Virtual surgery planning systems have demonstrated great potential to help surgeons achieve a better functional and aesthetic outcome for the patient, and at the same time reduce time in the operating room resulting in considerable cost savings. However, the two-dimensional tools employed in these systems today, such as a mouse and a conventional graphical display, are difficult to use for interaction with three-dimensional anatomical images. Therefore surgeons often outsource virtual planning which increases cost and lead time to surgery. Haptics relates to the sense of touch and haptic technology encompasses algorithms, software, and hardware designed to engage the sense of touch. To demonstrate how haptic technology in combination with stereo visualization can make cranio-maxillofacial surgery planning more efficient and easier to use, we describe our haptics-assisted surgery planning (HASP) system. HASP supports in-house virtual planning of reconstructions in complex trauma cases, and reconstructions with a fibula osteocutaneous free flap including bone, vessels, and soft-tissue in oncology cases. An integrated stable six degrees-of-freedom haptic attraction force model, snap-to-fit, supports semi-automatic alignment of virtual bone fragments in trauma cases. HASP has potential beyond this thesis as a teaching tool and also as a development platform for future research. In addition to HASP, we describe a surgical bone saw simulator with a novel hybrid haptic interface that combines kinesthetic and vibrotactile feedback to display both low frequency contact forces and realistic high frequency vibrations when a virtual saw blade comes in contact with a virtual bone model.  We also show that visuo-haptic co-location shortens the completion time, but does not improve the accuracy, in interaction tasks performed on two different visuo-haptic displays: one based on a holographic optical element and one based on a half-transparent mirror.  Finally, we describe two prototype hand-worn haptic interfaces that potentially may expand the interaction capabilities of the HASP system. In particular we evaluate two different types of piezo-electric motors, one walking quasi-static motor and one traveling-wave ultrasonic motor for actuating the interfaces.

Darbe nagrinėjamas kompleksinės pagalbos vaikams su įgimtais lūpos ir / ar gomurio nesuaugimais vertinimas tėvų požiūriu. Atlikta teorinė vaikų, turinčių įgimtą lūpos, alveolinės ataugos, gomurio nesuaugimus pagrindinių aspektų analizė. Tyrimo tikslas - ištirti tėvų požiūrį apie medicininės ir logopedinės pagalbos teikimą vaikams, turintiems įgimtų lūpos, alveolinės ataugos ir/ar gomurio nesuaugimų. Darbe aprašytos kompleksinės pagalbos vaikams su įgimtais lūpos ir / ar gomurio nesuaugimais strategijos, išnagrinėti logopedinės pagalbos ypatumai dirbant su tokiais vaikais. Panaudotas anketinės apklausos metodas, interviu ir atlikta statistinė duomenų analizė. Tyrime dalyvavo 105 tėvai, auginantys vaikus su įgimtais lūpos ir / ar gomurio nesuaugimais: 97 šeimos dalyvavo anketinėje apklausoje ir 8 – interviu. Svarbiausios empirinio tyrimo išvados: 1. Vaikams, turintiems lūpos, alveolinės ataugos ir gomurio nesuaugimų, reikalinga kompleksinė įvairių sričių specialistų pagalba. Tokiems vaikams pagalba teikiama iki 18 m. amžiaus. Visame šiame procese labai svarbu komandinis specialistų darbas ir aktyvus bendradarbiavimas su vaiko šeima. 2. Tėvų, auginančių vaikus su įgimtais lūpos, alveolinės ataugos ir/ar gomurio nesuaugimais, nuomonė apie teikiamą pagalbą jų vaikams yra skirtinga ir prieštaringa. Pagalbos suteikimo informacijos sklaida šeimoms, auginančioms vaikus su lūpos ir/ar gomurio nesuaugimais nėra tiek pakankama mažuose Lietuvos miesteliuose, kiek didžiuosiuose miestuose... [toliau žr. visą tekstą] / In this work, the approach to professional help for children with congenital cleft lip and / or palate was evaluated from the parents’ perspective. There was carried out the theoretical analysis of the main aspects related to children with congenital cleft lip, alveolus and palate. Aim of the study – to research parents’ opinion about the treatment and logopedic help support for children with congenital cleft lip, alveolus and palate. In the work, the strategies of professional help for children with congenital cleft lip and / or palate are described, and the peculiarities of logopedic help in work with such children are researched. It was used the method of questionnaire, interview, and it was performed the analysis of statistical data. In the study, there were involved 105 parents having children with congenital cleft lip and / or palate: 97 questionnaire respondents and 8 interview participants. The main conclusions of the empirical study: 1. For children with congenital cleft lip and / or palate, the complex course for rehabilitation of functions is applied until the age of 18 years. In order to achieve good results, the teamwork of surgeon, orthodontist, speech therapist with other specialists in cooperation together with children parents is useful. 2. The opinion of parents, having children with congenital cleft lip and / or palate, is different and contradictory in terms of the professional help for their children; it was revealed that there is a lack of information... [to full text]

