Risk factors associated with the occurrence of avulsion in the primary incisors: A case-control study.

BACKGROUND: Identifying factors associated with the occurrence of primary tooth avulsion is essential to promote prevention strategies. AIM: To investigate the risk factors associated with primary incisor avulsion and variables associated with post-avulsion sequelae in the permanent successor. DESIGN: This case-control study comprised 407 children (cases) with primary incisor avulsion and 407 children (controls) with other traumatic dental injuries (TDI). The association between explanatory variables and avulsion was evaluated through logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Poisson regression analyses between potential explanatory variables and sequelae were run, from which relative risks (RR) and corresponding 95% CI were estimated. RESULTS: TDI caused by moderate falls (OR = 2.20; 95% CI = 1.47 to 3.27), affecting lateral incisors (OR = 10.10; 95% CI = 3.89 to 26.54) and the lower arch (OR = 9.54; 95% CI = 3.15 to 28.85), were associated with primary incisor avulsion. Moreover, children with previous severe TDI, anterior open bite, and anterior crossbite had higher odds of primary incisor avulsion. Children who suffered from any primary tooth avulsion (RR = 2.68; 95% CI = 1.82 to 3.95) had a higher risk of sequelae in the permanent successors. The risk for sequelae in the permanent teeth was significantly greater for younger children under age 2 years than for children ages 3 to 5 years. CONCLUSION: Risk factors for primary incisor avulsion are related to the severity of the fall, tooth position, history of previous TDI, and malocclusion. Furthermore, avulsion increases the risk of sequelae in the permanent successors.

Traumatic dental injuries in the primary lower incisors.

BACKGROUND: Primary lower incisors are susceptible to traumatic dental injury (TDI), which may affect both primary and permanent dentitions. AIM: This study aimed to evaluate the prevalence of TDIs in the primary lower incisors and the factors associated with their occurrence and with the incidence of sequelae in the permanent successor teeth. DESIGN: Dental files (n = 2926) from patients who attended a reference center for dental trauma in the primary teeth, from 1998 to 2020, were screened. Multilevel Poisson regression analyses were conducted between exploratory variables related to the traumatized teeth and outcome variables: occurrences of severe TDI and sequelae in the permanent successor. Prevalence ratios (PRs), relative risks (RRs), and respective 95% confidence intervals (95% CIs) were calculated. RESULTS: One hundred and thirteen (3.9%) children and 208 teeth presented with TDIs in the primary lower incisors. The prevalence of severe TDI was lower in 4-year-olds (PR = 0.43; 95% CI = 0.19-0.94) than in 2-year-olds. Moreover, severe TDI was significantly associated with the occurrence of sequelae in the permanent successors (RR = 3.97; 95% CI = 1.72-9.18), when compared to not severe TDI. CONCLUSIONS: The prevalence of TDI in the primary lower incisors is low, with a higher prevalence in children younger than 3 years. Older children also present less frequently with severe TDI, and the risk of sequelae in permanent teeth is higher following severe TDI.

Impact of avulsion of the primary incisors on the occurrence of sequelae in the permanent teeth: A retrospective cohort study.

OBJECTIVES: The purpose of this retrospective cohort study was to investigate the occurrence of sequelae in the permanent teeth after avulsion of their primary antecessors and to evaluate the factors associated with this occurrence. METHODS: We screened 2922 records of patients with photographic and radiographic images who attended a reference centre for dental trauma in the primary teeth from 1998 to 2019. Among them, 240 were eligible records of children who had suffered avulsion of the primary incisors and were followed up until complete eruption of the permanent successors. Multilevel Poisson regression analyses were conducted between the explanatory variables related to children and avulsed teeth; outcome variables were occurrences of any type of sequelae in the permanent teeth, opacities, hypoplasia and malformation. Relative risks (RRs) and respective 95% confidence intervals (95% CIs) were calculated. RESULTS: Among the 240 children's records, 194 fulfilled the inclusion criteria. Finally, we found 266 primary avulsed teeth and 115 (43.2%) permanent teeth presenting with sequelae. Avulsion occurring when children were older than 4 years (RR = 0.48; 95% CI = 0.24-0.95) had lower risks for developing sequelae than children aged 0-2 years of age. Additionally, when avulsion occurred in the lower dental arch (RR = 1.45; 95% CI = 1.06-1.99) and when three or more teeth were affected (RR = 1.57; 95% CI = 1.02-2.41), the occurrence of sequelae in the permanent teeth was more probable than if avulsion occurred in the upper arch and affected only a single tooth. Age older than 3 years was a protective factor for the occurrence of hypoplasia and age older than 4 years protective for the occurrence of opacities. CONCLUSIONS: The risk of sequelae in the permanent teeth after avulsion of their antecessor is higher when the trauma occurs in young children (<2 years) and in patients with avulsions of greater magnitude, such as when it affects the lower jaw, and more teeth are involved.

