Rehabilitación cardíaca en pacientes diabéticos durante la pandemia de COVID-19

RESUMEN El beneficio del ejercicio en la prevención y el tratamiento de la diabetes mellitus tipo 2 tiene una base sólida de evidencia. La derivación a un programa de rehabilitación cardíaca o fisioterapeuta para un adecuado asesoramiento y prescripción de ejercicios puede servir de apoyo en el proceso de cambio de comportamiento iniciado en entornos de práctica general, para mejorar los resultados del paciente que padece esta enfermedad en medio de la pandemia de COVID-19. La existencia de un sistema de apoyo y educación para el autocontrol de la diabetes mellitus basado en equipos de rehabilitación cardíaca desempeña un papel fundamental para ello, de manera tal que pacientes y médicos logren una estrecha coordinación para lograr el éxito deseado. En este artículo se revisan los diversos aspectos de la atención centrada en el paciente a través de la educación para el autocontrol de esta enfermedad endocrino-metabólica durante la pandemia de COVID-19.

ABSTRACT The benefit of exercise in the prevention and treatment of type 2 diabetes mellitus has a strong body of evidence. The implementation of a cardiac rehabilitation or physiotherapeutic program for appropriate counseling and exercise prescription may support the behavioral change process initiated in general practice settings. This would ostensibly improve outcomes for patients suffering from type 2 diabetes mellitus in the midst of the COVID-19 pandemic. The existence of a support and education system for the self-management of diabetes mellitus based on cardiac rehabilitation teams plays a key role in this regard, so that patients and physicians achieve close coordination to attain the desired success. This article addresses the various aspects of patient-centered care through self-management education for this endocrine-metabolic disease during the COVID-19 pandemic.

Frequency of pulp canal obliteration in primary teeth after traumatic dental injury and its association with related variables / Frequência de obliteração do canal pulpar nos dentes decíduos após traumatismo dentário e sua associação com variáveis relacionadas

ABSTRACT Objective The aim of this study was to determine the frequency of pulp canal obliteration (PCO) after traumatic dental injury (TDI) of primary anterior teeth and to investigate its relation with the related variables. Methods This retrospective study has been done with dental records of patients selected from the Paediatric Dental Trauma Clinic between 2006 and 2016. Those who had PCO in the primary anterior teeth and were aged 0-108 months at the time of trauma were considered eligible. Data related to patients and TDI, such as sex, the child's age at the time of trauma, aetiology, affected teeth, the child's age at the time of the eruption of the permanent successor as well as the presence of crown discoloration were extracted from the dental records. Results Among the 483 children with traumatised teeth, 14.9% had PCO and the most of them exhibited crown discoloration. The average age of the children at the time of the trauma was 38 months and the most common aetiology of the TDI was falls. The average time for the beginning of the PCO process was 13.5 months. There was no statistically significant association between the child's age at the time of trauma and the types of TDI, PCO and the presence of crown discoloration. Conclusions The frequency of PCO was relatively low though the presence of crown discoloration was considerable. There was no association between the child's age at the time of trauma and the studied variable.

RESUMO Objetivo O objetivo desse estudo foi determinar a frequência de obliteração do canal pulpar (OCP) após traumatismo dos dentes decíduos anteriores e investigar sua associação com variáveis relacionadas. Métodos Este estudo retrospectivo foi realizado com base nos prontuários odontológicos de pacientes selecionados da Clínica de Trauma Dentário Pediátrico entre 2006 e 2016. Aqueles que tinham OCP nos dentes decíduos anteriores e tinham entre 0-108 meses no momento do traumatismo foram considerados elegíveis. Dados dos pacientes e dos traumatismos, tais como, sexo, idade da criança no momento do traumatismo, etiologia, dente afetado, idade da criança na época no momento da erupção do sucessor permanente, bem como presença de alteração de cor da coroa foram extraídos dos prontuários. Resultados Dentre as 483 crianças com dentes com traumatismos, 14.9% tinham OCP e a maioria delas apresentava alteração de cor da coroa. A média de idade da criança no momento do traumatismo foi de 38 meses e a etiologia mais comumente associada ao TD foram as quedas. O tempo médio decorrido para o início do processo de OCP foi de 13,5 meses. Não houve associação estatisticamente significativa entre a idade da criança no momento do traumatismo e os tipos de TD, OCP e presença de alteração de cor da coroa. Conclusão A frequência de OCP foi relativamente baixa, embora a presença de alteração da coroa tenha sido considerável. Não foi encontrada associação entre a idade da criança no momento do trauma e as variáveis estudadas.