Made available in DSpace on 2014-06-11T19:28:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-13Bitstream added on 2014-06-13T20:18:39Z : No. of bitstreams: 1 ribeiro_pp_me_araca.pdf: 1296460 bytes, checksum: 0aa88d770aee2b3e8787125e444deac4 (MD5) / O câncer da região de cabeça e pescoço é uma doença muito prevalente no Brasil, e as principais formas de tratamento são a cirurgia acompanhada ou não da radioterapia e quimioterapia. Perdas parciais ou totais de osso maxilar podem comprometer seriamente a fisiologia bucal causando sequelas como comunicações buconasosinosal. Neste caso, podese optar como forma de tratamento pela reabilitação protética com a aplicação de implantes osseointegrados. A literatura odontológica tem mostrado inúmeros trabalhos que avaliam a distribuição de forças com a finalidade de recolher melhores subsídios para o planejamento de próteses bucomaxilofaciais, que ainda é pouquíssimo explorada. Dentre os métodos utilizados, o da fotoelasticidade tem sido aceito, especialmente por permitir uma análise fiel da distribuição de forças. Assim, a proposta deste trabalho foi verificar a tendência de distribuição de forças e estresse, através do método fotoelástico, que incidem sobre diferentes tipos de sistemas de retenção em implantes (o’ring, barra clipe e o’ring/barra clipe) associado a próteses obturadoras palatinas implantoretidas e também em próteses obturadoras mucossuportadas (sem implante), utilizandose ou não de silicone com reembasamento direto (Sofreliner). O conjunto (prótese e modelo fotoelástico) foi posicionado em polariscópio circular e recebeu aplicação de carga de 100 N a velocidade de 10 mm/s no primeiro molar de cada prótese. Após as aplicações de carga houve a formação franjas correspondentes à tensão registrada. Então, as imagens foram transferidas para um computador e analisadas no programa ADOBE Photoshop. Ao se comparar os três sistemas de retenção das próteses obturadoras palatinas implantoretidas com a prótese mucossuportada (sem implantes), podese observar que as tensões foram distribuídas de forma mais homogênea... / The head and neck cancer is a very prevalent disease in Brazil and the main treatment is the surgery with or without radiation therapy and chemotherapy. Partial or total bone maxillary defects could involve seriously oral physiology causing consequences as buconasosinosal communications. In this case could be applied other option of treatment as prosthetic rehabilitation associated with osseointegrated implants. Scientific literature demonstrated countless studies that evaluate the force distribution with the aim to provide better subsidies for the planning of bucomaxillofacial prostheses, which still have few researches. Between the methodologies, the photoelastic method has been accepted; especially by allow an accurate analysis of the force distribution. Thus, the aim of this study was to verify the tendency of force distribution and the stress on different types of retention system (o’ring, clip bar and o’ring/clip bar) associated with palatal obturator prostheses with implant retention and conventional obturator prostheses (without implants), with or without silicone soft lining(Sofreliner), by means of photoelastic method. The set (prosthesis and photoelastic model) was located in circular polariscope and was applied a load of 100 load N at 10 mm/s on the first molar of each prostheses. After the load applications was registered the tension fringes. The images was transferred to a computer and analyzed at ADOBE Photoshop software. When compared the three retention systems of the palatal obturator prostheses and mucosupported prostheses (without implants), it can be observed that the stress was distributed more homogeneous and in lesser amount that the conventional prostheses, when compared to the other prostheses that presented implants and retention systems. With relation to stress distribution in the different retention systems, the bar clip... (Complete abstract click electronic access below)

Les techniques de chirurgie assistée par ordinateur suscitent depuis quelques années un vif intérêt, depuis l’aide au diagnostic jusqu’à l’intervention chirurgicale elle-même, en passant pas les prises de décision. Dans ce but, l’Analyse par Éléments Finis (AEF) du comportement de modèles biomécaniques tridimensionnels est une des méthodes numériques les plus utilisées et les plus efficaces. Cependant, la fiabilité des solutions de l’AEF dépend fortement de la qualité et de la finesse de la représentation des organes sous la forme de maillages d'éléments finis (MEF). Or la génération de tels maillages peut être extrêmement longue et exigeante en ressources computationnelles, car il est nécessaire de procéder à l’extraction précise de la géométrie de l’organe-cible à partir d’images médicales avant de recourir à des algorithmes sophistiqués de maillage. Confrontés à ces enjeux, certains travaux se sont attachés à éviter la procédure de maillage en exploitant des méthodes fondées pour chaque patient sur la déformation géométrique d’un maillage défini sur un sujet de référence, dit « Atlas ». Mais ces méthodes nécessitent toujours une description géométrique précise de l’organe-cible du patient, sous la forme de contours, de modèles surfaciques tridimensionnels ou d’un ensemble de points de référence. Dans ce contexte, le but de la thèse est de développer une méthodologie de conception automatique de maillages « patient-spécifiques », basée sur un Atlas, mais évitant cette étape de segmentation de la géométrie de l’organe-cible du patient. Dans une première partie de la thèse, nous proposons une méthode automatique qui, dans une première phase, procède au recalage volumétrique de l'image anatomique de l’Atlas sur celle du patient, afin d’extraire la transformation géométrique permettant de passer de l’Atlas au patient, puis, dans une seconde phase, déforme le maillage de l’Atlas et l’adapte au patient en lui appliquant cette transformation. Le processus de recalage est conçu de telle manière que la transformation géométrique préserve la régularité et la haute qualité du maillage. L’évaluation de notre méthode, à savoir l'exactitude du processus de