrapassar o instrumento fraturado, odontometria, escalonamento regressivo a partir da lima k#20, desinfecção com hipoclorito de sódio 5%, medicação com hidróxido de cálcio por 21 dias, agitação da substância irrigadora e obturação dos canais radiculares. Conclusão: O bypass ao instrumento é uma técnica conservadora, eficaz e uma solução adequada em casos de fratura de limas endodônticas dentro dos canais radiculares. Essa técnica visa preservar o máximo possível da estrutura dental original, evitando procedimentos mais invasivos.(AU)

Introduction: Even with all technological evolution of these instruments, with the development of nickel-titanium alloy (NiTi) files and mechanized systems, fractures can occur during chemical/mechanical preparation. There are three most commonly applie to resolve this complication: attempting to remove the instrument with ultrasound, attempting to bypass it, or obturating the segment. Objective: To report a case of bypass technique in fractured instrument in the root canal. Case description: A 47-year-old female patient from Brazil, with no associated systemic conditions, was referred to the clinic of the Dentistry Course at UNIFENAS, Divinópolis, Minas Gerais, Brazil, for resolution of an instrument fracture in the mesio-vestibular canal of the right upper first molar (16). Treatment was performed using the bypass technique, which involved the following steps: anesthesia, opening, use of a C-Pilot #08 file to bypass the fractured instrument, odontometry, regressive scaling from the k#20 file, disinfection with 5% sodium hypochlorite, medication with calcium hydroxide for 21 days, agitation of the irrigating substance and root canal filling. Conclusion: Instrument bypass is a conservative, effective technique and an adequate solution in cases of endodontic file fracture within root canals. This technique aims to preserve as much of the original tooth structure as possible, avoiding more invasive procedures.(AU)

Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Pulpectomies with Iodoform Versus Calcium Hydroxide-Based Paste: A Preliminary Randomised Controlled Clinical Trial

ABSTRACT Objective: To compare clinical and radiographical pulpectomy outcomes in primary teeth filled with different pastes. Material and Methods: The sample included thirty-eight teeth indicated for pulpectomy due to irreversible pulp inflammation or necrosis from thirty patients (2 to 9 years old). The first appointment comprised chemomechanical preparation (2.5% sodium hypochlorite), smear layer removal (6% citric acid), intracanal dressing and temporary restoration. Seven days later, teeth were randomly assigned to filling with iodoform (IP) or calcium hydroxide with zinc oxide (CHZO) based pastes and temporarily restored. Final restoration (composite resin) occurred at the 3rd appointment. Data from baseline, 6 and 12 months were analysed using descriptive and inferential statistics (p≤0.05). Results: The overall frequency of success was 63.6% (n=21), with no significant difference between groups (IP=62.5% n=10; CHZO=64.7% n=11, p=0.59). Multiradicular teeth, overfilled canals and teeth whose coronal restoration have been lost were significantly associated with failure (p=0.01, p=0.04 and p<0.001, respectively). Conclusion: After 12 months, both pastes showed similar outcomes and can be used as good options for pulpectomies in primary teeth. Moreover, tooth location, extent of the root canal filling, and integrity of final restoration during the follow-up influenced the outcome of pulpectomies.

Randomized Clinical Study of the Use of MTA and Biodentine™ for Pulpotomy in Primary Teeth

ABSTRACT Objective: To verify, through clinical and radiographic evaluations, the in vivo response of the dentin-pulpal complex of human primary teeth after pulpotomy with MTA and Biodentine™ in a follow-up period of 3, 6, and 12 months. Material and Methods: Thirty teeth were divided into MTA pulpotomy (n = 15) and Biodentine™ pulpotomy (n = 15) from children between 5 and 9 years of age, a randomized clinical trial with simple random sampling. The materials were inserted into the cavity after opening and removing the coronary pulp tissue. The cavity base consisted of glass ionomer cement and light-cured composite resin restoration. Clinical and radiographic analyses were performed after 3, 6, and 12 months. Statistical analysis by Fisher's exact test for dichotomous data at a 5% significance level was utilized. Results: Both materials caused color change after 12 months. However, MTA showed a higher percentage than Biodentine™ (p<0.0001). Pain was detected only with Biodentine™ at six months and mobility at 12 months (p=0.0013). Radiographically, after 12 months, periapical lesions, interradicular lesions, and internal resorption were evidenced in 13% of the cases for Biodentine™-treated teeth (p<0.0013). MTA induced pulp calcification in 13% of cases, unlike Biodentine™ (p<0.0013). Conclusion: BiodentineTM and MTA are suitable for clinical use in pulpotomy treatment, yet both materials lead to tooth discoloration.

Clinical Evaluation of Composite Restorations with and without Polyethylene Fiber in First Permanent Molars: A 24-Month Randomized Clinical Trial

ABSTRACT Objective: To evaluate the 24-month clinical performance of composite resin restorations with and without polyethylene fiber in the first permanent molars of pediatric patients with extensive caries. Material and Methods: In total, 75 Class II restorations were placed in the permanent molar teeth of 75 children (mean age 11.3 years) with (FC; n=38) or without (C; n=37) fiber. One operator placed all the restorations. The restorations were evaluated using the modified USPHS criteria in terms of retention, color match, marginal discoloration, anatomic form, marginal adaptation, secondary caries, and postoperative sensitivity. Statistical data were analyzed using chi-square and Cochran tests (p<0.05). Results: At the end of two years, 65 restorations (FC:31; C:34) were followed up. No changes were observed during the first six months. After 24 months of follow-up, there were minor changes in marginal adaptation and marginal color in both groups; however, no statistically significant difference was observed between the clinical performances for all criteria (p>0.05). Conclusion: Extensive composite restorations with or without fibers displayed good clinical performance in high load-bearing areas after 24 months.

