Intracanal dressing and root canal filling materials in tooth replantation: a literature review.

The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth.

Calcium hydroxide mixed with camphoric p-monochlorophenol or chlorhexidine in delayed tooth replantation.

This study evaluated the repair process after delayed replantation of rat teeth, using calcium hydroxide (Ca(OH)2) mixed with camphorated p-monochlorophenol (CMCP), chlorhexidine 2% (CHX), or saline as temporary root canal dressing to prevent and/or control inflammatory radicular resorption. Thirty Wistar rats (Rattus norvegicus albinos) had their right upper incisor extracted, which was bench-dried for 60 minutes. The dental papilla, the enamel organ, the dental pulp, and the periodontal ligament were removed. The teeth were immersed in 2% acidulated-phosphate sodium fluoride solution for 10 minutes. The root canals were dried with absorbent paper cones and divided into 3 groups of 10 animals according to root canal dressing used: group 1: Ca(OH)2 + saline, group 2: Ca(OH)2 + CMCP, and group 3: Ca(OH)2 + CHX 2%. Before replanting, the teeth sockets were irrigated with saline. Histological analysis revealed the presence of inflammatory resorption, replacement resorption, and ankylosis in all 3 groups. Statistical analysis showed a significant difference between group 3 and the other groups. The use of Ca(OH)2 mixed with CMCP or CHX did not show an advantage over the use of Ca(OH)2 mixed with saline in preventing and/or controlling inflammatory resorption in delayed replantation of rat teeth.

Uncommon crown-root fracture treated with adhesive tooth fragment reattachment: 7 years of follow-up.

Crown-root fractures account for 5% of all fractures in permanent teeth and can involve enamel, dentin, and cementum. Depending on whether there is pulpal involvement, these problems may be classified as complicated (which are more common) or noncomplicated. The treatment depends on the level of the fracture line, root length and/or morphology, and esthetic needs. Several treatment strategies are available for esthetic and functional rehabilitation in crown-root fractures. Adhesive tooth fragment reattachment is the most conservative restorative option when the tooth fragment is available and the biological width has no or minimal violation. This article reports a case of an uncomplicated crown-root fracture in the permanent maxillary right central incisor of a young patient who received treatment with adhesive tooth fragment reattachment, preserving the anatomic characteristics of the fractured tooth after periodontal intervention. The fracture line of the fragment had an unusual shape, starting on the palatal side and extending to the buccal side subgingivally. After 7 years, the attached coronal fragment remained in position with good esthetics, as well as clinical and radiographic signs of pulpal vitality, periodontal health, and root integrity, thus indicating success.

Treatment of traumatic dental intrusion by surgical repositioning.

The prevalence of dental trauma and its consequences are challenging. This article presents a clinical case of a 9-year-old female who was in a bicycling accident and had a dental intrusion of the left maxillary lateral incisor with extensive dislocation. In the emergency department, surgical repositioning of the intruded tooth and a splinting with steel wire and composite resin was performed and the soft-tissue lesions were sutured. Two weeks after the first visit, pulp necrosis was found and endodontic treatment of the intruded tooth was started with a calcium hydroxide dressing. Despite the traumatic nature of the dental injury, the result of treatment was favorable. After 3 years of follow-up, repair of the resorptions and no signs of ankylosis of the teeth involved were evident. Considering the patient's age and the extent of intrusion, it was concluded that surgical repositioning associated with adequate endodontic therapy was an effective alternative treatment for this case.

Resolution of a titanium implant fracture after a recurrent trauma.

Post-traumatic complications occasionally lead to tooth loss as well as the need for future implants. However, rehabilitation with endosseous osseointegrated implants does not protect the patient from the risk of suffering a new trauma. Implant fracture and the damage of the hexagon are post-traumatic complications that guide the clinician to preparing a more intricate treatment plan. The authors present a clinical case of a recurrent trauma of maxillary implant fracture. The treatment plan was to remove the implants followed by autogenous bone grafting to correct the defect. Two titanium implants were replaced, followed by connective tissue graft after allowing complete the healing process of the bone graft to occur. In the postoperative period of 6 months, satisfactory results have been shown as regards soft and hard tissues wound healing.

Crown and crown-root fractures: an evaluation of the treatment plans for management proposed by 154 specialists in restorative dentistry.

