Doutorado em Odontologia (FO)

URI Permanente para esta coleção


Submissões Recentes

Agora exibindo 1 - 20 de 21
  • Item
    Otimização dos protocolos de aquisição de tomografia computadorizada por feixe cônico para redução da dose de radiação
    (Universidade Federal de Goiás, 2022-02-23) Santos, Ananda Amaral; Silva, Maria Alves Garcia Santos;; Silva, Fernanda Paula Yamamoto;; Silva, Brunno Santos de Freitas; Mosconi, Carla; Silva, Fernanda Paula Yamamoto; Arruda, Karine Evangelista Martins; Paiva, Rogério Ribeiro de
    CBCT is influenced by a series of variables such as: the equipment, FOV, exposure time, mA, kVp and also the spatial resolution defined by the voxel size. As the dose should be as low as diagnostically possible, it’s reduction is only possible when the image quality is maintained. It is possible to reduce the radiation dose in patients undergoing dental exams without causing harmful impact on the image quality and, therefore, on diagnostic accuracy, by changing exposure parameters in CBCT equipment, so, the optimization of protocols is sought, for each device, characterized by low radiation dose and high image quality. This study aimed to evaluate the influence of different CBCT exposure protocols in reducing the radiation dose in a CBCT equipment while maintaining image quality. For this, medullary follicles were used in thermoluminescent regions, including radiosensitive regions, including bone, bone, skin, salivary glands, brain and eyes, eyes visible in an anthropomorphic Alderson RANDO® phantom. Eight different ones were performed on the Picasso Trio® scanner (Vatech, Hwaseong, South Korea), with different variations of kVp, mA and number of base images. The effective dose was defined by the International Commission in accordance with Radiological Protection. A subjective assessment of image quality was performed by three experts. When comparing the 8 acquisition protocols, the protocol that obtained the lowest values of radiation DE was protocol 1. The protocol that obtained the highest radiation DE was protocol 8. Protocol 5 (3 mA, 99kVp, 450 IB) proves to be an ideal option among the protocols, due to the low DE associated with a good score obtained when evaluating image quality More studies are needed to standardize a methodology in order to compare different equipment.
  • Item
    Desempenho biomecânico de novos retentores intrarradiculares em dentes com ou sem férula
    (Universidade Federal de Goiás, 2020-02-28) Almeida, Letícia Nunes de; Fonseca, Rodrigo Borges;; Fonseca, Rodrigo Borges; Lopes, Lawrence Gonzaga; Barata, Terezinha de Jesus Esteves; Kasuya, Amanda Vessoni Barbosa; Favarão, Isabella Negro
    The aim of this study was to evaluate the influence of intrarradicular post system and the amount of coronary remnant (ferrule) on maximal fracture load, fracture pattern and stress distribution of endodontically treated teeth. Eight experimental groups were created: Pf-0 e Pf-2 - glass fiber post (GFP) no. 3 in teeth with and without ferrule respectively; GFP no. 1 relined with experimental composite (EC) with and without ferrule respectively; EC-0 and EC-2 - custom post made with the experimental composite (EC) with and without ferrule respectively, CAD-0 e CAD-2 - custom milled post with and without ferrule respectively. The EC was composed of 22.5 wt% of methacrylate resin (Bis-GMA, TEGDMA, Bis-EMA), 30% of glass fibers and 47.5% of filler particles. After endodontic treatment, post cementation and crowns with composite resin, the teeth were tested to verify the maximum fracture load (n = 10) in a universal testing machine (Instron 5965) a 0.5 mm/min. Subsequently, the fracture pattern was analyzed and stress distribution was evaluated by the finite element method using the modified von Mises criterion (MSC Marc & Mentat). The maximum fracture load results were subjected to factor analysis, and subsequently Kolmogorov-Smirnov, ANOVA, Tukey and T-Test for comparison between groups (α = 0.05). Interaction was observed between the factors under study (p = 0.046), and ANOVA and Tukey showed a statistically significant difference between the groups (p = 0.001). EC-0 (752.81N) and CAD-0 (728.84N) were similar and superior Pr-0 (545.16) and Pf-0 (498.01N). In ferrule groups, all retainers were similar (p>0.05) Pf-2 (791.85), Pr-2 (699.1), EC-2 (822,81), CAD-2 (779.89). Pf-0 showed a greater number of non-repairable failures and the Pr-2 posts promoted a greater number of favorable failures. Groups without ferrule showed higher number of non-repairable failures. The posts made with EC showed lower stress concentration and the posts made by CAD / CAM technique, the highest stress concentration. Retainer type and presence of ferrule influence on maximal load, fracture pattern and stress distribution of endodontically treated teeth. CE custom posts promote higher maximum fracture load and more favorable stress distribution.
  • Item
    Análise topográfica e histológica de enxertos de mucosa ceratinizada removidos com mucótomo ou bisturi convencional: estudo ex-vivo em mandíbula suína.
    (Universidade Federal de Goiás, 2022-09-14) Santos, Kleber Vinícius Rodrigues dos; Leles, Cláudio Rodrigues;; Leles, Cláudio Rodrigues; Leles, José Luiz Rodrigues; Roriz, Virgilio Moreira
    To evaluate the surface and tissue quality of EMC obtained by the technique with conventional scalpel and mucotome. Methods: This is an experimental in vitro/ex vivo study. Six swine hemi-mandibles that had a favorable keratinized tissue condition were used for specimen removal in the anterior region of the mandible. Specimens were obtained using mucotome and conventional scalpel. For the purpose of greater precision, the procedure for removing specimens from the jaws was performed by a specialized and previously trained dental surgeon, offering the same conditions for graft removal by both techniques. random drawing to determine the technique to be performed for tissue removal. The specimens were prepared according to the protocols pre-established by the laboratories and then they were taken for analysis in optical microscopy to evaluate the epithelium and connective tissue and in scanning electron microscopy for analysis of topography and 3D profilometry. Results: Two areas were analyzed per sample with dimensions of 1920 x 2560 μm. It was possible to notice the presence of keratinized stratified squamous epithelial tissue and dense connective tissue modeled on the tissue slides removed with mucotome and scalpel. In the tissues removed with mucotome, there is a linearity in the tissue base and in the thickness of the tissue as a whole, presence of submucosa, fibrous connective tissue that is ideal for the success of the graft Differences in the surface of the samples removed by the two techniques were observed when to compare the images obtained through the two types of microscopy. Conclusion: Keratinized mucosa grafts when removed by the mucotome technique present greater uniformity and lower presence of undesirable cells compared to the scalpel technique, favoring a greater chance of success in surgical procedures for soft tissue grafting.
  • Item
    Acurácia de três tomógrafos e dois softwares no diagnóstico de defeitos peri-implantares do tipo deiscência: estudo in vitro
    (Universidade Federal de Goiás, 2022-03-04) Ferreira, Mário Serra; Silva, Maria Alves Garcia Santos;; Silva, Maria Alves Garcia Santos; Roriz, Virgílio Moreira; Rabelo, Luiz Eduardo Gregoris; Sousa, Thiago Oliveira; Gasperini, Giovanni
    In evaluating of the peri-implantitis, Cone Beam Computed Tomography (CBCT) has the advantage of estimating the bone site in a three-dimensional manner; however, the production of artifacts represents a negative factor against high-density materials. The objective of this work was to evaluate the accuracy of three CT scanners and two software in the identification and measurement of peri-implant dehiscence defects in vitro. For this, 36 bovine rib models were prepared to receive a Morse taper titanium implant Torq® 13 X 4,0 mm (Conexão, Arujá, São Paulo, Brazil). The ribs were divided into three groups: a group without bone defect as a control (n=12), a group with a dehiscence-like defect from 1.0 mm to 2.5 mm (n=12), and a group with a dehiscence-like defect > 2.5 to 4.15 mm (n=12). Rib blocks were submitted to CBCT using three different devices: Carestream 8100 3D (Carestream Health, Rochester, New York, USA), PreXion 3D (PreXion Inc, San Mateo, California, USA), and Orthopantomogram OP300 (Instrumentarium Kavo Kerr, Tuusula, Finland). These images were imported and processed by two software programs: e-Vol DX (CDT Software, Bauru, São Paulo, Brazil) and InVivo (Anatomage, San Jose, California, USA). Two evaluators experienced in identifying bone defects in tomographic images analyzed the presence/absence of a peri-implantitis dehiscence type defect and independently measured the size of the defect using a linear measurement tool using a five-point scale and measured the defect using a linear measurement tool. ROC curve was created to evaluate the accuracy, and the Friedman test was used to analyze the variables between the e-Vol DX and InVivo software. The results demonstrated a 100% accuracy value for defect detection with PreXion and Carestream and 98% for the OP300 across all defect sizes. The area under the curve presented 100% accuracy for InVivo and 99% for the e-Vol DX. Regarding measurement, the software showed a statistically significant difference, following the mean values: reference standard (2.6111), e-Vol DX (1.8542), and InVivo (1.5347). All equipment and software tested showed good accuracy in detecting dehiscence. In the measurement of defects, the e-Vol DX showed better results than the InVivo, but both software underestimated the real measurements.
  • Item
    Motivação de adolescentes para começar e parar de fumar e fatores associados: estudos embasados em teorias de mudança de comportamento
    (Universidade Federal de Goiás, 2020-12-22) Rios, Leonardo Essado; Freire, Maria do Carmo Matias;; Freire, Maria do Carmo Matias; Faria, Patrícia Corrêa de; Oliveira, Ana Cristina Borges de; Oliveira, Ana Maria de; Pinheiro, Helder Henrique Costa
    Introduction: Smoking is a chronic disease caused by nicotine dependence, and a risk factor for several general and oral health problems. Multiple factors have been linked to smoking during adolescence, including psychosocial indicators. At the same time, the Behaviour Change Science has advanced in identifying the three essential elements of the mental motivational system that prompts smoking initiation and cessation: beliefs, desires, and intentions. However, the relationships between these factors need to be better understood in the adolescent population. Objective: To investigate the motivation of adolescent students to start and stop smoking based on Behaviour Change Theories and associated factors. Methods: A systematic review of the literature with meta-analysis, and three cross-sectional analytical studies were carried out. Adolescents aged 12 to 19 years were the target population. In the review, a systematic search for eligible studies was conducted on scientific bases by previously calibrated reviewers, who selected and evaluated studies about the intention of adolescents to quit smoking based on the Transtheoretical Model of Stages of Change. In the cross-sectional studies, the data were collected in federal schools of a Brazilian Midwest state. A self-administered questionnaire was used, containing: a) questions based on the Prime Theory of Motivation that measured desires, beliefs and intentions related to smoking initiation and cessation, b) psychosocial variables through validated scales of Sense of Coherence (SOC) and Duke University Religion Index (DUREL), and c) questions about adolescents' belief regarding the benefit of smoking cessation interventions in medical and dental services. Poisson or Logistics regressions were used in the statistical analysis. Results: Among the participants in the systematic review (n=6469), 41% of smokers had no intention of quitting smoking, which was associated with more unfavourable characteristics in relation to smoking, such as lower decisional balance and self-efficacy (p<0.05). In the cross-sectional analyses (n=3034), most smokers (57%) did not want to, nor intended to quit smoking, and approximately 6% of the non-smokers had the highest level of motivation to start (simultaneous presence of desire, belief, and intention). Among the non-smokers, an inverse association was observed between the motivation to start smoking and the SOC, so that for each increase of one unit in the SOC score, the probabilities of desire to smoke, belief in the benefit of the habit, and intention to smoke in the future decreased by three, three and five times, respectively. Similarly, for each unit increased in scores for Organizational, Non-Organizational, and Intrinsic Religiosity, the likelihood of motivation to start smoking decreased by 23, 23 and 15 times, respectively. Among the smokers, an increase in the Intrinsic Religiosity score increased the motivation to quit by 1.13 times. Compared to those unmotivated to quit smoking, the motivated ones had a greater belief in the benefit of interventions for smoking cessation in health services (p <0.05). Conclusion: The proportion of adolescents motivated to start or stop smoking was low and associated with psychosocial factors, which could be considered as potential influences of anti-smoking interventions for this population.
  • Item
    Avaliação de cimentos e técnicas de obturação no preenchimento de istmos radiculares usando um novo software de tomografia computadorizada de feixe cônico
    (Universidade Federal de Goiás, 2022-05-25) Morais, André Luiz Gomide de; Estrela, Carlos;; Oliveira, Helder Fernandes de; Siqueira, Patrícia Correia de; Silva, Júlio Almeida; Silva, Brunno Santos de Freitas; Estrela, Carlos
    Aim: To evaluate the sealing ability of root isthmuses using different sealers and root canal filling techniques using a new Cone Beam Computed Tomography software (e-Vol DX). Methodology: 120 lower molars extracted from patients with indication for extraction were used. The teeth were divided into 6 groups according to the endodontic sealer and filling technique: G1: AH Plus® + lateral condensation technique (n=20), G2: AH Plus® + Tagger's hybrid technique (n=20), G3: AH Plus® + single cone technique (n=20), G4: BioRoot RCS + lateral condensation technique (n=20), G5: BioRoot RCS® + Tagger hybrid technique (n=20) and G7: BioRoot RCS® + single cone technique (n=20). The teeth were instrumented using the Wave One Gold® reciprocating system, irrigation performed with 2.5% sodium hypochlorite and EDTA (using ultrasonic passive irrigation) and then all canals were filled according to the division of the groups. Sealing evaluation was performed using scores. Nonparametric statistics were used for its analysis and the description was performed by median, minimum and maximum. Mann Whitney test was used to compare the scores between the sealers and Kruskal-Wallis test followed by Dunn-Bonferroni post hoc tests between the obturation techniques and groups. To compare scores obtained with and without Blooming Artifact Reduction (BAR) filter of e-Vol DX software, Wilcoxon test was used. Results: Results showed there was a significant difference in sealing lower molar isthmus using endodontic sealers studied in apical third with BAR (p=0.016), with scores being higher for AH Plus®. There were differences in sealing of lower molar isthmus using different filling techniques in middle and apical thirds. For middle third without BAR, difference was between single cone and Tagger's hybrid techniques (p=0.011) as well as for apical third without BAR (p<0.001). For middle third with BAR, difference was between single cone technique and lateral condensation (p=0.043) and Tagger hybrid (p=0.009) techniques. For apical third with BAR, the difference was between Tagger's hybrid technique and single cone (p<0.001) and lateral condensation (p=0.041) techniques. When comparing the sealing scores using different filling techniques and types of sealer, there were differences between G2 and G3 (p=0.015) and G2 and G6 (p=0.024) in apical third without BAR. Using BAR tool, statistical differences were as follows: in cervical third between G2 and G6 (p=0.023); in middle third, between G2 and G6 (p=0.072); in apical third, G6 had lower scores than G1 (p=0.046), G2 (p=0.002) and G5 (p=0.011) and G4 had lower scores than G2 (p=0.023). When comparing isthmus sealing scores with and without using BAR tool, there were significant differences, with higher values without using the tool, in all thirds. It is concluded that, when evaluating sealing ability of root isthmus using different sealers and filling techniques with e-Vol DX software, the best combination was the use of AH Plus and Tagger's hybrid technique. Using BAR filter of the eVol DX software in CBCT images showed more empty spaces in filling mass due to the reduction of white expansion, making tomographic image more reliable.
