Cementodentinal Tear Associated with a Periodontal- Endodontic Combined Lesion: A Case Report with a 14-Month Follow-up.

This case report describes the diagnosis and multidisciplinary treatment of a clinically indiscoverable cementodentinal tear associated with a periodontal-endodontic combined lesion. The tear site was located at the palatal root surface of the maxillary left canine. Due to its position and concomitant periapical periodontitis, it was not noticed at the initial visit until a 3D CBCT examination was conducted. Through combined endodontic-periodontal therapy (which included root canal therapy, root debridement, and periodontal flap surgery), the tear fragment was removed, and the periapical lesion healed gradually. A histologic examination confirmed the definitive diagnosis of a cementodentinal tear. After 14 months, the periodontal and endodontic status of the maxillary left canine were stable. According to these results, CBCT examination and multidisciplinary cooperation seem to be effective and necessary for the diagnosis and treatment of such clinically indiscoverable cementodentinal/cemental tears.

Cemental tear: An unusual cause for persisting endodontic periodontal lesion.

Cemental tear represents a rare form of root surface fracture which makes teeth prone to periodontal breakdown. The diagnosis of cemental tear becomes a challenge as it is usually neglected or misdiagnosed and is also underreported in the literature. Correct diagnosis and early treatment of cemental tear can prevent further periodontal breakdown and may preserve the affected tooth for a longer duration. This case presents the diagnosis, treatment, and an analysis of a right maxillary lateral incisor with an improper endodontic treatment coupled with a cemental tear. Despite surgical removal, the cemental tear led to the development of an endodontic periodontal lesion. This article intends to help recognize early signs and symptoms of cemental tear and establish timely diagnosis. It determines that if the periodontal destruction caused by cemental tears is diagnosed and treated early, it may be possible to prevent further periodontal breakdown and preserve the tooth for a longer period.

Cemental tear: To know what we have neglected in dental practice.

Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction.

Regeneration of the cementum and periodontal ligament using local BDNF delivery in class II furcation defects.

Periodontal furcation defects are usually addressed by the placement of a physical barrier which may limit the regenerative potential of periodontal wounds. This study morphometrically quantified the regenerative effect of brain-derived neurotrophic factor (BDNF) in furcation defects in a non-human primate model. Grade II furcation defects (with and without induced inflammation prior to surgery) were created on the first and second molars of eight non-human primates. Defects were treated with open flap debridement and subsequently filled with either: Group A; BDNF (500 µg mL-1 ) in high-molecular weight-hyaluronic acid (HMW-HA), Group B; BDNF (50 µg mL-1 ) in HMW-HA, Group C; HMW-HA acid only, Group D; unfilled defect, or Group E; BDNF (500 µg mL-1 ) in saline. Periodontal wound healing was observed every 2 weeks by computed-tomography. At 11 weeks all animals were sacrificed and maxillary and mandibular block biopsies were referred for nondecalcified histology. Linear measurements of new cementum (cellular and acellular) and periodontal ligament (PDL) formation were performed. Computerized-tomography reconstruction and software quantification demonstrated successful bone fill for all groups. However, histometric assessment demonstrated significantly higher level of total periodontal regeneration for the 500 µg mL-1 BDNF HMW-HA relative to all other groups. No significant differences in cementogenesis were observed among groups. Significantly higher acellular cementum formation was observed for sites where inflammation was not induced prior to surgical procedures. While all groups experienced similar bone fill and cementogenesis, the 500 µg mL-1 BDNF HMW-HA appeared to most effectively repair PDL (minimum increase of ∼22% relative to all groups; over 200% relative to unfilled defects). © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1611-1617, 2018.

Cemental Tears: A Report of Four Cases and Literature Review.

