Consequences of tooth luxation associated with complicated crown fracture: a case report.

The objective of this clinical case report is to describe the late treatment performed in a 10-year-old patient who suffered a complicated crown fracture associated with luxation of the maxillary left central incisor. The patient-s parents reported that the patient fell and was immediately taken to a hospital, where radiographs, splinting, and suturing were performed and an anti-inflammatory prescription was provided, but no treatment was given for the exposed pulp. The parents and patient sought treatment at a pediatric dentistry clinic 16 days post-trauma. The clinical examination revealed the presence of a left central incisor with a fracture of enamel and dentin involving the pulp, which was necrotic, and a splint extending from the right lateral incisor to the left lateral incisor. However, it was not possible to diagnose the type of luxation that had occurred. The fractured incisor was treated with periodic changes of calcium hydroxide dressing for apexification for 10 months, and the root was subsequently obturated with gutta percha and root canal sealer. The tooth fragment was stored in physiologic solution during this time. After obturation, tooth darkening was observed, and LED-assisted tooth bleaching was accomplished prior to reattachment of the fractured fragment. The tooth was reexamined every 6 months. Two years after the traumatic event, the left central incisor was infraoccluded in relation to the right central incisor. A radiograph confirmed ankylosis of the traumatized tooth. When trauma affects the enamel, dentin, pulp, and supporting tissues, the prognosis can be unfavorable even when late treatment is adequate, especially when a tooth in a growing patient has points of ankylosis.

Reimplantation of an avulsed mature permanent tooth after 6 days: a 1-year follow-up.

Tooth avulsion in children and adolescents demands emergency treatment to increase the chances of successful reimplantation. The treatment prognosis depends on intrinsic and extrinsic factors, such as the extra-alveolar time until reimplantation, storage medium, handling, and periodontal ligament condition of the avulsed tooth as well as the patient's general health. This case report describes the treatment of an 11-year-old boy who suffered an avulsion of the maxillary right central incisor followed by delayed reimplantation after the tooth was stored in a dry medium for 6 days. Although the tooth was kept in extremely unfavorable conditions, tooth reimplantation was attempted because the patient was young and it was desirable to avoid psychological trauma as well as esthetic and functional problems. The treatment performed followed the guidelines of the International Association of Dental Traumatology for an avulsed tooth with a closed apex and extraoral dry time exceeding 60 minutes. At a 1-year follow-up appointment, the tooth exhibited clinical function, no mobility or pain symptoms, and mild signs of ankylosis. A radiographic image showed resorption by substitution. Although the long-term prognosis is uncertain, this treatment approach was advantageous for the patient because it maintained esthetics, function, and alveolar bone height.

Delayed tooth reimplantation with 4-year follow-up: the management of ankylosis during facial growth.

This case report describes the consequences of delayed (24 hours) reimplantation of an avulsed maxillary central incisor, findings over a 4-year follow-up period, and the management of ankylosis during facial growth. After a traumatic event, a 10-year-old boy was taken to a hospital emergency department due to injuries to his face, including avulsion of the maxillary left central incisor. Despite the short amount of time before arriving at the hospital (10 minutes) and use of the correct storage medium (milk), the tooth was not reimplanted, and the parents did not receive instructions to seek dental treatment. The next day, the child was brought to a dental school because he objected to the loss of his tooth. The treatment chosen was delayed tooth reimplantation. At the 1-year follow-up, the reimplanted tooth was infraoccluded, and periapical radiography revealed signs of ankylosis and initial replacement root resorption. At the 2- and 3-year follow-up examinations, resorption and infraocclusion of the central incisor had progressed. In this case, the delayed reimplantation resulted in ankylosis that had a significant clinical impact due to the patient's facial growth. Direct resin restoration of the reimplanted tooth was therefore performed 3 years after trauma. Despite continued resorption and infraocclusion of the tooth observed 4 years posttrauma, the esthetic, low-cost treatment was well accepted, and the patient's quality of life was improved until definitive treatment can be performed.

Susceptibility of bovine dental enamel with initial erosion lesion to new erosive challenges.

