Comparing the use of silicone and polyurethane Peripherally Inserted Central Catheters in newborns: A retrospective study.

AIMS AND OBJECTIVES: To compare polyurethane and silicone peripherally inserted central catheters (PICCs) in newborns regarding the success rates of insertion and duration and the reasons for nonelective removal. BACKGROUND: Previous studies have attempted to identify predictors of PICC complications in newborns, such as lower extremity insertion or femoral catheter insertion, procedures that require 60 minutes or more, duration longer than 30 days and non-central position of the catheter tip. However, there is little evidence on which type of PICC material causes less complications, especially in newborns. DESIGN: Retrospective cohort, guided by the STROBE tool. METHODS: We divided the newborns into two groups according to the type of PICC material: polyurethane and silicone. Our sample was composed of 449 PICCs, of which 246 polyurethane PICCs and 203 silicone PICCs, inserted in 294 newborns. Bivariate analysis was performed for data comparison. All statistically significant variables in the bivariate analysis were included in the logistic regression (p ≤ .05). RESULTS: Of the 449 PICCs that we analysed, the central position of the catheter tip predominated for both types of materials, with a higher prevalence of false passage for the polyurethane group. There was no difference between the average duration. The incidence of nonelective PICC removal was 49.27% for the silicone group, and infiltration/extravasation and rupture were among the reasons for nonelective removal. CONCLUSION: The overall success rates in the insertion and duration of the PICC were almost identical for both types of material, despite the high incidence of false passage for polyurethane PICCs. Nonelective removals were higher for silicone PICCs, which also had a higher incidence for infiltration/extravasation and rupture. RELEVANCE TO CLINICAL PRACTICE: Can contribute to the knowledge of the strengths and weaknesses of polyurethane and silicone PICCs, with a view to reduce the incidence of nonelective removals.

Morphological Analysis of Dentin Surface after Conditioning with Two Different methods: Chemical and Mechanical.

BACKGROUND: Alternative pretreatment strategies of dentin and adhesionare constantly being developed and studied with the goal of improving the adhesion of resin restorative materials with this tissue. The objectives of the present study were to evaluate the ability of airborne-particle abrasion (APA) with aluminum oxide on dentin to remove the smear layer and the effects produced on the dentin microstructure. MATERIALS AND METHODS: The phosphoric acid (PA) was used for a comparison. For that, 20 human third molars were randomly allocated into two experimental groups, according to the dentin pretreatment method used: G1 (N = 10) - PA, G2 (N = 10) -APA. For dentin surface analyses, an environmental scanning electron microscope (ESEM) was employed to observe dentin surfaces before and after the procedures. Before pretreatment, the specimens of both groups were smear covered. RESULTS: After pretreatment, the G1 images revealed dentin tubule orifices opened, enlarged and some erosive effects. (G2) exposed tubule orifices without enlargement, but crack-like alterations were observed on the surfaces. In this way, APA with aluminum oxide was able to remove the smear layer. CONCLUSION: The influences of the dentin roughness on adhesion and the consequences on dentin integrity and hardness need further investigations. CLINICAL SIGNIFICANCE: A good conditioning of the dentin before cementation is necessary in order to obtain a satisfactory rehabilitation in adhesive dentistry. So, it is necessary to know all methods to do it.

Mapping large extensions of flat dentin through digital microscopy: introduction to the method and possible applications.

PURPOSE: To introduce a mapping method to characterize large dentin surfaces using digital microscopy and to discuss the advantages and possible applications of the method. MATERIALS AND METHODS: Twenty unerupted third molars were sectioned transversally exposing coronal dentin surfaces. The microscopic mosaic method was used to generate a large field image with the resolution necessary to measure characteristics of dentin tubules. The AxioVision 4.7 software was used to control a motorized optical microscope and the process of acquiring approximately 400 small images to generate each dentin mosaic. An image analysis routine measured the number of tubules (NT) and the ratio between the total area of tubules and the area of the mosaic - the area fraction (AF) - of each mosaic. An automatic procedure transformed the mosaic image into a color map, providing a direct visual representation of tubule density through colors. The dentin maps were used for a comparative qualitative analysis of tubule density distribution of each sample. RESULTS: The results for NT (92450 to 196029 tubules/sample) and AF (4.12% to 11.10%) demonstrated a wide variation among dentin samples. The maps confirmed the microstructure variety, also revealing strong local variations in tubule density within each sample. CONCLUSION: The mapping method was able to perform dentin morphology characterization and is a valuable tool for producing a baseline for dentin adhesion studies. The method could be also useful in determining the real contribution of dentin structures to the final adhesion quality.

Patient safety in dental care: an integrative review. / Segurança do paciente no cuidado odontológico: revisão integrativa.

