Tecnologia digital em próteses totais: propriedades dos materiais CAD-CAM e desenvolvimento de uma patente de inovação para simplificação do fluxo de trabalho / Digital technology in complete dentures: properties of CAD-CAM materials and development of an innovation patent to simplify the workflow

Recursos digitais, como a manufatura subtrativa (fresagem CAD-CAM) e a manufatura aditiva (impressão 3D) podem promover significativos avanços, reduzindo o tempo e o custo de produção de próteses totais (PTs). Assim, este estudo objetiva investigar as características superficiais (rugosidade e ângulo de contato), propriedades mecânicas (resistência mini-flexural) e a adesão de biofilme sobre polímeros de PMMA pré-polimerizado para fresagem CAD-CAM e sobre resinas para impressão 3D utilizados na fabricação de bases de PTs, bem como propor um fluxo de trabalho inovador para abreviar e simplificar as etapas de confecção de PTs. Para a análise in vitro, foram fabricados um total de 60 discos e 40 barras distribuídas igualmente em quatro grupos: fresagem CAD-CAM (GF), impressão 3D (GI) e PMMA convencional termopolimerizado por ciclo longo (GCL) ou por energia de micro-ondas (GCM). A rugosidade foi determinada pelo valor de Ra; o ângulo de contato foi medido pelo método da gota séssil; o teste de resistência à mini-flexão foi obtido por teste de flexão de três pontos, enquanto o comportamento frente à formação de biofilme foi analisado através da adesão de biofilme de C. albicans. Os dados foram analisados por meio de estatística descritiva e analítica (α = 0,05). Os resultados mostraram que o GI apresentou a maior rugosidade superficial (Ra: 0,317 ± 0,151µm) e os menores valores de resistência à miniflexão (57,23 ± 9,07MPa) e o GF apresentou a menor adesão de biofilme de C. albicans (log UFC/mL: 3,74 ± 0,57) e maior média de resistência à mini-flexão (114,96 ± 16,23 MPa). Não houve diferença estatística entre o GF e os grupos convencionais para rugosidade, ângulo de contato e resistência à mini-flexão. A patente de inovação desenvolvida estabeleceu um novo fluxo de trabalho para confecção de próteses totais através de um protocolo de três consultas em que foram feitas as moldagens anatômicas na 1ª sessão, juntamente com o registro do suporte labial, plano oclusal e linhas de referência para subsidiar a montagem dos dentes superiores. Uma prótese-teste foi confeccionada por meio de procedimentos convencionais ou CAD-CAM e avaliada na 2ª consulta, permitindo observar o resultado estético, executar a moldagem funcional e realizar o registro da relação maxilo-mandibular, fornecendo referências precisas para a confecção da prótese inferior. Com base nos resultados da fase in vitro deste estudo, os corpos-de-prova obtidos a partir de disco para fresagem CAD-CAM apresentaram resistência flexural e propriedades superficiais semelhantes às resinas convencionais e mostraram um comportamento inibidor da adesão de C. albicans, enquanto os espécimes produzidos por impressão 3D exibiram a menor resistência à flexão e a maior rugosidade da superfície. O dispositivo inovador apresentado para a execução das etapas clínicas relacionadas à fabricação de PTs mostrou-se efetivo para abreviar e simplificar as técnicas disponíveis, apresentando confiabilidade e previsibilidade para produção de PTs em número de sessões reduzido (AU).

Digital features like subtractive and additive manufacturing can promote breakthroughs by reducing the time and cost of making complete dentures (CDs). Thus, this study aims to investigate surface characteristics (roughness and contact angle), mechanical properties (mini-flexural strength), and biofilm adhesion on computer-aided design/computer-aided manufacturing (CAD-CAM) PMMA polymer, and threedimensional (3D) printed resin for denture´s base fabrication as well as to propose an innovative workflow. For in vitro analysis, a total of 60 discs and 40 rectangular specimens were fabricated from one CAD-CAM pre-polymerized PMMA disc (GF), one 3D-printed (GI), and two conventional heat-polymerized (GCL and GCM) materials for denture base fabrication. Roughness was determined by the Ra value; the contact angle was measured by the sessile drop method; the mini-flexural strength test was a three-point bending test while the biofilm formation inhibition behavior was analyzed through C. albicans adhesion. The data were analyzed using descriptive and analytical statistics (α = 0.05). Results showed that GI specimens presented the highest surface roughness (Ra: 0.317 ± 0.151 µm) and lowest mini-flexural strength values (57.23 ± 9.07 MPa) and the GF showed the lowest C. albicans adhesion (log CFU/mL: 3.74 ± 0.57) and highest mini-flexural strength mean (114.96 ± 16.23 MPa). There was no statistical difference between GF and conventional groups for roughness, contact angle, and mini-flexural strength. In turn, the presented novel workflow for complete dentures fabrication reached a three appointments protocol in which preliminary impressions were made in the 1st session, all together to maxillary registration of lip support, occlusal plane, and reference lines for teeth arrangement. A trial denture was manufactured and evaluated by the 2nd appointment through conventional or CAD-CAM procedures, allowing esthetics evaluation, final impression, and maxillomandibular relationship record and providing precise references for final dentures fabrication. Based on the findings of this in vitro study, GF presented surface and mechanical properties similar to conventional resins and show improved behavior preventing C. albicans adhesion, while GI specimens exhibited the lowest flexural strength, and highest surface roughness. The proposed device for CD´s fabrication clinical procedures reached feasibility and by simplifying available techniques, this protocol could achieve reliability and predictability to produce complete dentures with reduced working time (AU).

