jueves, 29 de marzo de 2012

Seminario N°1 Vera Omar

DOCUMENTO DE TRABAJO (PICO) Y ESTRATEGIA DE BUSQUEDA

1. Defina su pregunta identificando: PROBLEMA (P), INTERVENCION (I), GRUPO DE COMPARACIÓN (C), Y RESULTADO (O)

Paciente/Problema: xerostomía en pacientes con S. Sjögren.

Intervención: Asociación de terapias para la xerostomía en pacientes con S. Sjögren.

Comparación: Pacientes con S. Sjögren sin tto para la xerostomia.

Resultado: efecividad de la terapia aplicada

  1. Escriba su pregunta:

Actualmente, ¿Cuál es la terapia más efectiva para el tratamiento de la xerostomía que presentan los pacientes con Sindrome de Sjögren?

  1. Tipo de pregunta/Problema: encierre en un circulo

Terapia/Prevención

Diagnóstico

Etiología

Pronóstico

  1. Tipo de Estudio (Tipo de Publicación) para incluir en la búsqueda. Verifique todo lo que pueda corresponder:

Meta-Análisis

Revisión Sistemática

Ensayo Controlado Aleatorizado

Ensayo Clínico

Guía Practica

Revisión

Estudio de cohorte

Estudio de Caso y Control

Serie de caso o Reporte de caso

Editoriales, Cartas, Opiniones

Investigación animal

Investigación In Vitro/Laboratorio

Los principales temas y términos alternativos de su pregunta “PICO” que pueda ser usado para su búsqueda:

Xerostomia / therapy

Dental Caries

Sjogren's Syndrome / rehabilitation

Sjogren's Syndrome / therapy

Enumere sus criterios de inclusión

(genero, edad , año de publicación, idioma)

Humans, Clinical Trial, Meta-Analysis, Practice Guideline, Randomized Controlled Trial, Review, published in the last 5 years.

Enumere términos irrelevantes que puedan ser excluidos de su búsqueda






Enumere las Bases de Datos donde realizara la búsqueda

PUBMED

Describa las estrategias de búsqueda usadas en cada una de las Bases de datos mencionando las salidas y los artículos seleccionados. Usted debe elegir al final de la búsqueda el articulo que mejor responda a su pregunta de búsqueda

En pubmed realice la búsqueda con términos mesh como: Xerostomia / therapy, Dental Caries, Sjogren's Syndrome / rehabilitation –therapy. Incluí limites a la búsqueda como: en humanos, Clinical Trial, Meta-Analysis, Practice Guideline, Randomized Controlled Trial, Review y publicaciones nos posteriors a cinco años.

Articulos obtenidos en la búsqueda: 2

Lauritano D, Bussolati A, Baldoni M, Leonida A. Scleroderma and CREST syndrome: a case report in dentistry. Minerva Stomatol. 2011 Sep;60(9):443-65. Review. English.

Wu AJ. Optimizing dry mouth treatment for individuals with Sjögren's syndrome. Rheum Dis Clin North Am. 2008 Nov;34(4):1001-10, x. Review.

Artículo seleccionado:

Optimizing dry mouth treatment for individuals with Sjögren's syndrome. (full text.)

Wu AJ.

Rheum Dis Clin North Am. 2008 Nov;34(4):1001-10, x.

Abstract

A hallmark of the oral component of Sjögren's syndrome (SS) is the complaint of dry mouth thought to be secondary to dysfunction of the salivary glands. This article describes how treatment may be optimized for individuals who have dry mouth.

