Lesões cervicais não cariosas: considerações etiológicas, clínicas e terapêuticas / Lesiones cervicales no cariosas: consideraciones etiológicas, clínicas y terapéuticas / Non-carious cervical injuries: etiological, clinical and therapeutic considerations

RESUMO Introdução: As lesões cervicais não cariosas são lesões dentárias, que apresentam etiologia multifatorial, sem o envolvimento de bactérias. Objetivo: Descrever as características clínicas, etiologia e tratamento das lesões cervicais não-cariosas. Métodos: Realizou-se uma revisão bibliográfica de estudos publicados nos últimos 5 anos (2014-2018) por meio da busca nas bases de dados: PubMED/Medline, Lilacs, Science Direct, SciELO (Scientific Eletronic Library) e Google Acadêmico. Para a pesquisa foram utilizados os seguintes descritores: "lesões cervicais não cariosas (non-carious cervical lesions)", "abrasão dentária (dental abrasion)", "erosão dentária (dental erosion)", "abfração dentária (dental abfraction)" e "atrição dentária (dental atrittion). Após criteriosa filtragem, foram selecionados 26 artigos e 2 livros para inclusão no estudo. Análise e integração das informações: As lesões cervicais não cariosas comumente classificadas em: abrasão, abfração, erosão e atrição. Essas lesões podem apresentar diversas formas, apesar de serem incluídas em uma classe genérica de denominação. São lesões que causam a perda gradativa dos tecidos mineralizados dentários, podendo trazer inúmeras consequências ao dente acometido. Conclusão: Para um correto diagnóstico e decisão de tratamento, essas lesões devem ser vistas sob seu aspecto etiológico multifatorial. Diversas possibilidades terapêuticas podem ser utilizadas no tratamento dessas lesões sendo necessário que o clínico conheça os principais fatores etiológicos e características clínicas que as diferenciem(AU)

RESUMEN Introducción: Las lesiones cervicales no cariosas son lesiones dentales, que presentan etiología multifactorial, sin la participación de bacterias. Objetivo: Describir las características clínicas, etiología y tratamiento de las lesiones cervicales no cariosas. Métodos: Se realizó una revisión bibliográfica de estudios publicados en los últimos 5 años (2014-2018) a través de la búsqueda en las bases de datos: PubMED / Medline, Lilacs, Science Direct, SciELO (Scientific Eletronic Library) y Google Académico. Para la investigación se utilizaron los siguientes descriptores: "lesiones cervicales no cariosas", "abrasión dental", "erosión dental", "abfracción dental" y " " atrición dental. Después de un cuidadoso filtrado, se seleccionaron 26 artículos y 2 libros para su inclusión en el estudio. Análisis e integración de las informaciones: Las lesiones cervicales no cariosas comúnmente clasificadas en: abrasión, abfración, erosión y atrición. Estas lesiones pueden presentar diversas formas, aunque se incluyen en una clase genérica de denominación. Son lesiones que causan la pérdida gradual de los tejidos mineralizados dentales, pudiendo traer innumerables consecuencias al diente acometido. Conclusiones: Para un correcto diagnóstico y decisión de tratamiento, estas lesiones deben ser vistas bajo su aspecto etiológico multifactorial. Diversas posibilidades terapéuticas pueden ser utilizadas en el tratamiento de esas lesiones, por lo que resulta necesario que el clínico conozca los principales factores etiológicos y características clínicas que las diferencien(AU)

ABSTRACT Introduction: Non-carious cervical lesions are dental lesions of a multifactorial etiology, without the involvement of bacteria. Objective: Describe the clinical characteristics, etiology and treatment of non-carious cervical lesions Methods: A bibliographic review was conducted of studies published in the last five years (2014-2018) by searching the databases PubMED / Medline, Lilacs, Science Direct, SciELO (Scientific Electronic Library) and Google Scholar. The following descriptors were used: "non-carious cervical lesions", "dental abrasion", "dental erosion", "dental abfraction" and "dental attrition. After careful filtering, 26 articles and two books were selected for inclusion in the study. Data analysis and integration: Non-carious cervical lesions are commonly classified as abrasion, abfraction, erosion and attrition. These lesions may present various forms, but they are all grouped in a single generic class. They are lesions that cause the gradual loss of mineralized dental tissue, which may bring countless consequences to the affected tooth. Conclusions: For a correct diagnosis and treatment decision, these lesions must be seen under their multifactorial etiological aspect. Various therapeutic possibilities may be used in the treatment of these lesions, and it is necessary for the clinician to know the main etiological factors and clinical characteristics that differentiate them(AU)

Pica, a Little-Known Condition in Dentistry. Case Report / Pica, una Condición Poco Conocida en Odontología. Reporte de un Caso

ABSTRACT: Pica is a condition associated with the chronic, compulsive consumption of a particular substance or material that is not considered food. Culturally it is not accepted by society and its nutritional value is non-existent. When this behavior is repeated consistently for more than one month, it is considered to be Pica. This eating disorder does not have a clear etiology, but is associated with; orality in children, psychotic disorders, nutritional deficiencies, psychosocial problems, autism, family problems, OCD, stress, abuse, family separations and other traumatic events. In order to detect it, it is necessary to perform a correct anamnesis, clinical examination, radiographic examination, complementary examinations such as blood count, as well as a relationship of trust between the dentist and the patient are necessary. All of them will be able to guide us and make us come out of suspicion that this harmful behavior exists, since patients often hide it.