recalage inter-sujets, s’est faite en deux étapes. Nous avons d’abord utilisé un ensemble d’images CT de la cage thoracique, en accès libre. Puis nous avons exploité des données IRM de la langue que nous avons recueillies pour deux sujets sains et deux patients souffrant de cancer de la langue, en condition pré- et post-opératoire.Dans une seconde partie, nous développons une nouvelle méthode, toujours basée sur un Atlas, qui exploite à la fois l'information fournie par les images anatomiques et celle relative à la disposition des fibres musculaires telles qu’elle est décrite par imagerie par résonance magnétique du tenseur de diffusion (RM-DT). Cette nouvelle démarche s’appuie ainsi, d’abord sur le recalage anatomique proposé dans notre première méthode, puis sur l’identification et le recalage d’un ensemble de faisceaux de fibres musculaires qui seront ensuite intégrés aux maillages « patient-spécifiques ». Contrairement aux techniques usuelles de recalage d’images RM-DT, qui impliquent pour chaque image la réorientation des tenseurs de diffusion soit au cours de l'estimation de la transformation géométrique, soit après celle-ci, notre technique ne nécessite pas cette réorientation et recale directement les faisceaux de fibres de l’Atlas sur ceux du patient. Notre démarche est très importante, car la détermination et l’identification précises de toutes les sous-structures musculaires nécessiteraient une intervention manuelle pour analyser des milliers, voire des millions, de fibres, qui sont grandement influencées par les limitations et aux distorsions inhérentes aux images RM-DT et aux techniques de tractographie des fibres. L’efficacité de notre méthodologie est démontrée par son évaluation sur un ensemble d’images IRM et RM-DT de la langue d’un sujet. / During the last years, there has been considerable interest in using computer-aided medical design, diagnosis, and decision-making techniques that are rapidly entering the treatment mainstreams. Finite Element Analysis (FEA) of 3D models is one of the most popular and efficient numerical methods that can be utilized for solving complex problems like deformation of soft tissues or orthopedic implant designs/configurations. However, the accuracy of solutions highly depends upon the quality and accuracy of designed Finite Element Meshes (FEMs). The generation of such high-quality subject/patient-specific meshes can be extremely time consuming and labor intensive as the process includes geometry extraction of the target organ and meshing algorithms. In clinical applications where the patient specifiity has to be taken into account via the generation of adapted meshes these problems become methodological bottlenecks. In this context, various studies have addressed these challenges by bypassing the meshing phase by employing atlas-based frameworks using the deformation of an atlas FE mesh. However, these methods still rely on the geometrical description of the target organ, such as contours, 3D surface models, or a set of land-marks.In this context, the aim of this thesis is to investigate how registration techniques can overcome these bottlenecks of atlas-based approaches.We first propose an automatic atlas-based method that includes the volumetric anatomical image registration and the morphing of an atlas FE mesh. The method extracts a 3D transformation by registering the atlas' volumetric image to the subject's one. The subject-specific mesh is then generated by deforming a high-quality atlas FE mesh using the derived transformation. The registration process is designed is such a way to preserve the regularity and the quality of meshes for subsequent FEAs. A first step towards the evaluation of our approach, namely the accuracy of the inter-subject registration process, is provided using a data set of CT ribcage. Then, subject-specific tongue meshes are generated for two healthy subjects and two patients suffering from tongue cancer, in pre- and post-surgery conditions. In order to illustrate a tentative fully automatic process compatible with the clinical constraints, some functional consequences of a tongue surgery are simulated for one of the patients, where the removal of the tumor and the replacement of the corresponding tissues with a passive flap are modeled. With the extraction of any formal priorknowledge on the shape of the target organ and any meshing algorithm, high-quality subject-specific FE meshes are generated while subject’s geometrical properties are successfully captured.Following this method, we develop an original atlas-based approach that employs the information provided by the anatomical images and diffusion tensor imaging (DTI) based muscle fibers for the recognition and registration of fiber-bundles that can be integrated in the subject-specific FE meshes. In contrast to the DT MR images registration techniques that include reorientation of tensors within or after the transformation estimation, our methodology avoids this issue and directly aligns fiber-bundles. This also enables one to handel limited or distorted DTIs by deformation of an atlas fibers’ structure according to the most reliable and non-distorted subject’s ones. Such a manner becomes very important, since the classification and the determination of muscular sub-structures need manual intervention of thousands or millions of fibers for each subject, which are influenced by the limitations associated with the DTI image acquisition process and fiber tractography techniques. To evaluate the performance of our method in the recognition of subject’s fiber-bundles and accordingly in the deformation of the atlas ones, a simulated data set is utilized. In addition, feasibility of our method is demonstrated on acquired human tongue data set.

