Prevalence of oral injuries and salivary changes in patients with chronic renal failure on hemodialysis: systematic review and meta-analysis

The objective of this study was to evaluate whether individuals with chronic renal failure (CRF) undergoing hemodialysis treatment have more salivary and oral mucosa alterations when compared to healthy individuals, through a systematic review followed by meta-analysis. A systematic literature review was performed, evaluating randomized clinical trials found in the Proquest, Embase, Scopus, Cochrane Library, Web of Science, Lilacs and Pubmed databases, using MeSH terms and other keywords. Initially, 40 articles were included in the study and, after reading the complete articles, only 15 clinical trials that analyzed oral lesions and salivary changes in patients with CRF undergoing hemodialysis treatment were eligible. Most of the clinical studies included were cross-sectional and composed of a study group and a control group. The mean age of participants in the study group was 50.19 years and in the control group, 48.95 years. The most common oral alterations found in the CRF group in relation to the control group were xerostomia, uremic breath, dysgeusia, coated tongue, gingival bleeding and pale mucosa. The salivary flow of patients with CRF was 46.6% lower than the control group. The salivary pH in the study group was also more alkaline when compared to the control group. Greater amounts of urea, phosphate, C-reactive protein and total proteins were found in the saliva of individuals with CRF. Individuals with CRF undergoing hemodialysis are more prone to changes in both the quantity and quality of saliva, as well as having a greater amount of oral changes.

Uncommon case of histoplasmosis with oral manifestation: A case report of diagnosis in a South American patient.

INTRODUCTION: Histoplasmosis is a systemic fungal disease caused by the H. capsulatum fungus, which is mainly present in feces and guano of birds and bats. This condition manifests in several ways and it is more severe in its disseminated form and in immunosuppressed patients, putting the patient at risk of death if not diagnosed in time. CASE PRESENTATION: This report presents the case of a 39-year-old white female patient, a seller of agricultural machinery, with a history of lupus erythematosus, who attended a private dental office complaining of a tongue lesion. The patient reported having been subjected to an incisional biopsy of this lesion and the histopathological examination identified an inflammatory process. Considering the inefficient management of the lesion with intralesional application of corticosteroids, squamous cell carcinoma or granulomatous fungal infection was suspected, and a new biopsy was performed allowing the diagnosis of histoplasmosis already spread to the liver, intestines, and bone marrow. The diagnosed disease led the patient to undergo extensive antifungal treatment, including a period of hospitalization. DISCUSSION: The diagnosis of histoplasmosis can be delayed due to several factors, mainly due to its diverse clinical presentation between acute, chronic and disseminated forms. However, achieving an early diagnosis for histoplasmosis is very important to maintain the patient's quality of life. CONCLUSION: Greater education, information, and awareness about histoplasmosis among health professionals are required for managing these cases, especially in endemic areas to H. capsulatum.

Prevalence of red and orange microbial complexes in endodontic-periodontal lesions: a systematic review and meta-analysis.

OBJECTIVE: This systematic review assesses the prevalence of microbial complexes in endodontic-periodontal lesion. MATERIALS AND METHODS: Nine databases were searched through August 2020. Experts were consulted to indicate additional studies. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies that evaluated the prevalence of microbial orange and red complexes among patients with endodontic-periodontal lesion were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. RESULTS: From 572 articles found on all databases, 11 clinical studies were finally included. The following microorganisms were investigated: P. gingivalis, T. forsythia, T. denticola, F. nucleatum, F. periodonticum, P. micra, P. intermedia, P. nigrescens, S. constellatus, C. gracilis, C. rectus, C. showae and E. nodatum. Considering the orange complex, P. micra, E. nodatum and S. constellatus were prevalent in both root canal and periodontal pockets. P. gingivalis and T. forsythia belonging to the red complex were prevalent only in periodontal pockets. The red complex microorganisms were not found very frequently in root canal. CONCLUSIONS: There is a similarity between the microbiome of root canal and periodontal pockets, with prevalence of the three microorganisms of the orange complex. Two microorganisms from the red complex were prevalent only in periodontal pockets. CLINICAL RELEVANCE: The prevalence of specific microorganisms in endodontic-periodontal lesion is important to understand the microbiological profile of the patients involved and to correlate it with possible clinical and repair conditions of this pathology.

Orthognathic surgery and orthodontics associated with orofacial harmonization: Case report.

INTRODUCTION AND IMPORTANCE: Orthognathic surgery aims to restore the functional and esthetic standards of the face and non-surgical or minimally invasive procedures have been optimizing the results of facial orthosurgical treatments. This case report aimed to show the use of minimally invasive techniques that, associated with orthognathic surgery, represent a trend in current oral and maxillofacial rehabilitation. CASE PRESENTATION: A female patient, 28 years old, white, sought care from the Dentistry team of the São Vicente de Paulo Hospital, in Passo Fundo, Brazil, complaining of mandibular prognathism, anteroposterior maxillary deficiency, dental crowding, malocclusion, functional and esthetic changes that negatively affected her psychosocial interactions and stomatognathic function. The treatment involved orthodontics, orthognathic surgery, and orofacial harmonization with dermal fillers. CLINICAL DISCUSSION: The multidisciplinarity among the specialties of Oral and Maxillofacial Surgery and Traumatology, Orthodontics, and Orofacial Harmonization add and contribute to the process of planning and implementing the treatment proposed, as well as the prognosis toward patient satisfaction. CONCLUSION: The surgical procedure associated with minimally invasive facial harmonization not only corrected the functional complaint of the patient but also played an important role in improving facial harmony, contributing significantly to self-esteem.

