Contextual inequalities in specialized dental public health care in Brazil.

The present study aimed to investigate the contextual inequalities of specialized public dental care (SPDC) in Brazil. The outcome was the trajectory of dental specialized production in municipalities with SPDC (from 2015 to 2017) obtained by group-based trajectory modeling. A Poisson regression model was used to analyze the factors associated with the high trajectory of SPDC production. The inequality indicators for SPDC production were the slope index and the concentration index according to contextual factors. The study included 954 SPDC units distributed across 893 municipalities. Among the municipalities evaluated, 62.9% had a low trajectory of SPDC. Large-sized municipalities had the highest production (IRR = 2.84, 95%CI: 1.94-4.14) and the southern region had the lowest production (IRR = 0.73, 95%CI: 0.58-0.92). Municipalities presenting a very high human development index (HDI) showed the greatest SPDC production (IRR = 3.34, 95%CI: 1.09-10.24), as well as municipalities with the highest tertile of schooling rate (IRR = 1.23, 95%CI: 1.00-1.50). The absolute inequality was 52.1 percentage points for the average monthly wage (p < 0.001), 61.0 percentage points for the HDI (p < 0.001), -22.1 for infant mortality rate (p <0.001), and 14.8 for the schooling rate (p = 0.012). Thus, there are contextual inequalities in the Brazilian SPDC. Higher scores for social indicators were associated with better SPDC performance.

Dental students' self-perception of security and biosafety measures in times of pandemic by COVID-19: a cross-sectional study in private Universities in Southern Brazil

The study investigated the factors associated with the self-perception safety of dental students in clinical activities during the COVID-19 pandemic. This cross-sectional study was based on a semi-structured online (google forms) self-applied questionnaire, sent by e-mail to three private Dental Schools in Brazil. The variables were: 1) sociodemographic information; 2) questions about the measures adopted by dental schools before returning to clinical activities; 3) dental students' self-perception of security; 4) the General Health Questionnaire. Data were submitted to Fisher's exact test (p<0.05). Of the 294 eligible students, 97% were evaluated and 100% received previous specific biosafety training predominantly theoretical (72.16%) longer than one hour (51.55%). Most students (81.44%) felt secure performing clinical care during the COVID-19 pandemic. Students undergoing specific biosafety training for longer than one hour felt safer than those perfoming training for up to 1 hour (p=0.004). Students from schools where the aerosol-producing restriction was applied felt safer than those without restrictions (p=0.016). Women reported feeling less secure than men (p=0.046), and students who submitted to COVID-19 Specific Biosafety Training felt safer in clinical activities than those submitted to theoretical training only (p=0.011). Students from private universities presenting psychosomatic changes felt less secure in practicing clinical dental care activities (p=0.006). In conclusion, time-spent training in biosafety, restriction of the use of aerosol-producing procedures, and the gender of students were associated with the self-perception safety of students. Students with practical training felt safer in clinical activities for patients with COVID-19 than those who had only theoretical training

Flipped classroom and the use of role-play in the COVID-19 pandemic: challenges and learning

Aim In Brazil, COVID-19 remains one of the epicenters of the pandemic, thus, presential educational activities are suspended. The study aimed to describe the approach of flipped classroom performed to provide social distancing and to maintain teaching activities during COVID-19-pandemic. Methods Flipped Classroom was chosen to be associated with the role-play technique as a central methodology. To bring students closer to activities performed in the non-pandemic period, some actions and assessments were also role-played by Professor simulating patients in virtual meetings. Results Although the changes in the format of the lessons, our approaches stimulated the students maintained the high frequency of students in the activities (almost 100%) providing continuity activities. Conclusions This report can reinforce that meaningful learning can be taught by using a virtual/remote approach. However, the potential positive results observed cannot be used as an excuse to maintain remote teaching activities with the objective of cost-cutting by the institutions.

Laser photobiomodulation effect on fibroblasts viability exposed to endodontic medications

Aim: The literature has not yet reported investigations about the effect of laser photobiomodulation (LPBM) over the cytotoxicity of drugs for endodontic treatments. Thus, the aim of this study was to evaluate, in vitro, the effect of the association between LPBM and intracanal medications on fibroblasts viability in different exposure times. Methods: Calcium hydroxide (Ca(OH)2) and iodoform (IO) were used pure or associated to LPBM. Eluates of medications were prepared and placed in contact with the cells in three different periods: 24h, 48h and 72h. Laser irradiation (emitting radiation λ 660nm, power density of 10mW, energy density of 3 J/cm²) has been performed in two sessions within a six hour interval, for 12s per well. After each experimental time, the colorimetric assay (MTT) has been performed. Statistical analysis was applied for Mann-Whitney test with 5% α error admitted test. Results: At 24h, the use of LPBM did not increase cell viability while after 72h cell proliferation was stimulated in the group without medications. LPBM application did not increase cell viability in Ca(OH)2 group and IO at any tested time. Ca(OH)2 cytotoxicity at 24h was higher than iodoform, while at 72h not difference was observed. Therefore, after 72 hours was no statistical difference between the IO and Ca(OH)2 groups. Conclusion: LPBM was able to increase cell viability in 72h in the group without medication, although no improvement was observed in the other groups. Thus, LPBM was not able to reduce the cytotoxic effects of the materials on fibroblasts in vitro

Single nucleotide polymorphisms of taste genes and caries: a systematic review and meta-analysis.

