Esthetic treatment of buccal exostoses: a case report.

Buccal exostoses are benign bony protuberances that may grow over time but rarely result in functional alterations. The diagnosis is established by a combination of medical history and clinical and radiographic features of the affected region. This case report describes the surgical treatment of bilateral bone projections on the buccal surface of the maxilla that represented an undesirable esthetic alteration to the patient. The surgical procedures, which were performed at separate appointments for the left and right sides, involved reflection of full-thickness flaps and careful osteotomy with a carbide spherical drill and a Rhodes chisel. At completion of the procedures, flat buccal bone ridges with a clear esthetic improvement were observed. At the follow-up examination (3 months postsurgery on the left side and 1 month on the right), the presence of stable periodontal tissue-positioned where it was located during the immediately postoperative period-indicated a satisfactory clinical result.

Effect of hydrogen peroxide on color and whiteness of resin-based composites.

OBJECTIVE: To evaluate the influence of a 35% hydrogen peroxide gel on color and whiteness changes of resin-based composites (RBC). MATERIALS AND METHODS: Discs (n = 10; shade A3.5 enamel; and 8 mm diameter and 2 mm thick) were fabricated from three RBC (DF- Durafill, Heraeus Kulzer; ED- IPS Empress Direct, Ivoclar Vivadent; and AP- Amelogen Plus, Ultradent Products). Three subgroups were obtained for each RBC: before bleaching (T0 ) and after first (T1 ) and second (T2 ) bleaching applications. A dental spectrophotometer (VITA Easyshade, Vita Zahnfabrik) was used to obtain CIELAB color coordinates and whiteness index for dentistry (WID ) in all periods. CIELAB ( ΔEab* ) and CIEDE2000 (ΔE00 ) color differences were also obtained. Perceptibility (PT) and acceptability (AT) thresholds were used to analyze values of ΔEab* , ΔE00 , and ΔWID . Two-way analysis of variance (ANOVA; for L*, a*, b*, and WID ) and one-way ANOVA and Tukey tests (for ΔEab* and ΔE00 ) were used to analyzed the results (α = 0.05). RESULTS: L* and WID values from all RBC did not change after bleaching applications (T1 and T2 ) (P > .05). There were no significant differences in color differences ( ΔEab* and ΔE00 ) among all RBC evaluated after bleaching applications (T1 -T0 and T2 -T0 ; P > .05). Regardless of the RBC, mean values of ΔE00 between all different periods were always below 50%:50% PT value. CONCLUSIONS: The 35% hydrogen peroxide bleaching gel influences on color and whiteness of resin-based composites. However, color changes were not clinically perceived and whiteness variations were clinically acceptable. CLINICAL SIGNIFICANCE: Patients should be advised that existing composite restorations might not match the natural tooth color after bleaching, and their replacement may be required.

Clinical treatment of necrotizing ulcerative gingivitis: a case report with 10-year follow-up.

The aim of this case report is to describe the diagnosis and treatment of a patient with necrotizing ulcerative gingivitis. An 18-year-old man with no systemic problems reported with chief complaints of gingival bleeding during toothbrushing and spontaneous pain. Clinical examination revealed significant plaque accumulation on the surfaces of all teeth as well as papillary necrosis involving mainly the anterior teeth. Treatment included an initial phase of supragingival plaque and calculus removal along with at-home use of 0.12% chlorhexidine gluconate mouthrinse twice a day for 30 days. After the initial phase, subgingival scaling was performed, and regular oral hygiene methods were resumed by the patient. After active therapy was completed, a periodontal maintenance regimen was established, and the patient was recalled for periodontal maintenance therapy. Follow-up occurred weekly throughout treatment, monthly for the first 6 months posttreatment, and 2-3 times a year during the periodontal maintenance therapy. Clinical results after 10 years showed that this approach controlled the acute phase and maintained the patient's periodontal health over time.

Diversity, frequency and antifungal resistance of Candida species in patients with type 2 diabetes mellitus.