Building oral health assignments for community health workers through the Delphi technique. / Construção de atribuições em saúde bucal para agentes comunitários de saúde através da técnica Delphi.

The literature does not clearly define the assignments of Community Health Workers (CHW) in the field of oral health. This study aimed to redefine the main assignments of CHW regarding their work processes in oral health in basic health care. A theoretical-logical model based on an official publication from the Brazilian Ministry of Health, with six dimensions of work, was used. The model was built based on the assignments of CHW in Dentistry and sent to 30 experts chosen intentionally for the consensual study, using the Delphi technique. The matrix presented the following dimensions: registration of families, mapping the coverage area, home visits, work with community health education, participation in the community, and intersectoral work. These dimensions were detailed with sub-dimensions and measurable criteria. After the study participants analyzed the dimensions, two criteria were excluded. Fourteen experts concluded the study. The final matrix showed the need for CHW to be trained in several oral health topics. This study provides an objective framework of the work process of CHW in oral health and shows their ability to perform oral health promotion, surveillance, prevention, and education actions.

As atribuições dos Agentes Comunitários em Saúde (ACS) na área da saúde bucal não estão claramente especificadas na literatura. Este estudo objetivou redefinir as principais atribuições dos ACS em relação aos processos de trabalho em saúde bucal na atenção básica à saúde. Utilizou-se um modelo teórico lógico baseado em publicação oficial do Ministério da Saúde, com seis dimensões de trabalho. O modelo construído sobre as atribuições dos ACS na Odontologia foi enviado a trinta "experts" escolhidos de forma intencional para o estudo consensual através da técnica Delphi. A matriz apresentou como dimensões: cadastramento das famílias, mapeamento da área de atuação, visita domiciliar, trabalhando educação em saúde na comunidade, participação na comunidade e atuação intersetorial. O detalhamento dessas dimensões foi realizado com subdimensões e critérios mensuráveis. Depois de analisadas as dimensões pelos participantes do estudo, dois critérios foram excluídos. Quatorze experts realizaram o estudo por completo. A matriz final demonstrou a necessidade do ACS estar capacitado em diversos tópicos de saúde bucal. Este estudo fornece uma imagem-objetivo do processo de trabalho do ACS em saúde bucal e demonstra a capacidade do mesmo de realizar atividades de promoção, vigilância, prevenção e educação em saúde bucal.

Construção de atribuições em saúde bucal para agentes comunitários de saúde através da técnica Delphi / Building oral health assignments for community health workers through the Delphi technique

Resumo As atribuições dos Agentes Comunitários em Saúde (ACS) na área da saúde bucal não estão claramente especificadas na literatura. Este estudo objetivou redefinir as principais atribuições dos ACS em relação aos processos de trabalho em saúde bucal na atenção básica à saúde. Utilizou-se um modelo teórico lógico baseado em publicação oficial do Ministério da Saúde, com seis dimensões de trabalho. O modelo construído sobre as atribuições dos ACS na Odontologia foi enviado a trinta "experts" escolhidos de forma intencional para o estudo consensual através da técnica Delphi. A matriz apresentou como dimensões: cadastramento das famílias, mapeamento da área de atuação, visita domiciliar, trabalhando educação em saúde na comunidade, participação na comunidade e atuação intersetorial. O detalhamento dessas dimensões foi realizado com subdimensões e critérios mensuráveis. Depois de analisadas as dimensões pelos participantes do estudo, dois critérios foram excluídos. Quatorze experts realizaram o estudo por completo. A matriz final demonstrou a necessidade do ACS estar capacitado em diversos tópicos de saúde bucal. Este estudo fornece uma imagem-objetivo do processo de trabalho do ACS em saúde bucal e demonstra a capacidade do mesmo de realizar atividades de promoção, vigilância, prevenção e educação em saúde bucal.

Abstract The literature does not clearly define the assignments of Community Health Workers (CHW) in the field of oral health. This study aimed to redefine the main assignments of CHW regarding their work processes in oral health in basic health care. A theoretical-logical model based on an official publication from the Brazilian Ministry of Health, with six dimensions of work, was used. The model was built based on the assignments of CHW in Dentistry and sent to 30 experts chosen intentionally for the consensual study, using the Delphi technique. The matrix presented the following dimensions: registration of families, mapping the coverage area, home visits, work with community health education, participation in the community, and intersectoral work. These dimensions were detailed with sub-dimensions and measurable criteria. After the study participants analyzed the dimensions, two criteria were excluded. Fourteen experts concluded the study. The final matrix showed the need for CHW to be trained in several oral health topics. This study provides an objective framework of the work process of CHW in oral health and shows their ability to perform oral health promotion, surveillance, prevention, and education actions.

Clinical and satisfaction outcomes of using one or two dental implants for mandibular overdentures: preliminary short-term follow-up of a randomized clinical trial.

