Effect of systemic antibiotic therapy on pulp repair following extrusive luxation and avulsion in a murine model: A histomorphological study.

BACKGROUND/AIM: The evidence for any benefit of systemic antibiotic therapy on pulp survival following extrusive luxation and avulsion is inconclusive. The aim of this study was to evaluate the effect of systemic antibiotic therapy with amoxycillin and tetracycline for 7 days on different aspects of dental pulp repair in a murine model. MATERIAL AND METHODS: The right maxillary incisor of 180 4 to 8-week-old male Wistar rats underwent extrusive luxation or avulsion. The animals were then treated with saline solution (control), tetracycline, or amoxicillin administered intra-gastrically for 7 days, and euthanized at 7, 15, and 30 days post-operatively. The layer of odontoblast cells, reparative dentin deposition, Hertwig's epithelial root sheath, pulp necrosis, and periapical inflammatory infiltrate were histomorphologically analyzed and scored. Mann-Whitney, Kruskal-Wallis, and Dunn tests were used to compare mean scores for the different procedures, treatments, and times (p ≤ .05). RESULTS: Significant differences were observed between luxated and avulsed teeth (p < .05). In luxated teeth, no differences were observed among treatments and times, except for more tertiary dentin deposition in the coronal third with the use of tetracycline compared with amoxicillin at 15 days (p < .05). In avulsed teeth, higher scores for the layer of odontoblast cells and lower scores for periapical inflammatory infiltrate at 7 days and pulp necrosis at 7 and 15 days were observed in the amoxicillin group compared to the saline and tetracycline groups (p < .05). At 30 days, however, no differences were observed among treatments. CONCLUSIONS: The use of systemic antibiotic therapy with tetracycline or amoxicillin for 7 days did not contribute to pulp repair following extrusive luxation or avulsion in rats. However, the results warrant further research into the use of amoxicillin for a more extended period of time in cases of avulsion.

Educational Impact of Notebook Covers on the Knowledge of Sixth-Grade Primary Pupils About Tooth Avulsion and Replantation: A Randomized Trial.

BACKGROUND: Tooth avulsion is a common cause of tooth loss. However, there is a significant lack of knowledge about dental trauma and the appropriate emergency procedures to handle these cases. AIM: The aim of this study was to evaluate the educational effect of notebook covers illustrated with figures and informative texts about tooth avulsion and replantation in sixth-grade primary school pupils. MATERIAL AND METHODS: Sixth-grade pupils of two public school participated in this study. An experimental group consisting of 134 pupils received notebook covers illustrated with figures and informative texts about tooth avulsion and replantation, while a control group of 108 pupils received notebooks with neutral covers. An assessment of the educational effects on pupils was performed after 9 months, with a standardized questionnaire normally used to evaluate dental trauma. Statistical analysis was conducted with SPSS 21.0 (α = .05) for group description and comparison using chi-square and Student t tests. RESULTS: Compared with the control group, the experimental group showed statistically significant improvements in correct meaning of dental trauma (38% vs. 58.2%); procedures to follow in the case of dental avulsion (2.8% vs. 70.9%); storing the avulsed tooth in milk (18.5% vs. 76.9%); general knowledge about dental anatomy (61.1% vs. 95.5%); and the ideal time for the tooth to remain outside the mouth prior to replantation (20.4% vs. 59.7%). CONCLUSION: The use of notebook covers illustrated with figures and informative texts about dental trauma led to a significant increase in the knowledge of schoolchildren about tooth avulsion, first aid, and replantation.

Calcific metamorphosis of pulp after extrusive luxation.

