Aceitabilidade e conhecimento sobre remoção seletiva de tecido cariado de graduandos em odontologia e cirurgiões-dentistas

Aim: The aim of this study was to evaluate the acceptability and knowledge of undergraduate dental students and dentists on selective caries tissue removal (SCTR). Materials and Methods: Third- and fourth-year Dentistry undergraduates (Group 1) and graduates working in a Hospital Dentistry Center (Group 2) were included in the study. Participants anonymously and confidentially answered a validated questionnaire containing eleven questions on the diagnosis and management of deep caries lesions. Pearson’s Chi-square test and multivariate logistic regression compared the answers (p<0.05). Results: Total sample comprised 146 participants. Of these, 81.5% were female; 52.05% were graduates and the most prevalent age group was 18-29 years old (85.62%).  Sixty-nine participants chose stepwise caries removal (p=0.027). The logistic regression analysis showed statistically significant differences. The participants who considered pulp wall moist have approximately eight times more likelihood to choose an invasive treatment (p=0.028). Those who chose endodontic treatment as an option for two-year survival have three times more likelihood to choose an invasive treatment (p=0.032). Those who affirmed that the carious dentin close to the pulp should not be removed had almost three times more likelihood to choose minimally invasive treatments (p=0.031). Discussion: Studies with questionnaires can be useful tools to detect whether the students and dentists are following the most current evidences to treat deep carious lesions. Conclusion: The participants had certain level of knowledge on SCTR, but the technique acceptability lacked consensus.Objetivo: Avaliar a aceitabilidade e o conhecimento de estudantes de graduação em Odontologia e cirurgiões-dentistas sobre a remoção seletiva de tecido cariado (RSTC). Materiais e Métodos: Participaram do estudo graduandos do terceiro e quarto ano de Odontologia (Grupo 1) e egressos de um Centro Hospitalar de Odontologia (Grupo 2). Os participantes responderam de forma anônima e confidencial um questionário validado contendo onze questões sobre diagnóstico e manejo de lesões cariosas profundas. Teste qui-quadrado de Pearson e regressão logística multivariada foram aplicados (p<0.05). Resultados: A amostra total foi composta por 146 participantes. Destes, 81.5% eram do sexo feminino; 52.05% eram graduados e a faixa etária mais prevalente foi de 18 a 29 anos (85.62%). Sessenta e nove participantes escolheram o tratamento expectante (p=0.027). A análise de regressão logística mostrou diferenças estatisticamente significativas. Os participantes que consideraram a parede pulpar úmida têm aproximadamente oito vezes mais chances de escolha pelo tratamento invasivo (p=0.028). Aqueles que escolheram o tratamento endodôntico como opção de sobrevida em dois anos têm três vezes mais chances de optar pelo tratamento invasivo (p=0.032). Aqueles que afirmaram que a dentina cariada próxima à polpa não deveria ser removida tiveram quase três vezes mais chances de optar por tratamentos minimamente invasivos (p=0.031). Discussão: Estudos com questionários podem ser ferramentas úteis para detectar se estudantes e cirurgiões-dentistas estão seguindo as evidências mais atuais para o tratamento de lesões cariosas profundas. Conclusão: Os participantes tinham certo nível de conhecimento sobre RSTC, mas a aceitabilidade da técnica carecia de consenso

Six-year post-surgical evaluation in the treatment protocols in the dental arches of children with oral cleft: longitudinal study

