Orientador: Eduardo Passos Rocha / Banca: Wirley Gonçalves Assunção / Banca: Idelmo Rangel Garcia Júnior / Banca: Paulo Guilherme Coelho / Banca: Paulo Francisco César / Resumo: Proposição. O objetivo do presente trabalho foi avaliar a influência do conceito de plataforma switching na confiabilidade e modo de falha de restaurações unitárias sobre implante com hexágono externo ou interno na região anterior da maxila. Adicionalmente, análises de elementos finitos foram realizadas para avaliar o padrão de distribuição de tensão dentro do complexo pilar-implante e no tecido ósseo peri-implantar. Materiais e Métodos. 84 implantes foram divididos em 4 grupos (n = 21) para realização dos testes de fadiga: SWT-EH e REG-EH (implantes de conexão externa com plataforma switching ou regular, respectivamente); SWT-IH e REG-IH (implantes de conexão interna com plataforma switching ou regular, respectivamente). Análises estatísticas de Weibull foram realizadas considerando as missões de 50.000 ciclos a 210N e 300N. Adicionalmente, foram construídos 4 modelos de elementos finitos considerando as mesmas variáveis para obtenção das tensões equivalentes de von Mises (σvM) no complexo pilar-implante e das máximas tensões principais (σmax) no osso peri-implantar. Resultados. Os valores de Beta para os grupos SWT-EH (1,31), REG-EH (1,55), SWT-IH (1,83) e REG-IH (1,82) indicaram que a fadiga acelerou a falha em todos os grupos. Os valores de confiabilidade calculados para os grupos SWT-EH, REG-EH, SWT-IH e REH-IH foram 0,53 (0,33 - 0,70), 0,93 (0,80 - 0,97), 0,99 (0,93 - 0,99) and 0,99 (0,99 -de tensão estiveram no pilar (SWT-IH = 186 MPa e REG-IH = 88.8 MPa). No osso cortical, os implantes com plataforma switching geraram menor tensão (σmax) tanto para conexão externa (SWT-EH = 49.0 MPa e REG-EH = 56.5 MPa) como para conexão interna (SWT-IH = 37.7 MPa e REG-IH = 45.5 MPa)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Purpose. The aim of the present study was to evaluate the effect of platform switching concept on reliability and failure modes of anterior single-unit restorations for internal and external hex implants. Additionally, finite element analysis were performed to assess the stress distribution within implant-abutment complex and peri-implant bone. Materials and Methods. 84 implants were divided in 4 groups (n=21) for fatigue tests: REG-EH and SWT-EH (regular and switched-platform implants with external connection, respectively); REG-IH and SWT-IH (regular and switched-platform implants with internal connection, respectively). Weibull analysis for a mission of 50,000 cycles at 300N was performed. Additionally, 4 three-dimensional finite element models reproducing the characteristics of specimens used in mechanical tests were created to evaluate the equivalent von Mises stress (σvM) within implant-abutment complex and the maximum principal stress (σmax) in the peri-implant bone. Results. The Beta values for groups SWT-EH (1.31), REG-EH (1.55), SWT-IH (1.83) and REG-IH (1.82) indicated that fatigue accelerated the failure of all groups. The calculated reliability for groups SWT-EH, REG-EH, SWT-IH and REH-IH were 0.53(0.33-0.70), 0.93(0.80-0.97), 0.99(0.93-0.99) and 0.99(0.99-1.00), respectively. Failure modes (screw and/or abutment fracture) were similar for regular and switched-platform implants. Within implant-abutment complex, the higher peak of stress (σvM) was observed in fixation screw (SWT-EH = 190 MPa and REG-EH = 160 MPa) for groups with external hex implants; while for groups with internal hex implants was in abutment (SWT-IH = 186 MPa and REG-IH = 88.8 MPa). In the cortical bone... (Complete abstract click electronic access below) / Doutor

AIM: This systematic review enumerated the criteria used to determine the survival and success of the rehabilitation of the immediately loaded completely edentulous maxilla with surgically guided implant placement and restoration via fixed prostheses. By identifying these variables, the authors of this review hope to propose a new set of criteria that addresses current expectations of success and facilitates a better comparison of rehabilitation protocols. MATERIALS AND METHODS: The electronic databases PubMed and ScienceDirect were searched for clinical studies of restoration of complete maxillary implant supported fixed dental prostheses. The analysis was confined to prospective studies