RESUMO
Objectives: To evaluate the success rate of bone grafts and implants carried out at the Latin American Institute for Research and Dental Education (ILAPEO), considering the following: (i) the different pure bone substitutes (autogenous, xenogeneic, and alloplastic), (ii) the presurgical bone height, and (iii) how the treatment is compromised when membrane perforation occurs during sinus lift in maxillary sinus surgeries. Material and Methods. The initial sample comprised 1040 records of maxillary sinus lifting surgeries. After evaluation, the final sample retained 472 grafts performed using the lateral window technique with a total of 757 implants. The grafts were divided into 3 groups: (i) autogenous bone (n = 197), (ii) xenogenous bovine bone (n = 182), and (iii) alloplastic material (n = 93). One calibrated examiner classified the sample into two groups based on the residual bone height (<4 mm and ≥4 mm) of the area of interest measured on parasagittal sections of tomographic images. Data on membrane perforation occurrences in each group were collected; qualitative variables were described using frequency, expressed as percentages. The Chi-square test was used to analyze the success of the graft types and the survival rate of the implants as a function of the grafted material and the residual bone height. The Kaplan-Meier survival analysis was used to calculate the survival rate of bone grafts and implants according to the classifications adopted in this retrospective study. Results: The success rate of grafts and implants was 98.3% and 97.2%, respectively. There was no statistically significant difference in the success rate among the different bone substitutes (p = 0.140). Only 8 grafts (1.7%) and 21 implants (2.8%) failed. There was a greater success rate for both grafts (96.5%) and implants (97.4%) when the bone height was ≥4 mm. The success rate in the 49 sinuses in which the membrane was perforated was 97.96% for the grafts and 96.2% for the implants. The follow-up periods after rehabilitation ranged from 3 months to 13 years. Conclusions: Within the limitations of the data analyzed in this retrospective study, maxillary sinus lift was a viable surgical technique that enabled implant placement with a predictable long-term success rate, regardless of the type of material used. The presence of membrane perforation did not interfere with the success rate obtained for grafts and implants.
Assuntos
Substitutos Ósseos , Medicina , Animais , Bovinos , Seio Maxilar/cirurgia , Estudos Retrospectivos , Próteses e ImplantesRESUMO
Research has shown that the presence of implants can revert bone resorption and thus contribute to a greater preservation of the residual bone ridge, especially in edentulous mandibles. Bone remodeling has yet to be extensively studied in the context of prosthetic options for edentulous arches. This study aims to evaluate the long-term behavior of bone tissue in the posterior region of edentulous mandibles rehabilitated with implant-retained fixed prostheses using cone-beam computerized tomography (CBCT). Selected individuals were rehabilitated with 5 external hexagon platform implants and an implant-retained fixed prosthesis. The CBCT scans were performed immediately after surgery and after 8, 22, and 32 months (T0, T8, T22, and T32, respectively). Implants were installed between the mental foramen. Subsequently, bone crest height and density were measured in the posterior region of the mandible on the images in 3 distinct areas at 5, 10, and 15 mm from the center of the distal implant axis. Analysis of variance and the Bonferroni post hoc test were used for multiple analyses. The results indicate a statistically significant difference in bone height between T0 and all subsequent times; the bone height at T32 was 8.85% higher than at T0 (P = .05). There was a difference in bone height between all analyzed regions. The bone growth difference between the 5-mm and 15-mm positions was 28.42% after 32 months (P = .00). A significant increase of 5.76% in bone density was observed between T0 and T22 (P = .03). Within the limitations of this study (sample size, follow-up duration), it was demonstrated that the use of implant-retained fixed prostheses in the mandible resulted in qualitative and quantitative bone growth (bone preservation) in the posterior region of the mandible. Further research is needed to identify the validity of our findings for other populations and to determine the duration of the bone-remodeling process in rehabilitated edentulous mandibles.