Intervención temprana de dientes supernumerarios en dentición primaria: Reporte y seguimiento de caso clínico / Intervenção precoce de dentes supranumerários na dentição decídua: relato e acompanhamento de um caso clínico / Early intervention of supernumerary teeth in primary dentition: Report and follow-up of clinical case

El mesiodens es un diente supernumerario que se encuentra en la zona de los incisivos centrales superiores, cuyo diagnóstico temprano es fundamental ya que permite la extracción oportuna del mismo previniendo posibles alteraciones a futuro como son: el desarrollo de quistes, malposición de los dientes adyacentes, retraso de erupción, diastema interincisal, reabsorción apical de dientes vecinos. Reporte de caso: Paciente masculino, de 6 años con 11 meses de edad, que presentó mesiodens doble, cuyo hallazgo fue radiológico, mediante una panorámica, requisito de la odontóloga para control odontológico general, en el cual se pudo observar la presencia de dos dientes supernumerarios, los cuales estaban provocando la rotación de los incisivos permanentes superiores. El tratamiento se basó en la extracción quirúrgica temprana de los dientes supernumerarios, para determinar el abordaje fue necesario la realización de un estudio tomográfico, una vez determinada el proceso de extracción, y posteriormente la recuperación del paciente, y seguimiento radiográfico y clínico, se logró la erupción adecuada de los incisivos centrales superiores permanentes, hasta la actualidad se realizan controles periódicos y la colocación de placas de expansión superior e inferior. Conclusión: En este caso el tratamiento es la extracción temprana, y debido al diagnóstico oportuno y las condiciones óptimas del paciente como son: la reabsorción radicular fisiológica de los dientes primarios, la ubicación de los dientes supernumerarios, así como el estadio de Nolla de los incisivos centrales superiores, permite que el tratamiento elegido sea el óptimo y con las condiciones menos traumáticas posibles.

O mesiodens é um dente supranumerário encontrado na região dos incisivos centrais superiores, cuja detecção pode ser acidental. O diagnóstico precoce é fundamental, pois permite a extração oportuna do dente supranumerário, prevenindo possíveis alterações futuras como: desenvolvimento de cistos, má localização dos dentes adjacentes, atraso na erupção, diastema interincisal, reabsorção apical dos dentes vizinhos. Relato de caso: O caso apresentado é de um paciente pediátrico do sexo masculino, 6 anos e 11 meses, que apresentava duplo mesiodens, cujo achado foi radiológico, através de visão panorâmica, uma solicitação do cirurgião-dentista para controle odontológico geral, no qual pôde observar a presença de dois dentes supranumerários, que causavam a rotação dos incisivos permanentes superiores. O tratamento baseou-se na extração cirúrgica precoce dos dentes supranumerários, para determinar a abordagem foi necessário realizar um estudo tomográfico, uma vez determinado o processo de extração, e posteriormente a recuperação do paciente, e acompanhamento radiográfico e clínico , conseguiu-se uma erupção adequada dos incisivos centrais superiores permanentes, até o momento são realizadas verificações periódicas e colocação de placas de expansão superiores e inferiores. Conclusão: Neste caso, o tratamento é a extração precoce e devido ao diagnóstico oportuno e condições ideais do paciente, como: reabsorção radicular fisiológica dos dentes decíduos, localização dos dentes supranumerários, bem como o estágio Nolla dos dentes. incisivos centrais superiores, permite que o tratamento escolhido seja ótimo e com as condições menos traumáticas possíveis

Mesiodens is a supernumerary tooth found in the area of the upper central incisors, the detection of which may be accidental. Early diagnosis is essential since it allows timely extraction of the supernumerary tooth, preventing possible future alterations such as: the development of cysts, poor location of adjacent teeth, delayed eruption, interincisal diastema, apical resorption of neighboring teeth. Case report: The case presented is of a male pediatric patient, 6 years and 11 months old, who presented double mesiodens, whose finding was radiological, through a panoramic view, a requirement of the dentist for general dental control, in which could observe the presence of two supernumerary teeth, which were causing the rotation of the upper permanent incisors. The treatment was based on the early surgical extraction of the supernumerary teeth, to determine the approach it was necessary to carry out a tomographic study, once the extraction process was determined, and later the recovery of the patient, and radiographic and clinical follow-up, it was achieved. proper eruption of the permanent upper central incisors, to date periodic checks and placement of upper and lower expansion plates are performed. Conclusion: In this case, the treatment is early extraction, and due to timely diagnosis and optimal patient conditions such as: physiological root resorption of deciduous teeth, location of supernumerary teeth, as well as the Nolla stage of the teeth. upper central incisors, allows the chosen treatment to be optimal and with the least traumatic conditions possible

