Assuntos
Evolução Biológica , Hominidae , Paleodontologia , Dente , Animais , História Antiga , HumanosRESUMO
UNLABELLED: Implant therapy is a predictable method of replacing lost teeth and involves consideration of numerous surgical and restorative criteria. Part I of this article explained the behavior of the hard and soft tissue around the implant and reviewed various parameters that influence tissue remodeling. Part II emphasizes surgical factors (eg, tridimensional implant placement, platelet-rich fibrin, and the use of connective tissue grafts) and restorative factors as means of limiting soft tissue recession around implants. LEARNING OBJECTIVES: This article discusses tridimensional implant placement and the use of connective tissue grafting to complete the aesthetic restoration. Upon reading this article, the reader should: Become familiar with how platelet-rich fibrin enables the simple, effective, and predictable management of the gap between alveolar bone and an implant. Understand the benefits of connecting the final abutment at the surgical stage and leaving it undisturbed.
Assuntos
Implantação Dentária Endóssea/efeitos adversos , Implantes Dentários/efeitos adversos , Retração Gengival/prevenção & controle , Plaquetas , Tecido Conjuntivo/transplante , Dente Suporte , Implantação Dentária Endóssea/métodos , Oclusão Dentária Traumática/prevenção & controle , Fibrina , Retração Gengival/etiologia , HumanosRESUMO
When treatment with dental implants is indicated, an accurate diagnosis must be made to evaluate the clinical parameters and determine the optimal time for immediate or delayed (ie, early or late) implant placement and loading following tooth extraction. It is also important to identify complications and their implications on the aesthetic outcome. This article explains the behavior of the hard and soft tissue around the implant, evaluates the timing of implant placement after extraction, and reviews various parameters that influence tissue marginal remodeling.
Assuntos
Implantes Dentários/efeitos adversos , Estética Dentária , Retração Gengival/etiologia , Retração Gengival/prevenção & controle , Humanos , Fatores de TempoRESUMO
STATEMENT OF PROBLEM: The literature indicates that 0.5 to 1.5 mm of gingival recession most often occurs within the first months after implant placement or abutment connection. PURPOSE: The purpose of this pilot study was to evaluate the effect of a concave transmucosal profile on the vertical stability of soft tissues at the facial aspect of dental implants. MATERIAL AND METHODS: Fifty-four implants were placed in esthetically demanding sites in 41 patients (17 women, 24 men; age range of 23 to 62 years, mean 40.3 years; 5 smokers), primarily following a 1-stage approach. Twenty-five implants were placed immediately after extraction. Experimental concave titanium (n=49) and zirconia abutments (n=5) were used, and a provisional crown was placed at the same session. Digital photographs were made perpendicularly to the facial aspect of the teeth at abutment placement, and at 1, 3, 6, 12, 18, and 24 months, and enlarged views were subsequently analyzed by an independent examiner. Vertical changes in soft tissue levels were measured, and the definitive esthetic result was evaluated subjectively (poor to excellent). Data were analyzed with descriptive statistics. RESULTS: Twenty-four implants were evaluated at 24 months, 20 at 18 months, and 8 at 12 months. Vertical augmentation or no recession in soft tissue was observed in 87% of the situations, and in no situation was recession greater than 0.5 mm found. The gingival level remained stable at 12, 18, and 24 months. The average esthetic outcome was rated as 4.5 (very good to excellent) on a 0- to 5-point scale. CONCLUSIONS: The concave, gingivally converging abutments used in the study allowed for above-average soft tissue outcomes.