Orientador: Renata Cunha Matheus Rodrigues-Garcia / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-23T21:43:34Z (GMT). No. of bitstreams: 1 Goncalves_ThaisMarquesSimekVega_D.pdf: 2684657 bytes, checksum: b1b361a499cc2e74dc84aa2b63d2ae75 (MD5) Previous issue date: 2013 / Resumo: Estudos revelam melhora na mastigação após o uso de próteses sobre implantes osseointegrados. Entretanto, poucos são aqueles que avaliam a mastigação de pacientes parcialmente edêntulos, comparando a função mastigatória após a reabilitação por meio de diferentes próteses parciais, o qual foi o objetivo deste ensaio clínico pareado. Para tanto, foram selecionados 12 voluntários (8 gênero feminino, idade média 62.6 ± 7.8 anos), apresentando edentulismo total superior e parcial inferior (classe I de Kennedy), os quais receberam, de forma sequencial, próteses parciais removíveis (PPR), PPR com encaixe implanto-retido (PPRI) e prótese parcial fixa sobre implantes (PPFI). Todos os tratamentos foram realizados na mandíbula e utilizados por 2 meses antes da avaliação mastigatória, enquanto a maxila recebeu uma nova prótese total que foi utilizada durante todo o estudo. A mastigação foi avaliada por meio da mensuração da performance mastigatória (PM), índice de trituração dos alimentos (ITA), força máxima de mordida (FMM), espessura dos músculos masseter e temporal, movimento mastigatório, limiar de deglutição (LD), habilidade mastigatória, estado nutricional, qualidade de vida (QV) e satisfação do paciente. Foi realizada a análise exploratória dos dados e aplicada análise de variância para medidas repetidas seguido de teste de Tukey-Kramer para as comparações múltiplas entre os tratamentos. Todas as análises foram realizadas utilizando SAS software (release 9.1, 2003; SAS Institute Inc., Cary, USA) (p ? 0.05). A PM melhorou consideravelmente após o uso de PPRI e PPFI com aumento de 85% e 87%, respectivamente. Resultados similares foram observados em relação ao ITA e à FMM com aumento (p ? 0.0001) de 91% e 62% no ITA de 79% e 62% na FMM após o uso de PPRI e PPFI, respectivamente. Independente do tipo de prótese, o uso de PPRI e PPFI aumentou a espessura do masseter durante a contração voluntária máxima (p ? 0.0001) e alterou o movimento mastigatório, reduzindo o tempo total do ciclo, bem como a duração das fases de abertura e fechamento (p ? 0.05). A habilidade mastigatória melhorou após o uso da PPRI e PPFI, independente do alimento avaliado. O LD foi alterado pelo tratamento reabilitador, com redução no número de ciclos e tamanho da partícula triturada, sendo os menores valores observados com o uso da PPFI. Houve aumento no consumo de fibras (p = 0.007), cálcio (p = 0.001) e ferro (p = 0.02) após o uso de PPFI, além da redução no consumo de alimentos com altos níveis de colesterol (p = 0.02). A satisfação aumentou (p ? 0.05) e o impacto da saúde oral na QV reduziu, tanto no score geral (p = 0.04) quanto no domínio de dor física (p = 0.02) após o uso da PPFI. A reabilitação de pacientes parcialmente edêntulos com PPRI e PPFI melhorou significativamente a função mastigatória e a magnitude do efeito relacionou-se ao tipo de prótese / Abstract: Studies revealed the masticatory improvement after the use of prosthesis over dental implants. However, few are those who evaluated the chewing of partially edentulous patients, comparing the masticatory function after treatment with different partial dentures, which was the aim of this paired clinical trial. Therefore, 12 volunteers (8 females, mean age 62.6 ± 7.8 years) presenting total edentulism in maxilla and partial edentulism in the mandible (Kennedy class I) were selected and received, in a sequential way, a conventional removable partial dentures (RPD), implant-retained partial dentures (IRPD) and implant fixed partial denture (IFPD). All treatment were assembled in the mandible and used for 2 months, while the edentulous maxilla received a new complete denture which was used throughout the study. Mastication was assessed by measuring masticatory performance (MP), food comminution index (FCI), maximum bite force (MBF), masseter and temporal muscle thickness, chewing movements, swallowing threshold (ST), masticatory ability, nutritional status, quality of life (QOL) and patient satisfaction. Data were analyzed and repeated measures analysis of variance was applied followed by Tukey-Kramer multiple for comparisons between treatments. All analyzes were performed using SAS software (release 9.1, 2003, SAS Institute Inc., Cary, USA) (p ? 0.05). MP greatly improved after IRPD and IFPD use with an increase of 85% and 87% respectively. Similar results were observed in respect to FCI and MBF with an increase (p ? 0.0001) of 91% and 62% in FCI and of 79% and 62% in MBF after the IRPD and IFPD use, respectively. Regardless the prosthesis type, the use of IRPD and IFPD increased the masseter thickness during maximum voluntary clenching (p ? 0.0001) and altered the chewing movements, reducing the total cycle time, as well as the duration of opening and closing phases (p ? 0.05). MA improved after IRPD and IFPD use, irrespectively of the food rated. ST was affected by prosthetic treatment, showing a reduction in the number of chewing cycles and in the size of the comminuted particle, with the lowest values observed after IFPD use. There was a raise in fiber (p = 0.007), calcium (p = 0.001) and iron (p = 0.02) intake after the IFPD use and a reduction in the intake of food with high cholesterol levels (p = 0.02). Patients satisfaction also increased (p ? 0.05) and the impact of oral health on QOL decreased in overall score (p = 0.04) and in the physical pain domain (p = 0.02) after the IFPD use. The rehabilitation of partially edentulous patients with IRPD and IFPD significantly improved masticatory function and the magnitude of the effect was related to the prosthesis type / Doutorado / Protese Dental / Doutora em Clínica Odontológica

