Filtración de anastomosis colorrectal tratada con E-VAC con espuma de polivinilo podría reducir el tiempo de tratamiento / Colorectal anastomotic leak treated with E-VAC with polyvinyl sponge could reduce treatment time

RESUMEN Las filtraciones de anastomosis colorrectales tienen una incidencia de 5 a 15% y su manejo depende de las manifestaciones clínicas, la distancia desde el margen anal y su ubicación intra o extra peritoneal. En algunos casos seleccionados el manejo endoscópico ha demostrado ser un tratamiento efectivo. En el presente reporte de caso se utilizó el sistema de drenaje rectal transanal asistido por vacío descrito por Weidenhagen et al., para el tratamiento de una fuga anastomótica pero se utilizó una espuma de polivinilo en vez la espuma tradicionalmente usada de poliuretano con el fin de disminuir el número de cambios de la espuma y el tiempo de tratamiento.

ABSTRACT Colorectal anastomosis leaks have an incidence of 5 to 15% and their management depends on the clinical manifestations, the distance to the anal verge and the intra or extra peritoneal location. In some selected cases, endoscopic management has proven to be an effective treatment. In this case report, the vacuum-assisted transanal rectal drainage system described by Weidenhagen et al. was used for the treatment of an anastomotic leak. We used a polyvinyl sponge instead of the polyurethane sponge traditionally used with the intention to reduce sponge changes and treatment time.

Effect of stem cells combined with a polymer/ceramic membrane on osteoporotic bone repair

Abstract Cell therapy associated with guided bone regeneration (GBR) can be used to treat bone defects under challenging conditions such as osteoporosis. This study aimed to evaluate the effect of mesenchymal stem cells (MSCs) in combination with a poly(vinylidene-trifluoroethylene)/barium titanate (PVDF-TrFE/BT) membrane on bone repair in osteoporotic rats. Osteoporosis was induced in female rats by bilateral removal of the ovaries (OVX) or sham surgery (SHAM), and the osteoporotic condition was characterized after 5 months by microtomographic and morphometric analyses. Calvarial defects were created in osteoporotic rats that immediately received the PVDF-TrFE/BT membrane. After 2 weeks, bone marrow-derived MSCs from healthy rats, characterized by the expression of surface markers using flow cytometry, or phosphate-buffered saline (PBS) (Control) were injected into the defects and bone formation was evaluated 4 weeks post-injection by microtomographic, morphometric, and histological analyses. A reduction in the amount of bone tissue in the femurs of OVX compared with SHAM rats confirmed the osteoporotic condition of the experimental model. More bone formation was observed when the defects were injected with MSCs compared to that with PBS. The modification that we are proposing in this study for the classical GBR approach where cells are locally injected after a membrane implantation may be a promising therapeutic strategy to increase bone formation under osteoporotic condition.

Determination of the effective anticandidal concentration of denture cleanser tablets on some denture base resins

Abstract Objective Although the effectiveness of chemical cleansing against Candida albicans biofilm has been shown, the effective concentration of denture cleanser tablets has not been studied. The aim of this study was to assess the effect of three denture materials against Candida albicans biofilm and to determine effective concentrations of denture cleanser tablets. Material and methods The surface-roughness of Acron-hi™, QC-20™ and Deflex™ (n=45 per resin) resins was standardized by using a profilometer and their contact angle or surface free energy was calculated. C. albicans biofilm was formed on all three resins and were treated with Polident 3 min™, Corega™ and Fittydent™ cleanser solutions at various concentrations and both resin-biofilm and cleanser-biofilm interest were determined by using a MTT protocol according to the European Committee on Antimicrobial Susceptibility Testing's antifungal susceptibility testing (AFST-EUCAST). Scanning electron microscopy was used to compare the efficacy of different resin materials against C. albicans biofilm. Anticandidal activity and surface free energy statistical parameters were calculated by using 3-way and 1-way ANOVA, respectively (p<0.05). Results Polident 3 min™ and Corega™ tablets significantly inhibited (p<0.05) the proliferation of C. albicans against all denture resins at 27-37 mg/mL. Scanning electron microscopy results indicated that there was no significant difference among resin specimens regarding biofilm formation on dentures. We failed to find a significant relationship between surface free energy and the anticandidal effect of resin types. However, the polarity value of the resins was statistically associated with their anticandidal activity. Conclusions The polarity of the resins, the concentrations of tablets and the chemical content of the cleanser may directly affect C. albicans biofilm formations. Polident 3 min™ and Corega™ tablets should be suggested for patients who use any denture resin types, whereas the Fittydent™ tablet should only be proposed for those who use Deflex™, when two tablets are dropped into 150 mL water.

Abdomen abierto y contenido: sistema "no comercial - hand made" en pacientes traumatizados. Alternativa terapéutica en situaciones con bajos recursos. ¿Es una opción segura y eficiente? / Open abdomen and content in "non commercial hand made system" in trauma patients Therapeutic alternative in situations with low resources. Is it a safe and efficient option?

