Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-09-12T19:07:13Z No. of bitstreams: 1 JoyceGatti.pdf: 1210487 bytes, checksum: 71d9dfa07d0b48a036023d3e8f13c597 (MD5) / Made available in DSpace on 2017-09-12T19:07:14Z (GMT). No. of bitstreams: 1 JoyceGatti.pdf: 1210487 bytes, checksum: 71d9dfa07d0b48a036023d3e8f13c597 (MD5) Previous issue date: 2017-04-28 / The search for adhesive restorations that have greater durability in the oral cavity is constant. Enamel adhesion is already well established and resistant over time. The great challenge is to improve the adhesion of the resin to the dentin, since this substrate is more complex, presenting a greater amount of water in its composition, which directly compromises the adhesion process. In the literature, two major problems related to the degradation of the resin-dentin adhesive interface over time are highlighted: hydrolytic degradation, caused by the deleterious effects of the water inherent to the tooth and the adhesive material used; and the enzymatic degradation caused by the proteolytic enzymes, especially the metalloproneinases (MMP's) present in the dentin structure and that are activated after the acid conditioning. Several proposals have been tested to combat these problems. In the present work, we will focus on two strategies used to improve bond strength to dentin over time: the application of 2% chlorhexidine (CHX) and the ethanol wet-bonding technique (EWBT). The main objective was to evaluate in vitro the effects of the association of these two techniques on the bond strength values to dentin after 24h, 6 months and 12 months of storage in water by means of microtensile bond strength test. Two forms of association were used: the first applying the techniques in separate steps, the CHX technique being applied previously to EWBT; and the second by means of an experimental solution handled in a pharmaceutical laboratory composed of 2% CHX diluted in absolute ethanol solution and applied once in the exposed dentin and conditioned with phosphoric acid. The thesis was divided into two chapters that evaluate these techniques in vitro. The first chapter evaluated after 6 months the association of the techniques in separate steps in two types of adhesive systems (3-step and 2-step etch-and-rinse). It was concluded that the association was able to preserve the adhesive interface after the period evaluated only when using the 2- step adhesive system, presenting RU values statistically superior to the control group of this adhesive. The second chapter evaluated after 12 months the association of singlestep techniques by mixing the two solutions (CHX and absolute ethanol) using a etchand-rinse 2-step adhesive system. The results showed that the mixture of solutions applied in a single step was not able to preserve the adhesive interface after the period evaluated, in addition to presenting the worst results when compared to the other techniques tested, with a reduction of RU values of 55.65 %, thus not being an option to improve the longevity of adhesive interfaces. / A busca por restaurações adesivas que tenham maior durabilidade na cavidade bucal é constante. O grande desafio da adesão é a união da resina à dentina, pois este substrato apresenta maior quantidade de água na sua composição, comprometendo o processo adesivo. Dois grandes problemas relacionados à degradação da interface adesiva resinadentina ao longo do tempo são conhecidos: a degradação hidrolítica, ocasionada pelos efeitos deletérios da água inerente ao dente e ao material adesivo; e a degradação enzimática, ocasionada pelas enzimas proteolíticas, em especial as metaloproneinases (MMP’s) presentes na estrutura dentinária e ativadas após o condicionamento ácido. Várias propostas têm sido testadas para minimizar esses problemas e melhorar a estabilidade da interface resina-dentina. No presente trabalho, foi dado enfoque para duas delas: a aplicação de clorexidina a 2% (CHX) e a técnica da adesão úmida por etanol (TAUE). O objetivo principal foi avaliar in vitro os efeitos da associação dessas duas técnicas nos valores de resistência de união (RU) à dentina após 24h, 6 meses e 12 meses de armazenamento em água por meio de testes de microtração. Foram utilizadas duas formas de associação: a primeira aplicando as técnicas em passos separados, sendo a CHX aplicada previamente à TAUE; e a segunda por meio de uma solução experimental manipulada em laboratório farmacêutico, composta por CHX 2% diluída em solução de etanol absoluto e aplicada de uma única vez na dentina desmineralizada. A tese foi dividida em dois capítulos que avaliam in vitro essas técnicas. O primeiro capítulo avaliou após 6 meses a associação das técnicas em passos separados em dois tipos de sistemas adesivos (convencional de 3 passos e de 2 passos, respectivamente). Concluiu-se que a associação foi capaz de preservar a interface adesiva após o período avaliado somente quando se utilizou o sistema adesivo de 2 passos, apresentando valores de RU estatisticamente superiores ao grupo controle desse mesmo adesivo. O segundo capítulo avaliou após 12 meses a associação das técnicas em passo único por meio da mistura das duas soluções (CHX e etanol absoluto), utilizando um sistema adesivo convencional de 2 passos. Os resultados mostraram que a mistura das soluções aplicadas em único passo não foi capaz de preservar a interface de união após o período avaliado, além de ter apresentado os piores resultados quando comparada às demais técnicas testadas, com redução dos valores de RU de 55,65%, não sendo, dessa forma, uma opção para melhorar a longevidade das interfaces adesivas.

