Defective or diseased native valves have been replaced by bileaflet mechanical heart valves (BMHVs) for many years. However, severe complications still exist, and thus blood damage that occurs in BMHV flows must be well understood. The aim of this research is to numerically study platelet damage that occurs in BMHV flows. The numerical suspension flow method combines lattice-Boltzmann fluid modeling with the external boundary force method. This method is validated as a general suspension flow solver, and then validated against experimental BMHV flow data. Blood damage is evaluated for a physiologic adult case of BMHV flow and then for BMHVs with pediatric sizing and flow conditions. Simulations reveal intricate, small-scale BMHV flow features, and the presence of turbulence in BMHV flow. The results suggest a shift from previous evaluations of instantaneous flow to the determination of long-term flow recirculation regions when assessing thromboembolic potential. Sharp geometries that may induce these recirculation regions should be avoided in device design. Simulations for predictive assessment of pediatric sized valves show increased platelet damage values for potential pediatric valves. However, damage values do not exceed platelet activation thresholds, and highly damaged platelets are found far from the valve. Thus, the increased damage associated with resized valves is not such that pediatric valve development should be hindered. This method can also be used as a generic tool for future evaluation of novel prosthetic devices or cardiovascular flow problems.

Η παρούσα διδακτορική διατριβή πραγματεύεται την κατασκευή και τον έλεγχο ενός καινοτόμου τεχνητού χεριού, για προσθετικές κυρίως εφαρμογές, κάνοντας χρήση βιομιμητικών ενεργοποιητών και πιο συγκεκριμένα ειδικά κατεργασμένων λεπτών κυλινδρικών αγωγών από μορφομνήμονα μεταλλικά κράματα νικελίου-τιτανίου. Εκμεταλλευόμενοι τα συγκριτικά πλεονεκτήματα των ενεργοποιητών αυτών έναντι των αντίστοιχων συμβατικών, αναπτύσσεται μια πλήρως λειτουργική συσκευή με μικρό μέγεθος και βάρος, ανθρωπομορφική εμφάνιση, αθόρυβη λειτουργία και χαμηλό κόστος κατασκευής και συντήρησης, ικανή να εκπληρώσει σε μεγάλο βαθμό τις απαιτήσεις των ατόμων με αναπηρία στα άνω άκρα. Για τη φυσική υλοποίηση του σκελετού του τεχνητού αυτού χεριού χρησιμοποιείται η τεχνολογία της ταχείας προτυποποίησης. Καθένα από τα πέντε δάκτυλά του ελέγχεται ανεξάρτητα μέσω ενός υπο-ενεργοποιούμενου μηχανισμού κίνησης με τεχνητούς τένοντες. Για τον έλεγχο θέσης κάθε δακτύλου, αναπτύσσεται και εφαρμόζεται μία νέα μέθοδος ελέγχου βασισμένη στην έμφυτη δυνατότητα ανάδρασης θέσης των προαναφερθέντων ενεργοποιητών μέσω μέτρησης της ηλεκτρικής τους αντίστασης. Επιπλέον, αναπτύσσεται κατάλληλος αλγόριθμος για τον σχηματισμό διαφόρων θέσεων και συλλήψεων του τεχνητού χεριού. Για τη βελτίωση του ελέγχου, το χέρι εξοπλίζεται με αισθητήρες αφής στα ακροδάκτυλα, καθώς και με τη δυνατότητα οδήγησης συσκευών οπτικής και απτικής ανάδρασης. Όλα τα ηλεκτρονικά κυκλώματα που είναι απαραίτητα για την οδήγηση των ενεργοποιητών και τον έλεγχο του χεριού αναπτύσσονται και ενσωματώνονται στο εσωτερικό του φυσικού πρωτοτύπου. Με τη βοήθεια ειδικού προγραμματιστικού πακέτου, σχεδιάζεται μία γραφική διεπαφή ελέγχου μέσω της οποίας μελετάται και αξιολογείται η δυνατότητα του αναπτυχθέντος χεριού σε πειράματα σύλληψης διαφόρων αντικειμένων. Τέλος, προτείνονται διάφορες τεχνικές ελέγχου του χεριού από τους χρήστες του, ενώ αναπτύσσεται και κατάλληλος αλγόριθμος ελέγχου βασισμένος στη χρήση ηλεκτρομυογραφικών σημάτων. / This doctoral thesis presents the development and control of an innovative artificial hand, mostly for use in prosthetic applications, utilizing biomimetic actuators, and, more specifically, specially processed thin cylindrical wires made of shape memory nickel-titanium alloys. By exploiting the comparative advantages of these actuators over the conventional ones, a fully functional device is developed, of low size and weight, anthropomorphic appearance, silent operation, low fabrication and maintenance cost, which is capable of satisfying to a great extent the needs of the upper limb amputees. The physical implementation of the chassis of this artificial hand has been performed using rapid prototyping technology. Each of its five digits is independently controlled via a tendon-driven underactuated mechanism. For the position control of each digit, a novel control scheme is devised and implemented based on the inherent position feedback capability of these actuators via the measurement of their electrical resistance. In addition, the necessary algorithm is developed for the formation of various hand postures and prehension patterns. In order to improve the overall hand control, the hand is equipped with tactile sensors at its fingertips, and is also capable of driving optical and tactile feedback devices. All the necessary electronics for driving the actuators and controlling the hand are developed and embedded inside the physical prototype. Using a special programming package, a graphical user interface is designed, through which the grasp capabilities of the developed hand are studied and evaluated for various objects. Finally, several user control techniques of the hand are proposed, and a control algorithm based on the use of electromyographic signals is also developed.

