Periodontal outcomes of surgically exposed and orthodontically aligned buccally impacted maxillary canines: A systematic review and meta-analysis.

OBJECTIVE: To compare the periodontal outcomes of surgically exposed and orthodontically aligned buccally impacted maxillary canines to spontaneously erupted maxillary canines. DATA SOURCES: An unrestricted search was carried out of indexed databases (Medline, EMBASE, Web of Science and Scopus), reference lists of included studies, and grey literature published until December 2023. DATA SELECTION: Observational and experimental studies that addressed the focused question 'Do periodontal outcomes of buccally impacted maxillary canines that were surgically exposed and subsequently extruded and aligned using orthodontic alignment, differ from those of spontaneously erupted maxillary canines?' were included. DATA EXTRACTION: Study screening, selection and data extraction were performed independently by two authors, with disagreement resolved by a third reviewer. The risk of bias was assessed using the JBI Critical Appraisal Checklist and GRADE approach. RESULTS: A total of 857 citations were found and five studies were eligible for inclusion. Supragingival plaque accumulation and gingival inflammation were similar between impacted canines and their contralaterals in most studies. Meta-analyses revealed no significant differences in keratinised tissue width (prospective studies: MD = -0.28, 95% confidence interval [CI] = -1.13-0.56, I² = 78%; retrospective studies: MD = 0.61, 95% CI = -1.51-2.72, I² = 94%). However, a meta-analysis of prospective studies showed slightly greater mean probing depth for impacted canines compared to their contralateral canines (prospective studies: MD = 0.16, 95% CI = 0.04-0.28, I² = 0%). The evidence certainty for keratinised tissue width and probing depth outcomes was low. CONCLUSION: Surgically exposed and orthodontically aligned buccally impacted canines have slightly greater probing depths, potential bone loss and increased clinical crown length, compared to their counterparts. However, these small differences (<1 mm) are unlikely to be clinically significant.

Manejo de extrusión forzada ortodóntica: Reporte de un caso / Management and Follow-up of Orthodontic Forced Extrusion: A Case Report

El presente caso clínico se enfoca en el diagnóstico y el tratamiento de erupción forzada en un paciente con trauma dental. Objetivo: Proponer una alternativa de tratamiento multidisciplinario el cual permita incrementar estructura dentaria a través de la extrusión forzada y posteriormente rehabilitarlo en función y estética. Métodos: Se describe el caso de un paciente adulto de 78 años de sexo masculino, sano y sin antecedentes patológicos, acude a la clínica de la Especialidad de Ortodoncia y Ortopedia Dentomaxilo facial, referido por un especialista en Endodoncia, debido a fractura corono-radicular de canino superior derecho, pilar de puente fijo de tres unidades En la exploración intraoral presenta fractura cervical de la corona del canino superior derecho. Como primer paso, se realizó tratamiento endodóntico en la pieza dentaria y colocación de un aditamento intraconducto de soporte (endoposte vaciado), con el objeto de mejorar la tracción ortodóntica. Este aditamento consistió en un poste colado con perforaciones. Se procede a colocar aparatología fija en la arcada superior con técnica MBT (slot 0.022), del molar derecho hasta el canino izquierdo de cementado indirecto y pasivo (con los slots de los brackets alineados). Inmediatamente después, se colocó un arco rectangular 0.019 x 0.025 de acero inoxidable con un doblez de extrusión a nivel del canino superior derecho. En el mismo doblez, se adaptó un loop tipo helix que funcionó como apoyo para colocar la ligadura pasiva (lace back). Resultados : El tratamiento realizado en este paciente es satisfactorio, coadyuvando en su estado de salud general mejorando su autoestima. Conclusión: Aquí se aprovecharon todas las ventajas que ofrece la extrusión ortodóntica forzada, incluso en un paciente adulto mayor, logrando una tracción de cuatro milímetros, que se consiguió gracias al empleo de fuerzas extrusivas ligeras y controladas sobre el órgano dentario afectado. Con la modalidad de tratamiento descrita se puede lograr un alargamiento de corona sin la necesidad de realizar una resección ósea, lo que permite una correcta rehabilitación protésica, devolviendo la función y estética al diente lesionado y brindando un beneficio integral al paciente.

The case of an adult patient with a complicated Crown fracture of the right upper canine due to trauma is reported, diagnosing a class VII Ellis coronal fracture. There are several treatment alternatives that range from the extraction, placement of a bone graft and placement of an implant, to a forced root extrusión with bone removal to allow the biological space and subsequently be restored. In the present case, a multidisciplinary orthodontic forced extrusion treatment is performed, which allows to increase the amount of clinical remnant, preserving the periodontal support and maintaining the biologic thickness, thus achieving to maintain the root remnant with good length so that prosthetic rehabilitation is facilitated. The clinical and radiographic follow-up was 12 months. The multidisciplinary treatment involved: Root canal treatment, forced extrusion with orthodontics, fibrotomy with root planing and fixed prosthesis.

Extrusive, Intrusive Luxation and Avulsion in a 7-Year- Old Child: one year of Clinical, Radiographic and Tomographic Follow-Up / Luxación Extrusiva e Intrusiva y Avulsión en un Niño de Siete Años de Edad: un año de Seguimiento Clínico, Radiográfico y Tomográfico

Dental trauma is a serious injury that occurs frequently in children and adolescents, requiring urgent dental care. The upper central incisors are the most vulnerable teeth to such traumatic injuries, which can lead to bite restrictions, difficulties in phonation and esthetical questions. The aim of this study was to report the success of a conserva tive approach carried out on a 7-year-old patient, victim of multiple dental trauma, involving permanent and deciduous teeth. The male patient fell from his own height, causing soft tissue lacerations and dento-alveolar traumatism in both deciduous and permanent teeth. Complementary examinations (periapical radiographs and computed tomography) were carried out. Based on the diagnoses the patient was referred to specialists for appropriate treatment. The present report highlights the importanc e of an early diagnosis, suitable treatment and follow-up of patients after an alveoli-dental trauma and shows the direct relationship of this approach with the prognosis of the patient and the tooth.

