Flávio Renato Reis de Moura

Reattachment using a fragment from an extracted tooth to treat complicated coronal fracture

Reattachment of fragment is the preferred alternative to restore the fractured teeth, offering several advantages. Partial pulpotomy has demonstrated satisfactory results as a conservative treatment for pulp exposures because of trauma. This study reports a case in which the treatment of a complicated coronal fracture was accomplished by partial pulpotomy and reattachment of a dental fragment obtained from an extracted tooth using composite resin. The results show the feasibility of the conservative pulp therapy and the restorative approach.

Three-Year Clinical Performance of Composite Restorations Placed by Undergraduate Dental Students

This retrospective study evaluated the clinical performance and the reasons for failure of anterior and posterior composite restorations placed by undergraduate dental students over a 3-year period. All cavities were restored using Prime & Bond 2.1 and TPH (Dentsply), according to the manufacturers indications. One hundred and two patients who had received composite restorations by third and forth year undergraduate students were recalled and examined to analyze the quality of the restorations. The restorations were evaluated using the modified USPHS system. Two hundred and fifty-six composite restorations, 170 in anterior teeth and 86 in posterior teeth, were evaluated. Eighty-five percent of the restorations were considered satisfactory after 3 years. Class II and class IV restorations presented the highest prevalence of failure. Loss of the restoration and deficient marginal adaptation were the main causes of failure. No restoration failed due to secondary caries. Most restorations placed by dental students were considered satisfactory after long-term evaluation. Failure was more prevalent in larger restorations and was not associated with secondary caries.

An ethnomedicinal survey on phytotherapy with professionals and patients from Basic Care Units in the Brazilian Unified Health System.

ETHNOPHARMACOLOGICAL RELEVANCE In this study, an ethnomedicinal survey was conducted in the city of Pelotas, Brazil, with professionals and patients in the Unified Health System (SUS). With the approval of the National Policy on Medicinal Plants and Herbal Medicines, and with the adoption of a National Policy on Integrative and Complementary Practices in the SUS in Brazil, there is growing concern regarding Brazilian medicinal plants and their proper use in medicine. The expansion of the therapeutic options offered to the users of the SUS includes access to medicinal plants and herbal drugs, as well as related services, such as phytotherapy. For improving health and for the social inclusion of phytotherapies, safety, efficacy, and quality are important strategies. MATERIALS AND METHODS Interviews of both professionals and patients were conducted at five Basic Care Units, and a sample size of 393 was obtained. RESULTS Of the patients attending the Basic Care Units, 91.6% had experienced the use of medicinal plants at least once to treat certain diseases. Of the professionals, 65% had used medicinal plants but only 10% prescribed phytotherapeutics to their patients. Generally, the users were homemakers (26%) of the female gender (71.5%) who were older than 60 years (26%) and had a family income between 1 and 2 Brazilian minimal salaries. The professionals were predominantly female (80%), and a high proportion (80%) believed in the positive effects of phytotherapy (80%), even though these professionals had not been taught phytotherapy as undergraduate students (75%) and had not discussed the topic with their teachers (85%). Patients (81.5%) and professionals (45%) reported that their knowledge of medicinal plants came from their parents or grandparents. From a total of 66 different herbs used by the subjects, mauve (24%) was the most commonly used, often to treat toothaches (24.2%). CONCLUSION It is concluded that a high proportion of users and professionals made use of medicinal plants, and of the large number of plants mentioned in the questionnaire, mauve was the most commonly used, mainly for the treatment of toothaches. The major source of the transmission of knowledge concerning herbal medicine was parents or grandparents.

