Condicionamento gengival em coroas provisórias sobre implantes em área estética: um ensaio clínico / Gingival conditioning in provisional crowns on implants in the aesthetic area: a clinical trial

INTRODUÇÃO: O fator estético é um dos critérios utilizados na definição do sucesso de reabilitações implantossuportadas. Os critérios estéticos dos profissionais para essa característica variam a depender da sua área de especialização e vivência clínica. O objetivo desse trabalho é mensurar a influência do condicionamento gengival no resultado estético, bem como avaliar a percepção de diferentes especialidades no resultado dessa intervenção em restaurações provisórias unitárias sobre implante na região do sorriso. METODOLOGIA: Dez pacientes foram submetidos a cirurgia de instalação de implante com conexão cônica. Todos os pacientes receberam próteses provisórias sobre implante em resina acrílica. O processo de condicionamento gengival foi realizado pela técnica não-cirúrgica de pressão gradual. Fotografias da região reabilitada foram realizadas na instalação da coroa provisória e na última sessão de condicionamento gengival. Três avaliadores especialistas e um clínico geral, mascarados com relação a fase da restauração provisória, aplicaram o Pink Esthetic Score (PES) a partir dos critérios observados nas fotografias. Cada avaliador repetiu o PES três vezes num espaço de 3 dias entre as avaliações, nas quais a sequência de fotografias era diferente. Os resultados foram avaliados estatisticamente utilizando o Coeficiente de Correlação Intraclasse (CCI), o teste não-paramétrico de Wilcoxon e o teste de qui-quadrado de Pearson. RESULTADOS: Os avaliadores tiveram uma concordância média para os valores de PES e todos os critérios constituintes (entre 40% e 75%), no qual o clínico geral apresentou maior grau de discordância em todos os parâmetros. O protesista foi o mais criterioso para as avaliações enquanto o clínico geral e o periodontista apresentaram medianas semelhantes para os escores antes e depois. Existiu diferença significativa entre a avaliação do PES antes e depois do condicionamento gengival para todos os avaliadores (p<0,05), indicando que houve melhora na estética após a realização do condicionamento gengival. CONCLUSÃO: O condicionamento gengival influencia positivamente no escore do PES e de seus parâmetros constituintes e essa diferença pode ser notada por todos os avaliadores (AU).

BACKGROUND: The esthetic outcome is one of the criteria used to build a definition of success in implant-supported restorations. The esthetic criteria of professionals for these characteristics vary depending on their area of specialization and clinical experience. The aim of this study is to measure the influence of soft tissue conditioning on esthetic outcome as well as to evaluate the perception of different specialties in the result of this intervention in provisional crowns on single implants in the smile zone. METHODS: Ten patients underwent an implant placement surgery to insert a morse tapered implant. All patients received an acrylic resin implantsupported provisional crown. The soft tissue conditioning process was performed with a non-surgical technique of gradual pressure. Photographs of the rehabilitated region were taken at the first provisional crown insertion and at the last session of soft tissue management. Three specialists and a general practitioner were selected as blinded examiners and applied the Pink Esthetic Score (PES) based on the criteria observed in the photographs. Each examiner repeated the PES three times within three days between analyses. Each evaluation had a different sequence of photos. The results were analyzed using the Intraclass Correlation Coefficient (ICC), the nonparametric Wilcoxon signed-rank test, and the Pearson's chi-square test. RESULTS: The evaluators had a mean agreement for PES values and all the constituent criteria (between 40% and 75%), in which the general practitioner showed the greater degree of disagreement in all parameters. The prosthodontist gave the lowest scores for the evaluations while the general practitioner and the periodontist presented similar results (highest scores) for the before and after scores. There was a significant difference between the evaluation of PES before and after gingival conditioning for all evaluators (p <0.05), indicating that there was an improvement in aesthetics after gingival conditioning. CONCLUSION: Soft tissue conditioning positively influences the PES score and its constituent parameters and this difference could be noticed by all the evaluators (AU).

Evolución de pacientes tratados con implantes unitarios de carga inmediata en la Clínica Estomatológica Provincial de Santiago de Cuba / Progress of patients treated with immediately loaded single implants in the Provincial Stomatological Clinic from Santiago de Cuba

Se realizó un estudio descriptivo, longitudinal y prospectivo para describir la evolución de 55 pacientes tratados con 65 implantes unitarios de carga inmediata (marca MIS o Nano), colocados sobre huesos cicatrizados en la Clínica Estomatológica Provincial Docente de Santiago de Cuba durante el período comprendido desde septiembre de 2010 hasta enero de 2012. Entre los criterios más desfavorables para considerar la estética inadecuada en algunas restauraciones, sobresalieron el color y la posición de estas; asimismo, la higiene bucal deficiente, la masticación de alimentos duros y la no asistencia a los controles clínicos fueron las indicaciones más incumplidas. La rehabilitación con implante unitario de carga inmediata resultó exitosa en 86,2 por ciento de los integrantes de la casuística y 38 de ellos (74,5 por ciento) se mostraron satisfechos con los resultados terapéuticos de la técnica, cuya aplicación contribuyó a la integridad biopsicosocial y calidad de vida de los pacientes(AU)

