Pulpectomía mecanizada en molares primarios: caso clínico / Mechanized pulpectomy in primary molars: a clinical case

Las pulpectomías en molares primarios están indica-das en casos de diagnóstico de pulpitis irreversible o necrosis y reabsorción radicular mínima o nula. Son tratamientos laboriosos y extensos, que sólo pueden ser llevados a cabo en pacientes colaboradores. En búsqueda de simplificar esta terapéutica y mejorar su eficacia, se propone la mecanización de la pre-paración de los conductos de molares primarios. Diversos autores aseguran que esta técnica opti-miza el tiempo clínico y mejora la calidad del trata-miento, obteniendo gran aceptación en la literatura actual. Se presenta la secuencia de procedimientos, resolución y controles de dos tratamientos de pul-pectomía con instrumentación mecanizada en mola-res primarios (AU)

Pulpectomies in primary molars are indicated in cases of irreversible pulpitis or necrosis with mini-mal or no root resorption. They are laborious and ex-tensive treatments, which only can be carried out in cooperative patients. In order to simplify this therapy and improve its effectiveness, the mechanization of root canal preparation is proposed. Several authors assume that this technique optimizes preparation time and improves the quality of treatment, obtaining great acceptance in the current literature. We report the sequence of procedures, resolution, and controls of two pulpectomies with mechanized instrumenta-tion in primary molars (AU)

Dimensions of Occlusoproximal Cavitated Carious Lesions as a Cut-Off Point for Restorative Decision in Primary Teeth

ABSTRACT Objective: To investigate whether the dimensions of cavitated dentin carious lesions on the occlusoproximal surfaces of primary teeth could predict the location of cement-enamel junction (CEJ). Material and Methods: Two hundred extracted primary molars were selected and digital images were obtained. The teeth were set in arch models for clinical measurement. The cervical-occlusal (CO) and buccal-lingual/palatal (BL/P) cavities' dimensions were obtained by digital (Image J) and clinical (periodontal millimeter probe) assessments. The cervical margin location was also determined. The thresholds (cut-off points) were determined by sensitivity, specificity and the areas under the receiver operating characteristics curves (Az) for the two methods. Pearson's correlation coefficient was used to investigate the correlation between clinical and digital measurements. Logistic regression analysis was performed to evaluate the association between the dimensions and cervical margin location. Results: There was a strong correlation between methods for all measurements (CO: r=0.90, VL/P: r=0.95). Cavities with BL/P distance higher than 4.5 mm and CO dimension higher than 3.5 mm had a lower chance of presenting the cervical limit above the CEJ, irrespective of the measurement method. Conclusion: CO and VL/P dimensions could be used to predict the CEJ location and, ultimately, as a clinical parameter for restorative decision-making.

A 14-Year Follow-Up Study of Sequelae in Primary Teeth and Permanent Successors After Dental Trauma

ABSTRACT Objective: To evaluate the presence of sequelae in primary teeth and their permanent successors, as well as associations between TDI and the presence of sequelae in both teeth. Material and Methods: In this 14-year retrospective study, 2.290 records were reviewed, 192 patients who suffered dental trauma in primary teeth were followed until the eruption of successor teeth were included. Descriptive, chi-square, and regression logistic with generalized estimating equations tests were performed (p<0.05). Results: 362 primary and successor teeth were followed. Sequelae were present in 71.8% of primary teeth and 25.7% of their successors. Teeth with complicated fracture (100%), extrusion (100%) and avulsion (100%) resulted in the largest amounts of sequelae in primary teeth and intrusion (61%) on their successors. Age was associated with sequelae in permanent teeth (p<0.01). Extrusion (OR 10.06; CI 2.12-47.63) and intrusion (OR 7.51; CI 2.73-20.70) had a higher risk to cause sequelae in primary and permanent teeth, respectively. Conclusion: The type of injury involved influenced the sequelae in traumatized teeth and their successors, and the age of the child influenced the presence of sequelae in permanent teeth.

Potencial remineralizante del fluoruro diamino de plata al 38% en dentina de dientes temporales afectada por caries / Remineralizing potential of 38% silver diamine fluoride in dentin affected by dental caries

Introducción: la caries es una enfermedad compleja que afecta a cualquier edad. La prevalencia es mayor en la primera dentición, sobre todo en población con baja percepción económica. El fluoruro diamino de plata (FDP) al 38% ha sido utilizado como una alter- nativa de tratamiento para esta enfermedad. Funciona como una solución remineralizante y cariostática. Objetivo: evaluar el efecto remineralizante del FDP al 38% en dentina afectada por lesiones de caries en molares temporales. Material y métodos: estudio clínico, epidemiológico, descriptivo, longitudinal y experimental. Se llevó a cabo en molares de primera dentición de niños de tres a cinco años de edad. Los niños seleccionados tenían molares con lesiones cariosas dentinarias, Pitts las denomina D3. No se incluyeron niños con dientes que presentaron patologías pulpares irreversibles. La aplicación del FDP al 38% la efectuó un operador entrenado para esta finalidad. Se utilizaron los criterios de Nyvad para determinar el grado de dureza de la dentina y con ello deducir su remineraliza- ción. Se observó la permanencia de la remineralización efectuada por un periodo de cinco meses. Resultado y conclusión: el FDP es un compuesto eficaz en 91% de los casos en un periodo de cinco meses o más (AU)

