This retrospective clinical study aimed: (1) to establish and validate a reproducible geometrical measurement strategy in quantifying peri-implant alveolar bone changes based on CBCT images taken before and one year after implantation; (2) to quantify and compare the bone changes of Type 1 and Type 4 implant placement in the patient cohort that requested implant placement at premolar and molar sites; (3) to analyse the bone changes in relation to the two implant protocols in aspects of buccal and lingual, maxilla and mandible, within the cohort and combined cohorts. 3D imaging analysis in this study had used a software package - OnDemand3D. The evaluation of the measurement strategy was based on a simulation model which was made of human dry skull with and without a standard implant (Straumann Standard Plus, Ø3.3 mm diameter, L12 mm) to simulate before and after the implant placement. The recruited cases were 69 (44 Type 1 cases and 25 Type 4 cases); all data sets were provided by Shanghai 9th people's hospital, China. Each case had two CBCT data sets at before and one year after implant placement. With 69 cases, bone grafting was applied to all Type 1 cases, and the flap surgery was applied to Type 1 cases when buccal bone recession greater than 3 mm. The measurements were made in bone height (HL) and bone thickness (L0O0, L1O1, L2O2, L3O) at lingual side, while the same at buccal side (HB, B0O0, B1O1, B2O2, B3O3). The four sections of bone thickness were at 0, 1 mm, 4 mm and 7 mm from the top of the implant. Additionally, six special cases were reported, as they provided extra information. They were two spilt-mouth control cases, three 2-year follow-up cases and one 3-year follow-up case. The evaluation of the measurement strategy showed the error of the measurement strategy was -0.06 mm and the measurement uncertainty was ±0.05 mm. The main measurement outcomes from the clinical cases were as follows: (1) at buccal side, the mean value of bone changes in height was a positive value of +0.18±1.64 mm for Type 1, which was significantly more than +0.01±0.86 mm for Type 4 (p < 0.05). However the standard deviation over the 44 and 25 patient cohorts were as large as 1.64 mm and 0.86 mm; (2) at buccal side, the bone changes in thickness showed significantly more loss at B0O0 (p < 0.01) and B1O1 (p < 0.05) sections in Type 1 (-0.38±1.49 mm and -0.25±1.15 mm) compared with Type 4 (-0.19±0.34 mm and -0.16±0.76 mm); (3) in Type 1 cases, the bone thickness at buccal side showed significantly more absorption at L1O1B1 (p < 0.05), L2O2B2 (p < 0.01), L3O3B3 (p < 0.01) section (-0.25±1.15 mm, -0.19±0.99 mm, -0.12±0.57 mm) compared to lingual side (-0.13±0.85 mm, -0.16±0.28 mm, -0.05±0.28 mm); and the bone height (+0.18±1.64 mm) increased significantly more at buccal side than lingual side (-0.25±0.79 mm) with bone augmentation procedure (p < 0.01). However, within Type 4 cases, no significant difference in bone changes between buccal and lingual sides could be found. In conclusion, the measurement strategy established in this study was reproducible and provided valid quantifiable data of bone changes in relation to implant placement based on 3D CBCT images. The data analysis from these two patient cohorts suggested that Type 1 implant placement protocol could re-build the bone height at buccal side better than Type 4.

L'assurance qualité est une discipline récente dans le domaine médical, d'autant plus en odontologie. Sa mise en oeuvre passe dans notre discipline essentiellement par l'application de règles d'exigences vis-à-vis des dispositifs médicaux utilisés au sein des cabinets dentaires. Les implants, les piliers, les prothèses implantaires mais également les guides chirurgicaux sont des exemples appliqués au domaine implantaire. Cette technique chirurgico-prothétique se doit d'être exécutée dans les meilleurs conditions avec une exigence optimale : chaque acte pouvant avoir des conséquences sur le patient et/ou l'avenir du traitement. Afin de répondre aux exigences d'assurance qualité du traitement implantaire, il semble que les guides chirurgicaux statiques puissent être un moyen afin d'améliorer le placement implantaire impactant donc la qualité de la thérapeutique mise en place. Dans un premier temps, les notions d'assurance qualité et des dispositifs médicaux sont remis en lumière, notamment au travers du filtre de l'implantologie orale. Ensuite, la qualité du traitement implantaire est discutée : des bases historiques jusqu'aux connaissances d'aujourd'hui. Il est important de maitriser l'évolution de cette technique et des outils associées afin de comprendre et donc d'utiliser les outils diagnostics et thérapeutiques à notre disposition aujourd'hui. Le dernier temps de ce travail constitue l'évaluation des outils actuels en implantologie (CFAO, stéréolithographie, chirurgie guide statique, informatique) au travers d'une étude sur sujets anatomiques. Cette étude évalue la précision du positionnement implantaire avec des guides dits conventionnels et des guides de chirurgie guidée statique. Cette précision est évaluée par comparaison des images préalables de planification et des examens tridimensionnels post-opératoires / The quality assurance is a recent discipline in the medical domain, all the more in odontology. Its implementation passes in our discipline essentially by the application of rules of requirements towards medical devices used within dental surgeries. Implants, abutments, implant’s prosthesis but also the surgical guides are examples applied to the domain. This surgico-prosthetic technique owes be executed in the best conditions with an optimal requirement: every act which can have consequences on the patient and/or the future of the treatment. To meet the requirements of quality assurance of the treatment, it seems that the static surgical guides can be a way to improve the placement of implants thus impacting on the quality of the organized therapeutics. At first, the notions of quality assurance and medical devices are handed in light, in particular through the filter of the oral implantology. Then, the quality of the treatment is discussed: historic bases until the knowledge of today. It is important to master the evolution of this technique and tools associated to understand and thus use tools diagnoses and therapeutic at our disposal today. The last time of this work establishes) the evaluation of the current tools implantologie (CAD-CAM, stereolithography, surgery guides static, IT) through a study on anatomical subjects. This study estimates the precision of the implant’s positioning with conventional said guides and guides of static guided surgery. This precision is estimated by comparison of the preliminary images of planning and the post operative threedimensional examinations

Resumo: O objetivo do presente trabalho de pesquisa foi avaliar a influencia do tipo de conexao protetica, do platform-switching, e do design do implante no ambiente biomec.nico de implantes imediatos com carga imediata. Para tanto, um modelo de alveolo de extraçao de um incisivo central superior foi constru.do baseado em tomografia computadorizada. Implantes inseridos no alveolo de extra..o foram avaliados por meio de analises em elementos finitos. Uma Analise de Variancia (α=0.05) foi utilizada para interpretar os dados do pico de deformaçao equivalente no osso, do pico de tens.es equivalentes no parafuso do abutment, do deslocamento relativo osso-implante e do gap do abutment. A maior influ.ncia do tipo de conexao protetica e do platform-switching foi observado na tensao do parafuso e no gap do abutment. Por sua vez, o design do implante afetou consideravelmente as deformaçoes no osso e o deslocamento relativo entre o osso e o implante. Nao obstante, evitar a sobrecarga do implante e garantir uma alta estabilidade inicial sao os fatores mais importantes na previsibilidade de implantes imediatos com carga imediata / Abstract: The aim of the present research work was to evaluate the influence of different connection type, platform switching and implant designs on the biomechanical environment of immediately placed implants. A CT-based model of an upper central incisor extraction socket was constructed. The immediately placed implants were evaluated by finite element analysis. An Analysis of Variance was used to interpret the data for the peak equivalent strain in the bone, peak Von Mises stress in the abutment screw, bone-to-implant relative displacement and abutment gap. The largest influence of the connection type and platformswitching was seen on the peak equivalent stress in the abutment screw and implant-abutment gap. On contrary, the implant design considerably affects the biomechanical environment of immediately placed implants. However, avoiding implant overloading and ensuring a high implant initial stability are the most important factors for the predictability of implants in this protocol / Orientador: Luis Geraldo Vaz / Coorientador: Elcio Marcantonio Junior / Coorientador: Sonia Aparecia Goulart de Oliveira / Banca: José Maurício dos Santos Reis Nunes / Banca: Rogério Margonar / Banca: Pedro Yoshito Noritomi / Banca: Flávio Domingues das Neves / Doutor

Made available in DSpace on 2014-06-11T19:32:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-25Bitstream added on 2014-06-13T19:43:55Z : No. of bitstreams: 1 pessoa_rs_dr_arafo.pdf: 1780565 bytes, checksum: 78498002897f7571851e27403dd44a72 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / O objetivo do presente trabalho de pesquisa foi avaliar a influencia do tipo de conexao protetica, do platform-switching, e do design do implante no ambiente biomec.nico de implantes imediatos com carga imediata. Para tanto, um modelo de alveolo de extraçao de um incisivo central superior foi constru.do baseado em tomografia computadorizada. Implantes inseridos no alveolo de extra..o foram avaliados por meio de analises em elementos finitos. Uma Analise de Variancia (α=0.05) foi utilizada para interpretar os dados do pico de deformaçao equivalente no osso, do pico de tens.es equivalentes no parafuso do abutment, do deslocamento relativo osso-implante e do gap do abutment. A maior influ.ncia do tipo de conexao protetica e do platform-switching foi observado na tensao do parafuso e no gap do abutment. Por sua vez, o design do implante afetou consideravelmente as deformaçoes no osso e o deslocamento relativo entre o osso e o implante. Nao obstante, evitar a sobrecarga do implante e garantir uma alta estabilidade inicial sao os fatores mais importantes na previsibilidade de implantes imediatos com carga imediata / The aim of the present research work was to evaluate the