Orthodontic extrusion as treatment option for crown-root fracture: literature review with systematic criteria

To review the literature searching for a consensus for the choice of orthodontic extrusion as treatment for crown-root fracture. An electronic search was performed in the databases PubMed, Cochrane Central Register of Controlled Trials and Scopus and a manual search of the Journal Dental Traumatology. Forty articles were found in PubMed and 38 in Scopus and after removal of duplicate sample 51 contained articles. Of these, 48 were excluded for not having orthodontic treatment, no follow-up or follow-up less than 6 months, or not report the presence of crown-root fracture. In manual search in Dental Traumatology 20 articles were found, but none of them met the prerequisites established. So, three articles formed the basis of the study. The choice of how to treat orthodontic extrusion of crown-root fracture was effective and stable, without root and periodontal changes. Factors, such as root formation and presence of pulp vitality were decisive for determining the stages of treatment, however, there is no consensus based on scientific evidence about these protocols.

Fracture resistance of weakened bovine teeth after long-term use of calcium hydroxide

In some parts of the world, revascularization may not be the most feasible treatment option for necrotic immature teeth. Therefore, apexification remains the most widely utilized treatment option for these cases. This study aimed to evaluate the fracture resistance of weakened bovine tooth roots treated with various irrigant solutions as well as long-term application of calcium hydroxide intracanal medication (ICM). One hundred seventy bovine teeth were randomly divided into three experimental groups (n = 50) and two control groups (n = 10). Group SS was irrigated with physiologic solution; group CHX was treated with 2% chlorhexidine gel and group NaOCl was irrigated with 1% sodium hypochlorite. After instrumentation, root canals were dressed with calcium hydroxide and evaluated at different periods (15, 60, 90, 180, and 360 days). The specimens were loaded at a 45° angle to measure fracture resistance through the use of an EMIC test machine. A decrease in fracture resistance was observed during the time of ICM dressing. The highest values of fracture resistance were observed in group SS with 15 days of ICM, not differing from the control group. Irrigation with NaOCl associated with ICM for 15 days presented the lowest fracture resistance; however, a statistically significant difference was not observed when compared with SS and CHX in the same time period. In longer periods of exposure to ICM (180 and 360 days), root canals irrigated with NaOCl and CHX showed significantly lower fracture resistance than SS (P < 0.05). Apexification with periodic changes of calcium hydroxide medicament leads to weakness of the teeth independent of the irrigation solution used.

Synchronous reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular osteocutaneous flap in patients with nasopharyngeal carcinoma

The reconstruction of bilateral osteoradionecrosis (ORN) of mandibular defects using a single free bone flap is rarely performed because extensively radiated neck tissue with severe fibrosis is usually unsuitable for vascularized reconstruction. Thirty-one patients with nasopharyngeal carcinoma (NPC) underwent bilateral reconstruction of advanced ORN in the mandible using a single fibular osteocutaneous flap. Clinical factors associated with the operation were assessed, including classification of mandible defects, types of recipient vessels, perioperative complications, and postoperative outcomes. All of the fibular osteocutaneous flaps survived completely, with the exception of 1 inner skin paddle that presented partial necrosis in a reconstruction of through-and-through defects. All patients experienced an improvement in cosmetic results 6 months after the reconstruction, whereas 23 patients experienced improved mouth opening compared to the preoperative condition. Advanced bilateral ORN in patients with NPC could be synchronously reconstructed with a single fibular osteocutaneous flap. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

Drifting of teeth in the mandible studied in adult human autopsy material

Increase in lower anterior crowding is a general problem among adult Caucasians. The tooth movement responsible for this phenomenon, however, is not fully elucidated. Aim of this study was to describe signs of ongoing tooth movement reflected in the thickness of the bundle bone around mandibular teeth and the distribution of eroding surfaces of the alveolar wall in human autopsy material. The distribution of bundle bone and eroding surfaces was assessed histomorphometrically on 106 mandibular teeth, and the surrounding bone obtained at autopsy from 35 deceased persons ranging from 19 to 55 years of age. By examining the mesio-distal and bucco-lingual aspects at the cervical and apical levels of the roots, a pattern of tooth movements could be established. The distribution of the bundle bone thickness and the vectors of eroding surfaces enabled the direction of tooth movement to be reconstructed. Mesial and lingual displacement was prevalent for the anterior teeth. The signs of ongoing displacement of lower teeth support the concept of crowding occurring in adult individuals and support the maintenance of retainers, even following cessation of growth.

