Radiolucent image in lower third molar: hidden caries or pre-eruptive resorption?: a case report / Imagem radiolucente em terceiro molar inferior: cárie oculta ou reabsorção pré-eruptiva?: um relato de caso

ABSTRACT Caries is a multifactorial disease due to the imbalance of the de/re-mineralization process. Complementary radiographic examinations are able to detect hidden caries. The purpose of this short communication was to investigate the radiolucent image suggestive of hidden caries in lower third molar. The extraction of the tooth, decalcification, inclusion and preparation were performed for histological analysis of the lesion. Histological findings revealed a pre-eruptive resorption, and the etiological factors of this coronary resorption were undefined. The professional should be aware of the occurrences of these lesions to early diagnose and propose appropriate treatment to avoid future complications to the patient.

RESUMO A cárie é conceituada como uma doença multifatorial condicionada ao desequilíbrio no processo de desmineralização e remineralização das estruturas dentárias. O propósito desse trabalho foi investigar a imagem radiolúcida sugestiva de cárie oculta em terceiro molar. Foi realizado a exodontia do elemento dentário, descalcificação e confecção de lâminas para posterior estudo histológico da lesão. O achado histológico conclui-se tratar de uma reabsorção pré-eruptiva. O profissional deve estar atento às ocorrências dessas lesões para diagnosticar precocemente e propor o tratamento adequado, evitando complicações futuras ao paciente.

Resistance to fracture of intraradicular posts made of biological materials.

BACKGROUND: The aim was to analyze the fracture resistance of human teeth treated endodontically and restored with posts made of bovine dentin, human dentin, or glass fiber, and to evaluate the fracture pattern. METHODS: Cylindrical posts of 1.5 mm in diameter cemented to the roots of human maxillary canines presented a length of 15 mm, cervical diameter of 5-5.5 mm in the mesiodistal direction, and 7-7.5 mm in the vestibule-palatal direction. The groups studied were: Group I-10 glass fiber posts; Group II-10 human dentin posts; Group III-10 bovine dentin posts (self-adhesive resin cement); and Group IV-10 bovine dentin posts (resin-modified glass-ionomer cements). The coronal part of tooth was restored with a standardized core build-up using composite. All of the groups were submitted to a compression force test and the resistance to fracture was verified using a universal testing machine. The fracture pattern was likewise evaluated. RESULTS: The values of resistance to fracture were: 723.3N in group I, 561.5N in group II, 556.6N in group III, and, 613.27N in group IV. However, no statistically significant difference was observed among the groups. The fractures in groups I and II were most commonly found in the middle/apical third and were considered irreparable. For restored teeth in group III, half of the fractures appeared in the cervical third and were reparable. In group IV, all of the fractures were reparable, with the majority in the cervical thirds. CONCLUSION: Bovine dentin can be used as intraradicular post to substitute human dentin and glass fiber posts. The greater the malleability of the post, the greater the chances of survival of the teeth when subjected to fracture testing.

Biological restoration in permanent tooth: four-year follow-up / Restaurações biológicas em dentes permanentes: acompanhamento de 4 anos

Biological restorations, involving a technique of uniting autogenous or homogenous dental fragment for use as the primary restorative material, are an alternative for morphological and functional reestablishment of teeth with extensive coronal destruction. Despite the wide range of restorative materials available in dentistry, no material has proved to be as efficient as the natural tooth structure. This article illustrates a therapeutic option for rehabilitating a devitalized mandibular tooth with a weakened coronal remainder by using the biological restoration technique. The authors present the sequence of planning and performing the technique, such as the characteristics of preparation of the tooth and fragment, impression taking, cutting and cementation of the fragment, and the four-year follow-up of the biological restoration, which shows the success of the technique with marginal adaptation and satisfactory esthetic appearance. (AU)

As restaurações biológicas, envolvendo uma técnica de união de fragmentos dentários autógenos ou homogêneos como principal material restaurador, são uma alternativa para o restabelecimento morfológico e funcional de dentes com destruição coronal extensa. Apesar da ampla gama de materiais restauradores disponíveis na odontologia, nenhum material provou ser tão eficiente quanto a estrutura dentária natural. Este artigo ilustra uma opção terapêutica para reabilitar um molar inferior desvitalizado com um remanescente coronal fragilizado, utilizando a técnica de restauração biológica. Os autores apresentam a sequência de planejamento e execução da técnica, tais como as características de preparação do dente e do fragmento, moldagem, recorte e cimentação do fragmento, e o acompanhamento clínico de 3 anos da restauração biológica, mostrando o sucesso da técnica com uma adaptação marginal e aparência estética satisfatória (AU)

Do TMJ symptoms improve and last across time after treatment with red (660 nm) and infrared (790 nm) low level laser treatment (LLLT)? A survival analysis.

