Avulsión dental y mantenedor de espacio estético-funcional y correctivo en Odontopediatría / Dental avulsion and esthetic-functional and corrective retainers use in Pediatric Dentistry / Avulsão dentária e mantenedor do espaço estético-funcional e corretivo em Odontopediatria

RESUMEN Se presentó el caso de un niño de 8 años que acudió al Servicio de Estomatología del Policlínico Universitario "Chiqui Gómez Lubián", de Santa Clara, provincia Villa Clara. En el mismo se observó avulsión del incisivo central superior derecho, fractura no complicada de la corona en incisivo central superior izquierdo y una marcada vestibuloversión. Se confeccionó un aparato placa Hawley de acuerdo a las características y necesidades del paciente, con el fin de lograr la recuperación estética, mantener la longitud del arco y corregir la vestibuloversión en el mismo. El aparato permitió obtener un resultado satisfactorio, que ha influido psicológicamente en el paciente al elevar su autoestima y salud bucal.

ABSTRACT A boy of 8 years old was seen in the dental service at the Policlínico Universitario "Chiqui Gómez Lubián", in Santa Clara, Villa Clara. Examination revealed avulsion in the right upper central incisor, uncomplicated crown fracture in left upper central incisor and an improper alignment of the teeth. Taking into account patients´ characteristics and requirements, it was fabricated a Hawley´s retainer in order to achieve a better aesthetic outcome, maintain the length of the dental arch and correct the improper alignment of the teeth. The appliance has achieved a satisfactory outcome, which has had a psychological influence on the patient by improving his self-esteem and oral health.

RESUMO Foi apresentado o caso de um menino de 8 anos que veio ao Serviço de Estomatologia do Policlínico Universitario "Chiqui Gómez Lubián", em Santa Clara, província de Villa Clara. Neste, observou-se avulsão do incisivo central superior direito, fratura não complicada da coroa em incisivo central superior esquerdo e vestibuloversão acentuada. Um dispositivo de placa de Hawley foi confeccionado de acordo com as características e necessidades do paciente, a fim de se obter recuperação estética, manter o comprimento do arco e corrigir a vestibuloversão nele. O dispositivo permitiu obter um resultado satisfatório, o que influenciou psicologicamente o paciente, elevando sua autoestima e saúde bucal.

Population Knowledge and Attitude Toward Emergency Management of Avulsed Permanent Teeth

Abstract Objective: To evaluate the knowledge of patients treated in a public University concerning dental avulsion and its emergency first-aid management. Material and Methods: Three hundred patients were invited to answer a questionnaire about demographic characteristics, attitude and knowledge of first-aid management of dental avulsion. Chi-square test was used to assess the association between knowledge about dental replantation and education level. Results: Female gender (66.7%) aged from 31 to 40 years (31.3%) with high school education (50.3%) predominated among all the participants. It was not found a difference between education level and management of avulsed permanent teeth (p=0.076), and 66% of the respondents were not able to do the replantation. In relation to the management of avulsed tooth, 42.7% of the respondents would brush the tooth and if the replantation was not possible, most of them would choose inappropriate media for storage. The association between the storage medium and educational level showed to be statistically significant (p=0.043). Conclusion: It was possible to notice the lack of knowledge about this subject, and it could result in the worst prognosis. In avulsion cases, the subsequent root resorptions may lead to the loss of the child's tooth. It is important to implement educational campaigns to spread knowledge and improve success rates of permanent avulsed teeth

Prehospital emergency management of avulsed permanent teeth: Knowledge and attitude of schoolteachers.

Context: Tooth avulsion is one of the most serious dental emergencies in children. Often these injuries occur in school and, therefore, the knowledge of schoolteachers regarding the appropriate measures to be taken immediately after tooth avulsion is crucial to good prognosis. Aims: The purpose of the present study was to evaluate schoolteachers' knowledge and attitudes regarding immediate management of avulsed teeth in children. Materials and Methods: A total of 177 teachers from seven schools of Garhshankar town, Hoshiarpur District, Punjab, India, formed the sample of the study. A self-administered questionnaire consisting of 16 questions was used to assess the knowledge and attitudes of schoolteachers about tooth avulsion and its management. Statistical Analysis: The chi-square test and one-way analysis of variance (ANOVA) were used for analysis. Pair-wise comparison was done using Tukey's honestly significant difference (HSD) test. P≤0.05 was considered to be statistically significant. Results: Markedly low knowledge levels were noted among the schoolteachers. The mean knowledge score was 5 (of a maximum possible score of 10). Only 0.6% of the teachers answered correctly that they would use milk as a transport medium. The number of correct responses was not affected by previous experience with tooth avulsion, sex, educational level, teaching experience, or teacher training. Overall, 85.9% of teachers showed a positive attitude towards this campaign. Conclusions: Knowledge regarding emergency management of dental trauma is poor amongst schoolteachers. Therefore, we suggest that orientation to management of avulsed tooth be part of the teacher training education.

Traumatismos dentoalveolares que afectan a las estructuras de soporte de los dientes temporales y sus efectos en los sucesores definitivos / Dentoalveolar injuries affecting tooth support structures in temporary and the effects on permanent succesors

El propósito de este estudio fue determinar las secuelas producidas en la dentición definitiva luego de un traumatismo que afectó a las estructuras de soporte de dientes temporales. La muestra corresponde a 53 niños beneficiarios del Centro de Referencia Odontopediátrico Simón Bolívar, entre las edades de 1 a 7 años que sufrieron traumatismo dentoalveolar del sector anterior, durante el periodo 2005-2007 que se clasificó según Andreasen en subluxación, luxación lateral, luxación intrusiva, luxación extrusiva y avulsión. Los resultados obtenidos nos permiten determinar un 20 por ciento de secuelas clínicas en dientes sucesores permanentes, siendo las opacidades del esmalte con un 88 por ciento las lesiones mas frecuente, luego las hipoplasias del esmalte que alcanzó un 12 por ciento. La mayoría de las lesiones registradas según severidad son de tipo leves (65 por ciento) y el porcentaje de dientes con secuelas clínicas no cambia significativamente a través de los diferentes diagnósticos. La edad promedio de los niños al momento de sufrir el trauma y que presentaban secuelas fue de 4,7 años. No se registraron casos de luxación extrusiva puesto que no se observaron casos con secuelas. Se concluye que los dientes definitivos que remplazan dientes deciduos que han sufrido trauma como luxación intrusiva, subluxación, luxación lateral y avulsión, con frecuencia presentan secuelas que se expresan principalmente como opacidad e hipoplasias del esmalte. Las secuelas de estos traumas podrían disminuir si los niños expuestos a estas lesiones concurrieran tempranamente a centros de salud especializados en la atención del traumatismo dentoalveolar...

The purpose of this study was to determine the effects produced in the permanent teeth after trauma affecting the supporting structures of teeth. The sample is 53 children beneficiaries of the Reference Center Odontopediátrico Simon Bolivar, ages 1 to 7 years who suffered injury of the anterior dentoalveolar trauma during the period 2005-2007 that was classified according to Andreasen: subluxation, lateral luxation, intrusive luxation, extrusive luxation and avulsion. The results obtained allow us to determine 20 percent of clinical sequelae in permanent successor teeth, with enamel opacities with 88 percent more frequent injuries, then the enamel hypoplasias reached 12 percent. Most of the injuries recorded as mild severity are of type (65 percent) and the percentage of teeth with clinical sequelae not changes significantly across the different diagnoses. The average age when children suffer the trauma and had sequelae was 4.7 years. No cases of extrusive luxation since there were no cases with sequelae. It is concluded that the permanent teeth that replace primary teeth that have suffered trauma such as intrusive luxation, subluxation, lateral luxation and avulsion, often have consequences that are expressed mainly as opacity and enamel hypoplasia. The aftermath of this trauma could be reduced if children exposed to these lesions are entered into early health centers specialized in the care of dentoalveolar trauma...

