Study of anatomical variations in premolars by cone beam computerized tomography in a radiologic clinic in Piauí / Estudo de variações anatômicas em pré-molares por tomografia computadoriza de cone beam em uma clínica radiológica no Piauí

Introduction: Root canal cleaning is the main objective of endodontic treatment and requires knowledge of the internal anatomy. The premolars are evidenced in the literature with great anatomical variations. In view of this, studies indicate that the use of Cone Beam Computed Tomography helps in the visualization of highly complex anatomy. Objective: to describe the anatomical variations in maxillary and mandibular premolars using cone beam computed tomography in a radiologic clinic in Piaui. Methods: 54 cone beam computed tomography scans with 160 premolars were used, produced using the Orthopantomograph OP300 equipment and analyzed by multiplanar reconstructions: axial, coronal and sagittal. Data regarding sex, number of roots and canals were recorded to compare and classify according to Vertucci. Results: the maxillary first pre-molars had 63.5% two roots,83.7% with one root and the mandibular pre-molars mostly with one root. Regarding the number of channels, 92.3% of the first premolars had two channels, most of them maxillary second premolars and mandibular premolars only one channel. Vertucci variations of types I, II, III and IV were verified in single-rooted elements, observing a great variation in superior elements. As for the prevalence of sex, only the first superiors showed greater variation in males. Conclusions: the upper first premolars prevailed with a great anatomical variation in relation to the other premolars with prevalence of Vertucci Type I and in males.

Introdução: a limpeza do canal radicular é o principal objetivo do tratamento endodôntico e requer conhecimento da anatomia interna. Os pré-molares são evidenciados na literatura com grandes variações anatômicas. Diante disso, estudos indicam que o uso da Tomografia Computadorizada Cone Beam auxilia na visualização de anatomias de alta complexidade. Metodologia: foram utilizadas 54 tomografias computadorizadas de feixe cônico com 160 pré-molares, produzidas no equipamento Orthopantomograph OP300 e analisadas por reconstruções multiplanares: axial, coronal e sagital. Os dados referentes ao sexo, número de raízes e canais foram registrados para comparação e classificação segundo Vertucci. Resultados: os primeiros pré-molares superiores apresentavam 63,5% de duas raízes, 83,7% dos segundos pré-molares superiores tinham uma raiz e a maioria dos pré-molares inferiores tinha uma raiz. Em relação ao número de canais, 92,3% dos primeiros pré-molares possuíam dois canais, sendo a maioria segundos pré-molares superiores e pré-molares inferiores apenas um canal. Vertucci variações dos tipos I, II, III e IV foram verificadas nos elementos uniradiculares, observando-se a grande variação nos elementos superiores. Quanto à prevalência do sexo, apenas os primeiros superiores apresentaram maior variação no sexo masculino. Conclusão: os primeiros pré-molares superiores prevaleceram com grande variação anatômica em relação aos demais pré-molares com prevalência de Vertucci Tipo I e no sexo masculino.

Acolhimento acadêmico e reconfiguração dos modelos educacionais durante a pandemia de COVID-19: relato de experiência / Recepción académica y reconfiguración de modelos educativos durante la pandemia COVID-19: relato de experiencia / Academic reception and reconfiguration of educational models during the COVID-19 Pandemic: experience rep

O presente artigoobjetiva relatar a experiência da aplicação de ferramentas digitais em encontros virtuais para o acolhimento de alunos ingressantes do curso de Odontologia da Universidade Estadual do Piauí (UESPI)durante a fase de isolamento social advinda da pandemia do novo coronavírus no ano de 2020. A ação extensionista foi realizada em cinco encontros virtuais por meio da plataforma de reuniões Google Meete foram aplicadas ferramentas colaborativas como Padlet, Mentimetere Google Formspara integração do grupo. A participação dos ingressantes foi integral, 100% dos estudantes matriculados no primeiro período do curso se fizeram presentes nos encontros. Diante das incertezas relativas ao início do período letivo no ano de 2020, a proposta realizada obteve êxito no objetivo principal de acolher os ingressantes e estabelecer o vínculo com a família do curso de Odontologia da UESPI. Desta forma a experiência mostrou-se positiva, proporcionando uma acolhida dos discentes durante o período mais crítico da pandemia de COVID-19 e forte isolamento social (AU).

Este artículo tiene como objetivo relatar la experiencia de aplicación de herramientas digitales en reuniones virtuales de bienvenida a estudiantes que ingresan a la carrera de Odontología de la Universidad Estadual de Piauí (UESPI) durante la fase de aislamiento social derivada de la pandemia del nuevo coronavirus en 2020. La acción de extensión se llevó a cabo en cinco reuniones virtuales utilizando la plataforma de reuniones Google Meet y se aplicaron herramientas colaborativas como Padlet, Mentimeter y Google Forms para la integración del grupo. La participación de los estudiantes de primer año fue plena, en las reuniones estuvo presente el 100% de los estudiantes matriculados en el primer periodo del curso. Ante las incertidumbres respecto al inicio del periodo académico del año 2020, la propuesta realizada tuvo éxito en su objetivo principal de dar la bienvenida a nuevos estudiantes y establecer un vínculo con la familia de carreras de Odontología de la UESPI. De esta manera, la experiencia resultó positiva, brindando a los estudiantes una acogida durante el período más crítico de la pandemia de COVID-19 y de fuerte aislamiento social (AU).

The present article aims to report the experience of applying digital tools in virtual meetings to welcome students entering the Dentistry course at the State University of Piauí (UESPI) during the social isolation phase resulting from the new coronavirus pandemic in 2020. The extension action was carried out in five virtual meetings using the Google Meet meeting platform and collaborative tools such as Padlet, Mentimeter and Google Forms were applied to integrate the group. The participation of freshmen was full, 100% of students enrolled in the first period of the course were present at the meetings. Given the uncertainties regarding the start of the academic period in 2020, the proposal made was successful in its main objective of welcoming new students and establishing a bond with the UESPI Dentistry course family. In this way, the experience proved to be positive, providing students with a welcome during the most critical period of the COVID-19 pandemic and strong social isolation (AU).

Microscopy in Endodontics: A Bibliometric Survey.

Background: Microscopy is a resource used in endodontics as an aid in the study of pulp and periapical pathologies; it has allowed Endodontics to become more accurate, less invasive and has enabled greater chances of success in treatment. We aimed to map the scientific production on "microscopy" and "endodontics" in the databases, the ISI Web of Knowledge/Web of Science tm. Methods: This bibliometric survey was conducted using ISI Web of Knowledge/Web of Science database, in the time frame between the years 1945 and 2016, the first being found in 1981. Results: Overall, 287 articles were identified. These articles are published in 63 different journals and were written by 1145 authors who have links to 336 institutions, located in 46 countries. To achieve these articles, 5,668 references were used, with an average of approximately 20 references per article. In the national literature the number of studies on the subject is broad compared to the international literature. Conclusion: The bibliometric review showed the potential of microscopy in clinical practice, the continuity of the investigation, in view of the need to expand knowledge on the topic that remains relevant.

The Impact of Dental Midline on Asymmetric Faces: Perspective of Laypersons and Dentists.

BACKGROUND: The objective was to determine if asymmetric facial features, nasal and chin deviations, affect the perception of attractiveness of a dental midline angulation, and if it is consistent among both dentists and laypeople. It was also analyzed if factors, such as the sex, age group of the participants and the dentist's area of operation are relevant in their assessment. METHODS: A cross-sectional study, approved by the Ethics Committee of Fernando Pessoa University. From a symmetrical facial model (SFM) image, a natural-looking asymmetrical face was created. Based on this asymmetric facial model six images were created, with different directions and degrees of inclination of the dental midline. In total, 236 laypersons and 242 dentists completed the online questionnaire where they rated the self-perception of attractiveness of the eight images (VAS scale from 0 to 10). Non-parametric comparisons (IBM© SPSS Statistics vs. 27.0, p < 0.05). RESULTS: The results showed a significant difference in the perception of attractiveness between laypeople and dentists. This finding was consistent regarding every image, except for the SFM. The factors, sex of the people participating and dentist's area of operation, seemed only to contribute to a significant difference in the perception when it came to the SFM. The perceived attractiveness of the images, for dentists and laypersons, did not differ by age group of the participant, apart from images 6 and 8. CONCLUSIONS: Dentists are more rigorous about dental midline inclinations than laypersons. The perception of attractiveness was affected by the age group and sex of the participants and the dentist's area of operation.

Bone repair in defects filled with AH Plus sealer and different concentrations of MTA: a study in rat tibiae.