A descriptive, longitudinal and prospective study was carried out to describe the progress of 55 patients treated with 65 immediately loaded single implants (MI or Nano types), placed on healed bones in the Teaching Provincial Stomatological Clinic in Santiago de Cuba during the period from September, 2010 to January, 2012. Among the most unfavorable approaches to consider the inadequate aesthetics in some restorations, there were the color and their positions; also, the scarce buccal hygiene, the chewing of hard foods and the non attendance to the clinical appointments were the most unfulfilled indications. The rehabilitation with immediately loaded single implant was successful in 86.2 percent of the members of the case material and 38 of them (74.5 percent) were satisfied with the therapeutic results of the technique which application contributed to the bio psychosocial integrity and life quality of the patients(AU)

Evolución de pacientes con sobredentadura e implantología con carga inmediata / Progress of patients with overdenture and immediate load implant

Se realizó una investigación descriptiva, longitudinal y prospectiva en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba en el período comprendido desde septiembre de 2010 hasta julio de 2012, a fin de evaluar la evolución de 17 pacientes tratados con implantes roscados marca MIS, con abutmen o atache de bola, cargados inmediatamente, para lo cual se convirtió la misma prótesis que portaban en una sobredentadura mandibular soportada en la mucosa y retenida por el implante, pues su aparato protésico convencional carecía de la funcionalidad deseada. La rehabilitación con ese tipo de sobredentadura fue efectiva en aquellos pacientes con problemas en los principios biomecánicos de retención y estabilidad, así como también en los que presentaban una buena disponibilidad de hueso y en los que se colocaron implantes de mayor longitud, todos los cuales respondieron mejor al tratamiento; por consiguiente, se elevó su calidad de vida al proporcionarles confort y seguridad con el uso de su aparato protésico(AU)

A descriptive longitudinal and prospective study was conducted in Martires del Moncada Provincial School of Dentistry of Santiago de Cuba from September 2010 to July 2012 in order to evaluate the progress of 17 patients treated with threaded implants MIS, abutmen or ball attachment, immediately loaded, for which the same prosthesis became a mandibular overdenture supported on the mucosa and retained by the implant, because their conventional prosthetic device lacked the desired functionality. The rehabilitation with this type of overdenture was effective in those patients with compromised biomechanical principles of retention and stability, as well as in those having a good bone availability and in those with greater length implants, thus responding better to treatment. Therefore, their quality of life increased by providing comfort and safety with the use of this prosthetic device(AU)

Evolución de pacientes con sobredentadura e implantología con carga inmediata / Progress of patients with overdenture and immediate load implant

Se realizó una investigación descriptiva, longitudinal y prospectiva en la Clínica Estomatológica Provincial Docente "Mártires del Moncada" de Santiago de Cuba en el período comprendido desde septiembre de 2010 hasta julio de 2012, a fin de evaluar la evolución de 17 pacientes tratados con implantes roscados marca MIS, con abutmen o atache de bola, cargados inmediatamente, para lo cual se convirtió la misma prótesis que portaban en una sobredentadura mandibular soportada en la mucosa y retenida por el implante, pues su aparato protésico convencional carecía de la funcionalidad deseada. La rehabilitación con ese tipo de sobredentadura fue efectiva en aquellos pacientes con problemas en los principios biomecánicos de retención y estabilidad, así como también en los que presentaban una buena disponibilidad de hueso y en los que se colocaron implantes de mayor longitud, todos los cuales respondieron mejor al tratamiento; por consiguiente, se elevó su calidad de vida al proporcionarles confort y seguridad con el uso de su aparato protésico.

A descriptive longitudinal and prospective study was conducted in "Martires del Moncada" Provincial School of Dentistry of Santiago de Cuba from September 2010 to July 2012 in order to evaluate the progress of 17 patients treated with threaded implants MIS, abutmen or ball attachment, immediately loaded, for which the same prosthesis became a mandibular overdenture supported on the mucosa and retained by the implant, because their conventional prosthetic device lacked the desired functionality. The rehabilitation with this type of overdenture was effective in those patients with compromised biomechanical principles of retention and stability, as well as in those having a good bone availability and in those with greater length implants, thus responding better to treatment. Therefore, their quality of life increased by providing comfort and safety with the use of this prosthetic device.

