AVALIA����O DO ESPA��O DISPON��VEL PARA ERUP����O DOS SEGUNDOS E TERCEIROS MOLARES SUPERIORES PERMANENTES AP��S A DISTALIZA����O DOS PRIMEIROS MOLARES SUPERIORES PERMANENTES

A presente pesquisa tem como objetivo avaliar cefalometricamente, o espa��o e po-sicionamento das coroas dos segundos e terceiros molares superiores permanentes n��o erupcionados na regi��o da tuberosidade maxilar durante a distaliza����o dos pri-meiros molares superiores, al��m de verificar a correla����o entre estas duas vari��veis. A amostra foi constitu��da de 38 telerradiografias em norma lateral direita, obtidas de 19 pacientes, jovens brasileiros, leucodermas e melanodermas, sendo 6 do sexo masculino e 13 do sexo feminino, com idade m��dia de 9 anos 5 meses 13 dias. A metodologia constou inicialmente da divis��o dos tempos (T1) inicial, e ap��s a distali-za����o do primeiro molar superior permanente em (T2) por um per��odo m��dio de 10 meses e 23 dias. Para avalia����o do espa��o e angula����o das coroas existente utili-zou-se uma Linha referencial intracraniana (Linha M) sendo esta demarcada, a partir de dois pontos, o ponto SE localizado na sutura esfenoetmoidal, e o ponto Pt locali-zado na parte anterior da fossa pterigopalatina. Esta linha referencial foi transferida at�� o ponto F, (Linha M ) ponto este localizado na regi��o mais posterio-inferior da tuberosidade maxilar. O espa��o avaliado compreendeu entre a Linha M , at�� a face distal do primeiro molar superior permanente. Na an��lise estat��stica usou-se o teste t (Teste t Student) , e na correla����o entre espa��o e angula����o foi utilizado o coefi-ciente de correla����o de Pearson. Conclu��mos que o espa��o correspondente entre a distal dos primeiros molares superiores permanentes e extremidade da tuberosidade maxilar, na fase inicial e ap��s a movimenta����o distal, n��o �� suficiente para a erup-����o dos segundos e terceiros molares superiores permanentes. A angula����o das coroas na fase inicial e ap��s a movimenta����o distal posicionam-se com angula����es mais para distal. Quanto �� correla����o das angula����es das coroas dos segundos e terceiros molares superiores permanentes e o espa��o para erup����o verificamos que quanto maior a angula����o das coroas para distal, menor os espa��os oferecidos para a erup����o.(AU)

AVALIA����O DO ESPA��O DISPON��VEL PARA ERUP����O DOS SEGUNDOS E TERCEIROS MOLARES SUPERIORES PERMANENTES AP��S A DISTALIZA����O DOS PRIMEIROS MOLARES SUPERIORES PERMANENTES

A presente pesquisa tem como objetivo avaliar cefalometricamente, o espa��o e po-sicionamento das coroas dos segundos e terceiros molares superiores permanentes n��o erupcionados na regi��o da tuberosidade maxilar durante a distaliza����o dos pri-meiros molares superiores, al��m de verificar a correla����o entre estas duas vari��veis. A amostra foi constitu��da de 38 telerradiografias em norma lateral direita, obtidas de 19 pacientes, jovens brasileiros, leucodermas e melanodermas, sendo 6 do sexo masculino e 13 do sexo feminino, com idade m��dia de 9 anos 5 meses 13 dias. A metodologia constou inicialmente da divis��o dos tempos (T1) inicial, e ap��s a distali-za����o do primeiro molar superior permanente em (T2) por um per��odo m��dio de 10 meses e 23 dias. Para avalia����o do espa��o e angula����o das coroas existente utili-zou-se uma Linha referencial intracraniana (Linha M) sendo esta demarcada, a partir de dois pontos, o ponto SE localizado na sutura esfenoetmoidal, e o ponto Pt locali-zado na parte anterior da fossa pterigopalatina. Esta linha referencial foi transferida at�� o ponto F, (Linha M ) ponto este localizado na regi��o mais posterio-inferior da tuberosidade maxilar. O espa��o avaliado compreendeu entre a Linha M , at�� a face distal do primeiro molar superior permanente. Na an��lise estat��stica usou-se o teste t (Teste t Student) , e na correla����o entre espa��o e angula����o foi utilizado o coefi-ciente de correla����o de Pearson. Conclu��mos que o espa��o correspondente entre a distal dos primeiros molares superiores permanentes e extremidade da tuberosidade maxilar, na fase inicial e ap��s a movimenta����o distal, n��o �� suficiente para a erup-����o dos segundos e terceiros molares superiores permanentes. A angula����o das coroas na fase inicial e ap��s a movimenta����o distal posicionam-se com angula����es mais para distal. Quanto �� correla����o das angula����es das coroas dos segundos e terceiros molares superiores permanentes e o espa��o para erup����o verificamos que quanto maior a angula����o das coroas para distal, menor os espa��os oferecidos para a erup����o.(AU)

