Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT

Abstract: The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysis

Abstract: There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21-2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.

Physicochemical properties and filling capacity of an experimental iodoform-based paste in primary teeth

Abstract In this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p < 0.01); radiopacity: Vitapex: 4.47 mmAl, EP: 6.06 mmAl (p < 0.01); pH after 28 days: Vitapex: 7.79, EP: 8.19 (p = 0.12); and solubility after 28 days: Vitapex: 2.68%, EP: 2.89% (p > 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.

Remoção de mucocele com laser diodo: relato de caso clínico em paciente infantil / Mucocele removal with laser diode: case report on child patient

A mucocele é uma das lesões benignas que mais afeta a cavidade bucal. O laser de diodo de alta potência é uma opção que substitui ou associa procedimentos complementares aos processos convencionais,tendo mais conforto pós-cirúrgico. O objetivo deste trabalho foi relatar o caso clínico de remoção de mucocele de lábio inferior em paciente infantil utilizando laser de diodo de alta potência. Paciente do sexo feminino, 8 anos de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia São Leopoldo Mandic, em Campinas, relatando incômodo no lábio inferior, com a presença de uma “bolinha”. Ao exame clínico observou-se tumefação de consistência mole, flutuante, translúcida, com coloração similar à mucosa bucal. Após diagnóstico, o tratamento baseou-se na remoção cirúrgica com auxílio de laser de diodo de alta potência. Inicialmente foi realizada a anestesia infiltrativa ao redor da lesão, e então a remoção cirúrgica foi conduzida, juntamente com as glândulas acessórias para evitar recidiva, com uso do laser de diodo de alta potência. Ao fim do procedimento foi possível observar que a paciente saiu satisfeita, sendo o prognóstico favorável. No retorno de 30 dias, observou-se que não houve recidiva da lesão. O laser dediodo de alta potência, uma vez que apresenta uma série de benefícios, como excelente hemostasia, sem a necessidade de sutura, redução do edema e dor, cicatrização mais rápida e redução do tempo para realizar o procedimento, parece ser uma opção para remoção de mucocele em Odontopediatria.

Mucocele is a benign lesion that affects the oral cavity. The high power diode laser is an option as anadditional method or as a substitute to conventional procedures, with more post-surgical comfort. The objective of this study was to report a case of lower lip mucocele removal in a child patient using highpower diode laser. A female patient, 8 years old, attended the Clinic of Pediatric Dentistry, São Leopoldo Mandic School of Dentistry in Campinas, reporting discomfort in the lower lip, with the presence of a“ball”. On clinical examination it was observed swelling of soft consistency, floating, translucent, with coloring similar to the buccal mucosa. After diagnosis, the treatment was based on surgical removal with high power diode laser assistance. Initially infiltration anesthesia around the lesion was performed,and then the surgical removal was conducted, along with the accessory glands to prevent recurrence,with high power diode laser use. At the end of the procedure it was observed that the patient leftsatisfied, with a favorable prognosis. At the 30-day post-operative return, it was observed that there was no recurrence. The high power diode laser, since it presents a series of benefits such as excellen the mostasis, without the need for sutures, reduction of swelling and pain, faster healing, reducing the time to perform the procedure, it seems to be an option for removal of mucocele in pediatric dentistry.

Low-intensity laser phototherapy enhances the proliferation of dental pulp stem cells under nutritional deficiency

