Perspectiva econômica do mercado de inovação em tecnologia assistiva: cenário nacional e projeções mundiais / Economic perspective of the assistive technology innovation market: national scenario and environmental projections

Objetivo: A tecnologia assistiva (TA) busca suprir ou reduzir o impacto das deficiências na execução de tarefas da vida cotidiana. Embora muitas pessoas necessitem de TA, em 2021, a OMS estimou que apenas uma em cada dez pessoas tinha acesso a ela. Com a oferta retraída e a demanda em alta, observou-se um movimento mundial crescente de inovações em TA e a abertura de um cenário de oportunidades para esse mercado. O objetivo deste artigo é avaliar o mercado de TA no Brasil e as projeções futuras, no cenário mundial. Métodos: A pesquisa foi realizada em três etapas. Primeiramente, foi realizado um estudo bibliográfico do Livro Branco da Tecnologia Assistiva no Brasil (2017), para reconhecimento dos desafios do mercado brasileiro. Em seguida, foi realizado um estudo sobre o cenário de crédito nacional, com foco em financiamento de TA. Para compreensão do mercado mundial, foi realizada uma pesquisa nos sites de análise de mercado de TA. Resultados: Há escassez de TA no Brasil. Os principais fornecedores são pequenas e médias empresas, e são escassos os incentivos fiscais e de crédito, assim como os investimentos em pesquisa, desenvolvimento e inovação. Em escala mundial, o mercado de TA foi avaliado em US$ 21,95 bilhões de dólares em 2022, devendo atingir o valor de US$ 31,22 bilhões de dólares até o ano de 2030. Conclusão: O mercado mundial de TA está em franca expansão e apresenta grande potencial de abertura para novos mercados. Esse cenário reflete um momento de oportunidades de negócio para as empresas nacionais.

Objective: Assistive Technology (AT) seeks to overcome or reduce the impact of deficiencies when performing everyday tasks. Although many people needed AT, in 2021, the WHO estimated that only one in ten people had access. With reduced supply and rising demand, a growing global movement of AT innovations was inspired, opening up a scenario of opportunities for this market. The objective of this study is to evaluate the AT market in Brazil and future projections on the global stage. Methods: The research was carried out in three stages. Firstly, a bibliographical study of the "White Book of Assistive Technology in Brazil" was carried out to recognize the challenges of the Brazilian market. Next, a study was carried out on the national credit scenario, focusing on TA financing. To understand the global market, research was carried out on TA market analysis websites. Results: There is a shortage of AT in Brazil. The main suppliers are small and medium-sized companies, and tax and credit incentives, as well as investments in Research, Development and Innovation, are scarce. On a global scale, the AT market was valued at US$ 21.95 billion in 2022, and is expected to reach a value of US$ 31.22 billion by the year 2030. Conclusion: The global AT market is in rapid expansion and presents great potential for opening up new markets. This scenario reflects a moment of business opportunities for national companies.

Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis

ABSTRACT Introduction: Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. Objective: The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. Material and Methods: Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. Results: Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). Conclusions: Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

RESUMO Introdução: A expansão rápida da maxila assistida cirurgicamente (ERMAC) tem sido o tratamento de escolha em indivíduos que apresentam suturas esqueleticamente maduras. Objetivo: O objetivo deste estudo foi avaliar, utilizando uma análise não linear com elementos finitos, a distribuição de tensões e os deslocamentos das estruturas craniofaciais e dentoalveolares gerados por três tipos de expansores palatinos usados na ERMAC. Material e Métodos: Três tipos de expansores palatinos foram projetados: Modelo I (dento-osseossuportado com quatro mini-implantes), Modelo II (dento-osseossuportado com dois mini-implantes) e Modelo III (osseossuportado com quatro mini-implantes). Uma osteotomia Le Fort I foi realizada e foi simulada uma expansão palatina total de 5,0 mm. Um método de análise não linear (três teorias - teoria da não-linearidade geométrica, teoria do contato não linear e métodos para materiais não lineares) foi utilizado para avaliar a tensão e o deslocamento de diversas estruturas craniofaciais e dentoalveolares. Resultados: Independentemente do tipo de aparelho expansor palatino, a ERMAC produziu maior expansão anterior da maxila do que posterior (ENA variou de 2,675 mm a 3,444 mm e ENP variou de 0,522 mm a 1,721 mm); o Modelo I apresentou padrão de abertura mais paralela da sutura palatina mediana, com ENP/ENA igual a 54%. Com relação à ENA, o Modelo II (1,159 mm) e o Modelo III (1,000 mm) apresentaram maior deslocamento para baixo do que o Modelo I (0,343 mm). A ENP deslocou-se mais para anterior do que a ENA com todos os aparelhos; o Modelo III apresentou o maior deslocamento para anterior da ENP (1,147 mm) e da ENA (1,064 mm). Os três tipos de expansores apresentaram deslocamento dentário semelhante e separação mínima das suturas craniofaciais. Como esperado, diferentes designs de expansores palatinos produzem diferentes áreas primárias e níveis de tensões (o expansor osseossuportado apresentou tensão mínima nos dentes, e o expansor dento-osseossuportado com dois mini-implantes apresentou o maior). Conclusões: Com base nesse estudo de elementos finitos, os resultados mostraram que diferentes designs de expansores palatinos produzem diferentes áreas primárias e níveis de tensão, com deslocamento mínimo das suturas craniofaciais e diferentes expansões esqueléticas em forma de V.

Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor

Abstract Objective To verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). Methods Retrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21-42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. Results There was an increase in nasal width with an average of 1.3467 mm and an increase in the alar base with an average of 1.7333 mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. Conclusion Although our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. Level of evidence: Level 4.

Biomechanical behavior of three maxillary expanders in cleft lip and palate: a finite element study

Abstract: This study evaluated the stress distribution in the dentoalveolar and palatal bone structures during maxillary expansion in a 17-year-old male patient with bilateral cleft lip and palate (BCLP) using expanders with dental (HYRAX) and skeletal anchorage (MARPE). For the generation of the specific finite element models, cone-beam computed tomography was used, and the DICOM files were exported to Mimics 3-Matic (Materialise) and Patran (MSC Software) software. Three specific three-dimensional models were generated: A) HYRAX: conventional four-banded hyrax screw (9 mm); B) MARPE-DS: 3 miniscrews (1.8 mm diameter - 5.4 mm length) and four-banded dental anchorage; and C) MARPE-NoDS: 3 miniscrews without dental anchorage. Maxillary expansion was simulated by activating the expanders transversely 1 mm on the "X" axis. HYRAX resulted in higher levels of deformation predominantly in the dentoalveolar region. MARPE-DS showed stress in the dentoalveolar region and mainly in the center of the palatal region, at approximately 4,000 με. MARPE-NoDS exhibited evident stress only in the palatal region. High stress levels in the root anchoring teeth were observed for HYRAX and MARPE-DS. In contrast, MARPE-NoDS cause stress on the tooth structure. The stress distribution from the expanders used in the BLCP showed asymmetric expansive behavior. During the initial activation phase of expansion, the HYRAX and MARPE-DS models produced similarly high strain at the dentoalveolar structures and upper posterior teeth displacement. The MARPE-NoDS model showed restricted strain on the palate.

Effect of rapid maxillary expansion on masticatory and swallowing functions in children with posterior crossbite

Abstract Objective: Investigate the influence of posterior crossbite on masticatory and swallowing functions by videofluoroscopy examination and to analyze the effects of Rapid Maxillary Expansion (RME) on the same functions. Methods: A prospective longitudinal study was conducted on 32 children, 21 of them with posterior crossbite (10 girls and 11 boys, mean age 9.2 years, study group) and 11 children with no occlusal changes (6 girls and 5 boys, mean age 9.3 years, control group). The children were evaluated by an orthodontist for diagnosis, group characterization and occlusal treatment, by the otorhinolaryngology team for the assessment of respiratory symptoms, and by a speech therapist for videofluoroscopic evaluation of masticatory and swallowing parameters. The children with posterior crossbite were treated orthodontic ally using the Haas disjunctor for approximately six months and re-evaluated 5-months after removal of the appliance. Data were analyzed statistically by the Studentt-test for independent samples for comparison of the crossbite and control groups before and after treatment. Results: There was no significant difference in oral preparatory and oral transit times, nor in cycles and masticatory frequency, between the pre and post orthodontic treatment groups and the control group. Conclusion: Rapid maxillary expansion did not influence the masticatory and swallowing variables studied by videofluoroscopy. However, the data require caution in interpretation.