AVALIA����O DO ESPA��O DISPON��VEL PARA ERUP����O DOS SEGUNDOS E TERCEIROS MOLARES SUPERIORES PERMANENTES AP��S A DISTALIZA����O DOS PRIMEIROS MOLARES SUPERIORES PERMANENTES

A presente pesquisa tem como objetivo avaliar cefalometricamente, o espa��o e po-sicionamento das coroas dos segundos e terceiros molares superiores permanentes n��o erupcionados na regi��o da tuberosidade maxilar durante a distaliza����o dos pri-meiros molares superiores, al��m de verificar a correla����o entre estas duas vari��veis. A amostra foi constitu��da de 38 telerradiografias em norma lateral direita, obtidas de 19 pacientes, jovens brasileiros, leucodermas e melanodermas, sendo 6 do sexo masculino e 13 do sexo feminino, com idade m��dia de 9 anos 5 meses 13 dias. A metodologia constou inicialmente da divis��o dos tempos (T1) inicial, e ap��s a distali-za����o do primeiro molar superior permanente em (T2) por um per��odo m��dio de 10 meses e 23 dias. Para avalia����o do espa��o e angula����o das coroas existente utili-zou-se uma Linha referencial intracraniana (Linha M) sendo esta demarcada, a partir de dois pontos, o ponto SE localizado na sutura esfenoetmoidal, e o ponto Pt locali-zado na parte anterior da fossa pterigopalatina. Esta linha referencial foi transferida at�� o ponto F, (Linha M ) ponto este localizado na regi��o mais posterio-inferior da tuberosidade maxilar. O espa��o avaliado compreendeu entre a Linha M , at�� a face distal do primeiro molar superior permanente. Na an��lise estat��stica usou-se o teste t (Teste t Student) , e na correla����o entre espa��o e angula����o foi utilizado o coefi-ciente de correla����o de Pearson. Conclu��mos que o espa��o correspondente entre a distal dos primeiros molares superiores permanentes e extremidade da tuberosidade maxilar, na fase inicial e ap��s a movimenta����o distal, n��o �� suficiente para a erup-����o dos segundos e terceiros molares superiores permanentes. A angula����o das coroas na fase inicial e ap��s a movimenta����o distal posicionam-se com angula����es mais para distal. Quanto �� correla����o das angula����es das coroas dos segundos e terceiros molares superiores permanentes e o espa��o para erup����o verificamos que quanto maior a angula����o das coroas para distal, menor os espa��os oferecidos para a erup����o.(AU)

Pulpotomies with portland cement in human primary molars

Two clinical cases in which Portland cement (PC) was applied as a medicament after pulpotomy of mandibular primary molars in children are presented. Pulpotomy using PC was carried out in two mandibular first molars and one mandibular second molar, which were further followed-up. At the 3, 6 and 12-month follow-up appointments, clinical and radiographic examinations of the pulpotomized teeth and their periradicular area revealed that the treatments were successful in maintaining the teeth asymptomatic and preserving pulpal vitality. Additionally, the formation of a dentin bridge immediately below the PC could be observed in the three molars treated. PC may be considered as an effective alternative for primary molar pulpotomies, at least in a short-term period. Randomized clinical trials with human teeth are required in order to determine the suitability of PC before unlimited clinical use can be recommended.

Avalia����o cefalom��trica das altera����es dentoesquel��ticas de jovens com m�� oclus��o de Classe II dent��ria tratados com distalizadores Jones jig

