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Dente com prognóstico reservado: Endodontia ou Implante unitário?
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Dois dos principais objetivos da medicina dentária são a prevenção das doenças orais e preservação da dentição natural. Anteriormente à utilização de implantes dentários na prática clínica, tais objetivos eram frequentemente atingidos pela realização de tratamento endodôntico. Nos dentes não restauráveis, a única opção de tratamento era a sua exodontia e substituição através de próteses fixas ou removíveis. Com a descoberta do fenómeno de osteointegração, e com a validação científica dos níveis de sucesso a longo prazo, os implantes endosseos tornaram-se uma alternativa viável e promissora em inúmeras situações clínicas, incluindo a substituição de dentes unitários com prognóstico reservado. Desta forma, os clínicos enfrentam frequentemente o seguinte dilema: será preferível manter um dente com prognóstico reservado pela realização de tratamento endodôntico ou extraí-lo e substituí-lo por um implante dentário unitário? O debate desta questão tem ficado muitas vezes restrito à avaliação das percentagens de sucesso e sobrevivência de ambas as modalidades terapêuticas. Dentro da evidência científica disponível, verifica-se que as taxas de sucesso dos tratamentos endodôntico e implantar são igualmente elevadas a longo prazo. Assim, o clínico deve adicionalmente analisar de forma detalhada as indicações, contraindicações, riscos e benefícios para o paciente de cada opção de tratamento considerada, de modo a que este esteja adequadamente informado. Um plano de tratamento ideal deve atender às expectativas do paciente, ter um prognóstico favorável a longo prazo e ser sempre baseado na evidência científica. O presente trabalho tem como principal objetivo efetuar uma revisão bibliográfica, de modo a estabelecer os critérios para optar entre a manutenção de um dente com prognóstico reservado, através do tratamento endodôntico e restauração, ou a extração do mesmo e colocação de implante dentário unitário.
Two of the main goals in dentistry are the prevention of oral diseases and the preservation of natural dentition. Prior to the use of dental implants in clinical practice, these goals were often accomplished with endodontic treatment. In non-restorable teeth, the only treatment option available was extraction and its replacement by fixed or removable prostheses. With the phenomenon of osseointegration, endosseous implants have become a viable and promising option in several clinical situations, including the replacement of single tooth with poor prognosis. Thus, clinicians often face the following dilemma: is it preferable to maintain a tooth with poor prognosis by performing endodontic treatment or to extract it and replace it with a single-tooth implant? The discussion of this issue has traditionally been reduced to the debate around success and survival rates of each modality. Within the available evidence, it appears that the success rates of endodontic and implant treatments are equally high in the long term. Therefore, the clinician should also analyze thoroughly the indications, contraindications, risks and benefits of each treatment option considered to properly inform the patient. An ideal treatment plan must meet the expectations of the patient, have a favorable prognosis in the long term and must be based on scientific evidence. The main goal of this literature review is to establish the criteria to choose between the maintenance of a tooth with poor prognosis by performing endodontic treatment and restoration or its extraction and placement of a single-tooth implant.
Two of the main goals in dentistry are the prevention of oral diseases and the preservation of natural dentition. Prior to the use of dental implants in clinical practice, these goals were often accomplished with endodontic treatment. In non-restorable teeth, the only treatment option available was extraction and its replacement by fixed or removable prostheses. With the phenomenon of osseointegration, endosseous implants have become a viable and promising option in several clinical situations, including the replacement of single tooth with poor prognosis. Thus, clinicians often face the following dilemma: is it preferable to maintain a tooth with poor prognosis by performing endodontic treatment or to extract it and replace it with a single-tooth implant? The discussion of this issue has traditionally been reduced to the debate around success and survival rates of each modality. Within the available evidence, it appears that the success rates of endodontic and implant treatments are equally high in the long term. Therefore, the clinician should also analyze thoroughly the indications, contraindications, risks and benefits of each treatment option considered to properly inform the patient. An ideal treatment plan must meet the expectations of the patient, have a favorable prognosis in the long term and must be based on scientific evidence. The main goal of this literature review is to establish the criteria to choose between the maintenance of a tooth with poor prognosis by performing endodontic treatment and restoration or its extraction and placement of a single-tooth implant.
Descrição
Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2012
Palavras-chave
Endodontia Teses de mestrado - 2012