Ordem dos Médicos Dentistas (OMD)

The authors present a clinical case of bone atrophy at the level of premolars of the 2nd Q, regenerated with autograft in a block collected from the mandible body (oblique line), xenograft, PRGF and collagen membrane fixed with metal pins. Discussion: Various types of bone substitutes are available for this type of surgery. For many authors, the autograft is considered the ideal graft. In this case, given the great bone atrophy in thickness and height and the demanding aesthetic component (high smile line), exactly this type of graft was chosen. It has the inconvenience of the need for another surgical site, which can translate into more comorbidity. In any case, it is a very predictable procedure with good clinical results. Conclusions: In the absence of quantity and quality of bone for rehabilitation with dental implants, the surgeon has available surgical techniques and varied bone substitutes. One of these techniques is the autograft, considered by many to be the “Gold Standard” of bone grafting. In this case and in view of the need for a significant horizontal increase, as well as the desirable vertical increase and the availability of intraoral donors, this type of graft was obtained. The result obtained is predictable and with very satisfactory results. Schlagwörter: Autologous bone augmentation, Dental implants

Introduction and Aim: Larger periapical lesions are a challenging surgical procedure due to the greater amount of resorbed bone. L-PRF, a concept of naturally guided tissue regeneration, contains a dense fibrin network which releases various growth factors, cytokines and proteins. L-PRF improves the initial stages of healing, reducing the inflammatory process and risk of infection. Although L-PRF is popular among other dental fields, its regenerative potential in the apical region still seems to be unclear, therefore the aim of this review was to interpret the currently available literature and ascertain its effectiveness. Method: Search was carried out in PUBMED’s and EBSCO’s databases, between 2010 and 2020, combinations of keywords were used to find appropriate clinical and in vitro studies. Only articles in English were considered and human studies were not limited to RCTs. Results: In the 24 selected studies, L-PRF demonstrated to induce the proliferation of fibroblasts and stem cells, accelerate hemostasis, suppress osteoclastogenesis, increase osteoblastic expression and release growth factors, cytokines and proteins. In the apical region, complete regeneration was achieved in all studies and, a reduction of post-surgical pain, inflammation and administration of analgesics was also demonstrated. The centrifugation protocol and materials used demonstrated an influence over the viability of L-PRF. Conclusions: L-PRF in endodontic microsurgery achieved total apical regeneration in all studies. Nevertheless, more research, preferably with a implemmented standardized protocol, is required. Clinical Implications: L-PRF potentially accelerates hemostasis and tissue regeneration in the apical region, decreases inflammation, risk of infection and post-surgical pain. Schlagwörter: L-PRF, periapical lesions, healing process, bone recovery, tissue regeneration

Case report: A 12 years-old boy, with a preliminary radiographic diagnosis of pre-eruptive radiolucent lesion, made in 2016. In 2019, the diagnosis was confirmed through clinical observation after placing a separator orthodontic elastic in the interproximal space and radiographic exam. The treatment implemented was a full removal of the lesion, followed by dental bonding with total-etch (Prime&Bond®NT - DENTSPLY SIRONA) and restoration with composite resin (Synergy® Compact colour A2/B2 - Coltène Whaledent®). Follow-up after 6 months was performed. Discussion: Pre-eruptive intracoronal radiolucency is characterized by a well-circumscribed radiolucent area, within the dentine of unerupted teeth and close to the amelodentinal junction. There is yet no consensus regarding the clinical management of this lesion, due to a low predictability of its clinical course. The difficulty to perform a differential diagnosis with other lesions is aggravated, in particular with dental caries, at least until the eruption of the affected tooth. Conclusion: There are no reports of progression or reactivation of the lesion after dental restoration. Therefore, this seems to be the most appropriate therapeutic option, according to the particularities of each clinical situation. However, more prospective and retrospective studies are required in order to develop clinical guidelines for the treatment of this type of crown lesions. Schlagwörter: Pre-eruptive intracoronal radiolucency, Pre-eruptive intracoronal resorption, Radiolucent lesion, Unerupted teeth, Dentin, Clinical management

Endodontic treatment, in cases of traumatic teeth with immature apex, requires special care, due to anatomical particularities: Wide root canal, little thickness of dentine walls, absence of apical constriction and apical divergence. Currently, there are several apexification techniques using calcium hydroxide, MTA or other materials based on calcium silicate, as well as regenerative endodontic treatments. Female patient, 8 years old, attended the consultation with buccal fistula associated with tooth 11 and also discolored tooth. Parents reported a history of trauma a year and a half ago and dental phobia. After clinical and radiographic evaluation, it was diagnosed pulp necrosis, chronic apical abscess and incomplete root formation. Due patient's dental phobia, the suggested treatment was apexification with an MTA apical plug (MAP), in a surgery room. MTA has a high potential on endodontic treatments due to its sealing capacity, resistance to microleakage and the fact that it can be used in a humid environment or in the presence of blood, making it suitable for use as an apical barrier in teeth with immature apex. Due to this fact, reducing the apexification time for a single session allows definitive restoration to be carried out briefly in order to achieve the coronary resistance, reducing the risk of fracture. With the presentation of this clinical case, we pretend to highlight the importance of using MTA in apexification due to its high predictability in relation to apical sealing because it allows a reduction in the number of sessions and less dependence on patient compliance. Schlagwörter: MTA, Apexification, Surgery Room

