Atenção odontológica especializada para pessoas com deficiência no Brasil: perfil dos centros de especialidades odontológicas, 2014

Objective. To analyze the specialized services of oral health care for people with disabilities, attended by the specialty of Special Care Dentistry (SCD). Methods. A cross-sectional study with data from the Program for Improving Access and Quality of Dental Specialties Centers (PMAQ-CEO), 2014. Results. A total of 932 services were evaluated: 89.8% did have SCD, 30.4% had physical accessibility, 59.7% had reference to hospital care and most guaranteed complete treatment. Only a third of the CEOs offered 40 hours per week of SCD. Conclusion. The network of care for people with disabilities is being formed, and even with specific financial incentives, has limitations. Services need to eliminate physical and attitudinal barriers to ensure universal accessibility. Protocols based on risk classification are necessary, prioritizing the attendance in the CEO of the complex cases, not attended in the primary care and organizing the dental health care network of the people with disabilities.Objetivo. Descrever os serviços de atenção à saúde bucal para pessoas com deficiência, atendidas pela especialidade Odontologia para Pacientes com Necessidades Especiais (PNE). Métodos. Estudo transversal, com dados do Programa de Melhoria do Acesso e Qualidade dos Centros de Especialidades Odontológicas (PMAQ-CEO), 2014. Resultados. Dos 932 serviços avaliados, 89,8% contavam com atendimento a PNEs, 30,4% apresentavam acessibilidade física e 59,7% contavam com referência para atendimento hospitalar. A maioria garantia tratamento completo. São disponibilizadas 40h semanais de atendimento clínico a PNEs em 1/3 dos CEOs. Conclusão. A rede de cuidado para pessoas com deficiência encontra-se em formação e, apesar dos incentivos financeiros específicos, apresenta limitações. Os serviços precisam eliminar barreiras físicas e atitudinais para garantir acessibilidade universal. Protocolos baseados em classificação de risco são necessários, priorizando atendimento no CEO dos casos complexos, não atendidos na Atenção Básica e organizando a rede de cuidados em saúde bucal da pessoa com deficiência

Avaliação da resistência ao cisalhamento da união entre duas ligas a base de CoCr e uma cerâmica

INTRODUCTION: Based on the importance of the integrity of the metal/ceramic interface, the purpose of this work was to evaluate the shear bond strength of the metal-ceramic union of two Co-Cr alloys (Wirobond C, Bego; Remanium 2000, Dentaurum) combined with Omega 900 ceramic (Vita Zahnfabrik). MATERIAL and METHOD: Eleven cylindrical matrixes were made for each alloy, and the metallic portion was obtained with the lost wax casting technique with standardized waxing of 4mm of height and of 4mm of diameter. The ceramic was applied according to the manufacturer’s recommendations with the aid of a teflon matrix that allowed its dimension to be standardized in the same size as the metallic portion. The specimens were submitted to the shear bond test in an universal testing machine (EMIC), with the aid of a device developed for such intention, and constant speed of 0.5mm/min. RESULTS and CONCLUSIONS: The mean resistance was 48.387MPa for Wirobond C alloy, with standard deviation of 17.718, and 55.956MPa for Remanium 2000, with standard deviation of 17.198. No statistically significant difference was observed between the shear strength of the two metal-ceramic alloys. ______________________________________________________________________________________________________________ RESUMOINTRODUÇÃO: Baseados na importância da integridade da interface metal-cerâmica, este trabalho tem como objetivo avaliar a resistência ao cisalhamento da união metal-cerâmica de duas ligas de Co-Cr (Wirobond C, Bego; Remanium 2000, Dentaurum) combinadas com a cerâmica Omega 900 (Vita Zahnfabrik). MATERIAIS E MÉTODOS: Foram confeccionados 11 corpos-de-prova cilíndricos para cada liga utilizada, sendo que a porção metálica foi obtida por fundição pela técnica da cera perdida, através de enceramentos padronizados com 4mm de altura por 4mm de diâmetro. A aplicação da cerâmica foi realizada segundo recomendações do fabricante, com auxílio de uma matriz de teflon que permitia sua padronização com as mesmas dimensões da porção metálica. Os corpos-de-prova foram submetidos ao ensaio de resistência ao cisalhamento em máquina de ensaios universal (EMIC), com auxílio de dispositivo desenvolvido para tal propósito, sob velocidade constante de 0,5mm/ min. RESULTADOS E CONCLUSÕES: As médias de resistência obtidas foram 48,387 MPa para a liga Wirobond C, com desvio padrão de 17,718, e 55,956 MPa para a Remanium 2000, com desvio padrão de 17,198. Após análise de variância foi possível observar que não há diferença estatisticamente significante entre os valores de resistência ao cisalhamento das duas ligas metalocerâmicas

