A técnica All-on-Four foi idealizada visando diminuir a extensão do cantilever nas reabilitações de pacientes edêntulos com próteses implantossuportadas. Contudo, ainda persistem questionamentos relacionados ao comportamento biomecânico dos implantes e da própria técnica All-on-Four, posto que, questões como a perda óssea peri-implantar e falência de componentes da prótese ainda não estão claramente elucidadas. O objetivo da pesquisa foi avaliar a dissipação de tensões em próteses implantossuportadas dos tipos Branemark e All-on-Four, sob carga oclusal estática, e o papel do lado de balanceio e do comportamento do complexo implantes/próteses. Foram confeccionadas seis réplicas de mandíbula humana em resina fotoelástica, divididas em dois grupos:um com quatro implantes dispostos axialmente e paralelas entre si no espaço interforaminal (mandíbulas Branemark), e outro com quatro implantes inseridos de acordo com a técnica All-on-Four. Confeccionou-se uma prótese total implantossuportada, de maneira que se adaptasse em todas as seis mandíbulas. O experimento foi conduzido com o auxílio de um dispositivo giratório de carga, que permitiu a visualização das mandíbulas por todos os ângulos, sem alteração da carga aplicada. Após a fixação padronizada do corpo de prova no dispositivo, a prótese foi parafusada sobre os implantes da mandíbula. Os carregamentos de carga foram feitos em três pontos: no cantilever da prótese, no primeiro pré-molar e na incisal dos incisivos centrais inferiores. Para cada ponto de aplicação das cargas, fotografaram-se as mandíbulas nos lados de trabalho, de balanceio e na linha mediana, vestibular e na linha mediana também por lingual. Pelos resultados observados, quando as cargas foram aplicadas em regiões mais anteriores da prótese, as tensões nos implantes distais inclinados atenuaramse e as outras regiões da mandíbula apresentaram tensões menores e melhor distribuídas. As franjas também mostraram que a angulação dos implantes distais promoveu mudanças no eixo de rotação do conjunto implantes/prótese. Assim como verificou-se que o implante mais distal do lado de balanceio mostrou atuação conjunta com o implante distal do lado de trabalho nas mandíbulas com implantes axiais e, o mais distal do lado de balanceio nas mandíbulas com implantes inseridos segundo a técnica All-on-Four, mostrou tensão nos ápices, denotando função de estaca. Pela metodologia empregada foi possível concluir que, uma prótese total implantossuportada, segundo a técnica All-on-Four, apresentou melhor melhor dissipação das cargas oclusais e o lado de balanceio teve papel fundamental no auxílio à dissipação de cargas oclusais. / The All-on-Four technique was conceived in order to decrease the length of the cantilever in the rehabilitation of edentulous patients with implant-supported prosthesis. However, still persist questions related to the biomechanical behavior of implants and the proper technique All-on-Four, since issues such as peri-implant bone loss and failure of the prosthetic components are not yet clearly elucidated. The purpose of the study was to evaluate the dissipation of tensions in the Branemark implant-supported prosthesis and All-on-Four, under static occlusal load, and the role of the balancing side and the complex behavior of implants / prostheses. Six replicas of the human mandible were made in photoelastic resin, divided into two groups: one with four implants placed axially and parallel to each other in interforaminal space (Branemark jaws), and another four implants inserted according to the All-on-Four technique. It was made an implant-supported denture, so that would fit in all six jaws. The experiment was conducted with the aid of a rotating load device, which permitted visualization of the jaws from all angles, without changing the applied load. After the standardized setting of specimen in the device, the prosthesis was screwed onto the implants in the jaw. The cargo shipments were made on three points: the cantilever prosthesis, in the first premolar and the lower central incisor incisal. For each point of application of loads, photograph was taken from the work sides of the jaws, balancing and the midline, bucal view and the midline lingual also. By the observed results, when loads were applied to more anterior regions of the prosthesis, the stresses in the distal inclined implants attenuated and other regions of the mandible showed lower stresses and better distributed. The fringes also showed that the angulation of the distal implants promoted changes in the axis of rotation of the implant / prosthesis. As it was found that the most distal implantat on the balancing side showed joint action with the distal implant of the working side in the jaw with axial implants, and the most distal implant on the balancing side of jaw with implants inserted according to All-on Four technique, the tension showed apices, denoting stake function. For the methodology it was concluded that an implant-supported denture, according to the All-on-Four technique, had a better dissipation of occlusal loads and balancing side was fundamental hole in helping to dissipate occlusal loads.

