Made available in DSpace on 2014-06-11T19:28:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2004-02-27Bitstream added on 2014-06-13T20:57:38Z : No. of bitstreams: 1 ribeiro_fs_me_arafo.pdf: 126598 bytes, checksum: 8ba8de70ef22ae37dbd2b5dbe93ca194 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo deste estudo foi comparar, em curto período de tempo, o índice de sucesso de implantes osseointegráveis unitários submetidos à carga imediata, colocados imediatamente após a exodontia, com implantes colocados em rebordos cicatrizados. Foram examinados 71 pacientes consecutivos totalizando 91 implantes, sendo 48 realizados em clínica privada e 43 em cursos de especialização em implantodontia, entre dezembro de 2001 a dezembro de 2003. Sessenta e três implantes foram instalados em alvéolos e 28 em rebordos. Os critérios utilizados para avaliar o índice de sucesso foram os descritos por Albrektsson e Zarb (1993). Após o período de avaliação, 87 implantes examinados enquadravam-se dentro dos critérios de sucesso (95,6%). Dos quatro implantes perdidos, três haviam sido colocados em alvéolos (índice de sucesso de 95,2%) e um, em rebordo (96,4%). A diferença entre os índices de sucesso dos dois grupos não foi estatisticamente significante (p=0,76, teste Qui-quadrado). Podemos concluir, dentro das limitações deste estudo, que o carregamento imediato de implantes unitários, seja colocado em alvéolo ou rebordo, representa uma alternativa terapêutica com alta previsibilidade, comparado aos resultados encontrados na literatura para implantes seguindo o protocolo convencional de dois estágios cirúrgicos. / The aim of this study was to evaluate, in a short period of time, the success rate of immediate loading of single-tooth implants: immediate versus non-immediate implantation. Seventy-one patients were examined, totalizing 91 implants, which 48 implants were placed in private practice office and 43 were placed in dental school, between December 2001 and December 2003. Sixty-one implants were placed in fresh extraction sites, and 28 were placed in healed sites. Criteria to evaluate success rate were previously described by Albrektsson and Zarb (1993). After follow-up evaluation, 87 implants fulfilled the success rate criteria (95,6%). Four implants were lost, and among these, three were placed in fresh extraction sites (success rate 95,2%), and one placed in healed sites (success rate 96,4%). Rates of success between both groups was not statistically significant (p=0,76, Qui-square test). Within the limitation of the present study, it could be concluded that single-tooth osteointegrated implants submitted to immediate loading, in immediate and non-immediate implantation, represent a therapeutic alternative with high predictability, compared to the conventional protocol.

Resumo: O objetivo deste estudo foi comparar, em curto período de tempo, o índice de sucesso de implantes osseointegráveis unitários submetidos à carga imediata, colocados imediatamente após a exodontia, com implantes colocados em rebordos cicatrizados. Foram examinados 71 pacientes consecutivos totalizando 91 implantes, sendo 48 realizados em clínica privada e 43 em cursos de especialização em implantodontia, entre dezembro de 2001 a dezembro de 2003. Sessenta e três implantes foram instalados em alvéolos e 28 em rebordos. Os critérios utilizados para avaliar o índice de sucesso foram os descritos por Albrektsson e Zarb (1993). Após o período de avaliação, 87 implantes examinados enquadravam-se dentro dos critérios de sucesso (95,6%). Dos quatro implantes perdidos, três haviam sido colocados em alvéolos (índice de sucesso de 95,2%) e um, em rebordo (96,4%). A diferença entre os índices de sucesso dos dois grupos não foi estatisticamente significante (p=0,76, teste Qui-quadrado). Podemos concluir, dentro das limitações deste estudo, que o carregamento imediato de implantes unitários, seja colocado em alvéolo ou rebordo, representa uma alternativa terapêutica com alta previsibilidade, comparado aos resultados encontrados na literatura para implantes seguindo o protocolo convencional de dois estágios cirúrgicos. / Abstract: The aim of this study was to evaluate, in a short period of time, the success rate of immediate loading of single-tooth implants: immediate versus non-immediate implantation. Seventy-one patients were examined, totalizing 91 implants, which 48 implants were placed in private practice office and 43 were placed in dental school, between December 2001 and December 2003. Sixty-one implants were placed in fresh extraction sites, and 28 were placed in healed sites. Criteria to evaluate success rate were previously described by Albrektsson and Zarb (1993). After follow-up evaluation, 87 implants fulfilled the success rate criteria (95,6%). Four implants were lost, and among these, three were placed in fresh extraction sites (success rate 95,2%), and one placed in healed sites (success rate 96,4%). Rates of success between both groups was not statistically significant (p=0,76, Qui-square test). Within the limitation of the present study, it could be concluded that single-tooth osteointegrated implants submitted to immediate loading, in immediate and non-immediate implantation, represent a therapeutic alternative with high predictability, compared to the conventional protocol. / Orientador: Elcio Marcantonio Junior / Coorientador: Elcio Marcantonio / Banca: Luis Antônio Borelli Barros / Banca: Wilson Trevisan Junior / Mestre

