Erupção passiva alterada

Introdução: Nos últimos anos, a estética tem vindo a desempenhar um papel cada vez mais importante na Medicina Dentária. Um sorriso considerado agradável é uma parte indispensável relativamente à harmonia facial e consequentemente à autoestima das pessoas. Quando durante o sorriso há exposição de mais de 3mm de gengiva, este é designado por “sorriso gengival”. Considerado como um sorriso inestético, representa uma queixa muito comum por parte dos pacientes e à qual se tem vindo a dar cada vez mais importância. De entre as várias causas, no âmbito deste trabalho, destaca-se a Erupção Passiva Alterada (EPA). Com uma prevalência de 12% na população geral, a EPA é uma condição de difícil diagnóstico devido aos seus sinais pouco específicos e, por isso, muitas vezes ignorada ao longo dos últimos anos. É um fenómeno que não é previsível e a sua etiologia ainda não é muito clara, mas parece tratar-se de um anormal desenvolvimento a nível dentário, em que uma grande porção da coroa dentária fica coberta por gengiva, dando a aparência de coroas clínicas curtas. Apesar de estar hoje em dia propriamente classificada, não dispensa um cuidadoso diagnóstico para que venha a ser tratada adequadamente. O objetivo deste trabalho é efetuar uma revisão bibliográfica dos principais conceitos relativos à etiologia deste fenómeno e à sua classificação, assim como fazer uma abordagem ao seu diagnóstico e tratamento. Materiais e métodos: Foi realizada uma pesquisa na base de dados da PubMed e Research Gate, utilizando como palavras/expressões-chave: “altered passive eruption” e “delayed passive eruption”. A pesquisa resultou num total de 23 artigos, tendo sido complementada com duas obras literárias de interesse. Resultados/conclusões: Foi possível verificar que, apesar de não haver muitos estudos relativos à EPA, é cada vez mais importante realizar um diagnóstico correto para que o tratamento seja o adequado e irmos de encontro às expectativas do paciente, já que muitas vezes este é um fenómeno não identificado devido às suas características inespecíficas. O tratamento da EPA é feito de acordo com a sua classificação e os seus resultados melhoram bastante a estética do sorriso.

Tooth eruption: altered gene expression in the dental follicle of patients with cleidocranial dysplasia

OBJECTIVES The dental follicle plays an important role in tooth eruption by providing key regulators of osteogenesis and bone resorption. Patients with cleidocranial dysplasia (CCD) exhibit delayed tooth eruption in combination with increased bone density in the maxilla and mandible, suggesting disturbances in bone remodeling. The aim of this study was to determine the expression of genes relevant for tooth eruption and bone remodeling in the dental follicles of patients with CCD and normal subjects. MATERIAL AND METHODS Thirteen dental follicles were isolated from five unrelated patients with CCD, and fourteen dental follicles were obtained from 10 healthy individuals. All teeth were in the intraosseous phase of eruption. The expression of RANK, RANKL, OPG, and CSF-1 was determined by quantitative RT-PCR. RESULTS In patients with CCD, the mRNA levels of RANK, OPG, and CSF-1 were significantly elevated compared with the control group. Accordingly, the ratios of RANKL/OPG and RANKL/RANK mRNAs were significantly decreased in patients with CCD. CONCLUSION The observed alterations in the expression and ratios of the aforementioned factors in the dental follicle of CCD individuals suggest a disturbed paracrine signaling for bone remodeling that could be responsible for the impaired tooth eruption seen in these patients.

A influência do sorriso gengival no vedamentos labial

Ideally the smile should expose minimal gingival, therefore patients with gummy smile and passive eruption altered or excessive marginal gingivae, usually excessive gingival display because incomplete anatomical crown exposure is present. If the maxillary incisor show at rest is optimal, active upper incisor intrusion should not be iniciated. To achieve a smile with minimal gingival exposure, the anatomic crown should be fully exposed by surgical crown lengthening. Precise determination of the location of cementoenamel junction prior to surgery, precise placement of incisions and correct establish of biological width are necessary in order to achive this goal. One protocol is decribed and clinical results from 15 brazilian subjects, after three years post surgery are showed

Tratamento do sorriso gengival: como estabelecer proporção e harmonia

The etiology of gingival smile is multifactorial and the correct diagnosis eill determine a successful treatment planning. Altered passive eruption occurs during the final stages of tooth eruption, when apical migration of the periodontal tissues does not occur, resulting in a distance > 2mm between the alveolar crest and the cement-enamel juncrion. This change leads to the shortening of the clinical crown and even further may lead to excessive gingival exposure. For treatment, there is a necessity for the combined removal of gingiva and bone tissue. This article discusses the literature on the issue and reports a case where periodontal plastic surgery was performed for the correcrion of a gingival smile.

