Dissertations / Theses on the topic 'Fixed prosthodontic'

Base metal dental alloys are among the oldest restorative dental materials used in dentistry. They are still widely applied and are expected to remain in demand in the coming years. They demonstrate adequate properties required to meet the needs of wide and variable applications. Base metal alloys can be used alone or in combination with other dental materials to construct a dental restoration. Due to environmental and financial factors, variable practices have emerged in the processing of these alloys. Among these practices is the reuse of surplus alloys. The aim of this study was to evaluate the effect of recycling nickel-chromium and cobalt-chromium alloys on the quality of dental restorations employing a suggested test protocol where the correlation between the different factors tested was investigated. Wax patterns of different shapes were prepared for the different tests conducted. For each alloy type, five different combinations of new and surplus alloys were prepared to cast the wax patterns using an induction casting machine. Castings were subjected to different quality assessment investigations; (i) the microstructure was assessed for the presence of pores and inclusions and the chemical composition was evaluated for the amount of elements present (mass%), castings produced from new alloy were used as a control; (ii) castings were subjected to a polishing procedure simulating the technique used in dental laboratories. Surface roughness (Ra) was analysed prior to and after the polishing procedure using light profilometer; (iii) a metal to ceramic bond strength test was conducted following the requirements of ISO 9693: 2000. ISO standardised test pieces were subjected to a three-point bending test using a universal testing machine and bond strength evaluated; and (iv) ions released from castings were measured, where castings were placed into artificial saliva at pH 4 and 6 for five weeks. The mean amounts released were measured using inductively coupled plasma atomic emission spectroscopy (ICP/OES). The findings of this study imply that although microstructure and chemical composition of castings containing surplus alloy varied from those produced entirely from new alloys, these variations were not always significant and depended on the alloy type and restoration type. Surface roughness evaluation suggests that consecutive laboratory procedures, such as finishing and polishing procedures can considerably enhance surface topography of casting produced partially and entirely from surplus alloy. For the bonding test investigation, all test groups demonstrated bond strength values higher than that recommended by ISO 9693: 2000. A similar observation was documented for the ion release test; despite the increase in the amount of ions released from castings containing surplus alloys, the detected amount of ions was however very small compared to those documented in the literature. Although some of the tested characteristics of castings containing 100% recycled alloys were marginally inferior to those produced from new alloy, the former castings gave acceptable results and would be expected to function and perform appropriately in the patient’s mouth in the equivalent manner to castings produced from new alloys. However the addition of a small amount of new alloy, as low as 25%, has been shown to enhance the performance of castings compared to those containing 100% recycled alloy in the different tests conducted.

Chapter 1 is an introduction to lithium disilicate: its glass ceramic nature, its characteristics, its mechanical properties. The possibility to be etched allows lithium disilicate to be adhesively luted on dental tissues, influencing both the final properties of restoration and the clinical protocol of cementation. The aim of this thesis was investigate the adhesive interface between lithium disilicate, resin cement and dental tissues from different points of view: retention, fracture strength and survival rate. In Chapter 2 the retention of lithium disilicate crowns cemented using two different cementation systems was measured. Twenty extracted mandibular premolars were prepared. Anatomic crowns were waxed and hot pressed using lithium disilicate ceramic. Teeth were divided into two groups (n = 10): (1) self- curing luting composite and (2) glass-ionomer cement (GIC). After cementation, the crowns were embedded in acrylic resin block with a screw base. Each specimen was pulled along the path of insertion in Universal Testing Machine. Failure load in Newtons (N) and failure mode were recorded for each specimen. Failure mode was classified as decementation or fracture. Failure load data were analyzed using one-way analysis of variance (ANOVA). Failure modes were compared using Pearson’s Chi-square test. Mean failure load was 306.6(±193.8) N for composite group and 94.7(±48.2) N for GIC group (p = 0.004). Disilicate crown cemented with luting composite most often failed by fracture; otherwise, crown cemented with glass-ionomer cement most often failed by decementation (p = 0.02). Disilicate full crown cemented with luting composite showed higher failure load compared with conventional cementation with glass-ionomer cement. The interface between tooth, luting composite and lithium disilicate surface was also qualitatively evaluated using a scanning electron microscope (SEM). An extracted restoration-free human molar was stored in physiological solution until it was embedded in an autopolimerysing acrylic resin. A standard preparation for onlay was completed and after preparation an anatomic onlay was waxed on the tooth and then hot pressed using lithium disilicate ceramic. After cementation the sample was dissected using an Automatic Micromet (Remet s.a.s) and the section was analyzed using a SEM. SEM evaluation of the tooth showed the three layers seamlessly; by increasing the enlargement the interface did not change. In Chapter 3 the fracture strength of human teeth restored with lithium disilicate onlays, with and without fiber post build-up, was measured. Twenty human mandibular molars were horizontally sectioned and divided into two groups (n = 10). No treatment was applied in group A. Teeth in group B were endodontically treated, built-up using fiber post and composite core and prepared with a circumferential chamfer providing a 1 mm circumferential ferrule. Lithium disilicate onlays were pressed and luted on teeth using dual-curing luting composite. Teeth were tested under static load. Failures were classified as restorable or not restorable. Failure loads were analyzed with ANOVA. Failure modes were compared using Pearson’s Chi-square tests. The mean fracture loads were 1383.5 N for group A and 1286.3 N for group B. No difference was found (p = 0.6). Ninety per cent of fractures were classified as not restorable in both groups, with no difference (p = 0.8). It was concluded that, for teeth restored with adhesive procedures and lithium disilicate onlays, the presence of build-up with fiber post to provide retention and resistance form (as traditionally stated) does not influence the fracture strength. Finally, in Chapter 4, a retrospective study was conducted to assess the clinical performance of lithium disilicate single restorations adhesively cemented on natural teeth. All patients who received lithium disilicate single restorations between 2009 and 2013 at the dental clinic of the University of Ferrara were recalled for clinical evaluation. A total of 43 partial and total restorations in 17 patients were evaluated from a minimum of 36 months follow-up to a maximum of 81 months follow-up, with a mean follow-up of 51 months. The cumulative survival rate was 97.7%, and the cumulative success rate was 94.2%. Lithium disilicate can be successfully used for single-tooth restorations in both anterior and posterior regions, provided that an adhesive luting protocol is applied.

Abstract The aims of this study were to evaluate the treatment need of fixed bridges according to the distribution of pontics in dentition in different age groups, and to investigate the primary and late complications and survival of the conventional fixed metal ceramic prostheses, as well as patients' satisfaction with the prosthetic treatment. The whole material consisted of the patients treated with fixed metal ceramic prostheses by undergraduate students at the Institute of Dentistry during the years 1984 - 1996. There were altogether 772 patients, 460 women (60 %) and 312 men (40 %). Their mean age was 47 years (23 - 81 years). Altogether 944 single metal ceramic crowns and 543 fixed bridges (1374 abutments and 807 pontics) were prepared. It can be concluded that the fixed bridges are most often prepared to replace upper first premolars and lower first molars also in the future. The most usual primary complications related to fixed bridges occurred during preprosthetic endodontic treatment of abutment teeth and during the preparation of the root canals. Previous restoration of the prepared tooth does not have any marked effect on the prognosis of single crowns with dowels, although anatomically complicated upper lateral incisors and upper first premolars need special attention in the treatment planning. Patients were satisfied with aesthetics and function of the fixed metal ceramic prostheses. Late complications found in clinical examinations were few, and the survival rate for the fixed metal ceramic bridge prostheses was calculated to be 84 % after 10 years, long fixed bridges having a lower survival than the shorter ones. The treatment need for conventional fixed bridges seems to be highest among patients over 50 years of age in the future. Age does not influence the longevity of the fixed prostheses, but basic circumstances of the mouth, especially low secretion of saliva affected by diseases and/or medications and high scores of lactobacilli and streptococcus mutans of the saliva seem to decrease the survival.

