Cirugía guiada y reconstrucción tisular luego de un fracaso: la importancia del diagnóstico y la planificación. Reporte de caso clínico / Guided surgery and tissue reconstruction after failure: the importance of diagnosis and planning. Report of a clinical case

La realización de un nuevo tratamiento luego de un fracaso con implantes dentarios representa un gran desafío para el profesional especialistas en implan-tología, así como para el paciente que debe someter-se a un nuevo procedimiento para rehabilitarse. En estos casos, el diagnóstico y la planificación exhaus-tiva previa nos permiten optimizar el tiempo y los re-cursos, arribando al resultado esperado de forma eficiente. En este reporte de caso se presenta la re-habilitación de una paciente que acude a la consulta con un fracaso implantario previo y con alta deman-da estética. Se diseñó una guía quirúrgica de preci-sión para la colocación de un implante Straumann®Bone Level Tapered 3,3 NC ­ Narrow CrossFit® ø 3,3 mm 8 mm junto a la regeneración ósea guiada para compensar la deficiencia de los tejidos circundantes. La rehabilitación protésica consistió en una corona cemento atornillada en disilicato de litio. En el control al año pudo valorarse la estabilidad de la rehabilita-ción protésica, así como de los tejidos circundantes y el contorno estético junto al perfil de emergencia mimético logrado al final del tratamiento (AU)

Carrying out a new treatment after a failure with dental implants represents a great challenge for the implantology specialist professional, as well as for the patient who must undergo a new procedure to rehabilitate. In these cases, the diagnosis and prior exhaustive planning allow us to optimize time and resources, arriving at the expected result efficiently. This case report presents the rehabilitation of a patient who comes to the clinic with a previous implant failure and with high aesthetic demand. A precision surgical guide was designed for the placement of a Straumann® Bone Level Tapered 3.3 NC ­ Narrow CrossFit® ø 3.3 mm 8 mm implant together with guided bone regeneration to compensate for the deficiency of the surrounding tissues. The prosthetic rehabilitation consisted of a screw-retained cement crown in lithium disilicate. In the one-year control, the stability of the prosthetic rehabilitation, as well as the surrounding tissues and the aesthetic contour, together with the mimetic emergence profile achieved at the end of the treatment, could be assessed (AU)

Coronas cementadas comparado con coronas atornilladas para pacientes con restauraciones fijas implantosoportadas / Cement-retained versus screw-retained crowns in patients with implant rehabilitation

RESUMEN: Introducción: Los implantes dentales se han transformado en una opción de tratamiento de suma relevancia para pacientes parcial o totalmente desdentados. El éxito del tratamiento puede verse afectado por la elección del tipo de retención de estos (cementada o atornillada). A pesar que ambas presentan ventajas, aún no existe consenso sobre el mejor tipo de retención para restauraciones fijas implantosoportadas. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 14 revisiones sistemáticas que en conjunto incluyeron 43 estudios primarios, de los cuales cinco corresponden a ensayos aleatorizados. De estos, solamente dos ensayos responden a la pregunta de interés de manera directa. Concluimos que las coronas atornilladas podrían aumentar levemente el riesgo de pérdida de implante a largo plazo, podrían resultar en nula o poca diferencia en el riesgo de pérdida de implante a mediano plazo, reabsorción ósea y periimplantitis, pero la certeza de evidencia ha sido evaluada como baja. Por otro lado, no es posible establecer con claridad si las coronas cementadas disminuyen el riesgo de complicaciones estéticas y protésicas, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Dental implants have become a highly relevant treatment option for partially or totally edentulous patients. Implant retention systems (cemented or screwed) can influence the treatment success. Although both have advantages, there is still no consensus on the best type of retention for implant-supported fixed restorations. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 14 systematic reviews including 43 primary studies overall, of which five were randomized trials. Of these, only two trials answer the question of interest. We concluded that screw-retained crowns may increase long-term implant loss, may make little or no difference in the risk of medium-term implant loss, bone resorption, and peri-implantitis, but the certainty of the evidence has been assessed as low. On the other hand, it is not possible to clearly establish whether cemented crowns reduce the risk of cosmetic and prosthetic complications, since the certainty of the evidence has been assessed as very low.

