Infection Control in the Dental Practice with Emphasis on Intraoral Scanners and Semi-Critical Complex Instruments / Control de Infecciones en la Práctica Dental Con Énfasis en Escáneres Intraorales e Instrumentos Complejos Semicríticos

ABSTRACT: We present an integrative review of the literature conducted to find and analyse specific measures for disinfection and/or sterilization of intraoral complex instruments, applicable to intraoral scanners. We performed a two-stage search in the PubMed/MEDLINE, SciELO, REDALYCS, and LILACS databases, and the Google Scholar website, which included full articles in Spanish, Portuguese, and English. The strategy associated the terms 'disinfection', 'biosecurity', 'decontamination', and (a) 'intraoral scanners', and (b) other 'semi-critical' intraoral complex instruments, according to the American Dental Association definition (e.g., 'turbine', etc). Strategy (a) produced just one outcome, whereas (b) produced nine articles, which only suggested low-level disinfectants.The lack of empirically based protocols that allow effective microbiological control makes it necessary to create a new categorization for these instruments when trying to comply with American Dental Association recommendations for dental practice.

RESUMEN: Presentamos una revisión integradora de la literatura realizada para encontrar y analizar medidas específicas de desinfección y / o esterilización de instrumentos complejos intraorales, aplicables a los escáneres intraorales. Realizamos una búsqueda en dos etapas en las bases de datos PubMed / MEDLINE, SciELO, REDALYCS y LILACS, y en el sitio web Google Scholar, que incluía artículos completos en español, portugués e inglés. La estrategia asoció los términos 'desinfección', 'bioseguridad', 'descontaminación' y (a) 'escáneres intraorales', y (b) otros instrumentos complejos intraorales 'semicríticos', según la definición de la Asociación Dental Ameri- cana (p. Ej., 'turbina', etc.). La estrategia (a) produjo un solo resultado, mientras que (b) produjo nueve artículos, que solo sugirieron desinfectantes de bajo nivel. La falta de protocolos de base empírica que permitan un control microbiológico efectivo hace necesario crear una nueva categorización para estos instrumentos, cuando se trata de cumplir con las recomendaciones de la Asociación Dental Americana para la práctica dental.

Condutas práticas para atendimento odontológico em pacientes com necessidades especiais em tempos de Covid-19: minimizando os riscos / Practical conduct for dental care for patients with special needs in times of Covid-19: minimizings risks

O mundo está diante da pandemia pela Covid-19, novo coronavírus conhecido como causa da Síndrome Respiratória Aguda Grave 2 (SARS-CoV-2) e a Odontologia pode ser considerada uma das áreas com maior risco de contaminação. Objetivo: revisar a literatura existente sobre as manifestações da Covid-19 relacionadas com a atuação odontológica e apresentar orientações aos profissionais de saúde bucal no manejo de pacientes com necessidades especiais. Métodos: foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, SciELO, Wiley Online Library, Portal de Periódicos Capes e Google Acadêmico, além de orientações (protocolos) por órgãos oficiais de saúde nacionais e internacionais. Resultados: durante o atendimento odontológico, ocorre uma proximidade face a face entre dentistas e pacientes, além de exposição a saliva, sangue e instrumentos manuais que podem estar contaminados. A atenção aos pacientes com comprometimento sistêmico requer uma anamnese minuciosa, avaliando a necessidade ou não de interconsulta médica. Enquanto os pacientes de difícil manejo precisarão de técnicas lúdicas para reduzir as barreiras que dificultam o atendimento odontológico. Conclusão: pessoas com deficiência e com outras necessidades em saúde usualmente já tinham maior dificuldade para receber atendimento odontológico. Com a Covid-19, isso se agravou, visto que o atendimento eletivo é contraindicado neste grupo. No entanto, o conhecimento que a comunidade científica está produzindo não servirá apenas para esta pandemia. A melhora na biossegurança e a valorização dos profissionais de saúde devem ser mantidas mesmo quando o surto passar.(AU)

