Conservative management of a horizontal root fracture in a primary maxillary central incisor: Case report.

Dental trauma occurs frequently in toddlers and the treatment protocols vary depending on each case. Thus, clinicians must not only plan the treatment but also consider any possible sequelae and characteristics related to the child and the family. The aim of this paper was to report a case of a three-year-old boy who had a horizontal root fracture in the middle third of the primary maxillary right incisor root (tooth 51) and crown discoloration of the primary maxillary left incisor (tooth 61) which were successfully treated with conservative management. The management was established in agreement with the family and was based on active surveillance. The clinical and radiographic follow-ups showed no changes besides pulp canal calcification of the left incisor throughout the eight years of follow-up. The pulps remained normal with no pathological signs throughout their life cycle and the permanent successors erupted normally, presenting an excellent result of the non-invasive approach adopted.

Odontopediatría en el contexto de la COVID-19: publicaciones científicas y práctica clínica / Odontopediatria no contexto da COVID-19: publicações científicas e prática clínica / Pediatric dentistry in the context of COVID-19: scientific publications and clinical practice

El propósito es analizar las características de los estudios y las tendencias en las publicaciones científicas y las recomendaciones clínicas relacionadas con el COVID-19 en odontopediatría. La búsqueda electrónica se realizó en las bases de datos MEDLINE, Scopus, Web of Science Core Collection y LILACS/BVS, sin restricciones. Se incluyeron estudios que usaron términos referentes a COVID-19, odontología pediátrica y niños en el título, resumen o palabras clave. Se extrajeron datos bibliométricos y características de los estudios. Cada estudio se categorizó de acuerdo con su diseño, muestra y tema principal. Se incluyeron 49 estudios, la mayoría revisiones (n=25; 51,00%), estudios observacionales (n=23; 47,00%) y estudio clínico (n=1; 2%). Los principales temas fueron urgencias odontológicas (n=9; 18,30%), bioseguridad (n= 8; 16,30%) y teleodontología (n=6; 12,20%). Las urgencias odontológicas más reportadas fueron trauma (n=12; 63,10%), edema (n=9; 47,30%) y dolor (n=9; 47,30%). Se concluyó que se realizaron pocos estudios sobre COVID-19 y odontología pediátrica, y la mayoría de las revisiones y estudios observacionales sobre emergencias dentales se publicaron en Asia.

O objetivo é analisar as características dos estudos e tendências nas publicações científicas e recomendações clínicas relacionadas ao COVID-19 em odontopediatria. A busca eletrônica foi realizada nas bases de dados MEDLINE, Scopus, Web of Science Core Collection e LILACS/BVS, sem restrições. Foram incluídos estudos que usaram termos referentes a COVID-19, odontopediatria e crianças no título, resumo ou palavras-chave. Os dados bibliométricos e as características do estudo foram extraídos. Cada estudo foi categorizado de acordo com seu desenho, amostra e tema principal. Quarenta e nove estudos foram incluídos, sendo a maioria revisões (n=25; 51,00%), estudos observacionais (n=23; 47,00%) e estudo clínico (n=1; 2%). Os principais temas foram emergências odontológicas (n=9; 18,30%), biossegurança (n= 8; 16,30%) e teleodontologia (n=6; 12,20%). As emergências odontológicas mais relatadas foram trauma (n=12; 63,10%), edema (n=9; 47,30%) e dor (n=9; 47,30%). Concluiu-se que poucos estudos sobre COVID-19 e odontopediatria foram realizados, com a maioria das revisões e estudos observacionais sobre emergências odontológicas publicados na Ásia

The purpose is to analyze the characteristics of the studies and trends in scientific publications and the clinical recommendations related to COVID-19 in pediatric dentistry. Electronic search was performed on MEDLINE, Scopus, Web of Science Core Collection, and LILACS/VHL databases, without restrictions. Studies that used terms referring to COVID-19, pediatric dentistry, and children in the title, abstract, or keywords were included. Bibliometric data and studies' characteristics were extracted. Each study was categorized according to its design, sample, and main subject. Forty-nine studies were included, most of them reviews (n=25; 51.00%), observational studies (n=23; 47.00%), and clinical study (n=1; 2%). The main topics were dental emergencies (n=9; 18.30%), biosafety (n= 8; 16.30%) and teledentistry (n=6; 12.20%). The most reported dental emergencies were trauma (n=12; 63.10%), edema (n=9; 47.30%), and pain (n=9; 47.30%). It was concluded that few studies on COVID-19 and pediatric dentistry were conducted, and most reviews and observational studies regarding dental emergencies were published in Asia.

