Carreiro, Adriana da Fonte PortoPereira, Ana Larisse Carneiro2024-12-262024-12-262024-09-16PEREIRA, Ana Larisse Carneiro. Fluxo digital em próteses totais fixas implantossuportadas: estudo laboratorial e clínico. Orientadora: Dra. Adriana da Fonte Porto Carreiro. 2024. 182f. Tese (Doutorado em Ciências Odontológicas) - Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, 2024.https://repositorio.ufrn.br/handle/123456789/60978The advent of digital technology in the workflow of complete-arch implant-supported fixed prostheses (ISFP) has allowed the simplification of the conventional technique, while problematizing the union of its interfaces (framework/prosthetic base/artificial teeth), behavior of the materials for their manufacture and the transfer of the position of the implants. Therefore, this laboratory and clinical study aimed to evaluate the effectiveness of the union between the framework, prosthetic base and artificial teeth, the impact of a physical barrier to improve the properties and minimize the discoloration of the impression materials for the prosthetic base and artificial teeth, as well as transfer the position of the implants to the virtual environment, aiming to obtain a working model for the planning of passive and fit framework, and subsequent digital maxillary occlusal record. In the laboratory stage, two systematic reviews were carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, both registered in the International Prospective Registry of Systematic Reviews (PROSPERO) database (CRD42022384926 / CRD42022384926) to answer the PICO questions (population, intervention, control, outcomes): “Which surface treatment increases the bond strength between acrylic resin and metal alloys?” and “What is the most effective bonding protocol for prostheses manufactured from CAD/CAM materials (milled and 3D printed)?” They showed that abrading the metal with aluminum oxide followed by applying a 10-MDP (10-Methacryloyloxydecyl Dihydrogen Phosphate) based primer, increased the bond strength between the metal alloys (titanium and cobalt-chromium) and the prosthetic base (heatpolymerized). Meanwhile, the IvoBase CAD Bond bonding system increased the bond strength between the milled prosthetic base attached to the prefabricated acrylic resin teeth. Based on these findings, three bonding protocols were tested to join the prosthetic base (heat-polymerized [VipiWave] and 3D printed [Yller, Prizma and PrintaX]) (20×24 mm) to the artificial teeth (prefabricated in acrylic resin [VITA MFT] and 3D printed [Yller, Prizma and PrintaX]), namely (n=20): mechanical retention with perforation + monomer, mechanical retention with perforation + airborne-particle abrasion with 50-µm aluminum oxide + monomer and mechanical retention with perforation + Palabond, to evaluate the shear strength (1 mm/minute), type of failure, surface roughness (Ra) and wettability (º). Subsequently, specimens were made with artificial teeth (prefabricated in acrylic resin [VITA MFT] and 3D printed [Yller and Prizma]) glued to prosthetic base resin (heat-polymerized [VipiWave] and 3D printed [Yller and Prizma]) (20×10×10 mm) and then divided into two groups (n=32): unglazed and glazed. These were thermocycled (10,000 cycles) and then immersed in distilled water and coffee for 7 days for analysis of color differences, using a CIELab spectrophotometer. Finally, discs (10×3 mm) and bars (64×10×3.3±0.2 mm) were made from prosthetic base resins (heat-polymerized [VipiWave] and 3D printed [Yller, Prizma and PrintaX]) and divided into two groups: unglazed and glazed. These were thermocycled (10,000 cycles) and subjected to surface roughness (Ra), wettability (º), brightness (GU), flexural strength (MPa), Knoop microhardness (HK), microbiological analysis (dual biofilm with Streptococcus mitis and Candida albicans) and scanning electron microscopy. It was observed that mechanical retention with perforation + Palabond (2.62±0.574) or mechanical retention with perforation + airborneparticle abrasion with 50-µm aluminum oxide + monomer (2.22±0.392) applied to the 3D printed prosthetic base bonded to the artificial tooth 3D printed in Yller resin provided a bond strength similar to the heat-polymerized prosthetic base bonded to the prefabricated tooth in acrylic resin (2.65±0.663) after thermocycling (p>0.05). The application of glaze minimized the color change of the 3D printed resins for prosthetic base and artificial teeth, in addition to making the resins for prosthetic base smoother, brighter, harder and resistant to dual biofilm colonization (p<0.05). In the clinical phase, a device (BR 10 2019 026265 6) was developed for direct acquisition of the implant position for the virtual environment. From this, patients rehabilitated with mandibular provisional PTF underwent intraoral scanning (TRIOS; Shape) and the virtual images allowed digital planning and direct milling in Cobalt-Chromium of the metal framework. These were evaluated for clinical passivity and misfit, the latter using the framework on conventional and printed cast, using the single screw test, all screws tightened and interspersed tightening. With all framework evaluated, patients were randomized, considering the type of maxillary occlusal record (n=10): conventional (COR) and digital (DOR). When installing the PTF, the distribution and quantity of occlusal contact points, work time (clinical and laboratory) and occlusal adjustment were evaluated. The results showed no gap between the framework and the abutments, passage without resistance of the screw, no retention of the framework on the models and stability of the framework in the oral cavity. Greater misfits of the framework on the printed cast were observed compared to the conventional one when the single screw test was applied (p<0.008). There was similarity in the maxillary occlusal record methods in relation to the distribution of occlusal contact points. DOR required less occlusal adjustment time (COR: 9.14; DOR: 5.52; p=0.008) and clinical time (COR: 242.65; DOR: 15.26; p<0.001), on the other hand, more laboratory time (COR: 25.99; DOR: 582.00; p<0.001) and total workflow time than COR (COR: 264.48; DOR: 598.28; p<0.001). It is concluded that the use of mechanical retention with perforation + Palabond or mechanical retention with perforation + airborne-particle abrasion with 50-µm aluminum oxide + monomer, with application of glaze on the surface of the prosthesis, provides a reduction in infiltration, surface deterioration of the material, aesthetics and resistance to biofilm colonization. In addition, from the device, a working model can be obtained with the trueness position of the implants, allowing predictability and reliability in the production of passive and fit framework and functional space for tooth assembly.Acesso AbertoImageamento tridimensionalImplantação prótese dentáriaRegistro da relação maxilomandibularGlaceantesCordoctoralThesisCNPQ::CIENCIAS DA SAUDE::ODONTOLOGIA