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ABSTRACT: OBJECTIVE: To investigate in vivo the correlation between the bone microarchitecture of implant bone sites, bone tissue classification subjectively assessed in radiographs and primary implant stability. MATERIAL AND METHODS: Periapical and panoramic radiographs were obtained from 32 partially edentulous patients. Three surgeons classified bone quality at implant sites using two different methods: assessments in periapical and panoramic radiographs (PP) and according to the classification proposed by Lekholm and Zarb (L&Z). During the implant insertion, bone biopsies were taken, and three-dimensional parameters were measured by microcomputed tomography (microCT). Insertion torque value (ITV) and initial implant stability quotient (ISQ) were recorded at the moment of the implantation. ISQ was also recorded at the uncovering stage of a traditional implant protocol. RESULTS: Bone types 2 and 3 were the most prevalent classifications according to PP (54.3%) and L&Z (58.7%). The mean and standard deviation values of primary stability variables were 38.7(16.7) for ITV, 75.3 (7.7) for initial ISQ and 79.3 (6.8) for uncovering ISQ. Several microCT original and factor variables were found to correlate with bone tissue classifications and primary stability variables. L&Z correlated with architecture (r = 0.31; P < 0.05), density (r = -0.43; P < 0.01) and bulk (r = -0.35; P < 0.05), whereas ITV correlated with architecture (r = -0.40; P < 0.01) and density (r = 0.51; P < 0.01). Multiple linear regression analysis revealed that density and bulk explained 32% of the variability of L&Z bone classification, while density and architecture explained 42% of the variability of ITV. CONCLUSIONS: This study demonstrates the first step in validating L&Z classification. MicroCT provides objective and detailed quantitative data on bone microarchitecture. Intraosseous implant stability is mainly determined by the density of the bone. ITVs could be a good indicator of primary implant stability, whereas ISQs measurements have some limitations and should not be used alone.
Clinical Oral Implants Research 10/2012; · 2.51 Impact Factor
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ABSTRACT: BACKGROUND: Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients' clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. METHODS: Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. RESULTS: The most common diagnoses were localized masticatory muscle pain (n=125) and disc displacement without reduction (n=104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n=36), acute muscle pain (n=125), acute articular pain (n=75) and chronic articular impairment (n= 121). CONCLUSION: Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.
BMC Oral Health 08/2012; 12(1):26.
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ABSTRACT: The aim was to investigate the influence of social and health indicators on access to Primary Healthcare in the Belo Horizonte Metropolitan Area, Minas Gerais State, Brazil. Secondary data of 34 municipalities were analyzed; the dependent variables were three basic healthcare indicators: coverage of the Family Health Strategy; coverage of scheduled first dental appointment and mean annual number of appointments in medical specialties per inhabitant. All independent variables were analyzed using Principal Component Analysis, with VARIMAX rotation and Kaiser normalization. Student's t-test was used to compare the components originated by the factor analysis in relation to the primary care indicators with a significance of 5%. The development conditions had significantly greater weight in cities with low FHS coverage (p=0.022). The socioeconomic conditions were weighted significantly higher in municipalities with high dental appointment coverage (p=0.030) and with greater mean number of medical appointments (p=0.022). Socioeconomic and development conditions may be crucial to the identification of municipalities with the best and worst primary care indicators.
Ciencia & saude coletiva 11/2011; 16(11):4349-55.
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ABSTRACT: To identify the characteristics of bone tissue microarchitecture by microCT at dental implant bone sites, describing them in terms of clinical parameters.
Forty-six bone implant sites of the maxilla and mandible from 32 volunteers were evaluated by conventional radiographs and CT scans. During the installation of each implant, bone biopsies were removed using a trephine bur at the first drilling to prepare the socket implant. Each sample was evaluated by microCT and dimensional parameters measured.
Factor analysis summarized the microparameters into four components, which accounted for 92.8% of the total variance. The identified factors were (1) architecture - variables affecting 3D trabecular bone configuration and organization, (2) density - variables relating to surface/volume ratios and volume/volume ratios, (3) bulk - variables relating to the amount of bone and (4) spacing - variable related to the distance between trabeculae and the quantity and organization of marrow spaces.
These four summarized factors correspond to clinical and radiographically recognizable parameters used for routine bone quality evaluation for implant treatment planning, which can potentially influence the primary stability of dental implants. The understanding of factors related to bone microarchitecture might reveal important aspects of its mechanical properties, essential for implant success.