Correlative light-electron fractography of interlaminar fracture in a carbon-epoxy composite

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

Multidisciplinary approach for crown-root fracture treatment after trauma: case report

The development of an accurate diagnosis and appropriate treatment plan can be a complex task, especially in cases of dentoalveolar trauma. The authors present a case report of crown-root fracture caused by trauma and highlight the importance of a multidisciplinary approach for the treatment. An eighteen year-old boy had a bicycle accident resulting in dental trauma. The upper right first molar showed a complicated crownroot fracture and the lower left second pre-molar showed an uncomplicated crown-root fracture. Endodontic treatment, controlled tooth extrusion, periodontal surgery for recovery of biological width, and porcelain crown and onlay restorations were performed. Esthetic and functional results were achieved. At the two-year follow-up it was observed that the tooth/onlay interface of the upper right first molar was stained and the onlay of the left lower second pre-molar was fractured. Therefore, the interface stained was repaired and a porcelain crown was made for the lower second premolar. The clinical case presented herein leads to the conclusion that a multidisciplinary treatment plan is extremely important for a proper resolution in cases of dentoalveolar trauma.

Intraoral approach to zygomatic fracture

Abstract: The intraoral approach to zygomatic fracture treatment was introduced by Keen in 1909. This technique allows both an adequate visualization of the zygomaticomaxillary buttress and intraoral reduction of zygomatic arch fractures. Similar techniques have been published over the last 30 years. The aim of this study was to describe a modification of the Keen technique that promotes adequate visualization of the infraorbital rim and permits reduction and fixation of this region in cases of zygomatic fractures. The present technique has several advantages such as that (a) only 1 incision is necessary to approach the zygomaticomaxillary buttress and infraorbital rim, (b) it optimizes surgical time, and (c) it avoids periorbital scars. Fracture of the zygomatic complex is one of the most common facial traumas and has been extensively described in the literature.1 However, there are several controversies as regards the best technique and treatment of these fractures, such as closed versus open reduction; sequence of reduction and fixation in open techniques; complications; and morbidity rates of each technique. Currently, the intraoral approach for surgical treatment of zygomatic complex fractures has received special attention. It was first described by Keen in 1909, using the upper sulcus technique. Later, other studies showed different variations of this technique to reach the zygomatic arch and buttress.3,4 However, in most cases, infraorbital margin fixation was still performed through the subtarsal, subciliary, or transconjunctival approach. The purpose of this article was to describe the modifications made to the intraoral approach to allow reduction and fixation of the infraorbital rim in zygomatic fractures.

Chronic osteomyelitis of the maxilla and mandible: microbiological and clinical aspects

Osteomyelitis of the mandible and maxilla are common in developing countries and their treatment may be long-standing and difficult. Thus, the aim of this study was to discuss the main biological aspects of the chronic osteomyelitis of the jaws of especial interest for dental team. These infections are associated with a complex microbiota composed mainly by anaerobic bacteria, sometimes associated with microorganisms originated from the skin and digestive tract. These data suggest that chronic osteomyelitis of the mandible and maxilla should be treated as anaerobic infections in most cases. In addition, local surgical treatments are relevant in the therapy outcome, associated to the use of antimicrobial agents, and the failure to accomplish them is a major cause of treatment failure.

Hip fracture in a developing country: a picture in need of change

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Changes in Complete Blood Count in Patients With Surgically Treated Facial Fractures

The purpose of this prospective study was to verify the changes in the preoperative and postoperative complete blood counts of patients with surgically treated facial fractures. Fifty consecutive patients with a mean age of 34 years who presented facial fractures and underwent surgical treatment were included. A complete blood count was performed, comprising the red and white blood cell count (cells/mu L), hemoglobin (g/dL), and hematocrit (%) levels. These data were obtained preoperatively and postoperatively during a 6-week period. Statistical analyses were performed using the Kruskal-Wallis and Mann-Whitney tests to identify the possible differences among the groups and among the periods of observation using the Friedman and Wilcoxon matched-pairs signed-ranks tests. The most common location of the fractures was the mandible (42.3%), followed by the zygomatic-orbital (36.5%) and associated locations (21.2%). Leukocytosis was associated with neutrophilia in the immediate postoperative period in all of the groups. There were no values below the reference limits of the values of hemoglobin, hematocrit, and erythrocytes, and no values above the reference limits for the remaining white blood cells, although significant differences among periods were observed in most cells, depending on the type of fracture. The primary findings were leukocytosis associated with neutrophilia, verified in the immediate postoperative period in all of the groups, and the influence of the type of fracture on the significant alterations observed among studied periods on the values of hemoglobin, hematocrit, erythrocytes, leukocytes, neutrophils, and lymphocytes.

