Cesar Angelo Lascala

Association of laser phototherapy with PRP improves healing of bisphosphonate-related osteonecrosis of the jaws in cancer patients: A preliminary study

The aim of this study was to compare retrospectively the effect of three different treatments on the healing outcome of bisphosphonate-related osteonecrosis of the jaws (BRONJ) in cancer patients. Twenty-two cancer patients were treated for BRONJ with one of the following protocols: clinical (pharmacological therapy), surgical (pharmacological plus surgical therapy), or PRP plus LPT (pharmacological plus surgical plus platelet rich plasma (PRP) plus laser phototherapy (LPT). The laser treatment was applied with a continuous diode laser (InGaAlP, 660 nm) using punctual and contact mode, 40 mW, spot size 0.042 cm(2), 6 J/cm(2) (6 s) and total energy of 0.24 J per point. The irradiations were performed on the exposed bone and surrounding soft tissue. The analysis of demographic data and risk factors was performed by gathering the following information: age, gender, primary tumor, bisphosphonate (BP) used, duration of BP intake, history of chemotherapy, use of steroids, and medical history of diabetes. The association between the current state of BRONJ (with or without bone exposure) and other qualitative variables was determined using the chi-square or Fishers exact test. In all tests, the significance level adopted was 5%. Most BRONJ lesions occurred in the mandible (77%) after tooth extraction (55%) and in women (72%). A significantly higher percentage of patients reached the current state of BRONJ without bone exposure (86%) in the PPR plus LPT group than in the pharmacological (0%) and surgical (40%) groups after 1-month follow-up assessment. These results suggest that the association of pharmacological therapy and surgical therapy with PRP plus LPT significantly improves BRONJ healing in oncologic patients. Although prospective studies with larger sample sizes are still needed, this preliminary study may be used to inform a better-designed future study.

Micro-computed tomography and histomorphometric analysis of human alveolar bone repair induced by laser phototherapy: a pilot study

Immediate dental implant placement in the molar region is critical, because of the high amount of bone loss and the discrepancy between alveolar crest thickness and the implant platform. Laser phototherapy (LPT) improves bone repair. The aim of this study was to evaluate the human alveolar bone repair 40 days after molar extraction in patients submitted to LPT. Twenty patients were selected for this randomized controlled clinical trial; 10 underwent LPT (laser group) with a GaAlAs diode laser (808 nm, 100 mW, 0.04 cm(2), 75 J/cm(2), 30s per point, 3 J per point, at five points). The control group patients (n=10) were not irradiated. Forty days later, the tissue formed inside the sockets was analyzed by micro-computed tomography and histomorphometry. Data from the two groups were compared with Students t-test and Pearsons correlation test. The relative bone volume was significantly higher in the laser group (P<0.0001). The control group showed negative correlations (P<0.01) between number and thickness, and between number and separation of trabeculae, and a positive correlation between thickness and separation of trabeculae. The laser group showed a significant negative correlation between the number and thickness of trabeculae (P<0.01). The results suggest that LPT is able to accelerate alveolar bone repair after molar extraction, leading to a more homogeneous trabecular configuration represented by thin and close trabeculae.

Effectiveness of disinfection with alcohol 70% (w/v) of contaminated surfaces not previously cleaned

