Repositório RCAAP

ABSTRACT Multiple clinical specialties are usually needed for a successful long-term treatment in buccal cavity. The aim of this article is to report a clinical case of multi-disciplinary rehabilitation of fracture upper incisors without pulp exposure, concerning about endodontics, periodontics and restorative dentistry comments or procedures. A case of a patient reporting trauma that resulted in fracture and substantial loss of hard tissue, in mesial angle of both upper central incisors (11 and 21). In palatal side, fracture extended beyond cingulum up to subgingival region. Periodontal surgery was performed in order to reestablish biological space. Clinical and radiographic assessments demonstrated no need for endodontic treatment, since pulp was vital and non-altered. Preparations for restorative procedures were minimally invasive, followed by composite direct. A three-year follow-up was performed, consisting in re-assessment of clinical and radiographic aspects, re-polishing of the restorations and photographic documentation. No pulp tissue alteration was observed after the follow-up period. Restorative procedures, adjacent tissues and pulp vitality were considered adequate, and the patient was satisfied with the treatment.

ABSTRACT Digital smile design is an important tool for esthetic planning in dentistry as it facilitates ease of communication between professionals and patients. This clinical report has the objective of describing a clinical procedure involving digital smile design for the placement of porcelain laminate veneer restorations. The digital smile design included dental and facial analyzes. The smile curve was drawn and a dental ruler was used to delimitate the spaces between each tooth. An approximate simulation of the smile was generated using Adobe Photoshop software. For esthetic and functional evaluation of the digital plan was created a diagnostic waxing and mock-up. The laminate veneers were made with feldspathic porcelain. Digital smile design was essential for successful planning because it enabled better patient contact with the end result. This case demonstrates the importance of this tool in esthetic dentistry.

ABSTRACT Root resorption is characterized by the loss of cementum and / or dentin from the tooth root as a result of internal or external odontoclastic action. This case reports a premature cervical root resorption of deciduous teeth in an 8-year-old boy. Large root resorption on the mesial faces of the maxillary and mandibular right and left deciduous canines (teeth #53, #63, #73 and #83), with asymptomatic pulp involvement, was detected during routine radiographic examination for orthodontic planning. The patient was managed with extraction of the affected teeth using two different techniques: conventional and alternative. The conventional technique, forceps, was used for the maxillary and mandibular left canines (teeth #63 and #73). And alternative technique using the periotome device, usually required for extraction during dental implant surgery, was used for the maxillary and mandibular right canines (teeth #53 and #83). The periotome device showed to be an alternative to improve pediatric surgery due to better patient behavior and healing, and to reduced procedure length.

ABSTRACT Intraoral injuries affect the stomatognathic system, creating difficulties in mastication and speech articulation, especially when they affect the tongue. In this context, the quality of the suture and local care are important to proper recovery and the patient’s brief return to their normal functions. Oral lacerations resulting from trauma require specific approaches. Treatments of this type of trauma may primarily be performed by professionals who conduct emergency care; however, they may require the attention of specialists. This article contains recommendations for the primary approach, treatment, and postoperative care of complex lacerations in the tongue.

ABSTRACT The aim of the current study is to present a treatment approach in a case of severe early childhood caries (ECC). A 5-year-old girl was referred to the Pediatric Dentistry Division with multiple premature tooth loss, masticatory difficulties, prolonged breast-feeding, and low quality of life, who was diagnosed with severe ECC. A three-phased treatment plan was implemented: 1. Disease control – consisting of behavioral changes in oral hygiene habits, diet guidance, professional biofilm removal followed by fluoride application and temporary restorations; 2. Infection control – teeth extractions and pulpotomy; and 3. Functional rehabilitation – direct and semi-indirect resin restorations, a removable partial and total prostheses in the lower and upper jaws, respectively. In conclusion, the proposed multidisciplinary approach resulted in a positive impact on the patient’s nutrition and growth, speech production, communication, self-image, and social functioning leading to an improved quality of life.

ABSTRACT Neuropathic pain occurs when there is damage to nervous system structures, particularly as a result of direct injury or disease. It can occur in the orofacial territory after dental implants placement. Oral rehabilitation is often performed with dental implant placement for older adults. However, the general health status should be considered, requiring a careful assessment of the patient and the identification of geriatric conditions that could lead to predictable failures. The purpose of this case report is to present the diagnosis and treatment of neuropathic pain after dental implant placement in an older adult with dementia due to Alzheimer’s disease.

