Alveoloplastia associada à confecção de prótese parcial removível: relato de caso clínico

Abstract

Oral rehabilitation of partially edentulous patients can be performed through different prosthetic treatment options. Among the prosthetic alternatives, the Removable Partial Prosthesis (RPP) provides satisfactory functional and aesthetic restoration, preserving the remaining teeth and the alveolar ridge. In complex oral rehabilitations, when several clinical interventions of others dental specialties are necessary, the use of interim prosthesis is indicated, especially when associated with pre-protective surgeries such as alveoloplasty. Alveoloplasty consists in removing a part of the alveolar process with the aim to correct irregularities in the residual alveolar ridge. In this context, the patient of this clinical case sought the Dental Emergency Clinic (PSO) of Federal University of Uberlândia (UFU) complaining of aesthetic discomfort and chewing difficulties. After intra and extraoral examinations it was confirmed aesthetically commitment due to the absence of lip sealing with pronounced premaxillary projection, excessive buccalization of the upper anterior teeth, marked overjet/overbite and reduced occlusion vertical dimension. Thus, in order to restore the functions of the stomatognathic system (SS) and optimize the aesthetics, the treatment plan was dived in two prosthetic and one surgical steps. The first prosthetic step consisted of oral rehabilitation with interim prostheses, being the lower prosthesis characterized as overlay. Those interim prostheses were associated with alveoloplasty for correction of maxillary prognathism and alveolar ridge volume, improving the retention and adaptation of future prostheses. For this, the models of the upper arch and lower arch were assembled on semi-adjustable articulator in the OVD, established as adequate, for surgical planning (extractions and alveoloplasty) and later for manufacturing the interim prostheses and surgical guides. Therefore, the periodontally compromised teeth were extracted in the model and all vestibular contour regularization was performed, simulating the correct position of the ridge, within physiological limits, in order to achieve good aesthetics. Then, the compromised teeth were removed and the intrasseptal alveoloplasty or modified Dean technique was performed, which consists in the correction of the alveolar ridges by removing the intrasseptal bone and the repositioning of the buccal cortical bone. Immediately after pre-prosthetic surgery, the interim prostheses were installed, allowing the restoring of the aesthetics and functions of the SS. For an effective evaluation of the physiological tolerance of SS in relation to the restored OVD, the overlay was used for a period of six weeks. After this period, a conventional RPP was manufactured with the aim to preserve the remaining structures, stability, support, retention, chewing, aesthetics and comfort. Therefore, the use intrasseptal alveoloplasty or modified Dean technique associated to prosthetic rehabilitation of patient with pronunced projection of premaxilla resulted in better facial harmony associated with greater functional efficiency.