OBJETIVO: esta pesquisa objetivou avaliar cefalometricamente as altera����es dentoesquel��ticas de jovens com Classe II dent��ria tratados com o distalizador Jones jig. METODOLOGIA: foram avaliados 30 pacientes, sendo 15 de cada g��nero, com m��dia de idades iniciais de 13,63 anos; brasileiros, naturais da cidade de Bauru/SP, caracterizados por m�� oclus��o de Classe II, 1�� e 2�� divis��es de Angle sem comprometimento esquel��tico. Os jovens foram tratados com aparelho Jones jig a fim de distalizar os molares superiores a uma rela����o molar de "super Classe I"; sendo que esse dispositivo permaneceu, em m��dia, por 0,55 anos. Ao final da sobrecorre����o, os molares distalizados receberam um bot��o de Nance e, como ancoragem extrabucal, o aparelho extrabucal (AEB) com tra����o m��dia-alta, com o intuito de verticalizar e corrigir a angula����o radicular dos molares distalizados. Foram realizadas telerradiografias em normal lateral inicial (T1) e p��s-distaliza����o (T2). As medidas cefalom��tricas foram submetidas ao teste t dependente de Student para avaliar as altera����es de T1 para T2. RESULTADOS: com base nos resultados obtidos e a partir da metodologia empregada, observou-se altera����es dent��rias significativas, como a movimenta����o distal linear e angular, assim como a intrus��o dos segundos e primeiros molares superiores no sentido vertical. Tamb��m se confirmou efeitos indesej��veis, como a perda de ancoragem refletida em mesializa����o, extrus��o e angula����o mesial dos segundos pr��-molares, a protrus��o dos incisivos superiores e o aumento do trespasse vertical e horizontal. Pode-se confirmar que certas movimenta����es dent��rias promovem significativas altera����es esquel��ticas de estruturas localizadas �� dist��ncia, ou seja, observou-se extrus��o significativa dos segundos pr��-molares superiores, o que resultou em rota����o mandibular, aumento significativo da altura facial anteroinferior e protrus��o do l��bio inferior. CONCLUS��O: pode-se concluir que o distalizador Jones jig promove, basicamente, altera����es dent��rias.

Influence of cervical preflaring on determinationof apical file size in mandibular molars: SEM analysis

This study investigated the influence of cervical preflaring with different rotary instruments on determination of the initial apical file (IAF) in mesiobuccal roots of mandibular molars. Fifty human mandibular molars whose mesial roots presented two clearly separated apical foramens (mesiobuccal and mesiolingual) were used. After standard access opening and removal of pulp tissue, the working length (WL) was determined at 1 mm short of the root apex. Five groups (n=10) were formed at random, according to the type of instrument used for cervical preflaring. In group 1, the size of the IAF was determined without preflaring of the cervical and middle root canal thirds. In groups 2 to 5, preflaring was performed with Gates-Glidden drills, ProTaper instruments, EndoFlare instruments and LA Axxes burs, respectively. Canals were sized manually with K-files, starting with size 08 K-files, inserted passively up to the WL. File sizes were increased until a binding sensation was felt at the WL and the size of the file was recorded. The instrument corresponding to the IAF was fixed into the canal at the WL with methylcyanoacrylate. The teeth were then sectioned transversally 1 mm short of the apex, with the IAF in position. Cross-sections of the WL region were examined under scanning electron microscopy and the discrepancies between canal diameter and the diameter of IAF were calculated using the tool "rule" (FEG) of the microscope's proprietary software. The measurements (��m) were analyzed statistically by Kruskal-Wallis and Dunn's tests at 5% significance level. There were statistically significant differences among the groups (p<0.05). The non-flared group had the greatest discrepancy (125.30 �� 51.54) and differed significantly from all flared groups (p<0.05). Cervical preflaring with LA Axxess burs produced the least discrepancies (55.10 �� 48.31), followed by EndoFlare instruments (68.20 �� 42.44), Gattes Glidden drills (68.90 �� 42.46) and ProTaper files (77.40 �� 73.19). However, no significant differences (p>0.05) were found among the rotary instruments. In conclusion, cervical preflaring improved IAF fitting to the canals at the WL in mesiobuccal roots of maxillary first molars. The rotary instruments evaluated in this study did not differ from each other regarding the discrepancies produced between the IAF size and canal diameter at the WL.

