Post-trauma endodontic treatment of a patient with cerebral palsy: a case report

Tratamento endodôntico pós-trauma em paciente com paralisia cerebral: um relato de caso

ABSTRACT

Cerebral palsy is a neurodevelopmental condition that affects individuals early in life and persists over time. This condition non-progressively affects movement and motor coordination. Motor and cognitive limitations associated with cerebral palsy predispose these individuals to greater vulnerability to dental trauma and soft tissue injuries. The present study aimed to report a clinical case of endodontic treatment of teeth 21 and 11 in a 13-year-old male patient with cerebral palsy, following dental trauma with pulp involvement. The patient presented to the dental school clinic accompanied by his caregiver, with the chief complaint of a fistula in the region of the maxillary central incisors. The treatment plan consisted of endodontic therapy followed by resin composite restoration, carried out over four clinical sessions without the need for sedation. After six months of clinical and radiographic follow-up, no recurrence of the infectious condition was observed, and regression of the periapical lesion was evident. Therefore, endodontic treatment was effective in preserving functionally and aesthetically important teeth, constituting a conservative alternative to tooth extraction in patients with special needs.

Indexing terms
Cerebral palsy; Persons with disabilities; Tooth injuries

RESUMO

A paralisia cerebral é uma condição do neurodesenvolvimento que acomete os indivíduos no início da vida e perdura no tempo. Essa condição afeta, de modo não progressivo, os movimentos e a coordenação motora. As limitações motoras e cognitivas associadas à paralisia cerebral predispõem esses indivíduos a uma maior vulnerabilidade a traumatismos dentários e a lesões de tecidos moles. Nesse contexto, o presente estudo teve como objetivo relatar um caso clínico de tratamento endodôntico dos dentes 21 e 11 em um paciente adolescente com paralisia cerebral, após traumatismo dentário com envolvimento pulpar. Trata-se de um paciente do sexo masculino, de 13 anos de idade, que compareceu à clínica-escola de odontologia acompanhado de sua cuidadora, apresentando como queixa principal a presença de fístula na região dos incisivos centrais superiores. O plano de tratamento consistiu na realização de terapia endodôntica seguida de restauração com resina composta, conduzida em quatro sessões clínicas, sem a necessidade de sedação. Após seis meses de acompanhamento clínico e radiográfico, não foi observada recidiva do quadro infeccioso, bem como evidenciou-se regressão da lesão periapical. Os resultados demonstram que o tratamento endodôntico foi eficaz na preservação de dentes funcional e esteticamente relevantes, constituindo uma alternativa conservadora à exodontia em pacientes com necessidades especiais.

Termos de indexação
Paralisia cerebral; Pessoas com deficiências; Traumatismo dentário

INTRODUCTION

People with disabilities are individuals with sensory, physical, mental, congenital, or behavioral impairments, as well as conditions resulting from infectious or metabolic diseases. Disabilities are part of the human condition, and it is likely that most individuals will experience temporary or permanent functional limitations at some point in their lives [¹]. Factors such as population aging and increased survival of premature neonates have significantly contributed to the higher prevalence of these conditions [²]. Disabilities are multifactorial and include hereditary diseases, congenital abnormalities, conditions acquired throughout the life course, behavioral disorders, and systemic diseases, among others. These individuals may present long-term impairments that, in interaction with environmental and social barriers, may hinder or prevent their full and equal participation in Society [³].

Cerebral Palsy (CP) is the most common neurodevelopmental condition in childhood, affecting individuals during the fetal period or early childhood and resulting in physical and neurological disabilities. CP affects approximately 2-3 per 1,000 live births [⁴]. CP can be classified into different types depending on the neuromuscular condition and anatomical distribution: spastic/pyramidal (the most prevalent), dyskinetic/extrapyramidal, ataxic, and hypotonic. CP has a multifactorial etiology, including prenatal factors such as congenital infections and hypoxia; perinatal factors such as anoxia and eclampsia; and postnatal factors such as infections and trauma [⁵]. Significant neurological alterations frequently associated with CP include dysphagia, apraxia, hemianopsia, cognitive deficits, as well as impairments in perceptual, visual, and auditory functions [⁶].

