Recubrimiento radicular de recesiones gingivales con matriz dérmica acelular / Root coverage of gingival recession with acellular dermal matrix

La recesión gingival es considerada como una deformidad o condición mucogingival, la Academia Americana de Periodontología, define a la recesión gingival como el desplazamiento del margen del tejido blando apical a la unión cemento-esmalte con la exposición de la superficie radicular. El tratamiento de las recesiones gingivales es un motivo de consulta común debido a razones estéticas, hipersensibilidad dentinaria, molestias durante el cepillado e incluso temor a la pérdida dentaria. Es una situación clínica común, 60% de la población humana tiene algún tipo de recesión gingival. Al realizar el examen clínico a paciente masculino de 55 años, se observó una recesión gingival tipo 1 (RT1) sin pérdida de inserción interproximal de la clasificación de Cairo. Se realizó el colgajo posicionado coronalmente (CPC) utilizando una matriz dérmica acelular (MDA) de origen humano OrACELL®. Se obtuvo resultado favorable en el recubrimiento de recesiones gingivales múltiples; considerándolos como una buena alternativa frente a los injertos gingivales autógenos. Concluyendo que, el uso de la matriz dérmica acelular para el tratamiento de la recesión gingival tipo 1 es una adecuada opción para el recubrimiento radicular. Se recomiendan más estudios a largo plazo para ver la estabilidad de los resultados obtenidos con la MDA (AU)

Gingival recession, considered a deformity or mucogingival condition, the American Academy of Periodontology, defines gingival recession as the exposure of the root surface resulting from migration of the gingival margin apical to the cementoenamel junction (CEJ). The treatment of gingival recessions is a common reason for consultation due to aesthetic reasons, dentin hypersensitivity, discomfort during brushing and even fear of tooth loss. It is a common clinical situation, 60% of the human population has some kind of gingival recession. Clinical examination of a 55-year-old male patient showed a type 1 gingival recession (RT1) without loss of interproximal insertion of the Cairo classification. Coronally advanced flap (CAF) was performed using an acellular dermal matrix (ADM) of human origin OrACELL®. Favorable results were obtained in the coating of multiple gingival recessions; considering them as a good alternative to autogenous gingival grafts. Concluding that, the use of the acellular dermal matrix for the treatment of gingival recession type 1, is a suitable option for root lining. Further long-term studies are recommended to see the elasticity of MDA outcomes (AU)

Effect of various intracanal materials on the diagnostic accuracy of cone-beam computed tomography in vertical root fractures / 北京大学学报(医学版)

OBJECTIVE@#To study the effect of various intracanal materials on the accuracy of oral maxillofacial cone-beam computed tomography (CBCT) for the diagnosis of vertical root fracture (VRF).@*METHODS@#A total of twenty-four structurally intact single root canal dried and isolated teeth extracted for orthodontic treatment or periodontal disease were collected. The teeth were decrowned along the cemento-enamel junction (CEJ) and then used as samples for the study after conventional root canal preparation and post preparation. The 24 samples were divided into two groups with 12 samples in each group. Group A was the control group (no VRF group). According to intracanal materials, they were divided into five subgroups: blank group, fiber post group, gutta-percha point group, titanium post group and gold-palladium post group. Group B was the experimental group (VRF group), and subgroups were grouped as above. The VRF model was prepared by a unified method in the VRF group: the root was completely fractured in the buccolingual direction with a custom root canal nail and then cemented and reset. The control group was not subjected to the simulation of VRF. Titanium post and gold-palladium post were made according to the individuality of the root canal preparation, and the tightness of the post to the root canal wall was confirmed by X-ray radiograph. Then all the samples were scanned by CBCT in the isolate swine mandibular alveolar sockets. The diagnostic accuracy was statistically analyzed via blind interpretation by experienced endodontic specialists and oral and maxillofacial medical imaging specialists.@*RESULTS@#The accuracy of the diagnosis of VRF in the blank group, fiber post group, gutta-percha point group, titanium post group, and gold-palladium post group in CBCT was 95.83%, 91.67%, 87.50%, 79.17%, and 45.83%, respectively. Compared with the blank group, the differences were not statistically significant in the fiber post group (P>0.999), the gutta-percha point group (P=0.500) and the titanium post group (P=0.125). The lowest diagnostic accuracy of VRF was found in the gold-palladium post group, and the difference was statistically significant compared with all other groups (P < 0.001).@*CONCLUSION@#Various intracanal materials have different degrees of influence on the diagnostic accuracy of VRF diagnosis in CBCT. The influence of fiber post, gutta-percha point and titanium post was small, while the influence of gold-palladium post was significant.