OBJECTIVE: The aim of the present study was to systematically review the literature investigating the single nucleotide polymorphisms (SNP) related to taste genes and their influence on caries. MATERIAL AND METHODS: Search was performed in five databases to respond to the question: 'Are the polymorphisms of taste genes associated with dental caries?'. Studies in humans were included. Assessment of quality of studies, meta-analysis and sensitivity analysis were performed. RESULTS: Seven studies were included in the systematic review and two in meta-analysis. Most of studies (71.4%) presented cohort design with low-level of evidence. A total of 4,032 individuals were evaluated. Four different taste genes (TAS1R2, TAS2R38, TAS1R3 and GLUT2) and 12 SNPs were reported. Most SNPs of taste genes showed a protective effect of the minor allele against dental caries. Meta-analysis included the SNP rs713598 placed in the TAS2R38 gene. The results suggest an effect of the heterozygote genotype (CG), which was associate with low caries experience (OR = 0.35 CI95% [0.17-0.75]). However, the genotype GG was not associated (OR = 0.17 CI95% [0.03-1.04]). Sensitivity analysis showed an important influence of one study in the results. CONCLUSIONS: SNP of taste genes seems to be associated with caries experience. Causal inferences should be interpreted with caution and the results must be replicated in different populations.

Hydroxyapatite Synthesis and Covering of Titanium Surfaces by Dip-Coating Method

Abstract This study developed and characterized a method for controlled deposition of thin films of hydroxyapatite on titanium surfaces. Thirty-three titanium cylinders were randomly divided: negative control/polished (A), acid etched (B) and coated by hydroxyapatite (C). Acid etch was performed in an aqueous solution of nitric acid. The cylinders were subjected to coating by a thin film of hydroxyapatite with dip-coating method. These cylinders were submitted to a pre-heat treatment 450°C/10 minutes and 800°C/2 hours. Scanning electron microscopy analysis demonstrated a homogeneous and smooth surface (A), an irregular and porous surface (B) and a crystalline deposition (C). The X-ray energy dispersive analysis showed characteristic elements of hydroxyapatite (C). Analysis by X-ray diffraction showed the presence of characteristic peaks of hydroxyapatite, corresponding to the structural composition of hydroxyapatite. Cell viability (MTT-assay in NIH-3T3-Cells) test demonstrated no differences between the groups. Titanium surfaces coated with a hydroxyapatite film by the dip-coating method suggest adequate control of deposition of thin films of hydroxyapatite and similar cell viability using mouse fibroblasts.

Genes in the pathway of tooth mineral tissues and dental caries risk: a systematic review and meta-analysis.

OBJECTIVES: To perform a systematic review of the literature, investigating the influence of tooth mineral tissues genes on dental caries. MATERIALS AND METHODS: Five databases were searched. Only human studies with cross-sectional, longitudinal, and case-control design were included. Meta-analysis was performed for each polymorphism, providing allele and genotype estimates. A meta-analysis was performed, pooling several polymorphisms for each gene. A Funnel Plot and Egger's test were also performed. RESULTS: A total of 1124 records were found. Of these, 25 papers were included in the systematic review and 18 in the meta-analysis. Most of the studies (52%) were of medium quality. With regard to the allele analysis, the T allele of rs134136 (TFIP11) (OR 1.51; 95%CI 1.02-2.22) showed an association with high experience of caries and the summarization of polymorphisms investigated in the TFIP11 gene, after exclusion of SNP linkage disequilibrium, showed an association with caries experience (OR 1.64; 95%CI 1.08-2.50). An analysis of the homozygous genotype did not show any significant association. The pooled SNPs of AMBN showed associations with caries (OR 0.45; 95%CI 0.29-0.72). The pooled polymorphisms of AMELX were associated with caries experience (OR 1.78; 95%CI 1.23-2.56). In the analysis of the homozygous genotype, no SNP showed a significant association. Egger's test showed no significant publication bias for all models (p > 0.05). CONCLUSION: The present findings showed that the genes TFIP11, AMBN, and AMELX play an important role in dental caries. CLINICAL RELEVANCE: Several single nucleotide polymorphisms related to the genes in the formation of tooth mineral are linked to the occurrence of dental caries, and these genes have proved to be important for an explanation of differences in the risk of dental caries.

