Use of the connective tissue graft for the coverage of composite resin-restored root surfaces in maxillary central incisors

The purpose of this article is to report the use of the subepithelial connective tissue graft technique combined with the coronally positioned flap on a composite resin-restored root surface to treat Miller Class I gingival recessions associated with deep cervical abrasions in maxillary central incisors. Clinical measurements, including gingival recession height, probing depth, and bleeding on probing (BoP), were recorded during the preoperative clinical examination and at 2, 6, 12, and 24 months postoperatively. During the follow-up periods, no periodontal pockets or BoP were observed. The periodontal tissue of the teeth presented normal color, texture, and contouring. In addition, it was observed that creeping attachment had occurred on the restoration. This case report shows that this form of treatment can be highly effective and predictable in resolving gingival recession associated with a deep cervical abrasion. (Quintessence Int 2012;43:597-602)

Resolution of a titanium implant fracture after a recurrent trauma

Post-traumatic complications occasionally lead to tooth loss as well as the need for future implants. However, rehabilitation with endosseous osseointegrated implants does not protect the patient from the risk of suffering a new trauma. Implant fracture and the damage of the hexagon are post-traumatic complications that guide the clinician to preparing a more intricate treatment plan. The authors present a clinical case of a recurrent trauma of maxillary implant fracture. The treatment plan was to remove the implants followed by autogenous bone grafting to correct the defect. Two titanium implants were replaced, followed by connective tissue graft after allowing complete the healing process of the bone graft to occur. In the postoperative period of 6 months, satisfactory results have been shown as regards soft and hard tissues wound healing.

Importance of Clinical Examination in Dentoalveolar Trauma

Dental injuries are often the result of direct trauma. The most affected teeth are the upper incisors, and the most frequent lesions are coronal fractures, contusions, and lip and alveolar mucosa lacerations. The objective of this study was to draw attention to the importance of the correct management of cases of crow fractures associated with soft tissue lacerations when the fragment is not located. This is a clinical case of crown fracture, the fragment of which remained lodged inside the lip. After fragment removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.

Multidisciplinary approach for the treatment of a complicated crown-root fracture in a young patient: A case report

Crown-root fractures in permanent teeth cause esthetic and functional problems. This paper reports the case of a complicated crown-root fracture in the maxillary right central inc sor of a young patient who was treated with a multidisciplinary approach in two phases. A modified Widman flap, root canal therapy, glass fiber post cementation, and adhesive tooth fragment reattachment were performed shortly after an accident. Satisfactory esthetic and functional outcomes were obtained. However, the patient did not attend follow-up visits and returned after 7 years. During this second phase, the clinical and radiographic examination showed stability and adaptation of the fragment and good periodontal health conditions, but crown darkening and a radiolucent image associated with the root apex of the fractured tooth were also observed. The periapical lesion was surgically removed by apicoectomy, and the esthetics were recovered with a direct composite res n veneer on the traumatized tooth. (Quintessence Int 2011;42:729-735)

Influence of Microgap Location and Configuration on Peri-implant Bone Morphology in Nonsubmerged Implants: An Experimental Study in Dogs

Purpose: It is unknown whether different micro gap configurations can cause different pen-implant bone reactions. Therefore, this study sought to compare the peri-implant bone morphologies of two implant systems with different implant-abutment connections. Materials and Methods: Three months after mandibular tooth extractions in six mongrel dogs, two oxidized screw implants with an external-hex connection were inserted (hexed group) on one side, whereas on the contralateral side two grit-blasted screw implants with an internal Morse-taper connection (Morse group) were placed. on each side, one implant was inserted level with the bone (equicrestal) and the second implant was inserted 1.5 mm below the bony crest (subcrestal). Healing abutments were inserted immediately after implant placement. Three months later, the peri-implant bone levels, the first bone-to-implant contact points, and the width and steepness of the peri-implant bone defects were evaluated histometrically. Results: All 24 implants osseointegrated clinically and histologically. No statistically significant differences between the hexed group and Morse group were detected for either the vertical position for peri-implant bone levels (Morse equicrestal -0.16 mm, hexed equicrestal -0.22 mm, Morse subcrestal 1.50 mm, hexed subcrestal 0.94 mm) or for the first bone-to-implant contact points (Morse equicrestal -2.08 mm, hexed equicrestal -0.98 mm, Morse subcrestal -1.26 mm, hexed subcrestal -0.76 mm). For the parameters width (Morse equicrestal -0.15 mm, hexed equicrestal -0.59 mm, Morse subcrestal 0.28 mm, hexed subcrestal -0.70 mm) and steepness (Morse equicrestal 25.27 degree, hexed equicrestal 57.21 degree, Morse subcrestal 15.35 degree, hexed subcrestal 37.97 degree) of the pen-implant defect, highly significant differences were noted between the Morse group and the hexed group. Conclusion: Within the limits of this experiment, it can be concluded that different microgap configurations influence the size and shape of the peri-implant bone defect in nonsubmerged implants placed both at the crest and subcrestally. INT J ORAL MAXILLOFAC IMPLANTS 2010;25:540-547