Hipótese do trabalho: Avaliar a presença de um orifício de acesso ao parafuso do intermediário do implante em infra-estruturas cimentadas sobre o pilar de titânio. Objetivo: O presente estudo visou comparar resistência a compressão de infra-estruturas em zircônia estabilizada por ítrio e em dissilicato de lítio cimentadas sobre pilar em titânio, com e sem acesso ao parafuso. Método: Foram confeccionados quarenta corpos-de-prova compostos por análogos de implantes hexágono externo de plataforma 4,1mm, intermediários de titânio pré-fabricado para próteses cimentadas e infra-estruturas para coroas totais. Os corpos-de-prova foram divididos em quatro grupos experimentais, sendo vinte, em cerâmica de zircônia estabilizada por ítrio(G1 e G2) e vinte em cerâmica de dissilicato de lítio(G3 e G4), todas confeccionadas com a mesma anatomia, ambas para próteses cimentadas sobre implante. Das vinte infra-estruturas de cada tipo de cerâmica, dez foram infra-estruturas convencionais para coroas cimentadas, constituindo o grupo controle e dez apresentavam um orifício de acesso ao parafuso, transpassando a cerâmica, constituindo o grupo experimental. As cimentações foram efetuadas com agente de fixação RelyX U200, de acordo com as especificações do fabricante, e o grupo experimental (com acesso ao parafuso) teve o orifício de acesso ao canal restaurado com resina composta foto ativada Z350 Filtek Supreme XT. Os corpos-de-prova foram submetidos a teste de compressão com velocidade de 0,5mm/minuto em máquina de ensaio universal. Resultados: Não foram encontradas diferenças estatísticas significativas entre infra-estruturas de cerâmicas convencionais e as infra-estruturas confeccionadas com orifício de acesso oclusal(G2 1.675 N/cm., G3 1.931 N/cm e G4 1.447 N/cm), exceto as infra-estruturas convencionais de zircônia estabilizada por ítrio que se apresentou superior aos demais(G1 3.372 N/cm). Com base nos resultados todas as modalidades de infra-estruturas testadas são viáveis para o uso clínico. / Hypothesis of work: To evaluate the presence of an access hole to screw the intermediate cemented implant in infrastructure over the titanium abutment. Objective: This study aimed to compare the compressive strength of infrastructure in yttrium stabilized zirconia and lithium disilicate cemented to abutment in titanium, with and without access to the screw. Method: Forty bodies-specimens consisting of similar external hex implants platform 4.1mm, intermediate titanium prefabricated for cemented prostheses and infrastructures for crowns were fabricated. The bodies-specimens were divided into four experimental groups, twenty, ceramic yttrium stabilized zirconia (G1 and G2) and twenty in ceramic lithium disilicate (G3 and G4), all made with the same anatomy, both for cemented prostheses on implants. Infrastructure of twenty of each type of tile ten were conventional infrastructure for cemented crowns, constituting the control group and ten had an access hole to the screw, trespassing ceramics, constituting the experimental group. The cementation were performed with RelyX U200 fixing agent, according to the manufacturers specifications, and the experimental group (with access to the screw) had the access hole channel restored with composite resin Z350 photo activated Filtek Supreme XT. The bodies-specimens were subjected to compression test speed of 0.5 mm / min in a universal testing machine. Results: No statistically significant differences between conventional ceramic infrastructure and infrastructure made with port access were found occlusal (G2 1675 N / cm, G3 1931 N / cm and G4 1447 N / cm.) Except conventional infrastructure stabilized zirconia yttrium who introduced himself superior to the others (G1 3300 N / cm). Based on the results of all modalities tested infrastructure are feasible for clinical use.

Introduction: Porcelain fractures belong to the most frequent technical complications in implant borne fixed restorations. Aim of this retrospective clinical study was to determine the prevalence and extent of porcelain fractures and to detect possible risk indicators. Methods: The study was designed by the Department of Prosthetic Dentistry, Dental School, University Hospital Carl Gustav Carus of Technical University of Dresden (TUD). Only adult patients (age ≥ 18 years) having previously received implant borne either metal-ceramic or all-ceramic fixed dental restorations from January 1995 until August 2011 were recruited. On the day of examination demographic and clinical parameters were systematically collected. Any present porcelain fracture was recorded systematically in terms of position and extent through clinical examination under relatively dry conditions. The fractures were classified in four categories according to their extent and respective reparability. Descriptive statistical analysis was conducted and contingency table analysis was used to determine the correlation between potential risk indicators and porcelain fractures on patient, restoration and unit level. Results: A total number of 144 patients (66 males, 78 females) was examined and entered the analysis. They represented 507 units (483 porcelain-fused-to-metal (PFM), 24 all-ceramic (AC)). Further these units represented 291 single crowns (SC)/ splinted crowns (S SC) (278 PFM, 13 AC) and 28 implant borne fixed dental prostheses (FDP) (28 PFM, 0 AC), 16 implant-tooth borne FDPs (14 PFM, 2 AC) and 14 implant borne cantilevered FDPs (13 PFM, 1 AC). The porcelain fracture rate on patient level was 23.6%, while on PFM FDP level this rate was 16.4%, on SC level was 12.2% and on