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OBJECTIVES: To investigate long-term alveolar ridge bone changes in patients treated with the split-crest technique (SCT) with simultaneous implant placement. MATERIALS AND METHODS: Alveolar ridge width (ARW) was measured with a caliper immediately before (ARW1) and after SCT (ARW2) with a caliper. Existing CBCT scans taken at least 5 years postoperatively were used to assess the healed ARW (ARWF), buccal bone thickness (BBT), and lingual/palatal bone thickness (L/PBT) at 0, 3, and 5 mm apically from implant platform level (IPL). The distance between IPL and buccal bone crest (IPL-BBC) was also measured. Findings were compared with Wilcoxon and Student's t tests (p < .05). RESULTS: Records of thirty patients with 85 implants were included. Eleven patients (31 implants) presented CBCT scans taken in two separate occasions, resulting in 116 measurements. Tomographic follow-up ranged from 5 to 18 years (11.5 ± 4.18 years). Mean ARW increased from 3.2 ± 0.6 to 6.6 ± 0.48 mm after SCT, but significantly reduced overtime to 4.46 ± 0.83 mm (ARWF) (p < .0001). Mean BBT was 0.5 ± 0.9, 1.3 ± 0.9, and 2.0 ± 1.2 mm, while mean L/PBT was 0.9 ± 0.7, 1.6 ± 0.9, and 2.1 ± 1.0 mm at 0, 3, and 5 mm from IPL, respectively. IPL-BBC distance varied up to 8.7 mm (1.4 ± 2.0 mm), with 56/116 measurements (51/85 implants) showing IPL-BBC = 0 mm. CONCLUSION: Although SCT with simultaneous implant placement can predictably increase ARW postoperatively, ARW tended to significantly reduce over time, due to reductions in BBT and L/PBT, especially coronally. Nonetheless, 60% of the implants still presented some buccal bone at IPL.

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El tratamiento con implantes dentales hoy en día es un procedimiento clínico de rutina que permite rehabilitar a los pacientes con prótesis fijas. En este caso presentamos un tratamiento complejo de implantación inmediata del sector anterior con pérdida parcial de la cortical vestibular en el que se realizó una regeneración ósea guiada y provisionalización en un tiempo quirúrgico en un paciente con patología renal. Complementamos el estudio con una revisión de la efectividad de las técnicas utilizadas y las posibles respuestas celular asociadas a la patología renal.

Treatment with dental implants nowadays is a routine clinical procedure that allows patient rehabilitation with fixed prostheses. In this case we present a complex treatment of immediate implantation of the anterior sector with partial loss of the vestibular cortex, in which guided bone regeneration and provisionalization was performed in surgical time in a patient with kidney pathology. The study was complemented with a review of the effectiveness of the techniques used and the possible cellular responses associated with kidney pathology.

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BACKGROUND: Rehabilitation in the anterior region requires specific conditions for success, such as the presence of papilla, emergence profile, and balance between pink and white esthetic. OBJECTIVES: This systematic review aimed to evaluate the esthetic risk associated with immediate implant placement with immediate restoration in the anterior superior area, where the facial bone plate may be absent or deficient. MATERIAL AND METHODS: The search was done in PubMed, Embase, Cochrane, Lilacs, Scopus, Scielo, and Google Scholar databases. The investigation involved clinical studies and observational studies published between January 2012 and July 2023. Studies were excluded if there was less than 12-month follow-up, no immediate restoration or facial defect, heavy smokers, or systemic disease. The risk of bias was assessed using the ROBINS-I and Modified-Cochrane RoB tools. RESULTS: Twelve studies were included in this systematic review. The thinner the facial plate, the higher the alveolus's risk of gingival recession or shrinkage. There was an increased interproximal recession when the thin phenotype was associated with flap surgery. An increase in pink esthetic score (PES) was reached when immediate implant placement (IIP) and immediate restoration were done. Soft tissue augmentation achieved more gingival-level stability. Regardless of the initial phenotype, an esthetic outcome was delivered. The risk of bias was high in 1 study and moderate in 3 studies. CONCLUSION: It is possible to conclude that esthetic results and increased final PES or patient satisfaction index in IIP treatments associated with immediate restoration could be obtained even in buccal bone wall defects or gingival recession, regardless of their extension.