Adverse events pose a serious problem for quality of healthcare. Dental practice is eminently invasive and involves close and routine contact with secretions; as such, it is potentially prone to the occurrence of adverse events. Various patient safety studies have been developed in the last two decades, but mostly in the hospital setting due to the organizational complexity, severity of the cases, and diversity and specificity of the procedures. The objective was to identify and explore studies on patient safety in Dentistry. An integrative literature review was performed in MEDLINE via PubMed, Scopus via Portal Capes, and the Regional Portal of the Virtual Health Library, using the terms patient safety and dentistry in English, Spanish, and Portuguese, starting in 2000. The research cycle in patient safety was used, as proposed by the World Health Organization to classify studies. We analyzed 91 articles. The most common adverse events were allergies, infections, diagnostic delay or failure, and technical error. Measures to mitigate the problem highlight the need to improve communications, encourage reporting, and search for tools to assist the management of care. The authors found a lack of studies on implementation and assessment of the impact of proposals for improvement. Dentistry has made progress in patient safety but still needs to transpose the results into practice, where efforts are crucial to prevent adverse events.

Eventos adversos constituem grave problema relacionado à qualidade do cuidado de saúde. A prática odontológica, por ser eminentemente invasiva e implicar contato íntimo e rotineiro com secreções, é potencialmente propícia à ocorrência desses eventos. Diversos estudos em segurança do paciente foram desenvolvidos nas duas últimas décadas, entretanto, em maior número no ambiente hospitalar, em função de sua complexidade organizacional, gravidade de casos, diversidade e especificidade de procedimentos. O objetivo foi identificar e explorar os estudos voltados à segurança do paciente odontológico. Foi realizada revisão integrativa da literatura com consulta ao MEDLINE via PubMed, Scopus via Portal Capes e ao Portal Regional da Biblioteca Virtual de Saúde, utilizando-se os termos segurança do paciente e odontologia nos idiomas inglês, espanhol e português a partir de 2000. Utilizou-se o ciclo de pesquisa em segurança do paciente, proposto pela Organização Mundial da Saúde para classificar os estudos incluídos. Foram analisados 91 artigos. Os eventos adversos mais comuns foram relacionados às alergias, às infecções, ao atraso ou falha de diagnóstico e ao erro da técnica. Medidas para mitigar o problema apontaram para a necessidade de melhoria da comunicação, incentivo à notificação e procura por instrumentos para auxiliar a gestão do cuidado. Constatou-se carência de estudos de implementação e avaliação de impacto das propostas de melhoria. A Odontologia evoluiu no campo da segurança do paciente, mas ainda está aquém de transpor resultados para a prática, sendo importante envidar esforços para prevenir os eventos adversos nesta área.

Los eventos adversos constituyen un grave problema relacionado con la calidad del cuidado en la salud. La práctica odontológica, por ser eminentemente invasiva e implicar contacto íntimo y rutinario con secreciones, es potencialmente propicia para la ocurrencia de esos eventos. Diversos estudios en seguridad del paciente se desarrollaron en las dos últimas décadas, sin embargo, en mayor número en el ambiente hospitalario, en función de su complejidad organizativa, gravedad de casos, diversidad y especificidad de procedimientos. El objetivo fue identificar e investigar los estudios dirigidos a la seguridad del paciente odontológico. Se realizó una revisión integradora de la literatura con consulta al MEDLINE vía PubMed, Scopus vía Portal Capes y al Portal Regional de la Biblioteca Virtual de Salud, utilizándose los términos seguridad del paciente y odontología en los idiomas inglés, español y portugués a partir de 2000. Se utilizó el ciclo de investigación en seguridad del paciente, propuesto por la Organización Mundial de la Salud para clasificar los estudios incluidos. Se analizaron 91 artículos. Los eventos adversos más comunes estuvieron relacionados con las alergias, infecciones, retraso o fallo de diagnóstico y con el error de la técnica. Las medidas para mitigar el problema apuntaron la necesidad de una mejora de la comunicación, incentivos a la notificación y búsqueda de instrumentos para apoyar la gestión del cuidado. Se constató la carencia de estudios de implementación y evaluación de impacto de las propuestas de mejora. La Odontología evolucionó en el campo de la seguridad del paciente, pero todavía está lejos de trasladar resultados a la práctica, siendo importante aunar esfuerzos para prevenir eventos adversos en esta área.

Projeto de monitoria em Endodontia e a importância do suporte institucional: um relato de experiência / Proyecto de tutoría de Endodoncia y la importancia del apoyo institucional: un relato de experiencia / Monitoring project in Endodontics and the importance of institutional support: an experience report

A monitoria é uma atividade complementar que oferece apoio pedagógico e exerce papel importante na formação dos alunos de graduação e do próprio monitor, bem como em sua iniciação à docência. O presente relato tem como objetivoapresentar as experiências do desenvolvimento de um programa de monitoria, com suporte institucional, em uma disciplina de Endodontia de uma instituição de ensino superior federal. A equipe docente elaborou um plano de trabalho contemplando diferentes atividades pedagógicas, técnicas e científicas a serem desenvolvidas pelos monitores. Os seguintes resultados foram alcançados após quatro semestres: a) influência positiva no desempenho de 109 alunos com apenas três médias finais inferiores a sete; b) aprimoramento técnico-científico dos monitores com participação em workshopde instrumentação mecanizada em Endodontia; c) desenvolvimento científico dos monitores com a produção de materiais didáticos, projetos científicos, participação e apresentação de seis trabalhos em eventos científicos com três premiações, publicações de resumos em anais e produção de dois trabalhos de conclusão de curso; d) participação em ação institucional para reduzir aevasão no curso; e) elaboração de projeto de pesquisa para avaliação do desempenho de monitores estruturada por meio de questionário. Pode-se concluir que o desenvolvimento de um projeto de monitoria inserido no contexto de um programa de apoio acadêmico, com oferta de bolsas, pode gerar grande interesse de participação pelos discentes e que uma variedade de atividades propostas no plano de trabalho contribuiu de forma relevante para o processo ensino-aprendizado dos monitores e para a disciplina (AU).

La tutoria es una actividad complementaria que ofrece apoyo pedagógico y juega un papel importante en la formación de los estudiantes de pregrado y del propio tutor, así como en su iniciación a la docencia. Este informe tiene como objetivo presentar las experiencias de desarrollo de un programa de tutoría, con apoyo institucional, en una disciplina de Endodoncia en una institución de educación superior federal. El equipo docente elaboró un plan de trabajo que abarcaba diferentes actividades pedagógicas, técnicas y científicas a desarrollar por los monitores. Después de cuatro semestres se lograron los siguientes resultados: a) influencia positiva en el desempeño de 109 estudiantes con sólo tres promedios finales inferiores a siete; b) perfeccionamiento técnico-científico de tutores con participación en un taller de instrumentación mecanizada en Endodoncia; c) desarrollo científico de los tutores con la producción de materiales didácticos, proyectos científicos, participación y presentación de seis trabajos en eventos científicos con tres premios, publicación de resúmenes en anales y producción de dos trabajos de conclusión de curso; d) participación en acciones institucionales para reducir el abandono de cursos; e) elaboración de un proyecto de investigación para evaluar el desempeño de los tutores estructurado a través de un cuestionario. Se puede concluir que el desarrollo de un proyecto de tutoría en el contexto de un programa de apoyo académico, con la oferta de becas, puede generar gran interés de participación por parte de los estudiantes y que una variedad de actividades propuestas en el plan de trabajo contribuyeron significativamente para el proceso de enseñanza y aprendizaje de los monitores y de la disciplina. Projeto de monitoria em Endodontia e a importância do suporte institucional: um relato de experiência (AU).

Monitoring is a complementary activity that offers pedagogical support and plays an essential role in training undergraduate students and the monitor himself and their initiation to teaching. The report aimsto present the experiences of developing a monitoring program, with institutional support, in an endodontics discipline at a federal higher education institution. The teaching team prepared a work plan that contemplated different pedagogical, technical, and scientific activities to be developed by the monitors. The following results were achieved after four semesters: a) positive influence on the performance of 109 students with only three final averages lower than seven; b) technical and scientific improvement of the monitors with participation in a workshopon mechanized instrumentation in Endodontics; c) scientific development of the monitors with the production of didactic materials, scientific projects, participation and presentation of six papers in scientific events with three awards, publication of abstracts in annals and production of two-course completion papers; d) participation in institutional action to reduce dropout in the course; e) elaboration of a research project to evaluate the performance of monitors, structured through a questionnaire. It can be concluded that the development of a monitoring project inserted in the context of an academic support program, with the offer of scholarships, can generate significant interest in participation by students and that a variety of activities proposed in the work plan contributed in a relevant way to the teaching-learning process of the monitors and to the discipline (AU).

Longitudinal co-site optical microscopy study on the chelating ability of etidronate and EDTA using a comparative single-tooth model.

In the present study the smear layer dissolution kinetics of 18% etidronate (HEBP), 9% HEBP, and 17% ethylenediaminetetraacetic acid (EDTA) on human dentin were quantitatively and longitudinally analyzed by using a single-tooth comparative model. Coronal dentin disks were prepared from 3 maxillary human molars. A standardized smear layer was produced on the pulpal side of each disk. The smear layer-covered surface was divided into 3 similar areas. Each of these was then exposed to 1 of the 3 irrigants under investigation, whereas the others were covered with adhesive tape. Co-site image sequences of the areas under investigation were obtained after several cumulative demineralization times. Sixteen images were obtained from each dentin area of each tooth for each experimental time at 1000x magnification. An image processing and analysis sequence measured sets of images, providing data of area fraction for thousands of tubules over time and allowing us to quantitatively follow the effect of the chelating substances. The Kruskal-Wallis H test and Dunn multiple comparison test were used to analyze the data. Overall, it can be concluded that the demineralization kinetics promoted by both 9% HEBP and 18% HEBP were significantly slower than those of 17% EDTA (P < .05). In addition, the single-tooth model is advantageous over the first co-site optical microscopy dentin assessments when different chelator solutions are compared.

