Potencial remineralizante del fluoruro diamino de plata al 38% en dentina de dientes temporales afectada por caries / Remineralizing potential of 38% silver diamine fluoride in dentin affected by dental caries

Introducción: la caries es una enfermedad compleja que afecta a cualquier edad. La prevalencia es mayor en la primera dentición, sobre todo en población con baja percepción económica. El fluoruro diamino de plata (FDP) al 38% ha sido utilizado como una alter- nativa de tratamiento para esta enfermedad. Funciona como una solución remineralizante y cariostática. Objetivo: evaluar el efecto remineralizante del FDP al 38% en dentina afectada por lesiones de caries en molares temporales. Material y métodos: estudio clínico, epidemiológico, descriptivo, longitudinal y experimental. Se llevó a cabo en molares de primera dentición de niños de tres a cinco años de edad. Los niños seleccionados tenían molares con lesiones cariosas dentinarias, Pitts las denomina D3. No se incluyeron niños con dientes que presentaron patologías pulpares irreversibles. La aplicación del FDP al 38% la efectuó un operador entrenado para esta finalidad. Se utilizaron los criterios de Nyvad para determinar el grado de dureza de la dentina y con ello deducir su remineraliza- ción. Se observó la permanencia de la remineralización efectuada por un periodo de cinco meses. Resultado y conclusión: el FDP es un compuesto eficaz en 91% de los casos en un periodo de cinco meses o más (AU)

Introduction: dental caries is a complex disease that affects any age. The prevalence is higher in primary dentition, especially in a population with low economic perception. 38% silver diamine fluoride (FDP) has been used as an alternative treatment for this disease. It works as a remineralizing and cariostatic solution. Objective: to evaluate the remineralizing effect of 38% FDP on dentin affected by dental caries, in temporary molars. Material and methods: clinical, epidemiological, descriptive, longitudinal and experimental study. It was carried out in temporary molars of children between three and five years of age. The selected children presented molars with dental carious lesions, Pitts calls them D3. Children with teeth that presented irreversible pulp pathologies were not included. The application of the FDP to 38% was carried out by an operator trained for this purpose. The Nyvad criteria were used to determine the degree of hardness of the dentin and thereby deduce its remineralization. The permanence of the remineralization carried out was observed for a period of five months. Result and conclusion: the FDP is an effective compound in 91% of the cases, in a period of five months or more (AU)

Simplified vacuum dressing system: effectiveness and safety in wounds management

Purpose: Negative pressure wound therapy (NPWT) has revolutionized wound care, but its high cost reduces the procedure's availability. To solve the problem, streamlined vacuum dressings systems have been proposed, but the utility of these devices has been poorly studied. The objective of this study was to evaluate a simplified vacuum dressing system model (SVDM). Methods: Randomized clinical trial in which wounds were treated with SVDM compared to a complex occlusive dressing (silver hydrofiber, SHF). The analyzed outcomes were cleaning, presence of granulation tissue, clinical appearance, and indication for surgical closure of wounds. Results: Fifty injuries were treated (25 in each group), most located on lower limbs. SVDM proved to be more effective than SHF in the evaluated outcomes. Wound recalcitrance reduced the effectiveness of the equipment used. Despite its efficacy, complications occurred, the most frequent related to dressing changes: minor bleeding, foam adherence to a wound bed, and pain. Only for bleeding no favorable risk-benefit ratio was found. There were no severe complications, worsening conditions of injuries, or deaths. Conclusions: SVDM proved to be an effective and acceptably safe device for managing studied wounds.

Treatment of experimentally induced partial-thickness burns in rats with different silver-impregnated dressings

Purpose: To evaluate the morphometric, macroscopic and microscopic aspects of experimentally induced partial-thickness burns in rats treated with different silver-based dressings. Methods: Wistar rats were used, divided into six treatments: saline (NaCl 0.9%); silver sulfadiazine 1%; Silvercel; Mepilex Ag; Aquacel Ag and Acticoat. The animals were monitored daily and euthanized at 7, 14 and 30 days after injury induction (DAI). Results: At 7 DAI, necrosis/crust was greater in control, silver sulfadiazine and Mepilex Ag treatments, granulation tissue was induced by Aquacel Ag, polymorphonuclear infiltrate (PMN) infiltration was intensified by Mepilex Ag; mononuclear infiltrate (MN) infiltration and angiogenesis were increased by Silvercel. At 14 DAI, hemorrhage was decreased by Silvercel and Mepilex Ag, PMN infiltration increased by Acticoat. At 30 DAI, angiogenesis was greater in the Acticoat treatment and fibroblasts were increased by Acticoat and Mepilex Ag. Collagen was induced at 14 DAI by silver sulfadiazine and Aquacel Ag and, at 30 DAI, by silver sulfadiazine and Silvercel treatments. Conclusions: Silvercel and Acticoat presented better results than the other products. However, all the dressings were better than the control at some point during the process, and may contribute to the healing of partial thickness burns. Silvercel and Aquacel Ag treatments induced better cosmetic outcomes regarding wound closure and scarring.

