Dalva Cruz Laganá

Photoelastic analysis of stress distribution on parallel and angled implants after installation of fixed prostheses

The longevity of implant-supported prosthetic rehabilitation depends largely on how the masticatory forces are transferred to the implants and surrounding bone. Anatomical conditions, bone morphology and aesthetics usually dictate implant placement in less than ideal positions for prosthetic rehabilitation and sometimes it is possible to find them with different inclinations. The purpose of this paper was to compare, through photoelastic analysis, the stress distribution in a fixed prosthesis with 3 parallel implants, to the stress distribution in the same prosthesis in the existence of an angled central implant. Two photoelastic resin models were made and a polariscope was used in the visualization of isochromatic fringes formed in the models when axial loads of 2 kg, 5 kg and 10 kg were applied to a unique central point of the prosthesis. The presence of inducted tensions (preloads) was observed in the models after applying torque to the retention screws. Preloads were intensified with the incidence of occlusal forces. In the parallel implants, the force dissipation followed the long axis. The angled implant had a smaller quantity of fringes and the stresses were located mostly around the apical region of the lateral implants.

Effect of denture surface glazing on denture plaque formation

This study evaluated, in vivo, the efficacy of a denture glazing material (Palaseal) in modifying plaque colonization of dentures. Ten subjects were selected and received maxillary temporary partial removable dentures, with complete acrylic palatal coverage. The right half of the fitting surface of the denture bases were glazed with Palaseal, whereas the other half was not glazed. One month after insertion, two fragments of the resin base of all dentures were removed (one from the glazed side and another from the non-glazed side). These samples were prepared and examined by scanning electron microscopy. Three months after insertion, other fragments were obtained and analyzed. Microscopic observation at 1 month revealed that, for all patients, the plaque film was thinner on the treated side in comparison to the non-treated side. However, at the 3-month evaluation, some areas of the glaze showed cracking, and both glazed and non-glazed sides were covered by a dense bacterial plaque film. In conclusion, the findings of this clinical experiment showed that glazing dentures fitting surface did not prevent bacterial colonization, but favored plaque removal while the glaze layer remained intact. After three months, glaze cracks created microretentive areas that increased plaque accumulation.

Analysis of the condyle/fossa relationship before and after prosthetic rehabilitation with maxillary complete denture and mandibular removable partial denture

STATEMENT OF PROBLEM The influence of the loss of posterior teeth on the condylar position and on temporomandibular disorders (TMDs) remains a controversial issue. PURPOSE This study investigated whether prosthetic rehabilitation promoted modification of the condylar position in subjects without symptoms of TMDs. MATERIAL AND METHODS The temporomandibular joints (TMJs) of 12 women (age 37 to 74), all with existing maxillary complete dentures but no removable partial denture (RPD) restoring the Kennedy class I partially edentulous mandibular arch and no clinical signs of TMDs according to the criteria established by Helkimo, were viewed in maximal intercuspal position with corrected lateral tomography before and after prosthetic rehabilitation with a new maxillary complete denture and a mandibular RPD. Before prosthetic rehabilitation, a mandibular stabilizing base was fabricated to prevent the existing maxillary complete denture from dislodging during tomographic examination. Two methods were used to evaluate tomograms: (1) linear measurements of the subjective narrowest anterior and posterior intra-articular joint spaces made from the tomograms by use of a digital caliper and (2) linear measurements of the anterior and posterior intra-articular joint spaces on the basis of drawings and tracings. Repeated-measures analysis of variance followed by orthogonal contrasts were used to evaluate differences between measurements carried out on the same subject under the different test conditions of the study (before prosthetic rehabilitation, before prosthetic rehabilitation with a mandibular stabilizing base in position, and after prosthetic rehabilitation) (P<.05). RESULTS Before prosthetic rehabilitation, a predominance of posterior condylar positions was observed. Before prosthetic rehabilitation with a mandibular stabilizing base in position, a significant decrease was observed in posterior condylar positions (P=.03). This decrease was more marked after prosthetic rehabilitation (P=.02). The subjective evaluation and comparison on the basis of drawings and tracings used to analyze the tomograms produced similar results (P=.70). CONCLUSION Within the limitations of this study, significant changes in the condylar position occurred after prosthetic rehabilitation in subjects without symptoms of TMDs.

