Retromolar canal diagnosed by cone-beam computed tomography and its influence in inferior alveolar nerve block / Canal retromolar diagnosticado por tomografía computarizada de haz cónico y su influencia en el bloqueo del nervio alveolar inferior

The aim of this study was to observed the anesthetic efficacy of the alveolar nerve block on nine patients that CBCT diagnosed unilateral retromolar canal on a double-blind, split-mouth approach. The assessments of patient response to thermal (pulp vitality test) and pressure (compression of soft tissue) stimuli were carried out before and 5 minutes after the inferior alveolar nerve block procedure, using both visual analog scale (VAS) and Mc Gill pain questionnaires (McG). The mean percentage of patient response decreased after alveolar nerve block, according to both VAS and McG, and was statistically similar among hemi mandibles with and without retromolar canal (Wilcoxon>0.05); however, those without retromolar canal presented greater reduction in patient response in 6 out of 9 cases. Therefore, the retromolar canal is not a determinant factor of inferior alveolar nerve block failure.

El objetivo de este estudio fue observar la eficacia anestésica del bloqueo del nervio alveolar en nueve pacientes que CBCT diagnosticó canal retromolar unilateral en un abordaje de boca dividida doble ciego. Las evaluaciones de la respuesta del paciente a los estímulos térmicos (prueba de vitalidad pulpar) y de presión (compresión de los tejidos blandos) se realizaron antes y 5 minutos después del procedimiento de bloqueo del nervio alveolar inferior, utilizando tanto la escala analógica visual (VAS) como los cuestionarios de dolor de Mc Gill ( McG). El porcentaje medio de respuesta de los pacientes disminuyó tras el bloqueo del nervio alveolar, según EVA y McG, y fue estadísticamente similar entre hemimandíbulas con y sin canal retromolar (Wilcoxon>0,05); sin embargo, aquellos sin canal retromolar presentaron mayor reducción en la respuesta del paciente en 6 de 9 casos. Por lo tanto, el canal retromolar no es un factor determinante del fracaso del bloqueo del nervio alveolar inferior.

Quality by Design-driven investigation of the mechanical properties of mucoadhesive films for needleless anesthetics administration

Objectives: To systematically evaluate the effects of hydroxypropyl methyl cellulose (HPMC) type (E5LV, E15LV, and K100LV); plasticizer type (glycerol and mannitol), plasticizer loading (0.12 and 0.24% w/w); and loading of prilocaine and lidocaine hydrochlorides combined at 1:1 ratio (0 and 47 mg/cm2) in the mechanical properties of buccal films. Methods: A quality by design (QbD) approach based on a full factorial design (3 x 23) and complementarily multivariate statistical tools i.e., principal component analysis (PCA), response surface methodology (RSM), and correlation matrix were used in this pursuit. The thickness, elongation at break, tensile strength, force at break, and Young`s modulus of the anesthetic buccal films obtained by solvent casting were assessed. Results: The QbD, PCA and RSM altogether demonstrated that all studied formulation variables, mainly the drug loading, affect the mechanical properties of the films at different significance levels. The multivariate analysis yielded the modelling of elongation at break, tensile strength, and force at break, which significantly correlated with each other. The drugs exerted a synergic plasticizing effect on the films, and the use of HPMC K100 LV (with greater hydroxypropyl substitution degree and viscosity) and mannitol favored their elasticity and resistance. Furthermore, the majority of the films fulfilled the requirements for buccal administration due to their softness and mechanical resistance. Conclusion: Mannitol is suitable plasticizer for manufacturing HPMC anesthetic buccal films with improved mechanical properties. These results are a step forward in the rational development of formulations for the replacement of needles in dentistry

Surrogate endpoints: when to use and when not to use? A critical appraisal of current evidences

Abstract Clinical research needs to formulate a question, which must be answered by obeying ethical precepts with well-defined inclusion/exclusion criteria and approval of the study on platforms of ethical appreciation and clinical trial records. In comparing the results or clinically relevant outcomes should be prioritized in the study of techniques, products, inputs, drugs and therapies. However, it is not always possible to use long study drawings, with many participants, and with many costs, then look for study designs with surrogate outcomes, usually a shorter path, with less sample size and considerably lower costs to the research, with shorter intervention time. Considering these outcomes as major challenges in clinical research, the premise of this work was to examine in relevant research platforms, studies on the feasibility of using surrogate endpoints for clinically relevant parameters in dentistry, with a critical evaluation of the advantages, disadvantages, and need for validation of substitute parameters for clinical studies. After a critical analysis of the results, it could be concluded that surrogate endpoints may have an important role in the initial process of developing new drugs, faster, with less sampling, and lower risk of side effects for the patient. Careful use of the surrogate endpoints is advised because, even if validated, they can provide ambiguous evidence and not be extrapolated to other populations, and may lead to bias due to the individual interpretation of each researcher. The use of unplanned surrogate outcomes that arise during the study requires a lot of caution.