Genótipos e Fenótipos de Resistência a Metais Pesados e Agrotóxicos em Patógenos de Alto Risco em Saúde Única / Genotypes and Phenotypes of Resistance to Heavy Metals and Pesticides in High-Risk Pathogens in Single Health

As atividades industriais e de agronegócio, embora necessárias para o desenvolvimento da sociedade, tem causado sérios problemas ambientais devido à eliminação inadequada de seus efluentes, sendo o tratamento destes um dos assuntos mais importantes em relação ao controle de poluição. Os microrganismos podem ser utilizados como biomarcadores de contaminação, portanto, o conhecimento de mecanismos associados à resistência e a capacidade de imobilização e biotransformação de poluentes é um fator importante para a identificação de linhagens adaptadas, que podem ser eficientes no tratamento e na recuperação de áreas contaminadas. O objetivo do presente projeto foi avaliar o perfil de tolerância de patógenos bacterianos de alto risco em saúde única, aos metais pesados (mercúrio, prata, telúrio e arsênio) e ao agrotóxico glifosato; identificando o resistoma associado. A correlação fenótipo-genótipo foi avaliada em isolados de Klebsiella pneumoniae (n= 35), Escherichia coli (n=46), e Salmonella spp. (n=19), determinando a CIM pelo método de microdiluição, e analisando as respectivas sequências genômicas. Entre os isolados de K. pneumoniae, 32 cepas apresentaram CIM elevadas (64- 512µg/mL) para o metal prata, dos quais 20 carregam o operon silPABCRSE responsável por conferir resistência. Uma cepa de K. pneumoniae carregando genes terABCE apresentou uma CIM de 64 µg/mL para telúrio. Seis cepas de E. coli apresentaram uma CIM >32 µg/mL para telúrio, sendo que 3 cepas carregam os genes tehA/B. Outras 6 cepas de E. coli apresentaram CIM para prata de 256-512 µg/mL, mas só duas carregaram genes silPFCE. Duas cepas de Salmonella apresentaram CIM 64-128 µg/mL para telúrio, e carregam genes tehA/B e terABCDEF. Em relação ao arsênio, 24 cepas de E. coli apresentaram uma CIM ≥ 512 µg/mL, e destas, 12 cepas carregam os genes arsRBC. Salmonella spp., que carregam o gene merR apresentaram CIMs de 8-16 µg/mL para mercúrio. Não foi possível correlacionar a presença do operon phnC-P (sugerido como responsável pela tolerância ao glifosato) com CIMs elevadas para este composto. Os resultados obtidos suportam a hipóteses que a exposição de bactérias de origem humana, animal e ambiental, aos metais pesados pode estar contribuindo para a seleção de linhagens tolerantes, sendo que a tolerância à prata mediada pelo operon silPABCRSE em K. pneumoniae foi predominante no grupo clonal CG258, característica com potencial de biomarcador que pode ser utilizado para monitorar o impacto do uso deste metal nas diferentes atividades humanas. Neste trabalho foi possível padronizar a técnica de PCR com os genes do operon sil de interesse

Industrial and agribusiness activities have caused serious environmental problems due to the inadequate disposal of their effluents, the treatment of which being one of the most important issues in relation to pollution control. Microorganisms can be used as biomarkers of contamination, therefore the knowledge of mechanisms associated with resistance and the immobilization and biotransformation capacity of pollutants can be an important factor for the identification of adapted strains, efficient in the treatment and recovery of contaminated areas. The aim of this study was to evaluate the tolerance profile of critical priority bacterial pathogens relevant in One Health, to heavy metals (mercury, silver, tellurium, and arsenic) and to the pesticide glyphosate, identifying the associated resistome. The phenotype-genotype correlation was evaluated in antibiotic-resistant isolates of Klebsiella pneumoniae (n= 35), Escherichia coli (n= 46), and Salmonella spp. (n= 19), by MIC determination using the microdilution method, and by analysis of their respective genomic sequences. Among the isolates of K. pneumoniae, 32 strains showed elevated MIC (64-512 µg/mL) for silver metal, of which 20 carried the silPABCRSE operon responsible for conferring resistance. A strain of K. pneumoniae carrying terrace genes showed a MIC of 64 µg/mL for tellurium. Six strains of E. coli showed an MIC> 32 µg/mL for tellurium, with 3 strains carrying the Thea/B genes. Other 6 strainsof E. coli showed MIC for silver of 256-512 µg/mL, but only two carried silPFCE genes. Two strains of Salmonella showed MIC 64-128 µg/mL for tellurium and carried the/B and terABCDEF genes. In relation to arsenic, 24 strains of E. coli had a MIC 512 µg/mL, and of these, 12 strains carried the arsRBC genes. Salmonella spp., which carriedthe mer gene, had MICs of 8-16 µg/mL for mercury. It was not possible to correlate thepresence of the phonic-P operon (suggested as responsible for glyphosate tolerance) with elevated MICs for this compound. The silver tolerance mediated by the operon sil was a predominant feature in K. pneumoniae strains belonging to the clonal group CG258, suggesting a intrinsic property that has contributed to the persistence and wide dissemination of CG258 within a One Health context, which could be as a biomarkerto monitor the impact of the use of silver compounds and silver-based biomaterial on different human activities. In this work it was possible to standardize the PCR technique with the genes of the sil operon of interest

The effect of reduced glutathione on the toxicity of silver diamine fluoride in rat pulpal cells

