15-Year Retrospective Study on the Success Rate of Maxillary Sinus Augmentation and Implants: Influence of Bone Substitute Type, Presurgical Bone Height, and Membrane Perforation during Sinus Lift.

Objectives: To evaluate the success rate of bone grafts and implants carried out at the Latin American Institute for Research and Dental Education (ILAPEO), considering the following: (i) the different pure bone substitutes (autogenous, xenogeneic, and alloplastic), (ii) the presurgical bone height, and (iii) how the treatment is compromised when membrane perforation occurs during sinus lift in maxillary sinus surgeries. Material and Methods. The initial sample comprised 1040 records of maxillary sinus lifting surgeries. After evaluation, the final sample retained 472 grafts performed using the lateral window technique with a total of 757 implants. The grafts were divided into 3 groups: (i) autogenous bone (n = 197), (ii) xenogenous bovine bone (n = 182), and (iii) alloplastic material (n = 93). One calibrated examiner classified the sample into two groups based on the residual bone height (<4 mm and ≥4 mm) of the area of interest measured on parasagittal sections of tomographic images. Data on membrane perforation occurrences in each group were collected; qualitative variables were described using frequency, expressed as percentages. The Chi-square test was used to analyze the success of the graft types and the survival rate of the implants as a function of the grafted material and the residual bone height. The Kaplan-Meier survival analysis was used to calculate the survival rate of bone grafts and implants according to the classifications adopted in this retrospective study. Results: The success rate of grafts and implants was 98.3% and 97.2%, respectively. There was no statistically significant difference in the success rate among the different bone substitutes (p = 0.140). Only 8 grafts (1.7%) and 21 implants (2.8%) failed. There was a greater success rate for both grafts (96.5%) and implants (97.4%) when the bone height was ≥4 mm. The success rate in the 49 sinuses in which the membrane was perforated was 97.96% for the grafts and 96.2% for the implants. The follow-up periods after rehabilitation ranged from 3 months to 13 years. Conclusions: Within the limitations of the data analyzed in this retrospective study, maxillary sinus lift was a viable surgical technique that enabled implant placement with a predictable long-term success rate, regardless of the type of material used. The presence of membrane perforation did not interfere with the success rate obtained for grafts and implants.

A Zygomatic Bone Study Using Virtual Dental Implant Planning Software.

This study evaluated the anatomical factors that influence the virtual planning of zygomatic implants by using cone-beam computerized tomography (CBCT) scans. CBCT scans of 268 edentulous patients were transferred to specialized implant planning software for the following measurements: maxillo-sinus concavity size (small, medium, and large), zygoma width, implant insertion angle, implant length, and implant apical anchorage. Concavity sizes found were as follows: 34.95% small, 52.30% medium, and 7.35% large. The mean insertion angle was 43.2 degrees, and the average implant apical anchorage was 9.1 mm. The most frequent implant length was 40 mm. Significant differences were found when the different types of concavities in relation to the installation angle, the distance of the apical portion of the implant in contact with the zygomatic bone, and the lateral-lateral thickness of the zygomatic bone were compared (P < .001). Medium-sized maxillary sinus concavity presented greater apical anchorage of the implant (9.7 mm) and was the most frequent type (52.30%). The zygomatic bone is a viable site for zygomatic fixtures, and the use of specialized implant planning software is an important tool to achieve predictable outcomes for zygomatic implants and allows good visualization of the relation between implants and anatomical structures.

Comparação da expansão óssea promovida pela técnica de osseodensificação com dois tipos de conjunto de fresas / Comparison of bone expansion promoted by the osseodensification technique with two types of drill sets

Introdução: A estabilidade primária é um importante indicador de sucesso da osseointegração. Porém, fatores locais com osso de baixa intensidade podem interferir negativamente na obtenção da estabilidade primária. Objetivo: O presente estudo avaliou o efeito de diferentes direções, velocidades de rotação e sistemas de fresagem na expansão de perfurações e estabilidade de implantes instalados em blocos mimetizando osso do tipo IV. Material e método: Foram instalados 50 implantes em blocos de poliuretano sólido rígido. Esses implantes foram igualmente divididos em cinco grupos (n = 10): 1) Fresa Maximus (utilizadas no sentido horário a 1200rpm); 2) Fresa Maximus (utilizadas no sentido horário a 600rpm); 3) Fresa Neodent (utilizadas no sentido horário a 800rpm); 4) Fresa Neodent (utilizadas no sentido anti-horário a 800rpm); 5) Fresa Neodent (utilizadas no sentido anti-horário a 600rpm). Foram executadas análises de estabilidade dos implantes através de testes de torque de inserção e remoção, além das análises de frequência de ressonância. Adicionalmente, a expansão associada às perfurações promovida pelas brocas foi avaliada por meio de análises tomográficas. Resultado: Verificou-se que os implantes instalados após o preparo da perfuração com as brocas Maximus a 600rpm apresentaram valores de torque de inserção maiores, quando comparados ao grupo de implantes instalados em perfurações confeccionadas com brocas Neodent. Ademais, as brocas Maximus apresentaram valores de expansão maiores que as brocas Neodent. Conclusão: As brocas Maximus são mais eficientes em promover a osseodensificação, e sua utilização está associada ao aumento da estabilidade dos implantes instalados em blocos mimetizando osso do tipo IV.

Introduction: Primary stability is an important indicator to obtain a successful osseointegration. However, local factors like bone with low density can negatively interfere in obtaining primary stability. Objective: This study assessed the effect of different drilling systems, speeds, and movement directions on the expansion of perforations and the stability of implants placed in blocks that mimicked type IV bone. Material and method: Fifty implants were installed in rigid solid polyurethane blocks and equally divided into the following five groups (n = 10): 1) Maximus Driller (on a clockwise direction at 1200rpm); 2) Maximus Driller (on a clockwise direction at 600rpm); 3) Neodent Driller (on a clockwise direction at 800rpm); 4) Neodent Driller (on a counter clockwise direction at 800rpm); 5) Neodent Driller (on a counter clockwise direction at 600rpm). The stability analyses of the implants were performed through insertion and removal torque testing, in addition to resonance frequency analysis. Additionally, the expansion promoted by the drills associated with the perforations was assessed through tomographic analysis. Result: We found that implants placed after drilling preparation with Maximus drills at 600 rpm had higher values of insertion torque than the group of implants installed in drillings made with Neodent drills. In addition, the maximus drills showed higher expansion values than the Neodent drills. Conclusion Maximus drills are more efficient in promoting osseodensification and their use was associated with increased stability of implants installed in blocks that mimicked type IV bone.

Can Implant-Retained Fixed Prostheses Trigger Bone Response in the Posterior Region of Edentulous Mandibles? A 32-Month Cone-Beam Computerized Tomography Study Analyzing Bone Height and Density.

Research has shown that the presence of implants can revert bone resorption and thus contribute to a greater preservation of the residual bone ridge, especially in edentulous mandibles. Bone remodeling has yet to be extensively studied in the context of prosthetic options for edentulous arches. This study aims to evaluate the long-term behavior of bone tissue in the posterior region of edentulous mandibles rehabilitated with implant-retained fixed prostheses using cone-beam computerized tomography (CBCT). Selected individuals were rehabilitated with 5 external hexagon platform implants and an implant-retained fixed prosthesis. The CBCT scans were performed immediately after surgery and after 8, 22, and 32 months (T0, T8, T22, and T32, respectively). Implants were installed between the mental foramen. Subsequently, bone crest height and density were measured in the posterior region of the mandible on the images in 3 distinct areas at 5, 10, and 15 mm from the center of the distal implant axis. Analysis of variance and the Bonferroni post hoc test were used for multiple analyses. The results indicate a statistically significant difference in bone height between T0 and all subsequent times; the bone height at T32 was 8.85% higher than at T0 (P = .05). There was a difference in bone height between all analyzed regions. The bone growth difference between the 5-mm and 15-mm positions was 28.42% after 32 months (P = .00). A significant increase of 5.76% in bone density was observed between T0 and T22 (P = .03). Within the limitations of this study (sample size, follow-up duration), it was demonstrated that the use of implant-retained fixed prostheses in the mandible resulted in qualitative and quantitative bone growth (bone preservation) in the posterior region of the mandible. Further research is needed to identify the validity of our findings for other populations and to determine the duration of the bone-remodeling process in rehabilitated edentulous mandibles.