Nicole Portales


  1. Defina su pregunta identificando:
    Paciente/Problema:__Pacientes desdentados parciales mandibulares_____________________
Intervención:___atachesintracoronarios____________________________________________
Comparación: _____________________________
Resultado:___mejorar la retención de la prótesis parcial removible_______________________

  1. Escriba su pregunta:
__En pacientes desdentados parciales , ¿cuales son los requisitos para poder indicar ataches intracoronarios?_____________________________________________________________________________

  1. Tipo de pregunta/Problema:
Terapia/Prevención
Diagnóstico
Etiología
Pronóstico
  1. Tipo de Estudio
Meta-Análisis
Revisión Sistemática


 
Ensayo Controlado Aleatorizado
Ensayo Clínico
Guía Practica
Revisión
Estudio de cohorte
Estudio de Caso y Control
Serie de caso o Reporte de caso
Editoriales, Cartas, Opiniones
Investigación animal
Investigación In Vitro/Laboratorio

Enumere sus criterios de inclusión
(genero, edad , año de publicación, idioma)
.  en humanos
.  desde 1990 en adelante
.Ingles o español
. Pacientes adultos

.Enumere las Bases de Datos donde realizara la búsqueda
.Pubmed

Describa las estrategias de búsqueda usadas en cada una de las Bases de datos mencionando las salidas y los artículos seleccionados. Usted debe elegir al final de la búsqueda el artículo que mejor responda a su pregunta de búsqueda
Se busca en pubmed con  la palabra “dentureprecisionattachment” y arroja 1745 resultados. Algunos de los papersvistos fue:
Fakhry A, Tan SC, Heiner AD, Dehkordi-Vakil FH, Dircks HW. Methodology for measuring the in vitro seating and unseating forces of prefabricated attachment systems used to retain implant overdentures. J Prosthodont. 2010 Feb;19(2):87-94. Epub 2009 Nov 4.
Abstract
PURPOSE: The purpose of this in vitro investigation was to measure the forces generated during the continuous seating and unseating of prefabricated attachment systems used to retain implant overdentures. Materials and Methods: An experimental design consisting of interchangeable fixture mounts, a radially indexable fixture holder, and a materials testing systems (MTS) machine was used to measure forces generated during the insertion and removal of spherical stud attachments (Straumann, Inc, Waltham, WA). Three separate experiments were conducted measuring the seating and unseating forces of a vertically aligned patrix/matrix assembly, a 20 degrees angled patrix opposing a vertically positioned matrix, and a vertically positioned patrix opposing a 20 degrees angled matrix. For each patrix/matrix combination, three specimens were tested. Measurements were continuously recorded under reproducible conditions in the presence of artificial saliva. All specimens were subjected to 10,000 seating/unseating cycles. Statistical analysis was performed with rank analysis of variance (ANOVA) for a group comparison (alpha= 0.05).
RESULTS: Results showed variability in the initial insertion and removal forces among experimental groups and among specimens within each experiment. A marked increase in the seating and unseating forces was recorded for all specimens during the first 300 cycles, followed by a gradual decrease in these forces. The exact p-values for the Kruskal-Wallis test showed no significant difference between the initial and final seating/unseating forces (p > 0.1) nor in the maximum seating/unseating forces (p > 0.6) among the three experimental groups.
CONCLUSIONS: Spherical stud attachments exhibited consistent seating and unseating forces over 10,000 cycles. A 20 degrees angle between the patrix and matrix had no effect on the overall seating and unseating force values.
Luego, Se busco con Denture, Partial, Removable y aparecieron 6597 resultados.
Preiskel HW, Preiskel A. Precision attachments for the 21st century. Dent Update. 2009 May;36(4):221-4, 226-7.
Abstract
This paper outlines the evolution of precision attachment applications from partial denture retention to the implant-retained overdenture. CLINICAL RELEVANCE: Understanding precision attachments in the osseointegration era is essential to obtain optimal treatment outcomes with the new therapeutic methods available.
Después, se agregaron limites: Humanos, 1990 en adelante, revistas dentales, y adultos (>19) salieron 808 resultados.
Posteriormente, se utlizó los términos mesh, con el termino mesh “"Denture, Partial, Removable"[Mesh]”  y arrojó 5886 resultadosAl utilizar las palabras mesh"Denture, Partial, Removable" AND "DenturePrecisionAttachment"[Mesh], arrojó 649 resultados. Todo esto sin utilizar limites.
Jones JD, Turkyilmaz I, Garcia LT. Removable partial dentures--treatment now and for the future. Tex Dent J. 2010 Apr;127(4):365-72.
Abstract
The use of a removable partial denture (RPD) in clinical practice remains a viable treatment modality. Various advancements have improved the quality of a RPD, subsequently improving the quality of life for the individuals that use them. This article describes four removable partial denture treatment modalities that provide valuable treatment for the partially edentulous patient. These modalities include: the implant supported RPD, attachment use in RPDs, rotational path RPDs, and Titanium and CAD/CAM RPDs. Data on future needs for RPDs indicate that while there is a decline in tooth loss in the U.S., the need for RPDs will actually increase as the population increases and ages. With the growth in the geriatric population, which includes a high percentage of partially edentulous patients, the use of RPDs in clinical treatment will continue to be predictable treatment option in clinical dentistry.