Nanopartículas de plata contra bacterias presentes en biofilm dental de pacientes pediátricos / Silver nanoparticles against bacteria present in dental biofilm of pediatric patients

Introducción: el biofilm dental microbiano es el precursor de diversas enfermedades orales, una de ellas la caries, ésta representa la enferme- dad oral más significativa a nivel mundial, con una incidencia de 1.76 billones de niños afectados. Las nanopartículas de plata (AgNPs) se están usando como alternativa para el control y prevención del biofilm dental, ya que poseen propiedades antimicrobianas contra bacterias relacionadas a estas enfermedades. Sin embargo, no hay estudios que evalúen este comportamiento en pacientes pediátricos. Objetivo: eva- luar la actividad antimicrobiana de las AgNPs en bacterias de aislados clínicos tomados de pacientes pediátricos. Material y métodos: se tomó muestra del biofilm dental de 22 pacientes pediátricos, el efecto micro- biológico se evaluó mediante ensayos microbiológicos estandarizados internacionalmente por triplicado, usando dos diferentes tamaños de AgNPs. Resultados: los dos tamaños de AgNPs mostraron inhibición bacteriana, sin embargo, sólo se vio una diferencia estadísticamente significativa entre el género (p < 0.05), además, en general, hubo una correlación positiva significativa en relación a la concentración de las AgNPs y la velocidad del crecimiento bacteriano (p < 0.05). Conclusión: las AgNPs se pueden considerar como una alternativa para la prevención del biofilm dental y de esta manera para el control de diferentes enfermedades orales (AU))

Introduction: dental biofilm is the precursor of oral diseases, one of them dental caries, this represents the most significant oral disease worldwide with an incidence of 1.76 billion affected children. Silver nanoparticles (AgNPs) are being used as an alternative for the control and prevention of dental biofilm since they have antimicrobial properties against bacteria related to these diseases. However, there are no studies evaluating this behavior in pediatric patients. Objective: to evaluate the antimicrobial activity of AgNPs in bacteria from clinical isolates taken from pediatric patients. Material and methods: a sample of dental biofilm was taken from 22 pediatric patients, the microbiological effect was evaluated by international standardized microbiological tests in triplicate, using two different sizes of AgNPs. Results: the two sizes of AgNPs showed bacterial inhibition, however, only a statistically significant difference was seen between gender (p < 0.05), in addition, in general, there was a significant positive correlation in relation to the concentration of AgNPs and the speed bacterial growth (p < 0.05). Conclusion: AgNPs can be considered as an alternative for the prevention of dental biofilm and thus for the control of different oral diseases (AU)

Effectiveness of chlorhexidine oral rinse in preventing plaque accumulation and gingivitis in patients undergoing orthodontic treatment- a systematic review and meta analysis / Eficacia del enjuague oral de clorhexidina en la prevención de la acumulación de placa y la gingivitis en pacientes en tratamiento de ortodoncia: una revisión sistemática y metaanálisis

Aim: The aim of this review was to systematically assess and report the effectiveness of chlorhexidine (CHX) mouthwash in preventing plaque accumulation and gingivitis in patients undergoing orthodontic treatment. Material and Methods: The review was prepared according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and registered under PROSPERO database (CRD42020170776). Four electronic databases were systematically searched along with a complimentary manual search of orthodontic journals until June 2022. Only Randomized Control Trials (RCTs) reporting on antiplaque and antigingivitis efficacy of Chlorhexidine mouthwash compared with placebo or control in orthodontic patients were included. Risk of bias assessment was done using Cochrane ROB-2. Quantitative analysis (Random-Effects Model and Standard Mean Difference (SMD)) with 95 % confidence interval was used. Results: Six RCTs were included for qualitative analysis and four were included for quantitative analysis with a total of 211 participants. Out of six studies, 3 were judged to have a low risk of bias, two had some concerns and one of them had high risk of bias. Random effects meta-analysis performed for anti-plaque effect reported a significant reduction of -1.2 SMD for CHX at 4 to 6 weeks with low heterogeneity (I2-35%). The anti-gingivitis effect at 4 to 6 weeks was significant for CHX with a SMD of -1.03 and a moderate heterogeneity (I2-65%). Conclusion: On analyzing the available evidence a moderate level of certainty supports a short-term reduction in plaque accumulation and gingivitis in orthodontic patients subjected to rinsing with chlorhexidine oral rinse.

