Restabelecimento de ponto de contato em dentes com coroas totais posteriores: relato de caso / Reestablishment of contact point on teeth with posterior crowns: case report

A presença do ponto de contato é essencial para manter a saúde das estruturas periodontais, além de evitar inclinações dentárias e desgastes, conservando, assim, uma oclusão ideal. Objetivo: apresentar um relato de caso clínico com restabelecimento dos pontos de contato de forma conservadora, por meio da ortodontia e da dentística restauradora, em dentes com coroas totais. Relato de caso: paciente do gênero feminino, 69 anos de idade, compareceu à clínica odontológica da universidade com queixa de impacção alimentar e desconforto na região superior posterior direita da arcada. Foi observada clinicamente ausência do ponto de contato entre os dentes 15, 16 e 17, optando-se pelo tratamento multidisciplinar envolvendo a ortodontia e a dentística restauradora. Para isso, foram utilizados bráquetes no segundo pré-molar e no primeiro molar superior direito (dentes 15 e 16, respectivamente), e botões ortodônticos nas faces palatinas desses, e do segundo molar superior (dente 17), unidos por elástico corrente tamanho médio. Quando obtidos os pontos de contato, foi realizada a restauração do primeiro pré-molar direito (dente 17) com resina composta. Considerações finais: o uso de elásticos corrente e botões ortodônticos foi satisfatório para a obtenção de pontos de contato entre os dentes.(AU)

The presence of the proximal contact is essential to maintain the periodontal structures health, besides preventing diseases and wastes, thus preserving an ideal occlusion. Aim: the aim of this article is to present a clinical case report with restoration of the proximal contact in a conservative way, through orthodontics and restorative dentistry, in teeth with total crowns. Case report: a 69-year-old female patient attended the university dental clinic with complaint of food impaction and discomfort in the upper right posterior region of the arcade. It was clinically observed absence of the point of contact between the teeth 15, 16 and 17 and opted for the multidisciplinary treatment involving orthodontics and restorative dentistry. For this, brackets were used in the second premolar and first maxillary right molar (teeth 15 and 16, respectively), and orthodontic buttons on the palatal surfaces of the same, and on the second upper molar (tooth 17), joined by the current elastic medium size. When the proximal contact was obtained, the first right premolar restoration was performed with a composite resin. Final considerations: the use of current elastics and orthodontic buttons were satisfactory for obtaining proximal contact between these teeth.(AU)

Trastornos temporomandibulares e índice de dientes cariados, perdidos y obturados en personas con discapacidad psicosocial crónica internadas en el Hospital Psiquiátrico de la ciudad de Asunción, 2018 / Temporomandibular disorders and decayed, missing and filled teeth index in people with chronic psychosocial disability admitted to the Psychiatric Hospital of the city of Asunción, 2018

Introducción: Los pacientes con trastornos mentales están sometidos a un mayor número de factores de riesgo de enfermedades bucodentales y temporomandibulares. Ello debido a los efectos secundarios de las medicaciones que consumen, la falta de autocuidado, la dificultad para acceder a atención, la actitud hacia los profesionales sanitarios y también la falta de cooperación en los tratamientos dentales. Objetivo: Determinar la frecuencia de los trastornos temporomandibulares (TTM) y el índice de dientes cariados, perdidos y obturados (CPO-D) en pacientes con discapacidad psicosocial crónica internados en el Hospital Psiquiátrico de la ciudad de Asunción, Paraguay. Material y Métodos: El estudio tuvo un diseño observacional descriptivo de corte transversal y fue aprobado por el comité de ética institucional. Participaron 139 personas con discapacidad psicosocial crónica de ambos sexos, mayores de 18 años, en el mes de mayo, 2018. Como instrumentos de medición se utilizaron: un cuestionario de 3 preguntas, el examen clínico con 5 indicadores para la variable presencia de TTM, el odontograma para el índice CPO-D y los expedientes clínicos. Resultados: Se encontró una población en su mayoría masculina, con un rango de edad entre 40-50 años, y un alto porcentaje de fumadores activos. Se observó que el 83,5 % de los examinados presentaba TTM. El índice CPO-D fue 22,8. Entre los signos de TTM, el ruido articular fue el más común. Conclusión: Se observó una elevada frecuencia de TTM en las personas con discapacidad psicosocial y un elevado índice CPO-D. Palabras Claves: Salud bucal, trastornos ATM, índice CPO, salud mental, psiquiatría, trastorno psicosocial.

