Scielo RSS <![CDATA[Journal of Applied Oral Science]]> http://www.scielo.br/rss.php?pid=1678-775720110006&lang=en vol. 19 num. 6 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[<b>Impact factor, Associate Editors, acknowledgements and new editorial rules</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Instruments to assess the oral language of children fitted with a cochlear implant</b>: <b>a systematic review</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600002&lng=en&nrm=iso&tlng=en The oral language development depends on the effective development of the hearing system. In cases of children presenting with hearing loss, a cochlear implant is an electronic device indicated to (re)habilitate the hearing function. Thus, it is of paramount importance to assess and follow the oral language development of children fitted with a cochlear implant (CI) to measure the effectiveness of the electronic device and support the therapeutic planning of these children. Questions are currently being raised about the instruments to assess the oral language of children using a CI, and, seeking the answers, this systematic review aimed at surveying these instruments. Searches were performed in three different databases utilizing six different descriptors to select articles published from 2004 to 2009 that performed an oral language assessment of children with a CI. Initially, 373 articles were found, and, after the application of inclusion criteria, 47 articles were analyzed, resulting in a survey of 74 instruments for oral language assessment, including tests, questionnaires and inventories. In analyzing the articles, it was realized that the studies included in this systematic review presented varied methodologies and low levels of evidence, with a greater concentration of instruments assessing receptive and expressive language, emphasizing the survey of the child's vocabulary and questionnaires. Thus, it can be verified that other linguistic skills, such as morphosyntactic, semantic, and narrative-pragmatic ones that are important in structuring speech and language for the effectiveness of the child's speech, are not being focused on. Just one of the instruments cited, a questionnaire, was specific for the oral language assessment of children with cochlear implants. <![CDATA[<b>Adequacy of human milk viscosity to respond to infants with dysphagia</b>: <b>experimental study</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600003&lng=en&nrm=iso&tlng=en Neonatal nutrition is an important subject in health in the short, medium and long term. In preterm newborns, nutrition assumes a predominant role for the child's overall development. Babies with uncoordinated swallowing or respiration may not have the necessary oral abilities to suck the mother's breast and will need to implement different feeding practices; one of them is changing the consistency of the milk offered. Objectives: Determine viscosity variations of untreated human and pasteurized milk without and with thickening to adapt the diet to the needs of dysphagic infants hospitalized in the Neonatal Intensive Cara Unit (NICU). Material and Methods: The authors altered the viscosity of natural infant powdered milk and, after thickening, determined and adopted a thickening standard for human milk. Untreated human and pasteurized milk was thickened in concentrations of 2%, 3%, 5% and 7% and the viscosity were determined every 20 minutes for a period of 60 minutes at a temperature of 37ºC. Results: The infant lactose formula thickened at concentrations of 2% and 3% produced viscosities of 8.97cP and 27.73 cP, respectively. The increases were significantly different after 1 hour. Inversely, untreated human milk at 2%, 3%, 5% and 7% produced diminished viscosity over time; the changes were more accentuated in the first 20 minutes. In pasteurized human milk, the 2% concentration had no variation in viscosity, but with the 3%, 5% and 7% concentrations, there was a significant decrease in the first 20 minutes with stability observed in the subsequent times. Conclusion: In powdered milk, the viscosity increases over time; the viscosity in human milk diminishes. The results point out the importance not only of considering the concentration of the thickener but also the time being administered after its addition to effectively treat dysphagic infants. <![CDATA[<b>Development of a CD-ROM on written language for the continuing education of elementary school teachers</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600004&lng=en&nrm=iso&tlng=en Distance education has emerged to minimize the anxiety of many professionals who need to update their knowledge, but do not have the time and opportunity to travel to educational centers. Objectives: To describe the development of a CD-ROM to provide distance continuing education to basic school teachers that addresses issues related to written language. Material and Methods: Previously, a script was developed with themes related to the acquisition and development of written language. Subsequently, a technical team transformed the texts in multimedia language. Results: The titles of each content area addressed are available on buttons and links. The files can be viewed in a linear sequence, allowing the teacher to start learning at the desired moment and go straight to the file that he or she wants to access. Videos that show practical applications of the concepts available in text are included. Conclusions: Brazil is a