Retention force of T-bar clasps for titanium and cobalt-chromium removable partial dentures

The objective of this study was to evaluate the retention force of T-bar clasps made from commercially pure titanium (CP Ti) and cobalt-chromium (Co-Cr) alloy by the insertion/removal test simulating 5 years use. Thirty-six frameworks were cast from CP Ti (n=18) and Co-Cr alloy (n=18) with identical prefabricated patterns on refractory casts from a distal extension mandibular hemi-arch segment. The castings were made on a vacuum-pressure machine, under vacuum and argon atmosphere. Each group was subdivided in three, corresponding to 0.25 mm, 0.50 mm and 0.75 mm undercuts, respectively. No polishing procedures were performed to ensure uniformity. The specimens were subjected to an insertion/removal test and data was analyzed statistically to compare CP Ti and Co-Cr alloy in the same undercut (Student's t-test for independent samples) and each material in different undercuts (one-way ANOVA) (p=0.05). Comparisons between materials revealed significant differences (p=0.017) only for the 0.50-mm undercut. No significant differences (p>0.05) were found when comparing the same material for the undercuts. It may be concluded that for different undercuts, both Co-Cr alloy and CP Ti had no significant differences for T-bar clasps; CP Ti showed the lowest retention force values when compared to Co-Cr alloy in each undercut, but with significant difference only for the 0.50-mm undercut; and both materials maintained the retentive capacity during the simulation test.O objetivo deste estudo foi avaliar a força de retenção de grampos tipo barra T confeccionados em titânio cp e liga de Co-Cr, através do ensaio de simulação de uso de estruturas metálicas por um período de 5 anos. Sobre modelos de revestimento que simulavam uma extremidade livre unilateral, foram fundidas 36 estruturas em titânio cp (n=18) e em Co-Cr (n=18) utilizando padrões pré-fabricados. As fundições foram feitas em máquina de vácuo-pressão sob vácuo e atmosfera inerte de argônio. Cada grupo foi subdividido em três correspondendo às retenções de 0,25 mm, 0,50 mm e 0,75 mm, respectivamente. Para manter a uniformidade dos grampos, não foram realizados procedimentos de polimento. Os corpos-de-prova foram submetidos ao teste de inserção e remoção e os dados foram analisados estatisticamente (p=0,05) para comparar Ti cp e Co-Cr na mesma retenção (teste T de Student para amostras independentes) e cada material nas diferentes retenções (análise de variância a um fator). A comparação entre os materiais revelou diferença significativa apenas para retenção de 0,50 (p=0,017). Não foram encontradas diferenças quando se comparou o mesmo material nas diferentes retenções (p>0,05). Pode-se concluir que para as diferentes retenções, grampos barra T confeccionados em liga de Co-Cr e titânio não apresentaram diferença estatisticamente significante; o titânio apresentou menores valores de retenção quando comparado à liga de Co-Cr em cada uma das retenções, mas diferença estatisticamente significante só foi encontrada para a retenção 0,50-mm; e ambos materiais mantiveram a capacidade retentiva durante o teste de simulação de uso.FAPES

Tooth Extractions in Patients with Periodontal Diseases and Clinical Decision-Making Process

Ciljevi: Željelo se istražiti profesionalne aspekte te kliničke i rendgenske pokazatelje koji utječu na odluku parodontologa i općih stomatologa o vađenju zuba. Materijali i metode: Uzorak se sastojao od 150 (n = 106 žena i 44 muškarca) doktora dentalne medicine (n = 103 općih stomatologa i 47 parodontologa) koji su ispunili upitnik osmišljen za prikupljanje presječnih informacija koje se odnose uglavnom na razinu njihove edukacije i iskustvo u praksi, te na osobnu terapijsku odluku u slučaju četiri pacijenta s parodontnim bolestima. Bivarijantna analiza obavljena je kako bi se testirala povezanost kliničkih odluka i profesionalnih informacija prikupljenih od doktora dentalne medicine. Rezultati: U određenim slučajevima parodontolozi su odlučili sačuvati više zuba od općih stomatologa (p < 0,05). U drugima, pak, doktori s višegodišnjim iskustvom u praksi odlučili su se za više ekstrakcija (p < 0,05). Stupanj parodontne bolesti (50 – 92 %), loša oralna higijena (42,6 –67,3 %) i nedostatak alveolarne kosti (43,2 – 79,3 %) bili su najčešći razlozi za odluku o vađenju. Zaključak: Viša razina edukacije u dentalnoj medicini, posebno u parodontologiji te višegodišnje iskustvo u praksi mogu utjecati na utemeljenu odluku o vađenju zuba ili o očuvanju u specifičnim slučajevima.Objectives: To investigate the professional aspects and clinical and radiographic evidence that influences the decision for the extraction of teeth among periodontologists and general dentists. Material and methods: The sample consisted of 150 (n=106 females and 44 males) dentists (n=103 general dentists and 47 periodontologists) that responded to a questionnaire designed to retrieve crosssectional information related mainly to their level of training and time of experience in practice, as well as their personal decision for managing four patients with periodontal disease. Bivariate analyses were performed to test the association between the clinical decisions and the professional information collected from the dentists. Results: In specific cases, periodontologists decided to maintain more teeth than general dentists (p<0.05). In other cases, dentists with more years of experience in practice decided to opt for more extractions (p<0.05). The level of periodontal disease (50-92%), poor oral hygiene (42.6-67.3%) and lack of alveolar bone structure (43.2-79.3%) were the most prevalent reasons behind the decision for extractions. Conclusions: An advanced level of training in Dentistry, especially Periodontology, and more years of experience in practice may lead to more wellfounded decisions on whether extracting teeth or not in case-specific scenarios

