Age-Related Pattern of Dental Trauma in a Nigerian Tertiary Health Institution

Abstract Objective: To evaluate the pattern of traumatic dental injuries among children, adolescents, and adults. Material and Methods: This was a cross-sectional analytic study of children and adults who presented with dental trauma. Data utilized for this study were sociodemographic characteristics, history of the traumatic incident, presenting complaints, traumatized teeth and classification of the traumatized tissues using Ellis and Davey's classification. Results: A total of 163 participants with 307 traumatized teeth were included in the study. The participants' age ranged from 2 years to 75 years, with a mean age of 25.36 ±15.4 years. Children <10 years were the least represented (14.7%), adolescents 10-19 years accounted for 23.9%., young adults 20 to 40 years were the most represented (44.8%) and older adults >40 years (16.6%). A higher proportion of the study participants were female 83 (50.9%) and the most prevalent complaint was broken teeth (57.1%) The most prevalent aetiology of the trauma documented was fall (36.2%). The most prevalent injury type was extended crown fracture with noticeable dentinal involvement without pulp exposure. There was a statistically significant association between injury type, aetiology and age group. Conclusion: Traumatic dental injuries affect children, adolescents and adults alike. The central incisors were the most vulnerable teeth across all age groups. Age was significantly associated with the etiology of dental trauma and injury type (AU).

Prevalence of and factors associated with enamel fracture and other traumas in Brazilian children 8-10 years old

Abstract The aim of this study was to assess the prevalence and discriminate the associated factors between enamel fractures and other trauma/trauma sequelae in 8 to 10-year-old Brazilian schoolchildren. A representative sample of 1,201 children from public and private schools were enrolled in this cross-sectional study. Questionnaires about sociodemographic characteristics were answered by parents. The outcome variable (traumatic dental injury, TDI) was multi-categorized. Independent individual variables were sex, age, number of residents in household, parents/caregivers' level of education, family income, dental caries, and overjet. Type of school was considered an independent contextual variable. Multilevel analysis, bivariate, and multivariate multinomial logistic regression models were performed. The prevalence of TDI was 14.0% (2.8% with other trauma/trauma sequelae). The multilevel analysis revealed no significant difference between the type of school and TDI. The multinomial logistic regression showed that boys (OR = 2.3; 95%CI: 1.1-4.8), older children (OR = 1.8; 95%CI: 1.1-3.0) and individuals with an overjet > 3 mm (OR = 2.5; 95%CI: 1.0-6.2) were more likely to present other trauma/trauma sequelae. Enamel fracture was not significantly associated with any variables. The prevalence of TDI in 8 to 10-year-old schoolchildren was 14% but only 2.8% of other trauma/trauma sequelae. Differences regarding the associated factors of TDI involving enamel fracture or other trauma/trauma sequelae were detected, suggesting that the different TDI classification cannot be evaluated as a single category.

Influence of remaining coronal thickness and height on biomechanical behavior of endodontically treated teeth: survival rates, load to fracture and finite element analysis

Abstract Objective To evaluate the effect of restorative strategy (fiber post vs cast post and core), coronal height (0 mm vs 2 mm) and thickness (higher than 1 mm vs lower than 1 mm) on survival rate, fracture resistance and stress distribution. Material and Methods Seventy-two bovine teeth were cleaned and allocated in six groups (n = 12). Twenty-four teeth were sectioned at 13 mm length (no remaining coronal structure) and forty-eight were sectioned at 15 mm (2 mm remaining coronal structure). Half of the forty-eight had remaining coronal thickness lower than 1 mm and the other half had thickness higher than 1 mm. All root canals were prepared at 10 mm (luting length), fiber posts were cemented in thirty-six specimens and cast post and core in other thirty-six. All teeth were restored with metallic crowns. Specimens were submitted to 1.5 million cycles (100 N, 45°, 10 Hz at 2 mm below incisal edge) and evaluated at each 500,000 cycles to detect failures. Specimens that survived were submitted to load to fracture test. Bidimensional (Rhinoceros® 4.0) models were obteined survival data submitted to Kaplan-Meier (α=0.05) analysis and load to fracture values submitted to ANOVA and Tukey tests (α=0.05). Results Groups without remaining coronal structure showed survival rates lower than other groups (p=0.001). ANOVA showed higher values of load to fracture for groups with coronal thickness higher than 1 mm (p=0.0043). Finite element analysis showed better stress distribution in groups with remaining coronal structure and restored with fiber post. Conclusion Specimens without remaining coronal structure have lower survival rates. Specimens with remaining structure lower than 1 mm and without coronal structure support the same load to fracture value independently of the restorative strategy.

Retrospective Study of Traumatic Dental Injuries of Patients Treated at a Dental Trauma Clinic in Santiago, Chile / Estudio retrospectivo de Casos Atendidos en Clínica de Traumatología Dentoalveolar en Santiago, Chile

ABSTRACT: The aim of this study was to carry out a retrospective study of cases seen at the Child and Adult Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile, Santiago. A retrospective study was carried out analysing the records of patients seen at the Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile from January 2012 to March 2017. The inclusion criteria was that patient complaint was due to dental trauma. Data were tabulated indicating age and sex of the patient, cause, day, and tooth involved and the initial diagnosis of the dental trauma. Chi-square, Shapiro Wilk normality test and Mann-Whitney test were used for frequency analyses. A total of 117 dental records were analysed, 90 of these met the inclusion criteria. The age range of the sample was 5 to 60 years, and the average age was 14.3 years. Most injuries occurred in patients during the first and second decades of their life. Of the patients, 59.3 % were men and 40.7 % were women. The most frequent dental traumas were complicated and uncomplicated crown fractures, followed by root fractures. In the majority of the cases analysed, only one tooth was affected, and the tooth most frequently traumatized was the right upper central incisor, followed by the left upper central incisor. The most frequent dental trauma of the cases treated at the Child and Adult Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile, Santiago, between 2012 and 2017 were crown fractures.