Introducción: En la década del '80 se iniciaron los conceptos de laparotomía y relaparotomías. La hipertensión intraabdominal, la cirugía del control del daño, la necesidad de reexploración por packing hemostáticos o las colecciones abdominales son las indicaciones para considerar un abdomen abierto y contenido. A lo largo de los años distintos sistemas de contención del abdomen fueron comercializados, reduciendo la mortalidad a 7 %. Objetivos: El problema es la disponibilidad del recurso dado su alto costo en instituciones con bajo presupuesto. El objetivo es analizar la efectividad y seguridad del método propuesto para aplicar en medios donde el recurso no está disponible en su forma comercial. Material y Método: Realizado entre el 01 de enero 2015 y Julio de 2016, 10 pacientes fueron tratados con abdomen abierto y contenido "no comercial ­hand made". Consiste en la aplicación de un film de polivinilo, multifenestrado, ubicado en la cavidad abdominal por debajo del peritoneo. Sobre ésta, una cubierta de poliuretano y gasas que envuelve una sonda tipo K9. Un film adhesivo cubre toda la incisión, aplicándose una presión negativa de 100 a 150 cm de agua. En un solo caso se utilizó el Wittmann Patch. Resultados: En 7 pacientes se hallaron lesiones combinadas. Lesión hepática: 7; 2 presentaban hipertensión intraabdominal con dificultad para el afrontamiento abdominal. Packing pancreático duodenal: 1. Contaminación de la cavidad: 1. La cantidad de exploraciones fue de 9 y de 3 lavados en promedio. Conclusiones: El sistema "no comercial ­hand made" es un método seguro, de bajo costo y con baja de tasa de complicaciones

Introduction: In the decade of the'80 the concept of laparotomy and relaparotomies began. Intra-abdominal hypertension, damage control surgery, need for re ­examination by hemostatic packing or abdominal collections are indications to consider perfoming the open and contained abdomen. Throughout the years different systems of containment of the abdomen were commercialized. reducing mortality to 7%. Objectives: To analyze the effectiveness and safety of the method proposed to be applied where the resource is not available in its commercial way Material and Methods: In the period between January 1, 2015 and July 2016, 10 patients were treated with open abdomen and "non-commercial -hand made" contents. Consists in the application of a multilayer polyvinyl film of 80 microns, located in the abdominal cavity below the peritoneum, surpassing it inwards by 5 cm. A layer of polyurethane and gauze is placed over this layer, which envelops a polyvinyl probe type K9, until it reaches the edge of the wound. An adhesive film covers the whole incision and passes it by 15 cm, while applying a negative pressure of 100 to 150 cm of water. In only one case the technique described by Dietmar Witmann, the Wittmann Patch was used. Results: Combined lesions were found in 7 patients. Liver injury: 7; 2 also presented HIA with difficulty for abdominal coping. Packing Pancreatic duodenal 1. Cavity contamination: 1. The number of scans was 9 and 3 washes on average. Conclusions: The "non -commercial -hand made" system is a safe, low -cost and low complication rate.

Glaucoma secundário a fístula carótido-cavernosa / Secondary glaucoma following carotid cavernous fistula

RESUMO As fístulas carótido-cavernosas são uma causa rara, porém grave, de glaucoma secundário por aumento da pressão venosa episcleral. Apresenta-se um caso de uma mulher de 72 anos, negra, atendida no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (HC-UFTM) com dor, sensação de pulsação, proptose, engurgitamento episcleral e quemose em olho direito, com aumento da pressão intraocular (PIO) apesar do uso de mediação anti-glaucomatosa. Na arteriografia foi evidenciada fístula dural para o seio cavernoso à direita, com refluxo para as veias orbitárias ipsilaterais. Realizou-se tratamento com agente líquido de embolização e, após o tratamento cirúrgico, apresentou melhora completa da proptose e congestão dos vasos episclerais, porém manteve PIO aumentada e desenvolvimento de glaucoma de ângulo fechado pela presença de goniossinéquias em 270º, com controle satisfatório com medicação.

ABSTRACT Carotid-cavernous fistulas are a major cause of secondary glaucoma due to increased episcleral venous pressure. We present the case of a 72-year-old female patient, treated at the Hospital de Clínicas at the Universidade Federal do Triângulo Mineiro (HC-UFTM), with pain, proptosis, episcleral engorgement, chemosis and pulsation in the right eye, with increased intraocular pressure (IOP) on anti-glaucomatous medication.Arteriography showed dural fistula to the right cavernous sinus, with reflux to orbital veins.Treatment with liquid embolization agent was performed, following full recovery of proptosis and congestion of the episcleral vessels. However, the patient maintained increased IOP because of narrow-angle glaucoma development due to the presence of goniosynechiae in 270º, which was controlled satisfactorily with medication.

Rescuing axons from degeneration does not affect retinal ganglion cell death

After a traumatic injury to the central nervous system, the distal stumps of axons undergo Wallerian degeneration (WD), an event that comprises cytoskeleton and myelin breakdown, astrocytic gliosis, and overexpression of proteins that inhibit axonal regrowth. By contrast, injured neuronal cell bodies show features characteristic of attempts to initiate the regenerative process of elongating their axons. The main molecular event that leads to WD is an increase in the intracellular calcium concentration, which activates calpains, calcium-dependent proteases that degrade cytoskeleton proteins. The aim of our study was to investigate whether preventing axonal degeneration would impact the survival of retinal ganglion cells (RGCs) after crushing the optic nerve. We observed that male Wistar rats (weighing 200-400 g; n=18) treated with an exogenous calpain inhibitor (20 mM) administered via direct application of the inhibitor embedded within the copolymer resin Evlax immediately following optic nerve crush showed a delay in the onset of WD. This delayed onset was characterized by a decrease in the number of degenerated fibers (P<0.05) and an increase in the number of preserved fibers (P<0.05) 4 days after injury. Additionally, most preserved fibers showed a normal G-ratio. These results indicated that calpain inhibition prevented the degeneration of optic nerve fibers, rescuing axons from the process of axonal degeneration. However, analysis of retinal ganglion cell survival demonstrated no difference between the calpain inhibitor- and vehicle-treated groups, suggesting that although the calpain inhibitor prevented axonal degeneration, it had no effect on RGC survival after optic nerve damage.

