One-Piece Versus Two-Piece Abutments for Single Crowns in the Esthetic Zone: A Clinical Trial.

OBJECTIVE: To evaluate whether a two-piece abutment is equivalent to a one-piece in peri-implant esthetics, patients' satisfaction, and oral health-related quality of life (OHRQOL) for implant-supported anterior single crown placement. MATERIAL AND METHODS: Thirty implants were allocated sequentially: 15 in the one-piece abutment group (OP) and 15 in the two-piece abutment group (TP). Peri-implant esthetics were evaluated by the pink esthetic score (PES) at temporary crown insertion (T1), after tissue conditioning (T2), and at 30 days after the final crown insertion (T3). OHRQOL was measured using the OHIP-14 and satisfaction was evaluated using the visual analog scale (VAS) at baseline, T1, and T3. Treatment was considered equivalent if the 95% coefficient interval (CI) for mean difference in PES was between -1.5 and +1.5 points. Statistical analysis was performed using Mann-Whitney, SPANOVA, and Student's t-test, with Sidak's posttest, adopting p < 0.05. RESULTS: No differences were found between the groups for any variable and during follow-up. A significant increase in OHRQOL and satisfaction was observed at T3, when compared to baseline (p < 0.05) for both groups. Significant improvements in peri-implant esthetics were also observed throughout the treatment, particularly after tissue conditioning (p < 0.05). Primary and secondary outcomes were evaluated for equivalence, and both abutment types were considered equivalent following the insertion of the temporary crowns. CONCLUSIONS: Two-piece abutment was equivalent to one-piece abutment for peri-implant esthetics, quality of life, or the satisfaction of patients rehabilitated with metal-free single crowns. Tissue conditioning and final crown insertion appear to play a role in improving these outcomes.

Impact of CAD/CAM burs lifetime on surface properties of dental zirconia: Implications for biocompatibility of custom abutments.

OBJECTIVE: To evaluate the effect of the deterioration of computer aided design/computer aided manufacturing (CAD/CAM) burs during zirconia milling, on surface roughness, contact angle, and fibroblast viability. MATERIALS AND METHODS: Ceramic blocks were milled and 75 ceramic disks (8 × 1.5 mm) made and allocated into three groups (n = 25): G1-brand new 2L and 1L burs, G2-2L bur at the end of lifetime and brand new 1L bur and G3-both burs at the end of their lifetimes. Roughness (Ra, Rq, and Rz) was evaluated using a 3D optical profilometer, the contact angle by the sessile drop method and the cell viability of the mouse NIH/3T3 fibroblast, using the Alamar Blue assay at intervals of 24, 48, and 72 h (ISO 10993-5). Data were analyzed by one-way ANOVA and Kruskal-Wallis tests (p ≤ 0.05). RESULTS: Roughness increased as the burs deteriorated and G3 (0.27 ± 0.04) presented a higher value for Ra (p < 0.001). The highest contact angle was observed in G3 (86.2 ± 2.66) when compared with G1 (63.7 ± 12.49) and G2 (75.3 ± 6.36) (p < 0.001). Alamar Blue indicated an increase in cell proliferation, with no significant differences among the groups at 24 and 72 h (p > 0.05). CONCLUSIONS: The deterioration of the burs increased the surface roughness and decreased the wettability, but did not interfere in cell viability and proliferation. CLINICAL SIGNIFICANCE: The use of custom zirconia abutments represents an effective strategy for single crowns restorations. Our findings suggest that these abutments can be efficiently milled using CAD/CAM burs within their recommended lifetime.

Impact of splinting implant-supported crowns on the performance of adjacent posterior implants: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: While rehabilitation with implant-supported crowns in the posterior region is widely practiced, guidance on clinical considerations when choosing between splinted or nonsplinted implant-supported crowns is limited. PURPOSE: The purpose of this systematic review with meta-analysis was to assess whether adjacent implants with internal connections in the posterior region should be treated with splinted or nonsplinted crowns. MATERIAL AND METHODS: The systematic review was registered on the prospective register of systematic reviews (PROSPERO) under the code, CRD42021248525. Two authors searched 4 electronic databases (PubMed, Cochrane Library, Scopus, and Web of Science) independently for articles published up to December 2023. Additionally, a hand search was conducted in the nonpeer-reviewed literature and the reference lists of included articles. Only clinical studies comparing splinted and nonsplinted hexagonal or conical internal connection adjacent implants in the posterior region were considered. A single-arm meta-analysis was conducted using RevMan. Risk of bias and quality were assessed using the Cochrane Collaboration's Tool for Assessing Risk and the Newcastle-Ottawa scale. RESULTS: Qualitative synthesis included 17 studies, and quantitative synthesis involved 13 studies. A total of 2085 implants (1244 splinted and 841 nonsplinted) were inserted in 1027 participants, with observation times ranging from 5 months to 16 years. Thirteen studies related the type of crown retention (cemented or screw-retained). Only 2 studies related annual bone loss results considering the type of crown retention, but whether they were splinted or nonsplinted crowns and significant differences were not specified. The meta-analysis revealed no statistical differences between splinted and nonsplinted implants for biological complications (P=.95, I2=0%). However, the nonsplinted implants exhibited significantly more mechanical complications than the splinted implants (P<.001, I2=1%, RR 0.37; 95% IC [0.26-0.54]). The studies included demonstrated a low risk of bias and were of good quality. CONCLUSIONS: Splinting was not found to affect the incidence of biological complications in posterior adjacent implants. However, more mechanical complications occurred in nonsplinted crowns than splinted ones.