Dental alloys, and later zirconia, have been used in dentistry as frameworks for many years in making crowns and bridges veneered with ceramic e.g. feldspathic porcelain. Such methods of restoring teeth have been extensively studied both in the laboratory and clinically. Although such substructures have excellent strength there remains a large properties mismatch between these materials and bone or dentine e.g. elasticity. Furthermore, other drawbacks have been documented such as possible allergies, colouring of alloy margins, veneer chipping and excessive wear to opposing natural dentition. Polyaryletherketone (PAEK) thermoplastic biomaterial polymers such as polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) have been successfully applied in different medical applications with the latter recently being introduced to dentistry as a restorative material. The material is called Pekkton® ivory (Cendres+Métaux, SA, Switzerland) and is proposed to be used for fabricating both monolithic and bi-layered structures veneered with indirect composite resin. The manufacturer recommends methods similar to well-established restorations such as alloy and ceramic based crowns which makes it a user friendly material for both dental clinics and laboratories. Furthermore, the material’s properties such as high strength, low elastic modulus close to that of dentine, high temperature, chemical, hydrolysis and wear resistance, makes it a promising material for the replacement of tooth material. There is little published data about this material and hence the aim of this research was to evaluate the manufacturing process, aesthetic properties, structural integrity and durability of bi-layered crowns made from PEKK based thermoplastic high performance polymer (Pekkton® ivory, Cendres+Métaux, SA) and veneered with indirect light cured composite (Vita VM LC, VITA Zahnfabrik H. Rauter GmbH & Co.KG, DE). The processing route for Pekkton® ivory is either via milling or hot-pressing and the procedures were compared. The polymer-based restoration was compared to equivalent zirconia and metal based bi-layered restoration systems veneered with either light cured composite resin or feldspathic porcelain. Optical properties of each crown system were compared using a UV and visible light spectrophotometer. Structural integrity was compared for each system by testing the fracture resistance of the crowns using a universal testing machine and durability was evaluated by testing the fatigue limit and fatigue life using a fatigue chewing apparatus. The research hypothesis is that the PEKK polymer as anunderlying substructure material will perform equivalently to metal and zirconia substructures when veneered with light cured composite in the aspects of optical properties, strength and durability. The outcome of the study established a pressing protocol for PEKK using a standard ceramic pressing furnace where the pressed samples showed no significant differences in the CIEL*a*b* colour values, hardness or biaxial flexural strength to those samples produced via milling. There was no significant optical difference between the systems compared, the study found no evidence of difference in the CIEL*a*b* colour value of PEKK, zirconia or metal based samples when veneered with the same composite veneer. However, zirconia based groups displayed greater translucency with the composite veneer and feldspathic porcelain veneer. The fracture resistance of the PEKK and metal composite veneered crowns showed to be comparable, whereas zirconia based crowns demonstrated significantly lower fracture resistance. The durability of the PEKK composite veneered crowns showed the highest fatigue limit in comparison to the zirconia and metal composite veneered crowns. Similarly they showed the highest survival rate in the fatigue life assessment under the same cyclic load. Furthermore, the fracture mode was significantly different than observed with the zirconia and metal based crowns. The conclusion was that this material is promising for use as a restorative material and that clinical evaluation should be undertaken.

Abstract Metal ceramic restorations have been used in fixed prosthodontics since the 1950s, but the lack of aesthetics, the inclination to use metal-free materials, possible allergic reactions to metals, and the high cost of high noble alloys have increased the use of all-ceramic materials. The ongoing development of ceramic materials led to the introduction of zirconia to fixed prosthodontics over a decade ago. The mechanical properties of zirconia have proven to be excellent, but the clinical outcome of conventional fixed zirconia restorations over the long term is unclear. This retrospective clinical study evaluated two- to seven-year outcomes, early complications during prosthetic treatment and short-term failures during the first year of use of zirconia single crowns and fixed dental prostheses (FDPs). The usefulness and durability of zirconia single crowns in abutment teeth of partial removable dental prostheses (RDPs) was also evaluated. The material consisted of 173 patients treated with zirconia single crowns or FDPs by undergraduate dental students between 2007 and 2010. Of these patients 94 were women and 79 men (mean age 55 years, range 18–79 years). Altogether 268 zirconia single crowns (mean 3 crowns, range 1–12 crowns per patient) had been fabricated for 88 patients and 120 zirconia FDPs (range 3–12 units, mean 4.5 units) for 102 patients. Seventeen patients had received both crown(s) and FDP(s). The results show that zirconia single crowns and FDPs are a suitable treatment alternative in fixed prosthodontics. Early complications during prosthetic treatment and short-term failures during the first year of use were few. The survival rate of the zirconia single crowns after 3.9 years (2–6 years) was 89% and the success rate was 80%. The survival rate of zirconia FDPs after 4.9 years (3–7 years) was 100% and the success rate was 89%. Zirconia single crowns perform well as abutment teeth of partial RDPs with a metal framework, but fractures in the veneering porcelain remain a problem
Tiivistelmä Metallokeraamisia rakenteita on käytetty kiinteässä protetiikassa 1950-luvulta lähtien, mutta puutteet estetiikassa, pyrkimys metallittomiin materiaaleihin, mahdolliset allergiset reaktiot ja jalojen metallien korkea hinta ovat lisänneet kokokeraamisten materiaalien käyttöä. Kokokeraamisten materiaalien kehitystyö on tuonut zirkonian kiinteän protetiikan materiaaliksi. Zirkonian mekaaniset ominaisuudet ovat osoittautuneet erinomaisiksi, mutta hammaskantoisten kiinteiden zirkonia-runkoisten proteesien kliiniset pitkäaikaistulokset puuttuvat. Tämän retrospektiivisen kliinisen tutkimuksen tarkoituksena oli selvittää zirkonia-runkoisten yksittäisten kruunujen ja zirkonia-runkoisten siltojen menestymistä 2–7 vuoden aikavälillä sekä kartoittaa niiden valmistuksen aikaiset ongelmat ja varhaiset epäonnistumiset ensimmäisen vuoden aikana. Lisäksi tutkittiin zirkonia-runkoisten yksittäisten kruunujen käyttökelpoisuutta ja kestävyyttä metallirunkoisten rankaproteesien tukihampaina. Materiaali koostui 173 potilaasta, joille hammaslääketieteen opiskelijat olivat tehneet zirkonia-runkoisia yksittäisiä kruunuja tai zirkonia-runkoisia siltoja vuosina 2007–2010. Potilaista 94 oli naisia ja 79 miehiä (keski-ikä 55 vuotta, jakauma 18–79 vuotta). Kaiken kaikkiaan 268 zirkonia-kruunua (keskimäärin 3 kruunua, jakauma 1–12 kruunua potilasta kohti) oli valmistettu 88 potilaalle ja 120 siltaa (keskimäärin 4,5 yksikköä, jakauma 4,5 yksikköä) 102 potilaalle. Seitsemälletoista potilaalle oli tehty sekä kruunuja että siltoja. Tulokset osoittavat, että zirkonia-runkoiset kruunut ja sillat ovat käyttökelpoisia kiinteässä protetiikassa. Valmistuksenaikaiset ongelmat ja varhaiset epäonnistumiset ovat vähäisiä. Yksittäisten kruunujen selviytymisprosentti 3,9 vuoden jälkeen (2–6 vuotta) oli 89 % ja onnistumis-prosentti 80 %. Siltojen selviytymisprosentti 4,9 vuoden jälkeen (3–7 vuotta) oli 100 % ja onnistumisprosentti 89 %. Zirkonia-runkoiset kruunut toimivat hyvin rankojen tukihampaina, mutta niiden ongelmana ovat päällepolttoposliinin lohkeamat

