Regeneração óssea guiada vertical e horizontal em região posterior de mandíbula para reabilitação implantossuportada. Relato de caso com 44 meses de acompanhamento

Relato de caso tem como objetivo demonstrar a viabilidade e eficácia da ROG em defeito ósseo vertical e horizontal.

RESUMO

O objetivo deste relato de caso foi demonstrar a viabilidade e efi cácia da ROG em defeito ósseo vertical e horizontal. Paciente do sexo feminino, com 62 anos de idade e sem comorbidades, compareceu ao Instituto Opem com queixa principal de “difi culdade mastigatória”. Após avaliação clínica e imaginológica, identifi cou-se atrofi a óssea na região posterior de mandíbula no lado direito. O tratamento proposto foi ROG para aumento vertical e horizontal, com instalação de parafusos tenda, biomaterial xenógeno e tecido ósseo autógeno particulados (1:1) aglutinados com I-PRF, seguido da estabilização da membrana de PTFE e recobrimento da mesma com matrizes autólogas de L-PRF para oclusão da ferida cirúrgica. Foi realizado controle clínico e imaginológico com sete meses, e reabertura da área enxertada com instalação de implantes de conexão morse na região dos dentes 45 e 46, com nove meses de pós-operatório. Os implantes foram reabertos após quatro meses, seguido da instalação dos cicatrizadores e enxerto gengival livre para melhorar a qualidade da mucosa peri-implantar. Posteriormente, os minipilares foram instalados para confecção da prótese fi xa sobre implantes. Observou-se aumento vertical e horizontal expressivo na região posterior de mandíbula, possibilitando a instalação de implantes em um posicionamento tridimensional favorável à reabilitação protética, restabelecendo a função e estética, mostrando ser um procedimento viável e previsível após 44 meses de acompanhamento.

Palavras-chave – Regeneração óssea guiada; Implantes dentários; Enxerto ósseo.

ABSTRACT

The objective of this case report is to demonstrate the feasibility and eff ectiveness of GBR in vertical and horizontal bone defects. A 62-year-old female patient, without comorbidities, came to the Opem Institute with a main complaint of “masticatory diffi culty”. Aft er clinical and imaging evaluation, bone atrophy was identifi ed in the posterior mandibular right side. The proposed treatment was GBR for vertical and horizontal augmentation with the installation of tent screws, xenogenous biomaterial and particulate autogenous bone tissue (1:1) agglutinated with I-PRF, followed by stabilization of the PTFE membrane and covering it with autologous L-PRF matrices for occlusion of the surgical wound. Clinical and imaging control was performed at 7 months, and the graft ed area was reopened to receive Morse connection dental implants in the regions of teeth 45 and 46, nine months later. Then, the dental implants were reopened aft er four months, followed by installation of healing cap devices and free gingival graft to improve the quality of the peri-implant mucosa. Subsequently, the mini-abutments were installed to fabricate an implant-supported partial fi xed prosthesis. An expressive vertical and horizontal increase was observed in the posterior mandibular region, allowing the installation of dental implants in a three-dimensional approach favorable to the prosthetic rehabilitation, restoring function and aesthetics, being a viable and predictable procedure.

Key words – Guided bone regeneration; Dental implants; Bone graf

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