1968-2018 RBO.pdfOperative Dentistry Team • Antônio Fernando Monnerat • Carlos Eduardo S. B. da...

1968-2018

IntroductionPresentation of the School of Dentistry of the State University of Rio de Janeiro

EditorialFOUERJ’ 50th Anniversary Commemorative Supplement

HistoricSchool of Dentistry of the State University of Rio de Janeiro celebrates its gold-en jubilee

AbstractTop 10 abstract of 33rd Academic Journey/2018 - FOUERJ• Blue Nevus: a case report• Evaluation of the expression of pro and anti-infammatory cytokines and growth factors after stimulation with different irrigation agentes• Drug-drug interaction in dental clinic: risks in patients with hypothyroid-ism• Oral hygiene adaptations for elderly with Alzheimer’s disease: case reports• Conservative endodontic access cavity design. Is it viable? - a literature re-view• Osteoporosis type 1 and its relation with periodontal disease• Effectiveness of protaper next, protaper universal and waveone systems in reducing intracanal bacterial load• Tissue reaction to repair cement based on MTA with high plasticity in sub-cutaneous of rats• Clinical epidemiological study of Proliferative Verrucous Leukoplakia• Conventional endodontic approach of extensive cystic lesion

Commemorative Articles• Deployment and management of the Center of Dental Radiology and Care of Patients with Special Needs of the Piquet Carneiro Polyclinic = Original Article• The history of Pediatric Dentistry at Rio de Janeiro StateUniversity (UERJ) - 50 years of School of Dentistry = Original Article• The history of the Orthodontic discipline at UERJ = Original Article• Panoramic radiographs for visualization of upper airway narrowing = Origi-nal Article• Evolution and challenges of Public Health in School of Dentistry of Rio de Janeiro State University/UERJ = Original Article• Effects of disinfection and abutment dis/reconnection on peri-implant tis-sues: a randomized clinical trial = Original Article• Silhouette technique applied on dental preparation - case report - Short Communication• The School of Dentistry of UERJ completes 50 years - Letter to the Editor

TA B L E O F CONTENTS

Bra zi l i a n J o u rn a l of D enti s t ry

Revista Brasileira de Odontologia

RBO Volume 76 • Supplement 1 • August • 2019Founded in 1943 by Orandino Prado Filho, Antônio Leme Jr. and Homero CoutinhoA quarterly journal published by the Brazilian Dental Association - Section: Rio de Janeiro (ABO-RJ)

CNPJ 34.052.217/0001-67 / RBO is indexed by Index Dental to Literature, BBO, Lilacs, Latindex, Scirus for Scientific Information Only, Ulrich’s Directory Periodicals, Medline and Pubmed.

Editor-in-Chief and Director Prof. Geraldo Oliveira Silva-JuniorAdvertising [email protected]: +55-21-2504-0002 Ext.: 220Editorial ProductionNúcleo de Comunicação da ABO-RJAssistant Editor and JournalistCíntia de Assis (MTB 20209)Graphic Designer Valéria PontesOnline Editorial ProductionLuciana Manta (CRB-74451) General Composing and Administration ABO-RJ Headquarters - R. Barão de Sertório, 75Rio Comprido - Rio de Janeiro - RJ - BrazilCEP: 20.261-050 - Phone: +55-21-2504-0002 (Ext.: 220) Fax: +55-21-2504-3859Website: www.aborj.org.brRBO online: www.revista.aborj.org.brE-mail: [email protected]

Executive Board of the Brazilian Dental Association - Section: Rio de Janeiro (ABO-RJ)President: Ivan do Amaral Pereira; 1st Vice-President: Guilherme Vargas Gomes Almeida Russo; 2nd Vice-President: Marcio Souza Reis; General Secretary: Sergio Toniasso; General Deputy Secretary: Ismael Olímpio Batista de Oliveira; Finance Director: Renato Barbosa Firmo; Social Director: Regina Célia Tancredo; Director of RBO (Revista Brasileira de Odontologia): Geraldo Oliveira Silva-Júnior; Di-rector of Scientific Activities: Marcos César Pimenta de Araújo; Director of ABORJ’s Newsletter: Bruna Lavinas Sayed Picciani; CAP/UNIABO Director: Inácio Rocha da Silva; Director of Social Representation: Iracema Souza Dottori Von Uslar; Director of Students Activities: Cheung Ka Fai; DACom Director: Celson da Silva Couri; Director de Patrimony: Márcio Rocha Cavalcanti; Museum Direc-tor: Thales Ribeiro de Magalhães; Director of Congresses: Paulo Murilo Oliveira da Fontoura Junior; Director of Events: Paulo Murilo Oliveira da Fontoura Junior; Clinic Manager: Guilherme Vargas Gomes Almeida Russo; Barra da Tijuca Branch Manager: Rogério Bastos Ferraz; Advisors to the President: Afonso Fernandes Rocha and Paulo Murilo Oliveira da Fontoura.

Presentation of the School of Dentistry of the State University of Rio de Janeiro

Institutional ContactsHead of Secretary: +55 (21) 2868-8155

Secretary: +55 (21) 2868-8031Reception: +55 (21) 2868-8520

Website: http://www.odontologia.uerj.br/index.phpE-mail: [email protected]



MissionThe School of Dentistry has undergraduate, specialization, masters, doctorate and technical training courses. The Education Dental Clinics (COE – Clínicas Odontológicas de Ensino) serve the population performing about 3,000 dental visits per week in various specialties. Acting in the service rendering area since 1974, the School has in its register about 25,000 enrolled patients. The attendance is made by undergraduate and graduate students, under the supervision of the professors. We operate in 13 dental specialties, providing integral care to tients.

Ricardo Guimarães FischerDirector

Full Professor of Periodontics

Angela Maria Vidal Moreira Vice Direction

Associate Professor of Fixed Prosthodontics

Direction of lhe School of Dentistry



DEPARTMENTS

DEPROTES - Department of ProsthesisKnowledge Areas

Anatomy and Dental SculptureTeam• Eneida Dessimoni Teixeira• Patrícia Luise Scabell Evans• Tereza Cristina de Abreu

OcclusionTeam• Florence Mitsue Sekito• Hilda Maria M. Ribeiro de Souza • Mariana Ribeiro de Moraes Rego • Mayra Cardoso • Plínio Mendes Senna

Fixed ProsthodonticsTeam• Angela Maria Vidal Moreira • João Luiz Portella Duarte • Paulo Eduardo G. de Almeida Campos • Olivia Albertina da Silva Fraga • William Meirelles Frossard

Removable prosthodontics Team• Carlos Antônio Freire Sampaio • Daniel de Moraes Telles • Eduardo José Veras Lourenço • Gustavo Farias de Lacerda • Mario Land F. de Mendonça • Simonne Romaro P. de Mello

Dental MaterialsTeam• Cesar dos Reis Perez • Elio Vaz da Silva • Helio Rodrigues S. Filho • Nancy de Assis Ferreira

DIATER - Department of Diagnosis and TherapeuticsKnowledge Areas

Dental Radiology and ImagingTeam• Alexandre Perez Marques • Aurelino Machado Lima Guedes • Carlos Guilherme E. Malini • Marcelo Daniel Brito Faria • Mário Sérgio Alves Carneiro

StomatologyTeam• Geraldo de Oliveira Silva • Maria Eliza Barbosa Ramos • Marilia Heffer Cantisano • Mônica Simões Israel

Oral PathologyTeam• Fábio Ramôa Pires• Teresa Cristina Ribeiro B. dos Santos

Oral Maxillofacial Surgery and TraumatologyTeam• Danilo Passeado B. Ribeiro • Fábio Gambôa Ritto • Henrique Martins da Silveira • Paulo José D’Albuquerque Medeiros • Roberto Prado

PRECOM - Department of Preventive and Community DentistryKnowledge Areas

Collective Oral HealthTeam• Andréa Lanzillotti Cardoso • Celso da Silva Queiroz • Katlin Darlen Maia• Klaus Barretto dos Santos• Luciana Freitas Bastos • Márcia Maria Pereira Rendeiro• Maria Isabel de Castro de Souza • Rafaela Amarante de Andrade • Renata Rocha Jorge • Rhita Cristina C. Almeida Lattes

OrthodonticsTeam• Álvaro de Moraes Mendes • Álvaro Francisco C. Fernandes • Cátia Cardoso Abdo Quintão • Felipe de Assis Ribeiro Carvalho • Flávia Raposo G. Artese • Jonas Capelli Junior • José Augusto M. Miguel • Maria Teresa de Andrade Goldner Pediatric DentistryTeam• Ana Paula Pires dos Santos • Branca Heloisa de O. M. Vieira • Fernanda Barja Fidalgo Silva de Andrade• Michele Machado Lenzi da Silva• Mirian de Waele Souchois de Marsillac • Tatiana Kelly da Silva Fidalgo • Vera Ligia Vieira Mendes Soviero • Vera Lucia Campos Santos

PROCLIN - Department of Integrated Clinical ProceduresKnowledge Areas

Operative DentistryTeam• Antônio Fernando Monnerat • Carlos Eduardo S. B. da Silva • Hugo de Andrade Filho • José Freire de Alencar • Marcelo José Braga Pinhão • Mauro Sayão de Miranda • Nilda de Barros Soares • Ricardo Herzog Marchiori • Rogério Luiz de O. Mussel

EndodonticsTeam• Emmanuel João Nogueira Leal da Silva • Georgiana Amaral • Gustavo Ribeiro Álvares • Luciana Moura Sassone • Renato Liess Krebs • Sandra Rivera Fidel • Tauby de Souza Coutinho

PeriodonticsTeam• Antônio Carlos Canabarro A. Junior • Carlos Marcelo da Silva Figueiredo • Eduardo Muniz Barreto Tinoco • Luiz Eduardo M. D. da Rocha • Mariliza Lugon Ferreira Terezan • Paulo Gonçalo P. dos Santos • Ricardo Guimarães Fischer • Tânia Maria Galheigo Integrated Adult ClinicTeam• Anna Paula Kalix França Mendes • Eliane Ramos T. de Carvalho • Fernanda de Brito Silva • Gilberto Leal de Campos • Guaracilei Maciel Vidigal Junior • Luciana Meireles Miragaya • Marco André Berredo Pinho • Marco Antônio A. Carvalho • Maria Celeste Leitão Joaquim • Paulo Sérgio Souza da Silva





NAME PROFILE SECTOR

Abraão Gonçalves dos Santos Assist. Administrativo Clínica de Radiologia

Ailton Valadares Romão Técnico em Enfermagem Central de Esterilização

Aline de Abreu Técnico em Higiene Dental Clinicas

Aline de Souza Onofre Téc. em Laboratório de Histopatologia Lab. de Histopatologia

Aline Tani Dias Fonoaudióloga Setor de Fonoaudiologia

André Afonso Silva Programador Núcleo de Teleodontologia

Andre Manoel Lima da Fonseca Técnico em Prótese odontológica Lab. Central de Prótese

Andrea da Silva Santos Tec. em Enfermagem Central de Esterilização

Andrea Ferreira Sant anna Mendes Assist. Administrativo Almoxarifado

Anelyse de Carvalho Lira Santos Tec. Administrativo Clínica de Mestrado

Atilio Sergio Paiva Filho Técnico em Radiologia Clínica de Radiologia

Barbara de Paula Coelho Técnico em Laboratório Lab. da Pós-Graduação

Camilla Xaiver Duarte Tec. Administrativo Secretaria de Graduação

Cassia Ferraz F. Lima Lopes Dentista COE - Triagem

Cecilia Oliveira Milioni Pinto Tec. Administrativo Chefe de Secretaria

Célia Regina L. do Nascimento Tec. Administrativo Sec. de Especialização

Cezar de Souza Leite Tec. Administrativo Setor de Compras

Claudia Maria F. de Assis Correa Tec. Administrativo Lab. de Histopatologia

Cleber de Freitas Pereira Tec. Administrativo COE - Clínica A

Cristiane da Silva Soares Pereira Tec. Administrativo COE - Secretaria

Damião Moura de Oliveira Manutenção / Equip. Odontológicos Setor de Manutenção

Denise Pinheiro Muniz da Cruz Tec. Administrativo Secretaria de Mestrado

Douglas dos S. Camilo de Freitas Tec. Administrativo COE - Clínica D

Edvania Soares da Silva Enfermeiro do Trabalho Secretaria de Graduação

Felipe Cardoso W. da Costa Tec. Administrativo COE - Secretaria

Gabriela de Araújo Sixel Dentista COE - Triagem

Gabriela de O. Magalhães Neto Tec. em Enfermagem Central de Esterilização

Giselle de Albuquerque Pacheco Dentista COE - Triagem

Hilton Maragoni de Meneses Tec. Administrativo Sec. de Especialização

Inês de Araújo Assist. Administrativo Cirurgia – HUPE

Izabel Agra de Souza Tec. Administrativo Secretaria da Direção

Janaína Rezende Pardo Peres Tec. Administrativo Secretaria da Direção

Jane de Lima Nunes Assist. Administrativo COE - Secretaria

João Marcelo S. Teixeira Dentista COE - Triagem

Jonathas Meira Ramos Técnico de Informática Setor de Informática

José Carlos Barbosa de Medeiros Tec. Administrativo Banco de Dentes

Jussara Quaresma Magalhães Assist. Administrativo Secretaria Ortodontia

Jussara Sobral de Oliveira Silva Técnica em Enfermagem Central de Esterilização

Lauro Esperança da Silva Técnico em Prótese odontológica Lab. Central de Prótese

Administrative Technical Employees of the School of Dentistry of the State University of Rio de Janeiro

Lucas de Paiva Antonio Tec. Administrativo COE - Clínica D

Luiz Cláudio de Lima Pinto Assist. Administrativo Clínica de Odontopediatria

Marcelo da Silva Assist. Administrativo COE - Clínica A

Marcelo de Assis Côrrea Téc. em Laboratório de Histopatologia Lab. de Histopatologia

Márcia Cristina Marques Giacometti Enfermeiro Central de Esterilização

Marcos Flores Técnico em Prótese odontológica Lab. Central de Prótese

Maria Aparecida de Arruda Moura Técnico em Higiene Dental Clínica do PPC

Maria das Dores Aires Carneiro Técnico em Higiene Dental COE - Clínica A

Maria Eliene Pereira Nascimento Tec. Enfermagem Central de Esterilização

Maria Jorgenete Ferreira da Silva Assist. Administrativo Clínica de Mestrado

Maria Rita dos Santos Ritto Antônio Técnico em Higiene Dental Clínica do ERA

Marisa Santos de Oliveira Técnico em Higiene Dental PPC - ODO

Mauro Teixeira Filho Tec. Em Radiologia Clinica de Radiologia PPC

Murilo Rezende Junior Técnico em Prótese odontológica Lab. Central de Prótese

Nathalia Ferreira Vinagre Téc. em Laboratório de Biotecnologia Banco de Dentes

Olesia Milioni Santos Assuntos Universitários Direção

Patrick Félix Lacerda Santa Anna Assist. Administrativo Setor de Compras

Paulo Rodrigues de Carvalho Programador Visual Núcleo de Teleodontologia

Paulo Santos Júnior Assist. Administrativo COE - Clínica E

Rafael Bandeira Ferrarez Morani Técnico de Informática TI

Raquel Richelieu Lima de Andrade Pontes Dentista CUCC - LASERTERAPIA

Roberto Alves Assist. Administrativo COE - Secretaria

Roberto Araújo F. Lisboa Programador Núcleo de Teleodontologia

Rossinaldo Côrte Tonhá Tec. Em Radiologia Clinica de Radiologia PPC

Simone Dias Fonseca Técnico em Prótese odontológica Lab. Central de Prótese

Simone Gomes de Oliveira Técnico Veterinário Clínica de Mestrado

Silvana da Gama Pastana Fonoaudióloga Setor de Fonoaudiologia

Terezinha Egídio Santos de Castro Assist. Administrativo COE - Clínica A

Vicente Magno Geoffroy Filho Dentista Chefe do SECOM

Wagner Pereira Coutinho Filho Dentista CUCC - LASERTERAPIA



SOURCES:Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro [online]. Rio de Janeiro, Brasil; 2019. [capturado 03 mai. 2019] Disponível em: http://www.odontologia.uerj.br

The Brazilian Journal of Dentistry, in honor of FOUERJ’s 50 years of existence, publishes a commemorative supplement with a brief history of the School of Dentistry, the best abstracts of the

33rd FOUERJ Academic Journey and some articles of the institution’s scientific body.

FOUERJ is known for its excellence in teaching and for its work with society, especially in the areas of Orthodontics, Oral Bucomaxillofacial Surgery and Traumatology, Dental Prosthesis, Periodontics and Social and Preventive Dentistry.

The event organized by the representatives, of the Academic Den-tistry Center Professor Nelson Siqueira took place at the Mário Franco Barroso Pavilion on June 7 and 8, 2018. Courses, lectures and hands-on were held with varied themes. From the works presented, the 10 best abstracts were chosen to compose the edition.

The journey was accomplished through the efforts of students from different periods, teachers and researchers, who committed themselves to this journey commemorating the 50th anniversary of FOUERJ. The organizing committee was composed by the teaching representatives: Full Professor Ricardo Guimarães Fischer and Associate Professor Lu-ciana Moura Sassone (general coordinators of the event) and student representatives of the Nelson Siqueira Academic Dentistry Center: Denis Nogueira Machado and Maiara Gomes Roque da Silva (general event); Débora Boccacino (computer commission); Daniela Beatriz de Souza Cardoso (secretarial committee); Guilherme Goulart Cabral de Oliveira (logistics committee); Thayná Bastos Pereira (panels commit-tee); Lucas Alberto dos Santos Nunes (hands-on committee).

We hope this supplement can provide a good reading to everyone.

Geraldo Silva-Junior, DDS; PhDThe Editor in Chief of Brazilian Journal of Dentistry

FOUERJ’ 50th AnniversaryCommemorative Supplement

Geraldo Oliveira Silva-Junior - DDS

E D I T O R I A L



RBO Volume 76 • Supplement 1 • August • 2019Founded in 1943 by Orandino Prado Filho, Antônio Leme Jr. and Homero CoutinhoA quarterly journal published by the Brazilian Dental Association - Section: Rio de Janeiro (ABO-RJ)

CNPJ 34.052.217/0001-67 / RBO is indexed by Index Dental to Literature, BBO, Lilacs, Latindex, Scirus for Scientific Information Only, Ulrich’s Directory Periodicals, Medline and Pubmed.

Editor-in-Chief and Director Prof. Geraldo Oliveira Silva-JuniorAdvertising [email protected]: +55-21-2504-0002 Ext.: 220Editorial ProductionNúcleo de Comunicação da ABO-RJAssistant Editor and JournalistCíntia de Assis (MTB 20209)Graphic Designer Valéria PontesOnline Editorial ProductionLuciana Manta (CRB-74451) General Composing and Administration ABO-RJ Headquarters - R. Barão de Sertório, 75Rio Comprido - Rio de Janeiro - RJ - BrazilCEP: 20.261-050 - Phone: +55-21-2504-0002 (Ext.: 220) Fax: +55-21-2504-3859Website: www.aborj.org.brRBO online: www.revista.aborj.org.brE-mail: [email protected]

Executive Board of the Brazilian Dental Association - Section: Rio de Janeiro (ABO-RJ)President: Ivan do Amaral Pereira; 1st Vice-President: Guilherme Vargas Gomes Almeida Russo; 2nd Vice-President: Marcio Souza Reis; General Secretary: Sergio Toniasso; General Deputy Secretary: Ismael Olímpio Batista de Oliveira; Finance Director: Renato Barbosa Firmo; Social Director: Regina Célia Tancredo; Director of RBO (Revista Brasileira de Odontologia): Geraldo Oliveira Silva-Júnior; Di-rector of Scientific Activities: Marcos César Pimenta de Araújo; Director of ABORJ’s Newsletter: Bruna Lavinas Sayed Picciani; CAP/UNIABO Director: Inácio Rocha da Silva; Director of Social Representation: Iracema Souza Dottori Von Uslar; Director of Students Activities: Cheung Ka Fai; DACom Director: Celson da Silva Couri; Director de Patrimony: Márcio Rocha Cavalcanti; Museum Direc-tor: Thales Ribeiro de Magalhães; Director of Congresses: Paulo Murilo Oliveira da Fontoura Junior; Director of Events: Paulo Murilo Oliveira da Fontoura Junior; Clinic Manager: Guilherme Vargas Gomes Almeida Russo; Barra da Tijuca Branch Manager: Rogério Bastos Ferraz; Advisors to the President: Afonso Fernandes Rocha and Paulo Murilo Oliveira da Fontoura.



A group of dental professionals, led by the presidents of class associations and some professors, idealized the creation of a new School of Dentistry, in the then state

of Guanabara. Preliminary studies indicated the possibility of its installation in a university. The choice was the Guanabara State University (UEG – Universidade do Estado de Guanabara). The professors Orlando Chevitarese, Mario Franco Barroso and Wladimir de Souza Pereira participated actively in the project.

There was a need for a State Law for the creation of a School, and bill no. 658 was created in 1963, which was presented to the plenary on November 26, 1964. It was vetoed by the Executive Branch, but the Legislative Assembly, in a session on Abril 29, 1966, rejected the full veto. We observed, thus, that there was a gap of nearly two years before the School of Dentistry could be implemented.

On May 24, 1966, the Rector Magnificus Haroldo Lisboa da Cunha forwarded to the University Council message no. 7/66, asking for the approval for the creation of the School of Den-tistry at the UEG. Resolution no. 292/66 authorized the creation of the School, signed on June 20, 1966.

On January 5, 1967, Rector Haroldo Lisboa da Cunha ap-pointed the commission to organize the School of Dentistry, through ordinance no. 2/67. The Executive Act no. 48 of Decem-ber 11, 1967 (signed by the Rector João Lyra Filho) creates the School of Dentistry of the Guanabara State University as a high-er education unit, integrated to the Medical Center of the UEG.

On May 22, 1968, the installation of the School of Dentistry of the UEG was carried out.

In the small pavilion set on number 111, Ave. 28 de Setembro, in 1969, the laboratories of the disciplines Anatomy and Dental Sculpture, Dental Materials and Dentistry were provisionally installed. Process no. 100-750/70 resulted in the recognition of the School of Dentistry at State and Federal level. The process originated from letter no. 920, of November 17, 1970, by the Rec-tor Magnificus of the Guanabara State University. On March 2, 1971, finally, the new installations were inaugurated on 157, Ave. 28 de Setembro; which is to this day its working location. On December 18, 1971, the first class of Dental Surgeons graduated.

The School of Dentistry has undergraduate, specialization, master’s, doctorate and technical training courses. The Educa-tion Dental Clinics (COE – Clínicas Odontológicas de Ensino) treat the population, performing around 3,000 dental treatments a week, in several specialties. Working in the field of service pro-vision since 1974, the School has in its records about 25,000 en-

School of Dentistry of the State University of Rio de Janeiro celebrates its golden jubilee

rolled patients. Treatment is performed by undergraduate and graduate students, under supervision of professors. We operate in 23 dental specialties, providing a full service to our patients.

The undergraduate course in Dentistry is taught by the School of Dentistry – ODO and was recognized by Decree no. 69.955/72 – D.O.U. on 01/19/1972. The School has several labo-ratories: Prothesis, Orthodontics, Dentistry, Research, Dental Materials, Dental Sculpture, Oral Pathology, Radiology and Microbiology. It also has: 90 dental offices distributed by its 8 education dental clinics. Extramural activities are performed at the República Argentina school and Policlínica Piquet Carneiro. One of their main events is the Encontro de Temas Livres and the Freshmen Reception Week, held every year. The main rea-sons for pride among the students are the quality Graduation, pedagogical didactic organization, Scientific Initiation and Tu-toring. In the last National Exam for the Assessment of Student Performance – ENADE, performed in 2016, the course of Den-tistry obtained grade 4. According to the Ranking Universitário Folha (RUF – Folha University Ranking), it is among the best dental universities in the country, standing out mainly in the evaluations regarding labor market and internationalization.

With a history marked by sublimity in education in the state of Rio de Janeiro and also in the country, the School of Dentistry completes its Golden Jubilee with a trajectory of excellence in the fields of Education, Research, Extension, Innovation. Thus, the RBO, through this supplement, congratulates, along with all the professors, staff, students and alumni the success of the School of Dentistry and its great contribution to Brazilian soci-ety in these years.

Geraldo Silva-Junior, DDS; PhDThe Editor in Chief of Brazilian Journal of Dentistry

Sources______ Projeto Político Pedagógico da Faculdade de

Odontologia da Universidade do Estado do Rio de Janeiro, 2011

Faculdade de Odontologia da Universidade do Es-tado do Rio de Janeiro [online]. Rio de Janeiro, Bra-sil; 2019. [capturado 03 mar. 2019] Disponível em: http://www.odontologia.uerj.br

Departamento de Orientação e Supervisão Pedagógica - Sub-reitoria de Graduação (SR-1) [online]. Rio de Janei-ro, Brasil; 2019. [capturado 03 mar. 2019] Disponível em: http://www.dep.uerj.br/cursos/odontologia.html

H I S T O R I C



Facade of the School of Dentistry (Professor Paulo de Carvalho Building) in the 1970s, which was called the State University of

Guanabara (UEG, 1961-1975)



July 15 to 25, 1977Ecumenical Chapel of UERJ - III International Congress of Dentistry

Prof. Hilton Souchois de Albuquerque Mello (Full Professor of Pediatric Dentistry)

Prof. Charley Fayal de Lira (Full Professor of Operative Dentistry)

1 2

1

2



Graduation of the first class in 1977 of the Oral Health Technician course (TSB) in Brazil, being prestigious professors of several of dentistry (Prof. Dr. Hilton Souchois de A. Mello was the founder)

1

2

3

4

Prof. Charley Fayal de Lira (Full Professor of Operative Dentistry)

1

Prof. Paulo Severino da Silva (Full Professor of Pharmacology)

2

Prof. Paulo Medeiros (Full Professor of Oral Maxillofacial Surgery and Traumatology)

3

Prof. Mário Bruno (Full Professor of Dental Radiology and Imaging)

4



Professors of the Department of Preventive and Community Dentistry, team of Pediatric Dentistry in the 90’s

Mirian de Waele Souchois de Marsillac

1

Profa. Vera Camposs2

Prof. Hilton Souchois de Albuquerque Mello (Full Professor of Pediatric Dentistry (in memoriam))

3

Prof. Luiz Flávio Martins Moliterno

4

Profa. Sõnia Lúcia Macedo Marçal (in memoriam)

5

Prof. Hélio Cardoso Moliterno (Full Professor of Pediatric Dentistry)

6

1 2 3 4 65



Launch of the book “Diagnóstico e Tratamento dasAnomalias da Odontogênese “ of the pediatric dentistry team

Authors: Vera Campos, Roberval de Almeida Cruz and Hilton Souchois de Albuquerque Mello (2003)

Prof. Hilton Souchois de Albuquerque Mello1

Profa. Vera Campos2

Profa. Mirian de Waele Souchois de Marsillac3

Prof. Sileno Corrêa Brum4

Prof. Roberval de Almeida Cruz5

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2

3

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Prof. Ermelindo AntônioRadetic (Endodontics)

1

Prof. David Balassiano(Full Professor of Fixed Prosthodontics)

2

Prof. Hilton Souchois de Albuquerque Mello (Full Professor of Pediatric Dentistry)

3

Profa. Irani Cabral(Patologia Oral)

4

Profa. Maria José Marchon(Dental Materials)

5

Placidino Bigagão6

Marisa Balassiano7

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Launch of the book titled “Odontogeriatria”, the Full Professor Hilton Souchois de Albuquerque Mello at the International

Congress of Dentistry of Rio de Janeiro (16th CIORJ) in 2005



Inauguration of the Specialization ClinicDr. Hilton Souchois de Albuquerque (2007)

Profa. Sônia Lúcia Macedo Marçal (In memoriam) (Pediatric Dentistry)

1

Marisa Santos de Oliveira(Oral Health Technician - Pediatric Dentistry Clinic)

2

Profa. Marialice Barroso Pentagna(Pediatric Dentistry)

3

Profa Vera Campos(Pediatric Dentistry)

4

Pedro Hilton Souchois Olmo(Grandson of Dr. Hilton Souchois - Honored)

5

Prof. Luiz Flávio Martins Moliterno(Pediatric Dentistry)

6

Profa. Hilda Maria Montes Ribeiro de Souza(Occlusion)

7

Prof. Mário Sérgio Alves Carneiro(Dental Radiology and Imaging)

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6

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8

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Launch of the book “Primeiros Socorros: Traumatismo Dentário”

Authors: Eliane Raye Vallim Cruz and Vera Campos 2011

Profa. Vera Campos (Pediatric Dentistry), autographing book

1

1



Launch of the book“Controle da dor, medo e ansiedadeem Odontopediatria”

Author: Mirian de Waele Souillis de Marsillac (2014)

Profa. Ana Paula Pires dos Santos(Pediatric Dentistry)

1

Profa. Fernanda Barja Fidalgo Silvade Andrade (Pediatric Dentistry)

2

Profa. Mirian de Waele Souchoisde Marsillac (Pediatric Dentistry)

3

Prof. Luiz Flávio Martins Moliterno(Pediatric Dentistry)

5

Prof. Wiliam Frossard (Fixed Prosthodontics)

4

Profa. Branca Heloisa de OliveiraMartins Vieira (Pediatric Dentistry)

6

Profa. Tatiana Kellly da SilvaFidalgo (Pediatric Dentistry)

7

1

1

2

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4 5

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Meeting of the Coordinators of the Lato Sensu Postgraduate Courses (Specialization)

13/05/2018



Panoramic view of one of the clinics of the School of Dentistry of the State University of Rio de Janeiro



Feast of fraternization for the 50th anniversary of the School of Dentistry of the State University of Rio de Janeiro



First full Professors of the School of Dentistry of the State University of Rio de Janeiro

Prof. Charley Fayal of Lyra (Operative Dentistry)

Prof. Hilton Souchois de Albuquerque Mello (Pediatric Dentistry)

Prof. Waldemar Cantisano (Anatomy and Dental Sculpture)

Prof. Antônio Rothier Duarte (Endodontics),

Prof. David Félix Balassiano (Fixed Prosthodontics)

Prof. Moysés Moreinos (Periodontics)

Prof. Mário Franco Barroso (Occlusion)

Prof. Mário Bruno (Dental Radiology and Imaging)

1 5

2 6

3 7

4 8

1 2 3

4 5 67

8



Gallery of Directors and Vice-directors of the School of Dentistry of the University of Rio de Janeiro

Congratulations to all who contributed ethically committed to the growth and structuring of the School of Dentistry of UERJ

1968 a 1971 1972 a 1975

1976 a 1979 1980 a 1983





1984 a 1987 1988 a 1991

1992 a 1995 1996 a 1999





2000 a 2003 2004 a 2007

2008 a 2011 2012 a 2015





2016 a 2020



Agradecimento aos professores e funcionários aposentados

A educação pela pedraUma educação pela pedra: por lições;para aprender da pedra, frequentá-la;captar sua voz inenfática, impessoal(pela de dicção ela começa as aulas).A lição de moral, sua resistência friaao que flui e a fluir, a ser maleada;a de poética, sua carnadura concreta;a de economia, seu adensar-se compacta:lições da pedra (de fora para dentro,cartilha muda), para quem soletrá-la. (João Cabral de Melo Neto)

Com um texto singular de João Cabral de Melo Neto que ini-ciamos nossa singela homenagem aos professores e funcionários aposentados deixando nosso agradecimento por contribuir pelo sucesso da Faculdade de Odontologia nestes 50 anos.

