Pirmą kartą atliktas asmenų grupių, turinčių skirtingą neutrofilų funkcinį aktyvumą (sergančių priedančio audinių uždegimu ir sveikų asmenų), lyginamasis periferinio kraujo neaktyvintų ir aktyvintų neutrofilų oksidacinės funkcijos tyrimas. Tyrimams buvo panaudoti labai jautrūs nuo luminolo ir lucigenino priklausomos chemiliuminescencijos metodai. Pirmą kartą įrodytas homeopatinio preparato Traumeel S antioksidacinis poveikis in vitro, reikšmingai mažinantis sergančiųjų priedančio audinių uždegimu kraujo neutrofilų generuojamo superoksido anijono kiekį. Pirmą kartą tirtas sergančių priedančio audinių uždegimu ir sveikų asmenų periferinio kraujo, plazmos ir serumo redukcinis potencialas, įvertinant homeopatinio preparato Traumeel S poveikį redukciniam potencialui in vitro. Tyrimų rezultatai papildo žinias ir apie priedančio audinių uždegimo patogenezę. / For the first time, a complex comparative study was performed on the oxidative function of non-activated and activated neutrophils of peripheral blood from subject with differing functional activity of neutrophils (i.e. patients with periodontitis and healthy subjects). The study employed two very sensitive techniques – luminol-dependent and lucigenin-dependent chemiluminescence. For the first time, the study showed that the homeopathic medication Traumeel S had antioxidant effect in vitro, i.e. it significantly reduced superoxide anion levels generated by blood neutrophils in patients with periodontitis. The results of the study also complemented knowledge about the pathogenesis of periodontal inflammation. This finding may have a significant clinical implementation.

The teeth are amongst the most resilient elements of the human skeleton and are thus often utilised in routine forensic investigation involving the identification of unknown remains. The teeth, however, also have other practical forensic applications. Teeth exposed to thermal stress have the potential to not only aid in identification but also in understanding the circumstances surrounding the fire. Previous investigations have drawn conclusions that if a fire flares up suddenly and intensively, the teeth burst and enamel is lost. If the blaze commences gently and burns slowly, then the first observable morphologic change is the colour. The teeth subsequently are difficult to handle, thus changes in teeth can indicate the history of exposure to thermal conditions. Children are twice as likely to become victims of house fire because of an inability to safely evacuate from areas of danger. The literature demonstrates, however, that research on the effects of incineration on teeth is mostly restricted to the permanent teeth. The apparent lack of knowledge on the effects of incineration on deciduous teeth thus necessitates further research in this area. This research project primarily aims at understanding the effect of extreme temperatures on deciduous teeth. It also aims to relate colour changes that occur post heating with fragility to aid in proper handling of samples in a forensic scenario and to determine the possibility of identifying incineration temperature based on tooth condition. The samples analysed composed of 90 deciduous teeth (45 molars and 45 anteriors) extracted as a part of clinical treatment were used for the study. The project involved exposing extracted deciduous teeth to temperatures ranging from 100°C to 1100°C for 30 minutes using a laboratory Gallenkamp oven. Unheated deciduous teeth were used as controls for the project. Post-incineration the teeth were then analysed under a stereomicroscope and SEM for morphological changes. A colorimetric analysis was also undertaken to evaluate the colour changes induced in the primary teeth due to the thermal stress. It was found that it was possible to identify the incineration temperature based on the tooth condition when the colour changes, stereomicroscopic findings and SEM images were utilised collectively. It was also concluded that the thermally induced changes observed in primary teeth occur at lower temperatures in comparison to the permanent teeth. It was also established that post-incineration deciduous teeth are fragile and show a tendency to fragment after minimal exposure to thermal stress as compared to the permanent teeth. Moreover enamel and dentin remained identifiable in primary teeth even after exposure to 1100°C for 30 minutes while cementum lost its structural morphology at 900°C.