Considerações estéticas de dentes endodonciados

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina DentáriaIntrodução: A restauração de dentes que sofreram tratamento endodôntico é um dos assuntos que mais controvérsia gera em Medicina Dentária. Facto este, devido à vasta quantidade de soluções existentes, que tornam mais difícil a escolha do plano de tratamento mais adequado, que tenha os máximos benefícios funcionais, biológicos e estéticos. Objetivo: Demonstrar, de uma forma muito sucinta as várias modalidades existentes para restauração de dentes endodonciados, nomeadamente as suas indicações, vantagens e desvantagens e o seu prognóstico, e, por outro lado, mostrar soluções para resolver problemas extremamente comuns inerentes a este tratamento, tais como, o escurecimento do dente em comparação com os seus adjacentes. Materiais e Métodos: Revisão bibliográfica tendo por base as palavras-chave delineadas e critérios de inclusão e exclusão específicos, com o objetivo de angariar e debater o máximo de informação acerca desta grande controvérsia da Medicina Dentária. Resultados e Conclusões: Existem inúmeras soluções para restaurar dentes endodonticamente tratados. Todas estas apresentam vantagens, desvantagens e indicações bastante específicas. Assim, é de extrema importância ter um profundo conhecimento acerca das mesmas, a fim de escolher a melhor modalidade de tratamento, com os melhores resultados funcionais, biológicos e estéticos. Visto, atualmente, a vertente estética dos tratamentos revela-se equiparadamente importante. Também, é relevante referir que existem soluções para dentes endodonciados que apresentam o problema mais frequente decorrente do tratamento, o escurecimento do dente em comparação com os adjacentes. A fim de solucionar este problema, defende-se o branqueamento interno do dente, que tem vindo a demonstrar ótimos resultados e excelentes prognósticos.Introduction: The restoration of the teeth that went through endodontic treatment is one of the subjects that generate controversy in Dentistry. This happens because there’s a lot of solutions that make harder choosing the most suitable treatment plan. It has to include the most functional, biological and aesthetic benefits. Objective: To show, briefly, the many existing modalities to endodontic teeth restauration; namely its indications, advantages and disadvantages and its prognosis. On the other hand, to show solutions to solve extremely common problems due to this treatment. An example of this is the tooth darkening in comparison to its adjacent. Materials and Methods: Bibliographic review based on outlined keywords and specific inclusion and exclusion cryteria, with the objective of raising and debating as many information about this huge controversy as possible. Results and Conclusions: There are countless solutions to restore endodontically treated teeth. All of these have advantages, disadvantages and very specific indications. So, it’s really important to have a deep knowledge about them, in order to choose the best treatment modality, with the best functional, biological and aesthetic results. Currently, the aesthetic slope of the treatments is indeed considerable, so it’s also important to refer that there are solutions for endodontic teeth that feature its darkening in comparison to its adjacent (the most frequent disadvantage during the treatment). To solve this problem, it is advocated the internal teeth bleaching, which has been showing great results and excellent prognosis

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (>59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P <.001). Overall motor and cognitive performance (P <.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P <.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P <.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P <.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients