Reliability of panoramic radiography in predicting proximity of third molars to the mandibular canal: A comparison using cone-beam computed tomography.

PURPOSE: The purpose of this study was to analyze the reliability of 7 panoramic radiographic signs for predicting proximity of the root apices of mandibular third molars to the mandibular canal using cone-beam computed tomography and to correlate these findings with the Pell and Gregory and the Winter classification systems. MATERIALS AND METHODS: An observational, cross-sectional, descriptive study was conducted on 74 patients with bilateral impacted mandibular third molars. Four panoramic radiographic signs were observed in the tooth root (darkening, deflection, and narrowing of the root apices, and bifid apices), and another 3 in the mandibular canal (diversion, narrowing, and interruption of the mandibular canal). Cone-beam computed tomography images were analyzed to identify disruption and diversion of the mandibular canal and root deflection. RESULTS: Binary logistic regression showed that only 4 of the 7 panoramic radiographic signs were able to predict proximity of the root apices of the mandibular third molars to the mandibular canal: darkening of the root, deflection of the root, narrowing of the root, and interruption of the mandibular canal (P<0.05). CONCLUSION: Darkening, deflection, and narrowing of the root, in tandem with the interruption of the mandibular canal on panoramic radiographs, indicate that cone-beam computed tomography should be performed when planning the extraction of impacted mandibular third molars. Proximity between mandibular third molars and the mandibular canal is correlated with the Winter classification.

Bioactive glass containing 90% SiO2 in hard tissue engineering: An in vitro and in vivo characterization study.

Bioactive glass has been proved to have many applications in bioengineering due to its bone regenerative properties. In this work, an innovative, highly resorbable bioactive glass containing 90% SiO2 (BG90) to be used as a bone substitute was developed. The BG90 was synthetized by the sol-gel process with the dry step at room temperature. The biomaterial showed in vitro and in vivo bioactivities even with silica content up to 90%. Moreover, the BG90 presented high porosity and surface area due to its homogenously interconnected porous network. In vitro, it was observed to have high cell viability and marked osteoblastic differentiation of rat bone marrow-derived cells when in contact with BG90 ion extracts. The BG90 transplantation into rat tibia defects was analysed at 1, 2, 3, 4, 7, and 10 weeks post-operatively and compared with the defects of negative (no graft) and positive (autogenous bone graft) controls. After 4 weeks of grafting, the BG90 was totally resorbed and induced higher bone formation than did the positive control. Bone morphogenetic protein 2 (BMP-2) expression at the grafting site peaked at 1 week and decreased similarly after 7 weeks for all groups. Only the BG90 group was still exhibiting BMP-2 expression in the last experimental time. Our data demonstrated that the BG90 could be an attractive candidate to provide useful approaches in hard-tissue bioengineering.

Tracionamento de incisivo central superior impactado com apoio em barra transpalatina modificada: relato de caso / Traction of impacted upper central incisor with the aid of a modi-fied transpalatal bar: case report

Introdução: A impacção do incisivo central superior é uma condição desafiadora para os cirurgiões-dentistas e necessita, geralmente, de uma abordagem multidisciplinar. A não irrupção deste dente pode ocorrer devido à falta de espaço na arcada dentária, às alterações de erupções dos dentes decíduos e/ou permanentes, à presença de dentes supranumerários ou lesões patológicas adjacentes, e ao denso revestimento ósseo ou excesso de tecido mole local. O planejamento adequado e tratamento precoce podem minimizar os desconfortos estéticos e funcionais do paciente, evitando interferências negativas em seu desenvolvimento biopsicossocial. Objetivo: Apresentar um caso clínico de tracionamento de incisivo central superior impactado com apoio em barra transpalatina modificada em paciente infantil. Relato de Caso: Paciente do gênero masculino, 13 anos de idade, em desconforto estético com o sorriso devido à retenção prolongada do incisivo decíduo. Nos exames de imagem, notou-se a impacção do incisivo permanente, além de uma imagem sugestiva de odontoma composto e agenesia dos incisivos laterais permanentes. No primeiro momento, foi realizado a exodontia do incisivo e canino decíduo e exérese do odontoma composto, aguardando-se a erupção espontânea do incisivo permanente. Diante da irrupção incompleta do incisivo permanente no período de 6 meses, optou-se pelo seu tracionamento por meio da colagem de um botão ortodôntico e utilização de amarrilhos apoiados em uma barra transpalatina modificada. Resultado: Paciente encontra-se com o incisivo permamente erupcionado, aguardando correção ortodôntica para melhor alinhamento e nivelamento dentário. Conclusão: A barra transpalatina modificada é um importante aparato ortodôntico para o apoio do amarrilho durante o tracionamento do incisivo impactado em pacientes com impossibilidade do uso do aparelho ortodôntico fixo.

