There is little evidence that Health Technology Assessment (HTA) is much used in dentistry. Dental implant technology is an example of innovative oral health technology. The objectives of this research were to gather the evidence needed for the assessment of overdenture implant treatment so that both patients and dental practitioners can make informed decisions about this technology. These objectives included 1) investigating what types of dental clinicians adopt and provide dental implants 2) determining the effect of the clinicians' experience in the provision of implant supported prostheses and 3) measuring the patients' preference in provision of mandibular 2-implants overdenture technology. / For the first part, a cross-sectional survey was sent to all licensed Canadian Dentists to measure the adoption and provision of implant technology. For the second part, we used the data on the first 140 edentulous elders who were enrolled in a randomized controlled clinical trial to compare the effects of mandibular conventional (CD) and 2-implant overdentures (IOD) on nutrition. The change in patient ratings of satisfaction after treatment, laboratory costs and the number of unscheduled visits were compared. For the last part, edentulous elders (N=36) who were wearing maxillary dentures and either a mandibular conventional denture (CD, n=13) or a two-implant overdenture (IOD, n=23) participated in this study. Participants' preference was measured during a 20-minute interview. / Multivariate regression analysis on the data from the first part of the study shows that the Dentist's gender, province of practice, specialty, and whether they practice alone or in association with other practitioners, are significantly associated with the adoption of implant technology (p<0.05). It is also shown that there was no difference in satisfaction scores for either prosthesis between the groups treated by experienced specialists or new dentists. Furthermore, it is shown that IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses (p<0.05). / Overall, the results of this study 1) inform decision makers on what types of clinicians provide implant technology and 2) suggest that, with minimal training, all dental clinicians irrespective of their specialty, can provide successful implant overdenture prostheses that edentulous patients are willing to pay for.

Thesis (M.Sc. / Written for the Faculty of Dentistry. [Dept. of Dental Sciences]. Title from title page of PDF (viewed 2008/07/30). Includes bibliographical references.

Orientador: João Neudenir Arioli Filho / Banca: Rafael Leonardo Xediek Consani / Banca: Luiz Fernando Pegoraro / Banca: Ana Carolina Pero / Banca: Regnata Garcia Fonseca / Resumo: Problemática: De ocorrência clínica comum, o afrouxamento dos parafusos que compõe uma prótese sobre implante é uma complicação que traz transtornos tanto para o profissional quanto para o paciente. Entre os fatores que interferem na estabilidade da união parafusada destaca-se a pré-carga gerada durante o torque do parafuso, as formas como as forças se dissipam através do conjunto implante/pilar/parafuso e as características dos componentes utilizados. Proposição: O objetivo deste estudo foi analisar comparativamente três tipos de pilares sobre implantes, quanto a resistência mecânica previamente ao ensaio de carga cíclica; a porcentagem de torque retido na união parafusada e os níveis de desajuste vertical entre o pilar e o implante antes e após ciclagem; e alterações estruturais na base de assentamento dos pilares através de microscopia eletrônica de varredura (MEV). Material e método: Quarenta e cinco implantes, com conexão tipo hexágono externo foram incluídos em cilindros de PVC utilizando-se resina epóxica com módulo de elasticidade semelhante à estrutura óssea. Os grupos foram estabelecidos de acordo com o tipo de pilar utilizado (n=15): Titânio (pré-fabricado), Ouro (com cinta metálica pré-fabricada e sobre fundido) e Zircônia (pré-fabricado). Cinco pilares de cada grupo foram submetidos a teste de resistência estática para estabelecimento do valor da força a ser utilizada no ensaio de carga cíclica. Os outros 10 pilares de cada grupo foram fixados sobre os respectivos implantes através de parafuso de titânio, sob torque e retorque de 32 Ncm (pilares metálicos) e 20 Ncm (pilar de zircônia). Os corpos de prova foram submetidos à aferição do torque retido (précarga) e dos níveis de desajuste vertical... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Purpose: The aim of this study was to evaluate comparatively three type of abutment in regard to mechanical resistance before cyclic loading, the maintenance of the applied torque and vertical misfit in abutment/implant interface before and after cyclic loading, and damage surface by SEM. Material and Method: Forty five external hex implants were embedded in an epoxy resin and received your respective abutments, randomly divided in three experimental groups (n=15): (A) machined titanium (Ti) abutments; (B) premachined gold (Au) abutments and (C) machined zirconia (ZrO2) abutments. For all groups, only one type of screw was used. The abutment screws were tightened according to the manufacture's recommended torque. Initially, a static bending test was performed using 5 specimens of each group to determine the load applied in the cyclic loading test. Thus, 10 specimens of each group were used to measure the reverse torque value (preload) of the abutment screw and vertical gap between the abutments and implant, before and after loading. The tests were performed