Climate change-related distributional range shifts of venomous snakes: a predictive modelling study of effects on public health and biodiversity.

BACKGROUND: Climate change is expected to have profound effects on the distribution of venomous snake species, including reductions in biodiversity and changes in patterns of envenomation of humans and domestic animals. We estimated the effect of future climate change on the distribution of venomous snake species and potential knock-on effects on biodiversity and public health. METHODS: We built species distribution models based on the geographical distribution of 209 medically relevant venomous snake species (WHO categories 1 and 2) and present climatic variables, and used these models to project the potential distribution of species in 2070. We incorporated different future climatic scenarios into the model, which we used to estimate the loss and gain of areas potentially suitable for each species. We also assessed which countries were likely to gain new species in the future as a result of species crossing national borders. We integrated the species distribution models with different socioeconomic scenarios to estimate which countries would become more vulnerable to snakebites in 2070. FINDINGS: Our results suggest that substantial losses of potentially suitable areas for the survival of most venomous snake species will occur by 2070. However, some species of high risk to public health could gain climatically suitable areas for habitation. Countries such as Niger, Namibia, China, Nepal, and Myanmar could potentially gain several venomous snake species from neighbouring countries. Furthermore, the combination of an increase in climatically suitable areas and socioeconomic factors (including low-income and high rural populations) means that southeast Asia and Africa (and countries including Uganda, Kenya, Bangladesh, India, and Thailand in particular) could have increased vulnerability to snakebites in the future, with potential effects on public human and veterinary health. INTERPRETATION: Loss of venomous snake biodiversity in low-income countries will affect ecosystem functioning and result in the loss of valuable genetic resources. Additionally, climate change will create new challenges to public health in several low-income countries, particularly in southeast Asia and Africa. The international community needs to increase its efforts to counter the effects of climate change in the coming decades. FUNDING: German Research Foundation, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, German Centre for Integrative Biodiversity Research, Ministerio de Ciencia e Innovación de España, European Regional Development Fund.

Protocolos de Enfermagem no município de Jaraguá do Sul/SC: estratégia transformadora para atenção primária / Nursing protocols in the municipality of jaraguá do sul/sc: transforming strategy for primary care / Protocolos de enfermería en el municipio de jaraguá do sul / sc: estratégia transformadora para la atención primaria

Objetivo: relatar a implantação e os impactos advindos dos Protocolos de Enfermagem no contexto da Atenção Primária à Saúde do município de Jaraguá do Sul, Santa Catarina,. Método: Trata de um estudo descritivo do tipo relato de experiência. Resultados: O Fluxo de implantação foi desenvolvido com a instituição de uma Comissão de Implantação, Monitoramento e Avaliação dos Protocolos. Após a ampla divulgação, sensibilização e publicitação para a população do município, iniciou-se a implantação nas Unidades Básicas de Saúde, gerando impacto direto nos 12.765 pacientes que aguardavam a primeira consulta médica. Com a implantação dos protocolos, em um mês, houve redução de 74,71% (9.538 pacientes) e em sete meses, houve o resultado prospectado de zerar as filas de primeira consulta da Atenção Primária. Considerações Finais: a implementação dos Protocolos de Enfermagem, propicia mais segurança para a atuação dos enfermeiros da rede municipal e reduz a fila de espera na Atenção Primária. A consulta de Enfermagem e a prescrição de exames e medicamentos essenciais para a população, bem como o processo de acolhimento nas unidades de saúde, foram incorporados na rotina de trabalho dos enfermeiros, proporcionando maior resolutividade das demandas de saúde. (AU)

Objective: To report the implementation and impacts arising from the Nursing Protocols in the context of Primary Health Care in the municipality of Jaraguá do Sul, Santa Catarina. Methods: This is a descriptive study of the experience report type. Results: The Implementation Flow was developed with the institution of a Protocol Implementation, Monitoring and Evaluation Committee. After wide dissemination, awareness and publicity for the population of the city, the implementation of Basic Health Units began, generating a direct impact on the 12,765 patients who were waiting for their first medical appointment. With the implementation of the protocols, in one month, there was a reduction of 74.71% (9,538 patients) and in seven months, there was the prospected result of clearing the queues for the first consultation in Primary Care. Conclusion: The implementation of Nursing Protocols provides more security for the work of nurses in the municipal network and reduces the waiting list in Primary Care. Nursing consultation and the prescription of tests and essential medications for the population, as well as the reception process in health units, were incorporated into the nurses' work routine, providing greater resolution of health demands. (AU)

