Avaliação clínica e radiográfica de implantes curtos: estudo retrospectivo no período de 7 anos / Clinical and radiographic evaluation of short implants: retrospective study for a period of 7 years

Áreas edêntulas com severa reabsorção óssea têm sido reabilitadas com próteses fixas instaladas sobre implantes curtos, evitando que os pacientes sejam submetidos a cirurgias de reconstrução óssea. Este estudo retrospectivo descreve o comportamento de implantes curtos avaliados em um período de 7 anos. A amostra foi composta por 70 pacientes, de ambos os gêneros, que receberam 136 implantes, de 6 ou 8mm de comprimento (Straumann® bone level e tissue level standard plus) sobre os quais foram instaladas próteses unitárias e múltiplas, cimentadas e parafusadas. Foram realizadas avaliações clínicas e radiográficas mensurando a estabilidade do implante por frequência de ressonância, perda óssea marginal por meio de radiografias panorâmicas, índices de placa e de sangramento marginal, taxas de sobrevivência do implante e da prótese. Dois implantes instalados na mandíbula foram perdidos, resultando em uma taxa de sobrevivência de 98,3%. A taxa de sobrevivência das próteses foi de 100%; a média de perda óssea foi de - 0,28mm; a estabilidade média dos implantes foi de 76,515 ISQ; as médias dos índices de placa e de sangramento foram de 32,83% e 33,21%, respectivamente. A estabilidade do implante foi maior na mandíbula que na maxila (p = 0,006). Os resultados obtidos nesta pesquisa, possibilitam afirmar que os implantes curtos podem ser utilizados com segurança dentro de suas indicações específicas.(AU)

Edentulous areas with severe bone resorption have been rehabilitated with fixed prostheses installed on short implants, avoiding surgeries of bone reconstruction. This retrospective study describes the behavior of short implants evaluated during 7 years. The sample consisted of 70 patients, of both genders, who received 136 implants, 6 or 8mm in length (Straumann® bone level and tissue level standard plus) on which single and multiple, cemented and screwed prostheses were installed. Clinical and radiographic evaluations were performed by measuring implant stability by resonance frequency, marginal bone loss by panoramic radiographs, plaque and marginal bleeding rates, the implant and prostheses survival rates. Two implants installed in mandible were lost, resulting in a survival rate of 98,3%. The prostheses survival rate was 100%; mean bone loss was -0,28mm; mean implants stability was 76,52 ISQ; mean plaque and bleeding indexes were 32,83% and 33,21%, respectively. The implant stability was higher in the mandible than in the maxilla (p = 0.006). The results obtained in this research make it possible to state that short implants can be used safely within their specific indications.(AU)

Enxerto de tecido mole como opção para suprir defeitos peri-implantares. Relato de caso clínico / Soft tissue grafting as an option to address peri-implant defects. Clinical case report

A estética tem sido considerada um fator determinante no direcionamento do desenvolvimento da implantodontia, envolvendo além da anatomia do dente a ser substituído, a aparência saudável e harmônica do tecido peri-implantar. O enxerto de tecido conjuntivo tem sido empregado com alto índice de sucesso para obtenção de estética, função e saúde dessa mucosa. Objetivo: apresentar um caso clínico que ilustre a técnica de enxerto de tecido conjuntivo associada a retalho reposicionado lateralmente como uma opção viável para regiões peri-implantares esteticamente comprometidas. Materiais e Métodos: paciente do gênero feminino, 51 anos de idade, compareceu a clínica odontológica com queixa de desarmonia entre dentes, implante e gengiva na região superior-anterior. Optou-se por um retalho deslocado lateralmente seguido de enxerto de tecido conjuntivo na região peri-implantar do dente 11 com o objetivo de ganho de tecido em altura e volume gengival. Resultados: em um pós-operatório de 30 dias observou-se completa cobertura da superfície peri-implantar e ganho de tecido queratinizado. Em um controle pós-operatório de 1 ano, a estética e harmonia foram obtidas com a opção de tratamento escolhida. Conclusão: o relato de caso evidenciou a necessidade do reconhecimento pelo Cirurgião-Dentista das alternativas de cirurgias periodontais para suprir esses defeitos gengivais além de ilustrar uma das técnicas viáveis para solucionar este tipo de problema...

