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AIM: To evaluate the influence of different levels of metal artifact reduction (MAR) tool and milliamperage (mA) on the diagnosis of fracture extension in endodontically treated teeth using cone beam CT (CBCT). MATERIALS AND METHODS: Ten maxillary premolars were endodontically treated and positioned in the empty sockets of a human maxilla covered with wax. CBCT acquisitions were performed using the Eagle Edge device (Dabi Atlante, Brazil) adjusted to 120 kVp, FOV of 4 × 6 cm, exposure time of 24 s and voxel size of 0.2 mm in 8 different conditions with different MAR (1, 2 and 3) and mA (3.2 and 6.3) levels. Crown-root fractures were simulated in the universal testing machine, and CBCT images were acquired again. Five radiologists evaluated the presence and extension of fractures with a 5-point scale. Statistical analysis was performed by analysis of variance, Tukey and Kappa test (α = 0.05). RESULTS: Although different mA levels did not significantly (p > 0.05) affect the diagnosis values for fracture presence and extension, when evaluated the different levels of MAR, AUC and sensitivity showed significantly higher values (p < 0.05) for MAR 0 using 6.3 mA and kappa agreement showed significantly higher values (p < 0.05) for MAR 0 and 2 using 6.3 mA. CONCLUSIONS: Although mA levels do not have a diagnostic effect when isolating the MAR level; in 6.3 mA, MAR 0 and 2 can positively influence the diagnosis of fracture extension in endodontically treated teeth using CBCT. CLINICAL RELEVANCE: The isolate evaluation of dental fracture presence can overlook diagnostics error of its extension.

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This study presented a rehabilitation option for malpositioned implants; this involved obtaining their position and inclination through intraoral scanning, and producing a customized abutment with CAD/CAM technology. The patient in this case report presented a root fracture in tooth 21 and was subjected to extraction, implant installation, and immediate provisional prosthesis. The implant was installed with a distal inclination due to anatomical limitations. After osseointegration, an intraoral scanning transfer provided a digital model (file extension .stl), which reproduced the implant's position and inclination. Then, the file was sent so that a customized abutment (CAD/CAM) could be manufactured, promoting the final rehabilitation of the case; this allowed for good hygiene, load distribution in the dynamic interocclusal relationship, and favorable esthetics, whereas many would otherwise recommend implant removal. The result presented lower costs, a shorter time frame, and a lower morbidity for the patient.

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Although much progress has been obtained in terms of the Endodontic treatment, the literature shows that true success can be only achieved with adequate coronal seal to avoid bacterial contamination, and protect the tooth structure from fracture. There are many options available to the clinician to restore the endodontically treated tooth; however, there is not much evidence available on what alternative is better than another. This review will critically present the current knowledge on restorative choices, including posts and endocrowns, showing advantages and disadvantages of different treatment forms. With this knowledge, we will also introduce the concept of biomimetics to endodontically treated teeth, and how the nature of their remaining tooth structure can benefit from this approach. This concept entails the use of mechanisms and biologically produced materials to restore a tooth in a way that would mimic its natural structure, with the purpose of achieving better long-term prognosis (AU)

Embora tenha se obtido progresso em relação ao tratamento endodôntico, a literatura mostra que o sucesso real só pode ser atingido com o selamento coronal adequado, para evitar-se a contaminação bacteriana e proteger-se a estrutura dental de fraturas. Há muitas opções disponíveis para o clínico para a restauração do dente tratado endodonticamente; entretanto, não há muita evidência disponível sobre qual alternativa é melhor que a outra. Esta revisão apresentará criticamente o conhecimento atual sobre opções restauradoras, incluindo retentores intraradiculares e endocrowns, mostrando vantagens e desvantagens das diferentes formas de tratamento. Com esse conhecimento, também introduziremos o conceito de biomimética, uma vez que dentes tratados endodonticamente, devido a natureza de sua estrutura dental remanescente, podem se beneficiar desta abordagem. Esse conceito envolve o uso de mecanismos e materiais produzidos biologicamente para restaurar um dente de forma a imitar a estrutura natural, com o objetivo de alcançar melhor prognóstico de longo-prazo.(AU)