Clinical Oral Implants Research 07/2011; 23(8):981-6. · 2.51 Impact Factor
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ABSTRACT: Human papillomavirus (HPV) has been cited as a possible initiating agent in the pathogenesis of oral cancer. However, the literature tends to be both controversial and inconclusive about the prevalence of HPV and its potential for proliferation in oral squamous cell carcinoma (SCC). The aim of this study was to investigate the cellular proliferation and the presence of HPV in SCC and verrucous carcinoma (VC). Forty-seven samples of SCC were selected and divided into three groups: 39 SCC, 8 VC, and 9 of normal mucosa (control-CT). Quantitative analyses of all groups showed a greater expression of PCNA, followed by Ki-67 and cyclin B1. A significant difference was observed in cyclin B1 expression in the SCC group compared with VC. PCNA, Ki-67, and cyclin B1 were statistically significant when comparing the SCC and CT groups. However, when SCC and VC were compared, there was no difference in Ki-67 expression. Our results showed that only cyclin B1 had an association with histological grade, and that poorly differentiated tumors presented a higher expression of cyclin B1. Therefore, considerable differences in the cellular proliferation between SCC and VC were observed, and no correlation with HPV was established, since all samples were negative for HPV.
Tumor Biology 04/2011; 32(2):409-16. · 1.94 Impact Factor
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ABSTRACT: Low-level laser therapy has been used to reduce complications of head and neck cancer treatment. The aim was to assess the impact of laser in the quality of life (QOL) of patients receiving radiotherapy.
Sixty outpatients were randomly assigned into 2 groups. The laser group received applications and the placebo group received sham laser. QOL was assessed using the University of Washington QOL questionnaire. A repeated-measures analysis of variance (ANOVA) was used for comparisons of overall QOL scores and Mann-Whitney test compared changes in domain scores.
A decrease in QOL scores was observed in both groups and the reduction in the laser group was significantly lower (p < .01). Changes in QOL scores regarding pain, chewing, and saliva domains were evident in the placebo group. Both health-related QOL and overall QOL were rated higher by patients who received laser therapy.
Laser therapy reduces the impact of radiotherapy on the QOL of patients with head and neck cancer.
Head & Neck 04/2011; 34(3):398-404. · 2.40 Impact Factor
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ABSTRACT: The aim of this study was to qualitatively explore caregivers' perceptions of oral health care and factors influencing their work in a public long-term care institution for the elderly in Goiania, Brazil.
Data were collected from a sample of 10 caregivers using personal in-depth interviews and observation.
Caregivers were mainly nurses' aides without training in oral health care. Oral health was associated with access to dental treatment, oral hygiene and use of dentures. Edentulousness, use of inappropriate dentures and appetite loss were perceived as negative images. Procedures used for oral hygiene were toothbrushing, mouth cleaning with a gauze and using a mouthwash. Conflicting priorities in routine care, lack of caregivers' knowledge and the co-operation of the elderly were the main obstacles to satisfactory oral care.
Oral health care of the elderly was perceived as a burden by caregivers, and did not follow a standard protocol. Caregivers' knowledge and perceptions reinforce the need for education and training in oral health issues.
Gerodontology 03/2011; 28(1):69-75. · 1.03 Impact Factor
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ABSTRACT: To investigate the impact of the anterior teeth display during smiling (ATDDS) on the self-perceived psychosocial impacts of malocclusion in adolescents.
This cross-sectional study included a convenience sample of 301 adolescents (mean age 16.1 years, SD 1.8 years; 58.1% female). Two instruments were used for data collection: (1) the Dental Aesthetic Index (DAI) and (2) the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). In addition, ATDDS was assessed in posing smiling, and adolescents' satisfaction with their dental appearance was investigated. Data analysis included descriptive statistics, Kruskal-Wallis test and Mann-Whitney U-test, Spearman correlation, and multiple linear regression analysis.
Significant associations were observed between independent variables (ATDDS, DAI scores, and satisfaction with dental appearance) and total PIDAQ score (R(2) = 0.37) and dental self-confidence (R(2) = 0.37), psychological impact (R(2) = 0.30), esthetic concern (R(2) = 0.20), and social impact (R(2) = 0.15).
The excessive anterior teeth display during smiling may potentially influence the self-perceived psychosocial impacts of malocclusion in adolescents depending on the severity level of malocclusion and the self-reported satisfaction with dental appearance.