Vale lembrar que Educar é tarefa para poucos. É uma eterna construção do conhecimento – para si e para os outros. “Vamos nos fazendo aos poucos, na prática social de que tomamos parte”, como disse Paulo Freire. Na tarefa de transformarmos meninos e meninas em cidadãos e cidadãs.

É com espírito de gratidão e de respeito que prestamos esta singela homenagem aos professores e funcionários que no pas-sado lutaram pela construção de uma Universidade melhor; que foram responsáveis pelo que somos, no presente. Que deram o melhor de si para a formação de muitos Cirurgiões Dentistas e especialistas em diversas áreas da Odontologia.

Assim, saudosamente lembraremos sempre que o sucesso não se alcança sozinho, nosso muito obrigado!

Homenagem póstuma aos professores e funcionários da Faculdade de Odontologia da

Universidade do Estado do Rio de Janeiro

“O tempo é muito lento para os que esperam Muito rápido para os que tem medo Muito longo para os que lamentam Muito curto para os que festejam Mas, para os que amam, o tempo é eterno.”

William Shakespeare

Acknowledgments for retired professors and employees

Education through stoneAn education by stone: by lessons;to learn from the stone, to attend it;capture your inenaphic, impersonal voice(by the diction she starts classes).The moral lesson, your cold resistanceto the flowing and flowing, to being hindered;the one of poetics, its concreteness;the one of economy, its denser compact:lessons from the stone (from the outside in,booklet), for those who spell it.(João Cabral de Melo Neto)

With a singular text by João Cabral de Melo Neto, we began our simple homage to retired teachers and employees, leaving our thanks for contributing to the success of the Faculty of Dentistry in these 50 years.

It is worth remembering that Educating is a task for the few. It is an eternal construction of knowledge - for yourself and for others. “Let’s do it slowly, in the social practice of which we take part,” as Paulo Freire said. In the task of transforming boys and girls into citizens.

It is with a spirit of gratitude and respect that we pay this sim-ple homage to the teachers and employees who in the past fought for the construction of a better university; who were responsible for who we are in the present. They have done their best for the training of many dental surgeons and specialists in various areas of dentistry.

So, we will always remember that success is not achieved by ourselves, thank you!

Posthumous tribute to professors and employees of the School of Dentistry of the

State University of Rio de Janeiro

“Time is very slow for those who wait. Very fast for those who are scared.Very long for those who are lament.Very short for those who celebrate.But for those who love,time is eternal”

William Shakespeare

3

Revista Brasileira de Odontologia - Suplemento 1Brazilian Journal of Dentistry - Supplement 1

Associação Brasileira de Odontologia - Seção Rio de Janeiro

33rd Academic Journey/2018UERJ

A 44-years-old male patient, was referred to the sto-matologist by the clinical dentist who detected the lesion on the palate. During anamnesis, the patient reported having used crack and cocaine and cur-rently uses marijuana and alcoholic beverages, with a history of peeling and burning in the oral mucosa after use of “ether spray”. On the intraoral exam, pigmented macula was observed on the hard pala-te, well circumscribed, measuring approximately 4mm, with unknown evolution time. The diagnos-tic hypothesis was of melanocytic macule. An exci-sional biopsy was performed and the material was sent for microscopic analysis with histopathological

Blue Nevus: a case report

Alyne Amorim de Araújo,1 Adriana Terezinha Neves Novellino Alves,1 Ana Flávia Schueler de Assumpção Leite,1 Simone de Queiroz Chaves Lourenço,1 Simone Henriques Machado1

¹School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil

diagnosis of blue nevus. The blue nevus is a benign pigmented lesion composed of nevus or melanocy-tic cells. It is the second most common melanocytic nevus in the oral cavity, being the palate the most frequent site. The relevance of this report consist on the fact that the blue nevus makes differential diagnosis with the melanoma, malignant neoplasm of melanocytic origin. Therefore, oral pigmented lesions with unknown evolution should be investi-gated to avoid this possibility.Keywords: Blue nevus; Hard palate; Melanocytic nevus; Diagnosis differential.

Rev. Bras. Odontol. 2019;76:(Supl.1):3

1. Alyne Amorim de Araújo - ORCID: 0000-0001-7158-681X. E-mail: [email protected] 2. Adriana Terezinha Neves Novellino Alves - ORCID: 0000-0002-3665-6568. E-mail: [email protected]. Ana Flávia Schueler de Assumpção Leite - ORCID: 0000-0002-9333-6093. E-mail: [email protected]. Simone de Queiroz Chaves Lourenço - ORCID: 0000-0001-7970-8754. E-mail: [email protected]. Simone Henriques Machado - ORCID: 0000-0001-6645-103X. E-mail: [email protected]

4

Revista Brasileira de Odontologia - Suplemento 1Brazilian Journal of Dentistry - Supplement 1Associação Brasileira de Odontologia - Seção Rio de Janeiro


No endodontic auxiliary chemical solutions fills all the requirements considered ideal, especially for biocompatibility, since all solutions used have some degree of cytotoxicity. The aim of this study was to investigate the effect of auxiliary chemical solutions; sodium hypochlorite 5.25% (NaOCl), chlorhexidine 2% (CHX), chitosan 0.2%, etidronic acid 18% (HEBP) and grape seed extract 6.5% (GSE); in subcytotoxic concentrations, on the expression of pro and anti-inf lammatory cytokines, when in contact with human lymphoma lineage, differentia-ted into human macrophages, “human macropha-ge-like” U937. The cytotoxic and subcytotoxic con-centrations of each solution were determined using

Evaluation of the expression of pro and anti-infammatory cytokines and growth factors after stimulation with different irrigation agents

Paulo Rogério Nunes Barbosa,1 Milena do Valle Tomaz,1 Luciana Moura Sassone,1 Raphael Hirata Junior1

¹School of Dentistry, Rio de Janeiro State University (UERJ), RJ, Brazil

mouse cells fibroblasts (L929), by the MTT cell via-bility test. The subcytotoxic concentrations, of the auxiliary chemical solutions, were maintained in contact with the U937 cells and the expression of 7 pro-inf lammatory cytokines were analyzed. The substance with the lowest cytotoxic activity was the GSE, followed by HEBP, NaOCL, CHX and chito-san. The HEBP was a chemical agent that showed better results in modulating the expression of pro-inf lammatory cytokines, but all the auxiliary che-mical substances were able to induce the expression of various pro-inf lammatory cytokines.Keywords: Chitosan; Cytokines; Etidronic acid; Grape seed extract; Root canal irrigants


1. Paulo Rogério Nunes Barbosa - ORCID: 0000-0003-0270-8072. E-mail: [email protected]. Milena do Valle Tomaz - ORCID: 0000-0001-9616-7785. E-mail: [email protected]. Luciana Moura Sassone - ORCID: 0000-0002-6181-7490. E-mail: [email protected]. Raphael Hirata Junior - ORCID: 0000-0003-3091-6020. E-mail: [email protected]

5




Drug-drug interaction in dental clinic: risks in patients with hypothyroidism


Hypothyroidism is a clinical condition resulting from insufficient amounts or hormones absence, released by the thyroid gland, thyroxine (T4) and triiodothyronine (T3). This is the most common thyroid disease with a higher incidence in women and people over 60 years. Its clinical implications may increase the risk of drug interaction. Thus, in-trinsic patient factors are predictive, because their symptoms require a pharmacological approach. Ob-jective in dental clinic, there is a basic protocol of patients care, although, there is little information of possible drug-drug interaction (DDI) in this case. So, this study is a literature review which addres-ses possible DDI in patients with hypothyroidism, and also, the therapeutic approaches which may be adopted during dental treatment. This study has re-searched from bibliographical Portuguese articles, available in full of the following scientific databa-

Karoline Ferreira Farias,1 Luiza Rabello Leal,1 Raíssa Barbosa Ribeiro,1 Christina Gaspar Villela2

¹School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil2Department Physiology and Pharmacology /MFL, in Biomedical Institute of Fluminense Federal University (UFF), Niterói, RJ, Brazil

ses: Virtual Health Library (VHL); Latin American and Caribbean Literature in Health Sciences (LI-LACS); and Scientific Electronic Library and On-line (SciELO). In addition, it has fulfilled based on pharmacology and therapy books during the first semester of 2018. In conclusion hypothyroidism compromises the central nervous system, the basal metabolism, the cardiovascular and musculoskele-tal systems, which are highly important for body homeostasis. It is important to note the importance of dentists in knowing this disorder in order to be better prepared for the detection of possible cases and referral to appropriate medical specialty and to provide favorable care for patients already diagno-sed, being always attentive to possible DDI.Keywords: DDI; Pharmacology; Hypothyroidism; Dentists; Care.

1. Karoline Ferreira Farias - ORCID: 0000-0002-4332-7674. E-mail: [email protected]. Luiza Rabello Leal - ORCID: 0000-0002-2618-945X. E-mail: [email protected]. Raíssa Barbosa Ribeiro - ORCID: 0000-0002-9557-7122. E-mail: [email protected]. Christina Gaspar Villela - ORCID: 0000-0001-7442-0786. E-mail: [email protected]

6



Oral hygiene adaptations for elderly with Alzheimer’s disease: case reports


The limitations due to Alzheimer’s disease progres-sion require planning together with the caregiver, in order to weave strategies to overcome the diffi-culties. The aim of the present study is to report cases in wich different oral hygiene orientation strategies were used, adapted according to the dif-ficulties presented by the caregivers. Three patients were selected, all with Probable Alzheimer’s disease, Clinical Dementia Rating (CDR) 1, female, user of removable partial denture, research participants of the Dentistry project at the Center for Alzheimer’s Disease of the Institute of Psychiatry of the Fede-ral University of Rio de Janeiro (CDA/IPUB/UFRJ).

Melissa Cossich Uchoa Gomes,1 Raquel de Oliveira Araujo,1 Anna Thereza Thomé Leão,1 German Eduardo Miguel Villoria1

¹School of Dentistry, Rio de Janeiro Federal University (UFRJ), RJ, Braz

The project was approved by the Ethics Committee of the UFRJ. During the clinical examination, very different behavioral profiles were observed, despite equivalent diagnoses. Caregivers reported their di-fficulties and the Dentistry team proposed schemes to circumvent the situation. The new information was well received by the caregivers who reported improvements in the oral health care of the elderly. This group of patients requires care strategies gui-ded by the caregiver’s reports, adapting them to di-fferent behavioral profiles.Keywords: Alzheimer disease; Oral hygiene; Oral health.

1. Melissa Cossich Uchoa Gomes - ORCID: 0000-0003-3028-1424. E-mail: [email protected]. Raquel de Oliveira Araújo - ORCID: 0000-0003-3435-5638. E-mail: [email protected]. Anna Thereza Thomé Leão - ORCID: 0000-0001-5249-6616. E-mail: [email protected]. German Eduardo Miguel Villoria - ORCID: 0000-0002-3162-6095. E-mail: [email protected]

7





Conservative endodontic access cavity design. Is it viable? - a literature review

Conservative endodontic cavity (CEC) is a new te-chnique used as an alternative to traditional endo-dontic cavity (TEC), aiming at less removal of tooth structure. The aim of this study was to verify the ef-fects of this procedure. A literature search was car-ried out in the LILACS and PubMed databases. For a comparative analysis of data, 12 scientific articles were selected. The CEC showed to be more effective than the TEC in the removal of filling root material in retreatment with TRUShape instruments. About instrumentation efficacy of the root canal system, there was a drop in the quality of the distal root of lower molars. In relation to fracture resistance,

Tiago de Mello Guimarães,1 Ramon Cruz Rodrigues,1 Marcos Alexandre Nunes Silva,1 Renata Perez Vianna Silva Macedo,1 Henrique Eduardo Oliveira1

¹School of Dentistry, Fluminense Federal University (UFF), Niterói, RJ, Brazil

there was a significant increase in lower molars, however, the literature diverged in relation to the lower premolars. It should be concluded, based on the scientific literature, that few benefits were fou-nd on TEC. It is also emphasized that, for this te-chnique to be well performed, it depends on longer clinical time and use of specific equipment, such as cone beam computed tomography, operating opti-cal microscope and ultrasonic. Clinical research is suggested for long-term data collect.Keywords: Dental pulp cavity; Endodontics; Ins-trumentation; Minimally invasive; Pulp chamber.

1. Tiago de Mello Guimarães - ORCID: 0000-0003-4006-5469. E-mail: [email protected]. Ramon Cruz Rodrigues - ORCID: 0000-0002-9536-9331. E-mail: [email protected]. Marcos Alexandre Nunes Silva - ORCID: 0000-0002-1707-6525. E-mail: [email protected]. Renata Perez Vianna Silva Macedo - ORCID: 0000-0003-2192-0124. E-mail: [email protected]. Henrique Eduardo Oliveira - ORCID: 0000-0002-6324-2299. E-mail: [email protected]

8




Osteoporosis type 1 and its relation with periodontal disease

Osteoporosis and periodontitis are chronic in-f lammatory diseases associated with bone loss me-diated by local and systemic factors. Type 1 osteo-porosis is a heterogeneous disease that occurs after the natural or surgical menopause and leads to a decrease in bone mass. The risk for periodontitis can increase due to this osteoporosis type becau-se the density decrease of alveolar bone leads to a greater susceptibility of reabsorption by the effect of coexisting or subsequent periodontal infection. Thereby, the objective of this panel is to evaluate a possible relationship between periodontal disease and type 1 osteoporosis through a literature review.

Barbara Bruno Fagundes Marques,1 Carlos Marcelo da Silva Figueredo2

¹School of Dentistry, Rio de Janeiro State University (UERJ), RJ, Brazil2School of Dentistry and Oral Health, Griffith University, Queensland, Australia

Recent researches indicate that women with osteo-porosis often present a clinical condition with more intense gingival inf lammation, as well as values of clinical insertion loss and gingival recession higher than the women with normal bone mineral densi-ty. A higher loss of periodontal insertion observed in women with osteoporosis ratifies the association between osteoporosis and the level of clinical inser-tion, thus confirming that women at postmenopau-sal stage with osteoporosis are more susceptible to periodontitis.Keywords: Osteoporosis; Periodontitis; Inf lamma-tion; Menopause.

1. Barbara Bruno Fagundes Marques - ORCID: 0000-0003-0876-8607. E-mail: [email protected]. Carlos Marcelo da Silva Figueredo - ORCID: 0000-0003-0222-9231. E-mail: [email protected]

9





Effectiveness of protaper next, protaper universal and waveone systems in reducing

intracanal bacterial load

Bacteria and their by-products play an essential role in the development of pulp and periapical diseases and are factors which affect the results of root ca-nal therapy. Therefore, we evaluated the bacterial reduction achieved by ProTaper Next (PTN), ProTa-per universal (PTU) and WaveOne (WO) systems in root canals contaminated with Enterecoccus faeca-lis. A hundred human mandibular premolars were selected and 95 were contaminated with E. faecalis for 4 weeks. Then the teeth were randomly divided into six groups (n = 15): PTN + 2.5% NaOCl; PTU + 2.5% NaOCl; WO + 2.5% NaOCl; PTN + saline solution; PTU + saline solution; and WO + saline solution. Positive and negative control groups were created with five specimens each. Samples taken before (S1) and after (S2) chemomechanical proce-dures were cultured and the colony-forming units (CFUs) were counted. The paired t-test was used for

Gabrielly Carvalho Nascimento,1 Patrícia Reis Rezende de Brito,1 Carolina Oliveira de Lima,1 Emmanuel João Nogueira Leal Silva,1 Luciana Moura Sassone1


intragroup analysis, and one-way ANOVA for inter-group analysis. When significant differences were found amongst the groups, the Tukey test was used. The significance levels were set at 5% (P < 0.05).Af-ter root canal instrumentation, there was a signi-ficant reduction in bacterial load in all groups (P < 0.01). The WO + saline solution group showed a lower level of bacterial reduction when compared with the other tested groups (P < 0.01). Groups ir-rigated with NaOCl showed a higher level of bacte-rial reduction when compared with saline solution irrigation (P < 0.01), with no statistical differences amongst the systems used (P > 0.05). The PTN sys-tem was as effective as PTU and WO in the removal of bacteria during root canal treatment. Keywords: Enterococcus faecalis; Root canal; Den-tal instruments.

1. Gabrielly Carvalho Nascimento - ORCID: 0000-0001-5154-6650. E-mail: [email protected]. Patrícia Reis Rezende de Brito - ORCID: 0000-0002-0287-636X. E-mail: [email protected]. Carolina Oliveira de Lima - ORCID: 0000-0003-2132-4373. E-mail: [email protected]. Emmanuel João Nogueira Leal Silva - ORCID: 0000-0003-2132-4373. E-mail: [email protected]. Luciana Moura Sassone - ORCID: 0000-0002-6181-7490. E-mail: [email protected]

10




Tissue reaction to repair cement based on MTA with high plasticity in subcutaneous of rats

This study evaluated the biocompatibility, through histopathological analysis and immunohistoche-mistry of a new repair cement: MTA HP (Angelus Londrina, PR). White MTA (Angelus Londrina, PR), and a material based on zinc oxide and eugenol (IRM, Dentsply, Petrópolis, RJ) were used for com-parison. Thirty male Wistar rats had inoculated into the subcutaneous tissue an empty polyethylene tube (negative control) and three more tubes, each filled with one of the tested materials. After 7, 30 and 60 days of tube implantation the specimens were re-moved, fixed and embedded in paraffin. The sec-tions were stained with hematoxylin and eosin and gomori trichrome to assess inf lammatory reactions and also stained with Picrosirius Red to quantify as type I and type III collagen fibers. The presence of angiogenesis was performed using the VEGF (vas-cular endothelial growth factor) marker. Non-para-metric data were analyzed using the Kruskal-Wallis assay followed Dunn’s test. The significance levels adopted were 5% (P < 0.05). The results demons-trated a significant difference in inf lammatory res-

João Matheus Sobral Pena,1 Cláudio Malizia Alves Ferreira,1 Alexia da Silva Gonçalves,1 Luciana Moura Sassone,1 Emmanuel João Nogueira Leal da Silva1


ponse after 60 days between IRM and empty tube groups (P < 0.05). MTA HP showed similar biocom-patibility to the White MTA and the negative con-trol group in all experimental periods. Furthermo-re, after 7 days MTA HP stimulated less pronounced angiogenesis than White MTA, as it initially exhi-bited slower extracellular matrix remodeling when compared to White MTA and IRM. A decrease in the thickness of the fibrous capsule and the immu-nostaining with VEGF in all experimental groups and control throughout the healing process was ob-served. After 60 days, the experimental groups pre-sented extracellular matrix with more mature con-nective tissue, with predominance of type I collagen fibers. According to the results, it can be concluded that the MTA HP was biocompatible in all the expe-rimental periods, presenting similar results to the control and experimental groups with White MTA and IRM.Keywords: Mineral trioxide aggregate; Biocompati-bility; Immunohistochemistry; Subcutaneous tissue of rats.

1. João Matheus Sobral Pena - ORCID: 0000-0002-6759-1648. E-mail: [email protected]. Cláudio Malizia Alves Ferreira – ORCID: 0000-0002-4970-3757. E-mail: [email protected]. Alexia da Silva Gonçalves - 0000-0003-4050-8549. E-mail: [email protected]. Luciana Moura Sassone - Orcid: 0000-0002-6181-7490. E-mail: [email protected]. Emmanuel João Nogueira Leal da Silva - ORCID: 0000-0002-6445-8243. E-mail: [email protected]

11





Clinical epidemiological study of Proliferative Verrucous Leukoplakia

Proliferative verrucous leukoplakia (PVL) is a rare variant of leukoplakia, with high recurrence rate, that develops as multifocal white exophytic plaques in the mucosal surface. PVL tends to spread and in-volve other spots, and it can suffer malignant trans-formation into squamous cell carcinoma (SCC). An 8-year retrospective statistical survey was realized at Oral Medicine Department, in Rio de Janeiro State University. Fourteen patients were diagno-sed with PVL; 71.4% (10) were white-skinned and 92.8% (13) were females. The average age was 67.1 years. The most affected places were gingiva/alveo-lar ridge (85.7%), buccal mucosa (42.8%) and tongue

Giulianna Lima Pinheiro,1 Nathalia Almeida Freire,1 Fernanda Vieira Heimlich,1 Mayara Leonel Duarte Meira,1 Monica Simões Israel1


(28.6%). Malignant transformation was observed in 14.3% (2) of the cases. PVL has a strong predilec-tion for women, which can be confirmed, once that only one case was diagnosed in men. PVL showed no association with tobacco use; only 14.3% (2) of the patients related to use tobacco. The importance of a meticulous clinical examination is evidenced, for identification of premalignant lesions, which are mostly asymptomatic and due to its progression into SCC.Keywords: Leukoplakia; Leukoplakia Oral; Carci-noma squamous cell.

1. Giulianna Lima Pinheiro - ORCID: 0000-0003-4683-8610. E-mail: [email protected]. Nathalia Almeida Freire - ORCID: 0000-0002-3053-0665. E-mail: [email protected]. Fernanda Vieira Heimlich - ORCID: 0000-0001-6933-3450. E-mail: [email protected]. Mayara Leonel Duarte Meira - ORCID: 0000-0001-7732-7333. E-mail: [email protected]. Monica Simões Israel - ORCID: 0000-0002-9234-7903. E-mail: [email protected]

12




Conventional endodontic approach of extensive cystic lesion

This article aims to report a non-surgical endodontic treatment of an extensive cystic anterior maxillary lesion. Initially, conventional endodontic retreat-ment was proposed. Histopathological examination was suggestive of periapical. Clinical evaluation re-vealed a positive response to palpation and percus-sion. Also, grade II mobility was identified in all anterior maxillary teeth. Thermal test were perfor-med and only elements 11 and 21, showed a negati-ve response due to previous endodontic treatment, however considered unsatisfactory. Initially, con-ventional endodontic retreatment was performed on teeth 11 and 21. Accidentally, in the prosthetic

Tailane Vasconcelos Vitor,1 Georgiana Amaral,1 Nancy Kudsi de Carvalho,1 Renato Liess Krebs,1 Emmanuel João Nogueira Leal da Silva1


rehabilitation phase, the root canal deviation of the canal in tooth 21 and total removal of the filling material of tooth 11 occurred. Nevertheless, in 2015 was observed a significant decrease of the lesion. In 2017, conventional endodontic treatment of the ele-ments was performed again. It was concluded that conventional endodontic retreatment was essential in the bone formation of the associated lesion, ena-bling better conditions for any necessary surgical intervention, favoring the patient’s prognosis.Keywords: Endodontics; Root canal therapy; Radi-cular cysts.

1. Tailane Vasconcelos Vitor - ORCID: 0000-0003-2449-1820. E-mail: [email protected]. Georgiana Amaral - ORCID: 0000-0001-6565-8936. E-mail: [email protected]. Nancy Kudsi de Carvalho - ORCID: 0000-0003-3893-5330. E-mail: [email protected]. Renato Liess Krebs - ORCID: 0000-0002-6428-4992. E-mail: [email protected]. Emmanuel João Nogueira Leal da Silva - ORCID: 0000-0002-6445-8243. E-mail: [email protected]


1Rev. Bras. Odontol. 2019;76:(Supl.1):e1421

Original Article/Management in Dentistry

Deployment and management of the Center of Dental Radiology and Care of Patients with

Special Needs of the Piquet Carneiro Polyclinic

Luciana Freitas Bastos,1,2 Geraldo de Oliveira Silva-Junior,2,3 Débora Lúcia Teixeira Medina de Figueiredo,2 Bruna Michalski dos Santos,2 Bruna Lavinas Sayed Picianni,2,4 Urubatan Vieira de Medeiros,1 Maria Isabel de Castro de Souza,1 Fernanda Barja-Fidalgo,1,2 Michelle Quarti Machado da Rosa,2 Emylena Salgado Cobalea,2 Marcelo Daniel Brito Faria,2,3

1Department of Preventive and Community Dentistry, School of Dentistry, State University of Rio de Janeiro, RJ, Brazil2Center of Dental Radiology and Care of Patients with Special Needs, Piquet Carneiro Polyclinic, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil 3Department of Diagnosis and Therapeutics, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil 4Department of Stomatology, Fluminense Federal University, Nova Friburgo, RJ, Brazil• Conflicts of interest: none declared.

AbstrActThe Center of Dental Radiology and Care of Patients with Special Needs of the Piquet Carneiro Polyclinic was deployed through FAPERJ (FAPERJ notice 31/2012 – case E – 26/112.147/2012 and FAPERJ notice 31/FAPERJ – case E – 26/111.806-2013) and FINEP (No. 0109.0477.00) projects. The Dental Radiology services offer state-of-the-art digital equipment such as: ICAT Next Generation cone beam computed tomography, panoramic radiography, conventional ATM radiography, extra-oral face radiographs and intra-oral insulated and complete periapical radiographs. We have planned five dental offices with the necessary equipment for the dental care of Patients with Special Needs, one of them being specialized in the treatment of patients under general anesthesia. In 2016, we established a partnership with the State Health Department through Joint Resolution SES/UERJ No. 449 of 11 October, 2016, which added more value in relation to the management of personnel, inputs and purchasing of equipment. Special needs patients may reach our services via the State Regulatory System – SER, and in the dental radiology services, in addition to SER, we have the National Regulatory System – SISREG of the municipality of Rio de Janeiro. The Center extended its multidisciplinary care network to patients with disabilities and also to imaging tests in Dentistry, decreased infection foci with outpatient dental treatment, minimized costs and optimized care. In relation to education, we seek to enhance the opportunities for students interested in this type of practice, with extension projects and graduate courses. We consider the understanding of the relationship of profession-als with patients, their caregivers and family members to be fundamental, but we also know that the deep transformation processes in Health are complex, and the greatest challenge is seizing the extension of the implications of the disease in an individual’s life history. Dental treatment should be seen as the relationship between patient and professional, in the pursuit of the patient’s well-being, not only from a technical perspective, but with the aim of establishing a mutual sense of trust and satisfaction. Keywords: Dentistry; Radiology; Patients with special needs; Management.

Introduction

The Piquet Carneiro Polyclinic’s trajectory started on 22 May, 1967, with the inauguration of the São Francisco Xavier Health Care Center, of the Nation-

al Social Security Institute. In 1995, the Ministry of Health established a partnership with the State University of Rio de Janeiro and the Unit – which was considered the largest outpatient clinic of Latin America – gained a new name: the Piquet Carneiro Polyclinic, in honor of doctor Américo Piquet Carneiro, creator and found-er of the first Biomedical Center and of Universidade Aberta da Terceira Idade, both of the State University of Rio de Janeiro. The objective of this partnership was to turn this unit into a space/laboratory for formula-tion, implementation and evaluation of health models, to strengthen the Unified Health System and encour-age the professor-care integration with the prospect of de-hospitalization, emphasizing preventive and effec-tive health practices. After five years of a successful partnership, the Ministry of Health has granted the

transfer of the use of PPC to UERJ, turning it into a new Biomedical Center unit.1

Following the logic of the process of implementa-tion of the Unified Health System in the country (SUS), transformations occurring in the health services have been challenging us in relation to the training of per-sonnel, which requires, in addition to the reformula-tion of the curriculum followed in health schools, the adaptation to SUS’s principles.2 In this sense, PPC be-comes an important practice scenario in the produc-tion of primary and medium-complexity health care actions in various disciplines of undergraduate and graduate courses, as well as extension projects associ-ated with UERJ’s School of Dentistry, and also Projects focused on funding institutions such as FAPERJ and FINEP.