Injuries to the developing brain during the prenatal, perinatal, or early postnatal periods may compromise the neurological and musculoskeletal systems, resulting in clinical manifestations such as muscle hypertonia or hypotonia, postural alterations, restrictions in voluntary movements, and functional limitations. These impairments are frequently associated with sensory and perceptual disorders, cognitive deficits, communication difficulties, behavioral changes, epilepsy, and secondary musculoskeletal deformities [⁷]. People with special needs may have physical, sensory, and behavioral impairments and, in some specific conditions such as cerebral palsy, may also present with seizure disorders. Therefore, these individuals experience greater difficulties with locomotion, balance, and mobility, which hinder the performance and maintenance of proper oral hygiene, and increase their susceptibility to falls and traumatic injuries. Dental injuries in patients with special needs may occur as a result of their physical and mental conditions, which lead to reduced protective reflexes [⁸].

Recent studies have indicated that traumatic injuries are more frequent in male children and mainly affect the maxillary central incisors, with most cases resulting from falls. In individuals with disabilities, the most common dental approach to trauma is tooth extraction and pharmacological therapy, driven by the shortage of trained professionals, low health literacy among caregivers, and greater difficulty in behavioral management [⁹]. In addition, individuals with CP often present occlusal deformities resulting from neuromuscular, postural, and functional alterations that affect orofacial development. The presence of open bite, crossbite, mandibular retrognathism, bruxism, and lack of lip seal contributes to the incidence of dental trauma. Conditions that affect balance, coordination, response capacity, and reflexes may increase the occurrence of dental trauma, as well as conditions that affect the nervous system – such as epilepsy, seizures, autism, CP, and attention deficit hyperactivity disorder – which increase the risk of injuries [¹⁰]. Traumatic injuries may cause health, functional, aesthetic, and psychological problems, negatively affecting quality of life [¹¹].

CASE REPORT

The study was approved by the Research Ethics Committee under protocol number CAAE 92451225.2.0000.5374. A 13-year-old male patient with a diagnosis of nonprogressive chronic encephalopathy, also referred to as spastic (pyramidal) CP, and under continuous use of Depakene® 250 mg and Baclofen® 10 mg, presented to the outpatient clinic of São Leopoldo Mandic Dental School (Campinas, SP, Brazil) accompanied by his legal guardian, who signed the informed consent form. The chief complaint was the presence of a fistula associated with teeth 11 and 21. Dental examination revealed absence of lip seal and increased overjet, and a Class II malocclusion. Following anamnesis and clinical and radiographic examinations, a diagnosis of chronic apical periodontitis associated with pulp necrosis was established. During anamnesis, the patient’s caregiver reported that the trauma had occurred approximately one year earlier, during a physical therapy session, and that another professional had performed resin composite restorations. Subsequently, a fistula developed in the apical region of the incisors. Therefore, new clinical examinations were carried out by the São Leopoldo Mandic team, and the teeth diagnosed with pulp necrosis underwent four sessions of endodontic treatment at the outpatient clinic. In the first session, anamnesis, clinical examination, and initial radiographic assessment were performed, followed by local anesthesia with 3% Prilonest, rubber dam isolation, coronal access of tooth 11, compensatory wear, odontometric measurement, and instrumentation (preparation of the cervical and middle thirds) using K-files with a quarter-turn push-pull motion and a step-back technique. Verification of the real working length of 27 mm was performed using a WAKS (Woodpecker) electronic apex locator. The level of instrumentation was determined at 1 mm beyond the apical foramen, with manual instrumentation up to a size 80 K-file, complemented by the use of a UnivySense 25.08 reciprocating file at the apical third. A 2% chlorhexidine gel was used as an auxiliary chemical substance, while sterile saline solution served as the irrigant.

