ArticleLiterature Review

Prevention of Alveolar Ridge Deformities and Reconstruction of Lost Anatomy: A Review of Surgical Approaches

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Abstract

Prevention and treatment of alveolar ridge deformities aim at preserving and/or reconstructing soft and hard tissues of the edentulous ridge. Different surgical techniques may be used to prevent ridge collapse before tooth extraction or to reconstruct lost ridge anatomy before tooth replacement. In cases of mild or moderate ridge defects, soft tissue augmentation is generally sufficient to repair the deformity. On the other hand, hard tissue augmentation should be selected primarily when implant therapy is scheduled. In cases of severe ridge defects, a staged or a combined approach may be appropriate. This article reviews the various approaches for the prevention and treatment of ridge deformities.

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... Since a thin peri-implant mucosa can lead to gingival recession after insertion of the dental reconstruction, 5 a thick masticatory mucosa needs to be established. Surgical procedures, such as alveolar ridge augmentation before or during implant insertion, [6][7][8][9] preoperative orthodontics (eg, forced extrusion), 10 and soft tissue augmentation during or after implant insertion, 7,9 have been described in the literature as approaches to augmenting preexist ing defects. The choice of therapy depends on the dimensions of the defect. ...
... Since a thin peri-implant mucosa can lead to gingival recession after insertion of the dental reconstruction, 5 a thick masticatory mucosa needs to be established. Surgical procedures, such as alveolar ridge augmentation before or during implant insertion, [6][7][8][9] preoperative orthodontics (eg, forced extrusion), 10 and soft tissue augmentation during or after implant insertion, 7,9 have been described in the literature as approaches to augmenting preexist ing defects. The choice of therapy depends on the dimensions of the defect. ...
Article
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The esthetic outcome of implant-supported restorations has become increasingly important, especially for single-tooth implants in the esthetic zone. Because of the morphologic alterations that occur following tooth extraction, augmentation procedures are often necessary before, during, or after implantation to achieve an esthetically pleasing result. This article describes a modified technique for augmenting the soft tissue during stage-two implant surgery. The technique uses a modified roll flap, in combination with a tunneling approach to the adjacent teeth and a coronally positioned palatal sliding flap, to achieve sufficient horizontal dimensions and a scarless and harmonious architecture of the peri-implant soft tissue.
... Las variables clínicas incluyen angulación y posición 3D del implante, y el correcto contorno anatómico de la corona provisoria para el modelado de los tejidos blandos. Dependientes del paciente se agregan nivel y grosor óseo alveolar, la relación tejidos blandos-tejidos duros y el biotipo gingival (1,2,3) . ...
... Sin embargo la toma de decisiones y el criterio clínico certero continúan siendo peldaños ineludibles en la elección de una determinada terapia, por lo que hay que evitar la sobre-indicación especialmente de la implantología oral del sector antero-superior, ya que dado su grado de dificultad acarrea resultados que no son muchas veces positivos. Recesiones de la mucosa peri-implantaria y pérdida de la tabla vestibular por excesiva inclinación de los implantes hacia facial y/o detrimento de los tejidos papilares interproximales y reabsorción de la cresta ósea alveolar por una inapropiada posición mesio-distal (3,4) . Algo similar sucede cuando no se elige el implante adecuado en cuanto a su largo y ancho. ...
Article
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Description of two clinical cases showing surgical possibilities of correction or ridges reconstruction, using connective tissue graft and gingival sculping.
... However, alveolar bone resorption following tooth loss results in alveolar ridge defect and hampers the goal. [1] The high incidence of residual ridge defect has been found following anterior tooth loss; majority of which is Class III defect. [2,3] Normally, the height and width of residual ridge should allow placement of pontic that appears to emerge from the ridge and mimics the appearance of the neighboring teeth. ...
... When a fixed partial denture (FPD) is planned, soft tissue augmentation may be sufficient to solve ridge defects. [1] A novel pedicle autograft, vascularized interpositional periosteal connective tissue (VIP-CT) flap has been introduced for predictable large soft tissue augmentation in a single procedure. Excellent blood supply, less morbidity, primary closure of donor and recipient bed are the additional advantage of this flap. ...
