REABSORÇÃO CONDILAR INTERNA DA ARTICULAÇÃO TEMPOROMANDIBULAR NO PACIENTE ADOLESCENTE

A reabsorção condilar interna no adolescente (RCIA) é uma doença progressiva que afeta a articulação temporomandibular (ATM) e que pode resultar em maloclusão, deformidade facial, disfunção de ATM e dor. O aparecimento desta doença ocorre entre os 10 e os 15 anos, sendo mais freqüente em adolescentes do sexo feminino. Esses pacientes apresentam sinais clínicos característicos como: ângulo do plano oclusal e do plano mandibular aumentados, retrusão progressiva da mandíbula e maloclusão Classe II, com ou sem mordida aberta. Nos exames de imagem (tomografia computadorizada e ressonância magnética), observa-se reabsorção interna dos côndilos e deslocamento dos discos articulares da ATM. Tendo em vista a dificuldade em determinar a causa da RCIA e a importância em eliminar a dor e melhorar a função mastigatória, este estudo se propôs a avaliar as alterações promovidas no posicionamento mandibular, a sintomatologia dolorosa e a estabilidade do tratamento da RCIA, utilizando o protocolo de tratamento (Dr. Larry M. Wolford) em pacientes adolescentes submetidos a cirurgia de reposicionamento do disco articular e cirurgia ortognática, realizadas no mesmo ato cirúrgico. Neste estudo retrospectivo, foram avaliadas as telerradiografias laterais adquiridas na avaliação inicial (T1), pré-cirúrgica (T2), pós-cirúrgica imediata (T3) e de maior acompanhamento, com pelo menos um ano pós-cirurgia (T4) e questionários de dor e função mandibular de uma amostra de 24 pacientes com maloclusão de Classe II (20 do sexo feminino e 4 do sexo masculino) diagnosticados com RCIA, os quais foram submetidos ao protocolo de tratamento composto pela cirurgia de reposicionamento do disco articular da ATM concomitantemente à cirurgia ortognática. O protocolo de tratamento utilizado mostrou-se bastante positivo, uma vez que a estabilidade foi adquirida e uma melhora significativa nos níveis de dor e função mandibular foram atingidos. O tratamento dos pacientes diagnosticados com RCIA, através do protocolo de tratamento proposto, é um procedimento estável e atua diretamente em um ganho na redução da dor.

AVALIAÇÃO COMPARATIVA DA HIGIENIZAÇÃO BUCAL DE PACIENTES COM APARELHO ORTODÔNTICO FIXO LINGUAL E LABIAL

O objetivo desse trabalho foi avaliar a higiene oral de pacientes adultos, pela análise dos índices de sangramento gengival e de placa pré e pós-colocação do aparelho ortodôntico fixo lingual e compará-la a um grupo de pacientes com aparelho ortodôntico fixo labial. O grupo 1 (G1), foi constituído de 11 pacientes, com idade média de 22 anos e 9 meses, tratado com braquetes linguais. O grupo 2 (G2) foi formado por 19 pacientes, com idade média de 26 anos e 8 meses, tratado com braquetes labiais. O sangramento gengival e o índice de placa foram avaliados antes da colagem (T0); 1 semana/15 dias após a colocação total do aparelho, inclusive com arcos (T1). Após isso, foram dadas instruções de higienização. Os pacientes foram novamente avaliados 1 mês após a colocação (T2); 2 meses (T3) e 3 meses (T4), quando foram dados reforços das instruções conforme necessário. Nas avaliações inter-grupos, foram comparadas as alterações relativas ao tipo de aparelho empregado e nas avaliações intra-grupos comparou-se a face vestibular e lingual de um mesmo indivíduo. Os resultados mostraram que houve um significante aumento no índice de placa em T1, exceto na face vestibular dos pacientes com aparelho lingual. Em ambos os grupos, houve um aumento semelhante da gengivite caracterizada pelo aumento do sangramento gengival. Após as instruções de escovação, os pacientes do G2 foram capazes de retornar aos seus índices de placa anteriores à colocação do aparelho. Os pacientes do G1, apesar de haver melhora, não conseguiram voltar aos índices de placa iniciais e tiveram uma menor eficácia de higienização comparado a G2 em T1 e T4.