Clinical Factors Related to Abnormal General Movements Trajectories: Development of a Multicriteria Index.

PURPOSE: To create a multicriteria index with clinical factors associated with abnormal general movements (GMs) trajectories during a stay in the neonatal intensive care unit. METHODS: A longitudinal study assessed abnormal GMs trajectories in preterm infants in the neonatal intensive care unit. The multicriteria index included clinical factors such as intraventricular hemorrhage, respiratory support, gestational age, patent ductus arteriosus, and infection based on multi-attribute utility theory. RESULTS: A total of 52 preterm newborns, 57.7% male, were evaluated. The multicriteria index correlated with abnormal GMs trajectories and explained 26.5% of the variance in these trajectories. CONCLUSION: The developed multicriteria index, with the inclusion of combined clinical factors, allowed the identification of part of the abnormal trajectories of GMs in preterm infants. The multicriteria analysis can help clinicians to identify infants who have a greater chance of poor developmental trajectories before hospital discharge.

Frequency of peri-implant diseases and associated factors.

OBJECTIVE: To evaluate the frequency of peri-implant diseases and factors associated with its occurrence. MATERIAL AND METHODS: One hundred and fifty-five patients with dental implants were evaluated in this cross-sectional study. Dental implants were clinically and radiographically evaluated to diagnose their peri-implant condition, according to Mombelli (Proceedings of the 3rd European Workshop on Periodontology, 1999, Quintessence, London). Associations between peri-implant diseases and independent variables (socioeconomic, demographic and periodontal characteristics) were evaluated through bivariate analysis with chi-squared and Fisher's exact tests, as well as by multiple logistic regression. The significance level was set at 5%. RESULTS: The frequencies of the peri-implant diseases, mucositis and peri-implantitis, in individuals were 54% and 28% (CI, 95%), respectively. The sample was almost exclusively of patients with untreated periodontal disease (93%). Bivariate analysis showed that these peri-implant diseases were associated with male patients (prevalence ratio [PR], 3.38), medication use (PR, 2.94), systemic diseases (PR, 2.25), number of implants (PR, 2.53), visible plaque index (PR, 2.49) and gingival index (PR, 2.70). Multiple logistic regression analysis showed that medication use (prevalence ratio adjusted [PRadj], 1.23; 95% CI: 1.04-1.46; P = 0.017), having two or more implants (PRadj, 1.22; 95% CI: 1.02-1.46; P = 0.029) and gingival bleeding index > 10% (PRadj, 1.22; 95% CI: 1.03-1.44; P = 0.022) were associated with the presence of peri-implant disease. CONCLUSION: Peri-implant diseases were diagnosed in 54% of patients; gingival index of greater than 10%, having more than two implants and use of medication were associated with the frequency of peri-implant disease.

A systematic review and meta-analysis on the effects of crown lengthening on adjacent and non-adjacent sites.

OBJECTIVES: The objective of the study was to assess the impact of periodontal crown lengthening surgery on clinical parameters at adjacent and non-adjacent sites compared to treated sites. MATERIAL AND METHODS: An electronic search was carried out on MEDLINE-PubMed, The Cochrane Library, and ISI Web of Science databases between 1978 and 2015. Methodological quality assessment was based on Cochrane recommendations. Meta-analyses were assessed with RevMan 5.0 and heterogeneity between studies by the Higgin test (I 2). Clinical attachment level (CAL) and probing depth (PD) were the primary outcome variables. Four case series studies were included and three in the meta-analysis. All studies showed high risk of bias. RESULTS: The surgery promoted significant changes in treated, adjacent, and non-adjacent sites. There were greater changes in PD (mean difference -0.14, 95 % CI -0.18 to -0.10, p < 0.00001) and CAL (mean difference 0.16, 95 % CI 0.13 to 0.20, p < 0.00001) in treated sites when compared to adjacent and non-adjacent sites for PD (mean difference -0.09, 95 % CI -0.12 to -0.05, p < 0.00001) and CAL (mean difference 0.91, 95 % CI 0.87 to 0.94, p < 0.00001). CONCLUSION: Crown lengthening surgery results in changes of clinical parameters in treated, adjacent, and non-adjacent sites. CLINICAL RELEVANCE: Clinical and esthetic alterations on the adjacent/non-adjacent teeth can lead to clinical and esthetic alterations, which must be considered in surgical planning.

