Dissertations / Theses on the topic 'Diastermy'

Asymmetric phase-transfer catalysis is a powerful technique that enables a wide range of transformations under mild conditions, often using inexpensive and environmentally benign reagents. By extending the applications of phase-transfer catalysis we have developed a highly diastereo- and enantioselective synthesis of functionalized indolines bearing two contiguous stereocentres, one of which is quaternary and all carbon, in a single synthetic step. The reaction proceeds with complete diastereoselectivity and with high levels of enantioselectivity (up to 99% ee). Despite the development of phase-transfer catalysis as a primary synthetic tool in organic synthesis, the mechanistic understanding of these reactions still remains a challenge, due mainly to the difficulty of studying the complex multi-phase systems. Therefore, a further aim of this project was to understand the reaction mechanism of our phase-transfer catalysed transformation. Investigations into the mechanism of our phase-transfer catalysed reaction have been carried out by studying the reaction kinetics. These have shown that the reaction follows a sigmoidal curve with an induction period present. A detailed kinetic investigation was carried out which demonstrated that an autocatalytic mechanism is operational.

O objetivo deste estudo foi avaliar a estabilidade do fechamento dos diastemas interincisivos superiores, verificando sua correlacao com a largura inicial desses espacos, a sobressaliencia, a sobremordida e o paralelismo de raizes. A amostra foi composta por 30 pacientes com pelo menos um diastema, com largura minima de 0,77mm e media do somatorio dos tres diastemas interincisivos de 2,64mm (DP = 1,46; minimo= 0,77; maximo= 8,04). Todos os pacientes apresentavam os caninos superiores permanentes com, no minimo, a metade da coroa intrabucal. As mensuracoes foram realizadas em modelos de estudo (largura dos diastemas, sobressaliencia e sobremordida) e radiografias panorâmicas (paralelismo de raizes), obtidos nos estagios pre-tratamento, final de tratamento e, pelo menos, 2,4 anos pos-tratamento. Os resultados da analise de variancia para medidas repetidas demonstraram que a recidiva do diastema mediano foi significante (media= 0,45mm, DP= 0,66), mas foi estatisticamente menor do que sua largura inicial, e os diastemas entre os incisivos centrais e laterais permaneceram fechados, na maioria dos casos. Ocorreu recidiva do diastema mediano em 18 pacientes (60% da amostra) e 19 pacientes apresentaram reabertura de pelo menos um dos diastemas interincisivos. De acordo com a analise de regressao multipla, os unicos fatores associados a recidiva do diastema mediano foram a largura pretratamento deste espaco (p=0,000) e a alteracao da sobressaliencia durante o periodo pos-tratamento (p=0,046). Nao foi encontrada associacao entre o paralelismo de raizes e a recidiva dos diastemas interincisivos.
This study evaluated the stability of maxillary anterior diastemas closure and its association with relapse and dental casts variables (interincisor width, overjet and overbite) and also with root parallelism. Sample comprised 30 patients with at least one pretreatment anterior diastema of 0.77mm or greater after eruption of maxillary permanent canines. Data were obtained from dental casts and panoramic radiographs taken pretreatment, posttreatment and at least 2 years postretention. The sum of initial mean width of the diastemas was 2.64mm (SD=1.46, minimum=0.77). Repeated measures analysis of variance demonstrated significant relapse of median diastema (mean=0.45mm, SD=0.66) but this value was statistically slighter than its initial width, and closure of diastemas located between central incisors and lateral incisors showed great stability. Relapse of median diastema occurred in 18 cases, and 19 patients showed at least one space recurrence. Only initial diastema severity width and relapse of overjet showed association with the relapse of median diastema. There was no association between interincisor diastemas relapse and root parallelism.

Este trabalho teve como objetivo principal o estudo das maloclusões dos dentes incisivos em potros da raça Quarto de Milha, incluindo a revisão de literatura dos conceitos de oclusão, maloclusão, braquignatismo, prognatismo, sobressaliência e sobremordida. Objetivou-se determinar a prevalência de sobressaliências e analisar os resultados de acordo com idade, sexo e linhagem, assim como desenvolver técnicas simples de mensurações destas sobressaliências e dos diastemas, que pudessem ser aplicadas a campo e utilizadas para acompanhamento do crescimento das regiões rostrais de maxila e da mandíbula de potros. Foram utilizados 51 potros da raça Quarto de Milha, entre quatro e sete meses de idade. Resultados: a prevalência de lesões de sobressaliência foi de 50,98%. Dentre os animais afetados, 61,54% eram fêmeas e 38,46%, machos. Os potros de linhagem de conformação apresentaram maior prevalência de sobressaliência, pois dos 26 potros afetados, 50% eram desta linhagem. Foi observado que em 100% dos potros examinados, houve diferença entre as medidas dos diastemas superiores e inferiores. Pareceu haver um pico de crescimento uniforme dos diastemas entre quatro e cinco meses de idade, e a partir de cinco meses, as diferenças entre os diastemas superiores e inferiores aumentou gradativamente. Entre os potros de quatro meses, 44,44% apresentaram sobressaliência incisal, assim como 45,45% dos onze potros de cinco meses, 58,33% dos potros de seis meses e 60% dos potros de sete meses. Os métodos empregados para a mensuração dos diastemas e das sobressaliências incisais mostraram-se eficientes. Sem estudos cefalométricos é impossível confirmar o diagnóstico de braquignatismo e determinar em que região e se realmente existe a alteração de crescimento mandibular ou maxilar.
The main goal of this dissertation was to study incisor malocclusion in Quarter Horse foals, which included literature review of the terms occlusion, malocclusion, brachygnathism, prognathism, overjet and overbite. The purpose of this experiment was to determine overjet prevalence and analyse the results according to age, sex and lineage, as well as to develop simple field techniques for measuring incisor malocclusion and diastema that could be utilized to follow-up the growth of the rostral components of maxila and mandible. For this analysis, 51 Quarter Horse foals between four and seven months old were examined. Results: the prevalence of foals presenting overjet was 50,98%. Among these, 61,54% were females and 38,46% were males. Furthermore, show lineages foals presented overjet more commonly than the other lineages, as 50% of the 26 affected foals belonged to show lineages. All of the examined foals presented dysparities between the measurements of maxilary and mandibular diastemas. It seemed that there is a peak of diastema uniform growth between the ages of four to five months, but the differences between the superior and inferior diastemas seemed to increase as the age advanced. Among the four months old foals, 44,44% were affected, as well as 45,45% of the 11 foals of five months old, 58,33% of the foals of six months old and 60% of seven months old. The developed method for measurements of the diastema was considered efficient. Overjet was found to be common among Quarter Horse foals, specially among show lineages. Without further cephalometric studies, it is impossible to confirm the diagnosis, and to determine where or if there is an abnormality in the jaw.

Orientador: Ester Maria Danieli Nicola
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A presença de freio anômalo, tanto labial superior como lingual, pode desencadear uma série de alterações do ponto de vista ortodôntico e fonatório. Quando é indicada a remoção cirúrgica dos freios, denominada frenectomia, o profissional dispõe de diversas técnicas convencionais padronizadas, desenvolvidas com o objetivo de melhorar os resultados clinicos e minimizar os efeitos indesejáveis, presentes em cirurgias convencionais sob anestesia local, mesmo que considerados procedimentos simples. Os principais efeitos observados nas cirurgias de tecido mole realizadas com o uso de bisturi e lâmina fria, são a dor e o sangramento que, embora de pequena intensidade, leva, na maioria das vezes, à necessidade de sutura. O manuseio cirúrgico resulta em edema pós-operatório, acompanhado ou não de hematomas e necessidade de medicação analgésica e/ou antinflamatória. Considerando que a maioria dos pacientes submetidos a este tipo de cirurgia é constituída de crianças de 3 a 8 anos de idade e que, geralmente, pouco colaboram para a realização de uma intervenção mais invasiva, é sempre desejado um procedimento mais rápido, igualmente eficiente e com um pós-operatório de melhor qualidade. O laser de C02, devido à interação com os tecidos biológicos, apresenta-se como excelente instrumento para este tipo de cirurgia, minimizando e/ou eliminando os fatores adversos citados. O presente trabalho traz ampla revisão bibliográfica sobre o assunto, explica, brevemente, a fisica do laser e sua interação com os tecidos biológicos, propõe e padroniza uma técnica para realização de frenectomias labiais e linguais, descrevendo a relação destes freios com as funções ortodônticas e fonoarticulatórias, salientando a importância de um tratamento precoce. A técnica cirúrgica com laser de C02, bem como a indicação e as vantagens para cada uma das situações, serão apresentadas na forma de dois trabalhos independentes
Abstract: The presence of an anomalous frenum, either labial or lingual, can promote many orthodontics and/or speech disorders. When the surgery, so called frenectomv, is done, the professionals have a lot of conventional and standardized techniques that were developed to obtain better clinical results and reduce the effects of the surgery, that although simple, presents all the effects of any small conventional surgery, under local anesthesia. The main effects observed in soft tissue surgeries with scalpel are pain and bleeding which, even present in low intensity, needs suture. The tissue manipulation results in post-operative edema, with or without hematoma and requires analgesic and antinflammatory medication. Considering that the majority of patients submitted to frenectomy are children 3-8 years old which , usually, do not co-operated with the surgery, a quick and efficient procedure, with better post-operative sintoms is always desired. The CO2 laser, through its biologic tissue interaction, is an excellent instrument to this type of surgery, reducing and/or eliminating the adverse factors. The present work shows a large bibliographical revision about the frenum, explains shortly the laser physics, propose and standardize a technique to lingual and labial frenectomies. It also discuss the frenum relationship with orthodontic and speech function, emphasizingthe advantages of early treatment. The surgical technique with CO2 laser, as well as the indication and advantages of each situation, will be presented as 03 independent articles
Mestrado
Ciencias Biomedicas
Mestre em Ciências Médicas

Le travail presente dans ce memoire concerne la synthese diastereo-et enantioselective des 2,3-methanoaminoacides naturels et non naturels, de configuration (1s,2s). La preparation de ces composes a ete realisee par transfert de chiralite a partir d'un substrat naturel et asymetrique issu : le l-lactate d'ethyle. La premiere partie decrit une nouvelle voie d'acces aux derives des 2-vinylcyclopropanecarbonitriles racemiques hautement fonctionnalises, precurseurs des 2,3-methanoaminoacides et autres produits naturels. Ils sont obtenus diastereoselectivement et avec de bons rendements chimiques par des reactions en tandem d'alkylation et de cyclisation catalysees par le palladium(0). Les syntheses asymetriques ont ete effectuees a partir, soit : - d'un derive chiral non racemique du 1,4-dichlorobut-2-ene, - d'un catalyseur asymetrique, - d'une imine chirale non racemique derivee de la 2-hydroxy-3-pinanone. Aucune de ces strategies de syntheses n'a pu etre totalement enantioselective. Dans la deuxieme partie, nous proposons l'etude de la stereoselectivite des reactions en tandem a partir d'un complexe -allylique de palladium modelise et minimise par calculs de mecanique moleculaire. Nous avons mis en evidence, par une etude chimique, la reversibilite de la cyclisation, catalysee par le palladium(0), conduisant alors a une epimerisation. Une nouvelle voie d'acces tres generale aux 2,3-methanoaminoacides est proposee dans la troisieme partie de ce memoire. La cyclisation interne est realisee par une reaction intramoleculaire dans les conditions de mitsunobu a partir d'un alcool allylique asymetrique derive du l-lactate d'ethyle, compose naturel, commercial et abondant. Une excellente diastereoselectivite et un parfait transfert de chiralite ont ete obtenus par cette methodologie et ont permis la synthese asymetrique de l'acide (1s,2s) homocoronamique. La generalisation de cette methode a ete abordee et partiellement realisee.

Memoria para optar al Título Profesional de Médico Veterinario
Los diastemas (separaciones patológicas entre dientes) y la enfermedad periodontal son unas de las afecciones más dolorosas en la cavidad oral equina, ambos de carácter crónico y progresivo, por lo que el reconocimiento temprano, en un examen físico rutinario por parte de un médico veterinario dedicado a equinos, es fundamental. El objetivo de este estudio fue asociar ambas entidades para facilitar el diagnóstico de enfermedad periodontal, pesquisando la presencia de diastemas. Se realizaron periodontogramas y se registraron diastemas y alimento retenido entre dientes, en 200 cabezas de caballo criollo mayores a 5 años beneficiados en una planta faenadora en Quilpué (Valparaíso, Chile), encontrándose una prevalencia de 81,5% de animales con diastemas, con una media de 2,1 diastemas por animal, y una prevalencia de 54% de caballos afectados por enfermedad periodontal. El 70% de los diastemas presentaba alimento retenido en el espacio. La mayoría de los diastemas se encontraron entre molares y premolares de maxila. La literatura describe prevalencias de diastemas entre 1 y 85% y de enfermedad periodontal entre 30 y 60%, pero las muestras en edad, raza, manejo y procedencia difieren con el presente estudio y entre las investigaciones publicadas. Para estudiar asociación se trabajó con test de Chi cuadrado (y sus correcciones si correspondía) y Odds Ratio, con nivel de significancia de p < 0,05, e IC 95%. Se encontró una asociación estadísticamente significativa entre diastemas y enfermedad periodontal, y entre diastemas con enfermedad periodontal y retención de alimento en el espacio. Los caballos con diastema tienen 8,64 veces más riesgo de presentar enfermedad periodontal que aquéllos que no los tienen, y el riesgo es mayor 171,22 veces de que si una unión interproximal se encuentra diastemada de forma patológica, presente enfermedad periodontal. Un diastema con enfermedad periodontal presenta 13,92 veces más riesgo de presentar alimento retenido en el espacio que un diastema sin este signo. Se observa que existe una asociación estadísticamente significativa entre sexo y presencia de diastemas, pero no entre sexo y presencia de enfermedad periodontal. La muestra utilizada es restringida, pero se establece una base para nuevas líneas de investigación donde se evalúe la prevalencia y asociación estudiadas en este trabajo, según la edad individual de los caballos, su actividad deportiva, raza y alimentación entre otras.
Diastemata (pathological gaps between teeth) and periodontal disease -both chronic and progressive- are two of the most painful conditions in the equine oral cavity. Therefore, early recognition of these conditions in a routine oral check up by an equine veterinarian is essential. The aim of this study was to associate both conditions to facilitate the diagnosis of periodontal disease, by looking for the presence of diastemata. Periodontograms were performed and diastemata and food packed between teeth were examined and recorded in 200 heads of mixed breed horses older than 5 years in a slaughterhouse in Quilpué (Valparaíso, Chile). 81.5% of animals were affected with diastemata, with an average of 2.1 diastemata per animal, mostly found between maxillary molars and premolars. A prevalence of 54% of horses affected by periodontal disease was found. 70% of diastemata presented food packed in the gap. Literature describes prevalence of diastemata between 1 and 85% and of periodontal disease between 30 and 60%, but the animals used in this study differ from those in published research in age, breed, handling and origin among others. To study the association, Chi square test (and its corrections, if applicable) and Odds Ratio, with significance level of p < 0.05, and 95% CI, were used. A statistically significant association was found between diastemata and periodontal disease, and between diastemata with periodontal disease and food packing in the gap. Horses with diastemata have 8.64 times more chances of having periodontal disease, compared to those without diastemata, and the risk of periodontal disease in an interproximal junction is 171.22 times greater if it is pathologically diastemated. Chances of finding food packed in the gaps are 13.92 times greater when the diastema also presents periodontal disease. A statistically significant association was noticed between the sex and the presence of diastemata, but not between the sex and periodontal disease. The sample used is limited, but it establishes a basis for new branches of research where the prevalence and association analyzed in this study could be evaluated on horses, according to their individual age, sports activity, breed and feeding among others.

Memoria para optar al Título Profesional de Médico Veterinario
Los diastemas interproximales corresponden a un espacio anormal entre dientes, estos pueden ser de dos tipos, abiertos y cerrados, y que, debido a sus características anatómicas, parecieran generar distintos efectos en la evolución del cuadro. Debido a que estas características permiten en menor o mayor medida la retención de alimento, al no ser eliminada de estos espacios anormales, va progresando hacia una enfermedad periodontal, resultando así ser unas de las patologías orales más dolorosas en los equinos. Por lo tanto, su prevención y/o tratamiento oportuno es fundamental para evitar las consecuencias en el bienestar del ejemplar. El presente estudio tuvo por objetivo establecer la prevalencia de estas dos formas de diastemas, y la asociación entre los dos tipos y la enfermedad periodontal. La metodología utilizada para llevar a cabo esta investigación, consistió en realizar periodontograma en 200 cabezas de caballos criollos en una planta faenadora en Quilpué, Valparaíso. Los animales examinados que fueron incluidos en el estudio correspondían a mayores de 5 años; es decir, animales con dentadura definitiva completa. Dentro de los resultados obtenidos se observó que un 81,5% presentó diastema, donde 42,8% de los diastemas correspondieron al tipo abierto y un 57,2% a diastemas cerrados. La ubicación con mayor prevalencia se encontró en los dientes posteriores en la maxila para ambos tipos de diastemas. Un 8% de los diastemas abiertos y un 37% de los diastemas cerrados presentaron enfermedad periodontal. De los diastemas abiertos un 44,1% presentó retención de alimento, y en el caso de los diastemas cerrados el 90% retenía alimento. Para establecer la asociación se usó el test de Chi cuadrado y Odds Ratio, con un nivel de significancia de p < 0,05, e IC 95%, resultando ser estadísticamente significativo, donde los caballos con diastema abierto se asociaron a una menor presentación de periodontitis; es decir, siendo un factor protectivo. Los caballos con diastemas cerrados tienen 3,99 veces más riesgo, y, los que presentaron ambos tipos de diastemas, 7,02 veces más riesgo. Las hembras mostraron mayor prevalencia de presentación para ambos tipos de diastemas; sin embargo, se determinó que no existe una asociación estadísticamente significativa entre los tipos de diastemas y el sexo de los ejemplares.
The interproximal diastema is an abnormal space between teeth and it, can be of two types, open and closed, and, due to their anatomical characteristics, seems to generate different effects in the evolution of the periodontal disease. This, because these characteristics allow in smaller or greater quantity the retention of food, which is not eliminated from these abnormal spaces, progressing to a periodontal disease, resulting to be one of the most painful oral diseases in horses. Therefore, its prevention and timely treatment is essential to avoid the consequences on the welfare of the patient. The objective of this study was to establish the prevalence of these two forms of diastema, and the determination of association between the two diastemas types and periodontal disease. The methodology used was to perform a periodontogram on 200 horses heads in a slaughtering plant in Quilpué, Valparaíso. The examined animals that were included in the study were those older than 5 years; (animals with complete definitive teeth). Within the obtained results it was observed that 81.5% presented diastema, whereas 42.8% of the diastema was of the open type and, 57.2% closed diastemas. The location with the highest prevalence diastema was found in the posterior teeth in the maxilla for both types of diastema. Eight percent of the open diastemas and, 37% of the closed diastema presented periodontal disease. Of the open diastema, 44.1% had food retention, and in the case of closed diastema, 90% retained feed. To establish the association, the Chi square test and Odds Ratio were used, with a level of significance of p <0.05, and 95% CI. Statistically significant results, were found in horses with open diastema that were associated with a lower presentation of periodontitis; that is, being a protective factor. Horses with closed diastemas had 3.99 times more periodontitis risk, and horses that presented both types of diastemas, had 7.02 times more periodontitis risk. The females showed a higher prevalence of presentation for both types of diastema; however no statistically significant association between the types of diastemata and the sex of the horses was found.

A formal synthesis of eurylene (1.1) has been achieved where both trans- and cis-THF fragments were synthesised using diastereo- and chemoselective oxidative monocyclisations of triene systems. Synthesis of the trans-THF aldehyde fragment 1.50 of eurylene was accomplished starting from nerol, using (+)-trans tritylcyclohexanol (TTC) as a chiral auxiliary to direct the stereosfacial selectivity during the oxidative cyclisation of 1,5,9-triene 1.185 by sodium permanganate. The oxidative cyclisation used the new chiral auxiliary (TTC) as a highly effective chiral controller for the formation of the 2,5-substituted THF diol product with high diastereoselectivity (dr ∼13:1). Synthesis of cis-THF right hand fragment 1.189 was also achieved using permanganate mediated oxidative cyclisation of a 1,5,9-triene 1.60. The diastereoselectivity of the oxidation was controlled by using (2S)-10,2 camphorsultam as a chiral auxiliary. Consequently, seven, out of eight, stereogenic centres of eurylene were established by stereoselective permanganate oxidative cyclisations of 1,5,9-trienes. Towards the completion of the total synthesis of eurylene a chiral sulfoxide strategy was investigated to establish the eighth stereogenic centre and couple the two fragments. In addition a hydroxylsulfone dianion coupling strategy was also investigated. The stereochemical correlation for oxidative cyclisation products from trans-cumylcyclohexanol (TCC) and trans-tritylcyclohexanol (TTC) diene and triene esters was achieved. The oxidative cyclisation products were converted to a common intermediate and analysed by chiral HPLC to confirm absolute configuration. NOESY and NOE NMR studies were applied to some of 2 substituted cyclohexyl dienoates and an oxidative cyclisation product to study their conformation in solution.