Abstract Introduction Due to its ability to arrest untreated dental caries, silver diamine fluoride (SDF) has been advocated for indirect pulp capping procedures. However, the high concentrations of silver and fluoride in SDF raise concerns about its biocompatibility to pulpal tissues. Objectives This study aimed to investigate the effect of SDF on the viability, alkaline phosphatase (ALP) activity, and morphology of pulpal-like cells (RPC-C2A) and to evaluate the influence of reduced glutathione (GSH) on SDF-induced cytotoxicity and deposit formation on dentin. Methodology The cytotoxicity of diluted 38% SDF solutions (10-4 and 10-5), with or without the addition of 5 mM or 50 mM GSH, was evaluated at 6 and 24 hours. Cell viability was detected using WST-8 and the effect on ALP activity was performed using an ALP assay kit. Cell morphology was observed using a phase-contrast microscope. Scanning electron microscopy analysis was conducted to evaluate the effect of GSH incorporation or conditioning on SDF-induced deposit formation on dentin discs. Cytotoxicity data were analyzed by two-way analysis of variance (ANOVA) and Tukey post hoc tests (p<0.05). Results There were significant differences between the groups. The results demonstrated that all tested SDF dilutions caused a remarkable cytotoxic effect, while the addition of GSH prevented SDF-induced damage at 6-hour exposure time in the higher dilution of SDF. Dentin treated with plain SDF or GSH-incorporated SDF solution showed deposit formation with occluded dentinal tubules, unlike the other groups. Conclusion SDF severely disturbed the viability, mineralization-ability, and morphology of pulpal-like cells, while controlled concentrations of GSH had a short-term protective effect against SDF-induced damage. GSH showed an inhibitory effect on SDF-induced dentinal deposit formation. Further research is warranted to evaluate the effect of GSH on caries-arresting, anti-hypersensitivity, and antibacterial functions of SDF.

Fluoride Concentration in SDF Commercial Products and Their Bioavailability with Demineralized Dentine

Abstract The aim of this in vitro study was to determine the fluoride concentration in silver diamine fluoride (SDF) products and their bioavailability with demineralized dentine. The products evaluated (expected fluoride concentrations) were: I: Saforide 38% (45,283 ppm F); II: Advantage Arrest 38.3 to 43.2% (45,283 to 51,013 ppm F); III: Ancárie 12% (14,100 ppm F); IV: Ancárie 30% (35,400 ppm F), V: Cariestop 12% (14,100 ppm F) and VI: Cariestop 30% (35,400 ppm F). The fluoride concentration was evaluated using an ion-specific electrode (ISE) by direct technique, which was confirmed after microdiffusion. The pH of the products was determined with a pH test strip. For the bioavailability test, demineralized dentine slabs were treated with one of the products for 1 min. Loosely (CaF2-like) and firmly-bound fluoride (FAp) were determined. The fluoride concentration found in the products (mean±SD; ppm F) by the ISE direct technique was: I:53,491±554; II:57,249±1,851; III:4,814±268; IV:5,726±43; V:10,145±468; VI:11,858±575; these values were confirmed after microdiffusion (t-test; p>0.05) and disagree with the declared by the manufacturers. The pH of Ancárie 12 and 30% was 6.0 and 4.5, respectively, in disagreement with the alkaline pH expected for SDF solution and found in the other products evaluated. There was no correlation between either CaF2-like (r=0.221; p=0.337) or FAp (r=-0.144; p=0.830) formed in demineralized dentine and fluoride concentration found in the products. The problems of pH and fluoride concentration found in available professional commercial SDF products suggest that they are not under sanitary surveillance.

Resumo O objetivo deste estudo in vitro foi determinar a concentração de fluoreto nos produtos de diamino fluoreto de prata (DFP) e sua biodisponibilidade com dentina desmineralizada. Os produtos avaliados (concentrações esperadas de flúor) foram: I: Saforide 38% (45.283 ppm F); II: Advantage Arrest 38,3 a 43,2% (45.283 a 51.013 ppm F); III: Ancárie 12% (14.100 ppm F); IV: Ancárie 30% (35.400 ppm F), V: Cariestop 12% (14.100 ppm F) e VI: Cariestop 30% (35.400 ppm F). A concentração de fluoreto foi avaliada utilizando um eletrodo íon-específico (EIE) por técnica direta, que foi confirmada após microdifusão. O pH dos produtos foi determinado com uma tira de teste de pH. Para o teste de biodisponibilidade, blocos de dentina desmineralizada foram tratados com um dos produtos por 1 min. Fluoreto fracamente (tipo CaF2) e firmemente ligado (FAp) foram determinados. A concentração de fluoreto encontrada nos produtos (média±DP; ppm F) pela técnica direta com EIE foi: I: 53.491±554; II: 57.249±1.851; III: 4.814±268; IV: 5.726±43; V: 10.145±468; VI: 11.858±575; esses valores foram confirmados após microdifusão (teste t; p>0,05) e discordam dos declarados pelos fabricantes. O pH do Ancárie 12 e 30% foi de 6,0 e 4,5, respectivamente, em desacordo com o pH alcalino esperado para a solução de DFP e encontrado nos demais produtos avaliados. Não houve correlação entre CaF2 (r=0,221; p=0,337) ou FAp (r=-0,144; p=0,830) formados na dentina desmineralizada e concentração de fluoreto encontrada nos produtos. Os problemas de pH e concentração de fluoreto encontrados nos produtos comerciais profissionais disponíveis de DFP sugerem que eles não estão sob vigilância sanitária.

Fluoruro diamino de plata comparado con técnica de restauración atraumática para el tratamiento de caries cavitadas en dentición primaria y mixta primera fase / Silver diamine fluoride compared to atraumatic restorative technique for the treatment of caries in primary and mixed first phase dentition

INTRODUCCIÓN: Las lesiones de caries cavitadas en dentición primaria y mixta requieren un tratamiento oportuno, para evitar así la progresión de la caries. El fluoruro diamino de plata ha surgido como una alternativa a la técnica de restauración atraumática debido a su fácil aplicación. Sin embargo, aún existe incertidumbre en relación a su efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos diez revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos ensayos aleatorizados. Concluimos que el fluoruro diamino de plata en comparación a la técnica de restauración atraumática podría aumentar el arresto de caries en dentición primaria y mixta primera fase, pero la certeza de la evidencia ha sido evaluada como baja. Por otra parte, el tratamiento con fluoruro diamino de plata comparado con la técnica de restauración atraumática (ART) probablemente aumenta el riesgo de eventos adversos

INTRODUCTION: Cavitated carious lesions in primary and mixed dentition require prompt treatment to control caries progression. Silver diamine fluoride has emerged as an alternative to the atraumatic restorative technique due to its easy application. However, there is still uncertainty regarding its effectiveness and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a metanalysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified ten systematic reviews, including two studies overall, which are randomized trials. We concluded that silver diamine fluoride compared to the atraumatic restorative technique may increase the arrest of caries in primary and mixed first phase dentition, however, the certainty of the evidence has been assessed as low. On the other hand, treatment with silver diamine fluoride compared to the atraumatic restorative technique (ART) probably increases the risk of adverse events.