Lesiones perirradiculares asociadas a primeros molares superiores tratados endodónticamente: estudio a través de tomografías computadas / Periradicular lesions associated with endodontically treated maxillary first molars: study through computed tomography

Objetivos: Estudiar con tomografías computadas de haz cónico (CBCT) las lesiones perirradiculares de primeros molares superiores tratados endodónticamente; evaluar la lo- calización y, en los que tenían lesión en la raíz mesiovestibu- lar (MV), evaluar la frecuencia del conducto MV2. Materiales y métodos: A partir de una muestra de 179 tomografías, que incluían primeros molares superiores, se seleccionaron y analizaron aquellas en las cuales estos ha- bían recibido un tratamiento endodóntico previo, presentaban lesiones perirradiculares y conservaban una restauración co- ronaria. Las variables analizadas fueron: la localización de áreas radiolúcidas compatibles con lesiones perirradiculares de origen endodóntico y la correlación entre diferentes loca- lizaciones y la calidad del tratamiento realizado (adecuado, defectuoso o sin tratamiento). Los datos fueron analizados mediante la prueba de chi-cuadrado y la prueba de Spearman. Resultados: De las 179 CBCT que incluían primeros molares superiores, 90 reunían las condiciones requeridas. La frecuencia de las lesiones perirradiculares fue significativa- mente mayor en la raíz MV al compararla con las raíces disto- vestibular y palatina (p<0,05). El conducto MV1 presentó un tratamiento adecuado en todos los casos. El conducto MV2 recibió un tratamiento adecuado en 4 casos (4,44%), defec- tuoso en 4 casos (4,44%) y no tratado en 82 casos (91,1%); con una diferencia estadísticamente significativa (p<0,05). Conclusiones: En la muestra analizada, la localización de lesiones perirradiculares postratamiento endodóntico en primeros molares superiores se encontró con mayor frecuencia asociada a la raíz mesiovestibular, donde en la mayoría de los casos el con- ducto MB2 no fue tratado o presentó un tratamiento defectuoso (AU)

Aim: To study with cone-beam computed tomography (CBCT) the periradicular lesions of maxillary first molars with endodontical treatment; to evaluate its localization and, in those with a mesiobuccal root (MB) injury, assess the fre- quency of the MB2 root canal. Materials and methods: From a sample of 179 tomog- raphies (CBCT) that included maxillary first molars, those in which they had received previous endodontic treatment, pre- sented periradicular lesions and had a coronary restoration were selected and analyzed. The analyzed variables were: localization of radiolucent areas compatible with periradic- ular lesions of endodontic origin and the correlation between different localizations and quality of the performed treatment (adequate, defective, or untreated). Data were analyzed by the chi-square test and the Spearman test. Results: Of the 179 CBCT that included maxillary first molars, 90 met the required conditions. The frequency of periradicular lesions was significantly higher in the MB root when compared with distobuccal and palatal roots (P<0,05). The MB1 canal presented an adequate treatment in all cas- es. The MB2 canal received adequate treatment in 4 cases (4.44%), a defective one in 4 cases (4.44%) and was untreated in 82 cases (91.1%). The differences among these frequencies were statistically significant (P<0.05). Conclusions: In the analyzed sample, the localization of periradicular lesions after endodontic treatment in maxillary first molars was associated more frequently with the mesio- buccal root in which in the majority of cases the MB2 canal was untreated or presented a defective treatment

Effect of intracanal diode laser irradiation on fracture resistance of roots restored with CAD/CAM posts