Introduction: dental caries is a complex disease that affects any age. The prevalence is higher in primary dentition, especially in a population with low economic perception. 38% silver diamine fluoride (FDP) has been used as an alternative treatment for this disease. It works as a remineralizing and cariostatic solution. Objective: to evaluate the remineralizing effect of 38% FDP on dentin affected by dental caries, in temporary molars. Material and methods: clinical, epidemiological, descriptive, longitudinal and experimental study. It was carried out in temporary molars of children between three and five years of age. The selected children presented molars with dental carious lesions, Pitts calls them D3. Children with teeth that presented irreversible pulp pathologies were not included. The application of the FDP to 38% was carried out by an operator trained for this purpose. The Nyvad criteria were used to determine the degree of hardness of the dentin and thereby deduce its remineralization. The permanence of the remineralization carried out was observed for a period of five months. Result and conclusion: the FDP is an effective compound in 91% of the cases, in a period of five months or more (AU)

Perfil de caries de la infancia temprana / Profile of early childhood caries

La Caries de la Infancia Temprana (CIT) se ha descrito como una patología de origen multifactorial en niños hasta los 71 meses de edad. Se considera como Ca-ries de la Infancia Temprana Severa (CITS) cuando a los 3 años el índice ceod es ≥ 4; a los 4 años, ≥ 5, y a los 5 años ≥ 6. La rehabilitación de las lesiones provo-cadas por esta patología puede ser compleja debido a la calidad y cantidad de estructura remanente y a la edad de los pacientes afectados. Objetivos: Estimar la frecuencia de CIT y CITS en niños menores a 72 me-ses que concurrieron para su atención, e identificar el tipo de práctica realizada, y la adhesión al trata-miento. Métodos: Diseño retrospectivo observacional sobre las historias clínicas de pacientes menores a 72 meses asistidos por los cursantes de la Especiali-zación en Odontopediatría, entre febrero 2021 y julio 2022. Resultados: La muestra quedó constituida por 101 niños, de 46+13,5 meses. El 91% presentó CITS. La totalidad de los pacientes mantuvieron lactancia nocturna prolongada después del año, siendo en el 72,3% a libre demanda durante el sueño, en un perío-do de 23+6 meses. Se registró un total de 1010 lesio-nes de caries. El 29,3% de los pacientes abandonaron el tratamiento. Conclusiones: La mayor parte de los niños presentaron Caries de la Infancia Temprana Severa, con altos valores de patología y lactancia noc-turna prolongada a libre demanda después del año Los tratamientos recomendados en estos casos son muy prolongados y requieren de prácticas invasivas, complejas y de alto costo, lo que provoca el abandono del tratamiento (AU)

Early childhood caries (ECC) is defined as a multifactorial disease in children 71 months of age or younger. When the dmft index is ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) it is referred to as Severe early childhood caries (SECC). Management of ECC is complex due to the quality and quantity of remaining structure of teeth at an early age. Objectives: To estimate the frequency of ECC and SECC in children < 72 months of age undergoing comprehensive treatment, to identify the type of treatment provided and treatment compliance. Methods: Retrospective observational design on dental records of patients under 72 months of age treated by Pediatric Dentistry Specialty Program students between February 2021 and July 2022. Results: The sample included 101 children, mean age 46+13.5 months, 91% of patients with SECC. All patients were fed nightly for over 1 year, 72.3% of whom were fed nightly on demand over a period of 23±6 months. A total of 1010 caries lesions were detected. 29.3% of children discontinued treatment. Conclusions: Most of the children presented severe early childhood caries with high values of pathology and prolonged nocturnal breastfeeding on demand after one year. The recommended treatments in these cases are very long and require invasive, complex and expensive practices, which causes abandonment of the treatment (AU)

Mantenedor de espacio funcional elaborado con corona de NuSmile / Elaborated functional space maintainer with zirconia NuSmile crown

La caries de la infancia temprana, al igual que otras formas de caries, se caracteriza por ser multifactorial, infecciosa y de rápida evolución. Puede presentarse como lesiones cavitadas o no cavitadas, se diagnostica principalmente en menores de seis años en la superficies de los dientes anterosuperiores, debido a que son los primeros órganos dentales en erupcionar y tienen mayor contacto con el estímulo cariogénico. En casos severos pueden llegar a ocasionar la pérdida de órganos dentales, influyendo en la salud general del paciente y repercutiendo en su autoestima y desarrollo psicosocial. Para devolver las características y funciones perdidas en ausencia de algún órgano dental, se recurre a sustituirlo mediante aparatología, mayormente en forma de un mantenedor de espacio funcional. Las necesidades estéticas individuales de cada caso generan diversas alternativas para adaptarnos a la situación del paciente (AU))

Early childhood caries, like other forms of caries, is characterized by being multifactorial, infectious, and rapidly evolving. It can present as cavitated or uncavitated lesions, it is mainly diagnosed in children under six years of age on the surfaces of the anterior superior teeth, because they are the first dental organs to erupt and have greater contact with the cariogenic stimulus. In severe cases they can cause the loss of dental organs, influencing the general health of the patient and impacting on their self-esteem and psychosocial development. In order to restore the lost features and functions in the absence of any dental organ, it is resorted to by means of appliances, mostly in the form of a functional space maintainer. The individual aesthetic needs of each case generate various alternatives to adapt to the patient's situation (AU)