Fibra óptica como un material alternativo en la obturación endodóncica: un estudio piloto / Optical fiber as an alternative material in endodontics: a pilot study

La gutapercha es químicamente un polímero a base de isopreno, impermeable, no poroso y radiopaco entre otras características, empleado desde el siglo XIX; sin embargo manifiesta algunos inconvenientes propios del material, lo cual ha dado lugar al nacimiento de otros materiales para mejorar sus propiedades. Recientemente se ha desarrollado y caracterizado un material novedoso a base de fibra óptica recubierta por nano partículas de plata (FONP), propuesto como un material alternativo para la obturación de conductos radiculares. En el presente estudio se seleccionaron 24 dientes para conformar cuatro grupos experimentales comparativos entre la obturación con fibra óptica y con gutapercha, ambos con el sellador AH Plus. Las raíces fueron obturadas en grupos de diez y almacenadas en solución salina a 37 oC. La filtración apical se midió desde el extremo apical de la interfaz del material hasta la extensión más coronal del tinte observado microscópicamente. Se empleó la herramienta de LAS EZ V3.0 (Leica Microsystems, Switzerland), los datos se tabularon y se analizaron. Resultados: Las mediciones de microfiltración a nivel apical e intraconductos manifestaron diferencias en favor de la gutapercha, donde los grupos experimentales manifestaron una filtración promedio correspondiente a 0.872 mm en el grupo de Gutapercha/AH-PLUS y de 2.390 mm con técnica lateral utilizando FONP/AH-PLUS, aun así se evidenció que las propiedades de sellado de la fibra óptica con nanopartículas fueron suficientes para considerarlo como un material de obturación de conductos radiculares dentales como posible sustituto de la gutapercha (AU)

Gutta-percha is chemically an Isoprene-based polymer, impervious, non-porous and radiopaque, among other characteristics, used since the 19th century, it manifests some disadvantages inherent to the material, which has led to the birth of new materials with improved properties. Recently, a novel material based on optical fiber covered by silver nanoparticles (FONP) has been developed, characterized and proposed as an alternative material for root canal obturation. In the present study, 24 teeth were selected and divided into four comparative experimental groups for obturation with fiber optics and gutta-percha, both with the AH Plus sealer. The roots were sealed in groups of ten and stored in saline at 37 oC. Apical filtration test was performed from the apical end of the material interface to the most coronal extension of the dye observed microscopically. The LAS EZ V3.0 tool was used to make the measurements and the data was tabulated and analyzed. Results: Measurements of microfiltration at the apical and intracanal level showed differences in favor of gutta-percha, where the experimental groups showed an average filtration of 0.872 mm in the Gutapercha/AH-PLUS group and 2.390 mm using FONP/AH-PLUS, even so, it was evidenced that the sealing properties of the optical fiber with nanoparticles are sufficient to consider this material as a proper filling material for dental root canals as a substitute for gutta-percha (AU)

Efectividad bactericida del diamino fluoruro de plata a diferente concentración sobre estreptococos cariogénicos en muestras de saliva y dentina de escolares: un estudio in vitro / Bactericidal effectveness of silver diamine fluoride in different concentrations on cariogenic Streptococcus in salivary and dentinal samples of schoolchildren: an in vitro study

La OMS y la FDI han publicado que entre el 60 y 90% de los escolares padecen caries. En nuestro país, el Sistema de Vigilancia Epidemiológica de Patologías Orales (SIVEPAB) 2012, reporta un 85% de caries a nivel nacional en población pediátrica. Los agentes anticariogénicos como el diamino y el fluoruro de plata son un tratamiento alentador, este agente puede actuar como bactericida o bacteriostático en función de su concentración y su capacidad para inhibir el crecimiento de estreptococos del grupo viridans, y por ende, de la caries. Problema: ¿Cuál es la efectividad bactericida del diamino fluoruro de plata (Saforide®) a diferente concentración sobre la microbiota cariogénica de escolares? Objetivo: Determinar la eficacia bactericida del diamino fluoruro de plata (DFP) a diferentes concentraciones en el crecimiento bacteriano de Streptococcus mitis, S. mutans y S. salivarius en muestras de saliva y dentina en escolares. Material y métodos: Se llevó a cabo un estudio experimental con una variable independiente, el efecto bactericida del diamino fluoruro de plata y se tomó el halo de inhibición como la dependiente. Se utilizaron medidas descriptivas como prueba de comparación y análisis de varianza usando post-hoc Tukey≠ con una confianza del 95%, y análisis de datos exploratorios. Resultados: Se analizaron 100 muestras, de las cuales 48.3% correspondió a S. mutans, 41.4% a S. salivarius y 10.3% a S. mitis, se obtuvo una mayor zona de inhibición para las tres bacterias al 38% mostrando una diferencia estadísticamente significativa 12% (p < 0.05). También se observó un efecto bacteriostático al 12%, no así para el 38%, donde se encontró un efecto bactericida Conclusión: Nuestros resultados sugieren que al 38% de la concentración hay un claro efecto bactericida en el grupo de estreptococos viridans y el 12% no se recomienda para la detención de caries debido al efecto bacteriostático (AU)