RESUMEN: El objetivo fue realizar un estudio retrospectivo de los casos que acuden a la clínica de Traumatología Dentoalveolar (TDA) Pediátrica y del Adulto de la Clínica de Odontología de la Universidad de Chile. Se realizó un estudio retrospectivo analizando las fichas de pacientes atendidos en la Clínica de TDA de la Facultad de Odontología, Universidad de Chile desde enero 2012 hasta marzo 2017. El criterio de inclusión fue motivo de consulta por traumatismo dentoalveolar inmediato. Se tabularon datos consignando sexo y edad del paciente, causa, día, diente involucrado y diagnóstico inicial del TDA. Para los análisis de frecuencia se utilizó Chi-cuadrado, el test de normalidad de Shapiro Wilk y test de Mann-Whitney. Se analizaron un total de 117 fichas, donde 90 cumplieron con los criterios de inclusión. El rango de edad de la muestra fue de 5 a 60 años, con un promedio de 14,3 años. Siendo la primera y la segunda década de vida donde ocurren con mayor frecuencia los traumatismos. El 59,3 % eran hombres y 40,7 % mujeres. El TDA más frecuente fueron las fracturas coronarias complicadas y no complicadas, seguido por fracturas radiculares. En la mayoría de los casos analizados sólo un diente se encontraba afectado. El diente más frecuentemente traumatizado fue el incisivo central superior derecho, seguido por el izquierdo. Las causas más frecuentes de traumatismo fueron por caída y golpe. De los casos atendidos en la clínica de TDA de la Universidad de Chile entre 2012 y 2017 el traumatismo más frecuente es la fractura coronaria.

Incidência de fraturas em próteses fixas: estudo retrospectivo. Análise da sobrevivência de próteses metalocerâmicas após um período mínimo de quatro anos em função / Fractures incidence on fixed prostheses: a retrospective study

As próteses metalocerâmicas ainda são apontadas como o tratamento de escolha em reabilitação oral por apresentarem altas taxas de sobrevivência, mesmo que o fator estético possa ser comprometido devido às propriedades óticas relacionadas à infraestrutura metálica. Além disso, há pouca informação na literatura científica sobre os fatores que levam às fraturas das próteses fixas metalocerâmicas. Com isso, o presente estudo teve como objetivo avaliar se a quantidade de elementos que compõe uma prótese, se a quantidade de elementos por retentor, se o tipo de prótese, se o tipo de pilar, se a localização da prótese, se o bruxismo e se a utilização de placa miorrelaxante influenciam na incidência de fraturas em próteses fixas metalocerâmicas. Para este estudo, foram selecionados 16 pacientes, totalizando 74 próteses metalocerâmicas, instaladas entre 2000 e 2010, que tiveram um acompanhamento mínimo de 4 anos. Foram coletados dados, como: gênero, idade, data de instalação das próteses e sistema cerâmico utilizado. Foi realizada a avaliação clínica considerando integridade da prótese, características do elemento antagonista e coleta da história odontológica em caso de fratura, além de um questionário para identificar provável ou possível bruxismo. Foram determinadas as taxas de sucesso, insucesso e sobrevivência da mesma. Os resultados mostraram que a taxa de sucesso das próteses metalocerâmicas instaladas foi de 87,8% e a taxa de sobrevivência foi de 89,1%. Além disso, a taxa de sucesso não foi influenciada pela idade (p=0,903), tempo de instalação (p=0,830), número de próteses na boca (p=0,872), número de elementos (p=0,937) e número de pilares (p=0,064). Para as variáveis qualitativas também não houve diferença estatística significante (p>0,05) entre as proporções das taxas de sucesso e insucesso. Contudo, os resultados mostraram que pacientes que não usavam placa miorrelaxante tiveram taxa maior de sucesso que os pacientes usuários de placa (p=0,004). Assim, pode-se concluir que as próteses metalocerâmicas apresentam altas taxas de sucesso e sobrevida garantindo a longevidade desse tipo de reabilitação.(AU)

Metal-ceramic prosthesis are still the treatment choice in oral rehabilitation because they present high survival rates, even if the aesthetic can be compromised due to optical properties related to metallic infrastructure. In addition, there is little information on scientific literature about factors that lead to fractures of fixed metalceramic prosthesis. The purpose of this study was to evaluate if prosthesis elements number, number of elements per prosthetic abutment, type of prosthesis, type of prosthetic abutment, the prosthesis location, bruxism and myorelaxant plaque influences on incidence of fractures in fixed metal-ceramic prosthesis. For this study, 16 patients were selected totaling 74 metal-ceramic dentures installed between 2000 and 2010 with a follow-up of at least 4 years. Data were collected, such as: gender, age, prosthesis installation date and the ceramic system used. Besides a questionnaire to identify probable or possible bruxism, a clinical evaluation was performed to evaluate prosthesis integrity, antagonist element characteristics and dental history in case of fracture. Success, failure and survival rates were determined. The results showed that the success rate of metal-ceramic prosthesis was 87.8% and the survival rate was 89.1%. In addition, the success rate was independent of age (p=0.903), installation time (p=0.830), number of prosthesis (p=0.872), elements (p=0.937) and abutments (p=0.064). The qualitative variables also did not show significant statistical results (p> 0.05) between success and failure rates. However, the results showed that patients who did not use myorelaxant plaque had a higher success rate than plaque users (p=0.004). Thus, it can be concluded that the metal-ceramic prosthesis has high success and survival rates, ensuring longevity of this type of rehabilitation.(AU)

