Método de extrusión dentaria unitaria con fines protésicos: caso clínico / Single tooth extrusion method for prosthetic purposes: a clinical case

La pérdida de estructura dentaria por debajo del margen gingival y de la cresta ósea alveolar, ya sea por caries, fracturas traumáticas, desgaste, reabsorción radicular o perforaciones iatrogénicas, dificulta el tratamiento protésico y requiere un abordaje multidisciplinario para conseguir resultados óptimos y estables a largo plazo. Se presenta el caso de una paciente adulta que acude a consulta con la pieza 2.3, que no permite una adecuada restauración protésica sin invadir el espacio biológico. Dentro del abanico de posibilidades terapéuticas se selecciona la extrusión dentaria unitaria guiada, para poder exponer un remanente dentario adecuado supragingival, y conseguir un adecuado efecto ferrule para la posterior rehabilitación protésica. La técnica presentada es eficaz, simple, cómoda, higiénica y útil en pacientes que no desean realizarse tratamiento de ortodoncia en ambas arcadas (AU)

Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation

Abstract Objective The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. Material and Methods Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). Results There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. Conclusions Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.

Partial maxillary osteotomy following an unsuccessful forced eruption of an impacted maxillary canine: 10 year follow-up. Review and case report

The maxillary canines are amongst the most frequently impacted teeth, second only to the third molars. Several conservative orthodontic and surgical techniques are available to position the teeth properly in the dental arch, even in severe cases. However, when an extraction is necessary, it often leaves a critical alveolar defect of difficult management. The authors present the technique of Partial Maxillary Osteotomy, in which a dento-alveolar segment is moved mesially, hence closing the remaining space, allowing for the formation of healthy periodontium and resulting in an adequate functional and aesthetic outcome. A case report is presented with a 10 year follow-up, proving the technique's stability in the long term.

Apical stress distribution on maxillary central incisor during various orthodontic tooth movements by varying cemental and two different periodontal ligament thicknesses: A FEM study.

Context: During fixed orthodontic therapy, when the stress levels in the periodontal ligament (PDL) exceedsan optimum level, it could lead to root resorption. Aims: To determine an apical stress incident on the maxillary central incisor during tooth movement with varying cemental and periodontal ligament thickness by Finite Element Method (FEM) modeling. Settings and Design: A three dimensional finite element model of a maxillary central incisor along with enamel, dentin, cementum, PDL and alveolar bone was recreated using EZIDCOM and AUTOCAD software. ALTAIR Hyper mesh 7.0 version was used to create the Finite Element meshwork of the tooth. This virtual model was transferred to Finite Element Analysis software, ANSYS where different tooth movements were performed. Materials and Methods: Cemental thickness at the root apex was varied from 200 μm to 1000 μm in increments of 200 μm. PDL thickness was varied as 0.24 mm and 0.15 mm. Intrusive, Extrusive, Rotation and Tipping forces were delivered to determine an apical stress for each set of parameters. Results: Results indicated that an apical stress induced in the cementum and PDL, increased with an increase in cementum and PDL thickness respectively. Apical stress induced in the cementum remained the same or decreased with an increase in the PDL thickness. Apical stress induced in the PDL decreased with an increase in the cementum thickness. Conclusion: The study concluded that the clinical delivery of an orthodontic forces will cause stress in the cementum and PDL. Hence, it is necessary to limit the orthodontic force to prevent root resorption.

Abordagem multidisciplinar para reabilitação implantossuportada em área estética / Multidisciplinary pproach to rehabilitation with implant-supported prothesis in anterior area

Este relato descreve um caso clínico em que foi executado um planejamento multidis¬ciplinar para a reabilitação com pró tese implantossuportada de um dente indicado para ex¬tração por reabsorção radicular. Inicialmente, foi feita extrusão ortodôntica, após o período de contenção foram realizadas a extração do dente e a colocação de implante imediato, com associação de enxerto ósseo e de tecido subepitelial. Após o período de maturação dos tecidos e de ósseointegração a reabilitação protética foi finalizada. Esta abordagem usou técnicas e conhecimentos de várias especialidades, potencializando os resultados estéticos e trazendo satisfação ao paciente.

This study describes a case report of a single tooth implant-supported multidisciplinaryrehabilitation. The tooth indicated for extraction by root resorption was initially orthodonticaly extruded, and after the retention period was performed a tooth extraction, immediate implant placement in association with bone graft and subepithelial connective tissue graft. After tissuesmaturation and osseointegration period, prosthetic rehabilitation was completed.This approach I used techniques and knowledge in various specialties, enhancing the aesthetic results and brin¬ging satisfaction to the patient.

