Abordagem de incisivos centrais superiores traumatizados: relato de caso / Approach to traumati zed maxillary central incisors: case report

Introdução: O traumatismo dentário é uma ocorrência frequente durante a infância e adolescência. Geralmente, o diagnóstico acontece de forma tardia, devido à falta de conhecimento da população. Cada tipo de trauma necessita de uma conduta única e especializada. Nos casos de comprometimento pulpar, é necessário cuidado quanto à escolha da técnica a ser empregada, bem como a seleção da medicação intracanal que, por sua vez, apresenta grande interferência no sucesso do tratamento. Não obstante o avanço das técnicas de instrumentação, a troca da medicação entre as sessões nesses casos é mandatória. Relato de caso: Um paciente, sexo masculino, em idade escolar (15 anos) apresentou-se ao serviço de saúde bucal com relato de escurecimento e dores na mastigação após trauma dentário durante a infância. Os testes de vitalidade pulpar revelaram necrose pulpar, com resultado negativo no teste térmico e positivo na percussão. O exame radiológico evidenciou uma lesão apical, juntamente com reabsorção externa no elemento 21, confirmado em tomografia. O paciente foi submetido a um tratamento endodôntico. Resultado: Após o tratamento, foi solicitado novo exame tomográfico, em que se evidenciou um processo de cicatrização óssea no periápice e reabsorção por substituição na lesão cervical. Conclusão: A partir deste caso clínico, pôde-se evidenciar a importância do diagnóstico adequado, do manejo e da técnica endodôntica eficaz na resolução de problemas decorrentes de traumas dentários em pacientes jovens.

Introduction: Dental trauma is a frequent occurrence during childhood and adolescence. Generally, diagnosis happens late, due to lack of knowledge among the population. Each type of trauma requires a unique and specialized approach. In cases of pulp involvement, care must be taken when choosing the technique to be used, as well as the selection of intracanal medication, which, in turn, has a major impact on the success of the treatment. Despite advances in instrumentation techniques, changing medication between sessions in these cases is mandatory. Case report: A male patient of school age (15 years old) presented to the oral health service with reports of darkening and pain when chewing following dental trauma during childhood. Pulp vitality tests revealed pulp necrosis, with a negative result in the thermal test and positive in percussion. The radiological examination showed an apical lesion, together with external resorption in element 21, confirmed on tomography. The patient underwent endodontic treatment. Result: After treatment, a new tomographic examination was requested, which showed a process of bone healing in the periapex and resorption by replacement in the cervical lesion. Conclusion: From this clinical case, it was possible to highlight the importance of adequate diagnosis, management, and effective endodontic technique in solving problems arising from dental trauma in young patients.

Tratamiento de la transposición de incisivos inferiores / Treatment of transposition of lower incisors

La transposición es el intercambio de la posición de dos dientes adyacentes durante los primeros años de la dentición mixta. El objetivo de la investigación fue evaluar los cambios clínicos de un caso con transposición parcial bilateral de incisivos laterales mandibulares. Se atendió una paciente de 8 años de edad, femenina, de raza blanca, síndrome de Clase II división 1, con transposición de los incisivos laterales con caninos inferiores. Fue tratada con un arco lingual de cierre horizontal, de alambre 0,032 y dos muelles de NiTi comprimidos desde el cierre horizontal del arco hasta una armella soldada a la banda que se colocó en ambos incisivos laterales. Se recuperó el espacio necesario para la erupción de los caninos inferiores y así mejoró la estética dental y facial de la paciente.

Transposition is the exchange of the position of two adjacent teeth during the first years of the mixed dentition. The objective of this research is to evaluate the clinical changes of a case with partial bilateral transposition of mandibular lateral incisors. We present an 8-year-old white female patient with Class II Division 1 malocclusion and transposition of the lateral incisors with lower canines. She was treated with a 0.032 wire horizontal closure lingual arch and two NiTi springs compressed from the horizontal closure of the arch to an eyebolt welded to the band that was placed on both lateral incisors. The necessary space for the eruption of the lower canines was recovered, thus improving her dental and facial aesthetics.

Reabilitação estética e funcional com resina composta após trauma dentário: relato de caso / Aesthetic and functional rehabilitation with composite resin after dental trauma: case report

As lesões dentárias traumáticas são um problema de saúde pública mundial, dentre as quais a fratura dentária é a de maior ocorrência, envolvendo principalmente os dentes anteriores. A abordagem de grandes fraturas anteriores é um desafio para cirurgiões dentistas de qualquer nível pois, além da função, afetam diretamente a estética do paciente, fazendo-se necessário um planejamento que envolva diferentes especialidades na odontologia. Objetivo: Relatar um caso clínico de reabilitação funcional e estética de fratura dentária nos incisivos centrais superiores envolvendo tratamento endodôntico, instalação de pino de fibra de vidro e restauração direta em resina composta. Relato de Caso: O paciente de 17 anos sofreu fratura nos incisivos centrais superiores causada por uma queda de bicicleta. Devido à busca tardia por tratamento o elemento 21 foi diagnosticado com necrose pulpar e, portanto, foi submetido à tratamento endodôntico pela Técnica Crown Down e reabilitação com pino de fibra de vidro Splendor-SAP. Posteriormente, os elementos 11 e 21 foram restaurados com facetas diretas em resina composta pela técnica incremental. Conclusão: A reabilitação com instalação de pino de fibra de vidro associada à técnica de estratificação incremental em resina composta se mostra como uma boa opção para reabilitação estética pois permite dar forma anatômica ao dente com riqueza de detalhes na estratificação da dentina e esmalte, além de máxima preservação da estrutura dental. Os resultados obtidos reforçam o sucesso estético e funcional com significativo impacto na qualidade de vida do paciente(AU)

