Carlos Eduardo Francischone

Alberto Consolaro
Renato Savi de Carvalho
Ana Carolina Francischone
Carlos Eduardo Francischone Junior

Carlos Eduardo Francischone

3 7

-
- 7
9=
9= ?
9 9=
7 ? =
3 =
7
9+
- > 7
3
- 7
9=

W
7 -

7
6
7 ? -
7
9= 7
9= - 3 3
7

9= -
=
-
7
=

9=


9= 9
9 7 &
9= 3 -

9=
?
9=
9+
6 9=

9=
-

6 9=
7

9=
3 9=
9=
-
9= -
6
= - 9=
7 ?

-
9= ?
6 9= -
9=
? -
6
@ 9
- >
9= =
9+

9=
9= 9=


9=

9=
- >

-
9= 7
9= 7

>

&

9 9

9= 9= 3 -
+ 7
7
>
- 7

3 7

=
7
7

9= 7
7 -
+ -

3
3
?

-
9=
9= - =

6

= 6 ?
9=
>
6
@
9+

? 3
3 7
3 7 3 9+
3 3 ? 7


e

3 ?

, 7 -
9= ?
3 ? 7
3
7 -
? 3
7 3

- 9= 3 3
? -
6
? ,

3 3 ?
@

? 9=
7 -
3 ?

>
6 ? 9=
9= - ?
9= -
3 =
> W ?
>

- 6
= 7
?

9= ?

>
3 -
> 9=
=
7
9
7
9= -
3
9= = 9= -
9=
- 9=
- 9=
9= ?

9= >

9=
9=
3
-
9= -
9= 7
-
9= -

6
9= - 7

3 7

3
9= -
7 3 9 -
-
3 = & ?
9+
9+ ? -

6 =
9=


9+
- 9=
7 -


9= -
? >
3 3
-

- 7
7

-

9=
e

-
7
> =
9=
9= =
9=

&

& 7
=
=

?
= 7
7

-
3
7

9= 7
=
7

7
-
= 6

9= 7
=
9= 9= 3

9= -
7 >
9= 7 =
>
- 7
3

9= 7
>
3
9=
9=
9= 7
= =
3
9=

7
- 9+
7
- 9=
9= 7
? ?
k k k
k 3 - k
9= ?
7 7 ? 7 7
?
3 =
7 3
9= 9=
= 7
7 7
7 - 7
3

3 7

? 9=
9= ? 9=
>
9= 9=
7

6
7
? >
= -= 9=
3
9= 9= 9= 9=

9+

- 9=
@
9= 9=
, - 9= 9= 7
9= -
9= @
9= - 6

3 7
3

-
3 9

7
9= 7
9=
3 -
7 7 -
9= 6
6
- 9=
7 7
+ @ 3
7 7 7

7
9=
9= 7
7 9=
@ 7
9= 7
3 9=
6 9= -
3 9=

7 9=
9=
= >
- ?
7

Fig. 2.1 O epitlio estratificado pavimentoso gengival (EG) se justape com sua espessura normal logo aps a colocao do cicatrizador ou do pilar e da coroa. O epitlio ulcerado tem suas clulas
com membranas expostas e mediadores, para que interajam com seus
receptores. Em situao de estresse, as clulas aumentam a produo
de mediadores.O EGF (setas) das prprias clulas epiteliais estimula a
proliferao epitelial peri-implantar, iniciando a formao do epitlio
juncional peri-implantar. O EGF da saliva (S) deve participar deste processo, pois aumenta muito quando ocorrem cirurgias bucais.
The gingival stratified squamous epithelium (EG) is juxtaposed with
its normal thickness soon after the placement of healing caps or the
abutment and crown. The ulcerated epithelium has their cells with exposed membranes and mediators that interact with their receptors.
Under stress the cells increase the production of mediators. EGF (arrows) of epithelial cells stimulates the proliferation of the peri-implant
epithelium and initiates the formation of peri-implant junctional epithelium. EGF from saliva (S) must participate in this process because it
increases a lot when oral surgery happens.

