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Os Implantes dentários - Aspectos Positivos:
IMPLANTES
IMEDIATOS OU PRECOCE
EM
ALVÉOLOS FRESCOS
fernando oliveira
Os Implantes dentários - Vantagens:

Preservação de estruturas dentárias vizinhas;

Possibilidade de individualização das peças
dentárias;

Reabilitação fixa de áreas desdentadas
posteriores com extremos livres.
Os Implantes dentários - Buscando a
excelência:

Avançando nas técnicas cirúrgicas;

Aprimoramento e familiaridade no tocante ao
planejamento em todas as etapas do tratamento
proposto;

Aceleração no tempo de osseointegração;

Otimizando os resultados estéticos.
Numerosos estudos sobre as várias indicações
clínicas têm comprovado uma alta taxa de sucesso e
sobrevida para os implantes, com relação aos
critérios específicos de aplicação
Ekfeldt et al. 1994, Laney et al. 1994, Andersson et al. 1995, Brånemark et al. 1995, Lewis 1995, Jemt et
al. 1996, Lindqvist et al. 1996, Buser et al. 1997, Ellegaard et al. 1997a,b, Levine et al. 1997, Andersson
et al. 1998, Bryant & Zarb 1998, Eckert & Wollan 1998, Ellen 1998, Lindh et al. 1998, Mericske-Stern
1998, ten Bruggenkate et al. 1998, Wyatt & Zarb 1998, Gunne et al. 1999, Lekholm et al. 1999, Van
Steenberghe et al. 1999, Wismeijer et al. 1999, Behneke et al. 2000, Hosny et al. 2000, Hultin et al. 2000,
Weber et al. 2000, Boioli et al. 2001, Gomez-Roman et al. 2001, Kiener et al. 2001, Mengel et al. 2001,
Oetterli et al. 2001, Zitzmann et al. 2001, Bernard & Belser 2002, Buser et al. 2002, Haas et al. 2002,
Leonhardt et al. 2002, Romeo et al. 2002, Zarb et al., 2002, Wortington et al., 2003.
Os Implantes dentários - Aspecto negativo:

Schiroli (2003), refere que um dos aspectos
negativos da técnica convencional é justamente o
longo tempo de demora para completar o
tratamento, que pode se estender por meses e até
anos.
Os Implantes dentários
Avanços nas reabilitações com implantes:

Implante imediato:

Fase única:

Estética imediata:

Carga Imediata:
1

Os Implantes dentários
Avanços nas reabilitações com implantes:

Implante imediato:
 Exodontia e colocação do implante em tempo
único.

Fase única:
Instalação do implante deixando-o exposto ao
meio bucal, sem função.
Comportamento dos alvéolos frente a
Extrações:
A perda de uma ou várias unidades na região
anterior maxilar conduz:
1- Achatamento do festonado osso interproximal;
2- Restaurações alongadas com perda e ou
comprometimento da papila inter-implante.
Comportamento dos alvéolos durante o
processo de cicatrização:
• Extração de um único dente conduz a alterações
nos tecidos duros e moles no sítio;
• Enquanto as alterações do rebordo de múltiplos
dentes conduz a diminuição no tamanho em ambos
aspectos do rebordo alveolar desdentado;
23/04/2009
Os Implantes dentários
Avanços nas reabilitações com implantes:

Estética imediata:
 Instalação do implante e confecção de coroa
provisória simultânea, sem função mastigatória.

Carga imediata:
 O implante entra em função imediatamente após
sua instalação.
Comportamento dos alvéolos durante o
processo de cicatrização:
• Experimentos em animais e clínicos revelam que
os rebordos alveolares sofrem alterações
dimensionais tanto horizontal como verticais em
unidades extraídas;
Comportamento dos alvéolos durante o
processo de cicatrização:
• Schropp et al., (2003) observaram as alterações
(reabsorção) de rebordo pós-exo de pré-molares e
molares em 46 pacientes:
 As mudanças verticais são desprezíveis;
 As horizontais: 30% em 3 meses e 50% em 12
meses.
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 23/04/2009

Comportamento dos alvéolos durante o Comportamento dos alvéolos durante o

processo de cicatrização: processo de cicatrização:

• Estudos de acompanhamento em sítios de • Em recente estudo histológico em cães, como

cicatrização de alvéolos de uni e bi-radiculares: observado tempos atrás, que o padrão de reabsorção

 A redução na largura horizontal do rebordo foi da parede do alvéolo de extração vestibular é mais

de 3.1mm em 4 meses e 2.6 em 6 meses pronunciada que a antagônica lingual;

Camargo et al., 2000; Lasella et al., 2003 Araujo & Lindhe, 2005

Dimensional ridge alterations following Dimensional ridge alterations following

tooth extraction. An experimental study in tooth extraction. An experimental study in
Results:
the dog the dog
It was demonstrated that marked dimensional alterations occurred during the first 8 weeks
Material and Methods:

