Knowledge of firefighters with special paramedic training of the emergency management of avulsed teeth.

Immediate replantation into the socket is the ideal procedure in cases of accidental avulsion of permanent teeth. In Brazil, firefighters with special paramedic training are in charge of providing first-aid care to victims of road accidents and might have to deal with tooth avulsions. This study assessed the knowledge of firefighters regarding the emergency management of avulsed teeth. Information was collected from a questionnaire submitted to 110 volunteer firefighters in seven cities in the São Paulo State (Brazil). The results revealed that 70.9% of the respondents did not know what tooth avulsion was; 53.6% did not know what tooth replantation was or defined it incorrectly; 60% would not act properly in tooth avulsion cases; 20.9% did not consider replantation of the avulsed tooth into the socket as a treatment option; the ideal time interval for tooth replantation was unknown to 40% of the interviewees; 90% of the participants answered that they would not be able to perform tooth replantation. Among those who considered themselves unable to perform tooth replantation, 47.3% chose saline as the best storage medium for an avulsed tooth, 21.8% chose milk, 3.6% chose the patient's mouth and 20% reported not knowing where to store the tooth; 81.8% of the firefighters reported not to have ever received any specific directions on tooth replantation and 100% of them considered this knowledge a requirement for first-aid care to accident victims. In conclusion, the knowledge of the surveyed firefighters regarding emergency management after tooth avulsion was unsatisfactory in several aspects that are important for the success of replantation procedures. Firefighters with special paramedic training should be educated on how to proceed in cases of dentoalveolar traumas and tooth avulsions in order to improve treatment prognosis and increase the survival rate of replanted teeth.

Resposta tecidual ao enxerto xenógeno inorgânico de osso bovino: avaliação histomorfológica e histomorfométrica / Tissue response to inorganic bovine bone xenograft: histomorphological and histomorphometrical evaluation

Proposição: Avaliar a resposta tecidual ao enxerto xenógeno inorgânico de osso bovino, por meio de análise histomorfológica e histomorfométrica. Material e método: O enxerto foi obtido da costela de boi resfriada após 8 horas de sacrifício do animal e processado da seguinte maneira: imersão por 60 minutos em água oxigenada a temperatura ambiente, com trocas a cada 15 minutos; imersão em água oxigenada aquecida, a uma temperatura de 100ºC, por 30 segundos e resfriamento imediato com água destilada a uma temperatura variando de 6º a 8ºC; enxague em água destilada corrente por 6 horas; imersão em álcool 70º, 90º e 100º, respectivamente, sendo 15 minutos em cada álcool; esterilização em autoclave. Em seguida, 10 coelhos brancos (Nova Zelândia) foram utilizados, originando dois grupos: Grupo I – enxerto inserido no pavilhão auricular e Grupo II – enxerto inserido e fixado em tíbia. Decorridos 180 dias, foi realizado sacrifício dos animais por injeção excessiva de anestésico. Resultados: No Grupo I, o enxerto apresentou-se em íntimo contato com tecido subcutâneo. No Grupo II, o enxerto apresentou-se em justaposição com o leito ósseo receptor. E nos dois grupos havia espaços medulares preenchidos por medula óssea ativa e osso neoformado, além da ausência de osteócitos no osso bovino e presença destas células no osso neoformado, próximo aos espaços medulares. Conclusão: Em razão dos resultados obtidos o enxerto xenógeno inorgânico de osso bovino demonstrou biocompatibilidade, capacidade osteocondutora e discreta perda de volume, preenchendo requisitos importantes do material ideal para reconstrução óssea

Objective: To evaluate tissue response to inorganic bovine bone xenograft by histomorphological and histomorphometrical analyses. Material and methods: The bone grafts was obtained from cooled bovine rib 8 hours after slaughtering and were processed as follows: 60-minute immersion in hydrogen peroxide at room temperature, with changes at 15-minute intervals; 30-second immersion in hydrogen peroxide at 100ºC; immediate cooling with distilled water at temperatures ranging from 6º to 8ºC; rinsing in running distilled water for 6 hours; immersion in alcohol grades of 70º, 90º and 100ºGL (15-minute in each solution); autoclaving. Thereafter, 10 white New Zealand rabbits were distributed into two groups: Group I – graft inserted in the ear pavilion and Group II – graft inserted and fixed in the tibia. After 180 days, the animals were sacrificed by anesthetic overdose. Results: In Group I, the graft was in intimate contact with the subcutaneous tissue, while in Group II the graft was juxtaposed to the recipient site. Both groups presented medullar spaces filled with active bone marrow and newly formed bone. In addition, osteocytes were absent in the bovine bone graft and present in the newly formed bone, close to the medullar spaces. Conclusion: From the obtained results, the inorganic bovine bone xenograft showed biocompatibility