El trauma dentario es una lesión grave que ocurre con frecuencia en niños y adolescentes y requiere atención dental urgente. Los incisivos centrales superiores son las piezas dentarias más vulnerables a dichos traumas, pudiendo generar restricciones en la mordida, la fonación y a nivel estético. El objetivo de este estudio fue reportar el éxito de un enfoque conservador llevado a cabo en un niño de 7 años de edad, víctima de un trauma dentario múltiple, que involucró tanto dientes temporales como permanentes. El paciente masculino, cayó desde su propia altura, causando laceraciones en los tejidos blandos y traumatismo dento- alveolar en piezas de ambas denticiones. Se llevaron a cabo exámenes complementarios (radiografías periapicales y tomografía computarizada). Basado en el diagnóstico, el paciente fue referido a especialistas para realizar el tratamiento apropiado. El presente reporte destaca la importancia de un diagnóstico precoz, un tratamiento adecuado y el seguimiento de los pacientes luego de un trauma dento-alveolar, y cómo este enfoque muestra relación directa con el pronóstico del paciente y del diente.

Orthodontic treatment after intrusive dislocation and fracture of the maxillary central incisors.

The treatment for intrusive dislocation is a clinical challenge and must be started soon after the intrusion injury. The affected tooth or teeth must be extruded by using light forces. This case report of traumatic intrusion of permanent central incisors aims to describe and discuss the process of repositioning the teeth in the dental arch. After a domestic accident, a 10-year-2-month-old boy suffered 11-mm intrusion of the maxillary central incisors along with enamel-dentin fracture and subluxation of the maxillary lateral incisors. Treatment started 2 days after the incident with an orthodontic extrusion of the maxillary central incisors with a fixed edgewise standard appliance. Orthodontic arches were used, and the force vectors were directed to the desired locations for the repositioning of the teeth. The treatment for extrusion and stabilization of the maxillary central incisors lasted 5 months and 22 days. Orthodontic traction with a fixed appliance is an effective procedure for the extrusion of both permanent maxillary central incisors intruded after trauma. Correct diagnosis, a short period between the trauma and the beginning of treatment, and appropriate mechanics were determining factors for a successful treatment.

Método de extrusión dentaria unitaria con fines protésicos: caso clínico / Single tooth extrusion method for prosthetic purposes: a clinical case

La pérdida de estructura dentaria por debajo del margen gingival y de la cresta ósea alveolar, ya sea por caries, fracturas traumáticas, desgaste, reabsorción radicular o perforaciones iatrogénicas, dificulta el tratamiento protésico y requiere un abordaje multidisciplinario para conseguir resultados óptimos y estables a largo plazo. Se presenta el caso de una paciente adulta que acude a consulta con la pieza 2.3, que no permite una adecuada restauración protésica sin invadir el espacio biológico. Dentro del abanico de posibilidades terapéuticas se selecciona la extrusión dentaria unitaria guiada, para poder exponer un remanente dentario adecuado supragingival, y conseguir un adecuado efecto ferrule para la posterior rehabilitación protésica. La técnica presentada es eficaz, simple, cómoda, higiénica y útil en pacientes que no desean realizarse tratamiento de ortodoncia en ambas arcadas (AU)

Avaliação dos efeitos da movimentação dentária induzida sobre molares de ratos submetidos à luxação extrusiva / Evaluation of the effects of induced tooth movement on rat molars submitted to extrusive dislocation

A luxação extrusiva é caracterizada pela separação parcial ou total entre raiz e ligamento periodontal (LPD), podendo causar danos ao cemento por meio da compressão radicular contra o osso alveolar, além da ruptura do feixe vásculonervoso apical. A movimentação dentária induzida (MDI) é uma resposta de caráter inflamatório do conjunto LPD e osso alveolar, mesmas estruturas envolvidas na luxação extrusiva, a um estímulo provocado por uma força ortodôntica. Uma informação escassa na literatura é o efeito provocado pela movimentação dentária induzida em dentes que foram submetidos à luxação extrusiva (LE). O objetivo deste trabalho foi avaliar o efeito da movimentação dentária induzida sobre dentes submetidos à luxação extrusiva. Para a realização deste pesquisa, foram utilizados 40 ratos machos Wistar divididos em 4 grupos: o grupo controle (GC); o grupo Luxação Extrusiva (LE); o grupo Movimentação Dentária Induzida (MDI); e o grupo LEMDI. A LE foi exercida por uma força de 1.500Cn e a MDI por uma força de 50Cn por um período de 7 dias, após o qual os animais foram eutanasiados, as peças submetidas ao processamento laboratorial e obtidas lâminas que foram coradas por meio de hematoxilina e eosina. Foi realizada uma análise descritiva considerando-se quatro áreas ao redor da raiz mésio-vestibular: A1 região da crista óssea mesial, A2 região médio- cervical da face mesial, A3 região médio-apical da face distal e A4 região cervical da face. Em cada uma destas áreas foram observados os evento: reabsorção óssea frontal e à distância, reabsorção radicular, infiltrado infamatório e hemoragia no LPD.Os resultados mostraram que a associação entre MDI e LE provocou grande destruição óssea na crista óssea na A1, moderadas reabsorções radiculares na A3, ausência de infiltrado inflamatório em todas as áreas e hemorragia exuberante do LPD nas áreas 2 e 3. Nos demais grupos, tais observações foram ausentes ou quando presentes consideradas muito discretas. Conclui-se que, uma vez que a MDI em dentes submetidos a LE aumenta as áreas de hemorragia no LPD, provoca grande perda óssea frontal na crista alveolar, a MDI deveria ser interrompida, aguardando-se o período de reparo do LPD(AU)