Al buscar con ("Denture, Partial, Removable"[Mesh] AND "Denture Precision Attachment"[Mesh]) NOT "Dental Prosthesis, Implant-Supported"[Mesh]arroja 633 resultados.
Zitzmann NU, Rohner U, Weiger R, Krastl G. When to choose which retention element to use for removable dental prostheses. Int J Prosthodont. 2009 Mar-Apr;22(2):161-7.
Abstract
The aim of this article is to introduce criteria for planning treatment with a removable dental prosthesis (RDP) in a partially dentate arch, including the indications for placement of dental implants. The retention of RDPs is achieved through clasps, adhesive attachments, crowns, and fixed partial dentures with intra- or extracoronal attachments, telescopes, root caps, and/or prefabricated interradicular retainers. RDP designs vary from a removable partial denture to an overdenture prosthesis. Potential abutment teeth are selected for RDP retention according to their prognosis, their position in the arch, and the planned prosthesis design. Retainer selection mainly depends on the remaining tooth substance, the intra- and intermaxillary relationships, esthetics, and financial aspects. With dental implants as additional retainers, the supportive area for the RDP is increased, the soft tissue load is minimized, and the extension of the base of the prosthesis can be reduced to enhance a patient's comfort. For RDP planning, strategic considerations are needed to determine the appropriate prosthesis design, to select the abutment teeth, and to choose the appropriate retention element for each particular abutment.
Coye RB. Precision attachment removable partial dentures. W V Dent J. 1993 Jul;67(1):6-14.
Abstract
Although added preparations and skill are required to provide precision attachment removable partial dentures, more favorable esthetics and load distribution may outweigh the disadvantages. Basic design principles, categories (intracoronal, extracoronal, stud, bar and plunger) and selection of precision attachments are reviewed.
Burns DR, Ward JE. Review of attachments for removable partial denture design: 1. Classification and selection. Int J Prosthodont. 1990 Jan-Feb;3(1):98-102.
Abstract
An attachment is a mechanical device, other than a clasp assembly, that functions as a direct retainer. Attachments for removable partial denture treatment are reviewed and a method for classifying different types of attachments is provided. Attachments are categorized as precision or semiprecision, depending upon the method of manufacture; internal or external, according to their intracoronal or extracoronal location relative to the abutment tooth; and rigid or resilient, as determined by the amount of movement allowed between the component parts. They are also classified by design. The advantages and disadvantages of attachment use as well as indications and contraindications are considered. Additionally, the conventional clasp-type direct retainer is compared to attachments.
Dawson PE. A new attachment system for removable partial dentures. Signature. 1996 Spring:1-7.
Abstract
How a removable partial denture (RPD) attaches to its abutment teeth is the most important aspect of partial denture design. The reason is obvious: Many critical requirements for optimal design are dependent on the way the removable segment is related and secured to the abutment teeth. To appreciate the importance of the attachment design, it is necessary to understand several principles of overall RPD design. State-of-the-art RPD design is often the most effective means for achieving long-term maintainable health of the remaining teeth. Even weakened teeth with compromised bone support can, with good design, often be used effectively as abutments for RPDs while benefitting from the removable partial.
Luego se agrega los limites: 1990 en adelante, en adultos (>19 años), en revistas dentales, en ingles y español, y arrojó 35 resultados.
Owall B, Jönsson L. Precision attachment-retained removable partial dentures. Part 3. General practitioner results up to 2 years. Int J Prosthodont. 1998 Nov-Dec;11(6):574-9.
Abstract
PURPOSE: The aim of this study was to analyze the techniques, production problems, and 2-year results of attachment-retained removable partial denture (RPD) treatment provided by general practitioners in Sweden.
MATERIALS AND METHODS: At a major dental laboratory, consecutive cases involving new production of crowns, or of fixed partial dentures (FPDs) and RPDs retained with precision attachments, were studied. Parameters of the dentition, crown or FPD, type and brand of attachment, etc, as well as early satisfaction by dentist and patient, were recorded using specially designed forms at the dental laboratory and questionnaires for the dentists. After 2 years, questionnaires were again sent out to the dentists to record complications and patients' and dentists' opinions of the results. The sample gathered totaled 83 constructions. After 2 years, responses for 57 patients, all of whom had distal-extension RPDs, were received. Most drop-outs in the study were explicable.