Assuntos
Implantes Dentários , Arcada Edêntula , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endóssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Arcada Edêntula/cirurgia , Mandíbula/cirurgiaRESUMO
PURPOSE: The objective of this systematic review was to assess the three-dimensional changes in bone tissue after immediate installation of a single implant in a fresh extraction socket in the anterior maxilla. METHODS: After defining a strategy, an electronic search was carried out using the databases PubMed, Embase, LILACS, Web of Science, Cochrane, and Scopus. In addition, the gray literature was also researched using Google Scholar and ProQuest. Two reviewers independently screened for eligible studies, assessed the methodological quality, and extracted the data. The inclusion criteria were observational studies and experimental studies that assessed bone response after the immediate installation of a single implant in a fresh extraction socket, immediately loaded or not, in the region between the maxillary canines. Studies were included in any language, with no publication date restrictions and with a minimum of 6 months of follow-up after the surgical procedure. RESULTS: From a total of 3272 articles, only 12 studies met the inclusion criteria and were selected for the review. Bone remodeling after immediate installation of a dental implant was assessed using standardized periapical radiographs and cone beam computed tomography (CBCT). CONCLUSION: It can be concluded that bone remodeling occurs after tooth extraction and immediate implant installation.
Assuntos
Remodelação Óssea , Carga Imediata em Implante Dentário , Maxila/cirurgia , Humanos , Extração DentáriaRESUMO
A técnica socket shield é descrita como a retenção parcial de uma raiz em combinação com a instalação imediata de implantes. Tem como justificativa principal a manutenção do tecido ósseo vestibular em áreas estéticas. O objetivo deste artigo é relatar um caso clínico no qual uma série de implantes foi instalado, entre eles, um de acordo com a técnica socket shield e descrever uma situação clínica observada. Em avaliação clínica e tomográfica, após um ano em função, observou-se o deslocamento do fragmento radicular com reabsorção da parede óssea vestibular, porém sem sintomatologia clínica ou perda de função do implante. A pressão exercida durante a instalação do implante provocou o deslocamento do remanescente dentário. Posteriormente, em acompanhamento de 3 anos, observou-se manutenção e estabilização do fragmento deslocado. Pode ser concluído que a pressão exercida durante a instalação do implante provocou o deslocamento gradativo do remanescente dentário mantido propositalmente durante a instalação de um dos implantes. Porém, a prótese implantossuportada manteve-se em função (AU).
Socket shield technique is described as the partial retention of a root fragment combined to the immediate installation of an implant. It is justified by the maintenance of bone tissue in aesthetic areas. The aim of this paper is to report a clinical case in which a series of implants was inserted, one of them according to the socket shield technique, and to describe a related complication. In a clinical and tomographic evaluation, after one year in function, it was observed the displacement of the root fragment with reabsorption of the vestibular bone wall, but with no clinical symptomatology or loss of implant function. Afterwards, in the 3-year follow-up, it was observed maintenance and stabilization of the displaced fragment. It can be concluded that there was a complication in the technique observed by the buccal displacement of the intentionally left root fragment during the insertion of one implant. Nevertheless, the implant supported prosthesis remained in function (AU).
Assuntos
Humanos , Pessoa de Meia-Idade , Implantes Dentários , Estética Dentária , Maxila/cirurgia , Reabilitação Bucal/métodos , Brasil , Radiografia Panorâmica/instrumentação , Tomografia Computadorizada de Feixe Cônico/instrumentaçãoRESUMO
Introduction: The use of osseointegrated dental implants for the rehabilitation of patients has revolutionized dentistry. Objective: To retrospectively evaluate the survival rate and the frequency of complications with external hexagon platform supporting single crowns. Material and method: Dental forms of 110 patients who received 143 implants at the Ilapeo College (2004-2015) were used. The variables were: age, gender, systemic involvement at the time of surgery, region, implant design, type of surface, fixation system, pillar type and prosthesis material. The outcome variables were the incidence of complications in the implant or prosthesis and time in use. The mean follow-up period was 9 years. Result: 32.8% had some systemic disease. Ninety-six implants (67.1%) were installed in the maxilla and 47 (32.9%) in the mandible, 87 (60.8%) were in the posterior region and 56 (39.2%) in the anterior region, while 40 (28%) were placed in regions that had received bone reconstruction. The majority (97.2%) of the implants presented surface treatment, 42% had a cylindrical design and 58% were tapered. The majority of the prosthetic components (89.6%) used were UCLAs and most of the prostheses were fused-to-metal (79.7%). The rate of prosthetic complications was 19.58% and three implants had been lost (97.9% survival rate). There was no statistical difference between the variables analyzed for both the occurrence of prosthetic complications and for the loss of the implant. Conclusion: Implants with external hexagon connection were an effective and predictable option to support crowns and had high survival rates.
