Utiliza????o da cirurgia guiada na instala????o de mini-implantes ortod??nticos: aplica????o de um protocolo para a pr??tica cl??nica

• Author(s): Costa, Davi Mendes
• Date: 2018
• Origin: Oasisbr
• Subject(s): Cirurgia Assistida - Computador; Cirurgia Guiada - Imagem; Ortodontia; CIENCIAS DA SAUDE
• Document Type: Master thesis
• Language: Portuguese

Description

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The usage of cone beam computed tomography associated with CAD/CAM technology produce a reliable prototyped surgical guide and it's increasing the accuracy in positioning the metallic screw, reducing problems of lesion to periodontal ligaments and root surfaces. JUSTIFICATION: As in implantology, that the guided surgery helped reduce the variations between the localization planned and executed on installing metallic implants, the present study justifies itself by analyzing the usage of this technique on orthodontics micro-implants surgery install and suggests a protocol for daily use at clinical attendance. OBJECTIVES: The general aim is evaluate the efficiency of a protocol developed with assistance of guided surgery for orthodontic implant therapy; specifically, it aims to describe the use of virtual planning and condensation silicon for the confection of the prototyped surgical guide molding technique, evaluate the usage of the surgical guide concerning micro-implants installation in posterior regions of maxilla and mandible, and produce a manual of the protocol. METHODS: The patients were submitted to molding collect, acquisition of cone beam computerized tomography for planning, installation surgery, and postoperation tomography for the tridimensional evaluation of the metallic screws sites, wtih a reckoning of angulation deviation and the localization. RESULTS: A total of 41 micro-implants were installed in 16 patients, with a average time of the surgical phase was 2 minutes. Pain absence occurred in 81% of installations according to Visual Analog Scale of Pain (VAS). Emplacement of micro-implants by the labial surface medium deviation was 2,0 ?? 0,8 mm on the head (D1), 1,9 ?? 0,9 mm central (D2), 1,9 ?? 1,0 mm (D3) and 3,2???? 1,4 of long axis angulation (A1). Variations were higher by the lingual surface (2,8 ?? 1,6 mm, 3,1 ?? 2 mm, 3,5 ?? 2,3 mm e 4,4???? 2,3, respectively) and distal surface of inferior molars 4,7 ?? 3,3 mm, 4,8 ?? 3,1 mm, 4,8 ?? 2,9 mm, 4,5?? ?? 1,6, respectively). CONCLUSION: The offered protocol was efficient and of easy execution, presenting itself as a viable and safe option for daily clinic.

O uso da tomografia computadorizada associada a tecnologia CAD/CAM produz uma guia cir??rgica prototipada confi??vel e aumenta a acur??cia no posicionamento do mini-implante, reduzindo os problemas de les??o aos ligamentos periodontais e superf??cies radiculares. JUSTIFICATIVA: Baseado na implantodontia que conseguiu reduzir as varia????es entre a posi????o planejada e executada na instala????o dos implantes met??licos, justifica-se um estudo que analise o uso da cirurgia guiada na instala????o dos mini-implantes ortod??nticos, e que proponha protocolo para o seu uso na cl??nica di??ria. OBJETIVOS: O objetivo geral ?? avaliar a efici??ncia do protocolo desenvolvido com o aux??lio de cirurgia planejada por computador para a instala????o dos mini-implantes ortod??nticos. E especificamente, descrever o uso do planejamento virtual e da t??cnica de moldagem com silicona de condensa????o para a confec????o da guia cir??rgica prototipada, avaliar o uso da guia cir??rgica na instala????o dos mini-implantes nas regi??es posteriores da maxila e mand??bula, e produzir manual pr??tico para a aplica????o do protocolo. METODOLOGIA: Os pacientes foram submetidos a coleta da moldagem, aquisi????o da tomografia computadorizada feixe c??nico para planejamento cir??rgico, e tomografia p??s-operat??ria para a avalia????o tridimensional da localiza????o final dos mini-implantes, com o c??lculo dos desvios de angula????o e localiza????o. RESULTADOS: Foram instalados 41 mini-implantes ortod??nticos em 16 pacientes, com o tempo m??dio de cirurgia de 2 minutos. A aus??ncia de dor ocorreu em 81% das instala????es segundo a Escala Anal??gica Visual da Dor (VAS). O desvio m??dio de posicionamento dos mini-implantes instalados pela face vestibular foi de 2,0 ?? 0,8 mm na cabe??a, 1,9 ?? 0,9 mm no centro, 1,9 ?? 1,0 mm na apical, e 3,2???? 1,4 de angula????o do longo eixo. As varia????es foram maiores nas faces palatinas (2,8 ?? 1,6 mm, 3,1 ?? 2 mm, 3,5 ?? 2,3 mm e 4,4???? 2,3 respectivamente) e distal dos molares inferiores (4,7 ?? 3,3 mm, 4,8 ?? 3,1 mm, 4,8 ?? 2,9 mm, 4,5?? ?? 1,6 respectivamente). CONCLUS??O: O protocolo proposto foi eficiente e de f??cil execu????o, apresentandose como uma op????o vi??vel e segura para a cl??nica di??ria.