A method for the geometric standardization of intraoral radiographs for long-term follow up of replanted teeth: A case report

The interpretation of the set of radiographs taken during the follow-up period after tooth replantation might pose several difficulties, especially the inability to adequately reproduce the projection geometry of the exposures. This article describes a method for the geometric standardization of intraoral radiographs using a custom-made apparatus comprising a film-holder attached to an occlusal splint for the long-term follow up of dentoalveolar trauma. The method was applied in a patient who suffered an avulsion of the maxillary central incisors and had the teeth replanted after 4 h in saline storage. Endodontic treatment started 7 days after the trauma with changes of a calcium hydroxide intracanal medication every 15 days in the first 2 months and thereafter at 30-day intervals for 8 months. Root canal filling was carried out after this period. The radiographic exposures taken at the follow-up visits were standardized to identify the possible alterations during the repair process, such as root resorptions. A maxillary arch impression was made with alginate, and the model was cast in stone for fabrication of an acetate occlusal splint. The custom-made apparatus used for standardization of the radiographic exposures was fabricated by fixing a Rinn X-C-P film-holder and a 5-mm-long piece of 0.7-mm orthodontic wire to the occlusal splint with autopolymerized acrylic resin. Radiographs were taken at 4-month intervals, starting 10 months after replantation up to 76 months. The images were digitized and analysed using the Digora system. The length of the central incisors was determined to verify the reproduction of the projection geometry of the exposures and the orthodontic wire served to assess accuracy during length estimations in the radiographs. The method described in this article for geometric standardization of intraoral radiographs provided a consistent reproduction of the geometric exposure parameters, being indicated for use in the radiographic follow up of cases of dentoalveolar trauma. © 2012 John Wiley & Sons A/S.

Effect of immersion cleansers on the bond strength between a denture base resin and acrylic resin teeth

The aim of the present study was to assess the shear bond strength between a heat-polymerized denture base resin and acrylic resin teeth after immersion in different denture cleansers by simulating a 180-day use. Two acrylic teeth (Biotone, Biotone IPN, Dentsply Ind. e Com., Rio de Janeiro, RJ, Brazil) were chosen for bonding to a heat-polymerized denture base resin (Lucitone 550- Dentsply Ind. e Com., Rio de Janeiro, RJ, Brazil). Eighty specimens were produced and divided into eight groups (n=10) according to their experimental condition (distilled water, 2% chlorhexidine digluconate, 1% sodium hypochlorite and Corega Tabs). Shear bond strength tests (MPa) were performed with a universal testing machine at a crosshead speed of 0.5 mm/min. Data were analyzed by two-way analysis of variance (ANOVA) and Student-Newman-Keuls' multiple comparisons post hoc analysis (α=.05). The shear bond strength results revealed statistically significant differences between the groups. For the Biotone IPN tooth, significantly lower shear bond strength values were found for the group immersed in sodium-perborate solution (4.48±2.18 MPa) than for the group immersed in distilled water (control group) (10.83±1.84 MPa). For Biotone, significantly higher bond strength values (10.04±3.28 MPa) were found for the group immersed in Corega Tabs than for the control group (5.45±2.93 MPa). The immersion in denture cleanser solutions was more detrimental to the conventional acrylic denture tooth (Biotone) than to the highly cross-linked denture tooth (Biotone IPN). However, this effect was not observed for the groups immersed in Corega Tabs solution, regardless of the type of denture tooth. © 2013 Elsevier Ltd.

The Number of Bleaching Sessions Influences Pulp Tissue Damage in Rat Teeth

Introduction: Hydrogen peroxide tooth bleaching is claimed to cause alterations in dental tissue structures. This study investigated the influence of the number of bleaching sessions on pulp tissue in rats. Methods: Male Wistar rats were studied in 5 groups (groups 1S-5S) of 10 each, which differed by the number (1-5) of bleaching sessions. In each session, the animals were anesthetized, and 35% hydrogen peroxide gel was applied to 3 upper right molars. Two days after the experimental period, the animals were killed, and their jaws were processed for light microscope evaluation. Pulp tissue reactions were scored as follows: 1, no or few inflammatory cells and no reaction; 2, <25 cells and a mild reaction; 3, between 25 and 125 cells and a moderate reaction; and 4, 125 or more cells and a severe reaction. Results from each experimental group were compared between groups and within groups to the corresponding unbleached upper left molars and analyzed for significant differences using the Kruskal-Wallis test (P < .05). Results: All tissue sections showed significant bleaching-induced changes in the dental pulp. After 1 bleaching session, necrotic tissue in the pulp horns and underlying inflammatory changes were observed. The extent and intensity of these changes increased with the number of bleaching sessions. After 5 sessions, the changes included necrotic areas in the pulp tissue involving the second third of the radicular pulp and intense inflammation in the apical third. Conclusions: The number of bleaching sessions directly influenced the extent of pulp damage. © 2013 American Association of Endodontists.

