Efeito sinérgico entre a dexmedetomidina e a ropivacaína 0,75% na anestesia peridural

BACKGROUND. This study aimed to evaluate clinical characteristics of epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. METHODS. Forty patients scheduled for hernia repair or varicose vein surgeries under epidural anesthesia participated in this study. They were assigned to: Control Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg); and Dexmedetomidine Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg), plus dexmedetomidine, 1 μg.kg -1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, state of consciousness, hemodynamics, postoperative analgesia and incidence of side-effects. RESULTS. Epidural dexmedetomidine did not affect onset time or upper level of anesthesia (p > 0.05) however it prolonged sensory and motor block duration time (p < 0.05) and postoperative analgesia (p < 0.05), and also resulted in a more intense motor block, 1 (p < 0.05). Values of bispectral index were lower in Dexmedetomidine Group (p < 0.05). There was no difference in incidence of hypotension and bradycardia (p > 0.05). Occurrence of side-effects (shivering, vomiting and SpO 2 < 90%) was low and similar between groups (p > 0.05). CONCLUSION. There is clear synergism between epidural dexmedetomidine and ropivacaine, further this drug association does not bring about additional morbidity.

In vitro assessment of pulp chamber temperature of different teeth submitted to dental bleaching associated with LED/laser and halogen lamp appliances

This study sought to assess the pulp chamber temperature in different groups of human teeth that had been bleached using hydrogen peroxide gel activated with halogen lamps or hybrid LED/laser appliances. Four groups of ten teeth (maxillary central incisors, mandibular incisors, mandibular canines, and maxillary canines) were used. A digital thermometer with a K-type thermocouple was placed inside pulp chambers that had been filled with thermal paste. A 35% hydrogen peroxide-based red bleaching gel was applied to all teeth and photocured for a total of three minutes and 20 seconds (five activations of 40 seconds each), using light from an LED/laser device and a halogen lamp. The temperatures were gauged every 40 seconds and the data were analyzed by three-way ANOVA, followed by Tukey's test. Regardless of the light source, statistically significant differences were observed between the groups of teeth. The mean temperature values (±SD) were highest for maxillary central incisors and lowest for mandibular canines. The halogen lamp appliance produced more pulp chamber heating than the LED/laser appliance. The increase in irradiation time led to a significant increase in temperature.

In vitro evaluation of the effect of natural orange juices on dentin morphology

The patient's diet has been considered an important etiological factor of dentin hypersensitivity. The frequent ingestion of acidic substances can promote the loss of dental structure or remove the smear layer. The purpose of this study was to evaluate the degree of smear layer removal and dentinal tubules exposure by different natural orange juices. Extracted human teeth were submitted to manual scaling in order to develop the smear layer. Seventy dentin samples were obtained and distributed into the following groups: Control, lime orange, lime, valência orange, navel orange, mandarin, and tangerine. Each group included 2 methods of application: Topical and topical + friction. After preparation for SEM analysis, photomicrographs were assessed by a blind calibrated examiner using an index system. The Kruskal-Wallis test indicated a significant influence of the orange juices on smear layer removal. Significant difference was observed between navel orange, valência orange, mandarin and the control group (p < 0.05). These orange juices resulted in greater removal of the smear layer and greater opening of dentinal tubules. The comparison between the application methods for each group using the Mann-Whitney test showed that friction increased smear layer removal significantly only for lime orange and lime. The data suggest that certain natural orange juices are more effective in terms of smear layer removal and dentinal tubules exposure than others.

