Do irrigation solutions used during root canal instrumentation influence the adhesion of glass fiber posts? A systematic review / As soluções de irrigação usadas durante a instrumentação do canal radicular influenciam a adesão de pinos de fibra de vidro? Uma revisão sistemática

Statement of problem: the bond strength between adhesive cement and root dentin can be affected by irrigation protocols. Purpose: therefore, the objective of this systematic review was to answer the following question: Do irrigation solutions used during root canal instrumentation influence the adhesion of glass fiber posts to root dentin? Material and Methods: this study followed the recommendations of PRISMA 2020 for writing. PubMed, Scopus, Web of Science, and LILACS databases were searched for articles published until 26 January, 2022. Grey literature and a manual search were also performed. The inclusion criteria were based on the PICO strategy: permanent human or animal teeth (P), which were irrigated during root canal instrumentation with endodontic substances (I) and compared to irrigation with sodium hypochlorite at various concentrations (C) to analyze the bond strength of glass fiber posts (O). Two authors independently performed data extraction and the risk of bias. Results: eight articles were included. Four articles were classified as having a high risk of bias, where the others as medium risk. Studies have reported conflicting results regarding the influence of irrigating solutions and the different concentrations of sodium hypochlorite on the adhesion of glass fiber posts to root dentin. Conclusion: the heterogeneity between studies did not allow the conclusion of a true estimate regarding this topic, and further well-designed studies are needed to clarify this issue. Register: CRD42020221835. (AU)

Definição do problema: a resistência de união entre o cimento adesivo e a dentina radicular pode ser afetada pelos protocolos de irrigação. Objetivo: portanto, o objetivo desta revisão sistemática foi responder à seguinte questão: As soluções de irrigação usadas durante a instrumentação do canal radicular influenciam a adesão de pinos de fibra de vidro à dentina radicular? Material e Métodos: este estudo seguiu as recomendações do PRISMA 2020 para sua redação. As bases de dados PubMed, Scopus, Web of Science e LILACS foram pesquisadas para artigos publicados até 26 de janeiro de 2022. A literatura cinza e uma pesquisa manual também foram realizadas. Os critérios de inclusão foram baseados na estratégia PICO: dentes humanos ou animais permanentes (P), que foram irrigados durante a instrumentação do canal radicular com substâncias endodônticas (I) e comparados à irrigação com hipoclorito de sódio em várias concentrações (C) para analisar a resistência de união de pinos de fibra de vidro (O). Dois autores realizaram independentemente a extração de dados e o risco de viés. Resultados:oito artigos foram incluídos. Quatro artigos foram classificados como de alto riscode viés, enquanto os demais como de médio risco. Estudos relataram resultados conflitantes sobre a influência de soluções irrigadoras e as diferentes concentrações de hipoclorito de sódio na adesão de pinos de fibra de vidro à dentina radicular. Conclusão: a heterogeneidade entre os estudos não permitiu a conclusão de uma estimativa verdadeira sobre este tópico, sendo necessários mais estudos bem delineados para esclarecer esta questão. Registo: CRD42020221835 (AU)

Robert Jones bandage versus cast in the treatment of distal radius fracture in children: A randomized controlled trial / 中华创伤杂志(英文版)

PURPOSE@#The present study aimed to treat fractures of the distal end of the radius in children with Robert Jones (RJ) bandage. The objective was to compare this treatment modality with the cast regarding the frequency of the complication occurrence, child comfortability, and family satisfaction.@*METHODS@#The study was a randomized controlled non-inferiority clinical trial including children with recent (less than 5 days) fractures at the distal end of the radius OTA/AO 23-A2, which is usually treated conservatively. Those with open fractures, pathological fracture, severely displaced fracture that needs reduction or multiple injuries were excluded. The participants were divided randomly into 2 groups according to the treatment modalities. Group 1 was treated by plaster of Paris cast (the control group), and Group 2 by modified RJ bandage (the trial group). The difference between the 2 groups was found by the Chi-squared test. The difference was considered statistically significant when the p value was less than 0.05.@*RESULTS@#There were 150 children (aged 2 - 12 years, any gender) included in the study, 75 in each group. The complications occured in 5 (3.3%) cases only, pressure sores of 3 cases in Group 1 and fracture displacement of 2 cases in Group 2. There was no statistically significant difference in the rate of complication occurrence between both modalities of treatment (p = 0.649). Children treated by RJ bandages were more comfortable than those treated by the cast (97.3% vs. 73.3%, p < 0.001) with a statistically significant difference between them. Contrary to that, the families were more satisfied with the cast than RJ bandage (88.0% vs. 81.3%), but without a statistically significant difference (p = 0.257).@*CONCLUSION@#RJ bandage is a non-inferior alternative to the cast for the treatment of fractures at the distal end of the radius that can be treated conservatively in children.