This in vitro study evaluated the impact of initial erosion on the susceptibility of enamel to further erosive challenge. Thirty bovine enamel blocks were selected by surface hardness and randomized into two groups (n = 15): GC- group composed by enamel blocks without erosion lesion and GT- group composed by enamel blocks with initial erosion lesion. The baseline profile of each block was determined using the profilometer. The initial erosion was produced by immersing the blocks into HCl 0.01 M, pH 2.3 for 30 seconds, under stirring. The erosive cycling consisted of blocks immersion in hydrochloric acid (0.01 M, pH 2.3) for 2 minutes, followed by immersion in artificial saliva for 120 minutes. This procedure was repeated 4 times a day for 5 days, and the blocks were kept in artificial saliva overnight. After erosive cycling, final profile measurement was performed. Profilometry measured the enamel loss by the superposition of initial and final profiles. Data were analyzed by t-test (p<0.05). The result showed no statistically significant difference between groups (GS = 14.60±2.86 and GE = .14.69±2.21 µm). The presence of initial erosion on bovine dental enamel does not enhance its susceptibility to new erosive challenges.

Delayed Treatment of Traumatized Primary Teeth with Distinct Pulp Response: Follow-Up until Permanent Successors Eruption.

Complicated crown fracture and crown-root fracture with pulp involvement expose dental pulp to the oral environment. The pulp outcome is often unpredictable because the patient and injury which are related to variables can influence the treatment of choice and the prognosis of the case. This report presents the case of a 4-year-old boy with complicated crown fracture with pulp polyp in the primary right maxillary central incisor (51) and crown-root fracture with pulp involvement in the primary left maxillary central incisor (61), which was treated only 3 months after the tooth injuries. The treatment of choice was extraction of tooth (61) due to a periapical lesion with disruption of the dental follicle of the permanent successor and pulpotomy (MTA) of the tooth (51), because the pulp presented signs of vitality. At the follow-up visits, no clinical, symptomalogical, and radiographic changes were observed until the primary tooth's exfoliation. However, at 3-year follow-up, the permanent successors showed hypocalcification and the position of the permanent right maxillary central incisors (11) was altered. Besides the conservative and adequate delayed treatment, the sequelae on the permanent successors could not be avoided.

The Diagnosis and Treatment of Multiple Factitious Oral Ulcers in a 6-Year-Old Boy.

Factitious ulcers are characterized by self-inflicted lesions with multifactorial origin. These lesions are frequently found in head, neck, and hands. This report shows a 6-year-old boy diagnosed with factitious oral ulcers that occurred after the self-biting of buccal vestibule and nail-scratching of gingival tissue. Clinically, a significant swelling was observed, hard on palpation, located at the right lower third of the face, next to the posterior area of the mandible. In the intraoral examination, ulcers at different healing stages were noted on the swelling area. During the anamnesis, the father reported a change in his familial structure that triggers psychological stress, providing the clues to the presumptive diagnosis of factitious oral ulcers. We prescribed the topical use of Gingilone® three times a day to control the local pain and inflammation. At 7-day follow-up, we noticed the reduction of extraoral swelling and the initial healing of the ulcers. The presumptive diagnosis was confirmed at 30-day follow-up, with the lasting remission of oral lesions. The treatments of factitious oral ulcers should be individually tailored for each patient, focused on a multidisciplinary approach, including psychotherapy and periodic clinical control. To the best of our knowledge, gaps of evidence lead to the lack of standardized clinical protocols on this issue.

Estudo clínico randomizado de restaurações classe II de ART com e sem retenções proximais em dentes decíduos / Randomized clinical trial of multiple surface ART restorations with and without proximal retentions in primary teeth