Application of digital immediate implant restoration and angle screw channel abutment in the aesthetic area:case report and literature review / 口腔疾病防治

Objective @# To investigate the application of digital immediate implant and angle screw channel abutment in the aesthetic area and the related influencing factors by reviewing the data of one case of immediate implant repair of the upper anterior teeth and related literature. @*Methods@#One case of refractory chronic apicitis of the upper anterior teeth involved immediate implantation after extraction. The digital information of the patient was obtained by CBCT and intraoral scanning. According to the information from the patients, a preoperative evaluation was performed; a treatment scheme was formulated; a minimally invasive extraction was performed; implants were placed under a digital guide plate; and temporary restoration was immediately performed. Six months after the operation, the patients underwent individualized mold removal, and angle screw channel fixation was completed. We observed the cosmetic effects and soft and hard tissue and gingival contour maintenance effects after restoration and reexamined the patients 6 months after restoration. In addition, the relevant literature was reviewed. @*Results @#The height of the gingival margin and gingival papilla and gingival contour of this patient were well maintained. The red and white aesthetic effect was good. There was no redness or swelling of the gingiva nor obvious changes in the soft and hard tissues around the implant 6 months after restoration, and the patient was satisfied. The results in the literature review show that a preoperative design based on CBCT and intraoral scanning data combined with digital software and a whole digital guide plate make the procedure more accurate and safer. These factors can not only avoid important anatomical structures and serious surgical complications but can also result in implantation in the best three-dimensional position. In addition, the application of digital impression technology and CAD/CAM increases the efficiency, speed, accuracy, simplicity, and comfort of oral impressions and the construction of temporary and final prostheses more precise and faster, greatly improving clinical efficiency. @*Conclusion@#Digital immediate implant and angle screw channel abutment is a good method to restore the aesthetics and function of missing teeth and to avoid the complications caused by adhesive residue.

Clinical observation of cement-retained and screw-retained implant-supported denture in edentulous patients / 口腔疾病防治

Objective@# To evaluate the clinical effects of full-arch cement-retained implant-supported combined crowns and screw-retained implant-supported bridge dentures in complete or half edentulous patients. @*Methods @#A total of 25 patients with complete or partial edentulous dentures followed up for 1, 3, and 5 years in our hospital from June 2013 to June 2018 and were treated with Straumann bone horizontal implantation, cobalt-chromium stenting and cobalt-chromium porcelain restoration with cement-retained and screw-retained implant-supported fixed dental prostheses to evaluate the accumulative implant survival rate, accumulative prosthesis survival rate, mechanical complications, and biological complications in both groups. @*Results @#There were 25 complete or half edentulous patients who received 165 Straumann implants and 28 implant-supported fixed dental prostheses in this study. There were 11 cases with 69 implants in the cement group and 17 cases with 96 implants in the screw group. The accumulative implant survival rate was 100% in the cement group and 96.9% in the screw group. The accumulative prosthesis survival rate was 100% in both groups. The cumulative peri-implant mucositis rate was 23.2% in the cement group and 29.2% in the screw group, and the peri-implantitis rate was 6.8% in the cement group and 7.3% in the screw group. There was 1 case of porcelain collapse (n=1/11) and no screw of abutment loosening in the cement group and 4 cases of porcelain collapse (n=4/17) and 1 case of screw loosening in the screw group. No fracture of abutment was observed in either group. There was no difference in bone loss between the two groups in the first year (P > 0.05), and a higher rate of bone loss was found in the screw group in the third and fifth years (P < 0.05). There was no difference in the sulcus bleeding index(mSBI) between the two groups in the first year and the third year (P > 0.05) and a higher modified mSBI value in the cement group in the fifth year (P < 0.05).@*Conclusion @#The survival rates of the implant and prosthesis for cement-retained or screw-retained implant-supported fixed dental prostheses were both high, but there were more mechanical and biological complications in the traditional cobalt-chromium alloy screw-retainer group. The removal of residual adhesives must be reasonably considered when choosing the cement retention method.

