Dissertations / Theses on the topic 'Occlusal forces'

The initial phase of this study was to develop a force transducer to investigate occlusal forces during the process of mastication. The strain gauge transducer was designed to attach to an Astra implant. A commercial pressure transducer was also used under one distal saddle of the denture. The calibration method was designed to record unilateral masticatory forces regardless of the site of loading. Five edentulous subjects with implant stabilised mandibular overdentures and maxillary complete dentures were selected for the study. Mandibular movements and unilateral Masseter muscle EMG were recorded. Experiments were designed to establish within subject differences related to cycle type, food type, EMG-force relationship, chewing side and cycle phase. Maximum biting force on a bite gauge and in the intercuspal position were also recorded. Details of force production during the closing and occlusal phases improved the description of the movement cycle and it's relationship to food breakdown. A classification of chewing cycles is proposed based on the force exerted in the closing and occlusal phases. This provides objective criteria for separating crushing, reduction and mush cycles. Peak forces varied between subjects, but are characteristic for the type of food within subjects. The different strategies used by subjects appeared to be partly related to the force capacity of the individual. The duration of force in the closing phase was related to the stage in the chewing sequence and indicated the degree of bolus resistance. A longer force duration in the closing phase was usually accompanied by a shorter occlusal duration and consequently an early occurrence of force peak relative to occlusion. The progressive change of jaw gap at the beginning of force was consistent with the expected reduction of particles through the masticatory sequence. The jaw gape at maximum velocity correlated with maximum jaw gape but both did not decrease progressively 2 Abstract through chewing sequences. Conversely, the jaw gape at which force exceeded 5N showed patterns of progressive decrease especially with frangible foods. Integrated force and Emg showed high correlations during mastication, better than peak values. These correlations were, however, weaker than those found in static unilateral biting. The slope difference found between the two conditions contraindicate the use of Emg activity in static unilateral biting as an index for measuring masticatory forces. This study has, thus, validated a method for investigating masticatory forces and shown their value for analysis of dynamic aspects of the loads that occurs during mastication.

La courbe de Spee est une courbe située dans un plan para-sagittal. Son étude se fait uniquement au niveau des dents mandibulaires. Il ne s’agit pas d’un « simple » plan d’occlusion dentaire puisque cette courbe intéresse, également de l’os, c’est à dire le condyle mandibulaire et plus particulièrement son bord antérieur. La courbe de Spee est dépendante de l’emplacement du condyle mais également de l’axe de chacune des dents mandibulaires qui participent à sa forme. Son incurvation permet d’aligner les directions des contraintes le long des grands axes dentaires. À partir des valeurs métriques et angulaires mesurées sur des images 3D de mandibules numérisées les objectifs ont été : - de proposer une aide dans la reconstruction de mandibule incomplète et/ou déformée et du plan occlusal absent ou incomplet. - de dégager des principes géométriques simples permettant une optimisation du positionnement des racines artificielles (implants) chez l’Homme actuel. Ainsi les études des axes dentaires mandibulaires, de la position du condyle mandibulaire, de la courbe de Spee, ou encore de différentes mesures mandibulaires, ont permis de dégager un axe de recherche anthropologique et un axe de recherche odontologique Un axe anthropologique Qui amène à la découverte validée de formules de régressions pouvant apporter une aide dans la reconstructions de matériel dentaire, ou osseux incomplet, mandibulaire. Un axe odontologique Qui confirme, et valide cliniquement, que les axes dentaires mandibulaires doivent être orientés le plus favorablement possible en fonction des diverses contraintes occlusales
The curve of Spee is situated in a para-sagittal plane. His study is done only at the mandibular teeth. It is not a "simple" plan of dental occlusion because this curve interests, also of bone, the mandibular condyle and particularly its front edge. The curve of Spee depends on the condyle location but also on the axis of each of the mandibular teeth which participate in its shape. Its curve aligns the directions of the constraints along major dental axes. From metrics and angular values measured on 3D images of scanned mandibles, the objectives were: - To propose a help in the reconstruction of incomplete and / or deformed mandible and absent or incomplete occlusal plane. - To identify simple geometric principles to optimize the positioning of the artificial roots (implants) in modern Man. So the studies of mandibular dental axes, the position of the mandibular condyle, the curve of Spee, or differents mandibular measures allowed to clear an area of anthropological research and an area of Dental Research An anthropological area Which leads to the validated discovery regression formulas, which can brings help in reconstruction of dental material, or osseous incomplete, mandibular. An odontological area Which confirms and validates clinically, that the mandibular dental axes must be oriented as favorably as possible according to the various occlusal constraints

Dento-facial anomalies have been diagnosed for centuries. The diagnosis or observation thereof is reported to date back to the Fifth Century AD where Hippocrates observed and noted numerous craniofacial deformities (Moyers, 1988) Through a complex process of reception, selection and categorizationthe human form particularly the cranium, jaws and related soft tissue structures, have been studied and categorized over the years (Moyers, 1988). Dockrell (1952) focused on the aetiology of malocclusion and through extensive work on the topic, established an equation for the improved identification of aetiology of malocclusion. This equation essentially communicates that a causative factor will act at a specified time, on an identified tissue, to produce particular results. Thus resulting in a deviation from the accepted “normal” relationship. This will result in the development of an archetypally defined, classifiable malocclusion. These so termed causative factors as elicited to in the equation play a pivotal role in the outcomes or resultant malocclusions (Dockrell, 1952). The plasticity in aetiology and resultant Skeletal or dental positional discrepancy should not be overlooked. Multiple factors may act together stabilising each other thus lessening the severity of the expected effect. This research project aims to identify the potential of occlusal bite forces as a causative factor in the “orthodontic equation” and shed light on timing as well as resulting Skeletal and growth effects of variance in occlusal force. Occlusal force is a combined and quantifiable measurement of contributory muscle strength. Through this study a comparative analysis of the occlusal force will be carried out amongst subjects exhibiting differences in age, gender, race, and growth pattern. This study aims to elucidate the influence of occlusal forces and masticatory muscle strength in relation to the resulting craniofacial development. Data was collected from patients exhibiting various dental classes namely Class I, Class II and Class III dental and Skeletal patterns. Bite force strength of patients in primary, mixed and permanent dentition was measured using an occlusal force meter. The occlusal force meter was sourced from a Japanese based company, Nagano Keiki Co. LTD. The readings were done in Kilo newton, which is the standard international (SI) measurement of force. The study population consisted of 180 male and 180 female subjects. This group was split into Skeletal Class I, II and III subjects and then further divided into the three directions of growth (Horizontal, normal and Vertical). The relationship of bite force to Skeletal Class and growth direction was analysed using mean readings from five points of reference on each subject. Analysis of covariance was carried out on the data set with a mean age of 15,33 years (covariant). There was a significant difference found in the bite forces between growth direction and Skeletal Class P<0,05. There was also and interaction found between Skeletal classes and direction of growth. These findings are supportive to the hypothesis that a relationship exists between bite force and malocclusion.
Dissertation (MSc (Odont))--University of Pretoria, 2014.
tm2015
Community Dentistry
MScOdont
Unrestricted

