Effect of mechanical cycling, material and retorque screws, in stability of complete implant-suported prosthesis with two fit levels

Orientador: Marcelo Ferraz MesquitaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O afrouxamento dos parafusos protéticos é frequentemente encontrado nos exames de rotina e pode causar complicações. Assim, métodos para sua prevenção devem ser desenvolvidos. O objetivo neste estudo foi avaliar a influência do retorque de parafusos protéticos (titânio ou ouro) na estabilidade de próteses totais implantossuportadas com diferentes níveis de adaptação (passiva ou desadaptada), após simulação da função mastigatória por meio de ciclagem mecânica (6 meses, torque de afrouxamento, reaperto dos parafusos + 6 meses de simulação; ou 1 ano de simulação e torque de afrouxamento). No capítulo 1, 10 próteses mandibulares implantossuportadas e 20 modelos foram confeccionados para duas condições de adaptação: passiva (adaptada) e não-passiva (desadaptada). Também foram avaliadas duas técnicas de aperto em função da aplicação de retorque e materiais do parafuso: 1) sem retorque + parafusos de titânio; 2) sem retorque + parafusos de ouro; 3) com retorque + parafusos de titânio; e, 4) com retorque + parafusos de ouro. Para a técnica de aplicação de retorque, os parafusos foram apertados (10 Ncm) e após 10 minutos, reapertados (10 Ncm). O torque de afrouxamento dos parafusos foi mensurado por meio de torquímetro digital de precisão após simulação de 1 ano da função mastigatória. Os dados foram submetidos à análise de variância (ANOVA) em 2 fatores seguido pelo teste complementar de Tukey em (?=0,05). Os fatores adaptação e técnica de aperto (retorque e tipo de parafuso), e a interação entre os fatores foram estatisticamente significantes. O desajuste diminui o torque de afrouxamento. A aplicação do retorque aumentou a estabilidade da conexão dos parafusos, independente da adaptação ou material dos parafusos. No capítulo 2, próteses passivas e não-passivas foram fabricadas de modo semelhante ao capítulo 1. O torque de afrouxamento foi mensurado após 2 condições de simulação de uso clínico: 1) 6 meses / torque de afrouxamento / reaperto / mais 6 meses / torque de afrouxamento; 2) 1 ano de simulação / torque de afrouxamento. Foram utilizados parafusos de titânio e ouro. O teste estatístico foi similar ao capítulo 1. O fator tempo de ciclagem e condição de uso (nível de ajuste e tipo de parafuso), bem como a interação desses fatores influenciaram os valores de torque de afrouxamento (p<0,05). Após 6 meses + 6 meses de simulação de uso clínico, os parafusos de titânio apresentaram maiores valores de torque de afrouxamento quando comparados aos parafusos de ouro, para o mesmo nível de adaptação. Após 1 ano de simulação de uso clínico, ambos materiais dos parafusos em próteses passivas apresentaram valores mais elevados que em próteses não-passivas. Dessa forma podemos concluir que a desadaptação reduz o torque de afrouxamento dos parafusos e que o retorque após 10 minutos consegue estabilizá-los. Parafusos de titânio apresentaram maior estabilidade que parafusos de ouro após 6 meses de simulação devido a sua menor deformação plástica. Quando o tempo de ciclagem foi analisado, parafusos de titânio apresentaram menor estabilidade após 1 ano de simulação devido à perda de torque frente à desadaptação, necessitando acompanhamento mais criterioso para que mantenham sua estabilidadeAbstract: The prosthesis screw loosening is often found at routine examinations and may cause complications. Therefore, methods to prevent them must be developed. The objective of this study was to evaluate the influence of retorque application on joint stability of prosthetic screws (titanium or gold) in implant-supported dentures under different fit levels (passive or misfit), after masticatory function simulated by means of mechanical cycling (6 months, loosening torque, screws retightening and another 6 months of simulation; or 1 year of simulation). In the first chapter, 10 mandibular implant-supported dentures and 20 cast models were fabricated to two fit levels: passive fit and misfit. Two tightening techniques were also evaluated according to the retorque application and screws material: 1) without retorque + titanium screws; 2) without retorque + gold screws; 3) retorque + titanium screws; and 4) retorque + gold screws. The screws were tightened 10 Ncm and retightened to 10 Ncm after 10 min. The screw joint stability was measured after a one-year clinical function simulation using a digital torque meter. Data were analyzed statistically by ANOVA/Tukey's test (?=0.05). The factors of fit level and tightening technique and the interaction between the factors were statistically significant. The misfit decreases the loosening torque. The retorque application increased joint stability independent of fit level or screw material. In the chapter 2, passive and misfit dentures were fabricated as in chapter 1. The loosening torque was measured after two conditions of clinical use simulating: six months / torque loosening / retightening / further six months / loosening torque; and one year of simulation / loosening torque. Titanium and gold screws were used. The statistical analysis was similar to the first chapter. Therefore, the factor cycling time and condition use (fit level and screw type) as well the interaction between the factors influenced the loosening torque values (p<0.05). After six months another six months of masticatory function simulated, the titanium screws showed higher loosening torque than did gold screws for the same fit level. After one year of clinical use simulation, both material screws in passive dentures showed higher loosening torque values than did misfit dentures. Thus we can conclude that the misfit decreases the loosening torque and retorque application increased joint stability. The stability of titanium screws was higher than gold screws after 6 months of simulation, due to its lower plastic deformation. When the cycling time was analyzed, titanium screws were less stable after 1 year of simulation due to loss of torque in misfit presence, requiring more careful monitoring to maintain stabilityDoutoradoProtese DentalDoutor em Clínica Odontológic

