RESUMO
Las lesiones digitales distales han fomentado un gran debate referente a su tratamiento, que puede ser: quirúrgico o conservador. El tratamiento, en definitiva, siempre se encamina a lograr cubrir los tejidos expuestos y epitelizar el pulpejo del dedo afectado. Durante muchas décadas, ha existido la evidencia de que la cicatrización secundaria puede ser beneficiosa y logra resultados favorables; sin embargo, por diferentes motivos ha quedado rezagada frente a la opción quirúrgica. Presentamos el caso de un paciente con amputación traumática del extremo distal del 3er dedo de la mano derecha, que fue tratado de forma conservadora, y se logró buenos resultados estéticos y funcionales. Revisamos en la literatura la validez y equivalencia entre el resultado conservador y el quirúrgico
Distal digital injuries have presented a great debate regarding its treatment, it could be: Surgical and conservative. The treatment is always aimed at achieving coverage of exposed tissues and epithelialization of the affected finger pulp. There has been evidence for many decades that secondary healing can be beneficial for the patient with favorable results, however, due to different aspects, it has lagged behind the surgical option. We present a case of a patient with traumatic amputation of the distal end of the 3rd finger of the right hand, which was treated conservatively, finding good aesthetic and functional results over time. We review in the literature the validity and equivalence in the conservative and surgical result.Keywords: digital amputation, hand, pulp injury, conservative treatment, secondary scarring.
Assuntos
Humanos , Masculino , Adulto , Dedos , Mãos , Amputação Traumática , Terapêutica , Ferimentos e Lesões , Tratamento ConservadorRESUMO
Objective: To study the effect of Matrilin-4 on the reparative dentin formation in the rats after dental pulp injury, and to explore its possibility to be used as a new capping agent. Methods: A total of 28 male Wistar rats were selected. A cavity on the occlusal surface of maxillary first molars on both sides was prepared in each rat. Matrilin-4 was applied on the left exposed pulp (Matrilin-4 group), and PBS was applied on the right exposed pulp (PBS group); and the cavities in both sides were covered with glass ions. On days 3, 7, 14 and 28 after operation, the rats were sacrificed, and the maxillary first molars on both sides of the rats were selected. HE staining and immunohistochemistry staining were used to observe and analyze the reparative dentin formation and the expression of dentin sialoprotein (DSP) in the odontoblasts. Results: The HE staining results showed that there were less inflammatory cells under the exposed pulp in that Matrilin-4 group at 3 d after operation compared with PBS group, and obvious vasodilation was found. At 7 d after operation, the inflammatory reaction under the exposed pulps in two groups was aggravated, but the inflammatory reaction in Matrilin-4 group was significantly lighter than that in PBS group, and the prophase dentin formation was found. After injury of 14 d, the pulp-exposed areas were covered by more complete dentin bridge in Matrilin-4 group; at 28 d after operation, compared with PBS group, there was a thick, complete and reparative dentin bridge under the exposed pulps, composed of tubular dentin in Matrilin-4 group, and there were reorganized odontoblastic layers beneath the dentin bridge. The results of immunohistochemistry showed that the positive expression strengths of DSP in the odontoblasts of the rats in two groups were gradually increased at 3, 7 and 14 d after operation, and were decreased at 28 d. The positive expression strengths of DSP in the odontoblast of the rats in Matrilin-4 group were stronger than those in PBS group at each time point after operation, and the positive expression strength reached the peak at 14 d. Conclusion: Compared with PBS group, the positive expression strength of DSP in the odontoblasts of the rats in Matrilin-4 group had significant differences (P<0.01) at 3, 7 and 14 d.
RESUMO
La literatura ya ha sugerido la implicancia del uso de fuerzas ortodóncicas como productoras de daño mecánico, reacción inflamatoria periodontal, lesión periapical y reabsorción radicular. Los parámetros más comúnmente explorados en investigaciones de la respuesta tisular a fuerzas ortodónticas consisten en medir los niveles de oxígeno pulpar, la vasculatura y los cambios en la circulación sanguínea. Se ha demostrado que la irrigación pulpar disminuye tempranamente cuando se realizan aplicaciones continuas de fuerzas ortodóncicas, aun si éstas son de intensidad suave, concluyendo que la magnitud de las fuerzas no necesariamente debe ser excesiva para originar daño celular, el que eventualmente podría derivar en cuadros que van desde simples cambios de color coronario hasta obliteraciones camerales o la misma necrosis pulpar. Se presentan dos casos de pacientes tratados ortodóncicamente con extravasación hemorrágica y necrosis pulpar (canino e incisivo lateral superiores izquierdos respectivamente), con ausencia informada de traumatismo previo, y se discuten protocolos diagnósticos para la evaluación de la salud pulpar.
The literature has suggested the implication of the use of orthodontic forces as producing mechanical damage, inflammatory reactions in the periodontium, periapical injury and root resorption. More commonly explored parameters in investigations of the tissue response to orthodontic forces consist of measuring the levels of pulpal oxygen and disturbances in dental pulp circulation. It has been demonstrated that the pulpal irrigation diminishes early when continuous applications of orthodontic forces are realized, even if these are of soft intensity, concluding that the magnitude of the forces must not necessarily be excessive to originate cell damage, which eventually might derive in signs such as simple crown discoloration to progressive obliteration or pulp necrosis. Two cases of orthodontically treated subjetcs with hemorrhagic extravasation and pulp necrosis (canine and lateral incisive respectively, both left upper) with absence of previous trauma are presented and the diagnostic protocols for the evaluation of the pulpal condition are discussed.