Clinical Performance and Wear Resistance of Two Compomers in Posterior Occlusal Restorations of Permanent Teeth: Six-Year Follow-up

This study evaluated the clinical performance and wear resistance of compomer restorations placed in the occlusal cavities of posterior permanent teeth after six years. In 1999, 72 Class I restorations were placed by a single operator in 33 patients. Eighty-two percent of these restorations were located in molars. Each patient received at least two restorations, one with F2000 (3M ESPE) and another with Dyract AP (Dentsply). The finished and polished restorations that were free of any failure were considered the baseline. The restorations were clinically evaluated at baseline and at one-, two- and six-year intervals using modified USPHS criteria for color mismatch, marginal discoloration, surface roughness, marginal adaptation, anatomic form and secondary caries. Polyvinylsiloxane impressions (Express, 3M ESPE) were also taken, and models were obtained for indirect wear assessment (Leinfelder scale) at the same intervals. After six years, 11 patients attended the recall. Twenty-seven compomer restorations (11 with Dyract and 16 with F2000) were reevaluated. Data were submitted to the Friedmans test, ANOVA with repetitive measures, Tukeys test (clinical data), Wilcoxon and Kruskal-Wallis tests and the Spearmans correlation test (wear evaluation), all at a significance level of p < 0.05. When comparing the materials, F2000 and Dyract presented similar clinical performance and occlusal wear at the end of the clinical trial. The two compomers showed a significant increase in wear at the six-year follow-up, and a positive correlation (r2 = 0.65) was detected between wear and evaluation time (p < 0.001). Despite the decrease in restoration quality and the increase in occlusal wear, nearly all restorations were considered acceptable after the six-year evaluation.

Análise da produção ambulatorial em municípios com e sem centros de especialidades odontológicas no Brasil em 2010

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.O objetivo foi descrever a producao de servicos especializados em municipios brasileiros com e sem Centros de Especialidades Odontologicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informatica do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatistica. Utilizou-se regressao binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atencao basica, periodontia e cirurgia. Apos controle por fatores sociodemograficos, os municipios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atencao basica. No modelo final, com variaveis de estrutura dos servicos, os municipios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variaveis de estrutura, mais gastos em saude e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na producao municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito nao e explicado por variaveis de estrutura.

[Analysis of outpatient care in Brazilian municipalities with and without specialized dental clinics, 2010].

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.O objetivo foi descrever a producao de servicos especializados em municipios brasileiros com e sem Centros de Especialidades Odontologicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informatica do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatistica. Utilizou-se regressao binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atencao basica, periodontia e cirurgia. Apos controle por fatores sociodemograficos, os municipios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atencao basica. No modelo final, com variaveis de estrutura dos servicos, os municipios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variaveis de estrutura, mais gastos em saude e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na producao municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito nao e explicado por variaveis de estrutura.

Cumprimento de metas dos Centros de Especialidades Odontológicas da Região Sul do Brasil.

OBJECTIVE To evaluate the association of work factors with goals set in specialized dental centers (SDCs) of Southern Brazil. METHODOLOGY Cross-sectional exploratory study, in which the databases DATASUS, IBGE, SIOPS were used and complemented with an online questionnaire (FORMSUS). The questionnaire was answered by SDC managers. The Kruskal Wallis test was utilized to determine association of factors. RESULTS Nine hundred and thirty six months, corresponding to 78 SDCs, were analyzed; the response rate of the questionnaires was 68%. It was found that the variables Paraná State, municipalities with population size of 0-50 thousand/inhabitants, and the fourth quartile of total health expenditure and Gross National Product per capita were factors associated with goals achievement of periodontal procedures. The type of SDCs showed association with goals achievement of basics procedures. DISCUSSION Analyzes of the variables that may be associated with outpatient treatment in of SDCs are fundamental to verify issues regarding population access and applicability of public resources in the health area. CONCLUSION The study indicates low achievement goals by outpatient care delivery by specialized dental centers, which may indicate important factors associated with higher number months for achieving goals.

Análisis de la producción ambulatoria en municipios con y sin centros de especialidades dentales en Brasil, 2010

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.O objetivo foi descrever a producao de servicos especializados em municipios brasileiros com e sem Centros de Especialidades Odontologicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informatica do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatistica. Utilizou-se regressao binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atencao basica, periodontia e cirurgia. Apos controle por fatores sociodemograficos, os municipios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atencao basica. No modelo final, com variaveis de estrutura dos servicos, os municipios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variaveis de estrutura, mais gastos em saude e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na producao municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito nao e explicado por variaveis de estrutura.