A 14-Year Follow-Up Study of Sequelae in Primary Teeth and Permanent Successors After Dental Trauma

ABSTRACT Objective: To evaluate the presence of sequelae in primary teeth and their permanent successors, as well as associations between TDI and the presence of sequelae in both teeth. Material and Methods: In this 14-year retrospective study, 2.290 records were reviewed, 192 patients who suffered dental trauma in primary teeth were followed until the eruption of successor teeth were included. Descriptive, chi-square, and regression logistic with generalized estimating equations tests were performed (p<0.05). Results: 362 primary and successor teeth were followed. Sequelae were present in 71.8% of primary teeth and 25.7% of their successors. Teeth with complicated fracture (100%), extrusion (100%) and avulsion (100%) resulted in the largest amounts of sequelae in primary teeth and intrusion (61%) on their successors. Age was associated with sequelae in permanent teeth (p<0.01). Extrusion (OR 10.06; CI 2.12-47.63) and intrusion (OR 7.51; CI 2.73-20.70) had a higher risk to cause sequelae in primary and permanent teeth, respectively. Conclusion: The type of injury involved influenced the sequelae in traumatized teeth and their successors, and the age of the child influenced the presence of sequelae in permanent teeth.

Clinical and Radiographic Success Rates of Pulpotomies in Primary Molars Treated with Formocresol, BiodentineTM, and Endo Repair: A Randomized Clinical Trial

ABSTRACT Objective: To compare the clinical and radiographic success rates of formocresol, BiodentineTM, and Endo Repair agents in primary molars after 12 months. Material and Methods: This randomized double-blind clinical trial was conducted on healthy children referred to the Department of Pediatric Dentistry, Kerman, Iran, in 2018. One hundred twenty children (human primary molar teeth) aged 3-9 years were selected and randomly divided into three interventions (with pulpotomy medicament agents), including formocresol, BiodentineTM, and Endo Repair. All pulpotomized teeth were restored using stainless steel crowns and evaluated clinically and radiographically during a 12-month follow-up. Fisher exact test was used to determine the association of categorical variables and the data were analysed with SPSS 25. Results: All the available teeth in formocresol and BiodentineTM groups obtained clinical success, whereas 62.5% of the Endo Repair group was successful in this regard. Radiographic success rates of the formocresol, BiodentineTM, and Endo Repair groups were 94.7%, 70%, and 28.1% after a 12-month follow-up, respectively. Moreover, pulp canal obliteration was observed in 26.3%, 25%, and 12.5% of the formocresol, BiodentineTM, and Endo Repair groups. Conclusion: This study reported a high rate of clinical success using both BiodentineTM and formocresol pulpotomy techniques. However, the radiographic success rate of formocresol was higher than that of BiodentineTM, and Endo Repair was not considered a suitable pulpotomy medicament agent.

Actualización en equipos de Rayos X portátiles en odontología: revisión de literatura / Update on Hand-Held X-Ray Devices in Dentistry: a Literature Review

Resumen En las últimas dos décadas ha aumentado el uso de equipos portátiles de rayos X intraorales, los cuales son estabilizados por el operador. Si bien todos los equipos radiográficos presentan un riesgo inherente por el uso de radiación ionizante, el uso indebido de los equipos portátiles puede aumentar la exposición del operador. Se recomienda el uso de los equipos portátiles en un trípode o activados desde un área protegida. Sin embargo, en casos altamente justificados para su uso sin estos aditamentos, se debe seguir recomendaciones para disminuir la exposición del operador. Debido a que la radioprotección es fundamental al trabajar con rayos X, se debe favorecer el uso de equipos radiográficos dentales fijos sobre los equipos portátiles, ya que estos proporcionan una menor dosis de radiación al operador.

Abstract In the last two decades, the use of portable intraoral X-ray devices, stabilized by the operator, has increased. While all radiographic devices present an inherent risk from ionizing radiation, improper use of portable devices can increase operator exposure. Use of portable devices on a tripod or powered from a protected area is recommended. However, in highly justified cases, for using without these accessories, recommendations should be followed to reduce operator exposure. Because radioprotection is essential when using X-rays, fixed dental radiographic devices should be favored over portable equipment since the first provides a lower radiation dose to the operator.

About the recent Chilean immigration phenomenon: a scoping review on radiographic methods for dental age estimation in children / Sobre el reciente fenómeno migratorio chileno: una revisión con búsqueda sistemática sobre métodos radiográficos para la estimación de edad dental en niños

SUMMARY: The objective of this review was to identify original studies describing radiographic methods for dental age estimation applied in Chilean children, considering that it is a country with a long history of natural disasters and it has shown an unprecedented increase in the number of migrants in recent years, with significant percentages of individuals under 18 years of age. A scoping review was carried out following the methodology for the Joanna Briggs Institute scoping reviews and PRISMA guidelines. A specific search strategy was implemented in PubMed/Medline database, with complementary use of the Google Scholar website searching for full articles in English and Spanish. Five documents responded to the search objective, of which only 3 were published in refereed journals. Two documents focused their study on the maturation of upper and lower third molars, one on the maturation of the second and lower third molars, and two documents on the maturation of the seven mandibular teeth according to classical methodologies. The scarce existing literature, the almost absence of validated methods for the Chilean population, as well as the reported mass immigration phenomenon make a new and profound scientific research approach necessary for the application of updated methods.