Retention System and Splinting on Morse Taper Implants in the Posterior Maxilla by 3D Finite Element Analysis

Abstract The purpose of this study was to evaluate different retention systems (cement- or screw-retained) and crown designs (non-splinted or splinted) of fixed implant-supported restorations, in terms of stress distributions in implants/components and bone tissue, by 3-dimensional (3D) finite element analysis. Four 3D models were simulated with the InVesalius, Rhinoceros 3D, and SolidWorks programs. Models were made of type III bone from the posterior maxillary area. Models included three 4.0-mm-diameter Morse taper (MT) implants with different lengths, which supported metal-ceramic crowns. Models were processed by the Femap and NeiNastran programs, using an axial force of 400 N and oblique force of 200 N. Results were visualized as the von Mises stress and maximum principal stress (σmax). Under axial loading, there was no difference in the distribution of stress in implants/components between retention systems and splinted crowns; however, in oblique loading, cemented prostheses showed better stress distribution than screwed prostheses, whereas splinted crowns tended to reduce stress in the implant of the first molar. In the bone tissue cemented prostheses showed better stress distribution in bone tissue than screwed prostheses under axial and oblique loading. The splinted design only had an effect in the screwed prosthesis, with no influence in the cemented prosthesis. Cemented prostheses on MT implants showed more favorable stress distributions in implants/components and bone tissue. Splinting was favorable for stress distribution only for screwed prostheses under oblique loading.

Resumo O objetivo deste estudo foi avaliar diferentes sistemas de retenção (cimentada x parafusada) e configuração da coroas (unitárias x esplintadas) de próteses fixas implantossuportadas em relação a distribuição de tensões nos implantes/componentes e tecido ósseo pela análise de elementos finitos 3D. Quatro modelos 3D foram simulados com auxílio dos programas Invesalius, e Rhinoceros 3D, e SolidWorks. Os modelos foram confeccionados simulando bloco ósseo de região posterior da maxila (tipo ósseo III), com 3 implantes cone Morse com 4,0 mm de diâmetro e diferentes comprimentos, suportando prótese metalocerâmica de 3 elementos. Os modelos foram processados pelos programas FEMAP e NEiNastran sob força axial de 400 N e oblíqua de 200N. Os resultados foram plotados através de mapas de tensão de von Mises (vM) (implantes e componentes) e tensão máxima principal (TMP) (tecido ósseo). Sobre o carregamento axial, não foi observada diferenças entre os diferentes sistemas de retenção e tipo de prótese na distribuição das tensões nos implantes/componentes, porém, sobre o carregamento oblíquo as próteses cimentadas apresentaram melhor distribuição de tensões em comparação com as próteses parafusadas, enquanto que as próteses esplintadas apresentou uma tendência de redução das tensões no implante do primeiro molar. No tecido ósseo as próteses cimentadas apresentaram melhor distribuição das tensões em comparação com as próteses parafusadas, independente do carregamento. A esplintagem foi favorável somente para as próteses parafusadas, não havendo influência sobre as próteses cimentadas. As próteses cimentadas sobre implantes cone Morse apresentam melhor comportamento biomecânico nos implantes/componentes e tecido ósseo. A esplintagem foi efetiva somente nas próteses parafusadas sob carregamento oblíquo.