Objetivo: Reportar la implementación e impactos derivados de los Protocolos de Enfermería en el contexto de la Atención Primaria de Salud en el municipio de Jaraguá do Sul, Santa Catarina. Métodos: Se trata de un estudio descriptivo del tipo relato de experiencia. Resultados: El Flujo de Implementación fue desarrollado con la institución de una Comisión de Implementación, Monitoreo y Evaluación del Protocolo. Luego de una amplia difusión, sensibilización y publicidad para la población de la ciudad, se inició la implementación de Unidades Básicas de Salud, generando un impacto directo en los 12.765 pacientes que esperaban su primera cita médica. Con la implementación de los protocolos, en un mes hubo una reducción del 74,71% (9.538 pacientes) y en siete meses, se logró el resultado esperado de despejar las colas para la primera consulta en Atención Primaria. Conclusion: La implementación de Protocolos de Enfermería brinda mayor seguridad para el trabajo de los enfermeros en la red municipal y reduce la lista de espera en Atención Primaria. La consulta de enfermería y la prescripción de pruebas y medicamentos esenciales para la población, así como el proceso de recepción en las unidades de salud, se incorporaron a la rutina de trabajo de las enfermeras, brindando una mayor resolución de las demandas de salud. (AU)

Synthetic Parathyroid Hormone May Augment Bone Volume in Autogenous Grafts: A Study in Rats.

BACKGROUND: Synthetic parathyroid hormone [PTH(1-34)] has been investigated for its benefits on bone healing and osteoporosis treatment; however, there is little information regarding bone grafts. This study therefore investigates the effect of PTH(1-34) on autogenous bone graft healing. METHODS: Bone grafts were harvested from the calvarium of rats with a trephine bur (3-mm internal diameter) and placed on the cortex near the mandible angle with a titanium screw. Animals were randomly assigned to group 1 (control): subcutaneous injections of saline solution, three times a week (n = 15); group 2: 2 µg/kg PTH(1-34), three times a week (n = 15); and group 3: 40 µg/kg PTH(1-34), three times a week (n = 15). Thirty days postoperatively, the animals were killed, and specimens (implant + bed + graft) were removed and used for undecalcified sections. The following histometric parameters were evaluated: total bone thickness (TT) (bed + gap + graft), graft thickness (GT) (adjacent to the implant), bone-to-implant contact (BIC), and bone area (BA) (within the limits of the threads). Five additional animals were sacrificed immediately after surgery (zero hour) to register bed and graft sizes before healing. RESULTS: Group 3 showed significantly greater bone gain compared with groups 1 and 2 (TT and GT, P <0.05). In relation to initial thickness (zero hour), groups 1 and 2 showed a total decrease in volume of 15.91% and 20.83%, respectively, whereas group 3 showed a slight bone gain (1.21%). Data analysis revealed a significant difference for group 3 compared with groups 1 and 2 (P <0.01). No differences were observed for BIC and BA (P >0.05). CONCLUSION: Systemic administration of PTH(1-34) augmented bone volume in autogenous grafts.

The effects of zoledronic acid and dexamethasone on osseointegration of endosseous implants: histological and histomorphometrical evaluation in rats.

BACKGROUND: Bisphosphonates are a widely used class of drugs that prevent bone loss. Several side effects related to bisphosphonate therapy have been reported, including osteonecrosis of the jaws associated with invasive dental procedures and implants placement. OBJECTIVES: To evaluate the influence of intravenous nitrogen-containing BPs in combination with or without dexamethasone on osseointegration of titanium implants placed in an animal model. METHODS: Twenty-seven male Wistar rats were divided into three groups: group 1 was treated solely with zoledronic acid, group 2 was treated with zoledronic acid and dexamethasone, and group 3 did only receive saline solution injections. Two endosseous implants were placed in each tibia, and three animals from each group were sacrificed at postoperative times of seven, 14, and 28 days. Non-decalcified sections were observed with light microscopy for histological and histomorphometrical analyses. RESULTS: Histomorphometrical analysis using the animals and the implants as unit of measurement revealed no statistically significant difference regarding bone-implant contact and bone density among the three groups. Histological observation revealed that zoledronic acid-treated animals in combination with or without dexamethasone showed expressive less bone remodeling activity at 14 and 28 days after implants placement, compared with control specimens. CONCLUSIONS: The studied bisphosphonate regimens did not interfere with the osseointegration of the implants, cortical, or medular bone deposition, but a possible lack of bone remodeling of the original cortical bone may affect long-term osseointegration.

Role of rhBMP-2 and rhBMP-7 in the metabolism and differentiation of osteoblast-like cells cultured on chemically modified titanium surfaces.

