International Poster Journal of Dentistry and Oral Medicine, Supplement PDA/2017

Introduction: Nano desensitizers were recently introduced, specifically nano-hydroxyapatite, the nanometric proportions of n-HA allows an easier obliteration of dentinary tubules. Methods: The database of this research on pubmed central and pubmed/medline was conducted according to the keywords: dentin hypersensitivity, dentin sensitivity, n-HA, nano-HA, nano hydroxyapatite, combined with the connectors "AND" and "OR" (dentin hypersensitivity OR dentin sensitivity) AND (n-HA OR nano-HA OR nano hydroxyapatite). Results: From a universe of 208 studies, 5 were included. Conclusions: In this systematic review, all the included studies have shown the effectiveness of nano-hydroxyapatite by reducing dentin hypersensitivity in a minimal period of four weeks. Keywords: dentin hypersensitivity, nano-Hydroxyapatite, desensitizers

Introduction: The extraction of impacted mandibular third molars is one of the most frequent and delicate surgery that the dentist is faced in clinical practice. Minimize post-operative, not interfering with the quality of life of patients is the major objective of the surgeon. Thus ultrasonic surgery comes up as an alternative to osteotomy with conventional rotary instruments. Objectives: Evaluate the applicability of ultrasonic surgery by doing an analysis of the available evidence in the literature, using a methodology consistent with a systematic review. Compare with a randomized controlled clinical trial signals and post-operative symptoms (pain, swelling, trismus, paresthesia, bleeding, influence of surgical difficulty and duration of surgery) at the extraction of impacted mandibular third molars using two surgical techniques: ultrasonic surgery and conventional rotary osteotomy. Materials and Methods: As part of the systematic review, after eligibility criteria defined the PICOT question determined, a search was made in primary and mixed databases: MEDLINE, PubMed, Cochrane Library, EBSCO, B-On with different combinations of MesH terms with the boolean connector AND. Two independent observers performed the data collection and analysis, and all studies included in the systematic review were subjected to evaluation of their methodological quality. Under the randomized controlled trial, the sample comprised 30 patients divided equally and randomly into two groups: the test group - ultrasonic technique; and control group - conventional rotatory technique. All surgeries were timed. Swelling parameters, trismus and paresthesia were evaluated on the day of surgery and at 3rd, 5th and 7th post-operative day. Intraoperative bleeding was evaluated during surgery. Postoperative pain was evaluated daily by the patient through a VAS and the number of ingested analgesics. Results: Systematic Review included 9 clinical trials, 1 systematic review and 2 meta-analyzes. Comparing the signs and symptoms between two surgical techniques, there was lower levels of pain, edema, trismus and intraoperative bleeding in piezo surgery. On the other way, surgical time was longer in this technique. This clinical trial revealed similar results to those described in the literature. Pain, swelling and trismus presents better results with ultrasonic technique, but without statistical significance. Intra-operative bleeding was significantly lower with ultrasonic surgery (t (28) = 3.258; p = 0.003). Operative time was significantly higher in extractions involving osteotomy and cutting crown and roots either with conventional technique (p = 0.020) and ultrasonic technique (p= 0.039). Ultrasonic technique regardless of surgical difficulty, was more time-consuming compared to conventional technique, without statistical significance (t (28) = - 1.12, p = 0.271). Conclusions: Despite the high cost of the equipment and longer surgical time, lower intensity of post-operative signs and symptoms associated with the inherent technical advantages, makes ultrasonic surgery a favorable therapeutic option, especially in cases where the maintenance of noble anatomical structures is the most important risk factor. Keywords: ultrasonic surgery, impacted mandibular third molars 1, post-operative symptoms

Introduction: Reparative dentinogenesis can be stimulated through a direct capping on pulp tissues with biomaterials. Objectives: The aim is to evaluate the cytotoxicity of three materials: Life®, WhiteProRoot®MTA and Biodentine™. Materials and methods: The MDPC-23 cell line was exposed to medium conditioned (ISO10993-5). Metabolic activity was assessed by the MTT assay, viability by the SRB assay, and the type of death and cell cycle by flow cytometry. Differentiation was assessed by expression of alkaline phosphatase (AP) and dentin sialoprotein (DSP) by immunocytochemistry. The mineralization was evaluated with the AlizarinRedS assay. Results: WhiteProRoot®MTA and Biodentine™ have similar results, with decreases in metabolic activity and cell viability at 24 hours and increase in the following times. Life® shows a decrease in metabolic activity and viability, with an increase in cell death and changes in the cycle. The evaluation of differentiation and mineralization indicates a marked increase in the expression of AP and DSP and of the formation of calcium deposits with Biodentine™ when compared to WhiteProRoot®MTA. Conclusions and clinical implications: The results of WhiteProRoot®MTA confirm their indication for these therapies, justifying their recognition as a 'gold standard'. Biodentine™ can be an alternative, since it presents superior results in the phases of differentiation and mineralization, and its clinical manipulation is simplified by its short cure time. Funding: GAI 2013 (Faculty of Medicine, University of Coimbra); FCT, Portugal (Strategic Project PEst-C / SAU / UI3282 / 2013 and UID / NEU / 04539/2013), COMPETE-FEDER. Keywords: Biomaterials. cytotoxicity, pulp capping, reparative dentinogenesis, therapy

Purpose: To allow the placement of an implant on a site with reduced bone height, through a minimally invasive technique of sinus lift by crestal approach. Case description: A 45-year-old male patient went to our clinic to replace his missing upper left first molar with an implant (Fig. 2). The CBCT indicated a residual bone height of 5-6 mm up to the maxillary sinus (Fig. 3). The treatment plan consisted in sinus lift by crestal approach with osseodensification - a recent technique1,2 that advocates the use of specific drills in counterclockwise direction which promotes bone expansion and condensation (Fig. 4). Bone graft material (NovaBone®) was densified into the sinus with the burs at low- speed (150 rpm) counterclockwise without irrigation (Figs. 5 and 6). After sinus elevation, a platform-switched implant (IDCam 4,2mm x 12mm, IDI®) with a morse taper connection was placed. After 4 months, second stage surgery and final impression were made and a screw retained metal-ceramic crown was fabricated. Results: The immediate post-operative CBCT showed a successful three-dimensionally regenerative procedure with adequate containment of the graft material and apparent integrity of the Schneiderian membrane (Fig.8). One year after the procedure, it is possible to verify the stability of the case, both clinically and radiographically (Fig. 11 and 12). Discussion: The concept of osseodensification has changed the paradigm of implant site preparation and it can be applied for maxillary sinus lift by crestal approach in a simple, safe and predictable way with reduced morbidity. Conclusions: The described procedure was successful, returning aesthetic and masticatory function to the patient. Keywords: osseodensification, sinus lift, crestal approach