Desenvolvimento de ferramenta interativa auxiliar para decisão de terapiapulpar emdentes decíduos / Development of an auxiliary interactive presentation for deciding on pulp therapy in deciduous teeth

Objetivou-se desenvolver uma ferramenta interativa capaz de ajudar profissionais e graduandos de Odontologia a selecionar a terapia pulpar mais adequada para cada caso, bem como relatar a experiência dos usuários.Inicialmente, a partir deliteratura consagrada,foramestabelecidos os sinais e sintomas associados ao comprometimento pulpar de dentes decíduos para contemplar as situações clínicas possíveis, além de condições que poderiam contraindicar a realização do tratamento, como a impossibilidade de restauração. Esses dados foram utilizados para elaboração de uma apresentação de slides, em Microsoft Power Point®, em que é possível assinalar os dados colhidos na anamnesebem como as características clínicas e radiográficas do caso, e a partir da combinação de respostas, o usuário recebe a relação de procedimentos adequados. A ferramenta foi avaliada por graduandos, cirurgiões-dentistas e odontopediatras quanto ao uso, conteúdo e compreensão. Esses foram orientados a relatar suas considerações e incentivados a fazer sugestões, que foram discutidas pelos pesquisadores e, quando pertinentes, incorporadas. Ao final, a ferramenta interativa-composta por 41 slides-relaciona as respostas obtidas e informa a cirurgiões-dentistase graduandos a alternativa de terapia pulpar mais adequada para dentes decíduos que apresentem inflamação pulpar reversível, irreversível ou necrose. Osusuários a descreveram como "fácil de usar", "muito boa", "uma grande ajuda", entre outrosaspectos positivos (AU).

The objective was to develop an interactive presentationable to help dentists and undergraduates to select the most appropriate pulp therapy for each case, as well as to report the users' experience.Based on the literature, the signs and symptoms associated with pulp involvement indeciduous teeth were listed to cover the possiblerelatedclinical situations. Conditions that could contraindicate treatmentwere also listed, such as the impossibility of restoration. These data were used to create a slideshow, in Microsoft Power PointTM, in which it is possible to markthe data collected in the anamnesis as well as the clinical and radiographic signsof the case. From the combination of answers, the user receives arelation ofsuitable treatment options.The productwas evaluated by undergraduates, dentists and pediatric dentists regarding use, content and understanding. Theywere instructed to report their considerations and encouraged to make suggestions, which were discussed by the researchers and, when relevant, were incorporated.Finally, the interactive presentationconsisted of 41 slides that correlatethemarked dataand inform dentists and undergraduates about the mostappropriatetreatmentoptionsfor deciduous teeth that have reversible or irreversible pulpal inflammation or necrosis. Users described the toolas "easy to use", "very good", "a great help", among others. Thus, aninstrument was developed with the aim of assisting undergraduates and dentists in the clinical decision of treatments in cases of suspected pulp involvement. This was considered a good and accessible alternative (AU).

Protocolo de pulpectomia para dentes decíduos: um guia clínico e prático baseado em evidências científicas / Pulpectomy protocol for primary teeth: a clinical and practical guide based on scientific evidence

O procedimento de pulpectomia em dentes decíduos consiste na remoção total do tecido pulpar com inflamação irreversível ou com necrose, preparo químicomecânico e obturação com material reabsorvível, com o intuito de manter o dente o maior tempo possível na cavidade bucal, devolvendo função e saúde para o paciente infantil. Existem vários protocolos descritos na literatura, no entanto, não há consenso entre eles e poucos possuem acesso livre. Sendo assim, observa-se carência de um guia clínico e prático para nortear o cirurgião-dentista na realização desse procedimento durante o atendimento odontopediátrico. Portanto, o intuito deste trabalho é apresentar aos clínicos um protocolo de pulpectomia com altas frequências de sucesso clínico e radiográfico, baseado em evidências científicas, desenvolvido e aplicado pelo Grupo de Pesquisa de Endodontia em Odontopediatria da Universidade Federal do Rio de Janeiro (GEDOPED-UFRJ). O presente protocolo contempla indicações, contraindicações, tática operatória, materiais necessários e orientações para acompanhamento. Com esta publicação de maneira gratuita, de acesso livre e no idioma dominante do país, espera-se ampliar o alcance de odontopediatras e clínicos gerais que atendem crianças a um tratamento eficaz.