Influence of a retentive shoulder design to prevent early failure of three core build-ups

Abstract This study evaluated the influence of a retentive shoulder design to prevent early failure of three resin composite build-ups on molars. Ninety-six intact extracted human maxillary third molars were assigned to two groups (n=48) based on occlusal, buccal cusps only and all cusps reduction. The groups were divided into two subgroups: pin retained and non-pin retained build-ups resulting in four groups (n=24), according the cusps reduction: pin retained/partial, pin retained/complete, non-pin retained/partial, non-pin retained/complete. Occlusal reduction was 3 mm with a semi-lunar retentive shoulder of 3 mm and an axial wall height of 1.5 mm. Groups were restored using a microhybrid, flowable or titanium reinforced resin composite. Modified self-curing acrylic resin provisional crowns were fabricated, cemented with non-eugenol temporary cement and thermal cycled. An instron machine applied tension to the provisional crowns parallel to the long axis of the tooth until dislodgement. A three-way analysis of variance was conducted on the influence of the variables on the retention of the core build-up. Ninety-three build-ups were retained under tensile load, while three core build-ups without pins were dislodged. Three-way analysis of variance showed no statistically significant difference between core build-ups using a retentive shoulder and pin retained core build-ups when tested under tensile load. With the advent of adhesive systems, increased surface area and retentive shoulder design can provide a retentive core foundation to prevent early failures of core build-ups during indirect restoration fabrication which will contribute to the longevity of final restorations.

Resumo Este estudo avaliou a influência de um preparo retentivo em forma de ombro para prevenir a falha precoce de núcleos de preenchimento realizados em molares com 3 diferentes tipos de resina composta. Noventa e seis terceiros molares superiores hígidos extraídos de humanos, foram divididos em dois grupos (n=48) de acordo com o tipo de redução oclusal: em todas as cúspides (total) ou nas cúspides vestibulares (parcial). Os grupos foram divididos em dois subgrupos: núcleos retidos a pinos e não retidos a pinos, resultando em quatro grupos (n=24): redução oclusal total/retido a pino, redução oclusal parcial/retido a pino, redução oclusal total/não retido a pino, redução oclusal parcial/não retido a pino. A redução oclusal foi de 3 mm com um ombro retentivo semilunar de 3 mm e uma altura de parede axial de 1,5 mm. Os grupos foram restaurados utilizando resina composta microhíbrida, fluível ou reforçada com titânio. Foram confeccionadas coroas provisórias de resina acrílica autopolimerizável modificada, cimentadas com cimento provisório sem eugenol e termocicladas. Uma máquina universal de ensaios foi utilizada para tracionar as coroas provisórias paralelamente ao longo eixo do dente até o seu deslocamento. Análise de variância de 3 fatores foi aplicada para avaliar o efeito dos fatores na retenção do núcleo. Noventa e três núcleos de preenchimento permaneceram retidos sob a carga de tração, enquanto três núcleos de preenchimento sem pinos foram deslocados. A análise de variância não mostrou diferença significante entre os núcleos de preenchimento com desenho retentivo e os núcleos de preenchimento retidos a pinos. Com o advento dos sistemas adesivos, o aumento da área de superfície e o desenho retentivo dos ombros podem fornecer um preparo retentivo para evitar falhas precoces nos núcleos de preenchimento durante a fabricação de restaurações indiretas, o que contribuirá para a longevidade das restaurações finais.

Clinical Evaluation of Residual Tetrasodium Pyrophosphate Released from Two Different Anticalculus Flosses

The aim of this study was to compare the residual content of tetrasodium pyrophosphate released by two different anticalculus dental flosses (Reach PP(r) - entangled polypropylene floss and Reach NT(r) - texturized nylon) in the oral cavity. Ten healthy individuals (aged between 18 and 30 years) were enrolled in this randomized crossover clinical investigation. Participants received instructions on daily dental flossing and the interventions were randomly performed in 2 different groups (NT or PP) of five individuals each according to the dental flosses. Individuals were instructed to use each dental floss with a total of six slides on the two interproximal aspects of target teeth (3 slides on each interproximal aspect). A washout period of one week was used before start flossing interventions and after each type of dental floss to prevent any bias related to the exposure to any product that contained the active ingredient. Samples were collected by #35 sterilized absorbent paper points from interdental fluid after flossing and assessed by ion chromatography. The levels of residual tetrasodium pyrophosphate were evaluated by means of binomial generalized linear model proportions and canonical link function. Both dental flosses were effective in tetrasodium pyrophosphate release at therapeutic levels in the interdental gingival crevicular fluid for a period of up to 2 h after use. No significant differences were found between both groups (p>0.05). It may be concluded that both material composition and physical structure of the new dental floss did not affect the release or the maintenance of anticalculus agent at therapeutic levels for a period of up to 2 h after single use.