In the last two decades, zirconia has been of a great interest to dentists due to its superb mechanical and optical properties. At first, the use of zirconia was limited to fabrication of cores replacing the metal in crown construction. Nowadays, there is an increase in the trend of using monolithic ‘full contour’ translucent zirconia to overcome the problem of chipping of porcelain veneers and to overcome the limitation of using lithium disilicate in long span replacement. This has brought zirconia in direct contact with saliva and oral fluids and introduced the possibility of the material undergoing low temperature degradation. This study aimed to investigate the effect of accelerated hydrothermal aging on the mechanical and optical properties of two conventional core and two full contour translucent zirconia materials, expected to be used by 90% of zirconia manufacturers globally. Hydrothermal aging was carried out using an autoclave to simulate in vivo aging, using a specific protocol proposed by ISO 13356:2015 mimicking 15- 20 years of clinical service of the material. Each of the four materials were tested before and after aging, including structural analysis which was carried out using XRD, SEM, FIB-SEM and AFM. Mechanical property investigations were carried out by measuring BFS and Vickers hardness. Optical properties were thoroughly investigated through measuring a range of translucency parameters and changes in colour before and after aging. The results of this study showed that conventional core materials were less affected by hydrothermal aging in comparison to full contour translucent zirconia in terms of optical properties. All of the used materials showed clear colour changes after aging, however none of them showed significant changes in the mechanical properties even with more than 20% of t →m phase transformation in one of the translucent zirconia materials. Within the limitation of this in vitro study, it can be concluded that full contour translucent zirconia can be used clinically with no concern about its mechanical and optical properties, however, further studies on the perception and acceptability for changes in the optical properties would be highly recommended.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
O objetivo desse trabalho foi identificar por meio da utilização de geometrias complexas (pela análise de elemento finito) e simplificadas, se novas tecnologias (sistema CAD/CAM) resultam em um comportamento biomecânico mais favorável na cerâmica de cobertura quando comparado à técnica de aplicação convencional (estratificação). Foram modelados três diferentes estruturas de prótese parcial fixa de três elementos com diferentes técnicas de fabricação: convencional, Rapid Layer (feldspática, cimento resinoso e zircônia) e CAD-on (dissilicato, material vítrio de baixa fusão e zircônia) a fim de analisar a distribuição tensão de tração gerada durante um ensaio mecânico pelo método por elementos finitos. Discos (cerâmica de cobertura e zircônia) foram unidos seguindo as três diferentes técnicas (convencional, Rapid Layer e CAD-on). Foram também confeccionadas próteses parciais fixas de 3 elementos pela técnica de multicamada seguindo as mesmas configurações dos modelos utilizados na análise por elementos finitos. Essas coroas foram cicladas durante 2x106 ciclos para analisar falhas na cerâmica de cobertura, como trincas, lascamento, delaminação e falha catastrófica. Os resultados mostraram que as coroas confeccionadas com cerâmica de dissilicato de lítio e material vítreo na interface infraestrutura/cerâmica de cobertura apresentaram menor concentração de tensão de tração quando comparadas aos modelos confeccionados pela técnica convencional, que demonstraram maior concentração de tensão de tração entre as camadas (cerâmica de cobertura, interface e infraestrutura). Para os discos, o acréscimo de material na interface cerâmica de cobertura e infraestrutura mostrou maior resistência à fratura biaxial e menor propagação da trinca entre as camadas de cerâmica. As coroas cicladas não apresentaram falhas como: trincas, lascamento, delaminação e catastrófica nos primeiros 500.000 ciclos. Porém, as próteses confeccionadas com cerâmica feldspática apresentaram trincas a partir de 1x106 ciclos, diferentemente das coroas confeccionadas na técnica Rapid Layer e CAD-on. As coroas confeccionadas pela técnica RL e CAD-on podem ser consideradas um sistema favorável por prevenir a propagação de trincas radiais em direção à superfície da restauração e melhorar a tenacidade à fratura do material.
The aim was to identify whether the CAD/CAM approach resulted in more favourable stressing patterns in the veneer-ceramic when compared with a conventionally sintered Y-TZP core/veneer-ceramic. Three different designs crowns of prosthesis with three elements and different manufacturing techniques were modeled: conventional technique, Rapid Layer (feldspathic ceramic, resin cement and zirconia) and CAD-on (disilicate, fusion glass ceramic and zirconia) techniques to analyze the distribution stress tensile generated during a mechanical test by the finite element method. Moreover, were made feldspathic ceramic discs, lithium disilicate discs and Y-TZP zirconia discs to analyze the influence of biaxial flexure stress of these three different techniques. These discs (veneer ceramic and zirconia ceramic) were joined following the three different techniques (conventional, Rapid Layer and CAD-on). They were also made FPDs 3 elements: following the same design of models used in finite element analysis. These crowns were cycled during 2x106 cycles to analyze failure at veneer ceramic, such as cracks, chipping, delamination and catastrophic failure. The results showed that the crowns made from ceramic lithium disilicate and low fusion glass ceramic at the interface veneer ceramic/infraestructure showed low concentration of tensile stress when compared to models made by the conventional technique, which showed a greater concentration of tensile stress between layers (veneer ceramic, interface and infrastructure). For the discs samples, the multilayer materials showed lower crack propagation between the ceramic layers. The cycled crowns showed no failure as cracks, chipping, delamination and catastrophic failure for the first 500,000 cycles. However, the prostheses made with feldspathic ceramic showed cracks from 1.106 cycles. The incorporation of functionally and aesthetically graded layers would be realisable, considerable research would be required before the feasibility of the conceptual approach could be accurately assessed.
FAPESP: 2012/11095-0

碩士
高雄醫學大學
牙醫學研究所碩士在職專班
99
Patients with periodontitis often suffered from destruction of periodontal tissue, which leads to the pathological displacement or inclination of teeth. If combined with partial loss of teeth or loss of periodontal support, this situation will easily result in bite collapse. In addition to eradication of etiologies of periodontal destruction and reconstruction of the occlusal function, conditions of remaining teeth and maintenance of pateints’ oral hygiene should be brought in consideration. Therefore, the evaluation prior to treatment, the integration and intervention of different specialties, and the expectancy of the patient should all be prudently contemplated. In the present study of 9 cases, under cross-field full-treatment, with the use of dental implants to increase the periodontal support, selection of various periodontoal surgeries to improve the health of periodontium, provision of different designs of prostheses to stabilize occlusion and relieve trauma from occlusion, and with the help of orthodontic intervention to the meet the esthetic request, we can then step further to reach the goal of full-mouth rehabilitation. Besides, however, the periodically follow-ups and the maintenance of oral hygiene of the patients are the keys to promote the success rates of our treatments.

MUDr. BOLDAJI, Abdollah The author in his PhD thesis deals with the assessment of long-term stability of commonly used bevel crown. The work deals with the changes in color, shape, surface integrity, marginal adaptation and the state of the surrounding tissues to determine the ideal facet material.

Trabalho final do 5º ano com vista à atribuição do grau de mestre no âmbito do ciclo de estudos de Mestrado Integrado em Medicina Dentária apresentado à Faculdade de Medicina da Universidade de Coimbra.
Statement of the problem Recently, and attempting to overcome some limitations of the conventional tools, instruments obtained by a process of chemical vapour deposition (CVD) appeared with promising features and alleged advantages in many applications, such as preparation and finishing in fixed prosthodontics procedures. However, there is still no conclusive evidence of their superior performance. Objectives The aim of this study is to test different types of CVD-obtained instruments in crown preparations, using profilometric evaluation of surface roughness and three-dimensional form, in order to demonstrate, in a scientific manner, the advantages or disadvantages of these instruments, as well as diagnose possible flaws or confirm the accuracy of the methodology, thus being called a pilot study. Materials and methods Margin preparations were made, with the aid of a parallelometer, applying different methods of preparation and finishing in a split-tooth model. The margins were photographed with high magnification, and then a 3D profilometric evaluation was made, resulting in values for different roughness parameters, as well as three-dimensional images of the surface. Results The group prepared and finished with CVD burs achieved the lowest roughness values. The highest scores were associated to the group prepared with high-speed diamond burs and finishing made with CVD ultrasonic tips. Groups 4 and 1 achieved both median scores, whereas the latter presented greater variability. However, in a visual analysis of the three-dimensional images, groups 2 and 4 (both finished using CVD ultrasonic tips) show a more regular and smooth surface, with less relief marks, opposing to the ones corresponding to groups 1 and 3, which show a more pronounced bur path, matching its movements along the margin. Conclusion Preparations made with CVD burs present the best roughness results, conventional diamond burs presented the most variable ones and the association between conventional diamond burs and CVD ultrasonic tips presented the worst values. Nonetheless, by examining the three-dimensional images and taking in consideration a whole set of success parameters, groups finished using CVD ultrasonic tips seem to deliver better conditions for a positive outcome of fixed prosthodontic restorations by providing more precise, well-defined and sharp margins, which can enhance marginal fit, castability and aesthetics. Clinical significance Clinically, the definition, sharpness and precision on the margins are more important features than roughness, as dissected on this study. Provided that margins produced with CVD ultrasonic excel on these characteristics, this makes them a valid and important tool in the execution of a successful fixed prosthodontics restoration.