OBJECTIVE: This randomized clinical trial aimed to evaluate the marginal bone loss and peri-implant aspects in patients with mandibular overdentures retained by one or two implants and assess patient satisfaction, prosthesis-related clinical outcomes, and masticatory efficiency. METHODS: Patients from the School of Dentistry of the University of Passo Fundo (UPF) with lower conventional complete dentures dissatisfied with prosthetic retention were selected. Eighteen patients were analyzed and divided into randomized treatment groups: GA, installation of one implant in the midline of the mandibular symphysis (8 patients), and GB, installation of two implants in the lower canine region (10 patients). Implant survival and prosthetic maintenance were assessed by clinical and radiographic examinations performed 6 months after implant placement and 3 months after loading. Finally, the masticatory efficiency of the prostheses was evaluated with the QoLIP-10 (Quality of Life with Implant-Prostheses) questionnaire, and the degree of patient satisfaction used the visual analog scale (VAS). RESULTS: Regarding the esthetic satisfaction of the patients, there was no statistical difference between the two groups studied (p = 0.680). Patients who received two implants presented easier chewing (p = 0.049) and a lower average number of prosthesis maintenance. There was no difference between the groups regarding peri-implant bone resorption 3 months after the use of prostheses. CONCLUSIONS: The use of two dental implants showed higher masticatory ability and lower need for maintenance appointments when compared with one implant in mandibular overdentures but did not affect peri-implant aspects and patient satisfaction. The treatment using one implant was effective for the aspects evaluated, but further clinical studies are required on the subject.

Oral leukoplakia-epidemiological survey and histochemical analysis of 107 cases in Brazil.

OBJECTIVE: To perform an epidemiological survey comparing the cell proliferative activity of 107 cases of oral leukoplakia with their clinical and histopathological characteristics. MATERIALS AND METHODS: A cross-sectional, observational, and histological-histochemical study. The cases came from the Histopathological Diagnostic Service of UPF/RS and the School of Dentistry of Araçatuba FOA/UNESP/SP (1986-2016). The histopathological sections were stained using the silver staining (AgNOR) technique and the nuclei of 100 epithelial cells selected randomly were recorded to count the number of nucleolar organizer regions (NORs). The mean NORs per lesion were correlated to clinical and histological characteristics using ANOVA, at 5% significance. RESULTS: Most of the cases included men (62.62%), white (64.49%), and with an average age of 53.94 years. The most probable etiological factors were smoking (44.7%) and alcohol consumption (9.85%). The evolution time of most lesions was fast (33.65%), manifesting mainly in the form of plaques (70.37%) and without symptoms (58.88%). They were located mainly in the cheek mucosa (26.62%) and presented white color (66.35%), well-defined edges (59.81%), firm consistency (47.5%), and keratinized surface (49.53%). Etiological factor (p = 0.003), evolution time (p = 0.006), symptoms (p = 0.029), location (p = 0.020), consistency (p = 0.047), histopathological characteristics (p = 0.004), and superficial keratinization (p = 0.001) were statistically significant regarding the mean NORs of the leukoplakias studied. CLINICAL RELEVANCE: Oral leukoplakias caused by alcohol consumption and/or tobacco use, considering an evolution time of fewer than 12 months, asymptomatic, located in the lower lip or tongue, and with a firm consistency and increased superficial keratinization should be treated more aggressively by the clinician to avoid cancerization.

Diferenciação oxidativa em dispositivos temporários de ancoragem de Ti6Al4V e aço 316L ­ estudo piloto / Oxidative differentiation in temporary anchoring devices made by Ti6Al4V and 316L steel ­ a pilot study

Resumo Este estudo piloto testou a hipótese de que os dispositivos temporários de ancoragem (DATs) fabricados de Aço 316L são mais resistentes à corrosão, mesmo em meio com flúor, do que os DATs fabricados a partir de ligas de titânio, para tanto foram realizadas medições eletroquímicas em Potenciostato. Materiais e Métodos: Quatro amostras de cada material foram testadas em cada conjunto de teste, a formulação artificial de saliva de Fusayama foi usada como eletrólito solução neste estudo de corrosão in vitro, sem flúor em sua composição e, em um segundo momento, com a concentração de 1500ppM de flúor em sua composição. No teste, uma polarização catódica foi então realizada aumentando essa voltagem por 5 minutos ou até que se obtivessem os pitins de corrosão. Em saliva artificial contendo até 1500ppmF- foi repetido esse teste com novas amostras de cada material em solução de saliva artificial sem a presença de flúor. Resultados: Os resultados de escala de corrente de indução foram inseridos no software OriginPro8 para confecção dos gráficos de valores. Tratando-se de um número reduzido de amostras, para não violar a confiabilidade do estudo, não se realizou teste estatístico. Dentre todas as ligas metálicas utilizadas atualmente, a liga de Ti6Al4V apresentou uma boa resistência à corrosão em saliva artificial. Entretanto a corrosão dessas ligas ocorre em contato com altas concentrações de flúor, diferentemente da liga de Aço 316L, que além da corrosão faz a passivação da superfície. (AU)

Abstract The aim of this pilot study was to test the hypothesis that temporary anchoring devices (TADs) made of 316L steel are more resistant to corrosion even in fluorine environment than DATs manufactured in addition to titanium alloys, for this Potentiostat electrochemical measurements were performed. Materials and Methods: Four pieces of each material were tested in each test set, an application of Fusayama artificial saliva was used as an electrolytic solution in this study of in vitro corrosion, without fluorine in its composition and in a second moment with 1500ppM of fluorine in its composition. In the test, a cathodic polarization was performed by increasing this voltage for 5 minutes or until the corrosion pins were obtained. In artificial saliva containing up to 1500ppmF- this test was repeated with new samples of each material in artificial saliva solution without fluorine. Results: The results of the induction current scale were inserted into OriginPro8 software for making value graphs. As there was a small number of samples, in order not to violate the study's reliability no statistical test was performed. Among all metal alloys currently used the Ti6Al4V alloy showed good resistance to corrosion in artificial saliva. However, the corrosion of these alloys occurs in contact with high fluorine concentration, unlike 316L steel alloy, which in addition to corrosion makes surface passivation. (AU)

Treatment of facial myiasis in an elderly patient with oral squamous cell carcinoma: Case report.