Pacientes portadores de comunicação oronasal necessitam de dispositivo protético obturador, para o restabelecimento da sua função, estética e qualidade de vida perdida, devido à remoção ou ausência da maxila. Esta tecnologia reabilitadora vem se desenvolvendo há alguns séculos, com aprimoramentos das técnicas de confecção e materiais odontológicos que auxiliem na elaboração de obturadores cada vez mais eficientes, principalmente no que se refere a sua adaptação. Esta tecnologia é fortemente dependente tanto do domínio das técnicas laboratoriais, quanto de habilidades específicas na arte da reconstrução da face (manuais, sensitivas e tácitas), pois sua confecção é artesanal, personalizada e individualizada, determinando que a disponibilidade e distribuição dos recursos humanos qualificados para a sua elaboração constituam-se em obstáculo significativo para um acesso mais amplo e equânime. O trabalho em tela teve por objetivo examinar o estado da arte relativo às diferentes técnicas de moldagens e confecção das próteses obturadoras utilizadas no cuidado reabilitador de pacientes maxilarectomizados, buscando subsidiar proposições para o seu aprimoramento. Este estudo teórico-exploratório utilizou dois caminhos metodológicos complementares. O primeiro tomou por base uma revisão de literatura científica nacional e internacional e acadêmica, publicada sob a forma de artigos, teses e dissertações, utilizando as bases bibliográficas MEDLINE, BBO, LILACS, SCIELO, Biblioteca Virtual de Saúde e Colaboração Cochrane, e as bases de dissertações e teses da CAPES Banco de Teses; Base Thesis e Biblioteca Digital de Teses e Dissertações (BDTD), do Instituto Brasileiro de Informação em Ciência e Tecnologia (IBICT). O segundo caminho teve por foco a exploração de um dos principais limitadores ao acesso e utilização dos dispositivos obturadores do país a escassez de recursos humanos especializados buscando-se identificar os centros formadores de capacitação nesta área específica, a partir da Coordenação de Aperfeiçoamento de Pessoal Nível Superior (CAPES) do Ministério da Educação e do Conselho Federal de Odontologia, bem como o número de profissionais Protesistas Bucomaxilofaciais e Técnicos em Prótese Dentárias disponíveis em território Nacional para confecção dos obturadores, a partir de consulta ao Conselho Federal de Odontologia (CFO). Os resultados permitiram traçar um panorama histórico de desenvolvimento tecnológico destas próteses desde os primeiros dispositivos utilizando materiais da natureza. São apresentados e discutidos vários tipos de obturadores, bem como as diversas técnicas e materiais envolvidos, sendo também explorados seus benefícios para reabilitação, em particular os impactos na qualidade de vida associados ao seu uso, e alguns obstáculos técnicos a serem ultrapassados para melhoria da tecnologia reabilitadora. O exame do quantitativo e distribuição regional dos diversos profissionais envolvidos na sua confecção sinaliza uma grande escassez destes recursos humanos, bem como sua grande concentração na região Sudeste, em particular no eixo Rio - São Paulo. Além disto, o numero de centros formadores em termos técnicos de nível médio e de pós- graduação é insignificante e ainda vem ocorrendo à desativação de cursos, pela falta de procura. Esses dados apontam para significativas dificuldades no acesso a tecnologia, proveniente, sobretudo da falta e má distribuição regional de profissionais capacitados em prótese bucomaxilofacial em território nacional, dos escassos centros formadores de recursos humanos e do baixo incentivo ao ensino e pesquisa / Patients with oral-nasal connection due to the absence or extirpation of the maxilla need a prosthetic obturator for esthetical reasons, to restore function, and to partially regain the lost quality of life. This technology has evolved in the course of many centuries in conjunction with the improvement in manufacturing techniques and odontological materials that play a role in the elaboration and design of more efficient obturators, especially regarding their adaptation. This technology is exceedingly dependent on the mastery of laboratorial methods as well as specific skills in the art of facial reconstruction because its confection is artisanal, personalized, and customized. The existence and distribution of suitable human resources are an evident obstacle to the evenly access to this technology. The aim of this work was to scrutinize the state of the art regarding different moulding and manufacturing techniques of prosthetic obturators employed in the rehabilitation process of maxillectomized patients, intending to make a contribution for its improvement. This theoretical-exploratory study used two complementary methodological instruments. One was a broad review of the national and international scientific literature published as articles, doctoral thesis and dissertations, utilizing different bibliographical databases: MEDLINE, BBO, LILACS, SCIELO, Biblioteca Virtual de Saúde (Virtual Health Library), and The Cochrane Collaboration, as well as the doctoral thesis and dissertations included in the CAPES database - Base Thesis and Digital Library of thesis and dissertations, from the Brazilian Institute of Information in Science and Technology. The other methodological instrument focused on the investigation of the main reasons for the restricted access of patients to prosthetic obturators in our country the lack of expert human resources trying to identify the centers of excellence and development in this specific area using the Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior (CAPES) of the Ministry of Education and of the Federal Council of Odontology, as well as the number of dedicated technicians making bucomaxillofacial prosthesis and dental prosthesis in our national territory by consulting the Federal Council of Odontology. The results allowed the construction of a historical frame of the technological development of these prosthesis