Oral manifestations of syphilis: Knowledge and skills of senior dental students and newly graduated dentists.

OBJECTIVES: To evaluate the knowledge of senior dental students and newly graduated dentists about the prevention, diagnosis and treatment of oral manifestations of syphilis. MATERIALS AND METHODS: A 32-question questionnaire was designed with three domains: (I) demographic, academic and professional data of the participants, (II) attitudes, practices and self-perception regarding training about syphilis and (III) knowledge about syphilis. All knowledge responses were classified as correct or incorrect. Scores ranging from 1 to 14 were calculated, and grades were assigned to each participant according to their level of knowledge. RESULTS: The sample comprised 408 dental students and 339 newly graduated dentists. The mean score was 7.70 ± 3.35 for undergraduates and 9.09 ± 3265 for dentists. The highest frequency of correct answers (>70%) was attributed to questions about the aetiology, transmission and treatment of syphilis. The questions with the lowest frequency of correct answers (<50%) were about the identification of oral manifestations and stages of syphilis. CONCLUSIONS: The knowledge of dental practitioners and academics about the oral manifestations of syphilis was unsatisfactory. The lack of understanding of these aspects can delay the diagnosis and treatment of patients with this disease, which is concerning given the steady increase in cases in recent years.

Avaliação do conhecimento e da percepção de cirurgiões-dentistas e estudantes de odontologia acerca de desordens potencialmente malignas / Knowledge assessment and perception among dentists and dental students about potentially malignant disorders

Introdução: As desordens potencialmente malignas (DPM) são condições da cavidade oral que apresentam risco significativo para o desenvolvimento do câncer. Desse modo, o diagnóstico precoce torna-se essencial no prognóstico de lesões orais. Para isso, analisar o perfil de conhecimento acerca dessas desordens é fundamental ao identificar lacunas na educação e promover alternativas para melhorar a qualidade no diagnóstico. Objetivo: Avaliar a percepção de cirurgiões-dentistas (CDs) e estudantes de Odontologia brasileiros acerca de seu conhecimento e capacidade de identificar DPM. Métodos: Foi realizado um estudo transversal através de aplicação de questionário online. Foram aplicados dois questionários com 24 questões, um para estudantes e outro para CDs, divididos em três seções: dados demográficos e acadêmicos, treinamento, atitudes e autopercepção sobre DPM e conhecimento de DPM. A análise estatística envolveu os testes de Pearson, Mann-Whitney e Kruskal-Wallis. Resultados: O estudo foi composto por 209 participantes, 76 CDs e 133 estudantes de odontologia. A maioria dos participantes nunca realizou curso que envolvia o diagnóstico de desordens potencialmente malignas. A pontuação sobre o conhecimento de DPM variou de 0 a 10 pontos, sendo a média entre estudantes de 6,29±1,77 e entre CDs de 7,01±1,82. A maior taxa de acertos foi para as questões que discutiam a conduta clínica e a definição das desordens. Já as questões com menor taxa de acertos foram sobre lesões que não são consideradas potencialmente malignas, potencial de malignização e definição de Carcinoma in Situ. Conclusão: Há lacunas no conhecimento de estudantes de odontologia e CDs na identificação das desordens potencialmente malignas. Logo, essa deficiência reforça a necessidade de mais treinamentos e investimentos em educação, bem como de acompanhamento periódico de pacientes com tais desordens, a fim de prevenir potenciais transformações malignas.

Introduction: Potentially malignant disorders (PMD) are conditions of the oral cavity that present a significant risk for the development of cancer. Thus, early diagnosis becomes essential in the prognosis of oral lesions. Therefore, assessing the knowledge profile of these disorders is essential to identify gaps in education and to promote alternatives to improve the quality of their diagnosis. Objective: Evaluate the perception of brazilian dentists and dental students about their knowledge and ability to identify PMD. Methods: A cross-sectional study was carried out using an online questionnaire. Two questionnaires with 24 questions were applied, one for students and other for dentists, divided into three sections: demographic and academic data, training, attitudes and self-perception about potentially malignant disorders and knowledge of potentially malignant disorders. Statistical analysis involved Pearson, Mann-Whitney and Kruskal-Wallis tests. Results: The study consisted of 209 participants, 76 dentists and 133 dentistry students. Most participants never attended a course that involved the diagnosis of potentially malignant disorders. The score of knowledge about potentially malignant disorders ranged from 0 to 10 points, with a mean of 6.29±1.77 among students and 7.01±1.82 among dentists. The highest rate of correct answers was for questions that discussed clinical management and the definition of disorders. The questions with the lowest rate of correct answers were about lesions that are not considered potentially malignant, malignancy potential and the definition of Carcinoma in Situ. Conclusion: There are gaps in the knowledge of dental students and dentists in the identification of potentially malignant disorders. Therefore, this deficit reinforces the needed of more training and investments in education, as well as more training and investments in education and periodic follow-up of patients with such disorders are needed in order to prevent potential malignant transformations.

Knowledge about oral cancer among dental students and Primary Health Care dentists: A Brazilian study.

PURPOSE/OBJECTIVES: The present study aims to evaluate the knowledge of dental students and dentists who work in Primary Health Care (PHC). These are professionals who work in the public basic health units regarding oral cancer prevention, diagnosis, and treatment. METHODS: A cross-sectional and observational Brazilian study was conducted. A survey with 27 questions was carried out regarding the (i) demographic, academic, and professional data of the participants, (ii) attitudes, practices, and self-perception about their training, and (iii) knowledge about oral cancer. With the exception of one question regarding the clinical characteristics of oral cancer, all knowledge answers were graded as correct or incorrect. Grades were assigned to each participant according to their level of knowledge, and scores for each participant were calculated ranging from 1 to 10. Mann-Whitney and Kruskal-Wallis tests were used to examine the difference in the knowledge score of oral cancer according to explanatory variables. The level of significance adopted was 5%. RESULTS: The sample comprised 541 dental students and 82 PHC dentists. Most participants did not consider it appropriate or had not received training for palpation of lymph nodes or for identifying lymphadenopathies associated with oral cancer. Less than 20% of the participants had some kind of practice before and felt safe performing biopsy surgery. The average student score was 7.01 ± 2.15, and the average dentist score was 7.81 ± 1.467. CONCLUSION: Although the scores were satisfactory, most of the participants did not show adequate knowledge about biopsy and palpation of cervical lymph nodes.

Hepatite B: um alerta aos cirurgiões-dentistas / Hepatitis B: a warning to dentists

Objetivo: Apesar da disponibilidade e orientações acerca da vacinação contra o vírus da hepatite B (VHB), observa-se que a cobertura vacinal e o conhecimento entre os profissionais de Odontologia não são satisfatórios, especialmente nos países em desenvolvimento. Como um alerta aos estudantes e profissionais de Odontologia, o objetivo deste estudo é revisar a literatura acerca da infecção pelo VHB na prática odontológica. Materiais e métodos: Trata-se de uma revisão narrativa. Os artigos incluídos foram pesquisados nas bases de dados Pubmed, Scielo e Lilacs, utilizando os descritores "Hepatitis B virus" e "Dentist", no período de 2000 a 2020. Revisão de literatura: Os conhecimentos acerca do VHB devem ser incentivados durante a graduação, uma vez que os cirurgiões-dentistas desempenham papel importante na prevenção desta doença. A hepatite B é mais prevalente entre os cirurgiões-dentistas do que na população geral. Nesses profissionais, a transmissão acontece principal-mente durante o uso e descarte de instrumentos cortan-tes contaminados com sangue ou saliva infectada. Além disso, como as secreções nasofaríngeas carregam o vírus, embora remota, ainda existe a possibilidade de infecção por aerossol. Discussão: Dentre as formas de prevenção, podemos citar a realização do esquema vacinal completo, as orientações para manejo odontológico de pacientes com hepatite, a adoção às normas de biossegurança e os métodos corretos para limpeza e desinfecção e esterilização dos materiais. Conclusão: Os cirurgiões-dentistas possuem um risco maior de exposição à infecção pelo HBV do que o restante da população. Portanto, esses profissionais devem dispor de atenção especial às estratégias de prevenção contra a hepatite

Aim: Despite the availability and guidance regarding the hepatitis B virus (HBV) vaccination, it is observed that the vaccine coverage and knowledge among dental professionals are not satisfactory, especially in developing countries. As a warning to dental students and professionals, the aim of this study is to review the literature on HBV infection in dental practice. Materials and methods: This is a narrative review. The articles included were searched in the Pubmed, Scielo and Lilacs databases, using the des-criptors "Hepatitis B virus" and "Dentist", from 2000 to 2020. Literature review: Knowledge about HBV should be encouraged during graduation, since dentists play an im-portant role in preventing this disease. Hepatitis B is more prevalent among dentists than in the general population. In these professionals, the transmission occurs mainly due to a percutaneous injury involving the use and disposal of cutting instruments contaminated with the infected patient's blood or saliva. In addition, as nasopharyngeal secretions carry the virus, although remote, there is still the possibility of aerosol infection. Discussion: Among the forms of prevention, we can mention the accomplishment of the complete vaccination schedule, the guidelines for the dental management of patients with hepatitis, the adoption of biosafety standards and the correct methods for cleaning, disinfecting and sterilizing the materials. Conclusion: Dentists have higher risk of exposure to HBV infection than the rest of the population. Therefore, these professionals must pay special attention to strategies for preventing hepatitis.

Photobiomodulation associated with sclerotherapy for treatment of hemangioma in the hard palate.

Vascular changes frequently involve the head and neck region and hemagioma is the most common. A 61-year-old female patient complained of severe pain in the hard palate. A purple lesion was found, measuring 1.5 cm, sensitive to palpation, and with a history of hemorrhage. The patient was fully edentulous and her upper denture compressed the lesion site. Diascopy confirmed the lesion's vascular origin. A diagnostic hypothesis of hemangioma was raised. In the first session, red laser light (660nm) was applied at 4 points around the lesion, with 0.5 J at each point, in order to obtain analgesia and trigger the repair process. The upper denture was also relined. In the second session, 2 mL of 5% monoethanolamine oleate was applied. After 14 days, total regression of the lesion was observed. Dental surgeons must be able to recognize, diagnose and treat vascular lesions in the oral cavity.