Aim: To evaluate the fracture resistance of roots restored with CAD/CAM-fabricated posts, receiving or not intracanal laser treatment, compared with glass fiber posts under mechanical cycling. Methods: Twenty-seven endodontically treated, single-rooted teeth were divided into 3 groups: group 1 (control), prefabricated glass fiber posts relined with resin composite; group 2, CAD/CAM-fabricated intraradicular posts using Resin Nano Ceramic (RNC) blocks; and group 3, CAD/CAM-fabricated intraradicular posts using RNC blocks in canals irradiated with a 940-nm diode laser (100 mJ, 300-um optic fiber, coronal-apical and apical-coronal helical movements, speed of 2 mm/second, 4 times each canal). After cementation of the coping, cyclic loading was applied at an angle of 135° to the long axis of the root, with a pulse load of 130 N, frequency of 2.2 Hz, and 150,000 pulses on the crown at a point located 2 mm below the incisal edge on the lingual aspect of the specimen. Every 50,000 cycles, the specimens were evaluated for root fracture occurring below or above the simulated bone crest. Results were analyzed by one-way ANOVA followed by Tukey's test (p<0.05). Results: Group 1 was the least resistant, while groups 2 and 3 were the most resistant. Group 1 differed significantly from groups 2 and 3 (p<0.01), but there was no difference between groups 2 and 3 (p<0.01). Conclusion: Treatment of the intracanal surface with diode laser had no influence on fracture resistance of roots restored with CAD/CAM-fabricated posts, but a longer cycling time is required to evaluate the real benefits of diode laser irradiation

Comparação de duas técnicas cirúrgicas para recobrimento radicular de recessões unitárias: ensaio clínico paralelo, randomizado e duplo cego / Comparison of two surgical techniques for root coverage of single-unit recessions: parallel, randomized, double-blind clinical trial

As crescentes demandas dos pacientes pelo tratamento das recessões gengivais trazem à tona questões terapêuticas clinicamente significativas, exigindo dos profissionais constante aperfeiçoamento em técnicas cirúrgicas cada vez menos invasivas e mais previsíveis. OBJETIVO: Comparar duas técnicas para recobrimento radicular em recessões gengivais unitárias, unilaterais, do tipo 1. METODOLOGIA: Este estudo clínico, paralelo, randomizado e duplo cego avaliou indivíduos com recessões gengivais unitárias, unilaterais, do tipo 1 (RT1), submetidos à cirurgia para recobrimento radicular, através da associação do enxerto de tecido conjuntivo subepitelial ao retalho posicionado coronalmente (grupo controle) e técnica de túnel (grupo teste). Os principais parâmetros avaliados foram profundidade de sondagem (PS), sangramento à sondagem (SS), nível clínico de inserção (NCI), recessão gengival (RG), faixa e espessura da mucosa ceratinizada (MC e EG), percentual de recobrimento radicular (RR) e fenótipo gengival (FG), além de fatores centrados no paciente (FCP), como dor pós-operatória, hipersensibilidade dentinária cervical (HSDC), estética, grau de satisfação e a qualidade de vida, intra e intergrupo, ao longo de 06 meses de acompanhamento. Os dados foram analisados estatisticamente através dos testes t emparelhado de Student, teste t para amostras independentes, Qui-quadrado, McNemar, Análise de Variância Split-Plot com pós-teste t de Student (α = 5%). RESULTADOS: 46 indivíduos finalizaram este estudo (controle: 23; teste: 23). O tempo de cirurgia foi maior para o grupo teste (controle: 40min ± 5,6; teste: 51min ± 5,9; p = 0,041). Foram observadas reduções estatisticamente significativas para a RG e ganho significativo do NCI, de MC e de EG na análise intragrupo, em ambos os grupos de tratamento, porém, sem diferenças entre as técnicas. O RR aumentou significativamente nos períodos avaliados, mas não foram observadas diferenças intergrupo (controle: 89,2%; teste: 86,5%; p = 0,069). A análise intragrupo revelou mudança de FG (controle: 95,65%; teste: 91,3%; p < 0,001). Ambos os protocolos de tratamento reduziram dor pós-operatória e HSDC, e proporcionaram melhora na estética, satisfação e na qualidade de vida (p < 0,001), sem diferenças entre as técnicas ao longo do tempo. CONCLUSÃO: Ambos os tratamentos apresentaram eficácia clínica semelhante em termos de recobrimento radicular e melhora dos FCP (AU).

