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1.
Niger J Clin Pract ; 22(6): 833-841, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187770

RESUMO

Objective: To evaluate the mechanical properties of a glass hybrid (GH) restorative system (EQUIA Forte/GC) and compare it with a microhybrid composite (G-aenial Posterior/GC) by compressive strength (CS) and fracture resistance (FR) tests. Materials and Methods: Cylindrical specimens were subjected to a CS test (n = 12). There were about 48 mandibular molars were used for a FR test and divided into four groups: Group 1 (positive control), sound teeth; Group 2 (negative control), extended size Class 2 cavities prepared on the mesial surfaces of teeth; Group 3, extended size Class 2 cavities restored with a composite; and Group 4, extended size Class 2 cavities restored with GH. Specimens were subjected to loading until a fracture occurred. Data were analyzed statistically (α = 0.05). Results: The fracture modes were examined by scanning electron microscope (SEM). The CS values of the composite and GH were 278.20 ± 17.34 MPa and 164.62 ± 25.72 MPa, respectively (P < 0.05). No differences were observed between the FR of restored groups (P > 0.05). Conclusions: The GH exhibited sufficient mechanical properties as a restorative material, and could be preferred for extensive caries lesions on posterior teeth.


Assuntos
Resinas Compostas , Força Compressiva , Cárie Dentária/terapia , Vidro , Fraturas dos Dentes/diagnóstico por imagem , Preparo da Cavidade Dentária , Restauração Dentária Permanente , Humanos , Teste de Materiais , Microscopia Eletrônica de Varredura , Dente Molar
2.
Photodiagnosis Photodyn Ther ; 26: 324-326, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31042556

RESUMO

INTRODUCTION: The aim of this case report was to describe the process of diagnosis and treatment of a cracked tooth using quantitative light-induced fluorescence (QLF). CASE REPORT: A 43-year-old male presented at our dental clinic with a complaint of cold pain in #17 tooth. A routine oral examination with radiography was performed for evaluation of the oral condition and treatment planning. Additionally, QLF image capture was performed using Qraycam and Qraypen (AIOBIO, Seoul, Republic of Korea), to collect white-light and fluorescence images. The #17 tooth was observed to have a crack line, showing red fluorescence, from the distal to mesial aspect on the occlusal surface. Even though there was no visible root fracture in the radiographic image, bone loss was observed. Therefore, we performed periodontal treatment. One month later, a root canal treatment was performed because the patient still complained of pain in the #17 tooth. During this treatment, one fluorescent image and one white light image set was captured with the Qraypen. A crack line showing red fluorescence was observed, while the line was not visible to the naked eye. After treatment, the patient has had no complaint related to this tooth for 3 years until today. CONCLUSIONS: Clinically, use of QLF confirmed the presence of a crack before and during a root canal treatment. Therefore, it is postulated that the QLF technology could objectively facilitate the diagnosis and treatment of a cracked tooth.


Assuntos
Fluorescência Quantitativa Induzida por Luz , Fraturas dos Dentes/diagnóstico por imagem , Adulto , Humanos , Masculino , Fraturas dos Dentes/terapia
3.
J Endod ; 45(6): 750-755.e2, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056300

