Treatment of traumatic dental intrusion by surgical repositioning: clinical case report

The prevalence of dental trauma and its consequences are challenging. This article presents a clinical case of a 9-year-old female who was in a bicycling accident and had a dental intrusion of the left maxillary lateral incisor with extensive dislocation. In the emergency department, surgical repositioning of the intruded tooth and a splinting with steel wire and composite resin was performed and the soft-tissue lesions were sutured. Two weeks after the first visit, pulp necrosis was found and endodontic treatment of the intruded tooth was started with a calcium hydroxide dressing. Despite the traumatic nature of the dental injury, the result of treatment was favorable. After 3 years of follow-up, repair of the resorptions and no signs of ankylosis of the teeth involved were evident. Considering the patient's age and the extent of intrusion, it was concluded that surgical repositioning associated with adequate endodontic therapy was an effective alternative treatment for this case.

Low-temperature plasma: an effective approach against Candida albicans biofilm

This study evaluated the antifungal potential of low-temperature plasma (LTP) on a 72-hour Candida albicans biofilm. A growth inhibition zone test was conducted with agar plates inoculated with C. albicans and submitted to LTP and argon application at 3 and 10 mm for 10, 30, 60, 90, and 120 seconds. The groups for biofilm assays were 60 seconds of LTP application with a tip-to-sample distance of 3 mm (LTP-3) and 10 mm (LTP-10); –application of only argon gas for 60 seconds with a tip-to-sample distance of 3 mm (Ar-3) and 10 mm (Ar-10); and no treatment. The C. albicans biofilm was grown on saliva-coated discs. The medium was replaced every 24 hours. Confocal laser scanning microscopy revealed the proportion of live and dead cells, and variable pressure scanning electron microscopy (VPSEM) showed biofilm/cell structure. No inhibition zone was observed for control and either Ar groups. For the LTP groups, a progressively increasing of inhibition zone diameter was observed for different treatment durations. The LTP-3 and LTP-10 groups presented higher proportions of dead cells compared with the Ar-3 and Ar-10 groups. VPSEM revealed cell perforations in the LTP-3 and LTP-10 groups. A short period of LTP exposure demonstrated an antifungal effect on C. albicans biofilm.

Organização da demanda de um Centro de Especialidades Odontológicas

Introduction: Secondary care in oral health in Brazil is still a little researched topic. Objective: The aim of this study was to analyze the resolution of dental services in SUS based on the referral to secondary attention and backreferral to primary attention. Methodology: It’s a descriptive, quantitative study that used secondary data collected from dental records of patients seen at Centre of Dental Specialties (Ceo) in a city of São Paulo State. Result: It was analyzed 1030 dental records. Just 1236 proceedings received referral to Ceo and among then, 86.4% showed the first attendance on Basic Health Unity (UBS) through spontaneous demand and 50.4% (n=623) received referral to endodontic treatment. There was evasion of 2.27% of studied population (n=28) on the first specialized consultation. Among 1208 proceedings that started the treatment in Ceo, 62.6% (n=757) were finalized and received back-referral to primary attention, that finalized 61.1% (n=463) of proceedings. To conclude the treatment, considering the time spent in Ceo and primary attention, there was variation according to specialty: periodontics – 62 days (sd ±68) and endodontics – 71 days (sd ±51.8), requiring 3 consultations in average, regardless specialty. Conclusion: The Centre of Dental Specialties gave referral and attention to the majority of demand, regardless specialty. However, there are many cases of evasion during dental treatment, alerting managers to develop methods to entice these patients, reducing service expenses and raising solvability of dental procedures previously initiated.