Thus, this article aims to describe the deployment and management of the Center of Dental Radiology and Care of Patients with Special Needs of the Piquet Carneiro Polyclinic.

2 Rev. Bras. Odontol. 2019;76:(Supl.1):e1421

BASTOS LF et al.

DevelopmentDue to there being an inactive space in the Den-

tal Radiology services of the Piquet Carneiro Poly-clinic, the team of professionals of this same clinic, assigned to the areas of Radiology, Collective Oral Health, Pediatric Dentistry and Stomatology, achieved, through FAPERJ (FAPERJ notice 31/2012 – case E – 26/112.147/2012 and FAPERJ notice 31/FAPERJ – case E – 26/111.806-2013) and FINEP (No. 0109.0477.00) projects, the reactivation of the Imaging and Dental Radiology Center and the deployment of the service for the care of Special Needs Patients.

The Dental Radiology services offer state-of-the-art digital equipment such as: ICAT Next Generation cone beam computed tomography (Imaging Scienc-es International LLC, PA USA), which allows the re-al-time reproduction of the skull of patients and sub-sequent 3D reconstruction for virtual planning and guided surgery, with greater surgical predictability for cases of face anomalies, tumors, cleft lip and palate, special needs patients and patients with FAP (firearm projectile)-related bone loss. Panoramic radiography, conventional ATM radiography, extra-oral face radio-graphs and intra-oral insulated and complete periapi-cal radiographs are also offered.

Our center also has lines of research in the area of early oral cancer diagnosis via imaging tests, in part-nership with the School of Engineering and the Na-tional Computer Sciences Laboratory (LNCC), and in the area of dosimetry, alongside LCR-UERJ and MCTI’s IRD. The cone-beam computed tomography system allows the performance of 3D virtual guided surgery, with subsequent production of biomedical prototyping before the realization of laboratory surgeries in pa-tients with tumors, morphological face anomalies such as Cleft Lip and Palate, syndromes and special needs patients.

After a short investigation, we observed the lack of public and private services that provide dental care to Patients with Special Needs. In the municipality of Rio de Janeiro, with approximately 6 million inhabitants, 828,000 cariocas, or 14.8% of the population, have de-clared having some sort of disability; therefore, one in seven Brazilians or cariocas had a disability, a fact that justified our initiative. There is a repressed demand in the municipality of Rio de Janeiro, state of Rio de Ja-neiro, and also in Brazil, of individuals with Special Needs who need dental treatment in the three levels of complexity.3,4

A project that has the purpose of providing care to this layer of the population that has historically been excluded from social policies, translates into an oppor-tunity both in their favor, and in favor of the pursuit of the completeness and universality of actions in this sector.5

This choice was made based on the Federal Consti-tution of 1988, which foresees the care of people with disabilities as definite part of the public policy agenda and of the legal framework, in a cross-sectional and comprehensive manner. According to Cotta’s criteria (1998), we cannot evaluate a project without consider-ing its coordination with a broader initiative. In this regard, we follow the National Plan on the Rights of People with Disabilities – Viver sem Limite, and the National Oral Health Policy (PNSB) Programa Brasil Sorridente, implemented by the Ministry of Health (MS) in 2004.6

The specialty of Dentistry for Patients with Special Needs aims at the diagnosis, preservation, treatment and control of oral health problems of patients with complexities in their biological and/or psychological and/or social system, in addition to perception and ac-tion within a transdisciplinary structure shared with other health professionals and areas related to the pa-tient.7

In the Center in question, there are five dental offic-es with the necessary equipment available, one of them being specialized in the treatment of patients under general anesthesia.

We offer care to patients with mental disabilities, physical disabilities and congenital anomalies (de-formities, syndromes), behavioral disorders (autism), psychiatric disorders, sensory and communication disorders, chronic systemic diseases (diabetes, heart diseases, hematologic disorders, chronic kidney failure, autoimmune diseases, vesiculobullous diseases, etc.), contagious diseases (HIV, hepatitis, tuberculosis) and systemic conditions (irradiated, cancer, transplanted, immunocompromised patients and pregnant women), in both outpatient and hospital environments.8

The Center was opened at the end of 2016 and be-gan operations in January 2017 (Figure 1). A partner-ship with the State Health Department was established through Joint Resolution SES/UERJ No. 11 of 2016 Oc-tober, 2016, which added more value in relation to the management of personnel, inputs and purchasing of equipment.


Deployment and management of the Center of Dental Radiology and Care of Patients with Special Needs of the Piquet Carneiro Polyclinic

Special needs patients may reach our services via the State Regulatory System – SER, which resulted in the start and completion of the treatment of 232 new regulated patients, and more than 3,000 dental con-sultations in 2017 and in the beginning of 2018 (up to April). In relation to the dental radiology services, in addition to SER, patients may reach them via the Na-tional Regulatory System (SISREG) of the municipality of Rio de Janeiro, which resulted in around 1,100 com-puted face tomography exams, as well as 700 extraoral and 600 periapical radiographs.

So far, the Goals Achieved are:• The center works from Monday to Friday, offering

both radiological examinations and consultations to patients with disabilities, reducing the demand in the state of Rio de Janeiro;

• The partnerships with other healthcare specialties have been established both in relation to joint treat-ment with the Psychological Care of Patients with Dis-abilities, and to the use of the center’s space by the ar-eas of Ophthalmology and Plastic Surgery and CTAC inserted in the PPC. We also have a partnership with the PPC’s CAPs. In the Dental Radiology services, this partnership is extended to Institutions LCR, IRD and UFRJ.

• In relation to the socio-demographic and dental profile of the special needs patients of COPE ABO/RJ and of the UERJ Center, a database contemplating them has been created.

• We are reducing the foci of infections with outpa-tient dental treatment, minimizing costs and optimiz-ing the service.

• We have deployed the Catavento extension project;• The Specialization in Dentistry for Patients with

Special Needs has already been approved in the depart-ments of School of Dentistry, State University of Rio de Janeiro, and is scheduled to start in August/2018, with the coordination of Prof. Geraldo de Oliveira Silva Ju-nior.

• Several studies and scientific articles have been developed and presented in Congresses through pro-ceedings.

Future Goals• Publishing social, demographic and oral health

variables of the PWD seen in the Dental Radiology Center and in the specialized healthcare service;

• Intensifying the health workshops on the super-vised oral hygiene and topical application of f luoride for the PWD’s caregivers;

• Deploying a new tomography unit for PWD;• Evaluating the changes caused by the dental treat-

ment in the daily routine of PWD and their families;• Enhancing the opportunities for students interest-

ed in this type of practice with extension projects;• Expanding the partnership with other healthcare

specialties in the PPC for assessment of the patients’ overall health;

• Publishing articles in newspapers and magazines

Figure 1. Center of Dental Radiology and Care of Patients with Special Needs of the Piquet Carneiro Polyclinic


with national and international relevance;• Expanding the network of imaging examination

services in Dentistry;• Expanding the network of multidisciplinary care

of patients with disabilities; • Surveying the socio-demographic and dental pro-

file of patients with special needs of the UERJ Center;• Decreasing the foci of infection for the PWD with

outpatient dental treatment;• Enhancing the opportunities for students interest-

ed in both the care of PWD and in the internship pro-grams of the dental imaging and radiography services, with extension projects;

• Developing technical and scientific knowledge in graduate programs in the field of Special Needs Pa-tients and Dental Radiography – Imaging Examina-tions.

• Deploying a teleradiology system called laudoden-tal, which allows sending cone beam images and any digital portraits of the patient’s face to the health net-work system of the city and state of Rio de Janeiro, for the issuing of technical reports by dental radiologists, issuing of second opinion reports, crediting and train-ing of the municipal and state network, and coverage of the network’s state and municipal servers’ vacation and sick leave expenses. In addition to the quantitative increase in the offer of examinations, the following will also be ensured to users and dentists: specialized teams working 40 hours per week; properly recording and documentation of the examinations on CDs; revision and computerization of reports in real time; properly

packing for delivery; humanized services; constantly updated systems for the management, archiving and distribution of images and epidemiological data.

ConclusionWe know that, as an educational institution, we have

a fundamental role in the promotion of actions that ensure the access to health care services and adequate treatment within them, following proper technical standards and models. In this sense, the Center ex-tended the network of multidisciplinary care to patients with disabilities and also to imaging tests in Dentistry, decreased infection foci with outpatient dental treat-ment, minimized costs and optimized care. In relation to education, we seek to enhance the opportunities for students interested in this type of practice, with ex-tension projects and graduate courses. We consider the understanding of the relationship of professionals with patients, their caregivers and family members to be fundamental. We have noted the importance of the professional’s focus on the patient, since for many years, Dentistry worked under a technical and biolo-gy-based philosophy. However, we know that the deep transformation processes in Health are complex, and the greatest challenge is seizing the extension of the implications of the disease in an individual’s life histo-ry. Dental treatment should be seen as the relationship between patient and professional, in the pursuit of the patient’s well-being, not only from a technical perspec-tive, but with the aim of establishing a mutual sense of trust and satisfaction.

Conj. BH, 1(3):107-27,set/dez.1996.6. Reses, M. de L. N. Avaliação da implantação dos centros de especialidades odontológicas em Santa Catarina Dissertação (dissertação) - Santa Catarina: Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva; 2011.7. Schliehe F, Ewert T. The International Classification of Functioning, Disabil-ity and Health (ICF) - update of the problem based inventory]. Rehabilitation (Stuttg). 2013 Feb;52(1):40-50.8. Freire, A. L. A. e Silva de S. Saúde bucal para pacientes com necessidades espe-ciais: análise da implementação de uma experiência local. / Ana Lucia Araujo e Silva de Souza Freire. 2011. 254 f.

References1. Policlínica Piquet Carneiro [internet] Rio de Janeiro: [atualizado em setembro 2017] disponível em:http://www.ppc.uerj.br. 2. Ministério da Saúde (BR), Secretaria de Políticas de Saúde. Política Nacional de Saúde da Pessoa Portadora de Deficiência. Portaria Nº 1.060, de 5 de Junho de Brasília (DF); 2002.3. Ministério da Saúde (BR), Secretaria de Políticas de Saúde. Política Nacional de Saúde da Pessoa Portadora de Deficiência. Editora do Ministério da Saúde, 2008. 72 p.4. Cotta, T. C. Metodologias de Avaliação de Programas e Projetos Sociais: análise de resultados e de impacto. Revista de Serviço Público, 49(2):103-24.5. Figueiredo e Figueiredo. Avaliação política e avaliação de políticas. Anál e

BASTOS LF et al.


Submitted: 10/22/2018 / Accepted for publication: 11/06/2018

Corresponding Author

Luciana Freitas Bastos

E-mail: [email protected]

Mini Curriculum and Author’s Contribution 1. Luciana Freitas Bastos – DDS; PhD. Contribution: performed the data collection, manuscript writing, manuscript review and work supervisor. ORCID: 0000-0002-0788-42112. Geraldo de Oliveira Silva-Junior – DDS; PhD. Contribution: performed the data collection, manuscript writing. ORCID: 0000-0003-0987-26843. Débora Lúcia Teixeira Medina de Figueiredo – DDS; MSc. Contribution: performed the data collection and wrote the manuscript. ORCID: 0000-0002-2441-71134. Bruna Michalski dos Santos – DDS; PhD. Contribution: performed the data collection and wrote the manuscript. ORCID: 0000-0002-7707-46285. Bruna Lavinas Sayed Picianni – DDS; PhD. Contribution: performed the data collection, manuscript writing, manuscript review. ORCID: 0000-0001-7592-17856. Fernanda Barja-Fidalgo – DDS; PhD. Contribution: performed the data collection, manuscript writing, manuscript review. ORCID: 0000-0002-4098-86377. Urubatan Vieira de Medeiros – DDS; PhD. Contribution: performed the data collection, manuscript writing, manuscript review and work supervisor and the final approval. ORCID: 0000-0001-7822-26728. Maria Isabel de Castro de Souza – DDS; PhD. Contribution: performed the data collection, manuscript writing, manuscript review and work supervisor and the final approval. ORCID: 0000-0002-0355-9673 9. Michelle Quarti Machado da Rosa - PhD. Contribution: performed the data collection, manuscript writing. ORCID: 0000-0002-3036-399110. Emylena Salgado Cobalea - PhD. Contribution: performed the data collection, manuscript writing. ORCID: 0000-0001-9215-445011. Marcelo Daniel Brito Faria – DDS; PhD. Contribution: performed the data collection, manuscript writing, manuscript review, work supervisor. ORCID: 0000-0001-8853-9948

Deployment and management of the Center of Dental Radiology and Care of Patients with Special Needs of the Piquet Carneiro Polyclinic



Original Article/Pediatric Dentistry

The history of Pediatric Dentistry at Rio de Janeiro State University (UERJ) - 50 years of School of Dentistry

Fernanda Barja-Fidalgo,1 Tatiana Kelly da Silva Fidalgo,1 Mirian de Waele Souchois de Marsillac,1 Ana Paula Pires dos Santos,1 Vera Campos,1 Vera Lígia Mendes Soviero,1 Luiz Flávio Martins Moliterno,1 Branca Heloisa Oliveira1 1Department of Preventive and Community Dentistry, School of Dentistry, Rio de Janeiro State University (UERJ), RJ, Brazil• Conflicts of interest: none declared.

AbstrActThe objective was to report the history of the discipline of Pediatric Dentistry from the School of Dentistry of the Rio de Janeiro State University (FOUERJ). A survey of the history of Pediatric Dentistry of FOUERJ was carried out with data referring to the period from 1971 to the present day. Professors and other professionals were contacted to retrieve the history of the course. The history of Pediatric Dentistry at the FOUERJ is intertwined with that of the School of Dentistry itself. The discipline of Pediatric Den-tistry began in 1971 at FOUERJ. Pediatric Dentistry is one of the three disciplines within the Department of Community and Preventive Dentistry (PRECOM) of FOUERJ that is also composed by Orthodontics and Oral Public Health. Currently, there are eight active professors in the discipline. The Discipline of Pediatric Dentistry (DPP) of FOUERJ is dedicated to improve children’s oral health through teaching, research and extension activities. The predoctoral program consists of the disciplines of Pediatric dentistry I and II and extension activities and the post-doctoral program consists of the Specialty, master of science and PhD programs. The research activities focus on the following areas of research: Epidemiology and control of dental diseases; Dental materials, substances and medicines used in Pediatric Dentistry; Interrelationship between general health, oral health and quality of life. Pediatric Dentistry is a discipline that has been actively involved in teaching, research and extension activities of the School of Dentistry since its inauguration. Thus, we can conclude that in the 47 years of existence, our discipline assumed the commitment of guaranteeing a high-quality public education. In this sense, the discipline has formed undergraduate and postgraduate students based on ethics and human values, encouraging them to perform an evidence-based clinical practice in order to promote oral health and positively impact the quality of life of the patients.Keywords: Education; Pediatric Dentistry; School; Dental students.

Introduction

The history of Pediatric Dentistry at the School of Dentistry of the Rio de Janeiro State University (FOUERJ), former University of the State of Guana-

bara (UEG), is intertwined with that of the fchool of Den-tistry itself. Prof. Hilton Souchois de Albuquerque Mello, who was the first professor and chair (1971-1996) of the Discipline of Pediatric Dentistry at FOUERJ, was also one of the founding professors of FOUERJ. Currently, Pediatric Dentistry is one of the three disciplines within the Depart-ment of Community and Preventive Dentistry (PRECOM) of FOUERJ. The other disciplines are: Orthodontics and Dental Public Health.1

Prof. Hilton Souchois earned his DDS (1953) and PhD. (1964) degrees from the Federal University of Rio de Janeiro. He was awarded with Certificates in the Specialty of Pediatric Dentistry from the University of Illinois (1959) and the University of Michigan - Ann Arbor (1967) Prof. Hilton Souchois was one of the pioneers that led the groundwork for the development of Pediatric Dentistry as a dental specialty in Brazil. In sixties and seventies, when caries prevalence was very high among Brazilian children, he introduced in the country various technologies that would help to improve children’s dental care. Some examples are the use of: stain-less steel crowns for restoring severely damaged posterior

teeth, formocresol for performing pulpotomies in primary teeth and nitrous-oxide for conscious sedation to manage pain and anxiety at the dental office.1

MethodsA survey of the history of Pediatric Dentistry of FOUERJ

was carried out with data referring to the period from 1971 to the present day. Professors and other professionals were contacted to retrieve the history of the course.

Literature Review Historical ContentInitially, the pediatric dentistry school members at

FOUERJ were Profs. Hilton Souchois, Álvaro Cerchiaro, Harvey Generoso, and Roberval de Almeida Cruz. The latter served as interim chairman of the Pediatric Dentist-ry Discipline at FOUERJ while Prof. Souchois was abroad, serving as the Pediatric Dentistry Program Director at Tem-ple University (Philadelphia, EUA). In 1975, Prof. Souchois was awarded the certification in Pain Management and Se-dation from Temple University, being one of the pioneers in Brazil (Figure 1). Profs. Hilton and Roberval were promoted to full professor in 1995 and retired in 1996. In 2007, a new Specialty Dental Clinic was inaugurated at FOUERJ; it was named after Prof. Hilton Souchois.


FIDALGO FB et al.

In 1977, FOUERJ hired Ms. Marisa Santos de Oliveira to work as the pediatric dental clinic receptionist. By the end of the 1980s, she became a Dental Hygienist and in the early 1990s she began to provide services to our pediatric patients under the professors’ supervision. Marisa worked at the pe-diatric dental clinic until 2018.1 From the late-1970s to the early-1980s, other professors joined the Pediatric Dentistry Discipline: Álvaro de Moraes Mendes, Hélio Cardoso Coelho Filho, Hilda Maria Sant’anna, Luiz Sant’anna, Luiz Flávio Martins Moliterno, Magali Pereira Kather, Marco Antônio de Oliveira Almeida, Marialice Barroso Pentagna, Ronald Seaman Penido, Sônia Lúcia Macedo Marçal, Vera Lúcia Campos Santos and Teresa Sadaya (Figure 2). Profs. Marco Antônio and Álvaro later transferred to the Discipline of Or-thodontics. Profs. Hilda, Luiz, Magali and Teresa were mem-bers of the discipline team for a short period of time during the 1970s. Prof. Penido resigned and left the discipline in 1992. Profs. Hélio, Marialice and Luiz Flávio remained in the discipline until their retirement in 1996, 2013 and 2018, re-spectively (Figure 3). Prof. Luiz Flávio served as chair of the Pediatric Dentistry Discipline from 1997 to 2018. Prof. Sônia Marçal was a pediatric dental school member at FOUERJ un-til December 2016, when she passed away (Figure 3).

In the 1990s new permanent full-time school professors were incorporated into the Pediatric Dentistry Discipline: Branca Heloísa de Oliveira Martins Vieira, who had been a substitute professor at the discipline from 1986 to 1988, Mirian de Waele Souchois de Marsillac and Vera Ligia Vieira Mendes Soviero.

In 2000, Mr. Luiz Claudio de Lima Pinto became a pedi-atric dental clinic receptionist and began to work closely with Ms. Marisa Santos and the others pediatric dental school members.

In the years 2010s, there were new additions to the School team of the discipline: Ana Paula Pires dos Santos in 2012, Fernanda Barja Fidalgo Silva de Andrade in 2014, Tatiana Kelly da Silva Fidalgo in 2016 and Adilis Kalina Alexandria de França in 2018 (Figure 4). Before securing their permanent positions at FOUERJ, Profs. Ana Paula, Fernanda and Tatia-na had been substitute professors from 2003 to 2006, 2005 to 2014 and 2013 to 2014, respectively.

Figure 1. Prof. Souchois receiving the certification of pioneer in the technique of sedation with nitrous oxide and oxygen in Brazil

Figure 2. Pediatric Dentistry Team in 90’s. From left to right: Prof. Mirian de Marsillac (as postgraduate student), Profs. Vera Campos, Hilton Souchois, Luiz Flávio Martins Moliterno, Sônia Marçal e Hélio Cardoso Coelho Filho

Figure 3. Tribute to Marialice Barroso Pentagna due to her retirement. From left to right: Profs. Fernanda Barja Fidalgo, Luiz Flávio Martins Mo-literno, Sonia Marçal, Marialice Pentagna, Sandra de Paula (UNIFOA), Ana Paula Pires dos Santos, Mirian Marsillac and Branca Heloisa Oliveira

Figure 4. Pediatric dentistry lecture cycle at FOUERJ. From left to right: Profs. Ana Paula Pires dos Santos, Fernanda Barja Fidalgo, Luiz Flávio Mar-tins Moliterno, Tatiana Kelly da Silva Fidalgo and Branca Heloisa Oliveira



Importantly, many of the former and present professors at the Pediatric Dentistry and Orthodontic Disciplines of FOUERJ were students at our Specialty Pediatric Dentistry Postgraduate Certificate Program or Master of Science (MS) in Pediatric Dentistry Program:

• Álvaro de Moraes Mendes - Specialty Program • Ana Paula Pires dos Santos – Specialty and MS Program• Branca Heloisa de Oliveira Martins Vieira – Specialty

Program• Fernanda Barja Fidalgo Silva de Andrade – Specialty

and MS Program• José Augusto Mendes Miguel – MS Program • Luiz Flávio Martins Moliterno – MS Program • Marco Antonio de Oliveira Almeida – Specialty Pro-

gram• Marialice Barroso Pentagna – Specialty and MS Pro-

gram • Mirian de Waele Souchois de Marsillac – Specialty and

MS Program • Ronald Seaman Penido – MS Program• Sonia Lucia Macedo Marçal – Specialty and MS Pro-

gram • Vera Lucia Campos Santos – Specialty Program

Internal StructureActivities Developed at the Pediatric Dentistry

Discipline of FOUERJThe Discipline of Pediatric Dentistry (DPD) of FOUERJ is

dedicated to the improvement children’s oral health through teaching, research and extension activities.

• Teaching ActivitiesThe DPD provides pre-doctoral and post-doctoral train-

ing in comprehensive oral health care for pediatric patients.

• Pre-doctoral Program Pediatric Dentistry is taught at FOUERJ since its first

dental curriculum was developed. Until 2000 it was taught only in the 7th semester of an 8th semester degree course. In 2001, Pediatric Dentistry (PD) was split into PD I, taught in the 7th semester and PD II, taught in the 8th semester. There are no pre-clinical activities and during both PD I and II the students perform clinical procedures on children. PD I was coordinated, at different time periods, by professors Sônia Marçal, Vera Soviero, Mirian de Marsillac and Vera Cam-pos. PD II was coordinated by Prof. Branca Heloísa Oliveira from 2001 to 2008, by Prof. Marialice Pentagna from by prof. Marialice Pentagna in 2019 and 2013; by Prof. Mirian de Marsillac from 2010 to 2012; by Prof. Ana Paula Pires dos Santos from 2014 to 2015 and by Prof. Fernanda Barja Fidal-go from 2016 to 2018. In 2018, with the curriculum changes, the PD activities were included in “Core of Integrated Pro-

cedures for Children and Youth” (7th semester) and “Inte-grated Procedures for Children and Youth” (8th semester). The aim of the undergraduate PD program is to train gener-al dental practitioners to become capable of promoting the oral health of children through prevention, diagnosis and treatment of oral problems. At the 8th semester the emphasis is on dental care provided by the Brazilian Unified Health System (SUS). The clinical activities are developed extramu-rally, at Piquet Carneiro Polyclinic.

During the last 50 years, almost 3,000 undergraduate stu-dents took the disciplines of Pediatric Dentistry at FOUERJ.

It is worth noting that the Pediatric Dentistry Discipline itself and many of the pediatric dental school members, in-dividually, were the recipients of awards during graduation ceremonies of different classes in recognition to their out-standing contribution to the undergraduate education at FOUERJ (Profs. Luiz Flávio Moliterno, Sonia Marçal, Vera Campos and Tatiana Kelly da Silva Fidalgo).

• Post-doctoral Program

- Specialty Pediatric Dentistry Postgraduate Certificate Program

This specialty postgraduate program began in 1974 with the aim of providing scientific knowledge and clinical pe-diatric dentistry developing skills necessary for dentists, to provide proper dental care for infants, children, and ado-lescents. The program also encourages graduates to become involved in dental research and to pursue more advanced training in PD in order to start an academic career. During the last 44 years, more than 100 dentists obtained a certifi-cate in Pediatric Dentistry through our program.

Prof. Roberval de Almeida Cruz was the Program Di-rector from 1974 to 1978. From 1979 to 1989, the Program Directors were Prof. Hilton Souchois and Prof. Ronald Peni-do. From 1990 to 2014, the Program Director was Prof. Luiz Flávio Moliterno. From 2016 onwards the position was filled by Prof. Mirian de Waele Souchois de Marsillac. Many clini-cal instructors participated in our Specialty Program during its 44 years of existence, among them: Constance Mitchell, Daniel Passeado Branco Ribeiro, Daniela Britto, Diego Ju-nior da Silva Santos, Fernando Machado Moliterno, Gisele Caldas Alexandre, Gisele Moraes Abrahão, Lívia Kelly Fer-raz Nunes, Maria Angelina Amorim de Oliveira, Maria Cristina Pereira Quelhas and Rosana de Almeida Cardoso.

- Master of Science (MS) and PhD in Pediatric Dentistry Programs

FOUERJ has a Postgraduate dental program in the follow-ing concentration areas: Dental Surgery, Endodontics, Oper-ative Dentistry, Oral & Maxillofacial Surgery, Orthodontics, Pediatric Dentistry, Periodontics, and Prosthodontics.


The Master of Science (MS) in Pediatric Dentistry Pro-gram began in 1982, and four students were accepted: Luiz Flávio Martins Moliterno, Ronald Seaman Penido, Carlos Alberto dos Santos Pego and Helio Jorge dos Santos. All of them were FOUERJ professors. The program does not aim to improve students’ clinical skills. Its objective is to provide advanced knowledge in the Pediatric Dentistry area, solid teaching skills and research opportunities.

The former MS Pediatric Dentistry Program Directors were: Prof. Hilton Souchois de Albuquerque Mello (1982-1996), Prof. Ricardo Fischer (1997-2001), Prof. Luiz Flávio Martins Moliterno (2002-2013) and Prof. Branca Heloisa de Oliveira (2014-2018). Presently, Prof. Ana Paula Pires dos Santos is the MS Pediatric Dentistry Program Director.

In the last 36 years, approximately 60 dentists were awarded a Master’s degree by our MS Pediatric Dentistry Program. Many of them now hold permanent positions at Brazilian universities, among them: Ana Paula Pires dos Santos (UERJ - Rio de Janeiro), Elizangela Lins Cavalcanti Pimentel (Unesa - Rio de Janeiro), Fernanda Barja Fidalgo Silva de Andrade (UERJ - Rio de Janeiro), Gabriela Caldeira Americano (FASE - Petrópolis), José Augusto Mendes Mi-guel (UERJ - Rio de Janeiro), Marcia Rejane Thomas Cana-barro de Andrade (UFF - Nova Friburgo), Mirian de Waele Souchois de Marsillac (UERJ - Rio de Janeiro), Marlus Ro-berto Cajazeiras (UFF - Nova Friburgo), Michele Mikhael Ammari (UFF - Nova Friburgo), Roberta Jorge (FASE - Petrópolis), Gabriela Americano (FASE - Petrópolis) and Sileno Correa Brum (FO - Vassouras).

Our current MS students are: Laís Rueda Cruz, Isabel Monteiro D’Hyppolito and Patricia Papoula Gorni dos Reis.

Our PhD in Pediatric Dentistry Program was recently

created; it began in 2017 and the Program director is Prof. Vera Ligia Vieira Mendes Soviero. Our current PhD stu-dents are: Débora Medina, Gabriela Americano, Glaucia Athayde, Barbara Grisólia, Roberta Jorge, Hiorran Matos e Daniela Soares.

• Research ActivitiesThe main research interests of the pediatric dental school

professors at FOUERJ are in the areas of: Epidemiology and control of dental diseases; Dental materials, substances and medicines used in Pediatric Dentistry; Interrelationship between general health, oral health and quality of life. On-going researches focus on Dental Trauma, Dental Anxiety, Fluoride Varnishes and Toothpastes for Dental Caries Con-trol, Molar Incisor Hypomineralization and Oral Effects of Congenital Zika Syndrome.