Subsequently, intracanal medication with UltraCal XS (Ultradent) was placed, and the crown was temporarily sealed with glass ionomer cement (Maxxion R, FGM). In the second session, after one month, final irrigation was performed with 3 mL of 17% ethylenediaminetetraacetic acid (EDTA), followed by drying of the root canal with absorbent paper points (Tanari Industrial, Amazônia), a master cone trial, and obturation using the Tagger hybrid technique with a calibrated gutta-percha cone (Colored Calibrated Gutta-Percha Cones 45-80, 28 mm, pack of 120 – Dentsply Sirona). Root canal filling was completed using an endodontic sealer (Sealer 26 – Dentsply Sirona), delivered into the canal with the aid of a Univy Lentulo paste carrier #25 (25 mm). After the final radiographic assessment, obturation of tooth 11 was considered unsatisfactory due to the wide root canal diameter and inadequate sealing of the middle and cervical thirds. Nevertheless, the tooth was sealed with Tetric N-Flow resin (Ivoclar Vivadent) and followed up for 30 days. In the third session, the procedure began with a visual inspection of tooth 11, during which a reduction of the fistula and absence of painful symptoms were observed. Therefore, treatment of tooth 21 was carried out in a single session, using the same protocol for access, instrumentation, and irrigation, under relative isolation to reduce patient and caregiver anxiety. The real tooth length was 27 mm, instrumentation was performed up to 28 mm, and obturation was carried out according to the established working length. Irrigation and disinfection of the root canal were performed using 2% chlorhexidine gel and saline solution, followed by drying with absorbent paper points (Tanari Industrial, Amazônia). For obturation, two size 80 master cones (MK Life) were combined and supplemented with accessory cones, and the canal was filled with endodontic sealer Sealer 26 (Dentsply Sirona). The gutta-percha was cut using a thermoplastic instrument 2 mm below the cementoenamel junction, followed by coronal sealing with Coltosol at the canal entrances and subsequent application of light-cured resin composite (Charisma Classic Resin – Kulzer, shade A2) using the incremental technique. The outcome was satisfactory, with homogeneous and adequate filling of the root canals. In the fourth session, visual inspection also revealed a reduction of infection in tooth 21 and absence of pain. The obturation removal step was performed under magnification using an operating microscope, allowing for greater visual precision. The experience gained during the treatment of tooth 21 motivated the decision to re-treat tooth 11, despite the absence of symptoms and healing of the fistula, with the aim of improving the seal. During retreatment, partial removal of the obturation material was carried out under magnification under an operating microscope (Basic II Mobile Microscope with Casters -Alliance), allowing for greater visual accuracy while preserving the apical filling material. The new obturation followed the same technique used for tooth 21, with the combination of two size 80 master cones (MK Life) and accessory cones, use of Sealer 26 endodontic cement, thermoplastic cutting 2 mm below the cementoenamel junction, and coronal sealing with Coltosol followed by resin composite restoration (etching with 37% phosphoric acid, ALLPRIME; adhesive system Ambar, FGM; resin composite Charisma Classic – Kulzer, shade A2) using the incremental technique.

The treatment outcome showed precise adaptation and efficient sealing. The final radiograph was obtained immediately after completion of the procedure. After six months of follow-up, the teeth remained asymptomatic, with satisfactory root canal obturation and normal periapical conditions observed on periapical radiographs. During the appointment, the child remained cooperative despite his limitations. In addition, all procedures were planned to last up to 60 minutes. For dental management of the patient, who presented significant muscle rigidity, some devices were used: a neck pillow placed on the dental chair backrest to stabilize involuntary movements and maintain cervical positioning during the procedure. In addition, a wooden mouth prop was wrapped in sterile gauze and used to keep the mouth open during the procedures (figures 1, 2, 3 and 4).

Figure 1
A and B) Record provided by the legal guardian immediately after the trauma, showing complete loss of the crown and pulp exposure. C, D, and E): Initial appearance recorded during triage at São Leopoldo Mandic College (resin composite restorations performed by an external professional without endodontic treatment). Fistula associated with tooth 11.

Figure 2
Extraoral photographs taken at São Leopoldo Mandic College, Campinas, SP, Brazil.

Figure 3
A) Initial radiographic appearance (wide canals and arrest of root formation). B) Presence of periapical lesions in teeth 21 and 22 and working length determination. C) Unsatisfactory obturation of tooth 11 and master cone fitting of tooth 21. D) Final obturation of tooth 21. E) Removal of the obturation of tooth 11 and placement of a gutta-percha cone and endodontic sealer. F) Six-month follow-up showing regression of the periapical lesion.

Figure 4
A) Junction of two gutta-percha cones (thermal reaction). B) Partial removal of the root canal filling of tooth 11 using Endodontic Microscopy. C) Cushion for head protection and stabilization. D) Final clinical aspect.

DISCUSSION

This report presents a case of dental trauma involving the central incisors of a child with CP, in which endodontic treatment was chosen over tooth extraction, thereby maintaining the individual’s aesthetics, function, and quality of life. Previous studies have indicated a higher risk of dental trauma in children with special needs, especially those with autism, individuals with CP, and people with sensory and visual impairments, due to neurological, physical, mental, and behavioral impairments [¹²,¹³].

