No description available.

Thesis (M.Sc.D.)--Boston University School of Graduate Dentistry, May 20, 1966. / Bibliography included.

The physical health needs of people with serious mental illness have been neglected for a long time (1), this has initiated the development of guidelines and recommendations from the British Society for Disability and Oral Health (BSDH) for the oral health care for people with serious mental illness (2). Guidelines recommend monitoring and advice and although they are well meaning, randomised controlled trial evidence to support the recommendations is missing (3, 4). Cochrane systematic reviews found no randomised controlled trials of oral health advice or monitoring for people with serious mental illness (5). A Cochrane systematic review of general physical health advice interventions for people with serious mental illness (6) found evidence to suggest such interventions could lead to people accessing more health services. For oral health there is some survey evidence to suggest regular dental check-ups have been found to be associated with better oral health (7), so if a monitoring and advice intervention can influence someone with serious mental illness to visit a dentist this may in turn improve their oral health. A systematic review of 55 studies examining the prevalence of poor oral health and hygiene practices, dental treatment needs, and dental attendance of people with serious mental illness, was conducted to assess the extent to which people with serious mental illness brush their teeth and attend dental appointments. The majority of participants did not practice good oral hygiene, and were more likely not to have seen a dentist for a longer period of time than the general population. Those with serious mental illness also had more decayed teeth, more missing teeth, but fewer filled teeth, than the general population. Most of those with mental illness required some form of dental treatment ranging from oral hygiene instruction to complex dental treatment for those with shallow pockets or deep pockets in their teeth. A narrative review of the knowledge and attitudes regarding oral health in populations with serious mental illness from service users, and mental health and dental professionals’ perspectives found that individuals with serious mental illness were more likely to have poor oral health due to neglecting their oral hygiene and because they did not attend regular dental appointments. Previous negative experiences at dental appointments or general dental anxiety prevented individuals with a mental illness from seeking help until they experienced a dental emergency. The majority of service users reported that support from mental health nurses was helpful, even though nurses tended to report feeling unconfident and inadequately trained to provide this care. A systematic review of randomised controlled trials of interventions for improving the oral health of people with serious mental illness identified four studies which all had such varied interventions and measured different outcomes that combining them in a meta-analysis was not possible. Providing toothbrushes appeared to improve the oral health of people with serious mental illness. Some of the interventions involved an education element which also significantly improved oral health. A pragmatic cluster randomised controlled trial of an oral health intervention for people with serious mental illness involved 1074 service users from the Early Intervention in Psychosis teams in the East Midlands of England being randomised either to receive a dental intervention or standard care. The dental intervention involved completing a checklist with their Care Co-ordinator concerning their oral health and oral hygiene behaviour and the standard care simply involved continuing with standard care for 12 months before then completing the checklist. At baseline only 271/550 service users randomised to the dental intervention group completed dental checklists. Only 98/271 (36.1%) of service users returned a completed dental checklist at the 12 month follow up and for those allocated to standard care 91/524 (17%) returned a completed dental checklist at the 12 month follow up. The checklist did not improve oral health behaviour in people with serious mental illness. The oral health of people with serious mental illness remains a vastly under researched area. Mental health professionals should receive training to improve their oral health care knowledge. Mental health professionals should also provide advice to their patients regarding their oral health, monitor oral health as part of standard care and support patients to attend regular dental check-ups. An effective intervention that can be used within standard care could significantly improve the quality of life for people with serious mental illness.

Clinical reasoning is a skill required by all health professionals in managing patients. Research in clinical reasoning has come mostly from medicine and nursing, less from dentistry. The effect of curriculum on the development of clinical reasoning is still not well understood. Moreover, no research has been conducted to understand what clinical reasoning means to students and what educational strategies are valued by them. The aim of this research is to explore the effect of different educational strategies in different dental schools on clinical reasoning and to discover how students perceive clinical reasoning. Final year students from four different dental schools participated in the current research; a school using an integrated curriculum with conventional teaching, a school using Problem Based Learning (both from the UK) and two Saudi Arabian dental schools; a school using a traditional curriculum and a school using an integrated curriculum. Both UK schools participated in both studies, whereas each one of the Saudi Arabian schools participated in a different study. The research used both quantitative and qualitative methodology. An innovative clinical reasoning test measured final year students’ skills. An interview captured their own understanding of clinical reasoning and its acquisition plus they ‘talked through’ a clinical problem, using a ‘think aloud’ technique. Thematic analysis was used to analyse the transcripts of the recorded interviews. Results obtained were related to curriculum structure. The results indicated that the effect of curriculum structure, unlike teaching and assessment strategies, appeared to be minimal in final year students. Unfamiliarity with the term clinical reasoning was common in students. Students from different schools used different strategies to reason when discussing clinical vignettes. Different behaviours seemed to be affected by cultural factors. This research contributes to a greater understanding of how students learn, understand and apply dental clinical reasoning which hopefully will improve educational practices in the future.

