Aim To evaluate the prevalence of untreated caries and its association with biological, individual, and environmental variables in independently-living elderly people. Methods This cross-sectional study included 72 elderly (≥60 years) patients of a university dental clinic in Belo Horizonte, Brazil. Sociodemographic data, systemic diseases, medications, and free sugar intake were collected. Visible plaque, Decayed, Missing, and Filled Teeth (DMFT), and Decayed and Filled Root (DFR) indexes were assessed through clinical examination. Unstimulated saliva was collected to determine salivary flow, pH, and buffering capacity. Descriptive analysis and multilevel logistic regression analysis were performed following a dental caries theoretical model ( p <0.05, 95% CI). Results The mean DMFT and DFR were 24.44 (SD=4.59) and 3.21 (SD=2.93), respectively. The prevalence of untreated caries was 61.11%. In the adjusted multilevel regression model involving 1639 teeth, untreated dental caries was significantly associated with the presence of biofilm (OR = 1.84; 95% CI: 1.24–2.74), salivary buffering capacity (OR = 0.87; 95% CI: 0.77–0.99) and per capita income (OR = 0.06; 95% CI: 0.004–0.74). Conclusion The experience of dental caries was widespread among independently-living elderly patients, and its variability was best explained by the presence of biofilm, reduced salivary buffering capacity, and low per capita income. A comprehensive assessment is needed of the biological, individual, and environmental factors related to the presence of dental caries in independently-living elderly people.

ABSTRACT Introduction: Superposing 3D models is an imminent need. However, current methods rely on marking multiple points on the maxilla and mandible, which could increase point marking and overlapping errors. Objective: This study aimed at developing a method for superimposing 3D models of the maxillary and mandibular arches with Autodesk Inventor® engineering software, using a single universal coordinate system (UCS) point superposition. Methods: A total of 104 STL (stereolithography) models of the maxillary and mandibular arches exported from My iTero® platform were retrospectively selected, in which T0 and T1 were the initial and refinement periods, respectively (n=26 per group). The X, Y, and Z coordinates associated with a single point in each arch were inserted into the models with SlicerCMF® software for model orientation. The arch models with UCS registration were transferred to Autodesk Inventor® for superimposition and to measure tooth movements performed during Invisalign® treatment. Arch expansion, intrusion and rotation were analyzed by two examiners. The statistics were performed using intraclass correlation coefficients (ICC), Dahlberg’s formula, and t-test (p<0.05). Results: A reliable method of superimposing 3D digital models using a single UCS point in the maxilla and mandible was developed. ICC showed excellent intra- and inter-examiner correlation (ICC>0.90). A systematic error was not found concerning linear and angular measurements (<1mm and <1.5°, respectively). Digital dental movements could be analyzed, including arch expansion, dental intrusion, and tooth rotation. Conclusions: The developed method was proven reliable and reproducible for superimposing 3D models of the maxillary and mandibular arches by using UCS system.

RESUMO Introdução: A sobreposição de modelos 3D é uma necessidade iminente. No entanto, os métodos atuais dependem da marcação de múltiplos pontos na maxila e na mandíbula, o que pode aumentar a incorporação de erros no processo de sobreposição. Objetivo: O objetivo desse estudo foi desenvolver um método para sobrepor modelos 3D das arcadas superior e inferior utilizando o software de engenharia Autodesk Inventor®, por meio da marcação de um único ponto em cada arcada, usando o sistema de coordenadas universal (UCS). Métodos: No total, 104 modelos STL das arcadas superior e inferior exportados da plataforma My iTero® foram selecionados retrospectivamente, onde T0 foi o período inicial e T1, o de refinamento (n=26 por grupo). As coordenadas X, Y e Z associadas a um único ponto em cada arcada foram inseridas nos modelos usando o software SlicerCMF®. Os modelos com os pontos UCS demarcados foram transferidos para o software Autodesk Inventor® para realizar a sobreposição e medir os movimentos dentários realizados durante o tratamento com Invisalign®. Os movimentos de expansão, intrusão e rotação foram analisados por dois examinadores. A análise estatística foi realizada usando os coeficientes de correlação intra-classe (ICC), fórmula de Dahlberg e teste t (p<0,05). Resultados: Foi desenvolvido um método confiável de sobreposição de modelos digitais 3D usando um único ponto UCS na maxila e mandíbula. O ICC apresentou excelente correlação intra e inter-avaliadores (ICC>0,90). Não foi encontrado erro sistemático nas medidas lineares e angulares (<1mm e <1,5°, respectivamente). Os movimentos dentários puderam ser analisados por meio do método proposto, incluindo expansão da arcada, intrusão e rotação dentária. Conclusão: O método desenvolvido provou ser confiável e reprodutível para sobreposição de modelos 3D das arcadas superior e inferior usando o sistema UCS com marcação de ponto único.

