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1.
Acta Odontol Latinoam ; 36(2): 120-127, 2023 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-37776509

RESUMO

AIM: This study evaluated cytotoxicity and antioxidant gene expression of resin cements on human gingival fibroblasts (hGF). MATERIALS AND METHOD: RelyX Ultimate™(RXU), Variolink™II(VLII), and RelyXU200™(RXU200) resin cements were incubated with culture medium for 24 h to obtain eluates. Then, the eluates were applied over hGF to assess cell viability at 24 h, 48 h, and 72 h and antioxidant gene expression at 24 h. hGF cultures non-exposed to the eluates were used as Control. Data were submitted to ANOVA and Bonferroni tests (α≤0.05). RESULTS: RXU and RXU200 reduced the number of viable cells in 24 h. Longer exposure to cement extracts caused cell death. Gene expression showed peroxiredoxin 1 (PRDX1) induction by all resin cement types, and superoxide dismutase 1 (SOD1) induction by RXU200 and VLII. Moreover, RXU200 induced not only PRDX1 and SOD1, but also glutathione peroxidase 1 (GPX1), catalase (CAT), and glutathione synthetase (GSS). CONCLUSIONS: All resin cements showed toxicity, and induced antioxidant genes in hGF. Antioxidant gene induction is at least partly associated with cytotoxicity of tested cements to oxidative stress experience.


OBJETIVO: O objetivo deste estudo foi avaliar a toxicidade dos cimentos resinosos Rely X Ultimate 2, Rely X U200 e Variolink II, bem como sua influência na expressão de genes antioxidantes em fibroblastos gengivais humanos. Materiais e Método: Corpos de prova de cada cimento foram colocados em meio de cultura por 24 h e os extratos correspondentes foram aplicados aos fibroblastos. A viabilidade celular foi avaliada após 24, 48 e 72 h de exposição pelo ensaio de exclusão do azul de tripano e MTT. A expressão gênica foi avaliada por PCR quantitativo após 24 h de exposição aos extratos. Estes parâmetros foram comparados aos das células não expostas aos cimentos. Os dados foram submetidos ao teste ANOVA, seguido pelo pós-teste de Bonferroni (a≤0.05). RESULTADOS: Os resultados demonstraram que todos os cimentos promoveram redução do número de células viáveis e da atividade mitocondrial nos períodos de 48 e de 72 h (p< 0,01), sendo que o Variolink II apresentou o menor efeito e os cimentos Rely X Ultimate e Rely X U200 promoveram similarmente os maiores efeitos. A análise de expressão gênica evidenciou influência significativa em todos os cimentos avaliados sobre os níveis de transcritos de PRDX1, SOD1, GPX1 e GSS (p> 0,05), com um aumento considerável no Rely X U200. Conclusão: A indução de genes antioxidantes está, pelo menos em parte, associada à citotoxicidade dos cimentos testados para a experiência de estresse oxidativo.


Assuntos
Antioxidantes , Cimentos de Resina , Humanos , Cimentos de Resina/toxicidade , Antioxidantes/farmacologia , Superóxido Dismutase-1 , Teste de Materiais , Cimentos Dentários/toxicidade
2.
J Dent ; 122: 104158, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35550400

RESUMO

OBJECTIVES: The present study aimed to compare the in vitro cytocompatibility of two etch-and-rinse (Adper Scothbond, Optibond) and two self-etch (Clearfill SE Bond and Single Bond Universal) dental adhesives through a dentin-barrier model with human pulp fibroblasts. METHODS: Human fibroblasts were placed on a plastic device containing 500µm human dentin discs treated with each adhesive or without treatment (control). Other groups were directly exposed to media conditioned with adhesive samples according to ISO 10993-5:2009. After 24h exposure, cell viability was assessed by XTT, and released inflammatory mediators were detected with a multiparametric immunoassay. RESULTS: The standardized test without barrier indicated both etch-and-rinse adhesives and self-etch as cytotoxic, promoting viabilities under 70% of the control group (p<0.05). The dentin-barrier model identified increased cell viability for self-etch adhesives, with Clearfill SE Bond identified as non-cytotoxic. The immunoassay evidenced high rates of cytokines by cells exposed to the conditioned media of Adper Scotchbond, Optibond S, and Single Bond Universal. CONCLUSIONS: The use of a dentin-barrier in vitro model detected a better biocompatibility for self-etching adhesives and, in the case of Clearfill SE Bond, with a reversion from cytotoxic to biocompatible when compared to the indirect standardized test. CLINICAL SIGNIFICANCE: The use of a dentin-barrier in vitro model was able to detect a better biocompatibility for self-etching adhesives when compared to the indirect standardized test and presents itself as a predictive in vitro method for assessing the cytotoxicity of dental restorative materials that may simulate the clinical condition more accurately.