Introduction: Impacted maxillary central incisor is a challenging condition for dentists, generally requiring a multidisciplinary approach. It can occur due to lack of space in the dental arch, primary or permanent successor dental alterations, presence of supernumerary teeth and/or associated pathological lesions, or due to a dense bony coating and excess local soft tissue. Careful planning and early intervention become essential to minimize esthetic and functional compromises, avoiding negative interference to the patient's psychological and social development. Objective: Report a clinical case in pediatric patient related to the impaction of the permanent upper central incisor and its orthodontic traction with the modified transpalatal bar. Case Report: 13-year-old male patient with esthetic discomfort in his smile due to prolonged retention of the deciduous incisor. Imaging exams identified impaction of the permanent incisor and suggestive image of compound odontoma, as well as agenesis of the permanent lateral incisors. In the first moment, an extraction of the deciduous incisor and canines was performed along with the excision of the compound odontoma, while awaiting spontaneous eruption of the permanent incisor. Faced with an incomplete eruption of the permanent incisor during a 6 month period, the incisor traction was opted for with the aid of an orthodontic button and rubber bands supported by a modified transpalatal bar. Results: Patient is found with the central incisor erupted, awaiting fixed orthodontic treatment for correct dental alignment and leveling. Conclusion:The modified transpalatal bar is an important component for supporting the wire during the impacted incisor traction in patients unable to use fixed orthodontic appliances.

Hyaluronic acid accelerates bone repair in human dental sockets: a randomized triple-blind clinical trial.

This study evaluated the effects of hyaluronic acid (HA) on bone repair of human dental sockets. Thirty-two lower first premolars were extracted from 16 patients (2 per patient) for orthodontic reasons. Following the extractions, one socket was randomly filled with 1% HA gel, while the other was allowed to naturally fill with blood clot. After 30 and 90 days of surgery, patients underwent cone beam computed tomography. Five central orthoradial slices were captured from each socket. The gray intensity was measured in each image and results were reported as mean percentage of bone formation. The buccolingual alveolar ridge width was measured and dimensional changes were compared between the postoperative intervals. The pattern of alveolar trabecular bone was evaluated through the fractal dimension. Treated sockets showed a higher percentage of bone formation and fractal dimension values (58.17% and 1.098, respectively) compared with controls (48.97% and 1.074, respectively) in the 30-day postoperative period (p < 0.05). After 90 days, there was no significant difference between groups. Additionally, no significant difference was found between groups regarding the alveolar dimensions (p > 0.05). Use of 1% HA gel after tooth extraction accelerates bone repair in human dental sockets.

Hyaluronic acid accelerates bone repair in human dental sockets: a randomized triple-blind clinical trial

Abstract This study evaluated the effects of hyaluronic acid (HA) on bone repair of human dental sockets. Thirty-two lower first premolars were extracted from 16 patients (2 per patient) for orthodontic reasons. Following the extractions, one socket was randomly filled with 1% HA gel, while the other was allowed to naturally fill with blood clot. After 30 and 90 days of surgery, patients underwent cone beam computed tomography. Five central orthoradial slices were captured from each socket. The gray intensity was measured in each image and results were reported as mean percentage of bone formation. The buccolingual alveolar ridge width was measured and dimensional changes were compared between the postoperative intervals. The pattern of alveolar trabecular bone was evaluated through the fractal dimension. Treated sockets showed a higher percentage of bone formation and fractal dimension values (58.17% and 1.098, respectively) compared with controls (48.97% and 1.074, respectively) in the 30-day postoperative period (p < 0.05). After 90 days, there was no significant difference between groups. Additionally, no significant difference was found between groups regarding the alveolar dimensions (p > 0.05). Use of 1% HA gel after tooth extraction accelerates bone repair in human dental sockets.