Ejercicio físico y fibrilación auricular en atletas y en pacientes con insuficiencia cardíaca: ¿Favorable o perjudicial? / Physical exercise and atrial fibrillation in athletes and heart failure patients: Is it favorable or harmful?

RESUMEN La fibrilación auricular (FA), epidemia esperada en las próximas décadas, es comúnmente causada por la cardiopatía isquémica y la hipertensión arterial, también se asocia con el sobrepeso y la obesidad. El ejercicio físico (EF) se considera una medida que corrige los factores de riesgo cardiovascular y, por tanto, se recomienda en la prevención de las enfermedades cardiovasculares, y forma parte integral de la rehabilitación cardíaca. Aunque se ha señalado que el EF puede incrementar el riesgo de FA, los beneficios cardiovasculares de la actividad física regular son incuestionables. Se ha comprobado un mejor estado de salud y una mayor expectativa de vida en atletas de resistencia. El EF ligero o moderado protege contra la FA, lo que puede estar asociado a un mejoramiento de las funciones sistólica y diastólica del ventrículo izquierdo, así como a una disminución de la rigidez arterial. La rehabilitación cardíaca con EF, es una indicación aprobada actualmente en pacientes con insuficiencia cardíaca crónica, con FA o sin ella, la cual está demostrado que incrementa la capacidad funcional y la calidad de vida, así como que reduce la mortalidad general y las hospitalizaciones.

ABSTRACT Atrial fibrillation (AF), an expected epidemic in the coming decades, is commonly caused by ischemic heart disease and high blood pressure, and it is also associated with overweight and obesity. Physical exercise (PE) is considered a way to correct cardiovascular risk factors and it is therefore recommended in the prevention of cardiovascular diseases. It is also an integral part of cardiac rehabilitation. Although it has been noted that PE can increase the risk of AF, the cardiovascular benefits of regular physical activity are unquestionable. An improved health status and a longer life expectancy have been proven in endurance athletes. Mild or moderate PE protects against AF, which may be associated with an improved left ventricular systolic and diastolic function, as well as with a decreased arterial stiffness. Cardiac rehabilitation with PE is a currently approved indication in patients with chronic heart failure, with or without AF, which is shown to increase functional capacity and life quality, as well as to reduce overall mortality and hospitalizations.

Evaluación funcional de un programa de entrenamiento físico en pacientes infartados con disfunción sistólica severa del ventrículo izquierdo / Functional evaluation of a physical training programme in myocardial infarction patients with severe left ventricular systolic dysfunction

Resumen Objetivo: Evaluar la factibilidad y los efectos sobre la capacidad funcional de un programa de entrenamiento físico supervisado, aplicado en pacientes con disfunción sistólica severa del ventrículo izquierdo después de infarto agudo de miocardio. Métodos: Se estudiaron 37 pacientes, de ambos sexos y sin límites de edad, con diagnóstico de disfunción sistólica severa del ventrículo izquierdo, después de haber sufrido un infarto agudo de miocardio, que consecutivamente se incorporaron al programa ambulatorio del Centro de Rehabilitación del Instituto de Cardiología. Se hicieron pruebas de esfuerzo máximas limitadas por síntomas con determinación de consumo de oxígeno, ecocardiogramas en reposo y ventriculografías isotópicas en reposo y esfuerzo a los 2, 8 y 18 meses de evolución, y un tiempo medio de seguimiento clínico de 4,1 años. A todos se les prescribió un régimen de entrenamiento físico moderado o intenso, durante un año como mínimo. Se consideró disfunción sistólica severa cuando la fracción de eyección del ventrículo izquierdo fue menor de 35%. Resultados: Todos los parámetros ergométricos que expresaron capacidad funcional incrementaron significativamente en la evaluación del octavo mes (p< 0,0005), permaneciendo invariables a los 18. La fracción de eyección del ventrículo izquierdo media en reposo inicial fue de 28,3 ± 5,3%, la cual no mostró variaciones significativas con el esfuerzo ni con otros estudios evolutivos. La mortalidad total y la morbilidad de la serie fueron de 10,5% y 47,3%, respectivamente. Conclusión: El entrenamiento físico supervisado en pacientes infartados con disfunción sistólica severa de ventrículo izquierdo fue seguro y efectivo, y mejoró su calidad de vida, sin causar efectos negativos sobre la función ventricular.

