RESUMO
Sixteen consecutive patients with atrophic maxillae, who had been referred for bone augmentation using iliac bone grafting before the placement of dental implants, received a full clinical examination and underwent a CT scan before and after surgery. Linear vertical and horizontal measurements were made before and 6 months after surgery. Differences in mean bone gain or loss for each area were compared between a group that received an immediate total provisional prosthesis on temporary immediate implants (test group, 12 patients) and a control group (four patients). Both groups showed significant horizontal bone gain in all regions and vertical bone augmentation in the posterior regions. The test group showed no significant difference for bone gain compared to the control group, but half the test group had problems during treatment. Bone augmentation of the atrophic maxilla with iliac crest bone grafting resulted in sufficient vertical and horizontal bone augmentation to install six or eight implants in all patients and successfully rehabilitate them. The results suggest that the use of total provisional prostheses on temporary immediate implants meets the aesthetic demands required, but should be used with care and in special cases.
Assuntos
Autoenxertos/transplante , Transplante Ósseo/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Carga Imediata em Implante Dentário/métodos , Maxila/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Adulto , Idoso , Processo Alveolar/diagnóstico por imagem , Atrofia , Projeto do Implante Dentário-Pivô , Retenção em Prótese Dentária , Prótese Dentária Fixada por Implante , Prótese Total Imediata , Feminino , Seguimentos , Humanos , Ílio/transplante , Imageamento Tridimensional/métodos , Arcada Edêntula/diagnóstico por imagem , Arcada Edêntula/reabilitação , Arcada Edêntula/cirurgia , Masculino , Maxila/diagnóstico por imagem , Pessoa de Meia-Idade , Osseointegração/fisiologia , Infecção da Ferida Cirúrgica/etiologiaRESUMO
The purpose of this investigation was to determine the ability to perform the surgery that is planned based on the prediction tracing and model surgery when using the mandible as a guide to maxillary repositioning and internal reference points to establish the vertical dimension at the time of surgery. One hundred consecutive patients who underwent maxillary repositioning by means of Le Fort I osteotomy were selected. In all patients the unoperated mandible was used to provide anteroposterior and transverse maxillary position and measurements made on the lateral wall of the maxilla (internal reference points, IRP) to determine the maxillary vertical dimension. Tracings of all cranial structures were made of the preoperative cephalograms and superimposed on the postoperative cephalogram and on the prediction tracing using cranial base structures. Points were digitized to compare the preoperative, postoperative, and predicted position of the maxillary central incisor and first molar of each patient by computer. Comparison between the predicted and actual change in the position of the incisor and molar was calculated. Statistical analysis showed that there were significant differences between the predicted and actual change in vertical and horizontal position of both the incisor and the molar (P less than .0001). The results of this investigation indicate that the ability to determine vertical repositioning of the maxilla with internal reference lines is limited.