Influence of crosshead speed on failure load and failure mode of restored maxillary premolars

We analyzed the effect of the crosshead speed of an applied load on failure load and failure mode of restored human premolars. Fifty intact, noncarious human premolars were selected. Class II mesio-occlusodistal preparations were made with a water-cooled high-speed preparation machine, and the teeth were restored with composite resin. The specimens were divided into five groups (n = 10 each) and tested individually in a mechanical testing machine, in which a 6.0-mm-diameter steel cylinder was mounted to vary the crosshead speed: v0.5: 0.5 mm/min; v1: 1.0 mm/min; v2.5: 2.5 mm/min; v5: 5.0 mm/min; and v10: 10.0 mm/min. The cylinder contacted the facial and lingual ridges beyond the margins of the restorations. Peak load to fracture was measured for each specimen (N). The means were calculated and analyzed with one-way analysis of variance followed by Tukey's test (a = 0.05). The mean load at failure values were (N) as follows: v0.5, 769.4 ± 174.8; v1, 645.2 ± 115.7; v5, 614.3 ± 126.0; v2.5, 609.2 ± 208.1; and v10, 432.5 ± 136.9. The fracture modes were recorded on the basis of the degree of the tooth structural and restorative damage: (I) fracture of the restoration involving a small portion of the tooth; (II) fractures involving the coronal portion of the tooth with cohesive failure of the composite resin; (III) oblique tooth and restoration fracture with periodontal involvement; and (IV) vertical root and coronal fracture. Varying crosshead speeds of 0.5–5.0 mm/min did not influence the failure load of restored maxillary premolars; however, increasing the crosshead speed to 10 mm/min decreased the failure load values and the degree of tooth structural damage.

Fractura y alojamiento de aguja para infiltración de anestésico local en el espacio pterigomandibular: Técnica de extracción quirúrgica: reporte de caso y revisión de literatura / Surgical retrieval technique for a fractured local anesthetic infiltration needle embedded in the pterygomandibular space

Los instrumentos metálicos utilizados en las múltiples disciplinas de la odontología están sujetos a un desgaste considerable durante su vida de uso y pueden llegar a fracturarse. La remoción de los instrumentos fracturados puede ser un evento simple, siempre y cuando su localización sea visible y accesible, pero no siempre es el caso. Desde la introducción de las agujas dentales desechables, a inicios de los 1960, la frecuencia de ruptura d e éstas ha sido mínima. Hoy en día, la fractura de estos instrumentos se debe más a la falla de las técnicas de infiltración del operador y a la carencia de medidas preventivas. Es de interés mencionar la experiencia obtenida en el caso de una paciente femenina de 25 años de edad, a quien durante un procedimiento odontológico de rutina se le alojó la totalidad de una aguja dental en el espacio pterigomandibular. Es prudente recordar la sintomatología específi ca a estos casos, los métodos de diagnósticos antiguos y de nueva generación, y el difícil manejo quirúrgico para el retiro de cuerpos extraños tan peligrosos en una localización anatómicamente compleja.

The metallic objects used in the different disciplines of today’s dentistry are subject to considerable wear during the course of their useful life and can eventually fracture. Removing these foreign objects can be a simple procedure, provided they remain visible and easy to reach. However, this is not always the case. Since the introduction of disposable dental needles in the 1960s, the incidence of instrument fracture has been minimal and today, when this does occur, it is usually due to poor infi ltration techniques on the part of the user and a lack of appropriate preventive measures. We present the interesting case of a 25-year-old female patient who underwent a dental procedure during which a com-plete dental needle became lodged in the pterygomandibular space. In cases such as this, it is important to remember the specifi c symptoms, the differences in old- and new-school diagnosis methods, and the level of diffi culty involved in surgically removing dangerous foreign objects from an anatomically complex location.

Vertical root fracture associated with prolonged use of calcium hydroxide during apexification: a case report / Fractura radicular vertical asociada al uso prolongado de hidróxido de calcio durante una apexificación: reporte de caso

Apexification is a procedure performed in young permanent teeth to promote apical closure and root elongation if Hertwig’s epithelial sheath has not been irreversibly damaged. The objective of this article is to describe vertical root fracture as a complication during apexification when using calcium hydroxide for extended periods of time. The patient was a 9-year-old female student who went to the Faculty of Dentistry of the Universidad Andres Bello in Concepcion. She presented strong and spontaneous pain and pressure and swelling on the left cheek. Clinically, the vestibule of the lower left first molar (3.6) was edematous and had pus. Radiographically, lesions and open apices were seen in the apical zone. Diagnosis was pulp necrosis and acute apical abscess. The tooth was trephined to perform intracanal drainage and an oral antibiotic was prescribed. Afterwards, she was referred to the endodontic specialty office. The selected treatment was apexification with calcium hydroxide until achieving the formation of an apical barrier. When the apical formation was observed, a vertical root fracture was discovered as well, confirming that the use of calcium hydroxide should not be prolonged because dehydration processes lead to weakening of the walls and therefore of the tooth...

