Reabilitação Estética Anterior: a Propósito de um Caso Clínico

ResumoA presença de múltiplas lesões dentárias compromete significativamente a função e a estética do paciente. A prevalência de lesões cervicais (cariosas e não cariosas) é grande em adultos e a sua severidade aumenta com a idade.Com este trabalho pretende-se abordar as lesões classes V, identificar os diferentes factores etiológicos, caracterizálas e diagnosticá-las, e ainda, apresentar o protocolo de tratamento.De acordo com a revisão bibliográfica efectuada e o caso clínico apresentado, concluiu-se que as lesões classe V apresentam uma etiologia multifactorial e que o sucesso do tratamento restaurador está directamente relacionado com a eliminação da causa, bem como com a escolha do material restaurador adequadoAbstractThe presence of multiple dental lesions significantly compromises the function and the aesthetic of the patient. The prevalence of cervical lesions (carious and noncarious) is high in adults and its severity increases with the age.With this work it is intended to approach the dental lesions class V, to identify the different etiologic factors, to characterize and to diagnosis them, and to present the treatment protocol.In accordance with the bibliographical revision and the presented clinical case, it was concluded that the dental lesions class V present an multifactorial etiology and that the success of the restoring treatment is directly related with the elimination of the cause, as well as with the choice of the adjusted restoring material

Dental caries and bacterial load in saliva and dental biofilm of type 1 diabetics on continuous subcutaneous insulin infusion

Objectives: Since most of the studies evaluates diabetics on multiple daily injections therapy and continuous subcutaneous insulin infusion may help gain better metabolic control and prevent complications, the objective of this study was to evaluate the prevalence of dental caries, the unstimulated salivary flow rate and the total bacteria load, Streptococcus spp. levels and Lactobacillus spp. levels in saliva and supragingival dental biofilm of type 1 diabetics on insulin pump. Material and Methods: Sixty patients with type 1 diabetes on insulin pump and 60 nondiabetic individuals were included. The dental caries evaluation was performed using ICDAS and the oral hygiene was assessed according to Greene and Vermillion Simplified Oral Hygiene Index. Unstimulated saliva and supragingival dental biofilm were collected. Total bacteria, Streptococcus spp. and Lactobacillus spp. was quantified by qPCR. Results:Patients with type 1 diabetes had a higher prevalence of dental caries and filled and missing teeth when compared with the control group. These patients were associated with more risk factors for the development of dental caries, namely a lower unstimulated salivary flow rate and a higher bacterial load in saliva and dental biofilm. Conclusion: Some risk factors related to dental caries were associated with type 1 diabetics. An early diagnosis combined with the evaluation of the risk profile of the diabetic patient is imperative, allowing the dental caries to be analyzed through a perspective of prevention and the patient to be integrated into an individualized oral health program

Effects on gastric mucosa induced by dental bleaching – an experimental study with 6% hydrogen peroxide in rats

The value of aesthetic dentistry has precipitated several developments in the investigation of dental materials related to this field. The free marketing of these products is a problem and it is subject to various interpretations regarding its legality. There are several techniques for tooth whitening, the most used one being the external bleaching. It is the later version of such technique that poses the greatest danger of ingesting the product. The present study analysed the systemic effect of these products when they are swallowed.Objective This experimental study aimed to observe the effects of a tooth whitening product, whose active agent is 6% hydrogen peroxide, on the gastric mucosa of healthy and non-tumour gastric pathology animals.Material and Methods Fifty Wistar-Han rats were used and then distributed into 5 groups, one for control and four test groups in which the bleaching product was administered in animals with and without non-tumour gastric pathology (induced by the administration of 1 sample of 50% ethanol and 5% of drinking water during 6 days) at different times of study by gavage. There was a decrease in body weight in animals of groups handled during the study period, which was most pronounced in IV and VA groups. Changes in spleen weight relative to body weight revealed no statistically significant changes. An analysis of the frequency was performed on the results of macroscopic observation of the gastric mucosa.Results The gastric mucosa revealed lesions in all manipulated groups, being more frequent in groups III and IV. It appears that there is a synergism when using hydrogen peroxide and 50% ethanol in the same group.Conclusion Therefore, it seems that there are some signs of toxicity 3 to 4 days after administration of 6% hydrogen peroxide. The prescription of these therapies must be controlled by the clinician and the risks must be minimized

Microleakage study of a restorative material via radioisotope methods

AbstractObjectivesTo validate the quantitative method used in the evaluation of microleakage and to evaluate the microleakage of dental restorations using GCP Fill. The null hypothesis was that the restorative system doesn’t have any influence regarding microleakage.MethodsSixty noncarious extracted human molars were cut in two equal halves occlusogingivally and Class V cavities were prepared on the buccal or lingual surfaces of each tooth. The specimens were randomly divided into 4 groups. Two were restored with GCP Fill, while another was restored with Filtek Supreme. The control group was not restored. The specimens were stored in distilled water at 37°C for 7 days before 500 cycles of thermocycling between 5°C and 55°C, dwell time of 30s. The specimens were submersed in a solution of 99mTc-pertechnetate for 3h and the radioactivity was determined. The nonparametric Kruskal–Wallis and Mann–Whitney test with Bonferroni correction at a significance level of 5% were used for statistical analyses.ResultsThere were statistically significant differences between experimental groups and control groups (p<0.05). Apart from these differences, a significant difference was observed between negative and positive control groups (p<0.001). In the control+group there was a large microleakage, and the control-group received minimum counts.ConclusionThe GCP Fill and the Filtek Supreme XTE do not differ as regards microleakage; this technique proved to be simple, quick and fulfilled the objective of a quantitative method in the evaluation of microleakage. Long-term clinical studies need to be carried out to substantiate these results