Our school members have many scientific articles pub-lished in high-impact indexed journals (i.e., links to their CVs are provided in Table 1) and have been awarded grants from UERJ and from Brazilian research funding agencies: Profa. Ana Paula Pires dos Santos FAPERJ INST E-26/112.045/2013, FAPERJ APQ5 E-26/112.000/2013, FAPERJ IC 2013/02 E-26/100.824/2014; Profa. Branca Heloisa de Oliveira: FAPERJ/APQ5-E-26/110.056/2009; FAPERJ/APQ1-E-26/111.315/2014; FAPERJ Birmingham and/or Nottingham-E-26/010.002669/2014; FAPERJ IC 2015-02- E-26/200.824/2016; Profa. Vera Ligia Mendes Soviero: FAPERJ/APQ1-E-26/ 110.273/2012, FAPERJ IC E-26/100.674/2013; Profa. Fernanda Barja Fidalgo Silva de Andrade: FAPERJ INST E-26/211.288/2016, FAPERJ IC E-26/201.099/2016; Profa. Tatiana Kelly da Silva Fidalgo: FAPERJ/JCNE-E-03/2017, FAPERJ APQ5 2004.2, FAPERJ-

Table 1. Pediatric dentist professors at FOUERJ (active in December, 2018) and links to their CV on the Lattes Database

Name Link to CV on Lattes Database

Adilis Kalina Alexandria de França http://lattes.cnpq.br/8813744643679880

Ana Paula Pires dos Santos http://lattes.cnpq.br/8258756998579769

Branca Heloisa de Oliveira Martins Vieira http://lattes.cnpq.br/2733765551807694

Fernanda Barja Fidalgo Silva de Andrade http://lattes.cnpq.br/0960854816665570

Luiz Flavio Martins Moliterno http://lattes.cnpq.br/2475621282525155

Mirian de Waele Souchois de Marsillac http://lattes.cnpq.br/7357614344794408

Vera Campos http://lattes.cnpq.br/4933374110817924

Vera Lígia Vieira Mendes Soviero http://lattes.cnpq.br/8085785912172362

Tatiana Kelly da Silva Fidalgo http://lattes.cnpq.br/7877241939491498

FIDALGO FB et al.


INST-2015/1, FAPERJ IC 2018-1, PIBIC/UERJ IC 2018-2.Moreover, UERJ and Carlos Chagas Filho Research Sup-

port Foundation (FAPERJ) have individually rewarded some of them for their excellence in research. Profs. Bran-ca Heloisa de Oliveira Martins Vieira (2006-2018) and Ana Paula Pires dos Santos (2017-present) participate in the UERJ Incentive Program for Scientific, Technical and Ar-tistic Production – PROCIÊNCIA – that awards scholar-ships to UERJ professors based on the evaluation of their academic performance. Profs. Branca Heloisa de Oliveira Martins Vieira (2009-2012) and Tatiana Kelly da Silva Fi-dalgo (2017-current) were awarded “Young Scientist of Our State” scholarships from Carlos Chagas Filho Research Sup-port Foundation (FAPERJ).

Additionally, the school members of the discipline of PD have been involved in writing book chapters and editing books. Three books on themes related to the field of Pedi-atric Dentistry were organized and edited by our school: “Diagnosis and treatment of anomalies in odontogenesis”, authored by Profs. Vera Campos, Roberval Cruz and Hil-ton Souchois; “First Aid for Your Children. Dental trauma: Practical handbook for parents, teachers, technicians and parents, authored by Eliane Cross and Prof. Vera Campos; and “Control of Pain, Fear and Anxiety in Pediatric Dentist-ry” edited by Prof. Mirian Souchois.

• Extension ActivitiesThe pediatric dentistry school members at FOUERJ usu-

ally get involved in extension projects that aim to provide dental services or oral health-related information to the public. There are currently four extension projects being de-veloped under the guidance of our professors.

“Crescer Sorrindo” ProjectThe Crescer Sorrindo project has three main goals: to pro-

vide oral health care for children (0 to 12 years old), to offer training opportunities for dentists interested in providing dental care for preschool-aged children, and to perform pe-diatric dentistry-related research.

The project is held at Piquet Carneiro Polyclinic. Under-graduate and graduate students, under the supervision of pediatric dentistry professors, carry out the clinical activi-ties. The students also develop an oral-health education pro-gram at the dental clinic with the children and their parents. This program is designed to promote the increase in dental health awareness, the increase in the home use of fluoride toothpaste and the decrease in sugary snacking. During the last 17 years, 950 undergraduate and 177 postgraduate stu-dents took part in the project; additionally, more than 633 preschoolers and 1,234 schoolchildren benefited from it.

Moreover, many researches relevant to the subjects of Pediatric Dentistry and Public Health were conducted.2-6

These research findings allowed the development and im-plementation of clinical guidelines at the Dental Clinic of the Piquet Carneiro Polyclinic based on sound scientific ev-idence.

The Crescer Sorrindo project is a successful experience of teaching-research-public service integration. The follow-ing professors are or were part of its team members: Branca Heloísa de Oliveira Martins Vieira (Coordinator 2001-2011, present member), Ana Paula Pires dos Santos (Coordinator 2012-2017, present member), Fernanda Barja-Fidalgo (Coor-dinator 2018-present); Marialice Pentagna (Member 2001-2013), Mirian de Marsillac (Member 2007-2016), Luiz Flávio Martins Moliterno (Member 2016-2017), Tatiana Fidalgo (Member in 2017).

“Traumatismo Dentário” ProjectThis project began in 2006 and is coordinated by Prof.

Vera Campos. During its 12 years of existence, the project has been dedicated to the treatment and follow-up of chil-dren with dental trauma. It has also developed educational material regarding the prevention of dental injuries and first-aid measures for dental trauma patients. The project has had 55 participants; 16 of them were undergraduate students. The following professors are or were part of its team mem-bers: Vera Campos (Coordinator 2006-present); Fernanda Barja-Fidalgo (Member in 2014), Sonia Marçal (Member 2006-2016), Mirian de Marsillac (Member 2006- present), Luiz Flávio Martins Moliterno (Member 2006-2016).

“Crescer Sorrindo UERJ na Web” ProjectIn July 2012, a funpage was created on Facebook® social

network with the aim of disseminating the results of a scien-tific research carried out by members of the Crescer Sorrindo extension project. In view of the initial success of this Face-book funpage, the project’s team felt motivated to expand its scope and created the Crescer Sorrindo UERJ na Web ex-tension project. The primary objectives of this project are to publish online information regarding dental events, courses and publications and to report online findings from scientif-ic research related to children’s oral health.

Undergraduate and postgraduate students prepare the contents to be published online after reading and discussing scientific articles under the guidance of pediatric dentistry professors.

In October 2017, an account on Instagram® social network (@crescersorrindo_uerj) was created in order to increase the audience of the project. On December 2018 Crescer Sorrindo UERJ na Web had 7,315 followers on Facebook® and 1,608 followers on Instagram®.

From July 1, 2017 to July 26, 2018, 202 publications were made on the Facebook® funpage, reaching more than 15,800 people. From October 2017 to July 2018, 60 publications



were made on the Instagram® feed and 27 on the Instagram®

stories. During the week of July 14 to July 28, 1,048 profiles were reached with 8,395 impressions.

The following professors are part of the project team members: Branca Heloísa de Oliveira Martins Vieira (Co-ordinator 2012-2017, present member), Ana Paula Pires dos Santos (Coordinator 2018-present, member since 2012) and Fernanda Barja-Fidalgo (member since 2012).

“Hipomineralização de Molares e Incisivos” (HMI) Project

The interest of Prof. Vera Soviero in the subject of Molar incisor hypomineralization (MIH) was raised by a research in collaboration with Profs. Sven Poulsen and Dorte Haubek from the Department of Pediatric Dentistry at the Univer-sity of Aarhus Denmark in 2008. As a result of this collabo-ration, a paper on the prevalence of the condition in Brazil-ian schoolchildren was published having as co-authors two FOUERJ undergraduate students: Carolina Trindade and Thais da Matta. In 2012, after a two-year postdoctoral fel-lowship period, Prof. Vera Soviero began the extension proj-ect entitled Molar Incisor Hypomineralization (HMI): the challenge of identifying and treating children with this type of tooth defect. The project provides clinical care for patients with HMI and also develops teaching and research activities related to this dental enamel defect. To date, three Master’s degree dissertations related to this project were concluded. Currently, three PhD theses and one Master’s dissertation are under development. Moreover, the findings from this project were reported in scientific articles that were pub-lished in high-impact international dental journals: Clinical Oral Investigations, Pediatric Dentistry and The Interna-tional Journal of Pediatric Dentistry. Undergraduate stu-dents participate in the project as Extension and Scientific Initiation Fellows.

• Other Extension ActivitiesTwo free continue education courses in Pediatric Dentist-

ry: Oral health care during early childhood (started in 2003), and Evidence-Based Pediatric Dentistry (started in 2015) are offered to the dental community by pediatric dental school members at FOUERJ (Profs. Ana Paula Pires dos Santos, Bran-ca Heloisa de Oliveira and Fernanda Barja Fidalgo). The first is a clinical course that focuses on the development of compe-tences that are needed for the dental care of preschoolers. The second is a theoretical course that focuses on the development of skills for the critical appraisal of the dental literature.

From 2013 to 2018 Prof. Vera Lígia Mendes Soviero coordi-nated the group PET Odonto UERJ (Figure 5). Among the var-ious activities that were carried out by the PET group during this period, we highlight the FOUERJ Human Teeth BioBank.

Administrative ActivitiesBesides developing teaching, research and extension ac-

tivities related to the field of Pediatric Dentistry, some of FOUERJ’s pediatric dental school members have also served as Head and Deputy Head of the Department of Communi-ty and Preventive Dentistry (PRECOM) of FOUERJ. These professors were:

• Branca Heloisa de Oliveira Martins Vieira (Head and Deputy Head)

• Fernanda Barja Fidalgo Silva de Andrade (Deputy Head)

• Luiz Flávio Martins Moliterno (Head and Deputy Head)

• Marialice Barroso Pentagna (Head and Deputy Head)• Sonia Lucia Macedo Marçal (Deputy Head)

Other administrative roles developed by FOUERJ’s pedi-atric dental school members included:

• Hilton Souchois de Albuquerque Melo – School Direc-tor and Counselor at the UERJ University Council

• Roberval de Almeida Cruz - School Director• Luiz Flávio Martins Moliterno – Counselor at UERJ

Higher Council for Education and Research• Branca Heloisa de Oliveira Martins Vieira – Coordi-

nator of Extension Programs and Projects at the Extension Department of UERJ Vice-Chancellery of Extension and Culture (SR3) and Adjunct Research Coordinator - FOUERJ

• Fernanda Barja-Fidalgo - Coordinator of the Extension Core - FOUERJ

ConclusionPediatric Dentistry is a discipline that has been actively

involved in teaching, research and extension activities of the School of Dentistry since its inauguration. In the 47 years of

FIDALGO FB et al.

Figure 5. Professor Vera Soviero and Professor Maria Eliza Ramos with group PET Odonto UERJ


tition of preschool children. Community Dentistry and Oral Epidemiology. 2012;41:12.4. Carvalho CN, Martinelli JR, Bauer J, Haapasalo M, Shen Y, Bradaschia-Cor-rea V, et al. Micropush-out dentine bond strength of a new gutta-percha and niobium phosphate glass composite. Int Endod J 2015;48: 451-9.5. Oliveira BH, Carvalho DM, Falcão A, Campos K, Nadanovsky P. Biannu-al Fluoride Varnish Applications and Caries Incidence in Preschoolers: A 24-month Follow-Up Randomized Placebo-Controlled Clinical Trial. Caries Research. 2014;48(3):228-36.6. Barja-Fidalgo F, Oliveira MAA, Oliveira BH. A Systematic Review of Root Canal Filling Materials for Deciduous Teeth: Is There an Alternative for Zinc Oxide-Eugenol? International Scholarly Research Network Dentistry. 2011:1-7.

References1. Guedes-Pinto. A história da Odontopediatria no Brasil. Ed Gene, Salazar MRV, Azevedo C, Alexandre GC, Oliveira BH. Acurácia e efetividade do exame de triagem em saúde pública. In: 22a Reunião Anual da Sociedade Brasileira de Pesquisa Odontológica, 2005, Águas de Lindóia. Brazilian Oral Research. São Paulo: Sociedade Brasileira de Pesquisa Odontológica. 2005;19:33.2. Barja-Fidalgo F, Oliveira BH, Correa T. Elaborando um questionário para construção do perfil socioepidemiológico de pré-escolares: validades de face e de conteúdo. In: 21a Reunião Anual da Sociedade Brasileira de Pesquisa Odontológica, 2004, Águas de Lindóia. Brazilian Oral Research (Impresso). São Paulo: USP, 2004;18:31.3. Santos P, Oliveira BH. A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary den-



Fernanda Barja-Fidalgo


Mini Curriculum and Author’s Contribution 1. Fernanda Barja-Fidalgo - DDS; MSD; PhD. Contribution: intellectual idea of the literature review, data collection, data reporting, preparation and approval of the manuscript. ORCID: 0000-0002-4098-86372. Tatiana Kelly da Silva Fidalgo – DDS; MSD; PhD. Contribution: intellectual idea of the literature review, data collection, data reporting, preparation and approval of the manuscript. ORCID: 0000-0003-1340-99673. Mirian de Waele Souchois de Marsillac - DDS; MSD; PhD. Contribution: data reporting, preparation and approval of the manuscript. ORCID: 0000-0002-4452-73364. Ana Paula Pires dos Santos - DDS; MSD; PhD. Contribution: intellectual idea of the literature review, data collection, data reporting, preparation and approval of the manuscript. ORCID: 0000-0001-5688-47475. Vera Campos - DDS; MSD. Contribution: approval of the manuscript. ORCID: 0000-0003-3088-56156. Vera Lígia Mendes Soviero - DDS; MSD; PhD. Contribution: data reporting, preparation and approval of the manuscript. ORCID: 0000-0002-0572-31747. Luiz Flávio Martins Moliterno - DDS; MSD; PhD. Contribution: data reporting, preparation and approval of the manuscript. ORCID: 0000-0002-3583-174X8. Branca Heloisa Oliveira - DDS; MSD; PhD. Contribution: intellectual idea of the literature review, data collection, data reporting, preparation and approval of the manuscript. ORCID: 0000-0002-0798-2479


existence, our discipline assumed the commitment of guar-antee a quality public education. In this sense, the discipline has formed undergraduate and postgraduate students based on ethics and human values, encouraging them to perform a clinical practice evidence-based to promote oral health and positively impact the quality of life of the patients.

AcknowledgementWe would like to express our gratitude to the people who

challenged, trusted and helped us, thus contributing to our successful history, including UERJ academic and adminis-trative staff, cleaning team, undergraduate and postgradu-ate students, and our young patients and their parents. We would also like to acknowledge that financial support from Federal and State Grant Funding Agencies (CAPES, FAPERJ and CNPq) as well as from UERJ was of utmost importance for the successful development of our teaching and research activities.



Original Article/Orthodontic

The history of the Orthodontic discipline at UERJ

Rhita Cristina Cunha Almeida,1 Flavia Raposo Gebara Artese,1 Jonas Capelli Jr,1 Felipe de Assis Ribeiro Carvalho,1 Marco Antonio de Oliveira Almeida,1

Jose Augusto Mendes Miguel,1 Catia Cardoso Abdo Quintão1

1Department of Orthodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil• Conflicts of interest: none declared.

AbstrActIn 1968 the school of Dentistry of the Rio de Janeiro State University was inaugurated. This year the school is turning 50 years old. The aim of this paper is to describe the history of the Orthodontic discipline, present its` professors, describe the different activities, the goals achieved and how the discipline evolved after all those years. Keywords: Orthodontics; History; Specialization.

Introduction

Although the School of Dentistry of the Rio de Janei-ro State University (UERJ) opened in 1968 and is turning 50 years old in 2018, the orthodontic dis-

cipline only started in 1970, when the first undergraduate class reached the sixth semester. At this time, the laboratory 401 on the fourth floor of the school was inaugurated with the orthodontic discipline.

Since the beginning of the School of Dentistry, the un-dergraduate course had two semesters of Orthodontics. The Ortho I, laboratorial, and Ortho II, clinical, which was held together with the Pediatric Dentistry clinic. Having a clinic of preventive and interceptive orthodontics in the under-graduate program was always a significant differential of UERJ, and until today, in Brazil, most undergraduate pro-grams in Dentistry have only the orthodontic lab training.

The orthodontic school members were organized by Pro-fessor Antonio Carlos Peixoto da Silva and included him, Professor Washington Luis Monteior Scherpel and Profes-sor Alderico Artese.

As time went by, the school members changed, as Profes-sor Alderico left, the discipline was joined by Professors Es-telio Zen, Maria Teresa de Andrade Goldner, Alfredo Soares Veiga and Alvaro Francisco Carrielo Fernandes.

In 1979, professor Marco Antonio Almeida, that was pre-viously teaching in Pediatric Dentistry, was transferred to the Orthodontic discipline and organized the Orthodontic Graduate course.

The first Graduate class was in 1980 with three students. It was a 2-year part-time course. After a few years, the disci-pline arranged a cooperation with SESC, together with Dr. Paulo Murilo Fontoura, which allowed the construction and the installation of the necessary equipment for an exclusive orthodontic clinic on the second floor of the Dental School. With these adequate facilities, in 1990, the orthodontic

graduate course became a full-time program with six stu-dents per class. The course never stopped and has graduated to date 188 orthodontists from several parts of Brazil and a few countries abroad.

The school members continued to change with time. In 1982 professor Jonas Capelli Junior joined the group and in 1986 Professors Catia Cardoso Abdo Quintão and Rob-ert Willer Farinazzo Vitral replaced Professors Estelio and Alfredo, that left for personal reasons. Two years later, Pro-fessor Robert also left, to work at the Federal University of Juiz de Fora (UFJF) and was replaced by Professor Alvaro de Moraes Mendes.

From 1988 to 2000, the group stayed the same, with seven professors: Antonio Carlos, Alvaro Fernandes, Teresa Gold-ner, Marco Antonio, Jonas Capelli, Catia Quintão and Alva-ro Mendes.

In 1992 professor Marco Antonio Almeida went to the United States for an international experience. He stayed 18 months at the University of North Carolina and during this time, he published about 15 papers in high impact factors journals. 1-15 When he returned, in 1994, he became the first Full Professor in Orthodontics of the University. Thanks to the time he stayed abroad, the discipline stablished an in-terchange of students with the University of North Carolina that proceeds until today.

In 1998 the discipline launched the academic master’s de-gree. It is a two-year program with six students per class. Today this course is in the 11th class and has graduated 60 masters in Orthodontics.

In 2000, a new change in the school members. Profes-sor Jose Augusto Mendes Miguel joined the group and two years later, professor Flavia Raposo Gebara Artese also came in (Figure 1). During this time, professor Antonio Carlos, kindly called by the group as “chief”, retired.


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In 2004 the first PhD class began. Today, 24 students have presented their PhD thesis at UERJ and currently we have six PhD students. It is interesting to say that from the three students of the first PhD class, two were school members, Jonas Capelli and Alvaro Fernandes. With that, all school-members had a PhD degree. Dr Jonas Capelli, during his PhD, went to the Forsyth Institute, in Boston, USA, estab-lishing another important international bond and publish-ing his PhD thesis in high impact journals.16-17

In 2013, Professor Marco Antonio Almeida retired, al-though he continues lecturing in the Orthodontic Gradu-ate course until today. In his place, entered Professor Felipe de Assis Ribeiro Carvalho. In 2016 Professor Rhita Cristi-na Cunha Almeida joined the group (Figure 2). This year (2018), Professors Maria Teresa Goldner, Alvaro Mendes and Alvaro Fernandes are planning to retire, which means we will have other changes in school members.

In 2018 professor Jonas Capelli was nominated Full Professor in Orthodontics.

It is interesting to observe that four of the actual group of professors are former students of UERJ, showing how strong the relationship with the institution is. Besides that, all our professors have a PhD and all of them teach in all education levels, undergraduate, graduate, masters and PhD.

Our school members are all members of renowned prestige in the orthodontic scenario. Four of them, Drs Jonas Capelli, Flavia Artese, José Augusto and Felipe Carvalho are members of the Brazilian Board of Ortho-dontics. Dr Flavia Artese was the director of the Brazilian Orthodontic Association until last month (May 2018) and is also a member of the Angle Society. All our professors are members of the Brazilian Orthodontic Association and has been part of its board of directors at some point.

As international experience, besides the ones listed above, Dr Catia Quintão has been to Wales University College of Medicine Dental School, WUDS, and started an important research project with functional applianc-es,18 also establishing an international cooperation. Dr Catia has been working in the last four years as a member of the International Cooperation department of UERJ, settling several partnerships with foreign universities such as Peru and Sweden.

Dr Flavia Artese, during her PhD, went to the Uni-versity of Washington and besides publishing high im-pact papers,19-20 she won in 2004 the Hatton prize at the Brazilian dental research society (SBPqO), being a great achievement for our group.

Dr José Augusto Miguel and Dr Felipe Carvalho went to the University of North Carolina; Dr Alvaro Mendes went to Japan; Dr Rhita Almeida went to the University of North Carolina and to the Forsyth Institute; showing that all members have had an International experience, established partnerships and published papers in high impact journals.21-31

UndergraduateThe undergraduate curriculum today continues to

have an Orthodontic laboratory in the sixth semester with 30 students (Figure 3) and a preventive and inter-ceptive Orthodontic clinic in the seventh semester also with 30 students. In this clinic, we treat 390 children per year. After the mixed dentition, those children are sent to the Graduate orthodontic clinic for comprehensive treat-ment.

Figure 1. Professors Jonas Capelli, Flavia Artese, Marco Antonio Almei-da, Catia Quintão, Antonio Carlos Peixoto, Alvaro Mendes, Maria Teresa Goldner, Alvaro Fernandes and Jose Augusto Miguel

Figure 2. Professors Felipe Carvalho, Rhita Almeida, Jonas Capelli, Anto-nio Carlos Peixoto, Marco Antonio Almeida, Flavia Artese and Jose Au-gusto during an alumni meeting in 2017



Professor Maria Teresa has been responsible for ex-tension projects of the university for several years. The discipline always has undergraduate students working as professor assistants in both the lab and the orthodontic clinic. In addition, several research projects for scientif-ic initiation have been developed by our school members with undergraduate students.

Although the discipline only starts in the sixth semes-ter, the professors try to be involved with the undergrad-uate students in every possible way. Almost every gradua-tion has one orthodontic professor as an honored teacher.

Graduate CourseThe orthodontic specialization course continues to be

a two-year full-time course with six students per year. Now we are in the 38th class.

The course is extremely clinical, having around 1000 patients in active orthodontic treatment. In the first se-mester the students stay mostly with lab work. Then, there are 7 periods of clinic every week, each of them with a different professor, having different approaches and techniques. Besides that, there are 10 seminars presented by the students every week. Those seminars may be of

clinical cases or research papers of different journals. Besides the school members, we have guest professors

that enrich our course. Most of them are former students that really enjoy the exchange of knowledge with the new students. During these years we have had the help of Drs Ione Brunharo, Maria Carlini, Marco Antonio Schroed-er, Tatiana Lima, Daniel Fernandes, and today, helping us, there are Drs Cristiane Canavarro, Flavio Carvalho, Vera Cosendey, Klaus Barreto, Diego Santos and Hum-berto Iglesias. Besides those, our PhD students are always helping in the specialization course.

We also have a very well-established cooperation with other school disciplines. One of the most active coopera-tion is with the oral surgery. Our graduate students have several orthognathic surgery patients that are operated by the surgery residents in the Pedro Ernesto Universi-ty Hospital. One of those cases, that was supervised by professor Jonas Capelli in our discipline and by professor Paulo José Medeiros in the surgery department, was pub-lished in the American Journal of Orthodontics and Den-tofacial Orthopedics, one of the most important journals in the area, and won the prize case of the year.32

The Prosthetic Dentistry is also our partner. Several mutilated cases of patients that lost several teeth or cas-es with tooth anomalies due to different syndromes are treated jointly. These cooperations makes planning and treating very difficult cases possible and ennoble our stu-dents’ knowledge.

More than 4000 patients have been treated in this course. It’s a very well recognized course and students all around the country apply for it every year.

Today we have graduated 188 orthodontists from dif-ferent parts of the country: Alagoas (2); Amazonas (1); Bahia (11); Ceará (2); Distrito Federal (5); Espírito Santo (20); Goiás (2); Maranhão (1); Minas Gerais (15); Pará (8); Pernambuco (1); Rio de Janeiro (83); Rio Grande do Norte (4); Rio Grande do Sul (6); Santa Catarina (4); São Paulo (9); Sergipe (5) (Figure 4). We also have former students in Canada (1); Holland (3); Korea (1); Peru (1); Thailand (1) and Portugal (2).

Figure 3. Orthodontic lab with undergraduate students


To help maintaining this high-quality course, we formed an alumni association, where former students pay a monthly fee. This fee is used for maintaining the equipment, the clin-

ic, lab and materials. During this time, we have had several refurbishes that kept our space adequate for teaching and treating our patients (Figures 5-11).

Figure 4. Number of orthodontics that graduated in our course divided by states

Figure 5. First laboratory of the graduation course Figure 6. Orthodontic laboratory after the graduation course moved to the second floor of dental school

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Figure 7. Orthodontic laboratory after the last refurbishment

Figure 8. The first orthodontic graduate clinic

Figure 9. The orthodontic clinic in 2018

Figure 10. The seminars classroom in 2005

Figure 11. The seminars classroom in 2018

Besides that, several reputable professors from Brazil and all around the world have visited our department. Through the alumni association we promote lectures for our students and for the orthodontic public in general.

In 1998 Dr William Proffit, one of the most important orthodontists in the world, came to Brazil and lectured for 1000 people. It was the biggest event we ever promoted and was very important for our association, as we gained status and financial support.

Besides Dr Proffit, we have received Dr Ticiano Bacet-ti (Italy), Dr Sinclair (USA), Dr Camila Tulloch (USA), Dr Birte Melsen (Denmark), Dr Lucia Cevidanes (USA), Dr Juri Kurol (Sweden), Dr Moon (USA), Dr Malmgreen (Sweden), Dr Vanarsdall (USA) and several others.

In addition, every 2-years we promote an alumni meet-ing. Those happen in a different city every time. A group of former students from a specific city get together and or-



1994;18(3):181-5. 9. Valentim ZL, Capelli Jr J, Almeida MAO, Bailey LJ. Incisor retraction and profile changes in adult patients. Int J Adult Orthodon Orthognath Surg. 1994;9(1):31-6.10. Brunharo IHVP, Pacca CAD, Almeida MAO. Esterilização em Ortodontia: Avaliação de um método utilizando radiação ultra-violeta. Rev Bras Odontol. 1994;LI(6):26-31.11. Almeida MAO, Araujo TM, Chevitarese O. Effect of different time intervals between sealant application and bracket bond on adhesive strength. Am J Or-thod Dentofacial Orthop. 1994;106:389-94.12. Santos VLC, Almeida MAO, Albuquerque HS, Keith O. Direct bonded space maintainers. J Clin Pediatr Dent. 1993;17(4):221-5.13. Cerci V, Martins JES, Almeida MAO. Cephalometric standards for white Brazilians. Int J Adult Orthodon Orthognath Surg. 1993;8(4):287-92.14. Vieira ACL, Pinto RAC, Chevitarese O, Almeida MAO. Polishing after deb-racketing: Its influence upon enamel surface. J Clin Pediatr Dent. 1993;18(1):7-11.15. Heringer M, Almeida MAO, Miguel JAM. Direct bond brackets: cotton roll versus rubber dam isolation. Angle Orthod.1993;63(3):231-4.16. Capelli Jr J, Fidel Jr R, Figueredo CM, Teles RP. Change in the gingival

References1. Bailey LJ, Esmailnejad A, Almeida MAO. Stability of palatal rugae as land-marks for analysis of dental casts in extraction and nonextraction cases. Angle Orthod. 1996;66:73-8. 2. Miguel Jam, Almeida MAO, Chevitarese O. Clinical comparison between a glass ionomer cement and composite for direct bonding of orthodontic brack-ets. Am J Orthod Dentofacial Orthop. 1995;107:484-7. 3. Barbosa V LT, Almeida MAO, Chevitarese O, Keith O. Direct Bonding to porcelain. Am J Orthod Dentofacial Orthop. 1995;107:159-64. 4. Paula S, Almeida MAO, Lee PCF. Prediction of mesiodistal diameter of unerupted lower cuspid and bicuspids using 45 cephalometric radiography. Am J Orthod Dentofacial Orthop. 1995;107:309-14. 5. Almeida MAO, Phillips C, Kula K, Tulloch C. Stability of the palatal rugae as landmarks for analysis of dental casts. Angle Orthodontist. 1995;65(1):43-8.6. Barreto LCNP, Chevitarese O, Almeida MAO. Direct bonding brackets: Un-filled versus unfilled/filled resins. J Clin Pediatr Dent. 1994;19(1):31-4.7. Araujo TM, Wilhelm RS, Almeida MAO. Skeletal and dental arch asymmet-rics in individuals with normal dental occlusions. Int J Adult Orthodon Or-thognath Surg. 1994;9(2):111-8.8. Araujo TM, Wilhelm RS, Almeida MAO. Skeletal and dental arch asym-metries in class II division 1 subdivision malocclusions. J Clin Pediatr Dent.

ganize the meeting. During those meetings we have classes and of course, happy hours. Those meetings already have been in Florianopolis, Natal, Gramado, Friburgo, Buzios, Rio de Janeiro, Belem, Pedra Azul, Guarapari and sever-al other cities. Last year (2017), it was in Rio de Janeiro, at UERJ, because we inaugurated our brand-new clinic.

Figure 12. Alumni meeting at UERJ in 2017

Academic Master DegreeThe academic Master Degree, part of the Graduate

program of the University’s Dental School, is a well rated course with concept 5 by Capes. Now we are in the 11th class.

