A modified approach for vestibuloplasty in severely resorbed mandible using an implant-retained postoperative stent: a case report

Background. Severely resorbed mandibles often present a short band of keratinized tissue associated with a shallow vestibule. As a result, prominent muscle insertions are present, especially in the mental region of the mandible. This case report describes the deepening of the vestibular sulcus in an atrophic mandible by combining free gingival grafts harvested from the palate and a postoperative acrylic resin stent screwed on osseointegrated implants placed at the anterior region of the mandible. Study design. During the second-stage surgery, a split-thickness labial flap was reflected and apically sutured onto the periosteum. Two free gingival grafts were obtained and then sutured at this recipient site. A previously custom-made acrylic stent was then screwed onto the most distally positioned implants. To document the procedure`s stability over time, a metal ball was placed in the most apical part of the vestibule and standardized cephalometric radiographs were taken before and 6 months after the procedure. Linear measurements of vestibular depths over the observation time were realized using specific software for radiographic analysis. Results. The proposed technique augmented the band of attached masticatory mucosa, deepened the vestibule and prevented the muscle reinsertion. The difference between the 2 measurements of vestibular depths was 9.39 mm (initial 20.88 mm, final 11.49 mm) after a 6-month postoperative period. Conclusion. The technique, in combination with palatal mucosal graft and use of a postoperative stent, decreased the pull of mentalis muscle and provided a peri-implantally stable soft tissue around implants. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e7-e14)

Evaluation of the presence or absence of papilla between tooth and implant

Objective: The purpose of this study was to evaluate the papilla level adjacent to single-tooth implants in the maxillary anterior region in individuals with cleft lip, alveolus, and palate to verify whether there is correlation among the vertical distance, horizontal distance, dental/prosthetic crown shape, and periodontal/peri-implant biotype with the presence of interproximal papilla. Design: Cross-sectional. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC/USP). Patients: 77 papillae in 40 patients. Interventions: The periodontal/peri-implant biotype was clinically evaluated and characterized as thin or thick. Intraoral photographs were used to evaluate the presence or absence of papilla. Main Outcome Measures: Classification in scores (0 to 3) and determination of length (CL) and width (CW) of crowns adjacent to papillae. The CW/CL ratio was calculated for each crown in order to characterize it as square-shaped or triangular-shaped. The vertical and horizontal distances were obtained by radiographic evaluation. Results: The correlations between vertical distance and papilla score and horizontal distance and papilla score were statistically significant (p= .02 and p = .01). There was no significant difference between crown shape and periodontal/peri-implant biotype in distinct correlations with the papilla score (p = .41 and p = .07). Conclusion: The results suggest that the vertical and horizontal distances may have independent or combined relationship with the existence of interproximal papilla; the periodontal/peri-implant biotype (phenotype) was not correlated with the presence or absence of papilla, as well as the shape of the dental/prosthetic crown.

Microleakage into and from Two-Stage Implants: An In Vitro Comparative Study

Purpose: Gaps between an abutment and a dental implant are unavoidable, and microleakage may occur, leading to problems such as malodor and peri-implantitis. The aim of the present in vitro study was to investigate leakage of Staphylococcus aureus through the implant/abutment interface by the method of bacterial culture, and to compare the leakage rates of two different types of implant-abutment connections. Materials and Methods: Twenty Morse taper implants with abutments were divided into two groups: group A, which were evaluated for microleakage into the inner part of the implants, and group B, which were evaluated for microleakage from the inner part of the implants. Twenty internal-hexagon implants with abutments were also divided into two groups: group C, which were evaluated for microleakage into the inner part of the implants, and group D, which were evaluated for microleakage from the inner part of the implants. For the evaluation of leakage from the implants, the assemblies had the inner parts inoculated with S aureus, and each assembly was incubated in sterile brain heart infusion broth for 1 week. For assessment of leakage into the implants, each assembly was submerged in 4 mL S aureus culture in tubes and incubated for 2 weeks. The microleakage of the two implant connections was compared. Results: Microbial leakage occurred in all groups, and there was no statistically significant difference between groups A and C or between groups B and D. Conclusions: In vitro, S aureus leakage through the implant/abutment interface occurred with both Morse taper and internal-hexagon implants. INT J ORAL MAXILLOFAC IMPLANTS 2011;26:56-62