Validity of the Maturation Stage Method in the Individual Assessment of Midpalatal Suture Ossification Before Maxillary Expansion: A Systematic Review / Validez del Método de la Etapa de Maduración en la Evaluación Individual de la Osificación de la Sutura Palatina Mediana Previo a la Expansión Maxilar: Una Revisión Sistemática

In 2013, midpalatal suture maturation stage assessment was proposed for the evaluation of patients before performing maxillary expansion. In this study, we aimed to analyze the association between the midpalatal suture maturation stages assessed by CBCT, according to the method described by Angelieri et al., and other objective methods used to assess skeletal maturation or bone fusion. A computerized database search was conducted using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus, without language restriction. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Search terms included midpalatal suture, maturation, correlation, diagnostic performance, classification, evaluation, assessment, and relationship. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Eleven studies met the inclusion criteria. Of all the studies included, 81.9% had fair qualit y and 18.1% good quality, respectively. Eight out of eleven studies assessed the correlation between the midpalatal suture maturation method and the skeletal maturity evaluated by CVM method (Spearman's correlation coefficient: 0.244-0.908). Two out of eleven studies evaluated the correlation between midpalatal suture maturation method and the skeletal maturity assessed by HWM method (Spearman's correlation coefficient: 0.904-0.905) Even though midpalatal suture maturation stage assessment needs an exhaustive training and calibration process, it is a valid method to evaluate skeletal maturation or bone fusion. From a clinical perspective, for patients at CS4, CS5 and CS6, an assessment of the midpalatal suture on CBCT is indicated. A similar assessment should be done in patients at SMI 7-9.

En 2013, se propuso un nuevo método para la evaluación del estadio de maduración de la sutura palatina mediana para la evaluación de los pacientes antes de realizar la expansión maxilar. En este estudio, nuestro objetivo fue analizar la asociación entre las etapas de maduración de la sutura palatina mediana evaluada en CBCT, según el método descrito por Angelieri et al., y otros métodos objetivos utilizados para evaluar la maduración esquelética o la fusión ósea. Se realizó una búsqueda en las bases de datos PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, sin restricción de idioma. Se buscó literatura no publicada en ClinicalTrials.gov, el Registro Nacional de Investigación y la base de datos Pro-Quest Dissertation Abstracts and Thesis. Se estableció contacto con los autores cuando fue necesario y se revisaron las listas de referencias de los estudios incluidos. Los términos de búsqueda incluyeron sutura palatina mediana, maduración, correlación, rendimiento diagnóstico, clasificación, evaluación, valoración y relación. La evaluación de la calidad se realizó mediante la herramienta de Estudios transversales y de cohortes observacionales desarrollada por el Instituto Nacional del Corazón, los Pulmones y la Sangre. Once estudios cumplieron con los criterios de inclusión. Del total de estudios incluidos, el 81.9% tuvo calidad regular y el 18.1% calidad buena, respectivamente. Ocho de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método CVM (coeficiente de correlación de Spearman: 0.244-0.908). Dos de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método HWM (coeficiente de correlación de Spearman: 0.904-0.905). Aunque la evaluación del estado de maduración de la sutura palatina mediana necesita un proceso exhaustivo de entrenamiento y calibración, es un método válido para evaluar la maduración esquelética o la fusión ósea. Desde una perspectiva clínica, para pacientes en CS4, CS5 y CS6, está indicada una evaluación de la sutura palatina mediana en CBCT. Se debe realizar una evaluación similar en pacientes con SMI 7-9.

Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Split crest con colocación simultánea de implantes en sector anterior: reporte de un caso / Split crest with simultaneous placement of implants in the anterior sector: a case report

La pérdida ósea en el sector anterior, ya sea por un defecto horizontal, vertical o combinado, actualmente es un desafío, no sólo por la integración del implante, sino por la estética involucrada. Entre las técnicas de regeneración ósea que permiten solucionar estos defectos, cabe destacar la técnica de expansión de crestas. Se presenta el caso de una paciente de 58 años con reborde atrófico, que se sometió a la expansión de crestas con colocación simultánea de implantes en sector anterior, con xenoinjerto previo a técnica de expansión de crestas con piezoeléctrico, colocación simultánea de implantes Narrow Connection SLActive Straumann. Se logró ganancia ósea y estabilidad primaria de los implantes, sin complicaciones. En escenarios seleccionados, la técnica de expansión de crestas de manera predecible permite ganancia de hueso horizontal adecuada, el éxito de los implantes con tasa de supervivencia y mínimas complicaciones intra y postoperatorias (AU)