Tratamento estético periodontal: revisão de literatura sobre alguns tipos de cirurgias

Currently, periodontal aesthetics has been prized for harmony of the smile. The clinical crown lengthening, gingival excess or altered passive eruption, is effectively corrected by periodontal surgery. The purpose of this paper is to show, through a literature review, some types of surgery on clinical crown lengthening and root coverage. Clinical crown lengthening is done to Change the size of the anterior teeth and to optimize the cosmetic result of treatment with new coronal restoration and other cosmetic dental care. In general, the treatment plan and the choice of operative technique begin with careful clinical examination. Recessions tissue can be defined as a displacement of the gingival margin toward the junction mucogingival exposing the root surface. These, when present, impacting on patient comfort by providing the occurrence of cervical dentin hypersensitivity, and the esthetic, the amendment of the gum line. Successful treatment of recessions is based on knowledge of its etiology and assessment of predictability of surgical techniques that aim to root coverage. Through literature review, we can conclude that the types of surgery most often used are: 1) to increase the clinical crown, gingivectomy, flap surgery and gingivoplasty osteotomy, and 2) for root coverage, the use will depend on the amount of gum keratinized and especially the classification of Miller.

Case report: Cornelia de Lange Syndrome (CDLS)

The Cornélia of Lange´s syndrome is a genetic anomaly, described and published by Cornelia Catharina of Lange in 1933, however, their aspects were described previously by Winfried Robert Clemens Brechmann in 1916, that’s why it is also known as Brachmann of Lange’s syndrome. The most frequent clinical characteristics include typical face dismorfia, variable degree of mental delay, anomalies of the hands and feet, multiple malformations, retardation of the pre and postnatal physical development and microcephaly variable intellectual compromising. Some facial characteristics are peculiar and they are mixed with the inherited lines of their own family, the united brows, the long lashes, the small nose, the round face, the fine lips and lightly inverted. As oral manifestations they present micrognathia, dental crowding, periodontal disease, delayed dental eruption, enamel hypoplasia, erosion of the enamel and dentine caused by stomach acids of the gastroesophageal reflux and atresia of the dental arches. The purpose of this paper is to present a clinical report of a boy bearer of this syndrome assisted at CAOE - FOA - UNESP, emphasizing the importance of multiprofessional team for the diagnosis and treatment of this syndrome.

Vascular imprints of neuronal activity: Relationships between the dynamics of cortical blood flow, oxygenation, and volume changes following sensory stimulation

Modern functional neuroimaging methods, such as positron-emission tomography (PET), optical imaging of intrinsic signals, and functional MRI (fMRI) utilize activity-dependent hemodynamic changes to obtain indirect maps of the evoked electrical activity in the brain. Whereas PET and flow-sensitive MRI map cerebral blood flow (CBF) changes, optical imaging and blood oxygenation level-dependent MRI map areas with changes in the concentration of deoxygenated hemoglobin (HbR). However, the relationship between CBF and HbR during functional activation has never been tested experimentally. Therefore, we investigated this relationship by using imaging spectroscopy and laser-Doppler flowmetry techniques, simultaneously, in the visual cortex of anesthetized cats during sensory stimulation. We found that the earliest microcirculatory change was indeed an increase in HbR, whereas the CBF increase lagged by more than a second after the increase in HbR. The increased HbR was accompanied by a simultaneous increase in total hemoglobin concentration (Hbt), presumably reflecting an early blood volume increase. We found that the CBF changes lagged after Hbt changes by 1 to 2 sec throughout the response. These results support the notion of active neurovascular regulation of blood volume in the capillary bed and the existence of a delayed, passive process of capillary filling.