Introduction: Patients with mental disorders are subject to a greater number of risk factors for oral and temporomandibular diseases. This is due to the side effects of the medication they consume, the lack of self-care, the difficulty in accessing medical help, the attitude of the patients towards health professionals and also the lack of cooperation in their dental treatments. Objective: To determined the frequency of temporomandibular disorders (TMD) and the decayed, missing and filled teeth index (DMFT) in people with chronic psychosocial disability admitted to the Psychiatric Hospital of the city of Asunción. Material and Methods: This descriptive, observational and cross-sectional study was approved by the local ethics committee. One hundred and thirty-nine people with chronic psychosocial disabilities, of both sexes, over 18 years of age participated during May, 2018. The instruments used were a 3-item questionnaire, clinical examination with 5 indicators for presence of TMD, the odontogram for the DMFT index and the clinical charts. Results:A predominantly male population, with an age range between 40-50 years, and a high percentage of active smokers was found. TMD was found in 83.5% and the DMFT index was 22.8. Among the signs of TMD, joint noise was the most common. Conclusion:A high frequency of TMD was observed in people with psychosocial disabilities and a high CPO-D index. Key words: Oral health TMJ , disorder, DMF index, mental health, psychiatry

Factors associated with the number of filled teeth in adolescents from public schools: a cohort study

Abstract This study aimed to assess the association of demographic conditions, socioeconomic status, clinical variables, and psychosocial factors with the number of filled teeth in adolescents from public schools. This cohort study comprised 1,134 12-year-old adolescents enrolled in public schools in Santa Maria, Brazil, in 2012. They were followed-up in 2014, where 743 individuals were reassessed (follow-up rate of 65.52%) for the number of filled teeth. Data were collected via dental examinations and structured interviews. Demographic and socioeconomic characteristics were collected from parents or legal guardians. The psychosocial factor comprised students' subjective measurement of happiness (Brazilian version of the Subjective Happiness Scale - SHS). Dental examinations were performed to assess the number of filled teeth through decay, missing, and filled teeth index (DMF-T). Unadjusted and adjusted Poisson regression analyses were performed to assess the association between baseline variables and filled teeth at follow-up. The number of filled teeth in 2012 and 2014 were 193 (17.02%) and 235 (31.63%), respectively. The incidence of filled teeth in 2014 was 42 (5.65%). Adolescents with untreated dental caries, those who visited the dentist in the last 6 months, those that exhibited being happier, and those who had filled teeth at baseline were associated with a higher number of filled teeth at follow-up. We conclude that the number of filled teeth in adolescents was influenced by clinical and psychosocial factors, emphasizing the need to focus on oral health policies in individuals with higher disease burden and those who feel psychologically inferior.

Time expended on managing molar incisor hypomineralization in a pediatric dental clinic in Nigeria

Abstract This study assessed the difference in the number of visits made to a dental care clinic and the time spent providing specific dental treatment for children with and without molar incisor hypomineralization (MIH). Children aged 8 to 16 years who presented at the Pediatric Dental Unit of the Obafemi Awolowo University Teaching Hospital Complex, in Ile-Ife, Nigeria, were eligible for the study. A comprehensive medical and dental history was taken, and each child was clinically examined, diagnosed, and treated according to a drawn-up plan. The time taken to establish a diagnosis and to provide specific treatments (scaling and polishing, restoration, pulpectomy, extraction, and placement of stainless steel crowns) and the number of visits made to complete the treatment plan were recorded for each child. Differences in the number of visits, time expended to make a diagnosis and to treat children with and without MIH were analyzed. The average time for diagnosis (p = 0.001) and the average time for placing amalgam restorations (p = 0.008) were significantly longer in children with MIH than in those without it. Children with MIH made more visits to the clinic (p < 0.001).There was no significant difference in the average time for scaling and polishing (p = 0.08), glass ionomer cement restorations (p = 0.99), composite restorations (p = 0.26), pulpectomy (p = 0.42), tooth extraction (p = 0.06), and placement of a stainless steel crown (p = 0.83) in children with and without MIH. In conclusion, children with MIH required more time for oral health care. Placing amalgam restorations took significantly longer than placing tooth bonding restorative materials in children with MIH than in those without it.

Tratamiento estomatológico del paciente con síndrome nefrótico congénito e hipoplasia generalizada del esmalte: informe de un caso / Stomatological treatment of the patient with congenital nephrotic syndrome and generalized enamel hypoplasia: report of a case

El síndrome nefrótico es la glomerulopatía que se presenta con mayor frecuencia a nivel mundial. La historia natural de la enfermedad, laevolución, la histología renal y la respuesta al tratamiento, va desde la remisión hasta el trasplante renal. Los pacientes con nefropatía presentan alteraciones estomatológicas propias de la enfermedad y secundariasal tratamiento. Los niños con enfermedad renal crónica presentan doscondiciones orales importantes: alta incidencia de anomalías dentarias(hipoplasia del esmalte, retraso de erupción, calcificaciones pulpares) ybaja actividad de caries. Objetivo: Describir la técnica de restauración dental a base de ionómero mediante un caso clínico de un paciente con nefropatía e hipoplasia del esmalte. Conclusión: El uso de ionómero devidrio como obturación semipermanente en pacientes con hipoplasia del esmalte es una eficaz alternativa de tratamiento cuando no se pueden explotar opciones como sistemas adhesivos, coronas de acero cromo o coronas para dientes permanentes.

