Remodeling of gingival contour in the rehabilitation with fixed partial dentures – case report / Remodelação do contorno gengival em reabilitação com prótese parcial fixa – relato de caso

One of the most challenging aspects in rehabilitations is the correct manipulation of gingival tissues, aiming to achieve a natural contour, with interdental papillae and emergence profile, compatible with a natural tooth. The rehabilitation is impaired when there is loss of the interproximal papilla. To solve this problem, it is possible to use the gingival conditioning technique, which comprises relining the provisional crown with acrylic resin, applying gradual pressure, leading to formation of a gingival papilla. This paper presents a case of esthetic and functional recovery in a fixed partial denture by remodeling of the gingival contour by the gradual pressure technique, by gradual relining of the provisional crown. It is concluded that this gingival conditioning technique is simple, easy to accomplish and very effective for esthetic-functional reestablishment in rehabilitations with fixed partial dentures, provided the patient maintains correct hygiene and plaque control. 

Bruxismo infantil em tempos de pandemia por COVID-19: uma abordagem multidisciplinar

A pandemia por Covid-19 afetou diversas áreas na vida da sociedade, inclusive crianças e adolescentes, que enfrentaram grandes mudanças em suas vidas cotidianas, confinamentos e regras de distanciamento social, sobrecarregando-os substancialmente. Consequentemente essas mudanças podem ocasionar alguns hábitos comportamentais que interferem consideravelmente no desenvolvimento da criança e, dentre eles, o bruxismo que apresentou um aumento expressivo das queixas após o advento da pandemia da Covid-19. O bruxismo do sono definido como “uma atividade muscular mastigatória durante o sono que se caracteriza como um movimento rítmico (fásico) ou não rítmico (tônico)”, é um hábito oral parafuncional que atinge o sistema estomatognático. A etiologia do bruxismo é comprovadamente multifatorial e muito associada a fatores psicológicos como estresse, ansiedade, preocupações e medo, demandando uma abordagem interdisciplinar no seu tratamento. Acomete muitas crianças em idade escolar e é desencadeado principalmente por fatores psicoemocionais. O distanciamento social e as alterações da psicologia infantil marcadas por estresse psicológico, acentuaram as adversidades funcionais ou comportamentais nas crianças, podendo inclusive, influenciar na saúde bucal, principalmente doenças orais que tem como etiologia os fatores psicoemocionais, como o bruxismo. A melhor forma de diagnosticar bruxismo do sono é através do relato dos pais sobre o ranger de dentes das crianças. Esse estudo buscou realizar uma revisão integrativa sobre a ocorrência de bruxismo na infância em tempos de pandemia por Covid-19, com ênfase em uma abordagem multiprofissional na assistência às crianças portadoras desse hábito parafuncional, através de uma busca literária na base de dados (Pubmed e Scielo). É imprescindível que os pais e responsáveis estejam atentos aos hábitos parafuncionais dessas crianças para que seja diagnosticado precocemente e tratado da melhor forma, visto que o tratamento demanda de uma abordagem multidisciplinar, de acordo com as necessidades de cada paciente, visando favorecer o desenvolvimento, bem-estar e qualidade de vida das crianças

Indicações cirúrgicas de deslocamento do disco articular da articulação temporomandibular / Surgical indications for the treatment of displacement of the articular disk of the temporary mandibular joint

As articulações temporomandibulares, são representadas por articulações diartrodiais bilaterais (ATMs). Seu constituinte ósseo é correspondido pela eminência articular anterior (limite anterior da ATM, proveniente do arco zigomático) e posterior, côndilo mandibular, fossa temporal (lugar de repouso do côndilo). Os tecidos moles são correspondentes a um disco articular, cápsula, e constituintes da zona bilaminar. A ATM e suas estruturas associadas desempenham um papel essencial na orientação dos movimentos mandibulares e a distribuição de tensões produzidas por tarefas diárias, tais como a mastigação, deglutição e fala. A desarmonia no funcionamento dos componentes da ATM com o sistema estomatognático atribui-se o nome de disfunção temporomandibular (DTM). As DTM´s são uma classe de distúrbios musculoesqueléticas agudas, crônicas ou degenerativas associada a deformidades morfológicas e funcionais, podendo estar associadas ou não á oclusão, trauma ou tensão emocional.  Dentre as DTM's estão inseridos os desarranjos da posição discal intra-articular, sendo este categorizado de acordo com o sistema de estágios de Wilkes, incluídas nas DTM’S temos a disfunção da musculatura associada á amplitude de movimento e dor muscular conhecida como dor orofacial.  Dentre os sinais e sintomas que estão mais comumente associados a ATM, estão, a dor na região da articulação temporomandibular e masseter, estalos unilaterais ou bilaterais e travamento.  Caso seja confirmado o diagnóstico, deve-se considerar o tratamento multidisciplinar e tratamento conservador, poderá ser instituido, através de placas miorelaxantes, psicoterapia, técnicas de redução de stress, fisioterapia, farmacoterapia.  Entretanto caso seja esgotada a possibilidade do tratamento conservador, pode-se utilizar de técnicas cirúrgicas conservadoras como de artrocentese e artroscopia e cirurgias mais invasivas como a cirurgia articular aberta com reposicionamento do disco, eminectomia, artroplastia condilar ,discectomia e condilotomia mandibular. O presente trabalho tem por objetivo realizar uma revisão da literatura acerca dos desarranjos internos da ATM e seus respectivos tratamentos, dando enfoque a correta indicação cirúrgica para tal desarranjo.