Effect of different implant placement depths on crestal bone levels and soft tissue behavior: A 5-year randomized clinical trial.

OBJECTIVES: This randomized clinical trial analyzed the long-term (5-year) crestal bone changes and soft tissue dimensions surrounding implants with an internal tapered connection placed in the anterior mandibular region at different depths (equi- and subcrestal). MATERIALS AND METHODS: Eleven edentulous patients were randomly divided in a split-mouth design: 28 equicrestal implants (G1) and 27 subcrestal (1-3 mm) implants (G2). Five implants were placed per patient. All implants were immediately loaded. Standardized intraoral radiographs were used to evaluate crestal bone (CB) changes. Patients were assessed immediately, 4, 8, and 60 months after implant placement. The correlation between vertical mucosal thickness (VMT) and soft tissue recession was analyzed. Sub-group analysis was also performed to evaluate the correlation between VMT and CB loss. Rank-based ANOVA was used for comparison between groups (α = .05). RESULTS: Fifty-five implants (G1 = 28 and G2 = 27) were assessed. Implant and prosthetic survival rate were 100%. Subcrestal positioning resulted in less CB loss (-0.80 mm) when compared to equicrestal position (-0.99 mm), although the difference was not statistically significant (p > .05). Significant CB loss was found within the G1 and G2 groups at two different measurement times (T4 and T60) (p < .05). Implant placement depths and VMT had no effect on soft tissue recession (p > .05). CONCLUSIONS: There was no statistically significant difference in CB changes between subcrestal and equicrestal implant positioning; however, subcrestal position resulted in higher bone levels. Neither mucosal recession nor vertical mucosa thickness was influenced by different implant placement depths.

Splinted wide-short implants in the posterior region of an atrophic mandible opposed by an edentulous maxilla: immediate loading and 1-year follow-up.

The generally recommended treatment for patients with mandibular bone atrophy involves extensive bone reconstruction to enable the use of standard dental implants. In posterior areas with limited height and thickness, a combination of wide-short dental implants and long implants has also been recommended. This alternative treatment improves the biomechanical resistance to stress from occlusal forces during mastication and has achieved success rates comparable to those of standard implants. In most cases, this treatment option allows immediate loading, simplifying the oral rehabilitation and decreasing the morbidity rate. The purpose of this case report is to discuss clinical treatment of a patient with bilateral bone atrophy in the posterior regions of the mandible. Two wide-short implants splinted to 1 standard implant were used for rehabilitation on the right side. The mandibular left hemiarch had a greater amount of bone, and 3 standard implants were placed on the right side. One year after implant placement, the treatment outcomes were found to be similar on both sides. In this patient, the use of wide-short implants splinted to a standard implant improved mandibular occlusal stability in an area of reduced bone height.

Proposta de protocolo tomográfico para planejamento cirúrgico de implante zigomático / Tomographic protocol proposal for zygomatic implants surgical planning

O objetivo deste trabalho foi apresentar uma proposta de um protocolo de planejamento cirúrgico para implantes zigomáticos, por meio de imagens tomográficas inseridas em software de planejamento virtual. As etapas do protocolo foram descritas por meio de relato de caso clínico de paciente desdentado total superior candidato à reabilitação com ancoragem zigomática. A tomografia pré-operatória foi analisada no software de planejamento CoDiagonostiX (Dental Wings, Chemnitz, Alemanha). Uma vez obtidas medidas lineares, angulares e de volume das estruturas anatômicas envolvidas, o planejamento virtual de implantes zigomáticos foi realizado. Concluiu-se que o software de planejamento de implantes zigomáticos com possibilidade de obtenção de medidas lineares, angulares e de volume das estruturas anatômicas representa uma ferramenta importante que permite maior segurança e previsibilidade (AU).