OBJECTIVE: To determine number, species of Candida and Candida resistance to antifungal therapy according to the metabolic control state and the associated salivary changes in patients with type 2 diabetes mellitus (DM2). MATERIALS AND METHODS: Samples of non-stimulated saliva were collected from 52 patients with DM2. Salivary pH was measured and cultured on Sabouraud glucose agar and the values of CFU/ml were calculated. The species were presumptively identified using CHROMagar Candida® plates, and identification was confirmed by polymerase chain reaction (PCR). C. albicans isolates were cultured on SGA tetracycline agar with nystatin and fluconazole diffusion disks to measure susceptibility. RESULTS: Sixty six percent of the yeasts isolated were Candida albicans, followed by C. glabrata (20.7%). In patients with decompensated DM2, there was an inverse association between HbA1c value and salivary pH. At higher levels of salivary acidification, a greater diversity and quantity of yeasts of the genus Candida were observed. With nystatin, higher inhibition was observed at lower pH. CONCLUSIONS: The antifungal therapies could be more effective if it consider, qualitative salivary characteristics as pH, that could determine the susceptibility of species of Candida to at least to nystatin, which is the most used antifungal for treatment to oral candidiasis in patients with DM2.

Management of an uncomplicated crown fracture by reattaching the fractured fragment-Case report.

Coronal fractures of the anterior teeth are common sequelae of traumatic dental injuries. Reattachment of fractured tooth fragments using dental adhesive techniques offers some advantages, including restoration of the function, esthetics, shape, texture, and brightness of the surface. The present report describes a clinical case of reattachment with a 4-year clinical and radiographic follow up in a permanent maxillary central incisor with an uncomplicated crown fracture. Fragment reattachment is a conservative procedure, preserving esthetics and functionality, and it can provide an immediate positive emotional response from the patient.

Changing the gingival color discrepancy induced by pigmented root using subepithelial connective tissue graft: a case report.

Metallic alloys can suffer corrosion, and metallic posts and cores used for restorative procedures may develop a blue-gray pigmentation in root dentin, which in turn changes the color of gingival tissues. Removing posts and cores may lead to root fracture, and bleaching agents have a limited effect on staining from alloy corrosion. Surgical techniques for correcting undesirable esthetic deficiencies have been investigated in the literature. This article describes the case of a patient with gingival discoloration caused by root pigmentation in the maxillary area. A subepithelial connective graft harvested from the palate was used to treat the gingival color discrepancy.

Location and negotiability of second mesiobuccal canal in upper molar by tomographic and anatomical macroscopic analysis.

PURPOSE: The aim of this study was to assess the presence and negotiability of second mesiobuccal (MB2) canal at pulp chamber, cervical, medium and apical levels comparing the findings obtained by anatomical evaluation with cone-beam computed tomography (CBCT) images. METHODS: 56 and 43 human maxillary first and second upper molars, respectively, were assessed. The specimens were placed on an acrylic platform in a stationary position to identify the presence of MB2 canal at the pulp chamber floor, cervical, medium, and apical level. The samples were analyzed using two image acquisition softwares (XoranCat and DentalSlice) and subsequently by macroscopic anatomical analysis with a 4× magnifying glass. All data were summarized, and mean values, frequencies, and percentage values were calculated for each group of specimens. RESULTS: DentalSlice and XoranCat images of first molars showed a rate concordance index (CI) of present MB2 canals in comparison to anatomic evaluations of 65.2 and 70.1%, respectively. On the second molars, the rate of CI reached about 80 % in both sets of images. In the first molars, 29.9% of canals localized by XoranCat images did not display anatomical negotiability; 34.8% of canals localized by DentalSlice images did not display anatomical negotiability. Among second molars, 18.6% of canals localized by XoranCat did not display anatomical negotiability; 19.8% of canals localized by DentalSlice did not display anatomical negotiability. On the first molars with anatomical negotiability, errors not identified by XoranCat and DentalSlice reached rates of 22.3 and 25.4%, respectively. Among second molars, error rates were 8.7% (XoranCat) and 11.6% (DentalSlice). CONCLUSION: Our study indicated that (1) the tomographic image is an auxiliary way to detection and mapping of the MB2 canal in maxillary molars, (2) the tomographic image is ineffective in determining negotiability. Both image software packages used in this study showed similar results.