Extrusive dislocation is characterized by partial or complete separation of the root and periodontal ligament (PDL), which can cause damage to the cementum by compressing the root against the alveolar bone, and rupture of the apical nervevascular bundle. Induced tooth movement (ITM) is an inflammatory response of the whole of the SMP and alveolar bone, the same structures involved in extrusive dislocation, to a stimulus caused by an orthodontic force. Little information is available in the literature on the effect caused by induced tooth movement in teeth that underwent extrusive luxation (EL). The aim of this study was to evaluate the effect of induced tooth movement on teeth submitted to extrusive dislocation. For this research 40 male Wistar rats were used, divided into 4 groups: The control group (CG); the Extrusive luxation group (EL); the Induced Tooth Movement group (ITM); and the LEMDI group. The LE was exerted by a force of 1,500Cn and the ITM by a force of 50Cn for a period of 7 days, after which the animals were euthanized, the specimens were submitted to laboratory processing and slides were obtained and stained using hematoxylin and eosin. A descriptive analysis was performed considering four areas around the mesial vestibular root: A1 mesial bone crest region, A2 mesial face midcervical region, A3 distal face mid-apical region and A4 face cervical region. In each of these areas the following events were observed: frontal and distal bone resorption, root resorption, infamatory infiltrate and hemorrhagia in the PDL. The results showed that the association between MDI and LE caused great bone destruction in the bone crest in A1, moderate root resorption in A3, absence of inflammatory infiltrate in all areas, and exuberant hemorrhage of the PDL in areas 2 and 3. In the other groups, such observations were absent or when present considered very discrete. We conclude that, since ITM in teeth submitted to EL increases the areas of hemorrhage in the PDL, causes great frontal bone loss in the alveolar ridge, ITM should be interrupted, waiting for the period of repair of the PDL(AU)

Reto multidisciplinario ante fractura vertical / Multidisciplinary challenge in a patient with a vertical fracture

Resumen Introducción: La extrusión rápida ortodóntica puede usarse como alternativa para evitar extraer una pieza fracturada que no podría ser restaurada por trauma, caries extensas, problemas periodontales (dos o tres paredes), dientes con reabsorción interna y dientes con perforaciones endodónticas. Objetivo: De este caso clínico es presentar a todos los odontólogos una solución sencilla de tratamiento integral de un paciente el cual sufrió un trauma facial, causándole una fractura vertical a nivel del tercio medio radicular del incisivo central superior derecho. Método: Mediante una extrusión ortodóntica, retratamiento endodóntico y abordaje periodontal, de manera que facilite la futura rehabilitación con corona completa. El resultado de este procedimiento se logró con mucho éxito gracias a que concluimos que se trató en forma multidisciplinaria, en donde cada especialidad actúa o interviene en un momento preciso. Conclusiones: La extrusión rápida es un procedimiento en el cual una pieza que ha sufrido una fractura radicular a nivel marginal puede ser tratada sin necesidad de realizar un alargamiento de corona comprometiendo así el nivel del hueso de la pieza.

Abstract Introduction: Rapid dental orthodontic extrusion may be used as an alternative to avoid the extraction of fractured teeth that might not be suitable for restauration because od trauma, extensive cavities, periodontal problems (two or three walls), teeth with internal resorption, or with endodontical perforations. Objective: Of this clinical case is to present to all dentists a simple solution of integral treatment of a patient who suffered trauma to his face causing a vertical fracture at the level of the middle third root of the right upper central incisor. Methods: Used in this case was through orthodontic extrusion, endodontic retreatment and periodontal approach, so as to facilitate future rehabilitation with a full crown. The result of this procedure was achieved with great success because we conclude that it was treated in a multidisciplinary way, where each specialty intervenes at a precise moment. Conclusions: Rapid extrusion is a procedure in which a tooth that shows a radicular fracture close to it´s margin may be treated without dental crown lengthening that would risk bone level.

Apical extrusion of bacteria following the use of reciprocating single-file and rotary multi-file instrumentation systems in oval root canals / Extrusão apical de bactérias após o uso de sistemas alternativos de instrumentação de arquivo único e rotativo de arquivo múltiplo em canais radiculares ovais

Objective: All instrumentation techniques and instruments are associated with apical extrusion during chemomechanical preparation, and this causes postoperative pain and flare-up. However, it is controversial whether reciprocal systems or rotary systems cause more apical extrusion. The objective of this in vitro study was to determine the differences in the amounts of apically extruded bacteria (AEB) associated with nickel-titanium rotary and reciprocating systems when used in oval-shaped root canals. Material and Methods: Seventy human mandibular premolar teeth with oval-shaped canals were randomly assigned to four experimental groups (15 teeth in each group) and one control group (10 teeth). The root canals were contaminated with Enterococcus faecalis and instrumented using two full-sequence rotary instruments (ProTaper Universal [PTU] and ProTaper Next [PTN]) and two reciprocating single-file instruments (Reciproc [R] and WaveOne [WO]). A 0.9% NaCl solution was used as an irrigant, and the bacterial extrusion was quantified as the number of colony-forming units for each sample. The results were statistically analyzed using the Kruskal-Wallis one-way analysis of variance and the Mann-Whitney U test, and the statistical significance level was set at p < 0.05. Results: The R system was associated with the highest amount of bacterial extrusion (p < 0.05). The PTU system caused more bacterial extrusion than the PTN and WO systems (p < 0.05). There was no significant difference between the PTN and WO systems (p > 0.05). Conclusions: All instrumentation techniques caused apical bacterial extrusion. The instrument design and preparation techniques affect the number of extruded bacteria (AU)

