Use of a new fibrin sealant and laser irradiation in the repair of skull defects in rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Noninvasive and multidisciplinary approach to the functional and esthetic rehabilitation of amelogenesis imperfecta: a pediatric case report

Case Report. An 8-year-old girl with amelogenesis imperfecta (AI) reported unsatisfactory aesthetics, difficulty in mastication, and dental hypersensitivity. The intraoral examination observed mixed dentition, malocclusion in anteroposterior relationships, anterior open bite, and dental asymmetry. A hypoplastic form of AI was diagnosed in the permanent dentition. A multidisciplinary planning was performed and divided into preventive, orthopedic, and rehabilitation stages. Initially, preventive treatment was implemented, with fluoride varnish applications, in order to protect the fragile enamel and reduce the dental sensitivity. In the second stage, the patient received an interceptive orthopedic treatment to improve cross-relationship of the arches during six months. Finally, the rehabilitation treatment was executed to establish the vertical dimension. In the posterior teeth, indirect composite resin crowns were performed with minimally invasive dental preparation. Direct composite resin restorations were used to improve the appearance of anterior teeth. Follow-Up. The follow-up was carried out after 3, 6, 12, and 18 months. After 18 months of follow-up, The restoration of integrity, oral hygiene, and patient satisfaction were observed . Conclusion. Successful reduction of the dental hypersensitivity and improvement of the aesthetic and functional aspects as well as quality of life were observed.

Evaluation of crystallized biosilicate in the reconstruction of calvarial defects

The objective of this study was to assess the bone repair process of crystallized Biosilicate in surgically created defects on rats' calvaria. This biomaterial was recently developed for odontological use. We used fifteen rats (rattus norvegicus albinus, Wistar), and two 5 mm surgical defects were performed on each of them; the defects were made with trephine drill on the calvarium region prior to the biomaterial placement. Groups were divided as follows: Group 1-defect filled with clot; Group 2-defect filled with crystallized Biosilicate. After 7, 14 and 28 days the animals were killed, the parts were retrieved and slides were prepared for histological studies. Bone formation was satisfactory in all groups, with direct contact between biomaterial surface and bone and absence of infection signs. The 28 days periods showed better results, and statistically significant difference between Clot Group (90.2 %) and Biosilicate (58 %; p = 0.002) was seen, regarding presence of bone tissue on the surgical defects. Our study revealed that defects filled with clot present better results on bone formation compared to crystallized Biosilicate, which is considered a biocompatible material with favorable osteoconductive properties.

Reconstruction of maxillary ridge atrophy caused by sequela of dentoalveolar trauma with autogenous bone graft harvested from mentum

Dentoalveolar traumatisms, particularly those that affect the anterior teeth, interfere adversely in the patient s life.Among them, tooth avulsion is pointed out because it is characterized as a complex injury that affects multiple tissues, andbecause there is no effective treatment available for its resolution with a stable long-term outcome.Aim/Hypothesis: The aim of the present study was to relate a clinical case of complete reconstruction of atrophy of the alveolarbone corresponding to tooth 11, lost by tooth resorption 10 years after the tooth reimplantation procedure.Material and methods: Reconstruction was performed with autogenous bone harvested from the mentum donor site. Surgicalaccess began in the receptor area with a Newman mucoperiosteal incision using a scalpel blade 15 mounted in a scalpel handlefor detachment and exposure of the receptor site. Extensive bone resorption was observed in the vestibular-palatine direction,proved by the thinness of the receptor bed. Decorticalization of the vestibular bone plate was performed. After preparing thereceptor bed, and incision was made in the mucosa in the depth of the anterior vestibular fornix, then a perpendicular muscleperiostealincision to detach and exposure the donor area. The bone graft necessary for reconstruction of the donor area wasdelimited, followed by monocortical osteotomy and the monocortical graft was removed. The next stage was to perform shapingfor passive graft accommodation and fixation by means of two bicortical screws. After fixation of the graft the sharp angles wererounded off in order to avoid possible exposure and/or fenestrations of the reconstructed area, then the receptor and donor areawere sutured. After the 6-month period to allow incorporation of the autogenous graft, an osseointegrated dental implant wasinserted. At the end of the 6-month period of waiting for osseointegration to occur, the process of fabricating the screw-retainedmetal ceramic

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 1: overall aspects

C left lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of So Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

