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Implante dentário imediato na zona estética associado à técnica de retenção intencional do fragmento radicular: relato de caso clínico com 18 meses de acompanhamento

RESUMO

O objetivo deste caso clínico foi demonstrar a possibilidade e efetividade da terapia de remoção parcial da raiz, denominada técnica da retenção intencional do fragmento radicular (TRFR). Uma paciente com 32 anos de idade apresentou-se com mobilidade e giroversão do dente 21. Após uma TCFC, foi constatada fratura. Realizadas assepsia e anestesia local, a raiz foi seccionada no sentido mesiodistal e o fragmento palatino foi removido com o auxílio de periótomo e alavanca. A osteotomia foi realizada conforme as orientações da técnica, e o espaço entre o fragmento radicular vestibular e o implante dentário foi preenchido com osso xenogênico. Então, um munhão foi conectado ao implante e a coroa temporária foi feita com a prótese antiga da paciente. Os controles clínicos e de TCFC mostraram normalidade nos tecidos duros e moles após oito meses. A TRFR com manutenção do tecido periodontal pode levar a uma previsível osseointegração do implante instalado de forma imediata na região anterior da maxila, sendo um método confiável para reduzir a perda de osso vestibular após a exodontia. Esta apurada técnica exige experiência clínica para ser realizada adequadamente. Além disso, torna-se necessário que estudos clínicos controlados sejam direcionados a esta modalidade de tratamento, para haver um maior controle da espessura do fragmento radicular nos estudos clínicos.

Palavras-chave – Implante dental; Implante imediato; Reabsorção óssea; Terapia parcial de extração.


ABSTRACT

The aim of this case report was to demonstrate the possibility and effectiveness of partial root extraction therapy called the unintentional root fragment retention (URFR). A 32 years-old patient presented to with giroversion and mobility of tooth 21. After CBCT exam, dental fracture was detected. Upon local asepsis and anesthesia, the root was sectioned in the mesio-distal direction, and its palatal fragment was removed with the aid of the periotome and levers. The osteotomy was made according this technique, and the space between the buccal fragment and the dental implant filled with xenogeneic biomaterial. Then, a prosthetic transmucosal element was connected to the dental implant and a temporary restoration made with the own’s patient old prosthesis. Clinical and CBCT exams demonstrated soft and hard tissue normality 8 months later. The URFR associated to the periodontal maintenance can lead to a predictable osseointegration of the immediate implant in the anterior maxillary region, being a reliable method to alleviate buccal bone loss after tooth extraction. However, it demands clinical experience to be adequately performed. Besides, it is necessary to have more controlled clinical trials using this modality to generate more data regarding control on the thickness of the root fragment.

Key words – Dental implant; Immediate implant; Bone resorption; Partial extraction therapy.

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