Objetivo: Todas as técnicas e instrumentos de instrumentação estão associados à extrusão apical durante o preparo quimomecânico, o que causa dor e surto no pós-operatório. No entanto, é controverso se sistemas recíprocos ou rotativos causam extrusão mais apical. O objetivo deste estudo in vitro foi determinar as diferenças na quantidade de bactérias apicalmente extrudadas (AEB) associadas aos sistemas rotativo e alternativo de níquel-titânio quando usadas em canais radiculares em forma oval. Material e Métodos: Setenta dentes pré-molares inferiores humanos com canais em forma oval foram divididos aleatoriamente em quatro grupos experimentais (15 dentes em cada grupo) e um grupo controle (10 dentes). Os canais radiculares foram contaminados com Enterococcus faecalise instrumentados usando dois instrumentos rotativos de seqüência completa (ProTaper Universal [PTU] e ProTaper Next [PTN]) e dois instrumentos alternativos de arquivo único (Reciproc [R] e WaveOne [WO]). Uma solução de NaCl a 0,9% foi usada como irrigante e a extrusão bacteriana foi quantificada como o número de unidades formadoras de colônias para cada amostra. Os resultados foram analisados estatisticamente usando a análise de variância unidirecional de Kruskal-Wallis e o teste U de Mann-Whitney, e o nível de significância estatística foi estabelecido em p < 0,05. Resultados: O sistema R foi associado à maior quantidade de extrusão bacteriana (p < 0,05). O sistema PTU causou mais extrusão bacteriana que os sistemas PTN e WO (p < 0,05). Não houve diferença significativa entre os sistemas PTN e WO (p > 0,05). Conclusões: Todas as técnicas de instrumentação causaram extrusão bacteriana apical. O desenho do instrumento e as técnica (AU)

Impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes en usuarios de las Unidades Comunitarias de Salud Familiar Sociedad, Morazán y periférica San Vicente, en el año 2018 / Impact on the quality of life as a result of the mortality of permanent teeth in users of the Community Units of Family Health Society, Morazán and San Vicente peripheral, in 2018

Conocer el Impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes de los usuarios atendidos en las Unidades Comunitarias de Salud Familiar Sociedad, Morazán y Periférica, San Vicente en el año 2018. Metodología: estudio de tipo descriptivo, observacional y transversal desarrollado en usuarios de las Unidades Comunitarias de Salud Familiar (UCSF)Sociedad, Morazán y Periférica, San Vicente, en donde se realizó una investigación con una muestra de 288 pacientes de 15 a 60 años o más. Se utilizó una guía de observación, para completar variables sociodemográficas del paciente y luego una entrevista para conocer el impacto en la calidad de vida por la mortalidad dental. Los datos fueron analizados en el programa SPSS versión 23. Resultados: El 78.46% de la población en estudio presenta un bajo nivel educativo. El promedio de pérdida dental de la población en estudio es de 8ndientes. Las principales alteraciones clínicas y funcionales derivadas de la pérdida de dientes fueron las mesializaciones, distalizaciones y extrusiones dentales. Se reporta un efecto global del índice OIDP de 38.48±2.539 muy ligero. El 60% de los usuarios presenta mortalidad dental en maxilar y el 78% en la mandíbula sin ser restituidos protésicamente. Conclusiones: Pese a la presencia muy notoria de alteraciones por mortalidad dental, la autopercepción que los usuarios tienen respecto a la gravedad que representan, repercute mínimamente en el desempeño de sus labores diarias.

To know the Impact on the quality of life as a consequence of the mortality of permanent teeth of the users treated in the Community Units of Family Health Society, Morazán and Peripheral, San Vicente in 2018. Methodology: descriptive, observational and cross-sectional study developed in users of the Community Family Health Units Society. Morazán and Peripheral, San Vicente, where an investigation was carried out with a sample of 288 patients aged 15 to 60 years or more. An observation guide was used to complete the general data of the patient and sociodemographic variables, and then, an interview to find out the impact on quality of life due to dental mortality. The data was analyzed in the SPSS program, version 23. Results: The 78.46% of the population studied have a low level of education. The dental loss average of the entire population is 8 teeth. The main clinical and functional alterations derived from tooth loss were mesializations, distalizations and dental extrusions. A global effect of the OIDP index of 38.48 ± 2,539 has a very slight reported. 60% of user's present dental mortality in the maxilla and 78% in the mandible without being prosthetically restored. Conclusions: Despite the very notorious presence of dental mortality alterations, due to dental mortality, the self-perception that users have regarding the severity they represent, minimally affects the performance of their daily tasks.

Quantitative evaluation of debris extruded apically using reciprocating versus continuous rotation single file with rotary and hand glide path file

Chemomechanical root canal preparation (CMRCP) is an important step in root canal treatment. However, one of its negative consequences is apical extrusion of debris of the root canal system contributing to treatment failure and flare-ups. Glide path preparation (GPP) is the initial phase of CMRCP and is crucial for assessing root canal anatomy and establishing unobstructed access to the apical part of the canal. Materials and methods: Forty human mandibular permanent central and lateral incisors were selected; the debris collection apparatus was prepared and the teeth were then divided into four groups: Group 1: Rotary glide path preparation with ProGlider followed by instrumentation with Wave One files. Group 2: Rotary glide path preparation with ProGlider followed by instrumentation with One Shape files. Group 3: Hand glide path preparation with K-file followed by instrumentation with Wave One files. Group 4: Hand glide path preparation with K-file followed by instrumentation with One Shape files. The collected debris was weighed in an analytical digital balance and the collected data were statistically analyzed. Results: No significant difference was present between groups with the same method of glide path preparation or between Wave One and One Shape files. Rotary glide path preparation produced less debris than hand preparation (p≤0.05). Conclusions: Extrusion of debris was observed in all test groups. Rotary glide path preparation could be preferred in clinical practice as it is associated with less debris extrusion than the manual method.

Orthodontic traction of impacted canines: Concepts and clinical application.

Orthodontic traction of impacted canines stands as a major challenge for Orthodontics. It is a relatively frequent clinical complaint which management, more often than not, requires a multidisciplinary approach. Surgical exposure of the impacted canine, and the complex orthodontic mechanics applied to align the tooth back into the arch, may frequently lead to complications involving supporting tissues, not to mention the long treatment time and high costs imposed to patients. In face of that, it is worth highlighting the relevance of early diagnosis as to intervene efficiently and as soon as possible. This paper presents a review of the main concepts involving prevalence, etiology and classification of impacted canines, and describes the different clinical management options that would help solve the problem. It illustrates the topic by presenting a treatment delivered to a 13 year 7 months old male patient, suffering from a Class II, division 2, left subdivision, malocclusion, associated to a deep bite and a prolonged retention of a primary upper canine caused by the impaction of the permanent tooth. Corrective orthodontic therapy was associated to a rapid maxillary expansion and to the use of a high pull headgear. Impacted canine was submitted to orthodontic traction and correctly positioned back into the arch. This approach proved to be efficient in meeting both functional and aesthetic goals.