BACKGROUND/AIM: The literature on the pathogenesis of extrusive dental luxation has been focused on periodontal tissue responses, with little attention given to the pulp. The aim of this study was to evaluate the response of dental pulp of teeth following extrusive luxation in a rat model. MATERIAL AND METHODS: The maxillary right central incisors of 30 rats were extrusively luxated and repositioned after 5 minutes. The animals were euthanized after 7, 15, and 30 days to provide three groups: I, II, and III, respectively (n = 10). Histological sections were stained with H and E for histomorphometric analysis of the odontoblast layer, reparative dentin deposition, Hertwig's epithelial root sheath, pulp necrosis, and periapical inflammatory infiltrate. RESULTS: In most cases, new vascular formation occured in association with reparative dentin deposition on the root walls and within the pulp. In some cases, dentin deposition occupied the entire pulp space over time, with no other types of non-odontogenic hard tissues being observed. Pulp necrosis with the presence of periapical inflammatory infiltrate was also observed in a few cases. No statistical differences were observed among the studied groups. CONCLUSIONS: Following extrusive luxation, calcific metamorphosis of the pulp is very likely to occur.

Evaluation of cases of concussion and subluxation in the permanent dentition: a retrospective study.

Objectives This study evaluated the evolution of cases of concussion and subluxation through a retrospective study of 20 years. Material and Methods Were examined clinical and radiographic records of 1,309 patients who underwent treatment of dentoalveolar trauma in the discipline of Integrated Clinic of the School of Dentistry of Araçatuba, UNESP, of which we selected 137 whose patients had concussion and subluxation injuries, with average age of 23.3 (SD - 10.96). The variables collected were: gender, age, history of previous and actual trauma, treatments performed, the presence of necrotic pulp, and time elapsed until the same trauma. The concussion and subluxation groups were subjected to statistical analyses using the SPSS 16.0 version software (α=0.05), Chi-square, and t-tests. Results Of the 301 teeth involved, 49 (16.3%) suffered concussion and 252 (83.7%), subluxation, being the upper anterior teeth the most affected (75.1%) for both conditions. Subluxation and concussion traumas were more prevalent in men aged 10 to 20 years, most caused by cycling accidents (36.2%). There was a concomitant presence of crown fracture in 21% of cases of concussion and 34.7% of subluxation. Pulp necrosis was detected in 16.3% (concussion) and 27.1% (subluxation) (p=0.12), and most occurred within 6 months after the trauma (p=0.29). The pulp necrosis shows a positive correlation with motorcycle accidents (p=0.01), direct impact (p≤0.0001), crown fracture with pulp exposure (p≤0.0001), darkening of the crown (p=0.004) and spontaneous pain (p≤0.0001); and negative correlation with indirect impact (p≤0.0001). Conclusions Although concussion and subluxation traumas are considered of minor degrees, they must be monitored, since the possibility of pulp necrosis exists, and its early treatment favors a good prognosis.

Immediate tooth replantation: root canal filling for delayed initiation of endodontic treatment.

The aim of this study is to evaluate the action of paramonochlorophenol associated with Furacin followed by calcium hydroxide (CH) dressing in the control of inflammatory root resorption in cases of immediate tooth replantation with delayed endodontic treatment. A total of 28 incisors of 3 male dogs were extracted and replanted after 15 minutes, and randomly divided into 3 groups: Group I (n = 8) - endodontic treatment was performed before the extraction and replantation; Group II (n = 10) - endodontic treatment was performed 30 days after replantation and the root canal was filled with CH dressing; Group III (n = 10) - endodontic treatment was performed 30 days after replantation and root canals received temporary medication of paramonochlorophenol-Furacin followed by CH dressing. The animals were euthanized 90 days after replantation. The histomorphological events analyzed at the epithelial reattachment site were the intensity and extent of acute and chronic inflammatory processes, periodontal ligament (PDL) organization, the intensity and extent of acute and chronic inflammatory processes in the PDL space, root resorption, bone tissue, and ankylosis. Data were submitted to the Wilcoxon Signed Ranks Test for group comparison (α = 5%). In Groups I, II and III the periodontal ligament was regenerated and most of the resorption areas were repaired by newly formed cementum. The depth and extent of root resorption were significantly higher in Group II than in Group III. The use of paramonochlorophenol-furacin followed by CH dressing was more effective in controlling inflammatory root resorption after immediate tooth replantation.