Bone loss in the anterior sector, both a horizontal, vertical or combined defect is a challenge today; not only for the integration of the implant but also the aesthetic involved. There are techniques of bone regeneration that help us to solve this type of defects, among them we should highlight the crest expansion technique. We present the case of a 58-year-old patient with atrophic flange, who underwent the expansion of crests with simultaneous placement of implants in the anterior sector, with xenograft prior to the piezoelectric crest expansion technique, Simultaneous placement of Narrow Connection SLActive Straumann implants, bone gain and primary stability of the implants were obtained, without complications. In selected scenarios, the crest expansion technique could be considered a predictable approach that demonstrates a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications (AU)

Proposal for the Modification of the Method to Evaluate the Midpalatal Suture Maturation Status / Proposta de Modificação do Método para Avaliação do Status da Sutura Palatina Mediana

The objective of present research was to propose a new definition for the midpalatal suture (MPS) maturational stages through reevaluation of intermediate stages B, C and D. The sample was composed by 158 cone-beam computed tomography (CBCT) of individuals between 11 and 20 years of age (±15.4 years, 86 females and 71 males), divided into two groups: 74 individuals aged 11-15 years and 84 individuals aged 16-20 years. The CBCT scans were applied to evaluate midpalatal suture maturation status and comprised stages previously classified as B (29), C (92) and D (37). Each axial image was subdivided into six parts in the anteroposterior direction, and each portion was classified according to MPS maturational evaluation methodology. New definitions of stages were proposed. The reliability of the method was tested by two examiners and the intra- and inter-examiner concordances were defined for each evaluation through weighted kappa coefficients and 95% confidence intervals. The chi-square test was used to compare the groups. In all statistical tests, a significance level of 5% was adopted. Two new maturational stages were defined: sub-stage C- and sub-stage C+, with prevalence of 12% and 8.9%, respectively, in 11 to 20-year-olds. The redefinition and validation of the maturational stages of MPS, considering the sub-stages C- and C+, may allow to elucidate the difference in the prognosis of Rapid Maxillary Expansion among individuals aged 11 to 20 years. This data should be confirmed through a clinical study.(AU)

O objetivo da presente pesquisa foi propor uma nova definição para os estágios maturacionais da sutura palatina média (MPS) por meio da reavaliação dos estágios intermediários B, C e D. A amostra foi composta por 158 tomografias computadorizadas de feixe cônico (TCFC) de indivíduos entre 11 e 20 anos de idade (±15,4 anos, 86 do sexo feminino e 71 do sexo masculino), divididos em dois grupos: 74 indivíduos de 11 a 15 anos e 84 indivíduos de 16 a 20 anos. Os exames de TCFC foram aplicados para avaliar o estado de maturação da sutura palatina média e compreenderam os estágios previamente classificados como B (29), C (92) e D (37). Cada imagem axial foi subdividida em seis partes no sentido anteroposterior, e cada porção foi classificada de acordo com a metodologia de avaliação maturacional MPS. Novas definições de estágios foram propostas. A confiabilidade do método foi testada por dois examinadores e as concordâncias intra e interexaminadores foram definidas para cada avaliação por meio de coeficientes kappa ponderados e intervalos de confiança de 95%. O teste do qui-quadrado foi utilizado para comparar os grupos. Em todos os testes estatísticos adotou-se o nível de significância de 5%. Dois novos estágios maturacionais foram definidos: subestágio C- e subestágio C+, com prevalência de 12% e 8,9%, respectivamente, em jovens de 11 a 20 anos. A redefinição e validação dos estágios maturacionais da MPS, considerando os subestágios C- e C+, podem permitir elucidar a diferença no prognóstico da Expansão Rápida da Maxila entre indivíduos de 11 a 20 anos. Esses dados devem ser confirmados por meio de um estudo clínico.(AU)

Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review

Abstract Objective To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. Methods The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. Results We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. Conclusion Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.

Evaluación de Cambios Dimensionales en Ancho y Altura del Reborde Óseo Alveolar Mediante la Técnica de Oseodensificación en Zonas Posteriores del Maxilar. Reporte de Serie de Casos

