| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 4.51 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Introdução: Os processos remodeladores fisiológicos pós extração dentária são inevitáveis e levam a uma perda total do ligamento periodontal e da reabsorção do osso alveolar. Nos tratamentos com implantes imediatos pós extração, os pilares de cicatrização customizados apresentam-se como uma solução para o selamento do alvéolo e preservação do contorno de tecidos moles. O objetivo deste estudo é comparar as diferenças clínicas verificadas durante o primeiro ano de tratamento entre dois tipos de selamento de alvéolos pós extracionais, reabilitados com implantes dentários imediatos, na arcada maxilar. Materiais e Métodos: O presente estudo foi desenhado como um estudo clínico prospetivo, controlado randomizado com paralelismo de grupos teste. Pacientes tratados com implante imediato após extração atraumática sem recurso a retalho, entre o 15 e o 25, foram alocados a dois grupos que diferem no tipo de selamento do alvéolo: Grupo I recebeu matriz de colagénio e o grupo II foi tratado com pilar de cicatrização customizado. Impressões digitais foram realizadas antes da extração T0, a um mês T1, a quatro meses T2, e a doze meses T3 após inserção do implante. Os ficheiros digitais foram sobrepostos com um software informático para avaliar as alterações dimensionais entre os dois grupos em estudo. A variação da mucosa entre T0 e T3 foi calculada avaliando a presença da papila mesial (MPHv) e distal (DPHv) e da altura da mucosa (MGHv). Os valores médios foram comparados e a significância estatística foi estabelecida a 0,05. Resultados: Vinte e oito pacientes (idade média de 54,00+/-12,20 anos), quatorze em cada grupo, foram avaliados após um período de 12 meses. Durante o período de acompanhamento não foram registadas complicações biológicas ou protéticas. Foram observadas diferenças significativas entre os valores médios de volume vestibular em T1 (p=0,043) no grupo I e II (-9,75+/-6,65% e -4,76+/-5,29%, respetivamente). Também durante o primeiro mês de tratamento o volume total apresenta-se com significância estatística (p=0,021) mostrando uma variação de -8,90+/-5,03% no grupo I e -4,17+/-4,52% no grupo II. No acompanhamento de 1 ano, não foram encontradas diferenças significativas em termos de variação volumétrica entre os dois grupos. Considerando variações de mucosa, apenas os valores médios de MPHv apresentaram diferenças significativas (p=0,048), observando uma variação de - 0,47+/-0,38mm no grupo I e -0,24+/-0,18mm no grupo II. Conclusão: Ambas as modalidades de tratamento se apresentaram como opções de selamento alveolar previsíveis em colocações de implantes imediatos maxilares, mas ambas falharam na prevenção de perda volumétrica em zonas peri-implantares. No primeiro mês de tratamento, os pilares de cicatrização customizados apresentaram menor perda volumétrica, apesar de não existirem diferenças nos valores obtidos aos 12 meses de tratamento.