PURPOSE: To present four different cases with a diagnosed cemental tear. The differences in aetiology, clinical diagnosis and treatment of cemental tears are described and discussed in order to provide guidance for clinical practice. CASES: Four patients of different ages presented with gingival swelling and other different complaints. Clinically, localised deep periodontal pockets and inflammation were noted on affected aspects in four cases. Radiographic examination revealed a prickly or flakey structure and bone loss on the affected side of the involved tooth. Different treatments, such as extraction, traditional periodontal initial therapy, periodontal flap surgery, or no clinical intervention were given based on different extents of tooth mobility and bone loss. In the first two cases, teeth with cemental tear were extracted due to poor prognosis. In case 3, deep pockets recovered to a normal condition, while cemental tears on the distal aspect of tooth 21 had no abnormal sensation or clinical symptoms. In case 4, a periapical radiograph showed distal bone loss was interrupted, and the tooth also recovered normal mobility. Histopathological evaluation of the specimens with H&E staining all resulted in a definitive diagnosis of cemental/cementodentinal tears. CONCLUSIONS: Cementodentinal or cemental tears are unique, localized, tooth-related factors associated with attachment loss. Aging, trauma and occlusal overload are the main aetiological factors. Early diagnosis and appropriate treatment will avoid unnecessary tooth extraction and result in a better prognosis. Detailed clinical and radiographic examinations as well as explorative surgery may help to make a diagnosis of cemental tears, but histopathological analysis is the only method for a definitive diagnosis.

Tri-Layered Nanocomposite Hydrogel Scaffold for the Concurrent Regeneration of Cementum, Periodontal Ligament, and Alveolar Bone.

A tri-layered scaffolding approach is adopted for the complete and concurrent regeneration of hard tissues-cementum and alveolar bone-and soft tissue-the periodontal ligament (PDL)-at a periodontal defect site. The porous tri-layered nanocomposite hydrogel scaffold is composed of chitin-poly(lactic-co-glycolic acid) (PLGA)/nanobioactive glass ceramic (nBGC)/cementum protein 1 as the cementum layer, chitin-PLGA/fibroblast growth factor 2 as the PDL layer, and chitin-PLGA/nBGC/platelet-rich plasma derived growth factors as the alveolar bone layer. The tri-layered nanocomposite hydrogel scaffold is cytocompatible and favored cementogenic, fibrogenic, and osteogenic differentiation of human dental follicle stem cells. In vivo, tri-layered nanocomposite hydrogel scaffold with/without growth factors is implanted into rabbit maxillary periodontal defects and compared with the controls at 1 and 3 months postoperatively. The tri-layered nanocomposite hydrogel scaffold with growth factors demonstrates complete defect closure and healing with new cancellous-like tissue formation on microcomputed tomography analysis. Histological and immunohistochemical analyses further confirm the formation of new cementum, fibrous PDL, and alveolar bone with well-defined bony trabeculae in comparison to the other three groups. In conclusion, the tri-layered nanocomposite hydrogel scaffold with growth factors can serve as an alternative regenerative approach to achieve simultaneous and complete periodontal regeneration.

Prevention and management of external inflammatory resorption following trauma to teeth.

External inflammatory resorption is one of the potential consequences of trauma to the teeth. It occurs when there has been loss of cementum due to damage to the external surface of the tooth root during trauma, plus the root canal system has become infected with bacteria. It is characterized by the radiographic appearance of loss of tooth substance with a radiolucency in the adjacent periodontal ligament and bone. The loss of cementum allows the intracanal bacteria and/or their endotoxins to reach the periodontal ligament more readily and this can lead to the development of the inflammatory resorptive process. External inflammatory resorption can ultimately lead to loss of the tooth if it is not managed in a timely manner. There are some injuries that are very likely to develop this type of resorption and a preventive approach can be adopted by commencing root canal treatment immediately as part of the emergency management of such cases. In cases where the resorptive process is already established, root canal treatment can arrest the resorption and encourage hard tissue repair. The use of a corticosteroid-antibiotic intracanal medicament has been shown to be particularly useful in the prevention and management of external inflammatory resorption. Calcium hydroxide should not be used as an immediate medicament because of its inherent toxicity and irritant properties but it is valuable as a subsequent medicament to encourage hard tissue repair where required. This review outlines the external inflammatory resorptive process and the management strategies that can be employed to prevent it from occurring, and to treat it if already present.

Miniscrew implant fracture and effects of such retained tip on dentin-pulp complex: a histological report.

Miniscrew implants provide an excellent orthodontic anchorage. Besides the clinical benefits, miniscrew implants cause minor discomforts and in certain instances poses problematic complications. Damage to the adjacent tooth structure is the most feared complication of miniscrew implant placement, while fracture of miniscrew implants is the rarest. Miniscrew fracture could occur either during its placement or during its removal. An unusual case report is presented of a miniscrew implant tip fracture following root contact while attempting to remove it. This report highlights the effect of such miniscrew implant fracture on the dentin-pulp complex. The present case is probably the first to give direct histological evidence in humans that a miniscrew fracture or a retained miniscrew implant tip along the dentin/cementum without obvious miniscrew implant penetration could elicit pulp changes. Therefore this case report emphasizes the fact that prior to placing miniscrew implant, clinicians should have acquired proper training and adequate skills in terms of MSI placement and management of fractured MSI.

