A multidisciplinary direct restorative approach for recovering crown-root fractures in young patients: a case report / Tratamento multidisciplinar restaurador direto para reabilitação de fraturas corono-radiculares em pacientes jovens: relato de caso

The aim of this article is to describe a step-by-step protocol for emergency care of a young patient with multidisciplinary direct restorative approach for recovering crown-root fractures. Fractures of maxillary incisors are a frequent consequence of trauma in children and teenagers. Glass fiber post associated with composite resin restoration represents a conservative approach for this rehabilitation. This paper presents a case of a 14-year-old male patient with a crown-root fracture in a left maxillary lateral incisor. The patient was submitted to a periodontal surgery for coronal lengthening. After that, the post luting and restoration technique was performed. Finally, a mouthguard was made for preventing new trauma. The multidisciplinary treatment described for crown-root fracture rehabilitation is simple, providing esthetics and function with a conservative approach in younger patients.

O objetivo deste artigo é descrever passo a passo, um protocolo para tratamento de emergência de pacientes jovens, com abordagem multidisciplinar e restauração direta em resina composta para a reabilitação de fraturas corono-radiculares. Fraturas de incisivos superiores são uma consequência frequente de traumas em crianças e adolescentes. Pinos de fibra de vidro associados às restaurações em resina composta representam abordagem conservadora para este tipo de situação. Este artigo apresenta caso clinico de um paciente do sexo masculino de 14 anos de idade, com fratura corono- radicular em incisivo lateral superior esquerdo. Inicialmente,o paciente foi submetido à cirurgia periodontal para aumento de coroa clínica. Depois, foi realizada cimentação do pino de fibra de vidro, seguido de restauração direta em resina composta. Por fim, um protetor bucal foi confeccionado para prevenir novo trauma. O tratamento multidisciplinar descrito para reabilitação de fraturas corono-radiculares é simples, proporcionando estética e função com uma abordagem conservadora em pacientes jovens.

Clareamento dentário associado à facetas Indiretas em cerâmica: abordagem minimamente invasiva. / Tooth bleaching associated with ceramic veneers: a conservative approach.

O objetivo deste trabalho é relatar um caso clínico, demostrando protocolo conservador para reabilitação estética com facetas indiretas de cerâmica associadas ao clareamento dental. Paciente do gênero masculino insatisfeito em relação à estética do seu sorriso apresentou ao exame clínico restaurações em resina composta nos dentes anteriores com pigmentação e fraturas marginais. Foi realizada remoção das restaurações para avaliação dos diastemas. Inicialmente, foi realizado clareamento externo em consultório com peróxido de hidrogênio a 38%. Após uma semana, foram feitos preparos minimamente invasivos na superfície vestibular e moldagem. Os laminados foram confeccionados com cerâmica feldspática e cimentados adesivamente ao substrato dentário. Feita a cimentação, foi feito ajuste oclusal mantendo os contatos oclusais fisiológicos. A associação entre o clareamento dentário e laminados cerâmicos, com preparos conservadores, mostrou-se eficaz para a reabilitação estética e funcional do sorriso contribuindo para a satisfação do paciente.

The aim of this study is to describe a clinical case, showing conservative approach for aesthetic rehabilitation with ceramic veneers associated with tooth bleaching. A male patient presented dissatisfaction with smile was submitted to clinical examination and showing composite resin restorations on anterior teeth with marginal fractures and pigmentation. Restoration removal was performed for diastemata evaluation. Initially, was performed in-office tooth bleaching with hydrogen peroxide 38%. After one week, preparations were made with minimally removal of tooth structure at buccal surface and the impression was made. The veneers were fabricated with feldspathic ceramic and cemented adhesively to the tooth substrate. Once the luting procedure was performed, occlusal adjustment was made keeping the physiological occlusal contacts. The association between tooth bleaching and ceramic veneers with conservative approach was effective for the esthetic and functional rehabilitation of the smile contributing to patient satisfaction.

Sealing ability of MTA-Angelus with propyleneglycol in furcal perforations.

