RESUMO
OBJECTIVES: The objective of this study is to evaluate the longevity of two fiber post cementation strategies in a prospective, multicenter, non-inferiority, double-blind randomized controlled trial. METHODS: A total of 152 teeth, with adequate endodontic treatment and loss of coronal structure and bilateral simultaneous posterior occlusal contacts, were randomly allocated to receive glass fiber posts cemented with a conventional cementation strategy (CRC group: adhesive system + resin cement) (Adper Single Bond + RelyX ARC; 3 M-ESPE) or a self-adhesive cementation strategy (SRC group: self-adhesive resin cement; RelyX U100/U200; 3 M-ESPE). The patients were recalled annually for clinical and radiographical evaluation with a 93% recall rate (142 teeth, with 74 at CR groups and 68 at SRC group). The primary outcome was survival rate, considering the fiber post debonding (loss of retention). The secondary outcome included the success rate of the prosthetic treatment with crown debonding, post fracture, and tooth loss (not related to post failure). Both outcomes were evaluated annually. The Kaplan-Meier method and Cox regression with 95% confidence interval were used for the statistical analysis. RESULTS: For the primary outcome (failures directly related to fiber posts cementation strategy), there were 4 fiber post debondings (2 per group), 8 root fractures (3 for SRC group and 5 for CRC group), and one mixed failure (debonding combined with root fracture for CRC), with both strategies presenting similar survival rates (p = 0.331), with 88.9% for the CRC group and 90.9% for the SRC group. For the secondary outcome (failures not related to fiber post cementation strategies), there were 8 crown debondings, 3 post fractures, and 3 tooth losses, with no statistically difference between groups (p = 0.701), with 77% for SRC and 82% for CRC. CONCLUSION: Fiber post cementation strategies with conventional or self-adhesive resin cement presents similar tooth survival and success rates. TRIAL REGISTRATION: NCT01461239 CLINICAL RELEVANCE: Both adhesive cementation strategies led to high survival and success rates and are indicated for fiber post cementation, even after a long follow-up period (up to 106 months).
Assuntos
Colagem Dentária , Técnica para Retentor Intrarradicular , Humanos , Cimentos de Resina/química , Cimentação/métodos , Cimentos Dentários/química , Taxa de Sobrevida , Estudos Prospectivos , Vidro/química , Teste de Materiais , Análise do Estresse Dentário , DentinaRESUMO
OBJECTIVES: To evaluate the longevity of metal-ceramic single crowns cemented onto resin composite prosthetic cores using a self-adhesive resin cement in a prospective clinical descriptive study. METHODS: A total of 152 teeth were endodontically treated and received resin composite prosthetic cores and metal-ceramic crowns cemented with a self-adhesive resin cement. The patients included in the sample were recalled for clinical and radiography evaluation in an up-to-106-month period after the final cementation procedures, with an average of 62 months of follow-up. 91.5% of the sample (142 teeth) were evaluated regarding the treatment survival rate, analyzed considering the loss of crown retention (crown debonding) and tooth loss as the primary outcome. In addition, post debonding, and root fracture occurrences were also recorded as secondary outcomes to evaluate the success rate of the prosthetic treatment. The aesthetic parameters were also evaluated according to the FDI criteria. The Kaplan-Meier method and Cox regression with 95% confidence interval were applied for the statistical analysis. RESULTS: Regarding the primary outcome, the metal-ceramic crowns cemented with self-adhesive resin cement presented a high survival rate (91.5%), with 8 crown debondings and 3 tooth losses (1 due to caries and 2 due to periodontal disease) occurring after the evaluation period. For secondary outcomes, 9 root fractures and 4 post debondings occurred, generating a success rate of 72%. All crowns had a score 1 on the FDI criteria, indicating that they were clinically excellent or very good regarding the aesthetic parameters. CONCLUSION: The metal-ceramic crowns luted with a self-adhesive resin cement presented a survival rate of 91.5% after an average of 62 months of follow-up. Furthermore, the restorations remained aesthetically satisfactory over time, without changes that would indicate prosthetic retreatment. A success rate of 72% was obtained considering the secondary outcome, mainly related to intraradicular retainer failures (root fractures or post debonding). CLINICAL SIGNIFICANCE: The self-adhesive resin cement is clinically indicated for cementation of metal-ceramic crowns onto resin composite prosthetic cores.
