A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Oral manifestations of renal tubular acidosis associated with secondary rickets: case report / Manifestações bucais da acidose tubular renal associada ao raquitismo secundário: relato de caso

ABSTRACT This report describes the oral manifestations of renal tubular acidosis (RTA) associated with secondary rickets and discusses the biological plausibility of these findings. The characteristic electrolyte changes during RTA or genetic mutations that trigger RTA may be responsible for impaired amelogenesis, dental malocclusion, impacted teeth, and absent lamina dura. This report reinforces the possibility of an association between RTA and the oral manifestations described.

RESUMO Este relato de caso descreve as manifestações bucais da acidose tubular renal (ATR) associada ao raquitismo secundário e discute a plausibilidade biológica desses achados. As alterações eletrolíticas características da ATR ou as mutações genéticas que a desencadeiam podem ser responsáveis pela amelogênese imperfeita, maloclusão dentária, dentes impactados e ausência de lâmina dura. Este relato reforça a possibilidade de uma associação entre ATR e as manifestações bucais descritas.

Clorexidina melhora as propriedades mecânicas da dentina radicular / Chlorhexidine improves the mechanical properties of root dentin

Objetivo: avaliar a resistência máxima à flexão (MFS), módulo de elasticidade (E), microdureza Knoop (KHN) e rugosidade de superfície (Ra) da dentina radicular tratada com solução de clorexidina a 2% (CHX). Métodos: foram selecionados 50 incisivos bovinos com ápice fechado, e trinta raízes foram cortadas em barras de dentina (DB) e divididas em três grupos (n = 10): Controle (sem tratamento), G1 (NaOCl 2,5% + EDTA 17%) e G2 (CHX 2% + H2O). As DB foram submetidas ao ensaio de resistência flexural de três pontos, para se obter os valores de MFS e E. Vinte raízes foram cortadas longitudinalmente ao meio e inseridas em resina acrílica; as superfícies pulpares foram lixadas e polidas e, em seguida, irrigadas de acordo com o grupo (G1 ou G2; n = 20 metades por grupo) e submetidas aos testes de KHN e Ra. Foi realizada análise de MEV. Os dados foram analisados por meio dos testes de ANOVA de um e dois critérios, seguidos do teste de Tukey (α = 0,05). Resultados: os valores de MFS (p < 0,05) e E (p < 0,01) foram maiores para G2. A KHN foi reduzida após o tratamento com cada irrigante endodôntico (p < 0,001), sem diferenças entre eles (p = 0,115). A Ra foi maior para o G1 (p < 0,001). Conclusões: a solução de clorexidina a 2% melhora as propriedades mecânicas de MFS, E e Ra da dentina radicular. (AU)

Objective: To evaluate the maximum flexural strength (MFS), elastic modulus (E), Knoop microhardness (KHN), and surface roughness (Ra) of root dentin treated with 2% chlorhexidine (CHX) solution. Materials and methods: Fifty bovine incisors with closed apex were selected. Thirty roots were cut into dentin bars (DB) and divided into three groups (n=10): control (no treatment), G1 (2.5% NaOCl + 17% EDTA) and G2 (2% CHX + H2O). The DB were submitted to the three-point flexural strength test to obtain the MFS and E. Twenty roots were cut longitudinally into two half-halves and placed in acrylic resin. The pulp surfaces were sanded and polished. They were rinsed according to the group (G1 or G2; n = 20 per group) and subjected to the KHN and Ra tests. SEM analysis was made. Data were analysed by one- and two-way ANOVA and Tukey post hoc test (a = 0.05). Results: The values of MFS (P < 0.05) and E (P < 0.01) were higher for G2. The KHN reduced after both endodontic irrigation treatments (P < 0.001), with no differences between them (P = 0.115). Ra was higher for G1 (P < 0.001). Conclusions: 2% CHX improved the mechanical properties of MFS, E and Ra of root dentin (AU).

Management of atypical mucosal lesions from primary endodontic infection: two cases report

Aim/Case report: We have described here the diagnosis and treatment of two cases involving atypical mucosal lesions originating from primary endodontic infections in young patients. Differential diagnoses were established by clinical and radiographic examinations. In both the cases, a red-colored lesion was observed in the alveolar mucosa, with a soft consistency and a sessile-base without any drainage path in tooth 31 (case 1) and with a sinus tract in tooth 36 (case 2), as confirmed by X-ray. The cleaning and shaping of the root canals were performed, and camphorated paramonochlorofenol (CPMC)-enriched calcium hydroxide paste was used as an intracanal dressing for 6 months, with replacement every 60 days. Conclusion: Based on our experience, we thus conclude that long-term root canal maintenance with CPMC-enriched calcium hydroxide was an effective therapeutic protocol for promoting the healing of atypical mucosal lesions

Is sickle cell anemia a risk factor for severe dental malocclusion?