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The aim of this systematic review was to evaluate the benefit of ridge preservation (RP) with minimally invasive (MI) approaches with or without concomitant implant placement on morbidity, esthetics, and patient-related outcomes. Three Internet sources were used to search for appropriate papers. The search strategy was designed to include any clinical study published on RP with MI approaches such as flapless surgery, socket shield and socket sealing techniques and, use of biological agents. Characteristics of the individual studies, regarding methodological aspects, quantitative and qualitative data were extracted. The potential risk of bias was estimated, and the acquired evidence was graded. Independent screening of 860 reports resulted in 26 included original articles. Nine publications evaluated MI approaches for RP without concomitant implant placement. Eleven studies evaluated interventions for RP with immediate implant placement (IIP). Six studies compared RP with IIP vs RP without IIP. This systematic review found that MI approaches in most of the studies failed to improve clinical variables regarding morbidity, esthetics, and patient-related outcomes. Based on the limited number of studies analyzed and the methodological discrepancies observed, it is not possible to confirm that MI approaches promote a significant benefit when applied to RP procedures.

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Purpose: Computer-guided surgery has been increased in recent years. Nonetheless, few data are available on the validation of this technique for immediate implant placement. The purpose of this in vitro study was to evaluate the accuracy of computer-guided surgery in immediate implant placement. Materials and Methods: Cone-beam computed tomography scans (CBCTs) and virtual models were obtained of eight fresh pigs hemi-mandibles to perform the digital planning of implants placement. Fifteen implants were simulated, and surgical guides were designed to transfer the digital planning to the surgical procedure. Postsurgical CBCTs were performed to compare the position of the planned implants versus the real implant position. Paired t-test and the intra-class correlation coefficient (ICC) were used to assess the mean differences and correlations in each outcome variable evaluated twice by one experienced researcher. Furthermore, variations were compared with the results reported in the scientific literature using a one-sample t-test P < 0.05. Results: The measurements of the outcome variables (implants position at the neck and apex level and the angular deviation) showed significant reproducibility (mean difference-0.01 mm, 0.07 mm, and 0.30°, respectively, P > 0.05). The ICC values ranged from 0.888 to 0.949. Furthermore, the mean deviation was 1.43 mm at the implant neck, 2.19 mm at the apex, and 6.81° for the angular deviation. Similarly, significant differences (P < 0.05) were found at the neck and angular deviation when comparing the results with values reported in the literature. Conclusions: Although some variations were observed, they did not have a clinically significant impact. Therefore, computer-guided surgery could be satisfactorily used in immediate implants placement.

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OBJECTIVE: Maintenance of adequate interproximal tissue height between an implant and a natural tooth or between adjacent implants represents an esthetic challenge in implant dentistry. The aim of this case report is to describe a modified technique referred to as the beyond the gap filling (BGF) approach designed to improve the horizontal and vertical components of the facial aspect and particularly the height of interproximal bone peaks around immediately placed implants into fresh extraction sockets. CLINICAL CONSIDERATIONS: Four patients (five teeth) requiring anterior tooth extraction were treated with the BGF approach that included: (a) minimally traumatic tooth extraction; (b) immediate implant placement without flap elevation; (c) installation of a narrow profile healing abutment to protect the implant during grafting; (d) grafting with a construct with 90% bovine bone granules and 10% porcine collagen packed coronally to the facial and interproximal bone walls above the level of the bone crest; and (e) delivery of an immediate restoration. CONCLUSIONS: The current report suggests that the level/height of the interproximal bone crests between an implant and a natural tooth or between two adjacent implants can be improved by the BGF approach and, consequently, papilla height can be maintained in cases with a high risk of papilla height collapse and, consequently, esthetic outcomes can be maximized. CLINICAL SIGNIFICANCE: The BGF is a simple technique to be used by clinicians to prevent significant papilla collapse in anterior immediate implants and consequently achieve maximum esthetic outcomes in implant dentistry.