DETERMINAÇÃO DA POSIÇÃO DE REPOUSO DA LÍNGUA EM INDIVÍDUOS COM OCLUSÃO DENTÁRIA NORMAL

O propósito neste estudo foi determinar a posição de repouso da língua em indivíduos com oclusão dentária normal e respiração nasal, por meio de telerradiografias em norma lateral realizadas após a ingestão de bário. A amostra foi composta por 66 radiografias de indivíduos brancos com oclusão dentária normal, sendo 26 do sexo masculino e 40 do sexo feminino, na faixa etária de 12 a 21 anos de idade, procedentes de escolas da região do Grande ABC Paulista. O critério utilizado para diagnóstico da oclusão normal foi As Seis Chaves para a Oclusão Normal preconizadas por Andrews (1972), devendo estar presentes no mínimo quatro das seis chaves, sendo obrigatória a presença da primeira chave de oclusão que é a da relação interarcos. As radiografias foram obtidas com o indivíduo em posição natural da cabeça após a ingestão de contraste de sulfato de bário para evidenciar o controle da língua. Posteriormente foi feito o desenho anatômico das estruturas pesquisadas, marcados os pontos cefalométricos, traçadas as linhas e os planos, e por último obtidas as seguintes medidas lineares: comprimento e altura da língua, distância do dorso da língua na sua porção média até o palato duro e a distância entre a ponta da língua e a incisal do incisivo inferior. Por meio dos resultados encontrados verificou-se que não existe um padrão único de posicionamento de repouso da língua dentro da cavidade oral, em pacientes respiradores nasais, variando muito sua distância até a incisal dos incisivos inferiores, bem como até o palato duro, havendo uniformidade apenas no fato da língua tocar o palato mole em todos os indivíduos da amostra. Não houve relação estatisticamente significante entre a posição de repouso da língua e os biotipos faciais e nem dimorfismo sexual.

AVALIAÇÃO CEFALOMÉTRICA DA ESTABILIDADE PÓS-EXPANSÃO RÁPIDA DA MAXILA ASSISTIDA CIRURGICAMENTE

Este estudo avaliou a estabilidade das alterações dentárias e esqueléticas produzidas pela Expansão Rápida da Maxila Assistida Cirurgicamente (ERMAC), no sentido transversal e vertical. A amostra selecionada para este estudo retrospectivo foi composta de 60 telerradiografias em norma frontal, de 15 pacientes, sendo 6 do sexo masculino e 9 do sexo feminino, com média de idade de 23 anos e 3 meses. Utilizou-se o disjuntor tipo Hyrax e o procedimento cirúrgico foi caracterizado pela osteotomia sagital mediana da maxila e não abordagem da sutura pterigopalatina. O início da ativação ocorreu no terceiro dia pós-operatório, sendo que, os limites para a expansão foram determinados por critérios eminentemente clínicos. Todos os pacientes foram radiografados nas fases pré-expansão (T1), pós-expansão imediata (T2), 3 meses pós- expansão (com o próprio disjuntor como contenção) (T3) e 6 meses pós-expansão (com a placa de acrílico removível como contenção) (T4). Medidas lineares foram obtidas a partir dos traçados cefalométricos gerados por um programa computadorizado (Radiocef Studio 2) e analisadas estatisticamente pelo teste de variância (ANOVA) e Tukey ao nível de 5% de significância. Concluiu-se que a ERMAC produziu um aumento estatisticamente significante, da cavidade nasal, largura maxilar, distância intermolares superiores, de T1 para T2, e que se mantiveram em T3 e T4. A largura facial e as distâncias intermolares inferiores não apresentaram alterações após a ERMAC. Avaliando o comportamento vertical da face, notou-se um aumento da AFAI nos tempos T1 para T2 que, diminuiu após a contenção de 3 meses (T3) e permaneceu estável em T4, embora aumentada se comparada com T1.(AU)

AVALIAÇÃO DAS ALTERAÇÕES DO SORRISO EM INDIVÍDUOS SUBMETIDOS À EXPANSÃO RÁPIDA DA MAXILA

O objetivo deste estudo foi avaliar as possíveis alterações das características horizontais, verticais, de simetria e do arco do sorriso de pacientes com atresia maxilar submetidos à expansão rápida da maxila. A amostra consistiu de 81 fotografias extra-bucais do sorriso máximo de 27 pacientes com idade média de 10 anos e 3 meses. Foram realizadas fotografias do sorriso máximo nos períodos: inicial (antes da instalação do aparelho expansor); 3 meses após a fixação do parafuso expansor; 6 meses após a fixação do parafuso expansor. Para a calibragem e análise das fotografias foi utilizado o programa CEFX 2001 CDT. Os pontos fotométricos e as medidas a serem analisadas foram escolhidos após revisão da literatura do sorriso realizada. Para avaliar as alterações no sorriso durante as fases, foi utilizada a análise de variância ANOVA, com nível de significância de 5%. A expansão rápida da maxila promoveu aumento estatisticamente significante da dimensão transversal do sorriso; aumento da quantidade de exposição dos incisivos centrais e laterais superiores; manutenção da simetria entre os lados direito e esquerdo e da falta de paralelismo entre a curvatura das bordas dos incisivos superiores com a curvatura do lábio inferior (arco do sorriso).(AU)

