Ana Lúcia Pompéia Fraga de Almeida

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) Part 4: Oral Rehabilitation

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Evaluation of the effect of the GaAlAs laser on subgingival scaling and root planing.

OBJECTIVE To evaluate the auxiliary effect of the low-intensity laser in subgingival scaling and root planing by analysis of its clinical aspects, as well as its analgesic potential during the procedure. BACKGROUND DATA Despite the large number of studies conducted on low-intensity laser energy, few clinical studies are available on periodontics. MATERIALS AND METHODS Ten patients were selected and submitted to measurement of six sites per tooth, four teeth per hemiarch (960 sites in all). All patients then received subgingival scaling and root planing. Besides periodontal treatment, the test side was also submitted to laser application. The analysis comprised measurement of probing depth, clinical attachment level, and gingival index. Laser energy was applied at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec per site) for preoperative analgesia, and scaling and root planing were performed with application of laser energy at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec) for analgesia, and at a wavelength of 630 nm (8.8 J/cm(2), 35 mW, 10 sec) for healing. The patients filled out a visual analogue scale to assess the pain they felt during the procedure. After 24 and 48 h, the laser was again applied at the wavelength of 630 nm, and the patients were re-evaluated after 3 d. RESULTS There was a reduction in gingival inflammation, yet without a statistically significant difference between the study and control sides, both in clinical aspects and evaluation of pain during the procedure. CONCLUSION Utilization of the diode laser as an auxiliary in subgingival scaling and root planing did not provide any apparent clinical benefit for teeth with shallow to moderate pockets.

The role of keratinized mucosa in peri-implant health.

Objective To evaluate the role of keratinized mucosa around dental implants, correlating with other clinical parameters related to the success of dental implants. Design Cross-section. Setting Institutional tertiary referral hospital. Patients A total of 202 dental implants fixed in the cleft area of 109 patients with cleft lip and/or palate were evaluated. Interventions The evaluated clinical parameters were probing depth and gingival and plaque indexes on the buccal surface (three sites). Main Outcome Measures All clinical parameters were correlated with the width of keratinized mucosa around the implants. Results The largest probing depths were detected when the width of keratinized mucosa was 2 mm or more, with a statistically significant difference between the means of the probing depth and keratinized mucosa width. Conclusion Even though the present results suggest that peri-implant health can be observed in areas with keratinized mucosa width under 2 mm provided an adequate oral hygiene control is performed, longitudinal randomized studies are necessary to analyze the relationship between the width of keratinized mucosa and the health of peri-implant tissues.

Fracture resistance of endodontically treated teeth restored with glass fiber posts of different lengths.

STATEMENT OF PROBLEM Endodontically treated teeth are known to have reduced structural strength. Glass fiber posts may influence fracture resistance and should be evaluated. PURPOSE The purpose of this study was to evaluate the influence of glass fiber post length on the fracture resistance of endodontically treated teeth. MATERIAL AND METHODS Forty intact human maxillary canines were selected and divided into 4 groups, the control group consisting of teeth restored with a custom gold cast post and core, with a length of two-thirds of the root. Other groups received prefabricated glass fiber posts in different lengths: group 1/3, removal of one-third of the sealing material (5 mm); group 1/2, removal of one-half of the sealing material (7.5 mm); and group 2/3, removal of two-thirds of the sealing material (10 mm). All the posts were cemented with resin cement, and the specimens with glass fiber posts received a composite resin core. All the specimens were restored with a metal crown and submitted to a compressive load until failure occurred. The results were evaluated by 1-way ANOVA, and the all pairwise multiple comparison procedures (Tukey honestly significantly difference test) (α=.05). RESULTS The ANOVA showed significant differences among the groups (P<.002). The Tukey test showed that the control group presented significantly higher resistance to static load than the other groups (control group, 634.94 N; group 1/3, 200.01 N; group 1/2, 212.17 N; and group 2/3, 236.08 N). Although teeth restored with a cast post and core supported a higher compressive load, all of them fractured in a catastrophic manner. For teeth restored with glass fiber posts, the failure occurred at the junction between the composite resin core and the root. CONCLUSION The length of glass fiber posts did not influence fracture load, but cast post and cores that extended two-thirds of the root length had significantly greater fracture resistance than glass fiber posts.

Utilization of low-intensity laser during healing of free gingival grafts.

OBJECTIVES This study evaluates the action of a low-intensity diode laser with gallium-aluminum-arsenide (GaAlAs) active medium on the healing process and analgesia in individuals undergoing free gingival grafts. MATERIAL AND METHOD Ten individuals needing bilateral gingival graft in the mandibular arch were enrolled in a double-blind study. Each individual had a 30-d interval between the two surgeries. The side receiving application of laser was defined as test side and was established upon surgery; laser application was simulated on the control side. The laser was applied in the immediate postoperative period and after 48 h, and patients rated pain on a scale of 0 to 10, representing minimal and maximal pain, respectively. Photographs were obtained at 7, 15, 30, and 60 d postoperatively and evaluated by five periodontists. RESULTS No statistically significant difference was found at any postoperative period between control and test sides, even though greater clinical improvement associated with treatment was observed at 15 d postoperative. At 30 and 60 d, some examiners observed the same or greater clinical improvement for the control. Only one individual reported mild to moderate pain on the first postoperative day. CONCLUSIONS Low-intensity laser therapy did not improve the healing of gingival grafts and did not influence analgesia.