O presente trabalho destina-se a descrever e analisar, a atividade clínica do binómio 80, realizada na Clínica Dentária, da Universidade Católica Portuguesa de Viseu, no período de setembro de 2019 até março de 2020. Atualmente a medicina dentária está a evoluir no sentido em que cada vez mais se observa uma mudança positiva no comportamento da população portuguesa visto que existe uma procura crescente por um acompanhamento do estado da sua saúde oral. O relatório apresentado visa uma análise descritiva da atividade clínica exercida pelo binómio 80, com o objetivo de caraterizar a população que frequenta a Clínica Dentária da Universidade Católica Portuguesa. Este relatório contém também dois casos clínicos diferenciados, os quais estão a ser desenvolvidos nas disciplinas de Prostodontia Fixa e Odontopediatria. Os dados de cada paciente foram recolhidos em cada consulta com base na ficha clínica de cada área disciplinar e inseridos no software de gestão NewSoft®. Para a análise da amostra, utilizou-se o software Microsoft Excel® para Office 365, onde se avaliou o género, idade, tipo de hábitos de higiene oral e área clínica em que cada paciente foi observado. O objetivo deste relatório é analisar o protocolo clínico aplicado aos pacientes de acordo com cada área disciplinar, assim com descrever e discutir os princípios teóricos para abordagem de cada caso clínico diferenciado.
This work aims to describe and analyze the clinical activity of binomial 80, performed at the Dental Clinic of Universidade Católica Portuguesa Viseu, from September 2019 to March 2020. Currently, dental medicine is evolving in the sense that an increasingly positive change is being observed in the behavior of the Portuguese population as there is a growing demand for monitoring the state of their oral health. The presented report a descritptive analysis of the clinical activity performed by binomial 80, with the objective of characterizing the population that attends the Dental Clinic at UCP. This report also contains two different clinical cases, which are being developed in the disciplines of Fixed Prosthodontics and Pediatric Dentistry. The data of each patient were collected in each appointment based on the clinical record of each subject area and inserted in the NewSoft® management software. For the analysis of the sample, Microsoft Excel® software for Office 365 was used. The variables gender, age, type of oral hygiene habits and clinical area in which each patient was observed were evaluated. The purpose of this report is to analyze the clinical protocol applied to patients according to each disciplinary area, as well as to describe and discuss the theoretical principles for approaching each differentiated clinical case.

A Prótese Fixa é uma valência da Medicina Dentária responsável por reabilitar e substituir peças dentárias danificadas ou perdidas por substitutos artificiais, sendo que estes não podem ser removidos pelo paciente. A cimentação é o processo pelo qual, através da aplicação de um cimento, se procura obter uma boa retenção e adequado selamento marginal. A seleção incorreta ou a manipulação indevida de um cimento podem afetar a longevidade de uma restauração indireta. Este trabalho visa abordar os procedimentos de cimentação e determinar quais os cimentos definitivos mais utilizados atualmente, enumerando as suas vantagens e desvantagens, indicações e contra-indicações. Foi elaborada uma revisão bibliográfica, com recurso a bases de dados como a PubMed/Medline, B-On e Scielo. Cada cimento possui propriedades características, não existindo um cimento universal aplicável a todas as situações clínicas. A cimentação adesiva, apesar de tecnicamente mais complexa, apresenta melhores resultados, quando realizada corretamente.
Fixed Prosthodontics is a Dental Medicine field responsible for rehabilitating and replacing damaged or lost teeth by artificial substitutes, which can´t be removed by the patient. Cementation is the process by which, through the use of a cement, a good retention and suitable marginal sealing is sought. A cement’s incorrect selection or improper handling can affect the longevity of an indirect restoration. This work aims to review cementation procedures and determine which of the definitive cements are the most currently used, while identifying its advantages and disadvantages, indications and contraindications. A bibliographic review was performed using databases such as PubMed/Medline, B-On and Scielo. Each cement presents its own properties and there is no universal cement applicable to all clinical situations. Adhesive cementation, although technically more complex, presents better results, when correctly performed.

Introdução: A prostodontia fixa é a área da Medicina Dentária que se ocupa do restabelecimento e manutenção da função mastigatória e estética. O sucesso clínico passa sobretudo pela retenção e conservação da prótese na cavidade oral. A preparação dentária é a forma mais eficiente de reter a prótese, uma vez que a sua confeção obedece a regras explicitas, nomeadamente o ângulo de convergência, ângulo que duas paredes opostas formam entre si, e que deverá variar entre os 2º e os 6º. No entanto, na prática, e por se tratar de uma margem de erro tão pequena, é muitas vezes difícil cumprir este parâmetro. Isto pode acontecer por dificuldades na visualização, devido à quantidade/ qualidade do remanescente dentário, ou até mesmo pela falta de experiência do Médico Dentista. Objetivos: Criação e desenvolvimento de um paralelómetro de aplicação intraoral. Validação em clínica simulada do instrumento criado. Materiais e Métodos: Procedeu-se ao desenvolvimento de um instrumento para auxiliar as preparações dentárias, através da utilização de um acelerómetro e de um giroscópio. Estes dois componentes foram incorporados numa placa base que posteriormente foi acoplada à turbina. Este dispositivo foi testado em ambiente de clínica simulada, em dentes de Frasaco. Participaram neste estudo 12 alunos do 5º ano, do Mestrado Integrado em Medicina Dentária, Centro Regional de Viseu da Universidade Católica Portuguesa. A prova consistia em realizar dois pares de sulcos mesio-distais e vestíbulo-linguais de forma paralela, recorrendo ao paralelómetro e ao sistema tradicional (a-olho). Após a realização deste teste os dentes foram cuidadosamente observados e analisados. As observações feitas foram estatisticamente comparadas com ajuda do programa estatístico IBM SPSS® statistics (IBM Corp Released 2011. IBM SPSS Statistics for Windows, Version 20.0 Armonk, NY: IBM Corp.). Resultados: Na execução dos sulcos no sentido vestíbulo-lingual de molares e pré-molares obteve-se um erro significativamente menor (p<0.05), quando foi usado o paralelómetro em relação ao sistema tradicional (a-olho). Conseguiu-se uma resolução inferior a um grau na validação do paralelómetro Conclusão: Nas condições experimentais, o instrumento criado foi considerado útil.
Introduction: The fixed prosthodontics is the area of dentistry that deals with the restoration and maintenance of masticatory function and aesthetics. Clinical success is essentially the retention and preservation of the prosthesis in the oral cavity. The tooth preparation is the most efficient way to retain the prosthesis since it is confection follows explicit rules, including the angle of convergence, angle which two opposite walls form between them, which shall vary between 2º and 6º. However, in practice, and it is a margin of error so small, it is often difficult to meet this parameter. This can happen by difficulties in view, due to the quantity/quality of the tooth remaining, or even the lack of experience of the Dentist. Objectives: Creation and development of a parallelometer intraoral application. Validation in simulated clinical instrument created. Materials and Methods: The procedure was the development of an instrument for assisting dental preparations through the use of an accelerometer and a gyroscope. These two components were incorporated into a base plate which was subsequently coupled to the turbine. This device was tested in simulated clinical environment in Frasaco teeth. The sample consisted of 12 students of the 5th year of the MSc in Dental Medicine, Centro Regional de Viseu of Universidade Católica Portuguesa. The test was to perform two pairs of grooves mesio-distal and vestibule-lingual in parallel, using the parallelometer and eye. After this test the teeth were carefully observed and analyzed. The comments made were statistically compared with the help of statistical program SPSS (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0 Armonk, NY:. IBM Corp.). Results: In the execution of the grooves in vestibule-lingual of molars and premolars obtained a significantly lower error (p <0.05) when it was used parallelometer over the traditional system (eye). It could be a lower resolution to a degree in the validation of parallelometer. Conclusion: Under the experimental conditions, the created instrument was considered useful.