ABSTRACT The objective of this study was to evaluate the microtensile bond strength (μTBS) to dentin of two universal adhesive systems: Single Bond Universal (SBU) and Ambar Universal (AU), used in different adhesion strategies. Materials and Method: Thirty-six human teeth were prepared (n=6) and treated following different adhesive strategies: G1: SBU-etch-and-rinse, applied on dry dentin; G2: SBUetch- and-rinse, applied on moist dentin; G3: SBU-self-etching; G4: AU-etch-and-rinse, applied on dry dentin; G5: AU-etch-and-rinse, applied on moist dentin; G6: AU-self-etching. The specimens were submitted to μTBS test, failure analysis, and scanning electron microscopy (SEM). Data were analyzed with ANOVA and Tukey’s tests (p<0.05). Results: Microtensile bond strength was significantly lower in G1 than G2 and G3. AU adhesive performed worse than the SBU system, except in G5. Cohesive and mixed failures predominated in G1 and G2, while adhesive failures predominated in G3 and G5. Conclusions: Universal adhesives are an interesting innovation, but there are still doubts about their performance, mainly regarding the different protocols provided by the manufacturers. The conventional adhesive strategy on moist dentin demonstrated higher μTBS for both adhesives. The use of the selfetching strategy with the SBU showed promising results.

RESUMO O objetivo deste estudo foi avaliar a resistência de união à microtração (μTBS) de dois sistemas adesivos universais: Single Bond Universal (SBU) e Ambar Universal (AU), utilizados em diferentes estratégias de adesão. Materiais e método: 36 dentes humanos foram preparados (n=6) e tratados seguindo diferentes estratégias adesivas: G1: SBU-condicionamento e enxágue, aplicado sobre dentina seca; G2: SBU-condicionamento e enxágue, aplicado sobre dentina úmida; G3: SBU-autocondicionante; G4: AU-condicionamento e enxágue, aplicado em dentina seca; G5: AU-condicionamento e enxágue, aplicado sobre dentina úmida; G6: AU-autocondicionante. Os espécimes foram submetidos ao teste de μTBS, análise de falhas e microscopia eletrônica de varredura (SEM). Os dados foram analisados com os testes ANOVA e Tukey (p<0,05). Resultados: A resistência de união à microtração de G1 foi significativamente menor que G2 e G3. O adesivo AU teve um desempenho pior que o sistema SBU, com exceção do G5. Falhas coesivas e mistas predominaram em G1 e G2 enquanto G3 e G5 apresentaram predominância de falhas adesivas. Conclusões: Os adesivos universais representam uma inovação interessante, mas ainda há dúvidas sobre seu desempenho, principalmente em relação aos diferentes protocolos fornecidos pelos fabricantes. A estratégia adesiva convencional em dentina úmida demonstrou maior μTBS para ambos os adesivos. O uso da estratégia autocondicionante com a SBU apresentou resultados promissores.

