A systematic review and meta-analysis of the clinical performance of implant-supported overdentures retained by CAD-CAM bars

Currently, there is no consensus on the indications and clinical performance of implant-supported overdentures (IODs) involving computer-aided design and manufacturing (CAD-CAM) bars. Objective: To evaluate the performance of IODs involving CAD-CAM bars. Methodology: A comprehensive search of studies published until May 2023 was conducted in many databases, including PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The population, intervention, comparison, outcome (PICO) question was: “How do IODs retained by bars fabricated by CAD-CAM technology perform in daily clinical practice?” The meta-analysis included clinical studies based on effect size and a two-tailed null test with a 95% confidence interval (CI). Results: Ten studies were included in the meta-analysis. Among them, nine reported a 100% implant survival rate for all CAD-CAM milled bars. Complications were reported in two studies with CAD/CAM-milled titanium bars, and one study reported more fractures in soldered gold bars used in maxillary rehabilitation. However, no fractures were observed in IODs retained by PEEK and zirconia bars. According to six studies, biological complications, including peri-implantitis, were minimal in the BioHPP and PEEK bar groups, while no cases were reported in the titanium or zirconia bar groups. CAD-CAM-milled zirconia bars had higher plaque and bleeding indices compared with titanium bars, as evidenced by findings from five studies. All four studies that evaluated Oral Health Impact Profile (OHIP) scores showed a positive effect of IODs retained by CAD-CAM milled titanium bars on quality of life. Patient satisfaction and acceptance by prosthodontists were significantly high, according to the results of five studies. Conclusion: Overdentures retained with CAD-CAM milled titanium bars show great potential for use in daily clinical practice. Moreover, patient and practitioner satisfaction was very high when this method was used

The superiority of the CAD-CAM acrylic resins: myth or a reality?

As propriedades de rugosidade superficial e microdureza são reconhecidas como propriedades muito relevantes no que concerne ao tratamento com prótese total removível, estando associadas ao desgaste da prótese e à sua predisposição à colonização por microrganismos. A proposição deste estudo foi realizar uma análise longitudinal e comparativa, destas duas propriedades, entre uma nova resina acrílica (Vipi Block Gum) para bases de próteses totais removíveis, implementada na tecnologia CAD-CAM, e duas resinas acrílicas termopolimerizáveis, sendo uma convencional (Vipi Cril Plus) e outra polimerizada por ação de micro-ondas (Vipi Wave), antes e após a aplicação de sucessivos ciclos de envelhecimento térmico por temociclagem, de modo a investigar a existência de uma correlação entre o processo de polimerização e o desempenho do material. Para isto, foram confeccionados um total de 60 corpos de prova com formato quadrangular com dimensões de 12x12x3mm, sendo destinados 20 corpos de prova para cada material. Para cada resina, 10 corpos de prova foram destinados ao teste de microdureza Knoop (KHN) e os outros 10 corpos de prova foram submetidos ao teste de rugosidade superficial (Ra-m). As análises dos corpos de prova, para ambos os experimentos, foram realizadas em quatro estágios distintos. As primeiras leituras foram realizadas após imersão dos materiais em água deionizada a 37ºC durante 24 horas (T1), com subsequentes análises após a aplicação de 500 ciclos (T2), 1000 ciclos (T3) e 3000 ciclos (T4) de termociclagem, com temperaturas de 5ºC a 55ºC com duração de 60 segundos para cada banho. Na avaliação estatística, a comparação das médias entre os grupos de resinas foi realizada com o teste de análise de variância (ANOVA) de um critério sendo, seguido do teste de Tukey. Para a comparação interna de cada grupo, em relação ao estágio de termociclagem, foi utilizado um ANOVA de medidas repetidas. O nível de significância adotado foi de 5%. Não houve diferença estatisticamente significante, na comparação intragrupos e intergrupos, em relação à rugosidade superficial (p>0.05). Na análise comparativa da microdureza entre os grupos, foi observada diferença estatisticamente significante nas análises em T1 e T2, com a resina Vipi Block obtendo valores superiores às outras resinas (p=0.00). Em T3, observou-se uma redução significativa da microdureza de todas as resinas, sendo mais pronunciada na resina Vipi Block Gum, tendo esta sido estatisticamente superior apenas em relação à Vipi Wave (p=0.01). Em T4 foi observado um aumento significativo na resina Vipi Cril Plus, com diferença estatisticamente significante (p>0.05) em relação às outras resinas. Na análise interna de cada grupo, foram observadas interações estatisticamente significantes em todas as resinas (p0.05). The intergroup microhardness analyses showed significant differences at T1 and T2 (p=0.00), with higher values presented by the Vipi Block Gum resin when compared to the other groups. At T3, it was noticed a significant reduction for all materials, although it was more pronounced in the Vipi Block Gum resin, with this group having higher values than the Vipi Wave group (p=0.01). The comparison at T4 showed significant higher values presented by the Vipi Cril Plus in relation to the other groups (p<0.05). The intragroup analyses exhibited statistical significant differences for all materials (p<0.05). Vipi Block Gum resin suffered a significant decrease on its microhardness at T3, which remained similar at T4. However, these values were significant below (p<0.05) the ones obtained at T1 and T2. Vipi Cril Plus group showed a significant decrease at T3 in comparison with T1 (p=0.021). However, it increased significantly at T4 having statistical higher values than all other periods (p<0.05). Vipi Wave group suffered an expressive decrease at T3 in comparison with T2 (p=0.01). It also had an increase on its microhardness at T4, with statistical higher values than the ones observed at T3 (p=0.01)