Initiativet till projektet togs av tandvårdspersonal på Specialisttandvården i Halmstad då de upplevde problem vid arbete med oral protetik. Problemet, som projektet även bygger på, innebär att komponenter tappas och på grund av gravitationen samt patientens position riskeras att inhaleras eller sväljas. Detta innebär ett stress- och orosmoment, vilket bidrar till en försämrad psykosocial arbetsmiljö för tandvårdspersonalen.   2008 infördes det statliga tandvårdsstödet i Sverige vilket innebär en reducerad kostnad för protetikingrepp som lett till att fler har råd med oral protetik. Därför blir problemet mer och mer utbrett, vilket gjort kravet på en lösning mer eftertraktad.   I projektet har dynamisk produktutveckling tillämpats med stort fokus på involvering av framtida användare. Artikelsökning, observation och enkätundersökning i genomförd produktdefinitionsfas lade grunden till projektet. Olika konceptgenererings- och utvärderingsmetoder tillämpades och födde den slutgiltiga prototypen. Under hela projektets gång har en kontinuerlig dialog och testning hos uppdragsgivarna utförts.   Detta produktutvecklingsprojekt resulterade i ett instrument som underlättar för tandvårdspersonal samt ökar säkerheten för patienten vid oral protetik. Lösningen är en specialutformad pincett som träs på skruvmejseln och fixerar komponenter. / The project was initiated by dental personnel at the Specialist dentistry in Halmstad, Sweden, because they experienced problems when working with oral prosthetics. There is a risk that components are dropped and due to gravity and the patient's position, being inhaled or swallowed. This means stress and concerns, contributing to the deterioration of the psychosocial work environment for dental personnel.   The Swedish dental State support was introduced in 2008, which gives the patient a reduced cost for dental prosthetic procedures. This allows more people to afford oral prosthetics. Therefore, the problem becomes more and more prevalent and the demand for a solution is requiered.    The project has implemented dynamic product development with a major focus on the involvement of future users. The project was based on literature reviews, observation and survey, which was performed in the product definition phase. Different concept generation methods and evaluation methods were applied and resulted in a final prototype. A continuous dialogue and testing with the clients where performed throughout the project.   This product development project resulted in an instrument that facilitates for dental personnel and increase safety for the patient during oral prosthetics. The solution is a specially designed forceps which slips onto the screwdriver and secures components.

Thesis (MScEng (Industrial Engineering))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Current technology enables researchers to identify a broad spectrum of opportunities in the biomedical industry to develop new and innovative products. Imaging technology, such as Computerised Tomography (CT) scanners or Magnetic Resonance Imaging (MRI) scanners, allow doctors to visualise a patient’s internal organs and bone structure in high quality three-dimensional images. Rapid Prototyping Technology (RPT) can already produce high quality complex parts, such as concept parts for the automobile industry and medical models for preoperative planning. These parts are divided into thin layers and manufactured layer by layer. At the same time the layers are joined together to produce the desired part. Generic artificial intervertebral disc implants already exist. However, these discs are only available in standard geometrical dimensions. The possibility of using imaging technology and RPT to design and manufacture a customized, patient specific implant will be investigated. A simple design (ball and socket) is used to illustrate the design process of a customized disc. It should be noted that this project does not attempt to design a new artificial intervertebral disc implant, but rather describes the design process. The research question is: How accurate can the customised disc implant’s inverse geometry represent the geometry of the vertebrae’s endplates? A preliminary research was done and the results were used to calculate the sample size for this study. A cadaver, provided by Stellenbosch University’s Faculty of Health Sciences’ Anatomy and Histology Department, was CT scanned. The L4- and L5-vertebrae were dissected, cleaned and measured using a photogrammetry measuring machine. Meanwhile, the data gathered from the CT scan is used to design the customised disc implant. The disc is manufactured from Ti6Al4V using a RPT