Implant-prosthetic rehabilitation of missing teeth in the anterior maxilla is often challenging due to ongoing bone resorption and remodeling events and may require regeneration procedures involving the nasopalatine canal (NPC). We describe a surgical approach with a block graft in relation to the NPC and evaluate clinical performance, sensory perception, and aesthetic result of the implant-prosthetic treatment over a two- to nine-year (mean: 3.5 years) follow-up. Ten implants (six in the right central incisor and four in the left central incisor) were, respectively, placed in 10 consecutive patients with bone defects affecting the NPC and unfavorable widening of the incisive foramen. Treatment stages included: (1) Diagnosis: evaluation of clinical-aesthetic parameters using Cone Beam Computed Tomography; (2) Surgery: block graft placement by palatine and incisal with simultaneous guided bone regeneration, and late (6–10 months) implant placement; (3) Prosthetics: placement of a screw-retained crown (torque of 32 N/cm). At treatment initiation, all the NPCs evaluated in our study were free of pathologies. Treatment evaluation included bone crest thickness, neurosensory status, patients’ treatment perception, and pink and white aesthetic scores (PES/WES). Pre-surgery, anterior ridge thickness at the level of the incisive foramen was (mean ± SD) 3.5 ± 2 mm, 5.4 ± 1.5 mm, and 6.1 ± 1.9 mm at heights of 4, 8, and 14 mm apical to the marginal bone crest, respectively. Post-treatment values were, respectively, 10.1 ± 2.0 mm, 10.5 ± 1.0 mm, and 13.4 ± 3.0 mm. The perception of treatment with the aesthetic pink and white indices (PES/WES) was an average of 7.5 and 7 points, respectively, out of a total of 10 each index, with a recovery of 100% of the neurosensory perception of the area. We propose that bone augmentation using block and particulate graft material can compensate for anatomical variations in the NPC, optimize implant’s three-dimensional positioning and improve facial contour, providing tissue and implant stability and good aesthetic outcomes.
Background: The aim of the study was to analyze the distribution of stresses caused by an axial force in a three-dimensional model with the finite element method in the implant-supported fixed partial denture with distal overhang (PPFIVD) on short dental implants in the posterior edentulous maxilla. Methods: geometrical models of the maxilla with a bone remnant of 9 and 5 mm were created. Straumann SP® (Base, Switzerland) implants were placed in the premolar area. Two groups with subgroups were designed. Group A (GA): PPFIVD on two implants (GA1: 4.1 × 8 mm and GA2: 4.1 × 4 mm); Group B (GB): PPFIVD on the single implant (GB1: 4.1 × 8 mm and GB2: 4.1 × 4 mm). It was applied to a static force of 100 N to 30°. Results: PPFIVD on two implants reached the maximum tension in GA2 with respect to GA1; the difference was not significant in implants. In the maxilla GA2 was lower in relation to GA1; the difference was not significant. In PPFIVD over an implant, the stress was greater in GB2 with respect to GB1; the difference was significant in maxilla and implants. Peri-implant bone micro deformations and prosthesis-implant displacements were observed. Conclusions: PPFIVD over short splinted implants could be viable in the maxilla with reduced bone height, being an option when lifting the floor of the maxillary sinus. The rehabilitation with unitary implant (4 mm) did not provide adequate results. The dominant tensions evidenced bone micro-distortions with a displacement of the prosthesis-implant set. The real statement of this paper was to define that short splinted implants can be used in soft bone with high success rate in reducing bending forces.
Introducción. Docentes de anatomía, histología y asesoría pedagógica conformaron un equipo para diseñar e implementar una experiencia de enseñanza integrada (EI) en la Facultad de Odontología, Universidad Nacional de Córdoba, Argentina. El objetivo fue promover una mayor integración entre la anatomía e histología del sistema estomatognático y guiar la transferencia a situaciones clínicas. Materiales y métodos. En 2010 se rediseñó una propuesta sobre EI para su aplicación a la totalidad de alumnos y con todos los docentes, quienes participaron en ateneos interdisciplinarios para la actualización de contenidos, unificación de criterios, etc. Los alumnos realizaron cuatro clases teórico-prácticas y un trabajo práctico elaborado sobre un caso clínico, con la participación de un docente de anatomía y otro de histología. En el trabajo práctico, los alumnos efectuaron una exploración guiada de la cavidad bucal y trabajaron grupalmente para resolver preguntas sobre el caso clínico. Evaluaron cada actividad de EI, indicando aspectos positivos y a mejorar. Los docentes se expresaron a través de una encuesta. Resultados. Los alumnos destacaron que el abordaje integrado les permitió una mejor comprensión y relación de los temas de las dos asignaturas; valoraron el dinamismo, las explicaciones claras y bien ilustradas de las clases, y el trabajo sobre situaciones clínicas. Los docentes consideraron que la EI es una experiencia positiva, desafiante, enriquecedora, que mejora los nexos con sus colegas y alumnos. Conclusiones. La experiencia de EI permitió lograr los objetivos de aprendizaje propuestos para los alumnos y constituyó una valiosa oportunidad formativa para los docentes. Palabras clave. Anatomía. Enseñanza integrada. Histología. Sistema estomatognático.
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