Lucianne Cople Maia

Does rapid maxillary expansion have long-term effects on airway dimensions and breathing?

INTRODUCTION In this systematic review, we identified and qualified the evidence of long-term reports on the effects of rapid maxillary expansion (RME) on airway dimensions and functions. METHODS Electronic databases (Ovid, Scirus, Scopus, Virtual Health Library, and Cochrane Library) were searched from 1900 to September 2010. Clinical trials that assessed airway changes at least 6 months after RME in growing children with rhinomanometry, acoustic rhinometry, computed tomography, or posteroanterior and lateral radiographs were selected. Studies that used surgically assisted RME and evaluated other simultaneous treatments during expansion, systemically compromised subjects, or cleft patients were excluded. A methodologic-quality scoring process was used to identify which studies would be most valuable. RESULTS Fifteen articles fulfilled the inclusion criteria, and full texts were assessed. Three were excluded, and 12 were assessed for eligibility. Four articles with low methodologic quality were not considered. The remaining 8 were qualified as moderate. The posteroanterior radiographs showed that nasal cavity width increases; in the lateral radiographs, decreased craniocervical angulation was associated with increases of posterior nasal space. Cone-beam computed tomography did not show significant increases of nasal cavity volume. Rhinomanometry showed reduction of nasal airway resistance and increase of total nasal flow, and acoustic rhinometry detected increases of minimal cross-sectional area and nasal cavity volume. CONCLUSIONS There is moderate evidence that changes after RME in growing children improve the conditions for nasal breathing and the results can be expected to be stable for at least 11 months after therapy.

Amamentação natural como fonte de prevenção em saúde

The importance of breast-feeding has been addressed through multi-professional approaches. As healthcare practitioners, dentists are included in this context and - due to the close links between breast-feeding and the development of the stomatognathic system - should be able to advise pregnant women and new mothers on this practice, with countless benefits for mothers and their babies. This paper thus presents up-to-date and enlightened information through a review of the literature that supports the benefits of breast-feeding, urging heightened awareness of its importance and the preparation of policies and actions implemented through Brazils National Health System (SUS) that rank breast-feeding as a high-priority goal.

Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis.

Oropharyngeal changes caused by orthognathic surgery have been a concern because the sleep quality of patients may be enhanced or worsened by these changes. The purpose of this meta-analysis was to identify, review and compare scientific literature about changes in airway in adult patients undergoing orthognathic surgery to correct anteroposterior osseous discrepancies. An electronic search of four databases was carried out up to July 2010, with supplemental hand searching of the references of the retrieved articles. Quality assessment of the included articles was carried out. Data were extracted and a meta-analysis was performed. Heterogeneity was assessed amongst the studies and results were presented in forest plots. 49 studies met the inclusion criteria. Only studies with moderate or high methodological soundness were included in the review. Moderate evidence was found to support a significant decrease in the oropharyngeal airway in mandibular setback surgery, a milder decrease in bimaxillary surgery to correct Class III and an increase in maxillomandibular advancement surgery. Evidence is lacking on airway volume changes after orthognathic surgery.

Cervical vertebral maturation as a biologic indicator of skeletal maturity

OBJECTIVE To identify and review the literature regarding the reliability of cervical vertebrae maturation (CVM) staging to predict the pubertal spurt. MATERIALS AND METHODS The selection criteria included cross-sectional and longitudinal descriptive studies in humans that evaluated qualitatively or quantitatively the accuracy and reproducibility of the CVM method on lateral cephalometric radiographs, as well as the correlation with a standard method established by hand-wrist radiographs. RESULTS The searches retrieved 343 unique citations. Twenty-three studies met the inclusion criteria. Six articles had moderate to high scores, while 17 of 23 had low scores. Analysis also showed a moderate to high statistically significant correlation between CVM and hand-wrist maturation methods. There was a moderate to high reproducibility of the CVM method, and only one specific study investigated the accuracy of the CVM index in detecting peak pubertal growth. CONCLUSIONS This systematic review has shown that the studies on CVM method for radiographic assessment of skeletal maturation stages suffer from serious methodological failures. Better-designed studies with adequate accuracy, reproducibility, and correlation analysis, including studies with appropriate sensitivity-specificity analysis, should be performed.

Evaluation of self-adhesive resin cement bond strength to yttria-stabilized zirconia ceramic (Y-TZP) using four surface treatments.