technique called Direct Metal Laser Sintering. After the part is manufactured it is also measured using a photogrammetry measuring machine. The photogrammetry data from the vertebrae and the manufactured customised disc implant are compared, analysed and a hypothesis is formed. It can now be determined, with a certain degree of confidence, how accurate the customised disc implant’s geometry can represent the geometry of the vertebrae’s endplates. The design of a customised disc implant demands many work hours from a qualified engineer or designer, which in turn increases the production costs. This study describes a user-friendly program which will semi-automate the design process. Only limited input from the physician will be required. This program will decrease design time, which will have a direct effect on the production costs. The manufacturing costs are investigated as well. The results from this study indicates that it is possible to design a customized prosthetic, with the help of a custom disc generator, within 27 minutes. The customized disc can then be manufactured with an accuracy of 0.37 mm using rapid prototyping. / AFRIKAANSE OPSOMMING: Huidige tegnologie maak dit vir navorsers moontlik om ʼn breë spektrum geleenthede in die biomediese bedryf te identifiseer en nuwe produkte te ontwikkel. ʼn Pasiënt kan met ʼn Gerekenariseerde Tomografie (GT) -flikkergram of ʼn Magnetiese Resonansiebeelding (MRB) - masjien geskandeer word om sodoende ʼn drie-dimensionele beeld van sy of haar interne organe en beenstrukture te verkry. Deur gebruik te maak van snelle prototiperingstegnologie (SPT) kan daar alreeds enige komplekse geometriese vorm vervaardig word. Hierdie tegnologie word ingespan om parte, ontwerp met die hulp van RGO (Rekenaargesteunde Ontwerp), te vervaardig. Die spesifieke part word in dun lae opgedeel en daarna laag vir laag vervaardig. Terselfdertyd word die lae aan mekaar geheg, totdat die gewenste vorm gegenereer is. Die moontlikheid om ʼn GT-flikkergram én SPT te gebruik, met die doel om ʼn pasklaar-vervaardigde, persoon-spesifieke implantaat te ontwerp en te vervaardig, word in hierdie projek ondersoek. Daar bestaan alreeds generiese kunsmatige intervertebrale skyf-implantate (KISI’s). Hierdie skywe word egter beperk deurdat dit slegs in standaard geometriese dimensies vervaardig word. Met dié projek word die moontlikheid van ʼn pasklaar-vervaardigde intervertebrale skyf-implantate (PVKISI) vir ʼn bepaalde pasiënt, ondersoek. ʼn Eenvoudige meganiese ontwerp (bal-en-pootjie) word gebruik om die ontwerpproses van ʼn pasklaar-skyf in hierdie projek te beskryf. Let daarop dat die projek nie poog om ʼn nuwe kunsmatige intervertebrale skyf te ontwerp nie, maar om die ontwerpproses te beskryf. Die vraag wat ondersoek word, is: Hoe akkuraat kan ʼn PVKISI die inverse geometrie van die pasiënt se intervertebrale kontakoppervlaktes voorstel? ʼn Voorafgaande ondersoek is gedoen en die resultate is gebruik om die steekproef-grootte vir hierdie studie te bepaal. ʼn Kadawer, voorsien deur die Universiteit van Stellenbosch se Fakulteit Gesondheidwetenskappe se Departement Anatomie en Histologie, is met ʼn GT-flikkergram geskandeer. Die L4- en L5-werwels is gedissekteer, skoon gemaak en met ʼn fotogrammetriemeetmasjien gemeet. Intussen is die data, verkry van die GT-flikkergram, gebruik om die PVKISI te ontwerp. Die PVKISI is van Ti6Al4V vervaardig deur Direkte Metaal Laser-Sintering (DMLS). Die part is ook met ʼn fotogrammetrie-meetmasjien gemeet. Die fotogrammetrie-data van die werwels en die PVKISI is vergelyk, geanaliseer en ʼn hipotese is daar gestel. Daar kan dus met statistiese sekerheid bepaal word hoe akkuraat die PVKISI die inverse geometrie van die intervertebrale kontakoppervlaktes kan voorstel. Die ontwerp van ʼn PVKISI vereis baie werksure van ʼn gekwalifiseerde ingenieur of ontwerper, wat veroorsaak dat die vervaardigingskoste van so ʼn implantaat kan verhoog. In dié projek word ʼn gebruikersvriendelike koppelprogram beskryf wat die ontwerpproses semi-outomatiseer. Daar sal slegs beperkte bystand van die betrokke medici vereis word. Dié koppelprogram behoort heelwat te bespaar aan die hoeveelheid werksure bestee aan die ontwerp van die PVKISI, wat direk die koste van ʼn implantaat sal verlaag. Die kostes vir die vervaardiging van die PVKISI met DMLS is ook ondersoek om te bepaal hoe kostes bespaar kan word. Daar is getoon dat ʼn pasklaar-prostese se kontakoppervlaktes met ʼn akkuraatheid van 0.37 mm, deur snelle prototipering, vervaardig kan word. Deur van die koppelprogram, wat in die studie beskryf word, gebruik te maak, sal dit moontlik wees om ʼn pasklaar-protese binne 27 minute te ontwerp.