Influence of abutment height and convergence angle on the retrievability of cement-retained implant prostheses with a lingual slot

PURPOSE: Cement-retained implant prostheses can lack proper retrievability during repair, and residual cement can cause peri-implantitis. The purpose of this in vitro study was to evaluate the influence of abutment height and convergence angle on the retrievability of cement-retained implant prostheses with lingual slots, known as retrievable cement-type slots (RCS). MATERIALS AND METHODS: We fabricated six types of titanium abutments (10 of each type) with two different heights (4 mm and 6 mm), three different convergence angles (8°, 10°, and 12°), a sloped shoulder margin (0.6 mm depth), a rectangular shape (6 mm × 6.5 mm) with rounded edges, and a rectangular ledge (2 mm × 1 mm) for the RCS. One monolithic zirconia crown was fabricated for each abutment using a dental computer-aided design/computer-aided manufacturing system. The abutments and crowns were permanently cemented together with dual-curing resin cement, followed by 24 hours in demineralized water at room temperature. Using a custom-made device with a slot driver and torque gauge, we recorded the torque (N·cm) required to remove the crowns. Statistical analysis was conducted using multiple regression analysis and Mann-Whitney U tests (α=.05). RESULTS: Removal torques significantly decreased as convergence angles increased. Multiple regression analysis showed no significant interaction between the abutment height and the convergence angle (Durbin-Watson ratio: 2.186). CONCLUSION: Within the limitations of this in vitro study, we suggest that the retrievability of cement-retained implant prostheses with RCS can be maintained by adjusting the abutment height and convergence angle, even when they are permanently cemented together.

A new retaining method of cement-retained restoration with linguo-horizontal insertion of fiber post / 대한치과보철학회지

The retaining methods of implant prosthesis were classified into a screw-retained and a cement-retained type. A screw-retained prosthesis has many advantages, such as retrievability, preventing residual cement, while their disadvantages include the possibility of screw loosening and fracture, on the contrary advantages of cement-retained prosthesis are relatively low cost, but they are difficult to retrieve. To combine the advantages of both type, screw-cement retained prosthesis (SCRP) type have been introduced. But they still require ideal implant placement. So we introduce fiber post retained prosthesis without residual cement for preventing soft tissue trouble due to excessive cement.

Clinical analysis of peri-implantitis caused by cement remnant / 实用医学杂志

Objective To analyse the influencing factor,clinical appearance and solution of peri-implanti-tis,especially caused by cement remnant. Methods In this retrospective study 23 typical cases of peri-implantitis were collected in our implantology center from Jan.2016 to Dec.2016.The general data such as age,sex,systemic diseases,habits of smoking and alcohol,history of periodontitis,surgery process,materials and way of restoration were recorded in details.This study enrolled individuals from a private practice who had cement-retained implant res-torations,scheduled for regular implant maintenance or coming for consultation on a complication. Results All screw-retention(100%)and 50% cement retention peri-implantitis cases suffered from local and systemic diseases, 30% screw-retention and 20% cement retention healthy cases suffered from local and systemic diseases,which showed a significant differences(P<0.05),but there was no significant difference between screw and cement reten-tion in peri-implantitis group.85.7% of screw-retention and 50% of cement retention cases had a poor oral hygiene (PLI=2or3).Despite the other possible factors(such as diabetes,periodontitis and heavy smoker),8 cement-re-tained implants suffered from peri-implantitis.5 cases showed the cement remnant on the x-ray photo. Conclusion There are many pathogenic factors leading to peri-implantitis that may be single or combined.Cement remnant direct-ly leads to peri-implantitis.Clearance of excess cement together with scaling and laser treatment,or even combined with guided bone regeneration surgery are effective for treatment of peri-implantitis.