Introduction: Attractiveness plays an important role in personal self-esteem and social relationships, influencing our daily life. Therefore, it is essential to know the characteristics of a beautiful face. Objectives: The objective of this investigation was to evaluate the relationship between facial attractiveness and several hard and soft tissue cephalometric variables, in individuals with Class I and III. Material and methods: Facial attractiveness of 40 individuals with skeletal Class I and III was determined by 14 laymen using a Visual Analog Scale, in the frontal, frontal smiling, profile, and the triplet photographs. Facial attractiveness scores were correlated with the cephalometric analysis, through a non-linear regression. Results: A quadratic correlation described by a U-shaped curve was verified, between the distance LLip-SnPog' line and the attractiveness of the frontal (r=0,52, p=0,003) and profile photographs (r=0,42, p=0,003); and between the SNA angle and the triplet attractiveness (r=0,49, p=0,006). Maximum attractivity scores were found with LLip-SnPog'=3,8mm/3,7mm and SNA=83,8 degrees. Discussion and Conclusions: The correlation between cephalometric variables and facial attractiveness may assume a non-linear relationship, represented by a parabola of lower concavity, where the turning point corresponds to the maximum attractiveness. Few studies have investigated this type of correlation. Facial attractiveness assessed from the frontal and profile photographs showed a non-linear correlation with a soft tissue cephalometric variable assessing lip protrusion, and the facial attractiveness of the triplet with a skeletal measurement, the SNA angle. Schlagwörter: Attractiveness, Face, Class III, Cephalometrics, Photographs

Introduction: Temporomandibular disorder (TMD) is the most common cause of orofacial pain with non-dental origin, being pain the most frequent symptom. Bruxism is a movement disorder characterized by the clenching or grinding of teeth, often associated with TMD. The numerical scale has been widely used to record pain intensity. Objective: To evaluate the evolution of pain intensity in patients diagnosed with TMD and / or Bruxism before and after treatment, using the numerical scale. Materials and Methods: Longitudinal retrospective study to 5 years, carried out by consulting clinical processes in a university clinic (2015-2020). Results: For all groups, there was a reduction in pain intensity. The evolution of pain intensity was more significant for patients with TMD II, this reduction being 63.3% at peak, 80% in latency and 85.7% in current pain. Likewise, there was a more notable evolution for patients with Mixed Bruxism, with a decrease of 58.2% at peak, 86.5% in latency and 74% in current pain. Discussion: The population of this study is characterized by 80.2% of female patients and the average age is 42.2 years. Conservative therapy appears to be associated with symptom relief in both TMD and Bruxism cases. These results are according to previous studies. Conclusion: Pain intensity decreased in most diagnoses studied after conservative treatments. Clinical Implications: The pain scale has shown good clinical applicability for monitoring patients with TMD and/or Bruxism. Conservative treatments seem to have a positive effect on painful symptoms. Schlagwörter: Temporomandibular disorder, pain intensity, numerical scale, Bruxism

The extraction of a tooth is always accompanied by the resorption of the surrounding support tissues, a problem with which the dentist is inevitably challenged as the loss of soft tissues limits the aesthetic and functional prognosis of rehabilitation. The socket-shield (SST) technique is a promising complement to the treatment of patients with fixed rehabilitation, preserving the supporting tissues of the periodontal bone-ligament complex, especially in aesthetically challenging cases such as total rehabilitation. The use of digital implant placement planning tools and surgical guides provides greater accuracy and precision in implant placement. In this poster, we present the digital planning performed, the surgical technique of implant placement and total fixed upper rehabilitation of partially edentulous patient. Schlagwörter: rehabilitation, implants, socket shield, fixed rehabilitation

A big challenge in oral surgery includes the bioengineering of biomaterials that simultaneously promote soft and hard tissue regeneration while stimulating a pro-regenerative immune phenotype to support tissue remodeling. A strontium-rich hybrid system was developed, composed of Sr-doped HAp microspheres, delivered in an alginate vehicle. Herein a bilayer system based on the latter was developed, aiming to promote both gingival and bone tissue regeneration. This system was further enriched with decellularized human fetal membranes (dh-FMs). The objective of this work was to evaluate the immunomodulatory potential of a bilayer strontium-hybrid system doped with dh-FMs. A triton-X-based decellularization was performed. The physicochemical integrity and absence of nuclei was analyzed by histology, electronic microscopy, atomic force microscopy, and Fourier transform infrared spectroscopy analysis. Macrophage inflammatory response was evaluated by flow cytometry and ELISA assays. Statistically analysis was performed using Kruskal-wallis test. The effectiveness of the decellularization process was confirmed by the absence of nuclei and maintenance of its chemical structural integrity. The preliminary results indicated a low macrophage activation and a decrease of TNF-alpha, IL-4, and IL-6 secretion upon dFMs integration. Regarding the innovative biomaterial design, the understanding of biological approaches to mitigate the foreign body response and drive the tissue inflammation into a pro-regenerative phenotype is essential. Therefore the incorporation of dh-FMs into a biomaterial showed to be an interesting strategy for tissue regeneration. The preliminary results concerning immunomodulatory properties indicated low macrophage activation. We concluded that the dh-FMs incorporation into a biomaterial showed to be a promising multifunctional tissue approach. Further tests should be performed to explore the immunomodulation capacity of the biomaterial. Schlagwörter: Decellularization, fetal membranes, alginate, strontium, nano-hydroxyapatite, inflammation, macrophages

