Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial

Abstract Background Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. Objectives To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. Methodology In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). Results After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). Conclusion HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT02782390

Salud mental positiva: entre el bienestar y el desarrollo de capacidades / Positive mental health: between well-being and capacity development

Resumen Los esfuerzos de la Organización Mundial de la Salud por trascender los modelos biomédicos y comportamentales para la explicación de la salud han resaltado el bienestar como elemento clave en esta tarea. La inclusión del concepto de bienestar en las definiciones de salud mental ha provocado, en muchas ocasiones, la utilización de ambos conceptos como sinónimos, sin embargo, difícilmente el bienestar por sí solo puede dar cuenta de la salud mental de una persona. Este artículo de reflexión tiene como objetivo presentar el concepto de capacidad desde el campo del desarrollo humano, como respuesta a las limitaciones que presentan los modelos de bienestar, y los aportes que tendría su utilización en la construcción de una definición de salud mental a partir del enfoque socioeconómico y en la consolidación de una estrategia de promoción de la salud mental.

Abstract The efforts of the World Health Organization to transcend biomedical and behavioral explanations of health have highlighted well-being as a key element in this task. The inclusion of well-being concept in mental health definitions has caused, on many occasions, the use of both concepts as synonyms, however, well-being cannot hardly define by its own a person's mental health. This article aims to introduce the concept of capacity from the field of human development as a response to the limitations presented by well-being models and the contributions that their implementation would have in the construction of a definition for mental health from the socioeconomic approach and consolidate a strategy to promote mental health.

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT

Abstract: The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial

Abstract: This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Factores asociados con dolor severo en pacientes con fascitis plantar: Un análisis de relaciones / Factors associated with severe pain in patients with plantar fasciitis: An association analysis

Objetivo: Describir los factores asociados con niveles de dolor mas severo en una cohorte de pacientes con fascitis plantar. El objetivo secundario fue analizar cuales de estos factores estaban asociados con niveles mas altos de mejoria clinica luego del tratamiento conservador. Materiales y Métodos: Se evaluo a una cohorte prospectiva de pacientes con diagnostico de fascitis plantar. Cada participante completo una escala ordinal visual de dolor (del 1 al 10) para dolor del primer paso y dolor al final del dia y encuestas FFI-R (Foot Function Index-Revised). Tambien se realizo una evaluacion demografica. La dorsiflexion de la articulacion del tobillo, el rango de movilidad de la primera articulacion metatarsofalangica, la rigidez del gastrocnemio y el angulo popliteo tambien se evaluaron de manera estandar. Resultados: Se incluyo a 214 pacientes. El 64% eran hombres (118 pacientes), la media de la edad era de 49.67 anos (DE 13.16) y el indice de masa corporal promedio, de 28,53 (DE 5,18). En el analisis multivariado, se observo que el riesgo de un puntaje ≥8 en la escala de dolor aumento cuando el paciente refirio estar de pie por mas de 6 h (OR 1,17; p = 0,03; IC95% 1,02-1,35). El riesgo de un puntaje >8 fue mayor cuando el grado de dorsiflexion del tobillo fue <0° (OR 1,20; p = 0,03; IC95% 1,02-1,41). Conclusión: Nuestros hallazgos apoyan indirectamente la hipotesis de que la dorsiflexion limitada del tobillo juega un papel como factor de riesgo asociado a un puntaje ≥8 en la escala de dolor, en los casos de fascitis plantar. Nivel de Evidencia: IV

Objective: The main purpose of our study was to describe the factors associated with more severe pain levels in a cohort of patients with plantar fasciitis (PF). The secondary purpose of this study was to determine which of these factors were associated with higher levels of clinical improvement after conservative therapy. Materials and Methods: We conducted a prospective study in a cohort of patients with PF. Each participant completed an ordinal pain scale (1-10) for first-step pain and end-of-day pain, and Foot Function Index-Revised (FFI-R) surveys at enrollment. Also, patient demographics were evaluated. The ankle joint dorsiflexion, the range of motion (ROM) for the first metatarsophalangeal joint (MTPJ), the gastrocnemius tightness, and the popliteal angle were evaluated through standard tests. Results: Our study included 214 participants, of which 64% (118 patients) were males, the average age was 49.67 years (SD 13.16) and the average BMI was 28.53 (SD 5.18). The multivariate analysis showed that the risk of having a Visual Analog Scale (VAS) score ≥8 increased when the patient reported standing for more than 6 hours (OR=1.17; P=0.03; CI95%: 1.02-1.359). The risk of a >8-VAS score was higher when the level of ankle dorsiflexion was <0 (OR=1.20; P=0.03; CI95%: 1.02-1.41). Conclusion: Our findings indirectly support the hypothesis that limited ankle dorsiflexion ROM plays a role as a risk factor associated with VAS scores ≥8 in PF patients. Level of Evidence: IV

An Stx-EAEC O59:NM[H19] strain isolated from a hemolytic uremic syndrome case in Argentina / Cepa EAEC-Stx O59:NM[H19] aislada de un caso de síndrome urémico hemolítico en Argentina