Effect of acetyl resin retentive arms on the retentive force ofcircumferential clasps: an in vitro study.

PURPOSE: To compare and to evaluate the stability of the retentive force of cobalt-chromium (Co-Cr) circumferential clasps (control) to those with an acetyl resin retentive arm. METHODS: Sixteen specimens with a couple of circumferential clasps were made using Co-Cr over a metal model providing 0.25 mm undercuts. Eight specimens were fabricated without the anterior retentive arm, which was made later using acetyl resin (Dental D). Insertion and removal simulation test was performed through 7250 cycles. The retentive force was recorded in Newtons (N) for periods corresponding to 0, 1, 2, 3, 4, and 5 years. The data were subjected to ANOVA and Tukey test to compare periods and to Student's t test to compare groups (α=0.05). RESULTS: Mean (SD) is presented for Co-Cr and resin groups, respectively: 8.09(3.05) and 2.79(1.57) in period 0; 10.48(4.25) and 3.32(1.92) in 1 year; 10.09(4.15) and 3.47(1.81) in 2 years; 9.87(4.30) and 3.46(1.87) in 3 years; 9.46(3.93) and 3.27(1.59) in 4 years; 9.63(3.79) and 3.41(1.59) in 5 years. There were significant differences for Co-Cr between periods of 0 and 1 (p0.05). Comparisons between the groups showed statistical differences for all tested periods: 0 (p=0.0012), 1 (p=0.0013), 2 (p=0.0019), 3 (p=0.0031), 4 (p=0.0027) and 5 years (p=0.0014). CONCLUSIONS: Acetyl resin retentive arms, even if only in the anterior clasps, can significantly reduce the retentive force, but this force remained stable after 5 years of simulated use

A study of the correlation between marginal fit and tensions transmitted to implants by one-piece metal castings - a photoelastic analysis.