A saúde oral está intimamente ligada ao bem-estar geral, sendo um fator que contribui para manter ou restabelecer condições físicas, emocionais e sociais. Assim, a saúde oral é considerada parte integrante e essencial da saúde geral. Este facto acentua a importância do estudo e prática da Medicina Dentária em todas as suas áreas de atuação. A elaboração deste relatório de atividade clínica permitirá analisar os conhecimentos e competências adquiridas ao longo dos cinco anos de curso. Permitirá também expor todas as soluções encontradas e executadas perante os problemas específicos que se apresentaram ao longo da minha prática clínica neste último ano do curso. No presente relatório, serão descritos todos os atos clínicos efetuados pelo meu trinómio, na Clínica Universitária, nos quais desempenhei o papel de operadora ou assistente no período decorrido entre setembro de 2013 e maio de 2014. Para permitir esta descrição, serão analisadas, em cada consulta, as variáveis idade, sexo, profissão, Área Disciplinar, tratamento/diagnóstico e grau de dificuldade do procedimento executado. Os resultados serão apresentados de uma forma sintética, com recurso a gráficos. Todos os atos considerados diferenciados, serão apresentados com uma descrição do diagnóstico, plano de tratamento apresentado bem como a fundamentação teórica em que se basearam todas as opções tomadas. A realização deste relatório de atividade clínica permite sistematizar e consolidar todo o trabalho efetuado ao longo de um ano. Esta atividade consiste num processo de aprendizagem indispensável, uma vez que possibilita a aplicação prática de toda a informação adquirida ao longo do curso, permitindo aprofundar o conhecimento em todas as Áreas Disciplinares frequentadas, o que contribui não só para o desenvolvimento profissional mas também pessoal.
Oral health is closely related to general well-being as a contributing factor to maintain or re-establish physical, emotional and social conditions. Thus, it is considered an essential part of health in general. This fact enhances the importance of the study and practice of dental medicine in all its areas. This clínical activity report will analyze the knowledge and skills acquired over the five-year course. It will also reveal all the solutions found and implemented regarding the specific difficulties that I met with throughout my clínical practice in the last year of the course. The present report will describe all procedures undertaken by my clínical group, in which I played the dentist role or assistant, between September 2013 and May 2014. To allow this description, in each medical appointment, the variables age, sex, job, scientific area, treatment / diagnosis as well as the degree of difficulty of the procedure performed will be analyzed. The results will be presented in a summary form by means of graphs. All clínical procedures taken into account, in which I played the dentist role, will be presented with a description of the diagnosis, the treatment plan and the theoretical framework that supports them. This clínical activity report aims to organize and consolidates all the work done over a year of clínical activity. This activity consists of an essential learning process as it enables the practical usage of all knowledge acquired throughout the course, allowing the acquisition of the best knowledge possible in all academic subjects attended, which contributes not only to the professional but also to personal success.

O ensino da Medicina Dentária pretende enquadrar o aluno relativamente aos aspetos mais importantes do exercício profissional, não esquecendo de dar uma perspetiva histórica da evolução da Medicina Dentária desde a antiguidade até à atualidade bem como os conceitos humanitários da arte nobre da Medicina Dentária. As áreas disciplinares tratadas na Clínica Dentária Universitária da Universidade Católica Portuguesa (UCP) de Viseu são nomeadamente: a Medicina Oral, a Periodontologia, a Odontopediatria, a Ortodontia, a Dentisteria Operatória, a Prostodontia Removível, a Prostodontia Fixa, a Endodontia, a Oclusão e a Cirurgia Oral. O presente relatório está dividido em duas partes, sendo a primeira parte destinada à caracterização sucinta da população que procura os cuidados médico-dentários na Clínica Dentária Universitária da UCP de Viseu e análise estatística descritiva dos dados de atividade clínica realizada no 5° Ano do Mestrado Integrado em Medicina Dentária. Numa segunda parte, será realizada a apresentação de três casos clínicos diferenciados, referentes às áreas de Periodontologia, Prostodontia Removível, Prostodontia Fixa e Oclusão bem como a sua discussão do ponto vista clínico e científico.
The teaching of Dental Medicine intends to frame the student regarding the most important aspects of the professional practice, not forgetting to give a historical perspective of the evolution of Dentistry from ancient times to the present day as well as the humanitarian concepts of the noble art of Dentistry. The disciplinary areas treated in the University Dental Clinic of the Portuguese Catholic University of Viseu are: Oral Medicine, Periodontology, Pediatric Dentistry, Orthodontics, Operative Dentistry, Removable Prosthodontics, Fixed Prosthodontics, Endodontics, Occlusion and Oral Surgery. This report is divided into two parts. The first part is aimed at the brief characterization of the population that seeks medical-dental care at the University Dental Clinic of the UCP of Viseu and a descriptive statistical analysis of clinical activity data carried out in the 5th year of the Integrated Master’s in Dental Medicine. In the second part, we will present tree differentiated clinical cases, referring to the areas of Periodontology, Removable Prosthodontics, Fixed Prosthodontics and Occlusion as well as their discussion from a clinical and scientific point of view.

Introdução: A reabilitação com prótese fixa dento-suportada, é por vezes preferida à implanto-suportada, por ser passível de representar um procedimento menos traumático, de menor custo e podendo, inclusivamente, corrigir ou proteger os dentes pilares. O sucesso clínico da prótese relaciona-se com a sua capacidade de retenção e permanência na cavidade oral. O preparo dentário é a forma mais adequada de conseguir essa retenção destacando-se a angulação que duas paredes opostas fazem entre si ou ângulo de convergência. Recomenda-se que as paredes apresentem um ângulo de convergência, entre 2° e 6°. Contudo, parece que, na prática, a maioria dos preparos dentários analisados não respeita esse valor devido a dificuldades de acesso, erros de visualização ou aspetos inerentes ao próprio remanescente dentário, como altura, largura, localização e morfologia. Objetivos: Validação de um instrumento que permite ajudar a determinar o ângulo de convergência durante o preparo dentário. Materiais e Métodos: Procedeu-se ao aperfeiçoamento e fabrico de um instrumento para determinação da angulação das paredes de preparos dentários. Efetuaram-se observações de uma amostra de 140 ângulos de convergência mesio-distal e vestíbulo-lingual/palatino de preparos para coroas totais em dentes de Frasaco®, por alunos do 5º ano do Mestrado Integrado em Medicina Dentária da Universidade Católica Portuguesa. As observações foram estatisticamente comparadas com o grupo controlo com ajuda do programa estatístico SPSS® (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.), utilizando testes de correlação (teste do Coeficiente de Pearson) e de comparação de médias (teste t de Student). O nível de significância considerado foi de 1%. Resultados: Não se verificaram diferenças significativas entre as médias dos valores observados e o grupo controlo com t(139) = - 1,524 e p = 0,130. Por outro lado, foi possível demonstrar que os valores estavam tipicamente correlacionados com 0,30 < r(138) < 0,5 e p < 0,01. Conclusão: Foi possível verificar que os preparos em análise apresentaram ângulos de convergência compatíveis com o descrito na literatura. Nas condições experimentais o instrumento desenvolvido foi considerado válido no auxílio da determinação do ângulo de convergência de preparos dentários, em dentes Frasaco®, em ambiente de clínica simulada.
Introduction: The rehabilitation with dental-supported fixed prosthesis is sometimes preferred to implant-supported, since it could represent a less traumatic and less costly procedure and might even fix or protect the abutment teeth. The clinical success of the implant is related to its holding capacity and permanence in the oral cavity. The tooth preparation is the most reliable way to get the required retention. It is important to consider that the fundamental unit of retention is the angle that two opposite walls form together named convergence angle. It is recommended that the walls present a convergence angle between 2 and 6 degrees. However, it appears that most dental preparations analyzed do not respect this value, due to access difficulties, visualization errors and aspects inherent to the remaining tooth, such as height, width, position and morphology. Objectives: Validate an instrument that helps to determine the convergence angle during tooth preparation. Materials and Methods: First it was necessary to improve and manufacture an existing instrument designed to determine the convergence angle of tooth preparation. Subsequently a sample of 140 mesiodistal and buccolingual convergence angles of dental preparations for crowns performed on Frasaco® teeth was evaluated by 5th year students of Dental Degree of the Portuguese Catholic University. The observations were statistically compared with the control group with SPSS® (IBM Corp. Released in 2011. SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.), applying correlation (Pearson Coefficient test) and comparison of means tests (Student’s t-test). It was considered a significance level of 1%. Results: There were no significant differences between the means of the observed values and the control group whereas t(139) = - 1,524 and p = 0.130. Additionally, it was possible to demonstrate that the values were typically correlate with 0,30 < r(138) < 0,5 and p < 0,01. Conclusion: It was possible to check that the analyzed preparations showed convergence angles consistent with what is described in literature. Under the experimental conditions the developed instrument was considered valid to help determine the convergence angle of tooth preparations of Frasaco® teeth in simulated clinical environment.

