Content uploaded by Laura Paleckis
Author content
All content in this area was uploaded by Laura Paleckis on Jun 25, 2018
Content may be subject to copyright.
A preview of the PDF is not available
Implante Imediato e Preservação de Alvéolo com Bio-Oss Collagen® em Área Estética
Figures
Figures - uploaded by Laura Paleckis
Author content
All figure content in this area was uploaded by Laura Paleckis
Content may be subject to copyright.
... Quando há presença de GAP's, deve ser feito uso biometariais, com o objetivo de uma neoformação óssea para assim prevenir um colapso do tecido ósseo e consequentemente do tecido peri-implantar (Vasconcelos, et al., 2016;Mattos, et al., 2018). ...
A reabilitação de um paciente com algum tipo de perda dentária deve ser realizada o mais rápida possível, causando assim menos problemas estéticos e funcionais ao paciente. O implante dentário com função imediata, é uma ótima alternativa para diminuir o tempo de espera da reabilitação em relação à a técnica convencional, sendo colocada a prótese logo após a instalação do implante, com resultados similares ao da técnica convencional. Além disto, existe maior preservação do osso periimplantar como também do contorno gengival. Uma das indicações para o uso da técnica é quanto ocorre fratura dental. Portanto, o objetivo do trabalho foi descrever a técnica realizada em um caso clínico, no qual o paciente foi reabilitado com implante em função imediata, após a fratura do primeiro pré-molar superior, sendo removido o elemento 24 e instalado 1 implante. A técnica utilizada foi a de ósteo expansão juntamente com enxerto para preenchimento do GAP. Com a obtenção de um torque de 45N.cm foi possível reestabelecer a função e estética imediata da região. Foi concluído que a função imediata com o uso de implantes dentários após exodontia é possível, sendo uma técnica favorável que proporcionou o sucesso na reabilitação, devolvendo a função e estética imediata ao paciente.
... O resultado efetivo para os implantes imediatos está relacionado a correta adaptação entre a parede óssea/alvéolo e o implante dentário (Mattos et al., 2018). Na presença de GAP's, a utilização de membranas de preenchimento e biomateriais para enxertos ósseos são indicados com o objetivo de neoformação óssea, prevenindo também um colapso no tecido ósseo e consequentemente peri-implantar (Vasconcelos et al., 2016;Mattos et al., 2018). ...
A completa mineralização da cavidade pulpar pode ocorrer devido a inúmeros fatores, tal como o trauma e associação a tratamento ortodôntico. Impactos subsequentes a este evento podem ocasionar a inviabilidade do tratamento endodontico convencional, levando a condutas secundárias como os implantes dentários. Neste caso clínico utilizou-se o método do sistema KEAGUIDE. Justifica-se este trabalho devido a importância em distinguir as possíveis vias de tratamento pós trauma e a relevância da presença do setor estético anterior, além da interferência da perda dentária no sistema estomatognático. Objetivou-se descrever um caso clínico de uma paciente de 20 anos de idade com histórico de trauma nos dentes 11 e 21, no qual a evolução do caso levou à necessidade de exodontias atraumáticas e instalação de implantes guiados. Após detalhada anamnese, exame de imagens e aprovação do Comitê de ética em Pesquisa foi realizado a descrição clínica e uma pesquisa qualitativa, que teve a finalidade de aprofundamento acerca do tema, contribuindo com o acervo de informações. Conclui-se que o delineamento do tratamento pós trauma deve ser individualizado. Ademais, a escolha da técnica cirúrgica favoreceu resultados positivos a estética e reabilitação da paciente.
... The materials most used for this purpose are autogenous bone and xenogenic hydroxyapatite. Both are important sources in reconstructive procedures and can often even be associated according to the need of the recipient site [17]. Proper positioning of the implant in the mesiodistal direction allows the preservation of the papilla, in the vestibular-palatine sense, determines the dimensions of the prosthetic crown, and is a preponderant factor in the choice of definitive restorations, whether cemented or screwed [18]. ...
In the reported clinical case, the immediate dentoalveolar restoration (IDR) technique was applied to reconstruct the buccal bone wall, with autogenous graft of the maxillary tuberosity, which had been lost due to a root fracture, and to provide the necessary bone substrate for the installation of an implant and its provisioning. One of the greatest risks inherent in the survival of immediate implants is the maintenance of their stability during the healing period. In this case, due to a mechanical trauma in sports activity in the first postoperative month, there was a total failure in the osseointegration process, confirmed by tomographic examination of both the implant and the bone graft. The deleterious effects of this accident were compensated with a new approach and reapplication of IDR technique using a smaller-diameter implant and with conical macrogeometry in conjunction with the new bone reconstruction under the same compromised alveolus; associated, after the period of osseointegration, with the maneuvers of volume increase of the gingival tissue by subepithelial connective tissue graft. The tomographic result demonstrated the success of the surgical procedures, and the clinical/photographic analysis obtained showed the stability of the gingival margin without compromising the esthetic result of the prosthetic restoration.