Um dos maiores obstáculos para o sucesso das reabilitações com próteses sobre implantes consiste na obtenção de boa adaptação marginal dos componentes protéticos. Não está claro na literatura quais níveis de desajuste são considerados clinicamente aceitáveis, mas sabe-se que a ausência de perfeito ajuste e assentamento passivo pode provocar tensões inadequadas na interface de osseointegração, possibilitando problemas mecânicos e biológicos. A fotoelasticidade é uma técnica experimental para análise de tensões capaz de produzir resultados bastante confiáveis e fiéis aos parâmetros clínicos. Quando estruturas metálicas para próteses sobre múltiplos implantes são fundidas em monobloco, a obtenção de boa adaptação marginal parece ser ainda mais crítica. Contudo, não se verificam estudos que abordem a influência do tipo de metal ou liga empregado nessas fundições sobre os níveis de desadaptação protética. Assim, o presente estudo tem como objetivos verificar a adaptação marginal entre os pilares intermediários e estruturas fundidas em monobloco com diferentes materiais; avaliar, pelo método fotoelástico, as tensões impostas aos implantes quando a eles são fixadas as estruturas metálicas; e ainda pesquisar possíveis correlações entre os níveis de adaptação marginal e as tensões geradas na interface implante-material fotoelástico. Para tanto, utilizando cilindros calcináveis, foram enceradas 15 estruturas para próteses implanto-retidas sobre modelo simulando o posicionamento de cinco implantes na região intermentoniana. As estruturas foram divididas em grupos de cinco e fundidas em monobloco com titânio comercialmente puro grau I, liga de cobalto-cromo ou liga de níquel-cromo-titânio. A adaptação marginal foi avaliada, em microscópio ótico, quanto à passividade, por meio do teste de único parafuso, com aperto alternado nos implantes distais A e E, e quanto aos níveis de desajuste vertical, com todos os parafusos apertados com um torque de 10Ncm. As tensões geradas na área correspondente à região de crista óssea marginal em torno dos implantes foram avaliadas por meio de análise fotoelástica quantitativa empregando o método de compensação de Tardy. Após análise estatística dos resultados (p<0.05), verificou-se que, nos testes de passividade, o Ti cp apresentou resultados significantemente superiores de adaptação quando comparado as ligas de Co-Cr e Ni-Cr-Ti, as quais não apresentaram diferenças estatísticas entre si. O Ti cp foi semelhante à liga de Ni-Cr-Ti quanto aos níveis de desajuste vertical e tensões impostas aos implantes, com resultados superiores àqueles obtidos com a liga de Co-Cr. Foram aplicados testes de correlação entre as tensões fotoelásticas e os seguintes parâmetros: desajuste vertical, passividade média, adaptação marginal absoluta e percentual de redução de desajuste. Verificou-se correlação significante apenas entre os valores de adaptação marginal absoluta e tensões geradas pelas estruturas de Ni-Cr-Ti. Pode-se concluir que estruturas para próteses fixas sobre múltiplos implantes fundidas em monobloco podem produzir níveis biologicamente aceitáveis de desajuste, sendo os melhores resultados obtidos com o Ti cp, seguido das ligas de Ni-Cr-Ti e Co-Cr, respectivamente. Dentre os metais avaliados, a liga de Co-Cr transmitiu maiores níveis de tensões aos implantes. De um modo geral, não foram verificadas correlações entre valores de adaptação marginal e tensões impostas aos implantes.Obtaining a good marginal fit of the prosthetic components is one of the main obstacles to the success of rehabilitation with implant-supported prostheses. It is not clear, in the literature, which misfit levels are considered clinically acceptable, but it is known that the absence of a perfect and passive fit may cause inadequate tensions on the osseointegration interface, which may bring about mechanical and biological problems. Photoelasticity is an experimental technique, used to analyze tensions, which is capable of producing results that are reliable to clinical parameters. When metal multiple-unit implant frames are cast in a single unit, it seems that obtaining a good marginal fit is even more critical. However, there are no studies in the literature about the influence that the type of metal or alloy used in these castings may have on the levels of prosthesis misfit. Thus, the present study has the aim to verify the marginal fit between the intermediate abutments and the one-piece structures cast with different materials; perform a photoelastic assessment of the tensions caused on implants when metal frames are fixed to them; and, research the possible correlations between the levels of marginal fit and the tensions generated on the interface implant-photoelastic material. To do this, 15 frames for implant-retained prostheses were waxed, using calcinable cylinders, simulating the positioning of five implants on the inter-mentalis region. The frames were divided into groups (n=5) and cast in a single piece with commercially pure titanium grade I, cobalt-chrome alloy, or nickel-chrome-titanium alloy. Marginal fit was assessed by optic microscopy, in terms of passivity, by a single screw test with alternate tightening on the distal implants A and E. As to the levels of vertical misfit, all screws were tightened to a torque of 10Ncm. Tensions generated in the area corresponding to the marginal bone crest region surrounding the implants were assessed by quantitative photoelastic analysis using the Tardy compensation method. After the statistical analysis of the results (p<0.05), it was verified that, in the passivity tests, the Ti cp showed significantly superior fitting results when compared to the Co-Cr and Ni-Cr-Ti alloys, which showed no statistically significant differences between them. In terms of the levels of vertical misfit and tensions over the implants, Ti cp was similar to the Ni-Cr-Ti alloy, showing superior results when compared to the Co-Cr alloy. Correlation tests were performed between the photoelastic tensions and the following parameters: vertical misfit, mean passivity, absolute marginal fit, and percentage of misfit reduction. A significant correlation was observed only between the values of absolute marginal fit and the tensions generated by the Ni-Cr-Ti frames. It is concluded that one-piece cast multiple-unit implant frames may produce biologically acceptable misfit levels, and the best results are obtained with Ti cp, followed by the Ni-Cr-Ti and Co-Cr alloys, respectively. Among the assessed metals, the Co-Cr alloy transmitted higher tension levels to the implants. In a general way, no correlations were observed between the values of marginal fit and tensions on implants

Photoelastic analyses of stress generated by different designs of screw-retained fixed partial denture on morse taper implants