Assuntos
Cimentos Dentários , Cimentos de Resina , Humanos , Seguimentos , Estética Dentária , Resinas Compostas , Coroas , Cimentação/métodos , Cerâmica , Teste de Materiais , Falha de Restauração DentáriaRESUMO
Temporomandibular disorders are frequent in different segments of the population and harm the quality of life of individuals. The present sudy aimed to investigate the association between stress and temporomandibular dysfunction (TMD) in university students in Brazil. All incoming students at the Federal University of Pelotas were invited to participate in this cross-sectional study. A self-administered questionnaire was used with socioeconomic and oral health variables. TMD Fonseca questionnaire "Fonseca's anamnestic index" was used to identify the severity of symptoms of temporomandibular dysfunction. The same was elaborated in the form of Helkimo's anamnestic index. Stress was measured using a modified version of the Perceived Stress Scale and categorized into quartiles. Logistic multivariable regression models were used to analyze the associations of interest controlling for possible confounding variables. A backward stepwise procedure was used to select variables that should be kept in the final model. A total of 2,089 students answered the questionnaires and 82 (3.9%) were classified with the presence of TMD. Adjusted logistic regression shows that chance of presenting temporomandibular dysfunction was higher (OR=2.43; 95%CI=1.04-5.65) when the stress level increased. In conclusion, the mild degree of temporomandibular dysfunction was the most prevalent. Stress was associated with individuals with a higher prevalence of temporomandibular dysfunction. (AU)
As disfunções temporomandibulares são frequentes em diferentes segmentos da população e prejudicam a qualidade de vida dos indivíduos. O presente estudo teve como objetivo investigar a associação entre estresse e disfunção temporomandibular (DTM) em estudantes universitários no Brasil. Todos os alunos ingressantes da Universidade Federal de Pelotas foram convidados a participar deste estudo transversal. Foi utilizado um questionário autoaplicável com variáveis ââsocioeconômicas e de saúde bucal. O questionário TMD Fonseca "Índice anamnésico de Fonseca" foi utilizado para identificar a gravidade dos sintomas da disfunção temporomandibular. O mesmo foi elaborado na forma de índice anamnésico de Helkimo. O estresse foi medido usando uma versão modificada da Perceived Stress Scale e categorizado em quartis. Modelos de regressão logística multivariada foram usados ââpara analisar as associações de interesse controlando possíveis variáveis ââde confusão. Um procedimento de backward stepwise foi usado para selecionar as variáveis ââque deveriam ser mantidas no modelo final. Um total de 2.089 alunos responderam aos questionários e 82 (3,9%) foram classificados com presença de DTM. A regressão logística ajustada mostra que a chance de apresentar disfunção temporomandibular foi maior (OR=2,43; IC95%=1,04-5,65) quando o nível de estresse aumentou. Em conclusão, o grau leve de disfunção temporomandibular foi o mais prevalente. O estresse foi associado a indivíduos com maior prevalência de disfunção temporomandibular. (AU)
RESUMO
BACKGROUND: The present study aims to assess the influence of low-level laser therapy (LLLT) on stability in implants placed in healed sites. MATERIAL AND METHODS: The present study followed the SPIRIT statement and is reported according to CONSORT. Patients were randomly allocated to LLLT or control groups. LLLT consisted in the application of 808-nm GaAlA laser applied before the preparation of the implant bed and after suturing (80 seconds; 11J/cm2). Implant stability quotient (ISQ) and the distance between the implant platform to the alveolar bone crest (millimeters) were assessed at implant placement (T0) and the abutment selection phase (4-6 months, Ta). RESULTS: A total of 64 implants were placed in 33 patients. The insertion torque ranged from 10 to 70 N.cm (mean 43.23; SD ±16.82). The T0 ISQ ranged from 18 to 95.5 (mean 61.7; SD ±18.23) and the crestal bone radiographic distance was 2.03 mm (SD±1.27). At Ta, the ISQ ranged from 39 to 90 (mean 64.2; SD±9.84), and the mean crestal bone radiographic loss was 1.70mm (SD±1.65). However, no differences were observed when LLLT and control groups were compared with ISQ difference (Ta-T0; p=0.598) or radiographical peri-implant alterations (p=0.531). CONCLUSION: LLLT did not influence the implant stability in implants placed in healed sites compared to a control group. TRIAL REGISTRATION: ReBEC, RBR-35TNJ7 . Registered May 23, 2018.