with a minimum follow-up of 3 years and a minimum number of 10 patients published prior to June 24th, 2021. RESULTS: An initial total of 781 publications was screened from the database searches. After further screening by title and abstract using PRISMA protocol and defined inclusion/exclusion criteria, nine (9) articles were reviewed. Analysis for survival and success criteria resulted in the following: 1. It was difficult to define a conclusion from the selected articles since there was little uniformity as to study design and the criteria used to evaluate the data. 2. High implant and implant supported fixed prosthesis survival could be achieved in the short-term (less than 5 years) when at least 4 implants were placed. 3. The type of surgical guide used for implant placement did not affect the survival and success of implants and implant supported fixed prostheses. 4. Immediate loading of the prostheses did not affect the success and survival of implant and implant supported fixed prostheses. 5. Widely accepted and reproducible criteria should be established to facilitate a better comparison of future materials, rehabilitation protocols. 6. The author proposes the following: Proposed Success Criteria (Ramesh 2023) Successful (Optimal Health): 1. No pain or tenderness associated with function 2. 0 mobility 3. Radiographic bone loss of 20% or less of implant length from initial surgery 4. No bleeding on probing or exudate 5. <4 mild/moderate complications Satisfactory: 1. No pain associated with function 2. 0 mobility 3. Radiographic bone loss 20-40% of implant length 4. Peri-implant mucositis Compromised: 1. May have sensitivity associated with function 2. 0 mobility 3. Radiographic bone loss >40% of implant length 4. Peri-implantitis Failed (clinical or absolute failure): Any of the following: 1. Pain associated with function 2. Mobility 3. Uncontrolled exudate 4. No longer in mouth 5. Non-restorable *This criteria borrows concepts from the Pisa Consensus 200 7. The following list of considerations is necessary to include in all future implant study designs. Proposed necessary factors: 1. Standardized protocols a. Guide design b. Guide fabrication c. Defining conventional versus other methods 2. Maintenance intervals a. Recall with yearly data collection b. Maintenance visits (at least twice yearly) 3. Individual implant review findings 4. Consistent follow up (as previously defined on page 41) a. Must include all the necessary variables to determine implant success 5. Implant location a. Anterior: cuspids and forward b. Posterior: bicuspids and back 6. Implant details - brand, length, diameter 7. Prosthesis design and fabrication, dictated by existing or regenerated bone base

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Orientador: Idelmo Rangel Garcia Júnior / Coorientador Francisley Ávila Souza / Banca: Ana Paula Farnezi Bassi / Banca: Thallita Pereira Queiroz / Banca: Rodrigo dos Santos Pereira / Resumo: Modificações físicas e/ou químicas das superfícies dos implantes de titânio podem ser realizadas com intuito de facilitar e estimular o processo de osseointegração, consequentemente favorecendo um tempo de reparo mais curto. Sendo assim, o objetivo deste estudo foi avaliar as superfícies de implantes de titânio, modificadas com deposição de β-tricálcio fosfato pelo método biomimético, inseridos na maxila após levantamento de seio maxilar de coelhos, por meio da análise topográfica, biomecânica, microtomográfica, histológica e imunoistoquímica. Dezoitos (18) coelhos da raça Nova Zelândia (Albinus) receberam trinta e seis (36) implantes após elevação da membrana do seio maxilar bilateral. Foram divididos em dois grupos: No Grupo SBF - Implantes com superfícies modificadas pelo tratamento biomimético e preenchimento do seio maxilar esquerdo com coágulo; Grupo TCP - Implantes com superfícies modificadas com deposição de β-tricálcio fosfato pelo método biomimético e preenchimento do seio maxilar direito com coágulo. Os períodos de estudos foram de 7, 15 e 40 dias, onde foram realizadas as avaliações biomecânica, microtomográfica, histométrica e imunoistoquímica. Nas análises físico-químicas de microscopia eletrônica de varredura- MEV, espectroscopia de energia dispersiva- EDS e mapeamento da mineralização observou-se a formação de uma camada de apatita com maiores quantidades de Ca e P nos implantes com deposição biomimética com β-tricálcio fosfato. O teste de molhabilidade monstr... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Physical and/or chemical modifications of the surfaces of the titanium implants can be performed in order to facilitate and stimulate the osseointegration process, consequently favouring a shorter repair time. Thus, the objective of this study was to evaluate the surfaces of titanium implants, modified with deposition of β-tricalcium phosphate by the biomimetic method, inserted in the maxilla after lifting the maxillary sinus of rabbits, employing topographic, biomechanical, histological and immunohistochemical analysis. Eighteen (18) New Zealand rabbits (Albinus) received thirty-six (36) implants after bilateral maxillary sinus membrane elevation. They were divided into two groups: In the SBF Group - Implants with surfaces modified by the biomimetic treatment and filling of the left maxillary sinus with clot; Group TCP - Implants with modified surfaces with deposition of β-tricalcium phosphate by the biomimetic method and filling of the right maxillary sinus with clot. The study periods were 7, 15 and 40 days, where the biomechanical, microtomographic, histometric and immunohistochemical evaluations were performed. In the physico-chemical analyzes of scanning electron microscopy (SEM), dispersive energy spectroscopy (EDS) and mapping of mineralization, the formation of an apatite layer with higher amounts of Ca and P was observed in implants with biomimetic deposition with β-tricalcium phosphate. The wettability test showed high hydrophilicity surfaces in this group of impla... (Complete abstract click electronic access below) / Doutor

Orientador: Valfrido Antonio Pereira Filho / Resumo: O presente trabalho teve como objetivo avaliar a qualidade óssea das diferentes regiões alveolares da maxila e da mandíbula por meio da classificação óssea proposta por Leckholm e Zarb (1985) (L & Z), radiografias panorâmicas e periapicais, quociente de estabilidade do implante (ISQ), torque de inserção (TI), microtomografia computadorizada (micro-CT) e histomorfometria. Como objetivo secundário, foi avaliada a correlação entre os diversos métodos citados acima. Foram avaliadas 60 áreas edêntulas, sendo 15 áreas de cada quadrante da maxila e da mandíbula. A qualidade óssea tipo III foi a mais frequente na maxila posterior (73,33%) e anterior (73,33%), já a tipo II foi mais frequente na mandíbula posterior (53,33%) e anterior (60,00%). Foi observada uma diferença estatisticamente significante na densidade óssea óptica avaliada por meio de radiografias periapicais na região posterior da maxila (2,38±1,06) e posterior da mandíbula (3,84±0,68), em relação às demais regiões alveolares avaliadas (p≤0,015). Nas radiografias panorâmicas não foram observadas diferenças entre a densidade óptica das regiões alveolares (p=0,6322). A estabilidade inicial dos implantes instalados na região posterior da maxila foi estatisticamente diferente dos instalados na região posterior da mandíbula, tanto na avaliação por meio do TI como por meio do ISQ (p<0,05). Também foi possível detectar diferenças na qualidade óssea das regiões alveolares da maxila e da mandíbula por meio de vários parâmetros da ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed to evaluate the bone quality of the different alveolar regions of the maxilla and mandible through of the classification proposed by Leckholm e Zarb (1985) (L & Z), panoramic and periapical radiographs, implant stability quotient (ISQ), insertion torque (IT), microcomputed tomography (micro-CT) and histomorphometric analysis. The secondary objective was to evaluate the correlation between the several methods mentioned above. Sixty edentulous areas were evaluated, being 15 areas from each quadrant of the maxilla and mandible. The bone quality III was the most frequent in the posterior (73.33%) and anterior maxilla (73.33%) and quality II was the most frequent in the posterior (53.33%) and anterior (60.00%) mandible. A significant statistical difference was observed in the optical bone density evaluated through periapical radiographs of the posterior maxilla (2.38 ± 1.06) and posterior mandible (3.84 ± 0.68), in relation to the other alveolar regions (p≤0.015). With the panoramic radiograph no differences were observed between the optical density of the alveolar regions (p= 0.6322). The primary stability of the implants in the posterior maxilla was different from the posterior mandible, both in the evaluation through the TI and ISQ (p<0.05). It was possible to detect differences in the bone quality of the alveolar regions using several micro-CT parameters (BV, p≤0.002; BV/BT, p≤0.044; BS/TV, p <0.05; Tb.N, p<0.01 and Tb.Sp, p <0.05). With the histometry it was ... (Complete abstract click electronic access below) / Doutor

