Reparative phase events on periodontal disease progression: interpretation and considerations

Periodontal disease progress by destructive acute phases intercalated by reparative chronic phases. The aim of this study was to investigate the clinical and histological evidence of the periodontal disease reparative phase by analyzing bone wall conditions inside periodontal pockets and histologic images of periodontal pockets, identified in relevant publications. 81 patients with periodontitis, were randomly assigned into this study. Clinical and radiographic parameters were established to diagnose periodontal disease providing a sample of 133 diseased areas, which were treated by modified Widman flap. Documentation by digital photography were recorded in the surgery. Relevant publications showing histological images of periodontal pockets, were identified in Medline, PubMed and Google data base, were scanned and digitalized. All images obtained were evaluated and the presences of the reparative evidence in the zone around the underlying destroyed alveolar bone were critically analyzed. All periodontal bone defects, showed cortical bone reparations at different levels inside periodontal bone defects. All histologic images of periodontal pockets identified in relevant publications showed repaired gingival-attached connective tissue localized above underlying destroyed alveolar bone. All the evidences analyzed in this study suggested that periodontal disease is predominantly chronic, quiescent, showing reparative phases in different levels.

Tumor odontogênico queratocístico: relato de caso

Introduction: The odontogenic keratocyst tumor (OKT) derived from dental lamina rests with particularities and specific histological features, with high rates of relapse and aggressive clinical behavior. Presents certain predilection for males, affecting the mandible of 60% to 80% of cases may be related to impacted tooth 25 to 45% of cases. Objective: To highlight the clinical, histopathological and imaging procedures of the OKT, as well as discuss the treatment of this injury. Case Report: To report a case of 10 years of age to look for the orthodontist to correct anterior open bite was observed in panoramic radiography radiolucent area in the region of the body of the mandible associated with pathological inclusion of the lower premolar. It was performed an incisional biopsy of the lesion and the histopathologic diagnosis was odontogenic keratocyst tumor. It was performed a CT scan to assess the extent of the injury and its relation to anatomic structures. How to conduct, we opted for the extraction of the deciduous molar and enucleation of the lesion, preserving the premolar included. The same goes on clinical and radiographic control 18 months, after removal of OKT obtaining the eruption of premolar that was involved in the injury. Final Comments: It is necessary to adopt protocols that include dental care knowledge of oral diagnosis, medical history and careful clinical evaluation without forgetting the need for histopathological confirmation.

Fechamento de fístula buco-sinusal usando tecido adiposo bucal

The Oro-antral Fistula is a common pathologic event, which occurs an opening or communication of the maxillary sinus with the oral cavity through dental extractions of upper posterior elements whose roots have close relationship with the maxillary sinus. This study aims to clarify the Surgeon Dentist about the possible etiological factors responsible for Oro-antral Communication, to identify its clinical and radiographic signs, to explain the Buccal Fat Pad’s anatomy and functioning and to describe the surgical technique adopted front of these cases. For this, the authors present a case of a patient who had a fistula in the region where there was a dental extraction of the upper posterior element. The treatment of Oro-antral Fistula using the buccal fat pad provides to be a safe and effective surgical method, because this element presents a rich blood supply and easy access. Many authors have found that this method have a broad application, large index of success, lower risk of infection, provides a comfortable post-operative for the patient. However, it needs to be done properly so that you have minimum incidence of failures, and this requires some caution on the part of professional.

Surgical-orthodontic tractio for impacted maxillary canines: a critical review and suggested protocol

Maxillary canine impaction is a common occurrence, especially in the palate, despite sufficient space in the arch for tooth alignment. A proper approach requires knowledge of different specialties of dentistry, such as orthodontics, surgery, radiology, and periodontology, which are generally not centered on a single professional. The causes for canine impaction may be either generalized or localized, and the diagnosis should be made through specific clinical and radiographic examination. The prognosis of surgical-orthodontic treatment depends on the position of the canine in relation to the neighboring teeth and height of the alveolar process, in addition to careful surgical technique, considering that there are risks involved, such as ankylosis, loss of tooth vitality, root resorption of the involved tooth and adjacent teeth, and damage to supporting tissues. Given the important role played by impacted maxillary canines, their traction is the treatment of choice in orthodontically treated patients. The present study reviews the literature on important factors to be considered when approaching impacted canines, such as therapeutic possibilities, their advantages and disadvantages.

Displasia cemento-óssea florida: relato de caso

The florid cemento-osseous dysplasia is an asymptomatic lesion present in the fibro-osseous maxilla and mandible of uncertain etiology. It has higher expression in females, and patients melanoderm, middle-aged to elderly. This dysplasia is an asymptomatic condition that can be discovered when a radiograph is performed. A biopsy is contraindicated to avoid infection difficult to treat. We report the case of a white woman 52 years old, who searched the Clinic of Surgery and Traumatology Bucco-maxillofacial surgery, Faculty of Dentistry of Araçatuba with pain in the posterior portion of left mandible. After radiographic examination was diagnosed with florid cementoosseous dysplasia. Treatment was instituted clinical and radiographic.