Evaluation of an open access generic 3D software for Orthodontic diagnosis and treatment planning

Aim: To evaluate the accuracy and the validity of orthodontic diagnostic measurements, as well as virtual tooth transformations using a generic open access 3D software compared to OrthoAnalyzer (3Shape) software; which was previously tested and proven for accuracy. Methods: 40 maxillary and mandibular single arch study models were duplicated and scanned using 3Shape laser scanner. The files were imported into the generic and OrthoAnalyzer software programs; where linear measurements were taken twice to investigate the accuracy of the program. To test the accuracy of the program format, they were printed, rescanned and imported into OrthAnalyzer. Finally, to investigate the accuracy of editing capabilities, linear and angular transformation procedures were performed, superimposed and printed to be rescanned and imported to OrthoAnalyzer for comparison. Results: There was no statistically significant difference between the two groups using the two software programs regarding the accuracy of the linear measurements (p>0.05). There was no statistically significant difference between the different formats among all the measurements, (p>0.05). The editing capabilities also showed no statistically significant difference (p>0.05). Conclusion: The generic 3D software (Meshmixer) was valid and accurate in cast measurements and linear and angular editing procedures. It can be used for orthodontic diagnosis and treatment planning without added costs

Three-dimensional analysis of the gap space under forearm casts / 中华创伤杂志(英文版)

PURPOSE@#Secondary displacement represents a frequent complication of conservative treatment of fractures, particularly of the distal radius. The gap space between skin and cast may lead to a certain degree movements and this increased mobility might favor redisplacement. The aim of this study was to develop a new 3D method, to measure the gap space in all 3 geometrical planes, and to validate this new technique in a clinical setting of distal radius fractures.@*METHODS@#This study applies 3D imaging to measure the space between plaster and skin as a potential factor of secondary displacement and therefore the failure of conservative treatment. We developed and validated a new methodology to analyze and compare different forearm casts made of plaster of Paris and fiberglass. An unpaired t-test was performed to document differences between the investigated parameters between plaster of Paris and fiberglass casts. The significance level was set at p < 0.05.@*RESULTS@#In a series of 15 cases, we found the width of the gap space to average 4 mm, being slightly inferior on the radial side. Comparing the two different casting materials, plaster of Paris and fiberglass, we found a significantly larger variance of space under casts made of the first material (p=0.39). A roughness analysis showed also a markedly significantly higher irregularity of the undersurface of plaster of Paris as compared with fiberglass.@*CONCLUSION@#This study allows for a better understanding of the nature of the "gap space" between cast and skin and will contribute to develop and improve new immobilization techniques and materials.

Does the Presence of Clubfoot delay the Onset of Walking? / A presença do pé torto congênito atrasa o início da marcha?

Abstract Objective Congenital clubfoot (PTC) is a congenital orthopedic condition often requiring intensive treatment; little is known about the impact of such treatment on motor development. The present study assessed whether gait development is later in patients with PTC treated with the Ponseti method in comparison to a control group and analyzed possible related factors. Methods Patients born at term, < 6 months old, not submitted to previous treatment and with a minimum follow-up period of 24 months were included. The control group consisted of patients with no musculoskeletal disorders seen during the present study. Results The study group consisted of 97 patients, whereas the control group had 100 subjects. The mean age at gait start was 14.7 ± 3.2 months in the study group and 12.6 ± 1.5 months in the control group (p< 0.05). Factors related to late gait included age at beginning of treatment > 3 weeks, number of plaster cast changes > 7, recurrence and nonperformance of Achilles tenotomy. Age at beginning of treatment > 3 weeks was related to a greater number of plaster cast changes. Gender and laterality were not related to late gait development. Conclusion Congenital clubfoot patients treated with the Ponseti method show independent walking approximately 2 months later than the control group. Delayed treatment, higher number of plaster cast changes, recurrence and nonperformance of Achilles tenotomy were related to late gait.

Resumo Objetivo O pé torto congênito (PTC) é uma das alterações ortopédicas congênitas que mais frequentemente necessita tratamento intensivo, e pouco se sabe o impacto desse tratamento no desenvolvimento motor. O presente estudo buscou avaliar se pacientes portadores de PTC tratados pelo método de Ponseti desenvolvem a marcha mais tardiamente comparado a um grupo controle e analisar possíveis fatores relacionados. Métodos Incluídos pacientes nascidos a termo, com < 6 meses de idade, sem tratamento prévio e com seguimento mínimo de 24 meses. O grupo controle foi de pacientes sem alterações musculoesqueléticas, atendidos no mesmo período da realização do presente estudo. Resultados Um total de 97 pacientes formaram o grupo de estudo e 100 o grupo controle. A média de idade no início da marcha no grupo de estudo foi de 14,7 ± 3,2 meses, e 12,6 ± 1,5 meses (p< 0,05) no grupo controle. Fatores relacionados à marcha tardia foram: idade de início do tratamento > 3 semanas, número de trocas gessadas > 7, recidiva e não realização da tenotomia de Aquiles. Idade de início do tratamento > 3 semanas esteve relacionada a maior número de trocas de gessos. Gênero e lateralidade não tiveram relação com a marcha tardia. Conclusão Pacientes com PTC tratados com o método de Ponseti apresentam marcha independente aproximadamente 2 meses mais tarde do que o grupo controle. Início mais tardio do tratamento, maior número de trocas de gessos, recidiva e não realização da tenotomia de Aquiles foram relacionados com atraso da marcha.