Strong effect on dentin after the use of high concentrations of citric acid: an assessment with co-site optical microscopy and ESEM.

OBJECTIVES: To perform a longitudinal analysis of the effect of four substances (citric acid at 1%, 5% and 10% concentrations and 17% EDTA) on dentin. METHODS: Sixteen human molars had their crowns removed exposing cervical root dentin. A grinding procedure was used to produce a standardized smear layer and to create a smooth surface for analysis. Environmental scanning electron microscopy (ESEM) was used for qualitative observations while co-site optical microscopy (CSOM) and image analysis (IA) provided a quantitative comparison of the effect of the substances for several experimental times from 15 to 300s. The methods allowed the observation of the same areas after each experimental time. The open tubule area fraction was measured for several CSOM image fields, at each experimental time, for the four substances. Thus, it was possible to follow the phenomenon and quantitatively analyze the effect of the substances. Kolmogorov-Smirnov, Kruskal-Wallis H and Wilcoxon signed-ranks (with Bonferroni correction) tests were used to analyze the data. The level of significance was set at p<0.05. RESULTS: The CA solutions showed the greatest chelating effect, which was proportional to concentration (EDTA: 9.4-32.8% (15-300s); 1% CA: 21.1-32.2% (15-300s); 5% CA: 32.4-43.1% (15-300s); 10% CA: 35.1-39.5% (15-30s). Erosive effects were observed on inter and peritubular dentin for 5% CA and 10% CA after 60s. SIGNIFICANCE: ESEM allowed a detailed qualitative comparison of the effect of the four substances. CSOM and IA provided a quantitative comparison method with good statistical significance. Future studies should focus on the consequences of dentin erosion caused by citric acid.

Mucoadhesive assessment of different antifungal nanoformulations.

Oral candidiasis is an important opportunistic fungal infection and polyenes and azoles are still the most used antifungal agents. However, the oral absorption resulting from most available treatments is generally poor and, consequently, a very high frequency of administrations of antifungal agents is strongly required. Therefore, the major challenge is to improve the retention of the antifungal agents in buccal mucosa, and the encapsulation into mucoadhesive systems may be considered as a possible strategy to achieve this objective. Three types of mucoadhesive polymeric nanoparticles (polylactic acid (PLA), polylactic-co-glycolic acid (PLGA) and alginate) were prepared using nystatin as model drug. The drug-loaded nanoparticles were then included in toothpaste, oral gel and oral films, respectively. The results demonstrated that the loaded nanoparticles were successfully produced, presenting a mean size between 300-900 nm and with a negative surface charge. Also, the determination of the encapsulation efficiency of all nanoparticles showed values above 70%. In terms of the in vitro mucoadhesion, the best formulation was the oral film loaded with the PLGA nanoparticles followed by the oral gel with PLA nanoparticles and thirdly the toothpaste with alginate nanoparticles. This was confirmed in an in vitro rinsing model with mucus producing HT29-MTX cells, where the percentage of nystatin retained to the cells after 40 min of simulated saliva flow was between 10-27% when formulations were used and only 4% for free nystatin. Further studies will include in vivo testing using animal models.

Dentin demineralization when subjected to BioPure MTAD: a longitudinal and quantitative assessment.

In the present study, the demineralizing ability of BioPure MTAD (Dentsply/Tulsa, Tulsa, OK), 17% EDTA, and 5% citric acid on radicular dentin was quantitatively and longitudinally analyzed. 3 mm thick disks were obtained at the root cervical third from 9 maxillary human molars, and a standardized smear layer was produced. Cosite images of the dentin surface were obtained after several cumulative demineralization times. Sixteen images were obtained in each dentin sample for each experimental time, at 1000x magnification. An image processing and analysis sequence measured sets of images, providing data of area fraction for thousands of tubules over time. Thus, it was possible to follow the demineralization phenomenon and quantitatively analyze the effect of the various substances. The nonparametric Kruskal-Wallis H-test was used to analyze the data. Based on the present results, it can be concluded that the demineralization kinetics promoted by both 5% CA and BioPure MTAD was significantly faster than by 17% EDTA.

The ability of Portland cement, MTA, and MTA Bio to prevent through-and-through fluid movement in repaired furcal perforations.