Combined therapy with mineral trioxide aggregate, and guided tissue regeneration for a large radicular cyst: a 13-year follow-u

Biomaterials such as membrane barriers and/or bone grafts are often used to enhance periapical new bone formation. A combination of apical surgery and these biomaterials is one of the latest treatment options for avoiding tooth extraction. In case of periapical lesions, guided tissue regeneration (GTR) is attempted to improve the self-regenerative healing process by excluding undesired proliferation of the gingival connective tissue or migration of the oral epithelial cells into osseous defects. In many cases, GTR is necessary for achieving periodontal tissue healing. This report describes the healing process after surgery in a challenging case with a long-term followup. In this case report, endodontic surgery was followed by retrograde sealing with mineral trioxide aggregate (MTA) in the maxillary right central incisor and left lateral incisor. Apicectomy was performed in the maxillary left central incisor and a 1-mm filling was removed. The bone defect was filled with an anorganic bone graft and covered with a decalcified cortical osseous membrane. No intraoperative or postoperative complications were observed. After 13 years of follow-up, the patient showed no clinical signs or symptoms associated with the lesion and radiographic examination showed progressive resolution of radiolucency. In conclusion, the combination of apical surgery and regenerative techniques can successfully help the treatment of periapical lesions of endodontic origin and is suitable for the management of challenging cases

Root reconstructed with mineral trioxide aggregate and guided tissue regeneration in apical surgery: a 5-year follow-up

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

Raloxifene modulates regulators of osteoclastogenesis and angiogenesis in an oestrogen deficiency periapical lesion model

Aim To analyse the local regulatory mechanisms of osteoclastogenesis and angiogenesis during the progression of periapical lesions in female rats with oestrogen deficiency and treatment with raloxifene (RLX). Methodology Female Wistar rats were distributed into groups: SHAM-veh, subjected to sham surgery and treated with a vehicle; OVX-veh, subjected to ovary removal and treated with a vehicle; and OVX-RLX, subjected to ovary removal and treated with RLX. Vehicle or RLX was administered orally for 90 days. During treatment, the dental pulp of mandibular first molars was exposed to the oral environment for induction of periapical lesions, which were analysed after 7 and 30 days. After the experimental periods, blood samples were collected for measurement of oestradiol, calcium, phosphorus and alkaline phosphatase. The rats were euthanized and the mandibles removed and processed for immunohistochemical detection of receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), hypoxia-inducible factor-1 alpha (HIF-1α) and bone-specific alkaline phosphatase (BALP). Data were compared using Kruskal–Wallis followed by Dunn test (nonparametric values) and anova followed by the Tukey's test (parametric values). Results The plasma concentration of oestradiol showed hypo-oestrogenism in the rats subjected to ovary removal. On day 7, alkaline phosphatase activity, calcium and phosphorus were higher in the OVX-RLX group than in the OVX-veh group (P < 0.001), but immunolabelling for RANKL and HIF-1α was lower in OVX-RLX group (P < 0.001). On day 30, the OVX-veh group had higher immunolabelling for RANKL than the OVX-RLX group (P < 0.05). There were no significant differences in the immunoreactivity of OPG and BALP between any groups at either time-point (P > 0.05). Conclusion RLX therapy reversed the increased levels of the local regulators of both osteoclastogenesis and angiogenesis induced by oestrogen deficiency.

Cirurgias do Periápice

Apical surgeries are part of a segment of root canal treatment by which we can correct or eliminate iatrogenic deficiencies arising from conventional endodontic treatment. Currently no consensus among authors regarding to the factors linked to the surgery success as the execution of an apex resection followed by retropreparation and retrofilling. The apex resection performed 3mm from apical vertex allows the elimination of most apical ramifications, and it is a consensus part of the treatment. The preparation of cavities using ultrasonic tips has advantages over those made with drills such as better cleaning of the cavity, the possibility of lower cutting angle of the apical resection and deeper retropreparation. Another detail to consider is the type of tip, since the diamond tips in a more angulated inclination have higher cutting efficiency but causing increased formation of debris on the dentin walls. Finally, filling the cavity with an apical filling material allows proper sealing of the intracanal contents favoring apical healing.