influence of different connection type, platform switching and implant designs on the biomechanical environment of immediately placed implants. A CT-based model of an upper central incisor extraction socket was constructed. The immediately placed implants were evaluated by finite element analysis. An Analysis of Variance was used to interpret the data for the peak equivalent strain in the bone, peak Von Mises stress in the abutment screw, bone-to-implant relative displacement and abutment gap. The largest influence of the connection type and platformswitching was seen on the peak equivalent stress in the abutment screw and implant-abutment gap. On contrary, the implant design considerably affects the biomechanical environment of immediately placed implants. However, avoiding implant overloading and ensuring a high implant initial stability are the most important factors for the predictability of implants in this protocol

Contexte : Les patients recevant une pose d’implants dentaires ressentent une douleur procédurale faible à modérée pendant la chirurgie malgré une anesthésie locale et un analgésique préopératoire. Des affects négatifs sont également associés à cette douleur. Durant les jours suivants, la douleur se poursuit et est soulagée par des analgésiques. Il est donc important de réduire cette douleur périopératoire persistante, l’expérience émotionnelle négative qui l’accompagne et la consommation d’analgésiques, par une approche non pharmacologique. En ce sens, la musique peut les réduire chez diverses populations cliniques, mais à notre connaissance, son efficacité n’a pas été étudiée dans le contexte d’implantologie dentaire. Objectif : Ce projet de recherche visait à comparer les effets de l’écoute de musique à celle d’un livre audio (groupe contrôle) dans le cadre d’une pose d’implants dentaires, sur la douleur pendant la chirurgie et les affects associés, ainsi que la douleur et la consommation d’analgésiques au cours des jours suivants la chirurgie. Méthodologie : Vingt-huit patients ont été recrutés et répartis de manière aléatoire dans le groupe musique ou contrôle (livre audio). En fonction du groupe qui leur avait été assigné, chaque participant a choisi parmi sept options de musique ou de livre audio. Des mesures autorapportées ont été utilisées pour la douleur, les affects associés et la consommation d’analgésiques, avant et après la chirurgie, et au cours des sept jours postopératoires. Résultats : La douleur ressentie pendant la chirurgie était significativement moindre pour les participants qui écoutaient de la musique pendant la chirurgie que pour ceux qui écoutaient un livre audio. Cependant, il n’y avait pas de différences significatives entre les groupes pour la douleur et pour la consommation d’analgésiques durant les jours postopératoires. En ce qui concerne les affects négatifs, les participants ayant écouté de la musique en ressentaient significativement moins que ceux ayant écouté un livre audio. Conclusion : L’écoute de musique permet de réduire la douleur procédurale et ses affects négatifs lors d’une chirurgie de pose d’implants dentaires. Ainsi, elle pourrait être utilisée dans d’autres contextes cliniques comme approche analgésique non pharmacologique simple, abordable et adjuvante aux traitements pharmacologiques existant. / Background: Patients receiving dental implants placement experience mild to moderate procedural pain during surgery, despite local anesthesia and intake of a preoperative analgesic. There are also negative affects associated with this pain. During the following days, the pain continues and is treated with analgesics. Therefore, it is important to reduce this persisting perioperative pain, the negative emotional experience that accompanies it as well as consumption of analgesics with a non-pharmacological approach. In this sense, music can reduce them in various clinical populations, but to our knowledge, its effectiveness has not been studied in the context of dental implantology. Objective: The purpose of this research project was to compare the effects of listening to music and listening to an audiobook (control group) in the context of dental implant surgery on pain during surgery and associated affects, as well as pain and analgesics consumption in the days following surgery. Methodology: Twenty-eight patients were recruited and randomly assigned to the music or control (audiobook) group. Based on their assigned group, each participant chose from seven music or audiobook options. Self-reported measures were used for pain and associated affects, before and after surgery, and during the seven postoperative days. Results: Pain experienced during surgery was significantly lower for participants who listened to music during surgery than for those who listened to an audiobook. However, there was no significant difference between the groups in either pain or analgesics use during the postoperative days. Participants who listened to music felt signicantly fewer negative affects than those who listened to audiobooks. Conclusion: Listening to music reduces procedural pain and its negative affects during dental implant placement surgery. As such, it could be used in other clinical settings as a simple, affordable, non-pharmacological analgesic approach and adjuvant to pharmacological treatments already in place.