Técnica de restauración dentoalveolar inmediata del Dr. Da Rosa
IMMEDIATE DENTOALVEOLAR RECONSTRUCTION
La técnica IDR, inventada por del Dr. Carlos da Rosa, es la mejor técnica de regeneración para alvéolos de tipo II y III cuando hablamos de implantes inmediatos.
La implantología tiene un gran desafío cuando tenemos que hacer la reposición inmediata de un diente en el sector estético y es justamente cuando la causa de la reposición se debe a la movilidad y la consecuente pérdida de la pared vestibular del alvéolo, que tenemos que buscar la manera de REGENERAR la tabla vestibular. Así evitaremos problemas en el medio plazo de transparencia y recesiones. Maneras hay muchas, como la regeneración ósea guiada, pero el Dr. Da Rosa ha inventado una técnica que aprovecha el potencial regenerador de las células madre que se encuentran en la zona dadora de la tuberosidad.
Con su técnica obtendrás resultados excelentes, regenerando totalmente la tabla vestibular. Es una técnica probada con más de 10 años de prueba. Con múltiples casos, e indicaciones de acuerdo a su clasificación de defectos vestibulares. Aprende a obtener injertos óseos corticales, esponjosos y de tres capas.
Es un curso replicado en todo el mundo, con excelentes docentes, el propio Da Rosa y su equipo. Verás múltiples casos, videos y aprenderás cómo se ejecuta paso a paso. El instrumental necesario y harás una práctica que te permitirá enfrentarte a tu primer caso con seguridad. La curva de aprendizaje es relativamente corta y los resultados son espectaculares, no comparables a ninguna otra técnica.
*Curso impartido en inglés.
Dr. Jose Carlos Martins Da Rosa
– Graduation course in Dentistry, Federal University of Santa Maria – UFSM – Santa Maria/RS –
– Specialization course in Periodontics, São Paulo Association of Dental Surgeons – APCD –
Bauru/SP – Brazil, 1991
– Specialization course in Prosthodontics, Center of Dental Research São Leopoldo Mandic – CPO
SLMandic – Campinas/SP – Brazil, 2003
– Master of Science in Prosthodontics, Center of Dental Research São Leopoldo Mandic – CPO
SLMandic – Campinas/SP – Brazil, 2005
– PhD in Oral Implantology, Center of Dental Research São Leopoldo Mandic – CPO SLMandic –
Campinas/SP – Brazil, 2013
– Author of the book «Immediate Dentoalveolar Restoration (IDR) – Immediately loaded implants in
compromised sockets” by Quintessence Publishing.
– Private Practice in Caxias do Sul/RS – Brazil
Caso 1 | IDR technique using CORTICO-CANCELLOUS GRAFT
Figure 1. Clinical evaluation showing very poor quality soft tissue due to fracture and infection in the right lateral incisor.
Figure 2. The CBCT image shows fracture and loss of the buccal bone wall.
Figure 3. The damaged tooth was extracted applying minimally invasive procedure. A careful curettage of the socket was performed to completely remove the granulation tissue and remains of periodontal tissue. Probing depth showed approximately 11 mm in height of the buccal aspect.
Figure 4. The cortico-cancellous graft and particulate bone were harvested from maxillary tuberosity using IDR chisels (IDR kit, Schwert, Germany). The graft was reshaped according to the defect configuration. The cortico- cancellous graft was inserted and stabilized by juxtaposition into the receptor site.
Figure 5. The implant was anchored at the palatal wall in the 3-D position. Particulate bone was compacted to fully fill the gaps between the marrow portion of the cortico-cancellous graft and the implant. 3 mm in bone thickness was reconstructed at the buccal aspect.
Figure 6. A screwed provisional restoration was manufactured with an adequate emergence profile.
Figure 7. Soft tissue was stable in volume and with adequate thickness after 3 months.
Figure 8. Screwed porcelain crown insertion with ideal emergence profile. Maintenance of the anatomical contour of soft tissue can be observed.
Figure 9. Clinical follow-up after 3 years showing stability of soft tissue regarding gingival margin and papillae.
Figure 10. A CBCT image after 3 years highlights the stability of the buccal wall, in terms of thickness and height.
Caso 2 | IDR technique using CORTICO-CANCELLOUS GRAFT
Figure 1. Initial photograph showing the root resorption in the upper left central incisor, loss of the buccal wall and the balance of anatomical contour of gingival architecture.
Figure 2. A prostetically driven digital planning was performed.
Figure 3. The damaged tooth was extracted using a minimally invasive procedure that favored preservation of the remaining bone walls. Surgical guide in position allowing the drill site preparation in the 3D position. It’s possible to notice the palatal wall approach. It was performed a fully guided surgery. The implant was installed in the palatal wall. The 3D positioning of the implant allowed a gap of 3 mm at the buccal aspect.
Figure 4. The cortico-cancellous graft and particulate bone were harvested from maxillary tuberosity using IDR chisels.
Figure 5. After reshaping the graft according to the defect configuration, the cortico-cancellous graft was inserted at the buccal aspect. Particulate bone was compacted to fully fill the gaps between the marrow portion of the graft and the implant. A gap of 3 mm at the buccal aspect was completely restored. The provisional crown out of occlusion was installed immediately.
Figure 6. Soft tissue healed and maintained in the appropriate position after 3 months. It is observed the maintenance of the anatomical contour of the gingival architecture.
Figure 7. Clinical follow-up after 1 year showing stability of soft tissue regarding gingival margin and papillae.
Figure 8. A CBCT scan after 1 year highlighted the stability of the buccal wall, in terms of thickness and height.
Caso 3 | IDR technique using TRIPLE GRAFT
Fig 1. Clinical evaluation showed a condemned right central incisor with total loss of buccal wall and thin periodontal biotype. The damaged tooth was extracted applying minimally invasive procedures, favoring the preservation of the remaining bone.
Fig 2. The buccal defect was around 10mm height. It was confirmed a very thin periodontal biotype. A carefull curettage of the socket was done to remove completely the granulation tissue and remains of periodontal tissue.
Fig 3. The implant (13mm height and 4mm diameter) was anchored at the remaining palatal bone in the 3D position favoring the construction of the screwed provisional crown. It was possible to obtain 50Ncm of primary stability.
Fig 4. The triple graft (connective, cortical and cancellous bone in one single piece) harvested from maxillary tuberosity were inserted at the buccal defect to recover hard and soft tissue damaged.
Fig 5. Occlusal view showing the 3mm gap filled with triple graft and particulate bone graft harvested from maxillary tuberosity.
Fig 6. A screwed provisional crown using the same crown of the patient was manufactured with an adequate emergence profile allowing space to correct acommodation of the tissues. Immediate provisional crown installed out of occlusion.
Fig 7. Soft tissue healed and maintained in the appropriate position after 3 months.
Fig 8. The porcelain crown insertion with ideal emergence profile.
Fig 9. Clinical follow-up after 4 years showed stability of soft tissue countour regarding gingival margin and papillae.