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 inquiry investigated the suitability of the jaw of domestic sheep as an animal model for dental implantology research. Initially, parameters for osseous healing of critical size defects (CSD) in the sheep mandible were established. Pilot studies were conducted using machined-surface implants and a surgical protocol established for dental implant placement in ovine mandibular sites. Subsequent experiments considered the utility of this animal model for examination of techniques designed to enhance osseointegration. Hydroxyapatite-coated implants were compared with titanium plasma-sprayed (TPS) implants, either alone or combined with autogenous bone grafts or a bone graft/collagen vehicle loaded with transforming growth factor-beta (TGF-β). Immunofluorescent bone labelling gave information on the mineral apposition rate (MAR). Implant survival and "acceptability" (likelihood of clinical success) were major output variables, along with histomorphometric analysis of percent bone-implant contact (%BIC) and percent peri-implant bone density (%density). Naturally-occurring "broken-mouth" periodontitis in sheep was identified as a potential confounder. Subsequent experiments considered implants with different surfaces. The model was also extended from a two-stage surgical protocol to include single-stage implants. The effect of pre-existing ovine peridontitis was also examined. A systematic review and meta-analysis of published animal implant experiments was conducted in order to validate the candidate sheep model. Major findings were as follows. The size of non-healing sheep mandibular unicortical CSD is >12mm. Attempts to establish a chronic non-healing CSD were unsuccessful. The sheep diastema proved unsuitable for implant placement. The model was modified to a post-extraction protocol. Implant "acceptability" rates after 3 months integration in the sheep mandible (defined as implant survival with %BIC >10%) ranged from 50% - 100% for different implant surface treatments and placement protocols. Histomorphometriic analyses revealed that %BIC ranged from 11 � 17% to 81 � 29 % for different titanium surfaces and up to 85 � 11% for hydroxyapatite surfaces. Implants with TGF-β plus autogenous bone grafts had %BIC of 36 � 30% compared with 43 � 30% for implants with grafts alone. Bone per unit area (%density) adjacent to, but outside of the implant threads, ranged from 63 � 16% to 86 � 3% and was markedly lower for titanium plasma-sprayed surfaces and for one-stage implants. Within the implant threads, %density varied from 31 � 33% to 73.4 � 8.3%, and was markedly lower for machined titanium surfaces. Sheep periodontitis had little effect on the protocols investigated. The sheep mandibular model was found to be comparable to similar models in other species and merits further development.

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.

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.

published_or_final_version / Dentistry / Master / Master of Dental Surgery

This inquiry investigated the suitability of the jaw of domestic sheep as an animal model for dental implantology research. Initially, parameters for osseous healing of critical size defects (CSD) in the sheep mandible were established. Pilot studies were conducted using machined-surface implants and a surgical protocol established for dental implant placement in ovine mandibular sites. Subsequent experiments considered the utility of this animal model for examination of techniques designed to enhance osseointegration. Hydroxyapatite-coated implants were compared with titanium plasma-sprayed (TPS) implants, either alone or combined with autogenous bone grafts or a bone graft/collagen vehicle loaded with transforming growth factor-beta (TGF-β). Immunofluorescent bone labelling gave information on the mineral apposition rate (MAR). Implant survival and "acceptability" (likelihood of clinical success) were major output variables, along with histomorphometric analysis of percent bone-implant contact (%BIC) and percent peri-implant bone density (%density). Naturally-occurring "broken-mouth" periodontitis in sheep was identified as a potential confounder. Subsequent experiments considered implants with different surfaces. The model was also extended from a two-stage surgical protocol to include single-stage implants. The effect of pre-existing ovine peridontitis was also examined. A systematic review and meta-analysis of published animal implant experiments was conducted in order to validate the candidate sheep model. Major findings were as follows. The size of non-healing sheep mandibular unicortical CSD is >12mm. Attempts to establish a chronic non-healing CSD were unsuccessful. The sheep diastema proved unsuitable for implant placement. The model was modified to a post-extraction protocol. Implant "acceptability" rates after 3 months integration in the sheep mandible (defined as implant survival with %BIC >10%) ranged from 50% - 100% for different implant surface treatments and placement protocols. Histomorphometriic analyses revealed that %BIC ranged from 11 � 17% to 81 � 29 % for different titanium surfaces and up to 85 � 11% for hydroxyapatite surfaces. Implants with TGF-β plus autogenous bone grafts had %BIC of 36 � 30% compared with 43 � 30% for implants with grafts alone. Bone per unit area (%density) adjacent to, but outside of the implant threads, ranged from 63 � 16% to 86 � 3% and was markedly lower for titanium plasma-sprayed surfaces and for one-stage implants. Within the implant threads, %density varied from 31 � 33% to 73.4 � 8.3%, and was markedly lower for machined titanium surfaces. Sheep periodontitis had little effect on the protocols investigated. The sheep mandibular model was found to be comparable to similar models in other species and merits further development.

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.