Changes in Lip Profile of Edentulous Patients After Placement of Maxillary Implant-Supported Fixed Prosthesis: Is a Wax Try-in a Reliable Diagnostic Tool?

PURPOSE: A diagnostic wax try-in has been recommended to correctly design the future prosthesis for edentulous maxillae and to predict its effect on the supporting oral tissues. The objectives of this study were to analyze (1) the reliability of this diagnostic tool in planning fixed implant-supported prostheses and (2) the amount of prosthetic compensation required. MATERIALS AND METHODS: Nine female patients participated in this prospective study (mean age, 53.6 years). After anamnesis, clinical examination, and preoperative analysis, the patients underwent preoperative prosthetic preparation, and the wax try-in was fabricated. To evaluate the efficiency of the diagnostic wax try-in, three profile cephalograms were taken of each patient: (1) with the initial conventional prosthesis, (2) with the wax try-in, and (3) with the implant-supported prosthesis. Two analyses were carried out for the assessment of lip support: the nasolabial angle and Steiner's S-line. To analyze the amount of prosthetic compensation, two measurements-vertical and horizontal distances- were obtained for each wax try-in and final prosthesis. RESULTS: For the Steiner's S-line, the results of the statistical tests indicated no significant difference between the initial and final prosthesis for the upper (P = .237) and lower lips (P = .237), and between the wax try-in and final prosthesis for the upper (P = .463) and lower lips (P = .463). Regarding the nasolabial angle, the results of the statistical tests indicated no significant difference between the initial and final prosthesis (P = .594), and between the wax try-in and final prosthesis (P = .800). Regarding prosthetic compensation, the results of the statistical test indicated no significant difference between the vertical (P = .753) and horizontal evaluations (P = .855) carried out for the wax try-in and those for the final prosthesis. CONCLUSION: On the basis of the data collected, it was concluded that the methods of replacing muco-supported prostheses with implant-supported fixed prostheses were efficient at maintaining the original lip design. The wax try-in was capable of predicting the future lip design and the prosthetic compensation of the final prosthesis. More studies are required to consolidate these data.

Reabilitação de maxila em carga imediata utilizando técnica guiada flapless, baseada em planejamento virtual pré-cirúrgico: relato de caso clínico / Rehabilitation of the maxilla with computer-assisted flapless surgery according to virtual preoperative planning: A case report

A técnica da cirurgia guiada, associada à tecnologia CAD/CAM, auxilia na busca de precisão na instalação de implantes osseointegráveis, pois segue um planejamento virtual que permite a visualização em software da relação da necessidade protética com a quantidade óssea disponível. Objetivo: o objetivo desse trabalho é relatar um caso de reabilitação de arcada superior com utilização do sistema NeoGuide (Neodent, Curitiba/PR), com técnica guiada flapless em carga imediata. Métodos: após o preparo pré-tomográfico e o planejamento virtual, foram instalados oito implantes Titamax EX cone-morse (Neodent) com a utilização de um guia cirúrgico prototipado. Após a instalação dos implantes, foi realizado exame radiográfico panorâmico e tomografia computadorizada. Em seguida, foi instalada uma prótese fixa implantossuportada. Conclusão: a utilização de técnica guiada flapless em carga imediata mostrou-se um recurso valioso no tratamento de reabilitações de arcadas superiores edêntulas, com redução do tempo cirúrgico e diminuição dos sintomas pós-operatórios, como dor, edema e inflamação.

Computer-guided surgery combined with CAD/CAM technology is a useful technique for placement of osseointegrated dental implants with utmost accuracy, since it employs virtual planning technology which allows visualization by a computer software of the relationship between one’s prosthetic needs and the amount of bone available. Objective: The aim of this studywas to report a case of maxillary rehabilitation with the use of the Neoguide system (Neodent®,Curitiba, Brazil), with the aid of computer-guided flapless technique and immediate loading. Methods: after pre tomographic preparation and virtual planning, eight Titamax EX Morse taperimplants (Neodent®, Curitiba, Brazil) were placed using a prototyped surgical guide. After implantplacement, panoramic radiographs and CT scans were performed. Subsequently, a fixed implant supported denture was installed. Conclusion: The use of computer-guided flapless surgery with immediate loading proved a valuable resource in maxillary rehabilitation, with reduced surgical time and decreased post-operative symptoms such as pain, swelling and inflammation.

Attachment-retained gingival prosthesis for implant-supported fixed dental prosthesis in the maxilla: a clinical report.

The rehabilitation of edentulous maxillae is a complex procedure due to the involvement of esthetic and functional requirements. A trial maxillary denture can be used to identify the need for adequate upper lip support when replacing removable complete dentures by implant-fixed dental prostheses. This clinical report describes the outcome of the rehabilitation of an edentulous atrophic maxilla with unfavorable maxillomandibular relationship and deficient upper lip support. A trial denture was fabricated and used to diagnose the need for a prosthesis capable of restoring the upper lip support. The reduced upper lip support was also confirmed by a lateral cephalogram. The patient was rehabilitated by an implant-fixed dental prosthesis associated with an attachment-retained gingival prosthesis. The case presented shows that when loss of upper lip support is detected and the patient does not wish to undergo further surgical reconstruction procedure, the retention of a gingival prosthesis using a ball attachment is a satisfactory treatment option.