Traumatic tooth injuries involve function and aesthetics and cause damage that range from minimal enamel loss to complex fractures involving the pulp tissue and even loss of the tooth crown. Technical knowledge and clinical experience are essential to establish an accurate diagnosis and provide a rational treatment. The purpose of this study was to evaluate the knowledge of Restorative Dentistry specialists about the management of crown and crown-root fractures based on treatment plans proposed by these professionals for these cases. A descriptive questionnaire was mailed to 245 Restorative Dentistry specialists with questions referring to their professional profile and the treatment plans they would propose for the management of crown and crow-root fractures resulting from dental trauma. One hundred and fifty-four questionnaires were returned properly filled. The data were subjected to descriptive statistics and the chi-square test was used to determine the frequency and the level of the significance among the variables. The analysis of data showed that in spite of having a specialist title, all interviewees had great difficulty in planning the treatments. As much as 42.8% of the participants were unable to treat all types of dental trauma. Complicated and uncomplicated crown-root fractures posed the greatest difficulties for the dentists to establish adequate treatment plans because these fractures require multidisciplinary knowledge and approach for a correct case planning and prognosis.

Clinical evaluation of the association of noncarious cervical lesions, parafunctional habits, and TMD diagnosis.

OBJECTIVE: To verify a potential association between the presence of noncarious cervical lesions, parafunctional habits, and temporomandibular disorder (TMD) diagnosis. METHOD AND MATERIALS: Sample-size calculation provided a value of 130 participants with a confidence level of 95% and an error margin of 5%. A population of 132 volunteers (30 men: mean age, 23.7 ± 3.05 years; 102 women: mean age, 24.9 ± 5.86 years) underwent an oral examination and was interviewed by a trained dentist. The following parameters were registered: personal details, TMD diagnosis, parafunctional habits, and noncarious cervical lesion presence. The population was then divided into a noncarious cervical lesion group and a control group and subjected to the t test, chi-square test, Fisher exact test, and Spearman correlation (α = .05). RESULTS: Noncarious cervical lesions were present in 39% of the population, with the largest concentrations found in the maxillary premolars (32%). The data showed a significant association between noncarious cervical lesion presence, tooth clenching (P = .03), and nail biting (P = .02), as well as a relation with TMD diagnosis (Fonseca Index [P = .01] and Research Diagnostic Criteria for TMD (RDC/TMD) [P = .004] ). In the noncarious cervical lesion group, direct rank correlation was found between maxillary premolars and clenching (P = .03), mandibular canines and nail biting (P = .05), and mandibular incisors and parafunctional habits without dental contacts (P = .02). CONCLUSION: Parafunctional habits and TMD presence should be taken into account in the diagnosis and treatment plan of noncarious cervical lesions.

Análise do processo de reparo no reimplante tardio de dente de rato após curativo de demora com hidróxido de cálcio associado ao paramonoclorofenol canforado ou à clorexidina / Analysis of the repair process in the delayed replanting of rat teeth after application of calcium hydroxide, associated with camphoric p-monochlorophenol or chlorhexidine

O prognóstico do reimplante dentário tardio está vinculado à necessidade do tratamento endodôntico uma vez que a necrose pulpar tem uma relação direta com o surgimento da reabsorção radicular externa do tipo inflamatória. Muitas pesquisas têm sido realizadas com o objetivo de se prevenir, retardar ou tratar essa complicação e o hidróxido de cálcio é a substância mais empregada devido às suas propriedades antimicrobiana e reparadora tecidual. O objetivo do trabalho é avaliar o processo de reparo no reimplante tardio de dentes de rato, utilizando o hidróxido de cálcio (Ca(OH)2) associado ao paramonoclorofenol canforado (PMCC) ou à clorexidina (CHX) como curativo de demora em relação ao Ca(OH)2 associado ao soro fisiológico na prevenção e/ou controle da reabsorção radicular inflamatória. Trinta ratos (Rattus norvegicus albinus) machos, divididos em 3 grupos de 10 animais, tiveram o incisivo direito extraído e mantido em meio seco por 60 minutos. Em seguida, a papila dentária, o órgão do esmalte, a polpa dentária e o ligamento periodontal foram removidos. Os dentes foram imersos em solução de fluoreto de sódio fosfato acidulado a 2% pH 5,5, por 10 minutos. Após esse procedimento, os canais foram secos com cone de papel absorvente e divididos em 3 grupos, de acordo com o curativo de demora empregado: Grupo I: canais radiculares preenchidos com pasta de Ca(OH)2 e soro fisiológico, Grupo II: com pasta de Ca(OH)2 e PMCC e Grupo III: com pasta de Ca(OH)2 e solução de CHX 2%. Os alvéolos foram irrigados com soro fisiológico e os dentes reimplantados. A análise histológica mostrou presença de reabsorção inflamatória, por substituição e anquilose nos três grupos e a análise estatística mostrou diferença estatisticamente significante entre o grupo III e os demais grupos experimentais com relação à porcentagem de dentina reabsorvida. Diante dos resultados concluiu-se que a associação do Ca(OH)2 com o PMCC ou à CHX não apresentou vantagens em relação à pasta de Ca(OH)2 e...