Evaluation of cases of concussion and subluxation in the permanent dentition: a retrospective study

Abstract Objectives This study evaluated the evolution of cases of concussion and subluxation through a retrospective study of 20 years. Material and Methods Were examined clinical and radiographic records of 1,309 patients who underwent treatment of dentoalveolar trauma in the discipline of Integrated Clinic of the School of Dentistry of Araçatuba, UNESP, of which we selected 137 whose patients had concussion and subluxation injuries, with average age of 23.3 (SD - 10.96). The variables collected were: gender, age, history of previous and actual trauma, treatments performed, the presence of necrotic pulp, and time elapsed until the same trauma. The concussion and subluxation groups were subjected to statistical analyses using the SPSS 16.0 version software (α=0.05), Chi-square, and t-tests. Results Of the 301 teeth involved, 49 (16.3%) suffered concussion and 252 (83.7%), subluxation, being the upper anterior teeth the most affected (75.1%) for both conditions. Subluxation and concussion traumas were more prevalent in men aged 10 to 20 years, most caused by cycling accidents (36.2%). There was a concomitant presence of crown fracture in 21% of cases of concussion and 34.7% of subluxation. Pulp necrosis was detected in 16.3% (concussion) and 27.1% (subluxation) (p=0.12), and most occurred within 6 months after the trauma (p=0.29). The pulp necrosis shows a positive correlation with motorcycle accidents (p=0.01), direct impact (p≤0.0001), crown fracture with pulp exposure (p≤0.0001), darkening of the crown (p=0.004) and spontaneous pain (p≤0.0001); and negative correlation with indirect impact (p≤0.0001). Conclusions Although concussion and subluxation traumas are considered of minor degrees, they must be monitored, since the possibility of pulp necrosis exists, and its early treatment favors a good prognosis.

Immediate tooth replantation: root canal filling for delayed initiation of endodontic treatment

Abstract The aim of this study is to evaluate the action of paramonochlorophenol associated with Furacin followed by calcium hydroxide (CH) dressing in the control of inflammatory root resorption in cases of immediate tooth replantation with delayed endodontic treatment. A total of 28 incisors of 3 male dogs were extracted and replanted after 15 minutes, and randomly divided into 3 groups: Group I (n = 8) - endodontic treatment was performed before the extraction and replantation; Group II (n = 10) - endodontic treatment was performed 30 days after replantation and the root canal was filled with CH dressing; Group III (n = 10) - endodontic treatment was performed 30 days after replantation and root canals received temporary medication of paramonochlorophenol-Furacin followed by CH dressing. The animals were euthanized 90 days after replantation. The histomorphological events analyzed at the epithelial reattachment site were the intensity and extent of acute and chronic inflammatory processes, periodontal ligament (PDL) organization, the intensity and extent of acute and chronic inflammatory processes in the PDL space, root resorption, bone tissue, and ankylosis. Data were submitted to the Wilcoxon Signed Ranks Test for group comparison (α = 5%). In Groups I, II and III the periodontal ligament was regenerated and most of the resorption areas were repaired by newly formed cementum. The depth and extent of root resorption were significantly higher in Group II than in Group III. The use of paramonochlorophenol-furacin followed by CH dressing was more effective in controlling inflammatory root resorption after immediate tooth replantation.

The influence of traumatic occlusion on the repair process for teeth following subluxation.

