Ancoragem palatina para reabilitação de incisivos superiores

Relato de caso demonstra a eficácia da ancoragem palatina associada à regeneração óssea guiada em uma maxila atrófica com defeito horizontal.

AUTORES

Vinicius Ferreira Bizelli
Doutorando do Depto. de Diagnóstico e Cirurgia – Unesp; Professor de especialização em implantes – Tokape.
Orcid: 0000-0003-1813-3509.

Idelmi Garcia
Mestre em Reabilitação Oral e Implantes – PUCMM, Santiago de los Caballeros/ República Dominicana.

Paulo Henrique Orlato Rossetti
Doutor em Reabilitação Oral – FOB-USP; Professor convidado do mestrado em Reabilitação Oral e Implantes – PUCMM, Santiago de los Caballeros/República Dominicana.
Orcid: 0000-0002-0868-6022.

Wellington Cardoso Bonachela
Professor associado do Depto. de Prótese e Periodontia – FOB/USP.

Vinicius Rizzo Marques
Doutor em Reabilitação Oral – FOB/USP; Coordenador do mestrado em Reabilitação Oral e Implantes – PUCMM, Santiago de los Caballeros/República Dominicana.
Orcid: 0000-0002-9749-876X.

Thiago Freire Lima
Coordenador da especialização em Implantodontia – Tokape; Mestre em Ciências das Reabilitações – HRAC/USP.
Orcid: 0000-0001-5509-3230.

RESUMO

O objetivo deste relato de caso foi demonstrar a viabilidade e a eficácia da ancoragem palatina associada à regeneração óssea guiada (ROG) em uma maxila atrófica com defeito horizontal. Paciente do sexo feminino, com 40 anos de idade, sistemicamente saudável, compareceu à clínica de pós-graduação da Pontifícia Universidad Católica Madre y Maestra com queixa principal de função mastigatória e estética prejudicada. Após avaliação clínica e imaginológica, identificou-se dentes 12, 11, 21 e 22 ausentes, associados à atrofia óssea. O tratamento proposto foi a instalação de dois implantes de conexão cônica interna na região do 11 e do 21, com ancoragem palatina e ROG horizontal, utilizando biomaterial xenógeno particulado e membrana de colágeno porcino absorvível. Após seis meses de controle clínico e radiográfico, realizou-se reabertura dos implantes e condicionamento gengival. Após o condicionamento, foi realizada a restauração definitiva parafusada. Observou-se que a instalação de implantes osseointegráveis via ancoragem palatina, associada à ROG horizontal, conseguiu devolver estética e função para a paciente, mostrando-se uma técnica segura e previsível.

Palavras-chave – Implantação dentária; Procedimentos cirúrgicos bucais; Prótese dentária; Implantes dentários; Gengiva; Periodonto.

ABSTRACT

This case report aims to demonstrate the feasibility and efficacy of palatal anchorage associated with guided bone regeneration (GBR) in an atrophic maxilla with a horizontal defect. A 40-year-old female patient, systemically healthy, attended the post graduation clinic of the Pontifícia Universidad Católica Madre y Maestra with a main complaint of impaired masticatory function and aesthetics. After clinical and imaging evaluation, bone atrophy was identified in the anterior region of the maxilla in the region of teeth 12, 11, 21, and 22. The proposed treatment was the installation of two internal connection implants, in the region of 11 and 21 with palatal approach and horizontal GBR using particulate xenogeneic biomaterial and absorbable porcine collagen membrane. After six months of clinical and radiographic control, implant reopening and gingival conditioning were performed. After conditioning, the final screw-retained restoration was performed. It was observed that the installation of osseointegrated implants via palatal anchorage, associated with horizontal GBR, managed to restore aesthetics and function to the patient, proving to be a safe and predictable technique.

Key words – Dental implantation; Oral surgical procedures; Dental prosthesis; Dental implants; Gingiva; Periodontium.

Recebido em set/2021
Aprovado em set/2021

Referências

Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent 2003;23(4):313-23.

Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg 1988;17(4):232-6.

Rossetti PH, Bonachela WC, Rossetti LM. Relevant anatomic and biomechanical studies for implant possibilities on the atrophic maxilla: critical appraisal and literature review. J Prosthodont 2010;19(6):449-57.

Monje A, Ravidà A, Wang HL, Helms JA, Brunski JB. Relationship between primary/mechanical and secondary/biological implant stability. Int J Oral Maxillofac Implants 2019;34(suppl.):7-23.

Hwang KG, Park CJ. Ideal implant positioning in an anterior maxillary extraction socket by creating an apico-palatal guiding slot: a technical note. Int J Oral Maxillofac Implants 2008;23(1):121-2.

Rangert B, Sennerby L, Meredith N, Brunski J. Design, maintenance and biomechanical considerations in implant placement. Dent Update 1997;24(10):416-20.

Nkenke E, Neukam FW. Autogenous bone harvesting and grafting in advanced jaw resorption: morbidity, resorption and implant survival. Eur J Oral Implantol 2014;7(suppl.2):203-17.

Goyal S, Iyer S. Bone manipulation techniques. Int J Clin Implant Dent 2009;1(1):22-31.

Buser D, Chappuis V, Belser UC, Chen S. Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late? Periodontol 2000 2017;73(1):84-102.

Danieletto-Zanna CF, Bizelli VF, Ramires GADA, Francatti TM, de Carvalho PSP, Bassi APF. Osteopromotion capacity of bovine cortical membranes in critical defects of rat calvaria: histological and immunohistochemical analysis. Int J Biomater 2020;18:6426702.

Bassi APF, Bizelli VF, Francatti TM, Ferreira ACRM, Pereira JC, Al-Sharani HM et al. Bone regeneration assessment of polycaprolactone membrane on critical-size defects in rat calvaria. Membranes (Basel) 2021;11(2):124.

Urban IA, Nagursky H, Lozada JL, Nagy K. Horizontal ridge augmentation with a collagen membrane and a combination of particulate autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 25 patients. Int J Periodontics Restorative Dent 2013;33(3):299-307.

Tonella BP, Pellizzer EP, Falcón-Antenucci RM, Ferraço R, Almeida DAF. Photoelastic analysis of biomechanical behavior of single and multiple fixed partial prostheses with different prosthetic connections. J Craniofac Surg 2011;22(6):2060-3.

Veltri M, Ekestubbe A, Abrahamsson I, Wennström JL. Three-dimensional buccal bone anatomy and aesthetic outcome of single dental implants replacing maxillary incisors. Clin Oral Implants Res 2016;27(8):956-63.

Porto OCL, Silva BSF, Silva JA, Estrela CRA, Alencar AHG, Bueno MDR et al. CBCT assessment of bone thickness in maxillary and mandibular teeth: an anatomic study. J Appl Oral Sci 2020;28:e20190148.

Van Nimwegen WG, Raghoebar GM, Tymstra N, Vissink A, Meijer HJA. How to treat two adjacent missing teeth with dental implants. A systematic review on single implant-supported two-unit cantilever FDP’s and results of a 5-year prospective comparative study in the aesthetic zone. J Oral Rehabil 2017;44(6):461-71.

Arcas-Sanabre AJ, Gutierrez-Santamaria J, López-López J, Ayuso-Montero R, Velasco-Ortega E. Horizontal augmentation of the maxillary alveolar ridge to change the prosthetic profile: clinical and radiological results of a retrospective study. J Stomatol Oral Maxillofac Surg 2020;121(1):25-9.