La apexificación es un procedimiento realizado en dientes permanentes jóvenes que busca un cierre apical y elongación radicular, cuando la vaina epitelial de Hertwig no se encuentre irreversiblemente afectada. El objetivo de este artículo es relacionar a la fractura vertical radicular como una complicación durante una apexificación al trabajar por tiempo prolongado con hidróxido de calcio. Paciente de sexo femenino, estudiante, 9 años, acudió a la Facultad de Odontología de la Universidad Andrés Bello Sede Concepción, presentó dolor fuerte y espontaneo, presión e hinchazón de la mejilla izquierda. Clínicamente el fondo de vestíbulo del primer molar inferior izquierdo (3.6) edematoso y con contenido purulento. Radiográficamente se observó en la zona apical la presencia de lesiones y ápices abiertos. El diagnóstico fue Necrosis pulpar y Absceso Apical Agudo, se trepanó para realizar drenaje intraconducto y se prescribió medicación antibiótica oral, para luego ser remitida a la especialidad de endodoncia, donde el tratamiento seleccionado fue Apexificación con hidróxido de calcio hasta observar la formación de barrera apical. Al cumplirse el objetivo de formación apical se descubrió una fractura radicular vertical. La presencia de la fractura radicular vertical fue asociada al tiempo de uso del hidróxido de calcio, confirmando que este no debe ser prolongado ya que por procesos de deshidratación lleva al debilitamiento de las paredes y por ende de la pieza dental...

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 3 / Diagnosis and management of fractures teeth associated with parafunction: part 3

Presentar un tratamiento preventivo que consiste en la realización de un ajuste oclusal y de una placa neuromiorrelajante, en un paciente con facetas de desgaste debidas a parafunción. Caso clínico: un paciente de 28 años de edad consultó por un control. Se observaron facetas de desgaste patológicas en el esmalte de la pieza dentaria 4.7, con una relación cúspide/fosa profunda, por lo que se decidió realizar una remodelación oclusal y confeccionar una placa de protección neuromiorrelajante, a fin de evitar una posible fractura de la pieza. Conclusión: un diagnóstico correcto y temprano de las facetas dentarias patológicas en el esmalte y su posible tratamiento son fundamentales para evitar opsibles fracturas dentarias asociadas a la parafunción...

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 2 / Diangosis and management of fractured teeth associated with parafunction: part 2

Objetivo: presentar la resolución clínica de una fractura dentaria incompleta mediante la realización de una restauración adherida de tipo onlay. Caso clínico: un paciente de 36 años de edad consultó por dolor al masticar enl a pieza 3.7, la cual presentaba una restauración plástica oclusal. Al removerla, se observó una fractura en dirección mesiodistal, sin movilidad de ambos cabos de fractura, por lo que se realizó una incrustación adherida de tipo onlay. Conclusión: el correcto diagnóstico de una fractura dentaria incompleta y la comprensión de su etiología son fundamentales para la elección de un tratamiento conservador y con un alto grado de predictibilidad, como lo son las restauraciones adheridas tipo onlay.

Effect of root canal preparation, type of endodontic post and mechanical cycling on root fracture strength

Objective: To evaluate the impact of the type of root canal preparation, intraradicular post and mechanical cycling on the fracture strength of roots. Material and Methods: eighty human single rooted teeth were divided into 8 groups according to the instruments used for root canal preparation (manual or rotary instruments), the type of intraradicular post (fiber posts- FRC and cast post and core- CPC) and the use of mechanical cycling (MC) as follows: Manual and FRC; Manual, FRC and MC; Manual and CPC; Manual, CPC and MC; Rotary and FRC; Rotary, FRC and MC; Rotary and CPC; Rotary, CPC and MC. The filling was performed by lateral compactation. All root canals were prepared for a post with a 10 mm length, using the custom #2 bur of the glass fiber post system. For mechanical cycling, the protocol was applied as follows: an angle of incidence of 45°, 37°C, 88 N, 4 Hz, 2 million pulses. All groups were submitted to fracture strength test in a 45° device with 1 mm/ min cross-head speed until failure occurred. Results: The 3-way ANOVA showed that the root canal preparation strategy (p<0.03) and post type (p<0.0001) affected the fracture strength results, while mechanical cycling (p=0.29) did not. Conclusion: The root canal preparation strategy only influenced the root fracture strength when restoring with a fiber post and mechanical cycling, so it does not seem to be an important factor in this scenario. .

Estudo in vitro da perfuração radicular por diferentes diâmetros de mini-implantes / In vitro study of root perforation by different mini-implant diameters

Este trabalho teve como objetivo avaliar o torque e a carga axial de inserção e a severidade das lesões radiculares em dentes humanos decorrentes da utilização de diferentes diâmetros de mini-implantes com finalidade ortodôntica. Sessenta pré-molares extraídos foram inclusos em osso artificial e divididos em 3 grupos, correspondentes a 3 diferentes diâmetros de mini-implante (1,4mm, 1,6mm e 1,8mm). Em cada raiz dentária foram inseridos manualmente 2 mini-implantes autoperfurantes utilizando dois métodos de inserção (com e sem perfuração prévia inicial com fresa) e em duas alturas (apical e cervical). Quinze mini-implantes foram inseridos apenas em osso artificial como parâmetro de comparação. Foram quantificados o torque e a carga axial de inserção através de um torquímetro axial digital e uma célula de carga respectivamente. Os dentes foram, então, escaneados e analisados através de microtomografia computadorizada (Micro-CT) a fim de se observar as severidades das lesões radiculares provocadas pelos mini-implantes. Os dados referentes ao torque e à carga axial dos mini-implantes inseridos em pré-molares foram submetidos à análise de variância (ANOVA) a três critérios, sendo aplicados posteriormente testes de Tukey para comparação entre os grupos. A diferença dos torques e das cargas axiais entre os mini-implantes inseridos no osso artificial e nas raízes dentárias foi estimada por testes t. Foram aplicados também testes de Qui-Quadrado para avaliar as severidades das lesões radiculares. Tanto os torques como as cargas axiais de inserção dos mini-implantes inseridos em raízes de dentes humanos apresentaram diferenças estatisticamente significantes entre os diferentes diâmetros avaliados, porém sem um padrão definido. Os miniimplantes inseridos nas raízes apresentaram valores maiores estatisticamente significantes do que os inseridos em osso artificial somente em relação à carga axial. As lesões radiculares de dentes humanos...