Abstract Objective: To evaluate the efficacy of desensitizing agents for the obliteration of dentinal tubules subjected or not to a simulated oral environment. Material and Methods: Dentinal discs (n=8) treated with Riva-Star (RS) or PRG-Barrier-Coat (PRG) were submitted (cycled) or not submitted (control) to erosive-abrasive-thermal cycles and evaluated using scanning electron microscopy/energy dispersive spectroscopic analysis. The variables analyzed were tubule obliteration and dentin surface chemical composition. Data were analyzed by non-parametric tests (p<0.05). Results: The cycled and control groups did not differ significantly for the responses in each material. The PRG control and cycled groups had fewer visible tubules and a higher proportion of totally obliterated tubules than the RS groups. The percentages of silver coverage were higher in the RS-control than in the RS-cycled. There was a significant inverse correlation between the presence of silver and non-obliterated tubules (R=-0.791; p<0.001). The percentages of carbon, aluminum, strontium, and potassium were significantly higher in the PRG-control and PRG-cycled compared to the RS control. The percentages of calcium, phosphorus, and silver were significantly higher in the RS compared to the PRG groups. PRG-control showed a higher percentage of boron than RS-control. Conclusion: PRG promoted greater tubule obliteration than SR. Simulated stress did not affect the obliterating effect of each agent. Greater silver coverage corresponded to a lower proportion of non-obliterated tubules in RS. Carbon, aluminum, strontium, boron, and potassium predominated in the dentin surface treated with PRG, while calcium, phosphorus, and silver prevailed in RS groups.

Abstract: This in vitro study aimed to assess the effects of different pretreatments used to adapt glass-fiber posts cemented to root canals with different resin cements, regarding porosity percentage and bond strength. Twelve bovine incisor roots were prepared with Largo drills. After post space preparation, the specimens were randomized into two types of pretreatment groups (n = 3): water-wet bonding and ethanol-wet bonding. After the post were cemented, the roots were stored in 100% humidity at room temperature for 7 days. The samples were scanned by microcomputed tomography (micro-CT). Images were reconstructed by NRecon software, and CTAn software was used to analyze the porosity percentage (%) at the luting interface. Evaluation of the push-out bond strength was performed by serially cutting the roots, and submitting the slices to testing. Additionally, the resin cement post-gel shrinkage values (%) were measured using the strain-gauge method (n = 10). Data were analyzed by two-way ANOVA, Tukey's test and Student's t test (a = 0.05). The roots prepared with ethanol-wet bonding using RelyX™ U200 had significantly lower porosity in the coronal and apical thirds (p < 0.05). The group prepared with ethanol-wet bonding using RelyX™ ARC presented better bond strength results in the coronal and apical thirds (p < 0.05). RelyX™ ARC (0.97%) produced a higher post-gel shrinkage value than RelyX™ U200 (0.77%). Canals pretreated with ethanol-wet bonding presented better outcomes in regard to porosity percentage and push-out bond strength.

RESUMO O objetivo deste estudo é apresentar um relato de caso em que foi realizado o clareamento dentário com a combinação das técnicas de consultório e de moldeiras e discutir sobre considerações para a manutenção do resultado. Um plano de tratamento foi proposto envolvendo clareamento exógeno com moldeiras com peróxido de hidrogênio 7,5% e o clareamento em consultório com peróxido de hidrogênio 35%. O gel clareador de clareamento em consultório foi aplicado 2 vezes, por 15 minutos cada aplicação, sem luz do tipo Led. A paciente foi orientada a usar as moldeiras customizadas para o clareamento caseiro apenas a partir do dia seguinte, sendo uma gota de gel clareador no espaço equivalente a cada dente. Após a dosagem do gel, ela usou as moldeiras por 1 hora por dia, ininterruptamente por 30 dias, sendo 15 dias para cada arco. Diante do planejamento e terapia executados no caso clínico apresentado, pode-se concluir que a técnica clareadora utilizando a combinação de clareamento em consultório e clareamento com moldeiras customizadas, quando corretamente indicada, pode ser considerada uma alternativa de tratamento bastante satisfatória por ser uma técnica simples capaz de melhorar a estética do sorriso preservando a estrutura dental hígida. O paciente deve ser orientado para a máxima preservação da cor e manutenção estética alcançada, e deve ser ressaltado que retratamentos podem ser necessários dependendo da higiene oral e da frequência de ingestão de alimentos e bebidas corantes.

