International Poster Journal of Dentistry and Oral Medicine, Supplement PDA/2019

Introduction: Oral cancer is the sixth most common type of cancer worldwide. It's associated with high mortality rates. For this reason, new tools for diagnostic and prognostic have been studied. MicroRNAs, which are deregulated in oral cancer, have recently gained significant attention due to its potential as biomarkers of early diagnosis and prognosis in this disease. Aims: Investigate the role of microRNAs in oral cancer, showing some of the most deregulated, as well their potential as biomarkers of early diagnosis and prognosis in this malignancy. Materials and methods: Research on PubMed/Medline electronic database, using the keywords "microRNA", "biomarkers" and "oral cancer" and the Boolean operator "AND". Inclusion criteria included studies with human samples, published in the last 10 years (2009-2019) and in English. Results: 255 studies were found and after reading the title and the abstract and 65 studies were selected for full-text analysis. 12 met the inclusion and exclusion criteria. Conclusions: It's possible to conclude that microRNAs are effective biomarkers for early diagnosis and prognosis of oral cancer and can be a useful tool in clinical practice. Therefore, more studies and research are needed before their generalized use in the clinical field. Clinical implications: Dentists have a key role in early detection of oral malignant lesions and monitoring conditions with high risk of malignant transformation. Studies regarding miRs show positive perspectives for their use in clinical practice, for diagnosis and prognosis of OC and OPML. Therefore, clinicians should have knowledge about miRs and be aware of new tools based on these molecules. Keywords: microRNA, biomarkers, carcinogenesis, oral cancer, diagnostic and prognostic, oral squamous cells carcinoma

Background: Although significant clinical improvements were reported with the regeneration of periodontal infrabony defects (PID), graft stability of particulate bone substitutes remains an issue. Aim: Evaluate the efficacy of a combination of synthetic bone substitute with binding capacities (biphasic calcium sulphate (BB)) and a xenograft versus open flap debridment (OFD), through a minimally invasive surgical technique (MIST), for the treatment of PID. Material & Methods: A pragmatic, randomized controlled clinical trial of parallel design was performed. Twenty patients treated with MIST approach, providing one defect site with an infrabony component of at least 4mm deep and 2mm wide, were randomly allocated either to grafting with a combination of BB+xenograft (test group) or OFD (control group). At baseline and 12 months post-surgery, blind examiners assessed periodontal clinical parameters and marginal radiographic bone levels. Occurrence of complications and patient's satisfaction with treatment and aesthetics were also evaluated. Results: Both groups showed significant improvements in clinical parameters after 12 months. Intergroup comparison evidenced a tendency for better outcomes for the test group vs control group, regarding average PPD reduction (4.0±1.25mm vs 3.1±1.37mm) and CAL gain (3.3±1.06mm vs 2.4±1.06mm), despite not reaching significant statistically differences. Conclusion: Despite, not showing significant differences, it is suggested that in more challenging defects, as for non-contained morphology, the combination of MIST approach with BB+xenograft can have a beneficial added effect in terms of improving PPD reduction and CAL gain. Clinical implications: MIST+BB+xenograft appears to positively potentiate IPD's treatment. Keywords: periodontal, infrabony defect, minimally invasive surgery, regeneration

Female patient, 7 years old, diagnosed with mild hypomineralization with caries in teeth 36 and 46 and severe hypomineralization with extensive carious lesions and post eruptive fracture in teeth 16 and 26. Extensive caries in the deciduous molars. Due to the clinical signs and symptoms of pain, pulp involvement, need for immediate treatment of all lesions, sensitivity and difficulty in achieving appropriate anesthesia and lack of cooperation of the child, it was recommended to perform the treatment under general anesthesia. The treatment of MIH presents several difficulties and depends on its severity. In some cases, the treatment of this condition may be performed under general anesthesia (GA), which will allow to carry out the entire treatment plan at once. This approach also presents some disadvantages such as the cost, the need to perform the treatments in a single session and limitations in the space maintenance management, since it does not allow the execution of the necessary apparatus. All these considerations should be taked into account when deciding the treatment plan. MIH adversely affects the overall health of children. Clinically it is a huge challenge hence its early identification will allow the monitoring of the first permanent molars so that preventive measures can be instituted early to try to minimize its consequences. In specific cases the treatment of this pathology can be performed under GA, which allows the therapeutic procedures to be performed quicker and comfortably. Keywords: Molar-Incisor Hypomineralization, enamel, dental caries, general anesthesia