This study analyzed the role of recombinant human bone morphogenetic protein 2 (rhBMP-2) and recombinant human bone morphogenetic protein 7 (rhBMP-7) in the adhesion and differentiation of rat osteoblast-like (osteo-1) cells cultured on chemically modified titanium surfaces. Osteo-1 cells were cultured on chemically modified (modified sandblasted and acid-etched) titanium surfaces in 3 different types of medium: control, medium supplemented with 20 ng/mL rhBMP-2, and medium supplemented with 20 ng/mL rhBMP-7. The following parameters were evaluated: cell adhesion after 24 hours; total protein content; collagen content and alkaline phosphatase (AP) activity after 7, 14, and 21 days; and calcified nodule formation after 21 days. The addition of rhBMP-2 or rhBMP-7 did not influence cell adhesion (P = .1175). Cell differentiation was influenced by rhBMP-2, as demonstrated by a significant increase in collagen content after 7 days of culture (P < .0001) and a significant decrease in AP activity after 21 days (P < .0001). The addition of rhBMP-7 only influenced AP activity, and a significant increase was observed after 21 days (P < .0001). Within the limitations of the study, we conclude that the presence of rhBMP-2 or rhBMP-7 did not influence cell adhesion to chemically modified titanium surfaces but provided an additional stimulus during the differentiation of rat osteo-1 cells cultured on this type of surface.

Two-year randomized clinical trial of enamel matrix derivative treated infrabony defects: radiographic analysis.

BACKGROUND: This split-mouth, double-blind randomized controlled trial evaluated radiographic changes in infrabony defects treated with open flap debridement (OFD) or OFD associated with enamel matrix derivative (EMD) after a 24-month follow-up. The radiographic distance from the CEJ to the bottom of the defect (BD) was considered the primary outcome. CEJ-BC and defect angle were secondary outcomes. METHODS: Ten patients presenting 2 or more defects were selected. An individualized film holder was used to take standardized radiographs of the 43 defects, at baseline and after 24 months. Images were digitized and used to measure the distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), CEJ to the bottom of the defect (BD) and infrabony defect angle. Statistical analysis was performed in SPSS for Windows (version 5.2). Paired samples t test was used to compare test and control groups and to evaluate changes within each group. The level of significance was set at α = 0.05%. RESULTS: After 24 months, a significant crestal bone loss was observed for EMD (1.01 mm; p = 0.049) but not for OFD (0.14 mm; p = 0.622). However, no differences were detected between groups (p = 0.37). Reduction of the bone defect depth was significant for OFD (0.70 mm; p = 0.005) but not for EMD (0.04 mm; p = 0.86), while no differences were detected between them (p = 0.87). Both EMD (0.69°; p = 0.82) and OFD (5.71°; p = 0.24) showed an improvement in defect angle measurements but no significant differences were observed after 24 months or between the groups (p = 0.35). CONCLUSION: Linear radiographic analysis was not able to demonstrate superiority of EMD treated infrabony defects when compared to ODF after 24 months. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02195765. Registered 17 July 2014.

Uniformidade de aplicação de água na irrigação de mudas de espécies florestais nativas produzidas em tubetes / Water application uniformity on the irrigation of native forest seedlings grown in recipient tubes

Sistemas de irrigação mal dimensionados aliados a manejos inadequados podem afetar o uso satisfatório da irrigação em viveiros, ocasionando desperdício de água e energia e, consequentemente, o desenvolvimento inferior das espécies. Sendo assim, os objetivos do trabalho foram avaliar a uniformidade de irrigação de um sistema de microaspersão, já instalado em um viveiro de mudas de espécies florestais, bem como avaliar a uniformidade de um sistema de irrigação por capilaridade de mudas florestais cultivadas em tubetes. A avaliação de uniformidade da irrigação por microaspersão foi realizada em um viveiro de mudas de espécies nativas florestais, em Itutinga ­ MG, utilizando emissores modelos MA-20, Rondo e Inverted Rotor Spray. Para determinação da uniformidade foram calculados o Coeficiente de Uniformidade de Christhiasen (CUC) e o coeficiente de uniformidade de distribuição (CUD) de cada emissor, em três repetições. A uniformidade da irrigação por capilaridade foi avaliada em uma estufa localizada na Universidade Federal de Lavras (UFLA), em três espécies cultivadas em tubetes de 300 cm³ (Araucaria angustifolia (Bertol.) O. Kuntze., Syagrus romanzoffiana e Joannesia princeps) e três espécies cultivadas em tubetes de 110 cm³ (Guazuma ulmifolia Lam., Anadenanthera macrocarpa (Benth.) Brenan e Aspidosperma polyneuron), sendo calculados os coeficientes de uniformidade para cada espécie, também em três repetições. Para os sistemas de microaspersão os maiores valores de CUC e CUD foram obtidos para o emissor MA-20. Na irrigação por capilaridade, os maiores valores de CUC e CUD foram obtidos na espécie Mutamba. Em geral, a uniformidade de irrigação em espécies cultivadas em tubetes de 110 cm³ foi maior que em tubetes de 300 cm³.

