Avaliação microscópica dos fragmentos ósseos obtidos por diferentes métodos de osteotomia e de irrigação em aloenxertos irradiados e congelados de coelho

Oral and facial bone defects can undertake appearance, psychosocial well-being and stomathognatic function of its patients. Over the yerars several strategies for bone defect regeneration have arised to treat these pathologies, among them the use of frozen and irradiated bone allograft. Manipulation of bone grafts it s not determined yet, and several osteotomy alternatives can be observed. The present work evaluated with a microscope the bone fragments obtained from different osteotomy methods and irrigation on rings and blocks allografts irradiated and frozen at 80° negative in a rabbit model. The study is experimental in vitro and it sample was an adult male New Zealand rabbit. The animal was sacrificed to obtain long bones, that were submitted to freezing at 80º negative and irradiated with Cobalt- 60. Then the long bones were sectioned into 24 bone pieces, divided into 4 groups: G1 (n=06) osteotomy was performed with bur No. 6 forming rings with 5 mm thickness with high-speed handpiece with manual irrigation; G2 (n=06) osteotomy was performed with bur No. 6 forming rings with 5 mm thick with surgical motor with a manual irrigation rotation 1500 rpm; GA (n=06), osteotomy with trephine using manual irrigation with saline; and GB (n=06), osteotomy with trephine using saline from peristaltic pumps of surgical motor. Five bone pieces of each group were prepared for analysis on light microscopy (LM) and one on electronic scan electronic microscopy (SEM). On the SEM analysis edges surface, presence of microcracks and Smear Layer were evaluated. Analyzing osteotomy technics on SEM was observed: increased presence of microcracks cutting with high speed; increased presence of areas covered by Smear Layer when cutting with motor implant. The irrigation analysis with SEM was observed: that the presence of microcracks does not depend on the type of irrigation; on manual irrigation, there was greater discrepancy between the cutting lines. The descriptive analysis of the osteotomy and irrigation process on LM showed: histological analysis showing the bony margins with clear tissue changed layer, composed of blackened tissue of charred appearance near to the cortical bone; on the edges of the bony part, bone fragments that were displaced during the bone cut and bone irregularities were observed. After analysis of results we can conclude: that there was greater regularity of the bone cut using high-speed handpiece than using motor implant; the cut with trephine using saline irrigated from peristaltic pumps of surgical motor showed greater homogeneity when compared with manual irrigation; charred tissue was found in all obtained bone samples, whit no significant statistically difference on the proportion of carbonization of the two analysed technics

Avaliação de Percepção de periodontistas, protesistas, ortodontistas e leigos sobre parâmetros periodontais relacionados à estética do sorriso

The concept of facial esthetics has been increasingly diffused, being of interest to both the general public and the surgeon-dentists. However the difficult standardization and high variability in parameters aesthetic existing in the literature result in a huge difference of opinions between professionals and layperson. In this way, objective of this research was to evaluate the perception of periodontistas, protesistas, orthodontists and layperson about aesthetics smile. The sample included 30 periodontistas, 30 protesistas, 31 orthodontists and 37 layperson. The data collection was performed through an interview indirect, by the site, which had fifteen photos to be assessed by the participants. Each photograph was intentionally modified, with four increments 1mm for each amendment, in the program Adobe Photoshop CS2 version 9.0, adding-four aesthetic alterations: exposure gingival, recession gingival, absence of papilla and contour gingival. The smile for periodontistas, 3mm for orthodontists and laity and 4mm for protesistas. And changes in recession gingival, have undertaken the aesthetics of smiling from 2mm in accordance with the periodontistas and protesistas and 4mm for orthodontists and lay people. The end of the research was possible to conclude that the perception of periodontistas, protesistas, orthodontists and layperson are different in relation to aesthetics smile, and that among the changes in the research evaluated the papilla and recession have undertaken the aesthetics of smile

Avaliação clínica da relação entre o índice de placa, índice gengival, alinhamento dental, mucosa ceratinizada, tipo de periodonto e distúrbios oclusais com a ocorrência de recessão gengival