RESUMEN: El objetivo de esta revisión fue identificar estudios originales que describan métodos radiográficos para la estimación de la edad dental aplicados en niños chilenos, considerando que Chile es un país con una larga historia de desastres naturales y que ha mostrado un aumento sin precedentes en el número de inmigrantes en los últimos años, con porcentajes significativos de individuos menores de 18 años. Se llevó a cabo una revisión con búsqueda sistemática siguiendo la metodología del Instituto Joanna Briggs y las pautas PRISMA. Se implementó una estrategia de búsqueda específica en la base de datos PubMed/Medline, con uso complementario de Google Scholar, buscando artículos completos en inglés y español. Cinco documentos respondieron al objetivo de búsqueda, de los cuales solo 3 fueron publicados en revistas arbitradas. Dos documentos centraron su estudio en la maduración de los terceros molares superiores e inferiores, uno en la maduración de los segundos y terceros molares inferiores y dos documentos en la maduración de los siete dientes mandibulares según metodologías clásicas. La escasa literatura existente, la casi ausencia de métodos validados para la población chilena, así como el fenómeno de inmigración masiva reportado, hacen necesario un nuevo y profundo enfoque de investigación científica para la apli- cación de métodos actualizados.

Prevalencia del segundo conducto radicular en incisivos inferiores y su importancia clínica / Prevalence of the second root canal in lower incisors and its clinical importance

La alta necesidad de tratamientos de endodoncia en los diferentes grupos dentales continúa siendo un desafío para los profesionales; ya que, es necesario el conocimiento tanto de las técnicas, materiales, equipo e instrumental, así como de las variantes del complejo sistema de conductos, de lo cual depende el éxito o fracaso. Las variaciones anatómicas incluyen la presencia de un segundo conducto radicular en incisivos inferiores (SCRII). La presente investigación es de tipo revisión bibliográfica, incluyéndose estudios del tipo: revisión de literatura y estudios descriptivos, en idioma inglés y español; se realizó la búsqueda entre los meses de enero y julio del 2021, en las bases de datos: Hinari, EBSCO host, Pubmed. Los resultados indican que la prevalencia de dos conductos en los incisivos inferiores varía desde 2% hasta un 77.9%; de manera individual en incisivos centrales inferiores la prevalencia es del 11.90% hasta 32.50% y en incisivos laterales inferiores se encuentran entre el 17.50% y el 58% de los casos. La ubicación de la entrada del SCRII ha sido objeto de múltiples estudios, encontrando que no existe consenso en este punto; pues se han descrito porcentajes similares entre los diferentes tercios (cervical, medio y apical), un factor influyente podría ser la etnia. La tomografía computarizada de haz cónico le ha ganado terreno a la radiografía convencional y uso de magnificación como técnica diagnóstica más efectiva; sin embargo, se sugiere realizar un estudio con pacientes salvadoreños para obtener un valor que oriente a los profesionales y así evitar fracasos de tratamientos endodónticos en dichos dientes.

The high need for root canal treatments in different dental groups continues to be a challenge for professionals; since, it is necessary the knowledge of the techniques, materials, equipment and instruments, as well as of the anatomical variants on which the success or failure depends. Anatomical variations include the presence of a second root canal in lower incisors (SCRII). The present investigation is of a literature review type, articles of the type were included: literature review and descriptive studies, papers in English and Spanish were included; the search was carried out between the months of January and July 2021, in the following databases: Hinari, EBSCO host, Pubmed. The results indicate that the incidence of finding two canals in both lower incisors range from 2% to 77.9%; individually in lower central incisors the prevalence is from 11.90% to 32.50% and in lower lateral incisors, it is found between 17.50% and 58% of cases. The location of the SCRII entrance has been the subject of multiple studies, finding that there is no consensus on this point; since similar percentages have been described among the different thirds (cervical, middle and apical), an influencing factor could be ethnicity. Cone beam computed tomography has gained ground over conventional radiography and the use of magnification as the most effective diagnostic technique; however, it is suggested to carry out a study with Salvadoran patients to obtain a value that guides professionals and thus avoid endodontic treatment failures in said teeth.

Caries progression and need for reintervention on occlusal ICDAS 4 lesions after different treatments: a retrospective university-based study / Progressão de cárie e necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos: um estudo retrospectivo de base universitária

Objective: To assess the caries progression and the need for reintervention on occlusal ICDAS 4 lesions after different treatments. Material and Methods: The sample consisted of records of children treated in a public setting who had at least an occlusal ICDAS 4 lesion in primary and/or permanent molars. The radiographic images of ICDAS 4 lesions at the first and last appointments were classified as absence of radiolucency, radiolucent image at the enamel­dentin junction, at the outer half or inner of the dentin. The need for retreatment after different treatments (non-invasive - topical fluoride applications, oral hygiene instructions and dietary guidance, micro-invasive - resin-based sealant, or invasive - restoration) was assessed by reviewing clinical and radiographic records. The need for retreatment was defined as any complication requiring mending (e.g., caries progression, total loss of sealant, or restoration failure). The Poisson regression model was used to investigate the association between individual and tooth-related variables and the outcome. Results: Among the 111 lesions in 81 patients, most (73.0%) lesions were in primary molars. Most lesions (52.3%) did not exhibit radiolucency, whereas 29.7% had radiolucency at the outer half of the dentin. The mean follow-up was 18.8 ± 6.5 months. After follow-up, 82.9% of the lesions did not require retreatment. The prevalence of ICDAS 4 lesions that did not need retreatment was higher among lesions with radiolucency at dentin (p=0.01). Conclusion: Most occlusal ICDAS 4 lesions did not require reintervention, especially those exhibiting radiolucency in the outer half of the dentin (AU)