Irrigation systems poorly dimensioned allied to inadequate management could affect the satisfactory use of irrigation in nurseries, causing waste of water and energy and, consequently, less species development. Thus, the objectives of this study were to evaluate the uniformity of a microsprinkle irrigation system, already installed in a nursery of forest species, as well as evaluating the uniformity of a capillarity irrigation system of forest seedlings grown in plastic tubes. The microsplinkle irrigation uniformity evaluation was performed in a native forest nursery at Itutinga city, MG, using the emitters models MA-20, Rondo e Inverted Rotor Spray. To determine the irrigation uniformity, were calculated the coefficients CUC (Christiansen Uniformity Coefficient) and DUC (Distribution Uniformity Coefficient) of each emitter, with three replications. The capillary irrigation uniformity evaluation was evaluated in a greenhouse located in the Federal University of Lavras (UFLA), in three species cultivated in 300 cm³ recipient tubes (Araucaria angustifolia (Bertol.) O. Kuntze, Syagrus romanzoffiana e Joannesia princeps) and three species cultivated in 110 cm³ tubes (Guazuma ulmifolia Lam., Anadenanthera macrocarpa (Benth.) Brenan and Aspidosperma polyneuron), through the calculation of CUC and DUC for each species, also with three replications. To the microsprinkle systems, the largest values of CUC and DUC were obtained for the MA-20 emitter. In capillarity irrigation, the largest CUC and DUC were obtained at irrigation of the Guazuma ulmifolia Lam. plants. In general, the irrigation uniformity in the species cultivated in 110 cm³ tubes was higher than in tubes of 300 cm³.

Effect of Center-Pivot Irrigation in the Rust and Brown Eye Spot of Coffee.

Incidence of rust (caused by Hemileia vastatrix) and brown eye spot (caused by Cercospora coffeicola) of coffee was evaluated for 2 years in southern Minas Gerais, Brazil, in a center-pivot-irrigated coffee crop with different water application levels. Treatments consisted of six water levels of 0 (nonirrigated), 60, 80, 100, 120, and 140% applied according to class A evaporation pan (CAE). Progress of disease was influenced significantly by different water levels; the highest incidence of rust occurred with lower water levels-0 (nonirrigated), 60, and 80% CAE-whereas the lowest incidence was detected with larger water levels: 120 and 140% CAE. There was one peak of rust incidence in August. The highest incidence of brown eye spot occurred with water levels of 100 and 140% CAE and the lowest incidence was found in the nonirrigated treatment. Two incidence peaks occurred in March and June. This study identified that irrigation methods and water levels can decisively affect the epidemiological behavior of diseases and, therefore, their management.

Immunolocalization of bone morphogenetic protein 2 during the early healing events after guided bone regeneration.

OBJECTIVE: The objective of this study was to evaluate the immunolocalization of bone morphogenetic protein 2 (BMP-2) after autogenous block grafting covered or not with an e-PTFE membrane. STUDY DESIGN: Forty-eight rats were divided into 2 groups, autogenous block graft (B) and autogenous block graft + e-PTFE membrane (MB), and were evaluated by immunohistochemistry at baseline and 3, 7, 14, 21, and 45 days. RESULTS: The largest number of positive cells in the recipient bed was observed after 3 days in both groups. At the graft border, the largest number of positive cells was seen after 7 days in group B and after 14 days in group MB. The highest proportion of staining in the graft was observed after 3 days in group B and after 21 days in group MB. CONCLUSIONS: High proportions of stain were related to intense revascularization and osteogenesis. Except for the interface, BMP-2 staining occurred later in group MB than in group B in all structures analyzed.

Fontes de financiamento em ensaios clínicos: análise crítica / Sources of funding in clinical trials: critical analysis

Os ensaios clínicos são de grande valor para a descoberta e confirmação de terapias contra diferentes patologias. A declaração CONSORT tem o objetivo de evitar erros metodológicos e de interpretação de resultados em ensaios clínicos. Este artigo faz uma análise crítica acerca do item 25 da declaração CONSORT 2010, sobre Fontes de Financiamento em ensaios clínicos randomizados, pois pode haver tendenciosidade na publicação de resultados de pesquisas patrocinadas por indústrias. Assim, verifica-se a necessidade de adequação das pesquisas clínicas, principalmente quanto ao registro e à transparência no financiamento, a fim de promover uma real melhoria destas pesquisas, promovendo o surgimento de novas terapias.

Clinical trials in the medical are of great value for the discovery and confirmation of therapies against different diseases. However, one senses a possible bias in scientific articles published from clinical trials sponsored by industry. The CONSORT statement aims to avoid methodological errors and interpretation of results in clinical trials. Thus, this article makes a critical analysis of item 25 of the 2010 update of the CONSORT statement on Sources of Funding in randomized clinical trials. Thus, there is a need for adequacy of clinical research, especially regarding the registration and ethics in finance in order to promote a real improvement of this research, fostering the emergence of new therapies.