The objective of this paper was to present a proposal of zygomatic implants surgical planning protocol through tomographic images inserted in virtual planning software. The protocol stages were described through a clinical case report of an upper total edentulous patient, candidate for zygomatic anchorage rehabilitation. Preoperative tomography was analyzed in the CoDiagonostiX planning software (Dental Wings, Chemnitz, Germany). As linear, angular and volume measurements of the anatomical structures involved were obtained, the virtual zygomatic implant planning was performed. It was concluded that zygomatic implant planning software which allows to obtain linear, angular, and volume measurements of anatomical structures represents an important tool that allows greater security and predictability (AU).

Real Versus Virtual Position of Single Implants Installed in Premaxilla via Guided Surgery: A Proof of Concept Analyzing Positional Deviations.

The aim of this research letter was to report the results of a pilot study designed to compare the real and virtual position of implants placed using computer-guided flapless implant surgery for single restorations in the premaxilla. A total of 8 patients (2 men and 6 women) with a mean age of 40 years old (range: 32-73 years) had a total of 11 implants inserted using a tooth-supported stereolithographic guide. After implant placement, the positions (coronal, central, and apical) and angulation of the implants installed in relation to those planned were determined via the superposition of pre- and postoperative 3-dimensional models using Dental Slice software (Bioparts, Brasília, Brazil). The mean angular deviation was 2.54° ± 0.71°. The deviations found for the coronal, central, and apical positions were 1.3 ± 0.77 mm, 1.49 ± 0.58 mm, and 2.13 ± 1.32 mm, respectively.

Influence of cortical bone anchorage on the primary stability of dental implants.

PURPOSE: This retrospective chart review study assessed patient records to determine implant insertion torque (IT) and implant stability quotient (ISQ) values during implant placement to evaluate the correlation with cortical bone anchorage (mono- or bicortical). METHODS: Primary stability data (IT during implant placement surgery and ISQ values immediately after implant placement) and cone beam computed tomography of 33 patients (165 implants) were assessed. Patients were divided into the following groups: G1, implants with apical cortical bone contact; G2, implants with bicortical bone contact (apical and cervical regions); and G3, implants with cervical cortical bone contact. RESULTS: Sixty-eight implants were excluded due to cortical bone contact on regions other than implant apical or cervical. Ninety-seven implants were therefore assessed for this study. No implant failure was found after a mean 70.42-month follow-up time. Implants with bicortical anchorage (G2) showed higher IT (64.1 Ncm) during implant placement and higher ISQ values (76) (p < 0.05). Monocortical implants (G1, apical, and G3, cervical) showed similar IT (G1 52.3 and G3 54.3) and ISQ values (G1 71.9 and G3 73) (p > 0.05). No correlation (Pearson correlation coefficient) was found between the two stability measurement devices for the different cortical bone anchorages that were analyzed (G1 0.190, G2 0.039, and G3 - 0.027) (p > 0.05). CONCLUSIONS: Insertion torque values and implant stability quotients were influenced by cortical bone contact. No significant correlation was found between IT and ISQ values-higher insertion torque values do not necessarily lead to higher implant stability quotients.

Evaluation of the bone anatomy of the anterior region of the mandible using cone beam computed tomography / Avaliação da anatomia da região anterior da mandíbula por meio de tomografia de feixe cônico

Background: Hemorrhages, mouth floor edema and tongue elevation are complications related to surgical procedures in the anterior region of the mandible. Objective: The objectives of this study were to evaluate the presence and location of the lingual foramen in the anterior region of the mandible and to evaluate mandibular morphology using cone beam computerized tomography (CBCT). Material and method: The mandible's morphology and the location, diameter and height of the lingual foramina were analyzed using the midline and the mental foramen as references, in 278 CBCT. Result: 88% of the sample had a midline lingual foramen, totaling 408 foramina, with a mean diameter of 0.93 mm. Foramina in the lingual region between the midline and mental foramina were detected in 75% of the sample, with a mean diameter of 0.807 mm. There was no positive correlation between the presence of lingual foramina in the lateral or in the midline regions (r = -0.149; p = 0.013). In the midline region, the type I mandibular shape was predominant (96%), and type III was predominant in the lateral regions. Conclusion: Considering the prevalence of these structures and their clinical relevance in potential surgical complications, it is important to carefully analyze the anterior region of the mandible during surgical planning.

Introdução: Hemorragias, edema no assoalho bucal e elevação da língua são complicações relacionadas a procedimentos cirúrgicos na região anterior da mandíbula. Objetivo: Os objetivos deste estudo foram avaliar a presença e localização do forame lingual na região anterior da mandíbula e avaliar a morfologia mandibular utilizando tomografia computadorizada com feixe de cone (CBCT). Material e método: A morfologia da mandíbula e a localização, diâmetro e altura do forame lingual foram analisados utilizando a medula e o forame mental como referências em 278 CBCT. Resultado: 88% da amostra tinha um forame lingual da linha média, totalizando 408 forames, com um diâmetro médio de 0,93 mm. Na região lingual entre a linha média e forames mentais foram detectados em 75% da amostra, com um diâmetro médio de 0,807 mm. Não houve correlação positiva entre a presença de forames lingual nas regiões lateral ou na região média (r = -0,149; p = 0,013). Na região da linha média, a forma mandibular do tipo I era predominante (96%) e o tipo III predominava nas regiões laterais. Conclusão: Considerando a prevalência dessas estruturas e sua relevância clínica em possíveis complicações cirúrgicas, é importante analisar cuidadosamente a região anterior da mandíbula durante o planejamento cirúrgico.

Manejo de complicações protéticas de implantes zigomáticos ­ relato de caso com 1 ano de acompanhamento / Management of prosthetic complications of zygomatic implants - 1-year followup case report

A ancoragem de implantes em osso zigomático tem sido reconhecida como uma abordagem terapêutica menos invasiva quando comparada às grandes reconstruções para a reabilitação de maxilas severamente atróficas. Apesar de alcançar sucesso clínico elevado do ponto de vista cirúrgico e protético, melhorando a qualidade de vida e satisfação dos pacientes, problemas relacionados ao conforto da prótese são algumas vezes relacionados. Este caso clínico apresenta a resolução de 2 problemas: i) implantes zigomáticos do tipo cone morse em nível gengival, o que deixava a região côncava dos intermediários exposta ao meio oral e ii) hipersensibilidade na região de fossa nasal pela presença de implantes na região. A sensibilidade e trauma na língua, em decorrência dos implantes posteriores, foram solucionados pela personalização de um componente protético, enquanto a sensação de pressão na região anterior da maxila foi eliminada após a remoção de 2 implantes convencionais sem prejuízo à biomecânica da prótese implantossuportada (AU).

The anchorage of implants in the zygomatic bone has been recognized as a less invasive approach when compared to large reconstructions of severely atrophic maxilla. Although high rates of surgical and prosthetic success have been reached improving the patient life quality and satisfaction, problems in terms of prosthesis comfort are sometimes reported. This case report presents the resolution of 2 problems: i) morse taper zygomatic implants at the gingival level, resulting in the exposure of the concave area of the abutments and ii) hypersensitivity at the nasal cavity region, due to implants nearby this site. Sensitivity and tongue trauma, as a result of posterior implants, were solved by prosthetic component customization , while the pressure in the maxilla anterior area was eliminated after removing 2 conventional implants with no damage to the biomechanics of the implant supported prosthesis (AU).

Effect of different implant placement depths on crestal bone levels and soft tissue behavior: a randomized clinical trial.