Fig. 2.2 O epitlio juncional peri-implantar (EJ) ganha mais camadas de clulas e assume uma conformao semelhante do epitlio
juncional dos dentes naturais. Esta nova conformao do epitlio juncional aproxima-o da superfcie osseointegrada, aumentando a concentrao no local de EGF (setas) e, em consequncia, acelera-se a
reabsoro ssea e inicia-se a saucerizao
The peri-implant junctional epithelium (EJ) acquires more layers of
cells and assumes a conformation similar to the junctional epithelium
of natural teeth. This new conformation of the junctional epithelium
brings it closer of osteointegrated surface, increasing the local concentration of EGF (arrows) and consequently accelerates bone resorption
and begins the saucerization.

Fig. 2.3 O epitlio juncional peri-implantar (EJ), com a conformao semelhante do epitlio juncional dos dentes naturais, ganha
equilbrio estrutural com a insero peri-implantar e estabiliza sua
atividade proliferativa. Nas superfcies sseas, a reabsoro diminui
e se aproxima da observada no
normal. Desta forma, haver
uma corticalizao da superfcie ssea peri-implantar que indica uma
estabilizao do processo.
The peri-implant junctional epithelium (EJ) with similar conformation
to the junctional epithelium of natural teeth wins structural balance with
the insertion of peri-implant and stabilize their proliferative activity. In
bone surfaces the reabsorption decreases and approaches that observed
in normal turnover. Thus there will be a corticalization of peri-implant
bone surface which indicates a stabilization process.

3 7

3 3 9= 9=
3
9= 7 -
?
+ 7
-
9= = 3

3
=
?

Fig. 2.4 Representao esquemtica do mecanismo de saucerizao na conexo externa entre pilar prottico e implante.
Schematic representation of saucerization mechanism on the external connection between abutment and implant.

Fig. 2.5 Representao esquemtica do mecanismo de saucerizao na conexo interna entre pilar prottico e implante.
Schematic representation of saucerization mechanism on the internal connection between abutment and implant.

Fig. 2.6 Representao esquemtica do mecanismo de saucerizao em corpo nico do pilar prottico com o implante.
Schematic representation of saucerization mechanism in one body
abutment with the implant.

Fig. 2.7 Representao esquemtica do mecanismo de saucerizao na conexo cone-morse entre pilar prottico e implante.
Schematic representation of saucerization mechanism in morsetaper connection between abutment and implant.

Figs. 2.8A-D Conexo externa (Brnemark System Nobel Biocare). Durante prova do pilar prottico, o tecido sseo se apresenta com caractersticas de modelagem ssea ao redor da cabea do implante (A). Aps cimentao da coroa prottica, o tecido gengival apresenta contorno e papilas
satisfatrios. No controle radiogrfico (C) e clnico (D) de 19 anos, o remodelamento sseo mostra-se estvel com corticalizao pericervical (C) e
estabilidade do tecido gengival peri-implantar (D).
External connection (Brnemark System - Nobel Biocare). During the proof of the abutment, bone tissue presents bone molding characteristics
around the head of the implant (A), after cementing the prosthetic crown, gingival tissue presents satisfactory contours and papillae. In X-ray control
(C) and clinical (D) of 19 years, the bone remodeling shows stable with corticalization pericervical (C) and stability of peri-implant gingival tissue (D).

3 7

Figs. 2.9A-D
aps a sua instalao (A) e cimentao da coroa prottica (B). No controle radiogrfico e clnico de cinco anos, o remodelamento sseo est presente
(C) e o tecido gengival peri-implantar mostra-se normal e estvel (D).
Internal connection (Replace Select Nobel Biocare) Minimum molding bone around the neck of the implant, 6 months after installation (A) and
cementation of prosthetic crown (B). In clinical and radiographic control of five years, the bone remodeling is present (C) and peri-implant gingival
tissue appears to be normal and stable (D).