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This study was designed to evaluate the accuracy of a novel computer-designed and selectively laser sintered surgical guide for flapless dental implant placement in the edentulous jaw. Fifty dental implants were placed in 11 patients with at least 1 totally edentulous jaw. Initially, cone-beam computed tomography (CBCT) was performed in each patient to define the virtual position of the dental implants based on the assessment of bone availability and the proposed dental prosthesis. After virtual planning, 3D surgical guides were printed using selective laser sintering. CBCT was repeated after the surgery, and the pre- and postoperative images were overlapped in computer-assisted design software to compare the planned and actual positions of the dental implants using a 1-sample t test. The mean ± angular standard deviation between the long axes of the planned and final dental implant positions was 4.58° ± 2.85°; the linear deviation in the coronal position was 0.87 ± 0.49 mm and in the apical region of the dental implants was 1.37 ± 0.69 mm. These differences were statistically significant (P < .001). The proposed modifications reduced the deviations, resulting in an improvement in the technique. We were able to place implants and temporary prostheses using the present protocol, taking into account the differences between the planned and final positions of the dental implants.

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The full digital workflow involves the combination of intraoral and cone beam computerized tomography scans. In the present case report, a second intraoral scan is performed after soft tissue management facilitated by the use of a 3-dimensional-printed interim implant restoration. The new STL file resulting from the second intraoral scan can be associated with the previous STL from the initial intraoral scan. The custom abutment was also digitally designed as an STL file, and no implant scan bodies were required for intraoral scanning.

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O objetivo dessa revisão foi descrever o estado de arte da técnica de preservação radicular (TPR), abordando suas indicações, contraindicações, vantagens, desvantagens e sobretudo os resultados alcançados seja do ponto de vista estético e funcional. Para isso, foi realizada uma pesquisa bibliográfica no PUBMED com as palavras-chave "socket-shield technique", "socket preservation", "bonepreservation", "immediateimplant", "dental implant" e esthetic. Além do mais, foram feitas pesquisa e seleção manual de trabalhos na lista de referências dos trabalhos encontrados mais o acréscimo de dois capítulos de livro de Implantodontia, totalizando 66 publicações para a confecção desta monografia. Com base nessa revisão de literatura, as conclusões foram de que deve-se selecionar criteriosamente cada caso, levando-se em conta possíveis limitações inerentes a técnica; a TPR é uma técnica sensível que requer uma execução atraumática e cuidadosa, com o intuito de não lesionar as fibras do ligamento periodontal que mantém o remanescente radicular em posição; a determinação do remanescente ósseo e da saúde dos tecidos periodontais são fundamentais para o planejamento da TPR; o uso de alternativas complementares, como a tomografia computadorizada Cone Bean(TCCB), na elaboração de guia cirúrgicos têm sido consideradas com o objetivo de reduzir possíveis riscos e complicações inerentes a técnica; a TPR tem apresentado resultados clínicos e radiográficos satisfatórios a curto prazo, quanto a manutenção dos tecidos duros e moles no local do implante; a TPR tem apresentado bons resultados estéticos quando comparada as técnicas convencionais ou ao implante imediato; ensaios clínicos randomizados são requeridos para a obtenção de maior evidência clínica quanto ao sucesso da terapia; acompanhamentos mais longos são precisos para determinar o prognóstico clínico a longo prazo.

