Management of accidental swallowing in implant dentistry

This report describes a protocol for managing the accidental swallowing of dental instruments in implant dentistry, illustrated by a patient who accidentally swallowed a hexagonal wrench. The first step was to refer the patient to the medical emergency hospital service for radiographic and clinical evaluation. The hexagonal wrench was located in the stomach and was immediately removed with an endoscopic procedure. The gastric mucosa was sampled via biopsy and the sample submitted to the urease test, which was positive for Helicobacter pylori. Triple treatment was instituted for gastritis caused by H pylori to avoid exposing the patient to unnecessary risk. Removal of a foreign body by means of an endoscopic procedure constitutes a safe and effective treatment.

A oclusão nas próteses totais implantossuportadas mediatas e imediatas

Rehabilitation of edentulous patients has been a challenge for professionals since the primary concepts and fundaments of occlusal rehabilitation. However, this philosophy has been improved by implant-supported fixed dentures that represent a predictable clinical modality on modern dentistry. Nevertheless, considering that the traditional protocol requires a long period for bone healing and definitive rehabilitation, immediate loading of implants has been advantageous for functional and esthetic rehabilitation of patients in a reduced period. The aim of this study is to discuss the biomechanical and functional fundaments of occlusion for implant-supported fixed dentures with mediate and immediate loading to provide clinical evidences for longevity of this treat ment modality based on the current literature. According to this, some prerequisites as proper bone quality, excellent primary stability, sufficient number of implants, rigid splinting, and control and mastering of biomechanical fundamentals of static and dynamic occlusion are mandatory for treatment predictability and longevity.

Planejamento em reabilitação oral: restabelecimento da relação intermaxilar por meio de prótese provisória overlay

The present article describes the treatment planning and fabrication of overlay denture to restore the jaw relationship in a partial edentulous patient with bruxism. A male patient, 51 years old, was referred to the oral rehabilitation clinic complaining about the chewing and aesthetic. The occlusal surface of the superior teeth presented severe wear. The fabrication of an interim overlay denture to restore the jaw relationship was planned. The overlay had metallic projections and covered the occlusal surface of superior teeth. After overlay insertion both function and aesthetic of the patient were recovered. It was concluded that the use of overlay improved the physiological normal position of the jaw and could provide a favorable prognosis for a definitive oral rehabilitation with implant-supported fixed denture.

Influência do material oclusal na distribuição de tensões em próteses implantossuportadas unitárias

Objective: the aim of this study was to evaluate the influence of occlusal veneering material in single fixed implant-supported crowns through the 3-D finite element method. Material and methods: Four models were fabricated using the Rhinoceros 4.0, SolidWorks, and InVesalius softwares. Each model represented a block of mandibular bone with an external hexagon implant of 5 mm x 10 mm and different veneering materials including NiCr (1), porcelain (2), composite resin (3), and acrylic resin (4). An axial load of 200 N and an oblique load of 100 N were applied. Results: model (2) with porcelain veneering presented a lower stress concentration for the NiCr framework, followed by the composite resin and acrylic resin. The stress distribution to the implant and bone tissue was similar for all models. Conclusions: there is no difference of stress distribution to the implant and supporting structures by varying the veneering material of a single implant-supported prosthesis.

Influência do material oclusal na distribuição de tensões em próteses implantossuportadas unitárias

Objective: the aim of this study was to evaluate the influence of occlusal veneering material in single fixed implant-supported crowns through the 3-D finite element method. Material and methods: Four models were fabricated using the Rhinoceros 4.0, SolidWorks, and InVesalius softwares. Each model represented a block of mandibular bone with an external hexagon implant of 5 mm x 10 mm and different veneering materials including NiCr (1), porcelain (2), composite resin (3), and acrylic resin (4). An axial load of 200 N and an oblique load of 100 N were applied. Results: model (2) with porcelain veneering presented a lower stress concentration for the NiCr framework, followed by the composite resin and acrylic resin. The stress distribution to the implant and bone tissue was similar for all models. Conclusions: there is no difference of stress distribution to the implant and supporting structures by varying the veneering material of a single implant-supported prosthesis.

Sexual haressement in dentistry: prevalence in dental school

OBJECTIVE: Sexual harassment is unlawful in all work and educational environments in most nations of the world. The goals of this study were to describe the sexual harassment prevalence and to evaluate the experiences and attitudes of undergraduate students in one dental school in Brazil. MATERIAL AND METHODS: An 18-item questionnaire was administered to 254 dental students with a completion rate of 82% (208). Students were requested to respond to questions about their background and academic level in dental school, their personal experiences with sexual harassment and their observation of someone else being sexually harassed. Bivariate statistical analyses were performed. RESULTS: Fifteen percent of the students reported being sexually harassed by a patient, by a relative of a patient or by a professor. Male students had 3 times higher probability of being sexually harassed than female student [OR=2.910 (1.113-7.611)]. Additionally, 25.4% of the students reported witnessing sexual harassment at the school environment. The majority of students did not feel professionally prepared to respond to unwanted sexual behaviors. CONCLUSION: These findings demonstrate that sexual harassment can occur in a dental school setting. There is a need for ongoing sexual harassment education programs for students and university staff. Increased knowledge of sexual harassment during graduation can better prepare dental professionals to respond to sexual harassment during their practice.

Brazilian dentistry profiles and workforce

The aim of this study was to assess the dentistry profile, based on social and demographic data, post-graduation formation, and to verify the insertion of dental graduates in the labour force. The participants were professionals graduated from a Brazilian Public Dental School, between 2000 and 2010. An instrument was sent by mail and/or e-mail to them. It was used Kruskal Wallis Test. Among 1047 questionnaires, 189 returned and 65.6% were answered by female. In relation to post-graduation course, 57.7% of professionals performed it, however 56.9% not attended only in their area; 66.6% of professionals are concentrated in cities larger than 100 thousand habitants. There was association between income and gender, and others. The predominant work modality was self-employed. Among the total, 36.5% want to work part-time in dentistry. The female gender was predominant and there was wage discrepancy between genders. The professionals have been concentrated in largest cities.

