Importância do complexo osteomeatal no planejamento do levantamento de seio maxilar / Importance of the evaluation of the osteomeatal complex in the planning of maxillary sinus lift

O desvio de septo nasal, concha bolhosa e a obstrução do óstio são alterações do complexo osteomeatal, que podem interferir no volume dos seios maxilares, em sua oxigenação, drenagem adequada de fluidos e nos resultados de cirurgias nessa região. A adoção de um protocolo de avaliação do complexo osteomeatal envolvendo uma equipe multidisciplinar no planejamento de cirurgias de levantamento de seio maxilar pode proporcionar a diminuição do surgimento de complicações pós-operatórias relacionadas à drenagem e ventilação, prejudicadas pelo desvio de septo nasal, concha bolhosa e obstrução do óstio.

Nasal septum deviation, concha bullosa and ostium obstruction are alterations of the osteomeatal complex that may interfere with the volume of the maxillary sinuses, their oxygenation, adequate drainage of fluids and the results of surgeries in this region. The adoption of a protocol for evaluation of the osteomeatal complex involving a multidisciplinary team in the planning of surgeries of maxillary sinus can provide a reduction in the appearance of postoperative complications related to drainage and ventilation impaired by nasal septum deviation, concha bullosa and obstruction of the ostium.

Comparison of different criteria for periodontitis case definition in head and neck cancer individuals.

PURPOSE: Different periodontitis case definitions have been used in clinical research and epidemiology. The aim of this study was to determine more accurate criterion for the definition of mild and moderate periodontitis case to be applied to head and neck cancer individuals before radiotherapy. METHODS: The frequency of periodontitis in a sample of 84 individuals was determined according to different diagnostic criteria: (1) Lopez et al. (2002);(2) Hujoel et al. (2006); (3) Beck et al. (1990); (4) Machtei et al. (1992); (5) Tonetti and Claffey (2005); (6) and Page and Eke (2007). All diagnosis were based on the clinical parameters obtained by a single calibrated examiner (Kw = 0.71). The individuals were evaluated before radiotherapy. They received oral hygiene instructions, and the cases diagnosed with periodontitis (Page and Eke 2007) were treated. The gold standard was the definition 6, and the others were compared by means of agreement, sensitivity (SS), specificity (SP), and the area under ROC curve. The kappa test evaluated the agreement between definitions. RESULTS: The frequency of periodontitis at baseline was 53.6 % (definition 1), 81.0 % (definition 2), 40.5 % (definition 3), 26.2 % (definition 4), 13.1 % (definition 5), and 70.2 % (definition 6). The kappa test showed a moderate agreement between definitions 6 and 2 (59.0 %) and definitions 6 and 1 (56.0 %). The criterion with higher SS (0.92) and SP (0.73) was definition 1. CONCLUSION: Definition 1 was the most accurate criterion to case periodontitis definition to be applied to head and neck cancer individuals.

Biomechanical evaluation of screw- and cement-retained implant-supported prostheses: a nonlinear finite element analysis.

STATEMENT OF PROBLEM: The mechanical stability of the prosthetic components in the implant-prosthesis complex is essential to the long-term success of the restorations. However, little is known about the differences in the biomechanical behavior of screw- and cement-retained prostheses. PURPOSE: The purpose of this study was to compare the preload maintenance, stresses, and displacements of prosthetic components of screw- and cement-retained implant-supported prostheses by using the finite element method in a nonlinear analysis. MATERIAL AND METHODS: Two 3-dimensional models were constructed: implant-supported fixed partial prostheses with 3 elements retained either by screws (SFP) or cement (CFP). After the simulation of screw tightening, the preload was calculated for both prostheses. Then vertical and oblique loads (100 N) were applied on the models. The preload was identified, the maximum von Mises equivalent stresses (SEQV) were obtained on the screws, and the displacement among the abutment, the implant, and screw was identified by observing the penetration and gap in the contact interfaces. RESULTS: Under vertical load, there was a higher decrease in the preload and in the SEQV on the screw in the SFP. Under oblique load, the SEQV was 24% higher on the screw of the SFP. In the displacement analysis under vertical load, penetration was concentrated in the threads of the screw in the SFP and between the abutment and implant in the CFP. The gap was 118% greater for the SFP and was concentrated on the abutment extension. Under oblique load, the displacement pattern was similar for both prostheses, but with values 66% higher for penetration and 96% higher for gap for the SFP. CONCLUSIONS: The SFP showed a higher biomechanical risk of failure than the CFP.