Complications following replantation of primary teeth: a case report / Complicações após reimplante de dentes decíduos: um relato de caso clínico

Abstract Introduction: the avulsion of primary teeth is a disturbing and unexpected event. Description: this report describes the clinical case of a three-year-old child who suffered an avulsion and replantation of the primary upper central incisors at the site of the injury. The guardians sought treatment for the child at the Federal University of Minas Gerais after the replantation. Four months later, the child suffered a new trauma and the replanted teeth presented advanced mobility, root resorption and fistula. The clinical conduct was extraction and rehabilitation with a fixed esthetic maintainer. Discussion: the literature describes two treatment options for avulsion of primary incisors: replantation and non-replantation. According to a recent systematic review, the difficulty in obtaining a consensus regarding the best clinical conduct is due, in part, to the scarcity of publications that present not only follow-ups with clinical success, but also with failures. The outcomes of replantation can be influenced by several factors. The time elapsed between replantation and splinting, and the new episode of trauma, negatively influenced the prognosis in the present case, leading to failure. Replantation of primary incisors is not yet evidence-based treatment. Therefore, this option must be chosen with caution and in ideal situations. It requires constant clinical and radiographic monitoring for evaluation of outcomes.

Resumo Introdução: a avulsão de dentes decíduos é um evento perturbador e inesperado. Descrição: o presente relato descreve o caso clínico de uma criança de três anos que sofreu avulsão e reimplante dos incisivos centrais superiores decíduos no local do acidente. Os responsáveis procuraram atendimento para a criança na Universidade Federal de Minas Gerais após reimplante. Quatro meses depois, a criança sofreu novo trauma e os dentes reimplantados apresentavam mobilidade avançada, reabsorção radicular e fístula. A conduta clínica foi extração e reabilitação com mantenedor estético fixo. Discussão: a literatura descreve duas opções de tratamento para avulsão de incisivos decíduos: o reimplante e o não reimplante. De acordo com revisão sistemática recente, a dificuldade de se obter um consenso sobre a melhor conduta clínica se deve, em parte, à escassez de publicações que apresentem não apenas acompanhamentos com sucesso clínico, mas também com falhas. O reimplante pode ser influenciado por vários fatores. O tempo decorrido entre o reimplante e a contenção, e o novo episódio de trauma, influenciaram negativamente o prognóstico do presente caso, levando ao insucesso. O reimplante de incisivos decí- duos ainda não é um tratamento baseado em evidências. Portanto, essa opção deve ser escolhida com cautela e em situações ideais. Requer monitoramento clínico e radiográfico para constante avaliação do desfecho.

Traumatic Dental Injuries Occurred in Primary Teeth and their Sequel Effects on the Developmental Permanent Successors: A Controlled Study

ABSTRACT Objective: To examine the types of traumatic dental injuries of the primary teeth (TDI-p) and the long-term sequelae on permanent dentition (LSP) comparing with a control group (CG). In addition, a questionnaire that measures parents' knowledge and awareness was used. Material and Methods: The trauma group (TG) consisted of permanent teeth following TDI-p exposed teeth, while the CG consisted of permanent teeth following unexposed teeth with TDI-p of the same patients. In total, 141 teeth were evaluated in 27 patients. Data concerning such as teeth, when TDI-p occurred, types of treatments and types of LSP were collected. Chi-square test was used for intergroup comparison for gender, type of trauma, LSP, age of trauma and parameters in the parental information questionnaire. Significance level was p<0.05. Results: A statistically significant difference was found in the analysis between TG and CG (p<0.001). The prevalence of LSP due to TDI-p was 29.6% and the prevalence of sequelae in CG was 7.4%. The most common LSP was enamel hypoplasia (14.8%). Parents were aware of the importance of TDI-p, and they had insufficient knowledge about its management. Conclusion: TDI-p can be considered a high-risk factor in the development of LSP. Also, the lack of knowledge in parents should be supported by software-based application systems to be developed.

Dental trauma with intrusive luxation and six-year monitoring: clinical case report / Traumatismo dentário com luxação intrusiva com acompanhamento de seis anos: relato de caso clínico

Objective: this study is designed to report a clinical intrusion case, which exhibited enamel hypoplasia on the crown of tooth 11 and which underwent clinical and X-ray monitoring for six years. Case report: A threeyear- old female patient exhibited intrusion of deciduous teeth 51, 52, 61, and 62. After X-ray, it was detected that teeth 51 and 61 had perforated the nasal cavity floor, but all four teeth had re-erupted and began to be monitored. After six months, teeth 51 and 61 exhibited bone loss in the interproximal area, as well as mobility, which led to tooth extraction. Teeth 52 and 62 re-erupted in a satisfactory position, and exhibited no signs and symptoms of infection, periapical alteration, or mobility. These teeth were therefore maintained in the arch. After six years, it was detected that tooth 11 had erupted with enamel hypoplasia. Final considerations: Longterm clinical and X-ray control proved essential, as it allowed for the early diagnosis of potential alterations, and minimized potential sequelae to the permanent teeth.(AU)

