Avaliação comparativa entre as técnicas All-on-four e Four-onpillars em planejamentos virtuais 3D associadas a cirurgias guiadas em maxilas atróficas

Abstract

Thorough technical knowledge and anatomical understanding are critical for optimal surgical results. The difficulty of complete maxillary surgery can vary significantly depending on the complexity of the anatomy or bone defect. Guided surgery is currently a relevant option for bringing to the patient fewer surgical complications and is directly related to 3D virtual planning for the success of the case. In this work, we analyze and compare two methods of planning guided in software for the manipulation of dental implants, associated with the All-on-four (A.F.) and Four-on-pillars (F.P.) techniques used in patients with atrophic maxillae. Forty-two images of totally edentulous patients were analyzed, 30 of which were planned using ImplantViewer software for volume assessment and ImageJ software for area assessment. The volumes were acquired in a CRANEX 3D volumetric tomograph model from the Soredex brand. In each planning, the height and width of the bone remnant was used as guidance and the implants were installed virtually. The average area of the Fouron-pillars technique was 4.9x (p<0.0001) greater than the average area with the Allon-four technique, this represents a difference of 489%, which in the same force applied by the jaw we have a 4.9x lower pressure, that is, a better distribution of forces on the jaws. It was not possible to notice a statistical difference between the success proportions (p=0.2542), showing that the techniques have a non-different (similar) success proportion. We conclude that the area formed in the Four-on-pillars surgical planning is larger than in the All-on-four planning and also that there is no technique with successful advantages over another, therefore the Four-on-pillars technique becomes an excellent option as a treatment for atrophic jaws.