Assuntos
Colagem Dentária , Adesivos Dentinários , Cimentos Dentários/toxicidade , Dentina , Adesivos Dentinários/química , Adesivos Dentinários/toxicidade , Humanos , Teste de Materiais , Cimentos de Resina/química , Cimentos de Resina/toxicidade
3.
Acta Odontol Latinoam ; 33(2): 82-89, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32920609

RESUMO

The aim of this study was to evaluate the degree of conversion, cytotoxicity, solubility and pH of photopolymerizable calciumbased cements submitted to preheating. The degree of conversion was analyzed by Fourier transform infrared, cytotoxicity by the MTT test and solubility through loss of mass. The data were subjected to statistical tests (ANOVA / Tukey's, p<0.05). The photopolymerizable materials showed a low degree of conversion, regardless of preheating. All materials caused a reduction in cell viability at 24 hours and 7 days, with the Dycal (control) being more cytotoxic. Heat had a positive effect on Biocal at 7 days. Dycal is the most soluble material. Heat had no effect on the solubility or pH of the polymerizable materials. It is concluded that photopolymerizable calcium-based cements have a low degree of conversion and are soluble, which results in mild to moderate cytotoxicity.


O objetivo do presente estudo foi avaliar o grau de conversão, citotoxicidade, solubilidade e pH de cimentos à base de cálcio fotopolimerizáveis submetidos a pré-aquecimento. O grau de conversão foi analisado por espectroscopia no infravermelho com transformada de Fourier, a citotoxicidade pelo teste de MTT e a solubilidade através da perda de massa. Os dados foram submetidos a testes estatísticos (ANOVA/Tukey, p<0,05). Os materiais fotopolimerizáveis apresentaram baixo grau de conversão, independente do pré-aquecimento. Todos os materiais causaram redução da viabilidade celular nas análises de 24 horas e 7 dias, sendo que o Dycal (controle) apresentouse mais citotóxico e o calor apresentou efeito positivo sobre o Biocal na análise de 7 dias. O Dycal é o material mais solúvel e o calor não causou efeito na solubilidade e pH dos materiais polimerizáveis. Assim, conclui-se que os cimentos à base de cálcio fotopolimerizáveis apresentam baixo grau de conversão e são solúveis, que resulta em citotoxicidade suave e moderada.


Assuntos
Hidróxido de Cálcio/toxicidade , Sobrevivência Celular/efeitos dos fármacos , Cimentos Dentários/química , Agentes de Capeamento da Polpa Dentária e Pulpectomia/toxicidade , Cálcio , Hidróxido de Cálcio/química , Cimentos Dentários/toxicidade , Capeamento da Polpa Dentária , Humanos , Concentração de Íons de Hidrogênio , Cura Luminosa de Adesivos Dentários , Processos Fotoquímicos , Polimerização , Agentes de Capeamento da Polpa Dentária e Pulpectomia/química
4.
Acta odontol. latinoam ; 33(2): 82-89, Sept. 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1130737

RESUMO

ABSTRACT The aim of this study was to evaluate the degree of conversion, cytotoxicity, solubility and pH of photopolymerizable calciumbased cements submitted to preheating. The degree of conversion was analyzed by Fourier transform infrared, cytotoxicity by the MTT test and solubility through loss of mass. The data were subjected to statistical tests (ANOVA / Tukey's, p<0.05). The photopolymerizable materials showed a low degree of conversion, regardless of preheating. All materials caused a reduction in cell viability at 24 hours and 7 days, with the Dycal (control) being more cytotoxic. Heat had a positive effect on Biocal at 7 days. Dycal is the most soluble material. Heat had no effect on the solubility or pH of the polymerizable materials. It is concluded that photopolymerizable calcium-based cements have a low degree of conversion and are soluble, which results in mild to moderate cytotoxicity.


