Tilted implantation technique for edentulous patients / 华西口腔医学杂志

The tilted implantation technique is characterized by placing the implant at an angle of more than 15° and less than 45° from the horizontal plane. This technique can avoid damaging the maxillary sinus, inferior alveolar nerve, nasal base, and other anatomical structures when the height of the upper and lower jaw available bone is insufficient, to maximize the use of available bone and avoid a large range of bone increment. The tilted implantation technique can reduce the trauma of the surgery, increase the possibility of immediate restoration and shorten the treatment cycle, which has been widely used clinically. In this review, the scope of application, design elements, design scheme and complications of the tilted implantation technique for edentulous patients will be described.

Clinical assessment of pterygoid and anterior implants in the atrophic edentulous maxilla: a retrospective study / 华西口腔医学杂志

OBJECTIVES@#This study aims to evaluate the short-term clinical outcomes and patient satisfaction of anterior and pterygoid implants in the rehabilitation of edentulous maxilla with posterior atrophy.@*METHODS@#Given a minimum follow-up of 1 year, 25 patients with fixed maxillary rehabilitation over anterior and pterygoid implants were enrolled in this retrospective study. The implant survival rates, peri-implant soft tissue status (including probing depth, modified sulcus bleeding index, and plaque index), marginal bone loss, and patient satisfaction were measured.@*RESULTS@#The survival rates for anterior and pterygoid implants at 1-year follow-up were 96.5% and 97.8%, respectively (@*CONCLUSIONS@#For the edentulous maxilla with posterior atrophy, full-arch fixed prostheses supported by anterior and pterygoid implants has an acceptable short-term clinical outcome and excellent patient satisfaction. It may be considered as a predictable and feasible method for maxillary rehabilitation.

Can Denture Wearing Increase the Nutritional Status in Pre-Elderly and Elderly Patients?

Abstract Objective: To investigate the relationships among tooth loss, denture wearing, nutrition intake, and nutritional status. Material and Methods: This observational cohort study was conducted on 26 patients (≥ 45 years old) at the Faculty of Dentistry, Universitas Indonesia. Tooth loss was classified according to the Eichner Index. The Semi-quantitative Food Frequency Questionnaire was used to measure nutritional intake (kcal). Mini Nutritional Assessment Short Form (MNA-SF) and Handgrip Strength (HGS) assessments were employed to measure the nutritional status at baseline (before denture insertion), 1, 2, 3, 6, 9, and 12 months after denture use. Results: Significant differences in nutritional intake (p<0.05) between the Eichner B and C groups were noted at 3, 6, 9, and 12 months after using dentures. Significant increases in nutritional intake were noted after wearing the dentures (p<0.05) when compared with the baseline values. The nutritional status was considered normal in 65.4% of the patients at 12 months and 38.5% at baseline. Furthermore, the nutritional status 1, 2, 3, 6, 9, and 12 months after wearing denture was significantly improved compared with the baseline values (p<0.05). Significant differences in HGS (p<0.05) were observed between the Eichner B and C groups at 6, 9, and 12 months after using the denture. However, no significant differences in HGS were noted before and after wearing the denture (p<0.05). Conclusion: Denture wearing can improve the nutritional intake and status of pre-elderly and elderly patients.

Accuracy of computer-guided surgery / La precisión de la cirugía guiada por ordenador

Dental implant fixation techniques are widely studied in order to reduce surgical morbidity. Computer-guided flapless surgery has been considered an efficient alternative that presents several advantages and some limitations. This technique allows the virtual planning and simulation of the prosthetic-surgical treatment that can help predict the difficulties and limitations in order to reduce possible errors. In addition to the prosthetic predictability, computer-guided surgery enhances accuracy and reduces surgical morbidity. Thus, the aim of this study was to report on a 7-year follow-up of immediately loaded implants inserted into an edentulous maxilla using virtual planning and flapless surgery.

Las técnicas de fijación del implante dental se estudian ampliamente para reducir la morbilidad quirúrgica. La cirugía sin flapless guiada por ordenador ha sido considerada como una alternativa eficiente con varias ventajas y algunas limitaciones. Esta técnica permite la planificación virtual y simulación del tratamiento protésico quirúrgico con la predicción de las dificultades y limitaciones para reducir posibles errores. Además de la previsibilidad de prótesis, la cirugía guiada por ordenador mejora la precisión y reduce la morbilidad quirúrgica. Por lo tanto, el objetivo de este estudio fue reportar a 5 años de seguimiento de los implantes de carga inmediata insertados en un maxilar desdentado utilizando la planificación virtual y la cirugía sin colgajo. El presente caso prospectivo informó el éxito del tratamiento y destacó la importancia de la planificación, lo que justifica el costo de esta tecnología.

