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Influência do tecido queratinizado na estabilidade a longo prazo dos implantes dentários
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Abstract(s)
A osteointegração constitui um fator fulcral para a taxa de sobrevivência dos implantes dentários, tendo como base uma ligação forte e funcional entre osso e implante, sem interposição de tecido conjuntivo. Para além deste parâmetro, a capacidade e eficiência da mucosa formar uma barreira protetora e resistente, tendo em vista a preservação da saúde dos tecidos peri-implantares é igualmente essencial para o sucesso do tratamento.
Existem diversos fatores de risco locais e sistémicos associados à incidência das patologias peri-implantares, entre os quais, história de periodontite não controlada, diabetes, hábitos tabágicos, inexistência de uma higiene oral satisfatória e ausência de mucosa queratinizada, a qual tem sido alvo de diversos estudos.
Apesar de alguns autores referirem que áreas desprovidas de mucosa queratinizada são compatíveis com a saúde oral, desde que exista um bom controlo da placa bacteriana, sabe-se que a falta de mucosa queratinizada em torno dos implantes dentários parece levar a um controlo menos eficiente do biofilme, devido à dificuldade de higienização do local, bem como à sensação dolorosa relatada pela maioria dos pacientes. Para além disso, a mobilidade dos tecidos marginais resultante, promove a invasão bacteriana peri-implantar, podendo originar inflamação da mucosa e recessão tecidual. Desta forma, a presença de mucosa queratinizada facilita a higienização, contribuindo para a redução do desconforto do paciente, promove um maior selamento biológico, menor inflamação e recessão dos tecidos peri-implantares, proporciona maior resistência às forças da mastigação, maior estabilidade peri-implantar, facilita procedimentos protéticos e estética mais satisfatória.
Osseointegration is a crucial factor in the dental implants survival, based on a strong and functional bond between bone and implant, without interposition of connective tissue. Furthermore, the ability and efficiency of the mucosa to form a protective and resistant barrier to preserve the health of peri-implant tissues is also essential for successful treatment. There are several local and systemic risk factors associated with the incidence of peri-implant pathologies, including uncontrolled periodontal disease, diabetes, smoking habits, nonexistence of satisfactory oral hygiene and absence of keratinized mucosa, which has been subject of several studies. Although some authors mention that areas devoid of keratinized mucosa are compatible with oral health if there is good plaque control, it is known that the absence of keratinized mucosa around the implants seems to lead to a less efficient control of the biofilm, due to the difficulty of cleaning the site, as well as the painful sensation reported by most patients. Moreover, the resulting mobility of marginal tissues promotes peri-implant bacterial invasion, which can lead to mucosal inflammation and tissue recession. In this way, the presence of keratinized mucosa facilitates cleaning, contributing to the reduction of patient discomfort, promotes greater biological sealing, less inflammation and recession of peri-implant tissues, provides greater resistance to mastication forces, greater peri-implant stability, facilitates prosthetic procedures and more satisfactory aesthetics.
Osseointegration is a crucial factor in the dental implants survival, based on a strong and functional bond between bone and implant, without interposition of connective tissue. Furthermore, the ability and efficiency of the mucosa to form a protective and resistant barrier to preserve the health of peri-implant tissues is also essential for successful treatment. There are several local and systemic risk factors associated with the incidence of peri-implant pathologies, including uncontrolled periodontal disease, diabetes, smoking habits, nonexistence of satisfactory oral hygiene and absence of keratinized mucosa, which has been subject of several studies. Although some authors mention that areas devoid of keratinized mucosa are compatible with oral health if there is good plaque control, it is known that the absence of keratinized mucosa around the implants seems to lead to a less efficient control of the biofilm, due to the difficulty of cleaning the site, as well as the painful sensation reported by most patients. Moreover, the resulting mobility of marginal tissues promotes peri-implant bacterial invasion, which can lead to mucosal inflammation and tissue recession. In this way, the presence of keratinized mucosa facilitates cleaning, contributing to the reduction of patient discomfort, promotes greater biological sealing, less inflammation and recession of peri-implant tissues, provides greater resistance to mastication forces, greater peri-implant stability, facilitates prosthetic procedures and more satisfactory aesthetics.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Mucosa queratinizada Saúde peri-implantar Implantes dentários Patologias peri-implantares