Histological changes in pulp-dentin complex in tooth subjected to traumatic occlusion and subluxation.

Background: This study evaluated the influence of traumatic occlusion in the dentin-pulp complex a molar teeth submitted to subluxation. Material and methods: Ninety Wistar rats were divided into groups Naïve (N), Subluxation (S) and Subluxation with traumatic occlusion (STO) and submitted to histological analysis after 7 and 21 days. A quantitative analysis was submitted to one-way ANOVA and Tukey's post-hoc test, and Chi-square and Bonferronís post-hoc test. Results: S and STO showed a significant increase in blood vessels area (p < 0.0005), amorphous fundamental substance (p < 0.0005) and reactionary dentin formation (p < 0.0005), as well as a decrease in the nuclear profile (p < 0.0005), odontoblast layer (p = 0.013 and p < 0.0005) by day 7 when compared with N. These changes normalized by day 21, except for the reactionary dentin (p < 0.0005) in both S and STO groups. Interestingly, the STO group exhibited significant changes in the increase of pulp calcification (p < 0.0005), presence of tubules with nuclei (p < 0.0005), and inflammatory infiltrate (p < 0.0005), as well reduction of nuclear profile (p < 0.0005), odontoblast layer (p < 0.0005) compared with N and S at day 21. Conclusions: STO impaired the defence response and decreased pulp regeneration capacity by increasing the inflammatory infiltrate and pulp calcification, and decreasing the nucleated cell number in the odontoblast layer and central pulp.

Educational Impact of Notebook Covers on the Knowledge of Sixth-Grade Primary Pupils About Tooth Avulsion and Replantation: A Randomized Trial.

BACKGROUND: Tooth avulsion is a common cause of tooth loss. However, there is a significant lack of knowledge about dental trauma and the appropriate emergency procedures to handle these cases. AIM: The aim of this study was to evaluate the educational effect of notebook covers illustrated with figures and informative texts about tooth avulsion and replantation in sixth-grade primary school pupils. MATERIAL AND METHODS: Sixth-grade pupils of two public school participated in this study. An experimental group consisting of 134 pupils received notebook covers illustrated with figures and informative texts about tooth avulsion and replantation, while a control group of 108 pupils received notebooks with neutral covers. An assessment of the educational effects on pupils was performed after 9 months, with a standardized questionnaire normally used to evaluate dental trauma. Statistical analysis was conducted with SPSS 21.0 (α = .05) for group description and comparison using chi-square and Student t tests. RESULTS: Compared with the control group, the experimental group showed statistically significant improvements in correct meaning of dental trauma (38% vs. 58.2%); procedures to follow in the case of dental avulsion (2.8% vs. 70.9%); storing the avulsed tooth in milk (18.5% vs. 76.9%); general knowledge about dental anatomy (61.1% vs. 95.5%); and the ideal time for the tooth to remain outside the mouth prior to replantation (20.4% vs. 59.7%). CONCLUSION: The use of notebook covers illustrated with figures and informative texts about dental trauma led to a significant increase in the knowledge of schoolchildren about tooth avulsion, first aid, and replantation.

Avaliação da qualidade de vida, ansiedade, estresse e depressão de cuidadores de pessoas com ou sem Síndrome de Down / Evaluation of quality of life, anxiety, stress and depression of caregivers of people with or without Down's Syndrome