Hybrid developmental follow-up for preterm infants in Brazil: A feasibility study.

INTRODUCTION: The low attendance of families in child developmental follow-up programs for at-risk preterm children is a challenge in Brazil. OBJECTIVE: This study evaluates the feasibility of implementing a developmental follow-up program for Brazilian preterm infants in a hybrid format. METHODS: This is an observational, prospective cohort study, involving preterm infants. Longitudinal developmental test results, the participation frequency in the program, and the number of referrals to early intervention programs were used to assess feasibility. The General Movements (GMs) assessment, Alberta Infant Motor Scale (AIMS) and, Survey of Wellbeing of Young Children (SWYC) Milestones were administered via telehealth. The Bayley-III was administered in-person. RESULTS: Thirty-four preterm infants attended the follow-up until 12 months of corrected age and 18 (52.9 %) concluded all follow-up assessments. Twenty-six (76.5 %) attended all assessments via telehealth, and 26 (76.5 %) attended the in-person assessment. Eighteen (52.9 %) infants showed at least one altered result in development tests. Infants exhibiting abnormal results in the GMs assessment, motor developmental delay according to the AIMS, or developmental delay based on Balley-III were promptly referred to early intervention services. CONCLUSION: This study demonstrated high participation rate and low dropout in a developmental follow-up program employing a hybrid format. The substantial number of identified infants with developmental delay emphasizes the importance of timely detection of motor delays to referral to early intervention services.

Effect of Silicon Carbide Coating on Osteoblast Mineralization of Anodized Titanium Surfaces.

The objective of this study was to evaluate the influence of the titanium nanotube diameter and the effect of silicon carbide (SiC) coating on the proliferation and mineralization of pre-osteoblasts on titanium nanostructured surfaces. Anodized titanium sheets with nanotube diameters of 50 and 100 nm were used. The following four groups were tested in the study: (1) non-coated 50 nm nanotubes; (2) SiC-coated 50 nm titanium nanotubes; (3) non-coated 100 nm nanotubes and (4) SiC-coated 100 nm nanotubes. The biocompatibility and cytotoxicity of pre-osteoblasts were evaluated using a CellTiter-BlueCell Viability assay after 1, 2, and 3 days. After 3 days, cells attached to the surface were observed by SEM. Pre-osteoblast mineralization was determined using Alizarin-Red staining solution after 21 days of cultivation. Data were analyzed by a Kruskal−Wallis test at a p-value of 0.05. The results evidenced biocompatibility and non-cytotoxicity of both 50 and 100 nm diameter coated and non-coated surfaces after 1, 2 and 3 days. The statistical analysis indicates a statistically significant higher cell growth at 3 days (p < 0.05). SEM images after 3 days demonstrated flattened-shaped cells without any noticeable difference in the phenotypes between different diameters or surface treatments. After 21 days of induced osteogenic differentiation, the statistical analysis indicates significantly higher osteoblast calcification on coated groups of both diameters when compared with non-coated groups (p < 0.05). Based on these results, we can conclude that the titanium nanotube diameter did not play any role on cell viability or mineralization of pre-osteoblasts on SiC-coated or non-coated titanium nanotube sheets. The SiC coating demonstrated biocompatibility and non-cytotoxicity and contributed to an increase in osteoblast mineralization on titanium nanostructured surfaces when compared to non-coated groups.

Effectiveness of Counseling on Chronic Pain Management in Patients with Temporomandibular Disorders.

AIMS: To evaluate the effectiveness of counseling on pain intensity and oral health-related quality of life (OHRQoL) in temporomandibular disorders (TMD) patients. METHODS: Fifty female patients diagnosed with TMD were divided into two groups: a group of waiting list patients (control group) and a group of patients who received counseling therapy (experimental group) involving education about etiologic factors, avoidance of parafunctional habits, and sleep, as well as dietary advice. All patients were evaluated at baseline and 7, 15, 30, and 60 days later. Patients reported pain intensity using a visual analog scale (VAS), and the Oral Health Impact Profile (OHIP-14) was used to assess the impact of pain on OHRQoL. Statistical analyses were performed using the split-plot analysis of variance (SPANOVA) design, with post hoc Student t tests for independent samples and for dependent samples, adopting a significance level of P < .05. RESULTS: The control group consisted of 24 female patients with a mean age of 39.96 ± 13.93 years, and the experimental group consisted of 26 female patients with a mean age of 35.15 ± 10.78 years. Counseling was considered effective for reducing pain intensity, with a significant improvement observed at 7 days (P < .001). Counseling was also responsible for a significant improvement in the impact of TMD on OHRQoL at all follow-up time points analyzed (P < .001). When comparing the groups, a significant difference was observed for both pain intensity and TMD impact on OHRQoL during follow-up (P < .05). CONCLUSION: Counseling seems to significantly improve pain and OHRQoL in patients.