Incisor tooth in the nose: Anecdotal sequel to dog bite in a 3-year-old child.

A 3-year-old male child presented to the casualty with history of unprovoked dog bite over the right lateral wall of nose. He was managed conservatively with antirabies prophylaxis and dressings. He presented after 3 months with a healed wound and the right upper central incisor projecting into the nostril. The Orthopantomogram showed a rotated temporary incisor with the roots of the permanent incisor placed normally. The tooth was extracted intranasally. Among the mutilating dog bite injuries referred to a plastic surgeon, this injury though thought provoking was also comical.

Oral and maxillofacial trauma in patients with epilepsy: prospective study based on an outpatient population / Trauma oral e maxilofacial em pessoas com epilepsia: estudo prospectivo com base ambulatorial

OBJECTIVE: This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. METHOD: A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95 percent confidence interval, dependency analysis and the Pearson c² test were used for statistical analysis, and the significance level was set at p≤0.05. RESULTS: A total of 159 patients with epilepsy (91 males; 57.3 percent) and 68 control individuals (28 males; 41.1 percent) were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9 percent and 4.4 percent, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9 percent), followed by tooth avulsion (7.6 percent), tooth luxation (5 percent) and fracturing of prostheses in edentulous patients (3.8 percent). CONCLUSION: This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected.

OBJETIVO: O objetivo desse estudo foi avaliar a relação da epilepsia sobre as ocorrências de trauma dento-alveolar e maxilofacial causados por quedas. MÉTODO: Estudo caso-controle prospectivo foi conduzido no ambulatório de epilepsia e do Pronto Atendimento do Hospital de Base de São José do Rio Preto-SP no ano de 2006. Pacientes do grupo caso foram diagnosticados pelo neurologista chefe (sênior) especialista em epilepsia e avaliados quanto ao trauma oral e maxilo-facial pelo pesquisador, por meio de questionário, exame clínico e radiográfico, por ordem de chegada. O grupo controle (GC) foi constituído incluindo indivíduos sem crises, que fossem familiares ou vizinhos próximos dos pacientes com diagnóstico de epilepsia. Intervalo de confiança 95 por cento, ODD, análise de dependência (ANADEP) e c² de Pearson foram utilizados para análise estatística e se adotou nível de significância de p≤0,05. RESULTADOS: Analisaram-se 159 pacientes com epilepsia, dos quais 91(57,3 por cento) masculinos e 68 do GC, dos quais 28 (41,1 por cento) masculinos. A frequência do trauma oro-maxilar em paciente com epilepsia foi 23,9 por cento e no GC foi de 4,4. As crises tônico-clônicas generalizadas, crises generalizadas e as não classificadas estão fortemente co-relacionadas ao trauma. Fraturas das coroas dentais (32,9 por cento), seguidas de avulsão dentária (7,6 por cento), luxação dentária (5 por cento) e fratura da prótese em pacientes edêntulos (3,8 por cento) foram as lesões mais encontradas. CONCLUSÃO: O trabalho mostra que os ferimentos na face e dentes são frequentes em pacientes com crises epilépticas quando comparados ao GC, sendo as pessoas com crises sem a aura as mais afetadas.

Luxation injuries in primary teeth: a retrospective study in children assisted at an emergency service

The purpose of this study was to analyze luxation injuries in children between the ages of 0 and 5 years treated at an emergency service department. A total of 1,703 records, corresponding to a period of 10 years at the Emergency Center of the Baby Clinic at Londrina State University, Brazil, were analyzed. The age, gender, etiologic factors, type of injury, injured teeth, treatment and time interval between injury and treatment were determined for each patient. Of the examined records, 409 patients met the study criteria and included a total of 679 injured teeth. Statistical analyses were carried out using the chi-square test with the level of significance set at 5 percent. Trauma incidence was higher in boys (57.0 percent) and in children less than two years of age (40.3 percent). Falling while walking or running was the most predominant etiologic factor (37.7 percent), and the most prevalent type of injury was subluxation (32.6 percent). Luxation injuries decreased with increasing age (p = 0.045). Treatment usually occurred within the first 1-15 days and was significantly associated with the type of trauma (p = 0.041). "Monitor only" was the treatment most frequently observed (74.0 percent). In conclusion, more luxation injuries were found in younger children, predominantly in boys. Falls resulting from walking or running were the etiologic factor most observed, with subluxation as the most common type of trauma. Treatment usually occurred within the first 15 days after the injury. Despite the severity of these injuries, "monitor only" was the eligible treatment.