Aim: A Class II skeletal deformity is frequently considered to be a unilateral maxillary problem. The purpose of this presentation is to show that solving Class II skeletal problems can be achieved with bimaxillary surgery even when the problem is unilateral. A further aim is to show the benefit of a team approach and the aesthetic results of a series of severe Class II patients who underwent bimaxillary surgery. Subjects and methods: Three cases showing patients who underwent bimaxillary surgery. Results: Good aesthetic results were achieved together with a functional and stable occlusion. Conclusions: Orthognathic surgery is the best option when camouflage is not possible and growth modification is limited. Bimaxillary surgery is often necessary to achieve good aesthetic results in Class II patients. Keywords: Class II, hyperdivergent, orthognathic surgery, gummy smile, facial aesthetics

Introduction: Patients with cleft palate frequently have bone and tissue defects with a communication with the nasal cavity. Sometimes the defect is very large or there is local scar tissue making it difficult and unpredictable to use an adjacent mucosa flap to solve it. On this case, we can use a distance flap to solve it. The aim of this clinical poster is to describe a case where a patient was subjected to this approach using a tongue flap. Presentation of the clinical case: A male patient with bilateral primary cleft lip-palate was treated at age 18 with a secondary graft surgery using a tongue flap, after several unsuccessful graft surgeries to close the fistula. Results: We achieved a good clinical result without any graft necrosis or fistula recurrence. This procedure also improved the quality of life of this patient by allowing the closure of the fistula. We managed the communication between oral and nasal cavity and prevented future infections. Furthermore, it makes the bone graft more predictable and easier on a later stage. Discussion: The use of a tongue flap, although requiring two steps to repair the defect (first a lingual tissue graft and, subsequently - bone graft), it can be used successfully in situations where it is not possible to use a simple local mucosal tissue graft. Conclusion: After several attempts to repair the existing defect, the tongue flap was efficient. Keywords: cleft palate, tongue flap, cleft palate repair, orthodontics, surgery, graft

Introduction: Craniofacial traumatic lesions frequently lead to debilitating and challenging consequences, as a result of infectious processes which make the immediate and successful surgical regenerative treatment difficult and/or impossible. Objectives: In the present work, it is aimed the development and biological characterization of a poly methyl methacrylate (PMMA)-based minocycline delivery system, to be used as a space maintainer within craniofacial staged regenerative interventions. Materials and methods: Developed PMMA systems were characterized regarding solid state characteristics and assayed in vitro for anti-bacterial and anti-inflammatory activity, and cytocompatibility with human bone cells. Results: Drug release profile revealed the maintenance of minimum inhibitory concentrations against Staphylococcus aureus, slime-producer-S. epidermidis and Escherichia coli, up to 72 hours. Further, controlled minocycline release decreased the release of pro-inflammatory mediators from activated macrophages and enhanced the functionality of osteoblastic cells, within in vitro models. Discussion: PMMA-based minocycline delivery system allowed for an adequate drug release profile, supporting a sustained antibacterial activity against relevant pathogenic bacteria commonly associated with craniofacial bone infections. Further, a sustained anti-inflammatory activity and enhanced bone cell response were verified. Conclusions: The developed PMMA systems, with controlled release of minocycline, allowed for an effective antibacterial activity and enhanced cytocompatibility, supporting a prospective utility for staged craniofacial reconstructive approaches. Clinical implications: The developed PMMA system displays an effective antibacterial activity and expectedly primes tissue healing through inflammation modulation and enhancement of osteoblastic response. Funding: This work was partly supported by the FCT grant UID/DTP/04138/2013. Keywords: minocycline, bone, PMMA, drug delivery system, biological characterization and cytocompatibility

Clinical Cases Description: Case 1: Female patient, 42 years-old, healthy, with complaints of discomfort associated with the buccal gingiva of tooth 41. After clinical observation, a Miller class III gingival recession, with a narrow band of keratinized gingiva (KG) and a high insertion of the labial frenum was observed. Case 2: Female patient, 62 years-old, without relevant medical conditions, with complaints of discomfort associated with the buccal gingiva of tooth 41. After clinical observation, a Miller class II gingival recession, with a narrow band of KG and persistent inflammation was observed. In both cases, the proposed and performed treatment was mucogingival surgery to increase the width of KG, using a free gingival graft (FGG) from the palate. Discussion: The role played by KG in the maintenance of periodontal health is controversial. Some authors argue for a need of a minimum width of KG, while others suggest that there may be periodontal health even in areas where KG is absent, provided there is an adequate bacterial plaque control. However, when there is difficulty in maintaining good levels of oral hygiene, as in the presented cases, it should be considered the possibility of increasing the width of KG, in order to avoid the progression of inflammation and the consequent continuous loss of periodontal attachment. Conclusions: The FGG allowed to increase the band of KG and, therefore, to improve the periodontal health, creating conditions for its long-term maintenance. Thus, it can be concluded that, in both cases, the treatment fulfilled the proposed goals. Keywords: keratinized gingiva, gingival graft, free gingival graft, gingival recession, mucogingival defect, mucogingival surgery