from the very first obturators manufactured with natural materials. Different types of obturators are presented and discussed, along with the many techniques and the various materials employed. Their specific benefits for the rehabilitation process are also discussed, in particular the impact in quality of life associated with its specific use. Obstacles to the further development and implementation of the rehabilitation technology are also examined. The availability and regional distribution of qualified personnel reveal a remarkable shortage of human resources and its overwhelming concentration to the Southeast region, particularly the Rio de Janeiro - São Paulo area. There are a negligible number of centers for preparing technicians and offering post graduation opportunities. Furthermore, there are centers being deactivated due to the lack of demand. This data demonstrates the striking difficulties in making this technology more evenly available throughout the national territory as a result of the lack of incentive for education and research

Made available in DSpace on 2014-06-11T19:25:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-08-22Bitstream added on 2014-06-13T19:11:58Z : No. of bitstreams: 1 franca_dcc_me_araca.pdf: 2609587 bytes, checksum: 8a7904cdb64c406b06f726af6ac60fbc (MD5) / Universidade Estadual Paulista (UNESP) / No presente estudo foram utilizados 60 ratos submetidos a implantes subcutâneos de quatro elastômeros de silicone, sendo três usados em prótese bucomaxilofacial, LIM 6050, MDX 4-4210 e Silastic 732 RTV industrial e um indicado para cirurgia plástica, o Silimed. O objetivo do estudo foi avaliar os materiais em relação à compatibilidade biológica tecidual, nos tempos pós-operatórios de sete, quinze e trinta dias, quando os animais foram sacrificados e as peças processadas e coradas pela hematoxilina e eosina para análise qualitativa e quantitativa dos espécimes. Pelo estudo histomorfométrico, oito áreas de 60,11 mm2 foram analisadas, contando-se as células mesenquimais, inflamatórias mononucleares, eosinófilos e as células gigantes do tipo corpo estranho. O experimento foi desenvolvido em dois capítulos, estudando-se separadamente os silicones de uso em prótese e o Silimed. No primeiro capítulo, a análise da biocompatibilidade dos implantes subcutâneos dos elastômeros de silicone LIM 6050, MDX 4-4210 e Silastic 732 RTV industrial, observou-se biocompatibilidade aceitável em todos eles, considerando-se o fato de que sua indicação protética dependeria em especial das características físicas próprias de cada material, pela mínima reação tecidual observada, além de que em sua forma sólida é fácil a adaptação aos tecidos. No segundo capítulo, o estudo se baseou na análise das reações referentes ao implante de silicone utilizado em cirurgia plástica (Silimed), constatando-se a presença de processo inflamatório ligeiramente maior no silicone gel em relação aos outros grupos, porém com níveis aceitáveis de biocompatibilidade, confirmada pela rara presença de células gigantes do tipo corpo estranho. Todos os dados foram submetidos à análise de variância e teste de Tukey, demonstrando que todos os materiais implantados iniciaram uma resposta... / In the present study 60 rats were submitted to subcutaneous implant of four elastomers of silicon, being three of use in bucomaxillofacial prosthesis, LIM 6050, MDX 4-4210 and Silastic 732 RTV industrial and a suitable one for plastic surgery, Silimed. The objective of the study was to evaluate the materials in relation to the tissue biological compatibility, in the postoperative times of seven, fifteen and thirty days, when the animals were sacrificed and the processed pieces and stained for the hematoxilin and eosin for qualitative and quantitative analysis of the specimens. For the histomorphometric study, eight areas of 60,11 mm2 were analyzed, being counted the mesenchimal cells, inflammatory cells, eosinophile and giant cells. The experiment was developed in two chapters, being studied the use silicons separately in prosthesis and Silimed. In the first chapter, the analysis of the biocompatibility of the subcutaneous implant of the elastomers of silicon LIM 6050, MDX 4-4210 and Silastic 732 RTV industrial, acceptable biocompatibility was observed in all of them, being considered the fact that your prosthetic indication would especially depend on the own physical characteristics of each material, for the low tissue reaction observed, in addition in your solid form it is easy the adaptation to the tissues. In the second chapter, the study based on the analysis of the referring reactions to the it implants of silicon used in plastic surgery (silimed), being verified the presence of inflammatory process lightly larger in relation to the other groups, however with acceptable levels of biocompatibility confirmed by the rare presence of giant cells of the type strange body. All the data were submitted to the variance analysis and test of Tukey, demonstrating that all the implanted materials began an acceptable tissue inflammatory reaction, with tissue reactions of light intensity the moderate... (Complete abstract, click electronic address below)