Nephrotic syndrome is the glomerulopathy which occur mostfrequently in the world. The natural history of disease, evolution, renalhistology and response to treatment, ranging from referral to renaltransplantation. Patients with kidney disease have own stomatology alterations and secondary alterations related to treatment. Children with chronic renal failure have two oral conditions of interest: high incidence of dental anomalies (enamel hypoplasia, delayed eruption,pulp calcifications) and low caries activity. Objective: To describe the technique ionomer dental restoration by a clinical case of a patientwith nephropathy and enamel hypoplasia. Conclusion: The use of glass ionomer as semi-shutter in patients with enamel hypoplasia isan effective alternative of treatment when cannot be exploited options such as adhesive systems, steel crowns or crowns for permanent teeth.

Restauración post-endodoncia y condición social como factor de preservación dentaria: parte 1 / Post-endodontic restoration and social condition as afactor of tooth preservation. part 1

El objetivo de este estudio fue conocer el estado dental de piezas endodonciadas en correlación conlas variables de restauración coronaria, nivel de estudio, condición laboral y acceso a servicios odontológicos. Para ello, se analizó una población de individuos, compuesta por sujetos concurrentes a los cursos de posgrado de Endodoncia del Círculo Odontológico de Córdoba y al servicio de la Cátedra“B” de Endodoncia de la Facultad de Odontología de la Universidad Nacional de Córdoba. Se hicieron tratamientos controlados durante dieciocho meses. La muestra total la conformaron 144 pacientes y se trataron 174 casos. Sólo asistieron a control el 48,6 por ciento de los pacientes, de los cuales se evaluaron 89 dientes. El estudio mostró 37 casos con restauración coronaria definitiva sin fracturas, 52 dientes sinrestauración, 21 con fracturas y 1 se perdió. Se observó un incremento de fracturas en control a los 18 meses. La tasa de fracturas evidenció un mayor porcentaje en pacientes con nivel de estudio alto, menor en pacientes sin trabajo, y mayor en pacientes con trabajo estable y precario. El tipo de atención no se diferenció, pero los porcentajes observados sugieren que los atendidos en asistencia pública tendrían más probabilidad de fracturas. Se observó un mayor porcentaje de restauraciones definitivas enatención privada y menor en consultorios públicos. El elevado porcentaje de inasistencia a controlesmotivó un análisis específico, del cual se pudo concluir que a mayor estabilidad laboral, de estudios yde asistencia privada, mayor fue la asistencia a controles. Estos datos revelan información importantepara establecer políticas públicas de la atención posendodoncia.

The aim of this study was to know the dental state of endodontic pieces in correlation with different variables such as coronary restoration, level of study, employment status and access to dental services.To do so, we analyzed a population composed of subjects who participated in two different graduate courses at the Círculo Odontológico de Córdoba and the “Chair B” of Endodontics of the Faculty ofDentistry, National University of Córdoba. Treatments were clinically and radiographically controlled for eighteen months. The total sample included 144 patients and 174 treatments. Only 48.6% patients attended the control, 89 teeth of whom were evaluated. The study showed 37 cases with definitivecoronary restoration without fractures, 52 teeth without restoration, 21 with fractures, and 1 was lost.The fracture rate showed an increase in patients with high level of study, a decrease in unemployed patients, and an increase in both patients with stable and precarious work. The kind of attention didnot differ, but the observed percentages suggest that patients treated in public services would be morelikely to suffer from fractures. There was a higher percentage of definitive restorations in private services,and lower in public ones. The high percentage of non-attendance to controls motivated a specific analysis, from which it is possible to conclude that the more job stability, studies and private access todental services, the more the attendance to controls. These data reveal important evidence in order to establish public policies of post-endodontic services.

Restauración post-endodoncia y condición social como factor de preservación dentaria: parte 2 / Post-endodontic restoration and social condition asa factor of tooth preservation. Part 2

El objetivo de este estudio fue conocer el estado dental de piezas endodonciadas en correlación conlas variables de restauración coronaria, estado periodontal, nivel de estudio, condición laboral y acceso a servicios odontológicos. Para ello, se analizó una población de individuos compuesta por sujetos concurrentes a los cursos de posgrado de Endodoncia, del Círculo Odontológico de Córdoba, y al servicio de la Cátedra “B” de Endodoncia de la Facultad de Odontología, Universidad Nacional de Córdoba. Se hicieron tratamientos controlados durante dieciocho meses. La muestra total la conformaron 144 pacientes y se trataron 174 casos. El estudio mostró 37 casos con restauración coronaria definitiva sin fracturas, 52 dientes sin restauración, 21 con fracturas y 1 se perdió. De los dientes restaurados, el55,6 por ciento mostraron periodonto normal; 22,2 por ciento gingivitis, y 22 por ciento periodontitis leve. De los dientes sin restauración, el 3,9 por ciento mostraron periodonto normal; 7,8 por ciento gingivitis; 31,4 por ciento periodontitis leve; 35,3 por ciento periodontitis grave y 21,6 por ciento periodontitis complicada. De los dientes fracturados, el 16,7 por ciento mostraron periodonto normal o gingivitis; 35,3 por ciento periodontitis leve y grave, y un 72,7 por ciento periodontitis complicada. No se demostró asociación entre nivel de estudios, condición laboral y tipo de atención con fracturas de los pacientes, pero los porcentajes sugieren más probabilidad de sufrir fractura en los pacientes de la asistencia pública. El elevado porcentaje de inasistencia a control motivó un análisis específico, del cual se pudo concluir que cuanto más grave la patología periodontal, mayor el porcentaje de inasistencia. El estudio permitió observar desigualdad en el acceso a los servicios odontológicos, dientes no rehabilitados y con compromiso periodontal.