Fotobiomodulação associada à escleroterapia no tratamento de hemangioma em palato duro / Photobiomodulation associated with sclerotherapy for treatment of hemangioma in the hard palate

Resumo As alterações vasculares ocorrem frequentemente em região de cabeça e pescoço, sendo o hemangioma a mais comum. Paciente do sexo feminino, 61 anos, queixou-se de dor intensa em palato duro. Notou-se lesão arroxeada, de 1,5 cm, sensível à palpação e com histórico de hemorragia. A paciente era edêntula total, e a prótese total superior comprimia o local da lesão. Foi realizada a vitropressão, confirmando a origem vascular. A hipótese diagnóstica foi de hemangioma. Na primeira sessão, aplicou-se o laser vermelho (660 nm) em quatro pontos ao redor da lesão, sendo 0,5 J em cada ponto afim de se obter analgesia e iniciar o processo de reparo, além do reembasamento da prótese total superior. Na segunda sessão, foi feita aplicação de 2 mL de oleato de monoetanolamina 5%. Após 14 dias, observou-se regressão total da lesão. Os cirurgiões-dentistas devem estar aptos a reconhecer, diagnosticar e tratar as lesões vasculares em cavidade oral.

Abstract Vascular changes frequently involve the head and neck region and hemagioma is the most common. A 61-year-old female patient complained of severe pain in the hard palate. A purple lesion was found, measuring 1.5 cm, sensitive to palpation, and with a history of hemorrhage. The patient was fully edentulous and her upper denture compressed the lesion site. Diascopy confirmed the lesion's vascular origin. A diagnostic hypothesis of hemangioma was raised. In the first session, red laser light (660nm) was applied at 4 points around the lesion, with 0.5 J at each point, in order to obtain analgesia and trigger the repair process. The upper denture was also relined. In the second session, 2 mL of 5% monoethanolamine oleate was applied. After 14 days, total regression of the lesion was observed. Dental surgeons must be able to recognize, diagnose and treat vascular lesions in the oral cavity.

Aumento da hiperdensidade da cortical óssea línguo-basal após radioterapia em região de cabeça e pescoço: relato de caso / Hyperdensity of the lingual-basal bone cortex incresead after radiotherapy in the head and neck region: case report

Objetivo: relatar um caso de aumento da hiperdensidade da cortical óssea línguo-basal pós-radioterapia em região de cabeça e pescoço por meio de avaliação imaginológica. Relato de caso: paciente do sexo feminino, 80 anos, procurou tratamento odontológico com a finalidade de reabilitação oral com implantes dentários. Na anamnese, relatou histórico de carcinoma espinocelular em regiões distintas da cavidade oral. No exame clínico, notou-se que a paciente era edêntula total e foi solicitado um exame de tomografia computadorizada de feixe cônico. Foi observado, na região anterior inferior, aumento da hiperdensidade da cortical óssea línguo-basal, com osso compacto mais espesso, achado incomum na literatura após radioterapia. Considerações finais: os efeitos da radioterapia em mandíbula estão relatados na literatura. No caso clínico em questão, detectou-se uma alteração pouco notada em pacientes submetidos à radioterapia, fazendo surgir novos questionamentos, sendo eles sobre o diagnóstico dessa modificação na estrutura óssea e suas repercussões. (AU)

Objective: to report a case of increased hyperdensity of the lingual-basal bone cortex after radiotherapy in the head and neck region by means of imaging evaluation. Case report: female patient, 80 years old, sought dental treatment for the purpose of oral rehabilitation with dental implants. In the anamnesis, she reported a history of squamous cell carcinoma in different regions of the oral cavity. Upon clinical examination, it was noted that the patient was total edentulous and a cone beam computed tomography examination was requested. An increase in the hyperdensity of the lingual-basal bone cortex was observed in the lower anterior region, with thicker compact bone, an unusual finding in the literature after radiotherapy. Final considerations: the effects of radiotherapy on the mandible are reported in the literature. In the clinical case in question, a little-noticed change was detected in patients undergoing radiotherapy, leading to new questions, concerning the diagnosis of this change in bone structure and its repercussions.(AU)

Prótese bucomaxilofacial na Educação Superior em Odontologia: perspectivas curriculares / Maxillofacial Prosthesis in Higher Education in Dentistry: Curricular Perspectives

Introdução: A falta de contato dos estudantes com Prótese Bucomaxilofacial (PBMF) durante a graduação pode ser um fator agravante para o desinteresse na área. O objetivo do presente estudo é apresentar um panorama da disciplina de PBMF nos projetos pedagógicos dos cursos de Odontologia na Região Sudeste do Brasil. Metodologia: Estudo exploratório, quantitativo e transveral. Foram analisadas as grades curriculares disponibilizadas nos sítios web oficial das instituições de ensino superior (IES) cadastradas no portal e-MEC do Ministério da Educação. Buscou-se informações referentes às variáveis: categoria administrativa da IES, inserção e oferta da disciplina, natureza do componente curricular, método de ensino, carga horária média e formação curricular do coordenador da disciplina. Os dados foram analisados e tabulados por meio do software GraphPad Prism 8.1.2. Resultados: Os resultados desta pesquisa refletem a análise da grade curricular de 144 IES. Apenas 8 IES (5,55%) ofertam a disciplina de PBMF. Dentre estas, a maioria (62,5%) em universidades públicas, de forma obrigatória (66,6%), com conteúdo teórico, prática-laboratorial e prática-clínica (44,4%) e carga horária média de 54,56h. Conclusões: A implementação do componente curricular se encontra bastante reduzida e mais prevalente em universidades públicas. Assim, sugere-se a atualização dos curriculos do curso de Odontologia do sudeste brasileiro... (AU)