RESUMO O objetivo do presente estudo foi avaliar o grau de conversão, citotoxicidade, solubilidade e pH de cimentos à base de cálcio fotopolimerizáveis submetidos a pré-aquecimento. O grau de conversão foi analisado por espectroscopia no infravermelho com transformada de Fourier, a citotoxicidade pelo teste de MTT e a solubilidade através da perda de massa. Os dados foram submetidos a testes estatísticos (ANOVA/Tukey, p<0,05). Os materiais fotopolimerizáveis apresentaram baixo grau de conversão, independente do pré-aquecimento. Todos os materiais causaram redução da viabilidade celular nas análises de 24 horas e 7 dias, sendo que o Dycal (controle) apresentouse mais citotóxico e o calor apresentou efeito positivo sobre o Biocal na análise de 7 dias. O Dycal é o material mais solúvel e o calor não causou efeito na solubilidade e pH dos materiais polimerizáveis. Assim, conclui-se que os cimentos à base de cálcio fotopolimerizáveis apresentam baixo grau de conversão e são solúveis, que resulta em citotoxicidade suave e moderada.


Assuntos
Humanos , Hidróxido de Cálcio/toxicidade , Sobrevivência Celular/efeitos dos fármacos , Cimentos Dentários/química , Agentes de Capeamento da Polpa Dentária e Pulpectomia/toxicidade , Hidróxido de Cálcio/química , Cálcio , Cimentos Dentários/toxicidade , Capeamento da Polpa Dentária , Cura Luminosa de Adesivos Dentários , Processos Fotoquímicos , Agentes de Capeamento da Polpa Dentária e Pulpectomia/química , Polimerização , Concentração de Íons de Hidrogênio
5.
J Appl Oral Sci ; 26: e20160594, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29489936

RESUMO

Denture adhesives (DA) improve the retention and stability of ill-fitting dentures, especially for older adults. These materials should be biocompatible, i.e., they cannot cause undesired biological responses and be non-cytotoxic to oral tissues. However, in vitro testing of DA biocompatibility employing primary cell culture may possibly be affected by other factors, such as the donor age. OBJECTIVE: To compare the cytotoxicity of three different denture adhesives when assessed in primary gingival fibroblasts from a young donor or from an older donor, as well as the release of the basic fibroblast growth factor (bFGF), and the inflammatory response marker interleukin-6 (IL-6). MATERIAL AND METHODS: Gingival fibroblasts isolated from a 30- and a 62-year-old donor were assayed for proliferation (1-7 days) and sensitivity to latex (positive control). Fibroblasts were indirectly exposed to Corega Ultra (cream), Corega powder and Fixodent Original for a 24 h period and assayed by XTT and Crystal Violet tests. The release of IL-6 and bFGF by exposed cells was determined by ELISA. RESULTS: While cells from the young donor presented higher cell growth after 7 days, the sensitivity to increasing concentrations of latex extracts was very similar between young and older cells. Both XTT and CVDE detected no difference between the DA and the control group. All materials induced higher levels of IL-6 and bFGF compared to control. Cells from the older donor exposed to Corega Ultra released lower levels of cytokine and growth factor. CONCLUSIONS: All materials were considered non-cytotoxic, but affected cytokine and growth factor release. The biological differences found between fibroblasts from both donors could be due to individual or age-related factors. The authors suggest the use of cells from older donors on studies of dental products aimed at older patients, to better simulate their physiological response.


