Prevalence of pulp canal obliteration after traumatic dental injuries: a systematic review and meta-analysis.

This systematic review aimed to answer the following question: What is the estimated prevalence of pulp canal obliteration in subtypes of traumatic dental injury (TDI) in deciduous and permanent teeth? The searches were conducted in PubMed, Embase, Scopus, Web of Science, LILACS, Grey Literature, and Google Scholar, and complemented by a manual search, until April 16th, 2023. Observational studies were selected based on population, exposure, and outcome (PEO) (P, deciduous or permanent teeth; E, TDI; O, pulp canal obliteration). Two reviewers (kappa 0.90) applied the eligibility criteria, extracted qualitative data, and assessed the methodological quality using the Newcastle-Ottawa tool. A meta-analysis was performed using MedCalc 17.2. Thirty-four articles were selected after screening. The methodological quality was moderate to high. The estimated prevalence of pulp canal obliteration was 27.6% (95%CI: 18.7-37.7) and 21.9% (95%CI:16.0-28.4), for permanent and deciduous teeth, respectively. Considering the TDI subtypes, the prevalence of pulp canal obliteration was higher in root fractures of the permanent teeth (78.6 %, 95%CI: 62.8-90.9) and lateral luxation injuries in deciduous teeth (29.4%, 95%CI:19.1-41.0). Our review of 34 articles of moderate and high methodological quality found that the prevalence of pulpal canal obliteration ranges from 21.9% to 27.6%. Pulp canal obliteration was most frequently detected following lateral luxation injuries of the deciduous teeth and root fractures of the permanent teeth (PROSPERO CRD42020179438).

Risk factors associated with the occurrence of avulsion in the primary incisors: A case-control study.

BACKGROUND: Identifying factors associated with the occurrence of primary tooth avulsion is essential to promote prevention strategies. AIM: To investigate the risk factors associated with primary incisor avulsion and variables associated with post-avulsion sequelae in the permanent successor. DESIGN: This case-control study comprised 407 children (cases) with primary incisor avulsion and 407 children (controls) with other traumatic dental injuries (TDI). The association between explanatory variables and avulsion was evaluated through logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Poisson regression analyses between potential explanatory variables and sequelae were run, from which relative risks (RR) and corresponding 95% CI were estimated. RESULTS: TDI caused by moderate falls (OR = 2.20; 95% CI = 1.47 to 3.27), affecting lateral incisors (OR = 10.10; 95% CI = 3.89 to 26.54) and the lower arch (OR = 9.54; 95% CI = 3.15 to 28.85), were associated with primary incisor avulsion. Moreover, children with previous severe TDI, anterior open bite, and anterior crossbite had higher odds of primary incisor avulsion. Children who suffered from any primary tooth avulsion (RR = 2.68; 95% CI = 1.82 to 3.95) had a higher risk of sequelae in the permanent successors. The risk for sequelae in the permanent teeth was significantly greater for younger children under age 2 years than for children ages 3 to 5 years. CONCLUSION: Risk factors for primary incisor avulsion are related to the severity of the fall, tooth position, history of previous TDI, and malocclusion. Furthermore, avulsion increases the risk of sequelae in the permanent successors.

Dimensions of Occlusoproximal Cavitated Carious Lesions as a Cut-Off Point for Restorative Decision in Primary Teeth

ABSTRACT Objective: To investigate whether the dimensions of cavitated dentin carious lesions on the occlusoproximal surfaces of primary teeth could predict the location of cement-enamel junction (CEJ). Material and Methods: Two hundred extracted primary molars were selected and digital images were obtained. The teeth were set in arch models for clinical measurement. The cervical-occlusal (CO) and buccal-lingual/palatal (BL/P) cavities' dimensions were obtained by digital (Image J) and clinical (periodontal millimeter probe) assessments. The cervical margin location was also determined. The thresholds (cut-off points) were determined by sensitivity, specificity and the areas under the receiver operating characteristics curves (Az) for the two methods. Pearson's correlation coefficient was used to investigate the correlation between clinical and digital measurements. Logistic regression analysis was performed to evaluate the association between the dimensions and cervical margin location. Results: There was a strong correlation between methods for all measurements (CO: r=0.90, VL/P: r=0.95). Cavities with BL/P distance higher than 4.5 mm and CO dimension higher than 3.5 mm had a lower chance of presenting the cervical limit above the CEJ, irrespective of the measurement method. Conclusion: CO and VL/P dimensions could be used to predict the CEJ location and, ultimately, as a clinical parameter for restorative decision-making.