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The purpose of this narrative review was to discuss the scientific milestones that led to the current understanding of the root dentinal microcrack phenomenon based on the interplay between the usage of micro-computed tomography (micro-CT) as an analytical tool alongside a close-to-mouth experimental model. In 2009, reports on the development of dentinal microcracks in extracted teeth after root canal preparation triggered an awareness of the potential for vertical root fractures (VRFs) of endodontically treated teeth could be developed from defects created by the mechanical stress of nickel-titanium preparation systems on dentine. This assumption was taken for granted, even though no cause-effect relationship had been scientifically demonstrated. Since then, several studies using the sectioning method with extracted teeth have been published and the large discrepancy amongst their outcomes soon become evident. Moreover, the high frequency of reported dentinal microcracks largely contrasted with the clinical incidence of VRFs, raising doubts on their methodological reliability. Using micro-CT technology, it was demonstrated by several studies that, in extracted teeth, dentinal defects already existed before the endodontic procedures, indicating that the initial reports framed a non-existing cause-effect relationship between canal preparation and dentinal microcracks. Although these new findings contributed to a better comprehension of this phenomenon, the misconception that microcracks were the starting point for VRFs was only surpassed with a new in situ approach using fresh cadavers. Surprisingly, microcracks were not identified in sound teeth. As a conclusion, dentinal microcracks in extracted teeth can be considered a non-natural occurrence observed only in a laboratory set-up as a consequence of dehydration and storage conditions. Thus, dentinal microcracks shall not be considered as the starting point for VRFs as they do not manifest in non-extracted teeth. Identifying dentinal microcracks as a laboratory phenomenon highlights the impact of recent scientific developments to disclaim the clinical relevance of laboratory-obtained outcomes.

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OBJECTIVE: To assess the influence of field of view (FOV) size, scanning position within the FOV and scanning mode on the detection of root fracture and artifact perception. METHODS: Forty single-rooted premolars restored with NiCr and AgPd posts were divided into two groups: fractured and sound. All teeth were scanned using four CBCT scanning protocols varying FOV sizes (80 × 80 mm and 50 × 55 mm) and scanning modes (Standard and High Definition). The sample was positioned within the FOV in two pre-set positions (central and lateral) and in four positions established by the operator (quadrants). Detection of root fracture and artifact perception were assessed by two observers using 5-point and 4-point scales. Sensitivity, specificity, accuracy, and AUC values were calculated and compared by ANOVA two-way and Tukey's test. Chi-square and Fisher's exact test were used to assess artifact perception. The level of significance was set at p < 0.05. RESULTS: The central position within the FOV presented higher sensitivity, specificity, accuracy, and AUC values and differed from the lateral position within the FOV for the studied metal posts (p<0.05). Quadrant 2 presented the best sensitivity, accuracy, and AUC values (p<0.05). The lateral position within the FOV, AgPd posts, quadrants 1 and 3 and protocols 1 (SM, 80 × 80) and 2 (HD, 80× 80) presented higher frequency of artifacts classified as "severe". CONCLUSION: Positioning the object in the center or closer to the anterior periphery of the FOV while using a small FOV improved the detection of root fracture and decreased artifact perception.

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The aim of this study was to evaluate the accuracy of cone-beam CT (CBCT) for the detection of artificially created vertical root fractures (VRF) in extracted teeth restored with metallic (MP) and fiberglass (FGP) posts. After root canal obturation, 60 extracted human premolars were scanned by using the highest-resolution settings of a CBCT unit. Theprepared roots were randomly divided into three groups: group C (control group): non-restored and non-endodontically treated teeth (n = 20); group MP (n = 20); group FGP (n = 20). In all groups, 10 teeth were artificially fractured. Two external and independent observers blindly recorded the presence or absence of VRF. Sensitivity, specificity, accuracy, intra-and interobserver agreement were calculated. Kappa value for inter-and intraobserver agreement was 0.82 and 0.84 respectively, demonstrating goodagreement. The highest values for sensitivity (0.80 -0.90), specificity (1.00) and accuracy (0.90 -0.95) were found in the control group. The teeth with FGP restoration presented the lowest sensitivity (0.30 -0.50) and accuracy (0.60 -0.65) values. Both examiners had a good performance in the diagnosis of fractures in teeth with MP, with accuracy ranging between 0.85 -0.90. The presence of MP did not influence accuracy; however, the presence of FGP reduced the diagnostic capacity of CBCT.