The aim of this review is to describe the socket-shield technique (SST), discussing its indications, contraindications, advantages and disadvantages. Also, this study explores its functional and esthetics results. For this study, a bibliographic research was carried out in PUBMED database with "socket-shield technique", "socket preservation", "bone preservation", "immediate implant", "dental implant" and esthetic. Furthermore, research and manual selection were realized in the reference list of the selected articles, adding two chapters of Implantology's books. A total of 66 publications were added for the elaboration of this monograph. Based on this literature review, it can be concluded that each case must be carefully selected due to possible limitations from the technique; SST is a sensitive technique that requires an atraumatic procedure, in order to not injure fibers of periodontal ligament that keep the root's position; determination of the remaining bone and periodontal health are fundamental for the SST's planning; the use of alternative methods, such as cone beam computed tomography, in the surgical procedure guide, may reduce possible risks and complications inherent to SST; SST presented satisfactory short-term clinical and radiographic results due to the preservation of hard and soft tissues; SST showed good aesthetic results when compared to defined conventional techniques and immediate implantation; randomized clinical trials are required for further clinical evidence; longer follow-ups are needed to determine long-term clinical results.

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La estabilidad primaria es un requisito importante para la supervivencia y éxito de los implantes durante la osteointegración. En los últimos años, los implantes inmediatos postextracción han demostrado ser una opción de tratamiento exitosa y predecible para la reposición de dientes con mal pronóstico, pero surge la duda de si dichos implantes alcanzan valores de estabilidad primaria comparables a aquellos colocados en hueso maduro. Comparar la estabilidad primaria de implantes inmediatos colocados en alveolos postextracción con la de implantes colocados en hueso maduro. Se llevó a cabo un estudio clínico retrospectivo, con los datos recogidos sobre 175 implantes, colocados en 175 pacientes. Todos los implantes colocados pertenecían al modelo Essential Cone (Klockner Implant System) y se dividieron en dos grupos: implantes inmediatos (Grupo A, n=31) e implantes colocados en hueso maduro (Grupo B, n=144). La estabilidad primaria de todos los implantes se midió mediante torque de inserción y análisis de frecuencia de resonancia con Osstell ISQ. No se encontraron diferencias estadísticamente significativas respecto a la estabilidad medida a través del torque de inserción (26,29+10,07 Vs 25,76+9,72 N/cm) pero sí que se encontraron diferencias significativas en la medida de la estabilidad primaria mediante AFR, siendo inferiores los valores correspondientes a los implantes colocados en los alveolos post exodoncia (60,74 ± 6,17 en sentido VL y 62,19 ± 7.64 en sentido MD frente a 68,34 ± 6.26 en sentido VL y 69,29 ± 7.98 en sentido MD obtenidos en los implantes colocados en hueso maduro). El torque de inserción de los implantes inmediatos es similar al de los implantes colocados en hueso maduro, pero sus valores ISQ son significativamente inferiores, lo que demuestra un mayor grado de micromovimiento, y por consiguiente, un mayor riesgo de fracaso durante el período de osteointegración.

Primary stability is an important requirement for the survival and success of implants during osseointegration. In recent years, immediate post-extraction implants have proven to be a successful and predictable treatment option for the replacement of teeth with a poor prognosis, but the question arises as to whether these implants reach primary stability values comparable to those placed in mature bone. The objective of the study was to compare the primary stability of immediate implants placed in post-extraction alveoli with that of implants placed in mature bone. A retrospective clinical study was carried out, with data collected on 175 implants, placed in 175 patients. All implants placed belonged to the Essential Cone model (Klockner Implant System) and were divided into two groups: immediate implants (Group A, n = 31) and implants placed in mature bone (Group B, n = 144). The primary stability of all implants was measured by insertion torque and resonance frequency analysis with Osstell ISQ. No statistically significant differences were found regarding the stability measured through the insertion torque (26.29 + 10.07 Vs 25.76 + 9.72 N / cm) but significant differences were found in the measurement of primary stability by means of AFR, the values corresponding to implants placed in the post-exodontic alveoli being lower (60.74 ± 6.17 in the VL direction and 62.19 ± 7.64 in the MD direction versus 68.34 ± 6.26 in the VL direction and 69.29 ± 7.98 in the MD direction obtained in implants placed in mature bone). The insertion torque of immediate implants is similar to that of implants placed in mature bone, but their ISQ values are significantly lower, which demonstrates a higher degree of micromotion, and therefore, a greater risk of failure during the period of osseointegration.

