Orientador: João Maurício Ferraz da [Unesp] Silva / Resumo: Este estudo foi descritivo e teve como objetivo avaliar os enceramentos diagnóstico convencional e o digital, baseados no mesmo Planejamento Digital do Sorriso em 2D, realizado através de um protocolo fotográfico. Foram selecionados 20 pacientes, que foram moldados com alginato para obtenção dos modelos de estudo convencional e foram também escaneados para a obtenção do modelo virtual utilizado para o enceramento digital. O planejamento 2D foi então enviado ao laboratório de prótese juntamente com os modelos em gesso e os modelos virtuais, realizando então os enceramentos diagnósticos. A prova destes enceramentos foi realizada por meio de um ensaio restaurador seguindo uma ordem aleatorizada. A avaliação do ensaio restaurador foi feita sob a preferência de um dentista avaliador experiente e especialista em prótese dentária e do paciente através de questionário. Foi avaliada também, a preferência do paciente em relação às técnicas de impressão: analógica e digital. As respostas foram tabuladas e submetidas a teste estatístico. Os pacientes mostraram preferência pelo enceramento diagnóstico convencional em relação ao digital em 65% dos casos. Os pacientes mostraram preferência pelo método de impressão digital em relação ao convencional em 80% dos casos. O dentista avaliador mostrou preferência pelo enceramento convencional em 50% dos casos e pelo digital em 50% dos casos. / Abstract: This study was descriptive and aimed to evaluate the conventional and digital diagnostic waxing, based on the same 2D Digital Smile Planning, performed through a photographic protocol. Twenty patients were selected, who were molded with alginate to obtain the conventional study models and were also scanned to obtain the virtual model used for digital waxing. The 2D planning was then sent to the prosthesis laboratory together with the plaster models and the virtual models, performing the diagnostic waxing. The testing of these waxing was performed by a restorative assay following a randomized order. The evaluation of the restorative trial was made under the preference of an evaluating dentist and the patient through a questionnaire. It was also evaluated the patient's preference over printing techniques: conventional and digital. The answers were tabulated and subjected to statistical test. The patients showed preference for the conventional waxing over the digital one in 65% of the cases. Patients showed a preference for the fingerprint method over the analog in 80% of the cases. The evaluating dentist showed a preference for analogous waxing in 50% of cases and digital for waxing in 50% of cases. / Mestre

No description available.

O presente estudo teve por objetivo observar os níveis de concordância entre a avaliação clínica e fotográfica digital no diagnóstico de desempenho de restaurações posteriores (Classe I e Classe II) em resina composta. As avaliações clínicas foram feitas por dois examinadores (C1 e C2) calibrados (e-calib) usando critérios da Fédération Dentaire Internationale (FDI) considerando propriedades estéticas, funcionais e biológicas. Em cada momento de avaliação clínica, uma fotografia digital padronizada de cada restauração foi realizada. Dois examinadores digitais (D1 e D2), igualmente calibrados e usando os mesmos critérios avaliaram todas as imagens obtidas nas avaliações clínicas. Os dados foram analisados com Coeficiente de Cohen Kappa e teste não paramétrico de Kruskal-Wallis e o teste de Dunn de comparação múltipla, com nível de significância de 5%. Comparações intra (mesmo método) e inter (métodos diferentes) examinadores foram feitas. Os resultados revelaram que os níveis de concordância variaram de \"Perfeito\" a \"Justo\". Houve diferença significante (p < 0.05) intra-examinadores; entre C1 e C2 para o manchamento marginal; entre D1 e D2 para brilho superficial, estabilidade de cor e translucidez, forma anatômica, e fratura do material e retenção; inter-examinadores foram encontradas diferenças significantes em todas as propriedades estéticas (brilho superficial, manchamento marginal, estabilidade de cor e translucidez e forma anatômica) e funcionais (fratura do material e retenção e adaptação marginal) observadas. A associação entre a imagem digital e o exame clínico pode ser uma ferramenta promissora para detecção de falhas precoces em restaurações de resina composta, necessitando de mais estudos que investiguem o método digital. / The present study aimed to evaluate the agreement levels between clinical and digital photographic assessments on the performance of posterior composite resin restorations (Class I and Class II). The clinical assessments were made by two examiners (C1 and C2) calibrated through e-calib with the Fédération Dentaire Internationale (FDI) criteria considering esthetic, functional and biological properties. In each moment of clinical assessment, standard digital photographs of each restoration were obtained. Two digital examiners (D1 and D2), equally calibrated and using the same criteria, evaluated all the images obtained in the clinical assessment. The data were analyzed with the calculation of Cohen Kappa coefficient, Kruskal-Wallis non-parametric test and Dunn\'s multiple shared test, with significance of 5%. Intra (same method) and inter (different methods) comparisons were realized. The results showed that agreement levels varied from \"Perfect\" to \"Fair\". There was a significant difference (p < 0.05) intra-examiners; between C1 and C2 to the marginal staining parameter; between D1 and D2 in the parameters surface luster, colour match and translucency, esthetic anatomical form and fracture of material and retention; inter-examiners was noticed significant difference in all the esthetic (surface luster, colour match and translucency, marginal staining, esthetic anatomical form) and functional properties (fracture of material and retention and marginal adaptation) observed. The association between the digital image to the clinical exam may be a promising tool associated with the clinical method to detect early failures in composite resin restorations, requiring further studies investigating the digital method.