Objetivo: El objetivo de esta revisión fue evaluar e informar sistemáticamente la efectividad del enjuague bucal con clorhexidina (CHX) para prevenir la acumulación de placa y la gingivitis en pacientes que reciben tratamiento de ortodoncia. Material y Métodos: La revisión se preparó de acuerdo con las pautas de Preferred Reporting Items for Systematic Reviews (PRISMA) y se registró en la base de datos PROSPERO (CRD42020170776). Se realizaron búsquedas sistemáticas en cuatro bases de datos electrónicas junto con una búsqueda manual gratuita de revistas de ortodoncia hasta junio de 2022. Solo se incluyeron ensayos controlados aleatorios (ECA) que informaron sobre la eficacia antiplaca y antigingivitis del enjuague bucal con clorhexidina en comparación con placebo o control en pacientes de ortodoncia. La evaluación del riesgo de sesgo se realizó mediante Cochrane ROB-2. Se utilizó un análisis cuantitativo (modelo de efectos aleatorios y diferencia de medias estándar (SMD)) con un intervalo de confianza del 95 %. Resultados: Se incluyeron seis ECA para el análisis cualitativo y cuatro para el análisis cuantitativo con un total de 211 participantes. De los seis estudios, se consideró que tres tenían un bajo riesgo de sesgo, dos tenían algunas preocupaciones y uno de ellos tenía un alto riesgo de sesgo. El metanálisis de efectos aleatorios realizado para el efecto antiplaca informó una reducción significativa de -1,2 SMD para CHX a las 4 a 6 semanas con baja heterogeneidad (I2-35%). El efecto antigingivitis a las 4 a 6 semanas fue significativo para CHX con una SMD de -1,03 y una heterogeneidad moderada (I2-65%). Conclusión: Al analizar la evidencia disponible, un nivel de certeza moderado apoya una reducción a corto plazo en la acumulación de placa y gingivitis en pacientes ortodóncicos sometidos a enjuague con enjuague bucal con clorhexidina.

Cepillos interdentales, de la teoría a la práctica. Revisión de literatura e indicaciones clínicas / Interdental toothbrushes, from theory to practice: a review of the literature and clinical indications

Los cepillos interproximales son una herramienta de higiene interdental que tiene variadas indicaciones y múltiples beneficios. Pacientes con enfermedad periodontal, con papilas que no llenan el espacio interdentario, portadores de aparatología ortodóncica, prótesis fija o de implantes entre otros casos, pueden beneficiarse con su utilización. El presente artículo tiene como objetivo dar una orientación de su uso clínico basado en la evidencia científica disponible. Los resultados apoyan su utilización en combinación con el hilo dental para la prevención y tratamiento de las enfermedades bucales más prevalentes, con un efecto marcado sobre el control del biofilm y la inflamación gingival (AU)

Interproximal brushes are an interdental hygiene tool with diverse indications that have, multiple benefits. Among other uses, they are indicated in patients with periodontal disease, with papillae that do not fill the interdental space, patients with orthodontic appliances, fixed prosthesis or implant-supported prosthesis. The aim of this article is provide guidance on their clinical use based on the available evidence. The results support their use in combination with dental floss for preventing and treating the most prevalent oral diseases, with a significant effect on biofilm control and gingival inflammation (AU)

Periodontitis y Alzheimer: posibles mecanismos de vinculación: revisión de la literatura / Periodontitis and Alzheimer: possible linking mechanisms: a review of the literature

La periodontitis es una enfermedad inflamatoria, crónica que afecta a los tejidos de soporte de los dientes y puede repercutir en la salud general, afectando la calidad de vida del paciente. La enfermedad de Alzheimer es una condición neurodegenerativa y progresiva que va disminuyendo la memoria, el lenguaje y aprendizaje de los pacientes. El objetivo de la investigación es realizar una revisión bibliográfica para comprender la posible vinculación entre la periodontitis y el Alzheimer. Los microorganismos periodontopatógenos producen una respuesta inflamatoria que, por vía sistémica, puede desencadenar un mecanismo inflamatorio dentro del sistema nervioso central. La respuesta del hospedero es liberar gran cantidad de moléculas proinflamatorias que comprometen la barrera hematoencefálica sobreestimulando a las células microgliales, esto conduce a la destrucción de neuronas vitales y al mantenimiento de la inflamación crónica que contribuye a la progresión del Alzheimer. Por otra parte, la periodontitis puede favorecer la formación de placas ateromatosas que afectan la integridad vascular siendo éste un factor a considerar en el desarrollo de la patología cerebrovascular. A pesar que son pocos los estudios clínicos experimentales, ya se puede sugerir la correlación entre ambas enfermedades (AU)

Periodontitis is a chronic inflammatory disease that affects the supporting tissues of teeth, affecting the systemic health and quality of life of the patient. Alzheimer's disease is a neurodegenerative and progressive condition that decreases memory, speech and learning of patients. The objective of this literature review was to report the possible link between periodontitis and Alzheimer's disease. Periodontopathogens produce an inflammatory response that, systemically, can trigger an inflammatory mechanism within the central nervous system. Due to this attack, the host releases a great quantity of proinflammatory molecules that compromise the blood-brain barrier by over- stimulation microglial cells, this produces destruction of vital neurons and maintenance the chronic inflammation in CNS and that contribute to the progression of Alzheimer's disease. On the other hand, periodontitis can favor the formation of atheromatous plaques that affect vascular integrity, being a factor to consider in the development of the cerebrovascular disease. Although there are few experimental clinical studies, the correlation between both diseases can already be suggested (AU)

Effectiveness of three different types of educational methods on implementation of proper oral hygiene behaviour prior to orthodontic treatment