Magister Chirurgiae Dentium (MChD) / Chlorhexidine has been established as the gold standard against which new chemical plaque control agents are tested (Jones, 1997). The addition of alcohol in a chlorhexidine mouthwash had been widely used, however the comparative efficacy of alcohol free chlorhexidine mouthwash had not fully been explored in this study, two chlorhexidine mouthwash preparations were tested to evaluate their comparative efficacy in the treatment of periodontal disease. Aims: To assess the efficacy of alcohol-free chlorhexidine mouth wash in comparison to alcohol containing chlorhexidine mouth wash. Objectives: To determine pre- and post- operative clinical parameters and microbial load in the management of patients with chronic periodontitis. Methodology: A double blinded randomised control trial was conducted. Patients diagnosed with active chronic periodontitis were included in the study and randomised to either a test (chlorhexidine without alcohol) or control group (chlorhexidine with alcohol). A total of 50 patients were selected for the study. Results: The Wilcoxon Signed Rank test was used to test the difference between the pre-post pair per clinical indicator and Bana-Zyme. The differences between before and after treatment per indicator were significant at P<0.001 for respectively Paroex and Peridex. These values demonstrated the difference between the clinical parameters taken before the treatment and six weeks post treatment. Conclusion: Both mouth wash solutions with and without alcohol had proven to reduce the microbial load as shown by the BANA-Zyme test, with the alcohol containing solution having been more effective.

Postoperative surgical site infections are common complications in the operating room. Infections prolong hospital stays, heighten costs, and increase morbidity and mortality. The purpose of this evidence-based quality improvement project was to develop policy, program, and practice guidelines to prevent surgical site infections in vascular surgery patients. Rosswurm and Larrabee's change model was used to develop materials using the best evidence for the recommended practice changes. The Plan, Do, Check, Act model was selected to guide quality improvement. The project goal was to decrease the surgical site infection rate to below the national average. Products of the project include policy, protocol, and practice guidelines developed based on recommended practices of the Association of periOperative Registered Nurses and current peer-reviewed literature. An interdisciplinary project team of institutional stakeholders was used to insure context-relevant operationalization of the evidence in practice. The team was assembled, led in a review of relevant literature, and convened regularly until project products were finished. Three scholars with expertise in the content area were then identified by the project team and asked to validate the content of developed products. Products were revised according to expert feedback. Implementation and evaluation plans were developed by the project team to provide the institution with all necessary process details to carry out the practice change. The evaluation plan advises using a retrospective chart review to compare rates of infection between patients receiving chlorhexidine skin preparation with showers and preoperative chlorhexidine cloths alone. A positive outcome could contribute to positive social change by decreasing preventable infections.

In response to improving quality patient care, combined with the growing rates of surgical site infections (SSIs) in vascular patients, the need to explore current practice trends with current evidence has been identified. SSIs affect quality patient care and compromise patient safety. Empirical evidence has recommended the use of a chlorhexidine wash preoperatively to reduce SSIs. Despite this recommended practice, vascular patients were not receiving it in their routine plan of care within a hospital organization in southern Ontario. Guided by Lewin's theory of planned change, this project explored how the planning of a chlorhexidine preoperative surgical skin preparation protocol impacted progress toward improved care of vascular patients. The project was designed as a quality improvement project examining approximately 110 vascular surgical procedures over a 1-month period and staff surveys that were provided to staff in the preoperative (n = 88), same day surgery (n = 68), and inpatient (n = 47) units. These data were analyzed and demonstrated a reduction in vascular SSIs from 4.9% pre-implementation to 2.8% 1-month post-implementation. Major themes generated from the staff surveys demonstrated the nursing staff had a good understanding of the content that was presented in the in-service provided. These findings have implications for social change by highlighting the benefits of incorporating evidence in to practice and further informing the preoperative practice in other surgical specialties.

published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Thesis (M.D.S.)--University of Adelaide, Dental School, 2000. / Includes bibliographical references (leaves 127-141).