A qualidade de vida é a percepção do indivíduo sobre sua posição na vida e em relação aos seus objetivos, expectativas, padrões e preocupações representando seu grau de satisfação. Cuidar de pacientes com Sídrome de Down (SD) demanda tarefas complexas, delicadas e sofridas que somadas as responsabilidades diárias, podem gerar um impacto na qualidade de vida. Além disso, toda sobrecarga, pode causar estresse social e trazer sentimentos de ansiedade e depressão, em longo prazo, ao cuidador de um portador da SD. Assim, o objetivo foi avaliar a qualidade de vida, ansiedade, estresse e depressão de cuidadores de pacientes com ou sem síndrome de Down. O estudo foi conduzido com uma amostra de 144 participantes, que serão divididos entre dois grupos denominados GC (Grupo Controle) e GSD (Grupo Síndrome de Down). No GC, participou do estudo cuidadores de crianças com desenvolvimento normal de uma escola pública, numa faixa etária de 4 a 8 anos e no GSD, participou do estudo cuidadores principais de pacientes com SD, numa faixa etária de 4 a 30 anos de idade. Para coleta de dados foram utilizados 5 questionários para identificação do cuidador, avaliação da qualidade de vida (WHOQOL-Bref), avaliação de depressão (BDI), avaliação de ansiedade (BAI) e avaliação de estresse (LIPP). Para a análise dos dados foram identificadas categorias referentes ao perfil do cuidador, e foi utilizado teste Quiquadrado com post hoc Bonferroni modificado com nível de significância de p ≤ 0,05, para comparação entre os grupos e os testes de correlação de Rank e Pearson. Não houve diferença significativa entre os grupos na avaliação do BDI. Houve correlação maior e significativa do nível de ansiedade com os cuidadores do grupo C. A intensidade dos sintomas físicos de estresse foi significativamente maior no grupo SD, no qual 37,8% estavam na fase de exaustão do estresse. Na avaliação da qualidade de vida, o grupo SD teve correlação significativa menor referente ao domínio psicológico do que o grupo C e maior referente ao domínio do meio ambiente do que o grupo C. No grupo SD, houve correlação positiva entre sintomas físicos do estresse e o grau de dependência do portador de SD, (Correlação de Pearson=0,23; p=0,04). Também foi mostrado que a auto avaliação da qualidade de vida foi melhor entre os cuidadores de SD que tinham uma maior renda familiar (correlação de Pearson=0,53; p=0.02). Assim conclui-se que os cuidadores de pessoas com SD apresentaram piores sintomas de estresse físico e pior qualidade de vida no domínio psicológico do que os cuidadores de crianças sem SD. Os sintomas de estresse físico estão relacionados com o maior grau de dependência do portador de SD, enquanto que a qualidade de vida dos cuidadores de SD tem relação direta com uma maior renda familiar(AU)

Quality of life is the individual's perception of their position in life and in relation to their goals, expectations, standards and concerns representing their degree of satisfaction. Caring for patients with Down's Syndrome (DS) demands complex, delicate and painful tasks that, added to the daily responsibilities, can have an impact on quality of life. In addition, any overload can cause social stress and bring long-term feelings of anxiety and depression to the caregiver of a patient with DS. Thus, the objective was to assess the quality of life, anxiety, stress and depression of caregivers of patients with or without Down syndrome. The study was conducted with a sample of 144 participants, who will be divided between two groups called GC (Control Group) and GSD (Down Syndrome Group). In the CG, caregivers of children with normal development in a public school, aged 4 to 8 years, participated in the study and in the GSD, the main caregivers of patients with DS, aged 4 to 30 years, participated in the study. For data collection, 5 questionnaires were used to identify the caregiver, assess quality of life (WHOQOL-Bref), assess depression (BDI), assess anxiety (BAI) and assess stress (LIPP). For data analysis, categories related to the caregiver's profile were identified, and a Chi-square test with modified post-hoc Bonferroni was used, with a significance level of p ≤ 0.05, for comparison between groups and Rank and correlation tests. Pearson. There was no significant difference between groups in the BDI assessment. There was a greater and more significant correlation of the level of anxiety with the caregivers of group C. The intensity of the physical symptoms of stress was significantly higher in the DS group, in which 37.8% were in the phase of stress exhaustion. In assessing quality of life, the SD group had a significantly lower correlation with regard to the psychological domain than group C and a greater correlation with the environment domain than group C. In the SD group, there was a positive correlation between physical symptoms of stress and the degree of dependence of the DS patient, (Pearson's correlation = 0.23; p = 0.04). It was also shown that selfrated quality of life was better among DS caregivers who had a higher family income (Pearson's correlation = 0.53; p = 0.02). Thus, it is concluded that caregivers of people with DS had worse symptoms of physical stress and worse quality of life in the psychological domain than caregivers of children without DS. Symptoms of physical stress are related to a higher degree of dependence on the DS patient, while the quality of life of DS caregivers is directly related to a higher family income(AU)

Systematic review of the effects of excessive occlusal mechanical load on the periodontum of rats.