Microhardness assessment of different commercial brands of resin composites with different degrees of translucence

Owing to improvements in its mechanical properties and to the availability of shade and translucence resources, resin composite has become one of the most widely used restorative materials in present day Dentistry. The aim of this study was to assess the relation between the surface hardness of seven different commercial brands of resin composites (Charisma, Fill Magic, Master Fill, Natural Look, Opallis, Tetric Ceram, and Z250) and the different degrees of translucence (translucid, enamel and dentin). Vickers microhardness testing revealed significant differences among the groups. Z250 was the commercial brand that showed the best performance in the hardness test. When comparing the three groups assessed within the same brand, only Master Fill and Fill Magic presented statistically significant differences among all of the different translucencies. Natural Look was the only one that showed no significant difference among any of the three groups. Charisma, Opallis, Tetric Ceram and Z250 showed significant differences among some of the tested groups. Based on the results found in this study, it was not possible to establish a relation between translucence and the microhardness of the resin composites assessed. Depending on the material assessed, however, translucence variation did affect the microhardness values of the resin composites.

Comparison of resin push-out strength to root dentin of bovine- and human-teeth

Aim : To compare the push-out strength of bovine- and human-root dentin and, thus, evaluate the suitability of bovine-root dentin to substitute human-root dentin for bond strength testing. Materials and Methods : Ten single-rooted human-teeth and ten bovine incisors were prepared using a #3 bur of a fiber post system (12 mm long). The posts were duplicated with resin cement (Duolink). The root canals were treated with All Bond 2 adhesive system and the resin posts were cemented using Duolink. The specimens were cut perpendicular to their long axis, yielding disc-specimens with 1.5 mm thickness, which were submitted to a push-out test (1 mm/min). Ten bond strength values per group (n = 10) were used for statistical analysis (Student t test, a =.05). Results : Statistically significant differences were found for the bond strength values between bovine- (4.1 1.3 MPa) and human-root dentin (8.6 5.7 MPa) (P =.0001). Conclusion : The push-out strengths of bovine- and human-root dentin were statistically different.

Longitudinal bond strength evaluation using the deproteinized dentin technique

This study evaluated bond strength to dentin as a result of storage time for conventional adhesive systems (with or without collagen) that had been deproteinized with 10% sodium hypochlorite (NaOCl). For this study, 72 human molars were sectioned in a mesiodistal axial plane and embedded in acrylic resin; at that point, the vestibular and lingual surfaces were worn down with abrasive paper. Acid etching was performed for 15 seconds (using 37% phosphoric acid) and the specimens were divided into 12 groups (n = 6), depending on the adhesive system used, the dentin treatment performed, and the length of evaluation (24 hours or six months). A resin composite was inserted over the prepared area with the aid of a metal matrix. Following a mechanical shear test, fractured surfaces were analyzed by stereomicroscope and the data were submitted to ANOVA and Tukey's test. It was concluded that the dentin deproteinization treatment with 10% NaOCI improved the bond strength in five of the six groups. The bond strength after 24 hours was significantly higher than the bond strength measured after six months. Of the three adhesive systems tested in this study, DenTASTIC UNO demonstrated the lowest bond strength.

Effect of sodium bicarbonate on Candida albicans adherence to thermally activated acrylic resin

The purpose of this study was to evaluate the effect of 5% sodium bicarbonate on the adherence of Candida albicans to thermally activated acrylic resin. Fifty 4 mm specimens of acrylic resin were obtained using a metallic matrix. The specimens received chemical polishing, were sterilized and then immersed in Sabouraud broth, inoculated with Candida albicans standardized suspension. After 24 hours of incubation at 37°C, the specimens were divided into four groups according to the substance used for disinfection (5% sodium bicarbonate, 0.12% digluconate chlorhexidine, vinegar and Corega Tabs). A control group was included, in which distilled water was used. The adhered microorganisms were dispersed, diluted and plated onto culture media to determine the number of colony-forming units (cfu/mL). The results were analyzed through the Mann-Whitney statistical test at the 5% level of significance. Only 0.12% digluconate chlorhexidine and 5% sodium bicarbonate presented a statistically significant difference (p = 0.0010 and p = 0.0156, respectively) compared to the control group, decreasing the number of cfu/mL. However, when the different disinfecting solutions were compared with each other, only 0.12% digluconate chlorhexidine presented a statistically significant difference in the reduction of cfu/mL. It was concluded that although 0.12% digluconate chlorhexidine was more effective in the reduction of Candida albicans adherence values to thermally activated acrylic resin, 5% sodium bicarbonate also proved to be a viable alternative.