Introdução: O uso de implantes dentários osseointegrados para a reabilitação de pacientes revolucionou a Odontologia. Objetivo: Avaliar retrospectivamente o índice de sobrevivência e a frequência de complicações com plataformas de hexágono externo suportando coroas unitárias. Material e método: Foram utilizados prontuários de 110 pacientes que receberam 143 implantes na Faculdade Ilapeo (2004-2015). As variáveis foram: idade, sexo, envolvimento sistêmico no momento da cirurgia, região, desenho do implante, tipo de superfície, sistema de fixação, tipo de pilar e material da prótese. As variáveis de desfecho foram a incidência de complicações nos implantes e/ou próteses e o tempo em função. O tempo médio de acompanhamento foi de 9 anos. Resultado: 32,8% apresentavam alguma alteração sistêmica. Noventa e seis implantes (67,1%) foram instalados na maxila e 47 (32,9%) na mandíbula, 87 (60,8%) estavam em região posterior e 56 (39,2%) em região anterior, enquanto 40 (28%) necessitaram reconstrução óssea prévia. A maioria dos implantes (97,2%) apresentava tratamento de superfície, 42% eram cilíndricos e 58% cônicos. A maioria dos componentes protéticos (89,6%) eram UCLAs e a maioria das próteses fundidas em metal (79,7%). O índice de complicações protéticas foi de 19,58% e 3 implantes foram perdidos (97,9% de índice de sobrevivência). Não houve diferença estatística em relação às variáveis estudadas e a ocorrência de complicações protéticas e perda de implantes. Conclusão: Implantes com plataforma de hexágono externo são uma opção efetiva e previsível de reabilitação unitária e apresenta elevado índice de sobrevivência.
Assuntos
Humanos , Pacientes , Prótese Dentária Fixada por Implante , Implantação DentáriaRESUMO
Objective: To assess the behavior of the peri-implant soft margin after immediate implant placement with immediate function, by (1) direct clinical measurements of peri-implant soft margin height and thickness, (2) measurements of peri-implant soft margin height on photographs and (3) the perception of dental professionals regarding the results considering esthetic parameters. Material and method: The study included 8 patients with central or lateral incisors indicated to be extracted. Direct measurements of peri-implant soft margin height and thickness were done immediately before extraction (T0) and 1 (T1), 4 (T2), 8 (T3) and 12 (T4) months after the flapless insertion of the implant. Photographs were taken at the same time intervals. A questionnaire was filled in by implantology professionals regarding their visual perception of color and peri-implant soft margin architecture and harmony in the implant region using the photographs obtained at T4. Result: The clinical results showed significant changes to the height of the peri-implant soft margin, but the photographic results did not show significant changes for this measurement. The thickness of the attached gingiva was maintained during all the observation period. Of the professionals interviewed, 35.2% noticed an altered peri-implant soft margin color of the implant region, 39.8% noticed a change in the peri-implant soft margin architecture and 12.5% noticed a change in the peri-implant soft margin harmony. Conclusion: The soft tissues around immediate implants changed during this period, but did not affect the aesthetic outcome and in the opinion of professionals, the aesthetic results were satisfactory for these cases.