Article
Full-text available
Nowadays esthetics plays an important role in dentistry along with function of the prosthesis. Various soft tissue augmentation procedures are available to correct the ridge defects in the anterior region. The newer technique, vascularized interpositional periosteal connective tissue (VIP-CT) flap has been introduced, which has the potential to augment predictable amount of tissue and has many benefits when compared to other techniques. The study was designed to determine the efficacy of the VIP-CT flap in augmenting the ridge defect. Ten patients with Class III (Seibert's) ridge defects were treated with VIP-CT flap technique before fabricating fixed partial denture. Height and width of the ridge defects were measured before and after the procedure. Subsequent follow-up was done every 3 months for 1-year. Paired t-test was performed to detect the significance of the procedure. The surgical site healed uneventfully. The predictable amount of soft tissue augmentation had been achieved with the procedure. The increase in height and width of the ridge was statistically highly significant. The VIP-CT flap technique was effective in augmenting the soft tissue in esthetic area that remained stable over a long period.
... Recently, it has been suggested that a limited number of sites in the anterior maxilla represent a clinical situation that allows implant placement without considering auxiliary procedures, such as socket preservation and augmentation. 6 Several surgical approaches and grafting materials have been proposed to achieve sufficient alveolar bone volume (for a review, see Prato et al 7 ), which generally take two approaches: ridge preservation after tooth extraction or later reconstruction of lost ridge anatomy (before or at the time of implant placement). Fickl et al observed that intrasocket grafts seemed to be unsuitable to reach the ultimate goal of complete ridge preservation, but the technique did reduce the amount of resorption compared with spontaneous healing. ...
... 11 However, it is uncertain which socket preservation technique is the most predictable, 11 and the outcome of augmentation procedures is often related to the skill of the operator. 7 Fickl et al noticed that a major problem with imaging techniques to evaluate bone volume lies in the superimposition of the images and matching them in one coordinate system to allow exact measurement. 8 In a recent in vitro study, a high level of accuracy and reproducibility was described using an optical threedimensional (3D) method, which allowed clinicians to obtain a digital 3D image from laser-scanned impressions. ...
Article
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Purpose: To evaluate three-dimensionally the bone change following ridge preservation procedures (RPP) using computed tomography (CT). Materials and methods: Subjects in need of implant therapy were enrolled in the study. The teeth were extracted, and sockets underwent RPP with a bioactive glass (Inion BioRestore, Inion Oy). The patients were scanned with CT within 1 week and 3 months after surgery. Horizontal and vertical radiographic measurements were performed on superimposed CT scans to evaluate bone changes in the alveolar sites during the 3-month period. Results: Thirteen subjects participated, and 32 teeth were extracted and treated with grafting. Alveolar sites treated with RPP demonstrated a preservation of about 77% of the original width dimensions, with a mean loss of 1.8 ± 1.1 mm in width. Moreover, it was observed that the vertical loss of buccal bone was 2.7 ± 1.1 mm, while the loss of lingual bone was 1.9 ± 1.2 mm. Conclusions: The CT evaluation was helpful to assess that the bone loss in width was less than the vertical bone loss of both walls 3 months after RPP.
... [3] The selection of the technique depends on the extent and severity of the ridge defect and the type of the prosthetic treatment. [4,5] Recently, the use of Choukrouns' platelet rich fibrin (PRF) membrane for ridge augmentation has been utilized. [6] This case report describes a simple novel technique of soft tissue ridge augmentation for ovate pontic placement using the excised tissue as a connective tissue graft and PRF membrane. ...
... Literature shows that for small or moderate defects, soft tissue augmentation may be indicated, especially when an FPD is intended. [4,5] Therefore, a soft tissue augmentation was planned for the present case. A connective tissue graft is a predictable ingredient for soft tissue augumentation, and is useful in the treatment of ridge deformities, especially in cases of mild or moderate ridge defects. ...
... Differences in the outcomes of the various studies might be due to the variation in several associated factors, that can alter the extent of dimension gain after soft tissue grafting procedure, like patient selection, defects characteristics, data collection, biochemical characteristics of grafted materials, surgical variation, and patient attitude towards the treatment. [20] CONCLUSION Within the limitations of this study, modifi ed connective tissue graft is a better option as compared to subepithelial connective tissue in pouch for the treatment of alveolar ridge defi ciency. ...