Reverse Cast Metallic Core Based on the Original Prosthetic Crown

The dental crown can be restored using the root in clinical situations where the dental remnant allows adequate anchorage by the use of an intraradicular retainer. After endodontic treatment, reconstruction of the dental anatomy depends on correct planning and the type of restoration to be used. This requires reestablishment of form and function with creation of anchoring features, avoiding detachment and favoring the distribution of forces, thus preventing fracture of the remnant due to functional and parafunctional forces applied on the tooth. This paper reports the clinical case of a patient who sought dental care for a full metal-ceramic crown with a cast metallic core with reduced length that had been detached from tooth 24. After clinical and radiographic examination, root integrity was verified. The patient was offered reconstruction with a cast metallic core of satisfactory length, providing adequate retention and support, with reutilization of the original prosthetic crown, serving as a reverse template of the coronal portion of this new core, providing reduction in costs and operational time

Use of Local Melatonin with Xenogeneic Bone Graft to Treat Critical-Size Bone Defects in Rats with Osteoporosis: A Randomized Study

The aim of this study was to evaluate the effect of local administration of melatonin (MLT) on molecular biomarkers and calvaria bone critical defects in female rats with or without osteoporosis, associated or not with a xenogeneic biomaterial. Forty-eight female rats were randomly divided into two groups: (O) ovariectomized and (S) placebo groups. After 45 days of osteoporosis induction, two critical-size defects (5 mm diameter) were created on the calvaria. The groups were subdivided according to the following treatment: (C) Clot, MLT, MLT associated with Bio-Oss® (MLTBO), and Bio-Oss® (BO). After 45 days, the defect samples were collected and processed for microtomography, histomorphometry, and biomolecular analysis (Col-I, BMP-2, and OPN). All animals had one femur harvested to confirm the osteoporosis. Microtomography analysis demonstrated a bone mineral density reduction in the O group. Regarding bone healing, the S group presented greater filling of the defects than the O group; however, in the O group, the defects treated with MLT showed higher mineral filling than the other treatments. There was no difference between the treatments performed in the S group (p = 0.05). Otherwise, O-MLT had neoformed bone higher than in the other groups (p = 0.05). The groups that did not receive biomaterial demonstrated lower levels of Col-I secretion; S-MLT and S-MLTBO presented higher levels of OPN, while O-C presented statistically lower results (p p < 0.05). In the presence of ovariectomy-induced osteoporosis, MLT treatment increased the newly formed bone area, regulated the inflammatory response, and increased OPN expression

Organokines in Rheumatoid Arthritis: A Critical Review

Rheumatoid arthritis (RA) is a systemic autoimmune disease that primarily affects the joints. Organokines can produce beneficial or harmful effects in this condition. Among RA patients, organokines have been associated with increased inflammation and cartilage degradation due to augmented cytokines and metalloproteinases production, respectively. This study aimed to perform a review to investigate the role of adipokines, osteokines, myokines, and hepatokines on RA progression. PubMed, Embase, Google Scholar, and Cochrane were searched, and 18 studies were selected, comprising more than 17,000 RA patients. Changes in the pattern of organokines secretion were identified, and these could directly or indirectly contribute to aggravating RA, promoting articular alterations, and predicting the disease activity. In addition, organokines have been implicated in higher radiographic damage, immune dysregulation, and angiogenesis. These can also act as RA potent regulators of cells proliferation, differentiation, and apoptosis, controlling osteoclasts, chondrocytes, and fibroblasts as well as immune cells chemotaxis to RA sites. Although much is already known, much more is still unknown, principally about the roles of organokines in the occurrence of RA extra-articular manifestations

Photobiomodulation Therapy on the Guided Bone Regeneration Process in Defects Filled by Biphasic Calcium Phosphate Associated with Fibrin Biopolymer

The aim is to evaluate the effects of photobiomodulation therapy (PBMT) on the guided bone regeneration process (GBR) in defects in the calvaria of rats filled with biphasic calcium phosphate associated with fibrin biopolymer. Thirty male Wistar rats were randomly separated: BMG (n = 10), defects filled with biomaterial and covered by membrane; BFMG (n = 10), biomaterial and fibrin biopolymer covered by membrane; and BFMLG (n = 10), biomaterial and fibrin biopolymer covered by membrane and biostimulated with PBMT. The animals were euthanized at 14 and 42 days postoperatively. Microtomographically, in 42 days, there was more evident bone growth in the BFMLG, limited to the margins of the defect with permanence of the particles. Histomorphologically, an inflammatory infiltrate was observed, which regressed with the formation of mineralized bone tissue. In the quantification of bone tissue, all groups had a progressive increase in new bone tissue with a significant difference in which the BFMLG showed greater bone formation in both periods (10.12 ± 0.67 and 13.85 ± 0.54), followed by BFMG (7.35 ± 0.66 and 9.41 ± 0.84) and BMG (4.51 ± 0.44 and 7.11 ± 0.44). Picrosirius-red staining showed greater birefringence of collagen fibers in yellow-green color in the BFMLG, showing more advanced bone maturation. PBMT showed positive effects capable of improving and accelerating the guided bone regeneration process when associated with biphasic calcium phosphate and fibrin biopolymer