Case Description: Cleft lip and palate is one of the common facial deformities. Alveolar and nasal reconstruction is a challenge for the reconstructive surgeon. Presurgical nasoalveolar molding was introduced to mold the maxillary, alveolar, and nasal tissues prior to first surgical repair. Nasoalveolar molding also stimulated immature nasal chondroblasts, producing an interstitial expansion, which can improve nasal morphology.This appliance allowed the alignment of the intraoral alveolar segments and correction of the nasal tip, columella, the alar base and the philtrum. This paper aims to describe the treatment of two newly born male infants where presurgical orthopedic therapy was used. Two newly born male babies with a left cleft lip and palate. At two days of birth the impression for nasoalveolar molding was made. On the 15th day, we started alveolar modeling for six weeks. Nasal modeling was made for the next six weeks. The baby was seen weekly to make adjustments to the molding plate. The nasoalveolar molding aplliance was secure extraorally to the cheeks bilaterally by surgical tapes with orthodontic elastic bands at one end. Discussion: The tissue molding we achieved was measured on the lip approximation and was reduced from 3cm to 0,9cm on one subject and 3cm to 1,2cm on the other one. Conclusion: Presurgical orthopedic therapy of the cleft infant is intended to reduce severity of the oronasal deformity prior to surgery. Molding the nasal cartilage, premaxilla and alveolar ridges in the neonatal period with surgical procedures results in better aesthetics and a reliable longterm result. Keywords: Orthodontics, nasoalveolar molding, cleft lip and palate, NAM appliances, NAM protocol, presurgical infant orthopedics

Introduction: The obstructive sleep apnea syndrome (OSAS) is characterized by a reduction or absence of airflow in the oral/nasal cavity. The rapid maxillary expansion device (RME) has been considered an important treatment option. The objective is to review the literature to assess the effectiveness of RME in the treatment of children with OSAS. Methods: A research was developed over the following primary and secondary electronic data bases (PubMed, Web of Science, LILACS, Embase and Cochrane Library). A search strategy was made using the English terms: ("Palatal Expansion Technique" [Mesh]) AND ("Sleep Apnea, obstructive" [Mesh]) limited to randomized controlled trials, cohort studies, systematic review and meta-analysis, in Portuguese and English, performed in humans under 18 years and regarding articles published between January 2000 and December 2016. Results: In this review, a total of 84 articles were identified, 16 of which were considered potentially relevant. After applying the inclusion and exclusion criteria, 10 publications were eliminated. Of the 6 accepted publications, only 5 had a positive result after the CASP quality assessment and therefore were included in this study. Conclusion: The RME is effective in the treatment of children with OSAS combined with inadequate respiratory capacity and transverse maxillary deficiency, resulting in the improvement of polysomnographic variables, especially in the apnea-hypopnea index. Clinical implications: In children with maxillary endognatia presenting no adenotonsillar hypertrophy, as well as no neuromuscular disorders, cardiorespiratory or craniofacial anomalies, RME is a valid option for treating OSA. Keywords: Systematic review, meta-analysis, obstructive sleep apnea syndrome, rapid maxillary expansion, mouth breather, apnea-hypopnea index, adeno-tonsillectomy

Clinical case: A 57-year-old male smoker, referred by a colleague, came to the office complaining of a "ulcer" present for about 1 year. ASA II patient. After oral examination it was possible to observe the existence of a lesion on the left lateral border of the tongue and the oropharynx. Biopsy was done and sent for anatomopathological analysis. The result of the analysis was that we were in the presence of squamous cell carcinoma. Discussion: Over 90% of neoplasias of the oral cavity and oro-pharynxs are squamous cell carcinomas. Its most common location is on the pavement of the lateral side of the tongue and the soft palate. They can progress from an in situ carcinoma to invasive squamous cell carcinoma, and at this stage there is already penetration of the deeper areas of the oral cavity and/or oropharynx and may lead to the death of the affected individual. The main risk factors for this type of carcinoma are smoking and alcoholism, but may also be the result of chronic irritation such as dental caries, maladaptive dentures. Conclusion: Squamous cell carcinoma has different types of treatment, including surgery or radiotherapy, in cases in more invasive lesions. In lingual lesions, the treatment involves surgery and sometimes it's necessary surgical reconstruction in order to minimize postoperative oral sequelae. Due to the asymptomatic nature of most of these lesions, proper screening by dentists is an important weapon in the fight against oral cancer. Keywords: oral, carcinoma, cells, squamous, cancer, review

Introduction: Edentulism is defined as the absence of permanente teeth. It is the consequence of a multifactorial process envolving biological and non biological processes. Edentulism can be considered as an worldwind health issue and it has been associated with a negative effect in general health and quality of life. Objectives: To study the prevalence of maxillary and/or mandible edentulism of the patients who seek I.S.C.S.E.M.'s oral diagnosis consultation. Materials and Methods: Observational and epidemiologic study. 1000 patients records from the diagnosis consultation performed between January and April2017 were analyzed. Inclusion criteria: total edentulism in, at least, one dental arch. The cases were grouped into 3 classes: 1) Total Edentulism; 2) Total Upper Edentulism; 3) Total Lower Edentulism. Frequency tables were constructed according to: sex and age. Results: 57 cases of were identified. Discussion: Total maxillary and/or mandible edentulism was fless frequebt than in other literature sources. The advanced mean age observed in total edentulous patients in this study is consistent with the references searches, and confirms that the higher statistical frequency of total edentulism occurs in geriatric patients, ages ranging from 61 to 80 years old. Conclusions: Then statistical frequency of total upper and/or lower edentulism was low. Total edentulism and total upper edentulism were more frequently found in female patients. Total upper edentulism in male patients was more frequent in older patients. Clinical implications: Total edentulous patients need complex rehabilitative treatments. The therapeutical alternatives range from removable options to implant based treatments. Keywords: Total edentulism, epidemiology, diagnosis, sex, age