RESUMO

INTRODUCTION: Magnetic resonance imaging (MRI) has the potential to aid in determining the presence and extent of cracks/fractures in teeth because of better contrast without ionizing radiation. The objectives were to develop MRI criteria for root crack/fracture identification and to establish reliability and accuracy in their detection. METHODS: MRI-based criteria for crack/fracture appearance was developed by an MRI physicist and a panel of 6 dentists. Twenty-nine human adult teeth previously extracted after a clinical diagnosis of a root crack/fracture were frequency matched to 29 controls. Samples were scanned using an in vivo MRI protocol and the reference standard (ie, ex vivo limited field of view cone-beam computed tomographic [CBCT] imaging). A blinded, 4-member panel evaluated the images with a proportion randomly retested to establish intrarater reliability. Overall observer agreement, sensitivity, and specificity were computed for each imaging modality. RESULTS: Subjectively, MRI has increased crack/fracture contrast and is less prone to artifacts from radiodense materials relative to CBCT imaging. Intrarater reliability for MRI was fair to excellent (κ = 0.38-1.00), and for CBCT imaging, it was moderate to excellent (κ = 0.66-1.00). Sensitivity for MRI was 0.59 (95% confidence interval [CI], 0.39-0.76; P = .46), and for CBCT imaging, it was 0.59 (95% CI, 0.59-0.76; P = .46). Specificity for MRI was 0.83 (95% CI, 0.64-0.94; P < .01), and for CBCT imaging, it was 0.90 (95% CI, 0.73-0.98; P < .01). CONCLUSIONS: Despite advantages of increased contrast and the absence of artifacts from radiodense materials in MRI, comparable measures of sensitivity and specificity (to limited field of view CBCT imaging) suggest MRI quality improvements are needed, specifically in image acquisition and postprocessing parameters. Given the early stage of technology development, there may be a use for MRI in detecting cracks/fractures in teeth.


Assuntos
Imagem por Ressonância Magnética , Fraturas dos Dentes , Adulto , Tomografia Computadorizada de Feixe Cônico , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem
4.
Dentomaxillofac Radiol ; 48(6): 20180327, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31095425

RESUMO

OBJECTIVES: To compare the accuracy of cone-beam CT ex vivo and in vivo for the detection of artificially created large and small vertical root fractures in extracted teeth restored with post-core. METHODS: Individual metal cast post-cores were fixed in the root canals of 50 extracted single-rooted human teeth. In 30 teeth fractures were created by tapping posts with a hammer. The teeth were sterilised in autoclave and embedded into bite-plates made of silicon impression material. Cone-beam CT scanning was performed ex vivo and in vivo . For the in vivo scanning, teeth in sterile plastic bags were inserted into the mouths of volunteers. Then the teeth were sectioned with low-speed saw and the widths of the VRFs were measured microscopically. The teeth were distributed into 2 groups in accordance with the measured fractures' widths: large (wider than 180-250 µm) and small (80-150 µm). Five observers assessed the presence of vertical root fractures on axial CBCT slices. Sensitivity, specificity, accuracy and inter examiner agreement were calculated. RESULTS: The accuracy of cone-beam CT in vitro for large and small vertical root fractures detection was 0.56 and 0.40 respectively (p = 0.043). The sensitivity values were 0.53 and 0.27 for large and small vertical root fractures, respectively (p = 0.043). The visualisation of fracture lines in vivo was impossible in 90 % of cases, because of low image quality. Inter examiner reliability analysis showed κ values ranging from 0.02 to 0.54. CONCLUSIONS: Fracture width affected the in vitro detectability of vertical root fractures by cone-beam CT in teeth with metal cast post-cores. The detectability of root fractures in vivo was decreased because of low image quality, making the assessment of sound tooth tissue impossible.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Fraturas dos Dentes , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária
5.
J Endod ; 45(7): 856-862, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31030978

RESUMO

INTRODUCTION: The purpose of this study was to evaluate the diagnostic accuracy of cone-beam computed tomographic (CBCT) imaging in the detection of subtle vertical root fractures (VRFs) in endodontically treated teeth in vivo and to discuss direct and indirect evidence for the diagnosis of subtle VRFs. METHODS: Twenty-nine endodontically treated teeth with suspected VRFs from 29 patients were examined using CBCT imaging. CBCT images were scored based on evaluation of the fracture line and vertical buccopalatal (lingual) bone loss. VRF was diagnosed only when a definite fracture line was detected on CBCT images, and findings of periodontal exploration or surgical extraction were considered the gold standard. The diagnostic sensitivity, specificity, and accuracy were assessed. RESULTS: Of the 29 teeth, 27 were positive and 2 were negative for VRF according to the gold standard. Sensitivity, specificity, and accuracy were 33.3%, 100%, and 37.9%, respectively, based on the direct finding of a fracture line on CBCT images. However, vertical buccopalatal (lingual) bone loss was found in 25 of 27 teeth with VRFs. CONCLUSIONS: Although the accuracy of CBCT imaging for the diagnosis of subtle VRFs in endodontically treated teeth in vivo was poor, vertical buccopalatal (lingual) bone loss is an important indirect sign for the diagnosis of VRFs, which can be found on CBCT images.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Fraturas dos Dentes , Dente não Vital , Humanos , Sensibilidade e Especificidade , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões
6.
Clin Oral Investig ; 23(12): 4433-4439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30982180

RESUMO

OBJECTIVES: This study aimed to investigate the effect of fracture orientation on the detection accuracy of vertical root fractures (VRFs) in non-endodontically treated teeth using four different cone beam computed tomography (CBCT) units. MATERIALS AND METHODS: Thirty eight out of 148 extracted human permanent teeth were chosen randomly, and VRFs were artificially induced to result in 20 mesiodistally and 18 buccolingually oriented root fractures. The fracture width was subsequently measured. All the teeth were scanned with four CBCT units. CBCT images were evaluated independently by two observers. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated for each observer and fracture orientation. The AUC between the two fracture orientations was compared using Z test. RESULTS: The mean fracture width was 140 µm (standard deviation 26.8 µm). A statistically significant difference was found between the mesiodistal and buccolingual VRFs for the AUC from the CBCT unit 3D Accuitomo 170 (p = 0.02). There were no statistically significant differences between the mesiodistal and buccolingual VRFs for AUCs from the CBCT units NewTom VGi (p = 0.21), ProMax 3D Mid (p = 0.23), and i-CAT FLX (p = 0.21). CONCLUSION: Fracture orientations of teeth with VRFs in non-endodontically treated teeth may play a role in the detection accuracy of CBCT images, but this effect seems to be dependent on the CBCT unit used. CLINICAL RELEVANCE: Although for most of the CBCT units tested, the fracture orientation of VRF in non-endodontically treated teeth seems not to play a role for the diagnosis, clinical data is needed to further assess the impact of different devices on VRF detection.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Dente não Vital , Dente Pré-Molar , Humanos
7.
Indian J Dent Res ; 30(1): 135-139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30900674

RESUMO

An 18-year-old female patient reported to the Department of Conservative and Endodontics with the chief complaint of fractured tooth with respect to 21 and increased pain and mobility tooth with respect to 22. Intraoral periapical radiograph of 21 revealed coronal loss of tooth structure involving enamel, dentin, and pulp, suggestive of split tooth with respect to 21. Intraoral examination revealed a fracture of coronal structure of 22 and increased mobility in the coronal aspect, suggestive of horizontal crown-root fracture. For management of 21, after endodontic phase, placement of fiberpost, and coronal buildup, intentional reimplantation was done to expose and reattach the vertically fractured root fragment. For management of 22, after endodontic phase, crown lengthening was done, and the fractured fragment was reattached by making it a Natural Richmond's Crown. Radiographs revealed a complete sealing of the fractured fragment and proper positioning of the tooth.


Assuntos
Coroas , Colagem Dentária/métodos , Adesivos Dentinários , Endodontia/métodos , Estética Dentária , Resinas Sintéticas , Coroa do Dente/lesões , Fraturas dos Dentes/terapia , Mobilidade Dentária/terapia , Raiz Dentária/lesões , Adolescente , Feminino , Humanos , Coroa do Dente/diagnóstico por imagem , Fraturas dos Dentes/diagnóstico por imagem , Mobilidade Dentária/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Resultado do Tratamento
8.
Indian J Dent Res ; 30(1): 140-143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30900675

RESUMO

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.