Electromyographic evaluation of the upper lip according to the breathing mode: A longitudinal study

The present study aimed at analyzing and comparing longitudinally the EMG (electromyographic activity) of the superior orbicularis oris muscle according to the breathing mode. The sample, 38 adolescents with Angle Class II Division 1 malocclusion with predominantly nose (PNB) or mouth (PMB) breathing, was evaluated at two different periods, with a two-year interval between them. For that purpose, a 16-channel electromyography machine was employed, which was properly calibrated in a PC equipped with an analogue-digital converter, with utilization of surface, passive and bipolar electrodes. The RMS data (root mean square) were collected at rest and in 12 movements and normalized according to time and amplitude, by the peak value of EMG, in order to allow comparisons between subjects and between periods. Comparison of the muscle function of PNB and PMB subjects at period 1 (P1), period 2 (P2) and the variation between periods (Δ) did not reveal statistically significant differences between groups (p < 0.05). However, longitudinal evaluation of the muscle function in PNB and PMB subjects demonstrated different evolutions in the percentage of required EMG for accomplishment of the movements investigated. It was possible to conclude that there are differences in the percentage of electric activity of the upper lip with the growth of the subjects according to the breathing mode.

Immunohistochemical, tomographic and histological study on onlay bone graft remodeling. Part II: Calvarial bone

Objectives: Little information is available on the molecular events that occur during graft incorporation over time. The calvarial bone (Cb) grafts have been reported to produce greater responses compared with other donor regions in maxillofacial reconstructions, but the scientific evidences for this are still lacking. The objectives of this study are (1) to study the morphological pattern of Cb onlay bone grafts and compare them with the biological events through immunohistochemical responses and (2) to establish the effects of perforations in maintaining the volume and bone density of the receptor bed. Material and methods: Sixty New Zealand White rabbits were submitted to Cb onlay bone grafts on the mandible. In 30 rabbits, the receptor bed was perforated (perforated group), while for the remaining animals the bed was kept intact (non-perforated group). Six animals from each group were sacrificed at 5, 7, 10, 20 and 60 days after surgery. Histological sections from the grafted area were prepared for immunohistochemical and histological analyses. Immuno-labeling was found for proteins Osteoprotegerin (OPG), receptor activator of nuclear factor-κβ ligand (RANKL), alkaline phosphatase (ALP), osteopontin (OPN), vascular endothelial growth factor (VEGF), tartrate-resistant acid phosphatase (TRAP), Type I collagen (COL I) and osteocalcin (OC). The tomography examination [computerized tomography (CT) scan] was conducted just after surgery and at the sacrifice. Results: The histological findings revealed that the perforations contributed to higher bone deposition during the initial stages at the graft-receptor bed interface, accelerating the graft incorporation process. The results of the CT scan showed lower resorption for the perforated group (P≤0.05), and both groups showed high bone density rates at 60 days. This set of evidences is corroborated by the immunohistochemical outcomes indicating that proteins associated with revascularization and osteogenesis (VEGF, OPN, TRAP and ALP) were found in higher levels in the perforated group. Conclusions: These findings indicate that the bone volume of calvarial grafts is better maintained when the receptor bed is perforated, probably resulting from more effective graft revascularization and greater bone deposition. The process of bone resorption peaked between 20 and 60 days post-operatively in both groups although significantly less in the perforated group. © 2009 John Wiley & Sons A/S.

