Nasal septum-derived chondroprogenitor cells control mandibular condylar resorption consequent to orthognathic surgery: a clinical trial.

Condylar resorption is an aggressive and disability form of temporomandibular joint (TMJ) degenerative disease, usually non-respondent to conservative or minimally invasive therapies and often leading to surgical intervention and prostheses implantation. This condition is also one of the most dreaded postoperative complications of orthognathic surgery, with severe cartilage erosion and loss of subchondral bone volume and mineral density, associated with a painful or not inflammatory processes. Because regenerative medicine has emerged as an alternative for orthopedic cases with advanced degenerative joint disease, we conducted a phase I/IIa clinical trial (U1111-1194-6997) to evaluate the safety and efficacy of autologous nasal septal chondroprogenitor cells. Ten participants underwent biopsy of the nasal septum cartilage during their orthognathic surgery. The harvested cells were cultured in vitro and analyzed for viability, presence of phenotype markers for mesenchymal stem and/or chondroprogenitor cells, and the potential to differentiate into chondrocytes, adipocytes, and osteoblasts. After the intra-articular injection of the cell therapy, clinical follow-up was performed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and computed tomography (CT) images. No serious adverse events related to the cell therapy injection were observed during the 12-month follow-up period. It was found that autologous chondroprogenitors reduced arthralgia, promoted stabilization of mandibular function and condylar volume, and regeneration of condylar tissues. This study demonstrates that chondroprogenitor cells from the nasal septum may be a promise strategy for the treatment of temporomandibular degenerative joint disease that do not respond to other conservative therapies.

Age estimation by volumetric analysis of teeth using cone beam computed tomography.

OBJECTIVES: To evaluate the feasibility of using the pulp volume (Pv) to total volume (Tv) ratio (Pv:Tv), obtained from cone beam computed tomography (CBCT) scans of single-rooted teeth, for age estimation in a Brazilian population sample. METHODS: After obtaining approval from the ethics committee, the study commenced by applying inclusion criteria to screen CBCT scans, resulting in a probability-based sample of participants aged 18 years and older (ranging from 18 to 82 years, with a mean age of 46.44 years). A total of 517 single-rooted teeth, including maxillary central incisors (CI), mandibular canines (C), and mandibular first premolars (FP), were chosen based on excellent agreement values (> 0.9). Pv and Tv measurements were conducted using semi-automatic segmentation with ITK-SNAP 3.8 software. Statistical analysis was performed using Jamovi software, with a significance level set at 5% (α = 0.05). RESULTS: A strong negative correlation (r > -0.7) was observed between chronological age and the Pv:Tv ratio across all examined teeth. However, when conducting regression analysis with Pv:Tv data and chronological age as the independent variable, only the mandibular FP teeth exhibited a normal distribution. The resulting linear model demonstrated moderate predictive value (approximately 64%) in explaining the variance in chronological age, but caution should be exercised when interpreting these findings. CONCLUSIONS: The method of measuring individual tooth volume using CBCT to estimate chronological age via Pv:Tv has been demonstrated as effective and reproducible within the Brazilian population sample.

Optimizing forest road planning in a sustainable forest management area in the Brazilian Amazon.

The construction of forest roads in Brazilian Amazon is costly and has a significant environmental impact. Several practices and principles must be observed to comply with legislation, to preserve the remaining forest, and to ensure sustainable exploitation. Road planning is complex in this context, based on the number of aspects and variables that must be considered. This research aimed to evaluate computational methods' effectiveness in planning forest roads, optimizing resources to reduce damage to the remaining forest, compared to traditional planning methods. The study area was a native forest under a sustainable forest management regime located in municipalities of Terra Santa and Oriximiná, in Pará, in Brazilian Amazon. Data obtained from area made it possible formulate six instances of different sizes. A binary integer linear programming model was used, solved using CPLEX software, and Dijkstra, Bellman-Ford, Dial, and D'Esopo-Pape shortest path algorithm, implemented in C programming language. During processing of instances, the time taken to obtain the solution increased according to size of instance, however, time difference was not significant. Among the evaluated algorithms, the D'Esopo-Pape algorithm showed the best performance. The evaluated methods were effective in obtaining an optimal solution for proposed forest road planning. The solutions obtained using computational methods more effectively considered the restrictions associated with sustainable forest management, in contrast to those derived from the traditional planning by forestry company.

Metaheuristics applied for storage yards allocation in an Amazonian sustainable forest management area.