Aumento de coroa clínica

O sorriso não se baseia apenas em factores dentários relacionados com a cor, a forma ou o alinhamento dos dentes na arcada, mas implica também a presença de tecidos periodontais saudáveis e com um contorno gengival harmónico. Este trabalho tem como objectivo abordar as diversas técnicas de aumento de coroa clínica, enunciar as vantagens e indicações das mesmas, bem como comparar as técnicas cirúrgicas com as ortodônticas. Para tal foi realizada uma pesquisa bibliográfica recorrendo aos motores de busca da Pubmed e b-on, utilizando como palavras-chave: crown lengthening, biological width, crown lengthening AND surgery e crown lengthening AND orthodontic extrusion. Dos 539 artigos encontrados, foram seleccionados 28 que correspondiam aos critérios de inclusão por nós estabelecidos. Critérios de inclusão: meta-análises, ensaios clínicos randomizados e revisões sistemáticas publicadas em Português, Inglês e Espanhol nos últimos 12 anos. De acordo com a literatura, podemos verificar que o aumento de coroa clínica está indicado em várias situações clínicas tais como: cáries infra-gengivais, fracturas radiculares, resolução de alguns problemas estéticos, como o sorriso gengival, principalmente em casos de erupção passiva alterada e assimetrias das margens gengivais. Este aumento pode ser realizado por técnicas cirúrgicas (gengivectomia e retalho de reposicionamento apical), técnicas ortodônticas (extrusão ortodôntica com ou sem fibrotomia) ou através da combinação de ambas.

Técnicas de alongamento coronário

Introdução: O alongamento coronário é um procedimento que pode envolver, ou não, técnicas cirúrgicas, e que tem como principal objetivo aumentar o tamanho da coroa clínica, assim como devolver a estética, a forma e a função às arcadas dentárias. Este procedimento realiza-se, ou por motivos estéticos ou motivos restauradores. Ultimamente, os motivos estéticos têm vindo a ganhar importância e são eles que, muitas da vezes, levam os pacientes às consultas de medicina dentária. O sorriso gengival é um desses motivos, e pode ser causado, entre outras razões por, uma erupção passiva alterada ou/e um excesso vertical maxilar. Estas são as etiologias que serão descritas neste trabalho. O aumento coronário realiza-se, também, quando há a necessidade de reabilitar um dente, quer seja com resinas compostas ou com coroas. Este, deve sempre respeitar os limites biológicos do periodonto, nomeadamente o espaço biológico. A invasão deste espaço pode por em risco a manutenção da saúde do periodonto e a viabilidade do tratamento a longo prazo, por isto, preconiza-se que deve ser deixado um espaço de 3mm, desde a crista óssea até a margem restauradora. As técnicas de alongamento coronário enumeradas e definidas ao longo desta tese são: a gengivectomia, o retalho apicalmente posicionado e a erupção dentária forçada. Cada uma delas possui as suas indicações e contra-inidcaçoes. A gengivectomia é realizada quando não há necessidade de recontorno ósseo, pelo contrário, quando essa necessidade existe opta-se pelo retalho apicalmente posicionado. A erupção forçada é uma alternativa ao alongamento cirúrgico e aplica-se, normalmente a dentes não restauráveis mas com estrutura dentária sã abaixo do da crista óssea. Um ótimo diagnóstico é o essencial para a escolha da técnica de aumento coronário que melhor se adequa a cada caso. Objetivo: O objetivo desta revisão bibliográfica tem por base a pesquisa das técnicas de alongamento coronário, começando por perceber a anatomia do periodonto, as alterações que nele acontecem antes e depois dos procedimentos de alongamento coronário, a descrição e a comparação dos mesmos. Materiais e métodos: Para a realização desta revisão foram utilizados os principais motores de busca de dados científicos como a PubMed, B-on, Medline, Scielo, Google Académico e ainda o repositório on-line da Universidade Fernando Pessoa. Foram utilizadas as seguintes palavras chaves: “altered passive eruption”, “gingivectomy”, “gingivoplasty”, “apically repositioned flap”, “surgical crown lengthening”, “biologic width”, “mucogengival junction”, “forced eruption”, “prostethic dentistry”, “gummy smile”, resultando num pesquisa de 45 artigos e duas obras literarátias de interesse. Conclusões: Foi possível concluir que existem varias técnicas de alongamento coronário, cada uma adequada a cada caso e verificou-se que existem vários motivos pelo qual se realiza essa técnica.