Pulpectomy in primary teeth consists of the complete removal of the irreversibly affected pulp or necrotic pulp tissue, chemical-mechanical preparation of the root dentin and filling root canals with a resorbable material, to keep the tooth as long as possible in the oral cavity, restoring function and health. There are several pulpectomy protocols described in the literature, however, there is no consensus among them and only few of them are open access. Therefore, there is a lack of clinical and practical guides to the practitioner in performing this procedure during pediatric dental care. The aim of this article is to present a clinically and radiographically successful pulpectomy protocol, based on scientific evidence, developed, and applied by the Research Group on Endodontics in Pediatric Dentistry at the Universidade Federal do Rio de Janeiro. This protocol includes indications, contraindications, operative techniques, materials, and guidelines for follow-up appointments. With this open access publication in Portuguese, we hope to disseminate an effective treatment and expand the outreach of a pulpectomy technique protocol to pediatric dentists and clinicians who treat children.

Cytocompatibility of filling pastes by primary teeth root simulating model.

Evaluate the cytocompatibility of Calen®/ZO, Calcicur®, Vitapex®, Endoflas®, and zinc oxide/eugenol-based (ZOE) root canal pastes (RCP) to human primary osteoblasts (HPO) through a simplified model for primary teeth. The model employed pipette tips filled with 0.037 g of paste, exposed to 185 µL of culture medium for 24 h (n = 6). Release of components was analysed by Proton Nuclear Magnetic Resonance Spectroscopy (1H-NMR). HPO were exposed to conditioned media for 24 h. Cell viability was assessed by cell density and metabolic activity, and release of interleukin 6 (IL-6), vascular endothelial growth factor (VEGF) and fibroblast growth factor (bFGF) by immunological assay. Physicochemical properties and antimicrobial efficacy were also evaluated. 1H-NMR spectra analysis showed similarity between ZOE, Endoflas®, Calcicur®, and Vitapex® compared to Calen®/ZO and positive control, which showed distinct released components. Calen®/ZO and Calcicur® exhibited high alkaline pH in all periods and showed similar solubility. Calen®/ZO, ZOE, and Vitapex® showed similar flow rate. Calen®/ZO, Calcicur®, and Vitapex® did not exhibit antimicrobial efficacy. Calen®/ZO presented cytotoxicity (p < 0.05). Pastes did not increase IL-6 release compared to control. Apart from Vitapex®, all pastes significantly induced VEGF/bFGF release. Interactive effects among released products may affect biological response to filling pastes. Calcicur®, ZOE, Endoflas® and Calen®/ZO presented good to moderate cytocompatibility, with low impact on pro-inflammatory cytokine release and induction of growth factors of interest to tissue repair. This simplified model, specific for the evaluation of the cytocompatibility of RCPs on primary teeth, suggests how these pastes might contribute to bone repair in clinical situations of apical periodontitis in children.

Antimicrobial activity of antibiotic pastes used in pulp therapy through direct contact with a multispecies biofilm: a pilot study

Objective: To evaluate the antimicrobial activity of antibiotic pastes used in lesion sterilization and tissue repair (LSTR) technique, through a novel membrane direct contact methodology against a multispecies biofilm and to establish appropriate dilutions for this method. Methods: CTZ (chloramphenicol, tetracycline, zinc oxide) and two formulations of 3Mix pastes (ciprofloxacin, metronidazole, and minocycline), 3Mix1 and 3Mix3, were evaluated with negative (0.9% saline) and positive (chlorhexidine 0.2%) control groups. Candida albicans and Enterococcus faecalis (24-hour) biofilms (n=10) grown on cellulose membranes were directly exposed to standardized amounts of fresh pastes and control solutions (n=2) for 24h. Membranes were immersed in 900 µl of saline solution, and seven serial dilutions were made for each sample. Plating for each dilution (n=2) was performed on culture media for microbial colony-forming unit (CFU) counting of total microorganisms, Candida spp. and Enterococcus spp. Aiming the comparison between groups, CFU quantification data were transformed into log10 CFU / mL and the Mann-Whitney test was applied (p<0.05). Results: Inhibition of CFU was observed for all pastes, with greatest effects for CTZ paste in medium selective for Candida spp. (p<0.001) and 3Mix1 in non-selective (p<0.000) and selective for Enterococcus spp. (p<0.004). Conclusion: The pastes showed antimicrobial activity against the tested multispecies biofilm, and the proposed direct contact methodology was efficient. Moreover, the dilutions used proved to be appropriate for this methodology.