ULTRA Tomografia Computadorizada Multidetectores com ultra baixa dose de radiação e impressão 3D como auxiliares para cirurgia guiada em implantodontia / Ultra-low dose Multidetector CT and 3D printing as aids to guided implant surgery

Objetivo: relatar um caso clínico de reabilitação com implante dentário imediato realizado utilizando Tomografia Computadorizada Multidetectores (TCMD) com ultra baixa dose de radiação, software de código aberto para manipulação das imagens e impressão 3D de baixo custo do guia cirúrgico. Relato de caso: paciente, sexo masculino, 50 anos de idade, foi avaliado clinicamente relatando dor na região do dente 45, com suspeita de fratura radicular. Como complemento ao exame clínico, o paciente realizou TCMD com ultra baixa dose de radiação para avaliar a condição dentária e do tecido ósseo adjacente. Tendo sido diagnosticada fratura radicular vertical, procedeu-se ao planejamento virtual do implante e à confecção do guia cirúrgico. As imagens em formato DICOM da TCMD foram convertidas para formato STL (Stereolithography) para manipulação e confecção do guia cirúrgico virtual. Esse guia foi impresso em PLA (poliácido láctico) utilizando impressora 3D pelo método FDM (Fusão e Deposição de Material). Após a exodontia atraumática, o guia cirúrgico foi posicionado nos dentes adjacentes e o implante foi inserido. Clinicamente, o paciente encontra-se assintomático, o implante sem sinais clínicos de inflamação e a prótese em função. Uma segunda tomografia do paciente permitiu comparar de forma tridimensional a posição final do implante e o planejamento virtual, que se mostraram equivalentes. Considerações finais: a impressão 3D em PLA mostrou-se uma solução com custo acessível para a produção de guias cirúrgicos, fornecendo previsibilidade e segurança ao implantodontista.(AU)

Objective: to report a clinical case of rehabilitation with dental implant performed using ultra- -low dose Multidetector Computed Tomography (MDCT), open source software for image manipulation, and low cost 3D printing of the surgical guide. Case report: a 50-year-old male patient was clinically evaluated complaining of pain in the tooth 45, and a root fracture was suspected. As a complement to the clinical examination, the patient performed an ultra-low dose MDCT to assess the dental condition and the adjacent bone tissue. A vertical root fracture was diagnosed, and then the virtual planning of the implant and preparation of the surgical guide were performed. The DICOM images from the MDCT were converted into STL (Stereolithography) format for manipulation and confection of the virtual surgical guide. The surgical guide was printed on PLA using a 3D printer by the FDM (Fused Deposition Modeling) method. After atraumatic extraction, the surgical guide was placed in the adjacent teeth and the implant was inserted. Clinically, the patient is asymptomatic, the implant has no clinical signs of inflammation, and the prosthesis is in function. A second ultra- -low dose MDCT of the patient allowed a three-dimensional comparison of the final position of the implant and the virtual planning, which were shown to be equivalent. Final considerations: 3D PLA printing has proved to be an affordable solution for the production of surgical guides, providing predictability and safety for the implantologist.(AU)

Apego al método de Ponseti por parte de los familiares como determinante en el éxito del tratamiento del pie equinovaro / Adherence to the Ponseti method by family members as a determinant in the success of club foot treatment

Resumen: El pie equinovaro aducto congénito (PEVAC) es uno de los padecimientos más comunes en Ortopedia Pediátrica, el cual se compone del equino del retropié, el varo subastragalino, el aducto del antepié y el cavo del mediopié. El método de Ponseti es el tratamiento universalmente aceptado para el PEVAC; éste consta de tres fases: manipulación y enyesado, tenotomía del tendón de Aquiles y una fase de mantenimiento. El mayor porcentaje de las recaídas se presenta en la fase de mantenimiento; en la mayoría de los casos, está asociado el apego familiar deficiente. Presentamos el caso clínico de un paciente con PEVAC típico, tratado en cuatro ocasiones con el método de Ponseti y que no requirió tratamiento quirúrgico.