Abstract Shiga toxin-producing Escherichia coli (STEC) are a heterogeneous group of foodborne pathogens causing a broad spectrum of human disease, from uncomplicated diarrhea to hemolytic uremic syndrome (HUS). In this study, we report an HUS case associated with an O59:NM H19 mstrain, harboring stx2a, iha, lpfAO26, lpfAO113 genes associated with STEC, and aatA, aap, pic, sigA, agg4A genes associated with enteroaggregative E. coli (EAEC), named Stx-EAEC. The strain showed low toxicity on Vero cells, and was resistant to streptomycin and trimethoprim/sulfonamides. The child carried the bacteria for more than 100 days. Since the large outbreak associated with Stx-EAEC O104:H4, many strains with similar profiles have been described. In Germany, an O59:NM[H19] strain, with comparable characteristics to the Argentine strain, was isolated from a bloody diarrhea case. In Argentina, this is the first report of an HUS case associated with a Stx-EAEC infection, and represents a new challenge for the surveillance system. © 2019 Published by Elsevier Espana, S.L.U. on behalf of Asociacion Argentina de Microbiolog´a. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/ licenses/by-nc-nd/4.0/).

Resumen Escherichia coli productor de la toxina Shiga (STEC) es un grupo heterogéneo de patógenos transmitidos por alimentos que causan un amplio espectro de enfermedades humanas, desde diarrea no complicada hasta síndrome urémico hemolítico (SUH). Nosotros informamos de un caso de SUH por O59:NM[H19], que portaba los genes stx2a, iha, lpfAo26, lpfAoii3 asociados con STEC, y los genes aatA, aap, pic, sigA, agg4A de E. coli enteroagregativo (EAEC), llamado EAEC-Stx. La cepa mostró baja citotoxicidad en las células Vero, y fue resistente a estreptomicina y trimetoprima/sulfonamidas. El niño excretó la bacteria durante más de 100 días. Desde el brote asociado con EAEC-Stx O104:H4, se describieron muchas cepas con perfiles similares. En Alemania se aisló una cepa O59:NM[H19] de una diarrea sanguinolenta, con características comparables a la cepa argentina. Este es el primer informe de un caso de SUH asociado a una infección por EAEC-Stx, y representa un nuevo desafío para el sistema de vigilancia. © 2019 Publicado por Elsevier Espana, S.L.U. en nombre de Asociación Argentina de Microbiología. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons. org/licenses/by-nc-nd/4.0/).

Síndrome de Rubinstein-Taybi: Reporte de caso con 7 años de seguimiento / Síndrome de Rubinstein-Taybi: Relato de caso com 7 anos de acompanhamento / Rubinstein-Taybi syndrome: A case report with 7-year follow-up

El síndrome de Rubinstein-Taybi (SRT) es una rara anomalía congénita, de etiología todavía incierta. Su incidencia es de 1:100 000 a 1:300 000 nacimientos. El objetivo de este reporte de caso fue describir los hallazgos orofaciales y el acompañamiento dental por 7 años de un paciente del sexo masculino diagnosticado como portador del SRT. Las principales características orofaciales observadas fueron: mirada antimongoloide, "nariz en pico", orejas grandes y de baja inserción, estatura corta, gran cantidad de cabello, pequeña abertura de boca, queilitis angular, paladar estrecho y profundo, apiñamiento dental, mordida cruzada posterior bilateral, hipomineralización de molares primarios (HMP), hipomineralización de molares e incisivos (HMI), mala higiene oral, presencia de cálculos supragingival, gingivitis y gran número de lesiones de caries activas. El SRT muestra muchas manifestaciones orofaciales y su conocimiento puede ayudar en el diagnóstico y tratamiento temprano. Las consultas odontológicas a intervalos más cortos ayudan a acondicionar al paciente y reducen el riesgo de lesiones de caries y problemas gingivales.

A síndrome de Rubinstein-Taybi (SRT) é uma anomalia congênita rara, de etiologia ainda incerta. Sua incidência é de 1:100.000 a 300.000 nascimentos. O objetivo deste relato de caso foi descrever os achados orofaciais e o acompanhamento odontológico por 7 anos de um paciente do sexo masculino diagnosticado como portador da SRT. As principais características orofaciais observadas foram: olhar antimongolóide, "nariz em bico", orelhas grandes e de baixa inserção, baixa estatura, grande quantidade de cabelo, pequena abertura bucal, queilite angular, palato estreito e profundo, apinhamento dentário, mordida cruzada posterior bilateral, hipomineralização de molares decíduos (HMD), hipomineralização molar-incisivo (HMI), higiene bucal deficiente, presença de cálculos supra-gengivais, gengivite e grande número de lesões de cárie ativas. A SRT apresenta muitas manifestações orofaciais e seu conhecimento pode ajudar no diagnóstico e tratamento precoce. Consultas odontológicas em menores intervalos de tempo ajudam no condicionamento do paciente e reduzem o risco de lesões de cárie e problemas gengivais

Rubinstein-Taybi syndrome (RTS) is a rare congenital anomaly of uncertain etiology. Its incidence ranges from 1:100,000 to 300,000 births. The objective of this case report was to describe the orofacial findings and a 7-year follow-up of a male patient diagnosed with RTS. The main orofacial features observed include: antimongoloid slant, beaked nose, low set large ears, short stature, large amount of hair, limited mouth opening, angular cheilitis, narrow and deep palate, dental crowding, bilateral posterior crossbite, deciduous molar hypomineralization (DMH), molar incisor hypomineralization (MIH), poor oral hygiene, presence of supra-gingival calculi, gingivitis and a large number of active carious lesions. RTS has many orofacial manifestations and knowledge of this syndrome can help in proper diagnosis and early treatment. Dental appointments at shorter time intervals help in conditioning the patient and reduce the risk of caries lesions and periodontal problems.