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Os debates sobre formação profissional em saúde ampliaram seu espaço na agenda de discussões políticas brasileiras. As Diretrizes Curriculares Nacionais para Cursos na Área de Saúde, homologadas pelo Ministério da Educação em 2001, orientam mudanças em graduação dos profissionais, coerentes com a necessidade indicada pelo Ministério da Saúde de incentivar mudanças na formação em saúde com ênfase na integralidade da atenção. Este trabalho investigou as propostas das novas Diretrizes Curriculares Nacionais para os cursos de odontologia (DCNO), tendo como eixo de análise o princípio da Integralidade em saúde e o trabalho em equipe. A partir do referencial teórico da construção da Integralidade em saúde, foi analisada a percepção de seus elementos no discurso de gestores acadêmicos, professores e alunos de um curso de odontologia e no documento das DCNO. A análise do documento das DCNO demonstrou uma reduzida sistematização das ideias e conceitos associados à integralidade em saúde, reforçando a ênfase nas práticas do Cirurgião-Dentista ao âmbito da Saúde Bucal. A análise das entrevistas revelou certo grau de apropriação, pelos autores estudados, de discursos que ampliam o universo da odontologia, porém referem-se a práticas profissionais e de ensino-aprendizagem ainda bastante calcadas no conhecimento clínico-cirúrgico aplicável ao indivíduo. Existe uma associação entre integralidade em saúde, perfil generalista e trabalho em equipe à integração das especialidades odontológicas, viabilizadas pela integração das clínicas. Nota-se uma tendência à mudança de valores, inclusive nos depoimentos de estudantes, que demonstram interesse nas práticas no setor público, reforçando a necessidade de ampliação da odontologia na arena de discussões sobre a formação em saúde, de modo a aproximar conteúdos e práticas de saúde coletiva com aquelas do campo clínico-cirúrgico sob novas perspectivas e aproximar a teoria da área específica de atuação, avançando na construção do trabalho em equipe. / The debates on professional formation in health today occupy a great space in the Brazilian agenda of politics quarrels. In this aspect, the National Curriculum Guidelines for the Courses of the Health Area, homologated for the Ministry of the Education in 2001, guide changes in the graduation of the health professionals, in accordance to the needs indicated by the Health Department to stimulate changes in the formation in health with emphasis in the integrality of the attention. This work investigated the proposals of the National Curriculum Guidelines for Dental Education (DCNO), having as analytical vase the principle of the Integrality in health and teamwork . From the theoretical referential of the constructions of Integrality in health, the perception of its elements in the speech of academic managers, professors and pupils of dental course was analyzed, and in the document of the DCNO. The analysis of the DCNO document demonstrated reduced organization in ideas as well as concepts concerning health integrality, highlighting the emphasis on the dentists practice regarding oral health. The analyses of the interviews revealed a certain degree of appropriation, by the studied actors, of the speeches that enhance the universe of odontology, nevertheless referring to professional practices as well as teaching-learning process still deeply attached to clinical surgical knowledge applied to the individual. Moreover, there is a strong association between Integrality in health, general profile and teamwork to the integration of the dental specialties, made possible by the integration of clinics. A tendency of change in values is observed, even in the students speeches, showing interest in public practices, strengthening the need of increase in Odontology in the arena of quarrels on health graduation, in such a way as to attach public health theory and practice with those of the clinical-surgical field under new perspective and to approach theory to its specific practice, advancing in the construction of teamwork.

