Neste artigo, os autores testam o ácido hialurônico para aumento de papila gengival (obviamente após resolução de DPs). Becker W, Gabitov I, Stepanov M, Kois J, Smidt A, Becker BE. Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study. Clin Implant Dent Relat Res 2010;12(1):1-8. A total of 11 patients with at least one papillary deficiency in the esthetic zone were treated with a commercially available gel of hyaluronic acid, < 0.2 ml of which was injected 2-3 mm apical to the coronal tip of the affected papillae. Patients were followed up from 6 to 25 months after initial application. Three implant sites and one tooth site showed 100% improvement, seven sites showed 94-97% improvement, three showed 76-88% improvement, and one showed 57% improvement. The results suggested that papillary deficiencies can be enhanced by hyaluronic acid injection.
Aqui é traçada uma correlação entre estabilidade de inserção e sobrevivência dos implantes. Rodrigo D, Aracil L, Martin C, Sanz M. Diagnosis of implant stability and its impact on implant survival: a prospective case series study. Clin Oral Implants Res 2010;21(3):255-261. A total of 4,114 implants were evaluated and implant stability was classified according to degree of rotation, i.e. A (stable, no rotation), B (unstable, light rotation), C (unstable, rotation without resistance) and D (unstable, rotation and lateral oscillation), RFA was also measured on the day of surgery and at restoration placement. Of the 4,114 implants, 3,899 and 213 were classified as stable and unstable, respectively, with survival rates of 99.1% and 97.2%, respectively. Survival rates were significantly different between the implants classified as unstable, i.e. B (98.1%), C (94.1%) and D (100%). No association was found between primary implant stability measured by RFA and implant survival, but there was a significant association between stability at restoration placement and implant survival.
Resultados divergentes são expostos neste trabalho sobre carga precoce, entretanto há que se notar as características do trabalho. Vale o registro. Schwarz S, Gabbert O, Hassel AJ, Schmitter M, Séché C, Rammelsberg P. Early loading of implants with fixed dental prostheses in edentulous mandibles: 4.5-year clinical results from a prospective study. Clin Oral Implants Res 2010;21(3):284-289. Each of 37 patients received five implants to support FPDs in the edentulous mandible; the FPDs were connected after 2 weeks. The mean observation period was 4.5 years (range 1-8 years), during which 32 complications occurred. Implant survival was 89.7% (19 implants lost) and implant success was 84.9%. Signs of peri-implantitis were noted at 2.2% of implants, and complications included one complete prosthesis failure, 10 framework fractures, three adaptations/modifications and repair of facings. Early loading was therefore associated with higher complication rates than in delayed loading studies.
A substituição de implantes de diâmetro regular por estreito se mostra plausível se observada algumas características de cada caso. Arısan V, Bölükbaşı N, Ersanlı S, Özdemir T. Evaluation of 316 narrow diameter implants followed for 5-10 years: a clinical and radiographic retrospective study. Clin Oral Implants Res 2010;21(3):296-307. A total of 139 patients received 316 narrow diameter implants restored with 120 prostheses and evaluated clinically and radiographically for 60-124 months (mean 9.1 years). Survival and success rates were 92.3% and 91.4%, respectively, and the risk of failure was increased in smoking patients and with posterior implants. Mean marginal bone loss was 1.32 ± 0.13 mm in the maxilla and 1.28 ± 0.3 mm in the mandible, which predominantly occurred within 2 years of loading. The results suggested that narrow diameter implants can be used where regular diameter implants are not suitable.
Longa proservação de casos de dois implantes e overdenture mostra bons resultados mas que são alterados quando associados ao tabagismo e implantes de um estágio. Vercruyssen M, Marcelis K, Coucke W, Naert I, Quirynen M. Long-term, retrospective evaluation (implant and patient-centred outcome) of the two implants-supported overdenture in the mandible. Part 1: survival rate. Clin Oral Implants Res 2010;21(4):357-365. This retrospective evaluation analyzed 495 cases with ≥ 5 years loading time over the past 25 years. Follow- up visits were possible for 248 patients and data were collected by phone from another 121 patients; no contact was possible for the remaining 126 patients, so information from the last visit to the clinic was used. The majority of implants (95.5%) were machined surface and the most used anchorage system was bar (86.3%) followed by ball attachments (11.7%). Mean survival rate after 20 years of loading was 95.5% and was adversely affected by smoking and one-stage implant placement but not influenced by bone quality or implant length.
A técnica de levantamento de seio maxilar se mostra, neste artigo, confiável quando realizada em associação com uso de enxerto xenógeno. de Vicente JC, Hernández-Vallejo G, Braña-Abascal P, Peña I. Maxillary sinus augmentation with autologous bone harvested from the lateral maxillary wall combined with bovine-derived hydroxyapatite: clinical and histologic observations. Clin Oral Implants Res 2010;21(4):430-438. Autogenous bone was harvested from the lateral maxillary wall in each of 34 patients and combined with bovine-derived HA in the sinus cavity; a total of 90 implants were then placed and the access window covered with a collagen membrane. After 9m months, 14 randomly selected biopsies were obtained and evaluated. New bone comprised lamellae with osteocytes in close contact with HA particles. The specimens consisted of 29% newly formed bone, 21% anorganic bovine bone and 50% marrow space. Implant survival was 98.9% (one implant was lost). Outcomes were therefore predictable with this technique.