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BACKGROUND/AIMS: Cross-country mountain biking and field hockey are two Olympic sports that pose a potential risk for dentofacial trauma. However, mouthguard use is not mandatory in either of these sports and knowledge about tooth rescue among athletes is often neglected. The aim of this cross-sectional epidemiological survey was to evaluate the prevalence of sports-related dentofacial injuries, mouthguard use, and attitudes regarding tooth rescue among cross-country mountain biking and field hockey athletes participating at pre-Olympic competitions held in Rio de Janeiro, Brazil. MATERIALS AND METHODS: A convenience sample of 217 athletes from 33 countries participating in cross-country mountain biking (n = 82; mean age = 30.96 ± 8.52 years) and field hockey (n = 135; mean age = 19.72 ± 2.46 years) pre-Olympic competitions were examined clinically, and they answered a questionnaire regarding previous history of sports-related dentofacial injuries, attitudes toward mouthguard use, and tooth rescue. RESULTS: There were 120 (55.30%) males and 97 (44.70%) females who participated in the study. The prevalence of facial trauma was higher in mountain biking (54.88%) than in field hockey (26.66%, P < .001). Fracture was the most prevalent facial injury in mountain biking (80%), while laceration was the most prevalent in field hockey (30.55%). Extensive dental injuries occurred more often in mountain biking (47.37%) than in hockey (12.50%). The teeth most often affected were the maxillary central incisors in both mountain biking (57.89%) and field hockey (93.75%). Mouthguard use was more frequent among field hockey athletes (41.48%) than in mountain biking (1.22%, P < .001). The overall knowledge about tooth rescue was low, and most of the athletes in both sports did not know what to do in case of an avulsed tooth. CONCLUSIONS: Prevalence of dentofacial injuries among XCO-MTB and field hockey athletes participating at this pre-Olympic event was high. The majority of the athletes in this study did not use mouthguards and were unaware of recommendations in the case of an avulsed tooth.

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OBJECTIVES: The aim of this study was to compare the accuracy of vertical root fracture (VRF) detection using three tomography devices and two software systems in teeth with different endodontic fillings. METHODS: The sample consisted of 45 premolars divided into 3 groups: No filling (NF, n=15); Gutta percha (GP, n=15) and Metallic Post (MP, n=15). Cone-beam computed tomography (CBCT) images were acquired in Kodak 9000 3D, Orthopantomography 300 (OP300) and PreXion 3D devices, before and after induced root fractures. Two oral radiologists analyzed all images using InVivoDental and e-Vol DX software systems. The analysis was repeated after 15 days in 30% of the sample. Data analysis compared receiver operating characteristic (ROC) curves, as well the areas under the ROC curves. Accuracy, sensitivity, specificity, positive and negative predictive value were calculated according to each tomographic device and software. Intra- and interexaminer reliability were tested using the Kappa coefficient. RESULTS: The highest accuracy was seen in the image set from the PreXion 3D, using InVivo (0.96) or e-Vol DX (0.92) in image analysis. The OP300 device presented a similar performance of the PreXion 3D in teeth with different endodontic fillings. When using e-Vol DX, the accuracy of Kodak 9000 3D improved from 0.62 to 0.74. CONCLUSIONS: The PreXion 3D device is the most accurate when detecting VRF, with a performance similar to the OP300 in endodontic filled teeth. Kodak 9000 3D is indicated for teeth without fillings, with better accuracy using e-Vol DX software.

