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Previous issue date: 2017-12-14 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / The high prevalence of edentulous patients associated to the poor retention of the conventional complete dentures, combined to the high survival rate of dental implants and an increased demand for aesthetic dentistry, resulted in a higher number of fixed restorations provided to the patients. However, as any technique, this one is also not free from failures and these can occur due to problems related to the biomechanics of the implant/prosthesis. These complications may be from biologic or technical origin, the first being related to processes affecting the peri-implant hard and soft tissues, and the second to mechanical damage of the implant, implant components and prostheses. Due to the paucity of clinical studies reporting complications in implant fixed complete denture prostheses (IFCDPs), this thesis aimed to evaluate implants and prostheses survival rates, as well as the main complications observed in patients rehabilitated with IFCDPs after at least one year of follow-up. The secondary goal was to evaluate patient satisfaction.
Through the electronic records, based on the inclusion criteria, edentulous patients who were
rehabilitated with prostheses supported by at least four rough surface dental implants between January 2000 and December 2015 in the Departent of Postgraduate Prosthodontics at Tufts University School of Dental Medicine (Boston, MA, USA) were selected. A comprehensive multidisciplinary examination composed of medical and dental history, clinical examination involving periodontal and prosthetic examination, radiographic analysis and photographs was performed. Comparison was made as well between porcelain IFCDPs (Group 1) and metalresin IFCDPs (Group 2). A questionnaire to assess patient satisfaction regarding the treatment in general, aesthetics, chewing ability, taste, and speaking ability was also applied. For data analysis, Kaplan-Meier estimation curves were used to predict the survival of implants and prostheses. The chi-square test and Fisher's exact test where appropriate and logistic regression analysis were performed.
Four hundred fifty-seven implants (Nobel Biocare, Biomet 3i, Straumann) supporting a total
of 71 PDTFIs in 52 patients (mean age 65.5 years) were evaluated, with a mean follow-up time of 5.2 years (range 1 to 12 years). Of these prostheses, 38 were in the maxilla and 33 in the mandible (19 edentulous maxillae, 14 edentulous mandibles, 19 both arches); 55 were made of porcelain (porcelain-fused-to-metal or metal-free) (Group 1) and 16 were metal-resin (MR)
(Group 2); 36 were cement retained and 35 were retained by screws. Only 6 implants had to be removed, resulting in a survival rate of 98.7%. Of the 71 prostheses, 6 failed (1 porcelain and
5 MR), presenting a survival rate of 91.5%. A total of 274 biologic complications were
recorded in 63 prostheses (47 porcelain and 16 MR), being soft tissue recession around the
implants (7.7%) the most frequently observed, followed by soft tissue inflammation underneath the prostheses (7.4%), and peri-implant mucositis (6.3%). Soft tissue recession was the most frequent complication in both groups, and no statistical significant difference was observed for any biologic complication between Group 1 and Group 2. A total of 274 technical complications were observed in 57 prostheses (42 porcelain and 15 MR). Wear of the prosthetic material (9.8%) was the most frequent, followed by decementation of the cement-retained IFCDPs (2.9%), and loss of screw access filing material of the screw-retained IFCDPs (2.7%). The rate of wear of prosthetic material was 7.3% for porcelain IFCDPs (Group 1) and 19.4% for metal-resin IFCDPs (Group 2), yielding a statistically significant difference between the two groups (p < 0.05). Regarding the patient satisfaction evaluation, the greatest dissatisfaction was in relation to the ability to chew (12%). However, in general, 94% of the patients were satisfied with the treatment rendered. With a mean exposure time of 5.2 years, high implants and prosthetic survival rates can be
expected in rehabilitations with implanted-fixed complete denture prostheses, presence of
biologic and technical complications, and a high level of patient satisfaction. / A alta preval?ncia de pacientes ed?ntulos associada a pobre reten??o das pr?teses totais
convencionais, combinada com as altas taxas de sobreviv?ncia de implantes dent?rios e uma
maior da demanda por odontologia est?tica, resultou em um aumento no n?mero de
restaura??es fixas fornecidas aos pacientes. Entretanto, como toda t?cnica, esta tamb?m n?o ?
ausente de falhas e essas podem ocorrer devido a problemas relacionados com a biomec?nica
do conjunto pr?tese/implante. Essas complica??es podem ser de origem biol?gica ou t?cnica,
sendo a primeira relacionada a processos que afetam os tecidos de suporte peri-implantar e a
segunda a danos mec?nicos do implante, componentes de implantes e pr?teses. Devido ?
escassez de estudos cl?nicos relatando complica??es em pr?teses dent?rias totais fixas
implantossuportadas (PDTFIs), essa tese teve como objetivo avaliar taxas de sobreviv?ncia de
implantes e pr?teses, assim como as principais complica??es observadas em pacientes
reabilitados com PDTFIs ap?s terem sido acompanhados pelo per?odo de, pelo menos, um ano.