unit level 9.5%. The results for AC restorations were 33.3%, 0.0% and 4.2% respectively. The parameters bruxism, age, gender, number of natural teeth, number of implants and implant supported FDPs per patient, former technical complication, implant system, opposing arch and splinted crowns or not had statistically significant correlation to porcelain fractures. Conclusion: Porcelain fracture in implant borne fixed restorations is a multicausal event. According to the limitations of the retrospective study design, this study showed that a male patient, bruxer, over 60-years-old, with ≤20 existing natural teeth, non-splinted crowns and former technical complications is prone to porcelain fracture. The results encourage further prospective clinical studies. / Einführung: Unter den technischen Komplikationen bei festsitzenden implantatgetragenen Restaurationen zählen Verblendkeramikfrakturen zu den häufigsten. Ziel der vorliegenden klinischen retrospektiven Studie war die Bestimmung der Häufigkeit des Auftretens und Ausmaßes von Verblendkeramikfrakturen und möglicher Risikoindikatoren. Methode: Die Studie wurde in der Abteilung für Zahnärztliche Prothetik der UniversitätsZahnMedizin Carl Gustav Carus Dresden, Technische Universität Dresden (TUD) geplant und durchgeführt. Erwachsene Patienten (Alter ≥ 18 Jahre), die im Zeitraum von Januar 1995 bis August 2011 mit festsitzenden implantatgetragenen metall- oder vollkeramischen Restaurationen versorgt worden waren, wurden nachuntersucht. Dabei wurden demografische und klinische Parameter erhoben. Unter relativer Trockenlegung wurden alle Restaurationen systematisch auf Verblendkeramikfrakturen untersucht. Die Frakturen wurden in vier Gruppen je nach Ausmaß und Reparierbarkeit klassifiziert. Die Analyse der Daten erfolgte deskriptiv. Weiterhin erfolgte eine Kontingenztafelanalyse der Beziehungen zwischen den demografischen und klinischen Parametern und vorliegenden Verblendkeramikfrakturen auf Patienten-, Restaurations- und Einheitenebene. Ergebnisse: Eine Gesamtzahl von 144 Patienten wurde untersucht; 66 davon männlich und 78 weiblich. Es lagen 507 Einheiten (483 metallkeramisch/MK, 24 vollkeramisch/VK) vor, entsprechend 291 implantatgetragenen Einzelkronen/ verblockten Kronen (278 MK, 13 VK), 28 implantatgetragenen Brücken (28 MK, 0 VK), 16 Verbundbrücken (14 MK, 2 VK) und 14 implantatgetragenen Extensionsbrücken (13 MK, 1 VK). 23,6% der Patienten wiesen mindestens eine Verblendkeramikfraktur auf, wobei 16,4% der MK Brücken, 12,2% der MK Kronen und 9,5% der MK Einzeleinheiten betroffen waren. Die Ergebnisse für die VK Restorationen waren 33,3%, 0,0% und 4,2%. Es konnten Korrelationen zwischen den vorhandenen Veblendkeramikfrakturen und den Parametern Bruxismus, Alter des Patienten, Geschlecht, Anzahl der vorhandenen natürlichen Zähnen, Implantaten und implantatgetragenen Brücken pro Patient, frühere technische Komplikationen, Implantatsystem, Gegenkieferversrorgung und Verblockung der Einzelkronen ermittelt werden. Schlussfolgerung: Verblendkeramikfrakturen bei festsitzenden implantatgetragenen Restaurationen werden als multikausales Geschehen angesehen. Auf der Basis des vorliegenden retrospektiven Studiendesigns wurde ein männlicher Patient mit Bruxismus, über 60 Jahre alt, mit ≤20 vorhandenen natürlichen Zähnen, nicht verblockten Kronen und früheren technischen Komplikationen als Risikopatient für Verblendkeramikfrakturen identifiziert. Die Ergebnisse geben Anlass zu weiteren prospektiven klinischen Studien.

Indiana University-Purdue University Indianapolis (IUPUI) / The objective of this study was to evaluate the in vivo performance of the novel press-fit dental implant fabricated via electron beam melting (EBM, Southern Methodist Univ.) and compare it to a commercially-available porous-coated press-fit dental implant (Endopore, Innova Corp.). Twelve cylindrical shaped implants 3 mm in diameter x 5 mm long were made by EBM (Southern Methodist Univ.) using Ti6Al4V ELI alloy. Twelve commercial implants (Endopore, Innova Corp.) of the same geometry were used as controls. Samples were implanted in rabbit tibia and retrieved six weeks postoperatively. Six specimens from each implant type were embedded undecalcified, sectioned, and stained with toluidine blue (Sigma) for histomorphometry analysis. Bone-to-implant contact (BIC) was measured. On the six remaining samples from each implant type, the mechanical properties were evaluated by pushout test on a material testing machine. The samples were loaded at a loading rate of 1 mm/min. The pushout strength was measured and the apparent shear stiffness was calculated. The results were analyzed with a paired-t test. The histology shows osteointegration of surrounding bone with both implant types. Bone was found to grow into the porous space between the beads. Both the Endopore (Innova Corp.) and the EBM (Southern Methodist Univ.) showed similar BIC. The mean BIC for the Endopore (Innova Corp.) and EBM (Southern Methodist Univ.) implant were 35 ± 6% and 32 ± 9%, respectively. It failed to reach statistical significance (p > 0.05). The peak pushout force for Endopore (Innova Corp.) and EBM (Southern Methodist Univ.) implants were 198.80 ± 61.29 N and 243.21 ± 69.75 N, respectively. The apparent shear stiffness between bone and implant for the Endopore (Innova Corp.) and EBM (Southern Methodist Univ.) implants were 577.36 ± 129.99 N/mm; and 584.48 ± 146.63 N/mm, respectively. Neither the peak pushout force nor the apparent shear stiffness of the implants was statistically different between the two groups (p > 0.05). The results suggest that the implants manufactured by EBM (Southern Methodist Univ.) perform equally well as the commercial implant Endopore (Innova Corp.) in this current animal model.