according to ISO norm 14801. A cyclic loading (0,5 x 106 cycles; 15 Hz) between 11 - 211 N was applied at an angle of 30 degrees to the long axis of the implants. Group means were compared using ANOVA and Tukey test. Result: The mechanical strength test showed that the UFL mean for Au abutments was significantly higher than the mean of the other abutments (p<0.001). The analysis of reverse torque (preload) before cyclic loading showed no significant differences among abutment groups. After cyclic loading the lowest decrease in preload was observed in group Ti, whereas the highest was observed in group ZrO2, with significant differences between them. The group Au showed an intermediate decrease, with no significant difference to the other groups. In relation to the vertical misfit... (Complete abstract click electronic access below) / Doutor

Purpose The purpose of the present study was to assess the clinical outcomes of mandibular overdentures supported by dental implants (ISMO - implant-supported mandibular overdenture) based on a systematic review of the literature.   Materials and methods An electronic search, limited to studies published between 2018-2021, was performed in three databases, supplemented by hand searching of selected journals. Eligibility criteria included clinical human studies, either randomized or not, reporting case series of patients rehabilitated with ISMO. Interval survival rate (ISR) and cumulative survival rate (CSR) of implants and prosthesis were calculated in life-table survival analyses.   Results Sixty studies were included in the review, which reported 2261 ISMOs, supported by 4495 implants. A total of 111 implants and 191 ISMOs failed. The correlation between the survival rate of implants and the number of implants was very weak. Patients with less implants presented higher prosthesis failure rates than patients with more implants per prosthesis. There was no influence of the attachment system on the implant failure rates. The estimated CSR for the implants and the prostheses were 92.2% and 75.6%, respectively (23-year period). Replacement of attachment components was very often needed, as well as relining of the ISMO base. Complete transverse fracture of the ISMO was the most common technical complication.   Conclusion Using only one implant to support a mandibular overdenture is risky and should be avoided. In addition, metal reinforcement of the prosthesis base is recommended to minimize or prevent ISMO fractures, a common technical complication. / Syfte Syftet med denna studie var att undersöka de kliniska effekterna av implantatretinerade täckproteser i underkäken genom en systematisk översikt av befintlig litteratur. Material och metod En elektronisk sökning av studier publicerade mellan år 2018–2021, utfördes på tre olika databaser och kompletterades med en manuell sökning i utvalda tidskrifter. Studier som inkluderades var humana kliniska fall-kontrollstudier på patienter som behandlades med täckprotes. Både randomiserade och icke-randomiserade studier inkluderades. Intervall avöver överlevnadsfrekvensen och den kumulativ överlevnadsfrekvensen för implantat och täckproteser beräknades med hjälp av överlevnadsanalyser. Resultat I denna studie inkluderades 60 kliniska studier med totalt 2261 täckproteser som stöddes av 4495 implantat. Totalt misslyckades det 111 implantat och 191 täckproteser. Korrelationen mellan antal implantat som installerades och deras överlevnadsgrad var inte tydlig, däremot så uppvisade patienter med färre implantat mer omfattande problem med deras täckproteser jämfört med de proteser som stöddes av fler implantat. Val av retentionselement hade ingen påverkan på misslyckade frekvensen av implantaten. Den uppskattade kumulativa överlevnadsfrekvensen för implantaten och proteserna var 92,2 % respektive 75,6 % över en uppföljning på 23 år. Byte av retentionselement var vanligt förekommande och behövde utföras ofta, likaså relining av täckproteserna. Den vanligast förekommande tekniska komplikationen av täckproteser var en komplett tvärgående fraktur. Slutsats Att endast använda ett implantat för att stödja en täckprotes i mandibeln är riskabelt och bör undvikas. Metallförstärkning av protesbasen rekommenderas för att minska eller förhindra frakturer av täckprotesen, vilket var den vanligaste tekniska komplikationen som påträffades.

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Student Number : 8701355N - MDent research report - School of Oral Health Sciences - Faculty of Health Sciences / Purpose: The aim of this research project was to determine the fracture resistance to linear vertical compressive forces of acrylic and metal-reinforced acrylic fixed implant supported prosthesis cantilever arms. Methods: Ten non-reinforced and 10 reinforced acrylic superstructures were secured on five evenly distributed implants and subjected to linear axial compressive forces utilising an Instron® materials testing machine. The reinforcement consisted of commercially available preformed titanium metal strengthener bars. Force was applied to the cantilever arms 15mm distal to the distal most implant and two tests were conducted on each sample. The first drop in load recorded was noted as a fracture of the sample. Results: Fracture of the acrylic was noted at the distal most implant in both non-reinforced and the reinforced samples. The mean fracture value for the non-reinforced samples was 679N and for the reinforced samples, 628N. Conclusion: No significant difference between the fracture resistance of the two designs was noted.

