Reabilitarea implanto-protetică începe chiar în momentul extracției dentare. Odată cu pierderea dintelui, osul alveolar intră într-un proces fiziologic de resorbție, cu reducerea rapidă a volumului și modificarea conturului crestei. Aceste schimbări pot influența negativ poziționarea tridimensională a implantului și rezultatul estetic final [1], [2].

Conservarea alveolei postextracționale are rolul de a limita aceste modificări. Procedura, realizată imediat după extracție, presupune inserarea unui biomaterial de adiție osoasă (xenogrefă, alogrefă sau substituent sintetic biocompatibil) și protejarea acestuia cu o membrană resorbabilă, conform principiilor regenerării osoase ghidate [3], [4]. Membrana asigură stabilitatea compartimentului osos și permite vindecarea predictibilă, fără necesitatea unei reintervenții [5].

Vindecarea are loc, în general, în 4–6 luni, oferind o bază osoasă mai favorabilă inserării implantului și reducând nevoia de augmentări ulterioare.

Prezentare de caz

Vă invităm să urmăriți filmarea unei intervenții realizate și transmise în direct în timpul modulului „Basics and Beyond” al cursului Dinu & Associates Implant Academy 2023.

Intervențiile chirurgicale au fost realizate de către prof. dr. Cristian Dinu și au fost transmise live în cadrul primului modul al cursului, iar lucrarea protetică a fost realizată de dr. Cristina Dinu.

Pacienta, în vârstă de 67 de ani, s-a prezentat pentru evaluarea dintelui 4.6, pentru care tratamentul endodontic efectuat în antecedente nu a avut succes. În urma examinării imagistice și clinice multidisciplinare, dintele a fost considerat compromis din punct de vedere endodontic și parodontal, fiind indicat tratamentul radical.

Prima etapă terapeutică a constat în extracția atraumatică a molarului 4.6 cu separare radiculară, chiuretajul alveolei postextracționale, planarea radiculară și tratamentul suprafeței expuse a rădăcinii dintelui adiacent, urmate de reconstrucția alveolei postextracționale.

Filmarea surprinde etapele-cheie ale primei etape terapeutice: extracția atraumatică a molarului 4.6, separarea radiculară chiuretajul alveolei postextracționale, planarea radiculară și tratamentul suprafeței expuse a rădăcinii dintelui adiacent, urmate de reconstrucția alveolei postextracționale.

Reabilitarea implantară a fost realizată într-o etapă ulterioară, după evaluarea imagistică a vindecării și integrării grefei osoase, care au oferit condiții ideale pentru inserarea unui implant dentar pe poziția molarului 4.6. Implantul a fost încărcat imediat fiind realizată o coroană provizorie care ulterior va fi inlocuită de lucrarea protetică definitivă.

Tehnica de prezervare a alevolei postextracționale este o intervenție chirurgicală minim invazivă care oferă rezultate sigure și predictibile atunci când indicația și execuția chirurgicală sunt optim realizate. Un control adecvat al fazei postextracționale crește predictibilitatea, reduce complexitatea etapelor ulterioare și optimizează rezultatul funcțional și estetic pe termen lung.

Surse:

[1] Avila-Ortiz, G., Chambrone, L., & Vignoletti, F. Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. Journal of Clinical Periodontology, 2019, 46(Suppl. 21), 195–223. doi: https://doi.org/10.1111/jcpe.13057

[2] Jung, R. E., Ioannidis, A., Hämmerle, C. H. F., & Thoma, D. S. Alveolar ridge preservation in the esthetic zone. Periodontology 2000, 2018, 88(1), 175–196. doi: https://doi.org/10.1111/prd.12209

[3] Stumbras A, Kuliesius P, Januzis G, Juodzbalys G. Alveolar Ridge Preservation after Tooth Extraction Using Different Bone Graft Materials and Autologous Platelet Concentrates: a Systematic Review. J Oral Maxillofac Res. 2019 Mar 31;10(1):e2. doi: https://doi.org/10.5037/jomr.2019.10102

[4] Quisiguiña Salem C, Ruiz Delgado E, Crespo Reinoso PA, Robalino JJ. Alveolar ridge preservation: A review of concepts and controversies. Natl J Maxillofac Surg. 2023 May-Aug;14(2):167-176. doi: https://doi.org/10.4103/njms.njms_224_22

[5] Vignoletti F, Abrahamsson I. Quality of reporting of experimental research in implant dentistry. Critical aspects in design, outcome assessment and model validation. J Clin Periodontol. 2012 Feb;39 Suppl 12:6-27. doi: 10.1111/j.1600-051X.2011.01830.x.