The increasing demands of patients for the treatment of gingival recessions bring up clinically significant therapeutic issues, requiring professionals to constantly improve in less invasive and more predictable surgical techniques. AIM: To compare two root coverage techniques to treat single, unilateral, type 1 gingival recessions. METHOD: This parallel, randomized, doubleblind clinical trial evaluated individuals with single, unilateral, type 1 gingival recessions 1 (RT1), who underwent root coverage procedure with subepithelial connective tissue graft associated to a coronally advanced flap (control group) or a tunnel technique (test group). The main parameters evaluated were probing depth (PD), bleeding on probing (BoP), clinical attachment level (CAL), gingival recession (GR), heigth of keratinized tissue (KTH), gingival thickness (GT), percentage of root coverage (RC) and gingival phenotype (GP), in addition to patient-reported outcome measures (PROMs), such as postoperative pain, cervical dentin hypersensitivity (CDH), esthetics, degree of satisfaction and quality of life, intra and intergroup, throughout 06 months follow-up. Data were statistically analyzed using paired Student t-test, t-test for independent samples, Chi-square, McNemar, Split-Plot Analysis of Variance with post hoc t-test (α = 5%). RESULTS: 46 subjects completed this study (control: 23; test: 23). Surgery time was longer for the test group (control: 40min ± 5.6; test: 51min ± 5.9; p = 0.041). Statistically significant reductions for GR and significant gain for CAL, KTH and GT were observed in the intragroup analysis, in both treatment groups, however, without differences between techniques. The CR increased significantly, but no intergroup differences were observed (control: 89.2%; test: 86.5%; p = 0.069). Intragroup analysis revealed a change in GP (control: 95.65%; test: 91.3%; p < 0.001). Both treatment protocols reduced postoperative pain and CDH and improved esthetics, satisfaction and quality of life (p < 0.001), with no differences between the techniques over time. CONCLUSION: Both treatments showed similar clinical efficacy in terms of root coverage and improvement in PROMs (AU).

Incidencia de fracturas dentales verticales reportadas en la Ciudad de Chihuahua y su relación con la evolución de la pandemia por COVID-19 / Incidence of vertical dental fractures reported in Chihuahua City and its relationship with the evolution of the COVID-19 pandemic

Durante la pandemia por COVID-19, la presencia de un incremento de fracturas y/o fisuras verticales ha sido reportada por Cirujanos Dentistas en diferentes países y foros, Objetivo: Determinar por medio de un análisis si existe una relación con este aumento de casos y la evolu- ción de la pandemia. Material y método: Se recopilaron los casos de fracturas verticales no restaurables durante el periodo de mayor índice de casos de contagio y defunciones por COVID-19 en la Ciudad de Chihuahua, México. Resultados: Durante el primer pico de casos y defunciones causadas por la pandemia, se incrementó el número de casos de fracturas verticales no tratables. Conclusiones: Existió una relación entre la evolución de la pandemia con la aparición de casos de fracturas dentales verticales no restaurables (AU)

During the COVID-19 pandemic, the presence of an increase in fractures and/or vertical fissures has been reported by Dental Surgeons in different countries and forums. Objective: To determine through an analysis, if there is a relationship with this increase in cases and the evolution of the pandemic. Material and methods: The cases of non-restorable vertical fractures were collected during the period of highest rate of cases of contagion and deaths due to COVID-19 in the City of Chihuahua, Mexico. Results: during the 1st peak of cases and deaths caused by the pandemic, the number of cases of untreatable vertical fractures increased. Conclusions: There was a relationship between the evolution of the pandemic and the appearance of cases of non-restorable vertical dental fractures (AU)

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

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

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

Tratamiento de la fractura corono-radicular no complicada de la corona: caso clínico / Treatment of non-complicated crown-root fracture: a clinical case

