Preservação e manutenção do rebordo alveolar para instalação de implantes

A preservação das estruturas ósseas e a manutenção do volume do processo alveolar, que envolve o dente a ser extraído, podem ser obtidas por meio da exodontia minimamente evasiva...

Granuloma central de células gigantes / Giant cells central granuloma

El granuloma reparativo central de células gigantes es una lesión proliferativa no neoplásica de etiología desconocida. Se presenta un paciente masculino de 40 años de edad, portador de prótesis parcial superior. Fue remitido al Servicio de Cirugía Maxilofacial del Hospital V I Lenin por presentar aumento de volumen en reborde alveolar superior, de color rojo grisáceo y que provocaba expansión de corticales óseas. Una vez analizados los exámenes clínicos, radiográficos e histopatológicos se diagnosticó un granuloma reparativo central de células gigantes Se realizó exéresis quirúrgica de la lesión y extracción de dientes adyacentes con una evolución satisfactoria sin señales de recidivas luego de tres años del tratamiento. El granuloma reparativo central de células gigantes se presentó como respuesta a un trauma. La correcta interpretación de los datos clínicos, radiográficos e histopatológicos nos permitió llegar al correcto diagnóstico y plan de tratamiento(AU)

Giant-cell central reparative granuloma is non neoplastic proliferative lesion of unknown etiology. We report a 40 years old male patient who was admitted at the Maxillofacial Service of the V I Lenin Hospital. The patient had partial upper prosthesis and was complaining of red-grey volume increase lesion in upper alveolar ridge which led to the expansion of cortical bone. Having analyzed clinical, radiographic and histopathological findings the case was concluded as a giant-cell central reparative granuloma. Surgical exeresis and adjunct tooth extraction were done. After three years of treatment, satisfactory follow up without recurrence is reported(AU)

Distracción osteogénica alveolar como método de aumento del reborde alveolar / Alveolar osteogenic distraction as method to increase the alveolar ridge

La distracción osteogénica alveolar, como proceso biológico de neoformación de hueso alveolar, nos motivó a la realización de la presente revisión bibliográfica, con el objetivo enfatizar en el análisis de las variables: antecedentes históricos en Cuba, clasificación de los distractores, fases de la distracción (latencia, distracción y consolidación), indicaciones, contraindicaciones, ventajas, desventajas y complicaciones. Se realizó una revisión bibliográfica mediante la consulta de bases de datos de los sistemas referativos, como MEDLINE y PubMed con la utilización de descriptores alveolar distraction y osteogenic distraction. Se consultaron las fuentes bibliográficas publicadas fundamentalmente en los últimos 5 años, lo que reveló que esta técnica es una excelente alternativa para la formación de huesos y tejidos blandos en zonas de atrofia alveolar, que consta de tres etapas: latencia, distracción y consolidación; un método previsible y con bajas tasas de reabsorción ósea en comparación con otras técnicas de aumento del reborde alveolar. Tiene su principal indicación en la terapia de implantes al proveer volumen óseo. Debemos individualizar cada caso y usar el método más adecuado según las características clínicas y personales del paciente. Una adecuada selección de los casos y una mejor comprensión de la técnica son los puntales para lograr exitosos resultados mediante la distracción osteogénica alveolar. En Cuba se ha aplicado poco la distracción alveolar, por lo que ha sido necesario ampliar los estudios sobre esta temática(AU)

The alveolar osteogenic distraction, as a biological process of alveolar bone neoformation, motivates us to make the bibliographic review whose objective was to emphasize in analysis the following variables: historical backgrounds in Cuba, distraction classification, distraction phases (latency, distraction and consolidation), indications, contraindications, advantages, disadvantages and complications. A bibliographic review was made by database search of reference systems as MEDLINE and PubliMed using the descriptors alveolar distraction o osteogenic distraction. The published bibliographic sources mainly over 5 years concluding that this technique is an excellent alternative for the bone and soft tissues formation in zones of alveolar atrophy including three stages: latency, distraction and consolidation; being a foreseeable method and with low rates of bone reabsorption compared to other techniques of increase of alveolar ridge. It has its main indication in implant therapy to provide bone volume. We must to individualize each case and to use the more appropriate method according the clinical and personal features of patient. A proper case selection and a better understand of technique are essential to achieve successful results by alveolar osteogenic distraction. In Cuba the alveolar distraction has been not much applied being necessary to expand the studies on this subject matter(AU)

Peri-implant bone loss around posterior mandible dental implants placed after distraction osteogenesis: preliminary findings.

BACKGROUND: The present study evaluates implant survival and peri-implant bone loss around posterior mandible dental implants placed at sites of distraction osteogenesis. METHODS: On removal of the distraction devices, 34 dental implants were inserted into 14 posterior mandible sites in 10 healthy, non-smoking female patients. Prosthetic treatment was performed 4 months after implant placement using fixed implant prostheses. After 6 to 16.5 months, periapical radiographs were taken and evaluated for peri-implant bone loss and radiolucency. The distance between the implant margin and the first visible bone-implant contact was measured on the mesial and distal aspects of the implants using imaging software. Radiographic dimensional distortion was corrected as a function of the known true dimension of the implant. RESULTS: Of the 34 implants placed, two (5.9%) failed to integrate at reentry surgery. Both were replaced and restored during the course of the study so that a total of 34 implants was followed for 12.1 +/- 3.8 months post-restoration and 16.1 +/- 3.8 months post-insertion. Mean loss of marginal bone height was 2.6 +/- 1.0 mm. During the follow-up period, radiolucent lines along the implant surface were absent. CONCLUSIONS: The mean peri-implant bone loss in areas of alveolar bone distraction was 1.9 mm/year. A high implant survival rate was observed.