It is a two-year course with six students in each class. During those years, the students need to develop a re-search project besides acting as a teacher in the undergrad-uate course. They are stimulated to participate in different researches or teaching events, presenting research projects

or case reports. We have graduated 60 masters in Orthodontics from dif-

ferent regions of Brazil and we are proud to say that most of them published their papers in high quality journals.

PhDThe most important part of the PhD is the research proj-

ect. The course takes up to four years, and the student need to develop a relevant research and publish at least three articles in this area. Most students develop their projects in cooperation with other institution, mostly from United States. We have had cooperation with University of North Carolina, University of Michigan, Forsyth Institute, Uni-versity of California, Engineer Military Institution (IME), Fluminense Federal University (UFF), Federal University of Bahia (UFBA), Federal University of Para (UFPA), Fed-eral University of Juiz de Fora (UFJF), besides others.

Orthodontic Discipline after 50 YearsToday our discipline is passing through changes. The

dental school changed the curriculum and those changes are now in the sixth and seventh semesters. We have now the preclinic orthodontic, with theoretical class and labo-ratory work in the sixth semester, as it was before. But in the seventh semester we are now going to be part of the children clinic group, together with the Pediatric Dentist-ry. We are also part of the Adult clinic group, helping with small pre-prosthetic movements.

The graduation course, that used to start in August, now starts in February, but continues to be a two-year course with six students each year.

All the school members are very excited with all those changes and looking forward to continuing improving our course in every possible way.

ALMEIDA RCC et al.




Rhita Cristina Cunha Almeida


Mini Curriculum and Author’s Contribution 1. Rhita Cristina Cunha Almeida – DDS; PhD. Contribution: preparation and draft of the manuscript, critical review and final approval. ORCID: 0000-0002-2102-17892. Flavia Raposo Gebara Artese – DDS; PhD. Contribution: preparation and draft of the manuscript, critical review and final approval. ORCID: 0000-0003-2690-21523. Jonas Capelli Jr – DDS; PhD. Contribution: preparation and draft of the manuscript, critical review and final approval. ORCID: 0000-0002-6289-53784. Felipe de Assis Ribeiro Carvalho – DDS; PhD. Contribution: preparation and draft of the manuscript, critical review and final approval. ORCID: 0000-0002-5173-74385. Marco Antonio de Oliveira Almeida – DDS; PhD. Contribution: preparation and draft of the manuscript, critical review and final approval. ORCID: 0000-0001-6945-44396. Jose Augusto Mendes Miguel – DDS; PhD. Contribution: preparation and draft of the manuscript, critical review and final approval. ORCID: 0000-0001-5315-663X7. Catia Cardoso Abdo Quintão – DDS; PhD. Contribution: preparation and draft of the manuscript, critical review and final approval. ORCID: 0000-0003-4627-8190

fluid volume during maxillary canine retraction. Dental Press J Orthod. 2010;15:52-7.17. Capelli Jr J, Kantarci A, Haffajee A, Teles RP, Fidel Junior R, Figueredo CM. Matrix metalloproteinases and chemokines in the gingival crevicular fluid during orthodontic tooth movement. Eur J Orthod (Online). 2011;3:1-7.18. Quintão CCA, Brunharo IH, Almeida MA. Alterações Dento-esqueletais observadas durante o uso do aparelho funcional Twin-Block, em pacientes por-tadores de maloclusão de classe II, tratados na fase de pré-surto de crescimento puberal. Ortodontia Gaúcha. 2002;VI(1):1-12.19. Artese F, Kim TW, Artun J. Prevalence of third molar impaction in ortho-dontic patients treated nonextraction and with extraction of four premolars. Am J Orthod Dentofacial Orthop. 2003;123(2):138-45.20. Artese F, Rafferty KL, Herring SW. Three-dimensional loading and growth of the zygomatic arch. J Exp Biol. 2000;203:2093-104.21. Proffit WR, Miguel JAM. The Duration and Sequencing of Surgical-Ortho-dontic Treatment. Int J Adult Orthodon Orthognath Surg. 1995;10(1):35-42.22. Miguel JAM, Turvey TA, Phillips C, Proffit WR. Long-term stability of 2 jaw surgery for treatment of mandibular deficiency and vertical maxillary excess. Int J Adult Orthodon Orthognath Surg. 1995;10(4):235-45.23. Motta ATS, Carvalho FAR, Oliveira AEF, Cevidanes LH, Almeida MA. Su-perposição automatizada de modelos tomográficos tridimensionais em cirurg-ia ortognática. Dental Press J Orthod. 2010;15:39-41.24. Motta ATS, Carvalho FAR, Cevidanes LH, Almeida MA. Avaliação da ciru-rgia de avanço mandibular por meio da superposição de modelos tomográficos tridimensionais. Dental Press J Orthod. 2010;15:45.e1-45.e12.25. Carvalho FAR, Cevidanes LH, Motta ATS, Almeida MA, Phillips C. Editor’s

Comment and Q&A: Three-dimensional assessment of mandibular advance-ment 1 year after surgery. Am J Orthod Dentofacial Orthop. 2010;137:S53-S55.26. Almeida RC, Cevidanes LHS, Carvalho FAR, Motta AT, Almeida MAO, Styner M, Turvey T, Proffit WR, Phillips C. Soft tissue response to mandib-ular advancement using 3D CBCT scanning. Int J Oral Maxillofac Surg. 2011;40:353-9.27. Motta AT, Cevidanes LHS, Carvalho FAR, Almeida MAO, Phillips C. Three-Dimensional Regional Displacements After Mandibular Advancement Surgery: One Year of Follow-Up. J Oral Maxillofac Surg (Print). 2011;69:1447-57.28. De Paula LK, Ackerman JL, Carvalho FAR, Eidson L, Cevidanes LHS. Dig-ital live-tracking 3-dimensional minisensors for recording head orientation during image acquisition. Am J Orthod Dentofacial Orthop. 2012;141:116-23.29. Franco A, Cevidanes LHS, Phillips C, Rossouw PE, Turvey T, Carvalho FAR, Paula LK, Quintao CCA, Almeida MAO. Long-term three-dimensional stability of mandibular advancement surgery. J Oral Maxillofac Surg (Print). 2013;71:1588-97.30. Almeida RC, Capelli J, Teles RP. Levels of gingival crevicular fluid matrix metalloproteinases in periodontally compromised teeth under orthodontic forces. Angle Orthod. 2015;85:150309090608006-1014.31. Almeida RC, Santos DJS, Teles RP, Capelli Jr J. Gingival crevicular fluid volume evaluation in patients with controlled periodontal disease submitted to orthodontic treatment. J World Fed Orthod. 2012;1:e9-e12.32. Motta AT, Louro RS, Medeiros PJ, Capelli Jr J. Orthodontic and surgical treatment of a patient with an ankylosed temporomandibular joint. Am J Orth-od Dentofacial Orthop. 2007;131:785-96.




Original Article/Orofacial Pain - Sleep Disturbance

Panoramic radiographs for visualization of upper airway narrowing

Florence Mitsue Sekito,1 Mariana Ribeiro de Moraes Rego,1 Mayra Cardoso,1 Plínio Senna,1 Hilda Maria Montes Ribeiro de Souza,1 Daniel de Moraes Telles1

1Department of Prosthodontics, School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil • Conflicts of interest: none declared.

AbstrActObjective: the study evaluated the utilization of closed-mouth panoramic radiographies (PR) to the visualization of soft tissues of upper airways, from nasopharynx to oropharynx. The symmetry of sides, and narrowing sites were also evaluated. We established parameters for evaluation of the potentially obstructive soft tissues in the upper airways. Material and Methods: this study analyzed PR of 65 subjects (54 women and 11 men). We used closed-mouth panoramic radiographies to visualize the structures from the nasal cavity to the hypopharynx region, including upper and lower jaws, UA and soft palate. Results: the UA panoramic view, taken by the right and left sides proved to be advantageous, since it facilitated the detection of possible irregularities and asymmetry in these airways. The narrowest sites were seen in velopharynx (near to the oropharynx). The maximum and minimum distance measured at nasopharynx level were 44.8 mm and 17.3 mm; and at velopharynx level were 22.2 mm and 1.4 mm, respectively. The length of the soft palate ranged from 78.3 mm to 31.4 mm. Conclusion: it has been shown that PR can be a useful exam to preliminary investigation of narrowing sites of UA, and to suggest if the patient requests additional exams. Keywords: Panoramic radiography; Intrinsic sleep disorder; Obstructive sleep apnea.

Introduction

The participation of dentists has been progressively increasing in the study of the upper airways (UA), as well as their possible sites of collapse, in the ther-

apies associated with Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), which is characterized by recurrent el-evation of airflow obstruction due to total or partial colapse in the UA.1 The OSAHS form a part of a spectrum of sleep disordered breathing affecting a significant proportion of the general population2 and can lead to sleep fragmentation, sleep deprivation and the known sequelae of disturbed sleep architecture, including associated daytime tiredness and al-terations in normal behavior patterns.3 The regulation of the pharyngeal airway would occur due to four muscle groups, which could be classified as muscles regulating the soft pal-ate position, tongue, hyoid bone apparatus, and posterolater-al pharyngeal wall.4 The size and position of the tongue and soft palate are particularly important for the maintenance of the pharyngeal airway. Both are highly mobile structures that could occlude this passage.4 The type of respiration also seemed to influence air travel, such as oral breathing, which may further narrow the oro / velopharynx, since a 1.5 cm oral opening can produce a posterior displacement of the tongue with a decrease of 1.0 cm of the diameter of the oro-pharynx, mainly in dorsal decubitus.4,5 A prevalence of 81% of collapsing in the velopharynx was observed, while 50% of the patients presented areas of narrowing or secondary collapse in the oropharynx regions. Soft palate was the most affected region in patients with OSAHS.6 Among the high technology techniques and tests available for evaluation of UA, panoramic radiographs (PR) have been neglected, de-

spite the general visualization of the lower two thirds of the face, the information provided, and its widespread use in dentistry. They are valuable as a diagnostic aid in general practice and in various dental specialties, and can be further used to visualize UA.7 This study aims to propose an analy-sis of the upper airways using panoramic radiographs, with teeth in habitual occlusion (maximum habitual intercuspa-tion - MHI). The emphasis of this study is on the visibility and symmetry of air passages of naso, velo and oropharynx and detection of potentially obstructive regions. This study tested the hypothesis that panoramic radiographs allow the visualization and initial evaluation of narrowing of the upper airway that can influence the airflow of this region, through relative linear measurements.

Material and MethodsThe sample consisted of 65 subjects, 54 females and 11

males, aged between 19 and 75 years. The individuals were randomly selected among patients and students in spon-taneous demand at the dental care clinics of the School of Dentistry of the University of the State of Rio de Janeiro (FO-UERJ). All patients received and signed Free and In-formed Consent forms. The protocol of this research was ap-proved by the Research Ethics Committee of the Pedro Er-nesto University Hospital, under number 887-CEP/HUPE. Patients with a history of previous lung diseases, smokers, a history of systematic use of topical nasal medication and those with cardiorespiratory syndromes were excluded. The anamnesis collected documentary data such as name, ad-dress, telephone, age and sex. A clinical examination of the oral cavity was performed.


SEKITO FM et al.

Panoramic Radiography (PR) AnalysisPanoramic Radiographs were taken with the same device

(Orthophos Plus, Sirona Dental System, Bernsheim, Germa-ny) with program P1. They were performed with the head of the patient in an orthostatic position, at maximum habitual intercuspation (MHI), without the use of the interocclusal support device. The evaluation of UA spaces was performed by mapping the anatomical structures, using linear mea-sures established by morphometric points proposed by the authors (Figure 1). All points and lines are described in Ta-

ble 1. Panels of transparent acetate paper were made on a negatoscope (Konex Radiological Accessories, São Paulo, Brazil). The linear distances were measured with a digital caliper (model 727-6 / 150, Starrett, São Paulo, Brazil). All the analysis of the tracing were performed by the same ex-aminer from modifications of some of the parameters orig-inally idealized by the analysis of Levandoski8, proposed to diagnose asymmetries of hard tissues in panoramic radio-graphs.

Figure 1. Radiograph tracing with the reference points and the linear measurements



Table 1. Reference points and linear measurements for the PR analysis

Points and linear measurements Name Description

Cd Right condyle Upper point of the right mandibular fossa

Ce Left condyle Upper point of the left mandibular fossa

Pm Middle line point Intersection point between the middle line and the alveolar crest

Nd Right Nasopharynx, posterior wall Intersection point between line 1 (Cd-Pm) and posterior wall of right nasopharynx

Nd’ Right Nasopharynx, anterior wall Intersection point between line 1 (Cd-Pm) and anterior wall of right nasopharynx

Ne Left Nasopharynx, posterior wall Intersection point between line 2 (Ce-Pm) and posterior wall of left nasopharynx

Ne’ Left Nasopharynx, anterior wall Intersection point between line 2 (Ce-Pm) and anterior wall of left nasopharynx

ENPd Right posterior nasal spine Most distal and inferior point of the inferior plate of the right hard palate

ENPe Left posterior nasal spine Most distal and inferior point of the inferior plate of the left hard palate

Pd Right inferior soft palate Most inferior point of the right soft palate

Pe Left inferior soft palate Most inferior point of the left soft palate

Ed Narrowing of the posterior wall of the right velopharynx

Intersection point between Ed-Ed’ line (site of greater narrowing of the right velopharynx) and the posterior wall of the right velopharynx

Ed’ Narrowing of the anterior wall of the right velopharynx

Intersection point between Ed-Ed’ line (site of greater narrowing of the right velopharynx) and the anterior wall of the right velopharynx

Ee Narrowing of the posterior wall of the left velopharynx

Intersection point between Ed-Ed’ line (site of greater narrowing of the left velopharynx) and the posterior wall of the right velopharynx

Ee’ Narrowing of the anterior wall of the left velopharynx

Intersection point between Ed-Ed’ line (site of greater narrowing of the left velopharynx) and the anterior wall of the right velopharynx

ENPd-Pd Right soft palate Length of the soft palate on right side, obtained by the linear distance from the point ENPd to the point Pd.

ENPe-Pe Left soft palate Length of the soft palate on left side, obtained by the linear distance from the point ENPe to the point Pe.

Lm Sagital middle line Vertical line on the sagittal plane from the point Pm

Line Cd-Pm Line 1 Oblique line on right side, joining points Cd and Pm

Linha Ce-Pm Line 2 Oblique line on right side, joining points Ce and Pm

Nd-Nd’ Maximum right nasopharynx

Linear distance from the Nd point to the Nd ‘point, to obtain naso-pharyngeal airway at the inferior wall of the hard palate, on line 1 (Cd-Pm), on the right side. Point of greatest amplitude of the pharynx on line 1

Ne-Ne’ Maximum left nasopharynx

Linear distance from the Ne point to the Ne’ point, to obtain naso-pharyngeal airway at the inferior wall of the hard palate, on line 2 (Ce-Pm), on the left side. Point of greatest amplitude of the pharynx on line 2

Ed-Ed’ Right narrowingShorter linear distance from the Ed point to the Ed’ point (on a virtual line, parallel to line 1), to obtain the airway narrowing relation at the level of the velopharynx, on the right side.

Ee-Ee’ Left narrowingShorter linear distance from the Ee point to the Ee’ point (on a virtual line, parallel to line 2), to obtain the airway narrowing relation at the level of the velopharynx, on the left side.


In order to calculate the degree of narrowing of the UA, the percentage distance between the shorter distance and the greater distance of the pharynx, for the right and left sides, were as follows:

1. Relative narrowing of the right pharynx: Ratio between the narrower region (Ed-Ed’) and the wider region (Nd-Nd’) of the inner walls of the velo and nasopharynx, respectively, on the right side, as a percentage: Ed-Ed’/ Nd-Nd’.

2. Relative narrowing of the left pharynx: Ratio between the narrower region (Ee-Ee’) and the wider region (Ne-Ne’) of the inner walls of the velo and nasopharynx, respectively, on the left side, in percentage: Ee-Ee’/Ne-Ne’.

Mean measurements of each variable were calculated, corresponding to the arithmetic means between the left and right sides. Example: maxillary nasopharynx = (maximum right nasopharynx + maximum left nasopharynx) / 2. The distances of the soft palate were also measured.

The measures were analyzed using descriptive statistical analysis and Student-t test, using the SPSS 20.0 program (SPSS, Chicago, USA).

The agreement between two measurements performed by the same observer (intraobserver reliability) was evaluated by the Intraclasses Correlation Coefficient (ICC)9 with a sig-nificance level of 0.05.

ResultsAn intraobserver agreement between the first and second

evaluation was above 90% (p <0.0001) for all measurements.Comparing the right and left sides, the radiographic

measurements were similar in the larger air spaces (Nd-Nd’, Ne-Ne’) (p=0.78) and greater narrowing (Ed-Ed’, Ee-Ee’) (p=0.21) of the pharynx in the images of right and left sides. Also, no differences were found between measurements of soft palate length on the left and right sides (p=0.51). These results are presented in Table 2.

The mean relative narrowing was 25.6%. The relative nar-rowing was 26.3% for the right side and 24.9% for the left side.

DiscussionThis study demonstrated the possibility of using pan-

oramic radiographs to visualize the upper airways. In all the radiographs of this study, the nasopharynx, velopharynx, oropharynx and hypopharynx, as well as the regions of nar-rowing of these passages, were visualized without difficul-ties. The same occurred with the nasal cavity, air passages between the inferior nasal conchae, and the nasal septum.

The medical-dental specialties have numerous restric-tions in exploring the potential of panoramic radiographs as an auxiliary diagnostic examination. This is due to a pre-es-tablished concept that the PR present many distortions, which is not confirmed in the literature, through compar-ative studies between measurements of dry skulls and PR, and between these and computed tomography.10 Akcam et al.11 analyzed the correlation and level of prediction between PR and lateral cephalometric radiographs, using regression equations. They showed that the correlations and the level of prediction obtained were significantly corresponding be-tween them, when using the horizontal plane of Frankfurt.

Nowadays professionals are giving more importance to PR, for the ease of simultaneous visualization of the struc-tures on both sides, verification of the symmetry of the jaws and jaw, correlating the angular and linear measurements of the PR with other types of radiographs.12 The literature has shown that PR can be used in many forms of research, pro-vided that technical criteria for the acquisition of their im-age are carefully obeyed. It is the first radiography requested by most dentists, and therefore the areas of constriction of the UA could be observed quickly and simplified in the first

Variable N Mean SD Minimum Maximum

Maximum right nasopharynx (Nd–Nd’) (mm) 65 29,3 6,1 17,8 42,0

Maximum left nasopharynx (Ne–Ne’) (mm) 65 29,2 5,9 17,3 44,8

Mean maximum nasopharynx (mm) 65 29,3 5,5 17,9 43,4

Right narrowing (Ed–Ed’) (mm) 65 7,5 3,4 2,2 21,1

Left narrowing (Ee–Ee’) (mm) 65 7,2 3,6 1,4 22,2

Mean narrowing (mm) 65 7,3 3,3 1,9 21,7

Right relative narrowing (Ed-Ed’/Nd-Nd’) (%) 65 26,3 11,8 7,5 54,9

Left relative narrowing (Ee-Ee’/Ne-Ne’) (%) 65 24,9 11,3 3,9 57,9

Mean relative narrowing (%) 65 25,6 10,7 5,9 55,5

Right soft palate (ENPd-Pd) (mm) 65 51,3 8,9 33,5 78,3

Left soft palate (ENPe-Pe) (mm) 65 51,2 8,6 31,4 71,6

Mean soft palate (mm) 65 51,2 8,5 32,5 74,9

Table 2. Measurements of the variables evaluated on panoramic radiographs

SEKITO FM et al.


clinical visits. This would enable the early detection of po-tential candidates for OSAHS.

The evaluation of images through two different aqui-sitions of the same anatomical structure, during the same exam, favors the analysis of the symmetry. The lack of sym-metry between both sides would already be indicative of a morphological alteration of the pharyngeal light.

In this research we opted for the acquisition of the im-ages in maximum intercuspation (MHI), since the man-dibular protrusion could affect the posterior air space.13-15 In MHI we can visualize the maxillomandibular structures and the UA in a functional state closer to the habitual po-sition, which mean that the temporomandibular joints and the masticatory musculature are at lower levels of muscular activity, minimizing its influence on the airflow of the UA.

The analysis of the sample (Table 2) showed similar val-ues between the right and left side linear measurements of the same UA region (Nd-Nd’ and Ne-Ne’, Ed-Ed’ and Ee-Ee’), suggesting uniform dimensions, although their image was not symmetrical. However, the comparison of the rela-tive narrowings between naso and velopharynx in percent-age values showed that there was a 26.3% relation for the right side (Ed-Ed’/Nd-Nd’), 24.9% for the left side (Ee-Ee’/Ne-Ne’), and 25.6% for mean values. This means that the right and left nasopharynx measurements (Nd-Nd’ and Ne-Ne’, respectively) reduced their linear distance by approxi-mately 75% in the regions of greater narrowing in the right and left (Ed-Ed’ and Ee-Ee’). The maximum diameter of the pharynx reduced from a mean value of 29.3 mm to a mean

value of 7.3 mm, demonstrating the severity of the collapses observed.

According to Hudgel6 the sites of collapse may be pri-mary or secondary, depending on the extent of pharyngeal light reduction, commonly occurring in the velo and oro-pharynx. He considered primary when the reduction was greater than 75% of the normal value and secondary when the reduction occurred between 25% and 75% of the normal value.6 In this study, the maximum value of mean relative narrowing was 55.5%. We have found substantial reductions reaching 75.35%, mainly in the velopharynx (bordering the oropharynx), which is suggestive of primary obstruc-tions, in agreement with Hudgel.6 The authors suggest that patients with a history of daytime drowsiness, Mallampati 3 index, and reduction of UA above 50% in the PR would deserve attention. These findings could indicate the need of further examinations for the investigation of respiratory obstructions such as OSAHS. The magnification effect and the distance to the cut plane of the PR did not influence the evaluation of the sites of narrowing and the recognition of the anatomical structures involved in this study.

ConclusionAccording to our results, we can affirm that the analysis

of PR allowed the evaluation of upper airway symmetry and its possible narrowing sites, once the regions of interest were fully visualized and evaluated, without difficulties, through-out the entire sample.

9. Bartko JJ, Carpenter WT Jr. In: On the Methods and Theory of Rehabili-tation. The J Nerv Mental Dis. 1976;163(5):307-16.10. Catić A, Celebić A, Valentić-Peruzović M, Catović A, Jerolimov V, Muretić I. Evaluation of the precision of dimensional measurements of the mandible on panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86(2):242-8.11. Akcam MO, Altiok T, Ozdiler E. Panoramic radiographs: a tool for investigating skeletal pattern. Am J Orthod Dentofacial Orthop. 2003; 123(2):175-81.12. Langland OE, Sippy FH. Anatomic structures as visualized on the Or-thopantomogram Oral Surg. 1968;26(4):475-84.13. Smith AM, Battagel JM. Non-apneic snoring and the orthodontist: ra-diographic pharyngeal dimension changes with supine posture and man-dibular protrusion. J Orthod. 2004;31(2):124-31.14. Battagel JM, Johal A, Kotecha B. A cephalometric comparison of subjects with snoring and obstructive sleep apnoea. Eur J Orthod. 2000;22(4):353-65.15. Johal A, Battagel JM. An investigation into the changes in airway di-mension and the efficacy of mandibular advancement appliances in subjects with OSA. Br J Orthod. 1999;26(3):205-10.

References1. Farre R, Rigau J, Montserrat JM, Ballester E, Navajas D. Evaluation of a simplified oscillation technique for assessing airway obstruction in sleep apnoea. Eur Respir J. 2001;17(3):456-61.2. Cistulli PA, Gotsopoulos H, Marklund M, Lowe AA. Treatment of snor-ing and obstructive sleep apnea with mandibular repositioning appliances. Sleep Med Rev. 2004;8(6):443-57.3. Olsen KD, Kern EB. Nasal inf luences on snoring and obstructive sleep apnea. Mayo Clin Proc.1990;65(8):1095-105.4. Kuna ST, Remmers JE. Anatomy and physiology of upper airway obstruc-tion. In: Principles and practice of sleep medicine. 3rd ed. Philadelphia: WB Saunders; 2000.p. 840-58.5. Lopatiéne K, Babarskas A. Malocclusion and upper airway obstruction. Medicine. 2002;38(39):277-83.6. Hudgel DW. Variable site of airway narrowing among obstructive sleep apnea patients. J Appl Physiol. 1986;61(4):1403-9.7. Luz JG, Miyazaki LT, Rodrigues L. Verification of the symmetry of the mandibular ramus in patients with temporomandibular disorders and asymptomatic individuals: a comparative study. Bull Group Int Rech Sci Stomatol Odontol. 2002;44(3):83-7.8. Piedra I. The Levandoski Panoramic Analysis in the diagnosis of facial and dental asymmetries. J Clin Ped Dent. 1995;20(1):15-21.





Florence Mitsue Sekito


Mini Curriculum and Author’s Contribution 1. Florence Mitsue Sekito - DDS and MSc. Contribution: intellectual idea of the study, technical procedures, data acquisition, data interpretation, preparation of the manuscript. ORCID: 0000-0003-3625-87352. Mariana Ribeiro de Moraes Rego - DDS, MSc and PhD. Contribution: data interpretation, preparation of the manuscript, critical review and final approval. OR-CID: 0000-0003-2992-60023. Mayra Cardoso - DDS, MSc and PhD. Contribution: data interpretation, preparation of the manuscript, critical review and final approval. ORCID: 0000-0002-1232-85514. Plínio Senna - DDS, MSc and PhD. Contribution: preparation of the manuscript, critical review and final approval. ORCID: 0000-0003-0743-53765. Hilda Maria Montes Ribeiro de Souza - DDS, MSc and PhD. Contribution: preparation of the manuscript, critical review and final approval. ORCID: 0000-0001-5283-11466. Daniel de Moraes Telles - DDS, MSc and PhD. Contribution: data interpretation, preparation of the manuscript, critical review and final approval. ORCID: 0000-0001-9576-4342

SEKITO FM et al.



Original Article/Dentistry in Collective Health

Evolution and challenges of Public Health in School of Dentistry of Rio de Janeiro State University/UERJ

Urubatan Vieira de Medeiros,1 Luciana Freitas Bastos,1 Renata Rocha Jorge,1 Katlin Darlen Maia,1 Márcia Maria Pereira Rendeiro,1 Klaus Barretto dos San-tos Lopes Batista,1 Maria Isabel de Castro de Souza1

1Department of Preventive and Community Dentistry, School of Dentistry, Rio de Janeiro State University (UERJ), RJ, Brazil • Conflicts of interest: none declared.

AbstrActMany changes occurred in these 50 years of the course of Public Health in the School of Dentistry of Universidade do Estado do Rio de Janeiro (UERJ), not only due to scientific advances but mainly because of the social needs of the population. These changes were guided by the various curriculum reforms of the Dentistry course determined by the Ministry of Education through the years. This study aimed to analyze the historical evolution of public health in the School of Dentistry of UERJ. To this objective, the evolution of public health was compared to the Ministry of Education guidelines and the Public Health Politics, and it was created a timeline correlating the offered courses and the clinical practice activities. Additionally, it was discussed the possibilities to provide teaching with more quality, to enable the egress to address the health of the community adequately. The methodology was a historical description, using the available data to find the articles needed to assess the memory of those who participate of the construction of the knowledge of the Public Healtharea in the School of Dentistry of UERJ. It was observed that we came from an extremely conservative model, where the technical level was predominant, to a thoughtful model that tries to attend the real population needs. Moreover, nowadays, the Oral Public Health course and other correlated activities performed at the School of Dentistry of UERJ have a relevant space in the educational scenario. The challenges observed are related to the constant follow-up of social changes as well as the population health pattern changes, to offer high-quality teaching, with the development of the needed professional skills to the full and integrated performance of the people and the society in which we live an act.Keywords: Oral health; Higher education; Education measurement.

Introduction

The School of Dentistry of the Universidade do Es-tado do Rio de Janeiro (UERJ) was idealized at the beginning of the 1960s by a group of professors who

thought that it was necessary to enlarge the Dentistry teach-ing in the Rio de Janeiro, at that time named Universidade do Estado da Guanabara (UEG).

Some years later, in May 1968, the activities started in the School of Dentistry of UEG, recognized by the Educational State Council in 1971 and by the Ministry of Education in 1972.

At that time, Public Oral Health was given in the last year of the graduation and was named Hygiene, Social and Pre-ventive Dentistry, and Legal Dentistry.1 Nowadays, this is-given in the seventh and eighth periods of graduation.

In these 50 years of Public Health, many changes hap-pened, not only due to scientific advances but mainly be-cause of the social needs of the population. These facts high-lighted the necessity of curriculum reforms to adequate the teaching through the years, filling not only the academic knowledge but mainly giving value to the patient’s needs, which gradually let it be just a teaching object

The curriculum reforms were guided by the various pro-posals and guidelines for the high education developed by the Ministry of Education through the years.

This study aims to analyze the historical evolution of public health in the School of Dentistry of UERJ, compar-

ing it to the Ministry of Education guidelines and the Public Health Politics and creating a timeline correlating the of-fered courses and the clinical practice activities. Addition-ally, it will be discussed the possibilities to provide teaching with more quality, to enable the egress to address the health of the community adequately.