Marginal and internal fit of zirconia copings obtained using different digital scanning methods

Abstract The objective of this study was to evaluate the marginal and internal fit of zirconia copings obtained with different digital scanning methods. A human mandibular first molar was set in a typodont with its adjacent and antagonist teeth and prepared for an all-ceramic crown. Digital impressions were made using an intraoral scanner (3Shape). Polyvinyl siloxane impressions and Type IV gypsum models were also obtained and scanned with a benchtop laboratory scanner (3Shape D700). Ten zirconia copings were fabricated for each group using CAD-CAM technology. The marginal and internal fit of the zirconia copings was assessed by the silicone replica technique. Four sections of each replica were obtained, and each section was evaluated at four points: marginal gap (MG), axial wall (AW), axio-occlusal edge (AO) and centro-occlusal wall (CO), using an image analyzing software. The data were submitted to one-way ANOVA and Tukey's test (α = 0.05). They showed statistically significant differences for MG, AO and CO. Regarding MG, intraoral scanning showed lower gap values, whereas gypsum model scanning showed higher gap values. Regarding AO and CO, intraoral digital scanning showed lower gap values. Polyvinyl siloxane impression scanning and gypsum model scanning showed higher gap values and were statistically similar. It can be concluded that intraoral digital scanning provided a lower mean gap value, in comparison with conventional impressions and gypsum casts scanned with a standard benchtop laboratory scanner.

Influence of different fillers on the properties of an experimental vinyl polysiloxane

Abstract The aim of the study was to evaluate the effect of the incorporation of different fillers on an experimental vinyl polysiloxane (VPS) at two different concentrations, 20% and 40%. Different fillers were added to an experimental VPS. The study was developed in two stages: (i) incorporation of fillers in different concentrations: (a) 20 wt% fillers, and (b) 40 wt%. The fillers were added to experimental VPS and mixed with a speed mixer; (ii) characterization of experimental VPS; after the base paste and catalyst paste were mixed, the experimental VPS was used to make specimens specifically for each test, which were stored at 23°C for 24 hours. The tests were designed according to the specific standardization for the analysis of tensile strength, detail reproduction, Shore A hardness, and elastic recovery. For analysis of filler size pattern, scanning electron microscopy at 1500× magnification was used. The aerosil OX-50 40% (AE), and pure aluminum hydroxide 40% (PAH) groups presented the highest tensile strength and Shore A hardness values. However, those were the only groups that did not present continuous detail reproduction of an intersection of 20 μm line. The elastic recovery was not statistically significant. The undesirable characteristics of VPS (lowest Shore A hardness and tensile strength) were observed when it was added to the composition of acrylic polymer (AP) and fiberglass (FG) in both concentrations, 20% and 40%. In groups AE and PAH, agglomerates of nanofillers were shown in SEM micrography, while the other groups presented different shapes and fillers sizes.

Biocompatibility of human auricular chondrocytes cultured onto a chitosan/polyvynil alcohol/epichlorohydrin-based hydrogel for tissue engineering application / Biocompatibilidad de condrocitos humanos cultivados sobre un hidrogel a base de quitosano/alcohol polivnílico/epiclorhidrina para aplicación en ingeniería de tejidos

Tissue engineering (TE) has become an alternative for auricular reconstruction based on the combination of cells, molecular signals and biomaterials. Scaffolds are biomaterials that provide structural support for cell attachment and subsequent tissue development. Ideally, a scaffold should have characteristics such as biocompatibility and bioactivity to adequate support cell functions. Our purpose was to evaluate biocompatibility of microtic auricular chondrocytes seeded onto a chitosan-polyvinyl alcohol-epichlorohydrin (CS-PVA-ECH) hydrogel to propose this material as a scaffold for tissue engineering application. After being cultured onto CS-PVA-ECH hydrogels, auricular chondrocytes viability was up to 81%. SEM analysis showed cell attachment and extracellular matrix formation that was confirmed by IF detection of type II collagen and elastin, the main constituents of elastic cartilage. Expression of elastic cartilage molecular markers during in vitro expansion and during culture onto hydrogels allowed confirming auricular chondrocyte phenotype. In vivo assay of tissue formation revealed generation of neotissues with similar physical characteristics and protein composition to those found in elastic cartilage. According to our results, biocompatibility of the CS-PVA-ECH hydrogel makes it a suitable scaffold for tissue engineering application aimed to elastic cartilage regeneration.