Oral cleft surgical repairs are performed using different techniques worldwide. Objective: To evaluate and compare the development of the dental arches of children with unilateral cleft lip and palate before and after the primary surgeries performed with different techniques at the first months and six years of life. Methodology: This is a retrospective longitudinal study. The sample comprised 56 dental casts divided int the following groups: Group 1 (G1) – cheiloplasty (Millard technique) at three months and one-step palatoplasty (von Langenbeck technique) at 12 months; and Group 2 (G2) – cheiloplasty (Millard technique) and two-step palatoplasty: anterior hard palate closure (Hans Pichler technique) at three months and posterior soft palate closure (Sommerlad technique) at 12 months. The digitized dental casts were evaluated at three months – pre-surgical (T1) and six years of life– post-surgical (T2). The following linear measurements were analyzed: intercanine (C–C’), intertuberosity (T–T’) distances; anterior dental arch (I–CC’), anterior intersegment (I–C’), and total arch (I–TT’) lengths. The palate area was also measured. Parametric and non-parametric tests were applied (p<0.05). Results: In G1, the intragroup comparison showed statistically significant smaller I–CC’ and I–C’ at T2 (p=0.001 and p<0.001, respectively), while T–T’, I–TT’, and area comparisons were significantly greater (p<0.001, p=0.002, and p<0.001, respectively). In G2, the intragroup comparison exhibited statistically significant smaller C–C’ and I–C’ at T2 (p=0.004, for both), whereas T–T’, I–TT’ and area comparisons were significantly greater (p<0.001, p=0.004, and p<0.001, respectively). At T2, the intergroup analysis revealed that G1 had a statistically significant smaller I–CC’ (p=0.014). The analysis of the intergroup differences (∆=T2–T1) showed that G1 had a statistically smaller I–CC’ (p=0.043). Conclusion: The two-step palatoplasty showed a more favorable prognosis for the maxillary growth than one-step palatoplasty in children with oral clefts.

Uso da esterefotogrametria 3D para análises volumétricas e sobreposição de imagens dos arcos dentários pré e póscirurgias de pacientes com fissura labiopalatina unilateral e bilateral