O tratamento restaurador atraumático constitui-se numa abordagem de cuidados minimamente invasivos que objetivam a prevenção e interrupção da progressão da cárie dentária. Não existe na literatura estudo clínico randomizado em dentes decíduos comparando restaurações de classe II de ART, com e sem retenções adicionais. O objetivo deste trabalho foi avaliar o efeito de sulcos de retenção proximal sobre as taxas de sobrevida das restaurações classe II de ART em dentes decíduos, usando cimento de ionômero de vidro de alta viscosidade e alta resistência flexural. Foram incluídas 183 crianças com idade entre 4 a 7 anos, com boa saúde geral, 1 a 4 cavidades de classe II em molares decíduos sem envolvimento pulpar ou dor de dente. Dessas crianças, 300 dentes foram randomizados e distribuídos em dois grupos, conforme o índice de cárie da criança e o tamanho da cavidade a ser restaurada. Os grupos foram: controle restaurações de ART classe II convencionais (Grupo 1, n=150) e teste restaurações de ART classe II contendo sulcos de retenção proximais (Grupo 2, n=150). Cada um dos grupos seguiu procedimentos clínicos padronizados. No grupo teste as retenções foram realizadas com colher de dentina modificada no ângulo gengivovestibular/ lingual até 0,5 mm da junção amelo-dentinária da margem oclusal. Após 6 e 12 meses 130 restaurações do Grupo 1 e 110 restaurações do Grupo 2 foram examinadas de forma cega utilizando os critérios do ART Frencken adaptado e do USPHS modificado. Para a taxa de sobrevida das restaurações foi utilizado o teste de Kaplan-Meier (p<0,05). Não houve diferença significativa entre os grupos (p=0,70) utilizando os critérios do ART, sendo que as taxas de sobrevida encontradas para ambos os grupos foram superiores a 90%. O mesmo resultado foi observado em todos os critérios (cor, descoloração marginal, recidiva de cárie, forma anatômica, integridade marginal e textura superficial) USPHS (p>0,05). Os principais motivos de falhas das restaurações foram perda total ou parcial da restauração (84%), seguido de inflamação pulpar (16%). Conclui-se que as restaurações classe II de ART com sulcos de retenção proximal apresentaram taxa de sobrevida semelhantes às restaurações sem retenção após 6 e 12 meses.(AU)

The atraumatic restorative treatment is an approach of minimally invasive care that aims to prevent and interrupt the progression of dental caries. There is no randomized clinical trial in primary teeth with multiple surface ART restorations, with and without additional retentions. The aim of this study was to evaluate the effect of proximal retention grooves on the survival rates of occlusoproximal ART restorations in primary teeth using high viscosity glass ionomer cement with high flexural strength. A total of 183 children aged 4 to 7 years, with good general health, 1 to 4 occlusoproximal cavities in primary molars without pulp involvement or tooth pain were included. Of these children, three hundred teeth were randomized and alocated into two groups, according to the child's caries index and the size of the cavity to be restored. The groups were: control - conventional occlusoproximal ART restorations (Group 1, n=150) and test - occlusoproximal ART restorations containing proximal retention grooves (Group 2, n=150). The procedures of both groups followed standardized steps. In the test group the retentions were performed with a modified dentin spoon at the gingival-vestibular / lingual angle up to 0.5 mm from the amelodentin junction of the occlusal margin. After 6 and 12 months 130 restorations in Group 1 and 110 restorations in Group 2 were examined (blind) using the modified ART Frencken criteria and the modified USPHS criteria. The Kaplan-Meier test was performed for the survival rate of the restorations (p<0.05). There was no significant difference between groups (p=0.70) using the ART criteria, and the survival rates found for both groups were greater than 90%. The same results was observed for all USPHS criteria (color, marginal discoloration, secondary decay, anatomical form, marginal integrity and surface texture) (p>0.05). The main reasons for restorations failure were total or partial loss of restoration (84%), followed by pulpal inflammation (16%). It was concluded that multiple surface ART restorations with proximal retention grooves presented similar survival rates to non-grooves restorations after 6 and 12 months.(AU)

Conservative management of external root resorption after tooth reimplantation: a 3-year follow-up.

The aim of this case report is to describe the treatment of a 9-year-old patient who suffered external root resorption of the permanent maxillary left lateral incisor following reimplantation of the avulsed left central and lateral incisors. Sixteen days after reimplantation and splinting of the incisors in a hospital emergency department, the patient was brought to the pediatric department of a dental school for further treatment. Root canal access was created in the maxillary left lateral and central incisors, and calcium hydroxide paste was used as intracanal dressing. At the 5-month follow-up, a radiograph revealed extensive external root resorption, a communicating root canal, and a periodontal lesion affecting the left lateral incisor. Management of the root resorption included obturation of the apical third of the canal with gutta percha and the middle third with mineral trioxide aggregate (MTA). At the 3-year recall examination, the patient was asymptomatic, and no mobility or soft tissue alterations were observed clinically. There was no radiographic sign that resorption had progressed. Despite the success of treatment, observation is still required. The use of MTA may be considered an alternative treatment for external root resorption after tooth reimplantation. The technique may allow tooth preservation in children until skeletal growth and development are completed and implant treatment may be considered.

