A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis.

BACKGROUND: Dental trauma and deep caries are frequent findings in children and adolescents that may lead to pulp necrosis in young permanent teeth. As a consequence, the root stops its development, and managing these immature teeth becomes challenging due to the presence of open apexes and fragile dentinal walls. AIM: We aimed to carry out a systematic review including a meta-analysis to compare the endodontic treatments available in the management of immature necrotic permanent teeth and determine which one provides the best clinical and radiographic outcomes. DESIGN: The literature was screened via PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials databases until August 2015 to select randomized clinical trials that compared at least two different treatments regarding immature necrotic permanent teeth comprising clinical and radiographic success as outcome. Two reviewers independently performed the screening and evaluation of the articles. A total of 648 studies were retrieved from the databases, in which only 14 were selected to full-text analysis by the appliance of inclusion criteria. After the exclusion criteria, the remaining seven studies had their data extracted and assessed for bias risk. Pooled-effect estimates were obtained comparing clinical and radiographic success rates among MTA Versus other treatments. RESULTS: Evaluation of clinical (Z = 2.32, P = 0.02, OR = 5.37, 95% CI: 1.29-22.23, I = 0%) and radiographic (Z = 2.45, P = 0.01, OR = 4.31, 95% CI: 1.34-13.82, I = 0%) outcomes favored the MTA (control group) when compared to other endodontic treatments (P < 0.05). No evidence of heterogeneity was detected among the studies (I < 50%), whereas a moderate risk of bias was identified in five of them. CONCLUSIONS: Although almost all of the identified studies presented moderate risk of bias, MTA apexification seems to produce overall better clinical and radiographic success rates among the endodontic treatment available in immature necrotic permanent teeth.

Atendimento de urgência frente ao traumatismo alvéolo dentário: relato de caso clínico / Urgent care outside the tooth injuries: case report

Os traumatismos dentários são situações de urgência odontológica que impõem ao profissional um atendimento rápido, porém minucioso. Apesar da agilidade no primeiro atendimento, na maioria das vezes é necessário o acompanhamento do paciente por um longo período. O objetivo deste trabalho é relatar o caso de um menino que compareceu ao atendimento de urgência da Clínica Infantil da Universidade Luterana do Brasil (Ulbra) - campus Cachoeira do Sul/RS - Brasil, com várias lesões decorrentes de uma queda de bicicleta. O paciente chegou 24 horas após o trauma com vária lacerações faciais que já haviam sido suturadas no hospital anteriormente. Os dentes envolvidos, o 11, 12, 13,21,22 e 23, apresentavam lesões de fratura coronária, subluxação e luxação extrusiva Realizou-se uma radiografia da região e não se detectou fratura radicular ou da tábua óssea vestibular. No primeiro atendimento, optou-se pela confecção de uma contenção semirrígida manto por três semanas, pois alguns dentes estavam com grande mobilidade. Desde o atendimento de urgência o paciente vem sendo acompanhado e tratado na Universidade. Podemos concluir que o tratamento de urgência é bastante complexo, uma boa anamnese, um bom exame clínico e exames complementares são indispensáveis na instituição de um plano de tratamento rápido e adequada. O prognóstico é muitas vezes duvidoso, podendo envolver várias especialidades odontológicas e se torna mais favorável quando o profissional tem conhecimento, agilidade no tratamento de urgência e faz o encaminhamento correto do paciente quando necessário.

Dental injuries are emergencies that require the dental professional a fast, but thorough. Despite the agility in primary care, most often it is necessary to monitor the patient for a long perio The objective of this study is to report the case of a boy who attended the emergency care of theChildren's Clinic Lutheran University of Brazil (Ulbra) - campus Cachoeira do Sul/RS - Brazil, with multiple injuries resulting from a fali from a bike. The patient arrived 24 hours after the trauma with multiple facial lacerations that had been sutured to the hospital previously. The teeth involved, 11, 12, 13,21,22 and 23, had lesions of coronary fracture, extrusive luxation and subluxation. Was held radiography of the region was not detected root fracture or buccal bone plate. In the firs visit, it was decided for the construction of a semi-rigid containment maintained for three weeksi because some teeth were highly mobile. From the urgent care the patient has been followed an treated at the University. We can conclude that emergency treatment is quite complex, a good clinical history, a good clinical examination and exams are essential in establishing a plan for prompt and appropriate treatment. The prognosis is often uncertain, may involve various dental specialti and becomes more favorable when the professional's knowledge, speed in emergency treatmen and makes the correct routing of the patient when needed.