Freio labial superior: Quando e como intervir? [Upper labial frenum: When and how do I intervene?]

The upper labial frenum is a triangular anatomical structure that undergoes changes of shape, function and position during the development of the child. A displacement to the most apical portion about 3 to 4 mm above the marginal gingiva is expected. When this does not occur, with the frenum inserted in the incisive papilla, a developmental anomaly called the persistent tectolabial frenum is characterized. The timing and type of intervention in these situations generate much controversy; the evaluation of factors such as low insertion in the alveolar ridge, presence or absence of palatine papilla ischemia when the brake is pulled, presence of interincisive diastema, difficulty in hygiene and / or feeding and gingival retraction aid in the treatment decision. Thus, the objective of this study was to present 8 clinical cases on upper lip frenum approaches, discussing different moments. Children of different ages were evaluated and submitted to the following behaviors: frenectomy, repositioning by the Chelotti technique or clinical follow-up for later reevaluation. It was concluded that, although there is a frequent indication of intervention only after eruption of the permanent upper canines, there are other situations in which an early approach can bring more benefits to the patient

Sealing versus partial caries removal in primary molars: a randomized clinical trial

Abstract\ud \ud Background\ud The resin-based pit and fissure sealant is considered a successful tool in caries prevention, however there is a growing evidence of its use in controlling already established caries in posterior teeth. The aim of this clinical trial is to verify the efficacy of pit and fissure sealants in arresting dentinal caries lesions compared to partial excavation and restorative treatment in primary molar teeth.\ud \ud \ud Methods\ud Thirty six patients with occlusal cavitated primary molar reaching outer half of dentin were selected. The patients were randomly allocated into two groups: sealant application (experimental group – n = 17) and restoration with composite resin (control group – n = 19). Clinical and radiograph evaluation were performed after 6, 12 and 18 months. The chi-square test was used to verify the distribution of characteristics variables of the sample among the groups. The survival rate of treatments was evaluated using Kaplan–Meier survival and log-rank test. Fisher’s Exact and logistic regression tests were calculated in each evaluation period (α = 5%).\ud \ud \ud Results\ud The control group showed significantly better clinical survival after 18 months (p = 0.0025). In both groups, no caries progression was registered on the radiographic evaluations.\ud \ud \ud Conclusions\ud Sealing had similar efficacy in the arrestment of caries progression of cavitated occlusal lesions compared to partial excavation of the lesions, even though the frequency of re-treatments was significantly higher in sealed lesions.\ud \ud \ud Trial registration\ud Registro Brasileiro de Ensaios Clínicos (ReBEC): \ud RBR-9kkv53Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Assessment of Glass Ionomer Cements (GIC) restorations after acidic erosive challenges: an in vitro study

Objective: To analyze the marginal adaptation of two different Glass Ionomer Cements (GIC) after erosive challenges. Material and Methods: Sixty sound extracted primary canines were selected and class V cavities were made. Teeth were allocated into 6 groups according to restorative material: 1) high-viscosity GIC (Ketac™Molar Easymix) and 2) resin-modified GIC with nanoparticles (Ketac™N100), low pH beverage erosive challenge (Orange juice and Coca-Cola) or distilled water as control. Thereafter the sample was restored and subjecting to thermocycling. The sample was immersed for a 10-days period for the erosive simulation and then embedded in methylene blue solution during 4 hours. Finally teeth were sectioned for further analysis. Marginal adaptation test was performed by two trained examiners using the Salama et al. criteria. Descriptive and Kruskal-Wallis test (α=5%) were used to analyze the data. Results: The groups treated with Ketac™Molar EasyMix were similar in terms of marginal sealing ability when submitted to Orange juice and Coca-Cola but significantly worse than water. For samples restored with the Ketac™N100 the worst results were found in the Coca-Cola group. Conclusion: Erosive challenges with acidic drinks affected the marginal adaptation of the tested GIC

Sexual dimorphism involved in the mesiodistal and buccolingual dimensions of permanent teeth

Studies indicate that tooth crown diameters are clinical markers for sex differentiation. Therefore, the aim of this study was to assess the degree of sexual dimorphism in different teeth. Maximum mesiodistal (MD) and buccolingual (BL) dimensions of 2400 permanent teeth from 100 pretreatment orthodontic dental study casts and clinical records (50 males and 50 females) from the Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Brazil, were examined. Comparison of the MD and BL dimensions between males and females was performed using the Student’s t test with alpha 0.05, effect size, and discriminant function analysis. Comparisons in MD and BL widths between sexes demonstrated that the combined mean in the female group presented reduction when compared with the male group, except for the BL dimension of tooth 26. In regard to the MD dimensions, statistically significant differences were observed in various dental groups. The greatest sexual dimorphism was observed in the left mandibular canine (p<0.001) with effect size over 0.8 (0.94), which characterizes large effect. In BL dimension, numerous teeth demonstrated statistical differences between the sexes. Our findings reinforced the magnitude of sexual dimorphism in tooth size, and, in addition, highlighted the differences in specific dental groups

Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students

Abstract\ud \ud Background\ud The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants—38 dental students and 38 pediatric dentistry students—in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course.\ud \ud \ud Results\ud A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975–0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001).\ud \ud \ud Conclusions\ud The e-learning strategy has the potential of improving students’ knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning.We would like to thank for CAPES (Coordenação e Aperfeiçoamento de\ud Pessoal de Nível Superior) for PhD Scholarship, CNPq (Conselho Nacional\ud de Desenvolvimento Científico e Tecnológico) and FAPESP (Fundação\ud de Amparo à Pesquisa do Estado de São Paulo (FAPESP) for supporting\ud our study

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease