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1.
J Craniomaxillofac Surg ; 47(11): 1767-1778, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31711997

RESUMO

Intermaxillary fixation (IMF) and osteosynthesis plates (OP) are widely used for the non-surgical and surgical treatment of mandible and condyle fractures. The aim of this retrospective study was to analyze the frequency of tooth root injuries by IMF and OP screws. Electronic patient reports (2004-2013) were screened for patients treated with either IMF screws and/or OP in the Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Germany. The frequency and the position of endangered and injured teeth were analyzed by orthopantomogram (OPTG) and cone beam computer tomography (CBCT). Next, possible predictive factors for tooth root injuries, namely interdental- and crestal distance, screw length and distance between tooth root and screw were evaluated. Further, the accuracy of OPTG vs. CBCT concerning the diagnosis of tooth root injuries was analyzed. Three-hundred sixty-six patients were included and 3388 teeth were defined as endangered by IMF- and OP screws. Overall, 16 injured teeth (0.5%) in 13 patients (3.55%) were detected. Nine injuries (56.3%) were caused by IMF- and seven injuries (43.8%) by OP screws. Three teeth were non-vital, one tooth had to be extracted. No correlation between the predictive factors crestal distance, screw length and tooth root injuries was found. If tooth injury occurred, a significant correlation between the interdental distance and the distance between tooth root and screw was found (κ = 0.48; p < 0,0001). Comparison between OPTG vs. CBCT demonstrated that many of the injuries that were seen in the OPTG (n = 230) could not be verified in the CBCT scans (n = 16) (κ = 0.12). To conclude, screws for IMF and OP can be considered as a safe procedure concerning the risk of tooth root injuries.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Traumatismos Dentários/cirurgia , Tomografia Computadorizada de Feixe Cônico , Alemanha , Humanos , Radiografia Panorâmica , Estudos Retrospectivos , Traumatismos Dentários/diagnóstico por imagem , Raiz Dentária/lesões , Resultado do Tratamento
2.
J Endod ; 45(12S): S13-S27, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31623913

RESUMO

BACKGROUND: Root fractures are not a common injury, but a thorough understanding of their etiology, healing responses, diagnosis, management, and prognosis is essential. REVIEW: The prognosis is largely related to the patient's age; degree of displacement, if any, of the coronal fragment; and the location and orientation of the fracture. The more apical the fracture is located, the better the prognosis. Teeth with root fractures located supracrestally may have the worst prognosis, but their management and outcome depend on many factors, with the most influential factor being the ability to restore the tooth because the coronal fragment usually needs to be removed. In contrast, root fractures located in the apical and middle thirds and those subcrestally in the coronal third of the root have a good prognosis and usually require little, if any, treatment apart from immediate repositioning (if the coronal fragment has been displaced) and stabilization. Monitoring of root-fractured teeth over time is essential to determine the healing response and to assess whether the pulp survives or not. In some cases, the pulp in the coronal fragment may necrose and become infected, thus requiring root canal treatment, but this should only be done to the fracture line. Pulp necrosis and infection typically occur within the first 3-4 months if it is a direct result of the trauma. However, pulp necrosis and infection can also occur many years later, in which case it is likely to be a result of bacterial penetration via cracks or breakdown of restorations. CONCLUSION: Overall, root fractures should be managed conservatively unless they are located supracrestally.


Assuntos
Tratamento do Canal Radicular , Fraturas dos Dentes , Raiz Dentária , Polpa Dentária , Necrose da Polpa Dentária , Humanos , Raiz Dentária/lesões
3.
Ann Ital Chir ; 82019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-31527308

RESUMO

BACKGROUND: Modern cone beam computed tomography (CBCT) acquisition and three-dimensional (3D) image processing, combined with direct metal laser sintering (DMLS), allows custom-made, root-analogue implants (RAIs). PURPOSE: To demonstrate how DMLS permits customized titanium RAI production, with immediate insertion and restoration in a fresh extraction socket of the anterior maxilla. MATERIALS AND METHODS: A titanium RAI perfect copy of the radicular unit needed for replacement was created by customized DMLS, and inserted into a fresh extraction socket of the esthetic area of the anterior maxilla. RESULTS: Follow-up after 1 year: the DMLS RAI implant showed a satisfactory functional and esthetic integration, with no bone resorption or soft tissue recessions. CONCLUSIONS: The production of customized DMLS RAIs opens new interesting perspectives for immediate implantation. KEY WORDS: Direct metal laser sintering, Root analogue implant.


