Perfil sociodemográfico e condição bucal de usuários de drogas em dois municípios do Estado do Paraná, Brasil / Sociodemographic profile and oral condition of drug users in two municipalities of the State of Paraná, Brazil

Introdução: A pesquisa das condições bucais de usuários de drogas é importante para ser conhecida esta população, cujo crescimento é ascendente no Brasil, a fim de que metas preventivas e atendimento adequado sejam traçados. Objetivo: Identificar o perfil sociodemográfico e a condição bucal desta população, em dois municípios paranaenses. Material e método: Foram coletados, por meio de questionário e de exame físico, dados de 100 indivíduos. Foram obtidos os seguintes valores: índice CPOD, profundidade de sondagem (PS), nível de inserção clínica (NIC), índice gengival (IG), índice de placa (IP) e sangramento à sondagem (SS). Após análise descritiva inicial, empregaram-se os testes t de Student e ANOVA one way. Resultado: A média da idade foi 29,12 anos. As maiores frequências foram: gênero masculino (95,5%), solteiros (69,0%), baixa escolaridade (41%) e maior consumo de drogas lícitas - tabaco (90,9%) e álcool (84,5%) - seguidas de crack (80,9%) e maconha (77,3%). A média do CPOD foi 15,21 (DP=5,84) e quanto maior o tempo de dependência, maior este índice (p<0,05). A média da PS foi 3,55 e do NIC, 3,59. O SS ocorreu em 82,7% dos casos e a inflamação moderada, em 79,5%. Placa detectável e moderado acúmulo de placa foram identificados em 39,5% e 35,3%, respectivamente. Conclusão: Predominaram indivíduos do gênero masculino, jovens, solteiros, com baixa escolaridade e consumidores de drogas lícitas e ilícitas, com condição bucal ruim. Sugere-se mais atenção dos profissionais da área odontológica e dos elaboradores de políticas públicas, com vistas a esta população.

Introduction: Epidemiological survey of the oral conditions of drug users is an important strategy to know this population, whose growth is increasing in Brazil, so that preventive goals and adequate treatment can be proposed. Aim: The aim of this study was to identify the sociodemographic profile and oral health condition of drug users in rehab of two municipalities of the State of Paraná. Material and method: One hundred individuals participated in the study, which data were collected by questionnaire and physical exam. The following values were obtained: DMFT index (decay-missing-filled index), probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), and bleeding on probing (BOP). Data analyses were performed by Student t test and one-way ANOVA. Result: The mean age of participants was 29.12 years. The major frequencies were: male (95.5%), single (69.0%), lower schooling (41%) and higher consumption of licit drugs tobacco (90.9%) and alcohol (84.5%), followed by crack (80.9%), and marijuana (77.3%). The mean DMFT index was 15.21 (SD=5.84), and the longer the dependence time, the greater this index (p<0.05). Mean PD was 3.55 and mean CAL was 3.59. BOP occurred in 82.7% and 79.5% showed moderate inflammation. Detectable plaque and moderate plaque accumulation were observed in 39.5% and 35.3%, respectively. Conclusion: Prevalence was observed in young and single males with low schooling, and with consumption of licit and illicit drugs. Poor oral health condition was identified, which deserves more attention from health professional and policymakers for this population.

Rânula em paciente com HIV: relato de caso / Ranula in HIV patient: a case report

Objetivo: Relatar um caso de tratamento de rânula em paciente portador do HIV/AIDS. Discussão: Paciente de 21 anos, sexo feminino, leucoderma, HIV positivo de transmissão vertical, sem hábitos deletérios, não fazia uso de drogas ilícitas, com lesão de rânula indolor, em tratamento há três meses com clindamicina, receitada pelos médicos. A paciente não está na faixa etária mais prevalente da doença, sua contagem de CD4 + estava normal e, pela possível dificuldade de cicatrização, optou-se pela micromarsupialização. Conclusão: Os cirurgiões-dentistas precisam encarar as rânulas e os mucoceles como entidades que podem surgir em pacientes infectados pelo HIV e que o tratamento deverá ser o mais conservador possível.