Made available in DSpace on 2016-06-02T19:44:04Z (GMT). No. of bitstreams: 1 1962.pdf: 922052 bytes, checksum: 8f5bc0fd517ec09ae18b23799bc094b3 (MD5) Previous issue date: 2008-06-27 / Studies have shown that autistic adults and adolescents have a high incidence of cavities due to their substandard practices of oral hygiene. Disruptive behaviors like flinching or fleeing are commonly observed during toothbrushing, as well as agonistic conduct during dental treatment. Few studies have addressed the improvement of toothbrushing efficacy as a form of preventing these problems, and most of the existing works are poor in methodology. This study evaluates the effectiveness of a toothbrushing training program upon children of five to six years of age who have been medically diagnosed as autistic. The children were randomly divided into groups G1, G2 and G3. G1 had training on the use of conventional toothbrushes, with an accompanying song and physical guidance; G2 had electric toothbrush training and physical assistance; group G3 had electric toothbrush training, associated to a song and physical assistance. Video recordings of the training sessions were used to determine the brushing steps assimilated by the children, as well as their autonomy and ability to complete each of the steps along the study. Hygiene results were evaluated through a sequence of treatments and probes. The use of electric toothbrushes apparently resulted in better removal of plaque, even under adverse conditions. G3 showed better plaque indexes than the other two groups, and G2 had better results than G1, suggesting that the use of electric toothbrushes associated to a song and physical assistance can optimize oral hygiene in autistic children. Overall, five-year-olds had better results than sixyear- olds, suggesting that younger children have a lower incidence of adverse behavior (e.g. nausea or vomiting) during toothbrushing. / Estudos têm mostrado que adolescentes e adultos autistas tem péssima higiene bucal e apresentam alto índice de cáries, comportamentos de fuga e esquiva durante a escovação e problemas de comportamento durante o tratamento odontológico. Poucos estudos exploram a escovação como forma de prevenir tais problemas, e na sua maioria, eles carecem de rigor metodológico. Este estudo teve como objetivo avaliar um programa de treino de escovação em crianças com diagnóstico médico de autismo entre cinco e seis anos. As crianças foram divididas aleatoriamente em três grupos: G1 (treino de escovação com escova dental convencional, canção e ajuda física), G2 (treino de escovação com escova elétrica e ajuda física) e G3 (treino de escovação com escova elétrica associada a uma canção e ajuda física). Empregou-se um delineamento de múltiplos tratamentos e sondas. As sessões foram filmadas e analisadas a fim de se identificar os passos da escovação empregados pela criança, bem como verificar a independência e adequação da criança nesses passos, ao longo do estudo. Os resultados demonstraram que o uso da escova elétrica parece ter removido mais placa bacteriana do que a escova convencional, mesmo em condições adversas de escovação. O G3 apresentou melhores índices de placa bacteriana do que os outros grupos e o G2 pareceu ter melhores índices que o G1, indicando que o treino com escova elétrica, canção e ajuda física produziram melhor higiene bucal com crianças autistas. Constatou-se, também, que os participantes de cinco anos mostraram melhores resultados que os de seis anos, sugerindo que quanto mais jovens, menor a freqüência de comportamentos adversos emitidos durante a escovação (ânsia, náusea e vômitos).

Made available in DSpace on 2014-12-17T14:13:35Z (GMT). No. of bitstreams: 1 MariaCGM_DISSERT.pdf: 783345 bytes, checksum: 2bbd27cd96c8b3b35673be95266c5187 (MD5) Previous issue date: 2010-09-17 / Since Demirjian's system of estimating dental maturity was first described, many researchers from different countries have tested its accuracy among diverse populations. Some of these studies have pointed out a need to determine population-specific standards. In Brazil, the Northeast region is the one that most suffers the negative impact of exodus, specially related to the increase of abandoned children in the cities. The aim of this study was to test the accuracy of Demirjian's system for assessing the dental maturity of northeastern Brazilian children, so as to present a scale for maturity score conversion into dental age developed specifically for this population. This could