O objetivo deste estudo foi comparar o teor residual de pirofosfato de tetrasodio liberado por dois tipos diferentes de fio dental anti-cálculo (Reach PP(r) - polipropileno entrelaçado e Reach NT(r) - nylon texturizado) na cavidade oral. Dez indivíduos saudáveis (com idade entre 18 e 30 anos) foram selecionados para este estudo clínico em modelo crossover. Os participantes receberam instruções sobre como utilizarem os fios dentais e as intervenções foram randomicamente realizadas em 2 grupos de 5 participantes de acordo com o tipo de fio avaliado. O participantes foram instruídos a passarem cada fio dental em um total de 6 passadas ao redor dos 2 espaços interproximais dos dentes selecionados (3 passadas em cada face interproximal). Um período de washout de 1 semana foi utilizado antes do início do estudo e após cada intervenção com o objetivo de prevenir a ocorrência de viés relacionado à exposição de algum agente terapêutico. Amostras do fluido interdental após as intervenções foram avaliadas por meio de cromatografia de íons. A porcentagem residual de pirofosfato tetrassódico foi verificada empregando-se o método da cromatografia de íons, pela colheita do fluido interdental com cones de papel absorvente esterilizados. Os teores de pirofosfato tetrassódico residual foram comparados para cada fio dental e para cada tempo de colheita do fluido interdental. Não foram observadas diferenças significantes entre os grupos avaliados (p>0,05). Conclui-se que a composição do material e a estrutura física dos fios dentais não exerceram influência na liberação e na permanência do agente anti-tártaro, que permaneceu em níveis terapêuticos por um período de até 2 h após o uso único.

A Comparison of the Bleaching Effectiveness of Chlorine Dioxide and Hydrogen Peroxide on Dental Composite

This study was carried out to verify if composites could be bleached using chlorine dioxide as compared with hydrogen peroxide. 3M ESPE Filtek Z350 Universal Restorative discs were prepared (n=40), with dimensions 5 mm diameter x 2 mm thickness. The discs were divided into 4 groups of 10 discs each. Color assessment was performed by CIEDE2000. The discs were stained with coffee, tea, wine and distilled water (control) solutions for 14 days, 5 hours daily. Color assessment was repeated on stained discs and followed by bleaching of 5 discs from each group using chlorine dioxide and hydrogen peroxide in-office systems. Finally, a last color assessment was performed and compared statistically. DE2000 after bleaching was very close to baseline for both the bleaching agents, although chlorine dioxide showed better results than hydrogen peroxide. After staining, there was a clinically significant discoloration (∆E2000≥3.43) for the tea, coffee and wine groups, and discoloration (∆E2000) was seen more in the wine group as compared to tea and coffee. Overall, the control group (distilled water) had the least color change in the three intervals. After bleaching, the color in all specimens returned close to the baseline. The color differences between bleaching and baseline were less than 3.43 for all groups. The obtained results show that chlorine dioxide is slightly superior to hydrogen peroxide in the bleaching of composites, while maintaining the shade of the composite close to the baseline.

Este estudo foi realizado para verificar se resinas compostas podem ser clareadas com uso do dióxido de cloro, em comparação com peróxido de hidrogênio. Foram preparados discos com resina restauradora Filtek Z350 3M ESPE (n=40), com dimensões 5 mm de diâmetro × 2 mm de espessura. Os discos foram divididos em 4 grupos de 10 discos cada. A avaliação da cor foi realizada por meio do CIEDE2000. Os discos foram manchados com soluções de café, chá, vinho e água destilada (controle) por 5 h diárias durante 14 dias. A avaliação da cor foi repetida nos discos manchados e seguida por clareamento de 5 discos de cada grupo, utilizando dióxido de cloro ou peróxido de hidrogênio pela técnica de consultório. Finalmente, uma última avaliação da cor foi realizada e as técnicas comparadas estatisticamente. DE2000 após o clareamento foi muito próxima ao baseline, para ambos os agentes clareadores, embora o dióxido de cloro tenha mostrado melhores resultados do que o peróxido de hidrogênio. Após o manchamento, houve uma descoloração clinicamente significativa (ΔE2000≥3,43) para os grupos de chá, café e vinho, sendo que o clareamento (ΔE2000) foi melhor obtido com o grupo do vinho, em comparação com chá e café. No geral, o grupo controle (água destilada) teve a menor mudança de cor nos três intervalos. Após o clareamento, a cor em todos os espécimes voltou próxima ao baseline. As diferenças de cor entre o clareamento e o baseline foram inferiores a 3,43 para todos os grupos. Os resultados indicam que o dióxido de cloro é ligeiramente superior ao peróxido de hidrogênio no clareamento de resinas compostas, mantendo a cor próxima à escala do baseline.

Variação da temperatura superficial dos músculos masseter e temporal anterior durante o apertamento dental voluntário com placas interoclusais maxilares de duas diferentes espessuras / Variation of surface temperature on superficial masseter and anterior temporal muscles during voluntary teeth clenching with maxillary splints of two different thicknesses

A atividade muscular tem sido estudada de maneira indireta pela análise da variação da temperatura superficial cutânea sobre os músculos mastigatórios. Essas mensurações podem representar uma ferramenta valiosa na avaliação clínica da atividade e do progresso das desordens temporomandibulares, bem como no acompanhamento do protocolo terapêutico adotado, justificando sua utilização para verificar alterações patológicas na circulação sanguínea e/ou atividade metabólica nos tecidos abaixo da pele, como os músculos mastigatórios. Em vista disso, o objetivo do presente estudo foi verificar o efeito da espessura da placa interoclusal sobre a variação da temperatura superficial dos músculos temporal anterior e masseter, durante o repouso e o apertamento dental, considerando-se a condição assintomática de 20 indivíduos (10 do gênero masculino e 10 do gênero feminino) selecionados através do questionário Research Diagnostic Criteria (RDC). A temperatura em graus Celsius (ºC) da superfície dos músculos masseter e temporal anterior foi medida com o auxílio de um termômetro digital, com um sistema de leitura por irradiação infravermelha. A temperatura superficial dos músculos temporal anterior e masseter apresentou redução significativa diante do apertamento dental em relação à posição de repouso mandibular. Entretanto, não houve diferenças significantes entre as condições com e sem placa interoclusal, bem como entre as distintas espessuras de placas interoclusais analisadas. Adicionalmente, os músculos mastigatórios apresentaram uma considerável semelhança entre os lados, sem haver também distinções significantes entre o gênero masculino e o feminino.