OBJECTIVE: Temporomandibular disorder (TMD) is a variety of clinical problems that originate from the area of the temporomandibular joint (TMJ), masticatory muscles, and surrounding tissues. There are different treatment options; however, there is no evidence that low level laser treatment (LLLT) will last about six months. The aim of this study was to determine the survival rate of treatment with red (660 nm) and infrared (790 nm) laser in cases of TMDs. METHODS: In 19 subjects, one side of the face (half face) was randomly selected to receive intervention, in a total of 116 sensitive points. Pain was measured at baseline and time intervals of 24 h, 30, 90, and 180 days after treatment. Laser irradiation with 4 j/cm² in the TMJs and 8 j/cm² in the muscles was used in three sessions. Kaplan-Meier survival analysis and logistic regression were performed. RESULTS: Both treatments showed statistically significant results (p < 0.001). The survival rate for red and infrared laser was 0.24 and 0.30, respectively, at 180 days. Grinding teeth and headache were associated with recurrent pain. DISCUSSION: Both lasers were effective in the treatment of TMD symptoms and had a low survival rate at 180 days.

Prevalence of bruxism in undergraduate students.

OBJECTIVE: The aim of this study was to determine the prevalence of bruxism in students at the Federal University of the Jequitinhonha and Mucuri Valleys in Brazil. The secondary objectives were to identify the factors associated with bruxism; prevalence of dental wear; and to distinguish the signs and symptoms of temporomandibular dysfunction when present, and verify its relationship with bruxism. METHODS: Two hundred fifty-three students (106 males, 147 females) were clinically examined and answered a questionnaire. Trained researchers performed the dental wear evaluation. The incisal edge and occlusal surface were classified as follows: no wear, wear into enamel, wear into dentin, and extensive wear into dentin. Demographic data and factors related to bruxism were obtained by a questionnaire. The participants who presented dental wear and habit of clenching/grinding teeth were classified as bruxers. The data were analyzed by the SPSS program (p < 0.05). RESULTS: The results showed that 31.6% of the students had bruxism. Of the 7084 teeth evaluated, 376 (5.3%) had some type of facet wear. The teeth that had the highest prevalence of wear facets were the canines. Stress, muscle pain, temporomandibular joint (TMJ) pain, and TMJ noise were significantly associated with bruxism (p < 0.001). CONCLUSION: The prevalence of bruxism was 31.6% in this population. The factors most associated with bruxism were stress, muscle pain, TMJ pain, and TMJ noise.

Assessment of sodium fluoride 2% as a new method of disinfecting extracted human teeth / Avaliação de fluoreto de sódio 2% como um novo método de desinfecção dentes humanos extraídos

ABSTRACT Objective: Investigate the action of sodium fluoride 2% as a new method of disinfecting/sterilizing extracted human teeth, using E. faecalis. Methods: The survival rate of E. faecalis ATCC 29212 was assessed, in terms of absorbance from the culture media, using a spectrophotometer. The sterilization assessment was carried out in the following groups: Group I (GI) - control; GII - autoclave; GIII - sodium fluoride seven days; GIV - sodium fluoride 14 days. Results: When using the autoclave and sodium fluoride solution (2%), the quantity of bacteria reduced significantly when compared to the control group (p <0.001). Statistically significant differences were also found when the experimental groups were compared with each other (p < 0.001). Conclusion: The results of the present study suggest that sodium fluoride 2% solution can be considered a new disinfection method based on its capacity to reduce the load of E. faecalis.