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La alta incidencia de fracturas dentarias producidas a distancia del tratamiento endodóntico ha llevado a desarrollar cambios en los procedimientos operatorios, con el objeto de conservar la mayor cantidad de estructura dentaria durante la terapia de conductos radiculares. En relación con esta idea, el sistema TruNatomy trabaja sobre el concepto de endodoncia mínimamente invasiva. Una zona altamente sensible a ser considerada es el área pericervical, delimitada 4 mm por encima y 4 mm por debajo de la cresta ósea. El objetivo del presente informe es analizar las propiedades y las características técnicas del sistema de instrumentación Tru- Natomy y los cambios conceptuales que su utilización implica (AU)

The high incidence of dental fractures in the long-term after endodontic treatment has led to analyzed how to change the endodontic procedures to preserve the dental structure during root canal therapy. The TruNatomy system was developed based on the concept of Minimally Invasive Endodontics. A highly sensitive zone to be considered is the pericervical area, restricted to 4 mm above and 4 mm below the bone crest. The objective of this report is to analyze the properties and technical characteristics of the TruNatomy instrumentation system and the changes in the concepts in the clinical treatment procedures as a result of its use (AU)

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Abstract Objective: To evaluate the influence of cavosurface vestibular bevel (CSVB) application on the clinical success (CS) of class IV restorations of traumatized permanent teeth, the influence of the number of fracture angles and dental trauma recurrence (DTR) on the restorations retention rate (RRR) and incidence of pulp necrosis (PN). Material and Methods: Fifty-seven children and adolescents with enamel and dentin fractures requiring C-IV restorations were randomly allocated in groups with CSVB and without CSVB. The primary outcomes were the CS of restorations, evaluated using modified USPHS criteria, and the incidence of PN after a 6-months follow-up. As secondary outcomes, the influence of the number of fractured angles and the DTR on the RRR and on the incidence of PN were evaluated (p>0.05). Results: Of 57 children and adolescents, 74 teeth were restored, and 71 completed the six-month follow-up analysis. Teeth restored with and without CSVB displayed similar CS as well as the same incidence of PN (p>0.05). The number of fractured angles did not influence the RRR and DTR was not associated with PN (p>0.05). DTR was associated with a lower RRR (p<0.001). Conclusion: Cavosurface vestibular bevel did not influence the clinical success of Class IV restorations or incidence of PN after 6-months follow-up. DTR did not influence the incidence of pulp necrosis, but did negatively influence the restorations retention rate. The number of fracture angles did not influenced in the restorations retention rate.

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PURPOSE: To evaluate the influence of different post systems on the biomechanical behavior of teeth with a severe loss of remaining coronal structure. MATERIALS AND METHODS: Fifty standardized bovine teeth (n = 10 per group) were restored with: cast post-and-core (CPC), prefabricated metallic post (PFM), parallel glass-fiber post (P-FP), conical glass-fiber post (C-FP), or composite core (no post, CC). The survival rate during thermomechanical challenging (TC), the fracture strength (FS), and failure patterns (FP) were evaluated. Finite element models evaluated the stress distribution after the application of 100 N. RESULTS: All specimens survived TC. Similar FS was observed among post-containing groups. Groups P-FP and CC presented 100% repairable fractures. The von Mises analysis showed the maximum stresses into the root canal in groups restored with metallic posts. Glass-fiber posts and CC presented the maximum stresses at the load contact point. Glass-fiber groups showed lower stresses in the analysis of maximal contact pressure; CPC led to the highest values of contact pressure. The modified von Mises (mvM) stress in dentin did not show differences among groups. Moreover, mvM values did not reach the dentin fracture limit for any group. CONCLUSIONS: The type of intracanal post had a relevant influence on the biomechanical behavior of teeth with little remaining coronal structure.