Reconhecimento e avaliação da ansiedade em indivíduos com paralisia cerebral durante consultas odontológicas / Recognition and evaluation of anxiety in individuals with cerebral palsy during dental appointments

Objetivo: o objetivo deste estudo foi verificar a correlação entre a avaliação da ansiedade realizada por meio de medidas fisiológicas e pela observação do comportamento de pacientes com paralisia cerebral realizado pelo dentista durante a primeira consulta odontológica. Métodos: quarenta pacientes com idade variando de 7 a 26 anos, com paralisia cerebral foram submetidos a exames odontológicos. A pressão arterial e a frequência cardíaca foram aferidas no início e no final da primeira consulta odontológica. O dentista avaliou o comportamento antes e após o exame clínico dentário através da observação do comportamento do paciente (inquietação / agitação / tiques nervosos, palidez, transpiração excessiva, resistência e mudança aparente na frequência respiratória). Foi utilizado o teste de correlação de Spearman para determinar a correlação entre as medidas fisiológicas e a classificação comportamental da ansiedade feita pelo cirurgião dentista a um nível de significância de 95%. Resultados: os sinais comportamentais mais frequentes foram inquietação / agitação / tiques nervosos (50,0%) e resistência (27,5%). Foi encontrada uma correlação positiva significativa entre os dois métodos de avaliação de ansiedade utilizados (p <0,05). Os pacientes considerados ansiosos pelo dentista apresentaram medidas fisiológicas mais elevadas do que aqueles considerados calmos (p <0,05). Conclusão: a observação contínua do comportamento de pacientes com paralisia cerebral durante o exame odontológico é uma ferramenta valiosa para o reconhecimento e avaliação da ansiedade por parte da equipe odontológica. Estudos adicionais são necessários para validar um código de expressões faciais e corporais ou reações de ansiedade em pacientes com paralisia cerebral.(AU)

Aim: The present study aimed to verify the correlation between the evaluation of anxiety performed through physiological measures and the observation of the behavior of patients with cerebral palsy performed by the dentist during the first dental visit. Methods: Forty patients with cerebral palsy, varying from seven to 26 years of age, were submitted to dental examinations. The blood pressure and heart rate were measured at the beginning and end of the first dental appointment. The dentist evaluated the behavior before and after the dental exam by observing the patient's behavior (restlessness / agitation / nervous tics, pallor, excessive perspiration, resistance, and apparent change in breathing rate). The Spearman correlation test was used to determine the correlation between the physiological measures and the behavioral classification of anxiety made by the dentist at a significance level of 95%. Results: The most frequent behavioral signs were restlessness / agitation / nervous tics (50.0%), and resistance (27.5%). Through the Kruskal-Wallis test and Spearman's correlation, a significant positive correlation was found between the two anxiety assessment methods used in this study (p<0.05). The patients considered anxious by the dentist presented higher physiological measurements than did those considered calm (p<0.05). Conclusion: It can therefore be concluded that the continuous observation of the behavior of patients with cerebral palsy during the dental examination is a valuable tool for the recognition and evaluation of anxiety on the part of the dental team. Further studies are warranted to validate a code of facial and body expressions or anxiety reactions in patients with cerebral palsy.(AU)

Uso do ácido hialurônico como uma estratégia terapêutica para o reparo ósseo de alvéolos dentais humanos: um ensaio clínico randomizado, triplo-cego, boca dividida / Use of hyaluronic acid as a therapeutic strategy for bone repair in human dental sockets: a split-mouth randomized triple-blind clinical trial