Pit and Fissure Sealants with Different Materials: Resin Based x Glass Ionomer Cement ­ Results after Six Months

Objective: To compare the retention and superficial characteristics between a new resin-modified glass ionomer sealant and resin sealant. In addition, the teeth sealed were compared to partially erupted first molars (control group) without sealing in relation to the incidence of dental caries. Material and Methods: Initially, 31 children aged 6-8 years participated in this study. The study children showed caries history, but had at least two healthy first molars. A total of 114 teeth were randomly divided into three groups: Clinpro (n=36), Fluroshield (n=38), and control (n=40). The two sealants were applied under relative isolation after previous prophylaxis and enamel etching with phosphoric acid 35% (15s). Clinical evaluation was performed by two calibrated examiners. They evaluated the retention and surface characteristics of the occlusal surface. Results: Fluroshield® showed significantly greater retention than ClinproTM Varnish® XT (p=0.002). However, the performance analysis of the success and failure of retention presented no significant difference between the materials (p=0.141). Concerning to the surface characteristics, Fluroshield performed better than Clinpro after analyzing the marginal deterioration, marginal discoloration, and superficial discoloration (p<0.05). The surface texture of the materials under study was similar (p=0.071). Sealed groups (Clinpro=Fluroshield) showed similar performance in the prevention of dental caries, which was significantly lower than that of control group (p=0.001). Conclusion: Both sealants, Fluroshield® and Clinpro TM Varnish® XT were effective in preventing caries lesion within 6 months, although Fluroshield sealant showed better clinical retention.

Impact of Saliva and Intraoral Appliance on Erosion Lesions Rehardening Ability - A Pilot Study

Objective: To evaluate the ability of different periods of salivary exposure and two different removable appliances to rehardening initial erosive lesions. Material and Methods: This randomized, single blind in situ study was conducted with 2 crossover phases. The factors under study were: period of salivary exposure (15 minutes, 30 minutes, 1 hour and 2 hours) and type of oral appliance (maxillary or mandibular). Two hundred enamel blocks were selected by initial surface hardness (SHi). Enamel blocks were demineralized in vitro (0.05M citric acid; pH2.5 for 15 seconds), surface hardness (SHd) was remeasured and 160 blocks were selected and randomized among groups. Thus, there were 2 blocks per period of salivary exposure in each type of oral appliance for each one of the 10 volunteers. In each phase, one of the removable appliances was tested. The response variable was percentage of surface hardness recovery (%SHR=[(SHf-SHd)/SHi)]x100). Two-way ANOVA and Tukey's post hoc test were applied adopting 5% of significance. Results: No difference was found among oral appliances on enamel rehardening (p>0.01). Salivary exposure of 2 hours promoted similar enamel rehardening when compared to 1 hour (p>0.05), which showed similar rehardening to 30 min. All mentioned period of salivary exposure promoted superior rehardening than 15 min (p>0.01). Conclusion: The salivary time exposure between erosive attacks might be 2 hours to achieve a feasible maximum rehardening. In addition, both maxillary and the mandibular appliance have presented a similar rehardening ability.

Changes in Oral Health-related Behavior of Infants following a Preventive Program of Continuing Education Directed to their Parents

To evaluate changes in oral health-related behavior of infants following preventive program of continuing education directed to their parents.Material and Methods:We analyzed 53 dental files of infants aged up to 36 months, who participated in the Prevention and Education Program of the Infants Clinic, School of Dentistry of Bauru (USP), and attended at least 2 visits with a maximum of 4 missing appointments. Initially an educational lecture was conducted, pointing issues related to diet and oral hygiene. At the following visit, the professional filled in a form with questions about diet and hygiene performed at home. The following information was extracted from dental files: reason of the first visit, age, number of teeth, number of visits, missing appointments, and dietary and oral hygiene risk factors. The data were tabulated and analyzed using descriptive statistics comparing the information obtained from the first visit to that of the last one.Results:The reason for the first visit was dental caries prevention (88.68%) followed by dental trauma (7.55%), and needed of curative treatment (3.77%). The mean age of the sample was 14.85 months, the tooth number mean was 12.64 at first visit, the mean number of visits was 7 and the mean missing appointments was 0.83. The percentage of infants with inadequate diet and hygiene habits was 88.68% and 62.26%, and only 12.762% and 57.57% of these have changed their habits, respectively.Conclusion:After the preventive program of continuing education, the dietary habits showed were more difficult to change in relation to hygiene ones...