Assuntos
Cimentos Dentários/toxicidade , Fibroblastos/efeitos dos fármacos , Gengiva/citologia , Polímeros/toxicidade , Adulto , Fatores Etários , Contagem de Células , Células Cultivadas , Ensaio de Imunoadsorção Enzimática , Feminino , Fator 2 de Crescimento de Fibroblastos/análise , Formazans , Violeta Genciana , Gengiva/efeitos dos fármacos , Humanos , Interleucina-6/análise , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo
6.
J. appl. oral sci ; 26: e20160594, 2018. graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-893697

RESUMO

Abstract Denture adhesives (DA) improve the retention and stability of ill-fitting dentures, especially for older adults. These materials should be biocompatible, i.e., they cannot cause undesired biological responses and be non-cytotoxic to oral tissues. However, in vitro testing of DA biocompatibility employing primary cell culture may possibly be affected by other factors, such as the donor age. Objective To compare the cytotoxicity of three different denture adhesives when assessed in primary gingival fibroblasts from a young donor or from an older donor, as well as the release of the basic fibroblast growth factor (bFGF), and the inflammatory response marker interleukin-6 (IL-6). Material and Methods Gingival fibroblasts isolated from a 30- and a 62-year-old donor were assayed for proliferation (1-7 days) and sensitivity to latex (positive control). Fibroblasts were indirectly exposed to Corega Ultra (cream), Corega powder and Fixodent Original for a 24 h period and assayed by XTT and Crystal Violet tests. The release of IL-6 and bFGF by exposed cells was determined by ELISA. Results While cells from the young donor presented higher cell growth after 7 days, the sensitivity to increasing concentrations of latex extracts was very similar between young and older cells. Both XTT and CVDE detected no difference between the DA and the control group. All materials induced higher levels of IL-6 and bFGF compared to control. Cells from the older donor exposed to Corega Ultra released lower levels of cytokine and growth factor. Conclusions All materials were considered non-cytotoxic, but affected cytokine and growth factor release. The biological differences found between fibroblasts from both donors could be due to individual or age-related factors. The authors suggest the use of cells from older donors on studies of dental products aimed at older patients, to better simulate their physiological response.


Assuntos
Humanos , Masculino , Feminino , Adulto , Polímeros/toxicidade , Cimentos Dentários/toxicidade , Fibroblastos/efeitos dos fármacos , Gengiva/citologia , Fatores de Tempo , Teste de Materiais , Ensaio de Imunoadsorção Enzimática , Contagem de Células , Células Cultivadas , Reprodutibilidade dos Testes , Fator 2 de Crescimento de Fibroblastos/análise , Fatores Etários , Interleucina-6/análise , Estatísticas não Paramétricas , Formazans , Violeta Genciana , Gengiva/efeitos dos fármacos , Pessoa de Meia-Idade
7.
Scanning ; 2017: 9650420, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29109829

RESUMO

The aim of this study was to evaluate in fibroblast cultures the direct cytotoxic effects of etch-and-rinse, self-etch, and universal adhesive systems. The sterile glass cover slips (n = 3) were then immersed in culture medium to obtain the eluates for the experimental groups: (1) Adper™ Single Bond 2; (2) Ambar; (3) Adper™ Scotchbond™ Multi-Purpose; (4) Scotchbond™ Universal; (5) Ambar Universal; and (6) OptiBond All-In-One. As a negative control, sterile glass cover slips were immersed in culture medium only. After 24 h, the eluate obtained was applied on fibroblast culture. Cell viability and cell morphology were evaluated by MTT assay and SEM, respectively. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests (α = 0.05). All adhesive systems except universal reduced cell viability in 3T3 cells to between 26.04% and 56.57%, and Scotchbond Universal and Ambar Universal reduced cell viability to 2.13% and 3.57%, respectively, when compared to the negative control. Cytoplasmic membrane shrinkage and cell-free areas with residual membrane fragments from dead cells were observed. In conclusion, improvements in universal adhesive system formulations and their mechanisms of action are not accompanied by increased toxicity compared with those in other systems, warranting commitment to the use of these dentin-pulp complexes.


