Treatment of anterior crossbite and its influence on gingival recession / Pulpotomia em molar decíduo com agregado trióxido mineral

Several etiological factors for gingival recession have been discussed in the literature, and the vestibular region of the mandibular incisors is a critical anatomical area for the emergence of this condition. Anterior crossbite is an important factor, because the trauma from occlusion between the incisors generates an imbalance in the distribution of forces, causing changes in the periodontium and making the area more susceptible to mechanical trauma during brushing and to plaque formation. In view of these aspects, the objective of this paper was to demonstrate the influence of early treatment of anterior crossbite on the gingival margin level and risk of gingival recession in the region of the incisors. A case of anterior crossbite treated during the mixed dentition phase was used as an example. After orthodontic therapy with the use of a removable appliance with a finger spring, we noticed improvement in periodontal health and esthetics as the tooth was reattached at its base bone.

Diversos medicamentos vêm sendo testados e utilizados na terapia pulpar conservadora de dentes decíduos, no entanto, o formocresol continua sendo o material de escolha nas pulpotomias, mesmo não atendendo às exigências de biocompatibilidade e promovendo a fixação do tecido pulpar vital e não o seu reparo. Com o surgimento do Agregado Trióxido Mineral como um material com propriedades físico-químicas que promovem o reparo tecidual, aliados a outras propriedades importantes, tais como a ação antimicrobiana e a biocompatibilidade aos tecidos pulpares surgiu uma nova alternativa de material na Odontologia. O objetivo deste estudo foi relatar o desempenho do Agregado Trióxido Mineral em uma pulpotomia em molar decíduo e seu acompanhamento por um período de 1 ano. Foi realizada a pulptomia com o uso do MTA no dente 85 de um paciente infantil cujos resultados obtidos foram bastante favoráveis, demonstrando sucesso clínico e radiográfico no período avaliado. Apesar do pouco tempo de acompanhamento do dente decíduo tratado, acredita-se que o MTA possa ter um grande potencial biológico e futuramente podendo transformar-se em uma opção de material para ser utilizado como rotina nas pulpotomias de dentes decíduos.

A systematic review of etiological and risk factors associated with bruxism.

OBJECTIVE: The aim of the present work was to systematically review the literature and identify all peer-reviewed papers dealing with etiological and risk factors associated with bruxism. DATA SOURCES: Data extraction was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for randomized clinical trials (RCT), controlled clinical trials (CCT) or cohort studies: Cochrane Library, Medline, and Embase from 1980 to 2011. Unpublished literature was searched electronically using ClinicalTrials.gov. DATA SELECTION: The primary outcome was bruxism etiology. Studies should have a standardized method to assess bruxism. DATA EXTRACTION: Screening of eligible studies, assessment of the methodological quality and data extraction were conducted independently and in duplicate. Two reviewers inspected the references using the same search strategy and then applied the same inclusion criteria to the selected studies. They used criteria for methodological quality that was previously described in the Cochrane Handbook. Among the 1247 related articles that were critically assessed, one randomized clinical trial, one controlled clinical trial and seven longitudinal studies were included in the critical appraisal. Of these studies, five were selected, but reported different outcomes. DATA SYNTHESIS: There is convincing evidence that (sleep-related) bruxism can be induced by esophageal acidification and also that it has an important relationship with smoking in a dose-dependent manner. Disturbances in the central dopaminergic system are also implicated in the etiology of bruxism.

Esthetic perception and economic value of orthodontic appliances by lay Brazilian adults

OBJECTIVE: To evaluate the esthetic perception of different appliances by Brazilian lay adults and its influence in the attributed value of orthodontic treatment, considering evaluators' socioeconomic status, age and gender. METHODS: Eight different combinations of orthodontic appliances and clear tray aligners were placed in a consenting adult with pleasing smile. Standardized frontal photographs were captured and incorporated into a research album. A sample of adults (n = 252, median = 26 years old) were asked to rate each image for (1) its attractiveness on a visual analog scale and (2) the willingness to pay (WTP) for a cosmetic appliance when compared to a standard metalic appliance and a clear tray aligner. Comparisons between the appliances' attractiveness were performed using the Friedman's test and Dann's post-hoc test. Correlation between appliances' attributed value, socioeconomic status, age, gender, and esthetic perception was assessed using Spearman's correlation analysis. RESULTS: Attractiveness ratings of orthodontic appliances varied significantly in the following hierarchy: Clear aligners>sapphire brackets>self-ligating/conventional stainless steel brackets>and golden metal appliances. The correlation between WTP and esthetic perception was week. However, for individuals with better socioeconomic status and aged between 17-26 years old significantly, a significantly higher WTP was found. CONCLUSION: Clear aligners and sapphire brackets with esthetic archwire were considered better esthetic options in this sample. Nevertheless, patients were not willing to pay more money for appliances they deemed more esthetic, however, they were significantly influenced by their socioeconomic level and age.

