Luiz Antonio Borelli Barros’s research while affiliated with São Paulo State University and other places

Congenital dental agenesis, particularly in younger adults, can have a profound impact on aesthetics and overall quality of life. The scientific literature offers various management strategies for this condition, with orthodontic movement and implant-supported rehabilitation being central to treatment. However, achieving predictable and successful outcomes necessitates a comprehensive multidisciplinary approach. Such an approach integrates diverse professional perspectives to ensure accurate diagnosis, prognosis, and treatment planning, ultimately aiming to restore dental function and address aesthetic concerns effectively. In this case report, we present the successful rehabilitation of a young patient with congenital agenesis of the mandibular central incisors. The treatment strategy combined oral surgery (extraction of deciduous teeth and autogenous bone graft), orthodontic movement (opening spaces to allow implant installation), periodontics (connective tissue graft), implantology, and prosthetic planning. We detail the specific surgical approaches employed and discuss how their integration contributed to the overall success of the case. This multidisciplinary treatment approach not only restored dental function but also met the patient’s aesthetic expectations and enhanced the patient’s quality of life, highlighting the importance of a coordinated approach in managing complex dental conditions.

Dental rehabilitation following single tooth extraction in the esthetic zone is one of the most challenging clinical scenarios due to the high patient expectations and elevated level of technical skills needed. In contemporary dentistry, efforts have focused on improving both aesthetics and biological function for single tooth replacement with dental implants. This is achieved through advancements in implant materials, minimally invasive surgical techniques, and varies regenerative approaches combining different bone substitute materials. This article presents a comprehensive multidisciplinary treatment plan to address the complex challenges encountered after single tooth loss in the esthetic region. It explores strategies for implant rehabilitation in atrophic areas, including guided bone regeneration techniques for alveolar ridge preservation. Emphasis is placed on the versatility of xenogeneic bone grafts highlighting their crucial role in ensuring predictable and high-quality results aiming at restore the lost alveolar bone tissue. Additionally, the importance of autogenous connective tissue grafts is underscored for achieving superior aesthetic outcomes and promoting peri-implant health. Through a detailed case report, we illustrate how the application of these techniques led to successful oral rehabilitation in a patient with alveolar ridge atrophy for single tooth replacement. Moreover, this case highlights the clinical relevance and practical applicability of the chosen approaches that might help the clinicians to choose the best treatment option for similar cases. This reports provides valuable insights for professionals pursuing for satisfactory functional and esthetical outcomes in single implant-supported rehabilitation.

Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient’s expectations.

Em casos de edentulismo parcial na região anterior da maxila, o implante dentário tem se mostrado uma opção terapêutica altamente previsível. Em busca da excelência de um sorriso harmonioso, é necessária uma integração perfeita entre a estética rosa (gengiva) e branca (dentes) não apenas na questão biológica (osseointegração), mas também levando-se em consideração o fenótipo gengival e a arquitetura óssea do leito receptor. O uso do enxerto de tecido conjuntivo subepitelial (ETCS) associado com enxerto ósseo xenógeno, desempenham um papel importante em situações em que existam deficiências na espessura do tecido mole e/ou ósseo, devido a um fenótipo gengival fino e/ou pela reabsorção óssea alveolar em consequência da perda dentaria, respectivamente. Esta abordagem visando a correção das deficiências teciduais por meio de enxertos gengivais e ósseos permitem obter resultados esteticamente mais favoráveis beneficiando a função e a longevidade dos resultados obtidos. A presença de um fenótipo gengival espesso, de pelo menos de 2mm de espessura, ao redor dos implantes dentários é um fator fundamental para garantir o selamento biológico periimplantar e a longevidade do restauração implanto-suportada. Estudos recentes têm demonstrado que o ETCS é a abordagem mais indicada para aumentar a espessura do tecido gengival tanto ao redor de dentes como ao redor de implantes. Sendo assim, este trabalho tem como objetivo relatar um caso clínico em que foi realizado uma reabilitação com implante osseointegrado na região de incisivo lateral superior associado ao uso de enxerto xenógeno, membrana de colágeno e ETCS. Tal protocolo adotado demonstrou, nas condições estudadas, ser uma abordagem previsível, proporcionando estabilidade dos tecidos ao redor do implante associado com uma estética de excelência.

Background: The aim of this in vitro study was to evaluate the influence of the cortical thickness on the primary stability of short and conventional-sized implants with two types of prosthetic connection. Material and methods: Seventy-two implants were used. These implants were placed in polyurethane blocks that simulated low-density bone tissue (type IV bone), with two bone cortical heights (type I bone): 1mm and 3mm. The implants were divided into 6 groups with 12 implants each according to the type of prosthetic connections (external-hexagon -EH and morse taper- MT) and implant sizes (conventional- 4x10mm and short 5x5mm; 5.5x5mm; 5x6mm; 5.5x6mm). Insertion torque (IT) and resonance frequency analyzes (RFA) were performed to evaluate the primary stability of the implants. Results: All implants installed in blocks with 3mm of cortical thickness showed greater IT than those installed in 1mm. The short-sized MT implants had a higher IT than conventional implants of the same connection. Short-sized EH implants showed less IT than short-sized MT implants in blocks with 3mm of cortical. In blocks with 1mm of cortical, conventional EH implants had a higher IT compared to short-sized EH implants. The conventional sized implants presented higher RFA values despite the thickness of the cortical in the blocks. Conclusions: The greater bone cortical thickness and implants size provides greater primary stability of the implants regardless the prosthetic connection. Key words:Implants connection, implants macrostructure, primary stability.