Assuntos
Sobrevivência Celular/efeitos dos fármacos , Cimentos Dentários/toxicidade , Fibroblastos/efeitos dos fármacos , Fibroblastos/fisiologia , Células 3T3 , Animais , Membrana Celular/patologia , Forma Celular/efeitos dos fármacos , Fibroblastos/citologia , Formazans/análise , Camundongos , Microscopia Eletrônica de Varredura , Sais de Tetrazólio/análise
8.
Artigo em Espanhol | LILACS | ID: biblio-900288

RESUMO

RESUMEN: Los adhesivos de cianoacrilatos (ACA) son materiales sintéticos con propiedades adhesivas. Al ser aplicados en los tejidos polimerizan uniéndose con el tejido subyacente. Desde la década de los 70' se han explorado sus aplicaciones quirúrgicas para el cierre de heridas y fístulas, control de sangrado y fijación de injertos, entre otros, siendo su uso como alternativa para el cierre de heridas en piel y mucosas uno de los más estudiados. Los ACA presentan un limitado grado de absorción, sin evidencia de efectos tóxicos sistémicos. Tienen la ventaja de ser aplicados de forma rápida, indolora, con efecto antibacteriano y hemostático según los reportes de la literatura, pero presentan una reducida fuerza de tensión. El objetivo de esta revisión de la literatura es describir los usos y aplicaciones de los ACA, con enfoque en la cirugía oral y maxilofacial, evaluando de forma crítica sus aplicaciones.


ABSTRACT: The cyanoacrylate adhesives (ACA) are synthetic materials with adhesive properties. When is applied in tissues, it polymerizes and bonds with the underlying tissue. Since the 70s' have been explored their surgical applications for closing wounds, fistulas, bleeding control, and graft fixation, among others. Its use as an alternative for closing wounds in skin and mucous is one of the most studied. The ACA have a limited absorption degree, with no evidence of systemic toxic effects. They have the advantage of being applied quickly, painlessly, with antibacterial effect and hemostatic according to the report of literature, but with reduced tensile strength. The objective of this literature review is to describe the use and applications of ACA, with focus on oral and maxillofacial surgery, with a critically evaluation of their applications.


Assuntos
Humanos , Hemostáticos/uso terapêutico , Técnicas de Sutura , Procedimentos Cirúrgicos Bucais/métodos , Cianoacrilatos/uso terapêutico , Cimentos Dentários/uso terapêutico , Suturas , Cianoacrilatos/toxicidade , Cimentos Dentários/toxicidade , Técnicas de Fechamento de Ferimentos , Hemostasia/efeitos dos fármacos
9.
Braz Dent J ; 28(1): 57-64, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28301019

RESUMO

This study aimed to evaluate the cytotoxicity of a calcium aluminate cement (EndoBinder) containing different radiopacifiers, Bi2O3, ZnO or ZrO2, compared with Mineral Trioxide Aggregate (MTA). According to ISO 10993-12:2012 (E) recommendations, 0.2 g of each cement were applied in transwell inserts and placed in 24-well culture plates containing 1 mL of culture medium (DMEM). After 24 h of incubation, the extracts (DMEM containing components released from the cements) were applied to immortalized odontoblast-like MDPC-23 cells. Cell viability (MTT test), alkaline phosphatase activity (ALP), total protein production and cell morphology (Scanning Electron Microscopy - SEM) were evaluated. The volume of 50 µL of extract was used to determine the chemical elements released by the cements using Energy Dispersive Spectroscopy (EDS). The following groups were established (n=6): NC - negative control (without treatment); EB - EndoBinder without radiopacifier; EBBO - EndoBinder+Bi2O3; EBZnO - EndoBinder+ZnO; EBZrO - EndoBinder+ZrO2 and WMTA - White MTA. Data were subjected to statistical analysis (Kruskal-Wallis test, level of significance=5%). Cells exposed to the different versions of EndoBinder presented small reduction in viability, total protein production and ALP activity, with values similar to the NC and WMTA groups (p>0.05). Different elements (C, O, Na, Al, P, Si, Cl, Bi, K) released by the cements were detected in the extracts. However, the cells had no significant changes in their morphology. EndoBinder and MTA did not affect negatively the metabolism of the odontoblastic-like cells, showing it to be cytocompatible, irrespective of the used radiopacifier.