Assuntos
Cemento Dentário/lesões , Cemento Dentário/cirurgia , Endodontia/métodos , Doenças Periodontais/etiologia , Doenças Periodontais/cirurgia , Fraturas dos Dentes/diagnóstico por imagem , Fraturas dos Dentes/diagnóstico , Fraturas dos Dentes/cirurgia , Adulto , Apicectomia , Cemento Dentário/diagnóstico por imagem , Seguimentos , Humanos , Incisivo/diagnóstico por imagem , Incisivo/lesões , Masculino , Maxila , Doenças Periodontais/diagnóstico , Radiografia Dentária , Endodontia Regenerativa/métodos , Fraturas dos Dentes/complicações , Resultado do Tratamento
9.
Clin Oral Investig ; 23(3): 1263-1270, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29984377

RESUMO

OBJECTIVES: To evaluate the influence of artifacts produced by zirconium implant on the diagnosis of vertical root fracture (VRF) in teeth close and distant to the implant in cone beam computed tomography (CBCT) images. We also determined if kilovoltage (kVp) and metal artifact reduction (MAR) tool could influence this diagnosis. MATERIALS AND METHODS: Twenty single-root teeth were divided in control and fractured groups (n = 10). The teeth were randomly positioned in the first and second and right and left pre-molar alveoli of a dry human mandible. CBCT exams were acquired using a ProMax 3D unit with varying kVp (70, 80, or 90 kVp), with or without MAR, and with and without a zirconium implant placed in the alveolus of first right molar. The images were evaluated by five observers. The area under the receiver operating characteristic curve (ROC), sensitivity, and specificity were calculated and compared by analysis of variance with a significance level of 5%. RESULTS: In general, ROC and sensitivity were not affected by the factors studied (p > 0.05). The main effects occurred in specificity; when implant was used without MAR, the values were lower for tooth 45 for all kVps (p = 0.0001). CONCLUSIONS: Artifacts produced in the vicinity of teeth with suspected VRF impair the diagnosis by decreasing the specificity, because they can mimic the VRF line generating false positives. However, MAR improves the specificity, being its use recommended when metallic objects are present near teeth with suspected VRF. CLINICAL RELEVANCE: Since nowadays, many patients who undergo CBCT show implants and they definitively produce artifacts, it is important to evaluate the influence of such artifacts in the diagnosis of teeth that are close to the generator-artifact object.


Assuntos
Artefatos , Implantes Dentários , Fraturas dos Dentes/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Humanos , Mandíbula , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões
10.
Int Endod J ; 52(2): 223-236, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30107037

RESUMO

AIM: To evaluate artefact intensity in cone beam computed tomography (CBCT) images of two alloys used in metal posts scanned using different exposure parameters. METHODOLOGY: The sample consisted of 20 single-rooted teeth divided into two groups for use with either a NiCr post or AgPd post. All teeth were scanned with and without their corresponding metal posts and with and without the presence of an extra restored tooth in the arch. The samples were scanned using CS 9000 3D scanner with two exposure protocols: 85 kV 6.3 mA and 85 kV 10 mA. Voxel size and FOV were fixed at 0.100 mm and 5 cm × 3.75 cm. The presence of artefacts was assessed qualitatively by two calibrated observers using the CBCT volume and paired 2D images, and quantitatively by one trained observer, using ImageJ software. Wilcoxon's signed rank, Mann-Whitney, kappa and chi-square tests were used for qualitative analyses. Two-way anova and Tukey's tests were used for quantitative analyses. All analyses were conducted considering the 95% confidence level (α < 0.05). RESULTS: For the CBCT volume qualitative analysis, significant differences were observed between the metal alloys in the presence of an extra restored tooth, with higher artefact intensity for AgPd when assessing hypodense halos and lines (P = 0.006). Images with two restored teeth had significantly more hypodense and hyperdense lines (P = 0.033). When evaluating exposure parameters and number of restored teeth, the paired image quality analysis revealed significant disagreement between observers for diagnostic image quality (P = 0.001). Quantitative artefact analysis revealed higher artefact intensity for the AgPd posts in the presence of two restored teeth. CONCLUSION: Although the exposure parameters tested did not interfere with artefact intensity, post alloys with a higher atomic number and the presence of another metal structure in the arch increased artefact intensity and impaired the diagnostic quality of CBCT images.