Abstract Dental trauma in immature permanent teeth can damage pulp vascularization, which leads to necrosis and cessation of apexogenesis. Studies on tissue engineering using stem cells from human exfoliated deciduous teeth (SHEDs) have yielded promising results. Laser phototherapy (LPT) is able to influence the proliferation and differentiation of these cells, which could improve tissue engineering. SHEDs (eighth passage) were seeded into 96-well culture plates (103 cells/well) and were grown in culture medium supplemented with 15% defined fetal bovine serum (FBS) for 12 h. After determining the appropriate nutrition deficiency status (5% FBS), the cells were assigned into four groups: 1) G1 - 15% FBS (positive control); 2) G2 - 5% FBS (negative control); 3) G3 - 5% FBS+LPT 3 J/cm2; and 4) G4 - 5% FBS+LPT 5 J/cm2. For the LPT groups, two laser irradiations at 6 h intervals were performed using a continuous wave InGaAlP diode laser (660 nm, with a spot size of 0.028 cm2, 10 mW) in punctual and contact mode. Cell viability was assessed via an MTT reduction assay immediately after the second laser irradiation (0 h) and 24, 48, and 72 h later. We found that G3 and G4 presented a significantly higher cell growth rate when compared with G2 (p < 0.01). Moreover, G4 exhibited a similar cell growth rate as G1 throughout the entire experiment (p > 0.05). These findings indicate that LPT with 5 J/cm2 can enhance the growth of SHEDs during situations of nutritional deficiency. Therefore, LPT could be a valuable adjunct treatment in tissue engineering when using stem cells derived from the dental pulp of primary teeth.

CT study of the performance of reciprocating and oscillatory motions in flattened root canal areas

Root canal preparation is an important step in endodontic treatment. The anatomical complexity of the middle third of the root compromises the effective cleaning of this area. Thus, advances have been made in instrumentation techniques and instruments for this purpose. The aim of this study was to evaluate the effects of three different instrumentation systems on the enlargement of the middle thirds of root canals in mandibular incisors. The preparation methods used were the reciprocating systems Reciproc (Group I) and WaveOne (Group II) and the oscillatory system Tilos (Group III). Comparisons were made by three-dimensional image reconstruction with cone-beam computed tomography before and after instrumentation. Changes in area, perimeter, centering ability, and pattern of preparation were analyzed. The results were subjected to ANOVA complemented by the Tukey’s test. Changes in area, perimeter, and tendency of transportation showed similar results among groups. The transportation index of the Tilos system was significantly lower than that of the other groups. Qualitative analysis of the preparation pattern showed that the Tilos system had a more uniform preparation, although Reciproc and WaveOne preparations appeared more rounded, incompatible with the original canal anatomy. There was similarity in the systems’ performance on flattened areas, although the Tilos system presented a better pattern of root canal preparation and a lower index of transportation.

Como podemos otimizar a endodontia em dentes decíduos?: relato de caso / How can we optimize endodontics in primary teeth?: a reported case

O tratamento endodôntico em dentes decíduos decorrente de lesões cariosas ou traumáticas com envolvimento pulpar muitas vezes é necessário na Clínica Odontopediátrica. Entretanto, nota-se que a qualidade da técnica endodôntica em dentes decíduos muitas vezes é deixada de lado, justificada pelo difícil comportamento das crianças e pelas características anatômicas internas dos dentes decíduos. Assim, seria interessante resgatar e agregar novos conceitos à endodontia de dentes decíduos para facilitar o dia-a-dia clínico e otimizar o tratamento. Este trabalho teve como objetivo descrever um caso clínico de uma paciente atendida na Clinica de Graduação de Odontopediatria da Uniararas, onde se realizou o tratamento endodôntico no incisivo central superior decíduo esquerdo, através de uma nova proposta que tem por objetivo melhorar a qualidade da técnica endodôntica em dentes decíduos utilizando localizadores apicais eletrônicos e um sistema de instrumentação mecanizado. Concluiu-se que a utilização de novas tecnologias apresentou-se como uma alternativa viável no tratamento endodôntico do incisivo decíduo relatado, auxiliando e alcançando um resultado satisfatório em relação ao preparo mecânico do conduto e ao seu preenchimento com o material obturador. Mais estudos futuros deveriam ser realizados para avaliar a utilização dessas novas tecnologias no tratamento endodôntico de dentes decíduos.