Title: Xenogeneic Matrices in Peri-Implant Soft Tissue regeneration: Case Series Authors: Sérgio Matos, Pedro Nolasco, Cristiano Pereira Alves, Tony Rolo. Background: The role of keratinized tissue in the longevity of dental implants, based on the current knowledge of the literature, is still controversial. Several techniques are described in the literature in the attempt to enhance keratinized tissue width, which includes the use of collagen matrices (CM) isolated or with autogenous grafts harvested from the palate. Aim: Describe two different approaches in the correction of mucogingival defects around dental implants using xenogeneic collagen matrices (XCM) in a monotherapy or combined with a strip free gingival graft (SFGG) and, additionaly, to present a systematic review about its clinical efficacy. Material and Methods: In this case series, both patients were systemically healthy, non-smoking females with inadequate attached and keratinized tissue ( 2mm) and lower vestibule. The surgical technique applied included, for case 1, the use of a xenogeneic dermal matrix and, for case 2, a combination of XCM with an apical SFGG harvested from the palate. The systematic review was structured according to the PRISMA statement and a PICOT questions was structured. Results: The patient experienced no postoperative complications, such as intense pain, infection or bleeding. All treated sites exhibited an increased gain in KTW (between 1 to 5mm). Xenogeneic collagen matrix presented some shrinkage. The literature evidence emphasizes for surgery time and patient morbidity more favorable results achieved for collagen matrices, despite less keratinization and higher tissue contraction (more than 50%) compared with autogenous grafts. The application of CM is associated with high variability of gain in KTW (between 1.5 and 10 mm). Conclusions: All techniques showed efficacy in improving peri-implant KTW, nevertheless limited level of evidence prevents definitive guidelines. Apically positioned flap plus autogenous grafts seems to favor better outcomes related to gain in KTW and volume. XCM demonstrated less gain in KTW and higher volume contraction, but can be an alternative in specific indications due to less patient morbidity and surgery time. The association with a SFGG seems to diminish tissue shrinkage. However, this positive results should be considered carefully and must be tested in well-designed clinical trials. Keywords: gingivoplasty/methods, keratinized tissue, free gingival graft, collagen matrix, gingival autograft, attached gingiva, soft tissue augmentation, dental implant

Introduction: The term oral leukoplakia is a clinical diagnosis for a predominantly white lesion which is not immediately recognizable as another well definable lesion which is white in appearance. A patient with oral leukoplakia is generally referred to take a biopsy for a definitive histopathological diagnosis. The outcome of the histopathological study, which may vary from hyperkeratosis to invasive squamous cell carcinoma, will determine the treatment. Because of the risk of malignant transformation, many clinicians recommend the ablation of the lesion. Long term follow-up is indicated. Objective: The aim of this poster is to demonstrate one leukoplakia case with a relevant dimension on the tongue. Description of the case: A 62-year-old female patient was diagnosed with a white plaque lesion on the left side of the tongue. An incisional biopsy was previously performed and the histopathologic analysis indicated the presence of mucosa with keratosis without dysplasia. The diagnosis was leukoplakia with no dysplasia. The patient was referred for completed excision. The lesion was removed with safety margins using a LASER Diode (DenLaseⓇ) with power 4W, fiber 400 µm and pulse mode of 50-200 µs. The piece was sent for analysis and the first diagnosis was confirmed. Follow-up at 2 weeks and 3 months. Discussion: The malignant transformation of oral leukoplakia is about 3.5%, being the tongue one of the localizations with a higher risk. Consequently the complete ablation of the lesion is indicated. LASER has numerous advantages such as a better view of the surgery field, reduction of anesthetic needed, hemorrhagic risk and post-operatory symptomatology, when compared with conventional surgery. LASER Diode promotes coagulation during the surgery which helps the healing process. In extensive lesions, no need of suture could be an advantage. Due to the impossibility of closing the margins, a change of the original anatomy is prevented. The chance of removing with no vaporization increases the possibility of a new analysis. Conclusions: After the definitive differential diagnosis of a leukoplakia lesion, LASER is a safe and suitable option to removed oral lesions in particular cases, as an alternative of conventional surgery methods. The patient's comfort in the post-operatory time is probably the most important benefit from laser technique. Long-term follow-ups are always indicated because of the potentially malignant transformation. Keywords: Laser, oral surgery, biopsy, ablation, leukoplakia

Description of clinical cases: Case 1: A 13-year-old female patient with radiopaque findings associated with a tooth 36. Asymptomatic lesion, whose clinical and radiographic characteristics favor the diagnosis of idiopathic osteosclerosis, and control is recommended. Case 2: A 54-year-old female patient with tumoriform lesion in the posterior mandible, asymptomatic and hard to palpation. Radiopaque lesion with well defined regular limits. An excisional biopsy was performed, whose anatomopathological examination revealed the diagnosis of osteoma. Case 3: A 38-year-old female patient with several radiopaque lesions in the mandible. An incisional biopsy was performed, whose anatomopathological examination corroborated the diagnosis of cemento-osseous dysplasia. Case 4: A 35-year-old female patient with intraosseous radiopaque lesion. An excisional biopsy was performed, whose anatomopathological examination confirmed the diagnosis of odontoma, of the complex type. Case 5: A 65-year-old male patient with extensive bone exposure area in the posterior right maxillary region, clinically compatible with maxillary osteonecrosis associated with bisphosphonates. Surgical removal of the bone sequestration was performed, eliminating the area of necrosis. Discussion: Asymptomatic areas of sclerotic bone may be found frequently in radiographic examinations. Some of these lesions are related to inflammatory processes that occur in the bone and others appear to have a non-inflammatory origin. The differential diagnosis of radiopaque lesions of the jaws can be approached by categorization according to their appearance, relationship with the tooth and exact location with reference to this same tooth. Conclusion: The role of the clinician is to recognize the origin of the lesions in the oral cavity. Careful evaluation of the presence of radiographic changes and clinical signs may allow the development of a correct diagnosis and approach. Definitive diagnosis can be obtained by histological evaluation of the lesion. Keywords: radiopaque lesions, idiopathic osteosclerosis, osteoma, cemento-osseous dysplasia, odontoma, osteonecrosis of the jaw