Assuntos
Artefatos , Tomografia Computadorizada de Feixe Cônico/métodos , Ligas Dentárias/química , Metais/química , Técnica para Retentor Intrarradicular , Raiz Dentária/diagnóstico por imagem , Dente Pré-Molar/diagnóstico por imagem , Ligas de Cromo/química , Humanos , Imagem Tridimensional , Software , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/lesões
11.
J Formos Med Assoc ; 118(3): 671-678, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30145002

RESUMO

BACKGROUND/PURPOSE: Vertical root fracture (VRF) is a complication in endodontically treated teeth. This study aimed to assess the clinical outcomes of treatment of 6 VRF teeth with intentional replantation and root fragment bonding with 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin. METHODS: A series of 6 complete VRF teeth (one incisor, one canine, one premolar, and 3 M) were treated through intentional replantation and root fragment bonding with 4-META/MMA-TBB resin. RESULTS: This study included 6 VRF teeth in 6 patients (one man and 5 women; mean age, 44 ± 8 years). All 6 teeth had VRF in the bucco-lingual direction and one tooth had concomitant VRF in the mesio-distal direction. The root thickness was classified as thick in all 6 teeth. Of the 6 VRF teeth, 4 had biting, percussion, or palpation pain, 4 had gingival swelling, 3 had sinus tracts, 3 had discomfort, and one had tooth mobility. Radiographically, 5 of the 6 teeth had periradicular radiolucent lesions, 4 of which exhibited complete regression and one of which exhibited nearly complete regression after root fragment bonding therapy. Because all 6 treated teeth exhibited sound function in the oral cavity after a follow-up period ranging from 33 to 74 (mean, 50 ± 15) months, the clinical outcomes were all considered to be successful. CONCLUSION: For a VRF tooth, in addition to tooth extraction, intentional replantation combined with root fragment bonding with 4-META/MMA-TBB resin is a successful treatment modality that can be used to preserve a complete VRF tooth.


Assuntos
Tratamento do Canal Radicular/efeitos adversos , Extração Dentária , Fraturas dos Dentes/terapia , Reimplante Dentário/métodos , Raiz Dentária/lesões , Adulto , Compostos de Boro/uso terapêutico , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Metacrilatos/uso terapêutico , Metilmetacrilatos/uso terapêutico , Pessoa de Meia-Idade , Cimentos de Resina/uso terapêutico , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/cirurgia , Resultado do Tratamento
12.
Indian J Dent Res ; 29(6): 847-851, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30589019

RESUMO

Radiographic imaging is an important criteria in diagnosis, treatment planning, and follow-up of an endodontic treatment. When clinicians encounter with diagnostic difficulties and persistent symptoms, the need for advanced diagnostic aids, especially imaging methods, become imperative and essential. This paper reports a case, in which primary endodontic therapy having failed, the patient had persisting symptoms such as pain, swelling, and draining sinus along with signs and symptoms of maxillary sinusitis. Advanced diagnostic aids such as Cone Beam Computed Tomography was useful in accurate identification of the etiology, which was a fractured mesiobuccal root tip of maxillary molar. This is the first reported case, in which the fractured root tip has migrated to the maxillary sinus, during primary endodontic treatment, through the perforated antral floor causing odontogenic sinusitis. The operating microscope helped in the successful completion of endodontic retreatment along with fractured root fragment retrieval.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Sinusite Maxilar/diagnóstico por imagem , Sinusite Maxilar/etiologia , Complicações Pós-Operatórias , Fraturas dos Dentes/complicações , Fraturas dos Dentes/diagnóstico por imagem , Migração de Dente/complicações , Migração de Dente/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Adulto , Doença Crônica , Humanos , Masculino , Maxila/diagnóstico por imagem , Dente Molar/diagnóstico por imagem , Tratamento do Canal Radicular/efeitos adversos
13.
Braz Dent J ; 29(6): 530-535, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517474

