Review of Approaches to the Management of Vertical Dental Root Fractures and Tooth Preservation.

A vertical root fracture (VRF) is a complex condition in which the fracture lines can be partial or complete and extend along the long axis of the tooth. Considering the nature of the damage and the low likelihood of a successful outcome, such fractures can be difficult to manage. Their management typically involves complex endodontic or surgical procedures, which can be technically challenging for general dentists. Recent advancements introduce promising techniques, such as intentional replantation, adhesive methodologies, and regenerative procedures, showcasing potential in salvaging teeth affected by VRFs. Nonetheless, the imprecise nature of symptoms necessitates meticulous case evaluation by clinicians. Comprehensive patient counseling regarding diverse treatment options and potential ramifications remains crucial to preserving the affected tooth. Preserving a vertically fractured tooth aids in improving both function and aesthetics while safeguarding the arch's integrity by maintaining the height of the alveolar bone. It is important to note that the success of the treatment procedures depends on the extent and location of the fracture, the condition of the tooth and fragment, and the skill of the dental professional performing the treatment. This review highlights the complexity of VRF management, emphasizing the necessity for precise evaluation, patient education, and the exploration of innovative techniques. It aims to review the treatment of VRFs, ranging from classical to contemporary methods, with a focus on tooth preservation. The establishment of standardized protocols and conduct of further research to ascertain long-term efficacy are imperative in optimizing outcomes and retaining natural dentition in cases of VRFs.

Impact of Type 2 Diabetes Mellitus on the Occurrence of Vertical Root Fracture: A Case Control Study.

INTRODUCTION: The aim of this case-control study was to examine the relationship between type 2 diabetes mellitus (DM) and the occurrence of VRFs. The crack extension, dentin sclerosis, and chemical characteristics of root dentin in teeth with VRF from patients with/without DM were also compared. METHODS: One hundred and thirty-two patients diagnosed with VRF in crowned root filled posterior teeth were selected. The study was conducted in 2 parts. In Part-1: The cases were matched with control teeth (1:1) for age (±5 years), sex, tooth type, apical extent of root filling, time period after root filling to a diagnosis of VRF, presence or absence of intracanal post and abutment status. The presence or absence of type 2 DM (HbA1c > 6.5) was recorded. In Part-2: The extracted teeth with VRF from the case control study were used to evaluate the extension of VRF, presence of sclerotic dentin and isthmus using a microscopic analysis; while the levels of pentosidine, collagen cross-linking ratio and mineral-collagen ratio were determined by Fourier-transform infrared spectroscopy. The distribution of DM between cases and controls was analyzed using Pearson Chi-Square test and Odds Ratio estimated. Chemical composition data was analyzed using Mann-Whitney test. The extent of sclerotic dentin was analyzed using Pearson Chi-Square test. RESULTS: When compared to patients without DM, patients with DM had 2.67 (95% CI: 1.6-4.45) folds higher odds for occurrence of VRF. Pentosidine (P = .014), collagen cross-linking ratio(P = .047), mineral-collagen ratio (P = .009) and sclerotic dentin extent (P = .0009) were significantly higher in patients with DM and VRF. CONCLUSIONS: Type 2 DM was more often associated with VRFs in root canal treated teeth with crowns. Root dentin from patients with type 2 DM and VRF had higher levels of pentosidine, collagen cross-linking ratio, mineral to collagen ratio and sclerotic dentin.

Abordagem multidisciplinar no tratamento de incisivo lateral com fratura oblíqua e lesão periapical: relato de caso clínico / Multidisciplinary approach in the treatment of lateral incisor with oblique fracture and periapical injury: clinical case report