OBJECTIVES: This study aimed to evaluate the effects on bone repair of different concentrations of mineral trioxide aggregate (MTA) added to AH Plus. MATERIALS AND METHODS: Bone tissue reactions were evaluated in 30 rats (Rattus norvegicus) after 7 and 30 days. In the AH + MTA10, AH + MTA20, and AH + MTA30 groups, defects in the tibiae were filled with AH Plus with MTA in proportions of 10%, 20% and 30%, respectively; in the MTA-FILL group, MTA Fillapex was used; and in the control group, no sealer was used. The samples were histologically analyzed to assess bone union and maturation. The Kruskal-Wallis and Mann-Whitney tests were performed for multiple pairwise comparisons (p ≤ 0.05). RESULTS: At the 7-day time point, AH + MTA10 was superior to MTA-FILL with respect to bone union, and AH + MTA20 was superior to MTA-FILL with respect to bone maturity (p < 0.05). At the 30-day time point, both the AH + MTA10 and AH + MTA20 experimental sealers were superior not only to MTA-FILL, but also to AH + MTA30 with respect to both parameters (p < 0.05). The results of the AH + MTA10 and AH + MTA20 groups were superior to those of the control group for both parameters and experimental time points (p < 0.05). CONCLUSIONS: The results suggest the potential benefit of using a combination of these materials in situations requiring bone repair.

Trabalho de conclusão de curso de Odontologia: uma análise de perfil / Dentistry course monograph: a profile analysis

Este estudoavaliouo perfil de pesquisa acadêmica do Curso de Odontologia do Centro Universitário Uninovafapi por meio da análise de todososTrabalhos de Conclusão de Curso (TCC)apresentados no período de 2014/1 a 2019/1. Trata-se de pesquisa documental de caráter exploratório realizada no repositório de TCC da instituição. Dos 267 TCC defendidos no período pesquisado, 262atenderam aos critérios de inclusão. Os resultados apontaram que anota média foi 9,3±0,9 pontos. Observou-se que a área mais escolhida pelos alunos foia Ortodontia (17,2%). Apenas 19(7,3%)foram publicados em periódicos científicos. Conclui-se que a Ortodontia é a especialidade que desperta maior interesse nos acadêmicos de Odontologia para escrita do seu trabalho de conclusão. Além disso, verificou-se a necessidadede reflexão do corpo docente e discente para a concretização de publicações cientificas ainda na graduação (AU).

This study analyzed the academic research profile of the Dentistry Course at UninovafapiUniversity Centre through the analysis of all monographs presented in the period from 2014.1 to 2019.1. This is an exploratory research carried out in institution's monograph repository. The collected data were tabulated and analyzed with Microsoft Excel®software. Of the 267 monographs, 262 were included. The results showed that mean grade was 9.3 ± 0.9 points. It was observed that the area most chosen by students is Orthodontics (17.2%). Only 19 were published in scientific journals. We conclude that Orthodontics is the specialty with the greatest interest. In addition, it is important for teaching staff and students to think about achieving scientific publications during the undergraduate course (AU).

Acidentes perfurocortantes entre acadêmicos de Odontologia / Accidents with cutting and piercing materials among Dentistry students

Os profissionais da saúde estão expostos aos mais diversos riscos ocupacionais durante a sua jornada de trabalhoeos cirurgiões-dentistas lideram o número de acidentes com materiais biológicos. Os atendimentos por acadêmicos de odontologia os deixam expostos aos riscos ocupacionais de forma semelhante aos profissionais da área. Este estudo teve o objetivo de avaliar prevalência e características dos acidentes com instrumentais perfurocortantesentre osacadêmicos de umcurso de Odontologia. Constatou-se prevalência de 28,85%de acidentes, com o maior percentual no 5° períodode curso,principalmente nasclínicas de Cirurgia e Endodontia. Apenas 20% dos afetados relataram a ocorrênciae a sonda exploradora foi o instrumental mais envolvido.Além disso,osacidentes ocorreram de forma igual no atendimento ao pacienteelavagem do instrumental. Portanto, faz-senecessário investimento em ações educativas e normativas permanentes para conscientização de acadêmicos sobre acidentes perfurocortantes (AU).

Health professionals are exposed to the most diverse occupational risks during their workday and dentists lead the number of accidents with biological materials. The assistance provided by dental students leaves them exposed to occupational risks in a similar way to professionals in the field. This study aimed to evaluate the prevalence and characteristics of accidents with cutting and piercing instruments among students of a Dentistry course. There was a prevalence of 28.85% of accidents, with the highest percentage in the 5th period of the course, mainly in the Surgery and Endodontics clinics. Only 20% of those affected reported the occurrence and the sickle probe was the instrument most involved. In addition, accidents occurred equally in patient care and washing of instruments. Therefore, it is necessary to invest in permanent educational and normative actions to raise the awareness of students about needlestick injuries (AU).

Aesthetic Preference in the Transverse Orientation of the Occlusal Plane in Rehabilitation: Perspective of Laypeople and Dentists.