Case description: We present 4 clinical cases with calcifications in the upper anterior teeth and their follow-up, where the clinical pictures of the cases were different. Color change, bone lesions or iatrogenic problems were the reasons for performing the RCT in the clinical cases presented. In all of them, magnification was used through the operative optical microscope. Ultrasound tips were used to access the canal at various levels in the root and after being located with manual K files 08 and 10, permeabilization was performed. They were later instrumented with MTwo rotary files and filled with thermoplastic techniques. Discussion: Calcified radicular root canals are usually a clinical challenge. Alongside calcifications, there may be other complications. The treatment of a calcified canal with no other pathologies is not consensual in the literature. The clinician should be aware of the degree of difficulty of the case and have the technical and technological ability to decide how to treat involving the patient in the decision, as some adversities may happen to even the most experienced. Conclusions: The endodontics of this type of teeth should be well evaluated and the clinician should be aware of what they can do, as this type of treatment is very demanding and can lead to iatrogenic problems. At the clinical level, objectives were met and problems resolved, as shown in follow-ups. Keywords: root canal obliteration, root canal treatment, operative optical microscope, magnification

45-year-old patient whose reason for consultation was to improve the appearance of the incisor teeth. The evaluation of the clinical history led to the following diagnosis: Dental Fluorosis. Prognosis: Favorable. Treatment plan: Microleakage (ICON®) and sodium hypochlorite (etch-bleach-seal technique). In recent years, minimally invasive techniques, such as the microleakage technique, have been used to treat white spot lesions as an alternative to removing hard tissue with drills. The microleakage technique has been described as highly conservative in the treatment of non-cavitated white spot lesions. To improve this technique and decrease the need for regular composites at the end to smooth out the often cavity-surface, we have associated another lost-time technique such as sodium hypochlorite enamel bleaching, known in the literature as the ''Etch bleach and Seal'' technique. Whitening of hypomineralized enamel lesions using 5% sodium hypochlorite has been clinically applied and treatment using this approach has been successful in removing yellowish brown discolorations from lesions on young and permanent teeth. Conclusions: With the correct use of these techniques, it was possible to considerably improve the appearance of the anterior teeth, as being the least possible invasive. It can be concluded that there are two safe techniques, favorable results in the treatment of white spots and yellowish discolorations. However, despite this excellent result, further literature is needed with greater follow-up on the use of these two techniques. Keywords: resin infiltration, etch-bleach-seal, white spots, aesthetics, removal of stains

Introduction: Polymethylmethacrylate is a material used in prostheses that can cause adverse reactions associated to residual monomer release. This release is influenced by the polymerization method. Objectives: To compare, in vitro, cell viability (CV) of two acrylic resins, one with conventional thermal polymerization [ProBase®Hot (PBH)] and another with injection [IvoBase®System (IBS)]. Materials and Methods: Resin disks (n = 4) were incubated in a culture medium (30 minutes, 24 hours, 7 days, 14 days, 1 month). 200 μL of the extract were placed in contact with 3T3 mouse fibroblasts and the MTT test evaluated CV. The results were compared with ANOVA one-way and T-student tests, with p 0.05. Results: In PHB the VC at T14 was significantly lower than the other times and in IBS T0 and T30 presented significantly lower CV values (p0,05). There was no significant difference between the two resins for most of the times studied (p=0,012) except for T30 in which IBS cell viability was significantly lower than PHB (p˂0,05). Discussion: The small differences detected between the two resins studied suggest that the amount of residual monomer released doesn't significantly influence CV, for the contact times and amount of material used in the present study. Conclusion: The type of polymerization didn't have a significant effect on CV. According to ISO 10993-5: 2009, the CV values of the present study indicate that the resins studied are not considered cytotoxic. Keywords: cytotoxicity, acrylic resins, polymerization method, biomaterials, MTT test, cell viability, polymethylmethacrylate

Male patient, aged 20, was referred to the post-grad Endodontic clinic after an acute apical abscess episode associated to a complex internal tooth anatomy. Dental pulp tests performed on the maxillary right canine (13) were negative, and the presence of a sinus tract at the time of the appointment was noted. A diagnosis of total pulp necrosis and chronic apical abscess was made, with indication for non-surgical root canal treatment (NSRCT). Radiographic examination revealed a dens-in-dent (Dens Invaginatus DI) type IIIb (Oehlers classification) with presence of periapical radiolucency. CBCT was requested to aid treatment planning. The access cavity was carried out under rubber dam isolation using a round diamond bur in a high-speed hand-piece and refined using Start-X® (Dentsply-Sirona) ultra-sonic tips. Canal scouting and working-length determination was carried out using hand K10 files and an apex locator. The canals were instrumented using the WaveOne Gold® (Dentsply-Sirona) system and irrigated using NaOCl 5.25% and Citric Acid 10%, both activated using the sonic device EDDY® (VDW). Obturation was carried out using continuous wave and thermo-compaction of gutta-percha with resin cement 2Seal® (VDW) followed by a coronal seal with glass ionomer cement. The access cavity was restored using composite resin. A dental operating microscope was used for the whole procedure. Keywords: dens invaginatus, cone beam computed tomography, endodontics, operating microscope, root canal treatment, ultrasonic tip