O ácido hialurônico (AH), nas últimas décadas, tem sido amplamente estudado como um potente biomaterial na engenharia de tecidos, devido a sua biocompatibilidade, biodegradabilidade e participação em diversos processos biológicos relacionados à morfogênese e regeneração tecidual. O objetivo do presente estudo foi avaliar os efeitos do AH no reparo ósseo de alvéolos dentais humanos. Trinta e dois primeiros pré-molares inferiores foram extraídos de 16 pacientes com média de 18,67 (DP = 7,95) anos de idade com indicação de exodontia bilateral. Imediatamente após as exodontias, um dos alvéolos foi preenchido aleatoriamente com gel contendo AH a 1%, enquanto o contralateral foi preenchido naturalmente com coágulo. Durante os intervalos pós-operatórios de 30 e 90 dias, os pacientes realizaram exames de tomografia computadorizada cone beam (TCCB). Foram capturadas imagens dos cinco cortes ortorradiais mais centrais de cada alvéolo. A intensidade de cinza foi mensurada para cada imagem e os resultados foram expressos como porcentagem média de formação de osso. A espessura vestíbulo-lingual do processo alveolar foi mensurada e comparada entre os intervalos pós-operatórios para avaliar possíveis alterações dimensionais do alvéolo. Também foi avaliado o padrão do trabeculado ósseo alveolar através da dimensão fractal. A análise estatística envolveu análise descritiva e Testes T pareado e Wilcoxon (p<0,05). Os alvéolos tratados apresentaram maior porcentagem de formação óssea e valores de dimensão fractal (58,17% e 1,098, respectivamente) em comparação com os controles (48,97% e 1,074, respectivamente) no período de 30 dias pós-operatório (p<0,05). Com relação ao período de 90 dias, não foi observada diferença significativa entre os grupos. Além disso, não foram observadas diferenças estatisticamente significativas nas dimensões dos alvéolos entre os grupos (p>0,05). Assim, estes dados indicam que o AH acelerou o reparo ósseo em alvéolos dentais humanos

Hyaluronic Acid (HA), in the last decades, has become widely studied as a powerful biomaterial for tissue engineering, since its biocompatibility, biodegradability, and participation in several biological processes related to morphogenesis and tissue healing. The aim of this study was to evaluate the effects of HA on bone repair in human dental sockets. Thirty-two premolars were extracted from 16 patients with a mean age of 18.67 (SD = 7.95) years old with indication of bilateral extraction of lower first premolars. Immediately after the extractions, one socket was randomly filled with 1% HA gel, while the other side was naturally filled with blood clot. During the postoperative intervals of 30 and 90 days, the patients underwent cone beam computed tomography (CBCT). Five central parasagittal scan images were captured from each socket. The gray intensity was measured in each image and the results were expressed as mean percentage of bone formation. The buccolingual alveolar ridge width was also measured and dimensional changes were compared between the postoperative intervals. The pattern of the alveolar trabecular bone was evaluated through the fractal dimension. Statistical analyses included descriptive analysis and Wilcoxon and paired-t tests (p<0.05). The treated sockets showed a higher percentage of bone formation and fractal dimension values (58.17% and 1.098, respectively) compared with controls (48.97% and 1.074, respectively) in the 30-day postoperative period (p<0.05). After 90 days, there were no significant differences between the groups. Additionally, no significant differences were found between the groups regarding the alveolar dimensions (p>0.05). Thus, these data indicate that HA accelerate the bone repair in human dental socket

Down syndrome: a risk factor for malocclusion severity?

The aims of the present study were to compare aspects related to malocclusion between individuals with Down syndrome (DS) and a control group, establish malocclusion severity, and identify determinant factors. A total of 120 individuals (60 with DS and 60 with no physical or mental impairment), were included in the study. Data were collected through interviews, analyses of the medical charts, and oral examinations. The criteria of the Dental Aesthetic Index were used for the diagnosis of malocclusion. Chi-square test (p ≤ 0.05) and multivariate logistic regression were used for comparisons between the two groups and to determine the association between the dependent (malocclusion severity) and independent variables. Statistically significant differences were found between the two groups for the following variables: missing teeth, diastema, overjet, mandibular protrusion, anterior open bite, posterior crossbite, facial type, lip incompetence, and Angle classification. DS, a history of premature birth, and long face pattern were found to be associated with malocclusion severity. Individuals with DS exhibited more occlusal problems than those in the control group.