The present study had a convenience sample with 236 laypeople and 242 dentists who completed an online questionnaire to choose the most attractive image among six pairs for comparison. Control image: symmetric (parallelism between occlusal plane (OP), commissural line (CL), and interpupillary line (IL)). Change of Control, obtaining three images with a 3-degree inclination of the labial commissures. Image A: OP parallel to IL; Image B: OP parallel to CL; Image C: OP at 1.5 degree mean angulation between IL and CL. Non-parametric comparison (IBM© SPSS Statistics vs. 27.0, p < 0.05). The "Dentists" group's decreasing order of preference (attractiveness) of the images is: Control > A > C > B (p < 0.05). In the "Lay" group, it is: Control > A > (C not ≠ B). Dentists significantly prefer more the Control and Image A than laypeople (p < 0.001). Sex (single exception in laypeople), age, and dentist's area of activity did not interfere in the perception of attractiveness. Dentists and laypeople preferred the Control when compared to images with CL canted. In the existence of CL inclination, the preference of the groups was the IL as a reference for OP orientation, with the mean angulation or coincident with the CL being considered less aesthetic.

High-Power LED Units Currently Available for Dental Resin-Based Materials-A Review.

The pursuit of less time-consuming procedures led to the development of high-power light-curing-units (LCU) to light-cure dental-resin-based-materials. This review aims to describe high-power light-emitting-diode (LED)-LCUs, by a bibliometric systematization of in vitro and in vivo studies. The research-question, by PICO model, aimed to assess the current knowledge on dentistry-based high-power LED-LCUs by analyzing to what extent their use can promote adverse events on materials and patients' oral condition when compared to low-power LED-LCUs, on daily dental practice. PubMed and B-on database search focused on high-power (≥2000 mW/cm2) LED-LCUs outputs. Studies assessing performance of high-power LED-LCUs for light-curing dental-resin-based-materials were included. From 1822 screened articles, 21 fulfilled the inclusion criteria. Thirty-two marketed units with high levels of radiant emittance (≥2000 mW/cm2 up to 6000 mW/cm2) were identified. Most output values vary on 2000-3000 mW/cm2. The highest output found was 6000 mW/cm2, in FlashMax™P3. Reports suggest that light-curing protocols with lower emittance irradiance and longer exposure outperforms all other combination, however in some clinical procedures high-power LED-LCUs are advocated when compared to low-power LED-LCUs. Moreover, long time exposures and over-curing can be dangerous to the biological vital pulp, and other oral tissues. Evidence showing that high-power LCUs are the best clinical option is still very scarce.

Propriedades físico-químicas dos cimentos AH Plus e Sealer Plus: tempo de endurecimento e escoamento / Physicochemical properties of AH Plus and Sealer Plus cements: hardening and flow time

Introdução: O tratamento endodôntico busca sanificar o sistema de canais radiculares para permitir adequada obturação tridimensional. Para tanto, necessita-se de materiais plásticos, como a guta-percha, associados a cimentos endodônticos com adequadas características físico-químicas. Métodos: Comparação das propriedades físico-químicas tempo de endurecimento e escoamento dos cimentos endodônticos AH Plus e Sealer Plus, de acordo com a especificação 57 da American National Standard Institute/American Dental Association para materiais obturadores. Resultados: O tempo de endurecimento do AH Plus foi de 1178 minutos e do Sealer Plus foi de 422 minutos. O escoamento do APlus foi de 3259 milímetros e do Sealer Plus, 3150 milímetros. Conclusões: O tempo de endurecimento do AH Plus foi maior quando comparado ao do cimento Sealer Plus, e não houve diferença estatística no escoamento entre os cimentos estudados (AU).

Introduction: Endodontic treatment seeks to sanitize the root canal system to allow adequate three-dimensional filling, for which plastic materials such as guttapercha are required, associated with endodontic cements with adequate physico-chemical characteristics. Methods: Comparison of the physico-chemical properties hardening and flow time of the AH Plus and Sealer Plus endodontic sealers according to the American Dental Association / American Dental Association Specification 57 for sealing materials. Results: The hardening time of the AH Plus was 1178 minutes and the Sealer Plus was 422 minutes. The AH Plus flow was 3259 millimeters and the Sealer Plus was 3150 millimeters. Conclusions: The AH Plus hardening time was higher when compared to the Sealer Plus cement and there was no statistical difference in the flow between the cements studied (AU).

Digital Impressions in Implant Dentistry: A Literature Review.