Introduction: The spheno-occipital synchondrosis (SOS) is a center of endochondral growth that has a late ossification influencing the height and depth of the upper face. Objetive: This study aimed to evaluate the chronological age of complete ossification of the SOS in patients with cleft lip and palate (CLP) and a control group, using cone beam computed tomography (CBCT) images. Materials and methods: The study enrolled 125 patients divided in a CLP group (n = 91) and a control group (n = 34). The SOS of each patient was observed in a CBCT scan and the fusion stage assessed. A chi-square test was used to compare age. A Kaplan-Meyer analysis was used to determine the median time to reach complete ossification of the SOS (p 0.05). Results and Discussion: The experimental group showed statistically significant differences in the median time for complete ossification between males and females (p = 0.019). No statistically significant differences were found in the control group between males and females (p = 0.104). The median time for complete ossification of the SOS was, for males, 15.0 yr in both groups. For females, it was 14.0 yr in the experimental group and 13.0 yr in the control group. Conclusion: The present study showed no differences in the ossification of the SOS between individuals with and without CLP. The complete ossification of this synchondrosis occurs earlier in females than in males. Keywords: cleft lip and palate, spheno-occipital synchondrosis, cranial base, cone beam computed tomography

Introduction: Flare-up is defined as moderate to severe postoperative pain and/or swelling, beginning 12 to 48 hours after treatment and lasting for, at least, 48 hours. Aim: Evaluate which of the approaches, single session or multiple session, presents lower probability of appearance of Flare-up. Materials and Methods: The literature search was based on the b-On search engines, National Library of Medicine, PubMed Database, using, in different combinations, the terms: "flare-up", "endodontics", "postoperative pain" and "number of sessions", with the time limit between 2010 and 2019. Meta-analyzes, bibliographic reviews and randomized controlled trials were included. Excluded were articles whose purpose deviated from the main theme and those whose methodology of research was incomplete. Results: Seventeen articles were selected, 6 of which are systematic or bibliographical reviews and 11 are clinical studies. Conclusions: According to the literature reviewed, the number of sessions chosen to address the Non-Surgical Root Canal Treatment (NSRCT) is not a predisposing or precipitating factor of the occurrence of Flare-up. Nevertheless, the literature on the subject is still scarce and presents some defects. Further studies are needed to unambiguously establish the association or not with the number of NSRCT sessions. Clinical Implications: Knowledge of the factors that may be associated with the development of Flare-up aids the Dentist in the selection of the best approach to treatment, knowing that the number of sessions does not appear to be a prominent variable as long as the antimicrobial efficacy of the treatment is ensured. Keywords: flare-up, endodontics, postoperative pain, number of sessions

Introduction: The control of cross infection during dental practice is a subject that requires awareness and attention. A disinfectant for dental impression materials must preserve the dimensional stability and the surface details of both the impression and the resulting cast, to achieve a more precise clinical outcome. Objectives: The purpose of this study to evaluate the knowledge regarding disinfection procedures among prosthesis technicians and dentists, as well as to assess the impact of water wash and of four disinfection solutions on the dimensional stability of addition silicone and alginate impressions. Materials and Methods: A survey was sent to 1000 dentists and 320 prosthesis technicians to evaluate their awareness and practices of dental impressions disinfection - response rate of 9.5% and 7.8%, respectively. The dimensional stability was evaluated using a standardized model, according to ANSI/ADA n°18 and 19 specifications. Ten impressions were taken for each of the established protocols: unwashed control, water washing for 30 seconds, immersion for 10 minutes in 3% hydrogen peroxide, 1% and 5.25% sodium hypochlorite and 5 minutes in MD520®. Results: 21.3% of the dentists never disinfect dental impressions, being one of the most common reasons the fear of dimensional changes (25%). Addition silicone and alginate impressions disinfection by immersion does not significantly impact the dimensional stability of the impressions (p>0.05). Conclusion: In this study, no detrimental effects were observed regarding the dimensional stability of disinfected dental impressions. It is fundamental to reinforce that disinfection procedures are safe and crucial to prevent cross contamination. Keywords: silicone elastomers, colloids, disinfection, sodium hypochlorite, hydrogen peroxide, survey

Periodontitis is one of the most common diseases in dentistry and results from the accumulation of bacterial biofilm on the tooth surface. Black-pigmented, Gram negative oral anaerobes such as Porphyromonas gingivalis and Prevotella intermedia are thought to be pathogens in adult periodontitis [1, 2]. Odontogenic local infections require surgical treatment and, if required, a probabilistic antibiotherapy is needed that is effective on most recognized oral pathogens [3]. In most cases, antibiotic prescription is empirical and based on the clinical condition of the patient. Reports from different countries show an increasing prevalence of patients with oral antibiotic resistant bacteria. However, in Portugal there is no data concerning antibiotic resistance of oral flora. The main goal of this study was to identify Porphyromonas gingivalis and Prevotella intermedia strains from periodontal pockets of Portuguese adults suffering of periodontitis infections. Moreover, the isolated strains were also tested for the presence of antibiotic resistance genes. Keywords: periodontic infections, antibiotic resistance genes

