Estudio comparativo del tipo de carga en la supervivencia de los implantes dentales

Resumen

Resumen de la Tesis Tïtulo: Estudio comparativo del tipo de carga en la supervivencia de los implantes dentales. Introducción y motivación del estudio: Casi todas las líneas de investigación en la implantología moderna van dirigidas a la reducción de los tiempos de espera entre la fase quirúrgica y protésica, este hecho, unido a que los pacientes cada vez muestran mayor interés por las nuevas técnicas implantológicas que permiten cargar los implantes el mismo día de su colocación, nos ha hecho plantearnos un estudio con implantes con superficie tratada para poder efectuar en ellos una carga inmediata, precoz o convencional de la prótesis. Además en la mayoría de los artículos revisados es difícil hacer una comparativa en la tasa de éxito de los diferentes tipos de carga implantológica, ya que los resultados que observamos en la literatura derivan de antiguos y nuevos protocolos de carga, siendo en ocasiones no comparables, con metodologías de investigación frecuentemente inadecuadas y con un evidente confusionismo semántico. Por lo que hacen falta nuevas investigaciones sobre el tipo de carga en implantología que unifiquen criterios. La hipótesis nula es que la tasa de supervivencia de los implantes no difieren significativamente con respecto al tiempo de carga (inmediata, precoz o convencional). Los objetivos que nos planteamos en el siguiente estudio son: Objetivo general: - Comparar la tasa de éxito entre la carga inmediata (con y sin contacto oclusal), precoz y convencional. Objetivos específicos: - Conocer la influencia de la edad y el sexo en el éxito o fracaso de los implantes. - Comparar la relación existente entre la localización y tipo de hueso y la tasa de supervivencia de implantes. - Evaluar la influencia del cuerpo del implante (longitud y diámetro) en el éxito o fracaso de los mismos. - Analizar, según el número de implantes colocados, el éxito del tratamiento. - Relacionar según el tipo de prótesis, la supervivencia de los implantes. Para ello realizamos una revisión de las historias clínicas de pacientes que solicitaron tratamiento implantológico para la reposición de una o más piezas ausentes y/o dientes no restaurables entre los años 2006 y 2008 y que fueron monitorizados durante 5 años o más tras el tratamiento. Se han empleado un total de 164 implantes Zimmer SwissPlus® (Zimmer Dental Inc., Warsaw, Indiana, USA) de diámetros 3.7, 4.1 y 4.8 y longitudes 10, 12 y 14mm, con los que hemos realizado carga inmediata, precoz y convencional. Hemos evaluado el porcentaje de éxito según los criterios propuestos por Buser y colaboradores que mencionan que para considerar que un implante ha sido colocado exitosamente deberá encontrarse: 1. Perfectamente fijo, sin ningún tipo de movilidad detectable. 2. Carente de síntomas clínicos como: dolor, sensación de cuerpo extraño o disestesia. 3. Ausente de áreas radiolúcidas alrededor del implante. 4. Ausente de infección recurrente con supuración periférica al implante. Procesamiento de datos: Se realizaron tablas estadísticas teniendo en cuenta los siguientes parámetros: - Edad y sexo. - Numero total de implantes. - Tipos de implantes colocados por diámetro, longitudes y localización. - Calidad y cantidad ósea por implante. - Tipo de carga (inmediata con contacto oclusal, inmediata sin contacto oclusal, precoz o convencional) - Total de implantes que han llegado a éxito según objetivos al final del intervalo establecido. - Total de fracasos - Si ocurren fracasos, indicar tipo de implante por diámetro, longitud y localización. - Tipo de rehabilitación prostodóntica (corona unitaria, puente fijo, o sobredentadura). Todos los datos fueron introducidos en una hoja de cálculo (Excel, Microsoft Corporation, Redmond, WA) para su posterior análisis. Análisis estadístico: Para el análisis basado en pacientes se utilizó SPSS-Windows 17.0 (SPSS Inc., Chicago, IL) y SUDAAN 7.0 (RTI, RTP, NC) para el análisis basado en implantes; con el fin de ajustar los errores estándar y los valores de p para el agrupamiento (múltiples implantes por paciente). Las conclusiones que obtenemos del estudio realizado, para dar respuesta a los objetivos que nos hemos planteado, son: - Tanto la carga inmediata como la precoz son opciones viables de tratamiento, con tasas de éxito similares a las obtenidas con carga convencional. - La edad y el sexo del paciente no influyen en el éxito o fracaso de los implantes. - No se han encontrado diferencias estadísticamente significativas en cuanto a la localización para el éxito de los implantes. - La calidad de hueso es el factor más importante para el éxito de los implantes, observándose mayor tasa de fracaso en densidades óseas tipo III y sobre todo tipo IV. - El diámetro y la longitud del implante no influyen en el éxito del tratamiento, referido a rangos de entre 10-14mm de longitud y 3.7-4.8mm de diámetro. - Se ha demostrado que existe una relación directa entre el número de implantes y el éxito del tratamiento, de tal manera que obtenemos mayor tasa de fracaso con 1 o 2 implantes. - El tipo de prótesis realizada presenta una relación significativa con la supervivencia de los implantes, encontrándose una mayor tendencia al fracaso en restauraciones unitarias. 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