Les 2-chloro-3-aryl ou alkyl-3-oxopropionates sont reduits par des microorganismes en syn et/ou anti 2-chloro-3-hydroxyesters. Suivant l'espece utilisee, il est possible d'obtenir les chlorohydroxyesters enantiomeriquement purs. Ces composes peuvent etre convertis stereospecifiquement en esters glycidiques correspondants. L'ouverture regioselective des epoxyesters peut mener a la preparation de la 3-phenylisoserine, qui est le precurseur de la chaine laterale du taxotere

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The purpose of this study was to determine the prevalence of type I, II and mixed arches and primate spaces in children that attended Health Centers in Ponta Grossa, Brazil. The sample consisted of 219 children of both genders between 24 and 50 months old. The inclusion selection criteria used was: presence of 20 deciduous teeth with no visible interproximal caries lesions, no open nor crossbite and with no previous arch treatment. Primate spaces were present on the four hemiarchs in 65% of the sample; also, the prevalence of primate spaces on the upper arch was higher (16%) than the lower (3%). Differences in the frequency of the arch types were minor, with discrete predominance of the type I arch and equal prevalence of type II arch and mixed. The distribution of the arch types and primate space in both groups (24 to 36 months and 37 to 50 months) was homogeneous. Concerning gender, there was no statistical significant difference between male and females. It is suggested that service given by Public Health centers to preschoolers should encourage education and parent orientation on the preventive attention to this children, with trained and specialized personal. These measures could contribute to the improvement of the oral health quality significantly, reducing future malocclusion incidence.
RESUMO Esta pesquisa objetivou avaliar a prevalência dos arcos tipos I, II e misto e de espaços primatas em crianças que freqüentavam algumas Unidades de Saúde e creches da cidade de Ponta Grossa. Foram incluídas no estudo 219 crianças de ambos os sexos na faixa etária de 24 a 50 meses. Os critérios de inclusão consideraram a presença de vinte dentes decíduos em oclusão, sem lesões cariosas interproximais visíveis, ausência de mordida aberta ou cruzada e sem relato de tratamento ortodôntico prévio. Os resultados mostraram a prevalência de 39%, 32% e 29% para os arcos do tipo I, II e misto, respectivamente. Os espaços primatas estavam presentes com maior freqüência nos quatro hemi-arcos (65%) e foi maior a ocorrência bilateral para o arco superior (16%) do que para o inferior (3%). Concluiuse que as diferenças entre os arcos do tipo I, II e misto foram pequenas, com discreto predomínio do arco do tipo I e equivalência entre os arcos do tipo II e misto, nas crianças examinadas. A distribuição dos tipos de arcos e de espaços primatas em duas faixas etárias (24 a 36 meses e 37 a 50 meses) foi homogênea. Quanto ao gênero, verificou-se também uma distribuição uniforme dos tipos de arcos e de espaços primatas, pois não houve diferença estatisticamente significante entre meninos e meninas. A atenção especial dos serviços públicos e particulares aos préescolares, promovendo educação e orientação aos pais, no que tange à assiduidade nas unidades de saúde, levando as crianças para atendimento clínico preventivo, com pessoal treinado e especializado, são medidas que podem contribuir para a melhoria da qualidade de saúde bucal dessas crianças, reduzindo assim, os índices de más oclusões futuras.

Ce memoire presente la synthese diastereo- et enantioselective de 2,3-methanoaminoacides non naturels. L'originalite de notre methode resulte de l'utilisation des complexes -allyliques du palladium des esters de 1-vinylcyclopropanols de preparation relativement aisee, permettant l'acces aux 2,3-methanoaminoacides. La premiere partie decrit la synthese asymetrique de l'acide (1r, 2s)-allonorcoronamique a partir du (2s)-3-hydroxy-2-methylpropanoate de methyle. Les proprietes de l'hemiacetal de la cyclopropanone ont ete exploitees, permettant de realiser des substitutions nucleophiles hautement diastereoselectives. L'azidation d'esters de 1-vinylcyclopropanols catalysee par le palladium(0) a egalement ete etudiee. Dans la deuxieme partie, nous nous sommes interesses a la preparation de l'acide (z)-coronamique. Celle-ci a ete realisee en utilisant une reaction d'hydroxycyclopropanation induite par le titane(iv), reaction totalement diastereoselective en faveur du cyclopropanol (z). Nous avons egalement etendu cette methodologie a la synthese de l'acide (z)-methanobishomoserine. La troisieme partie relate la synthese de complexes chiraux de titane(iv) de facon a les utiliser dans des reactions d'hydroxycyclopropanation induite par le titane(iv). Seul le taddol a permis d'obtenir un exces enantiomerique, relativement faible cependant. Des etudes sont en cours pour ameliorer ces resultats.

Des reactions de photocycloaddition 2+2 a partir d'enones cycliques ont ete realisees a partir de la (5r)-5-menthyloxy-2-5h-furanone. Le choix de certaines enones cycliques permet le controle de la selectivite faciale sur la menthyloxyfuranone, mais le nombre important d'isomeres obtenus rend ces reactions insuffisamment selectives. L'irradiation de cetones aromatiques substituees se revele etre une methode efficace et selective d'initiation pour l'addition radicalaire d'amines tertiaires sur la menthyloxyfuranone. La selectivite faciale est complete dans tous les cas. Une optimisation des conditions de la reaction avec la methylpyrrolidine a permis d'obtenir des rendements pratiquement quantitatifs. L'application de cette methode a des amines tertiaires insaturees ou aromatiques engendre la formation de produits azotes polycycliques en une seule etape. Dans le cas des amines tertiaires insaturees, seul les derives allylique ou propargylique de la pyrrolidine disubstitues en de l'azote permettent une addition radicalaire tandem donnant acces a des indolizidines ou des perhydroazaazulenes. Avec les amines aromatiques, des produits parasites sont egalement formes. Un marquage isotopique demontre que les produits parasites sont une consequence de la rearomatisation d'intermediaires radicalaires. L'introduction d'acetone en exces dans le milieu reactionnel provoque la disparition des produits parasites et augmente considerablement le rendement en produit polycyclique azote. La synthese enantiospecifique de produits naturels est applicable a l'addition radicalaire d'amines tertiaires. Ainsi, deux pyrrolizidines, le ()-isoretronecanol et la (+)-laburnine, et une indolizidine, la base de l'enantiomere de la stellettamide a, sont accessibles en quatre etapes a partir de la menthyloxyfuranone. Une version intramoleculaire permet d'acceder en une seule etape a l'heliotridane racemique.

Fraturas do diastema mandibular são cirurgicamente mais desafiadoras porque, geralmente são bilaterais, instáveis e altamente contaminadas. Como cada fratura tem características particulares e são únicas, o conhecimento de diferentes técnicas de reparo permitirá que ao veterinário escolher um método de fixação mais adequado à configuração da fratura, considerando os equipamentos disponíveis, a expertise e preferências do cirurgião. O objetivo deste estudo foi avaliar 2 técnicas de fixação de fraturas do diastema mandibular por meio da mensuração de suas características biomecânicas. Mandíbulas osteotomizadas no diastema foram divididas em 2 grupos de fixação (n=8). As mandíbulas foram fixadas com placas bloqueadas (LCP) e por meio de implantes transdentários com placas LC-DCP. Oito mandíbulas intactas (não osteotomizadas) foram submetidas aos ensaios biomecânicos como controle. As mandíbulas foram submetidas à ensaios biomecânicos de flexão até ocorrer a falha. O deslocamento angular (radianos) foi derivado a partir contínua mensuração da largura da fenda com extensometros inseridos ao redor do local da osteotomia. Foram selecionados os dados da fenda da osteotomia a 50 e 100 N.m para comparação padronizada da largura da fenda antes dos pontos de limite elástico e limite de flexão máximo, respectivamente para as 2 técnicas de fixação testadas. Rigidez (N.m/radiano), limite elástico (N.m) e limite de flexão máximo (N.m) foram determinados a partir das curvas de deslocamento angular da flexão e foram comparadas por meio do teste estatístico ANOVA com testes adicionais quando indicado. Foram obtidas imagens radiográficas pré fixação das mandíbulas. Os dentes submetidos à implantes transdentários foram submetidos à exames tomográficos e foram obtidos cortes histológicos calcificados. As cargas de resistência à flexão, de limite elástico e de limite de flexão máximo foram maiores nas mandíbulas intactas. Nas mandíbulas osteotomizadas as cargas de resistência à flexão, de limite elástico, de limite de flexão máximo e da largura da osteotomia à 50 e 100 N.m não foram significantemente diferentes (P>0,05) nas fixações com placas LCP e implantes transdentários com placas LC-DCP. Estas técnicas foram biomecânicamente similares. A fixação com placas LCP transdentários com placas LC-DCP são uma forma estável de fixação de fraturas localizadas no diastema mandibular. Em alguns casos, a cavidade pulpar (71% em dentes incisivos e 43% em dentes pré molares) foi penetrada pelos implantes transdentários. Estudos adicionais com animais vivos devem ser realizados para determinar as consequências a longo prazo do uso de implantes transdentários.
Mandibular fractures of the interdental space are surgically more demanding because they are often bilateral, unstable, and heavily contaminated. Because each fracture is unique, knowledge of the different repair techniques will allow the practitioner to choose a repair method best suited to the fracture configuration, equipment available, and the skill level and preferences of the surgeon. The aim of this study was to evaluate 2 fixation techniques for equine interdental space fractures by mensuration their biomechanical characteristics. Mandibles with interdental osteotomies were divided into 2 fixation groups (n = 8/group). Fixation techniques were the locking compression plates (LCP) and (2) Trans-Dental low contact - dynamic compression-plate fixation (Trans dental LC-DCP). Eight intact (nonosteotomized) mandibles were tested as controls. Mandibles were subjected to monotonic cantilever bending until failure. Angular displacement data (radians) were derived from continuously recorded gap width measurements provided by extensometers placed across the osteotomy site. Osteotomy gap width data (mm) at 50 and 100 Nm were selected for standardized comparison of gap width before the yield point and failure point, respectively of all constructs tested. Stiffness (Nm/radian), yield strength (Nm), and failure strength (Nm) were determined from bending moment-angular displacement curves and were compared using ANOVA with appropriate post hoc testing when indicated. Radiographs were obtained prefixation. Axial tomography and calcified histological cuts were obtained of the teeth submited to trans dental screws implant. Bending stiffness, yield, and ultimate failure loads were greatest for intact mandibles. Among osteotomized mandibles, stiffness, yield, ultimate faluire, and osteotomy gap width at 50 and 100 Nm was not significantly different (P>0,05) among LCP and trans dental LC-DCP constructs. They were biomechanically similar. LCP and trans dental LC-DCP fixation are stable form of fixation for interdental space fractures. In some cases the pulp cavity was penetrated (incisors teeth, 71% and check teeth, 43%) by trans dental implants. Additional studies with live animals must be performed to determine the long term consequences of adhibition the trans dental implants.

Ce travail a consiste en l'extension de la reaction de michael des imines chirales aux cyclanones fonctionnalisees et aux olefines electrophiles substituees. Ainsi, une etude de la fonctionnalisation de cyclanones en diverses positions par rapport au groupe carbonyle a montre que lorsque celle-ci est en position beta ou alpha', l'imine chirale correspondante est tres peu reactive vis-a-vis des olefines electrophiles. Par contre lorsque la fonctionnalisation est en position gamma, l'imine chirale correspondante a conduit a des synthons chiraux polyfonctionnels avec des rendements et des enantioselectivites eleves. L'utilite de ces derniers a ete illustree par la preparation d'un compose de symetrie c#2, par une approche des cycles cd de steroides et par les premieres syntheses enantioselectives totales de deux composes, dont le (-)-polywood, tres importants en parfumerie. Une synthese enantioselective totale du (-)-tmd, un inhibiteur de la biosynthese du cholesterol, a ete egalement effectuee. La seconde partie a consiste en une etude systematique de la reaction des imines chirales avec des olefines electrophiles substituees. Elle a montre que dans tous les cas, la stereochimie de l'adduit majoritaire est en accord avec le modele theorique et avec la regle de selectivite diastereofaciale. De plus, la reaction d'addition a bien lieu sous controle cinetique. L'augmentation de la temperature ou de l'electrophilie de l'olefine entraine une diminution notable de la regioselectivite. Ce travail a ete illustre, dans le domaine des eremophilanes, par les premieres syntheses enantioselectives du (+)-valenc-1(10)-en-7alpha-ol et de la (+)-alpha-vetivone, un principe odorant de l'huile essentielle de vetiver. Enfin, l'utilisation de l'ethylidenemalonate de methyle a montre que dans le complexe d'approche des reactifs, le substituant en de l'olefine se place dans une orientation de type exo

