Retratamiento y reparación de una perforación radicular. Informe clínico, radiográfico e histológico / Retreatment and healing of a case of root perforation. Clinical, radiographic and histological report

Objetivo: Describir los aspectos clínicos, radiográfi- cos e histológicos del retratamiento realizado en un segundo molar superior en el que se había producido previamente una perforación radicular durante el tratamiento original. Caso clínico: Un paciente masculino de 50 años con- currió a la consulta para realizar un retratamiento endodóntico en un segundo molar superior derecho. El examen radiográfi- co reveló la presencia de un tratamiento incompleto, un área radiolúcida periapical y una perforación radicular producida por un poste roscado insertado fuera del espacio del conducto mesio vestibular. Una vez retirado el poste, se selló la perfo- ración con Biodentine y se realizó el retratamiento. Luego de dos años, el paciente regresó a la consulta con dolor a la mas- ticación, localizado en el área correspondiente al segundo mo- lar superior derecho previamente tratado. Durante el examen clínico y radiográfico se detectó la presencia de una fractura vertical en la raíz palatina. A causa del severo compromiso radicular el molar fue extraído y derivado para su análisis his- tológico. El informe del laboratorio reveló que la perforación había sido reparada por medio de la aposición de un nuevo tejido calcificado y que el remanente periodontal adherido a la raíz se encontraba dentro de los límites normales. El presente caso clínico resalta la importancia que tiene el conocimiento cabal de la anatomía del sistema de conductos radiculares con el objeto de evitar errores de procedimiento que puedan influir negativamente en el pronóstico del tratamiento (AU)

Aim: To describe the clinical, radiographic and histo- logical aspects of the retreatment of a second upper molar in which root perforation had occurred during the original treatment. Clinical case: A 50-year old male was referred for endo- dontic retreatment of the right second maxillary molar. Radi- ographic examination revealed the presence of an incomplete root canal treatment, a radiolucent periapical area and a root perforation produced by a threaded post placed outside of the mesiobuccal root canal. After post removal, the root perfo- ration was sealed with Biodentine and the root canals were retreated. Two years later, the patient returned to the office com- plaining of severe pain during mastication, in the area of the previously retreated right second maxillary molar. Clinical and radiographic examination revealed the presence of a ver- tical fracture on the palatal root. Since this kind of root dam- age non-restorable, the tooth was extracted and submitted to histologic analysis. The laboratory report revealed that the perforation site had healed by the apposition of new calci- fied tissue, and that the remnants of periodontal tissue which persisted attached to the root were within normal limits. This clinical case highlights the importance of thorough knowl- edge of the anatomy of the root canal system in order to avoid procedural errors which may compromise the prognosis of the treatment (AU)

Pulp canal obliteration after traumatic injuries in permanent teeth - scientific fact or fiction?

Abstract: Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.

50-year-old man with progressive dyspnea

Dental foreign body aspiration is a known complication in patients with maxillofacial trauma. Although diagnosis may be delayed, especially in elderly people with radiolucent dental appliances, clinician must be aware of dental tracheobronchial aspiration to minimize potentially serious consequences. We present a 50-year-old man with three months history of progressive dyspnea due to foreign body aspiration occluding distal trachea. The patient had a history of car accident with facial trauma and denture fracture two years before presentation. Fiberoptic bronchoscopy revealed almost totally obstructing mass-like lesion with nodular infiltration in distal trachea. The patient underwent rigid bronchoscopy and a piece of denture with three teeth was extracted

Sinusite odontogênica por iatrogenia com cinco anos de evolução / Odontogenic sinusitis due to iatrogenic with five years of evolution

Sempre que um procedimento odontológico, seja este cirúrgico ou não, for realizado no arco superior, deve-se considerar a relação anatômica do seio maxilar com as raízes dentárias, pois a penetração acidental dessas raízes ou de dentes no seio maxilar poderá ocorrer. Isto normalmente é resultado de falha no diagnóstico e uso de manobras cirúrgicas intempestivas. Caso esse material não seja removido e a comunicação tratada, o paciente poderá ter complicações como uma sinusite crônica. É relatado um caso de sinusite odontogênica crônica causada por deslocamento de fragmento dentário no seio maxilar com diagnóstico e tratamento adequado apenas após cinco anos da realização da extração que deu origem à sinusite.