RESUMO Objetivo: Investigar a ação do fluoreto de sódio à 2% como um novo método de desinfecção/esterilização de dentes humanos extraídos, usando E. faecalis. Métodos: A taxa de sobrevivência do E. faecalis ATCC 29212 foram avaliadas, em termos de absorbância a partir do meio de cultura, usando espectofotômetro. A avaliação de esterilização ocorreu de acordo com os seguintes grupos: Grupo I (GI) - controle; GII - autoclave; GIII - fluoreto de sódio 7 dias; GIV - fluoreto de sódio 14 dias. Resultados: Quando utilizado autoclave e solução de fluoreto de sódio (2%), a quantidade de bactérias foi reduzida significativamente quando comparado com o grupo de controle (p <0.001). Diferenças estatisticamente significantes também foram encontrados quando os grupos experimentais foram comparados uns com os outros (p < 0.001). Conclusão: Os resultados do presente estudo sugerem que a solução de fluoreto de sódio à 2% pode ser considerado como um novo método de desinfecção com base na sua capacidade para reduzir a carga de E. faecalis.

Biological Restoration of a Fractured Anterior Tooth with the Use of Dentine Pin (Biopins).

This case study describes the esthetic and functional reconstruction of a fractured maxillary central incisor. Due to the requirement for additional retention, treatment was performed using the homogenous technique of biological restoration associated with cementation of posts made from human dentin (biopins). This type of treatment is a new alternative to conventional techniques and favors the dental esthetic and function, as well as biocompatibility, and is an inexpensive procedure.

Esthetic and functional recovery of extensively decayed posterior teeth through conservative treatment.

The case exemplifies the combination of two important principles in dentistry: 1) the maintenance of pulp vitality by the partial excavation of the contaminated dentin followed by the application of a biomaterial; and 2) esthetic and functional recovery based on biological restoration. Tooth vitality was confirmed two months after pulp treatment and restoration was accomplished with a fragment of a tooth extracted from another individual. This method is easy to perform and offers esthetic, functional, emotional and social benefits to the patient.

Esthetic recovery of smile using composite resin and "biological posts" and crowns.

The recovery of teeth that have been extensively destroyed by dental caries can be achieved through direct and indirect restorative procedures. This paper presents a case of the esthetic and functional recovery of permanent maxillary incisors with extensive dental caries in an adolescent patient through the use of a composite resin and "biological posts and crowns". A case report was drafted to describe the direct restoration of central maxillary incisors using composite resin and endodontic treatment of the lateral maxillary incisors, the construction of dentinal posts, the adaptation and cementing of the posts to the root canals, preparation and molding of crown portions, model construction, the choice of extracted teeth and the making and cementing of "biological crowns". The use of a composite resin and the cementing of "biological posts and crowns" reestablish dental esthetics and function. Biological restorations maintain all the characteristics of natural teeth and have a significant psychosocial impact on the patient's quality of life. However it should be stressed that this technique was only indicated in the present case after the determination of a significant improvement in oral hygiene.

Iatrogenias mais frequentes em dentística: por que não evitá-las? / Most frequent iatrogenies in dentistry: why not avoiding them?

Iatrogenias consistem em erros causados pelo profissional ao paciente, na tentativa de sanar um problema, podendo ocasionar, na maioria das vezes, o desencadeamento de processos patogênicos. Assim sendo, o presente trabalho apresenta como propósito abordar, a partir de uma revisão bibliográfica, os fatores iatrogênicos mais comuns em Dentística, decorrentes de procedimentos clínicos restauradores; os danos causados pelos mesmos na cavidade bucal; bem como a maneira mais apropriada de evitá-los. Um dos aspectos que deve ser considerado refere-se à quantidade, cada vez mais crescente, de ações judiciais movidas contra cirurgiões-dentistas, sendo necessário maior zelo e presteza desses profissionais, quando da execução de seus trabalhos. Portanto, torna-se prudente salientar que o profissional tenha domínio sobre as técnicas de restaurações e sobre os materiais odontológicos utilizados, conhecendo suas propriedades e limitações, para que as mesmas possam ser superadas e, ainda, sigam rigorosamente as instruções de seus fabricantes, permitindo que as propriedades máximas oferecidas por tais produtos sejam então alcançadas.

Objetivo The term iatrogenic concerns any disorder caused to the patient by inappropriate practice, which intends to solve some kind of problem and, as a consequence may lead to some pathogens. This paper presents, through a literature review, the most common iatrogenic factors in Dentistry, due to clinical restorative procedures. It also presents the damages caused by those factors in the oral cavity, as well as the most appropriate ways of avoid them. One of the aspects to be considered is the increasing number of prosecutions against dental surgeons, which makes necessary to be very careful when doing that kind of job. The knowledge of restorative techniques and materials together with the appropriate clinical practice provide satisfactory results, thus avoiding injury in patients.