Histologic Characterization of Engineered Tissues in the Canal Space of Closed-apex Teeth with Apical Periodontitis

Introduction: The aim of this study was to investigate the capacity of endodontic regenerative procedures combining an induced blood clot, platelet-rich plasma (PRP), and bone marrow aspirate (BMA) to regenerate dental pulp in canine closed-apex necrotic teeth. Methods: Apical periodontitis was induced in 20 upper and lower premolars of 2 dogs. After biomechanical preparation, enlargement to a #60 file, and disinfection with a triantibiotic paste for 28 days, the roots were randomly assigned to 4 treatment groups: blood clot (BC), BC + PRP gel, BC + BMA gel, and BC + BMA/PRP gel. Negative controls were also included. After a 3-month follow-up period, the animals were killed. Results: Histologic analysis showed the presence of newly formed vital tissues (connective, cement-like, and bone-like tissue) in 23 of the 32 treated roots (71.87%). There was no statistically significant difference between the treatment groups. Conclusions: New vital tissues were formed and characterized as connective, cementum-like, or bone-like, but not as pulp-like tissue; PRP and/or BMA did not improve the tissue ingrowth. © 2013 American Association of Endodontists.

Use of cone-beam tomography and digital subtraction radiography for diagnosis and evaluation of traumatized teeth treated with endodontic surgery and MTA. A case report

The aim of this paper was to report the diagnosis and evaluation of periradicular bone repair by using computed tomography and digital subtraction radiography in an endodontic surgery case treated with mineral trioxide aggregate (MTA). The patient had local swelling and fistula 7years after trauma in the upper jaw. Periapical lesion on tooth #12 and root resorption of tooth #11 were detected radiographically. Endodontic therapy and placement of intracanal medication were carried out. After 3months, with no improvement in the clinical signs and symptoms, computed tomography was performed, showing extensive apical bone resorption on tooth #12 and dental resorption promoting communication of the root canal with the periodontium of tooth #11. The patient was referred to endodontic surgery. After surgery and postoperative periods of 15, 30, 60, 90, and 120days, standardized radiographs were taken, digitized, and subjected to digital subtraction of the images using Adobe Photoshop CS software. Four years later, a cone-beam computed tomography was performed, showing bone repair and absence of root resorption at tooth #11. In this clinical case, digital subtraction radiography was effective for early detection of new bone formation and evolution of repair. © 2011 John Wiley & Sons A/S.

Luxation injuries in primary teeth: a retrospective study in children assisted at an emergency service

ABSTRACT: The purpose of this study was to analyze luxation injuries in children between the ages of 0 and 5 years treated at an emergency service department. A total of 1,703 records, corresponding to a period of 10 years at the Emergency Center of the Baby Clinic at Londrina State University, Brazil, were analyzed. The age, gender, etiologic factors, type of injury, injured teeth, treatment and time interval between injury and treatment were determined for each patient. Of the examined records, 409 patients met the study criteria and included a total of 679 injured teeth. Statistical analyses were carried out using the chi-square test with the level of significance set at 5%. Trauma incidence was higher in boys (57.0%) and in children less than two years of age (40.3%). Falling while walking or running was the most predominant etiologic factor (37.7%), and the most prevalent type of injury was subluxation (32.6%). Luxation injuries decreased with increasing age (p = 0.045). Treatment usually occurred within the first 1-15 days and was significantly associated with the type of trauma (p = 0.041). "Monitor only" was the treatment most frequently observed (74.0%). In conclusion, more luxation injuries were found in younger children, predominantly in boys. Falls resulting from walking or running were the etiologic factor most observed, with subluxation as the most common type of trauma. Treatment usually occurred within the first 15 days after the injury. Despite the severity of these injuries, "monitor only" was the eligible treatment.