This study assessed the ability of Portland cement, white Angelus-mineral trioxide aggregate (MTA), and MTA Bio to seal furcal perforations in extracted human molar teeth. Fifty-five human mandibular molar teeth were accessed, and the canal orifices were located. The roots were horizontally sectioned in the middle third. Resin composite was used to fill the root canal orifices and the apical end of the root. Perforations were created in the center of the pulp chamber floor by using a size 3 round bur. The teeth were divided into 3 groups (n = 15), and an additional 10 teeth served as controls. In G1, the perforation defects were repaired with MTA, whereas in G2 and G3, MTA Bio and Portland cement were used, respectively. Each tooth was assembled in a hermetic cell to allow the evaluation of fluid filtration. Leakage was measured by the movement of an air bubble traveling within a pipette connected to the teeth. Measurements of the air bubble movement were made after 10 minutes at a constant pressure of 20 cm H(2)O. Kruskal-Wallis H test was applied to the fluid flow data to detect differences between the experimental groups (P < .05). Leakage existed in every sample and was very variable in all the experimental groups, ranging from 0.098-0.51 microL/min. Kruskal-Wallis H-test results showed that there was no significant difference in mean fluid flow between the experimental groups (P = .874). The sealing ability promoted by the 3 cements was similar; no cement was able to produce a fluid-tight seal.

Past, Recent Progresses and Future Perspectives of Nanotechnology Applied to Antifungal Agents.

Candida species remain a significant cause of nosocomial bloodstream infections, associated with prolonged hospital stay in the ICU and high healthcare cost. The incidence of Candida is very high in certain risk groups of patients (AIDS, diabetes, cancer, etc.). Recent developments of nanotechnology have strongly contributed to the design of new multifunctional drug carriers that improve drug bioavailability through a controlled and prolonged release profile or even through a more specific targeted delivery of the antifungal agent. Those types of systems have strongly increased with a progressive generation of new structures, permitting the conjunction of new materials, biomolecules, physical and chemical techniques, for better outcomes. Nanotechnology shows expanded possibilities within the medical field and in the case of the yeast infections it may overcome several issues related with the fungal proliferation or higher inhibition of the pathogen causing the infection. This review covers a period of the most representative research of Candidiasis since 1993 to the present.

Epoxy Resin-Based Root Canal Sealer Penetration into Dentin Tubules Does not Improve Root Filling Dislodgement Resistance.

OBJECTIVE: This study sought to evaluate the effect of the penetration of an epoxy resin-based root canal sealer into dentin tubules on the force required to dislodge the root canal filling. METHODS: Sixty extracted human central incisors with single canals were decoronated, instrumented, and filled with gutta-percha and AH Plus sealer labeled with 0.1% rhodamine B dye. The roots were further sectioned horizontally at 3, 6, and 8 mm from the apex. The coronal surfaces of the resulting 180 slices were evaluated using confocal laser scanning microscopy to measure the amount of sealer that penetrated into the dentin tubules. To quantify the force required to dislocate the root filling material, the root fillings of the slices were subjected to a dislodgement resistance test (push-out). Spearman's rho correlation test was further used to test the correlation between the push-out bond strength and sealer penetration into the dentin tubules (P<0.05). RESULTS: No significant correlation was observed between sealer penetration into the dentin tubules and the force required to dislodge the root canal filling (P=0.626). CONCLUSION: Following the results of this study, the penetrating ability of the AH Plus sealer into dentin tubules has no correlation with the force required to dislodge the root canal filling.

Polymicrobial leakage of four root canal sealers at two different thicknesses.

The present study investigated the sealing ability of four root canal sealers at two different thicknesses. There were 82 maxillary incisors roots prepared with Gates Glidden drills up to size 6 and divided into four groups: Pulp Canal Sealer, EndoREZ, Sealapex, and AH Plus. Each group was divided in two subgroups and gutta-percha cylinders 1.5 or 1 mm wide were used, respectively. The roots were mounted in a bacterial leakage model and the system was checked daily during the following 12 wk. Data were analyzed by Log-Rank test and Student t-test. In the thin layer samples, the sealers demonstrated similar results while, in the thick layer samples, AH Plus revealed the best performance. Generally, greater sealer thickness influenced negatively the sealing ability of the root canal filling, except in AH Plus samples.

Segurança do paciente no cuidado odontológico: revisão integrativa / Seguridad del paciente en el cuidado odontológico: revisión integradora / Patient safety in dental care: an integrative review