Abstract: The clubfoot is one of the most common conditions in Pediatric Orthopedics, may affect each part of the foot and ankle, equinus, varus, and internal rotation of the calcaneum, and true equinus of the ankle are common. The Ponseti method is an universally accepted treatment, consisting of three phases: manipulation and plaster, Achilles tendon tenotomy and maintenance phase. The highest percentage of relapses occurs in the maintenance phase and the deficient family member is associated in most cases. We present a clinical case of a patient with typical clubfoot treated with the Ponseti method on four occasions without the need of surgical treatment.

Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study

BACKGROUND: The aim of this study was to compare the results of the standard once-weekly Ponseti casting technique to an accelerated twice-weekly regimen in our population cohort.METHODS: A prospective randomized controlled study was conducted with a total of 100 consecutive patients (158 feet) being enrolled for the study. Fifty patients were randomized to each group and followed up for at least one year.RESULTS: Initial mean Pirani score was 4.67 ± 0.73 in the standard group and 4.35 ± 0.76 in the accelerated group, and the score decreased to 0.34 ± 0.38 and 0.35 ± 0.31, respectively. Initial mean Dimeglio score was 11.75 ± 2.75 in the standard group and 10.51 ± 2.57 in the accelerated group, and the score decreased to 0.79 ± 0.77 and 0.79 ± 0.71, respectively, immediately after casting. The average number of casts required to correct all the deformities was 6.3 ± 1.2 in the standard group and 6.1 ± 1.4 in the accelerated group (p = 0.45). Average time spent in cast was 58.2 ± 8.3 days in the standard group and 39.5 ± 5.2 days in the accelerated group (p < 0.001). Percutaneous Achilles tendon tenotomy was done in 86.42% in the standard group and in 84.41% in the accelerated group (p = 0.72). Final results were assessed by using a modified functional rating scoring system: 55.55% clubfeet had excellent results and 44.45% had good results in the standard group, whereas 66.23% clubfeet had excellent results and 33.77% had good results in the accelerated group. None amongst the two groups had fair or poor results.CONCLUSIONS: These results suggest that the accelerated Ponseti technique significantly reduces the correction time without affecting the final results and that it is as safe and effective as the traditional Ponseti technique.

Thermoplastic nipple splint: A simple method of maintaining nipple projection

Maintaining projection of the reconstructed nipple is important for achieving natural and aesthetically appealing outcomes in breast reconstruction. Although various methods of avoiding mechanical force on the reconstructed nipple have been developed, the existing methods are inconvenient, crude, non-reusable, and difficult to clean or adjust. In the present study, a simple method of creating a nipple splint using a thermoplastic material is described. This splint can be easily manipulated, washed, and reused, and it is comfortable to wear for long-term use without any complications and convenient for the patient to apply.

The accuracy of a 3D printing surgical guide determined by CBCT and model analysis

PURPOSE: The aim of this clinical study was to assess the accuracy of the implants placed using a universal digital surgical guide. MATERIALS AND METHODS: Among 17 patients, 28 posterior implants were included in this study. The digital image of the soft tissue acquired from cast scan and hard tissue from CBCT have been superimposed and planned the location, length, diameter of the implant fixture. Then digital surgical guides were created using 3D printer. Each of angle deviations, coronal, apical, depth deviations of planned and actually placed implants were calculated using CBCT scans and casts. To compare implant positioning errors by CBCT scans and plaster casts, data were analyzed with independent samples t-test. RESULTS: The results of the implant positioning errors calculated by CBCT and casts were as follows. The means for CBCT analyses were: angle deviation: 4.74 ± 2.06°, coronal deviation: 1.37 ± 0.80 mm, and apical deviation: 1.77 ± 0.86 mm. The means for cast analyses were: angle deviation: 2.43 ± 1.13°, coronal deviation: 0.82 ± 0.44 mm, apical deviation: 1.19 ± 0.46 mm, and depth deviation: 0.03 ± 0.65 mm. There were statistically significant differences between the deviations of CBCT scans and cast. CONCLUSION: The model analysis showed lower deviation value comparing the CBCT analysis. The angle and length deviation value of the universal digital guide stent were accepted clinically.

A simple technique for impression taking of teeth and functionally generated paths

The objective of this case report is to introduce a simple technique for simultaneously taking a closed-mouth impression and functionally generated path (FGP) for a full coverage crown restoration. A monolithic zirconia crown was the restoration of choice. An alginate impression of the abutment tooth was taken to fabricate a custom-made closed-mouth impression tray covering the abutment tooth and the adjacent teeth. The tray had an FGP table and an abutment tray in cameo and intaglio surfaces, respectively. The impression was taken with silicone impression material after adjusting the abutment tray and inscribing the FGP using self-curing acrylic resins. Plaster casts were made from the impression, and a zirconia crown was fabricated. The crown was cemented to the abutment tooth with minimal adjustments. This simple technique resulted in a well-fitting crown that accounted for mandibular movements. Using the custom closed-mouth impression tray incorporating an FGP table simultaneously aids in fabricating an accurately fitting restoration that incorporates harmonious mandibular movements using a single impression capture.

