Lesão endoperio: apicectomia com abordagem palatina: Relato de caso clínico com 30 meses de acompanhamento

Traditionally, the apicoectomies are carried out with the vestibular approach for visibility and easiness of access. The aim of this study was to present a case report of a patient with extensive injury endo-periodontal opted for the surgical access through a palatal incision. The patient presented with abscess drainage via periodontal ligament. The periodontal probing coincident with the radiographic apex in mesial tooth on dental element 22. Radiographically it was noted that the periapical lesion extended from the distal of the tooth 11 to the mesial of tooth 23. The tooth 22 had undergone endodontic treatment and showed signs of shutter material extravasation. It was decide to carry out an approach by the Palatine of the tooth to prevent gingival. After the flap elevation, the injury was debrided and apicoectomy was performed. The patient reported no pain or discomfort after surgery. Furthermore, as follow-up of 30 months there was total remission of signs and symptoms presented initially and absence of gingival recession. Therefore, according to the results showed in this case report, it is suggested that the Palatine access is an alternative approach that can be successfully employed in cases of apicoectomies in order to avoid the occurrence of gingival recessions.

Associação de prótese fixa, implantes e estética periodontal para reabilitação de pacientes parcialmente edêntulos

Periodontitis is a chronic inflammatory disease that results in the destruction of teeth and their supporting tissues with subsequent tooth loss. The replacement of missing teeth for implant-supported restorations has proven to be a highly predictable treatment method with good long-term prognosis. However, some consequences of tooth loss prevents dental implant placement in an ideal position, where regenerative procedures are necessary for this type of rehabilitation. Less invasive procedures such as conventional prosthesis emerge as a therapeutic option in cases where there is enough bone structure for implants and patient´s non-acceptance for invasive procedures. Thus, this paper aims to present the resolution of rehabilitation through a noninvasive and multidisciplinary treatment. One female patient referred to the clinic presented maladaptive bilateral mandibular fixed prostheses, endodontic lesions, gingival recession, and root sensitivity. For proper resolution of this case, an association among osseointegrated implants, fixed partial prosthesis, tooth extraction, and aesthetic periodontal procedures with the use of subepithelial connective tissue graft was proposed. After two years, the patient shows excellent aesthetics and chewing. Within the limits of this scenario, this paper discusses the various factors that may affect the choice of a particular treatment modality for the rehabilitation of edentulous single spaces.

A new calcium silicate-based material (Biodentine) for filling radicular perforation in an endodontic-periodontal lesion: a case report

This case report presents an apical radicular perforation management using new calcium silicate-based cement (Biodentine) in a combined endodontic-periodontal lesion. The presence of apical radicular perforation may interfere in the endodontic treatment prognosis. Radicular perforation filling with bioactive cement through endodontic surgery is a possible treatment. This study presents an apical radicular perforation with periodontal involvement, due to alveolar bone loss on the buccal radicular surface from an incorrect intracanal preparation for the fiber post placing. The chosen alternative was a periapical surgery, the perforation was filled with a silicate and calcium chloride bioactive cement (Biodentine; Septodont, Saint-Maur-des-Fosses Cedex, France), and the radicular surface was etched with citric acid, because the access from root canal was impossible. The follow-up was for 8 months, through clinical and radiographic analysis. At the end of the follow-up, radiographic analyses showed the bone healing, and no clinical changes in periodontal probing depth, gingival recession, and the height of the interproximal mesial and distal papillae were observed. The root perforation treatment has a difficult management, especially when the dental root has a simultaneous periodontal commitment. The Biodentine proves to be a promising material for use in these situations.

Comparative study between photodynamic and antibiotic therapies for treatment of footpad dermatitis (bumblefoot) in Magellanic penguins (Spheniscus magellanicus)

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

Evaluation of the progression and treatment of experimental periodontitis in rats subjected to chemotherapy with 5-fluorouracil

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

Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study

Background: This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach.Methods: Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up.Results: The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 +/- 16.60 years. The median duration of postoperative follow-up was 24.39 +/- 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement.Conclusion: Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Enamel matrix protein derivative plus synthetic bone substitute for the treatment of mandibular Class II furcation defects: a case series