Abstract Objective: To evaluate the feasibility and effects on the functional capacity of a supervised physical training programme carried out on patients with severe left ventricular systolic dysfunction after an acute myocardial infarction. Methods: The study included a total of 37 patients, males and females of any age, with a diagnosis of severe left ventricular systolic dysfunction after having suffered an acute myocardial infarction. They were consecutively included into the ambulatory programme of the Institute of Cardiology Rehabilitation Centre. Maximum effort tests, limited by symptoms, were performed to determine oxygen consumption. Echocardiograms were also performed at rest, with isotopic ventriculography at rest and then at 2, 8, and 18 months. The mean clinical follow-up was 4.1 years. They were all prescribed to a moderate or intense training programme for at least one year. Severe left ventricular systolic dysfunction was considered when the left ventricular ejection fraction was less than 35%. Results: All the ergometric parameters that expressed functional capacity increased significantly in the evaluation at 8 months (P< .0005), and remained at 18 months. The initial mean left ventricular ejection fraction at rest was 28.3 ± 5.3%, which showed no significant changes with effort or in the other evaluation times. The overall mortality and morbidity of the series was 10.5% and 47.3%, respectively. Conclusion: Supervised physical training in patients after an acute myocardial infarction and with severe left ventricular systolic dysfunction was safe and effective, and improved the quality of life, without causing negative effects on ventricular function.

Types of traumatic dental injuries to the primary dentition and the surface against which they occurred / Estudo retrospectivo dos tipos de traumatismos dentários na dentição decídua e as superfícies contra as quais esses ocorreram

ABSTRACT Objectives The aims of this retrospective study were to investigate the types of traumatic dental injury recorded in an oral health service within a ten-year period and to report the type of surface against which the traumatic dental injury occurred. Methods Dental records from children assisted in the Dental Trauma Clinic at the Rio de Janeiro State University's School of Dentistry, between 2006 and 2016, were analyzed. Only those records who had registered some type of trauma in the primary anterior teeth (incisors and canines) and aged 0-96 months at the time of trauma were considered eligible for the study. Results Four hundred and eighty-three dental records were included, totalizing 786 traumatized teeth. The average age when traumatic dental injury occurred was 37.25 months (±18.62). Enamel fractures (32.8%) and intrusive luxations (45.6%) were the most prevalent types of trauma. The majority of traumas occurred against ceramic surfaces (34%). The greatest number of teeth with lateral luxation were the ones that hit against a ceramic surface (p=0.014; U Mann-Whitney test). According to this study, the most prevalent type of trauma in the dental tissue and pulp was enamel fracture and in the periodontal tissue was intrusive luxation. The majority of traumas occurred due to falls, at home and against ceramic surfaces. Conclusion The results showed that a high frequency of the lateral luxation was associated to a traumatic impact against ceramic surfaces.

