Analysis of the ethical aspects of professional confidentiality in dental practice

From the point of view of deontological ethics, privacy is a moral right that patients are entitled to and it is bound to professional confidentiality. Otherwise, the information given by patients to health professionals would not be reliable and a trustable relationship could not be established. The aim of the present study was to assess, by means of questionnaires with open and closed questions, the awareness and attitudes of 100 dentists working in the city of Andradina, São Paulo State, Brazil, with respect to professional confidentiality in dental practice. Most dentists (91.43%) reported to have instructed their assistants on professional confidentiality. However, 44.29% of the interviewees showed to act contradictorily as reported talking about the clinical cases of their patients to their friends or spouses. The great majority of professionals (98.57%) believed that it is important to have classes on Ethics and Bioethics during graduation and, when asked about their knowledge of the penalties imposed for breach of professional confidentiality, only 48.57% of them declared to be aware of it. Only 28.57% of the interviewees affirmed to have exclusive access to the files; 67.14% reported that that files were also accessed by their secretary; 1.43% answered that their spouses also had access, and 2.86% did not answer. From the results of the present survey, it could be observed that, although dentists affirmed to be aware of professional confidentiality, their attitudes did not adhere to ethical and legal requirements. This stand of health professionals has contributed to violate professional ethics and the law itself, bringing problems both to the professional and to the patient.

Mechanical strength and subcritical crack growth under wet cyclic loading of glass-infiltrated dental ceramics

Objectives. Evaluate the flexural strength (sigma) and subcritical crack growth (SCG) under cyclic loading of glass-infiltrated alumina-based (IA, In-Ceram Alumina) and zirconia-reinforced (IZ, In-Ceram Zirconia) ceramics, testing the hypothesis that wet environment influences the SCG of both ceramics when submitted to cyclic loading.Methods. Bar-shaped specimens of IA (n = 45) and IZ ( n = 45) were fabricated and loaded in three-point bending (3P) in 37 degrees C artificial saliva (IA(3P) and IZ(3P)) and cyclic fatigued (F) in dry (D) and wet (W) conditions (IA(FD), IA(FW), IZ(FD), IZ(FW)). The initial sigma and the number of cycles to fracture were obtained from 3P and F tests, respectively. Data was examined using Weibull statistics. The SCG behavior was described in terms of crack velocity as a function of maximum stress intensity factor (K(Imax)).Results. The Weibull moduli (m = 8) were similar for both ceramics. The characteristic strength (sigma(0)) of IA and IZ was and 466 MPa 550 MPa, respectively. The wet environment significantly increased the SCG of IZ, whereas a less evident effect was observed for IA. In general, both ceramics were prone to SCG, with crack propagation occurring at K(I) as low as 43-48% of their critical K(I). The highest sigma of IZ should lead to longer lifetimes for similar loading conditions.Significance. Water combined with cyclic loading causes pronounced SCG in IZ and IA materials. The lifetime of dental restorations based on these ceramics is expected to increase by reducing their direct exposure to wet conditions and/or by using high content zirconia ceramics with higher strength. (C) 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Midsymphyseal distraction osteogenesis: A new alternative for the treatment of dental crowding

In this article, we describe a midsymphyseal distraction osteogenesis treatment with a novel dentally supported appliance. This approach differs from that used in previous reports because the incisors were allowed to move during the distraction procedure. This report shows that midsymphyseal distraction osteogenesis can be used to expand both arches to produce a wider smile. Borderline cases can be treated with this technique without the compromising effects commonly observed with conventional therapy. (Am J Orthod Dentofacial Orthop 2009;135:530-5)

Early loading of single crowns supported by 6-mm-long implants with a moderately rough surface: a prospective 2-year follow-up cohort study

