Master of Science in Dentistry / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

Master of Science in Dentistry / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

Thesis (M.S.D.)--Indiana University School of Dentistry, 2010. / Title from PDF t. p. (viewed July 28, 2010) Advisor(s): Mychel Vail, Chair of the Research Committee, Joseph Legan, B. Keith Moore, Kenneth Spolnik, Susan Zunt. Curriculum vitae. Includes abstract. Includes bibliographical references (leaves 93-109).

Submitted by Carla Teixeira Leite (carlateixeiraleite@hotmail.com) on 2018-11-20T12:57:24Z No. of bitstreams: 1 Tese_Carla_Teixeira_Leite.pdf 20:11:18.pdf: 1855862 bytes, checksum: fe5c4f3bdef84bfad158f4a2a2c01a4c (MD5) / Approved for entry into archive by Neli Silvia Pereira null (nelisps@fcav.unesp.br) on 2018-11-20T13:32:57Z (GMT) No. of bitstreams: 1 leite_ct_dr_jabo.pdf: 1855862 bytes, checksum: fe5c4f3bdef84bfad158f4a2a2c01a4c (MD5) / Made available in DSpace on 2018-11-20T13:32:57Z (GMT). No. of bitstreams: 1 leite_ct_dr_jabo.pdf: 1855862 bytes, checksum: fe5c4f3bdef84bfad158f4a2a2c01a4c (MD5) Previous issue date: 2018-08-03 / A doença periodontal (DP) é definida como conjunto de condições inflamatórias de origem bacteriana, a qual acomete cavalos de todas as idades, principalmente geriátricos. Possui correlação com perda prematura dos dentes, sialorreia, dor, disfagia e emagrecimento progressivo. Na maioria dos casos é secundária à má oclusão, desgaste dental irregular, biomecânica mastigatória descompensada, o que predispõe a compactação de alimentos nos espaços interproximais e colonização bacteriana. Com a evolução da afecção, ocorre comprometimento dos ligamentos periodontais causando mobilidade dental. O diagnóstico da DP em equinos pode ser dificultoso principalmente em relação à região caudal da cavidade oral. Por essa razão, o incremento da endoscopia intraoral, ao exame clínico tradicional permite, além da identificação e diagnóstico fidedigno, a documentação das lesões dentais e periodontais. O exame complementar radiológico possui finalidade de localização, caracterização e graduação da DP. A terapia medicamentosa de eleição na profilaxia e tratamento das afecções orais é a Clorexidina. Adicionalmente, o metronidazol é citado como antimicrobiano em potencial na DP. No intuito de incrementar o tratamento da doença periodontal equina, a aplicação de plasma enriquecido com plaquetas intralesional, surge como opção inovadora e com resultados promissores para a área da odontologia equina. Assim, objetivou-se avaliar a evolução de diferentes tratamentos a base de clorexidina, metronidazol e plasma rico em plaquetas, para a doença periodontal em pré-molares e molares de equinos adultos. Foram utilizados cinquenta e um equinos adultos, machos castrados e fêmeas não prenhes, com idade média de 16 anos e com diagnóstico prévio de doença periodontal. O experimento foi realizado nas dependências do Hospital Veterinário da Universidade Federal do Pampa, Câmpus Uruguaiana/RS e no Círculo Militar de Uruguaiana, Uruguaiana/RS. A partir dos resultados obtidos, pode-se concluir que não foi possível evidenciar efetividade com aplicação única de clorexidina 0,2% tópica. Entretanto, é importante ressaltar a melhora clínica dos pacientes devido aos procedimentos de curetagem e debridamento. Quanto à utilização de metronidazol, a aplicação única de 200 mg tópico também não foi benéfica no tratamento da DP. Entretanto, é importante frisar a necessidade de estudos complementares utilizando os fármacos com uma frequência maior. Por outro lado, a aplicação intralesional do plasma enriquecido com plaquetas em associação ao tratamento de curetagem da bolsa periodontal, demonstrou efetividade clínica, evidenciando uma inovação promissora no tratamento da DP equina. / Periodontal disease (PD) is defined as a set of inflammatory conditions of bacterial origin, which affects horses of all ages, mainly geriatric. It has a correlation with premature tooth loss, sialorrhea, pain, dysphagia and progressive weight loss. In most cases it is secondary to malocclusion, irregular dental wear, decompensated masticatory biomechanics, which predisposes to food compaction in interproximal spaces and bacterial colonization. With evolution of affection, periodontal ligaments compromise causing dental mobility. The diagnosis of PD in horses can be difficult mainly in relation to caudal region of oral cavity. For this reason, increment of intraoral oral endoscopy, in traditional clinical examination allows, besides identification and reliable diagnosis, documentation of dental and periodontal lesions. Complementary radiological examination has the purpose of locating, characterizing and graduating PD. Drug therapy of choice in prophylaxis and treatment of oral disorders is chlorhexidine. In addition, metronidazole is cited as potential antimicrobial in PD. In order to increase treatment of equine periodontal disease, application of intralesional platelet-enriched plasma appears as an innovative option with promising results for equine dentistry. Thus, the present study aimed to evaluate the evolution of different treatments for periodontal disease in premolars and molars of adult horses. Fifty-one adult horses, castrated males and non-pregnant females, with a mean age of 16 years, with prior diagnosis of periodontal disease, were used. The experiment was carried out at Veterinary Hospital of Federal University of Pampa, Campus Uruguaiana/RS and at Military Circle of Uruguaiana, Uruguaiana/RS. From the results obtained, it can be concluded that in present study it was not possible to show effectiveness with a single application of 0.2% topical chlorhexidine. However, it is important to highlight the clinical improvement of patients due to curettage and debridement procedures. Regarding the use of metronidazole, the single application of topical 200 mg was also not beneficial in treatment of PD. However, it is important to stress the need for further studies using drugs with a higher frequency. On the other hand, intralesional application of platelet-enriched plasma in association with curettage of periodontal pocket demonstrated clinical effectiveness, evidencing a promising innovation in treatment of equine PD.