Serum magnesium levels during magnesium sulfate infusion at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in women with severe preeclampsia: A randomized clinical trial.

BACKGROUND: Magnesium sulfate is the ideal drug for the prevention and treatment of eclampsia. Nevertheless, the best regimen for protection against eclampsia with minimal side effects remains to be established. This study aimed to compare serum magnesium levels during intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose to prevent eclampsia in pregnant and postpartum women with severe preeclampsia. METHODS: A randomized, triple-blind clinical trial was conducted, comparing serum magnesium levels during the intravenous infusion of magnesium sulfate at 1 gram/hour versus 2 grams/hour as a maintenance dose for the prevention of eclampsia in 62 pregnant and postpartum women with severe preeclampsia, 31 in each group. An intravenous loading dose of 6 grams of magnesium sulfate was administered over 30 minutes in both groups. The patients were then randomized to receive a maintenance dose of either 1 or 2 grams/hour for 24 hours. Primary outcomes consisted of serum magnesium levels at the following time points: baseline, 30 minutes, every 2 hours until the end of the first 6 hours, and every 6 hours thereafter until the termination of magnesium sulfate infusion. Side effects, maternal complications, and neonatal outcomes were the secondary outcomes. RESULTS: Serum magnesium levels were higher in the 2-gram/hour group, with a statistically significant difference from 2 hours after the beginning of the magnesium sulfate infusion (P <.05). Oliguria was the most common complication recorded in both groups, with no significant difference between the 2 regimens (RR 0.88; 95% CI: 0.49-1.56; P = .65). No cases of eclampsia occurred. Side effects were more common in the 2-gram/hour group (RR 1.89; 95% CI: 1.04-3.41; P = .02); however, all were mild. There were no differences between the 2 groups regarding neonatal outcomes, except for admission to neonatal intensive care, which was more frequent in the 1-gram/hour group (25% vs 6.3%; P = .04). CONCLUSION: Magnesium sulfate therapy at the maintenance dose of 1 gram/hour was just as effective as the 2-gram maintenance dose, with fewer side effects.

Comparison and optimization of imaging techniques in suspected physical abuse paediatric radiography.

OBJECTIVE: This study compares protocols in clinical use for paediatric suspected physical abuse (SPA) radiographic imaging across four National Health Service Trusts in the UK. The patient dose delivered from a SPA skeletal survey was compared between two sites using different imaging technology. Additionally, the technique in use for the abdomen anteroposterior (AP) radiographic projection was optimized at one of the participant sites. METHODS: Retrospective data collection was performed to compare SPA protocols. Exposure details and patient dose data for SPA skeletal surveys were collected and compared. SPA skeletal surveys were performed on two anthropomorphic paediatric phantoms using two digital imaging systems. Effective dose (ED) was calculated using a dose calculator software (PCXMC v. 2.0, STUK, Helsinki, Finland) and used as a quantification of the radiation risk. For the optimization study, abdomen AP radiographs of the phantoms were acquired over a range of tube potentials (40-117 kV) for constant ED on a digital radiography (DR) system. The contrast-to-noise ratio (CNR) between "bone" and "soft tissue" in the images was measured and used as an indicator of image quality. RESULTS: This study showed that there is a variation in the protocols and a range of techniques in use for SPA imaging across the four participant sites. The skeletal surveys undertaken on the newborn phantom at two sites resulted in an ED of 57 ± 3 µSv and 90 ± 4 µSv, on the DR unit and digital radiography/fluoroscopy (dRF) unit, respectively. Measurements of the abdomen AP projection achieved an improved CNR (4%) at a lower tube potential (55 kV) without increasing ED, compared with the current clinical setting (64 kV). Advances in knowledge: This study showed that an improved CNR can be achieved for newborn and 1-year-old abdomen AP radiographs using 0.1 mm copper filtration and a reduced kV (55 kV) without increasing ED.

PORTUGUESE STUDY OF MEAN GLANDULAR DOSE IN MAMMOGRAPHY AND COMPARISON WITH EUROPEAN REFERENCES.

To characterise the mean glandular dose (MGD) in a sample of healthcare providers for digital mammography in Portugal. To compare the achieved values with European references. The MGD was measured on a poly-methyl-methacrylate phantom (45 mm) for each system using dosimeters. In addition, MGD was estimated using exposure settings collected from mammography exams in clinical context. Data were collected from 25 computed-radiography systems (CR) and 13 integrated digital (DR). For both measurements (phantom and clinical exposures), the average MGD for CR was higher compared to the DR. For CR the mean MGD was 1.85 mGy (CC projection) and 2.10 mGy (MLO projection). For DR systems the corresponding values were 1.54 mGy (CC) and 1.68 mGy (MLO). The average MGD obtained using both methods and for both technologies is within the acceptable reference range proposed by European guidelines (<2.5 mGy). Dose Reference Levels implementation should be the next step to optimise mammography practice in Portugal.