This thesis aimed to present four scientific articles. Article 1: to use new threedimensional (3D) anthropometric analyses to verify the postsurgical effects on the maxillary segments of children with unilateral cleft lip and palate. The sample was composed by 150 digitized dental models with unilateral complete cleft lip (UCL) and unilateral cleft lip and palate (UCLP). The impressions were taken before cheiloplasty (T1), after cheiloplasty (T2), and after palatoplasty (T3). Linear measures (IC; IC; IT; IT) were analysed. The intergroup analysis showed that the measures IC and IT demonstrated a reduction of the dental arches growth of UCLP group. The new 3D anthropometric analysis showed that the development of the maxillary segments changed after cheiloplasty. Article 2: to evaluate the volumetric, linear, palatal surface area, and the dental arch superimposition of participants with bilateral complete cleft lip (BCL) and bilateral cleft lip and palate (BCLP) surgically treated. The sample was composed by 136 digitized dental models evaluated before cheiloplasty (T1), after cheiloplasty (T2), and after palatoplasty (T3). Volume, superimposition, area and linear (IC; IC; CC; IT; IT; TT) measurements were evaluated. The intergroup analysis revealed that CC, TT, IC, and IC were significantly smaller in BCLP group, whereas the volume, superimposition, and area were statistically similar between participants. The comparison between bilateral orofacial clefts showed reduction in the transversal and anteroposterior linear measurements, but not in the area, volume and superimposition. Article 3: to analyse whether the novel method of 3D3D superimposition can quantify the specific characteristics of the dental arches before and after cheiloplasty in children with cleft lip and palate. The stereophotogrammetry system software analysed the 3D3D superimpositions in two groups of matches (same participant) and one group of mismatches (different participant). The differences were evaluated by Root Mean Square (RMS). RMS was significantly greater in mismatches than in matches groups. 3D3D superimposition can quantify the individual characteristics of the dental arches of children with unilateral cleft lip and palate submitted to cheiloplasty. Article 4: to evaluate the effects of treatment protocols on the dental arches of children with cleft lip and palate treated with or without pre and postsurgical orthopedics (PSO). The sample comprised 96 digitized dental models divided into: Group 1 (G1) children treated by Hotz plate; Group 2 (G2) children treated with nasoalveolar molding (NAM); and Group 3 (G3) children treated without PSO. The evaluated treatment times were: T1 presurgical time and T2 postoperative time. The following measurements were obtained: intercanine, intertuberosity, anterior and total intrasegment, anterior and total intersegment; cleft (C Area) and segments area (S Area); and angular measurements: anterior greater segment (GCT); posterior greater segment; and posterior smaller segment with the use of software. Intergroup analysis showed that G3 had a smaller percentage growth for S Area, C Area, and GCT than children treated with PSO. Pre and postsurgical orthopedics reduced the residual effects produced by the healing tension of the lip on the dental arch.Esta tese teve o propósito de apresentar 4 artigos científicos. Artigo 1: utilizar novas análises antropométricas tridimensionais (3D) para avaliar os efeitos póscirúrgicos nos segmentos palatinos de crianças com fissura labiopalatina. Compôsse a amostra com 150 modelos dentários digitalizados com fissuras unilaterais, completa de lábio (FUCL) e lábio e palato (FULP). As moldagens foram efetuadas, antes da queiloplastia (T1), após a queiloplastia (T2) e após a palatoplastia (T3). Analisouse medidas lineares (IC; IC; IT; IT). Na análise intergrupo, as medidas IC\' e IT\' demonstraram uma redução significativa no grupo FULP. Assim, a nova análise 3D indicou mudança no desenvolvimento do palato após a queiloplastia. Artigo 2: avaliar volume, medidas lineares, área e sobreposição palatina em participantes com fissuras bilaterais, completa de lábio (FBCL) e lábio e palato (FBLP) tratados cirurgicamente. Compôsse a amostra com 136 modelos dentários digitalizados avaliados antes da queiloplastia (T1), após a queiloplastia (T2) e após a palatoplastia (T3). Volume, sobreposição, área e medidas lineares foram quantificadas (IC; IC\'; CC\'; IT; IT\'; TT\'). Na análise intergrupos, as medidas CC, TT, IC e IC foram significativamente menores no grupo FBLP, enquanto o volume, a sobreposição e a área foram semelhantes entre os participantes. Assim, a comparação entre os grupos verificouse redução das medidas lineares transversais e ânteroposteriores, mas não da área, volume e sobreposição. Artigo 3: analisar se o método, sobreposição 3D3D, é capaz de quantificar as características específicas dos arcos dentários antes e após a queiloplastia em crianças com fissura unilateral labiopalatina. A sobreposição 3D3D foi avaliada pelo software do sistema de estereofotogramtetria em três grupos, em que dois deles a análise foi efetuada em um mesmo participante, e o terceiro, a sobreposição foi realizada entre participantes diferentes. As diferenças foram avaliadas pelo Root Mean Square (RMS). RMS foi significativamente maior no grupo em que a sobreposição foi realizada entre pessoas diferentes. Concluise que, a sobreposição 3D3D contribuiu na quantificação das características individuais dos arcos dentários de crianças com fissura unilateral labiopalatina submetidas a queiloplastia. Artigo 4: avaliar os efeitos dos protocolos de tratamento nos arcos dentários de crianças com fissura labiopalatina tratadas ou não com Ortopedia pré e póscirúrgica (OPC). Amostra foi composta por 96 modelos dentários digitalizados divididos em Grupo 1 (G1) participantes tratados com placa de Hotz, Grupo 2 (G2) participantes tratados com placa de moldagem nasoalveolar e Grupo 3 (G3) sem OPC. Foram avaliados em Tempo 1 (T1), préoperatório e Tempo 2 (T2) pósoperatório. Por meio de um software quantificouse medidas lineares (intercanino, intertuberosidade, intrasegmento anterior e total, intersegmento anterior e total), áreas da fissura (Área F) e dos segmentos (Área S), além de medidas angulares, anterior do segmento maior (GCT) e posteriores dos segmentos maior e menor. Na análise intergrupo, G3 apresentou os menores percentuais dos parâmetros Área S, Área F e GCT em comparação aos participantes tratados com OPC. Concluise que, a Ortopedia pré e póscirúrgica reduziu os efeitos residuais decorrentes da tensão cicatricial do lábio sobre o arco dentário

