Avaliação do potencial de regeneração óssea guiada e biocompatibilidade de membrana polimétrica nano estruturada à base de quitosana / Evaluation of guided bone regeneration potential and biocompatibility of nano-structured polymeric membrane based on chitosan

A regeneração óssea guiada (ROG) é uma técnica muito utilizada na odontologia para reconstrução de defeitos alveolares para posterior instalação de implantes dentários. Para que a técnica seja efetiva, uma membrana que permita o isolamento de diferentes tipos teciduais é necessária. A quitosana nanoestruturada modificada por hidróxidos duplos lamelares (HDL) é um biopolímero sintético que busca unir as características promissoras da quitosana como material bioadesivo e com propriedades antimicrobianas com a hidrocalcita buscando aprimorar suas características estruturais. O objetivo deste estudo in vivo foi avaliar a biocompatibilidade e o potencial de regeneração óssea guiada de uma nova membrana produzida à base de quitosana nanoestrutada modificada por HDL. Ratos Wistar machos adultos (n=64) foram divididos randomicamente em 2 grupos de acordo com o tratamento: Colágeno (COL) e Quitosana (QTS). Os animais foram submetidos à cirurgia para instalação de uma membrana no subcutâneo da região dorsal e à realização de 2 defeitos críticos na calota craniana, respeitando cada lado do animal. O defeito do lado direito foi coberto por uma das membranas testadas (COL ou QTS) enquanto o outro permanecia descoberto (Controle). Oito animais de cada grupo foram sacrificados em 4 tempos de acompanhamento: 3, 7, 14 e 30 dias. Amostras de calota e subcutâneo foram coletadas e preservadas em paraformaldeído 4%. As amostras de calota foram escaneadas em viii microtomógrafico para análise da quantidade de osso neoformado. Em seguida, os espécimes de calota e subcutâneo foram processados laboratorialmente para exames histológicos em parafina: para avaliação histomorfológica das características do processo cicatricial e de degradação das membranas e histomorfométrica para quantificação do processo inflamatório e do nível de reação tecidual por meio do escore global de reação tecidual (EGRT). Análises descritivas e inferenciais foram realizadas para comparação entre os grupos com nível de significância de 5%. Os resultados não demonstraram diferenças entre os grupos COL e QTS quanto à intensidade do processo inflamatório e EGRT. Já em relação aos defeitos na calota, o grupo QTS apresentou maior neoformação óssea em relação ao grupo controle aos 30 dias (p=0,04). Com base nos resultados conclui-se que as membranas de quitosana nano particuladas modificadas por HDL apresentaram biocompatibilidade compatível com a membrana de colágeno e efetividade para uso como barreira em ROG. (AU)

Guided bone regeneration (GBR) is a technique widely used in dentistry to reconstruct alveolar defects for subsequent installation of dental implants. For the technique to be effective, a membrane that allows the isolation of different tissue types is necessary. Nanostructured chitosan modified by lamellar double hydroxides (HDL) is a synthetic biopolymer that seeks to combine the promising characteristics of chitosan as a bioadhesive material with antimicrobial properties with hydrocalcite seeking to improve its structural characteristics. The objective of this in vivo study was to evaluate the biocompatibility and guided bone regeneration potential of a new membrane produced based on nanostructured chitosan modified by HDL. Adult male Wistar rats (n=64) were randomly divided into 2 groups according to treatment: Collagen (COL) and Chitosan (QTS). The animals underwent surgery to install a membrane in the subcutaneous tissue of the dorsal region and to perform 2 critical defects in the cranial vault, respecting each side of the animal. The defect on the right side was covered by one of the tested membranes (COL or QTS) while the other remained uncovered (Control). Eight animals from each group were sacrificed at 4 follow-up times: 3, 7, 14 and 30 days. Calvary and subcutaneous samples were collected and preserved in 4% paraformaldehyde. The cap samples were scanned in a microtomograph to analyze the amount of newly formed bone. Then, the cap and subcutaneous specimens were processed in the laboratory for histological examinations in paraffin: for histomorphological evaluation of the characteristics of the scarring process and membrane degradation and histomorphometric for quantification of the inflammatory process and the level of tissue reaction through the global score of tissue reaction (EGRT). Descriptive and inferential analyzes were performed for comparison between groups with a significance level of 5%. The results showed no differences between the COL and QTS groups regarding the intensity of the inflammatory process and EGRT. In relation to the defects in the calvaria, x the QTS group presented greater new bone formation in relation to the control group at 30 days (p=0.04). Based on the results, it is concluded that the nanoparticulate chitosan membranes modified by HDL showed biocompatibility compatible with the collagen membrane and effectiveness for use as a barrier in GBR. (AU)

Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review.

The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review

Abstract: The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

Unusual case of ankyloglossia recurrence after frenectomy in a child with cerebral palsy

Introduction: Frenectomy is the most indicated treatment for ankyloglossia in children and adolescents, with recurrence being extremely rare. Objective: Here, we report the unusual case of an 8-year-old boy with cerebral palsy presenting recurrence of ankyloglossia 2 years after undergoing lingual frenectomy. Case report: On physicalexamination, in a follow-up, 2 years after a lingual frenectomy, we observed a slightly elastic, short and adhered lingual frenulum and the presence of a heart-shaped tongue, with severe restriction of lateral and superior movements, and difficulties in speech and swallowing. A new frenectomy was performed under local anesthesia, restoring lingual mobility. The patient has been followed-up periodically and has undergone speech therapy; 2 years after the second surgery, firm insertion of the frenulum and the continuity of the bifid aspect of the tongue have been again verified, but the tongue movements and oral functions remain satisfactory. The patient will continue to be followed periodically and a new intervention will be performed if there are changes in oral functions. Conclusion: Beyond the need forperiodic clinical follow-up, the diagnosis and multidisciplinary treatment of ankyloglossia are fundamental for identifying possible cases of recurrence, which, although rare, can occur.

Introdução: A frenectomia é o tratamento mais indicado para os casos de anquiloglossia em crianças e jovens, sendo a recorrência extremamente rara. Objetivo: O objetivo é relatar o caso incomum de um menino de 8 anos, com paralisia cerebral, apresentando recidiva de anquiloglossia dois anos após a realização de frenectomia lingual. Relato de caso: Ao exame físico, em consulta de revisão, 2 anos após uma frenectomia lingual observou-se freio lingual levemente elástico, curto e aderido, presença de formato de coração na língua, restrição severa dos movimentos laterais e superiores, além de dificuldades na fala e deglutição. Uma nova frenectomia foi realizada após dois anos da primeira frenectomia , sob anestesia local, restaurando a mobilidade lingual. O paciente foi acompanhado periodicamente junto com a fonoaudiologia e após 2 anos da segunda cirurgia, a inserção firme do freio e a continuidade do aspecto bífido da língua foram novamente verificadas, porém, os movimentos da língua e as funções orais mantiveram-se satisfatórios. O paciente continuará a ser acompanhado periodicamente e, se houver alterações nas funções orais, uma nova intervenção será realizada. Conclusão: É fundamental o diagnóstico e tratamento multidisciplinar da anquiloglossia, além da necessidade de acompanhamento clínico periódico para identificar possíveis casos de recidiva, que, embora raros, podem ocorrer.