Background: Maximal voluntary occlusal bite force (MVOBF) is the maximal force applied by the jaw muscles in dental occlusion. MVOBF is one parameter for functional capacity of the jaw system.  Aim: To evaluate MVOBF in different positions in the bite and to evaluate possible intra-individual differences between sessions.  Methods: MVOBF was measured with an electronic bite force device, with transducers sensitive to force, in 20 healthy men (mean 24.5 years). Eligibility of participants was full dental occlusion, Angle Class I relation, no diagnosis according to Diagnostic criteria for temporomandibular disorders. The test included three repeated measurements on each site: first molar right, first molar left and central incisor, in random order, with test-retest study design. Unpaired T-test was used to test the MVOBF in different positions in the bite and paired T-test for possible intra-individual differences between sessions. A post hoc test for repeated measure one-way ANOVA was added.  Results: MVOBF in different positions in the bite was lower in the incisor area compared with the molar region (P<0.0001), but similar between right and left molar side (P=0.48 and P= 0.96, respectively). No intra-individual differences between sessions (molar right P= 0.40; molar left P= 0.81; incisor area P= 0.66). The intra-individual variability for repeated measurements showed variability for incisor area (P= 0.007), but not for molar right and left region (P=0.95 and P=0.49, respectively).  Conclusion: The results may provide reference values for MVOBF in young adult men, to be compared with men with pain or dysfunction in the jaw system.

Cette thèse porte sur l'anatomie et la morphologie du complexe crânien chez les murinés. Ses objectifs sont de démontrer et de décrire le lien morpho-fonctionnel entre le crâne et la force de morsure, représentant la performance, d'identifier les sources génétiques de la variation de la performance et de la morphologie, et de comprendre comment la variation morpho-fonctionnelle dépend du mode de vie d'une espèce.La première partie décrit l'anatomie de l'appareil masticateur dans le genre Mus. Des différences fonctionnelles et liées au régime alimentaire sont montrées. Puis, on s'intéresse au lien entre morphologie et fonction, et aux proxies morpho-anatomiques permettant d'estimer la force de morsure. Un modèle biomécanique des muscles masticateurs est d'abord utilisé. Les estimations obtenues sontproches des mesures in vivo au niveau interspécifique, mais moins précises au niveau intraspécifique.L'avantage mécanique et la forme de la mandibule sont ensuite utilisés comme proxies. La force de morsure estimée et réelle sont corrélées au niveau interspécifique, mais moins au niveau intraspécifique, avec des différences selon les espèces. Pour expliquer ces imprécisions, la variation ontogénétique de la force de morsure et de la forme de la mandibule sont décrites. Lorsque l'âge est contrôlé, le développement osseux ralentit plus tôt que celui de la force de morsure, ce qui peut expliquer les biais trouvés dans les estimations de la force de morsure.La deuxième partie se concentre sur les sources génétiques des variations morpho-fonctionnelles. Chez Mus minutoides, des changements sur les chromosomes sexuels produisent des différences de taille et de force de morsure. Les mâles féminisés de cette espèces sont plus agressifs que les autres individus, et montrent une force de morsure plus puissante, principalement grâce à unplus gros crâne. Le(s) gène(s) féminisant produis(ent) donc des changements à l'échelle de l'organisme tout entier. La section suivante s'intéresse aux liens entre consanguinité, asymétrie et performance chez la souris domestique. Les souris les plus consanguines ne montrent pas d'augmentation de l'asymétrie de leurs mandibules, et la performance des souris les plus consanguines ou les plus asymétriques n'est pas affectée. Enfin, l'héritabilité de la force de morsure et de la morphologie est estimée. La force de morsure in vivo n'est pas héritable, bien que la morphologie le soit. Etant donné le lien entre morpho-anatomie et force de morsure, ces résultats suggèrent que les changements morphologiques sont des voies de moindre résistance évolutive, et qu'ils peuvent être à l'origine de changements de performance.La dernière partie utilise la morphologie et la performance en tant que caractères liés à l'écologie des espèces. La première section s'intéresse aux différences de performance entre Apodemus sylvaticus et Mus spretus, qui partagent leur habitat et leurs ressources alimentaires, malgré une différence de taille marquée. Nos résultats montrent un recouvrement des distributions des forces de morsures, soutenant l'hypothèse d'un régime alimentaire commun. Cette coexistence pourrait être due à une abondance de ressources là où ces espèces sont syntopiques. Enfin, la variation morphologique est quantifiée chez plusieurs murinés d'Asie du Sud-Est. Les espèces de rats commensaux et généralistes sont moins variables que les autres espèces. Les espèces synanthropiques montrent des réponses morpho-fonctionnelles convergentes entre localités qui suggèrent qu'elles partagent des patrons communs de réponse et donc qu’elles peuvent s'adapter aux variations environnementales régionales induites par l’homme. L'approche utilisée dans cette thèse nous a permis de montrer le lien entre variation génétique,phénotypique et écologique. Ce lien parfois difficile à décrire, est cependant à la base de l'apparition de nouvelles formes et espèces, et constitue un aspect crucial de la biologie de l'évolution
The theme of this thesis is the anatomy and morphology of the cranio-mandibular complexin various species of murine rodents. The main objectives are to describe the morpho-functional link between the skull and bite force as a measure of performance, to identify the genetic sources of morphological and performance variation, and finally to understand how morpho-functional variation depends on a species diet and lifestyle. The first part describes the anatomy of the masticatory apparatus in the genus Mus. Differences were found, which could be interpreted functionally and linked to variation in diets. The first part also investigates the links between morpho-anatomy and function, and various morphological proxies used for estimating bite force. This is done by building a biomechanical model of masticatory muscles. The bite force estimates obtained match the in vivo measurements at the inter-specific level, but are less precise at the intra-specific level. Then, two osseous mandibular proxies of bite force are compared (lever arms and their mechanical advantage, and its shape data). In vivo and estimated bite force werewell related at the inter-specific level, but less at the intra-specific level, depending on the species. To explain these imprecisions, the ontogenetic variation of bite force and mandibular morphology isdescribed. Under controlled age, the bony development is slowing down earlier than bite force, whichcan partly explain the inconsistencies of estimated bite force.The second part focuses on the genetics of morphological and functional variation. In Musminutoides, changes in the sexual chromosomes entail size and performance changes. The feminized males found in this species are known to be more aggressive than other individuals, and they produce ahigher bite force, mainly due to an increase in skull size. The feminizing gene(s) therefore drive whole-organism-scale changes. Then, the links between inbreeding, asymmetry and performance areinvestigated in the house mouse. The most inbred mice do not experience an increase in the asymmetry of their mandibles. Contrary to expectations, the performance of the most inbred or most asymmetric mice do not decrease and differences in asymmetry levels have no influence on biting performance.The last section estimates the heritabilities of bite force and morphology. In vivo bite force is notheritable, but some morphological characters are. Given the functional link between morpho-anatomyand bite force shown in the first part, these results suggest that morphological changes represente volutionary pathways of least resistance, and drive changes in performance rather than behavioral or related traits.The last part took morphology and performance as linked to a species' niche. The first sectionexplores the differences between Apodemus sylvaticus and Mus spretus. Both share their habitat and food resources, in spite of a marked size difference. Results show great overlap between their bite force distributions supporting the hypothesis of a shared diet. The absence of shift in a trait related toresource use may be due to a large abundance of the food resources where both species are found insyntopy. In the final section the morphological variation in several rodents from Southeast Asia wasquantified. Less morphological variability is found in generalist and commensal rats by comparison toother species. At the community level, synanthropic species show frequent convergent responsesbetween localities in terms of bite force and morphology. These common patterns in response suggestthat synanthropic species tend to be very adaptable to regional environmental differences.The approaches used in this thesis enable us to show the link between genetic, phenotypic andecological variation. This link, sometimes difficult to describe, is nevertheless at the root of theappearance of new forms and species, and constitutes a crucial aspect of evolutionary biology