Periodontal healing with a preameloblast-conditioned medium in dogs.

BACKGROUND AND OBJECTIVE: The predictability of conventional periodontal treatments for damaged periodontal tissue is limited, particularly on the regeneration of new cementum. As signaling molecules, a range of growth factors has been used to promote periodontal regeneration on periodontal ligament (PDL) and cementum defects. A preameloblast-conditioned medium (PA-CM) was prepared from cultured murine apical bud cells, which can differentiate into ameloblasts. We examined the effect of PA-CM on PDL cells and cementoblasts in vitro and evaluated histologically the effects of PA-CM on the regeneration of experimentally induced periodontal defects in vivo. MATERIAL AND METHODS: In vitro, the effects of PA-CM on the migration of human PDL cells were examined using a scratch wound healing assay and a transwell assay. The differentiation and mineralization potential of PA-CM-treated human PDL cells and murine cementoblastic OCCM-30 cells was examined by real-time polymerase chain reaction and Alizarin red-S staining. In vivo, six mongrel dogs (12-16 kg; 6-8 mo old) were used. Twenty-four roots were replanted with either, (i) only periodontal defects (n = 12; control group), or (ii) periodontal defects and PA-CM treatment (n = 12; experimental group). In the experimental group, the PDL and cementum between notches was removed using a Gracey curette and soaked in 0.08 mL water containing 80 µg of a PA-CM for 2 min. The dogs were killed at 4 and 8 wk post-surgery. RESULTS: The in vitro results showed that PA-CM stimulated the migration of PDL cells and promoted the differentiation and mineralization of PDL cells and cementoblasts. Real-time polymerase chain reaction analysis revealed stronger expression of Runx2, Osx, OC, Bsp and Cap mRNAs in the PA-CM-treated PDL cells and cementoblasts than those in the control cells. In vivo, newly formed PDL-like tissue and cementum-like tissue were observed partially between the root surfaces and newly formed bone in the experimental group. The regenerated PDL-like tissue in the experimental group was significantly higher than that in the control group at 8 wk (p < 0.05). The replacement resorption on the experimental group was significantly lower than that in the control group at 8 wk (p < 0.05). In addition, the amount of newly formed cementum-like tissue in the experimental group was significantly higher than that in the control group at 4 and 8 wk (p < 0.05). CONCLUSION: These results suggest that PA-CM has the potential to regenerate periodontal tissues in PDL and cementum defects.

Reabsorção radicular externa cervical invasiva: revisão de literatura / Invasive external cervical root resorrption: literature review

A reabsorção externa cervical (REC) caracteriza-se pela invasão da região cervical da raiz pelo tecido fibrovascular nas fases iniciais e, em seguida, por tecido fibro-ósseo que progressivamente reabsorve o cemento, a dentina e o esmalte. De acordo com Heithersay (2004) podem ser classificadas em 4 estágios de acordo com suas características clinicas e radiográficas. A REC é uma entidade insidiosa e, por isso, seu diagnóstico é eminentemente radiográfico. Uma vez identificada, a TCCB é um exame complementar essencial para o planejamento do melhor plano de tratamento por permitir a localização do ponto de início da reabsorção e da natureza do processo. A etiologia da REC ainda é mal compreendida Sabe-se que seu início depende da lesão ou deficiência da camada de cemento na região cervical da raiz, logo abaixo do epitélio juncional, na região correspondente à junção amelocementária. O tratamento ortodôntico, o traumatismo dentário, o clareamento endógeno e os procedimentos cirúrgicos representam os principais fatores predisponentes por resultarem na quebra de homeostasia desta região. Uma vez instalada a reabsorção, a natureza do estímulo necessário para sustentar a REC também gera discussões. Alguns autores o consideram puramente inflamatório, enquanto outros como reabsorção asséptica que pode ser invadida, secundariamente, por microrganismos oriundos do sulco gengival e, mais raramente dos túbulos dentinários em dentes com polpa necrótica. O tratamento cirúrgico/restaurador está indicado nas REC em estágios iniciais e médios classificação 1,2 e 3 de Heythersay, 1999. Quanto mais precoce o diagnostico maiores os índices de sucesso. As reabsorções classificadas como classe 4 tem baixa taxa de sucesso após o tratament

External cervical resorption (ECR), also called invasive cervical resorption (ICR), is defined as a localized resorptive process that commences on the surface of root below the epithelial attachment and the coronal aspect of the supporting alveolar process, namely the zone of the connective tissue attachment. It is an aggressive type of external resorption characterized by invasion of the cervical region of the root by fibrovascular tissue in the early stages and then by fibro-osseous tissue that progressively reabsorbs cementum, dentin and enamel.The resorptive cavity contains granulomatous fibrovascular tissue separated from the healthy pulp tissue by a thin layer of dentin and predentin, called pericanalar resorption resistant sheet (PRRS). According to Heithersay (2004) they can be classified in 4 stages according to their clinical and radiographic features. Because the majority of cases of REC is an insidious asymptomatic entity, the diagnosis is mostly made during routine radiographic examination. Cone-beam computed tomography (CBCT) is also used as a complementary technique to asses and manage this type of resorption. The onset of REC depends on the presence of gaps in the cement layer in the cervical region of the root, just below the junctional epithelium. Orthodontics, dental trauma, endogenous bleaching and surgical procedures represent the main predisposing factors. Additional factors that continuously stimulate the resorptive cells rendering ERC progressive are not well known. Some authors consider it purely inflammatory while others as aseptic resorption that can be contaminated by microorganisms originating from the gingival sulcus and, more rarely, from the pulp canal trough dentinal tubules. in teeth with necrotic pulp. Surgical/restorative treatment is indicated in the stages 1 to 3 (Heythersay, 1999) achieving higher success rates in earlier diagnosis. Teeth diagnosed with stage 4 of REC have puor prognosis

Cementum and Periodontal Ligament Regeneration.

The unique anatomy and composition of the periodontium make periodontal tissue healing and regeneration a complex process. Periodontal regeneration aims to recapitulate the crucial stages of wound healing associated with periodontal development in order to restore lost tissues to their original form and function and for regeneration to occur, healing events must progress in an ordered and programmed sequence both temporally and spatially, replicating key developmental events. A number of procedures have been employed to promote true and predictable regeneration of the periodontium. Principally, the approaches are based on the use of graft materials to compensate for the bone loss incurred as a result of periodontal disease, use of barrier membranes for guided tissue regeneration and use of bioactive molecules. More recently, the concept of tissue engineering has been integrated into research and applications of regenerative dentistry, including periodontics, to aim to manage damaged and lost oral tissues, through reconstruction and regeneration of the periodontium and alleviate the shortcomings of more conventional therapeutic options. The essential components for generating effective cellular based therapeutic strategies include a population of multi-potential progenitor cells, presence of signalling molecules/inductive morphogenic signals and a conductive extracellular matrix scaffold or appropriate delivery system. Mesenchymal stem cells are considered suitable candidates for cell-based tissue engineering strategies owing to their extensive expansion rate and potential to differentiate into cells of multiple organs and systems. Mesenchymal stem cells derived from multiple tissue sources have been investigated in pre-clinical animal studies and clinical settings for the treatment and regeneration of the periodontium.

Understanding root resorption with diagnostic imaging.

This article presents the clinical, radiographic and histopathologic features of various types of tooth root resorption. Tooth resorption may occur in a tooth internally or externally with distinctively different treatment approaches for each type of resorption. Given that proper diagnosis of the type of resorption is important, the use of cone beam computed tomography (CBCT) and conventional 2-D intraoral images in evaluation of resorptive lesions is discussed.

Treatment outcome of the teeth with cemental tears.