Recobrimento radicular associado a restaurações cervicais: posicionamento atual da literatura / Root coverage associated with cervical restorations: up date

As recessões gengivais constituem a migração apical da gengiva marginal em relação à junção cemento-esmalte (JCE). Devido à exposição radicular ao meio bucal, o elemento dental pode ficar susceptível à sensibilidade, cárie, reabsorção ou ainda lesão cervical não cariosa (LCNC). A presença destas alterações pode ser resolvida com restaurações estéticas de resina composta (RC) e/ou de ionômero de vidro modificado por resina (IVMR). Alguns estudos recentes têm associado técnicas de cirurgias plásticas periodontais à terapêutica restauradora, mostrando resultados promissores. Assim, o objetivo da presente revisão da literatura foi reportar o posicionamento atual sobre a utilização de cirurgias periodontais de recobrimento radicular em áreas de LCNC restauradas com diferentes materiais. Os resultados encontrados mostraram taxas médias de recobrimento da ordem de 80,20% quando o retalho deslocado coronariamente (RDC) foi associado à restaurações de IVMR e RC. O ganho de nível clínico de inserção (NCI) variou de 1,2 mm a 2,4 mm e a diminuição na profundidade de sondagem (PS) variou de 1,3 mm a 2,1 mm. Para todos os parâmetros, houve apenas diferença estatística para o parâmetro sensibilidade dentinária (SD), quando a técnica combinada foi utilizada. Concluiu-se que o procedimento associado entre a cirurgia periodontal e a Odontologia restauradora apresenta boa aplicabilidade clínica, sendo tão eficaz quanto a técnica cirúrgica sozinha, sem causar danos aos tecidos periodontais e não interferindo no resultado da cobertura da raiz com LCNC.

Subgingival ultrasonic instrumentation of residual pockets irrigated with essential oils: a randomized controlled trial.

AIM: To evaluate the clinical efficacy of subgingival ultrasonic instrumentation irrigated with essential oils (EOs) of residual periodontal pockets. MATERIAL AND METHODS: Sixty-four individuals with chronic periodontitis were invited to participate in this randomized, double-blind, parallel, and placebo-controlled clinical trial. All subjects received non-surgical periodontal therapy. After re-evaluation (baseline), residual pockets (pocket depth ≥5 mm) received test (ultrasonic instrumentation irrigated with EOs) or control therapy (ultrasonic instrumentation irrigated with negative control). Probing pocket depth (PPD), gingival recession (R), clinical attachment level (CAL), bleeding on probing (BOP), and plaque were assessed at baseline and after 4, 12, and 24 weeks. Differences between groups and changes over the course of time were analysed according to a generalized linear model. RESULTS: There was a significant reduction in PPD and BOP, as well as a significant CAL gain in the two groups (p<0.001). Nevertheless, there were no differences between the groups at any time of the study. When only initially deep pockets (PPD ≥7 mm) were analysed, a significantly greater CAL gain (p=0.03) and PPD reduction (p=0.01) was observed in the test group. CONCLUSION: The adjunctive use of EOs may promote significant CAL gain and PPD reduction in deep residual pockets.

Delineamentos de ensaios clínicos em pesquisas odontológicas / Clinical trial designs in dental researches

Ensaios clínicos randomizados, quando bem conduzidos, fornecem uma alta evidência para a avaliação da eficácia de intervenções, importante para decisões da prática clínica. A escolha certa do delineamento de ensaios clínicos, que é a forma como o estudo será conduzido, é fundamental para a redução de vieses nos resultados. O pesquisador precisa, portanto, conhecer os tipos de delineamento mais comuns e suas vantagens e implicações para que possa escolher o ideal para sua pesquisa. O objetivo desse trabalho é apresentar e analisar os principais tipos de delineamento no ensaio clínico odontológico, fornecendo informações básicas sobre cada um deles. Uma busca na literatura pela base de dados PubMed via Medline foi realizada a fim de localizar trabalhos que esclarecessem as normas dos delineamentos de estudos usados em ensaios clínicos. Os trabalhos selecionados tiveram suas informações extraídas e apresentadas nos resultados a fim de facilitar o entendimento de cada tipo de delineamento. Foram analisados os tipos de delineamento: paralelo, cruzado (“cross-over”), por agrupamento(“cluster”), boca- dividida e fatorial. A conclusão deste trabalho mostra que nem sempre o ensaio clínico do tipo paralelo, cujo uso é mais rotineiro, é o mais adequado para uma pesquisa. É necessário conhecer e escolher o delineamento que irá fornecer melhor custo-benefício e resultados significativos à pesquisa.