OBJECTIVES: This randomized clinical trial analyzed crestal bone changes and soft tissue dimensions surrounding implants with an internal tapered connection placed in the mandible anterior region at different depths (equicrestal and subcrestal). MATERIALS AND METHODS: Eleven edentulous patients (five implants per patient) were randomly divided in a split-mouth design: G1, 28 equicrestal implants; and G2, 27 subcrestal implants. All implants were immediately loaded. Correlation between keratinized tissue width (KTW) and vertical mucosa thickness (MT) with soft tissue recession was analyzed. Intraoral radiographs were used to evaluate crestal bone changes. Patients were assessed immediately, 4-, and 8-months after implant placement. Rank-based ANOVA-type statistical test was used for comparison between groups (α = 0.05). RESULTS: Fifty-five implants (G1 = 28 and G2 = 27) were assessed in 11 patients. Implant survival rate was 100% for both groups. Both tested implant placement depths presented similar crestal bone loss (P > 0.05). Significant crestal bone loss for each group was found in the different measurement times (T4 and T8) (P < 0.05). Implant placement depths, KTW, and vertical MT had no effect on soft tissue recession (P > 0.05). CONCLUSIONS: Different implant placement depths do not influence crestal bone changes. Soft tissue behavior is not influenced by different implant placement depths or by the amount of keratinized tissue.

Peri-implant bone response following immediate implants placed in the esthetic zone and with immediate provisionalization--a case series study.

PURPOSE: The aim of this case series was to evaluate success and peri-implant bone response around Morse taper immediate implants with an immediate provisionalization. METHODS: Twelve immediate implants were inserted in the maxilla of nine consecutively treated patients. Proximal bone response was evaluated with digital periapical radiographs, and the buccal wall height and width were evaluated with computed tomography. RESULTS: A slight decrease in the marginal bone crest (0.14 ± 0.41 mm) at the mesial face and an increase (0.07 ± 1.58 mm) at the distal face were observed. Considering the point where bone tissue meets the implant surface, there was a statistically significant increase at the mesial face (0.92 ± 1.29 mm) and a not significant increase at the distal face (0.43 ± 1.63 mm). Buccal bone wall width showed a statistically significant bone loss at the level of the implant/abutment junction (0.77 ± 0.75 mm) and at 3 mm (0.59 ± 0.76 mm) and 6 mm (0.46 ± 0.81 mm) apically to the implant/abutment junction. The height of the buccal wall showed a not statistically significant resorption (0.20 ± 0.51 mm). CONCLUSION: Based on the preliminary results (8 months) of this case series study, it can be concluded that there was bone loss on the mesial bone crest level and on the buccal face and bone increases on the mesial and distal faces in the area where the bone meets the implant surface. Nevertheless, this is just a case series study, and long-term controlled clinical trials are essential for a definitive conclusion.

Prospective tomographic evaluation of autogenous bone resorption harvested from mandibular ramus in atrophic maxilla.

Autogenous bone is considered the criterion standard for grafting procedures of severely resorbed alveolar ridges. However, the rate of autogenous graft resorption remains controversial. The aim of this study was to evaluate the mandibular graft resorption with cone beam computed tomography after 10 and 180 days of augmentation procedures in the atrophic maxilla. Twenty-two patients received 36 autogenous bone grafts harvested from the mandibular ramus. Tomographical evaluations were carried out after 10 (T1) and 180 (T2) days of augmentation procedures to obtain bone grafts area measurements. After 10 days postoperatively (T1), the mean area of bone graft was 81.38 mm (range, 46.33-113.73 mm), whereas, after 180 days postoperatively (T2), the mean area of bone graft was 66.13 mm (range, 33.51-101.93 mm). The mean percentage variation of graft resorption between T1 and T2 was 18.38%. Autogenous bone blocks harvested from the mandibular ramus presented a reduction of 18.38% in the measurement areas after the augmentation procedures in the atrophic maxilla. Therefore, the use of autogenous bone blocks remains as a viable and predictable procedure for the rehabilitation of the atrophic maxillae. Thus, other studies must be carried out to improve the knowledge on the bone graft resorption, which may serve as a basis for the development of more effective strategies for the rehabilitation of patients with an atrophic maxilla.

Evaluation of radiographic technique using a new customized film holder for dental implant assessment.