OBJETIVO: avaliar a eficacia desinfetante do alcool 70% (p/v) sob friccao, sem limpeza previa, nas superficies de trabalho, como procedimento de desinfeccao concorrente em Servicos de Saude. METODO: foi desenvolvido estudo experimental laboratorial, randomizado e unicegado. As amostras foram constituidas de superficies esmaltadas, intencionalmente contaminadas com microrganismos Serratia marcescens ATCC 14756 106 Unidades Formadoras de Colonias/mL, acrescidos de 10% de saliva humana, e submetidas ao procedimento de desinfeccao sem limpeza previa. Os resultados foram comparados a desinfeccao precedida da limpeza. RESULTADOS: houve reducao de seis logaritmos da populacao microbiana inicial, igualmente nos grupos com e sem limpeza previa (p=0,440) e uma carga microbiana residual ≤ 102 Unidades Formadoras de Colonias. CONCLUSAO: a pesquisa demonstrou a aceitabilidade da pratica avaliada, trazendo importante resposta para a area da saude, especialmente a enfermagem, que mais executa os procedimentos de limpeza/desinfeccao concorrentes dessas superficies de trabalho.OBJECTIVE To evaluate the disinfectant effectiveness of alcohol 70% (w/v) using friction, without previous cleaning, on work surfaces, as a concurrent disinfecting procedure in Health Services. METHOD An experimental, randomized and single-blinded laboratory study was undertaken. The samples were enamelled surfaces, intentionally contaminated with Serratia marcescens microorganisms ATCC 14756 106 CFU/mL with 10% of human saliva added, and were submitted to the procedure of disinfection WITHOUT previous cleaning. The results were compared to disinfection preceded by cleaning. RESULTS There was a reduction of six logarithms of the initial microbial population, equal in the groups WITH and WITHOUT previous cleaning (p=0.440) and a residual microbial load ≤ 102 CFU. CONCLUSION The research demonstrated the acceptability of the practice evaluated, bringing an important response to the area of health, in particular to Nursing, which most undertakes procedures of concurrent cleaning /disinfecting of these work surfaces.

Accuracy of direct digital radiography for detecting occlusal caries in primary teeth compared with conventional radiography and visual inspection: an in vitro study

OBJECTIVES the diagnosis of caries lesions is still a matter of concern in dentistry. The diagnosis of dental caries by digital radiography has a number of advantages over conventional radiography; however, this method has not been explored fully in the field of paediatric dentistry. This in vitro research evaluated the accuracy of direct digital radiography compared with visual inspection and conventional radiography in the diagnosis of occlusal caries lesions in primary molars. METHODS 50 molars were selected and evaluated under standardized conditions by 2 previously calibrated examiners according to 3 diagnostic methods (visual inspection, conventional radiography and direct digital radiography). Direct digital radiographs were obtained with the Dixi3 system (Planmeca, Helsinki, Finland) and the conventional radiographs with InSight film (Kodak Eastman Co., Rochester, NY). The images were scored and a reference standard was obtained histologically. The interexaminer reliability was calculated using Cohens kappa test and the specificity, sensitivity and accuracy of the methods were calculated. RESULTS examiner reliability was good. For lesions limited to the enamel, visual inspection showed significantly higher sensitivity and accuracy than both radiographic methods, but no significant difference was found in specificity. For teeth with dentinal caries, no significant differences were found for any parameter when comparing visual and radiographic evaluation. CONCLUSIONS although less accurate than the visual method for detecting caries lesions confined to the enamel, the direct digital radiographic method is as effective as conventional radiographic examination and visual inspection of primary teeth with occlusal caries when the dentine is involved.

Osteonecrose dos maxilares associada ao uso de bisfosfonatos: importante complicação do tratamento oncológico

Os bisfosfonatos sao um grupo de medicamentos utilizados no tratamento de doencas malignas metastaticas e em outras doencas osseas como osteoporose e doenca de Paget. A despeito dos seus beneficios, uma importante complicacao denominada de osteonecrose dos maxilares vem sendo observada nos pacientes usuarios cronicos dos bisfosfonatos que se caracteriza clinicamente por exposicoes osseas na regiao maxilofacial persistente, acompanhadas de osteomielite, geralmente sintomaticas e cujo tratamento e complexo. Este estudo tem por objetivo revisar a literatura sobre a osteonecrose associada ao uso dos bisfosfonatos, em especial, em oncologia, no periodo de 2003 a 2008. Serao apresentados e discutidos os fatores de risco, aspectos etiopatogenicos, clinicos, imagenologicos, terapeuticos e preventivos desta doenca. Devido a dificuldade de tratamento da osteonecrose associada aos bisfosfonatos, o foco deve ser a prevencao, sendo o ideal a eliminacao de quadros infecciosos orais antes da terapia com os bisfosfonatos ter sido iniciada e minimizar traumas em boca apos o uso destes medicamentos.