• Twelve mongrel dogs were included in the study. In both quadrants of the mandible incisions were
following the extraction of mandibular premolars. Thus, in this interval there was a marked
made in the crevice region of the 3rd and 4th premolars. Minute buccal and lingual full thickness flaps
osteoclastic activity resulting in resorption of the crestal region of both the buccal and the
were elevated. The four premolars were hemi-sected. The distal roots were removed. The extraction sites

were covered with the mobilized gingival tissue. The extractions of the roots and the sacrifice of the dogs lingual bone wall. The reduction of the height of the walls was more pronounced at the buccal

were staggered in such a manner that all dogs contributed with sockets representing 1, 2, 4 and 8 weeks
than at the lingual aspect of the extraction socket. The height reduction was accompanied by a
of healing. The animals were sacrificed and tissue blocks containing the extraction socket were
‘‘horizontal’’ bone loss that was caused by osteoclasts present in lacunae on the surface of
dissected, decalcified in EDTA, embedded in paraffin and cut in the buccal–lingual plane. The sections

were stained in haematoxyline–eosine and examined in the microscope Araujo & Lindhe, 2005 both the buccal and the lingual bone wall.
Araujo & Lindhe, 2005

Dimensional ridge alterations following Comportamento dos alvéolos durante o

processo de cicatrização:
tooth extraction. An experimental study in
the dog
Conclusions: Fig. 1 - Overview of the extraction site after
1 week of healing. Note the large amounts
The resorption of the buccal/lingual walls of the extraction site occurred in two overlapping
of provisional matrix and, in the center of
phases. During phase 1, the bundle bone was resorbed and replaced with woven bone. Since
the socket, remaining blood clot. BC, blood
the crest of the buccal bone wall was comprised solely of bundle this modelling resulted in
clot, B, buccal; L, lingual; PM, provisional
substantial vertical reduction of the buccal crest. Phase 2 included resorption that occurred matrix.

from the outer surfaces of both bone

walls. The reason for this additional bone loss is presently not understood.
Araujo & Lindhe, 2005
Araujo & Lindhe, 2005

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Comportamento dos alvéolos durante o Comportamento dos alvéolos durante o

processo de cicatrização: processo de cicatrização:
Fig. 3 - One week of healing.
Fig. 2 - 1 week of healing. The crestal region of the
lingual (a) and buccal (b)
Higher magnification of walls. The buccal bone crest is
made exclusively of bundle
outlined area in Fig. 1. The bone while the lingual crest is
comprised of a mixture of
bundle bone covered the cortical bone and bundle bone.
Note the presence of
socket wall. Lateral to the osteoclasts in the crestal
bundle bone a severed regions of both walls (arrows).
A, inner surface of the bone
periodontal ligament can be wall; BB, bundle bone; CB,
cortical bone; O, outer surface
identified. BB, bundle bone; of the bone wall; arrows,
osteoclasts.
PDL, severed periodontal
Araujo & Lindhe, 2005 Araujo & Lindhe, 2005

ligament;

Comportamento dos alvéolos durante o Comportamento dos alvéolos durante o

processo de cicatrização: processo de cicatrização:
Fig. 4. Overview of the extraction site after Fig. 5. Two weeks of
healing. The crestal
2 weeks of healing. Note the large amounts
region of the lingual (a)
of woven bone are presented in the lateral and buccal (b) walls.
Note the large number of
and apical portions of the socket. B, buccal;
osteoclasts present on
L, lingual; PM, provisional matrix; WB, the outter surface of the
crestal regions. A, inner
woven bone.
surface of the wall; BB,
bundle bone; CB, cortical
bone; O, outer surface of
the wall; arrows,
osteoclasts

Araujo & Lindhe, 2005 Araujo & Lindhe, 2005

Comportamento dos alvéolos durante o Comportamento dos alvéolos durante o

processo de cicatrização:
Fig. 6. Overview of the extraction site after 4 weeks
of healing. Note the extraction site at this interval is
dominated by newly formed woven bone. The
bundle bone of the crestal region of the buccal wall
was resorbed and partially replaced by woven
bone. Note also that the marginal portion of the old
buccal wall (arrow) is ‘‘apical’’ to its lingual
counterpart. B, buccal; L, lingual; WB, woven bone;
arrow, marginal portion of the old buccal wall.
processo de cicatrização:
Fig. 7 - Overview of the extraction site after 8
weeks of healing. The entrance of the socket is
sealed by a hard tissue ridge that is comprised of
woven bone and lamellar bone. The central portion
of the socket is dominated by bone marrow. Note
that the marginal portion of the buccal wall (arrow)
is about 2mm ‘‘apical’’ of the marginal termination
of the lingual wall. B, buccal; BM, bone marrow; L,
lingual; arrow, marginal portion of the buccal wall.

Araujo & Lindhe, 2005 Araujo & Lindhe, 2005

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Comportamento dos alvéolos durante o

processo de cicatrização: CICATRIZAÇÃO DO
Fig. 8. Eight weeks of healing at the crestal buccal
bone wall. Note the large number of osteoclasts
(arrows) that are present on the surface of the old
ALVÉOLO DE EXTRAÇÃO
cortical bone. The woven bone is in the process of
remodelling. CO, old cortical bone; WB, newly E O IMPACTO NA
formed woven bone; O, outer surface of the wall;

COLOCAÇÃO IMEDIATA
arrows, osteoclasts; dotted line, borderline
between the woven bone and the

old cortical bone.