ABSTRACT Objective: The aim of this study was to compare three teaching methods' time and personnel requirements, and their effects on plaque and gingival indices. Methods: This study was a single-blind randomized controlled trial on fixed orthodontic appliance candidates (n = 90), assigned into a control group (n = 30) and two different study groups (n = 30 each). The control group received standard printed educational material and was assisted with verbal information. The study groups either received video-assisted or hands-on training about fixed orthodontic appliance and oral hygiene. The time requirements for all three educational interventions was recorded during the initial visit. The adequacy of oral hygiene was documented through plaque and gingival indices during the initial visit and eighth week of the treatment. The continuous variables were analyzed using 1-way ANOVA. Tukey HSD and Student t-tests were used for post-hoc comparisons (α?#8197;= 0.05). Also, a chi-square test was used for the analysis of categorical variables. Results: Standard education failed to maintain the plaque and gingival indices at the eighth week of the treatment. Although both video-assisted and hands-on training took a considerable amount of time, they served well in preserving both of the indices at the eighth week. The longer the educational intervention was, the better the preservation of the plaque and gingival indices. Conclusion: Educational intervention, either with video-assisted or hands-on programs, provided better results in oral hygiene depending on the time and personnel constraints of the orthodontist.

RESUMO Objetivo: O objetivo do presente estudo foi comparar a duração e os pré-requisitos de equipe de três métodos de orientação ao paciente, e seus efeitos sobre os índices de placa e de sangramento gengival. Métodos: Esse foi um estudo controlado aleatório cego em candidatos (n=90) a tratamento ortodôntico fixo, que foram divididos em um grupo controle (n=30) e dois grupos de estudo (n= 30 cada). O grupo controle recebeu material educacional impresso e foi orientado com informações verbais. Os grupos de estudo receberam treinamento em formato de vídeo ou treinamento hands-on sobre o tratamento com Ortodontia fixa e higiene bucal. O tempo necessário para cada um dos três tipos de treinamento foi registrado durante a visita inicial. A qualidade da higiene bucal foi avaliada por meio dos índices de placa e de sangramento gengival durante a visita inicial e na oitava semana de tratamento. As variáveis contínuas foram analisadas utilizando-se one-way ANOVA. Os testes HSD de Tukey e t de Student foram utilizados para comparações post-hoc (α?#8197;= 0,05), e o teste qui-quadrado foi utilizado para análise das variáveis categóricas. Resultados: O método de ensino convencional fracassou em manter os índices de placa e de sangramento gengival até a oitava semana de tratamento. Apesar de tanto o método de treinamento com vídeos e de treinamento hands-on demandarem um tempo considerável, eles conseguiram manter ambos os índices até a oitava semana. Quanto mais longa a orientação realizada, melhor foi a manutenção dos índices de placa e de sangramento gengival. Conclusão: Tanto o método de treinamento com vídeo quanto no formato hands-on obtiveram melhores resultados de higiene bucal, mas dependem do tempo e das limitações de equipe de cada ortodontista.

Procedimientos libres de aerosol ante COVID-19 en odontología pediátrica / Aerosol-free procedures against COVID-19 in pediatric dentistry

A finales de 2019 se identificó el virus SARS-CoV-2 (por su significado en inglés Severe Acute Respiratory Syndrome Coronavirus 2) como agente etiológico de la COVID-19 (por su significado en inglés coronavirus disease 2019) en la ciudad de Wuhan, China. Debido a su rápida propagación al resto del mundo durante el primer trimestre del año 2020, la Organización Mundial de la Salud (OMS) la declaró pandemia mundial en marzo del mismo año. Por el potencial de contagio de COVID-19 se ha considerado que el entorno clínico en el que se desenvuelve la odontología puede ser de alto riesgo para el paciente, el odontólogo y sus asistentes si no se tienen las medidas de bioseguridad adecuadas. En un principio se vieron suspendidas las consultas regulares; sin embargo, al volver a la actividad laboral se han adaptado protocolos para el control de infecciones como reforzar el uso de barreras de protección y minimizar tratamientos que involucren aerosoles. La caries es uno de los principales motivos de consulta en la odontología pediátrica, por lo que en este escrito se sugieren algunos protocolos basados en la mínima invasión que prescinden de instrumental rotatorio para salvaguardar al paciente en riesgo de contagio, reduciendo el número de visitas y tiempo en consulta e incluso controlando algunos aspectos de salud bucal fuera de consulta clínica por medio de estrategias preventivas que pueden llevarse a cabo desde casa. Esto significa también mantener la tranquilidad por parte de los tutores del paciente ante la pandemia que se vive actualmente (AU)

At the end of 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified as the etiological agent of COVID-19 in the city of Wuhan China. Due to its rapid spread to the rest of the world during the first trimester of 2020, the WHO declared a global pandemic in March of the same year. Due to the contagion potential of COVID-19, it has been considered that the clinical environment in which dentistry operates may be in high risk for the patient if the appropriate biosafety measures are not taken, initially clinical practices were suspended. However, when returning to work, protocols have been adapted to the infection control procedures, reinforced the use of protective barriers, and minimize treatments that involve aerosols. Caries is one of the main reasons for consultation in Pediatric Dentistry, this article suggests some protocols based on minimal invasion that dispense with rotating instruments to safeguard the patient from the risk of contagion, reducing the number of visits and time in consultation and even controlling some aspects of the oral health outside the dental visit through preventive strategies that can be carried out from home. Modifications to Dental Home. This should include maintaining tranquility and calm on the part of the patient's tutors in the face of the pandemic that we are currently experiencing (AU)