Objetivo: Avaliar a atividade antimicrobiana de pastas antibióticas utilizadas na técnica Lesion Sterilization and Tissue Repair (LSTR), através de nova metodologia de contato direto com membrana contra um biofilme multiespécies e estabelecer diluições adequadas para avaliação. Métodos: CTZ (cloranfenicol, tetraciclina,óxido de zinco) e duas formulações de pastas 3Mix (Ciprofloxacina, Metronidazol e Minociclina), 3Mix1 e 3Mix3, foram avaliadas, além dos grupos controle, negativo (solução salina a 0,9%) e positivo (clorexidina 0,2%). Biofilmes de Candida albicans e Enterococcus faecalis cultivados sobre membranas de celulose (n=10) durante24 h foram expostos diretamente em contato com quantidades padronizadas de pastas frescas e controles (n = 2) por 24 h. As membranas foram imersas em 900µL de solução salina e sete diluições seriadas foram obtidas por amostra. O plaqueamento para cada diluição (n = 2) foi realizado em meios de cultura para microrganismos totais e seletivos para Candida spp. e Enterococcus spp. para contagem de unidades formadoras de colônias (UFC). Para comparação entre grupos, os dados da contagem de UFC foram convertidos em log10 UFC / mL e o teste Mann-Whitney foi aplicado (p<0,05). Resultados: Observou-se inibição de UFC para todas as pastas, maior para CTZ no meio seletivo para Candida (p<0,001)e 3Mix1 nos demais meios (p<0,004). Conclusão: Concluiu-se que as pastas apresentaram atividade antimicrobiana contra o biofilme multiespécies testado e que a nova metodologia de contato direto proposta foi eficiente. Além disso, as diluições utilizadas mostraram-se adequadas para essa metodologia.

Reliability of Two Methods of Evaluation of the Apical Limit of Obturation of Root Canals of Primary Teeth: A Pilot Study

Abstract Objective: To verify the concordance in the evaluation of the apical limit of obturation (ALO) in filled root canals of primary teeth between digital and visual methods. Material and Methods: Twenty periapical radiographs of endodontically treated primary teeth were digitalized and evaluated by an endodontics specialist (E1), a PhD pediatric dentist (E2), and a MSc general dentist (E3). Calibrated evaluators (Kappa = 1.00) analysed the images in a light-isolated environment two times (D1 and D2) with a one-week interval between evaluations. ALO scores were categorized as overfilled, flush-filled and underfilled. Results: The intra-rater reliability between methods was 0.82 (D1) and 0.75 (D2) for E1, 0.93 (D1 and D2) for E2, and 0.94 (D1 and D2) for E3. Inter-rater reliability ranged from 0.71 (E1 × E3) and 1.00 (E1 × E2) for the visual method to 0.76 (E1 × E3) and 0.88 (E1 × E2) for the digital method. Spearman correlation coefficients showed a similar ranking among the evaluators. There was greater disagreement among the underfilled and ideal scores. For all evaluators, the digital method favoured the identification of the ideal score. Conclusion: Both methods are suitable for the determination of the ALO of filled primary teeth and can be used in clinical practice.

Success frequency of root canal filling materials most used in pediatric dentistry

Introduction: There is no consensus on the literature about the best root canal filling material for primary teeth. Objective: The aim of this study was to describe the root canal filling materials most widely used in clinical pediatric dentistry, showing the observed success rates. Sources of data: A search, limited to the last 10 years and, no language restriction, was performed in October 2018 in the PubMed, Cochrane and LILACS databases using the terms "pulpectomy" and "primary teeth". This narrative literature review included clinical and randomized controlled trials conducted on children who had undergone pulpectomy as root canal therapy, with at least six months of clinical and radiographic follow-up. Synthesis of data: A total of 254 papers were retrieved from the databases. After applying the inclusion and exclusion criteria, 25 papers were included in this review. Zinc oxide and eugenol (ZOE) based paste was still the most widely used root canal filling material for primary teeth in pediatric clinical research, showing an overall clinical and radiographic success ranging from 63.3% to 93.3%. Conclusion: ZOE based paste is still the most used material for root canal filling in primary teeth, although there is a trend in the use of iodoform with calcium hydroxide pastes, which show high frequencies of success.

