Cirurgia guiada em mandíbula atrésica com carga imediata: relato de caso clínico com 24 meses de acompanhamento

Artigo científico descreve um caso clínico de paciente com mandíbula muito atrésica e condições sistêmicas desfavoráveis.

AUTORES

Sylvia Kang
Mestranda em Implantodontia – Faculdade Ilapeo.
Orcid: 0000-0002-4500-2371.

Douglas Porto Ferreira
Mestrando em Implantodontia – Faculdade Ilapeo.
Orcid: 0000-0002-0025-2916.

Rodrigo Yoshiyasu
Mestrando em Implantodontia – Faculdade Ilapeo.
Orcid: 0000-0003-3741-6010.

Leandro Eduardo Kluppel
Professor do curso de mestrado em Implantodontia – Faculdade Ilapeo.
Orcid: 0000-0003-0437-7211.

Ivete Aparecida de Mattias Sartori
Professora do curso de mestrado em Implantodontia – Faculdade Ilapeo.
Orcid: 0000-0003-3928-9430.

RESUMO

Esse relato foi elaborado com o objetivo de descrever um caso clínico de paciente com mandíbula muito atrésica e condições sistêmicas desfavoráveis. Os avanços tecnológicos estão trazendo muitos benefícios à clínica odontológica. A introdução de um software que possibilita o planejamento virtual do posicionamento dos implantes e da técnica que permite a transferência deste para a boca do paciente, através de um guia cirúrgico, trouxe maior previsibilidade, precisão e segurança para o procedimento, trazendo resultados estéticos e funcionais bastante satisfatórios. Além disso, pode-se considerar o fato de permitir cirurgias menos invasivas e com menor tempo de trabalho – fatores importantes para pacientes com atrofia óssea e condições sistêmicas desfavoráveis. Com base na experiência vivenciada na resolução desse caso clínico, foi possível concluir que a técnica de cirurgia guiada é bastante precisa, segura e previsível. Sua indicação pode ser importante em casos com limitações anatômicas e funcionais. Além dos benefícios técnicos, os benefícios clínicos (pós-cirúrgicos) foram observados neste caso de paciente com idade avançada e com comprometimentos sistêmicos.

Palavras-chave – Mandíbula atrófica; Implantes; Cirurgia guiada; Planejamento virtual de implantes; Arco total.

ABSTRACT

This report was prepared with the aim of describing a clinical case of a patient with very atresic mandible and unfavorable systemic conditions. Technological advances are bringing many benefits to the dental clinic. The introduction of a software that enables the virtual planning of implant positioning and the technique that allows its transfer to the patient’s mouth through a surgical guide, brought greater predictability, precision and safety to the procedure, bringing aesthetic and functional results. quite satisfactory. In addition to these important factors, we can consider the fact that it allows less invasive surgery and shorter working time, important factors for patients with bone atrophy and unfavorable systemic conditions. Based on the experience of solving this clinical case, it is possible to conclude that the guided surgery technique is very precise, safe, and predictable. Its indication may be important for cases with anatomical and functional limitations. In addition to the technical benefits, the clinical benefits (post-surgical) were observed in this case of an elderly patient with systemic impairments.

Key words – Atrophic mandible; Implants; Guided surgery; Virtual implant planning; Full arch.

Recebido em nov/2020
Aprovado em set/2021

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

Referências

Verstreken K, Van Cleynenbreugel J, Martens K, Marchal G, van Steenberghe D, Suetens P. An image-guided planning system for endosseous oral implants. IEEE Trans Med Imaging 1998;17(5):842-52.

Tardieu PB, Vrielinck L, Escolano E. Computer-assisted implant placement. A case report: treatment of the mandible. Int J Oral Maxillofac Implants 2003;18(4):599-604.

Vercruyssen M, Fortin T, Widmann G, Jacobs R, Quirynen M. Different techniques of static/dynamic guided implant surgery: modalities and indications. Periodontol 2000 2004;66(1):214-27.

BouSerhal C, Jacobs R, Quirynen M, Van Steenberghe D. Imaging technique selection for the preoperative planning of oral implants: a review of the literature. Clin Implant Dent Relat Res 2002;4(3):156-72.

Jacobs R, Adriansens A, Naert I, Quirynen M, Hermans R, Van Steenberghe D. Predictability of reformatted computed tomography for pre-operative planning of endosseous implants. Dentomaxillofac Radiol 1999;28(1):37-41.

Guerrero ME, Jacobs R, Loubele M, Schutyser F, Suetens P, Van Steenberghe D. State-of-the-art on cone beam CT imaging for preoperative planning of implant placement. Clin Oral Investig 2006;10(1):1-7.