Made available in DSpace on 2014-12-17T15:43:46Z (GMT). No. of bitstreams: 1 KassiaCD_DISSERT.pdf: 3074934 bytes, checksum: e11accf83a218e88932f4699f7d8e3bd (MD5) Previous issue date: 2012-12-06 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / There is a lack of clinical studies evaluating techniques of functional impression for partially edentulous arches. The aim of this double-blind non-randomized controlled clinical trial was to compare the efficacy of altered cast impression (ACI) and direct functional impression (DFI) techniques. The efficacy was evaluated regarding the number of occlusal units on denture teeth, mucosa integrity at 24-hour follow-up and denture base extension. The sample included 51 patients (female and male) with mean age of 58.96 years treated at Dental Department of UFRN. The patients, exhibiting edentulous maxilla and mandibular Kennedy class I, were divided into two groups (group ACI, n=29; group DFI, n=22). Clinical evaluation was based on the number of occlusal units on natural and/or artificial teeth, mucosa integrity at 24-hour follow-up, and denture base extension. Statistical analysis was conducted using the software SPSS 17.0? (SPSS Inc., Chicago, Illinois). Student T-test was used to reveal association between number of occlusal units and impression technique while chi-square test showed association between mucosa integrity and impression technique. Fischer s exact test was applied for association between denture base extension and impression technique at 95% level of significance. No significant difference was observed between the groups regarding number of occlusal units, mucosa integrity and denture base extension. The altered cast technique did not provide significant improvement in comparison to the direct technique when the number of occlusal units, mucosa integrity and denture base extension / A literatura cient?fica ? carente de estudos cl?nicos que avaliem a efici?ncia de t?cnicas de moldagem funcional para arcos parcialmente desdentados. Objetivou-se realizar um ensaio cl?nico controlado, n?o randomizado e duplo-cego, para comparar a efici?ncia da t?cnica de moldagem funcional do modelo alterado (TMMA) com a t?cnica de moldagem funcional direta (TMD), em rela??o ao n?mero de pontos de contato oclusais por unidade oclusal na instala??o de novas pr?teses, a integridade da fibromucosa na sess?o de controle de 24 horas e a extens?o da base de pr?tese. A amostra foi constitu?da por 51 pacientes, com m?dia de idade de 58,96 anos, portadores de arco maxilar totalmente desdentado e Classe I de Kennedy mandibular, de ambos os sexos, reabilitados nas cl?nicas do Departamento de Odontologia da Universidade Federal do Rio Grande do Norte. Os pacientes foram divididos em dois grupos: grupo TMMA (n=29) e Grupo TMD (n=22). As seguintes vari?veis foram utilizadas para as medidas cl?nicas: n?mero de pontos de contato oclusais por unidade oclusal, a integridade da fibromucosa no retorno programado de 24 horas e a extens?o da base da pr?tese. Para an?lise estat?stica, utilizou-se o programa SPSS 17.0? (SPSS Inc., Chicago, Illinois) e aplicou-se o teste t de Student para verificar a associa??o do n?mero de pontos de contato oclusais por unidade oclusal em dentes naturais e artificiais e a t?cnica de moldagem. Para verificar a associa??o entre a integridade da fibromucosa e a t?cnica, foi utilizado o teste quiquadrado. O teste exato de Fisher foi usado para verificar a associa??o entre a extens?o da base da pr?tese e a t?cnica, com confian?a estat?stica de 95%. N?o existiu diferen?a estatisticamente significativa entre os dois grupos quanto ? t?cnica de moldagem em rela??o ao n?mero de pontos de contato oclusais, ? integridade da fibromucosa e ? extens?o da base da pr?tese. A t?cnica de moldagem funcional do modelo alterado n?o oferece vantagens significativas, quando comparada ? t?cnica direta, em rela??o ? quantidade de n?mero de pontos de contato oclusais por unidade oclusal, ? integridade da fibromucosa e ? extens?o da base da pr?tese