Material and MethodsThe present study is a historical description and does not

want to be meta-analytic, but only obtain official material in the form of laws, decrees and administrative rules, and lit-erature related to the Dentistry teaching in the last 50 years.

It was used the available data to find the articles needed and also to assess the memory of those who participate of the construction of the knowledge of the Public Health area in the School of Dentistry of UERJ.

ResultsThe School of Dentistry of UERJ was created during the

validity of the Law 4024 from 20th December 1961. This law provided the Guidelines and Basis of National Education2 and advocated that the national education might be “in-spired in the principles of freedom and ideals of human sol-idarity.” The aims of this law were:

a) the comprehension of the human rights, citizen, State, family and other groups that form the community;

b) the respect to the dignity and the fundamental human


MEDEIROS UV et al.

freedom;c) the reinforcement of the national unity and interna-

tional solidarity;d) the integral development of human personality and its

participation in the work of common good;e) subject and society preparation to control the scientific

and technological resources that allow to use and to win the difficulties of the environment;

f) the preservation and expansion of the cultural heritage;g) the conviction of any unequal treatment due to phil-

osophic, political or religious belief as well as any class or racial prejudice.

From this legislation, the Education Federal Conciul3 (EFC) had the responsibility to choose the minimum cur-riculum of the courses of high education, which should be completed in every School of Brazil. In the field of Dentistry, the EFC defined that the egress from the Dentistry courses should be a general professional, polyclinical and prepared to attend the community. However, to put this normative into practice, there was just a single course of Hygiene and Preventive Dentistry in the minimum curriculum of the courses of Dentistry, resulting in a workload relationship of 10% to social courses and 90% to technical courses, showing that the Faculties of Dentistry, overall, had a robust techni-cal approach. Thus, despite its efforts, it was not possible to make the student sensible to work in the public health area, andthe EFC definition of the student was only theoretical.

Besides the workload of the public health courses used to be reduced and almost theoretical, the few contacts with the patient occurred when there were visits to the community to sporadically campaigns for topical fluoridation. In that time, the model of health campaigns was very prevalent in Brazil.

In 1971, the Dentistry curriculum was redefined. How-ever, according to Fernandes Neto4, there were no signifi-cant changes concerning the previous year. There was only a reorientation of the basic and professional contents. The course of Hygiene and Preventive Dentistry was renamed to Social and Preventive Dentistry, integrating the profession-al course. In the School of Dentistry of UERJ, the courses of Social and Preventive Dentistry I and II were created. In the Social and Preventive Dentistry I, it was given the basic content of the systems and politics of health, with no prac-tical activity. In the Social and Preventive Dentistry II, the content of the program comprehended the preventive meth-odology related to dental caries, where there was a practi-cal content in which the student of graduation performed dental caries surveys and topical application of Fluor in stu-dents of schools.

In 1975, the professions of Dental Hygiene Technician and Dental Office Attendant were regulated, being agreed on the workload of the courses and the content of work.5

These regulations were possible because of the initiative of a group of professionals that analyzed the situation of the dental attendance in Brazil and compared this to interna-tional models of work in public health services with the use of auxiliary professionals.

At a first moment, the conservative dental class feared that the Dental Hygiene Technicians could become a “practical dentist,” due to their expanded functions. Nevertheless, the group of Public Health of the School of Dentistry of UERJ started the studies to offer courses to training these cate-gories of professionals. Thus, UERJ was the first University to offer the courses of auxiliary professionals, and the first class began in 1979. Nowadays, the auxiliary professionals have another designation: Oral Health Technician and Aux-iliary in Oral Health, and we continue to offer the course.6

In 1980, occurred the Seventh National Conference of Health, where Dentistry was discussed for the first time. The group of debate considered the Dentistry practiced at that time as inefficient, disorientated, with a sparse distribution of human resources, low coverage, high complexity, curative focus, mercantilist, with the Dentist keeping the knowledge to himself with no sharing with the auxiliary professionals and clients and with no preparation in the training of hu-man resources. The focus of the Seventh Conference was to offer the basic services to the population, and the Dentistry analysis showed that the profession was going to the oppo-site side. Regarding the training of human resources, it was highlighted that “the professionals are trained in disaccord-ing to the real needs of the country, early sent to the special-ties, and totally dissociated from the characteristics of the services where they will work. Also, that, in the auxiliary and technical level, insist on the use of the formal mecha-nism of preparation that has already been overcome by pro-cedures demonstrably more agile and with less cost as the training or preparation in use.”7

The results of the Seventh Conference reflected strong-ly in the Dentistry teaching, creating new thinking on the characteristics of the egress and the national reality.

In 1982, from the Resolution 04/82 of CFE, new guide-lines were presented to the Dentistry courses. In the area of public health, it was inserted contents of Social Sciences in the basic courses, with fundamentals of Anthropology, Sociology, and Psychology. In the professional course, the denomination of Social Dentistry persisted, with the rec-ommendation of studies in the social area, dentistry, legal and professional orientation, mixing the contents of various courses. In the description of the egress, it was recommend-ed a robust social content and of attendance to the commu-nity with extramural activities.8

The School of Dentistry of UERJ follow this new context, and we started new courses, the Social Dentistry I, II and III. The Social Dentistry III was designed for the students



of the period of graduation as an extramural activity. There was a scenario of practice in the UERJ preparatory School, with a clinic with six fixed equipment, available in a hex-agonal model. Posteriorly, the School agreed with the Rio de Janeiro City hall, which provided transportation for the students of the graduation course and auxiliary professional course to attend in two public schools in the neighborhood of Ramos and Penha. This experience was not well succeed-ed because of the constant fails in the transportation and this last only one year.

In the next year, besides the clinic at the preparatory school, the extramural activity also started to be developed in the Municipal School República Argentina, which was be-side the School of Dentistry, with no need of transportation for the team. Dentists of the Rio de Janeiro City Hall worked together to the group of UERJ performing procedures of ba-sic care in cosmetic dentistry, Periodontology, Endodontics, and Surgery, with the social focus. The students of the auxil-iary professional’s course were involved in both scenarios of practice, instrumenting the graduate students of Dentistry.

Initially, the students struggled to use the simplified equipment, which was no conventional, and also to see the patient as an entire human being, and not as a teaching ob-ject. Supporting this thought, Rodrigues and Reis9 related that students considered the patient as being parts or frag-ments, and they did not understand the patients’ full neces-sities to solve them, because their training was done through isolated courses wherein each semester it was learned only “part” of the Dentistry as it was a specialty. This observation reinforces the difficulties that we had in the first moment.

The dissatisfaction of professionals and patients with healthcare in Brazil was growing exponentially, which lead to the movement named as “Reforma Sanitária” that orien-tated the creation of Sistema Único de Saúde (SUS), which was based on the guidelines of the Federal Constitution of 1988. Posteriorly, the Health Organic Law was regulated and affected the form as the institutions prepared the human re-sources to health.10

Regarding all this dissatisfaction, the School of Dentistry of UERJ started a study to adequate its curriculum to the new times. Thus, the team of public health began to discuss an approximation to the Municipal Secretary of Health and Education, resulting in the creation of the Oral Health Program for the Student, which was an extension of the ac-tivities that were done by the students of the eighth period of the graduation course as an extramural activity. In the beginning, it was tried to create a health program for the student. However, the Faculties of Medicine and Nursing did not allow their students to participate. Nevertheless, the Oral Health Program of the Student was able to establish a fixed clinic on the last floor of the school, with all the equip-ment needed for the complete patient care. The shared work

with the professionals of the municipality of the Rio de Ja-neiro allowed the attendance of all the community of the Municipal School República Argentina and decreased the prevalence of caries in the students substantially.

At the beginning of 1990s, we introduced another inno-vation in the teaching of Dentistry in Brazil, named “Inter-nato Rural.” The main objective was to offer dental atten-dance in the countryside. For 30 days, groups of students went to districts of Rio de Janeiro which had an agreement with UERJ. The districts provided housing and feeding to the students, who, in counterpart, provided attendance in the health units under the supervision of a Professor of the Dentistry School. Unfortunately, the project had not a long duration due to logistic issues of the city hall districts.

In 1996, through the Law 9394 of 20th December, the National Congress approved, and the President of Repub-lic signed, a new Law of Guidelines and Basis (LGB) of Na-tional Education, which substituted the previous one. This Law stated that “the education, which is a duty of the fam-ily and the State, inspired in the principles of freedom and the ideals of human solidarity, has the objective of the total development of the student, his preparation to practice the citizenship and the qualification to work.”11

In 1998, after many discussions, the School of Dentistry of UERJ used the LGB from that time, which proposed a change in the teaching approach, to begin a new curricu-lum, and changed the current form of credits to the old se-riated form to improve the quality of teaching. This change affected the public health course, which finally changed the name of Social Dentistry to Oral Public Health, and contin-ued the search for new scenarios of practice, intensifying the negotiations to an effective act of the students in the units of the health of the municipality of Rio de Janeiro.

While this was not materialized, it was opened a possibil-ity of multi-professional acting in Piquet Carneiro Policlin-ic, which was part of UERJ, where, as the name suggests, we can find attendance in various areas of health. There, ini-tially, part of the students of the eighth period of the course of Oral Public Health III started to treat adults and children patients. However, this new curriculum did not bring a so-cial sensitization to the student, as highlighted by Pieran-toni12, when stated that “still there is a predominance of projects of training based in the scientific knowledge, with a curriculum that does not address the real problems. Ad-ditionally, when there is a thinking in the curriculum re-form, it can be observed resistance to what is new, to what is different, indicating a necessity that the Universities adopt alternatives of knowledge organization, without addressing only the domain of the own knowledge, but to the existent demands.”

Based on the LGB of 1996, the Ministry of Education started to work with specific questions of training of each


professional category with the advent of National Curric-ulum Guidelines (NCG’s). Such changes are confirmed by Secco and Pereira13 that inform that the LDB/96 allowed the introduction of changes in thetraining of future pro-fessionalsthat contributed to effective thinking of the hu-manization of health and the real needs of the population health and not only to the logic ofthe market, what is very usual in Dentist training.

In the 4th March 2002, it was signed the Resolution that establishes the Nationals Curriculum Guidelines to the Graduation Course in Dentistry, which guided the new curriculum reform of the School of Dentistry of UERJ. Part of the text made clear that “the Course of Graduation in Dentistry has as characteristics of the egress/professional the Dentist, with general training, humanistic, critical and thoughtful, to act in all the levels of healthcare, with the basis in the technical and scientific discipline. Trained to the exercise of activities related to the oral health of the population, based on ethical and legal principles, and in the comprehension of the social, cultural and economic re-ality of its environment, guiding its attention to the trans-formation of the reality to benefit society.” Besides this, there is a focus in the Public Health because it clarifies the necessity of knowledge in planning, administration, and managing of health systems, as well as the using of Health Units of Municipality as a practice place.14

Since the NCG’s to Dentistry graduation, it was clear that there was a necessity of readjustment of the curricu-lum offered by UERJ. Thus, it was started discussions on the creation of a new curriculum that could attend what was indicated. The School of Dentistry intensified the ne-gotiation with the Municipal Secretary of Health of the Rio de Janeiro with the intention of enabling the participation of the students in the Health Units. At the same time, the first interventions of the Ministry of Health took place in the sector of training of human resources to the health, that later became the Pró-Saúde.

Pró-Saúde was then launched formally in 2005. It was a joint effort of the Ministry of Health and the Ministry of Education with the support of the Pan-American Orga-nization of Health. Pró-Saúde aimed to provide answers to the various difficulties that the healthcare Faculties were facing to implement NCG’s. The program provided financial and technical support for the institutions to redi-rect the teaching in healthcare. With this objective, it was launched a public notice for the institutions which want to participate in the Program of Reorientation of Professional Training. The general aim of the program was to integrate teaching and service, redirecting professional training withthe integral approach of the process of health-disease with the focus in the basic care, promoting transforma-tions in the process of generation of knowledge, teaching

and learning, and delivery of services to the population.Among the objectives of the program, it was highlight-

ed:• the reorientation of the training of professionals of

health to offer to society professionals capable of reply to the necessities of the Brazilian population and the work in SUS;

• to create mechanisms of cooperation between the managers of SUS and schools, aiming the improvement of the quality of care provided to the citizen, the integra-tion of public services of health to the health professionals training in graduation and permanent education;

• to incorporate, during the healthcare training, the in-tegral approach of the process health-disease, health pro-motion and the systems of referral and referral back;

• to expand the duration of the educational practice in the services ofbasic public healthcare, including the inte-gration of the clinical services of the academy in the con-text of SUS.15

At the end of 2005, the Ministry of Health accepted the purpose of Pró-Saúde recommended by the School of Den-tistry of UERJ. Then, in 2006, it was agreed with the School of Dentistry, Nursing, and Medical Sciences. In this same year, which was an intense year in the School of Dentistry, it was created the Commission of Curriculum Reform with the signature of the first agreement letter Pró-Saúde/Den-tistry. The Oral Public Health team participated intensely in all the process, considering that the main guideline was the public health.

The three phases of Pró-Saúde were from 2006 until 2012. The pilot project aiming at the inclusion of thestu-dents of graduation in the municipality healthcarenet (AP 2.2) started in the first semester of 2007. In the second se-mester, the students of the second, third, and eighth pe-riods were included formally in the public net. The Table 1 shows the participation of Oral Public Health courses during the period of Pró-Saúde and Table 2 shows the pub-lic service where the appointments took place with the tar-get audience and the procedures offered during the validity of Pró-Saúde.

Course Place of action Student body workload

Oral Public Health I (2nd period)

Escola Municipal República ArgentinaNet - PPC

30 hours

Oral Public Health II(3rd period) Public service 60 hours

Oral Public Health III (8th period) Public service 150 hours

Table 1. Participation of Oral Public Health courses during the validity of Pró-Saúde

MEDEIROS UV et al.


Analyzing the difficulties to implement Pró-Saúde in UERJ, PEREIRA explained that UERJ and SMS managers agreed that the late payment was the most critical factor, af-fecting the expected results negatively. Because of this, the Ministry of Health promoted some changes in the politics of pay to facilitate the program’s implementation. However, the author also highlighted advancements as various dis-cussion forums between University lectures, student body, and municipal managers, including a weekend class in 2010 to deep learning in the discussion on the new curriculum. Moreover, the author considered that “Pró-saúde played a role as a fomenter of the curricular changes, providing to school the addition of allocative resources through financial incentives and inclusion of new rules and patterns of profes-sional training recommended by the Ministry of Health in partnership with the Ministry of Education.”16

In 2011, the new Politic Pedagogic Project of the School of Dentistry of UERJ was approved in Department Council, in agreement with NCG’s and Pró-Saúde. In 2012, it was initi-ated the bureaucratic formalities with the rectory to the im-plementation of the new curriculum. Finally, in 2015, after many adjustments and corrections, the first class began the course with the new curriculum. This curriculum covered a considerable area of Public Health, as follows:

• First period- Social Sciences and Oral Public Health I;• Second period- Oral Public Health II;• Third period- Psychology applied to Dentistry and Oral

Public Health III;• Fourth period- Ethics and Bioethics, and Research

Methodology;• Sixth period- Oral Public Health IV;• Seventh period- Oral Public Health V;• Eighth period- Legal Dentistry and Professional Orien-

tation, and Oral Public Health VI.This new curriculum shows the evolution of the public

health in Dentistry, where, finally, we have a considerable number of courses as:

• the social and citizenship training (Social Sciences and Psychology applied to Dentistry);

• the scientific research training (Methodology of Re-

search applied to Dentistry and Bioethics);• the Dentistry legislation training (Ethics, Legal Dentist-

ry, and Professional Orientation);• the training to act in the health systems (Oral Public

Health).The scenario of practice and the activities developed by

the students begin in the first period, with the develop-ment of educational work. This work is based on scientific evidence in which the information about oral diseases are transmitted, as well as the preventive measures and focus in procedures of self-administration as diet control, and con-trol of the microbe environment of the mouththrough the regular and daily hygiene as recommended by Medeiros.17

In the second period, the focus of the clinical practice is directed to Epidemiology, where the students are train-ing their capacity of diagnoses based on indicators recom-mended by the World Health Organization. In this phase of their training, there is the first teaching that the planning of health services should be based on well-structured epidemi-ological and social diagnoses.18

In the third period, the clinical activity evolves to more effective intervention with the application of the knowledge of biosafety, clinical diagnoses of oral health and basic in-terventions of professional prophylaxis and topical use of fluorides.

In the sixth period, the clinical activity is expanded and comprehends, besides the previous ones, the application of basic care in oral health with interventions, principally, to the control of carious lesions, and periodontal disease as preparation to work in the municipality basic units of health.

In the seventh and eighth periods, the students have two scenarios of practice: The Policlinic Piquet Carneiro of UERJ, and the basic units of the health of the Municipal City Hall of Rio de Janeiro.

The Policlinic Piquet Carneiro was an old post of São Francisco Xavier Medical Assistance, which owned to the National Institute of Social Pension. The policlinic was given to UERJ after a well-succeeded five years partnership and became a relevant scenario of practice for some courses of graduation (as the Oral Public Health), post-graduation, ex-tension projects and technical courses (Oral Health Tech-nician, coordinated by the Oral Public Health team) of the School of Dentistry of UERJ. Importantly, the sector of Den-tistry of Policlinic Piquet Carneiro (PPC) acts in the level of basic care and medium complexity through the courses above mentioned, with the contribution of Dentists of the Ministry of Health.

The students of Oral Public Health of the old curriculum (which will finish in 2018), and the students of the new cur-riculum (which began in 2015), work in clinical practice (8th period) and Health Education (3rd period), using the Poli-clinic Piquet Carneiro as the practice scenario.

Public service Target audience Procedures offered

PAM Helio PellegrinoCMS Heitor Beltrão

Adults, children, older people

Health and clinic education

Municipal Hospital Jesus

Children until 12 years-old/patients with special needs

Health education, waiting room, hospital bed

IOC e CEO Including patients with special needs Observation

Table 2. Public service where the appointments took place with the target audience and the procedures offered during the validity of Pró-Saúde



The scheduled patients to the dentistry sector are those that already have records and are in treatment in any med-ical clinic of the policlinic or the Pedro Ernesto University Hospital. This service works using prioritization appoint-ments conducted by lectures of the course of Oral Public Health and today is done by a professional of the Ministry of Health, according to our capacity, once the reception still is in the discussion. The return (maintenance) will be decid-ed by the professional and scheduled according to the risk of each.

The students perform educational activities of oral health with patients of the clinics of nephrology, gynecology, Ophthalmology, vascular surgery, medical clinic, clinic of teenagers, man’s health, hypertension, endocrinology, rheu-matology, craniofacial anomalies, and plastic surgery, in-teracting not only with patients but also with professionals. The clinical activities focus on basic care, including the pro-cedures of cosmetic dentistry, periodontology, and surgery.

The estimative of the number of appointments depends on the number of students present in each class, as well as the necessities of each to finish the treatment. In a survey from 2009 to 2015, we could see an annual average of 3.986 procedures performed by the students of Oral Public Health, as we can see in Figure 1.

We are always looking for the improvement of this pro-ductivity. However, we are working in a health unit that has the characteristics of assistance and teaching. Thus, we need to prioritize the assistance to the community as well as to the teaching of the students of the School of Dentistry of UERJ. As a result, our services focus on the quality of actions by being a field of training of human resources of health.

In the basic units of the health of Municipal City Hall of Rio de Janeiro, the students in their last year develop indi-vidual and collective actions in the clinic, in the unit and the territory, approaching the student to the reality of SUS. The basic units of Rio de Janeiro present characteristics of attendance in consonance with the Strategy of Health of the

Family (SHF) and are located in the region of Coordination of Primary Care in Health in the Area of Planning 2.2 (CAP 2.2).

The interventions follow the logic of promotion of health, developing educational activities, clinical procedures of dental urgencies, basic healthcare actions, collective actions in the unit of health and territory, reception, actions in the health of the student program, participation in health cam-paigns. The students are included in the system, accompa-nied by a preceptor of service and by the supervision of the lecturer of the School of Dentistry of UERJ.

Besides these activities, the Oral Public Health team (Ta-ble 3) has direct participation in other activities that aim the improvement of teaching. One of them is the Distance learning course.

The approach of teaching through distance learning re-quires the presence of a professor in the elaboration of insti-tutional materials as well as the planning of other strategies. This model permits a unique interaction between professors and students, which are in a classroom without walls, time-less, and that shred distances, where the contactsand infor-mation can be mediated for the new process (emails, chats, forums). Importantly, there is not only the approaching of the professor to the student reality in his extramural activ-

Figure 1. Graph is showing the productivity of students of Public Oral Health of UERJ from 2009 to 2015

Role Name

General Coordinator Urubatan Medeiros

Coordinator of SBC I Celso Queiróz

Coordinator of SBC II Andrea Lanzillotti

Coordinator of SBC III Urubatan Medeiros

Coordinator of SBC IV Renata Rocha

Coordinator of SBC V Katlin Maia

Coordinator of SBC VI Katlin Maia e Luciana Bastos

Coordinator of Ethics and Bioethics Rafaela Andrade

Coordinator of Scientific Methodology Rhita Almeida

Coordinator of Social Sciences Celso Queiroz

Coordinator of Applied Psychology Luciana Bastos

Coordinator of Legal Dentistry and Professional Orientation Rafaela Andrade

Coordinator of the Public Health Clinic of Escola Argentina

Urubatan Medeiros

Coordinator of TeledentistryCoordinator of the course Maria Isabel de Souza

Coordinator of UNASUS/Dentistry Marcia Rendeiro

Coordinator of the Technical course Maria Isabel de Souza

Oral Health Technician Maria Rita dos Santos

Table 3. Oral Public Health team in 2018

MEDEIROS UV et al.


ities but also of the preceptors that help these students in the public net and that need a space to share contents.

This approach must be oriented for an academic leader, who operationalize his view in this direction, defining his goals and objectives, which should be worked pedagogi-cally, with the concretization of a proper politic of the ped-agogic and academic organization. The purpose is based on the necessity of articulation of theoretical orientation with the practical activities in the different levels of teach-ing (graduation, post-graduation, and extension), with the participation of the possible number of different areas.

In 2014, based on an innovative purpose for Dentistry, the Núcleo of Teleodontologia of the School of Dentistry of UERJ was created, with the coordination of the course of Oral Public Health. This project was contemplated with funds from Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ). In the beginning, the primary activity was the purpose of a platform development (free software Joomla) to computers, using different technologi-cal tools of information technology in the learning process for graduation and post-graduation students of Dentistry. Nowadays, besides the integration of teaching, research and extension of the own Academic Unit, Teledentistry also participate in other activities of departments of UERJ. With a new mission of teaching in the area of Dentistry, the project looked for new paths that could help to think the education in its broad conception again. For this, there wasthe recommendation of actions directed at the trans-formation of the current educational system, leading to a process more opened and flexible, where the students and professors can be the mentors of the educative process.

Another activity with the direct participation of the team of Oral Public Health is the National Program Teles-saúde Brazil andthe Open University of SUS (UnA-SUS), both using the technologies of distance learning.

The Ministry of Health purpose the creation of the Pilot Project of Telessaúde, structured in nine states, through the decree 35 from 4th January 2007. One of the centers was the Rio de Janeiro State, with the objective of support to the teams of Family Health, using the Technologies of In-formation and Communication to develop an educational and assistance process by distance (Teleducação, and Tele-diagnóstico).19

In 2011, through the decree 2.54620, the program was re-named to “Programa Nacional de Telessaúde Brasil Redes,” expanding its scope to consolidate the nets of healthcare. Nowadays, the Program is working in 22 states, bringing together around 6.000 points of Telessaúde, installed in Basic Units of Health (BUH) of 2.600 municipalities and 50.000 professionals of teams of basic care/health of the family with the possibility of access to the services of Te-lessaúde.”21

Initially, the project integrated the areas of Medicine

of Family, Dentistry, and Nursing. Next, other areas were incorporated as Physiotherapy, Nutrition, Geriatrics, and Management. The Public Health assumed the responsibili-ty of Dentistry actions in Telessaúde Brasil Redes, offering opportunities in Teleducation e Teleassistance, with the production of courses, conferences, presentations, syn-chronous and asynchronous. Besides these, we performed the Teleconsultory with the opportunity of discussion of cases and clinical doubts of professionals, who act in the basic care with the University lectures of Public Health.

The open University of SUS (UNA-SUS), generate the Program UNA-SUS/UERJ, begins with inducing politics to the training and permanent education of human re-sources in the health area.

UERJ was invited because of its history and pioneering in various initiatives in the educational and health area, its expertise in distance learning, in Residence courses, spe-cialization and management in health of the family, par-ticipation in Pró-Saúde, Telessaúde, besides the manifested interest in the project of the Rio de Janeiro State Secretary of Health.

The School of Dentistry was invited to be part of the Program through the Oral Public Health, with the partici-pation of its lecturers as follows:

• to manage the Program, management of Courses, and production of contents;

• to offer various courses of specialization and extension as the Course of Specialization in the Health of the Family in EaD model, to Rio de Janeiro and Espírito Santo, Course of Specialization in the Health of the family to PROVAB and MAIS MÉDICOS;

• to offerself-learning courses to Priority Politics as LGBT population, Man’s Health, Nutritional Health, Hearing care, and Cardiovascular Risk.

The Program UNA-SUS/UERJ trained, until now, 4.193 healthcare professionals, of which 645 are Dentists in the Courses of Specialization in the Health of the Family. The Self-learning Courses trained 41.245 healthcare profes-sionals.

DiscussionFrom all that was reported in this study, we can describe

a timeline that shows the evolution as well as the future challenges of the Oral Public Health in the School of Den-tistry of UERJ in these 50 years. We can observe its evo-lution and future challenges. We came from an extremely conservative model, where the technical level was predom-inant, to a thoughtful model that try to attend the real pop-ulation needs. Based in a military speech of modernization of the country in the 1960s, MOREIRA highlighted that this technician model guided the educational purposes of that time persisted for many years with the focus on the professional training instead of the population needs. 22



The paradigms of Dentist professional training were changing throughout the years, following the social chang-es and the discussions from the most representative forums of health in Brazil. Regarding this, FERRARI, ARAUJO, and DIAS23 consider that the form used nowadays to define a curriculum was not determined separately, but it was the result of a historical process that considers various hues in its composition. They observe that the teaching deficiencies cannot be attributed to the current legislation, which con-templates the fusion between teaching and service, but to the paternalist form delivered to the student, almost always

not stimulating the research, but only permitting the stu-dent to learn what is transmitted by the professor.

Finally, we could observe an exponential evolution of Oral Public Health at UERJ from 1968 until nowadays. We started with three courses with no clinical practices activ-ities in 1971, going to 11 courses and 25 clinical practices activities in 2015. These results showed an increase of 267% in the number of courses and 734% of clinical practices ac-tivities offered by Oral Public Health from 1968 until 2018, highlighting the changes in the training of dentists with more care to the population needs and the public service.

Figure 2. Timeline is showing the evolution of Oral Public Health between 1968 and 2015

MEDEIROS UV et al.


ConclusionRegarding our initial considerations, the purpose of the

study and the available literature, we can conclude that the Oral Public Health started its trajectory in UERJ with extreme low valuation because of the technician teaching system existing at that time, with reduced or no focus in the population care. Besides this, the Conferences and oth-er representative forums indicated the necessity of change in the professional profile of Dentistry, what was followed in the various curriculums implemented through the time.

In addition to this, we started with two courses in the Public Health area in 1968 going to 11 courses and oth-er correlated activities as the areas of technical training, teledentistry the effective iteration with the sector of public services, and the participation in UNASUS. As a result, the challenges that we can see are the constant follow-up of the social changes and in the health profile of the popula-tion, to allow us to offer to teach with quality to training a professional with an integral and integrated view of the patients’ needs.

