An association between liraglutide treatment and reduction in excessive daytime sleepiness in obese subjects with type 2 diabetes.

BACKGROUND: The main purpose of the present study is to evaluate whether treatment with long-acting human glucagon-like peptide-1 liraglutide was associated with an improvement of excessive daytime sleepiness (EDS) in obese subjects with type-2 diabetes. METHODS: This single-centre retrospective study included 158 obese (body mass index [BMI] ≥ 30 kg/m(2)) adult subjects with type-2 diabetes who were initiated with liraglutide treatment at least 3 months before study inclusion. Data of the Epworth Sleepiness Scale (ESS), anthropometric parameters, glucose-control and metabolic parameters were collected at liraglutide initiation (baseline) and at months 1 and 3 after liraglutide initiation. RESULTS: Significant reductions in ESS score were achieved at months 1 (-1.3 ± 2.8, p < 0.001) and 3 (-1.5 ± 3.0, p < 0.001) after liraglutide introduction. After 3 months of treatment with liraglutide, significant changes in body weight (p < 0.001), BMI (p < 0.001), waist (p < 0.001) and neck circumferences (p < 0.005), HbA1c (p < 0.001), mean blood glucose (p < 0.001), fasting plasma glucose (p < 0.001), triglycerides (p < 0.01) and total cholesterol (p < 0.001) were achieved. CONCLUSIONS: After 3 months of treatment with liraglutide a significant reduction in EDS was observed in obese subjects with type-2 diabetes. Besides this, significant changes in body weight and metabolic parameters of diabetes control were also accomplished. Further investigation is required to determine whether liraglutide could improve other abnormal sleep patterns and obstructive sleep apnoea.

Crown and crown-root fractures: an evaluation of the treatment plans for management proposed by 154 specialists in restorative dentistry.

Traumatic tooth injuries involve function and aesthetics and cause damage that range from minimal enamel loss to complex fractures involving the pulp tissue and even loss of the tooth crown. Technical knowledge and clinical experience are essential to establish an accurate diagnosis and provide a rational treatment. The purpose of this study was to evaluate the knowledge of Restorative Dentistry specialists about the management of crown and crown-root fractures based on treatment plans proposed by these professionals for these cases. A descriptive questionnaire was mailed to 245 Restorative Dentistry specialists with questions referring to their professional profile and the treatment plans they would propose for the management of crown and crow-root fractures resulting from dental trauma. One hundred and fifty-four questionnaires were returned properly filled. The data were subjected to descriptive statistics and the chi-square test was used to determine the frequency and the level of the significance among the variables. The analysis of data showed that in spite of having a specialist title, all interviewees had great difficulty in planning the treatments. As much as 42.8% of the participants were unable to treat all types of dental trauma. Complicated and uncomplicated crown-root fractures posed the greatest difficulties for the dentists to establish adequate treatment plans because these fractures require multidisciplinary knowledge and approach for a correct case planning and prognosis.

Integrated treatment to resolve a horizontal root fracture.

Root fractures are defined as those that involve cement, dentin and pulp, comprising from 0.5 to 7% of injuries in permanent dentition. Diagnosis is made through clinical and radiographic exams, the latter frequently being limited by the position of the fracture. Treatment varies according to the displacement and vitality of the fragments. The authors present a clinical case of recurrent trauma of tooth 21 causing a horizontal root fracture in the middle third. After several attempts at endodontic treatment, the option was to remove the apical fragment by surgery. The postoperative period of 4 years shows very satisfactory results with regard to wound repair and tooth mobility, or implantation of the coronal segment.

Insulinoma: a multicenter, retrospective analysis of three decades of experience (1983-2014).

