Reabilitação protética na arcada maxilar estreita com soluções personalizadas para implantes mal posicionados

João Paulo de Souza Borba
Aluno de Pós-graduação do Departamento de Dentística, Endodontia e Materiais Dentários, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brasil.
ORCID: 0009-0008-3438-5048

Elard Manfred Quiroz-Zubizarreta
Aluno de Pós-graduação do Departamento de Dentística, Endodontia e Materiais Dentários, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brasil.
ORCID: 0009-0002-4678-9898

Carlos dos Reis Pereira de Araújo
Professor Livre Docente do Departamento de Prótese Dentária, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brasil.
ORCID: 0000-0002-1858-154X

Renato de Freitas
Professor Doutor Departamento de Prótese Dentária, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brasil.
ORCID: 0009-0006-6156-9286

DOI: https://doi.org/10.71440/2675-5610.10.6.25.788-793.art

RESUMO

Este trabalho relata o caso de uma paciente de 68 anos com maxila atrésica, dentes mal posicionados e implantes instalados em posições limitantes. O planejamento integrado considerou intervenções como preparo para coroas totais, extrações dentárias seletivas e o uso de restaurações provisórias imediatas para promover estabilização funcional e estética durante o processo de cicatrização. Durante a execução, foi realizada a confecção de munhão personalizado para corrigir a saída vestibular inadequada de um implante dentário na região anterior superior, viabilizando uma solução estética e funcional. A adaptação das estruturas metálicas e cerâmicas foi guiada por provas clínicas detalhadas, culminando na entrega de próteses definitivas cimentadas nos dentes e aparafusadas nos implantes. A solução protética tubo-parafuso foi empregada para facilitar a reversibilidade e manutenções futuras. Os resultados demonstraram que a abordagem interdisciplinar, combinando técnicas convencionais e personalizadas, é eficaz na superação de limitações anatômicas e biomecânicas. O manejo individualizado, apoiado por evidências científicas, é indispensável para o sucesso em reabilitações protéticas complexas. Este relato contribui para a literatura especializada ao fornecer ideias práticas e fomentar discussões sobre soluções inovadoras na área de prótese dentária.

Palavras-chave: Reabilitação bucal, atresia maxilar, implantes dentários, munhão personalizado, sistema tubo-parafuso.

Prosthetic rehabilitation of the narrow maxillary arch with customized solutions for malpositioned dental implants

ABSTRACT

This report describes the case of a 68-years-old female patient with a narrowed maxilla, misaligned teeth, and malposed dental implants. The integrated planning approach included interventions such as full-crown preparations, selective tooth extractions, and immediate provisional restorations to ensure functional and aesthetic stabilization during the healing process. During treatment, customized abutments were fabricated to correct the inadequate buccal emergence of an anterior upper dental implant, enabling an aesthetic and functional solution. The adaptation of metal and ceramic infrastructures was guided by detailed clinical try-ins, culminating in the delivery of tooth-cemented prostheses and screw-retained, implant-supported prostheses. A tube-screw retention system was employed to facilitate retrievability and future maintenance. The results demonstrated that an interdisciplinary approach, combining conventional and customized techniques effectively overcomes anatomical and biomechanical limitations. This individualized management supported by scientific evidence is essential for success in complex prosthetic rehabilitations. This case report contributes to the specialized literature by providing practical insights and fostering discussions about innovative solutions in prosthetic dentistry.

Keywords: Prosthetic rehabilitation, narrowed maxilla, dental implants, customized solutions, tube-screw retention system.

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