La ingeniería de tejidos (TE) es una alternativa para la reconstrucción auricular basada en la combinación de células, señales moleculares y biomateriales. Los andamios fabricados con biomateriales brindan un soporte estructural que favorece la adhesión cellular y el desarrollo del tejido. Un andamio debe poseer características como biocompatibilidad y bioactividad para soportar adecuadamente funciones celulares. Nuestro objetivo fue evaluar la biocompatibilidad de condrocitos auriculares de microtia cultivados sobre un hidrogel a base de quitosano-alcohol polivinílico-epiclorhidrina (CS-PVA-ECH) y proponerlo como andamio con aplicaciones en ingeniería de tejidos. La viabilidad de los condrocitos auriculares es superior al 81% después de ser cultivados sobre el hidrogel. El análisis por SEM reveló la unión celular y formación de matriz extracellular sobre el hidrogel; confirmada mediante detección por IF de colágena tipo II y elastina. La expresión de marcadores moleculares durante la expansión in vitro y el cultivo sobre los hidrogeles confirmaron el fenotipo condral. El ensayo de formación de tejido in vivo demostró la generación de neotejidos con características físicas y composición similar al cartílago elástico. Nuestros resultados indican que la biocompatibilidad del hidrogel de CS-PVA-ECH lo hace un andamio adecuado para aplicaciones en ingeniería de tejidos enfocadas a regeneración de cartílago elástico.

Dimensional stability of a novel polyvinyl siloxane impression technique

AIM: To introduce a modification of the reline impression technique (MRIT), and compare the dimensional changes of impressions obtained by MRIT and by conventional reline impression technique (CRIT). METHODS: An acrylic resin tablet was milled by a CAD-CAM system to simulate three abutments (A, B and C) with different distances among them. The abutments were molded using both impression techniques. For MRIT, before completing the putty silicone polymerization, the relieve procedure was made by compression and it was immediately repositioned to complete the polymerization. Impressions were stored dry at room temperature for different periods (immediately, 1 h, 2 days and 7 days). The distances were obtained by scanning. The differences between the impressions and their respective matrix reference measurements were calculated to determine the dimensional changes. Data were subjected to ANOVA and Tukey's test (p<0.05). RESULTS: For AB and BC distances, there was no statistically significant difference between CRIT and MRIT (p=0.0597 and p=0.2167, respectively). For AC, there was statistically significant difference between the techniques for the immediate storage time (p=0.006). In general, for CRIT the material showed expansion, while for MRIT it showed contraction. CONCLUSIONS: It was verified that the addition silicon impressions obtained by both impression techniques showed dimensional stability, except for the immediate time-point...

Embolização das artérias uterinas com partículas de PVA-PVAC esférico como preparo para posterior ressecção cirúrgica de miomas / Uterine artery embolization with spherical pva-pvac particles as preparation for surgical resection of miyomas

OBJETIVO: avaliar a utilização de uma nova partícula de polivinil álcool e polivinil acetato (PVA-PVAc) esférica, para embolização das artérias uterinas, em pacientes portadoras de mioma, com indicação cirúrgica. MÉTODOS: doze pacientes foram submetidas à embolização de miomas uterinos com partículas de PVA-PVAc. Três a nove meses depois, realizou-se uma laparotomia com miomectomia. Analisaram-se os seguintes parâmetros: volume do útero e do maior mioma; concentrações do hormônio folículo estimulante e de hemoglobina; sangramento menstrual (número de dias e de absorventes utilizados), sinais e sintomas antes do tratamento, após a embolização e após a miomectomia. RESULTADOS: a média de idade foi 37 anos e a média do volume uterino, previamente ao tratamento, de 939,3cc. Três anos após a embolização, observou-se diminuição do volume uterino (p=0,0005). Houve melhora na concentração de hemoglobina (p= 0,0004), com elevação após a embolização, sem variação subsequente à miomectomia. Não ocorreu variação significante do hormônio folículo estimulante, (p=0,17). Não foi constatado nenhum caso de falência ovariana, mas uma das pacientes apresentou atrofia de endométrio. Duas pacientes engravidaram, com bons indicadores obstétricos. Quanto aos sinais e sintomas, houve melhora após a embolização, que se manteve após a miomectomia. CONCLUSÃO: a embolização arterial com partículas de PVA-PVAc esférico mostrou-se promissora no preparo para uma intervenção cirúrgica com retirada dos miomas, pois, associou-se à redução do volume uterino, à diminuição do sangramento operatório e tornou possível a utilização de incisões menores, aumentando a chance de preservação do útero.

OBJECTIVE: To evaluate the use of a new spherical particle of polyvinyl alcohol and polyvinyl acetate (PVA-PVAc) for uterine artery embolization in patients with myoma with surgical indication. METHODS: twelve patients underwent uterine myoma embolization with PVA-PVAc particles. Three to nine months later, they were submitted to laparotomy with myomectomy. We analyzed the following parameters: volume of the uterus and of the bigger myoma; concentrations of follicle stimulating hormone and hemoglobin; menstrual bleeding (number of days and used absorbents), signs and symptoms before treatment, after embolization and after myomectomy. RESULTS: The mean age was 37 years and mean uterine volume prior to treatment, 939.3 cc. Three years after embolization, there was reduction in uterine volume (p = 0.0005), increase in hemoglobin concentration after embolization (p = 0.0004), without variation after the myomectomy. There was no significant variation of the follicle stimulating hormone (p = 0.17). There was no case of ovarian failure, but one of the patients had endometrial atrophy. Two patients became pregnant, with good obstetric indicators. Signs and symptoms improved after embolization, and remained after myomectomy. CONCLUSION: Arterial embolization with spherical PVA-PVAc particles is promising in the preparation for myoma surgery, since it was associated with a reduction in uterine volume, decrease in intraoperative bleeding and made possible the use of smaller incisions, increasing the chance of preserving the uterus.

