Tratamento estético do implante mal posicionado na área de incisivo lateral superior – relato de caso clínico com quatro anos de acompanhamento

Samir Absy
Mestre em Periodontia e doutorando em Implantodontia – Unip.
ORCID: 0009-0006-3479-0807.

Carla Aparecida Seno Plaza Casati
Especialista e mestre em Prótese Dentária – Fousp.
ORCID: 0009-0009-1062-6983.

Márcio Zaffalon Casati
Professor doutor em Periodontia – FOP-Unicamp.
ORCID: 0000-0001-9234-0536.

Suzana Peres Pimentel
Professora doutora em Periodontia – FOP-Unicamp.
ORCID: 0000-0002-3577-8600.

Mônica Grazieli Corrêa
Professora doutora em Periodontia – FOP-Unicamp.
ORCID: 0000-0003-1895-3283.

Raissa Micaella Marcello-Machado
Professora doutora em Prótese – FOP-Unicamp.
ORCID: 0000-0001-7661-703X.

Fabiano Ribeiro Cirano
Professor doutor em Periodontia – Fousp.
ORCID: 0000-0002-7331-4612.

DOI: https://doi.org/10.71440/2675-5610.10.5.25.660-665.art

RESUMO

Este caso clínico ilustra uma abordagem de tratamento de um insucesso estético na região anterior de maxila. Paciente do sexo feminino com 46 anos de idade, saudável e não fumante, procurou a clínica por problemas no sorriso. No exame clínico, observou-se a desarmonia da margem gengival com recessões de mucosa peri-implantar e gengival no implante dentário (22) e canino superior (23), respectivamente. Além disso, a coloração da mucosa peri-implantar apresentou-se alterada pelo posicionamento incorreto do implante. O plano de tratamento consistiu na remoção do implante, preenchimento do leito ósseo com enxerto ósseo do tipo bovino com colágeno (Extra Graft), enxerto subepitelial de tecido conjuntivo (ESTC) removido da região de palato nos dois elementos como manejo tecidual, além de uma prótese provisória adesiva na área do 22. A nova terapia cirúrgica com implante foi realizada após seis meses, e todo o processo de reabilitação definitiva deste elemento realizado após três meses. A terapia periodontal/peri-implantar de suporte vem sendo realizada regularmente, com um acompanhamento de quatro anos, o que é primordial para o sucesso a médio prazo.

Palavras-chave: Recessão gengival; Tecido mole; Área estética; Remoção do implante dentário.

Aesthetic management of a malpositioned implant in the maxillary lateral incisor region – clinical case report with four-year follow-up

ABSTRACT

The objective of this clinical case report is to illustrate a treatment approach for a case of aesthetic failure in implant-supported rehabilitation in the anterior region of the maxilla. A 46-years-old, female, healthy, non-smoker patient, sought the clinic with aesthetic complaints when smiling. The clinical examination demonstrated disharmony of the gingival margin with peri-implant mucosa and gingival recessions in implant (22) and tooth (23), respectively. In addition, the color of the peri-implant mucosa was altered due to the incorrect positioning of the implant. Therefore, the implant was removed, the bone bed was filled with a bovine bone graft with collagen (Extra Graft), ESTC was removed from the palate region in both elements as tissue management, in addition to the provisional adhesive prosthesis in 22. The new surgical therapy with implant was performed after 6 months, and the entire definitive rehabilitation process of this element, after 3 months. It is worth highlighting that the establishment of supportive periodontal/peri-implant therapy is performed regularly, with a 4-year follow-up, which is essential for medium-term success.

Keywords: Gingival recessions; Soft tissue; Esthetic zone; Dental implant removal.

Referências

Testori T, Weinstein T, Scutellà F, Wang HL, Zucchelli G. Implant placement in the esthetic area: criteria for positioning single and multiple implants. Periodontol 2000 2018;77(1):176-96. https://doi.org/10.1111/prd.12211

Belser UC, Bernard JP, Buser D. Implant-supported restorations in the anterior region: prosthetic considerations. Pract Periodontics Aesthet Dent 1996;8(9):875-83.