Os materiais restauradores utilizados na região cervical dos dentes podem ser afetados por resultantes de forças oclusais excêntricas, que já podem ter contribuído à formação da lesão, e deveriam ser capazes de resistir às tensões. Não há consenso, porém, quanto ao papel de diferentes materiais, quiçá especialmente no tocante a seus módulos de elasticidade, no sucesso das respectivas restaurações. Avaliou-se, pois, a influência do uso desses materiais, com módulos de elasticidade (E) distintos em essência, e da associação entre eles, na qualidade marginal de restaurações cervicais em pré-molares submetidos a carregamento oclusal excêntrico. Cavidades cervicais em forma de cunha, preparadas em pré-molares unirradiculares superiores humanos, hígidos e extraídos, foram restauradas com uma resina composta (RC: Z250 XT, n=20); com a resina em associação a um ionômero modificado por resina para forramento (Mista/M: Vitrebond, n=20); ou com um ionômero modificado por resina para restauração (CIV: Vitremer, n=20). Metade dos dentes de cada grupo foi submetida a carregamento oclusal excêntrico (coe: inclusão em resina acrílica e ligamento periodontal artificial, 150 N, 106 ciclos, 2,5 Hz), e a outra metade, apenas armazenada por período de tempo equivalente (Controle/c: água destilada, 37º C). Um sistema adesivo marcado por fluoresceína foi utilizado para delimitação dos defeitos formados, que foram avaliados por meio de Microscopia Confocal de Varredura a Laser. Para a presença ou ausência de fendas marginais aplicou-se, num contexto geral, para cada fator em estudo (carregamento oclusal excêntrico - coe / c; material restaurador - RC / M / CIV), o teste do qui-quadrado (?=0,05). Em específico, aplicaram-se, individualmente, em cada nível do fator carregamento oclusal excêntrico, e em cada nível do fator material restaurador, respectivamente, o teste do qui-quadrado e o teste exato de Fisher (?=0,05). Para a localização das fendas em relação às paredes cavitárias (O: oclusal / C: cervical / OC: ambas) aplicou-se, para cada fator em estudo, o teste do qui-quadrado (?=0,05). O teste de Mann-Whitney foi aplicado para a largura e a profundidade das fendas marginais, para comparar os diferentes níveis do fator carregamento oclusal excêntrico, e o teste de Kruskal-Wallis, para comparar os diferentes níveis do fator material restaurador (?=0,05). Numa conjuntura abrangente, nenhum dos fatores associou-se significativamente com as variáveis de resposta qualitativas nominais ou exerceu influência sobre as quantitativas. Mais especificamente, por exclusivo quando da aplicação do carregamento oclusal excêntrico, o uso dos diferentes materiais restauradores associou-se significativamente com a frequência de fendas marginais (RC>M>CIV). Ainda que a qualidade marginal de restaurações cervicais possa não ser influenciada, de maneira geral, pelo carregamento oclusal ou pelo uso de diferentes materiais, inclusive em associação, o aspecto desfavorável do emprego da resina composta pode tornar-se relevante, em particular, quando da existência de carga oclusal excêntrica.
Restorative materials used in the cervical region of teeth may be impacted by resultants of eccentric occlusal loads that have already contributed to the formation of the lesion, and should be capable of withstanding the stresses. There is no consensus, however, about the role of different materials, maybe especially regarding their moduli of elasticity, in the success of respective restorations. The influence of the use of these materials, with different moduli of elasticity (E) in essence, and of their association, on marginal quality of cervical restorations in premolars subjected to eccentric occlusal loading was evaluated thus. Cervical wedge-shaped cavities, prepared in human upper single-rooted premolars, healthy and extracted, were restored with a resin composite (RC: Z250 XT, n=20); with the composite in combination with a resin-modified lining ionomer (Mixed/M: Vitrebond, n=20), or with a resin-modified restorative ionomer (GIC: Vitremer, n=20). Half of the teeth of each group was subjected to eccentric occlusal loading (eol: embedment in acrylic resin, artificial periodontal ligament, 150 N, 106 cycles, 2.5 Hz), and the other, only stored for an equivalent period of time (Control/c: distilled water, 37°C). A fluorescein-marked adhesive system was used for delimitation of formed defects, which were evaluated by means of Laser Scanning Confocal Microscopy. For the presence or absence of marginal gaps, in a general context and for each factor under study (eccentric occlusal loading - eol / c; restorative material - RC / M / GIC), chi-square test was applied (?=0.05). In specific, individually, at each level of the factor eccentric occlusal loading, and at each level of the factor restorative material, chi-square test and Fisher\'s exact test were respectively applied (?=0.05). For the location of the gaps in relation to the cavity walls (O: occlusal / C: cervical / OC: both), for each factor under study, chi-square test was applied (?=0.05). The Mann-Whitney test was applied to the width and depth of marginal gaps, to compare the different levels of the factor eccentric occlusal loading, and the Kruskal-Wallis test, to compare the different levels of the factor restorative material (?=0.05). In a comprehensive view, none of the factors was significantly associated with qualitative response variables or wielded any influence on the quantitative ones. More specifically, for exclusive when eccentric occlusal loading was applied, the use of the different restorative materials was significantly associated with the frequency of marginal gaps (RC>M>GIC). Though marginal quality of cervical restorations may not be in general influenced by the occlusal loading or the use of different materials, even in association, the unfavorable aspect of the use of the resin composite may become relevant particularly in face of the existence of eccentric occlusal load.