The world is facing the pandemic by Covid-19, a new coronavirus known as the cause of Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) and Dentistry can be considered one of the areas with the highest risk of contamination. The objective of this work was to review the existing literature on the manifestations of Covid-19 related to dental practice and to present guidelines that assist oral health professionals in the management of patients with special needs. Methods: a bibliographic search was performed in the databases PubMed, SciELO, Wiley Online Library, Portal of Journals Capes and Google Scholar, in addition to guidance by official national and international health agencies. Results: during dental care, there is a face- -to-face proximity between dentists and patients, in addition to exposure to saliva, blood and hand instruments that may be contaminated. Attention to patients with systemic impairment requires a thorough anamnesis, assessing the need or not for medical consultation. While difficult-to-manage patients will need playful techniques to reduce barriers that hinder dental care. Conclusion: people with disabilities and other health needs usually already had greater difficulty in receiving dental care. With Covid-19, this worsened, since elective care is contraindicated in this group. However, the TRAD that the scientific community is producing will not only serve for this pandemic. The improvement in biosafety and the valorization of health professionals must be maintained even when the outbreak passes.(AU)

Recommendations for a safety dental care management during SARS-CoV-2 pandemic / Recomendaciones para una atención odontológica segura durante la pandemia por SARS-CoV-2 / Recomendações para um atendimento odontológico seguro durante a pandemia do SARS-CoV-2

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted mainly through droplets, sneezes and aerosols, there is a high risk of transmission during dental procedures. This report describes measures that can be adopted by oral healthcare personnel to minimize the risk of cross-contamination in clinical practice during the current SARS-CoV-2 pandemic. (AU)

Dado que el SARS-CoV-2, causante de síndrome respiratorio agudo severo, se transmite principalmente por medio de gotitas, estornudos y aerosoles, existe un alto riesgo de transmisión durante los procedimientos dentales. En este informe se describen las medidas que puede adoptar el personal de salud bucodental para reducir al mínimo el riesgo de contaminación cruzada en la práctica clínica durante la actual pandemia por SARS-CoV-2.(AU)

Como o SARS-CoV-2, que causa síndrome respiratória aguda grave, é transmitido principalmente por gotícu-las, espirros e aerossóis, há um alto risco de transmissão durante os procedimentos odontológicos. Este relatório descreve os passos que podem ser tomados pelo pessoal de saúde oral para minimizar o risco de contaminação cruzada na prática clínica durante a actual pandemia do SARS-CoV-2.(AU)

Biological and social aspects of Coronavirus Disease 2019 (COVID-19) related to oral health

Abstract The expansion of coronavirus disease 2019 (COVID-19) throughout the world has alarmed all health professionals. Especially in dentistry, there is a growing concern due to it's high virulence and routes of transmission through saliva aerosols. The virus keeps viable on air for at least 3 hours and on plastic and stainless-steel surfaces up to 72 hours. In this sense, dental offices, both in the public and private sectors, are high-risk settings of cross infection among patients, dentists and health professionals in the clinical environment (including hospital's intensive dental care facilities). This manuscript aims to compile current available evidence on prevention strategies for dental professionals. Besides, we briefly describe promising treatment strategies recognized until this moment. The purpose is to clarify dental practitioners about the virus history and microbiology, besides guiding on how to proceed during emergency consultations based on international documents. Dentists should consider that a substantial number of individuals (including children) who do not show any signs and symptoms of COVID-19 may be infected and can disseminate the virus. Currently, there is no effective treatment and fast diagnosis is still a challenge. All elective dental treatments and non-essential procedures should be postponed, keeping only urgent and emergency visits to the dental office. The use of teledentistry (phone calls, text messages) is a very promising tool to keep contact with the patient without being at risk of infection.

