Protocolo inferior com os pilares distais inclinados
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May 19, 2025
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Resumo
Objetivo: Este trabalho teve como objetivo apresentar um método de tratamento cirúrgico baseado na técnica All on Four realizado no curso de especialização em implantodontia da Universidade Federal Fluminense. Detalhamento de caso: A atrofia alveolar em maxilares edêntulos dificulta a reabilitação total das arcadas, principalmente na reabilitação com implantes dentários osseointegrados, que demanda quantidade óssea suficiente ou cirurgia prévia para ganho ósseo, aumentando a morbidade e as complicações para o paciente. Por isso, técnicas têm surgido para evitar essas áreas de maior perda óssea e desviar das estruturas nobres, que muitas vezes são limitantes para instalação de implantes. Uma das técnicas sugeridas e bem aceitas para evitar essas estruturas anatômicas é o conceito “All on Four”, onde quatro implantes longos são instalados, dois anteriores são instalados axialmente e os posteriores são colocados em uma posição angulada para uma melhor distribuição ântero-posterior, assim como a variação dessa técnica apresentada minuciosamente nesse artigo. Considerações finais: Considerando a importância da reabilitação total com implantes, utilizando técnicas voltadas para a instalação de implantes em maxilares atróficos, cabe aos profissionais experientes fazer uso dessa técnica ou de variantes da técnica, de maneira cautelosa e com embasamento científico, para que a reabilitação traga as vantagens relatadas no presente artigo.
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CarvalhoM. B., MachadoA. N., AguiarT. R., CastroJ. P. G. de, RosalémG. P., MesquitaH. de S., CarvalhoR. M. de, AmorelliP. Q., LourençoE. S., & ReisP. L. C. (2025). Protocolo inferior com os pilares distais inclinados. Revista Eletrônica Acervo Odontológico, 7, e19392. https://doi.org/10.25248/reaodonto.e19392.2025
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Referências
1. BABBUSH CA, et al. Patient-related and financial outcomes analysis of conventional full-arch, rehabilitation versus the All-on-4 Concept: A cohort study. J Clin Implant Dent Relat Res, 2014; 16(6): 836-855.
2. BRANEMARK PI, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl., 1977; 16:1–132.
3. CAPELLI M, et al. Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either light or tilted implants: A multicenter clinical study. Int J Oral Maxillofac Implants, 2007; 22: 639–644.
4. CASTELLON P, et al. Immediate loading of dental implants in the edentulous mandible. J Am Dent Assoc., 2004; 135: 1543–1549.
5. CAWOOD JI e HOWELL RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg., 1988; 17: 232-6.
6. CHIAPASCO M, et al. Implant-retained mandibular overdentures with immediate loading. A retrospective multicenter study on 226 consecutive cases. Clin Oral Implants Res., 1997; 8: 48.
7. CHIAPASCO M. Early and immediate restoration and loading of implants in completely edentulous patients. Int J Oral Maxillofac Implants, 2004; 19: 76–91.
8. Ciftci Y e Canay S. Stress distribution on the metal framework of the implant-supported fixed prosthesis using different veneering materials. Int J Prosthodont., 2001; 14: 406–411.
9. CRESPI R, et al. A Clinical Study of Edentulous Patients Rehabilitated According to the "All on Four" Immediate Function Protocol. Int J Oral Maxillofac Implants. 2012; 27(2): 428-34.
10. CRESPI R, et al. A Clinical Study of Edentulous Patients Rehabilitated According to the "All on Four" Immediate Function Protocol. Int J Oral & maxillofac implant, 2012; 27: 428-34.
11. DEL FABBRO M, et al. Tilted implants for the rehabilitation of edentulous jaws: a systematic review. Clin Implant Dent Relat Res., 2012; 14: 612–621.
12. DEL FABBRO M, et al. Systematic review of survival rates for immediately loaded dental implants. Int J Periodontics Restorative Dent., 2006; 26: 249–263.
13. DUYCK J, et al. Magnitude and distribution of occlusal forces on oral implants supporting fixed prostheses: An in vivo study. Clin Oral Implants Res., 2000; 11: 465–475.
14. FRANCETTI L, et al. Immediate rehabilitation of the mandible with fixed full prosthesis supported by axial and tilted implants: Interim results of a single cohort prospective study. Clin Implant Dent Relat Res., 2008; 10: 255–263.