A 14-Year Follow-Up Study of Sequelae in Primary Teeth and Permanent Successors After Dental Trauma

ABSTRACT Objective: To evaluate the presence of sequelae in primary teeth and their permanent successors, as well as associations between TDI and the presence of sequelae in both teeth. Material and Methods: In this 14-year retrospective study, 2.290 records were reviewed, 192 patients who suffered dental trauma in primary teeth were followed until the eruption of successor teeth were included. Descriptive, chi-square, and regression logistic with generalized estimating equations tests were performed (p<0.05). Results: 362 primary and successor teeth were followed. Sequelae were present in 71.8% of primary teeth and 25.7% of their successors. Teeth with complicated fracture (100%), extrusion (100%) and avulsion (100%) resulted in the largest amounts of sequelae in primary teeth and intrusion (61%) on their successors. Age was associated with sequelae in permanent teeth (p<0.01). Extrusion (OR 10.06; CI 2.12-47.63) and intrusion (OR 7.51; CI 2.73-20.70) had a higher risk to cause sequelae in primary and permanent teeth, respectively. Conclusion: The type of injury involved influenced the sequelae in traumatized teeth and their successors, and the age of the child influenced the presence of sequelae in permanent teeth.

Pulpectomía mecanizada en molares primarios: caso clínico / Mechanized pulpectomy in primary molars: a clinical case

Las pulpectomías en molares primarios están indica-das en casos de diagnóstico de pulpitis irreversible o necrosis y reabsorción radicular mínima o nula. Son tratamientos laboriosos y extensos, que sólo pueden ser llevados a cabo en pacientes colaboradores. En búsqueda de simplificar esta terapéutica y mejorar su eficacia, se propone la mecanización de la pre-paración de los conductos de molares primarios. Diversos autores aseguran que esta técnica opti-miza el tiempo clínico y mejora la calidad del trata-miento, obteniendo gran aceptación en la literatura actual. Se presenta la secuencia de procedimientos, resolución y controles de dos tratamientos de pul-pectomía con instrumentación mecanizada en mola-res primarios (AU)

Pulpectomies in primary molars are indicated in cases of irreversible pulpitis or necrosis with mini-mal or no root resorption. They are laborious and ex-tensive treatments, which only can be carried out in cooperative patients. In order to simplify this therapy and improve its effectiveness, the mechanization of root canal preparation is proposed. Several authors assume that this technique optimizes preparation time and improves the quality of treatment, obtaining great acceptance in the current literature. We report the sequence of procedures, resolution, and controls of two pulpectomies with mechanized instrumenta-tion in primary molars (AU)

Potencial remineralizante del fluoruro diamino de plata al 38% en dentina de dientes temporales afectada por caries / Remineralizing potential of 38% silver diamine fluoride in dentin affected by dental caries

Introducción: la caries es una enfermedad compleja que afecta a cualquier edad. La prevalencia es mayor en la primera dentición, sobre todo en población con baja percepción económica. El fluoruro diamino de plata (FDP) al 38% ha sido utilizado como una alter- nativa de tratamiento para esta enfermedad. Funciona como una solución remineralizante y cariostática. Objetivo: evaluar el efecto remineralizante del FDP al 38% en dentina afectada por lesiones de caries en molares temporales. Material y métodos: estudio clínico, epidemiológico, descriptivo, longitudinal y experimental. Se llevó a cabo en molares de primera dentición de niños de tres a cinco años de edad. Los niños seleccionados tenían molares con lesiones cariosas dentinarias, Pitts las denomina D3. No se incluyeron niños con dientes que presentaron patologías pulpares irreversibles. La aplicación del FDP al 38% la efectuó un operador entrenado para esta finalidad. Se utilizaron los criterios de Nyvad para determinar el grado de dureza de la dentina y con ello deducir su remineraliza- ción. Se observó la permanencia de la remineralización efectuada por un periodo de cinco meses. Resultado y conclusión: el FDP es un compuesto eficaz en 91% de los casos en un periodo de cinco meses o más (AU)

Introduction: dental caries is a complex disease that affects any age. The prevalence is higher in primary dentition, especially in a population with low economic perception. 38% silver diamine fluoride (FDP) has been used as an alternative treatment for this disease. It works as a remineralizing and cariostatic solution. Objective: to evaluate the remineralizing effect of 38% FDP on dentin affected by dental caries, in temporary molars. Material and methods: clinical, epidemiological, descriptive, longitudinal and experimental study. It was carried out in temporary molars of children between three and five years of age. The selected children presented molars with dental carious lesions, Pitts calls them D3. Children with teeth that presented irreversible pulp pathologies were not included. The application of the FDP to 38% was carried out by an operator trained for this purpose. The Nyvad criteria were used to determine the degree of hardness of the dentin and thereby deduce its remineralization. The permanence of the remineralization carried out was observed for a period of five months. Result and conclusion: the FDP is an effective compound in 91% of the cases, in a period of five months or more (AU)

