Resistance to fracture of intraradicular posts made of biological materials

Background

The aim was to analyze the fracture resistance of human teeth treated endodontically and restored with posts made of bovine dentin, human dentin, or glass fiber, and to evaluate the fracture pattern.

Methods

Cylindrical posts of 1.5 mm in diameter cemented to the roots of human maxillary canines presented a length of 15 mm, cervical diameter of 5–5.5 mm in the mesiodistal direction, and 7–7.5 mm in the vestibule-palatal direction. The groups studied were: Group I—10 glass fiber posts; Group II—10 human dentin posts; Group III—10 bovine dentin posts (self-adhesive resin cement); and Group IV—10 bovine dentin posts (resin-modified glass-ionomer cements). The coronal part of tooth was restored with a standardized core build-up using composite. All of the groups were submitted to a compression force test and the resistance to fracture was verified using a universal testing machine. The fracture pattern was likewise evaluated.

Results

The values of resistance to fracture were: 723.3N in group I, 561.5N in group II, 556.6N in group III, and, 613.27N in group IV. However, no statistically significant difference was observed among the groups. The fractures in groups I and II were most commonly found in the middle/apical third and were considered irreparable. For restored teeth in group III, half of the fractures appeared in the cervical third and were reparable. In group IV, all of the fractures were reparable, with the majority in the cervical thirds.

Conclusion

Bovine dentin can be used as intraradicular post to substitute human dentin and glass fiber posts. The greater the malleability of the post, the greater the chances of survival of the teeth when subjected to fracture testing.

Prevalence of self-reported versus diagnosed dentinal hypersensitivity: a cross-sectional study and ROC curve analysis

OBJECTIVE

This study aimed to identify and compare the self-reported and diagnosed prevalence of dentinal hypersensitivity (DH) in an University population; and to verify accuracy, sensitivity and specificity of DH stimuli tests.

MATERIAL AND METHODS

Three hundred and eighty patients (67.2% women and 32.8% men) were assessed by questionnaire, clinical exam, tactile and cold water tests. The intensity of DH was assessed using a visual analogue scale, and a calibrated examiner measured the scores using a caliper. The ICC for intra-examiner was 0.990. Scores above 5 mm were considered sensitive teeth. The association between variables was assessed by Chi-square test. ROC curve analysis determined accuracy, sensitivity and specificity of the tests (p < .05).

RESULTS

The mean age of participants was 24.08 years. 158 (41.7%) volunteers self-reported the presence of DH, while, 88.7% of the participants were clinically diagnosed (p = .023). In total, 8958 teeth were evaluated, of those 3367 (37.6%) were diagnosed sensitive. The most prevalent teeth with DH were incisors and premolars. The accuracy of the tests with cold water and tactile were 99%. The sensitivity and specificity for cold water and tactile tests were 99.9%, 99.7%, 99.1% and 87.6%, respectively.

CONCLUSION

The self-reported prevalence of DH was significantly lower than that clinically diagnosed. The cold test proved to be a highly accurate stimulus for the diagnosis of DH.

Associated factors to cervical dentin hypersensitivity in adults: a transversal study

Background

This cross-sectional study aimed to identify the factors associated to the cervical dentin hypersensitivity (DH) in Brazilian adult population.

Methods

Three hundred and eighty patients (67.2% women and 32.8% men) were assessed by questionnaire and thermal test with ice. Participants marked in a visual analogue scale (VAS) the intensity of pain, and a calibrated examiner (ICC 0.990) measured the scores using a caliper. Pain scores above 0.5 mm were considered sensitive teeth. The DH associated factors were investigated by clinical examination. The association between variables was assessed by Spearman correlation and the Chi-square test. Logistic regression was used to determine the variables that predict DH (p < 0.05).

Results

The mean age of participants was 24.08 years. In this population, 8958 teeth were evaluated, of those 3037 (33.9%) were diagnosed sensitive. The most prevalent associated factors to DH were abnormal tooth positioning (9.0%), occlusal trauma (6.5%) and gingival recession (5.6%). The erosion predicted significantly the DH on both simple (OR 7.85, p < 0.001) and multiple(OR 4.36, p < 0.001) analysis.