Objetivo: relatar um caso clínico de intrusão com acompanhamento clínico e radiográfico de 6 anos, que apresentou hipoplasia de esmalte na coroa do dente 11. Relato de caso: paciente de 3 anos, sexo feminino, apresentou intrusão dos dentes decíduos 51, 52, 61 e 62. Após radiografia, foi detectado que os dentes 51 e 61 tinham perfurado o soalho da fossa nasal, porém, ocorreu re-erupção dos 4 dentes e foi realizado acompanhamento. Após 6 meses, nos dentes 51 e 61, foram observadas perda óssea na região interproximal e mobilidade, optando-se pelas exodontias. Os dentes 52 e 62 re-erupcionaram em posição satisfatória e com ausência de sinais e sintomas de infecções, alterações periapicais e mobilidade, sendo mantidos no arco. Após 6 anos, foi observado que o dente 11 erupcionou apresentando hipoplasia de esmalte. Considerações finais: mostrou-se essencial o controle, clínico e radiográfico, em longo prazo, diagnosticando precocemente possíveis alterações e minimizando sequelas que podem acometer os dentes permanentes.(AU)

Edema em lábio superior associado à alveólise de dente decíduo / Edema em lábio superior associado à alveólise de dente decíduo

Introdução: As úlceras traumáticas são caracterizadas por episódios breves e dolorosos, mas podem se tornar crônicas se o agente causador não for eliminado. A alveólise é uma alteração que pode ocorrer durante o processo de reabsorção da raiz do dente decíduo, caracterizada por sua exposição à cavidade bucal, sem reabsorção. Objetivo: Descrever o caso de uma paciente com edema no lábio superior devido à úlcera traumática causada pela exposição do ápice da raiz de um incisivo decíduo. Relato do caso: Paciente do sexo feminino, 5 anos de idade. Após exame clínico, deduziu-se que o edema labial associado com uma úlcera causada pelo contato constante com o ápice do dente que sofreu alveólise. O tratamento consistiu na extração do dente e proservação da úlcera na mucosa labial. A extração favoreceu a erupção do incisivo permanente, permitiu a cicatrização completa da lesão traumática e a remissão do edema no lábio superior. Conclusão: Embora simples, o caso ressalta a necessidade de o profissional reconhecer a alveolise, possíveis complicações associadas e a maneira adequada de tratá-las. Um caso aparentemente complexo foi resolvido simplesmente devido ao diagnóstico e tratamento adequados(AU)

Introducción: Las úlceras traumáticas se caracterizan por episodios breves y dolorosos, pero pueden llegar a ser crónicas si no se elimina el agente causal. La alveólisis es una alteración que puede ocurrir durante el proceso de reabsorción de la raíz del diente primario, caracterizada por su exposición a la cavidad bucal, sin reabsorción. Objetivo: Describir el caso de una paciente con edema en el labio superior debido a la úlcera traumática causada por la exposición del ápice de la raíz de un incisivo primario. Presentación del caso: Paciente del sexo femenino, de 5 años de edad. Después del examen clínico, se dedujo que el edema del labio estaba relacionado con la úlcera causada por el contacto constante con el ápice del diente que ha sufrido alveólisis. El tratamiento consistió en la extracción del diente y preservación de la úlcera en mucosa labial. La extracción favoreció la erupción del incisivo permanente, permitió la curación completa de la lesión traumática y la remisión del edema en el labio superior. Conclusiones: Aunque simple, el caso destaca la necesidad de que el profesional reconozca la alveólisis, posibles enfermedades asociadas y la forma adecuada de tratarlas. Un caso aparentemente complejo se resolvió simplemente debido a un diagnóstico y tratamiento adecuados(AU)

Introduction: Traumatic ulcers are characterized by short and painful episodes, but can become chronic if the causative agent is not removed. Alveolisis is an alteration that may occur during the primary tooth root resorption process, characterized by its exposure to the oral cavity, without resorption. Objective: To describe the case of a patient with an important edema and associated pain in the upper lip due to traumatic ulcer caused by exposure of the root apex of a primary incisor. Case presentation: Female patient aged 5 years old. After clinical examination, it was deduced that the lip swelling was related to the ulcer that was caused by the constant contact with the apex of the central incisor that has undergone alveolisis. The treatment consisted in the extraction of the tooth and the preservation of the labial mucosa ulcer. The extraction favored the eruption of the permanent incisor, allowed the complete healing of the traumatic lesion and the remission of the upper lip edema. Conclusions: Although simple, the case highlights the need for the professional to recognize the alveolisis and the possible associated complications as well as the appropriate way to manage them. A seemingly complex case was solved simply due to correct diagnosis and treatment(AU)

Canine transposition as an alternative to trauma of the maxillary incisors: case report

ABSTRACT Objective: The present article aims at reporting the clinical case of a patient who suffered trauma at two years of age, causing almost complete apical displacement of the deciduous maxillary left central incisor and of the permanent incisor. Methods: Ectopia secondary to intrusion was minimized by surgical removal of the ectopic tooth, and the left permanent canine was submitted to orthodontic traction to replace the extracted tooth. Results: The treatment period lasted 36 months, resulting in correct occlusion and a good aesthetic outcome. Conclusions: Dental transposition carried out by means of orthopedic traction is a good alternative in cases of a very unfavorable ectopic tooth position.

