Luis Eduardo Rilling da Nova Cruz

Granuloma gravidarum (pyogenic granuloma) treated with periodontal plastic surgery.

outcome included stillbirth, early neonatal death, and morbidity such as neonatal admission and birth asphyxia. Adversematernal outcomeswere mortality and morbidity, such as prolonged hospital stay of more than 7 days, anemia requiring blood transfusion, sepsis, and hysterectomy. Statistical analysis was performed using SPSS software, version 15.0 (SPSS, Chicago, IL, USA). Odds ratios (OR) and 95% confidence intervals (CI)were used to analyze the risk of developing obstetric complications. The total number of obstetric admissions during the study period was 6714. Of these, 664 women were admitted in a moribund state and a total of 140 women were enrolled in the study. Eclampsia and hemorrhage were the leading complications, affecting 34.3% and 20% of women respectively; antepartum hemorrhage affected 15% and postpartum hemorrhage affected 5% of women. Severe anemia (17%) and sepsis (11.5%), including septic induced abortion and puerperal sepsis, were the other primary causes of referral.When the occurrence of adverse maternal and perinatal outcomes was compared with the educational status of the couple there was a direct relationship between the level of literacy and health outcome (Table 1). Women who reached hospital within 4 hours of recognizing a problemhad a greater chance of a good outcome (OR 1.49; 95%CI, –0.27 to 1.07). For women reaching the hospital within 8 hours the odds ratio was9.43 (95%CI, 0.71–3.77). All 7womenwho tookmore than 12 hours to reach hospital died following admission. Regarding perinatal outcome, if a woman reached hospital within 2 hours the odds ratio was 1.86 (95% CI, –0.22 to 1.45), within 4 hours the odds ratio was 2.47 (95% CI, 0.13–1.68), within 8 hours it was 1.23 (95% CI, –1.05 to 1.45), and within 12 hours the odds ratio was 4.24 (95% CI, –0.78 to 3.67). Failure to arrange money was cited as the most common reason for thedelay in reachinghospital for 71(50.7%)women followedbydifficulty in arranging transport for 62 (44.3%) women. Only 3 women had used an ambulance. Owing to financial difficulties or lack of availability of transport, 15 (10.7%)womenhad resorted to nonmotorized vehicles (e.g. rickshaw, cart). Women who had received some prenatal care had a better chance of a goodmaternal outcome (OR1.28; 95%CI, –0.54 to 1.03) and a good perinatal outcome (OR 3.38; 95% CI, 0.29–2.15). Increasing access to health facilities at community level and prenatal care are vital for the improvement of health services for women in lowincome countries [2]. The present study highlights that the cost of travel and health services, coupled with the difficulty in arranging motorized transport and poor road infrastructure, were themain reasons for delay in reaching health facilities and consequently the increased maternal mortality rate. Poor literacy standards among the women and their partners also had a direct impact on health outcomes. Ensuring that pregnant women receive regular prenatal care and birth preparedness will help achieve the Millennium Development Goals [3].

Management of gingival hyperpigmentation

The gingival melanin hyperpigmentation may represent an esthetic problem for some patients. Among the alternative treatments, the epithelial abrasion or scrapping is a simple and effective technique. The aim of this report is to present a clinical treatment of gingival melanin hyperpigmentation treated by the technique of epithelial scrapping. The result of the employed technique proved to be effective in the removal of melanin pigment, restoring the patients esthetic, and self-esteem.

Transurgical re-attachment of coronal fragment in anterior-fractured tooth

Esthetic and functional rehabilitation is the primary goal of the treatment of crown-root-fractured tooth. A 14-year-old male patient that fractured her maxillary left canine with biologic width violation is presented. Transurgical exposures of the fracture remnant were performed to possibility the rubber dam isolation followed by crown re-attachment using bonding system and a resin composite. Clinical and radiographic examination 5 months after trauma showed good esthetics, pulp normality, and periodontal health.

Orthodontic extrusion and biologic width realignment procedures for rehabilitation in a permanent premolar with an extensive dental fracture

The present study reports a case of coronoradicular fracture with the biological width invasion that was successfully managed by orthodontic root extrusion. Clinically, the patient presented with a subgingival fracture of the first maxillary premolar, with a tooth fragment 5.0 mm below the enamel-cementum junction. The initial examination suggested a poor prognosis for the clinical case; however, we decided to employ an orthodontic root extrusion over 5 months. After 1 year, a satisfactory prosthetic rehabilitation, associated with the periodontal health, could be observed and it can be concluded that orthodontic root extrusion is an essential tool for the management of extensive subgingival fractures. Clinical Relevance to Interdisciplinary Dentistry Extrusion root is a conservative treatment. Root or coronal fractures can be treated with root extrusion. Prognosis of this type of treatment is extremely favorable.