The endodontic treatment in primary teeth due to caries or trauma with pulp involvement is often necessary in Pediatric Dentistry. However, it has been observed that the technical quality of endodontic primary teeth is often left out justified by the difficult behavior of children and the internal anatomical features of the deciduous teeth. Thus, it would be interesting to recover and add new concepts to endodontics in primary teeth to facilitate the day-to-day clinical and optimized treatment. The aim of this study was to describe a clinical case of a patient treated in the Pediatric Dentistry Clinic of the Graduate UNIARARAS, where they performed endodontic treatment in deciduous left maxillary central incisor, through a new proposal, which aims to improve the quality of endodontic technique in primary teeth using electronic apex locators, ultrasound, mechanical instrumentation system. It was concluded that the use of new technologies introduced as a viable alternative to endodontic treatment of deciduous incisor reported, aiding and achieving a satisfactory outcome in relation to the mechanical preparation of the canal and fill it with filling material. Further studies should be performed to evaluate the use of these new technologies in endodontic treatment of deciduous teeth.

Conhecimento dos cirurgiões-dentistas frente aos cuidados com a saúde bucal de crianças em idade pré-escolar / Knowledge of dentists compared to oral health care for children in preschool

Objetivo - Avaliar o nível de conhecimento dos cirurgiões-dentistas, exceto odontopediatras, frente aos cuidados com a saúde bucal de crianças em idade pré-escolar. Métodos - Foram questionados 137 cirurgiões-dentistas que não possuíam nenhum curso de pós-graduação em Odontopediatria. Foram coletados dados referentes à região que se formou; se realizou curso de especialização ou não; se o entrevistado tinha filho e a idade do mesmo na primeira visita ao cirurgião-dentista; qual a idade ideal para iniciar a limpeza na cavidade do bebê, qual o tipo de dentifrício e sua quantidade para diferentes faixas etárias, indicação ou não de chupeta ou mamadeira e a idade da remoção do habito. Resultados - Verificou-se que a maioria (62%) dos cirurgiões-dentistas fez graduação na região sudeste; 53% já eram especialistas; 33% têm filhos; 75% levariam seus filhos ao cirurgião-dentista entre zero até um ano de idade; 84% afirmaram que a idade ideal para iniciar a limpeza na cavidade bucal do bebê é antes do irrompimento do primeiro dente; 89% dos entrevistados não indicam dentifrícios para bebês edêntulos; 84% dos entrevistados indicam para pacientes entre quatro e seis anos dentifrício com flúor; 37% indicam a remoção da chupeta até dois anos de idade; 72% dos cirurgiões-dentistas indicam o bico da mamadeira ortodôntico e 36% indicam a remoção da mamadeira precocemente. Conclusão - A maioria dos cirurgiões-dentistas têm conhecimento suficiente para orientar os pais quanto aos hábitos de higiene, prevenção e remoção de hábitos deletérios das crianças, apesar de não serem da área de Odontopediatria.

Objective - This study assessed the level of knowledge of dentists compared to oral health care for children in preschool. Methods - We questioned 137 dentists who did not have any postgraduate course in Pediatric Dentistry. Data were collected regarding the region that was formed, held a specialist course or not, whether the respondent had a son the same age and in first visit to the dentist, which is the ideal age to start cleaning the cavity of the baby, which type and quantity of toothpaste for different age groups, indicating whether or not a pacifier or bottle and removing the old habit. Results - We found that most (62%) of dentists had graduated from the southeast, and 53% were specialists, 33% have children, 75% would take their children to the dentist between zero to one year of age; 84% said the ideal age to start cleaning the baby's oral cavity before the first tooth eruption, 89% of respondents did not indicate toothpaste for babies, 84% of respondents indicated for patients between four and six years with fluoride toothpaste, 37% indicate the removal of the pacifier after two years of age, 72% of dentists indicate the orthodontic nipple of the bottle and 36% indicate the removal of the bottle early. Conclusion - Most dentists have enough knowledge to guide parents as to hygiene, prevention and removal of harmful habits of children, although not in the area of Pediatric Dentistry.

Variability in the proportion of components of iodoform-based Guedes-Pinto paste mixed by dental students and pediatric dentists.