A double-blind randomized clinical trial of a silorane-based resin composite in class 2 restorations: 18-month follow-up.

PURPOSE: To compare the clinical performance of a silorane-based with a methacrylate-based restorative system in class 2 restorations after an 18-month follow-up. METHODS: This randomized, double-blind and controlled study included 33 subjects receiving 100 direct resin composite restorations that were completely randomized to silorane-based group (Filtek P90/Silorane System Adhesive - 3M ESPE) or methacrylate-based group (Filtek P60/Adper SE Plus - 3M ESPE). The restorative system was determined by chance using a coin toss until 50 units for each group were completed. Each subject contributed with one to seven restorations. A single operator performed all of the restorative procedures. Two calibrated examiners (kw > or = 0.7) assessed the restorations at baseline and after 18 months according to modified United States Public Health System (USPHS) criteria. The data were analyzed with Mann-Whitney U-test, Wilcoxon signed rank and Kaplan-Meier survival curves (alpha = 0.05). RESULTS: After 18 months, 88 restorations were evaluated, and five unacceptable restorations were observed. Proximal contact loss was the main reason for failure (three) followed by composite fracture (two). The marginal integrity of the silorane-based group was significantly worse than that of the methacrylate-based group (P= 0.035). Comparing baseline to 18-month evaluations, the silorane-based group showed significant differences for marginal discoloration, marginal integrity and surface texture (P < 0.05); and the methacrylate-based group differed significantly for marginal discoloration and surface texture (P < 0.05). Combined survival rate for both groups together was 95%. No statistically significant difference was found between methacrylate-based (98%) and silorane-based (92%) overall survival rate (Log rank test; P = 0.185).

Periodontal care in patients undergoing radiotherapy for head and neck cancer.

PURPOSE: The aim of this study was to evaluate periodontal changes after periodontal treatment and control in patients with malignant tumors of the upper aerodigestive tract who were submitted to radiotherapy with or without chemotherapy. METHODS: We included all patients attending the Oncology Clinic of the Federal University of Minas Gerais, School of Dentistry. Clinical periodontal parameters obtained by a single calibrated examiner were evaluated at baseline, 10 days after radiotherapy, and 180 days after radiotherapy. Patients were grouped into healthy or periodontally diseased individuals. All patients received oral hygiene instructions, and the diseased patients received periodontal therapy at baseline. Comparisons between the groups were performed via the McNemar and Wilcoxon tests using SPSS v. 17.0. RESULTS: A total of 28 patients were examined at baseline, of which 27 were examined 10 days after radiotherapy and 25 were examined 180 days after radiotherapy. The prevalence of periodontal disease at baseline was 67.9 % and did not decrease over time (p = 1.0). There was a significant reduction in probing depth (PD), plaque index (PI), and bleeding on probing between baseline and follow-up, which was not observed in the attachment level (AL). CONCLUSIONS: Periodontal therapy was effective in reducing PI and improving periodontal status, as evidenced by the decreases in PD and the maintenance of AL.

Efeito da terapia ativa não cirúrgica e da manutenção periodontal em indivíduos com câncer em região de cabeça e pescoço: um estudo prospectivo, controlado e pareado / Effect of non surgical active therapy and maintenance periodontal in individuals with head and neck cancer: a prospective study, controlled and paired