Estudo de 19 anos dos procedimentos odontológicos realizados no Sistema Único de Saúde brasileiro / A 19-years study of the dental procedures performed in the Brazilian Unified Health System

Resumo Introdução A saúde pública no Brasil sofreu grandes mudanças nas últimas décadas. Objetivo Descrever o panorama da produção odontológica realizada pelo SUS de 1999 a 2017 no Brasil e suas macrorregiões. Método Os dados foram obtidos no Sistema de Informação Ambulatorial (SIA-SUS) e do Instituto Brasileiro de Geografia e Estatística (IBGE). Foram criadas taxas de procedimentos (por 100 mil habitantes/ano) realizados em cada macrorregião: procedimentos restauradores, protéticos, coletivos, endodontia, exodontia, periodontia e preventivos de 1999 a 2017. A análise estatística das séries temporais foi realizada utilizando um modelo de regressão linear. Resultados Procedimentos protéticos e de periodontia foram os únicos que apresentaram uma tendência linear positiva em todas as macrorregiões brasileiras (p<0,001). A Endodontia não apresentou tendência positiva no Brasil (p=0,173). Restaurações apresentaram um crescimento na macrorregião Norte (p=0,003) e Centro-Oeste (p<0,001). Exodontias apresentaram na macrorregião Norte uma tendência de aumento (p=0,046) enquanto que, no Centro-Oeste, apresentaram uma diminuição (p=0,049). Procedimentos preventivos (p=0,042) e coletivos (p=0,017) apresentaram uma diminuição da sua produção durante o período. Conclusão A saúde bucal apresentou um grande crescimento dentro do Sistema Único de Saúde nos 19 anos avaliados. Procedimentos de periodontia e de prótese dentária foram aqueles com as maiores tendências de crescimento.

Abstract Background Public health in Brazil has undergone major changes in recent decades. Objective To describe the overview of dental production performed by the Brazilian Unified Health System from 1999 to 2017 in Brazil and its macroregions. Method Data were obtained from the Outpatient Information System (SIA/SUS) and from the Brazilian Institute of Geography and Statistics (IBGE). Procedures rates (per 100,000 inhabitants per year) were established in each macroregion: restorative, prosthetic, collective, endodontic, exodontia, periodontic and preventive procedures. Statistical analysis of the time series was performed using a regression linear model. Results Prosthetic and periodontal procedures were the only ones with a positive linear trend in all Brazilian macroregions (p<0.001). Endodontics did not show a positive trend in Brazil (p=0.173). Restorations showed a growth in the North (p=0.003) and Center-west (p<0.001) macroregions. Exodontia presented a tendency to increase in the North macroregion (p=0.046), while the Midwest presented a decrease of it (p=0.049). Preventive (p=0.042) and collective (p=0.017) procedures showed a decrease in their production during the period. Conclusion Oral health showed great growth within the single health system in the 19 years evaluated. Periodontal procedures and dental prostheses were those with the highest growth trends.

Bone, Periodontal and Dental Pulp Regeneration in Dentistry: A Systematic Scoping Review.

The aim of presented systematic scoping review was to investigate the actual and future clinical possibilities of regenerative therapies and their ability to regenerate bone, periodontal and pulp with histological confirmation of the nature of formed tissue. Electronic search was conducted using a combination between Keywords and MeSH terms in PubMed, Scopus, ISI-Web of Science and Cochrane library databases up to January 2016. Two reviewers conducted independently the papers judgment. Screened studies were read following the predetermined inclusion criteria. The included studies were evaluated in accordance with Arksey and O'Malley's modified framework. From 1349 papers, 168 completed inclusion criteria. Several characterized and uncharacterized cells used in Cell Therapy have provided bone regeneration, demonstrating bone gain in quantity and quality, even as accelerators for bone and periodontal regeneration. Synthetic and natural scaffolds presented good cell maintenance, however polyglycolid-polylactid presented faster resorption and consequently poor bone gain. The Growth Factor-Mediated Therapy was able to regenerate bone and all features of a periodontal tissue in bone defects. Teeth submitted to Revascularization presented an increase of length and width of root canal. However, formed tissues not seem able to deposit dentin, characterizing a repaired tissue. Both PRP and PRF presented benefits when applied in regenerative therapies as natural scaffolds. Therefore, most studies that applied regenerative therapies have provided promising results being possible to regenerate bone and periodontal tissue with histological confirmation. However, pulp regeneration was not reported. These results should be interpreted with caution due to the short follow-up periods.