Objetivo: Avaliar a progressão de cárie e a necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos. Material e Métodos: A amostra consistiu de prontuários de crianças atendidas em ambiente público que apresentavam pelo menos uma lesão oclusal ICDAS 4 em molares decíduos e/ou permanentes. As imagens radiográficas de lesões ICDAS 4 na primeira e última consultas foram classificadas como ausência de radiolucidez, imagem radiolúcida na junção esmalte-dentina, em metade externa ou interna da dentina. A necessidade de retratamento após diferentes tratamentos (não invasivo ­ aplicações tópicas de flúor, orientações de higiene e dieta, micro-invasivo ­ selante resinoso ou invasivo ­ restauração) foi avaliada por meio da revisão dos registros clínicos e radiográficos. A necessidade de retratamento foi definida como qualquer complicação que requer intervenção (por exemplo, progressão da lesão, perda total do selante ou falha na restauração). O modelo de regressão de Poisson foi utilizado para investigar a associação entre as variáveis individuais e dentárias e o desfecho. Resultados: Entre as 111 lesões em 81 pacientes, a maioria (73,0%) das lesões eram em molares decíduos. A maioria das lesões (52,3%) não exibiu radiolucidez, enquanto que 29,7% apresentaram radiolucidez em metade externa de dentina. O tempo de acompanhamento médio foi de 18,8 ± 6,5 meses. Após o acompanhamento, 82,9% das lesões não necessitaram de retratamento. A prevalência de lesões ICDAS 4 que não necessitaram de retratamento foi maior entre as lesões com radiolucidez em dentina (p=0,01). Conclusão: A maioria das lesões oclusais ICDAS 4 não requerem reintervenção, especialmente aquelas que exibem radiolucidez em metade externa da dentina.(AU)

In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography

Abstract Objective: To compare the accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for the detection of external apical root resorption (EARR) due to root canal contamination. Material and Methods: Dog's teeth with experimentally induced root resorption due to root canal contamination underwent or not root canal treatment (n=62). True positives (TP), false positives (FP), true negatives (TN), and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data were compared using chi-squared test (α=0.05). Results: EARR was detected in 35% of roots by PR, in 47% by CBCT, and in 50% of the roots by microscopy (p=0.03 PR versus microscopy; p=0.67 CBCT versus microscopy). Overall, CBCT produced more accurate diagnoses than PR (p=0.008). PR and CBCT allowed the identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p=0.003). Conclusion: Cone-beam computed tomography showed higher accuracy in detecting external apical root resorption of endodontic origin.

Influência da técnica de preparo sobre o contorno cervical dos laminados cerâmicos: relato de caso / Influence of the preparation technique on the cervical contour of ceramic laminates: a case report / Influencia de la técnica de preparación en el contorno cervical de los laminados cerámicos: reporte del caso

Introdução: Devido à crescente demanda estética, a odontologia restauradora se renova na intenção de alcançar melhores resultados na harmonia do sorriso. Entretanto, a atenção deve voltar-se também aos tecidos periodontais, visto que há uma integração entre material restaurador e os tecidos. Objetivo:Descrever e discutir as etapas clínicas para a confecção de laminados cerâmicos, atentando-se a preparos minimamente invasivos, contorno cervical e fatores que podem intervir na longevidade do procedimento.Relato de caso:Paciente do sexo masculino, 28 anos de idade, compareceu a Associação Brasileira de Odontologia, seção de Alagoas, relatando insatisfação em relação ao tamanho dos seus dentes. Os arcos superior e inferior foram moldados para a obtenção dos modelos de estudo e enceramento diagnóstico. Ao início do tratamento foi orientado ao paciente clareamento dental pela técnica combinada. O preparo dos dentes foi guiado por uma matriz de silicone, sendo estes uniformes e conservadores, seguido de moldagem, fase laboratorial e cimentação final. Finalizado o caso foi realizado o ajuste oclusal solicitando ao paciente que realizasse movimentos de lateralidade e protrusão. Conclusões:A técnica do preparo influência na longevidade dos laminados cerâmicos, por relacioanar-se à adesão e a saúde periodontal. O preparo deve ser mínino e limitado ao esmalte dental sempre que possível, determinando assim um maior e melhor prognóstico (AU).