RESULTS: The most frequently cited reasons for using attachments were esthetics and need for crowning the teeth abutting the RPD. McCollum rigid slide attachment was the predominant brand used (43% of constructions). Dentists and patients were dissatisfied with 6% of the constructions. During the first 2 years, 22 of 57 constructions were complication-free. Seventeen had attachment complications and 9 had serious complications related to the abutment teeth or RPDs. A comparison between these 2 groups revealed that those with complications had every second abutment root-canal treated and a root post, while the group without complications had every fifth abutment root-canal treated.
CONCLUSION: There were many technical and biotechnical complications and failures; the exact ratio, however, depended on the definition of "complications" and "failure." The 2-year results also deviated considerably from the dentists' opinions of the early results.
Owall B. Precision attachment-retained removable partial dentures: Part 2. Long-term study of ball attachments. Int J Prosthodont. 1995 Jan-Feb;8(1):21-8.
Abstract
Patients provided with 24 ball attachment-retained removable partial dentures were followed up to 23.5 years. The prosthetic treatment included fixed partial dentures in 8 arches, and combinations of crowns and splint bars in 16 arches. All ball attachment matrices were supplied with vertical occlusal stops in contact with the patrices. A nonresilient hinged coupling was established between fixed partial dentures and removable partial dentures. Seventeen arches had only two or three remaining teeth. A total of 66 abutments for fixed partial dentures were included, 30 of which were root canal treated and supplied with posts. No technical failures (loss of retention/cement failure, root or tooth fracture, metal framework fracture) with the fixed partial dentures were recorded. With the removable partial dentures, additional retention with clasps was introduced in 2 of the dentures (in addition to 8 originally), 2 had to be remade after fractures, and 4 dentures were relined.
Mensor MC. Removable partial overdentures with mechanical (precision) attachments. Dent Clin North Am. 1990 Oct;34(4):669-81.
Abstract
Mechanical attachments for overdentures have been available in various forms for over a century. The explosive interest in osseointegration and the effort on the part of the profession to avoid the complete denture as a treatment modality has stirred the interest in positive retentive elements for overdentures represented by the mechanical stud and bar attachments. The cited references provide a resource as a trouble-free guide in the selection and use of the various stud and bar attachment systems. The clinical examples show a pattern of application not generally discussed by the manufacturers, illustrating the simplicity of use with the options for all attachments including magnets. The discussion on magnets comes from 9 years of clinical experience. Rare earth magnets provide excellent adjunct retention, and their assembly follows the same protocol and complexity as stud attachment systems. All magnets, at the present state of the art, have a corrosion potential with the exception of the Laser Sealed Units (Golden Dental, Golden, CO). Finally, the mechanics of the attachment overdenture serves as an excellent training field for the osseointegrated prosthesis, be it the classic Brånemark (Nobelpharma USA, Chicago, IL) restorative or the implant overdenture concept.
·        Dentro de los papers revisados anteriormente el paper que mas se acomoda es:
Zitzmann NU, Rohner U, Weiger R, Krastl G. When to choose which retention element to use for removable dental prostheses. Int J Prosthodont. 2009 Mar-Apr;22(2):161-7.
Abstract
The aim of this article is to introduce criteria for planning treatment with a removable dental prosthesis (RDP) in a partially dentate arch, including the indications for placement of dental implants. The retention of RDPs is achieved through clasps, adhesive attachments, crowns, and fixed partial dentures with intra- or extracoronal attachments, telescopes, root caps, and/or prefabricated interradicular retainers. RDP designs vary from a removable partial denture to an overdenture prosthesis. Potential abutment teeth are selected for RDP retention according to their prognosis, their position in the arch, and the planned prosthesis design. Retainer selection mainly depends on the remaining tooth substance, the intra- and intermaxillary relationships, esthetics, and financial aspects. With dental implants as additional retainers, the supportive area for the RDP is increased, the soft tissue load is minimized, and the extension of the base of the prosthesis can be reduced to enhance a patient's comfort. For RDP planning, strategic considerations are needed to determine the appropriate prosthesis design, to select the abutment teeth, and to choose the appropriate retention element for each particular abutment.