Aplicabilidade dos enxertos em bloco de origem xenógena nas reconstruções ósseas: relato de caso clínico com avaliação tomográfica e histológica após seis meses / Applicability of xenogenous onlay grafts in bone reconstruction: case report with tomographic and histologic evaluation after six months

O osso autógeno é considerado padrão-ouro para reconstrução óssea em bloco e sustentação dos implantes dentários, mas limitações na disponibilidade e aumento na morbidade são associados a este material. Assim, o osso xenógeno em bloco vem sendo abordado como um substituto viável ao osso autógeno nos casos de recontorno vestibular do rebordo ósseo. Este caso clínico demonstrou a técnica de utilização deste material. Uma paciente de 52 anos de idade e com deficiência estética significativa na região anterior superior recebeu enxerto sintético em bloco fixado com parafusos apropriados. Após seis meses, quatro implantes foram instalados e permitida a osseointegração por mais seis meses. Tomografias computadorizadas foram realizadas antes (T0), após a cirurgia de enxertia do bloco (T1), e após o tempo de consolidação (T2), com as mudanças nos contornos volumétricos sendo comparadas em programa apropriado. Análises histológicas também foram realizadas ao redor do osso do parafuso removido. A estabilidade volumétrica do material foi considerada compatível com a literatura publicada após seis meses. Houve neoformação óssea ao redor do enxerto xenógeno com atividade de remodelação óssea.

Autogenous bone is considered the gold standard material for bone block reconstruction and dental implant supporting, but limited availability and morbidity are associated to this material. Thus, exogenous block substitutes have been studied for such bone augmentation. This case report describes the potential application of this material. A 52 years-old patient with significant deficit at the anterior region received a synthetic block secured with appropriate screws. Six months later, four dental implants were placed and osseointegration allowed for more six months. CBCT scans were performed at baseline (T0), after block grafting (T1), and after consolidation phase (T2). Volumetric changes were compared in the recommended software. Histological analyses were performed around the retrieved screws. The volumetric stability of this material after six months was considered compatible with the already published literature. Bone neoformation was seen around the xenograft with associated bone remodeling

Reabilitação de maxila edêntula com técnica cirúrgica guiada flapless em carga imediata / Rehabilitation of the edentulous maxillary arch using an immediate, surgically guided flapless technique – a case report

Este relato de caso demonstra o uso de um sistema de cirurgia guiada sem retalho para colocação de uma prótese em carga imediata. Uma paciente do gênero feminino, 38 anos de idade, compareceu à clínica com queixas estéticas e funcionais. Inicialmente, os dentes remanescentes na mandíbula foram extraídos e uma prótese implantossuportada foi instalada. Na maxila, após o enceramento diagnóstico, tomografias computadorizadas feixe cônico (TCFC) foram realizadas uma tomografia da paciente com o guia tomográfico em posição e um escaneamento apenas do guia. As imagens foram fundidas em um software específico, e o planejamento virtual foi realizado. Seis implantes de titânio com conexão cone-morse foram instalados (torque final 32 Ncm), conectados aos minipilares, e o processo de moldagem foi finalizado. A infraestrutura desenhada recebeu a prótese maxilar definitiva através de um processo de cimentação passiva (Panavia) dos cilindros de titânio, em carga imediata. Após três meses, foram realizados exames clínicos e uma nova radiografia panorâmica. A prótese foi removida e os implantes foram testados individualmente. Todos os implantes apresentaram-se osseointegrados, sem sinais e sintomas irreversíveis ou persistentes (dor, infecção, neuropatias, parestesia ou mobilidade) e sem evidência de radioluminescência peri-implantar. Dentro das limitações do caso e mediante indicação clínica adequada, a técnica de carga imediata com cirurgia sem retalho fornece excelentes resultados estéticos, reduzindo o tempo cirúrgico e os sintomas pós-operatórios, ao mesmo tempo em que preserva maior quantidade de tecido.

This case report demonstrates the use of flapless guided surgery for immediate implant placement and loading. A female, 38 years-old patient was referred with claims of poor esthetics and function. First, all remaining mandibular teeth were extracted and an implant-supported prosthesis delivered. For the maxillary arch, CBCTs were made based on the diagnostic wax-up, with and without the tomographic guide. Images were superimposed with the aid of an specifi c software, and the virtual planning was made. Six cone-morse dental titanium implants (32 Ncm torque) were installed and connected to mini-abutments for impression procedures. The designed framework received the definative prosthesis through passive cementation (Panavia) using titanium cylinders under immediate loading. Latter, the prosthesis was removed and all implants tested individually, showing osseointegration and no signs of irreversible or persistent symptoms (pain, infection, neuropathies, paresthesia, or mobility) or peri-implant radiolucency were seen. Within the limits of this case and following adequate clinical indication, the fl apless guided surgery with immediate implant loading provided excellent esthetic results, shortening the surgical time and postoperative discomfort, while also allowing for more tissue preservation