Muscle activity has been studied indirectly through analyses of temperature variation in skin surface temperature on the masticatory muscles. These procedure may be an important tool for clinical evaluation and assessment of the evolution of temporomandibular disorders, as well as monitoring the adopted protocol. Thus, its utilization for identified pathological alterations on blood circulation and/or on metabolic activity in subcutaneous tissues, such as the masticatory muscles, is justified. The aim of this study was to investigate the effect of occlusal splintsÆ thickness on the variation of surface temperature of the anterior temporal and masseter muscles during rest and clenching. It were analyzed 20 asymptomatic subjects (10 males and 10 females) selected through the Research Diagnostic Criteria (RDC) questionnaire. Temperature expressed in degrees Celsius (ºC) was measured on the surface of both muscles measured with the aid of a digital thermometer with an infrared radiation reading system. The surface temperature of the anterior temporal and masseter muscles presented significant reduction during teeth clenching in relation to the mandibular rest position. However, there were no significant differences between conditions with and without occlusal splint or between the different thicknesses of splints analyzed. Masticatory muscles showed a considerable similar behavior for both sides, and no significant distinctions were observed between male and female patients.

Shear Bond Strength of Acrylic Teeth to Heat-curing Denture Base Resin under Different Disinfectant Methods / Resistencia al Cizallamiento de Dientes Acrílicos en Bases Protésicas de Resina con Curado Térmico bajo Diferentes Métodos de Desinfección

The aim of this study was to evaluate the shear bond strength between acrylic teeth and heat-activated acrylic denture base resin using five different disinfectants solutions after simple immersion or under ultrasonic cleaner action. A total of 144 acrylic denture resin specimens were produced with both types of acrylic denture tooth (Biolux® and Trilux®). The specimens were randomly divided into subgroups according to the disinfection procedure used (immersion in Listerine®, Cepacol®, Periogard®, Riozyme II® and Cloro Rio® 1%, and/or ultrasonic cleaning action). The shear bond strength between acrylic teeth and denture base was assessed using a universal testing machine and the data obtained were analyzed by means of ANOVA followed by Fisher's LSD Multiple-Comparison test. The two layers teeth presented a bond strength average of 3.43 MPa while the three layer ones had an average of 3.02 MPa. The association of ultrasonic cleaner and the disinfectant solutions studied did not affect negatively the teeth bond resistance to the denture base. The three layer acrylic teeth had a lower shear bond strength compared to those with double pressing when immersed in disinfection solutions, regardless of the ultrasonic cleaner use.

El objetivo de este estudio fue evaluar la resistencia al cizallamiento entre dientes de resina acrílica y bases acrílicas curadas mediante calor, junto al uso de cinco soluciones de desinfectantes diferentes, mediante inmersión simple o bajo ultrasonido. Un total de 144 bases de acrílico fueron confeccionadas con los dos tipos de dientes de resina (Biolux ® y Trilux ®). Los especímenes se dividieron aleatoriamente en subgrupos de acuerdo con el procedimiento de desinfección utilizado (inmersión en Listerine ®, Cepacol ®, Periogard ®, Riozyme II ® y Cloro Río ® 1%, y/o acción de limpieza por ultrasonido). Se evaluó la resistencia al cizallamiento entre los dientes de resina y la base de la prótesis utilizando una máquina de ensayo universal; los datos obtenidos se analizaron mediante ANOVA seguido por el test LSD de Fisher de comparaciones múltiples. Las dos capas de los dientes presentaron una fuerza de adherencia promedio de 3,43 MPa, mientras que las tres capas tenían un promedio de 3,02 MPa. La asociación de limpiador ultrasónico y las soluciones desinfectantes estudiados no afectaron negativamente la resistencia de los dientes a la base de la prótesis. Las tres capas de acrílico de los dientes tuvieron una resistencia al cizallamiento menor en comparación con aquellos con doble prensado cuando se sumergen en soluciones desinfectantes, independientemente del uso de limpiador ultrasónico.