References1. Faculdade de Odontologia. A nossa história: 1968-2008. Rio de Janeiro: Ed. UERJ; 2008, 80 p.2. Brasil. Ministério da Educação. Lei 4024 de 1961. Institui as diretrizes e bases para a educação nacional. Brasília.3. Brasil. Conselho Federal de Educação. Parecer 299/62 de 1962. Delibera sobre o ensino da Odontologia. Brasília.4. Fernandes Neto AJ. A evolução dos cursos de Odontologia no Brasil. ABENO, [cesso em 2018 maio 26]. Disponível em http://www.abeno.org.br.5. Brasil. Ministério da Educação. Parecer nº 460 de 6 de fevereiro de 1975. Dispõe sobre a habilitação em nível de 2º grau de Técnico em Higiene Dental e Atendente de Consultório Dentário. Diário Oficial da República Federativa do Brasil, Poder Executivo, Brasília, DF, 6 fev, 1975. (171)20-26. 6. Brasil. Lei 11.889 de 24 de dezembro de 2008. Regulamenta o exercício das profis-sões de Técnico em Saúde Bucal - TSB e de Auxiliar em Saúde Bucal - ASB. Brasília, DF; 2008. [acesso em 2018 dez 10] Disponível em: http://www.planalto.gov.br/cciv-il_03/_ ato2007-2010/2008/lei/l11889.htm.7. Brasil. Ministério da Saúde. Anais da Sétima Conferência Nacional de Saúde. Brasília, 280p.8. Brasil. Ministério da Educação e Cultura. Parecer 04/82 de 9 de julho de 1982. Fixa o novo currículo mínimo do curso de Odontologia. Brasília, DF; 1982. [acesso em 2018 dez. 10]. Disponível em: http://www.dominiopublico.gov.br/download/texto/cd010939.pdf.9. Rodrigues MM, Reis SMAS. A interdisciplinaridade e a integração no ensino odontológico: reflexos sobre o perfil profissional em relação às reais demandas da maioria da população por atenção odontológica. Em Extens. 2004;4(1):20-7.10. Paiva CHA, Teixeira LA. Reforma sanitária e a criação do Sistema Úni-co de Saúde: notas sobre contextos e autores. Hist. ciênc. saúde – Manguinhos 2014;21(1):15-35. 11. Brasil. Lei nº 9394 de 20 de dezembro de 1996. Dispõe sobre as Diretrizes e Bases da Educação Nacional. Brasília, DF; 1996. [acesso em 2018 dez. 10]. Disponível em: http://www.planalto.gov.br/ccivil_03/LEIS/L9394.htm12. Pierantoni CR, França T, Garcia AC, Santos MR, Varella TC, Matsumoto KS. Gestão do trabalho e da educação em saúde. 1. Ed. - Rio de Janeiro: CEPESC: IMS/UERJ: ObservaRH; 2012, 156p.13. Secco LG, Pereira MLT. Formadores em odontologia: profissionalização docen-



Urubatan Vieira de Medeiros


Mini Curriculum and Author’s Contribution 1. Urubatan Vieira de Medeiros – DDS; PhD. Contribution: effective scientific and intellectual participation for the study; data acquisition, data interpretation; pre-paration and draft of the manuscript; critical and the final approval. ORCID: 0000-0001-7822-26722. Luciana Freitas Bastos – DDS; PhD. Contribution: preparation and draft of the manuscript about Polyclinic Piquet Carneiro. ORCID: 0000-0002-0788-42113. Renata Rocha Jorge – DDS; PhD. Contribution: preparation and draft summary and keywords. ORCID: 0000-0001-6879-38344. Katlin Darlen Maia – DDS; PhD. Contribution: organization and technical procedures; preparation and draft of the manuscript about the internship at the muni-cipality of Rio de Janeiro and organization of the bibliographic references. ORCID: 0000-0002-1746-21785. Márcia Maria Pereira Rendeiro – DDS; PhD. Contribution: preparation and draft of the manuscript about UnASUS-UERJ. ORCID: 0000-0002-0926-9597 6. Klaus Barretto dos Santos Lopes Batista – DDS; PhD. Contribution: organization, final review and English version. ORCID: 0000-0001-5275-470X7. Maria Isabel de Castro de Souza – DDS; PhD. Contribution: preparation and draft of the manuscript on the Pró-Saúde. ORCID: 0000-0002-0355-9673

te e desafios político-estruturais. Ciênc Saúde Colet. 2004;9(1):113-20.14. Brasil. Conselho Nacional de Educação. Resolução CNE/CES 3, de 19 de fe-vereiro de 2002. Institui diretrizes Curriculares Nacionais para o Curso de Gradu-ação em Odontologia. Brasília, DF; 2002. [acesso em 2018 dez 10]. Disponível em: http://portal.mec.gov.br/cne/arquivos/pdf/CES032002.pdf.15. Brasil. Ministério da Saúde/Ministério da Educação. Programa Nacional de Re-orientação da Formação Profissional em Saúde – Pró-Saúde: objetivos, implemen-tação e desenvolvimento potencial / Ministério da Saúde, Ministério da Educação. – Brasília: Ministério da Saúde, 2007. 86 p.: il. – (Série C. Projetos, Programas e Relatórios.16. Pereira LS. Escola de Odontologia da UERJ e a política nacional de reorientação da formação profissional: limites e potencialidades do processo de reforma curric-ular à luz da teoria da estruturação. Rio de Janeiro, ENSP. Dissertação. 2013. 104p.17. Medeiros UV. Ciências da Conduta. 2ª. Ed. Campinas, Ed. Mundi Brasil, 2015.18. Organização Mundial de Saúde. Levantamento Epidemiológico básico em saúde bucal. In: PINTO VG Saúde Bucal Coletiva. 6ª ed. Ed. Santos, 2013.19. Rendeiro MMP, Bavaresco C, Olival ARB. A Política da Telessaúde e a in-serção da Teleodontologia. In: Pedrosa SF, Groisman S, Moysés SJ. Programa de atualização em Odontologia Preventiva e Saúde Coletiva (PRO-ODONTO PRE-VENÇÃO)/[organizado pela] Associação Brasileira de Odontologia. Porto Alegre: Artmed/Panamericana Editora, 2007. p. 129-166.20. Brasil. Ministério da Saúde. Diretrizes da Política Nacional de Saúde Bucal. Brasília, DF; 2004. [acesso em 2018 dez 10]. Disponível em: http://189.28.128.100/dab/docs/publicacoes/geral/diretrizes_da_politica_nacional_de_saude_bucal.pdf.21. Brasil. Ministério da Saúde. Portaria 2546 de 27 de outubro de 2011. Redefine e amplia o Programa Telessaúde Brasil que passa a ser denominado Programa nacional de Telessaúde Brasil Redes (Telessaúde Brasil Redes). Brasília, DF; 2011. [acesso em 2018 dez 10]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt2546_27_10_2011.html.22. Moreira AFB. Currículos e programas no Brasil. 10 ed. Campinas: Papirus, 2003.23. Ferrari MAMC, Araújo ME, Dias RB. A teoria na prática: proposta de curricu-lum frente às diretrizes curriculares nacionais do curso de graduação em Odonto-logia. Odonto.2012;20(39):17-26.




Original Article/Implantodontology

Effects of disinfection and abutment dis/reconnection on peri-implant tissues:

a randomized clinical trial

Eduardo Santiago Gonçalves,1 Oldemar Ferreira Garcia de Brito,1 Aline Tavares de Melo,1 Mario Groisman,1 Guaracilei Maciel Vidigal Junior2 1Dental private practice, Rio de Janeiro, RJ, Brazil2Department of Oral Implantology, Faculty of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil • Conflicts of interest: none declared.

AbstrActObjective: to evaluate clinically (probing depth, gingival bleeding index, plaque index, buccal mucosal margin recession) and radiographically (radiographic bone loss) the effects of the successive dis-reconnections and the chemical and mechanical procedures for disinfecting healing abutments in a randomized clinical trial. Material and Methods: six external hexagonal implants (4.1 mm Ø) and their healing abutments were placed in the edentulous posterior mandible of 11 patients. Three months after surgery five healing abutments were disconnected once every month, for 5 months, and treated differently (immersed in: solution of 70% alcohol; solution of 0.12% chlorhexidine; sprayed with sodium bicarbonate solution; left exposed to air; or replaced by a new one), and one healing abutment was not disconnected; forming 6 different groups of 11 healing abutments. The examiners were calibrated and blinded before the evaluation. Results: the different treatments of healing abutments did not result in statistically significant differences for any of the criteria evaluated (P>0.05). The successive dis/reconnections did not result in statistically significant differences compared with the control group (P>0.05). Conclusion: the treatment of the healing abutments and the number of dis/reconnections performed did not have any significant effect on the peri-implant tissues, at least, 6 months after the initial dis/reconnection.Keywords: Dental abutment; Disinfection; Implant.

Introduction

The shape and size of the peri-implant mucosa are strongly influenced by the bone architecture, pri-marily of the marginal bone crest.1 Therefore, small

variations in the height of the peri-implant bone crest can have a significant impact on the aesthetic outcome of im-plant treatment. Abrahamsson et al.,2 Ericsson et al.3 and De Sanctis et al.4 observed histologically that the gingiva and peri-implant mucosa had 2 well-defined structures, the junctional epithelium and the connective tissue zone, measuring between 3 and 3.5 mm, with 1.5 to 2 mm corre-sponding to the junctional epithelium, and approximately 1 mm of connective tissue. These structures, with the dimen-sions mentioned, represent the biological seal around osse-ointegrated implants. These studies also showed that after the installation of a healing abutment, there was a marginal peri-implant bone loss of approximately 1 mm; however, no consensus has been reached on the exact cause of this bone loss. Therefore, several studies have attempted to identify the likely causes of marginal bone loss.5-8

Several factors have been associated with peri-implant marginal bone loss. These include the design of the implant,9 the design of the pillar,10 the chemical composition,11 the number of times that the abutment is dis/reconnected,12 the retention system of the prosthesis,13 and the surgical tech-

nique (1 or 2 surgical steps).14 Rompen et al.15 highlighted the constant removal and subsequent replacement of bio-compatible healing abutments at various manufacturing stages of the prostheses as a cause of peri-implant margin-al bone loss. Because of removal, these abutments possess a thin layer of living cells adhered to their surface, and, if the reinsertion of the pillars is planned, some care must be taken to preserve their biocompatibility. In their classic study, Abrahamsson et al.12 compared the changes in mu-cosal tissues when healing abutments were removed and reinstalled at 5 different times in their implants. The muco-sa around the peri-implant healing abutments, which were continually removed, was observed to have significantly smaller junctional epithelium and connective tissue com-pared with those of the abutments that were not removed. This caused a compensating marginal bone loss, which en-abled the gain of peri-implant mucosa of adequate size, thus protecting the osseointegration area. However, despite these animal studies, there is no clinical evidence from random-ized controlled trials in humans. Thus, the aim of this study was to evaluate clinically and radiographically the effect of the successive dis-reconnections and the chemical and me-chanical procedures for disinfecting healing abutments on the peri-implant tissues, through a randomized controlled clinical study in humans.


GONÇALVES ES et al.

Material and MethodsStudy DesignThe study was approved by the Research Ethics Commit-

tee under protocol number 0023.0.317.000-10. Patients re-ceived, read, and freely signed an informed consent form.

Sample size calculation was performed using the soft-ware Epi Info (Center for Disease Control and Prevention, Atlanta, USA). Eleven patients with bilateral posterior man-dibular edentulism were selected for the study. Three im-plants were installed in each hemi-arch of the mandible of each patient, totaling 66 connecting external hexagonal im-plants with a 4.1 mm diameter (Titamax TI cortical, JJGC indústria e comércio de materiais dentários LTDA, Curiti-ba, PR, Brazil), connected to the healing abutments with a standardized height of 4 mm (JJGC indústria e comércio de materiais dentários LTDA).

During the manufacture of permanent prostheses, the healing abutments were dis/reconnected 5 times to perform the prosthetic steps, which consisted of impression taken of implants, abutments selection, metal structures try-in, test-ing and adjusting the ceramic, and finally, at the end of the study, cementation of the definitive prostheses. The interval time between each step was 1 month, and the study lasted 5 months. The period for which the healing abutments re-mained outside the mouth was standardized to 30 min. Each healing abutment from each patient was treated differently. The treatments used for disinfection were: group A – im-mersion in an ethanol 70% solution; group B – immersion in chlorhexidine solution 0.12% (Perioxidin®, Laboratório Gross S.A., Rio de Janeiro, RJ, Brazil); group C – sodium bicarbonate spray for 1 min on each of the 4 sides of the healing abutment; group D –the healing abutment served as control, i.e. was not removed up to the final delivery of the prostheses; group E – the healing abutment was replaced with a new sterile abutment; and group F – the healing abut-ment was untreated, i.e. exposed to air over a sterile gauze.

Surgical PhaseThe steps prior to the surgical procedure consisted of a

study model impression, diagnostic waxing, constructing the tomographic guide, obtaining the CT scans, and man-ufacturing the surgical guide, where molding was used for the initial bone marking, ensuring that a distance of at least 2 mm between tooth and implant at the end of the osteot-omies, and of 3 mm between implants, was maintained. This distance was ensured during surgery using Hu-Friedy probes with millimeter markings (model-PCPUNC 156, Chicago, IL, USA).

All surgical procedures were performed under local anes-thesia. The protocol that preceded the anesthetic procedure consisted of an intra-oral mouth rinsing with chlorhexidine solution 0.12% for 2 min (Perioxidin®), followed by treatment with an extra-oral washing with chlorhexidine solution 2% (Riohex, Rioquímica indústria farmacêutica, Sao José do Rio Preto,SP, Brazil). Local anesthesia was performed with

a hydrochloride lidocaine solution 2% with epinephrine 1/100,000 (Alphacaine, DFL indústria e comércio S.A, Rio de Janeiro, RJ, Brazil). A straight incision was made on the crest of the alveolar ridge, thus ensuring the presence of equal amounts of keratinized tissue on the buccal and lin-gual sides of the implants. Once the implants and healing abutments had been connected, the flap was sutured with single sutures using nylon 5.0 sutures (Techsuture indústria e comércio de produtos cirúrgicos LTDA, Bauru, SP, Brazil), with 1 suture between tooth/implant and 2 sutures between implants.

During the protocol, all patients received amoxicillin 500 mg (Amoxil, GlaxoSmithKline Brazil, Rio de Janeiro, RJ, Brazil) every 8 h for 7 days, starting 24 h before surgery; dexamethasone 4 mg (Decadron, Aché Laboratórios Far-macêuticos S.A., Guarulhos, SP, Brazil) with an initial dose of 8 mg 1 h before surgery, repeating the same dose after 24 h and 4 mg on the third day; and 600 mg ibuprofen (Aliv-ium, Mantecorp Indústria Química e Farmacêutica LTDA, Rio de Janeiro, RJ, Brazil) every 6 h after surgery for 4 days. For oral antiseptic treatment, patients were instructed to wash the surgical site with a solution of 0.12% chlorhexidine (Perioxidin®) for 1 min, twice daily for a period of 14 days.

Experimental Period Fourteen days after surgery, a protocol for formation

biofilm control on healing abutments was instituted, which consisted of the use of ultra-soft brushes (TEPE, Malmö, Sweden) with sweeping movements, from the cervical mar-gin to the top with 10 movements per face. This protocol was maintained during the healing and experimental periods.

After the healing period of 3 months, the following clin-ical parameters were evaluated every 30 days (repeated 5 times): the presence of buccal mucosal recession; probing depth on all 4 sides of each implant, plaque index, and gin-gival bleeding index.16 Two previously calibrated examiners (K=0.57 with an interval between measurements of 1 week) performed the clinical measurements on all 4 sides of each implant using Hu-Friedy probes with millimeter markings. The study was double-blinded, and the examiners did not know which decontamination method was used in each healing abutment. The implants were numbered from 1 to 6 for all patients. Number 1 was the most posterior of the left side; number 2 was intermediate; number 3 was the most anterior on the left side; number 4 was the most anterior on the right side; number 5 was intermediate; and number 6 was the most posterior on the right side. Randomization of the decontamination procedures was performed for each of the implants, to eliminate bias toward a single area or spe-cific method.

The CT scan images with the aid of the software used to realize the bone measurements to install implants were used to evaluate the mucosa thickness. The CT stents were filled with gutta-percha in center of the long axis of each miss-ing tooth. This gutta-percha touches the crestal ridge in the


Effects of disinfection and abutment dis/reconnection on peri-implant tissues: a randomized clinical trial

models. So, in the CT scans, the distance between the bot-tom of the gutta-percha to the bone crest corresponds to the mucosa thickness. Two independently examiners evaluated the mucosa thickness in all sites twice and the values were used to calculate the mean and SD. According to the mean value of the mucosa thickness, two groups were evaluated.

Periapical radiographs using the paralleling technique were performed by the same operator with the same appa-ratus (Spectro 70x S eletronic, Dabi Atlante, Ribeirão Preto, SP, Brazil) using a custom tab for each hemi-arch of each patient, 3 months after the surgeries, after the healing peri-od, and the end of the experimental period.17,18 The primary outcome, the proximal bone loss, was evaluated by com-paring the initial radiograph, obtained at implant installa-tion, and the final radiographs, performed after 6 months. Images of periapical radiographs were digitized with the help of the CorelDRAW X5 program (Corel®, Ottawa, Can-ada). Bone levels using the implant shoulder, as a reference point, were measured at these images. To account for vari-ability, implant width was measured and compared to the documented dimensions, and ratios were used to adjust for distortion. Bone levels were determined by applying a dis-tortion coefficient. Two examiners, both specialists in peri-odontics, performed the measurements using the initial and final radiographs of each patient twice, at 2 separate times, and the examiners did not know that a second measurement would be performed. Radiographs were not available to the examiners during the interval between the 2 measurements. The second measurement was performed 1 week after the first, like the methodology of Geckili et al.19 At the end of the experimental period, all implants were restored with non-splinted crowns.

Statistical analysis of the results was performed using the Kruskal–Wallis test for the values of probing pocket depth and mucosal recession and to the values of marginal bone loss (mesial and distal). The Friedman test was used to compare the values of plaque index and gingival bleeding. The linear correlation test was used to correlate the thick (>1.7mm) and (≤1.7mm) thin mucosa thickness groups and marginal bone loss. The significance level was set at 5%.

ResultsAfter the surgery, patient 7 moved to other city and was

removed from the study. Patient 9 lost one implant during the healing phase and patient 11 lost two implants during healing phase, because these implants did not achieve good primary stability and lost the osseointegration. Patient 11drop out of the study just before the final X-ray examina-tion.

Table 1 shows the results of probing depth of each pa-tient after treatment of healing abutments for 5 months. The mean values of probing depth were: group A, 2.28 ± 0.48 mm; group B, 2.16 ± 0.49 mm; group C, 2.13 ± 0.97 mm; group D, 2.05 ± 0.35 mm; group E, 2.09 ± 0.31 mm; and group F, 2.24 ± 0.26 mm. There was no statistically signif-

icant difference between the means of the different healing abutments between any of the treatment groups (Kruskal–Wallis test; P = 0.533). Table 2 shows the results of the reces-sion of the mucosal margin of each patient after treatment of healing abutments. The mean values of the recession of the mucosa margin were: group A, 1.6 ± 0.69 mm; group B, 1.4 ± 0.84 mm; group C, 0.66 ± 0.70 mm; group D, 1.0 ± 1.41 mm; group E, 1.3 ± 0.48 mm; and group F, 0.5 ± 0.70 mm. The greatest losses were observed in groups A, B, and E. However, despite this difference, there was no statistically significant difference between any of the treatment groups (Kruskal–Wallis test; P = 0.24).

Treatment

Patient

Group A

Group B

Group C

Group D

Group E

Group F

1 2.12 2.25 2.12 1.75 2.12 2.25

2 2 1.87 2.12 2.25 1.75 2

3 2 2.12 1.5 1.5 2.12 2.62

4 2 1.87 2 2.37 2.75 1.87

5 2.75 2 1.37 2 2.12 2.37

6 2 2.12 2.25 2.12 1.87 2.62

8 2 2.12 2.12 2 2.5 2.25

9 2.25 1.75 2.25 – 1.75 2.25

10 3.5 3.5 3.5 2.25 2 2

11 2.25 2 – 2.25 2 –

Mean 2.28 2.16 2.13 2.05 2.09 2.24

Standard deviation 0.48 0.49 0.97 0.35 0.31 0.26

Table 1. Mean values of probing pocket depth (mm) during the experimental period

Kruskal–Wallis test: H = 2.99 with 5 degrees of freedom; P = 0.53.- Implants lost in the healing phase.

Table 2. Statistical analysis of the recession of the buccal mucosal margin (mm)

Kruskal–Wallis test: H = 4.87 with 5 degrees of freedom; P = 0.24.–Implants lost in the healing phase.

Treatment

Patient

Group A

Group B

Group C

Group D

Group E

Group F

1 2 2 1 0 1 0

2 2 0 2 2 2 2

3 1 1 0 2 1 1

4 2 3 2 1 1 3

5 1 1 0 1 1 1

6 3 2 1 1 1 2

8 1 1 0 1 2 2

9 1 1 0 – 1 0

10 1 2 0 1 1 1

11 2 1 – 2 2 –

Mean 1.6 1.4 0.66 1 1.3 0.5

Standard deviation 0.69 0.84 0.707 1.41 0.48 0.707


Table 3 shows the results of the gingival bleeding indi-ces. Statistical analysis was performed using the Friedman test, because the variable is qualitative, with the dependent variable being ordinal. For evaluation of gingival bleeding indices, we performed a comparative analysis of patients sep-arately, obtaining values during the 5-month study. Most pa-tients did not show a statistically significant difference, except for patients 3 and 5 who presented a statistically significant difference at a 5% and 1% probability level, respectively. Table 4 shows the results of the plaque index for each patient. As above, for evaluation of the plaque index, statistical analysis was performed using the Friedman test and we performed a comparative analysis of patients separately, obtaining val-ues during the 5-month study. Most patients did not show a statistically significant difference, except for patients 2 and 4 who showed a statistically significant difference at a 5% prob-ability level. Tables 5 and 6 show, respectively, the differences between the initial and final testing of the mesial and distal areas according to the different treatments. No statistically significant difference was found for the mesial (P = 0.538) and distal (P = 0.444) marginal bone loss with different types of treatment using the Kruskal–Wallis test.

DiscussionThe study by Abrahamsson et al.12 in dogs has served as

a reference for clinical procedures.8,20 However, the direct transference of results from animal studies to humans is, at a least, questionable. Therefore, the present study sought to follow the same methodology as the study of Abrahamsson et al.12 in compliance with good clinical practice. The pres-ent study is similar to the study of Abrahamsson et al.12 in the following ways: implants were performed in the posteri-or region of the mandible; the same periods of dis/reconnec-tion were followed; there was strict control of bacterial bio-films in both studies; and both studies used regular platform external hexagon implants. Although different implant sys-tems were employed in both studies, both implant systems presented a machined titanium collar in the cervical region.

Patient Results of the Friedman test (X2r) P

1 5.83 0.21

2 2.83 0.58

3 11.33* 0.02

4 3.00 0.55

5 15.33** 0.00

6 4.50 0.34

8 0.00 1.00

9 1.60 0.80

10 0.00 1.00

11 0.00 1.00

Table 3. Statistical analysis of the bleeding index results per patient, from the first to the fifth month, using the Friedman test

*In patient 3, statistically significant differences between the bleeding index in the time interval studied was found at the 5% probability level. **In patient 3, statistically significant differences between the bleeding index in the time interval studied was found at the 1% probability level.

Patient Result of the Friedman test (X2r) P

1 7.16 0.12

2 9.50* 0.05

3 6.33 0.17

4 12.00* 0.01

5 0.33 0.98

6 2.00 0.73

8 3.33 0.50

9 1.60 0.80

10 3.33 0.50

11 2.00 0.73

Table 4. Statistical analysis of the plaque index results per patient, from the first to the fifth month, using the Friedman test

*In patients 2 and 4, statistically significant differences between the plaque index in the time interval studied were found at the 5% probability level.

Patient

Treatment

Group A

Group B

Group C

Group D

Group E

Group F

1 0.42 0.89 0.47 0.14 0.66 0.07

2 0.45 0.29 0.15 0.37 0.37 0.04

3 0.4 0.27 0.46 0.48 0.51 0.53

4 -0.53 0.06 0.56 0.52 1.39 0.09

5 0.65 0.39 0.13 0.34 0.8 0.56

6 0.54 0.21 0.54 0.3 0.5 0.16

8 0.38 0.5 0.3 0.4 0.38 0.53

9 0.37 0.5 0.08 – 0.20 0.35

10 0.15 0.75 0.04 0.47 0.28 0.25

11 *** *** *** *** *** ***

Table 5. Results (mm) of the mesial marginal bone loss

Kruskal–Wallis test: H = 2.96 with 5 degrees of freedom; P = 0.53.–Implants lost in the healing phase.***Patient 11 did not undergo radiography, and hence this parameter was not evaluated.There was no statistically significant difference between groups.

Table 6. Results (mm) of the distal marginal bone loss

Kruskal–Wallis test: H = 3.44 with 5 degrees of freedom; P = 0.44.–Implants lost in the healing phase.***Patient 11 did not undergo radiography, and hence this parameter was not evaluated.There was no statistically significant difference between groups.

Patient

Treatment

Group A

Group B

Group C

Group D

Group E

Group F

1 0.36 0.17 0.17 0.17 0.19 0.07

2 0.69 0.29 0.42 0.29 0.12 0.03

3 0.95 0.12 0.42 0.51 0.5 0.15

4 0.46 0.02 0.05 0.29 0.44 0.17

5 0.93 0.09 0.37 0.13 0.49 0.81

6 0.14 0.83 0.4 0.35 0.49 0.31

8 0.12 0.76 0.79 1.22 0.45 0.32

9 0.47 0.39 0.36 – 0.17 0.19

10 0.57 0.27 0.44 0.56 0.02 0.37

11 *** *** *** *** *** ***



The performance of the experiment in humans is import-ant to obtain clinically relevant results. The lack of signifi-cant differences in recession of the buccal mucosal margin and the accompanying marginal bone loss, in contrast to that observed in the study by Abrahamsson et al.,12 after the successive removal and reconnection of healing abutments, may be due to the method of assessment. Abrahamsson et al.12 used histological measurements for working in the mi-crometer scale, whereas in the present study the millimeter scale was used. In addition, the difference in the rate of heal-ing in dogs and humans may also have influenced the mar-ginal bone loss that successive abutment dis/reconnections caused by allowing bacterial accumulation at the implant/abutment interface.21,22 This bacterial build-up in the im-plant/abutment interface causes the adhesion of junctional epithelium beneath this zone at bone level implants23, since a bacteria-free zone is necessary for its formation24. Thus, in the study of Abrahamsson et al.,12 bone loss was greater when the abutments were removed and reinstalled, in con-trast to the findings of the present study. However, the faster cell cycle in dogs compared with humans25 may explain the differences observed between both studies. Another rele-vant observation is that the histological sections evaluated in Abrahamsson et al.12 were in the bucco-lingual direction. The reduced bone thickness of the flange in dogs26 could ex-plain the differences between the 2 studies, since the present study conducted radiographic measurements mesiodistally for evaluation of marginal bone loss.

Several studies have been conducted to evaluate the value of imaging in the final diagnosis.19,27 Images obtained from panoramic radiographs result in overlapping structures and the formation of shadows, particularly from the skull and vertebral column, in addition to the distortion and magni-fication of images. Therefore, this test is not a suitable alter-native to the detailed view of the bone edges, particularly in the posterior mandible.18 Moreover, factors such as ade-quate radiolucency and radiopacity that are crucial for the accurate diagnostic tests have been criticized in panoramic radiographs.19,28 Consequently, the best radiographic tech-nique that can be applied in a simple and accurate manner yielding good image quality and low costs for routine exam-inations are periapical radiographs.29,30 Some studies have evaluated the radiographic distance between the implant shoulder and the first visible bone-implant contact and have shown the accuracy of periapical radiographs in the evalua-tion of changes in marginal bone crest and their superiority over panoramic radiographs.18,31 In the present study, cus-tom radiographic tabs enabled standardization in imaging of each area. This facilitated a comparison of changes in the peri-implant bone crest at different time intervals.17,18,32

The results of this study do not corroborate the results of the study by Canullo et al.,33 who also performed dis/recon-nections in (test group) abutments in humans that showed

significant marginal bone loss compared with control abut-ments, that were not removed during the experimental pe-riod. In the study of Canullo et al.,33 implants were installed in extraction sockets, whereas in this study the implants were installed in healed ridges. Furthermore, in the present study, the assessment of marginal bone loss was performed 6 months after the beginning of the dis/reconnections, while in the study of Canullo et al.33 assessment was performed after 3 years. Instead, the results of the present study cor-roborated the results of short-term data of other studies, in which marginal bone levels changes do not alter significant-ly when comparing test and control sites.34,35 On the other hand, the results of Esposito et al.36 showed that repeated abutment changes significantly increased bone loss of 0.16, but this difference can not be considered clinically relevant.

The purpose of disinfection of the abutments (healing and prosthetic) is to achieve a biocompatible surface that al-lows for the union and stabilization of the junctional epithe-lium on its surface, preventing its migration and consequent apical bone loss. The basis for the different treatment choices for healing abutments were as follows: 0.12% chlorhexidine solution is an antiseptic frequently used in postoperative surgery in the oral cavity;37 a solution of 70% ethanol is used for antisepsis of surfaces;38 spraying a solution of sodium bicarbonate is an efficient decontamination method for ti-tanium surfaces with different degrees of roughness;39 the installation of a new healing abutment in each time interval was intended to verify if the complete absence of any con-tamination would benefit the peri-implant tissue healing; the removed healing abutment that had not undergone any treatment and was exposed to air would simulate a com-mon clinical condition; and the control abutment installed and not removed was used to compare the margins of the mucosal margin and changes in marginal bone crest with the other abutments. Although several in vitro studies40-43 that evaluated the effects of contamination and different methods of sterilization of titanium abutments have report-ed a significant decrease in adhesion of epithelial cells and fibroblasts, they indicated that the method of treatment of the healing abutment did not influence marginal bone loss. Probably due to the complex conditions of a living organ-ism, variations caused by different forms of treatment did not result in significant differences, contrary to observations in studies using cultured cells.