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Pacienta, în vârstă de 27 de ani, s-a prezentat pentru evaluarea incisivului central 1.1, considerat compromis în urma examinării clinice și radiologice.

Prima etapă a constat în extracția incisivului central 1.1, reconstrucția alveolei postextracționale și aplicarea unei punți colate provizorii. Ulterior, cazul a necesitat un tratament ortodontic complex, integrat în planul general de reabilitare.

Etapa de implantare a fost realizată printr-un abord minim invaziv, cu inserarea imediată a unei coroane provizorii nefuncționale, care a permis modelarea țesuturilor gingivale și definirea profilului de emergență.

Acest caz clinic a fost rezultatul unei colaborări de înaltă calitate între Dinu & Associates Implant Academy și clinica Sikario Dental din Baia Mare. Participantă la cursurile academiei în 2023, doamna doctor Carmen Breban Cirțiu a ales să colaboreze cu noi pentru realizarea părții chirurgicale a acestui caz. Intervenția a fost efectuată cu succes de către prof. dr. Cristian Dinu și transmisă live în cadrul modulului dedicat reabilitărilor estetice. Restaurarea protetică finală a fost realizată ulterior, în condiții excelente, la clinica Sikario.

Adresăm mulțumiri doamnei doctor Carmen Breban Cirțiu pentru încrederea acordată și pentru deschiderea de a contribui activ la consolidarea acestei colaborări profesionale.

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Themed “Beyond the Limits of Bone: 30 Years of Challenges and the Path Forward,” the congress gathered internationally recognized professors in Guided Bone Regeneration (GBR) to reflect on three decades of progress in Implantology and explore future directions in bone augmentation.

Despite technological advances such as bone grafting, immediate implant placement, and ridge augmentation, long-term bone loss remains a persistent challenge. The symposium featured in-depth clinical discussions, successful and unsuccessful cases and insights into overcoming current limitations in alveolar bone preservation.

The Romanian-Italian team of Prof Dr. Cristian Dinu and Dr. Mattia Manfredini shared novel techniques and clinical perspectives in a lecture titled “Sinus Lifting Procedures: Innovations and Insights for Advanced Bone Augmentation” – reviewing the historical evolution, clinical insights, and challenges associated with sinus lifting techniques, and focusing on recent innovations that enhance outcomes and minimize complications.

The presentation emphasized the importance of the sinus lifting procedure as a cornerstone in modern implant dentistry, offering innovative solutions for advanced bone augmentation in cases of severe maxillary atrophy.

The history of sinus augmentation was first documented in the 1970s when the procedure was first introduced to address the lack of vertical bone height in the posterior maxilla. Over the decades, it has evolved significantly through advancements in surgical tools, biomaterials, and imaging technologies. These developments have not only improved procedural success but also expanded the indications for sinus lifts to include patients with more complex anatomical and systemic challenges.

Drawing on extensive clinical expertise, the lecture presented by Prof. dr. Cristian Dinu and dr. Mattia Manfredini highlighted key aspects of the procedure, including careful preoperative planning, patient selection, and the use of advanced imaging modalities such as cone-beam computed tomography (CBCT) for precise evaluation of sinus anatomy. Techniques such as the lateral window and transcrestal approaches were compared, with observations of their respective advantages and limitations. Despite its widespread success, the sinus lifting procedure presents several challenges. Managing complications such as sinus membrane perforation, infection, or insufficient bone integration remains critical.

The comprehensive presentation underscored the importance of balancing innovation with clinical rigor in advancing sinus lift procedures. By integrating historical insights with modern advancements, clinicians can achieve predictable outcomes and continue to expand the boundaries of implant dentistry.

The 18th MegaGen International Symposium fostered meaningful dialogue and innovation by bringing together knowledge, experience and passion for Implantology. For more information about the event and the invited speakers, click here.

The course was a three-day event that took place in Cluj-Napoca from July 13^th to 15^th, 2023. Participants learned about partial and full mouth implant rehabilitation workflows, from Digital Data Acquisition and Digital Planning Protocols using the R2Gate system to prosthetic planning and Immediate Load criteria, surgery execution and final prosthetics.

