Conservative Approach of Fractured Tooth with 7-Years of Clinical and Radiographical Follow-Up: Case Report

ABSTRACT: Clinical and radiographical diagnosis is crucial to treat a tooth with transverse root fracture (TRF) due to dental trauma (DT). This paper aimed to report a clinical case of TRF at the cervical third of tooth 21 injured by recurrent DT with 7 years of follow-up. A 7-years old female patient was referred to dental care after the first episode of DT in 2014. Base d on the radiographical examination, splinting of teeth 11 and 21 was performed using resin composite. After 11 months, the splint was removed and the patient was discharged. In 2015, the patient suffered a second DT of the same tooth. The clinical approach was splinting the traumatized tooth using orthodontic wire and resin composite. In 2018, a third episode of DT occurred. Then, the dental staff chose to maintain the splint and evaluate the case in a long-term. In 2021, based on bone tissue condition, dental fragment stability and radiographical follow-up, the splint was removed. The patient remains under regular follow up evaluations. It can be concluded that a conservative approach in cases of TRF, when possible, can preserve biological tissues.

RESUMEN: El diagnóstico clínico y radiográfico es fundamental para tratar un diente con fractura radicular transversa (FRT) por traumatismo dentario (DT). Este trabajo tuvo como objetivo reportar un caso clínico de FRT en el tercio cervical del diente 21 lesionado por DT recurrente con 7 años de seguimiento. Una paciente de 7 años de edad fue remitida a atención odontológica luego del primer episodio de DT en 2014. Con base en el examen radiográfico, se realizó la ferulización de los dientes 11 y 21 con resina compuesta. A los 11 meses se retiró la férula y se dio de alta al paciente. En 2015, el paciente sufrió un segundo DT del mismo diente. El abordaje clínico fue la ferulización del diente traumatizado utilizando alambre de ortodoncia y composite de resina. En 2018 ocurrió un tercer episodio de DT. Luego, el personal dental optó por mantener la férula y evaluar el caso a largo plazo. En 2021, en base al estado del tejido óseo, estabilidad de los fragmentos dentarios y seguimiento radiográfico, se procedió a la retirada de la férula. El paciente permanece bajo evaluaciones regulares de seguimiento. Se puede concluir que un abordaje conservador en casos de TRF, cuando sea posible, puede preservar los tejidos biológicos.

Coronavirus Disease 2019 as a Possible Cause of Severe Orbital Cellulitis.

ABSTRACT: Infection by severe respiratory syndrome coronavirus 2 (coronavirus disease 2019) has been the most important public health event of the last 100 years. The number of cases and deaths caused by this disease, its potential to rapidly spread and the search for a vaccine have been the center of discussion all over the world for over 1 year. In addition to the number of cases and all social, economic, and public health consequences of the pandemic, the variety of symptoms and clinical signs presented by infected patients has been subject of several studies and case reports. At the time of this writing, even with promising research, the clinical outcome of some patients is still unpredictable. The purpose of this article is to report an unusual case, the diagnostic process, and early treatment of this severe and atypical clinical picture. The patient is a young man diagnosed with coronavirus disease 2019 who sought our hospital in Southern Brazil reporting a history of pansinusitis progressing to a severe orbital cellulitis, requiring immediate surgical intervention.

Use of a generic violet light in the surgical management of medication-related osteonecrosis of the jaws: a technical note.

PURPOSE: Fluorescence-guided surgery has been recommended for the diagnosis of bone margins in cases of mandibular osteonecrosis. In this article, we report a case in which a generic violet light was used in order to activate bone fluorescence after the administration of tetracycline derivatives, as an alternative to a specific, more expensive equipment that is commercially available for this purpose. The patient had been using alendronate for osteoporosis, resulting in medication-related osteonecrosis of the jaws. METHODS: The treatment protocol includes preoperative administration of doxycycline and the application of a generic violet light during surgery in order to observe the fluorescence of bone in response to excitation through the light emitted by this device. RESULTS: With an effective visualization of the limit between healthy and devitalized bone tissue, it was possible to perform the necrotic tissue removal. The lesion regressed from stage 2 to stage 0, with no clinical or radiographic evidence of necrotic bone. CONCLUSIONS: These results suggest the feasibility of using a generic violet light source as a low-cost alternative for fluorescence-guided surgery.

Lipoma on the Lower Lip.

Lipoma is a benign tumor of fat tissue, found frequently in subcutaneous tissues. However, oral manifestations are relatively rare. The present patient illustrates the successful treatment of a lipoma treated by complete excision of the lesion. A female patient, 75 years old, presenting lesion in the right oral vestibule where excisional biopsy was performed. The professional must diagnose this type of injury as soon as possible and treat it so that it does not take large proportions, which can result in esthetic and functional sequelae to the patient.

Management of Blowout Fracture With Support of Video Endoscopy in a Pediatric Patient.