Perfil de caries de la infancia temprana / Profile of early childhood caries

La Caries de la Infancia Temprana (CIT) se ha descrito como una patología de origen multifactorial en niños hasta los 71 meses de edad. Se considera como Ca-ries de la Infancia Temprana Severa (CITS) cuando a los 3 años el índice ceod es ≥ 4; a los 4 años, ≥ 5, y a los 5 años ≥ 6. La rehabilitación de las lesiones provo-cadas por esta patología puede ser compleja debido a la calidad y cantidad de estructura remanente y a la edad de los pacientes afectados. Objetivos: Estimar la frecuencia de CIT y CITS en niños menores a 72 me-ses que concurrieron para su atención, e identificar el tipo de práctica realizada, y la adhesión al trata-miento. Métodos: Diseño retrospectivo observacional sobre las historias clínicas de pacientes menores a 72 meses asistidos por los cursantes de la Especiali-zación en Odontopediatría, entre febrero 2021 y julio 2022. Resultados: La muestra quedó constituida por 101 niños, de 46+13,5 meses. El 91% presentó CITS. La totalidad de los pacientes mantuvieron lactancia nocturna prolongada después del año, siendo en el 72,3% a libre demanda durante el sueño, en un perío-do de 23+6 meses. Se registró un total de 1010 lesio-nes de caries. El 29,3% de los pacientes abandonaron el tratamiento. Conclusiones: La mayor parte de los niños presentaron Caries de la Infancia Temprana Severa, con altos valores de patología y lactancia noc-turna prolongada a libre demanda después del año Los tratamientos recomendados en estos casos son muy prolongados y requieren de prácticas invasivas, complejas y de alto costo, lo que provoca el abandono del tratamiento (AU)

Early childhood caries (ECC) is defined as a multifactorial disease in children 71 months of age or younger. When the dmft index is ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) it is referred to as Severe early childhood caries (SECC). Management of ECC is complex due to the quality and quantity of remaining structure of teeth at an early age. Objectives: To estimate the frequency of ECC and SECC in children < 72 months of age undergoing comprehensive treatment, to identify the type of treatment provided and treatment compliance. Methods: Retrospective observational design on dental records of patients under 72 months of age treated by Pediatric Dentistry Specialty Program students between February 2021 and July 2022. Results: The sample included 101 children, mean age 46+13.5 months, 91% of patients with SECC. All patients were fed nightly for over 1 year, 72.3% of whom were fed nightly on demand over a period of 23±6 months. A total of 1010 caries lesions were detected. 29.3% of children discontinued treatment. Conclusions: Most of the children presented severe early childhood caries with high values of pathology and prolonged nocturnal breastfeeding on demand after one year. The recommended treatments in these cases are very long and require invasive, complex and expensive practices, which causes abandonment of the treatment (AU)

Mantenedor de espacio funcional elaborado con corona de NuSmile / Elaborated functional space maintainer with zirconia NuSmile crown

La caries de la infancia temprana, al igual que otras formas de caries, se caracteriza por ser multifactorial, infecciosa y de rápida evolución. Puede presentarse como lesiones cavitadas o no cavitadas, se diagnostica principalmente en menores de seis años en la superficies de los dientes anterosuperiores, debido a que son los primeros órganos dentales en erupcionar y tienen mayor contacto con el estímulo cariogénico. En casos severos pueden llegar a ocasionar la pérdida de órganos dentales, influyendo en la salud general del paciente y repercutiendo en su autoestima y desarrollo psicosocial. Para devolver las características y funciones perdidas en ausencia de algún órgano dental, se recurre a sustituirlo mediante aparatología, mayormente en forma de un mantenedor de espacio funcional. Las necesidades estéticas individuales de cada caso generan diversas alternativas para adaptarnos a la situación del paciente (AU))

Early childhood caries, like other forms of caries, is characterized by being multifactorial, infectious, and rapidly evolving. It can present as cavitated or uncavitated lesions, it is mainly diagnosed in children under six years of age on the surfaces of the anterior superior teeth, because they are the first dental organs to erupt and have greater contact with the cariogenic stimulus. In severe cases they can cause the loss of dental organs, influencing the general health of the patient and impacting on their self-esteem and psychosocial development. In order to restore the lost features and functions in the absence of any dental organ, it is resorted to by means of appliances, mostly in the form of a functional space maintainer. The individual aesthetic needs of each case generate various alternatives to adapt to the patient's situation (AU)