15. HINZE M, et al. Immediate loading of fixed provisional prostheses using four implants for the rehabilitation of the edentulous arch: A prospective clinical study. Int J Oral Maxillofac Implants, 2010; 25: 1011–1018.
16. JENSEN OT, et al. O All on 4 Shelf: Mandíbula. J Oral Maxillofac Surg., 2011; 69(1): 175-81.
17. JENSEN OT e ADAMS MW. Maxillary V-4: Four implant treatment for maxillary atrophy winth dental implants fixed apically at the vomer-nasal crest, lateral pyriform rim, and zygoma for immediate function: Report on 44 patients followed from 1 to 5 years. J Prosthet Dent., 2014; 112(6): 1319-1325.
18. JENSEN OT, et al. Paranasal bone: the prime factor affecting the decision to use transsinus vs. zygomatic implants for biomechanical support for immediate function inmaxillary dental implant reconstruction. Oral and Craniofac Tissue Eng., 2012; 2: 198-206.
19. JENSEN OT, et al. Transsinus dental implants, bone morphogenetic protein 2 and immediate function for all on four treatment of severe maxillary atrophy. J Oral Maxillofac Surg., 2012; 70: 141-8. 29.
20. JENSEN OT. Alveolar segmental ―sandwich‖ osteotomies for posterior edentulous mandibular sites for dental implants. J Oral Maxillofac Surg., 2006; 64: 471.
21. KIM KS, et al. Biomechanical Comparison of Axial and Tilted Implants for Mandibular Full-Arch Fixed Prostheses. Inter J oral & maxillofac implant., 2011; 26: 976-84.
22. KLINGE B, et al. Peri-implant diseases. Eur J Oral Sci. 2018 Oct;126 Suppl 1:88-94.
23. KREKMANOV L, et al. Tilting of posterior mandibular and maxillary implants of improbe prosthesis support. Int J Oral Maxillofac Implants, 2000; 15: 405–414.
24. KRENNMAIR G, et al. Clinical outcome and prosthodontic compensation of tilted interforaminal implants for mandibular overdentures. Int J Oral Maxillofac Implants, 2005; 20: 923.
25. MALÓ P, et al. A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: Case series. Clin Implant Dent Relat Res., 2006; 8: 223–232.
26. MALÓ P, et al. The use of computer-guided flapless implant surgery and four implants placed in immediate function to support a fixed denture: preliminary results after a mean follow-up period of thirteen months. J Prosthet Dent., 2007; 97: 26-34.
27. MALÓ P, et al. ―All-on-Four‖ immediate function concept with Brånemark system implants for completely edentulous mandibles: A retrospective clinical study. Clin Implant Dent Res., 2003; 5(suppl 1): 2–9.
28. MALÓ P, et al. All-on-4 immediate function concept with Brånemark system implants for completely edentulous maxillae: A 1-year retrospective clinical study. Clin Implant Dent Relat Res., 2005; 7(suppl 1): S88–S94.
29. MALÓ P, et al. Conceito All-on-4™: Manual clínico. Gotemburgo: Nobel Biocare; 2003.
30. MOHAMED LA, et al. Immediately Loaded mandibular fixed detachable restorations supported by axially aligned implants versus implants placed according to all-on-four concept. Alexandria Dental Journal, 2021; 47: 2.
31. MONJE A, et al. Marginal Bone Loss Around Tilted Implants in Comparison to Straight Implants: A Meta-Analysis, 2012; 27(6): 1576-83.
32. NAJAFI H, et al. Effects of Immediate and Delayed Loading on the Outcomes of All-on-4 Treatment: A Prospective Study. J Dent (Tehran), 2016; 13(6): 415-422.
33. JENSEN OT. Complete arch site classification for all-on-4 immediate function. J Prosthet Dent., 2014; 112(4): 741-51.
34. PAREL SM and PHILLIPS WR. A risk assessment treatment planning protocol for the four implant immediately loaded maxilla: preliminary findings. The Jour of prosthetic dentistry, 2011; 106(6): 359-66.
35. PATZELT SBM, et al. The All-on-Four Treatment Concept: A Systematic Review. Clin Implant Dent Relat Res, 2014; 16(6): 836-55.