A artrite reumatoide (AR) Ã uma condiÃÃo autoimune caracterizada por uma inflamaÃÃo das articulaÃÃes. As medicaÃÃes mais utilizadas no tratamento da AR sÃo drogas antireumÃticas modificadoras da doenÃa (DMARD), como o metotrexato (MTX) e agentes biolÃgicos, dentre estes os inibidores do fator de necrose tumoral alfa (anti-TNF-α). Trabalhos recentes relacionam estes fÃrmacos a um maior acometimento de infecÃÃes. O objetivo do estudo foi avaliar a ocorrÃncia de inflamaÃÃo, dor, cicatrizaÃÃo e presenÃa de infecÃÃes apÃs exodontias em pacientes com AR sob tratamento com anti-TNF-α e MTX que fizeram uso prÃ-operatÃrio ou pÃs-operatÃrio de amoxicilina. Os pacientes com AR foram distribuÃdos, de forma randÃmica, em dois grupos: grupo A (profilaxia antibiÃtica â utilizaram 4 cÃpsulas de 500mg de amoxicilina uma hora antes do procedimento) e grupo B (cobertura antibiÃtica- fizeram uso de uma cÃpsula de 500mg de amoxicilina de 8 em 8 horas por 5 dias). AlÃm desses, para fins de controle, um terceiro grupo foi formado por pacientes sem AR e sem prescriÃÃo de antibiÃticos. ApÃs avaliaÃÃo de exames hematolÃgicos e radiogrÃficos, foram realizadas 30 exodontias (13 pacientes com AR e 12 do grupo controle) por um mesmo operador nos 3 grupos. Esse operador, assim como os pacientes dos grupos A e B, desconhecia qual esquema de medicaÃÃo empregada. AvaliaÃÃes periÃdicas (24 horas, 72 horas, 7 dias, 14 dias e 30 dias apÃs o procedimento) foram feitas para identificar sinais clÃnicos e radiogrÃficos de infecÃÃo e de inflamaÃÃo. A avaliaÃÃo da cicatrizaÃÃo da ferida cirÃrgica foi feita atravÃs de mediÃÃes com um paquÃmetro nos intervalos de 24 horas, 72 horas, 7 dias e 14 dias. Para verificaÃÃo da sintomatologia dolorosa, utilizou-se uma escala visual analÃgica (VAS) que foi entregue aos pacientes apÃs a exodontia. Todos os pacientes fizeram 3 radiografias periapicais (antes da exodontia, com 24 horas e apÃs 30 dias) que foram digitalizadas e analisadas pelo software ImageJÂ com intuito de verificar o perÃodo cicatricial radiogrÃfico por meio da modificaÃÃo da Ãrea radiolÃcida alveolar. A maioria dos pacientes participantes foi mulheres, tanto no grupo controle (58,3%) quanto nos grupos A e B (83,3% e 100% respectivamente). Os nÃveis de plaquetas dos pacientes dos grupos A e B foram superiores aos do grupo controle (p=0,008). No que se refere aos sinais inflamatÃrios e de infecÃÃo, nÃo houve diferenÃa significativa entre os trÃs grupos, assim como nos Ãndices de dor e na cicatrizaÃÃo Ãssea avaliada radiograficamente, diferentemente dos Ãndices de cicatrizaÃÃo tecidual, onde os grupos A e B apresentaram menores Ãreas das feridas cirÃrgicas e melhor contraÃÃo das feridas que o grupo controle (p=0,005). Os pacientes dos grupos A e B apresentaram reparo Ãsseo, Ãndice de inflamaÃÃo e de infecÃÃo semelhantes ao grupo controle, entretanto, os parÃmetros de cicatrizaÃÃo tecidual nos grupos A e B foram superiores quando comparados ao grupo controle. Com isso, sugere-se que o uso da amoxicilina de forma profilÃtica seja o mais adequado e racional, uma vez que nÃo houve diferenÃa entre os esquemas antibiÃticos empregados. / Rheumatoid arthritis (RA) is an autoimmune condition characterized by an inflammation of the joints. The medications most commonly used in the treatment of RA are disease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX) and biological agents such as tumor necrosis factor alpha inhibitors (anti-TNF-α). These drugs are immunosuppressive and they are related to a higher incidence of infections. The aim of this study was to evaluate the occurrence of inflammation, pain, scarring, and the presence of infections after tooth extraction in patients with RA treated with anti-TNF-α and MTX that used pre or postoperative amoxicillin. The RA patients were divided randomly into two groups: Group A (antibiotic prophylaxis â a single dose of amoxicillin 2g orally, 1h prior to the procedure) and group B (postoperatively antibiotic - 500mg of amoxicillin 8/8h for 5 days). In addition, a third group was created for control purposes that consisted of patients without RA and with no prescription of antibiotics. After evaluation of hematologic and radiographic parameters were performed 30 extractions (13 patients with RA and 12 in control group) by a single operator. The distribution of medications was made randomly and double-blind. Periodic evaluation (1,3,7,14 and 30 days after the procedure) were taken in order to identify clinical and radiographic