The aim of this study was to investigate possible associations between sickle cell anemia (SCA) and the severity of dental malocclusion (MO). This was a retrospective cohort study of 93 individuals with SCA (G1) and 186 individuals without the disease (G2). SCA patients were randomly selected by a simple draw from patients treated in the Centro de Hematologia e Hemoterapia do Maranhão (HEMOMAR) in northeastern Brazil. Patients aged between 16 and 60 were included after being tested for the hemoglobin S gene. G2 consisted of individuals living in the same residence as the patients. The Dental Aesthetic Index (DAI), as well as some morphological deviations not included in DAI, were used for the orthodontic evaluation of MO. Poisson regression with robust variance adjustment was employed to estimate relative risk (RR). In the multivariate analysis, SCA was associated with moderate (RR = 1.36) and very severe MO (RR = 8.0). SCA is correlated with anterior tooth loss (RR = 1.94), anterior spacing (RR = 1.66), overjet (RR = 1.87), anterior crossbite (RR = 1.94), and open bite (RR = 1.94). Thus, SCA is a risk factor for moderate and very severe MO.

Effect of Chlorhexidine Gel in Mentally Handicapped Children highly Infected with Streptococcus Mutans

Objective:To evaluate the effect of 1% chlorhexidine (CHX) gel on mentally handicapped children (n=11) highly infected with Streptococcus mutans (SM) and evaluate the re-colonization time of this bacterium after the treatment period.. Material and Methods:Before CHX treatment, saliva samples were collected to establish baseline saliva SM levels. CHX gel was daily applied for 5 min, for 7 consecutive days. Saliva samples were then collected after 7, 30, 60, 90 and 120 days to evaluate SM oral re-colonization. Data were analyzed by the Wilcoxon test (α=0.05).Results:When compared to baseline (5.7 / 3.0 x 105), the collection performed 7 days after CHX treatment (0.06 / 0.2 x 105) showed a significant reduction (P <0.05) in SM saliva levels (mean / s.d., CFU ml-1). In subsequent collections, a gradual SM re-colonization was observed, and after 60 days of treatment, the levels of this bacterium (0.8 / 0.9 x 105) no longer statistically differed from SM levels considered high risk to caries (105) (P> 0.05).Conclusion:Treatment with CHX gel for 7 days was effective in reducing the SM levels of mentally handicapped children and should be repeated after 60 days to control the risk of caries in these children...

Qualitative SEM/EDS analysis of microleakage and apical gap formation of adhesive root-filling materials

OBJECTIVE: The aim of this study was to compare the correspondence between gap formation and apical microleakage in root canals filled with epoxy resin-based (AH Plus) combined or not with resinous primer or with a dimethacrylate-based root canal sealer (Epiphany). MATERIAL AND METHODS: Thirty-nine lower single-rooted human premolars were filled by the lateral condensation technique (LC) and immersed in a 50-wt% aqueous silver nitrate solution at 37ºC (24 h). After longitudinal sectioning, epoxy resin replicas were made from the tooth specimens. Both the replicas and the specimens were prepared for scanning electron microscopy (SEM). The gaps were observed in the replicas. Apical microleakage was detected in the specimens by SEM/energy dispersive spectroscopy (SEM/EDS). The data were analyzed statistically using an Ordinal Logistic Regression model and Analysis of Correspondence (α=0.05). RESULTS: Epiphany presented more regions containing gaps between dentin and sealer (p<0.05). There was correspondence between the presence of gaps and microleakage (p<0.05). Microleakage was similar among the root-filling materials (p>0.05). CONCLUSIONS: The resinous primer did not improve the sealing ability of AH Plus sealer and the presence of gaps had an effect on apical microleakage for all materials.

The diagnostic challenge of vertical root fracture in endodontically treated teeth: a case report / O desafio diagnóstico de fratura radicular vertical em dentes endodonticamente tratados: relato de caso

PURPOSE: To present the diagnostic challenge of a clinical case of vertical root fracture (VRF) in an endodontically treated mandibular left lateral incisor and discuss the diagnostic methods employed to achieve the conclusive diagnosis. CASE DESCRIPTION: At 16 months after endodontic treatment, a 60-year-old female patient reported pain during mastication. Clinically, she presented with an active distolingual fistula and a probing depth of 9 mm on the distal aspect of tooth 32. A radiographic examination indicated pear-shaped distal bone loss. The fistula was mapped, which confirmed that the lesion had a periodontal origin. A diagnostic hypothesis of a VRF was established. Exploratory surgery revealed the VRF on the distolingual aspect of the root without separation of the root fragments. CONCLUSION: Knowledge of the diagnostic aspects and the correct interpretation of radiographic images was enough to establish the diagnostic hypothesis of a VRF. However, the conclusive diagnosis was only confirmed during exploratory surgery.