Randomized clinical trials, when appropriately conducted, provide a high quality of evidence for evaluating therapeutic effectiveness, important on practical decisions. Choosing the right design for a clinical trial, which is how the study will be conducted, is crucial to the final power of the study. Researcher needs to get familiarized with the most common design methods and its implications, to be able to choose the one that fits ideally better on his study. The aim of this present study is to elucidate and analyze the most common design methods, informing the basics of each one. A literature search was conducted on PubMed via Medline to locate studies that clarify the rules of the study designs used in clinical trials. Selected studies had their information extracted and presented at the results in order to facilitate the understanding of each type of design. The following trial designs were analyzed: parallel, cross-over, cluster, split-mouth and factorial. Our conclusion is that not always the parallel design, which is the most common design in clinical trials, is ideally better to a research. It is important to know and chose the trial design that will provide the best cost-benefit and significant results to a research.

Retalho deslocado lateralmente na correção de recessão gengival causada pela excisão cirúrgica de um fibroma ossificante periférico: relato de caso / Use of laterally positioned flap to correct gingival recession caused by excisional biopsy of peripheral ossifying fibroma: case report

o presente relato de caso refere-se a um paciente do sexo masculino (JP) de 45 anos que compareceu à clínica do Centro de Extensão, Treinamento e Aperfeiçoamento em Odontologia (CETAOl, com a seguinte queixa principal: "Sanqramento na gengiva" (sic). Na anamnese não foi relatada nenhuma alteração sistêmica. No exame extraoral nada digno de nota foi observado, No exame intraoral, notou-se um nódulo, levemente consistente, na região da gengiva marginal vestibular dos incisivos inferiores (entre os dentes 41 e 32), de coloração semelhante à mucosa, liso e com dimensões de 1,6 cm x 1,0 em, associado à retração gengival no dente 31. Após a realização de procedimentos básicos, e devido aos possíveis diagnósticos diferenciais, optou-se pela biopsia excisional da lesão e correção cirúrgica da retração no mesmo tempo operatório, através da técnica de retalho deslocado lateralmente. A lesão foi levada ao exame histopato- lógico, revelando como diagnóstico fibroma ossificante periférico. O paciente não apresentou nenhuma complicação pós-cirúrgica e após 10 meses de acompanhamento observou-se um recobrimento radicular significativo, sem a presença de recidiva da lesão.

This paper describes the treatment of a male patient, 45 years old, who showed up at the office complaining about gingival bleeding. No relevant information was detected in the inter- view and the extra-oral examination. The intra-oral examination revealed a firm nodule (t.scrn x 1,Ocm) at the marginal gingiva of the buccal aspect of the lower incisors (between 41 and 32). The color of the lesion was similar to the oral mucosa and a gingival recession was asso- ciated with the buccal aspect of tooth 31. After root scaling and dental hygiene orientation, the diagnostic hypotheses were evaluated and indicated a good prognosis with low chance of recurrence. Thus, the adopted surgical approach included the nodule removal and the root co- verage of tooth 31 recession, by the laterally positioned flap technique, at the same procedure. The histopathological diagnosis of the lesion was peripheral ossifying fibroma. Ten months after surgery, no complications were reported and significant root coverage oftooth 31 recession was obtained without recurrence of the lesion.

Avaliação da capacidade de descontaminação da terapia fotodinâmica no pós-operatório imediato de implantes: estudo piloto / Efficiency of photodynamic therapy in the immediate postoperative of dental implants: pilot study

Em todo ato cirúrgico para instalação de implanttes dentários ocorre uma contaminação inerente ao procedimento que pode prejudicar a cicatrização. Este projeto foi proposto para encontrar uma forma de reduzir a microbiota da área peri-implantar com a terapia fotodinâmica (PDT, do inglês photodynamic therapy). Após triagem (critérios de inclusão: normorreativos, com espaço intercalar superior, sem histórico de doença periodontal grave), cinco pacientes foram selecionados e reabilitados com implantes Standard Plus da Straumann®. Ao término da cirurgia, uma primeira coleta microbiológica peri-implantar foi efetuada (controle). Aplicou-se o corante azul de metileno a 0,005% por 5 minutos. Em seguida, a área peri-implantar foi irradiada com laser diodo de baixa potência (AsGaAl, 660 nm, 40mW), por 2 minutos, totalizando 120 J/cm(2) de densidade de energia, dividida em 4 pontos (2 na vestibular e 2 na palatina). Ao término da PDT, outra coleta microbiológica foi realizada (teste). Todo o material coletado passou pelo seguinte processo: diluições seriadas; semeadura em meios de cultura; incubação em meio anaeróbio por sete dias e contagem do número de unidades de colônias totais (UFC). O teste estatístico de Wilcoxon mostrou haver diferença significante (p < 0,001) na redução bacteriana para as UFC, tendo como mediana dessa redução 93,67%. Os resultados permitem afirmar que a PDT é um método eficaz de descontaminação da área cirúrgica no pós-operatório imediato de implantes dentários.