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Introducción: La instalación inmediata del implante posterior a la extracción dental se está convirtiendo en un procedimiento de rutina debido a la reducción del tiempo de tratamiento y a la preservación de las estructuras anatómicas remanentes. Sin embargo, en muchos casos esta técnica involucra dientes afectados con procesos infecciosos. Hasta ahora, no se ha descrito a ciencia cierta el grado de éxito o fracaso del implante inmediato en alvéolos infectados, ni se ha establecido un protocolo para el manejo de este tipo de casos. Objetivo: Realizar una revisión bibliográfica actualizada, para determinar qué consideraciones se deben tener para instalar un implante inmediato en alvéolos con procesos infecciosos. Conclusión: Es posible obtener las ventajas de la instalación inmediata del implante en alvéolos infectados mediante la aplicación de un adecuado manejo clínico, donde se considere un adecuado tratamiento antibiótico, acompañado de un correcto curetaje alveolar, respetar la cadena de asepsia y antisepsia, posición subcrestal del implante y obtener siempre una buena estabilidad primaria del implante (AU)

Introduction: The immediate placement of the implant after dental extraction is a procedure that every time is becoming a routine procedure due to the reduction of the treatment time and the preservation of the remaining anatomical structures. However, in many cases, this technique involves affected teeth with infectious processes. Until now, the degree of success or failure of the immediate implant in infected alveoli has not been described for sure; nor has a protocol been established for the management of these types of cases. Objective: Carry out an updated bibliographic review, to determine what considerations must be taken to install an immediate implant in alveoli with infectious processes. Conclusion: Is possible obtain the advantages of the immediate installation of the implant in infected alveoli through the application of adequate clinical management, where appropriate antibiotic treatment is considered, accompanied by proper alveolar curettage, respect the aseptic and antiseptic chain, implant subcrestal position and always obtain a good primary stability of the implant (AU)

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The aim of the present review was to describe the studies produced in Latin America that contributed to the elucidation of the effect of tooth extraction with and without immediate implant installation. An electronic search was conducted in MEDLINE (PubMed), Scopus, Scielo, Lilacs, and Embase to include clinical and experimental (animal) studies on immediate implants. The studies selected had to fulfill the following inclusion criteria: (i) to present clinical and/or histological data on socket healing with or without immediate implant installation; (ii) to be approved by a Latin American Ethic Committee or comparable; and (iii) to include at least one author from a Latin American institution or to be conducted in a Latin America institution. Latin American studies that fulfilled these criteria demonstrated that immediate implant installation was conducive for predictable osseointegration and high survival rates but failed to prevent bone modeling and dimensional reduction of the alveolar ridge. In addition, it was also shown that regenerative approaches, including hard and soft tissue grafts at the time of immediate implant placement, may be beneficial to compensate for the alveolar ridge reduction. Regenerative approaches immediately after tooth extraction may decrease the amount of dimension reduction of the alveolar ridge.

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OBJECTIVES: This study aimed at evaluating soft and hard tissue dimensions after immediate implant placement and immediate temporization with or without alveolar preservation at the maxillary anterior region. MATERIALS AND METHODS: Twenty-two patients needing maxillary incisor extraction and with the possibility of immediate implant placement were randomly assigned to the following groups: test (n = 11): immediate implant placement + deproteinized bovine bone derived with collagen inserted into the alveolus or control (n = 11): immediate implant placement without biomaterial. All soft tissue measurements were evaluated at baseline, 3 months, and 6 months after implant therapy. Cone beam tomography was performed at baseline and at 6 months after implant placement to evaluate hard tissue dimension. RESULTS: The test group presented higher height of soft tissue at mesiobuccal and distobuccal sites at 3 months and 6 months when compared to the control group (p < 0.05). Regarding the bone tissue, the test group showed higher buccolingual ridge dimension at 6 months when compared to the control group (p < 0.05). CONCLUSIONS: It can be concluded that the use of deproteinized bovine bone derived with collagen together with immediate dental implants results in better soft and bone tissue outcomes than immediate implants alone. CLINICAL RELEVANCE: The use of deproteinized bovine bone derived with collagen may enhance the results regarding soft and bone tissue in combination with immediate implant and temporization.