Photoelastic stress analysis in mandibular bone surrounding bar-clip overdenture implants

The aim of this in vitro study was to evaluate, using the photoelastic analysis method, the stress distribution in mandibular bone surrounding a bar-clip overdenture when 2 implant angulations were simulated. Two mandibular photoelastic models were manufactured, with 2 implants embedded in the interforaminal region: model 1-PAPI, a photoelastic analysis model with parallel implants; and model 2-PAAI, a photoelastic analysis model with angled implants. A bar-clip retention system and an overdenture were positioned over the implants, and loads of 1.0, 2.0 and 3.0 bars were applied. The resultant stresses that developed in the supporting structure were photoelastically monitored and were recorded photographically. The results showed that there were no similarities in the areas of stress among the photoelastic resin models when the angulation of the implants was evaluated. Model 1-PAPI presented a higher stress concentration at the implant apex, while in model 2-PAAI, there were higher stress concentrations on the mesial and distal implant faces. Within the limitations of this study, it was concluded that the PAPI photoelastic model demonstrated better stress transfer compared to the PAAI model, since the forces oriented along the axis were better absorbed by the bone.

Thickness of the remaining enamel after the preparation of cingulum rest seats on maxillary canines

PURPOSE This study evaluated the level of tissue removal that takes place on enamel and dentin during cingulum rest seat preparation. MATERIAL AND METHODS A quantitative evaluation of the thickness of the remaining enamel of cingulum seat preparations to receive removable partial denture rests was carried out in 20 maxillary canines with a light optical microscope. RESULTS Thirty percent of the preparations were overextended into dentinal tissue, and 85% had depths that were insufficient to receive rests.

Effectiveness of Denture Cleanser Associated With Microwave Disinfection and Brushing of Complete Dentures: In Vivo Study

Complete dentures acts as a reservoir for microbial colonization, which may lead to systemic infections. Microwave irradiation has been used as an efficient method of denture disinfection. Even though current methods eliminate denture-base microorganisms, a recurrence rate of denture stomatitis (DS) is still observed among denture-wearing patients. It was hypothesized that microwave disinfection kills microorganisms but do not remove dead bacteria from the denture surface. To test this hypothesis, the biofilm found in the dentures of 10 patients with DS was evaluated. In addition, the effects of microwave irradiation plus brushing (MW+B) on the denture biofilm and the combination of denture cleanser with microwave irradiation and brushing (MW+DC+B) for the removal of denture-accumulating microorganisms were investigated. Microbiological data were analyzed statistically by nonparametric analysis (Friedman/Wilcoxon, α=0.05). MW+B and MW+DC+B were effective in reducing the rate of microorganisms (99.2% and 99.5% respectively), but without significant difference between them (p=0.553). However, it was observed that the complete removal of microorganisms from denture surface was only possible when all regimens were combined (MW+DC+B). Microwave irradiation in combination with soaking in denture cleanser and brushing effectively disinfected the dentures and removed denture biofilm.

Connecting accuracy of interchanged prosthetic abutments to different dental implants using scanning electron microscopy.

The present study evaluated the interchangeability of prosthetic components for external hexagon implants by measuring the precision of the implant/abutment (I/A) interface with scanning electron microscopy. Ten implants for each of three brands (SIN, Conexão, Neodent) were tested with their respective abutments (milled CoCr collar rotational and non-rotational) and another of an alternative manufacturer (Microplant) in randomly arranged I/A combinations. The degree of interchangeability between the various brands of components was defined using the original abutment interface gap with its respective implant as the benchmark dimension. Accordingly, when the result for a given component placed on an implant was equal to or smaller then that gap measured when the original component of the same brand as the implant was positioned, interchangeability was considered valid. Data were compared with the Kruskal-Wallis test at 5% significance level. Some degree of misfit was observed in all specimens. Generally, the non-rotational component was more accurate than its rotational counterpart. The latter samples ranged from 0.6-16.9 µm, with a 4.6 µm median; and the former from 0.3-12.9 µm, with a 3.4 µm median. Specimens with the abutment and fixture from Conexão had larger microgap than the original set for SIN and Neodent (p<0.05). Even though the latter systems had similar results with their respective components, their interchanged abutments did not reproduce the original accuracy. The results suggest that the alternative brand abutment would have compatibility with all systems while the other brands were not completely interchangeable.