Mandibular molar rehabilitation using orthodontic extrusion associated with odontoplasty.

The aim of this clinical report is to describe the successful treatment of a mandibular first molar presenting an extensive fracture at the buccal aspect in a young patient. The extension of the fracture was a negative prognostic factor for tooth maintenance. An alternative clinical treatment was proposed since the patient was young and presented with good oral hygiene and periodontal health. The treatment was based on orthodontic forced eruption associated with odontoplasty. A 3-year follow-up after the surgical procedure demonstrated the maintenance of periodontal health and good plaque control. It can be concluded that orthodontic forced eruption associated with odontoplasty promoted favorable conditions for prosthetic rehabilitation and is a feasible procedure in the treatment of tooth fracture extended below the cementoenamel junction.

Interdisciplinary esthetic approach in clinical dental rehabilitation.

During the esthetic evaluation of smile, the presence of diastemas, tooth color, size and shape, and the amount of gingival exposure are important factors to be considered. A 23-year-old female patient was referred to us with a dissatisfaction with her smile. After clinical examination revealed esthetic alterations as generalized tooth yellowish discoloration, a slight diastema in the upper anterior region, and a shortened appearance of maxillary dental crowns, providing a gingival smile. The proposed treatment consisted of an esthetic rehabilitation for resolution of gummy smile and closure of diastema in anterior teeth by the use of digital planning as a guide for the accomplishment of integrated procedures. The result obtained by the multidisciplinary treatment associating periodontal surgical procedure for esthetic crown lengthening with in-office bleaching and direct restorations with composite resin, by digital planning, provided evident harmonization between tooth color and shape and gingival contour, enabling more harmonious smile esthetics.

Retentive efficacy, antimicrobial and cytotoxicity comparisons between different types of commercial and experimental denture adhesives with antifungal action.

The effect of the addition of nystatin and an alternative antifungal derived from pyrazoles in different commercial denture adhesives on their retentive efficacy, cytotoxicity and antimicrobial activity against Candida albicans was evaluated. Commercial denture adhesives were prepared with the inclusion of nystatin and 3,5-diaryl-4,5-dihydro-1H-pyrazole-1-carboximidamide (pyrazole) in three concentrations: 23.78 %w/w, 3.02 %w/w, and 0.31 %w/w (0.015 g, 0.0015 g, and 0.00015 g, respectively). The retentive efficacy was tested observing the influence of the medium, type of commercial denture type and the test condition (dipping). The antifungal action through disk diffusion and direct contact tests at 1, 4, 8 and 12 h and cytotoxic activity was evaluated in mouse fibroblasts (NIH/3T3) by the MTT reduction colorimetric assay. The addition of pyrazole and nystatin in commercial denture adhesives did not affect retentive efficacy rates and enhanced antifungal actions against Candida albicans. Results show a possibility of using denture adhesives as a delivery system for commercial antifungals (Nystatin) or pyrazole, with the second concentration (1,560 µg-3.02 %w/w) as the most efficient.

Periodontal surgery associated with odontoplasty in the esthetic functional rehabilitation of a fractured anterior tooth.

Anterior dental fractures often require a multidisciplinary approach. This article presents a case in which an extensive fracture with palatal biological width invasion was treated successfully through clinical crown lengthening with odontoplasty. This procedure was a simple direct technique that restored the tooth without damaging the dental esthetics, the gingival contour, or the papillae.

Clinical importance of the presence of lateral canals in endodontics.

This article presents a clinical case in which the diagnosis and treatment of a lateral canal was instrumental in the successful completion of endodontic therapy. Endodontic treatment was performed by crown-down shaping and copious irrigation (using 2.5% sodium hypochlorite associated with 17% ethylenediaminetetracetic acid (EDTA)). After 10 months, there were no clinical symptoms of inflammation and radiographs showed periradicular healing.

Natural Crown Bonding of Anterior Fractured Teeth at Different Levels of Complexity: A 14-Month Follow-up.