Profile and neuropsychological differences in adolescent students with and without dyslexia / Perfil y diferencias neuropsicológicas en alumnos adolescentes con y sin dislexia

Abstract Dyslexia is a problem of increasing prevalence in school-age students. The latest experiences in the application of neuropsychology to education are interesting because they allow for the evaluation of different neuropsychological variables to obtain a better understanding of the learning processes of students in this population for specific subsequent interventions. The purpose of this study was to explore the following neuropsychological variables related to reading in adolescent students with and without dyslexia. The sample consisted of 60 students between 13 and 15 years of age, 30 with dyslexia and 30 without. The King Devick test was used to assess the saccadic eye movements, specifically the fast and automated denomination of digits; the Harris laterality test was used to evaluate functional laterality, and the ENFEN test for executive functions. The results revealed significant differences between the two groups. Students with dyslexia scored lower on the three neuropsychological skills assessed. These findings suggest that students with dyslexia may manifest poorer performance in those neuropsychological skills that are key to reader development.

Resumen La dislexia es un problema que cada vez afecta más al alumnado en edad escolar. Las últimas experiencias de aplicación de la neuropsicología al ámbito educativo resultan interesantes porque van a permitir evaluar distintas variables neuropsicológicas con el objeto de comprender mejor los procesos de aprendizaje del alumnado para plantear posteriormente intervenciones específicas en esta población. El propósito de este estudio fue explorar variables neuropsicológicas relacionadas con la lectura y escritura en estudiantes con y sin dislexia. La muestra estuvo compuesta por 60 estudiantes de entre 13 y 15 años, 30 con dislexia y treinta sin dislexia. La prueba King Devick fue utilizada para valorar los movimientos oculares sacádicos, la prueba de la lateralidad de Harris para evaluar la lateralidad y la prueba ENFEN para las funciones ejecutivas. Los resultados revelaron diferencias significativas entre los dos grupos. Los estudiantes con dislexia obtuvieron puntuaciones más bajas en las tres habilidades neuropsicológicas evaluadas. Estos hallazgos sugieren que los niños con dislexia podrían manifestar un peor desempeño en habilidades neuropsicológicas que son clave para el desarrollo lector y escritor.

Do Different Proportions of Antibiotics in the CTZ Paste Interfere with the Antimicrobial Action? In Vitro Study

Abstract Objective: To evaluate the antimicrobial action of the CTZ paste in three different proportions by diffusion in agar with the microorganisms: Enterococcus faecalis,Escherichia coli, and Candida albicans. Material and Methods: Three different proportions of antibiotics were tested: GROUP A - CTZ paste in the ratio of 33.33% chloramphenicol + 33.33% tetracycline + 33.33% zinc oxide, mixed with 2 drops of eugenol (1:1:1 ratio); GROUP B - CTZ paste in the proportion of 25% chloramphenicol + 25% tetracycline + 50% zinc oxide, mixed with 2 drops of eugenol (1: 1: 2 ratio); GROUP C - CTZ paste with 13% chloramphenicol + 13% tetracycline + 74% Zinc Oxide, mixed with 2 drops of eugenol (1:1:6 ratio); PC GROUP - Positive Control (0.12% Chlorhexidine); and NC GROUP - Negative Control (0.9% Saline solution). Data were analyzed through descriptive statistics (means and standard deviation). The one-way ANOVA and Tukey's test were used, with a significance level of 5% Results: No statistical differences for Enterococcus faecalis between groups A, B, and C (p = 0.1986) were found. There were statistical differences for Escherichia coli between groups B and C (p = 0.029), and for Candida albicans between groups A and C (p = 0.006). Groups A, B, and C had significant differences with both Positive and Negative Controls for all the microorganisms Conclusion: The three different ratios of CTZ paste showed antimicrobial efficacy against Enterococcus faecalis,Escherichia coli, and Candida albicans microorganisms.

Use of intrarradicular pins in primary teeth: case report of one year of accompanying / Uso de pinos intrarradiculares em dentes decíduos: relato de caso de um ano de acompanhamento

ABSTRACT Primary teeth have an important role in the growth and development of the child, besides being important for the good performance of masticatory function, phonation, occlusion and aesthetics, are the best space maintainers and eruption guide for the permanent successor. For anterior region, there are different alternatives of rehabilitation treatment, however, it is up to the professional to choose the best option. Objective To present a therapeutic management of upper incisors affected by carious lesion with intrarradicular pin in early childhood. Case report: male patient, with 2 years and 7 months of age and significant loss of dental structure at an early stage. In the impossibility of performing direct restoration, we opted for the rehabilitation with the use of glass fiber pins for intraradicular reinforcement and composite resin restorations in order to restore shape, function and aesthetics. Conclusion The use of fiberglass intra-radicular pins associated with direct restoration of composite resin is a recommended technique for the reconstruction of anterior teeth with great destruction.