A research report submitted to the School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Dentistry in the branch of Prosthodontics Johannesburg, 2017 / Purpose: To perform a comparative analysis of the accuracy of intra-oral and extra-oral digital scanners when used for the milling of a long-span implant supported superstructure framework. Method: Three intra-oral and three extra-oral scanners were used to measure a master model containing five implant analogues. The three-dimension positions of the implant analogues were measured with a coordinate measuring machine. The digital data from the scanners were used to mill the implant positions in aluminium blanks from a single milling device. These implant positions were measured at the same points as the master model. The three-dimensional differences were calculated to provide a measure of the most accurate frameworks. Results: For the intra-oral scanners, the further the measurement between points, the greater the standard deviation (the poorer the precision) and the poorer the mean accuracy. However, these were clinically acceptable over short distances. For the extra-oral scanners, there was no correlation between the length of the measured distances and the accuracy of the produced framework. All the extra-oral scanners were clinically acceptable for complete-arch prostheses. Conclusions: Noting the limitations of this study and the use of a milling centre to mill the frameworks, for the intra-oral scanners, the 3Shape Trios® (3Shape, Copenhagen, Denmark) can be used for measurements up to 21,5mm and the Sirona CEREC OmniCam (Sirona Dental Systems, Inc., Bensheim, Germany) can be used for measurements up to 34mm. The extra-oral scanners used in this study can be used for complete-arch implant prosthetics. The accuracy of these is relative to the model or impression created. Steps should therefore be made to ensure the accuracy of the model such as the use of a verification jig / MT2017

Nas próteses sobre implante, a escolha do sistema de retenção (cimentada ou parafusada) muitas vezes está relacionada com a preferência pessoal de cada profissional. Porém alguns aspectos que diferem esses tipos de prótese devem ser levados em consideração no momento desta seleção. A passividade de assentamento, a reversibilidade, a estética, a oclusão e a presença do orifício de acesso ao parafuso. A ausência de orifícios de acesso ao parafuso é uma grande vantagem quando se utilizam próteses cimentadas principalmente quando se trata de casos onde a estética é uma prioridade. Além disto, a descontinuidade da cerâmica nas próteses parafusadas pode se apresentar como um fator de fragilização para a cerâmica. Isto se torna ainda mais grave quando o orifício de acesso ao parafuso constituído apenas por cerâmica com o objetivo de minimizar sua deficiência estética. É neste sentido que o presente trabalho se propõe a avaliar a resistência à fratura da cerâmica em próteses metalo-cerâmicas implantosuportadas cimentadas e parafusadas com dois diferentes desenhos de infraestruturas. Além disto, observar se a simulação de envelhecimento da cerâmica através da ciclagem mecânica influencia na sua resistência à fratura sob carga compressiva. Para isto, 10 coroas metalo-cerâmicas cimento-retidas (Grupo controle), 10 coroas metalo-cerâmicas parafusadas diretamente sobre o implante e orifício de acesso ao parafuso em metal medindo 2mm de altura (Próteses parafusadas com \"chaminé\") e 10 coroas metalo-cerâmicas parafusadas diretamente sobre o implante com orifício de acesso ao parafuso em porcelana medindo 2mm de altura (Próteses parafusadas sem \"chaminé\") foram confeccionadas de forma padronizadas. Metade dos corpos-de-prova de cada grupo (n=5) foram submetidas ao teste de ciclagem mecânica com auxílio de uma máquina eletro-mecânica de fadiga que continha um dispositivo de aço inoxidável com a ponta da forma esférica (6mm de diâmetro) que promovia uma carga simultânea em 4 vertentes triturantes (2 vestibulares e 2 linguais), simulando um contato com o dente antagonista por 1.200.000 ciclos, com uma freqüência de contato de 2Hz e carregamento de 100N, em água a uma temperatura de 37ºC. Todos os corpos-de-prova foram submetidos ao teste de compressão axial realizado em uma máquina de testes a uma velocidade de 0,5mm/min para que um dispositivo de extremidade arredondada(6mm de diâmetro) entrasse em contato com a coroa. Os valores médios da força requerida para a fratura dos corpos-de-prova foram calculados e comparados pela análise de variância a 2 critérios (1= tipo de infra-estrutura; 2= ciclagem prévia) e teste de Tukey. Pode-se concluir que a ciclagem mecânica não influenciou na resistência final dos corpos-de-prova quando submetidos à carga compressiva. Além disto, verificou-se que as próteses cimentadas apresentaram maior resistência à fratura da cerâmica que as duas variações de infra-estrutura para próteses parafusadas com níveis de significância estatística (p\' < OR =\'0,5). Entre as próteses parafusadas não foram observadas diferenças estatisticamente significantes (p\' > OR = \'0,5). / In implant prosthodontics, the choice of retention system (cemented or screwed) is often related to