Casos de fraturas dentárias oblíquas muitas vezes possuem um prognóstico desfavorável, geralmente com indicação da extração do elemento dental. O presente artigo visou relatar o tratamento do caso clínico de um paciente do sexo masculino, 12 anos, que compareceu à Unidade de Saúde Bucal do Hospital Universitário de Brasília com encaminhamento de extração do dente 12, apresentando fratura oblíqua que se estendia subgengivalmente na face vestibular. O trauma havia ocorrido há três anos e o paciente havia sido submetido a diversas intervenções endodônticas, apresentando no momento da consulta inicial por nossa equipe uma lesão periapical extensa. Após a realização da anamnese, exame clínico e radiográfico, foi adotada uma abordagem multidisciplinar conservadora com a manutenção do dente e a realização da enucleação da lesão periapical por meio de intervenção cirúrgica e posterior reabilitação. Em uma mesma sessão, foi realizada a obturação do conduto com cone de guta percha e cimento sealer 26 e a cirurgia parendodôntica juntamente com a apicoplastia. Uma semana após a intervenção cirúrgica foi realizada restauração classe IV com resina composta baseada no enceramento dos modelos de diagnóstico montados em articulador. Com base em uma avaliação criteriosa e multidisciplinar, foi possível adotar uma abordagem conservadora no caso em questão, com a manutenção e reabilitação de um dente permanente em um paciente jovem, evitando a indicação de exodontia(AU)

Cases of oblique dental fractures often have an unfavorable prognosis, usually with the indication of extraction of the dental element. The present article aimed to report the treatment of the clinical case of a 12-year-old male patient, who attended the Oral Health Unit of the Hospital Universitário de Brasília with a referral for extraction of tooth 7, presenting an oblique fracture that extended subgingivally on the labial surface. The trauma had occurred three years ago and the patient had undergone several endodontic interventions, presenting an extensive periapical lesion at the time of the initial consultation by our team. After anamnesis, clinical and radiographic examination, a conservative multidisciplinar approach was adopted with the maintenance of the tooth and the enucleation of the periapical lesion through surgical intervention and subsequente rehabilitation. In the same session, the conduit was filled with gutta-percha cone and sealer cement 26 and parendodontic surgery was performed together with apicoplasty. One week after the surgical intervention, class IV restoration was performed with composite resin based on the waxing of the diagnostic models mounted on an articulator. Based on a careful and multidisciplinary evaluation, it was possible to adopt a conservative approach in the case in question, with the maintenance and rehabilitation of a permanent tooth in a young patient, avoiding the indication of extraction(AU)

Odontocrexis / Odontocrexis / Odontocrexis

Los cambios en la presión atmosférica pueden ocasionar patología odontológica en personas que presentan dientes con caries, obturaciones deficientes o temporales y en todas aquellas lesiones cavitadas donde puedan quedar albergadas burbujas de aire.Se presenta el caso clínico de un buceador de la Armada Española que acude al servicio de odontología de la Jefatura de Apoyo Sanitario del Arsenal de Cartagena, por presentar fractura dental completa, “odontocrexis”, derivado de la expansión volumétrica de los gases en el ascenso a la superficie terrestre durante la realización de un ejercicio de buceo militar. (AU)

Changes in atmospheric pressure can cause dental disease in people with decayed teeth, poor or temporary fillings, and in all cavitated lesions where air bubbles can be lodged.The clinical case of a diver from the Spanish Navy who attends the dentistry service of the Sanitary Support Headquarters of the Cartagena Arsenal is presented, due to presenting a complete dental fracture, “odontocrexis”, derived from the volumetric expansion of the gases during the ascent to the ground during a military diving exercise. (AU)

Mudanças na pressão atmosférica podem causar patologia dentária em pessoas com dentes cariados, obturações deficientes ou temporárias e em todas as lesões cavitadas onde bolhas de ar podem se alojar.É apresentado o caso clínico de um mergulhador da Marinha Espanhola que frequenta o serviço de odontologia do Quartel de Apoio Sanitário do Arsenal de Cartagena, por apresentar uma fratura dentária completa, “odontocrexia”, decorrente da expansão volumétrica dos gases durante a subida ao solo durante um exercício de mergulho militar. (AU)

Awareness and Preferred Mode of Getting Information on First Aid Management of Avulsed Permanent Teeth: Survey of Nigerian Mothers