developing country. The use of technologies for education reduces cultural isolation among education professionals. It is necessary to focus on making teaching materials for distance education. In order to provide an effective learning environment, the learners reality should be considered. A multidisciplinary team should prepare the materials. The development of educational material for distance education on the acquisition and development of written language seems not only appropriate, but also warranted to provide professional growth opportunity for teachers who need time flexibility and/or live far away from academic centers. <![CDATA[<b>Oral and vocal fold diadochokinesis in dysphonic women</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600005&lng=en&nrm=iso&tlng=en The evaluation of oral and vocal fold diadochokinesis (DDK) in individuals with voice disorders may contribute to the understanding of factors that affect the balanced vocal production. Scientific studies that make use of this assessment tool support the knowledge advance of this area, reflecting the development of more appropriate therapeutic planning. Objective: To compare the results of oral and vocal fold DDK in dysphonic women and in women without vocal disorders. Material and methods: For this study, 28 voice recordings of women from 19 to 54 years old, diagnosed with dysphonia and submitted to a voice assessment from speech pathologist and otorhinolaryngologist, were used. The control group included 30 nondysphonic women evaluated in prior research from normal adults. The analysis parameters like number and duration of emissions, as well as the regularity of the repetition of syllables "pa", "ta", "ka" and the vowels "a" and "i," were provided by the Advanced Motor Speech Profile program (MSP) Model-5141, version-2.5.2 (KayPentax). The DDK sequence "pataka" was analyzed quantitatively through the Sound Forge 7.0 program, as well as manually with the audio-visual help of sound waves. Average values of oral and vocal fold DDK dysphonic and nondysphonic women were compared using the "t Student" test and were considered significant when p<0.05. Results: The findings showed no significant differences between populations; however, the coefficient of variation of period (CvP) and jitter of period (JittP) average of the "ka," "a" and "i" emissions, respectively, were higher in dysphonic women (CvP=10.42%, 12.79%, 12.05%; JittP=2.05%, 6.05%, 3.63%) compared to the control group (CvP=8.86%; 10.95%, 11.20%; JittP=1.82%, 2.98%, 3.15%). Conclusion: Although the results do not indicate any difficulties in oral and laryngeal motor control in the dysphonic group, the largest instability in vocal fold DDK in the experimental group should be considered, and studies of this ability in individuals with communication disorders must be intensified. <![CDATA[<b>Psychometric assessments of life quality and voice for teachers within the municipal system, in Bauru, SP, Brazil</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600006&lng=en&nrm=iso&tlng=en Studies show a high prevalence of vocal alterations among teachers. One of the criteria for the establishment of the prevalence of vocal alteration is based on teachers' self-perception. Objective: This study aimed at comparing voice-disordered quality of life measures between a group of teachers who reported vocal alteration and a group of teachers who did not, by verifying the teachers' perception regarding the impact of vocal alteration in the different dimensions of voice quality of life. Material and Methods: Ninety-seven (97) teachers answered three psychometric protocols of voice quality of life: Voice Handicap Index (VHI), Voice-Related Quality of Life (V-RQOL), and the Voice Activity Participation Profile (VAPP), in addition to a questionnaire for characterization of the sample. Results: The results were that 39.8% of the teachers reported vocal alteration. When comparing voice measures between the groups (with and without vocal alteration), statistically significant differences were observed: the total score of VHI, total score of V-RQOL and total score of VAAP and its dimensions. It was also verified that the physical dimension of VHI has a greater impact among the dimensions of this protocol. For VRQOL, the most striking dimension was the physical functioning domain, both indicating the laryngeal discomfort and the impact of voice on communication, in teachers with and without complaints. As for VAAP, no domain prevailed over the others in the group with no complaints. For teachers with complaints, three domains, i.e., daily communication, work, and emotions have a greater impact than social communication. The limitation and restriction scores were calculated as well, and it was observed the limitation of activities is greater than the restriction of activities, both in the group with and the group without complaints. Conclusion: One may conclude that the teachers who reported vocal alterations better realize the impact of voice in different dimensions of voice quality of life. <![CDATA[<b>Occurrence of consonant production errors in liquid phonemes in children with operated cleft lip and palate</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600007&lng=en&nrm=iso&tlng=en Information about the prevalence of consonant production errors, including compensatory articulations (CA), in individuals with cleft lip and palate (CLP) who speak Brazilian Portuguese is limited, particularly regarding liquid sounds. The literature primarily reports the occurrence of CA for plosive and fricative sounds, since occurrence of CAs in sounds that require higher amounts of oral air pressure is expected. While the use of CA during liquid sound production is not expected, clinical experience suggests that individuals with CLP present with inadequate backing, elevation, and anteriorization of the tongue as well as tongue clicks during production of /r/ and /l/. Objectives: Describe the occurrence of consonant error productions during liquid sounds for children with CLP; compare the occurrence between children operated with the Furlow and von Langenbeck techniques for palatoplasty; and compare the occurrence between children operated between 9-12 months and 15-18 months of age at primary palatoplasty. Material and Methods: A sample of 397 children (237 males and 160 females) with operated unilateral CLP was studied. In this group, 163 underwent palatoplasty with the Furlow procedure and 234 with the modified von Langenbeck procedure. Age at palatoplasty was between 9 and 12 months for 189 children and between 15 and 18 months for 208 children. Data about production of /l/, /r/, /R/, /λ/ and consonant clusters /l/ and /r/ were obtained from speech pathology records. Speech pathologists registered the speech findings after an auditory-perceptual evaluation of the participants at the sixth year of age. Results: The use of middorsum palatal place (MDP) of production was identified for 2% of the sample. Tongue anteriorization of the /l/ production was observed for 55% of the children. No significant difference was found related to surgical technique, but children operated earlier developed the use of the consonant cluster /r/ sooner than children operated later (p=0.040). Conclusion: We found a low occurrence of use of cleft related CA during attempts of production of liquid phonemes, and the variable age at primary palatoplasty significantly interfered with the acquisition of consonant cluster /r/. <![CDATA[<b>Translation and adaptation of functional auditory performance indicators (FAPI)</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600008&lng=en&nrm=iso&tlng=en Work with deaf children has gained new attention since the expectation and goal of therapy has expanded to language development and subsequent language learning. Many clinical tests were developed for evaluation of speech sound perception in young children in response to the need for accurate assessment of hearing skills that developed from the use of individual hearing aids or cochlear implants. These tests also allow the evaluation of the rehabilitation program. However, few of these tests are available in Portuguese. Evaluation with the Functional Auditory Performance Indicators (FAPI) generates a child's functional auditory skills profile, which lists auditory skills in an integrated and hierarchical order. It has seven hierarchical categories, including sound awareness, meaningful sound, auditory feedback, sound source localizing, auditory discrimination, short-term auditory memory, and linguistic auditory processing. FAPI evaluation allows the therapist to map the child's hearing profile performance, determine the target for increasing the hearing abilities, and develop an effective therapeutic plan. Objective: Since the FAPI is an American test, the inventory was adapted for application in the Brazilian population. Material and Methods: The translation was done following the steps of translation and back translation, and reproducibility was evaluated. Four translated versions (two originals and two back-translated) were compared, and revisions were done to ensure language adaptation and grammatical and idiomatic equivalence. Results: The inventory was duly translated and adapted. Conclusion: Further studies about the application of the translated FAPI are necessary to make the test practicable in Brazilian clinical use. <![CDATA[<b>Bauru School of Dentistry Tele-Health League</b>: <b>an educational strategy applied to research, teaching and extension among applications in tele-health</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600009&lng=en&nrm=iso&tlng=en Tele-health is more than an innovative alternative; it is an excellent tool that enables access to health and education in health, making it possible to minimize distances, optimize time and reduce costs. Based on these advantages, some Brazilian Universities have used these actions in strategies of education, research and extension, aiming at the application of Tele-health in Brazil. In that way, the Bauru School of Dentistry - University of São Paulo (FOB-USP) has applied the use of information and communication technologies in health by means of a "Tele-Health League" (TL), in order to diagnose, prevent and treat diseases, in addition to educate the population and health services. Objective: The present study aims to introduce the characteristics of the Tele-Health League of FOB-USP, as well as the development of its projects. Material and Methods: The Tele-Health League consisted as a Diffusion Course approved by the Provost of Culture and Academic Extension of the University of São Paulo. It is composed as a large group enclosing professoriate coordinator, academician principal, contributing professors and league members, those, diversified between undergraduates students, graduated, health employees, technology and information areas. The participant members are evaluated by the presence frequency (minimum of 85%), and by the performance of tests and paperwork about the theoretical content provided. Results: In four years of activities, the TLFOB-USP obtained a high satisfaction index (90%), an increased number of vacancies due to the interest to become a member, more commitment of the professors of the University and the accomplishment of association with other Brazilian leagues. It is emphasized that the approval percentage of the course results in approval from approximately half of its members. Also, it is important to identify and repair the causes related to the quitting of some members. Conclusions: The results showed that the TLFOB-USP members, adjoining to the professor's participants, develop projects in Tele-helth, in Tele-aid and Tele-education areas, thus resulting in the involvement of the University and the community. <![CDATA[<b>Histomorphometric assessment of bone necrosis produced by two cryosurgery protocols using liquid nitrogen</b>: <b>an experimental study on rat femurs</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600010&lng=en&nrm=iso&tlng=en OBJECTIVE: The aim of this study was to evaluate the effects of liquid nitrogen cryosurgery on the femoral diaphysis of rats. MATERIAL AND METHODS: The femoral diaphyses of 42 Wistar rats were exposed to three local and sequential applications of liquid nitrogen for 1 or 2 min, intercalated with periods of 5 min of passive thawing. The animals were sacrificed after 1, 2, 4 and 12 weeks and the specimens obtained were processed and analyzed histomorphometrically. RESULTS: The depth and extent of peak bone necrosis were 124.509 µm and 2087.094 µm for the 1-min protocol, respectively, and 436.424 µm and 12046.426 µm for the 2-min protocol. Peak necrosis was observed in the second experimental week with both cryotherapy protocols. CONCLUSIONS: The present results indicate that the 2-min protocol produced more marked bone necrosis than the 1-min protocol. Although our results cannot be entirely extrapolated to clinical practice, they contribute to the understanding of the behavior of bone tissue submitted to different cycles of liquid nitrogen freezing and may serve as a basis for new studies. <![CDATA[<b>Effect of axial loads on implant-supported partial fixed prostheses by strain gauge analysis</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600011&lng=en&nrm=iso&tlng=en OBJECTIVES: The present study used strain gauge analysis to perform an in vitro evaluation of the effect of axial loading on 3 elements of implant-supported partial fixed prostheses, varying the type of prosthetic cylinder and the loading points. MATERIAL AND METHODS: Three internal hexagon implants were linearly embedded in a polyurethane block. Microunit abutments were connected to the implants applying a torque of 20 Ncm, and prefabricated Co-Cr cylinders and plastic prosthetic cylinders were screwed onto the abutments, which received standard patterns cast in Co-Cr alloy (n=5). Four strain gauges (SG) were bonded onto the surface of the block tangentially to the implants, SG 01 mesially to implant 1, SG 02 and SG 03 mesially and distally to implant 2, respectively, and SG 04 distally to implant 3. Each metallic structure was screwed onto the abutments with a 10 Ncm torque and an axial load of 30 kg was applied at five predetermined points (A, B, C, D, E). The data obtained from the strain gauge analyses were analyzed statistically by RM ANOVA and Tukey's test, with a level of significance of p<0.05. RESULTS: There was a significant difference for the loading point (p=0.0001), with point B generating the smallest microdeformation (239.49 µε) and point D the highest (442.77 µε). No significant difference was found for the cylinder type (p=0.748). CONCLUSIONS: It was concluded that the type of cylinder did not affect in the magnitude of microdeformation, but the axial loading location influenced this magnitude. <![CDATA[<b>Nasalance and nasality at experimental velopharyngeal openings in palatal prosthesis</b>: <b>a case study</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600012&lng=en&nrm=iso&tlng=en The use of prosthetic devices for correction of velopharyngeal insufficiency (VPI) is an alternative treatment for patients with conditions that preclude surgery and for those individuals with a hypofunctional velopharynx (HV) with a poor prognosis for the surgical repair of VPI. Understanding the role and measuring the outcome of prosthetic treatment of velopharyngeal dysfunction requires the use of tools that allow for documenting pre- and post-treatment outcomes. Experimental openings in speech bulbs have been used for simulating VPI in studies documenting changes in aerodynamic, acoustic and kinematics aspects of speech associated with the use of palatal prosthetic devices. The use of nasometry to document changes in speech associated with experimental openings in speech bulbs, however, has not been described in the literature. Objective: This single-subject study investigated nasalance and nasality at the presence of experimental openings drilled through the speech bulb of a patient with HV. Material and Methods: Nasometric recordings of the word "pato" were obtained under 4 velopharyngeal conditions: no-opening (control condition), no speech bulb, speech bulb with a 20 mm² opening, and speech bulb with 30 mm² opening. Five speech-language pathologists performed auditory-perceptual ratings while the subject read an oral passage under all conditions. Results: Kruskal-Wallis test showed significant difference among conditions (p=0.0002), with Scheffé post hoc test indicating difference from the no-opening condition. Conclusion: The changes in nasalance observed after drilling holes of known sizes in a speech bulb suggest that nasometry reflect changes in transfer of sound energy related to different sizes of velopharyngeal opening. <![CDATA[<b>Effect of repeated immersion solution cycles on the color stability of denture tooth acrylic resins</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600013&lng=en&nrm=iso&tlng=en OBJECTIVE: Chemical solutions have been widely used for disinfection of dentures, but their effect on color stability of denture tooth acrylic resins after repeated procedures is still unclear. The aim of this in vitro study was to evaluate whether repeated cycles of chemical disinfectants affected the color stability of two denture tooth acrylic resins. MATERIAL AND METHODS: Sixty disc-shaped specimens (40 mm x 3 mm) were fabricated from two different brands (Artiplus and Trilux) of denture tooth acrylic resin. The specimens from each brand (n=30) were randomly divided into 6 groups (n=5) and immersed in the following solutions: distilled water (control group) and 5 disinfecting solutions (1% sodium hypochlorite, 2% sodium hypochlorite, 5.25% sodium hypochlorite, 2% glutaraldehyde, and 4% chlorhexidine gluconate). Tooth color measurements were made by spectrophotometry. Before disinfection, the initial color of each tooth was recorded. Further color measurements were determined after subjecting the specimens to 7, 21, 30, 45, 60, and 90 immersion cycles in each tested solution. Color differences (ΔE*) were determined using the CIE L*a*b* color system. Data were analyzed using two-way repeated measures analysis of variance (ANOVA) followed by Tukey tests. The significance level was set at 5%. RESULTS: There were statistically significant differences in ΔE* among the 5 disinfectants and water during the 90 cycles of immersion for both denture tooth acrylic resins. Distilled water promoted the greatest color change in both denture tooth acrylic resins, nevertheless none of tested disinfectants promoted ΔE* values higher than 1.0 on these acrylic materials during the 90 cycles of disinfection. CONCLUSIONS: Repeated immersion cycles in disinfecting solutions alter ΔE* values, however these values do not compromise the color of the tested denture tooth acrylic resins because they are imperceptible to the human eye. <![CDATA[<b>Effects of sulfur-based hemostatic agents and gingival retraction cords handled with latex gloves on the polymerization of polyvinyl siloxane impression materials</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600014&lng=en&nrm=iso&tlng=en OBJECTIVES: This study investigated the possible interactions between three addition silicone materials (Express®, Aquasil Ultra® and Adsil®), three hemostatic agents (ferric sulfate, StatGel FS®; aluminum sulfate, GelCord®; and aluminum chloride, Hemostop®) and gingival retraction cords previously handled with latex gloves to determine whether direct contact with medicaments or indirect contamination by latex in conditions similar to those found in clinical practice inhibit or affect the setting of the impression materials. MATERIAL AND METHODS: A portable device for the simultaneous test of several specimens was specifically developed for this study. Polymerization inhibition was analyzed by examination of the impressions and the molded surface. Ten trials were performed for each addition silicone material used in the study, at a total of 240 study samples. RESULTS: All the samples tested (N=240) were nonreactive regardless of the type of combination used. CONCLUSIONS: Aluminum sulfate, ferric sulfate and aluminum chloride hemostatic solutions did not show any inhibitory potential on the addition silicone samples under study, and there were no changes in polymerization as a result of contact between addition silicone and retraction cords handled with latex gloves. <![CDATA[<b>Treatment effects of R-appliance and Anterior Inclined Bite Plate in Class II, Division I malocclusion</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600015&lng=en&nrm=iso&tlng=en OBJECTIVES: The purpose of this study was to compare the effects of a differently designed functional appliance (R-appliance) and the Anterior Inclined Bite Plate (AIBP) in Class II Division I (Cl II Div I) cases. MATERIAL AND METHODS: Fifty patients (28 girls, 22 boys) were chosen for the study: 25 patients (13 girls, 12 boys) with mean age of 10.4±0.8 years were treated with R-appliance for 11±2 months, the other 25 patients (15 girls, 10 boys) with mean age of 9±1.2 years were treated with AIBP for 10±2 months. All patients had Cl II Div I malocclusion due to mandibular deficiency. Lateral cephalograms were analyzed at the beginning (T1, T 1) and end of the study (T2, T 2). RESULTS: Paired T-test showed that SNB had a significant increase in both groups. The same test revealed that IMPA was reduced in R-appliance for 3.1±4.7 (p<0.01), but it was increased for 0.1±5.1 (p<0.9) in AIBP group. T-test showed that the inter-group difference of IMPA was statistically significant (p<0.05). SNA showed an increase in both groups (p<0.9). Ar-B and Ar-Pog showed an increase in both groups and the differences between them were statistically significant. CONCLUSIONS: Mandibular advancement was achieved in both groups, but R-appliance achieved this result