PURPOSE: The aim was to evaluate the reproducibility of a radiographic technique using a new customized film holder in the follow-up of screwed single-tooth implants. MATERIALS AND METHODS: Ten implants placed in the mandible (n = 6) and maxilla (n = 4) of 8 patients were submitted to radiographic assessments. Radiographs were taken using a customized film holder adapted to implant abutment after 4 (T0) and 8 (T1) months of implant placement. Quantitative evaluations were performed through horizontal and vertical measurements to analyze radiographic standardization. RESULTS: No differences were detected after comparison of implant and abutment diameter measurements between radiographs after 4 and 8 months. No significant variations were detected in vertical measurements (implant and abutment length) between radiographs obtained in T0 and T1. CONCLUSIONS: The use of customized film holder adapted to the implant abutment seems to contribute to the standardization of radiographs at different times of screwed single-tooth implants.

Análise radiográfica e tomográfica do reparo ósseo na instalação e carga imediata de implantes cone-morse, com provisionalização imediata e uso de biomaterial: série de casos / Radiographic and tomographic analysis of bone repair in the immediate placement and loading of morse taper implants with immediate provisional restoration and use of biomaterial: case series

Objetivo: avaliar o comportamento ósseo ao redor de implantes cone-morse, imediatamente instalados após exodontia e carregados com prótese provisória imediata e biomaterial concomitante. Material e métodos: oito pacientes tiveram seus dentes extraídos por motivo de cárie ou fratura radicular, sem levantamento de retalho. A presença de 4 mm de osso apical ao alvéolo foi critério de inclusão. Implantes cone-morse (3,5 mm e 4,3 mm) foram instalados seguindo a parede palatina (torque > 35 Ncm). O gap foi preenchido com biomaterial (hidroxiapatita e fosfato tricálcio). Coroas em resina acrílica foram cimentadas provisoriamente. Radiografi as periapicais foram realizadas imediatamente (T0) e quatro meses depois (T4), nas faces mesial e distal, considerando a crista óssea (COA) e o ponto de contato ósseo com a face lateral do implante (FLI). TCFCs com afastamento labial foram usadas para avaliar a altura, a espessura óssea da face vestibular em três níveis e a plataforma do implante 3 mm e 6 mm em direção apical. Resultados: não houve alteração estatisticamente significativa nas alturas ósseas proximais (COA e FLI), tanto na face mesial como distal. Em relação à altura da face vestibular, não foi observada alteração estatisticamente significante (0,16 + 0,64 mm). Observou-se redução estatisticamente significante na espessura óssea medida 3 mm aquém da porção cervical do implante (0,58 + 0,54 mm). Conclusão: ao final do tempo de acompanhamento de quatro meses, e de acordo com a metodologia empregada, pôde-se concluir que houve contribuição para minimização dos efeitos de reparo ósseo ao redor desse tipo de implante, apesar do acompanhamento a médio e longo prazo ser necessário para consolidação desses dados.

Cirurgia guiada sem retalho para implante unitário em região estética / Single-tooth, flapless-guided dental implant surgery in the esthetic zone

A cirurgia guiada sem retalho, associada a um planejamento computadorizado, realizada por meio de guia cirúrgico prototipado representa um dos grandes avanços da Implantodontia moderna, no sentido de melhorar a previsibilidade estético-funcional na colocação de implantes, proporcionando grande precisão no tratamento. Suas principais vantagens incluem a redução do tempo cirúrgico, maior preservação dos tecidos, diminuição dos sintomas pós-operatórios, como dor, edema e inflamação, permitindo uma cicatrização mais rápida. Portanto, essa técnica oferece ganho estético imediato, redução da morbidade do paciente, maior precisão cirúrgica, conforto ao paciente e segurança do profissional. O objetivo desse trabalho foi descrever cada etapa da técnica da cirurgia guiada sem retalho, ilustrado por um caso clínico com reabilitação unitária em área estética.