Traumatic dental injuries are a worldwide public health problem, among which dental fractures are the most frequent, mainly involving the anterior teeth. The approach of large anterior fractures is a challenge for dental surgeons of any level because, in addition to function, they directly affect the patient's esthetics, requiring a plan that involves different specialties in dentistry. Objective: Report a clinical case of functional and aesthetic rehabilitation of dental fractures in maxillary central incisors involving endodontic treatment, installation of a fiberglass post and direct restoration in composite resin. Case Report: The 17-year-old patient suffered a fracture in the upper central incisors caused by a fall from a bicycle. Due to the late search for treatment, element 21 was diagnosed with pulp necrosis and, therefore, underwent endodontic treatment using the Crown Down Technique and rehabilitation with a Splendor-SAP fiberglass pin. Later, elements 11 and 21 were restored with direct veneers in composite resin using the incremental technique. Conclusion: Rehabilitation with the installation of a fiberglass post associated with the incremental layering technique in composite resin is a good option for aesthetic rehabilitation as it allows the anatomical shape of the tooth with rich details in the layering of dentin and enamel, in addition to maximum preservation of the tooth structure. The results obtained reinforce the aesthetic and functional success with a significant impact on the patient's quality of life(AU)

Estimation of dental age using the kvaal method with digital panoramic radiographs in peruvian adults / Estimación de la edad dental según el método de Kvaal con radiografías panorámicas digitales en adultos peruanos

To determine the accuracy of the Kvaal method in the estimation of dental age through the analysis of digital panoramic radiographs of patients between 20 and 47 years of age who attended the stomatological clinic of the Universidad Científica del Sur, (2018 to 2019), Lima-Perú. 289 digital panoramic radiographs belonging to individuals of both sexes, aged 20 to 47 years were analyzed. Length and width measurements were obtained in the dental and pulp chamber in the upper central incisors. These data were subsequently evaluated by calculating the proportions between the pulp and root length of the upper central incisor by applying the formula of the method of Kvaal et al. to obtain the accuracy of the method in estimating dental age. Applying the formula of Kvaal et al. indicates that the relationship between the width of the pulp and the length of the root has a higher level of significance in relation to others proportions: M mean value of all ratios except T (-0.659) and W-L difference between W and L (-0.643). The coefficient of determination (r²) and standard error of estimation (SEE) using the original Kvaal formula is r²: 0.70, SEE: 4.90 years, then a modified Kvaal formula was proposed for the Peruvian population. The Method of Kvaal et al. has an accuracy of 1.24 in estimating the dental age of individuals, using the upper central incisor in digital panoramic radiographs.

Determinar la precisión del método de Kvaal en la estimación de la edad dental mediante el análisis de radiografías panorámicas digitales de pacientes entre 20 a 47 años atendidos en la clínica estomatológica de la Universidad Científica del Sur, (2018 a 2019), Lima-Perú. Se analizaron 289 radiografías panorámicas digitales pertenecientes a individuos de ambos sexos, de 20 a 47 años. Se obtuvo medidas de longitud y anchura en la cámara dental y pulpar en los incisivos centrales superiores. Estos datos se valoraron posteriormente al calcular las proporciones entre la pulpa y longitud de la raíz del incisivo central superior aplicando la fórmula del método de Kvaal et al. para obtener la precisión del método en la estimación de la edad dental. Al aplicar la fórmula de Kvaal et al. indica que la relación entre la anchura de pulpa y la longitud de la raíz presentan un nivel de significancia mayor en relación a otras proporciones: M valor medio de todas las proporciones excepto T (-0.659) y W-L: diferencia entre los valores de W y L (-0.643). El coeficiente de determinación (r²) y el error estándar de la estimación (SEE) utilizando la fórmula original de Kvaal es de r²: 0.70, SEE: 4.90 años, después se propuso una fórmula modificada de Kvaal para la población peruana. El Método de Kvaal et al. tiene una precisión del 1.24 en la estimación de la edad dental de los individuos, utilizando el incisivo central superior en radiografías panorámicas digitales.

Oclusión basada en evidencia: rompiendo paradigmas / Occlusion based on evidence: breaking paradigms

La odontología basada en evidencias es una metodología que busca que las decisiones clínicas diarias que toman los profesionales en estomatología se encuentren fundamentadas en la evidencia científica, en ella se integran las experiencias clínicas, las necesidades, las preferencias del paciente y la evidencia clínicamente relevante más actual analizada por pares. Estos pilares son parte del proceso en la toma de decisiones para la atención al paciente. La odontología basada en evidencias surge de las exitosas experiencias obtenidas con el desarrollo e implementación de la medicina fundamentada en pruebas, al aplicar el método científico en la evaluación, planificación y toma de decisiones de las prestaciones sanitarias, sobre todo a través de los estudios controlados. En general, toda la práctica odontológica ha tenido grandes avances basados en evidencias, con hechos verídicos comprobados, pero los conceptos fundamentales de oclusión no han tenido una mejora cimentada en el conocimiento científico, prueba de ello es que se siguen ocupando teorías y conceptos de las filosofías de oclusión en la rehabilitación de muchos pacientes, seguimos creyendo en mitos y sofismas que no han podido ser demostrados. En esta revisión, demostramos los grandes avances en los conceptos de oclusión e invitamos a todos los odontólogos a romper los paradigmas de la oclusión antigua sin evidencias científicas y a utilizar las herramientas del método científico en la práctica clínica odontológica (AU)

Evidence-based dentistry is a strategy that seeks to ensure that the daily clinical decisions made by the dental professional are based on scientific evidence. It integrates the clinical experience of the dentist, the needs and preferences of the patient, and the most current relevant clinical evidence. All three are part of the decision-making process for patient care. Evidence-based dentistry arises from the successful experiences obtained with the development and implementation of evidence-based medicine, applying the scientific method in the evaluation, planning and decision-making of health benefits, especially through controlled studies. In general, all dental practice has had great advances based on evidence, with proven true facts, but the fundamental concepts of occlusion have not had an improvement based on scientific knowledge, proof of this is that theories and concepts continue to be used. of the philosophies of occlusion in patient rehabilitation, we follow myths and sophisms that have not been demonstrated, in this review, we demonstrate the great advances in the concepts of occlusion and we know all dentists to break the paradigms of the old occlusion without scientific evidence (AU)

A new approach to endodontic access in anterior teeth: a pilot study / Uma nova abordagem para acesso endodôntico em dentes anteriores: estudo piloto