Resumo: Eventos adversos constituem grave problema relacionado à qualidade do cuidado de saúde. A prática odontológica, por ser eminentemente invasiva e implicar contato íntimo e rotineiro com secreções, é potencialmente propícia à ocorrência desses eventos. Diversos estudos em segurança do paciente foram desenvolvidos nas duas últimas décadas, entretanto, em maior número no ambiente hospitalar, em função de sua complexidade organizacional, gravidade de casos, diversidade e especificidade de procedimentos. O objetivo foi identificar e explorar os estudos voltados à segurança do paciente odontológico. Foi realizada revisão integrativa da literatura com consulta ao MEDLINE via PubMed, Scopus via Portal Capes e ao Portal Regional da Biblioteca Virtual de Saúde, utilizando-se os termos segurança do paciente e odontologia nos idiomas inglês, espanhol e português a partir de 2000. Utilizou-se o ciclo de pesquisa em segurança do paciente, proposto pela Organização Mundial da Saúde para classificar os estudos incluídos. Foram analisados 91 artigos. Os eventos adversos mais comuns foram relacionados às alergias, às infecções, ao atraso ou falha de diagnóstico e ao erro da técnica. Medidas para mitigar o problema apontaram para a necessidade de melhoria da comunicação, incentivo à notificação e procura por instrumentos para auxiliar a gestão do cuidado. Constatou-se carência de estudos de implementação e avaliação de impacto das propostas de melhoria. A Odontologia evoluiu no campo da segurança do paciente, mas ainda está aquém de transpor resultados para a prática, sendo importante envidar esforços para prevenir os eventos adversos nesta área.

Resumen: Los eventos adversos constituyen un grave problema relacionado con la calidad del cuidado en la salud. La práctica odontológica, por ser eminentemente invasiva e implicar contacto íntimo y rutinario con secreciones, es potencialmente propicia para la ocurrencia de esos eventos. Diversos estudios en seguridad del paciente se desarrollaron en las dos últimas décadas, sin embargo, en mayor número en el ambiente hospitalario, en función de su complejidad organizativa, gravedad de casos, diversidad y especificidad de procedimientos. El objetivo fue identificar e investigar los estudios dirigidos a la seguridad del paciente odontológico. Se realizó una revisión integradora de la literatura con consulta al MEDLINE vía PubMed, Scopus vía Portal Capes y al Portal Regional de la Biblioteca Virtual de Salud, utilizándose los términos seguridad del paciente y odontología en los idiomas inglés, español y portugués a partir de 2000. Se utilizó el ciclo de investigación en seguridad del paciente, propuesto por la Organización Mundial de la Salud para clasificar los estudios incluidos. Se analizaron 91 artículos. Los eventos adversos más comunes estuvieron relacionados con las alergias, infecciones, retraso o fallo de diagnóstico y con el error de la técnica. Las medidas para mitigar el problema apuntaron la necesidad de una mejora de la comunicación, incentivos a la notificación y búsqueda de instrumentos para apoyar la gestión del cuidado. Se constató la carencia de estudios de implementación y evaluación de impacto de las propuestas de mejora. La Odontología evolucionó en el campo de la seguridad del paciente, pero todavía está lejos de trasladar resultados a la práctica, siendo importante aunar esfuerzos para prevenir eventos adversos en esta área.

Abstract: Adverse events pose a serious problem for quality of healthcare. Dental practice is eminently invasive and involves close and routine contact with secretions; as such, it is potentially prone to the occurrence of adverse events. Various patient safety studies have been developed in the last two decades, but mostly in the hospital setting due to the organizational complexity, severity of the cases, and diversity and specificity of the procedures. The objective was to identify and explore studies on patient safety in Dentistry. An integrative literature review was performed in MEDLINE via PubMed, Scopus via Portal Capes, and the Regional Portal of the Virtual Health Library, using the terms patient safety and dentistry in English, Spanish, and Portuguese, starting in 2000. The research cycle in patient safety was used, as proposed by the World Health Organization to classify studies. We analyzed 91 articles. The most common adverse events were allergies, infections, diagnostic delay or failure, and technical error. Measures to mitigate the problem highlight the need to improve communications, encourage reporting, and search for tools to assist the management of care. The authors found a lack of studies on implementation and assessment of the impact of proposals for improvement. Dentistry has made progress in patient safety but still needs to transpose the results into practice, where efforts are crucial to prevent adverse events.

Accumulated hard tissue debris produced during reciprocating and rotary nickel-titanium canal preparation.

INTRODUCTION: This study compared the amount of hard tissue debris produced after different apical enlargement with single-file reciprocating systems (WaveOne [Dentsply Maillefer, Baillaigues, Switzerland] and Reciproc [VDW, Munich, Germany]) and a conventional multifile rotary system (BioRaCe [FKG Dentaire, La-Chaux-de-Fonds, Switzerland]) using micro-computed tomographic imaging. METHODS: Thirty moderately curved mesial roots of mandibular molars presenting 2 independent root canals were selected and scanned at an isotropic resolution of 14.16 µm. The sample was assigned to 3 groups (n = 10) with respect to the root length and degree of curvature of the mesial root according to the system used for the root canal preparation: Reciproc, WaveOne, and BioRaCe. Second and third scans were taken after the root canals were prepared up to ISO sizes 25 and 40, respectively. The matched images of the mesial canals, before and after preparation, were examined from the furcation level to the apex to evaluate the amount of hard tissue debris (%). Data were statistically compared using a general linear model for repeated-measures with a significance level set at 5%. RESULTS: Instrumentation systems per se did not influence the amount of hard tissue accumulation (P > .05), whereas a significant reduction in the percentage of hard tissue debris was observed after sequential enlargement in all groups (P < .05). CONCLUSIONS: None of the systems yielded root canals completely free from packed hard tissue debris. The increased final apical size resulted in significantly less debris accumulation for both reciprocating and rotary systems.

