Avaliação tridimensional da precisão de moldagens convencionais e digitais utilizando diferentes escâneres
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2022-08-04
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Universidade Estadual Paulista (Unesp)
Resumo
A moldagem sobre implante possui papel fundamental para o tratamento reabilitador. No entanto, os materiais de moldagem utilizados para a realização da moldagem possuem limitações, tais como a produção de subprodutos após o processo de presa final, gerando distorções no modelo final e forças deletérias no implante. A odontologia digital surgiu com o intuito de proporcionar tanto moldagens mais precisas, quanto eliminar etapas clínicas, porém possui limitações. Em determinadas situações clínicas, como em reabilitações anteriores, por exemplo, a estabilidade é essencial para favorecimento da estética. Assim, o objetivo deste estudo foi avaliar a precisão entre os fluxos digital e convencional de moldagens para próteses implantossuportadas em regiões anteriores. Um modelo mestre de uma maxila parcialmente dentada com 3 análogos (dois implantes com micro pilares e um sem componente), foi escaneado utilizando o escâner de bancada Ceramill map400 (controle, n=10). Através deste modelo mestre foram realizadas moldagens convencionais (n=10) e digitais, utilizando 3 escâneres intraorais (3Shape, Sirona e Medit, n=10). Todas as 40 imagens STL obtidas (convencional e dos escâneres intraorais) foram impressas por impressora 3D FlashForge Hunter. Para a obtenção dos dados numéricos, todos os 40 modelos manufaturados aditivamente foram escaneados pelo escâner de bancada para posterior sobreposição das imagens com o modelo mestre (controle) (1). Além disso, também foram realizadas sobreposições das imagens escaneadas anteriormente ao processo de manufatura aditiva com as imagens do modelo mestre (2), pois através do processo de sobreposição, pode-se determinar as alterações dimensionais obtidas. O resultado das diferentes formas de obtenção das imagens, na precisão inicial ou final, foi identificado por Análise de Variância (ANOVA) com dois fatores. Para a obtenção na precisão antes-após manufatura aditiva, aplicou-se ANOVA para medidas repetidas. Ambos os testes realizaram comparações múltiplas com o teste de Bonferroni (α=5%). Com relação aos resultados antes da impressão dos modelos, os escâneres 3SHAPE e SIRONA apresentaram melhor precisão do que o método convencional (p=0,46 e p=0,003, respectivamente), porém o escâner MEDIT não difere de nenhum dos outros métodos de obtenção avaliados (digital ou convencional sobre implantes, p>0,05). Adicionalmente, quando a moldagem é realizada a partir de um implante ou componente, os diferentes métodos de moldagem não diferem entre si. Para a análise após a manufatura aditiva, os valores de precisão são similares entre si, e independente do método, foi observado que antes da manufatura aditiva, a precisão é similar entre as moldagens sobre implante e componente (p>0,05). Já após a impressão, a precisão é melhor para as moldagens realizadas sobre componente (p<0,001). Desta forma, tanto o fluxo convencional quanto o digital foram precisos antes da manufatura aditiva pela impressora FlashForge Hunter, não tendo diferença entre os escâneres intraorais. Além disso, apesar de não ter diferença na precisão entre moldagens realizadas na presença ou ausência de componentes sobre o modelo mestre, quando analisados após manufatura aditiva, os componentes mostraram-se mais precisos que diretamente sobre o implante.
