Microbiological and microscopic analysis of the pulp of non-vital traumatized teeth with intact crowns

OBJECTIVE: This study evaluated the presence of microorganisms and analyzed microscopically the pulp of 20 traumatized human teeth with intact crowns and clinical diagnosis of pulp necrosis, based on the association of at least three of the clinical criteria: crown discoloration, negative response to thermal and electric pulp vitality tests, positive response to vertical and horizontal percussion, pain on palpation or mobility. MATERIAL AND METHODS: Microbiological collection was performed from the root canals to evaluate the presence of microorganisms. The pulp samples were stained with hematoxylin and eosin (H.E.) for histological evaluation of possible morphological alterations. RESULTS: Analysis of results was performed by statistical tests (linear regression test and diagnostic analysis) and subjective analysis of the sections stained with H.E. and revealed that only 15 percent of the sample did not exhibit microbial development. The time elapsed between dental trauma and onset of endodontic intervention ranged from 15 days to 31 months; the percussion test presented high sensitivity (80 percent) for detection of microorganisms in the root canal of traumatized teeth; 3 teeth (15 percent) did not present pulp tissue, being characterized as complete autolysis; analysis of pulp samples was performed on the other 17 cases, among which 3 (15 percent) exhibited partial necrosis without possibility of repair and 14 presented complete necrosis; none of the clinical criteria employed for the diagnosis of pulp necrosis in traumatized teeth was pathognomonic. CONCLUSIONS: The present results allowed the following conclusions: with regard to microbiological findings, 85 percent of teeth presented microorganisms in the root canal, despite the presence of an intact crown. Concerning the microscopic findings, 100 percent of traumatized teeth presented pulp necrosis; the pulp vitality tests based on pulp response to heat, cold and vertical percussion ...

Use of diagnodent® for diagnosis of non-cavitated occlusal dentin caries

The purpose of this study was to evaluate the use of a laser fluorescence device for detection of occlusal caries in permanent teeth. One hundred and ninety-nine non-cavitated teeth from 26 patients aged 10 to 13 years were selected. After dental prophylaxis, two previously calibrated dentists examined the teeth. Visual inspection, radiographic examination and laser measurements were performed under standardized conditions. The validation method was cavity preparation with a small cone-shaped diamond bur, when the two examiners agreed about the presence of dentin caries. It was found that the laser detection method produced high values of sensitivity (0.93) and specificity (0.75) and a moderate positive predictive value (0.63). The laser device showed the lowest value of likelihood ratio (3.68). Kappa coefficient showed good repeatability for all methods. Although the laser device had an acceptable performance, this equipment should be used as an adjunct method to visual inspection to avoid false positive results.

Radiographic diagnosis of incipient proximal caries: an ex-vivo study

The aim of this ex vivo study was to compare visual clinical and radiographic examinations to the histological analysis for proximal caries diagnosis in extracted permanent molars and premolars. The relationship between clinical aspects and carious lesions was also evaluated. Eighty-eight proximal surfaces (44 freshly extracted teeth) were longitudinally sectioned with a 370-µm diamond disk, thinned with wet silicon carbide paper and observed with a stereomicroscope at x40 magnification. Sensitivity and specificity were 65.6 percent and 83.3 percent for clinical examination and 29.7 percent and 95.8 percent for radiographic examination, respectively. Kappa values ranged from 0.64 to 0.91. The white spots corresponded to lesions restricted to enamel, while the dark spots corresponded to lesions that reached the dentinoenamel junction. In most cases, cavitation corresponded to dentin lesions. It may be concluded that interproximal radiographic examination is not a reliable method for detection of incipient proximal carious lesions.

Este estudo ex vivo comparou os exames visual e radiográfico com a análise histológica no diagnóstico de cárie interproximal em pré-molares e molares permanentes extraídos. Também foi avaliada a relação entre os aspectos clínicos e as lesões de cárie. Para tanto, 88 superfícies proximais (de 44 dentes recém-extraídos) foram seccionadas longitudinalmente com um disco diamantado de 370 µm, polidas com lixas abrasivas e observadas em estereomicroscópio com aumento de x40. A sensibilidade e especificidade dos exames clínico e radiográfico foram 65,6 por cento e 83,3 por cento, e 29,7 por cento e 95,8 por cento, respectivamente. O índice de Kappa variou de 0,64 a 0,91. As manchas brancas corresponderam a danos em esmalte, enquanto as manchas escuras corresponderam à profundidade da junção amelo-dentinária. As cavitações clínicas corresponderam a lesões em dentina, na maioria dos casos. Conclui-se que o exame radiográfico interproximal não é um método confiável para descoberta clínica de lesões de cáries proximais incipientes.