In the sustainable management of Amazonian forests, it is essential to carry out the optimal planning of logging infrastructures to reduce costs and environmental impacts. However, there is a high degree of complexity due to the number of variables involved. Among these infrastructures, wood storage yards are of utmost importance as they directly influence the opening of forest roads and trails. The objective of this research was to evaluate the allocation of wood storage yards through exact solution and metaheuristics in a forest management area. The study area was a native forest under sustainable forest management regime located in the Brazilian Amazon. Three instances were formulated involving 5947 trees and 3172 wood storage yards facilities. We used a binary integer programming model solved by CPLEX and the metaheuristics Greedy Randomized Adaptive Search Procedure (GRASP), Tabu Search (TS), Variable Neighborhood Search (VNS) and Simulated Annealing (SA). GAP values increased as a function of instances. Although all metaheuristics obtained significant solutions with shorter processing times, only SA obtained feasible solutions in all executions for all three instances. In general, the metaheuristics were efficient in obtaining feasible solutions faster than CPLEX, which represents the feasibility of the planning of allocation storage large areas, and without significant losses of best-known solution. The SA presented the best performance in the three evaluated instances. Contribution of this study can be highlighted: evaluation of alternative computational methods for planning the allocation of wooden storage yards; evidence was obtained of effectiveness and efficiency of assessed metaheuristics and, the applicability of approximate methods in this problem was evaluated.

Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report.

BACKGROUND: Upon orthognathic mandibular advancement surgery the adjacent soft tissues can displace the distal bone segment and increase the load on the temporomandibular joint causing loss of its integrity. Remodeling of the condyle and temporal fossa with destruction of condylar cartilage and subchondral bone leads to postsurgical condylar resorption, with arthralgia and functional limitations. Patients with severe lesions are refractory to conservative treatments, leading to more invasive therapies that range from simple arthrocentesis to open surgery and prosthesis. Although aggressive and with a high risk for the patient, surgical invasive treatments are not always efficient in managing the degenerative lesions. METHODS: We propose a regenerative medicine approach using in-vitro expanded autologous cells from nasal septum applied to the first proof-of-concept patient. After the required quality controls, the cells were injected into each joint by arthrocentesis. Results were monitored by functional assays and image analysis using computed tomography. RESULTS: The cell injection fully reverted the condylar resorption, leading to functional and structural regeneration after 6 months. Computed tomography images showed new cortical bone formation filling the former cavity space, and a partial recovery of condylar and temporal bones. The superposition of the condyle models showed the regeneration of the bone defect, reconstructing the condyle original form. CONCLUSIONS: We propose a new treatment of condylar resorption subsequent to orthognathic surgery, presently treated only by alloplastic total joint replacement. We propose an intra-articular injection of autologous in-vitro expanded cells from the nasal septum. The proof-of-concept treatment of a selected patient that had no alternative therapeutic proposal has given promising results, reaching full regeneration of both the condylar cartilage and bone at 6 months after the therapy, which was fully maintained after 1 year. This first case is being followed by inclusion of new patients with a similar pathological profile to complete an ongoing stage I/II study. TRIAL REGISTRATION: This clinical trial is approved by the National Commission of Ethics in Medical Research (CONEP), Brazil, CAAE 12484813.0.0000.5245, and retrospectively registered in the Brazilian National Clinical Trials Registry and in the USA Clinical Trials Registry under the Universal Trial Number (UTN) U1111-1194-6997 .

Impact of room lighting and image display device in the radiographic appearances of the endodontic treatments.

OBJECTIVES: To assess the radiographic appearances of the endodontic treatment in different room lighting conditions and image display devices. METHODS: After approval by Research Ethical Board, 20 images were obtained from blocks with one endodontically treated tooth. Of the 20 endodontic treatments conducted in the laboratory, of those the randomly selected 10 teeth (50% of sample) received some quality defect in three parameters-apical limit, adaptation to root canal and homogeneity of the root canal filling material. Digital radiographs (DIGORA® Optime, Soredex, Milwaukee, WI) were obtained, which were evaluated (8 times) by 10 observers in two different conditions of room lighting, with bright (1000 to 1200 lux) and dim light (25 to 50 lux), using two different image display devices, smartphones and laptop computers. The observers assessed the radiographic appearances of the endodontic treatment with respect to quality of each one of three parameters individually. The data of observers' responses in terms of the quality of each parameter were statistically compared using Cronbach's α coefficient, diagnostic tests, π coefficient and ANOVA with Tukey tests, at a significant level setting of 5% (α = 0.05). RESULTS: The mean of reliability of observer responses ranged from 0.89 (intra-evaluator) to 0.66 (inter-evaluator). The mean values of the receiver operating characteristic (ROC) area were 0.661 (PD = 0.098), with laptop in bright lighting appraising homogeneity of the root canal filling material on the worst performance (ROC area = 0.57), which was statistically significant (p < 0.05), and 0.81 with laptop in dim lighting appraising apical limit on the best performance. Differences (p < 0.05) occurred mainly among parameters used for assessment. CONCLUSIONS: Room lighting and image display devices have very little influence in the radiographic appearances of the endodontic treatment. Thus, we suggest the use of smartphones as an acceptable image display device in daily clinical practice in routine bright lighting conditions.