The aim of this study was to know the dental state of endodontic pieces in correlation with different variables such as coronary restoration, periodontic condition, level of study, employment status and access to dental services. A population composed of patients treated in two different postgraduate courses at the Círculo Odontológico de Córdoba and Chair “B” of Endodontics, Faculty of Dentistry,National University of Córdoba were analyzed. Treatments were clinically and radiographicallycontrolled for eighteen months. The total sample included 144 patients and 174 treatments. The studyshowed 37 cases with definitive coronary restoration without fractures, 52 teeth without restoration,21 with fractures, and 1 was lost. From restored teeth, 55.6% showed normal periodontium, 22.2%gingivitis, and 22% mild periodontitis. From teeth without restoration, 3.9% showed normalperiodontitis, 7.8% gingivitis, 31.4% mild periodontitis, 35.3% severe periodontitis and 21.6%complicated periodontitis. From fractured teeth, 16.7% showed normal periodontitis or gingivitis, 35.3% had mild and severe periodontitis, and 72.7% had complicated periodontitis. There has beenno correlation between level of education, work status, and kind of service on patient with fractures,but the percentage suggest that patients in public assistance are more likely to suffer fracture. The highpercentage of non-attendance to control led to a specific analysis, from which it is possible to concludedthat the more severe the periodontal disease, the greater the percentage of non-attendance. The study showed inequality in access to dental services, un rehabilitated teeth and with periodontal compromise.

Evaluación del tratamiento endodóntico y su relación con el tipo y la calidad de la restauración definitiva / Evaluation of edodontic treatment and its relationship with the type and quality of the definitive restoration

Introducción El éxito endodóntico está determinado por la calidad de los tratamientos de canales radiculares y restaurador, en conjunto con la ausencia de signos y síntomas. Objetivo Determinar el porcentaje de éxito de tratamientos de conductos y su relación con el tipo y la calidad de la restauración coronaria. Material y métodos Se realizó un estudio clínico retrospectivo en donde se evaluaron 227 dientes sometidos a tratamiento de canales radiculares con 4 años de evolución, por un dentista contralor, que realizó el examen clínico y radiográfico de estos dientes, evaluando los signos y síntomas que presentaron y el tipo y la calidad del tratamiento restaurador. Los datos se analizaron mediante el programa estadístico STATA 13. Resultados En los tratamientos evaluados existe un porcentaje de éxito del 93,8% y un 6,2% de fracaso, además de una asociación significativa en cuanto a que los dientes con una restauración coronaria adecuada, directa o indirecta, están relacionados con tratamientos considerados como exitosos, mediante test de Fisher (valor p < 0,01) con un nivel de confianza del 95%. Conclusiones Los resultados obtenidos en este estudio muestran un alto porcentaje de éxito de los dientes tratados endodónticamente (93,8%) y que existe una asociación estadísticamente significativa entre la calidad de la obturación y la sintomatología (p < 0,01) con un nivel de confianza del 95%.

Introduction Success in endodontic treatment is determined by the quality of the root canal treatment and definitive coronal restoration, with the absence of signs and symptoms. Objective The aim of this study was to determine the success rate of root canal treatment and its relationship with the type and quality of the coronary restoration. Material and methods A retrospective clinical study was conducted on 227 endodontically treated teeth over a period of 4 years. The analysis was performed by a comptroller dentist, who carried out the clinical and radiographical examination, evaluating signs and symptoms and the type and quality of the coronary restoration. The data analysis was performed using the STATA 13 statistics program. Results The results obtained show that there is a success rate of 93.8% and a 6.2% failure rate of the teeth evaluated. There was also significant evidence as regards teeth with proper restorations, whether direct or indirect, and root canal treatments considered as successful, according to Fisher's Test (P<.01), with a confidence level of 95%. Conclusions It can be concluded with the results obtained, that there is a high success rate (93.8%), and that there is a statistically significant association between the quality of the restoration and the presence of symptoms.

Clinical outcome of root caries restorations using ART and rotary techniques in institutionalized elders

Abstract The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.

Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT

Objective This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation. Material and Methods The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test. Results The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth]. Conclusions The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics. .

Periradicular lesions in HIV-infected patients attending the faculty of dentistry: clinical findings, socio-demographics status, habits and laboratory data - seeking an association

OBJECTIVE: The purpose of this study was to estimate the prevalence of periradicular lesions in HIV-infected Brazilian patients and to assess the correlation of several factors with the periradicular status. METHOD: One hundred full-mouth periapical radiographs were evaluated. A total of 2,214 teeth were evaluated for the presence of periradicular lesions, caries lesions, coronal restorations, pulp cavity exposure and endodontic treatment. RESULTS: The prevalence of periradicular lesions was 46%. There were no significant differences between individuals with or without periradicular lesions with respect to their socio-demographic status, habits, laboratory data and route of HIV infection. However, the presence of a periradicular lesion was statistically correlated with the number of teeth with endodontic treatment (p = 0.018), inadequate endodontic treatment (p = 0.025), images suggesting pulp cavity exposure (p = 0.002) and caries lesions (p = 0.001). CONCLUSIONS: The prevalence of periradicular lesions in HIV-infected individuals was 46% and was not related to HIV infection. .

Evaluación clínica de los tejidos periodontales después del aumento de corona clínica / Clinical evaluation of periodontal tissue after crown lengthening surgery

INTRODUCCIÓN: La cirugía de aumento de corona clínica es un medio para facilitar los procedimientos de restauración con el objetivo de restablecer el ancho biológico periodontal. OBJETIVO: Registrar la evolución clínica de los tejidos periodontales de dientes sometidos a cirugía de aumento de corona clínica durante un período de cicatrización de 6 meses. Material y métodos: Se realizó un estudio observacional prospectivo, en el cual se evaluaron 25 pacientes; todos cumplieron con los criterios de inclusión y exclusión. Para evaluar la evolución de los dientes, se registró el índice gingival, índice de placa, índice PMA, recesión gingival, profundidad de sondaje y después de la cirugía, presencia de movilidad y lesión de área de furcación. Para medir la migración del margen gingival libre, se utilizó un dispositivo de acrílico. Se realizó el análisis estadístico de análisis de la varianza de un factor, margen de error del 5%, intervalo de confianza de 95%. RESULTADOS: El 84% de los pacientes fueron de género femenino, concentrándose el mayor porcentaje de pacientes entre los rangos de edad de 30 a 40 años (60%). Con respecto a los dientes intervenidos, el 76% fueron dientes posteriores, el diagnóstico más prevalente fue la categoría de diente con eliminación de caries subgingival (48%). A los 6 meses, existió ausencia total de inflamación gingival tanto en diente tratado como diente adyacente. Con respecto a la exposición coronal, medida a través de la distancia dispositivo-margen gingival libre, existió variación con la medición inicial de 4,26 mm en diente tratado y 3,90 mm en diente adyacente en relación con los 3 meses, 5,10 mm en diente tratado y 4,40 mm en diente adyacente, manteniéndose casi de forma similar a los 6 meses. CONCLUSIÓN: La evolución clínica de los tejidos periodontales posterior a la cirugía de aumento de corona clínica de nuestros pacientes demostró que a los 3 meses existe ausencia de inflamación gingival y en todos los casos se produjo retracción gingival de la encía comparada con los datos iniciales, consideración que debe tenerse presente en el momento de la rehabilitación final del diente

INTRODUCTION: Crown lengthening is a surgical procedure performed to re-establish the periodontal biological width of the tooth for its subsequent restoration. OBJECTIVE: To record the clinical outcomes of the periodontal tissues subjected to crown lengthening surgery, for a period of 6 months. Materials and methods: A prospective observational descriptive study was conducted on 25 patients who fulfilled the inclusion and exclusion criteria. The parameters evaluated were: gingival index, plaque index, Papillary-Marginal-Attachment (PMA) index, classification for gingival recessions probing depth and after surgery, classes of mobility and furcation classification. An acrylic device was used to measure the gingival margin migration. Statistical analysis was performed using one-way ANOVA, margin of error of 5%, and confidence level of 95%. RESULTS: Of the 25 patients, 84% were female, with the highest percentage of patients between the age ranges of 30 to 40 years (60%). As regards the teeth, 76% were back teeth, and the most prevalent diagnostic category was the removal of subgingival tooth decay (48%). At six months there was complete absence of gingival inflammation in the treated (TT) tooth, as well as in the adjacent (AD) tooth. With respect to the coronal exposure measured by the free gingival margin distance device, there was a difference between the initial measurement of 4.26 mm for the TT tooth and 3.90 mm for the AD tooth, and at three months, 5.10 mm for the TT tooth and 4.40 mm for the AD tooth, remaining almost the same at 6 months. CONCLUSION: The clinical outcome of periodontal tissues after crown lengthening surgery on our patients showed that there is absence of gingival inflammation after 3 months, and in all cases gingival gum recession, compared to the initial data. This should be taken into account when the final restoration of the tooth is considered