Management of a complicated crown-root fracture using adhesive fragment reattachment and orthodontic extrusion

Dental trauma is more common in young patients and its sequelae may impair the establishment and accomplishment of an adequate treatment plan. This paper reports a case of complicated crown-root fracture in a young adult that was treated using adhesive tooth fragment reattachment and orthodontic root extrusion. Considering the time elapsed to follow up, the fracture extension, the amount of remaining root portion and the patient's low socioeconomic status, the treatment approach proposed for this case provided good functional and aesthetic outcomes. Clinical and radiographic results after 2 years were successful. This case report demonstrates the importance of establishing a multidisciplinary approach for a successful dental trauma management.

Delayed replantation of rat teeth after use of reconstituted powdered milk as a storage medium

Minimal extraoral dry storage period and moist storage for the avulsed tooth are identified as key steps for the treatment protocol of tooth replantation. Among the possible moist storage media, bovine milk has stood out because of its capacity of preserving the integrity of the periodontal ligament (PDL) fibers. This condition has attracted the attention to investigate the use of powdered milk, which is one of the presentation forms of bovine milk, as a feasible storage medium in cases of delayed tooth replantation. The aim of this study was to evaluate the healing process after delayed replantation of rat teeth stored in reconstituted powdered milk and long shelf-life (ultra high temperature) whole milk. Forty maxillary right rat incisors were assigned to four groups (n = 10): group I - the teeth were extracted and immediately replanted into theirs sockets; group II - the teeth were stored for 60 min in 200 ml of freshly reconstituted powdered milk; group III - the teeth were stored for 60 min in 200 ml of long shelf-life whole milk; group IV - the teeth were kept dry for the same time. All procedures were performed at room temperature. Next, the root canals of teeth in groups II, III, and IV were instrumented, filled with a calcium hydroxide-based paste, and replanted into their sockets. All animals received systemic antibiotic therapy and were killed by anesthetic overdose 60 days after replantation. The pieces containing the replanted teeth were removed, fixed, decalcified, and paraffin-embedded. Semi-serial 6-mu m-thick sections were obtained and stained with hematoxylin and eosin for histomorphological analysis. There was statistically significant difference (P < 0.05) between groups I and IV regarding the presence of replacement resorption and PDL remnants on root surface. The powdered milk and long shelf-life whole milk presented similar results to each other and may be indicated as storage media for avulsed teeth.

Knowledge of firefighters with special paramedic training of the emergency management of avulsed teeth

Immediate replantation into the socket is the ideal procedure in cases of accidental avulsion of permanent teeth. In Brazil, firefighters with special paramedic training are in charge of providing first-aid care to victims of road accidents and might have to deal with tooth avulsions. This study assessed the knowledge of firefighters regarding the emergency management of avulsed teeth. Information was collected from a questionnaire submitted to 110 volunteer firefighters in seven cities in the São Paulo State (Brazil). The results revealed that 70.9% of the respondents did not know what tooth avulsion was; 53.6% did not know what tooth replantation was or defined it incorrectly; 60% would not act properly in tooth avulsion cases; 20.9% did not consider replantation of the avulsed tooth into the socket as a treatment option; the ideal time interval for tooth replantation was unknown to 40% of the interviewees; 90% of the participants answered that they would not be able to perform tooth replantation. Among those who considered themselves unable to perform tooth replantation, 47.3% chose saline as the best storage medium for an avulsed tooth, 21.8% chose milk, 3.6% chose the patient's mouth and 20% reported not knowing where to store the tooth; 81.8% of the firefighters reported not to have ever received any specific directions on tooth replantation and 100% of them considered this knowledge a requirement for first-aid care to accident victims. In conclusion, the knowledge of the surveyed firefighters regarding emergency management after tooth avulsion was unsatisfactory in several aspects that are important for the success of replantation procedures. Firefighters with special paramedic training should be educated on how to proceed in cases of dentoalveolar traumas and tooth avulsions in order to improve treatment prognosis and increase the survival rate of replanted teeth.

