Severe lateral luxation and root fracture: report of a case with 5-year follow-up

A case of severe lateral luxation and root fracture in upper incisors is reported. Treatment involved the repositioning and fixation of the injured teeth and endodontic treatment with calcium hydroxide. The importance of long-term follow-up is emphasized.

Histological evaluation of dog permanent teeth after traumatic intrusion of their primary predecessors

The aims of this study were to analyze the histomorphology of developing permanent teeth whose primary teeth had suffered traumatic intrusion, as well as to compare the influence of immediate extraction of the intruded tooth to passive re-eruption. Nine dogs from 45 to 50 days old were submitted to the intrusion of the maxillary central and lateral primary incisors using a force applicator adapted to the teeth incisal cuspids. The right side intruded teeth were kept in their sockets and the ones on the left side were extracted 30 min later. After a postoperatory periods of 30 and 60 days, four (group 1) and five (group 2) dogs, respectively, were killed by perfusion. The histological evaluations showed that, in group 1, alterations had occurred in the odontoblastic layer and deposition of the enamel matrix had taken place in some specimens while in group 2, a portion of non-mineralized matrix was observed. We concluded that the morphological changes were because of the immediate trauma of intrusion. No differences were found between the groups where the primary tooth was immediately extracted or left to passively re-erupt.

Programa de extrações seriadas: variáveis relacionadas com a extração de pré-molares

OBJETIVO: verificar o percentual de pacientes que necessitaram extração de dentes permanentes, pré-molares, dentre aqueles tratados com extração de dentes decíduos para correção do apinhamento primário na dentição mista, bem como analisar as possíveis variáveis relacionadas. MÉTODOS: a amostra foi composta por documentações ortodônticas de 70 pacientes na dentição permanente, cujo tratamento iniciou-se na dentição mista com planejamento de um programa de extrações seriadas (PES). Todos os prontuários foram analisados por um único examinador, no intuito de verificar se o PES havia sido cumprido com a extração de dentes permanentes ou se havia sido realizada apenas extração de dentes decíduos. Verificou-se a associação entre a extração de dentes permanentes e as variáveis padrão facial; relação sagital entre as arcadas dentárias; IMPA; proporção tamanho do segundo molar permanente inferior/espaço retromolar; mecânica de controle de espaço e discrepância de modelo (teste exato de Fisher para as variáveis categóricas e modelo de regressão logística para as variáveis numéricas). Os resultados foram considerados para p<0,05. RESULTADOS: dos pacientes que haviam sido tratados com extração de dentes decíduos para a correção do apinhamento na dentição mista, 70% necessitaram de extração de dentes permanentes. A análise estatística não mostrou associação significativa entre as variáveis estudadas e a necessidade de extração de dentes permanentes, com exceção da variável discrepância de modelo. CONCLUSÃO: a discrepância de modelo representou a principal determinante de extração de pré-molares no PES.

Conhecimento sobre saúde bucal por concluintes de pedagogia

Este estudo teve por objetivo investigar as opiniões e o conhecimento de concluintes do curso de Pedagogia da cidade de Araçatuba, São Paulo, Brasil, em 2009, sobre saúde bucal. Para tanto, foi utilizado um questionário semiestruturado, abordando as opiniões dos estudantes sobre educação em saúde bucal e seu conhecimento sobre aspectos relativos à cárie dentária, à odontologia preventiva e à odontologia na primeira infância. de um universo de 120 estudantes, 92 (76,6%) consentiram participar do estudo. Destes, 86,8% acadêmicos acham que o professor deve atuar como educador em saúde bucal e 92,4% consideram importante a sua integração com profissionais de saúde. Responderam corretamente sobre o conceito de placa bacteriana e cárie dentária, respectivamente, 9% e 34,8%. Sobre o surgimento da cárie e sobre a possibilidade de se ter dentes saudáveis a vida inteira, responderam corretamente 67% e 83,7%, respectivamente. Assim, os concluintes de Pedagogia têm opiniões positivas em relação à educação em saúde bucal; entretanto, o seu conhecimento sobre a temática abordada é insatisfatório, uma vez que eles serão futuros professores e formadores de opinião.