Training on synthetic ethylene-vinyl acetate bench model allows novice medical students to acquire suture skills / Treinamento no modelo de bancada sintético de etileno vinil acetato permite que estudantes de medicina iniciantes na prática cirúrgica adquiram habilidades de sutura

PURPOSE: To assess the acquisition of suture skills by training on ethylene-vinyl acetate bench model in novice medical students. METHODS: Sixteen medical students without previous surgery experience (novices) were randomly divided into two groups. During one hour group A trained sutures on ethylene-vinyl acetate (EVA) bench model with feedback of instructors, while group B (control) received a faculty-directed training based on books and instructional videos. All students underwent a both pre-and post-tests to perform two-and three-dimensional sutures on ox tongue. All recorded performances were evaluated by two blinded evaluators, using the Global Rating Scale. RESULTS: Although both groups have had a better performance (p<0.05) in the post-test when compared with the pre-test, the analysis of post-test showed that group A (EVA) had a better performance (p<0.05) when compared with group B (control). CONCLUSION: The ethylene vinyl acetate bench model allowed the novice students to acquire suture skills faster when compared to the traditional model of teaching.

OBJETIVO: Avaliar a aquisição das habilidades de sutura com o treinamento no modelo de bancada de etileno vinil acetato em acadêmicos de medicina. MÉTODOS: Dezesseis estudantes de medicina iniciantes na prática cirúrgica foram divididos aleatoriamente em dois grupos. Durante uma hora o grupo A treinou diferentes suturas no modelo de bancada de etileno vinil acetato (EVA) com feedback dos instrutores, enquanto os do grupo B (controle) receberam um treinamento dirigido por instrutor baseado em livros e vídeos didáticos. Todos foram submetidos à pré e pós-testes para realização de suturas bi e tridimensionais em língua de boi. As performances gravadas foram avaliadas por dois avaliadores cegos, utilizando a Global Rating Scale. RESULTADOS: Embora os dois grupos tenham apresentado um melhor desempenho (p<0.05) no pós-teste quando comparado com o pré-teste, a análise do pós-teste mostrou que os alunos do grupo A (EVA) tiveram um melhor desempenho (p<0.05) quando comparados com os do grupo B (controle). CONCLUSÃO: O modelo de etileno vinil acetato permitiu que os alunos adquirissem habilidades de sutura mais rapidamente quando comparado ao modelo tradicional de ensino.

Avaliação do efeito de implantes subgengivais do polímero ELVAX com equistatina. Estudo microscópico em dentes de ratos extraídos e reimplantados / Evaluation of the effect of subgingival implants of polymer ELVAX with echistatin: microscopic study on rats' extracted and reimplanted teeth

O presente trabalho investigou microscopicamente o efeito da equistatina sobre o processo reabsortivo de dentes incisivos superiores de ratos, extraídos e reimplantados. Foram utilizados 42 animais, divididos em grupos com e sem equistatina. Os tempos extra-alveolares dos dentes foram de 30 e 60 minutos e os períodos experimentais pós-cirúrgicos foram 15, 60 e 90 dias. Os espécimes obtidos foram processados e corados em H.E. para observar os processos biológicos presentes. Os eventos microscópicos foram avaliados por dois examinadores, de modo quantitativo histomorfométrico e descritivo, de acordo com o tipo de infiltrado e intensidade da reação inflamatória; com o tipo, extensão e localização de reabsorção dentária; e presença de anquilose alveolodentária. O nível de concordância entre examinadores, determinado pelo índice Kappa, revelou-se quase perfeito para todas as variáveis avaliadas. A comparação entre os grupos testes e controle para as variáveis apresentadas foi feita por meio do teste Mann-Whitney e mostrou não haver diferença estatística entre a administração de equistatina e tempo extra-alveolar em relação à intensidade inflamatória nas diferentes porções radiculares. Quanto ao tipo de reabsorção estabelecida, notou-se que a presença de reabsorção inflamatória foi significativamente maior (p<0,05) no grupo controle nos tempos de 30 e 60 minutos no período pós-cirúrgico de 15 dias. A anquilose alveolodentária também esteve significativamente mais presente no grupo tratado com equistatina com 30 minutos extra-alveolar e 15 dias de período experimental. Houve, ainda, mais anquilose alveolodentária no grupo controle de 60 minutos extra-alveolar, com o período experimental de 60 dias. No período experimental de 90 dias todos os espécimes avaliados apresentaram processos reabsortivos inflamatórios e ausência de anquilose alveolodentária. O teste Kruskall-Wallis avaliou as diferenças significantes entre grupos, em relação à intensidade inflamatória por...