Surgeons' Performance Determining the Amount of Graft Material for Sinus Floor Augmentation Using Tomography

Abstract This study aimed to assess the performance of surgeons in determining the amount of graft material required for maxillary sinus floor augmentation in a preoperative analysis using cone-beam computed tomography images. A convenience sample of 10 retrospective CBCT exams (i-CAT®) was selected. Scans of the posterior maxilla area with an absence of at least one tooth and residual alveolar bone with an up to 5 mm height were used. Templates (n=20) contained images of representative cross-sections in multiplanar view. Ten expert surgeons voluntarily participated as appraisers of the templates for grafting surgical planning of a 10 mm long implant. Appraisers could choose a better amount of graft material using scores: 0) when considered grafting unnecessary, 1) for 0.25 g in graft material, 2) for 0.50 g, 3) for 1.00 g and 4) for 1.50 g or more. Reliability of the response pattern was analyzed using Cronbach's a. Wilcoxon and Mann-Whitney tests were performed to compare scores. Regression analysis was performed to evaluate whether the volume of sinuses (mm3) influenced the choose of scores. In the reliability analysis, all values were low and the score distribution was independent of the volume of the maxillary sinuses (p>0.05), which did not influence choosing the amount of graft material. Surgeons were unreliable to determine the best amount of graft material for the maxillary sinus floor augmentation using only CBCT images. Surgeons require auxiliary diagnostic tools to measure the volume associated to CBCT exams in order to perform better.

Resumo O objetivo deste estudo foi avaliar o desempenho dos cirurgiões na determinação da quantidade de material de enxerto necessária para a elevação do assoalho do seio maxilar em uma análise pré-operatória, utilizando imagens de tomografia computadorizada de feixe cônico. Foi selecionada uma amostra de conveniência de 10 exames retrospectivos CBCT (i-CAT®). Os exames foram da área da maxila posterior que possuíam ausência de pelo menos um dente e com osso alveolar residual de altura igual ou inferior a 5 mm. Os templates (n=20) continham imagens de secções transversais representativas numa vista multiplanar. Dez experientes cirurgiões voluntariamente participaram como avaliadores dos templates para o planejamento cirúrgico de enxerto para um implante de 10 mm de comprimento. Os avaliadores escolheram a melhor quantidade de material de enxerto usando os escores: 0) quando o enxerto era desnecessário, 1) para 0,25 g de enxerto, 2) para 0,50 g, 3) para 1,00 g, e 4) para 1,50 g ou mais. A confiabilidade do padrão de resposta foi analisada utilizando a a de Cronbach. Os testes de Wilcoxon e Mann-Whitney foram utilizados para comparar os escores. A análise de regressão foi realizada para avaliar se o volume dos seios (mm3) influenciou a escolha dos escores. Na análise de confiabilidade, todos os valores foram baixos e a distribuição dos escores foi independente do volume dos seios maxilares (p>0,05), o que não influenciou a escolha da quantidade de material de enxerto. Os cirurgiões apresentaram falta de confiabilidade ao determinar a melhor quantidade de material de enxerto para o aumento do assoalho do seio maxilar utilizando somente as imagens de TCFC. Assim, os cirurgiões necessitam de ferramentas de diagnóstico auxiliares para mensuração de volume associada à TCFC para um melhor desempenho.

Surgeons' Performance Determining the Amount of Graft Material for Sinus Floor Augmentation Using Tomography.