A proporção de plasma rico em plaquetas/enxerto ósseo autógeno pode influenciar o reparo ósseo de defeito de tamanho crítico: estudo radiográfico em calvária de ratos

Introduction: It has been suggested that bone grafts combined with platelet rich plasma (PRP) present greater density than bone grafts without PRP after healing process. However, this result may depend on proportion PRP/autogenous bone (AB) graft used. Objective: The purpose of this study was to analyze radiographically the influence of the proportion PRP/particulate autogenous bone (AB) graft on bone healing in surgically created criticalsize defects (CSD) in rat calvaria. Material and method: 50 rats were divided into 5 groups: C, AB, AB/PRP-50, AB/PRP-100 and AB/PRP-150. A 5 mm diameter CSD was created in the calvarium of each animal. In Group C the defect was filled by blood clot only. In Group AB the defect was filled with 0.01 mL of AB graft. In groups AB/ RP-50, AB/PRP-100 and AB/PRP-150 the defects were filled with 0.01 mL of AB graft combined with 50, 100 and 150 µL of PRP, respectively. All animals were euthanized at 30 days post-operative. Standardized radiographic images of the rat calvaria were obtained using Digora System (Soredex, Finland). The images were evaluated by three examiners using scores that indicated the percentage of radiopacity of the defect. The obtained data were subjected to statistical analysis (Kruskal-Wallis test, p < 0.05). Result: Group C presented radiopacity significantly lower than groups AB, AB/PRP-50, AB/PRP-100 and AB/PRP-150. Group AB/PRP-50 showed radiopacity significantly greater than groups AB/PRP-100 and AB. Conclusion: It can be concluded that the proportion PRP/AB graft influences bone healing in CSD in rat calvaria.

Avaliação longitudinal de duas técnicas de sinus lift

The implant has high success rates and predictability in this decade. However, bone availability is a factor that may limit the installation technique of dental implants in subsequent rehabilitation of the maxillary arch has been proposed technique’s maxillary sinus lifting when it presents itself pneumatized, for installation of dental implants The aim of this paper is to present two clinical cases using the surgical technique and rehabilitation to the patient with surgery maxillary sinus lifting with the use of a biomaterial alone or in combination with autogenous bone and the prosthetic resolution radiographic and clinical follow-up of three years.

Reabilitação Oral: prótese livre de metal, Removível e implantes. Um caso de 12 anos de acompanhamento

The literature has suggested that the association of removable partial dentures with dental implants can improve the quality of life of patients. Thus, the purpose of this study was to present a case report. This case report describes the development of a removable partial denture associated with dental implants bilaterally been monitored for 12 years, and the efficacy of the proposed treatment. The radiographic controls demonstrated no changes on bone tissue. The maxillary arch was rehabilitated with metal-free crowns. The patient was fully satisfied with this technique providing stability, esthetics, and proper function. It was concluded that the technique of using removable partial dentures associated with dental implants is viable and show the advantages of improved function, aesthetics and cost reductions in rehabilitation treatment.

A dental caries preventive program applied to children aged 5 to 8 years attending since the first year of age at the Baby Clinic of the Araçatuba Dental School, Brazil

Objective: Tooth decay is one of the more common diseases of childhood. Several studies recommend that early preventive measures must be implemented since the first years of life and continue throughout childhood and adolescence. The aim of the this study was to present results of a preventive dental program considering oral health maintenance, dental caries experience and the prevalence of dental caries relation with follow-up compliance visits. Material end method: Intraoral and interproximal radiographic exams were performed on 171 patients participants of a preventive dental program. Data regarding age, gender, previous caries experience and the frequency at which the patients attended return visits were obtained from the records. The data were analyzed statistically by the McNemar test, with the level of significance set at 1%. Result: Clinical and radiographic examination revealed that most children participating in the program had sound teeth (77.2 and 84.8%, respectively). The past dental history of the dental caries from patients included in this study showed statistical relevance when associated with the present dental caries experience and a statistical relationship was found from the absence of compliance to clinical visits and the dental caries presence. Conclusion: The preventive strategy had a positive influence on oral health maintenance in the children examined. Previous caries experience and the lack of compliance with return visits influenced the clinical oral condition of the children during participation in the preventive program.