O uso de membrana de PTFE mostra-se bastante interessante para preparo de rebordo pós-exodontia para implantação mediata. Barboza EP, Stutz B, Ferreira VF, Carvalho W. Guided bone regeneration using nonexpanded polytetrafluoroethylene membranes in preparation for dental implant placements – a report of 420 cases. Implant Dent 2010;19(1):2-7. In 420 cases of alveolar ridge maintenance for implant placement, nonexpanded PTFE membranes were placed over extraction sites and bone allograft used to prevent membrane collapse in the case of buccal wall loss. Soft tissue compatibility and keratinized gingiva were apparent at the time of implant placement, with preservation of the mucogingival position. The use of nonexpanded PTFE membranes therefore resulted in tissue suitable for implant placement.
Proservação de implantes em longo prazo e diversas condições sistêmicas. Anner R, Grossman Y, Anner Y, Levin L. Smoking, diabetes mellitus, periodontitis, and supportive periodontal treatment as factors associated with dental implant survival: a long-term retrospective evaluation of patients followed for up to 10 years. Implant Dent 2010;19(1):57-64. Data were obtained regarding smoking, diabetes, periodontitis and implant survival from 475 patients who received 1,626 implants. Patients were either in a supportive periodontal program (246 patients) or only attended annual implant examination (229 patients). Mean follow-up time was 30.82 ± 28.26 months (range 1 to 114 months). The implant survival rate was 95.3% (77 implants lost). Implant survival was significantly associated with attendance in a supportive periodontal program and smoking status. Implant survival was lower in patients with moderate-to-advanced periodontal disease, but the difference was not significant, and diabetes appeared to have no influence on implant survival.
Mais um trabalho sobre condições sistêmicas e implantes mostra sabidas correlações e a mais recente que é o risco de osteonecrose mandibular em usuários de bisfosfonados. Bornstein MM, Cionca N, Mombelli A. Systemic conditions and treatments as risks for implant therapy. Int J Oral Maxillofac Implants 2009;24(Suppl):12-27. A literature search was performed to identify studies citing implant survival in patients diagnosed with at least one of 12 systemic diseases. No comparisons with and without the condition in a controlled setting were found for most conditions – only case reports or case series were available for most conditions. There appeared to be no tendency towards a higher failure rate in diabetic patients, but a formal meta-analysis was not possible. Evidence for increased implant failure in osteoporosis was low, but the use of bisphosphonates was considered a risk factor for osteonecrosis of the jaw. A low level of evidence was therefore found for contraindications in implant therapy. Prospective controlled studies are therefore required.
Já com riscos locais à terapia com implantes, há também confirmação dos dados atualmente aceitos pela comunidade científica. Martin W, Lewis E, Nicol A. Local risk factors for implant therapy. Int J Oral Maxillofac Implants 2009;24(Suppl):28-38. Literature on clinical studies evaluating potential local risk factors was reviewed, a total of 19 papers were selected from an initial screen of 2,681. Proximal bone may be at risk when an implant is placed within 3 mm of an adjacent tooth, but data are limited. Implant placement in infected sites may be possible, but data are insufficient. There appeared to be no evidence of soft tissue thickness or keratinized tissue as a risk factor for success. No bone density studies were found, and examination of implant stability was difficult due to a lack of validated measurements.
Riscos à terapia com implantes e história de periodontite tratada e tabagismo também comprova que o índice de falhas tende a ser maior em pacientes que fumam. Heitz-Mayfield LJA, Huynh-Ba G. History of treated peridontitis and smoking as risks for implant therapy. Int J Oral Maxillofac Implants 2009;24(Suppl):39-68. Literature on periodontitis and smoking as risk factors for implant success was examined. Studies were very heterogeneous and most did not account for confounding variables. Survival rates > 90% were found in patients with treated periodontitis, and a higher risk of peri-implantitis was suggested in these patients, compared to patients with no history of periodontitis, by three studies. Smoking appeared to be a significant risk factor, with significantly lower implant survival rates found in smokers versus non-smokers.
Em riscos técnicos e mecânicos nota-se que overdentures em apoio de metal e "cantiléveres" maiores que 15mm e bruxismo aumentam o índice de falhas. Salvi GE, Bragger U. Mechanical and technical risks in implant therapy. Int J Oral Maxillofac Implants 2009;24(Suppl):69-85. From a total of 3,568 articles, 111 on the impact of mechanical/technical risk factors were selected, of which 33 were included in the analysis. After grouping according to different types of risk factor, the results indicated that more mechanical/technical complications were noted with an absence of metal framework in overdentures, cantilever extensions > 15 mm, length of construction, history of repeated complications, and bruxism. Type of retention, angled abutments, crown-implant ratio and number of implants were not associated with more complications. Implant survival/success rates did not appear to be affected.
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