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BACKGROUND: Enamel-dentin fracture causes impact on the oral health-related quality of life (OHRQoL) of children. AIM: To evaluate the impact of treatment of crown fracture involving enamel and dentin (CFED) in the permanent dentition on the OHRQoL of children and adolescents (C/As) and their families. DESIGN: This prospective clinical study included C/As between 8 and 14 years who presented anterior CFED treated thought direct composite resin restoration. Their parents/caregivers (P/Cs) were also invited to take part of the study. The quality of life was evaluated thought the Child Perceptions Questionnaires (CPQ8-10  and CPQ11-14 ), Parental-Caregiver Perceptions Questionnaire (P-CPQ), and Familiar Impact Scale (FIS), applied before and 3 months after the restorative procedure. T test for dependent samples and Wilcoxon test were applied(P < 0.05). RESULTS: Of 32 C/As included, 30 completed the study. The treatment of CFED reduced the negative impact in OHRQoL of C/As (CPQ8-10 P = 0.0065; CPQ11-14 P = 0.0486; P-CPQ, P = 0.0259), specially for "oral symptoms" (CPQ8-10 , P = 0.0003; P-CPQ, P = 0.0455) and "emotional well-being" (CPQ11-14 , P = 0.0431). Concerning the families' perceptions, the treatment did not influence OHRQoL both in terms of the domains and total FIS score (P > 0.05). CONCLUSION: Restorative treatment of CFED increases the OHRQoL of C/As but not influence the OHRQoL of their families.

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AIM: This study aimed to evaluate the fracture resistance of tooth crowns endodontically irrigated using different protocols. MATERIALS AND METHODS: A total of 76 bovine incisors were divided into four groups (n = 19): irrigation with distilled water (control; CON); conventional irrigation with positive apical pressure (PAP); passive ultrasonic irrigation using continuous flushing (PUI); and irrigation with PAP and heated sodium hypo-chlorite solution (PHS). The force required to fracture the crown was measured on a universal testing machine at an angle of 45°. RESULTS: The CON group had higher fracture resistance (351.71 ± 58.66 N) than the PAP and PUI groups (140.96 ± 37.26 N; 167.49 ± 40.08 N respectively). The PHS group had the lowest fracture resistance value (115.15 ± 41.07 N). Irrigation protocols had a significant effect on crown resistance (p < 0.01). CONCLUSION: Teeth subjected to irrigation with heated sodium hypochlorite showed decreased resistance to crown fracture. CLINICAL SIGNIFICANCE: The contact of the irrigating solution with the root canal walls potentially can cause their weakness, determining crown fracture.

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RESUMEN: Las lesiones dentales traumáticas (LDT) son comunes, siendo las principales causas: golpes por caídas u objetos, traumatismos deportivos, actividades físicas de ocio y accidentes automovilísticos. Casi todos los casos abarcan los dientes anteriores, con mayor frecuencia los incisivos centrales superiores. De las clasificaciones de LDT, se describe la propuesta por Andreassen y aceptada por la OMS en su «Clasificación internacional de las enfermedades¼ desde 1978. Sumando tecnologías a la práctica odontológica, el diseño asistido por computadora y la fabricación asistida por computadora (CAD/CAM), proporcionan al rehabilitador nuevas modalidades de tratamiento, mejorando el diseño y la aplicación de restauraciones cerámicas libres de metal, que a lo largo de la última década ha demostrado un buen desempeño clínico. Se presentan a la clínica de la Especialidad de Odontología Restauradora Avanzada, tres pacientes, de los cuales el primero se presentó en las primeras 48 horas luego de la LDT en centrales y lateral derecho; dos pacientes presentaban LDT de uno de los incisivos centrales, el primero un adulto de 28 años de edad con una evolución de cinco años y sin ningún tratamiento ejecutado aún; el segundo caso, un niño de nueve años de edad que se presenta con un tratamiento de sistemas de conductos con una evolución de seis meses.

ABSTRACT: Traumatic dental injuries (TDI) are very common, they are mainly originated from blows caused by objects or due to falls, sport injuries as well as injuries sustained during leisure activities and car accidents. Most cases involve anterior teeth, of which upper central incisors are more frequently affected. Andreassen's TDI classification, sanctioned by WHO in 1978 in «International disease classification ¼, is described here. When new technologies are incorporated into dental practice, computer-assisted design and computer-assisted manufacture (CAD/CAM) provide the restorative clinician with new treatment options, thus improving design and application of metal-free ceramic restorations, which, along last decade, have haven proven to provide suitable clinical performance. Three patients were treated at the Advanced Restorative Dental Graduate Program clinic. The first one sought treatment within the first 48 hours after TDI, in central and right lateral teeth; two patients exhibited TDI in one central incisor, the first one was a 28 year old male with a five year evolution of the injury and no previous treatment, the second case was a nine year old child who arrived having been subjected to root canal treatment, with a six month evolution.