Synchrotron microComputed tomography of the mature bovine dentinoenamel junction

The mature dentinoenamel junction (DEJ) is viewed by some investigators and the current authors, not as a fossilized, sharp transition between enamel and dentin, but as a relatively broad structural transition zone including the mantle dentin and the inner aprismatic enamel. In this study, the DEJ structure in bovine incisors was studied with synchrotron microComputed Tomography (microCT) using small cubes cut parallel to the tooth surface. The reconstructions revealed a zone of highly variable punctate contrast between bulk dentin and enamel; the mean linear attenuation coefficients and their standard deviations demonstrated that this zone averaged less mineral than dentin or enamel but had more highly variable structure than either. The region with the punctuate contrast is, therefore, the mantle dentin. The thickness of the mantle dentin seen in a typical data set was about 30 mu m, and the mantle dentin-enamel interface deviated +/- 15 mu m from the average plane over a distance of 520 mu m. In the highest resolution data (similar to 1.5 mu m isotropic voxels, volume elements), tubules in the dentin could be discerned in the vicinity of the DEJ. Contrast sensitivity was high enough to detect differences in mineral content between near-surface and near-DEJ volumes of the enamel. Reconstructions before and after two cubes were compressed to failure revealed cracks formed only in the enamel and did not propagate across the mantle dentin, regardless of whether loading was parallel to or perpendicular to the DEJ. (C) 2007 Elsevier B.V. All rights reserved.

Protection of short-time enamel erosion by different tetrafluoride compounds

objective: This in vitro study aimed to analyse the protective effect of differently concentrated titanium (TiF4), zirconium (ZrF4) and hafnium (HfF4) tetrafluoride on enamel erosion. Methods: Polished enamel surfaces of 36 bovine crowns were covered with tape leaving 4 enamel windows each 3 mm in diameter exposed. The crowns were randomly assigned to six groups (each n = 6) and pretreated with 4% TiF4, 10% TiF4, 4% ZrF4, 10% ZrF4, 4% HfF4 or 10% HfF4 for 4 min (first window), 10 min (second window) or 15 min (third window). The fourth window of each crown was not pretreated and served as control. Erosion was performed stepwise with 1% HCl (pH 2) in five consecutive intervals of each 15 s (total 75 s). Enamel dissolution was quantified by colorimetric determination of phosphate release into the acid. For each tooth, cumulative phosphate loss of enamel pretreated with one of the tetrafluoride compounds was calculated as percentage of the respective control and statistically analysed using two-way ANOVA.Results: Enamel erosion was significantly reduced by TiF4, ZrF4 and HfF4 application. Cumulative phosphate loss (mean % of control, 75 s erosion) after 4-15 min application was significantly lower for 4% ZrF4 (7-11%), 10% ZrF4 (2-6%), 4% HfF4 (11-9%) and 10% HfF4 (12-16%) compared to 4% TiF4 (42-27%) and 10% TiF4 (54-33%). Only for 4% and 10% TiF4, phosphate loss decreased with increasing duration of application, but also increased with increasing acid intervals.Conclusion: TiF4, ZrF4 and HfF4 might protect enamel against short-time erosion, but protection was more enhanced by ZrF4 and HfF4 compared to TiF4 application overtime. (C) 2008 Elsevier Ltd. All rights reserved.

12-Month color stability of enamel, dentine, and enamel-dentine samples after bleaching

The study aimed to quantify the color regression of enamel (E), dentine (D), and combined enamel-dentine (ED) of differently bleached ED specimens over a period of 12 months in vitro. Two ED samples were obtained from the labial surfaces of bovine teeth and prepared to a standardized thickness with the enamel and dentine layer each 1 mm. The ED samples were distributed on four groups (each n=80), in which the different bleaching products were applied on enamel (1, Whitestrips; 2, Illumine 15%; 3, Opalescence Xtra Boost) or dentine surfaces (4, mixture of sodium perborate/distilled water). Eighty ED samples were not bleached (control). Color (L*a*b*) of ED was assessed at baseline, subsequently after bleaching and at 3, 6, and 12 months of storage after bleaching (each 20 samples/group). E and D samples were prepared by removing the dentine or enamel layer of ED samples to allow for separate color analysis. Bleaching resulted in a significant color change (Delta E) of ED specimens. Within the observation period, Delta L but not Delta b declined to baseline. L* values of E and D samples also declined and were not significantly different from control samples after 12 months, while b* values did not decrease to baseline. Generally, no differences between the bleaching agents could be observed. Color change of enamel, dentine, and combined ED of in vitro bleached tooth samples is not stable over time with regard to lightness. However, yellowness did not return to baseline within 1 year.

