Análise da desadaptação marginal vertical e horizontal de infraestruturas de próteses fixas implantossuportadas confeccionadas através de diferentes técnicas.
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Data
2018-02-05
Autores
Gomes, Jéssica Marcela de Luna [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
O objetivo deste trabalho foi avaliar a desadaptação marginal vertical, horizontal e interna de infraestruturas e próteses fixas implantossuportadas confeccionadas através de diferentes técnicas. Além disso, realizar uma revisão sistemática e meta-análise avaliando o efeito da soldagem de infraestruturas de próteses fixas implantossuportadas em uma melhor adaptação quando comparada as infraestruturas confeccionadas em monobloco. Um total de 30 infraestruturas foram confeccionadas e divididas em 3 grupos: G1) Técnica convencional da cera perdida (n=10); G2) CAD/CAM (n=10); G3: CAD/CAM + Técnica da cera perdida (n=10). Uma matriz foi utilizada para simular uma prótese fixa implantossuportada de três elementos com um pôntico central. A infraestrutura do grupo G1 foi confeccionada em Ni-Cr, do grupo G2 em zircônia e G3 fresada em cera e fundida em Ni-Cr. Em todos os grupos a desadaptação marginal vertical e horizontal (subcontorno e sobrecontorno) foi avaliada através de um microscópio óptico tridimensional (Quick Scope, Mitutoyo). A revisão sistemática seguiu o critério PRISMA e está cadastrada na plataforma PROSPERO (CRD81865) e a busca foi realizada nas bases de dados Pubmed/MEDLINE, Embase and The Cochrane Library com artigos publicados até novembro de 2017. A questão PICO foi: “A técnica do ponto de solda contribui para uma melhor adaptação quando comparada a confecção em monobloco de infraestruturas e próteses fixas implantossuportadas?”. O estudo in vitro demonstrou maior valor de desadaptação marginal vertical para o grupo G3 (83.5µm), seguido dos grupos G1 (55 µm) e G2 (42 µm) (p<0,001). Quanto à desadaptação marginal horizontal, o maior valor de desadaptação foi do grupo G2 (118 µm), seguido de G3 (102 µm), ambos apresentando sobre contorno. O grupo G1 (- 85 µm) apresentou valores de sub contorno (p<0,001). Na revisão sistemática, 12 estudos foram selecionados para análise qualitativa e 7 estudos para análise quantitativa. Um total de189 espécimes foram avaliados, em diferentes ligas metálicas (cp-Ti; Ni-Cr; Cr-Co e ligas nobres) e técnicas de soldagem: laser welding, solda convencional, TIG e brazing. As desadaptações marginais verticais foram mensuradas através de microscópio óptico, estereomicroscópio e MEV. Uma análise qualitativa dos estudos foi realizada demonstrando um efeito positivo da soldagem na adaptação das infraestruturas quando comparadas aquelas confeccionadas em monobloco. A meta-análise confirmou o efeito positivo da soldagem na adaptação (P<0.00001; MD: -36.14; IC 95%: -48.69 to -23.59). Dentro das limitações pertinentes a um estudo in vitro pode-se concluir a confecção de infraestruturas através dos sistemas CAD/CAM apresentou os menores valores de DMV. A associação dos sistemas CAD/CAM e a técnica convencional da cera perdida, apresentou maior DMV. A DMH foi mais favorável quando confeccionadas infraestruturas pela técnica da cera perdida, apresentando sub-contorno. A revisão sistemática demonstrou que a técnica do ponto de solda é eficaz para obtenção de menores valores de desadaptação marginal, sendo a técnica do laser (laser welding) a mais eficaz.
The aim of this study was to evaluate the marginal vertical, horizontal and internal misfit of implant-supported prostheses made through different techniques. In addition, to perform a systematic review and meta-analysis evaluating the effect of the welding technique on fixed prosthesis implants supported in make a better adaptation when compared the infrastructures made in one piece cast. A total of 30 infrastructures were made and divided into 3 groups: G1) Conventional- lost wax technique (n = 10); G2) CAD/CAM (n = 10); G3: CAD/CAM + lost wax technique (n = 10). A reference model was used to to simulate a 3-unit implant-supported fixed prostheses with a central pontic. In the G1 group the frameworks were made of Ni-Cr alloy, G2 group in zirconia and G3 milled in wax and fused in Ni-Cr alloy. In all groups, vertical and horizontal marginal misfit (under-contour and over-contour) was evaluated using a 3D optical microscope (Quick Scope, Mitutoyo, Japan). The systematic review and meta-analysis followed the PRISMA criteria and is registered on the PROSPERO (CRD81865). The search was performed in the Pubmed/MEDLINE, Embase and The Cochrane Library databases with selection of articles published until November 2017. The PICO question was: "The welding technique contributes to a better adaptation when compared to the one-piece cast frameworks of implant-supported prostheses?" The in vitro study showed a higher value of vertical marginal misfit for the G3 group (83.5μm), followed by G1 (55μm) and G2 (42μm) (p <0.001). As for horizontal marginal misfit, the highest value of misfit was G2 (118 μm), followed by G3 (102 μm), both presenting over-contour. The G1 group (-85 μm) had under-contour values (p <0.001). In the systematic review, 12 studies were selected for qualitative analysis and 7 studies for quantitative analysis. A total of 189 specimens were evaluated in different metal alloys (cp-Ti, Ni-Cr, Cr-Co and noble alloys) and welding techniques: laser welding, conventional welding, TIG and brazing. Vertical marginal misfits were measured by optical microscope, stereomicroscope and/or SEM. A qualitative analysis of the studies was performed demonstrating a positive effect of welding technique on the adaptation of the frameworks when compared to those made in one piece cast. The meta-analysis confirmed the positive effect of welding on marginal adaptation (P <0.00001; MD: -36.14; 95% CI: -48.69 to -23.59). Within the limitations of an in vitro study it can be concluded that the construction of infrastructures through CAD/CAM systems presented the lowest values of DMV. The association of the CAD/CAM systems and the conventional lost wax technique presented higher DMV. The DMH was more favorable when frameworks were made by the lost wax technique, presenting under-contour. The systematic review showed that the welding technique is effective to obtain lower values of marginal misfit and the Laser Welding technique is the most effective.
The aim of this study was to evaluate the marginal vertical, horizontal and internal misfit of implant-supported prostheses made through different techniques. In addition, to perform a systematic review and meta-analysis evaluating the effect of the welding technique on fixed prosthesis implants supported in make a better adaptation when compared the infrastructures made in one piece cast. A total of 30 infrastructures were made and divided into 3 groups: G1) Conventional- lost wax technique (n = 10); G2) CAD/CAM (n = 10); G3: CAD/CAM + lost wax technique (n = 10). A reference model was used to to simulate a 3-unit implant-supported fixed prostheses with a central pontic. In the G1 group the frameworks were made of Ni-Cr alloy, G2 group in zirconia and G3 milled in wax and fused in Ni-Cr alloy. In all groups, vertical and horizontal marginal misfit (under-contour and over-contour) was evaluated using a 3D optical microscope (Quick Scope, Mitutoyo, Japan). The systematic review and meta-analysis followed the PRISMA criteria and is registered on the PROSPERO (CRD81865). The search was performed in the Pubmed/MEDLINE, Embase and The Cochrane Library databases with selection of articles published until November 2017. The PICO question was: "The welding technique contributes to a better adaptation when compared to the one-piece cast frameworks of implant-supported prostheses?" The in vitro study showed a higher value of vertical marginal misfit for the G3 group (83.5μm), followed by G1 (55μm) and G2 (42μm) (p <0.001). As for horizontal marginal misfit, the highest value of misfit was G2 (118 μm), followed by G3 (102 μm), both presenting over-contour. The G1 group (-85 μm) had under-contour values (p <0.001). In the systematic review, 12 studies were selected for qualitative analysis and 7 studies for quantitative analysis. A total of 189 specimens were evaluated in different metal alloys (cp-Ti, Ni-Cr, Cr-Co and noble alloys) and welding techniques: laser welding, conventional welding, TIG and brazing. Vertical marginal misfits were measured by optical microscope, stereomicroscope and/or SEM. A qualitative analysis of the studies was performed demonstrating a positive effect of welding technique on the adaptation of the frameworks when compared to those made in one piece cast. The meta-analysis confirmed the positive effect of welding on marginal adaptation (P <0.00001; MD: -36.14; 95% CI: -48.69 to -23.59). Within the limitations of an in vitro study it can be concluded that the construction of infrastructures through CAD/CAM systems presented the lowest values of DMV. The association of the CAD/CAM systems and the conventional lost wax technique presented higher DMV. The DMH was more favorable when frameworks were made by the lost wax technique, presenting under-contour. The systematic review showed that the welding technique is effective to obtain lower values of marginal misfit and the Laser Welding technique is the most effective.
Descrição
Palavras-chave
Prótese dentária sobre implantes, Adaptação marginal dentária, Projeto auxiliado por computador, Soldagem em odontologia, Dental prosthesis Implant-supported, Dental marginal adaptation, Computer-aided design, Dental soldering