This study aimed to assess the performance of surgeons in determining the amount of graft material required for maxillary sinus floor augmentation in a preoperative analysis using cone-beam computed tomography images. A convenience sample of 10 retrospective CBCT exams (i-CAT®) was selected. Scans of the posterior maxilla area with an absence of at least one tooth and residual alveolar bone with an up to 5 mm height were used. Templates (n=20) contained images of representative cross-sections in multiplanar view. Ten expert surgeons voluntarily participated as appraisers of the templates for grafting surgical planning of a 10 mm long implant. Appraisers could choose a better amount of graft material using scores: 0) when considered grafting unnecessary, 1) for 0.25 g in graft material, 2) for 0.50 g, 3) for 1.00 g and 4) for 1.50 g or more. Reliability of the response pattern was analyzed using Cronbach's a. Wilcoxon and Mann-Whitney tests were performed to compare scores. Regression analysis was performed to evaluate whether the volume of sinuses (mm3) influenced the choose of scores. In the reliability analysis, all values were low and the score distribution was independent of the volume of the maxillary sinuses (p>0.05), which did not influence choosing the amount of graft material. Surgeons were unreliable to determine the best amount of graft material for the maxillary sinus floor augmentation using only CBCT images. Surgeons require auxiliary diagnostic tools to measure the volume associated to CBCT exams in order to perform better.

Condição de saúde oral e indicativos da síndrome de Burnout em estudantes de Odontologia sedentários e atletas / Condition of oral health and Burnout syndrome indicatives in sedentary and athlete Dental students

O estudo objetivou comparar a condição de saúde oral e os indicativos de síndrome de Burnout em estudantes de Odontologia sedentários e atletas. Após aprovação do projeto pelo Comitê de Ética em Pesquisa, foi selecionada, por conveniência, uma amostra não probabilística de estudantes do terceiro ano do Curso de Odontologia de uma Universidade Federal brasileira com características semelhantes quanto ao sexo, idade, escolaridade e nível socioeconômico, para compor dois grupos independentes: 1) atletas e 2) sedentários. Para as estimativas da condição de saúde oral foram realizadas avaliação periodontal completa, levantamento de dados de um questionário elaborado a partir de uma ferramenta validada, o Maslach Burnout Inventory-General Survey (MBI), preenchimento de prontuário de paciente e radiografia panorâmica. Os dados coletados foram analisados estatisticamente pelo teste T ou Mann-Whitney, análise de regressão logística simples e correlação de Pearson (significância em 5%, α =0,05). Houve variações na condição de saúde oral de estudantes de Odontologia atletas em relação aos sedentários quanto ao sangramento à sondagem, a profundidade de sondagem e achados radiográficos, que apresentaram variações estatisticamente significativas (p<0,05) com piores resultados para o grupo de sedentários. O sangramento à sondagem foi o principal indicativo da discrepância que apresentou correlação fraca (ρ=0,31) com a exaustão emocional, que é a medida do sentimento de estar emocionalmente sobrecarregado e esgotado. Os estudantes sedentários são mais sensíveis a problemas e tensões desencadeados no ambiente acadêmico, com maior propensão a instalação de danos somáticos como os problemas orais (AU).

The study aimed to compare the oral health condition and the Burnout syndrome indicatives of athete and sedentary dental students. After the approval of the project by the research ethics committee a non-probabilistic sample of convenience, with students of third year of dentistry course of a Brazilian Federal University with similar characteristics in relation to sex, age, schooling and socioeconomic level were selected. They composed two independent groups: 1) Atheletes and 2) Sedentaries. For health estimations were performed a periodontal evaluation and data collections from a questionnaire on the basis of a validated tool, the Maslach Burnout Inventory-General Survey (MBI), a medical records and a panoramic radiograph. All data were statistically analyzed by T-test, Mann-Whitney test, simple logistic regression analysis and Pearson's correlation (significance at 5%, α = 0.05). There were variations in the oral health condition between the athelete and sedentary dental students for bleeding on probe, probe depth and radiographic findings that statistically differed (p<0.05) showing worst results for the sedentary group. The bleeding on probe was the main indicator of the discrepancy and presented a weak correlation (ρ = 0.31) with an emotional exhaustion, which measures feelings of being emotionally overextended and exhausted. Sedentary dental students are more sensitive to problems and tensions triggered in the academic environment with a greater propensity to instalation of somatic injuries such as oral problems (AU).

Growth of recombinant Drosophila melanogaster Schneider 2 cells producing rabies virus glycoprotein in bioreactor employing serum-free medium.