ABSTRACT Optical fluorescence detection aims to identify precursor lesions, little noticeable to the human eye, and oral cancer. Squamous cell carcinoma or spinocellular carcinoma is a malignant neoplasm that affects the mouth more. In this article, two clinical cases are analyzed, treated with the use of two types of equipment, namely: the photoevidenciation by optical fluorescence of light-emitting violet wavelength of 405nm, power of 100mW, which is luminous radiation, not Ionizing and in the adjuvant treatment, we used low-power laser therapy, power 100mW, with two wavelengths of 808nm infrared, for pain relief, and the red 660nm, for oral mucositis. In Photodynamic therapy, the Photosensitizing Chimiolux® (methylene blue) was used to control Candida albicans. From these cases, we discuss how a more assertive diagnostic hypothesis can save a life and save time, resources, and efforts for the correct diagnosis of the pathology compared to a biopsy and histopathology negative for neoplasia. We conclude that optical fluorescence has excellent social relevance due to its potential to help the professional not specialized in the establishment of early diagnosis of oral cancer. Early diagnosis improves the rates of death caused by this carcinoma, which would extend the post-diagnosis survival and decrease the financial and emotional costs for the patient and family.

ABSTRACT Digital dentistry is a ubiquitous phenomenon nowadays but it requires access to technologies and learning curve. To aid digital workflow implementation, digital steps can be progressively incorporated in conventional workflows. We aimed to demonstrate a multidisciplinary oral rehabilitation performed mixing conventional procedures with digital open-source software programs and low-cost devices. A 46-year-old female patient had photographs, intraoral scans, and cone-beam computed tomography obtained and used in combination with conventional clinical exams to develop a treatment plan. Power point software was used for digital smile planing and Horos for digital implant planning. The digital dataset were used to guide conventional clinical procedures (scaling and root planning, gingivoplasty, in-office tooth bleaching, fiber-post restoration, implant and bone graft placement, teeth preparation, and protheses design and milling). The inclusion of digital steps in the conventional workflow enabled the performance of rehabilitation procedures with reduced clinical time and increased predictability, favoring the overall workflow and the communication among the different dental specialties. A mixed workflow can progressively lead to an exclusively digital workflow as technologies become accessible and learning curve is coped.

ABSTRACT This clinical report describes the implant rehabilitation for the treatment of pathological roots resorption due to inadequate orthodontic movement in prosthetic space reduced by means of load and immediate implants, computer-guided surgery and use of the own tooth crown in a 21-year-old-patient. The atraumatic exodontics of the right and left upper lateral incisors was performed, and then immediate placement of osseointegrated implants using the computer guided surgery technique. The crown teeth itself was used in the immediate aesthetic and functional rehabilitation. Completion of the treatment resulted in a functional and aesthetic successful outcome and a 27 months follow-up presented uneventful. The procedures included in this complex rehabilitation treatment in the esthetic zone were appropriate and essential for the maintenance of the soft and hard tissues contour and thickness ensuring the excellence in rehabilitation.

ABSTRACT Tooth bleaching is one of the most conservative aesthetic techniques. At-home and in-office bleaching may be performed, as well as the combination of both techniques. As this combination may be done in different manners, distinct orders of combinations were proposed in this report. A 24 years-old man, whose upper central incisor and canine shades were A2 and A3 respectively, was initially treated by chair-side with 40-min application of 40% hydrogen peroxide (HP) for two sessions. Afterwards, an two-week overnight at-home bleaching was performed with 10% carbamide peroxide (CP). The shade of upper central incisors changed to 1M1 and canine was B1. Conversely, a 30 years-old woman was firstly conducted with at-home bleaching (overnight 4-weeks 10% CP) and, subsequently, with a single appointment of in-office bleaching for 45 minutes (35% HP). The shade of her upper central incisor changed from A1 to 0.5M1 and the upper canine from A3 to B1. The VITA classical (A1-D4) shade guide and VITA Bleached guide 3D-MASTER were used to determine the tooth color during the treatments. In both bleaching treatments, patients reported no significant tooth sensitivity and the final outcomes met their expectation.

