OBJECTIVES: To assess the craniofacial skeletal growth in pediatric hematopoietic stem-cell transplantation (HSCT) survivors in comparison with age-sex matched-paired controls. METHODS: A case-controlled retrospective comparison of the craniofacial growth in 25 HSCT children and 25 matched-paired controls was conducted. Craniofacial growth was quantitatively assessed by linear and angular measurements in panoramic radiographic images using ImageJ¯. Stature growth and body weight were obtained through physical examination. Cancer diagnosis, myeloablative conditioning, and HSCT were retrieved from medical records. RESULTS: Patients aged 12.2 years (±3.8; 16 male, 9 female). Radiographic images were obtained on an average of 2.43 (±2.0) years after HSCT. The main malignant diagnosis was acute lymphoblastic leukemia (56%), followed by acute myeloid leukemia (36%) and myelodysplastic syndromes (8%). Total body irradiation was associated with chemotherapy at 80%. Mean age at transplantation was 10 (±4.7) years. HSCT survivors showed reduced a vertical growth of the mandibular ramus (p=0.003). This persisted among individuals below 12 years of age (p=0.017). The HSCT group showed delayed dental eruption, though there was no statistically significant difference (p=0.3668). The HSCT group showed stature deficit, increased weight, and body mass index (Z-score stature: -0.28; Z-score weight: 0.38, respectively). CONCLUSIONS: Pediatric HSCT has decreased vertical craniofacial growth compared to their matched controls. There might be an association between reduced craniofacial vertical growth and reduced estature growth. Further studies to quantitatively investigate the impact of different myeloablative regimens in craniofacial skeletal growth and development.

OBJECTIVE: Hematopoietic stem-cell transplantation (HSCT) childhood survivors of hematologic malignancies are prone to develop late osteopenia and osteoporosis. The purpose of this retrospective study was to quantitatively and qualitatively assess bone mineral density (BMD) in HSCT childhood survivors and to compare the effectiveness of both qualitative and quantitative assessment methods. METHODS: DESIGN BMD assessment using panoramic radiographs of childhood HSCT survivors aged 3.69-18.88 years using two radiomorphometric indexes. Case-control double-blinded comparison of panoramic radiographic images from childhood HSCT survivors and age- and sex-matched healthy controls. Quantitative assessment was performed by measuring the cortical bone width bilaterally at the mental foramen level. Qualitative assessment was performed using the mandibular cortical index bilaterally on all panoramic images. RESULTS: Radiographs were taken 6.59-83.95 months after bone marrow transplantation [median±SD=25.92±24.9 months]. Fifty-two panoramic radiographic images were analyzed: 21 from HSCT survivors and 31 from healthy controls aged 3.69-25.1 years [mean±SD=11.89±5.28 years]. The mandibular cortical bone width was 17% smaller in childhood HSCT survivors than in healthy controls (case group: 2.420, control group: 3.307; p=0.00617). Qualitative analysis revealed an increased frequency of severe mandibular cortical erosion in childhood HSCT survivors, although no significant difference was observed (case group: 1.540, control group: 1.490; p=0.32). The interobserver agreement was 85% (Kappa index). CONCLUSIONS: HSCT childhood survivors exhibit quantitative and qualitative mandibular bone impairments. Further studies are needed to establish an association between mandibular cortical bone impairment and osteoporosis.

The aim of this study was to provide an updated review of dental procedures undertaken at the dental unit of the Onco-hematology service of the Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (ICr/HC-FMUSP). We retrospectively reviewed 565 of 1902 medical and dental records of patients diagnosed with onco-hematological diseases who were seen in a 3-year study (January 2015 to December 2017). We assessed data regarding population characteristics, onco-hematological diagnosis and dental procedures performed. Of the selected medical records, preventive dentistry was the most common procedure undertaken in this population, followed by oral maxillofacial surgeries, restorative dentistry and oral mucositis treatment. The most prevalent malignant diagnosis was acute lymphocytic leukemia, and the most prevalent nonmalignant diagnosis was sickle-cell anemia. Preventive dental procedures represent most of the dental procedures undertaken in hospitalized onco-hematological pediatric patients.