6 9=
6
3
-
9=
e

= 7
3 > >

7
6 @ 9=

9= 9=
? @ 3

Figs. 2.10A-D Implante corpo nico (Nobel Direct Nobel Biocare). Aps o perodo de osseointegrao de seis meses, quando as coroas foram cimentadas, notar a presena de modelagem ssea (A) e os tecidos gengivais com contorno e papilas normais (B). No controle radiogrfico e clnico de seis
anos, observa-se a presena de remodelamento sseo pericervical e corticalizao ssea (C) e estabilidade do tecido gengival peri-implantar (D).
One body implant (Nobel Direct - Nobel Biocare). After osseointegration period of six months, when the crowns were cemented, noting the presence
of bone modeling (A) and gingival tissues with normal contour and papillae (B). In clinical and radiographic control of six years, there is the presence
of bone remodeling and pericervical corticalization bone (C) and stability of peri-implant gingival tissue (D).

Figs. 2.11A-C Cone-morse (Ankylos Dentsply) Logo aps o implante ser instalado na parte infrassea, pode-se observar a relao osso
implante (A). No controle radiogrfico e clnico de seis meses, observa-se o modelamento sseo pericervical (B) e tecido gengival peri-implantar
normal em C. (cortesia de De Leo,C;Teixeira,ER Rev. Implant News Implantodontia, V5N3,285-90,2008).
Cone-morse (Ankylos - Dentsply) - Shortly after the implant installation bellow the level bone, one can observe the relationship implant - bone (A),
the clinical and radiographic control of six months, there is the modeling pericervical bone (B) and peri-implant gingival tissue in normal C. (Courtesy
from De Leo, C. Teixeira, ER - Rev. Implant News - Implantology, V5N3, 285-90, 2008).

3 7

Figs. 2.12A-D Dupla conexo interna (Amplified PI Branemark Philosophy) Logo aps instalao do implante a nvel infra-sseo (A), do pilar
prottico e provisria (B) pode-se observar a relao entre o tecido sseo e o implante.No controle radiogrfico e clnico de 1 ano, notar presena de
modelamento sseo pericervical (C) e tecido gengival peri-implantar normal (D).
Double internal connection (Amplified PI Branemark Philosophy) - After installing the implant below the level bone (A), the abutment and provisional (B) can observe the relationship between tissue bone and implant. In radiographic control and clinical of 1-year, note the presence of bone
modeling pericervical (C) and peri-implant gingival tissue normal (D).

= ? 9=

9=
>
=
?
9=


9= = 9
9=
9=
?
7

>
= =
9= 9=


?
6 -
9=
? @ 9=

&
9= -
= - 9=

-
- 7 ?
= 7 ? -
?
- 6
- 9= =
9= 9= 7 =
- p
? - 7 ?
9=
9=
-
p 9=
- -
7 =
? 3 @ 9= 7
-

= ? 3 9= -
- =
6
9=
9= @ 7
= 7

9=

9= = 9 ?
?

p




p

3 7

Fig. 2.13A Fotomicrografia mostrando reas de necrose ssea trmica caracterizadas como reas basoflicas, faceando o alvolo cirrgico preparado com broca usada e refrigerao ineficiente. Notar tecido que o sseo apresenta osteoplastos vazios e clulas com ncleos
picnticos (HE 20X).
Photomicrograph showing areas of thermal bone necrosis characterized as basophilic areas, faceando the surgical alveolus prepared with
used drill and with inefficient cooling. Note bone tissue presenting
empty osteoplasts and cells with pyknotic nuclei (HE 20X).

Fig. 2.13B Tecido sseo com predomnio de ostecitos normais

e sem lacunas vazias, demonstrando a viabilidade do tecido sseo,
decorrente do uso de broca nova e irrigao adequada (HE 40X).
Bone tissue with a predominance of normal osteocytes and without
empty lacunae, demonstrating the feasibility of bone tissue, resulting
from the use of new drill and adequate irrigation (HE 40X).

> 9= ?