Myiasis is caused by the infestation of fly larvae in human tissues and it presents immunodeficiency, poor hygiene, or malignant neoplasias as predisposing chronic diseases. OBJECTIVE: To describe a clinical case of myiasis associated with oral squamous cell carcinoma (OSCC) in an elderly patient. CASE PRESENTATION: A 60-year-old male, black, smoker, and alcoholic patient with OSCC, who refused initial cancer treatment and sought hospital care with an extensive facial lesion and approximately 150 larvae in the extraoral region. The treatment was given through the administration of 6 mg of Ivermectin associated with the surgical removal of the larvae. Subsequently, palliative chemotherapy began. DISCUSSION: Myiasis can sometimes be associated with OSCC and it commonly occurs in individuals who live in unhealthy locations and present poor hygiene and low immunity. In addition to medication, the surgical removal of the larvae is important in the treatment of myiasis. CONCLUSION: Patient adherence to cancer treatment is essential to avoid the negative evolution of the tumor. The social component linked to the development of myiasis makes it an important public health topic, as it is related directly to the lack of primary care. Surgical and drug treatments are required to cure myiasis.

Etiologia das lesões endo-periodontais - uma visão para o diagnóstico clínico: uma revisão de literatura / Etiology of endo-periodontal lesions - a vision for clinical diagnosis: a literature review

O objetivo deste estudo é apresentar e discutir as principais etiologias das lesões endo-periodontais com intuito de auxiliar o Cirurgião-dentista na busca de um correto diagnóstico clínico e posterior tratamento. Foram coletados dados na literatura, pertinentes ao assunto, nas plataformas de busca de dados Crochane, Medline, PubMed e Scielo, contendo artigos científicos no período de 01/2002 até 06/2019, nos idiomas inglês e português. Com isso, os resultados dessa busca foram selecionados pelos seguintes critérios: estudos abrangendo a etiologia das lesões endo-periodontais, estudos com metodologias e resultados claros, objetivos e pesquisas in vivo ou in vitro devidamente estruturadas e com resultados relevantes para a comunidade científica. Os critérios de exclusão foram os artigos que não apresentassem nenhum dos objetivos a serem pesquisados. Assim, os resultados encontrados no estudo foram: 73 artigos, incluídos 23 artigos e 50 artigos excluídos. As etiologias das lesões endo-periodontais estão relacionadas a diferentes alterações patológicas nos tecidos pulpares e/ou periodonto, entre elas pode-se considerar a anatomia dental, doença periodontal, doença endodôntica, microbiota, cárie dentária, biofilme dental, trauma dental, reabsorções dentárias, tratamento endodôntico deficiente, fraturas, mal formações dentárias, iatrogênias, entre outros. Assim, o Cirurgião-Dentista deve estar atento às diversas etiologias para futuramente elaborar um diagnóstico e um plano de tratamento eficiente baseado na fonte de origem dessa lesão endo-periodontal (AU)

The objective of this study is to present and discuss the main etiologies of the endo-periodontal lesions in order to assist the dentist in the search for a correct clinical diagnosis and subsequent treatment. Data were collected from the Crochane, Google Scholar, Medline, PubMed and Scielo data search platforms, containing scientific articles from 01/2002 to 06/2019, in the English and Portuguese languages. The results of this search were selected according to the following criteria: studies covering the etiology of endo-periodontal lesions, studies with clear methodologies and results, objectives and in vivo or in vitro research, duly structured and with relevant results for the scientific community. Exclusion criteria were articles that did not present any of the objectives to be investigated. Thus, the results found in the study were: 73 articles, including 23 articles and 50 excluded articles. The etiologies of the endo-periodontal lesions are related to different pathological alterations in the pulp and / or periodontal tissues, among them the dental anatomy, periodontal disease, endodontic disease, microbiota, dental biofilm, dental trauma, dental resorption, poor endodontic treatment, fractures, dental malformations, iatrogenes, among others. Thus, the Dentist should be aware of the different etiologies in order to elaborate a diagnosis and an efficient treatment plan based on the source of the endo-periodontal lesion. (AU)

Alterações estomatológicas mais frequentes e seu processo diagnóstico ­ revisão de literatura / Most frequent stomatological changes and their diagnostic process ­ literature review

Introdução: os estudos epidemiológicos exercem um importante papel na Saúde Pública, indicando a prevalência e a incidência das lesões do complexo bucomaxilofacial, e revelando fatores associados, como perfil socioeconômico, fatores genéticos e ambientais, e permitindo o direcionamento de ações de promoção e de prevenção de saúde. Objetivo: o objetivo do presente trabalho é realizar uma revisão de literatura acerca dos aspectos mais importantes para o estabelecimento do diagnóstico das alterações estomatológicas. Revisão de literatura: um dos principais obstáculos dos profissionais da saúde diante de um caso de lesão bucal é o estabelecimento de um diagnóstico preciso, devido à grande quantidade de diagnósticos diferenciais que tais condições podem apresentar. É viável, através do auxílio dos estudos de prevalência, reduzir o número de diagnósticos diferenciais, identificando a frequência das lesões para cada região, ao considerar também variáveis, como faixa etária, etnia e gênero. Considerações finais: conhecer a prevalência das lesões e saber identificar as variáveis associadas a cada uma é de suma importância para o estudante de odontologia e mesmo para o profissional, uma vez que este conhecimento contribuirá para o melhor manuseio e proservação de seu paciente.