ABSTRACT Objective: To determine the awareness and sources of information on first aid management of avulsed permanent teeth in a group of South-western Nigerian mothers. Material and Methods: An 18-item interviewer-administered questionnaire was used to survey 385 mothers attending the antenatal and immunization clinics on their perception towards dental avulsion, its management, sources, and preferred mode of receiving information on first aid. The effect of all significant factors was inferred at p<0.05. Results: Mothers who had previous information on the first aid management of dental avulsion had significantly higher knowledge (p=0.000). Majority (80.8%) of the mothers did not know that an avulsed permanent tooth could be replanted, though mothers whose children had not experienced dental trauma had significantly higher knowledge (p=0.003). The knowledge of first aid management of avulsed permanent tooth was low, regardless of age, education and employment status of the respondents. Conclusion: There was low knowledge among mothers regarding the first aid measures in the management of avulsed permanent teeth. Their main preference for receiving information was through social media and television. There is a need to increase oral health educational campaigns targeted towards mothers.

A 10-year retrospective study of dental trauma in permanent dentition / Estudio retrospectivo de 10 años sobre trauma dental en la dentición permanente

Objective. This study aims to identify the characteristics and factors associated with TDI treated at a referral service. Material and methods. A ten-year period cross-sectional retrospective analysis of medical records of patients with TDI in their permanent teeth was performed, and injury-related data were collected. Statistical analysis was performed using the chi-square association test and complex analysis (p<0.05). Results. Records of 545 patients, totaling 1438 traumatized teeth, were evaluated, and a male prevalence at a 2.4:1 ratio was found. The age group with highest incidence was 13-19 years. Central maxillary incisors and dislocations were the most affected teeth and TDI, respectively. Statistical analysis showed different TDI causes according to age: children are often victims of falls, traffic accidents, aggression and collisions, whereas adolescents are involved in sports accidents, and young adults in traffic accidents, falls and collisions. Conclusion. Considering the scope of this retrospective study at a single referral center, a profile of young male patients with TDI in superior central incisors due to falls, collisions, traffic accidents or sports could be detected

Objetivo. Identificar las características y los factores asociados con el traumatismo dentoalveolar (TD) atendido en un servicio de referencia. Material y métodos. Ha sido realizado un análisis retrospectivo de los pacientes con TD en dientes permanentes en un período de10 años. Fueron extraídos los datos relacionados con el TD. El análisis estadístico se realizó mediante el test de asociación chi-cuadrado y el análisis de los residuos (p<0,05). Resultados. Los registros de 545 pacientes con un total de 1.438 dientes traumatizados fueron incluidos. Se constata la prevalencia en el sexo masculino, con una proporción de 2,4:1. El grupo etario con mayor incidencia fue el de 13-19 años. Los incisivos centrales superiores fueron los dientes más afectados y el traumatismo dentario más diagnosticado fueron las luxaciones. El análisis estadístico ha mostrado una asociación de diferentes causas de TD con la edad: los niños son víctimas, con mayor probabilidad, de caídas, accidentes de tránsito, agresiones y colisiones, mientras que los adolescentes los son de accidentes deportivos, y los adultos jóvenes de accidentes de tráfico, caídas y colisiones. Conclusión. Considerando el alcance de este estudio retrospectivo en un único servicio de referencia, se detectó un perfil de jóvenes pacientes del sexo masculino con la presencia de TD en los incisivos centrales superiores por las caídas, colisiones, accidentes de tráfico o prácticas deportivas

Comparison of Digital Diagnostic Value and Cone Beam Computed Tomography (CBCT) in Determining Vertical Root Fracture in Single- Root Teeth