Redução da sobremordida com extrusão dos dentes posteriores / Overbite treatment with extrusion of the posterior teeth

O presente artigo descreve um método simples para redução da sobremordida promovendo a extrusão dos dentes posteriores. Tal método alia a técnica do arco contínuo com o levantamento de mordida anterior e com elásticos de intercuspidação na região de pré-molares e molares para extrusão dos dentes posteriores, sobretudo os inferiores.

Limpeza do forame e extrusão apical de raspas de dentina em dentes unirradiculares submetidos ao procedimento de patência apical / Cleaning of the foramen apical and apical extrusion of dentin chips in single-rooted teeth subjected to apical patency

Objetivo: Verificar a limpeza do forame e a extrusão periapical de raspas de dentina em dentes unirradiculares instrumentados por duas diferentes técnicas sendo que uma delas continha o procedimento de patência apical. Método: Foram selecionados 30 dentes corados internamente com nanquim, divididos em dois grupos, sendo somente o grupo I submeti do a patência apical. A extrusão das raspas de dentina foi coletada em um recipiente de vidro para mensuração. A região do forame apical dividida em quadrantes foi analisada por meio de microscópio estereoscópico para verificar a ação do instrumento sobre suas paredes. O número de paredes limpas (sem nanquim) recebeu pontuação de 0 a 4, sendo a pontuação 0 correspondente a nenhuma parede limpa. Resultados: No grupo I, não houve presença de plug dentinário, porém somente 1 dente obteve pontuação 4. No grupo II, 10 dentes apresentaram plug dentinário e todos receberam pontuação 0. A massa de dentina extruída não mostrou diferença significativa (teste Scheff e p<0,05) entre os grupos I e II. Conclusão: O emprego da patência apical em dentes unirradiculares não modifica a quantidade de raspas de dentina extruídas pelo forame apical, não produz limpeza adequada nas paredes do canal cementário, porém remove o tampão de raspas de dentina do canal cementário.

Objective: To verify the cleaning of the apical foramen and apical extrusion of dentin chips in single-rooted teeth instrumented with two techniques, one of which including the apical patency procedure. Method: Thirty teeth were internally stained with Indian ink, divided in two groups, of which only group I was subjected to apical patency. The dentin chips extruded through the apical foramen were collected in a glass receptacle and quantified. The apical foramen region was divided in quadrants and analyzed with a stereomicroscope to verify the action of the instrument on the cemental canal walls. The teeth were scored 0 4 according to the number of clean walls (without Indian ink), 0 corresponding to no clean wall. Results: In group I, there was no dentin plug, but only 1 tooth was scored 4. In group II, 10 teeth presented dentin plug and all of them were scored 0. There was no statistically significant difference between groups I and II regarding the extruded dentin mass (Scheff ‚ test; p<0.05). Conclusion: The use of the apical patency procedure in singlerooted teeth does not modify the amount of dentin chips extruded through the apical foramen, does not produce an adequate cleaning of the cemental canal walls, but remove the plug of dentin chips from the cemental canal. Tooth apex; Root canal preparation; Endodontics.

Extrusión dentaria en el tratamiento de una fractura mixta / Dental extrusion in the treatment of a mixed fracture

Se describe el caso clínico de un paciente que acudió a la consulta en busca de ayuda especializada, pues su diente número 13 presentaba una fractura mixta, oblicua de vestibular a lingual, con gran pérdida de tejido dentario en su cara bucal. El tratamiento pulporradicular, la extrusión dentaria y la reconstrucción de la pieza dañada mediante la técnica estratificada con resina fotopolimerizable, permitieron resolver el problema.

The clinical case of a patient who visited us searching specialized help, because his tooth number 13 presented an oblique from vestibular to lingual mixed fracture, with great loss of dental tissue in its buccal aspect is described. The pulpal-radicular treatment, the dental extrusion and the restoration of the damaged tooth by means of the stratified technique with photopolymerizable resin, allowed to solve the problem.

Extrusão ortodôntica como auxiliar na obtenção da excelência estética de prótese sobre implante / Orthodontic extrusion as an assistant on obtaining esthetic excellence of prosthesis over implant

Este artigo relata a seqüência de extrusão forçada de um incisivo central superior, através de aparotologia ortodôntica, previamente à colocação de implante osseointegrado e à realização de prótese sobre implante. Havia indicação de exodontia e a extrusão ortodôntica foi realizada com objetivo de fornecer área adequada para inserção do implante. A conjugação dos tratamentos ortodôntico, periodontal e protético é apresentada nesse relato de caso, que obteve resultado estéticos satisfatórios.