ABSTRACT An ideal aesthetic standard consists of facial and smile harmony. Discolored teeth generally cause an imbalance in facial aesthetics, leading to low self-esteem and disturbance in social relationships. Causes of teeth discoloration are classified as intrinsic or extrinsic. Bleaching is considered a safe and effective treatment for discolored nonvital teeth and can be associated with restorative treatment to properly correct the dental color and maximize the aesthetic results. This paper aims to present two case reports of single discolored nonvital anterior teeth and the protocol used to reestablish the dental harmony of these patients by bleaching and direct composite resin restoration. To exert minimally invasive dentistry is very important to preserve tooth structure and reduce the risk of fracture. Internal bleaching, although may not be sufficient to reestablish the aesthetic in some cases, it is important to minimize dental preparation to perform an indirect or direct restoration. Dentists must take into account the patients expectations, dominate the restorative technique and know the dental materials to properly be able to restore function and aesthetics and consequently improve life quality and social relationships.

ABSTRACT The present case report describes a modified technique of coronectomy for mandibular third molar with association of Platelet-Rich Fibrin Graft (PRF). The panoramic radiograph showed proximity of the roots of the vertical positioned 48 tooth with the superior wall of the mandibular canal, since the erasure of the superior cortical of the mandibular canal was observed. Due to the risk of injury to the inferior alveolar nerve, the technique of coronectomy was chosen. After the realized the coronectomy, in order to promote the regeneration of soft and hard tissues and also to prevent pulp changes that could lead to pain, pulp necrosis and infection, the PRF graft was used to fill the surgical defect formed by removal of the crown. Good healing evolution was observed and after 12 months of clinical and radiographic follow-up there was complete bone formation in the area where the crown was removed and no complications were observed.

ABSTRACT This paper reports on a patient with initial clinical diagnosis of Autism Spectrum Disorder level 3 and genetically confirmed as Syngap1 Syndrome (Synaptic RasGTPase activating protein). This study aimed to show the importance of genetic testing and accurate diagnoses associated with syndromes for the planning and accomplishment of dental treatments. The new diagnosis allowed reorganization of the plan and was useful in decision-making for the clinical practice of dental treatment for patients diagnosed with Syngap1.

ABSTRACT Because of multisystemic impairment in patients with Ellis-van Creveld syndrome, multidisciplinary care may be demanded since birth to assure breastfeeding. This report presents a case of an Ellis-van Creveld infant that was facing breastfeeding difficulties because of maxillary neonatal teeth. A 3 months old male infant with Ellis-van Creveld syndrome was referred to Pediatric Dentistry Department because of two upper neonatal teeth causing breastfeeding difficulties. Clinical examination revealed that teeth position was compatible to 51 and 61, and both presented uncommon ectopic soft tissue placement, conical crown and hypoplastic enamel covered by a large amount of dental biofilm. Radiography indicated they were of normal series and had 2/3 of crown completion. Due to teeth mobility that impaired breastfeeding, treatment option was exodontia. Early tooth eruption, such as in natal and neonatal teeth, by itself can’t be considered a reason for exodontia. But exodontia must be considered when an early erupted tooth(s) impairs breastfeeding, especially in systemically compromised infants. In this present case report, after teeth extraction, the infant was able to breastfeed and gain weight properly.

ABSTRACT Developmental disorders of human dentition may result in various abnormalities according to etiologic agents and the developmental period involved. The size, shape and number of teeth may be affected. Dental abnormalities can occur singly or in multiples in an individual and may or may not be associated with syndromes. Complementary radiographic examinations are valuable for diagnosis, especially in lesions that are asymptomatic and detected only through examination. The present study is intended to report a case of an incidental finding in panoramic radiography of an odontoma, a supernumerary tooth and permanent tooth agenesis in the same non-syndromic individual. According to the literature, the association of hypodontia and hyperdontia (called concomitant hypo-hyperdontia) is most common. The association of hyperdontia and odontoma is uncommon but still reported. However, regarding the association of hypodontia and odontoma no reports were found, as well as the association of the three pathologies.