Introduction: The coronal opening is essential, during endodontic treatment, for direct access to the root canals. Usually, in the anterior teeth, endodontic access is achieved on the palatal/lingual surface, more specifically in the cingulum region. However, the lack of observation for dental positioning can lead to some accidents and complications, such as buccal perforations, causing esthetic damage and compromising the treatment. Objective: To evaluate the applicability of a new approach for performing coronal opening in anterior teeth, regarding the wear caused on the tooth crown, and to evaluate the ease of performing the new technique to minimize the risk of perforation. Material and method: Ten students (n=10) from the Improvement in Endodontics program participated in the present study. Twenty artificial teeth were used, which were upper, central incisors. Each participant performed two coronal openings. First, with no guidance (Group A - Conventional Technique) and afterward, a new opening, but with guidance with the spherical diamond tip placed parallel to the long axis of the tooth (Group B - Modified Technique). Result: The results showed that 90% of the participants considered the Modified Technique as having lower risk of accidents, as well as being easier for locating the pulp chamber. There was a statistical difference both in the measurement of the total area of wear and in the width, while there was no statistical difference in the height. Conclusion: Preliminary data collected with the survey were satisfactory for the Modified Technique. Statistically, it showed a favorable difference in relation to the area of wear and the width. However, in height there was no statistical difference.

Introdução: A abertura coronária é fundamental durante o tratamento endodôntico para um acesso direto aos canais radiculares. Em geral, em dentes anteriores, o acesso endodôntico é realizado na face palatina/lingual, mais especificamente em região de cíngulo. Entretanto, a falta de observação do posicionamento dentário pode levar a alguns acidentes e complicações, como as perfurações por vestibular, ocasionando dano estético e comprometendo o tratamento. Objetivo: Avaliar a aplicabilidade de uma nova abordagem de realização da abertura coronária em dentes anteriores, quanto ao desgaste ocasionado na coroa dentária, e avaliar a facilidade de execução da nova técnica para minimizar os riscos de perfurações. Material e método: Dez alunos (n=10) do curso de Aperfeiçoamento em Endodontia participaram do estudo. Foram utilizados vinte dentes artificiais, sendo eles incisivos centrais superiores. Cada participante realizou duas aberturas coronárias. Primeiramente sem nenhuma orientação (Grupo A - Técnica Convencional) e após, uma nova abertura, porém com orientação, com a ponta diamantada esférica posicionada paralelamente ao longo eixo do dente (Grupo B - Técnica Modificada). Resultado: Os resultados demonstraram que 90% dos participantes consideraram a Técnica Modificada como a de menor risco de acidentes e, ainda, de mais fácil localização da câmara pulpar. Houve diferença estatística tanto para a medida da área total de desgaste quanto para a largura, enquanto na altura não houve diferença estatística. Conclusão: Os dados preliminares coletados pelo questionário se mostraram satisfatórios para a Técnica Modificada. Estatisticamente, apresentou diferença favorável em relação à área de desgaste e largura, já em altura não houve diferença estatística.

Interdisciplinary treatment to replace missing upper lateral incisors, 4.5 years follow up / Tratamiento interdisciplinario para reposición de incisivos laterales superiores faltantes, seguimiento de 4,5 años

Introduction: Multidisciplinary diagnosis and planning are essential to define the treatment option that will provide the best individual results for patients with congenitally missing upper lateral incisors. Objective: To determine the function and aesthetics after the therapeutic use of osseintegrated implants to replace congenitally missing upper lateral incisors in a young female at 4.5 years follow-up. Case report: The patient was a 13 years old female (at beginning of treatment) with congenitally missing upper lateral incisors condition. Five months after the orthodontic active treatment, the space for placing the implants was achieved. After 2 years of Orthodontic treatment and the evaluation of the craniomandibular growth term by hand radiography, two implants were placed with an expanded bone technique in the position of the upper lateral incisors. After 4 months, osseointegration was clinically confirmed and two screw retained temporary crowns were performed using temporary plastic abutments and acrylic teeth and recalled at 4.5 years to control. Conclusions: Our results showed predictable esthetics and functional results in a patient with congenitally missing upper lateral incisors. This was possible due to a multidisciplinary approach between the diagnosis and treatment performed (Orthodontics, Implantology and Prosthodontics(AU)

Introducción: El diagnóstico y la planificación multidisciplinarios son esenciales para definir la opción de tratamiento que proporcionará los mejores resultados individuales para los pacientes con incisivos laterales superiores que faltan congénitamente. Objetivo: Fue determinar la función y la estética después del uso terapéutico de implantes osteointegrados para reemplazar los incisivos laterales superiores ausentes congénitamente en una mujer joven a los 4,5 años de seguimiento. Presentación del caso: La paciente, mujer de 13 años (al inicio del tratamiento) con una condición congénita de incisivos laterales superiores ausentes. Cinco meses después del tratamiento activo de ortodoncia, se logró el espacio para la colocación de los implantes. Después de 2 años de tratamiento de Ortodoncia y la evaluación del término de crecimiento cráneo-mandibular corroborado mediante radiografía de mano, se colocaron dos implantes con técnica de hueso expandido en la posición de los incisivos laterales superiores. Después de 4 meses, se confirmó clínicamente la osteointegración y se realizaron dos coronas provisionales atornilladas utilizando pilares de plástico provisionales y dientes acrílicos y se controlaron a los 4,5 años de seguimiento. Conclusiones: Nuestros resultados mostraron resultados estéticos y funcionales predecibles en un paciente con incisivos laterales superiores ausentes congénitamente. Esto fue posible gracias a un abordaje multidisciplinar entre el diagnóstico y el tratamiento realizado (Ortodoncia, Implantología y Prostodoncia(AU)

Diagnóstico clínico, radiográfico e histológico de un caso de fibrosis periapical posendodóntica / Clinical, radiographic, and histologic diagnosis of a postendodontic periapical fibrosis case