36. STEGAROIU R, et al . Influence of superstructure materials on strain around an implant under 2 loading conditions: A technical investigation. Int J Oral Maxillofac Implants, 2004; 19: 735–7420.
37. STANFORD C. All on four- where are we now . The Int J of Oral. & Maxillofacial Implants, 2014; 29: 2.
38. TABRIZI R , et al. Do angulated implants increase the amount of bone loss around implants in the anterior maxilla? J Oral Maxillofac Surg., 2013; 71(2): 272-7.
39. TEALDO T, et al. Immediate function with fixed implant-supported maxillary dentures: A 12-month pilot study. J Prosthet Dent., 2008; 99: 351–360.
40. WU B, et al. Edentulism trends amog middle-aged and older adults in the United States: Comparison of five racial/ethnic groups. Community Dental Oral Epidemiol., 2012; 40: 145-153.
41. ZAMPELIS A, et al. Tilting of splinted implants for improved prosthodontic support: A twodimensional finite element analysis. J Prosthet Dent., 2007; 97: 35-43.
2. BRANEMARK PI, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl., 1977; 16:1–132.
3. CAPELLI M, et al. Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either light or tilted implants: A multicenter clinical study. Int J Oral Maxillofac Implants, 2007; 22: 639–644.
4. CASTELLON P, et al. Immediate loading of dental implants in the edentulous mandible. J Am Dent Assoc., 2004; 135: 1543–1549.
5. CAWOOD JI e HOWELL RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg., 1988; 17: 232-6.
6. CHIAPASCO M, et al. Implant-retained mandibular overdentures with immediate loading. A retrospective multicenter study on 226 consecutive cases. Clin Oral Implants Res., 1997; 8: 48.
7. CHIAPASCO M. Early and immediate restoration and loading of implants in completely edentulous patients. Int J Oral Maxillofac Implants, 2004; 19: 76–91.
8. Ciftci Y e Canay S. Stress distribution on the metal framework of the implant-supported fixed prosthesis using different veneering materials. Int J Prosthodont., 2001; 14: 406–411.
9. CRESPI R, et al. A Clinical Study of Edentulous Patients Rehabilitated According to the "All on Four" Immediate Function Protocol. Int J Oral Maxillofac Implants. 2012; 27(2): 428-34.
10. CRESPI R, et al. A Clinical Study of Edentulous Patients Rehabilitated According to the "All on Four" Immediate Function Protocol. Int J Oral & maxillofac implant, 2012; 27: 428-34.
11. DEL FABBRO M, et al. Tilted implants for the rehabilitation of edentulous jaws: a systematic review. Clin Implant Dent Relat Res., 2012; 14: 612–621.
12. DEL FABBRO M, et al. Systematic review of survival rates for immediately loaded dental implants. Int J Periodontics Restorative Dent., 2006; 26: 249–263.
13. DUYCK J, et al. Magnitude and distribution of occlusal forces on oral implants supporting fixed prostheses: An in vivo study. Clin Oral Implants Res., 2000; 11: 465–475.
14. FRANCETTI L, et al. Immediate rehabilitation of the mandible with fixed full prosthesis supported by axial and tilted implants: Interim results of a single cohort prospective study. Clin Implant Dent Relat Res., 2008; 10: 255–263.
15. HINZE M, et al. Immediate loading of fixed provisional prostheses using four implants for the rehabilitation of the edentulous arch: A prospective clinical study. Int J Oral Maxillofac Implants, 2010; 25: 1011–1018.
16. JENSEN OT, et al. O All on 4 Shelf: Mandíbula. J Oral Maxillofac Surg., 2011; 69(1): 175-81.
17. JENSEN OT e ADAMS MW. Maxillary V-4: Four implant treatment for maxillary atrophy winth dental implants fixed apically at the vomer-nasal crest, lateral pyriform rim, and zygoma for immediate function: Report on 44 patients followed from 1 to 5 years. J Prosthet Dent., 2014; 112(6): 1319-1325.
18. JENSEN OT, et al. Paranasal bone: the prime factor affecting the decision to use transsinus vs. zygomatic implants for biomechanical support for immediate function inmaxillary dental implant reconstruction. Oral and Craniofac Tissue Eng., 2012; 2: 198-206.