Estudos que investigam a condição periodontal em pacientes submetidos à radioterapia em região de cabeça e pescoço mostram aumento da perda de inserção periodontal, que pode ser explicada por uma associação de fatores como ação direta da radiação sobre os tecidos, acúmulo de biofilme bacteriano e por alteração da resposta imunológica do hospedeiro. Entretanto, estes estudos são poucos e com tamanho amostral reduzido. A proposta deste estudo prospectivo foi avaliar a condição da doença periodontal em pacientes submetidos à radioterapia associada ou não à quimioterapia (grupo caso) comparada a pacientes não submetidos a este tratamento (grupo controle). O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais. Uma amostra de conveniência foi selecionada por fluxo contínuo (n=56). Os grupos caso e controle (n=28) foram homogeneizados com relação a sexo, idade, tabagismo, etilismo e diagnóstico clínico periodontal no baseline. A medida basal (T0) dos parâmetros clínicos periodontais como: sangramento à sondagem (SS), profundidade à sondagem (PS), nível de inserção clínica (NIC) e recessão gengival (RG), e do índice de placa (IP), executado em todos os dentes, foi feita antes do início do tratamento oncológico. O tratamento periodontal foi realizado segundo as necessidades do paciente. Avaliações periodontais foram realizadas em até 15 dias após o término da radioterapia (T1), 180 dias (T2) e 1 ano (T3) para o grupo caso. Para o grupo controle, as avaliações periodontais foram feitas 3 meses após a primeira avaliação, seguidas de mais duas avaliações com intervalo de 6 meses entre elas. Medidas descritivas dos parâmetros periodontais foram relatadas em frequência absoluta, relativa e em valores médios e percentuais quando adequados. Para cada paciente, as médias de PS, NIC e RG foram obtidos dividindo-se a soma dos valores clínicos periodontais pelo número de sítios examinados...

The short-term clinical performance of a silorane-based resin composite in the proximal contacts of class II restorations.

AIM: The aim of this randomized clinical trial was to compare the proximal contact of a silorane-based resin composite with a conventional methacrylate-based resin composite in class II restorations after a 6 months follow-up period. MATERIALS AND METHODS: After obtaining informed consent, 33 patients were randomly allocated into a test group (Filtek P90/Adhesive System-3M ESPE) or control group (Filtek P60/ Adper SE Plus-3M ESPE), and 100 direct resin composite restorations (n = 50) were placed. A single operator performed the cavities and restorations. After rubber dam placement, a metal matrix and wooden wedge were placed. The restorative systems were applied according to the manufacturer's instructions. After 1 week, the restorations were finished and polished. The proximal contacts were assessed blindly and independently by two calibrated examiners (kW = 0.8) at the baseline and after 6 months according to a three-step grading criteria. Data were analyzed with the Mann-Whitney U-test and Wilcoxon signed Rank tests (a = 0.05). RESULTS: After 6 months, 96% of the restoration contacts were present for evaluation. The frequencies of restorations classified as Bravo in control and test groups were 6 and 8% at the baseline, and 6.25 and 12.75% after 6 months. No significant difference was found between the restorative materials (p > 0.05; Mann-Whitney U-test) neither between baseline and 6 months period (p > 0.05; Wilcoxon signed Rank tests). CONCLUSION: Both materials performed satisfactorily over 6 months follow-up period. CLINICAL SIGNIFICANCE: The short-term clinical performance of a silorane-based resin composite in the proximal contacts of class II restorations was similar to the well-known methacrylate-based resin composite.

Associações entre fatores de risco e complicações bucais em pacientes com câncer de cabeça e pescoço tratados com radioterapia associada ou não à quimioterapia / Association between risk factors and oral complications in patients with head and neck cancer treated with radiotherapy combined or not with chemotherapy

Objetivo: descrever as reações adversas que ocorreram em pacientes durante a radioterapia associada ou não à quimioterapia, bem como avaliar suas possíveis associações com fatores de risco. Métodos: neste estudo longitudinal prospectivo foram examinados 28 pacientes antes, durante e após completar seis meses do término do tratamento oncológico. Os dados coletados foram idade, gênero, cor da pele, tabagismo, etilismo. Sobre o tumor, foram registrados a localização, a classificação TNM (tamanho do tumor, presença de linfonodo acometido e metástase à distância), o tipo histológico, o grau de diferenciação, o número de frações da radioterapia e o tratamento oncológico proposto. Os pacientes foram encaminhados ao Projeto de Oncologia da Faculdade de Odontologia da Universidade Federal de Minas Gerais e receberam adequação do meio bucal antes do tratamento oncológico. Durante a radioterapia foram coletados dados relativos à presença de mucosite, xerostomia, disfagia, ardência e candidose. Após análise descritiva dos dados, as associações entre efeitos adversos durante a radioterapia e fatores de risco foram verificadas usando os testes do Qui-quadrado e Exato de Fisher (p menor que 0,05). Resultados: foi encontrada maior frequência de pacientes do sexo masculino (78,6%), leucoderma (71,4%) com carcinoma de células escamosas (78,6%). A prevalência da mucosite grau I, II e III, xerostomia, disfagia, candidose e ardência foram de 10,7%; 82,2%; 7,1%; 96,4%; 53,6%; 28,6% e 57,1%, respectivamente. Associação estatisticamente significativa foi encontrada somente entre presença ou ausência de maxilares irradiados e mucosite (p=0,03). Conclusão: efeitos adversos ocorreram durante a radioterapia associada ou não à quimioterapia em pacientes com câncer em região de cabeça e pescoço. Associação significativa foi verificada entre o local de irradiação e a presença de mucosite.