Introduction: epidemiological studies performs an important role in Public Health, indicating the prevalence and incidence of injuries of the bucomaxillofacial complex, and revealing associated factors such as socioeconomic profile, genetic and environmental factors, and allowing the promotion of prevention and Cheers. Objective: the aim of the present study is to carry out a literature review about the most important aspects for establishing the diagnosis of stomatologic alterations. Literature review: one of the main obstacles faced by health professionals in the case of oral lesions is the establishment of an accurate diagnosis, due to the large number of differential diagnoses that such conditions may be present. It is feasible, through the aid of prevalence studies, to reduce the number of differential diagnoses, identifying the frequency of lesions for each region, as well as variables such as age, ethnicity and gender. Final considerations: knowing the prevalence of lesions and knowing how to identify the variables associated with each one is of paramount importance for the student of dentistry and even for the professional, since this knowledge will contribute to the better handling and proservation of his patient.

Sobredentadura retida por sistema barra-clipe: revisão de literatura / Overdenture retained by bar-clip system: literature review

Introdução: as overdentures são próteses totais removíveis, mucoimplanto-suportadas, estabilizadas por elementos instalados sobre raízes residuais e/ou sobre implantes. Uma variedade de sistemas de encaixe tem sido utilizada para suportar as sobredentaduras, dentre os quais os sistemas barra-clipe, bolas, magnetos e coroas telescópicas. Objetivo: avaliar, por meio de uma revisão de literatura, as sobredentaduras retidas por sistema barra-clipe, expondo um correto planejamento, bem como descrevendo protocolos de confecção de tais aparelhos. Métodos: foi realizada uma revisão de literatura nas bases de dados do Centro Latino-americano e do Caribe de Informações em Ciências da Saúde (LILACS), Medline, Bibliografia Brasileira de Odontologia (BBO), na biblioteca virtual (SCIELO), e no acervo de livros da Universidade de Passo Fundo/RS (UPF). Revisão de literatura: o sistema barra-clipe consiste de uma barra plástica para fundição (ou já em metal) e de um clipe de retenção. Em algumas situações, o sistema de encaixes por barra-clipe é mais indicado do que os demais sistemas, apresentando, todavia, limitações em determinados cenários clínicos. O sistema barra-clipe permite considerável retenção e estabilidade, resultando num restabelecimento da função mastigatória, maior segurança e grande satisfação do paciente. Considerações finais: a maior parte dos estudos mostrou uma melhora da qualidade de vida relacionada à saúde bucal dos pacientes após tratamento com overdenture em comparação com a prótese total removível convencional.

Introduction: overdentures are removable, muco-implantsupported, complete dentures, stabilized by elements installed on residual roots or implants. A variety of docking systems have been used to support overdentures, including bar-clip systems, balls, magnets and telescoping crowns. Objective: to evaluate, through a literature review, the overdentures retained by bar-clip system, exposing a correct planning, as well as describing protocols of making such devices. Methods: a literature review was carried out in the databases of the Latin American and Caribbean Center on Health Sciences Information (LILACS), Medline, Brazilian Dentistry Bibliography (BBO), the virtual library (SCIELO) and the collection of books from the University of Passo Fundo/RS (UPF). Literature Review: the bar-clip system consists of a plastic bar for casting or already metal and a retention clip. In some situations, the clip-on system is more suitable than other systems, although it has limitations in certain clinical scenarios. The bar-clip system allows considerable retention and stability, resulting in a restoration of the masticatory function, greater safety and great patient satisfaction. Final considerations: most of the studies showed an improvement in the quality of life related to the oral health of the patients after treatment with overdenture compared to the conventional total removable prosthesis.

Recobrimento radicular de recessões gengivais classe II de miller: dois relatos de casos clínicos / Root coverage of miller class II gingival recessions: two clinical case reports

O presente estudo objetivou descrever dois casos clínicos de recessão gengival em incisivos inferiores Classe II de Miller, tratados através da técnica de enxerto gengival livre. Ambos pacientes eram do gênero feminino, com condição sistêmica saudável e procuraram atendimento em consultório particular. O diagnóstico e plano de tratamento foi enxertia gengival para os dois casos e o prognóstico considerado favorável. A sequência da técnica cirúrgica foi descrita para cada situação clínica individual. Também foi relatado o pós-operatório e a preservação dos dois casos clínicos. Observou-se que o recobrimento radicular foi obtido para as duas situações clínicas, sendo que o caso 1 teve um maior percentual de recobrimento de 90% e apresentou um "crepping attachment", e o caso 2, em função da altura da recessão, teve um recobrimento de 57%, que são resultados considerados favoráveis para a técnica empregada. Pôde-se concluir que a técnica cirúrgica executada nesta descrição clínica foi resolutiva no aspecto de efetivo ganho de gengiva ceratinizada em parte da área desnuda, possibilitando melhorias na condição de saúde periodontal e nos métodos de higiene adotados pelo paciente. (AU)