ConclusionIn conclusion, it was found that, within the limits of the

methodology used in the present study, the treatment of the healing abutments and the number of dis/reconnections used did not have any significant effect on the clinical and radiographic parameters of the peri-implant tissues, at least, 6 months after the initial dis/reconnection.



tapered implant. Clin Oral Implant Res. 2011;22(11):1303-7.21. Broggini N, Mc Manus LM, Herman JJ, Medina RU, Oates TW, Schenk R et al. Persistent acute inflammation at the implant abutment interface. J Dent Res. 2003;82(3):232-7.22. Dias EC, Bisognin ED, Machado SJ, Silva CHP, Soares GD, Vidigal Jr. GM. Evaluation of implant-abutment microgap and bacterial leakage in five exter-nal implant systems: An in vitro study. Int J Oral Maxillofac Implant. 2012; 27(2):346-51.23. Broggini N, Mc Manus LM, Herman JJ, Medina RU, Buser D, Cochran DC. Peri-implant inflammation defined by the implant-abutment interface. J Dent Res. 2006;85(5):473-8.24. Waerhaug J. Plaque control in the treatment of juvenile periodontitis. J Clin Periodontol. 1977;4(1):29-40.25. Roberts WE, Roberts JA, Epker BN, Burr DB, Hartsfield Jr JK. Remodeling of mineralized tissues. Part I: The frost legacy. Semin Orthod. 2006;12(4):216-37.26. Araújo MG, Lindhe J. Dimensional ridge alterations following tooth ex-traction. An experimental study in dog. J Clin Periodontol. 2005;32(2):212-8.27. Dare A, Yamaguchi A, Yoshiki S, Okano T. Limitation of panoramic radi-ography in diagnosing adenomatoid odontogenic tumors. Oral Surg Oral Med Oral Pathol. 1994;77(6):662-8.28. Perez CA, Farman AG. Diagnostic radiology of maxillary sinus defect. Oral Surg Oral Med Oral Pathol. 1988;66(4):507-12.29. Rohlin M, Kullendorff B, Ahlqwist M, Henrikson CO, Hollender L, Sten-stron B. Comparison between panoramic and periapical radiography in the diagnosis of periapical bone lesions. DentoMaxilloFac Radiol. 1989;18(4):151-5.30. Flint DJ, Paunovich E, Moore WS, Wofford DT, Hermesch CB. A diagnostic comparison of panoramic and intraoral radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(6):731-5.31. Levine RA, Sendi P, Bornstein MM. Immediate restoration of nonsub-merged titanium implants with a sandblasted and acid-etched surface: five-year results of a prospective case series study using clinical and radiographic data. Int J Period Rest Dent. 2012;32(1):39-47.32. Sunyoung M, Tawse-Smith A, Thomson WM, Payne AGT. Marginal bone loss with mandibular two-implant overdentures using different loading pro-tocols and attachment systems: 10-year outcomes. Int. J. Prosthodont. 2010; 23(4):321-32.33. Canullo L, Bignozzi I, Cocchietto R, Cristalli MP, Iannello G. Immediate positioning of a definitive abutment versus repeated abutment replacements in post-extractive implants: a 3-year follow-up of a randomized multicentre clin-ical trial. Eur J Oral Implantol. 2010;3(3):285-96.34. Koutousis T, Koutousis G, Gadalla H, Neiva R. The effect of healing abut-ment reconnection and disconnection on soft and hard peri-implant tissues: a short-term randomized controlled clinical trial. Int J Oral Maxillofac Implant. 2013;28(3):807-14.35. Luongo G, Bressan E, Grusovin MG, D’Avenia F, Neumann K, Sbricoli L et al. Do repeated changes of abutments have any influence on the stability of peri-implant tissues? Four-month post-loading preliminary results from a mul-ticenter randomized controlled trial. Eur J Oral Implantol. 2015;8(2):129-40.36. Esposito M, Bressan E, Grusovin MG, D’Avenia F, Neumann K, Sbricoli L et al. Do repeated changes of abutments have any influence on the stability of peri-implant tissues? One-year post-loading of a multicenter randomized con-trolled trial. Eur J Oral Implantol. 2017;10(1):57-72.37. Hosseini P, Mundis GM Jr, Eastlack R, Nourian A, Pawelek J, Nguyen S et al. Do Longer Surgical Procedures Result in Greater Contamination of Surgeons’ Hands? Clin Orthop Relat Res. 2016(7);474:1707-13.38. Talbot GH, Skros M, Provencher M. 70% Alcohol disinfection of transducer reads: experimental trials. Infect Control. 1985;6(6):237-9.39. Silva CHP, Vidigal Junior GM, Uzeda M, Soares GA. Influence of titanium surface roughness on attachment of streptococcus sanguis: an in vitro study. Implant Dent. 2005;14(1):88-93.40. Keller JC, Dranghn RA, Wightman JP, Dougherly WS, Meletion SD. Char-acterization of sterilized CP titanium implant surface. Int J Oral Maxillofac Implant. 1990;5(4):360-7.

References1. Ishikawa T, Salama M, Funato A, Kitajima H, Moroi H, Salama H et al. Three-dimensional boné and soft tissue requirements for optimizing esthetic results in compromised cases with multiple implants. Int J Period Rest Dent. 2010;30(5):503-11.2. Abrahamsson I, Berglundh T, Wennström J, Lindhe J. The peri-implant hard and soft tissues at different implant systems. A comparative study in the dog. Clin Oral Implant Res. 1996;7(3):212-9.3. Ericsson I, Nilner K, Klinge B, Glantz PO. Radiographical and histological characteristics of submerged and nonsubmerged titanium implants. An exper-imental study in the Labrador dog. Clin Oral Implant Res. 1996;7(1):206.4. De Sanctis M, Vignoletti F, Discepoli N, Muñoz F, Sanz M. Immediate im-plants at fresh extraction sockets: an experimental study in beagle dog com-paring four different implant systems. Soft tissue findings. J Clin Periodontol. 2010;37(8):769-76.5. Caneva M, Botticelli D, Salata LA, Souza SL, Bressan E, Lang NP. Flap vs “flapless” surgical approach at immediate implants: a histomorphometric study in dogs. Clin Oral Implant Res. 2010;21(3):314-9.6. Çehreli MC, Kökat AM, Uysal S, Akca K. Spontaneous early exposure and marginal bone loss around conventionally and early-placed submerged im-plants: a double-blind study. Clin Oral Implant Res. 2010;21(3):327-33.7. Weng D, Nagata MJ, Bell M, Melo LG, Bosco AF. Influence of microgap lo-cation and configuration on peri-implant bone morphology in nonsubmerged implants: An experimental study in dogs. Int J Oral Maxillofac Implant. 2010;25(3):540-7.8. Pieri F, Aldini NN, Marchetti C, Corinaldesi G. Influence of implant-abut-ment interface design on bone and soft tissue levels around immediately placed and restored single-tooth implants: A randomized controlled clinical trial. Int J Oral Maxillofac Implant. 2011;26(1):169-78.9. Hermann JS, Buser D, Schenk RK, Cochran DL. Crestal bone changes around titanium implants. A histometric evaluation of unloaded non-submerged and submerged implants in the canine mandible. J Periodontol. 2000;71(9):1412-24.10. Atieh MA, Ibrahim HM, Atieh AH. Platform switching for marginal bone preservation around dental implants: a systematic review and meta-analysis. J Periodontol. 2010;81(10):1350-66.11. Abrahamsson I, Berglundh T, Glantz P-O, Lindhe J. The mucosal attach-ment at different abutments. An experimental study in dogs. J Clin Periodontol. 1998;25(9):721-7.12. Abrahamsson I, Berglundh T, Lindhe J. The mucosal barrier following abutment dis/reconnection. An experimental study in dogs. J Clin Periodontol. 1997;24(8):568-72.13. Nissan J, Narobai D, Gross O, Ghelfan O, Chaushu G. Long-term outcome of cemented versus screw-retained implant-supported partial restorations. Int J Oral Maxillofac Implant. 2011;26(5):1102-7.14. Barros RRM, Novaes Jr AB, Papalexiou V. Buccal bone remodeling after immediate implantation with a flap or flapless approach: a pilot study in dog. Titanium. 2009;1(1):45-51.15. Rompen E, Touati B, Van Dooren E. Factors influencing marginal tissue re-modeling around implants. Pract Periodontics Aesthet Dent. 2003;15(10):754-61.16. Ainamo J & Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975; 25(4):229-35.17. Gomez-Roman G, Schulte W, d’Hoedt B, Axman-Krcmar D. The Frialit-2 implant system: five-year clinical experience in single-tooth and immediately postextraction applications. Int J Oral Maxillofac Implant. 1997;12(3):299-309.18. Almeida FD, Carvalho ACP, Fontes M, Pedrosa A, Costa R, Noleto JW et al. Radiographic evaluation of marginal bone level around internal-hex implants with switched platform: a clinical case report series. Int J Oral Maxillofac Im-plant. 2011;26(5):587-92.19. Geckili O, Bilhan H, Mumcu E, Bilgin T. Three-year radiologic follow-up of marginal boné loss around titanium dioxide grit-blasted dental implants with and without fluoride treatment. Int J Oral Maxillofac Implant. 2011;26(2):319-24.20. Degidi M, Nardi D, Piattelli A. One abutment at one time: non-removal of an immediate abutment and its effect on bone healing around subcrestal

AcknowledgementsThe authors wish to thank: Dr Geninho Thomé for pro-

viding the implants and abutments of this study; Dra Maria

Isabel de Castro de Souza to for the assistance in the statisti-cal analysis of the results.





Guaracilei Maciel Vidigal Junior


Mini Curriculum and Author’s Contribution 1. Eduardo Santiago Gonçalves - DDS and MSc. Contribution: effective scientific and intellectual participation for the study; data acquisition, data interpretation; preparation and draft of the manuscript; critical review and final approval. ORCID: 0000-0002-8724-63822. Oldemar Ferreira Garcia de Brito - DDS and Msc. Contribution: data acquisition. ORCID: 0000-0001-9129-08133. Aline Tavares de Melo – DDS. Contribution: data acquisition. ORCID: 0000-0001-5772-74364. Mario Groisman - DDS and MSc. Contribution: effective scientific and intellectual participation for the study and critical review. ORCID: 0000-0003-0202-41565. Guaracilei Maciel Vidigal Junior – DDS and PhD. Contribution: effective scientific and intellectual participation for the study; data acquisition, data interpretation; preparation and draft of the manuscript; critical review and final approval. ORCID: 000-0002-4514-6906

41. Vezean PJ, Koorbusch GF, Dranghn RA, Keller JC. Effects of multiple ster-ilization on surface characteristics and in vitro biologic responses to titanium. J. Oral Maxillofac. Surg. 1996;52(6):738-46.42. Zöller GO, Zentner A. Initial attachment of human gingival fibroblast-like cells in vitro to titanium surfaces pretreated to saliva and serum. Clin Oral

Implant Res. 1996;7(4):311-5.43. Kawahara H, Kawahara D, Mimura Y, Takashima Y, Ong JL. Morphologic studies on the biological seal of titanium dental implants. Report 2- in vivo study on the defending mechanism of epithelial adhesion/attachment against invasive factors. Int J Oral Maxillofac Implant. 1998;13(4):465-77.




Short Communication/Dental Prosthesis

Silhouette technique applied on dental preparation - case report

Paulo Eduardo Gomes de Almeida Campos,1 João Luiz Portella Duarte,1 Renato da Silva Fraga,2 Angela Maria Vidal Moreira,1 Fábio de Almeida Ribeiro,1 Luciana Meireles Miragaya,1 Olivia Albertina da Silva Fraga1 1Department of Dental Prosthesis, School of Dentistry, Rio de Janeiro State University (Uerj), RJ, Brazil2Department of Specific Formation, School of Dentistry, Fluminense Federal University (UFF), Nova Friburgo, RJ, Brazil • Conflicts of interest: none declared.

AbstrActObjective: the present study aims to show, through a case report, a wear technique capable to provide a correct full crown preparation. Case Report: as the patient’s need, tooth 21 was prepared for total crown by means of the silhouette technique, in which the volume of dental wear is guided by the thickness of the drills, as well as by the observation of the half dental profile formed after initial wear. A photographic sequence was performed to allow the understanding of preparation stages and its importance. Results: the final preparation presented ideal dimensions, within the proposed treatment. Conclusion: this approach allowed the correct orientation of the desired preparation.Keywords: Dental preparation; Silhouette technique; Fixed prothesis.

Introduction

The success of fixed dental prostheses is determined by three criteria: treatment longevity, pulp and periodontal health and patient satisfaction.1 How

can a prosthesis presents longevity, if dental preparation is not able to maintain it? What if the wear is excessive and lead to biological damage. In this context, dental prepara-tion should not be started before the professional defines the best treatment plan and knows how to perform it, re-specting the fundamental biomechanical principles. 2,3

The retention of a fixed dental prosthesis basically de-pends on the contact between the internal surfaces of the restoration and the external surfaces of the prepared tooth.4,5 Knowing this, all dental preparation techniques will converge to one point in common: to control the di-rection and amount of dental tissues wear, since all the principles to be fulfilled during dental preparation depend on this.6 Dental wear should be done selectively, according to the aesthetic and functional needs of the planned resto-ration.7 The important preservation of periodontal health is directly related to patient’s oral hygiene, as well as to the shape, contour and cervical margin location of prepared tooth. The ideal cervical margin location allows the pro-fessional to control all clinical procedures and the mainte-nance of proper hygiene by the patient.1,8

The dental preparation should ensure suitable restor-ative material thickness, while preserving pulp integrity. This minimum thickness required to make a full crown depends on the restoring material selected. On average, wear with a thickness of 0.5 to 0.7 mm on the buccal sur-face, 1.5 mm on the lingual surface and 2 mm on the in-

cisal surface, are well accepted.9

One way to guide a correct dental preparation, concerns to initially prepare only a half of the tooth. In this way, the untouched half is used as a reference to wear amount and direction of the preparation, by the observation of the created profile.10 That described protocol is called the sil-houette technique and was developed by the Prosthodon-tics Department on Bauru’s Dentistry College of São Pau-lo University. In order to reduce the number of steps and diamond burs used, new techniques and preparation in-struments have been studied and proposed over the years, always respecting the biological, mechanical, functional and aesthetic principles.11 The silhouette technique gives the operator a real idea of the amount of worn tooth, as it initially performs the preparation of the half of the tooth, preserving the other half as a guide.12

Another recognized technique of dental preparation was proposed by Inoue & Zanetti as the Reference Technique. On that protocol, the first step is to make the horizontal orientation grooves, that determines the amount of wear and the shape of the final preparation. The authors also de-veloped a special sequential-use kit (Inoue / Zanetti / Fel-trin-KG-Sorensen- ref.6727 kit) composed by specific burs that enable the dentist to reach the perfect wear prepara-tion thickness according to the selected crown materials.13

Martignoni et al. have stated that all techniques must have a common purpose; the control of depth and di-rection of removal of dental tissue.14 The objective of this article is to present a detailed clinical sequence of dental preparation, with photographic illustration, addressing important care on achieving a correct dental wear.


CAMPOS PEGA et al.

Report CasePatient sought dental care at the State University of Rio

de Janeiro through the Fixed Prosthesis clinic, reporting as main complaint, functional and aesthetic impairment.

A restorative treatment has been proposed by the prepa-ration of a fixed partial metal-ceramic prosthesis to replace the element 11. To this end, the elements 21 and 12 have been subjected to wear to serve as direct abutments.

The total axial wear of the solid element 21 was chosen, which was performed by the silhouette technique. To this end, the wear was started through the creation of an ori-entation groove in the cervical portion. A spherical dia-mond drill with a diameter of 1.4 mm (1014 - KG Sorensen) was used, the wearer extending the vestibular and palatal surfaces until near the proximal contact, in the absence of contact, the groove could extend the proximal faces. The groove depth of approximately 0.7 mm is achieved by in-troducing the bit at a 45° inclination to the surface to be worn (Figure 1a).

The metal-ceramic crowns require, on average, 1.5mm of wear on the vestibular face, 1.3mm on the palatal face and 2mm on the incisal portion. Thus, a good way to control wear is through orientation grooves on the buccal, incisal

and palatal surfaces. A diamond drill with rounded end (4138 - KG Sorensen) was used to perform the grooves cor-responding to the inclination of the mid-cervical third and the mid-incisal third (Figure 1b and 1c). The incisal grooves are made with the same drill and follow the same direction as the vestibular grooves, being inclined approximately 45° to the long axis of the tooth, facing the lingual surface. Its depth should be around 2mm, corresponding to one and a half times the depth of the drill bit (Figure 1d).

With the same drill, the joints of the vestibular, incisal and palatine grooves are joined, taking care not to lose the relation of pre-established parallelism. The wear of the pala-tine concavity should be performed with a pear-shaped drill (3168 - KG Sorensen), following the anatomy of the area. Af-ter this step, half of the tooth will be prepared, allowing an evaluation of the wear performed (Figure 2a and 2b).

Once the wear has been analyzed and approved, the preparation of the other half of the dental element begins, following the same care and criteria. (Figure 2c) If there is proximal contact, it must be removed by using a fine di-amond drill bit (2200 - KG Sorensen). The proximal scars should terminate at the gingival level and leave the proximal walls parallel to each other. This wear should be performed until a minimum distance of 1mm is reached between the

Figure 1. Silhouette Technique Applied on Dental Preparation: a) ori-entation groove in the cervical, b) orientation groove for cervical and moddle third vestibular reductions, c) orientation groove for vestibular reduction of the incisal third and c) incisal reduction groove

Figure 2. Continuation of repair technique applied in dental prepara-tion: a) complete reduction of half the tooth, b) check for wear size, c) orientation groove and d) preparation completed


Silhouette technique applied on dental preparation - case report

cervical end of the prepared tooth and the adjacent tooth. In the case of an aesthetic region, the end of the prepa-

ration should be positioned 0.5 mm inside the gingival sulcus, having a chamfer shape (Figure 2d). After finish-ing the preparation, all walls were finished with multila-minate (583 - KG Sorensen), facilitating future prosthetic steps and contributing to a better adaptation of the res-toration.

DiscussionOne of the basic objectives of a preparation technique

lies in the simplicity of the procedures.1 In order for the professional to achieve success in prosthetic restorations, he must follow a judicious protocol in the preparation of dental preparations, since negligence with the technique may lead to failure and consequently will induce the lab-oratory to make mistake in the making of restoration.13 The loss of the notion of depth and of the preparation di-rection during its execution can lead to unnecessary wear and may result in excessive pulp approximation associ-ated with a weakening of the dental structure, whereas inadequate inclinations may result in a significant loss of retention and stability.1,2,4,10 The more parallel the axial walls of the prepared tooth, the greater the frictional re-tention of the restoration. However, an exaggerated par-allelism may bring undesirable difficulties, especially in the laboratory stages and final cementing.1,6,7,15 The ide-al preparation should have a wear that accompanies the anatomy of the tooth in question. In anterior teeth, a cor-rect incisal wear should be performed in two planes on the vestibular face, thus facilitating aesthetic return and maintaining pulp integrity.13

Before initiating any dental wear, planning by means of diagnostic waxing is necessary to determine anatomy and final position of restorations. 1-3,5-7,13 This simulation of the desired end is the safest way to spatially locate the dental preparation.16 Once the waxing is approved, it is necessary to specify the restorative material to be used, thus determining the minimum thickness to establish adequate restorative patterns.1,3,7

Regarding the types of cervical endings, Touati et al.17 recommend for chamfering in metaloceramics the cham-fer, in which the amount of dental reduction is on average 1.2 mm from the axial faces and from 1.5 to 2.0 mm on the faces incisal and occlusal, with always rounded and smooth edges. In anterior teeth the preparation should finish intrasulcular so that the metallic strap does not in-terfere with esthetics.1 Before determining the position of the end line, the patient’s smile line should be evaluated since the less intrasulcular the end of the crown, the bet-ter the periodontal health.

There is unanimity among the authors that the major failures leading to prosthetic failure are related mainly to an insufficient reduction of the dental crown and the cervical terminus region leading to an incorrect crown emergence profile in relation to the adjacent periodon-tal structures, without counting with a weakening of the crown in certain areas and an aesthetic deficiency. They also report that, when the anatomy of the tooth in ques-tion is not accompanied, excessive parallelism is created leading to a maladaptation of the future restoration.1,4,8-10,14

Carefully following a protocol in the preparation of the preparation guarantees a favorable prognosis in the planning of a total crown. Several techniques are present-ed with defined protocols, also with suggestion of kits of drills for the accomplishment of the preparations.12,13 The technique presented in this report followed the basic steps of the silhouette technique, characterized by the creation of vertical orientation grooves and wear of a half of the tooth, which facilitates the visualization of the amount of wear, also results in a uniformity and the more important in the biological economy of dental tissue.12 The diamond tips were adapted to the reality of the fixed prosthesis dis-cipline of the Faculty of Dentistry of UERJ.

Conclusion It can be concluded that this technique allows the op-

erator in performing dental preparations a predictabili-ty, guaranteeing to reach the biomechanical principles of prosthetic preparations.

neer crown preparations in a dental school environment. J Prosthet Dent. 1991;66(5):706-8. 6. Rosenstiel SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 3rd ed. St. Louis: Mosby Inc; 2001;166-201. 7. Mezzomo E. Oral Rehabilitation - For the Clinician. Quintessence. 1994. 8. Pigozzo MN, Laganá DC, Mori M, Gil C, Mantelli AG. Dental prepara-tions with prosthetic purpose: a literature review. Rev Odontol Unicid. 2009;21(1):48-55. 9. Ribeiro VAQ et al. Evaluation of the marginal mismatch of copings for total crown metaloceramica in cervical terminus type chamfer and shoulder with bevel 45º. RFO UPF.2010;15(3):281-5.

References1. Pegoraro LF. Fixed prothesis: Base for planning. São Paulo: Artes Médicas. 2012 2. Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamen-tals of fixed prosthodontics. 3rd ed. Chicago: Quintessence Publishing; 1997; 119-38. 3. Fradeani M. Aesthetic analysis: a systematic approach to prosthetic treat-ment. Volume 1. Quintessence; 2006. 4. Ayada MF, Maghrabib AA, Rosenstielc SF. Assessment of convergence an-gles of tooth preparations for complete crowns among dental students. J Dent. 2005;33(8):633-8. 5. Noonan JE Jr, Goldfogel MH. Convergence of the axial walls of full ve-




Olivia Albertina da Silva Fraga


Mini Curriculum and Author’s Contribution 1. Paulo Eduardo Gomes de Almeida Campos - DDS; PhD. Contribution: effective scientific and intellectual participation for the study; responsible for clinical pro-cedures on the reported case. ORCID: 0000-0003-4598-17062. João Luiz Portella Duarte - DDS; PhD. Contribution: effective scientific and intellectual participation for the study; responsible for the literature researches. OR-CID: 0000-0002-1000-31633. Renato da Silva Fraga - DDS; MsC. Contribution: effective participation for the study, taking and treating the photographs used. ORCID: 0000-0003-2073-03024. Angela Maria Vidal Moreira - DDS; PhD. Contribution: effective participation for the study as responsible for bibliographic references. ORCID: 0000-0003-3657-02865. Fábio de Almeida Ribeiro - DDS; PhD. Contribution: effective participation for the study on literature review; responsible for clinical case follow-up. ORCID: 0000-0001-9786-47776. Luciana Meireles Miragaya - DDS; PhD. Contribution: effective scientific and intellectual participation for the study; critical reviewer; responsible for English text preparation. ORCID: 0000-0003-0864-70047. Olivia Albertina da Silva Fraga - DDS; PhD. Contribution: effective scientific and intellectual participation for the study; preparation and drafting of the manus-cript; responsible for the final submission. ORCID: 0000-0001-5551-4664

10. Velasquez-Plata D, Andres CJ. The art of crown preparation: a review of principles. J Indiana Dent Assoc.1996;75(3):6-11. 11. Faria IR, Segalla JMC, Silva RHBT, Pinelli LAP, Reis JMSN. Full Dent Sci. 2011;2(8):396-402. 12. Janson WA et al. Preparation of teeth. Silhouette technique (prosthetic purpose). Apostille of Dentistry Discipline, Faculty of Dentistry of Bauru- USP, 1985. 13. Farias FAR, Feltrin PP, Zanetti AL, Inoue RT. Tooth preparation to metal-loceramic crowns in anterior tooth using a referencial preparation technique

called Inoue & Zanetti. Rev Gaucha Odontol. 2011;59(Suppl 0):81-8. 14. Martignoni M, Schonenberger A. Precision in fixed partial prosthesis: clinical and laboratory aspects. São Paulo: Quintessence Books; 1998. 15. Parker MH. Resistance form in tooth preparation. Dent Clin North Am. 2004;48(2):387-96. 16. Goodacre CJ. Designing tooth preparations for optimal success. Dent Clin North Am. 2004;48(2):359-85. 17. Touati B, Miara P, Nathanson D. Modified ceramic and metal ceramics crowns. São Paulo: Ed.Santos; 2000.

CAMPOS PEGA et al.



Letter to the Editor/Social Dentistry

The School of Dentistry of UERJ completes 50 years

Andréa Lanzillotti Cardoso,1 Celso Queiroz1

1Department of Preventive and Community Dentistry, School of Dentistry, State University of Rio de Janeiro, RJ, Brazil• Conflicts of interest: none declared.

Dear Editor,

It is with great satisfaction that in this year we celebrate the 50th anniversary of the School of Dentistry of UERJ, we should feel happy, remember and rethink in the past

and what will be in the future... but with an understandable dose of concern about the political instability that affects the State of Rio de Janeiro and the entire Brazilian nation.

UERJ is a pioneer University in several factors that fa-vored social inclusion, such as the creation of more vacan-cies and night courses, quota system and courses for the el-derly. It is a place of scientific knowledge and production of great importance in the City and the country, being among the ten best in Brazil.

The School of Dentistry is an integral and indissociat-ed part of this University, it has formed in these 50 years, professionals who work in several dental specialties, as well as in the teaching area in all States of the Federation, com-ing from the postgraduate, masters and doctorate courses, which are configured as postgraduate of great excellence.

The history of School of Dentristy of UERJ in 50 years was written with a lot of struggle and commitment, begin-ning with a group of professionals of Dentistry and profes-sors who idealized a new Shool of Dentistry in the then State of Guanabara.1 Founded in 1968 and with daily dedication of teachers, administrative technicians and student team has been increasing and maintaining itself as a unit of reference. The celebration of the golden jubilee is a time to look to the future, but also a moment to thank, because the University is made up of people. And the people who are responsible to give identity and structure to achieve your goals.

Graduates are considered to be highly qualified profes-sionals. In recent years, the number of researches has been increasing in geometric progression, whether from the point of view of Evidence-Based Dentistry or the evaluation of subjective questions.

School of Dentristy of UERJ has complied the rules of the National Curricular Guidelines for the Dentistry Course.2 Although it has always trained dentists for the problems of the population, it has made efforts for its graduates to have a broader action of oral health problems. The patient in part of the biopsychosocial context, so the dentists should be gener-alists, critics, reflexives and that have a humanized behavior,

because this is not restricted for health promotion but also to recover lost health.

The investment that the School has to build a student with this profile is very large, but it is possible. Freidson3 says that different members of the same profession may come up with different ideas and still be considered legitimate mem-bers. In this way, it is known that these professionals will express themselves differently, but will take with them valu-able principles rooted in their formation.

The perception of the oral condition is an important health indicator, because it shows the actual health condi-tion, subjective responses, values and cultural expectations. Therefore, Dentistry is a science that assumes great benefit in the health of populations. Although Brazil is among the countries with low prevalence of caries, according to the World Health Organization, the National Oral Health Sur-vey shows that more than half of the Brazilian population (56%) present the problem, so School of Dentristy of UERJ constitutes a promising mechanism for the future of a Bra-zilian population with more oral health, with more quality of life.4

It is important to emphasize the financial breakdown of state of Rio de Janeiro in recent years has left many damages. The year 2017 was one of the more difficult in the history of UERJ. The Institution lived the worst crisis in 66 years of your life. The slogan “UERJ Resiste” figured on social net-works, T-shirts and turned the war cry into demonstrations. The lack of payment of wages affected professors, techni-cal-administrative, but also other sectors such as cleaning the campus. Now, in 2018, the condition has improved somewhat. Scholars, professors and staff already are receive your salary up-to-date; but the state still owes $ 156 million to suppliers, and the amount invested in research has been reset. But in the face of so many dark days, hope is gradually consolidating and believing that the persistence of human foundations will keep the Institution standing.

All the people who have been in the University, created an identity, a feeling of unity with colleagues, gratitude and stimulus for the study. School of Dentristy of UERJ marked the heart of who was in their classrooms, in the dental chairs or was somehow part of its history.


CARDOSO AL & QUEIROZ C

da União. 4 mar 2002.3. FREIDSON E. Renascimento do Profissionalismo: Teoria, Profecia e Políti-ca. São Paulo (SP): EDUSP; 2001.4. BRASIL. Ministério da Saúde. Projeto SB Brasil 2010. Pesquisa Nacional de Saúde Bucal. Resultados Principais. Brasília (DF): Ministério da Saúde, 2012.

References1. SOUZA MIC. Faculdade de Odontologia: a nossa história 1968 - 2008. Rio de Janeiro; 2009.2. BRASIL. Conselho Nacional de Educação. Câmara de Educação Superior. Resolução CNE/CES n. 3, de 19 de Fevereiro de 2002. Institui Diretrizes Cur-riculares Nacionais do Curso de Graduação em Odontologia. Diário Oficial



Andréa Lanzillotti Cardoso


Mini Curriculum and Author’s Contribution 1. Andréa Lanzillotti Cardoso – DDS; PhD. Contribution: bibliographic research, manuscript preparation, critical review and final corrections. ORCID: 0000-0003-4306-73552. Celso Queiroz – DDS; PhD. Contribution: bibliographic research, manuscript preparation, critical review and final corrections. ORCID: 0000-0003-1650-4820

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