Le système spirocyclique (7,5) est un motif récurrent dans un certain nombre de produits naturels tels que les Micrandilactones ou les Rubriflordilactones. Ces structures polycycliques représentent un réel défi synthétique pour les chimistes organiciens puisqu'elles présentent au moins neuf centres stéréogènes dont plusieurs sont quaternaires. L'objectif principal de ce travail était de développer de nouvelles réactions de cycloaddition [3+2] et de les utiliser comme étape clé afin d'obtenir rapidement et efficacement le squelette polycylique de ces composés. La première partie de ces travaux a été consacrée au développement d'une réaction de cycloaddition [3+2] intra- et intermoléculaire mettant un jeu un nouveau partenaire dipolarophile, les γ-alkylidènes-buténolides. Cette étape clé conduit à la formation de cycloadduits hautement fonctionnalisés de façon rapide et efficace avec d'excellents rendements et de façon hautement chimio-, régio- et diastéréosélective. De plus, des calculs théoriques ont permis d'appréhender le mécanisme réactionnel entre un 2-diazo-1,3-cétoester et la protoanémonine catalysé par un sel de rhodium mis en jeu dans ce type de processus et ainsi d'expliquer les résultats obtenus.Dans une deuxième partie, deux approches aux cœurs ABC et CD de la micrandilactone C ont été développées mettant respectivement en jeu une cycloaddition [3+2] formellement intermoléculaire utilisant un lien de type acétal de silicium et suivie par une réaction de Diels Alder. Ainsi, le motif tétracyclique devrait être rapidement accessible après quelques aménagements de la voie de synthèse initiale
The spiro (7, 5) ring system is a recurring structural moiety in numerous natural products such as Micrandilactones and Rubriflordilactones. In term of complexity, these polycyclic structures represent a synthetic challenge for organic chemist. Indeed, these molecules present at least nine stereogenic centres including several quaternary ones. The main goal of this work was to use unprecedented partners in the [3+2] cycloaddition reaction to obtain quickly and efficiently the polycyclic core of those natural products. The first part of these studies was dedicated to the development of an intra- and intermolecular [3+2] cycloaddition using for the first time a γ-alkylidene-butenolide dipolarophile. This approach provides rapid and facile access to highly functionalised polycyclic molecules along with excellent regio-, chemo- and stereoselectivities. In addition, thanks to computational studies an overall picture of the mechanism of the intermolecular rhodium catalysed [3+2] cycloaddition between 2-diazo-1,3-ketoester and protoanemonin was apprehended, and experimental results have been rationalised.Finally, two approaches to the ABC and CD cores of Micrandilactone C were developed using respectively a formal intermolecular [3+2] cycloaddition reaction in presence of a silicon acetal linker followed by a Diels Alder reaction. The ACDE tetracyclic moiety should be quickly accessible after few modifications of the initial strategy

Diastema é o espaço, ou ausência de contato entre dois ou mais dentes consecutivos, tanto na arcada superior quanto inferior, tendo maior frequência entre incisivos centrais superiores permanentes, quando então é chamado de ``Diastema Mediano Superior``. O melhor conhecimento sobre as patologias frequentes em saúde bucal permite ao clinico maiores ferramentas para solucionar de forma adequada os anseios dos pacientes. A presente revisão bibliográfica teve como objetivo principal proporcionar uma visão geral sobre o Diastema Mediano Superior, com o propósito de determinar a etiologia, bem como o correto diagnóstico, além de discutir as formas de tratamento, e elucidar formas de prevenir esta má oclusão. Para sua elaboração foi realizada uma pesquisa bibliográfica entre janeiro de 2018 a maio de 2018, nas bases de dados Pubmed, b-on, e Scielo. A partir da revisão bibliográfica podemos tirar a conclusão que o correto diagnóstico da etiologia dos diastemas é fundamental para definir o tratamento adequado. As informações sintetizadas sobre a temática, e a integração das especialidades para o tratamento desta patologia permite ao médico dentista adequar a necessidade real do paciente, aumentando o leque de alternativas para o correto tratamento.
Diastema is known as space or absence of contact between two or more consecutive teeth, and may occur anywhere in the upper or lower arches, although it has more frequency in anterior region of maxilla, between superior incisor, been called ``Superior median diastema``, dentists need to know all alternatives to provide patients a correct treatment for Diastema. This bibliographic review aims to present an overview about Midline Superior Diastema, determining its etiology, as well the correct diagnosis, try to discuss treatment options and elucidate ways to prevent this malocclusion. A literature search was done between January and May 2018, performed in Pubmed, b-on, e Scielo. From this bibliographical review it can be concluded that an effective diagnosis by etiology of the midline diastema is primordial to direct an effective treatment. The information synthesized on the subject, and the integration of specialties for the treatment of this pathology allows the dentist to adjust the real need of the patient.

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Introdução: Perante uma sociedade preocupada com a estética, torna-se cada vez mais difícil agradar todos pacientes nas consultas de medicina dentária. Os conceitos de beleza são subjetivos, pelo que é necessário ouvir os desejos e exigências de cada paciente em particular. O diastema interincisivo tem tido um papel cada vez mais controverso nos dias de hoje, uma vez que tanto pode ser visto como uma característica inestética ou, antes pelo contrário, como algo desejado ou a manter. Objetivos: Este estudo pretendeu compreender as diferentes noções de estética, ou semelhanças, de três populações distintas em relação ao diastema interincisivo e a necessidade, ou não, de tratamento. Materiais e Métodos: Tendo como base 8 indivíduos com diastema interincisivo, foi feito um levantamento de fotografias do terço inferior da face dos mesmos com um sorriso social. Foi elaborado um questionário de perceção estética e de avaliação de necessidade de tratamento, submetido a 139 participantes, dos quais 45 eram alunos do Instituto Universitário Egas Moniz do M.I. de Ciências Farmacêuticas (1º, 2º ou 3º ano), 50 eram alunos do Instituto Universitário Egas Moniz que frequentam o 5º ano do M.I. de Medicina Dentária e, por último, 44 Médicos Dentistas formados há 5 anos ou mais no Instituto Universitário Egas Moniz. Os dados recolhidos foram analisados estatisticamente utilizando o programa SPSS Statistical Package for the Social Sciences. Resultados: Os resultados obtidos revelam diferentes níveis de perceção entre os 3 grupos, apesar de não serem significativos. O grupo formado por Médicos Dentistas foi o mais crítico avaliando quase todas as fotografias com valores inferiores. Nalgumas fotografias houve semelhanças entre o grupo de leigos e os experientes em Medicina Dentária. Conclusões: A estética dentária apresenta um caráter subjetivo e as diferenças nas opiniões relativas a este diastema vão sempre existir, mas a decisão final sobre o tratamento, ou não, deste cabe apenas à pessoa que o tem.
Introduction: Living in a society concerned with aesthetics, it becomes increasingly difficult to please all patients in dental clinics. The concepts of beauty are subjective, so it is necessary to listen to the desires and requirements of each patient in particular. The midline diastema has played a controversial role these days, since it can be seen as an ugly feature or as something desired or to be maintained. Objectives: This study intends to understand the different notions of aesthetics, or similarities, of three distinct populations about the midline diastema and the need, or not, for treatment. Materials and methods: Based on 8 people with midline diastema, a survey of photographs of the lower third of the face with a social smile was done. A questionnaire for aesthetic perception and treatment need assessment was submitted to 139 participants, 45 of whom were Pharmaceutical Sciences students (1st, 2nd or 3rd grade) of the “Instituto Universitário Egas Moniz”, 50 were Dentistry students from the 5th grade of the “Instituto Universitário Egas Moniz” and 44 Dentists who have graduated for 5 years or more at the “Instituto Universitário Egas Moniz”. The collected data was statistically analyzed using SPSS Statistical Package for the Social Sciences. Results: The results obtained revealed different levels of perception among the 3 groups, although they were not significant. The group formed by Dentists was the most critical since they evaluated almost all the photographs with inferior values. In some photographs there were similarities between the group of laypersons and those experienced in Dentistry. Conclusions: Dental aesthetics have a subjective character and the different opinions regarding this diastema will always exist, but the final decision on its treatment is only up to the person who has it.

Tese de Doutoramento em Ciências (Especialidade em Química)
Stereoselective Diels-Alder cycloaddition is a very important methodology in the synthesis of chiral organic compounds. In this thesis, the selectivity was achieved by means of a chiral auxiliary or by the use of chiral Lewis acid complex. Diastereoselective Diels-Alder cycloaddition was achieved by reacting a 1,3- butadiene bearing 2,3,4,6-tetraacetyl glucosyl as chiral auxiliary with PTAD. Total facial selectivity was obtained in this process. The cycloadduct obtained was converted in the known (-)-1-azafagomine, and in (+)-5-epi-1-azafagomine. Two new 1-N-phenyl carboxamide derivatives of 1-azafagomine were obtained by partial reductive cleavage of the phenyltriazolidinone moiety. The inhibitory potency of these new compounds towards α- and β-glucosidases was evaluated, and with the compound related to (-)-1- azafagomine showing the best inhibitory activity against α-glucosidase. The biological mechanism of action of both enantiomers in yeast α-glucosidase was studied by molecular docking methodologies using the homologue Saccharomyces cerevisiae enzyme. The efficient packing of the aromatic ring of the N-phenyl carboxamide moiety into a hydrophobic subsite (pocket) in the enzyme’s active site seems to be responsible for the improved binding affinity. This process was very efficient in terms of facial discrimination; however a long sequence of reactions were needed to obtain the final products, due to the additional steps required to introduce and remove the chiral auxiliary. As an alternative, a shorter synthetic strategy was devised using a Diels-Alder cycloaddition catalysed by a bimetallic complex of Mg and Zn tethered to BINOL (LACASA-DA). Combination of a D-erythrose 1,3-butadiene with maleimides and achiral 2Hazirine 3-carboxylate in a LACASA-DA cycloadditions gave in most cases total facial selectivity. In the case of cycloadduct obtained from 2H-azirine, both enantiomers were obtained depending of the chirality of BINOL. The (R)-cycloadduct, obtained with (S)- BINOL, is a precursor of neuraminic acid and D-swainsonine analogues. Moreover, LACASA-DA methodology also gave excellent enantioselectivities (>99 %) with achiral reagents, such as 2,4-pentadienol (diene) and t-butyl 2H-azirine 3- carboxylate or DEAD (dienophiles). Both enantiomeric forms of cycloadducts were obtained only by changing BINOL stereochemistry. Cycloadducts obtained from 2H azirine were easily converted in two sets of polihydroxylated pipecolic acid derivatives, after 3 steps. All new compounds were fully characterized by the usual spectroscopic technics (1H NMR and 13C NMR and IR), analytical techniques (mass spectrometry) and physical properties (optical rotation). The absolute stereochemistry of stereocentres included in the molecules was determined by X-ray crystallography, in cases where single crystals could be obtained, or by combination of coupling constants (J) in the 1H NMR data with dihedral angles determined by molecular dynamics studies for the oils.
A reação de Diels-Alder estereosseletiva é uma metodologia muito importante na síntese de compostos orgânicos quirais. Neste trabalho, a seletividade foi conseguida utilizando um auxiliar quiral ou um ácido de Lewis quiral. A reação de Diels-Alder diastereosseletiva entre um dieno contendo o 2,3,4,6- tetra-acetilglucopiranosilo como auxiliar quiral e o PTAD, originou o aducto correspondente com total seletividade facial. O cicloaducto obtido foi convertido em aza-açucares conhecidos: (-)-1-azafagomina e (+)-5-epi-1-azafagomina. A clivagem redutiva parcial da unidade de feniltriazolidinona originou dois novos derivados N-fenilcarboxamida da 1-azafagomina. Estes novos compostos foram avaliados quanto à sua atividade inibitória face às enzimas α- e β-glucosidases. O composto relacionado com a (-)-1-azafagomina exibiu a melhor atividade inibitória face à α-glucosidase. O mecanismo biológico de acção de ambos os enantiómeros na -glucosidase (baker’s yeast) foi estudado por metodologias de “docking” molecular utilizando a enzima homóloga Saccharomyces cerevisiae. O acondicionamento eficiente do anel aromático da unidade N-fenil carboxamida numa bolsa hidrofóbica presente no local activo da enzima parece ser responsável pelo aumento da inibição. Esta metodologia mostrou-se muito eficiente em termos de discriminação facial, no entanto, era necessário uma longa sequência reacional para se obter os produtos finais, devido aos passos adicionais necessários para introduzir e remover o auxiliar quiral. Assim, enveredou-se por um processo mais curto que usa a cicloadição de Diels-Alder catalisada por um complexo bimetálico de Mg e Zn ligado ao BINOL (LACASA-DA). A combinação de um dieno derivado da D-eritrose, com maleimidas e uma azirina não quiral, a 2H-azirina 3-carboxilato de t-butilo, usando a estratégia LACASADA gerou, na maioria dos casos, total seletividade facial. No caso do cicloaducto obtido a partir da azirina, foram obtidos ambos os enantiómeros dependendo da quiralidade do BINOL. O cicloaducto (R) obtido com o (S)-BINOL, é um precursor de análogos do ácido neuramínico e da D-swainsonina. Adicionalmente, a metodologia LACASA-DA também originou produtos com excelentes enantiosseletividades (>99 %) usando reagentes não quirais, tais como, o 2,4-pentadienol (dieno) e a 2H-azirina 3-carboxilato de t-butilo ou o azodicarboxilato de dietilo (DEAD) (dienófilos). Ambas as formas enantioméricas dos cicloaductos foram obtidas apenas alterando a estereoquímica do BINOL. Os cicloaductos obtidos a partir da 2H-azirina foram facilmente convertidos, em dois conjuntos de derivados polihidroxilados do ácido pipecólico, em apenas três passos reacionais. Todos os compostos foram caracterizados pelas técnicas espetroscópicas usuais (1H e 13C RMN, e IV), técnicas analíticas (espetrometria de massa) e propriedades físicas (rotação ótica). A estereoquímica absoluta dos estereocentros incluídos nos produtos foram determinados por cristalografia de raio-X, nos casos em que os cristais puderam ser obtidos, ou por correlação das constantes de acoplamento (J) dos espetros de RMN de protão com os ângulos diedros determinados por estudos de dinâmica molecular, para os óleos.
Fundação para a Ciência e Tecnologia pela bolsa de Doutoramento atribuída (SFRH/BD/61290/2009) e pelo apoio financeiro ao projeto de investigação (PTDC/QUI/67407/2006) no qual se inseriu este trabalho.