BACKGROUND/AIM: Traumatic occlusion (TO) can cause morphofunctional alterations that interfere in the homeostasis of the periodontium. The aim of this study was to assess the influence of TO on the periodontal repair process for teeth following subluxation. MATERIALS AND METHODS: Ninety Wistar rats aged 12 weeks were divided into three groups: control (C), subluxation (S) and subluxation with traumatic occlusion (S+TO). Subluxation was created with an impact force of 900 cN applied by a tensiometer and TO was created with a direct composite resin filling. Healing after two experimental periods of 7 and 21 days was assessed histologically. The Kruskal-Wallis and Dunn post hoc tests were used for group comparison. RESULTS: At 7 days, there was a significant increase in periodontal ligament (PDL) width and amorphous fundamental substance, as well as a significant bone area reduction in groups S and S+TO. After 21 days, there was a significant PDL width increase in group S+TO, and in the percentage of collagen fibres in group S, whereas group S+TO showed a 52% bone area reduction compared to the same group at 7 days. Subluxation with or without TO caused only superficial root resorption. However, only group S+TO showed damage to the repair process of resorbed root areas after 21 days. CONCLUSION: TO can increase damage to the PDL after subluxation and it can also delay the repair process after PDL damage.

Uso de antibioticoterapia sistêmica após o reimplante de dentes permanentes avulsionados: uma revisão de literatura / Use of systemic antibiotic therapy after the replantation of avulsed permanent teeth: a literature review

Avulsão dentária é o tipo mais grave de traumatismo dentoalveolar, e o tratamento de escolha para esse tipo de lesão deve ser o reimplante do dente avulsionado. Após realizar uma revisão da literatura e promover discussões com pesquisadores experientes e especialistas clínicos de diferentes áreas, a Associação Internacional de Traumatologia Dentária (IADT) propôs um protocolo para o reimplante dentário com a recomendação de se usar a antibioticoterapia sistêmica (SAT) para reduzir o risco de ocorrência de reabsorção radicular. Diversos antibióticos foram testados, mas a tetraciclina e amoxicilina são, de longe, as drogas mais comumente usadas para lesões por avulsão. Este trabalho revisa a literatura sobre a prescrição de SAT em casos de reimplante imediato e tardio de dentes permanentes acidentalmente avulsionados, com base em uma análise crítica de artigos completos recuperados nos bancos de dados eletrônicos PubMed/Medline, Bireme e SciELO. Trabalhos de pesquisa original e revisões de literatura publicados em língua inglesa entre 1966 e 2016 e que contivessem alguma discussão sobre a relação entre antibioticoterapia e reimplante de dentes permanentes foram buscados por meio da utilização das palavras chave "avulsão dentária", "antibioticoterapia sistêmica" e "reimplante dentário". Observou-se que a prescrição de antibióticos para dentes reimplantados é um assunto controverso e que estudos clínicos randomizados são necessários para se estabelecer a real necessidade de se usarem antibióticos para o reimplante dentário. Até que os resultados desses estudos se tornem disponíveis, a recomendação é de se usar a SAT para o tratamento de dentes permanentes reimplantados após uma avulsão acidental. A melhor opção de prescrição é a tetraciclina durante 7 dias e a segunda melhor opção é a amoxicilina durante 4 a 7 dias

Dental avulsion is the most severe type of dentoalveolar trauma, and the treatment of choice for this type of injury should be the replantation of the exarticulated tooth. After conducting a review of the literature and holding discussions with experienced researchers and clinical specialists from different areas, the International Association of Dental Traumatology (IADT) proposed a protocol for tooth replantation, including a recommendation for systemic antibiotic therapy (SAT) to reduce the risk of root resorption. Several antibiotics have been tested, but tetracycline and amoxicillin are, by far, the most commonly used drugs for avulsion injuries. This paper reviews the literature on the prescription of SAT in cases of immediate and delayed replantation of accidentally avulsed permanent teeth, based on a critical analysis of full-length papers retrieved from the PubMed/Medline, Bireme and SciELO electronic databases. Original research reports and literature reviews published in English-language journals between 1966 and 2016, and directly or indirectly discussing the relation between antibiotic therapy and the replantation of permanent teeth, were searched using "tooth avulsion," "systemic antibiotic therapy" and "tooth replantation" as key words. The prescription of antibiotics for tooth replantation was found to be a controversial subject, and randomized clinical studies are needed to determine whether antibiotics for tooth replantation are actual indicated. Until the results of these studies become available, the recommendation is to use SAT for the management of permanent teeth replanted after an accidental avulsion. The best prescription option is tetracycline for 7 days, and the second best prescription option is amoxicillin for 4 to 7 days.