OBJECTIVE: This study aims to systematically evaluate the effects of traumatic occlusion on the periodontal tissue of rats. The set of questions to be answered were-Can traumatic occlusion acting on a healthy and an unhealthy periodontium cause periodontal destruction? DESIGN: The protocols for systematic review were all developed, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and applied to animal research. Reporting of In vivo experiment guidelines for reporting animal research to assess the risk of bias of the studies. MATERIALS AND METHODS: A literature search was conducted using MEDLINE through PubMed and manual search from the reference lists of main articles related to the theme. RESULTS: This search strategy identified 65 references, of which 33 were considered inappropriate. The full texts of 32 articles were read, 31 of which did not meet the eligibility criteria and were excluded. The final selection included 1 article for which data was extracted for further evaluation. The article included shows a strongest reaction in the periodontium in front of a secondary occlusal trauma as inflammation and apical migration of the junctional epithelium, bone degradation, and decrease in the quantity of collagen fiber. However, primary occlusal trauma also presents these alterations, with the exception of apical migration of the junctional epithelium. CONCLUSIONS: Although only one study was included in the systematic review of traumatic occlusion, there is some evidence from experimental studies on animals that shows a coherent picture of the effects of traumatic occlusion on the periodontium. However, new studies are needed to fully answer the questions posed by this systematic review.

Immediate tooth replantation: root canal filling for delayed initiation of endodontic treatment.

The aim of this study is to evaluate the action of paramonochlorophenol associated with Furacin followed by calcium hydroxide (CH) dressing in the control of inflammatory root resorption in cases of immediate tooth replantation with delayed endodontic treatment. A total of 28 incisors of 3 male dogs were extracted and replanted after 15 minutes, and randomly divided into 3 groups: Group I (n = 8) - endodontic treatment was performed before the extraction and replantation; Group II (n = 10) - endodontic treatment was performed 30 days after replantation and the root canal was filled with CH dressing; Group III (n = 10) - endodontic treatment was performed 30 days after replantation and root canals received temporary medication of paramonochlorophenol-Furacin followed by CH dressing. The animals were euthanized 90 days after replantation. The histomorphological events analyzed at the epithelial reattachment site were the intensity and extent of acute and chronic inflammatory processes, periodontal ligament (PDL) organization, the intensity and extent of acute and chronic inflammatory processes in the PDL space, root resorption, bone tissue, and ankylosis. Data were submitted to the Wilcoxon Signed Ranks Test for group comparison (α = 5%). In Groups I, II and III the periodontal ligament was regenerated and most of the resorption areas were repaired by newly formed cementum. The depth and extent of root resorption were significantly higher in Group II than in Group III. The use of paramonochlorophenol-furacin followed by CH dressing was more effective in controlling inflammatory root resorption after immediate tooth replantation.