Thesis (doctoral)--Göteborg University, 1994. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Thesis (M.S.)--University of Wisconsin--Madison, 1981. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 45-49).

Thesis (doctoral)--Göteborg University, 1994. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Orientador: Osmir Batista de Oliveira Junior / Banca: Andréa Abi Rached Dantas / Banca: Sérgio Salvador / Resumo: O objetivo deste estudo foi avaliar comparativamente o efeito do bochecho diário com solução de digluconato de clorexidina à 0,12% (TA - controle) em relação à solução de 0,03% de triclosan, 1% copolímero (Gantrez® ) e 0,05% de fluoreto de Sódio (TB - teste) em função da taxa de formação de placa dentária, retenção do antimicrobiano na placa dentária e saliva e redução de estreptococos do grupo mutans na saliva. Material e Método: Participaram deste estudo clínico randomizado, cruzado, com duplo cegamento e dois períodos de tratamento, 26 voluntários de ambos os gêneros e idade entre 18 e 30 anos (média de 24 anos), divididos em 2 grupo: G1(n=13) e G2 (n=13). Em cada período de tratamento os participantes realizaram 2 bochechos diários de 60 segundos cada, um ao se levantar e outro doze horas após, por sete dias. Resultado: A redução do índice de placa foi muito semelhante em ambos os grupos, já a análise por cromatografia líquida de alta eficiência não evidenciou traços dos antimicrobianos após 12 horas do uso dos enxaguatórios por 1 e 7 dias na placa dentária nem na saliva. A ação antimicrobiana evidenciou efeito estatisticamente significativo para tratamento (antes e após bochecho) com agente antimicrobiano (clorexidina e triclosan). A clorexidina foi mais eficaz que o triclosan (22,8% e 8,9% de redução, respectivamente). Conclusão: 1) Tanto o triclosan quanto a clorexidina, mostraram-se eficazes na redução da placa dentária dos voluntários. 2) Nenhum dos antimicrobianos permanecem na cavidade bucal após 12 horas do uso. 3) O uso de enxaguatórios bucais com clorexidina e triclosan, complementa o controle mecânico da placa dentária por sua eficaz ação antimicrobiana sobre os estreptococos do grupo mutans, reduzindo o risco de cárie dos pacientes. / Abstract: The aim of this study was to comparatively evaluate the effect of daily rinsing with a solution of chlorhexidine digluconate 0,12% (TA- control) with the solution 0,03% triclosan + 1% copolymer (Gantrez ® ) + sodium fluoride 0,05% (TB- test) according of the rate of dental plaque formation, retention of antimicrobial agent in dental plaque and saliva by high performance liquid chromatography and reduction on mutans streptococci in saliva .Material and Method: In this randomized clinical study, crossover, double blinding with two treatment periods, 26 volunteers of both genders with between 18-30 years ( average 24 years), was divide into 2 groups: G1 (n=13) and G2 (n=13). In each treatment period the volunteers realized two daily mouthwashes of 60 seconds each, the first to get up and other twelve hours later, for 7 days. Results: The reduction of rate of dental plaque formation was same in bouth groups; high performance liquid chromatography analysis wasn't show trace of antimicrobial after 12 hours use of mouthwashes by 1 or 7 days in dental plaque or in saliva .The antimicrobial action showed statistically significant effect for treatment (before and after rinsing) with antimicrobial agent (chlorhexidine x triclosan). The chlorexidine digluconate was more effective than triclosan (22,8% and 8,9 decrease, respectively). Conclusion: 1) As far as triclosan, chlorhexidine, were effective in reducing dental plaque volunteers. 2) None of the antimicrobial agents remain in the oral cavity after 12 hours of use. 3) The use of mouthwashes containing chlorhexidine and triclosan, complements the mechanical control of dental plaque for their effective antimicrobial action on mutans streptococci, reducing caries risk patients. / Mestre