Influence of school environment on occurrence of traumatic dental injuries in 12 years old children.

BACKGROUND/AIM: Since children spend most of their time in school, some environmental characteristics of the schools may influence the occurrence of traumatic dental injuries (TDI). Therefore, the aim of this cross-sectional study was to assess the prevalence of TDI in 12 years old children in Quito, Ecuador, and its association with some school environmental aspects. MATERIAL AND METHODS: Six calibrated examiners evaluated 998 children from 31 public schools of Quito, to evaluate the occurrence of TDI in anterior teeth. School coordinators answered questionnaires on school physical conditions, promotion of health practices and the occurrence of negative episodes in school. The occlusion and socioeconomic status of the participants were also evaluated. Prevalence of TDI, unadjusted and adjusted by the design effect was calculated. Association between individual and contextual explanatory variables and presence of TDI were evaluated using multilevel Poisson regression analysis (P < .05). RESULTS: TDI prevalence adjusted by design effect was 20.7%. Children studying in schools with patio floor of grass and with access ramps had significantly lower prevalence of TDI than children studying in schools with patio floor of cement and with only stairs, respectively. The prevalence of TDI was also lower in children from schools that offered healthy meals or that had a proper place for oral hygiene. CONCLUSIONS: Schools with adequate physical structures and that promote health practices to their students have a lower prevalence of TDI.

Pulp Calcification in Traumatized Primary Teeth - Classification, Clinical And Radiographic Aspects.

OBJECTIVE: The aim of this study was to standardize the nomenclature of pulp alteration to pulp calcification (PC) and to classify it according to type, quantity and location, as well as relate it to clinical and radiographic features. STUDY DESIGN: The dental records of 946 patients from the Research and Clinical Center for Dental Trauma in Primary Teeth were studied. Two hundred and fifty PC-traumatized upper deciduous incisors were detected. RESULTS: According to radiographic analysis of the records, 62.5% showed diffuse calcification, 36.3% tube-like calcification, and 1.2% concentric calcification. According to the extension of pulp calcification, the records showed: 80% partial calcification, 17.2% total coronal calcification and partial radicular calcification, and 2.8 % total coronal and radicular calcification. As for location, only 2.4% were on the coronal pulp, 5.2% on the radicular pulp and 92.4% on both radicular and coronal pulp. Regarding coronal discoloration, 54% were yellow and 2% gray. In relation to periradicular changes, 10% showed widened periodontal ligament space, 3.1% internal resorption, 10% external resorption, 10.4% periapical bone rarefaction. CONCLUSIONS: Since PC is a general term, it is important to classify it and correlate it to clinical and radiographic changes, in order to establish the correct diagnosis, treatment and prognosis of each case.

Rare sequelae in the permanent successor due to trauma in the primary incisor: a case report.

Severe dental trauma-such as intrusion or avulsion-to the primary dentition in infants and toddlers may cause developmental disturbances in the permanent successor. In this case, a 9-year-old boy was referred for treatment due to the absence of his permanent maxillary right central incisor. The mother reported avulsion of the corresponding primary tooth when the patient was 2 years old. The radiographic examination revealed impaction and root dilaceration of the permanent tooth; therefore, the treatment plan was tooth extraction. The extracted tooth presented multiple abnormalities, including enamel discoloration, enamel hypoplasia, root dilaceration, and root duplication. Several factors need to be considered when treatment of traumatic sequelae to a permanent successor is planned, including the age of the patient, the developmental stage of the permanent successor at the time of trauma, and the type of trauma to the primary tooth.

Giant Cell Fibroma in a Two-Year-Old Child.