Intellectual disability, coarse face, relative macrocephaly, and cerebellar hypotrophy in two sisters

We report on two Portuguese sisters with a very similar phenotype characterized by severe intellectual disability, absent speech, relative macrocephaly, coarse face, cerebellar hypotrophy, and severe ataxia. Additional common features include increased thickness of the cranial vault, delayed dental eruption, talipes equino-varus, clinodactyly, and camptodactyly of the fifth finger. The older sister has retinal dystrophy and the younger sister has short stature. Their parents are consanguineous. We suggest this condition constitutes a previously unreported autosomal recessive entity.

Effect of paradoxical sleep deprivation and stress on passive avoidance behavior

Previous studies have shown that several types of stress can induce memory impairment. However, the memory effects of paradoxical sleep deprivation (PSD), a stressor in itself, are unclear. We therefore compared passive avoidance behavior of rats undergoing PSD and PSD stress yoked-control (PSC) using the "reversed flowerpot method." When rats were kept isolated on a PSC platform for 24 It immediately after criterion training, retention trials showed impaired aversive memory storage. When delayed for 24 h after criterion training, PSC stress did not disrupt retention performance. In rats subjected to PSD, either immediately or 24 It after criterion training, there was no disruption of aversive memory consolidation. These results suggest that, during stress, paradoxical sleep plays a role in erasing aversive memory traces, in line with the theory that we "dream in order to forget." (C) 2003 Elsevier Inc. All rights reserved.

Sensitivity analysis of a time-delayed thermo-acoustic system via an adjoint-based approach

We apply adjoint-based sensitivity analysis to a time-delayed thermo-acoustic system: a Rijke tube containing a hot wire. We calculate how the growth rate and frequency of small oscillations about a base state are affected either by a generic passive control element in the system (the structural sensitivity analysis) or by a generic change to its base state (the base-state sensitivity analysis). We illustrate the structural sensitivity by calculating the effect of a second hot wire with a small heat-release parameter. In a single calculation, this shows how the second hot wire changes the growth rate and frequency of the small oscillations, as a function of its position in the tube. We then examine the components of the structural sensitivity in order to determine the passive control mechanism that has the strongest influence on the growth rate. We find that a force applied to the acoustic momentum equation in the opposite direction to the instantaneous velocity is the most stabilizing feedback mechanism. We also find that its effect is maximized when it is placed at the downstream end of the tube. This feedback mechanism could be supplied, for example, by an adiabatic mesh. We illustrate the base-state sensitivity by calculating the effects of small variations in the damping factor, the heat-release time-delay coefficient, the heat-release parameter, and the hot-wire location. The successful application of sensitivity analysis to thermo-acoustics opens up new possibilities for the passive control of thermo-acoustic oscillations by providing gradient information that can be combined with constrained optimization algorithms in order to reduce linear growth rates. © Cambridge University Press 2013.

Impacts of passive warming chambers on soil parameters in Antarctica

Passive chambers are used to examine the impacts of summer warming in Antarctica but, so far, impacts occurring outside the growing season, or related to extreme temperatures, have not been reported, despite their potentially large biological significance. In this review, we synthesise and discuss the microclimate impacts of passive warming chambers (closed, ventilated and Open Top Chamber-OTC) commonly used in Antarctic terrestrial habitats, paying special attention to seasonal warming, during the growing season and outside, extreme temperatures and freeze-thaw events. Both temperature increases and decreases were recorded throughout the year. Closed chambers caused earlier spring soil thaw (8-28 days) while OTCs delayed soil thaw (3-13 days). Smaller closed chamber types recorded the largest temperature extremes (up to 20°C higher than ambient) and longest periods (up to 11 h) of above ambient extreme temperatures, and even OTCs had above ambient temperature extremes over up to 5 consecutive hours. The frequency of freeze-thaw events was reduced by ~25%. All chamber types experienced extreme temperature ranges that could negatively affect biological responses, while warming during winter could result in depletion of limited metabolic resources. The effects outside the growing season could be as important in driving biological responses as the mean summer warming. We make suggestions for improving season-specific warming simulations and propose that seasonal and changed temperature patterns achieved under climate manipulations should be recognised explicitly in descriptions of treatment effects.