INTRODUCTION: A cemental tear is a special type of surface root fracture noted in combination with periodontal and/or periapical bony destruction. We hypothesized that clinical characteristics and treatment techniques may affect the prognosis of teeth with cemental tears. METHODS: Treatment outcome for the teeth with a cemental tear was assessed in a multicenter cemental tear study project. Of the 71 teeth with cemental tears, 38 teeth (53.5%) were extracted. The remaining 33 teeth (46.5%) were examined for a treatment outcome of healed, questionable, or failed. RESULTS: Outcome assessment found that 51.5% (17/33), 42.4% (14/33), and 6.1% (2/33) of teeth were classified as healed, questionable, and failed, respectively. Additive bivariate analysis indicated a significant difference between treatment outcome and the length (P = .01) and apicocoronal location (P = .02) of the separated root fragments. Logistic regression analysis found that treatment technique and apicocoronal location of cemental tears may affect the treatment outcome. The percentage of healed cemental tear cases located in the apical, middle, and cervical third of roots was 11.1%, 66.7%, and 60.0%, respectively. By surgical management, 57.7% of cemental tears were healed, whereas only 28.6% cases were healed after nonsurgical treatment. CONCLUSIONS: Most teeth with cemental tears can be retained to function by nonsurgical and surgical periodontal and endodontic treatment. Clinical diagnosis and treatment of cemental tears should also consider the apicocoronal location and the type of treatment technique to improve outcomes.

Effects of the bisphosphonate alendronate on molars of young rats after lateral luxation.

BACKGROUND AND AIM: The bisphosphonate alendronate (ALN) was employed with the aim of investigating its effects on dental and periodontal tissues after lateral luxation of developing molars. MATERIAL AND METHODS: Twenty-one-day-old Wistar rats had their second upper molars laterally luxated. Daily 2.5 mg kg(-1) ALN injections started at the day of the luxation; controls received sterile saline solution. The teeth were analyzed 7, 14, and 21 days after the procedure. On the days cited, the maxillae were fixed, decalcified, and embedded in paraffin or Spurr resin. The paraffin sections were stained with H&E, incubated for TRAP histochemistry or immunolabeled for osteopontin (OPN). Spurr ultrathin sections were examined in a transmission electron microscope. RESULTS: After 21 days, the root apex of luxated molars without ALN was wide open and disorganized and also covered by an irregular layer of cellular cementum, which was not observed in ALN-treated animals. Ankylosis sites were observed in ALN rats in both luxated and non-luxated teeth. The TRAP-positive osteoclasts were more numerous in ALN group, despite their latent ultrastructural appearance without the presence of resorption apparatus compared to controls. OPN immunolabeling revealed a thick immunopositive line in the dentin that must be resultant from the moment of the luxation, while ALN-treated specimens did not present alterations in dentin. CONCLUSION: The present findings indicate that alendronate inhibits some alterations in dentin and cementum formation induced by dental trauma.

Diagnosis and management of cemental tear: a case report.

A 32-year-old man complained of swelling after an extraction in the vicinity of the left maxillary premolars. The occlusal surface of the first premolar showed no caries while the second premolar was covered with a crown. Radiographic examination revealed a thin radiolucent defect subgingivally below the cementodentinal junction on the distal aspect. During a review of medical history, the patient presented an extracted fragment that was sent for histopathological examination. A root canal was performed and the defect was closed with mineral trioxide aggregate followed by glass ionomer cement. Histopathology revealed the fragment to be a cemental tear, a condition associated typically with old age, trauma, and traumatic occlusion. Dentists should be aware of this rare entity as a differential diagnosis in cases involving noncarious odontogenic pain.

Microscopic evaluation of induced tooth movement after subluxation trauma: an experimental study in rats.

OBJECTIVE: The objective of this study was to assess the histological alterations that occurred in the periodontal area of rat molars submitted to induced tooth movement (ITM) right after an intentional trauma (subluxation). METHODS: Forty adult male Wistar rats (Rattus norvegicus albinus) were selected. The animals were divided into eight groups (n=5), according to the combination of variables: Group 1--control (neither trauma nor ITM); Group 2--ITM; Groups 3, 4, 5 and 6--dentoalveolar trauma groups corresponding, respectively, to 1, 3, 8 and 10 days after trauma; Groups 7 and 8 - the animals' molars were subjected to a 900 cN impact and, one and three days after the trauma event, tooth movement was induced. The rats' maxillary first molars were mesially moved during seven days with a closed coil (50 cN). After the experimental period of each group, the animals were sacrificed by anesthetic overdose and the right maxillas were removed and processed for histological analysis under light microscopy. RESULTS: In the animals of group 3, 4, 5 and 6, the histological alterations were not very significant. Consequently, the effect of induced tooth movement right after a subluxation event (groups 7 and 8) was very similar to those described for Group 2. CONCLUSIONS: There was no difference in the quality of periodontal repair when ITM was applied to teeth that had suffered a subluxation trauma.

