Investimentos do Sistema Único de Saúde em avaliação miofuncional do sistema estomatognático / Investments of the Single Health System in myofunctional assessment of the stomatognatic system

Introdução: o sistema estomatognático é responsável por funções inatas e primordiais ao ser humano, como respiração, sucção, deglutição e fonação. O fonoaudiólogo é o profissional qualificado para realizar avaliação, diagnóstico e reabilitação desse sistema. Dessa forma, tais procedimentos são realizados por serviços de fonoaudiologia, e essa produtividade é lançada na plataforma correspondente do Sistema Único de Saúde (SUS) como "avaliação miofuncional do sistema estomatognático". Objetivo: analisar os investimentos do SUS destinados à avaliação miofuncional do sistema estomatognático no Brasil, no período de 2008 a 2021. Metodologia: trata-se de estudo ecológico, de caráter quantitativo, realizado com dados secundários disponibilizados na plataforma DataSUS/TABNet. Os dados coletados se referem a valores apresentados e aprovados para a avaliação miofuncional do sistema estomatognático, no período supracitado, no Brasil. Após a coleta, realizou-se a análise descritiva dos dados, com exposição dos valores absolutos e relativos, das taxas de crescimento e do déficit de repasses dos recursos financeiros. Resultados: no período estudado, foram realizadas 5,4 milhões de avaliações miofuncionais do sistema estomatognático, a um custo total de R$ 21,5 milhões com taxas de crescimento dos investimentos financeiros de até 64,1% ao longo dos anos. Observou-se que, em todo o período estudado, ocorreu déficit de repasses para procedimentos relacionados aos serviços de fonoaudiologia, chegando a taxas de 17464,6% de pagamentos não efetuados. Conclusão: constatou-se que houve aumento dos investimentos financeiros do SUS destinados ao procedimento de avaliação miofuncional. Contudo, foram notados, também, déficits de pagamentos pelas secretarias de saúde, destinados a uma parcela dos procedimentos realizados nos serviços de fonoaudiologia.

Introduction: the stomatognathic system is responsible for innate and primordial functions for human beings, such as breathing, sucking, swallowing and phonation. The speech therapist is the qualified professional to carry out evaluation, diagnosis and rehabilitation of this system. Thus, such procedures are performed by speech therapy services, and this productivity is released on the corresponding platform of the Unified Health System (SUS) as "myofunctional assessment of the stomatognathic system". Objective: to analyze SUS investments for the myofunctional assessment of the stomatognathic system in Brazil, from 2008 to 2021. Methodology: this is an ecological study, of a quantitative nature, carried out with secondary data available on the DataSUS/TABNet platform. The data collected refer to values presented and approved for the myofunctional assessment of the stomatognathic system, in the aforementioned period, in Brazil. After collection, a descriptive analysis of the data was carried out, with exposure of absolute and relative values, growth rates and the deficit in transfers of financial resources. Results: in the studied period, 5.4 million myofunctional assessments of the stomatognathic system were performed, at a total cost of R$ 21.5 million, with growth rates of financial investments of up to 64.1% over the years. It was observed that, throughout the studied period, there was a deficit in transfers for procedures related to speech therapy services, reaching rates of 17464.6% of payments not made. Conclusion: it was found that there was an increase in SUS financial investments for the myofunctional assessment procedure. However, deficits in payments by the health secretariats were also noted, destined for a portion of the procedures performed in the speech-language pathology services.

Effect of different smear layers on the bonding performance and durability of four adhesive systems / 中国组织工程研究