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

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Interceptive Approach to Treatment of Impacted Maxillary Canines

Impaction of maxillary canines can be prevented by early intervention in the mixed dentition phase after the correct diagnosis of malocclusion, reducing the complexity of the treatment. This article reports the case of a 10-year-old patient who possessed impacted maxillary canines and, after early extraction of primary canines, had reestablished favorable permanent successors' eruption axis. This 5-year radiographic follow-up study with panoramic radiography shows that this can be used in practice and that an effective control strategy ensures the accuracy in the inclination of the impacted canines. Treatment success is related to early diagnosis and strategic interceptive treatment choice.

Effect of prolonged erosive pH cycling on different restorative materials

This in vitro study evaluated the effect of a prolonged erosive pH cycling on the superficial microhardness change (SMHC) and the erosive wear of different restorative materials. Eighty enamel specimens with prepared cavities of 1.5 x 1.5 mm were randomly divided into eight groups according to the restorative materials used for the fillings (RMGI - resin-modified glass-ionomer, CGI - conventional glass-ionomer, CR- composite resin, A - amalgam) and immersion media used (ERO - erosive medium or SAL - artificial saliva). During 35 days, half of the specimens were immersed in a cola drink (ERO), for 5 min, three times a day, and they remained in SAL between the erosive cycles. The other half of the specimens was immersed in SAL only, for the entire experimental period (control). Data were tested for significant differences by anova and Tukey's tests (P < 0.05). Scanning electron microscopy images were made to illustrate the enamel erosive wear and restorative materials alterations. The mean SMHC (%) and mean erosive wear (mu m) of the materials were: RMGI-ERO (30/0.5); CGI-ERO (37/0.5); CR-ERO (-0.3/0.3); A-ERO (-4/0.3); RMGI-SAL (4/0.4); CGI-SAL (-6/0.4); CR-SAL (-3/0.2) and A-SAL (2/0.4). Scanning electron microscopy images showed pronounced enamel erosive wear on groups submitted to erosive pH cycling when compared with groups maintained in saliva. In conclusion, the prolonged pH cycling promoted significantly higher alterations (SMHC and erosive wear) on the glass-ionomer cements than the CR and amalgam.

Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces

Purpose: To compare visual inspection (VI), radiographic examination (RX) and the laser fluorescence device DIAGNOdent (L), as well as their combinations in vitro regarding treatment decisions for occlusal surfaces. Methods: 72 extracted human permanent teeth (molars and premolars) were used. Treatment decisions were recorded by three calibrated examiners, and the options available were fissure sealant and conservative restoration. For validation of treatment decisions, the teeth were sectioned and examined in a stereomicroscope. Thereafter, dental slices were scanned and the images were edited to facilitate classification of existing carious lesions. Intra and inter-examiner reproducibility for the determination of treatment plans were calculated using Cohen's kappa test (95%-CI). Sensitivity, specificity, positive and negative predictive values, and the area under the ROC curve were also calculated. Results: VI and L provided on average the greatest intra- and inter-examiner reproducibility, respectively. Although the combination of diagnostic methods may decrease both intra- and inter examiners reproducibility, combination of VI, L and RX resulted in the greatest sensitivity, being statistically superior to RX and L. There was more inter-examiner agreement for the option of restorative treatment, while the use of sealants as a treatment option yielded the lowest values. Negative predictive values were numerically inferior to positive predictive values, indicating that the examiners preferred not to restore a carious tooth than to proceed operatively in an intact tooth. The combination of the three methods studied showed the best results in determining treatment plans for occlusal surfaces, when compared to the other types of exams. on the other hand, radiographic examination and laser fluorescence were less efficient when used alone.