Esta pesquisa avaliou o sistema estomatognático de crianças saudáveis com ou sem necessidade de tratamento ortodôntico por meio do desempenho mastigatório, contato de forças oclusais e mobilidade mandibular. Noventa crianças foram selecionadas e distribuídas em três grupos: GSN (Grau 1, sem necessidade de tratamento ortodôntico, 8,00 ± 0,43 anos de idade, n = 26), GPN (Grau 2, pequena necessidade de tratamento, 8,89 ± 0,43 anos de idade, n = 28) e GMN (Grau 3, moderada necessidade de tratamento ortodôntico, 8,44 ± 0,22 anos de idade, n = 36). A necessidade de tratamento ortodôntico foi classificada pelo Índice de Necessidade de Tratamento Ortodôntico - Componentes de Saúde Dental (IOTN-DHC). O desempenho mastigatório foi avaliado pelo integral da envoltória do sinal eletromiográfico durante os ciclos mastigatórios do músculo masseter, temporal, orbicular da boca (segmento direito e segmento esquerdo) e supra-hioideo na mastigação habitual com alimentos macios e consistentes. Foi utilizado o sistema Trigno EMG com eletrodos sem fio para captação e análise do sinal eletromiográfico (µV). O sistema T-Scan® III Occlusal Analysis foi utilizado para analisar o contato de forças oclusais (%) entre as hemiarcadas superior e inferior (lado direito e esquerdo). A amplitude (mm) de abertura normal e abertura máxima voluntária e movimentos bordejantes mandibulares (lateralidade direita, lateralidade esquerda e protrusão) foi mensurada com régua milimetrada. Os dados obtidos foram tabulados e submetidos à análise estatística (SPSS 22.0, ANOVA, teste post-hoc de Bonferroni, p ≤0,05). Verificou-se que GMN apresentou menor desempenho mastigatório e desequilíbrio de forças oclusais na maxila/mandíbula em relação GPN e GSN, sem diferença significativa, e maior amplitude de abertura da boca e movimentos excursivos mandibulares com diferença significativa na abertura normal (p=0,02). Portanto, crianças com moderada necessidade de tratamento ortodôntico apresentaram alterações funcionais no sistema estomatognático, em especial no desempenho mastigatório, força oclusal e mobilidade mandibular.
This research evaluated the stomatognathic system of healthy children with or without orthodontic treatment need through masticatory performance, occlusal strength and mandibular mobility. Ninety children were selected and distributed into three groups: GSN (Grade 1, no orthodontic treatment need, 8.00 ± 0.43 years old, n = 26), GPN (Grade 2, small orthodontic treatment need, 8.89 ± 0.43 years old, n = 28) and GMN (Grade 3, moderate orthodontic treatment need, 8.44 ± 0.22 years old, n = 36). The orthodontic treatment need was classified by the Orthodontic Treatment Need - Dental Health Components Index (IOTN-DHC). The masticatory performance was evaluated by the full linear envelope of the electromyographic signal during the masticatory cycles of masseter, temporal, mouth orbicularis (left and right segments) and suprahyoids muscles in the habitual chewing with soft and consistent foods. The Trigno EMG system was used with wireless electrodes to capture and analyze the electromyographic signal (µV). The T-Scan® III Occlusal Analysis system was used to analyze occlusal forces (%) between the upper and lower dental arch (right and left sides). The normal and maximum opening width (mm) and mandibular movements (right laterality, left laterality and protrusion) were measured with a millimeter ruler. Data were tabulated and submitted to statistical analysis (SPSS 22.0, ANOVA, Bonferroni post-hoc test, p≤0.05). It was verified that GMN presented lower masticatory performance and imbalance of the occlusal forces in maxila/ mandible to GPN and GSN, with no significant difference, and greater mouth opening amplitude and mandibular excursive movements, with significant difference, in normal opening mouth (p=0.02). Therefore, children with moderate orthodontic treatment need presented functional alterations in the stomatognathic system, especially in the masticatory performance, occlusal force and mandibular mobility.

Orientadores: Maria Beatriz Duarte Gavião, Paula Midori Castelo
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Este estudo buscou identificar as possíveis relações dos padrões antropométricos nutricionais com as caracrerísticas morfológicas e funcionais do sistema mastigatório e níveis de biomarcadores salivares. Três estudos foram conduzidos, apresentados na forma de capítulos. As amostras foram compostas por sujeitos saudáveis, com idade entre 15 e 30 anos. Capítulo 1: Objetivou comparar a antropometria e a composição corporal e verificar se o padrão antropométrico nutricional estaria associado à disfunção temporomandibular (DTM). Foram avaliados 110 mulheres e 60 homens distribuídos em grupos controle, desordem muscular (MD) ou deslocamento de disco (DD), de acordo com o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). As medidas antropométricas foram peso, altura e perímetros da cintura, abdomen e quadril. A composição corporal foi avaliada por meio da porcentagem de gordura corporal (BF%), e das massas adiposa, óssea, muscular e residual. A intensidade da dor (CPI) e os sintomas físicos não específicos incluíndo dor facial (NSPSP) foram considerados. Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital.
Abstract: The aim of this study was to identify possible associations of nutritional anthropometric patterns with morphologic and functional characteristics of the masticatory system as well as with salivary biomarkers. Three studies were developed and reported in three chapters. Samples consisted of health subjects aged between 15 and 30 years. Chapter 1: To compare body characteristics and composition and to verify if nutritional anthropometric patterns are associated with temoromandibular dysfunctions (TMD). 110 females and 60 males were classified into Control, Muscle disorders (MD) or Disc displacements (DD) groups according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Anthropometric measurements recorded were weight, height and perimeters of waist, abdomen and hip. Body composition was evaluated with values of body fat percentage (BF%) as well as with values of fat, muscle, bone and residual mass. Pain intensity (CPI) and nonspecific physical symptoms including facial pain (NSPSP) were considered. ...Note: The complete abstract is available with the full electronic document.
Doutorado
Fisiologia Oral
Doutora em Odontologia