Les progrès de la mécatronique ont permis d’améliorer les prothèses du membre supérieur en augmentant le catalogue des mouvements prothétiques. Cependant, un fossé se creuse entre les capacités technologiques de la prothèse et leur méthode de contrôle. La commande myoélectrique, qui est la méthode la plus répandue, reste complexe, notamment pour les personnes amputées au niveau trans-huméral qui peuvent avoir un coude actif en plus de la main et du poignet motorisés. Une approche intéressante consiste à utiliser la mobilité du membre résiduel, présente chez la plupart des amputés trans-huméraux, pour contrôler des articulations prothétiques distales comme le coude. Les mouvements du coude sont couplés aux mouvements du membre résiduel selon un modèle de coordination épaule/coude saine. Cette thèse étudie une stratégie de commande d’un coude prothétique utilisant les mouvements du membre résiduel, mesuré par des centrales inertielles, et nos connaissances du contrôle moteur humain. Pour cela, un modèle de la coordination épaule/coude a été construit à partir d’enregistrements de gestes sains de préhension. Ce modèle, implémenté sur un prototype de prothèse, a été testé par 10 individus sains équipés du prototype afin de valider le concept, puis par 6 personnes amputées. Ces dernières ont aussi réalisé la tâche avec une commande myoélectrique conventionnelle afin de comparer les résultats. La commande couplant automatiquement les mouvements de l’épaule et du coude s’est montrée satisfaisante en termes de facilité d’utilisation et de réduction des stratégies de compensation. / Progress in mechatronics has enabled the improvement of upper limb prosthetics increasing the grasps catalog. However, a gap has been growing between the prosthesis technological possibilities and the methods to control it. Indeed, common myoelectric control strategy remains complex, especially for transhumeral amputees who can have an active elbow in addition to a prosthetic wrist and hand. Since most transhumeral amputees have a mobile residual limb, an interesting approach aims at utilizing this mobility to control intermediate prosthetic joints, like the elbow, based on the shoulder/elbow coordination observed in healthy movements. This thesis investigates the possibility of controlling an active prosthetic elbow using the residual limb motion, measured with inertial measurement units, and knowledge of the human motor control. A primary focus has been targeting the reaching movement for which a model has been built using regression tools and kinematic data from several healthy individuals. The model, implemented on a prosthesis prototype, has been tested with 10 healthy participants wearing the prototype to validate the concept, and with 6 amputated individuals. These participants also performed the task with a conventional myoelectric control strategy for comparison purpose. The results show that the inter-joint coordination-based control strategy is satisfying in terms of intuitiveness and reduction of the compensatory strategies.

Abstract Healthcare-associated infections (HAI) are infections acquired during treatment in a healthcare facility. The most common infections are pneumonias, surgical site infections (SSIs) and urinary tract infections (UTIs). HAIs burden the healthcare system by increasing patient days, the use of antibiotics, examinations, and thus the costs of care. The occurrence of HAIs can be used to evaluate the quality of care and to make comparisons between institutions. The purpose of this dissertation was to evaluate the burden of HAIs in the primary and tertiary healthcare wards and the costs of procedure-related prosthetic joint infections (PJIs). The first part of this dissertation evaluated the prevalence of HAIs in the wards of primary healthcare in the Oulu University Hospital (OUH) district with two point prevalence studies (one-day sampling) conducted in 2006 and