Publication: Tratamiento implantológico en pacientes trasplantados de órgano sólido inmunosuprimidos farmacológicamente: estudio prospectivo controlado
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2016-04-20
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Universidad Complutense de Madrid
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Abstract
En las últimas décadas, la terapéutica con implantes se ha convertido en un método predecible para reemplazar los dientes perdidos, sirviendo éstos de anclaje para prótesis implantosoportadas e/o implantorretenidas, con una evidencia clínica de tres décadas de uso. Tanto su eficacia como su seguridad, han sido ampliamente demostradas en la literatura científica. El mantenimiento a largo plazo de una interfase implante-hueso rígida requiere de una remodelación continua del hueso. Debido a la complejidad de la respuesta del tejido, la osteointegración y el mantenimiento de los implantes están influidos por muchos factores, incluyendo la edad, la dieta, medicamentos, enfermedades sistémicas y enfermedades orales. Los receptores de un trasplante de órgano sólido (TOS) han ido aumentando en número a lo largo del tiempo y viven más tiempo. También ha aumentado la demanda de tratamiento dental especializado, que va desde terapéutica periodontal y restauradora hasta el reemplazo de los dientes perdidos. El éxito de la osteointegración depende del estado del hueso del huésped y su capacidad de cicatrización. Sin embargo, el TOS puede tener un efecto negativo sobre el metabolismo óseo. Uno de los efectos de dicho tratamiento es una marcada supresión de la formación ósea y una inhibición de la función osteoblástica. A pesar de la gran abundancia de datos sobre los efectos de los regímenes inmunosupresores sobre la desmineralización ósea en pacientes trasplantados, hay una falta de datos sobre la respuesta del hueso a los implantes dentales en estos pacientes...
In the past few decades, the use of osseointegrated implants has become an important option for the treatment of total or partial rehabilitation of edentulous patients. Implant therapy has become a predictable method for replacing missing teeth, serving as an anchor for implant-supported and/or implant-retained prostheses, with a clinical evidence of more than three decades of use. Both its effectiveness and safety have been amply demonstrated in the scientific literature. The response of bone and soft tissue after a dental implant placement is controlled by wound healing factors (cytokines, chemokines and growth factors); biomechanics (gravitational, functional and therapeutic charges) and mineral metabolism (hormones, diet and excretion). The long-term maintenance of rigid implant-bone interface requires continuous bone remodeling. Due to the complexity of the tissue response, osseointegration and implants maintenance are influenced by many factors including age, diet, drugs, systemic diseases and oral diseases. Due to the big use of dental implants, the literature has also reported an increase in the number of associated complications. Among these complications, the most common are inflammatory processes affecting the soft tissue and bone, which is known as peri-implant mucositis and peri-implantitis. Clinically, this condition usually presents with edema, erythema, hypertrophy and even ulceration of the soft tissues. Dental literature contains numerous observations about the importance of systemic disorders as contraindications for implant treatment, although the justification for these conclusions is seemingly allegorical. In the past few years some of these assumptions have been questioned and the evidence of an increased failure rate of implant treatment in medically compromised patients is quite low...
In the past few decades, the use of osseointegrated implants has become an important option for the treatment of total or partial rehabilitation of edentulous patients. Implant therapy has become a predictable method for replacing missing teeth, serving as an anchor for implant-supported and/or implant-retained prostheses, with a clinical evidence of more than three decades of use. Both its effectiveness and safety have been amply demonstrated in the scientific literature. The response of bone and soft tissue after a dental implant placement is controlled by wound healing factors (cytokines, chemokines and growth factors); biomechanics (gravitational, functional and therapeutic charges) and mineral metabolism (hormones, diet and excretion). The long-term maintenance of rigid implant-bone interface requires continuous bone remodeling. Due to the complexity of the tissue response, osseointegration and implants maintenance are influenced by many factors including age, diet, drugs, systemic diseases and oral diseases. Due to the big use of dental implants, the literature has also reported an increase in the number of associated complications. Among these complications, the most common are inflammatory processes affecting the soft tissue and bone, which is known as peri-implant mucositis and peri-implantitis. Clinically, this condition usually presents with edema, erythema, hypertrophy and even ulceration of the soft tissues. Dental literature contains numerous observations about the importance of systemic disorders as contraindications for implant treatment, although the justification for these conclusions is seemingly allegorical. In the past few years some of these assumptions have been questioned and the evidence of an increased failure rate of implant treatment in medically compromised patients is quite low...
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Tesis inédita de la Universidad Complutense de Madrid de la Facultad de Odontología del Departamento de Estomatología III, leída el 27-01-2016