When a dental procedure, surgical or not, is conducted in the upper jaw, one must consider the anatomical relationship of the maxillary sinus with teeth roots, because the accidental penetration of them or of teeth in the maxillary sinus may occur. This usually results from failure to diagnose and untimely use of surgical maneuvers. If such body is not removed and the communication is not treated, the patient may have complications such as chronic sinusitis. A case of chronic odontogenic sinusitis caused by dislocation of dental fragment into the maxillary sinus diagnosed only after five years of the extraction realization and its treatment is reported.

A comparative evaluation of healing with a computed tomography scan of bilateral periapical lesions treated with and without the use of platelet-rich plasma.

Periradicular surgery aims to achieve complete wound healing and regeneration of the periodontal unit. Platelet-rich plasma (PRP) is a platelet concentrate that is widely used to promote tissue healing, and bone induction through its various growth factors has been used in this study. This case report describes the use of PRP unilaterally in a bilateral periapical lesion in the same patient. The site treated with PRP showed better healing than the untreated site. This was confirmed with computed tomography (CT) scan readings. It was hypothesized that PRP could promote tissue regeneration and alveolar bone repair.

Non-surgical management of a mutilated maxillary central incisor with open apex and large periapical lesion.

A 24-year-old female patient reported with a mutilated maxillary left central incisor. The coronal tooth structure remaining was very less, discolored, and brittle. She gave history of trauma about 15 years back when the tooth got fractured. An intraoral periapical radiograph revealed an open apex and a large periapical lesion. The case was managed successfully by conservative means using intracanal calcium hydroxide and mineral trioxide aggregate (MTA) apical barrier followed by a fiber post and a core. The final crown restored back esthetics and function. A 6-month follow-up demonstrated a clinically asymptomatic and adequately functional tooth, with radiological signs of healing.

Dental trauma involving root fracture and periodontal ligament injury: a 10-year retrospective study

The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion) treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP), Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were examined. The results of this survey revealed that subluxation (25.09 percent) was the most common type of periodontal ligament injury, followed by extrusive luxation (19.86 percent). There was a predominance of young male patients and most of them did not present systemic alterations. Among the etiologic factors, the most frequent causes were falls and bicycle accidents. Injuries on extraoral soft tissues were mostly laceration and abrasion, while gingival and lip mucosa lacerations prevailed on intraoral soft tissues injuries. Radiographically, the most common finding was an increase of the periodontal ligament space. The most commonly performed treatment was root canal therapy. Within the limits of this study, it can be concluded that traumatic dental injuries occur more frequently in young male individuals, due to falls and bicycle accidents. Subluxation was the most common type of periodontal ligament injury. Root canal therapy was the type of treatment most commonly planned and performed.

importance of long time follow-up after vital pulp therapy: a case report

This report describes a case of an eight years old girl who was treated for complicated crown fracture of right maxillary central incisor because of a sport accident. For the tooth total pulpotomy was performed in order to achieve apexogenesis and the tooth was restored with a composite resin. The patient was reviewed over 10 years. At first the tooth showed continued root development and complete apex formation following vital pulp therapy, however, after 10 years the tooth developed pulp necrosis and periapical radiolucency. Following root canal therapy, periapical radiolucency has been healed

Consideraciones clínicas de un caso de odontodisplasia regional / Clinical considerations of a regional odontodysplasia case

La odontodisplasia regional (RO) es una anomalía no hereditaria poco frecuente del desarrollo dentario, que afecta el componente ectodérmico y mesodérmico de las piezas dentarias, generalmente de un cuadrante y en forma unilateral. El diagnóstico y tratamiento de las anomalías dentales como ésta, constituye una de las áreas importantes de la odontopediatría. Caso clínico: paciente de género masculino de 4 años de edad, consulta por traumatismo de los incisivos temporales superiores izquierdos. Las radiografías oclusal, periapical y panorámica mostraron en el cuadrante superior izaquierdo indicios de restos radiculares de estos incisivos, así como una imagen normal del primer molar temporal y su sucesor; retardo en el desarrollo de los incisivos permanentes, y la imagen característica de diente fantasma en el segundo molar temporal y primer molar permanente. Se diagnostica odontodisplasia regional. El paciente se trató por 2 años con acciones preventivas, haciendo énfasis en el autocontrol de placa bacteriana y aplicaciones de fluoruros en forma tópica. El sector anterior se rehabilitó con prótesis removible, siendo controlado con examen clínico y radiográfico a la espera del tratamiento de ortodoncia e implantes osteointegrados al finalizar la etapa de desarrollo y crecimiento. Como conclusión, es importante conocer la patología para un temprano y correcto diagnóstico, suprimir el dolor y realizar acciones tendientes a conseguir una función adecuada, restablecer la estética y dimensión vertical, facilitando la planificación y desarrollo del tratamiento definitivo.