Analysis of four gutta-percha techniques used to fill mesial root canals of mandibular molars

P>Aim To compare the percentage of gutta-percha, sealer and voids and the influence of isthmuses in mesial root canals of mandibular molars filled with different techniques. Methodology Canals in 60 mesial roots of mandibular first molars were prepared with ProTaper instruments to size F2 (size 25, 0.08 taper) and filled using a single-cone, lateral compaction, System B or Thermafil techniques. An epoxy resin sealer was labelled with Rhodamine-B dye to allow analysis under a confocal microscope. The percentage of gutta-percha, sealer and area of voids was calculated at 2, 4 and 6 mm from the apex, using Image Tool 3.0 software. Statistical analysis was performed using nonparametric Kruskal-Wallis and Dunn tests (P < 0.05). The influence of isthmuses on the presence or absence of voids was evaluated using the Fisher test. Results At the 2 mm level, the percentage of gutta-percha, sealer and voids was similar amongst the System B, lateral compaction and single-cone techniques. The single-cone technique revealed significantly less gutta-percha, more sealer and voids in comparison with the Thermafil technique at the 2 and 4 mm level (P < 0.05). The analysis of all sections (2, 4 and 6 mm) revealed that more gutta-percha and less sealer and voids were found in root canals filled with Thermafil and System B techniques (P < 0.05). The Fisher test revealed that the presence of isthmuses increased the occurence of voids in the lateral compaction group only (P < 0.05). Conclusion Gutta-percha, sealer filled area and voids were dependent on the canal-filling technique. The presence of isthmuses may influence the quality of root filling.

Analysis of the gutta-percha filled area in C-shaped mandibular molars obturated with a modified MicroSeal technique

To analyse the gutta-percha filled area of C-shaped molar teeth root filled with the modified MicroSeal technique with reference to the radiographic features and the C-shaped canal configuration. Twenty-three mandibular second molar teeth with C-shaped roots were classified according to their radiographic features as: type I - merging, type II - symmetrical and type III - asymmetrical. The canals were root filled using a modified technique of the MicroSeal system. Horizontal sections at intervals of 600 mu m were made 1 mm from the apex to the subpulpal floor level. The percentage of gutta-percha area from the apical, middle and coronal levels of the radiographic types was analysed using the Kruskal-Wallis test. Complementary analysis of the C-shaped canal configurations (C1, C2 and C3) determined from cross-sections from the apical third was performed in a similar way. No significant differences were found between the radiographic types in terms of the percentage of gutta-percha area at any level (P > 0.05): apical third, type I: 77.04%, II: 70.48% and III: 77.13%, middle third, type I: 95.72%, II: 93.17%, III: 91.13% and coronal level, type I: 98.30%, II: 98.25%, III: 97.14%. Overall, the percentage of the filling material was lower in the apical third (P < 0.05). No significant differences were found between the C-shaped canal configurations apically; C1: 72.64%, C2: 79.62%, C3: 73.51% (P > 0.05). The percentage of area filled with gutta-percha was similar in the three radiographic types and canal configuration categories of C-shaped molars. These results show the difficulty of achieving predictable filling of the root canal system when this anatomical variation exists. In general, the apical third was less completely filled.

Pulpotomy of human primary molars with MTA and Portland cement: a randomised controlled trial

Objective This study compared the clinical and radiographic effectiveness of mineral trioxide aggregate (MTA) and Portland cement (PC) as pulp dressing agents in carious primary teeth. Methodology Thirty carious primary mandibular molars of children aged 5-9 years old were randomly assigned to MTA or PC groups, and treated by a conventional pulpotomy technique. The teeth were restored with resin modified glass ionomer cement. Clinical and radiographic successes and failures were recorded at 6, 12, 18 and 24-month follow-up. Results All pulpotomised teeth were clinically and radiographically successful at all follow-up appointments. Six out of 15 teeth in the PC group and five out of 14 teeth in the MTA group exfoliated throughout the follow-up period. No statistically significant difference regarding dentine bridge formation was found between both groups throughout the follow-up period. As far as pulp canal obliteration is concerned, a statistically significant difference was detected at 6-month follow-up (p < 0.05), since the beginning of mineralised material deposition could be radiographically detected in 100% and 57.14% of the teeth treated with PC and MTA, respectively. Conclusions PC may serve as an effective and less expensive MTA substitute in primary molar pulpotomies. Further studies and longer follow-up assessments are needed.

Comparative distalization effects of Jones jig and pendulum appliances

Introduction: In this study, we compared the dentoalveolar changes of Class II patients treated with Jones jig and pendulum appliances. Methods: The experimental group comprised 40 Class II malocclusion subjects, divided into 2 groups: group 1 consisted of 20 patients (11 boys, 9 girls) at a mean pretreatment age of 13.17 years, treated with the Jones jig appliance for 0.91 years; group 2 comprised 20 patients (8 boys, 12 grls) at a mean pretreatment age of 13.98 years, treated with the pendulum appliance for 1.18 years. Only active treatment time of molar distalization was evaluated in the predistalization and postdistalization lateral cephalograms. Molar, second premolar, and incisor angular and linear variables were obtained. The intergroup treatment changes in these variables were compared with independent t tests. Results: The maxillary second premolars showed greater mesial tipping and extrusion in the Jones jig group, indicating more anchorage loss during molar distalization with this appliance. The amounts and the monthly rates of molar distalization were similar in both groups. Conclusions: The Jones jig group showed greater mesial tipping and extrusion of the maxillary second premolars. The mean amounts and the monthly rates of first molar distalization were similar in both groups. (Am J Orthod Dentofacial Orthop 2009;135:336-42)