Considerações sobre o sucesso do tratamento endodôntico

The follow up after endodontic treatment is the most effective tool for evaluating the quality of treatments performed, as well as, it lets to examine the procedures used at different stages of endodontic therapy. Clinical and radiographic findings must be taken into consideration to determine the percentage of endodontic success. Clinical findings include: absence of pain or positive examinations for percussion and palpation, swelling, tooth mobility and fistula. Regarding the radiographic findings it is possible to report absence of periapical radiolucent areas suggestive of periapical lesions and presence of bone cortical. Thus the aim of this study was to perform a bibliographic revision and a discussion about the factors of endodontic treatment follow up.

Susceptibility of microorganisms isolated from necrotic pulps to calcium hydroxide

Calcium hydroxide has been used as pulp-capping agent and canal dressing due to its antimicrobial and anti-inflammatory properties besides its ability to induce formation of mineralized tissues. The aim of this study was to evaluate the susceptibility to calcium hydroxide of 146 bacterial strains isolated from endodontic infections. MIC was determined by using an agar dilution method, while contact bactericide activity was performed through in broth. All the isolates were sensitive to calcium hydroxide in concentrations that varied from 0.5mg/ml to 128 mg/ml, and the genera Enterococcus, Pseudomonas, Staphylococcus and Actinomyces were the most resistant. Gramnegative anaerobes proved to be the most sensitive isolates. All the isolates were inhibited after 60 minutes of contact with the alkali in concentration of 100mg/ml

Oral focal mucinosis: clinical case presentation with a focus on aesthetic and functional surgical resolution

Introduction: When planning excisional surgery, alterations in the oral mucosa, particularly in esthetically important areas, represent a challenge. For cases involving an exophytic lesion with a vegetative tumoral aspect, a clinician may prioritize obtaining a definitive diagnosis by histopathologic and histochemical examinations over the preservation of esthetics or maintenance of the involved tooth. Case Presentation: A painless, hard lesion with normal coloration was present in the maxillary left central incisor of a patient for at least 6 years. A biopsy was performed to preserve oral mucosa and a treatment plan was established that included endodontic retreatment and prosthetic restoration. The histopathologic diagnosis was oral focal mucinosis, an uncommon and poorly characterized type of lesion. Conclusion: A conservative biopsy of the lesion facilitated an accurate diagnosis, promoted the patient’s comfort, and achieved satisfactory esthetic results.

Honorários praticados por operadoras de planos odontológicos e pelo SUS em relação aos definidos pelo Conselho Federal de Odontologia

Aim: The present study investigated the fees paid by dental insurance companies to dental surgeons, referrent to groups of dental procedures. Materials and Methods: The fees offered by dental insurance companies were defined according to the average values from the price tables of 5 insurance plans that offered national coverage. These average values and the values paid by the Brazilian Unified Health System (SUS) were compared with those set forth in the VRCC table from Brazilian Federal Dental Council (CFO). For comparison, average values were obtained for the following groups of procedures: preventive, aesthetic, endodontic, and surgical. The values of these preventive procedures were compared with other groups of procedures. Results: The plans applied an average discount of approximately 54.51% upon the prices suggested in the CFO price list. The highest discount was observed within the group of preventive procedures (57.09%, on average). Conclusion: The evaluated health insurance companies in vestigated in the present study are applying an abusive discount upon the prices suggested in the CFO price list. It's necessary to identify alternatives to reverse this situation.

Análise da interface adesiva entre pinos de fibra de vidro e dentina intrarradicular submetida à irrigação com diferentes agentes condicionantes

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

Avaliação da neutralização dos efeitos citotóxicos do ácido lipoteicóico em canais radiculares

Pós-graduação em Odontologia Restauradora - ICT

Influência da hipertensão arterial no padrão fenotípico da lesão periapical, na diferenciação dos osteoclastos, na resposta teciduale na capacidade de mineralização do cimento reparador MTA

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

Propriedades físicas, químicas, antimicrobianas e biológicas de cimentos endodônticos com óxido de cálcio e resina salicilato

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)