Objective: Report the treatment of a ranula in a patient with HIV infection. Discussion: A 21-year-old female, caucasian, with HIV infection of vertical transmission, without harmful habits and with no use of illicit drugs, presenting painless ranula lesion from three months ago being treated with clindamycin by doctors. The patient is not in the most prevalent age group, and its CD4+ counting was normal, and for the possible difficulty of healing, micro-marsupialization technique was chosen. Conclusion: Although there are few studies involving this matter, dentists must face ranulae and mucole as entities that can develop in HIV/AIDS infected patients, and treatment should be as conservative as possible.

Carga Imediata em Implantologia û Considerações gerais / Immediate loading in Implantology - General considerations

A reabilitação oral com implantes dentários tem apresentado elevados índices de sucesso, o que resultou na busca de novos protocolos cirúrgicos e protéticos a fim de reduzir o tempo de tratamento, desconforto e custo para o paciente. Dessa forma, o conceito da carga imediata, a princípio indicado como um procedimento alternativo, tem mostrado resultados previsíveis e bem-sucedidos sendo cada vez mais aplicado na Implantodontia. Apesar de consolidado pela fisiologia óssea que a bioestimulação mecânica pode levar a um estímulo do crescimento ósseo. É importante ressaltar que para o sucesso da aplicação de carga imediata é essencial atingir a estabilidade primária, já que a retenção mecânica precede os processos de formação óssea. O objetivo deste trabalho é apresentar uma revisão de literatura ilustrada por dois casos clínicos, demonstrando a importância da técnica cirúrgica para o sucesso dos implantes submetidos à carga imediata

Lethal photosensitization and guided bone regeneration in treatment of peri-implantitis: an experimental study in dogs.

The purpose of this study was to evaluate the effect of lethal photosensitization and guided bone regeneration (GBR) on the treatment of ligature-induced peri-implantitis in different implant surfaces. The treatment outcome was evaluated by clinical and histometric methods. A total of 40 dental implants with four different surface coatings (10 commercially pure titanium surface (cpTi); 10 titanium plasma-sprayed (TPS); 10 acid-etched surface; 10 surface-oxide sandblasted) were inserted into five mongrel dogs. After 3 months, the animals with ligature-induced peri-implantitis were subjected to surgical treatment using a split-mouth design. The controls were treated by debridment and GBR, while the test side received an additional therapy with photosensitization, using a GaAlAs diode laser, with a wavelength of 830 nm and a power output of 50 mW for 80 s (4 J/cm2), and sensitized toluidine blue O (100 microg/ml). The animals were sacrificed 5 months after therapy. The control sites presented an earlier exposition of the membranes on all coating surfaces, while the test group presented a higher bone height gain. Re-osseointegration ranged between 41.9% for the cpTi surface and 31.19% for the TPS surface in the test sites; however differences were not achieved between the surfaces. The lethal photosensitization associated with GBR allowed for better re-osseointegration at the area adjacent to the peri-implant defect regardless of the implant surface.

Progression of experimental chronic peri-implantitis in dogs: clinical and radiographic evaluation.

BACKGROUND: The aim of this study was to evaluate the progression of experimental peri-implantitis in dogs using implants with different surface coatings. METHODS: Thirty-six dental implants with four different surface coatings, commercially pure titanium (cpTi), titanium plasma sprayed (TPS), hydroxyapatite (HA), and acid-etched (AE), were placed in six mongrel dogs. Five months after implantation, peri-implantitis was induced by cotton ligatures to facilitate plaque accumulation for 60 days. After 60 days, the ligatures were removed and supragingival plaque control was initiated for 12 months. Probing depth (PD), clinical attachment level (CAL), vertical bone level (VBL), horizontal bone level (HBL), and mobility were obtained at baseline, and 20, 40, 60 (acute phase), and 425 days (chronic phase) after ligature removal. RESULTS: PD and CAL changed around all implant surfaces after ligature placement (P<0.0001). However, the means of PD and CAL were not statistically significant among the different surfaces (P>0.05). The range of CAL variation, calculated between baseline and 60 days (acute phase) and between 60 and 425 days (chronic phase), decreased (P<0.05). Bone loss increased during the entire experiment (P<0.0001). The HA surface showed the greatest bone loss measurement (5.06+/- 0.38 mm) and the TPS showed the smallest bone loss (4.27+/- 0.62 mm). However, statistical significance was not assessed for different coatings (P>0.05). CONCLUSIONS: The clinical data at the initial phase showed rapid and severe peri-implant tissue breakdown. However, removal of ligatures did not convert the acute destructive peri-implant phase to a non-aggressive lesion and the progression of peri-implantitis was observed at chronic phase. The experimental peri-implantitis in dogs may be a useful model to evaluate the progression of peri-implantitis.