Objective: This study described the adverse reactions that occurred in patients during radiotherapy combined or not with chemotherapy, and assessed their possible associations with risk factors. Method: Using a prospective cross-sectional design, 28 patients were evaluated before, during and six months after the end of cancer treatment. The following data were collected: age, gender, ethnicity, smoking and alcohol consumption. Information recorded about the tumor included primary site of tumor, TNM classification (tumor size, lymph node status and distant metastasis), histological type, differentiation grade, number of fractions of radiotherapy and oncologic treatment protocol. The patients were referred to the Oncology Project of the School of Dentistry of the Federal University of Minas Gerais, and had their oral cavity prepared for cancer treatment. During radiotherapy, data were collected with respect to mucositis, xerostomia, dysphagia, burning sensation, and candidosis. After descriptive analysis of data, the associations between adverse effects raised during radiotherapy and risk factors were verified using the Chi-square and Fisher's Exact Test (p less than 0.05). Results: There was a predominance of male (78.6%), Caucasian (71.4%) patients with squamous cell carcinoma (78.6%). The prevalence of mucositis grades I, II, III, xerostomia, dysphagia, candida infections and burning sensation was 10.7%, 82.2%, 7.1%, 96.4%, 53.6%, 28.6% and 57.1%, respectively. A statistically significant association was found only between the presence or absence of irradiation of jaws and mucositis (p=0.03). Conclusion: Oral complications occurred during radiotherapy in combination or not with chemotherapy in patients with cancer in the head and neck region. A significant association was found between the site of irradiation and the presence of mucositis.

Enfermedad periodontal en oncológicos: Factor indicativo de exodoncias?

En este estudio se verificó las indicaciones de exodoncias en pacientes con cáncer en región de cabeza e cuello, que serán sometidos a radioterapia, en el servicio de Oncología de la Facultad de Odontología da Universidad Federal de Minas Gerais. Fueran evaluadas 114 historias clínicas y radiografías panorámicas y periapicales y fueran divididos de acuerdo con las indicaciones de exodoncias. Estas indicaciones fueron por caries, enfermedad periodontal, asociaciones de caries y periodontitis, falta de soporte para prótesis, diente incluidos, dientes extruidos, y en algunos casos dientes con indicaciones de extracciones exclusivamente por causa de la radioterapia. Los resultados mostraron que la mayor parte de indicaciones de exodoncias fueron debido a caries (21,05%) y enfermedades periodontales (26,31%). Debido a la predisposición a la pérdida de inserción periodontal y al riesgo de su progresión, pacientes que serán sometidos a la radioterapia de cabeza y cuello deberán ser evaluados en relación a la condición periodontal y a las indicaciones de exodoncia. Este estudio mostró que el diagnóstico de la enfermedad periodontal fue el principal factor relacionado con la indicación de exodoncias previamente al tratamiento oncológico.

The aim of this study was to describe the indication of the exodontias in patients with head embedded tooth, extruded tooth and some cases when indication is because of radiotherapy. The results show that caries (21, 05%) and periodontitis (26, 31%) were the biggest indications of exodontias in these patients. Due to a tendency of attachment loss and bone destruction and the risk of progression, patients that will be under head and neck radiotherapy should be evaluated on the periodontal status e tooth extraction indications. This study shows that the diagnosis of periodontal disease was the main indication to teeth extractions previous to oncological treatment.