  • Item
    Harmonização orofacial: Análise do conhecimento dos cirurgiões-dentistas sobre os riscos clínicos e aspectos legais e éticos na prática da rinomodelação e bichectomia
    (Universidade Federal de Goiás, 2021-02-23) Rodrigues, Lívia Graziele; Silva, Rhonan Ferreira;; Silva, Rhonan Ferreira; Dias, Paulo Eduardo Miamoto; Rosário Júnior, Ademir Franco do; Costa, Nádia do Lago; Goulart, Douglas Rangel
    Dentistry has proved to be a complex science that treats the patient holistically, restoring the masticatory functions and the aesthetics expected for a natural smile. However, when permeating the field of facial aesthetics, many dentist have been carrying out various procedures, which are considered controversial according to dental practice. Orofacial harmonization consists of making of a patient's face more aesthetically proportional through procedures such as: facial filling with biomaterials, application of botulinum toxin, bichectomy, cervical lipoplasty and rhinomodeling. The objective of this study is to evaluate the perception of dentists regarding the technical capacity to perform rhinomodeling and bichectomy procedures regarding the legal support for their performance. After approval by the ethics committee, a self-administered structured questionnaire with 16 questions about the participant's profile, orofacial harmonization topics and specific subjects on bichectomy and rhinomodeling was applied to the professionals who were willing to participate. Of the 180 questionnaires answered, 105 (58.3%) were from female professionals, 41 (22.9%) said they performed orofacial harmonization procedures in their clinical routine. Asked about feeling able to treat an already installed nasal necrosis, 19 (11.0%) participants declared to be qualified to proceed with this type of treatment, while 110 (72.8%) of them informed that they would forward this case of complication to a Doctor. It was possible to perceive that, in general, the professionals are not aware of the norms that support them regarding the performance of new procedures included in the list that Dentistry already practices, in addition, even among the professionals who attended training courses in Orofacial Harmonization, most of them do not feel prepared to perform procedures such as rhinomodeling and treat complications resulting from bichectomy surgery.
  • Item
    Avaliação imunoistoquímica de mediadores envolvidos na evasão imunológica de células tumorais em carcinoma adenóide cístico de glândulas salivares
    (Universidade Federal de Goiás, 2020-10-15) Mosconi, Carla; Mendonça, Elismauro Francisco de;; Mendonça, Elismauro Francisco de; Silva, Tarcília Aparecida; Mesquita, Ricardo Alves de; Alves, Pollianna Muniz; Costa, Nádia do Lago
    Justificativa do estudo: O Carcinoma adenoide cístico (CAC) é um dos tumores de glândulas salivares mais comuns na região de cabeça e pescoço. Caracteriza-se por possuir evolução lenta, curso clínico prolongado, ser altamente infiltrativo, com altas taxas de recidivas, ocorrência de metástase regional e à distância. Para evitar a ocorrência de metástases, as células neoplásicas devem ser combatidas pelo sitema imunológico. Os mediadores que estão expressos em células neoplásicas e linfócitos, podem propiciar a imunossupressão e o escape das células tumorais favorecendo a ocorrência de metástase local e a distância. Objetivos: O objetivo deste estudo foi avaliar a expressão das proteínas HLA-G, PD-L1, PD-L2, CD8, GrB, CD1a, CD83, CTLA-4 e PD- 1 em amostras de CAC e a associação destas com os parâmetros clinicopatológicos da doença. Material e métodos: Foram selecionadas 36 amostras de CAC e a identificação da expressão das proteínas foi realizada pela técnica da imunoistoquímica. As células neoplásicas do CAC, positivas para as proteínas HLA-G, PD-L1, PD-L2, foram avaliadas semi-quantitativamente em porcentagem de células positivas (0 – 100%) e do infiltrado inflamatório positivas para CD8, GB, CD1a, CD83, CTLA-4 e PD-1 foram quantificadas e convertidas em densidade (células/mm2). Amostras de trofoblastos, líquens plano e linfonodos foram utilizados como controle positivos das reações. Resultados: O CAC apresentou baixa expressão de TIL CD8+, GrB+, CD1a+ e CD83+, assim como, escassa positividade para CTLA-4 e PD-1. De forma contrária, observou-se expressão de PD-L2 e HLA-G, enquanto PD-L1 foi negativo em todas as amostras avaliadas. Interessantemente, casos que tinham baixa densidade de TIL CD8+, apresentaram maiores taxas de recidivas. Conclusão: Nossos achados sugerem que o microambiente do CAC apresenta uma baixa imunogenicidade, representada pela baixa densidade de TIL e células dendríticas. Além disso, parece haver ativação das proteínas inibitórias imunes PD-L2 e HLA-G, o que sugere um cenário que pode favorecer o escape tumoral do sistema imunológico e contribui para o prognóstico desfavorável dessas neoplasias.
  • Item
    Técnica socket shield: análise da distribuição de tensões
    (Universidade Federal de Goiás, 2019-04-30) Neves, Ricardo Guimarães; Torres, Érica Miranda de;; Souza, João Batista de;; Souza, João Batista de; Torres, Hianne Miranda de; Carvalho, Alexandre Leite; Silva, Maria Alves Garcia Santos; Veríssimo, Crisnicaw
    Objective: To compare, by means of a three-dimensional finite element method, the influence of the Socket Shield (SS) technique on the stress distribution on peri-implant bone, implants and prosthetic componentes in comparison to other techniques for rehabilitation of anterosuperior tooth loss. Material and method: Geometrical models of a implant-supported central incisor were designed by simulating three different placement techniques: SS group, with a 2,5mm-thick radicular dentine fragment positioned within the buccal alveolar wall and the implant; Heterogeneous Graft (HG) group, with a heterogenous bovine bone grafting material placed within the buccal alveolar wall and the implant; and control group, with the entire implant in contact with bone tissue of a healed alveolar ridge. Models were loaded with 100 N on the palatal surface (angled to 45º in relation to tooth long axis to simulate maximum intercuspation) and 25 N perpendicular to the incisal edge (to simulate "edge-to-edge” contact). Maximum stresses (tensile, shear and compressive) and displacement in the bone tissue including the alveolar crest cortical plate, trabecular bone, root dentin and bone graft were analyzed. Von Mises equivalent stress was evaluated for the implants and prosthetic components. Results: Higher stress values for bone tissue were observed for SS and HG groups in comparison to control. Stress values within groups were not significant different for dentin fragment, bone graft, implant and prosthetic components. Conclusion: Stress concentration in the bone tissue was higher for SS, followed by HG and control group.