This study evaluated the sealing ability of gray MTA-Angelus mixed with propyleneglycol in furcal perforations using a bacterial leakage test. Furcal perforations were created in 30 human mandibular molars using a size 3 round bur The samples were divided randomly into 2 experimental groups (n=10) according to the mixing agent. In G1, the MTA powder was mixed with propyleneglycol, while distilled water was used in G2. A 3:1 powder-liquid ratio was used for both groups. The MTA was placed in the perforation with an MTA carrier and condensed with hand pluggers. Non-repaired (n=5) and totally sealed (n=5) perforations served as positive and negative controls, respectively. Bacterial leakage was assessed daily for 30 days in a double-chamber apparatus with Enterococcus faecalis. Data were analyzed using Fisher exact test (p < 0.05) for three leakage periods: 1st to 10th day (P1); 11th to 20th day (P2); and 21st to 30th day (P3). The positive control presented leakage in all specimens within the first 24 hours, while no leakage was observed in the negative control during the experimental period. Leakage was observed in five (50%) of the 10 samples of the propyleneglycol group (G1) and seven (70%) of the distilled water group (G2) by the 20th day, without significant difference between the groups in periods P1 and P2 (p = 0.137). The leakage was significantly lower for G1 than G2 in period P3 (50% versus 100%, respectively, p = 0.016). In this single aerobic bacterial leakage method, the use of propyleneglycol as a vehicle for gray MTA-Angelus increased its sealing ability in furcal perforations at the end of the 30-day experimental period.

Sealing ability of MTA-Angelus with propyleneglycol in furcal perforations

This study evaluated the sealing ability of gray MTA-Angelus mixed with propyleneglycol in furcal perforations using a bacterial leakage test. Furcal perforations were created in 30 human mandibular molars using a size 3 round bur. The samples were divided randomly into 2 experimental groups (n=10) according to the mixing agent. In G1, the MTA powder was mixed with propyleneglycol, while distilled water was used in G2. A 3:1 powder-liquid ratio was used for both groups. The MTA was placed in the perforation with an MTA carrier and condensed with hand pluggers. Nonrepaired (n=5) and totally sealed (n=5) perforations served as positive and negative controls, respectively. Bacterial leakage was assessed daily for 30 days in a double-chamber apparatus with Enterococcus faecalis. Data were analyzed using Fisher exact test (p<0.05) for three leakage periods: 1st to 10th day (P1); 11th to 20th day (P2); and 21st to 30th day (P3). The positive control presented leakage in all specimens within the first 24 hours, while no leakage was observed in the negative control during the experimental period. Leakage was observed in five (50%) of the 10 samples of the propyleneglycol group (G1) and seven (70%) of the distilled water group (G2) by the 20th day, without significant difference between the groups in periods P1 and P2 (p=0.137). The leakage was significantly lower for G1 than G2 in period P3 (50% versus 100%, respectively, p=0.016). In this single aerobic bacterial leakage method, the use of propyleneglycol as a vehicle for gray MTAAngelus increased its sealing ability in furcal perforations at the end of the 30-day experimental period.

Este estudo avaliou a capacidade de selamento do MTA-Angelus cinza manipulado com propilenoglicol em perfuracoes de furca usando um teste de infiltracao bacteriana. Perfuracoes de furca foram criadas em 30 molares inferiores usando uma broca esferica numero 3. As amostras foram divididas aleatoriamente em dois grupos experimentais (n=10) de acordo com o agente de manipulacao. Em G1, o po do MTA foi manipulado com propilenoglicol enquanto que a agua destilado foi utilizada no G2. A proporcao po-liquido de 3:1 foi usada para ambos os grupos. O MTA foi colocado na perfuracao com uma porta- MTA e condensado com condensadores manuais. Perfuracoes nao-reparadas (n=5) e totalmente impermeabilizadas (n=5) serviram como controle positivo e negativo, respectivamente. A infiltracao bacteriana foi verificada diariamente durante 30 dias em um aparato de dupla camara com Enterococcus faecalis. Os dados foram analisados pelo teste exato de Fisher (p<0,05) para tres periodos: 1o ao 10o dia (P1), 11o ao 20o dia (P2) e do 21o ao 30o dia (P3). O controle positivo apresentou infiltracao em todas as amostras nas primeiras 24 horas, enquanto nenhuma infiltracao foi observada no controle positivo durante o periodo experimental. Infiltracao foi observada em 5 (50%) das 10 amostras do grupo do propilenoglicol (G1) e 7 (70%) do grupo da agua destilada no 20o dia, sem diferenca significativa entre o grupos nos periodos P1 e P2 (p=0,0137). A infiltracao foi significantemente menor para G1 que para G2 no periodo P3 (50% versus 100%, respectivamente, p=0,016). Neste metodo de infiltracao de apenas uma bacteria aerobica, o uso do propilenoglicol como veiculo para o MTA-Angelus cinza aumentou sua capacidade de selamento em perfuracoes de furca no final do periodo experimental de 30 dias.