Araujo & Lindhe, 2005
DO IMPLANTE

Comportamento dos alvéolos durante o

Os Implantes dentários Imediatos em alvéolos processo de cicatrização em sítios com
de extração: implantes dentários:

Ridge alterations following implant

A partir do primeiro relato publicado por Schulte et al.,
placement in fresh extraction sockets: an
(1978) da colocação de um implante dentário em alvéolo experimental study in the dog
de extração, só recentemente tem aumentado o interesse
J Clin Periodontol 2005; 32:645-652
nessa técnica na implantodontia.
Araujo et al., 2005

Ridge alterations following implant placement in Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in fresh extraction sockets: an experimental study in
Material and Methods:
the dog
• Five beagle dogs were included in the study. In both quadrants of the mandible, incisions the dog
Results:
were made in the crevice region of the third and fourth pre-molars. Buccal and minute lingual
At implant sites, the level of bone-to-implant contact (BC) was located 2.6 0.4mm (buccal
full-thickness flaps were elevated. The mesial root of the four pre-molars root was filled and the
aspect) and 0.2 0.5mm (lingual aspect) apical of the SLA level. At the edentulous sites, the
teeth were hemi-sected. Following flap elevation in 3P3 and 4P4 regions, the distal roots were
mean vertical distance (V) between the marginal termination of the buccal and lingual bone
removed. In the right jaw quadrants, implants with a sand blasted and acid etched (SLA)
walls was 2.2 0.9 mm. At the surgically treated tooth sites, the mean amount of attachment
surface were placed in the fresh extraction sockets, while in the left jaws the corresponding
loss was 0.5 0.5mm (buccal) and
sockets were left for spontaneous healing. The mesial roots were retained as surgical control
0.2 0.3mm (lingual)
teeth. After 3 months, the animals were examined clinically, sacrificed and tissue blocks

containing the implant sites, the adjacent tooth sites (mesial root) and the edentulous socket

sites were dissected, prepared for ground sectioning and examined in the microscope.
Araujo et al., 2005 Araujo et al., 2005

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Ridge alterations following implant placement in Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in fresh extraction sockets: an experimental study in
the dog
Conclusions: the dog Fig. 1. Clinical photograph illustrating the
extraction sockets – distal roots – of the third
Marked dimensional alterations had occurred in the edentulous ridge after 3 months of healing and

following the extraction of the distal root of mandibular premolars. The placement of an implant fourth mandibular pre-molars immediately after
root extraction. Note that the buccal–lingual
in the fresh extraction site obviously failed to prevent the re-modelling that occurred in the walls
width of the extraction socket of the fourth pre-
of the socket. The resulting height of the buccal and lingual walls at 3 months was similar at molar is wider than that of the third pre-molar.

implants and edentulous sites

and vertical bone loss was more pronounced at the buccal than at the lingual aspect of the

ridge. It is suggested that the resorption of the socket walls that occurs following tooth removal

must be considered in conjunction with implant placement in fresh extraction sockets.

Araujo et al., 2005 Araujo et al., 2005

Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog
Fig. 2. Clinical photograph illustrating the
experimental sites immediately after implant
installation. Note that the border of the sand
blasted and acid etched-coated surface of the
implants was flush with the buccal bone crest.
Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog
Fig. 3. (a) Clinical photograph illustrating the
wound in the third and fourth pre-molar region
after sutures had been placed. Two implants and
the adjacent ‘‘involved’’ teeth. Note that the
healing caps at the implants project above the
mucosa. (b) The corresponding edentulous site
and adjacent mesial roots of third and fourth pre-
molars.

Araujo et al., 2005 Araujo et al., 2005

Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog Fig. 4. (a) Clinical photograph illustrating one
experimental site (two implants and two
‘‘involved’’ roots) after 3 months of healing. Note
that the peri-implant mucosa as well as the
gingiva show no overt signs of inflammation. The
margin of the mucosa resides at the smooth
portion of the implant. (b) Clinical photograph of
two edentulous sites and adjacent
‘‘involved’’ tooth sites after 3 months of healing.
Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog Fig. 6. Buccal–lingual section representing
one implant site after 3 months of healing.
Note the location of the bone crest at the
buccal and lingual aspects of the implant.
BB, buccal bone wall; I, implant; LB, lingual
bone wall; PM, peri-implant mucosa.
Outlined area5detail presented in Fig. 6.