signs of infection, inflammation. The evaluation of wound healing was done through measurement with a caliper at intervals of 24 hours, 72 hours, 7 days, and 14 days. A visual analogue scale (VAS) was used for verification of painful symptoms which was delivered to the patients after the extractions. All patients had 3 periapical radiographs (before extraction, with 24 hours and after 30 days) that were digitized and analyzed by ImageJÂ software to verify radiographic healing period by modifying the alveolar radiolucent area. Most participants were women in control group (58.3%) and in groups A and B (83.3% and 100% respectively). Platelet levels of patients in groups A and B were higher than the control group (p = 0.008). In regard to inflammatory and infection signs, there was no significant difference between the three groups, as well as in pain levels and bone regeneration assessed radiographically, unlike tissue healing rates, where the groups A and B showed smaller areas of surgical wounds and the wounds contraction better than the control group (p = 0.005). Patients in groups A and B showed bone healing, inflammation and infection rate similar to the control group, however, the tissue healing parameters in groups A and B were higher when compared to the control group. In conclusion, it might be wise to suggest the use of amoxicillin prophylaxis considering rational antimicrobial use, since there was no difference between antibiotic regimens employed.

Orientador: Fabio Luiz Camargo Villela Berbert / Banca: Clóvis Monteiro Bramante / Banca: Mário Tanomaru Filho / Resumo: Este estudo objetivou: (1) comparar a topografia superficial e a interface entre a obturação e as paredes do canal de raízes seccionadas com laser, ultra-som ou broca; (2) avaliar o efeito do preparo retrógrado com retropontas ultra-sônicas ou laser na integridade da superfície apical; (3) e avaliar a espessura de dentina remanescente após retropreparos com laser ou ultra-som verificando sua correlação com o surgimento de trincas. Trinta dentes instrumentados e obturados foram usados para cada situação. No experimento 1, foram avaliados três métodos de apicectomias: broca Zekrya, ponta ultra-sônica CVD (9.5107-8) e laser de ErCr:YSGG (Waterlase). Para os experimentos 2 e 3, cavidades retrógradas foram preparadas com retropontas CVD (6.1107-6), retropontas EMS (DT-060/Berutti) ou laser de ErCr:YSGG. O tempo de preparo das apicectomias e das cavidades apicais foi registrado. Réplicas em resina epóxica das superfícies radiculares foram avaliadas por MEV. Todos os dados foram submetidos ao devido tratamento estatístico (Shapiro-Wilk, ANOVA, Tukey, Kruskal-Wallis, Student-Newman-Keuls) com α = 5%. A avaliação das réplicas após as apicectomias não revelou trincas e nem fraturas em nenhum dos grupos. A Zekrya apresentou o menor tempo para concluir as apicectomias (p<0,05) e produziu a superfície mais lisa e plana (p<0,05). A melhor adaptação entre obturação/dentina ocorreu no grupo do laser, mas sem diferença significativa para o ultra-som (p>0,05). A avaliação das réplicas das cavidades retrógradas mostrou que o laser de ErCr:YSGG removeu mais estrutura dental que as retropontas CVD e EMS (p<0,05). O Waterlase teve a maior média de tempo para os retropreparos (p<0,05). Fraturas no ângulo cavo-superficial ocorreram apenas no grupo da retroponta EMS. Os grupos CVD e EMS apresentaram melhores escores relacionados à qualidade do preparo do que o grupo com laser ErCr:YSGG (p<0,05). / Abstract: This study aimed: (1) to compare the surface topography, and the interface between the obturation and the root canal walls of roots resected with laser, ultrasonic tip, or bur; (2) to investigate the effect of retrograde preparations by using ultrasonic tips or laser on the integrity of root-end surfaces; (3) and to compare the thickness of surrounding dentine after ultra-sonics or laser root-end cavity preparation and its relationship with cracking formation. Thirty instrumented and root filled teeth were select for each situation. For the experiment 1, three root-end resections methods were evaluated: Zekrya bur, CVD (9.5107-8) ultra-sonic tip, and ErCr:YSGG laser (Waterlase). For the experiments 2 and 3, root-end cavities were prepared by CVD (6.1107-6) ultra-sonic tip, EMS (DT060/Berutti) ultra-sonic tip or ErCr:YSGG laser.The time required to cut through the apical portion of the root and to prepare the rootend cavity was recorded. Epoxy resin replicas of the root surfaces