Objectives of the procedure: Bone reconstruction of the maxilla for the placement of implants. Presentation of the case (clinical procedure step by step and scientific su-sized justifying the procedure); Female patient, 50 years old, without systemic pathologies, smoker of 10 cig/day, with average bone crest thickness of ≤3 mm. A linear incision was made between the teeth region 18 and 28, being full thickness flapped. The bilateral maxillary sinus was elevated by the lateral window technique described by Cadwell-Luc, the xenograft blocks were fixed with screws on a xenograft bed and covered with collagen membranes to promote ROG by the principles described by Melcher. Sutured with single stitches (supramide 4/0) was performed. Immediate results, short and medium term: After 10 months CT showed a bone gain that allowed implant rehabilitation as planned. Discussion: In the first 2-3-year period after extraction, occurs a reabsorption of the original bone volume between 40-60% [1]. The gold standard for reconstruction with onlay bone blocks is autologous bone intra- or extra-oral[2]. Harvesting requires a second surgical site, increasing surgical time, risk of morbidity and patient discomfort [3], has a tendency to resorb, especially with extra oral origin, limiting the durability of bone augmentation[4,5]. To overcome these difficulties, the xenogens blocks are a good alternative in the reconstruction of the jaws, presenting biological proprieties of remodelling and incorporation into the native bone proven histologically and radiographically[6-10]. Hammerle et al. indicate that the waiting time for the second surgical phase is 9-10 months[7]. Conclusions: The use of xenogenic blocks presented excellent results in the increase of the bone volume avoiding the morbidity associated to the autologous blocks. The regeneration materials are provided by two companies: Osteobiol mp3® and Evolution® membranes by Tecnoss® and bio-oss block®, bio-oss® granules and bio-gide® by Inibsa®. Dental implants and components were supplied by Dentsply®. This work was supported by Portuguese funds through the Portuguese Foundation for Science and Technology, within IEETA/UA project PEst -OE/EEI/UI0127/2014 and CIDMA/UA project PEst-OE/MAT/UI4106/2014. S.Gouveia acknowledges the postdoctoral grant by FCT (ref. SFRH/BPD/87037/2012). Keywords: Bone augmentation of the maxillary ridge, bone grafting, bone substitutes, bone regeneration, bovine bone mineral block, case reports

Introduction: Studies demonstrated that the accuracy of intra-oral scanners can be compared with conventional impressions for most indications. However, little is known about their applicability to take impressions of multiple implants. Objective: compare the accuracy between digital and different conventional impression techniques in implants. Material and Methods: Two master models were made: one with parallel implants (Model 1)and another with uneven implants(Model 2). Model 1: 4 types of impressions (Group A: impressions with reposition copings; Group B: Open tray for dragging copings; Group C: Open tray with Splinted copings; Group D: Using 3M ™ True Definition Scanner system). Model 2: 3 types of impressions (Group E: impression with reposition abutments; Group F: Open tray for dragging copings, without splinting; Group G: Using 3M ™ True Definition Scanner system). Master casts and conventional impression casts were digitized with na laboratory scanner. STL data sets from the seven groups were superimposed to assess the 3D (global)deviations. Results: Model 1: The value for the sum in group D was 1,068,292, which was significantly lower than those of group A, B and C, which were shown to be 2,114,342, 2,165,491 and 1,265,918 respectively. Model 2: The group F was the most accurate with 1,257,835 and 1,660,975 and 1,489,328 for groups E and G respectively. Conclusion: The methods tested here for the digital impression of full arch models are able to achieve the accuracy of conventional impressions in the in vitro model. However, further in vivo studies are needed to confirm the in vitro results. Keywords: Digital models, intraoral scanner, implants, digital impression

Case description: A 5 year old girl, with a history of varicella and no known pathologies, call on to a routine appointment. The pregnancy was uneventful and drug-free. At the clinical examination, lesions compatible with enamel hypoplasia (EH) were detected in 6 of the 20 deciduous teeth. Radiographically, there was a thinner enamel in some of the affected teeth. It was applied topical fluoride and control appointments were scheduled every 3 months. Discussion: EH is defined as an incomplete or defective formation in the organic matrix, leading to enamel quantity decrease. In the primary dentition, the etiology includes genetic, systemic and environmental factors, that occurred in the prenatal period or during the early childhood. It can affect only one, several or all the dental elements. It affects the permanent dentition more frequently, but can also reach the primary dentition. The enamel presents with irregular thickness, with depressions in its surface and the color can vary from normal to white or yellowish. In addition to aesthetic consequences, it may be responsible for increased risk of caries and dental sensitivity. It is necessary to carry out the differential diagnosis between EH and other enamel development defects, namely, diffuse opacities, fluorosis, enamel hypomineralization and imperfect amelogenesis. Conclusions: it is highlighted the relevance of monitoring during pregnancy and early childhood by the pediatric dentist, to prevent etiological factors of EH in the primary dentition, due to its functional and aesthetic importance. According to the severity of EH lesions, caries preventive interventions should be implemented. Keywords: Ameloblasts, amelogenesis, differential diagnosis, enamel, hypoplasia, enamel matrix

Dental anomalies are related to changes in number, size, eruption, morphology or development of the teeth. Most occur between the sixth and eighth week of gestation, when the enamel, dentine and cement begin histodifferentiation. They may be associated with hereditary, local, systemic or traumatic factors and arise in the deciduous and / or permanent dentition. Fusion is a developmental anomaly resulting from the union of one or more adjacent teeth during their formation. Any tooth may be affected and it can also involve supernumerary. This poster aims to illustrate the importance of early diagnosis of dental anomalies, through the description of two clinical cases followed in the university clinic of FMDUL. Clinical case 1 - Healthy 5-year-old child, who presented a fusion of the tooth 62 with a supernumerary. A small carious lesion involving the entire fusion fissure, in the palatal face was observed. Early diagnosis allowed for a conservative composite restoration. Clinical control was maintained regularly until exfoliation, which occurred at the expected age, in a symmetrical way with the contralateral. Clinical case 2 - Healthy 4-year-old child, with a fusion between tooth 61 and a supernumerary. Contrary to the previous case, the teeth presented extensive carious lesions, with pulp involvement. The non-restorability and difficulty inherent to pulpal treatment led to the decision to extract the teeth. These cases demonstrate the importance of the early diagnosis of dental anomalies, in order to allow a preventive or less invasive approach. Keywords: supernumerary tooth, deciduous teeth, fusion, dental anomalies, early diagnosis