El trauma dentoalveolar se define como aquella lesión de extensión e intensidad variable y de ori- gen accidental o intencional, causada por fuerzas que actúan sobre el órgano dentario y los tejidos que lo rodean. Se puede diagnosticar a simple vista o con ayuda de la radiografía, se debe tratar sin demora para preservar la vitalidad de la pulpa, sobre todo en casos de niños y adolescentes, to- mando en cuenta la formación radicular. El trau- ma dental es motivo de urgencia por el dolor que provocan en los pacientes, la prevalencia varia del 26 al 76% de las lesiones dentales en dentición permanente (AU)

Incidencia de fracturas dentales reportadas en la Ciudad de Chihuahua durante la pandemia por COVID-19 / Incidence of dental fractures reported in Chihuahua city during COVID-19 pandemic

Se presentan los casos de fracturas verticales sintomáticos que ameritaron la extracción de las órganos dentales afectados en un periodo de cinco meses durante la pandemia por COVID-19 en la ciudad de Chihuahua, México. Material y métodos: Se recolectaron 26 muestras para el estudio, proporcionadas por los cirujanos dentistas integrantes del Grupo de Egresados de la Facultad de Odontología de la Universidad Autónoma de Chihuahua. Resultados: Los resultados muestran diferencias a lo reportado previamente respecto al tipo de diente involucrado, sexo de los pacientes, restauraciones coronales y tratamientos endodóncicos previos. Conclusiones: Se puede suponer que las modificaciones en el estilo de vida de la población, sumadas a la angustia permanente, pueden ser factores que contribuyen a las fracturas dentales (AU)

There are cases of symptomatic vertical fractures that warranted the extraction of affected teeth are presented, over a period of five months during the COVID-19 pandemic in Chihuahua City, Mexico. Material and methods: 26 samples were collected for the study, provided by the dentist who were members of the Graduate Group of the Faculty of Dentistry of the Autonomous University of Chihuahua. Results: The results show differences from what was previously reported regarding the type of tooth involved, sex of patients, coronal restorations and previous endodontic treatments. Conclusions: It can be assumed that changes in the lifestyle of the population, added to permanent distress, may be factors to preserve dental fractures (AU)

Tratamiento regenerativo de lesión interproximal consecuente a fractura del tercio medio en diente permanente joven / Regenerative treatment of interproximal lesion following middle third fracture in a young permanent tooth

Se presenta un caso clínico de fractura radicular del tercio medio, de pieza 2.1 con desplazamiento de los cabos de fractura. Es tratado con un novedoso procedimiento terapéutico, mediante la utilización de un biomaterial de tercera generación osteoconductor, osteogénico y osteoinductor. Se obtiene la reparación del tejido conectivo interproximal y la formación de tejido calcificado (AU)

We present a clinical case of root fracture of the middle third, piece 2.1 with displacement of the fracture ends. It is treated with a novel therapeutic procedure, using a thirdgeneration osteoconductive, osteogenic and osteoinductive biomaterial. Interproximal connective tissue repair and calcified tissue formation are obtained (AU)

Empleo de Biodentine como alternativa para el tratamiento de perforaciones radiculares: informe de un caso clínico / The use of Biodentine for root perforation therapy: report of a clinical case

Objetivo: Presentar un caso clínico de dos premolares inferiores con perforación radicular iatrogénica obturadas con Biodentine. Caso clínico: Una paciente de 54 años de edad fue derivada para realizar el tratamiento endodóntico en las piezas dentarias 44 y 45. Los exámenes clínico y radiográfico revelaron la presencia de perforaciones radiculares, cuya localización fue confirmada por medio de una tomografía computarizada de haz cónico. Luego de la desinfección y la instrumentación de los conductos radiculares, ambas perforaciones fueron selladas con Biodentine. Finalmente, los conductos fueron obturados, y las cavidades de acceso, restauradas con resina compuesta. Una semana después los dientes se encontraban asintomáticos y sin tumefacción. La paciente fue controlada nuevamente a los 20 meses postratamiento. Al examen clínico, ambos dientes estaban asintomáticos y funcionales. No hubo signos de infección, inflamación o sensibilidad a la percusión y la palpación. Las imágenes radiográficas y tomográficas revelaron espacio periodontal y cortical ósea normales. Conclusión: En el presente caso clínico, el Biodentine resultó un material adecuado para la obturación de perforaciones radiculares de origen iatrogénico ubicadas en la unión de los tercios medio y coronal (AU)