Gingival Recession is defined as the apical location of the gingival margin in relation to the cementoenamel junction (JEC) of a tooth which causes root exposure in the oral cavity. Several surgical techniques have been proposed for the treatment of this pathology. Laterally Positioned Flap is the method of choice whenever the keratinized gingiva adjacent to the defect is adequate in length and thickness and there is not enough keratinized gingiva apical to the recession to be coronal repositioned. This poster reports a clinical case of a 23-year-old female presented two Miller's class III gingival recessions in teeth 31 and 41. According to the clinical picture, and in order to resolve the aforementioned situation in a single surgical time, the following treatment plan was established: Double laterally positioned flap + Enamel matrix proteins derivatives + Connective tissue graft. Different degrees of complexity are emerging in the treatment of gingival recessions. The dentist must be able to interconnect techniques and modifications in order to establish the most appropriate treatment plan for each situation. The double laterally positioned flap was effective in the treatment of two contiguous gingival recessions in a single surgical procedure. Schlagwörter: Gingival recession, pedicle gingival graft, laterally positioned flap, connective tissue graft

Introduction: Peri-implantitis results from a process that involves bacterial interactions and an excessive inflammatory response. The purpose of the modifications present on implant surfaces is to positively affect the tissue response to osteointegration. Goals: Pilot study: Characterization of the microbiome formed on titanium implant surfaces placed in devices present in the oral cavity of human volunteers and to investigate the impact of microorganisms on the implants structure. Materials and methods: 22 volunteers used intraoral devices containing a laterally machined titanium implant and another implant with Vellox® surface treatment (double acid etching + blasting with Al2O3) for a period of 48 hours. The adhered microbiome was characterized using gene sequencing. Additionally, the studied implants were observed by MEV and their wettability was analyzed. Results: The Vellox® surface showed a higher contact angle in comparison with the machined surface, characterizing them as hydrophobic. The machined surface and the Vellox® surface differ microscopically in terms of their nanostructure. Bacterial adhesion to both surfaces occurs qualitatively in a similar way. Discussion: The superficial microscopic aspects determined in the studied implants are in agreement with those described in the literature. It was possible to verify that the bacterial composition on both studied surfaces was the same. These results contrast with those described in the literature in which there appears to be a greater bacterial adhesion to irregular surfaces. Clinical implications: Understanding peri-implantitis by its microbiological etiology and the mechanisms that manufacturers can adopt to reduce its incidence. Conclusion: Wettability and the surfaces microtopographic characteristics do not promote the initial biofilms adhesion to the surfaces with different treatments, in the studied implants. Schlagwörter: Bacterial adhesion, titanium, implant, implant surface, wettability, surface properties

Introduction: Dental erosion is considered a challenge in oral rehabilitation. Adhesion to eroded substrates, especially dentin, is complex and defiant. Therefore, it is important to find out which adhesive protocols are evidence-based and what has been researched up to this date. Objectives: To report and summarize in vitro research that tested bond strength in eroded enamel/dentin. This will identify current knowledge gaps and guide future research. Methods: The review was conducted following PRISMA-ScR guidelines. PubMed/Medline, Scopus and EMBASE databases were searched to identify peer-reviewed articles published in the last 10 years. Laboratory studies which tested bond strength in human/bovine samples were included. Three reviewers independently performed data charting and quality assessment of papers. Results: The search retrieved 29 studies. The studies included comparison of restorative materials and application modes, enzymatic inhibitors, surface pre-treatments and remineralization techniques. Dentin (76%) was the preferred substrate, whereas 17% tested enamel and 7% evaluated both. 83% of studies document an effective intervention. The majority of studies tested an etch-and-rinse adhesive strategy. Conclusion: It is well established that eroded enamel seems to be beneficial as a substrate for adhesion, while the contrary happens in dentin. Adhesive type and composition seem significant in bonding to the latter. 10-MDP-containing adhesives demonstrated better bond strength results. Remineralising agents also represent a promising method to increase bond in dentin and should be further studied. Clinical implications: Establishing clear protocols based on current in vitro evidence is key to impact clinical outcomes regarding adhesion to an eroded substrate. Adhesive choice in dentin and remineralising formulations should be considered. Schlagwörter: dentin, erosion, adhesion, enamel, eroded, in vitro

In Forensic Odontology, the estimation of the stature often has a crucial role in the reconstructive phase of disjointed populations. The femur, being the longest bone in the human body, is usually the most reliable source in height estimation. This investigation aims to estimate the stature as well as to identify the minimum number of individuals (MNI) of the catastrophic population concerning the earthquake that occurred in 1755 in Lisbon, whose skeletal remains were found in the Cloister’s South Wing of Academia das Ciências de Lisboa in 2004. This study was conducted on eight complete femurs and twenty-one fragments, which were measured, using an absolute digimatic Mitutoyo® caliper or a vernier Mitutoyo® caliper, and weighted. Mildred Trotter and Goldine C. Gleser’s (1952) study was used to estimate the height using whole femurs. Based on the fragmented femurs, the total length of the femur was calculated using Steele and Mckern’s (1970) study. Afterwards, Mildred Trotter and Goldine C. Gleser’s (1952) study was applied in order to estimate each individuum’s height. It was possible to determine a minimum number of individuals (MNI) of 29, correspondent to 8 left whole femurs (from a total number of 14) and 21 left femur bodies (from a total number of 58). The results showed that, for the whole femur, the height varies between 148 cm and 169 cm and regarding the fragments, they vary between 151,67 cm and 181,59 cm. The results of the estimated heights are compatible with the expected for that period of time, therefore the carried-out investigation reveals that the applied methods seem to be viable. Schlagwörter: Forensic odontology, femur, estimation of height, catastrophic population