RESUMO Objetivos Investigar de forma retrospectiva os tipos de traumatismo alveolodentário ocorridos em um atendimento de saúde bucal durante um período de dez anos e relatar os tipos de superfícies contra as quais os traumatismos ocorreram. Métodos Foram selecionados prontuários de crianças atendidas na Clínica de Traumatismo Dentário na Faculdade de Odontologia da Universidade Estadual do Rio de Janeiro, entre os anos de 2006 e 2016. Os prontuários considerados elegíveis para esse estudo foram os das crianças que possuíam algum tipo de traumatismo em dentes anteriores na dentição decídua (incisivos e caninos) e tinham de 0-96 meses de idade. Resultados Foram incluídas no estudo 483 prontuários com um total de 786 dentes acometidos por traumatismos. A média de idade em que os traumatismos ocorram foi de 37,25 meses (±18.62). As fraturas de esmalte (32,8%) e as luxações intrusivas (45,6%) foram os tipos de trauma mais prevalentes. A maioria dos traumatismos ocorreu contra superfícies de cerâmica (34%). A luxação lateral foi o único tipo de traumatismo que apresentou associação com a superfície de impacto, no caso a cerâmica (p=0.014; Teste U de Mann-Whitney). De acordo com o presente estudo o tipo mais prevalente de trauma no tecido dentário e polpa foi a fratura de esmalte e no tecido periodontal foi a luxação intrusiva. A maioria dos traumatismos alveolodentarios ocorreu devido a quedas em suas próprias residências e contra superfícies de cerâmica. Conclusão Os resultados demonstraram que a alta frequência de luxações laterais está associada ao impacto do traumatismo contra superfícies de cerâmica.

Frequency of crown and root dilaceration of permanent incisors after dental trauma to their predecessor teeth.

BACKGROUND/AIMS: Dental trauma to the predecessor teeth can cause crown and root dilacerations to the successor teeth, which can interfere with the normal development of permanent teeth. The aims of this study were to verify the types of trauma more frequent to the predecessor teeth that cause dilaceration to their successor teeth, to determine the frequency of crown and root dilacerations in permanent incisors, taking into account the child's age at the time of trauma, and to describe the types of treatment performed. MATERIALS AND METHODS: Details of 815 anterior primary teeth with dental injury were obtained from 483 dental records of children aged 0-9 years at the time of trauma. RESULTS: Of 815 traumatized primary teeth, 161 successor teeth were clinically and radiographically reviewed until complete eruption and had some type of sequel. Avulsion and intrusive luxation were the most frequent types of trauma to the predecessor teeth that caused dilaceration to their successor teeth. Enamel discoloration (30.4%), hypoplasia (23.6%), root (14.3%) and crown (9.9%) dilacerations were the most common sequelae observed in the successor teeth. Root and crown dilacerations were more frequent in children aged more than and up to 3 years, respectively. Tooth extraction and orthodontic treatment were the most common treatments. CONCLUSIONS: Dentists must be aware of the relationship between the child's age at the time of trauma to the predecessor tooth and the type of sequel to the successor tooth in order to diagnose, monitor, and treat the sequel properly.

Low-intensity red and infrared lasers affect mRNA expression of DNA nucleotide excision repair in skin and muscle tissue.

Lasers emit light beams with specific characteristics, in which wavelength, frequency, power, fluence, and emission mode properties determine the photophysical, photochemical, and photobiological responses. Low-intensity lasers could induce free radical generation in biological tissues and cause alterations in macromolecules, such as DNA. Thus, the aim of this work was to evaluate excision repair cross-complementing group 1 (ERCC1) and excision repair cross-complementing group 2 (ERCC2) messenger RNA (mRNA) expression in biological tissues exposed to low-intensity lasers. Wistar rat (n = 28, 4 for each group) skin and muscle were exposed to low-intensity red (660 nm) and near-infrared (880 nm) lasers at different fluences (25, 50, and 100 J/cm(2)), and samples of these tissues were withdrawn for RNA extraction, cDNA synthesis, and gene expression evaluation by quantitative polymerase chain reaction. Laser exposure was in continuous wave and power of 100 mW. Data show that ERCC1 and ERCC2 mRNA expressions decrease in skin (p < 0.001) exposed to near-infrared laser, but increase in muscle tissue (p < 0.001). ERCC1 mRNA expression does not alter (p > 0.05), but ERCC2 mRNA expression decreases in skin (p < 0.001) and increases in muscle tissue (p < 0.001) exposed to red laser. Our results show that ERCC1 and ERCC2 mRNA expression is differently altered in skin and muscle tissue exposed to low-intensity lasers depending on wavelengths and fluences used in therapeutic protocols.

DNA damage in blood cells exposed to low-level lasers.