Objetivo: La fibrosis periapical posendodóntica es un proceso reparativo asintomático, radiolúcido y no progresivo que se interpreta con frecuencia como una lesión patológica persistente. El diagnóstico de esta entidad suele ser dudoso y sólo puede definirse mediante la correlación de las obser- vaciones clínicas, radiográficas e histológicas. El objetivo de este informe es describir el caso de un paciente que presenta un área radiolúcida periapical persistente y asintomática en un incisivo lateral superior. Caso clínico: Luego de cuatro años y dos meses de ha- ber recibido un tratamiento endodóntico el paciente concurre a la consulta para un examen de rutina. El examen radiográfico del diente revela un área radiolúcida persistente y bien defini- da. A causa de una fractura radicular irreparable, se indicó la extracción de la pieza dentaria. Esto permitió realizar el estu- dio histológico del tejido blando que permanecía adherido en el ápice de la raíz, lo que confirmó y completó el diagnóstico de fibrosis periapical posendodóntica.(AU)

Aim: The postendodontic periapical fibrosis is an asymp- tomatic radiolucent and non-progressive healing process that is often interpreted as a persistent pathological lesion. The diagnosis of this entity is usually uncertain, and it is only de- fined by the correlation of clinical, radiographic and histo- logical observations.The aim of this report is to describe the case of a patient with a long-term persisting asymptomatic and radiolucent area in a upper lateral incisor. Clinical case: Four years and two months after receiv- ing an endodontic treatment the patient comes to our office for a routine control. Radiographic examination revealed the presence of a persistent well defined radiolucent area. Sur- gical tooth extraction was required due to the presence of a complicated root fracture.This allowed to perform a histolog- ical study of the soft tissue attached to the apex of the ex- tracted root, which confirmed and completed the diagnosis of postendodontic periapical fibrosis (AU)

Síndrome del incisivo central maxilar medio único en neonato / Solitary median maxillary central incisor syndrome in neonates / Síndrome do incisivo central maxilar médio solitário em neonatos

Introducción: el síndrome del incisivo central maxilar medio único (SMMCI) es un trastorno de etiología desconocida, con base genética heterogénea, que se caracteriza por la erupción de un único incisivo central en el maxilar y que se puede relacionar con multitud de patologías y síndromes, entre los que destacan las alteraciones de la línea media, obstrucción nasal congénita, disfunción hipofisaria, talla baja y holoprosencefalia. Caso clínico: neonato mujer con síndrome dismórfico no filiado y obstrucción nasal congénita, que es diagnosticada de SMMCI tras consultar en repetidas ocasiones por cuadros de dificultad respiratoria y problemas para alimentarse. Conclusiones: el conocimiento de este raro síndrome es fundamental para la realización de un diagnóstico precoz por parte del equipo pediátrico y obstétrico, ya que un diagnóstico temprano es posible, mejorando la evaluación prenatal ecográfica, así como el adecuado manejo posnatal multidisciplinar posterior de nuestros pacientes.

Introduction: the Solitary Median Maxillary Central Incisor Syndrome (SMMCI) is a disorder of unknown etiology, with a heterogeneous genetic basis, characterized by the eruption of a single central incisor in the maxilla and that can be linked to various pathologies and syndromes, among which the alterations of the midline, congenital nasal obstruction, pituitary dysfunction, short stature and holoprosencephaly stand out. Clinical case: female newborns with unknown dysmorphic syndrome and congenital nasal obstruction, diagnosed with SMMCI after repeated consultations due to respiratory distress and feeding problems. Conclusions: understanding this rare syndrome is essential for an early diagnosis to be carried out by the pediatric and obstetric team, since it will improve the ultrasound prenatal assessment, as well as the adequate subsequent multidisciplinary postnatal patient management procedures.

Introdução: a síndrome do incisivo central maxilar médio solitário (SICMMS) é uma desordem de etiologia desconhecida, com base genética heterogênea, caracterizada pela erupção de um único incisivo central na maxila e que pode estar relacionada a uma infinidade de patologias e síndromes. onde se destacam alterações da linha média, obstrução nasal congênita, disfunção hipofisária, baixa estatura e holoprosencefalia. Caso clínico: recém-nascida com síndrome dismórfica de origem desconhecida e obstrução nasal congênita, diagnosticada com SICMSS após várias consultas por desconforto respiratório e problemas de alimentação. Conclusões: o conhecimento desta rara síndrome é essencial para que a equipe pediátrica e obstétrica possa fazer um diagnóstico precoce, pois ele pode melhorar a avaliação ultrassonográfica pré-natal, bem como o adequado manejo pós-natal multidisciplinar pós-natal dos pacientes.

Reproducibility and comparison between methods for gingival color evaluation: a validation study

Aim This study aims to evaluate and validate the sensibility and the level of agreement between different gingival color measures obtained by a spectrophotometer (SPECTRO) and a photography (PHOTO) method. Methods Among 40 patients, the color was measured 2 mm apical to the gingival margin by CIE L*, a*, b* system using a reflectance spectrophotometer and the photography's plus software. The level of agreement between three different measures (m1, m2, m3) in parameters L*, a*, b*, and ∆E (color variation) was evaluated by random and systematic errors, as well as the limits and coefficient of concordance. A comparison between the methods was performed by the Bland-Altman test and the sensibility level was evaluated accordingly to the ∆E: 3.7 thresholds with p<0.05 as the level of significance for these comparisons. Results The SPECTRO method has not presented the systematic error (p>0.05) and had reproducibly and agreement level in three variable measures L* (r: 0.6), a* (r: 0.3), and b* (r: 0.5) as to the PHOTO method L* (r: 0.6), a* (r: 0.5), and b* (r: 0.5), which presented systematic error in L* values (p<0.05). The means of ∆E between measurements were: 6.5 SPECTRO and 5.9 PHOTO. There was no good level of sensitivity ∆E> 3.7 and agreement between the methods, mainly for the a* values. On the other hand, for the L* and in for the most comparisons of b* values, the level of agreement was higher. Conclusion Both methods could quantify the gingival color from the coordinates L *, a *, and b *, which has shown greater reliability between the measurements acquired by the SPECTRO method.