Effects of ovariectomy on periodontal tissues following tooth replantation.

OBJECTIVES: The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation by histomorphometric, immunohistochemistry, and µCT analysis. MATERIALS AND METHODS: Eighty wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups: ovariectomized (OVX) and Sham. Two months after surgery, the rats' upper right incisor was extracted followed by immediate reimplantation. The animals were sacrificed after 28, 45, and 60 days healing time. Histomorphometric and immunohistochemical analysis were performed by evaluation of PCNA and TRAP straining. RESULTS: The periodontal ligament was reinserted into the bone and cementum in the both groups. The immunohistochemical analysis revealed PCNA positive cells on the periodontal ligament in both groups at 28 days. Root resorption was noted at 45 days with immunoreactive cells for TRAP present in bone and tooth surface however no statistical differences between the groups were noticed. Histomorphometric analysis showed significant difference between groups in the periodontal ligament and root resorption parameters for the sub-items: intensity of chronic inflammatory infiltrate at 60 days (p<0.01), the organization of the periodontal ligament at 28 days (p<0.05), depth of root resorption at 45 days (p<0.05) and at 60 days (p<0.001). The µCT analysis showed multiple areas of bone resorption in association with OVX at 28 and 60 days with no significant differences between times in vivo. CONCLUSION: The ovariectomy did not have significant influence in periodontal tissue parameters following tooth reimplantation.

Immediate tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline.

OBJECTIVES: The aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in immediate rat tooth replantation. MATERIALS AND METHODS: Ninety rats had their incisors extracted and stored in saline for 5 min. Next, the teeth were replanted, and the animals were assigned to three groups according to the antibiotic administered by oral gavage: control group, amoxycillin group, and tetracycline group. Euthanasia was performed at 7, 15, and 30 days after replantation. RESULTS: Regardless of the evaluation period, the connective tissue underlying the epithelial attachment and the periodontal ligament showed statistically significant difference relative to the acute inflammatory infiltrate, which was more intense in the control group followed by the tetracycline group. CONCLUSION: These results point to the fact that systemic antibiotic therapy (SAT) in immediate tooth replantation is beneficial to pulpal and periodontal ligament repair and that amoxycillin is an excellent option. CLINICAL RELEVANCE: There is a lack of randomized studies assessing how the use of systemic antibiotics could influence tooth healing after immediate replantation.

Delayed tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline.

Systemic antibiotic therapy (SAT) has usually been recommended after tooth replantation, but its actual value has been questioned. As there are no reports in the literature about its influence on tooth replantation, the aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in delayed rat tooth replantation. Ninety Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and bench-dried for 60 min. The dental papilla, enamel organ, pulp tissue, and root surface-adhered periodontal ligament were removed, and the teeth were replanted. The animals received no antibiotics (n = 30) or were medicated systemically with amoxicillin (n = 30) and tetracycline (n = 30), and were euthanized after 7, 15, and 30 days. Regardless of the evaluation period, the acute inflammatory infiltrate was less intense and root resorption presented smaller extent and depth in the group treated with amoxicillin. The results suggest that SAT has a positive influence on the repair process in delayed tooth replantation and that amoxicillin is an excellent treatment option.

Replantation as treatment for extrusive luxation.

In the treatment of extrusive luxation cases, it is important that the repositioning of extruded tooth in the socket is done as soon as possible. If this does not occur, periapical clot becomes organized and makes replantation difficult reposition. In this article the patient referred to the Clinics for dental trauma sustaining extrusive luxation of the maxillary right central incisor. The patient reported having suffered a bicycle accident 12 days before, which caused traumatic tooth injuries. The repositioning was attempted without success and an alternative form of treatment was necessary to solve the case. Intentional tooth replantation, which is the deliberate extraction of the tooth and its replantation, was indicated. This technique allows clot removal and correct repositioning of the extruded tooth. Care should be taken as endodontic treatment is required for the prevention of subsequent infection-related resorption. Intracanal dressing with calcium hydroxide was used for 30 days before final root filling. Splint, systemic antibiotics and avoidance of further damage to the root surface is also important. After 49 months, showed clinical and radiographic characteristics of normality and demonstrates the availability of this technique to adversity in trauma.