Introduction: Implant placement in extraction sockets is considered a daunting challenge due to ofering risks of bone remodeling and consequent gingival alterations. Objective: his study aims at proposing a protocol for selecting the diameter of upper anterior osseointegrated implants placed in extraction sockets. his protocol was based on the bucco-palatal dimension of the socket and allows a 3-mm gap to form between the implant and the outer surface of the buccal bone wall. Such gap must be illed with biomaterial or autograft so as to increase the predictability of long-term results.
Dimensional alterations of the facial bone wall following tooth extractions in the esthetic zone have a profound effect on treatment outcomes. This prospective study in 39 patients is the first to investigate three-dimensional (3D) alterations of facial bone in the esthetic zone during the initial 8 wks following flapless tooth extraction. A novel 3D analysis was carried out, based on 2 consecutive cone beam computed tomographies (CBCTs). A risk zone for significant bone resorption was identified in central areas, whereas proximal areas yielded only minor changes. Correlation analysis identified a facial bone wall thickness of ≤ 1 mm as a critical factor associated with the extent of bone resorption. Thin-wall phenotypes displayed pronounced vertical bone resorption, with a median bone loss of 7.5 mm, as compared with thick-wall phenotypes, which decreased by only 1.1 mm. For the first time, 3D analysis has allowed for documentation of dimensional alterations of the facial bone wall in the esthetic zone of humans following extraction. It also characterized a risk zone prone to pronounced bone resorption in thin-wall phenotypes. Vertical bone loss was 3.5 times more severe than findings reported in the existing literature.
Early implant placement is one of the treatment options after tooth extraction. Implant surgery is performed after a healing period of 4 to 8 weeks and combined with a simultaneous contour augmentation using the guided bone regeneration technique to rebuild stable esthetic facial hard- and soft-tissue contours.
In this prospective study, 20 patients were treated with an implant-born single crown and followed for 3 years. Clinical, radiologic, and esthetic parameters were recorded to assess treatment outcomes.
At the 3-year examination, all 20 implants were successfully integrated, demonstrating ankylotic stability and healthy peri-implant soft tissues as documented by standard clinical parameters. Esthetic outcomes were assessed by the pink esthetic score (PES) and white esthetic score (WES) and confirmed pleasing results overall. WES values were slightly superior to PES values. Periapical radiographs showed minimal crestal bone loss around used bone-level implants with a mean bone loss of 0.18 mm at 3 years. Only two implants revealed bone loss between 0.5 and 1.0 mm. One of these implants had minor mucosal recession <1.0 mm.
This prospective study evaluates the concept of early implant placement and demonstrated successful tissue integration for all 20 implants and stable bone-crest levels around implant-abutment interfaces according to the platform-switching concept. The midterm 3-year follow-up revealed pleasing esthetic outcomes and stable facial soft tissues. The risk of mucosal recession was low, with only one patient showing minor recession of the facial mucosa. These encouraging results need to be confirmed with a 5-year follow-up examination.
In 48 postextraction sites, sockets were grafted with bovine bone mineral plus collagen membrane (test) or had spontaneous healing (control). After 4 months, horizontal ridge width reduction was 0.71 mm in the test group and 4.04 mm in the control group, while vertical ridge loss was 0.58 mm and 1.67 mm, respectively. No correlation was found between the thickness of the buccal bone wall and the alveolar bone loss in the test group, while an inverse correlation was found in the control group. Ridge preservation compensated for postextraction alveolar ridge resorption irrespective of the buccal plate thickness, whereas leaving the extraction socket undisturbed may result in alveolar bone loss.
To evaluate the soft tissue and the dimensional changes of the alveolar bony crest at sites where deproteinized bovine bone mineral (DBBM) particles, concomitantly with the placement of a collagen membrane, were used at implants installed into sockets immediately after tooth extraction.
The pulp tissue of the mesial roots of (3) P(3) was removed in six Labrador dogs, and the root canals were filled. Flaps were elevated bilaterally, the premolars hemi-sectioned, and the distal roots removed. Recipient sites were prepared in the distal alveolus, and implants were placed. At the test sites, DBBM particles were placed in the residual marginal defects concomitantly with the placement of a collagen membrane. No treatment augmentation was performed at the control sites. A non-submerged healing was allowed. Impressions were obtained at baseline and at the time of sacrifice performed 4 months after surgery. The cast models obtained were analyzed using an optical system to evaluate dimensional variations. Block sections of the implant sites were obtained for histological processing and soft tissue assessments.
After 4 months of healing, no differences in soft tissue dimensions were found between the test and control sites based on the histological assessments. The location of the soft tissue at the buccal aspect was, however, more coronal at the test compared with the control sites (1.8 ± 0.8 and 0.9 ± 0.8 mm, respectively). At the three-dimensional evaluation, the margin of the soft tissues at the buccal aspect appeared to be located more apically and lingually. The vertical dislocation was 1 ± 0.6 and 2.7 ± 0.5 mm at the test and control sites, respectively. The area of the buccal shrinkage of the alveolar crest was significantly smaller at the test sites (5.9 ± 2.4 mm(2) ) compared with the control sites (11.5 ± 1.7 mm(2) ).