Periapical repair after root canal filling with different root canal sealers

The aim of this study was to evaluate periapical repair after root canal filling with different endodontic sealers. Sixty four root canals from dog ́s teeth were filled, divided into 4 groups (n=16). Root canals were instrumented with K-type files and irrigated with 1% sodium hypochlorite solution. Root canals were filled in the same session by active lateral condensation of the cones and sealers: Intrafill, AH Plus, Roeko Seal and Resilon/Epiphany System. After 90 days, the animals were euthanized and the tissues to be evaluated were processed and stained with hematoxylin and eosin. For histopathological analysis, the following parameters were evaluated: inflammatory process, mineralized tissue resorption, and apical mineralized tissue deposition. Histopathological analysis demonstrated that Intrafill had less favorable results in terms of apical and periapical repair, compared to the other sealers (p<0.05). AH Plus, Roeko Seal, and Epiphany sealers had similar and satisfactory results (p>0.05). In conclusion, AH Plus and the materials Roeko Seal and Epiphany are good options for clinical use in Endodontics.

Influence of preventive dental treatment on mutans streptococci counts in patients undergoing head and neck radiotherapy

The aim of this study was to evaluate the influence of chlorhexidine gluconate, sodium fluoride and sodium iodine on mutans streptococci counts in saliva of irradiated patients. Forty-five patients were separated into three experimental groups and received chlorhexidine (0.12%), sodium fluoride (0.5%) or sodium iodine (2%), which were used daily during radiotherapy and for 6 months after the conclusion of the treatment. In addition, a fourth group, composed by 15 additional oncologic patients, who did not receive the mouthwash or initial dental treatment, constituted the control group. Clinical evaluations were performed in the first visit to dental clinic, after initial dental treatment, immediately before radiotherapy, after radiotherapy and 30, 60, 90 days and 6 months after the conclusion of radiotherapy. After clinical examinations, samples of saliva were inoculated on SB20 selective agar and incubated under anaerobiosis, at 37oC for 48 h. Total mutans streptococci counts were also evaluated by using real-time PCR, through TaqMan system, with specific primers and probes for S. mutans and S. sobrinus. All preventive protocols were able to reduce significantly mutans streptococci counts, but chlorhexidine gluconate was the most effective, and induced a significant amelioration of radiotherapy side effects, such as mucositis and candidosis. These results highlights the importance of the initial dental treatment for patients who will be subjected to radiotherapy for head and neck cancer treatment.

A randomized and controlled trial about the use of oral isotretinoin for photoaging

Topical retinoids are used to treat photoaging; oral isotretinoin is gold standard for acne; off label indications, including photoaging, have been reported with insufficient evidence of efficacy. This is a randomized controlled phase II trial with clinical and histological assessment to evaluate efficacy and safety of oral isotretinoin for photoaging. Study population was comprised of 32 menopausal or sterilized women, aged 40-55, divided in 2 groups: A (21) received 20mg isotretinoin, 3 times per week, nightly moisturizer, and daily sunscreen, for three months; B (11) just moisturizer/sunscreen. Main outcome measures were: overall clinical assessment; profilometry, corneometer and elasticity tests in periocular regions and left forearm; before/after biopsies from left forearm in patients of B and in 10 randomly selected of A. Microscopic blinded evaluation of epidermal thickness, dermal elastosis, new collagen, p53 epidermal expression was performed by quantitative digital image analysis. All data were submitted to statistical analysis. Clinical evaluation showed slight improvement; profilometry, corneometer and skin elasticity tests presented significant difference in pre/post values (P = 0.001 to 0.028), but no differences between A/B. Histological findings and p53 expression were comparable between groups before treatment (P > 0.1); microscopic analysis showed no differences between groups for most variables, after treatment. Slight but significant difference between A/B for p53 with major reduction post isotretinoin [0.66±0.31 vs. 0.94±0.34 respectively (P = 0.04) was observed. There were minor side effects and no significant laboratory test alterations. We concluded that no significant clinical, microscopic changes but p53 epidermal expression reduction were observed. The role of ultra-violet induced p53 mutation in skin carcinogenesis reinforces retinoids chemoprevention. Oral isotretinoin seemed safe but not effective to treat photoaging. Caution should be considered for women prone to pregnancy. Further controlled studies are necessary. © 2010 The International Society of Dermatology.