AimTo evaluate prospectively the clinical and radiographic outcomes after 2 years of loading of 6 mm long moderately rough implants supporting single crowns in the posterior regions.Material and methodsForty SLActive Straumann (R) short (6 mm) implants were placed in 35 consecutively treated patients. Nineteen implants, 4.1 mm in diameter, and 21 implants, 4.8 mm in diameter, were installed. Implants were loaded after 6 weeks of healing. Implant survival rate, marginal bone loss and resonance frequency analysis (RFA) were evaluated at different intervals. The clinical crown/implant ratio was also calculated.ResultsTwo out of 40 implants were lost before loading. Hence, the survival rate before loading was 95%. No further technical or biological complications were encountered during the 2-year follow-up. The mean marginal bone loss before loading was 0.34 +/- 0.38 mm. After loading, the mean marginal bone loss was 0.23 +/- 0.33 and 0.21 +/- 0.39 mm at the 1- and 2-year follow-ups. The RFA values increased between insertion (70.2 +/- 9) and the 6-week evaluation (74.8 +/- 6.1). The clinical crown/implant ratio increased with time from 1.5 at the delivery of the prosthesis to 1.8 after 2 years of loading.ConclusionShort implants (6 mm) with a moderately rough surface loaded early (after 6 weeks) during healing yielded high implant survival rates and moderate loss of bone after 2 years of loading. Longer observation periods are needed to draw more definite conclusions on the reliability of short implants supporting single crowns.To cite this article:Rossi F, Ricci E, Marchetti C, Lang NP, Botticelli D. Early loading of single crowns supported by 6-mm-long implants with a moderately rough surface: a prospective 2-year follow-up cohort study.Clin. Oral Impl. Res. 21, 2010; 937-943.doi: 10.1111/j.1600-0501.2010.01942.x.

Patients' Expectations Before and Evaluation After Dental Implant Therapy

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Expectations and final evaluation of complete dentures by patients, dentist and dental technician

There is a poor association between the dentist's evaluation of denture quality and patients' satisfaction with their dentures. Possible differences between dental professionals and patients' expectations might help explain differences in outcome evaluations. This study compared scores given by a dentist, a dental technician and patients for their expectations before and their final evaluation after complete dentures treatment. Twenty completely edentulous patients, a prosthodontist and a dental technician provided scores for the expected aesthetic and functional results of their dentures based on a visual analogue scale at baseline. Post-treatment completion ratings were given after adjustments, by dentist and patients. The dental technician provided post-treatment completion ratings after completing the dentures. The patients had higher expectations than the dental technician and the dentist perceived for both aesthetic and function (P < 0.001). The patients also presented higher post-treatment completion ratings than the dental professionals perceived for final aesthetics (P = 0.016, Kendall's W = 0.207). and function (P = 0.002, Kendall's W = 0.303). Only the dentist presented a statistically significant difference between expectations (lower) and final (higher) outcomes for aesthetics (P = 0.017) and function (P = 0.003). There was no correlation between expectations and post-treatment completion ratings according to the patients' age. There was also no correlation between the patients' gender and expectation scores. Patients presented higher expectations regarding their dentures than dental professionals. The dentist believed that dentures would bring fewer benefits than patients did, but his perception of denture benefits post-treatment was significantly higher than his expectations.

Morphology of the dental carinae in Mariliasuchus amarali (Crocodylomorpha, Notosuchia) and the pattern of tooth serration among basal Mesoeucrocodylia.

Carinated teeth are common in Mesoeucrocodylia, and the occurrence of denticles over the carinae is related to high predacious species, often referred as ziphodont. This characteristic is broadly recognized as homoplastic. Carinae morphology is cryptic, difficult to be studied under common techniques, and Scanning Electronic Microscopy (SEM) allows the access to detailed information, offering a higher degree of confidence. Previous SEM study allowed the recognition of true/false ziphodont patterns, according to the morphology of the denticles, but such studies on gondwanan mesoeucrocodyles are uncommon. Mariliasuchus amarali is an Upper Cretaceous notosuchian mesoeucrocodyle from South America (Bauru Group, Brazil), with carinated teeth and specialized dentition. Its geological and biochronological distribution are reappraised. SEM study of two teeth shows carinae composed of isolated tuberous anisomorphic true denticles, supporting previous study. Enamel ornamentation does not develop over the carinae, and fabric becomes anastomosed in middle and posterior teeth. Carinae only occur in posterior molariform teeth, related to food processing. Morphological variability of Mariliasuchus is commented, focusing on dentition. Overall characteristics, molariform morphology and wear planes support a non-predacious habit for Matiliasuchus. Matiliasuchus pattern could not be related to true/false ziphodont patterns, either by morphology or function, and is defined as ziphomorph. Ziphomorph pattern is evaluated within the range of mesoeucrocodyles. The detailed study of homoplastic characteristics, such as dental carinae, may provide useful apomorphic information for cladistic analysis.