personal preferences of each professional. However, some aspects that differenciate these 2 types of prosthesis must be considered at the time of selection: the passivity of the fit, the reversibility, the aesthetics, the occlusion and the presence of the occlusal opening of the screw-access hole. The absence of access hole is a great advantage when using cemented prosthesis especially when it comes to cases where aesthetic is a priority. In addition, the discontinuing of the ceramic in the screwed prosthesis may be a factor of weakening. This becomes even more serious when the screw-access hole is totally ceramic in order to minimize its aesthetic deficiency. The aim of this study was to evaluate the resistance to fracture of cemented and screw-retained implant-supported metalloceramic crowns with two different frameworks designs. Moreover, the influence of the aging of ceramics by mechanical cycling on the resistance to fracture under compressive load was also observed. Ten cement-retained, ten screw-retained with the screw-access hole in metal measuring 2mm height (\"chimney\") and ten screw-retained with screw-access hole in ceramic measuring 2mm height (without \"chimney\") single crowns were manufactured. All screw-retained crowns were screwed directly over the implant. Half of the specimens from each group (n=5) were subjected to Mechanical cycling. The load (100N, 1.200.000 cycles, 2 Hz) was applied by a spherical stainless steel tip (6mm in diameter) simultaneously on 4 cusps (2 buccal and 2 lingual), simulating the contact with the antagonist tooth, under water at 37oC. All specimens were subjected to axial compression with a spherical tip (6mm in diameter) in a universal testing machine at 0.5mm/min. Mean values of maximum force required to fracture were analyzed using 2-way ANOVA (1=framework, 2=mechanical cycling) and Tukey\'s test for multiple comparisons (p\' < OR =\'0,5). Mechanical cycling did not affect the strength of the specimens when subjected to compressive load. Cemented prosthesis had greater resistance to fracture than the two variations of screwed frameworks with statistically significantdifferences. Between the 2 types of screwed prosthesis no statistically significant differences were observed.

Introdução: O objetivo desta pesquisa é analisar, pelo método fotoelástico, o comportamento das tensões que ocorrem nas estruturas periimplantares, em suportes de prótese fixa, segundo o protocolo de Brånemark, parafusada sobre cinco implantes, de diferentes comprimentos (10mm; 13mm e 15mm), quando submetidas às cargas oclusais. Métodos: Foram construídos três modelos fotoelásticos de mandíbulas: MD10; MD13 e MD15, com cinco implantes cada um, de 3,75mm de diâmetro, hexágono interno e posicionados paralelamente na região interforaminal. Sobre os implantes, em cada modelo, foram instalados pilares do tipo micro unit com cinta de 1mm e, sobre eles, uma única prótese, com uma infraestrutura metálica em cobalto/cromo, com cantilever de 15mm, revestida em resina acrílica. Foram aplicadas pressões de 1,0 e 3,0 bars e as imagens foram fotografadas e avaliadas. Resultados: Os resultados mostraram que as maiores tensões ocorreram nos implantes com 10mm de comprimento e o padrão de tensões se manteve nos vários comprimentos de implantes, mudando apenas a magnitude das tensões ao longo do corpo do implante. O incremento do comprimento foi relevante quanto à diminuição dos níveis de tensão na região analisada no modelo. Conclusões: Conclui-se que: 1) Os implantes de maior comprimento distribuíram melhor as tensões ao longo do corpo do implante; 2) As tensões se localizaram mais apicalmente, tanto por mesial como distal, nos implantes de maior comprimento, 3) Os implantes que sofreram maiores tensões foram os mais próximos do cantilever e o implante central. / The purpose of this study was to analyze, using the photoelasticity method, the behavior of stresses occurring in peri-implant structures and fixed prosthesis supports following Brånemark protocol that are screwed on five implants of different lengths, 10mm; 13mm and 15mm, when submitted to occlusal loads. Three mandible photoelastic models were built: MD10; MD13 and MD15, with five implants each, 3.75mm of internal diameter and located in parallel with each other in the interforaminal region. Microunit pillars were installed on each implant model with a 1mm-belt, and a single prosthesis was installed over them with a cobalt/chrome metallic infrastructure covered with thermoplastic acrylic resin. Loads of 1.0 and 3.0 bars were applied and images were photographed and evaluated. Results showed that highest tensions occurred in 10mm-length implants; the patterns of stresses was the same in implants of different lengths and only the magnitude of stresses changed along implant body. The greater the length the lower the stress in the analyzed region of the model. We concluded that: 1) The implants of greater length tension better distributed along the body of the implant. 2) Tensions were located more apically by both mesial and distal implants of greater length. 3) The implants have suffered greater tensions were the closest to the cantilever and implant center.