RESUMO Objetivo: o presente relato de caso descreve uma paciente que sofreu trauma aos dois anos de idade, causando deslocamento apical quase completo do incisivo central esquerdo decíduo e do incisivo permanente. Métodos: a ectopia resultante da intrusão foi minimizada pela remoção cirúrgica do dente ectópico, e o canino permanente esquerdo foi tracionado ortodonticamente para substituir o dente extraído. Resultados: o período de tratamento durou 36 meses, obtendo-se uma oclusão correta e um bom resultado estético. Conclusões: a transposição dentária realizada através da tração ortopédica é uma boa alternativa em casos de dentes ectópicos em posições muito desfavoráveis.

Impaction of primary tooth molar in mandibule ­ case report / Primeiro molar decíduo impactado em mandíbula - relato de caso

Tooth impaction results from a mechanical blocking that prevents the tooth from erupt. This situation is frequently associated to permanent tooth as wisdom teeth and canines. Impaction of a primary tooth can be associated to systemic or local etiologic factors. Treatment options could include dental extraction, removal of lesion associated without removing the primary tooth and others. The aim of this article is to present a rare case report of an impacted primary tooth in a 42 yearold man, with no complain of swelling. Extra oral examination revealed no alteration of normality. The panoramic radiograph showed a primary tooth impacted in the left body of the mandible. Most of the time the cause for non-eruption of primary tooth is the presence of a mechanical obstacle, not anatomical, in its trajectory. The surgical intervention is a possibility, but it can stay unaltered with no problems related to the impacted tooth. Many times the professional experience and the activity together in various areas of knowledge are the most important and wise conduct to be taken in health care.(AU)

A impactação dental resulta de um bloqueio mecânico que impede o dente de erupcionar. Esta situação está frequentemente associada à dentes permanentes como os terceiros molares e os caninos. Impactação de um dente decíduo pode estar associada a fatores sistêmicos ou locais. Opções de tratamento podem incluir extração dental, remoção da lesão associada sem remoção do dente decíduo, entre outros. O objetivo deste artigo é apresentar um raro relato de caso de um dente decíduo impactado em um paciente do gênero masculino, 42 anos de idade, sem queixas de inchaço. A avaliação extra-bucal não mostrou alterações de normalidade. A radiografia panorâmica evidenciou um dente decíduo impactado em corpo de mandíbula, lado esquerdo. Na maioria dos casos a causa para não erupção de um dente decíduo é a presença de um obstáculo mecânico, não anatômico, em sua trajetória de erupção. A intervenção cirúrgica é uma possibilidade, mas pode permanecer inalterada sem problemas relacionados ao dente impactado. Em muitos casos a experiência profissional e a atividade em conjunto com várias áreas do conhecimento são as condutas mais importantes e sábias a serem tomadas no cuidado em saúde.(AU)

Tratamiento endodóntico no instrumentado en dientes deciduos: reporte de caso / Non instrumentation endodontic techniques in deciduous teeth. case report

Actualmente, se han publicado diversos casos cl¡nicos que describen la esterilizaci¢n de la lesi¢n pulpar en dientes deciduos como un tratamiento alternativo a la pulpectom¡a, evitando la exodoncia en dientes con necrosis pulpar y absceso. El procedimiento incluye: anestesia local, aislamiento absoluto, apertura cameral, remoci¢n de la pulpa cameral, ampliaci¢n de la entrada a los conductos, colocaci¢n de una pasta triantibi¢tica y la restauraci¢n. Se presenta el reporte de caso de una ni¤a de 4 a¤os de edad, la cual acude a la Cl¡nica Estomatol¢gica Central de la Facultad de Estomatolog¡a Roberto Beltr n de la Universidad Peruana Cayetano Heredia; con dolor, aumento de volumen en la regi¢n inferior izquierda y movilidad de la pieza 75. Radiogr ficamente se observa reabsorci¢n de la ra¡z distal de 1/3 y una lesi¢n osteol¡tica a nivel de la furcaci¢n. Por lo cual se decide realizar el tratamiento endod¢ntico no instrumentado de conductos, acompa¤ado de controles hasta los 12 meses, donde cl¡nicamente permanece asintom tico acompa¤ado con una regeneraci¢n de tejidos blandos, y radiogr ficamente una aposici¢n ¢sea en furca. Se concluye que el tratamiento endod¢ntico no instrumentado, muestra resultados prometedores y podr¡a ser una alternativa a la pulpectom¡a y/o exodoncia en dientes deciduos en algunos casos.

Now a days, clinical cases has been published in which describes the esterilization of pulpar lesi¢n on primary teeths as an alternative treatment to the pulpectomies avoiding the toot extractions on primary and necrotics or abscessed teeth. The procedure includes: local anesthesia, isolation with a rubber dam, remove the necrotic tissue from the coronal portionof the pulp chamber, enlarged of the canal orificie and a three mix paste placed over the pulpar floor. A case of 4 years old girl is presented in this work , that went to “Cl¡nica Estomatol¢gica Central de la Facultad de Estomatolog¡a Roberto Beltr n de la Universidad Cayetano Heredia”, with pain, mandibular left posterior swelling and mobility of her mandibular left second primary molar. X-ray shows 1/3 distal root resorption and furcation radiolucency. The clinical procedure ofnon- instrumented endodontic treatment was performed successfully and 12 months posterior controls was maded, in which soft tissue healing was showed, increased trabeculation in the furcation area, normal mobility and the patient was symptom-free. It concludes that this treatment shows promising results for the future pediatric dentistry and is an alterantive to pulpectomy and tooth extraction.