Comparison of the effects produced by headgear and pendulum appliances followed by fixed orthodontic treatment

This study compared the effects produced by two different molar distalizers, namely cervical headgear (CHG) and the intraoral pendulum appliance, associated with fixed orthodontic appliances. The headgear group comprised 30 patients (19 females, 11 males), with an initial age of 13.07 years [standard deviation (SD) = 1.3], treated with CHG and fixed orthodontic appliances for a mean period of 3.28 years, and the pendulum group 22 patients (15 females, 7 males), with initial age of 13.75 years (SD = 1.86), treated with the pendulum appliance followed by fixed orthodontic appliances for a mean period of 4.12 years. Lateral cephalograms were taken at the start (T1) and on completion (T2) of orthodontic treatment. The pendulum and CHG groups were similar as to initial age, severity of the Class II malocclusion, gender distribution, initial cephalometric characteristics, and initial and final treatment priority index (TPI). Only treatment time was not similar between the groups, with a need for annualization for data for the pendulum group. The data were compared with independent t-tests. There was significantly greater restriction of maxillary forward growth and improvement of the skeletal maxillomandibular relationship in the CHG group (P < 0.05). The maxillary molars were more mesially tipped and extruded and the mandibular molars more uprighted in the CHG group compared with the pendulum group (P < 0.05). There was more labial tipping of the mandibular incisors and greater overbite reduction in the pendulum group. The pendulum appliance produced only dentoalveolar effects, different from the CHG appliance, which restricted maxillary forward displacement, thus improving the skeletal maxillomandibular relationship.

Movement evaluation of overerupted upper molars with absolute anchorage: An in-vitro study

Introduction: The overeruption of upper molars due to the premature loss of antagonist teeth can be treated with the help of miniscrews. The aim of this study was to evaluate the movement of a typodont molar according to the biomechanical approach used with miniscrews. Study design: The study was conducted with four plaster models filled with typodont wax. In each model we used one absolute anchorage on the palatal side and another on the buccal side in different positions, thus generating four different biomechanical systems. A force of 150 g was applied to each side of the resin tooth. Periapical radiographs were taken preintrusion and immediately after completion of the intrusion. Photographs were taken in both the sagittal and occlusal planes every 3 min. The radiographic films and photographs were measured and compared. Results: A vertical movement of the molar was observed in all the models, with system 4 showing the greatest movement. Rotation in the occlusal plane only occurred in system 2, while in system 1 there was a change in the axial axis of 37 degrees. Conclusions: The anchorage site and the combination of forces applied may determine the resulting tooth movement

Supernumerary molars. A review of 53 cases

Supernumerary molars are not uncommon and may be found nearly anywhere in the dental alveolar arches. A series of 36 patients that presented with 53 supernumerary molars are reviewed. They occurred more frequently in the maxilla (86.8%), had little or no clinical significance, tended to be impacted, and were not associated with the impactation of the third molar. Four cases of maxillary fifth molars are described

Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Barcelona, Spain) between July 2004 and March 2005. The following parameters were evaluated: sex, age, molar, type of impaction, position according to the classifications of Pell and Gregory and of Winter, and the reasons justifying extraction. Results: The lower third molars were the most commonly extracted molars (73.7%). A total of 69.6% of the teeth were covered by soft tissues only. Fifty-six percent of the lower molars corresponded to Pell and Gregory Class IIB, while 42.1% were in the vertical position. The most common reason for patient reference to our Service of Oral Surgery on the part of the PCD was prophylactic removal (51.0% versus 46.1% in the case of the oral surgeon). Discussion and conclusions. Our results show prophylaxis to be the principal indication of third molar extraction, followed by orthodontic reasons. Regarding third molars with associated clinical symptoms or signs, infectious disease-including pericoronitis- was the pathology most often observed by the oral surgeon, followed by caries. This order of frequency was seen to invert in the case of third molars referred for extraction by the PCD. A vertical position predominated among the third molars with associated pathology

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.