PURPOSE To evaluate the influence of four surface treatments on the bond strength of a self-adhesive resin cement to an yttria-stabilized zirconia (Y-TZP) ceramic material (Lava Frame zirconia). MATERIALS AND METHODS Forty plates (8 x 6 x 1 mm) of a Y-TZP ceramic restorative material were randomly assigned to four groups (n = 10) according to the surface treatments: control, no treatment; airborne-particle abrasion with 50-μm Al2O3; coating with an MDP-based primer; conditioning with Rocatec System. The ceramic plates treated with each of the four methods were further divided into 2 subgroups according to the resin cement tested: RelyXTM ARC (ARC, conventional) and RelyXTM Unicem (Ucem, self-adhesive). The resin cements were put into PVC tubes (diameter 0.75 mm, 0.5 mm height) placed on the ceramic plate surfaces. After water storage at 37°C for 24 h, the specimens were submitted to a microshear bond strength (μSBS) test at a crosshead speed of 1.0 mm/min. RESULTS The surface treatments significantly influenced the μSBS (p < 0.05). For the four surface treatments, UCem presented significantly higher μSBS than ARC (p < 0.05). For both resin cements, the best result was produced by the MDP-based primer: ARC 15.9 ± 5.0 MPa and UCem 36.2 ± 2.1 MPa. The highest μSBS values were presented by UCem on ceramic plates treated with the MDP-based primer (36.2 ± 2.1 MPa) and Rocatec system (37.4 ± 2.3 MPa). CONCLUSION Irrespective of the surface treatment, the self-adhesive resin cement performed better in terms of bond strength to yttria-stabilized zirconia ceramic than did conventional resin cement.

Prevalence of Dental Anomalies in Nonsyndromic Individuals With Cleft Lip and Palate: A Systematic Review and Meta-analysis

Objective To assess whether individuals born with nonsyndromic oral clefts display a higher frequency of dental anomalies. Design A search of MEDLINE, BIREME, OVID ALL EMB Reviews, and The Cochrane Library was conducted. The methodologic quality of the papers selected was assessed and scored. Papers reporting observational controlled studies of nonsyndromic forms of oral cleft matched for dental anomalies in primary and/or permanent teeth were included without language restrictions. Eligible studies were scored as “A”—low risk of bias, “B”—moderate risk of bias, or “C”—high risk of bias and poor quality. Fixed and random effects models were used to aggregate individual odds ratios (OR) and to derive pooled estimates and 95% confidence intervals. Results Six studies fulfilled our selection criteria and were included in the meta-analysis. Three distinct subgroup analyses were carried out in terms of dental anomalies. In the tooth agenesis meta-analysis, a random effects model was used because of heterogeneity and showed a significant association between tooth agenesis and oral clefts (OR = 12.31; 95% confidence interval [CI] = 3.75 to 40.36). In the remaining analyses, the fixed effects model revealed a positive association between supernumerary (OR = 4.99; 95% CI, 2.58 to 9.64) and crown morphologic abnormalities (OR = 5.69; 95% CI, 3.96 to 8.19) with oral clefts. Most included studies were of low to moderate quality. Conclusion Although general limitations in study design were observed, the evidence suggests that a higher number of dental anomalies in the permanent dentition are noted in individuals born with oral clefts.

Surface degradation of composite resins by acidic medicines and ph-cycling

This study evaluated the effects of acidic medicines (Dimetapp® and Claritin®), under pH-cycling conditions, on the surface degradation of four composite resins (microhybrid: TPH, Concept, Opallis and Nanofilled: Supreme). Thirty disc-shaped specimens (Ø = 5.0 mm / thickness = 2.0 mm) of each composite were randomly assigned to 3 groups (n = 10): a control and two experimental groups, according to the acidic medicines evaluated. The specimens were finished and polished with aluminum oxide discs, and the surface roughness was measured by using a profilometer. After the specimens were submitted to a pH-cycling regimen and immersion in acidic medicines for 12 days, the surface roughness was measured again. Two specimens for each material and group were analyzed by scanning electron microscopy (SEM) before and after pH-cycling. Data were analyzed by the Students-t test, ANOVA, Duncans multiple range test and paired t-test (α=0.05). Significant increase in roughness was found only for TPH in the control group and TPH and Supreme immersed in Claritin® (p<0.05). SEM analyses showed that the 4 composite resins underwent erosion and surface degradation after being subjected to the experimental conditions. In conclusion, although the roughness was slightly affected, the pH-cycling and acidic medicines caused surface degradation of the composite resins evaluated. Titratable acidity seemed to play a more crucial role on surface degradation of composite resins than pH.

