Patients' expectation and satisfaction with removable dental prosthesis therapy and correlation with patients' evaluation of the dentists

Objective. Considering that patients' satisfaction is one of the most important goals in conducting removable dental prosthesis (RDP) therapy and the fact that there are many factors which influence this parameter, the present study aims to evaluate the expectation before and satisfaction after therapy with RDP in patients who seek such therapy. As a secondary objective, other variables that may be associated with patient satisfaction are also evaluated, such as gender, age, Kennedy's classification of the arch supporting the RDP, the number of RDP adjustments after delivery and patients' evaluation of the dentists' conduct. Materials and methods. A sample of 44 patients who received RDP therapy were assigned visual analog scale scores for their expectation before and satisfaction after therapy regarding chewing, aesthetics, comfort and phonetics. They also completed a questionnaire concerning the dentists' conduct. Results. There was no statistically significant difference among scores concerning different genders, age, number of post-delivery settings and arch involved in the RDP. Regarding patients' evaluation of the dentists' conduct, there was a predominance of positive evaluations, but only different answers to the statement (i.e. 'The dentist I saw thoroughly explained the recommended treatment before it commenced') present statistically significant different scores for chewing (p = 0.040) and phonetics (p = 0.046). Conclusions. The average visual analog scale scores were high for both expectation prior to treatment and satisfaction after treatment; however, the scores for expectations were higher than those for satisfaction. © 2013 Informa Healthcare.

Histological analysis of the osseointegration of Ti-30Ta dental implants after surface treatment

Metallic biomaterials are used to reinforce or to restore the form and function of hard tissues. Implants and prosthesis are used to replace shoulders, knees, hips and teeth. When these materials are inserted in bone several biological reactions happen. This process can be associated to surface properties (topography, roughness and surface energy). In this work, the influence of biomimetic surface treatment in the osseointegration of Ti-30Ta dental implants was evaluated. Ingots were obtained from titanium and tantalum by using an arc-melting furnace. They were submitted to heat treatment at 1,100°C for 1 h, cooled in water and cold worked by swaging. Then, screw-shaped implants (2.0 mm diameter by 2.5 mm length) were manufactured and they were implanted in a rat's femur. Animals were divided into two groups: untreated (control group) and treated (biomimetic surface treatment). They were sacrificed 30 days after implantation. For histological analysis, implants with surrounding tissue were removed and immersed in formaldehyde. Samples were embedded in polymethyl methacrylate and after polymerization, cut with a saw, polished and mounted on glass slides. The results obtained suggest that biomimetic surface treatment was able to promote an increase osseointegration on the surface of dental implants. © Springer-Verlag Berlin Heidelberg 2013.

Guided implant surgery: What is the influence of this new technique on bone cell viability?

Purpose: To evaluate the effect of implant osteotomy on immediate bone cell viability, comparing guided surgery for implant placement with the classic drilling procedure. Materials and Methods: For this study, 20 rabbits were used. The animals were divided into a guided surgery group (GG) and a control group (CG) and were then divided into 4 subgroups - subgroups 1, 2, 3, and 4 - corresponding to drills used 10, 20, 30, and 40 times, respectively. All animals received 5 osteotomies in each tibia, by use of the classic drilling procedure in one tibia and guided surgery in the other tibia. The osteotomized areas were removed and processed immunohistochemically for detection of osteocalcin, receptor activator of nuclear factor κB ligand (RANKL), osteoprotegerin (OPG), and caspase 3. Results: Immunohistochemical analysis showed that osteocalcin expression was initially higher in the CG and remained constant after drill reutilization. Although the expressions of RANKL and OPG were not statistically different for the GG and CG, the RANKL/OPG ratio tended to be higher for the GG. Moreover, caspase 3 expression was elevated in the GG, proportionally to the number of osteotomies, indicating an increase in the apoptosis index in the GG. Conclusions: The classic drilling procedure is more favorable to cell viability than guided surgery.© 2013 American Association of Oral and Maxillofacial Surgeons.