Influence of Sealing of the Screw Access Hole on the Fracture Resistance of Implant-Supported Restorations

Abstract The purpose of this study was to assess the influence of sealing of the screw access hole (SAH) on the fracture resistance of metal-ceramic implant-supported restorations. UCLA abutments were used to make 30 implant-retained mandibular molar restorations and divide equally into three groups: Group SRS: screw-retained restorations with SAH sealed; Group SRNS: screw-retained restorations with SAH not sealed; Group CR: cement-retained restorations. The following protocol was adopted to restore the SAH: the ceramic surface of the SAH was air-abraded with aluminum oxide; etched with 10% hydrofluoric acid; a silane coupling agent and a bonding agent were applied; cotton pellets were used as filling material and P-60 resin composite as restoring material. The cement-retained restorations were cemented with Rely-X U100. A metal rod with a spherical tip of 6.0 mm diameter was used to apply a vertical static load, simultaneously on the buccal and lingual incline cusps, at a crosshead speed of 0.5 mm/min until the fracture of the specimens. Data were analyzed using one-way ANOVA and Dunnet test (p<0.05) for multiples comparisons. The mode of failure was evaluated by a scanning electron microscopy (SEM). No significant difference between screw-retained restorations was found. The highest mean fracture resistance values were observed with CR group. Therefore, it was shown that SAH sealing did not influence the fracture resistance of the screw-retained restorations.

Resumo O objetivo deste estudo foi avaliar a influência do selamento do orifício de acesso ao parafuso (OAP) na resistência à fratura de coroas metalocerâmicas implantossuportadas aparafusadas. Pilares UCLA foram utilizados para fazer 30 molares inferiores implantossuportados e divididos igualmente em três grupos: Grupo AS: coroas aparafusadas com o OAP selado; Grupo ANS: coroas aparafusadas com o OAP não selado; Grupo CC: coroas cimentadas. O seguinte protocolo foi utilizado para selar o OAP: a superfície de cerâmica do OAP foi jateada com óxido de alumínio; condicionada com ácido fluorídrico a 10%; um agente silano e um adesivo dentinário foram aplicados; bolinhas de algodão foram utilizadas como material de preenchimento e a resina composta P-60 como material de restauração. As coroas cimentadas foram cimentadas com Rely-X U100. Uma haste de metal com uma ponta esférica de 6.0 mm de diâmetro foi usada para aplicar uma carga estática vertical, simultaneamente nas vertentes triturantes das cúspides linguais e vestibulares, com 0,5 mm/min velocidade do atuador até a fratura das coroas. Os dados foram analisados através de ANOVA um fator e teste de Dunnett (p<0,05) para as comparações múltiplas. O modo de falha foi avaliado por um microscópio eletrônico de varredura (MEV). Não houve diferença significativa entre restaurações aparafusadas. Os maiores valores médios de resistência à fratura foram observados com o Grupo CC. Portanto, observou-se que o selamento do OAP não influenciou a resistência à fratura das coroas aparafusadas.

Compressive Resistance of Abutments with Different Diameters and Transmucosal Heights in Morse-Taper Implants

The aim of this study was to evaluate the compressive resistance under oblique loads of abutments with two different diameters and transmucosal heights used for cement-retained implant-supported prostheses in Morse-taper implants. Forty Morse-taper implants were divided into four groups with different abutment sizes for cement-retained prostheses in order to perform the compressive test. The groups were divided by abutment diameter and transmucosal height as follows: Group 1: 4.5 x 2.5 mm; Group 2: 4.5 x 3.5 mm; Group 3: 3.3 x 2.5 mm; and Group 4: 3.3 x 3.5 mm. An oblique compressive loading test was performed on each sample located in a platform at 30° using a universal testing machine with a load cell of 1,000 kgf and 0.5 mm/min speed until achieving the deformation of abutment's neck. The compressive resistance and its mechanical behavior were recorded for each group and the data were analyzed using ANOVA, the Shapiro-Wilk and Scheffé tests. In addition, the detailed damage of all samples was recorded with a conventional camera linked to the endoscopic equipment. Significant differences were observed among the groups, except between Groups 2 and 3 (p>0.005). All the abutments showed permanent deformations in the upper region and at the transmucosal portion, but the threads of the screws were intact. Fractures were only identified in Groups 3 and 4. Stronger mechanical behavior and compressive resistance was observed in the abutments with 4.5 mm diameter and 2.5 mm transmucosal height.