Investigation of Turkish dentists clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study

Abstract Currently, the whole world is under the threat of the COVID-19 pandemic, and dentists are at high risk. The aim of this study was to investigate what kind of precautions Turkish dentists take in dental clinics during the COVID-19 pandemic. The study population consisted of dentists in Turkey. An online questionnaire (23 questions-57 items) was sent to a sample of Turkish dentists from March 16 to March 20, 2020. The questionnaire comprised a series of questions about dentists' demographic characteristics, their concerns, and the measures taken in dental clinics against COVID-19. This study included a total of 1,958 Turkish dentists. A total of 1,274 (65.1%) were general dentists, and 684 (34.9%) were specialists. Five hundred twenty-two (26.7%) dentists attended an informational meeting on COVID-19. Of these dentists, 69.8% were aware of COVID-19 according to their self-assessed knowledge scores. More than 90% of the dentists were concerned about themselves and their families. Only 12% of the dentists wore an N95 mask. Although Turkish dentists took some precautionary measures, they did not take enough precautions to protect themselves, the dental staff, and other patients from COVID-19. As the number of COVID-19 cases increased, the measures taken slightly increased in dental clinics as well. Dentists are strongly recommended to take maximum precautions in the clinical setting. The guidelines about the COVID-19 pandemic should be sent to all dentists by the regional and national dental associations.

¿Por qué hacerlo? Simplemente porque es un procedimiento lógico y necesario / Why to do it? Just because is a logical and necessary procedure

En la odontología, el aislamiento absoluto del campo operatorio facilita y aumenta la eficacia de todos los procedimientos clínicos. Un campo operatorio seco y libre de contaminación protege al paciente, al profesional y al personal auxiliar. En general, el profesional, por incapacidad o impericia, recurre con frecuencia a excusas, sin comprender que su uso es lógico e insustituíble. La caída de instrumentos y la ingestión o la aspiración de cuerpos extraños que tienen origen dental constituyen la segunda causa médica más común de este tipo de accidentes. Teniendo en cuenta todos los cuidados y las precauciones que se toman para combatir y/o prevenir la infección microbiana durante un tratamiento endodóntico, resulta paradójico que muchas veces, en la reconstrucción posendodóntica, se trabaje sin efectuar la aislación absoluta...

Orthodontic treatment and referral patterns: a survey of pediatric dentists, general practitioners, and orthodontists

This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists. Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions. In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder [TMD] symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups. The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners

Standards of teeth preparations for anterior resin bonded all-ceramic crowns in private dental practice in Jordan

OBJECTIVES: To investigate if general dental practitioners (GDPs) in private practice in Jordan follow universal guidelines for preparation of anterior teeth for resin bonded all-ceramic crowns (RBCs). MATERIAL AND METHODS: A sample (n=100) of laboratory models containing 208 tooth preparations for IPS Empress and In Ceram, featuring work from different GDPs, was obtained from 8 commercial dental laboratories. Aspects of preparations were quantified and compared with accepted criteria defined following a review of the literature and recommendations of the manufactures' guidelines. RESULTS: Subgingival margins on the buccal aspect were noticed in 36 percent of the preparations, 54 percent demonstrated overpreparation with a tendency to overprepare the teeth on the mesiodistal plane more than buccolingual plane. Twenty percent of samples presented a shoulder finish line while a chamfer margin design was noticed in 39 percent. Twenty-nine percent and 12 percent of samples had either a feathered or no clear margin design respectively. Incisal underpreparation was observed in 18 percent of dies of each type. Only 17 percent of all preparations were found to follow the recommended anatomical labial preparations while 29 percent of the RBC preparations were found to have the recommended axial convergence angle. In total, 43 percent of preparations were found to have the recommended depth of the finish line. CONCLUSIONS: It was found that relevant guidelines for RBC preparations were not being fully adhered to in private practice in Jordan.

Ortodontia brasileira: ainda há boas safras / Brazilian orthodontics: still there are good vintages

O presente artigo relata o caso clínico ortodôntico de uma paciente adulta, tratada por Ortodontia fixa, com extração de quatro primeiros pré-molares e mecânica Straight Wire/Tweed. Destaca-se a importância do diagnóstico, baseado na avaliação clínica e análise da documentação ortodôntica; e da disciplina na aplicação do plano de tratamento, para contemplar a demanda estética e funcional da paciente e do ortodontista.