Objectives: The aim of this study is to report on the treatment of mandibular Class II furcation defects with enamel matrix protein derivative (EMD) combined with a beta TCP/HA (beta-tricalcium phosphate/hydroxyapatite) alloplastic material. Method and Materials: Thirteen patients were selected. All patients were nonsmokers, systemically healthy, and diagnosed with chronic periodontitis; had not taken medications known to interfere with periodontal tissue health and healing; presented one Class II mandibular furcation defect with horizontal probing equal to or greater than 4 mm at buccal site. The clinical parameters evaluated were probing depth (PD), relative gingival margin position (RGMP), relative vertical clinical attachment level (RVCAL), and relative horizontal clinical attachment level (RHCAL). A paired Student t test was used to detect differences between the baseline and 6-month measurements, with the level of significance of .05. Results: After 6 months, the treatment produced a statistically significant reduction in PD and a significant gain in RVCAL and RHCAL, but no observable change in RGMP. RVCAL ranged from 13.77 (+/- 1.31) at baseline to 12.15 (+/- 1.29) after 6 months, with a mean change of -1.62 +/- 1.00 mm (P<.05). RHCAL ranged from 5.54 (+/- 0.75) to 2.92 (+/- 0.92), with a mean change of -2.62 +/- 0.63 mm (P<.05). After 6 months, 76.92% of the patients improved their diagnosis to Class I furcation defects while 23.08% remained as Class II. Conclusion: The present study has shown that positive clinical results may be expected from the combined treatment of Class II furcation defects with EMD and beta TCP/HA, especially considering the gain of horizontal attachment level. Despite this result, controlled clinical studies are needed to confirm our outcomes.

Use of botulin toxin in the treatment of diffuse esophageal spasm. A case report

The diffuse esophageal spasm distinguishes from others esophageal disturbs by the symptoms severity and bad results to conservative treatment. This situation requires formal indication to surgical treatment or dilation. In high risk patients this situation becomes a big problem, due to the lack of another therapeutic option. In a patient with this problem we use an endoscopic injection of botulin toxin in cardia with good results in three months follow-up. Despite this short period of observation we believe that the infiltration with botulin toxin in cardia constitutes a valid therapeutic option in treatment of diffuse esophageal spasm.

Simplified periodontal record for pregnant women

The assessment using the PSR (Periodontal Screening and Recording) of the prevalence and severity of and the basic treatment needs for periodontal disease in a group of pregnant women who attended the Preventive Dentistry Clinic at the School of Dentistry of Araraquara--UNESP. Forty-one pregnant women of 16 to 37 years of age, were examined. The PSR index was evaluated with a suitable periodontal probe (Trinity-model 621-WHO) with index codes scores of from 0 to 4, capable of indicating the presence of the following conditions: periodontal health, bleeding on probing, calculus, shallow and deep pockets. These codes were attributed to each sextant and could be marked with an asterisk (*) to indicate the presence of gingival recession, furcation lesions, mobility or any other mucogingival alterations. It is shown that 100% of the pregnant women had some kind of gingival alteration, represented mainly by PSR code 2 (56.1%) and * (19.5%). The women in the youngest age groups, 15-19 and 20-24 years, had code 2 as their highest score with no sextant excluded. In the 25-29 age group, the PSR code 2 still prevailed (54.5%) although codes 3 and 4 were already appearing. The code * and the occurrence of excluded sextants tended to increase in the oldest age group (30-37). In general, the affected sextants showed codes 1 and 2 more frequently, corresponding to 41.6% and 39.8% respectively, which represented a mean of 2.49 and 2.39 sextants affected in each pregnant woman. Regarding the treatment needs, 90.2% of the women needed some treatment beyond the preventive measures begun, including scaling and root planning and/or corrections of defective restorative margins (61%), and more complex treatment (29.2%). The meeting of the treatment needs during pregnancy must include special efforts to increase motivation and promote oral health, minimizing the possibility of vertical transmission of pathogenic microrganisms to the child, and thus contributing to the primary prevention of the main oral diseases.

Clinical and surgical management of an aggressive cherubism treated with autogenous bone graft and calcitonin

Cherubism is a rare autosomal-dominant inherited syndrome and is usually self-limiting; it starts in early childhood and involutes by puberty. It is a benign fibroosseous disease, characterized by excessive bone degradation of the upper and lower jaws followed by development of fibrous tissue masses. The purpose of this clinical report is to describe a rare and aggressive form of cherubism on an adult female patient that has been treated in our Bioscience Center for Special Health Care Needs-CEBAPE. The patient was firstly submitted to the surgical procedure with partial curettage of the lesion, and the cavity was filled with autogenous cancellous bone and bone marrow grafts. Furthermore, the support treatment used was the administration of salmon calcitonin by nasal spray during the first year after the preconized procedure. At 4-year followup, we confirmed the stomatognathic system improvement and esthetic rehabilitation, which led to a significant increase in the patient's quality of life.