Condicoes dentarias entre adultos brasileiros de 1986 a 2010 / Condiciones dentarias entre adultos brasilenos de 1986 a 2010 / Dental health in Brazilian adults between 1986 and 2010

OBJETIVO: Identificar tendências do padrão da cárie dentária em adultos brasileiros. MÉTODOS: Foram utilizados dados provenientes de levantamentos epidemiológicos realizados pelo Ministério da Saúde nos anos de 1986, 2003 e 2010. A experiência de cárie, expressa pelo índice CPOD (dentes permanentes cariados, perdidos e obturados), e a saúde dentária, expressa pelo índice OH-D (dentes hígidos + obturados) relativo ao número de dentes funcionais, foram comparadas em amostras aleatórias de residentes de 35 a 44 anos de idade em cada região brasileira. As diferenças nas condições dentárias entre os anos foram estimadas por meio da razão dos valores dos índices, empregando-se análise de regressão de Poisson ajustada pela idade. RESULTADOS: Houve reduções no índice CPOD e aumento no índice OH-D em todas as regiões no período de 1986 a 2010. A região Norte, que tinha o pior padrão em 1986, apresentou o maior ganho em termos de dentição funcional. CONCLUSÕES: Tem ocorrido uma transição da saúde bucal para melhor nos adultos brasileiros. É plausível que a adição de flúor à água e ao creme dental, maior incorporação de serviços restauradores e a melhoria nos indicadores de desenvolvimento humano decorrentes de políticas públicas estejam relacionados a essa melhora. .

OBJETIVO: Identificar tendencias del patrón de la caries dentaria en adultos brasileños. MÉTODOS: Se utilizaron datos provenientes de pesquisas epidemiológicas realizadas por el Ministerio de la Salud en los años de 1986, 2003 y 2010. La experiencia de caries, expresada por el índice CPOD (dientes permanentes cariados, perdidos y obturados) y la salud dentaria, expresada por el índice OH-D (dientes hígidos + obturados) relativo al número de dientes funcionales, fue comparada en muestras aleatorias de residentes de 35 a 44 años de edad en cada región brasileña. Las diferencias en las condiciones dentarias entre los años fueron estimadas por medio del cociente de los valores de los índices, empleándose análisis de regresión de Poisson ajustado por la edad. RESULTADOS: Miolo abstract Miolo abstract Miolo abstract Miolo abstract Miolo abstract Miolo abstract Miolo abstract Miolo abstract Miolo abstract Miolo abstract Miolo abstract Miolo abstract. CONCLUSIONES: Ha ocurrido una transición de la salud bucal para mejor en los adultos brasileños. Es plausible que la adición de flúor en el agua y en la crema dental, mayor incorporación de servicios restauradores y la mejoría en los indicadores de desarrollo humano decurrentes de políticas públicas, pueden estar relacionados con esta mejoría. .

OBJECTIVE: To identify trends in the pattern of dental caries in Brazilian adults. METHODS: Data from epidemiological surveys carried out by the Brazilian Ministry of Health in 1986, 2003 and 2010 were used. Dental caries experience, using the DMFT index (decayed, missing and filled teeth) and dental health, expressed by the FS-T index (filled and sound teeth) related to functional teeth, were compared using random samples of 35 to 44 year old residents of each region of Brazil. The differences in dental health between the years were estimated using the ratio of the index values, by Poisson regression analysis adjusted for age. RESULTS: Reduction in the DMFT index and increase in the FS-T index in all regions in the period between 1986 and 2010. The North, where the worst standards were found in 1986, showed the greatest improvements in terms of functional teeth. CONCLUSIONS: The dental health of Brazilian adults changed for the better. It is plausible that this oral health transition is related to the addition of fluoride to water and to toothpaste as well as increased incorporation of restorative services and improvements in human development due to public policies. .

The occurrence of dental caries is associated with atherosclerosis

OBJECTIVE: Previous studies have suggested that marginal periodontitis is a risk factor for developing atherosclerosis. The objective of this study was to determine whether caries may also be associated with atherosclerosis. METHODS: The computed tomography data sets of 292 consecutive patients, 137 women and 155 men with a mean age of 54.1±17.3 years, were analyzed. Caries were quantified based on the number of decayed surfaces of all the teeth, and periodontitis was quantified on the basis of the horizontal bone loss in the jaw. The presence of chronic apical periodontitis (CAP) was assessed, and the aortic atherosclerotic burden was quantified using a calcium scoring method. RESULTS: The patients with <1 caries surfaces/tooth had a lower atherosclerotic burden (0.13±0.61 mL) than patients with ≥1 caries surfaces/tooth. The atherosclerotic burden was greater in patients with a higher number of lesions with pulpal involvement and more teeth with chronic apical periodontitis. In the logistical regression models, age (Wald 49.3), number of caries per tooth (Wald 26.4), periodontitis (Wald 8.6), and male gender (Wald 11) were found to be independent risk factors for atherosclerosis. In the linear regression analyses, age and the number of decayed surfaces per tooth were identified as influencing factors associated with a higher atherosclerotic burden, and the number of restorations per tooth was associated with a lower atherosclerotic burden. CONCLUSION: Dental caries, pulpal caries, and chronic apical periodontitis are associated positively, while restorations are associated inversely, with aortic atherosclerotic burden. Prospective studies are required to confirm these observations and answer the question of possible causality. .