Bone, periodontal and dental pulp regeneration in dentistry: a systematic scoping review

Abstract The aim of presented systematic scoping review was to investigate the actual and future clinical possibilities of regenerative therapies and their ability to regenerate bone, periodontal and pulp with histological confirmation of the nature of formed tissue. Electronic search was conducted using a combination between Keywords and MeSH terms in PubMed, Scopus, ISI-Web of Science and Cochrane library databases up to January 2016. Two reviewers conducted independently the papers judgment. Screened studies were read following the predetermined inclusion criteria. The included studies were evaluated in accordance with Arksey and O'Malley's modified framework. From 1349 papers, 168 completed inclusion criteria. Several characterized and uncharacterized cells used in Cell Therapy have provided bone regeneration, demonstrating bone gain in quantity and quality, even as accelerators for bone and periodontal regeneration. Synthetic and natural scaffolds presented good cell maintenance, however polyglycolid-polylactid presented faster resorption and consequently poor bone gain. The Growth Factor-Mediated Therapy was able to regenerate bone and all features of a periodontal tissue in bone defects. Teeth submitted to Revascularization presented an increase of length and width of root canal. However, formed tissues not seem able to deposit dentin, characterizing a repaired tissue. Both PRP and PRF presented benefits when applied in regenerative therapies as natural scaffolds. Therefore, most studies that applied regenerative therapies have provided promising results being possible to regenerate bone and periodontal tissue with histological confirmation. However, pulp regeneration was not reported. These results should be interpreted with caution due to the short follow-up periods.

Resumo O objetivo da presente Scoping review foi investigar as possibilidades clínicas atuais e futuras das terapias regenerativas e sua capacidade de regenerar tecido ósseo, periodontal e polpar em humanos com confirmação histológica da natureza do tecido formado. Uma busca eletrônica foi realizada utilizando uma combinação entre as palavras-chave e termos MeSH nos bancos de dados PubMed, Scopus, ISI-web of Science e Cochrane library até janeiro de 2016. Dois revisores realizaram de forma independente o julgamento dos documentos. Os estudos selecionados foram lidos seguindo os critérios de inclusão predeterminados. Os estudos incluídos foram avaliados de acordo com a estrutura modificada de Arksey e O'Malley. Dos 1349 artigos, 168 preencheram os critérios de inclusão. Várias células caracterizadas e não caracterizadas promoveram regeneração óssea utilizada em terapias celulares, demonstrando ganho ósseo em quantidade e qualidade, de forma rápida para regeneração óssea e periodontal. Os scaffolds sintéticos e naturais apresentaram boa manutenção celular, no entanto o poliglicol-polilácido apresentou uma reabsorção rápida e, consequentemente, pequeno ganho ósseo. A terapia mediada por fatores de crescimento foi capaz de regenerar tecido ósseo e todas as características de um tecido periodontal. Dentes submetidos à revascularização apresentaram aumento do comprimento e largura do canal radicular. No entanto, os tecidos formados não foram capazes de depositar dentina, caracterizando um tecido reparado. Tanto o PRP quanto o PRF parecem apresentar benefícios quando aplicados em terapias regenerativas sendo um bom scaffold natural. Portanto, a maioria dos estudos que aplicaram terapias regenerativas forneceram resultados promissores sendo possível regenerar tecido ósseo e periodontal com confirmação histológica. No entanto, não foi observada regeneração de polpa dental. Estes resultados devem ser interpretados com cautela.

Effect of temperature and storage time on dental bleaching effectiveness.

OBJECTIVE: To evaluate the effect of storage time and temperature on the effectiveness of bleaching agents. METHODS: Enamel slabs were randomly allocated according to the concentration of carbamide peroxide (CP): 10% (CP10) and 16% (CP16). Shade evaluations were conducted at baseline and then after 3 and 12 months of storage at 3 different temperatures: 10°C (±2°C), 25°C (±2°C), and 35°C (±2°C). Objective color evaluation was performed (spectrophotometer CIEL*a*b* system and CIEDE2000) to calculate the color change (ΔE00 ). Subjective evaluation was performed using the VITA classical shade guide followed by shade variation (ΔS). RESULTS: The bleaching effect of different CP concentrations (10% and 16%) at baseline showed no differences with regard to objective (ΔE00 ) and subjective parameters (ΔS) (P > .05). No differences were observed between CP concentrations stored for the same length of time and at the same temperature for either parameter (P > .05). In terms of objective measurement (ΔE00 ), a reduction in the bleaching effect was shown for both CP concentrations (10% and 16%) when stored for 12 months at 35°C, and compared with the baseline (P < .05). As regards the subjective parameters (ΔS), after 12 months, both CP concentrations (10% and 16%) stored at 35°C showed a decrease in bleaching capacity compared to baseline (P < .05). CP10 and CP16 stored at 10°C and 25°C did not suffer any loss in bleaching ability, even after 12 months (P > .05). CONCLUSIONS: The storage of bleaching agents for long periods at high temperatures can reduce the bleaching effectiveness of CP at 10% and 16%. CLINICAL SIGNIFICANCE: Clinicians must be made aware that they should store their bleaching products under proper temperature conditions and use them within an appropriate time frame; otherwise, the bleaching effect could be lost.