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.

The effect of blue light on periodontal biofilm growth in vitro

We have previously shown that blue light eliminates the black-pigmented oral bacteria Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, and Prevotella melaninogenica. In the present study, the in vitro photosensitivity of the above black-pigmented microorganisms and four Fusobacteria species (Fusobacterium nucleatum ss. nucleatum, F. nucleatum ss. vincentii, F. nucleatum ss. polymorphum, Fusobacterium periodonticum) was investigated in pure cultures and human dental plaque suspensions. We also tested the hypothesis that phototargeting the above eight key periodontopathogens in plaque-derived biofilms in vitro would control growth within the dental biofilm environment. Cultures of the eight bacteria were exposed to blue light at 455 nm with power density of 80 mW/cm(2) and energy fluence of 4.8 J/cm(2). High-performance liquid chromatography (HPLC) analysis of bacteria was performed to demonstrate the presence and amounts of porphyrin molecules within microorganisms. Suspensions of human dental plaque bacteria were also exposed once to blue light at 455 nm with power density of 50 mW/cm(2) and energy fluence of 12 J/cm(2). Microbial biofilms developed from the same plaque were exposed to 455 nm blue light at 50 mW/cm(2) once daily for 4 min (12 J/cm(2)) over a period of 3 days (4 exposures) in order to investigate the cumulative action of phototherapy on the eight photosensitive pathogens as well as on biofilm growth. Bacterial growth was evaluated using the colony-forming unit (CFU) assay. The selective phototargeting of pathogens was studied using whole genomic probes in the checkerboard DNA-DNA format. In cultures, all eight species showed significant growth reduction (p < 0.05). HPLC demonstrated various porphyrin patterns and amounts of porphyrins in bacteria. Following phototherapy, the mean survival fractions were reduced by 28.5 and 48.2 % in plaque suspensions and biofilms, respectively, (p < 0.05). DNA probe analysis showed significant reduction in relative abundances of the eight bacteria as a group in plaque suspensions and biofilms. The cumulative blue light treatment suppressed biofilm growth in vitro. This may introduce a new avenue of prophylactic treatment for periodontal diseases.

Claritromicina como adjuvante ao debridamento periodontal no tratamento de periodontite agressiva generalizada: estudo controlado randomizado

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Supratarsal approach to treatment of zygomatic complex fractures

Many incisions have been described for approaches to zygomatic fractures. Precise repositioning of zygomatic complex fractures is difficult. The traditional approach is through an eyebrow incision, but it can produce a scar that causes aesthetic and psychological problems for the patient. We describe the supratarsal fold approach to expose the frontozygomatic suture and to reduce small displacements of frontal sinus anterior wall; it gives good access and excellent aesthetic results.

Radiographic assessment of potodynamic therapy as an adjunctive treatment on induced periodontitis in immunosupressed rats

OBJECTIVE: The aim of this study was to assess radiographically the effect of photodynamic therapy (PDT) as an adjunctive treatment to scaling and root planing (SRP) on induced periodontitis in dexamethasone-induced immunosuppressed rats. MATERIAL AND METHODS: The animals were divided into 2 groups: ND group (n=60): saline treatment; D group (n=60): dexamethasone treatment. In both ND and D groups, periodontal disease was induced by the placement of a ligature in the left first mandibular molar. After 7 days, ligature was removed and all animals received SRP, being divided according to the following treatments: SRP: saline and PDT: phenothiazinium dye (TBO) plus laser irradiation. Ten animals per treatment were killed at 7, 15 and 30 days. The distance between the cementoenamel junction and the height of the alveolar bone crest in the mesial surface of the mandibular left first molars was determined in millimeters in each radiograph. he radiographic values were analyzed statistically by ANOVA and Tukey's test at a p value <0.05. RESULTS: Intragroup radiographic assessment (ND and D groups) showed that there was statistically signifcant less bone loss in the animals treated with PDT in all experimental periods compared to those submitted to SRP. Intergroup radiographic analysis (ND and D groups) demonstrated that there was greater bone loss in the ND group treated with SRP compared to the D group treated with PDT at 7 and 30 days. CONCLUSION: PDT was an effective adjunctive treatment to SRP on induced periodontitis in dexamethasone-induced immunosuppressed rats.