Conclusion

The exposure of dentinal tubules by erosion is probably the major predictor of dentin hypersensitivity. The healthy tooth is able to protect against DH.

Biological restoration in permanent tooth: four-year follow-up

Biological restorations, involving a technique of uniting autogenous or homogenous dental fragment for use as the primary restorative material, are an alternative for morphological and functional re-establishment of teeth with extensive coronal destruction.   Despite the wide range of restorative materials available in dentistry, no material has proved to be as efficient as the natural tooth structure. This article illustrates a therapeutic option for rehabilitating a devitalized mandibular tooth with a weakened coronal remainder by using the biological restoration technique. The authors present the sequence of planning and performing the technique, such as the characteristics of preparation of the tooth and fragment, impression taking, cutting and cementation of the fragment, and the  four-year follow-up of the biological restoration, which  shows the success of the technique with marginal adaptation and satisfactory esthetic appearance. KeywordsAdhesive; Devitalized tooth; Permanent dental restorations.

Esthetic-functional recovery of permanent posterior tooth using autogenous biological restoration

Occlusal morphology and difficult access for cleaning permanent molars result in the buildup of bacterial plaque and the development of caries. One method known as biological restoration was carried out. This technique known as biological restoration, has as main restorative material a fragment obtained from a duly donated extracted human tooth. This case report describes the restoration of an extensively decayed molar through the bonding of a fragment obtained from a third molar extracted from the patient himself. Biological restoration is a low-cost option that offers satisfactory aesthetic, morphological and functional results.The morphological/functional reestablishment of posterior teeth can be obtained through biological restoration, which allows the recovery of properties inherent to the dental structure, offers satisfactory aesthetic results and low cost.

Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars

The objective of this study was to verify, using periapical radiographs, whether a partially erupted mandibular third molar is a factor in the presence of dental caries on the distal surface of the adjacent second molar. Two-forty six high quality periapical radiographs were selected, each showing a partially erupted mandibular third molar. The variables analyzed were: tooth number; gender; age; radiographic presence of caries on the distal surface of the adjacent molar; Pell and Gregory classification; Winter classification; angulation and distance between the second and mandibular third molar. The examiners were previously calibrated to collect data (kappa statistics from 0.87 to 1.0). The prevalence rate of caries on the distal surface of the second molar was 13.4%. In the logistical multivariate regression analysis, the angulation (OR=8.5; IC95%: 1.7-43.8; p=0.011) and the gender (OR=3.3; IC95%: 1.4-7.7; p=0.005) remained statistically significant after an age adjustment was made. The results indicate that the presence of a partially erupted mandibular third molar with an angulation of 31 degrees or more, is a risk factor for caries on the distal surface of the mandibular second molars.

Fragment reattachment associated with pulpotomy in a posterior tooth with incomplete root formation

This article reports a case of preserving pulp vitality combined with aesthetics and functional reconstruction of an immature permanent molar extensively destroyed because of a carious lesion. After a pulpotomy using calcium hydroxide, the tooth crown was restored by bonding a dental fragment obtained from an extracted tooth from another individual. Aspects of diagnosis and treatment that directly affect the prognosis of the techniques are discussed. Radiographic and clinical follow-up for two years showed complete root development and a very satisfactory restoration with regard to aesthetics and function.

'Biological restoration': total crown anterior

Restorative odontology is in constant evolution and is constantly seeking more aesthetic solutions to attend to demands from patients in search of the perfect smile. The case study presented herein refers to the aesthetic and functional recuperation of dental element 21, through the use of a dental fragment obtained through an extracted tooth, a technique known as 'Biological Restoration'. The results obtained, which were highly satisfactory, lead one to conclude that this technique can be considered as an alternative to all others and can be carried out successfully, quickly, and inexpensively.

[Psychiatry and primary care. A liaison experience]

Psychiatric problems are common in general medical practice. This paper reviews information supporting the need to integrate psychiatry and general medical practice. The two year liaison between the psychiatric ward of Santa Maria Hospital and Sete Rios Medical Centre is described. A model of longitudinal case supervision analogous to that used in psychiatric residency training to provide knowledge and skills in mental health can respond to the needs of general practitioners.