RESUMO Os dentes decíduos possuem um papel importante no crescimento e desenvolvimento da criança, além de serem importantes para o bom desempenho da função mastigatória, fonação, oclusão e estética, são os melhores mantenedores de espaço e guia de erupção para o sucessor permanente. Para região anterior, existem diferentes alternativas de tratamento reabilitador, porém, cabe ao profissional escolher a melhor opção Objetivo Apresentar uma conduta terapêutica dos incisivos superiores acometidos por lesão de cárie com pino intrarradicular na primeira infância. Relato do caso: paciente do sexo masculino, com 2 anos e 7 meses de idade e perda significante de estrutura dentária de forma precoce. Na impossibilidade de ser realizado restauração direta, optou-se pela reabilitação com o uso de pinos de fibra de vidro para reforço intrarradicular e restaurações em resina composta em para restabelecimento da forma, função e estética. Conclusão A utilização de pinos intraradiculares de fibra de vidro associada a restauração direta de resina composta é uma técnica recomendada para a reconstrução de dentes decíduos anteriores com grande destruição.

Reproductive alternatives for patients with dystrophic epidermolysis bullosa / Opções reprodutivas para pacientes com epidermólise bolhosa distrófica

ABSTRACT Epidermolysis bullosa describes a group of skin conditions caused by mutations in genes encoding proteins related to dermal-epidermal adhesion. In the United States, 50 cases of epidermolysis bullosa per 1 million live births are estimated, 92% of which classified as simplex, 5% dystrophic, 1% junctional and 2% non-classified. Dystrophic epidermolysis bullosa is associated with autosomal, dominant and recessive inheritance. Epidermolysis bullosa causes severe psychological, economic and social impacts, and there is currently no curative therapy, only symptom control. Embryonic selection is available for epidermolysis bullosa patients in order to prevent perpetuation of the condition in their offspring.

RESUMO O termo "epidermólise bolhosa" descreve um grupo de afecções cutâneas causadas por mutações em genes que codificam proteínas relacionadas à aderência dermoepidérmica. Nos Estados Unidos, estima-se a ocorrência de 50 casos de epidermólise bolhosa por 1 milhão de nascidos vivos, sendo 92% deles da forma simples, 5% da forma distrófica, 1% da forma juncional e 2% não classificados. A epidermólise bolhosa do tipo distrófica foi associada a padrões autossômicos, dominante e recessivo. A epidermólise bolhosa causa sérios impactos psicológicos, econômicos e sociais, e não há tratamento curativo atualmente − apenas controle dos sintomas. A seleção embrionária é disponível para portadores de epidermólise bolhosa, a fim de evitar a perpetuação da condição em seus descendentes.

Treatment of Riga-Fede disease using laser therapy: clinical case report / Tratamento de lesão de Riga-Fede com laserterapia: relato de caso clínico

ABSTRACT Neonatal teeth arise in the oral cavity in up to 30 days of life. Early eruption of teeth associated with dental trauma on the ventral surface of the tongue during breastfeeding may lead to a set of signs and symptoms called the Riga-Fede lesion, which manifests as a chronic ulceration on the ventral surface of the tongue. Establishing the treatment plan is a challenging task. The pediatric dentist and pediatrician, should act in promoting health and recovery of the baby with the disease, taking care not to neglect the weight loss in newborns. The aim of this study was to demonstrate the clinical implications of a Riga-Fede lesion and treatment approach using laser therapy. A 43-day-old child was referred to pediatric dentistry, presenting weight loss and a congenital lingual injury caused by a neonatal tooth. The treatment, after radiographic examination was extraction of tooth 71, topical application of Triacinolone acetonide and laser therapy. Laser therapy has been shown to be a possible treatment option for Riga-Fede lesions, reducing the healing time to four days, allowing the return to feeding and improvement in the pain symptoms from the first day of application.

RESUMO Os dentes neonatais surgem na cavidade oral em até 30 dias de vida. A erupção precoce dos dentes associado ao trauma dental na língua durante a amamentação pode levar a um conjunto de sinais e sintomas chamado de lesão de Riga-Fede, que se manifesta como uma ulceração crônica no ventre da língua. O estabelecimento do plano de tratamento é uma resolução desafiadora. O odontopediatra, bem como o pediatra, deve atuar na promoção de saúde e recuperação do bebê com a doença instalada, com o cuidado de não negligenciar a perda de peso em neonatos. O objetivo desse trabalho foi demonstrar as implicações clínicas de uma lesão de Riga-Fede e abordagem de tratamento utilizando a laserterapia. Uma criança de 43 dias foi encaminhada para tratamento com odontopediatra, apresentando perda de peso e uma lesão no ventre lingual ocasionada por um dente neonatal. O tratamento efetuado, após exame radiográfico, foi a exodontia do elemento dental 71, aplicação tópica de Triacinolona acetonida e laserterapia. A laserterapia mostrou-se uma possível opção de tratamento para lesões de Riga-Fede, reduzindo o tempo de cicatrização para quatro dias, possibilitando o retorno à alimentação e melhora da sintomatologia dolorosa desde o primeiro dia da aplicação.