Resposta tecidual ao enxerto xenógeno inorgânico de osso bovino: avaliação histomorfológica e histomorfométrica / Tissue response to inorganic bovine bone xenograft: histomorphological and histomorphometrical evaluation

Proposição: Avaliar a resposta tecidual ao enxerto xenógeno inorgânico de osso bovino, por meio de análise histomorfológica e histomorfométrica. Material e método: O enxerto foi obtido da costela de boi resfriada após 8 horas de sacrifício do animal e processado da seguinte maneira: imersão por 60 minutos em água oxigenada a temperatura ambiente, com trocas a cada 15 minutos; imersão em água oxigenada aquecida, a uma temperatura de 100ºC, por 30 segundos e resfriamento imediato com água destilada a uma temperatura variando de 6º a 8ºC; enxague em água destilada corrente por 6 horas; imersão em álcool 70º, 90º e 100º, respectivamente, sendo 15 minutos em cada álcool; esterilização em autoclave. Em seguida, 10 coelhos brancos (Nova Zelândia) foram utilizados, originando dois grupos: Grupo I – enxerto inserido no pavilhão auricular e Grupo II – enxerto inserido e fixado em tíbia. Decorridos 180 dias, foi realizado sacrifício dos animais por injeção excessiva de anestésico. Resultados: No Grupo I, o enxerto apresentou-se em íntimo contato com tecido subcutâneo. No Grupo II, o enxerto apresentou-se em justaposição com o leito ósseo receptor. E nos dois grupos havia espaços medulares preenchidos por medula óssea ativa e osso neoformado, além da ausência de osteócitos no osso bovino e presença destas células no osso neoformado, próximo aos espaços medulares. Conclusão: Em razão dos resultados obtidos o enxerto xenógeno inorgânico de osso bovino demonstrou biocompatibilidade, capacidade osteocondutora e discreta perda de volume, preenchendo requisitos importantes do material ideal para reconstrução óssea.

Objective: To evaluate tissue response to inorganic bovine bone xenograft by histomorphological and histomorphometrical analyses. Material and methods: The bone grafts was obtained from cooled bovine rib 8 hours after slaughtering and were processed as follows: 60-minute immersion in hydrogen peroxide at room temperature, with changes at 15-minute intervals; 30-second immersion in hydrogen peroxide at 100ºC; immediate cooling with distilled water at temperatures ranging from 6º to 8ºC; rinsing in running distilled water for 6 hours; immersion in alcohol grades of 70º, 90º and 100ºGL (15-minute in each solution); autoclaving. Thereafter, 10 white New Zealand rabbits were distributed into two groups: Group I – graft inserted in the ear pavilion and Group II – graft inserted and fixed in the tibia. After 180 days, the animals were sacrificed by anesthetic overdose. Results: In Group I, the graft was in intimate contact with the subcutaneous tissue, while in Group II the graft was juxtaposed to the recipient site. Both groups presented medullar spaces filled with active bone marrow and newly formed bone. In addition, osteocytes were absent in the bovine bone graft and present in the newly formed bone, close to the medullar spaces. Conclusion: From the obtained results, the inorganic bovine bone xenograft showed biocompatibility.

Influence of enamel matrix derivative (Emdogain) and sodium fluoride on the healing process in delayed tooth replantation: histologic and histometric analysis in rats.

Although it has already been shown that enamel matrix derivative (Emdogain) promotes periodontal regeneration in the treatment of intrabony periodontal defects, there is little information concerning its regenerative capacity in cases of delayed tooth replantation. To evaluate the alterations in the periodontal healing of replanted teeth after use of Emdogain, the central incisors of 24 Wistar rats (Rattus norvegicus albinus) were extracted and left on the bench for 6 h. Thereafter, the dental papilla and the enamel organ of each tooth were sectioned for pulp removal by a retrograde way and the canal was irrigated with 1% sodium hypochlorite. The teeth were assigned to two groups: in group I, root surface was treated with 1% sodium hypochlorite for 10 min (changing the solution every 5 min), rinsed with saline for 10 min and immersed in 2% acidulated-phosphate sodium fluoride for 10 min; in group II, root surfaces were treated in the same way as described above, except for the application of Emdogain instead of sodium fluoride. The teeth were filled with calcium hydroxide (in group II right before Emdogain was applied) and replanted. All animals received antibiotic therapy. The rats were killed by anesthetic overdose 10 and 60 days after replantation. The pieces containing the replanted teeth were removed, fixated, decalcified and paraffin-embedded. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histologic and histometric analyses. The use of 2% acidulated-phosphate sodium fluoride provided more areas of replacement resorption. The use of Emdogain resulted in more areas of ankylosis and was therefore not able to avoid dentoalveolar ankylosis. It may be concluded that neither 2% acidulated-phosphate sodium fluoride nor Emdogain were able to prevent root resorption in delayed tooth replantation in rats.

