Reabilitação oral com distração osteogênica e colocação de implantes dentários em área de enxerto ósseo de crista ilíaca após cirurgia de ressecção de Ameloblastoma Sólido da mandíbula
DOI:
https://doi.org/10.26843/ro_unicid.v26i1.289Palavras-chave:
Reabilitação oral, Carga Imediata em Implante Dentário, Transplante ? sseo, Ameloblastoma.Resumo
A implantodontia é a alternativa de tratamento mais indicada nos processos de reabilitação oral de pacientes edêntulos. Entretanto, uma de suas limitações é a necessidade de altura óssea suficiente para a instalação dos implantes. A distração osteogênica surge como solução desse problema, induzindo uma osteogênese e, consequentemente, um aumento da altura do rebordo alveolar. Paciente K.A.V. (13), sexo masculino, foi submetido a cirurgia de ressecção mandibular para remoção de ameloblastoma e reconstrução imediata com enxerto ósseo de crista ilíaca. Após dezoito meses, parte do enxerto havia sido reabsorvida e nenhum sinal de recidiva da lesão foi detectado. Foi então realizada a distração osteogênica na região com dispositivo intraoral extraósseo, unidirecional. Após a instalação do mesmo, aguardou-se sete dias até a primeira ativação. Foram então realizadas ativações diárias de 1mm. Após 15 dias, a fase de ativação foi concluída, seguida de um período de consolidação de seis meses. Após remoção do dispositivo, verificou-se um ganho de 12mm na altura óssea. O processo possibilitou a instalação de três implantes na região com suas próteses, finalizando o tratamento reabilitador. A osteodistração mostrou ser uma alternativa viável e mais conservadora em relação às técnicas de enxertia óssea as quais acarretam maior morbidade.Downloads
Referências
. Neves FD, Fones D, Bernardes SR, do Prado CJ, Neto AJ. Short implants--an analysis of longitudinal studies. Int J Oral Maxillofac Implants 2006 JanFeb;21(1):86-93.
Brugnami F, Caleffi C. Prosthetically driven implant placement. How to achieve the appropriate implant site development. Keio J Med 2005 Dec;54(4):172-8.
Klein C, Papageorge M, Kovacs A, Carchidi JE. Initial experiences using a new implant based distraction system for alveolar ridge augmentation. Int J Oral Maxillofac Surg 2001 Apr;30(2):167-9.
Rubio-Bueno P, Naval L, RodriguezCampo F, Gil-Diez JL, Diaz-Gonzalez FJ. Internal distraction osteogenesis with a unidirectional device for reconstruction of mandibular segmental defects. J Oral Maxillofac Surg 2005 May;63(5):598-608.
McCarthy JG, Schreiber J, Karp N, Thorne CH, Grayson BH. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg 1992 Jan;89(1):1-8; discussion 9-10.
Barbosa RPL, Paiva JB, Rino Neto J, Miranda SL. Avaliação das alterações transversais mandibulares em paciente tratado com expansão média da sínfise por meio da distração osteogênica. Ortodontia 2003 jan./abr.;36(1):87- 100.
Baker B, Gibbons S, Woods M. Intraalveolar distraction osteogenesis in preparation for dental implant placement combined with orthodontic/orthognathic surgical treatment: a case report. Aust Dent J 2003 Mar;48(1):65- 8.
Bouguignon Filho AM, Dias ECLCM, Chiarelli FM, Rós L. Distração osteogênica na região de anterior de mandí- bula: relato de caso clínico. UFES Rev Odontol 2003 set./dez.;5(3):39-45.
Garcia AG, Martin MS, Vila PG, Maceiras JL. Minor complications arising in alveolar distraction osteogenesis. J Oral Maxillofac Surg 2002 May;60(5):496-501.
Hurzeler MB, Zuhr O, Schenk G, Schoberer U, Wachtel H, Bolz W. Distraction osteogenesis: a treatment tool to improve baseline conditions for esthetic restorations on immediately placed dental implants--a case report. Int J Periodontics Restorative Dent 2002 Oct;22(5):451-61.
Jensen O, Cockrell R, Kuhlke L. Anterior maxillary alveolar distraction osteogenesis: a prospective 5-year clinical study. In: Strean C, editor. Alveolar Distraction Osteogenesis: Quintessence; 2002. p. 98-118.
McAllister BS, Gaffaney TE. Distraction osteogenesis for vertical bone augmentation prior to oral implant reconstruction. Periodontol 2000 2003 33(54-66.
Oda T, Sawaki Y, Ueda M. Alveolar ridge augmentation by distraction osteogenesis using titanium implants: an experimental study. Int J Oral Maxillofac Surg 1999 Apr;28(2):151-6.
Rachmiel A, Levy M, Laufer D. Lengthening of the mandible by distraction osteogenesis: report of cases. J Oral Maxillofac Surg 1995 Jul;53(7):838- 46.