The Angle Orthodontist 01/2011; 81(3):540-5. · 1.21 Impact Factor
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ABSTRACT: A retrospective survey was designed to identify diagnostic subgroups and clinical factors associated with odontogenic pain and discomfort in dental urgency patients. A consecutive sample of 1,765 patients seeking treatment for dental pain at the Urgency Service of the Dental School of the Federal University of Goiás, Brazil, was selected. Inclusion criteria were pulpal or periapical pain that occurred before dental treatment (minimum 6 months after the last dental appointment), and the exclusion criteria were teeth with odontogenic developmental anomalies and missing information or incomplete records. Clinical and radiographic examinations were performed to assess clinical presentation of pain complaints including origin, duration, frequency and location of pain, palpation, percussion and vitality tests, radiographic features, endodontic diagnosis and characteristics of teeth. Chi-square test and multiple logistic regression were used to analyze association between pulpal and periapical pain and independent variables. The most frequent endodontic diagnosis of pulpal pain were symptomatic pulpitis (28.3%) and hyperreactive pulpalgia (14.4%), and the most frequent periapical pain was symptomatic apical periodontitis of infectious origin (26.4%). Regression analysis revealed that closed pulp chamber and caries were highly associated with pulpal pain and, conversely, open pulp chamber was associated with periapical pain (p<0.001). Endodontic diagnosis and local factors associated with pulpal and periapical pain suggest that the important clinical factor of pulpal pain was closed pulp chamber and caries, and of periapical pain was open pulp chamber.
Brazilian dental journal 01/2011; 22(4):306-11.
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Sérgio Henrique Nascente Costa,
Luiz Carlos da Cunha,
Maurício Yonamine,
Liuba Laxor Pucci,
Fernando Gomes Ferreira Oliveira,
Camila Gabriela de Souza,
Guilherme Alves Mesquita,
Ana Paula de Toledo Vieira,
Ludmilla Barros Vinhal,
Janayna Dalastra, Cláudio Rodrigues Leles
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ABSTRACT: To determine the prevalence of psychotropic drug use among military police officers in the state of Goiás, Brazil.
Study carried out at twelve military police units located in the municipalities of Goiânia and Aparecida de Goiânia between March to October 2008. Volunteers (n=221) were interviewed about drug use using a questionnaire especially designed by the Centro Brasileiro de Informações sobre Drogas Psicotrópicas (CEBRID). Descriptive statistics was used to determine the prevalence of licit and illicit drug use in the study sample.
The frequency of use was divided into: 1) lifetime use: tobacco-39.9%, alcohol-87.8%, cannabis-8.1%, cocaine-1.8%, stimulants-7.2%, solvents-10.0%, sedatives, anxiolytics, antidepressants-6.8%, LSD-0.5%, Bentyl®-0.5%, anabolic steroids-5.4%; 2) use in the previous year: tobacco-15.4%, alcohol-72.9%, stimulants-6.3%, solvents-0.5%, sedatives, anxiolytics, antidepressants-3.7%; 3) use in the previous 30 days: tobacco-14.5%, alcohol-57.5%, stimulants-5.0%, solvents-0.5, sedatives, anxiolytics, antidepressants-3.7%.
The high prevalence rate of psychotropic drug use found amoung military police officers in two cities of the state of Goiás in Brazil can be considered an important factor with potential influence on job activities.
Revista Brasileira de Psiquiatria 12/2010; 32(4):389-95. · 1.20 Impact Factor
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ABSTRACT: The aim of this study was to investigate the expression of bone resorption (RANK/RANKL), bone resorption inhibitor (osteoprotererin [OPG]), and bone formation marker (osteocalcin [OC]) in neoplastic and bone-related lesions (BRL).
Using immunohistochemistry, their expression was evaluated in ossifying fibroma (OF), fibrous dysplasia (FD), simple bone cysts (SBC), central giant cell lesions (CGCL), and osteosarcoma (OS).
Quantitative analyses of the expression of bone markers between all lesions, considering fibroblast-like cells and bone matrix, showed that RANK-RANKL presented higher expression in OF and CGCL, whereas OPG and OC presented higher expression in FD and SBC. There was higher expression of all proteins investigated when OS was the BRL. Moreover, the RANKL expression was greater than OPG in this neoplasm.
Our data indicate that the bone resorption markers are more highly expressed in OF, CGCL, and OS than in FD and SBC, indicating a significant association between these proteins and the clinical behavior of these lesions.
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 11/2010; 110(5):624-31. · 1.50 Impact Factor
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ABSTRACT: To compare 12-year-old students from public and private schools in the city of Goiânia, Brazil, in terms of the prevalence of caries, periodontal conditions, dentofacial anomalies, and fluorosis.
In 2003, the 2002-2003 Oral Health Conditions in the Brazilian Population project (SB Brasil) was expanded to Goiânia as a cross-sectional study, as described in the present article. The sample included 1 947 students from urban schools: 1 790 (91.9%) attended public schools and 157 (8.1%) attended private schools. Data on the following oral conditions were collected through clinical examination: dental caries (decayed, missing, or filled teeth index, DMFT), periodontal condition (Community Periodontal Index, CPI), dentofacial anomaly (Dental Aesthetics Index, DAI), and dental fluorosis (Dean index). The groups were compared using the chi-square and Mann-Whitney U tests.