O efeito da desinfecção por microondas no tratamento da estomatite protética associada à Candida spp. e na estabilidade dimensional de resinas acrílicas para bases de próteses totais removíveis

Microwave disinfection has been reported as an alternative method for treating Candida-associated denture stomatitis (CADS). However, the information regarding the best protocol for treating Candida-associated denture stomatitis, and that does not promote changes on the dimensional stability of the complete dentures, is still scarce and diverging. Therefore, the objective of this study was to systematically assess the effectiveness of microwave disinfection against CADS (part 1), and its effect on the dimensional stability of denture base acrylic resins (part 2). The PubMed/MEDLINE, EMBASE, and SCOPUS databases were searched for randomized clinical trials (part 1), and clinical and in vitro studies (part 2) published in English, that have compared microwave disinfection to positive and/or control groups. The main outcomes were the improvement of the clinical signs and/or the decrease in the residual yeast of the dentures and palatal mucosa, and the changes on the dimensional stability measured in grams. Therefore, the mean differences, standard deviations, risk ratio, and 95% confidence interval were calculated by using the random-effects model. Heterogeneity was assessed by using Cochrans Q test and I2 values. The level of significance was set at p0.05) to antifungal therapy with topical nystatin (100.000 IU/mL), chemical disinfection with 2% chlorhexidine and 0.02% sodium hypochlorite, and was more effective than topical application of miconazole (p0.05). Regarding the dimensional stability, microwave disinfection produced significant changes when compared with sodium hypochlorite, chloride solution, chlorhexidine, and water immersion (p0.05) and better (p0.05) à terapia antifúngica por meio da aplicação tópica de nistatina (100.000 IU/mL), assim como à desinfecção química com clorexidina a 2% e hipoclorito de sódio a 0.02%, e foi superior à aplicação tópica de miconazol no tratamento da estomatite protética. Adicionalmente, os resultados da meta-análise não mostraram diferença estatística entre a desinfecção por microondas e a aplicação tópica de nistatina (100.000 IU/mL) tanto para a contagem de células, assim como para as taxas de cura e recorrência (p>0.05). Em relação à estabilidade dimensional, a desinfecção por microondas gerou alterações significativas quando comparada à desinfecção química com hipoclorito de sódio, solução clorada, clorexidina e imersão em água (p0.05) ou melhores (p<0.05) que os grupos controle. Desta forma, a desinfecção por microondas demonstrou resultados comparáveis aos tratamentos convencionais usados para a estomatite protética, com o protocolo usando 650 Watts por 3 minutos, uma vez por semanas durante 14 dias apresentando melhor custo-benefício para a prevenção de tratamento da estomatite protética associada a Candida spp. Adicionalmente , os protocolos de desinfecção utilizando 500 Watts por 3 minutos, e 450 Watts por 5 minutos, indicaram ser mais seguros em relação à estabilidade dimensional das resinas acrílicas

The superiority of the CAD-CAM acrylic resins: myth or a reality?