Avaliação longitudinal 3D dos arcos dentários de pacientes com fissura labiopalatina unilateral

This study aimed to analyse the alterations of the maxillary dental arches of children with cleft lip and palate before and after the primary plastic surgeries. The sample comprises 150 digitized dental casts from children, age between 3 and 36 months, divided in: unilateral complete cleft lip (UCL) and unilateral complete cleft lip and palate (UCLP). The dental arches were evaluated in the following phases: before cheiloplasty (T1), before palatoplasty (T2), and one year after palatoplasty (T3). The digitized dental casts were measured three-dimensionally through the software of the stereophotogrammetry systems. The following distances were analysed: intercanine and intertuberosity distances; anterior and total dental arch length; dental arch area. The intraexaminer agreement analysis demonstrated that all measurements were reproductible (p>0.05). Independent t test and Mann-Whitney test were used to verify the changes occurred between groups. Repeated-measures ANOVA followed by Tukey test analysed the different phases of the rehabilitation protocol in the group UCLP. Paired t test and Wilcoxon test compared the different phases of the group UCL. At T1, intercanine and intertuberosity distances had statistically higher values in group UCLP than in group UCL. The dental arch lengths and the area were significantly smaller in group UCLP. Before palatoplasty, maxillary dimensions significantly increased, except for intertuberosity distance in UCL. The intercanine distance and the anterior length had a significant decreased, but the intertuberosity measurement and the total dental arch length showed significant increase between T1 and T3 (group UCLP). Based on these results, the primary plastic surgery negatively influences the bone segments growth and development of the maxillary dental archs of children with UCL and UCLP. The cheiloplasty negatively affected the development of the anterior palate, more evidently for the group UCLP. The palatoplasty did not affect the growth of the posterior palate.O propósito deste estudo foi realizar uma análise das alterações dimensionais dos arcos dentários superiores de crianças com fissura labiopalatina, antes e após as cirurgias plásticas primárias. A amostra foi composta por 150 modelos dentários digitalizados de crianças entre 3 e 36 meses de vida, divididos em 2 grupos: fissura completa de lábio unilateral (FLU) e fissura de lábio e palato unilateral (FLPU). Os arcos dentários foram avaliados nas seguintes fases: pré-queiloplastia (F1), prépalatoplastia (F2) e 1 ano pós-palatoplastia (F3). Os modelos dentários foram mensurados por meio de um software do sistema de estereofotogrametria. Analisouse distâncias intercanino e intertuberosidade, comprimentos anterior e total do arco dentário, além da área dos arcos dentários. A análise da reprodutibilidade intraexaminador demonstrou que todas as mensurações foram suficientemente reprodutíveis (p>0.05). Foram aplicados os Testes t independente e Mann-Whitney para verificar as alterações ocorridas entre os diferentes grupos. Para avaliação intragrupos, a Análise de Variância de medidas repetidas (ANOVA de medidas repetidas) foi utilizada para analisar as fases do protocolo reabilitador no grupo FLPU, seguido do Teste de Tukey. Os Testes t pareado e Wilcoxon foram aplicados na comparação às fases do tratamento da FLU. Em F1, as distâncias intercanino e intertuberosidade apresentaram valores significativamente maiores no grupo FLPU em relação ao grupo FLU. Os comprimentos, anterior e total, do arco dentário, e a área foram significativamente menores no grupo FLPU. Na pré-palatoplastia, todas as variáveis analisadas, exceto a distância intertuberosidade, apresentaram valores estatisticamente maiores no grupo FLU. A distância intercanino e o comprimento anterior apresentaram uma redução significativa, no entanto a intertuberosidade e o comprimento total do arco dentário demonstraram um crescimento significativo entre F1 e F3 (grupo FLPU). De acordo com os resultados obtidos, a cirurgia plástica primária influenciou no crescimento e desenvolvimento dos segmentos ósseos dos arcos dentários das crianças com FLU e FLPU. A queiloplastia afetou negativamente o desenvolvimento da região anterior do palato, de forma mais notória no grupo FLPU. A palatoplastia não afetou o crescimento da região posterior do palato

Innovative method to assess maxillary arch morphology in oral cleft: 3d-3d superimposition technique.