O condicionamento de tecido peri-implantar na reabilitação estética de próteses unitárias sobre implantes: relato de caso clínico / Peri-implant tissue conditioning in the esthetic rehabilitation of unitary prostheses on implants: Clinical case report / Acondicionamiento del tejido periimplantario en la rehabilitación estética de prótesis unitarias sobre implantes: Informe de caso clínico

Introdução:A reabilitação protética implantosuportada de espaços edêntulos na região do sorriso é um desafio para o cirurgião-dentista. Para obtenção da estética em próteses unitárias sobre implante é necessário considerar aspectos como o correto posicionamento do implante e sua harmonia com os tecidos moles e duros. Objetivo:relatar o resultado estético e funcional de um tratamento com auxílio de coroa provisória associada ao condicionamento gengival na reabilitação final com coroa unitária implantossuportada. Relato de caso clínico: Paciente MJFA, 36 anos, sexo feminino, compareceu à clínica de Prótese Dentária do Departamento de Odontologia/UFRN queixando-se de trauma dentário com perda do elemento dentário 15 e necessidade de "ficar com sorriso mais bonito". Após instalação de implante com conexão cônica e período de osseointegração, foi realizada a confecção da coroa provisória sobre implante e iniciada sessões de condicionamento gengival por meio de acréscimos com resina acrílica, utilizando a técnica de pressão gradual sob a margem gengival. Observou-se uma melhora no tecido periimplantar e um perfil de emergência adequado. O caso possui proservação de 3 anos. Conclusões:a realização de condicionamento gengival previamente a prótese final é uma etapa importante para alcançar umareabilitação com característicasestéticas e funcionais semelhantes à de dentes naturais (AU).

Introduction:Implant-supported prosthetic rehabilitation of edentulous spaces in the smile areais a challenge for dental surgeons. To achieve pleasing esthetics in single implant prostheses it is necessary to consider aspects such as the correct positioning of the implant and its harmony with the soft and hard tissues.Objective:to report the esthetic and functional results of a treatment with the aid of a provisional crown associated with gingival conditioning in the final rehabilitation with a single implant-supported crown.Clinical case report:Patient MJFA, 36 years old, female, attended the Prosthodonticsclinic of the Department of Dentistry/UFRN complaining of dental trauma with loss of tooth 15 and the need to "havea more beautiful smile". Afterinstalling an implant with a conical connection and a period of osseointegration, a temporary crown was made on the implant and gingival conditioning sessions were initiatedby means of acrylic resin augmentations, using the gradual pressure technique under the gingival margin. An improvement in the peri-implant tissue and an adequate emergenceprofile were observed. The case has a 3-year follow-up period.Conclusions:performing gingival conditioning prior to the final prosthesis is an important step in achieving rehabilitation with esthetic and functional characteristics similar to those of natural teeth (AU).

Introducción: La rehabilitación protésica implantosoportada de espacios edéntulos en el áreade la sonrisa es un desafío para el cirujano dentista. Para conseguir una buena estética en las prótesis unitarias sobre implanteses necesario tener en cuentaaspectos como el posicionamiento correctodel implante y su armonía con los tejidos blandos y duros.Objetivo: informar losresultadosestéticosy funcionalesde un tratamiento con ayuda de coronas provisionales asociado al acondicionamiento gingival en la rehabilitación final con corona única implantosoportada.Relato de caso clínico: Lapaciente MJFA, 36 años, sexo femenino, se dirigióa la clínica de Prostodonciadel Departamento de Odontología/UFRN quejándose de un traumatismodental con pérdida del diente 15 y de la necesidad de "tener una sonrisa más bonita". Después de la colocación de un implante con conexión cónica y de un período de osteointegración, se realizó una corona provisional sobre el implante y se iniciaron sesiones de acondicionamiento gingival con aumentos de resina acrílica, utilizando la técnica de presión gradual bajo el margen gingival. Se observó una mejora del tejido periimplantario y un perfil de emergencia adecuado. El caso tiene un seguimiento de 3 años. Conclusiones: el acondicionamiento gingival previo a la prótesis definitiva es una etapaimportante para conseguiruna rehabilitación con características estéticas y funcionales similares a las de los dientes naturales (AU).