No / Larval biotherapy is a debridement tool used in wound management. The mechanism of action involves degradation of eschar by serine proteases including chymotrypsin within the alimentary fluids of first instar Lucilia sericata. With the rationale of obviating some limitations of biotherapy, including cost, complexity of use, and patient reticence, the present study describes a mobile hydrogel formulation containing freeze-dried recombinant L. sericata chymotrypsin designed for topical application. Neither freeze-drying nor formulation into the hydrogel significantly attenuated the measured activity of released enzyme compared to fresh-frozen enzyme in aqueous solution. Gel electrophoresis confirmed qualitatively that the chymotrypsin/hydrogel formulation both with and without supplementary urea at 10% w/v degraded human chronic wound eschar ex vivo. Mindful that the hallmark of intractability of chronic wounds is aberrant biochemistry, the pH activity profile for the enzyme/hydrogel formulation was compared with exudate pH in chronic wounds of mixed aetiology in a cohort of 48 hospital in-patients. Five patients' wounds were acidic, however, the remainder were predominantly alkaline and coincided with the pH optimum for the insect enzyme. Thus, a recombinant L. sericata chymotrypsin and hydrogel formulation could represent a pragmatic alternative to larval therapy for the management of chronic wounds.

Introduction: (Experimental part). Hypothesis evaluates the quasi-static risk of transpedicular fixation failure in the spinal cadaver with anterior column defect due to the fixation extension and defines the risk of transpedicular fixation failure due to screw convergence in cyclic loading. (Clinical part). Hypothesis evaluates the risk of isolated dorsal approach to ventral lumbar spondylodiscitis due to clinic and radiopraphic results and the risk of anterior radical debridement due to using titanium implant in the site of bone infection. Methods: (Experimental part). Four anatomically preparated spinal cadavers with anterior spinal column defect transpediculary instrumented were quasi-statically tested on MTS 858,2 Mini-Bionix. Concept of cyclic loading part were based on ASTM standard F1717. (Clinical part). The group A consisting of 23 patients was treated only by dorsal transmuscular approach and the second group B consisting of 8 patients was treated by two-stage postero- anterior surgery in lumbar spondylodiscitis. Results: (Experimental part). There were progress in all assessed parametres with considerable asymmetry direction in extension to flexion and duction in spinal column loading with anterior defect during quasi-static loading. The rod deformation decrease with extent of...