Abstract This study aimed to analyze the maxillary growth and development of children with oral clefts using the innovative method of 3D-3D superimposition technique. Children with unilateral complete cleft lip (UCL) and unilateral cleft lip and palate (UCLP) participated in the study. The impressions of the dental arches were executed 1 day before and 1 year after lip repair surgery. A 3D laser scanner digitized the dental models and the stereophotogrammetry system software analyzed the 3D-3D superimpositions in two groups of matches (same child, UCL and UCLP) and one group of mismatches (different individuals). The differences were evaluated by Root Mean Square (RMS) and expressed in millimeters (mm). Kruskal-Wallis test followed by post-hoc Dunn test and Mann-Whitney test were assessed to compare the groups (α=5%). RMS was 1.34 mm (± 0.37) in UCL group, 1.41 mm (± 0.32) in UCLP group, and 3.38 mm (± 1.28) in mismatches group. RMS was significantly greater in mismatches than in matches groups (p<0.0001). No statistically significant differences occurred between genders. The 3D-3D superimposition technique showed the maxillary development after lip repair surgery in the anterior region of the palate. Thus, it is suggested that the cleft amplitude and the palatal segments proportion influenced the morphological heterogeneity and, consequently, the development and maxillary growth of children with orofacial cleft

Aceitabilidade e conhecimento sobre remoção seletiva de tecido cariado de graduandos em odontologia e cirurgiões-dentistas

Aim: The aim of this study was to evaluate the acceptability and knowledge of undergraduate dental students and dentists on selective caries tissue removal (SCTR). Materials and Methods: Third- and fourth-year Dentistry undergraduates (Group 1) and graduates working in a Hospital Dentistry Center (Group 2) were included in the study. Participants anonymously and confidentially answered a validated questionnaire containing eleven questions on the diagnosis and management of deep caries lesions. Pearson’s Chi-square test and multivariate logistic regression compared the answers (p&lt;0.05). Results: Total sample comprised 146 participants. Of these, 81.5% were female; 52.05% were graduates and the most prevalent age group was 18-29 years old (85.62%).  Sixty-nine participants chose stepwise caries removal (p=0.027). The logistic regression analysis showed statistically significant differences. The participants who considered pulp wall moist have approximately eight times more likelihood to choose an invasive treatment (p=0.028). Those who chose endodontic treatment as an option for two-year survival have three times more likelihood to choose an invasive treatment (p=0.032). Those who affirmed that the carious dentin close to the pulp should not be removed had almost three times more likelihood to choose minimally invasive treatments (p=0.031). Discussion: Studies with questionnaires can be useful tools to detect whether the students and dentists are following the most current evidences to treat deep carious lesions. Conclusion: The participants had certain level of knowledge on SCTR, but the technique acceptability lacked consensus.Objetivo: Avaliar a aceitabilidade e o conhecimento de estudantes de graduação em Odontologia e cirurgiões-dentistas sobre a remoção seletiva de tecido cariado (RSTC). Materiais e Métodos: Participaram do estudo graduandos do terceiro e quarto ano de Odontologia (Grupo 1) e egressos de um Centro Hospitalar de Odontologia (Grupo 2). Os participantes responderam de forma anônima e confidencial um questionário validado contendo onze questões sobre diagnóstico e manejo de lesões cariosas profundas. Teste qui-quadrado de Pearson e regressão logística multivariada foram aplicados (p&lt;0.05). Resultados: A amostra total foi composta por 146 participantes. Destes, 81.5% eram do sexo feminino; 52.05% eram graduados e a faixa etária mais prevalente foi de 18 a 29 anos (85.62%). Sessenta e nove participantes escolheram o tratamento expectante (p=0.027). A análise de regressão logística mostrou diferenças estatisticamente significativas. Os participantes que consideraram a parede pulpar úmida têm aproximadamente oito vezes mais chances de escolha pelo tratamento invasivo (p=0.028). Aqueles que escolheram o tratamento endodôntico como opção de sobrevida em dois anos têm três vezes mais chances de optar pelo tratamento invasivo (p=0.032). Aqueles que afirmaram que a dentina cariada próxima à polpa não deveria ser removida tiveram quase três vezes mais chances de optar por tratamentos minimamente invasivos (p=0.031). Discussão: Estudos com questionários podem ser ferramentas úteis para detectar se estudantes e cirurgiões-dentistas estão seguindo as evidências mais atuais para o tratamento de lesões cariosas profundas. Conclusão: Os participantes tinham certo nível de conhecimento sobre RSTC, mas a aceitabilidade da técnica carecia de consenso

