The parental psychological distress caused by separation from their critically ill child during the COVID-19 pandemic: A tale of two cities.

Introduction: A child's critical illness is a stressful event for the entire family, causing significant emotional distress among parents and changes to family functioning. The Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2) pandemic has abruptly caused modifications in visitation policies of Pediatric Intensive Care Units (PICUs) in many countries. We hypothesized that caregivers with no or severely restricted access to PICUs would demonstrate increased psychological distress as compared to those who had limitless access (LA) to PICUs. Methods: Sociodemographic variables, levels of psychological distress, ratings of family functioning, and ability to cope with stressful events were collected with an online survey in a group of caregivers after their child's hospitalization. Ratings of psychological distress were compared between caregivers with no/severely restricted (NA) and with LA to PICUs. Results: Measures of depression, anxiety, and global severity index (GSI) of psychological distress were significantly higher in NA caregivers as compared to LA. Among demographic characteristics of the sample, only gender influenced the severity of psychological symptoms: women showed an increased score on levels of somatization, depression, anxiety, and GSI. Avoidant coping style positively correlated with measures of depression. Univariate General Linear Model (GLM) analyses of the effects of sex, age, visitation policies of PICUs, and score of avoidant coping strategies on measures of psychological distress confirmed a significant univariate effect of no access to PICUs on parents' psychopathological scores. Conclusion: Restrictions imposed on visitation policies in PICU during the pandemic negatively impacted families' psychological wellbeing. A balance between the safety of patients, families, and health care professionals and meeting the needs of families is of utmost importance.

Efficacy of two low-level laser therapy protocols following lower third molar surgery - a randomized, double-blind, controlled clinical trial.

The aim of this study was to test two low-level laser therapy protocols by evaluating pain control, swelling and trismus in the postoperative period of lower third molar surgeries. This was a randomized, double-blind, placebo-controlled, crossover trial. Patients presenting two symmetrically impacted mandibular third molars were included. One side was randomly assigned for LLLT applied immediately after surgery (T1) and then after 24 (T2) and 48 hours (T3) (Protocol A). The other side received LLLT applied immediately after surgery and placebo after 24 and 48 hours (Protocol B). LLLT was given by intraoral application (660nm, 5 J/cm2, 10 s, 20 mW, 4 points) followed by extraoral application (789 nm, 30 J/cm2, 20 s, 60 mW, 8 points). The placebo application was similar to that of the experimental side but with laser simulation. The primary outcomes were pain control, swelling and trismus intensity at T1, T2, T3 and 7 days after surgery (T4). Data were analyzedbyANOVArepeated measures and Wilcoxon test (p<.05). The final sample consisted of 21 patients (42 teeth). There were no statistical differences for pain level between protocols A and B over time (p= .909), although the amount of analgesic medication was lower with protocol A at T2 (p=.022). There were no differences in swelling (p=.958) or trismus (p=.837) between the protocols used over time. Both protocols performed similarly for pain control, swelling and trismus. Therefore, for practical reasons, a single laser application in the immediate postoperative period could be indicated for the management of postoperative discomfort in lower third molar surgery.

