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Influência do número de implantes na reabilitação oral total fixa
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Resumo(s)
O edentulismo constitui um problema de saúde pública devido à sua elevada prevalência nas populações idosas e às repercussões funcionais, psicológicas e sociais na qualidade de vida dos doentes. As opções de tratamento incluem próteses completas mucosuportadas removíveis, próteses removíveis sobre implantes e próteses fixas sobre implantes. Entre os protocolos de reabilitação total fixa, os mais utilizados são o All-on-4, com 4 implantes por arcada, e o All-on-6, com 6 implantes por arcada.
Ambos os conceitos são amplamente descritos como referência para este tipo de tratamento, mas a superioridade de um protocolo em relação ao outro permanece controversa, não estando ainda definido o número ideal de implantes por arcada.
Esta revisão da literatura baseou-se numa pesquisa bibliográfica realizada nas bases de dados PubMed/MEDLINE, Wiley Online Library e MDPI como fontes primárias, e Google Scholar como fonte secundária, utilizando combinações dos termos “All-on-4”, “All-on-6”, “six implants”, “four implants”, “tilted implants” e “full-arch”. Após análise dos dados disponíveis, foram selecionados 17 estudos, incluindo 8 estudos clínicos, 7 revisões sistemáticas e 2 estudos de elementos finitos.
Os protocolos All-on-4 e All-on-6 foram comparados quanto às taxas de sobrevivência dos implantes e das próteses, perda óssea marginal, ocorrência de complicações técnicas e biológicas, satisfação dos pacientes e distribuição das forças oclusais, com o objetivo de avaliar uma eventual superioridade de um protocolo sobre o outro.
De forma geral, ambos os protocolos apresentam elevadas taxas de sucesso e sobrevivência, sem diferenças clinicamente relevantes na maioria dos parâmetros avaliados. O All-on-6 pode oferecer vantagens biomecânicas em termos de distribuição de cargas e redução de complicações mecânicas, enquanto o All-on-4 se destaca pela menor invasividade e melhor relação custo-benefício. Assim, a escolha do protocolo deve ser individualizada, considerando fatores anatómicos, biomecânicos e económicos, não existindo evidência suficiente para afirmar a superioridade inequívoca de um protocolo sobre o outro.
Edentulism constitutes a public health problem because of its high prevalence in elderly populations and its functional, psychological, and social impact on patients’ quality of life. Treatment options include conventional complete removable dentures, implant-supported removable prostheses, and implant-supported fixed prostheses. Among full-arch fixed rehabilitation protocols, the most commonly used are All-on-4, with four implants per arch, and All-on-6, with six implants per arch. Both concepts are widely described as reference treatments for this type of rehabilitation, but the superiority of one protocol over the other remains controversial, and the ideal number of implants per arch has not yet been established. This literature review was based on a bibliographic search conducted in PubMed/MEDLINE, Wiley Online Library, and MDPI as primary sources, and Google Scholar as a secondary source, using combinations of the terms “All-on-4,” “All-on-6,” “six implants,” “four implants,” “tilted implants,” and “full-arch.” After analysis of the available data, 17 studies were selected, including 8 clinical studies, 7 systematic reviews, and 2 finite element studies. The All-on-4 and All-on-6 protocols were compared according to implant and prosthesis survival rates, marginal bone loss, technical and biological complications, patient satisfaction, and occlusal force distribution, with the aim of assessing whether one protocol is superior to the other. Overall, both protocols show high success and survival rates, with no clinically relevant differences in most of the evaluated parameters. All-on-6 may offer biomechanical advantages in terms of load distribution and reduced mechanical complications, whereas All-on-4 stands out for being less invasive and more cost-effective. Therefore, protocol selection should be individualized, taking anatomical, biomechanical, and economic factors into account, as current evidence is insufficient to establish the clear superiority of one protocol over the other.
Edentulism constitutes a public health problem because of its high prevalence in elderly populations and its functional, psychological, and social impact on patients’ quality of life. Treatment options include conventional complete removable dentures, implant-supported removable prostheses, and implant-supported fixed prostheses. Among full-arch fixed rehabilitation protocols, the most commonly used are All-on-4, with four implants per arch, and All-on-6, with six implants per arch. Both concepts are widely described as reference treatments for this type of rehabilitation, but the superiority of one protocol over the other remains controversial, and the ideal number of implants per arch has not yet been established. This literature review was based on a bibliographic search conducted in PubMed/MEDLINE, Wiley Online Library, and MDPI as primary sources, and Google Scholar as a secondary source, using combinations of the terms “All-on-4,” “All-on-6,” “six implants,” “four implants,” “tilted implants,” and “full-arch.” After analysis of the available data, 17 studies were selected, including 8 clinical studies, 7 systematic reviews, and 2 finite element studies. The All-on-4 and All-on-6 protocols were compared according to implant and prosthesis survival rates, marginal bone loss, technical and biological complications, patient satisfaction, and occlusal force distribution, with the aim of assessing whether one protocol is superior to the other. Overall, both protocols show high success and survival rates, with no clinically relevant differences in most of the evaluated parameters. All-on-6 may offer biomechanical advantages in terms of load distribution and reduced mechanical complications, whereas All-on-4 stands out for being less invasive and more cost-effective. Therefore, protocol selection should be individualized, taking anatomical, biomechanical, and economic factors into account, as current evidence is insufficient to establish the clear superiority of one protocol over the other.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
All-on-4 All-on-6 Implantes inclinados Arcada completa