Laleman, I, Bernard L, Vercruyssen M, Jacobs R, Bornstein M, Quirynen M. Guided implant surgery in the edentulous maxilla: a systematic review. Int J Oral Maxillofac Implants 2017;31(suppl.):S103-17.

Albiero AM, Quartuccio L, Benato A, Benato R. Accuracy of computer-guided flapless implant surgery in fully edentulous arches and in edentulous arches with fresh extraction sockets. Implant Dent 2019;28(3):256-64.

Spielau T, Hauschild U, Katsoulis J. Immediate implant placement and immediate loading – a case report. Clin Dent 2009;3(1):24-9.

Souza FA, Aranega AM, Ponzoni D, Benetti F, Martins BB, Maciel JS et al. Reabilitação protética de mandíbula atrófica por meio de implantes curtos. Relato de caso clínico com oito anos de acompanhamento. ImplantNews 2013;10(4):441-6.

Chrcanovic BR, Albrektsson T, Wennerberg A. Bone quality and quantity and dental implant failure: a systematic review and meta-analysis. Int J Prosthodont 2017;30(3):219-37.

Blahout R, Hiennz S, Solar P, Matejka MH, Ulm CW. Quantification of bone resorption in the interforaminal region of the atrophic mandible. Int J Oral Maxillofac Implants 2007;22(4):609-15.

Orentlicher G, Horowitz A, Abboud M. Computer-guided implant surgery: indications and guidelines for use. Compend Contin Educ Dent 2012;33(10):720-33.

Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol 2006;77(12):1933‐43.

Apostolakis D, Brown JE. The anterior loop of the inferior alveolar nerve: prevalence, measurement of its length and a recommendation for interforaminal implant installation based on cone beam CT imaging. Clin Oral Implants Res 2012;23(9):1022‐30.

Fortin T, Isidori M, Bouchet H. Placement of posterior maxillary implants in partially edentulous patients with severe bone deficiency using CAD/CAM guidance to avoid sinus grafting: a clinical report of procedure. Int J Oral Maxillofac Implants 2009;24(1):96‐102.

Krennmair S, Weinländer M, Malek M, Forstner T, Krennmair G, Stimmelmayr M. Mandibular full-arch fixed prostheses supported on 4 implants with either axial or tilted distal implants: a 3-year prospective study. Clin Implant Dent Relat Res 2016;18(6):1119-33.

Maló P, de Araújo Nobre M, Lopes A, Ferro A, Gravito I. All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: a 7-year clinical and 5-year radiographic retrospective case series with risk assessment for implant failure and marginal bone level. Clin Implant Dent Relat Res 2015;17(suppl.2):e531-41.

Laverty DP, Buglass J, Patel A. Flapless dental implant surgery and use of cone beam computer tomography guided surgery. British Dent J 2018;224(8):1-12.

Horowitz A, Orentlicher G, Goldsmith D. Computerized implantology for the irradiated patient. J Oral Maxillofac Surg 2009;67(3):619-23.

Feine JS, Maskawi K, de Grandmont P, Donohue WB, Tanguay R, Lund JP. Within-subject comparisons of implant-supported mandibular prostheses: evaluation of masticatory function. J Dent Res 1994;73(10):1646-56.

Geertman ME, Slagter AP, van ‘t Hof MA, van Waas MA, Kalk W. Masticatory performance and chewing experience with implant-retained mandibular overdentures. J Oral Rehabil 1999;26(1):7-13.

Abu Hantash RO, Al-Omiri MK, Al-Wahadni AM. Psychological impact on implant patients’ oral health-related quality of life. Clin Oral Implants Res 2006;17(2):116-23.

Malo P, Nobre MA, Lopes A. Immediate rehabilitation of completely edentulous arches with a four-implant prosthesis concept in difficult conditions: an open cohort study with a mean follow-up of 2 years. Int J Oral Maxillofac Implants 2012;27(5):1177-90.

Coró ER, Sartori IAM, Vieira RA, Coró V, Borges AFS. Avaliação de mastigação e satisfação de pacientes reabilitados com prótese mandibular implantorretida. ImplantNews 2010;7(3a):183-90.

Vieira RA, Melo AC, Budel LA, Gama JC, Sartori IA, Thomé G. Benefits of rehabilitation with implants in masticatory function: is patient perception of change in accordance with the real improvement? J Oral Implantol 2014;40(3):263-9.

Tatakis DN, Chien HH, Parashis AO. Guided implant surgery risks and their prevention. Periodontol 2000 2009;81(1):194-208.

Aimi F. Reabilitação em Implantodontia através de cirurgia guiada e carga imediata: uma revisão de literatura [tese]. Florianópolis: Universidade Federal de Santa Catarina, 2014.

Orentlicher G, Horowitz A, Abboud M. What’s hindering dentistry from the widespread adoption of CT‐guided surgery? Compend Contin Educ Dent 2015;36(10):762‐66.