INTRODUCTION: Digital impressions in implant dentistry rely on many variables, and their accuracy, particularly in complete edentulous patients, is not well understood. Aim. The purpose of this literature review was to determine which factors may influence the accuracy of digital impressions in implant dentistry. Emphasized attention was given to the design of the intra-oral scan body (ISB) and scanning techniques. MATERIALS AND METHODS: A Medline, PubMed and EBSCO Host databases search, complemented by a hand search, was performed in order to select relevant reports regarding the appliance of digital impressions in implant dentistry. The search subject included but was not limited to accuracy of digital impressions in implant dentistry, digital scanning techniques, the design and material of the ISBs, and the depth and angulation of the implant. The related titles and abstracts were screened, and the remaining articles that fulfilled the inclusion criteria were selected for full-text readings. RESULTS: The literature search conducted for this review initially resulted in 108 articles, among which only 21 articles fulfilled the criteria for inclusion. Studies were evaluated according to five subjects: accuracy of digital impressions in implant dentistry; the design and material of the intra-oral scan bodies; scanning technique; the influence of implants depth/angulations on the digital impression and accuracy of different intra-oral scanner devices. CONCLUSIONS: The accuracy of digital impressions in implant dentistry depends on several aspects. The depth/angulation of the implant, the experience of the operator, the intra-oral scanner used, and environmental conditions may influence the accuracy of digital impressions in implant dentistry. However, it seems that ISBs' design and material, as well as scanning technique, have a major impact on the trueness and precision of digital impressions in implant dentistry. Future research is suggested for the better understanding of this subject, focusing on the optimization of the ISB design and scanning protocols.

A modified protocol for restorative implant abutment selection by using computer-aided design and computer-aided manufacturing technology.

STATEMENT OF PROBLEM: Implant abutment selection is complex because of the numerous factors involved. Computer-aided design (CAD) technology allows for the virtual selection and placement of abutments after all parameters have been precisely measured. The outcome of this new protocol should be validated. PURPOSE: The purpose of this in vitro study was to validate a new digital protocol in which abutment selection is made through a CAD software program, the abutments are virtually placed, and the restoration is then designed based on the virtual abutments to fit the actual abutments when delivered to the implants intraorally. MATERIAL AND METHODS: A cast with 2 parallel implants was scanned 10 times. Then, 2 abutments were placed and scanned 10 times. Twenty identical superstructures were designed and manufactured to simulate the clinical situation of a 3-unit fixed partial denture, screw-retained to 2 implants. These were divided into 2 groups-A, real abutment and B, virtual abutment-and then compared by means of digital and optical measurements. RESULTS: No significant differences were detected for the measurements between the control and test groups in either the x-axis or y-axis; significant differences were found for the median value of the measurements obtained from both groups regarding the z-axis (P=.046). The mean gap in the virtual abutment group was 50 µm and 35 µm in the real abutment group. CONCLUSIONS: Superstructures produced after the virtual selection and placement of intermediate restorative abutments compared favorably with those produced after the digitalization of actual abutments and placement in the implant model, thus validating the proposed digital protocol for virtual abutment selection and placement.

Prevalência da automedicação em acadêmicos de odontologia e enfermagem em uma instituição pública brasileira / Prevalence of self-medication in dentistry and nursing academics in a Brazilian public institution

Objetivo: Determinar a prevalência da automedicação em estudantes de Odontologia e Enfermagem da Universidade Estadual do Piauí no município de Parnaíba e avaliar se existe associação dessa tal prática com o nível socioeconômico, o sexo dos acadêmicos, bem como com o nível de conhecimento teórico-prático. Métodos: Consiste em uma metodologia quantitativa de natureza aplicada e de corte transversal. O levantamento contou com a participação de maiores de 18 anos de idade e fez o uso de um questionário autoaplicável com questões a respeito da automedicação e demais variáveis independentes. Os resultados obtidos foram tabulados e submetidos a testes estatísticos por meio de análise descritiva e bivariada. Foram utilizados os testes de Mann-Whitney, ANOVA Kruskal-Wallis, com o software Statistical Package for the Social Sciences (SPSS) versão 21,0. Resultados: A amostra contou com a participação de 70 acadêmicos, dos quais 41 (58,6%) são do curso de Odontologia e 29 (41,4%) do curso de Enfermagem, e a automedicação era praticada por 97,1% dos acadêmicos, predominantemente entre aqueles que estavam no início do curso (92,3%) (p < 0,05) e eram do sexo feminino (98,1%) (p < 0,05), não havendo variação estatisticamente significativa quanto a renda familiar ou curso em que estavam matriculados (p > 0,05). Além disso, a principal classe farmacológica utilizada foi a de analgésicos. Conclusão: A prevalência de automedicação foi alta e frequentemente relatada para o combate da cefaleia, os acadêmicos relataram que conhecimentos e experiências prévias os auxiliaram na escolha dos fármacos autoadministrados, não havendo associação dessa pratica de automedicação com o curso e a renda mensal. Além disso, essa prática foi estatisticamente mais prevalente no sexo feminino e dentre aqueles estudantes que estavam no início do curso da graduação.