Con el objetivo de tratar mediante implantes dentales zonas de tejido óseo incipiente y minimizar el uso de técnicas más invasivas, surge la oseodensificación (OD), una técnica realizada mediante la utilización de fresas Densah®, diseñadas para aumentar la densidad ósea, desplazando y condensando el tejido óseo circundante al fresado. El objetivo del estudio fue determinar los cambios dimensionales en ancho y altura del reborde óseo alveolar (ROA) en zonas posteriores del maxilar utilizando la técnica de OD, 3 meses posterior a realizada la cirugía. Se realizaron evaluaciones imagenológicas mediante Cone-Beam-CT (preoperatorio y mínimo 3 meses postoperatorio) a 9 pacientes, en los que se instalaron 10 implantes, divididos según instalación mediata e inmediata. En ambos grupos, se midió el ancho del ROA tanto a nivel marginal, utilizando como referencia el plano de la cresta ósea vestibular (COV), como 4 mm apical al plano COV. También se midió la altura del ROA con relación al plano COV y al piso del seno maxilar (PSM). Las comparaciones se realizaron mediante el análisis estadístico prueba t student-muestras pareadas. Los datos imagenológicos mostraron un valor de p<0,05 para la expansión ósea, tanto en ancho (solo implantes mediatos, media 2,11 ± 1,66 mm) como en altura con relación a PSM (implantes mediatos e inmediatos, medias de 2,28 ± 2,21 y 1,88 ± 1,82 respectivamente). La técnica de OD resultó ser efectiva en generar un aumento, tanto en ancho de implantes mediatos a nivel del plano COV como en altura del ROA en implantes mediatos e inmediatos.

In order to treat areas of incipient bone tissue with dental implants and minimize the use of more invasive techniques, osseodensification (OD) is a technique performed using Densah® drills, designed to increase bone density by displacing and condensing the bone tissue surrounding the drill. To determine the dimensional changes in width and height of the alveolar bone ridge (ABR) in posterior regions of the maxilla using the OD technique, 3 months after surgery. Imaging evaluations were performed by Cone- Beam-CT (preoperative and at least 3 months postoperative) in 9 patients, in whom 10 implants were installed, divided according to mediate and immediate installation. In both groups, the width of the ABR was measured both at the marginal level, using the vestibular osseous ridge plane (VOR) as a reference, and 4 mm apical to the VOR plane. The height of the ROA was also measuredin relation to the VOR plane and the maxillary sinus floor (MSF). Comparisons were performed by student t-test paired-samples statistical analysis. Imaging data showed a value of p<0.05 for bone expansion, both in width (mediated implants only, mean 2.11±1.66 mm) and height in relation to PSM (mediated and immediate implants, means of 2.28±2.21 and 1.88±1.82 respectively). The OD technique proved to be effective in generating an increase in width of dental implants mediated at the level of the VOR plane and in height of the ABR (mediated and immediate implants).

Unicystic Ameloblastoma ? A Case Series

Ameloblastoma is a benign, locally aggressive neoplasm that constitutes about 1–3% of the tumors of the jaw. Wide surgical excision with adequate safe margin is the most common treatment of choice. The study aimed to manage cases with unicystic ameloblastoma while preserving the continuity of the mandible (without resection). This article presents a series of cases ranging from 18 to 40 years old patients of both sexes with unicystic ameloblastoma, especially in the mandible showing more male predilection than female. All the cases presented in this article were treated by enucleation and curettage. None of the patients presented post?operative paresthesia. None of the cases went in for resection. Post?operative recovery was uneventful in all the patients. All the patients were followed up for a period of 3.5–5 years. None of the cases reported recurrence at the date of publication.

Short-term assessment of pain and discomfort during rapid maxillary expansion with tooth-bone-borne and tooth-borne appliances: randomized clinical trial

ABSTRACT Objective: The aim of this randomized clinical trial was to evaluate and compare, during the first week of rapid maxillary expansion (RME), the impact caused by two types of appliances: Hyrax and Hybrid Hyrax. Methods: Forty-two patients who met the eligibility criteria (aged 11-14 years, with transverse maxillary deficiency, posterior crossbite, and presence of maxillary first premolars and first permanent molars) were selected and randomly divided into two groups: TBB GROUP (tooth-bone-borne expander), treated with Hybrid Hyrax (12 females and 9 males, mean age 13.3 ± 1.3 years), and TB GROUP (tooth-borne expander), treated with Hyrax (5 females and 16 males, mean age 13.3 ± 1.4 years). Pain and discomfort were assessed in two times: after the first day of activation (T1) and four days after, by means of the numerical rate scale and the instrument MFIQ (Mandibular Functional Impairment Questionnaire). Descriptive statistics and the Mann-Whitney test were used for comparison between groups and between sexes. A 5% significance level was adopted. Results: Both appliances had a negative impact, generating pain and discomfort, and reducing functional capacity. However, the scores obtained were of low intensity and no significant differences were observed between the groups. Considering sexes, there were statistically significant differences, with the female sex presenting higher scores for pain and functional limitation. Conclusions: Despite causing impact in pain and increase in the functional limitation, these changes were of low intensity, with no statistical difference between the groups. Females were more sensitive to the impact caused by the RME.