Application of propolis to dental sockets and skin wounds.

The purpose of this study was to examine histologically the effects of propolis topical application to dental sockets and skin wounds. After topical application of either a 10% hydro-alcoholic solution of propolis or 10% hydro-alcoholic solution alone, cutaneous wound healing and the socket wound after tooth extraction were examined. The rats were sacrificed at 3, 6, 9, 15 and 21 days after the operation. The specimens were subjected to routine laboratory studies after staining with hematoxylin and eosin. It was concluded that topical application of propolis hydro-alcoholic solution accelerated epithelial repair after tooth extraction but had no effect on socket wound healing.

Sensibilidade do colo dental. Uma nova alternativa terapêutica.

The cervical hypersensitivity tooth was analysed and treated by application of a varnish with high fluoride ions content (Duraphat) and of a glass ionomer cement usually indicated to cavity lining (XR-ionomer-Kerr). This technique was applied in sixty-seven teeth of Clinic Graduation patients (Faculdade de Odontologia de Araçatuba) and demonstrated a high index of satisfactory results. The clinical findings of this study relate that, this technique is more one method of choose by clinicians.

Efeito da ciclofosfamida sobre o desenvolvimento de germe dental do incisivo do camundongo.

Thirty six female mice were injected on the 12th day of the gestational period with 0.2 ml of distilled water (control group) or of an acqueous solution containing either 30 mg/Kg or 50 mg/Kg of body weight of cyclophosphamide (treated group). The animal were killed at 24, 48, 72, 96 and 120 hours after the injection and 3 days after birth. It was verified that cyclophosphamide interferes on the tooth germ development and that this effect is in directly ratio of the doses used.

Estudo da penetração de agentes ácidos para o condicionamento do esmalte dental em cimentos à base de hidróxido de cálcio.

It was verified the penetration of phosphoric acid into 3 commercial calcium hydroxide-based cements (Life, Renew and Prisma VLC Dycal). The colorimetric method employed permitted the identidication of phosphorus amount in representative samples of 6 successive layers 0.1 mm thick of each material. The acid etching used were the commercial products Scotchbond Etching Gel--3M at 36.114% by weight and Solução Condicionadora--Johnson & Johnson at 36.054% by weight. The contact time was 60 seconds. The result showed that layers 0.1 mm tick for Life and Prisma VLC Dycal and 0.2 mm thick for Renew were able to block the penetration of phosphoric acid solution whereas layers 0.1 mm thick for the 3 cements were able to block the penetration of phosphoric acid gel.

Fadiga de grampos de retenção em prótese parcial removível. Efeito de ligas, espessuras e técnicas de fusão. Parte I.

The authors looked for the verification of the fatigue of retentive clasps utilized on the removable partial denture. According to this, it was idealized and built on assay machine, that through movements, simulate the insertion and removal of the clasp for a pattern tooth, manufactured on cobalt-chromium which has all the preparation normally utilized to the correct confection of this type of prosthesis. It was utilized three different commercial alloys based on cobalt-chromium: L1-Biosil; L2-Steldent; L3-Duracron. It was utilized the T clasp of Roach, with was tested upon three different proportions among width and thickness: E1-1.7;E2-2.0 and E3-2.3 and was casted through two casting techniques: F1-oxygen-gas and F2-oxygen-acetylene. The clasps were tested on the machine, which allowed the reading of the number of insertion and removal cycles made until fatigue appeared. The obtained results were submitted to the statistic analysis and the authors concluded that: a) L3 (Duracrom) obtained the best results followed by L1 (Biosil) and finally L3 (Steldent); b) among the analyzed thickness, the best results were obtained by E3, followed by E2 and after this E1; c) form the casting techniques, F2 gave us the best results.