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The aim of this study was to access the biomechanical behavior of teeth without remaining coronal structure when restored with posts of different materials and configurations. Fifty bovine teeth (n=10 per group) with standard dimensions were restored as follows: cast post and core (CPC), prefabricated metallic post (PFM), parallel glass-fiber post (P-FP), conical glass-fiber post (C-FP) or composite core (no post, CC). The survival rate during thermomechanical challenging (TC), the fracture strength (FS), and failure pattern (FP) were evaluated. Finite element models were realized to evaluate the stress distribution with a 100N load. All post-containing teeth survived TC, while CC had 30% of failures. CPC and C-FP had the higher fracture strength, but a high number of irreparable fractures (60%), such as PFM (70%). Von Mises analysis has shown the maximum stresses into the canal in groups restored with metallic posts, while glass-fiber posts and CC presented the maximum stresses at load contact point in the crown. CPC led to higher modified von Mises (mvM) stress in the cervical third of dentin. However, mvM values did not reach the dentin fracture limit for any group. Analysis of maximal contact pressure has shown better stress distribution along with the dentin interface in post-containing groups, especially for CPC.

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BACKGROUND/AIM: Few studies have assessed the incidence and risk factors to crown fractures in preschool children. The aim of this study was to estimate the incidence of crown fracture in the primary dentition over a 1-year follow-up period, identify risk factors, and test the hypothesis that children with previous crown fracture are more prone to experience further cases of crown fracture independently of other risk factors. MATERIALS AND METHODS: This study was developed in two phases: cross-sectional and prospective longitudinal study. The cross-sectional study was carried out 261 preschool children. The prospective longitudinal study was carried out 194 children allocated to two groups: exposed group (children with prior exposure to crown fracture) and non-exposed group (children without prior exposure). On both occasions, children were examined for the diagnosis of crown fracture and evaluation of lip coverage and overjet. The parents were interviewed with regard to the socioeconomic indicators. New cases of crown fracture were identified based on the comparison of the two examinations. Data analysis involved Pearson's chi-square test, McNemar's test, and Poisson regression with robust variance. RESULTS: Among the 261 children who participated in the cross-sectional study, 194 were re-examined (65 in the exposed group and 129 in the non-exposed group). The overall incidence of crown fracture was 55.7% (n = 108). The difference in percentage of increased risk of crown fracture in exposed and non-exposed groups was 13.4%. A greater incidence of crown fracture was found in the exposed group (64.6%; P < 0,001). The children exposed (RR: 1.30; 95% CI: 1.01-1.67) had a greater risk of developing new cases of crown fracture in comparison with the non-exposed group. CONCLUSION: The incidence of crown fracture was high and children with previous crown fracture had a greater risk of suffering new cases of crown fracture during the 1-year follow-up period.

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Abstract Crown-root fractures in primary teeth are rare, with a wide variation of patterns that make diagnosis and treatment difficult. The aim of this study was to present a case series of crown-root fractures in primary teeth of children who attended a reference center. The study followed 28 cases of crown-root fractures in 26 children, representing 4% of the total number of attendees over 11 years of reference service at the Universidade Federal de Pelotas, Pelotas, Brazil. In most cases, the maxillary central incisors (85.7%) were involved. In the crown, 57.1% of the cases had a simple line of fracture, and 42.9% had multiple lines. Simple lines predominated in the root (89.3%). In cases with simple fracture lines in the crown, 37.6% underwent a total extraction, 31.2% required a partial extraction and 31.2% underwent pulpectomy. In most teeth with multiple lines of fractures in the crown, total extraction was performed (91.7%) All cases were followed-up until the eruption of the permanent successor tooth, and all patients had favorable outcomes.