Selamento de fossas e fissuras após 6 meses com diferentes materiais: Resinoso X Ionómerico / Pit and fissure sealants with different materials: Resin Based X Glass Ionomer Cement Results after six months

Este estudo avaliou e comparou, após 6 meses, dois materiais usados como selantes de fossas e fissuras, FluroShield® (Dentsply, Germany) e Clinpro™ XT Varnish (3M ESPE, Dental Products, St. Paul, MN, U.S.A.) quanto à retenção e características superficiais. Além disso, comparou-os, com um grupo controle não selado, com relação à incidência de cárie no período. Participaram deste trabalho, 31 crianças de 6 a 8 anos de idade, com no mínimo dois primeiros molares permanentes hígidos e história de cárie, num total de 114 dentes divididos aleatoriamente em três grupos: CLP (Clinpro™ XT Varnish), FS (FluroShield®) e ctr (Controle). O selamento foi realizado sob isolamento relativo para ambos os materiais testados, após profilaxia prévia com jato de bicarbonato de sódio e água e, condicionamento com gel de ácido fosfórico a 35% por 15 segundos. A avaliação clínica foi realizada por dois examinadores calibrados após 6 meses. Avaliou-se a retenção e a incidência de cárie nas cinco áreas oclusais: OM, OC, OD, OV e OL; e as características superficiais e a retenção considerando a superfície oclusal como um todo. Houve diferença estatisticamente significante para a prevalência de cárie (teste de Kruskal Wallis, p=0,000 a 0,007), para todas as áreas, entre os grupos selados (CLP e FS) e o controle. Sendo que quanto à incidência, só foi verificada diferença significante para a área OL (p=0,014). O teste do Qui-quadrado identificou que não houve diferença estatisticamente significante entre os materiais, com relação à taxa de sucesso de retenção da superfície oclusal como um todo, quando se considerou o somatório das cinco áreas (p=0,079) ou quando se verificou a retenção por superfície (p=0,141). No entanto, a análise do conjunto de critérios de retenção na superfície oclusal toda, mostrou uma diferença estatisticamente significante para o FS (teste de Mann-Whitney, p=0,002). Em relação às características superficiais, o FS apresentou superioridade durante...

This study evaluated and compared two dental sealants, for 6 months. The materials, Fluroshield® (Dentsply, Germany) and Clinpro™ XT Varnish (3M ESPE Dental Products, St. Paul, MN, USA) were analyzed with regard their retention and superficial characteristics. They also were compared with a control group, without sealant, regarding the dental caries incidence. The sample was composed by 31 children from 6 to 8 years of age, with at least two sound first permanent molars, but with a dental caries history. A total of 114 teeth were randomly alocated in three groups: CLP (Clinpro™ XT Varnish), FS (Fluroshield®) and ctr (Control). The sealings were applyed under relative isolation after a previous prophylaxis with a water-air-polishing jet, and an enamel etching with a 35% phosphoric acid gel for 15 seconds. Clinical evaluation was performed by two calibrated examiners after 6 months considering: the sealant retention and the incidence of occlusal caries in five areas: OM, OC, OD, OV and OL and finally, the surface characteristics and retention considering the occlusal surface as only one area. It was shown a significant difference (Kruskal-Wallis test, p=0.000 to 0.007) for the caries prevalence in all areas comparing the sealed group (CLP and FS) versus control. Whereas the incidence, it was only verified a significant diference for the OL area (p=0.014). There was no significant difference (Chi-square test, p=0.079) between the materials regarding the success rate of retention for the occlusal surface when it was considered the sum of the five areas, or for the occlusal surface without divisions (p=0.141). Nevertheless there was a significant difference between the sealants (Mann-Whitney test, p=0.002), with better results for the FS group, when it was analysed the influence of all the retention criteria. Regarding the surface characteristics, the FS group showed a significant superiority (Mann-Whitney test) during the period of the study for the impairment...