In regards to Forensic Odontology, sex classification from unknown skeletal remains is vital in the reconstruction phase, and the most accurate methods to do it have been researched extensively on various bones of the human skeleton. The present work consists in the analysis of 129 coxal bones belonging to a population attributed to the 1755 Lisbon’s Earthquake, aiming to characterize the population whose skeletal remains were found in 2004 in the Cloister’s South Wing of Academia das Ciências de Lisboa. To achieve the final objective, six measurements were taken, in anatomic position, with a Mitutoyo Vernier Caliper and a Mitutoyo Absolute Digimatic Caliper®, and seven indices were calculated. Morphological characteristics were also observed through four different methods. From measurements and indices, there were 16 females and 5 males identified, but the overall results were not reliable, since there was no consensus between the different measurements, and so the majority of the coxal bones were classified as ambiguous. It was found that the morphological observations were more discriminating and, therefore, the Phenice’s Method showed the most precise results, because of the inclusion of three parameters simultaneously. Schlagwörter: Forensic odontology, sex classification, coxal, linear measurements, morphology

Introduction: All preparation techniques and instruments are associated with apically extruded debris (AED). Different preparation techniques promote different amounts of AED justified by the instruments design, namely its cross section, conicity, tip design and also the number of files, kinematics and cutting efficiency, associated with the quantity, type and technique of irrigation. Objective: Compare the amount of AED, created by two hybrid techniques and two single system techniques. The null hypothesis formulated stated that all groups present the same amount of AED. Materials and Methods: Eighty single root canal teeth were randomly assigned into 4 groups (n=20), according to the instrumentation technique: hybrid technique TruNatomy®/ProTaper Gold® (TN/PTG), hybrid technique TruNatomy/ProTaper Next® (TNP/TN), system ProTaper Gold (PTG) and system ProTaper Next (PTN) (Dentsply Sirona, Ballaigues, Switzerland). During preparation, for each specimen, a total of 13 mL 3% sodium hypochlorite (NaOCl) was used. AED was collected in Eppendorf tubes (ET). After instrumentation, each tooth was removed from the ET and, after filling with 1.5 mL NaOCl, each ET was stored in an incubator at 70ºC for 5 days. Three ET, without AED, containing 1.5mL 3% NaOCl were used as control. After the incubation period, each ET was weighed three times to obtain an average weight. The amount of AED, in each ET, was calculated by subtracting the control-weighed ET to the post-preparation weight. After checking normality (Shapiro-Wilk test), the Kruskal-Wallis non-parametric test was performed followed by the Mann-Whitney test with Bonferroni correction to identify significant differences (α=0.05). Results: Significant differences in the AED were detected for the various techniques (p<0.001). The hybrid techniques TN/PTG and TN/PTN groups produced significantly less extrusion compared to the PTG and PTN techniques (p=0.012 and p=0.046, respectively). The TN/PTN technique had a significantly lower AED than the other groups (p≤0.046) and the PTG technique significantly higher (p≤0.012). Discussion: In this study, the superior performance of the PTN system can be justified by the type of movement, less taper than PTG files and the type of cross-section that these instruments have, as well as the fact that this system has a smaller number of files. The significantly smaller differences related to AED, between TN/PTG and TN/PTN hybrid techniques and PTG and PTN alone, respectively, may be related to the fact that TN instruments have a maximum cervical diameter of 0.8mm which promotes greater dentin preservation when compared to S1, S2 and X1 files which cut the pericervical dentin more aggressively, as they have 1.20 maximum cervical diameter. Consequently, performing Preflaring with smaller cervical diameter before Root Canal preparation can reduce the amount of AED. Conclusion: Hybrid instrumentation techniques TN/PTN and TN/PTG produced significantly less AED than the PTN and PTG techniques. Schlagwörter: Glide Path, debris extrusion, TruNatomy, ProTaper

Introduction: Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder. The objective of this paper is to present a clinical case with OSAS successfully treated through orthognathic surgery. Material and Methods: Male patient, 43 years and 3 months old, with moderate OSAS and an apnea-hypopnea index of 22. In the cephalometric analysis, a skeletal Class I (< ANB 3º) with a setback in the position of the maxilla (< SNA 77º) and mandible (< SNB 74º) in relation to the skull base was observed. This skeletal pattern favors the narrowing or obstruction of the upper airway, which was confirmed by the radiographic examination. The proposed treatment plan consisted of: orthognathic surgery, using the Surgery First technique, with Le Fort I maxillary advancement of 7 mm and impaction of 2 mm and bilateral sagittal osteotomy with mandibular advancement of 7 mm. Results: Two months after surgery, there were no post-surgical complications, the patient reported an improvement in symptoms associated with OSAS, and in the assessment of radiographic examinations was observed an increase in the volume and the minimum axial dimension of the upper airway. Discussion: The bimaxillary advancement surgery allows the anterior pharyngeal wall to move forward, resulting in the enlargement of the pharyngeal airway and, consequently, a decrease in the apnea-hypopnea index. Conclusions: The Surgery First technique allowed for immediate surgery and the consequent improvement of OSAS. Bimaxillary advancement movement increased the volume and minimum axial distance of the upper airway. Schlagwörter: Sleep apnea, obstructive, upper airway, orthognathic surgery, surgery first, osteotomy, Le Fort, osteotomy, sagittal split ramus