The prognosis of delayed tooth replantation is linked to the need of endodontic treatment, once that necrotic pulp has a direct relationship with the rise of inflammatory external root resorption. Much research has been conducted with the objective of preventing or treating this complication and calcium hydroxide is the most commonly used substance because of its antimicrobial and tissue repairing properties. The aim of this study is to evaluate the repair process of the delayed teeth replantation in rat, treated with calcium hydroxide (Ca(OH)2) associated with camphorated p-monochlorophenol (CMCP) or chlorhexidine 2 % (CHX), and Ca(OH)2 in saline solution as temporization dressing to prevent and/or control inflammatory resorption. Thirty rats (Rattus norvegicus albinos) had extracted the right incisor and that was kept in a dry state for 60 minutes. Subsequently, the dental papilla, the enamel organ, the dental pulp and periodontal ligament were removed. The teeth were immersed in a solution of sodium fluoride acidulated 2% pH 5.5 for 10 minutes. After this procedure, the canals were dried with absorbent paper cone and divided into 3 groups, of 10 animals of which, according to the dressing: Group I: root canals filled with Ca(OH)2 and saline solution, Group II: with Ca(OH)2 and CMCP and Group III: with Ca(OH)2 and CHX 2%. The teeth sockets were irrigated with saline solution and the teeth were replanted. While histological analysis revealed the presence of inflammatory resorption, ankylosis and replacement in all three groups, statistical analysis showed a significant difference between group III and other groups. Departing from these results, it was concluded that the association between the use of Ca(OH)2 with PMCC or CHX did not show an advantage over the use of Ca(OH) 2 paste and saline solution to prevent and/or control the inflammatory root reabsorption in delayed replantation of rat teeth

Reconstrução da pirâmide nasal com prótese / Reconstruction of nasal pyramid with prosthesis

Os autores descrevem uma técnica de confecção de prótese nasal, em que o modelo do nariz do paciente, antes da perda, serviu como base para a escultura e modelagem desse órgão. O método proposto facilita sessões clínicas e viabiliza uma reprodução mais próxima à fisionomia do paciente.

Consideraçöes sobre o exame clínico integrado / Considerations on integrated clinical examination

O objetivo deste trabalho é discutir a importância do exame inicial do paciente como fator determinante para sucesso do tratamento odontológico. Säo sugeridas atitudes e técnicas capazes de direcionar o exame clínico inicial a um diagnóstico correto, que assegure maior probabilidade de sucesso para os planos de tratamento propostos

Estudo da pasta de metronidazol, lidocaína e ascorbosilane C sobre o processo de reparo de alvéolos dentais infectados em ratos / Effect of metronidazole, lidocaine and ascorbosilane C paste on delayed healing of wound extraction in rats

O processo de reparo do alvéolo infectado de ratos foi avaliado após a limpeza cirúrgica e irrigaçäo com soro fisiológico, seguida do preenchimento da loja com uma pasta composta por metronidazol, lidocaína e ascorbosilane C. Para tanto, foram extraídos os incisivos centrais superiores direitos de todos os animais e provocada alveolite naqueles dos grupos 2 (alveolite sem tratamento) e 3 (alveolite tratada). No Grupo 1, foi analisado o reparo normal. Os animais, em número de cinco em cada grupo, foram sacrificados aos seis, 15 e 28 dias pós-operatórios e as peças obtidas processadas para análise histológica. Com base nos resultados, foi possível concluir que a pasta constituída por metronidazol a 10 por cento, lidocaína a 2 por cento, carboximetilcelulose, menta e ascorbosilane C a 5 por cento näo interferiu na cronologia normal do processo de reparo em alvéolos dentais infectados de ratos, evidenciando comportamento similar àquele apresentado pelo Grupo Controle

A opinião do Cirurgião-Dentista sobre a clínica integrada / The dentists opinion about integrated clinic

A disciplina de Clínica Integrada, pela sua natureza didático-pedagógica, desempenha um papel fundamental na formação do cirurgião-dentista. O objetivo deste trabalho e discutir a sua importancia na formacao do cirurgiao-dentista clinico geral. Para tanto, um ofício expondo os objetivos da pesquisa e um questionário, com questões abertas e fechadas, foram enviadas pelo correio para um total de 1.000 cirurgiões-dentistas. Dos questionários enviados 46,8 por cento foram respondidos. Os profissionais relatam que os casos clínicos atendidos na disciplina simularam a realidade da rotina da profissão (94,8 por cento), que foi capaz de formar um clínico geral (80,6 por cento) e contribui para a adaptação ao mercado de trabalho (92,31 por cento). Com base nestes achados foi possível concluirque a disciplina de clínica integrada forma um cirurgião-dentista clinico geral, simula a prática profissional e contribui para a adaptação desses profissionais ao mercado de trabalho