Implante imediato com guia e provisório prototipados: relato de caso em área estética

Amanda Piol Cardoso
Departamento de Implantodontia do INSOE, Vila Velha – ES

Gabriel Villas Bôas Casotti Simão
Departamento de Implantodontia do INSOE, Vila Velha – ES

Jefferson Trabach Pires
Departamento de Implantodontia do INSOE, Vila Velha – ES; Departamento de Implantodontia e Reabilitação Oral da SOEP, Porto Velho – RO

Bruno Costa Martins de Sá
Departamento de Implantodontia do INSOE, Vila Velha – ES; Departamento de Implantodontia e Reabilitação Oral da SOEP, Porto Velho – RO

Celson Domingo de Calais
Departamento de Implantodontia do INSOE, Vila Velha – ES

André Javarini
Departamento de Implantodontia do INSOE, Vila Velha – ES

Tárcio Hiroshi Ishimine Skiba
Departamento de Implantodontia do INSOE, Vila Velha – ES; Departamento de Implantodontia e Reabilitação Oral da SOEP, Porto Velho – RO
ORCID: 0000-0003-3335-7279

DOI: https://doi.org/10.71440/2675-5610.10.4.25.524-528.art

RESUMO

A reabilitação em áreas anteriores com alta demanda estética exige um planejamento criterioso e técnicas que favoreçam a previsibilidade clínica. Com o avanço da odontologia digital, procedimentos como a cirurgia guiada tem viabilizado abordagens menos invasivas, com excelente controle das etapas cirúrgicas e protéticas. Neste artigo, relatamos um caso clinico de reabilitação do elemento 11 com implante imediato, utilizando guia cirúrgico prototipado (impresso em 3D) e provisório prototipado (PMMA fresado). O paciente apresentava fistula e lesão periapical no terço médio da raiz, o que levou a indicação de extração minimamente traumática seguida da instalação imediata do implante. Optou-se pela abordagem flapless, complementada com enxerto de tecido conjuntivo subepitelial (ETCS) e preenchimento do gap com substituto ósseo. O provisório fresado em PMMA foi instalado na mesma sessão. A integração entre o planejamento digital e a execução clinica permitiu alcançar um posicionamento tridimensional ideal do implante, além de preservar os tecidos peri-implantares e proporcionar um resultado estético previsível. O caso reforça a importância do fluxo digital associado a técnica cirúrgica bem indicada para alcançar excelência nos tratamentos implantossuportados em zona estética.

Palavras-chave: Implantes Dentarios; Enxerto Ósseo; Tecido Conjuntivo.

Immediate implant with guided surgery and prototyped provisional crown: a case report in the esthetic zone

ABSTRACT

Oral rehabilitation in anterior areas with high esthetic demands requires careful planning and techniques that favor clinical predictability. With the advancement of digital dentistry, procedures such as guided surgery have enabled less invasive approaches, with excellent control of the surgical and prosthetic stages. In this article, we report a clinical case of rehabilitation of tooth 11 with immediate implant placement, using a 3D-printed surgical guide and a prototyped provisional crown. The patient presented with a fistula and a periapical lesion extending to the middle third of the root, which led to indication for minimally traumatic extraction followed by immediate implant placement. A flapless approach was chosen, complemented by subepithelial connective tissue grafting (SCTG) and filling of the gap with a bone substitute. The milled PMMA provisional crown was delivered in the same session. The integration of digital planning and clinical execution allowed for ideal three- dimensional implant positioning, in addition to preserving peri-implant tissues and providing a predictable esthetic result. This case reinforces the importance of a digital workflow associated with a well-indicated surgical technique to achieve excellence in implant-supported treatments in the esthetic zone.

Keywords: Dental Implants; Bone Grafting; Connective Tissue.

Referências

Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla. Int J Oral Maxillofac Implants. 2004;19 Suppl:43–61.

Belser UC, Grütter L, Vailati F, Bornstein MM, Weber HP, Buser D. Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria. Clin Oral Implants Res. 2009;20(5): 495–503. https://doi.org/10.1902/jop.2009.080435

Coachman C, Calamita M. Digital Smile Design: a tool for treatment planning and communication. Quintessence Dent Technol. 2012;35:103–112.

Cunha RM, Pellizzer EP, Lemos CA, Moraes SL, Santiago Júnior JF, Verri FR. Accuracy evaluation of computer-guided implant surgery associated with prototyped surgical guides. J Prosthet Dent. 2020;123(6):800–8. https://doi.org/10.1016/j.prosdent.2019.07.010

Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla—A systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:186–215. https://doi.org/10.11607/jomi.2014suppl.g3.3

Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol. 2014;41 Suppl 15:S123–42. https://doi.org/10.1111/jcpe.12185

Mangano FG, et al. Digital implantology: comprehensive overview of digital workflow in implant dentistry. Int J Dent. 2019;2019:1–21.

Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction and implant placement: An experimental study in the dog. J Clin Periodontol. 2005;32(2):212–8. https://doi.org/10.1111/j.1600-051x.2005.00642.x

Monje A, Roccuzzo A, Buser D, Wang HL. Influence of buccal bone wall thickness on the peri-implant hard and soft tissue dimensional changes: a systematic review. Clin Oral Implants Res. 2023 Sep;34 Suppl 26:8-27. https://doi.org/10.1111/clr.14177

Kan JYK, Rungcharassaeng K, Yin S, Fang Q, Urban IA, Monje A, Tavelli L, Barootchi S, Chung JY, Lozada JL. Facial mucosal level change following maxillary anterior single immediate tooth replacement in extraction sockets with facial bone wall defects: a 4- to 15-Year retrospective study. Compend Contin Educ Dent. 2023 Jul-Aug;44(7):392-401.

Martins SCR, Marques MDC, Vidal MG, Tolentino PHMP, Dinelli RG, Fernandes GVO, Shibli JA. Is the facial bone wall critical to achieving esthetic outcomes in immediate implant placement with immediate restoration? A systematic review. Adv Clin Exp Med. 2024 Sep;33(9):979-997. https://doi.org/10.17219/acem/173573