without lingual tipping of lower incisors. <![CDATA[<b>A comparative scanning electron microscopy evaluation of smear layer removal with apple vinegar and sodium hypochlorite associated with EDTA</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600016&lng=en&nrm=iso&tlng=en OBJECTIVE: The purpose of this study was to evaluate by scanning electron microscopy (SEM) the removal of smear layer from the middle and apical root thirds after use of different irrigating solutions. MATERIAL AND METHODS: Forty roots of permanent human teeth had their canals instrumented and were randomly assigned to 4 groups (n=10), according to the irrigating solution: apple vinegar (group A), apple vinegar finished with 17% ethylenediaminetetraacetic acid (EDTA) (group B), 1% sodium hypochlorite (NaOCl) finished with 17% EDTA (group C) and saline (group D - control). After chemomechanical preparation, the roots were cleaved longitudinally and their middle and apical thirds were examined by SEM at ×1,000 magnification. Two calibrated examiners (kappa=0.92) analyzed the SEM micrographs qualitatively attributing scores that indicated the efficacy of the solutions in removing the smear layer from the surface of the dentin tubules (1 - poor, 2 - good and 3 - excellent). Data from the control and experimental groups were analyzed by the Kruskal-Wallis and Dunn's test, while the Wilcoxon test was used to compare the middle and apical thirds of the canals within the same group (a=0.05). RESULTS: The middle third presented less amount of smear layer than the apical third, regardless of the irrigant. There was statistically significant difference (p=0.0402) among the groups in the middle third. In the apical third, the apple vinegar/EDTA group showed the greatest removal of smear layer (p=0.0373). CONCLUSION: Apple vinegar associated or not with EDTA was effective in removing smear layer when used as an endodontic irrigant. <![CDATA[<b>Bond strength of different endodontic sealers to dentin</b>: <b>push-out test</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600017&lng=en&nrm=iso&tlng=en OBJECTIVE: The aim of this in vitro study was to evaluate the bond strength of different root canal sealers to dentin. MATERIAL AND METHODS: Forty extracted single-rooted human teeth were examined and the coronal and middle thirds of the canals were prepared with a 1.50 mm post drill (FibreKor Post System, Pentron). The teeth were allocated in two experimental groups, irrigated with 2.5% NaOCl+17% EDTA or saline solution (control group) and instrumented using Race rotary files (FKG) to a size #40 at the working length. Then, the groups were divided into four subgroups and filled with Epiphany sealer (Group 1), EndoREZ (Group 2), AH26 (Group 3) and Grossman's Sealer (Group 4). After 2 weeks of storage in 100% humidity at 37ºC, all teeth were sectioned transversally into 2-mm-thick discs. Push-out tests were performed at a cross-head speed of 1 mm/min using a universal testing machine. The maximum load at failure was recorded and expressed in MPa. RESULTS: Means (±SD) in root canals irrigated with 2.5% NaOCl and 17% EDTA were: G1 (21.6±6.0), G2 (15.2±3.7), G3 (14.6±4.5) and G4 (11.7±4.1).Two-way ANOVA and Tukey's test showed the highest bond strength for the Epiphany's group (p< 0.01) when compared to the other tested sealers. Saline solution decreased the values of bond-strength (p<0.05) for all sealers. CONCLUSION: Epiphany sealer presented higher bond strength values to dentin in both irrigating protocols, and the use of 2.5% NaOCl and 17% EDTA increased the bond strength values for all sealers. <![CDATA[<b>Resistance to compression of weakened roots subjected to different root reconstruction protocols</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600018&lng=en&nrm=iso&tlng=en OBJECTIVE: This study evaluated, in vitro, the fracture resistance of human non-vital teeth restored with different reconstruction protocols. MATERIAL AND METHODS: Forty human anterior roots of similar shape and dimensions were assigned to four groups (n=10), according to the root reconstruction protocol: Group I (control): non-weakened roots with glass fiber post; Group II: roots with composite resin by incremental technique and glass fiber post; Group III: roots with accessory glass fiber posts and glass fiber post; and Group IV: roots with anatomic glass fiber post technique. Following post cementation and core reconstruction, the roots were embedded in chemically activated acrylic resin and submitted to fracture resistance testing, with a compressive load at an angle of 45º in relation to the long axis of the root at a speed of 0.5 mm/min until fracture. All data were statistically analyzed with bilateral Dunnett's test (α=0.05). RESULTS: Group I presented higher mean values of fracture resistance when compared with the three experimental groups, which, in turn, presented similar resistance to fracture among each other. None of the techniques of root reconstruction with intraradicular posts improved root strength, and the incremental technique was suggested as being the most recommendable, since the type of fracture that occurred allowed the remaining dental structure to be repaired. CONCLUSION: The results of this in vitro study suggest that the healthy remaining radicular dentin is more important to increase fracture resistance than the root reconstruction protocol. <![CDATA[<b>Stress analysis of a fixed implant-supported denture by the finite element method (FEM) when