OBJETIVO: avaliar a percepção de brasileiros adultos leigos para diferentes aparelhos ortodônticos e sua influência na valorização econômica do tratamento, considerando o nível socioeconômico, idade e sexo dos avaliadores. MÉTODOS: oito combinações de aparelhos ortodônticos e alinhadores foram colocadas em um adulto com bom alinhamento dentário, e fotografias frontais foram feitas para compor um álbum de imagens de pesquisa. Uma amostra de adultos (n = 252, mediana = 26 anos) classificou cada imagem por (1) atratividade, em uma escala visual analógica, e (2) disposição a pagar a mais para realizar o tratamento com um aparelho estético em relação a um aparelho metálico e em relação a um alinhador. Comparações da atratividade dos aparelhos foram realizadas utilizando-se o teste de Friedman e o post-hoc de Dann. A correlação entre a valorização econômica, nível socioeconômico, idade, sexo e percepção estética foi calculada com a análise de correlação de Spearman. RESULTADOS: a atratividade dos aparelhos ortodônticos variou significativamente, na seguinte hierarquia: alinhadores > aparelhos de safira > aparelhos metálicos tradicionais e autoligáveis > aparelhos dourados. A correlação entre a atratividade dos aparelhos e a disposição em pagar mais por eles foi fraca. Contudo, ter melhor nível socioeconômico e idade entre 17 e 26 anos aumentou significativamente a disposição de pagar dos avaliadores. CONCLUSÕES: alinhadores e braquetes de safira com fio estético foram considerados as opções de maior atratividade para essa amostra. Entretanto, os avaliadores não estiveram dispostos a pagar a mais para realizar seus tratamentos com os dispositivos que julgaram mais estéticos, sendo, contudo, significativamente influenciados por seu nível socioeconômico e idade.

Man-in-the-barrel syndrome, a symmetrical proximal brachial amyotrophic diplegia related to motor neuron diseases: a survey of nine cases.

OBJECTIVE: To report on 9 patients presenting with sporadic motor neuron disease , who over a long period of time evolved with a symmetrical proximal brachial amyotrophic diplegia. METHODS: Nine patients were followed-up who , displayed, since onset, a progressive limitation of arm flexion/abduction resulting in a peculiar posture with both hands hanging loosely beside the trunk. Electrophysiological test results were consistent with lower motor neuron disease. Cervical MRI was performed in all patients. RESULTS: Nine male subjects with ages ranging from 38 to 73 years at onset of symptoms, developed bilateral and symmetric paresis and atrophy of upper limb muscles. Proximal muscles were more involved than the distal groups. In most patients tendon reflexes were absent or hypoactive in the upper limbs. Needle electromyography (EMG) revealed positive sharp waves and fibrillations and high amplitude polyphasic potentials with an incomplete recruitment pattern in most upper limb muscles. EMG of lower limb muscles was normal in some cases while abnormal in others. MRC did not disclose cervical spinal cord abnormalities from C5-T1. CONCLUSION: Attention is called to the Man-in-the-Barrel syndrome in some motor neuron diseases, especially in patients with progressive spinal atrophy and amyotrophic lateral sclerosis.

Man-in-the-barrel syndrome, a symmetrical proximal brachial amyotrophic diplegia related to motor neuron diseases: a survey of nine cases / Síndrome do homem no barril, uma diplegia amiotrófica braquial proximal simétrica relacionada a doença do neurônio motor: a propósito de nove casos

OBJECTIVE: To report on 9 patients presenting with sporadic motor neuron disease , who over a long period of time evolved with a symmetrical proximal brachial amyotrophic diplegia. METHODS: Nine patients were followed-up who , displayed, since onset, a progressive limitation of arm flexion/abduction resulting in a peculiar posture with both hands hanging loosely beside the trunk. Electrophysiological test results were consistent with lower motor neuron disease. Cervical MRI was performed in all patients. RESULTS: Nine male subjects with ages ranging from 38 to 73 years at onset of symptoms, developed bilateral and symmetric paresis and atrophy of upper limb muscles. Proximal muscles were more involved than the distal groups. In most patients tendon reflexes were absent or hypoactive in the upper limbs. Needle electromyography (EMG) revealed positive sharp waves and fibrillations and high amplitude polyphasic potentials with an incomplete recruitment pattern in most upper limb muscles. EMG of lower limb muscles was normal in some cases while abnormal in others. MRC did not disclose cervical spinal cord abnormalities from C5-T1. CONCLUSION: Attention is called to the Man-in-the-Barrel syndrome in some motor neuron diseases, especially in patients with progressive spinal atrophy and amyotrophic lateral sclerosis.

OBJETIVO: Relatar nove pacientes com a doença do neurônio de motor esporádica que apresentam progressiva e simétrica diplegia braquial amiotrófica. MÉTODOS: Acompanhamos nove pacientes que exibiram, desde o começo, uma limitação progressiva de flexão/abdução do membro superior resultando em uma postura peculiar com ambas as mãos pendentes ao longo do tronco. Os resultados dos testes eletrofisiológicos foram consistentes com achados de doença do neurônio motor inferior. Ressonância magnética (RM) cervical foi realizada em todos pacientes. RESULTADOS: Nove pacientes do sexo masculino com idades entre 38-73 anos no início dos sintomas desenvolveram paresia e a atrofia bilateral simétrica dos músculos dos membros superiores. Os músculos proximais foram mais comprometidos do que os distais. Os reflexos tendíneos dos membros superiores encontravam-se abolidos ou hipoativos na maioria dos pacientes. A eletromiografia (EMG) revelou ondas positivas, fibrilações e potenciais polifásicos de alta amplitude com padrão incompleto de recrutamento na maioria dos músculos dos membros superiores. A EMG dos membros inferiores foi normal em alguns casos e anormal em outros. A RM não evidenciou anormalidades da medula espinhal cervical de C5-T1. CONCLUSÃO: Atentamos para a síndrome do homem do Barril em algumas doenças do neurônio de motor, especialmente na atrofia espinhal progressiva e esclerose lateral amiotrófica.