Delayed tooth replantation following root canal filling with calcium hydroxide and MTA: Histomorphometric study in rats.

OBJECTIVE: The aim of this study was to perform a histomorphometric evaluation of the repair process in rat teeth replanted after root canals were filled with calcium hydroxide (CH) and mineral trioxide aggregate (MTA). DESIGN: Upper right incisors were extracted from 30 rats divided into three groups (n=10). The teeth were stored dry for 60min, after which the pulp and periodontal ligament (PDL) were removed and immersed in acidulated-phosphate sodium fluoride solution. In Group I, the root canals were filled with saline; in Group II, they were filled with CH; and in Group III, they were filled with CH, and the foramen was sealed with an MTA plug. The teeth were replanted, and the animals were sacrificed after 60 days. The sections with teeth were removed for histological preparation (haematoxylin and eosin, H&E). The characteristics of the PDL, cementum, dentine, and alveolar bone, as well as the occurrence of inflammatory and replacement root resorption and apical sealing, were subjected to histological and morphometric analysis (P<0.05). RESULTS: Group I was the most affected by root resorption (mean=67.05%). In Groups II and III, the resorption averaged 42.2% and 11.7%, respectively. Group III was less affected by inflammatory resorption and presented more areas of apical sealing by mineralized tissue (P<0.05). CONCLUSION: An apical MTA plug improved the repair of the replanted tooth by decreasing surface resorption and repairing mineralized tissue in the periapical region.

Replantation as Treatment for Extrusive Luxation

In the treatment of extrusive luxation cases, it is important that the repositioning of extruded tooth in the socket is done as soon as possible. If this does not occur, periapical clot becomes organized and makes replantation difficult reposition. In this article the patient referred to the Clinics for dental trauma sustaining extrusive luxation of the maxillary right central incisor. The patient reported having suffered a bicycle accident 12 days before, which caused traumatic tooth injuries. The repositioning was attempted without success and an alternative form of treatment was necessary to solve the case. Intentional tooth replantation, which is the deliberate extraction of the tooth and its replantation, was indicated. This technique allows clot removal and correct repositioning of the extruded tooth. Care should be taken as endodontic treatment is required for the prevention of subsequent infection-related resorption. Intracanal dressing with calcium hydroxide was used for 30 days before final root filling. Splint, systemic antibiotics and avoidance of further damage to the root surface is also important. After 49 months, showed clinical and radiographic characteristics of normality and demonstrates the availability of this technique to adversity in trauma.

No tratamento de casos de luxação extrusiva é importante que o reposicionamento do dente extruído em seu alvéolo seja feito o mais rápido possível. Se isso não ocorrer, o coágulo periapical se torna organizado e dificulta a reposição. Neste artigo, o paciente encaminhado para a clínica de traumatismo dentário apresentava luxação extrusiva do dente 11. O paciente relatou que havia sofrido um acidente de bicicleta 12 dias antes e teve lesões dentárias. Tentou-se fazer o reposicionamento sem sucesso e uma forma alternativa de tratamento foi necessária para resolver o caso. Reimplante intencional, que é a extração do dente e seu reimplante de forma proposital, foi indicado. Esta técnica permite a remoção do coágulo e o reposicionamento correto do dente extruído. Cuidado deve ser observado quanto ao tratamento endodôntico, para a prevenção de uma reabsorção relacionada a uma infecção. Curativo de demora com hidróxido de cálcio foi realizado por 30 dias antes da obturação final. Contenção, antibióticos sistêmicos e evitar maiores danos à superfície da raiz também são importantes. O controle de 38 meses mostrou características clínicas e radiográficas de normalidade e demonstra a disponibilidade desta técnica para a adversidade no trauma.