Evaluating the knowledge of sports participants regarding dental emergency procedures

Dental trauma is a common consequence of sports practice to which emergency treatment is critical. The purpose of this study was to evaluate the knowledge of sports participants about dental trauma procedures, particularly tooth avulsion. A specific questionnaire concerning concepts, experiences and behaviors after dental trauma and the use of mouthguard was standardized and validated with 80 people. The validated questionnaire was then distributed to 310 sports participants. The results showed that 28.4% had experienced a kind of dental trauma; 42.6% would look for a dentist for treatment; 51.7% reimplanted or would reimplant the avulsed tooth; 6.5% would maintain the avulsed tooth in milk. Although 47.4% of the participants were aware of the possibility of accidents during sports practice, only 13.9% reported to use a mouthguard. This study showed an overall lack of knowledge of sportsmen and sportswomen with regards to tooth avulsion, thus reinforcing the need for educational campaigns to improve the immediate emergency treatment of tooth avulsion.

Effect of heat treatment on stainless steel orthodontic wires

This study evaluated the effect of heat treatment on CrNi stainless steel orthodontic archwires. Half of forty archwires of each thickness - 0.014 (0.35 mm), 0.016 (0.40 mm), 0.018 (0.45 mm) and 0.020 (0.50 mm) (totalling 160 archwires) - were subjected to heat treatment while the remainder were not. All of the archwires had their individual thickness measured in the anterior and posterior regions using AutoCad 2000 software before and after compressive and tensile strength testing. The data was statistically analysed utilising multivariance ANOVA at a 5% significance level. All archwires without heat treatment that were subjected to tensile strength testing presented with anterior opening, which was more accentuated in the 0.020 archwires. In the posterior region, the opening produced by the tensile force was more accentuated in the archwires without heat treatment. There was greater stability in the thermally treated archwires, especially those subjected to tensile strength testing, which indicates that the heat treatment of orthodontic archwires establishes a favourable and indispensable condition to preserve the intercanine width.

Effect of monomer treatment and polymerisation methods on the bond strength of resin teeth to denture base material

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

Effect of methyl methacrylate monomer on bond strength of denture base resin to acrylic teeth

Bond failures at the acrylic teeth and denture base resin interface are still a common clinical problem in prosthodontics. The effect of methyl methacrylate (MMA) monomer on the bond strength of three types of denture base resins (Acron MC, Lucitone 550 and QC-20) to two types of acrylic teeth (Biotone and Trilux) was evaluated. Twenty specimens were produced for each denture base resin/acrylic tooth combination and were randomly divided into control (acrylic teeth received no surface treatment) and experimental groups (MMA was applied to the surface of the acrylic teeth for 180 s) and were submitted to shear tests (1 mm/mm). Data (MPa) were analyzed using three-way ANOVA/Student's test (alpha = 0.05). MMA increased the bond strength of Lucitone denture base resins and decreased the bond strength of QC-20. No difference was detected for the bond strength of Acron MC base resin after treatment with MMA. (C) 2008 Elsevier Ltd. All rights reserved.

Evaluation of the Bond Strength of Denture Base Resins to Acrylic Resin Teeth: Effect of Thermocycling

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

Mechanics of the maxillary central incisor. Influence of the periodontal ligament represented by beam elements

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

Influence of Crown Ferrule Heights and Dowel Material Selection on the Mechanical Behavior of Root-Filled Teeth: A Finite Element Analysis

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