Glycine, a simple amino acid(C2H5NO2 ), has a relevant presence in the extracellular structure of collagen and elastin, being discovered and isolated for the first time by the French chemist H. Bracannot. It can be synthetized by a variety of processes, according to its purpose in the organism and, despite the reduced knowledge regarding its mechanisms and action, glycine presents itself as a potential anti-inflammatory, immune system regulator and antioxidant, as well as being vital for the synthesis of cytokines and neurological functions. Due to its physical properties, such as a reduced abrasiveness and superficial damage of its particles, the glycine powder proves to be a suitable substitute of sodium bicarbonate in dental medicine treatments. Keywords: glycine powder, enamel, dentine, adhesive system, air-polishing enamel, size particles

Staphylococcus aureus is considered one of the Gram-positive bacteria most frequently isolated in the community and in the hospital environment, being associated with several infections. Multidrug-resistant strains (Methicillin-resistant Staphylococcus aureus - MRSA) represent one of the major causes of nosocomial infections worldwide, leading to high mortality rates. Different surfaces of dental medicine equipment were analysed to evaluate the presence of methicillin-sensitive Staphylococcus aureus (MSSA) and/or MRSA. Keywords: nosocomial infections, mecA gene, methicillin-sensitive staphylococcus aureus, methicillin-resistant dtaphylococcus aureus, dental clinics

Description of the clinical case: Female patient, 41 years old, non-smoker, ASA I, whose reason for the consultation was the rehabilitation of the 3rd sextant. In order to be able to place the implants in the ideal 3D position, because the bone crest had an average width of 3 ± 1mm observed on the CT, two implants were chosen: Nobel Replace (24-NP; 26-RP) concomitant to a technique of crest separation with simultaneous horizontal guided bone regeneration (xenograft and collagen membrane). At 13 weeks, the second surgical phase and the 3-element metal-ceramic bridge were performed. At three years stability of the regenerated tissues was observed. Discussion: The split-crest technique described in 1986 by Nentwig GH for narrow ridges is a predictable, simple and rapid and allows the simultaneous placement of implants (if they achieve primary stability) associated with the separation of the two bone cortical since there is a bone marrow to separate them and adequate bone height. This new space created must be regenerated and horizontal bone regeneration can be complemented. Massimo Simioni et al. in 1992 indicated a horizontal gain between 1-4 mm and histologically bone regeneration between the two cortical ones; Giovanni Bruschi et al. in 2017 report a survival rate of implants after 3 years of 98.54% and a vertical gain of 0.89 ± 0.39 mm. Conclusion: In cases of narrow bone ridges and where there is a medulla between the two cortical, this technique presents itself as a simple option technically with predictable results. Keywords: dental implants, split crest, bone regeneration, case reports

Description of cases: Case 1: Male patient, 54 years old, with whitish verrucous lesion on the retrocomissural jugal mucosa, whose anatomopathological examination revealed squamous papilloma. Case 2: A 50-year-old male patient with multiple papules in the jugal, labial and buccal mucosa, whose anatomopathological examination shows the scaly papillae (multifocal epithelial hyperplasia or Heck's disease). Case 3: Female patient, 45 years old, with exophytic white lesion on the edge of the tongue, whose anatomopathological examination showed squamous papilloma. Case 4: Male patient, 34 years old, with three exophytic lesions on the labial mucosa, gingiva and hard palate, whose anatomopathological examination was of squamous papillomas. Case 5: A 66-year-old female patient with a whitish plaque on the mandibular gum, whose anatomopathological examination suggested squamous papilloma. Case 6: Female patient, 66 years old, with verrucous exophytic lesion at the mucocutaneous transition near the labial commissure, whose anatomopathological examination confirmed verruca vulgaris. Discussion: HPV infection is relatively common in the population, affecting individuals of all ages. Benign oral manifestations include squamous papilloma, verruca vulgaris, condyloma acuminata and multifocal epithelial hyperplasia. These lesions may present similar clinical characteristics, being essential the histological analysis to obtain the correct diagnosis. Conclusions: The knowledge of the pathophysiology of the disease and the careful clinical evaluation of the lesions are fundamental for the institution of the appropriate therapeutic approach. Some HPV subtypes are associated with an increased risk of developing cancer, especially the oropharynx. The Dentist plays an important role in the diagnosis and treatment of oral lesions. Keywords: human papilloma virus (HPV), verruca vulgaris, squamous papilloma, condyloma acuminatum, multifocal epithelial hyperplasia

Introduction: The process of reproducing the final color of a rehabilitation is dependent on several factors: the characteristics of the ceramic system used, the thickness of the ceramic, type of ceramic, substrate and cement used. Objectives: To evaluate in vitro the color changes caused by different cementing materials. Materials and Methods: Lithium disilicate ceramic disks A2 color, with thicknesses of 0.5 mm were used (n = 40). For the substrate, composite resin discs with a thickness of 1mm were produced. The ceramic samples were cemented to the composite resin discs with different cements. The data corresponding to the color analysis were obtained with reflection spectrophotometry. The color differences between each sample were recorded with the L * a * b * system of CIELab. Results: There were no statistically significant differences between groups. The RelyX Veneer B0.5 cement corresponds to the group that presents a higher value of Delta E (4.1942) and the cement RelyX Veneer A3 presents a lower value of Delta E (3,4400). Discussion: All cements used had a Delta E value greater than 1.7, which means that all will cause a variation in the final color of the rehabilitation. Conclusions: The fact that the cements do not show statistically significant differences does not imply that these differences are not clinically perceptible. Clinical Implications: The optical properties of the cements are as important as those of the ceramic, and the aesthetics of the ceramic restoration depends on the type of cement used. Keywords: ceramics, color, resin cements, veneers, oral rehabilitation, aesthetics

