Avaliação de implantes de diâmetro reduzido na reabilitação oral de pacientes em crescimento após avulsão de incisivos permanentes superiores

Abstract

Oral injuries are common in young patients and may lead to tooth loss, for example, after avulsion. Maxillary incisors are the most commonly affected teeth, and their loss causes esthetic and functional issues. Treatment options for patients in the growth phase include the placement of a pontic space maintainer, dental autotransplantation, or orthodontically closing the space. The last two options are indicated in cases where arch contraction can improve the occlusion. Conventional implants are not indicated for patients who are still growing. Patients treated with a space maintainers must wait until adulthood for definitive rehabilitation. During this period, the process of alveolar bone resorption occurs in its natural course, which makes future rehabilitation more complex. A new treatment approach for these cases is the use of small-diameter implants (SDI) with a prosthetic crown to replace the space of the absent tooth until the end of growth. Some studies report that SDI can maintain the alveolar bone during this period, but its efficacy has not yet been proven. Thus, the present study will be divided into two parts. The first part presents the clinical case of a 13-year-old male patient who received an SDI to replace tooth 21, lost after avulsion. The patient was followed up for seven years clinically and tomographically. The second part presents a prospective clinical trial of 19 SDI for the replacement of permanent maxillary incisors following avulsion in 13 patients of both sexes, aged between 10–14 years. The cases were divided into two evaluation arms: implant installation in the healed socket (n = 9), and implant installation in the fresh socket (n = 10). The patients were followed up for one year, with quarterly clinical reviews to evaluate implant stability, provisional crown retention, and the peri-implant soft tissue, using the pink esthetic score. A questionnaire was administered to qualify the patients’ perception of the treatment. The alveolar ridge height and thickness were evaluated tomographically, one to predict SDI placement (T0) and the other one year after the treatment (T12). The intra- and inter-group measurements were compared. The Mann-Whitney and Wilcoxon or Friedman’s/Dunn’s tests were used for statistical analyses (p < 0.05; SPSS version 20.0, IBM Corp. New York, USA). Quantitative data and scores were expressed as means and standard deviations and analyzed using statistical tests at 95% confidence. The results of both studies were satisfactory regarding alveolar bone maintenance. Crown infraocclusion was not observed. In the clinical trial, the pink esthetic score index showed progressive improvement over the total investigated time. There was a significant improvement in the esthetic perception of the smile after treatment. SDI was an effective treatment alternative. A prospective study is necessary to improve treatment parameters and define safe long-term protocols in the future.