ABSTRACT This study goal is to present a case report of tooth bleaching treatment with the combination of the custom tray and in-office techniques, and to discuss about the considerations for result maintenance. A treatment approach was planned involving exogenous bleaching with custom trays with 7.5% hydrogen peroxide, and in-office bleaching with 35% hydrogen peroxide. The in-office bleaching agent was applied in two 15-minute applications, without led light. The patient was instructed to use the custom trays only a day after, with one drop of the bleaching agent for each tooth space. After the application of the bleaching agent, the patient used the trays for 1 hour per day, continuously for 30 days, 15 days for each arch. Considering the executed treatment approach, we may conclude that when correctly indicated, tooth bleaching with the combination of the in-office and custom trays techniques can be an acceptable choice of treatment, capable of enhancing the smile esthetics with a simple technique that preserves the sound dental structure. The patient should be instructed for the maximum color preservation and esthetic result maintenance, and should be advised that retreatments may become necessary depending on the oral hygiene and frequence of coloured food and drinks intake.

The goal of this study is to test photoelastic resins for manufacturing models with teeth and/or implants under chewing load. Four commercial brands have been chosen: Araldite (Ciba Chemicals), Flexible GIV-Rigid GIV (Polipox) and PL2 (Measurements Group). Nine discs were manufactured, four of them from each of the photoelastic resin brands and five from different proportions of mixture between Flexible GIV and Rigid GIV. All the models were subjected to the diametral compression test, and observed in a circular polariscope. The first order fringe has always been adopted as a benchmark to calculate the photoelastic constant. To the load of interest (150 Newtons), Flexible GIV resin showed areas that followed the elastic regime. Residual stresses for the resin PL2 and persistence of bubbles within the model were observed. Rigid GIV Resin generated the first fringe order only at 280 Newtons load. Araldite resin behaved within the elastic regime and there were no areas with excessive concentration of fringes. The models generated from the manual mixing generated non-homogeneous photoelastic images. The Araldite resin showed to be the most suitable material for manufacturing birefringent models with teeth and/or implants under chewing load.

Resumo Introdução Restaurações estéticas indiretas são preferencialmente cimentadas utilizando-se cimentos resinosos convencionais e sistema adesivo de condicionamento total ou cimentos resinosos autoadesivos. Estes últimos são tecnicamente menos sensíveis e aderem aos tecidos dentários sem tratamento prévio ou aplicação de adesivo, com um único passo para sua aplicação aos tecidos dentários. Objetivo Comparar qualitativamente as interfaces adesivas de dois cimentos resinosos autoadesivos e um cimento resinoso convencional, sob microscopia eletrônica de varredura. Material e método 42 coroas de incisivos bovinos foram seccionadas e as faces vestibulares planificadas expondo esmalte (E) ou dentina (D). Os subgrupos foram definidos de acordo com o tipo e tempo de condicionamento: E1-sem tratamento, E2-37% de ácido fosfórico por 15 segundos, E3-37% de ácido fosfórico por 30 segundos; D1-sem tratamento, D2-37% de ácido fosfórico durante 5 segundos; D3-11,5% de ácido poliacrílico durante 15 segundos. Um bloco de resina foi unido a cada substrato usando os cimentos resinosos autoadesivos RelyX U100 e RelyX U200 (3M ESPE) (n=3). Como referência de camada híbrida, foram cimentados seis blocos de resina com RelyX ARC e o sistema adesivo Scotchbond Multi-Purpose(esmalte-EA, dentina-DA). Após armazenamento (7 dias, umidade, 37±1°C), as amostras foram preparadas para análise microscópica. Resultado Nos espécimes ARC, houve formação de camada híbrida em EA e DA. U100 E1 mostrou lacunas na interface adesiva, enquanto E2 e E3 apresentaram boa interação para ambos os cimentos autoadesivos. Houve interação superficial com U100 e U200 em D1, enquanto em D2 e D3, foram observadas tags de resina apenas para U100. Conclusão Concluiu-se que o condicionamento do substrato pode aumentar a interação entre cimentos resinosos autoadesivos e os tecidos dentários, embora este não seja o caso do RelyX U200 e da dentina.