Orientador: Alessandro Roger Rodrigues / Banca: Hidekasu Matsumoto / Banca: Marcos Valerio Ribeiro / Resumo: Ligas metálicas destinadas a implantes, de um modo geral, têm sido cada vez mais pesquisadas quanto às suas propriedades mecânicas, microestruturais e características de biocompatibilidade. Apesar do surgimento de inúmeros materiais poliméricos, o titânio e suas ligas representam ainda a grande gama de aplicações na área da implantodontia. O titânio é considerado um material de difícil usinabilidade, pois desenvolve altas tensões e temperaturas em uma área de corte 2/3 menor que a de outros materiais. Assim, os parâmetros de usinagem e a ferramenta de corte necessitam ser adequadamente especificados, pois tanto a matéria-prima quanto o processo de fabricação levam a um alto valor agregado do produto final. Este trabalho determinou os efeitos da velocidade de corte e da profundidade de usinagem na usinabilidade (força de corte e energia específica de corte) e integridade superficial (microdureza e acabamento) no roscamento de implantes dentários de titânio comercialmente puro (grau 4, ASTM F67). Os ensaios foram realizados em torno CNC de cabeçote móvel, empregando ferramenta de metal duro revestida de TiAlN e fluido de corte abundante. Com base na Análise de Variância (ANOVA), os resultados mostraram que os parâmetros de corte afetam a usinabilidade e a integridade superficial da rosca, sendo a profundidade de usinagem o fator mais influente. Níveis muito baixos ou altos da profundidade de usinagem elevam a energia específica e a força de corte, respectivamente, encruando a subsuperfície da rosca e prejudicando a rugosidade dos flancos dos filetes. Velocidades de corte menores tendem a aumentar a força e a energia específica de corte, prejudicando o acabamento da rosca, mas não influem em sua dureza. Rugosidades estatísticas "Skewness" e "Kurtosis" apontaram a prevalência de picos agudos na superfície da rosca, favorecendo a osseointegração. Testes na condição High-Speed Cutting (HSC) indicaram ... / Abstract: Metallic alloys applied to implants have been researched aiming at improving their mechanical properties, microstructure and biocompatibility. Despite appearing several types of polymers in the last years, titanium and its alloys are still used extensively in the implantology. Titanium is considered a hard-to-cut material, because it develops high stresses and temperatures in a small cutting area (2/3 smaller than for other materials). Thus cutting parameters and tools need to be specified properly, since both raw material and manufacturing process increase the costs of the final product. This research determined the effects of cutting speed and depth of cut on machinability (cutting force and specific cutting energy) and surface integrity (microhardness and roughness) when threading pure commercially dental implants (grade 4, ASTM F67). Machining tests were carried out in a CNC lathe by applying TiAlN coated carbides and cutting fluid. Based on Analysis of Variance (ANOVA), the main results indicated that cutting parameters influence on machinability and surface integrity of the implant screw, being depth of cut the more influent. Low and high levels of depth of cut increase specific cutting energy and cutting force, respectively, hardening the screw subsurface and damaging the roughness of the thread flanks. Lower cutting speeds trend to raise both cutting force and specific cutting energy, damaging the screw finishing, but they do not affect its subsurface microhardness. Skewness and Kurtosis roughness parameters indicated the predominance of spiky surface on screw which is favorable to osseointegration. Tests at High-Speed Cutting (HSC) showed it is possible to machine implant screws, but depth of cut cannot be high so that avoiding vibration in threads / Mestre

Master of Dental Surgery / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

Typescript. Bibliography: leaves 131-167.