  • Item
    Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano
    (Universidade Federal de Goiás, 2019-08-23) Hartmann, Roberto; Schimmel, Martin; Leles, Cláudio Rodrigues;; Leles, Cláudio Rodrigues; Gonçalves, Thais Marques Simek Vega; Abreu, Mauro Henrique Nogueira Guimarães de; Ribeiro-Rotta, Rejane Faria; Nogueira, Túlio Eduardo
    This randomized trial compared the effectiveness and cost-effectiveness (cost x patient centered outcomes) of three treatment alternatives for mandibular edentulism rehabilitation: unit-implant-retained mandibular overdenture (Group I), two-implant-retained mandibular overdenture (Group II) and four-implant-supported mandibular fixed prosthesis (Group III). We included 50 fully edentulous patients who initially received new conventional total dentures (baseline) and were later randomly allocated to one of the treatment groups. External hexagon implants (Titamax TI Cortical, Neodent, Curitiba, Brazil) were installed following the conventional loading installation protocol. Generalized Estimating Equations (GEE) was used to calculate the primary outcome variables were the direct dental costs which were identified, measured and valued; oral health-related quality of life (OHIP-Edent) and patient satisfaction with prostheses in all groups for a follow-up period of 1 year. Masticatory performance, prosthetic complications, maintenance events and peri-implant evaluation (marginal bone loss, peri-implant tissue status, implant stability quotient - ISQ) were evaluated as secondary outcomes. Data from 37 participants: Group I (n = 11); Group II (n = 13); Group III (n = 13) were collected and were similar in relation to baseline clinical characteristics and outcomes of initial treatment with conventional full dentures. Incremental cost-effectiveness - ICER ranged for Group II (compared to Group I) from R$ 36.20 to R$ 81.46 for a 1-point increase in patient satisfaction (base value = R$ 54.30) for Group III (compared to Group I) ranged from R$ 1321.12 to R$ 2972.52 (base value = R$ 1981.68). The total cost of treatment for the surgical and prosthetic phases was R$ 2,370.70 for Group I, R$ 3,185.20 for Group II and R$ 5,739.50 for Group III. There was a significant difference between the costs in the three groups (p <0.001). The greatest impacts on total treatment cost were related to the initial laboratory, implant and component costs in Group III. The satisfaction questionnaires and OHIP-Edent satisfaction scores in the 12 months improved in all groups compared to baseline. and were similar in intergroup comparison at baseline (with new conventional full dentures) and 1 year after implant prosthesis capture. In intra- and inter-group comparisons there was no significant change regarding satisfaction with the maxillary prosthesis. Regarding masticatory performance, there was no difference between groups evaluated in the same period for the different cycles (20 and 50 cycles) with gradual improvement for all groups up to 6 months and a slight decrease in 12 months for all groups. It was concluded that the rehabilitation of edentulous patients with implants significantly improved patient-reported outcomes in all treatment groups. Regarding the economic aspects of the treatments, the direct dental cost and the clinical time spent to perform the treatment and follow-up during the 1 year period in the fixed prosthesis (Group III) was approximately three times higher than in Group I, which did not correspond to a proportional gain in effectiveness as well as the additional cost of overdenture retained by two implants did not result in significant effectiveness gain over overdenture retained per unit implant. The implant survival was 100% in all groups after the 1-year follow-up. Considering the limitations of the study, implant-retained overdentures were the most cost-effective modalities.
  • Item
    Análise tridimensional das dimensões da nasofaringe e orofaringe por diferentes métodos de mensuração e softwares
    (Universidade Federal de Goiás, 2017-02-03) Torres, Hianne Miranda de; Valladares Neto, José;; Silva, Maria Alves Garcia Santos;; Silva, Maria Alves Garcia Santos; Silva, Fernanda Paula Yamamoto; Vasconcelos, Carla de Faria; Guerra, Eliete Neves da Silva; Ruellas, Antônio Carlos de Oliveira
    Introduction: The need to assess the pharyngeal airway space (PAS) during diagnosis and planning for orthodontic treatment and orthognathic surgeries led to the development of several measurement methods. However, the variability of methods and softwares limits comparisons of results derived from different studies. Thus, this study aimed to test measurement methods for the assessment of the nasopharynx and oropharynx using two different softwares. Methods: Forty cone beam computed tomographies (CBCTs) were selected from an image database of patients aged between 20-50 years, with the purpose of diagnosis or planning for orthodontic treatment with skeletal relationship Class I. A resin prototype of the nasopharynx and oropharynx was fabricated and served as gold standard to evaluate the accuracy of the results indicated by the software used. Two examiners performed measured the CBCTs independently. The sub regions of the nasopharynx and oropharynx were measured volumetrically according to the limits of five different measurement methods (3 methods for nasopharynx and 2 methods for oropharynx) and using two softwares (InVivoDental and Dolphin3D). The minimum area and the location of the minimum area were measured. The intra-rater and inter-rater agreement for measurements in the different methods and softwares were calculated using the intra-class correlation coefficient (ICC). ANOVA for repeated measures was used to compare the measurements of the 3 methods for the nasopharynx. The comparison of the 2 methods for the oropharynx and of the 2 softwares were performed using paired t-test. Statistical tests were performed at the 5% significance level using the software SPSS 22.0. Results: The intra-rater ICC ranged from 0.58 to 0.99. The inter-rater ICC ranged from 0.95 to 1.00. There was a statistically significant difference for the nasopharynx volume in the 3 methods of both softwares (P = 0.001). Both methods for oropharynx assessment were different considering the volume in both softwares (P = 0.001), the minimum area and location of the minimum area for software InVivoDental (P = 0.001). The two softwares showed statistically significant difference in the volume considering the nasopharynx and oropharynx methods (P < 0.05), except for the method 1 of the nasopharynx. There was also a difference for the minimum area in the method 5 of the oropharynx (P = 0.001), as well as to the location of the minimum area for all the nasopharynx and oropharynx methods (P < 0.05), except the method 4 of the oropharynx. When considering the prototype measurements as a reference, Dolphin3D software showed higher values theand InVivoDental software showed lower. Conclusion: The two softwares were reliable for the measurement of the variables assessed in this study. Different measurement methods could not be compared for the evaluation of the nasopharynx and oropharynx volumes. The results of volume and the location of the minimum area could not be compared between InVivoDental and Dolphin3D softwares. Dolphin3D software overestimate the volumetric values of the nasopharynx and oropharynx, while the InVivoDental software underestimate measurements.