Aim: To determine the prevalence of self-medication in Dentistry and Nursing students at the State University of Piauí in the city of Parnaíba and to evaluate whether there is an association between this practice and the socioeconomic level and the sex of the students, as well as the level of theoretical and practical knowledge. Methods: This study consists of a quantitative methodology of an applied and cross-sectional nature. The survey counted on the participation of individuals over 18 years of age and used a self-administered questionnaire with questions regarding self-medication and other independent variables. The obtained results were tabulated and subjected to statistical tests through descriptive and bivariate analysis. Mann-Whitney and ANOVA Kruskal-Wallis tests were used, together with the Statistical Package for the Social Sciences (SPSS), version 21.0. Results: This study's sample counted on the participation of 70 students, 41 (58.6%) were from the Dental School and 29 (41.4%) of the Nursing Course, and self-medication was practiced by 97.1% of the students, predominantly among those who were at the beginning of the course (92.3%) (p < 0.05) and were female (98.1%) (p < 0.05), with no statistically significant variation as to family income or course in which the students are engaged (p > 0.05). In addition, the main pharmacological class used was analgesics. Conclusion: The prevalence of self-medication was high and frequently reported to combat headaches. Academics reported that previous knowledge and experience helped them to choose self-administered drugs, with no association between this self-medication practice and the course of study and monthly income. In addition, this practice was statistically more prevalent in females among those students who were in the beginning of the undergraduate course.

Effects of Different Undersizing Site Preparations on Implant Stability.

As immediate loading protocols are becoming more frequent, the primary stability of implants has become an essential criterion for the osseointegration of dental implants. Based on this, the objective of this study was to understand the influence of different undersized surgical preparation sites on the insertion torque (IT) and implant stability quotient (ISQ). Four different site-preparation protocols were performed on fresh humid type III bovine bone: one control, the standard protocol recommended by the manufacturer (P1), and three variations of undersized techniques (P2, P3 and P4). The implant used was VEGA by Klockner Implant System. The sample size was n = 40 for each of the four groups. A torquemeter was used to measure the IT, and the ISQ was measured with a Penguin RFA. Both variables showed a tendency to increase as the preparation technique was reduced, although not all the values were statistically significant (p < 0.05) when comparing with the standard preparation. The preparations without a cortical drill, P2 and P4, showed better results than those with a cortical drill. Given the limitations of this study, it can be concluded that reducing the implant preparation can increase both the IT and ISQ. Removing the cortical drill is an effective method for increasing implant stability, although it should be used carefully.

Implante Percutâneo Transeptal de Bioprótese em Disfunção de Prótese Valvar Cirúrgica Mitral - Experiência Multicêntrica Brasileira / Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience

Resumo Fundamento A intervenção percutânea em pacientes com disfunção de prótese biológica mitral apresenta-se como uma alternativa ao tratamento cirúrgico convencional. Objetivo Relatar a primeira experiência brasileira de implante transcateter de bioprótese valve-in-valve mitral via transeptal (TMVIV-via transeptal). Métodos Foram incluídos pacientes portadores de disfunção de bioprótese cirúrgica submetidos ao TMVIV-transeptal em 12 hospitais brasileiros. Foram considerados estatisticamente significativos valores de p<0,05. Resultados Entre junho/2016 e fevereiro/2019, 17 pacientes foram submetidos ao TMVIV-via transeptal. A mediana de idade foi 77 anos (IIQ,70-82), a mediana do escore STS-PROM foi 8,7% (IIQ,7,2-17,8). Todos os pacientes tinham sintomas limitantes de insuficiência cardíaca (CF≥III), tendo 5 (29,4%) sido submetidos a mais de uma toracotomia prévia. Obteve-se sucesso do TMVIV-via transeptal em todos os pacientes. A avaliação ecocardiográfica demonstrou redução significativa do gradiente médio (pré-intervenção, 12±3,8 mmHg; pós-intervenção, 5,3±2,6 mmHg; p<0,001), assim como aumento da área valvar mitral (pré-intervenção, 1,06±0,59 cm2; pós-intervenção, 2,18±0,36 cm2; p<0,001) sustentados em 30 dias. Houve redução significativa e imediata da pressão sistólica de artéria pulmonar, com redução adicional em 30 dias (pré-intervenção, 68,9±16,4 mmHg; pós-intervenção, 57,7±16,5 mmHg; 30 dias, 50,9±18,7 mmHg; p<0,001). Durante o seguimento, com mediana de 162 dias (IIQ, 102-411), observou-se marcada melhora clínica (CF≤II) em 87,5%. Um paciente (5,9%) apresentou obstrução de via de saída de ventrículo esquerdo (VSVE), evoluindo para óbito logo após o procedimento, e outro morreu aos 161 dias de seguimento.Conclusão: A primeira experiência brasileira de TMVIV-transeptal demonstra a segurança e a efetividade dessa nova técnica. A obstrução da VSVE é uma complicação potencialmente fatal, reforçando a importância da seleção dos pacientes e do planejamento do procedimento. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment. Objectives To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV). Methods Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05. Results From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm2; post-intervention, 2.18±0.36 cm2; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up. Conclusion The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients' selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Análise do teor de cloro ativo e ph de soluções de hipoclorito de sódio / Analysis of the active chlorine content and ph of sodium hypochlorite solutions

