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Doenças gengivais não induzidas por placa: um estudo multicêntrico sul-americano

Fri, 01 Aug 2025 00:00:00 GMT

Title: Doenças gengivais não induzidas por placa: um estudo multicêntrico sul-americano Author(s)/Inventor(s): Cavalcante, Israel Leal Advisor: Andrade, Bruno Augusto Benevenuto de Abstract: The present thesis is composed of five scientific articles, all focused on the clinicopathological study of non–plaque-induced gingival lesions. Article 1 presents a retrospective and observational study that analyzed 270 cases of peripheral ossifying fibroma (POF), diagnosed between 1999 and 2020 in an oral pathology service in Brazil. Morphological analysis, conducted using a semiquantitative methodology, assessed mesenchymal cellularity, inflammatory infiltrate, ulceration, and types of mineralized tissue. The findings showed a predominance in females (71.9%), with the most frequent site being the anterior upper gingiva (29.1%) and an association with incisors (49%). The most frequently found mineralized tissues were mature bone (86.7%) and immature bone (52.6%). A significant association was observed between immature bone deposition and lesions ≤ 1.7 cm in size (p = 0.041), as well as between immature bone and cementum-like tissue in lesions with an evolution time ≤ 16 months (p < 0.001). Additionally, there was an association between immature bone and hypercellularity of the mesenchymal component (p < 0.001), and between dystrophic calcification and ulceration (p < 0.001). Article 2 described a clinicopathological case of primary gingival rhabdomyosarcoma in an adult woman, whose clinical appearance mimicked a benign reactive lesion. The definitive diagnosis was established through biopsy and immunohistochemistry. Despite surgical resection followed by chemoradiotherapy, the patient experienced recurrence within seven months and died after further surgery and radiotherapy. The case underscores the importance of histopathological and immunohistochemical diagnosis to avoid underdiagnosis of malignant neoplasms in the gingiva. Article 3 consisted of a systematic review with meta-analysis aimed at estimating the global frequency of peripheral odontogenic fibroma (POdF) in oral pathology services. A total of 26 studies were included, selected from six electronic databases and gray literature. The results showed that POdF accounts for 0.05% of all biopsied oral lesions (95% CI: 0.03–0.06; I² = 80.8%), 2.31% of odontogenic tumors (95% CI: 1.57–3.06; I² = 87.2%), and 52.68% of peripheral odontogenic tumors (95% CI: 36.99–68.36; I² = 87.9%). The certainty of the evidence ranged from moderately low to very low due to methodological limitations of the included studies. It was concluded that POdF is one of the most frequent lesions among peripheral odontogenic tumors. Article 4 evaluated, in a multicenter and retrospective manner, the frequency and clinical features of reactive gingival lesions (RGLs) diagnosed in ten South American centers between 1996 and 2022. RGLs accounted for 6.1% of oral biopsies, with a predominance in females (68.1%; p ≤ 0.0001) and a median age of 47 years. The most common lesions were inflammatory fibrous hyperplasia (IFH) (40.8%), fibrous hyperplasia (FH) (21.3%), and pyogenic granuloma (PG) (16.1%). The anterior upper gingiva was the most frequently affected site (28.2%), followed by the posterior lower gingiva (26.2%) and anterior lower gingiva (24.4%). Most lesions were asymptomatic (88.6%; p ≤ 0.0001), sessile (64.9%; p ≤ 0.0001), and showed reddish (42.1%) or pink (26.4%; p ≤ 0.0001) coloration. Article 5 analyzed the prevalence and demographic characteristics of non–plaque-induced gingival diseases (NPIGDs) based on 11,624 cases diagnosed in ten Oral Pathology centers in Brazil and Argentina between 1996 and 2022. The most prevalent categories were reactive lesions (74.2%), potentially malignant oral disorders (8.6%), and malignant neoplasms (6.0%). The most frequent lesions were IFH (30.3%), FH (15.8%), PG (11.9%), POF (8.3%), peripheral giant cell lesion (6.5%), and squamous cell carcinoma (4.9%). Lesions were more frequent in females (66.2%), with a median age of 50 years and predominance in the lower gingiva (52.9%). Smoking was significantly associated with malignant lesions (77.5%; p ≤ 0.0001) and potentially malignant lesions (83.8%; p ≤ 0.0001). Taken together, the results of these five studies significantly contribute to the epidemiological, clinical, and diagnostic knowledge of non–plaque-induced gingival lesions in South American populations. They also reinforce the need for future revisions in current periodontal classifications and highlight the importance of histopathological examination in dental practice. Publisher: Universidade Federal do Rio de Janeiro Type: Tese

Ensaio clínico randomizado comparando a terapia periodontal não cirúrgica com e sem associação com a terapia fotodinâmica antimicrobiana (APDT) no tratamento da periodontite

Wed, 12 Mar 2025 00:00:00 GMT

Title: Ensaio clínico randomizado comparando a terapia periodontal não cirúrgica com e sem associação com a terapia fotodinâmica antimicrobiana (APDT) no tratamento da periodontite Author(s)/Inventor(s): Batista, Manuella Dias Advisor: Barros, Maria Cynésia Medeiros de Abstract: Antimicrobial photodynamic therapy with low-level laser therapy (aPDT) has garnered interest as an adjunctive procedure to non-surgical periodontal treatment. The present study aimed to compare the clinical outcomes of periodontitis treatment using non-surgical periodontal treatment (NSPT) alone versus NSPT combined with aPDT. This is a randomized clinical trial (RCT) comparing periodontal clinical parameters: visible plaque index, plaque-retentive factors, gingival bleeding, probing depth, clinical attachment level, bleeding on probing, furcation involvement, and tooth mobility between non-surgical periodontal treatment alone and that combined with aPDT. The target population consisted of periodontitis patients selected from the Periodontics Clinic of the Faculty of Dentistry at UFRJ. After a comprehensive periodontal clinical examination, research participants were randomly divided into two groups. One group received NSPT alone, while the other group underwent NSPT plus one session of aPDT: methylene blue (5 minutes) + 9J of red laser (660 nm). A total of 22 patients participated in the RCT, with a mean age of 57.86 years (SD ± 8.85), ranging from 41 to 79 years. Among this population, 50% were female. The results demonstrated that TPNC, whether combined with photodynamic therapy or not, showed significant improvement in the periodontal clinical parameters studied: visible plaque index (p 0.001), gingival bleeding (0.0001), probing depth (0.007), bleeding on probing (0.0001), and calculus (0.001). No statistical difference was observed between the treated groups. Publisher: Universidade Federal do Rio de Janeiro Type: Dissertação

Diagnóstico da ansiedade odontológica infantil: uma análise das evidências, desenvolvimento de itens para novos instrumentos e de material educativo para seu manejo clínico