Objetivo: Avaliar o comportamento do tecido gengival após a instalação de implantes imediatos em função imediata, por meio de (1) medidas clínicas diretas de altura e espessura da margem de tecido mole peri-implantar, (2) medidas de altura gengival em fotografias, e (3) percepção de profissionais da área de odontologia em relação a parâmetros estéticos. Material e método: O estudo incluiu 8 pacientes com incisivo central ou lateral indicados para extração. Medidas diretas de altura e espessura da margem de tecido mole peri-implantar foram realizadas imediatamente antes da extração (T0) e 1 (T1), 4 (T2), 8 (T3) e 12 (T4) meses após a instalação de implante sem abertura de retalho. Fotografias foram tiradas nos mesmos tempos. Um questionário foi respondido por Implantodontistas em relação à percepção visual dos mesmos sobre coloração, arquitetura da margem de tecido mole peri-implantar e harmonia na região do implante usando fotografias obtidas no T4. Resultado: Os resultados clínicos mostraram alterações significantes na altura da margem de tecido mole peri-implantar, mas nas fotografias não foi observada diferença estatisticamente significante para essa mesma medida. A espessura da gengiva inserida se manteve durante todo o período de observação. Dos profissionais entrevistados, 35,2% observaram coloração alterada na região do implante, 39,8% identificaram alteração na arquitetura da margem de tecido mole peri-implantar e 12,5% alteração na harmonia da margem de tecido mole peri-implantar. Conclusão: Os tecidos moles ao redor de implantes imediatos sofreram alterações durante o período estudado, mas não afetaram o resultado estético e na opinião dos profissionais os resultados foram satisfatórios.
Assuntos
Implantação Dentária , Estética Dentária , Gengiva , Incisivo , Maxila , TecidosRESUMO
O propósito desse estudo foi avaliar, retrospectivamente, o índice de sobrevivência de implantes com tratamento de superfície para aumento de molhabilidade instalados em ambos os maxilares e submetidos ou não à carga imediata. Um total de 78 pacientes (17 homens e 61 mulheres), nos quais 182 implantes foram instalados, compuseram a amostra. Todos os implantes foram instalados em pacientes com diferentes situações clínicas, podendo ser reabilitações unitárias, parciais ou totais, nos cursos de pós-graduação do Instituto Latino Americano de Pesquisa e Ensino Odontológico (ILAPEO), entre 2011 e 2015. Cento e dezenove implantes (65,38%) foram instalados em maxila e 63 (34,61%) em mandíbula, sendo que em 156 (85,71%) foi aplicada carga imediata. O índice de sobrevivência total foi de 98,90% (180 implantes). Houve perda de apenas 2 implantes instalados em maxila. A perda foi constatada após 5 semanas em ambos os casos. Consideradas as características do estudo, a metodologia aplicada, o tamanho e as características da amostra, o tempo de acompanhamento, bem como a diversidade de variáveis daí decorrentes, parece aceitável concluir, com base nos resultados aqui encontrados e discutidos, que os implantes com tratamento de superfície com aumento de molhabilidade, ora observados, apresentaram altas taxas de sobrevivência dentro dos critérios estabelecidos neste estudo (AU).
The aim of this study was to evaluate, retrospectively, the survival rates of implants with surface treatment that increased wettability, installed in both jaws, and submitted or not to immediate loading. The sample was composed of 78 patients (17 men and 61 women), in which 182 implants were installed. All implants were installed by dentists in post-graduate courses of the Latin American Institute of Research and Dental Education (ILAPEO), between 2011 and 2015. One hundred and nineteen implants (65.38%) were installed in the maxilla and 63 (34.61%) in the mandible, and 156 (85.71%) was applied immediate load. The overall survival rate was of 98.90% (180 implants). Only 2 implants placed in the maxilla were lost, and in both cases the loss was noticed after 5 weeks. Considering the parameters of the study, the methodology, sample size and characteristics, follow-up period and diversity of the variables, it seems acceptable to conclude, based on the present discussed results, that the implants with surface treatment with increased wettability, presented high survival rates according to the criteria considered in this study (AU).