Introduction:Due to the growing aesthetic demand, restorative dentistry is renewed to achieve better results in smile harmony. However, attention should also be turned to periodontal tissues since there is an integration between restorative material and tissues. Objective:To describe and discuss the clinical steps for the manufacture of laminate veneers, paying attention to minimally invasive preparations, cervical contour, and factors that can intervene in the procedure's longevity. Case report:A 28-year-old male patient attended the Brazilian Dental Association, the Alagoas section, reporting dissatisfaction with his teeth' size. The upper and lower arches were molded to obtain the study and diagnostic waxing models. At the beginning of treatment, the patient was instructed by the combined technique. After the case, the occlusal adjustment was performed, asking the patient to perform laterality and protrusion movements. Conclusions:The preparation technique influences the longevity of laminate veneers due to adherence and periodontal health. The preparation should be minimal and limited to dental enamel whenever possible, thus determining a higher and better prognosis (AU).

Introducción: Debido a la creciente demanda estética, la odontología restauradora se renueva para lograr mejores resultados en la armonía de la sonrisa. Sin embargo, también se debe prestar atención a los tejidos periodontales ya que existe una integraciónentre el material restaurador y los tejidos.Objetivo: Describir y discutir los pasos clínicos para la confección de carillas laminares, prestando atención a las preparaciones mínimamente invasivas, al contorno cervical y a los factores que pueden intervenir en la longevidad del procedimiento.Reporte del caso: Un paciente masculino de 28 años asistió a la Asociación Dental Brasileña, sección de Alagoas, reportando insatisfacción con el tamaño de sus dientes. Los arcos superior e inferior fueron moldeados para obtener los modelos de depilación de estudio y diagnóstico. Al comienzo del tratamiento, el paciente fue instruido por la técnica combinada. La preparación de los dientes fue guiada por una matriz de silicona, siendo estas uniformes y conservadoras, seguidas de moldeo, fase de laboratorio y cementación final. Después del caso, se realizó el ajuste oclusal, pidiendo al paciente que realizara movimientos de lateralidad y protuberancia. Conclusiones: La técnica de preparación influye en la longevidad de los laminados cerámicos, debido a la adherencia y la salud periodontal. La preparación debe ser mínima y limitada al esmalte dental siempre que sea posible, determinando así un pronóstico más alto y mejor (AU).

Displasia dentinária Tipo I: relato de caso clínico / Dental dysplasia Type I: a clinical case report

As anomalias de desenvolvimento dos dentes, como a displasia dentinária, podem ser observadas durante os exames clínicos e radiográficos em alguns pacientes. O presente relato de caso discute sobre a Displasia Ectópica Dentinária (DD), sendo um distúrbio de desenvolvimento relacionado a formação da dentina que possui obliteração da polpa e defeito da formação da raiz. Descrita como uma condição rara e transmitida geneticamente. Ela pode ser dividida em tipos I e II, uma vez que ambas podem afetar as dentaduras decídua e permanente. O tratamento clínico transformou-se com o passar dos anos, sendo que o protocolo indicava a necessidade de exodontia para um tratamento menos invasivo, utilizando métodos que consistem na manutenção da higiene oral, a idade do paciente, a gravidade da doença, a extensão dos sintomas e atendimento odontológico regular. Este trabalho tem como objetivo apresentar o caso clinico de um menino de 8 anos, diagnosticado com displasia dentinária do tipo I e com presença de restaurações insatisfatórias na dentição mista. Dessa forma é significativo o planejamento adequado, em favor de melhorias na manutenção profilática... (AU)

Anomalies in the development of teeth, such as dentin dysplasia, can be observed during clinical and radiographic examinations in some patients. The present case report discusses Dentinal Dysplasia Ec topic (DD), being a developmental disorder related to the formation of dentin that has pulp oblitera tion and root formation defect. Described as a rare and genetically transmitted condition. It can be divided into types I and II, since both can affect deciduous and permanent dentures. Clinical treatment has changed over the years, and the protocol indicated the need for extraction for a less invasive treat ment, using methods that consist of maintaining oral hygiene, the age of the patient, the severity of the disease, the extent of symptoms and regular dental care. This paper aims to present the clinical case of an 8-year-old boy, diagnosed with type I dentin dysplasia and with the presence of unsatisfactory restorations in the mixed dentition. Thus, adequate planning is significant, in favor of improvements in prophylactic maintenance... (AU)

Levantamento de dados secundários de anomalias dentárias em crianças atendidas na Faculdade de Odontologia de Pernambuco / Survey of secondary data of dental anomalies in children attended at the Pernambuco Dentistry Faculty

Os distúrbios de crescimento e desenvolvimento dos dentes são alterações no número, tamanho ou forma dos dentes com origem multifatorial, sendo o objetivo desse estudo conhecer a frequência de anomalias dentárias. Trata-se de uma pesquisa quantitativa, descritiva e com delineamento transversal de dados secundários, utilizando registros dos prontuários de crianças dos 3 aos 12 anos de idade atendidas na Clínica de Atenção Básica Infantil da FOP/UPE. Foram coletadas informações referentes ao sexo, idade, presença, tipo e localização da anomalia. Realizamos uma análise estatística utilizando o Microsoft Excel e Epi Info v.3.5.3. O estudo teve uma amostra final de 197 prontuários, 52,8% do sexo feminino e 47,2% do sexo masculino. Foram identificadas 4,5% anomalias dentárias, sendo (77,8%) anomalia de número, localizada na região anterior (88,8%). A predominância foi maior no sexo feminino (N=6). As anomalias dentárias presentes foram: anodontia (55,5%), dentes supranumerários (22,3%), giroversão (11,1%) e fusão (11,1%). A frequência de anomalia dentária foi de 4,5%, sendo a anomalia de número mais frequente (77,8%), acometendo mais o sexo feminino e com média de idade de 8,5 anos... (AU)