were assessed by SEM. Statistical analyses were performed using Shapiro-Wilk, ANOVA, Tukey, Kruskal-Wallis, and Student-Newman-Keuls tets (α = 5%). Assessment of the replicas of apices after apicectomy did not reveal cracks or fractures in any specimen. The Zekrya bur showed the lowest mean time to cut through the root-ends (p<0.05) and produced the smoothest and most uniplanar resected root surfaces (p<0.05). The best adaptation between the obturation and the root canal walls of roots was observed in laser group, but it did not differ from ultra-sonics group (p>0.05). The evaluation of the root-end cavities replicas showed that the ErCr:YSGG laser removed more dental structure than the CVD and EMS tips (p<0,05). The Waterlase showed the highest mean time to prepare the root-end cavity (p<0.05). / Mestre

Palavras-chave retiradas da vers?o impressa do trabalho. / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-09-19T20:33:45Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) anna_catharina_vieira_armond.pdf: 3140231 bytes, checksum: a3da3d5012b8c5145f53d838686f0611 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-10-09T13:25:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) anna_catharina_vieira_armond.pdf: 3140231 bytes, checksum: a3da3d5012b8c5145f53d838686f0611 (MD5) / Made available in DSpace on 2017-10-09T13:25:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) anna_catharina_vieira_armond.pdf: 3140231 bytes, checksum: a3da3d5012b8c5145f53d838686f0611 (MD5) Previous issue date: 2017 / O objetivo deste estudo foi avaliar a efic?cia da acupuntura no controle de dor, edema e trismo ap?s exodontia de terceiros molares e controle da ansiedade pr?-operat?ria comparada ? acupuntura placebo. Para isso, um ensaio cl?nico randomizado, controlado, triplo-cego, no formato boca dividida, foi realizado. Dezesseis pacientes com m?dia de idade de 22,5 (?3,45) anos foram submetidos ? remo??o dos dois terceiros molares inferiores em momentos diferentes e receberam quatro sess?es de acupuntura, uma anterior ? cirurgia e outras nos momentos 24, 48 e 72 horas ap?s. Nos momentos do baseline, 24, 48, 72 horas e 7 dias ap?s a cirurgia, foram feitas avalia??es de edema, atrav?s das medidas da face e trismo, pela abertura m?xima bucal. A dor foi avaliada pela escala visual anal?gica nos momentos 24, 48 e 72 horas e a ansiedade foi avaliada pelo question?rio STAI (State-Trate Anxiety Inventory) e pela escala visual anal?gica nos momentos baseline e antes e depois da acupuntura no dia da cirurgia. A an?lise estat?stica foi feita pelo teste T pareado e Wilcoxon. A acupuntura obteve melhor desempenho no controle de edema nos momentos 48 horas (p=0,026), 72 horas (p=0,046) e 7 dias (p=0,040) quando comparada ao placebo. N?o houve diferen?a estat?stica no controle de dor, trismo e ansiedade entre os grupos. Em conclus?o, o uso da acupuntura apresentou melhores resultados no controle de edema ap?s exodontia de terceiros molares quando comparada ? acupuntura placebo. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Odontologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / The objective of this study was to evaluate the efficacy of acupuncture in the control of pain, edema and trismus after third molar extraction and control of preoperative anxiety compared to placebo acupuncture. Thus, a randomized, controlled, triple-blind, split-mouth clinical trial was performed Sixteen patients with a mean age of 22.5 (?3,45) underwent removal of the two lower third molars at different times and received four acupuncture sessions, one prior to surgery and others at moments 24, 48 and 72 hours after. Edema evaluations were made through the measurements of the face and trismus by maximum buccal opening at the baseline and 24, 48, 72 hours and 7 days after surgery. The pain was evaluated by the visual analogue scale at moments 24, 48 and 72 hours and the anxiety was evaluated by the STAI questionnaire and the visual analogue scale at baseline and before and after acupuncture on the day of surgery. Statistical analysis was performed using the paired T test and Wilcoxon. Acupuncture showed better performance in the control of edema at 48 hours (p=0.026), 72 hours (p=0.046) and 7 days (p=0.040) when compared to placebo. There was no statistical difference in the control of pain, trismus and anxiety between the groups. In conclusion, the use of acupuncture showed better results on edema control after third molar extraction when compared to pacebo.