Implantes osseointegrados vêm sendo utilizados com sucesso para restaurar a função e a estética de pacientes desdentados totais e parciais, no entanto, apesar do alto índice de sucesso, a literatura apresenta uma série de complicações da técnica. Apesar da falta de consenso sobre qual a melhor maneira de se restaurar implantes múltiplos adjacentes, a confecção de próteses unitárias vem sendo sugerida e praticada por muitos profissionais. O objetivo deste trabalho foi verificar, pela técnica fotoelástica (qualitativa e quantitativa), o comportamento biomecânico de coroas unitárias sobre implantes hexágono interno com pilar UCLA. Foram confeccionadas coroas cimentadas e parafusadas, simulando a reabilitação da área posterior da mandíbula com e sem a presença de elemento dental distal aos implantes. Foram analisados, também, a liga metálica da infraestrutura (Ni-Cr-Ti ou Ni-Cr) e o tipo de material para revestimento estético (cerâmica ou resina). Foram confeccionados modelos fotoelásticos simulando espaço protético com ausência de segundo pré-molar e primeiro molar, reabilitado com coroas sobre implantes. Três modelos de pontas de aplicação de carga foram utilizados para produzir quatro diferentes condições de carregamento na superfície oclusal das coroas: 1 -puntiforme obtido com uma ponta simples para carregamento no pré-molar ou no molar com 5kgf; 2 puntiforme simultânea obtido por uma ponta dupla para carregamento das duas coroas ao mesmo tempo com 10kgf; 3 - oclusal distribuído obtido com uma ponta que simulou a oclusão antagonista com 10kgf. Após a aplicação das cargas, foram obtidos registros fotográficos para análise qualitativa e posteriormente foi realizada a análise quantitativa em três pontos na região cervical e um ponto na região apical de cada implante. De acordo com os resultados obtidos pode-se concluir que o uso de ligas de Ni-Cr-Ti ou Ni-Cr não interferiu na transmissão de tensões. Coroas revestidas em resina, de modo geral, geraram maior concentração de tensões em torno dos implantes quando comparadas às coroas revestidas em cerâmica. As coroas parafusadas provocaram maior tensão em torno dos implantes quando comparadas às coroas cimentadas. A presença do dente com ponto de contato efetivo à distal das coroas sobre implantes favoreceu a distribuição de tensões. / Osseointegrated implants have been successfully used to restore function and esthetic to fully and partially edentulous patients; however, regardless of the high success, the literature reveals some complications of the technique. Despite the lack of consensus about what is the better way to restore multiple adjacent implants, the use of single crowns have been suggested and practiced by many professionals. The purpose of the present study was to verify, using photoelastic analysis (qualitative and quantitative), the biomechanical behavior of single crowns on internal hexagon implants with UCLA abutment. Cement and screw-retained crowns was fabricated simulating the rehabilitation of posterior mandible area with or without the presence of a dental element distal to the implants. The metal framework alloys (Ni-Cr-Ti or Ni- Cr) and the esthetic veneering materials (ceramic or resin) was, also, analyzed. Photoelastic models were made simulating the missing of the second pre-molar and the first molar, rehabilitated with implant-supported crowns. Three models of loading application tips were used to produce different conditions of loading on crowns occlusal surface: 1 punctiform obtained with a simple tip for loading over premolar or molar with 5 Kgf; 2 simultaneous punctiform obtained with a Double tip for loading over both crowns in the same time with 10 Kgf; 3 distributed occlusal obtained with a tip simulating the antagonist occlusion with 10 Kgf. After loading application photographic records were obtained for qualitative analysis, and in sequence, quantitative analysis was realized in three cervical points and one point in the apical area of each implant. According to the obtained results, it was concluded that the use of Ni-Cr-Ti or Ni-Cr alloys did not interfere in stress transmission. Resin veneered crowns, generally generated higher concentration of stress around the implants when compared to ceramic veneered crowns. Screw-retained crowns promoted higher stress around the implants when compared to cement-retained crowns. The presence of teeth with effective interproximal contact distal to implantsupported crowns improved the stress distribution.

Statement of problem: With the variety of materials and techniques available, the knowledge of which combination provides frameworks with a better biomechanical behavior and greater fit accuracy is essential for a planning aiming prosthesis longevity. Purpose. To analyze which manufacture technique and material provides a better stress/strain and internal fit correlation. Material and methods. The groups were divided according to framework material and fabrication method: Titanium milled (TiCAD), Zirconia milled (ZrCAD), Cobalt-Chromium alloy milled (CoCrCAD), one-piece casting CoCr alloy (CoCrCAS) and cast and welded CoCr alloy (CoCrWEL). Four external hexagon implants and their respective mini-abutments were placed parallel to each other in a polyurethane model. This model was duplicated, scanned, and a single framework design was created to be used for all milled groups. Casting was done from a wax milled pattern following the same framework design used for the other groups. In preload condition, the strains generated by each framework were recorded by strain gauges fixed around the implants. The internal fit was evaluated by micro-CT scanning. Results. Regarding the uniformity of stress distribution, ZrCAD and CoCrCAD groups presented irregular stress distribution, while TiCAD presented the most uniform distribution. Regarding the internal fit, the TiCAD group presented values significantly better than the others, but not statistically different from ZrCAD. The three manufacturing methods associated to CoCr alloy presented no statistical differences among them. The correlation between the method was statistically significant. Conclusion. The physical and mechanical properties of the complete-arch implant-supported frameworks materials influence the stresses distribution and internal fit. TiCAD presented the best framework stress/strain ratio and internal fit. / Afirmação do problema. Diante da variedade de materiais e técnicas disponíveis, ter o conhecimento de qual combinação proporciona infraestruturas com um melhor comportamento biomecânico e maior precisão na adaptação é essencial para um planejamento visando a longevidade da prótese. Finalidade. Analisar qual material e método de confecção das infraestruturas proporciona a melhor relação tensão/deformação e adaptação interna. Material e métodos. Os grupos foram divididos de acordo com o material e forma de confecção das infraestruturas: fresado em Titânio (TiCAD), fresado em Zircônia (ZrCAD), fresado em Cobalto Cromo (CoCrCAD), CoCr fundido em monobloco (CoCrCAS) e CoCr fundido e com ponto de solda (CoCrWEL). Quatro implantes hexágonos externos e seus respectivos mini-abutments foram colocados paralelos entre si em um modelo de poliuretano. Este modelo foi duplicado, digitalizado e um único desenho de infraestrutura foi criado para todos os grupos fresados. Para fundição, foi utilizado um padrão de cera fresado a partir do projeto usado nos outros grupos. Na condição de pré-carga, as tensões geradas por cada infraestrutura foram registradas por strain gauges fixados ao redor dos implantes. A adaptação interna foi avaliada através de escaneamento por micro-CT. Resultados. Quanto a uniformidade na distribuição das tensões, os grupos ZrCAD e CoCrCAD se apresentaram irregulares, sendo que o grupo TiCAD apresentou distribuição mais uniforme. Quanto à adaptação interna, o grupo TiCAD apresentou valores significativamente melhores que os demais, mas sem diferença estatística em relação ao grupo ZrCAD. As três formas de produção da infraestrutura usando a liga de CoCr não apresentaram diferenças estatísticas entre si. A correlação entre os métodos foi estatisticamente significativa. Conclusão. As propriedades físicas e mecânicas dos materiais de confecção das infraestruturas influenciam na distribuição de estresses e na adaptação interna. O grupo que apresentou a melhor relação tensão/deformação e adaptação foi o grupo TiCAD.