Romandini M, Pedrinaci I, Lima C, Soldini MC, Araoz A, Sanz M. Prevalence and risk/protective indicators of buccal soft tissue dehiscence around dental implants. J Clin Periodontol 2021;48(3):455-63. https://doi.org/10.1111/jcpe.13417

Chen ST, Buser D. Esthetic complications due to implant malpositions: etiology, prevention, and treatment. In: Froum SJ (ed). Dental implant complications: etiology, prevention, and treatment. Wiley-Blackwell, 2010. p.134-55.

Moraes Jr. EF, Caetano AS, Bizelli VF. Remoção de implante mal posicionado e correção de complicação estética com regeneração óssea guiada vertical, com tela de titânio e rotação de enxerto de tecido conjuntivo. ImplantNewsPerio 2019;4(2):314-22.

Nicchio N, Martins RCV, Vimercati B, Ramos UD, Marcantonio Jr. E, Frizzera F. Remoção de implante dentário osseointegrado mal posicionado e implantação imediata associada à enxertia óssea. ImplantNews Reab Oral 2024;9(5):692-5.

Cosyn J, De Lat L, Seyssens L, Doornewaard R, Deschepper E, Vervaeke S. The effectiveness of immediate implant placement for single tooth replacement compared to delayed implant placement: a systematic review and meta-analysis. J Clin Periodontol 2019;46(suppl.21):224-41. https://doi.org/10.1111/jcpe.13054

Araújo MG, Hürzeler MB, Dias DR, Matarazzo F. Minimal invasiveness in the alveolar ridge preservation, with or without concomitant implant placement. Periodontol 2000 2023;91(1):65-88. https://doi.org/10.1111/prd.12441

Mardas N, Trullenque-Eriksson A, MacBeth N, Petrie A, Donos N. Does ridge preservation following tooth extraction improve implant treatment outcomes: a systematic review: Group 4: Therapeutic concepts & methods. Clin Oral Implants Res 2015;26(suppl.11):180-201. https://doi.org/10.1111/clr.12639

Atieh MA, Alsabeeha NHM. Soft tissue changes after connective tissue grafts around immediately placed and restored dental implants in the esthetic zone: a systematic review and meta-analysis. J Esthet Restor Dent 2020;32(3):280-90. https://doi.org/10.1111/jerd.12538

Seyssens L, Eghbali A, Cosyn J. A 10-year prospective study on single immediate implants. J Clin Periodontol 2020;47(10):1248-58. https://doi.org/10.1111/jcpe.13352

Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res 2008;19(2):119-30. https://doi.org/10.1111/j.1600-0501.2007.01453.x

Lima VCDS, Miguel MMV, Ferraz LFF, Filho ABM, Jardini MAN, Santamaria MP. Use of platelet-rich fibrin membranes with single implant placement for peri-implant mucosal thickness augmentation: a case series study. Clin Adv Periodontics 2022;12(1):17-20. https://doi.org/10.1002/cap.10143

Tavelli L, Barootchi S, Avila-Ortiz G, Urban IA, Giannobile WV, Wang HL. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: a systematic review and network meta-analysis. J Periodontol 2021;92(1):21-44. https://doi.org/10.1002/jper.19-0716

Lazzari TR, Jardini MAN, dos Santos NC, Neves FLS, Lima VCS, de Melo Filho AB et al. Single implant placement in the maxillary aesthetic area with or without connective tissue grafting: a 1-year follow-up randomised clinical trial. Int J Oral Implantol 2022;15(1):57-67.

Zabalegui I, Sicilia A, Cambra J, Gil J, Sanz M. Treatment of multiple adjacent gingival recessions with the tunnel subepithelial connective tissue graft: a clinical report. Int J Periodontics Restorative Dent 1999;19(2):199-206.

Horvath A, Mardas N, Mezzomo LA, Needleman IG, Donos N. Alveolar ridge preservation. A systematic review. Clin Oral Investig 2013;17(2):341-63. https://doi.org/10.1007/s00784-012-0758-5

Chen ST, Buser D, Sculean A, Belser UC. Complications and treatment errors in implant positioning in the aesthetic zone: diagnosis and possible solutions. Periodontol 2000 2023;92(1):220-34. https://doi.org/10.1111/prd.12474