Stress distribution in implant-supported prosthesis with external and internal implant-abutment connections

Objective. This study aimed to investigate the stress distribution in screwed implant-supported prostheses with different implant-abutment connections by using a photoelastic analysis. Materials and methods. Four photoelastic models were fabricated in PL-2 resin and divided according to the implant-abutment connection (external hexagon (EH) and Morse taper (MT) implants (3.75 × 11.5 mm)) and the number crowns (single and 3-unit piece). Models were positioned in a circular polariscope and 100-N axial and oblique (45) loading were applied in the occlusal surface of the crowns by using a universal testing machine. The stresses were photographically recorded and qualitatively analyzed using software (Adobe Photoshop). Results. Under axial loading, the MT implants exhibited a lower number of fringes for single-unit crowns than EH implants, whereas for a 3-unit piece the MT implants showed a higher number of fringes vs EH implants. The oblique loading increased the number of fringes for all groups. Conclusion. In conclusion, the MT implant-abutment connection reduced the amount of stress in single-unit crowns, for 3-unit piece crowns the amount of stress was lower using an external hexagon connection. The stress pattern was similar for all groups. Oblique loading promoted a higher stress concentration than axial loading. © Informa Healthcare.

Comparison of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible - A computed tomography-based three-dimensional finite element analysis

A finite element analysis was used to compare the effect of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible. Four models of an human mandible were constructed. In the OR (O'ring) group, the mandible was restored with an overdenture retained by four unsplinted implants with O'ring attachment; in the BC (bar-clip) -C and BC groups, the mandibles were restored with overdentures retained by four splinted implants with bar-clip anchor associated or not with two distally placed cantilevers, respectively; in the FD (fixed denture) group, the mandible was restored with a fixed full-arch four-implant-supported prosthesis. Models were supported by the masticatory muscles and temporomandibular joints. A 100-N oblique load was applied on the left first molar. Von Mises (σvM), maximum (σmax) and minimum (σmin) principal stresses (in MPa) analyses were obtained. BC-C group exhibited the highest stress values (σvM=398.8, σmax=580.5 and σmin=-455.2) while FD group showed the lowest one (σvM=128.9, σmax=185.9 and σmin=-172.1). Within overdenture groups, the use of unsplinted implants reduced the stress level in the implant/prosthetic components (59.4% for σvM, 66.2% for σmax and 57.7% for σmin versus BC-C group) and supporting tissues (maximum stress reduction of 72% and 79.5% for σmax, and 15.7% and 85.7% for σmin on the cortical and trabecular bones, respectively). Cortical bone exhibited greater stress concentration than the trabecular bone for all groups. The use of fixed implant dentures and removable dentures retained by unsplinted implants to rehabilitate edentulous mandible reduced the stresses in the periimplant bone tissue, mucosa and implant/prosthetic components. © 2013 Elsevier Ltd.

Evaluation of the biocompatibility of silicone gel implants - histomorphometric study

Breast implants are medical devices that are used to augment breast size or to reconstruct the breast following mastectomy or to correct a congenital abnormality. Breast implants consist of a silicone outer shell and a filler (most commonly silicone gel or saline). Approximately 5 to 10 million women worldwide have breast implants. Histomorphometric study to evaluate the biological tissue compatibility of silicone implants suitable for plastic surgery and the adverse effects and risks of this material. Thirty Wistar white rats received subcutaneous implants and the revestiment of silicone gel Silimed ®®, and randomized into six groups of five animals each, according to the type of implanted material and the time of sacrifice. Eight areas of 60.11mm2 corresponding to the obtained surgical pieces were analyzed, counting mesenchymal cells, eosinophils, and foreign body giant cells, observing an acceptable biocompatibility in all implants, for subsequent statistical analysis by Tukey test. Silicone gel showed inflammation slightly greater than for other groups, with tissue reactions varying from light to moderate, whose result was the formation of a fibrous capsule around the material, recognized by the organism as a foreign body. Despite frequent local complications and adverse outcomes, this research showed that the silicone and top layer presented an acceptable chronic inflammatory reaction, which did not significantly differ from the control group. In general, it is possible to affirm that silicone gel had acceptable levels of biocompatibility, confirmed the rare presence of foreign body giant cells, and when of the rupture, formed a fibrous capsule around the material, separating the material of the organism. © AVICENA 2013.