Assuntos
Desenho Assistido por Computador , Tomografia Computadorizada de Feixe Cônico , Projeto do Implante Dentário-Pivô , Implantes Dentários para Um Único Dente , Planejamento de Prótese Dentária/métodos , Carga Imediata em Implante Dentário , Incisivo/lesões , Metalurgia/métodos , Fraturas dos Dentes/cirurgia , Raiz Dentária/lesões , Desenho Assistido por Computador/instrumentação , Planejamento de Prótese Dentária/instrumentação , Estética , Humanos , Imageamento Tridimensional , Lasers , Masculino , Maxila , Metalurgia/instrumentação , Pessoa de Meia-Idade , Titânio
4.
Rev. Asoc. Odontol. Argent ; 107(3): 103-109, jul.-sept. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1048477

RESUMO

Objetivo: Informar el tratamiento de dos piezas con fractura radicular horizontal del tercio medio, patrones de curación y seguimiento por cinco años. Caso clínico: Se presentó a la consulta una niña de 9 años de edad con traumatismo de 10 días de evolución. Examen clínico: fractura amelodentinaria restaurada en la pieza 2.2, movilidad y sensibilidad a la percusión y palpación en ambos incisivos centrales superiores. Examen radiográfico: fractura radicular horizontal de tercio medio en piezas 1.1 y 2.1. Tratamiento: inmovilización con placa removible durante 4 semanas, indicaciones de higiene y uso, y controles de seguimiento. Al primero y al cuarto mes, ambos incisivos mostraron ausencia de movilidad, reacción positiva de sensibilidad y signos radiográficos de reabsorción superficial interna y externa. A los 6 meses, el 1.1 evidenció signos de reparación con tejido conectivo, y el 2.1, signos clínicos y radiográficos de necrosis pulpar del fragmento coronario. Se realizó el tratamiento endodóntico de la pieza 2.1 hasta el nivel de la fractura con pasta a base de hidróxido de calcio, y luego de la comprobación de la formación de una barrera de tejido duro, se obturó definitivamente con gutapercha y sellador endodóntico. Cinco años después del traumatismo, ambos incisivos se mostraron asintomáticos y los estudios por imágenes evidenciaron una completa consolidación de las fracturas. Conclusión: Un diagnóstico temprano, procedimientos apropiados de tratamiento, el conocimiento de los procesos curativos y un monitoreo cuidadoso de todos los parámetros clínicos y radiográficos son claves para un enfoque correcto y conservador de las piezas dentarias con fractura radicular (AU)


Aim: To report the treatment, healing patterns and fiveyear follow-up of two permanent incisors with horizontal root fracture located in the middle third. Case report: A 9-year-old girl who came to our consultation 10 days after a dental trauma. Clinical examination: restored enamel-dentin fracture in upper left lateral incisor; mobility and sensitivity to percussion and palpation in both upper central incisors. Radiographic examination: horizontal root fracture in the middle third of both upper central incisors. Treatment: stabilization with a removable splint for 4 weeks, indications for hygiene, use of the splint and follow-up controls. At first and fourth month, central incisors presented absence of mobility, positive response to pulp testing and radiographic signs of internal and external superficial resorption. At sixth month, signs of healing with connective tissue were found on the right central incisor, while the left one showed clinical and radiographic signs of necrosis of the coronal fragment. The root canal of this segment was treated initially with a calcium hydroxide paste and, after verifying the formation of a hard tissue barrier, it was filled with gutta- percha and endodontic sealer. Five years after the trauma, both central incisors were asymptomatic and imaging studies showed complete healing of the fractures. Conclusion: Early diagnosis, appropriate treatment procedures, knowledge of healing patterns and careful monitoring of clinical and radiographic parameters are key factors for a proper and conservative approach of injured tooth with root fracture (AU)


Assuntos
Humanos , Feminino , Criança , Fraturas dos Dentes/terapia , Raiz Dentária/lesões , Dentição Permanente , Argentina , Tratamento do Canal Radicular , Seguimentos , Incisivo/lesões
5.
Gen Dent ; 67(4): 47-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31355764

RESUMO

An 80-year-old patient fell while jogging, hitting his face on the concrete trail and causing a horizontal root fracture of his maxillary right central incisor. The fracture separated the root into 2 halves about 0.60-0.84 mm apart, resulting in extrusion of the incisal half. The patient had severe lip swelling and facial injury but no tooth pain. Various options for care were evaluated, but, other than reducing the extrusion, placing local antibiotics, and prescribing periodontal medication, the dentist did not provide or recommend further treatment. At the most recent recall, 8 years after the accident, the root exhibited good bone repair, there was no evidence of abscess, and the patient reported no discomfort. This report aims to remind clinicians that no or minimal treatment may be the best option in certain cases.


Assuntos
Incisivo , Fraturas dos Dentes , Raiz Dentária/lesões , Conduta Expectante , Idoso de 80 Anos ou mais , Humanos , Masculino , Maxila
6.
Microsc Res Tech ; 82(10): 1748-1755, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313438

RESUMO

The aim of the study was to compare different imaging methods in the diagnosis of microcracks on root dentin and to evaluate the frequency of dentinal microcracks observed after root canal preparation using the ProTaper Universal (PTU) system of different sizes. A total of 30 mandibular molars' mesial roots were scanned with microcomputed tomography (micro-CT) and cone beam computed tomography (CBCT) imaging methods before instrumentation. Root canal instrumentation was performed up to PTU F2 and F4 files. After instrumentation stages, the roots were scanned again with micro-CT and then with CBCT in same parameters. All roots were sectioned horizontally at 2, 4, 6, 8, and 10 mm from the apices of the specimens. The sections were imaged under a stereomicroscope. Finally, imaging of the sections was done by scanning electron microscopy (SEM). Statistical data analysis of instrumentation steps was performed using Friedman and Wilcoxon tests, and the data of imaging methods were analyzed using Kruskal-Wallis and Mann-Whitney U tests (p = .05). Instrumentation with the PTU system up to F2 and F4 files significantly increased the number of microcracks compared with preoperative samples according to micro-CT imaging (p < .05). For detecting microcracks on the root dentin, there were no statistically significant differences between micro-CT (43.9%) and stereomicroscopy (45.8%) (p < .05). SEM showed significantly higher percentage of microcracks (88.3%) (p > .05). No microcrack was observed using the CBCT method. There were no statistically differences between micro-CT and stereomicroscopy. SEM showed more dentinal microcracks while no microcrack was observed with CBCT.


Assuntos
Dentina/diagnóstico por imagem , Dentina/lesões , Diagnóstico por Imagem/métodos , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/lesões , Humanos , Dente Molar/diagnóstico por imagem , Dente Molar/lesões , Preparo de Canal Radicular/efeitos adversos
7.
J Endod ; 45(8): 977-984.e1, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31248698

RESUMO

INTRODUCTION: This study aimed to compare the incidence of root fractures that led to extraction in immature teeth endodontically treated by mineral trioxide aggregate (MTA) apexification and were restored with either reinforced (resin composite or fiber post) or nonreinforced (gutta percha or MTA) intraradicular materials. METHODS: Necrotic immature teeth treated with MTA apexification from 1996 to 2017 were selected according to the inclusion and exclusion criteria. Intraradicular materials and preoperative and treatment factors were obtained from dental charts and radiographs. The incidence of fatal root facture was identified. Kaplan-Meier survival analysis and the Cox proportional hazard model were used to show the survival rate and predisposing factors at a significance level of .05. RESULTS: The average recall period was 30 months. The incidence of root fracture in the teeth restored with the reinforced materials was 5.5%, which was not significantly different from the nonreinforced materials (8.3%). Furthermore, the fracture rates between the fiber post and resin composite groups were not significantly different. Two significant predisposing factors influencing the incidence of root fracture were detected: preoperative external inflammatory root resorption (hazard ratio = 26.86; P < .05) and patient age > 15 years (hazard ratio = 8.60, P < .05). CONCLUSIONS: Immature teeth treated with MTA apexification and restored with the reinforced or nonreinforced intraradicular materials exhibited a similar rate of root fracture. Preoperative external inflammatory root resorption and patient age > 15 years were found to be the predisposing factors that significantly increased the incidence of root fracture.