Objective: To compare the accuracy of digital radiography and CBCT for the diagnosis of vertical root fractures in single root teeth. Material and Methods: For this descriptive-analytic study, 50 non-fractured, single-root teeth were selected. The teeth were randomly divided into a control and an experimental group (25 teeth in each group). The teeth in the control group did not have vertical root fractures. In the test group, after preparing the access cavity, the root canal was cleared and loosened up to No. 80 file, then a vertical root fracture was created by one of the K-Reamers Nos. 90- 130.The images were prepared by CBCT radiography in axial and cross-sectional slices and in digital radiography with PSP sensors at mesial, distal, and parallel angles. The Chi-square test was used to express the correlation of variables. Results: In the diagnosis of vertical root fractures, the sensitivity of CBCT in the axial section was 32% and in the cross-sectional slice it was 20%, whereas the specificity in both the sections was 100%. The sensitivity of the digital radiography in detecting vertical root fractures for parallel, mesial, and distal angles was 38%, 16%, and 24%, respectively. Conclusion: According to this study, the sensitivity, specificity, and accuracy of digital radiography and CBCT were not significantly different.

Análise das tensões sobre os dentes e núcleos intrarradiculares variando o material e a quantidade de remanescente coronário pelo método 3D de elementos finitos / Intraradicular core and teeth tensions analysis with variation of material and quantity of coronary remanescent by the 3d finite element method

Um fator de insucesso bastante frequente na terapia com núcleos metálicos fundidos é a fratura radicular dos dentes suportes. Essa situação é afetada pela quantidade de estrutura coronária remanescente, bem como o tipo de liga metálica utilizado. O objetivo deste estudo é comparar as tensões e sua distribuição em um dente incisivo central superior. Para isto, este dente foi reconstruído virtualmente a partir de uma tomografia computadorizada e, por fim, exportado para um software de edição de modelos visuais Ansys Design Modeler v10 (Ansys Inc., Canonsburg, PA, EUA). Foram analisados ainda, neste trabalho, a variação de três fatores de projeções dentinárias, bem como suas interações. Houve a criação de grupos: um modelo controle sem projeção e outros catorze modelos variando a projeção dentinária e o material utilizado na confecção do núcleo metálico fundido. A disponibilidade de 1,5 mm de estrutura dentária cervical remanescente, que proporciona o efeito férula, aumenta a resistência à fratura da raiz, fratura do núcleo e deslocamento do núcleo. A presença da férula resulta, também, em uma menor tensão na dentina do que a sua ausência. Dessa forma, a presença da férula, a altura do remanescente e o material utilizado para a confecção do núcleo metálico fundido são variáveis que afetam diretamente as tensões que atuam sobre o dente tratado endodonticamente (AU).

A frequent failure factor in the therapy with molten metal cores is the root fracture of tooth holders. This situation can be affected by the quantity of coronary remanescent structure as well as the type of alloy used. The aim of this study is to compare the tensions and their distribution in a maxillary central incisor tooth. Therefore, this tooth was virtually reconstructed from a computed tomography and finally exported to a visual models editing software Ansys Design Modeler v10 (Ansys Inc., Canonsburg, PA, USA). In this work were also analyzed the variation of three factors of dentin projections, as well as their interactions. There was the creation of groups: a model control without projection and fourteen other models varying the dentin projection and the material used in the manufacturing of the molten metal core. The availability of 1.5 mm remanescent cervical tooth structure, which provides the ferrule effect, increases resistance of root fracture, of core fracture, and core displacement. The ferrule presence also results in less tension on dentin than in its absence. Thus, the presence of ferrule, the remanescent height and the material used to manufacture the molten metallic core are variables that directly affect the tensions actuating on the endodontically treated tooth (AU).

Retrospective Study of Traumatic Dental Injuries of Patients Treated at a Dental Trauma Clinic in Santiago, Chile / Estudio retrospectivo de Casos Atendidos en Clínica de Traumatología Dentoalveolar en Santiago, Chile