Removal of Water Binding Proteins from Dentin Increases the Adhesion Strength of Low-Hydrophilicity Dental Resins

Objectives To investigate the role of proteoglycans (PGs) on the physical properties of the dentin matrix and the bond strength of methacrylate resins with varying hydrophilicities. Methods Dentin were obtained from crowns of human molars. Enzymatic removal of PGs followed a standard protocol using 1 mg/mL trypsin (Try) for 24 h. Controls were incubated in ammonium bicarbonate buffer. Removal of PGs was assessed by visualization of glycosaminoglycan chains (GAGs) in dentin under transmission electron microscopy (TEM). The dentin matrix swelling ratio was estimated using fully demineralized dentin. Dentin wettability was assessed on wet, dry and re-wetted dentin surfaces through water contact angle measurements. Microtensile bond strength test (TBS) was performed with experimental adhesives containing 6% HEMA (H6) and 18% HEMA (H18) and a commercial dental adhesive. Data were statistically analyzed using ANOVA and post-hoc tests (α = 0.05). Results The enzymatic removal of PGs was confirmed by the absence and fragmentation of GAGs. There was statistically significant difference between the swelling ratio of Try-treated and control dentin (p \u3c 0.001). Significantly lower contact angle was found for Try-treated on wet and dry dentin (p \u3c 0.002). The contact angle on re-wet dentin was not recovered in Try-treated group (p = 0.9). Removal of PGs significantly improved the TBS of H6 (109% higher, p \u3c 0.001) and H18 (29% higher, p = 0.002) when compared to control. The TBS of commercial adhesive was not affected by trypsin treatment (p = 0.9). Significance Changing the surface energy of dentin by PGs removal improved resin adhesion, likely due to more efficient water displacement, aiding to improved resin infiltration and polymerization

Morphological analysis of glass, carbon and glass/carbon fiber posts and bonding to self or dual-cured resin luting agents