Prevalência da relação de procedimentos cirúrgicos periodontais e a odontologia restauradora / Prevalence of the relationship of periodontal surgical procedures and the restorative dentistry

O sucesso da odontologia restauradora está conjugado aos limites fisiológicos e exigências estruturais do periodonto. O objetivo deste trabalho é identificar a necessidade de cirurgia periodontal prévia frente à realização de restaurações de Classe II de Black, Classe V de Black, e próteses parciais fixas; além de identificar os procedimentos cirúrgicos periodontais mais empregados na clínica para este fim. Foram analisados 134 pacientes que buscaram atendimento em clínica geral, estabelecendo o total de restaurações tipo classe II e V, próteses parciais fixas, cirurgias periodontais prévias a procedimentos restauradores e técnicas cirúrgicas utilizadas. Num total de 854 procedimentos de dentística restauradora que foram realizados, 293 (34,30%) eram restaurações em cavidades Classe II e 69 (8,10%) em cavidades Classe V de Black. Constatou-se que 10,22% dos casos de restaurações tipo classe II e V e 36,48% dos casos de próteses parciais fixas necessitaram de cirurgia periodontal prévia. As técnicas cirúrgicas mais utilizadas foram: retalho deslocado apicalmente com osteotomia (50%), cunha interproximal (20,31%) e retalho de Widman modificado (18,75%). Concluí-se que existe uma alta demanda quanto à necessidade de cirúrgicas periodontais em função de procedimentos restauradores na clínica odontológica

The success of the restorative dentistry is conjugated to the periodontal physiological limits and structural requirements. The objective this paper was to analyze the prevalence of the necessity of periodontal procedures before restorative procedures. There was to analyzed 134 patients that searched attendance in general clinic, establishing the total of restorations type class II and class V, fixed partial prosthetic, previous periodontal surgery and which more used the periodontal surgical procedure in the solution of these cases. To 854 restorative procedures that was carried through, 293 (34.30%) was class II and 69 (8.10%) class V Black restaurations. It was observed that 10.22% of the cases of restorations type class II and V and 36.48% of the fixed cases of partial prosthetic, needed of periodontal procedures before. The used surgical techniques more had been: apically repositioned flap with osteotomy (50%), interproximal wedge (20,31%) and of Modified Widman flap (18,75%). Front to the gotten results we can conclude that exist an important prevalence of the necessity of periodontal procedures before restorative procedures

Stress distribution in delayed replanted teeth splinted with different orthodontic wires: a three-dimensional finite element analysis.

AIM: The aim was to evaluate the biomechanical behavior of the supporting bony structures of replanted teeth and the periodontal ligament (PDL) of adjacent teeth when orthodontic wires with different mechanical properties are applied, with three-dimensional finite element analysis. MATERIALS AND METHODS: Based on tomographic and microtomographic data, a three-dimensional model of the anterior maxilla with the corresponding teeth (tooth 13-tooth 23) was generated to simulate avulsion and replantation of the tooth 21. The teeth were splinted with orthodontic wire (Ø 0.8 mm) and composite resin. The elastic modulus of the three orthodontic wires used, that is, steel wire (FA), titanium-molybdenum wire (FTM), and nitinol wire (FN) were 200 GPa, 84 GPa, and 52 GPa, respectively. An oblique load (100 N) was applied at an angle of 45° on the incisal edge of the replanted tooth and was analyzed using Ansys Workbench software. The maximum (σmax) and minimum (σmin) principal stresses generated in the PDL, cortical and alveolar bones, and the modified von Mises (σvM) values for the orthodontic wires were obtained. RESULTS: With regard to the cortical bone and PDL, the highest σmin and σmax values for FTM, FN, and FA were checked. With regard to the alveolar bone, σmax and σmin values were highest for FA, followed by FTM and FN. The σvM values of the orthodontic wires followed the order of rigidity of the alloys, that is, FA > FTM > FN. CONCLUSION: The biomechanical behavior of the analyzed structures with regard to all the three patterns of flexibility was similar.