Microscopic evaluation of induced tooth movement after subluxation trauma: an experimental study in rats

OBJECTIVE: The objective of this study was to assess the histological alterations that occurred in the periodontal area of rat molars submitted to induced tooth movement (ITM) right after an intentional trauma (subluxation). METHODS: Forty adult male Wistar rats (Rattus norvegicus albinus) were selected. The animals were divided into eight groups (n = 5), according to the combination of variables: Group 1 - control (neither trauma nor ITM); Group 2 - ITM; Groups 3, 4, 5 and 6 - dentoalveolar trauma groups corresponding, respectively, to 1, 3, 8 and 10 days after trauma; Groups 7 and 8 - the animals' molars were subjected to a 900 cN impact and, one and three days after the trauma event, tooth movement was induced. The rats' maxillary first molars were mesially moved during seven days with a closed coil (50 cN). After the experimental period of each group, the animals were sacrificed by anesthetic overdose and the right maxillas were removed and processed for histological analysis under light microscopy. RESULTS: In the animals of group 3, 4, 5 and 6, the histological alterations were not very significant. Consequently, the effect of induced tooth movement right after a subluxation event (groups 7 and 8) was very similar to those described for Group 2. CONCLUSION: There was no difference in the quality of periodontal repair when ITM was applied to teeth that had suffered a subluxation trauma. .

OBJETIVO: avaliar as alterações histológicas ocorridas na área periodontal de molares de ratos submetidos à movimentação dentária induzida (MDI), logo após um trauma intencional (subluxação). MÉTODOS: quarenta ratos Wistar machos adultos (Rattus norvegicus albinus) foram selecionados. Os animais foram divididos em oito grupos (n = 5), de acordo com a combinação das variáveis: Grupo 1 - controle (sem trauma e sem MDI); Grupo 2 - MDI; Grupos 3, 4, 5 e 6 - grupos de trauma dentoalveolar correspondendo, respectivamente, para 1, 3, 8 e 10 dias após o trauma; Grupos 7 e 8 - os molares murinos foram submetidos a um impacto de 900cN e, de um e três dias após o evento trauma, o movimento do dente foi induzido. Os primeiros molares superiores dos animais foram movidos mesialmente durante sete dias, com uma mola fechada (50cN). Após período experimental de cada grupo, os animais foram sacrificados por overdose anestésica e as maxilas direitas foram removidas e processadas para análise histológica qualitativa. RESULTADOS: nos animais dos grupos 3, 4, 5 e 6, as alterações histológicas não foram muito significativas. Consequentemente, o efeito do movimento dentário induzido logo após um evento de subluxação (grupos 7 e 8) foi muito semelhante ao descrito para o grupo 2. CONCLUSÃO: não houve diferença na qualidade do reparo periodontal quando a MDI foi aplicada aos dentes que sofreram um trauma de subluxação. .

Root repair after contact with mini-implants: systematic review of the literature.

This systematic review identified and qualified the current evidence of dental root damage and repair after contact with mini-implants. The electronic databases Cochrane library, Ovid, Scirus, Scopus, and Virtual Health Library were used to search original articles from 1980 to December 2011. The inclusion criteria to select the articles were 1. randomized controlled trials and prospective clinical studies based on trials involving humans, 2. randomized controlled studies in animals, 3. use of mini-implants with a diameter less than 2.5 mm, and 4. root contact evaluation associated with the use of orthodontic mini-implants. Two authors independently reviewed and extracted data from the selected studies and a methodological quality assessment process was used to rank the studies classifying them as low moderate or high quality. The searches retrieved 579 citations. After initial selection, 17 studies were considered eligible and their full texts were assessed. Four of those were excluded because root damage was not evaluated and two were excluded because of overlapping samples. Eleven articles, nine in animals and two in humans, fulfilled the inclusion criteria. From these, two studies were ranked as presenting high methodological quality, eight were judged to be of moderate, and one of low quality. The evidence found suggested that the quality of root repair depends on the amount of damage caused by the mini-implant. When the damage is limited to the cementum or dentin, healing and almost complete and repair of the periodontal structure can occur. Mini-implants that injured the pulp were less likely to result in complete repair of the periodontal tissues.