The giant cell fibroma is a benign nonneoplastic fibrous tumor of the oral mucosa. It occurs in the first three decades of life in the mandibular gingiva, predominantly, showing predilection for females. This article reports a case of giant cell fibroma in a 2-year-old girl, which is an uncommon age for this lesion. The patient was brought for treatment at the Research and Clinical Center of Dental Trauma in Primary Teeth, where practice for the Discipline of Pediatric Dentistry (Faculty of Dentistry, University of São Paulo, Brazil) takes place. During clinical examination, a tissue growth was detected on the lingual gingival mucosa of the lower right primary incisors teeth. The lesion was excised under local anesthesia and submitted to histological examination at the Oral Pathology Department of the Faculty of Dentistry, University of São Paulo, which confirmed the diagnosis of giant cell fibroma. There was no recurrence after 20 months of monitoring. This instance reinforces the importance of oral care from the very first months of life in order to enable doctors to make precocious diagnosis and offer more appropriate treatments for oral diseases, as well as to promote more efficient oral health in the community.

Does the Decline in Caries Prevalence of Latin American and Caribbean Children Continue in the New Century? Evidence from Systematic Review with Meta-Analysis.

OBJECTIVE: To carry out a systematic review with meta-analysis of prevalence of caries in Latin America and Caribbean children considering studies performed in this new century. METHODS: Two reviewers searched PubMed, Embase, LILACS and governmental databases through May 2016 to identify papers published in English, Portuguese or Spanish. Studies in those countries performed with 5-6 or 11-13 year-old children and that presented separate prevalence figures from primary and permanent teeth were selected. We performed a descriptive analysis of studies and meta-analysis to calculate the overall prevalence and 95% confidence intervals (95% CI) in both primary and permanent teeth. We also analyzed the trends of prevalence of caries through the years and influence of other variables on caries prevalence using multilevel analysis. RESULTS: Seventy-five studies were included from the 1,306 articles initially retrieved. The meta-analysis of caries prevalence grouped for Latin American and the Caribbean countries were highly different from Brazil and other investigated countries for primary teeth (5-6 years-old-Brazil: 0.52, other countries:0.70) and permanent teeth (11-12 years-old-Brazil: 0.56, other countries: 0.63). For studies conducted only in Brazil the prevalence was significant lower for primary but not for permanent teeth. In Brazil, a downward trend of caries prevalence was observed in 11-13-year-old children. CONCLUSION: Despite the decline of caries prevalence in permanent teeth, mainly in Brazil, the disease still affects more than half of the children population in Latin American and Caribbean countries in the 21st Century.

An unusual case of four simultaneous eruption cysts in an infant.

Eruption cyst is a benign lesion with favorable prognosis that may occur during the primary or permanent dental eruption. The purpose of this paper is to report the case of an infant who presented with multiple eruption cysts (ECs), describe their clinical and histological features, and discuss the treatment performed. The first ECs occurred around the primary mandibular central incisors when the patient was seven months old, which ruptured spontaneously. Ten months later, the patient presented with simultaneous eruption cysts around the primary mandibular and maxillary first molars, making the child very uncomfortable. Radiographically, all the involved molars had two thirds root formation. Two cysts, both on the right side, were surgically removed, and the other two ruptured spontaneously.

Trends and associated factors in prevalence of dental trauma in Latin America and Caribbean: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to perform a systematic review on the prevalence of, and trends in, dental trauma in permanent teeth in 'Latin America and Caribbean' region and possible factors associated with this injury. METHODS: Literature search was carried out, in PubMed database up to 07 July 2011, for articles written in Portuguese, Spanish, or English reporting on dental trauma prevalence in the Latin American and Caribbean countries. Meta-analyses were undertaken by using random effects modeling to satisfy the purposes of this review. Pooled estimates were calculated with a confidence interval of 95% (95% CI) both for prevalence and odds ratios (OR). RESULTS: This online searching strategy collected and listed 2436 articles on this topic. After evaluating their titles and abstracts, only 24 were finally selected for complete review and data collection. All studies had been performed during adolescence, mostly in 12-year-old adolescents. The pooled prevalence of dental trauma in permanent teeth was 18.6%. Positive summary association of dental trauma with boys (pooled OR = 1.72; 95% CI: 1.57-1.89), inadequate lip coverage (pooled OR = 2.26; 95% CI: 1.45-3.52), and increased overjet (>5 mm) (pooled OR = 1.98; 95% CI: 1.61-2.44) were observed across all meta-analysis models. Differences in estimation could be observed when different criteria were used for evaluating dental trauma. On the other hand, prevalence of dental trauma did not tend to show sudden changes over time, despite criteria used. Prevalence of dental trauma after 2000s tended to decrease over time. CONCLUSIONS: Approximately 15-20% of the adolescents in Latin American and Caribbean countries have shown some type of dental trauma in permanent teeth, and it seems there is a trend of decreasing prevalence of dental trauma in the studied areas of this region. Boys, adolescents presenting inadequate lip coverage, or an increased overjet greater than 5 mm are more likely to have traumatic dental injuries.