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ABSTRACT: We describe a case report of a 53 years old patient with osteopenia treatment, which presented a longitudinal root fracture in relation to 9 tooth Single Fixed Prothesis (SFP), an active fistula and a bucal plate loss. It was prescribed the tooth extraction and the immediate Biohorizons® Tapered Internal® implant installation. The regeneration of the bucal plate was performed using the technique of "ice cream cone" using Mineross®, Mem Lok® and L-PRF.

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Introdução: nos dias atuais a estética e o sorriso agregam um valor social considerável. Uma dentição saudável, com a presença de todos os dentes, é uma condição almejada por grande parte da população, independente de idade e classe social. Diversos fatores podem atingir os indivíduos, fazendo com que venham perder seus dentes. Diante dessa circunstância, temos o implante imediato, considerado um avanço na implantodontia e uma realidade para pacientes que necessitam suprir essa ausência. Objetivo: relatar um caso clínico de instalação de implante imediato após extração dentária, associado ao enxerto ósseo e a manipulação de tecido mole, visando restabelecer a estética e função. Resultado e discussão: após uma avaliação clínica e radiográfica, foi detectada uma reabsorção óssea externa no dente 11, prosseguiu-se com a extração do elemento perdido, instalação de implante, remoção de tecido conjuntivo e de tecido ósseo da região do túber, posteriormente esses foram levados ao sítio receptor, onde finalizou- se com uma restauração provisória. Depois de 9 meses, procedeu-se a reabilitação definitiva com prótese de cerâmica sistema CAD-CAM. Frente aos resultados obtidos desse caso clínico, pode-se que concluir que a instalação imediata de implantes após extração apresenta um excelente prognóstico. Conclusão: tal abordagem clínica pode ser adotada com sucesso, a minimização do tempo de tratamento e um impacto relevante na satisfação do paciente.

Introduction: nowadays aesthetics and smile, add a considerable social value. A healthy dentition, with the presence of all teeth, is a desired condition for much of the population, regardless of age and social class. Several factors may reach individuals, causing them to lose their teeth. Given this circumstance, we have immediate implant, considered a breakthrough in implant and a reality for patients who need fill this absence. Objective: to report a case of immediate implant placement after tooth extraction, associated with bone grafting and soft tissue manipulation, aiming to restore aesthetics and function. Results and discussion: after a clinical and radiographic evaluation, an external bone resorption was detected in the tooth 11, the extraction continued with the lost element of implant installation, removal of connective tissue and bone tissue in the túber region, then these were brought to the site receiver, which ended with a temporary restoration. After nine months held final rehabilitation with ceramic prosthesis CAD-CAM system. Facing the results of this clinical case can be concluded that the immediate implant placement after extraction has an excellent prognosis. Conclusion: this clinical approach can be obtained as a success, minimizing the processing time and a significant impact on patient satisfaction.

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RESUMEN: Objetivo: El objetivo de este estudio fue evaluar la prevalencia de neumatización del seno maxilar y la relación con la pérdida de piezas adyacentes, en la población peruana geriátrica de un centro reconocido por la atención médica integral a los pacientes adultos mayores. Material y métodos: Se recogieron como muestras 60 radiografías panorámicas del Servicio de Odontología de la Clínica Geriátrica Militar de Chorrillos. El conteo de milímetros de la neumatización del seno maxilar fue mediante una plantilla milimetrada estandarizada. Resultados: De las 60 radiografías se obtuvieron 51 para el estudio. La neumatización fue grado 4 de neumatización (50%) en la pared mesial, grado 4 de neumatización (57.1%) en la pared medial y grado 3 de neumatización en la pared distal (64.7%). Conclusiones: A través de los resultados de este estudio se pudo concluir que la pérdida de piezas dentarias afecta a la neumatización del seno maxilar. Según los resultados de este estudio se encontró el mayor grado de neumatización del seno maxilar cuando había por lo menos dos piezas dentarias adyacentes al lado edéntulo.