Stucki-McCormick SU, Winick R, Winick A. Distraction osteogenesis for the reconstruction of the temporomandibular joint. N Y State Dent J 1998 Mar;64(3):36-41.
Zauza K, Celar AG, Zechner W, Watzek G. Novel development for intraoral distraction osteogenesis by individually fabricated traction prostheses. Clin Oral Implants Res 2004 Jun;15(3):371-4. F
Valcanaia T, Palma FR, Chaves Júnior AC. Reposicionamento de implantes osseointegrados com a utilizaçäo de dispositivos protéticos para distrçäo óssea alveolar. BCI, Rev Bras Cir Implantodont 2002 9(32):302-5.
Watzek G, Zechner W, Crismani A, Zauza K. A distraction abutment system for 3-dimensional distraction osteogenesis of the alveolar process: technical note. Int J Oral Maxillofac Implants 2000 Sep-Oct;15(5):731-7.
Abbott LC. The operative lengthening of the tibia and fibula. J Bone Joint Surg 1927 9(
Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 1989 Jan;238):249- 81.
Snyder CC, Levine GA, Swanson HM, Browne EZ, Jr. Mandibular lengthening by gradual distraction. Preliminary report. Plast Reconstr Surg 1973 May;51(5):506-8.
Michieli S, Miotti B. Lengthening of mandibular body by gradual surgicalorthodontic distraction. J Oral Surg 1977 Mar;35(3):187-92.
Chin M, Toth BA. Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases. J Oral Maxillofac Surg 1996 Jan;54(1):45-53; discussion 4.
Aronson J. Temporal and spatial increases in blood flow during distraction osteogenesis. Clin Orthop Relat Res 1994 Apr;301):124-31.
Carls FR, Sailer HF. Seven years clinical experience with mandibular distraction in children. J Craniomaxillofac Surg 1998 Aug;26(4):197-208.
.Karp NS, Thorne CH, McCarthy JG, Sissons HA. Bone lengthening in the craniofacial skeleton. Ann Plast Surg 1990 Mar;24(3):231-7.
Mehrara BJ, Rowe NM, Steinbrech DS, Dudziak ME, Saadeh PB, McCarthy JG, et al. Rat mandibular distraction osteogenesis: II. Molecular analysis of transforming growth factor beta-1 and osteocalcin gene expression. Plast Reconstr Surg 1999 Feb;103(2):536-47.
Tavakoli K, Walsh WR, Bonar F, Smart R, Wulf S, Poole MD. The role of latency in mandibular osteodistraction. J Craniomaxillofac Surg 1998 Aug;26(4):209-19.
Kojimoto H, Yasui N, Goto T, Matsuda S, Shimomura Y. Bone lengthening in rabbits by callus distraction. The role of periosteum and endosteum. J Bone Joint Surg Br 1988 Aug;70(4):543-9.
Diner PA, Kollar E, Martinez H, Vazquez MP. Submerged intraoral device for mandibular lengthening. J Craniomaxillofac Surg 1997 Jun;25(3):116- 23.
Hollier LH, Kim JH, Grayson B, McCarthy JG. Mandibular growth after distraction in patients under 48 months of age. Plast Reconstr Surg 1999 Apr;103(5):1361-70.
Niederhagen B, Braumann B, Schmolke C, Appel T, von Lindern JJ, Berge S. Tooth-borne distraction of the mandible. An experimental study. Int J Oral Maxillofac Surg 1999 Dec;28(6):475- 9.
Smith SW, Sachdeva RC, Cope JB. Evaluation of the consolidation period during osteodistraction using computed tomography. Am J Orthod Dentofacial Orthop 1999 Sep;116(3):254-63.
Juenger TH, Klingmueller V, Howaldt HP. Application of ultrasound in callus distraction of the hypoplastic mandible: an additional method for the follow-up. J Craniomaxillofac Surg 1999 Jun;27(3):160-7.
Gaggl A, Schultes G, Karcher H. Vertical alveolar ridge distraction with prosthetic treatable distractors: a clinical investigation. Int J Oral Maxillofac Implants 2000 Sep-Oct;15(5):701-10
Sawaki Y, Ohkubo H, Yamamoto H, Ueda M. Mandibular lengthening by intraoral distraction using osseointegrated implants. Int J Oral Maxillofac Implants 1996 Mar-Apr;11(2):186-93.
Caplanis N, Sigurdsson TJ, Rohrer MD, Wikesjo UM. Effect of allogeneic, freeze-dried, demineralized bone matrix on guided bone regeneration in supra-alveolar peri-implant defects in dogs. Int J Oral Maxillofac Implants 1997 Sep-Oct;12(5):634-42.
Nystrom E, Kahnberg KE, Gunne J. Bone grafts and Branemark implants in the treatment of the severely resorbed maxilla: a 2-year longitudinal study. Int J Oral Maxillofac Implants 1993 8(1):45-53.