Complications of misdiagnosis of maxillary canine ectopic eruption

Ectopic eruption of maxillary canines can be associated with root resorption of adjacent teeth. This case report describes and discusses an interesting case of a 15-year-old girl with a Class III malocclusion and an impacted maxillary canine. Because of the unfavorable position of the ectopic canine and the severe root resorption of the maxillary left central and lateral incisors, the treatment options included extraction of the maxillary permanent canines. The mandibular first premolars were extracted to compensate for the Class III malocclusion. A panoramic radiograph taken earlier in the mixed dentition already indicated a possible eruption disturbance of the maxillary left permanent canine. The importance of early diagnosis of maxillary canine ectopic eruption is highlighted in this case report. The early identification of radiographic signs of an ectopic pathway of eruption should be followed by deciduous canine extraction to prevent canine retention and maxillary incisor root resorption. (Am J Orthod Dentofacial Orthop 2012;142:256-63)

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) – part 4

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Effects of active and passive lacebacks on antero-posterior position of maxillary first molars and central incisors

The purpose of this study was to compare the effects of active and passive lacebacks on antero-posterior position of maxillary first molars and central incisors during leveling phase. Twenty-three subjects with Class I and Class II malocclusion were treated with first premolars extraction using preadjusted appliances (MBT 0.022-inch brackets). The leveling phase was performed with stainless steel archwires only. The sample was divided into 2 groups: 14 subjects received active lacebacks (Group 1) and 9 subjects received passive lacebacks (Group 2). Lacebacks were made from 0.008-inch ligature wire. Lateral cephalometric radiographs were taken pre- and post-leveling phase. Student's t-test was applied to determine the differences between pre- and post-leveling mean values and to determine the mean differences between groups. In Group I, the first molars showed a significant mesial movement, whereas no change was observed in Group 2. In both groups, maxillary central incisor crowns moved to lingual side. In conclusion, active laceback produced anchorage loss of maxillary first molars whereas passive laceback did not affect the position of these teeth. Active and passive lacebacks were effective in preventing central incisor proclination.

Influence of cervical preflaring on determination of apical file size in the palatal roots of maxillary molars

PURPOSE: The aim of this study was to investigate the influence of cervical preflaring in determining the initial apical file (IAF) in the palatal roots of maxillary molars, and to determine the morphologic shape of the canal 1 mm short of the apex. METHODS: After preparing standard access cavities the group 1 received the IAF without cervical preflaring (WCP). In groups 2 to 5, preflaring was performed with Gates-Glidden (GG), Anatomic Endodontics Technology (AET), GT Rotary Files (GT) and LA Axxes (LA), respectively. Each canal was sized using manual K-files, starting with size 08 files, and making passive movements until the WL was reached. File sizes were increased until a binding sensation was felt at the WL. The IAF area and the area of the root canal were measured to verify the percentage occupied by the IAF inside the canal in each sample by SEM. The morphologic shape of the root canal was classified as circular, oval or flattened. Statistical analysis was performed by ANOVA/Tukey test (P < 0.05). RESULTS: The decreasing percentages occupied by the IAF inside the canal were: LA>GT=AET>GG>WCP. The morphologic shape was predominantly oval. CONCLUSION: The type of cervical preflaring used interferes in the determination of IAF.

Stability of maxillary anterior crowding treatment

OBJECTIVE: To evaluate the stability and the relapse of maxillary anterior crowding treatment on cases with premolar extraction and evaluate the tendency of the teeth to return to their pretreatment position. METHODS: The experimental sample consisted of 70 patients of both sex with an initial Class I and Class II maloclusion and treated with first premolar extractions. The initial mean age was 13,08 years. Dental casts' measurements were obtained at three stages (pretreatment, posttreatment and posttreatment of 9 years on average) and the variables assessed were Little Irregularity Index, maxillary arch length and intercanine. Pearson correlation coefficient was used to know if some studied variable would have influence on the crowding in the three stages (LII1, LII2, LII3) and in each linear displacement of the Little irregularity index (A, B, C, D, E) in the initial and post-retention phases. RESULTS: The maxillary crowding relapse ( LII3-2) is influenced by the initial ( LII1), and the teeth tend to return to their pretreatment position. CONCLUSION: The results underline the attention that the orthodontist should be given to the maxillary anterior relapse, primarily on those teeth that are crowded before the treatment.