Sucrose and Xylitol-Induced Streptococcus mutans Biofilm Adherence

Abstract Objective: To study the adherence of Streptococcus mutans biofilm after induction with sucrose and xylitol. Material and Methods: Laboratory experimental study incorporating posttest-only control group design. S. mutans biofilm was generated for 24 hours at a temperature of 37°C using BHIB with 5% sucrose and BHIB with 1% xylitol. An adherence assay was conducted in accordance with the method applied previously. The quantity of adhered bacteria was measured by means of a spectrophotometer at 570 nm. The data were presented as mean and standard deviation. Results: A biofilm induced with sucrose has a higher adherence level (0.9294 ± 0.0431) compared with one induced with xylitol (0.5095 ± 0.0392). Sucrose induces adherence levels by increasing glucan binding protein and glucosyltransferase of the bacteria, whereas xylitol will inhibit the glycolysis process of the bacteria. Conclusion: The adherence of sucrose-induced S. mutans biofilm is higher than that of xylitol-induced S. mutans biofilm.

Electric toothbrush for biofilm control in individuals with Down syndrome: a crossover randomized clinical trial

Abstract Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl's behavioral scale was used during toothbrushing to assess the participants' cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher's Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 -9 years, p = 0.919; 10-14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.

Oral Hygiene and Dental Caries Status on Systemic Lupus Erythematosus Patients: A Cross-Sectional Study

Abstract Objective: To evaluate the oral hygiene and dental caries status on Systemic Lupus Erythematosus (SLE) patients, also it's with SLE disease activity. Material and Methods: This is a descriptive study with a cross-sectional approach. The study was conducted on 93 SLE patients from 2017 to 2019 on Saiful Anwar Hospital Indonesia. All SLE patients had clinical examination using DMF-T, Personal Hygiene Performance-Modified (PHP-M), Calculus Index (CI), Debris Index (DI), Plaque Index (PI) and Simplified Oral Hygiene Index (OHI-S). Clinical examination and laboratory tests are conducted to assess the activity of SLE measured using. The data were analyzed by One Way ANOVA test. Results: A total of 74% of subjects with SLE had dental caries. PHP-M with SLE severity was found significant (p<0.001) and a strong positive correlation (r=0.982). Plaque with SLE severity was found significant (p=0.001) and a strong positive correlation (r=0.938). OHI-S with SLE severity was found significant (p<0.001) and a strong positive correlation (r=0.953). DMF-T levels with SLE severity was found significant (p=0.001) and a strong positive correlation (r=0.974). It showed that the severity of disease activity was related to poor oral hygiene and a high incidence of dental caries. Conclusion: There is a correlation between oral hygiene, dental caries and SLE severity.

Association Between Periodontal Health Knowledge and Oral Hygiene in Brazilian Adolescents

Abstract Objective: To evaluate the influence of oral health knowledge in adolescents' oral hygiene pattern. Material and Methods: Cross-sectional study involving 291 participants aged between 14 and 19 years old enrolled in a public school in Curitiba, Brazil. A self-administered questionnaire containing five affirmations about periodontal diseases and their forms of prevention was arranged on a three-point Likert scale. Correct answers were given a weight=1 and incorrect ones, weight=0. The knowledge score (KS) was determined by the sum. Socioeconomic and demographic data were obtained by a questionnaire sent to those responsible. The oral hygiene pattern was evaluated through the simplified oral hygiene index (OHI-S) by a calibrated researcher (K=0.89). Mann-Whitney U test and univariate and multivariate Poisson regression with robust variance were used for data analysis (α=0.05). Results: There was an inversely proportional association between KS and OHI-S (p=0.018). The multiple model showed that adolescents with a lower KS (PR = 0.93, CI95%: 0.88-0.99), male gender (PR = 1.17, CI95%: 1.01-1.37) and whose caregivers presented a lower level of education (PR=1.30, CI95%: 1.03-1.64) showed a higher index of dental plaque. Conclusion: The level of oral health knowledge, the gender and the caregivers' level of education influences the adolescents' oral hygiene pattern.

Aplicação do plasma de baixa temperatura sob pressão atmosférica no controle de biofilmes e reparo inicial de feridas infectadas / Application of low temperature plasma under atmospheric pressure in biofilm control and wound infected repair initial

O manejo clínico e tratamento das feridas crônicas têm sido considerados grandes desafios nas áreas médicas. Infecções por biofilmes em feridas crônicas afetam milhões de pessoas no mundo a cada ano e muitas mortes ocorrem como consequência. O plasma de baixa temperatura sob pressão atmosférica (LTAPP) é uma mistura gasosa contendo partículas carregadas, radicais livres e radiação. As ações biológicas das espécies reativas geradas concomitantemente, em particular antimicrobiana, anti-inflamatória e indutora de reparação tecidual, mostram-se altamente promissoras dentro do contexto do controle das feridas crônicas. O objetivo deste estudo foi avaliar os efeitos LTAPP frente a biofilmes monoespécie e multiespécies de micro-organismos frequentemente isolados de feridas crônicas. Além disso, objetivou-se avaliar estudar os efeitos citotóxicos e genotóxicos do LTAPP nos parâmetros físicos eficazes para o controle dos biofilmes A seguir, o protocolo eficaz e seguro foi avaliado in vivo utilizando modelo murino e modelo de úlcera dermal em coelhos. O LTAPP foi capaz de reduzir as UFC/mL de biofilmes monoespécie e mutiespécie a partir de 5 minutos de exposição. O LTAPP, nos parâmetros efetivos antibiofilme, apresentou-se seguro para uso em ensaios in vivo, pois não foi cito ou genotóxico. O tratamento com LTAPP levou à maior redução da área da ferida quando comparado ao grupo controle, em ambos os modelos de ferida com infecção polimicrobiana. Redução da resposta inflamatória foi observada no modelo de úlcera dermal no tempo de 8 dias. Não houve evidências de que o LTAPP aumente significativamente a proliferação celular. Com base nos resultados obtidos, conclui-se que o LTAPP acelera o processo de reparação de feridas, porém o mecanismo de ação ainda precisa ser elucidado(AU)