Esthetics has been considered one of the dominating factors for the development of the implant therapy, involving not only the anatomy of the tooth to be replaced, but also the healthy and harmonious appearance of the periimplant tissue. Connective tissue grafting has been employed with high success rates to obtain esthetics, function and health of the soft tissue mucosa. Objective: To present a clinical case that illustrates a connective tissue grafting technique associated with a laterally-displaced flap approach as an option for esthetically compromised periimplant regions. Materials and Methods: A Female patient, 51 years, attended our dental office complaining of lack of harmony between teeth, implant and gingiva in the anterosuperior region of the mouth. A laterally-displaced flap approach followed by connective tissue grafting was performed in the periimplant region of tooth 11 in order to increase gingival tissue height and volume. Results: Thirty days post-operatively, the patient demonstrated complete coverage of the periimplant surface and gains in keratinized tissue. In the one-year follow-up visit, esthetics and harmony were obtained with the chosen treatment. Conclusion: This case report demonstrated the need to recognize the different periodontal surgeries alternatives by the dentist in order to deal with gingival defects, and to illustrate one of the possible techniques to solve this type of problem...

The Infection after Augmentation Rhinoplasty Using Silicone Implant

Augmentation rhinoplasty using silicone implant is one of the most common cosmetic procedures in Korea, but is not without several complications such as exposure of the implant, its deviation and deformity. Above all, infection and extrusion through the skin is most serious complication. The purpose of this study was to determine the type of microbial colonization on silicone implant removed from symptomatic patients and to prevent from the infection. Over the past 11 years, from February of 1996 to February of 2007, we have done 134 aesthetic rhinoplasties using silicone implant in our clinic, patient ages ranged from 15 to 62 years with an average of 29.2 years. 78 percent of patients (105) were female, and 22 percent (29) were male. Among them, four cases had the local infection. The infection rate was 2.9 percent. Total six cases of implant including the other two case augmented elsewhere having the infection were removed and submitted for Gram stain, standard aerobic and anaerobic bacterial culture, and fungal cultures. Staphylococcus aureus was isolated most frequently (four cases), followed by Pseudomonas aeruginosa (one case) and Proteus mirabilis (one case). No fungal infections were identified. In order to reduce the infection rates after augmentation rhinoplasty using silicone implant, rhinorrhea as a source of bacterial nutrients should thoroughly be managed perioperatively. The hairs of the nostril should appropriately be shaved, and the patient's entire face and internal nares meticulously prepared. The implant should be shaped to be shorter, smaller and thinner, appropriately to the patient's nasal phenotype. Also, subperiosteal implantation rather than subcutaneous or subfascial is better choice.

Implante subperióstico parcial superior / Upper partial subperiosteal implant

Se realizó un trabajo clínico sobre un paciente desdentado parcial superior clase II de Kennedy (desdentado de extensión distal unilateral), con extrema reabsorción alveolar y neumatización amplia del seno maxilar. La rehabilitación consistió en una prótesis fija empleando como pilares los dos dientes naturales próximos a la zona desdentada y un muñón distal emergente de un implante subperióstico parcial. Los controles a los 3, 6, 9 y 12 meses demostraron morfofuncionalidad de dientes e implante subperióstico, cuando éstos se conectan a través de una prótesis fija convencional

A newly designed partial subperiosteal implant and the classical design: a comparative study

Seventy two partial subperiosteal implants were inserted in 52 patients. Thirty six of these implants had a classical design in which the submerged structure had thick primary and secondary connectors. Thirty six implants had a newly designed submerged structure consisting of long and thin primary connectors with grooves along their outer surfaces designed to stop or delay the downgrowth of epithelial mucosa. A six year evaluation revealed a 92.5 per cent success of the newly designed implants and an 84 per cent success for the classical design. A 10 year statistical projection revealed a 50 per cent cumulative success for the classical design and a 92.5 per cent success for the new design

Terapia con implantes / Implant therapy

En este documento se describen las diferentes técnicas de implantes, los tipos existentes y materiales disponibles, los métodos de selección, sus indicaciones y los criterios de éxito para evaluar los beneficios terapéuticos