Incisal coverage or not in ceramic laminate veneers: A systematic review and meta-analysis

BACKGROUND There is no consensus on whether incisal coverage is a risk or a protective factor in preparations for ceramic veneers. OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the survival rates of preparation designs for ceramic veneers with and without incisal coverage. METHODS Primary clinical studies with the following characteristics were included: 1) studies related to ceramic laminate veneers and 2) prospective or retrospective studies conducted in humans. From the selected studies, the survival rates and failures rates for ceramic veneers were extracted according to preparation design, with or without incisal coverage. The Cochran Q test and the I(2) statistic were used to evaluate heterogeneity. Metaregression, meta-analysis were performed. Two reviewers searched in the MEDLINE (Pubmed) and Cochrane Central Register of Controlled Trials (Central) electronic databases, from 1977 to June 5, 2016, without language restrictions. RESULTS Eight studies out of 1145 articles initially identified were included for risk of bias and systematic assessment. No study was identified for crystalline ceramic veneers. The estimated survival rate for laminate veneers with incisal coverage was 88% and 91% for those without incisal coverage. Incisal coverage presented an OR of 1.25. CONCLUSIONS Irrespective of the preparation designs, with or without incisal coverage, ceramic veneers showed high survival rates. As regard implications for future clinical research studies, randomized clinical studies are necessary to compare preparation designs with and without incisal coverage, and to provide clear descriptions of these preparation designs.

Patient outcomes and procedure working time for digital versus conventional impressions: A systematic review

Statement of problem. Limited evidence is available comparing digital versus conventional impressions from the point of view of patient preference. Purpose. The purpose of this systematic review was to identify and summarize the available literature related to patient‐centered outcomes for digital versus conventional impression techniques. Material and methods. The databases Medline, Cochrane, Science Direct, Scopus, and Embase were electronically searched and complemented by hand searches. All published papers available on the databases from 1955 to July 2016 were considered for title and abstract analysis. Results. A total of 2943 articles were initially identified through database searches, of which only 5 met the inclusion criteria for qualitative analysis. Four studies comparing patient‐reported outcome measures (PROMs) between conventional and digital impressions revealed that the digital technique was more comfortable and caused less anxiety and sensation of nausea. Only 1 study reported no difference between the techniques regardless of patient comfort. Two studies reported a shorter procedure for the conventional technique, whereas 3 studies reported a shorter procedure for the digital technique. Conclusions. A lack of clinical studies addressing patient outcomes regarding digital prosthodontic treatments was observed among the included articles. However, current evidence suggests that patients are more likely to prefer the digital workflow than the conventional techniques.

Stress Distribution Around Dental Implants Placed at Different Depths.

Introduction:The progressive bone loss at the neck of dental implant is a clinical concern since it affects the maintenance of dental aesthetics. The current study evaluated the influence of insertion depth, prosthetic connection, and type of loading on the stress distribution around dental implants, using photoelastic evaluation. Materials and Methods:A total of three blocks of photoelastic resin for each type of implant connection (external hexagon, external hexagon flattened, internal hexagon, and Morse taper) were built. Each block differed in the position of the implant platform in relative to the upper margin of the block: I (2 mm below), II (at the same level), and III (2 mm above). A force of 100 N was applied to both straight and tilted abutments. Totally, 4 selected points were evaluated at 1 side of the implant. Quantitative data were collected for the statistical analysis. Results:A multiple linear regression showed the relation between the stress distribution and the insertion depth. For all the implant types, both with straight and tilted abutments, group I presented the lowest stress concentration around the fixture when compared with group II and III (P < 0.05). Conclusions:Within the limitations of this study, it could be concluded that the deeper the insertion, the lower the stress concentration.