Assuntos
Compostos de Alumínio , Apexificação , Compostos de Cálcio , Óxidos , Materiais Restauradores do Canal Radicular , Silicatos , Fraturas dos Dentes , Combinação de Medicamentos , Humanos , Incidência , Estudos Retrospectivos , Raiz Dentária/lesões
8.
Dent Traumatol ; 35(6): 312-323, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31152620

RESUMO

Each year, millions of children are injured and live with the consequences of those injuries. Through infancy and childhood, orofacial trauma caused by falls or being struck by or against objects occurs in children. The long-term implications on the developing permanent teeth are little known, even when the oral region is the second most frequently injured body area in children under 6 years of age. During this period, the developing permanent teeth may be directly involved after trauma, causing mild to severe hypoplasia, displacement, damage to the tooth germ, or an extended range of morphofunctional disturbances. In some cases, the effects of oral and dental injuries caused by trauma appear later with the eruption of the permanent incisors when ectopic eruption, malalignments, and other developmental disturbances become visible. Therefore, long-term follow up of the patient in order to diagnose and treat associated complications becomes essential. Critical points for facing the consequences of orofacial trauma on the developing dentition are to recognize the impact of orofacial trauma in young children and the dentist's role in providing anticipatory guidance to parents and health care professionals, differentiate between mild and severe disturbances affecting the developing permanent teeth after oral injuries in early childhood, recognize the importance of follow-up controls, and recognize the importance of early referral to a pediatric dentist and orthodontist for diagnosis and treatment planning.


Assuntos
Dentição Permanente , Anormalidades Dentárias , Avulsão Dentária , Dente Decíduo/lesões , Criança , Pré-Escolar , Hipoplasia do Esmalte Dentário/epidemiologia , Dentição , Humanos , Incisivo/lesões , Anormalidades Dentárias/epidemiologia , Anormalidades Dentárias/etiologia , Avulsão Dentária/epidemiologia , Avulsão Dentária/etiologia , Fraturas dos Dentes/epidemiologia , Raiz Dentária/lesões
9.
Gen Dent ; 67(3): 52-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31199745

RESUMO

Complications can occur during implant placement; thus, clinicians should be aware of all potential outcomes, and staff members should be fully prepared to respond in case of emergency. A thorough medical history, precise surgical technique, knowledge, and skill are essential to prevent complications. The most serious complications, which could threaten the patient's life, are airway obstruction, bleeding, aspiration of the implant or its parts, infection, cavernous sinus thrombosis, nerve injury, and mandibular fracture.


Assuntos
Implantação Dentária Endo-Óssea/efeitos adversos , Implantes Dentários , Procedimentos Cirúrgicos Bucais , Planejamento de Assistência ao Paciente , Período Perioperatório , Complicações Pós-Operatórias/prevenção & controle , Implantação Dentária Endo-Óssea/métodos , Implantes Dentários/efeitos adversos , Emergências , Humanos , Fraturas Mandibulares , Aspiração Respiratória/etiologia , Raiz Dentária/lesões
10.
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
11.
J Endod ; 45(4): 447-452, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30827767

RESUMO

INTRODUCTION: The aim of this study was to assess the frequency of root crack formation caused by the use of manual instrumentation, 2 rotary systems, and 1 reciprocating system using light-emitting diode transillumination. METHODS: One hundred fifty mandibular premolars were randomly divided into 5 groups (n = 30): control 1, no intervention; control 2, instrumented with hand files; group 3, instrumented with ProTaper Universal rotary files (Dentsply Maillefer, Ballaigues, Switzerland); group 4, instrumented with OneShape rotary files (Micro-Mega, Besancon, France); and group 5: instrumented with the WaveOne reciprocal system (Dentsply Maillefer, Ballaigues, Switzerland). After root canal preparations, the roots were sectioned at 3, 6, and 9 mm from the apex with water irrigation. The slices were inspected under a stereomicroscope with light-emitting diode transillumination from the buccal, lingual, mesial, and distal directions at ×40 magnification to determine the presence/absence of cracks (dentinal defects). The chi-square test was used to analyze the data. RESULTS: There was a significant difference among the groups in crack frequency (P < .05). The 2 single systems had significantly higher cracks than the other 3 groups. At 3 mm from the apex, there were significantly more cracks in groups 4 and 5 than in groups 1, 2, and 3 (P < .05). At 6 mm from the apex, no significant difference was noted (P > .05). At 9 mm from the apex, the frequency of cracks in group 3 was significantly higher (P < .05). CONCLUSIONS: According to the results, using rotary instrumentation can result in some dentinal defects, and single-file systems, regardless of motion type, can cause significantly higher crack formation in the apical third of root canals.