Cancer is the third most frequent cause of death in children in Brazil. Early diagnosis and medical advances have significantly improved treatment outcomes, which has resulted in higher survival rates and the management of late side effects has become increasingly important in caring for these patients. Dental abnormalities are commonly observed as late effects of antineoplastic therapy in the oral cavity. The incidence and severity of the dental abnormalities depend on the child's age at diagnosis and the type of chemotherapeutic agent used, as well as the irradiation dose and area. The treatment duration and aggressivity should also be considered. Disturbances in dental development are characterized by changes in shape, number and root development. Enamel anomalies, such as discoloration, opacities and hypoplasia are also observed in these patients. When severe, these abnormalities can cause functional and esthetic sequelae that have an impact on the children's and adolescents' quality of life. General dentists and pediatric dentists should understand these dental abnormalities and how to identify them aiming for early diagnosis and appropriate treatment.

Acid erosion is a superficial loss of enamel caused by chemical processes that do not involve bacteria. Intrinsic and extrinsic factors, such as the presence of acid substances in the oral cavity, may cause a pH reduction, thus potentially increasing acid erosion. The aim of this study was to evaluate the microhardness of bleached and unbleached bovine enamel after immersion in a soda beverage, artificial powder juice and hydrochloric acid. The results obtained for the variables of exposure time, acid solution and substrate condition (bleached or unbleached enamel) were statistically analyzed by the ANOVA and Tukey tests. It was concluded that a decrease in microhardness renders dental structures more susceptible to erosion and mineral loss, and that teeth left unbleached show higher values of microhardness compared to bleached teeth.

OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. RESULTS: Review of 1,236 visits indicated that 54% (n=100) of the patients had blood cancers, 46% (n=86) had solid tumors and 63% were undergoing anticancer therapy. The proportion of males (52.7%) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2%). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. CONCLUSION: The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients' quality of life, which is critical to provide oral care and prevent future oral problems.

O objetivo deste estudo foi avaliar in vitro três sistemas adesivos: um monocomponente com condicionamento ácido total (G1 Prime & Bond 2.1), um "primer" autocondicionante (G2 Clearfil SE Bond) e um adesivo autocondicionante (G3 One Up Bond F), através de resistência ao cisalhamento ao esmalte de dentes humanos, avaliando o tipo de fratura por estereomicroscopia, seguindo as normas ISO para testes adesivos. Trinta pré-molares hígidos foram seccionados ao meio em sentido mésio-distal, incluídos em resina acrílica, polidos até lixa d'água de granulação 600 e aleatoriamente divididos em três grupos (n = 20). Cilindros de resina composta foram adicionados às superfícies de teste. Os espécimes foram armazenados em água destilada (37°C/24 h), termociclados por 500 ciclos (5°C-55°C) e submetidos ao teste de cisalhamento com velocidade de 0,5 mm/min, sendo o tipo de fratura analisado sob estereomicroscopia e os dados submetidos à análise estatística Anova, Tukey e Qui-quadrado (5%). As médias de resistência adesiva foram: G1: 18,13 ± 6,49 MPa, (55% de fraturas coesivas em resina); G2: 17,12 ± 5,80 MPa (90% de fraturas adesivas) e G3 10,47 ± 3,14 MPa (85% de fraturas adesivas). Em termos de resistência adesiva, não houve diferenças significantes entre G1 e G2, tendo G3 apresentado diferença significante em relação aos demais grupos. G1 apresentou tipo de fratura diferente de G2 e G3. Em conclusão, apesar de os sistemas adesivos com condicionamento ácido total e "primer" autocondicionante terem apresentado valores de resistência adesiva similares, o tipo de fratura apresentado por eles foi diferente, o que pode ter implicações clínicas.