Down syndrome: a risk factor for malocclusion severity?

The aims of the present study were to compare aspects related to malocclusion between individuals with Down syndrome (DS) and a control group, establish malocclusion severity, and identify determinant factors. A total of 120 individuals (60 with DS and 60 with no physical or mental impairment), were included in the study. Data were collected through interviews, analyses of the medical charts, and oral examinations. The criteria of the Dental Aesthetic Index were used for the diagnosis of malocclusion. Chi-square test (p ≤ 0.05) and multivariate logistic regression were used for comparisons between the two groups and to determine the association between the dependent (malocclusion severity) and independent variables. Statistically significant differences were found between the two groups for the following variables: missing teeth, diastema, overjet, mandibular protrusion, anterior open bite, posterior crossbite, facial type, lip incompetence, and Angle classification. DS, a history of premature birth, and long face pattern were found to be associated with malocclusion severity. Individuals with DS exhibited more occlusal problems than those in the control group.

Valeriana officinalis L. for conscious sedation of patients submitted to impacted lower third molar surgery: A randomized, double-blind, placebo-controlled split-mouth study.

INTRODUCTION: Anxiety is one of the components of patient stress in the dental office and is recognized as one of the main factors that negatively affect treatment. The control of anxiety can be performed through conscious sedation, for which benzodiazepine is the drug of choice in dental practice, however present side-effects. OBJECTIVE: The objective of the following study is to evaluate the efficacy of Valeriana officinalis L. (Valerian) for control of anxiety during the third molar surgery. MATERIALS AND METHODS: A single oral dose of either Valerian (100 mg) or placebo was randomly administered 1 h before each surgical procedure to 20 volunteers between 17 and 31 years of age. Anxiety level was assessed by physiological parameters (blood pressure and heart rate [HR]) and the observation of signs. Descriptive analysis, Chi-square test, Friedman test, Wilcoxon test and effect size test were performed (P < 0.05). RESULTS: According to the researcher's (80%) and surgeon's (75%) evaluations, the patients treated with Valerian were calmer and more relaxed during surgery. Valerian had a greater effect on the maintenance of systolic blood pressure and HR after surgery. CONCLUSION: Valerian was more effective at controlling anxiety than a placebo when used for the conscious sedation of adult patients submitted to impacted lower third molar surgery.

Clinical and SEM characterization of prolonged retention of a primary tooth with pulpectomy.

Root canal filling with zinc oxide-eugenol (ZOE) paste following primary tooth pulpectomy is a common practice in pediatric dentistry. This material offers high clinical and radiographic success rates. In some cases, however, it is not resorbed along with the root of the primary tooth. The aim of this study was to describe a case of prolonged retention of a primary maxillary incisor that was subjected to pulpectomy and filled with ZOE paste in order to characterize the aspects of root resorption using scanning electron microscopy.

Esthetic and functional recovery of extensively decayed posterior teeth through conservative treatment.

The case exemplifies the combination of two important principles in dentistry: 1) the maintenance of pulp vitality by the partial excavation of the contaminated dentin followed by the application of a biomaterial; and 2) esthetic and functional recovery based on biological restoration. Tooth vitality was confirmed two months after pulp treatment and restoration was accomplished with a fragment of a tooth extracted from another individual. This method is easy to perform and offers esthetic, functional, emotional and social benefits to the patient.

Flexural strength of a composite resin light cured with different exposure modes and immersed in ethanol or distilled water media.