The high prevalence of dental trauma in children with disabilities is associated with oral, systemic, and social factors. Among the most frequently associated factors are the presence of involuntary movements, primitive reflexes, slow neuromuscular responses, and masticatory difficulties. Similar to other studies, the maxillary central incisor is the most affected tooth, mainly due to its anatomical position, labial inclination, and lack of lip protection, which is commonly caused by muscle hypotonia in patients with CP [¹⁴]. In children with CP, the main causes of dental trauma are falls, seizures, and reduced protective reflexes. In addition, oral conditions such as increased overjet, mouth breathing, and absence of lip seal contribute to the occurrence of dentoalveolar trauma [¹⁵]. Regarding the treatment of this population, it is important to emphasize that trauma management in these patients is complex, as it requires multiple rehabilitation procedures and adaptations to the dental care setting [¹⁶,¹⁷].

Orofacial trauma involving permanent teeth represents a significant public health problem [¹⁸]. Among the possible sequelae resulting from these injuries, pulp necrosis is the most prevalent and is associated with impairment of the neurovascular bundle due to inflammatory processes, tissue pressure, and tension on the apical nerves [¹⁹]. Endodontic management, indicated after a period of clinical and radiographic observation, is indicated when signs and symptoms compatible with pulp necrosis are present, with the aim of preserving the tooth element and avoiding its extraction. Endodontic treatment seeks to eliminate or prevent the establishment of infectious processes within the root canal system, thereby preserving tooth function and integrity within the oral cavity [²⁰].

In Brazil, Act no. 13.146/2015 guarantees the rights of people with disabilities to broad access to dental treatments; however, such care remains scarce and limited. As a result, these individuals face several barriers, including the shortage of trained professionals, inadequately adapted dental environments, high treatment costs, and a suppressed demand for care [²¹]. This situation is further aggravated when more complex and timeconsuming procedures are required, such as endodontic treatment. When this specific treatment is indicated, it is common for people with disabilities to be referred to more invasive and mutilating interventions, such as tooth extraction. Previous studies have stated that this practice persists due to dentists’ perceptions regarding the lack of cooperation from patients with special needs and the challenges involved in behavioral management [²²-²⁴]. However, the premature and unnecessary loss of teeth not only negatively impacts self-esteem and socialization in these individuals, but also worsens occlusal and masticatory problems [²⁵,²⁶].

The increased life expectancy of people with special needs, coupled with the growing interest in and need for tooth preservation, requires that dentists be trained to perform the most conservative treatments in this population. Patients with special needs have the right to receive dental care under conditions equivalent to those offered to the general population. In this context, adopting a conservative approach in the management of these patients expands the possibilities for tooth preservation, reserving more invasive procedures, such as extraction, only as the last therapeutic alternative [²⁷]. Despite the difficulty in accessing services, dental care for patients with disabilities through the Sistema Único de Saúde (SUS, Brazilian Public Health System) is fundamental for the promotion and prevention of oral health within the family context. The Dental Clinic for Patients with Special Needs at the São Leopoldo Mandic Dental School provides care to all people with disabilities. These patients can access care through the Dental Specialties Center following referral from the SUS, via primary healthcare units, or through referral by other health professionals. In this environment, professors and students work together in an interdisciplinary manner to provide maximum comfort for these patients and their families.

CONCLUSION

Endodontic treatment in patients with CP may require adaptations in the dental office, in handling, and in the choice of materials. Furthermore, in cases of dental trauma, the presence of wide canals poses challenges regarding obturation and instrumentation techniques. Endodontic treatment, however, has proven effective and promising in these patients, avoiding invasive treatments such as tooth extraction and the unnecessary loss of a functional and aesthetic structure for the development and growth of children with special needs.

• Article aligned with the Good Health and Well-Being and Quality Education goal of the Sustainable Development Goals (SDGs).
• How to cite this article
  Bispo SS, Fontes NHS, Santos ICO, Santos YA, Silva TMR, Souza GR, Marega T. Post-trauma endodontic treatment of a patient with cerebral palsy: a case report. RGO, Rev Gaúch Odontol. 2026;74:e20260034. http://dx.doi.org/10.1590/1981-86372026003420260004

Data Availability

The research data are available in the body of the document.