Digital models: How can dental arch form be verified chairside?

ABSTRACT Introduction: Plaster dental casts are routinely used during clinical practice to access maxillary dental arch form and assist on fabrication of individualized orthodontic archwires. Recently introduced, digital model technology may offer a limitation for the obtainment of a dental physical record. In this context, a tool for dental arch form assessment for chairside use is necessary when employing digital models. In this regard, paper print of the dental arch seems thus to be useful. Methods: In the present study, 37 lower arch models were used. Intercanine and intermolar widths and dental arch length measurements were performed and compared using plaster dental casts, digital models and paper print image of the models. Ortho Insight 3D scanner was employed for model digitalization. Results: No statistically significant differences were noted regarding the measurements performed on the plaster or digital models (p> 0.05). Paper print images, however, showed subestimated values for intercanine and intermolar widths and overestimated values for dental arch length. Despite being statistically significant (p< 0.001), the differences were considered clinically negligible. Conclusion: The present study suggests that paper print images obtained from digital models are clinically accurate and can be used as a tool for dental arch form assessment for fabrication of individualized orthodontic archwires.

RESUMO Introdução: os modelos de gesso são usados rotineiramente, durante a prática clínica, para avaliação da forma da arcada inferior e para auxiliar na confecção de arcos ortodônticos individualizados. A tecnologia dos modelos digitais, introduzida recentemente, pode oferecer uma limitação na obtenção de um registro físico da arcada dentária. Assim, quando se utilizam modelos digitais, faz-se necessária uma ferramenta clínica para obtenção da forma da arcada. Com essa finalidade, poderia-se imprimir, em papel, uma imagem da arcada dentária obtida a partir do modelo de gesso. Métodos: nesse estudo, 37 modelos da arcada inferior foram utilizados, nos quais foram realizadas medições das distâncias intercaninos, intermolares e comprimento da arcada; sendo, então, comparadas entre modelos de gesso, modelos digitalizados com um scanner Ortho Insight 3D e imagens impressas em folha de papel A4. Resultados: não foram encontradas diferenças estatisticamente significativas nas medidas realizadas nos modelos de gesso e modelos digitais (p > 0,05). As imagens impressas, contudo, mostraram valores subestimados para as distâncias intercaninos e intermolares, e superestimados para o comprimento da arcada. Apesar de serem estatisticamente significativas (p< 0,001), as diferenças foram consideradas clinicamente insignificantes. Conclusão: o presente estudo sugere que as imagens obtidas por meio dos modelos digitais e impressas em papel são clinicamente acuradas e podem ser utilizadas como uma ferramenta auxiliar na confecção dos arcos ortodônticos individualizados.

Nivel de evidencia y grado de recomendación del uso del método de Ponseti en el pie equino varo sindromático por artrogriposis y síndrome de Moebius: una revisión sistemática / Evidence level and grade of recommendation of the Ponseti method for arthrogryposis-related syndromic talipes equinovarus and Moebius syndrome: a systematic review

Resumen: Antecedentes: El pie equino varo aducto congénito (PEVAC) es una malformación musculoesquelética común que afecta de uno a 4.5 de cada 1,000 nacidos vivos; se asocia de manera común a artrogriposis y síndrome de Moebius; éstos son más difíciles de tratar y requieren de tratamientos quirúrgicos agresivos para lograr un pie plantígrado; por lo tanto, ¿cuál es el nivel de evidencia y grado de recomendación del uso del método de Ponseti en el pie equino varo sindromático por artrogriposis y síndrome de Moebius? Métodos: Estudio de diseño de revisión sistemática de acuerdo a las recomendaciones del grupo Cochrane por medio de la identificación de Medical Subject Headings (MeSH) y del método booleano para ubicar artículos que cumplieran con los criterios de selección mediante búsqueda de fuentes primarias como OVID, Cochrane, EBSCOhost, Elsevier, Medigraphic. Resultados: En total, seis artículos cumplieron con los criterios de selección a través de la búsqueda de fuentes primarias: cinco de ellos sobre el tratamiento del PEVAC con método de Ponseti en pacientes con artrogriposis y uno para pacientes con Moebius. Se encontraron artículos con niveles de evidencia y grado de recomendación: IV-D (3), III-D (1) y II (B). Conclusiones: El método de Ponseti es un tratamiento inicial en artrogriposis y síndrome de Moebius; es barato, no invasivo y no requiere de un médico para poderse realizar (pero sí un personal capacitado); se recomienda su uso para evitar cirugías extensas y complicaciones médicas que trascienden al orden económico intrahospitalario.