El canal incisivo: ¿maxilar o mandibular? Revisión narrativa / The incisive canal: a maxillary or mandibular structure? Narrative review

El canal incisivo es una estructura anatómica ósea que, según la terminología anatómica actual, se encuentra ubicada exclusivamente en la premaxila. Sin embargo, a continuación de los canales mandibulares, se desprenden hacia lateral los canales mentonianos (que contiene el paquete vasculonervioso del mismo nombre) y hacia anterior continua un paquete vasculonervioso, también denominado incisivo que inerva e irriga a dichos dientes mandibulares. Con el fin de aclarar lo previamente mencionado y distinguir ambas estructuras incisivas, se pretende agregar un sufijo (maxilar o mandibular) rectificando los nombres de dichos canales. Para lo anterior, se realizó una revisión de la bibliografía disponible en PubMed y Google Académico, con las palabras clave "CANAL INCISIVO" e "INCISIVE CANAL", utilizando como operador booleano la palabra OR. Los criterios de inclusión de los estudios fueron: 1) que se refieran a algún canal incisivo (ya sea maxilar o mandibular) 2) que estén disponibles para ser leídos a texto completo y 3) que su idioma sea inglés o español. De la totalidad de los artículos analizados, un 52 % hablaba exclusivamente del canal incisivo maxilar, un 43 % solo del canal incisivo mandibular y un 5 % sobre ambos. Concluyendo, podemos colegir que es de suma importancia que se regularice la nomenclatura de dichas estructuras anatómicas, debido a que, el hecho de reconocerla como tal permite garantizar su estudio y aporte desde toda la comunidad científica, sin importar la procedencia ni el idioma. Además, el canal incisivo mandibular está bien documentado, por lo que, al no ser reconocido en la terminología anatómica, se pierde la principal misión de la asociación internacional de asociaciones de anatomía (IFAA), la cual es unificar y organizar los nombres de las estructuras anatómicas existentes.

SUMMARY: The incisive canal is an anatomical bone structure that, according to current anatomical terminology, is located exclusively in the premaxilla. However, following the mandibular canals, the mental canals (containing the neurovascular bundle of the same name) branch off laterally and a neurovascular bundle continues anteriorly, also called the incisor, which innervates and irrigates said mandibular teeth. In order to clarify what was previously mentioned and to distinguish both incisive structures, it is intended to add a suffix (maxillary or mandibular) correcting the names of said canals. For the above, a review of the literature available in PubMed and Google Scholar was carried out, with the keywords "INCISIVE CANAL" and "INCISIVE CANAL", using the word OR as a boolean operator. The inclusion criteria of the studies were: 1) that they refer to an incisive canal (whether maxillary or mandibular) 2) that they be available to be read in full text and 3) that their language be English or Spanish. Of all the articles analyzed, 52% spoke exclusively about the maxillary incisive canal, 43% only about the mandibular incisive canal, and 5% about both. In conclusion, we can infer that it is of the utmost importance that the nomenclature of these anatomical structures be regularized, because the fact of recognizing it as such allows guaranteeing its study and contribution from the entire scientific community, regardless of origin or language. In addition, the mandibular incisive canal is well documented, therefore, by not being recognized in anatomical terminology, the main mission of the international association of anatomy associations (IFAA) is lost, which is to unify and organize the names of the anatomy. existing anatomical structures.

Restabelecimento estético de incisivos laterais conóides e amplas restaurações em resina composta com laminados cerâmicos: relato de caso / Aesthetic recovering of conoid side incisives and wide restoration in composed resin with ceramic laminates: case report

Introdução: As cerâmicas odontológicas são amplamente utilizadas na Odontologia, desfrutando de grande popularidade devido a sua capacidade de mimetizar as características ópticas do esmalte e da dentina. O constante desenvolvimento de pesquisas tem desencadeado o lançamento de novos sistemas cerâmicos com propriedades aprimoradas e melhores resultados clínicos em longo prazo. Objetivo: O relato de caso aqui apresentado descreve uma reabilitação da zona estética do sorriso com laminados cerâmicos por meio de uma abordagem minimamente invasiva. Relato de caso: Paciente do gênero feminino, compareceu à clínica odontológica relatando insatisfação com a aparência do seu sorriso. Durante avaliação foram observadas, na região anterossuperior, restaurações extensas em resina composta deficientes nos incisivos, com proporção, volume, forma e texturização insatisfatórias, que em conjunto comprometia a zona estética do sorriso. Diante disso, após fotografias extra e intraorais, o tratamento proposto foi a reabilitação com laminados cerâmicos nas unidades 1.2 ao 2.2. Assim, foi realizado o enceramento e o mock-up, os quais serviram de orientação para os preparos dentários, a seguir, foram moldados e as restaurações confeccionadas no sistema IPS e.max. Após prova de cor e adaptação, os preparos e a superfície interna dos laminados cerâmicos foram tratados e cimentados com cimento resino fotopolimerizável. Conclusão: Instituindo uma abordagem conservadora, o plano de tratamento realizado através da reabilitação com laminados cerâmicos nas unidades dentárias anterossuperiores, permitiu o restabelecimento da função e estética, com reprodução das características dos dentes naturais e promoção do equilíbrio, da jovialidade e da harmonia no sorriso(AU)

Introduction: Dental ceramics are widely used in dentistry, enjoying great popularity due to the ability to mimic both enamel and dentin optical characteristics. The constant research development has triggered the launch of new ceramic systems with improved properties and better long-term clinical results. Objective: The case report presented here describes the zone rehabilitation of the aesthetic smile with ceramic laminates through a minimally invasive approach. Case report: Female patient, attended the dental clinic reporting dissatisfaction with the appearance of her smile. During the evaluation, extensive restorations in composite resin were observed in the incisors in the anterosuperior region, with unsatisfactory proportion, amount, shape and texturing, which together compromised the aesthetic zone of the smile. Faced with this, after extra and intraoral photographs, the proposed treatment was the restoration with the ceramic laminates in units 1.2 to 2.2. Thus, waxing and mock-up were performed, which served as guidance for the dental preparations, then they were molded and restorations fabricated in the IPS e.max system. After shade and adaptation proof, the preparations and the inner ceramic laminates surface were treated and cemented with light-cured resin cement. Conclusion: Adopting a conservative approach, the treatment plan carried out through restoration with ceramic laminates on the upper anterior teeth allowed the recovering function and aesthetics, reproducing characteristics of natural teeth and promoting balance, joviality and harmony in the smile(AU)