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
A frenectomia é uma técnica cirúrgica que consiste na remoção de freios. Existem vários tipos de frenectomias assim como vários tipos de freios (freio labial superior, freio labial inferior, freios laterais e ainda freio lingual), que podem, efetivamente, ser submetidos a esta intervenção. Relativamente às várias técnicas cirúrgicas de frenectomia, esta tese aborda desde as mais convencionais, com envolvimento de bisturi, como a plastia em V-Y, a plastia em Z, a frenectomia romboidal e a técnica de Miller, às técnicas com recurso ao laser e ao eletrobisturi, sendo todas estas intervenções direcionadas e relativas ao freio labial superior. Quando os incisivos centrais superiores erupcionam separados, se o osso não se deposita na porção inferior do freio, surge então a presença de um espaço interincisivo denominado de diastema, podendo este interferir na harmonia e estética do sorriso, assim como na função, havendo passagem de ar e de saliva através do mesmo. A frenectomia labial superior é muitas vezes realizada concomitantemente ao tratamento ortodôntico. Hoje em dia, ainda existe muita controvérsia relativamente à inserção anómala do freio, pois ainda não se conseguiu concluir se esta é a causa ou uma consequência do aparecimento do diastema interincisivo maxilar. Existem diferentes abordagens terapêuticas para o encerramento do diastema, no entanto há uma grande discussão acerca de como e qual o melhor momento em que este deve ser realizado, de modo a conseguir-se obter os melhores resultados possíveis e também com menor grau de recidiva. Esta tese visa uma revisão bibliográfica sobre a influência da frenectomia no diastema interincisivo maxilar e pretende descrever qual o estado da arte, atualmente, acerca deste tema.
Frenectomy is a surgical technique that consists of removing frenulum. There are several types of frenectomies as well as several types of frenulum (upper lip frenulum, lower lip frenulum, lateral frenulum and even lingual frenulum) that can, effectively, be submitted to this intervention. Regarding the various surgical techniques of frenectomy, this thesis addresses the most conventional ones, with scalpel involvement, such as V-Y plasty, Z plasty, rhomboid frenectomy and the Miller´s technique, as well as the techniques using laser and the electrocautery, with all these interventions directed and related to the upper lip frenulum. When the upper central incisors erupt separately, if the bone is not deposited in the lower portion of the frenulum, then there is the presence of an interincisive space called the diastema, which can interfere with the harmony and aesthetics of the smile, as well as interfering with the function, with passage of air and saliva through it. Upper lip frenectomy is often performed concurrently with orthodontic treatment. Nowadays, there is still much discussion regarding the anomalous insertion of the frenulum, as it has not yet been possible to conclude whether this is the cause or a consequence of the appearance of the maxillary interincisive diastema. There are different therapeutic approaches to the closure of the diastema. However, there is a great discussion about how and what is the best time to be performed, in order to achieve the best possible results and also with a lower degree of recurrence. This thesis aims at a literature review on the influence of frenectomy on the maxillary interincisive diastema and intends to describe the state of the art currently on this theme.

碩士
國立陽明大學
牙醫學系
105
Midline diastema is a normal feature in mixed dentition, and the supernumerary teeth in the premaxilla is not uncommon abnormality noted at the same developmental stage. However, it is inability of a young child to tolerate the surgical procedure. The prevalence of midline diastema in school age children with impacted supernumerary tooth was compared with those without impacted supernumerary tooth in our study. In addition, to observe the change of midline diastema in children with impacted supernumerary tooth along with the growth of the age and the eruption of permanent canines. This study divided into two parts. The patients who visited the Outpatient department of Pediatric Dentistry in Taichung Veterans General Hospital from January 2002 to January 2005 were collected in the first part. Patients with two erupted maxillary permanent central incisors were included in this study. The percentage of midline diastema in school age children with impacted supernumerary teeth and without impacted supernumerary teeth were compared. Periapical radiograph of patients who visited Taichung Veterans General Hospital and diagnosed as supernumerary teeth were collected for ten years since November 1st in 2005 in the second part. In the first part, it was noted that midline diastema is not related to impacted premaxillary supernumerary teeth in school age children. Furthermore, the percentage of midline diastema was decreased with age even in school age children with impacted premaxillary supernumerary teeth. Midline diastema in mixed dentition was not simply caused by impacted supernumerary teeth and even in children with impacted supernumerary teeth, the prevelence of midline diastema was decreased with age. Clinically, if a impacted supernumerary teeth in anterior maxilla, periodically follow up of the midline diastema can be suggested if the complications such as rotation and delay eruption of permanent incisors were not seen. Extraction of the impacted supernumerary teeth may not be the only choice.

Introdução: Define-se por diastema a inexistência de contacto entre dois dentes adjacentes, por vezes relacionado com a ausência de papila interdentária. Ocorre em qualquer lugar na arcada superior ou inferior, sendo comumentemente observado entre os incisivos centrais superiores. Objetivo: Este trabalho pretendeu dar a conhecer a etiologia do Diastema Interincisivo e de que forma este afeta a perceção estética do sorriso perante 3 grupos distintos: Grupo I – alunos com conhecimentos na área da Medicina Dentária; Grupo II - alunos com conhecimentos de estética geral; e Grupo III- alunos cuja formação académica não versa sobre componentes estéticos. Materiais e métodos: Tendo como base cinco pacientes da Clínica Universitária da Universidade Católica Portuguesa, portadores de diastema entre incisivos centrais superiores, foi efetuado o levantamento de fotografias frontais da cavidade oral e do terço facial inferior em sorriso e em intercuspidação máxima. Com recurso ao programa Adobe Photoshop CS6, manipularam-se computorizadamente, as fotografias em três etapas, I-Diastema inicial, II-Encerramento parcial e III-Encerramento total do diastema. As fotografias foram submetidas a avaliação por parte de 334 estudantes da Universidade Católica Portuguesa do Centro Regional das Beiras. Para a análise desta avaliação fotográfica os respetivos alunos responderam a um questionário. Os dados recolhidos foram analisados estatisticamente utilizando o programa IBM SPSS Statistics 20. Discussão: Os resultados obtidos revelam diferentes níveis de valoração entre os 3 grupos, observando-se diferentes classificações entre géneros, apesar de não serem significativas. Por último, existe por parte dos avaliadores diferentes valorações das fotografias intra e extra-orais. Conclusão: A estética dentária apresenta um caráter subjetivo e individual, visto que existe uma grande variabilidade na perceção estética entre os grupos em análise. Não foi encontrada diferença significativa em relação ao género na amostra em estudo. São necessários mais estudos com a inclusão de diferentes grupos étnicos e diferentes grupos de avaliadores na área da Medicina Dentária.
Introduction: Defined by the absence of diastema contact between two adjacent teeth, sometimes it’s related to the absence of the interdental papilla. Occurs anywhere in the upper or lower, is commonly observed between maxillary central incisors. Objective: This study was made to publicize the etiology and how affects the perception Diastema interincisal smile aesthetics to 3 different groups: Group I - students with knowledge in dentistry, Group II - students with knowledge of general aesthetics and Group III-students whose academic training is not about aesthetic components. Materials and methods: Based on five patients of the University Clinic of Viseu, carriers diastema between the maxillary central incisors, frontal photographs of mouth and inferior third in smile and intercuspation maximum were taken. To manipulate the photos it was used Adobe Photoshop CS6 the manipulation process was divided in three steps, I-Diastema initial, II- Partial closure and III-Closure total diastema. The photos were submitted to evaluation by 334 students of the Catholic University, Regional Centre Borders. In order to analyze this photographic evaluation the students answered a questionnaire. The collected data will be statistically analyzed using the IBM SPSS Statistics 20. Discussion: The results show different levels of valuation between the 3 groups, can also be observed different ratings between genders, although not significant. The evaluators made different valuations of photographs intra and extra-oral. Conclusion: The dental aesthetics shows a subjective and individual character, since there is a great variability in aesthetic perception between the analyzed groups. No significant difference was found in relation to gender in the study sample. Further studies are needed with the inclusion of different ethnic groups and different groups of assessors in the field of dentistry.