Progress of health psychology regulation: A comparison between countries

The independent practice of clinical psychology has experimented recent changes. Spain has achieved to regulate the current professional situation of the different figures of clinical psychologists mainly in three arms: 1) by authorizing those psychologists who met the required legal criteria to continue with their clinical practice, 2) by creating the Master in General Health Psychology (MGHP) and 3) by maintaining the tasks and public scope for Psychologist Specialized in Clinical Psychology (PSCP) This manuscript aims to summarize the process for the regulation of clinical and health psychology in Spain and to compare it to other European and North American countries. Discussion about the quality, benefits and future ambitions of the MGHP programs have been made.

Análisis conductual de niños brasileños que participan del "Programa boquita del bebé" ­ Gurupi/Tocantins / Behavioral analysis of Brazilian children participating in the "Baby's Little Mouth Program" at Gurupi-Tocantins / Análise comportamental de crianças brasileiras participantes do "Programa Bo-quinha do Bebê" ­ Gurupi/Tocantins

La respuesta del comportamiento del niño ha sido estudiada en algunas investigaciones y es útil para predecir cómo el niño reacciona al tratamiento odontológico, especialmente los bebés y los niños más pequeños, que es donde se encuentra uno de los mayores desafíos de la odontopediatría. Objetivo: Evaluar el patrón de comportamiento de niños de 3 a 5 años de edad, en un programa preventivo de la municipalidad de Gurupi/Tocantins, Brasil. Materiales y métodos: Este estudio fue evaluado y aprobado por el comité de ética e investigación. Un total de 60 niños, con diferentes perfiles de participación del programa "boquita del bebé" fueron analizadas. Entre ellos, 20 frecuentaban el programa, 20 habían desistido y 20 nunca participaron anteriormente. El perfil de comportamiento fue analizado por un examinador externo en el momento de la higiene bucal (profilaxis) por medio de la escala de comportamiento de Venham. Los datos fueron analizados mediante la regresión de Poisson (α=5%). Resultados: Los niños que presentaron peor comportamiento fueron aquellas que nunca participaron del programa "boquita del bebé" (OR: 3.80 / p=0.008), así como, los niños que no permitían el cepillado en casa (OR: 4.17 / p=0.001) y aquellos que sólo permitían el cepillado en ocasiones (OR: 3.07 / p=0.010). Conclusión: Existe una influencia positiva del programa en el condicionamiento psicológico, en la ansiedad de los niños y en la adopción de hábitos correctos en sus rutinas diarias.

The behavioral response of the child has been studied in some researches and is useful to predict how the child reacts to dental treatment, especially infants and young children, which is one of the greatest challenges of pediatric dentistry. Ob-jective: To evaluate the behavioral pattern of children from 3 to 5 years of age in a preventive program in the municipality of Gurupi /Tocantins, Brazil. Materials and methods: This study was evaluated and approved by the Ethics and Research Committee. A total of 60 children, with different participation profiles of the program "Baby's Little Mouth" were analyzed. Of these, 20 were frequent program participants, 20 were dropouts and 20 had never participated in the program before. The behavioral profile was analyzed by an external examiner, at the time of oral hygiene (prophylaxis), through the behavioral scale of Venham. Data were analyzed using Poisson regression analysis (α = 5%). Results: The children who presented the worst behavior were those who had never participated in the "Baby's Little Mouth" program (OR=3.80; p=0.008), as well as children who did not allow brushing at home (OR=4.17; p=0.001) and those that only allowed brushing someti-mes (OR=3.07; p=0.010). Conclusion: There is a positive influence of the program on psychological conditioning, on the anxiety of children and on the adoption of correct daily habits in their routines.

A resposta comportamental da criança tem sido estudada em algumas pesquisas e sendo útil para prever como a criança reage ao tratamento odontológico, especialmente os bebês e as crianças mais novas, que é onde se encontra um dos maiores desafios da odontopediatria. Objetivo: Avaliar o padrão comportamental de crianças de 3 a 5 anos de idade, em um programa preventi-vo do município de Gurupi/Tocantins, Brasil. Materiais e métodos: Este estudo foi avaliado e aprovado pelo Comitê de ética e pesquisa. Um total de 60 crianças, com diferentes perfis de participação do programa "Boquinha do bebê" foram analisadas. Dentre elas, 20 eram frequentadoras assíduas do programa, 20 eram desistentes e 20 nunca participaram anteriormente. O perfil comportamental foi analisado por um examinador externo no momento da higienização bucal (profilaxia) por meio da escala comportamental de Venham. Os dados foram analisados mediante a Regressão de Poisson (α=5%). Resultados: As crianças que apresentaram pior comportamento foram aquelas que nunca participaram do programa "Boquinha do bebê" (OR: 3,80 / p=0,008), assim como, as crianças que não permitiram escovação em casa (OR: 4,17 / p=0,001) e aquelas que só permi-tiam a escovação às vezes (OR: 3,07 / p=0,010). Conclusão: Existe uma influência positiva do programa no condicionamento psicológico, na ansiedade das crianças e na adoção de corretos hábitos em suas rotinas.