Resumo Fraturas coronorradiculares em dentes decíduos são raras, com uma ampla variação de padrões que dificultam o diagnóstico e tratamento. O objetivo deste estudo foi apresentar uma série de casos de fraturas coronorradiculares na dentição decídua de crianças atendidas em um centro de referência. O estudo acompanhou 28 casos de fratura coronorradicular em 26 crianças, representando 4% do número total de participantes ao longo de 11 anos no serviço de referência na Universidade Federal de Pelotas. Na maioria dos casos, o incisivo central superior (85,7%) foi o mais envolvido. Na coroa, 57,1% dos casos tiveram linha de fratura simples, e 42,9% tiveram múltiplas linhas. As linhas simples predominaram na raiz (89,3%). Nos casos com linhas de fratura simples na coroa, 37,6% foram submetidos à extração total, 31,2% necessitaram de extração parcial e 31,2% de pulpectomia. A maioria dos dentes com múltiplas linhas de fratura na coroa, a extração total foi realizada (91,7%). Todos os casos foram acompanhados até a erupção do dente permanente sucessor, e todos os pacientes tiveram resultados favoráveis.

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Introdução: a odontologia prioriza a manutenção e integridade dos dentes na boca e a ocorrência de traumatismos dentais vem dificultando o cumprimento desta meta, uma vez que suas consequências envolvem danos funcionais, estéticos, psicológicos, sociais e terapêuticos, além dos altos custos para a reabilitação e acompanhamento por longos períodos de tempo. Objetivo: avaliar o conhecimento dos cirurgiões dentistas da região metropolitana de Juazeiro do Norte sobre as condutas clínicas baseadas nos planos de tratamentos propostos por estes profissionais sobre fraturas coronárias com ou sem exposição pulpar. Método: a partir de um questionário descritivo, foram abordadas questões referentes ao perfil dos profissionais entrevistados e procedimentos empregados na conduta frente a fraturas coronárias. Setenta e cinco questionários foram devidamente preenchidos, sendo 34 mulheres e 41 homens. Resultados: dos entrevistados 13 relataram nunca terem atendido casos de trauma dental, 26% relataram serem incapazes de tratar todos os casos de traumatismo dentário. E mesmo a maioria tendo formação especializada, grandes dificuldades foram encontradas nos planos de tratamento propostos em relação a fraturas mais complicadas. Discussão: as lesões dentais traumáticas envolvendo tecidos duros e de sustentação podem representar padrões de cicatrização bastante complexos. As lesões traumáticas do tipo fraturas coronárias apresentam um prognóstico favorável para a manutenção da vitalidade pulpar em relação às fraturas coronárias complicadas. As fraturas corono-radiculares com ou sem envolvimento pulpar, foram as que apresentaram mais indicações inadequadas de tratamento, provavelmente por necessitarem de uma abordagem multidisciplinar. Conclusão: considera-se primordial a multidisciplinaridade durante a formação acadêmica do clinico geral, bem como o aperfeiçoamento ao atendimento a pacientes com trauma dental. (AU)

Introduction: Dentistry prioritizes the maintenance and integrity of teeth in the mouth and the occurrence of dental trauma is hampering the achievement of this goal, since its consequences involve functional, aesthetic, psychological, social and therapeutic damage, in addition to high costs for rehabilitation and monitoring for extended periods of time. Objective: The objective of this study was to assess the knowledge of dentists in the metropolitan region of Juazeiro do Norte on the clinical management based on treatment plans proposed by these professionals on crown fractures with or without pulp exposure. Methods: For that, starting from a descriptive questionnaire, some questions regarding the profile of inquired professionals and procedures used in the performance of treatment of crown fractures. Results: Seventy-five questionnaires were fully completed, 34 women and 41 men. Only 13 reported ever having met cases of dental trauma, 26% reported being unable to deal with all cases of dental trauma. And even most having specialized training, great difficulties were encountered in the proposed treatment plans for the most complicated fractures. Discussion: Traumatic injuries involving pulp and periapical tissues can represent very complex healing patterns. The crown fractures have a favorable prognosis for the maintenance of pulpal vitality in relation to coronary complicated fractures. The corono-root fractures with or without pulp involvement, were the ones that had more inadequate treatment, probably because they require a multidisciplinary approach. Conclusion: it is essential for multidisciplinary academic training of general practitioner as well as improving service to patients with dental trauma. (AU)

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Los dientes con paredes radiculares delgadas poseen un alto índice de fractura, por lo que es un reto encontrar el método ideal para proveerles resistencia. Para tal fin se utilizan postes con y sin relleno intrarradicular; pero aún no existe claridad acerca de la diferencia entre estas opciones terapéuticas. El objetivo de esta revisión fue comparar resultados de la evidencia sobre la resistencia a la fractura en dientes con raíces debilitadas reforzadas con postes con y sin relleno, luego de ser sometidos a fuerzas compresivas. Una búsqueda electrónica se realizó en las bases de datos (Medline, Embase, PubMed y Ovid), sin restricción por año o idioma, arrojando 148 artículos. La extracción de datos y la evaluación de calidad de cada artículo se realizaron de forma independiente por cada autor siguiendo los parámetros establecidos en la calibración. Finalmente se seleccionaron siete artículos que cumplieron con los criterios de inclusión. Luego de la recolección de información y análisis, se concluyó que el incremento de la resistencia en dientes con raíces debilitadas se produce con el uso de postes intrarradiculares, aunque indistintamente si están o no acompañados de refuerzo radicular dentinal.

Teeth with thin root walls exhibit high fracture rate; it is therefore a challenge to find the ideal method to provide them with resistance. To this end, posts, either unfilled or filled with intra-root filling have been used, nevertheless, to this date, no certainty has been established on the differences among these therapeutic options. The main purpose of the present review was to compare evidence results on resistance to fracture of teeth with weakened roots which had been reinforced with either filled or unfilled posts, after being subjected to compressive forces. An electronic search was conducted in different databases (Medline, Embase, PubMed and Ovid). The search was unrestricted with respect to year or language. Aforementioned search produced 148 articles. Each author independently conducted data extraction and quality assessment of each article, following parameters established in calibration (gauging). Finally, seven articles meeting with inclusion criteria were selected. After information collection and analysis, it was concluded that resistance increase in root-weakened teeth was effected when intra-root posts were used, irrespectively of whether these posts had or did not have dentin root reinforcement material.

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El objetivo de este estudio fue examinar el resultado clínico longitudinal de dientes endodónticamente tratados, rehabilitados con postes colados y una restauración coronaria, durante 44 años. Materiales y Métodos. En 130 pacientes seleccionados al azar, 95 presentaron 297 dientes rehabilitados con un poste colado y una restauración coronaria. El criterio de éxito fue que el diente rehabilitado permaneciera funcional sin patología clínica ni radiográfica. Resultados: Doscientos sesenta y ocho (90%) estaban en función y 29 (10%) habían fracasado. El Indice Kappa de Cohen, fue de 0.78 - 1. Conclusiones. El éxito clínico fue de 90%. La sobrevida media observada de los dientes estudiados fue de 19 años. La tasa de fracaso fue de 10%, siendo la fractura dentaria la falla más prevalente (5% de todos los dientes restaurados)...

The aim of this study was to examine the longitudinal clinical result of the use of cast posts and cores and crown restorations in endodontically treated teeth over a 44-year period. Materials and methods. Out of 130 randomly selected patients, 95 had had 297 teeth rehabilitated with cast posts and cores and crown restorations. The endodontic rehabilitation was considered successful when the tooth remained functional with no clinical or radiographic pathology. Results. The success rate was 90% (268) and the failure rate 10% (29). Cohen’s Kappa index ranged between 0.78 and 1. Conclusions. In this 44-year retrospective study, the clinical success rate was 90%. The mean survival time of the studied teeth was 19 years. The failure rate was 10%; tooth fractures were the most prevalent failures (5% of all restored teeth)...

Assuntos