A “teoria dos volumes”: possíveis fatores que controlam as relações entre tecidos moles e duros na Implantodontia

“Teoria dos volumes”: trabalho explora como dimensões se relacionam em situações clínicas conhecidas e como influenciam no volume ideal ao redor do ombro do implante.

AUTORES

Sergio Maia
Especialista em Periodontia – APCD Bauru; Especialista em Implantodontia – USP Bauru; Mestre em Implantodontia – Unisa; Professor do curso de especialização em Implantodontia – CPGO; Coordenador do aperfeiçoamento em Implantodontia – ABO Natal/RN.
Orcid: 0000-0002-3740-3562.

Valdir Antonio Muglia
Especialista em Prótese Dentária, mestre e doutor em Reabilitação Oral, e professor associado do Depto. de Materiais Dentários e Prótese – Forp-USP.
Orcid: 0000-0002-7966-8892.

RESUMO

Embora seja difícil definir o volume ideal de tecidos moles e duros ao redor do ombro do implante para garantir a papila interproximal/ interimplantar e uma margem de mucosa estável, a análise da literatura revela que pode existir um controle delicado entre os compartimentos formados por estas estruturas, criando-se a teoria dos volumes. Neste sentido, rebordos cicatrizados teriam dois volumes menores (tábuas vestibular e lingual) e um volume maior (distância vestibulolingual preenchida por osso maduro). Por outro lado, alvéolos de extração teriam os mesmos compartimentos, mas seu volume interno preenchido parcialmente por osso imaturo e o implante dentário. Além disso, o uso da plataforma switching criaria um volume adicional para preenchimento vertical de tecido duro e mole. Como a espessura ideal de osso no lado vestibular de um implante deve ser de pelo menos 2 mm, a maioria das situações clínicas precisará de aumento ósseo. Para que uma papila entre dois implantes adjacentes seja estabelecida, a distância interimplante deve ser superior a 3 mm. Alternativamente, é necessário um volume ósseo adicional no lado vestibular da papila. A espessura ideal de tecido mole seria de 4 mm na vertical e 3 mm na horizontal, sendo que a espessura de tecido mole horizontal manteria os tecidos verticalmente e a quantidade de tecido mole na vertical seria responsável pela manutenção do tecido ósseo. Entretanto, dados científicos adicionais corroborando estas situações ainda não foram elaborados.

Palavras-chave – Osso; Tecido mole; Implante imediato; Teoria dos volumes.

ABSTRACT

Although it is difficult to define the optimal volume of soft and hard tissues around the dental implant shoulder to ensure the interproximal/inter-implant papilla and a stable mucosal margin, a literature analysis reveals that there may be a delicate control between the compartments formed by these structures, creating the theory of volumes. In this sense, healed ridges would have two smaller volumes (buccal and lingual bone plates) and a larger volume (buccolingual distance filled by mature bone). On the other hand, the extraction alveoli would have the same compartments, but their internal volume partially filled by immature bone and dental implant. In addition, the use of platform switching modes would create additional volume for vertical filling of hard and soft tissues. Because the ideal bone thickness on the buccal aspect of an implant should be at least 2 mm, most clinical situations will need bone augmentation. For a papilla between two adjacent implants to be established, the inter-implant distance must be greater than 3 mm. Alternatively, an additional bone volume is required on the buccal papillary aspect. The ideal soft tissue thickness would be 4 mm vertically and 3 mm horizontally, being that the horizontal soft tissue thickness would keep the tissues vertically and the amount of soft tissue vertically would be responsible for the maintenance of bone tissue. However, additional scientific data corroborating the above-mentioned situations still have not been elaborated.

Key words – Bone; Soft tissue; Immediate implant placement; Theory of volumes.

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