Os orifícios de acesso aos parafusos de retenção devem ser preenchidos para que o parafuso não seja danificado caso seja necessária a remoção da prótese. Dentre os materiais mais utilizados estão o algodão, a fita de politetrafluoretileno e a guta percha. O objetivo deste estudo é avaliar a formação de biofilme de Candida albicans nos materiais anteriormente descritos, buscando estabelecer um parâmetro que contribua para a escolha do tipo de material mais adequado a ser utilizado clinicamente. Foram utilizados UCLAs, análogos e parafusos sextavados, todos de titânio. Os conjuntos foram montados com torque de 32N. Os materiais foram condensados no interior dos UCLAs e colocados em meio de cultura com uma suspensão de 3x106 células/ml de Candida albicans. O sistema foi armazenado à 37C com agitação, por 15 dias e o meio foi renovado a cada 48 horas. A quantificação de biofilme foi realizada pelo ensaio de MTT e leitura à 490nm, resultando em diferentes valores de densidade óptica. A normalidade (p=0,304 - Kolmogorov-Smirnov) e a igualdade de variâncias (p=0,721 - Scheffe) foram testadas primeiramente. O teste de análise de variância demonstrou diferença significativa entre os grupos (p<0,001) e com o Holm-Sidak foi observada diferença significativa entre os grupos algodão e guta (p<0,05) e algodão e fita de politetrafluoetileno (p<0,05); não houve diferença significativa entre os grupos guta e fita de politatrafluoretileno (p>0,05), apesar dos valores da fita de politetrafluoetileno terem sido maiores. Considerando-se as limitações deste estudo in vitro, podemos concluir que tanto a guta-percha quanto a fita de politetrafluoretileno apresentaram menor formação de biofilme, não havendo diferença estatisticamente significativa entre os materiais. O algodão apresentou um nível de formação de biofilme significativamente maior que a fita de politetrafluoretileno e a guta percha. Diante disso, serão necessários novos estudos para confirmar as limitações que este tipo de material pode apresentar quando usado como material de preenchimento do acesso do parafuso da prótese sobre implante. / The access holes for fixing screws in prostheses on implants must be completed so that the screw is not damage if is necessary to remove the prostheses. Among the most common materials used are cotton, gutta percha and polytetrafuoroetylene tape. The aim of this study is to evaluate the biofilm formation in the materials described above, in order to establish a parameter that contributes to the choice of most suitable material. We used UCLAs, similar (4,1 mm) and titanium screws. The set was assembled with a torque of 32 N.cm. The materials were condensed inside the UCLAs and placed in culture medium with suspension of 3x 106 cells/ml of Candida albicans. The system was stored at 37 o C with shaking for 15 days and renewed every 48 hours. The quantification of biofilm was performed by MTT assay at 490 nm and reading. Analyzed the normal (p=0,304-Kolmogorov-Smirnov) and equal variances (p= 0,721- Scheffe). The ANOVA showed significant difference between groups (p<0,001) and Holm- Sidak significant difference was observed between the cotton and gutta groups (p<0,05) and cotton and PTFE (p<0,05), not significant difference between groups gutta and polytetrafuoroetylene tape (p>0,05), although values were higher polytetrafuoroetylene tape. Considering the limitations of this in vitro study, we conclude that:1. Both gutta-percha and polytetrafluorethylene tape showed less biofilm formation, with no statistically significant difference between the materials. 2. Cotton showed a level of biofilm formation significantly higher than the polytetrafluoroethylene tape and gutta percha. Therefore, further studies are necessary to confirm the limitations that this type of material can have when used as filling material of the screw access on the prosthetic implant.

Made available in DSpace on 2014-12-17T15:43:52Z (GMT). No. of bitstreams: 1 PolianaMCD_DISSERT.pdf: 1792247 bytes, checksum: 7f68d2f3ec1dcc9a4fd54fc8a9e991be (MD5) Previous issue date: 2012-12-13 / The evaluation criteria of the cases treated with dental implants are based on clinical and radiographic tests. In this context it is important to conduct research to determine prognosis of different types of prosthetic rehabilitation and determination of the main problems affecting this type of treatment. Thus, the objective of this study was to assess the prosthetic conditions of individuals rehabilitated with implant-supported prosthesis. In this cross-sectional study 153 patients were treated, accounting for a sample of 509 implants. The failures were observed by clinical and radiographic examination. The results showed that the fracture (0.2%) loss (0.4%) and loosening of the screws (3.3%) were failures are less frequent. The fracture structures as the resin (12.4%), porcelain (5.5%) and metallic (1.5%), loss of resin that covers the screw (23.8%) and loss of retention overdentures on implants (18.6%) had a higher occurrence. The failure of adaptation between the abutment and the implant (6.9%) and especially between the prosthesis and the abutment (25.4%) had a high prevalence and, when related to other parameters showed a significant association, particularly with the cemented prosthesis (OR = 6.79). It can be concluded that to minimize the appearance of failures, protocols must be observed from diagnosis to the settlement and control of prostheses on implants, particularly with respect to technical steps of the making of the prosthesis and care in radiographic evaluating the fit between their components / Os crit?rios de avalia??o dos casos tratados com implantes osseointegrados s?o baseados em testes cl?nicos e exames radiogr?ficos. Nesse contexto, ? importante a realiza??o de pesquisas na determina??o do progn?stico dos diferentes tipos de reabilita??es prot?ticas e na determina??o dos principais problemas que atingem este tipo de tratamento. Desta forma, o objetivo deste trabalho foi avaliar as condi??es prot?ticas de indiv?duos reabilitados com implantes osseointegrados e pr?teses sobre implantes. Neste estudo transversal foram atendidos 153 pacientes, contabilizando uma amostra de 509 implantes. As falhas foram observadas atrav?s do exame cl?nico e radiogr?fico. Os resultados demonstraram que a fratura (0,2%), a perda (0,4%) e o afrouxamento dos parafusos (3,3%) foram as falhas menos frequentes. A fratura das estruturas como a resina (12,4%), porcelana (5,5%) e met?lica (1,5%), a perda da resina que recobre o parafuso de fixa??o (23,8%) e a perda de reten??o nas pr?teses overdentures (18,6%), tiveram uma ocorr?ncia maior. A falha de adapta??o, entre o pilar e o implante (6,9%) e principalmente entre a pr?tese e o pilar (25,4%) teve uma alta preval?ncia e, quando relacionada com outros par?metros, demonstrou uma associa??o significativa, principalmente com a fixa??o do tipo cimentada (OR= 5,39). Pode-se concluir que para minimizar o aparecimento de falhas, protocolos devem ser observados desde o diagn?stico at? o assentamento e controle das pr?teses sobre implantes, principalmente com rela??o aos passos t?cnicos da confec??o da pr?tese e com o cuidado em avaliar radiograficamente a adapta??o entre seus componentes