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz
BIOMIMÉTICA a palavra decomposta quer dizer BIO (Estruturas biológicas) e MIMÉTICA (vem do Grego Mimétikos, e significa capaz de imitar). É um conceito em Medicina Dentária em que se procura reproduzir a estrutura biológica na sua imitação mais aproximada, com materiais que integram de maneira harmoniosa e que equilibram a Biologia, a biomecânica, a função, e a estética. A biomimética em Medicina Dentária tem vindo a desempenhar um papel mais relevante entre os clínicos devido á sua abordagem ultra conservadora permitindo ao paciente preservar ao máximo o seu órgão dentário e o respeito pelas estruturas vizinhas. Este relatório de caso descreve um caso clínico no qual um paciente adulto do sexo feminino com múltiplos diastemas nos dentes antero-superiores e antero-inferiores é tratado com restaurações ultra finas em cerâmica aderida com uma redução mínima nos antero-superiores e no incisivo central inferior direito e sem redução no incisivo lateral inferior direito e canino inferior direito.

Os diastemas são frequentemente fonte de grande preocupação por parte dos pacientes nas consultas de Medicina Dentária. Apesar de poderem ser transitórios na dentição decídua e nem sempre necessitarem de uma abordagem clínica, numa dentição definitiva requerem um exame pormenorizado e um tratamento adequado. Assim o objectivo deste trabalho foi analisar as possíveis causas etiológicas dos diastemas nos dentes anteriores e os tratamentos existentes para a correcção desta alteração na estética, permitindo adquirir conhecimentos sobre os parâmetros que devem ser tidos em conta para a concepção de um sorriso ideal. Na execução desta revisão bibliográfica, os motores de pesquisa on-line utilizados foram os seguintes: b-On, Pubmed, Scielo e Science Direct. Os critérios de inclusão limitaram o uso de artigos publicados entre 2000 e 2017 e nos idiomas de português, inglês e espanhol. Os critérios de exclusão rejeitaram artigos dos quais o teor não teria relevância para a concretização do trabalho e artigos fora dos limites temporais. Para que o sucesso do tratamento seja alcançado, existe uma panóplia de tratamentos que devem ser ponderados mediante uma atitude multidisciplinar e atendendo sempre à etiologia e expectativa do paciente.
Diastemas are often a source of great concern from part of the patients in dental medical appointments. Although they may be transitional in the deciduous dentition and do not always require clinical approach, a permanent dentition requires an excellent examination and appropriated treatment. The main aim of this monograph was to analyze the possible etiological causes of diastemas in anterior teeth and the existing treatments for the correction of this alteration in aesthetics, allowing to acquire knowledge about the parameters that should be taken into account for the design of an ideal smile. In this research the keywords were: “diastema”, “sorriso”, “facetas”, “ortodontia”, “freio labial”, “agenesia”, “encerramento”, “estética”, “composite resins”,”midle diastema”,”diastema closure”, using b-On, Pubmed, Scielo and Science Direct as data bases. The inclusion criteria have limited the use of articles published between 2000 and 2017 and in the languages of Portuguese, English and Spanish. Exclusion criteria rejected articles in which the content would not have relevance to the theme and items outside the time limits.

Objetivo: Realizar uma revisão bibliográfica sobre freios orais e técnicas cirúrgicas utilizadas aquando da anormalidade destes. Metodologia: Pesquisa bibliográfica de artigos científicos nas bases de dados PubMed e Google Académico utilizando termos de pesquisa isolados ou combinados através do marcador boleano “AND”: Freios Orais, Frenectomia, Técnicas de frenectomia, Frenectomy, Oral frenulum. Foram aplicados critérios de inclusão: artigos publicados desde 2001, nos idiomas português, espanhol e inglês, e com o formato de artigo: review, clinical trial, guidelines. Foram eliminados artigos sem resumo disponível ou que se afastavam do tema em estudo. Finalmente foram selecionados 17 artigos. Descrição do tema: É imperativo o recurso a cirurgia para normalizar complicações associadas a freios anormais. A frenectomia é a técnica utilizada e pode ser realizada de diversas formas: frenectomia convencional, Plastia em V-Y, Plastia em Z e frenectomia com laser. Sendo possível realizar qualquer técnica, é relevante saber qual a técnica mais vantajosa em cada caso.
Objective: Aims to realize one revision as part of the oral frenulums, more specifically, about the surgical techniques used when exist abnormalities of these. Methodology followed: Bibliographic research of scientific articles through electronic databases PubMed and Academic Google. Were used key words isolated and in combination search terms through the Boolean marker “and”: oral frenulum, frenectomy, frenectomy techniques. Inclusion criteria were applied: articles published since 2001, in Portuguese, Spanish and English and the article type: review, clinical trial and guidelines. Thus, were selected 17 articles to developing this work. Theme description: Is imperative the use of surgery to normalize the situation. The frenectomy is a technique used with this purpose and can be realize in different ways: conventional frenectomy, V-Y Pasty, Z Pasty and laser frenectomy. All the technique is possible to be performed, is relevant to knowin which situations certain techniques will be more advantageous.

Includes a copy of an article co-authored by the author during the preparation of this thesis.
Includes addendum attached to back cover.
Includes bibliographical references (leaves 211-217).
iv, 221 [3] leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
The development of a new synthetic pathway for the formation of a diverse range of diastereo- and enantio-pure cyclopropanes derived from trans [gamma]-hydroxy enones is presented.
Thesis (Ph.D.)--Adelaide University, Dept. of Chemistry, 2001

O diastema, pode ser definido como um espaço extra existente entre dois ou mais dentes consecutivos, sendo mais frequente entre os incisivos centrais da arcada superior. O agente etiológico do diastema, pode estar associado a fatores patológicos e/ou fisiológicos. Pode ser causado pela existência de mesiodens, por hábitos bucais deletérios, problemas periodontais ou por herança genética. Atualmente, a medicina dentária apresenta uma variedade de tratamentos para o encerramento dos diastemas, nomeadamente, frenectomia, as restaurações diretas realizadas em resina composta, restaurações indiretas através da prótese fixa que possibilita o encerramento do espaço com facetas de cerâmica, coroas totais e também o tratamento ortodôntico. Este trabalho teve como principal objetivo, apresentar as diferentes formas de tratamentos para a correção dos diastemas, centrado na dentística restauradora em parceria com o tratamento ortodôntico. Foi realizada uma pesquisa bibliográfica utilizando os motores de busca PubMed, Science Direct, Scielo.
The diastema can be defined as an extra space between two or more consecutive teeth, being more frequent between the central incisors of the upper arch. The etiologic agent of diastema may be associated with pathological and/or physiological factors. However, it can be caused by the existence of mesiodens, deleterious oral habits, periodontal problems or genetic inheritance. Currently, a dentistry presents a variety of treatments for the closing of the diastema, in particular, frenectomy, such as direct restorations performed in composite resin, indirect restorations through the prosthesis, which is the possibility of closing the space with ceramic facets and crowns and also orthodontic treatment. The main objective of this work was to present different forms of treatments for a diastema correction, centered on restorative dentistry in partnership with orthodontic treatment. A bibliographic search was performed using PubMed search engines, Science Direct, Scielo.

Trabalho Final do Mestrado Integrado em Medicina Dentária apresentado à Faculdade de Medicina
INTRODUÇÃO: A estética pessoal assume atualmente um papel importante nos aspetos sociais, emocionais e profissionais. A presença de diastemas nos dentes anteriores pode estar associada a um impacto negativo na estética do sorriso e na fonação. O conhecimento detalhado da morfologia dentária e periodontal associada aos diastemas é fundamental para a elaboração e previsibilidade do eventual plano de tratamento.OBJECTIVO: Caracterização do morfotipo dentário e periodontal associado à presença de diastemas no 2º sextante de jovens adultos, particularmente na correlação da presença de diastemas com a morfologia dos tecidos periodontais.METODOLOGIA: Foram selecionados 22 pacientes, 11 com diastemas (Grupo 1) e 11 sem diastemas nem apinhamento (Grupo 2). Em todos foi realizado um exame oral completo, uma história clinica, um protocolo fotográfico, impressões convencionais e digitais, radiovisiografias e uma tomografia de feixe cónico de modo a determinarem-se alguns dos componentes da morfologia dentária e periodontal destes pacientes. Além das medições analógicas directas e digitais, foram também efetuadas medições com recurso a programas informáticos de integração, análise e coorelação de dados digitais. Foi utilizado o IBM SPSS Statistics 23.0 para executar a análise estatística. A normalidade da distribuição foi avaliada pelo teste de Shapiro-Wilk e as diferenças médias entre os grupos avaliados com o t-test. A correlação de Pearson foi usada para avaliar a correlação entre as variáveis escalares. O nível de significância foi fixado em 0,05.RESULTADOS: No grupo 1, a distância média entre a crista óssea e a papila no diastema mediano foi de 4,18mm± 0,64 e a distância média entre a papila e o zenith é 4,49mm±0,81. No grupo 2, a distância média entre a crista óssea e a papila no diastema mediano foi 3,75mm± 0,38 e a distância média entre a papila e o zenith de 3,97mm±0,63. Em ambos, 90% dos pacientes apresentaram um padrão regular ascendente de distribuição vertical das papilas no 2º sextante. Para estas 3 variáveis analisadas não se verificaram diferenças estatisticamente significativas entre os dois grupos.DISCUSSÃO e CONCLUSÕES: Dentro das limitações deste estudo, pode deduzir-se que, apesar das diferenças nas relações interdentárias nos pacientes com diastemas, o morfotipo periodontal não parece ter alterações relevantes relativamente aos pacientes sem diastemas. A posição e disponibilidade dos tecidos de suporte periodontais na zona dos diastemas não parece ser prejudicada pela existência de espaços interdentários.PALAVRAS-CHAVE: “Diastemas” , “Papila dentária”, “Osso alveolar”, “Dente anterior”, “Interdentária”, “Maturação da sutura média palatina”, “Freio Labial”
INTRODUCTION: Personal aesthetics nowadays play an important role in social, emotional and professional aspects. The presence of diastema in the anterior teeth may be associated with a negative impact on smile aesthetics and phonation. The detailed knowledge of the dental and periodontal morphology associated with diastemas is fundamental for the elaboration and predictability of an eventual treatment plan.OBJECTIVE: Description of the dental and periodontal morphotypes associated with the presence of diastema in the 2nd sextant of young adults, particularly in the correlation of the presence of diastema with periodontal tissue morphology.METODOLOGY: Were selected 22 patients, 11 with diastema (Group 1) and 11 with no diastemas or crowding (Group 2).. All participants were realized a full oral examination and filled a clinical history. Data collection was done using a digital photographic protocol, conventional prints, intra-oral fingerprints, radiovisiographies, and a conical beam tomography to determine some of the components of the dental and periodontal morphology of these patients through various analytical processes. Furthermore to direct and digital-analog measurements in some of the analysis methods, measurements were also made using digital data integration, analysis, and co-data processing software. IBM SPSS Statistics 23.0 was used to perform the statistical analysis. Normality of distribution was assessed with Shapiro-Wilk test and mean differences between groups evaluated with the t-test. Pearson correlation was used to assess correlation between scalar variables. Significance level was set at 0.05.RESULTS: In group 1, the mean distance between the crestal bone and the papilla in the median diastema was 4,18mm±0,64 and the mean distance between the papilla and the zenith was 4,49mm±0,81. In group 2, the mean distance between the bone crest and the papilla in the median diastema was 3,75mm± 0,38 and the mean distance between the papilla and the zenith was 3,97mm±0,63. In both groups, 90% of the patients had the regular ascending pattern of the vertical distribution of the papillae in the 2nd sextant.DISCUSSION and CONCLUSION: Within the limitations of this study, it can be deduced that, despite differences in interdental relationships in patients with diastemas, the periodontal morphotype does not appear to have relevant alterations regarding patients without diastema. The position and availability of periodontal support tissues in diastemas does not appear to be affected by the existence of interdental spaces.KEY – WORDS : “Diastema”, “Dental Papilla”, “Alveolar bone”, “Anterior teeth”, “Interdental”, “Midpalatal suture maturation”, “Labial frenum”