Immediate tooth replantation: root canal filling for delayed initiation of endodontic treatment

Abstract The aim of this study is to evaluate the action of paramonochlorophenol associated with Furacin followed by calcium hydroxide (CH) dressing in the control of inflammatory root resorption in cases of immediate tooth replantation with delayed endodontic treatment. A total of 28 incisors of 3 male dogs were extracted and replanted after 15 minutes, and randomly divided into 3 groups: Group I (n = 8) - endodontic treatment was performed before the extraction and replantation; Group II (n = 10) - endodontic treatment was performed 30 days after replantation and the root canal was filled with CH dressing; Group III (n = 10) - endodontic treatment was performed 30 days after replantation and root canals received temporary medication of paramonochlorophenol-Furacin followed by CH dressing. The animals were euthanized 90 days after replantation. The histomorphological events analyzed at the epithelial reattachment site were the intensity and extent of acute and chronic inflammatory processes, periodontal ligament (PDL) organization, the intensity and extent of acute and chronic inflammatory processes in the PDL space, root resorption, bone tissue, and ankylosis. Data were submitted to the Wilcoxon Signed Ranks Test for group comparison (α = 5%). In Groups I, II and III the periodontal ligament was regenerated and most of the resorption areas were repaired by newly formed cementum. The depth and extent of root resorption were significantly higher in Group II than in Group III. The use of paramonochlorophenol-furacin followed by CH dressing was more effective in controlling inflammatory root resorption after immediate tooth replantation.

The influence of traumatic occlusion on the repair process for teeth following subluxation.

BACKGROUND/AIM: Traumatic occlusion (TO) can cause morphofunctional alterations that interfere in the homeostasis of the periodontium. The aim of this study was to assess the influence of TO on the periodontal repair process for teeth following subluxation. MATERIALS AND METHODS: Ninety Wistar rats aged 12 weeks were divided into three groups: control (C), subluxation (S) and subluxation with traumatic occlusion (S+TO). Subluxation was created with an impact force of 900 cN applied by a tensiometer and TO was created with a direct composite resin filling. Healing after two experimental periods of 7 and 21 days was assessed histologically. The Kruskal-Wallis and Dunn post hoc tests were used for group comparison. RESULTS: At 7 days, there was a significant increase in periodontal ligament (PDL) width and amorphous fundamental substance, as well as a significant bone area reduction in groups S and S+TO. After 21 days, there was a significant PDL width increase in group S+TO, and in the percentage of collagen fibres in group S, whereas group S+TO showed a 52% bone area reduction compared to the same group at 7 days. Subluxation with or without TO caused only superficial root resorption. However, only group S+TO showed damage to the repair process of resorbed root areas after 21 days. CONCLUSION: TO can increase damage to the PDL after subluxation and it can also delay the repair process after PDL damage.

The effect of traumatic dental occlusion on the degradation of periodontal bone in rats.

CONTEXT: A better understanding of the relation between traumatic dental occlusion and periodontal changes is needed. AIMS: This study aimed to evaluate the pattern of osteoclastic activity in the periodontal bone in front of the traumatic dental occlusion in rat molars. PATIENTS AND METHODS: Traumatic dental occlusion (TO) was induced in twenty rats, which were sacrificed after periods of 2, 5, 7, and 14 days. Transversal histological sections of both jaws were stained with tartrate-resistant acid phosphatase and hematoxylin and eosin. Mann-Whitney U-test was used for group comparison, and Pearson's correlation test was applied for the number of osteoclasts and bone area (BA). RESULTS: Traumatic dental occlusion caused an increase in the number of osteoclasts in the bone of the upper and lower right first molar from days 2-5 to 2-14, respectively. In the TO groups, the number of osteoclasts on the lamina dura and in the center of the alveolar bone septum, respectively, increased almost 4-fold and 9-fold in the lower jaw; and 3-fold and 5-fold in the upper jaw, during all periods. In the TO groups, the BA of the alveolar bone septum was substantially reduced. There was a negative correlation between the number of osteoclasts and BA in both jaws during all experimental periods. CONCLUSIONS: Traumatic dental occlusion increases osteoclast activity in the alveolar lamina dura and in the center of alveolar bone and stimulates a higher degradation in the center of the alveolar bone septum.