Introduction: (Experimental part). Hypothesis evaluates the quasi-static risk of transpedicular fixation failure in the spinal cadaver with anterior column defect due to the fixation extension and defines the risk of transpedicular fixation failure due to screw convergence in cyclic loading. (Clinical part). Hypothesis evaluates the risk of isolated dorsal approach to ventral lumbar spondylodiscitis due to clinic and radiopraphic results and the risk of anterior radical debridement due to using titanium implant in the site of bone infection. Methods: (Experimental part). Four anatomically preparated spinal cadavers with anterior spinal column defect transpediculary instrumented were quasi-statically tested on MTS 858,2 Mini-Bionix. Concept of cyclic loading part were based on ASTM standard F1717. (Clinical part). The group A consisting of 23 patients was treated only by dorsal transmuscular approach and the second group B consisting of 8 patients was treated by two-stage postero- anterior surgery in lumbar spondylodiscitis. Results: (Experimental part). There were progress in all assessed parametres with considerable asymmetry direction in extension to flexion and duction in spinal column loading with anterior defect during quasi-static loading. The rod deformation decrease with extent of...

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to evaluate and compare the debridement efficacy of the EndoActivator (Dentsply Tulsa Dental, Tulsa, OK) versus the Ultrasonic Bypass system (Vista Dental) following hand-rotary instrumentation in anterior teeth. Sixty extracted human, maxillary anterior teeth were randomly assigned to three groups. Teeth were instrumented using (ISO k-flex) hand files and EndoSequence nickel-titanium rotary files (Brasseler, Savannah, GA) to a size 40/.06 taper. Group 1 served as the control group and had no additional treatment performed. Groups 2 and 3 were subjected to a final irrigating regimen that consisted of 6-percent sodium hypochlorite for a 1- minute duration. For group 2 the irrigation solution was activated for 1 minute using the EndoActivator system (DENTSPLY). For group 3, the irrigation solution was activated for 1 minute using the Ultrasonic Bypass System (Vista Dental). The teeth were then sectioned longitudinally and each half was divided into three equal parts 3 mm from the anatomic apex. The sample with the most visibly identifiable section of the apex was used for SEM evaluation. A scoring system to measure the efficacy of debris removal was utilized to quantify the results. Statistical analysis was performed using the Kruskal- Wallis test. If the overall test is significant, a Wilcoxon Rank Sum tests was used to compare each pair of groups. The results of this study indicate that both the EndoActivator and Ultrasonic Bypass groups had a smaller percentage of canal space occupied by smear layer and debris when compared with the control group at all three levels. This difference was statistically significant for the Ultrasonic Bypass System when compared with the control at both the coronal and middle thirds of the samples evaluated. This difference was not statistically significant in the apical third. When compared with the EndoActivator, the Ultrasonic Bypass System produced cleaner canals in the coronal and middle thirds, with the difference being statistically significant in the middle third only. These results of this research support the use of either of these two devices when compared with the controls. Smear layer removal and debridement efficacy was greatly increased when using either sonic or ultrasonic activation of sodium hypochlorite. More research is warranted concerning these two devices. Examining the antimicrobial efficacy with the use of these two devices could lend additional validation to their use in non-surgical endodontic therapy.