Introduction: Saliva reflects many systemic and oral pathologies. At SalivaTec we are interested in using this fluid in diagnostics and patient stratification. Our goal in the present work was to demonstrate that total salivary protein profile determined by capillary electrophoresis (SalivaPrint) may be used to direct the search for biomarkers. Material and Methods: SalivaPrints were obtained for 26 elder individuals with periodontal disease. These profiles were compared with SalivaPrints from healthy individuals and the most representative features for separation of the two groups were selected. Results: Five molecular weight ranges of SalivaPrint seem to be important separate the individuals with periodontal disease from the healthy individuals. These molecular weight ranges (28-29, 42-43, and 77-78 kDa) have been shown to include several proteins (Rosa et al 2016). Some of these proteins are functionally related to processes deregulated in oral and systemic disease. Discussion: Proteins such as P31947 (14-3-3 protein sigma) are related to the mTor pathway involved in glucose resistance, a condition related to obesity and diabetes. This is consistent with a high prevalence of these pathologies in the individuals with periodontal disease included. Conclusion: SalivaPrint can provide information on which molecules should be used to distinguish between individuals with oral health and periodontal disease. Clinical implications: Although the diagnostics of periodontal disease through salivary markers is an interesting approach, explored by our laboratory, these results indicate that metabolic deregulations such as diabetes and obesity have to be considered if the quantification of salivary markers is to be used for diagnostics. Keywords: oral health, saliva, protein profile, periodontitis, diagnosis

Introduction: Multi-Mode (MM) are contemporary generation of simplified adhesives indicated for use under different application strategies. Objectives: Describing the randomized clinical trial (RCT) design and baseline output of MM adhesives applied by Self-Etch (SE; with non-etched or etched enamel) and Etch-and-Rinse (ER) strategies, analysing NCCL restorations for two-years (2016-2018). Materials and Methods: Prospective, double blind RCT approved by UFP-Ethics Committee, National-Clinical-Trials-Ethics-Committee (NCTEC-20150305), Infarmed (EC/011/2015), NCT02698371, in 38 patients with 210 restorations (Admira Fusion®) randomly allocated in six groups (Adhesive's; Strategies) of 35 restorations: G1-Control (Futurabond®DC;SE); G2-Control (Futurabond®DC;SE etched-enamel); G3 (Futurabond®U;ER); G4-(Futurabond®U;SE); G5 (Adhese®Universal;ER); G6 (Adhese®Universal;SE). RCT design included NCCL characteristics. All restorations evaluated (success rate-efficacy) at baseline (one-month after restoration) by three calibrated examiners (ICC≥0.952) using USPHS and FDI criteria. Statistical analysis with nonparametric tests (alpha=0.05). Results: Median age: 55.5years, 21(55.3%) male; 210 NCCL in 176(83.8%) pre-molars and 34(16.2%) molar teeth (p=0.252).; NCCL Dentin sclerosis categories (Chi2-test;p=0.353): 146(69.5%) One, 35(16.7%) Two, 8(3.8%) Three and 21(10%) Four; Median NCCL estimated volume of 30.3(18.0-49.1)mm3; NCCL-geometry (p=0.903): 84(40%) Acute, 60(28.6%) Severe and 60(31.4%) Obtuse. At baseline all restorations showed 100% success rates. Discussion: Efficacy of different adhesion strategies are usually evaluated in NCCL restorations. No differences were found in NCCL characteristics by RCT groups. RCT designs should include NCCL features when evaluating clinical performance of adhesive's strategies. Conclusions: NCCL characteristics were similar in RCT groups. MM adhesives with different strategies showed baseline excellent performance. Clinical Implications:Restoration evaluation at mean/long term are mandatory to determine clinical performance of MM adhesion strategies. Keywords: Multi-mode, self-etch, universal adhesive, NCCL, RCT, composite restorations

Case Description: A healthy, 36-year-old female patient appeared in the clinic unhappy with the aesthetics of her smile. After a correct anamnesis, clinical, photographic and radiographic evaluation, the diagnosis was made and the treatment plan was delineated: Diagnosis: Infiltrated restorations on teeth 12, 11, 21, 22 and 36; Periapical lesions on the teeth 11, 21, 22 and 36; Gingival smile. Treatment plan: Endodontic retreatment, internal bleaching and resin restorations composed of teeth 11, 21, 22 and 36; Ceramic overlay on tooth 36; Gingivectomy + Feldspatic facets on the teeth 12, 11, 21, 22. Discussion: Although orthodontics and implant rehabilitation were also included in the initial treatment plan in order to balance the patient's occlusion, she decided not to perform at this stage for economic reasons. The risks of this option were explained and a stabilized splint was performed, in order to preserve the rehabilitation performed and the entire joint complex. Feldspathic ceramics are the material of choice when we talk about rehabilitation in the anterior sector from aesthetic, optical and biomimetic points of view. Conclusion: Although the ideal treatment plan was not done, it was possible to achieve the goals and restore the patient's self-esteem. It was made a stabilized splint, in order to preserve the rehabilitation performed and the entire joint complex. This treatment option does not limit in any way for later, if there is interest on the part of the patient, to perform orthodontics and implant rehabilitation, in order to complete the treatment plan stipulated initially. Keywords: veneers, feldspathic, internal bleaching, gingivectomy, overlay

Introduction/Objectives: The present case report the importance of endodontic surgery in the treatment of two radicular lesions that were associated to endodontically compromised teeth as well as the multidisciplinary value in order to get better aesthetic and functional results. Case Description: A healthy 46-year female patient presented to the FMDUP dental clinic in November 2015 with complaint of an aesthetically unpleasing on her upper anterior teeth. The clinical examination revealed that the central and lateral incisors were endodontically treated and had aesthetically inadequate restorations. Radiographically two osteolytic lesions were visualized in anterior maxilla. Endodontic surgery was the first choice of treatment for excision of the lesions and control of the bone defect. A later rehabilitation of upper anterior teeth using fixed prosthesis was suggested. Discussion: Although the prognosis of endodontic microsurgery in young patients is better we take measures to perform the conventional surgery within the main parameters for its success: good curettage of the bone wall and irrigation with saline solution, apical section of the incisors and apical obturation with 3 mm depth with MTA biomaterial because of its biocompatibility, osteogenic potential and excellent sealing in the elimination of untreated apical ducts. Conclusion: Properly performed endodontic surgery is an effective surgical method when root canal treatment fails. Follow-up is essential to detect early recurrences as well as the multidisciplinary work in order to correct other outcomes that may be inherent to perioendodontic problems. Keywords: apicoectomy, endodontic surgery, anterior maxilla, radicular cyst, MTA, outcomes