Plasma-polymerized acetylene nanofilms modified by nitrogen ion implantation

Thin films were prepared by plasma enhanced chemical vapour deposition (PECVD) from a mixture of acetylene and argon, and post deposition-treated by plasma immersion ion implantation (PIII). The effect of PIII on the nanofilms properties was evaluated as a function of treatment time. The average thickness and roughness were diminished upon PIII. On the other hand, hardness (0.7-3.9 GPa) and elastic modulus (29-54 GPa) increased upon 60 min of ion bombardment. Such results are ascribed mainly to the densification of the film structure caused by the increment in the crosslinking degree with increasing the energy deposited in the films. Wettability of the samples, investigated by contact angle measurements, was reduced (from 64 to 21°) right after PIII. This result, attributed to the introduction of polar groups in the film structure, was not preserved as the sample was aged in atmosphere. After aging, contact angles were larger than 70° but still smaller than 90°. Although the wettability has decreased with aging, the hydrophilic character of the samples was preserved. For certain treatment times, nitrogen PIII turned the plasma-polymerized acetylene films smoother, denser, mechanically and tribologicaly more resistant than the as-deposited material. © 2013 Elsevier B.V.

Airway space changes after maxillomandibular counterclockwise rotation and mandibular advancement with TMJ Concepts® total joint prostheses: Three-dimensional assessment

This study focused on three-dimensional (3D) airway space changes and stability following simultaneous maxillomandibular counterclockwise rotation, mandibular advancement, and temporomandibular joint (TMJ) reconstruction with custom-made total joint prostheses (TMJ Concepts®). Cone beam computed tomography (CBCT) scans of 30 consecutive female patients with irreversibly compromised TMJs were obtained at the following intervals: T1, presurgery; T2, immediately after surgery; and T3, at least 6 months after surgery. The CBCT volumetric datasets were analysed with Dolphin Imaging ® software to evaluate surgical and postsurgical changes to oropharyngeal airway parameters. The average changes in airway surface area (SA), volume (VOL), and minimum axial area (MAA) were, 179.50 mm2, 6302.60 mm3, and 92.23 mm2, respectively, at the longest follow-up (T3 - T1) (P ≤ 0.001). Significant correlations between the amount of mandibular advancement and counterclockwise rotation of the occlusal plane and 3D airway changes were also found (P ≤ 0.01). The results of this investigation showed a significant immediate 3D airway space increase after maxillomandibular counterclockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses, which remained stable over the follow-up period. © 2013 International Association of Oral and Maxillofacial Surgeons.

Histologic and biomechanical evaluation of 2 resorbable-blasting media implant surfaces at early implantation times

This study evaluated 3 implant surfaces in a dog model: (1) resorbable-blasting media + acid-etched (RBMa), alumina-blasting + acid-etching (AB/AE), and AB/AE + RBMa (hybrid). All of the surfaces were minimally rough, and Ca and P were present for the RBMa and hybrid surfaces. Following 2 weeks in vivo, no significant differences were observed for torque, bone-to-implant contact, and bone-area fraction occupied measurements. Newly formed woven bone was observed in proximity with all surfaces.

Tilted and Short Implants Supporting Fixed Prosthesis in an Atrophic Maxilla: A 3D-FEA Biomechanical Evaluation

Purpose: This study compared the biomechanical behavior of tilted long implant and vertical short implants to support fixed prosthesis in an atrophic maxilla. Materials and Methods: The maxilla model was built based on a tomographic image of the patient. Implant models were based on micro-computer tomography imaging of implants. The different configurations considered were M4S, four vertical anterior implants; M4T, two mesial vertical implants and two distal tilted (45°) implants in the anterior region of the maxilla; and M6S, four vertical anterior implants and two vertical posterior implants. Numerical simulation was carried out under bilateral 150N loads applied in the cantilever region in axial (L1) and oblique (45°) (L2) direction. Bone was analyzed using the maximum and minimum principal stress (σmax and σmin), and von Mises stress (σvM) assessments. Implants were analyzed using the σvM. Results: The higher σmax was observed at: M4T, followed by M6S/L1, M6S/L2, M4S/L2, and M4S/L1 and the higher σvM: M4T/L1, M4T/L2 and M4S/L2, M6S/L2, M4S/L1, and M6S/L1. Conclusions: The presence of distal tilted (all-on-four) and distal short implants (all-on-six) resulted in higher stresses in both situations in the maxillary bone in comparison to the presence of vertical implants (all-on-four). © 2013 Wiley Periodicals, Inc.

