Inter-relação entre lesão cervical não cariosa e comprometimento periodontal: diagnóstico, tratamento e previsibilidade - estudo clínico prospectivo e laboratorial

The coexistence of gingival recession (GR) with root coverage indication and non-carious cervical lesions (LCNC) generates the need for a protocol that respects and promotes health of dental and periodontal tissues and allows treatment predictability. The main objectives of this theses were: (1) verify, through clinical evaluations, the connective tissue graft for root coverage on direct and indirect restorations made of ceramic resin; (2) analyze the influence of the battery level of the LED curing unit in the composite resin characteristics; (3) assess the influence of restorative materials, composite resin and ceramics, on the viability of gingival fibroblasts from primary culture. Nine patients with good oral hygiene and occlusal stability diagnosed with LCNCs the anterior teeth including premolars associated with gingival recession (class I and II of Miller) and only gingival recession were selected. After initial clinical examination, occlusal adjustment was performed and the patients had their teeth randomized allocated on direct composite resin restoration of LCNC, polishing and GR treatment with connective tissue graft and advanced coronally flap CR group (n = 15); and indirect ceramic restoration of the LCNC's and GR treatment (CTG+CAF) Group C (n = 15). The GR presented teeth with no clinically formed LCNCs cavity were treated using (CTG+CAF) being the control group (n = 15). Sorption and solubility tests, analysis of the degree of conversion and diametral tensile strength were performed in composite resin samples (n = 10) photoactivated by 100, 50 and 10% battery charge LED unit. The viability of fibroblasts on composite resin, ceramics and dentin disks (n = 3) was examined. Clinical follow-up was performed for three months. The data obtained at different stages were tabulated and subjected to analysis for detection of normal distribution and homogeneity. The results showed that: the LED unit with 10% battery affects the characteristics of the composite resin; restorative materials present biocompatibility with gingival fibroblasts; and the association of surgical and restorative treatment of teeth affected by NCCL and GR presents successful results at 3-month follow-up.

Avaliação comparativa da remodelação óssea periimplantar em implantes com junção cone-morse e hexágono externo: estudo clínico randomizado controlado, duplo cego, boca dividida

Background: Several theories, such as the biological width formation, the inflammatory reactions due to the implant-abutment microgap contamination, and the periimplant stress/strain concentration causing bone microdamage accumulation, have been suggested to explain early periimplant bone loss. However, it is yet not well understood to which extent the implant-abutment connection type may influence the remodeling process around dental implants. Aim: to evaluate clinical, bacteriological, and biomechanical parameters related to periimplant bone loss at the crestal region, comparing external hexagon (EH) and Morse-taper (MT) connections. Materials and methods: Twelve patients with totally edentulous mandibles received four custom made Ø 3.8 x 13 mm implants in the interforaminal region of the mandible, with the same design, but different prosthetic connections (two of them EH or MT, randomly placed based on a split-mouth design), and a immediate implant- supported prosthesis. Clinical parameters (periimplant probing pocket depth, modified gingival index and mucosal thickness) were evaluated at 6 sites around the implants, at a 12 month follow-up. The distance from the top of the implant to the first bone-to-implant contact – IT-FBIC was evaluated on standardized digital peri-apical radiographs acquired at 1, 3, 6 and 12 months follow-up. Samples of the subgingival microbiota were collected 1, 3 and 6 months after implant loading. DNA were extracted and used for the quantification of Tanerella forsythia, Porphyromonas gingivalis, Aggragatibacter actinomycetemcomitans, Prevotella intermedia and Fusobacterium nucleatum. Comparison among multiple periods of observation were performed using repeated-measures Analysis of Variance (ANOVA), followed by a Tukey post-hoc test, while two-period based comparisons were made using paired t- test. Further, 36 computer-tomographic based finite element (FE) models were accomplished, simulating each patient in 3 loading conditions. The results for the peak EQV strain in periimplant bone were interpreted by means of a general linear model (ANOVA). Results: The variation in periimplant bone loss assessed by means of radiographs was significantly different between the connection types (P<0.001). Mean IT-FBIC was 1.17±0.44 mm for EH, and 0.17±0.54 mm for MT, considering all evaluated time periods. All clinical parameters presented not significant differences. No significant microbiological differences could be observed between both connection types. Most of the collected samples had very few pathogens, meaning that these regions were healthy from a microbiological point of view. In FE analysis, a significantly higher peak of EQV strain (P=0.005) was found for EH (mean 3438.65 µ∑) compared to MT (mean 840.98 µ∑) connection. Conclusions: Varying implant-abutment connection type will result in diverse periimplant bone remodeling, regardless of clinical and microbiological conditions. This fact is more likely attributed to the singular loading transmission through different implant-abutment connections to the periimplant bone. The present findings suggest that Morse-taper connection is more efficient to prevent periimplant bone loss, compared to an external hexagon connection.

Tratamento tópico para xerostomia pós-radioterapia para câncer de cabeça e pescoço – Revisão Sistemática

The purpose of this systematic review was to compare the effectiveness of topical treatments to minimize post-radiotherapy xerostomia. PubMed, Cochrane Library (CENTRAL) and LILACS databases were searched without restriction on date or language until the 6thAugust, 2015. Key-wordsused for searching were radiotherapy, xerostomia and saliva. Two independent reviewers screened titles and abstracts, carried out data extraction and assessed risk of bias. The first search identified 429 articles. From these, 117 studies were selected for full-text reading, from which 18 were included in the qualitative synthesis. From the eighteen articles included, seven were non- controlled clinical trial, one article was controlled clinical trial and ten studies were randomized clinical trials (three clinical trials were placebo controlled and seven were crossover). By the assessment of the quality of the studies included, ten showed high risk of bias, four showed moderate risk of bias and four presented low risk of bias. All interventions were considered effective in treating xerostomia (mucin, polysaccharides, aloe vera, rape oil, linseed oil, carboxymethylcellulose, polyethylene oxide, pilocarpine and systems of care for xerostomia - gel, paste and mouthwash). Meta-analysis could not be performed due to heterogeneity between thestudiesand interventions. This systematic review showed that a single and general protocol for topical treatment of xerostomia post-radiotherapy does not exist and that follow-up visits should be performed to validate the individualized treatment plan.

Uma metodologia para geração otimizada de ambientes virtuais baseados em usinas hidrelétricas

Based on the possibility of real-time interaction with three-dimensional environments through an advanced interface, Virtual Reality consist in the main technology of this work, used in the design of virtual environments based on real Hydroelectric Plants. Previous to the process of deploying a Virtual Reality System for operation, three-dimensional modeling and interactive scenes settings are very importante steps. However, due to its magnitude and complexity, power plants virtual environments generation, currently, presents high computing cost. This work aims to present a methodology to optimize the production process of virtual environments associated with real hydroelectric power plants. In partnership with electric utility CEMIG, several HPPs were used in the scope of this work. During the modeling of each one of them, the techiniques within the methodologie were addressed. After the evaluation of the computional techniques presented here, it was possible to confirm a reduction in the time required to deliver each hydroelectrical complex. Thus, this work presents the current scenario about development of virtual hydroelectric power plants and discusses the proposed methodology that seeks to optimize this process in the electricity generation sector.