A retrospective study of the potential complications during alveolar distraction osteogenesis in 55 patients.

The aim of this retrospective study was to analyse the outcome of alveolar distraction osteogenesis for the correction of vertical defects in a large series of 55 cases. The existing bone deficiencies were secondary to atrophy after periodontal disease or tooth extraction. The overall success rate of this technique was 89.1%. The complications presented during treatment were divided into minor (no effect on final result, but immediate intervention required) 14/55 patients (25.4%), and major (lead to technique failure) 6/55 patients (10.9%). The frequency of minor complications was 8/27 in the anterior maxillary region, 1/27 in the anterior mandibular region and 15/27 in the posterior mandibular region. The frequency of major complications was 5/6 in the posterior mandibular region and 1/6 in the anterior maxillary region. The mean alveolar height achieved was 6mm. The overall rate was 36.3%. On the basis of these results it was concluded that alveolar distraction osteogenesis is an effective technique to treat vertical alveolar ridge deficiencies.

Distracción osteogénica alveolar con dispositivo simple: revisión del tema a propósito de un caso / Osteogenic alveolar distraction with simple appliance: Review of the topic apropos of a case

Con el objetivo de validar un dispositivo simple con tornillos de distracción para aumentos del reborde alveolar deficitario mediante distracción osteogénica, se realiza la presentación de un caso y se revisa la literatura médica actual disponible sobre el tema, se describe su evolución histórica y bases fisiológicas. La paciente de 56 años presenta una atrofia alveolar mandibular, con una altura de 7 mm. Se realizó incisión en vestíbulo, despegamiento de colgajo mucoperióstico, marcado de la osteotomía y colocación del distractor. Previo período de latencia, que se observó durante 7 días, el período de distracción se realizó activando el distractor 1,0 mm al día, hasta alcanzar un aumento en la altura de 8 mm. Una vez finalizada la distracción se mantuvo el dispositivo durante 8 semanas, hasta que consolidó el callo de fractura. Posteriormente se retiró el distractor y se colocaron los implantes a las 10 semanas de finalizada la activación. El dispositivo intraoral de distracción en estudio es una técnica novedosa y los resultados obtenidos son todavía variables, pero en este caso resultó eficaz y fiable para conseguir un determinado volumen de masa ósea en una posición predeterminad sobre la cual insertar implantes osteointegrados y lograr una correcta rehabilitación protésica(AU)

In order to validate a simple appliance with distraction screws for the enlargement of the deficient alveolar crest by osteogenic distraction, a case is presented, the current medical literature available on this topic is reviewed and the historical evolution and physiological bases are described. The 56-year-old patient presents an alveolar mandibular atrophy with a height of 7 mm. An incision was made in the vestibule, followed by the detachment of the mucoperiosteal flap, the marking of the osteotomy and the placing of the distractor. After a previous period of latency that was observed during 7 days, the distractor was activated 1.0 mm a day during the period of distraction, until attaining a height increase of 8 mm. Once the distraction was finished, the appliance was maintained during 8 weeks till the fracture callus was consolidated. Later on, the distractor was removed and the implants were placed 10 weeks after ending the activation. The intraoral distraction appliance under study is a novel technique, and the resutls attained are still variable, but in this case it proved to be efficient and reliable to achieve a certain volume of bone mass in a position predetermined to insert osteointegrated implants and to obtain a correct prosthetic rehabilitation(AU)

Short implants--an analysis of longitudinal studies.

PURPOSE: The purpose of this study was to consider the therapeutic decision whether to use advanced surgery or short implants based on data concerning the use of these implants found in follow-up studies. MATERIALS AND METHODS: The MEDLINE database was consulted for follow-up studies published between the years 1980 and 2004. For those studies that met the inclusion and exclusion criteria, data concerning the number of implants 7, 8.5, or 10 mm long placed and lost, the time at which the failure occurred, and related risk factors were gathered for 33 studies arranged in tables and subjected to analysis. The studies included 16,344 implant placements with 786 failures (4.8%). Implants were analyzed according to the time of failure (i.e., before or after prosthesis seating) and risk factors implicated in the failures. RESULTS: The total rate of failures was 4.8%. Implants 3.75 mm wide and 7 mm long failed at a rate of 9.7%, compared to 6.3% for 3.75 x 10-mm implants. It was found that 54.9% of failures occurred before the prosthesis connection. Finally, 66.7% of all failures were attributed to poor bone quality, 45.4% to the location (maxilla or mandible), 27.2% to occlusal overload, 24.2% to location within the jaw, and 15.1% to infections (an implant could be associated with multiple risk factors). DISCUSSION: The analysis revealed that among the risk factors, poor bone quality in association with short implants seemed to be relevant to failure. The use of implants 4 mm in diameter appeared to minimize failure in these situations. The 3.75 x 7-mm implant presented the highest failure rate (9.7%) of 1894 implants analyzed (excluding implant designs with higher failure rates but few total implants). CONCLUSION: Short implants should be considered as an alternative to advanced bone augmentation surgeries, since surgeries can involve higher morbidity, require extended clinical periods, and involve higher costs to the patient.