Article
Full-text available
Abstract Background: Localized alveolar ridge defect may create physiological and pathological problems. Developments in surgical techniques have made it simpler to change the confi guration of a ridge to create a more aesthetic and more easily cleansable shape. The purpose of this study was to compare the effi cacy of alveolar ridge augmentation using a subepithelial connective tissue graft in pouch and modifi ed connective tissue graft technique. Materials and Methods: In this randomized, double blind, parallel and prospective study, 40 non-smoker individuals with 40 class III alveolar ridge defects in maxillary anterior were randomly divided in two groups. Group I received modifi ed connective tissue graft, while group II were treated with subepithelial connective tissue graft in pouch technique. The defect size was measured in its horizontal and vertical dimension by utilizing a periodontal probe in a stone cast at base line, after 3 months, and 6 months post surgically. Analysis of variance and Bonferroni post-hoc test were used for statistical analysis. A two-tailed P < 0.05 was considered to be statistically signifi cant. Results: Mean values in horizontal width after 6 months were 4.70 ± 0.87 mm, and 4.05 ± 0.89 mm for group I and II, respectively. Regarding vertical heights, obtained mean values were 4.75 ± 0.97 mm and 3.70 ± 0.92 mm for group I and group II, respectively. Conclusion: Within the limitations of this study, connective tissue graft proposed signifi cantly more improvement as compare to connective tissue graft in pouch. Key Words: Alveolar ridge augmentation, connective tissue graft, periodontal plastic surgery
... Studies have showed that a thick mucosa was associated with lesser mucosal recession, compared to a thin mucosa (Zigdon & Machtei 2008). The use of soft tissue volume augmentation is also indicated for aesthetic reasons and to facilitate oral hygiene (Pini-Prato et al. 2004). ...
Article
Full-text available
To systematically review changes in mucosal soft tissue thickness and keratinised mucosa width after soft tissue grafting around dental implants. An electronic literature search was conducted of the MEDLINE database published between 2009 and 2014. Sequential screenings at the title, abstract, and full-text levels were performed. Clinical human studies in the English language that had reported changes in soft tissue thickness or keratinised mucosa width after soft tissue grafting at implant placement or around a present implant at 6-month follow-up or longer were included. The search resulted in fourteen articles meeting the inclusion criteria: Six of them reported connective tissue grafting around present dental implants, compared to eight at the time of implant placement. Better long-term soft tissue thickness outcomes were reported for soft tissue augmentation around dental implants (0.8-1.4 mm), compared with augmentation at implant placement (-0.25-1.43 mm). Both techniques were effective in increasing keratinised tissue width: at implant placement (2.5 mm) or around present dental implants (2.33-2.57 mm). The present systematic review discovered that connective tissue grafts enhanced keratinised mucosa width and soft tissue thickness for an observation period of up to 48 months. However, some shrinkage may occur, resulting in decreases in soft tissue, mostly for the first three months. Further investigations using accurate evaluation methods need to be done to evaluate the appropriate time for grafting. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
... These resorption processes have a negative impact on the subsequent implant-based rehabilitation. By the targeted use of guided bone regeneration (GBR) techniques, it has been attempted for many years now to preserve the alveolar ridge in all its dimensions [11,13]. The most simple and, from an ontogenetic perspective, most physiological approach to the prevention of alveolar ridge resorption is to naturally preserve the inflammation-free dental root-if possible. ...
Article
Full-text available
After tooth extraction, the alveolar bone undergoes a remodeling process, which leads to horizontal and vertical bone loss. These resorption processes complicate dental rehabilitation, particularly in connection with implants. Various methods of guided bone regeneration (GBR) have been described to retain the original dimension of the bone after extraction. Most procedures use filler materials and membranes to support the buccal plate and soft tissue, to stabilize the coagulum and to prevent epithelial ingrowth. It has also been suggested that resorption of the buccal bundle bone can be avoided by leaving a buccal root segment (socket shield technique) in place, because the biological integrity of the buccal periodontium (bundle bone) remains untouched. This method has also been described in connection with immediate implant placement. The present case report describes three consecutive cases in which a modified method was applied as part of a delayed implantation. The latter was carried out after six months, and during re-entry the new bone formation in the alveolar bone and the residual ridge was clinically evaluated as proof of principle. It was demonstrated that the bone was clinically preserved with this method. Possibilities and limitations are discussed and directions for future research are disclosed.
... In a 25-year longitudinal study, it was discovered that 25% of total bone width accompanied by 4 mm of ridge height was lost in the first year after extraction. 3 In addition, a mean ridge volume loss of 40% to 60% was expected in the first 2 to 3 years after extraction. 1 It was also determined that horizontal bone loss occurred before vertical bone loss 3 and to a greater extent. 1 To counter the deterioration, various bone and softtissue augmentation techniques have been proposed. 4 In 1988, Dahlin et al. 5 were among the first to show, in a rat model, that the principle of guided tissue regeneration could be used to regenerate bone successfully. Guided bone regeneration (GBR) has been a well-accepted treatment modality because it has demonstrated predictable bone gain. ...