Survival of Dental Implants in the Cleft Area—A Retrospective Study

Objective To evaluate the survival rate of dental implants placed in the cleft area. Design Retrospective study. Setting Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Institutional Tertiary Healthcare Center. Patients 120 patients who received dental implants in the grafted cleft area in the years 1999 to 2005. Interventions Clinical data were evaluated from the records of 120 patients according to the following criteria: placement grafted, cleft area, and age at surgery; age at placement of dental implants; site and dimension of implants; interval between placement of implants and the last clinical follow-up; and interval between placement and removal or indication for removal of implants. Main Outcome Measures Percentage of survival rate of implants. Results Mean age at placement of the bone graft was 17.6 years and 21 years at placement of implants. A total of 123 cleft areas received secondary bone graft and bone graft to install implants (regraft). The mean survival rate was 34 months since placement of the implant to the last clinical follow-up and 26 months since placement of the prosthesis. Seven dental implants were removed. The survival rate since placement to the last clinical follow-up was 94.3%. Conclusion Rehabilitation of the cleft area with dental implants is a viable and secure alternative, with good prognosis.

Effect of low-level laser on bone defects treated with bovine or autogenous bone grafts: in vivo study in rat calvaria.

Objective. The purpose of this study was to histologically evaluate the effect of low-level laser (LLL) on the healing of critical size defects (CSD) in rat calvaria, filled with autogenous or inorganic bovine bone grafts. Methods. Sixty rats were divided into 6 groups (n = 10): C (control—filled with blood clot), LLL (low-level laser—GaAlAs, λ 780 nm, 100 mW, 210 J/cm2, Φ 0.05 cm2; 6 J/point), AB (autogenous bone), ABL (autogenous bone + low-level laser), OB (inorganic bovine bone), and OBL (inorganic bovine bone + LLL). Material and Methods. The animals were killed after 30 days. Histological and histometric analyses were performed by light microscopy. Results. The groups irradiated with laser, LLL (47.67% ± 8.66%), ABL (39.15% ± 16.72%), and OBL (48.57% ± 28.22%), presented greater area of new bone formation than groups C (9.96% ± 4.50%), AB (30.98% ± 16.59%), and OB (11.36% ± 7.89%), which were not irradiated. Moreover, they were significantly better than group C (Kruskal-Wallis test followed by Dunn test, P < 0.05). Conclusion. The laser accelerated the healing of bone defects and the resorption of particles of the graft material.

Thermo and mechanical cycling and veneering method do not influence Y-TZP core/veneer interface bond strength

OBJECTIVES The purpose of this study was to evaluate the influence of thermal and mechanical cycling and veneering technique on the shear bond strength of Y-TZP (yttrium oxide partially stabilized tetragonal zirconia polycrystal) core-veneer interfaces. MATERIALS AND METHODS Cylindrical Y-TZP specimens were veneered either by layering (n=20) or by pressing technique (n=20). A metal ceramic group (CoCr) was used as control (n=20). Ten specimens for each group were thermal and mechanical cycled and then all samples were subjected to shear bond strength in a universal testing machine with a 0.5mm/min crosshead speed. Mean shear bond strength (MPa) was analysed with a 2-way analysis of variance and Tukeys test (p<0.05). Failure mode was determined using stereomicroscopy and scanning electron microscopy (SEM). RESULTS Thermal and mechanical cycling had no influence on the shear bond strength for all groups. The CoCr group presented the highest bond strength value (p<0.05) (34.72 ± 7.05 MPa). There was no significant difference between Y-TZP veneered by layering (22.46 ± 2.08 MPa) or pressing (23.58 ± 2.1 MPa) technique. Failure modes were predominantly adhesive for CoCr group, and cohesive within veneer for Y-TZP groups. CONCLUSIONS Thermal and mechanical cycling, as well as the veneering technique does not affect Y-TZP core-veneer bond strength. CLINICAL SIGNIFICANCE Different methods of veneering Y-TZP restorations would not influence the clinical performance of the core/veneer interfaces.

The effect of low-level laser on bone healing in critical size defects treated with or without autogenous bone graft: an experimental study in rat calvaria

OBJECTIVE The objective of this study was to evaluate the effect of low-level laser (LLL) on bone healing process in surgically created critical size defects in rat calvaria treated with or without autogenous bone graft (AB). MATERIAL AND METHODS The study was conducted on 40 male rats (Rattusnorvegicus, albinus, Wistar), weighing 250-300 g. For accomplishment of the experimental procedures, the rats were anesthetized with an intramuscular injection of xylazine (0.02 ml/kg) and ketamine hydrochloride (0.4 ml/kg). Acritical size defect with 5-mm diameter was created. The animals were divided into four groups: Group C (Control- filled with blood clot), Group LLL, Group AB (autogenous bone graft), Group AB + LLL (autogenous bone graft and LLL). The animals treated with LLL received applications of LLL at the infrared spectrum wavelength (λ = 810 nm) and energy density of 6 J/cm(2) per point, 60 s per point, adding up to five points on the entire created defect. The animals were euthanized at 30 days postoperatively. After decalcification, each specimen was longitudinally divided into two blocks, exactly along the center of the original surgical defect, processed and embedded in paraffin. Longitudinal serial sections with 6-μm thickness were made, initiating from the center of the original surgical defect. The sections were stained with hematoxylin and eosin (HE) for light microscopy analysis for histomorphometric analysis. RESULTS Group C presented smaller quantity of new bone formation than Groups LLL (P < 0.01), AB (P < 0.01), and AB + LLL (P < 0.01). CONCLUSIONS Utilization of LLL favored the healing process in rat calvaria. The quantity of new bone formation with use of the LLL was similar to the autogenous bone graft.