O presente estudo teve por objetivo observar os níveis de concordância entre a avaliação clínica e fotográfica digital no diagnóstico de desempenho de restaurações posteriores (Classe I e Classe II) em resina composta. As avaliações clínicas foram feitas por dois examinadores (C1 e C2) calibrados (e-calib) usando critérios da Fédération Dentaire Internationale (FDI) considerando propriedades estéticas, funcionais e biológicas. Em cada momento de avaliação clínica, uma fotografia digital padronizada de cada restauração foi realizada. Dois examinadores digitais (D1 e D2), igualmente calibrados e usando os mesmos critérios avaliaram todas as imagens obtidas nas avaliações clínicas. Os dados foram analisados com Coeficiente de Cohen Kappa e teste não paramétrico de Kruskal-Wallis e o teste de Dunn de comparação múltipla, com nível de significância de 5%. Comparações intra (mesmo método) e inter (métodos diferentes) examinadores foram feitas. Os resultados revelaram que os níveis de concordância variaram de \"Perfeito\" a \"Justo\". Houve diferença significante (p < 0.05) intra-examinadores; entre C1 e C2 para o manchamento marginal; entre D1 e D2 para brilho superficial, estabilidade de cor e translucidez, forma anatômica, e fratura do material e retenção; inter-examinadores foram encontradas diferenças significantes em todas as propriedades estéticas (brilho superficial, manchamento marginal, estabilidade de cor e translucidez e forma anatômica) e funcionais (fratura do material e retenção e adaptação marginal) observadas. A associação entre a imagem digital e o exame clínico pode ser uma ferramenta promissora para detecção de falhas precoces em restaurações de resina composta, necessitando de mais estudos que investiguem o método digital. / The present study aimed to evaluate the agreement levels between clinical and digital photographic assessments on the performance of posterior composite resin restorations (Class I and Class II). The clinical assessments were made by two examiners (C1 and C2) calibrated through e-calib with the Fédération Dentaire Internationale (FDI) criteria considering esthetic, functional and biological properties. In each moment of clinical assessment, standard digital photographs of each restoration were obtained. Two digital examiners (D1 and D2), equally calibrated and using the same criteria, evaluated all the images obtained in the clinical assessment. The data were analyzed with the calculation of Cohen Kappa coefficient, Kruskal-Wallis non-parametric test and Dunn\'s multiple shared test, with significance of 5%. Intra (same method) and inter (different methods) comparisons were realized. The results showed that agreement levels varied from \"Perfect\" to \"Fair\". There was a significant difference (p < 0.05) intra-examiners; between C1 and C2 to the marginal staining parameter; between D1 and D2 in the parameters surface luster, colour match and translucency, esthetic anatomical form and fracture of material and retention; inter-examiners was noticed significant difference in all the esthetic (surface luster, colour match and translucency, marginal staining, esthetic anatomical form) and functional properties (fracture of material and retention and marginal adaptation) observed. The association between the digital image to the clinical exam may be a promising tool associated with the clinical method to detect early failures in composite resin restorations, requiring further studies investigating the digital method.