Made available in DSpace on 2014-12-17T15:43:52Z (GMT). No. of bitstreams: 1 DaniloGBF_DISSERT.pdf: 1485726 bytes, checksum: 4640fbe2db551567fc003e0585ff8950 (MD5) Previous issue date: 2013-03-22 / The aim of this study was to compare the misfit vertical, horizontal and passivity of zirconia and cobalt-chromium frameworks fabricated for CAD / CAM technology and conventional method of casting. Sixteen frameworks in one-piece, were obtained from a metallic matrix containing three Br?nemark compatible implants with regular platform (Titamax Cortical Ti, Neodent). Eight frameworks were fabricated by CAD / CAM system (NeoShape, Neodent): four in zirconia (ZirCAD) and four cobalt-chromium (CoCrcad). Eight other frameworks were obtained by conventional casting method: four cobalt-chromium with UCLA abutment premachined Co-Cr (CoCrUCci) and four cobalt-chromium with UCLA abutment castable (CoCrUCc). The fit vertical, horizontal and passivity by one-screw test were measured using scanning electron microscopy with magnification of 250x. Initially evaluated the passivity by one-screw test and subsequently to assess the vertical and horizontal misfit, tightened all the screws with a torque of 20 Ncm. Mean, standard deviation, minimum and maximum values were calculated for each group. Measurements of horizontal misfit were transformed into cumulative frequency for categorization of the variable and the group later comparison groups. To evaluate the existence of quantitative differences between the groups tested for vertical misfit and passivity, we used the Kruskal-Wallis test. The Mann-Whitney test was used to compare group to group statistical differences (p <0.05). Were observed the respective mean and standard deviation for vertical misfit and passivity in micrometers: ZirCAD (5.9 ? 3.6, 107.2 ? 36), CoCrcad (1.2 ? 2.2, 107.5 ? 26 ), CoCrUCci (11.8 ? 9.8, 124.7 ? 74), CoCrUCc (12.9 ? 11.0, 108.8 ? 85). There were statistical differences in measures of vertical misfit (p = 0.000). The Mann-Whitney test revealed statistical differences (p <0.05) between all groups except between CoCrUCci and CoCrUCc (p = 0.619). No statistical difference was observed for the passivity. In relation to the horizontal misfit groups ZirCAD and CoCrcad did not show best values in relation to CoCrUCci and CoCrUCc. Based on the results it can be concluded that frameworks fabricated by CAD / CAM technology had better values of vertical fit than those manufactured by the casting method, nevertheless, the passivity was not influenced by manufacturing technique and material used. The horizontal fit obtained by frameworks manufactured by CAD / CAM was not superior to those manufactured by casting. A lower variability in vertical adjustment and passivity was observed when frameworks were fabricated by CAD / CAM technology / O objetivo deste estudo foi comparar o desajuste vertical, horizontal e a passividade de infraestruturas fabricadas em zirc?nia e cobalto-cromo por tecnologia CAD/CAM e pelo m?todo da fundi??o convencional. Dezesseis infraestruturas em monobloco, foram obtidas a partir de uma matriz met?lica contendo tr?s implantes Br?nemark compat?veis de plataforma regular (Titamax Cortical Ti, Neodent). Oito infraestruturas foram confeccionadas pelo sistema CAD/CAM (NeoShape, Neodent): quatro em zirc?nia (Zircad) e quatro em cobalto-cromo (CoCrcad). Outras oito infraestruturas foram obtidas pelo m?todo da fundi??o convencional: quatro em cobalto-cromo com pilar UCLA cinta Co-Cr (CoCrUCci) e quatro em cobalto-cromo com pilar UCLA calcin?vel (CoCrUCc). O ajuste vertical, horizontal e a passividade pelo teste do parafuso ?nico foram mensurados usando microscopia eletr?nica de varredura com aumento de 250x. Inicialmente avaliou-se a passividade pelo teste do parafuso ?nico e posteriormente para avaliar o desajuste vertical e horizontal, apertou-se todos os parafusos, com torque de 20Ncm. M?dia, desvio padr?o, valor m?nimo e m?ximo foram calculados para cada grupo. As medidas de desajuste horizontal foram transformadas em frequ?ncia cumulativa para categoriza??o da vari?vel e posterior compara??o grupos a grupo. Para avaliar a exist?ncia de diferen?as quantitativas entre os grupos testados para desajuste vertical e passividade, foi usado o teste Kruskal-Wallis. O teste Mann-Whitney foi usado para comparar as diferen?as estat?sticas grupo a grupo (p<0,05). Foram observados os respectivos valores de m?dia e desvio padr?o em micr?metros para desajuste vertical e passividade: Zircad (5,9 ? 3,6; 107,2? 36), CoCrcad (1,2 ? 2,2; 107,5? 26), CoCrUCci (11,8 ? 9,8; 124,7? 74), CoCrUCc (12,9 ? 11,0; 108,8? 85). Observaram-se diferen?as estat?sticas para medidas de desajuste vertical (p=0,000). O teste Mann-Whitney revelou diferen?as estat?sticas (p<0,05) entre todos os grupos, exceto entre CoCrUCci e CoCrUCc (p=0,619). Nenhuma diferen?a estat?stica foi observada para a passividade das infraestruturas. Em rela??o ao desajuste horizontal, os grupos ZirCAD e CoCrcad n?o apresentaram melhores valores em rela??o a CoCrUCci e CoCrUCc. Baseado nos resultados pode-se concluir que infraestruturas confeccionadas por tecnologia CAD/CAM obtiveram melhores valores de ajuste vertical que aquelas fabricadas pelo m?todo da fundi??o, apesar disso, a passividade das infraestruturas n?o foi influenciada pela t?cnica de fabrica??o e material utilizado. O ajuste horizontal obtido pelas infraestruturas fabricadas por CAD/CAM n?o foi superior ?quelas fabricadas por fundi??o. Uma menor variabilidade no ajuste vertical e na passividade foi observada quando infraestruturas foram fabricadas por tecnologia CAD/CAM