Introduction: The lack of contact of students with Maxillofacial Prosthesis (PBMF) during graduation can be an aggravating factor for the lack of interest in the area. The objective of the present study is to present an overview of PBMF discipline in the pedagogical projects of Dentistry courses in the Southeast Region of Brazil. Methods: Exploratory, quantitative and crosssectional study. The curricula available on the official websites of higher education institutions (HEIs) registered in the e-MEC portal of the Ministry of Education were analyzed. Information on the variables was sought: administrative category of the HEI, insertion and provision of the discipline, nature of the curricular component, teaching method, average workload and curricular training of the subject coordinator. Data were analyzed and tabulated using GraphPad Prism 8.1.2 software. Results: The results of this research reflect the analysis of the 144 HEI curriculum. Only 8 HEIs (5.55%) offer the discipline of MFP. Most (62.5%) in public universities, compulsorily (66.6%), with theoretical content, laboratory practice and clinical practice (44.4%) and average workload of 54.56h. Conclusions: The implementation of the curricular component is quite reduced and more prevalent in public universities. Thus, it is suggested to update the curricula of the Dentistry course in southeastern Brazil... (AU)

Medical emergencies teaching in dentistry undergraduate courses in Southeastern Brazil

Aim: The aim of this study is to offer an overview of the MedicalEmergencies (ME) discipline offer in Dentistry graduations insoutheastern Brazil and to observe the curricular characteristicsof the discipline when present. Methods: This cross-sectionaldocumentary study analyzed the available curricular frameworksin the official websites of Higher Education Institutions (HEI)in southeastern Brazil registered on the Ministry of Education'se-MEC website. The data were analyzed and tabulated using theGraphPad Prism 8.1.2 software, being described by absolute andrelative frequencies. Fisher's exact test was used to compare theproportions between public and private institutions. Results:Of the 176 courses in the Southeast, 144 were included in thestudy for providing access to the curriculum, 19 (13.19%) werepublic and 125 (86.81%) were private. Only 27 (18.75%) of the HEIpresent the discipline of ME, with a greater tendency of supply inprivate HEIs (20.80%) when compared to public HEIs (5.26%),but this difference was not statistically significant (p> 0.05).As a positive aspect, the discipline is predominantly mandatory(88.88%), and the with regard to the teaching methodology ispredominantly theoretical (68.18%). The average workload is50.14 hours (SD=19.54). Conclusions: In only 18.75% of thedental institutions in Southeast Brazil, ME discipline were offered.When offered, the discipline is predominantly theoretical andmandatory. This study raises an important discussion regardingthe need to include specific and mandatory subjects on ME inthe dentistry curricula in Brazil and reflects the need to updateand standardize the national curricular guidelines for dentistry

Uma atualização sobre biomateriais em implantodontia / Biomaterials in Implantology: an update

O processo alveolar é uma estrutura dente dependente que sofre alterações dimensionais após a exodontia. Defeitos ósseos resultantes prejudicam a colocação de implantes e o sucesso em longo prazo. Diversas técnicas cirúrgicas e biomateriais tem sido apresentados como opções terapêuticas para preservação e recuperação dos rebordos edêntulos. Assim, o objetivo desta revisão narrativa é evidenciar o estado atual dos biomateriais disponíveis bem como as possíveis perspectivas futuras. A utilização de biomateriais para cirurgias de reconstrução e manutenção de rebordo alveolar com sucesso é evidente. As cirurgias de reconstrução e preservação de rebordo alveolar com a utilização de novos biomateriais apresentam sucesso evidente. A impressão em 3D de estruturas biocompatíveis, fatores de crescimento, a matriz de dentina desmineralizada (DDM), parafusos e membranas reabsorvíveis podem ser as perspectivas futuras.

The alveolar bone depends on the presence of teeth and dimensional changes occurs after tooth extraction. The resulting bone defects impair both implant installation and long term success. Surgical procedures and biomaterials are considered as treatment options for maintenance and recovery of edentulous ridge. Thus, the aim of this narrative review is to present the current biomaterials as well as future perspectives. Surgical procedures for alveolar ridge preservation and reconstruction with new biomaterials are successful. 3D-Printed biocompatible scaffolds, growth factors, decellularized extracellular matrix (dECM), resorbable pins and membranes could be the future perspectives.

The impact of oral rehabilitation on quality of life by installing a fixed prosthesis with immediate loading in edentulous mandibles / O impacto da reabiliação bucal na qualidade de vida através da instalação de prótese implanto-suportada sob carga imediata em mandíbulas edêntulas

Objetivo: Este estudo avaliou o impacto da reabilitação bucal na qualidade de vida através da instalação de prótese implanto-suportada sob carga imediata em mandíbulas edêntulas. Material e Métodos: Foi realizado um estudo longitudinal de base ambulatorial reunindo 14 pacientes com idade igual ou superior a 18 anos, atendidos nos cursos de especialização em Implantodontia da Associação Brasileira de Odontologia (Juiz de Fora) e da Faculdade de Odontologia da UFJF. Os participantes foram entrevistados sobre dados de identificação, auto percepção de saúde geral e saúde bucal e dados socioeconômicos. Foi utilizado o Oral Health Impact Profile (OHIP-14). Após o teste de normalidade Kolmogorov-Smirnov os valores de tendência central do OHIP-14 foram comparados pelo teste de Wilcoxon pareado com nível de significância de 5%. Resultados: A pontuação média do questionário de qualidade de vida foi 30,14 (antes) e 48,93 (depois). Houve redução significativa do impacto em todos os domínios no período pós cirúrgico, exceto na limitação funcional que se manteve inalterada. Não foi identificado impacto das dimensões dor física e deficiência pós a instalação de implantes. Conclusão: A reabilitação protética e autopercepção são impactantes na saúde bucal, por isso vale ressaltar a necessidade do cuidado, da observação criteriosa de todos os fatores que possuem influência sob as enfermidades, e não somente aos seus sinais e sintomas. (AU)