ABSTRACT: Objective: The aim of the present study was to assess prevalence of maxillary sinus pneumatization and its relationship to loss of adjacent teeth, in a geriatric Peruvian population treated at a geriatric center recognized for the comprehensive medical care it provides to elderly patients. Material and methods: A sample of 60 panoramic X-rays were gathered from the dental service of the Military Geriatric Clinic at Chorrillos. Millimeter count of maxillary sinus pneumatization was conducted with a standardized millimeter template. Results: From a total of 60 X-rays, 51 were selected for the study. Grade 4 pneumatization was observed (50%) in the mesial wall, grade 4 pneumatization was observed in the medial wall (57.1%) and grade 3 pneumatization was observed in the distal wall (64.7%). Conclusions: Based on results of the present study it could be concluded that there was higher maxillary sinus pneumatization degree when there were at least two teeth adjacent to the edentulous side.

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The aim of this systematic review and meta-analysis was to compare the survival rate of the implants and the peri-implant tissue changes associated with implants inserted in fresh extraction sockets and those inserted in healed sockets. This review has been registered at PROSPERO under the number CRD42016043309. A systematic search was conducted by two reviewers independently in the databases PubMed/MEDLINE, Embase, and the Cochrane Library using different search terms; articles published until November 2016 were searched for. The searches identified 30 eligible studies. A total of 3,049 implants were installed in a total of 1,435 patients with a mean age of 46.68 years and a minimum of 6 months of follow-up. The survival rate of delayed implants (98.38%) was significantly greater than immediate implants (95.21%) (p=.001). For the marginal bone loss (p=.32), implant stability quotients values (p=.44), and pocket probing depth (p=.94) there was no significant difference between the analysed groups. The immediate implants placed in fresh sockets should be performed with caution because of the significantly lower survival rates than delayed implants inserted in healed sockets.

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The authors present a complete surgical and prosthetic case report of a 50-year-old male patient who lost the element 11 by periodontal disease, and during the phase of provisional restorations of the elements 12, 11, 21 and 22 had the element 21 fractured in domestic accident. The roots of the elements 11 and 21 suffered extraction and were replaced in the same act by a conic osseointegrated HE implant measuring 18 X 4 mm and graft of synthetic hydroxyapatite with a three months gap between the two surgical procedures. Six months after the second extraction with replacement of the root of the 21 element by an implant, four individual metal-free ceramic crowns were placed on the elements 12, 11, 21 and 22, two toothsupported (12, 22) and two implant-supported on custom abutments of zirconia (11, 21), which fully rehabilitated the function and esthetics of the patient with the regeneration and maintenance of bone level and gingival papillae between the elements, due to the strict respect of the biological distances between the individual parts, with monitoring and photographic, radiographic and tomographic documentation previously, during and after the surgery, twenty eight months after the installation of the implant of the 21 element and twenty-one months after the cementing of the four crowns. The authors and the patient signed the Free Informed Consent Form for the presentation of the case which was submitted in accordance with the standards of CONEP. (AU)

