Incidência de desfechos protéticos associados à overdenture mandibular retida por quatro mini-implantes: estudo prospectivo aninhado a ensaio clínico randomizado
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2023-10-20
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Universidade Federal de Goiás
Resumo
The use of mini-implants is gaining popularity due to less surgical complexity and
advantages for cases of atrophic mandibles, and a new system of mini-implants was recently
launched (Straumann Optiloc Mini-Implant System®). Aim: This prospective study is part of a
randomized clinical trial and aimed to evaluate the incidence of prosthetic outcomes and associated
factors in completely edentulous patients after the insertion of mandibular overdentures retained by
four mini-implants. Methods: Completely edentulous individuals using conventional complete
dentures were recruited for the installation of four mini-implants for treatment with mandibular
overdenture. The study combined two surgery protocols (flapped or flapless) and loading (immediate
or delayed). During follow-up, the incidence of prosthetic complications and maintenance events
were recorded at scheduled and unscheduled appointments. Independent variables were considered
as age, gender, surgery and loading protocol, and ridge form (CAWOOD & ROWEL, 1988). A
classification of prosthetic outcome (six-field protocol) (PAYNE et al., 2001) was assessed at the
end of the follow-up period. Descriptive statistical analysis was performed, with measurements of
incidence rates, as well as Kaplan-Meier survival analysis and Cox regression, considering the
significance level of p<0.05. Results: 74 participants were accompanied, with a mean age of 64
years (35-80 years), and total follow-up time varied between 19 and 26 months. There were a total
of 182 prosthetic events in 147 consultations, 88 of which (59.87%) were unscheduled. The most
frequent event was the need for minor adjustments to the base of the overdenture (incidence of 38),
due to sore spots; followed by minor repairs at the base (incidence of 16); total (incidence of 21) or
partial (incidence of 11) exchange of matrices; indirect relining (incidence of 21) due to instability;
new intraoral capture (incidence of 8); fracture of the overdenture (n = 1) and tooth fracture (n = 1).
The outcome of success was attributed to 69 participants (93.2%). The most significant predictor for
the incidence of adjustments was the flapless surgery protocol (p=0.011), and the age was the most
one for the incidence of total matrix replacement (p=0.031). There was no statistically significant
difference in the incidence of other prosthetic complications with regard to gender, loading protocol,
or ridge form (p>0.05). Conclusions: There was a high incidence of prosthetic events, but they were
considered acceptable and mostly represented by small adjustments or repairs to the overdenture
base in the initial period of treatment. The high survival and success rate of the implant and prosthesis
shows that this is a favorable treatment option for this follow-up, and it is recommended to establish
scheduled appointments for the expected events. Longer follow-ups are recommended to obtain more
representative data regarding prosthetic outcomes.