Complications following replantation of primary teeth: a case report / Complicações após reimplante de dentes decíduos: um relato de caso clínico

Abstract Introduction: the avulsion of primary teeth is a disturbing and unexpected event. Description: this report describes the clinical case of a three-year-old child who suffered an avulsion and replantation of the primary upper central incisors at the site of the injury. The guardians sought treatment for the child at the Federal University of Minas Gerais after the replantation. Four months later, the child suffered a new trauma and the replanted teeth presented advanced mobility, root resorption and fistula. The clinical conduct was extraction and rehabilitation with a fixed esthetic maintainer. Discussion: the literature describes two treatment options for avulsion of primary incisors: replantation and non-replantation. According to a recent systematic review, the difficulty in obtaining a consensus regarding the best clinical conduct is due, in part, to the scarcity of publications that present not only follow-ups with clinical success, but also with failures. The outcomes of replantation can be influenced by several factors. The time elapsed between replantation and splinting, and the new episode of trauma, negatively influenced the prognosis in the present case, leading to failure. Replantation of primary incisors is not yet evidence-based treatment. Therefore, this option must be chosen with caution and in ideal situations. It requires constant clinical and radiographic monitoring for evaluation of outcomes.

Resumo Introdução: a avulsão de dentes decíduos é um evento perturbador e inesperado. Descrição: o presente relato descreve o caso clínico de uma criança de três anos que sofreu avulsão e reimplante dos incisivos centrais superiores decíduos no local do acidente. Os responsáveis procuraram atendimento para a criança na Universidade Federal de Minas Gerais após reimplante. Quatro meses depois, a criança sofreu novo trauma e os dentes reimplantados apresentavam mobilidade avançada, reabsorção radicular e fístula. A conduta clínica foi extração e reabilitação com mantenedor estético fixo. Discussão: a literatura descreve duas opções de tratamento para avulsão de incisivos decíduos: o reimplante e o não reimplante. De acordo com revisão sistemática recente, a dificuldade de se obter um consenso sobre a melhor conduta clínica se deve, em parte, à escassez de publicações que apresentem não apenas acompanhamentos com sucesso clínico, mas também com falhas. O reimplante pode ser influenciado por vários fatores. O tempo decorrido entre o reimplante e a contenção, e o novo episódio de trauma, influenciaram negativamente o prognóstico do presente caso, levando ao insucesso. O reimplante de incisivos decí- duos ainda não é um tratamento baseado em evidências. Portanto, essa opção deve ser escolhida com cautela e em situações ideais. Requer monitoramento clínico e radiográfico para constante avaliação do desfecho.

Traumatic Dental Injuries Occurred in Primary Teeth and their Sequel Effects on the Developmental Permanent Successors: A Controlled Study

ABSTRACT Objective: To examine the types of traumatic dental injuries of the primary teeth (TDI-p) and the long-term sequelae on permanent dentition (LSP) comparing with a control group (CG). In addition, a questionnaire that measures parents' knowledge and awareness was used. Material and Methods: The trauma group (TG) consisted of permanent teeth following TDI-p exposed teeth, while the CG consisted of permanent teeth following unexposed teeth with TDI-p of the same patients. In total, 141 teeth were evaluated in 27 patients. Data concerning such as teeth, when TDI-p occurred, types of treatments and types of LSP were collected. Chi-square test was used for intergroup comparison for gender, type of trauma, LSP, age of trauma and parameters in the parental information questionnaire. Significance level was p<0.05. Results: A statistically significant difference was found in the analysis between TG and CG (p<0.001). The prevalence of LSP due to TDI-p was 29.6% and the prevalence of sequelae in CG was 7.4%. The most common LSP was enamel hypoplasia (14.8%). Parents were aware of the importance of TDI-p, and they had insufficient knowledge about its management. Conclusion: TDI-p can be considered a high-risk factor in the development of LSP. Also, the lack of knowledge in parents should be supported by software-based application systems to be developed.

