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Efecto de la colocación inmediata del pilar definitivo versus 4 retiradas del pilar en los niveles óseos interproximales y los tejidos blandos periimplantarios: estudio clínico aleatorizado

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2021
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Introducción: La conexión y desconexión repetida de los pilares de cicatrización durante el periodo de osteointegración de los implantes se ha asociado significativamente con una mayor pérdida de hueso periimplantario, en comparación con la colocación del pilar de prótesis definitivo en el momento de la cirugía. Esta reabsorción aumentada se ha asociado con un mayor estado inflamatorio de los tejidos blandos periimplantarios debido a la disrupción repetida de la inserción de los tejidos blandos al pilar de prótesis y a la hipotética contaminación microbiana de la interfase implante-pilar. Resultados previos de estudios animales sugieren que, a mayor número de retiradas del pilar, mayor es la reabsorción ósea alrededor de los implantes. Objetivo: Comparar los cambios que se producen en los niveles de la cresta ósea periimplantaria entre el protocolo convencional de colocación de los pilares de cicatrización (se colocan en el momento de la cirugía y se retiran cuatro veces antes de la colocación de los pilares y prótesis definitivos), y aquel en el que se colocan los pilares definitivos inmediatamente después de la colocación de los implantes y no se vuelven a retirar. Material y Métodos: Se realizó un ensayo clínico aleatorizado en el cual se colocaron implantes con cambio de plataforma en el área posterior del maxilar o la mandíbula en pacientes parcialmente edéntulos. Inmediatamente después de la colocación de los implantes, los pacientes fueron aleatorizados para recibir los pilares definitivos en el momento de la colocación de los implantes (protocolo”one abutment – one time”), o a las 12 semanas, después de haber retirado los pilares de cicatrización cuatro veces durante la preparación de la prótesis definitiva, siguiendo el protocolo convencional para restauraciones implantosoportadas. El día de la colocación de la prótesis, se tomó una biopsia mucosa de los tejidos adyacentes al implante. El paciente fue tomado como unidad de análisis estadístico. Los cambios en los niveles óseos interproximales fueron considerados la variable respuesta primaria. Las variables respuesta cuantitativas se presentaron como valores medios, intervalos de confianza al 95%, desviaciones estándar y medianas. Los resultados se consideraron significativos tomando un valor de p≤0.05. Resultados: En este trabajo se presentan los resultados de variables clínicas y radiográficas de un total de 70 implantes colocados en 35 pacientes con un seguimiento de 12 meses. La diferencia en la pérdida ósea desde el momento de la cirugía hasta el seguimiento a 12 meses tras la carga de la prótesis en los implantes sometidos a la retirada del pilar de cicatrización 4 veces en comparación con aquellos en los cuales se colocó un pilar definitivo no fue estadísticamente significativa. Para las variables clínicas analizadas índice de placa modificado, índice de sangrado modificado y profundidad de sondaje no se observaron diferencias estadísticamente significativas entre los dos grupos durante el seguimiento. Conclusiones: En cuanto a la comparación de la pérdida ósea periimplantaria entre implantes en los cuales se conecta y desconecta el pilar de cicatrización cuatro veces durante el proceso protésico e implantes colocados utilizando el protocolo “one abutment – one time” (pilar definitivo) no se obtuvieron resultados estadísticamente significativos a los 12 meses de seguimiento.
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Trabajo Fin de Master encuadrado en la línea de investigación "Eficacia de intervenciones con implantes dentales y protocolo de regeneración ósea"
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