RESUMO
La pérdida ósea en el sector anterior, ya sea por un defecto horizontal, vertical o combinado, actualmente es un desafío, no sólo por la integración del implante, sino por la estética involucrada. Entre las técnicas de regeneración ósea que permiten solucionar estos defectos, cabe destacar la técnica de expansión de crestas. Se presenta el caso de una paciente de 58 años con reborde atrófico, que se sometió a la expansión de crestas con colocación simultánea de implantes en sector anterior, con xenoinjerto previo a técnica de expansión de crestas con piezoeléctrico, colocación simultánea de implantes Narrow Connection SLActive Straumann. Se logró ganancia ósea y estabilidad primaria de los implantes, sin complicaciones. En escenarios seleccionados, la técnica de expansión de crestas de manera predecible permite ganancia de hueso horizontal adecuada, el éxito de los implantes con tasa de supervivencia y mínimas complicaciones intra y postoperatorias (AU)
Bone loss in the anterior sector, both a horizontal, vertical or combined defect is a challenge today; not only for the integration of the implant but also the aesthetic involved. There are techniques of bone regeneration that help us to solve this type of defects, among them we should highlight the crest expansion technique. We present the case of a 58-year-old patient with atrophic flange, who underwent the expansion of crests with simultaneous placement of implants in the anterior sector, with xenograft prior to the piezoelectric crest expansion technique, Simultaneous placement of Narrow Connection SLActive Straumann implants, bone gain and primary stability of the implants were obtained, without complications. In selected scenarios, the crest expansion technique could be considered a predictable approach that demonstrates a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Implantação Dentária Endóssea/métodos , Aumento do Rebordo Alveolar/métodos , Osteotomia/métodos , Piezocirurgia/métodos , XenoenxertosRESUMO
Objetivo: Presentar una técnica quirúrgica de disyunción con bisturí piezoeléctrico y expansión de rebordes delgados en maxilar inferior que permita la colocación de implantes en la posición tridimensional correcta en el mismo acto quirúrgico. Casos clínicos: Se presenta la resolución de dos casos clínicos de pacientes que acudieron a la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires. Ambos requerían la colocación de implantes en sectores posteroinferiores. Las imágenes tomográficas mostraban adecuada altura del reborde alveolar pero deficiente espesor para la colocación de implantes en la posición tridimensional correcta. Se decidió realizar una técnica de disyunción horizontal del reborde alveolar con bisturí piezoeléctrico, expansión del reborde y colocación de implantes e injerto óseo particulado de forma simultánea. Luego de 3 meses, se efectuó la segunda cirugía para iniciar la rehabilitación protésica. Conclusión: La técnica de disyunción horizontal del reborde alveolar mediante el uso del bisturí piezoeléctrico permitió ubicar al implante en la posición tridimensional correcta dentro del tejido óseo nativo sin la necesidad de realizar regeneraciones complejas en rebordes alveolares delgados (AU)
Aim: Present the horizontal split crest technique with a piezoelectric scalpel and the immediate implant placement in the correct tridimensional position, in thin mandibular alveolar ridges. Cases report: The surgical resolutions of 2 clinical cases of patients who attended the Adult Integral Dentistry Chair of the Faculty of Dentistry of the UBA, are presented. Both patients required implant placement in posterior madibular residual ridge. The tomographic images showed adequate height of the alveolar ridge but poor thickness for implants placement in a correct three-dimensional position. It was decided to perform a horizontal split crest technique of the alveolar ridge with piezoelectric scalpel, ridge expansion, and immediate implant placement with xenograft. After 3 months, the second surgery was performed to start with the prosthetic rehabilitation. Conclusion: The horizontal split crest technique using a piezoelectric scalpel, allowed immediate implant placement in the correct tridimensional position within native bone tissue, avoiding a guided bone regeneration technique, in these cases with thin alveolar ridges (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Técnica de Expansão Palatina , Implantação Dentária Endóssea , Piezocirurgia/métodos , Argentina , Faculdades de Odontologia , Osseointegração , Transplante Ósseo/métodos , Processo Alveolar/cirurgia , Reabilitação BucalRESUMO
The aim of this case report was to describe the inferior alveolar nerve (IAN) lateralization technique using the piezoelectric device for the posterior rehabilitation of an atrophic mandible with implants. The patient presented the absence of elements 35 and 36 associated with a vertical defect impairing the adequate dental implant placement without IAN damage. A full-thickness mucoperiosteal flap was raised, and a bone window was made with a piezoelectric device centralized on the IAN canal position. After dissection, the IAN was moved buccally with a sterile elastic strip. Morse cone 4.0 × 1.5-mm implants were inserted while the IAN remained retracted. At the 4-month follow-up, the screw-retained prosthesis was installed guaranteeing the recovering masticatory function. In conclusion, the case report showed that the IAN lateralization performed with an adequate surgical technique can be successfully indicated for longer implant placement in edentulous atrophic posterior mandible with no permanent neural damage.