Effect of whitening toothpaste on titanium and titanium alloy surfaces

Dental implants have increased the use of titanium and titanium alloys in prosthetic applications. Whitening toothpastes with peroxides are available for patients with high aesthetic requirements, but the effect of whitening toothpastes on titanium surfaces is not yet known, although titanium is prone to fluoride ion attack. Thus, the aim of the present study was to compare Ti-5Ta alloy to cp Ti after toothbrushing with whitening and conventional toothpastes. Ti-5Ta (%wt) alloy was melted in an arc melting furnace and compared with cp Ti. Disks and toothbrush heads were embedded in PVC rings to be mounted onto a toothbrushing test apparatus. A total of 260,000 cycles were carried out at 250 cycles/minute under a load of 5 N on samples immersed in toothpaste slurries. Surface roughness and Vickers microhardness were evaluated before and after toothbrushing. One sample of each material/toothpaste was analyzed by Scanning Electron Microscopy (SEM) and compared with a sample that had not been submitted to toothbrushing. Surface roughness increased significantly after toothbrushing, but no differences were noted after toothbrushing with different toothpastes. Toothbrushing did not significantly affect sample microhardness. The results suggest that toothpastes that contain and those that do not contain peroxides in their composition have different effects on cp Ti and Ti-5Ta surfaces. Although no significant difference was noted in the microhardness and roughness of the surfaces brushed with different toothpastes, both toothpastes increased roughness after toothbrushing.

Chronic temporomandibular pain treatment using sodium diclofenac / Tratamiento crónico del dolor temporomandibular con diclofenaco sódico

This study evaluate spontaneous pain after and before administration of sodium diclofenac, isolated or associated to carisoprodol, acetaminophen and caffeine, in chronic temporomandibular disorders (TMD) patients. Were selected eighteen volunteers, both men and women, between 35-70 years of age (mean age 50 years). The inclusion criteria was masticatory muscle pain, and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used on the diagnose. The selection of treatment for each individual was done by a triple-blind full-randomized crossover methodology. Thus, all patients were submitted to all treatment at different moments, in a non standardized sequence, avoiding tendentious results. The treatments were: A (sodium diclofenac + carisoprodol + acetaminophen + caffeine), B (sodium diclofenac) and C (placebo), all associated with an occlusal splint. Each treatment period was followed by an eleven-day washout. There weren't observed differences between initial and final values of treatments. However, there were statistically significant differences in evaluative and miscellaneous sensorial groups after B treatment; and in sensorial, affective, and total score groups after B and C treatments. Within the limitations of this investigation, we conclude that treatment of muscular TMD patients with sodium diclofenac isolated promoted higher analgesia than treatment with sodium diclofenac more associations or placebo, when associated to an occlusal splint.

Este estudio evaluó el dolor espontáneo antes y después de la administración de diclofenaco sódico, aislado o asociado a carisoprodol, paracetamol y cafeína, en pacientes con trastornos temporomandibulares crónicos (TTM). Se seleccionaron dieciocho voluntarios, hombres y mujeres, entre 35-70 años de edad (edad media 50 años). Los criterios de inclusión fueron dolor muscular masticatorio, y los criterios diagnósticos para trastornos temporomandibulares (RDC / TMD) como diagnóstico. La selección del tratamiento para cada individuo se llevó a cabo mediante una metodología de cruce triple ciego completo al azar. Por lo tanto, todos los pacientes fueron sometidos a todos los tratamientos en diferentes momentos, en una secuencia no estandarizada, evitando los resultados tendenciosos. Los tratamientos fueron: A (diclofenaco sódico + carisoprodol + acetaminofen + cafeína), B (diclofenaco sódico) y C (placebo), todos asociados a una férula oclusal. Cada período de tratamiento fue seguido por once días. No se encontraron diferencias entre los valores inicial y final de los tratamientos. Sin embargo, hubo diferencias estadísticamente significativas en los grupos de evaluación sensorial y después del tratamiento B, y en los grupos de calificación sensorial, afectivo, y el total después de los tratamientos B y C. Dentro de las limitaciones de esta investigación, se concluye que el tratamiento con diclofenaco sódico aislado en pacientes con TTM musculares promueve una mayor analgesia que el tratamiento con diclofenaco sódico más asociaciones o placebo, cuando se asocia a una férula oclusal.

Tratamiento periodontal quirúrgico en rehabilitación oral estética: reporte de caso clínico / Periodontal surgical treatment in aesthetic oral rehabilitation: a clinical case report

La rehabilitación de dientes que presentan grandes desgastes por atrición, erosión o abfracción tiene como objetivo devolver la función y la estética comprometida. En muchos casos es necesario realizar tratamientos periodontales quirúrgicos previos para respetar el espacio biológico y así rehabilitar, posteriormente, en perfecta armonía los dientes afectados. Este reporte muestra la técnica y recuperación de un caso con desgastes severos en los dientes anteroinferiores, el cual se tuvo que someter a un tratamiento periodontal quirúrgico mediante osteotomía para recuperar la dimensión vertical perdida a través de restauraciones provisorias...

Teeth rehabilitation that present great scuffs by attrition, erosion or abfraction, has as a main purpose to restore the function and aesthetic compromised. In some cases previous surgical periodontal treatments is required to respect the biological width and subsequently, the rehabilitation in perfect harmony of affected teeth. The present report has the objective to show the technique and recovering of a case with severe scuffs in lower anterior teeth, which was subjected to a surgical periodontal treatment by osteotomy to restore lost vertical dimension through temporary restorations...