História oral de vida de pessoas com úlcera venosa nos serviços de atenção primária à saúde

The Chronic Venous insufficiency is characterized as a set of physical changes including how most serious complication of venous ulcers, characterized by irregular and progressive loss of continuity of the skin. The occurrence of venous ulcers in people with chronic venous insufficiency generates dependence on them with health services, with long-term treatments that cause limitations and high-impact changes, affecting their quality of life, affecting the physical, psychological, social, cultural and spiritual as an important public health problem. This study aimed to describe the experience of having a venous ulcer, in the scenario of primary health care services to Health, which includes Primary Care Units and Family Health Strategy in the city of Natal / RN, based on the life histories of users. This is a qualitative study, exploratory and descriptive, with the Oral History of Life as a methodological framework. From the ponto zero was the recruitment of participants who formed the network, totaling six employees, of both sexes and aged between 57 and 79 years. After approval by the Research Ethics Committee - UFRN under the Protocol 653 788/2014 and CAAE 30408014.0.0000.5537 was held data collection, between the months of July and August, through interviews, using identification and characterization of the instrument employees and open questions. Interviews were recorded, transcribed, transcriadas and returned to employees for a conference. The narratives were subjected to Content thematic analysis technique, according to Bardin, allowing the construction of three themes that encompass categories, namely: Axis I - Perspectives on the changes: the impact wound in social relations (changes with ulcer venous, venous ulcer and social and family relationships); Axis II - Brands in body and soul: the story of being hurt (conceptions of the body injured; therapeutic itinerary in primary care services); and Axis III - Reconstruction of being hurt: coping mechanisms (redefinition of the wounded body, resilience to chronic wound). The impact of having a chronic venous ulcer generates impact of physical, psychological and social order. As aspects related to changes after the appearance of venous ulcers, survey participants reported the presence of pain, physical limitations, psychological distress, social and emotional isolation, incapacity, aesthetic discomfort and dependency on health services; the family was the aspect thatshowed no significant change after the occurrence of wound for most participants, an ally in the therapeutic process as a support network. The redefinition of the body and the wound are the main coping mechanism of chronic condition. The services in the Primary Care Network play a fundamental role in the rehabilitation of patients with venous ulcers, although there are difficulties in accessing appropriate treatment and need for expanded services, with permanent professional training of health teams and providing the resources managers to strengthen the comprehensive care of people with venous ulcers in Health Primary Care.

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 in vitro da atividade antimicrobiana de diferentes soluções a base de hidróxido de cálcio

The science of Dentistry wishes obtains the ideal solution for the dental plaque chemical control. This research evaluated antimicrobial action capacity in calcium hydroxide and tergentol various solutions starting for the CHD 20, a root canals irrigating solution with a reason of 80% calcium hydroxide saturated solution and 20% tergentol detergent with the aim of evaluate this drug mouth rinse indication with prevention or combat objective for dental caries and periodontal diseases. Antibiogram disks and biofilm tests were accomplished for the microorganisms: Streptococcus mutans, Streptococcus sanguis, Streptococcus sobrinus and Lactobacillus casei. Different reasons of detergent for the calcium hydroxide saturated solution, tergentol and distillated water solution, 0,12% clorhexydine digluconate solution was positive control and distillated water was negative control. The results showed better performance of clorhexydine in relation to calcium hydroxide directing to not accept this (CHD20) as mouth rinse solution

Efetividade do clareamento dentário com peróxido de carbamida a 10% e avaliação dos efeitos adversos sobre o esmalte dentário

