A new rehabilitation protocol for edentulous patients with the use of fixed prosthesis supported by implants - a Retrospective study

Edentulism is a public health problem, with direct impact over quality of life. Considering this fact, this Doctoral Thesis will pursue four specific objectives: 1 – Evaluate the influence of different maxillary dentitions on the survival rate of mandibular metal-resin implant-fixed complete denture, by means of systematic reviews and meta-analysis; 2 – Present a new multifunctional template design for immediate loading procedures, by means of a case report and 3 – Analyze rehabilitation protocol survival of mandibular metal-resin implant-fixed complete denture, supported by 3 implants, opposed by conventional dentures. In a total of 112 natural, 69 implant-supported and 204 removable dentitions, the general prevalence of failure was respectively 5.4% (6/112; IC 95% [2.3 a 10.76]), 13,99% (20/69; IC 95% [0.77 a 39.41]) e 4.9% (10/204; IC 95% [0.69 a 12.18]). There were no statistical differences between natural and removable dentitions (difference = 0,00 [-0.06, 0.06]; P = 0.93; I2 = 27%), or not even between natural and implant-supported (difference risk = 0,00 [-0.06, 0.07]; P = 0.97; I2 = 0%). With moderate certainty of evidence it is suggested that natural maxillary dentitions do not affect the survival rate of mandibular mandibular metal-resin implant-fixed complete denture differently from other prosthetic designs. The multifunctional template precisely transferred the surgical implants locations, the impression, the vertical dimension and data transfer to the dental technician. Radiographic cantilever extensions varied from 1.7 mm a 22.9 mm. Intra-Class Correlation (ICC) presented values over 0.9. T-test returned values of p>0.05 for all groups. From fifty mandibular prostheses, installed over 150 implants, 10 implants failed. Technical complications observed were abutment screw loosenings (3,0%), prosthetic screw loosenings (17%), prosthetic screw fractures (1%), superstructure detachments (16%), framework fracture (2%), fractures of maxillary dentures (6%) and loss of mandibular prosthesis (4%). Cumulative survival rates of implants and mandibular prosthesis were respectively 93.3% and 96%. Main peri-implant complications were biofilm formation, bleeding on probing and pain, which were controlled during maintenance visits. None of the evaluated variables influenced clinical failures and/or technical complications in statistical significant level. The guided surgery for the installation of mandibular implants on the mandibular symphysis can be performed with enough predictability, using low cost multifunctional templates. The use of maxillary dentures as opposed mandibular metal-resin implant-fixed complete dentures, supported by three implants, being one in the vertically placed, in the mandibular symphysis, and the other two distally tilted in parasymphisary regions, is a reliable, and should be be encouraged for the treatment of edentulism in global scale.FAPERJ - Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de JaneiroTese (Doutorado)O edentulismo é um problema de saúde pública, com impacto direto na qualidade de vida. Considerando este fator esta tese de doutorado possui três objetivos específicos: 1 – Avaliar a influência de diferentes desenhos oclusais maxilares nos índices de sobrevivência das próteses mandibulares totais fixas metaloplásticas implantossuportadas por meio de revisão sistemática e metaanálise; 2 – Apresentar um novo desenho de guia multifuncional para procedimentos de carga imediata mandibular, através de relato de caso. 3 – Analisar a sobrevivência de protocolo reabilitador com próteses mandibulares totais fixas metaloplásticas suportadas por 3 implantes opostas à próteses totais convencionais. Em um total de 112 dentições naturais maxilares, 69 implanto-suportadas e 204 removíveis, a prevalência geral de falhas foi: 5,4% (6/112; IC 95% [2,3 a 10,76]), 13,99% (20/69; IC 95% [0,77 a 39,41]) e 4,9% (10/204; IC 95% [0,69 a 12,18]) respectivamente. Não houve diferenças estatísticas nas taxas de sucesso entre naturais e removíveis (Diferença = 0,00 [-0,06,0,06]; P = ,93; I2 = 27%) ou entre naturais e implanto-suportadas (Risco Diferença = 0,00 [-0,06, 0,07]; P =, 97; I2 = 0%). com moderada certeza de evidência que o desenho das dentições maxilares, sejam estas naturais ou protéticas, não é determinante no sucesso das metaloplásticas fixas implantosuportadas mandibulares. A guia multifuncional transferiu com precisão a localização cirúrgica, a impressão, a dimensão vertical e transferência de dados ao laboratório de prótese dentária. Os comprimentos digitais dos cantilevers distais radiográficos variaram de 1,7 mm a 22,9 mm. O Coeficiente de Correlação Intraclasse apresentou resultados acima de 0,9. teste t pareado retornou valores de p>0,05 para todos os grupos. De um total de 50 próteses mandibulares instaladas sobre 150 implantes houve falha de 10 implantes. As complicações técnicas observadas foram afrouxamento do parafuso do pilar (3,0%), afrouxamento do parafuso protético (17%), fratura do parafuso protético (1%), descolamentos e fraturas da superestrutura (16%), fratura da estrutura metálica (2%), fraturas da prótese maxilar (6%) e perda da prótese mandibular (4%). As taxas de sobrevivência cumulativa de implante e prótese mandibular foram de 93,3% e 96%, respectivamente. As principais complicações perimplantares foram a formação de biofilme, sangramento à sondagem e dor, que foram controlados durante as visitas de manutenção. Nenhuma das variáveis avaliadas influenciou falhas clínicas e/ou complicações técnicas em níveis estatisticamente significantes. A cirurgia guiada para instalação de implantes mandibulares em região de sínfise mandibular pode ser realizada com guias multifuncionais de baixo custo com previsibilidade. A utilização de próteses totais convencionais maxilares opostas a próteses fixas totais mandibulares implanto-suportadas por três implantes, sendo um em posição vertical em sínfise mandibular e os outros inclinados bilateralmente em sentido distal é uma modalidade de tratamento confiável e de baixo custo, a ser replicado no combate ao edentulismo em escala mundial

Management of bone defects with Bio-oss

Introduction: The defects in the alveolar bone might appear as a result of congenital malformations, traumatic injuries, periodontal disease, surgical traumas, chronic periapical changes and tumors from benign or malignant origin. The aim of this study was to provide solid and healthy area with application of Bio-Oss in the defect. Materials and methods: Based on the clinical diagnosisestablished by previously taken history, clinical examination and radiographic images oral-surgery interventions was made. To realize the aim of this work, augmentative material was implicated in the bone defects made in the patients after removal of follicular cyst, chronic periapical lesion, and parodontopathia. During the first and seventh day of the interventions, the patients have been followed through from aspect of possible development of local and general complications after the oral-surgery intervention. After period of one, three and six mount control x-ray was made. Results: Obtained results confirmed that: volume of the socket and defect of the bone was kept, fast revascularization was achieved, bone formation and slow resorption of the augmentative material was achieved, and period of normal healing without infection was also achieved. Conclusions: The augmentative materials used for treatment of bone defects besides their basic chemical and physical characteristics referring to their solubility in the body fluids, the transformation, modulation and resorption must be completely safe or secure, i.e. not to bring any risk of infection, immunological risk, physiological intolerance or inhibition of the process of restitutio ad integrum. In our study Bio-Oss was confirmed as augmentative material who had this characteristics. Keywords: bone defect, resorption of the bone, augmentative material, Bio-Os