There were differences between the public and private schools for all the variables. DMFT, CPI, and DAI indexes were higher in children from public schools (P < 0.05). Fluorosis was more prevalent in students from private schools (P < 0.05).
The type of school was associated with the oral health condition of the children in this sample. Investments in actions and services to mitigate this inequality and its effects should be made as part of the policies to promote oral health.
Revista Panamericana de Salud Pública 08/2010; 28(2):86-91. · 0.85 Impact Factor
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ABSTRACT: This clinical report presents an implant-retained obturator overdenture solution for a Prosthodontic Diagnostic Index Class IV maxillectomy patient with a large oronasal communication and severe facial asymmetry, loss of upper lip and midfacial support, severe impairment of mastication, deglutition, phonetics, and speech intelligibility. Due to insufficient bone support to provide satisfactory zygomaticus implant anchorage, conventional implants were placed in the body of the left zygomatic arch and in the right maxillary tuberosity. Using a modified impression technique, a cobalt-chromium alloy framework with three overdenture attachments was constructed to retain a complete maxillary obturator. Patient-reported functional and quality of life measure outcomes were dramatically improved after treatment and at the two-year follow-up.
Journal of Prosthodontics 04/2010; 19(3):240-4. · 1.01 Impact Factor
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ABSTRACT: Maxillofacial injuries occur in a significant number of trauma patients. Epidemiological assessments are essential to reaffirm patterns, identify new trends and develop clinical and research priorities for effective treatment and prevention of these injuries.
The aim of this study was to identify the epidemiological profile and risk factors associated with maxillofacial trauma treated at a referral emergency hospital for the Public Health System in the State Capital of Goiás, Brazil.
A cross-sectional study was designed including 530 patients with maxillofacial trauma, 76% male, with a mean age of 25.5+/-15.0 years. Data were collected between May 2003 and August 2004 over weekly shift-working periods.
The main causes of trauma were traffic accidents (45.7%) and physical assaults (24.3%), and differences in etiological factors were identified according to gender (p<0.001). The distribution of patients according to age and etiology showed significant differences for traffic accidents (p<0.01), physical assaults (p<0.001), falls (p<0.001) and sport injuries (p<0.01). In the multinomial logistic regression analysis (R(2) = 0.233; p<0.05), age was associated with injury in traffic accidents and falls (p<0.01), sports-related accidents were associated with males (p<0.05), and alcohol consumption with assaults and traffic accidents (p<0.001). Facial soft tissue lesions were found in 98% of patients and facial fractures in 51%.
The significant association of maxillofacial trauma with young males and alcohol consumption reinforces the need for educational strategies and the development of policies for the prevention and reduction of associated damage in this specific risk group.
Journal of applied oral science: revista FOB 02/2010; 18(1):23-9. · 0.39 Impact Factor
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ABSTRACT: Tumor-infiltrating lymphocytes (TILs) are a heterogeneous cell family which plays an important role in tumor-associated immune response. Of these, T regulatory (Treg) cells have also been shown to inhibit anti-tumor response. We aimed to evaluate the expression of T regulatory cell markers (CD4, CD25, CTLA-4 and FoxP3) in samples of oral cavity squamous cell carcinoma (OCSCC) and lip SCC (LSCC) by immunohistochemistry. The relationship of Treg markers with survival data and the proliferative index were also evaluated. We observed similar numbers of CD4-, CD25- and FoxP3(+) cells in OCSCC and LSCC. On the other hand, numbers of CTLA-4(+) cells were significantly lower in OCSCC than in LSCC. OCSCC samples with high numbers of CD4 exhibited a high proliferative index, while samples with high CTLA-4 counts demonstrated a low tumoral proliferative index. A log-rank test showed that patients with OCSCC that presented high counts of CD4 showed a significantly decreased survival compared with patients with low cell counts. In contrast, high CD25(+) cell counts were associated with increased survival. Our results suggest an association of CD4 with poor prognosis, while CD25 expression is related with favorable prognosis. These findings result from the heterogeneity of TIL subsets that display an antagonistic role in tumor immune cell response.
