RESUMO Objetivo As próteses metalocerâmicas apresentam altas taxas de sobrevivência e, por isso, são indicadas para diversos casos em reabilitação oral. Entretanto, na literatura científica, existem poucos relatos clínicos sobre os fatores que levam à fratura dessas restaurações. Diante do exposto, o presente estudo teve como objetivo avaliar se a quantidade de elementos que compõem a prótese, se a quantidade de elementos por retentor, se o tipo de prótese e tipo de pilar, bem como sua localização, e o bruxismo, influenciam ou não nas fraturas dessas restaurações indiretas. Métodos Para isso, selecionaram-se 74 próteses metalocerâmicas, instaladas entre 2000 e 2010 em 16 pacientes, com acompanhamento mínimo de quatro anos. Foram coletadas informações dos pacientes, como: gênero, idade, data da instalação das próteses e cerâmica utilizada. Durante a avaliação clínica, observou-se a integridade da prótese e, em caso de fratura, coletava-se informações sobre a história clínica. As características do dente antagonista também foram avaliadas. Além disso, aplicou-se um questionário, com o intuito de identificar a provável presença de bruxismo. Resultados Como resultado, tem-se que a taxa de sucesso das próteses metalocerâmicas foi de 87,8% e, a taxa de sobrevivência, foi de 89,1%. A taxa de sucesso não teve influência da idade, tempo de instalação, número de próteses na boca, número de elementos ou pilares. Conclusão Embora pouco frequente, a fratura da cerâmica de cobertura foi a complicação mais comum. As próteses metalocerâmicas possuem altas taxas de sobrevida e de sucesso, o que garante a longevidade e a indicação desse tipo de restauração.

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.

Abstract Polymer-based composite materials have been proposed as an alternative for single unit restorations, due to their resilient and shock absorbing behavior, in contrast to the brittleness of ceramic materials that could result in failure by fracture. Objective: To evaluate the fatigue strength and damage modes of monolithic posterior resin nanoceramic and lithium disilicate glass ceramic crowns. Methodology: Twenty-six resin nanoceramic (RNC) and lithium disilicate glass ceramic (LD) 2 mm monolithic crowns (n=13) were cemented on composite resin replicas of a prepared tooth and subjected to cyclic load with lithium disilicate indenters for 2 million cycles. Specimens and indenters were inspected every 500,000 cycles and suspended when presenting fractures or debonding. Surviving specimens were embedded in epoxy resin, polished and subsurface damage was analyzed. Specimens presenting fractures or severe subsurface damage were considered as failures. Survival data was subjected to Fisher's exact test; damage modes were subjected to Mann-Whitney test (p<0.05). Results: There were no debonding, cohesive or catastrophic failures. Considering subsurface damage, 53.8% of RNC and 46.2% of LD crowns survived the fatigue test, presenting no statistical difference. Chief damage modes were radial cracks for RNC and inner cone cracks for LD, presenting no statistical difference. Conclusions: The results suggest that if debonding issues can be resolved, resin nanoceramic figures can be an alternative to posterior crowns. Although distinct, damage modes revealed potential to cause bulk fracture in both glass ceramic and resin nanoceramic crowns.

ABSTRACT Because many mechanical variables are present in the oral cavity, the proper load transfer between the prosthesis and the bone is important for treatment planning and for the longevity of the implant-supported fixed partial denture. Objectives To verify the stress generated on the peri-implant area of cantilevered implant-supported fixed partial dentures and the potential effects of such variable. Material and Methods A U-shaped polyurethane model simulating the mandibular bone containing two implants (Ø 3.75 mm) was used. Six groups were formed according to the alloy’s framework (CoCr or PdAg) and the point of load application (5 mm, 10 mm and 15 mm of cantilever arm). A 300 N load was applied in pre-determined reference points. The tension generated on the mesial, lingual, distal and buccal sides of the peri-implant regions was assessed using strain gauges. Results Two-way ANOVA and Tukey statistical tests were applied showing significant differences (p<0.05) between the groups. Pearson correlation test (p<0.05) was applied showing positive correlations between the increase of the cantilever arm and the deformation of the peri-implant area. Conclusions This report demonstrated the CoCr alloy shows larger compression values compared to the PdAg alloy for the same distances of cantilever. The point of load application influences the deformation on the peri-implant area, increasing in accordance with the increase of the lever arm.