The aim of the present study was to assess the effectiveness and adverse effects on dental enamel caused by nightguard vital bleaching with 10% carbamide peroxide. This was accomplished through the interaction of researchers from different areas such as dentistry, materials engineering and physics. Fifty volunteers took part in the doubleblind randomized controlled clinical trial. They were allocated to an experimental group that used Opalescence PF 10% (OPA) and a control group that used a placebo gel (PLA). Fragments of human dental enamel from the vestibular surface of healthy premolars, extracted for orthodontic reasons, were fixed to the vestibular surface of the first upper molars of the volunteers for in situ observation. Bleaching was performed at night for 21 days. The observation periods included Baseline (BL), T0 (21 days), T30 (30 days after treatment) and T180 (180 days after treatment, only for the OPA group). Tooth color was assessed by comparing it with the Vita® scale and by the degree of satisfaction expressed by the volunteer. We also assessed adverse clinical effects, dental sensitivity and gingival bleeding. The study of adverse effects on enamel was conducted in vivo and in situ, using the DIAGNOdent® laser fluorescence device to detect mineral loss. Scanning electron microscopy (SEM) was used to check for superficial morphological alterations, energy dispersive spectrophotometry (EDS) to semiquantitatively assess chemical composition using the Ca/P ratio, and the x-ray diffraction (XRD) technique to observe alterations in enamel microstructure. The results showed that nightguard vital bleaching with 10% carbamide peroxide was effective in 96% of the cases, versus 8% for the PLA group. Dental sensitivity was present in 36% (9/25) of the cases. There was no significant association between gingival bleeding and the type of gel used (p = 1.00). In vivo laser fluorescence analysis showed no difference in values for the control group, whereas in the OPA group there was a statistically significant difference between baseline values in relation to the subsequent periods (p<0.01), with lower mean values for post-bleaching times. There was a significant difference between the groups for times T0 and T30. Micrographic analysis showed no enamel surface alterations related to the treatment performed. No significant alteration in Ca/P ratio was observed in the OPA group (p = 0.624) or in the PLA group (p = 0.462) for each of the observation periods, nor between the groups studied (p=0.102). The XRD pattern for both groups showed the presence of three-phase Hydroxyapatite according to JCPDS files (9-0432[Ca5(PO4)3(OH)], 18-0303[Ca3(PO4)2.xH2O] and 25-0166[Ca5(PO4)3(OH, Cl, F)]). No other peak associated to other phases was found, independent of the group analyzed, which reveals there was no disappearance, nucleation or phase transformation. Neither was there any alteration in peak pattern location. With the methodology and protocol used in this study, nightguard vital bleaching with 10% carbamide peroxide proved to be an effective and safe procedure for dental enamel

Efetividade do flúor e da escovação e eficácia dos materiais de colagem ionômero de vidro e resina composta na reversão das microporosidades criadas pelo condicionamento ácido no esmalte dentário

The objectives of this clinical study was to evaluate the use of the toothpaste with fluoride and without fluoride and the daily tooth brushing are effective in the reversion of the dental enamel conditioned by acid. Another objective of this clinical study was to evaluate if the positioning of orthodontic accessories with glass ionomer cement helps in the reversion of the dental enamel conditioned by acid, when compared to composed resin. One hundred and twenty teeth were selected with indication of extraction by orthodontic reasons. The 30 volunteers were divided, randomly, in two groups. A group used toothpaste without fluoride and the other with it. The teeth of the sample were shuffled, in each volunteer. The teeth were conditioned by the 37% orthophosphoric acid. One of the conditioned teeth stayed in the mouth and suffered action of the abrasion for the tooth brushing, in another teeth a stainless steel mesh protection was positioned with glass ionomer cement, in another tooth the screen was glued with composed resin, in a fourth tooth (the control) was only conditioned after the extractions, 60 days later. All the teeth were appraised through DIAGNOdent, MEVA and EDS. In the obtained data it was possible to observe that there were not statistic significant differences in any comparison, even in the group that did not have access to the fluoride in the toothpaste as in the other that had. According with the used methodology, it was possible to observe too that there was not statistic significant differences in any comparison, even in the group that had the stainless steel mesh positioned with glass ionomer cement as in the group that the stainless steel mesh was positioned with composed resin. However, it was observed that there was an improvement in the topography of the enamel in all the teeth. The accomplishment of this study was facilitated due to the participation of the researchers' of the health area (dentistry), materials engineer, physics and chemistry. The researchers were originating from the Federal University of Rio Grande do Norte and of the University of Queensland, in Australia. This interdisciplinary group was decisive in the accomplishment of the study. It can be concluded that the enamel tends to return to its initial aspect, even if the patient does not have access to fluoride. That is probably due the action of the abrasion for the tooth brushing and mastication. In spite of it not being significant, it is suggested that the conditioned enamel was more resistant to the abrasion in the group that had access to fluoride. It was also possible to conclude that the fluoride liberated by the glass ionomer was not enough to provide a significant difference in the enamel conditioned by the acid, when compared with the composed resin, even in the group that did not use fluoride in the toothpaste as in the group that used