Oncology letters 01/2010; 1(1):127-132. · 0.11 Impact Factor
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Gerodontology 01/2010; · 1.03 Impact Factor
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ABSTRACT: The aim of this study was to observe the prevalence of diagnostic groups of temporomandibular disorders (TMD) in patients who were referred or sought treatment for TMD and/or orofacial pain in a private clinic. The clinical records of 357 patients were evaluated and selected based on inclusion/exclusion criteria; the mean age was 32 years. A clinical examination was performed and the diagnosis was based on the American Academy of Orofacial Pain criteria. Results showed that 86.8% of patients were women and 93.3% of the patients presented more than one diagnosis. The most frequent chief complaint (n = 216, chi2 = 30.68, p = 0.001) and total diagnosis realized (n = 748, chi2 = 14.14, p = 0.001) were muscle related. We concluded that women seek treatment for dysfunction/disorders of orofacial structures more than men do; patients seeking specialized treatment have more than one diagnosis and muscle dysfunction is more prevalent than intra-articular disorders.
Cranio: the journal of craniomandibular practice 08/2009; 27(3):194-9. · 0.66 Impact Factor
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ABSTRACT: The chemokine stromal cell-derived factor (SDF-1/CXCL12) and its specific receptor, CXCR4, have been implicated in the regulation of tumor growth and organ-specific spread. The aim of this study was to determine the expression of CXCL12 and CXCR4 in samples obtained from primary squamous cell carcinoma (SCC) of the oral cavity (OCSCC) and of the lip (LSCC) and in metastatic and non-metastatic lymph node tissues. The relationship of CXCL12/CXCR4 with clinical and microscopic parameters was also evaluated. The analysis of mRNA expression revealed a higher expression of CXCR4 in oral SCC compared with healthy oral mucosa (p = 0.006). The density of CXCR4+ cells was higher in parenchyma of OCSCC with lymph node metastases than in LSCC. With regard to the stroma, OCSCC showed a greater CXCR4+ and CXCL12+ cell percentage in relation to LSCC. Furthermore, the density of CXCL12+ and CXCR4+ nodal cells was higher in metastatic than non-metastatic lymph nodes in the same patients. Considering clinical and microscopic parameters, we found a positive association between the percentages of CXCL12+ and CXCR4+ stromal cells and the tumor proliferation index. Our findings suggest that the CXCL12/CXCR4 system may play a role in tumor cell spread to lymph nodes and also in neoplastic development.
Tumor Biology 10/2008; 29(4):262-71. · 1.94 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the accuracy of imaging methods for detection of apical periodontitis (AP). Imaging records from a consecutive sample of 888 imaging exams of patients with endodontic infection (1508 teeth), including cone beam computed tomography (CBCT) and panoramic and periapical radiographs, were selected. Sensitivity, specificity, predictive values, and accuracy of periapical and panoramic radiographs were calculated. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic accuracy of the panoramic and periapical images. Prevalence of AP was significantly higher with CBCT. Overall sensitivity was 0.55 and 0.28 for periapical and panoramic radiographs, respectively. ROC curves and area under curve (AUC) with periapical radiography showed a high accuracy for the cutoff value of 5 for both periapical (AUC, 0.90) and panoramic (AUC, 0.84) radiographs. AP was correctly identified with conventional methods when showed advanced status. CBCT was proved to be accurate to identify AP.
Journal of Endodontics 04/2008; 34(3):273-9. · 2.88 Impact Factor
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ABSTRACT: The aim of this study was to compare the expression of nuclear factor kappaB (RANK), RANK ligand (RANKL), and osteoprotegerin (OPG) in odontogenic epithelial tumors and dentigerous cysts.
The expression of these molecules was evaluated in solid/multicystic ameloblastomas (n = 12) and unicystic ameloblastomas (n = 8), keratocystic odontogenic tumors (n = 19), dentigerous cysts (n = 9), and dental follicles (n = 9) by immunohistochemistry.
In odontogenic epithelium, a similar expression of RANK, RANKL, and OPG was observed in all samples. With regard to stroma, the number of RANK-positive and RANKL-positive cells was higher in solid/multicystic ameloblastomas compared with dentigerous cysts. Dental follicles had lower numbers of RANK-positive, RANKL-positive, and OPG-positive cells than solid/multicystic ameloblastomas and keratocystic odontogenic tumors. The majority of solid/multicystic ameloblastomas (75%) and unicystic ameloblastomas (62.5%) had higher numbers of RANKL-positive than OPG-positive cells. In contrast, 62.4% of keratocystic odontogenic tumors and 100% of dentigerous cysts exhibited a higher content of OPG-positive than RANKL-positive cells.
Our results indicate differences in the RANK, RANKL, and OPG expression in odontogenic epithelial tumors. The imbalance of these factors could contribute to the differential bone/tooth resorption activity in these lesions.
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 04/2008; 105(3):333-41. · 1.50 Impact Factor