This study clinically evaluated the relationship of gingival recessions with the periodontal index of gingival and plaque, dental alignment, keratinized mocous, type of periodontal, and occlusal disorders. Study participants were individuals aged between 19 and 33 years. The evaluations were performed by using questionnaires and clinical examinations. In subjects examined, the teeth were assessed and divided into groups (Molars, premolars, canines and incisors). The gingival recession were measured in the central region of the teeth and individuals were subject to disclosure to the plate and observing the poll of plaque and gingival index, respectively. 558 teeth were examined, with 24.1%, 135 had gingival recession greater than or equal to 1mm. Through the combination of tests used to evaluate the average of the recession and its relationship with the variables studied, we observed that the degree of recession of the elements assessed dental showed, almost for the most part, when higher values associated with the index plaque (p = 0.101), Gingival Index (p = 0.053), dental alignment (p = 0.962), width of keratinized mocous (p = 0.004) and type of periodontium (p = 0.033), however statistically significant difference could only be considered when related the recessions in the keratinized mocous and the type of the periodontium. Although we identify, when we evaluate the whole set of teeth that occlusal disturbances (p = 0.002) were more strongly associated with cases of gum recession that the gingival index (p = 0.006), however, these two conditions were correlated with the cases of recession, contributing to its occurrence

Programa de odontologia para bebês: uma avaliação quantitativa e qualitativa

The objective of this study was to evaluate a baby dentistry program which has been in the city of Natal for five years. The research was based on two analysis: a quantitative one, which tried to check caries prevalence in 52 children supported by the program and a qualitative one, which, through interviews carried out with the mothers, using the focus group technique, tried to realize the effect of the program their attitudes related to the care of their children´s oral health. For the quantitative analyses of caries prevalence there was the use of def-s and knutson rates and the values obtained were shown in a descritive and analytical way.The results showed that 4.2% of babies ranging 24 to 36 months old presented carie disease. Children from 36 to 48 months old and above 48 months old presented 18.2% and 16.7% carie prevalence respectively.The def-s averages found in ages 24 to 36, 36 to 48 and 48 to 60 months old were 0.08; 0.40 and 1.16 respectively, considered as being equally low, going along with Knutson rates. The qualitative analyses showed a high level of the mothers` satisfaction, considering the access,practitioner-patient relationship and opportunity to keep the oral health. Children supported by the program showed a low carie prevalence and the program turned out to be effective under the mothers` point of view

Avaliação in vitro da adesão e proliferação de células mesenquimais do ligamento periodontal humano em diferentes superfícies de titânio

In the last years, many scientific researches in implantology have been focused on alternatives that would provide higher speed and quality in the process of osseointegration. Different treatment methods can be used to modify the topographic and chemical properties of titanium surface in order to optimize the tissue-implant reactions by a positive tissue response. This study aimed to evaluate the adhesion and proliferation of mesenchymal cells from human periodontal ligament on two different titanium surfaces, using cell culture techniques. Grade II titanium discs received different surface treatments, forming two distinct groups: polished and cathodic cage plasma nitriding. Human periodontal ligament mesenchymal cells were cultured on titanium discs in 24-well cell culture plates, at a density of 2 x 104 cells per well, including wells with no discs as positive control. Data obtained by counting the cells that adhered to the titanium surfaces (polished group and cathodic cage group) and to the plastic surface (control group), in the 24, 48 and 72-hour periods after plating, were used to analyze cell adhesion and proliferation and to obtain the cell growing curve in the different groups. The data were submitted to nonparametric analysis and the differences between groups were compared by Kruskal-Wallis and Friedman statistical tests. No statistically significant differences were found in the cells counts between the groups (p>0.05). It was concluded that both treatments produced surfaces compatible with the adhesion and proliferation of human periodontal ligament mesenchymal cells