Assuntos
Implantação Dentária Endóssea/métodos , Arcada Parcialmente Edêntula/cirurgia , Mandíbula/cirurgia , Nervo Mandibular/cirurgia , Piezocirurgia/métodos , Adulto , Tomografia Computadorizada de Feixe Cônico , Implantes Dentários , Planejamento de Prótese Dentária , Feminino , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/inervação , Nervo Mandibular/fisiologia , Retalhos CirúrgicosRESUMO
Los osteomas fronto-etmoidales son los tumores benignos más frecuentes de los senos paranasales, pudiendo evolucionar con complicaciones por compresión de estructuras adyacentes. Se presenta el caso de una paciente de 63 años de edad, que consultó por aumento de volumen nasofrontal, cefalea y diplopía. Tras el examen clínico, se evidenció una asimetría facial con lateralización del bulbo ocular derecho y exoftalmo. La tomografía de los senos paranasales mostró una lesión que ocupa parcialmente el seno frontal, etmoidal y parte de la cavidad nasal. Los cuidados anatómicos y planificación quirúrgica se desarrollaron en un modelo estereolitográfico mientras que la cirugía de exéresis total se realizó con ayuda del sistema piezoeléctrico. El examen histológico confirmó el diagnostico de osteoma. Se obtuvo una reconstrucción exitosa, recuperando totalmente simetría y función ocular.
Fronto-ethmoidal osteomas are the most frequent benign tumors of the paranasal sinuses, and may evolve with complications by compression of adjacent structures. The case is a 63-year-old female patient, who consulted about increased nasofrontal volume, headache and diplopia. After the clinical exam, she presented a facial asymmetry with lateralization of the right eyeball and exophthalmus. Computed tomography of the sinuses showed a lesion that partially occupies the frontal sinus, ethmoidal sinus and part of the nasal cavity. The anatomical care and surgical planning was developed in a stereolithographic model while the total excision surgery was performed with the help of the piezoelectric system. Histological examination confirmed the diagnosis of osteoma. A successful reconstruction is obtained, fully recovering symmetry and ocular function.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Osso Etmoide/cirurgia , Seio Frontal/cirurgia , Osteoma/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Piezocirurgia/métodos , Cirurgia Assistida por Computador , Osso Etmoide/patologia , Seio Frontal/patologia , Modelos Anatômicos , Osteoma/patologia , Neoplasias dos Seios Paranasais/patologia , Planejamento de Assistência ao PacienteRESUMO
This systematic review aimed to determine: (1) the expected bone volume gain with the split crest technique, and (2) how the use of surgical instruments affects the performance of this technique. An electronic search was performed in the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Embase, PubMed/MEDLINE, Scopus, and Web of Science databases. Twenty-seven articles met the selection criteria and were subjected to meta-analysis of bone gain and survival rate; 17 reported the use of conventional surgical instruments and nine the use of surgical ultrasound. A total of 4115 implants were installed in 1732 patients (average patient age 52 years). The overall implant survival rate was 97%. The average bone gain in studies that used conventional surgical instruments was 3.61mm, while this was 3.69mm in those that used ultrasound. Only two studies presented a low risk of bias. The greatest problems identified during the qualitative analysis were related to random selection of the population and the absence of statistical analysis. The split crest technique appears to be a promising and effective technique to gain bone width, regardless of the surgical instruments used. Considering the diversity of the studies and implant types, no definitive recommendations can be made, especially with regard to the best instruments and implant design to be used.