Tooth growth and development disorders are changes in the number, size or shape of teeth with multifactorial origin, and the aim of this study is to know the frequency of dental anomalies. This is a quantitative, descriptive and cross-sectional study of secondary data, using records from the medical records of children aged 3 to 12 years attended at the Primary Child Care Clinic of FOP/UPE. Information regarding gender, age, presence, type and location of the anomaly was collected. We performed a statistical analysis using Microsoft Excel and Epi Info v.3.5.3. The study had a final sample of 197 medical records, 52.8% female and 47.2% male. 4.5% dental anomalies were identified, (77.8%) number anomaly, located in the anterior region (88.8%). Predominance was higher in females (N=6). The dental anomalies were: anodontics (55.5%), supernumerary teeth (22.3%), gyroversion (11.1%) and fusion (11.1%). The frequency of dental anomaly was 4.5%, being the most frequent number anomaly (77.8%), affecting the female sex more and with a mean age of 8.5 years... (AU)

Evaluación radiográfica de tratamientos endodónticos realizados por alumnos de grado. Una experiencia docente / Radiographic evaluation of endodontic treatments performed by undergraduate students: a teaching experience

Objetivo: Describir una experiencia de capacitación de alumnos de grado en la evaluación radiográfica de tratamientos endodónticos realizados ex vivo. Material y métodos: Participaron un docente y 13 alumnos, cada uno de los cuales evaluó radiográficamente 100 tratamientos endodónticos realizados ex vivo para determinar si estos eran correctos o incorrectos. Posteriormente, el mismo docente, en una clase teórica, presentó a los alumnos otras imágenes radiográficas a fin de calibrar qué debería considerarse correcto o incorrecto. Luego fueron proyectadas nuevamente las radiografías de los 100 casos, y los alumnos efectuaron una nueva valoración. Para cada alumno, se determinó la frecuencia de concordancia con el docente en los 100 casos, antes y después de la calibración. Se categorizó cada observación como sin cambio, positiva (precalibración sin concordancia y poscalibración con concordancia) y negativa (precalibración con concordancia y poscalibración sin concordancia). En cada caso se calcularon la frecuencia para cada categoría, la frecuencia de concordancia entre cada alumno y el docente antes y después de la calibración, y la diferencia entre frecuencias. Resultados: La frecuencia absoluta de casos con concordancia alumno/docente sin cambios fue entre 65 y 85; con cambio positivo, entre 14 y 29; y con cambio negativo, entre 1 y 8. La concordancia antes y después de la calibración resultó entre 37% y 79,2%. Conclusión: La calibración mejoró parcialmente la capacitación de los alumnos para la evaluación radiográfica de los tratamientos endodónticos (AU)

Aim: To describe one experience of calibration in the radiographic evaluation of 100 endodontic treatments performed ex vivo in undergraduate students. Material and methods: One professor and 13 undergraduate students participated in this study, who independently radiographically evaluated 100 ex vivo endodontic treatments and determined whether each case was correct or incorrect. Later, the same professor presented a theoretical class to the students with other radiographic images in order to calibrate the difference between correct and incorrect treatments. Then the radiographs of the same 100 cases were projected and the students made a new evaluation. The frequency of agreement with the teacher was determined for each student in the 100 cases before and after the calibration. Each observation was categorized as without change, with positive change (pre-calibration without agreement and post-calibration with agreement) and with negative change (pre-calibration with agreement and post-calibration without agreement). The frequency for each category was calculated for each student. In each of the cases, the frequency of students in which concordances with the teacher were observed before and after calibration, and the difference between both frequencies were calculated. Results: The absolute frequency of cases with agreement of the students/teacher without changes varied between 65 and 85, with a positive change between 14 and 29 and a negative change between 1 and 8. The concordance before and after calibration varied between 37.0% and 79.2%. Conclusion: Calibration partially improved the training of students in radiographic evaluation of endodontic treatments (AU)

Comparación entre trazados cefalométricos manual y digital en radiografías laterales del cráneo / Comparison between Manual and Digital Cephalometric Tracing in Side Radiographies of the Skull

Resumen Objetivo: Evaluar la diferencia del trazado cefalométrico manual con el digital en radiografías laterales de cráneo. Materiales y métodos: Inicialmente se realizó un piloto para calibrar al investigador principal, en donde se analizaron 10 radiografías pertenecientes a cinco pacientes del Servicio de Radiología del Centro Odontológico de nuestra institución para evaluar la concordancia entre los dos evaluadores y establecer el tamaño de la muestra. Finalmente, se analizaron 78 radiografías cefalométricas de 39 pacientes, en las que se realizó el trazado cefalométrico de Steiner manual y digital. Esas radiografías se analizaron en una escala 1:1 y posteriormente se evaluó la diferencia de las mediciones mediante el análisis univariado, se determinó en mediana e intervalo intercuartil por separado. En el análisis bivariado, se aplicó la prueba de signo de rangos de Wilcoxon y muestras pareadas para determinar la diferencia de las mediciones cefalométricas de Steiner entre el tipo del análisis cefalométrico. El nivel de significancia se fijó en p < 0,05 y confiabilidad al 95%, respectivamente. Resultados: No hubo diferencia significativa en la mayoría de las mediciones hechas de manera manual y digital, siendo el ángulo interincisal la única medición angular en la cual hubo diferencia significativa al obtener un resultado de p = 0,002. Mientras tanto, en las mediciones lineales, la única medición en la que hubo diferencia significativa fue en el segmento incisivo inferior - NB con p = 0,005. Conclusión: No se encuentran diferencias significativas entre el trazado cefalométrico manual y el digital. No obstante, es importante tener en cuenta que la muestra o población evaluada es reducida para definir conclusiones.