=
-

9= -
9= 7 &
9 7

9 ?
9= 9

6 9= -
W ? 9 9= =
3 9= @
- @

Fig. 2.14A Modelo do implante Amplified mostrando, em simulao com elementos finitos, reas de tenses (verde) concentradas nas
partes internas do implante (cortesia: PI Brnemark Philosophy).
Model of the implant Amplified showing in simulation with finite
element stress areas (green) concentrated in the inner parts of the
implant (courtesy: PI Brnemark Philosophy).

Fig. 2.14B Pilar prottico conectado no implante mostrando reas

de tenses concentradas internamente (verde), em simulao feita
com elementos finitos (cortesia: PI Brnemark Philosophy).
Pillar prosthetic conected to the implant, showing areas of concentrated stress internally (green) in simulation made with finite element
(courtesy: PI Brnemark Philosophy).

Figs. 2.15A-B Controle radiogrfico de 15 anos mostrando saucerizao pericervical em que fatores como confeco de
, flange e
pescoo polidos possam ter influenciado a sua ocorrncia. Notar a corticalizao do tecido sseo peri-implantar (A) e o comportamento clnico normal
do tecido gengival (B).
Radiographic control of 15 years showing saucerization pericervical, where factors such as countersink, neck and flange polished may have influenced their occurrence. Note corticalization of the peri-implant bone tissue (A) and normal clinical behavior of gingival tissue (B).

9
9

3
;
7 3
9
9 9
3
> =
9= 9

3 7

9 = ?
9= 9 7
? &
W
? 3 9=
7 ?
7 =
3 7

W =


9= 9+ 9 -

? 9
=
7 9
9 9=
9= 3 6
9=
= =

Figs. 2.16A-B Durante a prova do pilar prottico, observa-se na radiografia o nvel de tecido sseo pericervical e incio e saucerizao (A), e tecido
gengival normal ao redor da coroa prottica (B).
During the test of the abutment, observe on radiograph the level of pericervical bone tissue and first and saucerization (A) and normal gingival
tissue around the prosthetic crown (B).

Figs. 2.16C-D Controle radiogrfico e clnico de 19 anos. Observar a presena de saucerizao pericervical estvel, tecido sseo corticalizado (A)
e tecido gengival peri-implantar estvel e saudvel (B).
Clinical and radiographic control of 19 years. Notice the presence of stable saucerization pericervical, bone tissue corticalized (A) and peri-implant
gingival tissue healthy and stable (B).

Figs. 2.17 (A) Radiografia periapical mostrando o nvel sseo logo aps a instalao do pilar prottico sobre o implante. (B) Radiografia periapical
do controle de 1 ano mostrando remodelamento sseo pericervical discreto, num sistema de dupla conexo interna (hexagonal e cnica) e implante
sem pescoo e com
cervicais. (C) Aspecto clnico da prtese sobre implante e tecido gengival com contorno e papila normais. (cortesia:
Luigi Canullo Univ. Bonn Alemanha)
(A) Periapical radiograph showing the bone level after installation of the abutment on the implant. (B) Periapical radiograph of one year control,
showing discreet bone remodeling pericervical, in a system of double internal connection (hexagonal and conical), implant without neck and with
cervical minigrooves. (C) Clinical aspect of the prosthesis retained by implants and normal gingival tissue contours and papillae (courtesy: Luigi
Canullo Univ. Bonn Germany).

9= 9=
3 -

3 -
7 3 -
9= 9 -
7 >

=
-
? 7
9 - 7 9
- ? 3
7
? 9=

3 7

Figs. 2.18A-D Implante instalado em nvel infrasseo requer uso de pilares de cicatrizao (A) e pilares protticos com dimetro menor (D), para
proporcionar espao a ser preenchido pelo tecido conjuntivo e epitlio juncional. Nessas condies o espao biolgico vertical se torna maior do que
o horizontal (D). Notar que o implante localizado esquerda da foto foi instalado em nvel sseo e o pilar prottico utilizado apresentava dimetro
igual ao da plataforma do implante. O espao biolgico horizontal e vertical se equivalem.
Installed Implant below the bone level, requires the use of healing abutments (A) and abutments with smaller diameter (D) to provide space to be
filled by conjunctive tissue and junctional epithelium. Under these conditions the biological space vertical becomes bigger than the horizontal (D),
note that the implant on the left of the photo, was installed in bone level and the abutment used had the same diameter as the platform of the
implant. The biologic space horizontal and vertical are equivalent.