Success rate of zygomatic implants forrehabilitation of severely atrophied maxillae: a review of the literature / Tasa de éxito de los implantes cigomáticos para la rehabilitacióndel maxilar severamente atrofiado: una revisión de la literatura

Severe resorption in the posterior maxilla sectors as a result of tooth loss along with the process of pneumatization of the maxillary sinus, difficult the prosthetic rehabilitation supported by conventional implants due to the shortage of vertical bone availability. So that over the years they have designed therapeutic alternatives to help overcome these drawbacks. The zygomatic implant was introduced in 1988 by Branemark. This implant has a design which allows it to be positioned over the ridge to the height of the first molar, reducing vestibular cantilever up to 20 percent and reducing complications of peri-implant inflammation, infection and gingival hyperplasia, which may lead to perforation horizontal process of the palatine bone. The purpose of this review is to determine the success rate of zygomatic implants for rehabilitation of severely atrophied maxillae. A total of 1410 zygomatic implants and 1673 Traditional implants were included in selected articles. Of these 1410 zygomatic Implants, 365 were conventional loading and 1045 were immediately and early loading, these had a success rate of 98.3 percent and 98.7 percent, respectively. Of these 1673 Traditional Implants, 463 were conventional loading and 1210 were immediately and early loading, they had a success rate of 93.9 percent and 97.8 percent, respectively. The overall success rate of zygomatic implants and Conventional implants was 98.6 percent and 96.8 percent, respectively. The rehabilitation of severely atrophied maxilla with fixed prosthesis immediately and conventional loaded by zygomatic implants gives excellent results in the medium term. When comparing traditional treatment modalities, proposals for prosthetic reconstruction of severely atrophied maxilla, the zygomatico implant has the highest success rate over conventional treatments...

La reabsorción severa en sectores posteriores del maxilar, como resultado de la pérdida de dientes junto con el proceso de neumatización del seno maxilar, resulta en una difícil rehabilitación protésica conel apoyo de los implantes convencionales, debido a la escasez de hueso vertical disponible. A lo largo de los años se han diseñado alternativas terapéuticas para ayudar a superar estos inconvenientes. El implante cigomático fue introducido en 1988 por Branemark. Este implante tiene un diseño que permite colocarse sobre la cresta hasta la altura del primer molar, reduciendo el voladizo bucal hasta en un 20 %, con la consecuente reducción de las complicaciones del peri-implantarias, como inflamación, infección y la hiperplasia gingival, que pueden conducir al desarrollo del proceso de perforación horizontal del hueso palatino. El propósito de esta revisión fue determinar la tasa de éxito de los implantes cigomáticos para la rehabilitación del maxilar gravemente atrófico. Un total de 1410 implantes cigomáticos y 1673 implantes tradicionales fueron descritos en los artículos seleccionados. De estos 1410 implantes cigomáticos, 365 eran de carga convencional y 1045 fueron de carga inmediata y temprana, teniendo una tasa de éxito del 98,3 % y 98,7 %, respectivamente. De los 1673 implantes tradicionales, 463 fueron de carga convencional y 1210 fueron de carga inmediata y temprana, presentando una tasa de éxito del 93,9 % y 97,8 %, respectivamente. La tasa de éxito de los implantes cigomáticos y los implantes convencionales fue del 98,6 % y 96,8 %, respectivamente. La rehabilitación del maxilar severamente atrofiado con prótesis fija convencional cargado inmediatamente y por los implantes cigomáticos otorgó excelentes resultados en el mediano plazo. Al comparar las modalidades de tratamiento tradicionales, propuestas para la re-construcción protésica del maxilar severamente atrofiado, el implante cigomático tiene la mayor tasa de éxito respecto a los tratamientos convencionales.

Use of a Titanium Mesh "Shelter" Combined with the Soft Tissue Matrix Expansion (Tent Pole) Grafting in the Reconstruction of a Severely Resorbed Edentulous Mandible. Technical Note.

Patients wearing complete dentures for a long time usually exhibit lack of bone and keratinized mucosa in the bearing area due to bone resorption. The patients suffering from this phenomenon usually have unstable and non-retentive complete denture, which result in constant trauma to the mucosa, pain, functional limitations and worsening of facial esthetics. An innovative technique has been described in which a novel surgical approach using osseointegrated dental implants as "tent poles" was applied concomitant with particulate autogenous bone graft. The authors claim that the control and maintenance of the surgically expanded soft tissue volume should prevent graft resorption in the long term. Nevertheless, resorption of the bone graft is usually more significant where the bone mass is poorer, in the mandibular body. This paper describes a case of severely resorbed edentulous mandible in which the "tent pole" technique was applied with some modifications. Use of the titanium mesh "shelters" and two additional implants was effective in "protecting" the bone graft in the posterior portion of the mandibular body increasing bone mass volume in this area. Furthermore, we believe that this kind of graft "protection" on the whole residual alveolar ridge can increase the width of bone mass gain optimizing the "tent pole" technique.

Pacientes portadores de próteses totais por um longo período geralmente apresentam perda significativa de osso do processo alveolar e de mucosa ceratinizada na área chapeável devido ao processo de reabsorção óssea associada com a perda de função. Estes pacientes geralmente possuem próteses totais sem retenção e estabilidade, o que resulta em trauma crônico à mucosa, limitações funcionais e piora da estética facial. Uma técnica cirúrgica inovadora foi descrita na qual implantes osseointegráveis são posicionados em forma de "pilares" conjuntamente com enxerto ósseo autógeno particulado. Os autores afirmam que o controle e manutenção do volume tecidual obtido cirurgicamente diminui a perda em volume do enxerto ósseo utilizado. Entretanto esta reabsorção geralmente ocorre com maior intensidade onde a massa óssea é mais pobre, ou seja, em corpo mandibular. Este artigo descreve um caso onde uma mandíbula severamente reabsorvida foi reconstruída utilizando-se a técnica de "tent pole" com algumas modificações propostas pelos autores. O uso da malha de titânio em forma de "cabana" e dois implantes dentários osseointegráveis adicionais contribuíram para "proteger" o enxerto ósseo autógeno na região posterior do corpo mandibular aumentando o volume ósseo na região. Adicionalmente, nós acreditamos que o uso deste tipo de proteção em todo rebordo alveolar residual pode melhorar o ganho de massa óssea otimizando, portanto, a técnica original de "tent pole".

Función protésica inmediata con técnica all on-4 mandibular: primer reporte al 1er año de carga inmediata / Immediate prosthetic function with all on-4 mandibular technique: first report after 1 year of immediate loading

Propósito: El objetivo del presente estudio prospectivo es la observación del comportamiento de la función protésica inmediata sobre implantes axiales en combinación con implante inclinados posteriores distribuidos poligonalmente en mandíbulas edéntulas. Material y Métodos: De un grupo de 28 individuos desdentados completos mandibulares se observaron 25 individuos distribuidos en 13 hombres y 12 mujeres con un promedio de edad de 57.8 años, bajo la modalidad de rehabilitación protésica implanto asistida en distribución poligonal de arco completo híbrida con una barra de titanio soldada de sección circular de 2mm de grosor instalada a las 48 hrs. de realizada la inserción de los implantes, la cual a los 3 meses fue cambiado por una estructura colada en titanio como prótesis definitiva. Durante el periodo de observación se evaluó la tasa de éxito implantario, las complicaciones biológicas y mecánicas por un periodo inicial de 1 año. El protocolo se inicia con la valoración y confección de un enfilado dentario de prótesis completa convencional, el que, una vez aceptado por el paciente, es duplicado para la confección de una guía tomográfica, con la cual se procederá a la toma de un scanner dental, relacionado las necesidades protésicas y la distribución implantaria en relación a la emergencia y prolongación del nervio mentoniano, altura del foramen mentoniano y forma de la mandíbula. Todos los pacientes fueron operados elevando un colgajo de espesor total y utilizando la guía quirúrgica All on-4 (Nobel Biocare) bajo sedación endovenosa y utilizando una cubeta multifuncional para la toma de registros maxilomandibulares e implantarios en el proceso de carga imediata...

Purpose: The purpose of this prospective study is the observation of the behaviour of immediate occlusal loading with axial implants in combination with posterior tilted implants in edentulous mandibles polygonally distributed. Methods: From a group of 28 individuals with complete edentulous mandible, 25 individuals distributed in 13 men and 12 women were observed with an average age of 57.8 years, under the implant-assisted prosthetic rehabilitation modality in full arch polygonal hybrid distribution with a welded 2mm-thick titanium bar of circular section installed 48 hrs after insertion of the implant, which was changed after 3 months to a titanium casting structure as definitive prosthesis. During the observation period, the implant success rate, biological and mechanical complications were assessed for an initial period of 1 year. The protocol begins with the assessment and preparation of the lining of a conventional complete denture. Once accepted by the patient, it is doubled to make a tomographic guidance, used to take a dental scanner, The prosthetic needs and implant distribution are related to the emergence and continuation of the mental nerve, mental foramen and height and shape of the jaw. All patients were operated lifting a full-thickness flap and using the All on-4 (Nobel Biocare) surgical guide under intravenous sedation, and a flexible bucket for the maxillomandibular and implant records in the immediate loading...

Edentulismo, uso e necessidade de prótese e fatores associados em município do nordeste brasileiro / Edentulism, denture use and need and associated factors in a brazilian northeastern city

Introdução: No Brasil, a população idosa cresce com o aumento da expectativa de vida constituindo uma responsabilidade para os gestores públicos na perspectiva de uma oferta de atenção adequada com conhecimento epidemiológico para o planejamento efetivo de políticas públicas. Para a saúde bucal o mais importante indicador para essa população é o edentulismo. Objetivo: Testar a associação entre os desfechos edentulismo/uso e necessidade de prótese dentária e dados sociodemográficos e de acesso em adultos e idosos em um município no Nordeste do Brasil (Bayeux/PB). Método: Utilizou uma abordagem indutiva, com procedimento descritivo e comparativo-estatístico e técnica da observação direta intensiva, por meio de exames bucais, e extensiva, por meio de formulários. O exame das condições bucais foi realizado por uma examinadora previamente calibrada em uma amostra probabilística de adultos (n=64) e idosos (n=22), de acordo com os critérios estabelecidos pela OMS. Os dados foram analisados mediante estatística descritiva e regressão logística (p-valor menor que 0,10). Resultados: Os fatores de risco identificados para necessidade de prótese foram: idade (OR = 1.07), necessidade de tratamento dentário autorreferida (OR = 32,02) e ter procurado o dentista pelos seguintes motivos: Extração dentária (OR = 5,58) e tratamento (OR = 14,69). Conclusão: A prevalência do edentulismo em adultos e idosos no município é alta, sendo expressiva a necessidade de prótese dentária, constatando-se maior necessidade de prótese nos pacientes mais velhos, que referiram necessitar de tratamento odontológico e cujo motivo da consulta foi para realização de exodontia ou tratamento.

Introduction: In Brazil, the elderly population grows with the increase of life expectancy, representing a responsibility to the public managers in the perspective of offering adequate attention with epidemiological knowledge for an effective planing of public policies. As far as oral health is concerned, edentulism is the most important indicator for this population. Objective: To assess the association between the endpoints edentulism/denture use and need and sociodemographic and access data in adults and elderly in a Brazilian northeastern city (Bayeux - PB). Method: An inductive approach with a descriptive and comparative-statistical approach was used, as well as intensive (oral exams) and extensive (questionnaires) direct observation. Examination of oral conditions was performed by a previously calibrated examiner in a probabilistic sample of adults (n=64) and elderly (n=22), according to the criteria established by the WHO. Data were analyzed by descriptive statistics and logistic regression (p less than 0.10). Results: The risk factors identified for denture need were: age (OR = 1.07), self-referred dental care need (OR = 32.02) and seeking the dentist for dental extraction (OR = 5.58) and treatment (OR = 14.69). Conclusion: The prevalence of edentulism in adults and elderly in the evaluated city is high, being expressive the denture need. Higher need of denture was observed in the older patients who reported needing dental care for alleged tooth extraction or treatment reasons.

Rehabilitation of severely resorbed edentulous mandible using the modified visor osteotomy technique

The prosthetic rehabilitation of an atrophic mandible is usually unsatisfactory due to the lack of support tissues, mainly bone and keratinized mucosa for treatment with osseointegrated implants or even conventional prosthesis. The prosthetic instability leads to social and functional limitations and chronic physical trauma decreasing the patient's quality of life. A 53-year-old female patient sought care at our surgical service complaining of impairment of her masticatory function associated with the instability of the lower total prosthetic denture. The clinical and complementary exams revealed edentulism in both arches, while the mandibular arch presented severe reabsorption resulting in denture instability and chronic trauma to the oral mucosa. The proposed treatment plan consisted in the mandibular rehabilitation with osseointegrated implants and fixed Brånemark's protocol prosthesis after mandibular reconstruction applying the modified visor osteotomy technique. The proposed technique offered predictable results for reconstruction of the severely resorbed edentulous mandible and posterior rehabilitation with osseointegrated implants.

A reabilitação protética de mandíbulas edêntulas muitas vezes torna-se insatisfatória em função da falta de tecido de suporte para reabilitação com implantes osseointegrágeis ou mesmo próteses totais convencionais. A falta de estabilidade protética ocasiona perda de qualidade de vida, pois geralmente resulta em limitação funcional e transtornos sociais. Este artigo descreve um caso clínico de uma paciente de 53 anos que procurou atendimento em nosso serviço queixando-se de dificuldade em mastigação e instabilidade da prótese total inferior, e apresentando atrofia severa de mandíbula. A reabilitação mandibular foi realizada com prótese fixa do tipo protocolo Brånemark, após cirurgia pré-protética reconstrutora com a utilização da osteotomia em "viseira modificada" e enxerto ósseo autógeno. A técnica proposta ofereceu resultados previsíveis para a reconstrução de mandíbulas severamente reabsorvidas para posterior reabilitação com implantes osseointegráveis.

Nutritional and anthropometric analysis of edentulous patients wearing implant overdentures or conventional dentures

As masticatory efficiency diminishes drastically in edentulous patients, several researchers have studied over the past two decades how dietary intake varies when different types of oral rehabilitation are provided. Since the use of implants to support prostheses in edentulous mandibles has been shown to significantly improve masticatory performance, the question remains as to whether this improvement will influence the nutritional status. The purose of this study was to evaluate the nutritional status of edentulous patients who randomly received either a mandibular conventional denture (CD) or an implant-supported overdenture (IP) 1 year previously. Weight, height, body composition and handgrip strength measurements were collected for analysis. Blood tests were performed to measure plasma parameters of diet intake. Participants responded to a Food Frequency Questionnaire and a Masticatory Function Questionnaire. Fifty-three people participated (58 percent men, 42 percent women; mean age = 53). Body composition indicators as well as plasma parameters were generally within normal range, and no statistically significant difference (p>0.05) was found between the groups. Patients in the CD group had significantly lower ratings for items regarding difficulty in chewing (p<0.05), but no significant difference was found for dietary intake (p>0.05). Although the CD wearers reported having more difficulty in chewing hard foods, both groups appeared to have a similar nutritional status.

O uso de implantes para suportar próteses em pacientes edêntulos completos causa uma melhora significativa na performance mastigatória desses indivíduos. Contudo, a influência desse benefício no estado nutricional do paciente ainda não está completamente estabelecida. Esse estudo avaliou o estado nutricional de pacientes desdentados completos reabilitados com próteses totais convencionais (grupo CD) ou com próteses totais implanto-suportadas (grupo IP) na mandíbula. Foram coletados dados sobre composição corporal e uma amostra de sangue para análise. Os participantes responderam a um questionário sobre freqüência alimentar (QFA) e outro sobre habilidade mastigatória e método de preparo dos alimentos (QMF). A amostra foi composta de 53 participantes selecionados a partir de um estudo randomizado, sendo 58 por cento homens e 42 por cento mulheres, com idade média de 53 anos. Os indicadores de composição corporal se encontraram dentro da normalidade e sem diferenças significativas (p>0.05). O grupo CD obteve valores significativamente diferentes para itens do QMF sobre dificuldade de mastigar (p<0.05). Os dados do QFA e o resultado do exame de plasma estavam dentro dos níveis normais, e os valores entre os grupos foram semelhantes (p>0.05). Embora os participantes que receberam prótese total convencional tenham relatado maior dificuldade de mastigar alimentos duros, os dois grupos apresentaram estados nutricionais semelhantes.

Use of models in surgical predictability of oral rehabilitations

PURPOSE: To evaluate the rehabilitation of edentulous mandibles with osseous integrated implants in immediate loading, using models in reverse planning. METHODS: A prospective study was performed on 14 patients with a total of 56 implants placed. It was proposed a technique for the rehabilitation of edentulous mandible with osseous integrated implants of immediate loading, using anatomical replicas derived from computerized tomography scan linked to the rapid prototyping technique of stereolithography in reverse planning, elaborating the definitive fixed prosthesis, with rigid union of the implants on the same day. The patients' mandible models were divided in two groups. In the first one, there were patients with edentulous mandible models and with models elaborated after exodontics procedures (Group 1). In the second (Group 2), patients with dentulous mandible models, which allow an evaluation of difficulty in the surgery. RESULTS: The proposed technique using anatomical models for the personalization of mandibles in immediate loading had 100 percent of less difficulty in the adaptation of the surgery guide while the dentulous models had 83,3 percent of more difficulty. CONCLUSION: The proposed technique using the mandible models in the rehabilitation of mandibles is feasible.

OBJETIVO: Avaliar a reabilitação de mandíbulas edêntulas com implantes osseointegrados, em função imediata, utilizando biomodelos no planejamento inverso. MÉTODOS: Foi realizado um estudo prospectivo em 14 pacientes com um total de 56 implantes colocados, em que foi proposta uma técnica de reabilitação de mandíbulas edêntulas com implantes osseointegrados, em função imediata, utilizando biomodelos, confeccionados a partir dos dados da tomografia computadorizada, no planejamento inverso, confeccionando a prótese fixa final, com união rígida dos implantes, no mesmo dia. Os biomodelos dos pacientes foram divididos em dois grupos. Um deles composto pelos pacientes com biomodelos edêntulos e aqueles confeccionados após exodontia (grupo 1). O outro (grupo 2) composto pelos pacientes com biomodelos dentados, sendo avaliada a dificuldade do procedimento, quanto a cirurgia. RESULTADOS: A técnica proposta do uso da prototipagem biomédica na função imediata nas mandíbulas com biomodelos edêntulos teve 100,0 por cento de menor dificuldade na adaptação da guia cirúrgica, enquanto os biomodelos dentados apresentaram 83,3 por cento de maior dificuldade. CONCLUSÃO: O biomodelo no planejamento inverso de reabilitações orais teve 100,0 por cento de menor dificuldade em comparação com os protótipos dentados 83,3 por cento de maior dificuldade.

Length determination of zygomatic implants using tridimensional computed tomography / Determinação do comprimento de fixações zigomáticas a partir de tomografia computadorizada tridimensional

Considering the potential of tridimensional computed tomography (3D-CT) as a predictor of real bone dimensions, nine dried human skulls with maxillary edentulism were evaluated using images obtained by 3D-CT, prior to the installation of zygomatic implants, in order to obtain the measurements of the implants. In the analysis of correlation between the two 3D-CT examiners, a 75 percent agreement was found, and no correlation was found between them and the surgical measurement. The worst result was the surgical one, possibly because an inaccurate probe was used. Based on the obtained data, we concluded that the probe used is inaccurate, suggesting that the surgical probe be changed in its measurement scale. Agreement between surgeon and radiologist could possibly be obtained by using insertion guides, since what might have possibly caused the discrepancy in the results is the fact that the 3D-CT examiners and the surgeon used different implant insertion points. It is also possible that a larger sample might produce a more accurate evaluation, thus improving the results.

Considerando-se o potencial da tomografia computadorizada tridimensional (TC-3D) como preditor de dimensões ósseas reais e avaliando-se nove crânios humanos secos com edentulismo maxilar, foi feito um estudo utilizando-se o recurso das imagens obtidas por TC-3D, previamente à execução da técnica de fixação zigomática, para mensurar o comprimento de tais fixações. Na avaliação da concordância interexaminador da TC-3D, houve uma boa correlação entre o primeiro e segundo (75 por cento), e ausência de correlação entre estes e a medida cirúrgica. Contextualizando, o pior resultado foi o cirúrgico, possivelmente pelo fato de utilizar uma sonda imprecisa. Diante dos dados obtidos, concluiu-se que a sonda utilizada é imprecisa, sugerindo uma mudança na mesma quanto ao seu escalonamento e que medidas para aproximar as linguagens do cirurgião e do radiologista talvez fossem conseguidas com a utilização de guias de inserção, pois o que possivelmente ocasionou a discrepância nos resultados foi o fato de os examinadores 1 e 2 da TC-3D medirem um local de inserção da fixação e o cirurgião inserir esta em outro. É possível que uma amostra maior, por proporcionar avaliações mais abrangentes, possa incrementar os resultados ora encontrados.