Demasiado extensa la busqueda Nicole, hay que acotarla mas, buscar en clinical queries o con buenos limites en la base de pubmed
Tu pregunta tampoco esta muy bien planteada, qué es lo que verdaderamente quieres saber de los attaches intracoronarios?, no es la relacion con la retencion de la protesis pues sabemos que la retiene, tal vez quieras saber el exito o la eficacia repecto a un control que es un retenedor extracoronario y la eficacia medida en algunas variables intermedias que puedes desglosar y mirarlas de a una, por ejemplo biomecanicamente grado de retencion,  estetica, durabilidad de las piezas pilares, sobrevida de la protesis.
Dra Torres

miércoles, 28 de marzo de 2012

Seminario N°1 Ponce Rodrigo

1. Defina su pregunta identificando: 
Paciente/Problema: Xerostomia e Hiposialia
Intervención: Uso de Cevimelina
Comparación: Uso de Pilocarpina
Resultado: Aumento del flujo salival

Escriba su pregunta:
¿En pacientes que sufren de Xerostomia e/o Hiposialia influye más el uso de Cevimelina en el flujo salival en comparación al uso de Pilocarpina?

Tipo de pregunta/Problema:  Terapia

Tipo de Estudio (Tipo de Publicación)
1.-Meta-Análisis 2.-Revision Sistemática 3.-  Ensayo Controlado Aleatorizado 4.- Ensayo Clínico

Los principales temas y términos alternativos  de su pregunta “PICO” que pueda ser usado para su búsqueda:
Xerostomia
Hiposialia
Sequedad Bucal
Pilocarpina
Cevimelina
Flujo salival

Enumere sus criterios de inclusión (género, edad , año de publicación, idioma)
Humanos, estudios realizados en últimos 10 años, inglés y español, revistas dentales

Enumere las Bases de Datos donde realizara la búsqueda.
PubMed

Describa las estrategias de búsqueda usadas en cada una de las Bases de datos mencionando las salidas y los artículos seleccionados. Usted debe elegir al final de la búsqueda el articulo que mejor responda a su pregunta de búsqueda:
En PubMed busqué términos MeSH, acote la búsqueda con los límites, luego vi los resultados y seleccioné el articulo.

De la búsqueda realizada PubMed arrojó 5 articulos de los cuales 3 eran de mi interés y 1 resolvió mejor mi pregunta, el primero de la lista a continuación.

1.- Chainani-Wu N, Gorsky M, Mayer P, Bostrom A, Epstein JB, Silverman S Jr. Assessment of the use of sialogogues in the clinical management of patients withxerostomia. Spec Care Dentist. 2006 Jul-Aug;26(4):164-70.
2.- Fox PC. Salivary enhancement therapies. Caries Res. 2004 May-Jun;38(3):241-6.
3.- Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Jan;97(1):28-46.