O tratamento ortodôntico em uma perspectiva a longo prazo: avaliação da estabilidade oclusal e do grau de satisfação dos pacientes

This study aimed to evaluate factors associated to orthodontic treatment stability and patient satisfaction in the long-term. A total of 209 patients (88 class I and 121 class II) treated with straight wire fixed appliance were selected at least 5 years post treatment. Six hundred twenty seven dental casts were examined with the PAR Index at pretreatment (T1), end of treatment (T2), and at long-term follow up (T3, mean 8.5 years post treatment). At T3, a Dental Impact on Daily Living questionnaire was used to assess patient satisfaction with the dentition in the long-term. Friedman test and multiple regression analysis were used to evaluate changes among the time points and factors associated with stability and patient satisfaction. Predictive factors used to exam the occlusion were: PAR Index at T1 and T2, age at T1, the amount of time without retainer, length of Hawley retainer wear, length of follow-up, sex, extraction and third molar status. To assess patient satisfaction were considered: changes produced by the orthodontic treatment (PAR T2-T1), post treatment stability (PAR T3), age at the start of treatment (T1), length of treatment (T2-T1), gender, and extraction. Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at T3. No significant change was observed between T2 and T3. However, when the sample was divided according to the level of finalization (PAR T2), it was observed that well-finished patients experienced some deterioration (P<.001), whereas the less well-finished ones showed some improvement (P<.05). Even with the deterioration, the well-finished patients still had a better PAR Index at T3 compared to the less well-finished ones (PAR T2- T3). Regression analysis showed that PAR Index at T1 and T2, age at T1, and length of retainer wear had a slight association with occlusal stability (R2 = 0.27). Patient satisfaction was significantly associated only with PAR Index at T3 (r2=0.125, P<.0001). We can conclude that, even thought orthodontic treatment is quite stable, not so well-finished treatments tend to show some improvement and well-finished ones deteriorate some in the long-term. Despite of that, well-finished patients still have better occlusal characteristics. Patient satisfaction is not related to the result of orthodontic treatment; nevertheless, there is a slight association with dentition in the long-term

Controle profissional de biofilme dentário como estratégia para manutenção da saúde periodontal de pacientes com aparelho ortodôntico fixo: análise comparativa entre diferentes períodos

The presence of fixed orthodontics appliances interfere on sanitation, allowing periodontal diseases to appear, despite the fact patients keep on visiting the dentist every month. This research aims to determine a protocol for the mechanical control of the dental biofilm performed by the professional. A protocol that was able to maintain the periodontal health of the patients under orthodontic treatment with fixed appliances, and in order to do so, it used a non-controlled, randomized and blind clinical essay. The sample involved 40 adolescents who were under the installation of fixed orthodontics appliances and it was divided in three groups, as follows: monthly controlled group (group 1) composed of 11 patients, the quarterly controlled group (group 2) with 16 patients and the semestrial controlled group (group 3) with 13 patients. For data collection, an interview and clinical exams with probing depth measurement, quantity of keratinized mucosa, Gingival Index and the Plaque Index were used. On the initial exam all patients received brushing guidelines as well as the professional control of dental biofilm, with periodontal scaler, Robinson s brush and prophylactic paste. However, Group 1 returned every month for control procedures; Group 2 every three months and Group 3 after six months. The intervention had a six-month duration (for all the three groups), when all the exams were repeated by another examiner who did not know which group each patient was inserted in. Finally, the research concluded that despite the fact there is no statistically significant difference among the three groups, clinically the patients from the monthly group presented a better response to professional control, with less accumulation of dental biofilm and less rate of gingival inflammation. Thus, the mechanical control of the dental biofilm performed by the professional could not avoid gingival increase, characterized by the raise of probing depth measurement, neither the quantity of keratinized mucosa

Avaliação da eficácia de selante ionomérico modificado por resina e escovação dentária na preservação de cárie oclusal

