RESUMO
Primary implant stability (PIS) depends on surgical technique, implant design, and recipient bone characteristics, among other factors. Bone density (BD) can be determined in Hounsfield units (HUs) using cone beam computerized tomography (CBCT). Reliable prediction of PIS could guide treatment decisions. We assessed whether PIS was associated with recipient bone characteristics, namely, BD and alveolar ridge width (ARW), measured preoperatively by CBCT. We studied a convenience sample of 160 implants placed in 48 patients in 2016 and 2017. All underwent CBCT with a radiologic/surgical guide yielding values for ARW and BD. PIS measures used were the implant stability quotient (ISQ) from resonance frequency analysis and insertion torque (IT). IT was most influenced by the HU value at 0.5 mm outside the implant placement area, followed by the value within this area, and ISQ by the HU value at 0.5 mm outside the placement area, followed by implant placement site and apical ARW. ISQ values were significantly related to ARW in coronal (P < .05), middle (P < .01), and apical (P < .01) thirds. ISQs were higher with larger-diameter implants (P < .01). ISQ and IT were strongly correlated (P < .001). PIS in terms of ISQ and IT is positively correlated with edentulous alveolar ridge BD measured by CBCT, implying that implant stability may be predicted preoperatively. Wide alveolar ridges favored lateral PIS but did not affect rotational PIS. The most significant predictor of lateral and rotational PIS in our patients was the HU value at 0.5 mm outside the implant placement area.
Assuntos
Densidade Óssea , Implantes Dentários , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Implantação Dentária Endóssea , Humanos , TorqueRESUMO
El papel de una anchura adecuada de mucosa queratinizada (MQ) alrededor de los implantes dentales en la estabilidad a largo plazo de los tejidos periimplantarios sigue siendo un tema de debate. El objetivo de esta revisión fue evaluar y describir los resultados sobre las técnicas quirúrgicas disponibles y el momento temporal en el que llevar a cabo el incremento de los tejidos blandos periimplantarios. Para ello se realizó una búsqueda bibliográfica electrónica en las bases de datos PubMed y Medline, y manual de artículos relevantes, considerando el período entre 2012 y 2017 e incluyendo aquellos artículos que trataban sobre diferentes técnicas quirúrgicas realizadas a partir del momento temporal B (desde la colocación de los implantes). Se incluyeron un total de 10 artículos, comparándolos en función del momento temporal en el que se realizó la técnica quirúrgica y analizando las siguientes variables de estudio: anchura de mucosa queratinizada, grosor/espesor de mucosa queratinizada, contracción postoperatoria, tiempo quirúrgico y estética y disconfort postoperatorio. Se puede concluir que el injerto gingival libre ha demostrado obtener las mayores anchuras de mucosa queratinizada. No obstante, existen otros materiales disponibles que reducen la morbilidad del paciente y evitan un segundo sitio quirúrgico como la matriz de colágeno xenogénica que podría ser tan efectiva y predecible como éste. Tanto la matriz de colágeno xenogénica como el injerto de tejido conectivo ofrecen resultados estéticos superiores a los conseguidos con el injerto gingival libre
The role of an adequate width of keratinized mucosa (KM) around dental implants in the long-term stability of peri-implant tissues is still controversial. The aim of this study was to evaluate and describe the results of the surgical techniques available and the moment in which the increase of the peri-implant soft tissues should take place. An electronic bibliographic search was carried out in the PubMed and Medline databases, considering the period between 2012 and 2017 and including those articles that dealt with different surgical techniques performed from time B (from the implants fitting). A total of 10 articles were included, comparing them according to the time when the surgical technique was performed and analyzing the following study variables: width of keratinized mucosa, thickness of keratinized mucosa, postoperative contraction, surgical and aesthetic time and postoperative discomfort. It can be concluded that the free gingival graft has been shown to obtain the largest widths of keratinized mucosa. However, there are other materials available that reduce the morbidity of the patient and avoid a second surgical site such as the xenogeneic collagen matrix which can be as effective and predictable as the free gingival graft. Both the xenogeneic collagen matrix and the connective tissue graft offer superior aesthetic results to those obtained with the free gingival graft
