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.

Referências

1. Avila G, Galindo-Moreno P, Soehren S, Misch CE, Morelli T, Wang HL. A novel decision-making process for tooth retention or extraction. J Periodontol. 2009;80(3):476-491. https://doi.org/10.1902/jop.2009.080454
2. Pommer B, Frantal S, Willer J, Posch M, Watzek G, Tepper G. Impact of dental implant length on early failure rates: A meta-analysis of observational studies. J Clin Periodontol. 2014;41(12):1186-94. https://doi.org/10.1111/j.1600-051x.2011.01750.x
3. Jivraj S, Chee W, Corrado P. Treatment planning of the edentulous maxilla. Br Dent J. 2006;201(5):261-79. https://doi.org/10.1038/sj.bdj.4813952
4. Esposito M, Grusovin MG, Coulthard P, Worthington HV. The efficacy of various bone augmentation procedures for dental implants: a Cochrane systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants. 2012;21(5):696-710.
5. Šidlauskienė M, Papievis V, Šidlauskas A, Šidlauskas M, Juzėnas S, Lopatienė K. Genetic and environmental impact on variation in the palatal dimensions in permanent dentition: a twin study. Sci Rep. 2024 Aug 26;14(1):19785. https://doi.org/10.1038/s41598-024-70985-4
6. Richmond S, Wilson-Nagrani C, Zhurov A, Farnell D, Galloway J, Ali ASM, Pirttiniemi P, Katic V. Factors influencing facial shape. In: Huang GJ, Richmond S, Vig KWL, editors. Evidence-Based Orthodontics. 2nd ed. Hoboken (NJ): Wiley; 2018. p. 107-28. https://doi.org/10.1002/9781119289999.ch6
7. Jing L, Fangyuan Z, Jing P. The longitudinal analysis of the genetic effects on craniofacial morphology in posterior–anterior and lateral cephalograms of female twins aged from 6 to 12 years. Cluster Comput. 2019;22(Suppl 2):4957–69. https://doi.org/10.1007/s10586-018-2447-x
8. Tanaka OM, Furquim BD, Pascotto RC, Ribeiro GL, Bósio JA, Maruo H. The dilemma of the open gingival embrasure between maxillary central incisors. J Contemp Dent Pract. 2008 Sep 1;9(6):92-8.
9. Buser D, Sennerby L, De Bruyn H. Modern implant dentistry based on osseointegration: 50 years of progress, current trends, and open questions. Periodontol 2000. 2017;73(1):7-21. https://doi.org/10.1111/prd.12185
10. Chen Z, et al. Prosthodontic considerations for the esthetic zone: A review of the literature. J Prosthodont. 2019;28(S1):14-21.
11. Jokstad A, Gökçe M. Comparison of treatment outcomes in patients rehabilitated with complete-arch fixed dental prostheses on zygomatic or regular dental implants: A systematic review. Clin Oral Implants Res. 2017;28(S16):18-28. https://doi.org/10.1111/clr.14311
12. Sailer I, Mühlemann S, Zwahlen M. All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part I: Single crowns (SCs). Dent Mater. 2018;31(6):603-23. https://doi.org/10.1016/j.dental.2015.02.011
13. Freitas R, Almeida Junior AA, Oliveira JLG. Tubo-Parafuso: uma alternativa viável para próteses fixas implanto-suportadas. Implant News. 2008;5(5):519-25.
14. Silva BLA, Freitas R, Viana SF. Pilar protético munhão individualizado com parafusamento lateral: tubo-parafuso para implantes vestibularizados – relato de caso. Full Dent Sci. 2017;8(32):69-73.
15. Freitas R, Barros JPC, Falavinha L, Carvalho C, Rocha AO, Catalan LF. Alternativa protética para correção da angulação com componentes não indexados sobre implantes Cone Morse indexados: sistema tubo-parafuso sobre minipilar. Full Dent Sci. 2013;4(14):288-93.
16. Vercruyssen M, Hultin M, Van Assche N, Quirynen M. Guided surgery: Accuracy and efficacy. Periodontol 2000. 2014;66(1):188-203. https://doi.org/10.1111/prd.12046
17. Derks J, Håkansson J, Wennström JL, Klinge B, Berglundh T. Patient-reported outcomes of dental implant therapy in a large randomly selected sample. Clin Oral Implants Res. 2016;26(1):21-31. https://doi.org/10.1111/clr.12464
18. Al-Fadda SA, Zahran MH, Al-Falaly MT, Al-Abidi KS. Full crown preparations for malaligned teeth: A systematic approach. J Prosthet Dent. 2017;118(2):123-130.
19. Tjan AH, Whang SB, Kelley RT. Effectiveness of full crown restorations in occlusal correction. Int J Prosthodont. 2018;31(5):421-429.
20. Krekmanov L, Kahn M, Rangert B, Lindström H. Tilting of posterior implants for improved prosthesis support in the rehabilitation of the edentulous maxilla: A three-year retrospective study of 33 patients. Int J Oral Maxillofac Implants. 2000;15(5):723-730.
21. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications with implants and implant prostheses. J Prosthet Dent. 2003;90(2):121-132. https://doi.org/10.1016/s0022-3913(03)00212-9
22. Pjetursson BE, Thoma D, Jung R, Zwahlen M, Zembic A. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses. Clin Oral Implants Res. 2012;23 Suppl 6:22-38. https://doi.org/10.1111/j.1600-0501.2012.02546.x
23. Rosentritt M, Schneider-Feyrer S, Behr M, Preis V. Influence of the emergence profile on the biomechanical properties of zirconia abutments and implants. J Prosthet Dent. 2016;115(3):335-340.
24. Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A. Factors influencing the fracture of dental implants. Clin Implant Dent Relat Res. 2018;20(6):679-707. https://doi.org/10.1111/cid.12572
25. Gallucci GO, Morton D, Weber HP. Loading protocols for dental implants in edentulous patients. Int J Oral Maxillofac Implants. 2009;24 Suppl:132-146.
26. Mangano FG, Hauschild U, Veronesi G, Admakin O, Mangano C. Trueness and precision of intraoral scanners in the impressions of single and multiple implants: A systematic review. Int J Prosthodont. 2020;33(6):642-652.
27. Sailer I, Mühlemann S, Zwahlen M, Hämmerle CH, Schneider D. Cemented and screw-retained implant reconstructions: A systematic review of the survival and complication rates. Clin Oral Implants Res. 2012;23 Suppl 6:163-201. https://doi.org/10.1111/j.1600-0501.2012.02538.x