Daily biofilm control and oral health: an epidemiological challenge consensus – brazilian advisory panel in oral health

Dental plaque is known as the primary etiological factor for the periodontal diseases. Knowledge about dental plaque has extensively evolved being recognized, not only as a simple bacterial conglomerate adhering to the tooth surface, but also defined as biofilm. Adequate oral hygiene is the most effective way to prevent periodontal disease and caries, which are caused by specific microorganisms found in the oral biofilm. Disorganization and constant removal of this biofilm represents the major strategy utilized in the prevention and treatment of such diseases. The inclusion of oral antiseptics, in daily home care, provides a more effective recommendation for prevention by dental professionals. It is possible to establish a hierarchical order of effectiveness. Chlorhexidine (CHX) promotes the highest anti-plaque effects followed by the essential oils (EOs), cetylpyridinium chloride (CPC) and finally triclosan. For anti-gingivitis action the EOs are equivalent to CHX being both superior agents when compared with CPC and triclosan. Based on the available scientific evidence this group of experts in oral care is favorable to recommending the daily use of an essential oil-containing mouthwash as the active principle, for the majority of the population, excluding children under 6 year of age, individuals with sensitivity to the formula components and those who present adequate oral hygiene using only mechanical methods (brushing and flossing) and dentifrice.

Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching

The extent of separation between the maxillary and mandibular teeth in the fabrication of interocclusal splints designed to achieve efficiency and muscle relaxation is controversial and undefined in the literature. Based on this premise, the aim of this study was to evaluate the effect of interocclusal splint thicknesses of 3 and 6 millimeters on the electrical activity of the anterior temporal and masseter muscles during rest and dental clenching. Twenty asymptomatic individuals (10 males and 10 females) were selected using the Research Diagnostic Criteria (RDC). Electromyography (EMG) was performed both with and without the 3- and 6-mm splints using the Bio EMG software package, which recorded values given in microvolts (µV). The results, which were assessed using analysis of variance (ANOVA) to a 5 percent significance level (p < 0.05), showed increased electrical activity of the masticatory muscles during dental clenching compared with at rest, with greater activity in the masseter muscle. The electrical activity did not differ according to the thickness of the splints or between males and females. We can conclude that both splint thicknesses are effective in treating muscle hyperactivity given their similar clinical behavior for asymptomatic individuals.

Avaliação do teor de fluoretos em géis neutros e acidulados de uso tópico profissional / Evaluation of fluoride content in neutral and acidic gels for topical professional use

Os géis fluoretados para aplicação tópica pelo profissional têm sido empregados comoagentes de prevenção da cárie dental, no tratamento da hipersensibilidade dentinária ecomo remineralizadores do esmalte dental. Neste estudo foi analisado in vitro, por meiodo método do fluorímetro com eletrodo específico termo-plus®, o teor de flúor de 10 produtosbrasileiros de gel fluoretados, ( 5 de fluoreto de sódio a 2% em concentração, e 5 deflúor fosfato acidulado a 1,23% em concentração). Os resultados indicaram que todos osprodutos avaliados nesse estudo apresentaram irregularidades no teor de fluoreto, sendoque nove destes apresentavam uma concentração menor que a indicada na embalageme uma apresentou uma concentração maior que o declarado. Com base nessas análises,conclui-se que os produtos avaliados neste trabalho não apresentam a concentração indicadaem suas embalagens.

Fluoride gels for topical application by the professional staff have been employed as preventionof dental caries, in dentin hypersensitivity treatment and as mineralizing enamelagents. The aim of this study was to evaluate in vitro by the method of the fluorometer witha specific electrode termo-plus®, the fluoride concentration of 10 Brazilian products offluoride gel, (5 sodium fluoride at 2% concentration of fluoride and 5 acidulated phosphateto 1.23% in concentration). The results indicated that all the products evaluated in thisstudy showed irregularities in the fluoride content, nine of them had a lower concentrationthan indicated on the package and one of them had a higher concentration than stated.Based on this analysis, we conclude that the products evaluated in this study do not showthe concentration indicated on their packaging.

Pré-molarização: uma alternativa para reabilitações implantossuportadas em região posterior / Premolarization: an alternative to implant-supported rehabilitations in the posterior region

Diferenças anatômicas e biomecânicas fazem do tratamento com implantes em regiões posteriores substancialmente diferentes daquele em região anterior. Sem os implantes e diante da perda de dentes posteriores, as opções de tratamento incluem próteses parciais fixas extensas ou próteses parciais removíveis, especialmente quando não há um pilar distal disponível. Contemporaneamente, as próteses implantossuportadas representam um tratamento altamente eficaz e aceitável para a reabilitação oral de indivíduos parcialmente edêntulos, entretanto, tornou-se necessário reavaliar e modificar alguns conceitos previamente estabelecidos devido aos impactos negativos proporcionados por modelos de próteses nos quadrantes posteriores, como o desfavorável perfil de emergência, dificultando o controle de placa bacteriana, a impacção alimentar e a dissipação não axial das forças oclusais. Modificando-se o planejamento dessas próteses, onde coroas de molares sejam substituídas por coroas de pré-molares, proporciona-se uma possível solução para esses problemas. Assim, três pré-molares podem equivalentemente substituir dois molares, situação esta que caracteriza o conceito de pré-molarização. O objetivo do presente estudo foi relacionar os aspectos funcionais e biomecânicos envolvidos nas próteses implantossuportadas em regiões posteriores, estabelecendo-se assim as possíveis vantagens da aplicação da pré-molarização nas reabilitações orais sobreimplantes.