Orthodontic traction of impacted canines: Concepts and clinical application

ABSTRACT Orthodontic traction of impacted canines stands as a major challenge for Orthodontics. It is a relatively frequent clinical complaint which management, more often than not, requires a multidisciplinary approach. Surgical exposure of the impacted canine, and the complex orthodontic mechanics applied to align the tooth back into the arch, may frequently lead to complications involving supporting tissues, not to mention the long treatment time and high costs imposed to patients. In face of that, it is worth highlighting the relevance of early diagnosis as to intervene efficiently and as soon as possible. This paper presents a review of the main concepts involving prevalence, etiology and classification of impacted canines, and describes the different clinical management options that would help solve the problem. It illustrates the topic by presenting a treatment delivered to a 13 year 7 months old male patient, suffering from a Class II, division 2, left subdivision, malocclusion, associated to a deep bite and a prolonged retention of a primary upper canine caused by the impaction of the permanent tooth. Corrective orthodontic therapy was associated to a rapid maxillary expansion and to the use of a high pull headgear. Impacted canine was submitted to orthodontic traction and correctly positioned back into the arch. This approach proved to be efficient in meeting both functional and aesthetic goals.

RESUMO O tracionamento de caninos impactados representa um dos grandes desafios da Ortodontia. Trata-se de um problema clínico relativamente frequente, cujo tratamento muitas vezes requer uma abordagem multidisciplinar. A exposição cirúrgica do canino impactado e a complexa mecânica ortodôntica aplicada para alinhar o dente na respectiva arcada podem, com frequência, levar a complicações nos tecidos de suporte, sem mencionar o longo tempo de tratamento e os custos elevados para o paciente. Por isso, vale a pena ressaltar a importância dos diagnósticos precoces, para que a interceptação do problema seja feita o mais cedo possível e de maneira eficaz. O presente trabalho apresenta uma revisão dos principais conceitos envolvendo a prevalência, etiologia e classificação dos caninos impactados, e descreve os vários tipos de abordagem clínica para a resolução do problema. Ao final, ilustra o tema com a apresentação de um tratamento realizado em um paciente de 13 anos e 7 meses de idade, portador de má oclusão de Classe II, divisão 2, subdivisão esquerda, associado a mordida profunda, que apresentava retenção prolongada de um canino superior decíduo, devido à impacção de seu sucessor permanente. O tratamento ortodôntico corretivo foi associado à expansão rápida de maxila e ao uso de aparelho extrabucal de tração cervical. O canino impactado foi tracionado ortodonticamente e posicionado corretamente na arcada. Essa abordagem foi eficiente para atingir as metas funcionais e estéticas propostas.

Reabilitação dentária anterior através da extrusão ortodôntica lenta e instalação de implante com provisionalização imediata ­ relato de caso / Anterior dental rehabilitation through slow orthodontic extrusion and implant installation with immediate prosthesis ­ case report

A remoção de um elemento dentário resulta em reabsorção óssea alveolar como consequência do processo natural de reparação, sobretudo, em região anterior. Essa reabsorção pode limitar ou até comprometer a reabilitação estética e funcional do dente perdido. Diante da previsibilidade das mudanças ocorridas no pós-extração, tem-se considerado cada vez mais a modalidade de reabilitação no mesmo instante da remoção do dente comprometido. Em casos específicos de recessão gengival e perda óssea vestibular, na presença de raiz remanescente, a Ortodontia exerce papel fundamental na adequação dos tecidos da região acometida, pois possibilita alterar a posição do osso alveolar e margem gengival, aumentando o potencial estético do caso. O objetivo desse trabalho foi demonstrar as etapas clínicas de um caso de extrusão ortodôntica lenta com o objetivo de neoformação óssea na região apical e reposicionamento coronal dos tecidos ósseo e gengival para instalação de implante imediatamente após a extração, seguido da colocação de coroa provisória imediata (AU).

Removal of a dental element results in alveolar bone resorption as a consequence of the natural repair process, especially in anterior region. This resorption may limit or even compromise the aesthetic and functional rehabilitation of the lost tooth. In view of the predictability of changes in post-extraction, the rehabilitation modality has been increasingly considered at the same time as the removal of the involved tooth. In specific cases of gingival recession and vestibular bone loss, in the presence of remaining root, orthodontics plays a fundamental role in the adequacy of the tissues of the affected region, since it allows altering the position of the alveolar bone and gingival margin, increasing the aesthetic potential of the case. The objective of this study was to demonstrate the clinical stages of a slow orthodontic extrusion with the objective of bone neoformation in the apical region and coronal repositioning of the bone and gingival tissues to implant the implant immediately after the extraction, followed by the placement of an immediate provisional crown (AU).

Impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes en usuarios de las unidades comunitarias de salud familiar de San Rafael Obrajuelo, La Laguna y Juayúa en el año 2018 / Impact on the quality of life as a consequence of the mortality of permanent teeth in users of the community health units of San Rafael Obrajuelo, La Laguna and Juayúa in 2018

Objetivo: Conocer el impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes. Metodología: El diseño corresponde a un estudio descriptivo, observacional y transversal; con un universo de 432 individuos, a quienes se les realizó una entrevista donde se hizo uso del índice Oral Impacts on Daily Performances (OIDP) para determinar la percepción que tienen de su salud oral relacionada con la pérdida dental. Posteriormente, se realizó un examen clínico donde se registraron dientes perdidos, mesializaciones, distalizaciones, extrusiones, ruidos articulares y uso de prótesis. Los datos fueron analizados con el programa Statistical Package for the Social Sciences (SPSS) versión 25. Se utilizó pruebas de chi-cuadrado para asociación de variables. Resultados: El promedio de pérdida dental aumentó a partir de los 34 años, siendo los mayores de 60 años los más afectados. El nivel educativo que predominó fue Primaria (28.93%). Las alteraciones clínicas más comunes fueron las mesializaciones (56.72%). La actividad diaria más afectada tras la pérdida dental fue comer y disfrutar de los alimentos (51.39%). El promedio global del OIDP resultó de 22.78 (±1.49), clasificando a la población con un nivel de calidad de vida de Sin efecto/Muy ligero. Conclusiones: Independientemente del número de dientes perdidos, la presencia de alteraciones clínicas o funcionales y las variables sociodemográficas, el nivel de calidad de vida más prevalente fue Sin efecto/Muy ligero, encontrándose diferencias significativas entre la pérdida dental y la calidad de vida (p=.000). Palabras clave: Calidad de vida, OIDP, mortalidad dental, mesializaciones, distalizaciones, extrusiones, ruidos articulares.

Objective: To know the impact on quality of life as a result of the mortality of permanent teeth. Methodology: The design corresponds to a descriptive, observational and crosssectional study with a universe of 432 individuals, who were interviewed using the Oral Impacts on Daily Performances (OIDP) index to determine their oral health perceptions of tooth loss. Subsequently, a clinical examination was performed where missing teeth, mesializations, distalizations, extrusions, joint noises and use of prostheses were recorded. The data was analyzed with the Statistical Package for the Social Sciences (SPSS) version 25 program. Chi-square tests were used for variable association. Results: The average tooth loss increased from the age of 34, with the over-60s being the most affected. The level of education that prevailed was Primary (28.93%). The most common clinical alterations were mesializations (56.72%). The most affected daily activity after tooth loss was eating and enjoying food (51.39%). The overall average for OIDP was 22.78 (±1.49), classifying the population with a quality of life level of No effect/Very light. Conclusions: Regardless of the number of missing teeth, the presence of clinical or functional alterations and sociodemographic variables, the most prevalent quality of life level was No Effect/Very light, with significant differences found between tooth loss and quality of life (p=.000).

Impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes en usuarios de las unidades comunitarias de salud familiar Cuscatancingo, Nejapa y San Ramón, 2018 / Impact on the quality of life as a consequence of the mortality of permanent teeth in users of the community health units Cuscatancingo, Nejapa and San Ramón, 2018

Objetivo: Conocer el impacto en la calidad de vida a consecuencia de la mortalidad de dientes permanentes de los usuarios de las UCSF de Cuscatancingo, Nejapa y San Ramón en el año 2018. Metodología: El estudio es descriptivo, observacional, trasversal; el cual se realizó en usuarios de tres UCSF durante el año 2018, en un total de 432 pacientes; seleccionados en base a los criterios establecidos. Para la obtención de datos se hizo mediante un instrumento compuesto por cédula de entrevista y guía de observación. El procesamiento y tabulación de los datos se realizó con el programa SPSS versión 25 mediante la prueba estadística del x2. Resultados: el estudio permitió caracterizar a la población según edad y sexo, así mismo determinó que la mortalidad dental presenta una tendencia ascendente con respecto a la edad notando un salto evidente a los 60 años. En cuanto a las principales alteraciones clínicas y funcionales las más prevalentes fueron: extrusiones (65.50%) y mesializaciones (59.25%), por otra parte, se identificó que el 60.87% de los pacientes se encuentran en un efecto global de OIDP de ligero a moderado. Además, al evaluar el estado protésico se encontró que en el maxilar superior (81.01%) y maxilar inferior (83.56%) no presentaban ningún tipo de prótesis. Conclusiones: existe asociación entre la mortalidad de dientes permanentes y la calidad de vida, sin embargo el sexo del paciente, el nivel educativo y la calidad de vida no se encontraron asociados

Objective: To know the impact on quality of life as a result of the mortality of permanent teeth of UCSF users of Cuscatancingo, Nejapa, and San Ramon in 2018. Methodology: The study is descriptive, observational, and transversal. It was performed on users od three UCSFs during 2018, in a total of 432 patients selected on the basis of established criteria. Data collection was done by means of an instrument composed of interview card and observation guide. The processing and, tabulation of the data was carried out with the SPSS version 25 program using the statistical test of X. Results: The study allowes to characterize the population by age and gender and it determined that dental mortality has an upward trend with respect to age noticing an obvious jump at 60 years. As for the main clinical and functional alterations, the most prevalent were: extrusions (65.50%) and mesializations (59.25%). On the other hand, 60.87% of patients were identified as having a light to moderate overall OIDP effect. In addition, when assessing the prosthetic state, it was found that in the upper jaw (81.01%) and lower jaw (83.56%) they didn´t have any kind of prosthetics. Conclusions: there is an association between permanent tooth mortality and quality of life, however patient gender, educational level and quality of life were not found associated.

Extrusión: una alternativa de tratamiento de la fractura corono-radicular / Extrusion: an alternative for the treatment of crown-root fracture

La extrusión dentaria o erupción forzada es una opción de tratamiento con enormes ventajas cuando nos vemos obligados a tratar fracturas corono-radiculares. Se define como el movimiento en dirección coronal a través de la aplicación de fuerzas ligeras y continuas para provocar cambios en los tejidos blandos y hueso. La extrusión dental forzada amplía las alternativas en cuanto a la rehabilitación futura del paciente, ya que se puede optar por la restauración periférica total con anclaje del resto radicular, o bien por la exodoncia posterior a la extrusión, con la consecuente mejoría de las condiciones del tejido óseo para una posterior rehabilitación implanto-asistida. Presentación de caso clínico, pieza dentaria 2.2 con fractura corono-radicular en la cual se realizó tratamiento de erupción forzada y rehabilitación protésica (AU)

Extrusion or forced eruption es a treatment option with enormous advantages when we are forced to treat crown-root fractures. It is defined as the movement in the coronal direction through the application of light and continuous forces to cause changes in the soft tissues and bone. Forced dental extrusion expands the alternatives regarding the future rehabilitation of the patient, since it is possible to choose either total peripheral restoration with anchoring of the radicular rest of the post-extrusion extraction, with the consequent improvement of bone tissue conditions for subsequent implant-assissted rehabilitation. Presentation of a case report: tooth 2.2 with a crown-root fracture in which forced eruption and prosthetic rehabilitation were performed (AU)

Mandibular Incisor Impaction: A Rare Condition.

