Carlos Kiyoshi Moreira Massuda
Doutor, Mestre em Implantodontia (Unisa), Especialista em Implantodontia (Uniararas),
Prof. Coordenador do curso de especialização em Implantodontia da Universo Niterói (RJ).
ORCID: 0000-0002-8665-3920
Marcia Rosa de Carvalho
Especialista em Implantodontia (Universo).
ORCID: 0000-0002-1586-5678
Marcia Naomy Moreira Massuda Armond
Especialista em Implantodontia (Universo). Professor do curso de especialização em Implantodontia da Universo Niterói (RJ).
ORCID: 0000-0001-9734-7032
Francisco Martins Pereira Júnior
Especialista em Implantodontia (Universo). Professor do curso de especialização em Implantodontia da Universo Niterói (RJ).
ORCID: 0000-0002-8263-7544
Leandro Carvalho Barbosa
Especialista em Implantodontia (Universo).
ORCID: 0009-0006-1857-6616
Ricardo Violante de Souza
Doutor em Traumatologia (FMRP/USP), Mestre em Clínica Cirúrgica (FMRP/USP), Especialista
em Implantodontia (Uniararas), Prof. Coordenador do curso de especialização em Implantodontia
da Universo Niterói (RJ).
ORCID: 0000-0001-6250-5790
DOI: https://doi.org/10.71440/2675-5610.10.3.25.379-385.art
RESUMO
O objetivo deste trabalho é demonstrar o planejamento e a utilização de um guia cirúrgico para o fluxo de trabalho digital, impresso em 3D, guiando a osteotomia da janela lateral na cirurgia de levantamento da membrana do seio maxilar e instalação de implantes dentários. Na primeira situação clínica, uma paciente de 70 anos de idade apresentava perda dentária do elemento 16. Na segunda situação clínica, uma paciente de 36 anos apresentava ausência dos elementos dentários 16 e restos radiculares do elemento 15. Em ambos os casos, após os exames de TCFC e consentimento esclarecido, as arcadas dentárias foram escaneadas intrabucalmente e os arquivos STL foram importados para sobreposição aos arquivos DICOM. Após as anestesias infiltrativas e os descolamentos dos retalhos de tecido mole, os guias cirúrgicos, já desenhados com apoio sobre os dentes existentes, mas com uma alça vertical contendo uma janela circular como ponto de partida das osteotomias, foram testados. Subsequente ao levantamento das membranas de Schneider, biomateriais particulados sintéticos foram compactados no espaço obtido, e implantes de conexão cone Morse foram instalados, respeitando-se as suas dimensões correspondentes. Em seguida, as janelas foram recobertas com membranas de L-PRF e realizadas as suturas. Radiografias periapicais pós-operatórias constataram a segurança e o posicionamento adequado do implante em relação às estruturas vizinhas. A utilização do guia cirúrgico impresso para a osteotomia guiada na cirurgia de sinus lift proporciona maior previsibilidade, com excelente redução do tempo cirúrgico nos referidos casos clínicos.
Palavras-chave: Levantamento do Assoalho do Seio Maxilar. Cirurgia assistida por computador. Impressão tridimensional. Implantes dentários.
The lateral window sinus lift 3D-printed guided osteotomy: optimizing results through the digital workflow
ABSTRACT
The aim of this study is to demonstrate the planning and use of a 3D-printed surgical guide in a digital workflow to assist the lateral window osteotomy for maxillary sinus membrane elevation and dental implant placement. In the first clinical case, a 70-years old female patient presented with the absence of tooth #16. In the second case, a 36-year-old female patient exhibited absence of tooth #16 and root remnants of tooth #15. In both cases, after CBCT scans and signing of informed consent, the dental arches were intraorally scanned, and the STL files were imported and superimposed onto the DICOM files. Following local infiltrative anesthesia and elevation of full-thickness soft tissue flaps, the surgical guides— designed with support on the existing teeth and incorporating a vertical arm with a circular window as the osteotomy entry point—were tried in. After elevation of the Schneiderian membranes, synthetic particulate biomaterials were packed into the created sinus cavity, and Morse taper connection dental implants were placed according to their respective dimensions. The windows were then covered with L-PRF membranes and sutured. Postoperative periapical radiographs confirmed the safe and proper positioning of the implants relative to adjacent structures. The use of a 3D-printed surgical guide for guided osteotomy in lateral window sinus lift surgery provided greater predictability and significantly reduced operative time in the reported cases.
Keywords: Sinus Floor Elevation. Computer-Assisted Surgery. Three-Dimensional Printing. Dental Implants.