Avaliação clínica e radiográfica de dentes decíduos intruídos por traumatismo alvéolo-dentário / Clinical and radiographic evaluation of intrusion in primary teeth by the dental trauma

A luxação intrusiva é causada por um impacto no sentido axial, no qual o dente é deslocado para dentro do osso alveolar, afetando comumente a dentição decídua e podendo gerar sequelas. O seu tratamento é definido por sinais clínicos e radiográficos. Objetivo: acompanhar dentes decíduos intruídos e observar a ocorrência de sequelas. Método: Avaliaram-se prontuários de pacientes com história de traumatismo alveolodentário na dentição decídua e selecionaram-se os prontuários de pacientes que sofreram intrusão com, no mínimo, dois anos de acompanhamento, verificando-se: graus de intrusão e de reerupção; presença de mobilidade dentária; coloração e posição do dente após reerupção; presença de fístula; condição do canal pulpar e da região periapical; presença de reabsorção radicular; e tratamento executado. Resultados: Dentre os 435 pacientes atendidos, foram encontrados 83 casos de intrusão e 29 desses foram incluídos na amostra, totalizando 39 dentes decíduos traumatizados. Assim, as intrusões representaram 19,1% dos traumatismos observados. Embora o sexo feminino fosse o mais acometido (55,2%), não existiu correlação entre sexo e prevalência de dentes decíduos traumatizados. Em relação aos dentes atingidos, o mais acometido foi o 61 (34,4%), seguido pelo 51 (31,0%). Ainda, em 31,0% dos casos, os dois incisivos centrais superiores foram acometidos. O estudo aponta, ainda, que queda da própria altura foi a etiologia prevalente, com 58,6% dos casos. Do total de dentes, 27 tiveram reerupção total, três reerupção de 2/3 da coroa e nove esfoliaram ou foram extraídos. Observando-se as sequelas, discoloração dentária foi a mais frequente, sendo encontrada em 23 dentes (79,3%). Quanto ao tratamento, dos 39 dentes, 28 foram apenas acompanhados (71,8%), nove necessitaram de endodontia (23,1%) e dois de extração (5,1%). Conclusão: o monitoramento da reerupção espontânea dos dentes intruídos e a observação cuidadosa do aparecimento de sequelas são as melhores alternativas, pois algumas complicações podem aparecer vários meses após o traumatismo. As sequelas e o grau de intrusão apresentam grande relação, visto que quanto maior o grau de intrusão, maior será a gravidade das sequelas e mais importante torna-se o acompanhamento por um profissional.

Intrusive luxation is caused by an impact in the axial direction by which the tooth is displaced into the alveolar bone. It usually affects the primary dentition and can generate sequalae. Its treatment is defined by clinical and radiographic signs. Objective: to follow intrusive primary teeth and observe sequela occurrence. Methods: Dental records of patients with a history of alveolodental trauma were evaluated and records from patients that had suffered intrusion with at least a two-year follow-up period were selected. Intrusion and reeruption degrees, dental mobility occurrence, coloration and tooth position after reeruption, fistula occurrence, pulp canal and periapical region condition, root resorption occurrence and treatment performed were checked. Results: Out of 435 treated patients, 83 intrusion cases were found, 29 of which were included in the sample, totaling 39 traumatized primary teeth. Thus, intrusion represented 19.1% of the analyzed traumas. Although females were more affected (55.2%) than males, a correlation between sex and traumatized primary teeth was not found. With reference to affected teeth, the most affected was tooth 61 (34.4%), followed by tooth 51 (31.0%). Also, in 31.0% of the cases, the two central upper incisives were affected. The study showed that fall from height was the prevailing etiology, encompassing 58.6 % of the cases. Out of the total, 27 teeth showed total reeruption, 3 presented a 2/3 reeruption of the crown, and 9 either exfoliated or were extracted. Upon observing sequelae, dental discoloration was most frequent, having been encountered in 23 teeth (79.3%). As to treatment, 28 out of 39 teeth were only followed up (71.8%), 9 needed endodontic treatment (23.1%) and 2 extraction (5.1%). Conclusion: the monitoring of the spontaneous reeruption of intruded teeth and the careful observation to determine sequela occurrence are the best choices, once complications might arise several months after trauma. Sequelae and inclusion degree are closely related, inasmuch as the higher the intrusion degree, the greater the sequela severity; thus, professional follow-up is indispensable.

Epidemiologic survey of traumatic dental injuries in children seen at the Federal University of Rio de Janeiro, Brazil

This epidemiologic survey aimed at assessing the prevalence of traumatic dental injuries in children seen at the Federal University of Rio de Janeiro, Brazil. The records of a total of 111 children (aged 0 to 6 years) seen from 2004 to 2006 in the dental trauma clinic were surveyed, comprising a total of 201 traumatized primary teeth. Data pertaining to the child and to the trauma such as age, gender, etiology, teeth involved, type of traumatic injury, time elapsed between the trauma and seeking care, and the presence and kind of clinical and radiographic sequelae in the first visit were collected from the dental records. All variables studied were assessed by means of frequency analysis and the Chi-square test (p < 0.05). A higher prevalence of trauma was observed in boys (56.7 percent) and in the age group from 0-3 years (73.8 percent). The most affected teeth were the central incisors (84.7 percent) and the most common trauma etiology was a fall from the child's own height (63.0 percent). The supporting tissues were the most affected. Lateral luxation was the most frequent alteration observed (33.4 percent), followed by concussion (21.0 percent). Coronal discoloration (17.7 percent) and external resorption (18.3 percent) were, respectively, the most prevalent clinical and radiographic sequelae. Gender had no influence on the clinical (p = 0.54) and radiographic (p = 0.55) sequelae. Even though age had no influence on radiographic sequelae (p = 0.41), clinical sequelae were more prevalent in children aged 0 to 3 years (p = 0.03). In conclusion, traumatisms in primary teeth were more prevalent in boys, and in 0-3-year-old children. Luxation was the most frequent traumatic lesion, and coronal discoloration and external resorption were the most prevalent sequelae.

Intrusion in implant-tooth-supported fixed prosthesis: an in vitro photoelastic stress analysis.

BACKGROUND AND OBJECTIVE: Intrusion of natural teeth is a very common and interesting problem associated with implant-assisted fixed partial prostheses. Various theories have been put forth to explain this phenomenon, most of which revolve around the philosophy of exertion of excessive forces onto the natural tooth in a combination fixed partial denture. This photoelastic study examines the current theories revolving around intrusion and evaluates whether natural tooth intrusion is a definite possibility in an implant-tooth-connected fixed partial prosthesis. MATERIALS AND METHODS: A two-dimensional photoelastic method was employed for testing and analysis. Two sets of photoelastic models were fabricated, one depicting a totally tooth-supported situation and the other an implant-tooth-supported situation. A rigid type and non-rigid type of connection were also incorporated into the fixed partial denture used in the both the situations in the study. Loads were applied on the anterior and posterior abutments and the pontic regions in both sets of models and the fringe patterns were photographically recorded for analysis. RESULTS AND CONCLUSION: The forces were proportionately consistent with the increase in applied loads in both the situations. The use of a non-rigid connection did not show any major significance but in fact may be erroneous. The forces were considerably higher in the implant-tooth-connected situation. The results indicated that the differences in the forces exerted were not light and continuous and may not cause tooth intrusion. Natural tooth intrusion may be caused by reasons other than excessive forces and needs further investigation.