A adaptação passiva e estabilidade têm sido descritos como pré-requisitos importantes na escolha dos materiais e técnicas de confecção em prótese implantossuportada. A proposta deste trabalho foi estudar, com auxílio dos strain gauges, a deformação média gerada nos intermediários após a aplicação de carga axial em infraestruturas confeccionadas por três diferentes materiais. Além disso, através da microscopia confocal a laser, avaliar as medidas de comprimento, altura e angulação desses espécimes e mini pilares. Esses dados foram submetidos à análise estatística, a fim de encontrar possível correlação entre a deformação gerada e as medidas internas das infraestruturas com as externas dos intermediários em que foram parafusadas. Para essa investigação foi utilizado um modelo em poliuretano com dois implantes, hexágono externo, posicionados nas áreas dos dentes 43 e 45. A partir deste modelo, 12 infraestruturas de três elementos foram fabricadas e divididas em 3 grupos (n=4) de acordo com a técnica utilizada: (C) fundição convencional em Ni-Cr; (U) usinada em zircônia por CAD/CAM e (S) sinterizada a laser em Co-Cr pelo CAD/CAM. Durante a aplicação de carga axial, as tensões geradas foram registradas por extensômetros unidos aos intermediários, e avaliadas quantitativamente e qualitativamente. De maneira geral, houve um predomínio de áreas de compressão, sendo que as poucas áreas de tração apresentaram baixos valores. O grupo sinterizado a laser foi o único que apresentou forças compressivas para todos os sensores. Os grupos usinado e convencional apresentaram comportamento semelhante, diferindo apenas em uma região. Posteriormente, as infraestruturas e os intermediários foram submetidos à microscopia confocal para avaliação de ângulo, comprimento e altura de suas paredes internas (infraestruturas) e externas (intermediários), nas regiões correspondentes à localização dos strain gauges. Para a angulação, todos os grupos mostraram valores semelhantes entre si e maiores que os dos mini pilares. Quanto ao comprimento e altura, todos valores foram diferentes entre si. Em relação aos mini pilares, os valores foram maiores na altura e menores no comprimento. Estes resultados foram analisados pelo método estatístico de Pearson o que levou à conclusão que, para algumas regiões dos medidores de tensão, há correlação entre deformação e comprimento, e também, deformação e ângulo. Quanto maior o ângulo, e quanto menor for o comprimento, maior a deformação mostrada. / The passive adaptation and stability have been described as important prerequisites in the choice of materials and manufacturing techniques in implant-supported prosthesis. The aim of this work was to study, with the aid of strain gauges, the average deformation generated in the abutment, after application of axial load on frameworks made up of three different materials. Besides, through confocal laser microscopy, assess the length, height, and angle of these specimens, and abutment. These data were statistically analyzed in order to find possible correlation between the deformation generated, and the internal measures of the framework and the external measure of the abutments they were screwed on. For this research, a model made of polyurethane with two external hexagon implants, positioned in the areas of teeth 43 and 45 was used. From this model, 12 three-element frameworks were fabricated and divided into 3 groups (n = 4), according to the technique used: (C) conventional Ni-Cr casting; (U) machined zirconia CAD / CAM and (S) laser sintered Co-Cr by CAD / CAM. During application of axial load, the tensions generated were recorded by strain gauges attached to the abutments, and evaluated quantitatively and qualitatively. In general, there was a predominance of compression areas, and the few areas of traction showed low values. The laser sintered group was the only one with compressive forces for all sensors. The milled and conventional groups behaved similarly, differing only in a region. Subsequently, the framework and the abutment were analyzed by confocal microscopy for evaluation of angle, length and height of the inner (framework) and outer (abutment) walls in regions corresponding to the location of strain gauges. For the variable angle, all groups showed similar values among themselves and greater than the abutments. As for the variables length and height, all values were different. Regarding the abutments, the values were higher in height and smaller in length. These results were analyzed by Pearson statistical method, leading to the conclusion that, for some regions, there was correlation between deformation and length, and also deformation and angle. The higher the angle and the smaller the length, the greater the deformation shown.