A 12-Year Retrospective Study of Avulsion Cases in a Public Brazilian Dental Trauma Service

Abstract This study assessed the epidemiological characteristics and management of the permanent teeth avulsion cases attended in a Brazilian dental trauma service from December 2005 to August 2016. A retrospective study was conducted of case records of 93 patients involving 139 avulsed teeth. Data included sex, age, trauma etiology, location of the accident, number and position of avulsed teeth, and presence and type of associated traumatic lesions. Management of the avulsed teeth was addressed as: time elapsed until teeth were retrieved from the accident's location; teeth's cleaning method and storage media; time elapsed until seeking treatment and replantation. The majority of the patients were children from 6-10 (31.2%) and 11-15 years old (26.9%). Male patients were more affected than female. Bicycle accident was the main etiological factor (31.2%). In 56 (60.2%) cases, traumatic lesions to neighboring teeth were present. In 55 (59.1%) cases, lesions to adjacent soft tissues were reported. In 82 (88.2%) cases, patients requested treatment at the same day of the accident. Sixty-four teeth (46.0%) were immediately retrieved and 28 (20.1%) were not found. Forty-two teeth (30.2%) were kept dry. Only one tooth (0.7%) was immediately replanted at the accident's site, while 51 teeth (36.7%) were not replanted. Numerous avulsed teeth were inappropriately managed and immediate replantation was not frequent. Public policies must be created to raise awareness towards the particularities of avulsion cases.

Resumo Este estudo avaliou as características epidemiológicas e de manejo dos casos de avulsão de dentes permanentes atendidos em um serviço de trauma dental de dezembro de 2005 a agosto de 2016. Foi realizado um estudo retrospectivo de 93 casos, envolvendo 139 dentes avulsionados. Os dados incluíram sexo, idade, etiologia do trauma, localização do acidente, número e posição dos dentes avulsionados e presença e tipo de lesões traumáticas associadas. O manejo dos dentes foi abordado de modo a analisar: o tempo decorrido até que os dentes fossem recuperados do local do acidente; Método de limpeza dos dentes e meios de armazenamento; Tempo decorrido até a busca por tratamento e reimplante dental. A maioria dos pacientes eram crianças de 6-10 (31,2%) e 11-15 anos (26,9%). Os pacientes do sexo masculino foram mais acometidos que do feminino. O acidente de bicicleta foi o principal fator etiológico (31,2%). Em 56 (60,2%) casos, ocorreram lesões traumáticas aos dentes vizinhos. Em 55 (59,1%) casos foram relatadas lesões de tecidos moles. Em 82 (88,2%) casos, os pacientes solicitaram tratamento no mesmo dia do acidente. Sessenta e quatro dentes (46,0%) foram imediatamente recuperados e 28 (20,1%) não foram encontrados. Quarenta e dois dentes (30,2%) foram mantidos secos. Apenas um dente (0,7%) foi imediatamente reimplantado no local do acidente, enquanto 51 dentes (36,7%) não foram reimplantados. Numerosos dentes avulsionados foram manejados de forma inadequada e o reimplante imediato não foi frequente. Devem ser criadas políticas públicas para a conscientização da população sobre as particularidades dos casos de avulsão dental.

Can the Cure Time of Endodontic Sealers Affect Bond Strength to Root Dentin?

The cure time of endodontic sealers may influence the bond strength of fiber posts to root dentin. Forty teeth were selected and endodontically filled using calcium hydroxide cement and then divided into 2 groups according to the time elapsed between endodontic filling and post luting (n = 20): Immediately - glass fiber post luting immediately after endodontic filling; and Delayed - post luting performed 7 days after endodontic filling. The roots were also subdivided according to resin cement used for post luting (RelyX ARC and RelyX Unicem). The specimens were stored at 37°C for 24 h and sectioned in six 1-mm-thick slices from cervical, middle and apical thirds. The slice specimens were submitted to a push-out test at a crosshead speed of 0.5 mm/min, and the bond strength values obtained (MPa) were submitted to two-way ANOVA in a split-plot arrangement and Tukey's test (α=0.05). For both RelyX ARC and Unicem, the bond strength was significantly higher when the posts were cemented 7 days after the endodontic treatment. RelyX Unicem showed significantly higher bond strength values than RelyX ARC for both cementation periods. It was concluded that post luting should be made after the complete setting of the root canal sealer. Self-adhesive resin cement should be preferred for fiber post luting.

O tempo de presa de cimentos endodônticos pode afetar a resistência de união de pinos de fibra de vidro à dentina radicular. Quarenta dentes foram selecionados e tratados endodonticamente com cimento à base de hidróxido de cálcio. Em seguida, os mesmos foram divididos em dois grupos de acordo com o tempo decorrido entre o tratamento endodôntico e a cimentação definitiva (n=20): Imediato - pinos de fibra de vidro cimentados após o tratamento endodôntico; e Mediato - cimentação do pino realizada 7 dias após o tratamento endodôntico. As raízes foram subdivididas de acordo com o cimento resinoso (RelyX ARC e RelyX Unicem). As amostras foram armazenadas a 37 °C durante 24 h e seccionadas em seis fatias de 1 mm de espessura relacionadas com terços cervical, médio e apical. Os espécimes foram submetidos a teste de push-out a uma velocidade de 0,5 mm/min e os valores de resistência de união obtidos (MPa) foram submetidos à análise de variância em esquema de parcelas subdivididas e teste de Tukey (α=0,05). Para os cimentos RelyX ARC e Unicem, a resistência de união foi maior quando os pinos foram cimentados 7 dias após o tratamento endodôntico. RelyX Unicem apresentou valores de resistência de união superiores ao RelyX ARC para os períodos de cimentação. Concluiu-se que a cimentação do pino de fibra de vidro deve ser feita após o completo tempo de presa do cimento endodôntico. Cimentos resinosos auto-adesivos devem ser preferidos para cimentação de pinos de fibra.

Influence of core-finishing intervals on tensile strength of cast posts-and-cores luted with zinc phosphate cement

The core finishing of cast posts-and-cores after luting is routine in dental practice. However, the effects of the vibrations produced by the rotary cutting instruments over the luting cements are not well-documented. This study evaluated the influence of the time intervals that elapsed between the cementation and the core-finishing procedures on the tensile strength of cast posts-and-cores luted with zinc phosphate cement. Forty-eight bovine incisor roots were selected, endodontically treated, and divided into four groups (n = 12): GA, control (without finishing); GB, GC, and GD, subjected to finishing at 20 minutes, 60 minutes, and 24 hours after cementation, respectively. Root canals were molded, and the resin patterns were cast in copper-aluminum alloy. Cast posts-and-cores were luted with zinc phosphate cement, and the core-finishing procedures were applied according to the groups. The tensile tests were performed at a crosshead speed of 0.5 mm/min for all groups, 24 hours after the core-finishing procedures. The data were subjected to one-way analysis of variance (ANOVA) and Tukey's test (α = 0.05). No significant differences were observed in the tensile strengths between the control and experimental groups, regardless of the time interval that elapsed between the luting and finishing steps. Within the limitations of the present study, it was demonstrated that the core-finishing procedures and time intervals that elapsed after luting did not appear to affect the retention of cast posts-and-cores when zinc phosphate cement was used.