Congenital erythropoietic porphyria in three siblings.

Congenital erythropoietic porphyria is a rare autosomal recessive disorder that usually presents with marked skin photosensitivity, hypertrichosis, blistering, scarring, milia formation and dyspigmentation of the photo-exposed areas. Three adult siblings (two sisters and one brother) are presented here with variable degree of skin manifestations. During early childhood, all the siblings started showing signs of photosensitivity with darkening of urine color followed by skin blistering over the face and hands. The oldest showed severe sclerodermiform mutilation and the youngest exhibited an initial involvement with hypertrichosis. None of them had any history of convulsions, acute abdominal pain or joint pain. Woods lamp examination and laboratory investigations confirmed the diagnosis.

Results after two years of non-operative treatment of occlusal surface in children with high caries prevalence

The aim of this study was to describe the 2-year results of an individualized treatment program designed to control occlusal caries in erupting first permanent molars. The sample consisted of 145 five-to-six-year-old students divided into a control group (n=71) and a test group (n=74). All test children received a biannual basic preventive program and a recall system according to individual disease activity. The basic program consisted of 3 (March) and 2 (August) sessions of oral hygiene orientation and toothbrushing with fluoride gel. The analysis of the baseline and 1-2-year data showed a significant reduction in the number of active lesions in the test group. In the control group, there were initially 70 active lesions and after two years 68 surfaces remained with disease and 24 surfaces had been filled. The children in the test group had 80 surfaces with active lesions initially and after two years only 3 surfaces with disease remained. From the 15 cavitated lesions, only 5 surfaces needed to be filled. This program showed that care of erupting teeth on an individualized basis can control occlusal caries

Generalized odontodysplasia--a case report.

Odontodysplasia is a relatively uncommon condition that can affect both primary and permanent dentition. It is characterized by defective formation of both enamel and dentin, with enlarged pulp chambers and root canals with open apices. It is usually a localised condition where one or few teeth may be involved. Sometimes, an entire quadrant or more than one quadrant may be involved but generalized involvement is extremely rare. An interesting case of a generalized odontodysplasia affecting both primary and permanent dentition in an eight year old girl is presented here.

Avaliaçäo clínica de restauraçöes estéticas com resina composta em dentes anteriores / Clinical evaluation of esthetics restorations with composite resins in anterior teeth

O objetivo desse trabalho foi avaliar o comportamento clínico de restauraçöes estéticas de classe III, IV e V com resina composta realizadas por alunos de graduaçäo da FOB - USP no período de 1974 a 1988. Foi realizado um levantamento no arquivo de prontuários e fichas clínicas do Departamento de Dentística para a seleçäo dos pacientes, sendo solicitado o comparecimento de 618 pacientes dos quais compareceram 277 portadores de 776 restauraçöes. O exame clínico foi efetuado por 2 examinadores previamente calibrados utilizando o método de avaliaçäo preconizado por RYGE & CVAR enfocando os seguintes aspectos: padräo de cor, descoloraçäo marginal, forma anatômica, adaptaçäo marginal e cárie. A análise estatística, aplicada somente aos dados em que foi possível a sua realizaçäo, permitiu afirmar que: - a qualidade das restauraçöes estéticas com resina composta efetuada por alunos de graduaçäo da FOB - USP entre 1974 e 1988 apresentou um índice de sucesso superior a 80 por cento em quase todos os aspectos; - as restauraçöes com resina composta convencional (Adaptic e Concise) apresentaram-se ligeiramente superiores às com resinas de micropartículas ou partículas intermediárias (Herculite, Prisma Fil e Durafil), exceto quanto ao aspecto padräo de cor, embora esses dados näo pudessem ser confrontados diretamente por estarem representados por restauraçöes realizadas em anos distintos; - as restauraçöes de classe IV apresentaram o menor índice de sucesso quando comparadas às de classe III e V, principalmente no ítem forma anatômica, com exceçäo das restauraçöes com Durafil que apresentaram-se 100 por cento satisfatórias quanto à esse aspecto; - entre as resinas convencionais näo foi verificado um comportamento estatisticamente significante, embora muitas vezes, as restauraçöes com Concise se mostrarem superiores às com Adaptic; - entre as resinas de micropartículas ou partículas intermediárias, as restauraçöes com Herculite apresentaram, em todos os aspectos analisados, um comportamento estatisticamente significante inferior aos das restauraçöes com as demais resinas...