Dental fractures comprise the most frequent form of traumatic dental injury and often require an immediate procedure for their treatment. The repositioning of fractured crown fragments using the bonding fragment technique offers several advantages, including the reestablishment of function, esthetics, shape, shine, and surface texture, in addition to the maintenance of the original contour and alignment of the teeth. The aim of this article is to describe a therapeutic approach used with a patient who suffered varying degrees of crown fractures in three teeth that were treated with adhesive fragment reattachment. The natural crown bonding technique, using tooth fragments and a direct composite resin, successfully restored all of the fractured anterior teeth. The clinical examinations showed good esthetics and periodontal health after a 14-month follow-up, proving that the technique is a good option for tooth fractures.

Orthodontic treatment in traumatized permanent teeth: a systematic review / Tratamento ortodôntico em dentes permanentes traumatizados: uma revisão sistemática

Objective: to analyze, through literature review, the available literature on orthodontic treatment in traumatized permanent teeth. Methods: A literature search was performed in electronic databases (PubMed and SciELO) using the descriptors [tooth injuries] OR [injuries, teeth] OR [injury, teeth] OR [teeth injury] OR [injuries, tooth] OR [injury, tooth] OR [tooth injury] OR [teeth injuries] AND [orthodontics]. Observational studies and clinical trials were included, narrative reviews, laboratory and in vitro studies, case reports and series as well as articles that presented abstracts written in languages other than Portuguese, English and Spanish were excluded from the study. Two reviewers considered the eligibility, the risk of bias of the analyzed data and the qualitative synthesis of the studies included. A total of 1,322 references were found and 4 articles met all inclusion criteria and were included in the qualitative analysis. Some consequences like pulp necrosis and root resorption have been highlighted and trauma severity should be considered when orthodontically intervening in previously traumatized teeth. Final considerations: The traumatized teeth can be orthodontically treated as long as the time of tissue reorganization is respected, and the pull and periodontal conditions are followed up.(AU)

Objetivos: analisar, por meio de revisão de literatura, a respeito do tratamento ortodôntico em dentes permanentes traumatizados. Metodologia: Uma pesquisa bibliográfica foi realizada em bancos de dados eletrônicos (PubMed e SciELO) usando os descritores [tooth injuries] ou [injuries, teeth] ou [injury, teeth] ou [teeth injury] ou [injuries, tooth] ou [injury, tooth] ou [tooth injury] ou [teeth injuries] e [orthodontics]. Foram incluídos estudos observacionais e ensaios clínicos, revisões narrativas, estudos laboratoriais e in vitro, relatos de casos e séries, bem como artigos que apresentassem resumos redigidos em idiomas diferentes do português, inglês e espanhol foram excluídos do estudo. Dois revisores consideraram a elegibilidade, o risco de viés dos dados analisados e a síntese qualitativa dos estudos incluídos. Foram encontradas 1.322 referências e 4 artigos atenderam a todos os critérios de inclusão e foram incluídos na análise qualitativa. Algumas consequências como necrose pulpar e reabsorção radicular têm sido destacadas e a gravidade do trauma deve ser considerada na intervenção ortodôntica em dentes previamente traumatizados. Considerações finais: Os estudos incluídos nesta revisão sugerem que dentes traumatizados podem ser tratados ortodônticamente desde que respeitado o tempo de reorganização tecidual e acompanhadas as condições pulpares e periodontais.(AU)

Therapeutic Approach to Pulp Canal Calcification as Sequelae of Dental Avulsion.

Tooth avulsion represents the most complicated dental injury, and the classic treatment is tooth replantation. The most common sequelae are pulp canal calcification (PCC) and pulp necrosis. The presence of pulp necrosis after PCC is reported in up to 30% of the cases and is a challenge due to the difficulty of endodontic treatment. This case report describes the surgical treatment of a replanted tooth presenting PCC and periapical pathology eight years after the trauma. An endodontic surgery was performed to remove the apical granuloma, to prepare the apical root, and to seal the apical region with an endodontic cement. In a three-year follow-up, there was an absence of inflammatory signs and symptoms or apical lesion. This report shows the importance of close follow-up after dentoalveolar injuries. After the initial dental trauma and its consequences to pulpal tissues, the executed procedures allowed a favourable outcome.