Abordagem multidisciplinar no tratamento de incisivo lateral com fratura oblíqua e lesão periapical: relato de caso clínico / Multidisciplinary approach in the treatment of lateral incisor with oblique fracture and periapical injury: clinical case report

Casos de fraturas dentárias oblíquas muitas vezes possuem um prognóstico desfavorável, geralmente com indicação da extração do elemento dental. O presente artigo visou relatar o tratamento do caso clínico de um paciente do sexo masculino, 12 anos, que compareceu à Unidade de Saúde Bucal do Hospital Universitário de Brasília com encaminhamento de extração do dente 12, apresentando fratura oblíqua que se estendia subgengivalmente na face vestibular. O trauma havia ocorrido há três anos e o paciente havia sido submetido a diversas intervenções endodônticas, apresentando no momento da consulta inicial por nossa equipe uma lesão periapical extensa. Após a realização da anamnese, exame clínico e radiográfico, foi adotada uma abordagem multidisciplinar conservadora com a manutenção do dente e a realização da enucleação da lesão periapical por meio de intervenção cirúrgica e posterior reabilitação. Em uma mesma sessão, foi realizada a obturação do conduto com cone de guta percha e cimento sealer 26 e a cirurgia parendodôntica juntamente com a apicoplastia. Uma semana após a intervenção cirúrgica foi realizada restauração classe IV com resina composta baseada no enceramento dos modelos de diagnóstico montados em articulador. Com base em uma avaliação criteriosa e multidisciplinar, foi possível adotar uma abordagem conservadora no caso em questão, com a manutenção e reabilitação de um dente permanente em um paciente jovem, evitando a indicação de exodontia(AU)

Cases of oblique dental fractures often have an unfavorable prognosis, usually with the indication of extraction of the dental element. The present article aimed to report the treatment of the clinical case of a 12-year-old male patient, who attended the Oral Health Unit of the Hospital Universitário de Brasília with a referral for extraction of tooth 7, presenting an oblique fracture that extended subgingivally on the labial surface. The trauma had occurred three years ago and the patient had undergone several endodontic interventions, presenting an extensive periapical lesion at the time of the initial consultation by our team. After anamnesis, clinical and radiographic examination, a conservative multidisciplinar approach was adopted with the maintenance of the tooth and the enucleation of the periapical lesion through surgical intervention and subsequente rehabilitation. In the same session, the conduit was filled with gutta-percha cone and sealer cement 26 and parendodontic surgery was performed together with apicoplasty. One week after the surgical intervention, class IV restoration was performed with composite resin based on the waxing of the diagnostic models mounted on an articulator. Based on a careful and multidisciplinary evaluation, it was possible to adopt a conservative approach in the case in question, with the maintenance and rehabilitation of a permanent tooth in a young patient, avoiding the indication of extraction(AU)

Inter-incisive index in Bulgarians and its application in dentistry / Indice interincisivo en búlgaros y su aplicación en odontología

SUMMARY: In recent years, aesthetic dentistry has become a major focus for the public. Facial attractiveness plays a key role on modern society and the creation of harmonious smile is an aim for every dentist. The objective of this study was to define certain values of the inter-incisive index in Bulgarians, the sexual dimorphism and bilateral asymmetry and to verify differences of this index between Bulgarians and other Balkan populations. The present study included 121 males and 111 females of Bulgarian origin aged 20- 40 years. Mesiodistal dimensions of maxillary central and lateral incisors were measured by Dentistry Sliding Vernier Caliper. We used the technique of direct anthropometry, modified by Prof. Y. Yordanov. We calculated the inter-incisive index as ratio of the mesiodistal dimension of maxillary lateral incisor to the mesiodistal dimension of the maxillary central incisor. The measurements were analyzed with SPSS 23. The level of statistical significance was set at P< 0.05. The inter-incisive index showed no statistically significant differences between left and right side of the dental arch in both sexes. We did not find statistically significant differences between males and females as well. On the other hand, we found statistically significant differences in MD values of incisors between Bulgarians and other Balkan nations. Inter-incisive index shows no sexual dimorphism and bilateral asymmetry in Bulgarians. This can be helpful in aesthetic dentistry, in prosthodontics and in orthodontic treatment planning.

RESUMEN: En los últimos años, la odontología estética se ha convertido en un foco importante para el público. El atractivo facial juega un papel clave en la sociedad moderna y la creación de una sonrisa armoniosa es importante para todos los dentistas. El objetivo de este estudio fue definir ciertos valores del índice interincisivo en búlgaros, el dimorfismo sexual y la asimetría bilateral y verificar diferencias de este índice entre búlgaros y otras poblaciones balcánicas. El presente estudio incluyó a 121 hombres y 111 mujeres de origen búlgaro entre 20 y 40 años de edad. Las dimensiones mesiodistales de los incisivos superiores centrales y laterales se midieron con un calibrador Vernier deslizante de odontología. Utilizamos la técnica de antropometría directa, modificada por el Prof. Y. Yordanov y se calculó el índice interincisivo como la relación entre la dimensión mesiodistal del incisivo lateral superior y la dimensión mesiodistal del incisivo central superior. Las medidas se analizaron con SPSS 23. El nivel de significancia estadística se fijó en P<0,05. El índice interincisivo no mostró diferencias estadísticamente significativas entre los lados izquierdo y derecho de la arcada dentaria en ambos sexos. Tampoco encontramos diferencias estadísticamente significativas entre hombres y mujeres. Por otro lado, encontramos diferencias estadísticamente significativas en los valores de DM de los incisivos entre búlgaros y otras naciones balcánicas. El índice interincisivo no muestra dimorfismo sexual ni asimetría bilateral en los búlgaros. Esto puede ser útil en odontología estética, en prostodoncia y en la planificación de tratamientos de ortodoncia.