Assuntos
Aumento do Rebordo Alveolar/métodos , Implantação Dentária Endóssea/métodos , Implantes Dentários , Piezocirurgia/métodos , Instrumentos Cirúrgicos , Aumento do Rebordo Alveolar/instrumentação , Implantação Dentária Endóssea/instrumentação , Retenção em Prótese Dentária , Falha de Restauração Dentária , Humanos , Piezocirurgia/instrumentaçãoRESUMO
Piezosurgery is a new and modern technique of bone surgery in implantology. Selective cutting is possible for different ultrasonic frequencies acting only in hard tissues (mineralized), saving vital anatomical structures. With the piezoelectric osteotomy technique, receptor site preparation for implants, autogenous bone graft acquistition (particles and blocks), osteotomy for alveolar bone crest expansion, maxillary sinus lifting, and dental implant removal can be performed accurately and safely, providing excellent clinical and biological results, especially for osteocyte viability. The aim of this review was, through literature review, to present clinical applications of piezosurgery in implant dentistry and outline their advantages and disadvantages over conventional surgical systems. Moreover, this study addressed the biological aspects related to piezosurgery that differentiate it from those of bone tissue approaches. Overall, piezosurgery enables critical operations in simple and fully executable procedures; and effectively, areas that are difficult to access have less risk of soft tissue and neurovascular tissue damage via piezosurgery.
Assuntos
Implantação Dentária Endóssea/métodos , Piezocirurgia/métodos , Aumento do Rebordo Alveolar/métodos , Autoenxertos/transplante , Transplante Ósseo/métodos , Humanos , Complicações Intraoperatórias/prevenção & controle , Osteotomia/métodos , Levantamento do Assoalho do Seio Maxilar/métodosRESUMO
El objetivo de este trabajo es presentar los riesgos anatómicos en el abordaje de la anquilosis de la articulación temporo mandibular (ATM) y el uso del sistema piezoeléctrico para realizar la resección de la misma. La paciente sexo femenino, 12 años, presento una anquilosis de la ATM derecha, previamente operada en base a reconstrucción con un injerto costocondral. Luego de 4 años de realizada la primera reconstrucción se presentó con una nueva anquilosis del área presentando una masa de tejido óseo de 31 mm en sentido latero-medial, que abarcaba hasta el foramen oval en la base de cráneo y de 28 mm en sentido anteroposterior. La lesión fue abordada con un acceso preauricular y posterior resección con sistema piezoeléctrico, utilizando una técnica de resección en bloque. Se presenta la técnica y se discute la potencialidad de realizar este procedimientos con los nuevos sistemas piezoeléctrico.
The aim of this report is to present the anatomical risk for to treat the temporo mandibular joint (TMJ) ankylosis and the use of the piezoelectric system for to make the bone resection. Female patient, 12 years old, presented a right TMJ ankylosis, that was previously operated with a costocondral graft reconstruction. After 4 year from these reconstructive surgery the patient was involved in a new TMJ anklylosis of the same side showing a bone mass with 31mm in an meddle-lateral direction, with compromise until to oval foramen in the skull base and 28mm in the anterior-posterior direction. The lesion was operated by a preauricular approach and then a bone resection with the piezoelectric system, using a block resection technique. In this report it´s present the technique and is discusses the potentiality of the new piezoelectric system for these procedures.