Anatomical and histological characteristics of teeth in agouti (Dasyprocta prymnolopha Wagler, 1831)

A cutia espécie Dasyprocta prymnolopha (D. prymnolopha) é um roedor de tamanho médio, diurno e característico do Nordeste do Brasil, sul da Amazônia. Vários estudos têm sido feitos sobre estes roedores. No entanto, há uma carência de estudos do sistema estomatognático, em particular, a morfologia dos dentes. Assim, esta pesquisa procura descrever aspectos anatômicos e histológicos dos dentes cutia. Para isto, nós utilizamos cutias adultas, em que as mensurações e as descrições dos dentes e dos tecidos dentais foram feitas. Observou-se que a arcada dentária de D. prymnolopha é composta por vinte dentes, distribuídas uniformemente no arco superior e inferior, sendo os dentes inferiores, maiores do que os seus correspondentes superiores. Os incisivos são maiores, e entre os pré-molares e molares posteriores, existe um aumento gradual no comprimento do arco anterior-posterior. No exame microscópico, uma forma prismática foi observada o que consiste de prismas de esmalte dispostos em diferentes direções, atrás do esmalte e dentina com túbulos dentinários com padrão tubular de diâmetro variável e distantes entre si, mostrando também um caminho sinuoso a partir da parte interna da junção com o esmalte mais superficial. A análise morfológica dos tecidos dentários mostrou um esmalte com a organização estrutural adaptada para o ato de mastigar e dentina de alto impacto compatível com a função do padrão tubular de resiliência e amortecimento mecânico de forças mastigatórias, como encontrado em animais maiores, confirmando o entendimento de hábitos alimentares que definem muito das suas funções ecológicas dentro do ecossistema em que vivem.

In Vivo study of an intracanal dressing of calcium hydroxide/chlorhexidine in necrotic primary teeth

AIM:To evaluate the clinical and radiographic success of endodontic treatment in human primary teeth with necrotic pulp with and without radiographically visible furcal/periapical lesion treated with a calcium hydroxide (CH) and chlorhexidine (CHX) intracanal dressing. The tested hypothesis was that there is no difference in the clinical and radiographic success in primary teeth medicated with CH pastes prepared with polyethylene glycol (PEG) or CHX.METHODS:Thirty-two teeth with necrotic pulp were used in this randomized clinical study: 12 without and 20 with lesion. Canals were prepared and medicated with CH pastes with polyethylene glycol (CH/PEG) (n=16) or 2% CHX gel (CH/CHX) (n=16). Definitive filling was done after 30 days. The teeth were clinically and radiographically examined during 12 months to determine the success of the endodontic therapy. Data from clinical and radiographic examination of the initial condition and 12 months after treatment were compared using the Z test (α = 0.05).RESULTS:There was no significant difference (p>0.05) in the success rate of teeth with and without lesion medicated with CH/PEG or CH/CHX. No significant difference (p>0.05) was found between the pastes regardless of the presence of lesion.CONCLUSIONS:Combination of CHX and CH was not more effective than the CH/PEG paste, as similar clinical and radiographic success rate was observed in teeth medicated with either type of intracanal dressing.

Effect of Indomethacin on Surface Treatment and Intracanal Dressing of Replanted Teeth in Dogs

Purpose: This study evaluated the healing process of teeth replanted after root treatment and intracanal dressing with indomethacin alone or indomethacin with calcium hydroxide (Ca[OH](2)).Materials and Methods: Through a case-control study, 24 teeth of 6 adult dogs were extracted, dried, and divided into 4 groups according to the root surface treatment protocols performed before replantation and the intracanal medication used after replantation. In group 1 (negative control), root surfaces were treated by immersion in a 0.9% saline solution and then replanted. In the other groups, the roots were immersed for 10 minutes in Ca(OH)(2) (group 2), indomethacin (group 3), or a solution of indomethacin and Ca(OH)(2) (group 4). After 2 weeks, group 1 teeth were subjected to single-visit root canal treatment and obturation with gutta-percha and sealer consisting of zinc oxide and eugenol. The teeth in the other groups were subjected to intracanal dressing with the same material used for immersion. After an additional period of 28 weeks, the animals were euthanized and the jaws containing the replanted teeth were processed for histologic analysis. Histometric values were statistically analyzed, with significance set at a P value less than or equal to .05.Results: Group 1 exhibited significantly more normal periodontium than group 4 (P = .02). Total resorption was greater in group 4 than in group 1 (P = .02). No statistically significant difference in the percentage of surface resorption or in total inactive resorption was observed between the groups.Conclusions: The findings of this study suggest that intracanal dressing and topical root treatment with Ca(OH)(2) with or without indomethacin is not recommended for teeth dried for 50 minutes, but the use of indomethacin alone as root surface treatment for delayed tooth replantation deserves further study using longer drying periods. In addition, the present results suggest that a single-visit root canal, performed up to 2 weeks after replantation, might be indicated for teeth dried for up to 50 minutes. (C) 2014 American Association of Oral and Maxillofacial Surgeons

Filling of extraction sockets of feline maxillary canine teeth with autogenous bone or bioactive glass

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

Color degradation of acrylic resin denture teeth as a function of liquid diet: ultraviolet-visible reflection analysis