in 2017. In 2006, the study comprised 27 healthcare centres with 44 wards and 1,294 patients. HAIs were found in 9.3% of the patients. The most common infections were UTIs, skin and soft tissue infections and lower respiratory tract infections (LRTIs). In 2017, there were 20 healthcare centres with 34 wards and 764 patients; 9.4% of the patients had a HAI. The most common HAIs were pneumonias, SSIs and LRTIs. In the second part, we evaluated the incidence of HAIs in the OUH with a computer-based electronic infection surveillance program. The study covered 15 adult wards with a total of 353 beds. The overall incidence of HAIs during the six-year study period was 4.5% of discharged patients. The most common infections were SSIs, pneumonias and UTIs. The surveillance carried out in this way required a total of one person's workload per year. The third part evaluated hospital costs of procedure-related PJIs. The study population consisted of all total knee and hip arthroplasties performed in the OUH from 2013 to 2015: 1,768 patients with 42 PJIs. A PJI tripled the cost of a procedure compared to an arthroplasty without an infection (€25,100 vs. €7,200). Two-stage revision caused three times more costs than debridement, antibiotics and implant retention treatment (DAIR) (€53,400 vs. €18,500). HAIs are common in the wards of primary and tertiary healthcare in the OUH district. Electronic HAI monitoring is feasible but requires relatively large employer resources. Postoperative PJI triples the cost of the procedure. / Tiivistelmä Sairaalainfektio (SI) on infektio, jonka potilas saa ollessaan hoidossa laitoksessa. Yleisimpiä SI:ita ovat leikkausalueen infektio, keuhkokuume ja virtsatieinfektio (VTI). SI:t kuormittavat terveydenhoitoa lisäämällä hoitopäiviä, antibioottien käyttöä, tutkimuksia ja näin myös hoidon kustannuksia. SI:iden määrää voidaan käyttää hoidon laadun mittarina sekä sairaaloiden väliseen vertailuun. Tämän väitöskirjan tarkoituksena oli arvioida SI:iden määrää Pohjois-Pohjanmaan sairaanhoitopiirin (PPSHP) terveyskeskusten ja Oulun yliopistosairaalan (OYS) vuodeosastoilla sekä selvittää tekonivelleikkauksen jälkeisen tekonivelinfektion (TI) aiheuttamia sairaalakustannuksia. Väitöskirjan ensimmäisessä osatyössä selvitettiin SI:iden esiintyvyyttä PPSHP:n terveyskeskusten vuodeosastoilla pisteprevalenssilla eli yhden päivän otannalla vuosina 2006 ja 2017. Vuoden 2006 tutkimuksessa oli 27 terveyskeskusta, joissa oli 44 vuodeosastoa ja yhteensä 1 294 potilasta. SI todettiin 9,3 %:lla potilaista. Yleisimpiä olivat VTI:t, pehmytkudosinfektiot ja alahengitystieinfektiot. Vuonna 2017 tutkimuksessa oli 20 terveyskeskusta, 34 vuodeosastoa ja 764 potilasta. Tällöin SI todettiin 9,4 %:lla. Yleisimmät infektiot olivat keuhkokuume, leikkausalueen infektio ja alahengitystieinfektio. Toisessa osatyössä selvitettiin OYS:n SI:iden ilmaantuvuutta kuuden vuoden ajan jatkuvan infektioseurannan mahdollistavan tietokoneohjelman avulla. Tutkimuksessa seurattiin 15:ttä aikuisvuodeosastoa, joissa oli yhteensä 353 potilaspaikkaa. SI todettiin 4,5 %:ssa hoitojaksoista. Seuranta vaati yhteenlaskettuna noin yhden hoitajan työpanoksen vuodessa. Väitöskirjan kolmannessa osatyössä selvitettiin vuosina 2013–2015 OYS:ssa tehtyjen tekonivelleikkausten jälkeisten TI:iden sairaalakustannuksia. Tutkimuksessa oli 1 768 tekonivelleikkausta, joista 42 infektoitui. Infektoitumattoman tekonivelleikkauksen sairaalakustannukset olivat keskimäärin 7 200 € ja TI:iden 25 100 €. Hoitomenetelmänä kaksivaiheisen revision eli tekonivelen vaihtohoidon hinta oli kolminkertainen tekonivelen säilyttävään hoitoon verrattuna (53 400 € vs. 18 500 €). SI:t ovat yleisiä PPSHP:n alueella sekä terveyskeskusten että OYS:n vuodeosastoilla. SI:iden seurantaohjelma soveltuu infektioseurantaan, mutta se vaatii kohtalaisesti henkilökuntaresurssia. Leikkauksen jälkeinen TI kolminkertaistaa tekonivelleikkauksen sairaalakustannukset.