Objectives: The Objective of the present study was to describe the effects observed after conservative treatment of TMJ osteoarthritis and osteoarthrosis. The procedure consisted of stabilization(1) using occlusal appliance and physiotherapy(2-4) for functional recovery and restoration of joint biomechanics. These interventions were associated with minimally invasive treatment injecting hyaluronic acid (5-9), (AH) into the upper and lower joint space and the results evaluated by cone beam computed tomography (CBCT). Materials and methods: 60 year old man, diagnosed using DC/TMD with myofascial pain, osteoarthritis, osteoarthrosis, and presumption of diagnosis of disc displacement without reduction, of the two temporo-mandibular joints associated with primary or idiopathic(9-12) wake and sleep bruxism, was submitted to a sequential protocol of injection of medium molecular weight HA(13) (Osteonil plus-TRB pharma) in the posterosuperior compartment and low molecular weight HA (Hylart-Bagó pharma) interspersed with Osteonil plus-TRB pharma for the anteroinferior compartment of both TMJs, monthly for 4 months (13,14) . Evaluation with CBCT was performed before treatment and six months after the last infiltration. The patient underwent physiotherapy after each viscosupplementation session and the following week, home oriented exercises(2,15) and monthly clinical evaluation with measurement of oral opening amplitude (ROM) with therabite and pain using the visual analogue scale (VAS)(16). The patient was instructed to use applications for mobile phone to control bruxism while awake and occlusal split to control sleep bruxism (17,18). Results: Significant structural gain seen in shape and volume of the mandible head in both TMJs, functional joint improvement, with increased amplitude of oral opening, The initial opening was 30 mm and after the end of treatment 44 mm, absence of pain at the end of treatment with obvious improvement in activities of daily living such as eating or speaking. Conclusions: Sequential viscosupplementation with AH of the two joint compartments associated with conservative treatment and control of awake and sleep bruxism, were effective in the treatment of osteoarthritis and osteoarthrosis of patient TMJs. Schlagwörter: viscosupplementation, hyaluronic acid, temporomandibular joint, osteoarthritis, osteoarthrosis

Introduction: A skeletal class II patient may present a mandibular retrognathia. This condition can lead to an inefficient breathing pattern, suboptimal mastication due to the improper occlusion pattern as well as an unsatisfactory profile. Although mandibular hypoplasia is a rather common occurrence, the combination of orthodontic and orthognathic procedures can be the most appropriate treatment for moderate to severe discrepancies. The lengthening of the mandible ramus can be achieved through a split ramus osteotomy or, in more severe cases, through a distraction device. This intervention can be chosen in order to achieve better aesthetics and function therefore improving the patient’s quality of life. The aim of this poster is to present a surgical-orthodontic approach for effective treatment of a skeletal class II associated with severe mandibular retrognathia. Material and Methods: A twenty-three-year-old patient with severe skeletal class II presented to the Institute of Orthodontics looking for malocclusion correction. The patient had undergone previous orthodontic treatment at another centre, however she presented both breathing and feeding difficulties as well as unappealing facial aesthetics. After careful consideration of the initial case tooth-borne distraction osteogenesis for mandibular lengthening and surgical orthodontic treatment were suggested as the best treatment option. Results: Roth 0,018 prescription fixed appliances were placed to level the arches followed by the placement of the tooth-borne distraction osteogenesis device which was activated twice bilaterally every 12 hours. At the end of the distraction, 11 mm of mandibular lengthening were obtained. After this intervention the orthodontic treatment progressed in order to prepare the patient for a orthognathic surgery of maxillary impaction and mandibular repositioning. A significant improvement in the ANB angle was achieved from 16º to 4º. Despite the facial soft tissue improvement, the convex profile still did not meet the patient’s aesthetic expectations so the patient was subsequently submitted to a genioplasty. Discussion and Conclusions: The patient had re-established a functional occlusion, a more suitable breathing pattern, a desirable profile and an overall pleasant facial aesthetic. Schlagwörter: Orthodontics, orthognatic surgery, class II, mandibular retrognathia

Full mouth rehabilitation with immediate loading implants has become a predictable procedure whereas implant and prosthesis survival are concerned. However less information is known from the patient centered outcomes measures perspective. This was a practice based prospective single cohort study aiming at studying the Impact of immediate loading implant supported full mouth rehabilitation on the oral health related quality of life (OHRQoL). 43 patients were recruited in a Portuguese dental clinic. Inclusion criteria were indication of full mouth rehabilitation with immediate loading protocol, exclusion criteria were nonnative Portuguese language. A Portuguese version of the Oral Health Impact Profile 14 was administered at study baseline before the intervention (visit 1), day 10 (visit2), 1 month (visit 3) and 6 months follow up (visit 4). Predictive variables were age, gender, household owning, marital status, education, profession, dental needs, type of rehabilitation provided and visit number. Primary outcome was total OHIP 14 PT score and partial domains. Glass effect size was calculated. Mean differences were tested with paired student t test and significance was set at alpha 5 %. Total OHIP 14 scores at visits 1, 2, 3 and 4 were 18,00±11,20 SD; 11,47±7,95 SD; 5,84±4,07 SD; 5,02±3,04 respectively. There was an extremely significant improvement in OHRQoL along the study follow up (p<0,001 Paired Student t Test) except for comparisons between visit 3 and 4 for every OHIP 14 domain. Full mouth rehabilitation with immediate loading protocol significantly increases the OHRQoL, from baseline through six months follow up. Schlagwörter: quality of life, immediate dental implant loading, mouth rehabilitation, implant-supported, prosthodontics, dentistry