Abstract: Background: Adduct congenital talipes equinovarus (CTE) or clubfoot is a common musculoskeletal malformation affecting between 1 and 4.5 out of every 1000 live births. It is usually associated with arthrogryposis and Moebius syndrome with the latter two being more difficult to treat as they require aggressive surgery to achieve a plantigrade foot. We therefore ask what is the evidence level and grade of recommendation of the Ponseti method to treat syndromic talipes equinovarus resulting from arthrogryposis and Moebius syndrome. Methods: Systematic review according to the recommendations of the Cochrane group identifying medical subheadings (MeSH) and of the Boolean method to identify the articles that met the selection criteria through the search of primary sources such as OVID, Cochrane, EBSCOhost, Elsevier, Medigraphic. Results: A total of six papers met the selection criteria through the search in the primary sources. Five of them address the treatment of adduct CTE with the Ponseti method in patients with arthrogryposis, and one in patients with Moebius. Evidence levels and grades of recommendation of these papers were: IV-D (3), III-D (1) y II (B). Conclusions: The Ponseti method is an first-line treatment for arthrogryposis and Moebius syndrome. It is unexpensive, non-invasive and does not require a physician to perform it (however, it does require trained staff). Its use is recommended as it avoids extensive surgeries and medical complications that go beyond the hospitals' economic possibilities.

Evaluación ultrasonográfica del tendón de Aquiles en niños con pie equino varo aducto congénito posterior a tenotomía de Aquiles con el método de Ponseti. Seguimiento a 12 semanas / Sonographic evaluation of Achilles tendon healing in tenotomies for congenital clubfoot and Ponseti's treatment. A 12-week follow-up

Resumen: Objetivo: Determinar el tiempo de curación del tendón de Aquiles en pacientes pediátricos tratados mediante tenotomía de Aquiles con método Ponseti en el Hospital Shriners para Niños de México, AC. Material y métodos: Estudio experimental, analítico, prospectivo, longitudinal de pacientes con diagnóstico de pie equino varo aducto congénito idiopático en tratamiento con método Ponseti con evaluación estática y dinámica mediante ecógrafo en tiempo real Siemens Diagnostic Ultrasound System Sonoline 650 con transductor lineal de 10.5 mHz seriada del tendón de Aquiles previa a la tenotomía y a las tres, seis, nueve y 12 semanas tras el tratamiento quirúrgico. Resultados: Se obtuvo una muestra de 23 pacientes, 16 masculinos y siete femeninos, 16 con patología bilateral y siete unilateral, para un total de 39 pies, 18 derechos y 21 izquierdos, con una media de edad de 8.3 ± 2.3 meses. Previamente a la tenotomía, la anchura en corte longitudinal ultrasonográfico media fue de 2.7 ± 0.42 mm; en la semana tres, la media fue 3 ± 0.39 mm; a las seis semanas, 2.92 ± 0.36 mm; el ultrasonido de las nueve semanas reportó media de 2.84 ± 0.38 mm y a las 12 semanas, 2.82 ± 0.39 mm. Se compararon mediante t de Student el ancho prequirúrgico y a las 12 semanas, sin encontrarse diferencia p > 0.03. Conclusiones: La valoración ecográfica muestra integridad a las tres semanas posteriores a la tenotomía de Aquiles. Sin embargo, la reparación completa se logra a las 12 semanas.

Abstract: Objective: The aim of this study was to determine the healing time of Achilles tendon in pediatric patients treated with Achilles tenotomy with the Ponseti method in Shriners Children's Hospital of Mexico, AC. Material and methods: Experimental, analytical, prospective, longitudinal study of patients with a diagnosis of idiopathic congenital clubfoot treated with the Ponseti method with serial static and dynamic evaluation by ultrasound in real time with a Siemens Diagnostic Ultrasound System Sonoline 650, linear transducer 10.5 MHz of Achilles tendon before tenotomy and at three, six, nine and 12 weeks after the surgical treatment. Results: A sample of 23 patients, 16 male and seven female, 16 with unilateral and seven with bilateral pathology was obtained, for a total of 39 feet, 18 right and 21 left, with a mean age of 8.3 ± 2.3 months. Before tenotomy, the width was 2.7 ± 0.42 mm; in week three, the average was 3 ± 0.39 mm; at six weeks, 2.92 ± 0.36 mm; ultrasound at nine weeks reported an average of 0.38 ± 2.84 mm, and 2.82 ± 0.39 mm at twelve weeks. They were compared using Student's t presurgical width and at twelve weeks, without finding difference p > 0.03. Conclusions: Although there is integrity at three weeks after Achilles tenotomy, complete repair is achieved at 12 weeks.