Referências
1. Tattan M, Chambrone L, González-Martín O, Avila-Ortiz G. Static computer-aided, partially guided, and free-handed implant placement: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Implants Res. 2020 Oct 1;31(10):889–916.
2. Younes F, Cosyn J, De Bruyckere T, Cleymaet R, Bouckaert E, Eghbali A. A randomized controlled study on the accuracy of free-handed, pilot-drill guided and fully guided implant surgery in partially edentulous patients. J Clin Periodontol. 2018 Jun;45(6):721–32.
3. Smitkarn P, Subbalekha K, Mattheos N, Pimkhaokham A. The accuracy of single-tooth implants placed using fully digital-guided surgery and freehand implant surgery. J Clin Periodontol. 2019 Sep;46(9):949–57.
4. Varga E, Antal M, Major L, Kiscsatári R, Braunitzer G, Piffkó J. Guidance means accuracy: a randomized clinical trial on freehand versus guided dental implantation. Clin Oral Implants Res. 2020 May ;31(5):417–30.
5. Mistry A, Ucer C, Thompson JD, Khan RS, Karahmet E, Sher F. 3d guided dental implant placement: impact on surgical accuracy and collateral damage to the inferior alveolar nerve. Dent J (Basel). 2021 Sep 2;9(9):99.
6. Fortin T, Luc Bosson J, Isidori M, Blanchet E. Effect of flapless surgery on pain experienced in implant placement using an image-guided system. Int J Oral Maxillofac Implants. 2006 Mar-Apr;21(2):298-304.
7. D’haese J, Ackhurst J, Wismeijer D, De Bruyn H, Tahmaseb A. Current state of the art of computer-guided implant surgery. Periodontology 2000. 2017 Feb;73(1):121–33.
8. Esquivel J, Meda RG, Blatz MB. The impact of 3D implant position on emergence profile design. Int J Periodontics Restorative Dent. 2021 Jan-Feb;41(1):79–86.
9. Tahmaseb A, Wu V, Wismeijer D, Coucke W, Evans C. The accuracy of static computer-aided implant surgery: A systematic review and meta-analysis. Clin Oral Implants Res. 2018 Oct: 29 Suppl 16;416–35.
10. Massuda CKM, de Carvalho MR, de Moraes JB, Pallos D, Kim YJ. Accuracy of guided dental implant surgery using a fully digital workflow: a case series. J Prosthet Dent. 2024 Nov;132(5):973–80.
11. Skjerven H, Riis H, Herlofsson B, Ellingsen J. In vivo accuracy of implant placement using a full digital planning modality and stereolithographic guides. Int J Oral Maxillofac Implants. 2019 Jan/Feb;34(1):124–32.
12. Siqueira R, Chen Z, Galli M, Saleh I, Wang HL, Chan HL. Does a fully digital workflow improve the accuracy of computer-assisted implant surgery in partially edentulous patients? A systematic review of clinical trials. Clin Implant Dent Relat Res. 2020 Dec;22(6):660–71.
13. Goodacre BJ, Swamidass RS, Lozada J, Al-Ardah A, Sahl E. A 3D-printed guide for lateral approach sinus grafting: a dental technique. J Prosthet Dent. 2018 Jun;119(6):897-901.
14. Cecchetti F, Baggi L. Guided sinus lift: Virtual planning of surgical templates for lateral access. J Biol Regul Homeost Agents. 2021 May-Jun;35(3 Suppl. 1):139–45
15. Osman AH, Mansour H, Atef M, Hakam M. Computer guided sinus floor elevation through lateral window approach with simultaneous implant placement. Clin Implant Dent Relat Res. 2018 Apr;20(2):137–43.
16. De Stavola L, Fincato A, Bressan E, Gobbato L. Results of computer-guided bone block harvesting from the mandible: a case series. Int J Periodontics Restorative Dent. 2017 Jan/Feb;37(1):e111–9.
17. Wang T, Ye L, Sun Y, Wu Y. Fabricating a surgical template for guiding sinus floor elevation in the maxillary sinus septa with simultaneous implant placement: a dental technique. J Prosthet Dent. 2023 Jun;129(6):840–3.
18. De Stavola L, Cristoforetti A, Fincato A, Nollo G, Ghensi P, Cantarutti A, et al. Accuracy and technical predictability of computer guided bone harvesting from the mandible: a cone-beam CT analysis in 22 consecutive patients. J Funct Biomater. 2022 Dec 10;13(4):1–17.
19. Goodacre BJ, Swamidass RS, Lozada J, Al-Ardah A, Sahl E. A 3D-printed guide for lateral approach sinus grafting: a dental technique. J Prosthet Dent. 2018 Jun;119(6):897-901.