Aim: To present a clinical case of two lower premolars with iatrogenic root perforations in which both defects were repaired with Biodentine. Clinical case: A healthy 54-year old female was referred for endodontic treatment of teeth number 44 and 45. Clinical and radiographic examination revealed the presence of root perforations whose buccal localization was confirmed by a cone beam computed tomography scan. After the root canals were instrumented, both perforations were filled with Biodentine. The canals were obturated and the endodontic accesses were restored. A week later, the teeth were asymptomatic and without the presence of swelling. The patient was recalled 20-months after treatment and both teeth were asymptomatic and functional with no signs of infection, inflammation or sensitivity to percussion and palpation. Radiograph and cone beam computed tomography images showed a normal periodontal width and an intact lamina dura. Conclusion: Based on the outocome of this clinical case, Biodentine was an adequate material to repair iatrogenic root perforations (AU)

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

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

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

Empleo del MTA en la obturación de perforaciones radiculares de origen iatrogénico / The use of MTA in the filling of root perforations of iatrogenic origin

Objetivo: Presentar una serie de casos clínicos con perforaciones radiculares obturadas con MTA. Casos clínicos: Este estudio retrospectivo muestra una serie de 5 casos clínicos correspondientes a elementos dentarios con perforaciones radiculares obturadas con MTA y evaluadas clínica y radiográficamente a distancia del tratamiento. Conclusión: El MTA es un material de obturación válido para el tratamiento de las perforaciones radiculares, permitiendo la reparación de los tejidos perirradiculares comprometidos (AU)

Aim: To present a series of clinical cases with root perforations filled with MTA. Case report: This retrospective study shows a series of five clinical cases corresponding to teeth with root perforations filled with MTA and assessed clinically and radiographically for a long period of time. Conclusion: MTA is a valid filling material for root perforation treatment allowing the healing of compromised periradicular tissues (AU)

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)

Current options concerning the endodontically-treated teeth restoration with the adhesive approach

Abstract: Adhesive procedures have changed the way to restore endodontically treated teeth (ETT). It started with the shift from cast post-and-core to fiber post. The original focus on strength also shifted towards failure modes, revealing that catastrophic failures are still a concern when restoring endodontically-treated teeth even with fiber posts. As an alternative, postless approaches have been proposed in order to improve the chances of repair. The goal of this critical review is to present a survey of the current knowledge on adhesive approaches to restore endodontically treated teeth with and without extensive coronal tissue loss. The preservation of tooth structure of endodontically treated teeth is paramount. Partial versus full coverage of ETT, the role of the ferrule, the post type effect on catastrophic failures and postless alternatives as endocrowns and postless build-ups are reviewed. There is a consensus that the remaining tooth structure plays an important role in ETT survival, although the current literature still is contradictory on the influence of post type on root fractures as well as the benefits of avoiding a post or partially restoring a tooth. More clinical studies should be carried out with the modern postless adhesive alternatives to conventional approaches.

Estabilizador Endodóntico en Fractura Complicada de Raíz en visita única / Endodontic Stabilizer in Complicated Root Fracture in a single visit

Introducción: La fractura complicada de raíz del tercio medio es una entidad compleja de pronóstico mayormente desfavorable y curso sintomático, donde el éxito clínico en no pocas oportunidades se convierte en una utopía, dado que la estabilidad en el afrontamiento de los bordes libres de los fragmentos fracturados es difícil de lograr. En este sentido el estabilizador edodóntico busca garantizar un anclaje bilateral satisfactorio, que posibilite unificar en una consulta los tiempos operatorios necesarios para un tratamiento exitoso. Objetivo: Describir la factibilidad del uso de un estabilizador endodóntico en el manejo de una fractura complicada de raíz del tercio medio en una visita. Presentación del caso: Paciente de 60 años, femenina que acude a consulta tras sufrir traumatismo dentoalveolar consistente con fractura complicada de raíz del tercio medio en 21; a los rayos X se observa ligero ensanchamiento periodontal y bordes discontinuos. Se realiza tratamiento edodóntico radical mediante la aplicación de un estabilizador intraconducto en la reducción de la fractura. Conclusiones: El uso de un estabilizador endodóntico en el manejo de una fractura complicada de raíz del tercio medio realizado en una sola visita es una alternativa factible de realizar en el tratamiento mediato e inmediato, ya que supone una rápida recuperación de las funciones buco-dentales del paciente(AU)