Influência da oclusão traumática no processo de reparo do periodonto em dentes submetidos à subluxação / The influence of traumatic occlusion on the repair process in teeth subjected to subluxation

A subluxação caracteriza-se pelo dano ao ligamento periodontal (LP) com sangramento e mobilidade anormal do dente; e a presença de edema na região apical do dente pode provocar discreta extrusão. O objetivo desse estudo foi avaliar a influência da oclusão traumática (OT) no processo de reparo do periodonto em dentes submetidos à subluxação, por meio de análises histomorfométricas e imunoistoquímica. Para este estudo, 90 ratos Wistar com 12 semanas de idade; foram distribuídos em três grupos: controle (C), subluxação (S) e subluxação com oclusão traumática (S+OT); nos períodos experimentais de 7 e 21 dias. A subluxação foi induzida pela aplicação de uma força de 900cN no sentido ocluso-gengival na superfície oclusal do 1ºMSD calibrada por um tensiômetro e a OT foi induzida por uma restauração de resina composta na superfície oclusal do primeiro molar superior direito (1°MSD). Para comparação estatística entre os grupos e períodos foi usado o teste de Kruskal-Wallis com Dunn post hoc teste. No período de 7 dias, houve um aumento significativo da espessura do LP (S34% e S+OT-80%), da substância fundamental amorfa (S-84% e S+OT-148%) e uma redução significativa da área óssea (S-60,8% e S+OT-81,8%) em relação ao grupo controle. Aos 21 dias houve um aumento da espessura do ligamento periodontal significativo no grupo S+OT e na porcentagem de fibras colágenas (S-86%) no grupo S, mas não no grupo S+OT. A porcentagem de substância fundamental amorfa permaneceu proporcionalmente aumentada nos dois grupos experimentais e o perfil nuclear mostrou um aumento significativo no grupo S quando comparada ao período de 7 dias. Nos 2 grupos experimentais também houve um aumento do número de células TRAP positivas tanto no LP (4x) quanto no osso do septo alveolar (16x). O grupo S apresentou um pequeno aumento na porcentagem da área óssea do septo alveolar, enquanto no grupo S+OT houve redução de 52% da área óssea quando comparada ao mesmo grupo no período de 7 dias. A subluxação com ou sem a OT provocou apenas reabsorções radiculares superficiais e a OT foi capaz de prejudicar o reparo das áreas radiculares reabsorvidas após a subluxação no período de 21 dias. Assim conclui-se que a oclusão traumática agravou os danos no ligamento periodontal, no osso alveolar e na superfície radicular gerados após a subluxação, bem como atrasou o processo de reparo dos mesmos(AU)

Subluxation is characterised by damage to the periodontal ligament (PDL), accompanied by bleeding and abnormal tooth mobility. The presence of edema in the apical region of the tooth can provoke discrete extrusion. The aim of this study was to assess the influence of traumatic occlusion (TO) on the periodontal repair process in teeth submitted to subluxation, by means of histomorphometrical and immunohistochemical analyses. For this study, 90 Wistar rats aged 12 weeks were divided into three groups: control (C), subluxation (S) and subluxation with traumatic occlusion (S+TO); with experimental periods of 7 and 21 days. Subluxation was induced by applying a 900cN force in the occlusal-gingival sense on the occlusal surface of the 1st SRM calibrated by a tensiometer. TO was induced by a composed resin restoration on the occlusal surface of the first superior right molar (1st SRM). The Kruskal-Wallis with Dunn post-hoc test was used for group and period comparison. At 7 days, there was a significant increase in PDL width (S-34% and S+TO-80%), amorphous fundamental substance (S-84% and S+TO-148%), and a significant reduction of bone surface (S-60.8% and S+TO-81.8%), in comparison to the control group. After 21 days, there was a significant increase in the periodontal ligament width in group S+TO and in the percentage of collagen fibres in group S (86%), but not in group S+TO. The percentage of amorphous fundamental substance remained proportionally increased in the two experimental groups, and the nuclear profile showed a significant increase in group S, compared to the 7 days period. In the two experimental groups an increase in positive TRAP cells was also observed, in the PDL (4x) as well as in the bone area of the alveolar septum (16x). Group S presented a small increase in the alveolar septum's bone area, whereas group S+TO showed a 52% bone area reduction compared to the same group at 7 days. The subluxation with or without TO caused only superficial root resorption. The TO was able to damage the repair processo of reabsorbed root areas after 21 days of subluxation. It can be concluded that traumatic occlusion aggravates post-subluxation damage to the periodontal ligament, the alveolar bone and the radicular surface, and has a delaying effect on the repair process(AU)

Orthodontic Extrusion as Treatment Option for Crown-Root Fracture: Literature Review with Systematic Criteria.