A restauração protética deve receber e transmitir cargas funcionais aos implantes de forma controlada, a fim de minimizar a ocorrência de falhas mecânicas e biológicas. A concentração de tensões inadequadas na interface osso-implante pode provocar reabsorção óssea em torno dos implantes em níveis superiores aos considerados clinicamente aceitáveis. Não existe consenso na literatura quanto ao melhor planejamento protético para reabilitações parciais com múltiplos implantes adjacentes, a fim de minimizar as tensões geradas na interface osso-implante. A fotoelasticidade é uma técnica experimental para análise de tensões, bastante empregada devido à sua relativa simplicidade e confiabilidade quanto à correspondência clínica dos achados observados. O presente trabalho se propôs a avaliar, por meio de análise fotoelástica, o comportamento biomecânico de próteses parciais fixas parafusadas sobre implantes cone morse com coroas isoladas ou unidas, simulando a reabilitação de áreas posteriores com e sem a presença de elemento dental distal aos implantes, e ainda variando o tipo de material de recobrimento estético empregado na restauração protética (cerâmica ou resina), quando sobre estas próteses foram aplicadas diferentes tipos de cargas estáticas. Para tanto, foi confeccionado um modelo fotoelástico simulando um espaço protético intercalado, com ausência do segundo prémolar e primeiro molar, reabilitado por meio de quatro tipos de coroas parafusadas sobre dois implantes cone morse (Neodent) adjacentes: UC - coroas unidas com recobrimento estético em cerâmica; IC - coroas isoladas com recobrimento estético em cerâmica; UR - coroas unidas com recobrimento estético em resina; IR - coroas isoladas com recobrimento estético em resina. A adaptação marginal das coroas foi avaliada pela leitura dos desajustes verticais na interface coroa/pilar em microscópio ótico. Análise fotoelástica qualitativa foi realizada sob diferentes condições de aplicação de carga na superfície oslusal das coroas: oclusal distribuída (1kgf), puntiforme simultânea (1kgf), puntiforme alternada no molar e no pré-molar (0,5kgf). A primeira análise foi feita na presença de contato proximal efetivo entre as próteses e o dente a distal dos implantes. A segunda análise foi realizada após eliminar a coroa do dente distal no modelo fotoelástico. Registros fotográficos foram obtidos de cada situação de interesse para análise, a fim de facilitar a observação e comparação do padrão de distribuição das franjas isocromáticas em torno dos implantes. De acordo com os resultados obtidos pode-se concluir que a ferulização das coroas promoveu melhor distribuição de tensões em torno dos implantes. As restaurações metalocerâmicas resultaram em menor magnitude e concentração de tensões em torno dos implantes quando comparadas às restaurações metaloplásticas. A presença de um dente com ponto de contato efetivo na distal das coroas não modificou as tensões resultantes em torno dos implantes, mas este dente participou da distribuição de tensões para o modelo fotoelástico. A ausência de uma oclusão bem ajustada e distribuída sobre as restaurações protéticas pode provocar sobrecarga nos implantes.Prosthetic restoration should suffer and apply functional loads over implants in a controlled way with the aim to reduce the occurrence of mechanical and biological failures. The concentration of inadequate stress on the implant-bone interface may cause bone resorption around implants at levels above those considered clinically acceptable. There is no consensus in the literature about the best prosthetic plan for partial rehabilitation with multiple adjacent implants, with the aim to reduce the stress generates over the implantbone interface. Photoelasticity is an experimental technique used to analyzes stress and is highly used due to its relative simplicity and reliability in terms of the clinical agreement of the findings. The purpose of the present study was to assess, using photoelastic analysis, the biomechanical behavior of screwretained fixed partial dentures on morse taper implants with individual or connected crowns, simulating the rehabilitation of posterior areas with or without the presence of a dental element distal to the implants. Furthermore, the analyses considered different esthetic materials used in prosthetic restorations (ceramic or resin), and different static loads were applied over the prostheses. To do this, a photoelastic model was fabricated simulating the missing of the second pre-molar and the first molar. The model was rehabilitated through four types of screw-retained crowns over two adjacent morse taper implants (Neodent): CC connected crowns with ceramic esthetic overlay; IC individual crowns with ceramic esthetic overlay; CR connected crowns with resin esthetic overlay; - IR - individual crowns with resin esthetic overlay. The crowns marginal fit was assessed by reading the vertical misfits on the crownabutment interface using an optic microscope. The qualitative photoelastic analysis was performed under the application of different loads on the crowns occlusal surface: distributed occlusal (1kgf), simultaneous punctiform (1kgf), alternate punctiform over the molar and pre-molar (0.5 kgf). The first analysis was done with an effective proximal contact between the prostheses and the distal tooth. The second analysis was performed after eliminating the crown of the distal tooth in the photoelastic model. Photoelastic records were obtained in each situation that was of any interest to the analysis, with the aim to make it easy to observe and compare the distribution standard of the isochromatic fringes around the implants. According to the obtained results, it is concluded that crown splint promoted better stress distribution around the implants. The metallo-ceramic restorations resulted in less magnitude and stress concentration around the implants compared to metaloplastic restorations. The presence of one tooth with an effective contact point on the crown distal did not change the resulting stress around the implants, but that tooth took part in the stress distribution for the photoelastic model. A bad distributed occlusion over the prosthetic restorations can cause overload on the implants