Effects of high temperature plasma immersion ion implantation on wear resistance of Ti-Si-B sintered alloys

Although titanium and its alloys own good mechanical properties and excellent corrosion resistance, these materials present poor tribological properties for specific applications that require wear resistance. In order to produce wear-resistant surfaces, this work is aimed at achieving improvement of wear characteristics in Ti-Si-B alloys by means of high temperature nitrogen plasma immersion ion implantation (PIII). These alloys were produced by powder metallurgy using high energy ball milling and hot pressing. Scanning electron microscopy (SEM) and X-ray diffraction identified the presence of α-titanium, Ti6Si2B, Ti5Si3, TiB and Ti3Si phases. Wear tests were carried out with a ball-on-disk tribometer to evaluate the friction coefficient and wear rate in treated and untreated samples. The worn profiles were measured by visible light microscopy and examined by SEM in order to determine the wear rates and wear mechanisms. Ti-7.5Si-22.5B alloy presented the highest wear resistance amongst the untreated alloys produced in this work. High temperature PIII was effective to reduce the wear rate and friction coefficient of all the Ti-Si-B sintered alloys. © 2013 Elsevier B.V.

Improvements of plasma immersion ion implantation (PIII) and deposition (PIII&D) processing for materials surface modification

Plasma immersion ion implantation (PIII) process is a three dimensional surface modification method that is quite mature and well known to the surface engineering community nowadays, especially to those working in the field of plasma-materials interaction, aiming at both industrial and academic applications. More recently, deposition methods have been added to PIII, the PIII&D, opening possibilities of broader range of applications of these techniques. So, PIII&D is becoming a routine method of surface modification, with the advantage of pushing up the retained dose levels limited by the sputtering due to ion implantation. Therefore, well adherent, thick, three-dimensional films without stress are possible to be achieved, at relatively low cost, using PIII&D. In this paper, we will discuss about a few PIII and PIII&D experiments that have been performed recently to achieve surface improvements in different materials: 1 - high temperature nitrogen PIII in Ti6Al4V alloy in which a deep nitrogen rich treated layer resulted in surface improvements as increase of hardness, corrosion resistance and resistance to wear of the Ti alloy; 2 - nanostructures in ZnO films, obtained by PIII&D of vaporized & ionized Zn source; 3 - combined implantation and deposition of calcium for biomaterial activity of Ti alloy (PIII&D), allowing the growth of hydroxyapatite in a body solution; 4 - magnetron sputtering deposition of Cr that was enhanced by the glow discharge Ar plasma to allow implantation and deposition of Cr on SAE 1070 steel (PIII&D) resulting in surfaces with high resistance to corrosion; and 5 - implantation of nitrogen by ordinary PIII into this Cr film, which improved resistance to corrosion, while keeping the tribological properties as good as for the SAE 1070 steel surface. © 2012 Elsevier B.V.

Optical, mechanical and surface properties of amorphous carbonaceous thin films obtained by plasma enhanced chemical vapor deposition and plasma immersion ion implantation and deposition

Diverse amorphous hydrogenated carbon-based films (a-C:H, a-C:H:F, a-C:H:N, a-C:H:Cl and a-C:H:Si:O) were obtained by radiofrequency plasma enhanced chemical vapor deposition (PECVD) and plasma immersion ion implantation and deposition (PIIID). The same precursors were used in the production of each pair of each type of film, such as a-C:H, using both PECVD and PIIID. Optical properties, namely the refractive index, n, absorption coefficient, α, and optical gap, ETauc, of these films were obtained via transmission spectra in the ultraviolet-visible near-infrared range (wavelengths from 300 to 3300 nm). Film hardness, elastic modulus and stiffness were obtained as a function of depth using nano-indentation. Surface energy values were calculated from liquid drop contact angle data. Film roughness and morphology were assessed using atomic force microscopy (AFM). The PIIID films were usually thinner and possessed higher refractive indices than the PECVD films. Determined refractive indices are consistent with literature values for similar types of films. Values of ETauc were increased in the PIIID films compared to the PECVD films. An exception was the a-C:H:Si:O films, for which that obtained by PIIID was thicker and exhibited a decreased ETauc. The mechanical properties - hardness, elastic modulus and stiffness - of films produced by PECVD and PIIID generally present small differences. An interesting effect is the increase in the hardness of a-C:H:Cl films from 1.0 to 3.0 GPa when ion implantation is employed. Surface energy correlates well with surface roughness. The implanted films are usually smoother than those obtained by PECVD. ©2013 Elsevier B.V. All rights reserved.

Precisão das técnicas de moldagem e vazamento para próteses implantossuportadas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise da distribuição das tensões em restaurações cerâmicas sobre dente natural e implante por meio do método dos elementos finitos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)