Objective: Guedes-Pinto paste (GPP) is an iodoform paste used in most dental schools in Brazil. The paste is a composite of medicines (Rifocort® , camphorated paramonochlorophenol [PMCC], and iodoform) used for endodontic treatment of primary teeth. The aim of this study was to evaluate the proportion variability of GPP components when mixed by undergraduate dentistry students and pediatric dentists. Materials and Methods: The study was divided into 4 groups: G1 (15 undergraduate students), G2 (15 specialists in Pediatric Dentistry), G3 (15 professors with clinical activity), and G4 (7 professors-researchers). All volunteers prepared GPP according to the original specifications: the same visual proportion for each component. The components were weighed using an analytical balance and the percentage was calculated. Result: After normality (Kolmogorov-Smirnov) and homogeneity tests (Levene test), the data were submitted to analysis of variance and intraclass correlation coefficient tests (P<0.05). The percentage means of each respective group were as follows: Rifocort® 20.2%, 20.8%, 26.7%, 27.3%; camphorated PMCC 9.2%, 8.1%, 6.7%, 5.1%; and the iodoform 70.6%, 71.1%, 64.7%, 67.6%. There were no significant differences between groups for the component percentages. There was a high intraclass correlation coefficient (G1 0.945; G2 0.951; G3 0.921; and G4 0.870). Conclusion: The proportion of GPP was similar in all the groups, allowing us to conclude that ideal GPP proportion, based on the entire group mean, was 23.8% of Rifocort® ; 7.0% of camphorated PMCC; and 69.2% of iodoform.

Nd:YAG laser irradiation effect on apical intracanal dentin - a microleakage and SEM evaluation

The purpose of this in vitro study was to evaluate the effect of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation on intracanal dentin surface by SEM analysis and its interference in the apical seal of filled canals. After endodontic treatment procedures, 34 maxillary human incisors were randomly assigned to 2 groups. In the negative control group (n=17), no additional treatment was performed and teeth were filled with vertically condensed gutta-percha; in the laser-treated group (n=17), the root canals were irradiated with Nd:YAG laser (1.5 W, 100 mJ, 15 Hz) before filling as described for the control group. Two specimens of each group were prepared for SEM analysis to evaluate the presence and extent of morphological changes and removal of debris; the other specimens were immersed in 0.5 percent methylene blue dye (pH 7.2) for 24 h for evaluation of the linear dye leakage at the apical third. SEM analysis of the laser-treated group showed dentin fusion and resolidification without smear layer or debris. The Student’s t-test showed that the laser-treated group had significantly less leakage in apical third than the control group. Within the limitations of this study, it may be concluded that the morphological changes on the apical intraradicular dentin surface caused by Nd:YAG laser resulted in less linear dye apical leakage.

Performance de diferentes métodos de instrumentação radicular em dentes decíduos humanos e artificiais avaliado pela tomografia computadorizada por feixe cônico / Performance of different methods of root canal instrumentation in natural and artificial primary teeth evaluated by cone beam computed tomography

No intuito de avaliar novas possibilidades de instrumentação radicular em dentes decíduos, o objetivo do presente estudo foi avaliar a performance de três diferentes métodos, manual e mecanizados, utilizando tomografia computadorizada por feixe cônico (TCFC). As técnicas utilizadas foram manual (MAN), rotatória com o sistema Protaper (ROT) e oscilatória com o sistema EndoEZE (OSC). Para o segundo objetivo, as técnicas foram testadas em dentes decíduos naturais e artificiais, para que também se pudesse avaliar a diferença entre a performance dos métodos nesses dois tipos de dentes. Após o acesso endodôntico inicial, imagens padronizadas foram realizadas em aparelho de TCFC (sistema iCat), com cortes sagital, coronal e axial. Após a instrumentação dos dentes pelos diferentes métodos, novas imagens foram realizadas. Avaliações quantitativas foram feitas medindo-se nas imagens axiais dos canais radiculares, a espessura das paredes e área do canal, em três diferentes regiões: terços cervical, médio e apical. Três desfechos foram considerados após instrumentação: desvio para a parede de risco, descentralização do canal e diferença na área do canal antes e após a instrumentação. Os valores foram comparados com análise de variância e teste de Tukey, ou com testes não paramétricos. Não houve diferença no desvio entre os métodos para os dentes anteriores artificiais e naturais. Nos posteriores naturais, entretanto, a técnica MAN apresentou maior desvio no terço cervical (p<0,05). Com relação as áreas do canal, para os dentes anteriores, o método ROT e OSC apresentaram maior desgaste que o MAN nos terços cervical e médio, mas no terço apical o OSC e o MAN foram semelhantes (p > 0,05). Para os posteriores, o método ROT apresentou um desgaste estatisticamente maior do que os demais apenas no terço apical (p<0,05). Análises qualitativas do padrão de desgaste de cada método de instrumentação radicular foram realizadas e representadas em gráficos e imagens obtidas pela TCFC. Avaliando as imagens, o padrão anatômico de todos os canais mostrou uma área maior da cervical e menor na apical. O método MAN apresentou uma tendência de preservar a anatomia inicial do canal em todos os terços. Já o ROT apresentou expressiva alteração no perfil anatômico em todos os terços e o método OSC atuou com maior expressão nas regiões cervical e média, comparado à região apical. Os dentes artificiais apresentaram similaridade de forma e radiopacidade com os dentes naturais, mas apresentaram resultados diferentes nos diversos desfechos, limitando seu uso como substitutos dos dentes naturais em pesquisas. Em conclusão, o método MAN apresenta boa performance na instrumentação radicular de dentes decíduos, mas o sistema oscilatório seria a melhor opção para obter as vantagens da instrumentação mecanizada. Em relação aos modelos de dentes artificiais utilizados, ainda necessitam ser aperfeiçoados para substituírem os dentes naturais nas pesquisas.