The effect of different beverages on acrylic resin denture teeth color degradation is evaluated. Ten acrylic resin denture teeth brands were evaluated: Art Plus (AP), Biolux (BX), Biotone IPN (BI), Magister (MG), Mondial 6 (MD), Premium 6 (PR), SR Vivodent PE (SR), Trilux (TR), Trubyte Biotone (TB), and Vipi Dent Plus (VP). Teeth were immersed in staining solutions (coffee, cola, and orange juice) or artificial saliva (control) (n = 6) for 1, 7, 15, or 30 days. Specimen colors were evaluated spectrophotometrically based on the Commission Internationale d'Eclairage L*a*b* system. Color differences (Delta E) were calculated between the baseline and post-staining results. Data were evaluated by analysis of variance and Tukey test (alpha = 0.05). BI (1.82 +/- 0.95) and TR (1.78 +/- 0.72) teeth exhibited the greatest Delta E values, while BX (0.88 +/- 0.43) and MD (1.09 +/- 0.44) teeth were the lowest, regardless of solution and measurement period, and were different from BI and TR teeth (P < 0.05). Cola and coffee promoted higher denture teeth color alterations than orange juice and saliva (P < 0.05). Saliva generated the lowest denture teeth color alterations. Greater immersion times caused higher denture teeth color changes. The lifespan of removable dentures and the aesthetic satisfaction of several edentulous patients may be increased with the use of stain-resistant artificial denture teeth. (C) The Authors.

Histopathological Condition of the Remaining Tissues after Endodontic Infection of Rat Immature Teeth

Introduction: Recently, case reports have shown that immature teeth diagnosed with necrotic pulp and periapical periodontitis can be repaired through a regenerative endodontic procedure. True regeneration depends on the presence of stem cells in the remaining vital tissues. The aim of this study was to evaluate the histologic condition of the pulp tissue, root apical papilla, and periapical tissues after inducing endodontic infection in immature rat teeth for different periods. Methods: This study evaluated 18 first upper rat molars (36 roots). Periapical lesions were induced and were confirmed radiographically, and the animals were divided into 3 groups according to the days of pulp exposure for endodontic infection induction: 30, 60, and 90 days. Histologic analysis was performed in 5 different areas (ie, cervical, middle, and apical root canal thirds; the apical papilla; and the periapex surrounding the apical papilla). Results: At 30 days, one third of the specimens still showed vital but intensely inflamed pulp tissue in the apical third and vital apical papilla with varying degrees of inflammation. After 60 days, the results were similar with respect to the apical pulp tissue and apical papilla. Completely necrotic pulp tissue in the space canal and vital apical papilla were observed in about 67% of the cases after 90 days. Conclusions: Vital pulp tissue was observed in the apical third until 60 days and in the vital apical papilla until 90 days of infection in a rat model.

Two-year Clinical Performance of Self-etching Adhesive Systems in Composite Restorations of Anterior Teeth

Objective: The aim of this study was to evaluate the two-year clinical performance of Class III, IV, and V composite restorations using a two-step etch-and-rinse adhesive system (2-ERA) and three one-step self-etching adhesive systems (1-SEAs).Material and Methods: Two hundred Class III, IV, and V composite restorations were placed into 50 patients. Each patient received four composite restorations (Amaris, Voco), and these restorations were bonded with one of three 1-SEAs (Futurabond M, Voco; Clearfil S3 Bond, Kuraray; and Optibond All-in-One, Kerr) or one 2-ERA (Adper Single Bond 2/3M ESPE). The four adhesive systems were evaluated at baseline and after 24 months using the following criteria: restoration retention, marginal integrity, marginal discoloration, caries occurrence, postoperative sensitivity and preservation of tooth vitality. After two years, 162 restorations were evaluated in 41 patients. Data were analyzed using the chi(2) test (p<0.05).Results: There were no statistically significant differences between the 2-ERA and the 1-SEAs regarding the evaluated parameters (p>0.05).Conclusion: The 1-SEAs showed good clinical performance at the end of 24 months.

Bonding durability of dental sealants to deciduous and permanent teeth

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

Mini-implants as provisional anchorage for the replacement of missing anterior teeth: A clinical report

This clinical report describes an adult patient referred for orthodontic treatment with mini-implants as anchorage to correct the root angulation of maxillary lateral incisors. The purpose of this report was to demonstrate the versatility of mini-implants placed in a vertical direction in esthetic areas. During orthodontic treatment, some aspects must be observed to preserve the interim restoration against the occlusal loads to avoid screw fracture. A fixed appliance was placed to correct the position of the maxillary anterior teeth and to complete the treatment. Acceptable esthetics and function were achieved.