The purpose of this study was to evaluate the effectiveness during a twelve-month period, of resin-modified glass ionomer (Vitremer@) used as fissure sealants compared to supervised teeth brushing in the prevention of oclusal caries in permarient molars of pubIlc school children from 5 to 7 years of age. A total of 91 children participated in the study, being randomly divided up into three groups of investigation: group with sealant (n=31), group of supervised brushing (m=30), and control gorup (n=30). After 12 months, a total of 28.5% of tosses in the sample of 26 children was registered, and although there wasn t a significant diference between these losses and the groups studles (p = 0.6355), there was a considerable reduction in the sample. The results showed that none of the independentIy studied variables (present caries experience, biofilm, bleeding, sealant retention, position of the tooth in the arch, and sex) interfered in the final results, and that there was no significant difference between applying the sealant in question, perfornling supervised dental brushing, or not intervening at alI (p=0.542). These results could have been a consequence of the limitations found alI through the study, especially relating to the losses occurred because of school evasion, transfer, or because of the accident in the Marise Paiva Municipal School, Keeping students away for approximately one semester, so tht a new reseach had to be developed sos as to better clarify the effects among the treatments done there

Os Centros de Especialidades Odontológicas como suporte da atenção básica: uma avaliação na perspectiva da integralidade

The public dental services in Brazil were limited, practically, to the basic care, so that the specialized services acted, up to 2002, no more than 3,5% of the total of clinical procedures. That lower offer reveals the difficulty of continuity of the attention, that is, the comprehensiveness in the assistance, particulary, the reference and counter-reference system. Brasil Sorridente search to supply those needs when proposing Speciality Dental's Centers(CEOs Centros de Especialidades Odontológicas, Brazil) to compose the services of average complexity. In 2005, Ministry of Health enabled the three CEOs of Natal, located in the North II, East and West Sanitary Districts. This investigation evaluated the implantation of these CEOs, as support of the family health care teams, in the perspective of organization of the services in assistencial nets in Natal/RN. It was a study of evaluation, with qualitative approach and some quantitative data as contribution. Dentists, users and managers were interviewed to identify and to understand their perceptions, relationships and experiences in the daily of the services. The conceptual base that orientated the investigation was the principle of comprehensiveness, in its operational sense of the hierarchization in health attention levels. The collection of data was done with documental research, direct observation and semi-structured interview. The analysis was accomplished by triangulation of the extracted content from the used techniques and sources of interviewed groups depositions, looking for theoretical-conceptual support in specific bibliography. The results pointed aspects that go away from the comprehensiveness like: low resolution of problems in the basic net; little valorization of the space in the health units; traditional models of access to health services, insufficient offer for some specialties, compromising the reference and counter-reference system; practices centered in procedures in the CEO; bureaucratic directions from basic care to the specialized service; disintegrated and disjointed system among levels of attention; disrespect to the municipal protocol. On the other hand, there is an approach of compreensiveness in situations like: increase of the access and covering in the Family Health Strategy (ESF Estratégia Saúde da Família, Brazil); larger approach between professional and user; tendency to the quantitative and qualitative growth of specialized actions; punctual initiatives of relationships among levels; existence of protocol to guide professionals

Avaliação clínica do efeito da irradiação pós-opratória do laser de baixa intensidade na cicatrização de gengivoplastias em humanos

Many studies have been made to understand the process of tissular cicatrization, as well as the possible effects of laser therapy in the wound healing. However, the influence of low frequency laser irradiation in the repairing process is not completely understood. Our study has the purpose to assess clinically the effect of postoperative irradiation of the low frequency laser in humans, and the gingival repairing process postgingivoplasty performed with the extern bevel technique. Twenty-four patients with inflammatory gingival hyperplasia were enrolled in this study, which did not reduce with basic periodontal procedures, and patients with melanin pigmentation, with esthetic indications. After surgery the test group, randomly selected by a drawing, received laser application with energy density of 4 J/cm2, immediately after surgery and each 48 hours, during a week, with a total of 4 sections. The control group did not receive irradiation. The visual clinical analyses were performed by a single blind examiner, in the 2nd, 4th, 6th, 8th, 15th and 21st days post surgery. For statistic analyses of the data was used a Q-square test. Concerning the color, the results showed a better wound healing during days 6 to 8. when assessed the degree of progress of surgical wound, the results showed that the test group had a better cicatrization compared with the control group in the 2nd, 6th, 8th and 15th days post surgery, and at the 21st day both groups had the same results. Our results confirm that the laser had clinical influence in the repairing process after gingivoplasty surgery during days 2 to 15 post surgery