Remoção de mucocele com laser diodo: relato de caso clínico em paciente infantil / Mucocele removal with laser diode: case report on child patient

A mucocele é uma das lesões benignas que mais afeta a cavidade bucal. O laser de diodo de alta potência é uma opção que substitui ou associa procedimentos complementares aos processos convencionais,tendo mais conforto pós-cirúrgico. O objetivo deste trabalho foi relatar o caso clínico de remoção de mucocele de lábio inferior em paciente infantil utilizando laser de diodo de alta potência. Paciente do sexo feminino, 8 anos de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia São Leopoldo Mandic, em Campinas, relatando incômodo no lábio inferior, com a presença de uma “bolinha”. Ao exame clínico observou-se tumefação de consistência mole, flutuante, translúcida, com coloração similar à mucosa bucal. Após diagnóstico, o tratamento baseou-se na remoção cirúrgica com auxílio de laser de diodo de alta potência. Inicialmente foi realizada a anestesia infiltrativa ao redor da lesão, e então a remoção cirúrgica foi conduzida, juntamente com as glândulas acessórias para evitar recidiva, com uso do laser de diodo de alta potência. Ao fim do procedimento foi possível observar que a paciente saiu satisfeita, sendo o prognóstico favorável. No retorno de 30 dias, observou-se que não houve recidiva da lesão. O laser dediodo de alta potência, uma vez que apresenta uma série de benefícios, como excelente hemostasia, sem a necessidade de sutura, redução do edema e dor, cicatrização mais rápida e redução do tempo para realizar o procedimento, parece ser uma opção para remoção de mucocele em Odontopediatria.

Mucocele is a benign lesion that affects the oral cavity. The high power diode laser is an option as anadditional method or as a substitute to conventional procedures, with more post-surgical comfort. The objective of this study was to report a case of lower lip mucocele removal in a child patient using highpower diode laser. A female patient, 8 years old, attended the Clinic of Pediatric Dentistry, São Leopoldo Mandic School of Dentistry in Campinas, reporting discomfort in the lower lip, with the presence of a“ball”. On clinical examination it was observed swelling of soft consistency, floating, translucent, with coloring similar to the buccal mucosa. After diagnosis, the treatment was based on surgical removal with high power diode laser assistance. Initially infiltration anesthesia around the lesion was performed,and then the surgical removal was conducted, along with the accessory glands to prevent recurrence,with high power diode laser use. At the end of the procedure it was observed that the patient leftsatisfied, with a favorable prognosis. At the 30-day post-operative return, it was observed that there was no recurrence. The high power diode laser, since it presents a series of benefits such as excellen the mostasis, without the need for sutures, reduction of swelling and pain, faster healing, reducing the time to perform the procedure, it seems to be an option for removal of mucocele in pediatric dentistry.

Evaluation of the relationship between the cost and properties of glass ionomer cements indicated for atraumatic restorative treatment

The aim of this study was to evaluate microshear bond strength (μSBS), water sorption and solubility of glass ionomer cements (GIC) indicated for atraumatic restorative treatment (ART). Cylindrical specimens (6x2.4 mm) were used to test the sorption and solubility of each GIC (n = 5). The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10) groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R – MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400x magnification). The powder to liquid ratio and cost of material were also determined (n = 3). The data were analyzed by ANOVA and Tukey's post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70) than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06) and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35), as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p < 0.001) and dentin (R2 = 0.43; p < 0.001); and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001) and solubility (R2 = 0.79; p < 0.001). In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

Efeito de diferentes modelos de envelhecimento na resistência de união em dentina decídua hígida e cariada / Different degradations models to evaluate bond strength in sound and caries primary dentin

A resistência de união (RU) dos materiais deve ser avaliada após a degradação da interface adesiva, tentando simular um processo que ocorre naturalmente ao longo do tempo na cavidade bucal. O presente estudo avaliou a degradação da interface adesiva em diferentes materiais utilizando o modelo de envelhecimento in vitro e in situ em dentina hígida e cariada. Noventa segundos molares decíduos hígidos e sem defeitos de esmalte, foram aleatoriamente divididos em dois grupos de acordo com o substrato a ser testado (hígido e com lesão de cárie induzida). A seguir, cada um dos grupos foi subdividido aleatoriamente de acordo com o material restaurador (n=15): resina composta associada ao sistema adesivo - RC, cimento de ionômero de vidro modificado por resina - CIVMR e cimento de ionômero de vidro de alta viscosidade - CIVAV. A superfície da dentina foi preparada e com o auxílio de cânulas de polietileno, foram confeccionados os espécimes com os materiais restauradores. Partes de um mesmo dente foram submetidas a cada envelhecimento: in vitro (24 horas e 6 meses) - armazenados em água destilada à 37°C; e in situ (uso de dispositivo intraoral palatino por voluntários em uma fase experimental de 7 dias). Os espécimes foram submetidos ao teste de microcisalhamento (MPa) para avaliação da RU, seguido de análise do padrão de fratura em estereomicroscópio (400X). Os dados foram submetidos a análise de variância de medidas repetidas seguida pelo teste de Bonferroni (? = 5%). De forma geral, o armazenamento por seis meses em água degradou o grupo CIVMR em dentina hígida (<0,001) e RC em dentina cariada (p=0,007), para os outros materiais não houve diferença estatística (p=1,00)...