3 -
9 - 7 =
= =
7 9=

+
7 -
+ 3
3
7 =

9+ 9= @ +
=
,
, & 9=

9= @ , = -
, 7
= 9= 7
6
= ?
? 9 -
9
+ 7 9
>
9=
9=
7 >
=

7 >
7
7 >
W
? >
9 9=
9
9+ -
9=
= 7

>
9 9=

9= 7 9= >
7 =

6 7 7 >
>
9+
+

- 7
-
7
>

7 ,
= - ,r
,r
?

r r

3 7

Figs. 2.19A-C (A) Radiografia mostrando implante com plataforma expandida no momento da instalao do pilar prottico. Notar o tecido sseo
faceando o pilar e a plataforma do implante. (B) Radiografia mostrando implante com plataforma expandida. No controle de um ano, notar o modelamento sseo ao redor do pilar prottico e na plataforma do implante (incio da saucerizao). (C) Exemplo de pilar prottico de dimetro menor
instalado sobre implante de plataforma normal.
(A) Radiograph showing the implant with expanded platform at the time of installation of the abutment, note bone tissue flush the implant abutment and the platform. (B) Radiograph showing the implant with expanded platform. In 1 year control, note the modeling bone around the abutment
and on the implant platform (beginning of the saucerization). (C) Example of abutment of smaller diameter, installed on a normal implant platform.

>
7
-

9 9= 7

9=
@ ,
6
9= 7 9=

-

-
7
?
= 7

=
7
9= 7
>
? =
-
9=
-

Figs. 2.20A-D Tipos de pilares protticos com perfil biolgico e dimetro menor. (A) Perfil biolgico reto; (B e C) perfil biolgico minicncavo; (D)
perfil biolgico cncavo.
Types of abrutment with biological profile and small diameter. (A) Straight biological profile. (B and C) Miniconcave biological profile. (D) Concave
biological profile.

Figs. 2.21A-D (A) Pilar de zircnia com perfil biolgico e personalizado. (B) Pilar instalado sobre o implante; notar o espao interproximal para
acomodao da papila gengival. (C) Aps a instalao da coroa Allceram, notar contorno e papila gengival em arco cncavo regular. (D) Radiografia
periapical mostrando pilar personalizado com perfil biolgico e terminao chanfrada para receber a coroa prottica.
(A) Zirconia`s pillar with biological profile and personalized. (B) Pillar installed on the implant, note interproximal space to accommodate the gingival
papilla. (C) After installation of the AllCeram crown, note contour and gingival papilla with regular concave arc. (D) Periapical radiograph showing
custom abutment with biological profile and finishing beveled to receive the prosthetic crown.

3 7

>
7 ? -
6 9=

> 9
- 9 -
7
-
? -
= -

?
-
= ?
-

9=
> 3
- >

Figs. 2.22A-C (A) Pilar prottico de perfil divergente no sentido oclusal faceando ou comprimindo o tecido sseo quando assentado sobre o
implante instalado infrasseo. (B) Modelamento e remodelamento sseo para criar espao biolgico para acomodao do tecido conjuntivo e epitlio
juncional, visto no controle de cinco anos. (C) Vista frontal, no controle de cinco anos, mostrando comportamento clnico normal do tecido gengival
peri-implantar.
(A) The Pillar prosthetic Profile divergent towards occlusal faceando or compressing the bone tissue while seated on the implant below the level
bone installed. (B) Modeling and bone remodeling to make room for accommodation of biological tissue and junctional epithelium, whereas in control
of five years. (C) Front, in control of five years, showing clinical behavior of normal peri-implant gingival tissue.