Odontoameloblastoma: report of two cases.

Odontoameloblastoma (OA) is a very rare mixed odontogenic neoplasm, characterized by the simultaneous occurrence of an ameloblastoma and a compound or complex odontoma in the same tumor mass. To date, less than 50 cases of OA and/or ameloblastic odontoma have been reported in the English dental literature. This neoplasm was called ameloblastic odontoma. The term OA was included in the 1971 WHO classification. In this study, we present two cases of OA, which we hope will contribute to the awareness and knowledge of surgeons regarding the existence of this odontogenic tumor so that patients having it may be treated and followed-up properly.

Eficácia da desinfecção com álcool 70% (p/v) de superfícies contaminadas sem limpeza prévia

OBJETIVO: avaliar a eficacia desinfetante do alcool 70% (p/v) sob friccao, sem limpeza previa, nas superficies de trabalho, como procedimento de desinfeccao concorrente em Servicos de Saude. METODO: foi desenvolvido estudo experimental laboratorial, randomizado e unicegado. As amostras foram constituidas de superficies esmaltadas, intencionalmente contaminadas com microrganismos Serratia marcescens ATCC 14756 106 Unidades Formadoras de Colonias/mL, acrescidos de 10% de saliva humana, e submetidas ao procedimento de desinfeccao sem limpeza previa. Os resultados foram comparados a desinfeccao precedida da limpeza. RESULTADOS: houve reducao de seis logaritmos da populacao microbiana inicial, igualmente nos grupos com e sem limpeza previa (p=0,440) e uma carga microbiana residual ≤ 102 Unidades Formadoras de Colonias. CONCLUSAO: a pesquisa demonstrou a aceitabilidade da pratica avaliada, trazendo importante resposta para a area da saude, especialmente a enfermagem, que mais executa os procedimentos de limpeza/desinfeccao concorrentes dessas superficies de trabalho.OBJECTIVE To evaluate the disinfectant effectiveness of alcohol 70% (w/v) using friction, without previous cleaning, on work surfaces, as a concurrent disinfecting procedure in Health Services. METHOD An experimental, randomized and single-blinded laboratory study was undertaken. The samples were enamelled surfaces, intentionally contaminated with Serratia marcescens microorganisms ATCC 14756 106 CFU/mL with 10% of human saliva added, and were submitted to the procedure of disinfection WITHOUT previous cleaning. The results were compared to disinfection preceded by cleaning. RESULTS There was a reduction of six logarithms of the initial microbial population, equal in the groups WITH and WITHOUT previous cleaning (p=0.440) and a residual microbial load ≤ 102 CFU. CONCLUSION The research demonstrated the acceptability of the practice evaluated, bringing an important response to the area of health, in particular to Nursing, which most undertakes procedures of concurrent cleaning /disinfecting of these work surfaces.

Effect of a resin-based and a glass-ionomer sealant on the treatment of noncavitated occlusal caries lesions in teenagers

Objectives: The aim of the study was to use clinical outcomes and digital radiographs to compare the effects of two types of sealant materials on the treatment of noncavitated occlusal caries lesions regarding their progression or arrest in teenage permanent molars. Methods: The sample consisted of 28 teeth from 20 patients aged 11-15 years with random distribution to receive either a resin-based sealant (Fluroshield ® , Dentsply, Philadelphia, PA, USA; Gres group) or a glass-ionomer sealant (RIVA Protect ® , SDI, São Paulo, Brazil; Ggis group). Caries progression was monitored by clinical evaluation and radiographic examination. Clinical outcomes were analyzed using the Mann-Whitney and Fisher′s exact test, and radiographic data were analyzed by Student′s t-test for paired data (P ≤ 0.05). Results: There were no significant differences between the clinical outcomes of both groups regarding the sealant retention, thermal sensitivity, and development of new caries lesions adjacent to the sealed surface. There was an increase in the radiographic density coefficient (carious dentin density/sound dentin density) at the end of the study for the Gres group (P = 0.003), but the coefficient for the Ggis group was similar for both time points (P = 0.49). Conclusions: Radiographic features showed an increase in the mineralization of the caries lesions when the teeth were sealed with a resin-based sealant; however, both techniques may be considered an adequate clinical approach for controlling the progression of the lesions.