be used for forensic, anthropological and legal matters, and also as a model for other countries attempting to formulate their own conversion scales. Panoramic radiographs of 1,491 children (821 females and 670 males), aged 7 to 13 years, from Cear? state, northeast Brazil, were assessed by a single observer to determine dental age (DA) according to Demirjian's system. The mean percentage of intra-observer agreement was 86.6%, with a mean Cohen's Kappa coefficient of 0.67 (substantial agreement). The DA was compared by paired t-test to subjects' chronological age (CA). The differences between CA and DA in all age groups were statistically significant (p<0.0001), demonstrating a great advancement in DA among Brazilians. Scatter plots were drawn for both genders, and the data were fitted to a growth curve, y = 100/ (1 + e-a(x b)). Graphs corresponding to the 50th percentile curves were produced. A table with new values for the conversion of maturity score into dental age for northeastern Brazilian children is presented. The great advancement in DA, as obtained by Demirjian's system in this population, justified the determination of specific scores for dental maturity assessment / A estimativa da maturidade dent?ria tem sido descrita na literatura basicamente atrav?s de dois m?todos, a observa??o direta do processo de erup??o do dente na cavidade oral ou por meio de radiografias. A radiografia panor?mica, obtida por t?cnica extra-oral de uso dos raios X, ? um elemento essencial para o diagn?stico por imagens em Radiologia odontol?gica. Este trabalho apresenta dois estudos quantitativos anal?tico-descritivos utilizando o m?todo de determina??o da idade dental atrav?s de radiografia panor?mica em crian?as brasileiras nordestinas. Um estudo piloto realizado com 325 crian?as (191 meninas e 134 meninos) de 7 a 16 anos, da cidade de Fortaleza, objetivando determinar as interrela??es entre as suas idades cronol?gica (data de nascimento), ?ssea (pelo m?todo de Grewlich & Pyle) e dental (segundo Demirjian et al.). Outro estudo, j? publicado, conduzido com 1.491 crian?as (821 meninas e 670 meninos) cearenses, de 7 a 13 anos, visando avaliar a aplicabilidade do m?todo de Demirjian na popula??o estudada. Em ambos os estudos, mostra-se que a estimativa de idade dental utilizando as tabelas de convers?o de maturidade dental propostas por Demirjian et al. n?o se ad?qua ? popula??o pesquisada. Assim, uma escala de valores de convers?o de maturidade dental em idade dental foi desenvolvida especificamente para crian?as nordestinas e ? agora apresentada, visando ? sua aplica??o n?o s? na cl?nica, mas em quest?es forenses, antropol?gicas, legais e/ou criminais. As pesquisas de car?ter interdisciplinar envolveram pesquisadores das ?reas de Odontologia (Odontopediatria, Ortodontia e Radiologia); Medicina (Endocrinologia e Metabologia); e F?sica, preenchendo os requisitos de multidisciplinaridade do Programa de P?s-Gradua??o em Ci?ncias da Sa?de

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Os debates sobre formação profissional em saúde ampliaram seu espaço na agenda de discussões políticas brasileiras. As Diretrizes Curriculares Nacionais para Cursos na Área de Saúde, homologadas pelo Ministério da Educação em 2001, orientam mudanças em graduação dos profissionais, coerentes com a necessidade indicada pelo Ministério da Saúde de incentivar mudanças na formação em saúde com ênfase na integralidade da atenção. Este trabalho investigou as propostas das novas Diretrizes Curriculares Nacionais para os cursos de odontologia (DCNO), tendo como eixo de análise o princípio da Integralidade em saúde e o trabalho em equipe. A partir do referencial teórico da construção da Integralidade em saúde, foi analisada a percepção de seus elementos no discurso de gestores acadêmicos, professores e alunos de um curso de odontologia e no documento das DCNO. A análise do documento das DCNO demonstrou uma reduzida sistematização das ideias e conceitos associados à integralidade em saúde, reforçando a ênfase nas práticas do Cirurgião-Dentista ao âmbito da Saúde Bucal. A análise das entrevistas revelou certo grau de apropriação, pelos autores estudados, de discursos que ampliam o universo da odontologia, porém referem-se a práticas profissionais e de ensino-aprendizagem ainda bastante calcadas no conhecimento clínico-cirúrgico aplicável ao indivíduo. Existe uma associação entre integralidade em saúde, perfil generalista e trabalho em equipe à integração das especialidades odontológicas, viabilizadas