Os autores apresentam um caso clínico implantocirúrgico-protético completo em área estética com follow-up de dois anos de um paciente do sexo masculino, 50 anos de idade que inicialmente perdeu o elemento 11 por problema periodontal e, durante a fase dos provisórios nos elementos 12, 11, 21 e 22 teve o elemento 21 fraturado em acidente doméstico. As raízes dos elementos 11 e 21 sofreram exodontia e substituídas no mesmo ato por implantes osseointegráveis HE cônicos na medida de 18 X 4 mm e enxerto com hidroxiapatita sintética com interstício de três meses aproximadamente entre os dois procedimentos cirúrgicos. Seis meses após a segunda exodontia com substituição da raiz do 21 por implante, foram realizadas quatro coroas cerâmicas metal-free individuais nos elementos 12, 11, 21 e 22, sendo duas dento suportadas (12 e 22) e duas implanto-suportadas sobre abutments de zircônia personalizados (11 e 21), as quais reabilitaram plenamente a função e a estética do paciente com a regeneração e manutenção do nível ósseo e das papilas gengivais entre os elementos, graças ao estrito respeito às distâncias biológicas entre os elementos isolados, com acompanhamento e documentação fotográfica, radiográfica e tomográfica do período pré, trans e pós-operatório até a presente data, vinte e oito meses após a instalação do implante da região do 21 e vinte e um meses após a cimentação das quatro coroas cerâmicas. Os autores e o paciente assinaram o Termo de Consentimento Livre e Esclarecido (TCLE) para apresentação do caso o qual foi submetido de acordo com as normas da CONEP. (AU)

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O objetivo deste trabalho foi apresentar três casos clínicos de implantação imediata com provisionalização imediata, empregando a filosofia one abutment at one time. Nos três casos clínicos, após a realização das imagens tomográficas e prescrição medicamentosa, os implantes foram posicionados nas raízes mesiais (molares inferiores) e distovestibulares (molares superiores), sendo o espaço remanescente preenchido com biomaterial para preservação alveolar. Após a colocação dos pilares defi nitivos, coroas provisórias permaneceram por 90 dias até a cimentação das coroas metalocerâmicas definitivas. Os implantes são colocados abaixo do nível da crista óssea e o pilar utilizado constitui um exemplo de platform switching, que cria um espaço biológico e uma zona de selamento. Os controles destes casos vão de um a quatro anos demonstrando excelente estabilidade dimensional. Os resultados clínicos sugerem que a osseointegração de implantes unitários imediatamente carregados na região posterior pode ser alcançada. O uso de uma restauração provisória com a anatomia ideal de um dente molar pode facilitar a formação de contornos naturais da mucosa peri-implantar. É importante que o paciente não apresente bruxismo, possua osso suficiente para o posicionamento do implante e que pratique uma boa higiene oral.

The aim of this paper was to present three clinical cases with immediate implant insertion and provisionalization using the one abutment one time philosophy. On these, after CBCT and medicament prescription, the implants were positioned at the mesial (mandibular molars) and at the alveolar center (maxillary molars) aspects, being the gaps and the alveoli filled with a biomaterial for alveolar preservation. After the definitive abutments being placed, the provisional crowns remained in position for 90 days until cementation of the definitive metalloceramic crowns. The implants are placed below the bone crest level and the prosthetic abutment forms a platform-switching which creates a biologic space and a sealing zone. The follow-ups range from 1 to 4 years demonstrating excellent dimensional stability. The clinical results suggest that the osseointegration of immediate, single-tooth implants at the posterior region can be achieved. The use of a provisional restoration with ideal characteristics of a molar tooth facilitates the peri-implant mucosa contouring. It is important to select symptom-free bruxism patient, with sufficient bone for implant placement, and having good oral hygiene levels.

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RESUMEN

A instalação de implantes imediatos em alvéolos após as exodontias requer uma série de cuidados importantes para a manutenção dos tecidos peri-implantares e, consequentemente, um adequado resultado estético. O correto posicionamento do implante é chave para o sucesso desta terapia. A cirurgia guiada confere à instalação do implante a segurança na execução do seu correto posicionamento. O presente artigo discute os benefícios da técnica de cirurgia guiada por meio da apresentação de um caso clínico (AU).

The immediate implant placement after tooth extraction has many important details for the preservation of peri-implant tissues and therefore a suitable aesthetic result. The correct positioning of the implant is the key to the success of this therapy. Guided surgery enables a safe implant installation in the proper positioning. This article discusses the benefits of guided surgery technique through a case report (AU).

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