OBJECTIVE: To analyze the clinical features, diagnostic procedures, treatment, and clinical outcome of insulinomas diagnosed and treated in the period 1983-2014 in four Spanish hospitals. METHODS: All patients with either biochemical and morphological criteria of insulinoma and/or histological demonstration of insulin-secreting tumor were included. RESULTS: Twenty-nine patients [23 women (79.3%); mean age 48.7±17.4 years (range, 16-74)] were recruited. Twenty-six patients (89.7%) had sporadic tumors, and the rest (3 women, 10.3%) developed in the context of multiple endocrine neoplasia type 1. There were 3 (10.3%) multiple insulinomas, one associated with multiple endocrine neoplasia type 1, and two (6.9%) malignant insulinomas, both sporadic. Most patients (n=18, 62.1%) had fasting hypoglycemia, about a third (31%) both postprandial and fasting hypoglycemia, and 6.9% postprandial hypoglycemia only. Time to glucose nadir (37.3±6.5mg/dL) in the fasting test was 9.0±4.4h, with maximal insulin levels of 25.0±20.3µU/mL. Abdominal CT detected insulinoma in 75% of patients. Twenty-seven (93.1%) patients underwent surgery [enucleation, 18 (66.7%) and subtotal pancreatectomy, 9 (33.3%); tumor size, 1,7±0,7cm]. Surgery achieved cure in the majority (n=24, 88.9%) of patients. CONCLUSION: In our setting, insulinoma is usually a benign, small, and solitary tumor, mainly affecting women aged 45-50 years, and usually localized with abdominal CT. The most commonly used surgical technique is enucleation, which achieves a high cure rate.

Full-Mouth Rehabilitation Using All-Ceramic Restorations.

The scientific and technological advancement of cosmetic dentistry has improved metal-free ceramic systems for fixed prosthodontics as well as porcelain veneers, making them an excellent treatment option for delivering superior cosmetic results. The authors present a clinical case of full-mouth rehabilitation using all-ceramic restorations with porcelain metal-free unit crowns in the maxilla, and porcelain veneers from the left inferior premolar to the right inferior premolar. Using this approach, they were able to achieve an excellent esthetic and functional result for the patient.

Multidisciplinary approach for the treatment of a complicated crown-root fracture in a young patient: a case report.

Crown-root fractures in permanent teeth cause esthetic and functional problems. This paper reports the case of a complicated crown-root fracture in the maxillary right central incisor of a young patient who was treated with a multidisciplinary approach in two phases. A modified Widman flap, root canal therapy, glass fiber post cementation, and adhesive tooth fragment reattachment were performed shortly after an accident. Satisfactory esthetic and functional outcomes were obtained. However, the patient did not attend follow-up visits and returned after 7 years. During this second phase, the clinical and radiographic examination showed stability and adaptation of the fragment and good periodontal health conditions, but crown darkening and a radiolucent image associated with the root apex of the fractured tooth were also observed. The periapical lesion was surgically removed by apicoectomy, and the esthetics were recovered with a direct composite resin veneer on the traumatized tooth.

Dental trauma involving root fracture and periodontal ligament injury: a 10-year retrospective study.

The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion) treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP), Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were examined. The results of this survey revealed that subluxation (25.09%) was the most common type of periodontal ligament injury, followed by extrusive luxation (19.86%). There was a predominance of young male patients and most of them did not present systemic alterations. Among the etiologic factors, the most frequent causes were falls and bicycle accidents. Injuries on extraoral soft tissues were mostly laceration and abrasion, while gingival and lip mucosa lacerations prevailed on intraoral soft tissues injuries. Radiographically, the most common finding was an increase of the periodontal ligament space. The most commonly performed treatment was root canal therapy. Within the limits of this study, it can be concluded that traumatic dental injuries occur more frequently in young male individuals, due to falls and bicycle accidents. Subluxation was the most common type of periodontal ligament injury. Root canal therapy was the type of treatment most commonly planned and performed.

Multidisciplinary treatment approach for crown fracture and crown-root fracture - a case report.

The increased incidence of traumatic injuries to anterior teeth is a consequence of leisure activities, where the most common injuries are crown fractures. Treatment of the dental trauma is complex and requires a comprehensive and accurate diagnostic and treatment plan. It is also important to consider the biological, functional, esthetic and economic aspects, as well as the patient's desire. The purpose of this article is to report a case that shows the multidisciplinary approach required to successfully manage the rehabilitation of a maxillary central incisor with a complex crown fracture and a maxillary lateral incisor, that at first presented an oblique crown-root fracture, and after the orthodontic extrusion, suffered a more apical new crown-root fracture.