pela integração das clínicas. Nota-se uma tendência à mudança de valores, inclusive nos depoimentos de estudantes, que demonstram interesse nas práticas no setor público, reforçando a necessidade de ampliação da odontologia na arena de discussões sobre a formação em saúde, de modo a aproximar conteúdos e práticas de saúde coletiva com aquelas do campo clínico-cirúrgico sob novas perspectivas e aproximar a teoria da área específica de atuação, avançando na construção do trabalho em equipe. / The debates on professional formation in health today occupy a great space in the Brazilian agenda of politics quarrels. In this aspect, the National Curriculum Guidelines for the Courses of the Health Area, homologated for the Ministry of the Education in 2001, guide changes in the graduation of the health professionals, in accordance to the needs indicated by the Health Department to stimulate changes in the formation in health with emphasis in the integrality of the attention. This work investigated the proposals of the National Curriculum Guidelines for Dental Education (DCNO), having as analytical vase the principle of the Integrality in health and teamwork . From the theoretical referential of the constructions of Integrality in health, the perception of its elements in the speech of academic managers, professors and pupils of dental course was analyzed, and in the document of the DCNO. The analysis of the DCNO document demonstrated reduced organization in ideas as well as concepts concerning health integrality, highlighting the emphasis on the dentists practice regarding oral health. The analyses of the interviews revealed a certain degree of appropriation, by the studied actors, of the speeches that enhance the universe of odontology, nevertheless referring to professional practices as well as teaching-learning process still deeply attached to clinical surgical knowledge applied to the individual. Moreover, there is a strong association between Integrality in health, general profile and teamwork to the integration of the dental specialties, made possible by the integration of clinics. A tendency of change in values is observed, even in the students speeches, showing interest in public practices, strengthening the need of increase in Odontology in the arena of quarrels on health graduation, in such a way as to attach public health theory and practice with those of the clinical-surgical field under new perspective and to approach theory to its specific practice, advancing in the construction of teamwork.

Este estudo in vitro teve como objetivo a comparação de diferentes protocolos para fotoativação de restaurações em resina composta por meio de teste de microdureza e análise da adaptação marginal com microscopia eletrônica de varredura. Foram confeccionadas restaurações de 2mmx4mmx2mm com a resina composta Premisa (Kerr) em 30 dentes bovinos. Durante o procedimento restaurador, o método de fotoativação teve variação, sendo um grupo ativado com o método contínuo (grupo controle) durante 20 segundos, utilizando o fotoativador Elipar Freelight 2; outro grupo utilizou o mesmo equipamento fotoativador, com variação da distância da ponta ativadora, a fim da promoção de um método soft-start (grupo soft-start), tendo distância inicial de 6mm por 20 segundos, seguido de distância mínima por mais 10 segundos; e um terceiro grupo utilizou a tecnologia PLS (grupo DEMI), fornecida pelo equipamento DEMI, que fornece uma luz pulsada e permite a polimerização adequada de uma resina composta em 5 segundos (segundo o fabricante). Após 24 horas de restaurados, mantidos em estufa a 37ºC, os dentes foram seccionados no sentido inciso cervical resultando em 60 corpos de prova, sendo metade deles utilizados em cada teste (N=10). As metades tiveram as superfícies correspondentes ao corte transversal lixadas até a obtenção de superfícies planas e polidas, sendo que 30 delas foram selecionadas aleatoriamente para o teste de microdureza Knoop em 3 diferentes profundidades e as outras 30 metades foram replicadas em resina epóxica para leitura em microscopia eletrônica de varredura. Com as imagens obtidas foram feitas medidas de porcentagem de perímetro de restauração com desadaptação marginal e largura da maior fenda encontrada. Foram aplicados testes estatísticos de análise de variância split plot para os resultados de dureza e one way para a adaptação marginal. Em relação à dureza, os testes mostraram não haver diferença estatisticamente significante entre os grupos