O presente Relatório de Atividade Clínica (RAC) reporta-se a todas as atividades clínicas desenvolvidas pela autora durante o curso de Medicina Dentária na Clínica Dentária Universitária da Universidade Católica Portuguesa (UCP), Instituto de Ciências da Saúde de Viseu. Este trabalho permitiu uma introspeção acerca dos conhecimentos adquiridos ao longo do curso, possibilitando a formação de uma base sólida de referências para o trabalho futuro. Foi efetuada uma análise estatística descritiva da amostra de pacientes cujo tratamento foi efetuado pelo binómio da autora, binómio 9. Esta análise foi realizada inicialmente de forma geral, sendo caracterizada em relação ao tipo de trabalho (distribuição por área disciplinar e segundo a ação da autora como operador/ajudante) e segundo as características individuais (género, antecedentes clínicos, hábitos de risco, estado periodontal, higiene oral e área geográfica). De seguida foi executada a análise específica para cada área disciplinar. Nomeadamente para as áreas de: Medicina Oral, Dentisteria Operatória, Periodontologia, Odontopediatria, Endodontia, Cirurgia Oral, Prótese Removível, Prótese Fixa, Oclusão e Ortodontia. Foram estudadas as especificações da amostra de cada uma, em relação ao diagnóstico, tipo de tratamento efetuado e nível de colaboração. Destacam-se três casos clínicos diferenciados que, por isso, terão uma abordagem específica dos restantes fazendo-se um desenvolvimento mais pormenorizado dos respetivos planos de tratamentos efetuados. No final do trabalho serão referidas as conclusões: aquisição e consolidação de conhecimentos e competências, relação médico-paciente e experiências vividas.
This Clinical Activity Report refers to all clinical activities developed by the author during the course of Dental Medicine at the University Dental Clinic of the Portuguese Catholic University (UCP) Institute of Health Sciences in Viseu. It allows introspection about the acquired knowledge, in order to create a solid base of references for future work. A descriptive statistical analysis was carried out on the sample of patients whose treatment was performed by the author's binomial, binomial 9. This analysis was initially performed in a general way, characterizing in relation to the type of work (distribution by disciplinary area and according to the author's action as operator / assistant) and according to individual characteristics (gender, clinical history, risk habits, periodontal status, oral hygiene and geographic area). Then, the specific analysis for each disciplinary area was performed. Particularly in the areas of: Oral Medicine, Dentistry, Periodontology, Pediatric Dentistry, Endodontics, Oral Surgery, Removable Prosthesis, Fixed Prosthodontics, Occlusion and Orthodontics. Were studied the sample specifications of each one, in relation to the determined diagnoses, type of treatment performed and level of collaboration. Differential clinical cases were highlighted, which, therefore will take a different approach from the others by making a more detailed development of the respective treatment plans carried out. At the end of the study, will be referred to the conclusions reached: acquisition and consolidation of knowledge and skills, doctor-patient relationship and experiences.

A visão da Medicina Dentária como uma área multidisciplinar tem sido cada vez mais uma realidade, sendo que na Clínica Dentária Universitária da Universidade Católica Portuguesa de Viseu, a Medicina Dentária exerce-se por áreas disciplinares, que são elas, a Medicina Oral, a Periodontologia, a Odontopediatria, a Dentisteria Operatória, a Prostodontia Removível, a Prostodontia Fixa, a Endodontia, a Ortodontia, a Oclusão e por fim a Cirurgia Oral. O presente relatório está dividido em duas partes, sendo a primeira parte destinada à caraterização sucinta da população que procura cuidados médico-dentários na Clínica Dentária Universitária, e análise estatística descritiva dos dados de atividade clínica realizada no 5º Ano do Mestrado Integrado em Medicina Dentária. Numa segunda parte, será realizada a apresentação de três casos clínicos diferenciados, referentes às áreas de Medicina Oral/Cirurgia Oral, Dentisteria Operatória e Prostodontia Fixa. Em suma, será realizada uma reflexão associada à atividade clínica, confluindo numa análise crítica dos casos clínicos diferenciados.
The vision of Dental Medicine as a multidisciplinary area has been a reality, and in the Dental Clinic of the Universidade Católica Portuguesa, Dental Medicine is practiced by disciplinary areas, which take part: Oral Medicine, Periodontology, Paediatric Dentistry, Operative Dentistry, Fixed and Removable Prosthodontics, Orthodontics, Occlusion and Oral Surgery. The present report is divided in two parts. The first part is intended for a brief description of the population that sought clinical care at the University Dental Clinic, and the descriptive statistical analysis of clinical activity data performed in the 5th year of the Integrated Master’s in Dental Medicine. On the second part, three differentiated clinical cases will be presented, related to the areas of Oral Medicine/Oral Surgery, Operative Dentistry and Fixed Prosthodontics. In summary, a reflection associated with clinical activity will be performed, converging in a critical analysis of the differentiated clinical cases.