Submitted by Rúbia Gomes de Oliveira (rubiagoliveira@gmail.com) on 2018-10-04T19:18:25Z No. of bitstreams: 1 DISSERTAÇÃO - Final.pdf: 1168570 bytes, checksum: cad1e7fa9d153dc04d0ef37e6a0db0b2 (MD5) / Approved for entry into archive by Silvana Alvarez null (silvana@ict.unesp.br) on 2018-10-04T20:38:58Z (GMT) No. of bitstreams: 1 oliveira_rg_me_sjc.pdf: 1168570 bytes, checksum: cad1e7fa9d153dc04d0ef37e6a0db0b2 (MD5) / Made available in DSpace on 2018-10-04T20:38:59Z (GMT). No. of bitstreams: 1 oliveira_rg_me_sjc.pdf: 1168570 bytes, checksum: cad1e7fa9d153dc04d0ef37e6a0db0b2 (MD5) Previous issue date: 2018-08-16 / A exodontia de terceiros molares inferiores é uma prática comum nas clínicas odontológicas, porém o pós-operatório inerente a esta cirurgia apresenta dor, edema e trismo. Algumas das posições de inclusão do terceiro molar podem acarretar comprometimento periodontal nos segundos molares adjacentes. Com isso o presente trabalho buscou desenvolver através deste estudo clínico controlado, um protocolo com o laser de baixa intensidade para aplicação no pós-operatório das exodontias de terceiros molares mandibulares, de modo a minimizar os sinais e sintomas e melhorar os parâmetros periodontais dos segundos molares adjacentes. O laser empregado foi o Photon Laser III – DMC, São Carlos, SP/Brasil – como meio de condução o vermelho, com comprimento de onda 660 nm, potência útil de 30 mW, meio ativo AsGaAl. Sessenta pacientes de ambos os gêneros, com necessidade de exodontia dos terceiros molares, em classificações padrões de posição, foram randomizados em três grupos para análise – Grupo I: 10J/cm2, Grupo II: 30J/cm2 e Grupo III: Sham, e acompanhados pelo período de 6 meses. A análise do trismo e edema facial no pós-operatório e do nível clínico de inserção encontraram diferenças estatísticas significantes entre os grupos que receberam a terapia laser quando comparado ao grupo sham. Portanto, a utilização do laser de baixa intensidade como terapia adjuvante após a exodontia de terceiros molares demonstrou efetividade. Sendo que o Grupo I se destacou, após seis meses de avaliação. / The extraction of lower third molars is a common practice in dental clinics, but the postoperative period inherent to this surgery presents pain, edema and trismus. Some of the inclusion positions of the third molar can lead to periodontal involvement in the adjacent second molars. The aim of this study was to develop a low-intensity laser protocol for the post-operative treatment of mandibular third molar extractions in order to minimize the signs and symptoms and to improve the periodontal parameters of the second molars adjacent. The laser used was Photon Laser III - DMC, São Carlos, SP / Brazil - as red conduction medium, with wavelength 660 nm, useful power of 30 mW, active medium AsGaAl. Sixty patients of both genders, in need of third molar extraction in standard position classification, were randomized into three groups for analysis - Group I: 10J / cm2, Group II: 30J / cm2 and Group III: Sham, and monitored for the period of 6 months. The analysis of trismus and facial edema in the postoperative and the clinical level of insertion found significant statistical differences between the groups that received the laser therapy when compared to the sham group. Therefore, the use of the low intensity laser as an adjuvant therapy after third molar extraction was effective. As Group I stood out after six months of evaluation.

