Enxerto ósseo xenógeno interposicional na região anterior da mandíbula para aumento vertical do rebordo e posterior reabilitação implantossuportada

RESUMO

A reabsorção do rebordo ósseo alveolar desdentado ocorre no sentido horizontal e vertical, e, dependendo da região, pode dificultar ou inviabilizar a reabilitação com implantes osseointegrados. O objetivo deste relato foi apresentar uma alternativa de tratamento em regiões de atrofia óssea vertical, utilizando a técnica de osteotomia sanduíche associada ao enxerto ósseo xenógeno na região anterior da mandíbula e posterior reabilitação com implantes osseointegrados. Paciente do sexo feminino, com 38 anos de idade, leucoderma, sistemicamente saudável e apresentando boa higiene oral, compareceu à clínica odontológica queixando-se de estética e função mastigatória prejudicadas. Ao exame clínico e imaginológico, foi observado um extenso defeito ósseo vertical na região anterior de mandíbula, uma pequena faixa de mucosa ceratinizada, presença de um implante na região do 32 com quatro roscas expostas e tecido peri-implantar inflamado. O plano de tratamento elaborado foi: remoção do implante; reconstrução óssea da região anterior de mandíbula por meio da técnica de osteotomia sanduíche; reabertura da área enxertada e instalação dos implantes; reabertura dos implantes associada ao enxerto gengival livre; e instalação dos munhões universais para confecção dos provisórios. O controle clínico e radiográfico após um ano da instalação das coroas provisórias revelou manutenção dos resultados obtidos e satisfação por parte da paciente e do cirurgião-dentista. Concluiu-se que a técnica de osteotomia sanduíche associada ao enxerto ósseo xenógeno para reconstrução de região com intensa atrofia óssea vertical mostrou-se viável e previsível para aumento em altura da região anterior da mandíbula e posterior reabilitação com implantes osseointegrados, restabelecendo estética e função.

Palavras-chave – Aumento do rebordo alveolar; Implantes dentários; Perda do osso alveolar; Procedimentos cirúrgicos reconstrutivos.

ABSTRACT

Reabsorption of the edentulous alveolar bone marrow occurs horizontally and vertically, and depending on the region, it may hamper or prevent implant rehabilitation. The aim of this report is to present an alternative treatment for regions of vertical bone atrophy using the sandwich osteotomy technique associated with the xenogenous bone graft in the anterior region of the mandible and posterior implant rehabilitation. A 38 years-old, female patient, systemically healthy, with good oral hygiene attended the dental clinic complaining of impaired aesthetic and masticatory function. The clinical and imaging examination revealed an extensive vertical bone defect in the anterior region of the mandible, a small range of keratinized mucosa, presence of an implant in the region of 32 with 4 exposed threads and inflamed peri implant tissue. The treatment plan was elaborated: implant removal; bone reconstruction of the anterior mandible region using the sandwich osteotomy technique; reopening of the grafted area and implant installation; reopening of the implants associated with the free gingival graft and installation of the prosthetic component and preparation of the provisional ones. The clinical and radiographic control after 1 year of installation of the provisional crowns revealed maintenance of the obtained results and satisfaction on the part of the patient and the dental surgeon. It was concluded that the sandwich osteotomy technique for the reconstruction of the region with intense vertical bone atrophy proved to be viable and predictable for height increase of the anterior region of the mandible and posterior implant rehabilitation restoring aesthetics and function.

Key words – Alveolar ridge augmentation; Dental implants; Alveolar bone loss; Reconstructive surgical procedures.

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