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Carga Imediata em Implante Dentário/métodos , Reabilitação Bucal/métodos , Estudo Observacional , Osseointegração , Molhabilidade , Brasil , Análise de SobrevidaRESUMO
The rehabilitation of maxillary and mandibular bone atrophy represents one of the main challenges of modern oral implantology because it requires a variety of procedures, which not only differ technically, but also differ in their results. In the face of limitations such as deficiencies in the height and thickness of the alveolar structure, prosthetic rehabilitation has sought to avoid large bone reconstruction through bone grafting; this clinical behavior has become a treatment system based on evidence from clinical scientific research. In the treatment of atrophic maxilla, the use of zygomatic implants has been safely applied as a result of extreme technical rigor and mastery of this surgical skill. For cases of posterior mandibular atrophy, short implants with a large diameter and a combination of short and long implants have been recommended to improve biomechanical resistance. These surgical alternatives have demonstrated a success rate similar to that of oral rehabilitation with the placing of conventional implants, allowing the adoption of immediate loading protocol, a decrease in morbidity, simplification and speed of the treatment, and cost reduction. This case report presents complete oral rehabilitation in a patient with bilateral bone atrophy in the posterior regions of the maxilla and mandible with the goal of developing and increasing posterior occlusal stability during immediate loading.
RESUMO
The aims of this study were to identify (1) patient-related factors (sex, age, craniofacial pattern and smoking habit), (2) miniscrews implants (MSI)-related factors (length and diameter) and (3) location-related factors [bone (maxilla or mandible) and area (buccal, lingual and alveolar ridge)] that may be associated with MSI loss of stability. A total of 1356 MSI were installed in 570 patients (423 females and 147 males) with mean age of 42.7 during a 10-year period and were clinically evaluated once a month until the end of the proposed movement. Length (5, 7, 9 and 11 mm) and diameter (1.3, 1.4 and 1.6 mm) of the MSI were selected according to insertion site. The evidence of clinical mobility during treatment or fracture during insertion was considered as failure. A total success rate of 89.1% was observed. There was no statistically significant difference in loss of stability when considering age, sex, craniofacial pattern or smoking habit. Considering diameter, there was no statistically significant difference (p = 0.645), but the shorter miniscrews (5 mm) showed higher failure rates (p < 0.001) than the longer ones. There were more loses (p < 0.001) in the mandible than in the maxilla, but the area (buccal, lingual or alveolar ridge) did not interfere in the results (p = 0,421). It can be concluded that MSIs are effective for skeletal anchorage in orthodontics. Patient-related factors, such as sex, age, smoking habit and craniofacial pattern, did not affect MSI success. However, the use of shorter MSIs (5 mm) was inversely proportional to failure probability, and loss of stability was greater in the mandible.
Assuntos
Parafusos Ósseos , Implantes Dentários , Falha de Restauração Dentária , Procedimentos de Ancoragem Ortodôntica/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Cefalometria , Criança , Estudos Transversais , Implantação Dentária/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Desenho de Aparelho Ortodôntico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Adulto JovemRESUMO
O objetivo deste trabalho foi comparar a efetividade de dois dispositivos de ancoragem ortodôntica, nos movimentos de intrusão de molares superiores. Neste estudo clínico prospectivo, 12 indivíduos que necessitavam de intrusão de molares superiores receberam miniplacas e mini-implantes para proporcionar ancoragem esquelética temporária. Observaram-se os aspectos clínicos e os sintomas pós-operatórios, bem como a efetividade dos métodos. Houve a perda de uma miniplaca por infecção e de mini-implantes palatinos, por falta de higiene local. Os dois tipos de dispositivos de ancoragem se mostraram capazes de auxiliar o movimento ortodôntico de intrusão sem causar nenhum tipo de prejuízo aos pacientes.
The aim of this study was to compare the effectiveness of two orthodontic anchorage devices for upper molar intrusion. In this prospective clinical study, 12 subjects received miniplates and mini-implants to provide temporary skeletal anchorage. Clinical and postoperative symptoms were observed as well as the effectiveness of both methods. One miniplate and palatal mini-implants were lost due to lack of local hygiene. Both types of anchoring devices can help orthodontic intrusion movement without patient compromising.