O objetivo deste estudo foi testar dois protocolos de terapia com laser de baixa intensidade (LBI) para controle da dor, edema e trismo no período pós-operatório de cirurgias de terceiro molar inferior. Neste estudo randomizado, duplo-cego, controlado, de boca dividida foram incluídos pacientes que apresentavam os terceiros molares inferiores simetricamente. Um lado foi aleatoriamente designado para receber LBI aplicada imediatamente após a cirurgia (T1) e após 24 (T2) e 48 (T3) horas (Protocolo A). O lado oposto recebeu LBI imediatamente após a cirurgia e placebo após 24 e 48 horas (Protocolo B). A aplicação de LBI foi realizada intraoralmente (660nm, 5 J/cm2, 10 s, 20 mW, 4 pontos), seguida pela aplicação extraoral (789 nm, 30 J/cm2, 20 s, 60 mW, 8 pontos). O efeito do placebo foi similar ao experimental. Os desfechos primários eram dor, edema e intensidade do trismo nos tempos T1, T2, T3 e 7 após a cirurgia (T4). Os dados foram analisadosporANOVA e teste deWilcoxon (p<.05). A amostra final consistiu de 21 pacientes (43 dentes). Não houve diferença estatística para o nível de dor entre os protocolos A e B ao longo do tempo (p=.909), embora a quantidade de medicação analgésica tenha sido menor com o protocolo A em T2 (p= .022). Não houve diferença para edema (p=.958) ou trismo (p=.837) entre os protocolos ao longo do tempo. Em conclusão, a aplicação de LBI imediatamente após a cirurgia e após 24 e 48 horas (Protocolo A) apresenta melhor resultado para controle da dor. Ambos os protocolos foram similares para dor, edema e trismo. Portanto, por razões de praticidade, uma aplicação única de laser imediatamente após a cirurgia pode estar indicada para o manejo do desconforto pós-operatório em cirurgias de terceiros molares inferiores.

Efficacy of two low-level laser therapy protocols following lower third molar surgery - a randomized, double-blind, controlled clinical trial / Eficácia de dois protocolos de terapia a laser de baixa intensidade após cirurgia de terceiros molares inferiores - ensaio clínico duplo-cego, randomizado

ABSTRACT The aim of this study was to test two low-level laser therapy protocols by evaluating pain control, swelling and trismus in the postoperative period of lower third molar surgeries. This was a randomized, double-blind, placebo-controlled, crossover trial. Patients presenting two symmetrically impacted mandibular third molars were included. One side was randomly assigned for LLLT applied immediately after surgery (T1) and then after 24 (T2) and 48 hours (T3) (Protocol A). The other side received LLLT applied immediately after surgery and placebo after 24 and 48 hours (Protocol B). LLLT was given by intraoral application (660nm, 5 J/cm2, 10 s, 20 mW, 4 points) followed by extraoral application (789 nm, 30 J/cm2, 20 s, 60 mW, 8 points). The placebo application was similar to that of the experimental side but with laser simulation. The primary outcomes were pain control, swelling and trismus intensity at T1, T2, T3 and 7 days after surgery (T4). Data were analyzed by ANOVA repeated measures and Wilcoxon test (p<.05). The final sample consisted of 21 patients (42 teeth). There were no statistical differences for pain level between protocols A and B over time (p= .909), although the amount of analgesic medication was lower with protocol A at T2 (p=.022). There were no differences in swelling (p=.958) or trismus (p=.837) between the protocols used over time. Both protocols performed similarly for pain control, swelling and trismus. Therefore, for practical reasons, a single laser application in the immediate postoperative period could be indicated for the management of postoperative discomfort in lower third molar surgery.

RESUMO O objetivo deste estudo foi testar dois protocolos de terapia com laser de baixa intensidade (LBI) para controle da dor, edema e trismo no período pós-operatório de cirurgias de terceiro molar inferior. Neste estudo randomizado, duplo-cego, controlado, de boca dividida foram incluídos pacientes que apresentavam os terceiros molares inferiores simetricamente. Um lado foi aleatoriamente designado para receber LBI aplicada imediatamente após a cirurgia (T1) e após 24 (T2) e 48 (T3) horas (Protocolo A). O lado oposto recebeu LBI imediatamente após a cirurgia e placebo após 24 e 48 horas (Protocolo B). A aplicação de LBI foi realizada intraoralmente (660nm, 5 J/cm2, 10 s, 20 mW, 4 pontos), seguida pela aplicação extraoral (789 nm, 30 J/cm2, 20 s, 60 mW, 8 pontos). O efeito do placebo foi similar ao experimental. Os desfechos primários eram dor, edema e intensidade do trismo nos tempos T1, T2, T3 e 7 após a cirurgia (T4). Os dados foram analisados por ANOVA e teste de Wilcoxon (p<.05). A amostra final consistiu de 21 pacientes (43 dentes). Não houve diferença estatística para o nível de dor entre os protocolos A e B ao longo do tempo (p=.909), embora a quantidade de medicação analgésica tenha sido menor com o protocolo A em T2 (p= .022). Não houve diferença para edema (p=.958) ou trismo (p=.837) entre os protocolos ao longo do tempo. Em conclusão, a aplicação de LBI imediatamente após a cirurgia e após 24 e 48 horas (Protocolo A) apresenta melhor resultado para controle da dor. Ambos os protocolos foram similares para dor, edema e trismo. Portanto, por razões de praticidade, uma aplicação única de laser imediatamente após a cirurgia pode estar indicada para o manejo do desconforto pós-operatório em cirurgias de terceiros molares inferiores.

