Surgical Reconstruction of Interdental Papilla Using an Interposed Subepithelial Connective Tissue Graft: A Case Report

Section of Periodontics, State University of Londrina, Paraná, Brazil.
The International journal of periodontics & restorative dentistry (Impact Factor: 1.42). 03/2004; 24(1):31-7. DOI: 10.1016/j.prosdent.2004.06.011
Source: PubMed


The unpredictability of current surgical procedures for papilla reconstruction has been a matter of concern for both periodontists and patients. This case report presents a complete papilla reconstruction in a 20-year-old woman using an interposed subepithelial connective tissue graft. The results show that this technique can be successfully used in treating the loss of papillae and achieving long-term stability. The objective of this report is to describe the surgical technique and comment on the factors that may have influenced the final result.

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    • "In addition, the distance of flap advancement in the RPSCTG may be elongated by using either rotation or rolling around the axis. Moreover, the palatal connective tissue graft may be useful in several other possible situations requiring periodontal surgery [14,36,37,38]. Many factors should be evaluated before palatal graft, such as the palatal vault anatomy, wound healing from the donor site, postoperative patient discomfort, the blood supply, and the need for sutures, stents, or hemostatic agents [39]. "
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    ABSTRACT: Purpose: In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect. Methods: We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture. Results: Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment. Conclusions: The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.
    Journal of periodontal & implant science 06/2014; 44(3):147-55. DOI:10.5051/jpis.2014.44.3.147 · 1.15 Impact Factor
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    • "Semilunar coronally repositioned flap: Approach[2131] based on a flap design reported previously by Tarnow.[32] In their modification for papilla reconstruction, they recommended placing the semilunar incision in the interdental region. "
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    ABSTRACT: In recent years, clinician and dentist's esthetic demand in dentistry have increased rapidly, driven by an enhanced awareness of beauty and esthetics. The ultimate goal in modern restorative dentistry is to achieve "white" and "pink" esthetics in esthetically important zones. "White esthetics" is the natural dentition or the restoration of dental hard tissues with suitable materials. "Pink esthetics" refers to the surrounding soft-tissues, which includes the interdental papilla and gingiva that can enhance or diminish the esthetic result. Reconstruction of the lost interdental papilla is one of the most challenging and least predictable problems. Restoration and maintenance of these tissues with adequate surgical and prosthetic techniques are a real challenge in modern esthetic dentistry. Treatment of marginal tissue recession, excessive gingival display, deficient ridges, ridge collapse, and esthetic defects around teeth and implants are some of the esthetic problems associated with the interdental papilla that have to be corrected in todays scenario which has been discussed in this review.
    Dental research journal 03/2013; 10(3):296-301.
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    • "Although many surgical procedures have been proposed for augmentation of bone and soft tissue structures, predictable results may not be routinely achievable [10] [11]. In addition, many patients are not responsive or have systemic diseases, contraindicating invasive oral surgeries such as bone and soft tissues grafting [4,10–12]. "
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    ABSTRACT: Tooth replacement in the maxillary anterior region is especially difficult when the loss includes significant amounts of the residual ridge and the soft tissue. Several techniques are available, such as dental implants or fixed partial denture, and bone and gingival grafts or gingival prostheses, respectively. This article showed a clinical case of an elderly who was treated with a collarless metal-ceramic fixed partial denture and acrylic removable gingival prosthesis to recover the esthetics in the maxillary anterior region. The association of a metal-ceramic fixed denture and gingival prosthesis was an excellent alternative in cases when surgical procedures are contraindicated.
    05/2012; 56(3):222-6. DOI:10.1016/j.jpor.2012.02.003
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