OBJETIVO: Apresentar o desafio de diagnosticar Fratura Radicular Vertical (FRV) em um incisivo lateral inferior esquerdo tratado endodonticamente e discutir os métodos diagnósticos empregados para obtenção do diagnóstico conclusivo. DESCRIÇÃO DO CASO: Após 16 meses do término do tratamento, a paciente relatou dor à mastigação. Clinicamente apresentava uma fístula disto-lingual ativa e profundidade de sondagem de 9-mm na face distal do dente 32. Radiograficamente apresentava perda óssea distal em forma de "pêra". Foi realizado o mapeamento da fístula, confirmando tratar-se de uma lesão de origem periodontal. Estabeleceu-se a hipótese diagnóstica de FRV. Para a confirmação do diagnóstico realizou-se cirurgia exploratória. Foi constatada a FRV na face disto-lingual da raiz sem o afastamento dos fragmentos radiculares. CONCLUSÃO: Concluiu-se que o conhecimento dos achados semiotécnicos e a correta interpretação das imagens radiográficas foram suficientes para se estabelecer a hipótese diagnóstica de FRV. Entretanto, o diagnóstico conclusivo só foi confirmado durante a cirurgia exploratória.

Avaliação do Conhecimento de Pais e Educadores de EscolasPúblicas do Município de São Luis, MA, Sobre Avulsão Dental / Knowledge of Parents and Public School Teachers of the City of São Luis, MA about Dental Avulsion

Objeti vo: Verifi car o nível de esclarecimento dos educadores epais e/ou responsáveis de escolares da rede pública estadual domunicípio de São Luis/MA sobre condutas imediatas nos casosde avulsão dental relacionadas à criança e ao dente.Método: Foi aplicado um questi onário em forma de entrevistapara avaliar o nível de conhecimento de uma população-alvo dacidade de São Luis acerca das condutas adotadas no atendimentoimediato às crianças víti mas de avulsão dental, especifi cando oscuidados com a criança e com o dente avulsionado. O municípiofoi dividido em pólos e foram selecionadas 11 escolas, nas quaisforam aplicados 384 questi onários em forma de entrevistasendo 280 aos pais e/ou responsáveis e 84 aos educadoresdos escolares da faixa etária de 7 a 10 anos e não houve aidenti fi cação de nenhum dos parti cipantes.Resultados: Observou-se que 92,5% dos pais e 97,6% doseducadores desconhecem os procedimentos corretos a seremadotados para salvar um dente em casos de avulsão dental.Quanto aos cuidados com a limpeza do dente avulsionado eao seu meio de transporte, a maioria da amostra estudada osfariam de forma inadequada.Conclusão: Sendo o reimplante dental a única terapêuti caimediata para avulsão dental em crianças, a populaçãoleiga não possui o conhecimento básico para atuar frentea estes traumati smos, tornando-se necessária e urgente ainsti tucionalização de campanhas educati vas preventi vase...

Objecti ve: To verify the level of knowledge of teachers andparents and/or caregivers of children att ending state publicschools in the city of São Luis, MA, Brazil, about the immediatecare in cases of dental avulsion, regarding the child and theavulsed tooth.Method: A questi onnaire was applied in form of interview toevaluate the level of knowledge of a target populati on of thecity of São Luis, MA, regarding the procedures adopted in theimmediate care to children victi ms of dental avulsion, specifyingthe care with the child and the avulsed tooth. The city wasdivided into two regions and 11 schools were selected. A totalof 384 questi onnaires in form of interview were used, being280 directed to the parents and/or caregivers and 84 directedto the teachers of 7-10-year-old children. The identi ty of theparti cipants was preserved.Results: 92.5% of the parents and 97.6% of the teachers didnot know the appropriate procedures to the adopted to savean avulsed tooth. Regarding the cleaning and storage mediafor avulsed teeth, most of the interviewees would have aninappropriate proceeding.Conclusion: Replantati on is the only immediate treatment fordental avulsion in children, and the layman does not have thebasic knowledge to proceed when these types of traumati smsoccur. It is thus necessary and urgent the development ofpreventi ve and systemati c educati ve campaigns, having thedenti st as the educati ng agent...