Made available in DSpace on 2014-06-11T19:35:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-27Bitstream added on 2014-06-13T19:44:51Z : No. of bitstreams: 1 santos_dm_dr_araca.pdf: 1533021 bytes, checksum: 248d1fb3f8ac9369529ebf0ea03f0654 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O presente estudo teve por objetivo avaliar a influência de dois pigmentos (pó de cerâmica e tinta a óleo) e um opacificador (sulfato de barium) sobre as propriedades físicas de estabilidade de cor, dureza, absorção e solubilidade do silicone facial MDX4-4210, submetido ao envelhecimento acelerado. Para a confecção das amostras, foram utilizadas 2 matrizes metálicas em alumínio, contendo em seu interior 10 compartimentos circulares com 45mm de diâmetro apresentando estes, em uma matriz, uma espessura de 2mm para os testes de estabilidade de cor e dureza e, na outra, 1mm para os ensaios de absorção e solubilidade. Foram confeccionadas 120 amostras, metade para os ensaios de análise cromática e dureza e, a outra metade, para o teste de absorção e solubilidade. As amostras destinadas para cada teste foram distribuídas em seis grupos, incolor (G1), incolor com opacificador (G2), cerâmica (G3), cerâmica com opacificador (G4), óleo (G5), óleo com opacificador (G6). Após a obtenção das amostras, a análise cromática inicial foi verificada por meio da análise visual e da espectrofotometria de reflexão. Os ensaios de dureza foram realizados com auxílio de um durômetro Shore A. Os testes de absorção e solubilidade foram realizados por meio de um dessecador no qual as amostras permaneceram neste ambiente em estufa à temperatura de 37±2°C, sendo pesadas diariamente até obtenção de massa constante (W1); posteriormente as amostras foram submetidas ao envelhecimento seguido de nova pesagem (W2), e nova dessecação com pesagem final (W3). As amostras foram submetidas ao envelhecimento acelerado por 1008 horas, sendo os ensaios realizados nos períodos correspondentes a 252, 504 e 1008 horas. Os dados obtidos foram submetidos à ANOVA e Tukey, com significância de 5%. Pode-se observar pela análise espectrofotométrica que os grupos com opacificador apresentaram melhor... / The aim of this study was to evaluate the influence of two pigments (ceramic powder and oil paint) and one opacifier (barium sulfate) on physical properties of color stability, hardness, absorption and solubility of the facial silicone MDX4-4210 submitted to artificial aging. The replicas were fabricated in two metallic matrixes in aluminum containing 10 circular compartments with 45mm in diameter. One matrix generated specimens with 2mm in thickness for color stability and hardness evaluations while the other matrix, specimens with 1mm in thickness for absorption and solubility tests. The replicas were divided into six groups: colorless (G1), colorless with opacifier (G2), ceramic (G3), ceramic with opacifier (G4), oil (G5) and oil with opacifier (G6). Initial chromatic evaluation was performed by visual analysis and reflection spectrophotometry. The hardness tests were carried out by a Shore A durometer. The evaluations of absorption and solubility were performed through a desiccator to maintain the replicas in a stove at 37±2°C. The specimens were weighed daily until obtaining a constant mass, (W1). Then, the replicas were submitted to aging followed by a new weighing (W2) and drying with final weighing (W3). The replicas were submitted to accelerated aging during 1008 hours with evaluation after 252, 504 and 1008 hours. Data were submitted to statistical analysis by ANOVA and Tukey’s test at 5% level of significance. According to spectrophotometry, the groups with opacifier presented statistically significant better chromatic stability than the other groups. The accelerated aging generated significant chromatic alterations in all groups, except for colorless and oil groups both with opacifier. There was no statistically significant difference among the groups after aging regarding hardness, absorption and solubility. According to the results, it may be concluded that... (Complete abstract, click electronic access below)

Pacientes portadores de comunicação oronasal necessitam de dispositivo protético obturador, para o restabelecimento da sua função, estética e qualidade de vida perdida, devido à remoção ou ausência da maxila. Esta tecnologia reabilitadora vem se desenvolvendo há alguns séculos, com aprimoramentos das técnicas de confecção e materiais odontológicos que auxiliem na elaboração de obturadores cada vez mais eficientes, principalmente no que se refere a sua adaptação. Esta tecnologia é fortemente dependente tanto do domínio das técnicas laboratoriais, quanto de habilidades específicas na arte da reconstrução da face (manuais, sensitivas e tácitas), pois sua confecção é artesanal, personalizada e individualizada, determinando que a disponibilidade e distribuição dos recursos humanos qualificados para a sua elaboração constituam-se em obstáculo significativo para um acesso mais amplo e equânime. O trabalho em tela teve por objetivo examinar o estado da arte relativo às diferentes técnicas de moldagens e confecção das próteses obturadoras utilizadas no cuidado reabilitador de pacientes maxilarectomizados, buscando subsidiar proposições para o seu aprimoramento. Este estudo teórico-exploratório utilizou dois caminhos metodológicos complementares. O primeiro tomou por base uma revisão de literatura científica nacional e internacional e acadêmica, publicada sob a forma de artigos, teses e dissertações, utilizando as bases bibliográficas MEDLINE, BBO, LILACS, SCIELO, Biblioteca Virtual de Saúde e Colaboração Cochrane, e as bases de dissertações e teses da CAPES Banco de Teses; Base Thesis e Biblioteca Digital de Teses e Dissertações (BDTD), do Instituto Brasileiro de Informação em Ciência e Tecnologia (IBICT). O segundo caminho teve por foco a exploração de um dos principais limitadores ao acesso e utilização dos dispositivos obturadores do país a escassez de recursos humanos especializados buscando-se identificar os centros formadores de capacitação nesta área específica, a partir da Coordenação de Aperfeiçoamento de Pessoal Nível Superior (CAPES) do Ministério da Educação e do Conselho Federal de Odontologia, bem como o número de profissionais Protesistas Bucomaxilofaciais e Técnicos em Prótese Dentárias disponíveis em território Nacional para confecção dos obturadores, a partir de consulta ao Conselho Federal de Odontologia (CFO). Os resultados permitiram traçar um panorama histórico de desenvolvimento tecnológico destas próteses desde os primeiros dispositivos utilizando materiais da natureza. São apresentados e discutidos vários tipos de obturadores, bem como as diversas técnicas e materiais envolvidos, sendo também