Analysis of the crown fractures and crown-root fractures due to dental trauma assisted by the Integrated Clinic from 1992 to 2002.

The purpose of this study was to analyze crown fractures and crown-root fractures due to dentoalveolar trauma, treated in the Integrated Clinic comprehensive dental care at Aracatuba School of Dentistry (UNESP), from January 1992 to July 2002. The data were obtained from files of trauma cases. On the analysis period, 293 patients had crown fractures or crown-root fractures, in 605 teeth. Sixty-nine percent were males and 31% were females. Adolescents between 11 and 18 years old were the most prevalent group (41.6%) and the maxillary arch was the most commonly traumatized (83%). The most commonly affected tooth was the maxillary central incisor (58.3%). The most frequent causes were falls from bicycles (30.8%). It was concluded that the reality of the local service is similar to the published data.

Diastemas: reestablishment of an attractive smile / Diastemas: restabelecimento da harmonia do sorriso

A healthy and attractive smile is very valued in today´s society. Yet this requires better aesthetic and cosmetic solutions from dental surgeons. The present paper presents a case report of diastema closure using an association of tooth movement induced by orthodontic elastics, dental cosmetics and resin-bonded prosthesis. The female patient L.B.A.J., aged 19 years, visited the Integrated Clinic of Araçatuba Dental School - UNESP mainly complaining of missing teeth and poor esthetics. After anamnesis, clinical and radiographic examination revealed hypodontia of the maxillary right and left first premolars, abnormal maxillary right lateral incisor shape and diastema between the maxillary right lateral incisor and canine and between the maxillary left lateral incisor and canine. Planning was done which included indication of diastema closure with composite resin restoration and metal-free resin-bonded prosthesis, with a structure made of Vectris (Ivoclar Vivadent Inc., Amherst, NT, USA). The option for dental cosmetics associated with resin-bonded prosthesis after movement with orthodontic elastics resulted in an excellent aesthetic outcome of low cost and short treatment duration.

Ter um sorriso saudável e harmônico representa grande valor na sociedade atual. Para esta condição, exigem-se melhores soluções estéticas e cosméticas pelos cirurgiões-dentistas. O objetivo deste artigo é apresentar um caso clínico de fechamento de diastema utilizando a associação da movimentação dentária por meio de borrachas ortodônticas, com a plástica dentária e a prótese fixa adesiva. Paciente L.B.A.J., sexo feminino, 19 anos, procurou o serviço da Clínica Integrada da Faculdade de Odontologia de Araçatuba da Universidade Estadual Paulista Júlio de Mesquita com queixa de ausência de dentes e estética comprometida. Após anamnese, exame clínico e radiográfico foi diagnosticado agenesia dos dentes 14 e 24, alteração de forma do 12 e diastema entre o 12 e 13 e o 22 e 23. Foi realizado o planejamento, com indicação de fechamento de diastema, com restauração de resina composta e prótese fixa adesiva sem metal, com estrutura em Vectris (Ivoclar Vivadent Inc., Amherst, NT, USA). A opção pela plástica dentária associada à prótese fixa adesiva, após movimentação com borrachas, mostrou-se um excelente resultado estético com menor custo e tempo de tratamento.

Razões para substituição de restaurações em clínica integrada / Reasons for replacing restorations in the integrated clinic