O objetivo deste estudo foi avaliar a resistência compressiva sob carga oblíqua em pilares com dois diferentes diâmetros e alturas de transmucoso usados para prótese implanto-suportada cimentada em implantes de cone Morse. Quarenta implantes de cone morse foram divididos em quatro grupos com diferentes tamanhos de pilares para próteses cimentadas a fim de realizar o teste compressivo. Os grupos foram divididos pelo diâmetro do pilar e altura de transmucoso como segue: 1) 4,5 x 2,5 mm; 2) 4,5 x 3,5 mm; 3) 3,3 x 2,5 mm; e 4) 3,3 x 3,5 mm. Um ensaio de compressão oblíqua foi realizado em cada amostra localizada numa plataforma a 30º utilizando uma máquina de ensaios universal, com célula de carga de 1.000 kgf e 0,5 mm/min de velocidade até atingir a deformação do pescoço do pilar. A resistência compressiva e seu comportamento mecânico foram registrados para cada grupo e os dados foram analisados utilizando os testes Shapiro-Wilk, ANOVA e Scheffé. Além disso, a deformação detalhada de todas as amostras foi registrada com uma câmera convencional conectada ao equipamento endoscópico. Foram observadas diferenças significativas entre os grupos, com exceção dos Grupos 2 e 3 (p>0,005). Todos os pilares mostraram deformação permanente na região superior e na porção transmucosa; porém, as roscas dos parafusos estavam intactas. Fraturas foram apenas identificadas nos Grupos 3 e 4. Foi observado melhor comportamento mecânico e resistência compressiva nos pilares com diâmetro de 4,5mm e altura de transmucoso de 2,5mm.

A modified technique for extraoral cementation of implant retained restorations for preventing excess cement around the margins

The major drawback of cement-retained restorations is the extrusion of the excess cement into the peri-implant sulcus, with subsequent complications. Insufficient removal of the excess cement may initiate a local inflammatory process, which may lead to implant failure. This article presents a method of controlling cement flow on implant abutments, minimizing the excess cement around implant-retained restorations.

Submucosal zirconia implant prosthesis fabricated with CAD/CAM / 대한치과보철학회지

They have been recently introduced many aesthetic implant prosthesis using with zirconia and CAD/CAM. However, there are many limitations in their gingival and occlusal region. In this case, submucosal zirconia implant prosthesis were fabricated with CAD/CAM system. The connection of these screw cement retained prosthesis and titanium abutment was designed to 1mm above the fixture. The clinical results were satisfactory on the aesthetics and function.

Maxillary cement retained implant supported monolithic zirconia prosthesis in a full mouth rehabilitation: a clinical report

This clinical report presents the reconstruction of a maxillary arch with a cement retained implant supported fixed prosthesis using a monolithic zirconia generated by CAD/CAM system on eight osseointegrated implants. The prosthesis was copy milled from an interim prosthesis minimizing occlusal adjustments on the definitive prosthesis at the time of delivery. Monolithic zirconia provides high esthetics and reduces the number of metal alloys used in the oral cavity.

Utilización de una guía para el posicionamiento de prótesis fija cementada sobre implantes: relato de un caso clínico / Use of guide to positioning of cement-retained implant protheses: case report

