Reabilitação de maxila atrófica com implantes dentários em approach palatino, sem utilização de enxertos: 24 meses de acompanhamento

Artigo descreve caso clínico em que a maxila totalmente edêntula atrófica foi reabilitada utilizando-se a técnica do approach palatino.

AUTORES

Thiago Martins de Mayo
Mestrando e especialista em Implantodontia – São Leopoldo Mandic.
Orcid: 0000-0002-9882-8150.

Victor Paes Dias Gonçalves
Mestrando em Implantodontia e especialista em Cirurgia e Traumatologia Bucomaxilofacial – São Leopoldo Mandic.
Orcid: 0000-0001-6469-5735.

Abilio Ricciarde Coppedê
Mestre e doutor em Reabilitação Oral – Forp-USP.
Orcid: 0000-0003-4884-7078.

Fabiano Capato de Brito
Doutor em Farmacologia – Unicamp; Mestre e especialista em Implantodontia – São Leopoldo Mandic.
Orcid: 0000-0002-1786-9656.

Eduardo Cláudio Lopes de Chaves e Mello Dias
Doutor em Implantodontia e coordenador dos cursos de mestrado e especialização em Implantodontia – São Leopoldo Mandic; Mestre e especialista em Implantodontia – Unigranrio.
Orcid: 0000-0002-4541-1095.

RESUMO

Este artigo descreveu um caso clínico em que a maxila totalmente edêntula atrófica foi reabilitada utilizando-se a técnica do approach palatino. Um paciente com 57 anos de idade, com insatisfação estética e funcional do seu sorriso, usuário de prótese total superior e com dentes remanescentes na região inferior, apresentava estabilidade mastigatória apenas na região anterior e perda óssea acentuada na região da pré-maxila. Após sedação hospitalar e anestesia infiltrativa, o retalho foi totalmente descolado, sendo dois implantes (4,3 mm x 13 mm) instalados na região anterior e outros dois implantes instalados na região posterior (4,3 mm x 16 mm) seguindo-se a abordagem all-on-four, com travamento eletrônico de 45 Ncm e mecânico final acima dos 80 Ncm. Após a moldagem e instalação dos componentes protéticos, a prótese total fixa parafusada foi entregue em 48 horas e as consultas de manutenção agendas semestralmente. O controle clínico e tomográfico após 24 meses demonstrou normalidade dos tecidos duros e moles no rebordo alveolar. A técnica do approach palatino mostrou-se viável em pacientes com maxilas atróficas extremamente reabsorvidas.

Palavras-chave – Implante dentário; Maxila atrófica; Maxila edêntula; Approach palatino.

ABSTRACT

This article describes a clinical case where an atrophic totally edentulous maxilla was rehabilitated using the palatal approach technique. A 57 years old patient, with aesthetic and functional smile complaints, wearer of an upper complete denture and with remaining teeth in the lower region, presented masticatory stability only in the anterior region and accentuated bone loss in the premaxillary region. After hospital sedation and infiltrative anesthesia, the flaps were completely elevated, with two dental implants (4.3 mm x 13 mm) being installed in the anterior region, and another two dental implants in the posterior region (4.3 mm x 16 mm) following the all-on-four approach, having an electronic torque of 45 Ncm and final mechanical locking above 80 Ncm. After impression procedures and fastening of the prosthetic components, the complete, screw-retained fixed denture was delivered within 48 hours and maintenance appointments were scheduled every six months. Clinical and tomographic controls after 24 months showed normality of hard and soft tissues across the alveolar ridge. The palatal approach technique proved to be feasible in patients with extremely resorbed atrophic maxillae.

Key words – Dental implants; Atrophic maxilla; Edentulous maxilla; Palatal approach.

Recebido em nov/2021
Aprovado em fev/2022

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