Routine ultrasound screening in diabetic pregnancies

Objectives To assess the detection rate of congenital fetal malformations and specific problems related to routine ultrasound screening in women with pre-existing diabetes. Methods A retrospective study was carried out to assess the performance of routine ultrasound screening in women with pre-existing diabetes (Types 1 and 2) within a tertiary institution. The incidence, type and risk factors for congenital fetal malformations were determined. The detection rate of fetal anomalies for diabetic women was compared with that for the low-risk population. Factors affecting these detection rates were evaluated. Results During the study period, 12 169 low-risk pregnant women and 130 women with pre-existing diabetes had routine ultrasound screening performed within the institution. A total of 10 major anomalies (7.7%) and three minor anomalies (2.3%) were present in the fetuses of the diabetic women. Central nervous system and cardiovascular system anomalies accounted for 60% of the major anomalies. Peri-conceptional hemoglobin A 1 c of more than 9% was associated with a high prevalence of major anomalies (14311000). Women who had fetuses with major anomalies bad a significantly higher incidence of obesity (78% vs. 37%; P < 0.05). Ultrasound examination of these diabetic pregnancies showed high incidences of suboptimal image quality (37%), incomplete examinations, and repeat examinations (17%). Compared to the 'low-risk' non-diabetic population from the same institution, the relative risk for a major congenital anomaly among the diabetic women was 5.9-fold higher (95% confidence interval, 2.9-11.9). The detection rate for major fetal anomalies was significantly lower for diabetic women (30% vs. 73%; P < 0.01), and the mean body mass index for the diabetic group was significantly higher (29 vs. 23 kg/m(2); P < 0.001). Conclusion The incidence of congenital anomalies is higher in diabetic pregnancies. Unfortunately, the detection rate for fetal anomalies by antenatal ultrasound scan was significantly, worse than that for the low-risk population. This is likely to be related to the maternal body habitus and unsatisfactory examinations. Methods to overcome these difficulties are discussed.

Comparative sperm ultrastructure of the Baikalian endemic prosobranch gastropods

Mature euspermatozoan ultrastructure is described for seven species of the rissooidean family Baicaliidae (endemic to Lake Baikal, Russia)-Liobaicalia stiedae, Teratobaikalia ciliata, T. macrostoma, Baicalia carinata, Pseudobaikalia pulla, Maackia bythiniopsis, M. variesculpta, and M. herderiana. For comparison with these species and previously investigated Rissooidea, two species of the Lake Baikal endemic genus Benedictia (B. cf. fragilis and B. baicalensis; Hydrobiidae: Benedictiinae of some authors, Benedictiidae of other authors) in addition to Lithoglyphus naticoides (Hydrobiidae: Lithoglyphinae) and Bythinella austriaca (Hydrobiidae: Bythinellinae) were also investigated. Paraspermatozoa were not observed in any of the species examined, supporting the view that these cells are probably absent in the Rissooidea. In general, the euspermatozoa of all species examined resemble those of many other caenogastropods (basally invaginated acrosomal vesicle, mid-piece with 7-13 helical mitochondria, an annulus, glycogen piece with nine peri-axonemal tracts of granules). However, the presence of a completely flattened acrosomal vesicle and a specialized peri-axonemal membranous sheath (a scroll-like arrangement of 4-6 double membranes) at the termination of the mid-piece, clearly indicates a close relationship between the Baicaliidae and other rissooidean families possessing these features (Bithyniidae, Hydrobiidae, Pyrgulidae, and Stenothyridae). Euspermatozoa of Benedictia, Lithoglyphus, Bythinella, and Pyrgula all have a solid nucleus, which exhibits a short, posterior invagination (housing the centriolar complex and proximal portion of the axoneme). Among the Rissooidea, this form of nucleus is known to occur in the Bithyniidae, Hydrobiidae, Truncatellidae, Pyrgulidae, Iravadiidae, Pomatiopsidae, and Stenothyridae. In contrast, the euspermatozoa of the Baicaliidae all have a long, tubular nucleus, housing not only the centriolar derivative, but also a substantial portion of the axoneme. Among the Rissooidea, a tubular nuclear morphology has previously been seen in the Rissoidae, which could support the view, based on anatomical grounds, that the Baicaliidae may have arisen from a different ancestral source than the Hydrobiidae. However, the two styles of nuclear morphology (short, solid versus long, tubular) occur widely within the Caenogastropoda, and sometimes both within a single family, thereby reducing the phylogenetic importance of nuclear differences within the Rissooidea. More significantly, the occurrence of the highly unusual membranous sheath within the mid-piece region in the Baicaliidae appears to tie this family firmly to the Bithyniidae + Hydrobiidae + Stenothyridae + Pyrgulidae assemblage. Eusperm features of Benedictia spp. strongly resemble those of hydrobiids and bithyniids, and neither support recognition of a distinct family Benedictiidae (at best this is a subfamily of Hydrobiidae) nor any close connection with the hydrobiid subfamily Lithoglyphinae.