varying the number of teeth used as abutments</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600019&lng=en&nrm=iso&tlng=en OBJECTIVES: In some clinical situations, dentists come across partially edentulous patients, and it might be necessary to connect teeth to implants. The aim of this study was to evaluate a metal-ceramic fixed tooth/implant-supported denture with a straight segment, located in the posterior region of the maxilla, when varying the number of teeth used as abutments. MATERIAL AND METHODS: A three-element fixed denture composed of one tooth and one implant (Model 1), and a four-element fixed denture composed of two teeth and one implant (Model 2) were modeled. A 100 N load was applied, distributed uniformly on the entire set, simulating functional mastication, for further analysis of the SEQV (Von Mises) principal stresses, which were compared with the flow limit of the materials. RESULTS: In a quantitative analysis, it may be observed that in the denture with one tooth, the maximum SEQV stress was 47.84 MPa, whereas for the denture with two teeth the maximum SEQV stress was 35.82 MPa, both located in the region between the pontic and the tooth. CONCLUSION: Lower stresses were observed in the denture with an additional tooth. Based on the flow limit of the materials, porcelain showed values below the limit of functional mastication. <![CDATA[<b>Corrosion in Haas expanders with and without use of an antimicrobial agent</b>: <b>an <i>in situ</i> study</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600020&lng=en&nrm=iso&tlng=en OBJECTIVES: The purpose of this study was to evaluate in situ the occurrence of corrosion in the soldering point areas between the wire, silver brazing and band in Haas expanders. MATERIAL AND METHODS: Thirty-four 7-12-year-old patients who needed maxillary expansion with a Haas expander were randomly assigned to two groups of 17 individuals each, according to the oral hygiene protocol adopted during the orthodontic treatment: Group I (control), toothbrushing with a fluoride dentifrice and Group II (experimental), toothbrushing with the same dentifrice plus 0.12% chlorhexidine gluconate (Periogard®) mouthrinses twice a week. The appliances were removed after approximately 4 months. Fragments of the appliances containing a metallic band with a soldered wire were sectioned at random for examination by stereomicroscopy, scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS). Data were analyzed statistically by Fisher's test at 5% significance level. RESULTS: The analysis by optical microscopy revealed areas with color change suggestive of corrosion in the soldering point areas joining the band and the wire in all specimens of both groups, with no statistically significant difference between the groups (p=1). The peaks of chemical elements (Ni, Fe, Cr, O, C and P) revealed by EDS were also similar in both groups. CONCLUSION: Color changes and peaks of chemical elements suggestive of corrosion were observed in the soldering point areas between the wire, silver brazing and band in both control and experimental groups, which indicate that the 0.12% chlorhexidine gluconate mouthrinses did not influence the occurrence of corrosion in situ. <![CDATA[<b>The effectiveness of chemical denture cleansers and ultrasonic device in biofilm removal from complete dentures</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600021&lng=en&nrm=iso&tlng=en Adequate denture hygiene can prevent and treat infection in edentulous patients. They are usually elderly and have difficulty for brushing their teeth. OBJECTIVE: This study evaluated the efficacy of complete denture biofilm removal using chemical (alkaline peroxide-effervescent tablets), mechanical (ultrasonic) and combined (association of the effervescent and ultrasonic) methods. MATERIAL AND METHODS: Eighty complete denture wearers participated in the experiment for 21 days. They were distributed into 4 groups (n=20): (1) Brushing with water (Control); (2) Effervescent tablets (Corega Tabs); (3) Ultrasonic device (Ultrasonic Cleaner, model 2840 D); (4) Association of effervescent tablets and ultrasonic device. All groups brushed their dentures with a specific brush (Bitufo) and water, 3 times a day, before applying their treatments. Denture biofilm was collected at baseline and after 21 days. To quantify the biofilm, the internal surfaces of the maxillary complete dentures were stained and photographed at 45º. The photographs were processed and the areas (total internal surface stained with biofilm) quantified (Image Tool 2.02). The percentage of the biofilm was calculated by the ratio between the biofilm area multiplied by 100 and the total area of the internal surface of the maxillary complete denture. RESULTS: The Kruskal-Wallis test was used for comparison among groups followed by the Dunn multiple-comparison test. All tests were performed respecting a significance level of 0.05. Significant difference was found among the treatments (KW=21.18; P<0.001), the mean ranks for the treatments and results for Dunn multiple comparison test were: Control (60.9); Chemical (37.2); Mechanical (35.2) and Combined (29.1). CONCLUSION: The experimental methods were equally effective regarding the ability to remove biofilm and were superior to the control method (brushing with water). Immersion in alkaline peroxide and ultrasonic vibration can be used as auxiliary agents for cleaning complete dentures. <![CDATA[<b>Attitudes of a group of Brazilian