The assessment of infection control in dental practices in the municipality of São Paulo

OBJECTIVE: The goal of this study was to evaluate the infection control measures actually implemented by dental surgeons during dental practice, as patients and professionals are exposed to high biological risk in dental care environments. METHOD: 614 questionnaires (90.69 percent) were answered by professionals registered in updating or in post-graduate courses in the Municipality of São Paulo. RESULTS: Out of surveyed professionals 30.62 percent admitted that surface protection barriers were not used, whereas 34.17 percent were using non ideal or outdated pre-disinfection practices. The autoclave was used by 69.38 percent of participants, although 33.80 percent were not monitoring control of the sterilization cycles. Chemical and biological indicators were not used simultaneously by 83.21 percent of respondents and were not employed on a daily or weekly basis by at least 81.75 percent. Dubious methods of sterilization were cited by 44.77 percent. Occupational accidents caused by cutting and piercing objects were reported by 47.88 percent; however, the biologic risk was underestimated by 74.15 percent of the professionals who suffered the accidents. Irritant solutions were used as an antiseptic agent by 18.55 percent. CONCLUSIONS: Infection control measures reported by dental surgeons during their practices are deficient. It is necessary to educate, raise awareness of professionals, and promote constant updating courses on procedures which aim at improving safety of dental care.

Condutas do cirurgião-dentista frente a acidentes biológicos / Dentist behavior concerning occupational biological accidents

Objetivo: revisar as condutas a serem adotadas em casos de acidente com material biológico contaminado, propondo um fluxograma de encaminhamento aos setores de competência, além de pesquisar junto aos profissionais de Odontologia o conhecimento dos mesmos a respeito das condutas frente aos referidos acidentes. Outro objetivo foi avaliar os aspectos éticos e legais envolvidos com a questão. Material e métodos: a pesquisa foi realizada por meio do envio de questionários distribuídos de forma aleatória à cirurgiões dentistas da cidade de Macaé-RJ. Posteriormente os dados foram tabulados e analisados por estatística simples. Resultados: dentre os pesquisados, 95,2% disseram conhecer os riscos biológicos presentes na atividade clínica diária e 38,1% responderam que já sofreram algum tipo de acidente biológico, sendo que metade dos participantes declararam conhecer as condutas a serem tomadas nessas situações. Conclusões: foi possível propor um fluxograma de fácil entendimento para os interessados. Há um conhecimento incipiente dos profissionais questionados sobre o protocolo a ser seguido em caso de acidente com contaminação biológica, bem como a inobservância de importantes aspectos éticos e legais que norteiam a profissão.

Aim: review the measures to be adopted in cases of accidents with biological material contaminated by proposing a flow chart for referral to the areas of jurisdiction, and research from the professionals of Dentistry of the same knowledge about the behavior front to such accidents, as well as the ethical and legal issues involved with the issue. Material and methods: the study was conducted by sending questionnaires distributed randomly to dentists in the city of Macaé. Subsequently, data were tabulated and analyzed by simple statistics. Results: among those surveyed, 95.2% said they were aware of biological hazards present in daily practice and 38.1% said they had experienced some kind of biological accident, half of the participants said they knew the conduct to be taken in these situations. Conclusions: it was possible to propose a flow chart easy to understand for those interested. There is an incipient knowledge of the professionals were asked about the protocol to be followed in case of accidents with biological contamination and the failure of important ethical and legal issues that guide the profession.

Oral health in the family health strategy: a change of practices or semantics diversionism / Saúde bucal na estratégia de saúde da família: mudança de práticas ou diversionismo semântico

OBJECTIVE:To evaluate public health dentistry practices of two different family health models. METHODS: Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands. RESULTS: There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities. CONCLUSIONS: Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defines public policy priorities.

