The use of calcium hydroxide and mineral trioxide aggregate on apexification of a replanted tooth: a case report

To report the outcome of the endodontic treatment of a reimplanted central maxillary incisor with open apex after 8 years and 7 months of follow-up.This case report presents the treatment of a right central maxillary incisor of an 8-year old white male patient with history of traumatic avulsion and immediate replantation. The endodontic therapy consisted of periodical changes of calcium hydroxide dressing and a definitive root canal filling with mineral trioxide aggregate (MTA). The treatment was successful without pathologies up to 7 years of follow-up. After the institution of orthodontic treatment a localized and late root resorption was noticed at the last radiographic examination (8 years and 7 months postoperative follow-up). Moreover, the use of MTA promoted a mild crown grey discoloration.

Knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth and dental trauma prevention

A high prevalence of dental trauma exists and its effects on function and esthetics deserve the attention of general dentists. The aim of this study was to assess the level of general dental practitioners' (GDPs) knowledge about guidelines for dental avulsion and its prevention using a questionnaire. The 21-item questionnaire was distributed among 264 GDPs and the survey was realized between August-November 2006. The data obtained were statistically analyzed using descriptive analysis and Pearson's Chi-square test to determine associations between knowledge regarding emergency treatment and dentists from public or private dental schools and years of experience. The results showed that the participants exhibited appropriate knowledge concerning procedures in cases of tooth avulsion and its prevention. The number of correct answers was low in relation to recommended treatment at the site of injury. Storage medium, preparation of the alveolus and splint time for receiving the avulsed tooth received a high number of correct answers. One statistically significant association between years of experience and recommended treatment at the site of the injury in the case an avulsed tooth (KH2 = 9.384, P = 0.009). In conclusion, this survey showed appropriate knowledge of dental avulsion management and its prevention among the surveyed dentists. The findings also showed that communication between dentists and the population is deficient, especially concerning practitioners of high risk and contact sports.

Root surface treatment using diode laser in delayed tooth replantation: radiographic and histomorphometric analyses in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

River avulsions on the Taquari megafan, Pantanal wetland, Brazil

The Pantanal wetland is located in a tectonically active interior sedimentary basin in west-central Brazil. The south-flowing Paraguay River is the trunk-river of an alluvial constructional landform comprising several large alluvial fans, the largest one of which is the Taquari megafan. The Taquari River flows in two distinct geomorphologic zones within the megafan. Entrenched on sediments of Pleistocene fan lobes, the Taquari River flows in a 3 to 5 km wide meander belt in the upper fan, where avulsion is hindered by entrenchment. Downstream of the intersection point, stream discharge progressively decreases and the Taquari River becomes narrow and shallow toward the Paraguay River plain. Within the distributary fan lobe, the channel-levee sandy complex is topographically higher than the adjacent floodplains and avulsion is a natural consequence of crevasses in the natural levees. Many channel avulsions have occurred during the last decades and documented cases show that significant channel changes may take place in a few years. Beginning with crevassing in 1988 and ending with the abandonment of the former channel in 1998, the river completely changed course in the lower fan. Presently, a major avulsion is occurring in the upper portion of the growing fan lobe, where many crevasses have appeared in the natural levees with associated splays onto the floodbasin. New anastomosed channels have formed north of the Taquari River, but downstream of them the flow is unconfined and the water spreads into natural floodbasins. This avulsion is still in process and allows observation of channel evolution, the geomorphic features produced, the sedimentary processes involved, and resulting effects. If the new channels do not rejoin the main channel, the river mouth may abandon its present master channel and shift to a position a hundred kilometers north from its present position. A large volume of sediment has been transferred to the floodbasin, with progradation of crevasse splay deposits over fine overbank sediments. Many geomorphic features, recognizable in satellite and radar images, clearly show that avulsion has occurred many limes before in the Taquari River. Avulsion belt deposits and former diverted channels testify to ancient avulsion events within the fan lobe and show that progradation of splays onto the floodbasin is the most important infilling process within the Taquari distributary fan lobe. The avulsion process in the lower Taquari River has accelerated in the last 30 years, along with the magnitude of flooding. Pasture and intensive agriculture in the catchment area has increased the sediment supply to the wetland, but larger floods are also a consequence of higher rainfall since 1973. Avulsion and floods have been a cause of great concern among the local population and landowners. Before human intervention in attempting to control floods, however, a better understanding of the avulsive river system is needed, especially because a major navigation project including the channelization of the Paraguay River was recently proposed. (c) 2005 Elsevier B.V. All rights reserved.