avaliados, enquanto houve diferença nas diferentes profundidades (p<0,0001), sendo a dureza na região profunda maior do que na média, que foi maior do que na superficial. Para a adaptação marginal, os testes não mostraram diferença estatisticamente significante para a largura de maior fenda encontrada entre os grupos controle e DEMI, somente o grupo soft-start foi diferente dos outros grupos (p=0,0064), tendo ele os menores valores. Apesar de a porcentagem de perímetro com desadaptação marginal ter apresentado valores com grandes valores de desvio padrão, foi encontrada diferença estatisticamente significante entre os grupos controle e DEMI, mas não entre os grupos DEMI e soft-start. O teste de correlação de Pearson demonstrou correlação linear positiva entre largura da maior fenda encontrada e porcentagem de perímetro com desadaptação marginal. Foi possível a conclusão de que o protocolo de fotoativação soft-start melhorou a adaptação marginal das restaurações em resina composta, sem alterar a dureza do material; o equipamento fotoativador DEMI, com a utilização da tecnologia PLS, teve resultados sem diferença estatisticamente significante na avaliação da adaptação marginal, quando comparados ao grupo controle; nenhum dos protocolos de fotoativação testados causou alteração na dureza da resina composta fotoativada, quando comparadas entre si, havendo aumento dessa propriedade conforme houve aumento da profundidade. / This in vitro study aimed to compare different protocols for the photoactivation of composite resin restorations using microhardness test and analysis of marginal adaptation with scanning electron microscopy. Restorations with 2mmx4mmx2mm were made in 30 bovine teeth using the composite resin Premisa (Kerr). During the restorative procedure, the polymerization method had change, being one group activated with the continuous method (control group) for 20 seconds using the curing unit Elipar Freelight 2, another group used the same curing unit equipment, varying the distance from the activator tip in order to promote a soft-start method (soft-start group), with initial distance of 6mm for 20 seconds, followed by minimum distance for 10 seconds, and a third group used technology PLS (DEMI group) supplied from the DEMI, which provides a pulsed light and allows an adequate polymerization of a resin composite in 5 seconds (according to manufacturer). 24 hours after restoration, maintained at 37 ° C, the teeth were sectioned incisocervical towards resulting in 60 specimens, half of them being used in each test (N = 10). The halves were sanded on the transversal section surfaces to obtain flat and polished surfaces, of which 30 were randomly selected for Knoop microhardness testing in 3 different depths and the other 30 halves were replicated in epoxy resin for microscopy scanning electron reading. Measures of percentage of perimeter with marginal desadaptation and width of the largest slot found were made with the obtained images. Split plot analysis of variance tests were applied to hardness results and one way to the marginal adaptation. Regarding the hardness, tests showed no statistically significant difference among the groups, while there were differences at different depths (p<0,0001), being the hardness of the deep region highest than the medium, which was higher than the superficial. For marginal adaptation, tests showed no statistically significant difference for the width of the largest slot found between the control group and DEMI, only the soft-start group was different from the other groups (p=0,0064), having the lowest values. Despite the large standard deviations shown by the percentage of perimeter with marginal desadaptation, statistically significant difference was found between the control and DEMI, but not between groups DEMI and soft-start. The Pearson correlation test showed positive linear correlation between the width of the largest slot found and the percentage of perimeter with marginal desadaptation. It was possible to conclude that the soft-start photoactivation protocol improved the marginal adaptation of composite resin restorations, without changing the hardness of the material; DEMI curing unit equipment, using PLS technology, showed no statistically significant difference in the evaluation of marginal adaptation, comparing with the control group; none of the protocols tested photoactivation caused change in hardness of composite resin when compared to each other, with an increase of this property as the depth increased.