Fragment reattachment associated with pulpotomy in a posterior tooth with incomplete root formation.

This article reports a case of preserving pulp vitality combined with aesthetics and functional reconstruction of an immature permanent molar extensively destroyed because of a carious lesion. After a pulpotomy using calcium hydroxide, the tooth crown was restored by bonding a dental fragment obtained from an extracted tooth from another individual. Aspects of diagnosis and treatment that directly affect the prognosis of the techniques are discussed. Radiographic and clinical follow-up for two years showed complete root development and a very satisfactory restoration with regard to aesthetics and function.

"Biological restoration": root canal and coronal reconstruction.

UNLABELLED: Anterior tooth fracture, as a result of traumatic injuries, frequently occurs in dentistry. Proper reconstruction of extensively damaged teeth can be achieved through the fragment reattachment procedure known as "Biological Restoration." This case report refers to the esthetics and functional recovery of extensively damaged central maxillary incisors through the preparation and adhesive cementation of "Biological Posts and Crowns" in a young patient. Both biological posts and crowns--post and dental fragment obtained through natural, extracted teeth from another individual--represent a low-cost option and alternative technique for the morphofunctional recovery of extensively damaged anterior teeth. CLINICAL SIGNIFICANCE: The biological restorations are an alternative technique for reconstruction of extensively damaged teeth that provides highly functional and esthetic outcomes.

Coroa total confeccionada pela técnica de restauração biológica / Full-crown made by the biological restoration technique

A odontologia restauradora vem evoluindo e buscando soluções cada vez mais estéticas para suprir as necessidades dos pacientes que se tornam ainda mais exigentes na busca por um sorriso perfeito. Este artigo apresenta um caso clínico referente à recuperação estética e funcional do elemento dentário 46, mediante a utilização de fragmento obtido a partir de um dente extraído como principal material restaurador. Essa técnica é conhecida como “restauração biológica”. Atualmente, não se conhece material restaurador sintético que substitua por completo as propriedades originais dos tecidos dentários, entretanto, as restaurações biológicas apresentam tais propriedades, o que lhes confere grande vantagem sobre os materiais restauradores existentes.

Restorative dentistry has evolved due to the increasing esthetic demand by patients. The case report refers to a functional and esthetic restoration of tooth #30, using a fragment of an extracted tooth, wich was the main portion of the restoration. This technique is called "biological restoration". There is no restorative material that replaces completely the original properties of the dental tissues. Nevertheless, “biological restorations” present these characteristics, and this represents a great advantage against other modern restorative materials.

'Biological restoration': total crown anterior.

Restorative odontology is in constant evolution and is constantly seeking more aesthetic solutions to attend to demands from patients in search of the perfect smile. The case study presented herein refers to the aesthetic and functional recuperation of dental element 21, through the use of a dental fragment obtained through an extracted tooth, a technique known as 'Biological Restoration'. The results obtained, which were highly satisfactory, lead one to conclude that this technique can be considered as an alternative to all others and can be carried out successfully, quickly, and inexpensively.

Cárie oculta: a importância de um diagnóstico precoce / Hidden caries: the importance of a precocious diagnosis

O diagnóstico de lesões cariosas através do exame clínico visual tem-se tornado extremamente difícil ou até mesmo impossível, uma vez que mesmo sem defeito aparente no esmalte, uma lesão cariosa pode estar presente em dentina. Atualmente, o termo cárie oculta tem sido usado para descrever lesões de cáries desenvolvidas em dentina sob esmalte superficial aparentemente hígido ou minimamente desmineralizado, podendo ocorrer tanto na superfície oclusal como na proximal dos dentes que, quando abertos, encontram-se com aspecto amolecido e com grande destruição do tecido dentinário. Considerando a freqüência com que este tipo de lesões tem sido observadas na Clínica de Dentística da Faculdade de Odontologia das Faculdades Federais Integradas de Diamantina, MG, torna-se imprescindível destacar a importância das radiografias interproximais aplicadas como rotina em associação a uma criteriosa inspeção visual para a detecção de cáries oclusais, procurando minimizar as dificuldades no diagnóstico de cáries oclusais, uma vez que as mesmas, quando não detectadas precocemente, são capazes de promover extensa destruição dentinária, podendo até mesmo resultar em um envolvimento pulpar