Epidemiologic survey of traumatic dental injuries in children seen at the Federal University of Rio de Janeiro, Brazil

This epidemiologic survey aimed at assessing the prevalence of traumatic dental injuries in children seen at the Federal University of Rio de Janeiro, Brazil. The records of a total of 111 children (aged 0 to 6 years) seen from 2004 to 2006 in the dental trauma clinic were surveyed, comprising a total of 201 traumatized primary teeth. Data pertaining to the child and to the trauma such as age, gender, etiology, teeth involved, type of traumatic injury, time elapsed between the trauma and seeking care, and the presence and kind of clinical and radiographic sequelae in the first visit were collected from the dental records. All variables studied were assessed by means of frequency analysis and the Chi-square test (p < 0.05). A higher prevalence of trauma was observed in boys (56.7%) and in the age group from 0-3 years (73.8%). The most affected teeth were the central incisors (84.7%) and the most common trauma etiology was a fall from the childs own height (63.0%). The supporting tissues were the most affected. Lateral luxation was the most frequent alteration observed (33.4%), followed by concussion (21.0%). Coronal discoloration (17.7%) and external resorption (18.3%) were, respectively, the most prevalent clinical and radiographic sequelae. Gender had no influence on the clinical (p = 0.54) and radiographic (p = 0.55) sequelae. Even though age had no influence on radiographic sequelae (p = 0.41), clinical sequelae were more prevalent in children aged 0 to 3 years (p = 0.03). In conclusion, traumatisms in primary teeth were more prevalent in boys, and in 0-3-year-old children. Luxation was the most frequent traumatic lesion, and coronal discoloration and external resorption were the most prevalent sequelae.

Controle operacional da fluoretação da água de Niterói, Rio de Janeiro, Brasil

Abstract The aim of this study was to evaluate the operational control of water fluoridation atthe city water supply plant in Niteroi, Rio de Janeiro, Brazil, from January to December 2000.The water treatment supervisor filled out a questionnaire on the control of water fluoridation.In addition, water samples were collected every two weeks for fluoride analysis before and aftertreatment. Samples were analyzed by an independent laboratory using an ion-specific electrode.According to the water treatment supervisor, the entire process for controlling fluoride concen-tration in the water was rigorous and complied with Brazilian guidelines, but according to test-ing, 96% of samples were inadequate in terms of risks/benefits of fluoride use from water. The in-formation obtained from the plant supervisor and the test data were thus mutually inconsistent.Based on these data, an independent water fluoride concentration control program is needed toensure the benefits of dental caries prevention for the population.

Mother-to-child transmission of Streptococcus mutans: A systematic review and meta-analysis

OBJECTIVES A systematic review was performed with the aim of determining whether there is scientific evidence of the transmission of Streptococcus mutans from mother to child. DATA The eligibility criteria, based on the PECO strategy, were the following: observational human studies whose subjects were mother and child pairs (P) contaminated by S. mutans (E); comparison according to the presence or absence of S. mutans (C); and whether there is transmission (O). The qualitative analysis was performed by assessing the risk of bias of the included studies, while quantitative synthesis was performed through comprehensive Meta-Analysis software (p<0.05). SOURCES Two reviewers performed the database search of studies published between January 1950 and May 2014. The strategy included observational studies that assessed the vertical transmission of S. mutans from mothers to children through analyzing genetic strains. STUDY SELECTION It was found 166 non-duplicated studies. However, after reviewing the articles in full and applying the eligibility criteria, 36 papers were selected for qualitative analysis and 19 for quantitative analysis. The cumulative meta-analysis demonstrated vertical transmission of S. mutans from mother to child (p<0.001). CONCLUSIONS The present systematic review and meta-analysis demonstrated evidence of vertical transmission of S. mutans from mother to child because there was an association between S. mutans n mothers and their respective children. CLINICAL SIGNIFICANCE The knowledge of the S. mutans strains is important because the virulence of the microorganisms is varied; also, the virulence affects the dental caries evolution rate, being more or less aggressive.