Evolución de pacientes tratados con implantes unitarios de carga inmediata en la Clínica Estomatológica Provincial de Santiago de Cuba / Progress of patients treated with immediately loaded single implants in the Provincial Stomatological Clinic from Santiago de Cuba

Se realizó un estudio descriptivo, longitudinal y prospectivo para describir la evolución de 55 pacientes tratados con 65 implantes unitarios de carga inmediata (marca MIS o Nano), colocados sobre huesos cicatrizados en la Clínica Estomatológica Provincial Docente de Santiago de Cuba durante el período comprendido desde septiembre de 2010 hasta enero de 2012. Entre los criterios más desfavorables para considerar la estética inadecuada en algunas restauraciones, sobresalieron el color y la posición de estas; asimismo, la higiene bucal deficiente, la masticación de alimentos duros y la no asistencia a los controles clínicos fueron las indicaciones más incumplidas. La rehabilitación con implante unitario de carga inmediata resultó exitosa en 86,2 % de los integrantes de la casuística y 38 de ellos (74,5 %) se mostraron satisfechos con los resultados terapéuticos de la técnica, cuya aplicación contribuyó a la integridad biopsicosocial y calidad de vida de los pacientes.

A descriptive, longitudinal and prospective study was carried out to describe the progress of 55 patients treated with 65 immediately loaded single implants (MI or Nano types), placed on healed bones in the Teaching Provincial Stomatological Clinic in Santiago de Cuba during the period from September, 2010 to January, 2012. Among the most unfavorable approaches to consider the inadequate aesthetics in some restorations, there were the color and their positions; also, the scarce buccal hygiene, the chewing of hard foods and the non attendance to the clinical appointments were the most unfulfilled indications. The rehabilitation with immediately loaded single implant was successful in 86.2% of the members of the case material and 38 of them (74.5%) were satisfied with the therapeutic results of the technique which application contributed to the bio psychosocial integrity and life quality of the patients.

Implantes de carga inmediata: revisión de la literatura y presentación de un caso clínico / Immediately loaded implants: literature review and presentation of a clinical case

La actual demanda estética y funcional de nuestros pacientes, hace que cada vez se intente disminuir el tiempo de espera desde la colocación del implante dental y la rehabilitación protésica. Estudios en los últimos años han demostrado que bajo ciertas condiciones se pueden obtener resultados satisfactorios en periodos más cortos con la aplicación de cargas inmediatas. El tipo de hueso y su calidad, así como la superficie del implante, la estabilidad primaria del implante dental; son algunos de los parámetros que determinen en qué casos podría realizarse la carga prematura de los implantes dentales. Actualmente la carga inmediata es ya considerada como una opción terapéutica segura, habitual y frecuentemente solicitada por nuestros pacientes. El objetivo de este trabajo es presentar un revisión de la literatura en donde trataremos el tema de la carga inmediata y todo lo que esta técnica implica, al igual que la presentación de un caso clínico de una paciente femenina de 52 años de edad la cual fue rehabilitada protésicamente con implantes dentales unitarios de carga inmediata en zona de maxilar superior y en zona mandibular

The current aesthetic and functional demands of our patients, makes it increasingly try to decrease the waiting time from the placement of dental implant and prosthetic rehabilitation. Studies in recent years have shown that under certain conditions can be obtained satisfactory results in shorter periods with the implementation of immediate charges. The type and quality of bone and the surface of the implant, the primary stability of dental implant; are some of the factors that determine the selection of patients who can undergo the premature loading of dental implants. Currently immediate loading is already regarded as a safe therapeutic option, routine and frequently requested by our patients. The objective of this study is to present a review of the literature where we address the issue of immediate loading and all that this implies, as well as the presentation of a case of a female patient aged 52 which was rehabilitated prosthetic dental implant unit immediate loading zone area maxilla and mandibl

Implante unitário com carga imediata: relato de 2 casos clínicos / Unitary conical implant with immediate load: report of two clinical cases

A instalação de uma coroa imediatamente após a instalação do implante pode ajudar a preservar a arquitetura gengival e o osso alveolar, permitindo uma redução significativa do tempo e custo de tratamento. Este trabalho descreve dois casos clínicos onde uma coroa acrílica provisória foi instalada imediatamente após a instalação do implante e as pacientes acompanhados por 6 (seis) e 4 (quatro) meses respectivamente , não apresentando neste período qualquer complicação. Embora o tempo de acompanhamento seja curto, acreditamos que esta pode ser uma técnica a ser utilizada quando bem indicada e executada

The installation of a crown immediately after the installation of its implant can help to preserve the architecture of gum and the alveolar bone, allowing a significant reduction of the time and treatment cost. This work describes two clinical cases where a temporary acrylic crown was installed immediately after the installation of its implant and the patient accompanied by 6 (six) and 4 (four) months, not presenting in this period any complication. Although the time of accompaniment is short, we believed that this could be a technique to be used when very suitable and executed