WHO and FDI have ruled that 60-90% of schoolchildren are affected by caries. In our country, the System of Epidemiological Surveillance of Oral Pathologies (SIVEPAB) (SIVEPAB) 2012. Report a rate of 85% of caries nationally in pediatric population. Anticariogenic diamino agents such as silver fluoride are an encouraging decrease in treatment for these high rates of tooth decay in our country, this agent can act as bactericidal or bacteriostatic based on their concentration and their ability to inhibit endogenous metalloproteinase (MMP-2, 8, 9). Problem: What will be the bactericidal effectiveness of silver diamine fluoride different concentration on cariogenic Streptococci saliva samples taken from school and dentin? Objective: Determine the bactericidal effectiveness Silver diamine fluoride (SDF) to different concentration on bacterial growth of Streptococcus mitis, S. mutans, and S. salivarius in saliva samples and dentin in school. Material and methods: An experimental study was conducted as an independent variable the bactericidal effect of silver diamine fluoride was taken as dependent inhibition halo. Descriptive measures were used as a comparison test and analysis of variance using Post-hoc Tukey with 95% confidence, and exploratory data analysis. Results: One hundred samples, of which 48.3% corresponded to S. mutans, 41.4% to S. salivarius and 10.3% to S. mitis, were analyzed, we obtained a larger zone of inhibition for all three organisms at 38% showing a statistically significant difference from 12% (p < 0.05). It was also observed that the 12% sample bacteriostatic effect, not to the concentration of 38% was found a bactericidal effect. Conclusion: Our results suggest that 38% concentration has a bactericidal effect on Streptococcus viridans group and 12% showed not recommended for the arrest or detention of dentine caries bacteriostatic effect (AU)

Effect of silver diamine fluoride (SDF) on the dentin-pulp complex: ex vivo histological analysis on human primary teeth and rat molars / Efecto del diamino fluoruro de plata (DFP) sobre complejo dentino-pulpar. Análisis histológico ex vivo en dientes primarios humanosy molares de rata

The aim of this study was to determine the effect of SDF on thedentin­pulp complex using two models: teeth after SDFapplication (ex vivo) and experimental animal molars. Adescriptive study was performed using two models. In the firstmodel, primary teeth (ex vivo) with enamel­dentin caries, withoutpulp involvement and previously treated with 38% SDF, wereevaluated by means of two techniques: (a) Scanning ElectronMicroscopy (SEM) and energy­dispersive X­ray detector (EDS)to determine qualitative and quantitative composition, and (b)brightfield optical microscopy (OM) after decalcification. Thesecond model used laboratory animal molars from 12 maleWistar rats. Standardized enamel­dentin cavities approximately0.5 mm deep were made the distal fossa of the occlusal face ofboth first lower molars, to one of which a 38% SDF solution wasapplied, while the other was used as a control. Histologicalsections were prepared and dental pulp was evaluatedqualitatively in both groups. SEM on ex vivo teeth showed areasof hypermineralization in the intertubular dentin and few blockedtubules, while EDS detected Ag in the center of the lesion(7.34%), its concentration declining at the edges (1.71%), withnone in the areas farthest from the lesion...

El objetivo del trabajo fue determinar del efecto del DFP encomplejo dentino­pulpar aplicando dos modelos: piezasdentarias luego de su aplicación (ex vivo) y en molares deanimales experimentales. Se realizó un estudio descriptivoaplicando dos modelos: en piezas dentarias primarias (ex vivo)con caries amelodentinarias sin compromiso pulpar que hayansido sometidas previamente con DFP 38%, mediante dosevaluaciones: Microscopía electrónica de Barrido (MEB) ydetector de energía dispersiva de rayos X (EDS) a fin dedeterminar su composición cuali y cuantitativa y Microscopíaóptica de campo claro (MCC) mediante la técnica descalcifi ­cación y en molares de animales de laboratorio donde seutilizaron 12 ratas Wistar macho. La técnica fue estandarizadaen la fosa distal de la cara oclusal del primer molar inferior, serealizó una cavidad amelodentinaria aprox. 0.5 mm de profun ­didad, en ambos molares. En un molar se aplicó la soluciónDFP al 38 % y el opuesto como control. Se realizaron corteshistológicos y se evaluó en forma cualitativa la pulpa dentalen ambos grupos. En las piezas ex vivas mediante MEBse observaron áreas de hipermineralización en la dentinaintertubular y escasos conductillos obliterados y por EDS sedetectó Ag en el centro de la lesión (7.34%), disminuyendo suconcentración en los límites (1,71%) y no se detectó en las zonasmás alejadas de la misma. En MCC se observó DFP sellando losconductillos sólo en sitio de colocación y con una penetraciónlimitada, por debajo, los conductillos se observaron de aspectonormal y el tejido pulpar asociado con la caries tratadaha mostrado un infiltrado inflamatorio crónico y formaciónde dentina terciaria, sin observarse precipitado de Ag...

General treatment and wound management in hereditary epidermolysis bullosa: indication and experience using silver hydrofiber dressing / Tratamento geral e das feridas na epidermólise bolhosa hereditária: indicação e experiência usando curativo de hidrofibra com prata

Introduction: Hereditary epidermolysis bullosa (EB) is a rare disorder characterized by cutaneomucous fragility, with formation of blisters during minimal trauma. Treatment consists of clinical and nutritional support and management of pain and skin lesions. Silver hydrofiber (Aquacel Ag®) is a type of carboxymethylcellulose fiber dressing with silver that can be used in selected cases of EB. Objective: To review the literature on the general treatment and management of cutaneous lesions in congenital EB and evaluate the indication and experience of using silver hydrofiber dressing. Methods: The review included original articles and systematic reviews published between 2009 and 2014. We also selected two patients with congenital EB treated at the Plastic Surgery Division of Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto at the University of São Paulo. Results: There is a shortage of scientific evidence related to the treatment of skin lesions in congenital EB, with most recommendations being based on expert opinions. Hydrofiber is indicated in most consensuses for wounds with some exudation and has been shown to be more absorbent than alginate. In our experience, there was apparent improved control of pain, bleeding, and hypothermia with the use of hydrofiber, which has the advantage of not requiring daily changes and can remain on the wound for up to two weeks. Conclusions: The general and lesion treatments in EB are challenging. Hydrofiber with silver is a treatment option for wounds in hereditary EB, without the need for daily dressing changes.

Introdução: Epidermólise bolhosa (EB) hereditária é uma desordem rara caracterizada pela fragilidade cutaneomucosa, com formação de bolhas ao mínimo trauma. O tratamento consiste em suporte clínico, nutricional, manejo da dor e das lesões cutâneas. A hidrofibra com prata (Aquacel Ag®) é um tipo de curativo de fibra de carboximetilcelulose e prata que pode ser utilizada em casos selecionados de EB. Objetivo: Revisão da literatura sobre o tratamento geral e o manejo das lesões cutâneas na EB congênita, além de avaliar a indicação e experiência usando curativo de hidrofibra com prata. Métodos: A revisão incluiu artigos originais e revisões sistemáticas, publicados entre 2009 e 2014. Selecionamos ainda dois pacientes com EB congênita tratados na Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Resultados: Há escassez de evidências científicas relacionadas ao tratamento das lesões cutâneas na EB congênita, sendo a maioria das recomendações baseadas em opiniões de especialistas. A hidrofibra está indicada na maioria dos consensos para feridas com alguma exsudação e mostrou-se mais absorvente que o alginato. Em nossa experiência, houve aparente melhor controle da dor, do sangramento e da hipotermia com o uso da hidrofibra, que apresenta a vantagem de não necessitar de trocas diárias, podendo permanecer na ferida por até duas semanas. Conclusões: O tratamento geral e das lesões na EB é um desafio. A hidrofibra com prata é uma opção de tratamento para as feridas na EB hereditária, sem necessidade de trocas diárias de curativo.

Implantação de nova tecnologia para otimização do atendimento em ambulatório de queimados, sem adição de custos / Implementation of a new technology to improve the treatment of outpacients burn, without adding costs

As evidências científicas ainda são insuficientes para determinar se os tipos de curativos contendo prata diferem entre si quanto ao tempo para completar a epitelização da ferida, a proporção de lesões epitelizadas, dor e percentual de infecção. Objetivos: Analisar o custo, efetividade e segurança dos curativos de prata nanocristalina e da sulfadiazina de prata 1% no trata¬mento ambulatorial de pacientes queimados. Método: Estudo observacional analítico em um único centro com pacientes adultos entre 18 e 55 anos, independentemente do sexo, que apresentavam queimaduras de segundo grau, em regime ambulatorial, sem a necessidade de tratamento cirúrgico. Será comparado o custo para realização dos curativos à base de prata nanocristalina e sulfadiazina de prata a 1%. Resultados: Os resultados obtidos esclarecerem que há diferenças entre os curativos à base de prata e o curativo à base de prata nanocristalina é custo efetivo, proporcionando economia substancial à instituição. Conclusão: Os curativos de prata nanocristalina são custo efetivos e proporcionam uma diminuição de custos médicos e não médicos, podendo ser padronizado pelas instituições como alternativa para tratamento de pacientes queimados ambulatoriais.

The scientific evidences are still insufficient to determine whether the types of dressings containing silver differ from each other in the time to complete epithelialization of the wound, the proportion of epithelialized lesions, pain and percentage of infection. Objectives: To analyze the cost effectiveness and safety of nanocrystallinesilver dressings and silver sulfadiazine 1% in the outpatient treatment of burn patients. Method: Analytical study in a single enter with adult patients between 18 and 55 years, regardless of gender who had second degree burns in an outpatient setting, without the need of a surgical treatment. It will be compared the cost of carrying out dressing of the base nano¬crystalline silver and the silver sulfadiazine 1%. Results: The results clarify that there are differences between the silverbased dressings and the dressings is nanocrystalline silver-based costeffective providing substantial savings to the institution. Conclusion: The nanocrystalline silver dressings are cost effective and provide a reduction in medical costs and non-medical ones, it may be standardized by the institutions as an alternative for the treatment of burn patients and outpatients.

Tratamento ambulatorial de queimaduras com prata nanocristalina em malha flexível: uma alternativa terapêutica / Ambulatory treatment of burns with nanocrystalline silver in flexible mesh: an alternative therapeutic

Objetivo: Avaliar a eficácia e o tempo de tratamento de pacientes em tratamentoambulatorial com prata nanocristalina em malha flexível na Unidade de Tratamento de Queimados do Hospital Regional de Sorocaba. Método: Série de casos na qual foram selecionados pacientes vítimas de queimadura emmembros superiores, que não possuíam critérios de internação no período entre junho de 2011 e junho de 2012. Foram incluídos oito pacientes. Todos apresentavam queimaduras de 2º grau, sem sinais de infecção local, acometendo membros superiores. A média de idade foi de 24,87 anos. A porcentagem de área queimada foi calculada segundo a tabela de Lund e Browder. Os pacientes foram submetidos à lavagem do curativo com soro fisiológico e desbridamento se necessário. Em seguida, foi aplicada uma malha de poliéster flexível contendo prata nanocristalina, recoberta por gaze e faixa tipo crepe. Os pacientes eram examinados a cada três dias e, se necessário, um novo curativo foi realizado. Todos os pacientes foram acompanhados até a cicatrização total da queimadura. Resultados: A maioria das lesões foi causada por escaldo, seguido por fogo econtato. A média de dias dos curativos contendo a malha de poliéster com prata nanocristalina foi de 13 dias. Conclusão: A malha de poliéster flexível mostrouse eficaz na cicatrização de queimaduras e uma boa alternativa terapêutica.

