Clipping de Literatura Científica Maio-Junho 2010

Neste trabalho, os autores mostram que cirurgia de implante sem retalho é factível, mas, como esperado, depende de uma série de fatores que implicam em adequada indicação. Brodala N. Flapless surgery and its effect on dental implant outcomes. Int J Oral Maxillofac Implants 2009;24(Suppl):118-125. A literature search was performed for clinical studies with flapless surgery form implant placement. The available prospective studies showed an implant survival rate of 98.6%, while retrospective studies showed a survival rate of 95.9%. Mean radiographic bone loss ranged from 0.7 to 2.6 mm. Intraoperative complications reported in four studies included perforation of the buccal or lingual bony plate, and the overall incidence was 3.8%. Flapless surgery therefore appeared to be suitable, but successful outcomes are dependent on a number of factors.

Para protocolos de carga em implantes deve-se observar, segundo esta série de  trabalhos, as evidências de segurança e o tipo de carga para a mais segura indicação. Gallucci GO, Morton D, Weber H-P. Loading protocols for dental implants in edentulous patients. Int J Oral Maxillofac Implants 2009;24(Suppl):132-146. From a total of 2,371 articles, 61 articles on loading protocols for rough-surfaced implants fulfilled the inclusion criteria; the data included 9,701 implants in 2,278 patients. Conventional loading with maxillary fixed prostheses and mandibular overdentures had the highest level of evidence; in contrast, evidence was insufficient for immediate loading of maxillary overdentures and immediately placed implants with foxed or removable prostheses.

Roccuzzo M, Aglietta M, Cordaro L. Implant loading protocols for partially edentulous maxillary sites. Int J Oral Maxillofac Implants 2009;24(Suppl):147-157. Articles on early and immediate loading of posterior maxillary implants were reviewed; 18 papers were identified for evaluation (12 on early loading and six on immediate loading). The results of the papers suggested that early or immediate loading is possible in selected patients, although success appears to be technique-sensitive. Implant surface characteristics and good primary stability seem to be important. No conclusions could be drawn on contraindications, bone quality, stability threshold values, impact of loading forces or surgical technique. Further clinical investigations are therefore necessary.

Cordaro L, Torsello F, Roccuzzo M. Implant loading protocols for the partially edentulous posterior mandible. Int J Oral Maxillofac Implants 2009;24(Suppl):158-168. A total of 19 articles (15 prospective studies and five randomized clinical trials) on early and immediate loading of implants in the posterior edentulous mandible met the inclusion criteria for evaluation. Early loading is supported by the literature and can be a routine and predictable procedure. Immediate loading was also shown to be a viable treatment alternative, however, the exclusion criteria were inconsistent in many immediate loading studies and confounding factors were noted. Further clinical trials are therefore necessary.

Grutter L, Belser UC. Implant loading protocols for the partially edentulous esthetic zone. Int J Oral Maxillofac Implants 2009;24(Suppl):169-179. Papers relating to different implant placement and loading protocols were reviewed. The results of 10 prospective cohort studies and one case series showed an implant survival rate of 97.3% for immediately restored or conventionally loaded implants after 12 months, but the survival rate was as low as 10% from four studies with immediately placed and restored implants with full occlusal loading. It was not possible to evaluate success criteria. The authors suggested that objective esthetic success criteria should be used for implant protocols in the anterior maxilla.

O protocolo do consenso ITI para implantação precoce x imediata tem dados favoráveis segundo também este trabalho. Chen ST, Buser D. Clinical and esthetic outcomes of implants placed in postextraction sites. Int J Oral Maxillofac Implants 2009;24(Suppl):186-217. A literature search for articles on implants in postextraction sites gathered a total of 1,107 articles, of which 91 studies were selected that met the inclusion criteria. Bone augmentation procedures appeared to be effective for defect resolution at post-extraction sites, more so with immediate and early implant placement than with late placement. Survival rates were over 95% in most studies, and survival rates were similar for immediately and early placed implants. Facial mucosal recession was often noted with immediate placement and was less common with early placement.

Os autores aqui mostram (como visto em outros trabalhos) que o sucesso em longo prazo de enxertos tipo onlay ou em situações limítrofes é limitado. Prioridade, sempre que possível, deve ser dada a procedimentos mais simples. Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants 2009;24(Suppl):237-259. A literature search focusing on different surgical techniques and implant survival/success rates in augmented sites was performed. A review of the relevant articles identified a wide range of surgical procedures, but it was not possible to demonstrate superiority of any one treatment. Moreover, improvement of long-term implant survival was as yet unknown with some procedures, e.g. onlay autogenous bone grafts in edentulous mandibles and maxillary sinus grafting with limited/moderate pneumatisation. The authors suggested that priority should be given to simpler, less invasive procedures with less risk of complications.

Esta revisão aponta para a tendência da evolução da superfície dos implantes e seu papel na otimização da osseointegração. Wennerberg A, Albrektsson T. On implant surfaces: a review of current knowledge and opinions. Int J Oral Maxillofac Implants 2009;25(1):63-74. This review examined implant surface characteristics, particularly in terms of micro- and nanometer roughness, surface modifications (e.g. hydrophilicity, biochemical bonding) and suggested a hypothetical common mechanism behind enhanced bone response. Surface roughness (Sa) of implants from four major manufacturers varied from 0.3 to 1.78 μm, while developed surface area ratio varied from 24% to 143%. Implants from Biomet 3i had the lowest Sa and implants from Straumann had the highest. Novel implants from Biomet 3i, Astra Tech and Straumann all differed from their respective predecessors and all had nano- roughness structure characteristics that were not found in their respective predecessors. It was suggested that this may be a common mechanism leading to the enhanced bone responses to these implants compared to controls.

Importância da manutenção em próteses sobre implantes é discutida nestes três próximos estudos. Akça K, Cehreli MC, Uysal S. Marginal bone loss and prosthetic maintenance of bar-retained implant- supported overdentures: a prospective study. Int J Oral Maxillofac Implants 2009;25(1):137-145. A total of 35 patients received 124 implants (80 maxillary and 44 mandibular) to support bar-retained overdentures. There was one early implant failure in the mandible and one late implant failure in the maxilla, both of which were replaced after 12 weeks. Similar soft tissue parameters were noted for maxillary and mandibular implants, and 1- and 5-year survival rates were similar. Mandibular overdentures showed a higher probability of requiring retainer re-tightening and occlusal adjustments, but there appeared to be no difference in other maintenance requirements. The results indicated that maxillary and mandibular implant- supported overdentures have similar survival and soft tissue outcomes.

Cehreli MC, Karasoy D, Kokat AM, Akca K, Eckert SE. Systematic review of prosthetic maintenance requirements form implant-supported overdentures. Int J Oral Maxillofac Implants 2009;25(1):163-180. A literature search for studies with implant overdentures gave 3,120 articles, of which 287 were selected for full-text analysis and 49 were included in the review. No change in the frequency of complications over time was noted, but more matrix replacements were required after 5 years in the maxilla and mandible, and more matrix and patrix fractures occurred after 1 year in the mandible. Dislodged, worn or loose matrices were more common with ball attachments after the first year, but prosthetic complications were comparable for all attachment types, with the exception of peri-implant or inter-abutment-mucosal enlargement after 1 year

Rentsch-Kollar A, Huber S, Mericske-Stern R. Mandibular implant overdentures followed for over 10 years: patient compliance and prosthetic maintenance. Int J Prosthodont 2010;23(2):91-98. Follow-up periods of over 10 years were completed for 147 patients with 314 implants supporting mandibular ovedentures between 1984 and 2008, at which time 101 patients were available for re-evaluation. A high compliance rate (over 90%) was found and over 80% of dentures were still in service. Major prosthetic maintenance was uncommon, and retention device complications consisted mainly of the mounting of new female retainers, bar repair and changing of ball anchors; complications and the need for prosthetic service were significantly higher with ball anchors compared to bar attachments. Implant overdentures are therefore a useful treatment, provided there is regular maintenance and prosthetic service.