Time domain passivity control for delayed teleoperation

La telepesencia combina diferentes modalidades sensoriales, incluyendo, entre otras, la visual y la del tacto, para producir una sensación de presencia remota en el operador. Un elemento clave en la implementación de sistemas de telepresencia para permitir una telemanipulación del entorno remoto es el retorno de fuerza. Durante una telemanipulación, la energía mecánica es transferida entre el operador humano y el entorno remoto. En general, la energía es una propiedad de los objetos físicos, fundamental en su mutual interacción. En esta interacción, la energía se puede transmitir entre los objetos, puede cambiar de forma pero no puede crearse ni destruirse. En esta tesis, se aplica este principio fundamental para derivar un nuevo método de control bilateral que permite el diseño de sistemas de teleoperación estables para cualquier arquitectura concebible. El razonamiento parte del hecho de que la energía mecánica insertada por el operador humano en el sistema debe transferirse hacia el entorno remoto y viceversa. Tal como se verá, el uso de la energía como variable de control permite un tratamiento más general del sistema que el control convencional basado en variables específicas del sistema. Mediante el concepto de Red de Potencia de Retardo Temporal (RPRT), el problema de definir los flujos de energía en un sistema de teleoperación es solucionado con independencia de la arquitectura de comunicación. Como se verá, los retardos temporales son la principal causa de generación de energía virtual. Este hecho se observa con retardos a partir de 1 milisegundo. Esta energía virtual es añadida al sistema de forma intrínseca y representa la causa principal de inestabilidad. Se demuestra que las RPRTs son transportadoras de la energía deseada intercambiada entre maestro y esclavo pero a la vez generadoras de energía virtual debido al retardo temporal. Una vez estas redes son identificadas, el método de Control de Pasividad en el Dominio Temporal para RPRTs se propone como mecanismo de control para asegurar la pasividad del sistema, y as__ la estabilidad. El método se basa en el simple hecho de que esta energía virtual debido al retardo debe transformarse en disipación. As__ el sistema se aproxima al sistema deseado, donde solo la energía insertada desde un extremo es transferida hacia el otro. El sistema resultante presenta dos cualidades: por un lado la estabilidad del sistema queda garantizada con independencia de la arquitectura del sistema y del canal de comunicación; por el otro, el rendimiento es maximizado en términos de fidelidad de transmisión energética. Los métodos propuestos se sustentan con sistemas experimentales con diferentes arquitecturas de control y retardos entre 2 y 900 ms. La tesis concluye con un experimento que incluye una comunicación espacial basada en el satélite geoestacionario ASTRA. ABSTRACT Telepresence combines different sensorial modalities, including vision and touch, to produce a feeling of being present in a remote location. The key element to successfully implement a telepresence system and thus to allow telemanipulation of a remote environment is force feedback. In a telemanipulation, mechanical energy must convey from the human operator to the manipulated object found in the remote environment. In general, energy is a property of all physical objects, fundamental to their mutual interactions in which the energy can be transferred among the objects and can change form but cannot be created or destroyed. In this thesis, we exploit this fundamental principle to derive a novel bilateral control mechanism that allows designing stable teleoperation systems with any conceivable communication architecture. The rationale starts from the fact that the mechanical energy injected by a human operator into the system must be conveyed to the remote environment and Vice Versa. As will be seen, setting energy as the control variable allows a more general treatment of the controlled system in contrast to the more conventional control of specific systems variables. Through the Time Delay Power Network (TDPN) concept, the issue of defining the energy flows involved in a teleoperation system is solved with independence of the communication architecture. In particular, communication time delays are found to be a source of virtual energy. This fact is observed with delays starting from 1 millisecond. Since this energy is added, the resulting teleoperation system can be non-passive and thus become unstable. The Time Delay Power Networks are found to be carriers of the desired exchanged energy but also generators of virtual energy due to the time delay. Once these networks are identified, the Time Domain Passivity Control approach for TDPNs is proposed as a control mechanism to ensure system passivity and therefore, system stability. The proposed method is based on the simple fact that this intrinsically added energy due to the communication must be transformed into dissipation. Then the system becomes closer to the ambitioned one, where only the energy injected from one end of the system is conveyed to the other one. The resulting system presents two benefits: On one hand, system stability is guaranteed through passivity independently from the chosen control architecture and communication channel; on the other, performance is maximized in terms of energy transfer faithfulness. The proposed methods are sustained with a set of experimental implementations using different control architectures and communication delays ranging from 2 to 900 milliseconds. An experiment that includes a communication Space link based on the geostationary satellite ASTRA concludes this thesis.