Objectives: The present work was under taken to compare osseointegration of immediately and delayed restored implants in a sheep model, and to compare methods of assessing osseointegration. Methods: Twenty wide-platform implants were placed in the posterior mandibles of 10 sheep, 3 months after premolar extractions. Ten were control implants placed and restored after 3 months of submerged healing. Ten were test implants placed contralaterally and immediately restored. Animals were sacrificed after a further 3 months of healing. At each experimental stage implant stability was measured with resonance frequency analysis (RFA) and standardized radiographs were taken. Tissue blocks with the implants were embedded in acrylic resin. The specimens were analysed by three-dimensional micro tomogram (micro-CT) images. Ground sections of the tissue blocks were then prepared for light microscopy and quantitative morphometry. Morphometric parameters computed by both methods were mean percent bone-to-implant contact (BIC) and mean percent bone density (BD). Radiographic, stability and morphometric measurements were compared statistically. Results: The survival rate was 60% (controls) versus 40% (test) (p=0.28). Mean crestal bone levels after three months restoration did not differ significantly between control (5.54 � 0.92) and test groups (4.35 � 1.61) (p=0.56). All surviving implants were stable at stage three and RFA values in implant stability quotient (ISQ) did not differ significantly between the two groups (test 82.3 � 3.9 versus control 78.8 � 4.3, p=0.36). No correlation was found between crestal bone loss and RFA (Spearman�s rho =-0.27, p=0.46). Histomorphometric analysis found no statistical difference (%BIC test 65.65 � 12.7%, control 53.36 � 6.41%, p=0.18; and %BD test 54.84 � 8.45%, control 64.69 � 13.57%, p=0.11). A similar trend was observed for mean micro-CT (%BIC test 65.72 � 72, control 50.84 � 4.19, p=0.11). Histology revealed high density inflammatory infiltrates beneath the sulcular and pocket epithelium. No significant difference was found between histomorphometric (HMA) and microCT analysis (%BIC p=0.08, %BD p=0.08). A statistically significant correlation was observed between HMA and microCT for %BIC (Spearman�s rho = 0.89, p=0.02) but not %BD (Spearman�s rho = 0.51, p=0.30). Conclusions: The results suggest that the sheep mandibular model has limited potential for evaluation of implants designed for poor quality bone and for the assessment of implant loading protocols. This thesis does highlight the potential for the use of this model in peri-implantitis studies. The results suggest that morphometric variables determined by HMA and microCT analysis are comparable, however further studies are required to standardize the microCT protocol to reduce metal artifacts and enhance bone-implant contrast.

This study evaluated differences in dental implant outcomes in patients with osteoporosis and their matched controls. Twenty-four patients, who received dental implants at the University of Toronto, were 60+ yrs and had osteoporosis at the time of implant placement, and their controls matched for age, sex and implant related features were examined clinically and radiographically. Clinical and demographic variables recorded at implant placement and follow-up examination, were analyzed. Implant survival rates of 95.1% and 100%, and success rates of 91.4% and 100% were noted in the osteoporosis and control samples respectively. All failures in the osteoporosis sample occurred in the maxilla of a single subject, raising suspicion that these were related to individual problems specific to this subject. Due to the paucity of adverse outcomes and with all the implant failures having occurred in one subject, no relationship of adverse outcomes with clinical and demographic variables could be analyzed.