O objetivo do presente estudo é verificar o teor de cloro ativo e pH das soluções de hipoclorito de sódio nas concentrações de 0,5%, 1% e 2,5% adquiridas em lojas de material odontológico de Teresina - PI. Analisou-se 11 amostras medindo o teor de cloro ativo através do método da titulometria e pH utilizando pHmetro eletrônico. Observou-se que as substâncias analisadas se encontravam com o teor de cloro acima do especificado nos rótulos e pH alcalino, sendo apenas uma das amostras com o teor abaixo do especificado e pH menor que 9. De acordo com os resultados, conclui-se que as amostras avaliadas com soluções de hipoclorito de sódio dotam de concentrações de cloro diferentes daquelas especificadas nos rótulos.

One of the most important stages of endodontic treatment is the chemical-mechanical preparation that aims to generate cleaning, with the use of chemical irrigation solutions and instruments that help to sanitize the canal. The objective of the present study is to verify the active chlorine content and pH of the sodium hypochlorite solutions at the concentrations of 0.5%, 1% and 2.5% obtained at dental material stores in Teresina - PI. The 11 samples were analyzed by measuring the active chlorine content using the titration method and pH using electronic pH meter. It was observed that the substances analyzed were chlorine content higher than specified on the labels and alkaline pH, being only one of the samples with chlorine content below the specified and pH less than 9. According to the results, it was concluded that samples tested with sodium hypochlorite solutions were contained chlorine concentrations different from those specified on the labels.

Decontamination of Gutta-percha Cones employed in Endodontics.

The gutta-percha cones used in endodontic treatment are produced in aseptic conditions and their composition includes zinc oxide, which is responsible for antibacterial activity. However, there is the possibility of microbial contamination by manipulation, aerosol or during storage. Although several chemical agents have been tested for their decontamination, there is no consensus on the best disinfection protocol to be used. The aim of this study was to evaluate the decontamination of gutta-percha cones contaminated with the bacteria Enterococcus faecalis, by using chlorhexidine digluconate (CHX) and sodium hypochlorite (NaClO) at different concentrations for short exposure times. For this purpose, gutta-percha cones (size 40) were selected at random from a sealed box and immersed for 1 min in a microbial suspension. Then they were immersed in specific Petri dishes for different groups containing: CHX 2%, NaClO 1% or NaClO 2.5% for 30 s or 1 min, and subsequently placed in tubes containing BHI broth. After incubating the tubes for 48 h, it was observed that 1% and 2.5% NaClO and 2% CHX were effective for decontaminating the cones at those exposure time intervals. Microbial growth was detected in one of the replicates of the group with CHX applied for 30 s. To prevent the possibility of failures at this stage, the exposure time of gutta-percha cones to the decontaminating agent should not be reduced.

Os cones de guta-percha utilizados no tratamento endodôntico são produzidos em condições assépticas e possuem óxido de zinco em sua composição, responsável pela atividade antibac-teriana. No entanto, existe a possibilidade de contaminação microbiana por manipulação, aerossol ou seu armazenamento. Embora vários agentes químicos já tenham sido testados para sua descontaminação, não há consenso sobre o melhor protocolo de desinfecção a ser usado. Nosso objetivo foi avaliar a descontaminação de cones de guta-percha contaminados com a bactéria Enterococcus faecalis, utilizando digluconato de clorexidina (CHX) e hipoclorito de sódio (NaClO) em diferentes concentrações e tempos de exposição curtos. Para esse fim, 40 cones de guta-percha foram selecionados aleatoriamente, de uma caixa selada e imersos por 1 min em uma suspensão microbiana. Em seguida, foram imersos em placas de Petri específicas para diferentes grupos contendo: CHX 2%, NaClO 1% ou 2,5%, nos tempos de exposição de 30s e 1min e subseqüentemente imersos em tubos contendo caldo BHI. Após incubação dos tubos por 48 h, observou-se que NaClO 1% e 2,5% e CHX 2% foram eficazes para a descontaminação dos cones nesses intervalos de tempo de exposição. Em uma das réplicas do grupo com CHX aplicado por 30s foi detectado crescimento microbiano. O tempo de exposição dos cones de guta-percha ao agente de descontaminação não deve ser reduzido para evitar a possibilidade de falhas nesse estágio.