Reestablishing the Function and Esthetics in Traumatized Permanent Teeth with Large Apical Lesion.

Dental trauma is a challenge for dental integrity and can lead to pulp necrosis. The clinical case reports the diagnosis of a maxillary right central incisor traumatized and its multidisciplinary treatment. Calcium hydroxide material was used to perform the processing apexification. An apical surgery was carried out to remove the apical periodontitis and to return the aesthetics to the patient; internal and external tooth whitening in maxillary right central incisor was performed. We conclude that surgery associated with the root filling in the central incisor led to a successful completion. Moreover, it is of utmost importance to demonstrate the interaction between the various areas of dentistry.

Non-surgical periodontal treatment for drug-influenced gingival enlargement: a four-year follow-up case report

ABSTRACT: Drug-influenced gingival enlargement is considered to be an important side effect related to the use of some medications and often produces important esthetic changes for patients, as well as clinical symptoms such as pain, bleeding, abnormal tooth movement and occlusion problems. Anticonvulsants, immunosuppressants and antihypertensive drugs have been reported as the main inducers of these periodontal disorders. This case report describes the 4-year clinical follow-up of a young patient with a history of excessive gingival enlargement as a consequence of drug therapy for epilepsy (phenytoin and phenobarbital); the nonsurgical periodontal treatment of the excessive gingival enlargement was associated with the replacement of the patient's epilepsy medications with valproic acid. We conclude that intensive mechanical control of bacterial biofilms, instruction on oral hygiene guidelines and behaviors and the substitution of alternative anticonvulsant medications are the best way to control the drug-influenced gingival enlargement.

Fatores preditivos do sucesso en dodôntico em tratamentos realizados por alunos de graduação§ / Predictive factors of endodontic success in treatments performed by undergraduate / Factores predictivos del éxito endodontico en tratamientos realizados por un estudiante

Resumo Introdução e objetivo: Ainda são escassos os estudos que avaliam com exatidão o sucesso do tratamento e retratamento endodônticos e quais as falhas que realmente impactam no desfecho dos mesmos. Determinar o índice e os fatores preditivos para o sucesso de tratamentos e retratamentos endodônticos, realizados por alunos de graduação com o mesmo nível de aprendizado. Materiais e métodos: Foram verificados os registros de proservação, com pelo menos 12 meses, dos tratamentos endodônticos realizados na Faculdade de Odontologia de Pelotas, analisando o sucesso ou o fracasso endodôntico, de acordo com critérios clínicos e radiográficos. As variáveis preditivas no resultado do sucesso do tratamento foram: dente, número de canais, coroa dentária, sintomas, diagnóstico da polpa e índice periapical radiográfico. As variáveis relacionadas ao tratamento foram: técnica de instrumentação, número de sessões e limite de instrumentação apical. Resultados: 136 tratamentos endodônticos foram realizados com um acompanhamento de, pelo menos, 12 meses. A avaliação mostrou que o sucesso endodôntico foi influenciado pelo número de sessões (P = 0,015), diagnóstico inicial e grupo dentário (P= 0.014). Também foi possível observar que, quanto maior o índice periapical radiográfico inicial, pior o prognóstico endodôntico (P < 0.001). Conclusão: O índice de sucesso do tratamento endodôntico foi de 96.7% para casos de polpa vital, 87.5% para os casos de necrose pulpar e 92.9% em retratamentos. Estes índices foram influenciados pelo dente tratado, diagnóstico inicial, índice periapical radiográfico inicial e pelo número de sessões utilizadas no tratamento.

Abstract Introduction and objective: There are still few studies that accurately address endodontic success and which failures actually impact the endodontic treatment outcome. Determine success rate and predictive factors for successful endodontic treatment and retreatment by undergraduate students of the same learning level. Materials and methods: The preservation records (12 months) of the endodontic treatments performed in the Faculty of Dentistry of Pelotas were verified, indicating the success or failure of the treatment. Predictive variables in the outcome of successful endodontic treatment or retreatment were: tooth, number of channels, dental crown, symptoms, pulp diagnosis, radiographic periapical index. The treatmentrelated variables were: instrumentation technique, number of sessions and apical instrumentation limit. Results: 136 endodontic treatments were performed with a follow-up of at least 12 months. The evaluation showed that endodontic success was influenced by the number of sessions (P = 0.015), initial diagnosis and dental group (P = 0.014). It was also observed that the higher the initial radiographic periapical index, the worse the endodontic prognosis (P < 0.001). Conclusion: The success rate of endodontic treatment was 96.7% for cases of vital pulp, 87.5% for cases of pulp necrosis and 92.9% for retreatments. These indices were influenced by type tooth, initial diagnosis, initial radiographic periapical index and the number of visits used in the treatment.

Resumen Introducción y objetivo: Todavía hay pocos estudios que aborden con precisión el éxito endodóntico y cuáles fracasos realmente impactan el resultado del tratamiento endodóntico. Determinar la tasa de éxito y los factores predictivos para el tratamiento y el retratamiento exitoso de endodoncia por estudiantes universitarios del mismo nivel de aprendizaje. Materiales y métodos: Se verificaron los registros de conservación (12 meses) de los tratamientos de endodoncia realizados en la Facultad de Odontología de Pelotas, lo que indica el éxito o el fracaso del tratamiento. Las variables predictivas en el resultado de un tratamiento o retratamiento endodóntico exitoso fueron: diente, número de canales, corona dental, síntomas, diagnóstico pulpar, índice periapical radiográfico. Las variables relacionadas con el tratamiento fueron: técnica de instrumentación, número de sesiones y límite de instrumentación apical. Resultados: se realizaron 136 tratamientos de endodoncia con un seguimiento de al menos 12 meses. La evaluación mostró que el éxito endodóntico estaba influenciado por el número de sesiones (P = 0.015), el diagnóstico inicial y el grupo dental (P = 0.014). También se observó que cuanto mayor es el índice periapical radiográfico inicial, peor es el pronóstico endodóntico (P <0.001). Conclusión: La tasa de éxito del tratamiento endodóntico fue del 96.7% para casos de pulpa vital, 87.5% para casos de necrosis pulpar y 92.9% para retratamientos. Estos índices fueron influenciados por el tipo de diente, el diagnóstico inicial, el índice periapical radiográfico inicial y el número de visitas utilizadas en el tratamiento.

Systemic and clinical treatment of gingival hyperplasia associated with use of anticonvulsant

ABSTRACT: Anticonvulsants are drugs that can modify the gingival tissues response to inflammatory processes in the presence of dental plaque, inducing gingival overgrowth. Preexisting gingival inflammation induced by dental plaque seems to be a favorable condition to the development and/or expression of gingival overgrowth. This study describes a case in which the use of phenytoin and phenobarbital anticonvulsant associated with the presence of dental plaque provided a large and severe extent of gingival alteration. We concluded that it was possible to achieve a good result in the patient with an intensive mechanical control of dental plaque, oral hygiene orientations and substitution of the drug for other alternative medication.

Antimicrobial activity of essential oils and chloroform alone and combinated with cetrimide against Enterococcus faecalis biofilm.

The Enterococcus faecalis bacteria have been identified as the most commonly recovered species from teeth with persistent endodontic infections. The antimicrobial activity of essential oils and chloroform (CHL), alone and in association with various concentrations of cetrimide (CTR), against biofilm of Enterococcus faecalis was investigated. Solutions of CHL, eucalyptus oil (EO) and orange oil (OO) associated with CTR at 0.3%, 0.2%, 0.1%, and 0.05% were used to determine antimicrobial activity by exposing treated bovine dentine blocks to E. faecalis. Biofilms grown in the dentine blocks for 7 days were exposed to solutions for 2 and 5 min. Biofilm reduction between OO and EO at 2 min did not show any significant differences; however, OO had a higher kill percentage of biofilms than did the eucalyptus oil at 5 min (p < 0.01). Combinations with CTR at all concentrations achieved a 100% kill rate at 2 and 5 min. The association of CTR with solvent agents achieved the maximum antimicrobial activity against E. faecalis biofilms in dentine.