<p>U uvodnom delu doktorske disertacije opisane su osnovne konvencionalne metode otiskivanja, kao i modifikovane tehnike koje se koriste u savremenoj implant protetici. Prikazana je specifičnost biomehanike implantno no&scaron;enih i poduprtih nadoknada u odnosu na biomehaniku nadoknada retiniranih prirodnim zubima. Akcenat je stavljen na kompleksnost problematike postizanja apsolutno pasivnog naleganja nadoknade na nosač implanta (abatment), sa posebnim osvrtom na uticaj same procedure otiskivanja implanata i angulacije implanata na tačnost naleganja. Detaljno su opisani i svi ostali faktori koji mogu da utiču na tačnost radnih modela pri izradi nadoknada na implantima, pozivajući se na aktuelne podatke iz literature i naučno opravdanje za potrebe istraživanja. Cilj rada je bio ispitati uticaj metode otiskivanja, angulacije implanata i vrste otisnog materijala na tačnost definitivnog radnog modela za izradu implantno no&scaron;enih zubnih nadoknada. Eksperiment je obavljen u in vitro uslovima. Istraživanje je bazirano na ispitivanju tačnosti otiskivanja pomoću tri različite metode otiskivanja (direktne, indirektne i modifikovane &bdquo;splint&ldquo; metode), dve vrste elastičnih otisnih materijala (adicionog silikona i polietra) i uticaja dve različite grupe implanata (anguliranih od 20&deg; i paralelnih implanata) na tačnost otiskivanja. Master (referentni) model je isplaniran tako da simulira čest klinički slučaj parcijalne bezubosti gornje vilice (klasa Kenedi I), koji je osim dva ugrađena angulirana implanta sa jedne, i dva paralelna implanta sa druge strane, podrazumevao i prisustvo bru&scaron;enih zuba, pripremljenih za prihvatanje keramičkog mosta u frontalnoj regiji. Otiskivanje zuba i implanata vr&scaron;eno je istovremeno i drugi deo istraživanja je obuhvatao ispitivanje uticaja primenjene metode i materijala na tačnost otisnutih povr&scaron;ina zuba. Time je pro&scaron;ireno polje istraživanja i omogućeno dono&scaron;enje zaključka o pravoj indikaciji metode i materijala za otiskivanje konkretnog kliničkog slučaja. Kompletna metodologija izrade master i definitivnih radnih (replika) modela, kao i sama procedura otiskivanja, izvedena je po najsavremenijim principima istraživanja, uz upotrebu instrumenata i materijala vodećih svetskih proizvođača. Za potrebe analize odstupanja implanata i zuba na replica modelima u odnosu na referentni, modeli su podvrgnuti optičkoj 3D (trodimenzionalnoj) digitalizaciji pomoću dva savremena laboratorijska skenera koje karakteri&scaron;e izuzetna tačnost skeniranih povr&scaron;ina. Prvo je digitalizovan master model za potrebe dobijanja nominalne geometrije, a nakon toga 30 replika modela, za potrebe uporedne geometrijske analize. Analiza je vr&scaron;ena pomoću najnovijeg specijalizovanog softverskog programa, primenom metode CAD-inspekcije (eng. Computer-Aided Design). Geometrijska analiza odstupanja bru&scaron;enih zuba (patrljaka) izvedena je tehnikom preklapanja odnosno superpozicije (eng. bestfit) realne geometrije (na replika modelu) sa nominalnom geometrijom (na master modelu). Za razliku od analize patrljaka, za potrebe geometrijske analize odstupanja implanata kreiran je lokalni koordinatni sistem za svaki analizirani implant, pomoću specijalnih abatmenta upotrebljenih za digitalizaciju i uvozom 3D modela implanata iz CAD biblioteke proizvođača. Odstupanja su analizirana u odnosu na centar baze implanta (odstupanje od centra) i u odnosu na centralnu osu implanta (ugao odstupanja), &scaron;to je omogućilo tačno prostorno orijentisanje implanata na replika modelima u poređenju sa referentnim. Ova metodologija je originalna, jer je u odnosu na metodologije koje su do sada kori&scaron;ćene u svrhu prostorne orijentacije implanata, uvođenjem novih parametara u analizu, omogućila tačnije defi nisanje prostornog odstupanja analiziranih implanata. Rezultati dobijeni u istraživanju doveli su do zaključka da metoda otiskivanja i vrsta otisnog materijala utiču na tačnost otiskivanja implanata. Takođe, angulacija implanata od 20&deg; ima veći uticaj na tačnost definitivnih radnih modela u poređenju sa paralelnim angulirana implanta sa jedne, i dva paralelna implanta sa druge strane, podrazumevao i prisustvo bru&scaron;enih zuba, pripremljenih za prihvatanje keramičkog mosta u frontalnoj regiji. Otiskivanje zuba i implanata vr&scaron;eno je istovremeno i drugi deo istraživanja je obuhvatao ispitivanje uticaja primenjene metode i materijala na tačnost otisnutih povr&scaron;ina zuba. Time je pro&scaron;ireno polje istraživanja i omogućeno dono&scaron;enje zaključka o pravoj indikaciji metode i materijala za otiskivanje konkretnog kliničkog slučaja. Kompletna metodologija izrade master i definitivnih radnih (replika) modela, kao i sama procedura otiskivanja, izvedena je po najsavremenijim principima istraživanja, uz upotrebu instrumenata i materijala vodećih svetskih proizvođača. Za potrebe analize odstupanja implanata i zuba na replika modelima u odnosu na referentni, modeli su podvrgnuti optičkoj 3D (trodimenzionalnoj) digitalizaciji pomoću dva savremena laboratorijska skenera koje karakteri&scaron;e izuzetna tačnost skeniranih povr&scaron;ina. Prvo je digitalizovan master model za potrebe dobijanja nominalne geometrije, a nakon toga 30 replika modela, za potrebe uporedne geometrijske analize. Analiza je vr&scaron;ena pomoću najnovijeg specijalizovanog softverskog programa, primenom metode CAD-inspekcije (eng. Computer-Aided Design). Geometrijska analiza odstupanja bru&scaron;enih zuba (patrljaka) izvedena je tehnikom preklapanja odnosno superpozicije (eng. bestfit) realne geometrije (na replika modelu) sa nominalnom geometrijom (na master modelu). Za razliku od analize patrljaka, za potrebe geometrijske analize odstupanja implanata kreiran je lokalni koordinatni sistem za svaki analizirani implant, pomoću specijalnih abatmenta upotrebljenih za digitalizaciju i uvozom 3D modela implanata iz CAD biblioteke proizvođača. Odstupanja su analizirana u odnosu na centar baze implanta (odstupanje od centra) i u odnosu na centralnu osu implanta (ugao odstupanja), &scaron;to je omogućilo tačno prostorno orijentisanje implanata na replika modelima u poređenju sa referentnim. Ova metodologija je originalna, jer je u odnosu na metodologije koje su do sada kori&scaron;ćene u svrhu prostorne orijentacije implanata, uvođenjem novih parametara u analizu, omogućila tačnije definisanje prostornog odstupanja analiziranih implanata. Rezultati dobijeni u istraživanju doveli su do zaključka da metoda otiskivanja i vrsta otisnog materijala utiču na tačnost otiskivanja implanata. Takođe, angulacija implanata od 20&deg; ima veći uticaj na tačnost definitivnih radnih modela u poređenju sa paralelnim implantima. Time su potvrđene radne hipoteze doktorske disertacije. &bdquo;Splint&ldquo; metoda otiskivanja i adicioni silikon izdvojili su se kao najtačniji pri otiskivanju implanata. Kombinacije &bdquo;splint&ldquo; metode sa adicionim silikonom i polietrom i otvorene metode sa adicionim silikonom dale su bolje rezultate pri otiskivanju anguliranih implanta, dok je u grupi paralelnih implanata zaključeno da metoda i materijal ne utiču na tačnost otiskivanja. &bdquo;Splint&ldquo; i otvorena metoda i adicioni silicon pružili su najtačnije otiske bru&scaron;enih zuba. &bdquo;Splint&ldquo; metoda u kombinaciji sa adicionim silikonom dala je najmanja ukupna odstupanja pri otiskivanju implanata i zuba zajedno. Prezentovana studija je specifi čna, kako po izboru zadatog kliničkog slučaja I uporednoj analizi tačnosti istovremenog otiskivanja implanata i zuba, tako i po samoj metodologiji analiza odstupanja implanata, te predstavlja originalni doprinos naučnoj i stručnoj javnosti.</p> / <p>The introductory part of the PhD-theses describes fundamental conventional impression methods, as well as modified techniques used in modern-day implant prosthetics. The biomechanics specificity of the implant supported prosthesis in relation to the biomechanics of natural-teeth retained prosthetics is showed. The emphasis is on the issue&rsquo;s complexity at accomplishing the absolute passive fit of the prosthesis onto the abutment, with particular regard to the impact of the implant impression procedure and implant angulation its elf. A detailed description is provided for all other factors which can influence the accuracy of working casts during implant-based dental prosthesis, making reference to the current data in the literature, as well as to the scientific justification for research. The aim of the study was to examine the influence of the impression method, implant angulation and type of the impression material on the accuracy of the definitive working model for production of the implant-supported dental prosthesis. The experiment was conducted in the in vitro conditions. The research is based on examining the impression accuracy by using three different impression methods (direct, indirect, as well as modifi ed &ldquo;splint&rdquo; method), by using two types of elastic impression materials (addition silicone and polyether), as well as the impact from two different implant groups (angled at 20&deg;, and parallel ones). Master (referential) model was planned to simulate a common clinical case of the upper jaw partial edentulism (Kennedy 1st class), which apart from the two angulated implants on one side, and two parallel implants on the other, also presupposed presence of milled teeth, prepared to accept ceramic dental bridge in the frontal region. Impression of teeth and implants was conducted simultaneously, and second part of the research encompassed examination of the applied method&rsquo;s and material&rsquo;s impact onto accuracy of the impressed teeth surfaces. This expanded the research fi eld and enabled drawing conclusions regarding the appropriate method indication and material for impression of a particular clinical case. Complete production methodology of master and definitive working casts (replicas), as well as the impression procedure itself, were all conducted according to the cutting-edge research principles, as well as with the application of instruments and materials of leading world producers. For the purpose of the analysis of implants and teeth deviation on replica models in relation to the reference model, the models underwent optical 3D (three-dimenzional) digitalization by using two state-of-the-art laboratory scanners characterized by exceptional accuracy of scanned surfaces. First model to be digitalized was the master one, in order to obtain nominal geometry, following which 30 model replicas were scanned, for the purpose of comparative geometrical analysis. The analysis was conducted by using latest specialized software designed for CAD (Computer-Aided Design) inspection method. Geometric analysis of the milled teeth (tooth abutments) deviation was conducted by using the overlapping superposition technique (bestfit) real geometry (on the replica model) with nominal geometry (on the master model). As opposed to the teeth-stump analysis, for the purpose of geometrical analysis of implant deviations, a local coordinate system for each analyzed implant was created, by using special abutments used for digitalization and by importing 3D implant models from the manufacturer&rsquo;s CAD library. Deviations were analyzed in relation to the implant base center (deviation from the center), and in relation to the implant central axis (deviation angle), which enabled accurate implant spatial orientation on the replica models in comparison the referential ones. This methodology is original, since unlike methodologies used so far for implant spatial orientation, it has enabled, through introducing new parameters into analysis, a more accurate defining of analyzed implants spatial deviation. Results obtained during research have led to the conclusion that that the impression methodology and type of the impression material influence the implant impression accuracy. Also, implant angulation of 20&deg; has a higher impact on accuracy of definitive working models in comparison with parallel implants. This confirms the PhD-thesis working hypotheses. The &ldquo;splint&rdquo; impression method and addition silicone have excelled as most accurate at implant impression. Combination of &ldquo;splint&rdquo; methods with addition silicone and polyether and opened methods with addition silicone proved to obtain better results when impressing angulated implants, while in the group of parallel implants, it was concluded that the method and material do not infl uence the impression accuracy. The &ldquo;splint&rdquo; and the open method and addition silicone provided most accu rate imprints of ground teeth. The &ldquo;splint&rdquo; method in com bination with addition silicone provided the least over all deviation at impression of implants and teeth together. The presented study is a specifi c one, both in terms of selection of the given clinical case and comparative analysis of the simultaneous impression of teeth and implants, but also in terms of the methodology itself used to analyze implant deviation, which in its own right represents an original contribution to the scientific and expert public.</p>