Dental trauma with intrusive luxation and six-year monitoring: clinical case report / Traumatismo dentário com luxação intrusiva com acompanhamento de seis anos: relato de caso clínico

Objective: this study is designed to report a clinical intrusion case, which exhibited enamel hypoplasia on the crown of tooth 11 and which underwent clinical and X-ray monitoring for six years. Case report: A threeyear- old female patient exhibited intrusion of deciduous teeth 51, 52, 61, and 62. After X-ray, it was detected that teeth 51 and 61 had perforated the nasal cavity floor, but all four teeth had re-erupted and began to be monitored. After six months, teeth 51 and 61 exhibited bone loss in the interproximal area, as well as mobility, which led to tooth extraction. Teeth 52 and 62 re-erupted in a satisfactory position, and exhibited no signs and symptoms of infection, periapical alteration, or mobility. These teeth were therefore maintained in the arch. After six years, it was detected that tooth 11 had erupted with enamel hypoplasia. Final considerations: Longterm clinical and X-ray control proved essential, as it allowed for the early diagnosis of potential alterations, and minimized potential sequelae to the permanent teeth.(AU)

Objetivo: relatar um caso clínico de intrusão com acompanhamento clínico e radiográfico de 6 anos, que apresentou hipoplasia de esmalte na coroa do dente 11. Relato de caso: paciente de 3 anos, sexo feminino, apresentou intrusão dos dentes decíduos 51, 52, 61 e 62. Após radiografia, foi detectado que os dentes 51 e 61 tinham perfurado o soalho da fossa nasal, porém, ocorreu re-erupção dos 4 dentes e foi realizado acompanhamento. Após 6 meses, nos dentes 51 e 61, foram observadas perda óssea na região interproximal e mobilidade, optando-se pelas exodontias. Os dentes 52 e 62 re-erupcionaram em posição satisfatória e com ausência de sinais e sintomas de infecções, alterações periapicais e mobilidade, sendo mantidos no arco. Após 6 anos, foi observado que o dente 11 erupcionou apresentando hipoplasia de esmalte. Considerações finais: mostrou-se essencial o controle, clínico e radiográfico, em longo prazo, diagnosticando precocemente possíveis alterações e minimizando sequelas que podem acometer os dentes permanentes.(AU)

How does orofacial trauma in children affect the developing dentition? Long-term treatment and associated complications.

Each year, millions of children are injured and live with the consequences of those injuries. Through infancy and childhood, orofacial trauma caused by falls or being struck by or against objects occurs in children. The long-term implications on the developing permanent teeth are little known, even when the oral region is the second most frequently injured body area in children under 6 years of age. During this period, the developing permanent teeth may be directly involved after trauma, causing mild to severe hypoplasia, displacement, damage to the tooth germ, or an extended range of morphofunctional disturbances. In some cases, the effects of oral and dental injuries caused by trauma appear later with the eruption of the permanent incisors when ectopic eruption, malalignments, and other developmental disturbances become visible. Therefore, long-term follow up of the patient in order to diagnose and treat associated complications becomes essential. Critical points for facing the consequences of orofacial trauma on the developing dentition are to recognize the impact of orofacial trauma in young children and the dentist's role in providing anticipatory guidance to parents and health care professionals, differentiate between mild and severe disturbances affecting the developing permanent teeth after oral injuries in early childhood, recognize the importance of follow-up controls, and recognize the importance of early referral to a pediatric dentist and orthodontist for diagnosis and treatment planning.

Trauma in primary teeth and its effect on the development of permanent successors: a controlled study.

Objective: This controlled study investigated the occurrence of sequelae to permanent successors (SPS) following traumatic dental injury in primary teeth (TDIp). Additionally, this study evaluated whether TDIp is a risk factor for SPS, with a focus on an association between SPS and the child's age and type of trauma. Materials and methods: The trauma group (TG) consisted of permanent teeth, whose antecessors had suffered TDIp, in a population of children with complete eruption of permanent teeth. The control group (CG) consisted of permanent teeth from the same individuals, whose antecessors had not suffered TDIp. There were 214 cases of TDIp with their respective permanent teeth. In the CG 247 permanent teeth, whose antecessor had not suffered TDIp, were included. Data concerning such teeth and when TDIp occurred (in terms of the child's age) and types of SPS were collected. The chi-square test, regression logistic with generalized estimating equations (GEE) test, and risk analyses were applied to investigate the associations. Results: Overall, 29% of the permanent teeth in the TG presented SPS. This was compared to the development disturbances in the CG, which was 7%. The TG demonstrated the highest risk for SPS (OR, 5.388; p = .0001). The discolouration of enamel (37%) was the most common type of SPS found. SPS was more prone to occur in permanent teeth whose antecessors had been intruded (39%; p < .001). TDIp when the child was 1-year old was associated with SPS (p < .001). Moreover, children who had TDIp had a 4.1 times higher risk of presenting SPS. Conclusions: TDIp is a risk factor for the development of SPS. All types of TDIp caused SPS in this research. Additionally, the younger ages at the time of the injury and intrusions were related to SPS.