Assuntos
Compostos de Alumínio/toxicidade , Compostos de Cálcio/toxicidade , Cimentos Dentários/toxicidade , Animais , Linhagem Celular Transformada , Sobrevivência Celular/efeitos dos fármacos , Combinação de Medicamentos , Microscopia Eletrônica de Varredura , Óxidos/toxicidade , Silicatos/toxicidade , Espectrometria por Raios X
10.
Braz. dent. j ; 28(1): 57-64, Jan.-Feb. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-839113

RESUMO

Abstract This study aimed to evaluate the cytotoxicity of a calcium aluminate cement (EndoBinder) containing different radiopacifiers, Bi2O3, ZnO or ZrO2, compared with Mineral Trioxide Aggregate (MTA). According to ISO 10993-12:2012 (E) recommendations, 0.2 g of each cement were applied in transwell inserts and placed in 24-well culture plates containing 1 mL of culture medium (DMEM). After 24 h of incubation, the extracts (DMEM containing components released from the cements) were applied to immortalized odontoblast-like MDPC-23 cells. Cell viability (MTT test), alkaline phosphatase activity (ALP), total protein production and cell morphology (Scanning Electron Microscopy - SEM) were evaluated. The volume of 50 µL of extract was used to determine the chemical elements released by the cements using Energy Dispersive Spectroscopy (EDS). The following groups were established (n=6): NC - negative control (without treatment); EB - EndoBinder without radiopacifier; EBBO - EndoBinder+Bi2O3; EBZnO - EndoBinder+ZnO; EBZrO - EndoBinder+ZrO2 and WMTA - White MTA. Data were subjected to statistical analysis (Kruskal-Wallis test, level of significance=5%). Cells exposed to the different versions of EndoBinder presented small reduction in viability, total protein production and ALP activity, with values similar to the NC and WMTA groups (p>0.05). Different elements (C, O, Na, Al, P, Si, Cl, Bi, K) released by the cements were detected in the extracts. However, the cells had no significant changes in their morphology. EndoBinder and MTA did not affect negatively the metabolism of the odontoblastic-like cells, showing it to be cytocompatible, irrespective of the used radiopacifier.


Resumo Este estudo avaliou a citotoxicidade de um cimento de aluminato de cálcio (EndoBinder) contendo diferentes radiopacificadores, Bi2O3, ZnO ou ZrO2, comparativamente ao trióxido mineral agregado (MTA). Seguindo a norma ISO 10993-12:2012 (E), 0,2 g de cada cimento foi aplicada em insertos transwell, que foram colocados em placas de cultura de 24 wells contendo 1 mL de meio de cultura (DMEM). Após 24 h de incubação, os extratos (DMEM contendo componentes liberados dos cimentos) foram aplicados sobre células pulpares imortalizadas MDPC-23. Viabilidade celular (teste de MTT), atividade da fosfatase alcalina (ALP), produção de proteína total e a morfologia das células (Microscópio Eletrônico de Varredura - MEV) foram avaliadas. Um volume de 50 µL do extrato foi utilizado para determinar, através de Espectroscopia de Energia Dispersiva (EDS), os elementos químicos liberados pelos cimentos. Os seguintes grupos foram estabelecidos (n=6): NC - controle negativo (sem tratamento); EB - EndoBinder sem radiopacificador; EBBO - EndoBinder+Bi2O3; EBZnO - EndoBinder+ZnO; EBZrO - EndoBinder+ZrO2 e WMTA - MTA branco. Os dados foram submetidos à análise estatística (teste de Kruskal-Wallis, nível de significância=5%). Células expostas às diferentes versões de EndoBinder apresentaram pequena redução na viabilidade, produção de proteína total e atividade da ALP, com valores semelhantes aos grupos NC e WMTA (p>0,05). Diversos elementos (C, O, Na, Al, P, Si, Cl, Bi, K) liberados pelos cimentos foram detectados nos extratos. Entretanto, as células não apresentaram alterações significativas em sua morfologia. EndoBinder e MTA, não afetaram negativamente o metabolismo das células odontoblastóides, mostrando-se citocompatíveis, independente do radiopacificador utilizado.


Assuntos
Animais , Compostos de Cálcio/toxicidade , Compostos de Alumínio/toxicidade , Cimentos Dentários/toxicidade , Óxidos/toxicidade , Espectrometria por Raios X , Linhagem Celular Transformada , Microscopia Eletrônica de Varredura , Sobrevivência Celular/efeitos dos fármacos , Silicatos/toxicidade , Combinação de Medicamentos
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