Made available in DSpace on 2014-06-11T19:24:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-04-28Bitstream added on 2014-06-13T19:52:08Z : No. of bitstreams: 1 fariajunior_nb_me_arafo.pdf: 2744351 bytes, checksum: d5a40b9a081c08ee1ecb555c255cffc7 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Este estudo objetivou: (1) comparar a topografia superficial e a interface entre a obturação e as paredes do canal de raízes seccionadas com laser, ultra-som ou broca; (2) avaliar o efeito do preparo retrógrado com retropontas ultra-sônicas ou laser na integridade da superfície apical; (3) e avaliar a espessura de dentina remanescente após retropreparos com laser ou ultra-som verificando sua correlação com o surgimento de trincas. Trinta dentes instrumentados e obturados foram usados para cada situação. No experimento 1, foram avaliados três métodos de apicectomias: broca Zekrya, ponta ultra-sônica CVD (9.5107-8) e laser de ErCr:YSGG (Waterlase). Para os experimentos 2 e 3, cavidades retrógradas foram preparadas com retropontas CVD (6.1107-6), retropontas EMS (DT-060/Berutti) ou laser de ErCr:YSGG. O tempo de preparo das apicectomias e das cavidades apicais foi registrado. Réplicas em resina epóxica das superfícies radiculares foram avaliadas por MEV. Todos os dados foram submetidos ao devido tratamento estatístico (Shapiro-Wilk, ANOVA, Tukey, Kruskal-Wallis, Student-Newman-Keuls) com α = 5%. A avaliação das réplicas após as apicectomias não revelou trincas e nem fraturas em nenhum dos grupos. A Zekrya apresentou o menor tempo para concluir as apicectomias (p<0,05) e produziu a superfície mais lisa e plana (p<0,05). A melhor adaptação entre obturação/dentina ocorreu no grupo do laser, mas sem diferença significativa para o ultra-som (p>0,05). A avaliação das réplicas das cavidades retrógradas mostrou que o laser de ErCr:YSGG removeu mais estrutura dental que as retropontas CVD e EMS (p<0,05). O Waterlase teve a maior média de tempo para os retropreparos (p<0,05). Fraturas no ângulo cavo-superficial ocorreram apenas no grupo da retroponta EMS. Os grupos CVD e EMS apresentaram melhores escores relacionados à qualidade do preparo do que o grupo com laser ErCr:YSGG (p<0,05). / This study aimed: (1) to compare the surface topography, and the interface between the obturation and the root canal walls of roots resected with laser, ultrasonic tip, or bur; (2) to investigate the effect of retrograde preparations by using ultrasonic tips or laser on the integrity of root-end surfaces; (3) and to compare the thickness of surrounding dentine after ultra-sonics or laser root-end cavity preparation and its relationship with cracking formation. Thirty instrumented and root filled teeth were select for each situation. For the experiment 1, three root-end resections methods were evaluated: Zekrya bur, CVD (9.5107-8) ultra-sonic tip, and ErCr:YSGG laser (Waterlase). For the experiments 2 and 3, root-end cavities were prepared by CVD (6.1107-6) ultra-sonic tip, EMS (DT060/Berutti) ultra-sonic tip or ErCr:YSGG laser.The time required to cut through the apical portion of the root and to prepare the rootend cavity was recorded. Epoxy resin replicas of the root surfaces were assessed by SEM. Statistical analyses were performed using Shapiro-Wilk, ANOVA, Tukey, Kruskal-Wallis, and Student-Newman-Keuls tets (α = 5%). Assessment of the replicas of apices after apicectomy did not reveal cracks or fractures in any specimen. The Zekrya bur showed the lowest mean time to cut through the root-ends (p<0.05) and produced the smoothest and most uniplanar resected root surfaces (p<0.05). The best adaptation between the obturation and the root canal walls of roots was observed in laser group, but it did not differ from ultra-sonics group (p>0.05). The evaluation of the root-end cavities replicas showed that the ErCr:YSGG laser removed more dental structure than the CVD and EMS tips (p<0,05). The Waterlase showed the highest mean time to prepare the root-end cavity (p<0.05).