Dra Kuky: Interesante busqueda, acotada y bien planteada como pregunta, me habria gustado que propusieras bases de datos secundarias que muestran mejor evidencia en terapia, aunque probablemente no arroje grandes resultados respecto al tema, pero habria que ver, por ejemplo en la base cochrane. Respecto a la estrategia, me habria encantado verla, que elementos booleanos usaste, que palabras Mesh elegiste en pubmed.
Creo que una busqueda en 10 años es demasiado extrensa

martes, 27 de marzo de 2012

Seminario N°1 Yamada Toshiro

 DOCUMENTO DE TRABAJO (PICO) Y ESTRATEGIA DE BUSQUEDA

1. Defina su pregunta identificando: PROBLEMA (P), INTERVENCION (I), GRUPO DE COMPARACIÓN (C), Y RESULTADO (O)

Su pregunta debería ser usada para ayudar a establecer su estrategia de búsqueda

Paciente/Problema: Pacientes con periodontitis crónica
Intervención: Desinfección oral completa
Comparación: Tratamiento periodontal convencional
Resultado: Mayor ganancia de inserción clínica


2.           Escriba su pregunta:

En un paciente con periodontitis crónica, ¿al utilizar un tratamiento de desinfección oral completa comparado con un tratamiento periodontal convencional, se obtendrá mayor ganancia de inserción clínica?


3.           Tipo de pregunta/Problema: encierre en un circulo

Terapia/Prevención
Diagnóstico
Etiología
Pronóstico

4.             Tipo de Estudio (Tipo de Publicación) para incluir en la búsqueda. Verifique todo lo que pueda corresponder:

Meta-Análisis
Revisión Sistemática
Ensayo Controlado Aleatorizado
Ensayo Clínico
Guía Practica
Revisión
Estudio de cohorte
Estudio de Caso y Control
Serie de caso o Reporte de caso
Editoriales, Cartas, Opiniones
Investigación animal
Investigación In Vitro/Laboratorio




Los principales temas y términos alternativos  de su pregunta “PICO” que pueda ser usado para su búsqueda:

.Full mouth disinfection
.Full mouth treatment
.Chronic periodontitis
.
.
.
.


Enumere sus criterios de inclusión
(genero, edad , año de publicación, idioma)

Enumere términos irrelevantes que puedan ser excluidos de su búsqueda
. Ambos géneros
.
. Todas las edades
.
. Publicado en los últimos 10 años
.
. Inglés o español
.

.
Enumere las Bases de Datos donde realizara la búsqueda
.
Pubmed

Describa las estrategias de búsqueda usadas en cada una de las Bases de datos mencionando las salidas y los artículos seleccionados. Usted debe elegir al final de la búsqueda el artículo que mejor responda a su pregunta de búsqueda
.

En la base de datos Pubmed, se hizo la búsqueda con la opción LÍMITES, en el buscador se escribieron los términos “full mouth treatment” y “full mouth disinfection”.

Se limitó a buscar los siguientes tipos de artículos: meta-análisis, ensayos clínicos, revisiones, y ensayos clínicos randomizados.
Publicado en los últimos: 10 años
Especie: humanos
Subcategoría: Medline, revisiones sistemáticas, revistas dentales
Opciones de texto: Todos
Lenguaje: Inglés y español
Sexo: Ambos
Edad: Todas las edades.

Publicaciones encontradas:

1)   Farman M, Joshi RI, Full-mouth treatment vs quadrant root surface debridement in the treatment of chronic periodontitis: a systematic review. Br Dent J. 2008 Nov 8;205 (9):E18; discussion 496-7.

2)    Aimetti M, Roamno F, Guzzi N, Carnevale G. One-stage full-mouth disinfection as a therapeutic approach for generalized aggressive periodontitis. J Periodontol. 2011 Jun;82(6):845-53


3)     Eberhard J, Jepsen S, Jervoe-Storm PM, Needleman I, Worthington HV. Full-mouth disinfection for the treatment of adult chronic periodontitis. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004622


Artículo seleccionado:

1)     Eberhard J, Jervoe-Storm PM, Needleman I, Worthington H, Jepsen S. Full-mouth treatment concepts for chronic periodontitis: a systematic review. J Clin Periodontol. 2008 Jul;35(7):591-604


Me encantaria conocer las conclusiones de este articulo, buena busquda, por que no ves si hay algo en cochrane,entrando por BVS