BACKGROUND: When the tooth surface is treated with a rotary or manual instrument, a smudge layer is formed on the enamel and dentin by debris generated by cutting and abrasion. The bonding interface between the adhesive and the dentin is considered as a weak part in the direct repair process. To clarify the effect of smear layer on different kinds of adhesive is significantly important for dentists to select and correctly use the adhesive in clinical treatment. OBJECTIVE: To evaluate the effect of different diamond burs on the dentin bonding performance of four adhesive systems to dentin after 24 hours and 100 days of artificial saliva-storage. METHODS: Adhesive systems were: (1) VSA (Optibond Versa, Kerr); (2) AIO (Optibond All in One, Kerr); (3) SBU (Single bond Universal, 3M); (4) GLU (Bond 5, Gluma, Heraeus). In present study, 80 extracted human molars were randomly divided into four groups and each group is divided into 4 subgroups. Dentin surfaces were prepared by: (1) 600-grit SiC-paper (control group); (2) super-fine diamond bur; (3) regular diamond bur; (4) coarse diamond bur. Bonding agent was applied according to each manufacturer’s instruction. After light-curing, dentin surfaces were built-up with resin composite (A2, CHARISMA, Heraeus). The micro-tensile bond strength was determined after 24 hours and 100 days of storage in artificial saliva at 37 °C. The fractured surfaces on dentin side were observed by scanning electron microscope. RESULTS AND CONCLUSION: (1) Storage for 24 hours: There was no significant difference among groups under VSA and GLU. Under SBU and AIO, the bond strength in the coarse diamond bur group was significantly lower than that in the control group (P 0. 05). Using coarse diamond bur, the bond strength in the VSA group had significant difference compared with the AIO, GLU and SBU groups (P 0. 05). (2) Storage for 100 days, there was no significant difference among groups under VSA and GLU. Under SBU, the bond strength in the coarse diamond bur group was significantly lower than that in the control group (P 0. 05). Using regular diamond bur, the bond strength showed no significant difference in the GLU group compared with the SBU, and VSA groups (P > 0. 05). Using coarse diamond bur, the bond strength had no significant difference between VSA and AIO groups (P < 0. 05). (3) Using VSA, the bond strength in each group at 100 days showed significant difference compared with that at 24 hours (P < 0. 05). (4)Compared with immersed for 24 hours, the ratio of bond interface and combined crack in the VSA, SBU and GLU groups after immersed for 100 days was increased, especially the VSA group. Compared with the other groups, the ratio of bond interface and combined crack in the GLU group after immersed for 24 hours and 100 days both increased by 50%. (5) These results indicate that preparation by different burs produces different smear layers, which has significant effect to self-etching adhesive system and has no significant effect to total-etching adhesive system. Storage time makes effect on different adhesives.

Automatic Electronic Device Used for the Evaluation of Cyclic-Fatigue Resistance of Nickel-Titanium Instruments

he aim of this study was to evaluate the cyclic-fatigue fracture of different Nickel-Titanium motor-driven rotary instruments (ProTaper® Universal, ProFile®, and Mtwo® systems) in artificial canals by means of an Automatic Electronic Device (AED). The study was performed using NickelTitanium instruments 25/0.06 evaluated in canals with a 45-degree curvature and 2-mm radius. The analyses evaluated two parameters: fracture by cyclic fatigue, and time of fracture; in addition, the length of separated fragment was evaluated. Medians and range values were calculated for each group. Data were analyzed by the Kruskall-Wallis and Mann-Whitney U tests to determine statistical difference. The ProFile motor-driven rotator system exhibited highest resistance to fracture due to cyclic fatigue and highest fracture time compared with the ProTaper and Mtwo systems (p <0.05). The equipment proposed in this study (AED) demonstrated efficiency for recording information, automation, scheduled work times and durations, cycle number, time of fracture, pressure changes and, principally control of the human factor.

l objetivo del presente estudio fue evaluar la fractura a la fatiga cíclica de diferentes instrumentos rotatorios de Niquel-Titanio (sistemas ProTaper® Universal, ProFile® y Mtwo®) en conductos artificiales por medio de un Dispositivo Electrónico Automático (DEA). Se usaron instrumentos de Niquel-Titanio 25/0.06, los cuales se evaluaron en conductos con una curvatura de 45 grados y 2 milímetros de radio. Se analizaron dos parámetros: Fractura a la fatiga cíclica y tiempo a la fractura; además se evaluó la longitud del fragmento separado. Medianas y rangos fueron calculados para cada uno de los grupos. Los resultados fueron analizados por las pruebas de Kruskall-Wallis y U de Mann-Whitney para determinar diferencias estadísticas. El Sistema ProFile mostró una mayor resistencia y tiempo a la fractura en comparación con los sistemas ProTaper y Mtwo (p <0.05). El equipo propuesto en este estudio (DEA) demostró eficiencia para el registro de la información, tiempos de trabajo y duración, número de ciclos, tiempo a la fractura, cambios en la presión y principalmente control del factor humano.

Influence of Apical Patency and Cleaning of the Apical Foramen on Periapical Extrusion in Retreatment

This study evaluated the influence of apical patency, root filling removal technique and cleaning of the apical foramen, concerning the amount of debris extruded during root canal retreatment. Forty mandibular incisors were randomly assigned to 4 groups - GIM (n=10), GIIM (n=10), GIPT (n=10) and GIIPT (n=10), which were named according to leaving (I) or not (II) apical patency during canal preparation and filling removal technique (manual - M or ProTaper system - PT). After filling material removal, each specimen of each group had the apical foramen cleaned by sizes 15, 20 and 25 instruments, generating 12 subgroups: GIM15, GIM20, GIM25, GIIM15, GIIM20, GIIM25, GIPT15, GIPT20, GIPT25, GIIPT15, GIIPT20 and GIIPT25. Extruded filling debris was collected by a Milipore filtration system, an HV-durapore, 0.45 µm pore filter with a 25 mm diameter. The filters were weighed before and after the collection on an analytical scale (10–5 g), and the difference was calculated. The mean weight of extruded filling debris was analyzed statistically by Kruskal-Wallis and Friedman ANOVA tests (α=0.05). The mean values found in the groups (in mg) were: GIM (0.95±0.94), GIIM (0.47±0.62), GIPT (0.30±0.31) and GIIPT (0.32±0.44). There was no statistically significant difference among any of the groups or subgroups (p>0.05). ProTaper provided the smallest amount of extruded filling material, regardless of presence or absence of apical patency, followed by manual technique, without and with apical patency. Additional amounts of debris were collected during cleaning of the apical foramen, regardless of the instrument, presence/absence of patency or root filling removal technique.