Smile Arc Esthetics in Middle-Aged Man from the Layperson's Perspective Via Eye-Tracking

Abstract Objective: To evaluate the perceptions of smile esthetics associated with variations in the vertical plane of the maxillary incisors in the smile arc using eye-tracking software. Material and Methods: An image of a 59-year-old Caucasian male model was adapted and edited to make three changes in the vertical plane, simulating a convex, straight, and reverse smile arc. Four areas of interest were inserted at the right and left eyes, nose, and mouth. Forty laypeople raters between 18 and 45 years of age participated of the study. Eye-tribe hardware and Ogama software were used to perform eye-tracking. Attractiveness and age-perception questions were also incorporated into the study. ANOVA test and Pearson's correlation coefficient, at p < 0.05. Results: The most observed AOI in images with convex, straight, and reverse smiles, as assessed using heatmaps and point maps, was the mouth, followed by the right eye. A significant difference for the eye (p=0.02) was found when comparing convex and reverse smiles, whereas a significant difference for the mouth was observed between the straight and reverse smiles (p=0.03). Conclusion: Convex and straight smile arcs were associated with equal levels of attractiveness; the reverse smile was less attractive. No significant difference was noticed regarding age perception and the smile arcs. However, the reverse smile recorded a more complete fixation time.

Effect of Chelating Agents on Push-Out Bond Strength of NeoMTA Plus to Root Canal Dentin

ABSTRACT Objective To evaluate and compare the effect of 17% Ethylenediaminetetraacetic Acid (EDTA), 9% Etidronic acid (HEDP), and 7% Maleic acid (MA) on the push-out bond strength of NeoMTA Plus sealer to the coronal, middle, and apical thirds of root canal dentin. Material and Methods Forty single-rooted human maxillary central incisors were selected and decoronated to 12 mm long root fragments. Working length was established and root canals were then enlarged up to rotary Protaper F3. After each instrumentation, the root canal was irrigated with 2.5% NaOCl. For the final irrigation regimen, the specimens were divided into 4 groups (n=10) and treated with EDTA, HEDP, MA or Saline. Root canals were coated with NeoMTA Plus sealer, and obturation was done with single cone obturation technique. Subsequently, three horizontal sections were taken from the coronal, middle and apical thirds of each specimen, and POBS was measured using a universal testing machine. The type of bond failures was assessed under a stereomicroscope. Statistical analysis was done with One-way ANOVA with Tukey's Post hoc analysis. Results MA and EDTA showed the highest POBS. There was no significant difference in bond strength between MA and EDTA (p>0.05). HEDP and Saline showed lower POBS. Among all the four groups, the coronal third showed the highest values, followed by middle and apical thirds. Conclusion The type of chelating agent used during the root canal treatment significantly affects the bond strength of NeoMTA Plus to the root canal dentin.

Desgaste erosivo en preescolares de 5 años de Montevideo­Uruguay: primer estudio poblacional / Erosive tooth wear in 5 -year- old preschool children of Montevideo­Uruguay: first population study / Desgaste erosivo em preescolares de 5 anos de MontevideoUruguai: primer estudo populacional

Objetivo: determinar prevalencia, extensión, severidad y distribución del desgaste erosivo (DE) en preescolares de Montevideo. Metodología: estudio transversal de base poblacional, muestra representativa de centros educativos públicos y privados. Fueron indagados aspectos sociodemográficos, biológicos y de comportamiento con un cuestionario auto-reportado por padres/responsables. Los exámenes fueron realizados por dos operadores Kappa ≥ 0,7. DE fue registrado con el índice O´Brien modificado, reportándose porcentaje y promedio; intervalo de confianza (IC) 95%. Se realizaron análisis de asociación con sexo y nivel socioeconómico. Resultados: se examinaron 614 preescolares. Prevalencia: 57,6% (IC95%: 52,7-62,5). Extensión: 4,8 (IC95%: 4,3-5,3). DE severo: 8,2% (IC95%: 5,5-10,9) Las superficies más afectadas fueron palatino de incisivos superiores. Los preescolares de nivel socioeconómico alto presentaron mayor DE que los de nivel bajo; 73,1% (IC95%:61,9-84,2) y 48,4% (IC95%:39,2-57,7) respectivamente (p≤0,01). Conclusiones: la prevalencia y extensión del DE fue alta. Estos datos pueden contribuir en la modificación de medidas que apunten a controlar la prevalencia de DE.

Aims: assess the prevalence, extent,severity, and distribution of erosive tooth wear (ETW) in preschoolers of Montevideo. Methods: cross-sectional populationbased study of representative sample of public and private educational centers. Sociodemographic, biological, and behavioral aspects were investigated with a self-reported questionnaire to parents /guardians. The examinations were performed by two examiners (Kappa ≥ 0.7). The ETW was registered with modified O´Brien index, reported in percentage and average, confidence interval (CI) 95%. Analysis of association with sex and socioeconomic level were carried out.Results: 614 preschoolers were examined. Prevalence: 57.6% [95%CI=52.7-62.5]. Severe ETW: 8.2% [95%CI 5.5-10.9]. ETW extension: 4.8 [95%CI=4.3-5.3]. The most affected surfaces were palatal upper incisors. Preschoolers of high socioeconomic level presented higher ETW than those of low level; 73.1% (95% CI: 61.9-84.2) and 48.4% (95% CI: 39.2-57.7) respectively (p≤0.01). Conclusion: ETW prevalence and extent was high. These data can contribute to the modification of measures that aim to control ETW prevalence.

Objetivo: determinar prevalência, extensão, severidade e distribuição do desgaste erosivo (DE) em pré-escolares de Montevidéu. Metodologia: estudo transversal de base populacional, amostra representativa de centros educacionais públicos e privados. Aspetos sociodemográficos, biológicos e comportamentais foram investigados por meio de questionário autorreferência pelos pais/responsáveis. Os exames foram realizados por dois operadores Kappa ≥ 0,7. DE foi registado com o Índice O´Brien modificado, relatando porcentagem e média; intervalo de confiança (IC) 95%. Foi realizada análise de associação com sexo e nível socioeconômico. Resultados: 614 pré-escolares foram examinados. Prevalência: 57,6% (IC95%: 52,7-62,5). Extensão: 4,8 (IC 95%: 4,3-5,3). DE grave: 8,2% (IC 95%: 5,5-10,9). As superfícies mais afetadas foram palatinas dos incisivos superiores. Pré-escolares de alto nível socioeconômico apresentaram maior DE que os de baixo nível; 73,1% (IC 95%: 61,9-84,2) e 48,4% (IC 95%: 39,2-57,7) respetivamente (p≤0,01). Conclusões: a prevalência e extensão da DE foi alta. Esses dados podem contribuir em la modificação de medidas que visam controlar a prevalência de DE.