BACKGROUND AND OBJECTIVE: In regenerative medicine, there are increasing applications of low-level lasers in therapeutic protocols for treatment of diseases in soft and in bone tissues. However, there are doubts about effects on DNA, and an adequate dosimetry could improve the safety of clinical applications of these lasers. This work aimed to evaluate DNA damage in peripheral blood cells of Wistar rats induced by low-level red and infrared lasers at different fluences, powers, and emission modes according to therapeutic protocols. MATERIAL AND METHODS: Peripheral blood samples were exposed to lasers and DNA damage was accessed by comet assay. In other experiments, DNA damage was accessed in blood cells by modified comet assay using formamidopyrimidine DNA glycosylase (Fpg) and endonuclease III enzymes. RESULTS: Data show that exposure to low-level red and infrared lasers induce DNA damage depending on fluence, power and emission mode, which are targeted by Fpg and endonuclease III. CONCLUSION: Oxidative DNA damage should be considered for therapeutic efficacy and patient safety in clinical applications based on low-level red and infrared lasers.

Caspase-3 activation and increased procollagen type I in irradiated hearts.

The caspase-3-cleaved presence was evaluated in this study in the heart of irradiated rats, during the decline of ventricular function. Female Wistar rats were irradiated with a single dose of radiation (15 Gy) delivered directly to the heart and the molecular, histological and physiological evaluations were performed at thirteen months post-irradiation. The expressions of procollagen type I, TGF-ß1 and caspase-3-cleaved were analyzed using Western blotting. Cardiac structural and functional alterations were investigated by echocardiography and electron microscopy. In the irradiated group, the levels of procollagen type I, TGF-ß1 and caspase-3-cleaved are increased. Significant histological changes (degeneration of heart tissue and collagen deposition) and functional (reduced ejection fraction) were observed. Data suggest that the cardiac function decline after exposure to ionizing radiation is related, in part, to increased collagen and increased caspase-3-cleaved.

DNA repair gene expression in biological tissues exposed to low-intensity infrared laser.

Special properties of laser light have led to its usefulness in many applications in therapy. Excitation of endogenous chromophores in biotissues and generation of free radicals could be involved in its biological effects. DNA lesions induced by free radicals are repaired by base excision repair pathway. In this work, we evaluated the expression of APE1 and OGG1 genes related to repair of DNA lesions induced by free radicals. Skin and muscle tissues of Wistar rats were exposed to low-intensity infrared laser at different fluences and frequencies. After laser exposition of 1 and 24 h, tissue samples were withdrawn for total RNA extraction, cDNA synthesis, and evaluation of APE1 and OGG1 gene expression by quantitative polymerase chain reaction. Data obtained show that laser radiation alters the expression of APE1 and OGG1 mRNA differently in skin and muscle tissues of Wistar rats depending of the fluence, frequency, and time after exposure. Our study suggests that low-intensity infrared laser affects expression of genes involved in repair of DNA lesions by base excision repair pathway.

Chemotherapy and radiation regimens to breast cancer treatment induce changes in mRNA levels of renin-angiotensin system related genes in cardiac tissue.

BACKGROUND AND AIM: Cardiovascular complications are one limitation of breast cancer treatment. The aim of the current study was to investigate whether the renin-angiotensin related genes could be altered by chemotherapy and radiotherapy, using a rat model. METHODS: Female rats were divided into three groups: control, chemotherapy + irradiation (TC+IR) and irradiation (IR). Molecular analyses of the left ventricle were performed five months after the end of treatment. The analyses evaluated the changes in mRNA levels of some renin-angiotensin system (RAS) related genes: angiotensinogen, renin, angiotensin-converting enzyme (ACE) and angiotensin II type 1 receptor (AT1) and vascular endothelial growth factor (VEGF), which can be related to ACE production, by RT-PCR. RESULTS: Renin was only observed in treated groups, TC+IR and IR, compared with the control group. ACE and VEGF levels were decreased in TC+IR (p<0.001) and in IR (p<0.001), and AT1 mRNA was higher in groups TC+IR (p<0.01) and IR (p<0.05) compared with the control group. CONCLUSION: Chemotherapy and irradiation can induce significant changes in some RAS related genes. These alterations are important to understand the pathways and consequences beyond cardiotoxicity induced by breast cancer treatments.