Este estudo mostra as vantagens de contenção de dentes com periodonto reduzido via PPF ou outros dispositivos. Fardal Ø, Linden GJ. Long-term outcomes for cross-arch stabilizing bridges in periodontal maintenance patients – a retrospective study. J Clin Periodontol 2010;37(3):299-304. This study retrospectively analyzed 80 patients with reduced periodontal support who received a total of 94 cross-arch stabilizing bridges and who were maintained for at least 7 years (mean 10 years). Bridge loosening occurred in four patients and bridge fracture occurred in one patient. Five patients lost a total of eight abutment teeth, but no patients lost implant abutments. Rates of tooth loss were low for patients with stabilizing bridges and for patients with no bridges, but were higher in the bridge group. Cross-arch stabilizing bridges as part of periodontal maintenance therapy therefore had few complications and low rates of abutment tooth loss.

Tema muito discutido ultimamente, os próximos dois abstracts mostram relação entre bisfosfonados e falhas de implantes previamente osseointegrados. Martin DC, O’Ryan FS, Thomas Indresano A, Bogdano P, Wang B, Hui RL, Lo JC. Characteristics of implant failures in patients with a history of oral bisphosphonate therapy. J Oral Maxillofac Surg 2010;68(3):508- 514. From a dental survey, dental implants were reported in 589 patients out of 8,572 who received oral bisphosphonate drugs; 26 implant failures were reported in 16 of these patients and the characteristics of loss were analyzed. There were 12 failures in the maxilla (8 patients) and 14 failures in the mandible (9 patients). The majority of failures occurred more than 1 year after placement, so were classified as late failures (18 implants in 10 patients compared to 8 implant failures in 8 patients within 1 year). The role of chronic bisphosphonate therapy in implant survival and osseointegration requires further investigation.


Lazarovici TS, Yahalom R, Taicher S, Schwartz-Arad D, Peleg O, Yarom N. Bisphosphonate-related osteonecrosis of the jaw associated with dental implants. J Oral Maxillofac Surg 2010;68(4):790-796. Records of patients with bisphosphonate-associated osteonecrosis of the jaws (BRONJ) treated with dental implants over a 6-year period; a total of 27 patients were enrolled. BRONJ was seen in 11 patients taking oral bisphosphonates and 16 patients on intravenous bisphosphonates, and BRONJ developed after a mean of 68 months for alendronate, 16.4 months for zoledronic acid and 50.2 months for pamidronate. The mean duration of onset of BRONJ if treatment began prior to implant placement was 16.2 months. No significant association was found between BRONJ and diabetes, steroid intake or smoking.

Apesar da terapia por radiação e pequena redução na taxa de sucesso nos implantes, este trabalho mostra que a segurança do uso de implantes nestes casos, desde que observados protocolos como oxigenação hiperbárica e outros. Salinas TJ, Desa VP, Katsnelson A, Miloro M. Clinical evaluation of implants in radiated fibula flaps. J Oral Maxillofac Surg 2010;68(3):524-529. Mandibular resection and reconstruction was performed in 44 patients, who were retrospectively evaluated. Half of the patients received adjuvant doses of radiation therapy (> 6,000 Gy) and 20 preoperative and 10 postoperative hyperbaric oxygen treatments. In 44 patients, 206 implants were placed (144 in a fibula flap and 92 in the native mandible). After a mean follow-up of 41.1 months (range 4-108 months), there were 31 implant failures, giving a success rate of 85% (82.4% in fibula flaps and 88% in native bone) and a cumulative survival rate of 91.1%. Most failures in fibula flaps occurred within 6 months, while more failures in native bone occurred later. Radiation therapy therefore did not adversely affect implant survival.

Os autores discutem a relação entre overdentures e presença de dentição natural antagonista. Ohkubo C, Baek KW. Does the presence of antagonist remaining teeth affect implant overdenture success? A systematic review. J Oral Rehabil 2010;37(3):306-312. A literature review was performed to assess the potential influence of antagonist natural teeth on the success of implant overdentures. Opposing natural dentition was not well described in the literature, but 10 articles each on the maxilla and mandible were selected. High success/survival rates for mandibular overdentures were noted, while rates were lower for maxillary overdentures. Antagonist teeth were not judged to be a risk factor for mandibular overdentures but may have an adverse effect on maxillary overdentures; however, the presence of antagonist teeth is not a contraindication in these circumstances. No apparent correlation between the presence of antagonist teeth and overdenture success was found.