Oculo-auriculo-vertebral spectrum: clinical and molecular analysis of 51 patients.

INTRODUCTION: Oculo-auriculo-vertebral spectrum (OAVS OMIM 164210) is a craniofacial developmental disorder affecting the development of the structures derived from the 1st and the 2nd branchial arches during embryogenesis, with consequential maxillary, mandibular, and ear abnormalities. The phenotype in OAVS is variable and associated clinical features can involve the cardiac, renal, skeletal, and central nervous systems. Its aetiology is still poorly understood. METHODS: We have evaluated the clinical phenotypes of 51 previously unpublished patients with OAVS and their parents, and performed comparative genomic hybridization microarray studies to identify potential causative loci. RESULTS: Of all 51 patients, 16 (31%) had a family history of OAVS. Most had no relevant pre-natal history and only 5 (10%) cases had a history of environmental exposures that have previously been described as risk factors for OAVS. In 28 (55%) cases, the malformations were unilateral. When the involvement was bilateral, it was asymmetric. Ear abnormalities were present in 47 (92%) patients (unilateral in 24; and bilateral in 23). Hearing loss was common (85%), mostly conductive, but also sensorineural, or a combination of both. Hemifacial microsomia was present in 46 (90%) patients (17 also presented facial nerve palsy). Ocular anomalies were present in 15 (29%) patients. Vertebral anomalies were confirmed in 10 (20%) cases; 50% of those had additional heart, brain and/or other organ abnormalities. Brain abnormalities were present in 5 (10%) patients; developmental delay was more common among these patients. Limb abnormalities were found in 6 (12%) patients, and urogenital anomalies in 5 (10%). Array-CGH analysis identified 22q11 dosage anomalies in 10 out of 22 index cases screened. DISCUSSION: In this study we carried out in-depth phenotyping of OAVS in a large, multicentre cohort. Clinical characteristics are in line with those reported previously, however, we observed a higher incidence of hemifacial microsomia and lower incidence of ocular anomalies. Furthermore our data suggests that OAVS patients with vertebral anomalies or congenital heart defects have a higher frequency of additional brain, limb or other malformations. We had a higher rate of familial cases in our cohort in comparison with previous reports, possibly because these cases were referred preferentially to our genetic clinic where family members underwent examination. We propose that familial OAVS cases show phenotypic variability, hence, affected relatives might have been misclassified in previous reports. Moreover, in view of its phenotypic variability, OAVS is potentially a spectrum of conditions, which overlap with other conditions, such as mandibulofacial dysostosis. Array CGH in our cohort identified recurrent dosage anomalies on 22q11, which may contribute to, or increase the risk of OAVS. We hypothesize that although the 22q11 locus may harbour gene(s) or regulatory elements that play a role in the regulation of craniofacial symmetry and 1st and 2nd branchial arch development, OAVS is a heterogeneous condition and many cases have a multifactorial aetiology or are caused by mutations in as yet unidentified gene(s).

Assessing accumulated hard-tissue debris using micro-computed tomography and free software for image processing and analysis.

INTRODUCTION: The accumulation of debris occurs after root canal preparation procedures specifically in fins, isthmus, irregularities, and ramifications. The aim of this study was to present a step-by-step description of a new method used to longitudinally identify, measure, and 3-dimensionally map the accumulation of hard-tissue debris inside the root canal after biomechanical preparation using free software for image processing and analysis. METHODS: Three mandibular molars presenting the mesial root with a large isthmus width and a type II Vertucci's canal configuration were selected and scanned. The specimens were assigned to 1 of 3 experimental approaches: (1) 5.25% sodium hypochlorite + 17% EDTA, (2) bidistilled water, and (3) no irrigation. After root canal preparation, high-resolution scans of the teeth were accomplished, and free software packages were used to register and quantify the amount of accumulated hard-tissue debris in either canal space or isthmus areas. RESULTS: Canal preparation without irrigation resulted in 34.6% of its volume filled with hard-tissue debris, whereas the use of bidistilled water or NaOCl followed by EDTA showed a reduction in the percentage volume of debris to 16% and 11.3%, respectively. The closer the distance to the isthmus area was the larger the amount of accumulated debris regardless of the irrigating protocol used. CONCLUSIONS: Through the present method, it was possible to calculate the volume of hard-tissue debris in the isthmuses and in the root canal space. Free-software packages used for image reconstruction, registering, and analysis have shown to be promising for end-user application.

