A Decision Making: Implant or Endodontic Treatment? A Case Report

The present report describes the successful treatment of a tooth with an endo-perio lesion and an extensive area of bone resorption. The possibility of extraction and dental implant was discussed with the patient. Chemomechanical preparation was performed, and canals were filled with bioceramic cement and gutta-percha cones. After 12 months, clinical and radiographic evaluations showed remarkable remineralization. The decision to perform the endodontic treatment or implant was based on scientific evidence and correct clinical assessment

Patologias atuais: a compulsão e a sociedade dos excessos: Current pathologies: compulsion and the society of excesses

O artigo em tela tem por objetivo analisar os aspectos biopsicossociais da conduta compulsiva de consumo. Propõe-se a apresentar os elementos psicológicos contidos nesse comportamento, além de verificar quais são os resultados decorrentes dessa compulsão. O consumo compulsivo, também chamado de oniomania, é um transtorno causado pela ansiedade despertada pela necessidade de comprar e saciada, somente, quando é materializada a aquisição daquilo que se deseja comprar. O estudo em questão pode ser classificado como sendo de cunho bibliográfico, a partir da análise de documentos publicados em forma de artigos científicos e livros em formato digital

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

The use of antimicrobial photodynamic therapy in the successful management of a nonsurgical complex type II Dens Invaginatus

Because of its complex root canal morphology, dens invaginatus (DI) is a developmental anomaly that represents an endodontic challenge to complete cleaning, shaping, and disinfecting the root canal system. The present case report describes the use of antimicrobial photodynamic therapy as an adjunctive treatment in the successful management of nonsurgical complex type II DI in a left maxillary lateral incisor with thin and fragile dentin walls associated with periradicular lesion

Tratamento endodôntico de segundo molar inferior com presença de canal mesiomediano: relato de caso [Endodontic treatment of a lower second molar with the presence of a mesiomedian canal: case report]

Introdução: A identificação de possíveis variações anatômicas é decisiva para o correto diagnóstico e planejamento da terapia endodôntica. Objetivo: Relatar o tratamento endodôntico de um dente #37, no qual foi identificado um terceiro canal na raiz mesial (canal mesio-mediano, CMM). Caso clínico: Dente #37 com diagnóstico de pulpite irreversível sintomática, foi encaminhado para realizar tratamento endodôntico. Durante o acesso coronário, e com auxílio de microscópio operatório (MO), foram identificadas trincas coronárias. Foi solicitada uma tomografia computadorizada de feixe cônico (TCFC), a partir da qual foi descartada a presença de trinca radicular. A TCFC possibilitou, também, identificar a presença de um terceiro canal na raiz mesial, localizado entre os canais mesiovestibular e mesiolingual. O tratamento endodôntico foi executado pelo sistema reciprocante WaveOne GOLD. A solução irrigadora de escolha para o preparo químico-mecânico foi o hipoclorito de sódio a 5,25%. Imediatamente antes da obturação, os canais foram irrigados com EDTA a 17%, para auxiliar na remoção da smear layer e, em seguida, foi realizada nova irrigação com hipoclorito de sódio a 5,25%. Os canais foram secos com pontas de papel absorvente e obturados pela técnica de onda contínua de condensação. Resultados: Os canais radiculares do dente #37 foram devidamente instrumentados e obturados. A paciente não apresentou qualquer sintomatologia pós-operatória, sendo encaminhada para a reabilitação protética final. Conclusão: A TCFC e o microscópio operatório foram decisivos para o correto planejamento do caso, tanto em relação à trinca observa- da quanto à detecção do canal mesiomediano. [Introduction: The identification of possible anatomical variations is crucial for the correct diagnosis and planning of endodontic therapy. Objective: To report the endodontic treatment of a tooth #37, in which a third canal was identified in the mesial root (mesiomedian canal, MMC). Clinical case: Tooth #37 diagnosed with symptomatic irreversible pulpitis was referred for endodontic treatment. During coronary access, and with the aid of an operating microscope (OM), coronary cracks were identified. A cone-beam computed tomography (CBCT) was requested, from which the presence of a root crack was ruled out. CBCT also made it possible to identify the presence of a third canal in the mesial root, located between the mesiobuccal and mesiolingual canals. Endodontic treatment was performed by the WaveOne GOLD reciprocating system. The irrigating solution of choice for the chemical-mechanical preparation was 5.25% sodium hypochlorite. Immediately before obturation, the canals were irrigated with 17% EDTA to aid in the removal of the smear layer, and then a new irrigation was performed with 5.25% sodium hypochlorite. The canals were dried with absorbent paper points and filled using the continuous wave condensation technique. Results: The root canals of tooth #37 were properly instrumented and filled. The patient did not present any postoperative symptoms and was referred for final prosthetic rehabilitation. Conclusion: CBCT and the operating microscope were decisive for the correct planning of the case