Introduction:The complicated fracture of the medium third of the root is a complex entity, particularly with an unfavorable prognosis and a symptomatic course in which the clinical success becomes a utopia in not just a few opportunities because the stability by confrontation of the free edges of the fractured fragments is difficult to achieve. In this respect, the endodontic stabilizer is used to guarantee a satisfactory bilateral anchorage that gives the possibility to unify, in a single visit, the necessary operation times for a successful treatment. Objective: To describe the feasibility of the use of an endodontic stabilizer in the management of a complicated fracture of the medium third of the root in a single visit. Case presentation: Female 60-year-old patient who comes to the consulting room after suffering from a consistent dentoalveolar trauma with a complicated fracture of the medium third of the root in tooth no.21; radiograph reveals a slight periodontal widening, and discontinuous edges. Radical endodontic treatment is performed with the placement of an intraductal stabilizer in the reduction of the fracture. Conclusions: The use of an endodontic stabilizer in the management of a complicated fracture of the medium third of the root in a single visit to the dentist is a feasible alternative in the mediate and immediate treatment seeing that it supposes a fast recovery of the bucco-dental functions of the patient(AU)

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

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

Crown-Root Fractures in Primary Teeth: A Case Series Study of 28 Cases

Abstract Crown-root fractures in primary teeth are rare, with a wide variation of patterns that make diagnosis and treatment difficult. The aim of this study was to present a case series of crown-root fractures in primary teeth of children who attended a reference center. The study followed 28 cases of crown-root fractures in 26 children, representing 4% of the total number of attendees over 11 years of reference service at the Universidade Federal de Pelotas, Pelotas, Brazil. In most cases, the maxillary central incisors (85.7%) were involved. In the crown, 57.1% of the cases had a simple line of fracture, and 42.9% had multiple lines. Simple lines predominated in the root (89.3%). In cases with simple fracture lines in the crown, 37.6% underwent a total extraction, 31.2% required a partial extraction and 31.2% underwent pulpectomy. In most teeth with multiple lines of fractures in the crown, total extraction was performed (91.7%) All cases were followed-up until the eruption of the permanent successor tooth, and all patients had favorable outcomes.

Resumo Fraturas coronorradiculares em dentes decíduos são raras, com uma ampla variação de padrões que dificultam o diagnóstico e tratamento. O objetivo deste estudo foi apresentar uma série de casos de fraturas coronorradiculares na dentição decídua de crianças atendidas em um centro de referência. O estudo acompanhou 28 casos de fratura coronorradicular em 26 crianças, representando 4% do número total de participantes ao longo de 11 anos no serviço de referência na Universidade Federal de Pelotas. Na maioria dos casos, o incisivo central superior (85,7%) foi o mais envolvido. Na coroa, 57,1% dos casos tiveram linha de fratura simples, e 42,9% tiveram múltiplas linhas. As linhas simples predominaram na raiz (89,3%). Nos casos com linhas de fratura simples na coroa, 37,6% foram submetidos à extração total, 31,2% necessitaram de extração parcial e 31,2% de pulpectomia. A maioria dos dentes com múltiplas linhas de fratura na coroa, a extração total foi realizada (91,7%). Todos os casos foram acompanhados até a erupção do dente permanente sucessor, e todos os pacientes tiveram resultados favoráveis.