A Narrative Review on Non-Invasive Diagnostic Tools for the Analysis of Dental Arches in Orofacial Cleft Patients

Background: It is necessary to analyze and monitor the facial growth of orofacial cleft patients. The documentation should therefore begin before and after primary surgeries. Technological evolution has transformed plaster models into 3D images through scanners that allow rational storage, manipulation, and rotation without the possibility of breakage or damage. Based on this fact, this narrative review aims to provide a feature on the three-dimensional tools available for the assessment of dental arches in children with orofacial cleft and mixed dentition. Material and Methods: Three databases were chosen (PubMed, ScienceDirect, and Scopus) and keywords were used to select papers. Results: During the database screening, 292 potentially relevant papers were found. After removing duplicates, titles, and abstracts, 32 papers presented qualifications for analysis. Through evaluating each document by reading it one by one, 24 papers fulfilled the eligibility criteria. Conclusions: It was concluded that digital tools&mdash;i.e., benchtop scanners which evaluate the dental arches of children with cleft lip, palate, and mixed dentition&mdash;are reproducible and reliable, without the use of ionizing radiation, allow storage, manipulation with sustainability, and help preserve the environment

Correlation between cleft width and dental arch symmetry in cleft lip and palate: a longitudinal study

Abstract This study aimed to evaluate the influence of cleft width on dental arch symmetry of children with unilateral cleft lip and palate. Forty-one children were subjected to impression preoperatively (T1; mean age = 0.31 ± 0.07 years) and postoperatively (T2; mean age = 6 .73 ± 1.02 years). Eighty-two digitized dental casts were analyzed by stereophotogrammetry software. The cleft palate width was measured in the anterior (P-P’), middle (M-M’), and posterior (U-U’) regions. Also, the following measurements were obtained: anterior intersegment (I-C’) and intrasegment (I-C); total intersegment (I-T’) and intrasegment (I-T); cleft-side (C’-T’) and non-cleft-side (C-T) canine tuberosity. Paired t test and Pearson correlation coefficient were applied (α = 5%). Cleft width had the following means: 10.16 (± 3.46) mm for P-P’, 12.45 (± 3.00) mm for M-M’, and 12.57 (± 2.71) mm for U-U’. In the longitudinal analysis, I-C’ had a significant reduction, while the other measurements significantly increased (p < 0.001). Asymmetry was verified in the following analyses at T1: I-C’ vs. I-C and I-T’ vs. I-T (p < 0.001); at T2, only in I-C’ vs. I-C (p < 0.001). At T1, P-P’ vs. I-C’ (r = 0.722 and p < 0.001), P-P’ vs. I-T’ (r = 0.593 and p < 0.001), M-M’ vs. I-C’ (r = 0.620 and p < 0.001), and M-M’ vs. I-T’ (r = 0.327 and p < 0.05) showed a positive and significant correlation. At T2, there was a correlation between M-M’ and I-C’ (r = 0.377 and p < 0.05). In conclusion, the anterior and middle cleft widths influenced palatal asymmetry in the first months of life, while middle width influenced residual asymmetry