Ozone Gas Effect on Mineral Content of Dentin exposed to Streptococcus mutans Biofilm: An Energy-dispersive X-ray Evaluation.

AIM: This study aims to assess the effect of ozone gas on dentin exposed to Streptococcus mutans biofilm by evaluation of mineral content [log calcium-to-phosphorus (Ca/P)] using energy-dispersive X-ray (EDX) spectroscopy. MATERIALS AND METHODS: Five human third molars were sectioned into four slices of dentin and distributed in four groups: I - control (no treatment); II - ozone therapy; III - biofilm development; IV - ozone therapy followed by biofilm development. Mineral content (log Ca/P) was evaluated by EDX. Data were analyzed by analysis of variance and Tukey's test (p < 0.05). RESULTS: Results showed that the mineral content of control group (I) was similar to ozone group (II), and was statistically higher than biofilm (III) and ozone + biofilm (IV). The lowest log Ca/P was determined in biofilm group (III). CONCLUSION: It can be concluded that ozone gas did not grant preventive effects of demineralization by S. mutans biofilm on dentin surface. CLINICAL SIGNIFICANCE: Ozone gas therapy may be an alternative noninvasive treatment aiming to reduce the levels of caries-associated microorganisms. This therapy may, thereby, be an alternative and/or complementary treatment strategy in preventive dentistry.

Comparison of the correlation of photoelasticity and digital imaging to characterize the load transfer of implant-supported restorations.

STATEMENT OF PROBLEM: Whether splinting or not splinting adjacent implants together can optimize the stress/strain transfer to the supporting structures remains controversial. PURPOSE: The purpose of this study was to compare the photoelasticity and digital image correlation (DIC) in analyzing the stresses/strains transferred by an implant-supported prosthesis. MATERIAL AND METHODS: A polymethylmethacrylate model was made with a combination of acrylic resin replicas of a mandibular first premolar and second molar and threaded implants replacing the second premolar and first molar. Splinted (G1/G3) and nonsplinted (G2/G4) metal-ceramic screw-retained crowns were loaded with (G1/G2) and without (G3/G4) the presence of the second molar. Vertical static loads were applied to the first molar implant-supported crown (50 N-photoelasticity; 250 N-DIC). The resulting isochromatic fringes in the photoelastic models were photographed, and a single-camera 2-dimensional DIC system recorded the deformation at the surface of the resin models. RESULTS: Residual stresses were present in the photoelastic model after screw fixation of the crowns. The following average photoelastic stress results (MPa) were found around the loaded implant: G1 (20.06), G2 (23.49), G3 (30.86), G4 (37.64). Horizontal strains (εxx, %) between the molars averaged over the length of the loaded implant were found by DIC: G1 (0.08 ± 0.09), G2 (0.13 ± 0.10), G3 (0.13 ± 0.11), G4 (0.16 ± 0.11). Splinted crowns transferred lower stresses to the supporting bone when the second molar was absent. The second molar optimized the stress distribution between the supporting structures even for nonsplinted restorations. CONCLUSIONS: Both methods presented similar results and seemed capable of indicating where issues associated with stress/strain concentrations might arise. However, DIC, while apparently less sensitive than photoelasticity, is not restricted to the use of light-polarizing materials.