RESUMEN: Pica es una condición asociada al consumo compulsivo y crónico de alguna sustancia o material en particular, que no es considerada alimento. Culturalmente no es aceptado por la sociedad y su valor nutricional es inexistente. Cuando esta conducta se repite consiste-ntemente durante más de un mes, se considera como Pica. Este desorden de comportamiento alimenticio no tiene una etiología clara, pero se asocia a la oralidad en niños, trastornos psicóticos, deficiencias nutricionales, problemas psicosociales, autismo, problemas familiares, TOC, estrés, abuso, separaciones familiares y otros eventos traumáticos. Para detectarla, es necesaria una correcta anamnesis, examen clínico, radiográfico, exámenes complementarios como hemograma, además de una relación de confianza rapport odontólogo- paciente. El conjunto de ellos nos podrán guiar y salir de sospecha que esta conducta dañina existe, ya que los pacientes muchas veces lo esconden.

Factores de riesgo de la atrición dental severa: un estudio de casos y controles / Severe dental attrition and associated factors: a case-control study

Objetivo: identificar los factores de riesgo de la atrición dental severa en pacientes que acudieron a instituciones de atención odontológica, públicas y privadas, de la ciudad de Cuenca, Ecuador. Materiales y métodos: fueron analizados 237 pacientes adultos, 79 casos con atrición dental grados 2, 3 y 4, según el índice de Smith y Knight, y 158 contro- les con atrición grados 0 y 1. Se realizó un examen clínico y fotográfico para determinar la relación entre la atrición dental y factores como edad, sexo, procedencia, número de dientes residuales, pH salival y bruxismo. Resultados: los pacientes mayores de 25 años (OR= 2,47; IC= 1,41 ­ 4,35; X2= 10,21; p= 0,001), con menos de 20 dientes en boca (OR= 4,95; IC= 1,47 ­ 16,62; X2= 7,97; p= 0,004 ) y con bruxismo (OR= 2,64; IC= 1,45 ­ 4,81; X2= 10,49; p= 0,001) tienen más probabilidades de presentar atrición dental severa. Luego de una regresión logística binaria se confirmó dicha relación: pacientes mayores de 25 años (OR= 2,03; IC= 1,08 ­ 3,818) con menos de 20 dientes en boca (OR= 3,90; IC= 1,07 ­ 14,19) y con bruxismo (OR= 3,22; IC= 1,70 ­ 6,10); sin embargo, se observó una capacidad predictora muy baja de la variables ajustadas según el R­cuadrado de Cox y Snell (0,123) y el R­cuadrado de Nagelkerke (0,172). Conclusiones: edad avanzada, menor cantidad de dientes en boca y bruxismo aumentaron la posibilidad de presentar atrición dental severa en los pacientes analizados. Mientras que el sexo masculino, la procedencia rural y el pH salival crítico (menor a 6) no se comportaron como factores de riesgo.

Restauraciones transicionales de resina mediante la técnica de matriz transparente / Transitional resin restorations with the transparent matrix technique

La colocación de restauraciones directas a base de resina en el área de premolares y molares permite realizar tratamientos complejos en pacientes afectados por atrición dental severa y/o bruxismo. Hoy en día gracias a la técnica de grabado ácido, la fuerza de adhesión de la resina al esmalte disminuye la microfi ltración y sensibilidad postoperatoria. El objetivo de este artículo es describir la rehabilitación provisional mediante restauraciones adhesivas de resina compuesta en un paciente con atrición dental severa, el cual recibirá posteriormente tratamiento de ortodoncia por discrepancia de las arcadas. Al término de este tratamiento se colocarán restauraciones onlay de disilicato de litio (AU)

The placement of resin-based direct restorations in the area of premolars and molars allows the treatment of complex cases in patients aff ected by dental attrition and/or bruxism. Nowadays, due to the acid etching technique, the bond strength of the resin to the enamel will reduce the micro-leakage and post-operative sensitivity. The aim of this article is to describe the provisional rehabilitation with resin adhesive restorations, in a patient with a severe dental attrition, which will receive orthodontic treatment due to discrepancies in the arches. At the end of this treatment, ceramic restorations will be placed (AU)

Occurance of different tooth wear and degree of dental attrition / Шинэ санаа Шинэ нээлт