In order to appraise new options of root canal instrumentation in primary teeth, the aim of the present study was to evaluate the performance of three different methods, manual and mechanical, using cone beam computed tomography (CBCT). The techniques tested were manual (MAN), rotatory with Protaper system (ROT) and oscillatory with EndoEZE system (OSC). For the second objective, the techniques were assessed in natural and artificial primary teeth, in order to evaluate the difference in the performance of the methods in these types of teeth. After initial endodontic access, standardized scans were obtained by CBTC (iCat system), with sagittal, coronal and axial planes. After the root canal instrumentation of teeth with different methods, new images were achieved. Quantitative evaluations were performed measuring the thickness of root canal wall and canal area in the axial images of root canals, at three different places: coronal, middle and apical thirds. Three outcomes were considered after the instrumentation: canal transportation towards the side of root resorption, centering ability and difference in canal area before and after the instrumentation. The values were compared using ANOVA and Tukey test, or with non-parametric tests. There were no differences among the methods used in both natural and artificial anterior teeth concerning the canal transportation. In the natural posterior teeth, however, the MAN technique showed greater canal transportation towards the size of root resorption in the coronal third (p < 0.05). With regard to the canal area, for the anterior teeth, the ROT and OSC methods presented higher increase in canal area than the MAN in coronal and middle thirds, but in the apical third, OSC and MAN were similar (p > 0.05). In posterior teeth, the ROT method showed statistically higher increase in canal area than the other methods only in the apical third. Qualitative analysis of the shaping patterns of each root canal instrumentation method were carried out and presented in graphics and images obtained with CBCT. After evaluating the images, the shaping pattern of all root canals showed a larger area in the coronal and smaller in apical third. The MAN method tended to preserve the baseline anatomy of the root canal in all areas. The ROT method, on the other hand, presented more significant changes in the anatomical shaping in all thirds, and the OSC method showed higher increase in canal area in the coronal and middle thirds, compared to the apical third. The artificial teeth are very similar to natural teeth in their anatomical shape and radiopacity, but they yielded different results in several of the outcomes, which limits their use as substitute of natural teeth for research purpose. In conclusion, the MAN method presents good performance for root canal instrumentation in primary teeth, but the OSC system would be the best option to achieve the advantages of mechanical instrumentation.