Effect of Time Lapse on the Diagnostic Accuracy of Cone Beam Computed Tomography for Detection of Vertical Root Fractures

Abstract Accurate and early diagnosis of vertical root fractures (VRFs) is imperative to prevent extensive bone loss and unnecessary endodontic and prosthodontic treatments. The aim of this study was to assess the effect of time lapse on the diagnostic accuracy of cone beam computed tomography (CBCT) for VRFs in endodontically treated dog's teeth. Forty-eight incisors and premolars of three adult male dogs underwent root canal therapy. The teeth were assigned to two groups: VRFs were artificially induced in the first group (n=24) while the teeth in the second group remained intact (n=24). The CBCT scans were obtained by NewTom 3G unit immediately after inducing VRFs and after one, two, three, four, eight, 12 and 16 weeks. Three oral and maxillofacial radiologists blinded to the date of radiographs assessed the presence/absence of VRFs on CBCT scans. The sensitivity, specificity and accuracy values were calculated and data were analyzed using SPSS v.16 software and ANOVA. The total accuracy of detection of VRFs immediately after surgery, one, two, three, four, eight, 12 and 16 weeks was 67.3%, 68.7%, 66.6%, 64.6%, 64.5%, 69.4%, 68.7%, 68% respectively. The effect of time lapse on detection of VRFs was not significant (p>0.05). Overall sensitivity, specificity and accuracy of CBCT for detection of VRFs were 74.3%, 62.2%, 67.2% respectively. Cone beam computed tomography is a valuable tool for detection of VRFs. Time lapse (four months) had no effect on detection of VRFs on CBCT scans.

Resumo Um diagnostico correto e a tempo das fraturas radiculares verticais (FRVs) é essencial para prevenir extensa perda óssea, tratamentos endodônticos e próteses desnecessárias. O objetivo do presente estudo foi avaliar o efeito do tempo decorrido sobre a acurácia diagnóstica da tomografia computadorizada de feixe cônico (TCFC) para detecção de FRVs em dentes de cães tratados endodonticamente. Quarenta e oito dentes incisivos e premolares obtidos de três cães machos adultos tiveram os seus canais tratados. Os dentes foram divididos em dois grupos: no primeiro grupo (n=24) foram artificialmente induzidas FRVs, enquanto no segundo grupo (n=24) os dentes permaneceram intactos. As imagens de TCFC foram obtidas pela unidade NewTom 3G imediatamente após a cirurgia de indução das FRVs e uma, duas, três, quarto, oito, 12 e 16 semanas depois. Três radiologistas cegos para as datas das imagens avaliaram a presença/ausência de FRVs nas imagens de TCFC. Foram calculados os valores da sensibilidade, especificidade e acurácia, sendo os dados analisados por ANOVA e pelo programa SPSS v.16. As acurácias totais de detecção das FRVs imediatamente após sua indução e uma, duas, três, quarto, oito, 12 e 16 semanas depois foram respectivamente de 67,3%, 68,7%, 66,6%, 64,6%, 64,5%, 69,4%, 68,7% e 68%. O efeito do tempo decorrido foi sem significado estatístico (p>0,05). A TCFC produziu valores gerais de sensibilidade, especificidade e acurácia de 74,3%, 62,2% e 67.2%, respectivamente. A tomografia computadorizada de feixe cônico é uma ferramenta valiosa para detecção de FRVs. O tempo decorrido (quatro meses) não teve influência sobre a detecção de FRVs nas imagens de TCFC.

Fractura radicular vertical / Vertical root fracture

El propósito de este reporte es presentar el caso de un paciente femenino con presencia de fractura radicular vertical (FRV) de un segundopremolar superior izquierdo, remitida a la clínica de Postgrado de Endodonciade la Universidad De La Salle Bajío para remoción de poste y retratamiento dental. Una vez realizado el diagnóstico se determinó FRV mediante sondeo minucioso irregular en un solo punto con sonda flexible, ligero dolor a la masticación y pérdida ósea radiográfica en forma de halo o gota, se sugirió como tratamiento extracción dental y cirugía exploratoria a petición del paciente

The aim of this report is to present the case of a female patient with a vertical root fracture (VRF) of a maxillary second premolar who was referred to the Postgraduate Endodontic Clinic of De La Salle Bajío University in León, Guanajuato, Mexico for the removal of a metallic post and retreatment of root canals. Examination via thorough irregular periodontal probing at a single point with a fl exible probe resulted in a diagnosis of VRF, slight pain on chewing, and radiographic bone loss in the shape of a halo or droplet, for which the suggested treatment was the extraction of the tooth, a surgical procedure that was subsequently performed at the patient’s request.