Confecção de guia multifuncional para planejamento de reabilitação implantossuportada: relato de caso / Preparation of a multifuncional guide for the planning of implant-supported rehabilitations: case report / Elaboración de una guía multifuncional para la planificación de rehabilitación implantosoportada: informede caso

Introdução:Em busca da estética e da função mastigatória,é cada vez mais crescente aprocurapor reabilitações implantossuportadas. O guia multifuncional surgepara orientar a disponibilidade óssea e contribuir no planejamento da instalação tridimensional dos implantes, seguindo os princípios do planejamento reverso.Objetivo:Descrever, por meio de um caso clínico, a possibilidade de obtenção de resultados de excelente previsibilidade em coroas unitárias implantossuportadas, por meio do uso de guias multifuncionais, no planejamento do início ao fim de tratamento.Relato decaso:Paciente A.M.F, 44 anos, sexo feminino, compareceu à clínica de Prótese dentária do Departamento de Odontologia/UFRN com queixa de insatisfação da sua prótese removível e harmonia do sorriso. Ao exame clínico e radiográfico, observou-se ausência do elemento 12, apresentando um espaço interoclusal de 5mm e distância médio-distal de 7mm. Foi confeccionado o guia em resina acrílica, o qual foi preenchido o espaço desdentado com um dente de estoque. Em seguida, o dente deste guia teve seu centro perfurado com uma broca esférica para peça reta na região de cíngulo e com isso, preenchida com guta percha em bastão. Após isso, o paciente foi encaminhado para realizar uma tomografia computadorizada cone beam com o guia multifuncional em posição.As imagens obtidas permitiram o planejamento para instalação do implante, como inclinação e posicionamento favorável, bem como ausência de disponibilidade óssea na região. Além disso, o guia funcionou em outras etapas do tratamento da paciente, como na fase provisória.Conclusão:Os guias auxiliam em diversas fases do tratamento e permitem maior previsibilidade dos resultados em reabilitações protéticas unitárias implantossuportadas, apresentando-se como um dispositivo promissorpara ocorreto posicionamento do implante (AU).

Introduction:In search of esthetics and improved masticatory function, the demand for implant-supported rehabilitation is increasing. Multifunctional guides emerge to assess bone availability and help plan the three-dimensional installation of implants, following the principles of reverse planning. Objective:To describe, through a clinical case, the possibility of obtaining excellent predictability in implant-supported single crowns, through the use of multifunctional guides, inthe planning of a treatment from beginning to end. Case report:Patient A.M.F, 44 years old, female, came to the Prosthodontics clinic at the Department of Dentistry/UFRN complaining of dissatisfaction with her removable prosthesis and the harmony of her smile. Clinical and radiographic examination revealed the absence of element 12, with an interocclusal space of 5mm and a mid-distal distance of 7mm. The acrylic resin guide was made and the edentulous space was filled with a stock tooth. The center of theguide tooth was then drilled with a spherical straight-bit burr in the cingulum region and filled with gutta-percha stick. The patient was then referred for a cone beam computed tomography with the multifunctional guide in position. The images obtained allowed planning for implant installation, such as favorable inclination and positioning, as well as the absence of bone availability in the region. In addition, the guide was effective during other stages of the patient's treatment, such as the provisional phase.Conclusion:The guides assist in various phases of treatment and allow greater predictability of results in implant-supported single prosthetic rehabilitations, presenting themselves as a promising device for correct implant positioning (AU).

Introducción:En busca de estética y función masticatoria, la demanda de rehabilitaciones implantosoportadas es cada vez mayor. La guía multifuncional hasurgido para orientar la disponibilidad ósea y ayudar a planificar la instalación tridimensional de implantes, siguiendo los principios de la planificación inversa. Objetivo: Describir, a través de un caso clínico, la posibilidad de obtener una excelente predictibilidad en coronas unitarias implantosoportadas, mediante el uso de guías multifuncionales, en la planificación desde el início hasta el final del tratamiento. Informe de caso: Paciente A.M.F, 44 años, sexo femenino, compareció a la clínica de Prostodoncia del Departamento de Odontología/UFRN quejándose estar insatisfecha con su prótesis removible y con la armonía de su sonrisa. El examen clínico y radiográfico reveló la ausencia del elemento 12, con un espacio interoclusal de 5 mm y una distancia medio-distal de 7 mm. Se confeccionó una guía de resina acrílica y se rellenó el espacio edéntulo con un diente provisorio. A continuación, se perforó el centro del diente guía con una broca recta esférica en la región del cíngulo y se le rellenó con gutapercha en barra. Posteriormente, el paciente fue remitido a una tomografía computarizada cone beamcon la guía multifuncional en posición. Las imágenes obtenidas permitieron planificar la instalación del implante, como inclinación y posicionamiento favorables, así como la ausencia de disponibilidad ósea en la región. La guía también funcionó en otras fases del tratamiento del paciente, como en la fase provisional. Conclusión:Las guías ayudan en varias fases del tratamiento y permiten una mayor previsibilidadde los resultados en rehabilitaciones protésicas unitarias implantosoportadas, presentándose como un dispositivo prometedor para el correcto posicionamiento de los implantes (AU).

Quality Controls in Digital Mammography protocol of the EFOMP Mammo Working group.

