Giovanella Fernando, Bezerra Fábio, Dantas Soares Michel A, Oliveira Guilherme, Ghiraldini Bruna
Dentistry, Private Practice, Blumenau, BRA.
Biotechnology, Universidade Estadual Paulista (UNESP), São Paulo, BRA.
Cureus. 2024 Apr 17;16(4):e58453. doi: 10.7759/cureus.58453. eCollection 2024 Apr.
This case report describes a dual full-arch rehabilitation focusing on a modified buccal incision for installation of four implants for full-arch rehabilitation of an edentulous maxilla. A modified buccal incision was performed in the subcrestal buccal region to promote direct access to the periosteum without incising the muscles in the region. For the installation of anterior implants, an 8.5 mm implant was locked in the cortical bone of the alveolar ridge and in the cortical bone of the floor of the pyriform cavity. The drilling point of the posterior implants was defined using the anterior implants as a visual reference, and the entry point could be visually estimated from the topography of the palatal surface of the maxilla. After bone leveling, the drilling enlargement sequence was carried out using drills that allowed the installation of long implants (18 mm). Straight mini-abutments were installed in the anterior implants and angled at 30º in the posterior implants. The flap was then perforated in the exact region where the mini-abutments were located. The buccal incision line was sutured with continuous 5-0 nylon suture. On the following day, aesthetic tests were carried out with teeth mounting. The patient presented minimal edema, and the lip motricity and smile width were completely preserved. The prosthesis was delivered five days after surgery. The suture was removed, and the prosthesis was installed while maintaining compression on the gingival tissue. The patient reported no pain during the prosthesis installation. The modified buccal flap enables implant placement for full-arch rehabilitation of an edentulous maxilla.
本病例报告描述了一次双全牙弓修复，重点是采用改良颊侧切口植入4枚种植体，用于上颌无牙颌的全牙弓修复。在牙槽嵴顶下方的颊侧区域做改良颊侧切口，以便在不切开该区域肌肉的情况下直接进入骨膜。为植入前部种植体，将一枚8.5毫米的种植体锁定在牙槽嵴的皮质骨以及梨状孔底部的皮质骨中。以后部种植体的钻孔点以前部种植体作为视觉参考来确定，并且可以从上颌腭面的地形中直观估计进入点。在骨平整后，使用允许植入长种植体（18毫米）的钻头进行钻孔扩大序列操作。在前部种植体中安装直的微型基台，在后部种植体中安装成30°角的微型基台。然后在微型基台所在的确切区域将瓣穿孔。颊侧切口线用连续的5-0尼龙缝线缝合。第二天，进行牙齿安装的美学测试。患者出现轻微水肿，唇运动和微笑宽度完全保留。术后五天交付假体。拆除缝线，安装假体时保持对牙龈组织的压迫。患者在假体安装过程中未报告疼痛。改良颊侧瓣能够为上颌无牙颌的全牙弓修复植入种植体。
