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Reabilitações com implantes subperiósseos para atrofias maxilares
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Introdução: Quando os doentes têm uma atrofia óssea severa e se torna impossível a colocação de implantes endósseos é possível recorrer-se a técnicas cirúrgicas regenerativas, tais como: enxerto ósseo em bloco, split da crista óssea alveolar, elevação do seio maxilar, distração óssea, lateralização do nervo alveolar inferior, ou outras formas de regeneração óssea. A associação da tecnologia digital à implantologia, e o uso de novos métodos imagiológicos e novos materiais ajudaram a simplificar, melhorar e acelerar variados procedimentos cirúrgicos e permitiram que diversas técnicas de impressão 3D fossem usadas para fabricação de elementos personalizados perfeitamente adaptados aos requisitos anatómicos específicos do doente. Assim, foi possível recuperar técnicas usadas no passado que caíram em desuso, como a da colocação de implantes subperiósseos que permitiu a redução do tempo de tratamento que passou de duas para uma sessão cirúrgica, com custos mais reduzidos para o doente e em particular a resultados mais precisos e previsíveis logo, mais seguros especialmente em doentes idosos que possuam anomalias anatómicas, que não queiram passar por procedimentos cirúrgicos regenerativos complexos e necessitem de reabilitações protéticas. Desta forma, o objetivo principal desta revisão é estruturar e sintetizar a informação que está disponível relativamente à sobrevivência dos implantes subperiósseos em doentes com maxilas severamente atróficas, face aos implantes endósseos convencionais.
Metodologia: Com este trabalho pretende-se responder à seguinte questão: “Em pacientes com atrofia maxilar óssea, os implantes subperiosteais apresentam taxas satisfatórias de sobrevida e complicações dos implantes?”. Para a formulação desta questão foram considerados os critérios PIO: População – Pacientes que apresentem atrofia maxilar e necessitem de reabilitação oral; Intervenção – Colocação de implante subperiósseo; Outcome – Sobrevivência do implante e complicações existentes. A pesquisa foi realizada em diferentes bases de dados: PubMed, ScienceDirect e GoogleScholar, com os artigos elegíveis a serem identificados e selecionados seguindo as guidelines PRISMA.
Resultados: Foram incluídos 8 artigos, sendo que 5 são case series, e dos restantes 3 um é observacional, outro multicêntrico prospetivo, e o último multicêntrico retrospetivo. Os estudos selecionados incluíram dados de 111 implantes subperiósseos colocados em 107 pacientes (61 mulheres / 46 homens) com idade média ponderada de 59,1 anos. Os vários estudos analisaram a taxa de sobrevivência bem como complicações decorrentes da utilização de implantes subperiósseos. Verificou-se que os implantes subperiósseos apresentaram uma sobrevida satisfatória a curto prazo (tempo médio ponderado de acompanhamento de 15,6 meses; intervalo médio de 1 a 74 meses), mas há escassez de dados sobre as suas taxas de sucesso e comportamento clínico de médio ou longo prazo. A exposição do braço vertical acima dos pilares sem sinais de mucosite é uma complicação comum mas não parece prejudicar a sobrevivência do implante ou ser percebido como um problema pelo paciente.
Conclusões: Com base nos estudos disponíveis (observacionais), o implante subperiósseo "moderno" provou ser uma técnica segura para reabilitação de arcada completa em pacientes com atrofia maxilar grave, com uma sobrevida satisfatória no curto espaço de tempo. No entanto, mais estudos com períodos de acompanhamento mais longos são necessários para monitorizar a reabsorção óssea e o estado de saúde dos tecidos moles para além de 5 anos, para validar a taxa de sucesso e o comportamento clínico a médio e longo prazo.