Araujo et al., 2005 Araujo et al., 2005

6

Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog
Fig. 7. Higher magnification of the area outlined
in Fig. 5. LB, lingual bone wall; I,
implant. Arrows indicate the presence of a
typical reversal line
Araujo et al., 2005
Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog Fig. 9. Buccal–lingual section representing
an edentulous site. Note the location of
the original bone crest (outlined area) at
the buccal (b) and lingual (l) aspects of the
alveolar crest. BB, buccal bone wall; LB,
lingual bone wall; M, mucosa of the edentulous
ridge.
Araujo et al., 2005
Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog
Fig. 11. Buccal–lingual section. Magnified
microphotograph of (l) the lingual aspect
of the crest identified (outlined area) in
Fig. 8. The dotted line represents the borderline
between the old and newly formed bone.
Araujo et al., 2005
23/04/2009
Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog Fig. 8. Buccal–lingual section representing
an involved tooth site. Note that the lingual
bone crest is closer to the CEJ (arrows) at the
lingual than at the buccal aspect of the tooth.
The apical level (aJE) of the junctional
epithelium (arrowheads). BB, buccal bone
wall; LB, lingual bone wall; CEJ, cementoenamel
junction.
Araujo et al., 2005
Ridge alterations following implant placement in
fresh extraction sockets: an experimental study in
the dog
Fig. 10. Buccal–lingual section. Magnified
microphotograph of (b) the buccal aspect of
the crest identified (outlined area) in Fig. 8.
The dotted line represents the borderline
between the old and newly formed bone.
Araujo et al., 2005
Comportamento dos alvéolos durante o
processo de cicatrização em sítios com
implantes dentários:
Hard-tissue alterations following
immediate implant placement in
extraction sites
J Clin Periodontol 2004; 31:820-828
Botticelli et al., 2004
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Hard-tissue alterations following immediate implant Hard-tissue alterations following immediate implant
placement in extraction sites placement in extraction sites

Material and Methods: Results:

• Eighteen subjects with a total of 21 teeth scheduled for extraction were included. Following Fifty-two marginal defects exceeding 3mm were present at baseline: 21 at buccal, 17 at

flap elevation and the removal of a tooth and implant installation, clinical measurements were lingual/palatal, and 14 at approximal surfaces. At the re-entry eight defects exceeding 3.0mm

made to characterize the dimension of the surrounding bone walls, as well as the marginal remained. During the 4 months of healing, the bone walls of the extraction underwent marked

defect. No membranes or filler material was used. The flaps were subsequently replaced and change. The horizontal resorption of the buccal bone dimension amounted to about 56%. The

secured with sutures in such a way that the healing cap of the implant was exposed to the oral corresponding resorption of the lingual/

environment. After 4 months of healing a re-entry procedure was performed and the clinical palatal bone was 30%. The vertical bone crest resorption amounted to 0.3 0.6mm (buccal), 0.6

measurements were repeated. 1.0mm (lingual/palatal), 0.2 0.7mm (mesial), and 0.5 0.9mm (distal)

Botticelli et al., 2004 Botticelli et al., 2004

Hard-tissue alterations following immediate implant Hard-tissue alterations following immediate implant
placement in extraction sites placement in extraction sites

Conclusion: Fig. 1. Clinical photographs describing the

implant site of patient L. C. immediately after
The marginal gap that occurred between the metal rod and the bone tissue following implant implant installation: (a) buccal view and (b)
installation in an extraction socket may predictably heal with new bone formation and defect occlusal view, (c) follow flap closure with
sutures and (d) after 4 months of healing.
resolution. The current results further documented that marginal gaps in buccal and During the 4-month interval, the marginal
bone crest at
palatal/lingual locations were resolved through new bone formation from the inside of the
the buccal surface exhibited minor signs of
defects and substantial bone resorption from the ‘‘vertical’’ resorption ((e) to be compared with
(a)) and the buccal bone wall (yellow lines)
outside of the ridge. was

Reabsorção = 50% no lado vestibular e 30% no lado lingual do implante markedly reduced in width ((f) to be
compared with (b)).

Botticelli et al., 2004

Botticelli et al., 2004

Hard-tissue alterations following immediate implant

placement in extraction sites

Fig. 2. Schematic drawing illustrating the

landmarks used for the clinical measurements.
S, shoulder of the implant; C, coronal
margin of bone crest; OC, outer surface of
the bone crest; D, base of the defect; G, gap
between the implant surface and the inner
side of the bone wall. Botticelli et al., 2004

Fig. 3. Case T. M.: The implant was placed in the palatal socket of the extracted tooth 14 ((a) occlusal view). Note
the long distance between the outer surface of the buccal bone wall (OC) and the implant. (b) (buccal view)
illustrates that the buccal bone margin is at about the same ‘‘vertical’’ level as the implant shoulder. The large
horizontal dimension of the socket (9mm bucco-lingually and 7mm disto-mesial) allowed probing the defect at the
buccal, mesial and lingual aspects. The implant in position 15 was placed in the same surgical procedure but in a
healed ridge. After 4 months of healing ((c) occlusal view) there has been a marked remodeling of the buccal bone
Botticelli et al., 2004
tissue and a substantial reduction of the height of the marginal bone crest (d).

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Fig. 5. Case B. M.: (a) A clinical photograph that illustrates an implant that was
placed in the socket immediately after the extraction of tooth 15 (occlusal view).
Note the wide marginal gaps that are present at the buccal and palatal surfaces of
the extraction site. (b) After 4 months of healing, the marginal defect was reduced,
but the depth at the buccal aspect was not completely resolved.
Fig. 4. Case E. M. C.: The implant was installed in the
extraction socket in position 21 ((a) occlusal view; (b)
buccal view). Note the wide palatal defect (arrow). After 4
months, the defect was resolved (c, d).