Pure orbital fractures have the tendency to occur on medial wall and orbital floor; because these points are more fragile, the endoscopy can be utilized for accomplishing the task of repositioning the herniated content, as well as serving as an additional tool, helping to view the orbital defects through a transantral approach. The presented case is a female patient, 12 years old, who was diagnosed as having a pure blowout fracture, on right orbital floor, type trapdoor, with orbital content herniated toward the maxillary sinus. It was realized that a surgical procedure for reduction of orbital content through video endoscopy, via antral, allowed a great viewing of soft and hard structures, checking the positioning of implants and its relation with the orbital cavity, enabling installing through a small surgical access and minimum detachment, and favoring postoperative recovery.

Mucoepidermoid Carcinoma of the Hard Palate in a Young Patient.

Carcinomas of salivary glands are rare and can affect major or minor salivary glands. Among them, the mucoepidermoid carcinoma is the most prevalent and its occurrence in the first 2 decades of life is highly unusual. Their common clinical aspect to different diseases is a challenge in diagnosis. The objective of this work is to elucidate the diagnosis of lesion in the hard palate of an adolescent patient, brown-skinned, male, forwarded to the oral surgery department at the State University of Londrina. Initially, he complained about a progressive swelling in the last 60 days. Through computed tomography scan, it was noted intraosseous involvement in the maxilla involving dental apex of the elements 13, 14, 15, right maxillary sinus extending to piriform sinus. Proceeding with clinical examination, followed by biopsy, histology, and immunohistochemical analysis, we established the diagnosis of mucoepidermoid carcinoma. After verification, the patient was sent to the referenced service to start cancer treatment.

Rare presentation of adenomatoid odontogenic tumor in a pediatric patient: a case report.

The adenomatoid odontogenic tumor (AOT) is a painless benign tumor with slow growth, usually asymptomatic. It has three variants: follicular, extrafollicular, and peripheral. In the follicular type, the tumor is associated with an impacted tooth, and maxillary canines are the most frequently affected. Association with primary teeth is very rare. Treatment consists essentially in a total lesion enucleation. The objective of this paper is to present the clinical case of a 7-year-old female patient with an adenomatoid odontogenic tumor associated with the crown of the left lower deciduous canine (73), dislodging it to the mandibular base and consequently shifting and also impacting the permanent lower canine (33). The lesion was treated with careful enucleation, preserving the permanent canine, which then had its eruption path released favoring its migration to an ideal position.

How safe is your motorcycle helmet?

PURPOSE: Motorcycle crash helmets do not totally prevent head and facial trauma. The aim of this study was to investigate if protection offered by helmets differs according to helmet type. MATERIALS AND METHODS: In this retrospective cohort study, outpatient records of motorcyclists were analyzed for the Facial Injury Severity Scale (FISS), traumatic brain injury (TBI), facial fractures, and helmet use. Statistical analysis was conducted using the Fisher and Bonferroni tests, bivariate regression analysis, and 1-way analysis of variance. RESULTS: There were 253 motorcyclists who sustained craniomaxillofacial injuries and were referred for outpatient treatment (men, 88.9%; mean age, 29.64 ± 11.6 yr); 60.1% had up to 9 years of formal education; 156 patients reported not using crash helmets, 51 were using open-face helmets, and 46 were using full-face helmets. The mean FISS score was significantly higher for unhelmeted riders compared with full-face helmet riders (P = .047), with no difference between unhelmeted riders and open-face helmet users (P = 1.00). Results for TBI were statistically greater for those wearing open-face helmets compared with full-face helmets (P = .035). CONCLUSION: In this study, a large percentage of motorcyclists had facial fractures and TBI, and crash helmets did not always offer adequate protection against craniomaxillofacial injury, especially open-face helmets. Thus, further investigation into helmet types and quality of protection offered is recommended.

Conservative treatment of bilateral temporalis muscle hypertrophy in a pregnant woman.

BACKGROUND: Hypertrophy of the masticatory muscles may affect the temporalis, masseter, and pterygoid muscles in several different combinations. METHODS: A case of bilateral temporalis muscle hypertrophy, with masseter and pterygoid involvement, in a 26-year-old white woman in the fourth month of gestation is reported. Magnetic resonance imaging and physical examination were used for diagnosis. Hypertrophy was considered to be of acquired nature. The patient was managed using alternative, noninvasive methods. RESULTS: After 2 months, visible reduction was observed. Clinical symptoms of muscle discomfort were also reported. CONCLUSIONS: In the presented case, we were able to use an alternative, noninvasive form of treatment, which provided our patient with an overall improvement in physical and psychologic aspects.

Submental endotracheal intubation as an alternative to tracheostomy in selected cases of facial fracture: literature review and technique report.

Intermaxillary fixation (IMF) is an essential guide to optimize the reduction and fixation of most facial fractures associated with occlusal alterations. To allow IMF, nasotracheal intubation is used in most cases. When nasotracheal intubation is not possible, a tracheostomy may be indicated, but this carries significant morbidity. Submental endotracheal intubation allows IMF to be used without resorting to nasal intubation or tracheostomy, and it does not interfere with reduction and fixation of fractures in most cases. The purpose of this article is to describe the indications, contraindications and the technique of submental endotracheal intubation as performed in our service.