Frequency of intrusive luxation in deciduous teeth and its effects.

The aims of this study were three-fold: First, to determine the prevalence of partial and total intrusion of the primary anterior teeth. Second, to investigate the sequelae of total and partial intrusive luxation in the primary anterior teeth and in their successors and finally, to establish whether the sequelae on both deciduous and permanent teeth were related to the child's age at the time of the intrusion. Data collected from records of 169 boys and 138 girls, all between the ages of zero and 10 years, who were undergoing treatment during the period of March 1996 to December 2004. The sample was composed of 753 traumatized deciduous teeth, of which 221 presented intrusive luxation injury. Children with ages ranging from one to 4 years were the most affected with falls being the main cause of intrusion. Of all intruded teeth 128 (57.9%) were totally intruded and 93 (42.1%) partially. Pulp necrosis/premature loss and color change were the most frequent sequelae in both total and partial intrusions. Concerning permanent dentition, the most common disturbances were color change and/or enamel hypoplasia. Both types of intrusion caused eruption disturbance. Total intrusion was the most frequent type of intrusive luxation. There was no significant correlation between the child's age at the time of intrusion and the frequency of subsequent sequela on primary injured teeth (P = 0.035), between the age at the time of injury and the developmental disturbances on permanent teeth (P = 0.140).

Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: a longitudinal study of 8 years.

The aim of this study was to determine the prevalence of sequelae in the permanent anterior teeth following trauma in their predecessors, and also to verify the existence of association between the sequelae in the permanent teeth and the type of injury in their predecessors according to the age group at the time of injury. This study was performed based on data from the records of 169 boys and 138 girls who received assistance at the dental clinic of the State University of Rio de Janeiro from March 1996 to December 2004. The sample was collected from 753 traumatized deciduous teeth of children aged 0-10 years. The number of boys and girls with dental trauma corresponded to 55.0% and 45.0%, respectively. The more affected age period was between 1 and 4 years (75.3%). The most common type of traumatic injury was the intrusion (29.3%), followed by avulsion (14.1%). Concerning permanent dentition, the most common developmental disturbances were discoloration of enamel and/or enamel hypoplasia (46.08%) and eruption disturbances (17.97%) due to the traumatic injury in their predecessors. It was not possible to find an association between the type of injury in primary teeth and sequelae in their successors in the studied age groups (P

Impactação dos segundos pré-molares: diagnóstico, etiologia e tratamento / Impactation of second premolars: diagnosis, etiological factors and treatment

Este estudo consta de uma revisão da literatura sobre a impactação dos segundos pré-molares, tendo como finalidade descrever os critérios de diagnóstico, os fatores etiológicos, as consequências e o tratamento desta anomalia. Para complementar este propósito foram utilizadas ilustrações clínicas e radiográficas pertencentes ao acervo da disciplina de Odontopediatria da FO-UERJ. Com base nestas ilustrações e na literatura consultada, pôde-se concluir que o diagnóstico precoce e a intervenção em época oportuna nos casos de impactações dos segundo pré-molares são essenciais para evitar ou minimizar as consequências danosas para a oclusão do paciente

Thyroid morphology and function in adults with untreated isolated growth hormone deficiency.

OBJECTIVE: GH influences thyroid function and anatomy. Although goiter is frequent in acromegalic patients, the effects of GH deficiency (GHD) are difficult to assess, because hypopituitaric subjects who lack GH often also have a partial or complete deficit of TSH. STUDY DESIGN: We studied thyroid morphology and serum levels of thyroid hormones in adult members of a large Brazilian kindred with untreated isolated GHD due to a homozygous mutation in the GHRH receptor gene (GHRHR; nine men and 15 women; GHD group) and compared them to subjects heterozygous for the same mutation (eight men and 10 women; HET group) and subjects homozygous for the wild-type allele [seven men and 11 women; control (CO) group]. RESULTS: GHD subjects had a smaller thyroid volume (TV) than HET and CO. The TV of the HET group was intermediate between those of the GHD and CO groups. When TV was corrected by body surface area, it remained smaller in the GHD and HET groups than in the CO group, but the difference between GHD and HET groups disappeared. The GHD group had lower serum T3 levels than the CO group and higher free T4 levels than HET and CO groups. CONCLUSIONS: Individuals with severe untreated GHD due to a homozygous GHRHR mutation and heterozygous carriers of the same mutation have smaller TV than normal subjects, suggesting that GH has a permissive role in the growth of the thyroid gland. In addition, GHD subjects have reduced serum total T3 and increased serum free T4, suggesting a reduction in the function of the deiodinase system.