OBJECTIVE: The aim of this study was to evaluate the morphology of glass (GF), carbon (CF) and glass/carbon (G/CF) fiber posts and their bond strength to self or dual-cured resin luting agents. MATERIAL AND METHODS: Morphological analysis of each post type was conducted under scanning electron microscopy (SEM). Bond strength was evaluated by microtensile test after bisecting the posts and re-bonding the two halves with the luting agents. Data were subjected to two-way ANOVA and Tukey's test (&#945;=0.05). Failure modes were evaluated under optical microscopy and SEM. RESULTS: GF presented wider fibers and higher amount of matrix than CF, and G/CF presented carbon fibers surrounded by glass fibers, and both involved by matrix. For CF and GF, the dual-cured material presented significantly higher (p<0.05) bond strength than the self-cured agent. For the dual agent, CF presented similar bond strength to GF (p>0.05), but higher than that of G/CF (p<0.05). For the self-cured agent, no significant differences (p>0.05) were detected, irrespective of the post type. For GF and G/CF, all failures were considered mixed, while a predominance of adhesive failures was detected for CF. CONCLUSION: The bonding between fiber posts and luting agents was affected by the type of fibers and polymerization mode of the cement. When no surface treatment of the post is performed, the bonding between glass fiber post and dual-cured agent seems to be more reliable

Effect of intracanal medication on the bond strength of root canal sealer to dentin

Objetivo: Este estudo teve como objetivo avaliar a influência da medicação intracanal na resistência de união de um cimento obturador endodôntico à dentina radicular. Métodos: Foram utilizadas 24 raízes bovinas unirradiculares que foram submetidas ao preparo químico-cirúrgico e divididas aleatoriamente em 4 grupos da seguinte forma: G1, (controle), sem medicação; G2, Hidróxido de Cálcio (Ca(OH)2) + Clorexidina (CHX); G3, bolinha de algodão embebida em Formocresol; e, G4, bolinha de algodão embebida em Paramonoclorofenol Canforado. As amostras ficaram armazenadas em temperatura ambiente e 100% de umidade por 1 semana. Logo após, foram obturadas com cimento endodôntico AH Plus e cones de guta-percha. Os dentes foram então fatiados transversalmente e o teste de push-out foi realizado. Os dados foram tabulados e submetidos à Análise de Variância. Resultados: As médias e seus respectivos desvios-padrão foram: G1, 2,42 (±1,45) ; G2, 1,81 (±1,04); G3, 2,21 (±1,14); e, G4, 2.63 (±1.32). Os resultados mostraram que não houve diferença estatisticamente significante entre os grupos em estudo. Conclusão: Pode-se concluir que as medicações intracanal utilizadas neste estudo não influenciaram na resistência de união do cimento obturador AH Plus à dentina radicular. Objective: The aim of this study was to investigate the influence of intracanal medication on the bond strength of root canal sealer to dentin. Methods: The root canals of 24 bovine incisor were prepared and randomly divided into 4 groups as follows: G1, (control group) no intracanal medication; G2, calcium hydroxide (Ca(OH)2) + chlorhexidine; G3, cotton with Formocresol; and, G4, cotton with camphorated paramonochlorophenol. The samples were stored at temperature of 37 degrees and 100% humidity for 1 week. After, they were sealed with AH Plus sealer and gutta-percha. All roots were sectioned transversely, and the push-out test was performed. The bond strength means were analyzed by analysis of variance. Results: The mean values for the bond strength test and standard deviations were: G1, 2.42 (±1.45); G2, 1.81 (±1.04); G3, 2.21 (±1.14); e, G4, 2.63 (±1.32). The results showed no statistically significant difference between the groups. Conclusion: It can be concluded that intracanal medications used in this study did not influence on the bond strength of AH Plus root canal sealer to dentin

Behavioral manifestations in rodent models of autism spectrum disorder : protocol for a systematic review and network meta-analysis