Through current scientific evidence, the application of pit and fissure sealants in permanent dentition is a procedure consistently based on the prevention of caries, however, little evidence supports the performance of this technique in primary molars, and its application is reserved for high risk conditions. The objective of this systematic review was to answer the following question, formulated through the PICO strategy: Does the application of sealants contribute effectively to the prevention of caries in primary molars? Additionally, it was intended to understand the success rates inherent to the retention of sealants in this dentition. Bibliographic research of scientific articles published between 2005 and 2020 in the electronic databases PubMed, B-On, Cochrane Library and ScienceDirect, through research terms: pit and fissure sealants; primary teeth; primary molars; dental caries; prevention and retention, articulated through the boolean AND marker. Inclusion and exclusion criteria were established. For inclusion: clinical trials, randomized controlled trials, cohort and case-control studies, conducted in primary dentition and whose dental outcome was: the development of caries and/or, the rate of retention of pit and fissure sealants, comparing the intervention (sealant application) with the absence of application or with the implementation of other preventive measures. The methodological line followed for the selection of articles is presented in the PRISMA flow diagram. The methodological quality assessment of clinical trials was performed using a Cochrane tool and the Newcastle-Ottawa scale was used for the cohort study. Regarding the efficacy of the application of sealants in the prevention of caries, three of the four studies included showed a positive association between the application of this technique and the lower incidence of caries. Although the studies of Joshi et al.; Hong et al. and Chadwick et al. share a similar methodology (application vs. non-application of sealant), in the latter, there was no significant association between the intervention and the outcome evaluated. Regarding the retention rate, it is verified that the authors consider, in a different way, different variables, namely, light curing cycles, acid conditioning techniques and different types of sealants, making it difficult to accurately evaluate them. However, it is verified that, overall, the application of this technique presents satisfactory retention rates in this dentition and can be applied effectively in primary molars. Given the effectiveness of the application of sealants in the prevention of caries in primary dentition, this measure should be included in a holistic preventive program, without being specifically reserved for children at high risk for this disease. Despite the anatomical characteristics less favorable to the retention of sealants, in this dentition, it is verified that due to their shorter period of permanence in the oral cavity, the retention rates are satisfactory. It is denoted, however, the need for future studies with stricter methodologies in order to obtain more robust results on this theme. In conclusion, there is scientific evidence that demonstrates that the application of pit and fissure sealants in primary molars is an effective method to prevent dental caries. Schlagwörter: Pit and fissure sealants, primary teeth, prevention, retention, pediatric dentistry, preventive dentistry

Epidermolysis Bullosa (EB) is a rare genetic disease characterized by a recurrent formation of blisters due to structural weakness of the skin and mucous membranes. It is caused by mutations in genes, which alter the cohesion between epithelial cells or between these cells and connective tissue. The disease can be classified into four types: EB simplex; junctional EB; dystrophic EB (DEB) and Kindler syndrome. There is no predominance of sex or race. The most common clinical manifestations of this pathology are blisters that, when they rupture, leave painful ulcers. Changes in the shape and structure of teeth, ankyloglossia, susceptibility to tooth decay, limited mouth opening, among others, may also occur. In recessive dystrophic epidermolysis bullosa (RDEB), oral lesions appear with minimal trauma, requiring specific care in dental treatment. A 5-year-old caucasian male patient attended a dental appointment in 2016, having been diagnosed with RDEB since he was 23 months old. Clinically, the patient had bullous and hemorrhagic lesions on the oral mucosa, ulcers and skin scars. He had a high plaque index, tartar deposition, gingival inflammation, tooth decay, dental number changes such as gemination in a deciduous dentition tooth and left unilateral crossbite. The reason for the consultation was the presence of tooth decay and difficulty in oral hygiene. Initially, specific oral hygiene and dietary instructions were addressed. Scaling were performed, as well as the wear of the edges of the cusps that traumatized the mucous membranes and topical applications of fluoride. The treatment of caries and extraction of certain deciduous teeth that had not exfoliated began. Appointments were scheduled quarterly, although given the patient's little cooperation, they were limited to urgent treatments. DEB can be inherited in an autosomal dominant or recessive manner. In the present case, the mutation has maternal origin and atypical, given the benignity of the phenotype. The clinical and radiographic findings showed that we were facing a patient with a high risk of tooth decay. Brushing has always been very difficult, the patient is unable to use dental floss and doesn't tolerate manipulation of the oral cavity. As such, preventive measures were adopted. Treatments were sometimes postponed due to painful symptoms prior to the appointments. Currently, scaling is performed with Guided Biofilm Therapy®, which was well tolerated by the patient and didn’t form new bullous lesions. For a correct follow-up in the field of dentistry, both the dentist and caregivers must be aware of preventive measures and appropriate recommendations for these patients. Considering the fragility of the oral mucosa in patients with EB, preventive dentistry plays a fundamental role in reducing the need for dental treatments, and it is essential that the dentist knows the care to be taken. Schlagwörter: epidermolysis bullosa, prevention, guidelines

