The assessment of rehabilitation methods in patients with severe upper jaw atrophy

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra de chirurgie OMF şi implantologie orală „Arsenie Guţan”, Chisinau, Republica Moldova, Catedra de Odontologie, Parodontologie și Patologie Orală, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Insufficient bone volume is difficult to manage in rehabilitating patients with maxillary atrophy. The currently available solutions are: • increasing the bone amount followed by standard implantation • the alternative method by using zygomatic implants without preimplantation bone growth. Purpose. Comparative evaluation of standard versus alternative methods of rehabilitation in patients with severe maxillary atrophy. Material and methods. Study was axed on 12 patients, aged 32 - 67 years, mean age 54.5 years, divided into 2 groups. Patients in group I (7) were rehabilitated by zygomatic implants without bone grafting, and patients in group 2 (5) were rehabilitated by bone grafting, with delayed implantation. Patient data was processed in Sidexis 4.2 and Microsoft Excel. Results. In group I, 4.42 implants / patient were used, 1 intervention was performed under general anesthesia, 1 under local anesthesia with intravenous sedation and 5 under local anesthesia only. The patients underwent a single surgery with an average duration of 134 minutes and the functional rehabilitation of the patients lasted an average of 6.28 days. In group II, 8.4 implants / patient were used, all 5 bone grafting procedures were performed under general anesthesia, and subsequent interventions were performed under local anesthesia, the average summary time of surgery was 385 minutes. The functional rehabilitation lasted on average 12.8 months. Conclusions. The study demonstrated the effectiveness of both methods, but showed that the alternative rehabilitation method can be performed in a shorter time, with a smaller number of implants, mostly under local anesthesia, in a single surgery with a shorter duration

Managementul țesuturilor moi periimplantare

Background. The absence of sufficient width and thickness of keratinized gingiva creates conditions for development of microbial flora with appearance of peri-implantitis. At the 2nd stage of implants surgery the intervention are performed on the mucogingival tissues in order to avoid further complications. Objective of the study. Assessment of the condition of soft peri-implant tissue and prove evidence of surgical interventions on the mucogingival substrate at the 2nd stage of implant surgery. Material and Methods. The study contains seven women with age between 24-64 years with medium of 43,23 years. The methods used: The vestibuloplasty, in combination with free gingival graftFGG on four patients; subepithelial graft on two of them and FGG on one patient, in sum were performed 22 implants. The data obtained from the clinic and radiologic research’s were operated in the programs: Sidexis 4.2 and Excel. Results. The medium height of the pre-operatively gum - 2,28mm, postoperatively- 6,28mm; medium thickness of the pre-operatively-1,14mm, post-operatively 3,28mm; buccal vestibule with the medium depth of pre-operatively - 2,4 mm post-operatively - 5,14mm. Donor zone: rough palatal 6 cases, tuberosity 1 case. Complications were not discovered in neither of cases. The displaying of the implants in 4 cases was followed by a surgery on the mucogingival substrate and in another 3 cases was performed delayed. Conclusion. At the 2nd stage of implant surgery, interventions at mucogingival substrate are indicated in order to obtain a morphofunctional and aesthetic long term results. Introducere. Absența lățimii și grosimii suficiente de gingie keratinizată, creează condiții benefice pentru multiplicarea florii microbiene cu apariția periimplatitei. La descoperirea implanturilor sunt efectuate intervenții chirurgicale asupra substratului muco-gingival pentru a reduce complicațiile ulterioare. Scopul lucrării. Evaluarea stării țesuturilor moi periimplantare și justificarea intervențiilor chirurgicale asupra suportului muco-gingival la etapa de descoperire a implanturilor. Material și Metode. Studiul a cuprins 7 femei cu vârsta 24-64 ani, cu media 43,23 ani. S-au utilizat metodele: vestibuloplastie cu grefă gingivală liberă la 4 paciente; grefă subepitelială la 2 și grefă gingivală liberă la o pacientă, efectuate în total 22 de implanturi. Datele obținute din măsurările clinice și radiologice au fost prelucrate în programele Sidexis4.2 și Microsoft Excel. Rezultate. Lățimea medie a gingiei preoperator- 2,28mm, post-operator- 6,28mm; grosimea medie pre-operator-1,14mm, post-operator 3,28mm; vestibulul bucal cu adâncimea medie pre-operator de 2,4 mm post-operator- 5,14mm. Zona donor: palatul dur 6 cazuri, tuberozitate 1 caz. Complicații nu au fost determinate nici într-un caz. Descoperirea implanturilor în 4 cazuri a fost însoțită de operația asupra substratului muco-gingival, iar în alte 3 cazuri s-a efectuat amânat. Concluzii. Intervențiile chirurgicale la etapa de descoperire a implanturilor în cazul insuficienței suportului muco-gingival sunt indicate pentru obținerea unui rezultat morfofuncțional și estetic de durată