The clinical management and treatment of chronic wounds have been considered one of the main challenges in the medical area. Biofilm infections in chronic wounds affect millions of people worldwide each year and many deaths occur as consequence. LTAPP is a gas containing charged particles, free radicals and radiation. The biological actions of the reactive species generated concomitantly, anti-inflammatory and tissue repair inducing, are highly promising within the context of chronic wound control. The aim of the present project is to evaluate the effects of low temperature plasma under atmospheric pressure (LTAPP) on mono and multispecies biofilms frequently isolated from chronic wounds. The cyto and genotoxic effects of LTAPP in the effective parameters were also assessed. The effective and safe protocol was tested in vivo using a murine model and a rabbit dermal ulcer model. LTAPP was able to reduce significantly the mono and multispecies biofilm after 5 minutes exposure. In the anti-biofilm effective parameters, LTAPP was not cyto or genotoxic. Treatment with LTAPP reduced significantly the wound area when compared to control in both animal models. Anti-inflammatory effect was observed in dermal ulcer model at 8 days. No evidences of increase in cell proliferation caused by LTAPP were noted. According to the results, it could be concluded that LTAPP enhanced the wound repair process, however the mechanism of action must be still elucidated(AU)

Métodos para el control de la placa bacteriana durante la fase de contención fija posortodoncia. Revisión narrativa / Methods for the control of bacterial plaque during the post orthodontic fixed containment phase. Narrative review

Terminado el tratamiento de ortodoncia, el objetivo principal es mantener la estabilidad oclusal a largo plazo evitando la recidiva, y esto es posible utilizando una contención fija posortodoncia. El propósito de esta investigación fue evaluar los diferentes métodos que existen para el control de placa bacteriana en los pacientes con contención fija posortodoncia y como podrían afectar el estado de salud periodontal. Existen muchos estudios a corto y largo plazo sobre este tema, pero no hay uno que realmente indique que existen efectos negativos. Sin embargo, se conoce que estos pacientes tienen tendencia a acumular una mayor cantidad de placa bacteriana, lo que conlleva a que haya un mayor riesgo de formación de cálculo, inflamación gingival, recesión gingival, caries lingual e interproximal, y enfermedad periodontal. Por eso, la mayoría de estudios resaltan como factor determinante la buena higiene oral para garantizar la salud periodontal y acudir a las citas control con el ortodoncista para evaluar el estado físico de la aparatología, a fin de evitar posibles fracturas o fallas en el sistema de adhesión de la contención fija y darle un tratamiento inmediato si esto ya hubiera ocurrido. La literatura no indica una técnica oral específica para los pacientes con contención fija posortodoncia, pero sí señala que se puede lograr una buena salud periodontal si el paciente mantiene una higiene oral adecuada y cómo el ortodoncista juega un rol importante motivando al paciente para lograrla.(AU)

The main objective following orthodontic treatment is to maintain long-term occlusal stability to avoid recurrence, and this is possible using post orthodontic fixed containment. The purpose of this study was to evaluate the different methods used for the control of bacterial plaque in patients with post orthodontic fixed containment and how these methods affect periodontal health status. There are many short- and long-term studies in this regard, but none have described negative effects. However, it is known that these patients tend to accumulate a greater amount of bacterial plaque, leading to a greater risk of calculus formation, gingival inflammation, gingival recession, lingual and interproximal caries, and periodontal disease. The refore, most studies have described good oral hygiene as the determinant factor for ensuring adequate periodontal health. They also report the need for patients to attend control appointments with their orthodontist to evaluate the state of the aprotology, avoiding possible fractures or failures in the adhesion system of the fixed retainer and receiving immediate treatment when this occurs. While the literature does not indicate a specific oral hygiene technique for patients with post orthodontic fixed containment, it does indicate that good periodontal health can be achieved if adequate oral hygiene is maintained and the important role orthodontists play in motivating the patients to achieve this. (AU)

Prevalence of Gingival Recession in Dental Students from the Federal University of Juiz de Fora - Brazil / Prevalencia de Recesión Gingival en Estudiantes de Odontología de la Universidad Federal de Juiz de Fora - Brasil

ABSTRACT: Gingival recessions are characterized by partial denudation of the root surface due to apical displacement of the gingival margin from the amelocemental junction and may be localized or generalized. The aim of this study was evaluate the prevalence of gingival recession and dentine hypersensitivity of dental students of Federal University of Juiz de Fora, Brazil. Were examined 80 students with on average age of 22.9, randomly selected to assess the prevalence, level of gingival recession and the presence of dentinal hypersensitivity. Fifty students had at least one gingival recession and dentine hypersensitivity was observed in 28 students. Buccal surface was the most prevalent (86.6 %), with measures mostly between 1 and 2 mm (92 %) and classified as Class I Miller (96.25 %). The pre-molars were the group most frequently affected teeth (37.35 %). Gingival recession with small measures is a very common condition in young patients.