The implant impression plays a fundamental role in the rehabilitation treatment; however, the impression materials used have limitations, such as the production of products after the final setting process, generating distortions in the final model and harmful forces on the implant. Digital dentistry has emerged with the aim of providing both more accurate impressions and eliminating clinical steps, but it has limitations. In certain clinical situations, such as in anterior rehabilitation for example, stability is essential to favor aesthetics. Thus, this study evaluated the accuracy between digital and conventional flows for implant-supported prostheses in anterior regions. A master model of a partially dentate maxilla with 3 analogues (two implants with micro abutments and one with implant level) was scanned using the Ceramill map400® desktop scanner (control, n=10). Conventional (n=10) and digital impressions were performed using this master model, using 3 intraoral scanners (3Shape, Sirona, and Medit, n=10). All 40 STL images obtained (conventional and intraoral scanners) were printed using a FlashForge Hunter 3D printer. To obtain the numerical data, all 40 additively manufactured models were scanned by a desktop scanner for later superimposition of the images with the master model (control) (1). Additionally, the images scanned before the additive manufacturing process were also overlapped with the images from the master model (2), because through the overlapping process, the dimensional changes obtained can be determined. The results of the different ways of obtaining the images, in the initial or final precision, were identified through analysis of variance (ANOVA) with two factors. To obtain the precision before-after additive manufacturing, ANOVA for repeated measures was applied. Both tests performed multiple comparisons with the Bonferroni test (α=5%). Regarding the results before printing the models, the 3Shape and Sirona scanners showed better accuracy than the conventional method (p=0.46 and p=0.003, respectively), but the Medit scanner does not differ from any other method for obtaining evaluated. (digital or conventional on implants, p>0.05). Additionally, when impression is performed from an implant or abutment level, the different impression methods do not differ from each other. For the analysis after additive manufacturing, the precision values are similar, and regardless of the method, it was observed that before additive manufacturing, the precision was similar between implant and abutment-level impressions (p>0.05). After printing, the accuracy was better for impressions made on the abutment (p<0.001). In this way, both conventional and digital flows were accurate before additive manufacturing by the FlashForge Hunter printer, with no difference between intraoral scanners. Additionally, although there was no difference in accuracy between impressions performed in the presence or absence of abutments on the master model, when analyzed after additive manufacturing, the abutments proved to be more accurate than directly on the implant.
The implant impression plays a fundamental role in the rehabilitation treatment; however, the impression materials used have limitations, such as the production of products after the final setting process, generating distortions in the final model and harmful forces on the implant. Digital dentistry has emerged with the aim of providing both more accurate impressions and eliminating clinical steps, but it has limitations. In certain clinical situations, such as in anterior rehabilitation for example, stability is essential to favor aesthetics. Thus, this study evaluated the accuracy between digital and conventional flows for implant-supported prostheses in anterior regions. A master model of a partially dentate maxilla with 3 analogues (two implants with micro abutments and one with implant level) was scanned using the Ceramill map400® desktop scanner (control, n=10). Conventional (n=10) and digital impressions were performed using this master model, using 3 intraoral scanners (3Shape, Sirona, and Medit, n=10). All 40 STL images obtained (conventional and intraoral scanners) were printed using a FlashForge Hunter 3D printer. To obtain the numerical data, all 40 additively manufactured models were scanned by a desktop scanner for later superimposition of the images with the master model (control) (1). Additionally, the images scanned before the additive manufacturing process were also overlapped with the images from the master model (2), because through the overlapping process, the dimensional changes obtained can be determined. The results of the different ways of obtaining the images, in the initial or final precision, were identified through analysis of variance (ANOVA) with two factors. To obtain the precision before-after additive manufacturing, ANOVA for repeated measures was applied. Both tests performed multiple comparisons with the Bonferroni test (α=5%). Regarding the results before printing the models, the 3Shape and Sirona scanners showed better accuracy than the conventional method (p=0.46 and p=0.003, respectively), but the Medit scanner does not differ from any other method for obtaining evaluated. (digital or conventional on implants, p>0.05). Additionally, when impression is performed from an implant or abutment level, the different impression methods do not differ from each other. For the analysis after additive manufacturing, the precision values are similar, and regardless of the method, it was observed that before additive manufacturing, the precision was similar between implant and abutment-level impressions (p>0.05). After printing, the accuracy was better for impressions made on the abutment (p<0.001). In this way, both conventional and digital flows were accurate before additive manufacturing by the FlashForge Hunter printer, with no difference between intraoral scanners. Additionally, although there was no difference in accuracy between impressions performed in the presence or absence of abutments on the master model, when analyzed after additive manufacturing, the abutments proved to be more accurate than directly on the implant.
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Palavras-chave
Impressão tridimensional, Implantes dentários, Prótese dentária, Printing, Three-Dimensional, Dental implants, Dental prosthesis