. Satow S, Slagter AP, Stoelinga PJ, Habets LL. Interposed bone grafts to accommodate endosteal implants for retaining mandibular overdentures. A 1-7 year follow-up study. Int J Oral Maxillofac Surg 1997 Oct;26(5):358- 64.
Martins L, Burr D, Sharkey NA. Skeletal tissue mechanics. New York: Springer; 1998.
Frost H, Meyer U, U J. Dental alveolar distraction osteogenesis and the Utah Paradigm. In: Strean C, editor. Alveolar Distraction Osteogenesis: Quintessence; 2002. p. 1-16.
Frost HM. The Utah paradigm of skeletal physiology: an overview of its insights for bone, cartilage and collagenous tissue organs. J Bone Miner Metab 2000 18(6):305-16
Rahn B. Bone healing: histologic and physiologic concepts. In: G SS, editor. Bone in Clinical Orthopedics: a study in comparative osteology. Philadelphia: Saunders 1982. p. 335-86.
Wallace A, Draper E, Strachan R. The vascular response to the fracture microenvironment. Clin Orthop Rel Res 1994 301(281-90.
Zaffe D, Bertoldi C, Palumbo C, Consolo U. Morphofunctional and clinical study on mandibular alveolar distraction osteogenesis. Clin Oral Implants Res 2002 Oct;13(5):550-7.
Ferreira L. Avaliação pelo método dos elementos finitos de cargas axiais aplicadas sobre implantes e componentes protéticos com diversas inclinações [Dissertação]. Araraquara: Universidade Estadual Paulista; 2007.
Branemark PI, Engstrand P, Ohrnell LO, Grondahl K, Nilsson P, Hagberg K, et al. Branemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res 1999 1(1):2-16.
Fugazzotto PA. Success and failure rates of osseointegrated implants in function in regenerated bone for 6 to 51 months: a preliminary report. Int J Oral Maxillofac Implants 1997 JanFeb;12(1):17-24.
Carvalho P. Planejamento cirúrgico protético em implantodontia. Rev Inovations Journal, 2006 37(4):12-8.
Sartori I. Preparo protético visando o planejamento cirúrgico em implantologia. Revista Biodonto 2004 jun./ ago.;1(3):
Francischone CE, Vasconcelos LW. Osseointegração e as próteses unitá- rias como otimizar a estética. São Paulo: Artes Médicas; 1998.
Nary Filho H, Ribeiro Júnior PD, Matsumoto MA, Batista AC, Soares AB, Consolaro A. Neurilemoma no palato duro: relato de caso clínico. BCI 2002 jan-mar;9(33):37-41.
White SH, Kenwright J. The timing of distraction of an osteotomy. J Bone Joint Surg Br 1990 May;72(3):356-61.
Padwa BL, Kearns GJ, Todd R, Troulis M, Mulliken JB, Kaban LB. Simultaneous maxillary and mandibular distraction osteogenesis with a semiburied device. Int J Oral Maxillofac Surg 1999 28(1):2-8. Stewart KJ, Lvoff GO, White SA, Bonar SF, Walsh WR, Smart RC, et al. Mandibular distraction osteogenesis: a comparison of distraction rates in the rabbit model. J Craniomaxillofac Surg 1998 Feb;26(1):43-9.
Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res 1983 Apr;174):28-42.
Ray RD. Vascularization of bone grafts and implants. Clin Orthop Relat Res 1972 Sep;87(43-8.
Mofid MM, Manson PN, Robertson BC, Tufaro AP, Elias JJ, Vander Kolk CA. Craniofacial distraction osteogenesis: a review of 3278 cases. Plast Reconstr Surg 2001 Oct;108(5):1103-14; discussion 15-7.
Soares M. Alveolar distraction in the class V and VI edentulous mandible. In: Strean C, editor. Alveolar Distraction Osteogenesis: Quintessence; 2002. p. 77-88.
De Bastiani G, Aldegheri R, RenziBrivio L, Trivella G. Limb lengthening by callus distraction (callotasis). J Pediatr Orthop 1987 Mar-Apr;7(2):129-34.
Delloye C, Delefortrie G, Coutelier L, Vincent A. Bone regenerate formation in cortical bone during distraction lengthening. An experimental study. Clin Orthop Relat Res 1990 250(34- 42.
Uckan S, Haydar SG, Dolanmaz D. Alveolar distraction: analysis of 10 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002 Nov;94(5):561-5.
Herford AS, Audia F. Maintaining vector control during alveolar distraction osteogenesis: a technical note. Int J Oral Maxillofac Implants 2004 SepOct;19(5):758-62.
Block MS, Almerico B, Crawford C, Gardiner D, Chang A. Bone response to functioning implants in dog mandibular alveolar ridges augmented with distraction osteogenesis. Int J Oral Maxillofac Implants 1998 MayJun;13(3):342-51.
Pastori C, Marzola C, Tsumanuma A, Toledo Filho J. Distração osteogênica alveolar ? relato de caso clínico cirúrgico. Revista de Odontologia 2007 27):534-62.