orthodontists towards the diagnosis and management of primary headache (migraine)</b>: <b>an electronic-based survey</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600022&lng=en&nrm=iso&tlng=en OBJECTIVES: The aim of this study was to investigate the knowledge and attitudes of orthodontists in the diagnosis and management of migraine without aura. MATERIAL AND METHODS: Participants were dentists, recruited among members of the Brazilian Association of Orthodontics and Facial Orthopedics (ABOR). An e-mail was sent to all ABOR members, with a link to a website, especially prepared for this research. Dentists were presented to a report of a fictional patient fulfilling diagnostic criteria for a primary headache disorder, known as migraine without aura. Participants were asked to describe how they would relieve the patient's pain. Professional procedures were classified as "adequate" or "inadequate" according to the answers given. RESULTS: 161 valid answers were received (18.8% response rate). Of them, 36% of the actions were considered to be "adequate" procedures, while 64% were "inadequate". The results yielded 12 main procedures, based on common characteristics. Eighty-two orthodontists suggested orthodontic treatment with or without orthognathic surgery, and some suggested using stabilization appliances prior to the orthodontic treatment. CONCLUSIONS: The majority of participants proposed inadequate therapies, and 51% suggested orthodontic correction of occlusion, including orthognathic surgery. Educational activities on migraine should also target orthodontists. <![CDATA[<b>Speech therapy for compensatory articulations and velopharyngeal function</b>: <b>a case report</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600023&lng=en&nrm=iso&tlng=en The objective of this study was to describe the process of intensive speech therapy for a 6-year-old child using compensatory articulations while presenting with velopharyngeal insufficiency (VPI) and a history of cleft lip and palate. The correction of VPI was temporarily done with a pharyngeal obturator since the child presented with very little movement of the pharyngeal walls during speech, compromising the outcome of a possible pharyngeal flap procedure (pharyngoplasty). The program of intensive speech therapy involved 3 phases, each for duration of 2 weeks incorporating 2 daily sessions of 50 minutes of therapy. A total of 60 sessions of intervention were done with the initial goal of eliminating the use of compensatory articulations. Evaluation before the program indicated the use of co-productions (coarticulations) of voiceless plosive and fricative sounds with glottal stops (simultaneous production of 2 places of productions), along with weak intraoral pressure and hypernasality, all compromising speech intelligibility. To address place of articulation, strategies to increase intraoral air pressure were used along with visual, auditory and tactile feedback, emphasizing the therapy target and the air pressure and airflow during plosive and fricative sound productions. After the first two phases of the program, oral place of articulation of the targets were achieved consistently. During the third phase, velopharyngeal closure during speech was systematically addressed using a bulb reduction program with the objective of achieving velopharyngeal closure during speech consistently. After the intensive speech therapy program involving the use of a pharyngeal obturator, we observed absence of hypernasality and compensatory articulation with improved speech intelligibility. <![CDATA[<b>Erratum</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1678-77572011000600024&lng=en&nrm=iso&tlng=en The objective of this study was to describe the process of intensive speech therapy for a 6-year-old child using compensatory articulations while presenting with velopharyngeal insufficiency (VPI) and a history of cleft lip and palate. The correction of VPI was temporarily done with a pharyngeal obturator since the child presented with very little movement of the pharyngeal walls during speech, compromising the outcome of a possible pharyngeal flap procedure (pharyngoplasty). The program of intensive speech therapy involved 3 phases, each for duration of 2 weeks incorporating 2 daily sessions of 50 minutes of therapy. A total of 60 sessions of intervention were done with the initial goal of eliminating the use of compensatory articulations. Evaluation before the program indicated the use of co-productions (coarticulations) of voiceless plosive and fricative sounds with glottal stops (simultaneous production of 2 places of productions), along with weak intraoral pressure and hypernasality, all compromising speech intelligibility. To address place of articulation, strategies to increase intraoral air pressure were used along with visual, auditory and tactile feedback, emphasizing the therapy target and the air pressure and airflow during plosive and fricative sound productions. After the first two phases of the program, oral place of articulation of the targets were achieved consistently. During the third phase, velopharyngeal closure during speech was systematically addressed using a bulb reduction program with the objective of achieving velopharyngeal closure during speech consistently. After the intensive speech therapy program involving the use of a pharyngeal obturator, we observed absence of hypernasality and compensatory articulation with improved speech intelligibility.