As propriedades de rugosidade superficial e microdureza são reconhecidas como propriedades muito relevantes no que concerne ao tratamento com prótese total removível, estando associadas ao desgaste da prótese e à sua predisposição à colonização por microrganismos. A proposição deste estudo foi realizar uma análise longitudinal e comparativa, destas duas propriedades, entre uma nova resina acrílica (Vipi Block Gum) para bases de próteses totais removíveis, implementada na tecnologia CAD-CAM, e duas resinas acrílicas termopolimerizáveis, sendo uma convencional (Vipi Cril Plus) e outra polimerizada por ação de micro-ondas (Vipi Wave), antes e após a aplicação de sucessivos ciclos de envelhecimento térmico por temociclagem, de modo a investigar a existência de uma correlação entre o processo de polimerização e o desempenho do material. Para isto, foram confeccionados um total de 60 corpos de prova com formato quadrangular com dimensões de 12x12x3mm, sendo destinados 20 corpos de prova para cada material. Para cada resina, 10 corpos de prova foram destinados ao teste de microdureza Knoop (KHN) e os outros 10 corpos de prova foram submetidos ao teste de rugosidade superficial (Ra-m). As análises dos corpos de prova, para ambos os experimentos, foram realizadas em quatro estágios distintos. As primeiras leituras foram realizadas após imersão dos materiais em água deionizada a 37ºC durante 24 horas (T1), com subsequentes análises após a aplicação de 500 ciclos (T2), 1000 ciclos (T3) e 3000 ciclos (T4) de termociclagem, com temperaturas de 5ºC a 55ºC com duração de 60 segundos para cada banho. Na avaliação estatística, a comparação das médias entre os grupos de resinas foi realizada com o teste de análise de variância (ANOVA) de um critério sendo, seguido do teste de Tukey. Para a comparação interna de cada grupo, em relação ao estágio de termociclagem, foi utilizado um ANOVA de medidas repetidas. O nível de significância adotado foi de 5%. Não houve diferença estatisticamente significante, na comparação intragrupos e intergrupos, em relação à rugosidade superficial (p>0.05). Na análise comparativa da microdureza entre os grupos, foi observada diferença estatisticamente significante nas análises em T1 e T2, com a resina Vipi Block obtendo valores superiores às outras resinas (p=0.00). Em T3, observou-se uma redução significativa da microdureza de todas as resinas, sendo mais pronunciada na resina Vipi Block Gum, tendo esta sido estatisticamente superior apenas em relação à Vipi Wave (p=0.01). Em T4 foi observado um aumento significativo na resina Vipi Cril Plus, com diferença estatisticamente significante (p>0.05) em relação às outras resinas. Na análise interna de cada grupo, foram observadas interações estatisticamente significantes em todas as resinas (p0.05). The intergroup microhardness analyses showed significant differences at T1 and T2 (p=0.00), with higher values presented by the Vipi Block Gum resin when compared to the other groups. At T3, it was noticed a significant reduction for all materials, although it was more pronounced in the Vipi Block Gum resin, with this group having higher values than the Vipi Wave group (p=0.01). The comparison at T4 showed significant higher values presented by the Vipi Cril Plus in relation to the other groups (p<0.05). The intragroup analyses exhibited statistical significant differences for all materials (p<0.05). Vipi Block Gum resin suffered a significant decrease on its microhardness at T3, which remained similar at T4. However, these values were significant below (p<0.05) the ones obtained at T1 and T2. Vipi Cril Plus group showed a significant decrease at T3 in comparison with T1 (p=0.021). However, it increased significantly at T4 having statistical higher values than all other periods (p<0.05). Vipi Wave group suffered an expressive decrease at T3 in comparison with T2 (p=0.01). It also had an increase on its microhardness at T4, with statistical higher values than the ones observed at T3 (p=0.01)

Metal-ceramic partial fixed dentures: a retrospective study

ABSTRACT Objective Metal-ceramic prosthesis are the treatment of choice in oral rehabilitation because of their high survival rates. However, there are few reports in the scientific literature about factors that lead to fractures of metal-ceramic prostheses. The aim of this study was to evaluate whether prostheses units number, abutment type and number, type of the prostheses, prostheses position in the mouth, bruxism and occlusal plaque influence the incidence of fractures in fixed metal-ceramic prostheses. Methods For this study, 16 patients were selected, totaling 74 metal-ceramic prostheses installed between 2000-2010, with follow up of at least four years. Besides dental history, other information was collected, such as patients’ gender and age, prostheses installation date, and the ceramic system used. In case of prostheses fracture, a questionnaire was applied to identify signs of bruxism. A clinical evaluation was done to evaluate the prostheses integrity and opposing dentition characteristics. Success, failure and survival rates were determined. Results The results showed that the success rate of metal-ceramic prostheses was 87.8% and the survival rate was 89.1%. In addition, the success rate was independent of patient age, prostheses installation time, number of prosthesis, number of prosthesis’ units and abutments. The qualitative variables also did not show significant statistical results between success and failure rates. Conclusion It was concluded that metal-ceramic prostheses have high success and survival rates, what guarantees longevity and indication of this type of prostheses in daily practice

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora