Cuantificación de torque manual de tornillos protésicos intra e inter operadores: estudio invitro
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Fecha
2013
Autores
Profesor/a Guía
Facultad/escuela
Idioma
es
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Universidad Andrés Bello
Nombre de Curso
Licencia CC
Licencia CC
Resumen
Introducción: Aún cuando es sabido, que uno de los principales problemas en las
rehabilitaciones protésicas sobre implante es el aflojamiento o fractura de los tornillos
protésicos, el rigor sobre el torque de apriete de tornillos protésicos, es escaso.
Sin duda que la estabilidad de las rehabilitaciones en el tiempo, está dada por múltiples
factores, pero el correcto apriete o torque logrado con los tornillos protésicos es
fundamental, y al parecer no se le da la relevancia que merece. Muchos especialistas se ven
tentados a realizar aprietes solo con desatornilladores manuales, pensando que están
logrando torques óptimos, sin embargo, al no tener un control real de la fuerza ejercida,
estarían realizando mayores o menores fuerzas, que pueden comprometer la integridad o
estabilidad de los tornillos.
Se planteó la hipótesis, de que existen diferencias entre los valores de torque del apriete
manual aplicado a un tornillo protésico, por un cirujano dentista, con un desatornillador
manual y el indicado por el fabricante
Objetivo: El objetivo del estudio, fue cuantificar el torque (Nw/cm2) que se realiza en un
apriete manual, a un tornillo protésico.
Materiales y Método: Se seleccionaron 34 cirujanos dentistas, con experiencia en el área
de rehabilitación sobre implantes e implantología, para realizar mediciones de torque en
tornillos protésicos con desatornillador manual.
Se solicitó a los operadores, que realizaran 3 aprietes al tornillo protésico, con el
desatornillador manual, sobre un calibrador digital. El primer torque solicitado, se utilizó a
modo de calibración, con la intención de que el operador conociera el valor de su apriete
máximo. Este primer intento se denominó torque 0 o de calibración. Se realizaron 2 intentos
más (torque 1 y 2), solicitando llegar a torque de 15 Nw/cm2, teniendo como referencia el
torque de calibración (torque 0). Para medir el torque ejercido, se utilizó un calibrador digital de torque, con rango de
medición de 0,2 a 500 Nw/cm2. Se utilizaron tornillos protésicos de titanio, para
rehabilitaciones múltiples, que fueron atornillados en análogos de pilar multiflex (ambos
de marca P.l Branemark). Se registraron los torques de los intentos 0, 1 y 2, en una tabla diseñada especialmente para
este estudio y se realizaron los respectivos análisis estadísticos. Estos resultados fueron
individuales y de todo el grupo. Se consideraron variables adicionales como género y tiempo
de experiencia del operador en 3 rangos (1=de 1 a 11 meses; 2= de 1 a 3 años; 3= más de
3 años).
Resultados: Los resultados de este estudio, muestran que existen diferencias altamente
significativas entre los valores de torque aplicados al tornillo protésico, con un destornillador
manual, y el solicitado en este estudio e indicado por el fabricante (15 Nw/cm2), tanto intra e
ínter operador, así como también que, en general, no fue determinante el sexo ni la
experiencia de los operadores de manera significativa, para lograr el objetivo solicitado.
Conclusiones: Se puede concluir que el torque entregado por un desatornillador manual es
poco confiable, y teniendo en consideración las múltiples variables que pueden afectar la
correcta aplicación de torque a un tornillo, se aconseja que el torque dado a los tornillos
definitivos, deba ser realizado con llaves de torque, y no con destornilladores manuales.
lntroduction: While it is known, that one of the main problems in prosthetic restorations on implants are the loosening or fracture of the prosthetic screws, the rigor of the screw tightening torque is scarce. No doubt that the stability of the rehabilitation in time is given by multiple factors, but the proper tightening or torque achieved wit_h prosthetic screws is essential, and apparently not given the importance it deserves. Many specialists are tempted to tighten the screws only with manual screwdrivers, thinking they are achieving optimal torques, nevertheless, having no real control of the force, larger or smaller forces would be made, which can compromise the integrity or stability of the screws. This study raises the hypothesis, that there are differences between the values of torque applied to a prosthetic screw, by a dental surgeon, with a manual screwdriver and the specified by the manufacturer. Objective: the objective of the study, was to quantify the torque (Nw/cm2) performed in a manual tightening on a prosthetic screw. Material and Methods: Thirty four dental surgeons, with experience in the area of rehabilitation on implants and implantology, were selected for measurement of prosthetic screws torque with manual screwdrivers. The operators were asked to make three consecutive tightenings on the prosthetics screws with the manual screwdriver on a digital torque gauge. The first torque applied, was used as a calibration, with the intention that the operator knew the value of his maximum torque. This first attempt was called torque O or calibration. Two more attempts were made (torque 1 and 2), applying torque, to reach 15 Nw/cm2, taking as reference the calibration torque (torque 0). To measure the torque achieved, a digital torque gauge was used, with measuring range from 0.2 to 500 Nw/cm2 . Prosthetic titanium screws for multiple restorations were used, which were tightened in multiflex pillar analogs (both PI Branemark brand). Torques O, 1 and 2, were recorded in a table specifically designed for this study and performed the statistical analyzes. These results were individuals and the entire group also. Additional variables were considered such as gender and operator experience, in 3 ranges ( 1 = 1 to 11 months, 2 = 1 to 3 years, 3 = more than 3 years). Results: The results of this study show that there are significant differences between the values of torque applied toa prosthetic screw with a manual screwdriver, and the solicited in this study and indicated by the manufacturer (15 Nw/cm2 ), both intra-and inter-operator and also that, in general, was not significantly determining sex or experience of the operators to achieve the objective requested. Conclusions: lt can be concluded that the torque delivered by a manual screwdriver is unreliable, and taking into account the many variables that can affect the proper application of torque to a screw, it is advised that the torque given to definitive screws, should be made with a torque wrench and not with manual screwdrivers.
lntroduction: While it is known, that one of the main problems in prosthetic restorations on implants are the loosening or fracture of the prosthetic screws, the rigor of the screw tightening torque is scarce. No doubt that the stability of the rehabilitation in time is given by multiple factors, but the proper tightening or torque achieved wit_h prosthetic screws is essential, and apparently not given the importance it deserves. Many specialists are tempted to tighten the screws only with manual screwdrivers, thinking they are achieving optimal torques, nevertheless, having no real control of the force, larger or smaller forces would be made, which can compromise the integrity or stability of the screws. This study raises the hypothesis, that there are differences between the values of torque applied to a prosthetic screw, by a dental surgeon, with a manual screwdriver and the specified by the manufacturer. Objective: the objective of the study, was to quantify the torque (Nw/cm2) performed in a manual tightening on a prosthetic screw. Material and Methods: Thirty four dental surgeons, with experience in the area of rehabilitation on implants and implantology, were selected for measurement of prosthetic screws torque with manual screwdrivers. The operators were asked to make three consecutive tightenings on the prosthetics screws with the manual screwdriver on a digital torque gauge. The first torque applied, was used as a calibration, with the intention that the operator knew the value of his maximum torque. This first attempt was called torque O or calibration. Two more attempts were made (torque 1 and 2), applying torque, to reach 15 Nw/cm2, taking as reference the calibration torque (torque 0). To measure the torque achieved, a digital torque gauge was used, with measuring range from 0.2 to 500 Nw/cm2 . Prosthetic titanium screws for multiple restorations were used, which were tightened in multiflex pillar analogs (both PI Branemark brand). Torques O, 1 and 2, were recorded in a table specifically designed for this study and performed the statistical analyzes. These results were individuals and the entire group also. Additional variables were considered such as gender and operator experience, in 3 ranges ( 1 = 1 to 11 months, 2 = 1 to 3 years, 3 = more than 3 years). Results: The results of this study show that there are significant differences between the values of torque applied toa prosthetic screw with a manual screwdriver, and the solicited in this study and indicated by the manufacturer (15 Nw/cm2 ), both intra-and inter-operator and also that, in general, was not significantly determining sex or experience of the operators to achieve the objective requested. Conclusions: lt can be concluded that the torque delivered by a manual screwdriver is unreliable, and taking into account the many variables that can affect the proper application of torque to a screw, it is advised that the torque given to definitive screws, should be made with a torque wrench and not with manual screwdrivers.
Notas
Tesis (Magíster en Odontología, Especialización en Rehabilitación Oral)
Palabras clave
Torque, Prótesis Dental, Chile, Rehabilitación Oral, Implantes Dentarios