Avaliação dos hábitos alimentares de pacientes adultos submetidos ao tratamento ortodôntico / Assessment of feeding habits of adult patients under orthodontic treatment

Objetivo: Avaliar os hábitos alimentares de pacientes que estão sendo submetidos ao tratamento ortodôntico, abordando inter-relações entre saúde bucal e nutrição.Método: Foram selecionados 50 pacientes, de 20 a 39 anos de idade, em consultórios particulares de ortodontia, que faziam uso de aparelhagem fixa, cujos hábitos alimentares foram avaliados através de um questionário específico. No instrumento de coleta de dados foram feitos questionamentos sobre as alterações e continuidade de ingestão de alimentos agrupados segundo a pirâmide alimentar. O pesquisador estava atento para qualquer dúvida ou esclarecimento sobre as questões, recolhendo as fichas após seu preenchimento completo. Finalizada a coleta dos dados, os mesmos foram submetidos à estatística descritiva.Resultados: Quarenta e duas pessoas (84%) afirmaram que sua alimentação mudou após a colocação do aparelho ortodôntico, sendo que 21 (42%) mudaram após as manutenções. Quando perguntados sobre a freqüência e quantidade, apenas 16 pessoas (32%) afirmaram passar a comer menos após ter colocado o aparelho. Foi observada uma diminuição no consumo de doces, gorduras, frituras, cereais e frutas e aumento no consumo de peixes, leite e derivados. As mudanças ocorreram em maior número imediatamente após as manutenções, principalmente em pacientes com mais de um ano de uso do aparelho e, para grande parte dos pacientes com até um ano de uso, persistem até hoje.Conclusão: Ocorreram alterações nos hábitos alimentares em pacientes submetidos ao tratamento ortodôntico, ratificando-se a necessidade de um aconselhamento nutricional aos pacientes ortodônticos, especialmente no primeiro ano de tratamento, quando as mudanças ocorreram com maior freqüência.

Cimentos resinosos endodônticos: selamento apical, aspectos micromorfológicos, características físicas e resistência de união à dentina / Resin-based root canal sealers: apical sealing, micromorphological aspects, physical characteristics and bond strength to dentin

Avaliou-se o selamento apical, os aspectos micromorfológicos da interface adesiva, as características físicas e a resistência de união à dentina de cimentos resinosos endodônticos. Setenta e dois pré-molares humanos unirradiculares foram preparados endodonticamente. Trinta e três dentes foram divididos aleatoriamente em 3 grupos, impermeabilizados externamente e obturados pela técnica da condensação lateral acorde as seguintes condições: AH Plus (AH Plus/Gutapercha); AH Primer (Epiphany primer/AH Plus/Gutapercha) e Epiphany (sistema Epiphany). Foram mantidos a 37ºC e 100% de umidade por 72 h e, em seguida, imersos em solução aquosa de nitrato de prata a 50% por 24 h. Após secção longitudinal dos dentes, foram realizadas réplicas em resina epóxica. Réplicas e espécimes foram preparados para MEV. Nas réplicas, observou-se a freqüência de fendas apicais na interface dentina/cimento. Nos espécimes, detectou-se e confirmou-se com EDS (Energy Dispersive Spectroscopy) a microinfiltração apical. A interface dentina/cimento foi observada em seis espécimes de cada grupo, selecionados aleatoriamente. A microinfiltração foi similar entre os grupos (p>0,05), sendo influenciada pela freqüência de fendas (p<0,05). Foram observadas tanto regiões com fendas quanto com camada híbrida e longos tags para o grupo Epiphany. Para os grupos AH Primer e AH Plus foi verificada boa adaptação marginal com longos tags vazios e pequenos plugs, respectivamente, embora tenha ocorrido a formação de fendas em ambos. Os outros dentes foram utilizados para as avaliações...

Resin-based root canal sealers had their apical sealing, micromorphological aspects, physical characteristics and bond strength to dentin evaluated in this study. For this purpose, seventy-two single-rooted human premolars were endodontically treated. Thirty-three teeth were randomly divided into three groups, externally coated with nail varnish and obturated by lateral condensation technique according to such conditions: AH Plus (AH Plus/Gutta-percha); AH Primer (Epiphany primer/AH Plus/ Gutta-percha) and Epiphany (Epiphany system). They were kept in 100% humidity at 37oC for 72 h, and then the specimens were immersed in 50% aqueous silver nitrate tracer solution for 24 h. The teeth were longitudinally sectioned and their epoxy resin replicas were obtained. Both the specimens and their corresponding replicas were prepared for SEM. In the replicas, the frequency of apical gaps at the dentin/cement interface was observed. In the specimens, the apical microleakage was detected and confirmed by EDS (Energy Dispersive Spectroscopy). The dentin/cement interface was observed in six specimens of each group randomly selected. The microleakage was similar among the groups (p>0,05) being influenced by gaps frequency (p<0,05). The Epiphany group presented gap-containing regions, hybrid layer formation and long tags. For AH Primer and AH Plus groups, good marginal adaptation with long empty tags and small plugs, respectively, although gaps formation was found in both groups. The remaining teeth were used for other evaluations: six, to finish micromorphological study at the adhesive interface; three, for Knoop microhardness...