La résorption post-extractionnelle est de nos jours une conséquence inéluctable après avulsion. Cette résorption, lors d'une réhabilitation prothétique sur implants, peut avoir des conséquences néfastes tant dans le résultat esthétique que fonctionnel. Les techniques de régénération pré-implantaire (technique dérivée de la régénération tissulaire guidée) par l'emploi d'autogreffe, de xénogreffe ou encore d'allogreffe associée ou non à une membrane ont montré des bénéfices quant à la préservation du volume osseux. Les délais d'ostéointégration ayant été de nos jours réduits avec un taux de survie implantaire satisfaisant, la technique d'extraction/implantation immédiate a été envisagée dans le but d'éviter la perte osseuse post-extractionnelle et réduire le temps de traitement. Toutefois, les études menées chez le chien par différents auteurs ont montré que cette technique ne permettait en aucun cas d'éviter la resorption post-extractionnelle. La mise en place précoce d'un implant dans une alvéole déshabitée permet seulement de limiter cette dernière. Le but de note étude animale a donc été, dans les cas d'extraction/implantation immédiate, d'évaluer la perte osseuse obtenue au travers des résultats tomodensitométriques et histovolumétriques, perte osseuse comparée, à celle mesurée dans les chirurgies de comblement ainsi que dans les chirurgies régénératives avec membranes positionnées en supra ou intra-alvéolaire. Nous avons également souhaité évaluer l'intérêt de la régénération osseuse guidée dans la préservation du volume osseux lorsqu'une prothèse sur implant est envisagée. Notre choix s'est porté sur une membrane collagénique résorbable qui ont montré au travers de nombreuses études certains avantages : biocompatibilité satisfaisante, exposition n'engendrant pas un échec de la chirurgie et enfin une résorbabilité évitant une chirurgie de dépose. Concernant le matériau de comblement, nous avons opté pour une allogreffe corticale afin d'évaluer la cicatrisation osseuse obtenue, la résorbabilité du matériau et la qualité de l'interface os/implant. Dans une première partie, nous ferons un rappel sur le tissu osseux et son remodelage après avulsion. La seconde partie sera consacrée aux techniques de préservation du volume osseux, la troisième partie faisant le point sur la technique d'extraction/implantation immédiate d'un point de vue cicatrisation osseuse. Enfin la quatrième et dernière partie sera consacrée à l'étude animale. / Post-extraction resorption is nowadays an inevitable consequence of teeth extraction. This loss, during prosthetic implant rehabilitation, strongly affects aesthetic and functional results.Guided bone regeneration, issue from the guided tissular regeneration, using autogenous bone, xenograft or still allograft associated or not with a barrier membrane shows benefits in the conservation of bone volume.The delays of osteointegration having nowadays been reduced with a good rate of implant survival; immediate extraction-implantation is supposed to avoid post-extraction resorption and to reduce overall treatment time. However, animal studies from many authors showed that this technique cannot avoid the post-extraction resorption. The immediate implantation only allows to reduce it.The purpose of our animal study was to estimate the bone loss for immediate extraction-implantation technique through the histotomodensimetric and histovolumetric measurements. Bone loses were compared for allogenic bone grafting associated or not with supra or intra alveolar barrier membranes. We investigate also the benefits of guided bone regeneration in the preservation of bone volume for delayed implantation. The parameters followed were the alveolar bone loss, the resorbability of the material and the quality of bone/ implant interface. We selected absorbable collagenic barrier membrane which have shown in numerous studies many advantages: good biocompatibility, exposure don't challenge clinical results and resorbability avoiding an additionnal removal surgery. Concerning the bone grafting material, we opted for a cortical allograft. In the first chapter, we made a review of the bone histology and physiology and of its remodeling after extraction. The second chapter is dedicated to alveolar bone preservation techniques and in the third chapter we reviewed immediate extraction-implantation surgical techniques from the point of view of bone healing. Finally the fourth part of our thesis is dedicated to the presentation and analysis of our animal study.