Objective: This study assessed the impact of oral rehabilitation with immediate-loading fixed prostheses on the quality of life of patients with mandibular edentulism. Material and Methods: A longitudinal study was conducted on an outpatient basis. The sample included 14 patients over 18 years of age, treated in the Implantology Specialization programs of the Brazilian Dental Association (in Juiz de Fora, Brazil) and the School of Dentistry, Federal University of Juiz de Fora. Participants were interviewed about identification data, self-perceived general health and oral health, and socioeconomic data. The Oral Health Impact Profile (OHIP-14) was used. After the Kolmogorov-Smirnov normality test, the OHIP-14 central tendency values were compared using the Wilcoxon paired test with a 5% significance level. Results: The overall mean found for the quality of life questionnaire was 30.14 (before) and 48.93 (after). There was a significant reduction of impact in all areas in the post-surgical period, except for functional limitation. No impact was identified for the dimensions of physical pain and disability after installing implants. Conclusion: Prosthetic rehabilitation and self-perception have high impact on oral health, thus emphasizing the need for care, careful observation of all the factors that may have an influence on infirmities, and not only their signs and symptoms.(AU)

Taxa de sobrevivência dos implantes após elevação atraumática do seio maxilar: revisão sistemática em diferentes técnicas nos últimos cinco anos / Implant survival rates after atraumatic maxillary sinus elevation: a systematic review of different techniques in the last 5 years

Objetivo: avaliar por meio de revisão sistematizada os fatores relacionados à taxa de sobrevivência dos implantes, na técnica de elevação atraumática do seio maxilar (LASM) e a influência das variáveis: técnica, tamanho dos implantes e altura óssea remanescente (AOR). Material e métodos: realizou-se pesquisa de artigos sobre as técnicas de LASM publicados na base de dados PubMed entre junho de 2008 e julho de 2014, com amostra mínima de dez pacientes e follow-up mínimo de seis meses. Estes foram divididos em três grupos: levantamento do seio maxilar com osteótomos sem enxerto ósseo (LSMO), e com enxerto ósseo (LSMOE) e levantamento do seio maxilar com brocas e enxerto (LSMBr). A sobrevivência do implante foi considerada como desfecho primário. Resultados: dos 92 artigos encontrados, apenas 18 foram selecionados, envolvendo 1.228 pacientes e 1.581 implantes. O comprimento dos implantes foi dividido em quatro grupos: 6 mm a 7 mm (8,03%); 8 mm a 10 mm (57,42%); 11 mm a 12 mm (27,21%) e 13 mm a 15 mm (7,34%). A AOR prévia à instalação dos implantes foi dividida em dois grupos (≤ 5 mm, 33,79% e > 5 mm, 66,2%). A taxa de sobrevivência dos implantes nas diferentes técnicas variou entre 93,6% e 100% (LSMO), 90% e 100% (LSMOE), e 92,7% e 96,3% (LSMBr). Quanto ao uso de biomaterial, o Bio-Oss (Geistlich) foi o mais utilizado. Houve maior perda quando da utilização de implantes curtos. Conclusão: o LASM apresenta-se como uma técnica segura com altas taxas sobrevivência dos implantes. Fatores como a técnica de acesso ao seio, AOR e tamanho dos implantes devem ser levados em consideração na execução da técnica.

Objective: to evaluate through a systematic review factors related to implant survival rates regarding the atraumatic sinus lifting technique (AMSLT) and the influence of variables such: technique, implant length, and the remaining bone height (RBH). Material and methods: an electronic search was made at the PubMed from June 2008 to July 2014, with at least 10 patients and six months of follow-up per study. These were divided into three groups: the osteotome maxillary sinus lifting with no bone graft (OMSL-NG), the same but with bone graft (OMSL-G), and maxillary sinus lifting with burs and grafting (MSL-BG). The implant survival was considered as the primary outcome. Results: from the 92 retrieved articles, only 18 were selected, involving 1228 patients and 1581 dental implants. Implant length was divided into four groups: 6-7 mm (8.03%), 8-10 mm (57.42%), 11-12 mm (27.21%), and 13-15 mm (7.34%). The RBH before implant placement was divided into two groups (≤ 5 mm: 33.79% and > 5 mm: 66.2%). The implant survival rates ranged from 93.6%-100% (MSL-BG), 90%-100% (OMSL-G), and 92.7%-96.3% (MSL-BG). The anorganic bovine bone matrix (Bio-Oss, Geistlich) was the most frequent biomaterial. Most losses occurred for short dental implants. Conclusion: The AMSLT is safe with high implant survival rates. Factors such as sinus access, the RBH, and implant lengths must be taken into account during surgical execution.

[Serum levels of vitamin D and chronic periodontitis in patients with chronic kidney disease].