Influence of Implant Design and Under-Preparation of the Implant Site on Implant Primary Stability. An In Vitro Study.

The aim of this study was to evaluate the effects of different implant sites an under-preparation sequence associated with two different implant designs on implant primary stability measured by two parameters: insertion torque (IT) and implant stability quotient (ISQ). It used two different implants: one cylindrical as a control and another one with a tapered design. The implants were inserted in type III fresh humid bovine bone and four drilling sequences were used: one control, the one proposed by the implant company (P1), and three different undersized (P2, P3 and P4). P2 was the same as P1 without the cortical drill, P3 was without the last pilot drill and P4 was without both of them. The sample size was n = 40 for each of the eight groups. Final IT was measured with a torquemeter and the ISQ was measured with Penguin resonance frequency analysis. Results showed that both ISQ and IT have a tendency to increase as the preparation technique reduces the implant site diameter when compared with the standard preparation, P1. The preparations without cortical drill, P2 and P4, showed the best results when compared with the ones with a cortical drill. Tapered implants always showed higher or the same ISQ and IT values when compared with the cylindrical implants. Giving the limitations of this study, it can be concluded that reducing implant preparation can increase IT and ISQ values. Removing the cortical drill and the use of a tapered design implant are also effective methods of increasing primary implant stability.

Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience. / Implante Percutâneo Transeptal de Bioprótese em Disfunção de Prótese Valvar Cirúrgica Mitral ­ Experiência Multicêntrica Brasileira.

BACKGROUND: Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment. OBJECTIVES: To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV). METHODS: Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05. RESULTS: From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm2; post-intervention, 2.18±0.36 cm2; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up. CONCLUSION: The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients' selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

FUNDAMENTO: A intervenção percutânea em pacientes com disfunção de prótese biológica mitral apresenta-se como uma alternativa ao tratamento cirúrgico convencional. OBJETIVO: Relatar a primeira experiência brasileira de implante transcateter de bioprótese valve-in-valve mitral via transeptal (TMVIV-via transeptal). MÉTODOS: Foram incluídos pacientes portadores de disfunção de bioprótese cirúrgica submetidos ao TMVIV-transeptal em 12 hospitais brasileiros. Foram considerados estatisticamente significativos valores de p<0,05. RESULTADOS: Entre junho/2016 e fevereiro/2019, 17 pacientes foram submetidos ao TMVIV-via transeptal. A mediana de idade foi 77 anos (IIQ,70-82), a mediana do escore STS-PROM foi 8,7% (IIQ,7,2-17,8). Todos os pacientes tinham sintomas limitantes de insuficiência cardíaca (CF≥III), tendo 5 (29,4%) sido submetidos a mais de uma toracotomia prévia. Obteve-se sucesso do TMVIV-via transeptal em todos os pacientes. A avaliação ecocardiográfica demonstrou redução significativa do gradiente médio (pré-intervenção, 12±3,8 mmHg; pós-intervenção, 5,3±2,6 mmHg; p<0,001), assim como aumento da área valvar mitral (pré-intervenção, 1,06±0,59 cm2; pós-intervenção, 2,18±0,36 cm2; p<0,001) sustentados em 30 dias. Houve redução significativa e imediata da pressão sistólica de artéria pulmonar, com redução adicional em 30 dias (pré-intervenção, 68,9±16,4 mmHg; pós-intervenção, 57,7±16,5 mmHg; 30 dias, 50,9±18,7 mmHg; p<0,001). Durante o seguimento, com mediana de 162 dias (IIQ, 102-411), observou-se marcada melhora clínica (CF≤II) em 87,5%. Um paciente (5,9%) apresentou obstrução de via de saída de ventrículo esquerdo (VSVE), evoluindo para óbito logo após o procedimento, e outro morreu aos 161 dias de seguimento.Conclusão: A primeira experiência brasileira de TMVIV-transeptal demonstra a segurança e a efetividade dessa nova técnica. A obstrução da VSVE é uma complicação potencialmente fatal, reforçando a importância da seleção dos pacientes e do planejamento do procedimento. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).