Introdução: Não há consenso na literatura quanto ao material obturador ideal para canais radiculares de dentes decíduos. Objetivo : O objetivo deste estudo foi descrever os materiais obturadores para canais radiculares mais utilizados na clínica Odontopediátrica, mostrando os índices de sucesso observados. Fonte dos dados : Uma busca, limitada aos últimos 10 anos e sem restrição de idioma, foi realizada em outubro de 2018 nas bases de dados PubMed, Cochrane e LILACS usando os termos "pulpectomy" e "primary teeth". Esta revisão narrativa da literatura incluiu estudos clínicos controlados randomizados em crianças submetidas a pulpectomia como tratamento endodôntico, com, no mínimo, seis meses de acompanhamento clínico e radiográfico. Síntese dos dados : Foram recuperados nas bases de dados 254 artigos. Após a aplicação dos critérios de inclusão e exclusão um total de 25 artigos foram incluídos nesta revisão. A pasta à base de óxido de zinco e eugenol (OZE) foi o material obturador mais utilizado para canais radiculares de dentes decíduos em pesquisa clínica Odontopediátrica, mostrando sucesso clínico e radiográfico geral que variou de 63,3% a 93,3%. Conclusão : A pasta à base de óxido de zinco e eugenol é o material mais utilizado para a obturação de canais radiculares de dentes decíduos, embora exista uma tendência para a utilização de pastas à base de iodofórmio com hidróxido de cálcio, que apresentam altas frequências de sucesso.

Oral health and self-care in adolescents from different Brazilian regions

Introduction: Adolescents present a potential risk for the development of caries and periodontal diseases. Objective: The objective of the present study was to review the indicators of self-care and oral health in brazilian adolescents. Methodology: The search strategy (adolescent AND oral health) AND Brazil* was used in Pubmed and LILACS databases. Articles published between 2012 and 2017 that presented data on self-care and oral health of brazilian adolescents were included in this review. Synthesis of data: 837 and 1375 articles were retrieved from the Pubmed and LILACS databases, respectively. After applying the inclusion and exclusion criteria, 7 articles were included. The characteristics of the studies and the data obtained regarding sel-care and oral health of the adolescents were presented descriptively. Most of the studies included adolescents between the ages of 15 and 19 years, the majority of whom sought dental care in less than one year of the interview and caries was the most prevalent disease compared to gingival bleeding. Conclusion: According to the indicators of self-care evaluated, the majority of Brazilian adolescents reported having sought dental care in less than one year and caries disease was the most prevalent condition.

Introdução: Adolescentes apresentam potencial risco para o desenvolvimento das doenças cárie e periodontal. Objetivo: O objetivo do presente estudo foi revisar, na literatura, dados acerca da saúde oral de adolescentes brasileiros através da prevalência ou presença de cárie e sangramento gengival, como indicadores indiretos (consequências), e frequências de escovação dentária, uso de fio dental e visita odontológica como indicadores diretos deautocuidado oral. Fontes dos dados: Utilizou-se a estratégia de busca ((adolescent AND oralhealth) AND Brazil*) nas bases de dados PubMed e LILACS. Os artigos publicados entre setembro 2012-2017 que apresentaram dados de ao menos um dos indicadores de saúde oral e autocuidado em adolescentes brasileiros, foram incluídos nesta revisão. As características dos estudos e os dados obtidos foram apresentados de forma descritiva. Síntese dos dados: Foram recuperados nas bases de dados PubMed e LILACS 837 e 1375 artigos, respectivamente. Após a aplicação dos critérios de inclusão e exclusão, 10 artigos foram incluídos. A maioria dos estudos incluiu adolescentes entre 15 e 19 anos, com relato de atendimento odontológico realizado em menos de 1 ano antes da entrevista, sendo a cárie a alteração bucal mais prevalente. Conclusão: Dentro das limitações do presente estudo, de acordo com os dados obtidos através dos indicadores de autocuidado pesquisados, os adolescentes brasileiros mostraram cárie como o agravo observado mais prevalente; as frequências de escovação e uso de fio dental variaram na região Sul; e relataram atendimento odontológico no período inferior a um ano da entrevista.