RESUMEN: Las recesiones gingivales se caracterizan por una denudación parcial de la superficie radicular debido al desplazamiento apical del margen gingival, desde la unión amelocemental y puede ser localizada o generalizada. El objetivo de este estudio fue evaluar la prevalencia de la recesión gingival y la hipersensibilidad dentinaria en estudiantes de Odontología de la Universidad Federal de Juiz de Fora, Brasil. Se examinaron 80 estudiantes con una edad promedio de 22,9, seleccionados al azar para evaluar la prevalencia, el nivel de recesión gingival y la presencia de hipersensibilidad dentinal. En cincuenta estudiantes se observó al menos una recesión gingival y se reportó hipersensibilidad a la dentina en 28 estudiantes. La superficie oral fue la más prevalente (86,6 %), con medidas principalmente entre 1 y 2 mm (92 %) y clasificada como Clase I Miller (96,25 %). Los premolares fueron el grupo de dientes afectados con mayor frecuencia (37,35 %). La recesión gingival con medidas pequeñas es una condición muy común en pacientes jóvenes.

Modelo operativo de promoción de la salud y prevención de enfermedades bucales en preescolares de Cuautla, Morelos-México / Operational model of health promotion and prevention of oral diseases in preschool children in Cuautla, Morelos-Mexico

Las estrategias tradicionales para abordar la salud bucal en México han carecido de un enfoque integrado a la promoción de la salud y a los factores de riesgo en común con otras patologías, principalmente crónicas. De unir esfuerzos se aprovecharían mejor los limitados recursos sanitarios. Esta investigación tuvo como objetivo implementar un modelo operativo de promoción de la salud y prevención de las enfermedades bucales, usando un ciclo de mejora continua en el preescolar de la comunidad Peña-Flores, Cuautla, Morelos. Se realizó un estudio cuasi-experimental con 120 niños de ambos sexos. La implementación contempló: diagnóstico epidemiológico bucal y social, capacitación de actores clave, ejecución del programa de salud bucal, monitoreo, análisis y evaluación de resultados. Se levantaron datos mediante una guía de observación participante, de reuniones con madres de familia y maestras bajo la perspectiva participativa del triple diagnóstico de educación popular. Se determinó el índice de dientes cariados, a extraer y obturados. Se realizó la medición de la placa dento-bacteriana utilizando el índice de sedimento dental (DIS). Como resultado del control y sistematización del proceso de cepillado dental y del monitoreo de la placa dento-bacteriana, se identificó una disminución del DIS de 1,04 a 0,47. Con la implementación de un menú escolar, se mejoró la alimentación infantil. El modelo implementado constituye una posible solución a la problemática de salud bucal del preescolar de la comunidad Peña-Flores, situado en un contexto de desventaja social por factores como pobreza, migración y déficit de servicios públicos(AU)

Cepillos interdentales, de la teoría a la práctica: revisión de literatura e indicaciones clínicas / Interdental toothbrushes, from theory to practice: a review of the literature and clinical indications

Los cepillos interproximales son una herramienta de higiene interdental que tiene variadas indicaciones y múltiples beneficios. Pacientes con enfermedad periodontal, conpapilas que no llenan el espacio interdentario, portadores de aparatología ortodóncica,prótesis fija o de implantes entre otros casos, pueden beneficiarse con su utilización. El presente artículo tiene como objetivo dar una orientación de su uso clínico basado en la evidencia científica disponible. Los resultados apoyan su utilización en combinación con el hilo dental para la prevención y tratamiento de las enfermedades bucales más prevalentes, con un efecto marcado sobre el control del biofilm y la inflamación gingival (AU)

Interproximal brushes are an interdental hygiene tool with diverse indications that have multiple benefits. Among other uses, they are indicated in patients with periodontal disease, with papillae that do not fill the interdental space, patients with orthodontic appliances, fixedprosthesis or implant-supported prosthesis. The aim of this article is provide guidance on their clinical use based on the available evidence. The results support their use in combination with dental floss for preventing and treating the most prevalent oral diseases, with a significant effect on biofilm control and gingival inflammation (AU)

Occurrence of Gingivitis and Oral Hygiene in Individuals with Down Syndrome

Abstract Objective: To determine the frequency distribution of gingivitis and oral hygiene in individuals with Down syndrome. Material and Methods: This study used a cross-sectional descriptive method and the subjects were 174 individuals with Down syndrome aged ≥14 years attending type C (intellectual disability) special needs schools in Jakarta. Gingivitis was measured using the gingival index, and oral hygiene was measured using the Simplified Oral Hygiene Index (OHI-S). The measurement of the two components of plaque and calculus was completed on six teeth on different surfaces, including the facial side of three maxillary teeth, the lingual side of the two posterior mandibular teeth, and the labial side of one anterior mandibular tooth. Descriptive statistics were used to calculate the absolute and relative frequencies Results: 3.4% had no gingivitis, 47.2% had mild gingivitis, 40.8% had moderate gingivitis, and 8.6% had severe gingivitis. Regarding oral hygiene, 28.2% had good hygiene, 49.4% had fair, and 22.4% had poor hygiene Conclusion: Individuals with Down syndrome had a frequency distribution of gingivitis mainly in the mild and moderate categories, and a majority of subjects had fair OHI-S.