Contracted Endodontic Cavity in a Severely Calcified Anterior Tooth Using Guided Endodontics Technique: Case Report

Pulp canal obliteration (PCO) is characterized by the deposition of calcified tissue within the root canal space, which may partially or totally involve the canal. The endodontic treatment of calcified teeth is considered a challenging task depending on the severity of pulp obliteration. Recently, guided endodontics has become an alternative approach for those cases. This case report describes the use of guided endodontic access for the maxillary left lateral incisor of a 73-year-old male patient that required restorative treatment. The tooth had an extensive coronary fracture and demanded endodontic treatment for prosthetic purposes. Periapical radiography showed that pulp obliteration was severe at the cervical and middle thirds of the root. A cone beam computed tomography (CBCT) was requested in order to assess the level of obliteration. A three-dimensional (3D) template was planned with the CBCT's images along with intraoral scanning. A prototyped guide for guided endodontic access was performed, and the dental procedures were concluded safely. Guided endodontic access was paramount to overcome the pulp obliteration and ensured the endodontic treatment, and prosthetic rehabilitation could be performed

<b>Estratégias de suplementação para antecipação da idade à puberdade para novilhas de corte em pastagem tropical</b> - DOI: 10.4025/actascianimsci.v30i4.1372 <b>Supplementation strategies for the anticipation of age to puberty for beef heifers on tropical pasture</b> - DOI: 10.4025/actascianimsci.v30i4.1372

Objetivou-se avaliar suplementos formulados com diferentes fontes de proteína, no período das águas, sobre o desempenho produtivo de novilhas de corte em recria. Para avaliar o desempenho produtivo, 20 novilhas mestiças Holandês x Zebu e aneloradas, com peso corporal médio de 234 kg e idade aproximada de 14 meses, foram distribuídas em cinco piquetes de <em>B. decumbens</em> Stapf de 2,5 ha cada, em delineamento inteiramente casualizado, com cinco tratamentos e quatro repetições. Os suplementos foram à base de farelo de soja (FS), farelo de algodão 38% PB (FA38), farelo de glúten de milho 60% PB (GM) e farelo de trigo + ureia (FT), além de um tratamento-testemunha, constituído apenas de mistura mineral (MM). A quantidade diária de suplemento foi fixada para fornecer aproximadamente 180 g de PB dia^-1, sendo 0,450; 0,550; 0,350 e 0,450 kg animal^-1 dia^-1, respectivamente, para os tratamentos FS, FA38, GM e FT. Os animais foram pesados a cada 28 dias e rotacionados entre os piquetes a cada sete dias. Os animais submetidos ao tratamento FT apresentaram ganhos médios diários (GMD) superiores (p < 0,10) àqueles recebendo o tratamento MM (0,839 X 0,666 kg dia^-1). Recomenda-se o fornecimento de 500 g de suplemento que contém ureia, farelo de trigo e minerais para novilhas em recria, quando se deseja obter ganhos de peso moderados, em torno de 850 g dia^-1.<br>This paper aimed to evaluate the supplements formulated from different sources of protein during the rainy season over the productive performance of beef heifers during breeding. In order to evaluate productive performance, 20 Holstein x Zebu crossbred heifers, with average body weight of 234 kg and approximate age of 14 months, were divided into five paddocks of <em>B. decumbens</em> Stapf of 2.5 ha each, in a completely randomized design with five treatments and four repetitions. The supplements were based on soybean meal (FS); cottonseed meal (FA) 38% crude protein (CP) (FA 38); corn gluten meal 60% CP (GM) and wheat bran + urea (FTU); and a treatment witness, composed of mineral mix (MM) only. The daily amount of supplement was established for providing about 180 g of CP day^-1; that is, 0.450, 0.550, 0.350 and 0.450 kg animal^-1 day^-1, respectivelly, for the treatments with FS, FA38, GM and FTU. The animals were weighted every 28 days and rotated among the paddocks every 7 days. The ones which were submitted to the FTU treatment showed higher average daily gains (ADG) (p < 0.10) than those which received a MM treatment (0.839 X 0.666 kg day^-1). The 500 g supply of supplement containing urea, FTU and minerals for heifers during breeding is recommended when intending to get moderate weight gain - around 850 g day^-1