Marginal fit of electroformed copings before and after the coction of the porcelain

The aim of this study was to evaluate the marginal discrepancy of electroforming copings, before and after the porcelain application, varying the cervical preparation of the crowns.Two master die were prepared with stainless steel to complete crown margin designs: chamfer and rounded shoulder. The impressions were taken with a polyvinylsiloxane by the double impression technique and, the insertion and removal axis were standardized by a dental surveyor. Ten type IV plaster dies from each cervical margin were obtained, on which a die spacer was applied before duplicate. The duplicated dies received a silver layer and connected to a copper wire to enable the gold electrodeposition. After cleaning and adjustments all specimens were examined under a microscope (magnificatio X 30). The marginal gap was measured before and after ceramic application. The results were elaborated by descriptive statistical and two-way analysis of variance (ANOVA). The ANOVA revealed no significant difference between marginal gap before and after the ceramic application (p=5%). It was concluded that the porcelain application does not influence the marginal fit of copings, therefore the two marginal endings can be used with the electroforming system

Evaluation of marginal adaptation of ceramic crowns depending on the marginal design and the addition of ceramic

This study evaluates the marginal adaptation of ceramic copings front of two finish lines and addition of ceramic. Hence, two master steel dies were milled with all-ceramic crowns preparation, one with a round shoulder finish line margin design, and the other with a deep chamfer. From each one of them, 15 copings were made, and the marginal discrepancy was evaluated in measuring microscope. The ceramic addition was accomplished in both groups with aid of a silicone matrix, and the discrepancies were measured again, obtaining the final mean gap values. The initial measurements resulted means of 44,0μm for deep chamfer and 24,0μm for the round shoulder, and the final measurements were 53,3μm for the deep chamfer and 27,4μm for the round shoulder. The data were submitted to the analysis of variance for verification of influence of the finish lines and application of the ceramic. When analyzed the interaction among the variables it was not observed statistical differences, but when comparing the two types of finish lines or the groups before and after ceramic addition, statistical differences were found. It is was concluded that the round shoulder finish line presents better values of marginal gap than deep chamfer and the addition of ceramic influences in the final gap values of marginal adaptation

Marginal fit of electroformed copings before and after the coction of the porcelain

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SOLUBILIDAD Y DUREZA SUPERFICIAL DE CERÁMICAS ODONTOLÓGICAS DESPUÉS DE SER EXPUESTAS A FLUIDO GÁSTRICO ARTIFICIAL. ESTUDIO IN VITRO

Enfermedades como reflujo gastroesofágico y bulimia, provocan alteraciones ácidas en la cavidad bucal que pueden causar erosión dental. El efecto de este medio ácido sobre materiales restauradores y posibles cambios en sus propiedades son poco relatado en la literatura. De esta forma, el objetivo de este trabajo fue evaluar la solubilidad y la microdureza de cerámicas feldespáticas expuestas in vitro a fluido gástrico simulado sin enzimas (pH 1,2). Fueron confeccionados 100 discos, de 8mm de diámetro y 2mm de altura, con las siguientes cerâmicas: Vitadur Alfa (I), Vita Omega 900 (II) Finesse All-Ceramic (III), IPS dSign (IV) y Carmen (V). Estos fueron divididos en tres grandes grupos según la exposición al fluido gástrico: (A) sin exposición, (B) 24 horas de exposición y (C) 7 días de exposición. La solubilidad fue evaluada por medio del pesaje en balanza digital (Metler Toledo), calculándose la cantidad de pérdida de masa (MP). El análisis de microdureza Vickers (MD) fué realizado utilizando un microdurómetro FM-700 (Future Tech). Los resultados obtenidos mostraron valores de pérdida de masa (%) de B, comparado con A, de: 0,1280(I), 0,2143(II), 0,0485(III), 0,1377(IV), 0,0824(V); y para C de: 0,1182(I), 0,2305(II), 0,0773(III), 0,1653(IV), 0,3256(V). Se observaron valores de dureza superficial para A de: 527,53(I), 531,67(II), 519,85(III), 544,72(IV), 523,72(V); para B de: 505,38(I), 529,63(II), 478,60(III), 514,91(IV); 504,97; y C de: 484,96(I), 495,61(II), 493,5(III), 482,76(IV), 488,22(V). El análisis estadístico con el test de ANOVA (p<0,05), mostró influencia del fluido gástrico tanto en la pérdida de masa como en la solubilidad de las cerámicas evaluadas