Tragedy on grade crossing: driver failure or systemic fragility?

In 2010, an accident occurred in Americana-SP, Brazil, involving two trains and one bus on a Grade Crossing, when 10 people died and 17 were injured including workers. This paper aims to analyze the accident using the Model of Analysis and Prevention of Work Accidents (MAPA). The method provides observation of work, interviews and analysis of documents to understand precedents of the event in the following stages: to understand the usual work from the involved people, the changes occurred in the system, the operation of barriers, managerial and organizational aspects. By the end, measures are suggested to avoid new occurrences. The accident took place at night in a site with insufficient lighting. The working conditions of bus drivers, train operators and watchmen are inadequate. There were only symbolic barriers (visual and acoustic signals) triggered manually by watchman upon train operator radio communication. The fragility of the barrier system associated to poor lighting and short time to trigger the signaling seem to play a critical role in the event. Contrary to the official report which resulted in guilt of the bus driver, the conclusion of the paper emphasizes the fragility of the safety system and the need of level crossing reproject.

Characterization of the motor performance in infants with a diagnosis of Cerebral Palsy in process of rehabilitation: the importance of the proactivity of caregivers

Introduction: The progress in technology, associated to the high survival rate in premature newborn infants in neonatal intensive care units, causes an increase in morbidity. Individuals with CP present complex motor alterations, with primary deficits of abnormal muscle tone affecting posture and voluntary movement, alteration of balance and coordination, decrease of force, and loss of selective motor control with secondary problems of contractures and bone deformities.Objective: The aim of this work is to describe the spontaneous movement and strategies that lead infants with cerebral palsy to move.Methods: Seven infants used to receive assistance at the Essential Stimulation Center of CIAM (Israeli Center for Multidisciplinary Support - Philanthropic Institution), with ages ranging between six and 18 months with diagnosis of Cerebral Palsy (CP) were assessed.Results: The results show the difficulty presented by the infants with respect to the spontaneous motor functions and the necessity of help from the caregiver in order to perform the functional activity (mobility). Prematurity prevails as the major risk factor among the complications.Conclusion: The child development can be understood as a product of the dynamic interactions involving the infant, the family, and the context. Thus, the social interactions and family environment in which the infant live may encourage or limit both the acquisition of skills and the functional independence.

Rehabilitation of Atrophic Maxilla Using the Combination of Autogenous and Allogeneic Bone Grafts Followed by Protocol-Type Prosthesis

Currently, there are several techniques for the rehabilitation of atrophic maxillary ridges in literature. The grafting procedure using autogenous bone is considered ideal by many researchers, as it shows osteogenic capability and causes no antigenic reaction. However, this type of bone graft has some shortcomings, mainly the restricted availability of donor sites. In recent years, several alternatives have been investigated to supply the disadvantages of autogenous bone grafts. In such studies, allogeneic bone grafts, which are obtained from individuals with different genetic load, but from the same species, have been extensively used. They can be indicated in cases of arthroplasty, surgical knee reconstruction, large bone defects, and in oral and maxillofacial reconstruction. Besides showing great applicability and biocompatibility, this type of bone is available in unlimited quantities. on the other hand, allogeneic bone may have the disadvantage of transmitting infectious diseases. Atrophic maxillae can be treated with bone grafts followed by osseointegrated implants to obtain aesthetic and functional oral rehabilitation. This study aimed to show the viability of allogeneic bone grafting in an atrophic maxilla, followed by oral rehabilitation with dental implant and protocol-type prosthesis within a 3-year follow-up period by means of a clinical case report.

Anterior Tooth Rehabilitation With Frozen Homogenous Bone Graft and Immediately Loaded Titanium Implant Using Computer-Guided Surgery

Computed tomographic scanning is a precise, noinvasive surveying technique that enables the professionals to improve the precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of anterior tooth rehabilitation with frozen homogenous bone graft and immediately loaded titanium implant using computer-guided surgery. A multislice computed tomography was realized, and a prototype was built. All the procedures were previously realized in the prototype before started in the patient. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.

Patients' Satisfaction After Surgical Facial Reconstruction or After Rehabilitation With Maxillofacial Prosthesis

The matching of the aesthetic, functional, and psychosocial results of a facial deformity may produce devastating effects in its carriers, especially if the lesion is extensive or the treatment is aggressive. Because of this, the objective of the present article was to evaluate patient's satisfaction rating after surgical facial reconstruction or rehabilitation with oral and maxillofacial prosthesis, by means of reviewing the literature.

Rehabilitation with ear prosthesis linked to osseointegrated implants

Background: The absence of an ear, which can be the result of a congenital malformation, surgical tumour resection or traumatic injury, is a significant aesthetic problem. Attachment of ear prostheses with adhesives can cause local irritation for the wearer and affect the colour of the prostheses. Use of implants in craniofacial reconstruction can improve the retention and stability of prostheses giving to patient greater comfort and security relative to adhesive attachment.Objective: The aim of this report was to present a clinical case of a mutilated patient who was rehabilitated by means of installing an ear prosthesis fixed through osseointegrated implants.Materials and methods: The patient had two implants installed in the mastoid region that were linked by a bar, and a clip-type system was used. The ear prosthesis was constructed from medical-use silicone, pigmented to match the patient's skin colour and linked to the retention system.Conclusion: The patient's rehabilitation was satisfactory from both a functional and an aesthetic point of view, making it possible for the patient to return to a normal social life and regain lost self-esteem.