Este relatório foi desenvolvido no decorrer do 5ºano do curso de Mestrado Integrado em Medicina Dentária da Universidade Católica Portuguesa de Viseu – Faculdade de Medicina Dentária, nas áreas disciplinares de Projeto I e II. Abrange toda a atividade clínica praticada compreendida no período de 20 de setembro de 2019 e 13 de março de 2020. A Medicina Dentária é uma área que engloba temas desde a saúde pública, à saúde e bem-estar humano, focando essencialmente o seu estudo, no que diz respeito ao diagnóstico, avaliação e tratamento de patologias que afetam todo o sistema estomatognático. É uma vasta área científica que se dedica ao estudo da face, cavidade oral, pescoço, bem como dos respetivos ossos, músculos, articulações e ao estudo das patologias que os envolvem. Realizou-se um levantamento geral da atividade clínica, no qual foi contabilizado o número de consultas realizadas, o número de reencaminhamentos, as faltas e as desmarcações e as transferências de pacientes entre binómios. Os atos clínicos dispuseram-se num gráfico, tendo em conta o operador e o assistente, as consultas organizaram-se segundo a classificação de consultas de primeira vez e consultas de continuidade. Ao longo dos gráficos apresentados, conjugam-se diversas variáveis epidemiológicas, como o género, faixa etária, mas também variáveis/indicadores clínicos como hábitos de higiene, saúde periodontal e hábitos tabágicos. Cada área disciplinar apresenta os seus resultados estatísticos próprios. Em segunda instância realizou-se um enquadramento teórico para cada uma das seguintes áreas disciplinares, Dentisteria Operatória, Endodontia, Prostodontia Removível, Prostodontia Fixa, Cirurgia Oral, Medicina Oral, Periodontologia, Odontopediatria, Ortodontia e Oclusão. Por último, expõem-se detalhadamente três casos clínicos diferenciados realizados na Clínica Dentária da Universidade Católica Portuguesa Viseu, no âmbito das áreas disciplinares de Prostodontia Fixa, Medicina Oral e Odontopediatria/Ortodontia, respetivamente.
This report was developed during the 5th year of the Integrated Master Course in Dental Medicia at Universidade Católica Portuguesa de Viseu - School of Dental Medicine, in the disciplines of Project I and II. It covers all clinical activities practised in the period from 20 September 2019 to 13 March 2020. Dental Medicine is an area that encompasses various topics from public health to human health and well-being. The focus of its study is evaluation and treatment of pathologies that affect the entire stomatognathic system, regarding the diagnosis. It is a vast scientific field dedicated to the study of face, oral cavity, the neck and its respective bones, muscles, articulations and pathologies involved with the upper mentioned. It was carried out a survey of all clinical activity which counted the number of appointments made, patients referred, absences, cancellations and patients transferred between pairs. The clinical acts are arranged by graphics, considering the operator and the assistant, and the appointments by first-time consultations and patients undergoing on treatment. Throughout the presented graphs, not only several epidemiological variables are combined (such as gender and age group), but also clinical variables/indicators such as hygiene habits, periodontal health and smoking habits. Each subject area presents its statistical results. Finally, three different clinical cases performed at the Dental Clinic of Universidade Católica Portuguesa Viseu are presented in detail, regarding the disciplinary areas of Fixed Prosthodontics, Oral Medicine and Paediatric Dentistry / Orthodontics, respectively.

Introdução: Os pacientes que necessitam de reabilitação protética fixa têm vindo a aumentar ao longo das últimas décadas. A redução dentária obrigatória dos dentes pilares embora conservativa em relação à vitalidade pulpar, não é isenta de dano. Porque nem sempre é possível garantir uma quantidade de remanescente dentinário de segurança após a sua redução e dada a sua importância por condicionar o resultado final, há necessidade de se aprofundar mais este assunto para o seu correto esclarecimento. Objectivo: Quantificar o remanescente dentinário e espessuras de redução efetuadas na preparação de dentes pilares de prótese fixa. Estabelecer os seus relacionamentos com os indicadores de sucesso clínico: satisfação estética e complicações. Materiais e Métodos: Estudo retrospetivo, exploratório e descritivo das distâncias mesio-distal e vestíbulo-palatino/lingual ao nível do colo e da coroa dentária dos dentes pilares recolhida nos modelos de gesso e ortopantomografias dos pacientes tratados na clínica universitária da Universidade Católica Portuguesa. Registaram-se as datas da cimentação definitiva e da última consulta de controlo, a presença de vitalidade dentária, a existência de complicações pulpares, o grau de satisfação, a estética, o sexo e a idade. O tratamento estatístico dos dados consistiu na análise univariada, bivariada usando o programa SPSS. O nível de significância usado foi de 95%. Resultados: A médias das reduções mesio-distal ao nível do colo foi de 1,9 mm e na coroa foi de 2mm. Na zona vestíbulo-palatina/lingual a média de reduções foi de 2mm nas zonas do colo e coroa. A quantidade de redução na zona da coroa estava estatisticamente relacionada em relação à satisfação estética, p<0,05. O valor médio de remanescente dentinário da amostra avaliada foi de 1,9 mm. A dimensão da polpa é influenciada pela quantidade de remanescente dentinário, p<0,05. Houve significativamente mais paciente satisfeitos quanto à estética quando os dentes estavam vitais, p<0,05. Não foi obtido resultado estatístico significativo da quantidade de remanescente dentinário em relação ao sexo. Conclusões: Não se encontraram complicações pulpares nas reduções efetuadas nos dentes pilares de prótese fixa. A satisfação estética estava relacionada com a maior redução vestíbulo-lingual. A espessura do remanescente dentinário estava dentro do sugerido pela literatura, estava inversamente correlacionado com a dimensão da câmara pulpar mas não com a estética. Os pacientes com próteses fixas em dentes vitais estão significativamente mais satisfeitos com a sua estética.
Introduction: Patients who require fixed prosthetic rehabilitation have been increase over the past decades. The dental reduction is not free of damage, although the conservative relationship to the pulp. It is not possible guarantee an amount of remaining dentin safety after their reduction and the final result are dependent on this term; so it is necessary clarify this subject. Objective: Quantify the remaining dentin and the dentin thickness reduction in the abutment teeth. Establish their relationships with clinical success like aesthetic satisfaction and complications. Materials and Methods: Retrospective, exploratory and descriptive study of mesial distal and bucco-palatal/lingual distances at crown and at cervical level of the abutment teeth collected in plaster models and panoramic radiographs of patients treated at the Clinic of Catholic University. We recorded permanent cementation date and the last control visit, presence of tooth vitality, existence of pulp complications, aesthetic satisfaction, gender and age. Statistical tests consisted of univariate and bivariate analysis using SPSS. The level of significance used was 95%. Results: The average of mesio-distal reductions in cervical level was 1.9 mm and in the crown was 2mm. In the bucco-palatal/lingual distance the average reduction was 2mm in cervical and crown areas. The reduction in the crown was statistically related with aesthetic satisfaction, p <0.05. The mean value for remaining dentin was 1.9 mm. The size of the pulp is influenced by the amount of remaining dentin, p <0.05. There were significantly more patients satisfied when the teeth were vital, p <0.05. There were no statistically significant results on the amount of remaining dentin about sex. Conclusion: Reductions made in abutment teeth did not cause any pulpal complication. The aesthetic satisfaction was related to greater bucco-lingual reduction. The thickness of the remaining dentin is according to the literature, it was inversely correlated with the dimension of the pulp chamber but not correlated with aesthetic. Patients with fixed prostheses on vital teeth are significantly more satisfied with their aesthetics.

Este Relatório tem como base a atividade clínica realizada no período entre o dia 16 de Setembro de 2013 e o dia 27 de Junho de 2014, realizado no âmbito da Prática Clínica enquadrada no 5º ano curricular do Mestrado Integrado em Medicina Dentária do Instituto de Ciências da Saúde da Universidade Católica Portuguesa – Centro Regional das Beiras. O objetivo deste relatório incide em relatar o conhecimento crítico das várias atividades presenciais realizadas e observadas durante o período da atividade clínica e todas as aprendizagens. A atividade clinica incide nas seguintes disciplinas Medicina Oral, Odontopediatria, Periodontologia, Dentisteria Operatória, Prostodontia Removível, Prostodontia Fixa, Endodontia, Ortodontia, Oclusão e Cirurgia Oral, durante trinta e quatro semanas na Clínica Dentária Universitária do Instituto de Ciências da Saúde da Universidade Católica Portuguesa – Centro Regional das Beiras. A atividade clínica permitiu a rotação pelas diversas disciplinas que asseguravam a assistência ao doente, durante trinta e quatro semanas na Clínica Dentária Universitária do Instituto de Ciências da Saúde da Universidade Católica Portuguesa – Centro Regional das Beiras. De uma forma geral, a Atividade Clínica foi ao encontro dos objetivos previamente estabelecidos, permitindo um enriquecimento em termo curriculares e humanos, com o intuito de adquirir conhecimentos e o desenvolvimento de normas de conduta clinica do âmbito das especialidades de Medicina Dentária, imprescindíveis à formação básica, e com grande importância no futuro da nossa carreira
This Report is based on the clinical activity carried out in the period between September 16th 2013 and June 27th 2014. This activity was carried out in the context of Clinical Practice, a subject from the 5th year curriculum of the Integrated Master in Dental Medicine from the Institute of Health Sciences of the Portuguese Catholic University - Beiras Regional Center. The objective of this report focuses on reporting the critical knowledge of several live activities performed and observed during the period of clinical activity and all the learning. The clinical activity has focused on the following subjects: Oral Medicine, Paediatric Dentistry, Periodontology, Dental Surgery, Fixed Prosthodontics, Removable Prosthodontics, Endodontics, Orthodontics, Occlusion and Oral Surgery, during thirty-four weeks in the University Dental Clinic Institute of Health Sciences at the Portuguese Catholic University - Beiras Regional Center. The clinical activity has allowed the rotation through the various disciplines that reaped the assistance to the sick, during thirty and four weeks in Dental Clinic University Institute of Health Sciences at the Portuguese Catholic University - Beiras Regional Center. Generally, the Clinical Activity was meeting the goals which were previously established, allowing an enrichment in curricular and human terms, with the aim of acquiring knowledge and the development of standards of clinical conduct in the context of the specialties of Dental Medicine, indispensable for basic training and with great importance for the future of our career.

