Planejamento digital e cirurgia guiada em reabilitação oral: relatório de caso

Digital planning of the prosthesis associated with surgical planning increased predictability, since surgical guides indicate the best place for implant installation, thus reducing the number of complications, and the CAD/CAM system provides predictability in the preparation of final restorations, according to the procedure previously planned. Our study reported a digital workflow used for the guided installation of two dental implants in regions 14 and 16, extraction of tooth 15 and installation of a fixed prothesis over implants. After anamnesis and clinical evaluation, intra- and extra-oral photographs of the patient were performed, molding the upper arch with polyvinylsiloxane (2-step putty/light-body technique) and requesting computed tomography. The plaster model obtained was sent to the laboratory and scanned. The generated file (STL) was used to create a diagnostic wax-up that was aligned to the tomography (in DICOM format), enabling the three-dimensional planning of the implants, which generated a partial printed surgical guide after approval of the dentist. After six months, the patient received the provisional fixed prosthesis printed in PMMA (polymethylmethacrylate) on an intermediate in PEEK (polyetheretherketone) aiming to condition an emergency profile to receive a definitive prosthesis two months later, with zirconia-milled infrastructure on a ti-base. The correct understanding of the operator about the steps of the digital workflow (diagnosis, prosthetic planning, surgical planning, guide preparation, temporary and final restorations) gives the operator improved predictability at the time of surgery as well as satisfactory aesthetic and functional result of definitive restorations.Planejamento digital de prótese associada a planejamento cirúrgico aumenta a previsibilidade devido às guias cirúrgicas que indicam o melhor local para instalação do implante, reduzindo o número de complicações, e o sistema CAD/CAM permite previsibilidade ao preparar as restaurações finais, de acordo com o procedimento planejado anteriormente. Nosso estudo relata um fluxo de trabalho digital usado para a instalação guiada de dois implantes dentários nas regiões 14 e 16, extração do dente 15 e instalação de prótese fixa no lugar de implantes. Após anamnese e avaliação clínica, fotografias intra e extraorais do paciente foram tiradas, moldando o arco superior usando polivinilsiloxano (técnicas da dupla mistura e reembasamento) e solicitando tomografia computadorizada. O modelo de gesso obtido foi enviado para o laboratório e escaneado. O arquivo gerado (STL) foi usado para criar um diagnostic wax-up alinhado à tomografia (em formato DICOM), permitindo o planejamento tridimensional dos implantes, o que gerou uma guia cirúrgica parcialmente impressa após aprovação pelo dentista. Após seis meses, o paciente recebeu uma prótese fixa provisória impressa com PMMA (polimetilmetacrilato) em um intermediário em PEEK (Poli(éter-éter-cetona)) para condicionar um perfil emergencial e receber uma prótese definitiva dois meses depois, incluindo infraestrutura de zircônia moída em uma base TI. O entendimento adequado do operador a respeito dos passos envolvidos no fluxo de trabalho digital (diagnóstico, planejamento de prótese, planejamento cirúrgico, preparação da guia, restaurações temporárias e finais) forneceu ao operador maior previsibilidade no momento da cirurgia e um resultado estético e funcional satisfatório para as restaurações definitivas

Resin matrix ceramics – mechanical, aesthetic and biological properties

ABSTRACT Resin matrix ceramics consist in a polymeric matrix with predominantly inorganic refractory compounds which may include porcelain, glass, ceramics, and glass ceramics, and are divided into three subgroups: Nanoceramics, Vitroceramics, and Zirconia-silica. The aim of this study was to compare, through a literature review, the mechanical and biological properties of resin matrix ceramics, with glass matrix ceramics and polycrystalline ceramics. After reviewing 44 articles found in the US National Library of Medicine (PubMed) database (studies published in English, human clinical studies, in vitro or in vivo studies) that evaluated some properties of this material, such as elasticity modulus, wear resistance, adhesiveness, stain resistance and hardness, this article concluded that, although they belong to the same group, resin matrix ceramics are different from each other due to their microstructures. Moreover, when compared to other ceramic groups, it showed some superior properties, such as flexural strength, fatigue strength and internal adaptation