explorados seus benefícios para reabilitação, em particular os impactos na qualidade de vida associados ao seu uso, e alguns obstáculos técnicos a serem ultrapassados para melhoria da tecnologia reabilitadora. O exame do quantitativo e distribuição regional dos diversos profissionais envolvidos na sua confecção sinaliza uma grande escassez destes recursos humanos, bem como sua grande concentração na região Sudeste, em particular no eixo Rio - São Paulo. Além disto, o numero de centros formadores em termos técnicos de nível médio e de pós- graduação é insignificante e ainda vem ocorrendo à desativação de cursos, pela falta de procura. Esses dados apontam para significativas dificuldades no acesso a tecnologia, proveniente, sobretudo da falta e má distribuição regional de profissionais capacitados em prótese bucomaxilofacial em território nacional, dos escassos centros formadores de recursos humanos e do baixo incentivo ao ensino e pesquisa / Patients with oral-nasal connection due to the absence or extirpation of the maxilla need a prosthetic obturator for esthetical reasons, to restore function, and to partially regain the lost quality of life. This technology has evolved in the course of many centuries in conjunction with the improvement in manufacturing techniques and odontological materials that play a role in the elaboration and design of more efficient obturators, especially regarding their adaptation. This technology is exceedingly dependent on the mastery of laboratorial methods as well as specific skills in the art of facial reconstruction because its confection is artisanal, personalized, and customized. The existence and distribution of suitable human resources are an evident obstacle to the evenly access to this technology. The aim of this work was to scrutinize the state of the art regarding different moulding and manufacturing techniques of prosthetic obturators employed in the rehabilitation process of maxillectomized patients, intending to make a contribution for its improvement. This theoretical-exploratory study used two complementary methodological instruments. One was a broad review of the national and international scientific literature published as articles, doctoral thesis and dissertations, utilizing different bibliographical databases: MEDLINE, BBO, LILACS, SCIELO, Biblioteca Virtual de Saúde (Virtual Health Library), and The Cochrane Collaboration, as well as the doctoral thesis and dissertations included in the CAPES database - Base Thesis and Digital Library of thesis and dissertations, from the Brazilian Institute of Information in Science and Technology. The other methodological instrument focused on the investigation of the main reasons for the restricted access of patients to prosthetic obturators in our country the lack of expert human resources trying to identify the centers of excellence and development in this specific area using the Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior (CAPES) of the Ministry of Education and of the Federal Council of Odontology, as well as the number of dedicated technicians making bucomaxillofacial prosthesis and dental prosthesis in our national territory by consulting the Federal Council of Odontology. The results allowed the construction of a historical frame of the technological development of these prosthesis from the very first obturators manufactured with natural materials. Different types of obturators are presented and discussed, along with the many techniques and the various materials employed. Their specific benefits for the rehabilitation process are also discussed, in particular the impact in quality of life associated with its specific use. Obstacles to the further development and implementation of the rehabilitation technology are also examined. The availability and regional distribution of qualified personnel reveal a remarkable shortage of human resources and its overwhelming concentration to the Southeast region, particularly the Rio de Janeiro - São Paulo area. There are a negligible number of centers for preparing technicians and offering post graduation opportunities. Furthermore, there are centers being deactivated due to the lack of demand. This data demonstrates the striking difficulties in making this technology more evenly available throughout the national territory as a result of the lack of incentive for education and research

Objetivos: Estabelecer a espessura (EPV) e a extensão (ETV) do véu palatino, a profundidade da nasofaringe (PNF) e a razão PNF/ETV para um grupo de indivíduos sem fissura labiopalatina (FLP) e sem disfunção velofaríngea (DVF). Analisar as diferenças nas medidas entre: a) padrões faciais tipo I, II e III; b) sexos; c) as medidas deste estudo e as normativas de Subtelny (1957), e d) as medidas deste estudo e os achados de Souza (2013). Material e método: A EPV, ETV e PNF, e razão PNF/ETV foram mensuradas para um grupo de 234 telerradiografias. As imagens estudadas foram obtidas de um grupo de brasileiros com idades entre 5 e 14 anos e foram agrupadas de acordo com o padrão facial I (N=105), II (N=69) e III (N=60) e distribuídas de acordo com o sexo feminino (N=130) e o masculino (N=104). Após escaneadas usando-se o software Dolphin Imaging (versão 11.5) as medidas de interesse foram estabelecidas usando-se princípios da cefalometria e a razão PNF/ETV foi calculada. As medidas foram comparadas com as normativas de Subtelny (1957) e com os achados de Souza (2013). Resultados: Entre os padrões faciais I, II e III não houve diferença significativa na EPV e na razão PNF/ETV; a ETV foi significativamente menor no padrão III nas idades de 6 e 8 anos; a PNF foi significativamente menor no padrão III na idade de 6 anos. Não houve diferença significativa entre os sexos. No presente estudo o véu palatino foi mais fino do que as normas de Subtelny em todas as idades; o véu também foi mais curto do que as normas entre 8 e 14 de idade; as medidas da profundidade da nasofaringe foram similares