The present study aimed at modifying the clinical cases of Miller's Class II in lower lateral incisor gingival recessions, followed by the free gingival graft technique. Both patients were of the female gender, had a healthy systemic condition and were attended in a private practice, the diagnosis and plan of treatment was gingival graft for both cases and the prognosis were considered favorable. The sequence of the surgical technique was reported for each individual clinical situation. The postoperative period and the proservation of the two clinical cases were also reported. It was observed that the root coverage was revised for both clinical situations, with case 1 having a higher percentage of root coverage of 90% and presenting a "creping attachment", and case 2, as a function of the height of recession has covering of 57%, which is results considered favorable for the technique used. It was concluded that the surgical technique used in the description of this case was decisive in the effective gain of keratinized gingiva in the recession area, allowing for improvements in periodontal health and the hygiene methods adopted by the patient (AU)

Prevalence and severity of periodontal disease in type 2 diabetes mellitus patients: a cross-sectional study / Prevalência e severidade da doença periodontal em pacientes portadores de diabete mellitus tipo 2: um estudo transversal

This is a cross-sectional clinical study performed with type 2 diabetes mellitus patients and nondiabetic patients, in the city of Passo Fundo, RS, Brazil, which aimed to verify whether periodontal disease is more prevalent in type 2 diabetes mellitus (DM2) patients. The study sample included 275 patients, wherein 117 were type 2 diabetes patients and 158 were non-diabetic patients, who were assessed between the years of 2007 and 2010. The inclusion criteria of the study were patients older than 35 years with DM2 diagnosed for more than one year through glycemia and glycosylated hemoglobin tests. The same criteria was used for the control group, except for the presence of diabetes. The participants were evaluated by students calibrated for the Periodontal Screening and Recording (PSR) index and through a questionnaire assessing age, gender, oral hygiene conditions, and medications of the patients. Generalized gingivitis was more prevalent in diabetic patients (p<0.001). The level of oral hygiene of the diabetic patients was considered fair and poor (p<0.001) when compared to the non-diabetic patients. More sextants with periodontal health were observed in non-diabetic patients (p<00.1) when compared to type 2 diabetes mellitus patients; tooth loss was also greater in DM2 patients. The study allowed concluding that DM2 patients presented higher prevalence of periodontal disease than the control group. The factors that might have influenced these results were systemic condition (DM2), level of oral hygiene, and age, which justifies the high rate of periodontal disease and tooth loss in these individuals.

O presente estudo realizou um estudo clínico transversal em pacientes com diabete mellitus tipo 2 e não diabéticos na cidade de Passo Fundo/RS - Brasil, com o objetivo de verificar se a doença periodontal é mais prevalente nos pacientes com diabetes mellitus tipo 2 (DM2). A amostra do estudo foi composta por 275 pacientes, sendo 117 portadores de diabete tipo 2 e 158 pacientes sem diabete tipo 2, examinados no período de 2007-2010. Os critérios de inclusão neste estudo foram: pacientes com mais de 35 anos de idade e com DM2 diagnosticada há mais de 1 ano através de exames de glicemia e hemoglobina glicosilada. O mesmo critério foi utilizado para o grupo de controle, exceto a diabete. Os participantes foram avaliados por alunos calibrados para o índice Periodontal Screening and Recording (PSR) e através de um questionário avaliando a idade, gênero, condições de higiene bucal e medicamentos utilizados pelos pacientes. A gengivite generalizada foi observada com maior frequência nos portadores de diabete (p<0,001). O grau de higiene bucal dos diabéticos foi considerado regular e ruim (p<0,001) quando comparado ao dos pacientes não diabéticos. Observou-se mais sextantes com saúde periodontal nos pacientes sem diabete (p<00,1) quando comparados com os pacientes com diabete mellitus tipo 2 e também maior perda dentária nos pacientes com DM2. Conclui-se com o estudo que os pacientes com DM2 apresentaram maior prevalência da doença periodontal quando comparados ao grupo de controle. Os fatores que podem ter influenciado esses resultados foram a sua condição sistêmica (DM2), grau de higiene oral e idade dos mesmos, justificando o alto índice de doença periodontal e perda dentária nesses indivíduos.

Perception of dentists, dental students, and patients on dentogingival aesthetics / Percepção de dentistas, estudantes de odontologia e pacientes sobre a estética dentogengival

Abstract Introduction Patients' demand for dentogingival aesthetics has increased significantly in recent years, and this is a complex concept due to numerous factors involved in obtaining patient/professional satisfaction. Some dentogingival features may alter smile harmony, such as excessive gingival display. Objective To evaluate whether the presence of gingival display has a negative influence on the perception of dentogingival aesthetics. Material and method 180 individuals (60 dentists, 60 dental students, and 60 patients) evaluated images of volunteer smiles. These images were digitally altered by the Adobe Photoshop™ software, creating different situations of gingival display (4 mm, 2 mm, 0 mm, -2 mm, -4 mm), and graded by the evaluators with the following scores: (01) very pleasant smile, (02) pleasant smile, and 03) unpleasant smile. The scores assigned were analyzed using ANOVA (α=0.05). Result Gingival displays between 0 and 2 mm were considered aesthetically pleasing. Changes of -4 and +4 mm were defined as the most disharmonious smiles. The 0-mm female smile was considered the most harmonious for dentists (1.51) and dental students (1.77), by Student's t test (p<0.05). In the opinion of patients, the smile of +2 mm was considered the most aesthetic. In the image evaluations of men, the 0-mm smile was considered the most aesthetic (p <0.05) for dentists (1.85) and dental students (1.62). The patients considered +2 mm of gingival display the most harmonious smile. Conclusion The aesthetic perception of dental students and dentists was different when compared to the group of patients.