Description of the clinical case: A 65-year-old male leucodermic patient, accompanied at the Clinic of Surgery and Oral Medicine of the Faculty of Dental Medicine - University of Lisbon (FMDUL), with indication for multiple exodontia and posterior removable prosthetic rehabilitation. Medicated with enalapril maleate/lercanidipine hydrochloride and simvastatin for the control of hypertension and hypercholesterolemia. History of sinusitis, malaria and intestinal polyposis. Extraoral objective examination revealed multiple papular cutaneous lesions on the face. Intraorally, several asymptomatic papules on the dorsum of the tongue were also identified. The clinical condition was suggestive of Cowden syndrome or multiple hamartoma syndrome. The differential diagnosis of these lesions includes transient lingual papillitis, neurofibromatosis and multifocal epitelial hyperplasia (or Heck's disease), among other entities. An excisional biopsy of one of the lesions of the lingual mucosa was performed, whose anatomopathological examination confirmed fibroepithelial hyperplasia. Discussion: Cowden syndrome or multiple hamartoma syndrome is a rare autosomal dominant genetic condition, with alteration of the PTEN gene, which is found on chromosome 10. Its prevalence is only 1:200 000 cases and affects, generally, leucodermic females. It is characterized by the presence of several mucocutaneous hamartomatous lesions of ectodermal, mesodermal and endodermal origin. The pathognomonic criteria include multiple skin (trichilemmomas) and oral papules (fibromas), as well as palmar or plantar acral keratosis. Conclusion: Cowden syndrome is a relatively unknown entity in the medical community and, therefore, underdiagnosed in the population. Patients are at increased risk of malignant neoplasias in various organs and systems. Dentist plays a fundamental role in the diagnosis of oral manifestations of the disease. Keywords: cowden syndrome, multiple hamartoma, oral medicine and pathology, oral biopsy

Clinical case's description: A 15-year-old female patient institutionalized in a foster care went to the Dental Clinic of the University UCP-Viseu, under the "Pequenos Grandes Sorrisos" social program referring a discomfort in the 2nd quadrant. At the oral examination, agenesis of the teeth 1.2 and 2.2 was observed, with the permanence of 6.3 and a marked deviation of the upper dental middle line to the right. After extracting the 63 (urgency), a tooth that caused the discomfort, a treatment plan was drawn up. The ideal treatment would pass through a bi-maxillary orthodontic treatment. The patient's personal history and her particularities, that hypothesis had to be excluded. Was then proposed to perform a coronoplasty of the canines and increase of the central incisors. For planning were performed: photographic status, study models, and occlusal recording (Oclufast, Zhermack, Germany). Afterward was done a Digital Smile Design and sent to the laboratory for the diagnostic waxing. The mock-up allowed an aesthetic and functional evaluation. The restorations were done with composite resin (SynergieD6, Coltène, Switzerland) were performed, with the support of a transparent silicone mold (RegistradoClear, VOCO, Germany). Discussion: Orthodontic treatment would last at least two years. The patient is temporarily institutionalized and was looking for a quick and economical solution. Coronoplasties with individualized mock-ups can quickly solve some of the questions, particularly in the field of aesthetics in Pediatric Dentistry. Conclusion: The treatment plan must be molded to each patient. The limitations that he/she presents must be a motivation according to factor for solutions that meet the patient's objectives. Keywords: aesthetic, crown-plasty, minimally invasive, odontopediatrics

Introduction: Cone-beam computed tomography (CBCT) is indicated in cases where conventional radiography does not provide necessary information for an adequate diagnosis and treatment plan, being a normal requisition nowadays, in most dental clinical practices. An incidental finding (IF) detected on a radiographic image can be defined as any abnormal or pathological finding that is unrelated to the original purpose of the imaging test. The aim of this study was a review of the literature to determine the nature of non-dental IFs in the head and neck region that were found in CBCT scans. Materials: A conducted computerized search on databases Cochrane and Pubmed was perform with the following terms: "cone beam computed tomography" [Mesh] AND "incidental findings"[Mesh]. A total of 74 publications were found, and after full read of title and abstract 47 were selected. The inclusion criteria were articles in Portuguese or English; articles reporting incidental findings using CBCT. The exclusion criteria were case reports and opinion articles. After application of the criteria 17 articles were selected. Results: The most common incidental findings identified were vertebral degenerative changes, mucosal thickening, pineal gland calcification, mucous retention cysts, condylar degenerative changes and concha bullosa. Conclusion: General practitioners should be aware that incidental findings in CBCT scans, are frequent and that their identification is essential for a correct medical documentation. The effect of these IFs requires additional research in terms of follow-up care, treatment and costs. Keywords: cone-beam computed tomography, incidental findings