Do denture teeth dimensions match natural anterior teeth?

ABSTRACT Objective To compare dimensions of natural maxillary anterior teeth and several denture teeth molds and also address differences between genders. Methods A single examiner with a digital caliper measured dental casts of 41 males and 55 females in order to determine CIW (central incisor width), CIL (central incisor length) and WS (width of anterior teeth on a straight line). In addition, WC (width of anterior teeth on a curve) was measured with a flexible ruler. These parameters were also observed on three denture teeth mold charts: Premium Pala, Vivodent and Trilux. The comparison between genders was analyzed using Student’s t-test (?=.05), while absolute frequencies within several ranges were used to compare natural and denture teeth. Results CIW, CIL, WS and WC obtained from males were significantly higher than those found for females (p<0.05). CIW of nearly half of natural and denture teeth were within 8.0–8.5 mm. Almost half of natural teeth presented CIL values within 10.6–11 mm, while the highest frequency of denture teeth was observed within 9.6–10 mm. The majority of natural and denture teeth presented WS values within 42 to 49 mm. Only one denture teeth chart described WC values, which were mainly observed within 44–51 mm, while the majority of WC values obtained from natural teeth ranged from 48 to 55 mm. Conclusion Some commercially available denture teeth present dimensions not observed in natural teeth. Teeth dimensions in function of gender differences must be considered when selecting denture teeth

Socket shield technique: Stress distribution analysis

Background: To analyze through finite element analysis the stress distribution in peri-implant bone tissues, implants, and prosthetic components induced by the socket shield (SS) technique in comparison to other techniques used to treat tooth loss. Materials and Methods: A three-dimensional model of a superior central incisor crown supported by implant was modeled and three different placement conditions were simulated: SS – 2.0-mm-thick root dentin fragment positioned between the alveolar buccal wall and implant; heterologous bone graft (HBG) – bovine bone graft positioned the alveolar buccal wall and implant; and control (C) – implant fully placed in bone tissue of a healed alveolus. The model was restricted at the lateral surfaces of the bone tissue and the following loads were simulated: Both oblique (45°) loads of 100 N on the lingual surface of the crown (maximal habitual intercuspation) and 25.5 N on the incisal edge of the crown (tooth contact during mandibular protrusion) were simultaneously applied. Tensile stress, shear stress, compression, and displacement were analyzed in the cortical bone, trabecular bone, dentin root fragment, and bone graft; while equivalent von Mises stresses were quantified in the implant and prosthetic components. Results: Stress values of SS and HBG in the bone tissues were higher than C, while slight differences within models were observed for dentin root fragment, bone graft, implant, and prosthetic components. Conclusions: The SS technique presented the highest stress concentration in the peri-implant tissues

Cranioplasty using Polymethylmethacrylate (PMMA) self-curing by the conventional casting process: clinical case report

Cranioencephalic trauma which results in extensive edema and / or bruising usually requires surgical treatment through a greater withdrawal of the bone portion. Thus, the absence of bone tissue implies the lack of protection of the brain tissue or even compromises the esthetics especially when located in the frontal or frontoparietal region. The purpose of this case report is to describe a treatment option for head trauma, through the prefabricated part by obtaining the skull model. These bone faults can be reconstructed either by the direct method using polymethylmethacrylate directly on the defects or by means of pre-made pieces such as prototyping or from the skull model. Although other techniques have many good points, some show certain drawbacks, from storage conditions below abdominal fat, preheating due to the release of heat during the high polymerization reaction or the high cost when they are prototyped. The technique described in this work reports its simple performance, eliminating the risk of local heating, allows prior sterilization in autoclave, it is biocompatible, allows perfect anatomical recovery, easy placement, low cost, also highlighs the advantage of the bucomaxillofacial surgeon's performance due to the familiarization with the relevant head and neck procedures. Clinical and tomographic examination after 24 months of treatment showed stability of the polymethylmethacrylate plate, adhesions to the bone margins, and absence of tissue alterations