ABSTRACT The technique using CTZ paste (chloramphenicol, tetracycline, and zinc oxide-eugenol) in the endodontic treatment of deciduous teeth is easy to perform and requires a single session, which is an advantage with child patients. The inexistence of clinical protocols with the use of CTZ and the multifactorial endodontic repair process in deciduous teeth evidence the need for research on the subject. This study aimed to suggest a clinical protocol model for the systematization and standardization of the endodontic treatment of deciduous teeth using CTZ paste. In the case report presented, after pulp therapy, clinical-radiographical follow-up was conducted after 30, 60, 90 and 180 days. It was concluded that using CTZ paste is a simple, viable, and satisfactory alternative. Future clinical studies are needed regarding CTZ use in child clinic with strong scientific evidence.

ABSTRACT The aim of this study was to describe a clinical protocol for fabrication of maxillary and mandibular dentures using CAD/CAM technology. Further, digital and conventional dentures fabricated for the same patient were compared. The comparison was based on patient’s satisfaction, comfort, retention, number of follow-up sessions, masticatory performance and quality of life. No laboratorial step was needed for CAD/CAM fabrication and less sessions were required up to denture insertion. Compared to the conventional dentures, digital dentures provided better satisfaction, comfort and retention and required less follow-up sessions. Both dentures presented similar results about masticatory performance and quality of life. As a conclusion, digital denture is a viable treatment alternative for edentulous patients. However, controlled and randomized clinical trials are required to reveal the real benefits of this treatment alternative compared to the conventional denture.

ABSTRACT Jacob’s disease or osteochondroma is a rare disease that presents as a pseudo-joint between the coronoid process of the mandible and the posterior surface of the zygomatic bone. The present case report is of an 11-year-old female patient with a maximum mouth opening of 2mm. When evaluating computed tomography with three-dimensional reconstruction, a mushroom-shaped increase in the coronoid process of the mandible on the left side was observed, intimately connected to the zygomatic bone (inferoposterior region of the body of the zygoma), which suggests a pseudoarticulation. Surgical removal of the tumor mass was performed under general anesthesia via intraoral access and is called coronoidectomy. Histopathological, the presence of hyaline cartilage was observed, a condition that is pathognomonic for Jacob’s Disease. Jacob’s disease case reports are still rare in the literature, with mushroom shape and histopathological confirmation due to the presence of hyaline cartilage.

ABSTRACT Objective: To evaluate the effectiveness of play strategies to break the pacifier-sucking habit and induce self-correction of the anterior open bite in the primary dentition. Methods: Data collection took place at the Pediatric Dentistry clinic of a public education institution. Three children, aged between 3 and 4 years old, using a pacifier and presenting with a 2 to 5 mm anterior open bite, participated in the research. Pediatric dental guidance was imparted to educate the family and to provide play strategies for the child by means of an illustrated book about the pacifier fairy. Results: After the first consultation, two children quit their pacifier habit. Subsequent consultations were devoted to positive reinforcement and follow-up of the self-correction of the anterior open bite. The third child required four visits to stop the pacifier habit, but other habits persisted and the open bite was only corrected after intervention by a multidisciplinary team. Conclusions: After receiving orientation from the professionals, the parents/guardians cooperated in stimulating the child, and the play activities were effective in encouraging the child to stop sucking on the pacifier, permitting self-correction of the anterior open bite. Bottle feeding, tongue interposition and mouth breathing may hinder the spontaneous correction of the anterior open bite after the pacifier habit is abandoned, requiring multidisciplinary intervention.

ABSTRACT To report one case of bleeding episodes after impacted teeth extractions had been performed in a patient with undiagnosed clotting disorder, describing a sequence of approaches for hemostasis up to the appropriated diagnosis and effective resolution. A male 16-year old patient with surgical indication to remove eight impacted teeth. After the surgery, there were bleeding episodes, being needed for hospital admission to keep on his physiological functions, blood pressure and heartbeat frequency regularly, to carry out laboratory blood tests, and to achieve hemostasis by using antifibrinolytics and blood products. After 24 hours, 11% of IX clotting factor was verified into bloodstream by specific blood test, being diagnosed with mild Hemophilia B. From the diagnosis, infusions of IX clotting factor were performed to the adequate resolution and recovery of the patient. The clinical conducts were efficient to keep on stable vital signs and achieving appropriate diagnosis. However, preventive behaviors should be applied in hemophilic patients in pre- or intra-operative, avoiding circumstances that can compromise health condition of the patient.