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The guest of honor was Dr. Sam Omar, an internationally awarded lecturer and a dentist with major contributions to developing Stackable Guides Protocols and also R2GATE and Digital Oral Design (DOD) software. He is continuously sharing his knowledge as a senior lecturer at OneDay International Academy for Digital Dentistry. Sam practices Implantology and Oral surgery in his clinic in Giza, Egypt.

 “Here, at Dinu & Associates Implant Academy, we had three days of full intense hands-on and live surgery education!” said Dr. Sam Omar. “We had a lot of lectures where we discussed the clinical aspects of planning the complex cases, as well as hands-on sessions, so on the first day, all participants learned how to use the R2Gate Software in order to plan full mouth cases. On the second day, we talked mainly about stackable guides, and all participants practiced on models and had the full experience of implant placement and immediate load using the stackable guide. The last day was dedicated to a live surgery session, and all participants could see up close how Dr. Cristian Dinu and I applied what we discussed on previous days”.

The Digital Implantology workflows available today allow dentists to do the best treatments in the shortest possible time. For this reason, researchers have been working for years on developing a predictable digital protocol for One-Day implant rehabilitation. This is a teamwork that also involves dental technicians, and their role has changed over time.

“With the guided surgery, the role of dental technicians becomes very important in implant placement. In time, this role got to be very refined, and right now I think we can call them bio-technicians, because it also involves biology knowledge and other information which, in the classic approach, is not common knowledge”, declared DT Cristian Butnărașu. ­­­

“This is one of the most complete courses we have given in the last few years. Usually, we organize only two-day events, but Dr. Cristian Dinu came up with the idea of a third day of live surgery so that participants would have the complete picture and see how the rehabilitation is finalized”, added Dr. Sam Omar.

Professor Cristian Dinu emphasized the major role of live surgery sessions in the educational process: “In our programs here, at Dinu & Associates Implant Academy, live surgery is a very important part of the educational process. Thus, in our yearly course, we have five to six live surgical procedures per module so that participants benefit from the theoretical and the hands-on part and see every step of the plan being executed with the actual patient.

Putting together Sam’s experience as an educator with ours, we have the opportunity to adjust and improve the way we share information. I am certain we will continue to nurture this friendship and professional connection!”, added Professor Dinu.

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During his professional life, Prof. Dinu has had the opportunity to meet and learn from some of the biggest names in the scientific and clinical dental community: Professor Gyula Takacs, Istvan Urban, Giovanni Zucchielli, Kwang Bum Park, and many more. So, now is his turn to become a mentor for younger generations of dentists, both as a professor of Maxillofacial Surgery and Oral Implantology at Iuliu Hațeganu University of Medicine and Pharmacy in Cluj-Napoca, and also as a surgeon at Dinu & Associates Implant Academy.

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“Oral Implantology is going through a continuous and dynamic process of transformation, both conceptually and technologically. In recent years, the biological concepts that underlie the structural and functional changes that occur after tooth loss have been stabilized, along with protocols that take biology into account. Implantology has evolved a lot towards attaining aesthetics and functionality according to the concept restitution ad integrum through the technological progress brought by implants with designs that allow immediate application and loading, bioactive surfaces that facilitate faster osseointegration, and stable implant-prosthetic connections that contribute to the maintenance of peri-implant tissues. Today we can enjoy implants like AnyRidge and Blue Diamond that shorten the treatment time and give long-term stable results.

Another important factor is the emergence of digital protocols that have revolutionized our daily practice. These protocols are becoming more precise and more effective every day. I think that, in the near future, the biggest challenge will be the integration of the human factor with the technological and digital factors in order to achieve success.”

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Together with two other young dentists from Germany and Republic of Moldova, Darius will represent Europe at the big Finale, fighting for the chance to be a speaker on the stage of the 8th Middle East Africa Scientific Meeting (MEASM) organized by MegaGen in Antalya, Turkey.

MEGAMIND is an international program launched by MINEC (MegaGen International Network of Education and Clinical Research), with the purpose of identifying young speakers around the world, developing their abilities and talents and launching them at the global level. In 2023, the first seven finalists will present clinical cases on the stage of MEASM, sharing their innovative ideas and treatment solutions with the world. 

Dr. Darius Tomina’ presentation – Digital Implant Prosthodontics, key factor for success – was based on his clinical experience with several patients. The treatment plan and the results were described and evaluated, with the significant impact of digitalization (including the usage of stackable guides) in the success of the treatment.

Click here for the winning presentations on MegaMind website.

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