Immediate implant in the esthetic zone: clinical and CBCT follow-up of peri-implant tissues / Implante imediato em região estética: acompanhamento clínico e tomográfico dos tecidos peri-implantares

Technological advances in implant dentistry have substantially increased the number of rehabilitations of patients with immediate esthetic needs, particularly when the use of removable prosthesis during osseointegration does not meet patient expectations and demands. The placement of dental implants and the adequate immediate provisionalization should ensure high-quality functional and esthetic results and a good prognosis. However, questions remain about whether rehabilitation should be immediate in case of fresh sockets, particularly when the gingival phenotype is unfavorable. This report describes a clinical case of extraction of teeth #11 and #21, immediate dental implant placement and placement of a provisional using the crown of the natural teeth freshly extracted. Results are compared with findings reported in recent studies, and the ideal treatment to maintain gingival architecture is discussed.

Os avanços tecnológicos na Implantodontia fizeram com que as reabilitações de pacientes com necessidade estética imediata tivessem um crescimento exponencial nos últimos anos, especialmente em situações onde a utilização de restaurações protéticas removíveis durante o período de osseointegração não contemplam o nível de exigência e a expectativa do paciente. A instalação de um implante osseointegrável e a sua adequada provisionalização imediata devem ser feitas com elevada qualidade a fim de se colaborar com as questões funcionais e estéticas para um bom prognóstico. Todavia, questionamentos se estabelecem no momento em que a resolução imediata do caso deva ser feita em alvéolo fresco pós-exodontia, especialmente em situações de fenótipo gengival desfavorável. Assim sendo, este artigo tem por objetivo apresentar um caso clínico onde se realizou a exodontia dos dentes 11 e 21, a inserção imediata de implantes osseointegráveis e a provisionalização com a coroa dos dentes naturais recém-extraídos, comparando com a literatura atual, a condição ideal de reabilitação desses casos para manutenção da arquitetura gengival inicial.

Preservação da arquitetura gengival em região estética com extração e colocação imediata do implante osseointegrável após traumatismo dentário: um ano de acompanhamento com tomografia de feixe cônico / Preservation of gingival architecture in the esthetic region after tooth trauma, extraction, and immediate implant placement: CBCT one-year follow-up results

Este artigo buscou demonstrar um caso clínico de fratura radicular de um incisivo central superior direito (dente 11) após traumatismo dentário, no qual se realizou a exodontia daquele elemento, inserção de um implante osseointegrável e provisionalização imediata através da coroa natural do dente fraturado, realizando-se o diagnóstico e o acompanhamento do caso por meio de tomografia computadorizada cone-beam. Pode-se notar que a possibilidade do uso de provisórios realizados imediatamente após a extração com a coroa natural do dente perdido alia a manutenção das características gengivais e dentárias. Além disso, o controle por meio do uso de TCCB possibilitou a avaliação pós-operatória, onde se notou a manutenção do tecido ósseo vestibular mesmo sem o uso de enxertia óssea nessa região, neste caso, tendo-se o gap menor do que 2 mm.

This article illustrates a case report with trauma and root fracture at the maxillary central incisor (11) followed by extraction and immediate provisionalization using the own patient´s natural tooth crown. This treatment modality allows for maintenance of the gingival and dental characteristics. Besides, the use of CBCT in the postoperative phase demonstrated that the bone tissue was preserved without grafting in a gap area with less than 2 mm.

Correction of facial asymmetry resulting from hemimandibular hyperplasia: surgical steps to the esthetic result.

Hemimandibular hyperplasia is a facial deformity in which there is an increase in the condyle, neck of the condyle or ramus, and an occlusal cant. Different surgical treatments are proposed in the literature, from simple low or high condylectomy to more complex procedures combining osteotomies in different sites of the mandible. Surgical procedure is defined by the scintigraphic diagnosis of activity or inactivity in the center of condylar growth. The case report describes a 35-year-old female patient with hemimandibular hyperplasia on the left side with inactivity of condylar growth, successfully treated with bilateral sagittal split ramus osteotomy associated with a basilar osteotomy in form of "L" on the affected side. The surgical technique was easily executed, with an improvement in function, aesthetics, and patient satisfaction. Correction of facial asymmetry caused by excessive growth of the mandible using this basilar osteotomy in the form of "L" combined with bilateral sagittal split ramus osteotomy proved to be a relatively simple technique of easy execution with a low risk of nerve damage.