115 f. / Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-04-29T16:19:40Z No. of bitstreams: 1 Juliana Marzo.pdf: 2124412 bytes, checksum: 7227627c20983b0724b8eed22b01410d (MD5) / Approved for entry into archive by Maria Auxiliadora Lopes(silopes@ufba.br) on 2013-04-30T17:20:13Z (GMT) No. of bitstreams: 1 Juliana Marzo.pdf: 2124412 bytes, checksum: 7227627c20983b0724b8eed22b01410d (MD5) / Made available in DSpace on 2013-04-30T17:20:13Z (GMT). No. of bitstreams: 1 Juliana Marzo.pdf: 2124412 bytes, checksum: 7227627c20983b0724b8eed22b01410d (MD5) Previous issue date: 2007 / A dissertação analisou os significados que os indivíduos atribuíam aos seus corpos e suas vidas cotidianas após terem sido submetidos ao processo de adaptação a próteses e inseridos ao mundo do esporte. O material empírico foi coletado através de entrevistas semi-estruturadas realizadas no NEFEA (Núcleo de Atividade Física e Esporte Adaptado) da UEFS (Universidade Estadual de Feira de Santana), o qual desenvolve atividades esportivas junto às pessoas deficientes. O grupo participante do estudo foi atletas do núcleo, todos dependentes de alguma prótese para realizar as atividades cotidianas e no esporte, são homens, com idades variando entre 23 e 37 anos, sendo que têm em comum o fato de terem se tornado deficientes após um acidente ou doença. O estudo caracterizado como uma análise qualitativa teve a pesquisa de campo desenvolvida no período de julho de 2005 no NEFEA, onde foram feitas todas as entrevistas. Consistiu em problematizar os efeitos que as tecnologias provocam na vida cotidiana através do esporte destes indivíduos pelas transformações ocorridas em seus corpos, o estranhamento e a naturalização do “novo” corpo fabricado pelas tecnologias, um ser protético. Contou como base teórica os Estudos Culturais assim como autores que discutem o corpo sob concepções pós-modernas. A dissertação representa, por sua vez, as reflexões construídas destes indivíduos em constantes questionamentos com a hegemonia cultural, na qual este corpo protético e atleta, lembrado como híbrido, ao final foi deslumbrado como algo produzido e ressignificado constantemente, assim como inovável, moldável e provisório. / Salvador

Thesis deals with the problem of the older school age boys dental injuries in České Budějovice region. The injury means: ?sudden damage of the health by effect of external factors which exceed adaptation options of the human body?. In the sphere of dental injuries the children is the most jeopardized group of population. The most often reason for the children injuries is their imperfect stability. In case of older children and young people there are injuries mostly caused by sport. Teoretical part of my thesis is focused on definition of older school age as well as on anatomy and teeth physiology. The part of thesis also is the enumeration of dental injuries and its treatment. I also mention prosthetic dentistry and the influence of accidents on individual physical and mental health. At the end of teoretical part there is mentioned process of the injured examination, posttraumatic dental hygiene and patient nutrition after teeth accident. Research part finds with the help of questionnaire survey the kinds of dental accidents, circumstances of injuries formation and the influence of accidents on individual physical and mental health in specific age category. The questionnaire survey was evaluated and processed in grafical part of thesis. The part of thesis also is health and educational material which helps to rise the quality of dental hygiene and also contributes to the prevention of dental accidents formation of second degree students at primary schools.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The present thesis was structured in two scientific articles that investigated the adhesion of zirconium oxide ceramic crowns. The first article aimed to evaluate different methods for silica deposition at the inner surface of Y-TZP crowns by means of a retention test. A hundred simplified full-crown preparations obtained from fiber-reinforced polymer were scanned and 100 zirconium oxide crowns with occlusal retention were machined. The preparation/crown assemblies were randomly divided in 5 groups according to the inner surface treatment: TBS – tribochemical silica coating with silica-coated alumina particles (30 μm); GHF1 – application of a thin glaze layer + hydrofluoric acid for 1 min; GHF5 – glaze application + hydrofluoric acid for 5 min; GHF15 – glaze application + hydrofluoric acid for 15 min; and Nano – silica nanofilm deposition (5 nm) via magnetron sputtering. All groups received silane coupling agent application. The preparations surfaces were etched with 10% hydrofluoric acid for 30 s and silanized. Crowns were cemented with resin cement, thermocycled (12.000 cycles; 5 / 55 °C), stored for 60 days and submitted to retention test (0.5 mm/min until failure). Retention data (MPa) were statistically analyzed by one way– ANOVA and Tukey test, as well as Weibull analysis. Failures were classified as 50C (above 50% of cement in the crown) and 50S (above 50% of cement on the substrate). TBS (5.6 ± 1.7 MPa) and Nano (5.5 ± 1 MPa) groups showed higher retention values than the other groups (p<0.0001), as well as higher characteristic strength (6.18 e 5.91, respectively). There was no difference for Weibull modulus, except for GHF1 group, which showed statistically inferior value. TBS and GHF15 presented, respectively, 60% and 70% of the failures classified as 50C, while the other groups had 50S as most part of the failures. Air-abrasion with silica-coated alumina particles and silica nanofilm deposition on the inner surface of Y-TZP crowns generated higher retention values. The second article evaluated the retention of zirconia crowns cemented to aged composite cores and prepared with burs of different grit sizes. Sixty simplified full-crown preparations were fabricated with composite resin and scanned. Sixty