Mon, 14 Apr 2025 00:00:00 GMT

Title: Diagnóstico da ansiedade odontológica infantil: uma análise das evidências, desenvolvimento de itens para novos instrumentos e de material educativo para seu manejo clínico Author(s)/Inventor(s): Amorim, Camila Silva de Advisor: Pithon, Matheus Melo Abstract: This thesis consists of four articles (A1-A4) and a technical product (PT) that will be presented separately: (A1) Objective: to observe the evidence of correlation between objective and subjective methods for assessing dental anxiety. Methodology: A systematic review was conducted, defining the eligibility criteria in patients (P): individuals in the dental environment; index test (I): subjective methods; reference test (R): objective methods; outcome (O): correlation between methods. QUADAS-2 assessed the risk of bias. Random effects meta-analyses calculated pooled correlation coefficients (r). Correlations were classified as weak (r = 0.1 to 0.3); moderate (0.31 to 0.5); strong (0.31 to 0.5). GRADE assessed the certainty of the evidence. Results: 29 studies were included (22 in the meta-analysis). The risk of bias was mainly “unclear” due to methodological limitations. Weak correlations were observed between subjective methods applied by the Dental Anxiety Scale (DAS); Dental Anxiety ScaleRevised (DAS-R); Modified Dental Anxiety Scale (MDAS); Short version of the Dental Anxiety Inventory (S–DAI) and the objective verified by heart rate (r 0.15 [0.08, 0.21], p < 0.001, I2 = 56%) and the subjective methods applied by CFSS-DS; DAS; Modified Child Dental Anxiety Scale (MCDAS); MDAS and the objective verified by alphaamylase (r 0.25 [0.11, 0.38], p < 0.001, I2 = 43%). The subjective methods Abeer Children Dental Anxiety Scale (ACDAS); DAS; MCDAS; MDAS showed a moderate correlation with the objective verified by cortisol (r 0.40 [0.33, 0.47] p < 0.001, I2 = 72%). The certainty of the evidence was very low. Conclusion: Overall, low to moderate correlations were found between objective and subjective methods, with very low certainty of evidence. (A2) Objective: to conduct an exploratory and critical analysis of the studies and tests applied to evaluate the psychometric properties of the Dental Subscale of Children’s Fear Survey Schedule (CFSS-DS). Methodology: a scientometric review was conducted, evaluating parameters such as country, publication periods, and original language used in the adaptation. In addition to the psychometric tests applied to the CFSS-DS, compliance with the categories for obtaining validity evidence was also evaluated. Results: The psychometric properties of the CFSS-DS were analyzed in 18 countries, with the highest number of publications between 2012 and 2024, with English being the most widely used language in the adaptations. The main tests applied were Cronbach’s alpha and Principal Component Analysis, which are not very robust approaches. Furthermore, of the five parameters of validity evidence, a maximum of two were achieved by most studies, indicating a low accumulation of evidence for the scale. Conclusion: Over the past four decades, the psychometric properties of the CFSS-DS have been evaluated in 18 countries, mainly based on the original English version. The analyses were largely superficial, with limited coverage of the validity evidence categories. (A3) Objective: to verify the evidence of validity based on the internal structure of the CFSS-DS. Methodology: the reliability of the scale was assessed considering McDonald’s ω (ω> 0.70= satisfactory) as a parameter of internal consistency, and Item Response Theory was applied by the Graded Ratings Scale Model in a sample of children aged 7 to 12 years old in Rio de Janeiro. Results: ω = 0.86 was observed; item 14 presented adjustment problems and items 3, 6, 7, 12, and 13 presented discrimination problems. Conclusion: the scale presented satisfactory internal consistency, but the inconsistencies of some items indicate the need for reformulation. (A4) Objective: to develop instruments for comprehensive assessment of dental anxiety in children. Methodology: initially, focus groups with pediatric dentists were conducted and recorded. The central themes were defined considering the intended structure for the instruments; the recordings of the focus groups were transcribed and coded to generate the items. The items generated were then evaluated for Content Validity Coefficient (CVC). Results: A total of 24 pediatric dentists participated in six focus groups. A battery of instruments was structured based on the following themes: 1) child (cognitive, physiological/emotional, and behavioral domains); 2) caregivers; 3) professional. The coding generated 35, 7, and 9 items for each instrument, respectively. The CVC after two rounds of judgment was acceptable for all instruments. Conclusion: The study developed a preliminary battery of three instruments with acceptable initial evidence of content validity. (PT) Objective: to develop and disseminate material with accessible tools for managing dental anxiety in children. Methodology: After a literature review, an e-book was developed, which followed the stages of theoretical structuring; layout; evaluation of clarity, comprehension and evidence of content validity by dental surgeons; and dissemination. Results: nine techniques were selected for the e-book, including acupressure and aromatherapy. After being evaluated, the e-book showed good properties in terms of clarity, comprehension and evidence of content validity, and was then published in the Pantheon Repositório Institucional da UFRJ. Conclusion: the ebook was a satisfactory strategy for disseminating accessible tools for managing children’s dental anxiety. Publisher: Universidade Federal do Rio de Janeiro Type: Tese

Avaliação clinica e radiográfica da reparação pulpar e periodontal em dentes autotransplantados

Wed, 01 Jan 2003 00:00:00 GMT

Title: Avaliação clinica e radiográfica da reparação pulpar e periodontal em dentes autotransplantados Author(s)/Inventor(s): Intra, João Batista Gagno Advisor: Roldi, Armelindo Abstract: Fifty autotransplanted teeth in 43 individuals were clinic and radiographically analyzed, in order to understand pulpal and periodontal reparative phenomena, and to fundament the therapeutic procedures. Clinic exams of pulpal sensibility and periodontal conditions were made, as well as periapical radiographies of the transplanted teeth for pulpal and periodontal analysis. From the results was verified that: 1) There was, during the period, decrease of pulpal answers in the sensibility tests of transplanted teeth with incomplete rhizogenesis. There was also greater presence of pulpal calcifications and increase of radiopacity of light in radicular roots comparing to non-transplanted homologous teeth; 2) The occurrence of pulpal necrosis was, in great majority, related to the degree of radicular development. Radiographic signs of pulpal necrosis were more often in transplanted teeth with complete rhizogenesis; 3) Retraction and gingival bleeding were eventually found and related to bad mouth hygiene, not happening installation of periodontal pocket verified by sounding, nor pathological alterations of dental mobility; 4) The constatation of external radicular resorptions did not compromise the transplantation 's success; 5) Periapical radiographic images indicating periapicopathy were linked to pulpal necrosis. Those permitted us conclude that: 1) Reintegration of the transplanted tooth in its new site was considered a success in all specimens; 2) Transplanted teeth in incomplete rhizogenesis stages presented better results of pulpal reparation than transplanted teeth with complete rhizogenesis; 3) Dental transplantation is a therapeutic able to rehabilitate physiologic and esthetically traumatized patients with superior incisive loss; 4) The success of this therapeutic depends on observation of various factors, including a severe surgical contral. Publisher: Universidade Federal do Rio de Janeiro Type: Tese