Implant handpiece with adapted drills in orthognathic surgery: preventing facial scars.

The attachment of bilateral sagittal-split osteotomy of the mandibular ramus with bicortical screws or the combination of miniplates and a bicortical screw is complicated through the intraoral approach because of the angle required for insertion of screws, so it is necessary to use a trocater. This article aimed to report a technique developed and used in 60 patients, wherein an implant handpiece with adapted drills was used in the intraoral attachment. The setting was performed intraorally to prevent scarring and extraoral facial nerve damage, which may be caused by extraoral and transbuccal approaches routinely performed when using the trocater. The versatility of the handpiece implant allows for the insertion of monocortical and bicortical screws and rigid internal fixation of mandibular sagittal-split osteotomy, as well as surgical time reduction, decreasing postoperative morbidity.

Embolization of pseudoaneurysm of the internal maxillary artery after orthognathic surgery.

In orthognathic surgery, Le Fort I osteotomy is one of the most often used methods for the correction of dental-facial deformities and is considered technically safe. However, this procedure may lead to diverse complications, including uncommon vascular complications. A clinical case is described of late development of pseudoaneurysm in one of the branches of the maxillary artery in a 20-year-old patient who had undergone Le Fort I osteotomy, bilateral sagittal osteotomy of mandibular branch, and mentoplasty and subsequently treated with embolization. The main forms of treating vascular injuries are reviewed, and embolization is demonstrated to be a technically safe procedure with few complications.

Self-drilling and self-tapping screws: an ultrastructural study.

OBJECTIVE: The aim of the current study was to compare self-drilling and self-tapping screws with regard to bone contact and the production of bone debris using scanning electron microscopy. MATERIALS AND METHODS: Three New Zealand rabbit calvariae were used. Self-tapping and self-drilling screws were inserted into the outer surface of the skull with and without saline solution irrigation. All screws were 5 mm in length and were inserted until their tips projected through the endosteal side. Sixteen screws were used--8 with a head diameter of 1.5 mm and 8 with 2.0 mm. All self-tapping screws were inserted through a drill bit hole (1.6 mm for 2.0-mm screws and 1.3 mm for 1.5-mm screws). RESULTS: There was no damage to the screws after insertion. Bone damage occurred when irrigation was not used during the installment of the self-tapping screws. Bone debris formed during the installment of the self-drilling screws, which is considered beneficial. CONCLUSIONS: Because the insertion of self-drilling screws is performed with manual pressure, irrigation is not essential. Unlike the drilling that occurs with self-tapping screw, the bone debris formed with self-drilling screws is not the result of the heat generated, but rather the result of biologically active bone tissue capable of reacting with the screw and improving its performance. The animal model used proved highly appropriate for comparisons with human beings because the bone structures of the head have the same density and thickness.

Use of autologous fat graft for correction of facial asymmetry stemming from Parry-Romberg syndrome.

Facial hemiatrophy is a typical manifestation of Parry-Romberg syndrome, characterized by a slow progressive atrophy that appears in early stages of life, primarily affecting the subcutaneous tissue and subjacent fat on 1 side of the face. We describe the case of a 42-year-old female patient with stabilized moderate facial hemiatrophy on the left side of the face, successfully treated with a 2-stage autologous fat transplant and the use of subcutaneous tunnels among the musculature for the placement of the graft. We also describe the principal forms of correcting facial asymmetry in patients with Parry-Romberg syndrome and demonstrate that an autologous fat graft provides good results in the correction of this deformity, with improved esthetics and patient satisfaction.