Resumo Introdução A procura dos pacientes pela estética dentogengival tem aumentado significativamente nos últimos anos, sendo um conceito complexo devido aos inúmeros fatores envolvidos para a obtenção da satisfação paciente/profissional. Algumas características dentogengivais podem alterar a harmonia do sorriso como por exemplo o excesso de exposição gengival. Objetivo Avaliar se a presença da exposição gengival tem uma influência negativa na percepção da estética dentogengival. Material e método 180 indivíduos (60 dentistas, 60 acadêmicos de odontologia e 60 pacientes) avaliaram imagens de sorrisos de voluntários. Essas imagens foram alteradas digitalmente pelo software Adobe Photoshop™, criando diferentes situações de exposições gengivais (4 mm, 2 mm, 0 mm, -2 mm, -4 mm), e classificados pelos avaliadores através dos escores: (01) sorriso muito agradável, (02) agradável e (03) desagradável. Os escores atribuídos foram analisados por meio da ANOVA (α=0,05). Resultado Exposições gengivais entre 0 e 2 mm foram consideradas esteticamente agradáveis. Alterações de -4 e +4 mm foram definidas como as mais desarmônicas. O sorriso de 0 mm no sexo feminino foi considerado mais harmônico para os dentistas (1,51) e estudantes de odontologia (1,77), pelo teste t de Student (p<0.05). Na opinião dos pacientes o sorriso de +2 mm foi considerado o mais estético. Na avaliação das imagens do sexo masculino, o sorriso de 0 mm foi considerado o mais estético (p<0,05), para dentistas (1,85) e estudantes de odontologia (1,62). Os pacientes consideraram +2 mm de exposição gengival como o sorriso mais harmônico. Conclusão A percepção estética de estudantes de odontologia e cirurgiões dentistas foram diferentes quando comparado ao grupo dos pacientes.

Perception of Dental Students, Dentists and Patients on the Esthetics of Gingival Recession.

BACKGROUND: This cross-sectional study verified the self perception of different observers on gingival recession. METHODS: Areas of gingival recession were digitally modified using software simulating different clinical conditions in the esthetic area. A total of 180 individuals (60 dentists, 60 patients, and 60 dental students) participated in this study. From an original photograph of the smile of a volunteer, five cases of gingival recession (GR), including unilateral recession (lateral incisor and canine), bilateral recession (lateral incisor and canine), and generalized recession in upper anterior teeth, were intentionally created with Adobe Photoshop 2015™ image-editing software. The participants analyzed the photographs with scores of 1 (very pleasant), 2 (pleasant), and 3 (unpleasant). The data were evaluated using Student's t-test and ANOVA with Tukey's post hoc test at p less than 0.05. RESULTS: Unilateral recession was considered more esthetically pleasing when compared to bilateral recession, showing a signifi cant difference for all groups (p less than 0.05). Patients considered generalized recession and bilateral recession of upper canines less esthetic (p less than 0.05). CONCLUSION: Within the limits of this study, it could be concluded that dentists have better visual perception when compared to dental students, who in turn were more perceptive than patients.

Síndromes em Odontologia - revisão de literatura / Syndromes in Dentistry - literature review

Objetivo: o presente trabalho teve por objetivos descrever as principais síndromes de acometimento bucal primário, relatando seus sinais, sintomas, métodos de diagnóstico e tratamento e ressaltar a importância do cirurgião-dentista no diagnóstico de alterações sistêmicas. Métodos: foi realizada uma pesquisa bibliográfica acerca de cinco síndromes de acometimento bucal primário, para isso, realizou-se uma busca de informações nas bases de dados eletrônicas Scielo, Bireme, Pubmed entre 2000 a 2017. Revisão de Literatura: Entende-se por "síndrome" um conjunto de sinais e sintomas que caracterizam determinada enfermidade, essas, podem ocorrer de forma isolada ou manifestar seus primeiros sintomas na cavidade oral, os quais são indícios de alterações sistêmicas que possam estar ocorrendo. Entre tantas, destacam-se a seguir cinco das principais síndromes de acometimento bucal primário: Síndrome de Behçet, Síndrome de Sjögren, Síndrome de Peutz-Jeghers, Doença de Addison, e Síndrome de Gardner. Considerações finais: a partir da revisão de literatura foi possível notar que as síndromes podem ocorrer de forma isolada ou manifestar seus primeiros sintomas na cavidade oral. Como suas primeiras manifestações são orais, é imprescindível que o cirurgião-dentista tenha conhecimento sobre elas para que seja elaborado um diagnóstico e protocolo de tratamento corretos e de rápida execução, já que sua terapia será executada com auxílio de vários profissionais da área da saúde.

Objective: the objective of this study was to describe the main syndromes of primary oral affection, reporting its signs, symptoms, methods of diagnosis and treatment, and to emphasize the importance of the dental surgeon in the diagnosis of systemic alterations. Methods: we carried out a literature search about five syndromes of primary oral affection. For this, a search of information was made in the electronic databases Scielo, Bireme, Pubmed between 2000 and 2017. Literature Review: "Syndrome" is understood as a set of signs and symptoms that characterize a particular disease; these can occur in isolation or manifest their first symptoms in the oral cavity, which are indications of systemic changes that may be occurring. Among so many, five of the main syndromes of primary buccal involvement are: Behçet's Syndrome, Sjögren's Syndrome, Peutz-Jeghers Syndrome, Addison's Disease, and Gardner's Syndrome. Final considerations: from the literature review it was possible to note that the syndromes may occur in isolation or manifest their first symptoms in the oral cavity. Since the first manifestations are oral, it is essential that the dentist know about them so that a correct diagnosis and protocol of treatment is elaborated and fast execution, since its therapy will be executed with the help of several professionals of the health area.