Traumatismos nos dentes decíduos: entendendo sua complexidade / Trauma in primary teeth: understanding its complexity

Os traumatismos em dentes decíduos são comuns de ocorrer, sendo seu primeiro episó­dio normalmente nas crianças quando estão aprendendo a andar. Traumas novos ou repetidos podem ocorrer ao longo do crescimento e desenvolvimento da criança, sendo importante seu diagnóstico, acompanhamento e tratamento quando necessário. Os traumas podem afetar tan­to o próprio dente decíduo como o dente permanente que está se formando. O tratamento deve envolver tanto o atendimento logo após o trauma, como o acompanhamento das possíveis sequelas na dentição decídua e permanente. A abordagem do bebê e da criança nem sempre é fácil, devido a pouca idade do paciente, as condições do atendimento de urgência e a falta de experiência profissional. A prevenção é limitada, restringindo-se aos cuidados gerais com as crianças, evitar a falta de selamento labial e a instalação de maloclusões anteriores (mordida aberta e protrusão dos incisivos superiores), associadas aos hábitos de sucção. Independente­ mente dos desafios e da incerteza perante a evolução de cada caso, devemos estar preparados para atender estas urgências, os traumas tardios e suas repercussões para ambas as dentições, proporcionando saúde bucal para nossos pacientes.

Trauma in primary teeth are likely to occur in childhood, and its first episodes usually ha­ppens in children who are learning to walk. New or repeated traumas may occur throughout the growth and development of children, and it is important to diagnosis, to monitor and to treat these traumas when necessary. Trauma can affect the traumatized primary tooth and the per­ manent tooth germ which is in development. The treatment should involve: dental assistance shortly after the dental trauma and the monitoring of possible sequelae in primary and perma­ nent dentition. The approach in babies and children is not always easy because of their age and the characteristics of urgency and professional lack of experience. Prevention is limited, being restricted to general child care, avoidance of lack of lip seal and installation of malocclusion in anterior teeth (open bite and protrusion) which are associated with sucking habits. Regardless the challenges and uncertainty ahead the evolution of each case, we must be prepared to meet these emergencies, late trauma and its repercussions on both dentitions, providing oral health to ou r patients.

Predictive factors for pulp necrosis in traumatized primary incisors: a longitudinal study.

BACKGROUND: This study aimed to assess factors associated with occurrence of pulp necrosis (PN) in traumatized primary incisors, which may contribute to the prognosis of this outcome. DESIGN: Data were collected by single examiner through the analysis of clinical files of traumatized patients. The occurrence of PN in traumatized teeth was the evaluated outcome. Poisson regression analysis was applied to calculate the relative risk (RR) and the respective 95% confidence interval. RESULTS: Five hundred and twenty-one files were assessed, summing up 727 traumatized primary incisors. The proportion of teeth affected by PN was 23.8%. Multiple regression analysis indicated the following factors as positively associated with PN: trauma with displacement, pulp exposure fracture, self-report of pain, yellow, grey and brown crown discoloration, internal root resorption, and bone loss. Trauma in 4- to 5-year old and more than 5-year-old children, pulp canal obliteration, and external root resorption with bone formation were negatively associated with PN. CONCLUSIONS: Teeth that suffered more aggressive injuries, pain, some types of discoloration, and other radiographic findings (for instance, internal root resorption) are positively associated with the occurrence of PN. On the other hand, trauma in older children, canal obliteration, or external resorption show less probability of PN.

Pulp polyp in traumatized primary teeth--a case-control study.

