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176 rev port estomatol med dent cir maxilofac. 2019;60(4):175-188

Uma classificação abrangente para reabilitação total sobre implantes

r e s u m o

Palavras-chave: Objetivos: Este artigo propõe um sistema de classificação das opções de reabilitação total
Classificação sobre implantes, tendo em conta o padrão de reabsorção ósseo individual do doente.
Avaliação clínica Métodos: Através da análise e avaliação radiográfica (Cone Beam Computed Tomography) de
Diagnóstico 150 maxilas e 150 mandibulas edêntulas de forma consecutiva, foram descritos cinco níveis
Reabilitação total de atrofia dos maxilares de acordo com a disponibilidade óssea a nível de altura e largura
Resultados centrados no paciente nas regiões anteriores e posteriores
Proposta de classificação: Foram propostos esquemas de reabilitação fixa e de reabilitação
removível para cada nível. De acordo com a informação clínica e a evidência científica dis-
ponível foram definidos os seguintes parâmetros: número, localização, posição e desenho
dos implantes e a necessidade de procedimentos regenerativos.
Conclusões: Os esquemas de reabilitação ilustrados têm como propósito auxiliar os clínicos
durante o planeamento baseando-se numa pirâmide hierárquica das diferentes classes, do
mais simples ao mais complexo. Além da sua utilidade, esta classificação também visa
otimizar a comunicação entre clínicos e pacientes. (Rev Port Estomatol Med Dent Cir Maxi-
lofac. 2019;60(4):175-188)
© 2019 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

ridge in different levels of atrophy, they do not suggest any
Introduction
prosthodontic rehatbilitation options for each level.
Complete edentulism is still a global health problem. Availa- Some classification systems have been proposed to guide
ble data collected worldwide report a wide variation of the clinicians and provide a basis for diagnostic and treatment pro-
prevalence of edentulism, equating up to 70% in population cedures for full-arch implant rehabilitations and simplify com-
1
groups aged 60 years old or over. Some epidemiological stud- munication between patients, colleagues and technicians. 20,21
ies highlight a decrease in prevalence in developed countries However, there is still a need for a classification system that
2
due to preventive oral health measures. However, the in- simultaneously takes into consideration the jaw anatomy and
crease in life expectancy seems to balance this tendency and resorption pattern, the implant placement site, the surgical
promote the need for treatment. 3 technique and the prosthodontic rehabilitation scheme. 22,23
An implant-supported full-arch rehabilitation, either fixed The classification system proposed in this manuscript con-
or removable, represents a highly predictable treatment for siders the patient’s clinical information as the cornerstone of
edentulous patients to recover masticatory function, aesthet- the therapeutic decision-making process. Medical factors, ex-
4,5
ics and psychological well-being. Patient-related outcome pectations, biomechanics and prosthodontic design should be
measures evaluated through oral health-related quality of life the primary starting point from which this process begins. This
(OHRQol) parameters, patient satisfaction and patient prefer- unique information is crucial for adjusting and optimizing the
ence, serve to confirm these prosthodontic needs. Several implant-prosthodontic scheme decision. The classification sys-
6,7
prospective studies 8-12 and, recently, randomized clinical tri- tem proposed follows this principle and is the result of twen-
als 13,14 and systematic reviews, after evaluation at the im- ty-four years of clinical experience in full-arch implant surgery
15
plant and prosthesis levels, have described high survival and and prosthodontics by the author. This period was characterized
success rates associated with these types of rehabilitations by more than 3500 edentulous arches rehabilitated at the au-
either in immediate, early or conventional loading protocols. thor’s clinical center. To complement this specialist proposal
From the clinician’s perspective and according to the SAC and provide clinicians with predictable clinical options for each
Classification proposed by ITI, surgical and prosthodontic con- category from Maxilla and Mandible Class I to Class V, this tool
siderations for a fixed full-arch rehabilitation fall within Ad- for aiding decisions also integrates the best available evidence
16
vanced and Complex procedures. Several factors determine to support the prosthodontic options suggested for each class.
these levels of difficulty. A variable bone resorption pattern
associated with different levels of atrophy, the proximity to
anatomical landmarks or patient risk factors require accurate Classification Proposal
17
planning and a highly skilled surgeon. Several classical an-
atomical classifications have been proposed to help diagnose A complete anamnesis should collect and emphasize pa-
resorption patterns in edentulous jaws. 17-19 Although those tient-related factors. General systemic health, soft-tissue
classifications express the type and profile of the alveolar conditions, type of the opposing jaw, oral hygiene, parafunc-