This study aimed to microscopically investigate the effect on the dental resorptive process of subgingival implants of ELVAX polymer with peptide echistatin in reimplantation of upper incisors in rats. For this purpose, 42 animals were used and divided into groups with and without echistatin. Extra alveolar socket period was 30 and 60 minutes and post-surgical experimental periods were 15, 60 and 90 days. Specimens were processed and stained with H.E. to observe the biological processes in the area. The microscopic events were evaluated by two examiners. Quantitative histomorphometric and descriptive evaluation of the events were performed according to the presence, type and location of the inflammatory response, incidence of resorptions or dental ankylosis. The level of agreement between examiners determined by the Kappa index, proved to be almost perfect for all variables. The comparison between the experimental and control groups for the variables presented was performed using the Mann-Whitney test and showed no statistical difference between the administration of echistatin and extra alveolar socket period relative to the inflammatory intensity in different portions of the root. Regarding the type of resorption established, it was noted that the presence of inflammatory resorption was significantly higher (p<0.05) in the control group on days 30 and 60 minutes in the postoperative period of 15 days. Dental ankylosis was also significantly more prevalent in the group treated with echistatin in extra alveolar socket period of 30 minutes and 15-day trial period. There was even more dental ankylosis in control group with 60 minutes of extra alveolar socket, with the trial period of 60 days. In the trial period of 90 days all specimens studied featured inflammatory resorptives processes and absence of dental ankylosis. The Kruskal-Wallis test assessed significant differences between groups in relation to the intensity of...

Avaliação do efeito de implantes subgengivais do polímero ELVAX com equistatina. Estudo microscópico em dentes de ratos extraídos e reimplantados / Evaluation of the effect of subgingival implants of polymer ELVAX with echistatin: microscopic study on rats' extracted and reimplanted teeth

O presente trabalho investigou microscopicamente o efeito da equistatina sobre o processo reabsortivo de dentes incisivos superiores de ratos, extraídos e reimplantados. Foram utilizados 42 animais, divididos em grupos com e sem equistatina. Os tempos extra-alveolares dos dentes foram de 30 e 60 minutos e os períodos experimentais pós-cirúrgicos foram 15, 60 e 90 dias. Os espécimes obtidos foram processados e corados em H.E. para observar os processos biológicos presentes. Os eventos microscópicos foram avaliados por dois examinadores, de modo quantitativo histomorfométrico e descritivo, de acordo com o tipo de infiltrado e intensidade da reação inflamatória; com o tipo, extensão e localização de reabsorção dentária; e presença de anquilose alveolodentária. O nível de concordância entre examinadores, determinado pelo índice Kappa, revelou-se quase perfeito para todas as variáveis avaliadas. A comparação entre os grupos testes e controle para as variáveis apresentadas foi feita por meio do teste Mann-Whitney e mostrou não haver diferença estatística entre a administração de equistatina e tempo extra-alveolar em relação à intensidade inflamatória nas diferentes porções radiculares. Quanto ao tipo de reabsorção estabelecida, notou-se que a presença de reabsorção inflamatória foi significativamente maior (p<0,05) no grupo controle nos tempos de 30 e 60 minutos no período pós-cirúrgico de 15 dias. A anquilose alveolodentária também esteve significativamente mais presente no grupo tratado com equistatina com 30 minutos extra-alveolar e 15 dias de período experimental. Houve, ainda, mais anquilose alveolodentária no grupo controle de 60 minutos extra-alveolar, com o período experimental de 60 dias. No período experimental de 90 dias todos os espécimes avaliados apresentaram processos reabsortivos inflamatórios e ausência de anquilose alveolodentária. O teste Kruskall-Wallis avaliou as diferenças significantes entre grupos, em relação à intensidade inflamatória por...

This study aimed to microscopically investigate the effect on the dental resorptive process of subgingival implants of ELVAX polymer with peptide echistatin in reimplantation of upper incisors in rats. For this purpose, 42 animals were used and divided into groups with and without echistatin. Extra alveolar socket period was 30 and 60 minutes and post-surgical experimental periods were 15, 60 and 90 days. Specimens were processed and stained with H.E. to observe the biological processes in the area. The microscopic events were evaluated by two examiners. Quantitative histomorphometric and descriptive evaluation of the events were performed according to the presence, type and location of the inflammatory response, incidence of resorptions or dental ankylosis. The level of agreement between examiners determined by the Kappa index, proved to be almost perfect for all variables. The comparison between the experimental and control groups for the variables presented was performed using the Mann-Whitney test and showed no statistical difference between the administration of echistatin and extra alveolar socket period relative to the inflammatory intensity in different portions of the root. Regarding the type of resorption established, it was noted that the presence of inflammatory resorption was significantly higher (p<0.05) in the control group on days 30 and 60 minutes in the postoperative period of 15 days. Dental ankylosis was also significantly more prevalent in the group treated with echistatin in extra alveolar socket period of 30 minutes and 15-day trial period. There was even more dental ankylosis in control group with 60 minutes of extra alveolar socket, with the trial period of 60 days. In the trial period of 90 days all specimens studied featured inflammatory resorptives processes and absence of dental ankylosis. The Kruskal-Wallis test assessed significant differences between groups in relation to the intensity of...