INTRODUÇÃO: A clonidina é um agonista seletivo do receptor adrenérgico alfa2 com propriedades sedativas, analgésicas e possibilita a redução do consumo de outros anestésicos. Suas ações podem mitigar o impacto hemodinâmico e psíquico da S+ Cetamina. Os grandes queimados são de difícil manejo e ainda não existe uma técnica anestésica padrão para estes pacientes, sendo a cetamina amplamente utilizada nestes pacientes em regimes muito variados, apresentando várias vantagens. Os objetivos do estudo foram avaliar os efeitos hemodinâmicos e psíquicos da interação da clonidina e da S+ cetamina e propor uma técnica anestésica para grandes queimados. MÉTODOS: O estudo foi prospectivo, duplo encoberto, aleatório e placebo controlado, planejado para 48 pacientes adultos grandes queimados, estado físico ASA II ou III, que foram agendados para trocas de curativos ou debridamentos cirúrgicos. Para a anestesia foi usado midazolam 0,07mg/kg e duas doses de 1 mg/kg de S+ cetamina. No Grupo Clonidina foi usada a dose de 2 mcg/kg e soro fisiológico no Grupo Placebo. Foram avaliadas as alterações hemodinâmicas durante o intra-operatório. Durante as duas primeiras horas foram avaliadas detalhadamente as alterações psíquicas utilizando 13 variáveis, o retorno da consciência, a analgesia e a ocorrência de complicações. Após 24 horas foram avaliadas a analgesia, a ocorrência de sonhos e delírios. RESULTADOS: O Grupo Clonidina apresentou redução estatisticamente significativa nas pressões arteriais durante o procedimento. Dentre as 13 variáveis psíquicas analisadas, 5 foram menores com significância estatística no Grupo Clonidina durante a avaliação de 30 minutos, incluindo Corpo, Arredores, Pensamento, Sonolento e Ansioso. Na avaliação de duas horas, apenas a variável Ansioso teve redução estatisticamente significativa no Grupo Clonidina. A frequência cardíaca, a ocorrência de delírio e sonhos e a analgesia pós-operatória foram similares nos dois grupos. Não houve diferença entre os grupos na ocorrência de complicações. CONCLUSÃO: O uso de Clonidina em anestesia para pacientes grandes queimados, com S+ cetamina e midazolam reduz as pressões arteriais durante o procedimento e os efeitos psíquicos, sem aumentar a ocorrência de complicações / Abstract: Clonidine is a selective alpha2-adrenoceptor agonist with sedative, analgesic and anesthetic sparing properties. Because of its sympathoinhibitory activity, it may reduce the hemodynamic and psychic effects of S+ ketamine and improve analgesia. The ketamine is commonly used in burned patients worldwide. The objectives of this study were to evaluate the interactions between clonidine and ketamine in hemodynamic and psychic effects and also to propose an anesthetic technique for major burned patients. Method: A prospective, double-blind, placebo controlled study designed for 48 patients with major burns, aged 18-60 years, physical status ASA II or III, that were scheduled for dressing changes and wound debridements. For the anesthesia was used midazolam 0,07mg/kg, two doses of S+ ketamine 1 mg/kg, placebo or clonidine 2mcg/kg. Intraoperative hemodynamic alterations over time were assessed. During the first two hours after the procedures were evaluated, psychic effects in detail using 13 variables, the return of conscience, analgesia, dreaming and delirium and after 24 hours, analgesia, dreaming and delirium. Results: The Clonidine Group had low arterial pressure during the procedure. At the 30 minute evaluation of the psychic variables 5 out of 13 were lower in the Clonidine Group with statistically significance, these being Body, Surroundings, Thoughts, Drowsy and Anxious. At the 2 hour evaluation only the Anxious variable was lower in the Clonidine Group with statistically significance. Cardiac frequency, postoperative analgesia, occurrence of delirium and dreaming weren\'t different between both groups. There wasn\'t any difference in complication rates between both groups. Conclusion: We concluded that the use of Clonidine in S+ ketamine plus midazolam anesthesia in patients with major burns reduces the arterial pressures and the postoperative psychic effects, without increasing the complications