facial e a presença de anomalias dentárias como diastemas pode representar uma quebra na harmonia e estética facial, sendo considerados muitas vezes fator desagradável. Ao fim de corrigir este tipo de anomalia, ter conhecimento dos princípios estéticos básicos a seguir e dos fatores etiológicos dos diastemas è imprescindível. Entre as opções terapêuticas existentes para o encerramento dos diastemas, o tratamento restaurador com resinas compostas representa uma alternativa viável e satisfatória e a previsualização do resultado final e a utilização da chave de silicone a partir do enceramento diagnóstico permitem facilitar a elaboração do plano reabilitador e obter resultados de sucesso. Foi realizada uma pesquisa bibliográfica utilizando os motores de busca PubMed, Science Direct e Google Scholar.
In contemporary society the smile covers an important role in the context of facial aesthetics and the presence of dental anomalies as diastema, considered often unpleasant factor, may represent a break in harmony and facial aesthetics. In order to correct this type of anomaly, it is necessary to be aware of the basic aesthetic principles to follow and the etiological factors of the diastema. Among the existing therapeutic options for the diastema closure, the restorative treatment with composite resins, being considered an effective, conservative and quite long-lived method, represents a viable and satisfactory alternative. The pre-visualization of the final result and the use of the silicone key from the diagnostic waxing allow to facilitate the preparation of the rehabilitation plan, the definitive restoration execution and to obtain successful results.

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
A cavidade bucal é constituída pelos freios labiais maxilar e mandibular, freios laterais e o lingual. Estes freios são estruturas anatómicas compostas por pregas de membrana mucosa, que por sua vez têm na sua constituição tecido conjuntivo fibroso, muscular ou ambos. A função destes componentes orais é estabilizar, controlar e delimitar os movimentos da língua e do lábio superior e inferior na linha média. O freio lingual está ligado, por um lado, ao ventre da língua e, por outro, aos incisivos centrais mandibulares. O freio labial maxilar é mais dinâmico, quando comparado com o lingual, em parte também pelo facto de que com o desenvolvimento vai assumindo diferentes localizações e apresenta diferentes conformações. Se estas estruturas não evoluírem dentro de padrões bem definidos podem resultar em complicações que se manifestarão a nível protético, periodontal, ortodôntico, fonético e até estético. O Médico Dentista deve estar devidamente esclarecido da importância de um bom diagnóstico das anomalias relacionadas com estruturas anómalas como é o caso dos freios, bem como dos benefícios do seu tratamento no âmbito multidisciplinar. A intervenção cirúrgica que visa a correção destas anomalias anatómicas é designada por frenectomia. Até à data, este procedimento tem vindo a sofrer atualizações de modo a aperfeiçoar o aspeto estético e o resultado cirúrgico obtido. Com este trabalho pretende-se sumariar as várias opções terapêuticas existentes no âmbito da frenectomia, as respetivas indicações, o momento ideal para a intervenção em cada um dos freios e o que se pode esperar no pós-operatório.
The oral cavity consists of the maxillary and mandibular labial frenulum, lateral and lingual. These anatomical structures are composed of folds of mucous membrane, which have fibrous connective tissue, muscular or both, in their constitution. The purpose of these oral components is to stabilize, control and delimit the movements of the tongue and upper and lower lip in the midline. The lingual frenulum is connected, by one side, to the root of the tongue, and by the other side, to the central mandibular incisors. The maxillary lip frenulum is more dynamic when compared to the lingual one, in part also due to the fact that with its development it takes on different locations and shows different conformations. If these structures don’t develop within well-defined patterns, they can originate complications that will manifest themselves at prosthetic, periodontal, orthodontic, phonetic and even aesthetic levels. The dentist must be properly informed of the importance of a good diagnosis of the related anomalies regarding anomalous structures, such as the frenulum case, as well as the benefits of its treatment when it comes to multidisciplinary fields. The surgical intervention which aims at the correction of these anatomical abnormalities is called Frenotomy. Until this present moment, this procedure has undergone several updates in order to improve the aesthetic appearance and the surgical result obtained. The purpose of this project is to summarize the various therapeutic options available in the scope of Frenotomy, the respective indications, also the ideal moment for the intervention in each frenulum and what can be expected in the postoperative period.

碩士
大葉大學
工學院碩士在職專班
100
In recent years, the research topics for the disaster preventive education in schools are mostly the investigation about the students, not so many about teachers. But for the disaster preventive education,teachers’ professional knowledge and attitudes are also important factors to affect the teaching activities. In the study, we discuss the elementary school teachers’s accomplishment for disaster preventive education in Changhua County. We do a survey that uses stratified random sampling to as a research tool and the valid questionnaires are totally 425. We use SPSS12.0 statistical software to make descriptive statistical analysis, the independent sample t test,one-way ANOVA, Scheffe’ method and Pearson correlation analysis and data analysis. This study shows that the elementary school teachers in Changhua County have high accomplishment for the disaster preventive education. There are some significant differences about teachers’ professional knowledge for the disaster preventive education, which affected by teachers’ gender, school scale, teaching years and have they ever participated in some course about the disaster preventive education. If the teachers’ attitudes for the disaster preventive education are positive, the results which affected by the variables are not obvious. The professional knowledge and the attitudes for the disaster preventive education are not correlative significantly. Finally, according to the results of this study,we present some suggestions for educational administrative authorities,acadamic research units,schools,teachers and some reseaches about this topic in the future. Key Words：elementary school, accomplishment for the disaster preventive education,survey

碩士
國立臺北科技大學
土木與防災研究所
95
The occupational disasters of construction sector are the most serious occupational disasters in this country. And, it happened in construction job sites almost. Is there anything about stop the disasters happened that we have to pay attention and we don’t yet? That is the main goal of this research. This thesis is set about to discussion the disasters of construction fields cases in pass, and looking for the focus about the safety management of construction job sites by analyze serious occupational disasters of construction job sites have happened in years lately. This research is re-analyzes occupational disaster case instances from 1999 to 2005 in construction job sites. After that, this thesis is discover a new idea about to stop the disasters in job sites called “Disaster Stop Point“ to break away from the original concept for analyze of disaster investigation in the past. Using this idea ,during the same time, this research evaluate all serious construction occupational disasters by 915 case instances in the past seven years, and exclude 13 cases for non-construction sector after. There are 902 case instances match the definition of this research. There are 853 case instances identifiable by “Disaster Stop Point”. Via this research has arrange and statistics on “Disaster Stop Point”, can prove this idea is working on occupational disasters of construction sector, and the disaster can be stopped and prevented in advance with this idea.

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz
A importância da estética e aparência física, revela-se cada vez mais presente, como uma característica incontornável e universal para a sociedade. Assim, todo o bem-estar, autoestima e qualidade de vida da população, é influenciado por este mesmo paradigma. A face pode ser considerada, como uma espécie de “cartão-de-visita”, relativamente a uma determinada pessoa, permitindo-nos formular uma primeira imagem ou opinião acerca da mesma. O sorriso exerce aqui um papel central. O enfâse dado à estética dentária tem aumentado consideravelmente nos últimos anos. Como tal, o médico dentista deve praticar abordagens que resolvam, não só problemas funcionais, mas também estéticos, que por vezes podem ser prioritários para a satisfação do paciente. É difícil definir o que é considerado inestético em Medicina Dentária. Padrões ideais e sorrisos perfeitos são suscetíveis a preferências inter-individuais. É na linha de pensamento das questões anteriores que surge a temática dos diastemas incisivos. O espaço entre dentes, principalmente na zona anterior, é para muitos nos harmoniosa. De modo a solucionar este problema existem várias abordagens que o clínico pode tomar. Nesta dissertação, é dado foco, com maior destaque, a três opções terapêuticas que podem ser praticadas para o encerramento do espaço inter-incisivo. Nestas, enquadram-se então as restaurações diretas a resina composta, as restaurações indiretas com facetas de cerâmica e o recurso ao tratamento ortodôntico através de aparelhos fixos ou removíveis. Para além de vantagens e desvantagens, apresentadas pelas técnicas anteriormente referidas, umas relativamente às outras, o material e procedimento a serem escolhidos apresentam limitações, como o tempo ou fatores físicos, psicológicos ou económicos, inerentes ao paciente. Esta dissertação pretende assim mostrar cada uma delas de um ponto de vista científico e servir de guia clínico para o Médico Dentista.

A nossa sociedade atual vem demonstrando um grande interesse pelo sorriso perfeito. O bem-estar, autoestima e qualidade de vida da população, é influenciado por este mesmo arquétipo. A face é um “cartão de visita” para muitas pessoas, permitindo assim elaborar uma primeira impressão ou opinião acerca desta. Neste contexto o sorriso e a aparência facial são de extrema importância. A procura pela estética dentária, tem aumentado consideravelmente nos últimos anos, o que leva as pessoas a recorrerem aos profissionais de saúde, para que estes possam através de determinadas técnicas, resolver problemas, dar o retorno pretendido, e assim, devolver a autoestima e o sorriso perfeito ao paciente. Os diastemas são considerados espaços entre dentes, ou a ausência de contacto entre dentes consecutivos que torna um sorriso inestético. Para a correção dos diastemas, têm de ser levados em consideração vários aspetos, como a idade do paciente e fatores etiológicos que ocasionam este problema. Os diastemas podem ser resolvidos através de técnicas diretas e indiretas: Frenectomia, restauração dentárias (resinas compostas, facetas cerâmicas) e tratamento ortodôntico. O principal objetivo deste trabalho é analisar os principais fatores etiológicos do diastema e explorar as possíveis opções de tratamento, tendo sido realizada uma pesquisa bibliográfica utilizando os motores de busca PubMed, Science Direct, Scielo, RCAAP.
Our current society has been showing great interest in the perfect smile. The well-being, self-esteem and quality of life of the population is influenced by this same archetype. The face is a "business card" for many people, allowing you to make a first impression or opinion about it. In this context the smile and the facial appearance are of extreme importance. The demand for dental aesthetics has increased considerably in recent years, which leads people to turn to health professionals, so that they can through certain techniques, solve problems give the desired return, and thus, return the self-esteem and smile the patient. Diastemas are considered spaces between teeth, or the absence of contact between consecutive teeth that makes an unsightly smile. In order to correct the diastema, several aspects, such as the age of the patient and etiological factors that cause this problem, have to be taken into account. The diastemas can be solved through direct and indirect techniques: Frenectomy, dental restoration (composite resins, ceramic facets) and orthodontic treatment. The main objective of this work is to analyze the main etiological factors of the diastema and to explore the possible treatment options. A bibliographic search was done using the PubMed, Science Direct, Scielo and RCAAP search engines.