Effects of sulfur-based hemostatic agents and gingival retraction cords handled with latex gloves on the polymerization of polyvinyl siloxane impression materials

OBJECTIVES: This study investigated the possible interactions between three addition silicone materials (Express®, Aquasil Ultra® and Adsil®), three hemostatic agents (ferric sulfate, StatGel FS®; aluminum sulfate, GelCord®; and aluminum chloride, Hemostop®) and gingival retraction cords previously handled with latex gloves to determine whether direct contact with medicaments or indirect contamination by latex in conditions similar to those found in clinical practice inhibit or affect the setting of the impression materials. MATERIAL AND METHODS: A portable device for the simultaneous test of several specimens was specifically developed for this study. Polymerization inhibition was analyzed by examination of the impressions and the molded surface. Ten trials were performed for each addition silicone material used in the study, at a total of 240 study samples. RESULTS: All the samples tested (N=240) were nonreactive regardless of the type of combination used. CONCLUSIONS: Aluminum sulfate, ferric sulfate and aluminum chloride hemostatic solutions did not show any inhibitory potential on the addition silicone samples under study, and there were no changes in polymerization as a result of contact between addition silicone and retraction cords handled with latex gloves.

Efficacy of five rotary systems versus manual instrumentation during endodontic retreatment

The purpose of this study was to evaluate the efficiency of ProFile, GT, ProTaper, Race and K3 rotary instruments compared with hand K-files for removal of gutta-percha during retreatment. Sixty mandibular premolars were instrumented with GT rotary files and filled by thermomechanical compaction of gutta-percha and AH Plus sealer. The teeth are randomly divided into 6 groups of 10 specimens each. The roots were split longitudinally, digital images were created using a flatbed scanner, and the areas with remaining filling material were demarcated using Image Tool 1.21 software. The results indicate that GT left significantly less (p<0.05) remaining filling material (1.18 ± 1.47) than hand (3.70 ± 3.16) and Hero instruments (2.99 ± 2.58). There was no statistically significant difference (p<0.05) among the others techniques: ProFile (1.99 ± 2.66), ProTaper (2.00 ± 1.99) and K3 (2.71 ± 2.87) when compared with GT. In conclusion, GT, ProFile, ProTaper and K3 were more effective in removing gutta-percha than manual and Hero instruments.

O propósito deste estudo foi avaliar a eficiência dos instrumentos rotatórios ProFile, GT, ProTaper, Race e K3 comparados com limas K para a remoção do material obturador durante o retratamento. Sessenta pré-molares inferiores foram instrumentados com o sistema rotatório GT e obturados usando a técnica de compactação termomecânica de guta-percha com cimento AH Plus. Os dentes foram divididos aleatoriamente em seis grupos de dez espécimes cada. As raízes foram seccionadas longitudinalmente, imagens digitais foram criadas através de um scanner, e as áreas de remanescentes de material foram medidas usando o programa Image Tool 1.21. Os resultados indicaram que o GT deixou significantemente menos material remanescente (1,18 ± 1,47) do que os instrumentos manuais (3,70 ± 3,16) e os instrumentos Hero (2,99 ± 2,58) (p<0,05). Não houve diferença estatisticamente significante entre as outras técnicas ProFile (1,99 ± 2,66), ProTaper (2,00 ± 1,99) e K3 (2,71 ± 2,87) quando comparadas com o GT. Como conclusão, GT, ProFile, ProTaper e K3 foram revelados como mais efetivos em remover a guta-percha do que os instrumentos manuais e os instrumentos Hero.

Dural arteriovenous fistulas with direct cortical venous drainage treated with Onyx®: a case series / Fístulas arteriovenosas durais com drenagem cortical direta tratadas com Onyx®: casuística

Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct cortical venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct cortical venous drainage (CVR) using Onyx®. METHOD: Nine patients with DAVFs with direct cortical venous drainage were treated: eight type IV and one type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18®. Immediate post treatment angiographies, clinical outcome and late follow-up angiographies were studied. RESULTS: Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On follow-up, eight patients became free from symptoms, one improved and no one deteriorated. Late angiographies showed no evidence of recurrent DAVF. CONCLUSION: We recommend that transarterial Onyx® embolization of DAVFs with direct cortical venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.

As fistulas arteriovenosas durais (FAVDs) podem se manifestar com sintomas agressivos, especialmente se existe drenagem cortical direta. Relatamos nossa experiência preliminar na embolização transarterial de FAVDs com drenagem cortical direta usando Onyx®. MÉTODO: Nove pacientes com FAVDs com drenagem cortical direta foram tratados: oito do tipo IV e uma do tipo III (Cognard). O tratamento consistiu na embolização transarterial usando Onyx-18®. Angiografias imediatas pós-tratamento, evolução clínica e angiografias de controle tardias foram estudadas. RESULTADOS: A oclusão completa da fístula foi alcançada em todos pacientes através de um só procedimento e injeção em apenas um pedículo arterial. No seguimento, oito pacientes ficaram livres de sintomas, um melhorou e nenhum deteriorou. Angiografias tardias de controle não mostraram evidência de FAVD recorrente. CONCLUSÃO: Nós recomendamos que a embolização transarterial com Onyx® das FAVDs com drenagem cortical direta, seja considerada como uma opção terapêutica, uma vez que mostrou ser factível, segura e efetiva.