Este estudo verificou a influência da patência apical, técnica de desobturação e limpeza foraminal na quantidade de material sólido extruído, durante retratamento endodôntico. Quarenta incisivos inferiores foram divididos aleatoriamente em quatro grupos - GIM (n=10), GIIM (n=10), GIPT (n=10) e GIIPT (n=10) - nomeados de acordo com a realização (I) ou não (II) de patência apical durante o preparo de canais e a técnica de desobturação - manual (M) ou sistema ProTaper (PT). Após a desobturação, realizou-se a limpeza foraminal em cada espécime de todos os grupos com instrumentos #15, #20 e #25, gerando 12 subgrupos: GIM15, GIM20, GIM25, GIIM15, GIIM20, GIIM25, GIPT15, GIPT20, GIPT25, GIIPT15, GIIPT20 e GIIPT25. O material sólido extruído foi coletado pelo sistema de filtração Millipore®, com filtros de 0,45 µm de poro e 25 mm de diâmetro. Os filtros foram pesados antes e após a coleta, em balança analítica de precisão (10–5g), e as diferenças foram calculadas. Os valores médios encontrados (em mg) foram: GIM (0,95±0,94), GIIM (0,47±0,62), GIPT (0,30±0,31) e GIIPT (0,32±0,44), sem diferença estatística entre quaisquer dos grupos ou subgrupos (p>0,05). O sistema Protaper proporcionou a menor quantidade de material sólido extruído, independente da presença ou não de patência apical seguidos da técnica manual sem e com patência apical. Quantidades adicionais foram coletadas durante a limpeza foraminal, independente do instrumento utilizado, da presença ou não da patência apical ou da técnica de desobturação.

Approaches And Future Direction Of Social Security System: Malaysian Perspective

Social security traditionally means a social insurance program providing social protection, or protection against socially recognized conditions, including poverty, old age, disability, unemployment and others. It also hovers around the subject of social insurance, where people receive benefits or services in recognition of contributions to an insurance scheme. Providing services for medical care, aspects of social work and even industrial relations may be included as part of social security services. Lately, the term is also used to refer to basic security, a term roughly equivalent to access to basic necessities. The 1 World Conference on Social Security organised by the Brazilian Government on 1st to 5th of December 2010 stimulates the countries to adopt universal, comprehensive and equitable social security systems as a valid, ethical and feasible option in the process of national reforms and regional integration. The main challenge to achieving the noble objective of universal social security system is financial sustainability and social cohesion supported by political will. As seen in a number of countries, Malaysia has a mixed social security schemes comprising state and private schemes, statutory obligatory requirements on the part of employers as well as state social assistance programmes. Maintaining the quality of life of the individuals and their dependents has become the primary focus of policies and programmes in providing social security. Among the critical pressures on the population’s standard of living is the provision of health care. Extension of the coverage for social security is critical in ensuring social inclusion.

Wear promoted in the apical third of simulated canals after instrumentation with protaper universal system

OBJECTIVE: This study evaluated the wear in the apical third of simulate canals after preparation with ProTaper Universal Rotary System. MATERIAL AND METHODS: 24 sets of instruments were used in 24 simulated canals in transparent epoxy resin blocks with degree of curvature of either 20°or 40°. The canals were photographed preoperatively and after preparation of the apical stop with ProTaper F3, F4 and F5 instruments. The initial and final images were exported to Adobe Photoshop® software and superimposed to detect the root canal wall differences (in mm) between them, in two points located 1 (A) and 5 (B) mm from the point where the working length was established. Data were subjected to analysis of variance to verify the existence of interaction among the factors: canal curvature, instrument size and curve location. Significant level was set at 5 percent. RESULTS: Regardless of the location and the canal curvature, F4 and F5 instruments produced the greatest wear (p<0.05). CONCLUSIONS: There was a deviation from the original pathway towards the outside of the root curvature in both analyzed points. All instruments produced canal transportation, but the F4 and F5 instruments produced more than the other instruments, and should thus be used with care in curved canals.