Objetivo: Analisar as razões para as substituições de restaurações de amálgama e resina composta dentre os pacientes atendidos na disciplina de Clínica Integrada, da Faculdade de Odontologia de Araçatuba (UNESP). Método: Após a realização do exame dos pacientes para a coleta dos dados destinada à formulação do diagnóstico, o plano de tratamento foi delineado utilizando ficha constando as restaurações a serem substituídas, as razões para essa substituição, o material restaurador utilizado e o número de faces restauradas. A seguir, todas as indicações de substituições foram conferidas e checadas quanto à sua verdadeira necessidade por 5 examinadores calibrados quanto aos conceitos teóricos sobre os critérios propostos da necessidade ou não de substituição. O período de análise foi de 5 anos (2001 a 2005). Para padronizar a análise das restaurações, foi anexada à ficha, critérios para as substituições. Resultados: Foram atendidos 856 pacientes, dos quais 753 necessitaram substituir restaurações. As principais razões que levaram a substituição de restaurações de amálgama foram: adaptação marginal deficiente (40,9%), recidiva de cárie (24,1%) e forma anatômica deficiente (15,4%). Para as restaurações de resina composta foram: razões estéticas (31,4%), adaptação marginal deficiente (29,2%) e recidiva de cárie (20,7%). Conclusão: A despeito da pouca experiência clínica da população estudada (alunos de graduação), as razões para substituição das restaurações não divergem da literatura sendo o fator estético o principal motivo para as restaurações de resina composta e a adaptação marginal deficiente para as de amálgama.

Objective: To analyze the reasons for replacing amalgam and composite resin restorations of patients treated at the Integrated Clinic Discipline of the Dental School of Araçatuba (UNESP), SP, Brazil. Method: After examining the patients for data collection to obtain a diagnosis, the treatment plan was outlined using a clinical form containing the restorations to be replaced, the reasons for replacing, the restorative material of choice and the number of restored surfaces. Next, all restorations indicated for replacement were examined as to their real need of replacement by 5 calibrated examiners taking into account the theorical concepts on the proposed criteria for the need of replacing or not. The analyzed period comprised 5 years (2001 to 2005). The criteria adopted for replacement were attached to the data collecting form in order to standardize the analysis of the restorations. Results: 856 patients were treated within the studied period and 753 needed restoration replacement. The main reasons for replacing amalgam restorations were defective marginal adaptation (40.9%), recurent caries (24.1%) and deficient anatomical form (15.4%). The main reasons for replacing resin restorations were esthetics (31.4%), defective marginal adaptation (29.2%) and recurent caries (20.7%). Conclusion: In spite of the little clinical experience of the studied population (undergraduate students), the reasons for replacing restorations were in accordance with the literature, having estehtics as the main reason for the replacement of composite resin restorations and defective marginal adaptation for amalgam restorations.

Dental trauma involving root fracture and periodontal ligament injury: a 10-year retrospective study

The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion) treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP), Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were examined. The results of this survey revealed that subluxation (25.09 percent) was the most common type of periodontal ligament injury, followed by extrusive luxation (19.86 percent). There was a predominance of young male patients and most of them did not present systemic alterations. Among the etiologic factors, the most frequent causes were falls and bicycle accidents. Injuries on extraoral soft tissues were mostly laceration and abrasion, while gingival and lip mucosa lacerations prevailed on intraoral soft tissues injuries. Radiographically, the most common finding was an increase of the periodontal ligament space. The most commonly performed treatment was root canal therapy. Within the limits of this study, it can be concluded that traumatic dental injuries occur more frequently in young male individuals, due to falls and bicycle accidents. Subluxation was the most common type of periodontal ligament injury. Root canal therapy was the type of treatment most commonly planned and performed.

Prótese adesiva: uma opção estética, conservadora e funcional / Adhesive prosthesis: an esthetic, conservative and functional option

A evolução dos sistemas adesivos tanto para esmalte quanto para dentina associado à fibra de reforço possibilitou o surgimento da prótese adesiva livre de metal. É objetivo apresentar um caso clínico de associação da plástica dentária e prótese adesiva em Targis/Vectris. O paciente D.S.P., sexo masculino, 16 anos de idade, procurou a disciplina de Clínica Integrada da Faculdade de Odontologia de Araçatuba, da Universidade Estadual Paulista (UNESP), em conseqüência da perda do 43. No exame clínico inicial, além da ausência do 43 foi constatado diastema entre o 41 e 42. O tratamento iniciou-se pela plástica dentária, e em seguida foram realizados os preparos para a confecção da prótese. O resultado obtido permite concluir que a associação das técnicas, proporciona uma excelente qualidade estética, com preservação de estrutura dentária e menor tempo clínico.