Introduction: After a single-tooth extraction, physiological remodeling processes are unavoidable which leads to a total loss of the periodontal ligament and resorption of the bundle bone. Immediate implant placement (IIP) associated with the use of bone substitutes and collagen matrices seems to reduce the amount of resorption at periimplant areas. Recently, customized healing abutments appeared as another solution to seal the socket and preserve the original soft tissue contour. The aim of this study is to compare the clinical differences reported during the first year of treatment between two types of alveolar sealing, when used with immediate implants in the aesthetic area. Materials and Methods: The present study was designed as a prospective, randomized, controlled clinical trial with a parallel-group design. Patients treated with single-tooth maxillary implants after atraumatic flapless extraction, between 15 and 25, were allocated into two groups regarding a different type of socket sealing: Group I received a collagen matrix and group II was treated with a customized healing abutment. Digital impressions were taken prior to extraction (T0), one month (T1), four months (T2) and 12 months (T3) after implant insertion. The digital files were superimposed with computer software allowing to evaluate volumetric changes between different time points at peri-implant tissue areas like Buccal Volume Variation (BVv) and Total Volume Variation (TVv). Mucosa variation between T0 and T3 was digitally computed assessing the papilla presence at mesial (MPHv) and distal (DPHv) sites and the mucosa height (MGHv). Mean values were compared and statistical significance was set at 0,05. Results: Twenty-eight patients (mean age 54,00+/-12,20 years), fourteen in each group, were evaluated after a 12-month period. No complications occurred in all included patients during the follow-up periods. Significant differences between mean values of BVv at T1 (p=0,043) were observed at the Group I and Group II (-9,75+/-6,65% and -4,76+/-5,29%, respectively). Also, during the first month of treatment, TVv appeared as statistically significant (p=0,021) showing a variation of -8,90+/-5,03% at Group I and -4,17+/-4,52% at Group II. At one-year follow-up, no significant differences were found in terms of volume variation between the two groups. Regarding mucosa variation, only mean values of MPHv exhibited significant differences (p=0,048), observing a variation of -0,47+/-0,38mm at Group I and -0,24+/-0,18mm at Group II. Conclusion: Both treatment modalities showed a predictable socket sealing option in maxillary immediate implant placement yet failed to prevent volume tissue loss on periimplant areas. At the first month of treatment, customized abutments presented less volume variation, although no differences could be assessed at the 1-year follow up.
Introduction: After a single-tooth extraction, physiological remodeling processes are unavoidable which leads to a total loss of the periodontal ligament and resorption of the bundle bone. Immediate implant placement (IIP) associated with the use of bone substitutes and collagen matrices seems to reduce the amount of resorption at periimplant areas. Recently, customized healing abutments appeared as another solution to seal the socket and preserve the original soft tissue contour. The aim of this study is to compare the clinical differences reported during the first year of treatment between two types of alveolar sealing, when used with immediate implants in the aesthetic area. Materials and Methods: The present study was designed as a prospective, randomized, controlled clinical trial with a parallel-group design. Patients treated with single-tooth maxillary implants after atraumatic flapless extraction, between 15 and 25, were allocated into two groups regarding a different type of socket sealing: Group I received a collagen matrix and group II was treated with a customized healing abutment. Digital impressions were taken prior to extraction (T0), one month (T1), four months (T2) and 12 months (T3) after implant insertion. The digital files were superimposed with computer software allowing to evaluate volumetric changes between different time points at peri-implant tissue areas like Buccal Volume Variation (BVv) and Total Volume Variation (TVv). Mucosa variation between T0 and T3 was digitally computed assessing the papilla presence at mesial (MPHv) and distal (DPHv) sites and the mucosa height (MGHv). Mean values were compared and statistical significance was set at 0,05. Results: Twenty-eight patients (mean age 54,00+/-12,20 years), fourteen in each group, were evaluated after a 12-month period. No complications occurred in all included patients during the follow-up periods. Significant differences between mean values of BVv at T1 (p=0,043) were observed at the Group I and Group II (-9,75+/-6,65% and -4,76+/-5,29%, respectively). Also, during the first month of treatment, TVv appeared as statistically significant (p=0,021) showing a variation of -8,90+/-5,03% at Group I and -4,17+/-4,52% at Group II. At one-year follow-up, no significant differences were found in terms of volume variation between the two groups. Regarding mucosa variation, only mean values of MPHv exhibited significant differences (p=0,048), observing a variation of -0,47+/-0,38mm at Group I and -0,24+/-0,18mm at Group II. Conclusion: Both treatment modalities showed a predictable socket sealing option in maxillary immediate implant placement yet failed to prevent volume tissue loss on periimplant areas. At the first month of treatment, customized abutments presented less volume variation, although no differences could be assessed at the 1-year follow up.
Descrição
Palavras-chave
Implantes dentários Perda óssea alveolar Tecidos peri-implantares Análise volumétrica Pilar cicatrização customizado Dental implants Alveolar ridge augmentation Alveolar bone loss Three-dimensional imaging Customized healing abutment