Assuntos
Terapia com Luz de Baixa Intensidade , Processo Alveolar , Humanos , Próteses e Implantes , Radiografia , TorqueRESUMO
Cleft lip and/or cleft palate defects often result in a functional deficiency in the patient's chewing, speech ability, and aesthetic appearance, usually demanding multidisciplinary effort for addressing the aesthetic and functional patient's requirements. This clinical report describes the planned oral rehabilitation of a 46-year-old woman with unilateral cleft lip defect based on the patient's peculiarities and age. Due to limitations concerning bone grafts and implant procedures, as well as orthodontic treatment, the prosthodontic rehabilitation using the metal-ceramic fixed partial denture was chosen. The treatment adequately reestablished the aesthetic and functional activities, positively impacting the patient's quality of life.
Assuntos
Fenda Labial , Fissura Palatina , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estética Dentária , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
OBJECTIVE: This clinical case report describes a novel bendable abutment as a prosthetic solution for implants presenting with an unfavorable inclination. CLINICAL CONSIDERATIONS: A metal-ceramic screw-retained single crown was made on this novel bendable abutment in a patient presenting with a pronounced buccal inclination of an implant. A plastic reference guide is used to define the correct inclination and then this inclination is transferred to the abutment using a specific bending device at the same appointment. CONCLUSIONS: Bendable abutments can be used as a solution to correct unfavorable implant inclinations. This abutment can be customized at the same appointment considering a case-specific inclination rather than conventional pre-angled abutments. CLINICAL SIGNIFICANCE: Bendable abutments can be customized according to each case specificities while conventional pre-angled abutments may not be adequate for all patients. Also, the abutment customization could be easily done by dentists at their own practices using a specific bending device with hand pressure only, saving time, and the need to order pre-angled abutments or having it in stock.
Assuntos
Dente Suporte , Implantes Dentários , Parafusos Ósseos , Cerâmica , Coroas , Projeto do Implante Dentário-Pivô , Porcelana Dentária , HumanosRESUMO
BACKGROUND: Low-level laser therapy (LLLT) has been suggested to improve primary stability at the early stages of osseointegration in animal models. However, there is still scarce evidence about its influence on implant stability in humans. PURPOSE: To assess the influence of LLLT on implant stability in implants placed in fresh extraction sockets. MATERIAL AND METHODS: A randomized controlled trial was designed according to the SPIRIT guidelines and is reported following the CONSORT. Patients were randomly allocated according to control or LLLT groups. LLLT consisted in the application of GaAlAs laser (808 nm, avg. power density: 50 mW, circular spot diameter and area: 0.71 cm/0.4cm2 ) applied in six points in contact mode with peri-implant soft tissue (1.23 minutes in each point of application; dose per point 11 J) before bone perforation and after suturing. The total dose resulted in 66 J per application moment. This LLLT protocol was applied only in the dental implant placement session. Implant stability was by ISQ at implant placement (T0 ) and the abutment selection (Ta ). Digital radiographs for T0 and Ta were used to assess the distance between the implant platform and alveolar bone crest, in millimeters. T-test and Shapiro-Wilk test were used to analyze data between groups using the implant as a unit of analysis. RESULTS: Fifty implants were placed in 44 patients. The insertion torque ranged from 15 to 60 N.cm (mean 35.64 ± 13.34). Two implants of the LLLT and one of the control groups were lost to follow-up and one implant of the control group failed to osseointegrate (4.3%). ISQ at T0 ranged from 17 to 79 (mean 59.33 ± 13.05) and from 40 to 89 (mean 66.46 SD ± 11.56) at Ta . No differences were observed when comparing the groups with ISQ difference (P = .433) or radiographical peri-implant alterations (P = .261). CONCLUSIONS: LLLT did not influence implant stability in implants placed in fresh extraction sockets when assessed at healing abutment installation.