mplant treatment in posterior regions is substantially different, both anatomical and biomechanically, from the anterior regions. Without considering dental implants, and with the loss of posterior teeth, treatment options include an extensive fixed or removable partial denture, especially when no distal tooth abutments are available. Nowadays, the implant-supported dental prosthesis represent a highly effective and acceptable treatment for oral rehabilitation of partially edentulous individuals, however, it became necessary to reevaluate and modify some of the concepts previously established due to the negative impacts provided by prosthesis models in the posterior regions, as the unfavorable emergence profile, making it difficult to control plaque, food impaction and non-axial dissipation of the occlusal forces. By modifying prosthesis design, where molar crowns are replaced by premolars crowns, a possible solution is offered. Thus, three premolars can equivalently replace two molars, a situation that characterizes the concept of premolarization. The aim of this study was to compare the biomechanical and functional aspects involved in implant-supported dental prosthesis for posterior regions, thus establishing the potential benefits of applying the premolarization concept to the implant-supported oral rehabilitation.

Hand and ultrasonic instrumentation for orthograde root canal treatment of permanent teeth

Root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. OBJECTIVES: The objectives of this systematic review of randomized controlled trials were to determine the relative clinical effectiveness of hand instrumentation versus ultrasonic instrumentation alone or in conjunction with hand instrumentation for orthograde root canal treatment of permanent teeth. MATERIAL AND METHODS: The search strategy retrieved 226 references from the Cochrane Oral Health Group Trials Register (7), the Cochrane Central Register of Controlled Trials (CENTRAL) (12), MEDLINE (192), EMBASE (8) and LILACS (7). No language restriction was applied. The last electronic search was conducted on December 13th, 2007. Screening of eligible studies was conducted in duplicate and independently. RESULTS: Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95 percent confdence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomized controlled trials were identifed. CONCLUSIONS: This review illustrates the current lack of published or ongoing randomized controlled trials and the unavailability of high-level evidence based on clinically relevant outcomes referring to the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment. In the absence of reliable research-based evidence, clinicians should base their decisions on clinical experience, individual circumstances and in conjunction with patients' preferences where appropriate. Future randomized controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant, but also patient-centered outcomes.

In vitro fluoride release and tensile bond Strength of a polymeric intra-buccal bioadhesive / Liberación in vitro de flúor y fuerza de tracción de un bioadhesivo polimérico intra-bucal

The intra-buccal polymeric bioadhesive systems that can stay adhered to the oral soft tissues for drug programmed release, with the preventive and/or therapeutic purpose has been employed for large clinical situations. A system based on hydroxypropyl methyl cellulose/Carbopol 934'/magnesium stearate (HPMC/Cp/StMg) was developed having the sodium fluoride as active principle. This kind of system was evaluated according to its resistance to the removal by means of physical test of tensile strength. Swine buccal mucosa extracted immediately after animals' sacrifice was employed as substrate for the physical trials, to obtain 16 test bodies. Artificial saliva with or without mucin was used to involve the substrate/bioadhesive system sets during the trials. Artificial salivas viscosity was determined by means of Brookfield viscometer, showing the artificial saliva with mucin 10.0 cP, and the artificial saliva without mucin 7.5 cP. The tensile strength assays showed the following averages: for the group "artificial saliva with mucin" - 12.89 Pa, and for the group "without mucin" - 12.35 Pa. Statistical analysis showed no significant difference between the assays for both artificial salivas, and it was possible to conclude that the variable mucin did not interfered with the bioadhesion process for the polymeric devices. The device was able to release fluoride in a safe, efficient and constant way up to 8 hours.

Los sistemas bioadhesivos poliméricos intra-bucales pueden permanecer adheridos a los tejidos blandos orales para una liberación programada de fármacos, con finalidad preventiva y/o propósito terapéutico han sido empleados en diversas situaciones clínicas. Un sistema basado en Hidroxipropilmetilcelulosa/Carbopol934Ô/ estearato de magnesio (HPMC/Cp/StMg) fue desarrollado con fluorato de sodio como principio activo. Este tipo de sistema fue evaluado de acuerdo a su resistencia a la eliminación física por medio de pruebas de resistencia a la tracción. Mucosas bucales de cerdos fueron tomadas inmediatamente después del sacrificio de los animales y se utilizaron como sustrato para las pruebas físicas, obteniendo 16 cuerpos de prueba. Saliva artificial con o sin mucina fue utilizada para participar como parte del sistema sustrato/bioadesivo durante los ensayos. La viscosidad de la saliva artificial, se determinó mediante un viscosímetro Brookfield, mostrando la saliva artificial con mucina 10,0 cP y saliva artificial sin mucina 7,5 cP. Las pruebas de resistencia a la tracción mostraron los siguientes promedios: para la "saliva artificial con mucina" - 12,89 Pa, y para el grupo "sin mucina" - 12,35 Pa. El análisis estadístico no mostró diferencias significativas entre las pruebas de saliva artificial, y es posible concluir que la variable de mucina no interfiere con el proceso de bioadhesión del dispositivo polimérico. El dispositivo fue capaz de liberar fluor de forma segura, eficiente y constante durante un máximo de hasta 8 horas.