Tratamiento del pie bot idiopático luego de la edad de la marcha: revisión sistemática de la bibliografía / Treatment of the idiopathic clubfoot after the walking age: a systematic bibliographic review

Introducción: La eficacia obtenida con el método de Ponseti en pacientes recién nacidos ha llevado a extender las indicaciones a pacientes de mayor edad. Llevamos a cabo una revisión sistemática de la bibliografía para: 1) definir el grado de comprobación científica con respecto al tratamiento del pie bot con el método de Ponseti en niños >1 año, 2) determinar el número de yesos y procedimientos asociados, 3) determinar el porcentaje de corrección y 4) identificar la tasa de complicaciones. Materiales y Métodos: Utilizando las bases de datos informáticas disponibles en Ovid, PubMed, LILACS y Cochrane Library, se recogieron todos los trabajos sobre pacientes >1 año, con tratamiento de pie bot idiopático mediante el método de Ponseti, publicados hasta el 1 de mayo de 2014. Se revisaron aquellos que cumplieran con criterios de inclusión y exclusión prestablecidos. Resultados: La muestra analizada incluyó 11 estudios con 492 pacientes. La edad promedio al iniciar el tratamiento fue de 3.8 años (rango 1-18). El seguimiento promedio fue de 31 meses. Se realizaron un número promedio de 8 yesos (rango 4-12). Se consiguió un pie plantígrado en el 75% de los casos. La tasa de complicaciones fue del 4,3%. Conclusiones: La evidencia actual en niños >1 año tratados con el método de Ponseti es de nivel IV. Si bien el uso de esta técnica requiere de un mayor número de yesos y procedimientos asociados que en el recién nacido, permite corregir la deformidad, de forma segura, en un alto porcentaje de los casos. Nivel de Evidencia: IV

Introduction: Ponseti´s method efficacy in newborns has led to widen the indications in older patients. A systematic review of the literature was performed to: 1) define the degree of scientific evidence on Ponseti´s method in children over one-year-old with clubfoot; 2) assess the number of casts and associated procedures required to accomplish full correction; 3) determine the percentage of full corrected patients; and 4) identify the rate of recurrence and complications related to this method. Methods: We retrieved from Ovid, PubMed, LILACS and Cochrane Library articles referred to Ponseti´s method in children over one-year-old published until May 1st 2014. Papers that met predetermined inclusion and exclusion criteria were reviewed. Results: Eleven papers met the inclusion criteria. The sample consisted in 492 patients. Average age at the beginning of treatment was 3.8 years (range 1-18). Average follow-up was 31 months. A mean of 8 (range 4-12) casts was required to accomplish full correction. Plantigrade feet were achieved in 75%. Complication rate was 4.3%. Conclusions: Current evidence regarding Ponseti’s method for patients over one-year-old is primarily Level IV. Even though this technique requires higher number of casts and associated procedures, deformity correction is safely achieved in most patients. Level of Evidence: IV

Odontometric analysis of molars for sex determination

Aim: To investigate the existence of sexual dimorphism between the first and second permanentmolars. Methods: A cross-sectional, observational, blind study using comparative and statisticaldescriptive procedures. The sample included 50 pairs of plaster casts from undergraduate dentalstudents (25 men/25 women) from the Federal University of Paraíba, João Pessoa/PB, Brazil,aged 20-26 years. Odontometric measurements of first and second maxillary/mandibular, right/left permanent molars were performed. Mesiodistal (MD) and buccolingual/palatal (BL/BP) widthsand the distance between the lingual cusps of corresponding molars in opposite quadrants, weremeasured. The data were analyzed by Student’s t test and ANOVA with Bonferroni (p≤0.05).Results: The crowns of all first molars were statistically larger in men than in women (p<0.05).Maxillary and mandibular left second molars (#27 and #37) did not differ in their MD widths (p=0.66,p=0.75), whereas mandibular left and right second molars (#37 and #47) showed statisticallydifferent BL widths (p=0.007 and p=0.008). As to the distance between the lingual cusps, only thefirst left-to-right mandibular molars (#36-46) showed no sex dimorphism (p=0.107). Conclusions:Molars are larger in males than in females. Individually, first molars demonstrated higher evidenceof sex distinction than second molars.

Does the maxillary anterior ratio in Korean adults follow the Golden Proportion?

PURPOSE: The purpose of this study was to determine the effect of changes in the horizontal plane angle on the mesiodistal width ratios of the maxillary anterior teeth during the acquisition of frontal view photographs, derive these ratios for Korean adults on the basis of the data obtained, and analyze them using the Golden Proportion as a reference. MATERIALS AND METHODS: In experiment I, 30 plaster casts were mounted on an articulator and positioned on the angle-measuring device with a center setting of 0°. The device was rotated to 10° in 1° increments in a counterclockwise direction. At each angle, photographs were obtained and analyzed. Experiment II was based on 60 patients who visited the Department of Prosthodontics at Kyungpook National University Dental Hospital from February 2012 to February 2015. The patients were divided into three groups [Male (M), Female (F), Total (M + F)]. Frontal views were obtained for all groups and analyzed. RESULTS: From 1° to 10°, the relative mesiodistal width ratios for the maxillary anterior teeth showed no significant differences from those at 0°. In all three groups, the relative width ratio of the maxillary central incisor was smaller than that specified in the Golden Proportion; the opposite was true for the canine. CONCLUSION: Our results suggest that the mesiodistal width ratios of the maxillary anterior teeth do not follow the Golden Proportion in Korean adults, and that a change in the horizontal plane angle from 1° to 10° during frontal photography does not affect these ratios.