The American Defense Institute for Medical Operations (DIMO) states that deaths associated with disasters have increased by 50 percent each decade and as Alexander (2002) notes, although disasters require special organization, coordination and resources, they are not exceptional events. Disasters tend to be repetitive; often re-occurring in the same places and as such, are sufficiently frequent and predictable enough to plan for. Disasters are occurring more frequently due to industrialization and rapid development, and as the world’s population has grown, large numbers of people are “vulnerable”; living in less desirable, less ‘safe’ areas. “Natural” disasters hit developing countries perhaps harder, where more people are vulnerable, infrastructure is lacking to begin with and resources are already stretched. Many countries including South Africa are challenged by the increasing number of natural disasters and how to protect the most vulnerable who are without basic infrastructure and largely without access to media. Thus effective public health communication and promotion has become of critical importance particularly in high risk communities and is possible since disasters often occur in the same places. Purpose Literature exists on the efficacy of using media channels to reach people with critical public health messages during disasters, but no studies have focused specifically on other means of communicating public health messages during disasters in places where media doesn’t reach or people can’t justify the cost of batteries for their radios. No research has been done to determine if the people affected recall life saving lessons imparted during disasters; why or why not. Similarly, there is little in the way of documentation detailing the following during past disasters that have occurred both on the African continent and worldwide: who communicated public health messages; what messages were communicated and how messages were imparted. Media – specifically radio and television are used in developed countries to communicate warnings and evacuation messages for example. At best there are reports from the different NGO’s that operate in communities affected by a disaster or NGO’s that arrived to provide humanitarian assistance. It can be surmised that communication is done by those that take the JENNIFER HESLOP/ Student ID No. 0516028Y 6 initiative using whatever channels exist; this may likely include the affected country’s own resources, NGO’s and responders. Coordination to prevent duplicating messages or groups operating in the same areas has in the past been lacking. As such, there is a need to look critically at vulnerable places and people, the value of the information imparted during disasters, why messages may or may not be heeded and if communities would apply the information in future without outside assistance. The study looks at a community that was affected by a specific disaster in South Africa; what proportion of the sample learned life-saving information for the first time during the disaster and whether they would recall these life-saving mechanisms, unaided, in similar future scenarios. Another objective was to determine if gender, age, education or employment status was of any significance against the portion of the study population that learned the information for the first time during the floods. The research leads one to question whether messages are in context with people’s realities and what would prevent them from applying the principles imparted. Broader questions arose, like, do disasters provide an opportunity for learning where there was no learning yet established; and is there an opportunity for engagement between “outsiders” (those with expertise) and “insiders” (affected community) that is truly beneficial to those in need of the information – beneficial in the sense that the information could be applied in future without outside assistance? Design/ methodology The research included two key groups of people: those responsible for the decision making around the communication and public health response to the disaster, and the affected communities. The research design included qualitative key informant interviews accessed through snowballing technique and quantitative face-to-face interviews with 100 community members. The qualitative study was a descriptive, semi-structure interview outline designed to provide a framework to describe the situation, the health risks, priorities, health promotion messages that were communicated and how they were communicated. Key informants were made up of members of the disaster response team as well as others that played a role during the floods. The interviews were transcribed; reoccurring themes were identified and distilled to get the three most critical public health messages that were communicated during the floods. The recurring themes formed the basis of the quantitative questionnaire. JENNIFER HESLOP/ Student ID No. 0516028Y 7 The quantitative study, a cross sectional descriptive study, relied on one hundred community members living in the broader Qho area during the floods and provided they met the criteria (they lived in the area during the floods and could recall what happened), they were asked for their consent before the interview commenced. The data were captured and analysed using Epi Info 6, frequencies were run to describe the sample, and then cross tabulations were performed, looking for associations between the outcome variables and demographic and media variables; chi square tests were performed to test for significance. The three most critical public health messages were: water purification, oral re-hydration therapy for diarrhea and warnings not to eat an animal that had died of unknown causes during the floods. Findings The findings of the research indicate that across two public health messages more than half of all respondents learned the information that may have saved their lives for the first time during the floods. Forty-eight percent learned how to purify water for the first time during the floods; 54.2 percent learned about oral re-hydration therapy during the floods; and 55.6 percent learned not to eat an animal that has died of unknown causes during the floods. Determining whether the sample population would apply the same lessons learned, unaided, in future similar circumstances, is harder to prove since it is self-reported. Nearly 100 percent across the three questions said categorically that they would and most could name ways to purify water, stop diarrhea and said that they knew not to eat an animal that has died of unknown causes. One hundred percent of responders said they would know what to do to make dirty water clean and some cited ways they would do this by boiling and/ or the use of ‘Jik’ (brand of bleach; in South Africa, the word ‘Jik’ has become synonymous with ‘bleach’). Ninety percent of the sample said they would use “the salt and sugar mixture in water” to treat diarrhea and 90 percent knew they should not eat an animal that has died of unknown causes. It is perhaps of interest to note that significantly more men learned during the flood to use OTR for diarrhea than women. Thus disasters may likely provide an opportunity for men to learn health practices that normally women would be more likely to have learned. There was also a significant difference between those that learned about ORT during the floods and those that learned before the floods by level of education, with 63 percent of those that learned about ORT before the floods, having completed primary school. Also of interest was the fact that while only 15 percent of the total sample population has access to television, of the 55.6 percent that learned not to eat an animal that has died of an unknown cause during the floods, 24.5 percent had access to television, and 86 percent of those with access to TV learned about this during the flood. Practical implications Disasters provide opportunities to fast-track development and public health goals. However, based on the research, for communication to have the desired response, communities and public health experts should be involved in dialogue with broader stakeholders before, during and after disasters. It is important to include “locals” (experts from the broader community) and community healthcare workers on an on-going basis, in public health promotion and preparedness strategies and to involve men in the community; a group that has largely been absent in communities and not historically involved in family health care. When a disaster is declared, an injection of resources – human, physical and financial assists significantly in making things happen, from providing and / or upgrading infrastructure to getting critical information and resources to affected populations. Just as critical is education – teaching people how to respond and why, as opposed to just telling people. Knowledge is more sustainable than physical resources, although both are often required. People need to truly understand the information in their own contexts, as well as the “why’ and “how” if they are going to be able to replicate the lessons unaided in future. Concurrently, affected people are more open to information and changing behaviours that may now seem foolish or outdated. Electronic media channels cannot be relied upon as the sole means of communication but need to be incorporated despite low penetration, due to the powerful effect the mediums have in stimulating word-of-mouth transmission of messages, particularly messages that may lead to social discomfort. Alternative means of communication like face-to-face dialogue and use of cell phone messaging, and understanding how communication must be done to ensure effectiveness is imperative - and these guidelines are applicable across cultural, political and socio-economic JENNIFER HESLOP/ Student ID No. 0516028Y 9 boundaries. It is imperative that those providing assistance understand the affected population and their realities as if they were his or her own. This includes local resources like media; literacy levels; beliefs and values; as well as who is trusted by the community.

Introdução: A estética do sorriso é preponderante para o diagnóstico e elaboração do plano de tratamento ortodôntico. Um sorriso harmonioso e equilibrado influencia positivamente o bem-estar individual. Objetivo: Este estudo visa comparar a perceção estética entre médicos dentistas, leigos e estudantes de Medicina Dentária relativamente aos desvios da linha média dentária maxilar e à presença de diastema interincisivo maxilar. Também se comparou a perceção estética entre os estudantes de Medicina Dentária de diferentes unidades de ensino, bem como entre os anos curriculares (4º e 5º) que frequentavam. Metodologia: Foram adicionadas alterações digitais, ao nível do diastema interincisivo maxilar e do desvio da linha média maxilar, que interferissem com o equilíbrio e com a harmonia de um sorriso considerado esteticamente normal, segundo os padrões atuais. As 7 fotografias foram organizadas num álbum para posterior avaliação por parte de três grupos de observadores, que eram compostos por: 100 leigos, 100 médicos dentistas e 100 estudantes de Medicina Dentária, sendo que 34 eram da Universidade Católica Portuguesa, 33 eram da Faculdade de Medicina da Universidade de Coimbra e 33 eram da Faculdade de Medicina Dentária da Universidade do Porto. A classificação foi efetuada numa Escala Visual Analógica de 100 mm. Resultados: No desvio da linha média de 2 mm, os médicos dentistas foram mais críticos do que os leigos. No desvio da linha média de 4 mm os médicos dentistas e os estudantes de Medicina Dentária foram mais críticos do que os leigos e na comparação por género entre os leigos, os homens foram mais críticos do que as mulheres. Nos desvios da linha média de 6 mm, os médicos dentistas e os estudantes de Medicina Dentária foram mais críticos do que os leigos e na comparação por anos curriculares, os alunos do 5º ano foram mais críticos do que os alunos do 4º ano. Relativamente à presença de diastema interincisivo de 1 mm, na comparação por género entre leigos, os homens foram mais críticos do que as mulheres e na comparação entre as diferentes Universidades, os alunos de Viseu foram mais críticos do que os alunos do Porto e de Coimbra. Nos diastemas de 2 mm na comparação entre as Universidades, os alunos de Viseu foram mais críticos do que os alunos de Coimbra. Nos diastemas de 3 mm, os alunos mostraram-se mais críticos do que os leigos e na comparação por género entre os estudantes de Medicina Dentária, os homens foram mais críticos do que as mulheres. Ainda nos diastemas de 3 mm, os alunos do Porto e de Viseu, foram mais críticos do que os alunos de Coimbra. Conclusão: A formação académica na área da Medicina Dentária é um requisito que permite aos observadores detetarem, mais facilmente, alterações ligeiras que influenciam a harmonia e o equilíbrio do sorriso
Introduction: The smile aesthetics is vital for the diagnosis and development of the orthodontic treatment plan. A harmonious and balanced smile positively influences individual well-being. Objective: The aim of this study is to compare the aesthetic perception among dentists, laypeople and dental students about the presence of maxillary interincisal diastema and maxillary midline deviations. It was also compared the aesthetic perception among dental students, between 4th and 5th curricular years, and from different teaching Universities. Methodology: Digital alterations were made to the interincisal maxillary diastema and maxillary midline deviation. It was evaluated the interference of these parameters with the balance and harmony of a smile considered aesthetically normal, by today's standards. In addition, 7 photographs were arranged in an album for later evaluation by three groups of observers, which consisted of: 100 laypeople, 100 dentists and 100 dental students, where 34 of them were from the Portuguese Catholic University, 33 were from the Faculty of Dental Medicine, University of Coimbra, and 33 were from the Faculty of Dental Medicine, University of Oporto. The classification was performed using a Visual Analogue Scale of 100 mm. Results: In the 2 mm dental midline deviation, dentists were less tolerant than laypeople. In the 4 mm dental midline deviation, both dentists and dental students were less tolerant than laypeople and in the comparison by gender among layople, men were less tolerant than women. In the 6 mm midline deviation, dentist and dental students were less tolerant than laypeople and in the comparison by academic years, the 5th year students were less tolerant than the 4th year students. For the presence of 1 mm interincisal diastema in the comparison by gender among laypeople, men were less tolerant than women and in the comparison between different Universities, students from Viseu were less tolerant then students from Oporto and Coimbra. In the 2 mm interincisal diastema in the comparison among different universities, students from Viseu were less tolerant then students from Coimbra. In the 3 mm interincisal diastema dental students were less tolerant than laypeople and in the comparison by gender among dental students, men were less tolerant than women. Finally, in the comparison of 3 mm interincisal diastema, students from Oporto and Viseu were less tolerant than students from Coimbra. Conclusion: The academic training in the field of dentistry is a requirement that allows observers to detect more easily slight changes that affect the harmony and balance of smile.