The aim of this study was to evaluate placement torque, axial placement load and severity of root lesions in human teeth caused by different diameters of orthodontic mini-implants. Sixty extracted premolars were included in artificial bone and divided into three groups according to different mini-implant diameters (1.4mm, 1.6mm and 1.8mm). Two self-drilling mini-implants were manually inserted into each root using two placement methods (with and without initial pre-drilling) in the apical and cervical regions. Fifteen mini-implants were inserted into artificial bone as a comparison parameter. Placement torque and axial placement load were quantified by a digital torquimeter and a load cell, respectively. The teeth were scanned and analyzed with microcomputed tomography (Micro-CT) to observe the severity of root lesions caused by the mini-implants. The torque and the axial load of mini-implants inserted into premolars were analyzed by 3-way analysis of variance (ANOVA), followed by Tukey tests. Differences in the torques and axial loads between the mini-implants inserted in dental roots and artificial bone were compared with t tests. Chi-square tests were applied to assess the severity of root lesions. The placement torques and the axial placement loads of mini-implants inserted into human dental roots showed significant differences between the different diameters evaluated, but with no standardized effect. Mini-implants inserted into the roots showed significantly higher axial placement load values than those inserted into artificial bone. The root lesions of human teeth caused by mini-implants became statistically more severe with initial pre-drilling.

Estudo in vitro da perfuração radicular por diferentes diâmetros de mini-implantes / In vitro study of root perforation by different mini-implant diameters

Este trabalho teve como objetivo avaliar o torque e a carga axial de inserção e a severidade das lesões radiculares em dentes humanos decorrentes da utilização de diferentes diâmetros de mini-implantes com finalidade ortodôntica. Sessenta pré-molares extraídos foram inclusos em osso artificial e divididos em 3 grupos, correspondentes a 3 diferentes diâmetros de mini-implante (1,4mm, 1,6mm e 1,8mm). Em cada raiz dentária foram inseridos manualmente 2 mini-implantes autoperfurantes utilizando dois métodos de inserção (com e sem perfuração prévia inicial com fresa) e em duas alturas (apical e cervical). Quinze mini-implantes foram inseridos apenas em osso artificial como parâmetro de comparação. Foram quantificados o torque e a carga axial de inserção através de um torquímetro axial digital e uma célula de carga respectivamente. Os dentes foram, então, escaneados e analisados através de microtomografia computadorizada (Micro-CT) a fim de se observar as severidades das lesões radiculares provocadas pelos mini-implantes. Os dados referentes ao torque e à carga axial dos mini-implantes inseridos em pré-molares foram submetidos à análise de variância (ANOVA) a três critérios, sendo aplicados posteriormente testes de Tukey para comparação entre os grupos. A diferença dos torques e das cargas axiais entre os mini-implantes inseridos no osso artificial e nas raízes dentárias foi estimada por testes t. Foram aplicados também testes de Qui-Quadrado para avaliar as severidades das lesões radiculares. Tanto os torques como as cargas axiais de inserção dos mini-implantes inseridos em raízes de dentes humanos apresentaram diferenças estatisticamente significantes entre os diferentes diâmetros avaliados, porém sem um padrão definido. Os miniimplantes inseridos nas raízes apresentaram valores maiores estatisticamente significantes do que os inseridos em osso artificial somente em relação à carga axial. As lesões radiculares de dentes humanos...

The aim of this study was to evaluate placement torque, axial placement load and severity of root lesions in human teeth caused by different diameters of orthodontic mini-implants. Sixty extracted premolars were included in artificial bone and divided into three groups according to different mini-implant diameters (1.4mm, 1.6mm and 1.8mm). Two self-drilling mini-implants were manually inserted into each root using two placement methods (with and without initial pre-drilling) in the apical and cervical regions. Fifteen mini-implants were inserted into artificial bone as a comparison parameter. Placement torque and axial placement load were quantified by a digital torquimeter and a load cell, respectively. The teeth were scanned and analyzed with microcomputed tomography (Micro-CT) to observe the severity of root lesions caused by the mini-implants. The torque and the axial load of mini-implants inserted into premolars were analyzed by 3-way analysis of variance (ANOVA), followed by Tukey tests. Differences in the torques and axial loads between the mini-implants inserted in dental roots and artificial bone were compared with t tests. Chi-square tests were applied to assess the severity of root lesions. The placement torques and the axial placement loads of mini-implants inserted into human dental roots showed significant differences between the different diameters evaluated, but with no standardized effect. Mini-implants inserted into the roots showed significantly higher axial placement load values than those inserted into artificial bone. The root lesions of human teeth caused by mini-implants became statistically more severe with initial pre-drilling...

Traumatismo dentario.15 a 18 años. Escuela Militar Camilo Cienfuegos. Sancti Spíritus 2011 / Dental trauma between 15 - 18 years old. Camilo Cienfuegos Military School. Sancti Spíritus 2011

Fundamento: los traumatismos dentarios representan la segunda causa de atención odontopediátrica que afecta la población menor de 19 años. Objetivo: identificar el traumatismo dentario en la población de 15 a 18 años de la Escuela Militar Camilo Cienfuegos de Sancti Spíritus. Metodología: se realizó un estudio descriptivo. La población fueron 417 estudiantes, de ellos se obtuvo una muestra de 121 adolescentes con traumas dentarios, con previo consentimiento informado. Las variables: edad, sexo, etiología y tipo de trauma, así como el diente afectado, factores de riesgo y el tratamiento recibido. Para el procesamiento de la información se utilizó la frecuencia absoluta y relativa. Resultados: el grupo de edad más afectado fue el de 15-16 años con predominio del masculino. El diente más afectado fue el incisivo central superior derecho y la fractura no complicada de corona tuvo mayor incidencia seguido de la infracción o infractura del esmalte. Conclusiones: los traumatismos dentales se presentaron en la mayoría de los estudiantes de 15-18 años que a su vez no recibieron atención estomatológica lo que afecta la conservación del órgano dentario.