Dental trauma on primary teeth at different root resorption stages-A dynamic finite element impact analysis of the effect on the permanent tooth germ.

BACKGROUND/AIM: Dental trauma is a common emergency in children with primary teeth. The aim of this study was to determine stress propagation to the permanent tooth germ and surrounding bone and soft tissues during dental trauma to primary central incisors with three levels of physiological root resorption. MATERIAL AND METHODS: Stresses were determined using finite element analysis (FEA). Cross-sectional models were created using cone-beam computed tomography images of 3.5, 5, and 6 years olds, representing three different physiological root resorption stages of a maxillary primary central incisor. The models included periodontal ligament, bone, and soft tissues. An impact with an asphalt block moving at 1 m/s,was simulated for two impact two directions, frontal on the labial tooth surface, and on the incisal edge. Stresses and strains were recorded during impact. RESULTS: The impact caused stress concentrations in the surrounding bone and soft tissues and permanent tooth germ, regardless of the direction of impact and the primary tooth resorption stage. Impact stresses in dental follicles and surrounding bone increased in models with more physiological root resorption of the primary tooth. Incisal impact generated higher stress concentrations in surrounding bone and soft tissues and permanent tooth germ regardless of physiological root resorption stage. The primary incisor with no physiological root resorption showed high stress concentrations at its root apex. CONCLUSION: During impact to a primary incisor, stresses most significant for potential damage to the formation of permanent enamel and dentin were at the dental follicle and surrounding bone tissue with the three levels of physiological root resorption.

Edema em lábio superior associado à alveólise de dente decíduo / Edema em lábio superior associado à alveólise de dente decíduo

Introdução: As úlceras traumáticas são caracterizadas por episódios breves e dolorosos, mas podem se tornar crônicas se o agente causador não for eliminado. A alveólise é uma alteração que pode ocorrer durante o processo de reabsorção da raiz do dente decíduo, caracterizada por sua exposição à cavidade bucal, sem reabsorção. Objetivo: Descrever o caso de uma paciente com edema no lábio superior devido à úlcera traumática causada pela exposição do ápice da raiz de um incisivo decíduo. Relato do caso: Paciente do sexo feminino, 5 anos de idade. Após exame clínico, deduziu-se que o edema labial associado com uma úlcera causada pelo contato constante com o ápice do dente que sofreu alveólise. O tratamento consistiu na extração do dente e proservação da úlcera na mucosa labial. A extração favoreceu a erupção do incisivo permanente, permitiu a cicatrização completa da lesão traumática e a remissão do edema no lábio superior. Conclusão: Embora simples, o caso ressalta a necessidade de o profissional reconhecer a alveolise, possíveis complicações associadas e a maneira adequada de tratá-las. Um caso aparentemente complexo foi resolvido simplesmente devido ao diagnóstico e tratamento adequados(AU)

Introducción: Las úlceras traumáticas se caracterizan por episodios breves y dolorosos, pero pueden llegar a ser crónicas si no se elimina el agente causal. La alveólisis es una alteración que puede ocurrir durante el proceso de reabsorción de la raíz del diente primario, caracterizada por su exposición a la cavidad bucal, sin reabsorción. Objetivo: Describir el caso de una paciente con edema en el labio superior debido a la úlcera traumática causada por la exposición del ápice de la raíz de un incisivo primario. Presentación del caso: Paciente del sexo femenino, de 5 años de edad. Después del examen clínico, se dedujo que el edema del labio estaba relacionado con la úlcera causada por el contacto constante con el ápice del diente que ha sufrido alveólisis. El tratamiento consistió en la extracción del diente y preservación de la úlcera en mucosa labial. La extracción favoreció la erupción del incisivo permanente, permitió la curación completa de la lesión traumática y la remisión del edema en el labio superior. Conclusiones: Aunque simple, el caso destaca la necesidad de que el profesional reconozca la alveólisis, posibles enfermedades asociadas y la forma adecuada de tratarlas. Un caso aparentemente complejo se resolvió simplemente debido a un diagnóstico y tratamiento adecuados(AU)