A abfração, uma das causas das lesões cervicais não cariosas, caracteriza-se pela perda de tecido mineralizado, em forma de cunha, próxima à junção cementoesmalte. Hipoteticamente, é o resultado de forças oclusais excêntricas aplicadas sobre os dentes. Essas lesões são freqüentemente restauradas para impedir sua progressão, para proteger e aumentar a resistência do remanescente dental, reduzir a hiperestesia dentinária e manter a saúde periodontal. Entretanto, pouco se sabe quanto ao efeito dos fatores causadores da abfração na qualidade marginal de restaurações cervicais, quando da reabilitação dessas lesões. Este estudo in vitro propõe-se, portanto, a analisar o efeito da aplicação de carga oclusal na qualidade marginal de restaurações de cavidades cervicais em forma de cunha, utilizando microscopia confocal de varredura a laser. Para tal, foram utilizados 40 dentes prémolares superiores humanos hígidos, extraídos, nos quais foram preparadas cavidades padronizadas em forma de cunha, em sua região cervical vestibular, por meio da utilização de pontas diamantadas cilíndricas de topo plano nº 3100 (1,6 mm de diâmetro e 21 mm de comprimento), posicionadas em 45º com a superfície mais plana e próxima à junção amelo-cementária. As cavidades (1,3 mm de profundidade, 2,3 mm de abertura ocluso-cervical, 4,0 mm de abertura mésio-distal, 1,6 mm de extensão na parede oclusal e 1,9 mm de extensão na parede cervical) foram restauradas com resina composta (Z250®) em associação ao uso de um sistema adesivo (Single Bond®). Para possibilitar a análise ao microscópio confocal, o sistema adesivo foi marcado previamente com adição de rodamina B. Após imersão em água deionizada, por 7 dias e polimento das restaurações, os espécimes foram incluídos em uma matriz de resina acrílica. A porção radicular de cada dente foi revestida com uma camada de poliéter (Impregum®), de aproximadamente 1 mm, a fim de simular o ligamento periodontal. A porção coronária foi mantida totalmente exposta ao meio externo. Os dentes foram, então, submetidos à ciclagem mecânica, pela ação de uma ponta metálica em forma de torpedo, exercendo carga de 150 N, num total de 106 ciclos. Para tanto, a ponta foi posicionada de acordo com as seguintes condições experimentais: sobre a vertente triturante interna da cúspide vestibular (GI; n=10); sobre o sulco central (GII; n=10); e sobre a vertente triturante interna da cúspide lingual (GIII; n=10). O grupo controle (GIV; n=10) não foi submetido à ciclagem mecânica, permanecendo apenas armazenado em água deionizada, a 37ºC, durante todo o período experimental. Finalizada a ciclagem mecânica, as superfícies vestibulares dentárias foram, então, recobertas com duas camadas do sistema adesivo (Single Bond®), agora marcado com fluoresceína, para delimitação dos possíveis defeitos formados. Os dentes foram seccionados longitudinalmente em duas metades (mesial e distal) e submetidos à avaliação em microscopia confocal, para análise da qualidade da margem das restaurações. Foi aplicado o teste do qui-quadrado (p<0,05) para as variáveis qualitativas presença ou ausência de fendas marginais e localização das fendas em relação às paredes cavitárias (oclusal, cervical ou ambas). Para as variáveis quantitativas (amplitude e extensão das fendas) aplicou-se o teste de Kruskal-Wallis (p<0,05). Os espécimes submetidos ao carregamento oclusal, independentemente do local de aplicação da força, apresentaram maior porcentagem de fendas marginais (53,33%) quando comparados aos espécimes do grupo controle (10%; p=0,016). Não houve diferença estatisticamente significante entre o local de aplicação de força oclusal tanto para a presença ou ausência de fendas marginais (p=0,875); como para a localização das fendas em relação às paredes cavitárias (p=0,270) ou mesmo para a extensão (p=0,190) e amplitude das mesmas (p=0,070). Conclui-se, portanto, que a aplicação de carga oclusal prejudicou o comportamento marginal de restaurações cervicais, mas a variação do local de incidência de carga não interferiu no comportamento marginal das mesmas.
Tooth abfraction, one of the causes of non carious cervical lesions, is a wedgeshaped tissue loss, situated next to the cement-enamel junction, being, hypothetically, the result of eccentric occlusal loads applied to the teeth. These lesions are often restored to avoid their progression, to protect and increase remnant tooth resistance, to reduce dental hypersensitivity and to maintain periodontal health. However, there is little knowledge about the effect of abfraction etiology factors on the restoration marginal quality in the rehabilitation of these lesions. This in vitro study intends, therefore, to analyze the effect of the application of occlusal load on the marginal quality of cervical restorations in wedge-shaped cavities, by employing laser scanning confocal microscopy. Standardized wedge-shaped cavities were prepared in the cervical buccal region of 40 sound extracted upper human premolars, by the use of a cylindrical diamond bur #3100 (1.6 mm in diameter and 21 mm in length), positioned in 45º with the surface that is plainer and closer to the cementenamel junction. The cavities (1.3 mm in depth, 2.3 mm in occluso-cervical opening, 4.0 mm in mesio-distal opening, 1.6 mm in occlusal wall length and 1.9 mm in cervical wall length) were filled with a composite resin (Z250®) associated with the use of an adhesive system (Single Bond®). For the analysis at the confocal microscope to be possible, the adhesive system was previously modified by the addition of rodhamine B. After storage in deionized water for 7 days, and after the finishing and polishing of the restorations, specimens were included in acrylic resin matrixes. The radicular portion of each tooth was covered by an approximately 1 mm layer of a polyether (Impregum®), for the creation of an artificial periodontal ligament. The crown portion was kept totally exposed to the external environment. Teeth were, then, submitted to the mechanical cycling, by the action of a torpedo-shaped tip that exerted a 150 N load for a total of 106 cycles. The tip was positioned according to the following experimental conditions: over the internal triturant vertent of the buccal cusp GI; n=10); over the centre of the fissure (GII; n=10); and over the internal triturant vertent of the lingual cusp (GIII; n=10). The control group (GIV; n=10) was not submitted to the mechanical cycling, staying only stored in deionized water, at 37oC, during the whole experimental period. When the mechanical cycling was over, buccal dental surfaces were, then, covered with two layers of the adhesive system (Single Bond®), now modified by the addition of fluorescein, for delimitation of the possible formed defects. Teeth were longitudinally sectioned into two halves (mesial and distal ones), and submitted to evaluation through confocal microscopy, for analysis of the restorations marginal quality. Chi-square test (p<0.05) was applied for evaluation of qualitative variables (presence or absence of marginal defects and their location according to the cavity walls occlusal, cervical or both); and Kruskal-Wallis test (p<0.05) was applied for evaluation of quantitative variables (length and width of the defects). Specimens submitted to occlusal loading, independently of the location of the tip, presented a higher percentage of marginal defects (53.33%), when compared to the control group (10%; p=0.016). There was no significant statistical difference among the local of load placement for the presence or absence of marginal defects (p=0.875); for their localization according to the cavity walls (p=0.270); or even for their length (p=0.190) and width (p=0.070). It can be concluded, therefore, that occlusal loading was harmful for the margins of cervical restorations; but the different local of its incidence did not interfere with their marginal quality.

