Concern about the risk of aerosol contamination from ultrasonic scaler: a systematic review and meta-analysis.

BACKGROUND: Many instruments used in dentistry are rotary, such as handpieces, water syringes, and ultrasonic scalers that produce aerosols. The spray created by these instruments can carry, in addition to water, droplets of saliva, blood, and microorganisms, which can pose a risk of infections for healthcare professionals and patients. Due to the COVID-19 pandemic, this gained attention. OBJECTIVE: The aim was to carry out a systematic review of the evidence of the scope of the aerosol produced by ultrasonic scaler in environmental contamination and the influence of the use of intraoral suction reduction devices. DESIGN: Scientific literature was searched until June 19, 2021 in 6 databases: Pubmed, EMBASE, Web of science, Scopus, Virtual Health Library and Cochrane Library, without restrictions on language or publication date. Studies that evaluated the range of the aerosol produced by ultrasonic scaler during scaling/prophylaxis and the control of environmental contamination generated by it with the use of low (LVE) and high (HVE) volume evacuation systems were included. RESULTS: Of the 1893 potentially relevant articles, 5 of which were randomized controlled trials (RCTs). The meta-analysis of 3 RCTs showed that, even at different distances from the patient's oral cavity, there was a significant increase in airborne bacteria in the dental environment with the use of ultrasonic scaler. In contrast, when meta-analysis compared the use of HVE with LVE, there was no significant difference (P = 0.40/CI -0.71[-2.37, 0.95]) for aerosol produced in the environment. CONCLUSIONS: There is an increase in the concentration of bioaerosol in the dental environment during the use of ultrasonic scaler in scaling/prophylaxis, reaching up to 2 m away from the patient's mouth and the use of LVE, HVE or a combination of different devices, can be effective in reducing air contamination in the dental environment, with no important difference between different types of suction devices.

Peri-implant health after supportive mucositis therapy is associated with increased levels of FGF-2.

This study aimed to analyze Fibroblast Growth Factor-2 (FGF-2) levels in the peri-implant crevicular fluid throughout supportive mucositis therapy. Twenty-six participants with Branemark protocol prosthesis were divided into two groups: the control group, characterized by healthy peri-implants, and the mucositis group, presenting a diagnosis of peri-implant mucositis. All participants underwent clinical examination, radiographic analysis, prosthesis removal, and non-invasive peri-implant therapy (mechanical debridement associated with chlorhexidine 0.12%) during a period of 36 days divided into three intervals. Peri-implant crevicular fluid samples were collected at each interval in order to analyze FGF-2 levels by immuno-enzymatic assay. The control and mucositis groups showed difference in keratinized mucosa. The smaller the range of keratinized mucosa the higher susceptibility of peri-implant mucositis. Throughout the treatment intervals, participants were diagnosed in different groups indicating whether or not the non-invasive therapy was able to treat peri-implant mucositis. There was a significant difference of FGF-2 levels between groups, with the higher FGF-2 levels in the control group (p=0.01). After supportive therapy, the mucositis group showed significantly increased FGF-2 levels (p<0.01) compared to initial levels. After 36 days of supportive therapy, there was a reduction of peri-implant mucositis from 70% to 23%. Clinical and laboratory outcomes showed a clear correlation since FGF-2 levels increased after 36 days. It was concluded that the therapy protocol was effective and promoted a regenerative reaction and FGF-2 can be considered a future target for peri-implant mucositis understanding.

Epidermal Growth Factor Is Associated with Loss of Mucosae Sealing and Peri-Implant Mucositis: A Pilot Study.

This study aimed to evaluate the correlation between epidermal growth factor (EGF) and receptor (EGFR) levels in different clinical stages of dental implant rehabilitation and trace mucositis development's biological profile. Thirty-six participants from the Specialization in Implant Dentistry, Universidade Federal Fluminense, Brazil, were included in the study and underwent sample collection: inside the alveolar socket, immediately before implant placement (Group 1, n = 10); at the peri-implant crevicular fluid (PICF) during reopening (Group 2, n = 10); PICF from healthy peri-implant in function (Group 3, n = 8); and PICF from mucositis sites (Group 4, n = 18). Quantitative polymerase chain reaction (PCR) evaluated EGF/EGFR gene expression using the SYBR Green Master Mix detection system. The results showed that EGF expression in the peri-implant crevicular fluid was statistically different. There was a higher EGF expression for group C (peri-implant health) (p = 0.04) than for the other groups. Regarding EGFR, there was no statistical difference among the groups (p = 0.56). It was concluded that low levels of EGF gene expression in the peri-implant crevicular fluid are related to the development of peri-implant mucositis and the absence of mucosae sealing. There was no correlation between EGFR gene expression with health or mucositis.

Peri-implant health after supportive mucositis therapy is associated with increased levels of FGF-2

Abstract This study aimed to analyze Fibroblast Growth Factor-2 (FGF-2) levels in the peri-implant crevicular fluid throughout supportive mucositis therapy. Twenty-six participants with Branemark protocol prosthesis were divided into two groups: the control group, characterized by healthy peri-implants, and the mucositis group, presenting a diagnosis of peri-implant mucositis. All participants underwent clinical examination, radiographic analysis, prosthesis removal, and non-invasive peri-implant therapy (mechanical debridement associated with chlorhexidine 0.12%) during a period of 36 days divided into three intervals. Peri-implant crevicular fluid samples were collected at each interval in order to analyze FGF-2 levels by immuno-enzymatic assay. The control and mucositis groups showed difference in keratinized mucosa. The smaller the range of keratinized mucosa the higher susceptibility of peri-implant mucositis. Throughout the treatment intervals, participants were diagnosed in different groups indicating whether or not the non-invasive therapy was able to treat peri-implant mucositis. There was a significant difference of FGF-2 levels between groups, with the higher FGF-2 levels in the control group (p=0.01). After supportive therapy, the mucositis group showed significantly increased FGF-2 levels (p<0.01) compared to initial levels. After 36 days of supportive therapy, there was a reduction of peri-implant mucositis from 70% to 23%. Clinical and laboratory outcomes showed a clear correlation since FGF-2 levels increased after 36 days. It was concluded that the therapy protocol was effective and promoted a regenerative reaction and FGF-2 can be considered a future target for peri-implant mucositis understanding.

Resumo Este estudo teve como objetivo analisar os níveis de FGF-2 no fluido crevicular peri-implantar durante a terapia de suporte da mucosite. Vinte e seis participantes com prótese protocolo Branemark foram divididos em dois grupos: o grupo controle, caracterizado por saúde peri-implanter, e o grupo mucosite, apresentando diagnóstico de mucosite peri-implantar. Todos os participantes foram submetidos a exame clínico, análise radiográfica, retirada da prótese e terapia não invasiva peri-implantar (debridamento mecânico associado à clorexidina 0,12%) durante um período de 36 dias, dividido em três intervalos. Amostras de fluido crevicular peri-implantar foram coletadas em cada intervalo para análise dos níveis de FGF-2, por ensaio imunoenzimático. Os grupos controle e mucosite não apresentaram diferença nos parâmetros clínicos, exceto para mucosa queratinizada. Ao longo dos intervalos de tratamento, os participantes foram diagnosticados em diferentes grupos, indicando se a terapia não invasiva era ou não capaz de tratar a mucosite peri-implantar. Houve diferença significativa dos níveis de FGF-2 entre os grupos, sendo os níveis de FGF-2 maiores no grupo controle (p = 0.01). Após a terapia de suporte, o grupo com mucosite apresentou níveis de FGF-2 significativamente aumentados (p <0.01) em comparação aos níveis iniciais. Após 36 dias de terapia de suporte, houve redução da mucosite peri-implantar de 70% para 23%. Os resultados clínicos e laboratoriais mostraram uma correlação clara, uma vez que os níveis de FGF-2 aumentaram após 36 dias. O protocolo de terapia foi eficaz e promoveu uma reação regenerativa. O FGF-2 pode ser considerado um alvo futuro para o tratamento da mucosite peri-implantar.