zirconium oxide crowns with occlusal retention were machined. The composite resin cores were stored for 120 days in humid environment at 37 °C and randomly divided in 3 groups (n=20) according to the finishing of the composite resin core: CTRL (control) – no treatment; EFB – extra-fine diamond bur (25 μm); and CB – coarse diamond bur (107 μm). Superficial grinding was performed with an adapted surveyor to standardize speed and pressure. The inner surfaces of the crowns were air-abraded with silica-coated alumina particles (30 μm) and a silane coupling agent was applied. Crowns were cemented with a self-adhesive resin cement (RelyX U200). Then, the assemblies core/crown were thermocycled (12.000 cycles; 5/55°C), stored for 120 days and submitted to retention test (0.5 mm/min until failure). Tesile date (MPa were analyzed by one way- ANOVA and Tukey test (p≤0,05), as well as Weibull analysis. Failures were classified as 50C (above 50% of cement adhered in the crown), 50S (above 50% of cement adhered on the resin substrate) and COE (cohesive failure of the core). No statistical difference was observed for the retention values (p=0.975), but the control group (CTRL) showed higher Weibull modulus. The predominant failure mode was 50S. The occurrence of cohesive failures was higher on the control group. Retention of the zirconium oxide crowns was not affected by the core roughness. It was concluded that air-abrasion followed by silane application and silica nanofilms deposition improve the retention of zircônia crowns, as well as finishing of resin cores with diamond burs does not influence the retention of zirconia crowns. / A presente tese foi estruturada em dois artigos científicos que investigaram a adesão de coroas de cerâmicas à base de óxido de zircônio. O primeiro artigo objetivou avaliar diferentes métodos de deposição de sílica na superfície interna de coroas de Y-TZP por meio de teste de retenção. Para isso, 100 preparos simplificados para coroa total produzidos a partir de polímeros reforçados por fibras com foram escaneados e 100 coroas em óxido de zircônio com retenções oclusais foram usinadas. Os conjuntos preparo/coroa foram divididos de forma randômica em 5 grupos (n=20) de acordo com o tratamento da superfície interna: TBS- jateamento com partícula de alumina revestida por sílica (30 μm); GHF1- aplicação de fina camada de glaze + ácido fluorídrico por 1 min; GHF5- aplicação de glaze + ácido fluorídrico por 5 min; GHF15- aplicação de glaze + ácido fluorídrico por 15 min; e Nano- deposição de nanofilme de sílica (5 nm) via desbastamento iônico. Todos os grupos receberam aplicação de um agente de união silano. As superfícies dos preparos foram condicionadas com ácido fluorídrico 10% por 30 s e silanizadas. As coroas foram cimentadas com um cimento resinoso, termocicladas (12.000 ciclos; 5 / 55 °C), armazenadas por 60 dias e submetidas ao teste de retenção (0.5 mm/min até a falha). Os dados de retenção (MPa) foram analisados estatisticamente utilizando-se ANOVA- um fator e teste de Tukey (p≤0,05), além da análise de Weibull. As falhas foram classificadas em 50C (acima de 50% do cimento aderido na coroa) e 50S (acima de 50% de cimento no substrato). Os grupos TBS (5.6 ± 1.7 MPa) e Nano (5.5 ± 1 MPa) apresentaram maiores valores de retenção do que os demais grupos (p<0.0001), assim como maiores valores de resistência característica (6.18 e 5.91, respectivamente). Não houve diferença no módulo de Weibull exceto para o grupo GHF1, que apresentou valor estatisticamente inferior. Os grupos TBS e GHF15 apresentaram, respectivamente, 60 e 70% de suas falhas classificadas como 50C, enquanto os outros grupos apresentaram a maior parte das falhas 50S. O jateamento com partículas de alumina revestidas por sílica e a deposição de nanofilme de sílica na superfície interna de coroas de Y-TZP promoveram maiores valores de retenção. O segundo artigo avaliou a retenção de coroas de zircônia cimentadas em núcleos protéticos envelhecidos construídos em resina composta e preparados com brocas diamantadas de diferentes granulações. Para isso, 60 preparos simplificados para coroa total foram confeccionados em resina composta e escaneados. Sessenta coroas à base de óxido de zircônio com retenções oclusais foram usinadas. Os preparos em resina composta foram armazenados por 120 dias em ambiente úmido a 37 °C e randomicamente divididos em 3 grupos (n=20) de acordo com o tipo de finalização do núcleo em resina: CTRL (controle) – sem tratamento; EFB – broca diamantada extrafina (25 μm); e CB – broca grossa (107 μm). O desgaste superficial foi realizado por meio de um paralelômetro adaptado com o objetivo de padronizar a velocidade e a pressão de desgaste. As superfícies internas das coroas foram jateadas com partículas de alumina revestidas por sílica (30 μm) e então um agente de união silano foi aplicado. As coroas foram cimentadas com um cimento resinoso autoadesivo (RelyX U200). Então, os conjuntos núcleo/coroa foram termociclados (12.000 ciclos; 5/55°C), armazenados por 120 dias e submetidos ao teste de retenção (0.5 mm/min até a falha). Os dados de tração (MPa) foram analisados por meio de ANOVA- um fator e teste de Tukey (p≤0,05), assim como análise de Weibull. As falhas foram classificadas como 50C (mais que 50% de cimento aderido na coroa), 50S (mais que 50% de cimento aderido ao substrato de resina) e COE (fratura coesiva do núcleo). Nenhuma diferença estatística foi observada nos valores de retenção (p=0.975), porém o grupo controle (CTRL) apresentou o maior módulo de Weibull. O tipo de falha predominante foi 50S. A ocorrência de falhas coesivas foi maior no grupo controle. A retenção das coroas à base de óxido de zircônio não foi afetada pela rugosidade do núcleo. Concluiu-se que jateamento seguido de silano e deposição de nanofilmes de sílica aumentam a retenção de coroas de zircônia, assim como o acabamento de núcleos de resina com pontas diamantadas não influencia a retenção de coroas de zircônia.