Avulsion injuries among Libyan school children prevalence and fate

This prospective study aimed to determine the prevalence and fate of reimplanted teeth of the Libyan school children. The prevalence was 5.0%. Mean age group was 10.1, Mode was 9 and Median was 9.5 years. Females were injured more frequently [55.6%] than male [44.4%]. Upper centrals were the most common teeth injured [85.6%]. Saliva storage seemed to be the most favourable storage media; the success rate was 100%. Dry storage would lead to progressive root resorption; replacement and inflammatory root resorptions were recorded in 69.2% of the cases. In this study the extra-alveolar period seemed to have no significant relation with the success rate where the success rate was 84.6% and the failure rate was only 15.4%, the authors related this to improper recording of the exact extra-alveolar period from the parents, however the longer the extra-alveolar period the more the complications will result. Fall at home was the main reason for the avulsion. Parental Educational programs are very important for the quick management of such injuries

Emergencias odontológicas en la montaña / Dental emergencies in the mountain

Seis de la tarde del primer día, refugio, cansado por el acarrero delt ramo incial, me apresto a descargar la mochila apurado pr cargar agua de deshielo que corre cerca al refugio antes que se congele al caer el sol. De repente, un dolor de muelas soportable (hiperemia). Se va incrementando (pulpitis) y haciéndose imposible de soportar; no traje nada para el dolor pero el guía de montaña alivia mi angustia de psar una noche terrible o, lo que es peor, terminar mi aventura. Una bolita de algún embebida en un líquido (eugenol), la coloco en la caries, previo secado con algodón también, una pasata que lka colocamos con algún instrumento pequeño que haga las veces de espátula la mantendrá en su lugar. Situaciones como esta pueden sucederles a cualquier persona. Algunas, de fácil resolución, otras, incapacitantes, dependiendo también de la distancia (horas o días) a algún centro urbano. Si les han extraído un elemento dentario recientemente no olviden que tienen que dejar pasar al menos 48 hs antes de realizar un esfuerzo físico importante. Lo aconsejable, y aunque parezca un detalle menor sería pasar por el odontólogo que, a pesar de no ser un santo de devoción de muchos, suele darles una cierta tranquilidad al poner vuestra boca en condiciones aceptables para excursiones en la que estarán a kilómetros de distancia de su consultorio.

Avulsión dentaria: caso clínico / Tooth avulsion: a clinical case

Caso clínico que describe el tratamiento realizado en una niña de 10 años que sufrió la avulsión de los incisivos centrales superiores. El objetivo del tratamiento está destinado a mantener las piezas dentarias en boca el mayor tiempo posible, favoreciendo la viabilidad y reparación del ligamento periodontal y el tratamiento temprano de la reabsorción radicular

Intrusión de dientes temporarios: diagnóstico, tratamiento y pronóstico / Primary teeth intrusion: diagnosis, treatment and prognosis

Dentro de los traumatismos que afectan a los dientes temporarios, la intrusión constituye uno de los más severos, ya que si la misma es moderada o severa puede producir daño en el germen del diente permanente. Se deben conocer bien las pautas de tratamiento para evitar secuelas mayores en la dentición permanente. El presente artículo tiene como propósito destacar las características clínicas y radiográficas de la intrusión y establecer guías de tratamiento de acuerdo al grado de intrusión, destacando las secuelas postraumáticas no sólo de los dientes temporarios sino también de los permanentes

Luxaçäo intrusiva de dentes decíduos / Inclusive luxation in primary teeth

Este trabalho visa identificar as causas mais comuns da luxaçäo intrusiva e determinar sua freqüência em dentes decíduos, com base na análise de 180 prontuários odontológicos de pacientes com traumatismo dentário, atendidos na clínica de Odontopediatria da FOUERJ. Relata também as conseqüências desse tipo de traumatismo para os dentes sucessores, enfatizando a importância do tratamento precoce e do acompanhamento do paciente