Experimental peri-implant tissue breakdown around different dental implant surfaces: clinical and radiographic evaluation in dogs.

PURPOSE: Tissue reactions to 4 different implant surfaces were evaluated in regard to the development and progression of ligature-induced peri-implantitis. MATERIALS AND METHODS: In 6 male mongrel dogs, a total of 36 dental implants with different surfaces (9 titanium plasma-sprayed, 9 hydroxyapatite-coated, 9 acid-etched, and 9 commercially pure titanium) were placed 3 months after mandibular premolar extraction. After 3 months with optimal plaque control, abutment connection was performed. Forty-five days later, cotton ligatures were placed around the implants to induce peri-implantitis. At baseline and 20, 40, and 60 days after placement, the presence of plaque, peri-implant mucosal redness, bleeding on probing, probing depth, clinical attachment loss, mobility, vertical bone loss, and horizontal bone loss were assessed. RESULTS: The results did not show significant differences among the surfaces for any parameter during the study (P > .05). All surfaces were equally susceptible to ligature-induced peri-implantitis over time (P < .001). Correlation analysis revealed a statistically significant relationship between width of keratinized tissue and vertical bone loss (r2 = 0.81; P = .014) and between mobility and vertical bone loss (r2 = 0.66; P = .04), both for the titanium plasma-sprayed surface. DISCUSSION AND CONCLUSIONS: The present data suggest that all surfaces were equally susceptible to experimental peri-implantitis after a 60-day period.

Microbiologic and radiographic analysis of ligature-induced peri-implantitis with different dental implant surfaces.

PURPOSE: The goal of this study was to evaluate microbiota and radiographic peri-implant bone loss associated with ligature-induced peri-implantitis. MATERIALS AND METHODS: Thirty-six dental implants with 4 different surfaces (9 commercially pure titanium, 9 titanium plasma-sprayed, 9 hydroxyapatite, and 9 acid-etched) were placed in the edentulous mandibles of 6 dogs. After 3 months with optimal plaque control, abutment connection was performed. On days 0, 20, 40, and 60 after placement of cotton ligatures, both microbiologic samples and periapical radiographs were obtained. The presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia/nigrescens, Campylobacter spp, Capnocytophaga spp, Fusobacterium spp, beta-hemolytic Streptococcus, and Candida spp were evaluated culturally. RESULTS: P intermedia/nigrescens was detected in 13.89% of implants at baseline and 100% of implants at other periods. P gingivalis was not detected at baseline, but after 20 and 40 days it was detected in 33.34% of implants and at 60 days it was detected in 29.03% of dental implants. Fusobacterium spp was detected in all periods. Streptococci were detected in 16.67% of implants at baseline and in 83.34%, 72.22%, and 77.42% of implants at 20, 40, and 60 days, respectively. Campylobacter spp and Candida spp were detected in low proportions. The total viable count analysis showed no significant differences among surfaces (P = .831), although a significant difference was observed after ligature placement (P < .0014). However, there was no significant qualitative difference, in spite of the difference among the periods. The peri-implant bone loss was not significantly different between all the dental implant surfaces (P = .908). DISCUSSION AND CONCLUSIONS: These data suggest that with ligature-induced peri-implantitis, both time and periodontal pathogens affect all surfaces equally after 60 days.