The current status of laser applications in dentistry

A range of lasers. is now available for use in dentistry. This paper summarizes key current and emerging applications, for lasers in clinical practice. A major diagnostic application of low power lasers is the detection of caries, using fluorescence elicited from hydroxyapatite or from bacterial by-products. Laser fluorescence is an effective method for detecting and quantifying incipient occlusal and cervical,carious lesions, and with further refinement could be used in the, same manner for proximal lesions. Photoactivated dye techniques have been developed which use low power lasers to elicit a photochemical reaction, Photoactivated dye techniques' can be used to disinfect root canals, periodontal pockets, cavity preparations and sites of peri-implantitis. Using similar principles, more powerful lasers tan be used for photodynamic therapy in the treatment of malignancies of the oral mucosa. Laser-driven photochemical reactions can also be used for tooth whitening. In combination with fluoride, laser irradiation can improve the resistance of tooth structure to demineralization, and this application is of particular benefit for susceptible sites in high caries risk patients. Laser technology for caries' removal, cavity preparation and soft tissue surgery is at a high state of refinement, having had several decades of development up to the present time. Used in conjunction with or as a replacement for traditional methods, it is expected that specific laser technologies will become an essential component of contemporary dental practice over the next decade.

Boletim eletr??nico de bibliografias especializadas:comunica????o e lideran??a

A 4a edi????o do Boletim Eletr??nico de Bibliografias Especializadas apresenta publica????es do acervo da Biblioteca Graciliano Ramos e do Portal de Peri??dicos da ENAP. Este n??mero tem como foco o Programa de Comunica????o e Lideran??a (Comlide). Trata-se de uma iniciativa da ENAP, sob a responsabilidade da Diretoria de Desenvolvimento Gerencial (DDG), envolvendo todas as ??reas da Escola. As obras reunidas neste Boletim d??o ??nfase a t??cnicas de comunica????o e lideran??a dentro de organiza????es. O objetivo dessas estrat??gias ?? viabilizar o melhor desempenho em rela????o aos trabalhos em grupo. Com a crescente import??ncia de l??deres nas institui????es, estudos e projetos prop??em caminhos para que esses gestores motivem suas equipes a alcan??ar cada vez mais qualidade, produtividade e crescimento. Enfim, a colet??nea presente neste Boletim permite que se desenvolva uma melhor compreens??o quanto a conceitos e m??todos sugeridos por diversos autores, al??m de apresentar estudos de caso voltados para negocia????es e gest??o de equipes

Eco postal: um programa socioambiental com gera????o de emprego e renda

Na Empresa Brasileira de Correios e Tel??grafos (ECT), um grande n??mero de empregados recebe uniformes com periodicidade semestral, o que inclui tamb??m a troca peri??dica dos malotes inutilizados pelo desgaste. Por quest??es de seguran??a, todo esse material inserv??vel era destinado ao aterro sanit??rio. Mas, desde 2004, foi encontrado um novo destino para esses objetos a partir das cooperativas formadas em conv??nio com a Universidade Federal do Paran??, Associa????o Comercial do munic??pio de Toledo e Organiza????es N??o-Governamentais (ONGs). As cooperativas transformam artesanalmente esse material em v??rios produtos que geram emprego e renda, especialmente para as fam??lias que, em muitas situa????es, viviam do subemprego. Isso demonstra a import??ncia que a empresa confere ??s a????es de responsabilidade social que ultrapassam a oferta de servi??os com qualidade ?? comunidade, assegurando que todo o processo de trabalho seja feito de forma socialmente respons??vel. Este programa gera emprego e renda para aproximadamente 50 fam??lias em todo o estado, com projeto de amplia????o para outras regi??es

