RESUMO
A reabilitação de maxilas atróficas representa desafio complexo, levando à busca de abordagens inovadoras. Procedimentos convencionais, como levantamento de seio maxilar, têm limitações, impulsionando o interesse em implantes zigomáticos. Contudo, complicações persistem, especialmente em áreas de concavidade acentuada. Este relato de caso visa demonstrar a eficácia de uma abordagem cirúrgica inovadora, combinando implantes zigomáticos e transnasais, para superar as limitações anatômicas e alcançar resultados estéticos e funcionais satisfatórios. Paciente de 58 anos, sexo feminino, desdentada total, foi submetida à reabilitação no Instituto Rosenvaldo Moreira, devido à atrofia maxilar pronunciada. Foram propostos dois planos de tratamento, envolvendo implantes zigomáticos e transnasais. A cirurgia, realizada em ambiente ambulatorial sob sedação intravenosa e anestesia local, incluiu a instalação sequencial de implantes transnasais e zigomáticos, com especial atenção à usinagem do terço cervical para prevenir complicações. A abordagem cirúrgica empregada, combinando implantes zigomáticos e transnasais, revelou-se eficaz na reabilitação da maxila atrófica. A usinagem cuidadosa contribuiu para evitar complicações, evidenciando estabilidade e ausência de inflamações peri-implantares no acompanhamento de um ano. Este relato oferece uma contribuição valiosa, destacando a viabilidade e sucesso dessa abordagem inovadora em situações desafiadoras de atrofia maxilar na implantodontia.
The rehabilitation of atrophic jaws represents a complex challenge, leading to the search for innovative approaches. Conventional procedures, such as sinus lifts, have limitations, driving interest in zygomatic implants. However, complications persist, especially in areas of pronounced concavity. This case report aims to demonstrate the effectiveness of an innovative surgical approach, combining zygomatic and transnasal implants, to overcome anatomical limitations and achieve satisfactory aesthetic and functional results. A 58-year-old female patient, completely toothless, underwent rehabilitation at the Instituto Rosenvaldo Moreira, due to pronounced maxillary atrophy. Two treatment plans were proposed, involving zygomatic and transnasal implants. The surgery, performed in an outpatient setting under intravenous sedation and local anesthesia, included the sequential installation of transnasal and zygomatic implants, with special attention to machining the cervical third to prevent complications. The surgical approach used, combining zygomatic and transnasal implants, proved to be effective in the rehabilitation of the atrophic maxilla. Careful machining helped to avoid complications, demonstrating stability and absence of peri-implant inflammation in the one-year follow-up. This report offers a valuable contribution, highlighting the feasibility and success of this innovative approach in challenging situations of maxillary atrophy in implant dentistry.
RESUMO
The aim of this study was to assess the surface and tissue quality of keratinized mucosa grafts (KMG) obtained using the conventional scalpel and mucotome techniques. This was an experimental in vitro/ex vivo study involving six porcine hemi-mandibles. Specimens were harvested using both the mucotome and conventional scalpel techniques, with randomization determining the choice of technique for tissue removal. The specimens were prepared following predefined laboratory protocols and subsequently subjected to optical microscopy for evaluating epithelial and connective tissue and scanning electron microscopy for topographical and 3D profilometry analysis. Tissues harvested using the mucotome exhibited a linear base and uniform thickness, along with the presence of submucosa and fibrous connective tissue, all of which are ideal for graft success. Differences in the surface characteristics of specimens obtained through the two techniques were observed during a comparative analysis of images obtained through both microscopy types. KMG obtained using the mucotome technique displayed greater uniformity and reduced undesirable cell presence compared to the scalpel technique, thereby enhancing the likelihood of success in soft tissue graft surgical procedures. This study provides valuable insights to oral healthcare professionals and may contribute to future research aimed at achieving more successful surgeries, shorter postoperative recovery times, reduced discomfort, and an overall more positive patient experience.