Publication: Evaluación clínica de la regeneración ósea horizontal de maxilares atróficos mediante injerto de rama mandibular y técnicas quirúrgicas de tunelización para su rehabilitación con implantes dentales
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2018-01-24
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Universidad Complutense de Madrid
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Abstract
El contraste de las diferentes alternativas terapéuticas en la regeneración ósea y el establecimiento de las indicaciones precisas para cada caso son una constante en la investigación, para obtener el mejor resultado y la menor morbilidad. Las técnicas de tunelización permiten un abordaje más seguro, pero ¿se pueden hacer injertos óseos mediante tunelización logrando un hueso con el que tener el mismo resultado que los implantes alojados en huesos indemnes? Se seleccionaron casos de déficit óseo horizontal maxilar tipo IV de Lekholm y Zarb, cuyo tratamiento regenerativo se realizó con un injerto en bloque autólogo de rama mandibular fijado con tornillos con técnicas de tunelización complementado, sí lo requerían, con técnicas de injerto del seno maxilar por ventana lateral. Madurado este, se situaron implantes para rehabilitar a estos enfermos. Se estudiaron las variables: edad, género, localización anatómica, torque de inserción quirúrgico, análisis de frecuencia de resonancia quirúrgica y en el momento de la carga, y supervivencia de los implantes a la carga, y la regeneración conseguida mediante el estudio del área regenerada en el entorno del implante. Estos datos se contrastaron con tres grupos: hueso indemne (control 0); hueso regenerado autólogo con técnica abierta sin membrana en defectos horizontales menores (control 1); y, con injerto del seno maxilar lateral con incisión mediocrestal (control 2)...
Implant therapy is a widespread procedure. However, it is necessary an adequate surrounding tissue, specially bone. Depending on bone quantity and location, different techniques have been described. The efficacy of autogenous block graft (in combination with maxillary sinus lift at the same time when necessary) has been clearly proven in the literature. Medium size defects can be treated with intraoral autogenous bone grafts. Lately, it has been demonstrated advantages on mandibular ramus block grafts over the chin block grafts due to less morbidity. One of the critical points in these procedures is getting enough soft tissue to achieve primary closure. Primary closure is essential to avoid one of the biggest complication: wound opening that lead to infection and graft loss. Tunnel technique, tunneling or subperiostal envelope, is an alternative to avoid this complication. In the tunnel technique a full thickness flap is elevated through a single incision, avoiding further periosteal incisions that would lead to a lower periosteal regenerative potential and graft resorption. Furthermore, by maintaining the integrity of the periosteum the use of regenerative membranes is unnecessary...
Implant therapy is a widespread procedure. However, it is necessary an adequate surrounding tissue, specially bone. Depending on bone quantity and location, different techniques have been described. The efficacy of autogenous block graft (in combination with maxillary sinus lift at the same time when necessary) has been clearly proven in the literature. Medium size defects can be treated with intraoral autogenous bone grafts. Lately, it has been demonstrated advantages on mandibular ramus block grafts over the chin block grafts due to less morbidity. One of the critical points in these procedures is getting enough soft tissue to achieve primary closure. Primary closure is essential to avoid one of the biggest complication: wound opening that lead to infection and graft loss. Tunnel technique, tunneling or subperiostal envelope, is an alternative to avoid this complication. In the tunnel technique a full thickness flap is elevated through a single incision, avoiding further periosteal incisions that would lead to a lower periosteal regenerative potential and graft resorption. Furthermore, by maintaining the integrity of the periosteum the use of regenerative membranes is unnecessary...
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Tesis inédita de la Universidad Complutense de Madrid de la Facultad de Odontología del Departamento de Estomatología III, leída el 20-01-2016