Resumo Este estudo teve como objetivo medir a pré-carga em diferentes conexões implante/pilar baseado em imagens de micro-CT. Implantes de hexágono externo (EH) e Cone Morse (MT) (n = 5) foram utilizados para a medição de pré-carga. Os parafusos de pilares foram digitalizados em um micro-CT de alta resolução para obter seus modelos virtuais, que foram utilizados para registrar o comprimento inicial. Os pilares foram parafusados sobre o implante com um torque de 20 Ncm e, o conjunto composto por implante, parafuso do pilar e pilar foi levado para o micro-CT para obter cortes virtuais dos espécimes. Esses cortes permitiram a medida do comprimento dos parafusos após a aplicação do torque. Assim, com base no alongamento dos parafusos, os valores de pré-carga foram calculados usando a Lei de Hooke. A pré-carga de ambos os grupos foram comparados pelo Test-t independente. O torque de remoção de cada espécime foi registrado. Para avaliar a precisão da técnica de micro-CT, três bastões foram escaneados em micro-CT e o comprimento do seu modelo virtual foi comparado com o comprimento original dos bastões. Um bastão foi digitalizado e mensurado quatro vezes para avaliar a variação do método de medição e a sua repetitividade. Não houve diferença entre os grupos para a pré-carga (EH = 461,6 N e MT = 477,4 N), no entanto o grupo EH apresentou maiores valores de torque de afrouxamento do parafuso (13,8 ± 4,7 contra 8,2 ± 3,6 Ncm para o grupo MT). A técnica de micro-CT mostrou uma variabilidade de 0,053% e a repetitividade apresentou um erro de 0,23 a 0,28%. Dentro das limitações deste estudo, não houve diferença entre Hexágono Externo e Cone Morse para pré-carga. O método baseado em imagens de micro-CT pode ser considerado para mensuração da pré-carga.

This study aimed to measure the preload in different implant platform geometries based on micro-CT images. External hexagon (EH) implants and Morse Tapered (MT) implants (n=5) were used for the preload measurement. The abutment screws were scanned in micro-CT to obtain their virtual models, which were used to record their initial length. The abutments were screwed on the implant with a 20 Ncm torque and the set composed by implant, abutment screw and abutment were taken to the micro-CT scanner to obtain virtual slices of the specimens. These slices allowed the measurement of screw lengths after torque application and based on the screw elongation. Preload values were calculated using the Hooke's Law. The preloads of both groups were compared by independent t-test. Removal torque of each specimen was recorded. To evaluate the accuracy of the micro-CT technique, three rods with known lengths were scanned and the length of their virtual model was measured and compared with the original length. One rod was scanned four times to evaluate the measuring method variation. There was no difference between groups for preload (EH = 461.6 N and MT = 477.4 N), but the EH group showed higher removal torque values (13.8±4.7 against 8.2±3.6 Ncm for MT group). The micro-CT technique showed a variability of 0.053% and repeatability showed an error of 0.23 to 0.28%. Within the limitations of this study, there was no difference between external hexagon and Morse taper for preload. The method using micro-CT may be considered for preload calculation.