This article aims to present the protocol on Quality Controls in Digital Mammography published online in 2015 by the European Federation of Organisations for Medical Physics (EFOMP) which was developed by a Task Force under the Mammo Working Group. The main objective of this protocol was to define a minimum set of easily implemented quality control tests on digital mammography systems that can be used to assure the performance of a system within a set and acceptable range. Detailed step-by-step instructions have been provided, limiting as much as possible any misinterpretations or variations by the person performing. It is intended that these tests be implemented as part of the daily routine of medical physicists and system users throughout Europe in a harmonised way so allowing results to be compared. In this paper the main characteristics of the protocol are illustrated, including examples, together with a brief summary of the contents of each chapter. Finally, instructions for the download of the full protocol and of the related software tools are provided.

Overview of the radiographers' practice in 65 healthcare centers using digital mammography systems in Portugal.

PURPOSE: To assess current practices in digital mammography (DM) in Portuguese healthcare providers using digital systems. To investigate compliance with European standards regarding mean glandular dose and quality control practice and to identify optimisation needs. METHODS: Two questionnaires, targeted at breast radiographers and chief radiographers, were designed and applied in 65 imaging departments offering DM. Questions fielded were focused on the staff profile and technical/clinical practice. RESULTS: Prior to starting their activity in DM, 70% (82 out of 118) of the respondents received training in DM. The practice in 29 out of 59 providers was established by the manufacturers' recommendations for image acquisition. Variations were observed between radiographers who belong to the same provider namely the selection of exposure parameters such as the target-filter combination and automatic mode. The use of the manual exposure mode was reported for imaging breast implants (44%) and surgical specimens (22%). The main causes of repeat examinations were skin folding (21%) and absence of pectoral muscle (PM) (20%). CONCLUSIONS: The study revealed opportunities to optimise radiographers' practice in DM regarding the selection of exposure parameters. A robust and consistent training programme in DM and established local protocols can help to reduce the variations observed and improve clinical practice. MAIN MESSAGES: • Radiographers adopted different practices selecting AEC modes and T/F combinations. • Radiographer practice is more consistent using DR than using CR systems. • The main causes for rejecting images were the visibility of skin folding and PM absence. • Radiographers were partly unaware of the dose indicator. • Radiographers' training needs: QC, interventional procedures and breast dose optimisation.

Técnicas de marcação de próteses dentárias: revisão da literatura / Techniques of denture marking: review of literature

Indivíduos edêntulos representam um desafio na identificação humana, por isso, em 1931, a marcação identificadora de próteses dentárias foi proposta pela primeira vez, e várias técnicas e materiais têm sido testados ao longo dos anos. A marcação ou identificação de próteses é feita através da incorporação de materiais metálicos, não metálicos, microchips ou outros que são introduzidos no material da prótese removível, ou, ainda, pela marcação da superfície. O presente estudo teve como objetivo descrever as técnicas de marcação protética através de uma revisão narrativa da literatura com busca sistemática realizada nas bases de dados PubMed, Google Acadêmico e SciELO, além de uma busca manual nas referências dos trabalhos selecionados. É responsabilidade ética e legal do cirurgião-dentista auxiliar em investigações de identificação humana, assim, dado o amplo uso de próteses no Brasil, o valor de uma identificação, a relevância e comprovada eficiência em situações forenses, a marcação de próteses deve ser oferecida como opção a todos os pacientes

Edentulous people are a challenge in human identification, therefore in 1931, denture identification marking was proposed for the first time, and several techniques and materials have been tested over the years. The marking or identification of dentures is done through the incorporation of metallic, non-metallic materials, microchips or others that are introduced into the material of the removable prosthesis, or by marking the surface. The present study aimed to describe the techniques of denture marking in a narrative review of the literature with a systematic search using the databases PubMed, Google Scholar and SciELO, and also a manual search of the references of the selected works. It is the dentists ethical and legal responsibility to assist in investigations of human identification, so, given the wide use of dental prostheses in Brazil, the value of an identification, the relevance and proven efficiency of denture marking in forensic situations, the practice must be offered as an option for all patients

Conhecimento, prática e opinião de odontolegistas sobre a marcação identificadora de próteses dentárias / Knowledge, practice and opinion of forensic dentists on denture marking

Introdução: A marcação ou identificação de próteses dentárias é feita através da incorporação de etiquetas metálicas, não metálicas ou outras no material da prótese, ou ainda pela marcação da superfície. Apesar de ser recomendada por organizações governamentais e forenses, ela não é amplamente empregada no Brasil. Objetivo: Analisar o nível de conhecimento e descrever a opinião e experiência de odontolegistas brasileiros com a marcação protética. Material e métodos: Foi aplicado um questionário semiaberto a odontolegistas sobre o conhecimento, opinião e prática com a identificação protética. A análise estatística foi feita no software Microsoft Excel. Resultados: Foram obtidas respostas de 43 especialistas das cinco regiões do Brasil. 76% afirmaram conhecer o termo, mas apenas 14% relataram possuir experiência prática e 95% julga ser importante. Dos que já realizaram a prática e a descreveram, todos a utilizaram em situações forenses com cadáveres. Os maiores obstáculos apontados para a implementação foram a falta de conhecimento, a falta de diretrizes oficiais e o custo. Sobre a necessidade de implementar a marcação na prática clínica, 77% responderam que é necessária em todos os casos, mas com relação à obrigatoriedade de implementá-la, 56% declararam que deve ser recomendada, mas não obrigatória e 39%, que deve ser obrigatória. Conclusão: O conhecimento dos odontolegistas sobre a marcação de próteses é considerável e a maioria julga importante, no entanto, poucos tiveram contato com a prática e nenhum a realiza na clínica. Evidencia-se a necessidade da elaboração de diretrizes ou recomendações por entidades odontológicas, ressaltando a importância sócio-legal da prática