Case Descripton: Male patient, 68 years of age, non-smoker, with type II diabetes mellitus, showed-up in the appointment with complaints of recurrent abscesses on the tooth 23. After periodontal assessment and radiographic examination (panoramic + periapical radiography), a total loss of the buccal insertion on the tooth 23 was observed, with Probing Pocket Depths (PPD) of 6mm in (MV), 12mm in (V) and 12mm in (DV), degree III mobility, not detecting, however, increased PPD's on the adjacent teeth. After non-surgical periodontal treatment, followed a discussion about the several therapeutic options, being selected the Reconstructive Periodontal Therapy (RPT) with Enamel Matrix Derivatives (EMD), bone substitute (Bio-Oss) and resorbable membrane (Bio-Gide). Previous to surgery, the tooth 23 was endodontically treated and splinted to the neighboring teeth. Postoperative recommendations and medication were prescribed. The follow-up period is 11 months. Discussion: Teeth related to infra-bony defects with deep periodontal pockets became a clinical challenge. There are several therapeutic approaches, however, RPT has proven to be suitable in the retention and healthy maintenance of the teeth, with good long-term results. It's a conservative treatment, although it demands a very strict periodontal protocol. Conclusion: RPT can be successfully used on hopeless teeth associated with infra-bony defects to or beyond the apex and has potential to modify the dental prognosis. The mid-term results are promising, however, further scientific evidence in this field is required. Keywords: infrabony defects, reconstructive surgery, periodontal regeneration, prognosis, hopeless teeth

Introduction: Belonging to the group of Giant and Cystic Cell Lesions of the 4th Edition of the Head and Neck Tumours Classification by WHO, the Central Giant Cell Granuloma is an intraosseous osteolytic lesion, with and unknown etiology, characterized by a benign proliferation of fibroblasts and osteoclast-like giant cells, within a well vascularized stroma. Most of these lesions happen in the anterior sector of the maxillary bones, in women under 30 years of age, being typically assimptomatic and non aggressive. The conventional therapy for the Central Giant Cell Granuloma is the surgical complete enucleation. Clinical Case: Femmale caucasion patient, 21 years old, sent by her medical assistant for evaluation of a radiolucent lesion in the posterior mandible, between teeth 47 and 48. A CBCT was required and after that, the tooth 48 was extracted and an access to the lesion was created followed by it's enucleation and anatomopathological analysis. The analysis result sugested the diagnosis of a Central Giant Cell Granuloma (CGCG), asking for a differentiation between the four entities, due to both having the same morphological pattern. The distinction and exclusion of these entities was based on three criteria: Radiological (Cherubism), Blood Tests (Hyperparathiroidism) and Histological (Aneurismatical Bone Cyst), concluding in this was, the diagnosis of CGCG. Discussion: Some of the caracteristics found in this case are typical of a CGCG, like the gender, age and lack of symptoms envolved. However, the location of the lesion does not follow the normal patterns of a CGCG, once it envolves the posterior mandible, and being so, this entitie was not suggested as a diagnostic hypothesis. The definit diagnosis was then established by the anatomopathological analysis. For the treatment of the lesion, total enucleation was made, as it is established by the literature as the therapy to follow. Conclusion: Although typically not aggressive, the Central Giant Cell Granuloma may appear with a destructive and painfull character, and can be similar, either radiographically or histologically, to other conditions that are more aggressive or have a systemic envolvnment, making the early diagnostic and intervention of extreme importance. Keywords: Central Giant Cell Granuloma, Oral Pathology, Osteolytic Lesions, Head and Neck Tumours

The presence of a melanic pigmentation in the oral mucosa should be questioned by the clinician, leading him to establish a definitive diagnosis based on an excellent clinical history supported by complementary means of diagnosis. The most common causes of pigmentation of the oral mucosa may have several etiologies. Melanomas and pigmentation associated with systemic diseases should always be excluded. There are drugs that cause hyperpigmentation through prolonged use, such as hydroxychloroquine. It is an immunomodeler, discovered before World War II with anti-malaria characteristics. To date, the FDA has approved its use in the treatment of discoid lupus, systemic lupus erythematosus and rheumatoid arthritis, as well as in malaria. The patient performed hydroxychloroquine as a treatment for rheumatoid arthritis approximately for more than 10 years. The hyperpigmentation in this clinical case was dark gray, of consistency and normal surface, with irregular borders, diffuse, located in the hard palate, symmetric, asymptomatic and of approximate diameter 4cm. In English literature only 14 similar cases are described. After biopsy, a mandatory complementary examination to confirm the lesion, the diagnosis of hydroxychorochorine-induced palpinal hyperpigmentation was established. From the point of view of oral health, these cases do not require treatment, and the subsequent procedure is the ophthalmologic referral. Given the rarity of this oral manifestation, it is important to alert dentists to this drug, its prolonged use and side effects that may lead to other more severe systemic conditions, such as retinopathy. Keywords: hydroxychloroquine, immunomodulator, palatal hyperpigmentation, oral mucosa, retinopathy, rheumatoid arthritis, oral medicine