Abstract Objective: To evaluate the difference of the manual cephalometric tracing with the digital tracing on lateral cranial radiographs. Materials and Methods: Initially, a pilot study was carried out to calibrate the principal investigator, where 10 radiographs belonging to 5 patients of the Radiology Service of the Dental Center, were analyzed to evaluate the intraclass concordance between the two evaluators. To establish the size of the sample, finally, 78 cephalometric radiographs of 39 patients were analyzed, in which the manual and digital Steiner cephalometric tracing was performed. These radiographs were analyzed on a 1: 1 scale and then the difference of the measurements was evaluated using the univariate analysis, which was determined in the median and interquartile range, separately. In the bivariate analysis, the Wilcoxon rank sign test and paired samples were applied to determine the difference of Steiner's cephalometric measurements between the cephalometric analysis type. The level of significance was set at p < 0.05 and 95% reliability, respectively. Results: There was no significant difference in most of the measurements made manually and digitally. The interincisal angle the only angular measurement in which there was a significant difference when obtaining a result of p = 0.002, while, in the linear measurements, the only measurement in which there was significant difference was in the lower incisor segment - NB with p = 0.005. Conclusion: There is no significant difference between manual and digital cephalometric tracing, nevertheless it is important to keep in mind that the simple or population evaluated is reduced to define conclusions.

O uso da tomografia computadorizada de feixe cônico no diagnóstico e no gerenciamento de insucesso endodôntico: relato de caso clínico / The use of cone beam computed tomography in the diagnosis and management of endodontic failure: clinical case report

Objetivo: descrever um caso clínico em que a tomografia computadorizada de feixe cônico (TCFC) foi utilizada para auxiliar no diagnóstico e no melhor gerenciamento de retratamento endodôntico. Relato de caso: uma paciente compareceu à clínica com queixa de uma fístula na região dos molares superiores do lado direito há aproximadamente dois meses. Radiograficamente, observou-se lesão periapical do elemento 17. Após a confirmação da necessidade do retratamento, a paciente relatou já ter feito duas intervenções endodônticas nesse elemento. Assim, optou-se por solicitar um exame de TCFC, para melhores diagnóstico e planejamento do caso. Ao avaliar a TCFC, verificou-se presença de lesão periapical extensa, presença de espaços vazios no canal mesiovestibular (MV) e palatino (P), cone de guta percha além do ápice no canal distovestibular (DV) e localização do canal mesiopalatino (MP), que não havia sido manuseado anteriormente, rompimento de cortical óssea vestibular e palatino. Após planejamento, a paciente foi submetida ao retratamento endodôntico. Foi realizada a desobstrução dos canais radiculares com remoção do cone ultrapassando no canal DV, localização do MP e instrumentação completa de todos os canais. O hidróxido de cálcio foi utilizado como medicamento intracanal entre as consultas. Ao observar a regressão da fistula e os canais sem presença de exsudato, realizou-se a obturação do canal radicular. Considerações finais: a TCFC permitiu a visualização de erros operatórios pertinentes ao caso durante os tratamentos endodônticos prévios, o que possibilitou a indicação de um novo tratamento endodôntico e a manutenção do dente na arcada dentária.(AU)

Objective: to describe a clinical case where cone beam computed tomography (CBCT) was used to assist in the diagnosis and better management of endodontic retreatment. Case report: the patient attended the clinic complaining of a fistula in the upper molar region on the right side for approximately two months. Radiographically, the presence of a periapical lesion of element 17 was observed. After confirming the need for retreatment, the patient reported having already undergone two endodontic interventions on this tooth. Thus, it was decided to request a CBCT exam for better diagnosis and case planning. When assessing the CBCT, there was the presence of extensive periapical lesion, presence of empty spaces in the mesiobuccal (MB) and palatal (P) canal, gutta percha cone beyond the apex in the distobuccal (DB) canal and location of the mesiopalatal (MP) canal - which had not been previously handled -, rupture of the cortex vestibular and palatal bone. After planning, the patient underwent endodontic retreatment. Then, all the previous filling material were removed, including the gutta-percha by passing into the DB canal, MP was localized and complete instrumentation of all root canals were done. Calcium hydroxide was used as an intracanal medication between appointments. When the regression of the fistula was observed and canals were without exudate, root canal filling was performed. Final considerations: the CBCT allowed the visualization of operative errors pertinent to the case during previous endodontic treatments, which allowed the indication of a new endodontic treatment and the maintenance of the tooth in the dental arch.(AU)