ABSTRACT
Tem sido demonstrado que as recessões gengivais estão frequentemente associadas às lesões cervicais não cariosas (LCNC), provocando queixas de hipersensibilidade e aspecto antiestético. Além da prevenção dos fatores etiológicos, as opções de tratamento geralmente são baseadas nos ajustes oclusais, restauração das lesões cervicais e cirurgias de recobrimento radicular. Essas terapias podem ser utilizadas individualmente ou combinadas. Porém, as restaurações são frequentemente selecionadas como terapia única, desconsiderando a permanência da recessão gengival no resultado estético final. Alguns estudos comprovaram a eficácia e a previsibilidade do recobrimento radicular no tratamento de LCNC previamente restauradas. Entretanto, pouco se sabe a respeito da durabilidade das restaurações e se estas influenciarão negativamente a integridade do tecido periodontal em longo prazo. O objetivo desse trabalho é fazer uma revisão de literatura sobre o tratamento de recessões gengivais classe I e II de Miller associadas a lesões cervicais não cariosas e discutir a indicação e viabilidade de se restaurar essa lesão previamente à cirurgia de recobrimento radicular. Nesse sentido, demonstra-se que as técnicas cirúrgicas para o recobrimento radicular, os materiais restauradores estéticos ou a combinação de procedimentos aparecem como possíveis opções de tratamento de recessões gengivais associadas a LCNC, desde que o planejamento seja cauteloso e relacionado diretamente com a etiologia e características anatômicas da lesão.
It has been demonstrated that gingival recessions are often associated with non-carious cervical lesions (NCCL), causing hypersensitivity and antiesthetic complaints. Besides the prevention of etiologic factors, treatment options are usually based on oclusal adjustments, restoration of cervical lesions and root coverage surgery. These therapies can be used individually or combined. Nevertheless, restorations are frequently selected as unique therapy, disregarding the maintenance of the gingival recession in final aesthetic results. Several studies have demonstrated the effectiveness and predictability of root coverage surgery in the treatment of previously restored NCCL. However, little is known about restorations durability and if they will negatively affect periodontal tissue integrity in a long-term period. The purpose of this work is to review the literature about the treatment of Miller class I and II gingival recessions associated with noncarious cervical lesions and to discuss the indication and viability to restore this lesion prior to root coverage surgery. Thus, it has been demonstrated that surgical techniques for root coverage, esthetic restorative materials or procedures combination appear to be possible treatments options for gingival recessions and NCCL, since planning is cautious and directly related to the etiology and anatomical characteristics of the lesion.
Subject(s)
Dental Restoration, Permanent , Gingival Recession , Tooth Abrasion , Tooth RootABSTRACT
Purpose - To report the result of patients treated with IV methylprednisolone divided into three groups and compare their follow-up during the last 12 years. Methods - Seventy children with active rheumatic carditis (76 episodes) in heart failure Class III and IV (NYHA) were studied. The diagnosis was based on modified Jones' criteria. After rulling out infections and stronglyoidiasis, treatment with IV methylprednisolone bolus was started three times a week until the laboratory tests became negative. Patients were divided into 3 groups, according to the time of hospital admittance: Groups 1,2 and 3, comprising of 40, 18 and 12 children, respectively. Results - Eighteen children in Group 1 (45 per cent) were in their 1st attack: 2 series of pulsetherapy were used in 10 (25 per cent), 3 in 9 (23 per cent) and 4 in 21 (52 per cent). In Group 2, 14 cases (77 per cent) were in their 1st attack: 2 series were used in 7 (39 per cent), 4 in 9 (50 per cent) and 5 in 2 (11 per cent). The echocardiogram showed a flail mitral valve in 12 (66 per cent) of these patients (1 death occurred after mitral valvoplasty). In Group 3,6 patients needed 5 or more series of pulsetherapy and a flail mitral valve was present in 5 (41 per cent). One child underwent mitral valve replacement while still in the active phase, after 8 series of pulsetherapy, and another died. The number of patients who needed 5 or more series was significantly higher in Group 3. Conclusion - There were variations in the presentation and evolution of the cases during these 12 year. The established pulsetherapy protocol continues to be useful to treat severe cases.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Anti-Inflammatory Agents/therapeutic use , Methylprednisolone/therapeutic use , Myocarditis/drug therapy , Rheumatic Heart Disease/drug therapy , Injections, Intravenous , Prospective Studies , Treatment OutcomeABSTRACT
Identifica a Educaçäo em Saúde comprometida na crise do conhecimento comum às demais ciências. Esse enfoque alargado do entendimento da Educaçäo em Saúde proporciona uma análise dos problemas e inquietudes dessa ciência sob o ângulo da crise paradigmática do conhecimento científico. Enquanto ciência histórica, a Educaçäo em Saúde compartilha com o momento atual, exibindo em algumas de suas açöes, como na Oficina de Territorializaçäo, o surgimento de novas práticas colaborando na formaçäo do novo paradigma científico. Perseguindo essas intençöes, apresenta 3 momentos dissertativos: o primeiro que procura identidicar as críticas sobre o conhecimento dentro das ciências naturais; o segundo que traz a mesma reflexäo sobre o conhecimento, agora no painel da história social localizando a Educaçäo em Saúde e caracterizando seu curso na Faculdade de Saúde Pública da Universidade de Säo Paulo. Por fim, descreve o trabalho da Oficina de Territorializaçäo de Vila Varela, fundamentado sob as características do Planejamento Ascendente