Osseointegration is the major success factor for dental implants. In order to optimize the biological response, several strategies have been investigated. Due to its piezoelectric properties similar to bone electric potentials generated in loading function, barium titanate (BaTiO3) piezoelectric ceramic is a potential approach for promoting osteogenic proliferation and differentiation and, consequently, accelerating osseointegration. However, the potential inflammatory effects in peri-implant cells and tissues are not defined. The aim of this in vitro study was to evaluate the inflammatory response of gingival fibroblasts and human fetal osteoblasts in contact with BaTiO3-functionalized zirconia implant surfaces with piezoelectric properties. Composite discs with 5 wt.% BaTiO3 in Yttria-stabilized zirconia (YSZ) were prepared through press-and-sintering technique (n=15). Contact poling was carried out in silicon oil bath under DC 2 kV/mm electric field at 130 °C for 30 min followed with field cooling. Reference samples of YSZ were processed parallel to the composites. Human gingival fibroblasts (hTERT) and fetal osteoblasts (hFOB1.19) were cultured on discs for 14 and 7 days, respectively, by previously described methods. Cell viability was evaluated at 1, 3, 7 and 14 days using a commercial resazurin-based method. IL-1b and IL-6 were evaluated at 1 and 3 days in each fibroblast and osteoblast culture and osteopontin was measured in osteoblast cell culture at 3- and 7-days using ELISA. Osteoblasts alkaline phosphatase (ALP) activity was measured using an enzymatic colorimetric assay at 7 and 14 days. All results were presented as mean ± confidence interval (CI). Group comparisons were based on one-way ANOVA repeated measures or Kruskal-Wallis and Tukey’s post-hoc using appropriate statistical software and significance was set at p<0.05. Cell viability increased over time for all groups in both cell cultures. However, in osteoblasts was significantly lower in non-poled group at 14 days comparing to poled group. No significant differences in fibroblasts viability were observed between groups. Although a trend towards ALP activity significantly higher in poled group at 7 days (1.18±0.49 umol/min/mL) and YSZ group (2.22±0.17 umol/min/mL) at 14 days comparing to non-poled group (p<0.05), no significant differences in osteopontin secretion were observed between groups. Regarding osteoblasts inflammatory markers, IL-1b remains constant and a notorious increase from 1 to 3 days in IL-6 were observed in poled group, but without statistically significant differences between groups. Fibroblasts IL-1b secretion was similar to osteoblasts, with constant values over time and no significant differences between groups. However, IL-6 secretion decreased from 1 to 3 days in all study groups and repeated measures analysis revealed significant lower values in non-poled group (20.93±3.00 pg/mL) comparing to YSZ (43.79±13.77 pg/mL) at 3 days (p<0.05). Our results suggest that the Zirconia composite surfaces with the addition of BaTiO3 is not cytotoxic to peri-implant tissues cells. Additionally, samples with or without piezoelectric properties do not affect cellular differentiation and inflammatory profile. Nevertheless, the addition of non-poled BaTiO3 to YSZ may have a potential reduction effect in IL-6 mediated—inflammatory activity in fibroblasts. Schlagwörter: Dental implants, fibroblasts, osteoblasts, barium titanate, piezoelectric properties, cell culture

Introduction: Currently, Periodontitis is characterized by defining the stage and grade of the disease. Stage IV periodontitis has unique features that require treatment of a higher level of complexity. In this communication the sequence of periodontal treatment of a stage IV, generalized, grade C periodontitis is presented. Clinical case description: A 30-year-old female patient attended at Periodontology Postgraduate Clinic in the Faculty of Dental Medicine, Lisbon, with complaints of tooth mobility and gingival bleeding. Smoker (≥ 1o cigarettes/day) without any other systemic diseases (ASA II). After the clinical and radiographic evaluation was diagnosed with a Stage IV, generalized, grade C Periodontitis. Following the interventions in Step 1 which included smoking cessation, explanation of the disease, professional oral hygiene instructions, patient started step 2 interventions – subgingival instrumentation (2 appointment of scaling and root planning). At periodontal re-evaluation, presented a plaque index of 15% and the presence of residual periodontal pockets. Step 3 included subgengival repeated instrumentation (2nd sextant), Resective/access periodontal surgery (3rd , 4th , 5th e 6th sextant) and Regenerative periodontal surgery (tooth 14 and 15). Conclusion: The treatment has been successful in achieving a stable and healthy periodontium. Patient was placed in a supportive periodontal care programme (follow-up 8 months), with regular visits (3 in 3 months) Schlagwörter: Periodontitis, stage, grade, non-surgical treatment, surgical treatment

The increasing number of elderly population created a need of knowing better this population and giving them better quality of life by finding which are the gaps missing. One of the ways to study the oral health-related quality of life (OHRQoL) is applying the Geriatric Oral Health Assessment Index (GOHAI). This index is compound by three domains (physical, psychological and pain/discomfort). The main objective of this study was to evaluate OHRQoL and the relationship between quality of life, sociodemographic characteristics and oral hygiene habits in the elderly of Egas Moniz Dental Clinic. For seven months, an aleatory sample of 150 participants (n=150) of Egas Moniz Dental Clinic with 65 years or more of age and non-institutionalized were evaluated. It was applied a questionary about sociodemographic, oral hygiene and OHRQoL was obtained through GOHAI. A descriptive and inferential statistical analyze methodologies were used, and a significance level of 5% was considered. In the studied population, 37.3% had a high classification of GOHAI. The male participants had tendency to have higher GOHAI self-perception (p=0.042), and especially in the physical domain (p=0.032). Participants who lived alone had lower global classification (p=0.025) and also in the pain/discomfort domain (p=0.025). Elderly who didn’t clean oral cavity had lower classification (p=0.033). The use of interdental cleaning aid (ICA) and not having the need of using an oral prosthesis showed higher GOHAI values. The majority of the participants had a moderate and high self-perception of quality of life. Male, not living alone, who cleaned oral cavity, used ICA and did not have the need of use oral prothesis presented significantly better oral health-related quality of life. The gender and not living alone are aligned with previous researches. However, further research is needed. Schlagwörter: Elderly, GOHAI, geriatric population, oral health