In vitro evaluation of the effect of dietary acids and toothbrushing on human root dentin permeability

OBJECTIVES: The purpose of this in vitro study was to quantify the alterations in human root dentin permeability after exposure to dietary acids and to evaluate the effect of toothbrushing after acid application. METHOD AND MATERIALS: Extracted human third molars had their crowns sectioned above the CEJ, pulp tissue removed, and cervical root dentin exposed using a high-speed bur (approximately 1 mm in depth of substance loss). From each root fragment, one specimen was prepared. A total of 25 specimens were used and distributed randomly into five groups. The specimens were attached to a hydraulic pressure apparatus to evaluate the alterations of root dentin permeability after exposure to different acids. Dentin permeability was measured after the following sequential steps: (1) treatment with EDTA for 3 minutes to obtain the maximum permeability; (2) root planing to create a smear layer; (3) exposure to different acidic substances for 5 minutes (vinegar, cola drink, lemon juice, white wine, and orange juice); and (4) brushing for 3 minutes. RESULTS: All acidic substances increased dentin permeability after root planing. Lemon juice produced higher values for permeability when compared to the other substances (P = .009); moreover, orange juice showed similar results (P < .02) except when compared to vinegar (P = .12). Brushing right after acid exposure significantly reduced dentin permeability except in the vinegar group (P = .07). CONCLUSION: Under the experimental conditions, dietary acids increased root dentin permeability, and immediate brushing reduced permeability levels.

The use of surface electromyography for the study of auricular acupuncture

The advancement of knowledge in neurophysiology has demonstrated that acupuncture is a method of peripheral neural stimulation that promotes local and systemic reflexive responses. The purpose of this study was to determine if surface electromyography can be used as a tool to study the action of auricular acupuncture on striated skeletal muscle. The electromyographic amplitudes of the anterior, middle and posterior deltoid muscle and the upper trapezium muscle with 20%, 40% and 60% of maximal voluntary contraction of 15 healthy volunteers, were analyzed after the individuals were submitted to the auricular acupuncture treatment. The non-parametric Friedman test was used to compare Root Mean Square values estimated by using a 200 ms moving window. Significant results were further analyzed using the Wilcoxon signed rank test. In this exploratory study, the level of significance of each comparison was set to p < 0.05. It was concluded in this study that a surface electromyography can be used as a tool to investigate possible alterations of electrical activity in muscles after auricular acupuncture. However there is still a lack of adequate methodology for its use in this type of study, being that the method used to record the electromyographic signal can also influence the results. © 2008 Elsevier Ltd. All rights reserved.

Effect of toothbrushing with different manual toothbrushes on the shear bond strength of orthodontic brackets

The aim of this study was to evaluate the effect of brushing with a Colgate 360° or Oral B Indicator 35 toothbrush on the shear bond strength of orthodontic brackets bonded to extracted human teeth. The bristle wear and bristle tip morphology were also examined after simulated tooth-brushing. Orthodontic brackets (Roth-P/1 st and 2 nd pre-molar S/D- Slot 0.18) were bonded (Transbond XT ®) to the smoothest surface of each of 45 extracted human molar and premolar teeth. Test specimens were randomly divided into three groups: Group 1, control group with no brushing; Group 2, brushing with the Oral B Indicator 35; Group 3, brushing with the Colgate 360°. Samples were adapted to a machine that simulated tooth-brushing. The bond strength of each bracket to each tooth was assessed with a mechanical testing machine. The bristle wear and bristle tip morphology indices were also assessed. Statistically significant differences were defined for p ≤ 0.05. The average bond strengths (range: 90.18-90.89 kgf/cm 2) did not differ among the three groups. The Colgate 360° showed less bristle wear and a better bristle tip morphology than the Oral B Indicator 35 toothbrush. However, use of either toothbrush did not decrease the bond strength of the orthodontic brackets. Therefore, patients undergoing orthodontic therapy can safely use either toothbrush.