The use of DBBM particles concomitantly with the application of a collagen membrane used at implants placed into sockets immediately after tooth extraction contributed to the preservation of the alveolar process.
following tooth extraction and immediate implant installation, the edentulous site of the alveolar process undergoes substantial bone modeling and the ridge dimensions are reduced. objective: the objective of the present experiment was to determine whether the process of bone modeling following tooth extraction and immediate implant placement was influenced by the placement of a xenogenic graft in the void that occurred between the implant and the walls of the fresh extraction socket.
five beagle dogs about 1 year old were used. The 4th premolar in both quadrants of the mandible ((4) P(4) ) were selected and used as experimental sites. The premolars were hemi-sected and the distal roots removed and, subsequently, implants were inserted in the distal sockets. In one side of the jaw, the marginal buccal-approximal void that consistently occurred between the implant and the socket walls was grafted with Bio-Oss Collagen while no grafting was performed in the contra-lateral sites. After 6 months of healing, biopsies from each experimental site were obtained and prepared for histological analyses.
the outline of the marginal hard tissue of the control sites was markedly different from that of the grafted sites. Thus, while the buccal bone crest in the grafted sites was comparatively thick and located at or close to the SLA border, the corresponding crest at the control sites was thinner and located a varying distance below SLA border.
it was demonstrated that the placement of Bio-Oss Collagen in the void between the implant and the buccal-approximal bone walls of fresh extraction sockets modified the process of hard tissue healing, provided additional amounts of hard tissue at the entrance of the previous socket and improved the level of marginal bone-to-implant contact.
Socket or ridge preservation is performed to maintain the contour of the alveolar ridge prior to conventional or implant-based prosthetic therapy. In this retrospective analysis of consecutive subjects, a natural bone mineral containing collagen was grafted into 110 sockets in 62 patients. The sites were left open to heal. Based on external measurements with a periodontal probe, the soft tissue volume and contour were largely preserved at all sites, irrespective of the initial defect morphology. Clinical advantages of this protocol include predictable preservation of the soft tissues, favorable healing characteristics, and easy handling of the material. (Int J Periodontics Restorative Dent 2009;29:489-497.).
To study dimensional alterations of the alveolar ridge that occurred following tooth extraction as well as processes of bone modelling and remodelling associated with such change.
Twelve mongrel dogs were included in the study. In both quadrants of the mandible incisions were made in the crevice region of the 3rd and 4th premolars. Minute buccal and lingual full thickness flaps were elevated. The four premolars were hemi-sected. The distal roots were removed. The extraction sites were covered with the mobilized gingival tissue. The extractions of the roots and the sacrifice of the dogs were staggered in such a manner that all dogs contributed with sockets representing 1, 2, 4 and 8 weeks of healing. The animals were sacrificed and tissue blocks containing the extraction socket were dissected, decalcified in EDTA, embedded in paraffin and cut in the buccal-lingual plane. The sections were stained in haematoxyline-eosine and examined in the microscope.
It was demonstrated that marked dimensional alterations occurred during the first 8 weeks following the extraction of mandibular premolars. Thus, in this interval there was a marked osteoclastic activity resulting in resorption of the crestal region of both the buccal and the lingual bone wall. The reduction of the height of the walls was more pronounced at the buccal than at the lingual aspect of the extraction socket. The height reduction was accompanied by a "horizontal" bone loss that was caused by osteoclasts present in lacunae on the surface of both the buccal and the lingual bone wall.
The resorption of the buccal/lingual walls of the extraction site occurred in two overlapping phases. During phase 1, the bundle bone was resorbed and replaced with woven bone. Since the crest of the buccal bone wall was comprised solely of bundle this modelling resulted in substantial vertical reduction of the buccal crest. Phase 2 included resorption that occurred from the outer surfaces of both bone walls. The reason for this additional bone loss is presently not understood.
The aim of this study is to evaluate whether tooth extraction without the elevation of a muco-periosteal flap has advantageous effects on the resorption rate after tooth extraction.
In five beagle dogs polyether impressions were taken before the surgery. The roots of the first and second pre-molars (P(1) and P(2)) were extracted and the sites were assigned to one of the following treatments: treatment group (Tx) 1, no treatment; Tx 2, surgical trauma (flap elevation and repositioning); Tx 3, the extraction socket was filled with BioOss Collagen and closed with a free soft-tissue graft; Tx 4, after flap elevation and repositioning, the extraction socket was treated with BioOss Collagen and a free soft-tissue graft. Impressions were taken 2 and 4 months after surgery. The casts were scanned, matched together with baseline casts and evaluated with digital image analysis.
The "flapless groups" demonstrated significant lower resorption rates both when using socket-preservation techniques and without. Furthermore, socket-preservation techniques yielded better results compared with not treating the socket.
The results demonstrate that leaving the periosteum in place decreases the resorption rate of the extraction socket. Furthermore, the treatment of the extraction socket with BioOss Collagen and a free gingival graft seems beneficial in limiting the resorption process after tooth extraction.