Avaliação de lesões brancas de cáries: um estudo de prognóstico

Objective: The aim of the present study is to assess the current situation of white enamel lesions on vestibular surfaces of permanent upper incisors, diagnosed 6 years ago, without clinical intervention. Methods: A prospective study reassessed 53 students of both sexes, aged between 13 and 18 years old, all attending the public school system in Natal, Brazil. Data collection was performed by duly calibrated examiners, and a clinical chart consisting of demographic data on dental caries, oral hygiene, and gingival condition was prepared. A tactile-visual examination was conducted using a clinical mirror and periodontal probe. Data compilation and analysis were carried out using a SPSS software. In this analysis the chi-squared test was used for qualitative independent variables. To identify the net effect of treatment, multiple logistic analysis with forward stepwise model selection was performed. Results: The final sample was composed of 106 lesions in the 53 individuals, with mean age of 15.02 years, visible plaque index (VPI) of 23.34%, and gingival blood indices (GBI) of 25.92%. A statistically significant relationship (p = 0.003) was found between initial DMFS and prognosis of white enamel lesion. Conclusions: We observed that past caries experience and dental plaque were the main predictive factors for negative lesion outcomes, demonstrating the need for oral hygiene control through continuing preventive measures

Condições de saúde bucal e capacidade funcional em idosos

Population aging is one of the greatest challenges to contemporary public health and, in this perspective, the functional capacity emerges as an important feature in geriatric assessment. The oral health of elderly, in turn, deserves special attention because, historically, in the dental services, this population group was not considered a priority for attention, which is verified by high rates of edentulism found even among these individuals. The present study proposes to examine the relationship between oral health status and functional capacity in an elderly population. To this end, intra-oral epidemiological examination was performed to assess the degree of dental caries, periodontal status, use and need of prosthesis and the presence of lesions. Functional capacity was assessed by the Independence in Activities of Daily Living, which considers the independence or not in the performance of six self-care functions. Socioeconomic and demographic characteristics and general health status were also investigated, in view of the possibility of intervention of these variables in the investigated relation. An factor analysis of the principal components was conducted which resulted four indicators of oral health conditions, representative of the population studied. 441 seniors were enrolled with mean age of 71.7 (± 8.7) years, the majority being female (68%). Functional capacity was dichotomized into completely independent individuals (89.6%) and dependent on at least one of the functions considered (10.4%). There was an association between functional capacity and the indicators related to the presence of many teeth and dental caries, and to that associated with the use and need of prostheses. These associations in turn, lost statistical significance when adjusting for confounding variables, combined in separate models for each indicator. Some of these variables, however, remained associated with functional capacity. It is considered that the study of oral health status of elderly, associeted with the search for an association with functional capacity is important in the construction of indicators necessary for planning preventive and therapeutic interventions that reduce the risk for loss of ability in daily physical functions and their consequences, as the harm in the oral self-care

Avaliação longitudinal do impacto da saúde bucal na estratégia saúde da família em Natal

As a result of the financial incentive provided by the GM / MS 1.444, since 2000, Brazil has experienced a substantial increase in the number of oral health services at the Family Health Strategy. There is, however, evidence that these teams have produced qualitatively different experiences which do not translate necessarily into improved quality of life and health. Thus, evaluative research of great importance. This study aims to assess the impact of the Family Health Strategy in oral health in a longitudinal perspective natalense the years 2006 and 2009. This is an intervention study whose design is a community trial in parallel, nearly randomized. The sample consisted of census tracts covered by oral health teams in the Family Health and the Traditional Model (Basic Health Units and non-FHS Program of Community Health Agents and areas not covered.) The sample was determined by drawing ten census tracts to form the experimental group and ten other sectors for the control group by pairing intentional based on socio-economic and geographic. To check the net effect of the intervention was performed multivariate analysis by Poisson regression. As a result of cross-sectional analysis of year 2009, it was found that the effects of the ESF in Natal were satisfactory only for the variables of injuries and for other purposes without and with negative impact on stock coverage reclaimers. However, the longitudinal analysis revealed that the ESB / ESF improved their performance in dealing with grievances, access and coverage of the type of actions and this fact is independent of age, sex and social and economic conditions. In other employees' words are related to the presence of the Family Health Strategy in the region. However it does not say that both models under study (the Family Health Strategy Model and Traditional) are different in terms of performance and it is pertinent to reflect on the need for further development of evaluation studies that use other approaches able to clarify the dynamics of the process whose results can come to the knowledge of the actors responsible for leading the ESF and encourage them to incorporate the assessment in their routine

Avaliação em saúde bucal na perspectiva do usuário: enfoque ao estudo da acessibilidade organizacional