9 9
7 = 3
?
9
?
-
9 9+
9= 7

9=

9=
7 - >
-

9+ =

Figs. 2.23A-C
desadaptao em funo da base do pilar apoiar no tecido sseo. (B) Pilar prottico corretamente adaptado no implante, em funo de ter recebido
desgaste para diminuir o seu dimetro. (C) Aps instalao da prtese, notar o espao de acomodao do tecido conjuntivo e epitlio juncional.
(A) Proof of abutment available with a larger diameter than the implant platform, which was installed at sub-bone; note misfit function in the base
of the pillar supporting the bone tissue. (B) Pillar prosthetic implant properly fitted out as a function of receiving wear to reduce its diameter. (C) After
installation of the prosthesis, noted space to accommodate the connective tissue and junctional epithelium.

3 7

Figs. 2.24A-D Osteotomia realizada (A,B) para permitir a adaptao do pilar prottico promove a saucerizao, porm no traz qualquer comprometimento para a longevidade funcional e esttica; isto pode ser visto no controle de 15 anos em C e D.
Osteotomy performed (A,B) to allow adjustment of the abutment, promotes saucerization, but brings no compromise to functional and aesthetic
longevity, this can be seen in 15 years in control C and D.

9=
7

=
7
9=
? 7
9= 7 7
9= 7 ?


3 =
9=
@ 9= =
@ 9= 7
3
= , 9=
9= = ?
= 7
= - -
9= 9=

Figs. 2.25A-D Dispositivo de osteotomia sendo usado para a remoo de osso ao redor da cabea do implante (A,B) e assim possibilitar o assentamento dos pilares protticos de emergncia cnica (C); o resultado a saucerizao pericervical (D).
Osteotomy device being used for removal of bone around the head of the implant (A,B) to allow the seating of abutments emergency conical (C),
the result is saucerization pericervical (D).

7
-
7 @ >
, = 9+
9= ?
9+
?
6 7 9= ?
?


9= = ?

7 -

3 7

Figs. 2.26A-B Produtos derivados de ligas metlicas do pilar prottico ou da prtese podem provocar tatuagem no tecido conjuntivo e at saucerizao.
(A-B) Products derived from metallic leagues of the prosthetic pillar or prosthetic can provoke tattooing in the fabric conjunctive and until saucerization.

9= 3
&

3 3 =
-
- ?

& -
3
-
9=
9=
9= =
?
9=
9= = ?
3 3
@ 3 7
7 3
? 9= 7
=

- -
7 9=
9=
3
+ 7
+
?

? 6
9=
= ? ?
9 7 9+

3
9= =
9= =
9= 3 ? ?

7

+ -

+ 9= ?
= 3 -

+ = + -

9= 9=

-
9= 7
9=

Figs. 2.27A-B Figuras representativas de gerao das tenses no implante, em reas prximas crista ssea.22
(A,B) Figures representing generation of stresses in the implant in areas near the bone crest.22

3 7

Figs. 2.28A-B Implante amplified, mostrando minigrooves na

regio cervical e pilar prottico correspondente com conexo cnica e indexada.
(A,B) Amplified implant, showing minigrooves in the neck and
abutment connection with corresponding conical and indexed.

6 9=
9= 3 7
9=
9=
-
3 ?
9+
3 7
= 3 3
= 3
3 = 7
- 7 3 @
,
3 3
3 =
? +
7
+ = 3
9=

3 = ?

9= - =
? 6
- 9= 77
7 7
= ? 7
9 , , ?
3
9
3 =
- = 7 7

Fig. 2.29A Imagem obtida por microscpio de fora atmica mostrando as nanoestruturas presentes na superfcie de um implante dentrio. Imagem cedida pelo Dr. Luiz Meirelles.
Image obtained with an atomic force microscope showing the nanostrucutres of dental implant suface. Photo courtesy: Dr. Luiz Meirelles.