Smoking and Periodontal Disease: Clinical Evidence for an Association

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

Immediate reimplantation of primary teeth: a histological study in dogs

Reimplantation of primary teeth has been the subject of various clinical and histological studies, but very little is known about the effect of this treatment on primary teeth. The aim of the present study was to histologically evaluate the biological response of dog primary teeth after immediate reimplantation. Twelve dogs were divided into two groups according to postoperative time: 1 week and 3 weeks. Twenty-one upper and lower intermediate incisors were extracted and submitted to endodontic treatment, reimplantation and splinting. The 21 homologous teeth not submitted to treatment served as controls. The animals were killed after the respective experimental periods, and the obtained specimens were processed for histological analysis. Most dogs of the 1-week group exhibited the following alterations: gingival epithelium was inserted in the cemento-enamel junction, with a small number of chronic inflammatory cells being observed in the gingival corium; the periodontal ligament was partially reestablished, with a more expressive chronic inflammatory infiltrate being observed in the apical third; small root resorption was observed on the palatine/lingual side in the apical third. In contrast, in 3-week animals, gingival epithelial insertion was predominantly absent on the buccal side, and a moderate chronic inflammatory infiltrate was present; the periodontal ligament generally showed no bone-cementum reinsertion especially on the palatine/lingual side, with an expressive inflammatory infiltrate in the apical region, and large root resorption was mainly observed on the palatine and lingual sides. In conclusion, reimplantation causes histological alterations in the tooth and its supporting periodontal structures that suggest the impossibility of its maintenance.

pH-cycling models for in vitro evaluation of the efficacy of fluoridated dentifrices for caries control: strengths and limitations

Despite a plethora of in situ studies and clinical trials evaluating the efficacy of fluoridated dentifrices on caries control, in vitro pH cycling models are still broadly used because they mimic the dynamics of mineral loss and gain involved in caries formation. This paper critically reviews the current literature on existing pH-cycling models for the in vitro evaluation of the efficacy of fluoridated dentifrices for caries control, focusing on their strengths and limitations. A search was undertaken in the MEDLINE electronic journal database using the keywords "pH-cycling", "demineralization", "remineralization", "in vitro", "fluoride", "dentifrice". The primary outcome was the decrease of demineralization or the increase of remineralization as measured by different methods (e. g.: transverse microradiography) or tooth fluoride uptake. Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. One hundred and sixteen studies were included, of which 42 addressed specifically the comparison of dentifrices using different pH-cycling models. The other studies included meta-analysis or reviews, data about the effect of different fluoride sources on de-remineralization, different methods for analysis de-remineralization and chemical variables and characteristics of dental hard tissues that might have influence on de-remineralization processes. Generally, the studies presented ability to detect known results established by clinical trials, to demonstrate dose-related responses in the fluoride content of the dentifrices, and to provide repeatability and reproducibility between tests. In order to accomplish these features satisfactorily, it is mandatory to take into account the type of substrate and baseline artificial lesion, as well as the adequate response variables and statistical approaches to be used. This critical review of literature showed that the currently available pH-cycling models are appropriate to detect dose-response and pH-response of fluoride dentifrices, and to evaluate the impact of new active principles on the effect of fluoridated dentifrices, as well as their association with other anti-caries treatments.

Anticaries effect of dentifrices with calcium citrate and sodium trimetaphosphate

Because of the growing concerns regarding fluoride ingestion by young children and dental fluorosis, it is necessary to develop new dentifrices. Objective: The aim of this study was to evaluate the effect of dentifrices with calcium citrate (Cacit) and sodium trimetaphosphate (TMP) on enamel demineralization. Material and Methods: Enamel blocks (n=70), previously selected through surface hardness analysis, were submitted to daily treatment with dentifrices diluted in artificial saliva and to a pH-cycling model. The fluoride concentration in dentifrices was 0, 250, 450, 550, 1,000 and 1,100 mu g F/g. Crest (TM) was used as a positive control (1,100 mu g F/g). Cacit (0.25%) and TMP (0.25%) were added to dentifrices with 450 and 1,000 mu g F/g. Surface hardness was measured again and integrated loss of subsurface hardness and fluoride concentration in enamel were calculated. Parametric and correlation tests were used to determine difference (p<0.05) and dose-response relationship between treatments. Results: The addition of Cacit and TMP did not provide a higher fluoride concentration in enamel, however it reduced (p<0.05) mineral loss when compared to other dentifrices; the dentifrice with Cacit and TMP and a low fluoride concentration presented similar results when compared to a dentifrice with 1,100 mu g F/g (p>0.05). Conclusions: Dentifrices with 450 and 1,000 mu g F/g, Cacit and TMP were as effective as a gold standard one.