  • Item
    Comportamentos de risco à saúde geral e bucal em adolescentes no Brasil: distribuição temporal, desigualdades socioeconômicas, padrões de agrupamentos e fatores associados
    (Universidade Federal de Goiás, 2017-01-23) Jordão, Lídia Moraes Ribeiro; Freire, Maria do Carmo Matias; Nomes dos; Freire, Maria do Carmo Matias; Morais Neto, Otaliba Libânio de; Queiroz, Edna Mendonça Oliveira de; Costa, Nádia do Lago; Barata, Terezinha de Jesus Esteves
    This thesis focuses on oral and general health-compromising behaviours among Brazilian adolescents. Such behaviours constitute major causes of morbimortality in the worldwide population, are often initiated during adolescence, and tend to track into adulthood. Oral diseases, like dental caries, periodontal disorders and cancer, share a number of behavioural risk factors that are common to other preventable chronic noncommunicable diseases. Nevertheless, there is no evidence about the overtime distribution, and socioeconomic inequalities, neither about clustering patterns with other health behaviours and associated factors of oral health- compromising behaviours among Brazilian adolescents. The present studied aimed to analyze oral health-compromising behaviours based on the Brazilian National School-based Student Health Surveys (PeNSE) as regards to: a) overtime distribution and social inequalities, and b) clustering patterns with other health behaviours and associated factors. The first approach is presented in one original paper regarding oral health behaviours changes over time in Brazilian adolescents, in relation to maternal educational inequalities. For this, we used data from PeNSE for the years 2009 and 2012, a survey that investigates health risk and protective factors among Brazilian adolescents attending schools. The results showed that: the proportion of adolescents with low toothbrushing frequency increased, and the consumption of sweets and soft drinks, and cigarette experimentation decreased. In private schools, we found higher soft drink consumption and higher cigarette experimentation among students who reported greater maternal education, while in public schools we found higher soft drink consumption among students who reported lower maternal education, and higher cigarette experimentation among students who reported greater maternal education. There were no inequalities for toothbrushing frequency or sweets consumption in both types of school. The second approach is presented in two original papers that described the clustering patterns of oral and general health-compromising behaviours among Brazilian adolescents and identified associated factors. For these analyses, we used data from the Brazilian National School-based Student Health Survey (PeNSE) for the year 2012. The main findings are: a) oral and general health-compromising behaviours were inter-related and clustered into two specific patterns; one cluster gathered a combination of lack of adherence to preventive behaviours and the undertaking of risky conduct, while the second reflected an unhealthy lifestyle; and b) the odds for presenting two or more oral health-compromising behaviours were greater for adolescents without parental involvement in homework, from public schools, males, whose mothers had fewer years of education, and of lower family affluence. It was concluded that the oral health-compromising behaviours underwent changes in their distribution over time; however they were not related to maternal education inequalities, have clustered with other health behaviours and were associated with sociodemographic and family factors among Brazilian adolescents. Interventions aiming at reducing health-compromising behaviours among adolescents should prioritize groups that have been identified as being at most risk and preferably employ a common risk factor approach.
  • Item
    Associação de fatores individuais e familiares com o comportamento da criança na sedação odontopediátrica
    (Universidade Federal de Goiás, 2016-12-13) Machado, Geovanna de Castro Morais; Costa, Luciane Ribeiro de Rezende Sucasas da;; Costa, Luciane Ribeiro de Rezende Sucasas da; Batista, Aline Carvalho; Sacono, Nancy Tomoko; Serra-Negra, Júnia Maria Cheib; Gonçalves, Ilda Machado Fiúza
    Objectives: Moderate sedation is indicated to control children’s behavior during dental care, reducing anxiety and maintaining the child's well-being. However, some sedated children do not present good behavior making it difficult to perform dental procedures. This study investigated the association of possible individual factors (temperament) and family (parents’ dental anxiety, parents’ pain catastrophizing and coping strategies adopted by parents) with the children’s behavior during dental treatment under moderate sedation. Methods: A total of 110 children/parents (<7 years), referred to sedation at Dental Sedation Center (NESO) of the Faculty of Dentistry of the Federal University of Goiás, for not have cooperated during dental care, and their parents, participated of this observational study of data from two clinical trials. Children had two appointments: clinical examination and tooth restoration, with local anesthesia and rubber dam, under moderate sedation. The restorative session was filmed for further evaluation of the children's behavior by trained and calibrated observers. The behavior was assessed using the Ohio State University Behavioral Rating Scale OSUBRS. Positive behavior was considered when the children presented 80% or more of the sum of the scores 1 and 2 (quiet or crying) during the entire session. The children’s stress was evaluated through the increased cortisol levels present in the saliva, collected in three moments: arrival, 25 min after local anesthesia, and 25 min after the end of the procedure. Children’s temperament was assessed through the Children’s Behavior Questionnaire (CBQ) answered by parents. Factors related to parents’ anxiety were thus evaluated: dental anxiety using Corah Dental Anxiety Scale; level of pain catastrophizing through the Pain-Catastrophizing Scale-parents; coping strategies through Brief COPE. Data were analyzed using descriptive statistics and the Chi-square test, Friedman, Wilcoxon, Mann-Whitney, Kruskal Wallis or t-test for independent samples. Results: More than half of the children displayed negative behavior (n = 60 54.5%). Temperament did not associate with the negative behavior of children. Extroversion/surgency (P = 0.03) and the subscales ‘activity level’ (P = 0.04), ‘impulsivity’ (P = 0.04) and ‘smiling/laughter’ (P = 0.01) differed between behavior groups, where children with positive behavior had higher scores than those who had negative behavior. In a sample of 42 children, 31 (73.8%) were reactive to stress during local anesthesia and temperament was not associated with increased levels of children’s stress. Dental anxiety and pain catastrophizing were not associated with negative children’s behavior. Parents of children with negative behavior had higher scores in maladaptive coping and Venting subscale, and lower scores in the Acceptance subscale. Conclusion: Coping strategies adopted by the parents explained, in part, negative or positive children´s behavior. These results have shown that parental coping strategies may have protective or destructive effects on children's behavior. Temperament was not associated with negative behavior and did not influence the children´s stress during the injection of local anesthesia. However, many children were stressed during this procedure, a fact that should be always considered by the professional who assist children under moderate sedation.
  • Item
    Anquilose dentária: desafios no diagnóstico utilizando exame de tomografia computadorizada de feixe cônico
    (Universidade Federal de Goiás, 2018-04-09) Rege, Inara Carneiro Costa; Leles, Claudio Rodrigues;; Mendonça, Elismauro Francisco de;; Mendonça, Elismauro Francisco de;; Freitas, Claudio Froes de; Leite, André Ferreira; Caldas, Maria de Paula; Leite, Angélica Ferreira Othon
    Dental ankylosis is the fusion of dental tissue (dentin and cementum) to alveolar bone without the presence of the periodontal ligament (PDL), which can progress to replacement resorption. Cone-beam computed tomography (CBCT) has been prescribed for the evaluation of unerupted teeth, and ankylosis is an important characteristic to be observed in the analysis of these teeth. The objective of this research was to establish diagnostic criteria, using pixel intensity in CBCT and associate with clinical and demographic factors. The pixel intensity value was performed by two analyzes. The first (analyze 1) evaluated the mean pixel intensity in different regions of the dento-alveolar complex in normal and ankylosis areas. The second (analyze 2) was observed the variation of pixel intensity values in two normal areas and one of ankylosis. Data were analyzed statistically by means of absolute and relative frequency measurements; odds ratio, Chi-square. The t-test was used to compare the means of pixel intensity. One hundred and fifty-seven CBCT exams of individuals with unerupeted or partially erupted teeth with suspected ankylosis were evaluated, totaling 206 teeth. Fifty-seven teeth (27.6%) had a presumptive diagnosis of ankylosis and were evaluated using pixel intensity value. In analysis 1, it was observed that the values of alveolar bone in the normal and ankylosis areas, practically have the same variability of pixel intensity value (t-test = 0.07). When comparing the density of normal PDL with the ankylosis area, a higher density is observed (t-test p <0.001). When compared to the alveolar bone interface with PDL and alveolar bone with ankylosis area, it is observed that the intensity of the pixels in the ankylosis region is greater than in the normal area (t-test p <0.001). In analysis 2, it was observed that there was a marked reduction of pixel intensity value in the PDL area, which did not occur in the ankylosis areas. Considering the clinical and demographic factors, the occurrence in individuals over 20 years old was 72.5%, and less or equal to 20 years was 27.5% (odds ratio 1.8 95% CI 0.87-3.73), and 77.2% (n = 44) were in the upper arch. The mesioangular inclination was observed in 49.1% (n = 28), and the association between impaction and dental ankylosis was not observed (p = 0.44 Chi-square). The cervical and middle thirds of root were the most affected, 38.6% and 35.1%, respectively. It was possible to observe ankylosis in 22 teeth (38.6%) in three multiplanar reconstructions. In summary, the results suggest that the CBCT examination allows the diagnosis of ankylosis and the analysis of the pixel intensity values and their variability are an important digital tool for the interpretation and diagnosis process.
  • Item
    Influência dos diferentes padrões faciais nas dimensões do espaço aéreo faríngeo avaliados em tomografia computadorizada de feixe cônico
    (Universidade Federal de Goiás, 2018-04-16) Alves, Celha Borges Costa; Valladares Neto, José;; Silva, Maria Alves Garcia Santos;; Silva, Maria Alves Garcia Santos; Fantini, Solange Mongelli de; Torres, Hianne Miranda de; Souza, João Batista de; Sousa, Thiago Oliveira
    The pharyngeal airway space (PAS) determines vital functional processes such as swallowing and phonation. It includes nasopharynx and oropharynx and actively contributes to the development of facial morphology as a whole and the ideal occlusion. Pathological alterations that lead to PAS narrowing may cause alterations in craniofacial development due to variations in the respiratory pattern and swallowing. The relationship between PAS, severity of malocclusion, and variations in the skeletal pattern is well established. This study aimed to assess whether there is a relationship between the dimensions of PAS and the different skeletal facial patterns. A total of 207 cone beam computed tomographies (CBCTs) of patients between 20 and 40 years of age referred to orthodontic treatment were selected. These tomographic images were analyzed and divided into groups regarding anteroposterior skeletal facial pattern (APP) or maxillomandibular anteroposterior relationship (Classes I, II, and III) and vertical skeletal facial patterns (VP) dolichofacial, mesofacial, and brachyfacial. All the measures were performed by only one rater, using the software Dolphin. Statistical tests of rater calibration and of the measures obtained were conducted using the software Statistical Package for the Social Sciences (SPSS) for Windows version 24.0 at the 5% level of significance. For interrater reliability analysis, the intraclass correlation coefficient (ICC) was used. The Kruskal-Wallis test and Mann-Whitney post-test, the one-way analysis of variance (one-way ANOVA) and Tukey post-test, as well as Pearson correlation and the multivariate analysis of variance (MANOVA) of all measures of APP and VP were used. Excellent ICC results, above 0.9, were found for intrarater reliability. Statistically significant differences were found in the comparison of Class I regarding pharyngeal (p = 0.033) and oropharyngeal minimum area (p = 0.036) and pharyngeal (p = 0.024), nasopharingeal (p = 0.008), and oropharingeal anteroposterior width (p = 0.008) among mesofacial and dolichofacial patients. Mesofacial patients had significant differences in pharyngeal volume (p = 0.039), pharyngeal minimum area (p = 0.013), nasopharyngeal length (p = 0.017), and oropharyngeal length (p = 0.001) among Classes I, II, and III. For Class III, significant differences were found in nasopharyngeal (p = 0.046) and oropharyngeal length (p = 0.039) among mesofacial and dolichofacial patients. Dolichofacial patients had significant differences in nasopharingeal (p = 0.019) and oropharyngeal anteroposterior width (p = 0.012) among Classes I, II, and III. A negative correlation was found between VP and the location of minimum area of nasopharynx (p = 0.001) and oropharynx (p = 0.002), as well as between APP and nasopharingeal (p = 0.002) and oropharingeal anteroposterior width (p = 0.003). Interactions were found between APP, VP, and APP x VP. Therefore, significant differences were observed in the comparisons, correlations, and interactions between APPs and VPs and PAS dimensions.
  • Item
    Comportamento clínico de restaurações classe I e II de resina composta realizadas com sistema adesivo universal em diferentes protocolos de aplicação - estudo clínico randomizado
    (Universidade Federal de Goiás, 2018-04-20) Carvalho, Andreia Assis; Lopes, Lawrence Gonzaga;; Lopes, Lawrence Gonzaga;; Veríssimo, Crisnicaw; Silva, Maria Alves Garcia Santos; Reges, Rogério Vieira; Torres, Érica Miranda de
    The objective of this study was to evaluate the clinical behavior of direct composite resin restorations (Class I and II), varying the universal dental adhesive application protocol, using the FDI and USPHS evaluation criteria. It was a randomized, double-blind, mouth5 divided, and sample-based randomized controlled trial. The selected participants should have a Class I and/or II restorative need for at least three dental elements or multiples of three resulting from the presence of carious lesions and/or unsatisfactory restorations. Three protocols for the application of the Single Bond Universal adhesive (3M ESPE) were tested (n=150): CAT (control) = etch-and-rinse + adhesive (n=50); CASE = selective etching in enamel + adhesive (n=50) and Ac = self-etch (n=50). The three groups were similarly restored using Filtek Z350 XT composite resin (3M ESPE) by means of the oblique incremental technique. Clinical evaluations were performed by two evaluators at the baseline (T1) and after 15.8 (±2.7 months) (T2), using the FDI and USPHS criteria. Friedman (between groups at different times), Wilcoxon (between times for each group) and McNemar (between FDI and USPHS criteria) were performed, α=0.05. The Kappa test showed excellent inter-examiner agreement (κ>0.80). For the "superficial staining" property, a statistically significant difference was observed in T2 between the CAT and CASE groups (p=0.01) with higher values for CAT and, when T1 and T2 were compared for each group, there were differences in the CAT group (p=0.001) and in the Ac group (p=0.007) for T2. For the other comparisons between groups and times there were no statistically significant differences, even when the FDI and USPHS criteria were compared (p≥0.05). It can be concluded that the different protocols of universal adhesive application (CAT, CASE and Ac) did not influence the clinical behavior of the restorations evaluated in 15.8 months of evaluation. The FDI and USPHS criteria provided comparable results.