Abstract Introduction Convencional resin cements can be used in combination with a total-etch system in a conventional mode or as self-adhesive resin cements. The latter are less technique sensitive and able to bond to dental tissues without previous treatment or adhesive layer and requires only a single step to be applied to dental structures. Objective To compare qualitatively the adhesive interfaces of two self-adhesive resin cements and one conventional resin cement after different tooth surface treatments under scanning electron microscopy. Material and method 42 crowns of bovine incisors were sectioned and flattened exposing enamel (E) or dentine (D) substrate. Subgroups were defined according to conditioning type and time: E1—no treatment, E2—37% phosphoric acid for 15 seconds, E3—37% phosphoric acid for 30 seconds; D1—no treatment, D2—37% phosphoric acid for 5 seconds; D3—11.5% polyacrylic acid for 15 seconds. A resin block was bonded to each substrate using the self-adhesive resin cements RelyX U100 (3M ESPE) and RelyX U200 (3M ESPE). As a reference hybrid layer, six resin blocks were luted with RelyX ARC and Scotchbond Multi-Purpose adhesive system (3M ESPE) (enamel—EA; dentine—DA). After aging for 7 days in a moist environment at 37±1°C, samples were prepared for microscopy analysis. Result and Discussion In the ARC specimens, there was hybrid layer formation in both EA and DA. U100 E1 showed gaps at the adhesive interface, while E2 and E3 showed interaction for both self-adhesive cements. There was superficial interaction with bothU100 and U200 in D1, while in D2 and D3, resin tags were only observed in the case of U100. Conclusion It was concluded that substrate conditioning may enhance the interaction between self-adhesive resin cements and dental tissues, although this is not the case for RelyX U200 and dentine.

Resumo Avaliou-se o efeito da espessura, cor e translucidez de uma cerâmica vítrea a base de dissilicato de lítio para CAD / CAM sobre a transmissão da luz de unidades de diodos emissores de luz (LED) e de quartzo-tungstênio-halogênio (QTH). Cerâmica IPS e.max CAD nas cores A1, A2, A3, A3.5 de translucidez alta (HT) e baixa (LT) foram cortadas (1, 2, 3, 4, 5 mm). Os espectros de emissão das fontes de luz foram determinados. A intensidade da luz incidente e transmitida através de cada espécime de cerâmica foi medida para determinar a percentagem de transmissão de luz (TP). Um modelo de regressão linear foi utilizado para a análise estatística. Houve interação significativa entre a fonte de luz e translucidez cerâmica (p = 0.008) e forte correlação negativa (r = -0.845, p <0.001) entre a espessura da cerâmica e TP. O aumento da espessura em uma unidade levou a uma redução média de 3.17 em TP. Não houve diferença significativa em TP (p = 0.124) entre as cores A1 (ß1 = 0) e A2 (ß1 = -0.45), mas ocorreu redução significativa para as cores A3 (ß1 = -0.83) e A3.5 (ß1 = -2.18). A interação QTH/HT proporcionou maior TP (ß1 = 0) do que LED/HT (ß1 = -2.92), QTH/LT (ß1 = -3.75) e LED/LT (ß1 = -5.58). A transmissão de luz foi mais eficaz utilizando QTH e cerâmica de alta translucidez, diminuiu à medida que a espessura de cerâmica aumentou, e foi maior para as cores A1 e A2. A partir do modelo de regressão (R2 = 0.85), obteve-se uma equação para estimar o valor de TP utilizando os valores de ß1 encontrado. Foi observada TP máxima de 25% para QTH e 20% para LED, sugerindo que a atenuação promovida pela cerâmica pode comprometer a ativação de um cimento resinoso fotoativado e de ativação dupla.

The effect of thickness, shade and translucency of CAD/CAM lithium disilicate glass-ceramic on light transmission of light-emitting diode (LED) and quartz-tungsten-halogen units (QTH) were evaluated. Ceramic IPS e.max CAD shades A1, A2, A3, A3.5, high (HT) and low (LT) translucency were cut (1, 2, 3, 4 and 5 mm). Light sources emission spectra were determined. Light intensity incident and transmitted through each ceramic sample was measured to determine light transmission percentage (TP). Statistical analysis used a linear regression model. There was significant interaction between light source and ceramic translucency (p=0.008) and strong negative correlation (R=-0.845, p<0.001) between ceramic thickness and TP. Increasing one unit in thickness led to 3.17 reduction in TP. There was no significant difference in TP (p=0.124) between shades A1 (ß1=0) and A2 (ß1=-0.45) but significant reduction occurred for A3 (ß1=-0.83) and A3.5 (ß1=-2.18). The interaction QTH/HT provided higher TP (ß1=0) than LED/HT (ß1=-2.92), QTH/LT (ß1=-3.75) and LED/LT (ß1=-5.58). Light transmission was more effective using halogen source and high-translucency ceramics, decreased as the ceramic thickness increased and was higher for the lighter shades, A1 and A2. From the regression model (R2=0.85), an equation was obtained to estimate TP value using each variable ß1 found. A maximum TP of 25% for QTH and 20% for LED was found, suggesting that ceramic light attenuation could compromise light cured and dual cure resin cements polymerization.