Assuntos
Síndrome de Dente Quebrado/etiologia , Instrumentos Odontológicos/efeitos adversos , Dentina/lesões , Preparo de Canal Radicular/efeitos adversos , Preparo de Canal Radicular/instrumentação , Fraturas dos Dentes/etiologia , Raiz Dentária/lesões , Dente Pré-Molar , Humanos , Mandíbula
12.
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
13.
Oral Maxillofac Surg ; 23(1): 63-69, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739261

RESUMO

PURPOSE: To assess different types of dental injuries associated with facial bone fractures. METHOD: One hundred dentate patients were selected randomly of all age and gender who had maxillofacial trauma only and having dental injury in association with facial bones fractures were included. They were thoroughly examined for injury/fracture to facial region as well as for dental injuries (teeth). Tooth injuries were noted according to Ellis classification. The data was collected, compiled, and put to statistical analysis. RESULTS: Dental injuries were more in females than males found to be statistically significant with (p < 0.05).Crown fracture of maxillary teeth was more as compared to mandibular except molars found to be statistically significant (p < 0.05). Root fracture was more in maxillary incisors followed by canine as compared to mandibular incisors and canines found to be insignificant. Avulsion, extrusion and luxation were more in maxilla as compared to mandible found to be significant. CONCLUSION: Different types of tooth injuries associated with facial bone fracture found more in females and maxillary teeth.


Assuntos
Ossos Faciais/lesões , Fraturas Ósseas/complicações , Traumatismos Dentários/complicações , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Ossos Faciais/diagnóstico por imagem , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia Dentária , Fatores Sexuais , Tomografia Computadorizada por Raios X , Avulsão Dentária/complicações , Coroa do Dente/lesões , Traumatismos Dentários/diagnóstico por imagem , Raiz Dentária/lesões , Adulto Jovem
14.
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 , Imageamento Tridimensional , Software , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/lesões
15.
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
16.
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
17.
J Formos Med Assoc ; 118(3): 713-720, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30193836

RESUMO

BACKGROUND/PURPOSE: Diagnosis of vertical root fractures (VRFs) can often be challenging due to the similarity of signs and symptoms with other common dental infectious diseases. This study was aimed at evaluating the potential relationship between VRFs and commonly used clinical diagnostic factors. METHODS: 330 root-filled teeth with endodontic failures were subjected to endodontic microsurgery over a six-year period. VRFs were identified in 61 teeth. A randomly age- and sex-matched retrospective case-control study was conducted on a subset of 59 root-filled teeth with VRFs (cases) and 177 root-filled teeth without VRFs (controls). The strength of association between preoperative signs and radiographic findings and VRFs was evaluated using logistic regression model. RESULTS: Sinus tract, periodontal pocket depth ≥5 mm, periodontal swelling or abscess, and radiological image of J-shaped or "halo" radiolucency were significantly more frequent in cases than in controls (p < 0.05). With regard to logistic regression analysis, J-shaped or "halo" radiolucency demonstrated the greatest association with VRF, followed by periodontal pocket depth ≥5 mm, sinus tract, and periodontal swelling or abscess. Approximately 70% of cases manifested themselves as combinations of at least two of these factors. Teeth having two and three or four of these factors had 3.14 times and 11.64 times higher risks for the presentations of VRFs, respectively (p < 0.001). CONCLUSION: The major risk for VRFs was represented by those presenting radiological image of J-shaped or "halo" radiolucency, periodontal pocket depth ≥5 mm, sinus tract, and periodontal swelling or abscess simultaneously.


Assuntos
Obturação do Canal Radicular/efeitos adversos , Fraturas dos Dentes/epidemiologia , Raiz Dentária/lesões , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Taiwan/epidemiologia , Fraturas dos Dentes/etiologia
18.
Scanning ; 2019: 5240430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31969970