RESUMO

In order to evaluate the volume of dentinal cracks taking into account the age of the dentin and the type of file system used for endodontic procedures, forty freshly extracted single-rooted lower incisive teeth presenting similar root volume, were divided into two groups according to the age of the patient: Group Young (18 - 30 years old) and Group Old (60 years old or more). Each specimen was scanned by microcomputed tomography (micro-CT) in three stages: (i) before any treatment, (ii) after endodontic treatment with Reciproc files (REC), and (iii) after subsequent endodontic retreatment. Each group was subdivided into two subgroups, according to the retreatment technique used: retreatment with REC or with ProTaper Universal Retreatment (PUR) files. For each subgroup, the images were analyzed for differences in the volume of dentinal cracks in the middle and apical thirds of the teeth , according to the dentin age. In both stages (before and after instrumentation), the micro-CT images of the old root dentin presented with higher volume of cracks than those of the young root dentin, statistical significance notwithstanding (p>0.01). The use of REC files appeared to have no statistically significant differences in the generation of cracks in any type of root dentin when compared with PUR files (p>0.01). When retreated with PUR, the old root dentin presented with a significantly higher volume of cracks (p<0.01) when compared with the old root dentin initially.


Assuntos
Dentina/diagnóstico por imagem , Dentina/lesões , Preparo de Canal Radicular/métodos , Fraturas dos Dentes/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Humanos , Técnicas In Vitro , Pessoa de Meia-Idade , Retratamento , Microtomografia por Raio-X
14.
BMJ Case Rep ; 20182018 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-30396891

RESUMO

Chronic periapical lesions in necrotic teeth with open apex are difficult to manage. The situation becomes more complex if the tooth has a fracture line. This case report describes the management of a traumatised tooth that had already undergone unsuccessful endodontic treatment with a large periapical lesion and open apex along with a fracture line in the root. An attempt was made to save the tooth by using mineral trioxide aggregate (MTA) cement for orthograde filling, retrograde filling and also for sealing of the fracture line. Moreover, the bone defect was filled with autogenous bone harvested from the external oblique ridge. MTA, a bioactive tricalcium silicate cement, has been used in treating complex endodontic cases as it shows promising potential by inducing the biological mechanisms necessary for repair of involved teeth. A 1-year follow-up showed progressive healing as evident by radiographs and lack of any clinical signs and symptoms.


Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Óxidos/uso terapêutico , Silicatos/uso terapêutico , Odontopatias/terapia , Fraturas dos Dentes/terapia , Adolescente , Transplante Ósseo/métodos , Combinação de Medicamentos , Feminino , Humanos , Radiografia , Retratamento , Materiais Restauradores do Canal Radicular/uso terapêutico , Ápice Dentário/diagnóstico por imagem , Odontopatias/diagnóstico por imagem , Fraturas dos Dentes/diagnóstico por imagem
15.
Am J Orthod Dentofacial Orthop ; 154(4): 570-582, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30268267

RESUMO

This case report shows the treatment of a severe traumatic tooth injury. For the maxillary right central incisor, the trauma was considered a complicated crown-root fracture. The level of the fracture line, the length of the remaining root segment, and the presence and condition of the tooth fragment determined the type of therapy. Traumatized teeth with fractures below the alveolar crest are often considered hopeless. As this report shows, the treatment of a complicated crown-root fracture in the esthetic region can be challenging. Orthodontic extrusion and crown-length surgery were performed to bring the fracture line above the alveolar bone crest. A multidisciplinary approach was required for complete rehabilitation of the traumatized maxillary incisor. Suggestions are made to improve treatment planning of complicated crown-root fractures.