19. JENSEN OT, et al. Transsinus dental implants, bone morphogenetic protein 2 and immediate function for all on four treatment of severe maxillary atrophy. J Oral Maxillofac Surg., 2012; 70: 141-8. 29.
20. JENSEN OT. Alveolar segmental ―sandwich‖ osteotomies for posterior edentulous mandibular sites for dental implants. J Oral Maxillofac Surg., 2006; 64: 471.
21. KIM KS, et al. Biomechanical Comparison of Axial and Tilted Implants for Mandibular Full-Arch Fixed Prostheses. Inter J oral & maxillofac implant., 2011; 26: 976-84.
22. KLINGE B, et al. Peri-implant diseases. Eur J Oral Sci. 2018 Oct;126 Suppl 1:88-94.
23. KREKMANOV L, et al. Tilting of posterior mandibular and maxillary implants of improbe prosthesis support. Int J Oral Maxillofac Implants, 2000; 15: 405–414.
24. KRENNMAIR G, et al. Clinical outcome and prosthodontic compensation of tilted interforaminal implants for mandibular overdentures. Int J Oral Maxillofac Implants, 2005; 20: 923.
25. MALÓ P, et al. A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: Case series. Clin Implant Dent Relat Res., 2006; 8: 223–232.
26. MALÓ P, et al. The use of computer-guided flapless implant surgery and four implants placed in immediate function to support a fixed denture: preliminary results after a mean follow-up period of thirteen months. J Prosthet Dent., 2007; 97: 26-34.
27. MALÓ P, et al. ―All-on-Four‖ immediate function concept with Brånemark system implants for completely edentulous mandibles: A retrospective clinical study. Clin Implant Dent Res., 2003; 5(suppl 1): 2–9.
28. MALÓ P, et al. All-on-4 immediate function concept with Brånemark system implants for completely edentulous maxillae: A 1-year retrospective clinical study. Clin Implant Dent Relat Res., 2005; 7(suppl 1): S88–S94.
29. MALÓ P, et al. Conceito All-on-4™: Manual clínico. Gotemburgo: Nobel Biocare; 2003.
30. MOHAMED LA, et al. Immediately Loaded mandibular fixed detachable restorations supported by axially aligned implants versus implants placed according to all-on-four concept. Alexandria Dental Journal, 2021; 47: 2.
31. MONJE A, et al. Marginal Bone Loss Around Tilted Implants in Comparison to Straight Implants: A Meta-Analysis, 2012; 27(6): 1576-83.
32. NAJAFI H, et al. Effects of Immediate and Delayed Loading on the Outcomes of All-on-4 Treatment: A Prospective Study. J Dent (Tehran), 2016; 13(6): 415-422.
33. JENSEN OT. Complete arch site classification for all-on-4 immediate function. J Prosthet Dent., 2014; 112(4): 741-51.
34. PAREL SM and PHILLIPS WR. A risk assessment treatment planning protocol for the four implant immediately loaded maxilla: preliminary findings. The Jour of prosthetic dentistry, 2011; 106(6): 359-66.
35. PATZELT SBM, et al. The All-on-Four Treatment Concept: A Systematic Review. Clin Implant Dent Relat Res, 2014; 16(6): 836-55.
36. STEGAROIU R, et al . Influence of superstructure materials on strain around an implant under 2 loading conditions: A technical investigation. Int J Oral Maxillofac Implants, 2004; 19: 735–7420.
37. STANFORD C. All on four- where are we now . The Int J of Oral. & Maxillofacial Implants, 2014; 29: 2.
38. TABRIZI R , et al. Do angulated implants increase the amount of bone loss around implants in the anterior maxilla? J Oral Maxillofac Surg., 2013; 71(2): 272-7.
39. TEALDO T, et al. Immediate function with fixed implant-supported maxillary dentures: A 12-month pilot study. J Prosthet Dent., 2008; 99: 351–360.
40. WU B, et al. Edentulism trends amog middle-aged and older adults in the United States: Comparison of five racial/ethnic groups. Community Dental Oral Epidemiol., 2012; 40: 145-153.
41. ZAMPELIS A, et al. Tilting of splinted implants for improved prosthodontic support: A twodimensional finite element analysis. J Prosthet Dent., 2007; 97: 35-43.