Due to the fact of oral health sector reestructuration within Brazilian public health politics, this work had the object of evaluating, under users point of view, the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect. To achieve this, questionnaires were given to users in their homes, considering the censitary sector. Nine sectors of the urban zone were evaluated, selected by chance, and one from the rural zone, selected by convenience. The sample was composed by 194 users, calculated considering the estimated prevalence of event represented by the indicator I ve never been to the dentist + I ve been to the dentist more than three years ago from the Projeto SB Brasil Report . To complement the results, interviews were made with others actors involved in the process of oral health care: professionals (dentists) and manager (Health Municipal Secretary). From the data obtained it was possible to identify that 12,9% of the population had never visited the dentist, and that the search for the service was not influenced by the users individual and socioeconomics characteristics, excepting the gender. It was verified that 36,1% of the users went to the dentist in less than one year, with the youngests (p<0,05) being among those who went to the dentist more frequently. 63,3% of the interviewed related that they found some kind of difficulty when they search for dentistry services, with the difficulties for schedule, the queues and the long wait among the most cited. It was identified that 43,2% of the users wait three weeks or more for the appointment. It is still pointed out that 71,4% of the interviewed find difficulties to get urgency appointment, the long wait to be attended by the dentist was the most found. 92,9% and 94,1% of the interviewed had never been headed to especialized appointments and complementary exams, respectively. Due to the data founded, it was possible to verify that the accessibility to oral health services in Santa Cruz (RN) is damaged by factors related to the organization of public polices developed, mainly in relation to the working process

Avaliação da saúde bucal na atenção básica: a perspectiva do usuário

Nowadays, the basic attention in health works according to the Health Family Program (HFP), which is responsible for the organization of the health services with view to provide an appropriate attendance to the needs of the population. Its expansion is expressive in whole country and, the oral health, included in this process, has been seen as a possibility of change the health practices centered in the disease. In face of this perspective, the proposal of study is to discover possible changes in the health care model of oral health in a district, made possible through the perception, evaluation and degree of satisfaction of the user s health service. To reach such objectives, the district of Macaíba in the State of Rio Grande do Norte, was chosen for operational subjects, such as time of implantation of HFP and great covering of this program. The current research used interviews structured with objectives and subjectives questions and questionnaires of socioeconomic characterization addressed to two hundred and seventy (270) individuals (ninety users of an Urban PSF, ninety of a Rural PSF and ninety of an unit non PSF). The analysis of the data was accomplished through the software SPSS/99, that made possible a statistical and analytic appreciation. The HFP units and non HFP units has shown to sort the common odontology problems of the community, and this didn't establish a direct relationship with the general satisfaction. On the other hands, the programmed consultation is related with lager satisfaction of the users. The access form to the odontology treatment of the Units, the satisfaction with the attendance rendered by the dentist and the equip, enough dentists for the community and the social class of the user were decisive for the general satisfaction with the service of oral health. On the other hand, variables as age and education, resolution of the problem and physical conditions of the unit didn't influence the general satisfaction. In spite of the progresses in the implantation of the oral health in ESF, preventive activities, visits at home, access and social participation still reproduce the traditional model of attendance, showing a primary change process

Avaliação clínica longitudinal do periodonto de dentes pilares e não pilares de próteses parciais removíveis

The literature has shown a relation between periodontics and the removable partial denture (RPD), with progressive destruction observed in the support structures. The aim of this study was to clinically assess periodontal condition in users of removal partial denture (RPD), and compare right abutments teeth, indirect abutments and controls before installation and after 1 year, in addition to comparing tooth-supported and tooth mucosa-supported abutments. A total of 50 patients, 32 women and 18 men, mean age of 45 years, took part in the study. The patients were examined by a single examiner at prosthesis installation and after 3, 6, 9 and 12 months. The following were verified at each examination: Probe Depth (PD), Plaque Index (PI), Gingival Index (GI), the amount of Keratinized Mucosa (KM), Gingival Recession (GR) and Dental Mobility (DM); in addition patients received oral hygiene orientation, accompanied by prophylaxis, periodontal scaling and root planing (PSRP), when necessary. Analysis of Variance (ANOVA) with Tukey-Kramer post test was used to assess the dependent variables (PD, PI, KM, GR) of the three groups over time while Friedman s test was used for GI. To assess the outcomes of prosthesis type in the right abutment group, a confidence interval-based analysis was performed. The results showed that the control group was the least compromised in all the variables studied. With respect to development of the groups over time, it was verified that the measures for GR, PD, GI and KM increased from initial examination to 1 year of use in all the groups, but only PI showed a significant increase. There was a non-discriminatory low prevalence of dental mobility. The tooth mucosa-supported prosthesis had significantly higher values for GR, GI and PI and significantly lower ones for KM when compared to tooth-supported. Over time, both types of prostheses showed no significant differences from initial to final examination for the variables GR, PD, KM and GI, with PI significant only for tooth-supported. The results showed that the teeth most involved in RPD design had greater potential of periodontal damage, probably because of greater dental biofilm accumulation. Abutments elements adjacent to the free extremities had less favorable periodontal condition than those adjacent to interpolated spaces, but the use of RPD did not worsen the initial condition