Effect of laser phototherapy on human alveolar bone repair: micro tomographic and histomorphometrical analysis

The immediate dental implant placement in the molars region is critical, because of the high amount of bone loss and the discrepancy between the alveolar crest thickness and the dental implant platform. Laser phototherapy (LPT) improves bone repair thus could accelerate the implant placement. Twenty patients were selected for the study. Ten patients were submitted to LPT with GaAlAs diode laser (808nm) during molar extraction, immediately after, 24h, 48h, 72h, 96h and 7 days. The irradiations were applied in contact and punctual mode (100mW, 0.04cm2, 0.75J/cm2, 30s per point, 3J per point). The control group (n=10) received the same treatment; however with the power of the laser off. Forty days later samples of the tissue formed inside the sockets were obtained for further microtomography (microCTs) and histomorphometry analyses. Data were compared by the Student t test, whereas those from the different microCT parameters were compared by the Pearson correlation test (p<0.05). The relative bone volume, as well as area was significantly higher (p<0.001) in the lased than the control group. In the control group there were negative correlations between number and thickness, and between number and separation of trabecula (p<0.01). Between thickness and separation of trabecula the correlation was positive (p<0.01). The laser group showed significant negative correlation between the number and the thickness of trabecula (p<0.01). LPT accelerated bone repair. By the Pearson correlation test it was possible to infer that the lased group presented a more homogeneous trabecular configuration, which would allow earlier dental implant placement.

Eficacia de la desinfección con alcohol al 70% (p/v) de superficies contaminadas sin limpieza previa

OBJETIVO: avaliar a eficacia desinfetante do alcool 70% (p/v) sob friccao, sem limpeza previa, nas superficies de trabalho, como procedimento de desinfeccao concorrente em Servicos de Saude. METODO: foi desenvolvido estudo experimental laboratorial, randomizado e unicegado. As amostras foram constituidas de superficies esmaltadas, intencionalmente contaminadas com microrganismos Serratia marcescens ATCC 14756 106 Unidades Formadoras de Colonias/mL, acrescidos de 10% de saliva humana, e submetidas ao procedimento de desinfeccao sem limpeza previa. Os resultados foram comparados a desinfeccao precedida da limpeza. RESULTADOS: houve reducao de seis logaritmos da populacao microbiana inicial, igualmente nos grupos com e sem limpeza previa (p=0,440) e uma carga microbiana residual ≤ 102 Unidades Formadoras de Colonias. CONCLUSAO: a pesquisa demonstrou a aceitabilidade da pratica avaliada, trazendo importante resposta para a area da saude, especialmente a enfermagem, que mais executa os procedimentos de limpeza/desinfeccao concorrentes dessas superficies de trabalho.OBJECTIVE To evaluate the disinfectant effectiveness of alcohol 70% (w/v) using friction, without previous cleaning, on work surfaces, as a concurrent disinfecting procedure in Health Services. METHOD An experimental, randomized and single-blinded laboratory study was undertaken. The samples were enamelled surfaces, intentionally contaminated with Serratia marcescens microorganisms ATCC 14756 106 CFU/mL with 10% of human saliva added, and were submitted to the procedure of disinfection WITHOUT previous cleaning. The results were compared to disinfection preceded by cleaning. RESULTS There was a reduction of six logarithms of the initial microbial population, equal in the groups WITH and WITHOUT previous cleaning (p=0.440) and a residual microbial load ≤ 102 CFU. CONCLUSION The research demonstrated the acceptability of the practice evaluated, bringing an important response to the area of health, in particular to Nursing, which most undertakes procedures of concurrent cleaning /disinfecting of these work surfaces.