  • Item
    Avaliação do estresse, ansiedade e comportamento associados ao tratamento odontológico infantil sob sedação
    (Universidade Federal de Goiás, 2016-12-09) Rodrigues, Heloisa de Sousa Gomes; Costa, Luciane Ribeiro de Rezende Sucasas da;; Batista, Aline Carvalho;; Batista, Aline Carvalho;; Costa, Paulo Sérgio Sucasas da; Rotta , Rejane Faria Ribeiro; Paiva, Saul Martins; Silva , Tarcília Aparecida da
    Paediatric dental treatment may stress children and their parents influencing the child behaviour and the maternal dental anxiety. It is important to understand those behavioural and physiological alterations to aid using of adequate sedatives techniques during paediatric dental procedure. The aim of this study was to evaluate the stress of children and their mothers during the paediatric dental treatment using different sedation protocols. Also, the maternal dental anxiety, the child’s behaviour and age and its associations were evaluated. This observational study is a secondary analysis of two randomised controlled clinical trials. Children aged 2-6 years old received one tooth restoration under moderate sedation according to the groups: [A] 18 children received oral midazolam (1.0 mg/kg) and [B] 18 children received placebo in a crossover design [Clinical Trials database (NCT01795222)]; [C] 14 children received oral midazolam (0.5 mg/kg) and oral ketamine (3.0 mg/kg) plus sevoflurane inhalation (0.3% - 0.4%) and [D] 13 children had oral midazolam (0.5 mg/kg) and oral ketamine (3.0 mg/kg) plus oxygen inhalation in a parallel design (NCT02284204). The sessions were video recorded for evaluation of child behaviour using OSUBRS scale (Ohio State University Behavioural Rating Scale) and mothers answered the Brazilian version of Dental Anxiety Scale (DAS). The saliva samples were collected on children and on their mothers at 4 moments: waking up (T0), upon arrival at Dental School (T1), 25 minutes after the local anaesthesia injection on child (T2) and 25 minutes after the end of procedure (T3). Salivary cortisol was measured using an immunoassay kit (ELISA). As the data presented non normal distribution (Shapiro Wilk, p>0,05), Kruskal-Wallis and Mann-Whitney tests were used for non paired comparisons and Mann-Whitney for associations among the variables. For paired comparisons, Friedman and Wilcoxon tests were used (p<0,05). The increase of cortisol levels from T1 to T2 (reactivity to stressful stimulus – local anaesthesia) was higher in children of group [B] [median (interquartile)] – [0.53 (0.60)] following by groups [D] – [0.21 (0.35)], [C] – [0.11 (0.49)] and [A] – [0.02 (0.59)] (p=0.02). The decrease of cortisol levels from T2 to T3 (regulation to stress) was higher in children of group [B] – [0.08 (0.29)] following by groups [A] [-0.02 (0.40)], [C] – [-0.18 (0.41)] and [D] – [-0.19 (0.8)] (p=0.02). Majority of mothers were not stressed during their child’s local anaesthesia injection (67.9%) and presented low/moderate anxiety (69.6%), while 25.0% of them presented high/severe anxiety (DAS scale). Mothers who reacted to stress (increasing of cortisol at least 10% from T1 to T2) had higher cortisol levels at the moments T2 [0.15 (0.48)] and T3 [0.16 (0.50)] compared to T1 [0.09 (0.17)] (p<0.01 and p<0.006, respectively). On the other hand, mothers who did not react to stress had higher cortisol levels at the moments: T1 [0.36 (0.18)] compared to T2 [0.16 (0.18)] (p<0.01) and T3 [0.10 (0.12)] (p<0.01) and T2 compared to T3 (p=0.01). There was no statistically significant association between maternal stress (salivary cortisol levels) with child behaviour (p=0.56), child’s age (p=0.48) and maternal dental anxiety (DAS) (p=0.69). The findings of this study allow to conclude that sedation protocol using oral ketamine caused higher liberation of salivary cortisol at the moments of local anaesthesia and at the end of procedure (higher reactivity and lower regulation) indicating a prolonged response to physiological stress in children, which was not observed during the use of oral midazolam. Although, there was any maternal dental anxiety most of mothers were not stressed during the dental treatment under sedation of their children. Also, maternal dental anxiety, child’s age and child behaviour did not influence the maternal stress.
  • Item
    Comportamento biomecânico de pinos personalizados em remanescente dentário fragilizado
    (Universidade Federal de Goiás, 2017-03-02) Kasuya, Amanda Vessoni Barbosa; Fonseca, Rodrigo Borges;; Fonseca, Rodrigo Borges;; Torres, Érica Miranda de; Barata, Terezinha de Jesus Esteves; Marson, Fabiano Carlos; Carlo, Hugo Lemes
    The objectives of this work were to evaluate the stress distribution (SD), fracture resistance (RF), adhesive strength (AS) and their respective fracture patterns of weekeaned bovine roots, rehabilitated with customized pins with different resinous materials. In addition, the objective of this study was to evaluate the polymerization depth of the resinous materials by Knoop microhardness method (MH). Eight experimental groups were established (n = 10 for FR and AS; n = 5 for MH), with the factor under study: 1. The post type (industrialized glass fiber post relined (I) and personalized post (P), 2. the relining material only for industrialized glass fiber post (experimental composite (e) and composite resin (R)); 3. the material used only for personalized post (experimental composite (e) and bulk fill resin (b), and 4. the amount of remaining dentin (root embrittlement inner wear, in lengths of 5 mm or 10 mm). One hundred and forty bovine roots of similar size were selected and restored according to the group to which they belonged. For FR, Pperiodontal and alveolar bone were simulated and the specimens were placed in an Instron 5965 machine at a 135 ° angle to the long axis and loaded at a constant velocity of 0.5 mm/min in compression until the fracture. The fracture pattern was classified as: F1- crown; F2- root; F3- crown/root; F4- fracture with displacement of the crown/post. For AS, the specimens were sectioned in slices of 1 mm perpendicular to their long axis. Each specimen was placed in a test machine to received the load in the apical-coronal direction, at a constant velocity of 0.5mm / min, pushing the pin through the largest side of the sample until fracture. The fracture pattern was classified as: F1- cohesive of the pin and/or reline material; F2- cohesive of dentin; F3- adhesive of pin/reline material; F4 - Adhesive bonding cement/ eline material and F5 - mixed. For MH, the specimens were sectioned parallel to their long axis. The tests were performed with a Knoop penetrator under a static charge of 50 grams per 10 seconds. MH was calculated as the average value for each third. Finally, the finite element method was used to analyze the DT. 3D virtual models representative of each experimental group were created and analyzed under von Mises equivalent stresses criterion, simulating loading of 100N at a 45o angle with the long axis. The experimental composite proved to be an alternative for the rehabilitation of weakened roots when used to create personalized posts or when used as a relining material, with FR values similar to the traditional technique, but with more favorable stress distributions. Moreover, it presented excellent adhesive strength to the dentin structure, being comparable to conventional composite resin and bulk fill resin. The bulk fill resin resulted in low values of fracture resistance associated with the fracture and displacement of post/crown. Lower microhardness values were observed in the apical third for bulk fill resin.
