Morphological analysis and immunohistochemical expression in restorations with self-adhesive resin: A randomized split-mouth design-controlled study.

BACKGROUND: To evaluate the morphology and immunohistochemical expression of MMP-9, TIMP-3, COL-I, TNF-alfa and COX-2 in the dentinopulp complex of restorations with self adhesive composite (Vertise Flow/Kerr) compared with conventional resin composite with self-etching adhesive (Filtek Z250/3M ESPE and Clearfil SE Bond/Kuraray-Noritake). MATERIAL AND METHODS: A randomized, controlled, double-blind, split-mouth, two-arm clinical trial was conducted. Twenty-seven volunteers with third molars indicated for extraction received two deep class I restorations, one with each material. The morphology and immunohistochemical expression were measured at 15 days after the restorative procesures. The data were submitted to the Fisher`s Exct test (α=0.05). RESULTS: Through morphological analysis, a slight disorganization of the odontoblastic layer was visualized, along with a slight inflammatory infiltrate in the VERT and CSEB groups (p< 0.05). In immunohistochemical analysis, TNF-alpha, MMP-9, TIMP-3 and COX-2 demonstrated more cases of positive pulp labeling. CONCLUSIONS: Self-adhesive resin composite and conventional resin composite with a self-etching bonding agent promoted slight alterations in the dentin-pulp complex, indicating a repair ability and reversibility of the inflammatory process against aggressions of the adhesive restorative procedure. Key words:Immunohistochemistry, inflammation, randomized clinical trial, self-adhering composite, dentistry.

Absence of influence of polymorphisms of the MBL2 gene in oral infections by HSV-1 in individuals with HIV.

Polymorphisms in the structural gene MBL-2 (mannose-binding lectin-2) may result in low MBL serum concentration, associated with greater susceptibility to infection. The study evaluated the effects of MBL-2 polymorphisms with the oral manifestations of the HSV in human immunodeficiency virus (HIV)-infected patients. An observational case-control study was carried out, with the sample comprising 64 HIV+ and 65 healthy individuals. The signs and symptoms of HSV oral infection were evaluated, and oral mucosa buccal smears were collected. Polymorphisms of the MBL-2 gene and HSV-1 DNA were amplified through real-time PCR. The data revealed that of 64 HIV+, 29.6% presented signs and symptoms of HSV oral infection. Of these, the HSV-1 DNA was detected through real-time PCR in 21% of cases, and in 13.3% of asymptomatic individuals. There was no statistically significant difference between the symptomatic (p = 1) and the asymptomatic (p = 0.52) individuals, HIV+ and HIV-. Different genotypes (AA, A0, or 00) did not contribute to the oral manifestation of HSV in the HIV+ patients (p = 0.81) or HIV- (p = 0.45). There was no statistically significant difference in either group (p = 0.52). No significant association was identified between the MBL-2 gene polymorphisms in the oral manifestation of HSV infection. However, further studies are recommended with larger population groups before discarding this interrelationship.

Effect of infrared laser in the prevention and treatment of paresthesia in orthognathic surgery.

Orthognathic surgery is the surgical procedure that makes correcting deformities of the bones in the region of the maxilla and mandible a reality in the Brazilian dentistry. However, this type of surgery usually involves paresthesia in the postoperative period, concerning the surgeons who perform them and generating discomfort to patients. This study aimed at evaluating the effect of infrared laser (830 nm) in the prevention and treatment of paresthesias after orthognathic surgery. Six patients underwent orthognathic surgery: the experimental group composed of 4 patients and the control group that did not receive laser therapy composed of 2 patients. The experimental group received laser applications during the transoperative and 12 postoperative sessions. Tests for mechanical (deep and shallow) and thermal (cold) sensitivity were performed in the preoperative and postoperative period (during 12 sessions) in the lip and chin areas by the same operator. The paresthesia was classified into 1, strong; 2, moderate; 3, mild; and 4, absent, through the patient's response to stimuli. The results showed that all patients had no disturbance of sensitivity in the preoperative period, but paresthesia was presented at various levels in the postoperative period. Both groups showed recovery of deep mechanical sensitivity within a shorter time interval compared with the superficial mechanical and thermal sensitivity. However, at the 12th assessment, patients who underwent the laser therapy showed better reduction in the level of paresthesia or even complete regression of this. The laser, therefore, brought benefits to the treatment of paresthesia, accelerating the return of neurosensorial sensitivity.

Aspectos éticos e legais na abordagem de pacientes Testemunhas de Jeová / Ethical and legal aspects when treating Jehovah's Witnesses

Os Testemunhas de Jeová representam uma ordem religiosa que, de acordo com suas interpretações de livros da Bíblia (Gênesis 9:3, 4, Levítico 17:10 e Atos dos Apóstolos 15:28-29), não permite que alguém da religião ou da família se submeta à transfusão de sangue e derivados. Casos graves nesse sentido têm surgido, provocando a opinião pública e resultando em situações difíceis para médicos e cirurgiões-dentistas, pois suas formações os direcionam para salvar vidas. Porém, se realizarem a transfusão contra a vontade do paciente, sujeitar-se-ão às conseqüências de natureza civil e penal decorrentes da intervenção não consentida no corpo do paciente. Percebe-se que a recusa à transfusão de sangue mediante risco de morte é questão de interesse muito abrangente e alvo de incansáveis discussões. Este trabalho objetivou realizar uma discussão acerca do assunto baseada em revisão de literatura, enfatizando os aspectos éticos e legais na abordagem desses pacientes. Concluiu-se que, por se tratar de conflitos de valores científicos, religiosos e filosóficos, não é fácil apresentar soluções prontas capazes de abranger todos os casos.

Jehovah’s witnesses represent a religious order that, according to their interpretations of Bible passages (Gênesis 9:3, 4, Levítico 17:10 and Apostle Acts 15:28-29), do not allow that someone from their religion or family receive blood or blood derivatives. Severe cases have occurred, stirring public opinion and resulting in difficult situations for physicians and dental-surgeons, since their profession requires that they save lives. However, if they perform a transfusion against the patient’s will, they will likely face consequences of civil and penal nature due to an unauthorized intervention in the patient’s body. It is known that refusing a blood transfusion when there is a risk of death is a very interesting issue and object of endless discussions. The objective of this work was to discuss the subject based on literature review, emphasizing the ethical and legal aspects of treating these patients. The conclusion is that this is a conflict of scientific, religious and philosophical values and it is not easy to present ready solutions capable of covering all cases.