Prevalência de lesões dentárias traumáticas em pré-escolares de escolas públicas e particulares / Prevalence of traumatic dental injuries in preschool children of private and public schools

Objetivo - Este estudo teve como finalidade: I) avaliar a prevalência das lesões dentárias traumáticas (LDTs) em pré-escolares; II) comparar a prevalência em escolas públicas e particulares; III) avaliar a necessidade de tratamento das LDTs. Métodos - Foi realizado um levantamento epidemiológico com 411 pré-escolares. As LDTs foram classificadas de acordo com Ellis (1972), adicionando-se a esse critério a alteração de cor. Os dados foram submetidos à análise de regressão de Poisson. Resultados - A prevalência das LDTs foi de 14,8%. O incisivo central superior foi o dente mais afetado sem diferença entre os lados. As meninas apresentaram menos trauma que os meninos (p<0,05) e a prevalência foi menor em escolas públicas (p<0,05). O trauma mais comum nas instituições públicas foi fratura de coroa envolvendo apenas esmalte, e nas privadas foi alteração de cor da coroa. Os resultados mostraram grande necessidade de tratamento, 41,4% para escolas públicas e 27,1% para particulares. Conclusão - Conclui-se que a prevalência das LDTs foi 14,8%, crianças de escolas particulares tiveram mais trauma e existe grande necessidade de tratamento, principalmente nas escolas públicas.

Objective - The aim of the study was to: I) evaluate the prevalence of traumatic dental injuries (TDIs) in pre-scholars; II) compare the prevalence of the TDIs in private and public schools; III) evaluate the need of treatment of the TDIs. Methods - This study was conducted with the use of a transversal epidemiological study in 411 preschool children. Results - TDIs were classified according to Ellis (1972), adding color alteration to this criterion. Data were submitted to Poisson regression analysis. TDIs prevalence was 14.8%. The superior central incisor was the most affected tooth, without any difference between left and right sides. Univariate analysis showed that girls presented less trauma than boys and the prevalence was lower in public schools (p < 0.037). The most common trauma in public schools were fractures of crowns involving only enamel while in private schools was alteration in the color of the crown and TDIs needed treatment. Conclusion - It was concluded that there was association among traumatic dental injuries and gender (boys had more trauma than girls), school (children from private school had more TDIs) and big need of treatment for the LDTs exists.

Diagnóstico e tratamento cirúrgico do freio teto labial persistente em pacientes no período intertransitório da dentição mista: relato de caso / Diagnosis and surgical treatment of an abnormal upper labial frenum at inter-transitory period of mixed dentition: a case report

O freio labial superior é uma estrutura dinâmica sujeito a variações na forma, tamanho e posição durante os diferentes estágios de crescimento e desenvolvimento do indivíduo. No nascimento, o freio é geralmente largo e espesso e se estende até a papila palatina. Com a erupção dos incisivos permanentes e à medida que ocorre o desenvolvimento do processo alveolar, há uma tendência à atrofia fisiológica e ao afastamento apical da inserção do freio. Quando o freio permanece com a inserção na papila palatina ou na margem gengival é então chamado de freio teto labial persistente. Este pode causar diastema mediano, interferir na escovação, causar recessão gengival, provocar a formação de bolsas periodontais, restringir o movimento do lábio, interferir na fonação e produzir efeito estético indesejável. O objetivo deste trabalho consistiu em apresentar um relato de uma paciente do gênero feminino, com dez anos de idade, as principais consequências e o tratamento cirúrgico do freio teto labial persistente. Frente ao relato, pode-se concluir que a frenectomia foi o tratamento que propiciou o reposicionamento e uma nova inserção para o freio labial, deixando que, com o desenvolvimento da oclusão, ocorresse o fechamento do diastema.

The upper labial frenum is a dynamic structure and changeable structure and is subject to variations in shape, size and position during the different stages of growth and development. At birth, the frenum is generally wide and thick and extends to the palatal papillae. The eruption of permanent incisors and the vertical growth of the alveolar process make the insertion of frenum move apically. When the frenum insertion remains at the palatal papillae, its called abnormal upper labial frenum. The abnormal labial frenum, besides creating a diastema, is capable of interfering at oral hygiene, limiting labial movement, causes gingival recession and affects esthetics. The purpose of this study was to present a ten years old female patient report, the main consequences and the surgical treatment of an abnormal labial frenum. In front of this report, it is possible to conclude that frenectomy was the treatment which caused the frenum new position and its new insertion, making possible that, by the occlusion development, it occurred the diastema closing.