Análise da tecnologia CAD-CAM na confecção de próteses unitárias implantossuportadas e seu efeito na adaptação sob simulação da mastigação e na presença de microoorganismos.
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Data
2022-03-08
Autores
Gomes, Jéssica Marcela de Luna [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Este trabalho foi dividido em dois capítulos, com objetivos semelhantes, porém, diferentes grupos foram avaliados. O objetivo geral deste trabalho foi avaliar qual técnica apresentará um melhor comportamento mecânico e biológico quando próteses implantossuportadas parafusadas sob hexágono externo foram submetidas à simulação da mastigação durante cinco anos. Em ambos os capítulos, os corpos de prova foram submetidos as análises de desadaptação (vertical e horizontal), torque e quantificação de microrganismos antes e após a ciclagem mecânica (angulação de 30°, a 37°C, 5 x 10⁶ ciclos com 150N de carga a uma frequência de 2,0Hz). A quantificação de microrganismos foi realizada após imersão dos corpos de prova em biofilme multi-espécie composto por quatro microrganismos, incluindo três cepas de bactérias (Fusobacterium nucleatum, Streptococcus mutans e Streptococcus oralis) e uma cepa de levedura (Candida albicans) incubados por 115h. Para o capítulo 1, foram confeccionados 30 corpos de prova, divididos em três grupos (n=10 por grupo) sendo UCoCr (Ucla com cinta de Cr-Co); Ucal (Ucla Calcinável); Fc (Fresado em cera+ fundição em liga metálica) e como resultado podemos observar que antes da ciclagem, quanto à desadaptação marginal vertical houve diferença significativa quando se comparou o grupo UCoCr aos grupos FC e Ucal (p<0,05). O grupo Ucal foi o que apresentou maior diferença média após a ciclagem. Quanto à desadaptação horizontal antes da ciclagem houve diferença significativa quando se comparou o grupo UCoCr ao FC (p<0,05). O grupo FC foi o que apresentou maior diferença média positiva (sobrecontorno) após a ciclagem quando comparado a todos os demais grupos, e sendo significativo na comparação com UCoCr (subcontorno) (p<0,05). Quanto ao torque, o grupo UCal foi o que apresentou maior diferença média após a ciclagem, logo, o grupo que sofreu o maior efeito da ciclagem. Quanto à quantificação de células viáveis não foi possível observar diferença entre os grupos (p>0,05) antes da ciclagem. Após a ciclagem, o grupo Ucal apresentou a menor quantidade de microrganismos (p<0,05). O grupo Fc foi o que a presentou a maior adesão de microrganismos pós ciclagem. Pode-se concluir que a técnica que apresenta o melhor comportamento mecânico quanto à adaptação marginal (vertical e horizontal) e torque é a técnica convencional, a partir do UCLA com cinta de Cr-Co (UCoCr). Entretanto, a técnica híbrida (Fc) foi a que apresentou a maior quantidade de células viáveis após a simulação dos 5 anos de uso da prótese. Para o capítulo 2, foram confeccionados 50 corpos de prova, divididos em cinco grupos (n=10 por grupo), sendo UCOCR (Ucla com cinta de Cr-Co); CADIN (abutment customizado (escâner intraoral)); CADEX (abutment customizado (escâner extraoral); TIBASEIN (Tibase (intraoral)); TIBASEEX (Tibase (extroral)) e como resultados vimos que antes da ciclagem uma maior desadaptação marginal vertical para o grupo UcoCr. Houve diferença significativa quando se comparou o grupo UcoCr aos grupos CadEX e CadIN (p<0,05), com maiores valores de desadaptação para o grupo UCoCr. Quanto à desadaptação marginal horizontal os grupos UCoCr, TibaseIN e TibaseEX apresentaram subcontorno. Houve diferença significativa quando se comparou o grupo UCoCr aos grupos CadEX e CadIN p<0,05 (sobrecontorno). Quanto ao total de quantidade de células viáveis foi possível observar uma diferença entre os grupos UCoCr e os grupos CadIN. (p<0,05). Após a ciclagem, não houve uma diferença significativa na comparação dos grupos analisados (p>0,05). Considerando o sistema CAD CAM (CadIN+CadEX) vs. Tibase (TibaseIN+TibaseEX) não foi identificada uma diferença significativa. Entretanto, na comparação sistema intraoral (CadIN+TibaseIN) vs. Extraoral (CadEX+TibaseEX) foi identificada uma diferença significativa (p≤0,001), mais favorável ao sistema extraoral. Quanto à desadaptação marginal horizontal com maior subcontorno para o grupo UCoCr, seguido por TibaseIN e TibaseEX. Houve diferença significativa quando se comparou o grupo UCoCr aos grupos CadEX e CadIN (p<0,05),com os grupos cad-cam apresentando menores valores de desadaptação. O grupo CadIN e CadEX apresentaram valores de desadaptação marginal horizontal positiva (sobrecontorno) e diferença significativa quando comparado aos grupos: UCoCr, TibaseIN e TibaseEX (p<0,05). Quanto à quantidade total de células viáveis foi possível observar uma diferença significativa para o grupo UCoCr (p<0,05) com maior quantidade de células comparado aos demais grupos. Dessa forma, conclui-se que o TiBaseIn ou TiBaseEx podem ser consideradas as técnicas que apresentariam clinicamente a maior longevidade, pois associam baixos valores de desadaptação marginal (horizontal e vertical), além de pouca adesão de microrganismos.
This thesis was divided into two chapters, with similar objectives, however, different groups were evaluated in each chapter. The general objective of this work was to evaluate which technique will present a better mechanical and biological behavior when screwed implant-supported prostheses to external hexagon were submitted to five years of masticatory simulation. In both chapters, the specimens were subjected to analysis of misfit (vertical and horizontal), torque and quantification of microorganisms before and after mechanical cycling (30° angle, at 37°C, 5 x 10⁶ cycles with 150N of load at a frequency of 2.0Hz). The quantification of microorganisms was performed after immersion of the specimens in a multi-species biofilm composed of four microorganisms, including three strains of bacteria (Fusobacterium nucleatum Streptococcus mutans and Streptococcus oralis) and a strain of yeast (Candida albicans) incubated for 115h. For chapter 1, 30 specimens were made, divided into three groups (n=10 per group) being UCoCr (Ucla with Cr-Co strap); Ucal (Castable Ucla); Fc (Wax milled + metal alloy casting) and as a result we can observe that before cycling, regarding the vertical marginal misfit there was a significant difference when comparing the UCoCr group to the FC and Ucal groups (p<0.05). The Ucal group showed the highest mean difference after cycling. As for the horizontal misfit before cycling, there was a significant difference when comparing the UCoCr group to the FC (p<0.05). The FC group showed the highest positive mean difference (overcontour) after cycling when compared to all other groups, and it was significant when compared with UCoCr (undercontour) (p<0.05). As for torque, the UCal group showed the highest mean difference after cycling. As for the quantification of viable cells, it was not possible to observe a difference between the groups (p>0.05) before cycling. After cycling, the Ucal group had the lowest amount of microorganisms (p<0.05). The Fc group was the one that presented the higher adhesion of post-cycling microorganisms. It can be concluded that the technique that presents the best mechanical behavior in terms of adaptation to marginal misfit (vertical and horizontal) and torque is the conventional technique, based on UCLA with Cr-Co (UCoCr) strap. However, the hybrid technique (Fc) was the one that presented the highest amount of viable cells after the simulation of 5 years of prosthesis use. For chapter 2, 50 specimens were made, divided into five groups (n=10 per group), being UCOCR (Ucla with Cr-Co strap); CADIN (custom abutment (intraoral scanner)); CADEX (custom abutment (extraoral scanner); TIBASEIN (Tibase (intraoral)); TIBASEEX (Tibase (extroral)) and as results we saw that before cycling a greater vertical marginal misfit for the UCoCr group. There was a significant difference when comparing the group UCoCr to CadEX and CadIN groups (p<0.05) Regarding horizontal marginal misfit for UCoCr, TibaseIN and TibaseEX groups presenting subcontour, there was a significant difference when comparing the UCoCr group to CadEX and CadIN groups p<0.05 ( As for the total amount of viable cells, it was possible to observe a difference between the UCoCr groups and the CadIN groups (p<0.05).After cycling, there was no significant difference in the comparison of the analyzed groups (p> 0.05. Considering the CAD CAM system (CadIN+CadEX) vs. Tibase (TibaseIN+TibaseEX) a significant difference was not identified. However, in the comparison intraoral system (CadIN+TibaseIN) vs. Extraoral (CadEX+TibaseEX) identified a difference significant difference (p≤0.001), more favorable to the extraoral system. As for the horizontal marginal misfit with subcontour for the UCoCr group, followed by TibaseIN and TibaseEX. There was a significant difference when the UCoCr group was compared to the CadEX and CadIN groups (p<0.05). The CadIN and CadEX groups presented values of positive horizontal marginal misfit (overcontour) and significant difference when compared to the groups: UCoCr, TibaseIN and TibaseEX (p<0.05). As for the total amount of viable cells, it was possible to observe a significant difference for the UCoCr group (p<0.05) with a greater number of cells compared to the other groups. Thus, it can be concluded that TiBaseIn or TiBaseEx can be considered the techniques that would clinically present the highest longevity, as they associate low values of marginal misfit (horizontal and vertical), in addition to low adhesion of microorganisms.
This thesis was divided into two chapters, with similar objectives, however, different groups were evaluated in each chapter. The general objective of this work was to evaluate which technique will present a better mechanical and biological behavior when screwed implant-supported prostheses to external hexagon were submitted to five years of masticatory simulation. In both chapters, the specimens were subjected to analysis of misfit (vertical and horizontal), torque and quantification of microorganisms before and after mechanical cycling (30° angle, at 37°C, 5 x 10⁶ cycles with 150N of load at a frequency of 2.0Hz). The quantification of microorganisms was performed after immersion of the specimens in a multi-species biofilm composed of four microorganisms, including three strains of bacteria (Fusobacterium nucleatum Streptococcus mutans and Streptococcus oralis) and a strain of yeast (Candida albicans) incubated for 115h. For chapter 1, 30 specimens were made, divided into three groups (n=10 per group) being UCoCr (Ucla with Cr-Co strap); Ucal (Castable Ucla); Fc (Wax milled + metal alloy casting) and as a result we can observe that before cycling, regarding the vertical marginal misfit there was a significant difference when comparing the UCoCr group to the FC and Ucal groups (p<0.05). The Ucal group showed the highest mean difference after cycling. As for the horizontal misfit before cycling, there was a significant difference when comparing the UCoCr group to the FC (p<0.05). The FC group showed the highest positive mean difference (overcontour) after cycling when compared to all other groups, and it was significant when compared with UCoCr (undercontour) (p<0.05). As for torque, the UCal group showed the highest mean difference after cycling. As for the quantification of viable cells, it was not possible to observe a difference between the groups (p>0.05) before cycling. After cycling, the Ucal group had the lowest amount of microorganisms (p<0.05). The Fc group was the one that presented the higher adhesion of post-cycling microorganisms. It can be concluded that the technique that presents the best mechanical behavior in terms of adaptation to marginal misfit (vertical and horizontal) and torque is the conventional technique, based on UCLA with Cr-Co (UCoCr) strap. However, the hybrid technique (Fc) was the one that presented the highest amount of viable cells after the simulation of 5 years of prosthesis use. For chapter 2, 50 specimens were made, divided into five groups (n=10 per group), being UCOCR (Ucla with Cr-Co strap); CADIN (custom abutment (intraoral scanner)); CADEX (custom abutment (extraoral scanner); TIBASEIN (Tibase (intraoral)); TIBASEEX (Tibase (extroral)) and as results we saw that before cycling a greater vertical marginal misfit for the UCoCr group. There was a significant difference when comparing the group UCoCr to CadEX and CadIN groups (p<0.05) Regarding horizontal marginal misfit for UCoCr, TibaseIN and TibaseEX groups presenting subcontour, there was a significant difference when comparing the UCoCr group to CadEX and CadIN groups p<0.05 ( As for the total amount of viable cells, it was possible to observe a difference between the UCoCr groups and the CadIN groups (p<0.05).After cycling, there was no significant difference in the comparison of the analyzed groups (p> 0.05. Considering the CAD CAM system (CadIN+CadEX) vs. Tibase (TibaseIN+TibaseEX) a significant difference was not identified. However, in the comparison intraoral system (CadIN+TibaseIN) vs. Extraoral (CadEX+TibaseEX) identified a difference significant difference (p≤0.001), more favorable to the extraoral system. As for the horizontal marginal misfit with subcontour for the UCoCr group, followed by TibaseIN and TibaseEX. There was a significant difference when the UCoCr group was compared to the CadEX and CadIN groups (p<0.05). The CadIN and CadEX groups presented values of positive horizontal marginal misfit (overcontour) and significant difference when compared to the groups: UCoCr, TibaseIN and TibaseEX (p<0.05). As for the total amount of viable cells, it was possible to observe a significant difference for the UCoCr group (p<0.05) with a greater number of cells compared to the other groups. Thus, it can be concluded that TiBaseIn or TiBaseEx can be considered the techniques that would clinically present the highest longevity, as they associate low values of marginal misfit (horizontal and vertical), in addition to low adhesion of microorganisms.
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Projeto Auxiliado por Computador, Implantes dentários, Prótese dentária, Projeto auxiliado por computador, Dental implants