Gênero e Odontologia: Um relato de experiência / Gender and Dentistry: a clinical case report

Objetivo: a literatura tem apontado para uma pequena sensibilização e capacitação dos profissionais de saúde ao acolher e atender a população LGBT. O presente estudo objetivou relatar um caso clínico de uma usuária trans e discutir aspectos importantes sobre o atendimento e o acolhimento de transexuais e travestis. Relato de caso: a usuária, nome social de "A", 25 anos de idade, sexo biológico masculino e gênero feminino foi encaminhada da Unidade Básica de Saúde com queixas estéticas e cálculo supra/subgengival. A usuária chegou ao atendimento já apresentando sinais claros de desconforto e reclusão. Ao observar tal estado foi indagado à usuária, no início da entrevista dialogada, se ela teria outro nome em que gostaria de ser identificada. Então, prontamente a paciente identificou seu nome social. A partir daquele momento, J.F.C.P., passou a ser "A" durante todo o atendimento, bem como seu direito lhe assegura. Em seguida, a usuária já demonstrou estar mais confortável e receptiva a conversa da entrevista dialogada, fortalecendo o vínculo com a estudante. Ainda durante a entrevista, a usuária demonstrou ter dúvidas em relação a alguns de seus direitos enquanto mulher trans, como por exemplo, o uso do nome social no cartão do SUS. Considerações Finais: o profissional de saúde tem como principal papel no acolhimento de transexuais e travestis a criação de um vínculo isento de preconceitos. Assim, é dever do profissional atualizar-se em relação a questões de gênero e sexualidade a fim de prevenir situações e propagações de preconceito, discriminação e violência.(AU)

Objective: The literature has indicated a low level of awareness and training of health professionals in welcoming and serving the LGBT population. The present study aimed to report a clinical case of a trans user and discuss important aspects about the care and reception of transsexuals and transvestites. Case report: The user, with a social name of "A", 25 years old, male biological sex and female gender, was referred from the Basic Health Unit with aesthetic complaints and supra/subgingival calculus. The user arrived at the service already presenting clear signs of discomfort and seclusion. Considering such a state, the user was asked at the beginning of the dialog interview whether she had another name in which she would like to be identified. Then, the patient promptly identified her social name. From that moment, J.F.C.P. became "A" throughout the service, as assured by her rights. After this, the user was already more comfortable and receptive to the conversation in the interview, strengthening the bond with the student. During the interview, the user also expressed doubts about some of her rights as a trans woman, such as the use of the social name on her public health system card. Final considerations: The main role of health professionals in the reception of transsexuals and transvestites is to create a bond free of prejudices. Thus, professionals have a duty to be updated on issues of gender and sexuality to prevent situations and propagations of prejudice, discrimination, and violence.(AU)

O ensino da Odontologia minimamente invasiva: relato de experiência / The teaching of minimally invasive dentistry: an experience report

Por muitos anos o ensino de Odontologia foi baseado apenas na reprodução de técnicas restauradoras e o estudante era motivado a apenas realizar procedimentos, sem desenvolver habilidades reflexivas, as quais são tão importantes quanto as técnicas. O presente relato de experiência discute um caso clínico como problematizador no ensino da Odontologia minimamente invasiva. Discussões e formulação de tabelas e quadros foram realizadas pelos estudantes, assim como a elaboração de um guia prático para auxiliar a escolha do tratamento restaurador. As atividades foram tidas como produtivas e complementares na resolução das dúvidas que ainda estavam pendentes. Conclui-se que a utilização da metodologia ativa relatada na construção de conhecimento foi uma importante estratégia para criar situações de aprendizado na abordagem da Odontologia minimamente invasiva. O aprendizado significativo advindo de um caso clínico em andamento se mostrou uma importante estratégia de ensino (AU).

For many years, teaching dentistry has been based solely on the reproduction of restorative techniques, students being motivated merely to perform procedures without developing reflective skills, which are as important as the techniques themselves. This experience report discusses a clinical case and problematizes the teaching of minimally invasive dentistry. Discussions were held and the formulation of tables and charts was performed by the students, as well as the compilation of a practical guide to help with the choice of restorative treatment. The activities were considered productive and complementary in solving lingering doubts. It was concluded that the use of the active methodology reported in knowledge building was an important strategy for the creation of learning situations in the approach to minimally invasive dentistry. Meaningful learning from an ongoing clinical case proved to be an important teaching strategy (AU).