Remote sensing analysis of depositional landforms in alluvial settings: Method development and application to the Taquari megafan, Pantanal (Brazil)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Contrasting fluvial styles of the Paraguay River in the northwestern border of the Pantanal wetland, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Tratamento cirúrgico da fratura-avulsão da inserção tibial do L.C.P. do joelho: experiência de 21 casos

Avaliamos 21 pacientes, sendo 16 pacientes do sexo masculino e 5 do feminino, com idade média de 30 anos, foram submetidos à tratamento cirúrgico da fratura-avulsão do LCP. em 57% dos casos a lesão foi secundária a acidente motociclístico e 19% a acidente automobilístico. em 72% dos casos foi identificada uma lesão na face anterior do joelho. O tratamento cirúrgico consistiu na abordagem posterior do joelho e fixação do fragmento ósseo com parafuso e arruela em 18 casos; e amarrilhas trans-ósseas em 3 casos, onde o fragmento ósseo era muito pequeno. em 91% dos casos, a cirurgia foi realizada dentro dos primeiros 15 dias apos a lesão. Os pacientes foram avaliados objetivamente (teste de gaveta posterior) e subjetivamente (Escala de Lysholm), apos um seguimento pós-operatório mínimo de 12 meses. A análise estatística não mostrou diferença significativa, ao nível de 5%, entre as avaliações objetiva e subjetiva. A ausência de lesão ligamentar periférica pode ter contribuído para que os resultados clínicos pós-operatórios tenham avaliação subjetiva satisfatória; entretanto, a presença de uma posteriorização tibial residual sugere que a fratura-avulsão do ligamento cruzado posterior deve ser abordada não como uma lesão óssea pura, mas sim, como uma lesão ósteo-ligamentar.

Physical education undergraduates and dental trauma knowledge

The aim of the present study was to assess the level of knowledge of undergraduates from the College of Physical Education (Toledo, Aracatuba) concerning dental avulsion injuries. Data showed that 95% of the respondents did not know what dental avulsion is, 73.5% said they know how to define dental replantation, however, only 26% were able to do it correctly. When asked about first emergency measures after an avulsion, 50% of the respondents said they know what they should do, and the most cited measure was to seek a dentist. When asked about optimal storage media, 45.5% would keep it in a favorable one, and 28% did not know where to keep the tooth until treatment. Only 25.6% indicated a suitable extra-oral time for replantation; 90.3% of the respondents had received no advice about the emergency management of dental avulsion; 90% said they consider this an important and necessary subject. The results indicated that educational campaigns are necessary to improve the emergency management of dental injuries by those future P.E. professors for a better prognosis of dental replantation.

Pulpal and periodontal reactions of immature permanent teeth in the dog to intrusive trauma.

Pulpal and periodontal tissues of immature incisors of 10 dogs were radiographically and histopathologically evaluated immediately, 7, 15, 30 and 60 days after experimental intrusion induced by mechanical blows. Forty upper central and mesial lateral incisors showing incomplete root formation on radiographs were submitted to intrusive force. After the observation periods, the dogs were killed, two at a time. The hemi-maxilas were removed and processed for histopathologic examination. The traumatized teeth showed accelerated apical formation with reduced radicular length. Pulpal vitality was maintained and the subjacent tissues did not present irreversible changes. All traumatized teeth re-erupted spontaneously.

GPR survey in the Taquari River, Pantanal Wetland, west-central Brazil

A pioneer GPR - Ground Penetrating Radar - survey was carried out in the Pantanal of Mato Grosso State, westcentral region of Brazil. Fieldwork acquisitions were carried out in February/2001 and August/2002 in order to understand avulsion processes that are occurring within the Taquari alluvial megafan. The main subjects were to map channel, crevasses and floodplain morphology, as well as active sedimentary bedforms. Many GPR profiles were surveyed in the medium and lower Taquari River course. Subaqueous megaripples and exposed sand bars inside the Taquari channel were identified in the medium fan area. Similar features were observed in the lower fan channels, where there are also many crevasses in the marginal levees. During the flooding seasons the flow splays out in the floodplain where new distributary channels are being formed. As shown by GPR data, in the lower fan the Taquari channel is topographically higher than the adjacent floodplain, situation in which avulsion is a natural process of river course shifting. The lack of information about river morphology and dynamics is a major strain to better understand the sediment transport and the avulsion processes in the Taquari megafan. In this context, the GPR data obtained in wet and dry seasons, integrated to sedimentological information, have been very important to characterize the fluvial dynamics and the avulsion phenomena.

Application of GPR in the study of a modern alluvial megafan: The case of the Taquari river in Pantanal wetland, West-Central Brazil

A novel and timely ground penetrating radar (GPR) survey has been carried out in Pantanal from Mato Grosso State, west-central Brazil. Fieldwork was carried out on February/2001 and August/2002 in an attempt to understand avulsion processes that are occurring within Taquari alluvial megafan. The main objectives were to map channel, crevasse and floodplain morphology, as well as active sedimentary bedforms. Many GPR profiles were acquired in the medium and lower Taquari River course. Subaqueous megaripples and exposed sand bars were identified in the medium fan area. Similar features were observed in the lower fan channels, where there were many crevasses in the marginal levees. During the flooding seasons, the flow splays out on to the floodplain, where new distributary channels are being formed. GPR data show that the lower fan, Taquari channel is topographically higher than the adjacent floodplain, thus favoring avulsion as a natural process of river course shifting. GPR data obtained during the wet and dry seasons, together with sedimentology information have been very important in characterizing the fluvial dynamics, and avulsion phenomena. © 2005 Springer Science+Business Media, Inc.