O tratamento com implantes dentários tem evoluído significativamente desde a década de 70 até os dias atuais, tanto na questão de planejamento quanto na bioengenharia e tratamento da superfície desses implantes, com o objetivo de tornar o tratamento mais eficaz. Atualmente o uso de implantes imediatos tem sido cada vez mais estudado pelos pesquisadores e utilizado para a reabilitação oral dos pacientes. A literatura nos mostra que a inserção imediata de implantes dentários pós-extração é um tipo de tratamento com altas taxas de sucesso, possibilitando ao paciente ser submetido a apenas uma cirurgia, retorno à função mastigatória e estética mais rápidas. Para isso são necessários planejamento correto e seleção adequada do paciente para o sucesso do tratamento, levando em consideração a condição óssea e periodontal. O objetivo deste estudo é discorrer sobre o planejamento da reabilitação oral de uma paciente que foi submetida da extração dentária total dos dentes inferiores, instalação de 4 implantes dentários imediatos e confecção de uma prótese total com carga imediata do tipo protocolo.

Background: The aim of this study was to retrospectively evaluate the success and survival rate of implants with different types of prosthetic connections inserted in the posterior maxilla in native bone or in sinuses previously grafted with different biomaterials. Methods: A total of 310 implants inserted in 113 patients were evaluated, 87 of which were inserted in association with grafted maxillary sinuses (56 morse taper (MT) implants and 31 external hexagon (EH) implants) in 37 patients, and 223 implants were inserted in native bone areas (112 MT and 111 EH implants) in 76 patients. Peri-implant clinical analyses were performed (bleeding on probing, probing depth, clinical insertion level, peri-implant marginal level, and the presence of mobility or suppuration), and the radiographic bone level was evaluated. Results: Two implants were lost, yielding a survival rate of 99.35%. The MT implants had lower probing depths and peri-implant bone levels than the EH implants in both grafted areas and native bone areas (P<0.05). No statistically significant differences in any parameter evaluated were found between implants inserted in native bone and those inserted in grafting areas. EH implants inserted in native bone areas showed higher peri-implantitis rates. Conclusions: It can be concluded that the MT implants connection reduce peri-implant bone loss, but implants inserted in maxillary sinuses previously grafted with osteoconductive biomaterials do not predispose patients to peri-implant bone loss.

Rehabilitation of atrophic maxilla with dental implants is still a challenge in clinical practice especially in cases of alveolar bone resorption due to peri-implantitis and pneumatization of the maxillary sinuses. Several surgical approaches have been employed to reconstruct the lost tissues allowing the proper tridimensional position of the implants. In this context, the aim of this case report is to describe a surgical and prosthetic approach to fully rehabilitate the atrophic maxilla with dental implants. The patient presented with unsatisfactory functional and esthetical implant-supported prosthesis with some of the implants already lost by peri-implantitis. The remaining three implants were also affected by peri-implantitis. Reversal prosthetic planning was performed, and a provisional prosthesis was fabricated and anchored in two short implants. Sinus floor augmentation procedure and onlay bone graft were then accomplished. After a healing period of 8 months, digital-guided surgery approach was performed to place the implants. Finally, a definitive prosthesis was installed. One-year follow-up has revealed stabilization of the bone tissue level, successful osseointegration, and a pleasant esthetic and functional result. A proper diagnosis and careful planning play an important role to enhance precision and to achieve patient esthetic and functional outcomes.

Two cases of aesthetic implant abutment rehabilitation in the maxillary anterior area in periodontally compromised patients following conventional periodontal therapy and tooth extractions are presented. For the two cases of anterior tooth loss due to advanced periodontal disease progression, atraumatic flapless extractions were performed followed by the placement of immediate implants and provisional restorations. For the first case, lithium disilicate cemented over the abutment was used to achieve excellent aesthetic results. In the second case, custom zirconia abutments were used as prosthetic components. The results at the 3-year follow-up showed absence of inflammation and/or infection on the peri-implantar tissue with satisfactory aesthetic and excellent biological and clinical results achieved with reduced treatment time and morbidity for both patients. Total absence of infection and frequent plaque control after implant placement are mandatory before selection of the abutment material. The planning of the final treatment as specified by the concept of comprehensive dental care is outlined, and the final outcome is discussed in relation to the literature.