Assuntos
Incisivo/lesões , Incisivo/cirurgia , Maxila/cirurgia , Extrusão Ortodôntica/métodos , Fraturas dos Dentes/cirurgia , Fraturas dos Dentes/terapia , Raiz Dentária/lesões , Raiz Dentária/cirurgia , Adulto , Processo Alveolar/lesões , Processo Alveolar/cirurgia , Cerâmica , Tomografia Computadorizada de Feixe Cônico , Porcelana Dentária , Restauração Dentária Permanente , Restauração Dentária Temporária , Facetas Dentárias , Estética Dentária , Feminino , Humanos , Incisivo/diagnóstico por imagem , Técnica para Retentor Intrarradicular , Pulpotomia , Tratamento do Canal Radicular , Coroa do Dente/diagnóstico por imagem , Coroa do Dente/lesões , Coroa do Dente/cirurgia , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Resultado do Tratamento
16.
Braz Oral Res ; 32(suppl 1): e75, 2018 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-30365616

RESUMO

Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.


Assuntos
Cavidade Pulpar/lesões , Doenças da Polpa Dentária/etiologia , Dentição Permanente , Avulsão Dentária/complicações , Fraturas dos Dentes/complicações , Cavidade Pulpar/diagnóstico por imagem , Cavidade Pulpar/patologia , Doenças da Polpa Dentária/patologia , Humanos , Radiografia Dentária , Avulsão Dentária/diagnóstico por imagem , Avulsão Dentária/patologia , Coroa do Dente/patologia , Descoloração de Dente/etiologia , Fraturas dos Dentes/diagnóstico por imagem , Fraturas dos Dentes/patologia
17.
Eur Arch Paediatr Dent ; 19(5): 379-385, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30194610

RESUMO

BACKGROUND: Dental trauma is very common among children. Crown fractures represent the majority of dental trauma in the permanent dentition. Complicated crown-root fractures require a multidisciplinary approach, for long-term success. CASE REPORT: The multidisciplinary treatment of a traumatised permanent upper incisor of an 11-year-old patient that sustained a complicated crown root fracture, while under active orthodontic treatment is presented. The pulp was widely exposed and therefore endodontic treatment was necessary. However most of the crown (and part of the coronal part of the root as well) had been fractured and the tooth could not be properly isolated for an aseptic procedure. METHODS: Orthodontic extrusion was decided and it was achieved using a custom-made, intra-canal wire loop that was cemented in the root canal and attached to the patients' orthodontic fixed appliances. RESULTS: The remaining tooth structure was successfully extruded coronally and following endodontic treatment (under proper rubber dam isolation [RDI]), root canal obturated using the cold gutta-percha technique (in order to avoid further trauma to the periodontal ligament, if a warm obturation technique was chosen) and subsequently restored under RDI. At the 7-years follow-up, no signs of clinical or radiographical inflammation were evident. CONCLUSIONS: A custom wire loop as an anchoring site is an easy-to-adopt-and-perform option for such cases. Cold gutta-percha obturation techniques should be opted for root canal obturation to avoid further trauma to the periodontal ligament.


Assuntos
Endodontia/métodos , Incisivo/lesões , Extrusão Ortodôntica/instrumentação , Fraturas dos Dentes/terapia , Criança , Seguimentos , Guta-Percha , Humanos , Incisivo/diagnóstico por imagem , Masculino , Radiografia Dentária , Obturação do Canal Radicular/métodos , Coroa do Dente/lesões , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/lesões
18.
Int J Paleopathol ; 22: 143-148, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30126700

RESUMO

Dental root fractures are rarely documented in past human populations, but when they are observed, diagnosing ante-mortem events as causal factors can be difficult due to postmortem alteration. Can high resolution X-ray computed tomography (CT) improve our ability to diagnose if a dental fracture was caused ante- or post-mortem? To test this, a case study of two individuals with previously diagnosed dental root fractures were re-examined with high resolution CT to confirm or refute the original diagnoses. For individual 4170, use of high resolution CT supported the original diagnosis of an ante-mortem root fracture on the right mandibular central incisor that was made based on planar X-ray. With the new analyses, the root fracture was found to be associated with evidence of calcification, and with radicular and alveolar bone resorption, which are positive correlates of an ante-mortem origin. Resolving this level of detail of bone modification was not possible without using high resolution CT. For individual 4172, the use of high resolution CT enabled visualisation of fracturing and cracking throughout several molars and crowns of other teeth that were not evident in planar X-ray, suggesting that these fractures were likely produced by post-mortem taphonomic processes rather than ante-mortem events as originally diagnosed. In this case study, high resolution CT offered critical advantages compared to a planar X-ray approach, such as using 3D multiple slice views without superimposing alveolar bone and teeth as in planar X-ray imaging. This study demonstrates the potential of high resolution CT in confirming and refuting ante-mortem processes, and that visualisation of 3D structures is crucial for arriving at definitive diagnoses.


Assuntos
Paleopatologia/métodos , Fraturas dos Dentes/diagnóstico por imagem , Fraturas dos Dentes/história , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões , Adulto , Feminino , História do Século XV , Humanos , Masculino , Tomografia Computadorizada por Raios X , Zâmbia
19.
Dent Med Probl ; 55(2): 139-145, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30152616

RESUMO

BACKGROUND: Diagnosis of tooth root fractures is based on radiographic examination, which is not reliable in the case of oblique root fractures. OBJECTIVES: The aim of the study was to evaluate the efficacy of cone beam computed tomography (CBCT) imaging of oblique root fractures. MATERIAL AND METHODS: Twenty-four bovine incisors were used in the study. They were randomly divided into 2 groups: an experimental group with artificially created oblique root fractures and a control group without fractures. The teeth underwent a CBCT evaluation with a CS 9300 cone-beam scanner (Carestream, Rochester, USA) using a 5 × 5 cm field of view with the resolution up to 90 µm, and a dental radiography. The specimens were examined by 2 observers with different job experience. RESULTS: In the CBCT scans, fracture lines were detected in 95.8% of cases (the 1st observer made a proper diagnosis in 100% of cases and the 2nd in 91.7%). Fracture lines were identified on radiographs in 33.3% of roots (the 1st observer was able to see the lines in 41.7% of cases and the 2nd in 25%). The inter-observer agreement was very high (the kappa coefficient for CBCT scans was 1.00 and 0.88 for radiographs). The best diagnostic value was recorded for contiguous slices. CONCLUSIONS: Cone beam computed tomography with a small field of view and high resolution significantly surpasses radiographs in effective imaging of oblique tooth root fractures and should be the method of choice in the diagnosis of these fractures.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões , Animais , Bovinos , Técnicas In Vitro , Radiografia Dentária/métodos
20.
Spec Care Dentist ; 38(5): 319-323, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29971831

RESUMO

The difficulty in providing stability to the coronal segment makes cervical root fracture one of the most challenging dental traumatic injury. This type of injury is less frequent in children. However, due to their serious consequences and poor prognosis, tooth loss may occur. This report presents the management of a case of cervical root fracture in an 11-year-old patient with epilepsy. The stabilization of the root-fractured tooth with a splint failed due to the recurrent seizures the patient had. Coronal fragment was removed and vital root submergence was performed in order to support the alveolar growth. The natural tooth crown was incorporated into a modified Nance appliance to meet the esthetic and functional requirements of the patient. After 5-year follow-up, this treatment approach has seemed to offer a long-term provisional and satisfactory solution to the consequences of a cervical root fracture injury.


Assuntos
Epilepsia/complicações , Fraturas dos Dentes/etiologia , Fraturas dos Dentes/terapia , Raiz Dentária/lesões , Criança , Feminino , Humanos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem
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