Avaliação do planejamento para prótese parcial removível e da qualidade dos modelos e requisições enviados aos laboratórios / Evaluation of planning for removable partial denture and quality of casts and prescriptions sent to the dental laboratories

Objetivo: Avaliar a qualidade dos modelos de gesso e requisições enviados a laboratórios de prótese dentária para confecção de Prótese Parcial Removível (PPR) e analisar o planejamento das estruturas metálicas a serem confeccionadas. Material e Método: A amostra foi composta por modelos e requisições enviados por cirurgiões-dentistas a quatro laboratórios comerciais da cidade de Goiânia-GO, selecionados a partir de uma lista fornecida pela Vigilância Sanitária do Município. Para coleta de dados foi utilizado um roteiro estruturado. Os modelos foram identificados segundo a Classificação de Kennedy e as Regras de Applegate. Informações adicionais foram agrupadas nas seguintes categorias: condições gerais dos modelos (local de vazamento, material de moldagem, gesso, presença de bolhas nas superfícies de assentamento da PPR), requisição do trabalho ao laboratório (avaliadas segundo a clareza das informações nelas contidas) e planejamento da estrutura metálica (desenho, qualidade dos preparos dentários ? nichos, planos guia, retenções). Resultados: Foram avaliados 121 modelos, dos quais apenas 36 (29,8%) possuíam requisição por escrito e somente 11 (9,1%) possuíam indicação do desenho das estruturas metálicas. Foram verificadas bolhas positivas e/ou negativas em 85 (70%) modelos. Apenas 22(18,2%) apresentavam nichos e 6 (5%) possuíam evidências de preparos de planos guia. 76 (62,8%) apresentavam paralelismo relativo das superfícies dos dentes pilares e em 74 (61,2%) as retenções foram consideradas adequadas. Conclusões: A qualidade dos modelos e requisições encaminhados aos laboratórios para confecção de PPR é precária. Na maioria dos casos, o planejamento da estrutura metálica é delegado ao técnico de prótese dentária e os preparos dentais básicos para PPR não são realizados.

Objective: This paper aims to evaluate the planning of frameworks for Removable Partial Denture and quality of casts and work orders sent to dental laboratories. Material and Methods: The sample consisted of casts and prescriptions sent by dentists to four commercial dental laboratories located in Goiânia-GO selected from a list provided by the city health surveillance. For data collection it was used a structured form. The casts were grouped according to the classification of Kennedy (1925) and the Rules of Applegate (1935). Additional information was grouped into the following categories: cast general condition (place of pouring, impression material, plaster type, presence of blisters on cast surfaces), work orders sent to dental laboratories (evaluated according to explicitness of information contained therein) and framework planning (framework design, quality of dental preparations ? rest seats, guide planes, retention). Results: It were assessed a total of 121 casts, and 36(29.8%) had a prescription of the work to be done and 11(9.1%) of all casts had the design of frameworks to be made. Only 22(18.2%) casts had rest seats prepared. Only 6(5%) had evidence of preparation of guide planes, 76(62.8%) had a relative parallel surfaces between edentulous spaces and 74(61.2%) regions which receive retention clasp arms were considered suitable. Conclusions: The quality of casts and work orders sent to the dental laboratories is precarious. The planning stage for removable partial denture, in most cases, is delegated to the dental lab, where professionals do not even bother to make the basic dental preparations for this kind of rehabilitation.

Effects of early functional loading on maintenance of free autogenous bone graft and implant osseointegration: an experimental study in dogs.