Discussão sobre os efeitos da sinvastatina versus placebo (em uso local) na melhora dos parâmetros periodontais. Pradeep AR, Thorat MS. Clinical effect of subgingivally delivered simvastatin in the treatment of patients with chronic periodontitis: a randomized clinical trial. J Periodontol 2010;81(2):214-222. A total of 60 patients with chronic periodontitis were treated with scaling and root planing together with either 1.2 mg simvastatin or placebo. Clinical evaluations were performed at baseline and after 1, 2, 4 and 6 months. Significant improvements were observed in both groups, but there was a greater decrease in modified sulcus bleeding index and probing depth, a greater increase in clinical attachment level, and a greater increase in intrabony defect fill in the simvastatin group. Locally delivered simvastatin therefore improved clinical parameters more than scaling and root planing alone.

Aqui, mostra-se a correlação entre HbA1c e PCR em pacientes com diabetes 1 e periodontopatas. Chen L, Wei B, Li J, Liu F, Xuan D, Xie B, Zhang J. Association of periodontal parameters with metabolic level and systemic inflammatory markers in patients with type 2 diabetes. J Periodontol 2010;81(3):364- 371. Periodontal parameters were examined and blood analyses were performed in 140 patients with type 2 diabetes, who were then stratified according to probing depth level. The results indicated that patients with higher probing depth levels had significantly higher HbA1c and high-sensitivity C-reactive protein (hsCRP) levels, but there were no significant differences in TNF-α, fasting glucose or lipid profiles. Taking other patient parameters into account, there was a positive correlation between probing depth and HbA1c and between probing depth and hsCRP.

Corrobora-se aqui, a segurança do uso de implantes imediatos em sítios com lesões periapicais. Crespi R, Capparè P, Gherlone E. Fresh-socket implants in periapical infected sites in humans. J Periodontol 2010;81(3):378-383. Single tooth extraction was performed in 30 patients; 15 patients had periapical lesions/radiolucencies and 15 patients had no periapical lesions but had root caries/fractures. Implants were placed immediately in the extraction sockets and loaded after 3 months. Clinical evaluations were performed at baseline and after 12 and 24 months. Implant survival was 100% after 24 months and the mean bone loss was 0.86 ± 0.54 mm and 0.82 ± 0.52 mm in the groups with and without periapical lesions. Similarly, there were no significant differences in plaque accumulation, modified bleeding index or probing depth between the groups. Predictable outcomes were therefore observed in immediate implant placement in patients with periapical lesions.

Segurança de implantes imediatos é descrita neste trabalho. Gökçen-Röhlig B, Meriç U, Keskin H. Clinical and radiographic outcomes of implants immediately placed in fresh extraction sockets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(4):e1-e7. Remaining mandibular teeth were extracted in 10 patients, each of whom received four implants, two in fresh extraction sockets and two in mature bone. Scores of 0 and 1 for modified plaque index were comparable in both groups at 1 year and remained stable at 2 years. There were also no significant differences in modified bleeding index, probing depth or keratinized mucosal width between the two groups, indicating that placement of implants in fresh extraction sockets can be a suitable and predictable treatment.

Estudo mostra a segurança no uso de implantes inclinados em certas técnicas para reabilitação de arcos edêntulos. Agliardi E, Clericò M, Ciancio P, Massironi D. Immediate loading of full-arch fixed prostheses supported by axial and tilted implants for the treatment of edentulous atrophic mandibles. Quintessence Int 2010;41(4):285-293. A total of 24 patients with edentulous atrophic mandibles received axial and tilted implants to support a complete prosthesis, delivered within 2 days if implant surgery, and were assessed for up to 42 months. The mean follow-up was 30.1 months and the mean bone loss after 12 months was 0.8 mm for tilted implants and 0.9 mm for axial implants (total mean bone loss 0.85 mm). Immediate rehabilitation of the edentulous atrophic mandible with careful implant positioning can therefore be successful.