Introduction: When patients have severe bone atrophy and it becomes impossible to place endosseous implants, it is possible to resort to regenerative surgical techniques, such as: bone graft en bloc, alveolar bone crest splint, maxillary sinus augmentation, bone distraction, inferior alveolar nerve lateralization, or other forms of bone regeneration. The association of digital technology with implantology, and the use of new imaging methods and new materials have helped to simplify, improve and speed up various surgical procedures and have allowed various 3D printing techniques to be used to manufacture personalized elements perfectly adapted to the specific anatomical requirements of the patient. Thus, it was possible to recover techniques used in the past that fell into disuse, such as the placement of subperiosseous implants, which allowed the reduction of treatment time, which went from two to one surgical session, with lower costs for the patient and in particular more accurate and predictable results, therefore, safer, especially in elderly patients who have anatomical anomalies and who do not want to undergo complex regenerative surgical procedures and need Prosthetic rehabilitations. Thus, the main objective of this review is to structure and synthesize the information that is available regarding the survival of subperiosseous implants in patients with severely atrophic jaws, compared to conventional endosseous implants. Methodology: This study aims to answer the following question: "In patients with maxillary bone atrophy, do subperiosteal implants have satisfactory survival rates and implant complications?". For the formulation of this question, the IOP criteria were considered: Population – Patients who present maxillary atrophy and need oral rehabilitation; Intervention – Subperiosseous implant placement; Outcome – Implant survival and existing complications. The search was carried out in different databases: PubMed, ScienceDirect and GoogleScholar, with eligible articles being identified and selected following the PRISMA guidelines. Results: 8 articles were included, 5 of which are case series and the remaining 3, one is observational, another prospective multicenter and the last retrospective multicenter. The selected studies included data from 111 subperiosseous implants placed in 107 patients (61 women/46 men) with a weighted mean age of 59.1 years. The various studies analyzed the survival rate as well as complications resulting from the use of subperiosseous implants. Subperiosseous implants were found to have satisfactory short-term survival (weighted mean follow-up time of 15.6 months; mean range 1 to 74 months), but there is a paucity of data on their success rates and medium- or long-term clinical behavior. Exposure of the vertical arm above the abutments with no signs of mucositis is a common complication, but it does not appear to impair implant survival or be perceived as a problem by the patient. Conclusions: Based on the available (observational) studies, the "modern" subperiosseous implant has proven to be a safe technique for full-arch rehabilitation in patients with severe maxillary atrophy. presented a satisfactory survival in the short period of time. However, further studies with longer follow-up periods are needed to monitor bone resorption and soft tissue health status beyond 5 years, to verify the success rate and clinical behaviour in the medium and long term.
Introduction: When patients have severe bone atrophy and it becomes impossible to place endosseous implants, it is possible to resort to regenerative surgical techniques, such as: bone graft en bloc, alveolar bone crest splint, maxillary sinus augmentation, bone distraction, inferior alveolar nerve lateralization, or other forms of bone regeneration. The association of digital technology with implantology, and the use of new imaging methods and new materials have helped to simplify, improve and speed up various surgical procedures and have allowed various 3D printing techniques to be used to manufacture personalized elements perfectly adapted to the specific anatomical requirements of the patient. Thus, it was possible to recover techniques used in the past that fell into disuse, such as the placement of subperiosseous implants, which allowed the reduction of treatment time, which went from two to one surgical session, with lower costs for the patient and in particular more accurate and predictable results, therefore, safer, especially in elderly patients who have anatomical anomalies and who do not want to undergo complex regenerative surgical procedures and need Prosthetic rehabilitations. Thus, the main objective of this review is to structure and synthesize the information that is available regarding the survival of subperiosseous implants in patients with severely atrophic jaws, compared to conventional endosseous implants. Methodology: This study aims to answer the following question: "In patients with maxillary bone atrophy, do subperiosteal implants have satisfactory survival rates and implant complications?". For the formulation of this question, the IOP criteria were considered: Population – Patients who present maxillary atrophy and need oral rehabilitation; Intervention – Subperiosseous implant placement; Outcome – Implant survival and existing complications. The search was carried out in different databases: PubMed, ScienceDirect and GoogleScholar, with eligible articles being identified and selected following the PRISMA guidelines. Results: 8 articles were included, 5 of which are case series and the remaining 3, one is observational, another prospective multicenter and the last retrospective multicenter. The selected studies included data from 111 subperiosseous implants placed in 107 patients (61 women/46 men) with a weighted mean age of 59.1 years. The various studies analyzed the survival rate as well as complications resulting from the use of subperiosseous implants. Subperiosseous implants were found to have satisfactory short-term survival (weighted mean follow-up time of 15.6 months; mean range 1 to 74 months), but there is a paucity of data on their success rates and medium- or long-term clinical behavior. Exposure of the vertical arm above the abutments with no signs of mucositis is a common complication, but it does not appear to impair implant survival or be perceived as a problem by the patient. Conclusions: Based on the available (observational) studies, the "modern" subperiosseous implant has proven to be a safe technique for full-arch rehabilitation in patients with severe maxillary atrophy. presented a satisfactory survival in the short period of time. However, further studies with longer follow-up periods are needed to monitor bone resorption and soft tissue health status beyond 5 years, to verify the success rate and clinical behaviour in the medium and long term.
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Palavras-chave
Subperiosteal implants Edentulous Maxillary atrophy Severe Rehabilitation