Introduction: Traumatic ulcers are characterized by short and painful episodes, but can become chronic if the causative agent is not removed. Alveolisis is an alteration that may occur during the primary tooth root resorption process, characterized by its exposure to the oral cavity, without resorption. Objective: To describe the case of a patient with an important edema and associated pain in the upper lip due to traumatic ulcer caused by exposure of the root apex of a primary incisor. Case presentation: Female patient aged 5 years old. After clinical examination, it was deduced that the lip swelling was related to the ulcer that was caused by the constant contact with the apex of the central incisor that has undergone alveolisis. The treatment consisted in the extraction of the tooth and the preservation of the labial mucosa ulcer. The extraction favored the eruption of the permanent incisor, allowed the complete healing of the traumatic lesion and the remission of the upper lip edema. Conclusions: Although simple, the case highlights the need for the professional to recognize the alveolisis and the possible associated complications as well as the appropriate way to manage them. A seemingly complex case was solved simply due to correct diagnosis and treatment(AU)

Canine transposition as an alternative to trauma of the maxillary incisors: case report.

OBJECTIVE: The present article aims at reporting the clinical case of a patient who suffered trauma at two years of age, causing almost complete apical displacement of the deciduous maxillary left central incisor and of the permanent incisor. METHODS: Ectopia secondary to intrusion was minimized by surgical removal of the ectopic tooth, and the left permanent canine was submitted to orthodontic traction to replace the extracted tooth. RESULTS: The treatment period lasted 36 months, resulting in correct occlusion and a good aesthetic outcome. CONCLUSIONS: Dental transposition carried out by means of orthopedic traction is a good alternative in cases of a very unfavorable ectopic tooth position.

Frequency of crown and root dilaceration of permanent incisors after dental trauma to their predecessor teeth.

BACKGROUND/AIMS: Dental trauma to the predecessor teeth can cause crown and root dilacerations to the successor teeth, which can interfere with the normal development of permanent teeth. The aims of this study were to verify the types of trauma more frequent to the predecessor teeth that cause dilaceration to their successor teeth, to determine the frequency of crown and root dilacerations in permanent incisors, taking into account the child's age at the time of trauma, and to describe the types of treatment performed. MATERIALS AND METHODS: Details of 815 anterior primary teeth with dental injury were obtained from 483 dental records of children aged 0-9 years at the time of trauma. RESULTS: Of 815 traumatized primary teeth, 161 successor teeth were clinically and radiographically reviewed until complete eruption and had some type of sequel. Avulsion and intrusive luxation were the most frequent types of trauma to the predecessor teeth that caused dilaceration to their successor teeth. Enamel discoloration (30.4%), hypoplasia (23.6%), root (14.3%) and crown (9.9%) dilacerations were the most common sequelae observed in the successor teeth. Root and crown dilacerations were more frequent in children aged more than and up to 3 years, respectively. Tooth extraction and orthodontic treatment were the most common treatments. CONCLUSIONS: Dentists must be aware of the relationship between the child's age at the time of trauma to the predecessor tooth and the type of sequel to the successor tooth in order to diagnose, monitor, and treat the sequel properly.

Canine transposition as an alternative to trauma of the maxillary incisors: case report

ABSTRACT Objective: The present article aims at reporting the clinical case of a patient who suffered trauma at two years of age, causing almost complete apical displacement of the deciduous maxillary left central incisor and of the permanent incisor. Methods: Ectopia secondary to intrusion was minimized by surgical removal of the ectopic tooth, and the left permanent canine was submitted to orthodontic traction to replace the extracted tooth. Results: The treatment period lasted 36 months, resulting in correct occlusion and a good aesthetic outcome. Conclusions: Dental transposition carried out by means of orthopedic traction is a good alternative in cases of a very unfavorable ectopic tooth position.

RESUMO Objetivo: o presente relato de caso descreve uma paciente que sofreu trauma aos dois anos de idade, causando deslocamento apical quase completo do incisivo central esquerdo decíduo e do incisivo permanente. Métodos: a ectopia resultante da intrusão foi minimizada pela remoção cirúrgica do dente ectópico, e o canino permanente esquerdo foi tracionado ortodonticamente para substituir o dente extraído. Resultados: o período de tratamento durou 36 meses, obtendo-se uma oclusão correta e um bom resultado estético. Conclusões: a transposição dentária realizada através da tração ortopédica é uma boa alternativa em casos de dentes ectópicos em posições muito desfavoráveis.

Profile of intrusive luxation and healing complications in deciduous and permanent teeth - a retrospective study.