Knowing how stresses are dissipated on the fixed implant-supported complex allows adequate treatment planning and better choice of the materials used for prosthesis fabrication. Objectives: The aim of this study was to evaluate the deformation suffered by cantilevered implant-supported fixed prostheses frameworks cast in silver-palladium alloy and coated with two occlusal veneering materials: acrylic resin or porcelain. Material and Methods: Two strain gauges were bonded to the inferior surface of the silver-palladium framework and two other were bonded to the occlusal surface of the prosthesis framework covered with ceramic and acrylic resin on each of its two halves. The framework was fixed to a metallic master model and a 35.2 N compression force was applied to the cantilever at 10, 15 and 20 mm from the most distal implant. The measurements of deformation by compression and tension were obtained. The statistical 2-way ANOVA test was used for individual analysis of the experiment variables and the Tukey test was used for the interrelation between all the variables (material and distance of force application). Results: The results showed that both variables had influence on the studied factors (deformation by compression and tension). Conclusion: The ceramic coating provided greater rigidity to the assembly and therefore less distortion compared with the uncoated framework and with the resin-coated framework. The cantilever arm length also influenced the prosthesis rigidity, causing higher deformation the farther the load was applied from the last implant.

INTRODUÇÃO: A estabilidade dimensional das resinas acrílicas influencia na adaptação das coroas provisórias e, consequentemente, no resultado do tratamento reabilitador. OBJETIVO: Avaliar a estabilidade dimensional, ao longo do tempo, de uma resina acrílica processada de diferentes maneiras. MATERIAL E MÉTODO: Cinco técnicas de polimerização da resina acrílica foram testadas: I - polimerização térmica utilizando líquido de polimerização rápida em mufla; II - autopolimerização sob pressão; III - autopolimerização utilizando pincel; IV - autopolimerização após mistura (pó + líquido) em pote Dappen e inserção em matriz de aço na fase arenosa; V - autopolimerização após mistura em pote Dappen com inserção na matriz metálica na fase plástica. Foram confeccionados dez corpos de prova para cada tipo de processamento. Avaliou-se a estabilidade dimensional por meio de matriz de aço inox confeccionada segundo a especificação nº19 da ADA. Os corpos de prova foram armazenados em água destilada a 37ºC e examinados nos períodos de 1 hora, 1, 7, 15, 10, 90 e 180 dias após a polimerização, com o auxílio de um microscópio óptico com aumento de 20×. Os resultados foram submetidos à análise de dupla variância (Teste de Tukey para Tempo e Técnica de processamento) em nível de 5% de significância. RESULTADO: Todos os grupos experimentais apresentaram alterações dimensionais entre o sétimo e o 15º dia; após esse período de tempo, houve alterações dimensionais estatisticamente significantes, para as diferentes técnicas estudadas. CONCLUSÃO: A estabilidade dimensional da resina acrílica não sofreu influência das diferentes técnicas de processamento avaliadas; entretanto, foi influenciada pelo tempo de armazenamento.

INTRODUCTION: The dimensional stability of acrylic resins influences the temporary crowns fitting and can affect the final restoration results. OBJECTIVE: To evaluate the long-term dimensional stability of an acrylic resin used for fabrication of provisional crowns. MATERIAL AND METHOD: Five types of processing techniques were evaluated: I - thermal polymerization using fast polymerization liquid and flask; II - auto-polimerization under pressure in a stainless steel matrix; III - auto-polimerization using the bead brush technique to build the sample; IV - auto-polimerization after mixture (powder + liquid) in a dappen dish and insertion in a stainless steel matrix at the sand stage; V - auto-polimerization after mixture in a dappen dish with insertion in a stainless steel matrix at the plastic stage. For each type of processing technique, 10 samples were made. Dimensional stability was evaluated by means of a steel matrix made following the ADA specification nº19. The samples were stored in distilled water at 37 ºC and examined at the periods of 1 hour, 1, 7, 15, 30, 90 and 180 days, with an optic microscope with 20× magnification. The results were subjected to the 2-way analysis of variance (Tukey Test) at the significance level of 5% for the variables Time and Processing Technique. RESULT: All samples had dimensional alterations from day 7 to the day 15, regardless of the technique used. From day 15 to 180, there were no statistically significant dimensional alterations. CONCLUSION: The dimensional stability of the acrylic resin was not influenced by the different processing techniques tested, however, it was influenced by the storage time.