OBJETIVO: Avaliar práticas de saúde bucal coletiva de dois modelos de atenção à saúde familiar. MÉTODOS: Estudo qualitativo realizado por meio de grupos focais constituídos por 58 cirurgiões-dentistas atuantes em programa de saúde da família há pelo menos três anos. Foram adotados os modelos de atenção Método Paidéia em Saúde da Família (Campinas, SP, 34 profissionais) e Estratégia de Saúde da Família (Curitiba, PR, 24 profissionais). O estudo foi realizado entre os meses de agosto e outubro de 2006. O referencial teórico utilizado para análise dos dados foi a hermenêutica-dialética. Foram empregados indicadores analíticos visando a indicar retrocesso, estagnação ou progresso nas práticas de saúde bucal que tiveram efeito a partir da implantação das estratégias em estudo. Os indicadores utilizados foram: processo de trabalho, interdisciplinaridade, territorialização, qualificação dos trabalhadores, promoção da saúde, resolutividade às demandas dos usuários. RESULTADOS: Houve progresso no acesso dos usuários aos serviços, na humanização do cuidado em saúde, no acolhimento das pessoas e no vínculo entre os profissionais e os pacientes. Os resultados relativos às práticas de promoção de saúde, territorialização, abordagem interdisciplinar e qualificação das equipes indicaram a necessidade de avanços técnicos e operacionais nas duas cidades. CONCLUSÕES: Os dois modelos apresentam importantes avanços na qualificação do acesso e na humanização do cuidado em saúde. Não obstante, o direito universal ao acesso à saúde bucal, em todos os níveis de complexidade, mostrou-se deficiente nas duas cidades. Os gestores locais dos serviços de saúde e os coordenadores municipais de saúde bucal, devem atuar com maior intensidade ao definir prioridades em políticas públicas de saúde local.

OBJETIVO: Evaluar prácticas de salud bucal colectiva de dos modelos de atención a la salud familiar. MÉTODOS: Estudio cualitativo realizado por medio de grupos focales constituidos por 58 cirujanos-dentistas actuantes en programa de salud de la familia hace por lo menos tres años. Fueron adoptados los modelos de atención Método Paideia en Salud de la Familia (Campinas, Sureste de Brasil, 34 profesionales) y Estrategia de Salud de la Familia (Curitiba, Sur de Brasil, 24 profesionales). El estudio fue realizado entre los meses de agosto y octubre de 2006. El referencial teórico utilizado para análisis de los datos fue la hermenéutica-dialéctica. Fueron empleados indicadores analíticos con el objetivo de indicar retroceso, estancamiento o progreso en las prácticas de salud bucal que tuvieran efecto a partir de la implantación de las estrategias en estudio. Los indicadores utilizados fueron: proceso del trabajo, interdisciplinaridad, territorialidad, cualificación de los trabajadores, promoción de la salud, resolución a las demandas de los usuarios. RESULTADOS: Hubo progreso en el acceso de los usuarios a los servicios en la humanización del cuidado en salud, en el acogimiento de las personas y en el vínculo entre los profesionales y los pacientes. Los resultados relativos a las prácticas de promoción de salud, territorialidad, abordaje interdisciplinar y cualificación de los equipos indicaron la necesidad de avances técnicos y operacionales en las dos ciudades. CONCLUSIONES: Los dos modelos presentan importantes avances en la cualificación del acceso y en la humanización del cuidado en salud. Sin embargo, el derecho universal al acceso a la salud bucal, en todos los niveles de complejidad, se mostró deficiente en las dos ciudades. Los gestores locales de los servicios de salud y los coordinadores municipales de salud bucal, deben actuar con mayor intensidad al definir prioridades en políticas públicas de salud local.

Dental practitioners' attitudes, subjective norms and intentions to practice atraumatic restorative treatment (ART) in Tanzania

The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5 percent. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045). A total of 73.2 percent of dental practitioners felt that ART was worth introducing in Tanzania, 92.8 percent recommended ART training for all dental practitioners and 97.8 percent recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3 percent, 28.1 percent and 90.6 percent of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (p<0.0001). The results indicated that dental practitioners were willing to have ART introduced in Tanzania and had positive attitudes towards practicing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.