Prevalência da terapia pulpar em dentes decíduos realizada na Clínica Escola de Odontologia do UNIPÊ / Prevalencia de la terapia pulpar en dientes temporales realizada en la Facultad de Odontología de Clínica de UNIPÊ / Prevalence of pulp therapy in deciduous teeth performed in UNIPÊ Clinical Dentistry School

Introdução: são vários os problemas que acometem o meio oral infantil, mas o principal deles é a cárie, devido à falta de conhecimento, negligencia com a saúde da criança, e informações inadequadas dos pais, a doença acaba progredindo e tomando proporções maiores. Objetivo: avaliar a prevalência da terapia pulpar em dentes decíduos realizados na Clínica Escola de Odontologia do Unipê. Métodos: foram analisados 600 prontuários clínicos de crianças na faixa etária de 3 a 10 anos, atendidos entre os anos de 2010 a 2013. Os prontuários foram analisados individualmente procurando obter dados referentes aos principais agentes etiológicos que acometem a dentição decídua, à identificação da faixa etária em que ocorre maior prevalência da terapia pulpar, quais os dentes mais acometidos, quais as técnicas de escolha de acordo com o material utilizado para dentes vitalizados e desvitalizados e qual a condição pulpar. Os dados foram analisados mediante estatística descritiva (frequências e valores percentuais) e inferencial. Resultados: os resultados mostraram que 11 por cento destas crianças, apresentavam pelo menos um dente que foi submetido à terapia pulpar, sendo maior a prevalência no sexo masculino com 56,1 por cento. O principal fator etiológico foi à cárie com 95,5 por cento. O índice de Higiene Bucal que prevaleceu foi o regular com 56,1 por cento. Os dentes mais acometidos foram o primeiro molar decíduo inferior direito, com 18,2 por cento e o segundo molar decíduo superior direito com 13,6 por cento. A pulpectomia foi o tratamento mais realizado, correspondendo a 51,5 por cento dos casos. Conclusão: conclui-se que a prevalência da terapia pulpar em dentes decíduos é maior no sexo masculino e tem como principal fator etiológico a cárie, sendo a pulpectomia o principal tratamento(AU)

Introduction: there are several problems that affect children's oral environment, but the main one is caries, due to lack of knowledge, neglect to the child's health, and inadequate information by the parents, the disease progresses and ends up taking larger proportions. Objective: to evaluate the prevalence of pulp therapy in primary teeth performed at the UNIPÊ Clinical School of Dentistry. Methods: we analyzed 600 medical records of children aged 3-10 years treated between the years 2010-2013. The records were analyzed individually seeking data to the main etiologic agents affecting the primary dentition, the identification of the age group in which there is greater prevalence of pulp therapy, which affected teeth most, which techniques of choice according to the material used for vital teeth and devitalized which the pulp and condition. Data were analyzed using descriptive statistics (frequencies and percentages) and inferential. Results: 11 percent of the children had at least one tooth that underwent pulp therapy, with a higher prevalence in males with 56.1 percent. The main cause was to decay to 95.5 percent. The oral hygiene index that prevailed was regular with 56.1 percent. The most affected teeth were the first deciduous molar bottom right, with 18.2 percent and the second primary molar upper right with 13.6 percent. The pulpectomy is most commonly performed treatment, corresponding to 51.5 percent of cases. Conclusions: the prevalence of pulp therapy in primary teeth is higher in males and its main etiological factor is decay, the pulpectomy being the main treatment.(AU)

Introducción: existen varios problemas que afectan al cavidad bucal de los niños, pero el principal es la lesión de caries, debido a la falta de conocimientos, el descuido de la salud del niño y la insuficiente información de los padres; la enfermedad progresa y termina con mayores afectaciones. Objetivo: evaluar la prevalencia de la terapia pulpar en dientes temporales realizada en la Escuela Clínica de Odontología UNIPÊ. Métodos: se revisaron 600 historias clínicas de los niños de 3 a 10 años tratados entre 2010-2013. Se analizaron los registros de búsqueda de datos individualmente a los principales agentes causales que afectan a la dentición primaria, la identificación del grupo de edad en el que hay una mayor prevalencia de la terapia de pulpa, los dientes más afectados, las técnicas de selección de acuerdo con el material utilizado para dientes vitales y desvitalizados, la pulpa y el estado. En el procesamiento de la información se empleó la estadística descriptiva (frecuencias y porcentajes) e inferencial. Resultados: el 11 por ciento de los niños tenían al menos un diente que se sometió a terapia pulpar, con una mayor prevalencia en los del sexo masculino, para el 56,1 por ciento. La causa principal fue la caries, con 95,5 por ciento. El índice de higiene oral que prevaleció fue regular con 56,1 por ciento. Los dientes más afectados fueron el primer molar temporal inferior derecho con el 18,2 por ciento y el segundo molar superior derecho primario con 13,6 por ciento. La pulpectomía fue el tratamiento más común, para el 51,5 por ciento de los casos. Conclusiones: la prevalencia de la terapia pulpar en dientes primarios es más alta en el sexo masculino y su principal factor causal resulta la caries; la pulpectomía constituye el principal tratamiento(AU)

Tratamiento de marsupialización de un quiste odontogénico inflamatorio en un niño de 5 años con preservación de los gérmenes dentarios permanentes / Marsupialization of a inflammatory dentigerous cyst in a 5-year-old child with preservation of the permanent tooth germs

El quiste radicular ha sido catalogado como un quiste inflamatorio, como resultado de una necrosis pulpar por un proceso de caries, con una reacción inflamatoria periapical. Avanza lentamente y en los primeros estadios puede ser asintomático. Debido a esto pueden tener grandes dimensiones.A continuación, presentamos una situación de un quiste radicular inflamatorio en relación con el segundo molar temporario inferior en un paciente de 5 años de edad. La ortopantomografía muestra una gran radiolucidez unilocular con un borde bien definido en la región periapical del segundo molar temporario inferior que se extiende desde la raíz hasta el primer molar temporario con desplazamientode los gérmenes de los premolares permanentes hacia la basal mandibular del sector derecho.

Clinical and radiographic sequelae to primary teeth affected by dental trauma: a 9-year retrospective study

Abstract This retrospective study aimed at determining the predicted risks of clinical and radiographic complications in primary teeth following traumatic dental injuries, according to injury type, severity and child's age. Data were collected from records of children treated at a Dental Trauma Center in Brazil for nine years. Records of 576 children were included; clinical sequelae were assessed in 774 teeth, and radiographic sequelae, in 566 teeth. A total of 408 teeth (52.7%) had clinical sequelae and 185 teeth (32.7%), radiographic sequelae. The type of injury with the highest number of clinical sequelae was the crown-root fracture (86.4%). Clinical sequelae increased with injury severity (p < 0.001), whereas radiographic sequelae did not (0.236). The predicted risk of color change was 29.0% (95%CI 19-41) for teeth with enamel fracture, and 26.0% (95%CI 14-40) for teeth with enamel dentin fracture as well as enamel dentin pulp fracture. Risk of periapical radiolucency was higher for teeth with enameldentinpulp fracture (61.1% 95%CI 35-82) and those with subluxation (15.8% 95%CI 10-22). Risk of premature loss was 27.3% (95%CI 13-45) for teeth with extrusive luxation, and 10.2% (95%CI 5-17) for those with intrusive luxation. The assessment of predicted risks of sequelae showed that teeth with hard tissue trauma tended to present color change, periapical radiolucency and premature loss, whereas teeth with supporting tissue trauma showed color change, abnormal position, premature loss and periapical radiolucency as the most common sequelae. Knowledge about the predicted risks of complications may help clinicians establish appropriate treatment plans.

Fractura radicular en piezas primarias / Root fracture in primary teeth

Los traumatismos dentarios constituyen uno de los motivos más frecuentes en la consulta odontopediátrica. Si bien las fracturas radiculares en dentición primaria son las lesiones traumáticas menos prevalentes (2-4 por ciento), son de difícil resolución y ocasionan la pérdida de dichas piezas en la mayoría de los casos. Objetivo: describir la resolución del traumatismo con fractura radicular en ambos incisivos centrales superiores primarios. Diagnóstico de la situación inicial: paciente masculino de 4 años que acude con su madre a la Cátedra de Odontología Integral Niños de la FOUBA presentando un traumatismo dental de 2 horas de evolución. Diagnóstico clínico-radiográfico: fractura radicular horizontal de tercio medio del 5.1 y 6.1 (sin reabsorción fisiológica radicular), sin desplazamiento del fragmento coronario, con laceración de labio superior y encía marginal. Secuencia de procedimientos operatorios: historia clínica con consentimiento informado; anamnesis médica y odontológica; examen clínico y radiográfico de 5.1 y 6.1 y antagonistas; limpieza de tejidos blandos con clorhexidina; impresión con alginato; confección de placa posicionadora para ferulización; prueba e instalación de la placa; indicaciones al paciente y a su madre: uso permanente durante 45 días y uso nocturno, para comer y hacer deportes 45 días más. Recomendaciones de higiene; controles inmediatos: 30 y 45 días y 3 y 6 meses. Resolución del caso: en todos los controles, ambas piezas se presentaron asintomáticas. A los 6 meses se observa la correcta cicatrización radicular y la presencia de vitalidad en ambos incisivos. Conclusiones: el tratamiento temprano y los controles posteriores son fundamentales para preservar la salud pulpar y conseguir la reparación de los tejidos duros afectados.

Anti-dentine Salivary SIgA in young adults with a history of dental trauma in deciduous teeth

Anti-dentin autoantibodies are associated with inflammatory root resorption in permanent teeth and are modulated by dental trauma and orthodontic force. However, it is not known whether deciduous tooth trauma can stimulate the development of a humoral immune response against dentin. The aim of this study was to evaluate the levels of salivary SIgA reactivity against human dentin extract in young adults with a history of trauma in the primary dentition. A sample of 78 patients, aged 18 to 25, who had completed an early childhood (0 to 5 years old) caries prevention program years earlier at the Universidade Estadual de LondrinaPediatric Clinic, underwent radiographic examination and salivary sampling. Anti-dentin SIgA levels were analyzed by immunoenzymatic assay and Western blotting. Although dental trauma to deciduous teeth had occurred in 34 (43.6%) of the patients, no differences in SIgA levels were detected between individuals who had experienced trauma and those who had not (p > 0.05). Multivariate regression analysis showed no association between dental trauma and SIgA levels (p > 0.05). Patients with a history of deciduous trauma presented low levels of anti-dentin antibodies, associated with orthodontic root resorption (p < 0.05). Western blot analysis showed that salivary antibodies recognized a single band of approximately 45 kDa in dentin extract. We concluded that salivary SIgA recognizes a specific component of the dentin matrix and that anti-dentin antibodies were not triggered by trauma to primary teeth. However, trauma to deciduous teeth may down-modulate SIgA in response to orthodontic root response.

Clinical Effectiveness of Two Commercial Fluoride Varnish Formulations on the Control of White Spot Lesion in Primary Teeth: A Pilot Study

To evaluate the in vivo clinical effectiveness of two commercial fluoride varnish formulations.Material and Methods:The sample consisted of seven children aged 2-5 years for a total of 24 active white spot lesions (WSL) in primary teeth. Children were randomly divided into two groups in accordance with the varnish used: G1 -Duraphat® -DR (n = 14 WSL); and G2 -Duofluorid XII® -DF (n = 10 WSL). Children were submitted to treatment with varnishes applied once a week for four consecutive weeks. Maximum mesiodistal and incisogengival dimensions were measured with a periodontal probe at the beginning of treatment and on the fifth week of treatment. The average between the two dimensions represented the value of the WSL dimension. The comparison of the mean final values of WSL dimensions between groups of fluoride varnishes tested was analyzed by the Mann-Whitney U test. The significance level adopted was 5%. Results:After five weeks, most WSL were ranked as inactive (G1 = 71.4% and G2 = 40%). No significant difference between G1 and G2 in relation to lesion activity was observed (p = 0.124). There was a significant decrease of 24% between initial (3.12 mm ± 1.49 mm) and final WSL dimension (2.35 mm ± 1.06 mm) (p = 0.012) in G1. In G2, there was a significant reduction of 40% in lesion dimension with initial value of 5.7 mm (± 3.82 mm) and final value of 3.4 mm (± 3.35 mm) (p = 0.013). Regarding the reduction in the WSL dimension, no significant difference between groups was observed (p = 0.931). Conclusion:Both fluoride varnish formulations tested had similar effect on the control of active white spot lesions in primary teeth...

Conduta dos odontopediatras e clínicos gerais diante de uma avulsão traumática na dentição decídua / Conduct of the pediatric dentists and dentists before a traumatic avulsion primary dentition

Avaliar a conduta e o conhecimento de cirurgiões dentistas diante de uma situação de avulsão traumática na dentição decídua. Material e Métodos: Foi um estudo transversal, no qual participaram 99 cirurgiões-dentistas (26 odontopediatras e 73 clínicos gerais), selecionados por conveniência a partir dos registros no Conselho Regional da Paraíba do município de João Pessoa. Os profissionais responderam a um questionário sobre a conduta pós-avulsão, bem como ao tratamento adequado para os casos de avulsão de dentes decíduos. Os dados foram analisados segundo estatística descritiva e inferencial, a partir do teste Qui-quadrado de Pearson (p<0,05). Resultados: A maior parte dos profissionais tinha experiência com situações de avulsão de dentes decíduos (53,5%), entretanto nunca realizou reimplante deste tipo de elemento (78,8%). Melhores resultados foram observados nos odontopediatras do que nos clínicos gerais, porém as únicas variáveis que apresentaram diferença estatística entre os grupos foram experiência prévia (p=0,01) e frequência de contato com situações de avulsão de dentes decíduos (p=0,03). Conclusão: O conhecimento e conduta dos profissionais foram razoavelmente satisfatórios, sendo superior por parte dos odontopediatras, entretanto sem diferença significativa entre os grupos. Ressalta-se a necessidade de campanhas de educação continuada direcionadas para estes profissionais...

To evaluate the conduct and knowledge of dentists in a situation of traumatic avulsion in the primary dentition. Materials and Methods: A cross-sectional study in which 99 dentists (26 pediatric dentists and 73 general practitioners) were selected by convenience from the records of the Regional Council of Dentistry of Paraíba, in the city of João Pessoa, Brazil. Professionals completed a questionnaire about post-avulsion conduct, as well as appropriate treatment for cases of avulsion of primary teeth. Data were analyzed according to descriptive and inferential statistics(Chi-square test) with a margin of error of 5%. Results: Most of the professionals had experience with cases of avulsion of primary teeth (53.5 %), however, most of them had never performed replantation (78.8 %). Better results were observed in pediatric dentists than in general practitioners , but the only variables that showed statistical differences between groups were previous experience (p = 0.01) and frequency of contact with situations of avulsion of primary teeth (p = 0.03). Conclusion: The knowledge and professional conduct were reasonably satisfactory, being higher by the pediatric dentists, however there was no significant difference between groups. We emphasize the need for continued education campaigns targeting these professionals...