às normas com valores ligeiramente abaixo aos 6, 9 e 14 anos e acima aos 5, 6 e 10 anos; a razão PNF/ETV foi maior que a norma aos 9, 11, 12 e 14 anos de idade. Ao comparar os achados com os de Souza (2013) o véu palatino, no presente estudo, foi mais estreito em todas as idades e a extensão foi maior aos 6 e 7 anos e menor aos 12 e 14 anos; a nasofaringe foi mais profunda e a razão PNF/ETV foi maior, exceto aos 14 anos de idade. Conclusão: Normas preliminares com medidas da EPV, ETV, PNF e PNF/ETV foram estabelecidas para indivíduos representativos da diversidade étnico-racial dos brasileiros. Achados diferentes dos de Subtelny (1957) e de Souza (2013) sugerem que brasileiros apresentam variações nas medidas com importância para a interpretação clínica e uso destas informações no processo diagnóstico e na definição da melhor conduta para correção da DVF. / Objectives: To establish velar width (VW), velar length (VL), depth of nasopharynx (DN) and the ration DN/VL for a group of individuals without cleft lip and palate (CLP) and without velopharyngeal dysfunction (VPD). To compare measures between: a) facial pattern I, II and III; b) between sexes; c) with Subtelnys norms (1957); d) with Souzas findings (2013). Material and methods: VW, VL, DN and ratio DN/VL was obtained for a group of 234 cephalometric X-ray. The images were obtained from a group of Brazilians with ages between 5 and 14 years which were grouped according to facial pattern I (N=105), II (N=69) and III (N=60) and distributed according to sex, females (N=130) and males (N=104). After scanning the images using the Dolphin Imaging software (version 11.5), the measures were established using cephalometric principles and the ration DN/VL was calculated. The findings were compared to Subtelnys (1957) norms and to Souzas (2013) data. Results: There was no significant difference in VW and ration DN/VL between facial pattern I, II, III; VL was significantly smaller for facial patter III at ages 6 and 8; and DN was significantly smaller for facial patter III at age 6. There was no significant difference for the measures between males and females. VW was narrower in the present study when compared to Subtelnys norms for all ages studied; VL was shorter in the present study when compared to Subtelnys norms between 8 and 14 years; DN was similar to the norms, slightly lower at ages 6, 9 e 14 years and higher at ages 5, 6 e 10 years; ration DN/VL was above the norms at 9, 11, 12 and 14 years. When comparing the findings to Souzas, VW was narrower for all ages; VL was longer at 6 and 7 years and shorter at 12 and 14 years; DN and the ration DN/VL were greater at all ages, except 14 years. Conclusion: Preliminary norms for VW, VL, DN and ration DN/VL were established for a group of individuals representative of the Brazilian Ethnic-racial diversity. Findings were different from Subtelnys and from Souzas suggesting the importance of considering these variations during clinical interpretation and use of this information during the diagnostic process and to identify the most adequate treatment for VPD.

Introdução: A mutilação intra-oral, após tratamento de tumores, ocasiona além de deformidades estéticas, perda de função e impacto na qualidade de vida do paciente. Proposição: Avaliar a experiência individual do paciente tratado por lesões benignas e malignas que resultaram em mutilação intra-oral e necessidade de reabilitação complexa maxilo mandibular Material e Método: Através de entrevistas semi estruturadas, à luz da metodologia de análise de conteúdo, proposta por Bardin em 1977, utilizando a pergunta norteadora O que aconteceu na sua vida antes, durante e o que acontecerá depois da lesão/doença que te trouxe aqui, foram entrevistados seis pacientes, como mutilação intra-oral em reabilitação protética maxilo facial. Resultados e Discussão: Após análise, exploração e interpretação dos resultados colhidos em entrevistas semi-estruturadas, que duraram em média 1hora e meia a duas horas cada, foram extraídas duas categorias dos discursos dos sujeitos: Vivendo a mutilação, perdendo os dentes, a comunicação e a socialização e Preservando a esperança de um novo normal, respeitando a doença com a sombra da recidiva. Conclusão: Os dados revelam que o paciente que sofreu mutilação intra-oral após tratamento de tumor, é um sujeito que vive as seqüelas da terapêutica, tem respeito extremo pela doença que o levou àquela condição, tem medo de possíveis recidivas, mas, fundamentalmente, nutre a esperança de retomar sua vida e construir um novo normal. / Introduction: Intra-oral mutilation after treatment of tumors, causes beyond cosmetic deformities, loss of function and impact on quality of life of patients. Proposition: To evaluate the experience of the individual patient treated for benign and malignant lesions that resulted in injury intra-oral and maxillofacial complex rehabilitation needs Methods: Using semi-structured interview, supported of content analysis proposed by Bardin in 1977, using the guiding question \"What happened in your life before, during and what will happen after the injury / illness that brought you here,\" were interviewed six patients, such as mutilation intra-oral maxillo facial prosthetic rehabilitation. Results and Discussion: After analysis, exploration and interpretation of the results collected from semi-structured interviews, which lasted on average 1 hour and a half to two hours each, were extracted from two categories of the speeches: Living mutilation, losing teeth, communication and socialization and preserving the hope of a \"new normal\", respecting the disease in the shadow of recurrence. Conclusion: Our data show that patients who suffered mutilation after intra-oral tumor treatment, is a guy who lives the consequences of therapy, has utmost respect for the disease that led to that condition, afraid of possible relapse, but fundamentally nurtures the hope of resuming their lives and build a \"new normal\".