Produção especializada no SUS em capitais brasileiras com centros de especialidades odontológicas: uma análise descritiva / Specialized production in the unified health system in Brazilian capitals with dental specialty centers: a descriptive analysis

Centros de especialidades odontológicos (CEOs) são estabelecimentos de saúde de âmbito especializado que devem realizar uma quantidade mínima de procedimentos. Objetivos: descrever a produção odontológica especializada e reportar o cumprimento das metas nas capitais brasileiras com CEOs. Materiais e método: foi conduzido um estudo do tipo longitudinal retrospectivo, sendo realizada uma busca por CEOs cadastrados no Cadastro Nacional de Estabelecimentos de Saúde (CNES). A produção odontológica foi pesquisada no Sistema de Informações Ambulatoriais do Sistema Único de Saúde (SIASUS), de maio de 2015 a abril de 2016. Resultados: foram encontrados e considerados elegíveis para o presente estudo 59 CEOs, localizados em 19 capitais brasileiras e no Distrito Federal, sendo 48% CEOs tipo II. Cerca de 730 mil procedimentos especializados foram realizados durante os 12 meses avaliados. Uma taxa de 86% das metas foi cumprida, sendo que cirurgia foi à área com maior cumprimento (92%), seguida de periodontia (89%) e endodontia (76%). Uma das capitais apresentou apenas 33% das metas cumpridas. Três capitais não atingiram nenhuma das metas estabelecidas em procedimentos de endodontia. Conclusão: foi observada uma grande variação no cumprimento das metas entre as capitais com CEOs. Enquanto algumas capitais apresentaram elevado cumprimento das metas, outras exibiram dados preocupantes, principalmente nos procedimentos de endodontia. (AU)

Dental Specialty Centers (Centros de Especialidades Odontológicas ­ CEOs) are specialized health facilities that should perform a minimum number of procedures. Objectives: this study aimed to describe the specialized dental production and report the achievement of goals in Brazilian capitals with CEOs. Materials and method: a retrospective longitudinal study was performed with a search for the CEOs listed in the National Registry of Health Establishments. The dental production was searched in the Outpatient Information System of the Brazilian Unified Health System for the period from May 2015 to April 2016. Results: fifty-nine CEOs were found and considered eligible for the present study. They were located in 19 Brazilian capitals and in the Federal District, whereas 48% were CEOs Type II. Approximately 730 thousand specialized procedures were performed during the 12 months evaluated. A rate of 86% of goals was met and surgery presented the highest achievement (92%), followed by periodontics (89%) and endodontics (76%). One of the capitals achieved only 33% of the goals. Three capitals did not achieve any of the goals set for endodontic procedures. Conclusion: there was a great variation in the achievement of goals among capitals with CEOs. While some capitals showed high achievement of goals, others presented concerning data, especially for endodontic procedures. (AU)

Restorations in primary teeth: a systematic review on survival and reasons for failures.

BACKGROUND: Several restorative materials with specific indications are used for filling cavities in primary teeth. AIM: To systematically review the literature in order to investigate the longevity of primary teeth restorations and the reasons for failure. DESIGN: Electronic databases were screened, and eligible studies were hand-searched to find longitudinal clinical studies evaluating the survival of restorations (class I, class II, and crown) placed with different materials in primary teeth with at least one year of follow-up. RESULTS: Thirty-one studies were included, and a high bias risk was observed. Overall, 12,047 restorations were evaluated with 12.5% of failure rate. A high variation on annual failure rate (AFR) was detected (0-29.9%). Composite resin showed the lowest AFRs (1.7-12.9%). Stainless steel crowns (SSC) had the highest success rate (96.1%). Class I restorations and restorations placed using rubber dam presented better AFR. The main reason for failure observed was secondary caries (36.5%). CONCLUSIONS: An elevated number of failures were observed due to recurrent caries, highlighting the need for professionals to work with a health-promoting approach. The high variation on failure rate among the materials can be due to children's behavior during the procedure, which demands short dental appointments and a controlled environment.

What is the clinical applicability of regenerative therapies in dentistry? / Qual a aplicabilidade clínica das terapias regenerativas na odontologia?

ABSTRACT Regenerative therapies have been widely developed in dentistry and it is important to incorporate dentists' knowledge of these new therapies into the dental clinic routine. This study reviewed the literature on regenerative therapies and clinical applications. Tissue engineering has contributed to changes in the paradigm of restorative health sciences. Its pillars underpin the techniques of tissue and organ regeneration. Despite the majority of studies in this field being in vitro, a range of preclinical studies and methodologies has been formed using these principles and they are already being used on humans. The use of platelet-rich plasma and platelet-rich fibrin in surgery as natural scaffolds for the reestablishment of bone and periodontal tissue are often reported in the literature and clinical trials using this approach have shown promising results. Stem cells from autologous dental pulp have been successfully applied in bone tissue regeneration using natural collagen scaffold in humans. In addition, revascularization of the root canal already appears in the literature as a promising alternative to apexification. The principle behind this therapy is the use of the blood clot as a scaffold and the migration of stem cells of the apical papilla to regenerate the dental pulp organ. Final considerations: Although still in the early stages, regenerative therapies can now be used in dental practice. Knowledge of the principles governing these therapies should be understood by the dentist for use in clinical practice.