@#65 Non-bacterial originated tooth wear is a normal process which occurs throughout lif. If the rate of loss is likely to prejudice the survival of the teeth, or is a source of concern to the patient, then it may be considered ‘pathological’. Robb reported that the prevalence of pathological loss of tooth tissue in patients less than 26 years of age was greater than in many older age groups. Tooth surface loss was classified into 4 groups: attrition, erosion, abfraction and abrasion. To find the prevalence of four different types of tooth wear among patients visited Digital Dental Office, Ulaanbaatar, Mongolia and investigate their dental attrition severity. Methods: From total of patients visited Digital Dental Office clinic between September 2016 and September 2017 adults aged 16-62 who was found with any type of tooth wear were explored by 4 types. Those patients with attrition were chosen and severity was determined by Bardsley’s simplified tooth wear index (TWI). There were total of 5432 patients examined and treated during this period of time. From them total of 1002 patients aged 16-62 presented some degree of tooth hard tissue wear/dental attrition. Most of the patients were with combination of 4 types of tooth wear: attrition, abrasion, abfraction and erosion. Attrition (At) was found in 68 patients which was only 6.7%, Abrasion (Ab) in14 people-1.3%, Abfraction (Abf) in 4-0.3%, Erosion (Er) in 2 -0.1% alone. The combination of these types of tooth hard tissue was dominant. At+ab+abf+er in 59 patients of total 1002 (5.8%). At+ab+er in 58 (5.7%). Ab+abf in 29 (2.8%). At+er in 25 patients (2.4%). Er+ab in 27 (2,6%). At+abf+er in 264 people (26.3%). At+abf in 452 (45.1%), which was the most prevalent combination. Dental attrition severity in these 1002 patients were shown as following: -0-0- No loss of contour. -1-229 people (22.8%) - Loos of enamel surface characteristics. Minimal loss of contour. -2- 505 people (50.3 %) - Loss of enamel exposing dentine for less than one third of surface.Loss of enamel just exposing dentine. Defect less than 1 mm deep. -3- 211 people (21 %) - Loss of enamel exposing dentine for more than one third of surface.Loss of enamel and substantial loss of dentine. Defect less than 1-2 mm deep. -4-57 people (5.6%) - Complete enamel loss - pulp exposure - secondary dentin exposure.Pulp exposure or exposure of secondary dentine. Defect more than 2mm deep - pulp exposure - secondary dentine exposure. In this descriptive study showed patients with some degree of tooth wear were around 19% from total patients visited during 1 year of period. Four types of tooth hard tissue wear shown as a different combination, very low percentage was in these types alone. Most of the attrition patients were with mild to moderate degree of enamel loss. This kind of study should be continued to explore harmful dentofacial change

Full mouth rehabilitation on the patient with severe tooth wear and tooth fracture using reestabilishment of occlusal vertical dimension

Severe dental attrition causes pathological changes of the tooth, imbalanced occlusion, and functional and aesthetic complications and can also result in a decrease in occlusal vertical dimension that can incur temporomandibular joint and muscular complications. Before restoring the vertical dimension with full-mouth prosthetic restorations, it is important to determine the amount of vertical lifting through complete diagnosis. In this study, a 59 year-old male patient with generalized attrition and fracture of teeth was treated with full-mouth zirconia prosthetic restoration in order to recover vertical dimension and aesthetics. Through the analysis of physiologic rest position and inter-canine distance, the treatment was planned for lifting 3 mm in vertical dimension. Interim crown were fabricated after full-mouth wax up, having the patient use for 6 months. The final monolithic and bilayered zirconia restorations were completed. The patient showed satisfaction in function and aesthetics for 18 months of follow-up since delivering the final restorations.

Condylar path of the patients with severe dental attrition / 实用口腔医学杂志

Objective:To study the characteristics of condylar path in the patients with severe dental attrition.Methods:Using D5A De nar fully adjustable articulator and the Pantronic recording system, the kinemat ic character of condylar paths of 15 patients with severe occlusal attrition was investigated. In addition, the effects of posterior condylar determinants on oc clusal rehabilitation were studied in 5 cases. Results: The mean intercondylar distance of the patients was (60.72?4.40) mm, and the immediate side shift (ISS) was 1.35 mm(right)and 1.24 mm(left),the progressive si de shift (PSS) were 14.65 degrees (right) and 17.11 degrees (left),respectively. The Pantronic protrusive condylar guidance (PRO) were 23.45 degrees (right) and 26.85 degrees (left); The Pantronic nonworking path (ORB) was 26.50 degrees and the Fisher angle was present between protrusive path and nonworking path. In th e 5 cases of occlusal rehabilitation ISS, PSS and Panotronic reproducibility ind ex (PRI) were decreased.Conclusion: Occlusal rehabilitation main ly affect ISS, PSS and PRI.