A Etiologia da Lesão Cervical não Cariosa: Um Novo Desafio para o Cirurgião-Dentista do Século XXI / The Etiology of Noncarius Cervical Lesions: a New Challenge for the 21ST Century Dentist

O termo Lesões Cervicais Não Cariosas (LCNCs) refere-se à perda de tecido dentário duro na Junção Cemento-Esmalte (JCE), cuja etiologia não está relacionada com o envolvimento bacteriano. A origem e a progressão desses defeitos cervicais são consideradas multifatoriais, sendo atribuídas a três fatores principais, sendo eles: abfração, biocorrosão e abrasão. Tais fatores podem estar combinados e associados a eventos de força excessiva aplicada durante a escovação, juntamente com a abrasividade de dentifrícios, hábitos alimentares e/ou parafuncionais. Essas lesões podem ter morfologias diferentes de acordo com seu fator etiológico principal, podendo se apresentar em forma de cunha, oval ou arredondada. O objetivo deste trabalho foi realizar uma revisão de literatura a fim de apresentar os desafios do Cirurgião-Dentista na descoberta dos diferentes fatores etiológicos das LCNCs. O desafio em questão se dá pelo estudo da combinação desses diversos fatores, bem como a realização de um diagnóstico preciso, fazendo-se necessário o conhecimento adequado da etiologia a fim de prevenir futuras novas lesões, estagnar as existentes e assim, capacitar o Cirurgião-Dentista a realizar um tratamento eficaz e longínquo das LCNCs. No entanto, ainda existem muitas controvérsias na literatura, tornando necessária a elaboração de mais estudos para elucidar a etiologia das LCNCs

The term noncarious cervical lesions (NCCL) refers to the loss of hard tooth tissue at the Cemento-Enamel Junction (CEJ), whose etiology is not related to bacterial involvement. The origin and progression of these cervical defects are considered multifactorial, being attributed to three main factors: abfraction, biocorrosion and abrasion. Such factors may be combined and associated with excessive force events applied during brushing, along with the abrasiveness of dentifrices, eating and/or parafunctional habits. These lesions may have different morphologies according to their main etiological factor, and may be wedge-shaped, oval or rounded. Our aim in this paper was to perform a literature review in order to present the challenges of the dental surgeon in identifying the different etiological factors of NCCL. Such challenge regards the study of the combination of these factors, as well as the achievement of an accurate diagnosis, requiring adequate knowledge of the etiology in order to prevent future lesions, stagnate existing ones, thus enabling the Dental Surgeon to treat NCCL effectively in the long term. However, there are still many controversies in the literature, making it necessary to develop more studies to elucidate the etiology of NCCL

Chronic Periodontitis and RANKL/OPG Ratio in Peri-Implant Mucosae Inflammation

Abstract tHistory of chronic periodontitis (CP) is a risk factor for oseointegration failure. The osteoclastogenesis system (RANK, RANKL and OPG) is critical for bone homeostatic control. We investigated the levels of OPG and RANKL in peri-implant tissues from volunteers with and without a history of CP and their association with mucosae inflammation. This is a single-blind case-contro study. Diagnosis of a history of CP and peri-implant examination was performed on 46 volunteers, divided into control (without history of CP, n=26) and CP group (with history of CP, n=20). Gingival biopsies were harvested during implant exposure. Quantitative PCR evaluated OPG/RANKL mRNA expressions. OPG and RANKL proteins were analyzed by western blot and immunohistochemistry assay. The chi-square test analyzed the significance of nominal variables between groups while continuous variables were analyzed by T-test or Mann-Whitney test, after Shapiro-Wilk test evaluation. The 2-ΔΔCT Livak method calculation evaluated the gene expression. Values of p<0.05 were considered statistically significant. Volunteers with CP history had 23 times higher chance of developing mucosae inflammation. High mucosae levels of RANKL (p=0.04) and RANKL/OPG (p=0.001) mRNA expressions were observed in CP group. CP volunteers showed increased RANKL protein levels in opposition to decreased OPG expression. Even without active periodontitis, volunteers with a history of CP had elevated gingival levels of RANKL/OPG and higher correlation with peri-implant mucosae inflammation and implant loss.