Botticelli et al., 2004 Botticelli et al., 2004

Comportamento dos alvéolos durante o Bone tissue formation adjacent to implants placed in
processo de cicatrização em sítios instalados fresh extraction sockets: an experimental study in
com implantes dentários: Material and methods:
dogs
Six dogs were used. The right side of the mandible was used in the first part of the study. The

Bone tissue formation adjacent to first, second premolars and first molars were extracted. After 3 months of healing the bone was

prepared for implant installation in these premolar and molar sites. The marginal 5mm of each

implants placed in fresh extraction recipient site was widened with a conical drill. Following implant installation a gap of varying

dimension occurred around the titanium rod (artificial defect (A) sites). At this interval the third
sockets: an experimental study in dogs and fourth premolars were extracted

and implants were installed in the distal socket of the two teeth (natural defect (N) sites). The

Clin Oral Implants Res 2006; 17:351-358 flaps were sutured to allow non-submerged healing. After 2 months, the procedures were

repeated in the left side. Two months later the animals were euthanized, and biopsies were

Botticelli et al., 2006

obtained and prepared for histological examination. Botticelli et al., 2006

Bone tissue formation adjacent to implants placed in Bone tissue formation adjacent to implants placed in
fresh extraction sockets: an experimental study in fresh extraction sockets: an experimental study in
dogs dogs
Results:
Conclusion:
The length of the zone of de novo ‘bone-to-implant contact’ in the defect region was longer at

the A sites than at the N sites both at the 2- and the 4-month interval. Further, while after 4
The process of bone modeling and remodeling at an implant placed

months of healing the marginal bone crest at the A sites was located close to the in a fresh extraction socket differs from the resolution of marginal
abutment/fixture junction, at the N sites a marked reduction of the height of the bone crest was
defects that may occur following implant installation in a healed
documented. Hence, most A site defects became completely resolved whereas healing of the N

site defects was incomplete. ridge.

Botticelli et al., 2006 Botticelli et al., 2006

9

Bone tissue formation adjacent to implants placed in
fresh extraction sockets: an experimental study in
dogs
Fig. 1. Clinical photograph illustrating three recipient sites. Two of the implants were installed in the
distal socket of the third and fourth premolars immediately after tooth extraction (N sites, natural
sites). The third implant was installed in a defect prepared in a healed ridge (A sites, artificial sites).
Note that the margin of three implants is situated slightly above the margin of the buccal bone crest.
Botticelli et al., 2006
Bone tissue formation adjacent to implants placed in
fresh extraction sockets: an experimental study in
dogs
Fig. 3. Schematic drawing illustrating an implant in an A site.
After implant installation a gap occurred between the implant
surface and the bone wall that was 5mm deep and varied
between 1 and 0.25mm in width.
Botticelli et al., 2006
Fig. 5. Photomicrographs. (a) The ground sections illustrate the result of healing after 2 months
at the buccal (B) and lingual (L) aspects at an A site (originalmagnification 16). The prepared
defect is only partially filled with newly formed bone that in the marginal portion is separated
from the implant surface by a layer of connective tissue. New bone was also formed at the top
of the crest. (b) The ground sections represent the result of 2 months of healing in an N site.
New bone was formed in the apical portion of the defect. Crestal bone resorption can be
Botticelli et al., 2006
observed especially at the buccal aspect.
23/04/2009
Bone tissue formation adjacent to implants placed in
fresh extraction sockets: an experimental study in
dogs
Fig. 2. Clinical photograph illustrating three recipient sites, one A site and two N sites on the right
side. Note the presence of a gap around all three implants.
Botticelli et al., 2006
Bone tissue formation adjacent to implants placed in
fresh extraction sockets: an experimental study in
dogs Fig. 4. A photomicrograph illustrating the landmarks used for the
histological assessments. Abutment-fixture (A/F) connection
indicates the implant margin. The distance between A/F and the
coronal edge of the rough surface was 0.28mm. C is the top of
the bone crest. B is the most coronal level of contact between
bone and implant and D is the base of the original bone defect.
The dotted lines encircled the area that was exposed to
morphometric measurements.
Botticelli et al., 2006
Fig. 6. Photomicrographs. (a) Result of healing after 4 months at the lingual (L) and buccal (B)
aspects (original magnification 16) at an A site. The prepared defect was almost completely
filled with newly formed bone that was in contact with the implant surface. The top of the bone
crest was close to the abutment-fixture level. (b) The ground sections represent the result of
healing in an N site. New bone formation can be seen in the apical part. Note the marked
resorption of the crestal bone that occurred especially at the buccal aspect.
Botticelli et al., 2006
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COMPLEXO DENTO GENGIVAL Os Implantes dentários Imediatos

Sulco gengival histológico - 0,69 mm
 Classificações
visando as técnicas de
recobrimento radicular:

Epitélio juncional - 0,97 mm

 Classificação esquemática de Muller (1985)

Área de inserção conjuntiva - 1,07 mm

Gargiulo et al., 1961

Os Implantes dentários Imediatos Os Implantes dentários Imediatos

Classificação esquemática de Miller (1985) Classificação esquemática de Miller (1985)

 Classe I : Recessão do tecido marginal que  Classe II : Recessão do tecido marginal se

não se estende até a JMG . Não há perda de estendendo até ou além da JMG . Não há

osso ou de tecido mole interdental; perda de osso ou de tecido mole interdental

Os Implantes dentários Imediatos

Os Implantes dentários Imediatos Classificação esquemática de Miller (1985)
Classificação esquemática de Miller (1985)