Yesos seriados en niños con parálisis cerebral espástica con pie y marcha en equino previamente infiltrados con toxina botulínica tipo A: estudio de 8 casos / Serial casts in children with spastic cerebral palsy and equinus foot previously treated with botulinum toxin type A: study of 8 cases

Introducción: Los yesos seriados son una estrategia de tratamiento para prevenir, corregir o disminuir alteraciones del pie equino, sin embargo, los resultados no son concluyentes cuando se usan combinados con toxina botulínica para mejorar funcionalidad. Objetivo: Evaluar los efectos de yesos seriados en el rango de movimiento (ROM) de tobillo y en la función motora gruesa, de pacientes con parálisis cerebral (PC) espástica ingresados al programa de yesos seriados del Instituto Teletón (IT) Coquimbo, entre junio y septiembre de 2014. Método: Se evaluó el ROM de tobillo mediante test de Silfverskiold y el control motor selectivo (CMS) acorde al protocolo de yesos seriados del IT Coquimbo en 8 niños con PC espástica, Gross Motor Function Classification System (GMFCS) I, infiltrados con toxina botulínica tipo A, en dosis 3U por kg/peso. Anterior al primer yeso y una semana posterior a la última aplicación, fueron evaluados en la función motora gruesa con Gross Motor Function Measure-66 (GMFM-66) en sus dimensiones D y E. Se utilizó test de Wilcoxon para comparar las medianas de las diferencias de los puntajes de las pruebas aplicadas. Se consideró un valor p < 0,05 como estadísticamente significativo. Resultados: Los 8 niños presentaron mejoría significativa en el ROM de tobillo con rodilla en extensión (p = 0,011), con rodilla en flexión (p = 0,011), en la GMFM-66 (p = 0,034) y GMFM-66-D (p = 0,038) de la misma evaluación. La dimensión E no presentó una variación estadísticamente significativa. Conclusión: La terapia con yesos seriados en pacientes con PC espástica, GMFCS I previamente infiltrados con toxina botulínica tipo A, produce incremento en el ROM de tobillo y en GMFM-66-D.

Introduction: Serial casting is a treatment strategy to prevent, correct or reduce alterations of equinus foot; however, the results are not conclusive when used in combination with botulinum toxin to improve function. Objective: To evaluate the effects of serial casting on the range of motion (ROM) of the ankle, and the gross motor function of patients with spastic cerebral palsy (CP) admitted into the serial casting program at Coquimbo Telethon Institute between June and September 2014. Method: The ROM of the ankle was evaluated using the Silfverskiold Test and the selective motor control (CMS), according to the serial casting program at Coquimbo Telethon Institute in 8 children with spastic CP, Gross Motor Function Classification System (GMFCS) level I, and injected with botulinum toxin type A, at a dose of 3U per kg of body weight. Children were evaluated before the first cast and after the last one with the Gross Motor Function Measure, version 66 (GMFM-66), dimensions D and E. Wilcoxon test was used to compare the medians of the differences in all the tests applied. A p-value < 0.05 was considered statistically significant. Results: All children showed significant improvement in ROM of the ankle with extended knee (p = 0.011), and flexed knee (p = 0.011). Similarly, all children showed significant improvement in the GMFM-66 (p = 0.034) and GMFM-66-D (p = 0.038). The GMFM- E did not show significant changes. Conclusion: Serial casting in patients with spastic CP, GMFCS I and previously injected with botulinum toxin type A improved ROM of the ankle and the GMFM-D.

Tratamento estético de diastemas múltiplos com facetas pelo sistema CAD-CAM / Aesthetic rehabilitation of multiple diastemas using veneers produced through CAD-CAM system

Facetas minimamente invasivas, também conhecidas como ôlentes de contatoõ, têm sido consideradas uma alternativa interessante para tratar problemas estéticos nos dentes anteriores. O presente relato de caso descreve passo a passo o tratamento de diastemas múltiplos com facetas minimamente invasivas, e discute tópicos importantes relacionados a este assunto quanto a indicações, materiais utilizados e longevidade destes tipos de restaurações...

Minimally invasive veneers, also known as ôcontact lensesõ, are being considered an interesting alternative for aesthetic rehabilitation of anterior teeth. This case report describes, step by the step the treatment of multiple diastemas with minimally invasive veneers, and addresses important issues related to this topic concerning indications, materials and longevity of these type of restorations...