AIM: The aim of this in vitro study was to evaluate the flexural strength of a composite resin polymerized with three different modes of light exposure. MATERIALS AND METHODS: The three different modes of light exposure were conventional, 600 mW/cm2/40s; soft start, 300 mW/cm2/10s + 600 mW/cm2/30s; pulse delay, 600 mW/cm2/1s + 60 s of waiting time + 600 mW/cm2/39s). Twenty samples were prepared for each polymerization method. Flexural strength (FS) tests were carried out with a 2 kN load at a speed of 0.5 mm/ min. All tested groups were submitted to analysis of variance (one-way-ANOVA) and Tukey's test (P < 0.05). RESULTS: When stored in water, conventional and pulse delay groups presented higher FS values which were statistically different from the soft start group. When stored in 100% ethanol, conventional and soft start groups presented higher FS values which were statistically different from the pulse delay group. CONCLUSION: Different polymerization modes and immersion media can affect the physical properties (flexural strength) of composite resin.

Does intellectual disability affect the development of dental caries in patients with cerebral palsy?

The aim of this study was to evaluate if the severity of intellectual disability is a factor that affects the development of dental cavities in patients with cerebral palsy. This cross-sectional study was conducted on 165 individuals who were selected from a physical rehabilitation center, a special public school and a regular public school. Of these, 76 individuals had been diagnosed with spastic cerebral palsy and 89 had no neurological impairment. The subjects were matched based on age and gender and selected randomly by lottery. All patients were examined to determine the number of dental cavities, and tested for their intellectual functioning (Raven Test) and motor abilities. The study showed that children with CP who presented with intellectual disabilities had a larger number of dental cavities than children with CP without intellectual disabilities. Considering intellectual functioning and motor impairment in the multivariate logistic regression, only intellectual functioning was found to have a significant effect on the development of dental cavities. These results suggest that intellectual disability can be considered a contributing factor for the development of dental caries in patients with cerebral palsy.

Effects of different surface treatments and accelerated artificial aging on the bond strength of composite resin repairs.

The purpose of the present study was to assess the bond strength of composite resin repairs subjected to different surface treatments and accelerated artificial aging. 192 cylindrical samples (CSs) were prepared and divided into 24 groups (n = 8). Half of the CSs were stored in water for 24 h, and the other half were subjected to C-UV accelerated aging for non-metallic specimens. The treatments were phosphoric acid + silane + adhesive (PSA); phosphoric acid + adhesive (PA); diamond bur + phosphoric acid + silane + adhesive (DPSA); diamond bur + phosphoric acid + adhesive (DPA); air abrasion + phosphoric acid + silane + adhesive (APSA); and air abrasion + phosphoric acid + adhesive (APA). The repair was performed and the specimens were again aged as described above. A control group (n = 8) was established and did not receive any type of aging or surface treatment. The specimens were loaded to failure in shear mode with a crosshead speed of 0.5 mm/min until fracture. Data were analyzed by one-way ANOVA/Tukey's test (p < 0.05). No statistically significant differences were found among DPSA, DPA, APSA, APA, and the control group. The aged PSA and PA achieved low bonding values and were statistically different from the control group, whereas the non-aged PSA and PA presented no statistically significant difference from the control group. Repairs with the proposed surface treatments were viable on both recent and aged restorations; however, phosphoric acid + adhesive alone were effective only on recent restorations.

Effects of different surface treatments and accelerated artificial aging on the bond strength of composite resin repairs

The purpose of the present study was to assess the bond strength of composite resin repairs subjected to different surface treatments and accelerated artificial aging. 192 cylindrical samples (CSs) were prepared and divided into 24 groups (n = 8). Half of the CSs were stored in water for 24 h, and the other half were subjected to C-UV accelerated aging for non-metallic specimens. The treatments were phosphoric acid + silane + adhesive (PSA); phosphoric acid + adhesive (PA); diamond bur + phosphoric acid + silane + adhesive (DPSA); diamond bur + phosphoric acid + adhesive (DPA); air abrasion + phosphoric acid + silane + adhesive (APSA); and air abrasion + phosphoric acid + adhesive (APA). The repair was performed and the specimens were again aged as described above. A control group (n = 8) was established and did not receive any type of aging or surface treatment. The specimens were loaded to failure in shear mode with a crosshead speed of 0.5 mm/min until fracture. Data were analyzed by one-way ANOVA/Tukey's test (p < 0.05). No statistically significant differences were found among DPSA, DPA, APSA, APA, and the control group. The aged PSA and PA achieved low bonding values and were statistically different from the control group, whereas the non-aged PSA and PA presented no statistically significant difference from the control group. Repairs with the proposed surface treatments were viable on both recent and aged restorations; however, phosphoric acid + adhesive alone were effective only on recent restorations.