Materials bond strength (BS) should be evaluated after degradation of the adhesive interface, simulating the intra-oral enviroment. This study assessed the degradation of the bonding interface of differents materials using in vitro and in situ models of aging in sound and caries - affected primary dentin. Ninety sound second primary molars without enamel defects were randomly assigned into two groups (sound and induced carious) according to the substrate to be tested. Then each group was subdivided according to the restorative material (n=15): composite resin associated with the adhesive system - CR, resin-modified glass ionomer cement - RMGIC or high-viscous glass ionomer cement- HVGIC. Dentin surface was prepared and with the aid of polyethylene tubes specimens of each restorative materials were prepared. Parts of a same tooth were subjected to in vitro and in situ models of aging. For in vitro model, the specimens were stored in distilled water at 37°C during 24 hours per 6 months; and for in situ model an intraoral palatal device was confectioned and used by volunteers in an experimental phase for 7 days.Specimens were submitted to microshear test (MPa) for BS evaluation and then stereomicroscopy (400X) analys of failure mode. Data were analyzed by repeated measures ANOVA for followed by Bonferroni test (? = 5%). In general, the storage for six months in distilled water degraded the RMGIC group in sound dentin (<0.001) and RC group in caries-affect dentin substrate (p = 0.007), for the others materials there was no statistical difference (p = 1.00)...

Ansiedade dos bebês durante o tratamento restaurador atraumático (ART) / Anxiety in babies during atraumatic restorative treatment (ART)

O objetivo foi avaliar o nível de ansiedade dos bebês comparando o ART com a abordagem restauradora convencional. Os dados analisados são referentes à clínica de pesquisa em ART da Fousp. Foram 9 pacientes divididos em 2 grupos: Grupo ART (11 restaurações atraumáticas em 4 bebês) e Grupo Convencional (10 restaurações convencionais em 5 bebês). O nível de ansiedade foi avaliado por meio do registro do comportamento pelo índice de Venham. As avaliações foram realizadas nos seguintes momentos: início do tratamento, isolamento/anestesia local, remoção do tecido cariado, momento da restauração, final da sessão. Em geral, as médias se mostraram mais elevadas nas crianças submetidas ao tratamento convencional, entretanto não houve diferença estatisticamente significante na comparação das duas abordagens restauradoras. O comportamento dos bebês durante as abordagens restauradoras (ART e convencional) é semelhante. Porém, por apresentar evidência científica de efetividade restauradora e reduzir o tempo de tratamento, o Tratamento Restaurador Atraumático está indicado para bebês.

The objective was to assess the level of anxiety in babies comparing ART with conventional restorative approach. The data analyzed refer to a clinical research in ART of FOUSP. Nine patients were divided into 2 groups: Group ART (11 atraumatic restorations in 4 babies) and Conventional Group (10 conventional restorations in 5 babies). The anxiety was assessed by recording the behavior throuh Venham index. Evaluations were performed at the following times: baseline, local anestesia/rubber dam, caries removal, restore time, end of treatment. In general, the averages were more elevated in children undergoing conventional treatment, however there was no statistically significant difference when comparing the two restorative approaches. The babies behavior during the restorative approaches (ART and conventional) is similar. However, because it presents scientific evidence of restorative effectiveness and reduces the time of treatment, the Atraumatic Restorative Treatment is indicated for babies.

Tenodesis del biceps: comparación de técnica supra-pectoral artroscópica versus sub-pectoral abierta / Biceps tenodesis. Arthroscopic supra-pectoral versus mini-open sub-pectoral technique