RESUMO Objetivo: O objetivo deste ensaio clínico randomizado foi avaliar e comparar, durante a primeira semana de expansão rápida da maxila (ERM), o impacto causado por dois tipos de aparelhos: Hyrax e Hyrax Híbrido. Métodos: Quarenta e dois pacientes que atendiam aos critérios de seleção (idade de 11 a 14 anos, com deficiência transversal da maxila, mordida cruzada posterior e presença de primeiros pré-molares e primeiros molares permanentes superiores) foram selecionados e divididos aleatoriamente em dois grupos: Grupo DOS (expansor dento-osseossuportado), tratado com Hyrax Híbrido (12 mulheres e 9 homens, idade média 13,3 ± 1,3 anos), e Grupo DS (expansor dentossuportado), tratado com Hyrax (5 mulheres e 16 homens, idade média de 13,3 ± 1,4 anos). A dor e o desconforto foram avaliados em dois momentos: após o primeiro dia de ativação (T1) e após quatro dias, por meio da escala de frequência numérica e do instrumento MFIQ (Questionário de Limitação Funcional Mandibular). A estatística descritiva e o teste de Mann-Whitney foram utilizados para comparação entre os grupos e entre os sexos. Adotou-se nível de significância de 5%. Resultados: Ambos os aparelhos tiveram impacto negativo, gerando dor e desconforto e reduzindo a capacidade funcional. No entanto, os escores obtidos foram de baixa intensidade e não foram observadas diferenças significativas entre os grupos. Considerando os sexos, houve diferenças estatisticamente significativas, com o sexo feminino apresentando maiores escores para dor e limitação funcional. Conclusões: Apesar de causar impacto na dor e aumento na limitação funcional, essas alterações foram de baixa intensidade, sem diferença estatística entre os grupos. As mulheres foram mais sensíveis ao impacto causado pela ERM.

DYRK1-mediated phosphorylation of endocytic components is required for extracellular lumen expansion in ascidian notochord

BACKGROUND: The biological tube is a basal biology structure distributed in all multicellular animals, from worms to humans, and has diverse biological functions. Formation of tubular system is crucial for embryogenesis and adult metabolism. Ascidian Ciona notochord lumen is an excellent in vivo model for tubulogenesis. Exocytosis has been known to be essential for tubular lumen formation and expansion. The roles of endocytosis in tubular lumen expansion remain largely unclear. RESULTS: In this study, we first identified a dual specificity tyrosine-phosphorylation-regulated kinase 1 (DYRK1), the protein kinase, which was upregulated and required for ascidian notochord extracellular lumen expansion. We demonstrated that DYRK1 interacted with and phosphorylated one of the endocytic components endophilin at Ser263 that was essential for notochord lumen expansion. Moreover, through phosphoproteomic sequencing, we revealed that in addition to endophilin, the phosphorylation of other endocytic components was also regulated by DYRK1. The loss of function of DYRK1 disturbed endocytosis. Then, we demonstrated that clathrin-mediated endocytosis existed and was required for notochord lumen expansion. In the meantime, the results showed that the secretion of noto-chord cells is vigorous in the apical membrane. CONCLUSIONS: We found the co-existence of endocytosis and exocytosis activities in apical membrane during lumen formation and expansion in Ciona notochord. A novel signaling pathway is revealed that DYRK1 regulates the endocytosis by phosphorylation that is required for lumen expansion. Our finding thus indicates a dynamic balance between endocytosis and exocytosis is crucial to maintain apical membrane homeostasis that is essential for lumen growth and expansion in tubular organogenesis.

First Record of Zaprionus tuberculatus Malloch, 1932 (Diptera: Drosophilidae) in Minas Gerais, Brazil

ABSTRACT The Afrotropical Zaprionus Coquillett, 1902 (Diptera: Drosophilidae) has gained visibility since the 1990s due to the geographic expansion of Zaprionus indianus Gupta, 1970. More recently, a second species, Zaprionus tuberculatus Malloch, 1932, invaded regions outside its original African regions, causing economic concerns, particularly in Europe. In 2021, Z. tuberculatus was captured for the first time in the Americas, specifically in urban parks, and preserved fragments of the Brazilian Cerrado, causing concerns about the competition with native drosophilids. Here we report the occurrence of Z. tuberculatus 900 km from its first record in urban and rural areas of Viçosa, MG, but not in forest fragments. Considering the great capacity for dispersion and the potential of Z. tuberculatus to compete with native drosophilids species, as well as the potential harm to fruit production when co-occurring with Drosophila suzukii (Matsumura, 1931), further studies would be necessary to monitor this invasion and create mechanisms to control it.

O escorpionismo no Estado de Goiás (2003-2019) / Scorpionism in the State of Goiás (2003-2019)

Objetivo: realizar uma avaliação dos acidentes com escorpiões no Estado de Goiás no período de 2003 a 2019. Métodos: trata-se de um estudo epidemiológico descritivo, onde a coleta de dados se baseou nas Fichas de Notificações Compulsórias, mantidas no Centro de Informações e Assistência Toxicológica de Goiás. Foram utilizados formulários simplificados para a coleta de 23 variáveis que foram analisadas e tabuladas. Resultados: foram notificados 18.720 casos, sendo o município de Goiânia com o maior número de ocorrências do estado, com um predomínio dos acidentes na zona urbana, sendo a população economicamente ativa a mais vulnerável. A sazonalidade dos acidentes possui características pouco evidentes em relação à precipitação e à temperatura anual do Estado de Goiás, com uma discreta menor prevalência nos meses de junho e julho. O tempo de atendimento está associado a um prognóstico mais favorável e à classificação do caso. O aumento do número de acidentes é crescente a partir de 2012, ano em que a notificação compulsória passou a ser obrigatória. A distribuição geográfica dos acidentes é influenciada pelo processo de urbanização desorganizado. Os óbitos estão associados, principalmente, à faixa etária pediátrica. Conclusões: a sazonalidade dos acidentes escorpiônicos no Estado de Goiás tem um padrão pouco evidente em relação às condições ambientais. A faixa etária produtiva é a mais acometida. Existe uma necessidade de melhora na capacitação dos profissionais de saúde quanto ao diagnóstico, à quantidade de soro a ser utilizada e ao preenchimento e encaminhamento das fichas de notificação

Objective: to carry out an evaluation of accidents with scorpions in the State of Goiás from 2003 to 2019. Methods: this is a descriptive epidemiological study, where data collection was based on the Compulsory Notification Forms, kept at the Information and Toxicological Assistance in Goiás. A simplified form was used to collect 23 variables that were analyzed and tabulated. Results: 18,720 cases were notified, with the municipality of Goiânia having the highest number of occurrences in the state, with a predominance of accidents in the urban area, with the economically active population being the most vulnera-ble. The seasonality of the accidents has little evident characteristics in relation to annual precipitation and temperature in the State of Goiás, with a slight lower prevalence in the months of June and July. The length of service is associated with a better prognosis and case classification. The increase in the number of accidents has been increasing since 2012, when compulsory notification became mandatory. The geographic distribution of accidents is influenced by the disorganized urbanization process. Deaths are mainly associated with the pediatric age group. Conclusions: the seasonality of scorpion accidents in the State of Goiás has an unclear pattern with respect to environmental conditions. The productive age group is the most affected. There is a need to improve the training of health professionals regarding the diagnosis, the amount of serum to be used and the completion and forwarding of notification forms

Suppressing STAT3 activation impairs bone formation during maxillary expansion and relapse

Abstract Objectives The mid-palatal expansion technique is commonly used to correct maxillary constriction in dental clinics. However, there is a tendency for it to relapse, and the key molecules responsible for modulating bone formation remain elusive. Thus, this study aimed to investigate whether signal transducer and activator of transcription 3 (STAT3) activation contributes to osteoblast-mediated bone formation during palatal expansion and relapse. Methodology In total, 30 male Wistar rats were randomly allocated into Ctrl (control), E (expansion only), and E+Stattic (expansion plus STAT3-inhibitor, Stattic) groups. Micro-computed tomography, micromorphology staining, and immunohistochemistry of the mid-palatal suture were performed on days 7 and 14. In vitro cyclic tensile stress (10% magnitude, 0.5 Hz frequency, and 24 h duration) was applied to rat primary osteoblasts and Stattic was administered for STAT3 inhibition. The role of STAT3 in mechanical loading-induced osteoblasts was confirmed by alkaline phosphatase (ALP), alizarin red staining, and western blots. Results The E group showed greater arch width than the E+Stattic group after expansion. The differences between the two groups remained significant after relapse. We found active bone formation in the E group with increased expression of ALP, COL-I, and Runx2, although the expression of osteogenesis-related factors was downregulated in the E+stattic group. After STAT3 inhibition, expansive force-induced bone resorption was attenuated, as TRAP staining demonstrated. Furthermore, the administration of Stattic in vitro partially suppressed tensile stress-enhanced osteogenic markers in osteoblasts. Conclusions STAT3 inactivation reduced osteoblast-mediated bone formation during palatal expansion and post-expansion relapse, thus it may be a potential therapeutic target to treat force-induced bone formation.