Objectif: Suite aux traitements avec aligneurs, une insuffisance de contacts postérieurs est souvent notée cliniquement: existe-t-elle réellement, se corrige-t-elle spontanément? Cette étude vise à comparer la qualité de l’occlusion statique chez des patients ayant été traités avec boitiers conventionnels ou par aligneurs, dès la dépose des appareils orthodontiques et après six mois de mise en place fonctionnelle. Matériel and Méthodes: La mise en place fonctionnelle de l’occlusion chez des sujets traités par boitiers conventionnels (GB, n=25) ou par aligneurs (GA, n=14) et par a été évaluée par un système d’analyse occlusale informatisée (T-scan 9), au moment de la dépose (T0), puis à 3 et 6 mois de contention (T3 et T6). Les sujets (41% de filles, âge moyenne de 19,38 ± 5,98 ans), étaient traités sans extractions, ni chirurgie, avec pour contention des fils collés ou appareils sans recouvrement occlusal. La symétrie et la simultanéité des contacts ainsi que la position antéro-postérieure du centre de forces (CF) étaient évalués. Résultats : À tout moment (T0, T3, T6), aucune différence statistiquement significative n’a été observée quant à la position antéro-postérieure du CF (p=0,854), la répartition ou la simultanéité des contacts, quelle que soit la modalité de traitement. Le CF était situé antérieurement chez les patients de sexe féminin à tout temps (p=0,002). La mise en place fonctionnelle semblait être terminée dès trois mois pour les deux groupes. Conclusion: La qualité de l’occlusion était comparable dans les deux groupes six mois après la dépose des appareils orthodontiques, signifiant l’absence d’influence du type de traitement à court terme. Le sexe féminin pourrait être associé à un CF plus antérieur même après six mois de mise en place fonctionnelle.
Objective: Following aligner therapy, a lack of posterior contacts is common and is expected to resolve with settling. The aim of the study was to compare the quality of occlusion and settling, immediately after treatment and during a retention period of six months, in patients treated with fixed appliance therapy or clear aligners. Materials and Methods: 25 patients treated with fixed appliances and 14 patients treated with aligners were evaluated by a digital occlusal analysis (T-Scan 9) at time of debonding (T0) and 3 and 6 months later (T3 and T6). Subjects (41% female, average age 19.38 ± 5.98) were treated without extraction or maxillofacial surgery using either bonded wires or removable appliances without occlusal coverage as retainers. Contact symmetry, simultaneity and the antero-posterior position of the Center of Force (COF) were assessed at the time of debonding, and after 3 and 6 months of retention. Results: At all times of evaluation, the COF position was not statistically different for both treatment modalities (p=0.854), but was located more anteriorly in female patients when compared to male patients (p= 0.002). Settling appeared to be completed by 3 months in both groups. Conclusion: The quality of the occlusion was comparable after 6 months of settling when treated with either treatment modality indicating no short-term effect of treatment type. Females maintained a more anterior COF after six months of retention.