RESUMO Terapias regenerativas vem sendo amplamente desenvolvidas na odontologia e o conhecimento destas novas terapias por parte dos dentistas é importante para que elas sejam incorporadas na rotina clínica odontológica. Assim, este estudo revisou a literatura acerca das terapias regenerativas e suas aplicações clínicas. A engenharia tecidual tem contribuído na mudança do paradigma restaurador das ciências da saúde. Seus pilares embasam as técnicas de regeneração de tecidos e órgãos. Apesar da grande maioria dos estudos neste campo ser in vitro, uma gama de metodologias pré-clínicas foi consolidada e estudos utilizando estes princípios já estão sendo empregados em humanos. A utilização de plasma rico em plaquetas e plasma rico em fibrina como scaffolds naturais em cirurgias para reestabelecimento de tecido ósseo e periodontal são frequentemente relatadas na literatura e ensaios clínicos utilizando esta abordagem demonstram resultados promissores. Células-tronco da polpa dental autólogas já foram aplicadas com sucesso na regeneração de tecido ósseo utilizando scaffold naturais de colágeno em humanos. Além disto, a revascularização do canal radicular já aparece na literatura como uma alternativa promissora frente a opção de apecificação do canal radicular. Esta terapia utiliza como princípio o coágulo sanguíneo como scaffold e a migração das células-tronco da papila apical para regenerar o órgão pulpar. Considerações finais: Apesar de incipientes, as terapias regenerativas já podem ser utilizadas na prática clínica odontológica. O conhecimento dos princípios que regem estas terapias deve ser compreendido pelo dentista para que sejam utilizadas na prática clínica.

Platelet-Poor Plasma as a Supplement for Fibroblasts Cultured in Platelet-Rich Fibrin.

The aim of this study was to evaluate the proliferation and adhesion of mesenchymal cells (3T3/NIH) in Dulbecco's Modified Eagle Medium(DMEM) supplemented with Platelet-Poor Plasma (PPP) in aPlatelet-Rich Fibrin (PRF) scaffold. Human blood was obtained and processed in a centrifuge considering the equation G=1.12xRx(RPM/1000)2 to obtain PRF and PPP.Cell adhesion and maintenance analyses were performed by MTTassays in a 96 well plate withsupplemented DMEM: PPP (90:10) for 24 hours. Besides, the PRF was deposited in a 48 well plate and 10x104 cells were seeded above each PRF (n=3) with 800µl of DMEM: PPP (90:10) and cultured for 7 days. Histological analysis and the immunohistochemical staining for Vimentin were performed. Results were analyzed by one-way ANOVA in Stata12®. A significant decrease (p<0.05) of cells adhesion in relationship to FBSwas observed. However, a similar ability of cell-maintenance for PPP 10% was observed (P>0.05). Fibroblasts culture for 7 days in PRF supplemented with PPP 10% was possible, showing positive staining for Vimentin. Therefore, PPP cell supplementation decreased the initial adhesion of cells but was able to maintain the proliferation of adhered cells and able to support their viability in PRF.It seems that this method has many clinical advantagessince it provides an autologous and natural scaffold with their respective supplement for cell culture by only one process, without using xenogeneic compounds. This could improve the potential of clinical translational therapies based on the use of PRF cultured cells, promoting the regenerative potential for future use in medicine and dentistry.

Análise descritiva dos trabalhos de conclusão de curso da Faculdade de Odontologia, UFPel / Descriptive analysis of work completion course of the graduate course in Faculty of Dentistry, UFPel

Os Trabalhos de Conclusão de Curso (TCCs) se tornaram obrigatórios na Faculdade de Odontologia da Universidade Federal de Pelotas (FO-UFPel) a partir de 2006, sendo requisito indispensável para a obtenção do título de Cirurgião-Dentista. A compreensão de como os TCCs estão sendo realizados é imprescindível para um correto direcionamento de estratégias na construção dos currículos de graduação, uma vez que até o momento poucos estudos foram conduzidos com a finalidade de analisar os TCCs realizados nos cursos de Odontologia do Brasil. Desta forma, o objetivo deste estudo foi realizar um levantamento dos dados referentes aos TCCs realizados na FO-UFPel até 2014. As variáveis investigadas foram área de concentração do trabalho e tipos de estudos/metodologia empregada. Além disto foi realizada uma busca nas bases de dados PubMed, SciELO e Google Acadêmico para investigar se o trabalho foi publicado em periódicos científicos e o respectivo Qualis. Os dados foram tabulados e analisados descritivamente. Foram encontrados 474 TCCs, (impressos e em formato digital) sendo que a maioria deles foi realizada na área de Dentística (11,4%), Saúde Coletiva (11,0%) e Cirurgia Oral (10,5%). Do total de TCCs, 25,7% foram revisões narrativas da literatura. Apenas 9% das monografias foram publicadas em periódicos científicos. Portanto, é possível concluir que a maioria dos TCCs realizados na FO-UFPelsão revisões narrativas da literatura e que a taxa de publicação destes trabalhos é pequena. Além disso, recomenda-se que novas estratégias sejam empregadas pelos gestores da universidade para propiciar que os TCCs possam ser referência na difusão do conhecimento à comunidade acadêmica (AU).