OBJETIVO: Avaliar o índice de sucesso clínico dos implantes pilares de próteses totais implantossuportadas. As próteses implantossuportadas vêm sendo utilizadas como uma alternativa viável ao planejamento de reabilitação oral. O protocolo de dois estágios cirúrgicos, ao passar dos anos, vem sendo cada vez mais substituídos pelos procedimentos de carga imediata, principalmente na região anterior inferior, nos casos de reabilitação de pacientes totalmente desdentados. Tal procedimento torna-se viável devido ao alto índice de sucesso da técnica com resultados bastante satisfatórios. MÉTODOS: Por meio de uma revisão de literatura focada em trabalhos publicados com acompanhamento clínico entre 8 e 15 anos. RESULTADOS: Os implantes instalados em mandíbula apresentaram índices de sucesso maiores que os instalados em maxila. Os casos com acompanhamento mais longos, com 15 anos, apresentaram índices de sucesso maiores do que quando comparados aos acompanhamentos de 8 e 10 anos. CONCLUSÃO: O índice de sucesso dos implantes pilares de prótese total é bastante alto.

OBJECTIVE: The aim of this study was to assess the clinical success rate of implant-supported complete dental prostheses, which are being used as a feasible alternative in planning of oral rehabilitation. Over the years, the two-stage surgical protocol has increasingly been replaced by immediate loading procedures, especially in the mandibular anterior region in cases of rehabilitation of completely edentulous patients. This procedure has become feasible due to the high success rate of the technique with very satisfactory results. METHODS: By means of a literature review focused on published articles with clinical follow-up between 8 and 15 years. RESULTS: Implants placed in the mandible had higher success rates than those inserted in the maxilla. Cases with longer follow-up periods, 15 years, showed higher success rates in comparison with follow-up periods of 8 and 10 years. CONCLUSION: Success rates of implant-supported complete dental prostheses are very high.

INTRODUÇÃO: A reumatologia pediátrica (RP) é uma especialidade emergente, com número restrito de especialistas, e ainda não conta com uma casuística brasileira sobre o perfil dos pacientes atendidos e as informações sobre a formação de profissionais capacitados. OBJETIVO: Estudar o perfil dos especialistas e dos serviços em RP e as características dos pacientes com doenças reumáticas nessa faixa etária a fim de estimar a situação atual no estado de São Paulo (ESP). PACIENTES E MÉTODOS: No ano de 2010 o departamento científico de RP da Sociedade de Pediatria de São Paulo encaminhou um questionário respondido por 24/31 especialistas com título de especialização em RP que atuam no ESP e por 8/12 instituições com atendimento nesta especialidade. RESULTADOS: A maioria (91%) dos profissionais exerce suas atividades em instituições públicas. Clínicas privadas (28,6%) e instituições (37,5%) relataram não ter acesso ao exame de capilaroscopia e 50% das clínicas privadas não tem acesso à acupuntura. A média de tempo de prática profissional na especialidade foi de 9,4 anos, sendo 67% deles pós-graduados. Sete (87,5%) instituições públicas atuam na área de ensino, formando novos reumatologistas pediátricos. Cinco (62,5%) delas têm pós-graduação. Dois terços dos especialistas utilizam imunossupressores e agentes biológicos de uso restrito pela Secretaria da Saúde. A doença mais atendida foi artrite idiopática juvenil (29,1%-34,5%), seguida de lúpus eritematoso sistêmico juvenil (LESJ) (11,6%-12,3%) e febre reumática (9,1%-15,9%). Vasculites (púrpura de Henoch Schönlein, Wegener, Takayasu) e síndromes autoinflamatórias foram mais incidentes nas instituições públicas (P = 0,03; P = 0,04; P = 0,002 e P < 0,0001, respectivamente). O LESJ foi a doença com maior mortalidade (68% dos óbitos), principalmente por infecção. CONCLUSÃO: A RP no ESP conta com um número expressivo de especialistas pós-graduados, que atuam especialmente em instituições de ensino, com infraestrutura adequada ao atendimento de pacientes de alta complexidade.