Female patient, healthy, 48 years old, attended the clinic unhappy with the aesthetics of her smile due to the presence of a maladaptation metal-ceramic crown associated with the tooth 33. It was previously endodontic and had no symptoms. According to the American Association of Endodontists the endodontic diagnosis is pretreated tooth and normal periapical tissues. The periodontal disease of the patient was stable, being in the periodontal support treatment at about one year. Through the CAD/CAM technology, the crown was replaced in a single appointment. CAD/CAM technology is not recent, as the first indirect restoration was made in 1983 by François Duret. However the medical-dental community has recently witnessed an exponential evolution of techniques and materials used in this field. This great scientific evolution allows a harmonious and fast workflow, in which the dentist can keep control of all phases of work. It also represents a great advantage for the patient since he can see his rehabilitation completed in a single appointment, avoiding consecutive visits and obtaining a final result equal to the conventional methods. Keywords: Dentistry, CAD/CAM, lithium dissilicate, adhesion

Introduction: Faced with the limitations of artificial materials, regenerative dentistry (RD) aims to regenerate tissues, recurrently using stem cells. However, therapies based on stem cells have important limitations, such as obtaining the desired cells and the associated ethical/rejection problems. Innovative strategies for obtaining stem cells are needed, such as the use of gingival fibroblasts. Aim: The aim of this work is to apply a methodology of cellular dedifferentiation into gingival fibroblasts, hence to obtain stem-like cells, which in turn can be differentiated into cells of interest, for use in RD. Methodology: Cultures of mouse gingival fibroblasts were established using the explant methodology. The cells obtained were subjected to dedifferentiation with dedifferentiation agent (DA) (1 to 5μΜ) with and without medium change for 4 days. (1) morphological changes, using optical microscopy of live cells and stained with crystal violet, (2) cell cycle analysis by flow cytometry, (3) cell proliferation and (4) clonogenic efficiency were evaluated. Results: The DA promotes an increase in cell size, morphological changes, and cell death until 25%, as described for the methodology. There is an increase in the cell population in G2/M phase and the appearance of a tetraploid population. DA also induced a decrease in cell proliferation and clonogenic efficiency. Discussion: The morphological and genotypic changes observed are compatible with the appearance of a stem-like population. Conclusions: Gingival fibroblasts were successfully dedifferentiated using the DA. Clinical Implications: Stem-like cells obtained by gingival fibroblasts dedifferentiation, can be used in the future in dentistry regenerative procedures. Funding: FCT, Portugal (Strategic Project PEst-C/SAU/UI3282/2013 e UID/NEU/04539/2013],COMPETE-FEDER. Keywords: Cellular dedifferentiation, regenerative dentistry, dental pulp stem-like cells, gingival fibroblasts, morphological changes

A 38 year old female patient, followed in the oral rehabilitation appointment at ISCSEM clinical university, came to the control appointment after the adhesion of feldspathic veneers of 13, 12 and 11, as well as total coating feldspathic ceramic crown adhesion in 21 tooth and a crown on the implant of 22. After intraoral examination, a wedge fracture of the crown of 21 was observed. The proposed treatment suggests the adhesion of a new total crown, however, the patient didn't want to be subjected to more appointments, so she opted for a faster solution. It was suggested to repair the veneer in mouth with composite resin. When adhesion is preferred over cementation, it becomes more difficult to replace the fractured crown, and conventional treatment for fractured veneers / crowns usually involves the destruction of the piece in its entirety. This substitution involves the repetition of the whole process, requiring the need for new and time-consuming appointments, both for the patient and for the medical dentist. The use of alternative therapies is essential if the patient is not willing to undergo this clinical process (veneer preparation, molds, photographs and a new adhesion appointment). As an alternative, mouth repair by infiltration with a loaded adhesive has been increasingly applied, leading to a longer life of this type of restorations, constituting a very viable, conservative and fast-applied alternative. With this therapeutic approach, a suitable aesthetic and functional result was achieved, saving chair time to the patient. Keywords: Ceramic crack, reparing, feldspatic crack

Twenty-one-year-old patient with no relevant prior clinical conditions came to the clinic due to an emergency regarding the tooth 1.3 which presented a crown-root fracture caused by an aggression, the tooth was previously intact. Due to the fracture configuration to position the clamp on the tooth 1.3 the mucoperiosteum was detached distally from the 1.1 and mesially from the 1.4 so that the clamp could be grasped directly to the bone. After direct pulp capping with calcium hydroxide and applying glass ionomer, the fragment was attached using dental adhesive and heated composite. Keywords: pulp capping, emergency, crown-root fracture

Clinical case description: A 27 years-old female patient with localized aggressive periodontitis presents a recurrent periodontal pocket after a previous regenerative procedure on the mesial surface of tooth 16, with a pocket depth of 7mm. A minimally invasive surgical approach (M-MIST) was used to regenerate the present deep infrabony periodontal defect, using a xenogenic/L-PRF bone block and L-PRF membranes. Discussion: Regarding the revival of the use of platelet concentrates in periodontal regeneration, the combination of PRF with allografts or xenografts presents encouraging clinical results scientifically supported . The results of the presented clinical case are in agreement with the available scientific evidence, with a pocket depht reduction of 2 mm; a clinical attachment gain of 2mm and a good radiographic bone fill of the defect, without adverse effects. Conclusion: Despite the limits of short-term healing of this clinical case, the combined use of L-PRF with a xenograft proved to be effective in the treatment of this infrabony periodontal defect, without significant morbidity for the patient. Although with promising outcomes, the existing scientific evidence emphasize the necessity of more studies with quality and scientific validity to prove the effectiveness of this technique. Keywords: PRF, L-PRF, xenograft, platelet concentrates, infrabony defects, periodontal regeneration