INTRODUCTION: Concomitance of chronic periodontitis (CP) in patients with chronic kidney disease (CKD) have been associated with adverse outcomes. Vitamin D (25(OH)D) deficiency my play a role in CP and inadequate vitamin D status is common among patients with CKD. OBJECTIVE: To examine the relationship between vitamin 25(OH)D and CP in patients with CKD not yet on dialysis. METHOD: A case-control study was conducted. Cases and controls were defined as patients with CKD with and without CP, respectively. The demographic, clinical and laboratory data were obtained when the patient was attended in the outpatient clinic. CKD was defined and staged according to the NKF QDOKI TM. Serum 25(OH) D levels were measured by chemiluminescence when assessing the CP, which was definined according to the American Academy of Periodontoly (1999). Serum 25(OH)D levels were stratified into deficient (< 14 ηg/mL), insufficient (15-29 ηg/mL) and sufficiency (> 30 ηg/ mL). RESULTS: A total of 15 cases were compared with 14 controls. Cases had lower median 25(OH)D levels than controls (22.6 versus 28.6 ηg/mL, p < 0.01) and were more likely to be categorized as vitamin D insufficiency/deficiency (93,3% versus 57,1%, p < 0,004). On the other hand, the percentage of controls with vitamin D sufficiency was higher then cases (42,9% versus 6,7%, p < 0,004). CONCLUSION: In patients with CKD not yet on dialysis, vitamin D deficiency is associated with CP.

Níveis séricos de vitamina D e periodontite crônica em pacientes com doença renal crônica / Serum levels of vitamin D and chronic periodontitis in patients with chronic kidney disease

INTRODUÇÃO A concomitância de periodontite crônica (PC) em pacientes com doença renal crônica (DRC) tem sido associada a desfechos adversos. A deficiência de vitamina D (25(OH)D) parece desempenhar papel importante na PC e níveis inadequados de vitamina D têm sido descritos em pacientes com DRC. OBJETIVO: Examinar a relação entre níveis séricos de vitamina D e PC em pacientes com DRC pré-dialítica. MÉTODO: Estudo de caso-controle, definidos, respectivamente, como pacientes com DRC e PC e DRC sem PC. Os dados demográficos, de exame físico e laboratoriais foram obtidos no dia da consulta. A DRC foi definida e estagiada segundo a NKF QDOKI TM. Os níveis séricos de 25(OH) D foram dosados por quimioluminescência quando da avaliação da PC, a qual foi caracterizada segundo os critérios de Academia Americana de Periodontologia (1999). Os resultados de 25(OH)D foram estratificados em deficiência (< 14 ηg/mL), insuficiência (15-29 ηg/mL) e suficiência (> 30 ηg/mL). RESULTADOS: Um total de 29 pacientes foram estudados, 15 no grupo caso e 14 no grupo controle. Os pacientes casos apresentaram mediana de 25(OH) D inferior a dos pacientes controles (22,6 vs. 28,6 ηg/mL; p < 0,01). A frequência de pacientes casos com insuficiência/deficiência de vitamina D foi maior do que entre os pacientes controles (93,3% vs. 57,1%, p < 0,004). Por outro lado, o percentual de pacientes com suficiência de vitamina D foi maior entre os controles se comparados aos integrantes do grupo casos (42,9% vs. 6,7%, p < 0,004). CONCLUSÃO: Em pacientes com DRC, a deficiência de vitamina D se associa com PC.

INTRODUCTION: Concomitance of chronic periodontitis (CP) in patients with chronic kidney disease (CKD) have been associated with adverse outcomes. Vitamin D (25(OH)D) deficiency my play a role in CP and inadequate vitamin D status is common among patients with CKD. OBJECTIVE: To examine the relationship between vitamin 25(OH)D and CP in patients with CKD not yet on dialysis. METHOD: A case-control study was conducted. Cases and controls were defined as patients with CKD with and without CP, respectively. The demographic, clinical and laboratory data were obtained when the patient was attended in the outpatient clinic. CKD was defined and staged according to the NKF QDOKI TM. Serum 25(OH) D levels were measured by chemiluminescence when assessing the CP, which was definined according to the American Academy of Periodontoly (1999). Serum 25(OH)D levels were stratified into deficient (< 14 ηg/mL), insufficient (15-29 ηg/mL) and sufficiency (> 30 ηg/ mL). RESULTS: A total of 15 cases were compared with 14 controls. Cases had lower median 25(OH)D levels than controls (22.6 versus 28.6 ηg/mL, p < 0.01) and were more likely to be categorized as vitamin D insufficiency/deficiency (93,3% versus 57,1%, p < 0,004). On the other hand, the percentage of controls with vitamin D sufficiency was higher then cases (42,9% versus 6,7%, p < 0,004). CONCLUSION: In patients with CKD not yet on dialysis, vitamin D deficiency is associated with CP.

Assessment of knowledge toward periodontal disease among a sample of nephrologists and nurses who work with chronic kidney disease not yet on dialysis.

INTRODUCTION: Recent studies have identified periodontal disease (PD) as a risk factor for chronic kidney disease (CKD). The aim of this study was to assess the general knowledge about, attitudes toward, and behaviors/practices concerning PD among physicians and nurses who work with CKD patients. METHODS: An 8-question questionnaire was distributed to participants of the XXV Brazilian Congress of Nephrology (2010) and the Minas Gerais Nephrology Congress (2011). The questions covered the following aspects of PD: epidemiology, clinical presentation, predisposing factors, systemic expression, inclusion of oral examination during routine physical examination, and the frequency of referral for dental treatment. RESULTS: Most physicians and nurses interviewed correctly answered the questions on general knowledge about PD. 42.2% of the physicians and 38% of the nurses did not routinely examine the oral cavity of their patients. Most patients seen by nephrologists (59.4%) and nurses (61.5%) were referred to dental care in less than 30% of the consultations. CONCLUSION: Nephrologists and nurses demonstrated good self-reported general knowledge about PD, albeit with limited clinical experience, as evidenced by the low rates of examination of the oral cavity and referral for specialist treatment. These findings suggest the need of theoretical and practical training in oral health at both, undergraduate (medicine and nursing) and postgraduate levels (medical and multiprofessional residency programs).