Assuntos
Implantes Dentários , Terapia com Luz de Baixa Intensidade , Processo Alveolar , Animais , Implantação Dentária Endóssea , Humanos , Osseointegração , Alvéolo Dental/cirurgiaRESUMO
OBJECTIVE: This study aimed to assess the survival and success of glass fiber posts compared to cast metal posts in teeth without ferrule. MATERIAL AND METHODS: An equivalency, prospective, double-blind (patient and outcome evaluator) randomized controlled trial (RCT) with parallel groups was designed to compare the clinical performance of cast metal and glass fiber posts cemented in endodontically treated teeth without ferrule (NCT01461239). Teeth were randomly allocated to the glass fiber or cast-metal post groups. All teeth were restored with single metal-ceramic crowns. Kaplan-Meier analysis with the log-rank test was used to test the success and survival between glass fiber and cast metal posts considering a cut-off value of P = 0.05. The annual failure rates were calculated considering the survival data for all restorations and separated by type of post after five years. RESULTS: A hundred and nineteen patients and 183 posts (72 cast metal posts and 111 glass fiber posts) were analyzed. The median follow-up was 62 months (IQR 37-81). The log-rank test for success (P = 0.26) and survival (P = 0.63) analyses did not present statistically significant differences. The AFR of both posts after 5 years was 1.5%. Considering the posts separately and after 5 years, cast metal posts presented AFR of 1.2% and glass fiber posts AFR of 1.7%. Most failures were in posterior teeth (16/23), 10 failures were classified as root fractures and 5 as post debonding. The follow-up rate was 95.3%. CONCLUSIONS: Glass fiber and cast metal posts showed good and similar clinical performance. CLINICAL SIGNIFICANCE: Results of this randomized controlled trial can help dentists to answer how the best technique to rehabilitate endodontically treated teeth with no remaining coronal wall.
Assuntos
Técnica para Retentor Intrarradicular , Fraturas dos Dentes , Dente não Vital , Resinas Compostas , Coroas , Análise do Estresse Dentário , Vidro , Humanos , MetaisRESUMO
This study evaluated fracture resistance values and failure mode of weakened roots restored with cast post and core, fiber post and anatomical posts. In vitro studies, published in English, Portuguese and Spanish, that evaluated weakened roots restored with at least two of mentioned strategies were searched for in three databases MEDLINE, PubMed and Scopus until June 2017; there was no restriction regarding the publication year. Fracture resistance values were obtained, and the following comparisons: cast post and core vs. fiber post and vs. anatomical post and fiber post vs. anatomical post were performed. Meta-analyses were conducted using the random effects model to calculate the combined effect of the difference between the averages. Six articles were included in the study. There was no significant difference between the fracture resistance values, but more catastrophic failures were observed on cast post and core, and the included studies presented a low risk of bias for the most domains. It was concluded that weakened roots restored with the searched strategies seem to have similar fracture strength, but fiber and anatomic post decreases the possibility of catastrophic failure. (AU)
Este estudo avaliou os valores de resistência à fratura e modo de falha de raízes fragilizadas restauradas com núcleos metálicos fundidos, pinos de fibra de vidro e pinos anatômicos. Foram pesquisados estudos in vitro, publicados em inglês, português e espanhol, que avaliaram raízes fragilizadas restauradas com pelo menos duas das estratégias citadas, em três diferentes bases de dados MEDLINE, PubMed e Scopus até junho de 2017; não houve restrição quanto ao ano de publicação. Os valores de resistência à fratura foram obtidos, e as seguintes comparações foram feitas: núcleo metálico fundido vs. pino de fibra de vidro e vs. pino anatômico e pino de fibra de vidro vs. pino anatômico. Meta-análises foram realizadas utilizando o modelo de efeitos randômicos para calcular o efeito combinado da diferença entre as médias. Seis artigos foram incluídos no estudo. Não houve diferença significativa entre os valores de resistência à fratura, mas foram observadas mais falhas catastróficas nos núcleos metálicos fundidos, e os estudos incluídos apresentaram um baixo risco de viés para a maioria dos domínios. Pode-se concluir que raízes fragilizadas, restauradas com as estratégias pesquisadas, parecem ter semelhante resistência à fratura, porém os pinos anatômicos e de fibra de vidro diminuem as possibilidades de falha catastrófica (AU)
Assuntos
Raiz Dentária , Falha de Restauração Dentária , Pinos DentáriosRESUMO
Resin cements are often used for single crown cementation due to their physical properties. Self-adhesive resin cements gained widespread due to their simplified technique compared to regular resin cement. However, there is lacking clinical evidence about the long-term behavior of this material. The aim of this prospective clinical trial was to assess the survival rates of metal-ceramic crowns cemented with self-adhesive resin cement up to six years. One hundred and twenty-nine subjects received 152 metal-ceramic crowns. The cementation procedures were standardized and performed by previously trained operators. The crowns were assessed as to primary outcome (debonding) and FDI criteria. Statistical analysis was performed using Kaplan-Meier statistics and descriptive analysis. Three failures occurred (debonding), resulting in a 97.6% survival rate. FDI criteria assessment resulted in scores 1 and 2 (acceptable clinical evaluation) for all surviving crowns. The use of self-adhesive resin cement is a feasible alternative for metal-ceramic crowns cementation, achieving high and adequate survival rates.