AIM: To assess clinical characteristics and other factors associated with the occurrence of pulp polyp in traumatized primary teeth as well to evaluate the impact of pulp polyp occurrence on clinical decision-making after traumatic injuries. MATERIAL AND METHODS: This study was divided into three phases. First, occurrence and clinical characteristics of pulp polyp were assessed followed by a descriptive analysis and categorical tests of association. Secondly, a case-control design was used, and the occurrence of pulp polyp was set as the outcome. In third phase, the occurrence of pulp polyp after fracture with pulp exposure was investigated as a variable possibly associated with clinical decision-making (dental extraction/endodontic treatment). Logistic regression analyses were used, and odds ratios and 95% confidence interval (OR; 95% CI) were calculated in second and third phases. RESULTS: Occurrence of pulp polyp in traumatized primary teeth was of 2.3%. Hyperplastic tissue color and proliferation size were not associated with the time to seek treatment after injury (P > 0.05). Children up to 2 years of age had more chance of having pulp polyp in comparison with older children (3.15; 1.15-8.64). Teeth with crown-root fracture had more chance of dental extraction in the therapeutic approach than the teeth with only crown fracture (4.36; 1.10-17.32). Presence of pulp polyp was not associated with the treatment carried out. CONCLUSIONS: Occurrence of pulp polyp in traumatized primary teeth is not frequent and is associated with the age when traumatic dental injury occurs but does not interfere directly with the therapeutic approach.

Effectiveness of triple-headed toothbrushes and the influence of the person who performs the toothbrushing on biofilm removal.

PURPOSE: The objectives of this study were 1) to compare the efficacy of biofilm removal with conventional (Bitufo 22) and triple-headed (DenTrust) toothbrushes on smooth and occlusal surfaces, and 2) to verify the influence of the person who performs the toothbrushing (mother vs dentist). MATERIALS AND METHODS: Twenty children aged 4 years old with sound, complete primary dentition participated in this crossover study. The quantity of biofilm was evaluated using the bacterial plaque revealer Plaque Test (Vivadent) before and after toothbrushing by the mother or dentist for 1 minute per arch. This was done at two separate appointments, one week apart, with one type of toothbrush at the first and the other type at the second appointment. The Green & Vermillion index (1960) was used for smooth surfaces and Rodrigues et al (1999) indexes for the occlusal surfaces. Data were submitted to analysis of variance. RESULTS: A statistically significant difference was observed on biofilm removal on occlusal and smooth surfaces, regardless of the toothbrush used or who performed the brushing (P < 0.0001). The triple-headed toothbrush showed a better performance than the conventional one on smooth and occlusal surfaces when the mother had brushed the teeth. The conventional toothbrush showed a better performance only on occlusal surfaces when the dentist performed the brushing (P < 0.0001). The dentist removed significantly more biofilm than the mother, 76% and 53%, respectively (P < 0.0001). CONCLUSION: It was concluded that effective biofilm removal was achieved with both toothbrushes; however, the tripleheaded type had a better performance on surfaces when the mother brushed the teeth. The dentist removed more biofilm than the mother.

Eficácia da escova dental convencional e de cabeça tripla na remoção do biofilme dental em crianças / The cleaning efficiency of a conventional and a triple-headed toothbrush in children

Objetivo: Comparar a eficácia de duas escovas na remoção de biofilme dental utilizadas por crianças de quatro anos de idade. Métodos: As escovas dentais convencional (Bitufo® 22, Bitufo, Itupeva, Brasil) e de cabeça tripla (DenTrust®, Dental HealthWay Inc., Newport, EUA) foram utilizadas por 20 crianças previamente treinadas para realizarem a escovação pelo tempo de um minuto em cada arco. A eficácia de cada escova foi avaliada pela quantidade de biofilme dental presente nas superfícies dentárias antes e após a escovação, evidenciada com o uso do corante fluorescente (Plaque Test® Vivadent, Ivoclar Vivadent AG, Schaan, Principado de Liechtenstein) e categorizada pela utilização dos índices de Rodrigues et al.1 para superfícies lisas e de Greene & Vermillion2 para superfícies oclusais. Os dados foram submetidos à Análise de Variância, Teste de Tukey e Kruskal-Wallis (?=0,05).Resultados: Independente da escova utilizada houve redução dos escores na quantidade de biofilme presente nas superfícies dentárias (p=0,000). Considerando somente as superfícies oclusais, não foram encontradas diferenças estatísticas significativas entre as escovas. Entretanto, a escova tripla apresentou melhor desempenho na remoção de biofilme nas superfícies lisas (p<0,05) principalmente nas faces linguais/palatinas (p<0,0001). Na região anterior do arco não houve diferença entre as escovas e na região posterior a escova tripla também proporcionou maior redução de biofilme em comparação à escova convencional (p<0,0001). Conclusão: Com base nos resultados, concluiu-se que as duas escovas avaliadas foram efetivas na remoção de biofilme dental, contudo que a escova de cabeça tripla apresentou desempenho superior.