Orientador: Eduardo Dias de Andrade / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-15T10:59:54Z (GMT). No. of bitstreams: 1 Moreira_Alcides_D.pdf: 1121532 bytes, checksum: c92e82c008dbefd9aa2585b01ab95d3f (MD5) Previous issue date: 2010 / Resumo: A analgesia preemptiva consiste na instituição de um regime analgésico previamente ao estímulo nociceptivo, com o objetivo de prevenir a hiperalgesia e a subsequente amplificação da dor. O objetivo deste trabalho foi avaliar a analgesia preemptiva com o lumiracoxibe, inibidor seletivo da cicloxigenase-2 (COX-2), em exodontias bilaterais de terceiros molares mandibulares retidos, comparando-a à analgesia preventiva. Foram selecionados 16 voluntários com bom estado de saúde geral, com indicação para a remoção dos dois terceiros molares mandibulares retidos, em posições simétricas e assintomáticos. O estudo foi delineado de forma duplo-cego e cruzado. Em uma das cirurgias os voluntários foram tratados com lumiracoxibe 400 mg, via oral, em dose única, administrada uma hora antes da cirurgia, seguido da administração de placebo, logo após o término do procedimento. Na cirurgia contralateral, de modo inverso, o tratamento consistiu do uso do placebo antes da intervenção, seguido da administração de lumiracoxibe 400 mg após o término do ato cirúrgico. A eficácia dos regimes analgésicos foi avaliada pelos seguintes parâmetros: tempo decorrido para a tomada do primeiro comprimido de analgésico a partir do final da intervenção; quantidade de comprimidos de analgésico tomada nas primeiras 24 h do pósoperatório; escala visual analógica nos tempos de 4, 8, 12 e 24 h e qualidade do tratamento. Não houve diferenças estatisticamente significantes entre os tratamentos preemptivo e preventivo no que se refere ao tempo requerido para a tomada da primeira dose de analgésico: 241,5 (±322,5) e 137,2 (± 246,48) minutos (p=0,3633); quantidade de comprimidos analgésicos tomados no período pósoperatório: 2,6 (±2,56) e 4,2 (± 5,13) comprimidos (p=0,5471), qualidade do tratamento (p=0,6794) e escala visual analógica (p=0,3916). Concluiu-se que o tratamento com lumiracoxibe, prévio ao estímulo nociceptivo (analgesia preemptiva) ou posterior a ele (analgesia preventiva), promove efeito analgésico efetivo e similar em cirurgias de terceiros molares mandibulares retidos. / Abstract: Preemptive analgesia is defined as an analgesic regimen established before the occurrence of noxious stimulus in order to prevent hyperalgesia and subsequent amplification of pain. The aim of this study was to evaluate the preemptive analgesia with lumiracoxib, a selective cicloxigenase-2 (COX-2) inhibitor, in impacted third molars surgery, compared to the protocol of preventive analgesia. Sixteen subjects who required elective surgical removal of symmetric and asymptomatic impacted mandibular third molars, in an outpatient setting were selected for the study, characterized as double-blind and crossover. In one of the surgeries, the volunteers where treated with lumiracoxib 400 mg orally in a single dose given one hour before surgery, followed by administration of placebo, immediately after the end of the procedure. Conversely, in contralateral surgery, treatment consisted of using placebo before intervention, followed by administration of lumiracoxib 400 mg after surgery. The effectiveness of analgesia was evaluated by the following parameters: time elapsed from the end of the intervention, until the first analgesic intake in the postoperative period; number of analgesic tablets consumed in the first 24 hours after surgery; visual analog scale (VAS) at of 4, 8, 12 and 24 h after the surgery and treatment quality. There were o statistically significant differences between preemptive and preventive treatments in relation to the time required for the first analgesic intake: 241.5 (± 322.5) and 137.2 (± 246.48) minutes (p = 0.3633), number of analgesic tablets taken in the postoperative period: 2.6 (± 2.56) and 4.2 (± 5.13) tablets (p = 0.5471), quality of treatment (p = 0.6794) and visual analog scale (p = 0.3916). It was concluded that treatment with lumiracoxib, prior to noxious stimulation (preemptive analgesia) or after it (preventive analgesia), promotes similar analgesic effect in lower impacted third molars surgery. / Doutorado / Farmacologia, Anestesiologia e Terapeutica / Doutor em Odontologia