碩士
國立成功大學
生物醫學工程學系
104
SUMMARY The aim of this study is to obtain occlusal force on crown surface though a home-made force sensor array. The force sensor array is composed by industrial-grade piezoelectric-based multilayer ceramic capacitor (MLCC) force sensor for large force measuring. The MLCC was treated to enhance the piezoelectric property by using a re-poling process. A flexible PI electrode was developed to detect the force distribution on crown surface by using MEMS fabrication. A 3D MLCC force sensor system was fabricated in this study. The results indicated the 3D MLCC force sensor system was able to detect the force either a normal or a combined force. In additional, the 3D force measurement system with 3X3 array type was embedded against the crown surface of an artificial tooth to detect the occlusal force. However, the measured force distribution outcomes depended heavily on the position of the sensor location. The MLCC used to measure the shear force could be interference by the direct contact of the above crown. It was difficult to justify the correctness of the shear force measurement outcomes. Therefore, a numerical model was developed in this study. A sensor array system containing occlusal layer and bottom layer embedded artificial crown was fabricated with flexible PI-based electrode. The occlusal layer sensor array used to detect the contact point of the applied force. The bottom layer sensor array used to calculate the direction and magnitude of the applied force, and the results of bottom layer sensor array were compared to the results of finite element analysis. The difference between the applied force and the calculated force though optimization was lesser than 1% under the one and two point loading. However, in 3-point loading, the excessive unknown in calculation resulted in higher error up to 10% error. Keywords: occlusal force, multilayer ceramic capacitors force sensor, optimization INTRODUCTION Teeth play an important role in providing essential nutrition for our life. One of the most important functions of teeth is to provide force for the chewing of food. A sufficient chewing process can break down the particle size of food and increase the surface area, allowing the digestive juices and enzymes to efficiently digest food in the digestive system. In biomechanical point of view, the masticatory system can be consider a force generation and absorption biomechanical structure. With advance in science, various materials are now used for dental applications, such as metal, ceramic, and polymer. These design require precise evaluation results for function optimization, especially simulation with real oral loading condition. Incomplete loading conditions might lead to poor design and potential damage to patients. However, most of research in implant designing are still considering a vector total force on a single tooth crown. The result could be affected by the irregular geometry and specific contact point of the dental crown. Therefore, to provide an appropriate loading condition, it is important to investigate not only the magnitude, but also the direction and distribution. In this study, the aim is to obtain the detail information occlusal force on the crown surface, such as the magnitude, the direction and distribution of the occlusal force through synergy between numerical calculation method and developed Multilayer Ceramic Capacitor (MLCC) based sensing system. MATERIALS AND METHODS In this study, the industrial-grade multilayer ceramic capacitor was used to be a force sensing element. The MLCC is typical electric components composed of the capacitive material Barium titanate (BaTiO3), which is also a piezoelectric material. The piezoelectricity is electromechanical interaction between the mechanical and the electrical state that develop an electric charge proportional to a mechanical strain. This study reproduced the previous research of our lab, including sensing ability of MLCC, re-poling process and flexible electrode. In additional, this study also simplified the re-poling process and improved the sensing ability of MLCC with new pre-heating process. To obtain the direction and magnitude of occlusal force directly, this study used five MLCCs with a bump structure, as the force transfer median, to develop the 3D force measurement system. Four MLCCs were place around the bump to measure the horizontal (shear) force. The other one MLCC was place under the bump to detect the vertical (normal) force. In additional, a 3D force measurement systems with 3×3 array were embedded against the crown surface of an artificial tooth. These nine output of the MLCCs were mapped to a response pattern as force fingerprints to evaluate the feasibility. However, the MLCC used to measure the shear force could be interference by the direct contact of the above crown, it was difficult to justify the correctness of the shear force measurement outcomes. This study developed a numerical model work with two layer sensor arrays and embedded into an artificial crown. The crown surface sensor array used to detect the loading position. The bottom layer sensor array was used to calculate the direction and magnitude of applied force by finite element analysis. Moreover, the results of finite element analysis were used in building a preliminary calculation model in order to obtain the direction and magnitude of applied force on crown. The z-axis reaction force of the finite element model was used to calculate the condition of applied force on crown surface by using optimization algorithm, and compare with the real applied force to evaluate the feasibility of two-layer sensor array for occlusal force measurement. RESULTS ANS DISCUSSION This study reproduced the previous research, including sensing ability of MLCCs, re-poling process and flexible electrode. The MLCCs as a force sensor was able to provide a good force response. The re-poling method was used to improve and normalize the sensing property of the MLCC force sensor. Results indicated the MLCC could sustain an axial loading of up to 800 N and that there was a significant and linear output voltage in the applied force range of interest. The treated MLCC elements could obtain a low variation of 4.8% and high sensing ability about 1 mV/N, and the sensing ability of MLCC sensors became saturated after 60 minutes of re-poling. This study also reproduced a flexible copper-coated PI films that fabricated as flexible electrodes by using MEMS technology. To obtain the direction and magnitude of occlusal force, a 3D MLCC force sensor system was fabricated in this study. The results indicated the 3D MLCC force sensor system was able to detect the force either a normal or a combined force. The stress distribution of finite element analysis presented the higher stress values concentrated at the distobuccal groove (central area near the distal cusp ridge). The experiment normal responses pattern showed the higher normal response at the center. The measured force distribution outcomes depended heavily on the position of the sensor location. The response pattern of shear force was also mapped in this study. The high value of response of lingual and mesial shear force was observed at mesial side of molar model which was not contact with maxillary molar. The MLCCs used to measure the shear force could be interference by the direct contact of the above crown. It was difficult to justify the correctness of the shear force measurement outcomes. The two-layer force sensor array was embedded into artificial crown for measuring force pattern which was evaluated with finite element analysis. The high value of response pattern on occlusal surface was considered as the loading point of the applied forces. The sensor array of bottom layer sensor array was used to calculate the magnitude and direction of the load force. The result indicated same tendency between experiment result of bottom layer and finite element analysis. The error of calculated loading force can be as low as 1% under one or two loading points. When the applied loading points up to three, the excessive unknown number in calculation resulted in higher error with maximum 10%. CONCLUSIONS This study employed MLCC to be force sensing element for occlusal force measurement. The MLCC sensors are treated to improve and normalize the sensing-force properties using a simple re-poling process. A flexible sensor array based the treated MLCCs is fabricated by using standard MEMS process. The tow-layer sensor array is used to evaluate loading condition on the occlusal surface. The summary of achievements of this present study as follow: In this study, force sensing array with Industrial grade-MLCCs as force sensing components were improved to measure occlusal force. A 3D MLCC force-sensing structure, using bumper, were developed to measure the 3 components of the occlusal force. However, due to its complexity, it still can’t be used to measure the shear components of occlusal force with acceptable accuracy. Using numerical approach, it is demonstrated that it is possible to identify three loading force at a time .One-point load and two-point load were justified in this study. In case of three-point load, the error is larger than 10%.

Na reabilitação dentária com implantes, estes são sujeitos a diferentes forças de mordida (funcionais e parafuncionais). Tem havido muito interesse na comunidade científica em criar estratégias para otimizar a funcionalidade dos dispositivos de implantes para assegurar uma osteointegração duradoura. O objetivo deste estudo, uma revisão narrativa, será de investigar como as características dos implantes influenciam a transmissão de forças aos seus componentes e ao ambiente peri implantar e se estas têm um impacto no prognóstico protético. Materiais e métodos: pesquisa bibliográfica efetuada em diferentes bases de dados eletrónicas (B-ON, PUBMED, Researchgate, science direct). Critérios para inclusão: artigos completos respondendo a palavras-chave em combinações, revisões e trabalhos listados em sites de referência (Pubmed, science direct, Researchgate, B-on) em língua inglesa, portuguesa e francesa, sem critérios de exclusão relativos à data de publicação.
In dental rehabilitation, implants are subjected to different biting forces (functional and parafunctional). There has been much interest in the scientific community in strategies to optimize the functionality of implant devices to ensure lasting osseointegration. The aim of this study will be to investigate how the characteristics of implants influence the transmission of forces to their components and to the peri-implant environment and whether these have an impact on prosthetic prognosis. Materials and methods: bibliographic research carried out in different electronic databases (B-ON, PUBMED, Researchgate, science direct). Criteria for inclusion: full articles responding to keywords in combinations, reviews and papers listed in reference sites (Pubmed, science direct, Researchgate, B-on) in English, Portuguese and French, with no exclusion criteria for publication date.