Assuntos
Humanos , Feminino , Criança , Articulação Temporomandibular/cirurgia , Articulação Temporomandibular/patologia , Piezocirurgia/métodos , Anquilose/cirurgia , Anquilose/patologia , Osteotomia/métodos , Recidiva , Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Anquilose/diagnóstico por imagemRESUMO
The aim of this study was to present and evaluate a modified technique to inferior alveolar nerve lateralization (IANL) that allows the placement of longer implants in the posterior mandibular region. One hundred and forty-three consecutive patients were enrolled in this study; these patients had between 1.8 and 8mm residual crestal height above the mandibular canal. Vertical splitting of the mandibular body was performed using piezoelectric surgery followed by bone expansion and insertion of special conical implants of 10 and/or 12mm in length. Two hundred and sixty-nine osteotomies were performed and 636 implants were inserted, with a survival rate of 99% at the end of 12 months. Immediately postoperative there was an alteration of sensation in the lip/chin area in 8.5% of cases; 4.1% regained full sensation within 10-14 days, 2.6% after 8 weeks, and 0.7% had persistent paresthesia that did not affect their daily activities. Progressively increasing pain and numbness was present in 1.1%; the implants were removed 6 months postoperatively. This is a relatively simple procedure that has no limitations in clinical situations with minimal bone height. It allows for greater implant stability, and the risk of neurological disturbance is minimal.
Assuntos
Mandíbula/cirurgia , Nervo Mandibular/patologia , Osteotomia/métodos , Piezocirurgia/métodos , Idoso , Processo Alveolar/inervação , Queixo/inervação , Implantação Dentária Endóssea/métodos , Implantes Dentários , Planejamento de Prótese Dentária , Falha de Restauração Dentária , Remoção de Dispositivo , Feminino , Seguimentos , Humanos , Hipestesia/etiologia , Lábio/inervação , Masculino , Mandíbula/inervação , Pessoa de Meia-Idade , Osteotomia/instrumentação , Parestesia/etiologia , Estudos Prospectivos , Análise de SobrevidaRESUMO
One of the biggest challenges an orthodontic patient faces is the time spent wearing brackets. Over the years, several surgical techniques have been developed to address this issue and reduce the overall treatment time. These combine bone-healing mechanisms with orthodontic loads to accelerate tooth movement. Although effective, these techniques are also quite invasive in nature, requiring the elevation of buccal and lingual full-thickness flaps with extensive decortications of the buccal and lingual alveolar bone. Moreover, these techniques run the risk of teeth devitalization, avascular necrosis of the osseous block, alveolar resorption, and the risks of complications, with low acceptance by the patient. This manuscript reports three cases treated with a novel, flapless approach for minimally invasive rapid orthodontic (MIRO). This procedure includes radiographic-guided micro incisions and localized piezoelectric corticotomies. The clinical implications of this technique are discussed herein. MIRO reduces orthodontic treatment time, avoiding the reported adverse effects of accelerated orthodontics.
Uno de los mayores desafíos que enfrenta un paciente de ortodoncia es el tiempo que lleva usar brackets. A través de los años, varias técnicas quirúrgicas se han desarrollado para hacer frente a este problema y reducir el tiempo total de tratamiento. Estas combinan los mecanismos de cicatrización ósea, con cargas de ortodoncia para acelerar el movimiento de los dientes. Aunque eficaz, estas técnicas son bastante invasivas, que requieren la elevación de colgajos bucales y linguales de espesor total con decorticaciones extensas del hueso alveolar bucal y lingual. Por otra parte, con estas técnicas se corre el riesgo de desvitalización dentaria, necrosis avascular del bloque óseo, reabsorción alveolar, y los riesgos de complicaciones, con baja aceptación por parte del paciente. Este trabajo reporta tres casos tratados con un nuevo enfoque sin colgajo para ortodoncia rápida mínimamente invasiva (MIRO - minimally invasive rapid orthodontic). Este procedimiento incluye microincisiones guiadas por radiografías y corticotomías piezoeléctricas localizadas. Las implicaciones clínicas de esta técnica se analizan en este documento. MIRO reduce el tiempo de tratamiento de ortodoncia, evitando los efectos adversos reportados por la ortodoncia acelerada.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Técnicas de Movimentação Dentária/métodos , Osteotomia/métodos , Piezocirurgia/métodos , Microcirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Fatores de TempoRESUMO
Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.