ABSTRACT: The aim of this study was to carry out a retrospective study of cases seen at the Child and Adult Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile, Santiago. A retrospective study was carried out analysing the records of patients seen at the Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile from January 2012 to March 2017. The inclusion criteria was that patient complaint was due to dental trauma. Data were tabulated indicating age and sex of the patient, cause, day, and tooth involved and the initial diagnosis of the dental trauma. Chi-square, Shapiro Wilk normality test and Mann-Whitney test were used for frequency analyses. A total of 117 dental records were analysed, 90 of these met the inclusion criteria. The age range of the sample was 5 to 60 years, and the average age was 14.3 years. Most injuries occurred in patients during the first and second decades of their life. Of the patients, 59.3 % were men and 40.7 % were women. The most frequent dental traumas were complicated and uncomplicated crown fractures, followed by root fractures. In the majority of the cases analysed, only one tooth was affected, and the tooth most frequently traumatized was the right upper central incisor, followed by the left upper central incisor. The most frequent dental trauma of the cases treated at the Child and Adult Dental Traumatology Clinic, Faculty of Dentistry, Universidad de Chile, Santiago, between 2012 and 2017 were crown fractures.

RESUMEN: El objetivo fue realizar un estudio retrospectivo de los casos que acuden a la clínica de Traumatología Dentoalveolar (TDA) Pediátrica y del Adulto de la Clínica de Odontología de la Universidad de Chile. Se realizó un estudio retrospectivo analizando las fichas de pacientes atendidos en la Clínica de TDA de la Facultad de Odontología, Universidad de Chile desde enero 2012 hasta marzo 2017. El criterio de inclusión fue motivo de consulta por traumatismo dentoalveolar inmediato. Se tabularon datos consignando sexo y edad del paciente, causa, día, diente involucrado y diagnóstico inicial del TDA. Para los análisis de frecuencia se utilizó Chi-cuadrado, el test de normalidad de Shapiro Wilk y test de Mann-Whitney. Se analizaron un total de 117 fichas, donde 90 cumplieron con los criterios de inclusión. El rango de edad de la muestra fue de 5 a 60 años, con un promedio de 14,3 años. Siendo la primera y la segunda década de vida donde ocurren con mayor frecuencia los traumatismos. El 59,3 % eran hombres y 40,7 % mujeres. El TDA más frecuente fueron las fracturas coronarias complicadas y no complicadas, seguido por fracturas radiculares. En la mayoría de los casos analizados sólo un diente se encontraba afectado. El diente más frecuentemente traumatizado fue el incisivo central superior derecho, seguido por el izquierdo. Las causas más frecuentes de traumatismo fueron por caída y golpe. De los casos atendidos en la clínica de TDA de la Universidad de Chile entre 2012 y 2017 el traumatismo más frecuente es la fractura coronaria.

Lesión endo-periodontal: curación a tres años / Endo-periodontal lesion: a 3-year healing process

Las lesiones endo-periodontales pueden suponer un reto en el diagnóstico. Las imágenes radiolúcidas de furca acompañadas de sondajes profundos y aislados son compatibles con fracturas verticales, perforaciones o causas puramente endodónticas, es decir, abscesos periapicales crónicos con exacerbación por el surco gingival. Las perforaciones son complicaciones que afectan al pronóstico de la endodoncia y que desencadenan defectos periodontales. En el presente caso clínico se describe el retratamiento ortógrado con el sellado de una perforación en el tercio coronal de un primer molar inferior. Después de tres años de control, se observa curación radiográfica de ambas lesiones y una reducción de 6 mm en el sondaje periodontal

Diagnosis of endo-periodontal lesion can be challenging. Furcal radiolucencies accompanied with deep and isolated probings are compatible with vertical root fractures, perforations or with endodontic causes, that is to say, chronic periapical abscess exacerbated through the gingival sulcus.Perforations are complications that affect the prognosis of the root canal treatment and induce periodontal defects. The present case describes an orthograde root canal retreatment with a perforation sealing in the coronal third of a first lower molar. Three years after, a radiographic healing of both lesions and a reduction of 6mm periodontal probing is observed

Fracture Resistance of Endodontically Treated Teeth Restored with Different Types of Intracanal Posts