Retenção prolongada de molares decíduos: diagnóstico, etiologia e tratamento / Prolonged retention of deciduous molars: diagnosis, aetiology and treatment

Este estudo apresenta uma revisão de literatura e um relato de dois casos clínicos sobre retenção prolongada de molares decíduos, com o objetivo de descrever os meios de diagnóstico, a etiologia, as implicações clínicas e o tratamento desta condição. Fatores etiológicos locais, ambientais ou genéticos podem levar à retenção de molares decíduos, interferindo na seqüência normal de erupção dos pré-molares. Nos dois casos clínicos apresentados, os pacientes apresentaram um quadro de erupção dentária incompatível com a idade cronológica. A conduta terapêutica baseou-se na realização de exodontias dos elementos retidos, seguida da manutenção de espaço e controle clínico e radiográfico até a erupção dos sucessores. O diagnóstico e a intervenção precoces são de fundamental importância para evitar danos à oclusão.

Tratamento precoce da mordida cruzada posterior funcional / Early treatment of the functional posterior cross bite

O presente trabalho apresenta o relato do caso clínico de uma paciente de quatro anos de idade com mordida cruzada posterior unilaterial na dentição decídua, tratada apenas com desgate seletivo, com base na revisão da literatura sobre o assunto. Com o objetivo de se validar a opção pelo tratamento precoce, realizado ainda na dentição decídua, através do desgaste seletivo dos elementos dentários causadores de interferências oclusais, o correto diagnóstico e o mais indicado tipo de tratamento são destacados. O desgaste seletivo é um tratamento indicado em casos de mordida cruzada funcional. Ao final deste relato de caso clínico, a mordida cruzada posterior unilateral foi corrigida e a paciente e seus responsáveis foram instruídos a voltarem à clínica odontológica regularmente para a manutenção e controle do caso

A importância do exame radiográfico na dilaceração radicular de incisivos centrais superiores permanentes após traumatismo dentário / The importance of radiographic examination in root dilaceration of permanent maxillary central incisors after dental traumatism

Este trabalho é uma revisão de literatura que tem por objetivo alertar os Cirurgiões-Dentistas, principalmente os odontopediatras, quanto à importância do diagnóstico precoce da dilaceração radicular e do acompanhamento clínico e radiográfico do paciente para evitar ou, pelo menos, minimizar suas seqüelas. São apresentadas imagens radiográficas de dois pacientes portadores de dilaceração radicular nos incisivos centrais superiores permanentes, causada por traumatismo dentário. Com base nestas imagens e na literatura consultada, pôde-se concluir que um traumatismo dentário sobre o incisivo decíduo pode trazer repercussões ao seu sucessor em formação; a radiografia cefalométrica de perfil neste tipo de alteração é essencial; o tratamento de um incisivo dilacerado requer a atenção de uma equipe multidisciplinar

Infra-oclusäo de 2§ molares decíduos anquilosados: soluçäo clínica / Infraocclusion of ankylosed 2nd deciduous molars: clinical solution

A ocorrência de infra-oclusäo em molares decíduos é bastante comum e os danos causados à oclusäo podem ser muito graves ou até irreversíveis. O objetivo deste artigo é apresentar dois casos clínicos, um deles com tratamento alternativo para molares decíduos anquilosados em infra-oclusäo severa, e o outro onde foi possível recuperar o espaço perdido no arco, evitando maiores danos para a oclusäo. Foi realizada, também, uma revisäo da literatura, enfatizando as causas, conseqüências e o tratamento da anomalia