OBJECTIVE: To review the literature searching for a consensus for the choice of orthodontic extrusion as treatment for crown-root fracture. MATERIALS AND METHODS: An electronic search was performed in the databases PubMed, Cochrane Central Register of Controlled Trials and Scopus and a manual search of the Journal Dental Traumatology. RESULTS: Forty articles were found in PubMed and 38 in Scopus and after removal of duplicate sample 51 contained articles. Of these, 48 were excluded for not having orthodontic treatment, no follow-up or follow-up less than 6 months, or not report the presence of crown-root fracture. In manual search in Dental Traumatology 20 articles were found, but none of them met the prerequisites established. So, three articles formed the basis of the study. CONCLUSION: The choice of how to treat orthodontic extrusion of crown-root fracture was effective and stable, without root and periodontal changes. Factors, such as root formation and presence of pulp vitality were decisive for determining the stages of treatment, however, there is no consensus based on scientific evidence about these protocols.

Prevalência da relação de procedimentos cirúrgicos periodontais e a odontologia restauradora / Prevalence of the relationship of periodontal surgical procedures and the restorative dentistry

O sucesso da odontologia restauradora está conjugado aos limites fisiológicos e exigências estruturais do periodonto. O objetivo deste trabalho é identificar a necessidade de cirurgia periodontal prévia frente à realização de restaurações de Classe II de Black, Classe V de Black, e próteses parciais fixas; além de identificar os procedimentos cirúrgicos periodontais mais empregados na clínica para este fim. Foram analisados 134 pacientes que buscaram atendimento em clínica geral, estabelecendo o total de restaurações tipo classe II e V, próteses parciais fixas, cirurgias periodontais prévias a procedimentos restauradores e técnicas cirúrgicas utilizadas. Num total de 854 procedimentos de dentística restauradora que foram realizados, 293 (34,30%) eram restaurações em cavidades Classe II e 69 (8,10%) em cavidades Classe V de Black. Constatou-se que 10,22% dos casos de restaurações tipo classe II e V e 36,48% dos casos de próteses parciais fixas necessitaram de cirurgia periodontal prévia. As técnicas cirúrgicas mais utilizadas foram: retalho deslocado apicalmente com osteotomia (50%), cunha interproximal (20,31%) e retalho de Widman modificado (18,75%). Concluí-se que existe uma alta demanda quanto à necessidade de cirúrgicas periodontais em função de procedimentos restauradores na clínica odontológica

The success of the restorative dentistry is conjugated to the periodontal physiological limits and structural requirements. The objective this paper was to analyze the prevalence of the necessity of periodontal procedures before restorative procedures. There was to analyzed 134 patients that searched attendance in general clinic, establishing the total of restorations type class II and class V, fixed partial prosthetic, previous periodontal surgery and which more used the periodontal surgical procedure in the solution of these cases. To 854 restorative procedures that was carried through, 293 (34.30%) was class II and 69 (8.10%) class V Black restaurations. It was observed that 10.22% of the cases of restorations type class II and V and 36.48% of the fixed cases of partial prosthetic, needed of periodontal procedures before. The used surgical techniques more had been: apically repositioned flap with osteotomy (50%), interproximal wedge (20,31%) and of Modified Widman flap (18,75%). Front to the gotten results we can conclude that exist an important prevalence of the necessity of periodontal procedures before restorative procedures