The purpose of this case report is to present the management of an impacted permanent mandibular left central incisor using a removable appliance. A minor surgery was done to expose the tooth crown and bond an orthodontic button. The removable appliance was used to apply extrusion forces to the impacted tooth. Over a course of six months, the tooth was fully erupted. To recover the lost space of the primary canine, a fixed appliance was bonded on the mandibular arch and retention was placed until the permanent canine erupted. This report demonstrates the importance of early diagnosis and interceptive treatment in cases of tooth impaction.

Avaliação da capacidade de limpeza e biocompatibilidade de diferentes soluções irrigadoras utilizadas em Endodontia / Evaluation of the cleaning capacity and biocompatibility of different irrigation solutions used in Endodontics

Os objetivos deste estudo foram: Artigo 1 ­ Analisar a extrusão apical de hipoclorito de sódio (NaOCl), debris e sua citotoxicidade após o preparo dos canais radiculares utilizando NaOCl líquido ou gel. Artigo 2- avaliar a dissolução de matéria orgânica do NaOCl líquido e gel, e a limpeza das paredes dentinárias após a instrumentação; Métodos: Artigo 1 - A avaliação da extrusão apical de NaOCl e debris foi feita pela espectrofotometria do conteúdo extruído após o preparo biomecânico. A citotoxicidade foi avaliada pela resposta de culturas celulares de fibroblastos de ligamento periodontal (PDFL) frente as soluções irrigadoras extruídas, pelo teste XTT para análise da viabilidade celular. Para isso, oitenta dentes foram instrumentados com limas Reciproc #25 e #40 (VDW Munique, Alemanha) e utilizado NaOCl gel e líquido ativados por ultrassom. Os dados foram analisados estatisticamente pelo teste de ANOVA e as diferenças estatísticas pelo teste de Tukey e Dunn (p<0,05). Artigo 2 - A dissolução de matéria orgânica foi realizada usando cubos de carne com tamanho e peso determinado, os quais foram deixados em contato com 1 mL das amostras dos seguintes grupos: NaOCl gel 3% (ChlorCid V); NaOCl gel 3%(VIM); NaOCl líquido 2,5%; NaOCl líquido 5,25%; Solução fisiológica estéril (SF) (controle) por um período de 3 min, os fragmentos foram removidos e pesados novamente para quantificar a matéria orgânica não dissolvida. A comprovação da limpeza das paredes dos canais foi avaliada através do MEV e da estereomicroscopia para isso, oitenta dentes foram instrumentados com limas Reciproc #25 e #40 (VDW Munique, Alemanha) e utilizado NaOCl líquido e gel ativados por ultrassom. Os dados foram analisados estatisticamente pelo teste de ANOVA e as diferenças estatísticas pelo teste de Tukey (p<0,05); Resultados: Artigo 1 ­ A extrusão apical de hipoclorito ocorreu em todos os grupos, sento estatisticamente significante ao controle de SF. O grupo NaOCl 5,25 % foi o que teve a maior quantidade de hipoclorito nas amostras (4,76 µL) e o NaOCl gel 3% VIM a menor extrusão (2,32 µL) sendo estatisticamente significante. Quando comparado os grupos de NaOCl gel 3%, o VIM teve menor quantidade de hipoclorito nas amostras, comparado ao CV, com relevância estatística. A extrusão apical de debris esteve presente em todos os grupos, sendo maior no grupo da SF, porém não houve diferença estatística entre os grupos. Quanto a citotoxicidade, todos os grupos foram citotóxicos estatisticamente quando comparado ao controle (SF); O NaOCl 5,25% foi o mais citotóxico perante todos os grupos. O NaOCl 2,5% foi o menos citotóxico comparado ao NaOCl 5,25% e o NaOCl gel 3%VIM, sendo estatisticamente significante; Artigo 2- O NaOCl Liq 5,25 % foi o que mais dissolveu matéria orgânica comparado aos demais grupos, sendo estatisticamente significante. Todos os grupos contendo NaOCl foram estatisticamente eficientes em dissolução tecidual comparado ao grupo controle (SF). A avaliação da limpeza das paredes radiculares feita por MEV mostrou melhor eficiência no grupo do NaOCl 5,25% e pior resultado no grupo do NaOCl gel 3% VIM, com menor porcentagem de túbulos dentinários abertos. Conclusão: Artigo 1- Houve a extrusão apical de debris e hipoclorito em todos os grupos experimentais após a instrumentação. Sendo o NaOCl 5,25% o grupo com a maior extrusão de hipoclorito e o grupo do NaOCl gel 3% VIM o com menor extrusão apical comparado aos demais grupos. O NaOCl 5,25% foi o mais citotóxico para os fibroblastos, e o NaOCl 2,5% foi o menos citototóxico, sendo recomendado o seu uso no tratamento endodôntico; Artigo 2 ­ O NaOCl 5,25% foi o grupo com maior capacidade de dissolução tecidual e limpeza das paredes dentinarias, seguido pelo grupo NaOCl gel 3% CV.(AU)