The computer-planned, flapless surgery along with a stereolithographic-guided dental implant placement represents one of the great achievements of contemporary Implant Dentistry to improve esthetics and precision. Its main advantages include chairside time reduction, more tissue preservation, less postoperative symptoms such as pain, edema, and inflammation, which allows for a faster healing process. Thus, there are immediate esthetic benefits, less patient morbidity, more patient comfort, and safety for the dental practitioner. The aim of this paper is to describe each surgical step in flapless-guided surgery through a clinical case of a single unit in the esthetic zone.

Medidas lineares em radiografias panorâmicas digitalizadas, fornecidas por programa de imagem para planejamento na implantodontia: correlação e análise crítica / The linear measurementson digital panoramic radiographies obtained in two image softwares for presurgical implant: correlation and critical analysis

O objetivo da presente pesquisa foi avaliar, comparativa mete, as medidas lineares em radiografias panorâmicas obtidas no programa Planimp, desenvolvido para planejamento pré-cirúrgico em implantes, com as obtidas pelo método manual, utilizando um paquímetro digital. A amostra constou de 50 radiografias panorâmicas de pacientes edêntulos, nas quais foram marcados pontos de referência para delimitar 14 distâncias anatômicas em cada radiografia. As radiografias foram digitalizadas por meio de um scanner HP Scanjet 4C/T (Hewllett Pa ck a rd). As mensurações lineares das distâncias anatômicas foram realizadas pelo método manual (paquímetro digital) e pelo método digital (Planimp). Os dados obtidos foram submetidos à análise estatística por meio do teste de variância, com nível de significância de 5 por cento. Esta análise estatística mostrou que não houve diferença significante entre as medidas manuais e digitais. A partir dos resultados concluiu- se que o programa Planimp apresentou desempenho adequado para a calibração da imagem radiográfica, bem como para a mensuração de distâncias lineares.

The present study evaluated the linear measurements on panoramic radiographs obtained in image software for presurgical implant planning (Planimp) compared to the manual technique using a digital caliper. The sample comprised 50 panoramic radio graphs of edentulous patients, on which reference points were traced for delineation of 14 anatomical dimensions on each radiograph. The radiographs were digitized with a HP Scanjet 4C/T scanner (Hewllett Packard). Linear measurements of the anatomical dimensions were achieved by the manual method (digital caliper) and digital method (Planimp software). The data achieved were submitted to statistical analysis of variance, at a significance levelof 5 percent. This statistical analysis has not demonstrate any significant difference between the manual and digital measurements. The results allowed the conclusion that the Planimp software displayed proper performances for calibration of the radiographic image andfor measurement of linear dimensions.

Medidas lineares em radiografias panorâmicas digitalizadas, fornecidas por dois programas de imagem para planejamento na implantodontia: correlação e análise crítica / The linear measurementson digital panoramic radiographies obtained in two image softwares for presurgical implant: correlation and critical analysis

O objetivo da presente pesquisa foi avaliar, comparativamente, as medidas lineares em radiografias panorâmicas obtidas em programas de imagem para planejamento pré-cirúrgico em implantes (Radioimp e Planimp), com as obtidas pelo método manual, utilizando um paquímetro digital. Outro objetivo foi analisar os dois métodos de digitalização utilizados: escaner e câmera digital A amostra constou de 50 radiografias panorâmicas de pacientes edêntulos, nas quais foram marcados pontos de referência para delimitar 14 distâncias anatômicas em cada radiografia. As radiografias foram digitalizadas por meio de um escaner HP Scanjet 4C/T (Hewllett Packard) e uma câmera digital FinePix S602 (Fujifilm). As mensurações lineares das distâncias anatômicas foram realizadas pelo método manual (paquímetro digital) e pelo método digital (programas Radioimp e Planimp). Os dados obtidos foram submetidos à análise estatística de variância, com nível de significância de 5%. Esta análise estatística mostrou que não houve diferença significante entre as medidas manuais e digitais. A partir dos resultados concluiu-se que os programas Radioimp e Planimp apresentaram desempenhos adequados para a calibração da imagem radiográfica, bem como para a mensuração de distâncias lineares. Os sistemas de digitalização de imagens utilizados (escaner e câmera digital) não apresentaram diferenças significativas, sendo adequados para uso com esses programas