20 anos atrás na Implantodontia contemporânea: a “hora” da carga imediata

AUTOR

Paulo Henrique Orlato Rossetti
Cirurgião-dentista, mestre e doutor em Reabilitação Oral – FOB-USP. Orcid: 0000-0002-0868-6022.

RESUMO

Objetivo: revisitar os momentos que nos trouxeram aos atuais protocolos de carga em Implantodontia. Material e métodos: uma busca foi realizada em mais de 20 periódicos científicos, acessados número por número, apenas no ano de 2003. Resultados: três artigos foram selecionados como os mais representativos desta época. O primeiro fazia uma revisão da literatura sobre o paradigma da mudança, estabelecendo que taxas de sucesso acima de 90% eram possíveis no protocolo de carga imediata, desde que alguns critérios fossem aplicados: uso de implantes em formato de parafuso para atingir estabilidade primária e melhorar a resistência ao cisalhamento nesta interface com o osso, implantes com roscas modificadas, seleção de uma superfície rugosa (benefício ainda a ser confirmado em osso macio), indeterminação da melhor relação comprimento/ diâmetro, cautela/aconselhamento sobre os riscos no tratamento de pacientes com bruxismo, esplintagem/ferulização dos implantes e a melhor distribuição das cargas oclusais entre dentes e implantes dentários. O segundo trazia a síntese do encontro realizado em Barcelona, na Espanha, em maio de 2002, estabelecendo uma divisão nítida entre os momentos para realização da carga imediata, precoce e tardia, os conceitos de carregamento oclusal e não oclusal, e o torque de inserção e frequência de ressonância como ferramentas diagnósticas. O terceiro explicava os conceitos revolucionários all-on-four, reduzindo significativamente o risco biomecânico e possibilitando a função imediata em duas horas. Conclusão: as novas fronteiras entre os protocolos de carga alteraram para sempre o fluxo de trabalho clínico, laboratorial e o relacionamento entre profissionais e pacientes, representando um grande salto na Implantodontia.

Palavras-chave – Carga precoce; Carga imediata; Carga tardia; Osseointegração.

ABSTRACT

Objective: to revisit the moments that brought us to the actual loading protocols in implant dentistry. Material and methods: a search was conducted in more than 20 scientific periodicals, accessed number by number, only at the year 2003. Results: three articles were selected as the most representative of this time. The first made a literature review on the paradigm changing, establishing that success rates over 90% were possible under the immediate loading protocol, since some criteria could applied: the use of screw-threaded fixtures to obtain primary stability and to improve the shear resistance at the bone interface, dental implants with modified threads, the selection of rough surfaces (benefits still to be confirmed on soft bone types), the lack of science over implant diameter/length selection in those situations, caution/ advising over the treatment risks for patients with bruxism, splinting and better occlusal load distribution over tooth and implants. The second was the synthesis of a meeting held in Barcelona, Spain, May 2002, which established a clear division over the timing for early, immediate and delayed protocols, as well as the concepts of occlusal and non-occlusal loading, and the use of final insertion torque and resonance frequency values as diagnostic tools. The third explained the all-on-four revolutionary concepts, which significantly reduced the biomechanical risks while still achieving immediate function up to two hours. Conclusion: those new frontiers regarding the loading protocols changed forever the clinical and laboratory workflows, and the professional-patient relationship as well, representing a great leap for the Implant Dentistry.

Key words – Early loading; Immediate loading; Delayed loading; Osseointegration.

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