Objective: To evaluate the fracture resistance of endodontically treated teeth restored with different types of intracanal posts. Material and Methods: Sixty human upper central incisors (n = 60) were divided according to the performance of different protocols for restoration with intracanal posts. Groups without endodontic treatment (NT) and with endodontic treatment (TR) without placement of intracanal posts, served as controls. The experimental groups received endodontic treatment and were restored with: fiberglass post with composite resin filling core (PFV-NP); carbon fiber post with composite resin filling core (PFC-NP); nickel-chromium metal cast and core posts (NiCr); or copper-aluminum metal cast and core posts (CuAl). The specimens were then tested to determine the maximum fracture resistance and the failure types of fracture (infra-crestal and supra-crestal). Data were analyzed by one-way ANOVA and Tukey test (α<0.05). Results: Increased fracture resistance was observed for NT group (p<0.05). Within endodontically treated teeth groups, NiCr showed higher resistance to fracture, differing statistically from groups FV+NP and FC+NP (p<0.05). Higher frequency of infra-crestal fractures was observed in NT and TR groups. Conclusion: The installation of nickel-chromium intracanal cast and core posts contributed to higher fracture resistance and lower risk of fractures difficult to repair.

Láser Doppler y su uso en odontología / Laser Doppler and its use in dentistry

El efecto Doppler es la base científica de la flujometría láser Doppler. El efecto fue descrito por primera vez en el año de 1842 por el físico austriaco Christian Doppler en su tratado Über das farbige licht der doppelsterne und einige andere gestirne des himmels (Sobre el color de la luz en estrellas binarias y otros astros). Este principio ha permitido desarrollar técnicas y aparatos que han sido empleados en el ramo médico para medir la perfusión en diversos órganos y tejidos del cuerpo, y que han sido útiles como método diagnóstico. En la odontología, poco a poco comienza a reportarse información acerca del uso del Doppler en las diversas estructuras bucodentales, y ha demostrado ser no invasivo y de gran utilidad diagnóstica. Son pocos los estudios reportados en la rama de la odontología en cuanto a esta nueva tecnología; es importante comenzar líneas de investigación apoyadas en ella para beneficio de los pacientes.

The Doppler eff ect, the scientifi c basis of laser Doppler fl owmetry, wasfi rst described in 1842 by Austrian physicist Christian Doppler in histreatise Über das farbige Licht der doppelsterne und einige andere gestirnedes Himmels (On the Colored Light of the Binary Stars and SomeOther Stars of the Heavens). This principle has led to the developmentof techniques and devices that have been used in the fi eld of medicineto measure perfusion in various organs and tissues, and have provideda useful method of diagnosis. In dentistry, information on the use ofthis method in the various structures of the mouth has slowly begunto be published. As a result, the need for its continued use in the fi eldof oral health has become evident, given that it has proven to be noninvasiveand extremely useful in diagnosis. It is a diagnostic technique that is commonly used in healthcare and has been widely developedin the fi eld of medicine, yet there have been few reported studies of it suse in dentistry, which is an important step towards opening new linesof research based on this new technology for the benefi t of patients.

Fractura radicular vertical / Vertical root fracture

El propósito de este reporte es presentar el caso de un paciente femenino con presencia de fractura radicular vertical (FRV) de un segundopremolar superior izquierdo, remitida a la clínica de Postgrado de Endodonciade la Universidad De La Salle Bajío para remoción de poste y retratamiento dental. Una vez realizado el diagnóstico se determinó FRV mediante sondeo minucioso irregular en un solo punto con sonda flexible, ligero dolor a la masticación y pérdida ósea radiográfica en forma de halo o gota, se sugirió como tratamiento extracción dental y cirugía exploratoria a petición del paciente

The aim of this report is to present the case of a female patient with a vertical root fracture (VRF) of a maxillary second premolar who was referred to the Postgraduate Endodontic Clinic of De La Salle Bajío University in León, Guanajuato, Mexico for the removal of a metallic post and retreatment of root canals. Examination via thorough irregular periodontal probing at a single point with a fl exible probe resulted in a diagnosis of VRF, slight pain on chewing, and radiographic bone loss in the shape of a halo or droplet, for which the suggested treatment was the extraction of the tooth, a surgical procedure that was subsequently performed at the patient’s request.