Increased Expression of RUNX2 and ALP Resulting from a Combination of Propolis Extract and Bovine Bone Graft in Socket Preservation Material

Abstract The aim of this study was to determine the inductive effect of a combination of propolis and BBG extract on RUNX2 and ALP expression in the tooth extraction sockets of Cavia cobaya. Fifty- six Cavia cobaya were divided into four groups: polyethylene glycol (PEG), propolis extract + PEG, BBG + PEG, and propolis extract + BBG + PEG. The lower left incisor was extracted, and the socket subsequently filled with material according to the specific group of which the subject was a member. The subjects were sacrificed on the 14th and 30th days. Immunohistochemical staining was carried out under a light microscope at 400x magnification. Statistical analysis was then carried out by means of One-Way ANOVA and Tukey HSD tests. The mean number of RUNX2 and ALP expressions in each group was significantly different. The highest number of RUNX2 and ALP expressions occurred in the propolis + BBG + PEG group on the 30th day, while the lowest expressions were observed in the control group on the 14th day. A combination of propolis and BBG extract at a concentration of 2% of active substance effectively increases the expression of RUNX2 and ALP in preserving the tooth extraction sockets of Cavia cobaya.

Tratamiento conservador para intrusión severa de dientes primarios. Informe de caso / Tratamento conservador para intrusão severa de dentes decíduos. Relato de caso / Conservative treatment for severe intrusion of primary teeth. Case report

Las lesiones traumáticas en la dentición primaria constituyen uno de los principales motivos de consulta odontopediátrica. Las luxaciones intrusivas en la dentición primaria son injurias severas en las que el diente se desplaza de forma axial, hacia el alvéolo, ocasionando daño tisular que puede afectar gravemente a los tejidos de soporte y dientes sucesores, siendo recomendado el tratamiento conservador. Presentación de caso: Se trata de paciente masculino de 1 año y 10 meses de edad quien acude al área de emergencia pediátrica en El Centro Médico Docente la Trinidad por traumatismo dentofacial. Al momento de la exploración clínica, posterior a la evaluación pediátrica, se observa que presenta lesión lacerante en la encía del sector anterosuperior con ausencia del incisivo central superior primario (51). Al realizar examen radiográfico confirma el diagnóstico de luxación intrusiva completa con fractura de tabla vestibular en premaxila y fractura coronal no complicada esmalte-dentina del 51. Se realizó desinfección tópica de la zona, se recetó antibioticoterapia preventiva, antiinflamatorios, higiene bucal y dieta líquida y blanda. El tratamiento de elección fue conservador, esperando la reerupción espontánea para posterior restauración. Se realizaron controles periódicos presenciales y a través de la teleodontología, evidenciando evolución favorable. A los 12 meses posteriores al traumatismo el diente llegó al plano de oclusión, sin sintomatología. Se realizó la restauración estética con resina fotocurada. Conclusiones: El manejo conservador en casos de luxaciones intrusivas severas, acompañado de adecuado monitoreo, permite obtener resultados satisfactorios

Lesões traumáticas na dentição decídua são um dos principais motivos de consulta da odontopediatria. As luxações intrusivas na dentição decídua são lesões graves nas quais o dente se move axialmente em direção ao alvéolo,causando danos aos tecidos que podem afetar seriamente os tecidos de suporte e os dentes sucessores,e o tratamento conservador é recomendado. Objetivo: descrever a evolução do tratamento conservado causado por uma intrusão grave de um incisivo primário. Apresentação do caso: paciente do sexo masculino,com 1 ano e 10 meses de idade,que atende ao pronto-socorro pediátrico do El Centro Médico Docente la Trinidad para traumas dentofaciais. No momento do exame clínico,após da avaliação pediátrica, observou-se que apresentava lesão lacerante em gengiva do setor ântero-superior com ausência do incisivo central superior primário (51).O exame radiográfico confirmou o diagnóstico de luxação intrusiva completa com fratura da tábua vestibular no pré-maxilar e fratura coronal de esmalte-dentina não complicada de 51.Foi realizada desinfecção tópica da área, antibioticoterapia preventiva, anti-inflamatórios, higiene oral e dieta liquida foi prescrita. O tratamento de escolha foi conservador, aguardando re-erupção espontânea para posterior restauração. Os controles periódicos foram realizados pessoalmente e pela teleodontologia, apresentando evolução favorável. 12 meses após o trauma, o dente atingiu o plano de oclusão, sem sintomas. A restauração estética foi realizada com resina fotopolimerizável. Conclusões: o manejo conservador nos casos de luxações intrusivas graves,acompanhado de monitoramento adequado, permite a obtenção de resultados satisfatórios

Traumatic injuries in the primary dentition are one of the main reasons for pediatric dentistry consultation. Intrusive dislocations in the primary dentition are severe injuries in which the tooth moves axially towards the socket,causing tissue damage that can seriously affect the supporting tissues and successor teeth, and conservative treatment is recommended. Objective: to describe the outcome of conservative treatment for severe intrusion of a primary incisor. Case presentation: this is a 1 year and 10 month old male patient who attends the pediatric emergency area at El Centro Médico Docente la Trinidad for dentofacial trauma. At the time of the clinical examination,after the pediatric evaluation, it was observed that he presented a lacerating lesion in the gingiva of the anterosuperior sector with the absence of the primary upper central incisor (51). A radiographic examination confirmed the diagnosis of complete intrusive dislocation with a vestibular table fracture in the premaxilla and an uncomplicated enamel-dentin coronal fracture of 51. Topical disinfection of the area was performed,preventive antibiotic therapy, anti-inflammatories, oral hygiene and soft liquid diet were prescribed. The treatment of choice was conservative, waiting for spontaneous re-eruption for later restoration. Periodic controls were carried out in person and through teleodontology,showing favorable resolution. Twelve months after the trauma, the tooth reached the occlusion plane,with no symptoms. The aesthetic restoration was performed with light-cured resin. Conclusions: conservative management in cases of severe intrusive dislocations, accompanied by adequate monitoring,allows satisfactory results to be obtained