A Survival Analysis of Different Pulp Therapies in Decayed Primary Teeth

Abstract Objective: To identify the clinical and radiographic conditions associated with failure of pulp therapy in primary teeth through a survival analysis. Material and Methods: A total of 1000 records of children assisted at the pediatric dentistry clinic of the Federal University of Parana, Brazil, from the years 2000 to 2010, were analyzed. The mean evaluation time was 10.61 months (minimum/maximum: 1/28) from the report of pulp therapy. The different types of treatments analyzed included indirect pulp treatment (IPT), direct pulp treatment (DPT), pulpotomy and pulpectomy. The Kaplan-Meyer method and log-rank test were used for the survival analysis. Exodontia was considered as the outcome variable and censors included: traumatic tooth loss, presence of the tooth in the oral cavity and physiologic tooth exfoliation. Results: A total of 122 records reporting pulp therapy in the primary teeth were selected. From this, 16 teeth (13.12%) were extracted. Survival analysis showed that pulpectomy presented lower survival rates when compared to conservative therapies (p=0.0297). Teeth with furcal lesions and pathological root resorption before pulp therapy had lower survival rates when compared to those that did not present these conditions (P=0.006). Presence of fistula and abscess after pulp therapy were also associated with lower survival rates (P=0.0062 and 0.0143, respectively). Conclusion: Signals of pulp necrosis were associated to lower survival rates in primary teeth submitted to pulp therapy.

Utilização de restaurações indiretas na reabilitação de dentes decíduos anquilosados / Utilization of indirect restorations in rehabilitation of ankylosed deciduous teeth

A anquilose consiste na fusão anatômica do cemento dentário com o osso alveolar, situação que provoca a infra-oclusão do elemento dentário, evento comumente encontrado em molares decíduos e que pode causar prejuízo no desenvolvimento da oclusão. Na clínica odontopediátrica o diagnóstico precoce se torna fundamental, posto que dependendo do grau de severidade serão adotadas condutas diferentes para o tratamento. As restaurações indiretas em resina composta são indicadas como opção clinica no manejo desta situação, proporcionando a reabilitação funcional e oclusal. Este trabalho tem como objetivo relatar um caso de um paciente infantil do sexo feminino com sete anos de idade, no qual os primeiros molares decíduos inferiores encontravam-se em infra-oclusão de grau leve. O tratamento escolhido foi a reabilitação por meio de restaurações indiretas em resina composta, posto que se constitui de uma técnica de fácil execução e baixo custo. O exame radiográfico de controle após seis meses mostrou a reabsorção fisiológica de ambos os elementos dentários, demonstrando o sucesso do procedimento.

Ankylosis is the anatomical fusion of cementum with alveolar bone, a situation that causes tooth infra-occlusion, an event commonly found in primary molars and that can cause damage in the occlusion development. Early diagnosis in pediatric dentistry is fundamental, because depending on the severity degree different approaches for treatment will be adopted. Indirect restorations with composite resins are indicated as a clinical option to managing this situation, providing functional and occlusal rehabilitation. The aim of this work was to report the case of a female child patient, seven years old, whose first lower deciduous molars were in mild infraocclusion. The treatment selected was rehabilitation with indirect restorations with composite resins, because it is a simple technique with low cost. The control x-ray examination after six months showed the physiological root resorption of both teeth, demonstrating the success of the procedure.