 Classe IV: Recessões do tecido marginal se

estendendo além da JMG . A perda de osso
interdental se estende até um nível apical em
relação à extensão da recessão do tecido
marginal

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Os Implantes dentários Imediatos Os Implantes dentários Imediatos

1,5 mm

6-7 mm

3 mm

Os Implantes dentários Imediatos

The Effect of
Inter-Implant Distance
on the Height of Inter-Implant
Bone Crest
< 5 mm

Tarnow et al., J Periodontol, 2000 (4);71:546-549

12

Os Implantes Imediatos em Alvéolos Frescos:
 Apresentam taxas de sobrevivência variando de
93,6% a 100%, dependendo do local onde são
instalados (região anterior mandibular, região
posterior da maxila....)
Rosenquist & Grenthe, 1996
23/04/2009
Os Implantes Imediatos em Alvéolos Frescos:
• Trata-se de uma técnica avançada;
• Com indicações precisas;
• Exige experiência e conhecimento no planejamento e
execução;
• Provou ser uma modalidade de tratamento previsível.
Gelb, 1993; Augthun et al.; 1995; Schwartz-Arad & Chaushu, 1997; Becker et al., 1998
Os Implantes Imediatos em Alvéolos Frescos:
• Observaram em seu estudo que especialmente na
região anterior da maxila, a execução de implantes
imediatos ou em um período de 4 a 6 semanas pós-
exo aumentou a chances de preservação da
anatomia óssea e dos tecidos moles da região.
Nemcovsky et al., 2002
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Os Implantes Imediatos em Alvéolos Frescos: Os Implantes Imediatos em Alvéolos Frescos:

• Membranas absorvíveis associadas ao uso de

• A colocação imediata de implantes em locais
infectados (DP) pode predispor o surgimento de
substitutos ósseos para fechar e proteger os espaços
infecções, podendo não ocorrer um bom contato
entre o alvéolo e o implante. implante-osso.

Nemcovsky et al., 2002 Worthington et al., 2003

Immediate Implants Placed into Infected Sites:

Os Implantes Imediatos em Alvéolos Frescos:
A Histomorphometric Study in Dogs
To study the effect of chronically infected sites on the immediate placement of implants, periapical
• A colocação imediata de implantes em locais lesions were induced in the third and fourth premolars of four dogs and the contralateral teeth
were used as controls. Nine months after the induction of periapical lesions, experimental and
control teeth were extracted, and 28 IMZ implants were immediately placed. After a healing
infectados (DP) não são contra indicados para period of 12 weeks, the animals were sacrificed, the hemimandibles were removed, and specimens
were prepared to be hard-sectioned and stained with toluidine blue. All areas healed without

implantes imediatos, se antibióticos forem •.

inflammation or exudation and all implants were clinically immobile and were radiographically
determined to be surrounded by normal-appearing bone. Histologically, there were no signs of
infection, and the histomorphometric analyses revealed that 28.6% and 38.7% had
administrados no pré e pós-operatório e um bom osseointegrated for the experimental and control implants, respectively. The difference was not
statistically significant. It was concluded that chronically infected sites, such as those showing
signs of periapical pathosis, may not be a contraindication for immediate implants, if certain
debridamento dos alvéolos. clinical measures and preoperative and postoperative care are taken. (INT J ORAL
MAXILLOFAC IMPLANTS 1998;13:422–427)
Novaes et al., 1998

Immediate Placement of Implants into Periodontally Immediate Placement of Implants into Periodontally
Infected Sites in Dogs: A Histomorphometric Study of Infected Sites in Dogs: A Histomorphometric Study of
Bone-Implant Contact Bone-Implant Contact
Materials and Methods:
Purpose:
The placement of implants allows for re-establishment of function and esthetics following In the first phase, periodontitis was induced with ligatures in the mandibular premolars of 5
tooth loss. Immediate implant placement is a relatively recent procedure and has advantages, such as
mongrel dogs, using the contralateral teeth as controls (received prophylaxis only). After 3
reduced number of surgical procedures, preservation of alveolar bone, reduction of cost and period of
edentulism, and increased patient acceptance. However, there are some specific contraindications for months, in the second phase of the study, 40 implants were placed in the alveoli of both

the technique, such as the presence of an infection caused by periodontal disease and periapical
lesions. The objective of this study was to evaluate the percentage of bone-implant contact of
immediate implants placed in periodontally infected sites.
experimental and control teeth. After a healing period of 12 weeks, the animals were
euthanized, and the hemimandibles were removed, dissected, fixed, and prepared for
histomorphometric analysis of percentage of bone-implant contact. The Mann-Whitney test

Novaes et al., 2003 was used for statistical analysis. Novaes et al., 2003

14
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Immediate Placement of Implants into Periodontally Immediate Placement of Implants into Periodontally
Infected Sites in Dogs: A Histomorphometric Study of Infected Sites in Dogs: A Histomorphometric Study of
Bone-Implant Contact Bone-Implant Contact
Results: Discussion:

The results of the histomorphometric analysis indicated mean bone-implant contact of 62.4% in Histomorphometric results revealed similar bone-implant contact in both groups, with no signs of

the control group and 66.0% in the experimental group, a difference that was not statistically infection.

significant.
Conclusions:

It was concluded that periodontally infected sites may not be a contraindication for immediate

implantation in this animal model system, if adequate pre- and postoperative care is taken.

