Performance clínica de próteses fixas obtidas por CAD/CAM e técnica convencional

Estudo avalia próteses unitárias ou múltiplas confeccionadas por CAD/CAM comparadas à técnica convencional.

AUTORES

Larissa Dolfini Alexandrino
Cirurgiã-dentista, especialista em Prótese Dentária e DTM, mestra e doutoranda em Clínica Odontológica na área de Prótese Dentária – FOP-Unicamp. Orcid: 0000-0003-0289-1006.

Milton Edson Miranda
Cirurgião-dentista, mestre e doutor em Prótese Dentária, e professor – Faculdade São Leopoldo Mandic. Orcid: 0000-0002-5410-6500.

Ingrid Andrade Meira
Cirurgiã-dentista, especialista em Prótese Dentária e DTM, e doutora em Clínica Odontológica na área de Prótese Dentária – FOP-Unicamp. Orcid: 0000-0002-3631-0030.

Pedro de Penha Coutinho Nina Duarte
Cirurgião-dentista, especialista em Prótese Dentária e DTM, mestre em Diagnóstico Bucal e professor – Faculdade São Leopoldo Mandic. Orcid: 0000-0002-3388-2105.

RESUMO

Objetivo: avaliar a performance clínica de próteses unitárias ou múltiplas confeccionadas por CAD/CAM comparadas à técnica convencional. Material e métodos: a revisão sistemática foi realizada a partir das diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) e registrada no International Prospective Register of Systematic Reviews (Prospero). A estratégia de busca foi realizada nas bases de dados PubMed/MEDLINE, Scopus, Web of Science, Embase, Lilacs e literatura cinzenta entre janeiro de 2009 e outubro de 2020. Estudos clínicos randomizados e não randomizados foram analisados em relação aos aspectos de taxa de sobrevivência, adaptação marginal e cáries. O risco de viés e a qualidade de evidência também foram descritos. Resultados: três estudos clínicos randomizados e um estudo prospectivo foram incluídos (n=4). O acompanhamento de 335 pacientes nos estudos foi realizado entre 24 e 60 meses. A performance clínica das próteses unitárias produzidas por CAD/CAM foi semelhante à técnica convencional, apenas o ouro foi considerado estatisticamente melhor. Já as infraestruturas de próteses múltiplas digitais tiveram resultados piores em adaptação marginal quando comparadas às tradicionais, embora tenham apresentado um comportamento similar nos outros desfechos. O risco de viés foi considerado moderado em três artigos incluídos e apenas um com baixo risco, porém todos tiveram baixa certeza de evidência. Conclusão: os estudos sugerem que as coroas feitas por CAD/CAM são comparáveis às confeccionadas pela técnica convencional nos desfechos avaliados, porém as infraestruturas de próteses múltiplas ainda apresentam problemas de adaptação. Mais estudos são necessários para afirmar a performance clínica a longo prazo de próteses produzidas por CAD/CAM.

Palavras-chave – Desenho assistido por computador; Coroas; Prótese parcial fixa; Revisão sistemática.

ABSTRACT

Objective: to evaluate the clinical performance of single crown or multiple-unit prostheses made by CAD/CAM compared to the conventional technique. Material and methods: a systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) and was registered and approved in the International Prospective Register of Systematic Reviews (Prospero). The search strategy was carried out in the PubMed-MEDLINE, Scopus, Web of Science, Embase, Lilacs and Gray Literature from January 2009 to October 2020. Random and non-randomized clinical studies were analyzed concerning the survival rate, marginal adaptation, and caries. The risk of bias and quality of evidence were also described. Results: three randomized clinical studies and one prospective study were included (n=4). Nearly 335 patients were followed-up between 24 and 60 months. Clinical performance of the CAD/CAM crowns was similar to the conventional technique, only gold crowns was considered statistically superior. CAD/CAM multiple-unit infrastructures had inferior results in marginal adaptation compared to traditional, although they had similar behavior in other outcomes. The risk of bias was considered moderate in the 3 articles included, all in all, just one presented low risk even though the 3 of them had low certainty of evidence. Conclusion: therefore, studies suggest that the crowns made by CAD/ CAM are comparable to those made by the conventional technique in the outcomes evaluated, but multiple prostheses infrastructures still have adaptation problems. More studies are needed to affirm long-term clinical performance of CAD/CAM prostheses.

Key words – Computer-aided design; Crowns; Denture partial fixed; Systematic review.

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