Made available in DSpace on 2014-12-17T14:57:43Z (GMT). No. of bitstreams: 1 EdsonJAP.pdf: 1427766 bytes, checksum: 2d062c892b501f8f46093e7d7c17a9b2 (MD5) Previous issue date: 2007-08-10 / The manufacturing of above and below-knee prosthesis starts by taking surfac measurements of the patient s residual limb. This demands the making of a cartridg with appropriate fitting and customized to the profile of each patient. The traditiona process in public hospitals in Brazil begins with the completion of a record file (according to law n?388, of July 28, 1999 by the ministry of the health) for obtaining o the prosthesis, where it is identified the amputation level, equipment type, fitting type material, measures etc. Nowadays, that work is covered by the Brazilian Nationa Health Service (SUS) and is accomplished in a manual way being used commo measuring tapes characterizing a quite rudimentary, handmade work and without an accuracy.In this dissertation it is presented the development of a computer integrate tool that it include CAD theory, for visualization of both above and below-knee prosthesis in 3D (i.e. OrtoCAD), as well as, the design and the construction a low cos electro-mechanic 3D scanner (EMS). This apparatus is capable to automatically obtain geometric information of the stump or of the healthy leg while ensuring smalle uncertainty degree for all measurements. The methodology is based on reverse engineering concepts so that the EMS output is fed into the above mentioned academi CAD software in charge of the 3D computer graphics reconstruction of the residualimb s negative plaster cast or even the healthy leg s mirror image. The obtained results demonstrate that the proposed model is valid, because it allows the structura analysis to be performed based on the requested loads, boundary conditions, material chosen and wall thickness. Furthermore it allows the manufacturing of a prosthesis cartridge meeting high accuracy engineering patterns with consequent improvement in the quality of the overall production process / A fabrica??o de pr?teses para amputados de membros inferiores (transfemural e transtibial) exige a confec??o de um cartucho com encaixe adequado e personalizado ao perfil de cada paciente. O processo tradicional de atendimento a pacientes em hospitais p?blicos no Brasil inicia-se com o preenchimento de uma ficha conforme portaria n?388, de 28 de Julho de 1999 do minist?rio da sa?de para obten??o da pr?tese, onde ? identificado o n?vel de amputa??o, tipo de equipamento, tipo de encaixe, material, medidas etc. Atualmente, esses cartuchos s?o fabricados de forma manual atrav?s de instrumentos de baixa precis?o, caracterizando um trabalho bastante rudimentar, artesanal e sem nenhuma acuracidade. Nesta disserta??o prop?e-se o desenvolvimento de uma ferramenta integrada que envolva o CAD, para visualiza??o das pr?teses dos tipos transfemural/transtibial em 3D (OrtoCAD), bem como, o projeto e a constru??o um leitor eletromec?nico (esp?cie de scanner tridimensional), capaz de obter automaticamente e qualitativamente, com menor grau de incerteza as informa??es geom?tricas do coto ou da perna sadia. A metodologia inclui a aplica??o de conceitos de engenharia reversa para gerar computacionalmente a representa??o do coto e/ou a imagem reversa do membro sadio. Os resultados obtidos demonstram que o modelo posposto ? v?lido, pois permite a an?lise estrutural em fun??o do carregamento solicitado e a confec??o de um cartucho de pr?tese atendendo elevados padr?es de acuracidade da engenharia com conseq?ente melhoria na qualidade do processo de fabrica??o