Tamb?m teve como objetivo avaliar o grau de satisfa??o dos pacientes.
Atrav?s dos registros eletr?nicos, a partir de crit?rios de inclus?o, foram selecionados pacientes
ed?ntulos que foram reabilitados com pr?teses suportadas por pelo menos quatro implantes
dent?rios de superf?cie tratada entre janeiro de 2000 e dezembro de 2015 na Divis?o de P?s-
Gradua??o em Pr?tese da Faculdade de Medicina Dent?ria da Universidade Tufts (Boston,
MA, USA). Nestes pacientes, um exame compreensivo multidisciplinar composto de hist?ria
m?dica e dent?ria, exame cl?nico envolvendo exame periodontal e exame das pr?teses, an?lise
radiogr?fica e fotografias foi realizado. Tamb?m foi feito a compara??o entre PDTFIs
fabricadas com cer?mica (metalocer?micas ou livres de metal) (Grupo 1) e PDTFIs
metalopl?sticas (Grupo 2). Al?m disso foi aplicado um question?rio sobre a satisfa??o do
paciente de forma geral, em rela??o a est?tica, a mastiga??o, ao paladar, e a fona??o ap?s o
tratamento. Para a an?lise dos dados, as curvas de estimativas de Kaplan-Meier foram
utilizadas para prever a sobreviv?ncia dos implantes e das pr?teses. Foi feito o teste quiquadrado
e o teste exato de Fisher quando apropriado e ainda a an?lise de regress?o log?stica.
Foram analisados 457 implantes (Nobel Biocare, Biomet 3i, Straumann) suportando um total
de 71 PDTFIs em 52 pacientes (m?dia de idade de 65,5 anos), com um per?odo m?dio de
acompanhamento de 5,2 anos (intervalo de 1 a 12 anos). Destas pr?teses, 38 eram em maxila
e 33 em mand?bula (19 maxilas ed?ntulas, 14 mand?bulas ed?ntulas, 19 ambas as arcadas); 55
eram fabricadas em cer?mica (metalocer?micas ou livres de metal) (Grupo 1) e 16 eram
metalopl?sticas (MP) (Grupo 2); 36 eram cimentadas e 35 eram retidas atrav?s de parafusos.
Apenas 6 implantes tiveram que ser removidos, resultando uma taxa de sobreviv?ncia de
98,7%. De 71 pr?teses, 6 falharam (1 cer?mica e 5 MP), apresentando uma taxa de
sobreviv?ncia de 91,5%. Um total de 274 complica??es biol?gicas foram registradas em 63
pr?teses (47 cer?micas e 16 MP), sendo a grande maioria recess?o do tecido gengival ao redor
do implantes (7,7%), seguida de inflama??o nos tecidos moles abaixo das pr?teses (7,4%), e mucosite peri-implantar (6,3%). Recess?o de tecido mole foi a complica??o mais frequente em
ambos os grupos, n?o sendo observadas diferen?as estatisticamente significativas para
qualquer complica??o biol?gica entre o Grupo 1 e o Grupo 2. Foram observadas 274
complica??es t?cnicas em 57 pr?teses (42 cer?micas e 15 MP), sendo as mais frequentes o
desgaste do material prot?tico (9,8%), a decementa??o da pe?a prot?tica das PDTFIs retidas
atrav?s de cimento (2,9%), e perda do material de recobrimento do parafuso prot?tico das
PDTFIs retidas por parafusos (2,7%). A taxa de desgaste do material prot?tico foi de 7,3% para
PDTFIs cer?micas (Grupo 1) e 19,4% para PDTFIs metalopl?sticas (Grupo 2), resultando em
uma diferen?a estatisiticamente significativa entre os dois grupos (p < 0,05). Na avalia??o de
satisfa??o do tratamento recebido, a maior insatisfa??o foi em rela??o a capacidade de mastigar
(12%). Contudo, de uma forma geral, 94% dos pacientes demonstraram-se satisfeitos.
Com um tempo m?dio de exposi??o de 5,2 anos, pode-se esperar elevadas taxas de
sobreviv?ncia de implantes e de reconstru??es com pr?teses dent?rias totais fixas
implantossuportadas, presen?a de complica??es biol?gicas e t?cnicas, e um elevado grau de
satisfa??o dos pacientes.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/7888 |
| Date | 14 December 2017 |
| Creators | Bordin, Thaisa Barizan |
| Contributors | Teixeira, Eduardo Rolim, Weber, Hans-Peter |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Odontologia, PUCRS, Brasil, Escola de Ci?ncias da Sa?de |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | -8096554818733665164, 500, 500, 600, 600, -2070498469879244349, -2555911436985713659, 2075167498588264571 |
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