Qualitative methodogy: revealing a new path for research in dentistry

Currently, it is easy to find health professionals who not only attach importance to qualitative methods, but also recognize their help to better understand their patients' lives. However, its use in dentistry is still incipient, either due to ignorance or because of technical / operational difficulties in identifying possibilities for their use in research. Thus, the purpose of this study was to review the literature on the characteristics and peculiarities of the qualitative methodology, demonstrating their techniques of collecting, recording and analyzing data. For this, we performed a descriptive literature, from a survey in the "LILACS", "BBO" and "PUBMED" databases, by keywords related to the theme, selecting only the papers that mentioned the "importance" of qualitative research, the "characteristics and fundamentals," and the "techniques of collecting, recording and data analysis" involving this methodology. It was found that all studies have highlighted the importance of qualitative research to the construction of new knowledge that cannot be achieved by quantitative data. We found many different techniques to gather, record and analyze qualitative data applied to the dentistry field. It was concluded that qualitative research represents a new path to be followed by dentistry, so that we are able to plan actions in ethical and humane public health dentistry, bringing better results to the population, because of the depth of knowledge that your date can.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of So Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Zirconia in dentistry

The above factors emphasize the scope of this thesis for further investigations on zirconia, the improvement of all-ceramic zirconia restorations, and especially the interaction of zirconia and veneering and its influence on the performance of the whole restoration. The introduction, chapter 1, gave a literature overview on zirconia ceramics. In chapter 2, the objective of the study was to evaluate the effect of abrading before and after sintering using alumina-based abrasives on the surface of yttria-tetragonal zirconia polycrystals. Particular attention was paid to the amount of surface stress–assisted phase transformation (tetragonal→monoclinic) and the presence of microcracks. Chapter 3 is based on the idea that the conventional sintering techniques for zirconia based materials, which are commonly used in dental reconstruction, may not provide a uniform heating, with consequent generation of microstructural flaws in the final component. As a consequence of the sintering system, using microwave heating, may represent a viable alternative. The purpose of the study was to compare the dimensional variations and physical and microstructural characteristics of commercial zirconia (Y-TZP), used as a dental restoration material, sintered in conventional and microwave furnaces. Chapter 4 described the effect of sandblasting before and after sintering on the surface roughness of zirconia and the microtensile bond strength of a pressable veneering ceramic to zirconia.

Guidelines of Special Care Dentistry in Patients with Chromosomal and Genetic syndromes

Chromosomal and genetic syndromes are frequently associated with dental and cranio-facial alterations. The aim of our study is to identify and describe the dental and craniofacial alterations typical of six genetic and chromosomal syndromes examined. Materials and Methods- A dental visit was performed to 195 patients referred from Sant’Orsola Hospital of Bologna, University of Bologna, to Service of Special Need Dentistry, Dental Clinic, Department of Biomedical and Neuromotor Science, University of Bologna. The patients recruited were 137 females and 58 males, in an age range of 3-49 years (mean age of 13.8±7.4). The total sample consisted of subjects affected with Down Syndrome (n=133), Familiar Hypophosphatemic Ricket (n=10), Muscular Dystrophies (n=12), Noonan Syndrome (n=13), Turner Syndrome (n=17), Williams Syndrome(n=10). A questionnaire regarding detailed medical and dental history, oral health and dietary habits, was filled by parents/caregivers, or patients themselves when possible. The intra-oral and extra-oral examination valued the presence of facial asymmetries, oral habits, dental and skeletal malocclusions, dental formula, dental anomalies, Plaque Index (Silness&LÖe Index), caries prevalence (dmft/DMFT index), gingivitis and periodontal disease, and mucosal lesions. Radiographic examinations (Intraoral radiographies, Orthopanoramic, Skull teleradiography) were executed according to patient’s age and treatment planning. A review of literature about each syndrome and its dental and cranio-facial characteristics and about caries, hygiene status and malocclusion prevalence on syndromic and non-syndromic population was performed. Results - The data of all the patients were collected in the “Data Collection Tables” created for each syndrome. General anamnesis information, oral hygiene habits and dmft/DMFT, PI, malocclusion prevalence were calculated and compared to syndromic and non-syndromic population results found in literature. Discussions and conclusions - Guidelines of Special Care dentistry were indicated for each syndrome, in relation to each syndrome features and individual patient characteristics.

[Oral medicine: a specialty placed between medicine and dentistry]

Oral medicine is a dental specialty that bridges the traditional areas of health between dentistry and medicine. International descriptions reflect this and oral medicine is defined as "the dental speciality placed at the interface between medicine and dentistry and is concerned with the diagnosis and management of (non-dental) pathology affecting the oral and maxillofacial region." Oral medicine specialists provide clinical care to patients with a wide variety of orofacial conditions, including oral mucosal diseases, orofacial pain syndromes, salivary gland disorders, and oral manifestations of systemic diseases. There is a growing need to implement this specialty globally: due to the rapid progress in both medicine and dentistry, and to the growing percentage of senior citizens in many countries, the adequate diagnosis and treatment of oral diseases will become even more complex in the future. In this article, the authors' intention is to point out that oral medicine is neither a recognized specialty nor a distinct field of study in Germany, Austria, or Switzerland; thus, the need for postgraduate training in this field in countries where oral medicine is not a specialization is emphasized.