INTRODUÇÃO: A clonidina é um agonista seletivo do receptor adrenérgico alfa2 com propriedades sedativas, analgésicas e possibilita a redução do consumo de outros anestésicos. Suas ações podem mitigar o impacto hemodinâmico e psíquico da S+ Cetamina. Os grandes queimados são de difícil manejo e ainda não existe uma técnica anestésica padrão para estes pacientes, sendo a cetamina amplamente utilizada nestes pacientes em regimes muito variados, apresentando várias vantagens. Os objetivos do estudo foram avaliar os efeitos hemodinâmicos e psíquicos da interação da clonidina e da S+ cetamina e propor uma técnica anestésica para grandes queimados. MÉTODOS: O estudo foi prospectivo, duplo encoberto, aleatório e placebo controlado, planejado para 48 pacientes adultos grandes queimados, estado físico ASA II ou III, que foram agendados para trocas de curativos ou debridamentos cirúrgicos. Para a anestesia foi usado midazolam 0,07mg/kg e duas doses de 1 mg/kg de S+ cetamina. No Grupo Clonidina foi usada a dose de 2 mcg/kg e soro fisiológico no Grupo Placebo. Foram avaliadas as alterações hemodinâmicas durante o intra-operatório. Durante as duas primeiras horas foram avaliadas detalhadamente as alterações psíquicas utilizando 13 variáveis, o retorno da consciência, a analgesia e a ocorrência de complicações. Após 24 horas foram avaliadas a analgesia, a ocorrência de sonhos e delírios. RESULTADOS: O Grupo Clonidina apresentou redução estatisticamente significativa nas pressões arteriais durante o procedimento. Dentre as 13 variáveis psíquicas analisadas, 5 foram menores com significância estatística no Grupo Clonidina durante a avaliação de 30 minutos, incluindo Corpo, Arredores, Pensamento, Sonolento e Ansioso. Na avaliação de duas horas, apenas a variável Ansioso teve redução estatisticamente significativa no Grupo Clonidina. A frequência cardíaca, a ocorrência de delírio e sonhos e a analgesia pós-operatória foram similares nos dois grupos. Não houve diferença entre os grupos na ocorrência de complicações. CONCLUSÃO: O uso de Clonidina em anestesia para pacientes grandes queimados, com S+ cetamina e midazolam reduz as pressões arteriais durante o procedimento e os efeitos psíquicos, sem aumentar a ocorrência de complicações / Abstract: Clonidine is a selective alpha2-adrenoceptor agonist with sedative, analgesic and anesthetic sparing properties. Because of its sympathoinhibitory activity, it may reduce the hemodynamic and psychic effects of S+ ketamine and improve analgesia. The ketamine is commonly used in burned patients worldwide. The objectives of this study were to evaluate the interactions between clonidine and ketamine in hemodynamic and psychic effects and also to propose an anesthetic technique for major burned patients. Method: A prospective, double-blind, placebo controlled study designed for 48 patients with major burns, aged 18-60 years, physical status ASA II or III, that were scheduled for dressing changes and wound debridements. For the anesthesia was used midazolam 0,07mg/kg, two doses of S+ ketamine 1 mg/kg, placebo or clonidine 2mcg/kg. Intraoperative hemodynamic alterations over time were assessed. During the first two hours after the procedures were evaluated, psychic effects in detail using 13 variables, the return of conscience, analgesia, dreaming and delirium and after 24 hours, analgesia, dreaming and delirium. Results: The Clonidine Group had low arterial pressure during the procedure. At the 30 minute evaluation of the psychic variables 5 out of 13 were lower in the Clonidine Group with statistically significance, these being Body, Surroundings, Thoughts, Drowsy and Anxious. At the 2 hour evaluation only the Anxious variable was lower in the Clonidine Group with statistically significance. Cardiac frequency, postoperative analgesia, occurrence of delirium and dreaming weren\'t different between both groups. There wasn\'t any difference in complication rates between both groups. Conclusion: We concluded that the use of Clonidine in S+ ketamine plus midazolam anesthesia in patients with major burns reduces the arterial pressures and the postoperative psychic effects, without increasing the complications