PURPOSE: The aim of the present study was to investigate the healing, integration, and maintenance of autogenous onlay bone grafts and implant osseointegration either loaded in the early or the delayed stages. MATERIALS AND METHODS: A total of 5 male dogs received bilateral blocks of onlay bone grafts harvested from the contralateral alveolar ridge of the mandible. On one side, the bone block was secured by 3 dental implants (3.5 mm x 13.0 mm, Osseospeed; AstraTech AB, Mölndal, Sweden). Two implants at the extremities of the graft were loaded 2 days after installation by abutment connection and prosthesis (simultaneous implant placement group); the implant in the middle remained unloaded and served as the control. On the other side, the block was fixed with 2 fixation screws inserted in the extremities of the graft. Four weeks later, the fixation screws were replaced with 3 dental implants. The loading procedure (delayed implant placement group) was performed 2 days later, as described for the simultaneous implant placement sites. The animals were sacrificed 12 weeks after the grafting procedure. Implant stability was measured through resonance frequency analysis. The bone volume and density were assessed on computed tomography. The bone to implant contact and bone area in a region of interest were evaluated on histologic slides. RESULTS: The implant stability quotient showed statistical significance in favor of the delayed loaded grafts (P = .001). The bone-to-implant contact (P = .008) and bone area in a region of interest (P = 0.005) were significantly greater in the delayed group. Nevertheless, no difference was found in terms of graft volume and density between the early loaded and delayed-loaded approaches. CONCLUSIONS: The protocol in which the implant and bone graft were given delayed loading allows for effective quality of implant osseointegration and stabilization, with healing and remodeling occurring in areas near the implant resulting in denser bone architecture.

Reabilitação estética-funcional com ajuste prévio da oclusão em relação cêntrica / Aesthetic and functional rehabilitation with prior adjustment of the occlusion in centric relation

O presente artigo teve o objetivo de relatar um caso clínico de reabilitação estética e funcional de paciente com perda das guias anteriores causada por hábitos parafuncionais. Paciente DMS, 33 anos, gênero masculino, procurou a Faculdade de Odontologia da Universidade Federal de Goiás com queixa estética devido ao tamanho dos dentes anteriores. Ao exame clínico foi observado desgaste do terço incisal dos dentes anteriores, superiores e inferiores, provocado por hábitos parafuncionais (bruxismo do sono), e ausência dos dentes 18, 28, 35, 36, 38, 46 e 48. Na análise oclusal notou-se não haver espaço funcional para o restabelecimento da forma anatômica dos dentes na posição de máxima intercuspidação habitual. Foi proposto o ajuste oclusal em relação cêntrica, que uma vez posicionada a mandíbula mais posteriormente possibilitou a obtenção de espaço para reconstituição dos dentes anteriores desgastados. Após três sessões de ajuste foi confeccionada uma prótese parcial removível para reposição dos dentes inferiores ausentes (35, 36 e 46). Previamente à reanatomização dos dentes desgastados com resina composta direta, foi realizada a técnica de mock-up, permitindo a avaliação estética e aprovação do paciente. Concluídos os procedimentos restauradores por meio de guias de matriz de silicona, novos modelos foram obtidos e montados em articulador semiajustável para confecção de placa oclusal miorrelaxante em resina acrílica. Na entrega da placa e ajustes posteriores o paciente foi orientado quanto ao uso e cuidados para manutenção dos resultados alcançados.

The objetive of this article was report a case of cosmetic and functional rehabilitation of patients with loss theiranterior guides caused by parafunctional habits. DMD patient, 33 years, male, sought the Faculty of Dentistry of Federal University of Goiás with esthetic complain due the size of her anterior teeth. In the clinical examination was seen: incisal wear of anterior teeth, upper and lower, caused by deleterious habits (sleep bruxism) and absence of teeth 18, 28, 35, 36, 38, 46 and 48. In occlusal analysis noted that there was no space for the restoration of functional anatomic shape of teeth in the habitual intercuspal position. Occlusal adjustment was proposed in centric relation, once the jaw positioned subsequently had more space for restoration with direct composite of worn anterior teeth. After three sessions the adjustment was made a removable partial denture for replacement of the lower teeth missing (35, 36 and 46). The mock-up technique was performed before the teeth restoration with direct composite resin, allowing the aesthetic evaluation and patient approval. On completion of the restoration procedures using silicone matrix guides, new models were obtained and mounted on semi-adjustable articulator for fabrication of occlusal splints relaxant in acrylic resin. After delivery of the occlusal splints relaxant and subsequent adjustments the patient was instructed on the use and care for maintenance all results.