Introduction: Removable dentures should be resistant to chemical disinfection and temperature changes. Objective: Evaluate the effect of thermal aging and chemical disinfection on microhardness and flexural strength of resins. Materials and methods: Two flexible resins - Deflex® ClassicSR and Deflex®SupraSF and one thermo-polymerizable resin - ProBase® Hot were subjected to 1000 cycles of thermal aging (n=32) and three types of chemical disinfection (n=8): Corega®Whitening, Corega®Oxygen-Bio-Active, 2,5% Sodium Hypochlorite and control (distilled water). The Knoop microhardness and flexural strength at 3 points were evaluated. We used Mann-Whitney and T-tes (α = 0.05). Results: Thermal aging only influenced the microhardness of ClassicSR and SupraSF (p0.001). The microhardness values were influenced by the chemical disinfection in Probase®Hot (Corega®Whitening vs Control, Bleach and Sodium Hypochlorite) (p0,05), in ClassicSR (Bio-active vs Control; Corega®Whitening vs Sodium Hypochlorite) (p0,001) and SupraSF (Corega®Whitening vs Sodium Hypochlorite) (p=0,025). The flexural strength was influenced by chemical disinfection in SupraSF (Corega®Whitening vs Bio-active and Corega®Whitening vs Sodium Hypochlorite) (p0,05). Discussion: Disinfectant solutions affected the microhardness of all resins under study and the flexural strength of Supra SF resin alone. Thermal aging affects only the microhardness of the flexible resins. Conclusion: Chemical disinfection promoted significant changes in all resins and further studies are needed to determine the long term effect of thermal aging and chemical disinfection. Clinical Implications: Disinfectant solutions should be used with caution in order to preserve the physical and mechanical properties of the resins. Keywords: flexible resins, thermal aging, chemical disinfection, microhardness, flexural strength

Introduction: Intracanal medication (ICM) helps to reduce the microorganisms responsible for endodontic infections and to control symptomatology. Objectives: To compare the effectiveness of different solutions - Sodium Hypochlorite 3% (NaOCl), Ethylene Diamin TetraAcetic Acid 17% (EDTA) and Citric Acid 10% (CA) - in removal of Calcium Hydroxide powder mixed with 2% Chlorhexidine gel (CH/CHX) and detection of precipitate. Materials and Methods: 45 single root teeth, 3 groups (n = 15), inserted in a silicone base, were instrumented with ProTaper Universal® files (Dentsply Sirona, Switzerland) up to F3 and divided in halves with a microtome. Two standardized grooves (coronal and apical) were filled with CH/CHX and, for their removal, NaOCl or EDTA or CA activated with E1- Irrisonic Helse Ultrasonic® tip (Helse, São Paulo, Brazil) were used. The grooves were photographed before and after application of CH/CHX. The remaining CH/CHX was evaluated using a scoring system (4 levels). Data were statistically analyzed using the Kruskal-Wallis test and the U-Mann-Whitney test with Bonferroni correction (p 0.05) and using the R system (version 3.4.2). Results: CA was higher than NaOCl and EDTA (p 0.05). There were no significant differences between the other groups (p> 0.05). Only and always, in the NaOCl group, an orange-brown precipitate was observed. Discussion: The presence of ICM may compromise the adhesion of the filling material to dentinal walls. In this sense, it's important to optimize their removal. A precipitate formation should be avoided. Conclusions: None of the solutions tested was able to completely remove the ICM; however, CA proved to be more effective than NaOCl and EDTA, and this difference was statistically significant. Clinical Implications: Removal of the ICM in test should rather be done with CA. The use of NaOCl should be avoided if the ICM contains Chlorhexidine. Keywords: calcium hydroxide, chlorhexidine digluconate, removal, EDTA, sodium hypochlorite, citric acid

Clinical Case Description: A 52-year-old melanodermic female patient with no relevant medical history, referenced to an appointment of Surgery and Oral Medicine in FMDUL due to an exuberant bone swelling at the posterior region of the right maxilla. An hard palpation lesion of about 2.5 cm, painless, with slow growth and radiographic expression on retroalveolar radiography and orthopantomography was observed. Computed tomography (CT) scanning revealed a well-defined radiopaque mass with high density, involving teeth 17 and 18, suggestive of a calcifying epithelial odontogenic tumor (Pindborg's Tumor). A surgical procedure was performed for extracting the dental pieces and concomitant excisional biopsy of the lesion. Histhologic examination confirmed that it was an osteoma of the mixed subtype due to the identification of compact lamellar bone with areas of spongy bone. Discussion: Osteoma is a benign neoplasm, composed of mature bone, limited almost exclusively to craniofacial bones. It occurs predominantly between the third and fifth decades of life, with a male predilection. All osteomas, central or superficial, are more frequent in the mandible than in the maxilla, with the mandibular condyle being a common site. The differential diagnosis of these bone lesions should include exostoses, enostosis, osteoid osteoma, odontoma, osteoblastoma and cementoblastoma. Conclusion: Osteoma is an unusual entity in the jaw, so its approach can be a real challenge. The correct definitive diagnosis should be based on clinical and imaging examination, always requiring histopathological confirmation. Its treatment consists of surgical excision and the recurrence is rare, contributing to the good prognosis of this pathology. Keywords: osteoma, tumor, maxilla, surgery, oral pathology