Lethal photosensitization in microbiological treatment of ligature-induced peri-implantitis: a preliminary study in dogs.

This pilot study evaluated, by culture testing, the effectiveness of lethal photosensitization for the microbiological treatment of peri-implantitis in dogs. Experimental peri-implantitis was induced by ligature placement for 2 months. Following ligature removal, plaque control was instituted by scrubbing with 0.12% chlorhexidine daily for 12 months. Subsequently, mucoperiosteal flaps were elevated for scaling the implant surface. Microbial samples were obtained with paper points before and after treatment of implant surfaces by means of 100 microg/ml toluidine blue O (TBO,) and were exposed, for 80 s, to light with a wavelength of 685 nm from a 50 mW GaAlAs diode laser. The mean initial and final bacterial counts were 7.22 +/- 0.20 and 6.84 +/- 0.44 CFU/ml, respectively for TVC (P < 0.0001); 6.19 +/- 0.45 and 3.14 +/- 3.29 CFU/ml for P. intermedia/nigrescens (P = 0.001); 5.98 +/- 0.38 and 1.69 +/- 2.90 CFU/ml for Fusobacterium spp. (P = 0.001); and 6.07 +/- 0.22 to 1.69 +/- 2.94 CFU/ml for beta-hemolytic Streptococcus (P = 0.0039). It may be concluded that lethal photosensitization resulted in a reduction of the bacterial count. Complete elimination of bacteria was achieved in some samples.

Effect of air-powder system on titanium surface on fibroblast adhesion and morphology.

PURPOSE: To evaluate the number and morphology of fibroblasts grown on machined titanium healing abutments treated with an airpowder system. MATERIALS AND METHODS: Twenty-six abutments were assigned to two experimental groups: control (no treatment) and treated (exposed to the Prophy-Jet for 30 seconds). The specimens were incubated for 24 hours with fibroblastic cells in multiwell plates, followed by routine laboratory processing for scanning electron microscope analysis. The specimens were photographed at x 350, and the cell number was counted on an area of approximately 200 um2. RESULTS: No significant differences were found on morphology between the groups (P > 0.05); however, the control group presented a significantly greater amount of cells (71.44 +/- 31.93, mean +/- SD) in comparison with treated group (35.31 +/- 28.14), as indicated by a nonpaired t test (P = 0.001). CONCLUSION: The use of an air-abrasive prophylaxis system on the surface of titanium healing abutments reduced the cells proliferation but did not influence cell morphology.

Treatment of ligature-induced peri-implantitis by lethal photosensitization and guided bone regeneration: a preliminary histologic study in dogs.

BACKGROUND: The purpose of this pilot study was to evaluate the healing potential and reosseointegration in ligature-induced peri-implantitis defects adjacent to various dental implant surfaces following lethal photosensitization. METHODS: A total of 36 dental implants with 4 different surface coatings (9 commercially pure titanium surface [CPTi]; 9 titanium plasma-sprayed [TPS]; 9 hydroxyapatite [HA]; and 9 acid-etched [AE]) were inserted in 6 male mongrel dogs 3 months after extraction of mandibular premolars. After a 2-month period of ligature-induced peri-implantitis and 12 months of natural peri-implantitis progression, only 19 dental implants remained. The dogs underwent surgical debridement of the remaining dental implant sites and lethal photosensitization by combination of toluidine blue O (100 microg/ml) and irradiation with diode laser. All exposed dental implant surfaces and bone craters were meticulously cleaned by mechanical means, submitted to photodynamic therapy, and guided bone regeneration (GBR) using expanded polytetrafluoroethylene (ePTFE) membranes. Five months later, biopsies of the implant sites were dissected and prepared for ground sectioning and analysis. RESULTS: The percentage of bone fill was HA: 48.28 +/- 15.00; TPS: 39.54 +/- 12.34; AE: 26.88 +/- 22.16; and CPTi: 26.70 +/- 16.50. The percentage of reosseointegration was TPS: 25.25 +/- 11.96; CPTi: 24.91 +/- 17.78; AE: 17.30 +/- 15.41; and HA: 15.83 +/- 9.64. CONCLUSION: These data suggest that lethal photosensitization may have potential in the treatment of peri-implantitis.