4H silicon carbide particle detectors: study of the defects induced by high energy neutron irradiation

During the last decade advances in the field of sensor design and improved base materials have pushed the radiation hardness of the current silicon detector technology to impressive performance. It should allow operation of the tracking systems of the Large Hadron Collider (LHC) experiments at nominal luminosity (1034 cm-2s-1) for about 10 years. The current silicon detectors are unable to cope with such an environment. Silicon carbide (SiC), which has recently been recognized as potentially radiation hard, is now studied. In this work it was analyzed the effect of high energy neutron irradiation on 4H-SiC particle detectors. Schottky and junction particle detectors were irradiated with 1 MeV neutrons up to fluence of 1016 cm-2. It is well known that the degradation of the detectors with irradiation, independently of the structure used for their realization, is caused by lattice defects, like creation of point-like defect, dopant deactivation and dead layer formation and that a crucial aspect for the understanding of the defect kinetics at a microscopic level is the correct identification of the crystal defects in terms of their electrical activity. In order to clarify the defect kinetic it were carried out a thermal transient spectroscopy (DLTS and PICTS) analysis of different samples irradiated at increasing fluences. The defect evolution was correlated with the transport properties of the irradiated detector, always comparing with the un-irradiated one. The charge collection efficiency degradation of Schottky detectors induced by neutron irradiation was related to the increasing concentration of defects as function of the neutron fluence.

Synthesis of Hand Exoskeletons for the Rehabilitation of Post-Stroke Patients

This dissertation presents the synthesis of a hand exoskeleton (HE) for the rehabilitation of post-stroke patients. Through the analysis of state-of-the-art, a topological classification was proposed. Based on the proposed classification principles, the rehabilitation HEs were systematically analyzed and classified. This classification is helpful to both understand the reason of proposing certain solutions for specific applications and provide some useful guidelines for the design of a new HE, that was actually the primary motivation of this study. Further to this classification, a novel rehabilitation HE was designed to support patients in cylindrical shape grasping tasks with the aim of recovering the basic functions of manipulation. The proposed device comprises five planar mechanisms, one per finger, globally actuated by two electric motors. Indeed, the thumb flexion/extension movement is controlled by one actuator whereas a second actuator is devoted to the control of the flexion/extension of the other four fingers. By focusing on the single finger mechanism, intended as the basic model of the targeted HE, the feasibility study of three different 1 DOF mechanisms are analyzed: a 6-link mechanism, that is connected to the human finger only at its tip, an 8-link and a 12-link mechanisms where phalanges and articulations are part of the kinematic chain. The advantages and drawbacks of each mechanism are deeply analyzed with respect to targeted requirements: the 12-link mechanism was selected as the most suitable solution. The dimensional synthesis based on the Burmester theory as well as kinematic and static analyses were separately done for all fingers in order to satisfy the desired specifications. The HE was finally designed and a prototype was built. The experimental results of the first tests are promising and demonstrate the potential for clinical applications of the proposed device in robot-assisted training of the human hand for grasping functions.

Cognitive Assessment and Rehabilitation of subjects with Traumatic Brain Injury

This thesis regards the study and the development of new cognitive assessment and rehabilitation techniques of subjects with traumatic brain injury (TBI). In particular, this thesis i) provides an overview about the state of art of this new assessment and rehabilitation technologies, ii) suggests new methods for the assessment and rehabilitation and iii) contributes to the explanation of the neurophysiological mechanism that is involved in a rehabilitation treatment. Some chapters provide useful information to contextualize TBI and its outcome; they describe the methods used for its assessment/rehabilitation. The other chapters illustrate a series of experimental studies conducted in healthy subjects and TBI patients that suggest new approaches to assessment and rehabilitation. The new proposed approaches have in common the use of electroencefalografy (EEG). EEG was used in all the experimental studies with a different purpose, such as diagnostic tool, signal to command a BCI-system, outcome measure to evaluate the effects of a treatment, etc. The main achieved results are about: i) the study and the development of a system for the communication with patients with disorders of consciousness. It was possible to identify a paradigm of reliable activation during two imagery task using EEG signal or EEG and NIRS signal; ii) the study of the effects of a neuromodulation technique (tDCS) on EEG pattern. This topic is of great importance and interest. The emerged founding showed that the tDCS can manipulate the cortical network activity and through the research of optimal stimulation parameters, it is possible move the working point of a neural network and bring it in a condition of maximum learning. In this way could be possible improved the performance of a BCI system or to improve the efficacy of a rehabilitation treatment, like neurofeedback.

Extraction of maxillary first molars improves second and third molar inclinations in Class II Division 1 malocclusion

The aim of this study was to assess the changes in inclination of the maxillary second (M2) and third (M3) molars after orthodontic treatment of Class II Division 1 malocclusion with extraction of maxillary first molars.

The transposition advancement flap for repair of postsurgical defects on the upper lip

Skin cancer of the lip is frequent, and reconstruction after Mohs surgery might be challenging mostly when the postsurgical defect has a size of more than 1 cm(2) and is situated adjacent to the philtrum.