Drosophila melanogaster Schneider 2 (S2) cells have been increasingly used as a suitable expression system for the production of different recombinant proteins, and the employment of bioreactors for large-scale culture is an important tool for this purpose. In this work, Drosophila S2 cells producing the rabies virus glycoprotein RVGP were cultivated in bioreactor, employing a serum-free medium, aiming an improvement in cell growth and in glycoprotein production. To overcome cell growth limitation commonly observed in stirred flasks, different experiments in bioreactor were performed, in which some system modifications were carried out to attain the desired goal. The study showed that this cell line is considerably sensitive to hydrodynamic forces, and a high cell density (about 16.0 x 10(6) cells mL(-1)) was only obtained when Pluronic F68((R)) percentage was increased to 0.6% (w/v). Despite ammonium concentration affected RVGP production, and also cell growth, an elevated amount of the target protein was obtained, attaining 563 ng 10(-7) cells.

Fluorescence intensity of resin composites and dental tissues before and after accelerated aging: a comparative study.

This study quantitatively evaluated the fluorescence intensity of resin composites with different opacities and translucencies and determined changes in fluorescence after accelerated aging, using human enamel and dentin as controls. Six microhybrid and nanofilled composites, each in three different shades, were tested. Ten sound human incisors were used to obtain enamel and dentin specimens separately. Fluorescence measurements were obtained with a fluorescence spectrophotometer before (baseline) and after accelerated aging at 150 kJ energy for 120 hours. One-way analysis of variance (ANOVA) and Games-Howell multiple comparison tests were performed at a significance level of 0.05. Student's t-test was also used for comparison before and after aging. At baseline, there was no statistically significant difference (p>0.05) between the fluorescence intensity of dentin and any of the shades of Charisma or Opallis, Esthet-X dentin shade or Vit-l-escence enamel, or the translucent shades. After accelerated aging, all shades of the 4 Seasons, enamel and the translucent shades of Esthet-X had fluorescence intensities statistically similar to that of aged dentin (p>0.05). A significant reduction in fluorescence after aging (p<0.05) was observed for all the materials, except for human enamel and translucent Filtek Supreme XT. Accelerated aging reduced fluorescence in most of the composites evaluated.

Comparaçäo entre a ortopantomografia e a tomografia computadorizada no planejamento de implantes / Comparison between the orthopantomography and computed tomography for implant planning

O presente estudo avaliou-se as ampliaçöes verticais produzidas nas radiografias panorâmicas, comparando-as com as medidas obtidas em exames de tomografia computadorizada, utilizando o "Denta Scan". Foram escolhidas as regiöes das arcadas, denominadas sítios, que pudessem ser identificadas nos dois exames, mensuradas e comparadas. Foram incluídos no estudo 33 pacientes com o total de 90 sítios analisados (47 na maxila e 43 na mandíbula) e as medidas encontradas foram submetidas ao teste t de Student para valores pareados. Foram encontradas diferenças estatisticamente significativas (P<0,05) entre as medidas da panorâmica e da tomografia computadorizada em ambas as arcadas

Prescriçäo de chás para crianças menores de seis meses: a opiniäo dos médicos de uma cidade de porte médio no sul do Brasil / Prescription of herbal teas for children under six months of age: the opinion of physicians from a middle size city in Southern Brazil

Através de listagem dos médicos que atendiam crianças no final de 1993 em Pelotas, RS, acadêmicos de Medicina da Universidade Federal de Pelotas aplicaram questionário padronizado sobre recomendaçäo de chás para crianças menores de seis meses, fatores de risco associados ao seu uso e noçöes básicas de aleitamento materno. Cerca de metade dos entrevistados recomendava o uso de chás. Os principais motivos foram para o tratamento de cólicas intestinais(35 por cento), suplementaçäo à dieta(21 por cento)e reidrataçäo oral(18 por cento).A associaçäo entre o uso de chás e a ocorrência de diarréia foi mencionada por apenas 19 por cento dos entrevistados, enquanto que com desnutriçäo e desmame precoce foram, respectivamente,47 por cento e 83 por cento. Estas associaçöes mostraram-se significativas(P<0,05)mesmo após ajuste por tempo de formado e realizaçäo de residência ou especializaçäo em Pediatria. Os resultados revelam que boa parte dos médicos entrevistados näo vem manejando de forma adequada aspectos comuns relacionados à dieta infantil, o que é preocupante em virtude da sua repercussäo negativa sobre a saúde dessas crianças.