INTRODUCTION: Paediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country. OBJECTIVE: To investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo. PATIENTS AND METHODS: In 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care. RESULTS: Most (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as "restricted use" by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1-34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6-12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection. CONCLUSION: The field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.

OBJECTIVE: The occlusal patterns are key requirements for the clinical success of oral rehabilitation supported by implants. This study compared the stresses generated by the disocclusion in the canine guide occlusion (CGO) and bilateral balanced occlusion (BBO) on the implants and metallic infrastructure of a complete Brånemark protocol-type denture modified with the inclusion of one posterior short implant on each side. MATERIAL AND METHODS: A three-dimensional model simulated a mandible with seven titanium implants as pillars, five of them installed between the mental foramen and the two posterior implants, located at the midpoint of the occlusal surface of the first molar. A load of 15 N with an angle of 45° was applied to a tooth or distributed across three teeth to simulate the CGO or BBO, respectively. The commercial program ABAQUS® was used for the model development, before and after the processing of the data. The results were based on a linear static analysis and were used to compare the magnitude of the equivalent stress for each of the simulations. RESULTS: The results showed that the disocclusion in CGO generated higher stresses concentrated on the working side in the region of the short implant. In BBO, the stresses were less intense and more evenly distributed on the prosthesis. The maximum stress found in the simulation of the disocclusion in CGO was two times higher than that found in the simulation of the BBO. The point of maximum stress was located in the neck of the short implant on the working side. CONCLUSIONS: Under the conditions of this study, it was concluded that the BBO pattern was more suitable than CGO for the lower complete denture supported by implants without free distal ends.

Este estudo avaliou a atuação de cirurgiões-dentistas (CD) nas instituições de longa permanência de Belo Horizonte (MG) e as práticas de higiene bucal adotadas. Questionários semiestruturados foram entregues aos coordenadores das 37 instituições filantrópicas e trinta privadas e coletados após uma semana. Os resultados foram comparados pelos testes Qui-quadrado e Exato de Fisher (p<0,05). Houve retorno de 81% dos questionários. A maioria das instituições privadas (74,2%) e filantrópicas (87%) não possui CD na equipe de saúde (p=0,21). A localização da instituição, o tempo de fundação, o tipo e o número de residentes não interferiram na presença de CD (p>0,05). Nas instituições filantrópicas com consultório, 67% possuíam CD, e nenhum CD trabalhava onde não havia consultório. Mesmo sem consultório, 13% das instituições privadas possuíam CD. 69,6% das filantrópicas encaminhavam o idoso em caso de necessidade para centros de saúde e, nas privadas, 58,1% direcionavam ao familiar (p=0,00). Maior percentual de instituições privadas adotava medidas sistematizadas de higiene bucal (p=0,01), com grande variabilidade nas condutas relatadas. Há necessidade da incorporação do CD na equipe de saúde das instituições e da sistematização das práticas de higiene bucal.

This study evaluated the activities of dentists, dental care and oral hygiene practices in the long-term care institutions of Belo Horizonte (Minas Gerais, Brazil). A semi-structured questionnaire was handed out to the coordinators of 37 philanthropic and 30 private institutions. The data was compared by the chi-square and Fisher's Exact Tests. 81% of the questionnaires were answered. The majority of the private (74.2%) and philanthropic institutions (87%) do not have a dentist (p=0.21). The location, period of existence, type institution kind and number of residents weren't factors regarding the presence of a dentist (p>0.05). 67% of the philanthropic institutions with equipped consultation rooms had dentists, though there were none when there was no consultation room. Even without consultation rooms, 13% of the private institutions had dentists. When necessary, 69.6% of the philanthropic institutions refer the elderly to public health centers, while 58.1% of the private institutions refer them to their family dentists. A higher percentage of the private institutions adopted systematic oral hygiene procedures (p=0.01), with a considerable divergence of treatment reported. There is a need to include a dentist on the health staff in the institutions and for systematization of oral hygiene practices.