DOI: https://doi.org/10.71440/2675-5610.11.1.26.24-33.art

Alexandre Marcelo de Carvalho
Professor do curso de graduação em Odontologia – Unifagoc; Pós-doutorando – FOB/USP
ORCID: https://orcid.org/0000-0001-8080-8314

Liliane Pacheco de Carvalho
Diretora do curso de graduação em Odontologia – Unifagoc
ORCID: https://orcid.org/ 0000-0002-3837-7618

Laura Firmo de Carvalho
Doutora – FOB/USP
ORCID: https://orcid.org/0000-0001-7006-0998

Ernesto Byron Benalcázar-Jalkh
Professor doutor no Depto. De Prótese e Periodontia – FOB/USP
ORCID: https://orcid.org/0000-0002-7184-8485

Elisa S. Fermino
Mestranda – FOB/USP
ORCID: https://orcid.org/0000-0002-8872-5289

Larissa M. M. Alves
Pós-doutora – FOB/USP
ORCID: https://orcid.org/0000-0003-4561-0980

Vinicius C. Conceição
Cirurgião-dentista – Unifagoc
ORCID: https://orcid.org/ 0009-0002-8364-4196

Estevam A. Bonfante
Professor associado no Depto. de Prótese e Periodontia – FOB/USP
ORCID: https://orcid.org/ 0000-0001-6867-8350

RESUMO

Este caso clínico relata uma alternativa para reabilitação de maxila atrófica sob a perspectiva cirúrgica e protética. Uma paciente do sexo feminino, com 61 anos de idade, apresentou como queixa principal a insatisfação com suas próteses totais removíveis usadas por mais de 40 anos. Após a consulta inicial e anamnese, o planejamento seguiu para a obtenção dos modelos físicos, montagem em articulador semiajustável, fotografias intra e extraorais, e exames por imagem (radiografia panorâmica e TCFC). Quatro implantes foram colocados na maxila, sendo os mais distais inclinados, através da técnica transinusal. Tanto nos implantes distais como nos axiais anteriores, foi realizado o approach palatino. Na mandíbula, quatro implantes foram colocados utilizando a técnica all-on-four, além de enxerto conjuntivo para otimizar o fenótipo gengival. Na mesma sessão, a reabilitação da maxila e mandíbula foi finalizada com a instalação de prótese provisória em resina acrílica e sem infraestrutura. As próteses definitivas foram confeccionadas e instaladas após três meses, sendo as infraestruturas CAD/CAM feitas de compósitos reforçados por fibra de vidro, recebendo a cobertura estética gengival e dentária acrílica. Nenhum tipo de intercorrência com as próteses e implantes instalados foi observado após um ano de acompanhamento. Os recursos empregados nesta reabilitação, como o approach palatino, o implante transinusal, o enxerto de tecido conjuntivo e a utilização de infraestrutura fresada em compósito, se mostraram eficazes na restauração da função e estética da paciente.

Palavras-chave – Implante transinusal; Maxila atrófica; Compósito reforçado por fibra

de vidro.

ABSTRACT

This case report presents an alternative approach for the rehabilitation of an atrophic maxilla from both surgical and prosthetic perspectives. A 61 years-old female patient had complaints on her complete removable dentures in both jaws for more than 40 years. After initial examining and anamnesis, the treatment planning was followed by acquisition of the physical casts, mounting on a semi-adjustable articulator, intraoral and extraoral photographs, and imaging exams (panoramic radiograph and CBCT). In the upper jaw, four dental were placed, with the distal ones positioned using the trans-sinus technique. A palatal approach was adopted for both the anterior axial implants and the distal tilted implants. In the lower jaw, four implants were placed following the all-on-four technique, along with a connective tissue graft to enhance the gingival phenotype. During the same surgical session, immediate implant loading was performed through the delivery of provisional acrylic resin prostheses without a metallic framework. After three months, definitive prostheses were fabricated and delivered. These prostheses featured a CAD/CAM-designed and milled substructure made of glass fiber-reinforced composite, veneered with pink and denture acrylic resins for esthetic contouring. No complications with both implants and the prostheses were registered after one year of follow-up. The resources employed in this rehabilitation, such as the palatal approach, trans-sinus implant placement, connective tissue grafting, and the use of a milled composite substructure, proved to be effective in restoring both function and esthetics for the patient.

Keywords – Trans-sinus dental implants; Atrophic maxilla; Glass fiber-reinforced composite.

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