Effects of Tissucol and epsilon aminocaproic acid in the healing process following dental extraction in dehydrated rats.

A histological study was conducted of the alveolar bone healing process following tooth extraction of dehydrated rats after the implantation of fibrin adhesive (TISSUCOL) associated to previous irrigation of the wound with a 5% epsilon aminocaproic acid solution (EACA). Seventy two rats were used, divided into three groups receiving different treatments after the surgical procedure. In group I, the gingival mucosa was sutured after extraction of the right upper incisor. In groups II and III, chronic dehydration was produced by water deprivation for 9 days (3 days in the preoperative period and 6 days in the postoperative period). In the animals of Group II, after tooth extraction, the gingival mucosa was sutured in the same way as performed in group I. In group III, after extraction, the dental socket was irrigated with 5% EACA, followed by implantation of the fibrin adhesive (TISSUCOL). The mucosa was sutured in the same way as performed in the other groups. At 3, 7, 15 and 21 postoperative days, the animals were sacrificed in number of 6 for each group. Specimens containing the dental socket were removed and fixed in 10% formalin and decalcified in an equal part formic acid and sodium citrate solution. After routine processing, the specimens were embedded in paraffin for microtomy. We obtained 6 microm semi-serial slices that were stained with hematoxylin and eosin for histological evaluation. The results showed that the water deprivation in the pre- and postoperative periods caused a delay in the alveolar bone healing process. The use of the fibrin adhesive (TISSUCOL) produced an improvement in the fibrinolytic picture caused by dehydration.

Disfunção temporomandibular associada à hiperplasia bilateral do processo coronóide da mandíbula - relato de caso clínico / Influence of temporomandibular dysfunctions in bilateral hyperplasia of the coronoid process of the mandible - case report

A articulação temporomandibular (ATM) é uma das articulações mais exigidas do ser humano por participar de todos os movimentos mandibulares. Mesmo sendo as desordens musculares e articulares as principais responsáveis pelas disfunções temporomandibulares (DTMs), outras alterações anatômicas, como a hiperplasia do processo coronóide, associados ou não aos hábitos parafuncionais, podem provocar limitação evidente em todos os movimentos mandibulares. Os autores apresentam um caso clínico de um paciente do gênero masculino, 53 anos, que procurou a Faculdade de Odontologia de Araçatuba - UNESP, queixando-se de dor na face e dificuldade para abrir a boca. Após exame físico e radiográfico, constatou-se que o paciente apresentava bruxismo e hiperplasia dos processos coronóides direito e esquerdo. O plano de tratamento constou da remoção do processo coronóide bilateral, fisioterapia, placa miorrelaxante e reabilitação oclusal. O tratamento multidisciplinar envolvendo cirurgia bucomaxilofacial, fisioterapia e reabilitação oral foram eficazes para o restabelecimento destes pacientes

Effects of Tissucol™ and epsilon aminocaproic acid in the healing process following dental extraction in dehydrated rats

Foi estudada histologicamente a reparação do alvéolo dental de ratos desidratados, após o implante de adesivo fibrínico (TISSUCOL®) associado à irrigação prévia da ferida com solução a 5% de ácido épsilon-aminocapróico. Foram empregados 72 ratos, divididos em três grupos, que receberam diferentes tratamentos após o procedimento cirúrgico. No Grupo I, após a extração do incisivo superior direito, a mucosa gengival foi suturada. Nos Grupos II e III foi provocada a desidratação crônica pela privação de ingestão de líquidos durante 09 dias (3 dias no pré-operatório e 6 dias no pós-operatório), sendo que, no Grupo II, após a extração dental, a mucosa gengival foi suturada de forma semelhante à do Grupo I; no Grupo III, logo após a exodontia, o alvéolo foi irrigado com a solução de ácido épsilon-aminocapróico a 5%, seguida de implante de adesivo fibrínico (TISSUCOL®) e foi feita sutura da mucosa de forma semelhante à dos demais grupos. Decorridos 3, 7, 15 e 21 dias após o ato operatório, os animais foram sacrificados em número de 6 para cada grupo. A seguir, as peças contendo o alvéolo dental foram removidas e fixadas em formalina a 10% e descalcificadas em solução de ácido fórmico e citrato de sódio em partes iguais. Após processamento laboratorial de rotina, foram incluídas em parafina para microtomia. Foram obtidos cortes semi-seriados com 6 micrômetros de espessura, seguidos de coloração em hematoxilina e eosina para estudo microscópico. Os resultados obtidos mostram que a hidroprivação no pré e pós-operatório ocasiona profundo retardo no processo de reparo em feridas de extração dental. O emprego de adesivo fibrínico (TISSUCOL®) melhora o quadro fibrinolítico provocado pela desidratação.