Fractura radicular en piezas primarias / Root fracture in primary teeth

Los traumatismos dentarios constituyen uno de los motivos más frecuentes en la consulta odontopediátrica. Si bien las fracturas radiculares en dentición primaria son las lesiones traumáticas menos prevalentes (2-4 por ciento), son de difícil resolución y ocasionan la pérdida de dichas piezas en la mayoría de los casos. Objetivo: describir la resolución del traumatismo con fractura radicular en ambos incisivos centrales superiores primarios. Diagnóstico de la situación inicial: paciente masculino de 4 años que acude con su madre a la Cátedra de Odontología Integral Niños de la FOUBA presentando un traumatismo dental de 2 horas de evolución. Diagnóstico clínico-radiográfico: fractura radicular horizontal de tercio medio del 5.1 y 6.1 (sin reabsorción fisiológica radicular), sin desplazamiento del fragmento coronario, con laceración de labio superior y encía marginal. Secuencia de procedimientos operatorios: historia clínica con consentimiento informado; anamnesis médica y odontológica; examen clínico y radiográfico de 5.1 y 6.1 y antagonistas; limpieza de tejidos blandos con clorhexidina; impresión con alginato; confección de placa posicionadora para ferulización; prueba e instalación de la placa; indicaciones al paciente y a su madre: uso permanente durante 45 días y uso nocturno, para comer y hacer deportes 45 días más. Recomendaciones de higiene; controles inmediatos: 30 y 45 días y 3 y 6 meses. Resolución del caso: en todos los controles, ambas piezas se presentaron asintomáticas. A los 6 meses se observa la correcta cicatrización radicular y la presencia de vitalidad en ambos incisivos. Conclusiones: el tratamiento temprano y los controles posteriores son fundamentales para preservar la salud pulpar y conseguir la reparación de los tejidos duros afectados.

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 3 / Diagnosis and management of fractures teeth associated with parafunction: part 3

Presentar un tratamiento preventivo que consiste en la realización de un ajuste oclusal y de una placa neuromiorrelajante, en un paciente con facetas de desgaste debidas a parafunción. Caso clínico: un paciente de 28 años de edad consultó por un control. Se observaron facetas de desgaste patológicas en el esmalte de la pieza dentaria 4.7, con una relación cúspide/fosa profunda, por lo que se decidió realizar una remodelación oclusal y confeccionar una placa de protección neuromiorrelajante, a fin de evitar una posible fractura de la pieza. Conclusión: un diagnóstico correcto y temprano de las facetas dentarias patológicas en el esmalte y su posible tratamiento son fundamentales para evitar opsibles fracturas dentarias asociadas a la parafunción...(AU)

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 3 / Diagnosis and management of fractures teeth associated with parafunction: part 3

Presentar un tratamiento preventivo que consiste en la realización de un ajuste oclusal y de una placa neuromiorrelajante, en un paciente con facetas de desgaste debidas a parafunción. Caso clínico: un paciente de 28 años de edad consultó por un control. Se observaron facetas de desgaste patológicas en el esmalte de la pieza dentaria 4.7, con una relación cúspide/fosa profunda, por lo que se decidió realizar una remodelación oclusal y confeccionar una placa de protección neuromiorrelajante, a fin de evitar una posible fractura de la pieza. Conclusión: un diagnóstico correcto y temprano de las facetas dentarias patológicas en el esmalte y su posible tratamiento son fundamentales para evitar opsibles fracturas dentarias asociadas a la parafunción...

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 2 / Diangosis and management of fractured teeth associated with parafunction: part 2

Objetivo: presentar la resolución clínica de una fractura dentaria incompleta mediante la realización de una restauración adherida de tipo onlay. Caso clínico: un paciente de 36 años de edad consultó por dolor al masticar enl a pieza 3.7, la cual presentaba una restauración plástica oclusal. Al removerla, se observó una fractura en dirección mesiodistal, sin movilidad de ambos cabos de fractura, por lo que se realizó una incrustación adherida de tipo onlay. Conclusión: el correcto diagnóstico de una fractura dentaria incompleta y la comprensión de su etiología son fundamentales para la elección de un tratamiento conservador y con un alto grado de predictibilidad, como lo son las restauraciones adheridas tipo onlay.