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition associated with severe social communication, interaction, and sensory processing impairments. Efforts to understand its etiology and pathophysiology are crucial for improving treatment and prevention measures. Preclinical models of ASD are essential for investigating the biological mechanisms and should present translatability potential. We aim to evaluate the consistency of the most commonly used rodent models of ASD in displaying autistic-like behavior through a systematic review and meta-analysis. Methods: This review will focus on the most frequently used autism models, surveying studies of six genetic (Ube3a, Pten, Nlgn3, Shank3, Mecp2, and Fmr1), three chemically induced (valproic acid (VPA), lipopolysaccharide (LPS), and polyinosinic:polycytidylic acid (poly(I:C))), and one inbred model (BTBR T+ Itpr3tf/J mouse strain). Two independent reviewers will screen the records. Data extraction of behavioral outcomes and risk of bias evaluation will be performed. We will conduct a meta-analysis whenever at least five studies investigate the same model and behavioral outcome. We will also explore the heterogeneity and publication bias. Network meta-analyses are planned to compare different models. Discussion: By shortening the gap between animal behavior and human endophenotypes or specific clinical symptoms, we expect to help researchers on which rodent models are adequate for research of specific behavioral manifestations of autism, which potentially require a combination of them depending on the research interest

Influence of glass fiber posts and class III direct restorations on the resistance of anterior teeth

This study objectives to evaluate the fracture strength of upper central incisors (UCI) restored with composite resin (CR) in Class III cavities and endodontically treated teeth with or without glass fiber post (GFP), analyzing their failure mode. Sixty human UCI were randomly divided into four experimental groups: endodontically treated teeth without GFP (G1), endodontically treated teeth with GFP (G2), teeth with mesial/distal Class III cavities restored with CR without GFP (G3), and teeth with mesial/distal Class III cavities restored with CR with GFP (G4). The samples were submitted to the fracture strength test in a universal testing machine with a compression shear load applied at speed of 1.0 mm/min until fracture occurred. The data were submitted to one-way ANOVA (α=0.05) and the samples were analyzed for failure mode. The analysis did not show a significant statistical difference in fracture strength between the groups (p>0.05). The results showed that only endodontically treated teeth (G1) (753.4N) presented behavior similar to teeth with GFP (G2) (702.1N). The same occurred when comparing teeth with Class III cavities without GFP (G3) (670.2 N) and with GFP (G4) (746.1N). It can be concluded that glass fiber posts do not change the fracture strength of incisors with endodontic treatment and Class III cavities

Caso 3/19: “O 18º espaço porta”

Caso relatado na Reunião de Discussão de Casos Clínicos do Hospital Universitário Prof. Polydoro Ernani de São Thiago, iniciada pelos Profs. Jorge Dias de Matos, Marisa Helena César Coral e Rosemeri Maurici da Silva, em julho de 2017. No dia 12 de agosto de 2019, no bloco do curso de medicina, realizou-se a apresentação e discussão do caso cujo registro é apresentado a seguir: um paciente masculino de 25 anos é encaminhado ao serviço de gastroenterologia com esplenomegalia e hipertensão portal. Qual é o diagnóstico

Odontologia na extensão universitária: saúde bucal ao alcance de todos / Dentistry in university extension: oral health within everyone's reach

A constante interdisciplinaridade entre as áreas da saúde, incluindo a Odontologia, objetiva, por meio de ações de extensão universitária, proporcionar tratamento às populações socialmente vulneráveis. O objetivo deste trabalho é relatar, por meio de um caso clínico de prótese total imediata (PTI), a experiência extensionista dos acadêmicos de Odontologia da UPF. A PTI consiste na instalação de uma dentadura imediatamente após a extração dos dentes de um arco dentário. Tal tratamento auxilia o paciente a manter ou restaurar as funções bucais durante o período de transição. O objetivo dessa prótese é suprir as perdas dentárias tão efetivamente quanto possível. O caso clínico apresentado trata de um paciente masculino, leucoderma, 58  anos,  que  possuía  situação  dentária precária no aspecto estético e funcional. Após o devido planejamento, confeccionou-se duas PTIs, que foram instaladas logo após a exodontia dos dentes remanescentes, os quais se encontravam periodontalmente abalados. Pode-se notar que tratamentos simples e relativamente pouco onerosos como a PTI possibilitam devolver satisfatoriamente a saúde bucal e auto-estima das populações vulneráveis.