Objective: The objective of this study was to compare the efficacy of bacterial plaque removal with conventional (Bitufo® 22, Bitufo, Itupeva, Brazil) and triple-headed (DenTrust®, Dental HealthWay Inc., Newport, USA) toothbrushes. Methods: Twenty children aged 4 years old participated in this crossed study, with weekly intervals. The quantity of biofilm was evaluated before and after toothbrushing by children for 1 minute each arch. A fluorescent light-cured bacterial plaque revealer (Plaque Test® Vivadent, Ivoclar Vivadent AG, Schaan, Principality of Liechtenstein) was used to report Greene and Vermillion1 index for free smooth surfaces, and Rodrigues et al.2 index for occlusal surfaces. Data were submitted to ANOVA. Results: In spide of the employed toothbrush, there was statistically significant difference on plaque removal between smooth or occlusal surfaces (p=0.000). The triple-headed and the conventional type cleaned occlusal surfaces similarly. However, the triple-headed toothbrush removed more plaque on buccal surface than the conventional type (p<0.05). The triple-headed toothbrush removed more plaque on the buccal surface (p<0.0001). The conventional and the triple-headed promoted a similar plaque removal both in anterior buccal areas. The triple-headed toothbrush was more effective than the conventional type on the posterior area (p<0.0001). Conclusion: It was concluded that effective plaque removal was achieved by the children with both toothbrushes; however the triple-headed toothbrush had a better performance.

Variability in the proportion of components of iodoform-based Guedes-Pinto paste mixed by dental students and pediatric dentists.

OBJECTIVE: Guedes-Pinto paste (GPP) is an iodoform paste used in most dental schools in Brazil. The paste is a composite of medicines (Rifocort , camphorated paramonochlorophenol [PMCC], and iodoform) used for endodontic treatment of primary teeth. The aim of this study was to evaluate the proportion variability of GPP components when mixed by undergraduate dentistry students and pediatric dentists. MATERIALS AND METHODS: The study was divided into 4 groups: G1 (15 undergraduate students), G2 (15 specialists in Pediatric Dentistry), G3 (15 professors with clinical activity), and G4 (7 professors-researchers). All volunteers prepared GPP according to the original specifications: the same visual proportion for each component. The components were weighed using an analytical balance and the percentage was calculated. RESULT: After normality (Kolmogorov-Smirnov) and homogeneity tests (Levene test), the data were submitted to analysis of variance and intraclass correlation coefficient tests (P<0.05). The percentage means of each respective group were as follows: Rifocort 20.2%, 20.8%, 26.7%, 27.3%; camphorated PMCC 9.2%, 8.1%, 6.7%, 5.1%; and the iodoform 70.6%, 71.1%, 64.7%, 67.6%. There were no significant differences between groups for the component percentages. There was a high intraclass correlation coefficient (G1 0.945; G2 0.951; G3 0.921; and G4 0.870). CONCLUSION: The proportion of GPP was similar in all the groups, allowing us to conclude that ideal GPP proportion, based on the entire group mean, was 23.8% of Rifocort® ; 7.0% of camphorated PMCC; and 69.2% of iodoform.

Uso da fluxometria laser doppler em dentes decíduos traumatizados / Use of laser Doppler flowmetry in traumatized primary teeth

A necrose pulpar apresenta-se como uma sequela de difícil diagnóstico em dentes decíduos traumatizados e, muitas vezes, somente é detectada após o aparecimento de sinais como fístula, lesão periapical e reabsorção inflamatória externa. Os dados provenientes da anamnese, dos exames clínicos intra-bucal e radiográfico são limitados. Para melhorar esse diagnóstico, sugere-se a utilização de testes objetivos e não invasivos que avaliem a circulação sanguínea. O objetivo deste artigo foi apresentar um caso clínico que utilizou a Fluxometria Laser Doppler para auxiliar no diagnóstico de necrose pulpar do dente 51, em uma criança de 4 anos e 2 meses de idade atendida no Centro de Atendimento e Pesquisa de Traumatismos em Dentes Decíduos da Disciplina de Odontopediatria da Faculdade de Odontologia da Universidade de São Paulo. O dente 51 não apresentava sinais clínicos de necrose pulpar. O aparelho utilizado foi o Fluxômetro Laser Doppler (Moor Instruments, Axminster, Inglaterra), modelo moorLAB, com diodo laser emitindo no comprimento de onda de 780nm, potência de 1mW, banda Doppler fixada em 15kHz. Para o dente 51, foi obtido valor de fluxo de 2,1UA e o valor da variação percentual entre o dente 51 e 52 foi de 40,4%. Estes valores classificam o dente como desvitalizado. Assim sendo, foi possível realizar o diagnóstico de necrose pulpar utilizando a Fluxometria Laser Doppler como método auxiliar sem que houvesse sinais clínicos evidentes dessa sequela.