Purpose: Evaluate the efficacy and time of treatment of patientes in ambulatory treatment with nanocrystalline silver in flexible mesh in the Unit of Treatment of Burns int the Regional Hospital in Sorocaba. Methods: Series of cases in which were selected patients victms of burns in upper limbs, that had no criterion of internment in the period between June 2011 and June 2012. In the study eight patients were included. All of them have second degree burn, with no local infection in the upper limbs. The mean of age was 24,87 years. The burn area was calculated by the Lund and Browder table. The patients had their wounds washed with saline sodium chloride solution and debridement if necessary. After that, was apllied a flexible polyester mesh with nanocrystalline silver, and covered with gaze and band. The patients were examined every three days and if it necessary a new dressing was made. All the patients were monitored until the total healing. Results: The most of burns was caused by skald, followed by fire and contact. The mean of days with the mesh with nanocrystalline silver was 13 days. Conclusion: The polyester mesh with nanocrystalline silver was effective in the healing of burns and a good alternative therapeutic.

Systematic Review: which topical agent is more efficacious in the prevention of infections in burn patients? / Revisión sistemática: ¿Cuál es el agente tópico más eficaz en la prevención de infecciones en el paciente quemado?

Topical agents are widely used in the care of burn patients; however the efficacy to prevent local infections and/or sepsis has not been clearly established in studies with a high level of evidence. This systematic review was conducted to assess the comparative efficacy among different topical agents. Material and Methods. The literature search was performed using the Medline database. Key MESH terms were: (burn* or scald*) AND (antibacterial or antibiotic*) AND (topic*) AND (therap* or prophylax*). Only randomized or quasi-randomized clinical trials, with a primary endpoint of local infection and/or sepsis were included. Studies were scored and classified regarding methodological key issues according to their level of evidence. Results. The initial search identified 457 studies of which 14 were eligible for final evaluation, and full text was available for 11 of them. Conclusions. The evidence found in our review does not support differences in efficacy of topical agents to reduce sepsis and/or local infections in burn patients.

Los agentes tópicos son ampliamente utilizados en el cuidado de los pacientes quemados. Con el objetivo de evaluar la eficacia comparativa entre diferentes agentes tópicos habitualmente utilizados para la prevención de infecciones, llevamos a cabo una revisión sistemática. Material y métodos. La búsqueda bibliográfica se realizó en la base Medline. Las palabras clave utilizadas, fueron: burn* or scald* AND antibacterial or antibiotic* AND topic* AND therap* or prophylax*. Solamente se incluyeron estudios con asignación aleatorizada o cuasi-aleatorizada de las intervenciones y cuya variable principal fuera la presencia de infección local y/o sepsis. Resultados. La búsqueda inicial detectó 457 artículos, de los cuales se seleccionaron 14 para su evaluación final, disponiendo del texto de 11 de ellos. Conclusiones. Las evidencias halladas sobre el tema fueron de calidad científica moderada. No se identificaron evidencias que demostraran la superioridad de alguno de los agentes tópicos sobre otros para reducir la infección o la sepsis en el paciente quemado.

Avaliação comparativa do uso de hidroalginato com prata e o curativo convencional em queimaduras de segundo grau / Comparative evaluation of use of silver hydroalginate and conventional dressing in second degree burns

Introdução: O tratamento do paciente queimado sempre foi um desafiopara o profissional que busca melhores resultados no que diz respeito a maiorvelocidade de restauração tecidual, redução da dor e da infecção, além demelhor aspecto estético final da ferida. Entre as novas tecnologias em curativos, destaca-se a cobertura de hidroalginato associado à prata. Objetivo: Comparar o tratamento convencional da queimadura de segundo grau superficial (curativode quatro camadas) e profunda (curativo de quatro camadas + sulfadiazina de prata a 1%) com a utilização do curativo de hidroalginato com prata, quanto aos critérios: dor, evolução da queimadura e praticidade de uso. Método: Este estudo foi conduzido na Divisão de Queimaduras do Hospital do Servidor Público Estadual de São Paulo, em 20 pacientes, de ambos os sexos, entre 5 e 60 anos de idade, vítimas de queimaduras de segundo grau superficial ou mista,com superfície corpórea queimada (SCQ) de até 5%. Resultados: As trocas de curativos convencionais foram extremamente dolorosas (escala de dor 7, 8 e 9), enquanto que, com o curativo de hidroalginato com prata, as trocas receberam notas 0, 2 e 3. Este curativo mostrou-se fácil e prático, especialmente pela reepitelizaçãomais rápida e menor número de trocas. Conclusão: O curativo de hidroalginato com prata mostrou-se de fácil aplicação e manuseio, possibilitando a troca pelo paciente em seu próprio domicílio, proporcionando maior conforto para este e comodidade para os profissionais da saúde.