Backgroud: Dental traumas represents the second cause of pediatric dentistry care affecting the population under 19 years old. Objective: to identify the dental traumas in the population between 15-18 years old at Camilo Cienfuegos Military School from Sancti Spíritus city. Methodology: a descriptive study was carried out. The population was composed by 417 students with a simple of 121 adolescents with dental trauma with a previous consent. The variables were age, sex, etiology and type of trauma as well as the tooth affected, risk factors and treatment received. For the processing of the information the absolute and relative frequency were used. Results: the age group mostly affected was between 15-16 years old, prevailing males. The most affected tooth was the central right upper incisive and the non complicated fracture of crown had the most incidence followed by the infraction of the enamel. Conclusions: Dental traumas were present in the majority of the students between 15-18 years old and at the same time they did not receive dental care which affects greatly the preservation of the dental organ.

Traumatismos dentoalveolares que afectan a las estructuras de soporte de los dientes temporales y sus efectos en los sucesores definitivos / Dentoalveolar injuries affecting tooth support structures in temporary and the effects on permanent succesors

El propósito de este estudio fue determinar las secuelas producidas en la dentición definitiva luego de un traumatismo que afectó a las estructuras de soporte de dientes temporales. La muestra corresponde a 53 niños beneficiarios del Centro de Referencia Odontopediátrico Simón Bolívar, entre las edades de 1 a 7 años que sufrieron traumatismo dentoalveolar del sector anterior, durante el periodo 2005-2007 que se clasificó según Andreasen en subluxación, luxación lateral, luxación intrusiva, luxación extrusiva y avulsión. Los resultados obtenidos nos permiten determinar un 20 por ciento de secuelas clínicas en dientes sucesores permanentes, siendo las opacidades del esmalte con un 88 por ciento las lesiones mas frecuente, luego las hipoplasias del esmalte que alcanzó un 12 por ciento. La mayoría de las lesiones registradas según severidad son de tipo leves (65 por ciento) y el porcentaje de dientes con secuelas clínicas no cambia significativamente a través de los diferentes diagnósticos. La edad promedio de los niños al momento de sufrir el trauma y que presentaban secuelas fue de 4,7 años. No se registraron casos de luxación extrusiva puesto que no se observaron casos con secuelas. Se concluye que los dientes definitivos que remplazan dientes deciduos que han sufrido trauma como luxación intrusiva, subluxación, luxación lateral y avulsión, con frecuencia presentan secuelas que se expresan principalmente como opacidad e hipoplasias del esmalte. Las secuelas de estos traumas podrían disminuir si los niños expuestos a estas lesiones concurrieran tempranamente a centros de salud especializados en la atención del traumatismo dentoalveolar...

The purpose of this study was to determine the effects produced in the permanent teeth after trauma affecting the supporting structures of teeth. The sample is 53 children beneficiaries of the Reference Center Odontopediátrico Simon Bolivar, ages 1 to 7 years who suffered injury of the anterior dentoalveolar trauma during the period 2005-2007 that was classified according to Andreasen: subluxation, lateral luxation, intrusive luxation, extrusive luxation and avulsion. The results obtained allow us to determine 20 percent of clinical sequelae in permanent successor teeth, with enamel opacities with 88 percent more frequent injuries, then the enamel hypoplasias reached 12 percent. Most of the injuries recorded as mild severity are of type (65 percent) and the percentage of teeth with clinical sequelae not changes significantly across the different diagnoses. The average age when children suffer the trauma and had sequelae was 4.7 years. No cases of extrusive luxation since there were no cases with sequelae. It is concluded that the permanent teeth that replace primary teeth that have suffered trauma such as intrusive luxation, subluxation, lateral luxation and avulsion, often have consequences that are expressed mainly as opacity and enamel hypoplasia. The aftermath of this trauma could be reduced if children exposed to these lesions are entered into early health centers specialized in the care of dentoalveolar trauma...

Oral and maxillofacial trauma in patients with epilepsy: prospective study based on an outpatient population / Trauma oral e maxilofacial em pessoas com epilepsia: estudo prospectivo com base ambulatorial

OBJECTIVE: This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. METHOD: A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95 percent confidence interval, dependency analysis and the Pearson c² test were used for statistical analysis, and the significance level was set at p≤0.05. RESULTS: A total of 159 patients with epilepsy (91 males; 57.3 percent) and 68 control individuals (28 males; 41.1 percent) were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9 percent and 4.4 percent, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9 percent), followed by tooth avulsion (7.6 percent), tooth luxation (5 percent) and fracturing of prostheses in edentulous patients (3.8 percent). CONCLUSION: This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected.

OBJETIVO: O objetivo desse estudo foi avaliar a relação da epilepsia sobre as ocorrências de trauma dento-alveolar e maxilofacial causados por quedas. MÉTODO: Estudo caso-controle prospectivo foi conduzido no ambulatório de epilepsia e do Pronto Atendimento do Hospital de Base de São José do Rio Preto-SP no ano de 2006. Pacientes do grupo caso foram diagnosticados pelo neurologista chefe (sênior) especialista em epilepsia e avaliados quanto ao trauma oral e maxilo-facial pelo pesquisador, por meio de questionário, exame clínico e radiográfico, por ordem de chegada. O grupo controle (GC) foi constituído incluindo indivíduos sem crises, que fossem familiares ou vizinhos próximos dos pacientes com diagnóstico de epilepsia. Intervalo de confiança 95 por cento, ODD, análise de dependência (ANADEP) e c² de Pearson foram utilizados para análise estatística e se adotou nível de significância de p≤0,05. RESULTADOS: Analisaram-se 159 pacientes com epilepsia, dos quais 91(57,3 por cento) masculinos e 68 do GC, dos quais 28 (41,1 por cento) masculinos. A frequência do trauma oro-maxilar em paciente com epilepsia foi 23,9 por cento e no GC foi de 4,4. As crises tônico-clônicas generalizadas, crises generalizadas e as não classificadas estão fortemente co-relacionadas ao trauma. Fraturas das coroas dentais (32,9 por cento), seguidas de avulsão dentária (7,6 por cento), luxação dentária (5 por cento) e fratura da prótese em pacientes edêntulos (3,8 por cento) foram as lesões mais encontradas. CONCLUSÃO: O trabalho mostra que os ferimentos na face e dentes são frequentes em pacientes com crises epilépticas quando comparados ao GC, sendo as pessoas com crises sem a aura as mais afetadas.

Age, gender distribution and etiology of dentoalveolar fractures

This descriptive study was undertaken to determine age and gender distribution and causes of dentoalveolar fractures. One hundred patients with dentoalveolar fracture were examined at the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar; Pakistan in six months. The age range in this study was 3-60 years with mean age 18.17 years; and Std Deviation13.08. The male to female ratio was 2.7: 1. Road traffic accident was the major cause of dentoalveolar fractures[39%] followed by fall[30%], sports accidents[15%], violence [5%], work accidents [4%], fire arm injuries[4%], and horse kick[2%]

Ex-vivo evaluation of the intrapulpal temperature variation and fracture strength in teeth subjected to different external bleaching protocols

This study evaluated the influence of bleaching protocols on intrapulpal temperature and fracture strength of the bleached teeth. Ninety maxillary incisors were assigned to 9 groups (n=10): G1: 35 percent carbamide peroxide (35 percent CP), G2: 38 percent hydrogen peroxide (38 percent HP), G3: halogen light, G4: LED-laser, G5: 35 percent CP + halogen light, G6: 38 percent HP + halogen light, G7: 35 percent CP + LED-laser, G8: 38 percent HP + LED-laser, and G9: no treatment (control). Pulp space was widened, a thermocouple was introduced through the apex up to the pulp chamber and the temperature was recorded (°C). The fracture strength (kN) was determined using an Instron machine. Data were analyzed by ANOVA and Tukey's test (p<0.05). The halogen light alone (1.10 ± 0.24) (G3) and associated with 38 percent HP (1.15 ± 0.30) (G6) produced the highest temperature increase, statistically different (p<0.05) from the other groups. G1 (0.15 ± 0.06) and G6 (0.19 ± 0.07) produced the lowest values, statistically different (p<0.05) from G5 (0.65 ± 0.49). The bleaching protocols increased the temperature, but no increment exceeded the critical value of 5.6°C. Neither 35 percent CP nor 38 percent HP or the light sources alone altered the fracture strength of the teeth.

Este estudo avaliou a influência de protocolos de clareamento na temperatura intrapulpar e resistência à fratura de dentes clareados. Noventa incisivos superiores foram divididos em 9 grupos (n=10): G1: peróxido de carbamida a 35 por cento (PC 35 por cento), G2: peróxido de hidrogênio a 38 por cento (PH 38 por cento), G3: luz halógena, G4: LED-laser, G5: PC 35 por cento + luz halógena, G6: PH 38 por cento + luz halógena, G7: PC 35 por cento + LED-laser, G8: PH 38 por cento + LED-laser e G9: sem tratamento (controle). O canal radicular foi alargado, um termopar foi introduzido no ápice até a câmara pulpar e a temperatura foi calculada (°C). A resistência à fratura (kN) foi determinada em máquina Instron. Os dados foram analisados por análise de variância e teste de Tukey (p>0,05). A luz halógena utilizada isoladamente (1,10 ± 0,24) (G3) e associada ao PH 38 por cento (1,15 ± 0,30) (G6) proporcionaram os maiores valores de temperatura, sendo estatisticamente diferentes dos demais grupos (p<0,05). O G1 (0,15 ± 0,06) e o G6 (0,19 ± 0,07) produziram os menores valores de resistência à fratura, sendo estatisticamente diferentes (p<0,05) do G5 (0,65 ± 0,49). Os protocolos de clareamento aumentaram a temperatura, mas nenhum incremento excedeu o valor crítico de 5,6oC. O PC 35 por cento, PH 38 por cento e as fontes de luz utilizadas isoladamente não alteraram a resistência à fratura dos dentes.