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 1 / Diagnosis and management of fractured teeth associated with parafunction: part 1

Objetivo: presentar el caso de un paciente con fractura dentaria de etiología parafuncional y su resolución implantoprotética. Caso clínico: una paciente de 65 años de edad, con fractura verticalc ompleta en la pieza dentaria 2.4, consultó por dolor al masticar. Se realizó la exodoncia atraumática del diente y se colocó un implante con corona provisoria, de forma inmediata. Finalmente, se colocaron un emergente y una corona libres de metal y se instaló una placa de protección neuromiorrelajante. Conclusión: la prevención y el diagnóstico tempranos de las fracturas dentarias atribuidas a parafunción, permiten la realización de tratamientos menos invasivos que conservan las piezas dentarias naturales del paciente (AU)

Diagnóstico y tratamiento de las fracturas dentarias asociadas a la parafunción: parte 1 / Diagnosis and management of fractured teeth associated with parafunction: part 1

Objetivo: presentar el caso de un paciente con fractura dentaria de etiología parafuncional y su resolución implantoprotética. Caso clínico: una paciente de 65 años de edad, con fractura verticalc ompleta en la pieza dentaria 2.4, consultó por dolor al masticar. Se realizó la exodoncia atraumática del diente y se colocó un implante con corona provisoria, de forma inmediata. Finalmente, se colocaron un emergente y una corona libres de metal y se instaló una placa de protección neuromiorrelajante. Conclusión: la prevención y el diagnóstico tempranos de las fracturas dentarias atribuidas a parafunción, permiten la realización de tratamientos menos invasivos que conservan las piezas dentarias naturales del paciente

Detection of vertical root fractures: an investigation into the impact of using orthogonal radiographs and separated by conventional methods and digital / Detecção de fraturas radiculares verticais: uma investigação sobre o impacto da utilização de radiografias ortogonais e dissociadas pelos métodos convencional e digital

Introdução: radiografias intrabucais são uma importante ajuda investigativa na detecção de alterações na raiz dentária, incluindo fraturas radiculares verticais (FRV). Objetivo: avaliar a capacidade de radiografias convencionais e digitais, ortogonais e dissociadas para detectar FRV em dentes que apresentam diferentes condições do canal radicular. Métodos: sessenta dentes foram divididos em três grupos, considerando-se a condição do canal (não obturado, obturado com guta-percha e obturado com guta-percha e pino metálico). Em cada grupo, dez dentes foram artificialmente fraturados e dez dentes (controles), não foram fraturados. Realizaram-se radiografias convencionais (Kodak), e digitais (placas de fósforo – VistaScan Durr Dental), ortogonais e horizontalmente dissociadas. Usando um teste cego, três observadores calibrados realizaram avaliações em quatro tempos distintos. Valores modais foram utilizados para calcular a sensibilidade, especificidade e acurácia. A área sob a curva ROC (aucROC), e intervalos de confiança (IC ), foram usados para comparar o desempenho entre os sistemas radiográficos, bem como a influência de imagens ortogonais e combinadas (ortogonal mais dissociadas). Resultados: radiografias combinadas (ortogonal + dissociadas), apresentaram maior aucROC para ambas as imagens convencionais e digitais. Os ICs mostraram diferenças estatisticamente significativas entre as radiografias convencionais ortogonais e digitais combinadas (IC: 0,403-0,697 e 0,767-0,967, respectivamente). Além disso, quando apenas incidências ortogonais foram consideradas, radiografias digitais proporcionaram melhores resultados do que as convencionais (IC: 0,622-0,878 e 0,403-0,697, respectivamente). Conclusão: a forte tendência de melhores resultados dos testes de diagnóstico proporcionados pelas radiografias digitais sugere que o sistema digital, utilizando projeções combinadas, é mais apropriado para investigar FRV do que o convencional