Reforma da administra????o p??blica e cultura pol??tica no Brasil: uma vis??o geral

Texto bastante did??tico que compreende uma revis??o da evolu????o da administra????o p??blica brasileira, dos anos 30 aos 90, incluindo tra??os da heran??a colonial. Enfoca a deteriora????o da administra????o p??blica federal e discute diretrizes para a reforma do Estado no Brasil, apontando problemas e resist??ncias pol??ticas a serem enfrentadas

Progressos recentes no financiamento da Previd??ncia Social na Am??rica Latina

Texto que compreende uma vis??o geral da hist??ria e das caracter??sticas dos sistemas de previd??ncia social da Am??rica Latina, e estudos de caso de cinco pa??ses (Chile, Peru, Col??mbia, Costa Rica e Brasil), relatando as suas respectivas experi??ncias e situa????o atual das reformas previdenci??rias

Avalia????o do desempenho de servidores em est??gio probat??rio

Conforme a legisla????o, ao entrar em exerc??cio, o servidor nomeado para cargo de provimento efetivo ficar?? sujeito a est??gio probat??rio, per??odo durante o qual sua aptid??o e capacidade para o exerc??cio das atribui????es do cargo estar??o sujeitas ?? avalia????o peri??dica de desempenho. O caso relata duas situa????es de aplica????o da Lei n?? 8.112/90 no item referente ao est??gio probat??rio: uma experi??ncia positiva e outra negativa. Ilustra situa????o que poder?? contribuir em discuss??es sobre gest??o de pessoas e lideran??a

A????es premiadas no 15?? Concurso Inova????o na Gest??o P??blica Federal 2010

Nesta publica????o, referente ao 15?? Concurso Inova????o na Gest??o P??blica Federal, o leitor encontrar?? iniciativas inovadoras nas seguintes ??reas: Arranjos institucionais para coordena????o e/ou implementa????o de pol??ticas p??blicas (intra e inter-governamental); atendimento ao cidad??o; gest??o da informa????o; melhoria dos processos de trabalho

O impacto do modelo gerencial na Administra????o P??blica: um breve estudo sobre a experi??ncia internacional recente

Texto que focaliza o processo de surgimento e desenvolvimento do modelo gerencial (managerialism ou public management) no campo da administra????o p??blica, analisando seus limites e potencialidades, mediante a abordagem do caso ingl??s e americano de reformas administrativas de governo, ao longo das d??cadas de 80 e 90; ao final, al??m do perfil das principais mudan??as administrativas que t??m afetado o setor p??blico em escala mundial, um coment??rio breve sobre o caso brasileiro.

A seguridade social no Brasil e os obst??culos institucionais ?? sua implementa????o

An??lise hist??rico-administrativa da forma????o do sistema de seguridade social no Brasil, enfatizando alguns dos principais aspectos condicionantes da sua gest??o. Registra as id??ias-for??a do modelo de prote????o social adotado em 1988, contextualizadas no processo de evolu????o das pol??ticas sociais de Estado; descreve e discute os problemas constatados na operacionaliza????o recente das pol??ticas p??blicas de sa??de, assist??ncia e previd??ncia social, vistas sob a ??tica dos seus processos de planejamento e or??amenta????o, das estruturas organizacionais formais e das pr??ticas diretivas e de controle, e da articula????o intergovernamental, conduzindo ?? avalia????o de desempenho do sistema atual e a propostas da sua consolida????o, com base nos princ??pios de descentraliza????o, controle social e manuten????o de um permanente processo de avalia????o institucional.

Normas de conduta para a vida p??blica

Texto conhecido como "Relat??rio Nolan", publicado originalmente na Gr??-Bretanha em 1995, aborda temas relativos aos padr??es de comportamento ??tico dos servidores p??blicos e dos pol??ticos, parlamentares e altos dirigentes de governo. O relat??rio est?? estruturado em quatro cap??tulos compreendendo: no primeiro, a introdu????o do tema; no segundo, quest??es sobre os parlamentares; no terceiro, quest??es sobre ministros e servidores; e no quarto, sobre os "quangos" (??rg??os p??blicos n??o-estatais).