The purpose of this study was to evaluate in vitro three adhesive systems: a total etching single-component system (G1 Prime & Bond 2.1), a self-etching primer (G2 Clearfil SE Bond), and a self-etching adhesive (G3 One Up Bond F), through shear bond strength to enamel of human teeth, evaluating the type of fracture through stereomicroscopy, following the ISO guidance on adhesive testing. Thirty sound premolars were bisected mesiodistally and the buccal and lingual surfaces were embedded in acrylic resin, polished up to 600-grit sandpapers, and randomly assigned to three experimental groups (n = 20). Composite resin cylinders were added to the tested surfaces. The specimens were kept in distilled water (37°C/24 h), thermocycled for 500 cycles (5°C-55°C) and submitted to shear testing at a crosshead speed of 0.5 mm/min. The type of fracture was analyzed under stereomicroscopy and the data were submitted to Anova, Tukey and Chi-squared (5%) statistical analyses. The mean adhesive strengths were G1: 18.13 ± 6.49 MPa, (55% of resin cohesive fractures); G2: 17.12 ± 5.80 MPa (90% of adhesive fractures); and G3: 10.47 ± 3.14 MPa (85% of adhesive fractures). In terms of bond strength, there were no significant differences between G1 and G2, and G3 was significantly different from the other groups. G1 presented a different type of fracture from that of G2 and G3. In conclusion, although the total etching and self-etching systems presented similar shear bond strength values, the types of fracture presented by them were different, which can have clinical implications.

O objetivo deste estudo in vitro foi de avaliar ao microscópio eletrônico de varredura os aspectos morfológicos do esmalte de dentes decíduos após condicionamento com ácido fosfórico a 36% ou com um agente condicionador não lavável. Foram selecionados 10 dentes decíduos anteriores esfoliados naturalmente. As amostras sofreram limpeza coronária com pasta de pedra-pomes e água, em baixa-velocidade. O condicionamento foi realizado no esmalte da face vestibular. Os espécimes foram divididos em dois grupos: G1 (n=10): condicionamento com ácido fosfórico a 36% na forma de gel - Conditioner 36 (Dentsply) durante 20 segundos, seguidos de lavagem com água durante 15 segundos; G2 (n=10): condicionamento com NRC - Non Rinse Conditioner (Dentsply) durante 20 segundos, seguidos de secagem com ar durante 15 segundos. As amostras foram desidratadas, montadas em bases metálicas e cobertas com ouro para análise ao microscópio eletrônico de varredura (Jeol JSM 6.100). A análise da eletromicrografias revelou que ambos os agentes condicionadores foram efetivos para condicionar o esmalte de dentes decíduos, causando microporosidades mas com melhor resultado quando utilizou-se o ácido fosfórico a 36% na forma de gel.

The aim of this in vitro study was to evaluate by scanning electron microscopy the morphological aspects of the enamel of primary teeth after etching with 36% phosphoric acid or a non-rinse conditioner. Ten naturally exfoliated anterior primary teeth were selected. The samples were subjected to prophylaxis with pumice paste and water using a low-speed hand piece. Etching was done on the buccal surface. Specimens were divided into 2 groups: G1 (n=10): etching with 36% phosphoric acid gel - Conditioner 36 (Dentsply) for 20 s, followed by water rinse for 15 s; G2 (n=10): etching with NRC - Non Rinse Conditioner (Dentsply) for 20 s, followed by air drying for 15 s. The samples were dehydrated, mounted on metal stubs, coated with gold and observed with Jeol JSM-6100 scanning electron microscope. Electron-micrographic analysis showed that both etching agents were effective for etching the enamel of primary teeth causing the formation of microporosities on the enamel surface, although the etching pattern was more effective with the use of 36% phosphoric acid gel.

O artigo demonstra a importância do programa de iniciação científica para o estudante do curso superior, enfatizando o papel complementar de melhoria da sua análise crítica, maturidade intelectual, compreensão da ciência e possibilidades futuras tanto acadêmicas como profissionais. Descreve as vantagens, mas também enumera alguns aspectos vulneráveis que refletem riscos a serem evitados. É ainda destacada a necessidade de formação de gente capacitada na área tecno-científica como premissa para o nosso desenvolvimento social e econômico.