Nível de informação sobre a conduta de urgência frente ao traumatismo / Level of information about the urgent procedurs in dental traumatism with avulsion

Avaliar o nível de informação de estudantes, comidade média de 12 anos, seus pais e professores, de escolas públicas e particulares, quanto à conduta de urgência frente ao traumatismo dental com avulsão. Método: A amostra foi constituída de 990 indivíduos, aos quais foi aplicado um questionário fechado, devidamente orientado, que, após análise e avaliação por dois endodontistas e uma patologista bucal, foram classificados em quatro níveis alto, razoável,baixo e muito baixo. Resultados: Do total de entrevistados,apenas 6,77 por cento apresentaram um alto nível de conhecimento;16,26 por cento apresentaram um nível razoável; 51,13 por cento um nível baixo, enquanto 23,84 por cento apresentaram um nível deconhecimento muito baixo. Não foi estabelecida uma correlação significativa entre escolas públicas e particulares.Conclusão: É baixo o nível de conhecimento sobre a condutade urgência frente ao traumatismo dental, tornando necessária a inclusão do tema nos programas de prevenção à saúde bucal.

Prevalencia de traumatismos dentoalveolares en niños preescolares de la comuna de Concepción: Chile / Prevalence of dental trauma in preschool children in Concepción, Chile

Se realizó un estudio de prevalencia de traumatismos dento alveolares en 336 niños entre 3 y 5 años 11 meses de la comuna de Concepción, Chile, estudiándose las variables sexo, edad, nivel socioeconómico y tipo de lesión encontrada. La prevalencia fue de 11,90%, con un 72% de lesiones de esmalte, 25% de cambios de coloración y 2,5% de lesiones de tejidos blandos. Un 8.73% de los niños de Jardines Particulares presentaron trauma a diferencia de un 13.8% de los niños de Jardines Públicos. Los pacientes de género masculino presentaron un 20%más de traumatismos dentoalveolares que las de género femenino, no siendo esta diferencia estadísticamente significativa. Los grupos etáreos de 4 y 5 años presentaron un 37.5% de prevalencia, a diferencia del grupo de 3 años que presentó un 25%. Sólo un 47,05% de los padres había notado la presencia del trauma.

A prevalence study on dentoalveolar trauma in 336 children between 3 and 5 years 11 months of age in Concepción, Chile is presented. Studied variables were gender, age, socioeconomic status and type oflesion encountered. Calculated prevalence for dentoalveolar trauma was 11,9%. Lesions encountered were enamel lesions (72%), changes in colour (25%) and soft tissue lesions (2,5%). Prevalence of lesions was 8,73% in private kindergartens and 13,8% in public ones. Male gender had 20% more lesions than females (Non statistically significant). Age group between 4 and 5 years had prevalence of 37,5% while 3 year-old group had only a 25% prevalence. Only 47,05% of parents had noticed the presence of dentoalveolar trauma in their children. When noted it immediately prompted odontological assistance.

Estudio de la reabsorción radicular: actualización e imagen radiográfica / A study of root resorption: update and radiographic image

La reabsorción radicular es una condición asociada a un proceso fisiológico o a uno patológico. Consiste en la pérdida de estructura por disolución de los tejidos que componen la raíz de una pieza dentaria, como son el cemento y la dentina. En el presente artículo se expone un análisis de los distintos tipos de reabsorción radicular, considerando los factores que condicionan su manifestación y la descripción de su imagen radiográfica

Intrusäo de incisivos decíduos provocando distúrbio no desenvolvimento de dentes permanentes: relato de caso / Incisor deciduous intruction caused disturbance in the development of the permanent tooth: case related

Dentes decíduos que tenham sofrido qualquer tipo de trauma devem ser periodicamente avaliados, para que se possa diagnosticar precocemente a ocorrência de patologia pulpar ou periapical que resulte em prejuízo para o desenvolvimento normal do dente permanente sucessor. Neste trabalho, é descrito um caso de distúrbio de desenvolvimento dos germes de incisivos superiores permanentes, que resultou em lesäo semelhante a odontoma nos centrais e hipoplasia nos laterais, e cuja causa foi, provavelmente, um traumatismo que provocou a intrusäo dos incisivos centrais decíduos, aos 16 meses de idade