A unicidade da cavidade sinusal frontal é um importante fator para a identidade humana. O uso de registros de imagens dessa cavidade para a identificação forense é amplamente difundido, sendo uma metodologia secundária segundo a INTERPOL. Recentes avanços nas tecnologias de imagem permitiram o registro de imagens tridimensionais dessa cavidade. Nosso objetivo foi validar a metodologia proposta por Beaini et al. (2015), padronizando critérios para a obtenção de imagens tridimensionais da cavidade sinusal frontal com tomografia computadorizada de feixe cônico e avaliando a capacidade desses dados para a identificação humana. Para tanto, utilizamos um banco de imagens tomográficas de 200 pacientes randomizados e analisados por três observadores. As imagens foram exportadas em formato DICOM e submetidas a dois processos de segmentação distintos e sobreposição tridimensional. Realizou-se a metodologia descrita para estabelecer a identificação entre pacientes randomizados. Os resultados mostraram que há uma diferença significativa entre os processos de segmentação, sendo mais indicada a técnica de segmentação manual. A metodologia proposta por Beaini et al. (2015) foi validada e um total de 166 pacientes foram identificados. O volume da cavidade sinusal possui um elevado potencial de identificação com uma probabilidade aproximada de 85% para determinar o gênero dos indivíduos. / The uniqueness of the frontal sinus cavity is an important factor for establishing human identity. The usage of imaging records of this cavity for human identity is a secondary methodology according to the INTERPOL protocols. Recent advances in imaging technologies have enabled the three-dimensional imaging records of this cavity. Our goal was to validate the methodology proposed by Beaini et al. (2015), by developing standardized criteria for the use of cone beam computed tomography three-dimensional images of the front sinus and evaluating the ability of these data for human identification. The aim of this study was to investigate a total of 200 imaging records from randomized patients that were analyzed by three observers. Images were exported in DICOM format and underwent two distinct segmentation processes and a three-dimensional overlap. The Beaini et al. (2015) technique was applied to establish identification of the randomized patients. My results showed a significant difference between both segmentation processes, with manual segmentation showing the best results. Beaini et al. (2015) technique was validated and a total of 166 patients were identified. The volume of the sinus cavity has a high identification probability with a rough probability of 85% to determine the sex of individuals.

Este estudo avaliou a microdureza de ligas de NiCr usadas em prótese fixa fundidas sob diferentes condições. As condições de fundição foram: 1- maçarico chama composta de GLP/oxigênio e centrífuga de mola sem controle de ambiente de fundição; 2- indução eletromagnética com ambiente controlado por argônio e vácuo. foram utilizadas três ligas NiCr, NiCrBe e NiCrTi. Foram realizados 18 fundições com 5 corpos-de-prova para cada anel, depois de fundidos os corpos-de-prova foram embutidos e polidos para as mensurações de microdureza vickers (VH) em equipamento Shimadzu-HMV-2 (1Kg por 10s). um total de 3 edentações foram feitas para cada corpo-de-prova.os dados de VH foram avaliados pelo teste de ANOVA e Tukey (=0,05) para contraste de média. A microdureza apresentou a seguinte ordem para maçarico e liga totalmente virgem: NiCrTi (42533,4)> NiCrBe (36215) > NiCr (25314,8), sendo diferentes entre si. Os valore obtidos nas condições de argônio e indução foram semelhantes (p>0,05). A microdureza depende da liga e do método de fundição. A liga de NiCrTi foi maior quando fundidas nas condições de maçarico oxigênio/GLP e totalmente refundida (42826,7). / This study evaluated the microhardess of NiCr alloys used in fixed prosthodontics after casting under different conditions. The casting were: 1-flame/air torch flame made of a gas/oxygen mixture and centrifugal casting machine in a non-controlled casting environment; 2-induction/argon electromagnetic induction in an environment controlled with argon. 18 castings with 5 in each ring were prepared. After casting the ring were embedded in resin and polished for Vickers microhardness (VH) measurements in a Shimadzu HMV-2 (1kgfor 10s). a total 3 indentations were for each ring, one in ring. The data was subjected to two-way ANOVA and Tukeys multiple comparison tests (=0,05). The VH values of NiCrTi NiCrTi (42533,4)> NiCrBe (36215) > NiCr (25314,8). The VH values obtained in the condition of the argon and induction were similar (p>0,05). The microdureza depends on the league and of the foundry method. The league of NiCrTi was larger when melted in the conditions of blowpipe oxygen/GLP and totally recast (42826,7).