Fracture resistance of teeth subjected to internal bleaching and restored with different procedures

This study evaluated the fracture resistance of teeth submitted to internal bleaching and restored with different procedures. Forty maxillary incisors were endodontically treated and assigned to 4 groups (n=10): G1- restored with composite resin (CR), G2- bleached with hydrogen peroxide (HP) and restored with CR, G3- restored with CR and fiberglass posts (CR + posts) and G4- bleached and restored with CR + posts. HP was applied in the buccal surface and pulp chamber 3 times at each one of 2 sessions with an interval of 7 days between them. Additional 10 sound incisors were subjected to fracture strength test (gold standard). The fracture strength (kN) was determined in an Instron machine. Data were analyzed by ANOVA and Tukey-Kramer test (α=0.05). The untreated teeth (gold standard) showed the highest (p<0.05) fracture strength (0.43 ± 0.16). Teeth restored with CR (G1) without internal bleaching had the lowest (p<0.05) fracture strength (0.23 ± 0.11). Teeth bleached and restored with CR (G2) (0.26 ± 0.10), restored with CR + posts ithout internal bleaching (G3) (0.31 ± 0.17) and, bleached and restored with CR + posts (G4) (0.33 ± 0.12) had intermediate values, sometimes similar to the group with the highest value, sometimes similar to the group with the lowest value. In conclusion, as far as the fracture strength is concerned, teeth subjected to internal bleaching can be restored with composite resin alone, as the use of posts in these teeth did not increase their resistance.

Este estudo avaliou a resistência à fratura de dentes submetidos ao clareamento interno restaurados com diferentes procedimentos. Quarenta incisivos superiores foram tratados endodonticamente e divididos em 4 grupos (n = 10): G1- restaurados com resina composta (RC), G2- clareados com peróxido de hidrogênio (PH) e restaurados com o RC, G3- restaurado com RC e pinos de fibra de vidro (RC + pinos) e G4- clareados e restaurados com RC + pinos. O PH foi aplicado na superfície vestibular e câmara pulpar 3 vezes por sessão, por 2 sessões com intervalo de 7 dias entre elas. Dez dentes hígidos adicionais foram submetidos a teste fratura (padrão ouro). A resistência à fratura (kN) foi determinada em máquina Instron. Os dados foram analisados por Análise de Variânica e teste de Tukey-Krammer (α= 0,05). Os dentes não tratados (padrão ouro) apresentaram a maior resistência à fratura (0,43 ± 0,16) (p <0,05). Os dentes restaurados com RC (G1) apresentaram a menor resistência à fratura (0,23 ± 0,11) (p <0,05). Os dentes clareados e restaurados com RC (G2) (0,26 ± 0,10), restaurado com RC + pinos (G3) (0,31 ± 0,17) e os clareados e restaurados com RC + pinos (G4) (0,33 ± 0,12) apresentaram valores intermediários, ora semelhantes ao do grupo com o maior valor, ora similares ao grupo de valores mais baixos. Pode-se concluir que os dentes submetidos ao clareamento interno podem ser restaurados com apenas resina composta.

Avaliação de Diferentes Compósitos na Resistência à Fratura de Núcleos de Preenchimento / Evaluation of the fracture strength of different composites used for core buildup

Objetivo: Avaliar e comparar diferentes resinas compostas na resistencia a fratura quando confeccionado nucleo de preenchimento. Metodo: Foram utilizados 36 dentes bovinos, os quais tiveram suas coroas seccionadas no terco cervical, padronizando o tamanho dos especimes em 20mm de comprimento. Os canais foram preparados com brocas do tipo largo no5 com irrigacao constante, correspondente ao tamanho e calibre dos pinos de fibra de vidro no3 Reforpost. Os pinos foram cimentados com cimento resinoso Enforce, sendo 16mm de pino dentro da raiz, e 4mm externo a raiz, depois polimerizados por 30 segundos de cada lado. Os corpos de provas foram divididos em tres grupos de 12, aos quais foram feitos munhoes de 4mm de diametro por 5mm de altura, confeccionados a parti r de um padrao prefabricado, sendo utilizado 3 tipos de resina: Grupo 1: Z100 (3M), Grupo 2: Z250(3M) e Grupo 3: P60(3M). Os corpos-de-prova foram fixados em um dispositivo cilindrico com um adaptador com inclinacao de 45§. Este dispositivo foi adaptado a uma maquina de Teste Universal (EMIC) para simular a forca ate a fratura do especime. Os dados foram submeti dos a Analise de Variancia (p<0,05). Resultados: Os munhoes confeccionados com resina Z250 apresentaram a maior media de valores de forca necessarias para fratura (45, 453 Kgf.), enquanto os grupos G1 e G3 obtiveram os seguintes valores de forca para fratura 38,014 kgf e 39,506 Kgf. respectivamente. Foi observado tambem que a resina P60 causou maior numero de fraturas radiculares. Conclusao: Pelas caracteristicas e propriedades das resinas testadas, a resina Z250 e mais indicada para a realizacao de nucleo de preenchimento.

Objective: To evaluate and compare the fracture strength of different composite resins used for core buildup. Method: Thirty-six bovine teeth were decoronated at the cervical third to standardize the length of specimens at 20 mm. Under constant irrigation, the canals were prepared with n§5 Largo drills corresponding to the size and diameter of n§3 Reforpost fiberglass post. The posts were cemented with Enforce resin sealer, being 16 mm inside the root canal and 4 mm outside the root canal, and the material was light-activated for 30 seconds at each side. The specimens were divided into 3 groups (n=12), in which cores (4 mm diameter and 5 mm high) were prepared from a prefabricated standard with three types of composite resins: Group 1: Z100 (3M), Group 2: Z250 (3M) and Group 3: P60 (3M). The specimens were fixed in a cylindrical device with an adaptor at 45§ inclination. This device was adapted to a universal testing machine (EMIC) to simulate the force until fracture of the specimen. Data were subjected to ANOVA (p<0.05). Results: The Z250 resin cores presented the highest mean fracture strength (45.453 kgf), while the mean fracture strengths in Group 1 and Group 3 were 38.014 and 39.506 kgf, respectively. P60 caused the largest number of root fractures. Conclusion: Considering the characteristics and properties of the tested resins, Z250 appears as the most indicated for core buildup.