Utilização dos plasma rico em plaquetas nos procedimentos cirúrgicos de elevação de seio maxilar. Estudo histomorfométrico em humanos / Use of platelet-rich plasma (prp) in maxillary sinus floor augmentation procedures. Histomorfometric study in humans

O propósito do presente estudo foi o de avaliar histomorfometricamente a neoformação óssea da região posterior de maxila após os procedimentos cirúrgicos de elevação de seio maxilar e enxerto ósseo autógeno inlay associado ou não ao plasma rico em plaquetas, em dois períodos de tempo: 6 e 8 meses. Foram selecionados 20 pacientes, com idade média de 42 anos, em boas condições de saúde geral. Os pacientes foram divididos, aleatoriamente em três grupos sendo: Grupo 1: enxerto ósseo autógeno e biópsia da área 8 meses após a cirurgia, 4 pacienttes (grupo contole). Grupo 2: enxerto óssea autógeno associado ao plasma rico em plaquetas e biópsia da área 6 meses após a cirurgia, 8 pacientes. Grupo 3: enxerto ósseo autógeno associado ao plasma rico em plaquetas e biópsia da área 8 meses após a cirurgia, 8 pacientes. Encontrou-se diferenças significantes nos períodos (G2 vs G3) em relação ao tecido ósseo (p=0,05) e em relação aos tecidos não calcificados (p=0,045), e nos tratamentos (G1 vs G3) em relação a presença de material de enxerto (p=0,041). Baseado nos resultados obtidos, pôde-se concluir que em relação à quantidade e qualidade do tecido ósseo formado o uso do Plasma Rico em Plaquetas não apresentou benefícios adicionais à utilizaçã do osso autógeno nos procedimentos cirúrgicos de...

Microbiologic and radiographic analysis of ligature-induced peri-implantitis with different dental implant surfaces / Análise microbiológica e radiográfica da ligadura peri-implantite induzido com diferentes superfícies em implante dentário

Purpose: The goal of this study was to evaluate microbiota and radiographic peri-implant bone loss associated with ligature-induced peri-implantitis. Materials and Methods: Thirty-six dental implants with 4 different surfaces (9 commercially pure titanium, 9 titanium plasma-sprayed, 9 hydroxyapatite, and 9 acid-etched) were placed in the edentulous mandibles of 6 dogs. After 3 months with optimal plaque control, abutment connection was performed. On days 0, 20, 40, and 60 after placement of cotton ligatures, both microbiologic samples and periapical radiographs were obtained. The presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedianigrescens, Campylobacter spp, Capnocytophaga spp, Fusobacterium spp, beta-hemolytic Streptococcus, and Candida spp were evaluated culturally. Results: P intermedianigrescens was detected in 13.89 percent of implants at baseline and 100 percent of implants at other periods. P gingivalis was not detected at baseline, but after 20 and 40 days it was detected in 33.34 percent of implants and at 60 days it was detected in 29.03 percent of dental implants. Fusobacterium spp was detected in all periods. Streptococci were detected in 16.67 percent of implants at baseline and in 83.34 percent, 72.22 percent, and 77.42 percent of implants at 20, 40, and 60 days, respectively. Campylobacter spp and Candida spp were detected in low proportions. The total viable count analysis showed no significant differences among surfaces (P = .831), although a significant difference was observed after ligature placement (P a .0014). However, there was no significant qualitative difference, in spite of the difference among the periods. The peri-implant bone loss was not significantly different between all the dental implant surfaces (P = .908). Discussion and Conclusions: These data suggest that with ligature-induced peri-implantitis, both time and periodontal pathogens affect all surfaces equally after 60 days

Microbiota relacionada à peri-implantite / Microbiota relationship with peri-implantitis

O objetivo desse artigo é prover uma revisão de literatura sobre a colonização microbiana dos tecidos peri-implantares e seu impacto sobre a sua manutenção a longo prazo, no contexto da presença de microrganismos associados à etiologia da doença periodontal