Effects of temporal muscle detachment and coronoidotomy on facial growth in young rats

This study analyzed the effects of unilateral detachment of the temporal muscle and coronoidotomy on facial growth in young rats. Thirty one-month-old Wistar rats were distributed into three groups: detachment, coronoidotomy and sham-operated. Under general anesthesia, unilateral detachment of the temporal muscle was performed for the detachment group, unilateral coronoidotomy was performed for the coronoidotomy group, and only surgical access was performed for the sham-operated group. The animals were sacrificed at three months of age. Their soft tissues were removed, and the mandible was disarticulated. Radiographic projections-axial views of the skulls and lateral views of hemimandibles-were taken. Cephalometric evaluations were performed, and the values obtained were submitted to statistical analyses. There was a significant homolateral difference in the length of the premaxilla, height of the mandibular ramus and body, and the length of the mandible in all three groups. However, comparisons among the groups revealed no significant differences between the detachment and coronoidotomy groups for most measurements. It was concluded that both experimental detachment of the temporal muscle and coronoidotomy during the growth period in rats induced asymmetry of the mandible and affected the premaxilla.

Effect of different restorative procedures on the fracture resistance of teeth submitted to internal bleaching

The aim of this study was to evaluate the influence of different restorative procedures on the fracture resistance of endodontically treated teeth submitted to intracoronal bleaching. Fifty upper central incisors were distributed into 5 groups: GI - healthy teeth; GII - endodontically treated teeth sealed with Coltosol; GIII - endodontically treated teeth bleached and sealed with Coltosol; GIV - endodontically treated teeth bleached and restored with composite resin; and GV - endodontically treated teeth bleached and restored with a fiberglass post and composite resin. In the bleached specimens, a cervical seal was made prior to bleaching with 38% hydrogen peroxide. The gel was applied on the buccal surface and in the pulp chamber, and was then light-activated for 45 s. This procedure was repeated three times per session for four sessions, and each group was submitted to the restorative procedures described above. The specimens were submitted to fracture resistance testing in a universal testing machine. There were statistically significant differences among the groups (p < 0.05). The mean value found for GIII was the lowest (0.32 kN) and was significantly different from the values found for GI (0.75 kN), GII (0.67 kN), GIV (0.70 kN), and GV (0.72 kN), which were not significantly different from each other (p > 0.05). The restorative procedures using composite resin were found to successfully restore the fracture resistance of endodontically treated and bleached teeth.

Mandibular Angle Fracture Treated With New Three-Dimensional Grid Miniplate

Fractures of the mandibular angle deserve particular attention because they represent the highest percentage of mandibular fractures and have the highest postsurgical complication rate, making them the most challenging and unpredictable mandibular fractures to treat. Despite the evolution in the treatment of maxillofacial trauma and fixation methods, no single treatment modality has been revealed to be ideal for mandibular angle fractures. Several methods of internal fixation have been studied with great variation in complications rates, especially postoperative infections. Recently, new studies have shown reduction of postsurgical complications rates using three-dimensional plates to treat mandibular angle fractures. Nevertheless, only few surgeons have used this type of plate for the treatment of mandibular angle fractures. The aim of this clinical report was to describe a case of a patient with a mandibular angle fracture treated by an intraoral approach and a three-dimensional rectangular grid miniplate with 4 holes, which was stabilized with monocortical screws. The authors show a follow-up of 8 months, without infection and with occlusal stability.

Using the Condylar Prosthesis After Resection of a Large Odontogenic Myxoma Tumor in the Mandible

Odontogenic myxomas are considered to be a benign odontogenic tumor with locally aggressive behavior. Because these neoplasms are rare in the oral cavity, the possible surgical management can be quite variable. Literature recommendation can vary from simple curettage and peripheral ostectomy to segmental resection. The authors report a case of a 20-year-old patient with an odontogenic myxoma tumor located in the left mandibular angle, ascending ramus, and mandibular symphysis. It was treated by radical resection followed by titanium reconstruction with condylar prosthesis, which allowed rapid return of function with improvement in quality of life and restoration of cosmetic and functional deficits. The lesion did not recur after surgical procedure.

Use of rhBMP-2 to reconstruct a severely atrophic mandible: a modified approach

This study reports the case of a patient with a severely resorbed mandible who was treated without a bone graft, using short implants, internal rigid fixation, rhBMP-2 and beta-tricalcium phosphate. A 76-year-old woman, with a severely resorbed mandible (less than 3 mm), reported a history of nearly 25 years of complete edentulism and consecutive treatment failures, with total bilateral exposed inferior alveolar nerves and complete bone resorption of the inferior border in some areas. The treatment of choice was the placement of a 2.0 mm thick unilock bone plate (MatrixMandible, Synthes Maxillofacial, Paoli, PA, USA), to reinforce the mandible. Eight short implants with a regular platform (Nobel Biocare, Goteborg, Sweden) were placed: three on the external oblique line on both sides and two on the symphysis. In order to augment mandible height and coat the exposed thread of the anterior implants, rhBMP-2 (Infuse Bone, Meditronic Sofamor Danek, Memphis, TN, USA) and beta-tricalcium phosphate (Cerasorb; Curasan, Kleinostheim, Germany) were used. Four 1.3 mm L miniplates were placed to support the graft. 14 months after surgery, the patient was satisfied and had excellent function without complications.