Oral Rehabilitation After Surgical Removal of Pleomorphic Adenoma

Although tumors of minor salivary glands are rare, the pleomorphic adenoma is the most common pathology among the benign neoplasm and can be found with high prevalence in the junction between hard palate and soft palate. The treatment of choice for most of maxillary tumors is surgical through either a total or partial maxillectomy. However, surgical defects caused by such type of treatment lead to both clinical and psychologic disorders for the patient. The immediate oral rehabilitation using interim palate obturator after maxillectomy provides optimization on the healing process, recovers the stomatognathic functions after surgery, and avoids psychosocial sequelae for the patients. This clinical report aimed to present the rehabilitation with immediate palate obturator of a patient who underwent a partial maxillectomy due to a hard palate pleomorphic adenoma of minor salivary glands. We report the clinical importance of the prosthetic rehabilitation and the improvements on both quality of life and stomatognathic functions of this patient. It can be concluded that the immediate rehabilitation of the patient after partial maxillectomy by using an interim palate obturator was a great option and provided clinical benefits in the immediate postoperative period, improving the patient's quality of life, allowing the patient's reinsertion into society, and reducing the surgical treatment sequelae.

Obturator for Rehabilitation of Cleft Palate With Implant-Supported Retention System

Objective: Surgical reconstruction and prosthetic obturation are alternatives for the treatment of cleft in the soft palate.Design: The present case reports the rehabilitation of a patient presenting cleft palate with obturator prosthesis associated with implant-supported retention system.Conclusions: The use of ball attachment system improved speech, masticatory efficiency, swallowing, and social behavior of the patient.

Postsurgical Care for Rehabilitation With Implant-Retained Extraoral Prostheses

The health of a peri-implant tissue is a critical factor for the long-term success of treatment with extraoral implants. However, infection and inflammation may occur and lead to implant loss and prostheses failure. Therefore, some postsurgical care as hygiene with soap and water, soft toothbrush, and Superfloss type dental floss and medication with anti-inflammatory and antibiotic are suggested to avoid complications. In addition, a thin and smooth layer of subcutaneous tissue in the peri-implant area should be preserved during implant insertion to favor the assistance recommended in this phase.

Oral rehabilitation of severely worn dentition using an overlay for immediate re-establishment of occlusal vertical dimension

The aim of this study was to describe the treatment used in an elderly patient presenting with bruxism and dental erosion, with good gingival health and bone support, but with decreased occlusal vertical dimension (OVD). The oral rehabilitation of elderly patients presenting with bruxism in association with tooth erosion has been a great challenge for dentists. The loss of OVD, the presence of occlusal instability and the absence of an effective anterior guide due excessive dental wear, can damage stomatognathic system (SS) biology, the function and the aesthetics. In the first treatment stage, an overlay removable partial denture (ORPD) was fabricated for the immediate re-establishment of function and aesthetics. After a 2-month follow up, with the patient presenting no symptoms, a second rehabilitation stage was accomplished, with fixed and removable prostheses. Oral rehabilitation with an ORPD was able to re-establish the SS biology, but a correct diagnosis and treatment plan are essential for success. The ORPD is a non-invasive and reversible restoring modality for general dentists that allow the re-establishment of the patient's immediate aesthetics and function at low cost.

Photoelastic Analysis of Stress Distribution in Oral Rehabilitation

The purpose of this study was to present a literature review about photoelasticity, a laboratory method for evaluation of implants prosthesis behavior. Fixed or removable prostheses function as levers on supporting teeth, allowing forces to cause tooth movement if not carefully planned. Hence, during treatment planning, the dentist must be aware of the biomechanics involved and prevent movement of supporting teeth, decreasing lever-type forces generated by these prosthesis. Photoelastic analysis has great applicability in restorative dentistry as it allows prediction and minimization of biomechanical critical points through modifications in treatment planning.

Craniofacial Implants Success in Facial Rehabilitation

The use of craniofacial implants is an effective treatment for patients with deformities, burns, and cancer sequelae. The sites with the most successful implants are the auricular, nasal, and orbital regions. Furthermore, other factors can affect the implant longevity such as irradiated area, surgical technique, bone quality and quantity, macrostructure and microstructure of the implant, maintenance, and systemic factors.

Surgical and Prosthetic Rehabilitation of Patients With Hemimandibular Defect

Purpose: This work intended to investigate, by means of a literature revision, the techniques and materials used for the rehabilitation of hemimandibular defect patients, prosthetic and occlusal aspects of these patients, and chewing and swallowing.Materials and Methods: For the confection of this revision, we consulted the database indexers Google Scholar, PubMed, and SciELO and found studies published between the periods 1972 and 2008. The terms used for the search had been "to hemimandibular defects," "to temporomandibular joint protheses," and "vascularized cap grafts," which had been searched separately and combined.Conclusions: Diverse techniques and materials used for the reconstruction of hemimandibular defects exist; however, great bone resorption is still observed, which will compromise the prosthetic rehabilitation of these patients. More prospective works and stories of clinical cases duly registered will be able to elucidate in a clearer form the anatomic and functional devolutions of the verbal socket of hemimandibular defect patients.

Use of a Tooth-Implant Supported Bone Distractor in Oral Rehabilitation: Description of a Personalized Technique

Osteodistraction is a clinical reality available for the resolution of bone deficiencies before dental implant placement or in cases where the existing implants are at the wrong position. The objective of this study is to suggest a new possibility for bone distraction, based on tooth-implant bone distractors, in areas were there is the need for extensive alveolar bone recovery, with installed dental implants. This technique presented good results associated with its simplicity and low cost, making it a viable clinical solution for bone tissue augmentation. Although its use is recent, the suggested technique shows the potential to become used widely in attempts to achieve bone-height augmentation, primarily when dental implants are installed and osteointegrated already. (C) 2008 American Association of Oral and Maxillofacial Surgeons