Avaliação dos níveis de proteína C-reativa ultra-sensível em pacientes com periodontite crônica severa generalizada e sem periodontite

INTRODUCTION: The high sensitivity C-reactive protein (hsCRP) constitutes an inflammatory mediator used as predictor of cardiovascular risk that comes being researched as indicative relation factor between cardiovascular and periodontal diseases. PROPOSITION: To compare serumals levels of C-reactive protein between patients with and without generalized severe chronic periodontitis. METHODOLOGY: A seccional study was realized using a sample with 62 patients, being 31 participants carriers of periodontal diseases (Group I) and 31 without periodontal diseases (Group II), grouped to the pairs by age and sex. As inclusion criterio were selected patients with diagnosis of generalized severe chronic periodontitis, being preculeds, individuals which presented systemic disease, recent infection history, historical of CVA or stroke, smokers, pregnants and lactants. The research consisted of two stages, a clinc and other biochemist. The clinical stage is constituted of periodontal examination and the biochemist stage, of the peripheral blood collection for determination hsCRP levels and a hemogram to inquire any panel which could suggest infectious and/or inflammatory process. RESULTS: Periodontal disease group presented a average of 0,36mg/dL, while the group without disease presented 0,17 mg/dL, do not existing significant difference statistically between the averages (p = 0,061). The cardiovascular risk for the group I was classified high for 27,6% of participants and low for 72,4% of them. In the group II, 6,45% presented high risk e 93,5% low risk, being this significant relation statistically gotten for Fisher s Test (p = 0,042) presenting OR = 5,33; IC = 95% (1,02 27,4). The independets variables reseacred do not presented significant association statistically with the levels of hsCRP. CONCLUSION: The study indicated that despite of carriers patients of periodontal diseases do not present differents serumals levels of hsCRP from the other group, the periodontal disease was considered as risk factor for hsCRP plasmatic levels elevation

Avaliação clínica e microbiológica da mucosa oral de crianças com leucemia linfoblástica aguda, submetidas à ação profilática do gluconato de clorexidina A 0,12%

Regarding the morbidity potential of oral complications in patients with leukemia, it evaluated the clínical and microbiologic changes of oral mucosal in children with LLA, with age range of O to 15 years old, undergone the chemotherapy antineoplastic and for the use prophylactic of chlorhexidine gluconate 0,12% during ten days, that was utilized in each chemotherapy treatment stage. The collect for rnicrobiological study was obtained preferentiality in intensification stage at the end prophylatic treatment. The study grouup had 20 children, where it observed clinically decrease in frequency of mucositis, with 8 cases (40%) only. In microbiological examination observed one reduced incidence of pathogenic microorganisms with Staphylococcus coagulase- negative (40%), Klebsiella pneumoniae (5%), Escherichia coZi enteropathogenic (15%), Stenotrophomonas maltophilia (5%) e Candida albicans (35%). The findings obtained in the present trial suggest that the use of chlorhexidine gluconate 0,12% can be responsible for incidence reduced of mucositis, but it wasn t possible to make correlation between isolated pathogenic microorganisms and mucositis development

Avaliação de alterações orais em pacientes submetidos a transplante de medula óssea