Avaliação do conhecimento sobre doença periodontal em uma amostra de nefrologistas e enfermeiros que atuam com doença renal crônica pré-dialítica / Assessment of knowledge toward periodontal disease among a sample of nephrologists and nurses who work with chronic kidney disease not yet on dialysis

INTRODUÇÃO: estudos recentes apontam a doença periodontal (DP) como fator de risco para doença renal crônica (DRC). O objetivo do presente estudo foi avaliar o grau de conhecimento, atitude e prática de médicos e enfermeiros que atuam na nefrologia relativos à DP. MÉTODOS: um questionário foi aplicado a médicos e a enfermeiros participantes do XXV Congresso Brasileiro de Nefrologia (2010) e IX Congresso Mineiro de Nefrologia (2011), abrangendo os seguintes aspectos da DP: epidemiologia, apresentação clínica, fatores predisponentes, repercussão sistêmica, a inclusão do exame da cavidade bucal no exame clínico dos pacientes com DRC e a frequência de encaminhamento para o dentista. RESULTADOS: a maioria dos médicos e enfermeiros responderam corretamente às perguntas que abordaram os conhecimentos gerais sobre a DP. À pergunta referente à inclusão do exame da cavidade bucal no exame físico do paciente, 42,2 por cento dos médicos e 38 por cento dos enfermeiros responderam não fazê-la (p > 0,05). Contudo, a maioria dos pacientes vistos por nefrologistas (59,4 por cento) e enfermeiros (61,8 por cento) são encaminhados ao dentista em menos de 30 por cento das consultas (p > 0,05). CONCLUSÃO: A amostra de nefrologistas e de profissionais de enfermagem participantes do estudo demonstrou conhecimento autorrelatado sobre DP considerado bom, embora com prática clínica limitada, expressada pelo baixo percentual de encaminhamento para tratamento especializado da doença. Os achados sinalizam para a necessidade da instituição de treinamento teórico-prático em saúde bucal nos cursos de graduação (medicina e enfermagem) e pós-graduação (residência médica e multiprofissional).

INTRODUCTION: Recent studies have identified periodontal disease (PD) as a risk factor for chronic kidney disease (CKD). The aim of this study was to assess the general knowledge about, attitudes toward, and behaviors/practices concerning PD among physicians and nurses who work with CKD patients. METHODS: An 8-question questionnaire was distributed to participants of the XXV Brazilian Congress of Nephrology (2010) and the Minas Gerais Nephrology Congress (2011). The questions covered the following aspects of PD: epidemiology, clinical presentation, predisposing factors, systemic expression, inclusion of oral examination during routine physical examination, and the frequency of referral for dental treatment. RESULTS: Most physicians and nurses interviewed correctly answered the questions on general knowledge about PD. 42.2 percent of the physicians and 38 percent of the nurses did not routinely examine the oral cavity of their patients. Most patients seen by nephrologists (59.4 percent) and nurses (61.5 percent) were referred to dental care in less than 30 percent of the consultations. CONCLUSION: Nephrologists and nurses demonstrated good self-reported general knowledge about PD, albeit with limited clinical experience, as evidenced by the low rates of examination of the oral cavity and referral for specialist treatment. These findings suggest the need of theoretical and practical training in oral health at both, undergraduate (medicine and nursing) and postgraduate levels (medical and multiprofessional residency programs).

Tomografia computadorizada de feixe cônico como instrumento complementar de diagnóstico e planejamento cirúrgico de cisto radicular: relato de um caso clínico / Cone beam computed tomography as complementary tool in diagnosis and surgical planning of radicular cyst: case report

O objetivo deste artigo foi destacar, por meio do relato de um caso clínico, a importância da utilização da tomografia computadorizada de feixe cônico (TCFC) como instrumento complementar de diagnóstico e planejamento cirúrgico de cisto radicular. Trata-se do cisto mais comum dos maxilares, originado de um granuloma, no ápice radicular de um dente necrosado. É assintomático, podendo sofrer processos de agudecimento, em que a dor e o edema encontram-se presentes. A cirurgia parendodôntica para enucleação da lesão é a escolha terapêutica quando não se obtém sucesso no tratamento endodôntico. Para um correto planejamento cirúrgico do caso, é importante a realização de exames complementares que permitam a visualização detalhada da região envolvida. A tomografia computadorizada de feixe cônico permite a visualização tridimensional das estruturas maxilofaciais, superando as limitações inerentes às radiografias periapicais. No caso clínico apresentado, uma paciente de 51 anos foi submetida à cirurgia para enucleação de lesão periapical radiolúcida, unilocular, localizada na região dos ápices radiculares dos dentes 31, 32 e 41. Para o planejamento cirúrgico, foi solicitada tomografia computadorizada de feixe cônico, que permitiu o detalhamento da lesão e dos ápices radiculares envolvidos. Após enucleação e apicoplastia, a lesão foi enviada para exame histopatológico, sendo a cavidade cirúrgica preenchida com enxerto bovino e membrana reabsorvível. O diagnóstico foi de cisto radicular. A paciente não apresentou recidiva em proservação após oito meses da cirurgia. Concluiu-se que a TCFC constitui um importante recurso complementar no diagnóstico e no planejamento cirúrgico de cisto radicular.