The final paper (TCCs) became mandatory in the Faculty of Dentistry, Federal University of Pelotas (FO-UFPel) since 2006, and an indispensable requirement for obtaining DDS title. Understanding how the TCCs are being carried out is essential for proper targeting strategies in the construction of the undergraduate curriculum, since to date few studies were conducted in order to analyze the TCCs made in dentistry courses in Brazil. Thus, the aim of this study was to survey the data for TCCs performed in FO-UFPel by 2014. The variables were: area of work concentration, types of studies/methodology. In addition, a search was conducted in PubMed, SciELO and Google Scholar to investigate whether the work was published in scientific journals and their Qualis conceit. The data were tabulated and analyzed descriptively. 474 TCCs were founded (printed and digital format), and most of them were held in operative dentistry (11.4%) followed by public health (11.0%) and oral surgery (10.5%). 25.7% of TCCs were narrative reviews of the literature. Only 9% of monographs have been published in scientific journals. Therefore, we note that the majority of TCCs made in FO-UFPel are narrative literature reviews and the publication of these works is small. In addition, it is recommended that new strategies are employed by the university managers to provide that the TCCs can be reference in dissemination of knowledge to the academic community (AU).

Does Cryopreservation Affect the Biological Properties of Stem Cells from Dental Tissues? A Systematic Review.

This systematic review evaluated if different cryopreservation protocols could affect biological properties (Cell survival rate (CSR), proliferation, differentiation, maintenance of stem cell markers) of stem cells obtained from dental tissues (DSC) post-thaw. An electronic search was carried out within PubMed and ISI Web Science by using specific keyword. Two independent reviewers read the titles and abstracts of all reports respecting predetermined inclusion/exclusion criteria. Data were extracted considering the biological properties of previously cryopreserved DSCs and previously cryopreserved dental tissues. DSCs cryopreserved as soon as possible after their isolation presents a CSR quite similar to the non-cryopreserved DSC. Dimethyl sulfoxide (DMSO) [10%] showed good results related to cell recovery post-thaw to cryopreserve cells and tissues for periods of up to 2 years. The cryopreservation of DSC in a mechanical freezer (-80°C) allows the recovery of stem cells post-thaw. The facilities producing magnetic field (MF), demand a lower concentration of cryoprotectant, but their use is not dispensable. It is possible to isolate and cryopreserve dental pulp stem cell (DPSC) from healthy and diseased vital teeth. Cryopreservation of dental tissues for late DSC isolation, combined with MF dispensability, could be valuable to reduce costs and improve the logistics to develop teeth banks.

Terapias para regeneração do disco articular

O presente estudo revisou a literatura científica em busca das perspectivas e dos principais desafios enfrentados pelas terapias de regeneração do disco articular. Revisão de literatura: a disfunção temporomandibular (DTM) é uma desordem de etiologia multifatorial em que patologias, deformidades e mau posicionamento do disco da articulação temporomandibular (ATM) estão presentes em até 70% dos casos diagnosticados. Dessa forma, o emprego de conhecimentos e princí- pios da engenharia tecidual para o desenvolvimento de terapias que busquem a regeneração do disco articular pode ser uma opção de tratamento futuro. Células- -tronco mesenquimais (MSC) são frequentemente empregadas, apresentando a capacidade de se diferenciar em condrócitos e depositar tecido semelhante ao da ATM. Estudos têm apontado que essas células podem apresentar melhor regeneração que células removidas da própria ATM lesionada, que apresentam uma menor deposição de matriz extracelular. Abordagens para reconstrução têm empregado, principalmente, scaffolds sintéticos, como polímeros e hidrogéis, assim como scaffolds naturais de origem colágena. Esses materiais têm possibilitado a proliferação celular e a deposição de matriz extracelular. Técnicas de descelularização com diversos solventes orgânicos têm apresentado a capacidade de não desenvolver resposta imune, sendo possível sua utilização. A utilização de fatores de crescimento parece contribuir significativamente na sinalização e diferenciação celular, incrementando a deposição de tecido cartilaginoso. Considerações finais: apesar de a regeneração tecidual do disco articular se apresentar como uma provável opção de tratamento para os diversos tipos de DTM, a literatura ainda se encontra em fase inicial de investigação, com estudos predominantemente in vitro e in vivo.