Espaço funcional livre em pacientes dentados naturais / Freeway space im patients with natural teeth

Estudo, em pacientes dentados naturais, da variaçäo do espaço funcional livre obtido pelo método métrico de PLEASURE, através da diferença entre a dimensäo vertical de repouso e a dimensäo vertical de oclusäo em funçäo de diferentes posiçöes estudadas (deitada, inclinada com encosto e suporte da cabeça e sentada com cabeça e tronco eretos sem suporte), os valores médios obtidos do espaço funcional livre näo foram estatisticamente significantes a nível de 5 por cento

Desenvolvimento da peri-implantite induzida por ligadura em diferentes superfícies de implantes osseointegrados: análise clínica e radiográfica em cães / Development of peri-implantitis ligature-induced at different surfaces of osseointegrated implants: clinical and radiographic analyze in dogs

Foram avaliados, clínica e radiograficamente, as reações de quatro diferentes superfícies de implante frente ao desenvolvimento e progressão da peri-implantite: Ticp: titânio comercialmente puro; TPS: titânio revestido com plasma spray de titânio; HA: hidroxiapatita; Ost. Superfícies tratadas com ácidos. Para tanto, foram utilizados seis cães, cujos prémolares inferiores e superiores foram extraídos. Decorridos 90 dias, os implantes foram aleatoriamente colocados, e iniciou-se o controle químico e mecânico do biofilme bacteriano; após o período de osseointegração (90 dias) foram colocados os conectores, e após 45 dias da colocação dos conectores, iniciou-se a indução da peri-implantite por meio de ligaduras de fio de algodão (suspensão do controle do biofilme bacteriano), e os primeiros exames clínicos (profundidade de sondagem, sangramento à sondagem, índices de placa e sangramento, e mobilidade) e radiográficos (perda óssea) foram realizados. Esses parâmetros foram novamente avaliados após 20, 40 e 60 dias, quando da troca das lidaguras. A análise dos resultados não demonstrou diferença significante entre as superfícies, em nenhum dos parâmetros analisados, com exceção da mobilidade (avaliada pelo Periotest) e perda óssea, que foram menores nos implantes TPS. Concluiu-se que as superfícies apresentam comportamento semelhante durante a indução da periimplantite, com exceção no parâmetros mobilidade e perda óssea, que apresentaram os implantes TPS com comportamento superior

The reactions of four different implant surfaces were evaluated in regard to the development and progression of peri-implantitis: titanium commercially pure (Ticp), titanium plasma spray (TPS) hidroxiapatite coated (HA) and acid attached surfaces (Ost). Six dogs had their premolars extracted. After 90 days, the implants were ramdonly placed and the dogs receive soft diet, chemical and mechanical plaque control; after the osseointegration period (90 days), the healing abutments were placed. After the healing period (45 days), the plaque control was suspended, and cotton ligatures were installed when the first clinical (probing depth, bleeding on probing, plaque index, bleeding index, and mobility) and radiographic (bone loss) exams were taken. These parameters were re-exanimate after 20, 40 and 60 days, when the ligatures were changed. The results did not show significant differences between the surfaces in any parameter observed except for the mobility )(evaluated with Periotest) , and bone loss. These two parameters had the TPS surface with the lower rates. It was conclude that the surfaces show similar behavior during the induction of peri-implantitis, except for the mobility and bone loss parameters witch the TPS implants had better behavior

Avaliação sobre o número de retornos e as causas que os acarretam após a instalação das próteses totais / Evaluation of the return numbers and the reasons that cause then after the complete denture installation

Este estudo avaliou o número de retornos que um paciente necessita realizar após a instalação de uma prótese total. Os autores observaram se os retornos estavam relacionados em relação ao sexo do paciente, a idade, ao tipo psicológico, se o paciente já usava ou não uma prótese total, e se o paciente tomava algum medicamento de forma regular. O presente estudo também observou quais foram as principais queixas do paciente quando vinham para os ajustes de suas próteses