The diagnosis of pulp necrosis in traumatized primary teeth is difficult. Pulp necrosis is usually detected after signs like fistula, periapical radiolucency and inflammatory root resorption appear. Data from anamnesis and clinical and radiographic examinations are limited. In order to improve diagnosis, the use of objective and noninvasive tests that assess blood flow has been suggested. The aim of this article was to present a clinical case where laser Doppler flowmetry was used to aid the diagnosis of pulp necrosis in the upper right central incisor (tooth 51) of a child aged 4 years and 2 months seen at the Pediatric Dental Trauma Research Center of the Pediatric Department of FOUSP. Tooth 51 presented no clinical sign of pulp necrosis. The laser Doppler flowmeter (Moor Instruments, Axminster, England) model moorLAB was used with a 780 nm diode laser, cut-off frequency of 15 kHz and intensity of 1mW. The flow value of tooth 51 was 2.1UA and the percentage variation between teeth 51 and 52 was 40.4%. These values classify the tooth as devitalized. Therefore, it was possible to obtain a diagnosis of pulp necrosis using laser Doppler flowmetry in a tooth without evident clinical signs of this sequela.

Reabilitação de dentes decíduos anteriores com o uso de pinos de fibra de vidro / Rehabilitation of primary anterior teeth using glass fiber core post

A destruição de dentes decíduos anteriores pode ocasionar diversas consequências, como a perda da dimensão vertical, redução da capacidade mastigatória, desvio no padrão de deglutição, distúrbios fonéticos, instalação de hábitos bucais nocivos, comprometimento estético e alterações emocionais na criança. Muitos são os recursos protéticos que o profissional pode lançar mão para restabelecer o equilíbrio perdido e devolver a estética ao paciente. O objetivo deste trabalho é relatar o caso clínico de um paciente de 2 anos e 3 meses de idade que apresentava grande destruição nos incisivos superiores, cuja reabilitação foi realizada com pinos de fibra de vidro e restaurações em resina composta. O uso de pinos de fibra de vidro e restaurações com resina composta é uma alternativa de fácil execução, com bons resultados estéticos e funcionais, podendo ser indicada para a reconstrução de dentes decíduos anteriores com grande destruição.

Destruction of primary anterior teeth may result in loss of vertical dimension, reduced masticatory efficiency, speech disturbances and development of parafunctional oral habits and psychological problems. There are many options to repair severely destroyed primary anterior teeth in order to reestablishing function, shape, and esthetics. The purpose of this report is to demonstrate the rehabilitation of severely destroyed primary incisors in a 27-month-old patient using fiber core posts. It was verified that fiber core post and restorations in composite resin are easily executed and indicated for in severely decayed primary anterior teeth with satisfactory aesthetic and functional results.

Técnica de microabrasão do esmalte em dentes decíduos / Enamel microabrasion technique in deciduos teeth

A técnica da microabrasão tem sido utilizada como alternativa de tratamento para remoção de diferentes tipos de alterações superficiais do esmalte por ser um método conservador. A microabrasão do esmalte melhora a estética do dente, pois devolve o brilho e a lisura superficial, sem perda significante de estrutura, desde que seja indicado adequadamente. É um método seguro, que pode ser utilizado inclusive em crianças pequenas, desde que medidas de segurança para olhos e tecidos moles sejam aplicadas. O objetivo deste trabalho é descrever a técnica de microabrasão com dois materiais, o ácido fosfórico gel a 37% misturado com pedra pomes e o OpalustreR (Ultradent Products Inc.), e abordar alguns cuidados que devem ser observados durante a aplicação.