Implantes transnasais: técnica Vanderlim como alternativa à técnica Zygoma Quad em maxilas totais atróficas – série de 12 casos em carga imediata e acompanhamento de dois a 26 meses

Artigo científico descreve a técnica Vanderlim como alternativa ao Zygoma Quad em maxilas totalmente atróficas.

AUTORES

Vanderlim Branco Camargo
Especialista em Implantodontia – Abeno.
Orcid: 0000-0002-7699-1651.

Daniel Baptista
Doutor em Dentística Restauradora – UFSC.
Orcid: 0000-0002-1702-7643.

João Ricardo Almeida Grossi
Doutor em Odontologia – Universidade Positivo.
Orcid: 0000-0003-2426-0686.

RESUMO

Objetivo: descrever a técnica Vanderlim como alternativa ao Zygoma Quad em maxilas totalmente atróficas. Material e métodos: pacientes com maxilas severamente atróficas foram examinados com TCFC e por biomodelos impressos tridimensionalmente. Após a anestesia terminal infiltrativa e descolamento do retalho palatal e vestibular, expondo a cavidade nasal, forâmen infraorbitário e osso zigomático, descolamento do assoalho nasal e da parede lateral do pilar frontonasal até a altura de 23 mm, as fresagens foram iniciadas em locais apropriados. Então, dois implantes transnasais longos e dois implantes zigomáticos foram inseridos. Em seguida, os minipilares foram instalados e os procedimentos iniciados para a realização de uma prótese total fixa parafusada com infraestrutura em cromo-cobalto. Resultados: 12 pacientes (três homens e nove mulheres, sendo dez edêntulos totais, um edêntulo parcial + PPR e um edêntulo sem próteses) foram tratados e acompanhados por dois meses até 26 meses. Cinco casos necessitaram de enxertos ósseos e todos os implantes se mostraram estáveis (torque acima de 40 Ncm) na instalação. Dor, infecção ou perda óssea não foram observadas. Ainda, não foram observadas complicações protéticas (soltura do parafuso e fratura dos dentes artificiais/infraestrutura). Conclusão: a técnica Vanderlim ou transnasal pode ser uma opção viável para substituir ou evitar a instalação de um segundo implante zigomático bilateralmente. Porém, há necessidade de um maior tempo de acompanhamento para aferir a longevidade do tratamento.

Palavras-chave – Implantes dentários; Osso frontal; Cirurgia bucal; Zigoma; Reabilitação bucal; Reabsorção óssea.

ABSTRACT

Objective: to describe the Vanderlim technique as an alternative to Zygoma Quad in totally atrophic maxillae. Material and methods: patients with severely atrophic maxillae were examined with CBCT and 3D printed biomodels. After terminal infiltrative anesthesia, incision, and releasing of the palatal and vestibular flaps to expose the nasal cavity, infraorbital foramen and zygomatic bone, detachment of the nasal floor and the lateral wall of the frontonasal pillar up to a height of 23 mm was performed. Next, osteotomies were started in appropriate places; then, two long transnasal implants and two zygomatic implants were inserted. Afterwards, the prosthetic components were installed and protocols for a screw-retained complete denture with a cobalt-chromium cast framework were followed. Results: twelve patients (3 men, 9 women; 10 totally edentulous, 1 partial edentulous + RPD, 1 edentulous without prostheses) were treated and followed for 2 months to 26 months. Five cases required bone grafts. All implants were stable (> 40 Ncm torque) at insertion. Pain, infection, and bone loss were not observed. Still, no prosthetic complications (screw loosening, fracture of artificial teeth/framework) were observed. Conclusion: the Vanderlim or transnasal technique can be a viable option to replace or avoid the installation of a second zygomatic implant bilaterally. However, there is a need for longer follow-up times to measure treatment longevity.

Key words – Dental implants; Frontal bone; Oral surgery; Zygoma; Oral rehabilitation; Bone resorption.

Recebido em jul/2021
Aprovado em jul/2021

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