Sodium hypochlorite with reduced surface tension does not improve in situ pulp tissue dissolution.

INTRODUCTION: Sodium hypochlorite (NaOCl) solutions with added wetting agents are advertised to dissolve necrotic tissue in root canals faster than their counterparts without a lowered surface tension. This was tested in the current study, and the null hypothesis formulated was that there was no difference between a commercially available NaOCl solution with a lowered surface tension (Chlor-XTRA; Vista Dental Products, Racine, WI) and a counterpart containing the same amount of available chlorine without added wetting agents regarding the soft tissue that remains in oval-shaped canals after mechanical preparation and irrigation. METHODS: Formerly vital extracted teeth (N = 44, 22 pairs) with similar anatomy were radiographically paired and chemomechanically prepared. In 1 tooth from each pair, a 5.25% NaOCl solution with reduced surface tension was used; in the other, a pure, technical-grade NaOCl solution of 5.25% was used. The percentage of remaining pulp tissue (PRPT) was histologically assessed in root cross-sections. The non-Gaussian raw data were subjected to Kruskal-Wallis and Mann-Whitney U tests to verify the respective effect of the cross-section level and solution on the PRPT. The relationship between the cross-section level and the PRPT was estimated by the Spearman correlation test. The alpha-type error was set at 5%. RESULTS: The cross-section level significantly influenced the PRPT (P < .05), whereas the PRPT was not influenced by the solution used (P > .05). A significant inverse correlation was found between the cross-section level and the PRPT (P < .05, r = -0.330). The lower the distance to the apex, the higher the PRPT regardless of the solution used. CONCLUSIONS: Contrary to the advertised statement, the dental solution with a reduced surface tension did not dissolve vital pulp tissue in oval root canals any better than a conventional NaOCl solution of similar strength. Closer to the apex, pulp tissue dissolution is less efficient irrespective of the solution.

Critical appraisal of published smear layer-removal studies: methodological issues.

The smear layer phenomenon has been extensively addressed over the past 3 decades. However, there still are unanswered questions on this issue and the main responsible factor is the qualitative and nonreproducible character of most in vitro smear layer removal studies. The methodological reasons that led to the current lack of reliable conclusions on procedures aiming to remove the smear layer are comprehensively addressed. The limitations and outcomes related to different assessment methods are discussed as well. General speaking, the results by score-based conventional SEM studies are not trustworthy and reproducible. Computational routines able to automatically extract quantitative data of dentin morphology are necessary to minimize the human bias. An ideal experimental model should have a longitudinal observational character, in which a given dentin area can be observed at different times. The use of flat dentin samples should be avoided because of the influence of gravity as well as root canal anatomy on the final result of the chelating process. The experimental model also needs to take into consideration the amount and distribution of sclerotic dentin and irregular secondary dentin, otherwise the final results can be compromised. Inasmuch as there is a clear lack of scientific standard, simple comparative SEM evaluations are pointless at the present moment. The ideal experimental model to assess smear layer removal is not currently available. Therefore, further research efforts should be directed to the development of and testing of new methodological approaches to be used in the smear layer removal studies. The improvement of the experimental models is a requirement to draw up optimized clinical guidelines for the chemical treatment of the root dentin.

The self-adjusting file optimizes debridement quality in oval-shaped root canals.

INTRODUCTION: Oval-shaped canals represent a challenge for rotary nickel-titanium (NiTi) files because buccal and/or lingual recesses are commonly left uninstrumented. The aim of the present study was to evaluate the debridement quality of the Self-Adjusting File (SAF) system in oval canals and compare it with the debridement achieved by a commonly used NiTi rotary system. METHODS: A careful specimen selection resulted in two equal groups each consisting of 12 extracted mandibular canines with oval canals that had vital pulps before extraction. All canals had a buccolingual diameter that was at least 2.5 times larger than that of the mesiodistal one as defined from radiographs. One group was subjected to the SAF protocol, whereas the other group underwent conventional protocol; the ProTaper system up to the F2 instrument was used with syringe and open end needle irrigation. Sodium hypochlorite (5.25%) was used as an irrigant for both groups. The roots were then histologically processed and 0.6-µm-thick cross-sections were obtained every 0.5 mm from the 1- to 5-mm apical levels. Morphometric evaluation was performed on cross-sections to determine the amount of remaining pulp tissue as a percent of the root canal area. RESULTS: The group-by-location interaction was not significant (P > .05), which means that the group comparisons were not dependent on the cross-sectional level. There was significantly greater residual pulp tissue left after ProTaper system instrumentation versus SAF instrumentation (21.4% vs 9.3%, P < .05). CONCLUSIONS: The SAF protocol was significantly more efficient for debridement of oval root canals than the rotary ProTaper protocol.