Introduction: Oral mucositis corresponds to the most prevalente complication in children with acute lymphoblastic leukemia resulting from oncologic therapy. This condition can cause sepsis, dysphagia and phonetic difficulties. Objective: To evaluate the importance of methods of prevention, diagnosis and treatment of oral mucositis lesions in children with acute lymphoblastic leukemia. Methods: Bibliographic research on PubMed database with keywords: oral mucositis, chemotherapy, oral health, prevention, pediatric patients, isolated, and combinated boolean marker "AND". The articles selection was made through the stipulation of inclusion and exclusion factors, highlighting the temporal limit, language and type of scientific article: Meta-Analysis; Randomized Controlled Trial; Review; Systematic Review. Results: In the diagnosis of oral mucositis the attention care should be directed to clinical aspect of the lesions as well as to the manifested signs/symptoms. It is important to understand the chronological relationship between the appearance of these conditions and the cancer treatment phase, so that it's possible to act preventively in order to avoid more invasive therapies. In the treatment of lesions at an early stage, analgesics, mouthwash solutions, mucosal lining agents and parenteral nutrition may be administered. Conclusion: The success for the maintenance of a healthy oral cavity during oncology therapy lies in the execution of an early diagnosis and the application of adequate preventive/therapeutic measures in each phase of mucositis/cancer treatment. Clinical Implications: In monitoring the cancer patient, it is fundamental intervention of a multidisciplinar team aiming to minimize impact of cancer treatment on oral and general health, and quality of life of child. Keywords: Oral mucositis, chemotherapy, oral health, prevention and pediatric patients

Introduction: The gummy smile is an aesthetic complaint that alters the spontaneity of facial expression. A gingival display greater than 2mm in the smile is classified as gummy smile. Objectives: The objective of this work is to identify the etiology, classification and treatments described in the literature of the gummy smile. Methods: This literature review was carried in the Pubmed, B-on, Scielo and Science Direct databases, using the combination of the terms "gummy smile", "excessive gingival display" and "lip repositioning surgery". We selected 17 articles published between 1996 and 2017. Results: The etiological factors of the gummy smile are: upper dentoalveolar protrusion, maxillary skeletal vertical excess, dental extrusion and/or altered passive eruption, hyperactivity of the upper lip muscles, infectious and/or drug gingival hypertrophy and morphofunctional characteristics of the upper lip. The gummy smile can be caused by a set of these factors. The treatment options described in the literature are periodontal surgery, dentoalveolar intrusion, orthognathic surgery, Botox^® infiltrations, lip repositioning surgery, surgery to release the nasal septum depressor muscle and surgery with reinsertion of the elevator muscle of the upper lip and wing of the nose. Conclusions: The study and the careful evaluation of the etiology and degree of gummy smile severity are determinant in the selection of the treatment. Clinical Implications: A multidisciplinary team, involving Orthodontics, Periodontology, Oral Rehabilitation, Maxillofacial Surgery and Plastic Surgery, is necessary for the diagnosis and treatment of gummy smile, when the etiology is multifactorial. Keywords: gummy smile, excessive gingival display, lip repositioning surgery

Description: Male patient, 48 years old, a smoker, without any general health problems, first came to the clinic in january 2016 reporting pain in the 4th quadrant. Clinically, theeth 44 and 45 presented extensive cavities and coronary destruction. The patient said that he had been diagnosed with a periapical lesion a year ago and had done some antibiotic therapy due to pain and suppuration. The radiographic exam showed a radiolucent unilocular lesion with radiopaque contour associated with teeth 44 and 45, both with endodontic treatment. In March 2016, teeth 44 and 45 were removed and decompression of the lesion trough the placing of a drain was accomplished. After 8 months, the enucleation of the cystic lesion was performed. The histopathological exam confirmed the provisional diagnosis of radicular/inflammatory cyst. Discussion: The radicular cysts are the most frequent cystic lesion in the oral cavity. Their treatment depends on their dimensions and their proximity to noble structures. In this case report, the lesion showed significant expansion and close relation with the alveolar nerve. Therefore, before the enucleation was done, it was decided to perform decompression by placement of a drain. This approach made it possible to decrease the lesion's volume and to minimize the risk of damaging the vascular and nervous structures. Conclusion: Periapical lesions can be asymptomatic for long periods of time and they can grow up to very significant dimensions. This leads to more complex treatments that may need to be done in various stages. Keywords: radicular cyst, enucleation, decompression, oral pathology

Introduction: Bruxism is a pathology considered by many authors a risk factor for dental implant placement. Aim: This literature review aims to answer the question: "Does implant placement in patients with bruxism represents a higher risk of implant failure, in comparison with patients without bruxism?" Methods: A search was conducted with the keywords (bruxism OR clenching) AND (implant fracture OR implant failure OR implant survival OR implant mechanical complications), in electronic databases, without time restrictions and considering articles in english, portuguese and spanish. The results were analyzed according to their abstract and the following inclusion criteria: systematic reviews and meta-analysis, randomized controlled trials, prospective and retrospective studies (case series including more than 10 patients). In vitro or animal studies were dismissed. No criteria was defined about population study or follow up. Results: Of the 105 articles found 9 of which were eligible for inclusion. Three of these studies found a positive association between bruxism and the risk of implant failure, two a negative relation and the remaining considered this relation questionable. The disparity of results may be due to several factors, such as study design and criteria applied for the diagnosis of bruxism. Conclusion: The causal relation studied remains controversial. Further investigations are necessary for a more objective answer. Clinical implications: The possible association between implant failure and bruxism requires a detailed diagnosis of the existing parafunction, in order to establish proper management of the problem during and after rehabilitation. Keywords: dental implants, bruxism, implant-supported rehabilitation, occlusion