Resumo A história de periodontite crônica (CP) é um fator de risco para falhas na osseointegração. O sistema de osteoclastogênese (RANK, RANKL e OPG) é crucial para o controle da homeostase óssea. O objetivo deste estudo foi investigar os níveis de OPG e RANKL no tecido peri-implantar de voluntários com e sem histórico de CP e sua associação com inflamação da mucosa. Este é um estudo tipo caso-controle. O exame para diagnóstico de CP e na região peri-implantar foi realizado em 46 voluntários, divididos em controle (sem história CP, n=26) e grupo CP (com histórico de CP, n=20). Descartes gengivais foram obtidos durante a exposição do implante. PCR quantitativo avaliou a expressão do RNAm de OPG/RANKL. As proteínas OPG e RANKL foram analisadas por western blot e imunohistoquímica. O teste do qui-quadrado analisou a significância entre as variáveis nominais enquanto as variáveis contínuas foram analisadas pelo teste-t e Mann-Whitney, após o teste de Shapiro-wilk. O método do Livak 2--ΔΔCT avaliou a expressão gênica. Os voluntários com CP apresentaram 23 vezes mais chances de desenvolver inflamação da mucosa. Expressão elevada no RNAm de RANKL (p=0.04) e RANKL/OPG (p=0.001) foram observadas no grupo CP. Voluntários com CP mostraram aumento dos níveis da proteína RANKL em contraste com diminuída expressão de OPG. Mesmo sem periodontite ativa, voluntários com histórico de CP apresentaram elevado nível gengival de RANKL/OPG e alta correlação com inflamação peri-implantar e perda do implante.

Chronic Periodontitis and RANKL/OPG Ratio in Peri-Implant Mucosae Inflammation.

tHistory of chronic periodontitis (CP) is a risk factor for oseointegration failure. The osteoclastogenesis system (RANK, RANKL and OPG) is critical for bone homeostatic control. We investigated the levels of OPG and RANKL in peri-implant tissues from volunteers with and without a history of CP and their association with mucosae inflammation. This is a single-blind case-contro study. Diagnosis of a history of CP and peri-implant examination was performed on 46 volunteers, divided into control (without history of CP, n=26) and CP group (with history of CP, n=20). Gingival biopsies were harvested during implant exposure. Quantitative PCR evaluated OPG/RANKL mRNA expressions. OPG and RANKL proteins were analyzed by western blot and immunohistochemistry assay. The chi-square test analyzed the significance of nominal variables between groups while continuous variables were analyzed by T-test or Mann-Whitney test, after Shapiro-Wilk test evaluation. The 2-ΔΔCT Livak method calculation evaluated the gene expression. Values of p<0.05 were considered statistically significant. Volunteers with CP history had 23 times higher chance of developing mucosae inflammation. High mucosae levels of RANKL (p=0.04) and RANKL/OPG (p=0.001) mRNA expressions were observed in CP group. CP volunteers showed increased RANKL protein levels in opposition to decreased OPG expression. Even without active periodontitis, volunteers with a history of CP had elevated gingival levels of RANKL/OPG and higher correlation with peri-implant mucosae inflammation and implant loss.

Estudo histopatológico da polpa de dentes humanos portadores de doença periodontal envolvendo o ápice radicular / Histopathological study of human dental pulp in teeth with periodontal disease involving the radicular apex

O objetivo deste trabalho foi analisar as possíveis alteraçöes pulpares em dentes humanos portadores de doença periodontal envolvendo o ápice radicular. Foram selecionados 52 pacientes, e obtidos 60 dentes unirradiculares, 30 portadores de Periodontite do adulto e 30 portadores de Periodontite de início precoce. Todos os dentes eram isentos de cárie, abrasäo, atriçäo, erosäo, restauraçöes e/ou tratamento periodontal prévio, apresentando, no exame radiográfico, destruiçäo de todo o osso de suporte até o ápice radicular. Pela avaliaçäo periodontal observou-se que a destruiçäo dos tecidos de suporte ultrapassava o ápice radicular. Adicionalmente a avaliaçäo endodôntica mostrou que todos os dentes estavam vitais. Após a exodontia e procedimentos para microscopia de luz as lâminas obtidas foram analisadas em fotomicroscópio. O estudo demonstrou que dentes vitais, isentos de cárie, abrasäo atriçäo, erosäo, e/ou restauraçöes, quando da presença de PA e PIP, apresentam diversas patologias pulpares. Na avaliaçäo histológica as alteraçöes observadas foram: atrofia pulpar, dentina reparadora, fibrose, calcificaçäo distrófica e infiltrado inflamatório crônico. Dentro dos limites deste trabalho foi possível concluir que, em dentes de pacientes portadores de PIP a patologia de maior freqüencia foi a fibrose seguida de calcificaçäo distrófica. E nos dentes de pacientes portadores de PA a patologia mais freqüente também foi a fibrose, seguida de dentina reparadora com conseqüente atrofia pulpar, e de calcificaçäo distrófica

Avaliaçäo clínica e histopatológica da polpa dental de humanos jovens 60 dias após seu condicionamento com ácido fosfórico a 37 por cento e colocaçäo de um sistema adesivo de quarta geraçäo sobre a área da exposiçäo / The clinical and histopathologic evaluation of the young human dental pulp 60 days after 37 per cent phosphoric acid action's and phacement of on adhesive system of the fourth generation in an exposition area

Neste trabalho, os autores observaram a açäo do ácido fosfórico a 37 por cento de um sistema adesivo em contato íntimo com a polpa de humanos jovens. Análise clínica e histopatológica, 60 dias após, constatou-se ausência de infiltraçäo com discreta fibrose na área de exposiçäo

Avaliaçäo clínica e histológica da polpa dental de humanos jovens 6 dias após seu condicionamento com ácido fosfórico a 37 por cento / The clinical and histological evaluation of the young human dental pulp six days after your condiction using phosphoric acid 37 per cents

Neste trabalho os autores procuram observar a açäo do ácido fosfórico a 37 por cento em contato íntimo, por 30 segundos, com polpa de humanos jovens. A análise clínica e histológica, seis dias após, constatou ausência de dor pós-operatória, presença de vitalidade pulpar e inflamaçäo crônica localizada

Instrumentos manuais x rotatórios / Manual instruments x rotatory instruments

Quarenta dentes caninos foram utilizados neste trabalho, vinte dos quais tiveram suas coroas dentárias removidas, a nível de junção amelocementária. Todos os dentes receberam, inicialmente, preparo biomecânico, através da técnica convencional, até atingir-se a lima tipo K número 30. Posteriormente, os elementos foram divididos em quatro grupos. A seguir os dentes do Grupo I e III foram preparados, até atingir a lima tipo K nº 55 e os dos Grupos II e IV até atingir a broca Gates Glidden nº 3. Os resultados revelaram que as limas tipo K nº 55 estatisticamente, produziram maior diâmetro cervical do que as brocas Gates Glidden nº 3. Outro resultado foi que as amostras sem coroa revelaram, comparativamente, diâmetro cervical maior do que as amostras com coroa dentária

Variação do diâmetro do furo em função do diâmetro da broca Gates-Glidden / Variation of the diameter of the role in relation to the diameter of Gates-Glidden drills

Atualmente, as brocas Gates-Gliden são instrumentos rotatórios, largamente empregados no preparo biomecânico de canais radiculares. Embora seu uso esteja muito difundido, não encontramos na literatura valores quantitativos que relacionam o diâmetro final do furo com o da broca. Neste trabalho, inicialmente, determinou-se o maior diâmetro da parte ativa das brocas Gates-Glidden, em um projetor de perfil, com precisão de 0,001 mm. Foram selecionados setenta e dois segmentos radiculares, cujos diâmetros anatômicos dos canais eram menores do que os das brocas correspondentes. A seguir, os furos foram realizados, montando-se as brocas em micromotor de baixa rotação com giro à direita, estando os segmentos dentários presos em um torno mecânico. De cada segmento radicular, através de discos de carborundum, retirou-se uma amostra com espessura de aproximadamente um mm. A seguir, no projetor de perfil, mediu-se o diâmetro do furo em cada amostra. Os resultados obtidos mostraram que os diâmetros dos furos executados em brocas Gates-Glidden foram aproximadamente 6 por cento maiores