Abordagem cirúrgica para o restabelecimento estético/funcional dos pacientes com fibromatose gengival hereditária / Surgical approach for functional and aesthetic reestablishment of the patients with hereditary gingival fibromatosis

A fibromatose gengival hereditária (FGH) é uma condição bucal rara, caracterizada clinicamente pelo crescimento contínuo e progressivo do tecido gengival. O crescimento gengival severo causa comprometimento estético/funcional, tendo como sinais clínicos comuns diastemas, mau posicionamento dentário e proeminência labial. Este relato de caso descreve o tratamento cirúrgico em duas etapas de um paciente que se apresentou à Universidade de São Paulo (FOUSP) queixando-se do aspecto antiestético ao sorrir, devido ao aumento gengival. A primeira etapa consistiu em um retalho parcial com excisão de margem gengival (remoção de altura/espessura do tecido conjuntivo). Na segunda etapa, foi realizado um retalho total associado à excisão de margem, para obter acesso ao tecido ósseo e melhorar o contorno da margem gengival. O pós-operatório mostrou uma reparação satisfatória, com um padrão da margem gengival e da crista-óssea compatível com a saúde periodontal e de acordo com as expectativas estéticas do paciente. A avaliação histológica das biópsias gengivais confirmou o diagnóstico clínico de FGH. Considerando as limitações de um relato de caso, coloca-se uma alternativa viável para demonstrar que a associação dessas técnicas, desde que bem indicadas, é uma possível abordagem cirúrgica para o restabelecimento estético/funcional dos pacientes com FGH.

Hereditary gingival fibromatosis (HGF) is a rare buccal condition, characterized by a continuous and progressive enlargement of the maxilary and mandibular gingiva. The severe gingival overgrowth causes functional and aesthetic problems with common clinical aspects as diastemas, irregular dental positioning and labial prominence. This article describes the surgical treatment in 2 stages of a man who presented himself at the University of São Paulo (FOUSP) complaining of unfavorable smile sapect due to the gingival overgrowth. First stage consisted of a partial flap with internal bevel incision to remove height/thickness of the connective tissue. In the second stage mucoperiostal flaps with internal bevel incision were made to access the bone and to improve the contour of the gingival tissue. The postoperative course showed a satisfatory healing with a compatible relation between gingival tissue/bone crest, periodontal health and the aesthetic expectations of the patient. Histological examination of gingival specimens supported the clinical diagnosis of HGF. Considering the limitations of a case report, na alternative is presented to demonstrate the association of surgical techniques if well indicated and a possible surgical approach for functional and aesthetic reestablishment of the patients with HGF.

Influence of osteopenia in autogenous bone graft healing with or without expanded polytetrafluoroethylene membranes: histologic and histomorphometric study in rats.

PURPOSE: The aim of this study was to quantitatively evaluate and qualitatively describe autogenous bone graft healing with or without an expanded polytetrafluoroethylene (e-PTFE) membrane in ovariectomized rats. MATERIALS AND METHODS: Eighty Wistar rats, weighing approximately 300 g each, were used. A graft was obtained from the parietal bone and fixed to the sidewall of each animal's left mandibular ramus. The animals were randomly divided into four experimental groups (n = 20 in each group): group 1, sham operated and autogenous bone graft only; group 2, sham operated and autogenous bone graft covered by e-PTFE membrane; group 3, ovariectomized (OVX) and autogenous bone graft only; group 4, OVX and autogenous bone graft covered by e-PTFE membrane. The animals were sacrificed at five different time points: immediately after grafting or at 7, 21, 45, or 60 days after grafting. Histologic examination and morphometric measurement of the sections were performed, and values were submitted to statistical analyses. RESULTS: Both groups (sham and OVX) experienced loss of the original graft volume when it was not covered by the membrane, whereas use of the membrane resulted in additional bone formation beyond the edges of the graft and under the membrane. Histologic analysis showed integration of the grafts in all animals, although a larger number of marrow spaces was found in OVX groups. CONCLUSIONS: Association of bone graft with an e-PTFE membrane resulted in maintenance of its original volume as well as formation of new bone that filled the space under the membrane. Osteopenia did not influence bone graft repair, regardless of whether or not it was associated with e-PTFE membrane, but descriptive histologic analysis showed larger numbers of marrow spaces in the bone graft and receptor bed and formation of new bone in the OVX animals.