OBJECTIVE: This retrospective study analyse the profile of intrusion in deciduous (DT) and permanent teeth (PT), the occurrence of healing complications (HC), type of treatments and predisposing factors. METHODS: The records of patients attended from 2005 to 2011 were analysed. Records of patients who had one or more intruded DT or PT were included in the study. Data collected from dental records included age, gender, attendance (immediate/mediate), healing complications and type of treatment. A Chi-square test and Logistic regression (p ≤ .05) were performed to evaluate the associations between the type of teeth and presence of HC, as well as to explore the interactions between predisposing factors. RESULTS: The intrusion prevalence was 9.98% in DT and 2.45% in PT. Partial intrusion (57.3%) with palatal direction of the crown (61.8%) was most prevalent in DT, while complete intrusion (56.7%) with buccal direction of the crown (58.1%) was predominant for PT. Mobility was the most common HC in DT compared to root resorption in PT. Minimally invasive treatments were the most common therapy for DT compared to invasive treatments for PT. PT demonstrated increased HC when compared to DT (p = .004). A logistic regression illustrated that the level of intrusion and crown direction during the trauma did not influence the occurrence of HC (p > .05). CONCLUSION: Intrusion's profile in DT and PT are different. PT showed more HC than DT, however the level of intrusion and crown direction were not associated with the presence of HC.

Traumatismos nos dentes decíduos anteriores e alterações clínicas nos seus sucessores / Traumatic dental injury in anterior primary teeth and clinical changes in their successor

O traumatismo em dentes decíduos pode interferir na odontogênese de seus dentes sucessores. Este estudo controlado investigou se sequelas clínicas nos dentes permanentes anteriores (SqP) estão relacionadas aos traumatismos nos dentes decíduos. Além disto, também foram testados possíveis fatores influenciadores para o surgimento destas sequelas, como idade, tipo de trauma, presença de sequela no dente decíduo e tempo de procura por atendimento. O grupo de estudo foi composto por crianças que tiveram traumatismos na dentição decídua e apresentavam seus dentes sucessores completamente erupcionados. O grupo controle consistiu de crianças com dentes permanentes anteriores erupcionados e sem história de traumatismo dentário. Os dados foram submetidos ao teste chi-quadrado e de Equações de Estimações Generalizadas (GEE) (p < 0,05). No total, 28,5% dos dentes permanentes no grupo estudo apresentaram sequelas clínicas nos dentes permanentes, prevalecendo a alteração de cor do esmalte e a hipoplasia. A prevalência de alterações no grupo controle foi de 2,5%. A idade até 1 ano no momento do trauma foi associada à presença de SqP (p<0,001; p<0,028 ), assim como a intrusão (p<0.0001). Em relação ao tempo de procura por atendimento odontológico, a busca tardia (mais de 6 meses) foi associada à presença de SqP (p<0,0001). Quando as sequelas nos dentes decíduos foram analisadas, a reabsorção radicular patológica foi associada a SqP(p<0,02). Crianças com traumatismos na dentição decídua apresentaram um maior risco de sequelas clínicas nos dentes sucessores, (OR: 10.5; CI = 4.357 ­ 25.729; p = 0.0001). Conclui-se que a o traumatismo no dente decíduo é um fator de risco para a presença de SqP e esta pode ter influência da pouca idade no momento do traumatismo, assim como, da presença de subluxação e intrusão, sequela no decíduo e busca tardia por atendimento odontológico. (AU)

Traumatic dental injury to primary teeth can interfere with the odontogenesis of your successor teeth. This controlled study investigated if clinical sequelae in anterior permanent teeth (SqP) are related to trauma to primary teeth. In addition, we also tested possible influencing factors for the occurrence of these sequels, such as age, type of trauma, presence of sequelae in the deciduous tooth and time of demand for care. The study group consisted of children who had trauma to the deciduous dentition and presented their successors with fully erupted teeth. The control group consisted of children with erupted anterior permanent teeth with no history of dental trauma. Data were submitted to chi-square test and Generalized Estimates (GEE) (p <0.05). In total, 28.5% of the permanent teeth in the study group presented clinical sequelae in the permanent teeth, prevailing the enamel color change and hypoplasia. The prevalence of changes in the control group was 2.5%. The age of 1 year at the time of trauma was associated with the presence of SqP (p <0.001; p <0.028), as well as intrusion (p <0.0001). Regarding the time of demand for dental care, the late search (more than 6 months) was associated with the presence of SqP (p <0.0001). When the sequelae in the deciduous teeth were analyzed, pathological root resorption was associated with SqP (p<0.02). Children with trauma to the deciduous dentition presented a higher risk of clinical sequelae in successor teeth (OR: 10.5; CI = 4.357 - 25.729; p = 0.0001). It is concluded that the trauma is a risk factor for the presence of SqP and this may have influence of the young age at the moment of the trauma, as well as of the subluxation and intrusion, sequelae in the deciduous and late search for dental care. (AU)