Non-accidental collision followed by dental trauma: associated factors.

The aim of the present cross-sectional survey was to assess factors associated with non-accidental collision followed by dental trauma among adolescents in the city of Diamantina, Brazil. A total of 387 students from 12 to 15 years of age (mean = 14 SD = 0.9) were randomly selected. The study was carried out in two stages. Firstly, data were collected through dental examinations of permanent incisors. Secondly, a thorough interview was held with 85 adolescents who exhibited dental trauma in the dental examinations. The interview consisted of a detailed description of the incident and physical environment in which it occurred. Descriptive analysis and the chi-square test (P < 0.05) were performed. The prevalence of dental injury was 22% (n = 85). Dental trauma was more prevalent in boys (P = 0.001) and individuals with overjet >3 mm (P = 0.007) and inadequate lip coverage (P = 0.013). Analysis of the event revealed that 22.3% of the cases of dental trauma occurred because of non-accidental collision. Non-accidental collision followed by injury occurred mainly at school (P < 0.001) and in an environment with a concrete, tiled or ceramic floor (P = 0.001). No statistically significant associations were found between non-accidental collision and gender, age or mother's schooling. It was concluded that the non-accidental collisions happened especially at school and in indoor environments with a concrete, tiled or ceramic floor.

Fragment reattachment associated with pulpotomy in a posterior tooth with incomplete root formation.

This article reports a case of preserving pulp vitality combined with aesthetics and functional reconstruction of an immature permanent molar extensively destroyed because of a carious lesion. After a pulpotomy using calcium hydroxide, the tooth crown was restored by bonding a dental fragment obtained from an extracted tooth from another individual. Aspects of diagnosis and treatment that directly affect the prognosis of the techniques are discussed. Radiographic and clinical follow-up for two years showed complete root development and a very satisfactory restoration with regard to aesthetics and function.

Determining skeletal maturation stage using cervical vertebrae: evaluation of three diagnostic methods.

The aim of the present study was to compare the use of three cervical vertebral evaluation methods (Hassel-Farman, Baccetti et al., and Seedat-Forsberg) for determinating skeletal maturation stage in orthodontic patients. Twenty-three radiographs were randomly selected from a private orthodontic practice. Each radiograph was analyzed on three separate occasions by four evaluators (one radiologist and three orthodontists), who determined the skeletal maturation stage using the references established by each of the three methods. Intraevaluator and interevaluator comparisons were performed, and the degree of agreement was established using the weighted Kappa coefficient (95% CI). Good agreement (Kappa between 0.61 and 0.80) was observed between the determinations of most of the evaluators. The three methods demonstrated clinical applicability. However, the method proposed by Baccetti et al. achieved the best results, followed by the Hassel-Farman and the Seedat-Forsberg methods.

Determining skeletal maturation stage using cervical vertebrae: evaluation of three diagnostic methods

The aim of the present study was to compare the use of three cervical vertebral evaluation methods (Hassel-Farman, Baccetti et al., and Seedat-Forsberg) for determinating skeletal maturation stage in orthodontic patients. Twenty-three radiographs were randomly selected from a private orthodontic practice. Each radiograph was analyzed on three separate occasions by four evaluators (one radiologist and three orthodontists), who determined the skeletal maturation stage using the references established by each of the three methods. Intraevaluator and interevaluator comparisons were performed, and the degree of agreement was established using the weighted Kappa coefficient (95 percent CI). Good agreement (Kappa between 0.61 and 0.80) was observed between the determinations of most of the evaluators. The three methods demonstrated clinical applicability. However, the method proposed by Baccetti et al. achieved the best results, followed by the Hassel-Farman and the Seedat-Forsberg methods.