REFERENCES

• ¹ World Health Organization. World Report on Disability. Geneva: WHO; 2011.
• ² Ministério da Saúde (Brasil). Secretaria de Atenção Primária à Saúde. Departamento de Saúde da Família. Guia de atenção à saúde bucal da pessoa com deficiência. Brasília: Ministério da Saúde; 2019.
• ³ Ministério da Saúde (Brasil). Secretaria de Atenção à Saúde. Política Nacional de Saúde da Pessoa Portadora de Deficiência. Brasília: Ministério da Saúde; 2008.
• ⁴ Vitrikas K, Dalton H, Breish D. Cerebral palsy: an overview. Am Fam Physician. 2020;101(4):213-20. doi: https://doi.org/PMID:32053326
• ⁵ Gulati S, Sondhi V. Cerebral palsy: an overview. Indian J Pediatr. 2018;85:1006-16. doi: https://doi.org/10.1007/s12098-017-2475-1
  » https://doi.org/10.1007/s12098-017-2475-1
• ⁶ Ruiz Brunner MM, Cuestas E. La construcción de la definición parálisis cerebral: un recorrido histórico hasta la actualidad. Rev Fac Cien Med Univ Nac Cordoba. 2019;76(2):113-7. doi: https://doi.org/10.31053/1853.0605.v76.n2.23649
  » https://doi.org/10.31053/1853.0605.v76.n2.23649
• ⁷ Ministério da Saúde (Brasil). Diretrizes de atenção à pessoa com paralisia cerebral. Brasília: Ministério da Saúde; 2014.
• ⁸ Secretaria de Saúde do Distrito Federal (Brasil). Protocolo de atenção à saúde: atendimento odontológico à pessoa com deficiência. Brasília: Secretaria de Saúde; 2017.
• ⁹ Kimura ACRS, Drumond VZ, Oliveira MG, Oliveira SR, Mesquita RA, Arruda JAA, et al. Occlusal features in individuals with cerebral palsy: a systematic review and meta-analysis. Eur J Orthod. 2025;47(5):cjaf070. doi: https://doi.org/10.1093/ejo/cjaf070.
  » https://doi.org/10.1093/ejo/cjaf070
• ¹⁰ Devi PK, Tewari N, O’Connell A, Srivastav S, Rajeswary A, Upadhyay AD, et al. Risk factors associated with traumatic dental injuries in individuals with special healthcare needs: a systematic review and meta-analysis. Dent Traumatol. 2024;40(1):91-110. doi: https://doi.org/10.1111/edt.12882
  » https://doi.org/10.1111/edt.12882
• ¹¹ Kaczmarek U, Gozdowski D, Olczak-Kowalczyk D. Prevalence of traumatic dental injuries in Polish 15-year-olds. Dent Med Probl. 2019;56(4):365-71. doi: https://doi.org/10.17219/dmp/112302
  » https://doi.org/10.17219/dmp/112302
• ¹² Habibe RCH, Ortega AO, Guaré RO, Diniz MB, Santos MT. Risk factors for anterior traumatic dental injury in children and adolescents with autism spectrum disorders: a case-control study. Eur Arch Paediatr Dent. 2016;17(2):75-80. doi: https://doi.org/10.1007/s40368-015-0207-7
  » https://doi.org/10.1007/s40368-015-0207-7
• ¹³ Al-Batayneh OB, Owais AI, Al-Saydali MO, Waldman HB. Traumatic dental injuries in children with special health care needs. Dent Traumatol. 2017;33(4):269-75. doi: https://doi.org/10.1111/edt.12334
  » https://doi.org/10.1111/edt.12334
• ¹⁴ Miamoto CB, Ramos-Jorge ML, Ferreira MC, Oliveira Md, Vieira-Andrade RG, Marques LS. Dental trauma in individuals with severe cerebral palsy: prevalence and associated factors. Braz Oral Res. 2011;25:319-23. doi: https://doi.org/10.1590/S1806-83242011000400007
  » https://doi.org/10.1590/S1806-83242011000400007
• ¹⁵ Cardoso AM, Silva CR, Gomes LN, Gomes MN, Padilha WW, Cavalcanti AL. Dental trauma in Brazilian children and adolescents with cerebral palsy. Dent Traumatol. 2015;31:471-6. doi: https://doi.org/10.1111/edt.12184
  » https://doi.org/10.1111/edt.12184
• ¹⁶ Murthy AK, Chandrakala B, Pramila M, Ranganath S. Dental trauma in children with disabilities in India: a comparative study. Eur Arch Paediatr Dent. 2013;14:221-5. doi: https://doi.org/10.1007/s40368-013-0051-6
  » https://doi.org/10.1007/s40368-013-0051-6
• ¹⁷ Bagattoni S, Sadotti A, D’Alessandro G, Piana G. Dental trauma in Italian children and adolescents with special health care needs: a cross-sectional retrospective study. Eur J Paediatr Dent. 2017;18:23-6. doi: https://doi.org/10.23804/ejpd.2017.18.01.05
  » https://doi.org/10.23804/ejpd.2017.18.01.05
• ¹⁸ Petti S, Andreasen JO, Glendor U, Andersson L. The fifth most prevalent disease is being neglected by public health organisations. Lancet Glob Health. 2018;6(10):e1070-e1. doi: https://doi.org/10.1016/S2214-109X(18)30380-2
  » https://doi.org/10.1016/S2214-109X(18)30380-2
• ¹⁹ Yamashita FC, Yamashita IC, Pavan NNO, Endo MS. Perfil dos pacientes atendidos no Centro de Traumatismo em Odontologia frente às fraturas coronárias e suas sequelas. Arch Health Investig. 2017;6(6):250-3. doi: https://doi.org/10.21270/archi.v6i6.206
  » https://doi.org/10.21270/archi.v6i6.206
• ²⁰ Fransson H, Dawson V. Tooth survival after endodontic treatment. Int Endod J. 2023;56:140-53. doi: https://doi.org/10.1111/iej.13835
  » https://doi.org/10.1111/iej.13835
• ²¹ Gondlach C, Catteau C, Hennequin M, Faulks D. Evaluation of a care coordination initiative in improving access to dental care for persons with disability. Int J Environ Res Public Health. 2019;16(15):2753. doi: https://doi.org/10.3390/ijerph16152753
  » https://doi.org/10.3390/ijerph16152753
• ²² Yap E, Parashos P, Borromeo GL. Root canal treatment and special needs patients. Int Endod J. 2015;48(4):351-61. doi: https://doi.org/10.1111/iej.1232
  » https://doi.org/10.1111/iej.1232
• ²³ Adyanthaya A, Sreelakshmi N, Ismail S, Raheema M. Barriers to dental care for children with special needs: general dentists’ perception in Kerala, India. J Indian Soc Pedod Prev Dent. 2017;35(3):216-22. doi: https://doi.org/10.4103/JISPPD.JISPPD_152_16
  » https://doi.org/10.4103/JISPPD.JISPPD_152_16
• ²⁴ Byrappagari D, Jung Y, Chen K. Oral health care for patients with developmental disabilities: a survey of Michigan general dentists. Spec Care Dentist. 2018;38(5):281-90. doi: https://doi.org/10.1111/scd.12303
  » https://doi.org/10.1111/scd.12303
• ²⁵ Faker K, Tostes MA, Paula VAC. Impact of untreated dental caries on oral healthrelated quality of life of children with special health care needs. Braz Oral Res. 2019;32:e117. doi: https://doi.org/10.1590/1807-3107bor-2018.vol32.0117
  » https://doi.org/10.1590/1807-3107bor-2018.vol32.0117
• ²⁶ Okamoto N, Amano N, Nakamura T, Yanagi M. Relationship between tooth loss, low masticatory ability, and nutritional indices in the elderly: a cross-sectional study. BMC Oral Health. 2019;19(1):110. doi: https://doi.org/10.1186/s12903-019-0778-5
  » https://doi.org/10.1186/s12903-019-0778-5
• ²⁷ Bragante FO, Botelho Filho CR, Silva AC, Silva BM, Fariniuk LF, Leonardi DP, et al. Índice de sucesso do tratamento endodôntico dos pacientes atendidos no Centro de Especialidades Odontológicas. Rev Sul-Bras Odontol. 2018;15(1):27-33. doi: https://doi.org/10.21726/rsbo.v15i1.611
  » https://doi.org/10.21726/rsbo.v15i1.611

Edited by

• Assistant editor
  Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  07 Sept 2026
• Date of issue
  2026

History

• Received
  25 Mar 2026
• Accepted
  01 May 2026