Correção de seqüelas do reimplante dentário - Soluções estéticas provisórias / Correction of dental reimplant sequels

Os autores relatam um caso clínico para solucionar o problema de mal posicionamento dentário, resultante de reimplantes dentários. Discutem as possibilidades de tratamento, dentre elas a movimentação ortodôntica, e elegem como opção terapêutica a confecção de facetas e coroas puras de porcelana por apresentarem biocompatibilidade, excelente qualidade estética e reduzido acúmula de placa.

Tratamento clínico integrado: relato de caso / General dentistry: a case report

Os autores relatam um caso clínico cujo plano de tratamento integrado exigiu tratamento endodôntico, cirurgia parendodôntica e restauração estética com faceta de resina composta. Após acompanhamento de 16 meses foi possível observar que a inter-relação de procedimentos foi capaz de promover a regressão da lesão periapical e recuperar favoravelmente a estética do paciente

Estudo "in vitro" da penetração de selantes de fóssulas e fissuras no esmalte dental humano, com ou sem contaminação / \"In vitro\" study of the pit and fissure sealants in human dental enamel, with or without contaminations

Através da microscopia ótica comum, foi analisada a penetração de selantes de fóssulas e fissuras no esmalte dental humano condicionado, contaminado ou não, pela umidade bucal ou saliva. Verificou-se que os selantes Delton, Oralin e Helioseal apresentaram um mesmo nível de penetração no esmalte dental e superior ao selante Prisma-Shield; o esmalte dental condicionado não contaminado mostrou-se superior quanto à penetração, o que demonstra a importância do isolamento absoluto durante o selamento oclusal

Enceramento e moldagem com silicona: uma nova técnica para fechamento de diastema / Waxing and molding with silicone: a new technique for diastema closure

Os autores apresentam uma nova técnica para fechamento de diastema, através de um caso clínico, utilizando enceramento de diagnóstico, feito em modelo de estudo e realizado em laboratório, com auxílio de uma moldeira de silicona

Avaliaçäo do desempenho dos alunos da F.O. Araçatuba-UNESP nas questöes de clínica integrada do exame nacional de cursos (proväo) / Performance evaluation of students from the school of dentistry at Araçatuba - UNESP in questions about general dentistry clinics in the national courses examination

Os autores avaliaram o desempenho dos alunos da F.O. Araçatuba - UNESP nas questöes de Clínica Integrada do Exame Nacional de Cursos (Proväo) de 1997, 1998 e 1999. Observaram que as médias obtidas na unidade foram ligeiramente maiores que as médias nacionais e que a Disciplina de Clínica Integrada de F.O. Araçatuba atende às exigências de formaçäo de um cirurgiäo dentista generalista

O perfil da disciplina de Clínica Integrada da Faculdade de Odontologia de Araçatuba - UNESP, após onze anos de implantaçäo / The profile of the Integrated Clinic of the Faculty of Dentistry of Araçatuba - UNESP, after eleven years of experience

A Clínica Integrada visa dar ao futuro profissional vivência clínica a fim de que possa diagnosticar, planejar e avaliar casos clínicos, constituindo a última etapa de formaçäo do Cirurgiäo-Dentista, buscando a formaçäo de um clínico geral. O primeiro registro de implantaçäo deste sistema data de 1954. Em 1970 foi introduzida formalmente no ensino odontológico brasileiro como estágio e, a partir de 1982, passou a ser uma Disciplina. Na Faculdade de Odontologia de Araçatuba - UNESP, este fato ocorreu em 1986, contando, a partir daí, com corpo docente próprio. É proposta deste estudo relatar as características básicas da Clínica Integrada, considerando histórico, conceito, objetivos, atividades clínicas e plano de ensino. Para tanto, a experiência de onze anos de implantaçäo é discutida com a regulamentaçäo do CFE (Conselho Federal de Educaçäo) e com as outras unidades. Após este período, foi possível concluir que esta disciplina guarda estreita semelhança com o proposto pelo CFE, proporcionando a formaçäo de um clínico geral