OBJECTIVES: The complexity and heterogeneity of human bone, as well as ethical issues, frequently hinder the development of clinical trials. The purpose of this in vitro study was to determine the modulus of elasticity of a polyurethane isotropic experimental model via tension tests, comparing the results to those reported in the literature for mandibular bone, in order to validate the use of such a model in lieu of mandibular bone in biomechanical studies. MATERIAL AND METHODS: Forty-five polyurethane test specimens were divided into 3 groups of 15 specimens each, according to the ratio (A/B) of polyurethane reagents (PU-1: 1/0.5, PU-2: 1/1, PU-3: 1/1.5). RESULTS: Tension tests were performed in each experimental group and the modulus of elasticity values found were 192.98 MPa (SD=57.20) for PU-1, 347.90 MPa (SD=109.54) for PU-2 and 304.64 MPa (SD=25.48) for PU-3. CONCLUSION: The concentration of choice for building the experimental model was 1/1.

OBJECTIVES: The complexity and heterogeneity of human bone, as well as ethical issues, most always hinder the performance of clinical trials. Thus, in vitro studies become an important source of information for the understanding of biomechanical events on implant-supported prostheses, although study results cannot be considered reliable unless validation studies are conducted. The purpose of this work was to validate an artificial experimental model based on its modulus of elasticity, to simulate the performance of human bone in vivo in biomechanical studies of implant-supported prostheses. MATERIAL AND METHODS: In this study, fast-curing polyurethane (F16 polyurethane, Axson) was used to build 40 specimens that were divided into five groups. The following reagent ratios (part A/part B) were used: Group A (0.5/1.0), Group B (0.8/1.0), Group C (1.0/1.0), Group D (1.2/1.0), and Group E (1.5/1.0). A universal testing machine (Kratos model K - 2000 MP) was used to measure modulus of elasticity values by compression. RESULTS: Mean modulus of elasticity values were: Group A - 389.72 MPa, Group B - 529.19 MPa, Group C - 571.11 MPa, Group D - 470.35 MPa, Group E - 437.36 MPa. CONCLUSION: The best mechanical characteristics and modulus of elasticity value comparable to that of human trabecular bone were obtained when A/B ratio was 1:1.

OBJETIVO: esta revisão de literatura visa avaliar, através de literatura específica, a sensibilidade e especificidade do exame de ressonância magnética (RM) para o diagnóstico dos desarranjos internos da articulação temporomandibular (ATM). METODOLOGIA: tanto artigos que utilizaram ATM de cadáveres para comparar achados anatômicos aos achados de ressonância magnética (RM), como artigos que compararam achados clínicos com achados de RM foram utilizados. Através dos achados desses artigos, as propriedades de sensibilidade e especificidade da RM para o diagnóstico de desarranjos internos da ATM foram calculadas. Com isso, a confiabilidade e a aplicabilidade do exame de RM no diagnóstico dos desarranjos internos da ATM foram discutidas. RESULTADOS: encontrou-se sensibilidade de 90% e especificidade de 88% da RM para desarranjos internos da ATM. CONCLUSÃO: o exame de RM de ATM possui ótima sensibilidade e especificidade para o diagnóstico dos desarranjos internos da ATM. Porém, tal exame deve ser solicitado com cautela, apenas nos casos onde a imagem seja indispensável para o plano de tratamento.

OBJECTIVE: the aim of this paper is to review the literature concerning the reliability and applicability of magnetic resonance imaging (MRI) in the diagnosis of temporomandibular joint (TMJ) internal disorders. METHODS: articles that have used TMJ from cadavers to compare MRI findings with anatomic findings, as well as some papers that have compared clinical findings with MRI findings were evaluated. According to the findings identified on these articles, the MRI sensitivity and specificity properties for the TMJ internal disorders diagnosis were calculated. Then, the MRI reliability and applicability for the TMJ internal disorders diagnosis were discussed. RESULTS: 90% of sensitivity and 88% of specificity were found. CONCLUSION: the TMJ MRI presents good sensitivity and specificity for the TMJ internal disorders diagnosis. But dentists should beware and request this exam only in cases where MRI will be essential to the treatment planning.