Summary Background Efficient endodontic instrumentation of primary teeth is a challenge for paediatric dentists. Aim To evaluate biomechanical outcomes of endodontic instrumentation with a reciprocating system in a polymer‐prototyped primary maxillary central incisor. Design The specimen was systematically instrumented and micro‐CT scanned before and after each file. The amount of debris, percentage of non‐instrumented areas, removed dentin volume, and lower dentin thickness at specific points along the root canal were analyzed. Results A 10% increase in removed dentin volume was observed when R40 was compared to R25 (14.5% vs 4.2%). When comparing R50 with R40, this increase was only 3.4% (17.9% vs 14.5%). In the root cervical third, there was substantial reduction in dentin thickness with R50 (48.8%), followed by R40 (39.5%) and R25 (18.6%). There was no difference between R25 and R40 in the removal of dentin at the apical third (15.8%), while R50 resulted in 39.8% reduction in dentin thickness. Percentage of non‐instrumented areas were the same for all files. Accumulated debris with R40 and R50 was the same (0.19 mm³) while for R25 was 0.11 mm³. Conclusions The Reciproc® system was effective for instrumentation of a prototyped primary maxillary central incisor. The most suitable file for apical preparation was R40.

This study aimed to evaluate the endodontic instrumentation outcomes with asymmetrical files compared to reciprocating and hand files (HFs) in 3D-printed prototypes of upper primary incisors using micro-computed tomography (micro-CT). For this purpose, 50 prototypes were randomly divided (n = 10) according to the instrumentation technique as follows: HFs, a reciprocating file (WaveOne ® Gold [WOG]), and three asymmetrical movement files: XP-Endo ® Shaper (XPS), XP-Endo ® Finisher (XPF), and XP Clean (XPC). The specimens were scanned and, after registration of the baseline and instrumented volumes, changes in the root canal volume (RCV), debris accumulation, removed root material volume (RRMV), non-instrumented areas, and the presence of cracks/perforations were quantified. Data were analyzed by analysis of variance and Student's t-test, while the effect size was calculated for statistically significant outcomes. All groups showed an increase in RCV after instrumentation (p < 0.05), but this was higher with HFs (p < 0.05). Accumulated debris was higher for WOG and XPS (p < 0.05), but WOG exhibited more in the medium and apical third areas. HFs showed the highest RRMV (p < 0.05), especially at the apical third. The non-instrumented areas were lower for HFs and XPC than for the other systems (p < 0.05). Cracks were present in a few WOG (n = 2) and HF specimens (n = 3) and in this group, one of the cracked specimens and two others showed perforations. The asymmetric systems resulted in conservative dentin removal and fewer cracks/perforations as compared to HFs and a reciprocation file in prototyped primary upper incisors. XPC showed the best compromise between RRMV and non-instrumented areas with a low accumulation of debris.

Palavras-chave: Mantenedor de Espaço. Dente Decíduo. Resina Composta. Má Oclusão. RESUMO Introdução:A dentição decídua é de extrema importância, pois exerce função mastigatória, atua como guia de erupção para os dentes permanentes, estimula o crescimento ósseo e auxilia na digestão e fonação. Em casos de perda prematura de algum dente, é necessário que o profissional faça um planejamento adequado para manutenção do espaço, de forma que este não seja perdido até a erupção do sucessor permanente, evitando assim o estabelecimento de más-oclusões. Objetivo: Descrever as etapas clínicas para confecção e instalação do aparelho mantenedor de espaço adesivo, bem como o acompanhamento até a erupção do sucessor. Relato do caso: Menina, 8 anos, apresentou fístula adjacente ao segundo molar inferior direito decíduo. Após avaliação clínica e radiográfica, foi indicada a exodontia do dente, devido à impossibilidade de realizar o tratamento endodôntico. Confeccionou-se e instalou-se o aparelho mantenedor de espaço adesivo, como uma alternativa ao banda-alça, comumente utilizado nesses casos de perda unilateral. Conclusão: O mantenedor de espaço colado foi uma boa opção para o caso apresentado, pois foi capaz de cumprir sua função até a erupção do dente sucessor, constituindo-se uma boa alternativa na prática clínica, devido à otimização do tempo e economia de material que proporciona. ABSTRACT Introduction:The primary dentition is extremely important, because besides the importance during chewing, acts as a guide to eruption for permanent teeth, stimulates the bone growth and helps in digestion and phonation. In cases of premature loss, it is necessary that the professional make adequate planning to space maintenance, so that it is not lost until the eruption of the permanent successor, thus avoiding the establishment of malocclusions. Objective: To describe the clinical steps for preparation and placement of a direct bonded space maintainer, as well as the follow-up until the eruption of the successor tooth. Case report: Girl, eight years old, presented an adjacent fistula to the primary mandibular right second molar. After clinical and radiographic evaluation, tooth extraction was indicated, due to the impossibility of performing the endodontic treatment. A direct bonded space maintainer was made and installed as an alternative to the band and loop, commonly used in these cases of unilateral loss. Conclusion: The direct bonded space maintainer was a good option for the case presented, as it was able to fulfill its function until the eruption of the successor tooth. It is a good alternative in clinical practice due to the time optimization and material savings it provides.

Report a case using a minimally invasive technique (ICON®) to treat mild dental fluorosis in an adolescent with an autism spectrum disorder. Male patient, 15 years old, diagnosed with autism spectrum disorder, with the chief complaint of white spots on anterior teeth resulting in low self-esteem. Upon clinical examination, opaque white areas were observed in the enamel of all teeth, compatible with the diagnosis of mild dental fluorosis. As the patient has a mild degree of autism spectrum disorder and exhibits collaborative behavior, the treatment of choice was the resin infiltration in the maxillary incisors, canines, and first premolars. The step-by-step application was carried out according to the manufacturer’s recommendations under the rubber dam. An immediate improvement in the appearance of fluorosis was significant, and the aesthetic result was satisfactory, with color stability after 36 months of follow-up. Resin infiltration was excellent for treating mild dental fluorosis, improving aesthetics, and easy of application. Additionally, the infiltrant obtained color stability 36 months after treatment and met the expectations of the patient and his family. Aesthetics should be considered when they impact their lives, facilitating care in these cases is essential to complete treatment.

The purpose of this case report is to describe the complexity of dental management of a pediatric patient with lamellar ichthyosis. A 9-year-old male patient was referred by the pediatrician to the special needs’ clinic with a major complaint of "tooth in the roof of the mouth", according to the person in charge. The patient's mother reported that he was diagnosed with lamellar ichthyosis at birth and regularly followed up with a medical team, including a cardiologist, due to the presence of mild pulmonary valve stenosis. The physical examination revealed presence of skin peeling, everted lip, mouth breathing, cognitive deficit, and speech delay. The intraoral clinical examination showed mixed dentition, absence of caries lesions and presence of supernumerary teeth on the palate, between teeth 11 and 21, which was confirmed by radiographic examination. Although he was cleared by the pediatrician and cardiologist for the procedure under general anesthesia, this procedure in the hospital setting was interrupted at the last minute and contraindicated by the anesthesiologist, as it would be a high risky due to the patient's airway conditions. Thus, one month later, the patient's surgery was performed under local anesthesia on an outpatient basis under sedation and protective stabilization. The patient remains on follow-up and receiving preventive treatment. Thus, it is fundamental that there is a multidisciplinary approach of these patients to prevent possible complications resulting from dental procedures. In addition, regular dental monitoring is essential to avoid subjecting the patient to invasive procedures.