Evaluation of some biological aspects of the presence of abrasive silica and thickening silica in basic formulations of dentifrices / Evaluación de algunos aspectos biológicos de la presencia de sílice abrasivo y sílice espesante en formulaciones básicas de dentífricos

The aim of this study was to evaluate some biological characteristics and toxicity of basic formulations of dentifrices containing such substances, and to compare them with two existing products in market which also contains silic in their formulations. In this way, it was evaluated some biological parameters: weight of the animals, oral toxicity, hematological parameters, urinary analysis, and histological evaluation. The thrombocytes were also statistically at normal levels. The glutamate-pyruvate transaminase (TGP) showed normal aspect in 5 of the tested groups, as in control. Meanwhile, the oxalacetic transaminase (AST) in one group had a small increase in the control group. Regarding urine, in exception the rats of one group, the rats of the 4 other experimental groups showed leukocytosis urinary statistically higher than the control group. The histological evaluation of the animals showed that specimens from liver, stomach, kidney and submandibular gland presented normal aspects for these organs, without significant characteristics related to inflammatory infiltrates in any of the 6 samples tested in their respective groups.

El objetivo del estudio fue evaluar algunas características biológicas y de toxicidad provenientes de las formulaciones básicas de dentífricos que contienen sílice en su composición y compararlos con dos dentífricos disponibles comercialmente que también presentan sílice. El análisis hematológico no mostró diferencias entre los grupos evaluados. Los niveles de trombocitos presentados por los grupos fueron también normales. La transaminasa gluámico pirúbica se mostró un aspecto normal en 5 de los grupos estudiados, así como en el grupo control. La transaminasa glutámico oxaloacética en uno de los grupos tuvo un pequeño incremento. En relación a la orina, 4 grupos presentaron leucocitosis urinaria significativamente mayor que el grupo de control. La evaluación histológica del hígado, estómago, riñones y glándulas submandibulares se presentó con aspecto normal, sin presencia de infiltrado inflamatorio.

Métodos mecânicos para o controle do biofilme dentário supragengival / Mechanical methods to control the supragingival biofilm

A placa dentária tem as propriedades de um biofilme semelhante a outros encontrados no corpo humano e na natureza. Aproximadamente 1000 espécies bacterianas diferentes são encontradas nos biofilmes dentários que são muito heterogêneos em sua formação estrutural. Na cavidade oral, o biofilme dentário é o responsável por duas das doenças mais prevalentes na população brasileira: a cárie dental e a doença periodontal. Métodos mecânicos estão entre as ações preventivas mais empregadas para o controle do biofilme dentário supragengival. Nesse artigo, são abordados os seguintes métodos para o controle do biofilme dentário: escovas dentárias, higiene interdentária e escovas elétricas. Objetivando o desenvolvimento desta revisão, foi considerada a literatura publicada desde 1920 até o momento da submissão do artigo (2008), empregando-se como meio de busca Medline, Scielo, MeSH, The Cochrane Library e pesquisa em biblioteca. Os descritores usados foram: biofilme dentário; doença periodontal; escovas dentárias; higiene interdentária; fio dental; escovas elétricas; prevenção. Interessante notar que mais importante que o tipo de instrumento (manual ou automatizado), a técnica empregada ou a qualidade do material dentário preventivo que se usa, o modo como o indivíduo higieniza seus dentes e tecidos moles bucais, notadamente vinculada à sua habilidade nata e ao grau de instrução de higiene oral recebidos, são fatores determinantes para a remoção do biofilme dentário e a promoção da saúde.

Dental plaque has the properties of a biofilm, similar to other biofilms found in the body and the environment. Modern molecular biological techniques have identified about 1000 different bacterial species in the dental biofilm, twice as many as can be cultured. Oral biofilms are very heterogeneous in structure. Additionally, in the oral cavity, dental biofilm is the responsible for dental caries and periodontal disease, two of the more prevalent diseases in Brazil. Mechanical methods are among the more employed preventive actions aiming the supragingival dental biofilmcontrol. This literature review concerns to the following means for dental biofilm control: toothbrushes, interdental hygiene and electric toothbrushes. Aiming to develop this review, it was considered the published literature since 1920 till the submission of this article, on 2008, and the searching process was developed by: Medline, Scielo, MeSH, The Cochrane Library and hand searching at the Libraries. The descriptors used were: dental biofilm; periodontal disease; toothbrushes; interdental hygiene; dental floss; electric toothbrushes; prevention. It is interesting to observe that in spite of thesort of instrument for dental hygiene (manual or mechanical/electrical), the employed technique or even the preventive dental material quality, the way the individual cleans both his teeth and oral soft tissues, mainly linked to his natural dexterity and to the received oral hygiene degree are marked factors for the dental biofilm removal and, consequentially, to his health promotion.

Oral health in Brazil - Part II: Dental Specialty Centers (CEOs)

The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers), which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System). Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.