História de avulsão e reabsorção por substituição 12 anos depois da reimplantação dentária – os benefícios da colocação tardia do implante na zona estética: controle clínico e radiográfico de quatro anos / A history of avulsion and resorption by substitution after 12 years of tooth reimplantation – the benefi ts of delayed implant placement in the esthetic zone: a 4-year clinical and radiographic follow-up

O traumatismo dentário desperta atenção na Odontologia, devido ao comprometimento estético e funcional que ocasiona. Dentre os traumas, a avulsão é uma das principais questões por ser uma lesão grave e envolver danos complexos ao ligamento periodontal. O tratamento de escolha é o reimplante dentário. O objetivo deste estudo foi apresentar a abordagem do trauma dental em um paciente que sofreu avulsão dos dentes 11 e 21. Os elementos foram reimplantados duas horas após o trauma, caracterizando o caso como reimplante tardio. Foi realizada endodontia de ambos os dentes e, após 12 anos de acompanhamentos clínico e radiográfico, houve necessidade de extração dos elementos 11 e 21 devido à presença de grandes áreas de reabsorção por substituição na porção radicular. Implantes osseointegráveis foram instalados na mesma sessão, a fim de reabilitar o paciente que nesse momento apresentava maturidade óssea, estando apto a receber o implante. O caso se encontra com quatro anos de acompanhamento e nenhuma sintomatologia clínica foi observada. Frente à avulsão dentária, o reimplante ainda é a conduta ideal mesmo quando há necessidade de um futuro implante devido à ocorrência das reabsorções dentárias, pois quanto maior a permanência do dente reimplantado no alvéolo, maior a preservação do osso alveolar que mantém sua forma e espessura, favorecendo assim também a estética e pela possibilidade de postergar as cirurgias para colocação dos implantes.

Tooth trauma demands attention in Dentistry due to its esthetic and functional impairments. Avulsion is one of the main issues regarding its severity and complex damage to the periodontal ligament. The treatment of choice is reimplantation. The aim of this article is to present an approach to avulsed teeth 11 and 21. Both elements were reinserted 2 hours later, which characterizes a delayed reimplantation. After endodontic treatment, as well as 12 years of clinical and radiographic follow-up, those teeth were extracted due to large root resorption areas. Dental implants were installed in the same session but now the patient presented with excellent bone maturity to receive the implants. This case now has 4 years of follow-up and no clinical symptomatology was reported. In case of tooth avulsion, the reimplantation is the ideal option aiming for further implant placement due to tooth resorption, because the longer a tooth can be kept in its alveolar socket, the more the bone contour and width preservation are seen, also favoring esthetics and postponing of dental implant surgeries.

Delayed tooth replantation: MTA as root canal filling.

MTA has been investigated as a root-end filling material. Its mechanism of action has some similarities to that of Ca(OH)2. The purpose of this study was to evaluate the repair process taking place in the delayed replantation of monkey teeth using calcium hydroxide and MTA as root canal filling materials. Five monkeys had their lateral incisors extracted and bench-dried for 60 minutes. After root canal preparation, the teeth were assigned to two groups according to root canal filling material: I, calcium hydroxide; and II, MTA. The same treatment sequence was followed for both groups: coronal seal, periodontal ligament removal, immersion of the tooth in 2% acidulated-phosphate sodium fluoride, irrigation of the socket with saline and replantation. Both groups exhibited replacement resorption, areas of ankylosis and absence of inflammatory root resorption. Statistically similar results (p > 0.05) were observed for both groups regarding replacement root resorption, but the groups differed significantly (p < 0.05) regarding the occurrence of ankylosis. MTA may be a viable clinical option for filling teeth submitted to delayed replantation, and is an acceptable option for treating replanted permanent teeth in order to prevent tooth resorption, particularly when dressing changes are not possible.