博士
國立成功大學
生物醫學工程學系
101
Chewing is the most important function of the teeth to provide essential nutrition and energy for life maintain. It has been showed that the loading force on the dental crown plays a vital role in long-term success of many dental treatments. However, the quantification of the force regarding human occlusion and mastication is still not well recognized, especially in how these forces are distributed over the dental crown. Improper distribution of the occlusal force may cause temporomandibular joint disorder, crown fracture, restoration damage, or loss of osseointegration in dental implants. A comprehensive measurement of the occlusion and mastication forces is therefore vital. This study aimed to evaluate the feasibility of developing a miniature force sensing array to measure the complicated occlusal force condition, force size, load site and direction. The multilayer ceramic capacitor (MLCC) is employed as the sensing element in this study. An MLCC element is composed of a stack of piezoelectric ceramic materials, typically using barium titanate (BaTiO3) as the dielectric layer and nickel as the conducting layer. The BaTiO3 is a general piezoelectric material providing great piezoelectric properties. A piezoelectric dielectric layer, with its top and bottom internal electrodes, can be viewed as a thin piezoelectric transducer unit. However, industrial-grade MLCC is used as capacitor rather than as force sensing components. The force sensitivity among different MLCCs can varied by 70%. A simple re-poling process was developed to pole the sensor to a saturation situation for normalization each MLCC. A force sensing array is then developed to evaluate the possibility of measuring the complete occlusal force information. Measurement results showed that a single MLCC force sensor with a cross section area of 2.4 mm2 can withstand load up to 600 N, suitable to bear the large occlusion force. The piezoelectric constant could be increased from 19 pC/N to 1,740 pC/N after re-poling while the variation could be reduced down to 6%. This indicated that the normalized MLCC provides good force response and excellent repeatability. More importantly, there was no time lag for dynamic force measurements. Two sheets of force sensor array, each composed of 4x4 re-poled MLCC elements soldered on a flexible circuit sheet, were embedded into a temporary crown to measure, in-vitro, the occlusion force. The first sensor array was integrated with the crown near the occlusal surface to identify the loaded site. The second sheet was placed under the bottom surface of the crown to measure the total force size as well as the distribution. The directions of each occlusal force could then be obtained from the simulation of a finite element analysis. This indirect measurement approach confirms that a simple and inexpensive MLCC-based force sensor system is feasible to investigate the complicated occlusal loading. This system has great potential to be developed for applications in both clinical and biomedical engineering.

碩士
高雄醫學大學
牙醫學研究所碩士在職專班
94
Abstract So called “periodontal prosthesis”, Dr Amsterdam( University of Pennsylvania, 1974) shared his view with us. He defined periodontal prostheses as “Those restoration prosthetic endeavors that are absolutely essential in the treatment of advanced periodontal disease”. Predictable long-term restorative success requires a combination of restorative principles with the correct management of periodontal tissues. The treatment of periodontally compromised and weakened teeth poses a serious challenge to clinicians. Approaches to treatment can vary from extraction to rehabilitation of the natural dentition. The treatment plan depends on many factors including age, health, psychologic status, the patient’s ability to improve and maintain adequate plaque control, and economics. There is convincing evidence that teeth with severe bone loss and furcation involvement can be maintained in a state of health and function with the appropriate treatment, continuing periodontal maintenance care, and oral-hygiene measures performed at home. Therefore, every effort should be made by the dentist to save compromised teeth. This paper presents 9 cases with moderate to advanced periodontitis, including 3 males and 6 females, aged from 46 to 68 years old . The periodontal treatments of these cases include non-surgical and surgical procedures, such as open-flap curettage, forced eruption, root separation/resection, free gingival graft, subepithelial connective tissue graft, guided tissue regeneration, and implantation. The final prosthesis design depends on dentition situation, patient’s economic consideration and dentist treatment philosophy, from fixed partial denture, clasp-retained removable partial denture, detachable crown sleeve coping telescopic denture, magnetic attachment with detachable crown sleeve coping telescopic denture, implant-supported fixed partial denture. Finally, the patients were periodiac recalled to reinforce oral hygiene instruction and perform root scaling and planning. Only the plaque was controlled effectively, the periodontal health can be maintained. The frequency of supportive periodontal therapy (SPT) and the patient’s cooperation determine long-term success or failure following periodontal therapy. Periodontal therapy without maintenance is of little value in terms of restoring periodontal health.

The knowledge of the occlusion is the key in the development of a successful restoration of the implant as most technical implant complications are related to biomechanical problems. We will understand the principles of occlusion in dental implants as clinical advices to determine the most important factors affecting the occlusal success or failure of dental implants. Understanding and delivering optimal occlusal schemes for a restoration over implants, the strategy recommended here is to utilize known concepts of occlusion for natural dentition with the added understanding that implants could fail by a completely different mechanism. The ultimate goal is to describe the clinical techniques required to fabricate implant restorations. The research was accomplished between December 2018 and May 2019 using the search engine PubMed, scientific article’s revision, scientific books, written in English, in French and in Portuguese.
O conhecimento da oclusão é a chave para o desenvolvimento de uma restauração bem sucedida sobre implantes assim como a maioria das complicações técnicas do implante estão relacionados com problemas biomecânicos. Predispomos a compreensão dos princípios de oclusão nos implantes dentários como os conselhos clínicos para determinar os fatores mais importantes que afetam o sucesso ou o fracasso oclusal dos implantes dentários. Faremos também uma compreensão e entrega de esquemas oclusais ideais para a restauração sobre o implante, a estratégia recomendada aqui é utilizar conceitos conhecidos de oclusão para a dentição natural com a informação acrescida de que os implantes falham por um mecanismo completamente diferente. O objectivo final é descrever as técnicas clínicas necessárias para realizar restaurações sobre implantes. A pesquisa foi realizada entre dezembro de 2018 e maio 2019 usando o motor de busca PubMed, revisão de artigos científicos, livros científicos, escritos em Inglês, Francês e Português.