Case Description: A female patient, 63 years old, came on the Oral Rehabilitation consultation with non funcional complete removable upper and lower dentures. In the intraoral examination we observed a upper and lower alveolar ridge round shaped, irregular and with slight resorption. In the attempt to improve the retention and stability of the prosthesic elements, the creation of new prostheses using CAD/CAM technology, using the Dentca™system, was proposed. Discussion: The creation of complete dentures using CAD/CAM methods is currently a reality in the field of oral rehabilitation. The integration of this technology in the design and manufacturing of these prothesis allows to improve the quality of the prosthetic elements and facilitates the communication with the prothesis technician. The CAD/CAM method allows for a reduction in the number of appointments required until the prosthesis is delivered (a major advantage when rehabilitating elderly patients or whom take too long to get to the dental office); reducing the duration of treatment, reducing the overload and fatigue of the dental practitioner; reducing costs without compromising the quality of health care services; absence of polymerization contraction, resulting in increased accomodation of the prosthetic base to the alveolar ridge; Conclusion: The integration of CAD/CAM technology for manufacturing and design of complete dentures, besides contributing significantly to simplifying and facilitating the clinician's and laboratory's work, aims to contribute to improve the quality of the prosthetic element, in which case there was an increase in retention and stability of the prosthesis. Regarding the aesthetic component, despite the very satisfactory result when in the mouth, the characterization of the prosthesis was inferior compared to those made using the conventional method. Keywords: complete denture, CAD-CAM

Previous studies have shown that overweight may influence occurrence of periodontal disease. The aim of study was investigate the association between abdominal obesity and periodontitis. This cross sectional study was conducted in 345 adultos (169 no obese and 167 obese), attended at Public Health Service, from Salvador, Bahia, Brazil. Obesity was established by abdominal circunference (AC). Structured questionnaries were applied to participants e physical exams were done. A trained dentist performed oral exam and gave diagnosis of periodontitis. Prevalence Ratio (PR) and 95% Confidence Intervals (CI 95%) were obtained using Poisson Regression with robust variance. Variables as schooling, diabetes, family income, smoking, sex, and age were adjusted in statistical models. Prevalences of obesity and periodontitis were 49.7% and 74.2%, respectively. There was statistically significant association between abdominal obesity and periodontitis only in female gender, even adjusted by confounders (PR adjusted: 1.20; 95%CI: 1.01-1.44 ). These findings corroborate previous studies that found positive association in women as compared to man. These investigations also suggest worse periodontal condition in obese individuals. Results suggest that women in age group 18 to 49 years having elevated AC are more likely to develop periodontitis compared with individuals with normal AC. Periodontitis and obesity are very prevalent chronic diseases in Brazilian population, and they have high impact on quality of life. Elucidation about real influence of overweight on oral health may contribute to clinical care management. Foundation for Research Support of the State of Bahia (FAPESB). Keywords: obesity, periodontitis, epidemiology

A female patient, healthy, non smoker, of 52 years olds, was referred to the periodontology department of I.U.E.M. to treat the bone defect on teeth 1.2, with probing pocket depth of 9 mm. A guided tissue regeneration was performed (GTR). The GTR is a surgical procedure that uses a barrier membrane, on an infra bony defect to maintain a blood clot in a space, to allow the periodontal attachment cell's to grow. The membranes of equine origin are three-dimensional estrutures of collagen, that have their effectiveness for 3 or 4 months, which is the necessary time for periodontal regeneration. The use of cortical-spongy bone substitute of equine origin, plays an important role in maintaining space, preventing the collapse of the membrane. The infra-bony defect had a probing pocket depth superior to 5 mm and a wide radiographic defect angle (superior to 37 degrees). In the presence of wide defects, the use of bone substitute is necessary. A modified papilla preservation technique was made and used a internal horizontal mattress suture. Follow-up appointments were made and standardized periapical radiographs were obtained through the use of an individualized device (paralleliser). Almost total bone filling was observed after 6 months and reduction of the pocket depth to 4 mm. The use of collagen membranes and corticocellular bone substitute of equine origin seems to be a viable alternative in the regeneration of infra-bony periodontal defects. Keywords: biomaterials of equine origin, infra bony defects, guided tissue regeneration, periodontal surgery