Endodontic and prosthetic treatment of teeth with periapical lesions in a 16-year-old-girl

This paper reports the nonsurgical endodontic therapy using calcium hydroxide intracanal dressing and prosthetic treatment of 9 teeth with periapical lesions in a 16-year-old female patient. The periodontal treatment plan included oral hygiene instructions, mechanical debridement and gingivectomy in the maxillary incisors to improve gingival contouring. Root canal treatment was indicated for teeth 11-13, 21, 22, 42-45. After successive changes of a calcium hydroxide intracanal dressing during 6 weeks, the size of the periapical radiolucencies decreased and lesion remission occurred after root canal obturation. The endodontically treated teeth received a bondable polyethylene reinforcement fiber (Ribbond) in the prepared canal space and crown buildup was done with composite resin. Prosthetic rehabilitation was planned with single-unit metal-ceramic crowns and fixed partial dentures. Clinical and radiographic evaluation after 6 months showed successful results. The outcomes of this case showed that chronic periapical lesions can respond favorably to nonsurgical endodontic treatment in adolescent patients and that, with proper indication, polyethylene fibers can provide an effective conservative and esthetic option for reinforcing endodontically treated teeth undergoing prosthetic rehabilitation.

Inorganic particle analysis of dental impression elastomers

The aim of this study was to determine quantitatively and qualitatively the inorganic particle fraction of commercially available dental elastomers. The inorganic volumetric fraction of two addition silicones (Reprosil Putty/Fluid and Flexitime Easy Putty/Fluid), three condensation silicones (Clonage Putty/Fluid, Optosil Confort/Xantopren VL and Silon APS Putty/Fluid), one polyether (Impregum Soft Light Body) and one polysulfide (Permlastic Light Body) was accessed by weighing a previously determined mass of each material in water before and after burning samples at 600ºC, during 3 h. Unsettled material samples were soaked in acetone and chloroform for removal of tthe organic portion. The remaining filler particles were sputter-coated with gold evaluation of their morphology and size, under scanning electron microscopy (SEM). Flexitime Easy Putty was the material with the highest results for volumetric particle fraction, while Impregum Soft had the lowest values. Silon 2 APS Fluid presented the lowest mean filler size values, while Clonage Putty had the highest values. SEM micrographs of the inorganic particles showed several morphologies - lathe-cut, spherical, spherical-like, sticks, and sticks mixed to lathe-cut powder. The results of this study revealed differences in particle characteristics among the elastometic materials that could lead to different results when testing mechanical properties.

O objetivo desse estudo foi determinar quantitativamente e qualitativamente a fração de partículas inorgânicas de elastômeros dentais disponíveis comercialmente. A fração volumétrica de dois silicones por adição (Reprosil Denso/Fluído e Flexitime Denso/Fluído), três silicones por condensação (Clonage Denso/Fluído, Optosil/Xantopren, e Silon 2 APS Denso/Fluído), um poliéter (Impregum Soft Light) e um polissulfeto (Permlastic Light Body) foi determinada pela pesagem prévia de uma determinada massa de cada material em água antes e após a queima das amostras a 600ºC, por 3 h. Amostras de material não polimerizado foram imersas em acetona e clorofórmio para a remoção da parte orgânica. As partículas de carga remanescentes foram cobertas com uma camada de ouro para avaliação da sua morfologia e tamanho, em microscopia eletrônica de varredura. O material Flexitime Denso foi o material com maior fração volumétrica de partículas de carga, enquanto que o Impregum teve menor fração volumétrica. Silon 2 APS Fluído apresentou partículas de carga de menor tamanho, enquanto que o Clonage Denso apresentou as maiores partículas. A observação em MEV. mostrou partículas de carga com vários tipos de morfologia (esféricas, irregulares, semi-esféricas, retangulares e mistura de retangulares/irregulares). Os resultados desse estudo mostraram diferenças nas partículas de carga dos materiais, as quais podem levar a diferentes resultados em suas propriedades mecânicas.

Effect of immediate and delayed post space preparation on the apical seal of root canals obturated with different sealers and techniques

During mechanical preparation of the post space, the root canal filling may be twisted or vibrated, depending on several factors associated with the preparation technique and quality of filling. OBJECTIVE: The purpose of this study was to investigate the effect of immediate and delayed post space preparation on the integrity of the apical seal. MATERIAL AND METHODS: Sixty-four extracted human incisors were biomechanically prepared using the step-back technique. Sixty roots were randomly assigned to 6 experimental groups of 10 teeth each and the remaining 4 roots served as positive and negative controls (n=2). The root canals in the different groups were obturated with cold lateral and warm vertical condensation of gutta-percha and one of two sealers (Sealapex and Diaket). Post space was prepared either individually or simultaneously. An insulated copper wire was cut into 10-cm-long pieces. In each canal, one piece was inserted to maintain contact with gutta-percha and extended to the outside as one of two working electrodes. A stainless steel wire with the same dimensions of those of the copper wire, used as the other working electrode, was immersed into the background electrolyte from the center of the bottle. The electrical current between standard and experimental electrodes in canals was measured over a period of 10 days applying a conductivity meter. The Kruskal-Wallis test (p=0.05) determined whether there was a significant difference in microleakage among the groups and the Mann-Whitney U test (p=0.01) was used for multiple comparison grouping variables. RESULTS: The results suggest that only the differences between the root canal filling techniques were statistically significant (p<0.01). There were no statistically significant difference in the sealers and the times of filling removal for post space preparation (p>0.01). CONCLUSION: The quality of the root canal filling is important for the integrity of the apical seal.