Abstract Oral health among older people is shown to be worse compared to younger people. The aim of this study was to evaluate oral health and associating factors among ageing Finns. A cross-sectional, descriptive epidemiologic survey was performed in Kirkkonummi in southern Finland and in the Lakeus District in northern Finland. Altogether 1,191 subjects aged 60 to 78 years, 625 from Kirkkonummi and 566 from Lakeus, were examined and interviewed. Edentulousness and poor occlusal stability were recorded clinically. Gonial angle, ramus height, condylar height and the amount of residual ridge resorption in the mandible and the presence of fixed prostheses were evaluated from panoramic radiographs. Based on the radiographs the scoring of infection foci was performed with an infection focus index. The signs of infection recorded were deep caries, periapical lesions, furcal lesions, vertical bone pockets and horizontal bone loss. The prevalence of edentulousness was 37%, being significantly higher among women than among men and significantly higher in the northern compared to the southern region. Edentulousness was more prevalent among subjects with primary school education than among those with higher education. The mean of the gonial angle was smaller among dentate subjects than among edentulous ones. Dentate subjects had significantly greater ramus height and condylar height than edentulous subjects. Women had significantly more often than men severe residual ridge resorption in the mandible. Poor satisfaction with dentures associated significantly with poor occlusal stability in both genders. More than three quarters of the subjects had severe risk of infection, more in the southern than in the northern region. In the dentate sample women showed higher prevalence of fixed prostheses than men. In the Kirkkonummi region both men and women had more fixed prostheses than subjects in the Lakeus region. Edentulousness was very frequent among ageing Finns. Mandibular bone morphology changed as a consequence of tooth loss. The prevalence of fixed prostheses was low and the prevalence of signs of infection of dental origin was high. The geographical differences in oral health should be considered by health authorities in order to promote good oral health in rural areas, especially focusing on older people with low socio-economical status and poor health. / Tiivistelmä Vanhusväestön suun terveydentila on useassa tutkimuksessa todettu huonommaksi kuin nuoremmilla. Tämän tutkimuksen tarkoituksena oli selvittää suomalaisen ikääntyvän väestön suun terveydentilaa ja siihen liittyviä tekijöitä. Epidemiologinen poikkileikkaustutkimus tehtiin Kirkkonummella Etelä-Suomessa ja Lakeuden terveyskeskuksen alueella Pohjois-Suomessa. Tutkimukseen ja haastatteluun osallistui yhteensä 1191 iältään 60–78-vuotiasta henkilöä, 625 Kirkkonummelta ja 566 Lakeudelta. Kliinisessä tutkimuksessa selvitettiin hampaattomuus ja proteesien purentatasapaino. Alaleuan leukakulma, nousevan haaran ja nivellisäkkeen korkeus, hammasharjanteen korkeus ja kiinteiden proteesien esiintyminen arvioitiin panoraamaröntgenkuvista. Tulehdusriskiä kuvaava indeksi arvioitiin röntgenkuvien tulehdusmuutoksista, joina rekisteröitiin syvä karies, hampaan juurenpään tulehdus, tulehdus takahampaiden juurten haarautumassa, syventyneet luutaskut ja kiinnityskudoskato usean hampaan alueella. Hampaattomuuden vallitsevuus oli 37 %. Se oli tilastollisesti merkitsevästi korkeampi naisilla kuin miehillä ja pohjoisella alueella merkitsevästi korkeampi kuin eteläisellä. Hampaattomuus oli yleisempää vähiten koulutusta saaneilla kuin korkeamman koulutuksen saaneilla. Hampaallisilla oli pienempi alaleuan leukakulma kuin hampaattomilla, ja heillä oli myös korkeampi nouseva haara ja nivellisäke kuin hampaattomilla. Naisilla oli merkitsevästi useammin vakavaa hammasharjanteen madaltumista kuin miehillä. Molemmilla sukupuolilla tyytymättömyys proteeseihin liittyi merkitsevästi huonoon purentatasapainoon. Yli kolmella neljäsosalla tutkituista oli vakava tulehdusriski, eteläisellä alueella enemmän kuin pohjoisella. Hampaallisessa aineistossa naisilla oli enemmän kiinteitä proteeseja kuin miehillä. Kirkkonummen alueella tutkituilla oli enemmän kiinteitä proteeseja kuin Lakeuden alueella. Hampaattomuus oli hyvin yleistä 60–78-vuotiailla suomalaisilla. Alaleuanluun muoto muuttui hampaiden menetyksen seurauksena. Kiinteiden proteesien määrä oli vähäinen ja ikääntyvillä suomalaisilla oli röntgenkuvissa runsaasti hammasperäisten tulehdusten löydöksiä. Suun terveyden alueelliset erot tulisi ottaa huomioon suu- ja hammasterveyden edistämistyössä, jossa erityisesti tulisi huomioida alhaisen sosioekonomisen aseman ja huonon terveyden omaava vanhempi väestö.