Efeitos do plasma rico em plaquetas no processo de reparação de feridas dérmicas padronizadas em ratos / Effect of platelet-rich plasma on the standardizd dermal wound healing in rats

O uso do plasma rico em plaquetas (PRP) pode apresentar resultados favoráveis na reparação de feridas. Analisou- se os efeitos do plasma rico em plaquetas no processo de reparação tecidual em feridas dérmicas padronizadas, com a utilização de “punch”, para excisão do fragmento de pele, com 5mm de diâmetro e 2mm de profundidade, no dorso de 40 ratos. Destes, 40 foram utilizados para análise microscópica e 8 para macroscópica. Os animais foram divididos em dois grupos: grupo teste as feridas foram tratadas com plasma rico em plaquetas e grupo controle foi utilizado soro fisiológico. Além disso, foram utilizados 5 ratos para a determinação do número de plaquetas presentes no PRP. Os resultados morfométricos obtidos através do teste de Mann-Whitney mostraram que não existiram diferenças estatisticamente significantes com relação à área e perímetro, entre os grupos teste e controle. No entanto houve diferença estatisticamente significante, em ambos os grupos, entre os períodos de avaliação, sendo maior no período “baseline” seguido em ordem decrescente pelos períodos 24 horas 3, 7 e 14 dias. Através da análise histomorfológica, utilizando o teste de Mann-Whitney, não foram verificadas diferenças estatisticamente significantes entre os grupos teste e controle em relação às variáveis estudadas, edema, exsudato inflamatório, neovascularização, necrose, colagenização, presença de fibroblastos jovens, reepitelização, presença de crosta, nos quatro períodos de observação (24 horas, 3 dias, 7 dias e 14 dias). A análise histomorfométrica também realizada através do teste de Mann-Whitney não mostrou diferenças estatisticamente significantes entre os grupos teste e controle em relação à celularidade, espaço em branco e matriz extracelular (matriz colagênica) nos quatro períodos de observação mencionados acima.

The employment of platelet-rich plasma (PRP) can present favorable outcomes in tissue healing since it represents anatural source of growth factors. The purpose of this research was to analyze the effects of platelet-rich plasma on tissue healing. Standard dermical wounds were made with the useof a punch, to excise a skin fragment with 5 millimeters of diameter and 2 milliner’s in depth in the back of 48 rats.Forty rats were used for microscopical analysis and 8 for macroscopic analysis. The animals were divided into twogroups according to the treatment they were submitted: in one group called Test, the wounds were treated with plateletrich plasma and in another one called Control, saline was used. Also, 5 rats were used to determine the number of platelets present in the platelet-rich plasma. The specimens were processed for macroscopic and microscopic analysis...

Avaliação da uniformidade de aplicação de água em um sistema de gotejamento para pequenas propriedades / Uniformity of water application for a drip irrigation system to small farms

O uso de sistemas de irrigação por gotejamento à baixa pressão tem como objetivo oferecer uma técnica de irrigação viável para pequenas propriedades. Foram dimensionados oito sistemas de irrigação, um com os seguintes acessórios: 210 metros de tubo gotejador com diâmetro interno (DI) de 10,4 mm, sete conectores de 12 mm, e seis metros de tubo de polietileno, um adaptador para tubo de polietileno, uma curva de 90º e três metros de tubo de PVC com DI igual a 20,6 mm. Quatro sistemas foram montados com um filtro de tela de 130 μm e os demais com um filtro de disco de 200 μm. Em todos os sistemas foram utilizados um reservatório de 1 m³ localizado a 3 m acima do nível do solo. Irrigou-se 1296 m² de uma cultura de tomate, em canteiros com dimensões de 1,20 m por 60 m. Para avaliação técnica do projeto foi obtida a uniformidade de aplicação de água através do coeficiente de uniformidade de emissão (UE) e coeficiente de uniformidade de distribuição (UD), durante um período de 90 dias. Os resultados indicaram que o UE e o UD foram excelentes e que os valores de grau de entupimento aumentaram com o uso da irrigação. Assim, de acordo com os resultados, comprova-se a viabilidade técnica da utilização de sistemas de irrigação por gotejamento funcionando a baixa pressão para pequenas áreas.

A low pressure drip irrigation gravity feed system may be a viable technique to small farms. So, according with it, eight irrigation systems with 10.4 mm internal diameter driptubing 210 m long, seven 12 mm adapters, 20.6 mm polyethylene pipe 6 m long, polyethylene adapter, 20.6 mm 90º elbow, 20.6 mm PVC pipe 3 m long and 1 m³ water reservoir at 3 m height, were designed and assembled to irrigate 1.296 m² with tomato cultivated in 0.8 x 60 m beds. One 130 mm screen filter was used to four systems and one 200 mm disc filter for the other ones. Emission uniformity coefficients (UE) and distribution uniformity coefficients (UD) were obtained throughout 90 days. UE and UD were excellent and the degree of clogging at the emitters increased with time. Therefore, according to the results, the low pressure drip irrigation systems tested are technically viable to small areas.