Contribution of benzodiazepines in dental care of patients with special needs.

BACKGROUND: Conscious sedation in dental treatment of patients with special needs (PNEs) has the purpose of controlling events such as anxiety and fear, as well as promoting muscle relaxation and mastery of uncoordinated movements. Benzodiazepines (BZDs) are among the most used drugs due to their anxiolytic, hypnotic and sedative properties. The objective of this investigation is to demonstrate a study on the contribution of conscious sedation with BZD in PNEs. MATERIAL AND METHODS: The study included 40 PNEs, non-collaborators, submitted to conscious oral sedation with Midazolam (0.5 mg/kg) for dental treatment, receiving vital signs monitoring in the pre, trans and postoperative periods. RESULTS: Male patients were more frequent with 70% of the cases, with a mean age of 18 years. As for medical diagnosis, autism and mental deficiency were the most prevalent. The most performed procedures were restoration (32%) and exodontia (30%). There was a statistically significant reduction in systolic and diastolic blood pressure parameters (p<0.05) in the transoperative and postoperative periods when compared to the preoperative period. Conscious sedation with BZDs resulted in 83% positive responses. CONCLUSIONS: The results demonstrate that this technique is safe and effective, and can be used in outpatient care for PNEs. However, the risk/benefit ratio should be correctly evaluated. Key words:Special patients, oral sedation, benzodiazepines, midazolam, dental care.

Resistance of Hydraulic Calcium Silicate Cements to Dislodgment in Short- and Long-term Assessment.

PURPOSE: To investigate the resistance to dislodgment produced by Biodentine (Septodont) and White-MTA (Angelus) after immersion in phosphate-buffered saline (PBS) for different durations. MATERIALS AND METHODS: Dentin disks 1 ± 0.1 mm thick were obtained from the middle third of the roots of 6 human maxillary canines. On the coronal surface of each dentin disk, four 0.8-mm-diameter holes were drilled. Then the slices were halved using a low-speed saw diamond disk, and the two holes in each half were filled with one of the two tested materials. Each filled half was immersed in PBS solution (pH 7.2) either for 7 days (short term) or 60 days (long term) at 37°C. The push-out test was performed after both time periods. A general linear model (GLM) for repeated measures ANOVA was used to verify the effect of the material and duration of contact with PBS on the push-out strength. The material was considered as the within-subject contrast and the contact duration as the between-subjects effect (p < 0.05). RESULTS: Repeated measures GLM indicated a significant impact of material and time on the push-out strength of the samples (p = 0.000 and p = 0.033, respectively). Biodentine significantly improved the push-out strength compared to MTA at both times (p = 0.000). The lack of significance in the interaction between material and time indicates that PBS immersion positively influenced the push-out values of both tested materials. CONCLUSION: Long-term PBS immersion positively influenced the resistance to dislodgement from dentin of all cements tested. The Biodentine cement provided greater resistance to push-out force than did the MTA.

Partially Edentulous Arches: A 5-Year Survey of Patients Treated at the Fluminense Federal University Removable Prosthodontics Clinics in Brazil.

PURPOSE: This study investigated the number and Kennedy Classification of the edentulous arches in patients treated at the Removable Partial Denture (RPD) Clinics of the Fluminense Federal University School of Dentistry (FO-UFF) in Rio de Janeiro, Brazil, from 2005 to 2010. MATERIALS AND METHODS: A cross-sectional retrospective survey was conducted on patient record charts to identify gender, age, number, and location of the edentulous arches, and Kennedy Class type. RESULTS: One hundred and forty-six patients were analyzed for this study (96 [65.8%] women and 50 [34.2%] men). Two hundred and ninety-two arches were analyzed: 74 arches (25%) were found with intact dentitions, 18 (6.1%) were edentulous arches, and 200 (68.8%) were partially edentulous arches. Ninety-one patients (62.3%) needed oral rehabilitation with RPDs on one arch and 55 (37.7%) in both arches. One hundred and eight (53.2%) partially edentulous mandibles and 92 (46.8%) partially edentulous maxillae were found. Kennedy Class I was more frequent in the mandibular arch (58 patients; 29%) whereas Kennedy Class III was more frequent in the maxillary arch (40 patients; 20%). Patients aged between 51 and 60 years presented the highest percentage of partially edentulous arches (33.6%). CONCLUSION: Mandibular Kennedy Class I and maxillary Kennedy Class III presented the highest frequency in patients treated at the FO-UFF. These results are in agreement with previous studies that evaluated the different Kennedy classes in partially edentulous arches.

Esthetic management of double tooth associated with talon cusp using a laminate veneer.

Double tooth and talon cusp are tooth shape anomalies with rare co-occurrences in a single tooth. Double tooth is a developmental anomaly that leads to the eruption of fused teeth and may contribute to compromised esthetics, pain, caries, and tooth crowding. Talon cusp is a rare developmental extra cusp-like projection on the cingulum area that may cause functional and esthetic problems. Differential diagnosis of these anomalies may be complicated. A multidisciplinary approach for the esthetic and functional rehabilitation of double teeth is important. Various treatment methods have been described in the literature for the different types and morphological variations of double teeth. The purpose of this paper is to report the case of an unusual combination of double tooth and talon cusp on a permanent maxillary incisor and describe its esthetic and functional rehabilitation using a porcelain laminate veneer.

Prophylactic agents and bacterial adherence to titanium.

AIMS: An evaluation was made of surface alterations of commercially pure titanium and Ti6Al4V alloy caused by fluoride at the concentration present in dentifrices and oral mouth washes (1500 ppm), and by prophylactic use of airborne particle abrasion with bicarbonate of soda. MATERIALS AND METHODS: For each material, 60 pre-fabricated disk-shaped test specimens with industrial metallographic finish, measuring 5 mm in diameter and 3 mm thick, were divided into four groups, according to the storage solutions: artificial saliva pH 7.0 (G1), fluoridated artificial saliva pH 5.5 (G2), airborne particle abrasion with bicarbonate of sodium (G3), airborne particle abrasion with bicarbonate of sodium followed by storage in fluoridated artificial saliva (G4). The surface roughness (Ra) was measured with a profilometer, before and after the storage periods. Afterwards, the test specimens were submitted to Streptococcus mutans adherence. RESULTS: A statistically significant reduction in surface roughness was observed in commercially pure titanium in G1, G4 and in Ti6Al4V alloy, G1, G2, G4, and no statistically significant reduction in G3. DISCUSSION: With a mean initial roughness surface of Ra=0.2 µm, fluoride promoted homogenization. Microscopy images confirmed these results. In the groups without significant homogenization, S. mutans adherence was greater, whereas it was lower in the groups in which the test specimens were stored previously in fluoridated saliva. CONCLUSION: The greater homogenization that occurred, as well as the antimicrobial effect of fluoride, proved that bacterial adherence and effects of fluoride were both dependent on the roughness of the surface topography.