Effect of maxillary expansion combined with orofacial myofunctional therapy on the position of the tongue of children with mouth breathing / 临床耳鼻咽喉头颈外科杂志

Objective:This study aimed to investigate the change of the position of the tongue before and after combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion. Methods:A total of 30 children with skeletal class Ⅱ malocclusion and unobstructed upper airway were selected. The 30 children were divided into mouth-breathing group（n=15） and nasal-breathing group（n=15） and CBCT was taken. The images were measured by Invivo5 software. The measurement results of the tongue position of the two groups were analyzed by independent samples t-test. 15 mouth-breathing children with skeletal class Ⅱ malocclusion were selected for maxillary expansion and orofacial myofunctional therapy. CBCT was taken before and after treatment, the measurements were analyzed by paired sample t test with SPSS 27.0 software package. Results:The measurement of the tongue position of the mouth-breathing and nasal-breathing groups were compared, the differences were statistically significant（P<0.05）. The measurement of the tongue position showed significant difference after the combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion（P<0.05）. Conclusion:Skeletal class Ⅱ malocclusion children with mouth-breathing have low tongue posture. The combined treatment of maxillary expansion and orofacial myofunctional therapy can change the position of the tongue.

Effect of pursed lip breathing on respiratory function and respiratory muscle strength while using a spine mat / 体力科学

It has been reported that using of the spine mat increases chest expansion, inspiratory capacity (IC) and maximum inspiratory mouth pressure (PImax). However, no changes were observed in other respiratory functions and the respiratory muscle strength. The purpose of this study was to clarify the effects of pursed-lip breathing lying on the spine mat to the respiratory function and respiratory muscle strength. Forty-two adult male participants were assigned to two groups; an intervention group (IG group) of 21 participants who performed pursed-lip breathing on top of a spine mat and a control group (CG group) of 21 participants who performed pursed-lip breathing only. The intervention period was 5 days, and the respiratory features evaluated were chest expansion, respiratory function, respiratory muscle strength, and spinal alignment. A significant increase between the Pretest and the Posttest in chest expansion at the circumference of the axilla level, of the xiphoid process level and of the 10th rib level was observed only in IG group. For the respiratory function and the respiratory muscle strength, intervention group showed significant increases in percentage of vital capacity (%VC), tidal volume (TV), PImax, and maximum expiratory mouth pressure (PEmax). In the control group, only the TV indicated a significant increase. Regarding changes before and after the intervention, the intervention group showed significantly higher PImax and PEmax than the control group. No significant difference in spinal alignment was observed between the two groups. These results showed that pursed-lip breathing lying on the spine mat would increase the PImax, PEmax and the chest expansion.

Effect of miniscrew-assisted rapid palatal expansion on mandibular position / 口腔医学

Objective@#To explore the effect of miniscrew-assisted rapid palatal expansion (MARPE) on mandible position in the treatment of adult skeletal Class Ⅰ malocclusion with maxillary transverse deficiency. @*Methods@#In this retrospective study, 20 cases of adult skeletal Class Ⅰ malocclusion with maxillary transverse deficiency treated with MARPE in our hospital from July 2019 to March 2022 were selected as research objects. CBCT data of three time points before treatment (T0), immediately after expansion (T1) and six months after retention (T2) were collected. The head position was standardized and calibrated by Dolphin software, and then mandible landmarks (left and right Condylion, left and right Gonion, Menton) were positioned. The linear distance changes of each landmark relative to the reference plane of coronal plane, axial plane and sagittal plane were measured, which represented the sagittal, vertical and horizontal displacement of mandible respectively. Repeated measurement ANOVA and LSD multiple comparison were used to evaluate the position change of each landmark.@*Results @#The Menton and right Gonion rotated clockwise at T1, and relapsed to the initial position at T2. No lateral displacement of Menton was found.@*Conclusion@#When MARPE is used to treat skeletal Class Ⅰ malocclusion with maxillary transverse deficiency, it causes a transient clockwise rotation of the mandiblar. The mandible does not show sagittal, vertical and horizontal position changes in long-term evaluation.