Introduction: Denture marking or identification is done through the incorporation of metallic, non-metallic or other labels in the material of the prosthesis, or by marking the surface. Despite being recommended by governmental and forensic organizations, it is not widely used in Brazil. Objective: To analyze the level of knowledge and describe the opinion and experience of Brazilian forensic dentists with denture marking. Material and methods: A semi-open questionnaire about the knowledge, opinion and practice with denture identification was applied to forensic dentists. Statistical analysis was performed using Microsoft Excel software. Results: Responses were obtained from 43 experts from the five regions of Brazil. 76% said they knew the term, but only 14% reported having practical experience and 95% thought it was important. Of those who have performed the practice and described it, all of them used it in forensic situations with corpses. The biggest obstacles pointed out to the implementation of the practice were the lack of knowledge, the lack of official guidelines and the cost. Regarding the need to implement marking in clinical practice, 77% answered that it is necessary in all cases, but regarding the obligation to implement it, 56% declared that it should be recommended, but not mandatory and 39%, that it should be mandatory. Conclusion: The knowledge of forensic dentists about denture marking is considerable and most consider it important, however, few had contact with the practice and none performs it in the clinic. The need for the elaboration of guidelines or recommendations by dental entities emphasizing the socio-legal importance of the practice is evident

Influências estrangeiras e concretizações nos intentos de regionalização da rede hospitalar em Portugal (1946-1974) / Foreign influence and achievements in the regionalization of Portugal's hospital network (1946-1974) / Influencias extranjeras y concretizaciones en los intentos de regionalización de la red hospitalaria en Portugal (1946-1974)

O presente artigo aborda os propósitos de regionalização da rede hospitalar portuguesa durante o regime ditatorial do Estado Novo (1933-1974), lançados no após Segunda Guerra Mundial. Almejando um sistema hospitalar coordenado com base regional, o governo português limitou-se a comparticipar a construção e a remodelação de edifícios, relegando as múltiplas tarefas envolvidas no funcionamento hospitalar para instituições particulares, o que dificultou o desenvolvimento e o acesso a cuidados de saúde a uma parte significativa da população. Com base na análise de viagens de estudo realizadas por administradores hospitalares e engenheiros sanitários nas décadas de 1940 e 1950, sobretudo a países europeus como Itália, França e Inglaterra, pondera-se acerca da importância dos contatos com redes internacionais de especialistas e da influência exercida pelos exemplos estrangeiros sobre as medidas de organização da assistência hospitalar em Portugal estabelecidas nos anos seguintes. (AU)

This article analyzes the regionalization of Portugal's hospital network during the "New State" dictatorial regime (1933-1974), launched after the second world war. In an attempt to create a regionally-based hospital system, the Portuguese government limited itself to subsidizing the construction and refurbishment of buildings, relegating the multiple tasks involved in hospital management to private organizations, hampering access to health care for a significant part of the population. Through the analysis of study trips made by hospital administrators and sanitary engineers in the 1940s and 1950s, mainly to European countries such as Italy, France and England, this article reflects on the importance of contacts with international networks of experts and influence of foreign experiences on the approach to the organization of hospital care in Portugal adopted in subsequent years. (AU)

El presente artículo aborda los principios de regionalización de la red hospitalaria portuguesa durante el régimen dictatorial del Estado Novo (1933-1974), lanzados después de la Segunda Guerra Mundial. El gobierno portugués, que anhelaba un sistema hospitalario coordinado con base regional, se limitó a coparticipar la construcción y remodelación de edificios, relegando a instituciones particulares las múltiples tareas envueltas en el funcionamiento hospitalario, lo que dificultó el desarrollo y el acceso a cuidados de salud para una parte significativa de la población. Por medio del análisis de viajes de estudio realizados por administradores hospitalarios e ingenieros sanitarios durante las décadas de 1940 y 1950, principalmente a países europeos como Italia, Francia e Inglaterra, se pondera sobre la importancia de los contactos con redes internacionales de especialistas y de la influencia ejercida por los ejemplos extranjeros sobre las medidas de organización de la asistencia hospitalaria en Portugal, establecidas en los años siguientes. (AU)