Novaes et al., 2003 Novaes et al., 2003

Os Implantes dentários Os Implantes dentários Imediatos em alvéolos

Imediatos em alvéolos de extrações:

de extrações
Tempo de tratamento é reduzido;

Padrão de reabsorção é desacelerado;
Vantagens
Cavicchia & Bravi, 1999

Os Implantes dentários Imediatos em alvéolos

Os Implantes dentários Imediatos em alvéolos de extrações:
de extrações:

Diminuem os custos de tratamento;

Redução no impacto social e econômico;
Aumentam a satisfação dos pacientes;

Podem melhorar os resultados clínicos;
Leary & Hirayama, 2003

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Os Implantes dentários Imediatos em alvéolos

Os Implantes dentários Imediatos em alvéolos
de extrações:
de extrações:

Em alvéolos frescos reduz a morbidade e

Segue uma orientação ideal (GUIA) para
número de intervenções cirúrgicas do
instalação do implante;
tratamento com implantes;
Wilson et al., 2003 Werbitt & Goldberg, 1992; Schultz, 1993

Os Implantes dentários Imediatos em alvéolos

de extrações:

O alvéolo como GUIA para instalação do

implante; Foco no 1° PM Superior

Fugazzotto, 2002 Fugazzotto, 2002

Fugazzotto, 2002 Fugazzotto, 2002

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Fugazzotto, 2002 Fugazzotto, 2002

Os Implantes dentários Imediatos em alvéolos Os Implantes dentários Imediatos em alvéolos

de extrações: de extrações:

Preserva a estrutura óssea no sítio da
Alcança ótima estabilidade estética do tecido

extração; mole.

Shanaman, 1993; Denissen et al., 1993; Watzek et al., 1995 Werbitt & Goldberg, 1992

Os Implantes dentários Os Implantes dentários Imediatos em alvéolos

Imediatos em alvéolos de extrações:

de extrações
Efeitos adversos quando da presença de

infecções;
Desvantagens
Rosenquist & Grenthe, 1996; Grunder et al., 1999; Polizzi et al., 2000

17
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PERIO – IMPLANTE - ENDODONTIA PERIO – IMPLANTE - ENDODONTIA

Associadas com inflamação dos tecidos Associadas com inflamação dos tecidos
periapicais periapicais

PERIO – IMPLANTE - ENDODONTIA PERIO – IMPLANTE - ENDODONTIA

Associadas com inflamação dos tecidos Associadas com inflamação dos tecidos
periapicais periapicais

PERIO – IMPLANTE - ENDODONTIA PERIO – IMPLANTE - ENDODONTIA

Associadas com inflamação dos tecidos Associadas com inflamação dos tecidos
periapicais periapicais

18
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PERIO – IMPLANTE - ENDODONTIA PERIO – IMPLANTE - ENDODONTIA

Associadas com inflamação dos tecidos Associadas com inflamação dos tecidos
periapicais periapicais

PERIO – IMPLANTE - ENDODONTIA PERIO – IMPLANTE - ENDODONTIA

Associadas com inflamação dos tecidos Associadas com inflamação dos tecidos
periapicais periapicais

PERIO – IMPLANTE - ENDODONTIA

Associadas com inflamação dos tecidos
periapicais

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Os Implantes dentários Imediatos em alvéolos

de extrações:
1

Dificuldade no fechamento do tecido mole e

deiscência do retalho no sítio da extração;

Wilson & Webwe, 1993

2

5
3

4 6

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7 8
A

9 B

C E

D F

Os Implantes dentários Imediatos em alvéolos

de extrações: Os Implantes dentários Imediatos em alvéolos
de extrações:

Dificuldade no fechamento do tecido mole e

deiscência do retalho no sítio da extração,
Deficiência do volume de tecido mole e
quando associado ao uso de membranas biotipo periodontal fino;
(ROG);
Becker et al., 1991; Wilson, 1992; Gher et al., 1994; Augthun et al., 1995
Schwartz-Arad & Chaushu, 1997; Wilson et al., 1998 Block & Kent, 1990

21

IMPLANTES DENTÁRIOS
IMEDIATOS
ABORDAGEM CLÍNICA
PROPOSTA
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 3. Uma boa avaliação física do paciente;
 3.1- Fotografias:
• Face – sorrindo e em repouso, frente e perfil;
• Intrabucais – do dente a ser extraído, vestibular e
oclusal, e da relação oclusal com o antagonista.
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 3. Uma boa avaliação física do paciente;
 3. 3 - Modelos de estudo:
• Gesso – configuração e posicionamento dos
implantes;
• Prototipagem – planejamento cirúrgico.
23/04/2009
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 1. Histórico médico e dentário do paciente;
 2. Uma boa avaliação bioquímica do paciente;
 Risco de 41% de falha no período pós-
menopausa e sem reposição hormonal
(August et al., 2001).
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 3. Uma boa avaliação física do paciente;
 3.2 - Radiografias:
• Periapical – relação endo-perio;
• Panorâmica – relação com estruturas vitais;
• TC – quantidade e qualidade óssea.
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 4. Utilização de Antibióticos;
 4.1- Antibióticos:
• A literatura não é conclusiva, mas há uma
concordância geral que o uso de antibióticos na
terapia de implantes é um procedimento vantajoso.
22

Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 5. Extração dentária
 Mínimo trauma dos tecidos duros e moles;
 Seccionamento das raízes dos dentes
multiradiculares;
 Remoção do tecido de granulação do alvéolo.
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 7. Seleção do sistema de Implantes
 Desenho do implante – Cônicos;
 Quantidade de osso apical (2 a 5mm);
 Quantidade e forma do osso inter-radicular;
 Relação com estruturas vitais.
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 9. Estabilidade primária do implante
 Volume e Densidade óssea suficiente;
 Escolha ideal do design do implante;
 Menor Trauma cirúrgico;
 Análise da Freqüência por Ressonância;
 Periotest;
 Valores de torque de inserção.
23/04/2009
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 6. Avaliação do sítio
• Crítico para a aplicação do plano de tratamento;
• Expectativa estética do paciente;
• Quantidade, qualidade e morfologia dos tecidos
moles e duros;
• Presença de patologias;
• Condições das estruturas de suporte e dentes
adjacentes.
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 8. Seleção do diâmetro do implante
 Através do diâmetro do alvéolo;
 Diâmetro do dente extraído (Especímetro);
 Espaço mínimo de 1,5 a 2 mm de implante a
dente vizinho, de 3 mm entre implantes e 2 a 3 mm
cervical à JCE.
Os Implantes dentários Imediatos
PLANEJAMENTO DOS CASOS:
 10. Biotipo periodontal fino;
 Crista Óssea Fina e em Bisel;
 Tecido Gengival Apresenta Longas Papilas
Interdentárias.
23
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Os Implantes dentários Imediatos

Os Implantes dentários Imediatos PLANEJAMENTO DOS CASOS:
PLANEJAMENTO DOS CASOS:  12. Colocação do implante;
 11. Biotipo periodontal espesso;
Irrigação abundante;
 Manual ou Control torque;
 Estrutura Óssea Espessa com Morfologia Achatada;
 Posições: AP e MD; em Nível ósseo; 3mm da
 Tecido Gengival Espesso; JCE;
 Papilas Curtas e Largas.  Respeitar 1mm de osso na vestibular;
 Área estética – perfuração da parede palatina.

Os Implantes dentários Imediatos

PLANEJAMENTO DOS CASOS: Os Implantes dentários Imediatos
 13. Consentimento informado pelo paciente
TÉCNICA CIRÚRGICA:
 Esclarecimento e possibilidades de tratamento;
 1. Prescrição pré-operatória;
 Possíveis riscos, complicações e limitações com
implantes imediatos;  2. Assepsia da face do paciente (gel de CH a 2%);
 Visa preservar a integridade e tranquilidade e  3. Anti-sepsia intra-bucal (sol CH a 0,12%);
adequação de cada caso em particular.

Os Implantes dentários Imediatos Os Implantes dentários Imediatos

TÉCNICA CIRÚRGICA: TÉCNICA CIRÚRGICA:

4. Proteção labial (vaselina ou Nebacetin);  7. Inspeção das paredes do alvéolo cirúrgico –
escaneamento – Remanescentes ósseos;
 5. Anestesia tópica e Anestesia local;
 8. Remoção de tecido de granulação – curetas de
 6. Realização da exodontia atraumática
Lucas ou curetas e limas periodontais ou brocas
(Periótomo);
esféricas ( diâmetro largo) do próprio sistema;

24
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Os Implantes dentários Imediatos Protocolo para a colocação

TÉCNICA CIRÚRGICA: de implantes em alvéolos
 9. Instalação imediata ou tardia do implante; de extração com suas
 10. Fechamento da ferida – retalhos deslizados vantagens e desvantagens
palatais. - Classificação -

Conclusões dos Recentes Estudos clínicos e

Experimentais dos Implantes dentários Imediatos

 Quando operar em regiões estéticas se possível

permita uma cicatrização dos tecidos moles e
duros antes da cirurgia de implantes;

 Colocação de enxertos de tecido duro e mole

quando da colocação do implante;

Conclusões dos Recentes Estudos clínicos e

Experimentais dos Implantes dentários Imediatos

 Quando instalar implante em alvéolo de

CASOS CLÍNICOS
extração, deverá este ser mais posicionado na
parede palatina ou lingual e pelo menos 1 mm
de abaixo da margem óssea para minimizar a
reabsorção esperada da parede vestibular.

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CASO CLÍNICO - 1

CASO CLÍNICO - 2

26
 23/04/2009

CASO CLÍNICO - 3
Coroa com fratura

Rx de diagnóstico

Remoção da raiz e coroa com fratura Abutment padronizado e coroa provisória

Fixação do abutment padronizado

Colocação do implante em alvéolo fresco

Coroa definitiva com 1 ano em função

Provisória

Abutment definitivo Rx controle de 1 ano

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 23/04/2009

CASO CLÍNICO - 4

CASO CLÍNICO - 5

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CASO CLÍNICO - 6

6 mo 1y

29
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CASO CLÍNICO - 7

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32