Tratamento de agenesia do incisivo lateral superior com cirurgia guiada e regeneração óssea guiada em paciente jovem: relato de caso clínico com 4 anos de acompanhamento

Shirley Oliveira Selvati
Pós-graduanda em Implantodontia – Faculdade São Leopoldo Mandic – Serra/ES
ORCID: 0009-0000-9980-5025

Fabrício Dutra Tebaldi
Mestre e Especialista em Prótese Dentária (Mandic)
ORCID: 0000-0002-6593-5427

Khalila Chequer Cotrim
Doutoranda em Implantodontia (UNG) e Especialista em Implantodontia (Mandic)
ORCID: 0009-0005-0397-7049

Eduardo Cláudio Lopes de Chaves e Mello Dias
Especialista e Mestre em Implantodontia – Unigranrio Doutorado em Implantodontia – Faculdade São Leopoldo Mandic
ORCID: 0000-0002-4541-1095

DOI: https://doi.org/10.71440/2675-5610.10.4.25.516-522.art

RESUMO

O tratamento da região anterior da maxila representa um grande desafio na Implantodontia, especialmente em casos de agenesia, que frequentemente resultam em atrofia do rebordo alveolar. Nesses casos, o planejamento digital torna-se uma ferramenta fundamental, permitindo a integração de exames radiográficos (DICOM) e escaneamentos intraorais (STL) em softwares gratuitos. Essa abordagem possibilita uma análise detalhada da anatomia do paciente, antecipando dificuldades e aumentando a previsibilidade do tratamento. Este trabalho apresenta o tratamento multidisciplinar de um caso de agenesia do incisivo lateral superior direito (elemento 12), no qual uma abordagem multidisciplinar envolvendo Ortodontia, Implantodontia, Periodontia e Prótese Dentária foi de extrema importância para a obtenção de um resultado estético a longo prazo. Foram utilizadas ferramentas digitais avançadas para planejamento, além de abordagens especializadas, como cirurgia guiada estática, regeneração óssea guiada, com a instalação do implante em posicionamento tridimensional ideal. Os tecidos moles peri-implantares foram manipulados pela Técnica do Rolo Modificada, além de cuidadosamente trabalhados com o desenho da prótese provisória a fim de obter um perfil estético adequado dos tecidos moles. Desta forma, foi possível alcançar um resultado estético e funcional ideal, garantindo previsibilidade, segurança e conforto à paciente, conforme demonstrado no acompanhamento clínico de 4 anos.

Palavras-chave: Planejamento virtual; cirurgia guiada estática; implante dentário; agenesia; regeneração óssea guiada.

Treatment of Maxillary Lateral Incisor Agenesis with Guided Surgery and Guided Bone Regeneration in a Young Patient: A 4-Year Clinical Case Report

ABSTRACT

The treatment of the anterior maxillary region represents a significant challenge in Implantology, particularly in cases of agenesis, which often lead to alveolar ridge atrophy. In such cases, digital planning becomes a fundamental tool, enabling the integration of radiographic data (DICOM) and intraoral scans (STL) using free software. This approach allows for a detailed analysis of the patient’s anatomy, anticipating challenges and increasing treatment predictability. This study presents the multidisciplinary management of a case of agenesis of the maxillary right lateral incisor (tooth 12), in which a multidisciplinary approach involving Orthodontics, Implantology, Periodontics, and Prosthodontics was essential to achieve a long-term esthetic outcome. Advanced digital tools were employed for planning, along with specialized approaches such as static guided surgery and guided bone regeneration, ensuring placement of the implant in an optimal three-dimensional position. The peri-implant soft tissues were manipulated using the Modified Roll Technique and carefully shaped with the provisional prosthesis design to achieve an adequate esthetic soft-tissue profile. As a result, an optimal esthetic and functional outcome was achieved, ensuring predictability, safety, and patient comfort, as demonstrated over a 4-year clinical follow-up.

Keywords: Virtual planning; static guided surgery; dental implants; tooth agenesis; guided bone regeneration.

Referências

Vignon M, Bensaidani T, Soliveres S, Bousquet P. Interdisciplinary Management of Bilateral Congenital Lateral Incisor Agenesis. Case Rep Dent. 2023 Jul 10;2023:5576050. https://doi.org/10.1155/2023/5576050

Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res. 2005 Dec;16(6):639-44. https://doi.org/10.1111/j.1600-0501.2005.01193.x

Pozzi A, Polizzi G, Moy PK. Guided surgery with tooth-supported templates for single missing teeth: A critical review. Eur J Oral Implantol. 2016;9 Suppl 1:S135-53.

Chackartchi T, Romanos GE, Parkanyi L, Schwarz F, Sculean A. Reducing errors in guided implant surgery to optimize treatment outcomes. Periodontol 2000. 2022 Feb;88(1):64-72. https://doi.org/10.1111/prd.12411

Nemec M, Schwarz L, Bertl MH, Bertl K, Gahleitner A, Mitteroecker P, Jonke E. Maxillary lateral incisor agenesis is associated with maxillary form: a geometric morphometric analysis. Clin Oral Investig. 2023 Mar;27(3):1063-1070. https://doi.org/10.1007/s00784-022-04690-9

Fauzi NH, Ardini YD, Zainuddin Z, Lestari W. A review on non-syndromic tooth agenesis associated with PAX9mutations. Jpn Dent Sci Rev. 2018 Feb;54(1):30-36. https://doi.org/10.1016/j.jdsr.2017.08.001

Al Yafi F, Camenisch B, Al-Sabbagh M. Is Digital guided implant surgery accurate and reliable? Dent Clin North Am. 2019 Jul;63(3):381-397. https://doi.org/10.1016/j.cden.2019.02.006

Varga E Jr, 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):417-430. https://doi.org/10.1111/clr.13578

Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:25-42. https://doi.org/10.11607/jomi.2014suppl.g1.2

Flügge T, Kramer J, Nelson K, Nahles S, Kernen F. Digital implantology-a review of virtual planning software for guided implant surgery. Part II: Prosthetic set-up and virtual implant planning. BMC Oral Health. 2022 Jan 30;22(1):23. https://doi.org/10.1186/s12903-022-02057-w

Elgali I, Omar O, Dahlin C, Thomsen P. Guided bone regeneration: materials and biological mechanisms revisited. Eur J Oral Sci. 2017 Oct;125(5):315-337. https://doi.org/10.1111/eos.12364

Donos N, Akcali A, Padhye N, Sculean A, Calciolari E. Bone regeneration in implant dentistry: Which are the factors affecting the clinical outcome? Periodontol 2000. 2023 Oct;93(1):26-55. https://doi.org/10.1111/prd.12518

Albrektsson T, Johansson C. Osteoinduction, osteoconduction and osseointegration. Eur Spine J. 2001 Oct;10 Suppl 2(Suppl 2):S96-101. https://doi.org/10.1007/s005860100282

Srivastava K, Kothawar S. Modified Palatal Roll Flap: A Novel Technique for Horizontal Ridge Augmentation. Cureus. 2024 Apr 24;16(4):e58890. https://doi.org/10.7759/cureus.58890

Kola MZ, Shah AH, Khalil HS, Rabah AM, Harby NM, Sabra SA, Raghav D. Surgical templates for dental implant positioning; current knowledge and clinical perspectives. Niger J Surg. 2015 Jan-Jun;21(1):1-5. https://doi.org/10.4103/1117-6806.152720