A reabilitação através de prótese fixa sobre dentes , é amplamente utilizada na reabilitação estética e funcional. No entanto, a recessão gengival é uma das mais comuns complicações inerentes a este tipo de restauração, expondo a linha de transição entre a margem protética e o dente natural. Tradicionalmente é executada uma linha de acabamento no preparo onde assenta a prótese (infra ou supragengival). A morfologia deste pilar desempenha um dos factores mais importantes para uma estabilidade da margem gengival, tendo isto em linha conta a técnica BOPT apresenta um novo realce, mediante o desenvolvimento de um perfil protético numa zona de acabamento sem margem definida no preparo. A BOPT é um protocolo de restauração que visa imitar os dentes naturais, para que a anatomia dentária seja transferida para a restauração protética definitiva. Desta forma, uma interação livre com a gengiva pode ocorrer de modo que se adapte, se forme e que assente em torno das novas formas e perfis. Comparando com técnicas convencionais, a BOPT tem demonstrado promover uma estabilidade dos tecidos a médio e longo prazo, adaptando-se por si mesmos e de forma natural ao preparo e à restauração.
Rehabilitation through fixed prosthesis on teeth is widely used in aesthetic and functional rehabilitation. However, one of the complications inherent to this type of restoration is the gingival recession, exposing the transition line between the prosthetic margin and the natural tooth. Traditionally a finishing line is executed where the prosthesis (infra or supragingival) rests. The morphology of this abutment plays an important role in the stability of the gingival margin, therefor the BOPT presents a new enhancement by developing a prosthetic profile in a finishing zone without defined margin of the preparation.. BOPT is a restoration protocol that aims to imitate the natural teeth, so that the dental anatomy is transferred to the final prosthetic restoration. In this way, a free interaction with the gum can occur so that it fits, forms and rests around new shapes and profiles. Compared with conventional techniques, BOPT has been shown to promote tissue stability in the medium and long term, adapting itself and naturally to the preparation and restoration.

A Medicina Dentária está em constante evolução, com o intuito de utilizar sempre novos materiais e novas técnicas para melhorar o resultado final e ter prognósticos cada vez mais previsíveis. Na última década, a elevada exigência estética por parte dos pacientes nos tratamentos dentários, fez com que os Médicos Dentistas melhorassem as técnicas e a pesquisa de materiais sempre mais estéticos, nunca esquecendo a importância do complexo mastigatório. De salientar a incrível evolução da Medicina Dentária com o advento de máquinas e sistemas tecnológicos mais inovadores, por exemplo a CBCT (cone beam computer tomography), ou o scanner intraoral ou o DSD (Dental Smile Design), obtendo assim uma simulação digital do resultado final. Este relatório de atividade clínica realiza uma análise qualitativa e quantitativa dos atos clínicos realizados como assistente e como operador, durante o último ano letivo do curso de Mestrado Integrado em Medicina Dentária na Clínica Universitária da Universidade Católica Portuguesa de Viseu. A presente dissertação é dividida em 3 seções: a primeira parte, é uma introdução à medicina dentária, tratada de uma forma geral; na segunda parte, é realizada uma análise epidemiológica dos pacientes atendidos na Clínica Universitária da Universidade Católica Portuguesa de Viseu e, por fim, são apresentados três casos clínicos, investigando mais especificamente as técnicas de diagnóstico, tratamento e prognóstico, envolvidos na resolução de cada um deles.
Dental Medicine is constantly evolving with the aim of always using new materials and new techniques to improve the final result and have increasingly predictable prognoses. In the last decade, the high aesthetic requirement on the part of the patients in the dental treatments, made that the dentists improved the techniques and the research of materials always more aesthetic, never forgetting the importance of the masticatory complex. Of note is the incredible evolution of dental medicine with the advent of more innovative machines and technological systems, for example cone beam computer tomography (CBCT), or intraoral scanner or Dental Smile Design (DSD), thus obtaining a digital simulation of the result Last. This clinical activity report performs a qualitative and quantitative analysis of the clinical acts performed both as assistant and operator during the last academic year of the Integrated Master in Dental Medicine course at the University Clinic of the Portuguese Catholic University of Viseu. The present dissertation is divided in 3 sections: the first part, is an introduction to dentistry, treated in a general way; in the second part is faced an epidemiological analysis of the patients treated at the University Clinic of the Portuguese Catholic University of Viseu. Finally, in the third part are presented three clinical, focusing on the diagnostic, treatment and prognostic techniques involved in the resolution of each case.

Este documento consiste no Relatório de Atividade Clínica realizada por mim no Ano Letivo 2013-2014 durante as aulas práticas do 5º ano que começaram no dia 16 de Setembro de 2013 e tiveram o seu término a 27 de Junho de 2014. Esta atividade Clínica realizou-se de acordo com o previsto no plano de estudos do Mestrado Integrado em Medicina Dentária da Universidade Católica Portuguesa. O relatório engloba todos os casos clínicos realizados por mim, a sua discussão e resolução. Este relatório tem como objetivo descrever toda a atividade clínica nas diferentes áreas da Medicina Dentária. Durante este período letivo tive oportunidade de aprender normas de conduta clínica necessárias no decorrer de todas as profissões e imprescindíveis há minha formação básica. Apliquei fundamentos teóricos aprendidos nas diferentes Unidades Curriculares e a sua aplicação na prática clínica sobre os vários aspetos pedagógicos que se poderiam melhorar. Este estágio permitiu-me trabalhar nas várias áreas disciplinares verificando os vários conteúdos teóricos e colmatando falhas existentes na minha prática. O estágio foi realizado com sucesso atingindo os objetivos previamente definidos. O atendimento de pacientes de variadíssimas idades e profissões facilitou a aprendizagem e vai facilitar a minha prática clínica aquando da finalização do meu curso. A atividade clínica integrada é o momento de formação privilegiado, que promove uma rápida socialização e integração profissional dos alunos no futuro mercado de trabalho.
This document is the Report of Clinical Activity performed by me in ear 2013-2014 during the practical lessons of the 5th year that began on September 16, 2013 and had its end on 27 June 2014. This clinic activity in accordance with the provisions of the syllabus of the MSc in Dental Medicine at the Catholic University. The report covers all clinical cases performed by me, the discussion and resolution. This report aims to describe all clinical activity in different areas of dentistry. During this semester I had the opportunity to learn standards for clinical management necessary in the course of all professions and there is my essential basic training. Applied theoretical foundations learned in different curricular units and their application in clinical practice on the various pedagogical aspects that could be improved. This internship allowed me to work in various disciplinary areas by checking the various theoretical concepts and bridging existing gaps in my practice. The stage was successful reaching predefined goals. The care of patients extensive range of ages and professions facilitated learning and will facilitate my practice upon completion of my course. The integrated clinical activity is the privileged moment of formation, which promotes rapid socialization and professional integration of students in the future job market.