RESUMO

Objective: This study is aimed at determining (1) the effect of root-end resection, ultrasonic root-end preparation, and root-end filling on the incidence of crack formation and propagation by using a digital microscope (DM) and optical coherence tomography (OCT) and (2) the performance of OCT on the detection of cracks by comparing with microcomputed tomography (micro-CT) as a reference standard. Methodology: Thirty extracted lower incisors were endodontically treated and subjected to root-end resection and ultrasonic root-end cavity preparation. Then, the teeth were divided into three groups (n = 10, each), and the root-end cavity was either left unfilled or filled with mineral trioxide aggregate (MTA) or super-EBA. The resected surface was observed with OCT and DM after the root-end resection, ultrasonic root-end preparation, and root-end filling, and the frequency of incomplete and complete cracks were recorded. The observation was repeated after two weeks, one month, and two months, and micro-CT scans after two months were taken as the gold standard. Results: The DM results show dentinal crack formation in 47% of the samples following root-end resection and in 87% following ultrasonic preparation. After the ultrasonic preparation, no existing crack propagated to a complete crack, but new cracks were formed. MTA and super-EBA had no effect on crack formation. The Spearman correlation coefficient between OCT and DM was 0.186 (very weak correlation; p = 0.015). Sensitivity and specificity in comparison to micro-CT were 0.50 and 0.55 in OCT and 1.00 and 0.35 in DM, respectively. McNemar's test showed a significant difference between OCT and DM (p < 0.05). Conclusion: Apical resection and ultrasonic preparation could form dentinal cracks. OCT and DM showed different detection frequencies of cracks with very weak correlation. DM showed superior sensitivity compared with OCT.


Assuntos
Obturação do Canal Radicular/efeitos adversos , Obturação do Canal Radicular/métodos , Preparo de Canal Radicular/efeitos adversos , Preparo de Canal Radicular/métodos , Sonicação/efeitos adversos , Sonicação/métodos , Raiz Dentária/lesões , Humanos , Incidência , Incisivo , Microscopia , Tomografia de Coerência Óptica , Microtomografia por Raio-X
19.
Rev. Fac. Odontol. (B.Aires) ; 33(75): 15-22, jul.-dic. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-999406

RESUMO

La extrusión dentaria o erupción forzada es una opción de tratamiento con enormes ventajas cuando nos vemos obligados a tratar fracturas corono-radiculares. Se define como el movimiento en dirección coronal a través de la aplicación de fuerzas ligeras y continuas para provocar cambios en los tejidos blandos y hueso. La extrusión dental forzada amplía las alternativas en cuanto a la rehabilitación futura del paciente, ya que se puede optar por la restauración periférica total con anclaje del resto radicular, o bien por la exodoncia posterior a la extrusión, con la consecuente mejoría de las condiciones del tejido óseo para una posterior rehabilitación implanto-asistida. Presentación de caso clínico, pieza dentaria 2.2 con fractura corono-radicular en la cual se realizó tratamiento de erupción forzada y rehabilitación protésica (AU)


Extrusion or forced eruption es a treatment option with enormous advantages when we are forced to treat crown-root fractures. It is defined as the movement in the coronal direction through the application of light and continuous forces to cause changes in the soft tissues and bone. Forced dental extrusion expands the alternatives regarding the future rehabilitation of the patient, since it is possible to choose either total peripheral restoration with anchoring of the radicular rest of the post-extrusion extraction, with the consequent improvement of bone tissue conditions for subsequent implant-assissted rehabilitation. Presentation of a case report: tooth 2.2 with a crown-root fracture in which forced eruption and prosthetic rehabilitation were performed (AU)


Assuntos
Humanos , Feminino , Adulto , Fraturas dos Dentes/terapia , Raiz Dentária/lesões , Coroa do Dente/lesões , Extrusão Ortodôntica , Prótese Dentária Fixada por Implante , Restauração Dentária Permanente
20.
Rev. Asoc. Odontol. Argent ; 106(4): 127-135, dic. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-981824

RESUMO

Objetivo: Presentar una serie de casos clínicos con perforaciones radiculares obturadas con MTA. Casos clínicos: Este estudio retrospectivo muestra una serie de 5 casos clínicos correspondientes a elementos dentarios con perforaciones radiculares obturadas con MTA y evaluadas clínica y radiográficamente a distancia del tratamiento. Conclusión: El MTA es un material de obturación válido para el tratamiento de las perforaciones radiculares, permitiendo la reparación de los tejidos perirradiculares comprometidos (AU)


Aim: To present a series of clinical cases with root perforations filled with MTA. Case report: This retrospective study shows a series of five clinical cases corresponding to teeth with root perforations filled with MTA and assessed clinically and radiographically for a long period of time. Conclusion: MTA is a valid filling material for root perforation treatment allowing the healing of compromised periradicular tissues (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Materiais Restauradores do Canal Radicular/uso terapêutico , Raiz Dentária/lesões , Doença Iatrogênica , Prognóstico , Seguimentos , Resultado do Tratamento , Retratamento
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