Solution Inhibitory of Ant Nest (Myrmecodia Pendans) Extract on the Formation of Plaque in Children with Early Childhood Caries

Abstract Objective: To evaluate the effectiveness of gargling the solution of ant nest extract against plaque formation in children who experience Early Childhood Caries (ECC) when used as a mouthwash. Material and Methods: This study uses a pretest-posttest design with a control group. Thirty children with ECC, which were divided into three groups, namely the treatment group which was given a solution of extracts of ant nests concentrations of 5% and 10% and the control group gargling Aquades. Plaque scores were measured using the Greene and Vermillon method before and after the intervention. The paired t-test was used, with a significance level of 0.05 Results: Significant differences were found before and after the treatment of ant nest extract (r<0.05). The increase in OHI-S mean in the control group before treatment was 2.41 ± 0.72 and after treatment 2.53 ± 0.69 while in the treatment group there was a decrease in the OHI-S average in the group of 5% before treatment 2.66 ± 0.90 and after treatment 2.29 ± 0.95 and group concentration of 10% before treatment 2.51 ± 0.89 and after treatment 1.82 ± 0.75 Conclusion: The distribution of ant nest extract solution extract with the concentration of 5% and 10% would be more effective with ant nest concentration of 10% where it can inhibit dental plaque formation, and there is a significant difference in mean plaque scores between the control group and the treatment groups.

Oral health promotion in patients with morbid obesity after gastroplasty: a randomized clinical trial / Promoção de saúde bucal em pacientes com obesidade mórbida após gastroplastia: ensaio clínico randomizado

ABSTRACT Background: The bariatric surgery may have negative repercussions on oral conditions. Aim: To evaluate the impact of oral health educational/preventive program developed with patients submitted to gastroplasties. Method: The sample consisted of 109 patients randomly allocated to two groups: intervention group (IG), where they participated in the oral health promotion program that include multiple educational-preventive approaches; control group (CG), where they received usual care from the bariatric clinic staff, without participation in the program. The oral conditions investigated in the pre-operative and postoperative periods of one month (1M) and six months (6M) were: dental caries, periodontal disease, tooth wear, dental plaque and salivary flow. Results: After bariatric surgery, patients in IG presented: fewer changes in enamel (6M: p=0.004), dentin (6M: p=0.005) and gingival bleeding (6M: p<0.0001), reduction in plaque index (1M, 6M: p<0.0001) and increased salivary flow (6M: p=0.039), when compared with CG. Incipient tooth wear was recorded in both groups (6M: p=0.713). Conclusion: There was a positive impact of the implemented program in the prevention of the main oral health problems in patients who underwent gastroplasties, contributing to their quality of life.

RESUMO Racional: A cirurgia bariátrica pode repercutir negativamente nas condições bucais. Objetivo: Avaliar o impacto de um programa educativo/preventivo em saúde bucal desenvolvido em pacientes submetidos à gastroplastia. Método: A amostra foi constituída por 109 pacientes aleatoriamente alocados em dois grupos: grupo de intervenção (GI), onde participaram do programa de promoção de saúde bucal com abordagens educativo-preventivas; grupo controle (GC), onde receberam cuidado da equipe da clínica, sem participação no programa. As condições bucais investigadas nos períodos pré e pós-operatório de um mês (1M) e seis meses (6M) foram: cárie dentária, doença periodontal, desgaste dentário, placa dentária e fluxo salivar. Resultados: Após a gastroplastia, pacientes do GI apresentaram: menor alteração em esmalte (6M: p=0,004), dentina (6M: p=0,005) e sangramento gengival (6M: p<0,0001); redução no índice de placa (1M, 6M: p<0,0001) e aumento do fluxo salivar (6M: p=0,039), quando comparados aos do GC. Desgaste dentário incipiente foi registrado em ambos os grupos (6M: p=0,713). Conclusão: Houve impacto positivo do programa implementado na prevenção dos principais problemas de saúde bucal em pacientes submetidos à gastroplastia, contribuindo para sua qualidade de vida.

The impact of maintenance on peri-implant health

Abstract Most of the literature evaluating dental implants focuses on implant survival, which is a limited proxy for the successful rehabilitation of patients with missing teeth. Success should include not only survival but also lack of mechanical, biological, and esthetics problems. A comprehensive review of local and systemic risk factors prior to implant placement will allow the tailoring of treatment planning and maintenance protocols to the patient's profile in order to achieve longitudinal success of the therapy. This review discusses the role of controlling different risk factors and prevention/treatment of peri-implant mucositis in order to avoid peri-implantitis. Although the literature addressing the topic is still scarce, the existing evidence shows that performing optimal plaque control and regular visits to the dentist seem to be adequate to prevent peri-implant lesions. Due to impossibility of defining a probing depth associate with peri-implant health, radiographic evaluations may be considered in the daily practice. So far, there is a strong evidence linking a past history of periodontal disease to peri-implant lesions, but this is not so evident for other factors including smoking and diabetes. The prevention of biological complications starts even before implant placement and include a broader analysis of the patient risk profile and tailoring the rehabilitation and maintenance protocols accordingly. It should be highlighted that the installation of implants does not modify the patient profile, since it does not modify genetics, microbiology or behavioral habits of any individual.