Introducción: La biotenodesis es la técnica preferida para el manejo de la patología del tendón de la porción larga del bíceps en personas jóvenes, deportistas, trabajadores, y aquellos que desean evitar alguna deformidad estética. El objetivo de nuestro trabajo es evaluar los resultados clínico funcionales, la satisfacción personal del paciente, y las posibles complicaciones de dos técnicas diferentes de tenodesis: Supra-pectoral Artroscopica y Sub-pectoral Abierta Materiales y Métodos: De enero de 2009 a enero de 2012 evaluamos en forma retrospectiva 81 pacientes con patología del tendón largo del biceps tratados con dos técnicas de tenodesis diferentes. Grupo A: 61 pacientes con técnica de biotenodesis artroscópica suprapectoral y Grupo B: 20 pacientes con técnica mini abierta subpectoral utilizando tornillo interferencial. Utilizamos los escores de ASES, Rowe, Simple Shoulder Test, Constant Murley y VAS, y el grado de satisfacción personal en cuanto a estética y dolor local en la cicatriz se evaluo mediante entrevistas personales y telefónicas. El tiempo promedio de seguimiento fue de 12 meses. Resultados: Grupo A: Rowe de 86 puntos, ASES de 81 puntos, el SST de 9 puntos, y Constant Murley de 87 puntos. VAS: escaso dolor post quirúrgico (2/10). El grado de satisfacción fue muy bueno. Grupo B: Rowe de 85 puntos, ASES de 82 puntos, el SST de 8,5 puntos, y el Constant Murley de 85 puntos. VAS: 3/10, mayor en el sitio del abordaje subpectoral. Molestias estéticas sobre la cicatriz en 4 casos, todos estos de sexo femenino. Conclusión: Una tenodesis íntegramente artroscópica es técnicamente mas desafiante y requiere inicialmente una curva de aprendizaje de mayor duración para realizar con éxito este procedimiento. La tenodesis subpectoral es un procedimiento más rápido, sencillo pero su elección estaría únicamente ligada a una cuestión de ahorro de tiempo quirúrgico...

Introduction: The biotenodesis is the preferred technique for handling the pathology of the long head of the biceps tendon in younger people, athletes, workers, and those wishing to avoid any cosmetic deformity. The aim of our study was to evaluate the functional clinical outcomes, patient satisfaction, staff, and possible complications of two different tenodesis techniques: Supra pectoral pectoral Sub Arthroscopic and Open. Materials and methods: From January 2009 to January 2012 retrospectively evaluated 81 patients with pathology of the long biceps tendon treated with two different tenodesis techniques. Group A: 61 patients with arthroscopic technique suprapectoral biotenodesis and Group B: 20 patients with mini open technique using subpectoral interference screw. We used the scores of ASES , Rowe, Simple Shoulder Test , Constant Murley and VAS , and the degree of personal satisfaction in terms of aesthetics and local pain at the scar was assessed through personal and telephone interviews. The average follow-up time was 12 months. Results: Group A: 86 points Rowe, ASES 81 points, 9 points SST , Constant and Murley 87 puntos.VAS : poor postsurgical pain (2/10). The degree of satisfaction was very good...

Relación entre laxitud articular e inestabilidad glenohumeral. Un meta-análisis de la literatura / Relationship between articular laxity and shoulder instability. A meta-analysis

El objetivo de esta revisión sistemática fue establecer si existe alguna relación entre la inestabilidad glenohumeral y cualquier forma de laxitud articular. Se realizó un algoritmo de búsqueda de acuerdo a las guías de PRISMA en las bases de datos de PubMed, OVID, Sport Discus, Scopus y Web of Science usando las palabras clave “(Ligament Laxity OR ligamentous Laxity OR generalized joint laxity) AND (shoulder dislocation OR shoulder subluxation OR shoulder luxation OR Shoulder instability) hasta Diciembre de 2013. Se incluyeron los artículos en lengua inglesa que describan algún tipo de relación objetiva, entre inestabilidad glenohumeral y laxitud articular focal o generalizada. Fueron excluidos estudios en cadáveres, o in vitro, o que contengan pacientes con enfermedades del tejido conectivo, reportes de casos, reportes biomecánicos, revisiones, cartas de editores y notas técnicas. La búsqueda arrojó un total de 603 artículos de los cuales 15 cumplían los criterios de inclusión. Según la evidencia encontrada la laxitud articular podría influir en la inestabilidad glenohumeral, pero debido a la gran diversidad de formas en que ambas se relacionan y las diferentes maneras de diagnosticarlas es imposible obtener un análisis estadístico que provea información confiable. Los cirujanos ortopedistas debemos unificar criterios en relación a la definición y a los test para evaluar laxitud articular e inestabilidad glenohumeral y, así de esta manera, poder obtener información más confiable y objetiva. Nivel de Evidencia: IV. Tipo de Estudio: Revisión Sistemática...

The aim of this meta-analisis was to establish whether there is a relationship between any kind of articular laxity and shoulder instability. The search algorithm according to the PRISMA guidelines of PubMed, OVID, Sport Discus, Scopus and Web of Science databases using the keywords “(Ligament laxity OR ligamentous laxity OR generalized joint laxity) AND (shoulder dislocation OR shoulder subluxation OR shoulder luxation OR shoulder instability) until December of 2013 was done. Inclusion Criteria: articles in English showing relationship between any types of glenohumeral instability with focal or generalized joint laxity. Studies on cadavers, or in vitro, involving patients with connective tissue diseases, case reports, biomechanical reports, revisions, letters to editors and technical notes were excluded. Fifteen articles of 603 reference of the search were included. Joint laxity may influence shoulder instability. We found diversity not only in how to relate joint laxity and glenohumeral instability buy also different ways of diagnosing. This makes it difficult to obtain statistical analysis that can provide reliable data. Additional efforts aiming to provide consensus are required to clarify this subject. Orthopedics surgeons must unify criteria regarding lax shoulder as well as glenohumeral instability and thus can get more objective and reliable data. Level of Evidence: IV. Study design: Systematic Review...