Ocorrência de reabsorção radicular no tratamento ortodôntico: revisão crítica da literatura

The root resorption is one of the possible sequels of greater complexity to the orthodontist, the difficulty of detection and be asymptomatic. The presence, during the orthodontic treatment, is linked to a multifactorial origin, a complex combination of biological activities, anatomical, physiological, genetic variables and mechanical forces. Thus, the aim of this study was perform to critical literature review related to root resorption in orthodontic movement. Were included articles published between 2004 to 2014, indexed in the PUBMED database. Used descriptors contained in the Mesh, being adopted as inclusion criteria: clinical trials in humans, only articles that had clear ideas and objective, articles with English language. The search strategy used resulted in 24 articles and after applied the inclusion and exclusion criteria, 11 articles remained. Based on the results of this study it was concluded that heavy forces of intrusion, inclination and torque leads to a greater degree of root resorption; its etiology is multifactorial, the periodic radiographic control during treatment is needed and further studies are suggested to identify more specifically the causes and risk factors for root resorption.

Odontoma em pacientes odontopediátrico: diagnóstico e tratamento. Relato de caso clínico.

Odontoma is a term that refers to a benign tumor of odontogenic and mixed nature, composed of epithelial and mesenchymal components. Histologically, they are compounds of different configurations including dental enamel, dentin, cementum and in some cases the pulp tissue. A slow growing asymptomatic tumor, odontoma is usually discovered through routine radiographic examination. A 3-year old male patient sought care at the School of Dentistry’s Baby Clinic (UNESP-Araçatuba), complaining of “small ball close to the teeth.” During the interview, the mother reported that the lesion was observed soon after a trauma, and evolved in less than one month. An ulcerated lesion with a 0.8 cm diameter was found during intraoral clinical examination. It was located in the inferior and anterior region of the mouth, between teeth 81 and 82, and there was also crown distalization. A radiographic examination showed a radiolucent area and root distance. In the absence of clinical and radiographic characteristics suggesting a case of odontoma, the differential diagnosis was peripheral giant cell lesion and pyogenic granuloma. So the area was punctured. Nonetheless, due to the absence of liquid, the surgical removal of the lesion was performed, followed by histological examination, which showed the definite diagnosis of a suggestive case of emerging odontoma.

Protocolo radiográfico para a instalação de mini-implantes: descrição da técnica

In the last decade mini-screws have gained popularity in orthodontics field and a correct placement of mini-screws is a critical point to the success of the skeletal anchorage. A careful clinical and radiographic diagnostic before insertion mini-screw is an essential requirement to achieve the central point of the radicular septum. The correct application of these pre-surgical procedures should avoid possible iatrogenic damages in periodontal ligament, dental roots, nasomaxillary cavities, or even important vascular tissues. As of today, periapical radiographs is a regular pre surgical procedure during mini-screw insertion technique. Nevertheless, accurate execution of the radiographic parallax technique can offer to us useful and precise radiographic images, to decide the right local insertion of mini-screws in to the septum bone. The purpose of this paper is to describe the ¬application of new positioning circular guides in conjunction with a ¬parallax radiographic protocol before placement of orthodontic mini-screws.

Combined therapy with mineral trioxide aggregate, and guided tissue regeneration for a large radicular cyst: a 13-year follow-u

Biomaterials such as membrane barriers and/or bone grafts are often used to enhance periapical new bone formation. A combination of apical surgery and these biomaterials is one of the latest treatment options for avoiding tooth extraction. In case of periapical lesions, guided tissue regeneration (GTR) is attempted to improve the self-regenerative healing process by excluding undesired proliferation of the gingival connective tissue or migration of the oral epithelial cells into osseous defects. In many cases, GTR is necessary for achieving periodontal tissue healing. This report describes the healing process after surgery in a challenging case with a long-term followup. In this case report, endodontic surgery was followed by retrograde sealing with mineral trioxide aggregate (MTA) in the maxillary right central incisor and left lateral incisor. Apicectomy was performed in the maxillary left central incisor and a 1-mm filling was removed. The bone defect was filled with an anorganic bone graft and covered with a decalcified cortical osseous membrane. No intraoperative or postoperative complications were observed. After 13 years of follow-up, the patient showed no clinical signs or symptoms associated with the lesion and radiographic examination showed progressive resolution of radiolucency. In conclusion, the combination of apical surgery and regenerative techniques can successfully help the treatment of periapical lesions of endodontic origin and is suitable for the management of challenging cases

Restauração transcirúrgica como alternativa na resolução das perfurações endodônticas

The endodontic perforations are iatrogenic communications that result in a communication between the endodonto and periodontium. This occurrence represents about 10 % of cas- es of failure in endodontic treatment. The management may vary and is related to the drilling site endodontic. This paper aims to report a case of iatrogenic perforation and one of the possible alternatives for the treatment of endodontic perforations -level cervical tooth. During the opening coronary perforation occurred due to improper slope cervical penetration drill. Considering the drilling site, we opted for sealing com- posite resin after surgical access and absolute isolation. After sealing, the channel was filled with medication and instru- mented based on calcium hydroxide. Later the canal was obturated by lateral condensation technique with Sealapex. The radiographic follow-up showed regression of the lesion and the clinical silence confirmed the success of the treatment.

Root reconstructed with mineral trioxide aggregate and guided tissue regeneration in apical surgery: a 5-year follow-up

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