Introduction: The concept of perineural inflammation in the mandible is old and well described in the literature, but it may be associated with bone morphological changes such as FDOJ (Fatty degenerative osteonecrosis in jawbone). FDOJ is a cavitational osteonecrosis, bone mineralization disorder, occurs in the medullary trabecular bone with aseptic, ischemic, sometimes asymptomatic nature, an immunologically altered chronic bone condition with expression of pro-inflammatory chemokines RANTES. Overexpression of this chemokine activates signaling pathways in the immune system, a fact that may contribute to neuralgias or atypical facial pain. Case report: This case study shows the need for a diagnosis of atypical pain associated with cavitational osteonecrosis and its surgical resolution. Female patient 31a, diagnosis of atypical facial pain, inconclusive neuralgia, without involvement of V cranial nerve. Shocking, limiting, radiating pain for 3 years. Materials and methods: After analysis of bone density using CBCT images, the patient underwent cortical osteotomy and curettage of the altered alveolar bone in regions 18, 28, 38 and 48. The material removed was subjected to histopathological analysis to confirm the FDOJ. Results: After surgically removing the cavitations in dental regions 18, 28, 38 and 48, the patient presented complete regression of the pain related to neuralgia. No new pain episodes at 1-year follow-up. Discussion: RANTES/CCL5 inhibit opioid receptors (they play an important role in modulating pain in peripheral neurons and CNS), amplifying pain signals and increasing the pro-inflammatory response in microglia, generating neuroinflammation . In this context, it makes sense to reduce facial pain and trigeminal neuralgia by surgically cleaning the FDOJ in RANTES signaling areas. A significant limitation refers to the detection of this pathology. The lack of local inflammatory signs and radiographic image impairs the diagnosis of osteonecrosis. The lack of knowledge of the relationships of the chemokine RANTES by dentistry can be a challenge in solving these cases. Conclusion: With the correct diagnosis of Cavitational Osteonecrosis and surgical FDOJ removal, it is possible to bring a consistent improvement in the patient's pain condition related to FDOJ. Bone density analysis of edentulous regions with tomography and transalveolar ultrasound can be a decisive diagnostic complement in the resolution of neuralgias and atypical facial pain. Schlagwörter: Osteonecrosis, Aseptic osteonecrosis, Bone cavitations, Cavitational osteonecrosis, FDOJ, NICO, BMDJ

Introduction: Chondrodysplasias are a heterogeneous group of genetic pathologies, characterized by changes in cartilage, which translate into abnormal skeletal development. Inside this group are the metaphyseal chondrodysplasias (MCDs), whose skeletal disorders mainly disturb the growth of long bones. Both the classification and diagnosis of these pathologies are based on clinical, radiological, and genetic aspects. In the MCDs, there is a group called type II collagenopathies, resulting from mutations in the gene that encodes the alpha-1 chain of type II collagen, the COL2A1 gene, culminating in an essential deficit for the endochondral ossification process. Therefore, these individuals suffer from disturbances in the epiphyseal plates, in the nucleus pulposus, and in the vitreous humor. Spondyloepimetaphyseal Dysplasia Strudwick type (SEMD) is a rare autosomal dominant entity. Clinically characterized by disproportionate short stature, pectus carinatum, scoliosis, lordosis, myopia, retinal detachment, equinovarus, genu valgum, coxa vara, hip arthritis, and even cleft palate, although there are cases described with normal craniofacial appearance. Radiographically, alterations such as metaphyseal dappling, atlantoaxial instability, hypoplasia of the odontoid process, platyspondyly and epiphyseal defects in the femur and tibia, among others, are detectable. Studies of MCDs at the orthodontic level are scarce and directed to specific subtypes, due to their low prevalence, and cases of orthodontic treatment (OT) in individuals with SEMD are absent in the literature.   Objective: This clinical case aims to demonstrate the importance of orthodontic diagnosis and correct planning of treatment timings in rare cases of craniofacial deformity. Case Report: A 14-year-old male patient with a history of SEMD and sleep apnea was referred for orthodontic treatment. Physical examination showed characteristic disproportionate short stature with genu valgum, coxa vara, pectus carinatum, and a face with mid-third hypoplasia, retrognathia, depression of the nasal bridge, and dental crowding. The main orthodontic problems observed were SEMD, skeletal and hyperdivergent class II, apical and buccal position of teeth 1.3 and 2.3, lack of maxillary and mandibular space, increased overjet and overbite, accentuated mandibular curve of Spee and deep bite. OT was planned with fixed multibracket appliances, transpalatal bar and extraction of the first premolars in the upper jaw. In the mandible, in addition to the multibrackets fixed appliance, stripping was performed. Results: In the short term, correction of crowding, overjet, overbite and smile line was achieved, and canine class I, molar class II and canine guides were obtained. In the medium and long term, it was possible to prevent temporomandibular joint pathology, improve the occlusal relationship, chewing and the patient's facial aesthetics. Conclusion: It is important that dentists, orthodontists and maxillofacial surgeons are conscious of this type of pathology in order to adapt OT to the severity of craniofacial anomalies, functional pathologies, and existing aesthetic alterations. In this way, it is possible to provide functional occlusion, improved facial appearance and quality of life in patients with MCD. Schlagwörter: Metaphyseal dysplasia, Collagen type II, Spondyloepimetaphyseal dysplasia, Strudwick type, Semd, Corrective Orthodontics

Leukoplakia is considered the most common potentially malignant lesion of the oral cavity, especially in adults over 40 years of age, and it has a multifactorial cause. Most of the time it is asymptomatic, which is why the Dentist must act with a global vision in routine consultations. Besides identifying and eliminating risk factors related to the appearance of the lesion, it is necessary to make a differential diagnosis by excluding other white lesions of the oral mucosa. A careful investigation of dysplasia in the histopathological study is essential to recognize the potential malignancy of the lesion and to promote an early diagnosis, which will strongly influence the prognosis, the treatment plan and the orientation of these patients. The present dissertation proposes to approach the potentially malignant oral leukoplakia lesion, providing the Dentist with updated and relevant information, supporting it with the presentation of a clinical case. Schlagwörter: Leukoplakia, Dysplasia, Histology, P16