  • Item
    Avaliação de moléculas envolvidas no escape imunológico em desordens potencialmente malignas de boca
    (Universidade Federal de Goiás, 2017-02-20) Gonçalves, Andréia de Souza; Batista, Aline Carvalho;; Batista, Aline Carvalho; Yamamoto, Fernanda Paula; Alves, Pollianna Muniz; Silva, Tarcilia Aparecida; Loyola, Patrícia Resende Alo Nagib
    Study Rationale: Oral potentially malignant disorders (OPMDs) consist of morphologically altered tissues, which present a greater risk of malignant transformation than normal tissue. The most frequently found OPMDs are leukoplakia (OL) and actinic cheilitis (AC). It is now known that mutated or genetically altered cells have developed immunomodulatory strategies which allow them to escape antitumor immune response. The immune escape mechanisms used by mutated cells include the expressions of HLA-G, HLA-E and PD-L1 molecules and the IL-10 and TGF-β cytokines. Objective: To evaluate tissue and salivary expressions of HLA-G, HLA-E and PD-L1 molecules and IL-10 and TGF-β1, -β2 e -β3 cytokines in OPMDs, and relate such immunomodulatory mediators with antitumor immune response and potential for malignant transformation of lesions. Methods: Samples of patients with OL (n= 80) were submitted to immunohistochemistry and ELISA techniques to evaluate tissue and salivary expressions of the HLA-G, HLA-E, PD-L1, IL-10, TGF-β1, TGF-β2 and TGF-β3. In addition, samples of patients with QA (n= 30) were submitted to immunohistochemistry technique to evaluation tissue expression of HLA-G, HLA-E, PD-L1 and IL-10. Control group (n= 20) consisted of saliva and tissue of healthy individuals. The immunostained tissue samples were measured using a semi-quantitative method in association with staining intensity. The expression of these molecules and cytokines were related with the malignant potential of the lesions (epithelial dysplasia grading, proliferation- Ki-67 and apoptosis index- mutated p53). Moreover, the association with the density of granzyme B (GB+) cells and regulatory T cells FOXP3+ was investigated. The statistical tests used were: Fisher’s exact or Pearson Chi-Squared, Mann-Whitney and Kruskal- Wallis tests. The significance level was set at P < 0.05. Results: Fifteen samples showed severe dysplasia, twenty moderate, thirty-two mild and thirteen non-dysplasia. Forty samples (50%) of OL presented combined high Ki-67/p53. Irrespective of the severity of epithelial dysplasia and proliferation/apoptosis index in OL, an overexpression of HLA-G, -E, PD-L1, IL-10, TGF-β2 and -β3 was found in OL when compared with control (P < 0.05). The number of GB+ and FOXP3+ cells in OL was similar to control. Salivary concentration of sHLA-G, IL-10 and TGF-β did not allow distinction between OL patients and healthy individuals (P > 0.05). As regards to AC, we showed that this lesion had an increase in expression of HLA-G, HLA-E, IL-10 and PD-L1 when compared to control; however this increase was statistically significant only for PD-L1 (P= 0.04). Conclusion: The OL showed a reduced cytotoxic immune response (low number of GB+ cells) associated with a high expression of immunomodulatory mediators; however, this expression was independent of epithelial dysplasia grading, proliferation and apoptosis index. Regarding AC we also showed an increase in expression of HLA-G, -E, IL-10 and PD-L1 when compared to the control. Thus, our findings suggest that this lesion present an immunosuppressive microenvironment which favors the escape of mutated keratinocytes in any stage dysplastic, proliferation or apoptosis which this disease finds itself.
  • Item
    Associação entre bem-estar psicossocial, religiosidade e espiritualidade em pacientes com sequelas aparentes de cirurgia oncológica na região de cabeça e pescoço
    (Universidade Federal de Goiás, 2016-12-20) Reis, Liliane Braga Monteiro dos; Leles, Cláudio Rodrigues;; Freire, Maria do Carmo Matias;; Freire, Maria do Carmo Matias; Rotta, Rejane Faria Ribeiro; Costa, Nádia do Lago; Silveira, Nusa de Almeida; Nunes, Maria de Fátima
    Treatment of cancer located in the head and neck region includes different therapeutic interventions according to the staging of the tumor, and the surgical approach may culminate in considerable sequelae and biopsychosocial changes in individuals. The objective of this study was to investigate the association between psychosocial well-being and religiosity / spirituality in patients with apparent sequelae of oncologic surgery in the head and neck region. A crosssectional study was conducted in 202 adults at a referral center for cancer treatment in the Midwest Brazil. Sociodemographic, health and health related behavious and psychosocial data were collected through interviews, clinical exams and search of medical records. The variables related to psychosocial well-being were: quality of life (QOL), using the Functional Assessment of Cancer Therapy Head and Neck (FACT-HN) and the University of Washington Quality of Life Questionnaire for patients with head and neck cancer (UW-QOL); and self-perception of appearance, assessed by the Derriford Appearance Scale 24 (DAS24). The explanatory independent variables were: religiosity, evaluated through the Duke University's Index of Religiosity (DUREL) and spirituality, with the Functional Assessment of Chronic Illness TherapySpiritual Well-Being Scale (FACIT-Sp12). Data were analyzed using the Chi-square test and Poisson regression with robust variance. The mean QOL score (FACT-HN) was 97.9 (SD=20.1) and the QOL (UW-QOL) was 744.6 (SD=228.0). The mean total self-perception score was 36.0 (SD=11.7). Religiousness had a mean score of 21.6 (SD=5.0) and spirituality 35.5 (SD=7.5). In the bivariate analyzes, the variables religiousness and spirituality were individually associated with the QOL evaluated by the FACT-HN instrument, while only religiosity was associated with the QV evaluated by the UW-QOL and only spirituality was associated with self-perception of appearance. In the final model of Poisson regression, after adjusting for clinical, sociodemographic characteristics and health behaviors, the variables associated with high QOL (FACT-HN) were: high religiosity and spirituality, male sex and surgery time equal to or greater than two years. Those associated with high QV (UW-QOL) were: high religiosity, cancer sites except oral cavity and oropharynx, types of cancer except squamous cell and basal cell, site of sequelae except the lower / cervical thirds and only surgery as treatment. The variables associated with the best self-perception of appearance were high spirituality, stage T of the lesion (T1+T2), cancer site except oropharynx and only surgery as treatment. It was concluded that there is an association between QOL, religiosity and spirituality and between self-perception of appearance and spirituality, regardless of sociodemographic variables, clinical conditions and health behaviors.