Bone marrow transplantation (BMT) is currently the best therapeutic option for patients with hematologic diseases, solid tumors or autoimmune disorders. It is characterized by intravenous infusion of hematopoietic stem cells in order to restore marrow function. However, this procedure requires concomitant immunosuppression treatment, which favors the development of certain complications, often manifested in the oral cavity. This study aimed to evaluate the incidence of oral changes in patients undergoing BMT and to correlate these results with clinical aspects related to the patients and the transplants performed. This is a prevalence study, with cross-sectional design, carried out in a BMT service at the Institute of Onco-Hematology of Natal (ION) and Natal Hospital Center. Data collection was based on questionnaires, clinical examination of the oral cavity and consultation in the medical records. The sample consisted of 51 patients undergoing BMT. After the analysis, was found a general status with good health conditions and presence of oral changes in about half of patients who composed the sample. The manifestations observed were, in decreasing order of frequency: mucositis; gingival alteration and thrombocytopenic purpura; mucosal pigmentation; lichenoid reaction and candidiasis. The oral changes were observed more frequently in cases of allogeneic TMO, in different periods post-transplant, without significant differences related to the source of cells. It was found statistically significant association between the presence of graft-versus-host disease (GVHD) and oral changes (p < 0,001). Therefore, it is concluded that there is a relatively high incidence of changes in oral cavity of patients receiving bone marrow transplantation, a fact which confirms the need to consider this site for examination, diagnosis, treatment and prognosis of possible complications of BMT

Avaliação imuno-histoquímica das galectinas -1, -3 e -7 em displasia epitelial ora

Introdução: A displasia epitelial oral (DEO) é uma lesão potencialmente maligna, cujo diagnóstico e gradação se baseia na histologia das alterações arquiteturais e citológicas, preconizados pela OMS, que divide a lesão em leve, moderada e severa, o qual é subjetivo. Maior concordância é observada no uso do sistema binário (baixo/alto risco), o qual está relacionado ao risco de transformação maligna. As galectinas constituem uma família de lectinas e estão envolvidas na tumorigênese, sendo a -1, -3 e -7 as mais investigadas, devido a expressão alterada em cânceres orais. Materiais e métodos: Foi analisada a expressão imuno-histoquímica dessas proteínas em 50 espécimes de DEO (21 baixo/ 29 alto risco) e 5 de mucosa oral normal e relacionamos com a presença/ausência de marcação, padrão de distribuição, intensidade, localização epitelial (estratificação) (1/3 inferior, médio e superior), e localização celular (compartimento) (núcleo, citoplasma e membrana) . Resultados: Dos 29 casos de alto e dos 21 de baixo risco, 21 (72,4%) e 12 (57,1%) foram positivos para a galectina -1, respectivamente. Dessa forma, de 50 casos, 33 foram positivos. O núcleo e citoplasma foram positivos em 91,7% nas de baixo risco e em 90,5% nas de alto. Todos os casos de mucosa normal foram negativos. Com relação a galectina -3, dos 21 casos das DEOs de baixo risco, 12 (57,1%) apresentaram expressão e dos 29 casos das DEOs de alto risco, 15 (51,7%) foram positivos, havendo imunoexpressão em um total de 27 casos. O padrão difuso, assim como a fraca intensidade foram os mais freqüentes para os 2 graus. O núcleo e o citoplasma foram a localização mais comum tanto nas lesões de baixo (58,3%), quanto nas de alto risco (66,7%). Quatro casos de mucosa normal foram positivos, com marcação membranar e intensidade fraca. Dos 21 casos das DEOs de baixo risco, 17 (81%) apresentaram expressão imuno-histoquímica para a galectina -7 e das 29 DEOs de alto risco, 27 (93,1%) foram positivos. Então, a expressão imuno-histoquímica da galectina -7 foi observada em 44 casos, a maioria com intensidade de moderada a forte. O núcleo e o citoplasma foram a localização mais freqüente, nas de baixo (70,6%) e alto risco (66,7%). Quatro espécimes de mucosa normal marcaram membrana em terço médio e superior, com intensidade moderada a forte. Conclusões: Alterações na expressão das galectinas -3 e -7 e principalmente da -1 sugerem seu envolvimento na fisiopatologia das displasias, participando do processo de transformação de fenótipo normal para o displásico.