Due to the increasing demand from patients and dentists for highly aesthetic and strong, metal-free restorations there has been a rapid increase in research into dental CAD CAM technique and zirconia based restorations over the last decade. Such new technology has the potential to take the place of conventional techniques and materials for fabricating indirect dental restorations in the future. In this PhD thesis, five laboratory studies were designed to investigate zirconia bridges constructed using dental CAD CAM. The studies concentrated on: 1. Ideal force applied by dentists for cementing zirconia bridges and the impact on seating. 2. The effect of firing cycles and zirconia thickness on the fit of zirconia bridges. 3. The effect of span length on the fit of three and four unit all zirconia bridges. 4. The effect of veneering on the strength of three unit zirconia bridges. 5. The fit of three unit all zirconia bridges produced by digital and conventional techniques. For these laboratory studies an ideal three unit (and four unit for study 3) fixed-fixed all ceramic bridge preparation was carried out on two plastic teeth and all SLA models and zirconia based bridges were made using the Lava COS and Lava™ CAD CAM system (3M, ESPE). In addition to the laboratory studies, a clinical audit was carried out to assess satisfaction (dentist, dental technician and patient) with zirconia based restorations (through a xvi series of questionnaires) made and fitted at Dundee Dental Hospital and School. In addition, as part of this audit a simple cost analysis was carried out to explore the differences in cost between zirconia based restorations and high fusing gold alloy based metal ceramic restorations. Four of the studies (studies 1, 2, 3 and 5) investigated the internal and marginal fit of the zirconia based restorations under differing laboratory and clinical procedures and conditions. It was found that the seating force used to cement a zirconia based bridge had no impact upon fit (Study 1). Whilst the thickness of zirconia (all-zirconia bridge and un-veneered zirconia framework) did not affect the fit of the restoration, veneering the framework did lead to a statistically significant deterioration in fit (Study 2). Although leading to a poorer fit veneering did have a positive effect in strengthening the zirconia framework, but neither un-veneered nor veneered frameworks were as strong as monolithic/all zirconia bridges (Study 4). Despite the high shrinkage during post milling sintering and the potential for greater distortion on longer span bridges, the longer span bridges investigated in Study 3 did not impact upon fit. In study 1, 2, 3 and 4 the Lava COS intra-oral scanner was used to create a digital impression of the tooth preparations and study 5 confirmed that the fit of bridges made from these impressions were better than those made using conventional addition cured silicone putty and wash impressions (Study 5). The results of the questionnaires used in the audit revealed high satisfaction rates with all stake holders and the cost analysis showed that producing zirconia based restorations can be five to six times cheaper than conventional gold based restorations. Despite the variations in fit which were found in Studies 2 and 5, all bridges produced were within what would be regarded as clinically acceptable and comparable to those produced with more traditional techniques.

In the modern era of metal-free minimally-invasive dentistry, there is a growing tendency toward using metal-free restorative alternatives that provide not only excellent aesthetics but also enable superior durability. Fibre-reinforced composite (FRC) is one cost-effective alternative that fulfils the requirements of aesthetics and durability, and offers favourable physico-mechanical properties. Many FRC applications are well-documented in the literature, such as crowns and fixed partial dentures (FPD); however, their clinical implementation is still limited, owing to the lack of significant knowledge about their longevity, deterioration signs, optimum design and overall performance. This in-vitro research aimed to address these uncertainties by investigating the performance of FRC restorations, and the influence of fibre reinforcement on particular physcio-mechanical properties, including surface hardness, edge-strength, shear bond strength, fatigue and wear resistance. Basic testing models were used to investigate the effect of incorporating differently-oriented FRCs on the surface hardness, edge-strength and shear bond strength of particulate-reinforced composite (PRC). The results revealed that the incorporation of FRC significantly enhanced surface hardness (by 12 - 19 %) and edge-strength (by 27 -75 %). However, this incorporation significantly reduced the shear bond strength (SBS) between PRC and other restorative materials, including lithium disilicate ceramic (10.9±3.1 MPa) and Co-Cr metal alloy (12.8±2.3 MPa), compared to the control (15.2±3.6 MPa, 15.0±3.7 MPa). The orientation of FRC was also found to affect the efficiency of reinforcement as bidirectional FRCs exhibited significantly higher hardness (76.8±1.2 VHN), edge-strength (67.7±8.2 N) and SBS (14.1±3.9 MPa) values than unidirectional FRCs (72.4±1.2 VHN, 56.8±5.9 N, 9.8±2.3 MPa).Clinically-relevant testing models, employing accelerated aging techniques, were performed to investigate the fatigue and wear behaviours of anatomically-shaped FRC restorations in-vitro. Direct inlay-retained FRC-FPDs with two framework designs, were tested for their fatigue behaviour and load-bearing capacity. Type-I design (with an additional bidirectional FRC layer incorporated perpendicular to the loading direction) yielded significantly higher fatigue resistance (1144.0±270.9 N) and load-bearing capacity (1598.6±361.8) than Type-II design (with a woven FRC embedded around the pontic core) (716.6±72.1 N, 1125.8±278.2 N, respectively). However, Type-19II design exhibited fewer delamination failures. Both framework design and dynamic fatigue were found to have a significant influence (p < 0.05) on the load-bearing capacity of FRC-FPDs. Additionally, the in-vitro fatigue and wear behaviours of FRC crowns, fabricated conventionally from bidirectional FRC and indirect PRC (Sinfony), were compared with those made of two CAD/CAM alternatives, namely Lava Zirconia (LZ) and Lava Ultimate (LU). A chewing simulator was employed to induce some fatigue wear in crowns, while an intraoral 3D scanner was used to quantify the resultant morphological changes. The results showed that FRC crowns had significantly lower mean cumulative wear (233.9±100.4 μm) than LU crowns (348.2±52.0 μm), but higher than LZ crowns (16.4±1.5 μm). The mean load bearing-capacity after fatigue simulation was also the highest for LZ crowns (1997.8±260.2 N) compared with FRC (1386.5±258.4 N) and LU crowns (756.5±290.9 N).Accordingly, the incorporation of FRC in resin-composite restorations is advocated since it increases surface hardness and marginal integrity, improves fatigue and wear behaviours, and enhances load-bearing capacity and overall performance.