The aim of this study was to highlight, through a clinical case, the importance of using cone beam computed tomography as a complementary tool in the diagnosis and surgical planning of radicular cyst. This is the most common cyst of the jaws, originated from a granuloma at the apex of a necrotic tooth. It's asymptomatic and may suffer from acute cases, where pain and swelling are present. The endodontic surgery for enucleation of the lesion is the therapy of choice when the conventional endodontic treatment isn't well succeeded. For a correct surgical planning is important to conduct complementary exams to allow detailed visualization of the region involved. The cone beam computed tomography allows three-dimensional view of structures, overcoming the inherent limitations of periapical radiographs. In the case presented, a 51 years old patient was submitted to a surgery for enucleation of a periapical lesion, radiolucent and unilocular, related to the root apex of 31, 32 and 41 teeth. For surgical planning was requested cone beam computed tomography, which allowed to view the details of the lesion and the root apex. After enucleation and flattening of the apex, the lesion was sent to hystopathological exam and the surgical cavity was filled with graft and bovine collagen membrane. The diagnosis was radicular cyst. The patient is under proservation after eight months. It was concluded that CBCT is an important complementary tool in diagnosis and surgical planning of radicular cyst.

Study of position and eruption of lower third molars in adolescents

Introduction: The occurrence of retained lower third molars (3M) is common. A careful analysis is necessary for proper clinical management and the radiographic examination is fundamental. The use of panoramic radiographs is extremely important for the analysis and classification of 3M position, allowing the diagnosis and the establishment of the treatment planning for the removal of these teeth. Objective: The aim of this study was to evaluate the changes in position and eruption state of lower 3M during a period of 3.6 years, as well as to identify factors that may be related with early diagnosis of dental retention of these teeth in adolescent patients. Material and methods: One hundred and one initial (T1) and final (T2) panoramic radiographs from patients treating at the university's orthodontic clinics were analyzed. The distribution of 195 lower 3Ms was evaluated taking into account personal data, collected from clinical records. The data obtained in relation to the positioning of the teeth were based on the ratings of Winter and Pell & Gregory. Results: The results showed that vertical position was the most prevalent and the C level and class II positions were predominant. The changes occurring in 3M position during the study interval were not statistically significant. Conclusion: After the final evaluation (T2) it was concluded that unpredictable changes in lower 3Ms position and eruption may occur. The variables race (P = 0.03) and anterior border of the mandibular ramus (P = 0.007) seem to have influence on the level of eruption, also suggesting influence on this tooth retention within dental arches over the years.

Treatment of chronic periodontitis decreases serum prohepcidin levels in patients with chronic kidney disease.

OBJECTIVE: To determine the impact of periodontal treatment on serum levels of prohepcidin (the prohormone of hepcidin) and systemic inflammation markers, as well as correlations among these markers, in patients with chronic periodontitis and chronic kidney disease who were not undergoing dialysis. METHODS: We included 56 chronic periodontitis patients, 36 with chronic kidney disease and 20 without systemic diseases and with normal renal function (control group). Chronic kidney disease was defined as suggested by the clinical practice guidelines in the National Kidney Foundation. Chronic periodontitis was defined through clinical attachment level and by probing pocket depth, according to the American Association of Periodontology. The inflammatory markers ultrasensitive C-reactive protein, interleukin-6, and prohepcidin were evaluated before and 3 months after periodontal treatment. RESULTS: The efficacy of periodontal treatment was confirmed by the improvement in clinical parameters of chronic periodontitis in the control and chronic kidney disease groups. Periodontal treatment resulted in significant reductions in ultrasensitive C-reactive protein, interleukin-6 and serum prohepcidin levels in both groups. Moreover, in multivariate linear regression, the reduction in prohepcidin after periodontal treatment was significantly and independently associated with interleukin-6 levels in the control group. CONCLUSIONS: By inducing a decline in the systemic inflammatory response and a decrease in serum prohepcidin, successful periodontal treatment may represent an important means of ameliorating the inflammatory burden seen in patients with chronic kidney disease. TRIAL REGISTRATION: ISRCTN59866656.

Treatment of chronic periodontitis decreases serum prohepcidin levels in patients with chronic kidney disease

OBJECTIVE: To determine the impact of periodontal treatment on serum levels of prohepcidin (the prohormone of hepcidin) and systemic inflammation markers, as well as correlations among these markers, in patients with chronic periodontitis and chronic kidney disease who were not undergoing dialysis. METHODS: We included 56 chronic periodontitis patients, 36 with chronic kidney disease and 20 without systemic diseases and with normal renal function (control group). Chronic kidney disease was defined as suggested by the clinical practice guidelines in the National Kidney Foundation. Chronic periodontitis was defined through clinical attachment level and by probing pocket depth, according to the American Association of Periodontology. The inflammatory markers ultrasensitive C-reactive protein, interleukin-6, and prohepcidin were evaluated before and 3 months after periodontal treatment. RESULTS: The efficacy of periodontal treatment was confirmed by the improvement in clinical parameters of chronic periodontitis in the control and chronic kidney disease groups. Periodontal treatment resulted in significant reductions in ultrasensitive C-reactive protein, interleukin-6 and serum prohepcidin levels in both groups. Moreover, in multivariate linear regression, the reduction in prohepcidin after periodontal treatment was significantly and independently associated with interleukin-6 levels in the control group. CONCLUSIONS: By inducing a decline in the systemic inflammatory response and a decrease in serum prohepcidin, successful periodontal treatment may represent an important means of ameliorating the inflammatory burden seen in patients with chronic kidney disease.