Introduction: The treatment of burn patients has always been a challenge for the professionals looking better results with regard to the higher rate of tissue restoration, reduction of pain and infection, and better aesthetics final wound. Among the new technologies indressings, stands out the coverage of Alginate associated with silver. Objective: To compare the conventional treatment of superficial seconddegree burn (four-layer bandage) and deep (four-layer bandage + silver sulfadiazine 1%) of the Alginate dressing with silver, for the criteria: pain, evolution of burn and practicality of use. Methods: This study was conducted at the Division of Burns Hospital for State Civil Servants of São Paulo, in 20 patients, of both sexes, between 5 and 60 years of age, victims of superficial second-degree burnsor mixed with body surface burned (SCQ) up to 5%. Results: The conventional dressing changes were extremely painful (pain scale of 7, 8 and 9), while with the silver Alginate dressing, exchanges were scored 0, 2 and 3. This dressing was easy and convenient, especially for faster re-epithelialization and fewer exchanges. Conclusion: Alginate dressing with silver proved easy application and handling, enabling exchange by patients in their own homes, providing greater comfort for them and convenience for health professionals.

Eficiencia de tres fluoruros concentrados para la estabilización de caries de esmalte / Efficiency of three concentrated fluorides for the stabilization of enamel caries

El principal objetivo social de la OMS y de los gobiernos ha sido que las poblaciones estén suficientemente sanas para llevar una vida social y económicamente útil. El objetivo de esta investigación fue comparar la eficiencia para estabilizar el proceso de caries determinado por tres tipos de fluoruros tópicos concentrados: el barniz de bifluoruro de amonio (Topic Bi(R) 2,26 por ciento F- y pH 3,5), el fluoruro diamínico de plata (Fluorplat(R) 25,4 por ciento de Ag- 4,48 por ciento de F- y pH 8,6) y fluoruro de sodio (Duraphat(R) 2,26 por ciento de F- y pH 7), a fin de controlar el avance de las lesiones. Fueron incluidos en el estudio treinta y seis niñas entre 6 y 9 años de edad con alto riesgo social y caries de esmalte en dos o más cuadrantes, previa autorización parental. La eficacia del programa fue evaluada clínica y radiográficamente sesenta días y un año después de realizados los tratamientos y se determinó la significación estadística de los resultados (intervalos de confianza). Los estudios de costo-eficiencia incluyeron los costos directos e indirectos. Los resultados revelaron: (a) no existió diferencias significativas en la eficacia alcanzada por los tres tipos de tratamientos; (b) sesenta días postratamiento el fluoruro diamínico de plata alcanzó el mayor porcentaje de superficies estabilizadas (97,1 por ciento), seguido del fluoruro de sodio (88,5 por ciento) y del bifluoruro de amonio (83,3 por ciento); (c) un año después del tratamiento los resultados revelaron que el fluoruro diamínico de plata mantuvo el más alto porcentaje de estabilización de las lesiones (57,14 por ciento), seguido por el bifluoruro de amonio (55,5 por cento) y por el fluoruro de sodio (47,06 por ciento); (d) 60 días después del tratamiento la relación costo-eficacia alcanzada fue de U$S 1,08/ por lesión estabilizada para el fluoruro diamínico de plata; seguido por el bifluoruro de amonio con una relación de U$S 1,34/SE y por el fluoruro de sodio son U$S 1,74 /SE; (e) un año después del tratamiento las relaciones costo-eficacia fueron de U$S 1,77/ por lesión estabilizada para el fluoruro diamínico de plata, seguido por el bifluoruro de amonio con una relación de U$S 1,92 /SE y por el fluoruro de sodio con U$S 2,74 /SE. La relación costo-eficacia de la aplicación de fluoruros concentrados reveló que esta modalidad de tratamiento no invasivo podría ser incluida en programas de salud bucal para determinar la estabilización de caries tempranas en niños

Lesiones de la mucosa oral ocasionadas por materiales de uso odontológico / Oral mucosal lesions caused by dental materials

Existe una gran cantidad de patologías que asientan sobre la mucosa bucal, cuyo origen está relacionado con materiales o instrumental utilizado durante la práctica odontológica diaria. Ellas van desde erosiones hasta ulceraciones o lesiones crónicas como las pigmentaciones y leucoplasias, entre otras. En este trabajo se propone una clasificación de estas lesiones según su etiopatogenia

M.E.B. Efecto del grabado ácido aplicado sobre dentina remineralizada con cariostático / S.E.M. Effect of acid etching applied on cariostatic-remineralized dentin

Uno de los agentes cariostáticos más usados en la actualidad en dentición temporaria, es el fluoruro dimaínico de plata. En este estudio realizamos su aplicación sobre caries dentinaria en dientes posteriores de pacientes adultos. Tanto clínica como radiográficamente, pudo observarse la remineralización de la dentina en las 50 piezas dentarias tratadas. Una de las comprobaciones más efectivas de esta remineralización fue llevar 25 de las piezas dentarias que fueron extraídas por otras patologías, al microscopio electrónico de barrido para su estudio. El objetivo de esta observación fue comprobar la obliteración de los conductillos dentinarios y la presencia de retenciones micromecánicas, luego del grabado ácido, en la dentina tratada con el cariostático. Según los resultados obtenidos en la totalidad de las piezas dentarias, la remineralización lograda con el cariostático se conservó en el 100 por ciento de los casos luego de aplicado el ácido grabador y produjo las microrretenciones necesarias para la adhesión de la resina compuesta de fotocurado

Cariostáticos y grabado ácido en pacientes con capacidades diferentes / Cariostatics and acid etching in handicapped patients

Dada la incidencia de caries y la dificultad para su tratamiento en pacientes con capacidades diferentes se utilizó fluoruro diamínico de plata al 38 por ciento, por su acción remineralizante y antibacteriana, su bajo costo y sencialla aplicación. No necesita el uso de anestesia ni elementos rotatorios para eliminar caries. Se restauró con resina compuesta de fotocurado. El objeto de este estudio fue comprobar que las microrretenciones producidas por el grabado ácido necesario para la ahesión de la resina no afecta la remineralización lograda