Delayed tooth replantation after root surface treatment with sodium hypochlorite and sodium fluoride: Histomorphometric analysis in rats

In cases of delayed tooth replantation, non-vital periodontal ligament remnants have been removed with sodium hypochlorite in an attempt to control root resorption. Nevertheless, reports of its irritating potential in contact with the alveolar connective tissue have been described. Therefore, this study evaluated the healing process on delayed replantation of rat teeth, after periodontal ligament removal by different treatment modalities. Twenty-four rats, assigned to 3 groups (n=8), had their upper right incisor extracted and left on the workbench for desiccation during 60 min. Afterwards, the teeth in group I were immersed in saline for 2 min. In group II, root surfaces were scrubbed with gauze soaked in saline for 2 min; and in group III, scrubbing was done with gauze soaked in 1% sodium hypochlorite solution. Thereafter, root surfaces were etched with 37% phosphoric acid and immersed in 2% acidulate-phosphate sodium fluoride solution, at pH 5.5. Root canals were filled with a calcium hydroxide-based paste and the teeth were replanted. The animals were sacrificed 60 days postoperatively and the pieces containing the replanted teeth were processed and paraffin- embedded. Semi-serial transversally sections were obtained from the middle third of the root and stained with hematoxylin and eosin for histomorphometric analysis. Data were analyzed statistically using Kruskal-Wallis and Dunn's tests. The results showed that root structure and cementum extension were more affected by resorption in group III (p<0.05). All groups were affected by root resorption but the treatment performed in group III was the least effective for its control. The treatment accomplished in groups I and II yielded similar results to each other.

Information for the diagnosis and treatment of root resorption due to tooth replantation.

A favorable prognosis after tooth avulsion depends on some variables, such as the extra-alveolar period and storage medium. Vitality of the periodontal ligament cells is considered a critical factor for a successful outcome without root resorption. The dental surgeon is provided with clinical information and radiographic findings to establish a diagnosis and may rely on current available guidelines. Once trauma has occurred, treatment must be quick and effective, and periodic follow-up must be performed. Clinical, radiographic, and histologic characteristics for each type of root resorption due to tooth replantation are presented, with the aim to provide information for the diagnosis and treatment of healing complications.

Root surface treatment with vitamin C in tooth replantation: microscopic study in rats

AIM: Late tooth replantation is a worthy procedure, especially in growing patients, being the best option for tooth avulsion. This study evaluated the effects of root surface treatment with 2% acidulated phosphate sodium fluoride and effervescent vitamin C (Redoxon) in late replantation. METHODS: Twenty rat teeth (Rattus norvegicus, albinus, Wistar) were extracted and left on a table for 6 h. Then, the dental papilla and enamel organ were sectioned and the pulp was removed through the apex. After removal of the periodontal ligament with a blade, the animals were divided into 2 groups: Group I teeth were immersed in 2% acidulated phosphate sodium fluoride solution for 10 min and obturated with Ca(OH)(2) paste. Group II teeth were immersed in effervescent vitamin C solution (Redoxon 2 g) for 10 min and obturated as for Group I. After these procedures, teeth were replanted and animals were killed after 60 days. RESULTS: The study revealed a larger amount of replacement resorption in Group I and larger amount of ankylosis in Group II, with statistically significant difference and absence of inflammatory resorption. CONCLUSION: The substances used for root surface treatment were unable to prevent replacement resorption and ankylosis, which are expected when the periodontal ligament has been lost.

Dental trauma involving root fracture and periodontal ligament injury: A 10-year retrospective study

The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion) treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP), Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were examined. The results of this survey revealed that subluxation (25.09%) was the most common type of periodontal ligament injury, followed by extrusive luxation (19.86%). There was a predominance of young male patients and most of them did not present systemic alterations. Among the etiologic factors, the most frequent causes were falls and bicycle accidents. Injuries on extraoral soft tissues were mostly laceration and abrasion, while gingival and lip mucosa lacerations prevailed on intraoral soft tissues injuries. Radiographically, the most common finding was an increase of the periodontal ligament space. The most commonly performed treatment was root canal therapy. Within the limits of this study, it can be concluded that traumatic dental injuries occur more frequently in young male individuals, due to falls and bicycle accidents. Subluxation was the most common type of periodontal ligament injury. Root canal therapy was the type of treatment most commonly planned and performed.