Fig. 2.29B Imagem obtida por um interfermetro mostrando as

microestruturas presentes na superfcie de um implante dentrio. Imagem cedida pelo Dr. Luiz Meirelles.
Image obtained with an interferometer showing the microstuctures
on dental implant surface. Photo courtesy: Dr. Luiz Meirelles.

7
9= = ?

7
-

6 9 =
9= - 9
-
7 6 ?

9= - ? @
6
9= 9=
9= 9= -
, ? -
3 ?
-
9= 3

9= 3
9+
9 9=
9= =


7 9= 3
= -
?

3 7

Figs. 2.30A-B Peri-implantite caracterizada pela perda ssea pronunciada e progressiva ao redor do implante (A) e presena de secreo intrassulcular e fstula no tecido gengival peri-implantar (B).
Peri-implantitis characterized by a pronounced and progressive bone loss around the implant (A) and presence of secretion intrassulcular fistula in
the gingival tissue and peri-implant (B).

3

?
3 3 ?
? 9
?

3
-
= 9=
-

? & =

9=
?
9=

?
? ?

9=
? 7 >
& 9=
? 7 -
9=

Figs. 2.31A-C (A) Presena de gengiva delgada ao redor do pilar de zircnia. (B) Cirurgia periodontal de enxerto do tecido conjuntivo com a
finalidade de aumentar a espessura do tecido gengival e harmonizar o contorno gengival (cirurgia realizada pelo Dr. Glcio Vaz Campos). (C) Aps
instalao da coroa Allceram, notar tecido gengival mais espesso e uniforme.
(A) Presence of thin gingiva around the abutment of zirconia. (B) Surgery of periodontal connective tissue graft in order to increase the thickness
of the gingival tissue and harmonize the gingival contour (surgery performed by Dr. Vaz Glcio Campos). (C) After installation of the crown AllCeram
noteworthy gum tissue and even thicker.

? 7 ?
9= 9=

= 9= + 9=


6
-
- 9=
9= - =

e
e
e
e
e
e
e
e
e

9+ - =

=
& p 9=
9=
=
3 =
=

& 6

?
@
= 7 9=

= =
?
-

-

-

e
e
e
e
e
e
e
e
e

3 7

Figs. 2.32A-C A ocluso e a desocluso harmoniosas promovem uma melhor distribuio e dissipao das foras da mastigao para a interface
osseointegrada e tecido sseo subjacente, tornando-o mais corticalizado (B), quando comparado com o tecido sseo, antes de receber os dois implantes (A). Controle de dez anos (B,C).
A-C The clamping and unclamping harmonious promote better circulation and dissipation of the forces of chewing to the osseointegrated interface
and underlying bone, making it more cortical (B) compared with the bone tissue before receiving the two implants (A). Control of 10 years (B, C).

7 ? @
9= ?
9= -
9=
9= ?
?
9=
7 , ?
@ 9=
3

-
9= 7 6 9+
W -

9= 7
6

W -

9=
3 ?
-


Figs. 2.33A-D
e radiografia periapical (B) logo aps a
cimentao da coroa sobre o implante
na regio do dente 12, no controle psoperatrio imediato. (C,D) Vista frontal e
radiografia periapical do controle de 20
anos mostrando remodelamento sseo
pericervical e corticalizao ssea (D) e
estabilidade dos tecidos gengivais periimplantares (C).
AB Front View (A) and periapical radiograph (B) after cementation of the
crown over the implant in the region of 12
in the immediate postoperative control.
(C,D) Front and Control periapical radiograph 20 years, showing bone remodeling pericervical Corticalization and bone
(D) and stability of peri-implant gingival
tissues (C).

9= @ 9=
3 - =








- 9= >
- 9= 7

3 7

7
9=
=

9=


9+
?
= 3
, =
7

9 9





- ? 3
@ 9=
















? + -
@
7 7
9=





* * 3




?
-
7 =