En France, sous l'impulsion de la loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé, des modifications profondes de la relation de soin en faveur d'une participation plus active des patients ont été engagées imposant un repositionnement de chaque acteur de cette relation. La loi précise que l'implication des patients dans les processus de prise de décision doit être recherchée y compris lorsque les patients présentent des limitations de leurs capacités de décision. L'affirmation de ces droits va de pair avec la reconnaissance de capacités de décision aux patients et le développement d'une décision médicale partagée. Elle entraîne néanmoins, lorsque ces capacités sont atteintes, des difficultés concrètes dans le recueil du consentement du patient et/ou de ses représentants légaux et aidants. Il est aujourd'hui reconnu que les besoins en santé orale des patients présentant des limitations durables de leurs capacités de décision sont non satisfaits et augmentés par rapport à la population générale. Ces inégalités de santé résultent de nombreux obstacles dans l'accès aux soins et à la prévention, mais aussi dans la prise en charge, et alors que le principe d'égal accès au soin de tous les citoyens est reconnu comme un fondement juridique national. Cette situation constitue une perte de chance pour ces personnes d'autant plus qu'une santé bucco-dentaire dégradée peut avoir, au-delà des conséquences locales, des répercussions sur la santé générale et plus particulièrement sur la qualité de vie et l'intégration sociale. Ces difficultés cumulées quotidiennement conduiraient donc à privilégier des thérapeutiques symptomatiques sans réflexion de l'ensemble des acteurs autour d'une réhabilitation fonctionnelle globale. Pourtant, il est reconnu que la lutte contre les inégalités de santé passe par le développement d'une prise en charge globale de la santé. S'appuyant sur une participation des différents acteurs et notamment des patients aux prises de décision, celle-ci prévoit un décloisonnement entre les domaines relevant du sanitaire, du social et de l'éducatif pour un continuum par priorité. Ce travail, par une recherche qualitative et participative, a pour objectif d'explorer les raisons des limitations de réponse thérapeutique auprès de chaque acteur de la relation de soin - les patients, les aidants et les chirurgiens-dentistes. Une fois celles-ci mieux comprises, les différentes représentations sont confrontées et les tensions éthiques qui s'y dégagent discutées. Puis, des pistes d'évolution de la prise en charge de la santé orale, et au-delà, des évolutions sociétales sont proposées pour espérer à terme réduire les inégalités de santé. / In France, under the impulse of the Law of 4 March 2002 on patients' rights and the quality of the health system, deep changes have been undertaken in the care relationship for a more active participation of patients. This imposes a repositioning of each individual involved in the relationship. The law specifies that the involvement of patients in decision-making should be sought even when they present limitations of their decision-making abilities. The affirmation of these rights is consistent with the recognition of patients' decision-making abilities and the development of a shared decision. Nevertheless, when the limits of these abilities are reached, it leads to practical difficulties in the consent of patients and/or legal guardians and caregivers. It is now recognized that the oral health needs of patients with enduring limitations of their decision-making abilities are not satisfied, and are increased compared to those of the general population. These health inequities result from many barriers in access to care and prevention, but also during care, and yet the principle of equal access to care for all citizens is recognized as a national legal principle. This situation constitutes a loss of opportunity for these people - especially as, beyond its local impacts, impaired oral health may have impacts on their overall health and particularly on their quality of life and social integration. These limitations, which accumulate day after day, may lead to symptomatic therapies being favoured without concerted thinking on a global functional rehabilitation. Yet it is recognized that the fight against health inequalities requires the development of comprehensive overall health care. This means that, relying on the participation of the different stakeholders including patients in decision-making, the barriers separating areas concerning health, social and educational care have to be abolished for a continuum by priority. The aim of this work is to explore, by qualitative and participatory research, the reasons for the limitations of the therapeutic response from each member of the care relationship - patients, caregivers and dentists. Once these reasons have been better understood, the different representations are considered face to face and the ethical tensions that emerge are discussed. Then, ways in which the management of oral health can be improved and, beyond this evolution, ways in which society could change are proposed with the ultimate hope of reducing health inequalities.