Two-year clinical evaluation of three adhesive systems in non-carious cervical lesions

OBJECTIVES: Adhesive systems are continuously being introduced to Dentistry, unfortunately often without sufficient clinical validation. The aim of this study was to evaluate the clinical performance of cervical restorations done with three different adhesive systems. MATERIAL AND METHODS: 158 non-carious cervical lesions of 23 patients were restored with a nanofilled composite resin (Filtek Supreme, 3M/ESPE) combined with Single Bond (3M/ESPE, group SI), Clearfil SE (Kuraray Medical Inc., group CL) and Xeno III (De Trey Dentsply, group XE). In groups SI-B, CL-B and XE-B, the outer surface of the sclerotic dentin was removed by roughening with a diamond bur before application of the respective adhesive systems. In groups CL-BP and XE-BP, after removal of the outer surface of the sclerotic dentin with the bur, the remaining dentin was etched with 37% phosphoric acid and the self-etch adhesive systems Clearfil SE and Xeno III were applied, respectively. Lesions were evaluated at baseline, and restorations after 3 months, 1 year and 2 years using modified USPHS criteria. RESULTS: After 2 years, no significant difference was found between the retention rates of the groups (p >0.05). Although groups CL and SI showed significantly better marginal adaptation than group XE (p<0.05) at 2 years, no significant difference was found between the marginal adaptation of the groups SI-B, CL-B and XE-B (p>0.05). After 2 years no significant difference was observed among the marginal staining results of all groups (p>0.05). CONCLUSION: Although all adhesive systems showed similar retention rates, Clearfil SE and Single Bond showed better marginal adaptation than Xeno III after 2 years of follow-up.

Remoção parcial de tecido cariado em lesões de cárie profundas de dentes permanentes / Partial removal of carious dentine in deep caries lesion in the permanent dentition

The partial removal of carious dentine was studied by means of a literature review and a multicenter randomized controlled clinical trial. The clinical trial compared the effectiveness of an alternative treatment for deep caries lesions and the stepwise excavation in Public Health Services in Brazil. The treatment consists of partial removal of carious dentine followed by restoration in one session. A cost-effectiveness analysis the two treatments was performed. The clinical performance of amalgam and resin restorations placed in deep caries lesions with or without decayed tissue beneath them was also evaluated. Inclusion criteria: patients with ¡Ý nine years old, permanent molars with deep caries lesions and absence of periapical alterations, pulp sensitivity; absence of spontaneous pain; negative percussion test. The subjects were assigned to: test-group - partial removal of carious dentine (PDR) and restoration, and control-group - stepwise excavation (SW). SW consists of partial removal of carious tissue, indirect pulp capping with calcium hydroxide cement; temporary filling; cavity re-opening after 60 days, removal of the remaining soft carious...

Dental caries and tooth loss in adults in a Brazilian southeastern state

OBJECTIVE: The purpose of this study was to analyze dental caries experience of adults living in the southeastern state of São Paulo, Brazil, according to some socio-demographic conditions of this population. MATERIAL AND METHODS: The sample consisted of 1,159 school teachers and workers (35 to 44 years old) from 29 cities of the state of São Paulo, Brazil. RESULTS: 92.3 percent were dentate and the DMFT index (number of decayed, missing and filled teeth) was 21.0 and the mean number of decayed teeth was 1.1, with no significant difference among adults from regions with and without fluoridation. Male subjects presented the highest mean values of "D" (decayed teeth) and "M" (missing teeth) components. The percentage of caries-free subjects was higher among white subjects, as well as the mean number of teeth present in the mouth. The mean values of the "F" component (filled teeth) [9.81] and present teeth [19.3] were higher for adults from fluoridated water regions. CONCLUSIONS: In this study, the worse condition observed was the early tooth loss in all groups. In addition, people with worse socio-demographic conditions had worse oral health conditions. It is expected that oral health programs targeted to this population could be established with the goal of improving the oral health conditions of this population and hence the maintenance of the teeth for a longer period in function.

The implementation and preliminary evaluation of an ART strategy in Mexico: a country example

The massive use of preventive measures in Mexico including fluoride toothpaste, a national program of salt fluoridation and education on prevention has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means to address this. This included the development of training materials, the organization of training courses for existing dentists and the incorporation of ART into the undergraduate curriculum. RESULTS: Six years after the introduction of ART in the year 2000, it was estimated that over 2 million ART procedures had been provided. As part of the planning cycle, an evaluation was undertaken in 2008 to determine amongst Mexican dentists what were the perceived problems when implementing the ART approach. Such research identified that the scarcity of appropriate dental materials and the lack of suitable instruments were the major problems. In addition, a preliminary evaluation of ART restorations and sealants placed as part of this National Oral Health Program was undertaken. The survival outcomes after one year compared favorably with one other study conducted in Mexico but were somewhat lower than the results reported from a number of other countries. CONCLUSION: The ambitious and forward thinking policy for improving the oral health in Mexico is now showing dividends. One example is the ART strategy, which has been successful both in terms of the number of ART procedures provided and generally in terms of clinical outcomes.

Dental needs in brazilian patients subjected to head and neck radiotherapy

In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5 percent) and was done in 209 patients (58.5 percent). From the total of examined patients, 94 (45 percent) did not require dental procedures at the moment of examination, while 115 (55 percent) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients.

Apesar dos benefícios da radioterapia no tratamento de tumores malignos, vários são os seus efeitos colaterais na região de cabeça e pescoço. Sendo assim, a avaliação das condições bucais pelo cirurgião dentista é fundamental para prevenir e/ou minimizar estes danos. Este estudo retrospectivo teve como objetivo verificar as condições dentárias e as necessidades de tratamento odontológico dos 357 pacientes que receberam radioterapia na região de cabeça e pescoço, atendidos pelo Orocentro/ FOP/UNICAMP, no período de janeiro de 1990 a dezembro de 2004. Em 148 (41,5 por cento) do total dos pacientes a avaliação odontológica não foi realizada previamente à radioterapia. A avaliação odontológica pré-radioterápica foi realizada em 209 pacientes (58,5 por cento) dos quais 94 (45 por cento) não tinham necessidades de tratamento odontológico no momento da avaliação, enquanto 115 (55 por cento) apresentavam algum tipo de necessidade odontológica. O grupo de pacientes avaliados antes da radioterapia apresentou menores necessidades de restaurações, endodontias e exodontias que os pacientes não avaliados. Conclui-se que a avaliação das condições bucais previamente à radioterapia é essencial para diminuir as necessidades de tratamento odontológico enfatizando a importância da participação do cirurgião-dentista na equipe multidisciplinar que trata pacientes com câncer.

Immediate implants placed into infected sockets: a case report with 3-year follow-up

The esthetics and functional integrity of the periodontal tissue may be compromised by dental loss. Immediate implants became a viable option to maintain the periodontal architecture because of their anatomic compatibility with the dental socket and the possibility of eliminating local contamination. This article describes the procedure of immediate implant placement in the anterior maxilla replacing teeth with chronic periapical lesions, which were condemned due to endodontic lesions persisting after failed endodontic treatment and endodontic surgery, and discusses the relationship between the procedure and periapical lesions. Surgical removal of hopeless teeth 11, 12 and 21 was performed conservatively in such a way to preserve the anatomy and gingival esthetics. A second surgical access was gained at the apical level, allowing the debridement of the surgical chamber for elimination of the periapical lesion, visual orientation for setting of the implants and filling of the surgical chamber with xenogenous bovine bone graft. After this procedure, the bone chamber was covered with an absorbent membrane and the healing screws were positioned on the implants. Later, a provisional partial removable denture was installed and the implants were inserted after 6 months. After 3 years of rehabilitation, the implants present satisfactory functional and esthetic conditions, suggesting that immediate implant placement combined with guided bone regeneration may be indicated for replacing teeth lost due to chronic periapical lesions with endodontic failure history in the anterior maxilla.

A integridade estética/funcional do tecido periodontal pode ser comprometida pela perda do elemento dental. Os implantes imediatos tornaram-se uma opção viável na manutenção da arquitetura periodontal, desde que haja a compatibilidade com o alvéolo e a possibilidade da contaminação local ser totalmente eliminada. O objetivo deste estudo foi descrever o procedimento de instalação de implantes imediatos na região anterior de maxila usados na reposição de dentes com lesões crônicas periapicais, discutindo a relação entre o procedimento e lesões periapicais. A remoção dos dentes condenados (11, 12 e 21) foi feita de forma conservadora a fim de preservar a estética e arquitetura periodontal. Um segundo acesso cirúrgico foi obtido a nível apical, permitindo: o debridamento da loja cirúrgica, orientação visual dos implantes e o preenchimento com enxerto ósseo bovino. A loja óssea foi coberta por uma membrana absorvível e uma prótese parcial removível provisória foi instalada e após 6 meses os implantes foram reabilitados. Após 3 anos de reabilitação, os implantes se apresentam em condições satisfatórias de estética/função, sugerindo que a instalação de implantes imediatos combinados com a regeneração tecidual guiada em lesões periapicais crônicas podem ser indicados para repor dentes perdidos devido a lesões periapicais crônicas com história de insucesso endodôntico na maxila anterior.