Assessment of the frequency of routine removal of dental plaque prior to caries diagnosis by dentists in three cities in southern Brazil

The aim of this study was to assess the frequency of routine use of dental prophylaxis prior to visual inspection, in order to diagnose caries, by dentists with different lapses of time after graduating time. One hundred and fifty one Brazilian dentists were interviewed in 3 Brazilian cities to determine if they usually remove dental plaque prior to visual inspection for caries diagnosis. The dentists were stratified according to year of graduation. The association between the lapse of time after graduating and the practice of routinely removing dental plaque before clinical examination was tested using the chi-square test with a significance level of 5 percent. Only 28.5 percent of the dentists reported that they usually remove dental plaque prior to clinical examination. The dentists who graduated in the last 15 years presented the lowest percentages of plaque removal prior to clinical examination (15.1 percent), whereas the more experienced dentists reported that they perform prophylaxis more frequently. Of the professionals who graduated from 1960-1975, 23.9 percent reported that they performed dental plaque removal prior to diagnosis, whereas the figure for those graduating from 1976-1990 was 46.2 percent. Most of the dentists interviewed reported that they did not remove dental plaque prior to performing visual diagnosis of caries.

Evaluation of the dental structure loss produced during maintenance and replacement of occlusal amalgam restorations

The aim of this in vitro study was to evaluate four different approaches to the decision of changing or not defective amalgam restorations in first primary molar teeth concerning the loss of dental structure. Ditched amalgam restorations (n = 11) were submitted to four different treatments, as follows: Control group - polishing and finishing of the restorations were carried out; Amalgam group - the ditched amalgam restorations were replaced by new amalgam restorations; Composite resin group - the initial amalgam restorations were replaced by composite resin restorations; Flowable resin group - the ditching around the amalgam restorations was filled with flowable resin. Images of the sectioned teeth were made and the area of the cavities before and after the procedures was determined by image analysis software to assess structural loss. The data were submitted to ANOVA complemented by the Student Newman Keuls test (p < 0.05). The cavities in all the groups presented significantly greater areas after the procedures. However, the amalgam group showed more substantial dental loss. The other three groups presented no statistically significant difference in dental structure loss after the re-treatments. Thus, replacing ditched amalgam restorations by other similar restorations resulted in a significant dental structure loss while maintaining them or replacing them by resin restorations did not result in significant loss.

Evaluación del Modelo de Aseguramiento Odontológico "Sonrisa Total" / Evaluation of the Model of Odontologyc Securing Total Smile

En mayo del 2003 se inaguró la clínica odontológica Sonrisa Total, contando con una ubicación privilegiada, equipamiento con tecnología de punta, profesionales especializados y sobre todo con una visión empresarial, capáz de proveer servicios odontológicos de calidad.Con la primeras experiencias obtenidas, fue surgiendo la necesidad de incursionar en el modelo de aseguramiento, sin tener como base ninguna formación en el tema, se estableció el conjunto de prestaciones y el precio mensual por afiliado, impulsando la necesidad de generar e incrementar la demanda.Con la firna de los primeros convenios institucionales y contando ya con 200 afiliados se inició en ocubre con el proceso de atención, simultáneamente se realizó el diagnóstico y tratamiento de los pacientes beneficiarios, optimizando el tiempo y los recursos, se concluyó con el tratamiento de los afiliados..

Estudo epidemiológico da síndrome do incisivo central maxilar mediano único / Epidemiologic study of the single median maxillary central incisor syndrome

O propósito desta investigação foi realizar estudo epidemiológico da síndrome do incisivo central maxilar mediano único (SMMCI) por meio da aplicação de questionários. Foram abordados ortodontistas pós-graduados pela Universidade do Brasil, atual UFRJ, e sete casos foram identificados. Os pacientes apresentaram características associadas ao SMMCI relatadas na literatura e outras não, como respiração bucal, absorção radicular externa, hérnia de disco na coluna vertebral, pressão arterial baixa e apnéias durante o sono. Apenas 2% dos entrevistados conheciam a síndrome SMMCI. Dentre os que possuíam casos, apenas um a conhecia, tendo realizado o diagnóstico e encaminhado seus pacientes para investigação das possíveis associações presentes. Os demais casos foram trartados como agenesia de um inciso central superior.