Correção de assimetria dentogengival com finalidade estética: Relato de caso clínico / Correction of dentogingival asymmetry with aesthetic purpose in a patient with gingival smile: case report

Introdução: a estética do sorriso pode ser alcançada por um conjunto de fatores que incluem a anatomia dentária, a anatomia gengival e as características faciais do paciente. Um sorriso agradável é baseado na harmonia desses fatores (estética branca-vermelha) e não somente na reabilitação dentária. O sorriso gengival é uma das principais queixas de pacientes que procuram o consultório odontológico, considerando que tal situação pode influenciar na sua vida pessoal ou profissional Objetivo: o propósito deste trabalho foi relatar o caso clínico de uma paciente com sorriso gengival e desarmonia entre a margem gengival e alinhamento das coroas clínicas de dentes anterossuperiores. Relato de Caso: paciente do sexo feminino, 58 anos de idade, com boa saúde geral, procurou consultório odontológico particular com o objetivo de melhorar a estética do sorriso. Ao exame clínico foi constatado sorriso gengival e necessidade de substituição presença de coroas metalo-cerâmicas. Considerações finais: a abordagem multidisciplinar envolvendo a técnica cirúrgica (retalho com osteotomia) e restauradora (confecção de facetas feldspáticas e coroas de porcelana pura na região anterossuperior) proporcionou o sucesso do tratamento reabilitador em questão, devolvendo à paciente um sorriso harmonioso com estética dentária e gengival agradáveis.

Introduction: smile's aesthetics can be achieved by a set of factors that include the dental anatomy, gingival anatomy and facial features of the patient. A pleasant smile is based on the harmony of these factors (white-red aesthetics) and not only on dental rehabilitation. The gingival smile is one of the main complaints of patients who seek the dental office, considering that such a situation may influence their personal or professional life. Objective: the purpose of this study was to report the clinical case of a patient with gingival smile and disharmony between the gingival margin and the alignment of the clinical crowns of anterosuperior teeth. Case Report: a 58-yearold female patient with good general health sought a private dental office with the aim of improving the aesthetics of the smile. The clinical examination revealed gingival smile and the need to replace the presence of metal-ceramic crowns. Final considerations: The multidisciplinary approach involving the surgical technique (restorative flap with osteotomy) and restorative (creation of feldspar facets and pure porcelain crowns in the anterior superior region) provided the success of the rehabilitation treatment in question, giving the patient a harmonious smile with aesthetics tooth and gum.

Uso de placas oclusais como tratamento de alterações no sistema estomatognático / Use of occlusal plaques as a treatment of diseases in stomatognathic system

Introdução: as disfunções temporomandibulares (DTMs) e musculares possuem causa multifatorial, sendo necessária a realização de anamnese minuciosa, além de exame clínico detalhado para que seja possível adotar a forma de tratamento mais correta. Objetivo: o presente trabalho visa, através de uma revisão de literatura, descrever o protocolo clínico de confecção, instalação e ajustes de placa miorrelaxante, compreender as indicações e os benefícios do uso das mesmas, além de comparar sua efetividade com outros métodos terapêuticos descritos na literatura. Revisão de literatura: responsável pelo correto funcionamento de nossas funções mastigatórias, deglutição, fonação, entre outras, o sistema estomatognático pode se tornar instável devido às alterações que variam de pequenos hábitos parafuncionais até disfunções na articulação temporomandibular e dores musculares. Geralmente não é possível descobrir qual é o exato fator responsável pelo surgimento dessas alterações, visto que a maioria possui causa multifatorial. Dessa forma, inicialmente são indicados tratamentos que sejam menos invasivos ao sistema. As placas oclusais surgem como alternativa reversível para o tratamento das disfunções temporomandibulares (DTMs) e outras injúrias sofridas pelo sistema e, embora seu exato mecanismo não tenha sido compreendido, elas demonstram efetividade na redução dos sintomas em diversos casos. Considerações finais: foi possível observar que as placas oclusais consistem numa forma de tratamento segura, com poucos efeitos adversos e que apresenta grande melhoria nos sintomas das DTMs.

Introduction: temporomandibular (TMD) and muscular dysfunction have a multifactorial cause, requiring a detailed anamnesis, as well as a detailed clinical examination so that it is possible to adopt the most correct form of treatment Objective: this paper aims to describe, through a literature review, the clinical protocol for confection, installation and adjustments of myorelaxant plaque, to understand the indications and benefits of its use and to compare its effectiveness with other therapeutic methods described in literature. Literature review: Responsible for the correct functioning of our masticatory functions, swallowing, phonation, among others, the stomatognathic system may become unstable due to alterations, ranging from small parafunctional habits to temporomandibular joint dysfunctions and muscular pains. Generally, it is not possible to find out the exact factor responsible for these changes, since most of them have multifactorial causes. Thus, treatments that are less invasive to the system are initially indicated. Occlusal plaques appear as a reversible alternative for the treatment of temporomandibular disorders (TMDs) and other injuries suffered by the system and although their exact mechanism has not been understood, they demonstrate effectiveness in the reduction of symptoms in several cases. Final considerations: it was observed that occlusal plaques consist of a safe form of treatment, with few adverse effects and a great improvement in TMD symptoms.