Autogenous tooth transplantation : evaluation of pulp tissue regeneration

Objective: The aim of this study was to assess the pulp survival that occur in transplants of autologous teeth, by comparing two surgical techniques: the conventional technique (autotransplantation for newly formed alveoli), and an alternative technique, (autotransplants for alveoli in the initial phase of healing). In each surgical techniques were applied, randomly, either saline solution or Emdogain ®. Study Design:The study group comprised 26 patents, in which 28 teeth were transplanted to recipient sockets prepared mechanically. Of the 28 teeth transplanted, 4 were intentional replants, and of the remainer, 11 had the apex closed and 13 open. The mean age at the time of transplantation was 22.34±8.14 years (mean ± SD). The transplantation were performed by the same operator, with the informed consent of the patient and authorized by the ethical committee of the hospital. Clinical and radiological examinations were performed during 24 to 65 months (48±12.96; MED±SD), from 10 days, 1 month, 3 months, 6 months and annually to 5.6 years. Results: Only two transplanted teeth were lost, due persistent apical periodontitis, and one transplanted patient with open apex missed the treatment. In the teeth with pulp, we needed to perform root canal therapy in 9. In the 73% of the teeth with closed apex, we needed to perform root canal treatment, with no statistically significant difference found among closed apex and root canal therapy (p=0.083). In only 8% of the teeth with open apex did we need to perform root canal treatment, with an association between open apex and root canal therapy (p=0.0002). The overall success rate was 98% with significant difference for losses (p=0.0001). Conclusions: Although not a frequent procedure, it was concluded that autotransplanted teeth, performed with appropriate surgical care had a good prognosis, and can render a very useful service to the patients. © Medicina Oral S. L

Sealing efficacy of system B versus Thermafil and Guttacore obturation techniques evidenced by scintigraphic analysis

This study compared root canal sealing ability, filled by Continuous Wave compaction and two carrier-based obturation systems, using the nuclear medicine approach. Fifty-five single-rooted extracted teeth were selected. The crowns were sectioned and each tooth was instrumented using rotary Protaper® Universal system. The roots were divided into 3 experimental groups and two control groups. Forty-five root canals were filled, using Continuous Wave, GuttaCore or Thermafil system and TopSeal sealer. Ten teeth were used as control. On the 7th days the apices were submersed in a solution of sodium pertechnetate 99mTc for 3 hours and the radioactivity was counted. Although apical leakage in the Continuous Wave group was lower compared with GuttaCore and Thermafil groups, there was no statistical difference (p>0.05). System B, GuttaCore and Thermafil techniques showed a similar sealing effect

Evaluation of dentinogenesis inducer biomaterials: an in vivo study

When exposure of the pulp to external environment occurs, reparative dentinogenesis can be induced by direct pulp capping to maintain pulp tissue vitality and function. These clinical situations require the use of materials that induce dentin repair and, subsequently, formation of a mineralized tissue. Objective: This work aims to assess the effect of tricalcium silicate cements and mineral trioxide aggregate cements, including repairing dentin formation and inflammatory reactions over time after pulp exposure in Wistar rats. Methodology: These two biomaterials were compared with positive control groups (open cavity with pulp tissue exposure) and negative control groups (no intervention). The evaluations were performed in three stages; three, seven and twenty-one days, and consisted of an imaging (nuclear medicine) and histological evaluation (H&amp;E staining, immunohistochemistry and Alizarin Red S). Results: The therapeutic effect of these biomaterials was confirmed. Nuclear medicine evaluation demonstrated that the uptake of 99mTc-Hydroxymethylene diphosphonate (HMDP) showed no significant differences between the different experimental groups and the control, revealing the non-occurrence of differences in the phosphocalcium metabolism. The histological study demonstrated that in mineral trioxide aggregate therapies, the presence of moderate inflammatory infiltration was found after three days, decreasing during follow-ups. The formation of mineralized tissue was only verified at 21 days of follow-up. The tricalcium silicate therapies demonstrated the presence of a slight inflammatory infiltration on the third day, increasing throughout the follow-up. The formation of mineralized tissue was observed in the seventh follow-up day, increasing over time. Conclusions: The mineral trioxide aggregate (WhiteProRoot®MTA) and tricalcium silicate (Biodentine™) present slight and reversible inflammatory signs in the pulp tissue, with the formation of mineralized tissue. However, the exacerbated induction of mineralized tissue formation with the tricalcium silicate biomaterial may lead to the formation of pulp calcifications

Competências profissionais no âmbito da prevenção e do tratamento do tabagismo no final da formação pré-graduada dos profissionais de saúde: Estudo de avaliação com os cursos de formação em ciências farmacêuticas, enfermagem, medicina e medicina dentária – Sumário Executivo.

Este documento é o resultado de um estudo de avaliação das competências profissionais no âmbito da prevenção e do tratamento do tabagismo no final da formação pré-graduada dos cursos de Ciências Farmacêuticas, Enfermagem, Medicina e Medicina Dentária. Principais conclusões? 1 - Elevadas prevalências de tabagismo; 2 - Atitudes positivas relativamente ao controlo do tabaco; 3 - Um nível razoável de conscientização sobre as políticas de não fumador nos espaços das práticas letivas e clínicas; 4 - Um alinhamento com o quadro teórico e concetual sobre as temáticas da prevenção e do tratamento do tabagismo, assim como acerca do papel dos profissionais de saúde neste domínio; 5 - Limitadas competências de intervenção ao nível da prevenção e do tratamento do tabagismo; 6 - Necessária introdução de um conjunto de temas teóricos e práticos na formação académica destes profissionais, percecionados como omissos, que suportem o seu pensamento e as suas decisões na atual no domínio do tabagismo