La importancia de las lesiones apicales en la colocación de implantes dentales
Este es el reflejo histopatológico de lo que vivimos practicamente a diario los odontólogos; procesos inflamatorios crónicos asociados a ápices dentales, con acumulación de bacterias…. ¿preocupante? Yo digo con toda seguridad SI, ¡MUY preocupante!
¿Le damos la importancia que requiere? ¡NO! Sabiendo que en esa zona afectada colocaremos un implante dental postexodoncia o tendremos dientes contaminados, adyacentes al implante colocado, incluso dientes que han recibido tratamiento de conducto y aunque no se refleje lesión en los medios diagnósticos, las bacterias y células inflamatorias pueden estar presentes.
¿Curetear es suficiente? ¡NO! ¿Antibiótico sistémico es suficiente? ¡NO! Y si observamos que hay lesión presente ¿pueden haber bacterias? ¡SI! La literatura refiere varios protocolos de lavado en el momento en que se atienden las zonas contaminadas o se extraen los dientes afectados; estos protocolos se basan en colocación de doxiciclina y clorhexidina 0.2% de forma local, sabiendo que ambos medicamentos pueden generar daños a los tejidos, es importante realizar enjuagues profusos con solución fisiológica posterior a la colocación de cada uno de ellos.
Si no se toman medidas dentro de la planificación de los implantes, tomando en cuenta que las lesiones apicales presentan gran acumulación de bacterias y tejido inflamatorio, el pronóstico del mismo se verá influenciado, pudiendo generarse de esta forma periimplantitis retrógrada, desarrollo de tejido de granulación en la superficie del implante, contaminación y finalmente pérdida del mismo.
¡Así de crítica es esta situación! Es necesario asegurar el éxito a largo plazo de los implantes dentales, sin exacerbaciones y reapariciones de cuadros inflamatorios-bacterianos. (imagen: inflamación crónica severa correspondiente a lesión apical de diente afectado).
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