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ABSTRACTBACKGROUND AND OBJECTIVES:Amelogenesis imperfecta is characterized by enamel structural defects, which may severely affect dental structure in both dentitions. When accompanied by severe decay, it may impair the pulp complex requiring endodontic treatment and in case of incomplete root formation treatment becomes more complex due to pulp volume and anatomic conditions. This study aimed at reporting a clinical case of patient with amelogenesis imperfecta and with multiple incomplete root formation as a consequence.CASE REPORT:Female patient, 12 years old, leucodermic, with painful symptoms, who has looked for dental assistance. At intraoral clinical evaluation teeth presented with shape and size changes, yellowish color, covered by a thin enamel layer with roughened surface and absent in some areas, with anterior vestibular sulcus fistula and without edema. At radiographic evaluation, both dentitions were affected by the abnormality with delayed chronology of permanent teeth eruption. At the end of all evaluations, patient was diagnosed with amelogenesis imperfecta, and periodontal treatment was started, followed by endodontic treatment.CONCLUSION:Amelogenesis treatment is complex, especially when in more advanced stages of dental structure destruction. However, it is possible to reestablish patient’s functionality and esthetics with good planning and multidisciplinary approach.
RESUMOJUSTIFICATIVA E OBJETIVOS:A amelogênese imperfeita é caracterizada por defeitos estruturais do esmalte, os quais podem acometer gravemente a estrutura dentária, em ambas as dentições. Quando acometida por lesões cariosas graves, pode comprometer o complexo pulpar, necessitando de tratamento endodôntico, e em se tratando de dentes com rizogênese incompleta, o tratamento torna-se mais complexo, em virtude do volume pulpar e das condições anatômicas. O objetivo deste estudo foi relatar um caso clínico de paciente com amelogênese imperfeita e que teve como consequência múltiplos casos de rizogênese incompleta.RELATO DO CASO:Paciente do gênero feminino, 12 anos, leucoderma, com sintomas dolorosos procurou atendimento odontológico. Ao exame clinico intraoral, apresentava dentes com alteração de forma e tamanho, coloração amarelada, recobertos por uma fina camada de esmalte com superfície rugosa e em algumas áreas ausente, com fístula na região do sulco vestibular anterior e sem edema. Ao exame radiográfico ambas as dentições mostraram-se acometidas por anomalia, com retardo na cronologia de erupção dos dentes permanentes. Ao final de todos os exames, recebeu o diagnóstico de amelogênese imperfeita, dando inicio ao tratamento, que começou pelo tratamento periodontal, seguido pelo endodôntico.CONCLUSÃO:O tratamento da amelogênese é complexo, principalmente quando em estágios mais avançados de destruição da estrutura dentária. Contudo é possível restabelecer a funcionalidade e a estética do paciente quando se faz um bom planejamento do caso, com interação multidisciplinar.
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Introduction: Endodontic treatment of young permanent teeth with incomplete root formation and necrotic pulp has been a challenge for the dentist. It is necessary to induce the formation of apical barrier (apical plug), enabling the complete root canal filling. Objective: This retrospective clinical study compared the protocols for treatment of teeth with incomplete root formation, using calcium hydroxide (CH) or mineral trioxide aggregate (MTA). Material and methods: 28 patients with incomplete root formation have undergone root canal treatments in the period from 2000 to 2009 were selected. The procedures for cleaning, shaping and intracanal medication (CH paste) were performed in a standardized manner. In 13 patients, after using the CH paste (14 days), apical plugs with MTA were made. In the remaining 15 teeth monthly exchanges with CH paste were executed until it was observed radiographically the formation of the apical barrier. In all cases the canals were filled conventionally with gutta-percha and sealer. Initially, follow-ups were made on a quarterly and semiannually at the end of first year. Results: All apical lesions showed apical healing between 4 and 13 months after starting treatment. There was not noted the continuing process of root formation. Conclusion: It was concluded that the treatment of teeth with incomplete root formation and necrotic pulp with the use of MTA as apical plug has the same clinical results compared with the use of CH, with the advantage of less clinical time.
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OBJETIVO: determinar as medidas lineares dos estágios de desenvolvimento da dentição permanente humana, usando tomografia computadorizada de feixe cônico (TCFC). MÉTODOS: este estudo foi desenvolvido a partir de bancos de dados de clínicas radiológicas privadas, envolvendo 18 pacientes (13 do sexo masculino, 5 do sexo feminino, com idades variando entre 3 e 20 anos). As imagens das TCFC foram obtidas por meio do sistema i-CAT e medidas com uma função específica do programa desse mesmo sistema. Duzentos e trinta e oito dentes foram analisados, em diferentes estágios de desenvolvimento, nos planos coronal e sagital. O método foi baseado na delimitação e mensuração das distâncias entre pontos anatômicos correspondentes ao desenvolvimento das coroas e raízes dentárias. A partir dos valores obtidos, pôde-se desenvolver um modelo quantitativo para se avaliar os estágios inicial e final de desenvolvimento para todos os grupos dentários. RESULTADOS E CONCLUSÕES: as medidas obtidas dos diferentes grupos dentários estão de acordo com as estimativas das investigações publicadas previamente. As imagens por TCFC dos diferentes estágios de desenvolvimento podem contribuir no diagnóstico, planejamento e resultado dos tratamentos em diversas especialidades odontológicas. As dimensões das coroas e das raízes dentárias podem ter importantes aplicações clínicas e em pesquisas, constituindo uma técnica não invasiva que contribui com estudos in vivo. Entretanto, mais estudos são recomendados a fim de minimizar possíveis variáveis metodológicas.
OBJECTIVE: To determine the linear measurements of human permanent dentition development stages using Cone-Beam Computed Tomography. METHODS: This study was based on databases of private radiology clinics involving 18 patients (13 male and 5 female, with age ranging from 3 to 20 years). Cone-Beam Computed Tomography (CBCT) images were acquired with i-CAT system and measured with a specific function of the i-CAT software. Two hundred and thirty-eight teeth were analyzed in different development stages in the coronal and sagittal planes. The method was based on delimitation and measurement of the distance between anatomical landmarks corresponding to the development of the dental crowns and roots. These measurements allowed the development of a quantitative model to evaluate the initial and final development stages for all dental groups. RESULTS AND CONCLUSIONS: The measurements acquired from different dental groups are in agreement with estimates of investigations previously published. CBCT images of different development stages may contribute to diagnosis, planning and outcome of treatment in various dental specialties. The dimensions of dental crowns and roots may have important clinical and research applications, constituting a noninvasive technique which contributes to in vivo studies. However, further studies are recommended to minimize methodological variables.