The objectives of this study were: Article 1 - Analyze the apical sodium hypochlorite (NaOCl) extrusion, debris and it´s cytotoxicity after the root canals preparation using liquid or gel NaOCl. Article 2 - Evaluate the tissue dissolution of NaOCl liquid and gel, and it´s cleaning efficiency of dentin walls after instrumentation; Methods: Article 1 - The evaluation of the apical extrusion of NaOCl and debris was done by the spectrophotometry of the extruded contents after the biomechanical preparation. Cytotoxicity was evaluated by the cell cultures response of periodontal ligament fibroblasts (PDFL) against extruded irrigation solutions by the XTT test for cell viability analysis. For this, eight teeth were instrumented with Reciproc # 25 and # 40 files (VDW Munich, Germany) and used NaOCl gel and liquid activated by ultrasound. Data were analyzed statistically by the ANOVA test and the statistical differences by the Tukey and Dunn test (p <0.05). Article 2 - The dissolution of organic matter was carried out using meat cubes of determined size and weight, which were left in contact with 1 mL of samples from the following groups: NaOCl gel 3% (ChlorCid V); NaOCL gel 3% (VIM); NaOCl liquid 2.5%; NaOCl liquid 5.25%; Sterile physiological solution (SP) (control) for a period of 3 min, the fragments were removed and weighed again to quantify the undissolved organic matter. The verification of the cleansing of the canal walls was evaluated through the SEM and the stereomicroscopy for this, eight teeths were instrumented with Reciproc # 25 and # 40 files (VDW Munich, Germany) and used NaOCl gel and liquid activated by ultrasound. Data were analyzed statistically by the ANOVA test and statistical differences by the Tukey test (p <0.05); Results: Article 1 ­ Hypochlorite apical extrusion occurred in all groups, and was statistically significant at SP control. The NaOCl 5.25% group had the highest amount of hypochlorite in the samples (4.76 µL) and the NaOCl gel 3% VIM the lowest extrusion (2.32 µL) was statistically significant. When compared to the 3% NaOCl gel groups, the VIM had lower amount of hypochlorite in the samples, compared to the CV, with statistical relevance. Apical extrusion of debris was present in all groups, being higher in the SP group, but there was no statistical difference between the groups. As for cytotoxicity, all groups were statistically cytotoxic when compared to control (SP); NaOCl 5.25% was the most cytotoxic in all groups. 2.5% NaOCl was the least cytotoxic compared to NaOCl 5.25% and NaOCl 3% VIM gel, being statistically significant; Article 2 -The NaOCl Liq 5.25% was the one that dissolved organic matter more compared to the other groups, being statistically significant. All groups containing NaOCl were statistically efficient in tissue dissolution compared to the control group (SP). The SEM evaluation showed a better efficiency in the NaOCl 5.25% group and a worse result in the NaOCl gel group 3% VIM, with a lower percentage of open dentinal tubules. Conclusion: Article 1 - There was the apical extrusion of debris and hypochlorite in all experimental groups after instrumentation. The NaOCl 5.25% group had the highest hypochlorite extrusion and the NaOCl 3% VIM group had the lowest apical extrusion compared to the other groups. NaOCl 5.25% was the most cytotoxic for fibroblasts, and 2.5% NaOCl was the least cytotoxic, being recommended for endodontic treatment; Article 2 - NaOCl 5.25% was the group with the greatest capacity for tissue dissolution and cleaning of the dentin walls, followed by the NaOCl group 2.5% (AU)

Extrusão ortodôntica de dentes condenados para reconstrução da arquitetura óssea tridimensional previamente à instalação de implantes osseointegrados ­ Análise crítica da literatura / Orthodontic extrusion of hopeless teeth for reconstruction of three-dimensional bone architeture prior to dental implant placement ­ a critical analysis of literature

Objetivo: o objetivo desta revisão sistemática foi investigar se a condição periodontal do defeito ao redor de dentes condenados à extração, por meio de extrusão ortodôntica para reconstrução da arquitetura óssea previamente à instalação de implantes, influencia a qualidade estética final. Material e métodos: estudos relatando extrusão ortodôntica para extração de dentes e posterior instalação de implantes, acompanhados por diferentes períodos após a instalação das próteses, foram considerados elegíveis. A busca por artigos, a extração de dados e a avaliação da estética foram realizadas por examinadores independentes. A condição periodontal inicial foi classificada em tipos, a partir das radiografias iniciais presentes nos estudos: I) sem perda óssea; II) até 75%; III) até 50%; IV) até 25%; ou V) menos de 25% de inserção remanescente. A fotografia final dos casos foi analisada de acordo com o índice de estética rosa (IER). Resultados: a busca no PubMed e Scopus resultou em 453 artigos, dois quais 394 foram excluídos pelo título e 41 por não atender aos critérios de inclusão, restando 18 artigos analisados. Não houve diferença estatisticamente significante no IER observado nos diferentes tipos de defeitos periodontais iniciais (Kruskal-Wallis, p=0,17). Conclusão: esses achados sugerem que a inserção residual existente previamente à extração de dentes por meio de extrusão ortodôntica não influencia a estética final do caso, devido à reconstrução dos tecidos gengival e ósseo, favorecendo o posicionamento ideal dos implantes.

Objective: the aim of this critical analysis of literature was to investigate if the periodontal status of defects surrounding hopeless teeth submitted to extraction by orthodontic extrusion prior to implant installation interfere at the final aesthetic outcome. Material and methods: studies describing this procedure followed by different periods after prosthesis installation were considered eligible. Search, data extraction and aesthetic evaluation were made by independent examiners. Inicial periodontal status was classified in types according inicial radiographs presented on studies: I) without bone loss; II) up to 75%; III) up to 50%; IV) up to 25%; or V) less than 25% remaining insertion. Cases' final photographs were evaluated according the pink aesthetics index (PAI). Results: the search in PubMed and Scopus resulted in 453 papers of which 394 were excluded by title and 41 for not fulfill the inclusion criteria, remaining 18 papers for analysis. No statistical significance difference on PAI was observed at different inicial periodontal defects (Kruskal-Wallis, p=0.17). Conclusion: these findings suggest that the residual insertion existent prior to tooth extraction through orthodontic extrusion do not influence the aesthetic outcome because of the reconstruction of the gingival and bone tissues, favoring an optimal site for implant positioning.