Actualmente el uso de prótesis sobre implantes se incrementó gradualmente desde el descubrimiento de la oseointegración. La indicación inicial de los implantes fue para pacientes edéntulos totales extendiéndose después para pacientes parcialmente edéntulos. Las alternativas de retención de las piezas protésicas van desde las prótesis atornilladas hasta las prótesis cementadas o por preparación de los pilares de la forma convencional. Las prótesis cementadas sobre implantes se utilizan frecuentemente en los casos donde la inclinación de los implantes imposibilita la confección de prótesis atornilladas, debido a la salida de los tornillos de fijación por vestibular o entre los espacios interdentales comprometiendo la estética, y la resistencia cuando están localizados en las cúspides oclusales de los dientes posteriores. En ese sentido, la confección de "copings" en los pilares preparados, puede tornar el tratamiento en un proceso más rápido y seguro. No obstante, pueden surgir problemas en el momento de la instalación, debido a que el intermediario puede asumir diversas posiciones en relación a la posición del implante dificultando la colocación de la prótesis definitiva, principalmente en situaciones clínicas con más de dos implantes. De este modo, el objetivo de este trabajo fue mostrar una técnica del uso de una guía para posicionamiento de los pilares protésicos en prótesis fija cementada sobre implantes, por medio de la descripción de un caso clínico

Nowadays, the use of implant-retained prostheses has been increasing progressively since the advent of the osseointegration. The basic indication was in total edentulous patients and it was also enlarged for partially edentulous patients. Alternatives of retention could be from screw-retained implant prostheses, cement-retained implant prostheses or conventional preparations. Cement-retained implant prostheses are used frequently when the implant inclination don't allow the use of screw-retained prostheses because the screw emerge in vestibular surface or the interdental space resulting in an unaesthetic appearance and when the screw emerge on the top of the posterior cuspid teeth, diminishing the resistance. The confection of the copings on the abutments, turn the treatment faster and secure. Although, some complications can appear in the placement, because the abutment can take different positions in relation to the implant modifying the set of the prosthesis, mainly in clinical situations with more than two implants support. Thus, the aim of this study was demonstrated the use of guide to positioning of cement-retained implant prostheses, by means of a clinical case

Restaurações cimentadas versus parafusadas: parâmetros para seleção em prótese sobre implante / Cement-retained versus screw-retained restorations: selection parameters in implant-supported prosthesis

Com a previsibilidade e longevidade relacionadas à osseointegração, o tratamento com implantes dentários tornou-se uma realidade na clínica odontológica, proporcionando uma significativa melhora no restabelecimento da saúde bucal, da função e da estética nos tratamentos odontológicos. A fim de alcançar um sucesso mais duradouro da restauração protética, é de fundamental importância a seleção adequada do sistema de retenção da prótese sobre implante. Dessa forma, é imprescindível o conhecimento de fatores como a passividade na adaptação da restauração protética, aspectos oclusais, espaço interoclusal, requisitos estéticos, saúde dos tecidos moles peri-implantares, necessidade de manutenção, reversibilidade da restauração e fator financeiro, a fim de fornecer um embasamento científico suficiente aos cirurgiões dentistas para a escolha mais adequada do tipo de sistema de retenção nas mais variadas situações clínicas. Dessa forma, o objetivo do presente estudo foi discorrer, baseado na literatura, as vantagens, desvantagens, indicações, contra-indicações e dificuldades técnicas relacionadas a cada modalidade restauradora sobre implante (parafusada e cimentada).

With the previsibility and longevity related to the osseointegration, the treatment with dental implants became a reality in the dental clinic, providing a significant improvement in the restoration of the buccal health, of the function and of the aesthetics in the dental treatments. In order to reach a prosthetic restoration more successfull, it is very important the appropriate selection of the retention system of the implant-supported prosthesis. By this way, it is indispensable the knowledge of factors as the passivity in the prosthetic restoration adaptation, occlusal aspects, interocclusal space, aesthetic requirements, peri-implant soft tissue health, maintenance necessity, reversibility and financial factor, in order to provide a satisfactory scientific support to the dentists in the most appropriate retention system choice during the several clinical situations. In that way, the aim of the current study was to discourse, based on the literature, the advantages, disadvantages, indications, contraindications and technical difficulties related to each restoring modality implant-supported screwed and cemented.