Avaliou-se o desempenho de dois materiais utilizados como selante oclusal (Fluroshield e Vitremer). Foram selados 46 pré-molares, superiores e/ou inferiores, sem sinais clínicos de lesões de cárie, sendo que 23 dentes foram selados com Vitremer e 23 com Fluroshield. Após seis, doze e vinte e quatro meses de acompanhamento, observou-se que o Vitremer apresentou uma retenção total de 91,30%, 91,30% e 82,60%, enquanto o Fluroshield apresentou 100% de retenção total nos três intervalos de tempo. Ambos os materiais impediram o desenvolvimento de lesões de cárie, independente de sua retenção e períodos avaliados.

The clinical performance of two dental materials used as pit and fissure sealants (Fluroshield and Vitremer) was evaluated. Forty-six sound upper or lower premolars were sealed. Twenty-three teeth were sealed with Vitremer and 23 with Fluroshield. After six, twelve, and twenty-four months Vitremer presented a total retention of 91.30%, 91.30%, and 82.60%, and Fluroshield presented a total retention of 100% in the three periods of evaluation. Both materials do not permit the development of caries, independent of their retention and period of evaluation.

Foram descritas a frequência, a estrutura e a espessura da camada de esmalte aprismático nas superfícies vestibular e lingual de molares decíduos não erupcionados. Os dentes foram extraídos e mantidos em solução de etanol a 70% e, em seguida, desidratados, cobertos com ouro e examinados em um microscópio eletrônico de varredura JEOL, JSM-6.100. A camada aprismática foi observada nos terços oclusal, médio e cervical de todas as superfícies vestibular e lingual. Os cristais de hidroxiapatita seguiram um arranjo paralelo entre si e perpendicular à superfície do esmalte. Nenhuma diferença estatisticamente significante foi observada entre os terços oclusal, médio e cervical, que apresentaram uma espessura

The frequency, structure and thickness of the prismless enamel layer in the buccal and lingual surfaces of non-erupted deciduous molar teeth were described. The teeth were extracted, kept in a 70% ethanol solution, dried, coated with gold and examined in a scanning electron microscope JEOL, JSM-6.100. The aprismatic layer was observed in the occlusal, middle and cervical thirds of all buccal and lingual surfaces. The hydroxyapatite crystals were arranged parallel to each other and perpendicular to the enamel surface. No statistically significant differences were observed between the occlusal, middle and cervical thirds, which had 7.257 <FONT FACE="Symbol">m</FONT> m of average thickness.

No presente trabalho, empregando a técnica de microscopia eletrônica de varredura, foram estudadas as características do esmalte da superfície vestibular de molares decíduos humanos não erupcionados, avaliando-os após utilização de ácido fosfórico durante períodos de 15, 30 e 45 segundos. Os dentes foram extraídos e mantidos em solução de álcool a 70% e, posteriormente, desidratados e montados em bases metálicas, para análise em microscópio eletrônico de varredura JEOL, JSM-6.100. A experiência in vitro com ácido fosfórico a 35% revelou que há uma tendência de predominância de dissolução de esmalte interprismático, ou padrão tipo II, com 15 e 45 segundos de tempo de condicionamento. A dissolução do esmalte interprismático é mais pronunciada quando são utilizados 45 segundos de condicionamento ácido. A superfície do esmalte demonstrou padrões tipo I e tipo II no caso de condicionamento ácido de 30 segundos

Under the scanning electron microscope, the characteristics of the buccal surface enamel of human non-erupted deciduous molars were evaluated after using 15, 30, and 45 seconds of phosphoric acid etching time. The teeth were extracted, kept in a 70% alcohol solution and later dehydrated and metallized for analysis with the scanning electron microscope JEOL, JSM-6.100. The in vitro experiment with 35% phosphoric acid revealed that there is a tendency of predominance of interprismatic enamel dissolution or type II pattern with 15 and 45 seconds etching time. The dissolution of the interprismatic enamel was more pronounced when an acid etching time of 45 seconds was used. The enamel surface demonstrated type I and type II patterns when acid etching time was 30 seconds