Article
Introduction: Horizontal ridge width reduction after tooth extraction is a common clinical scenario. As such, when implant-supported restorations are planned for tooth replacement, it is a challenge to regenerate adequate bone width to house the dental implant and ensure its long-term stability. Several horizontal ridge augmentation techniques, e.g. guided bone regeneration, ridge splitting, and block grafts, have been tested and proven to predictably augment bone width. Although these techniques are successful, treatment time is significantly increased and patients need to endure additional surgical procedures. Therefore, this case report aims at illustrating the ease and success of the sandwich bone augmentation technique when performed with dental implant placement. Case Presentation: A clinical case with a horizontally deficient ridge was selected. A buccal dehiscence was observed after placement of the dental implant in a prosthetically driven position. Autogenous bone graft harvested from the osteotomy site was placed on the exposed implant surface. Mineralized cancellous bone allograft was layered on, followed by a layer of mineralized cortical bone allograft. A collagen membrane was trimmed and used to contain the bone grafts as well as to exclude unwanted cells, such as epithelial cells and connective tissue fibroblasts. Tension-free primary closure was subsequently obtained. Six months later, mature regenerated bone was found on the buccal surface of the implant at surgical reentry. Conclusion: Simultaneous implant placement with the sandwich bone augmentation technique predictably regenerated bone on implant buccal dehiscence defects.
... Soft tissue augmentation procedures have widely been used for surgical correction of localized alveolar ridge defects, for pre-prosthetic site development and for ridge preservation (Seibert & Salama 1996;Studer et al. 2000). Several methods using autogenous grafts have been described for pontic site development in partially edentulous patients (Prato 2004; Thoma et al. 2009). These techniques include subepithelial connective tissue grafts (Garber & Rosenberg 1981), onlay grafts (Seibert 1983b), connective tissue pedicle grafts (Scharf & Tarnow 1992) and their modifications (Sclar 2003;Kim et al. 2012). ...
Conference Paper
Objective: The aim of this randomized controlled clinical trial was to test whether or not vascularized interpositional periosteal-connective tissue grafts are as successful as free subepithelial connective tissue grafts in augmenting volume defects of the alveolar process. Method: 17 subjects with Seibert class 1 ridge defects in the anterior maxilla were selected for the study. Patients were randomly distributed between the test vascularized interpositional periosteal-connective tissue graft group (T) and the control free subepithelial connective tissue graft group (C). Clinical periodontal parameters were recorded and conventional impressions were taken prior to surgery (baseline=t0) and 1, 3 and 6 months after surgery (t1, t3 and t6). The casts were optically scanned and digitally analyzed for volumetric changes in the augmented area. The data obtained were subjected to nonparametric Mann-Whitney U and Friedman tests. Result: The mean changes in labial distance between baseline and the 1, 3 and 6 months follow-up for the control group were 1.04 mm ± 0,35 (t0-t1), 1.06 mm ± 0.37 (t0-t3) and 0.66 mm ± 0.35 (t0-t6); and for test group 1.34 mm ± 0.49 (t0-t1), 1.25 mm ± 0.39 (t0-t3) and 1.23 mm ± 0.49 (t0-t6), respectively. Only the difference between groups at 6 months was statistically significant (p=0.036). No statistically significant difference was observed in any of the evaluated clinical periodontal parameters during the follow-up period between both groups (p<0.05). Conclusion: Vascularized interpositional periosteal-connective tissue grafts have been demonstrated to be as successful as free subepithelial connective tissue grafts in augmenting volume defects of the alveolar process. The pediculated connective tissue graft of the test group resulted in significantly less shrinkage and more soft tissue gain at 6 months.
... On the other hand, severe defects may require several surgical procedures or hard tissue augmentation. [5][6][7] Subepithelial connective tissue grafting appears to be superior in terms of volume gain, esthetics, and long-term stability compared with full-thickness free gingival grafts. 8 Nevertheless, little information is available regarding a combination of this type of graft with a minimally invasive pouch procedure without vertical incisions. ...
Article
Full-text available
The aim of this study was to describe a technique for the assessment of soft tissue volumetric and profilometric changes. The technique has been applied at the alveolar contour of mild to moderate horizontal ridge defects after soft tissue augmentation at pontic sites. A quantitative three-dimensional (3D) analysis based on laser scanning was used for the measurement of volume gain and horizontal changes of alveolar profile 5 months after a subepithelial connective tissue graft using a pouch approach in five patients. All the surgical sites healed uneventfully. A mean soft tissue volume increase of 35.9 mm3 was measured 5 months after the grafting procedure. The linear measurements showed that, in the area where the augmentation was performed, the distance between the preoperative vestibular profile and the postoperative one ranged from 0.16 to 2 mm. The described quantitative measurements based on 3D laser scanning appear to be an effective method for assessment of soft tissue changes in future studies. Additionally, within the limitation of a small sample size study, the present data suggest that the investigated surgical technique can be considered when corrections of mild to moderate alveolar horizontal ridge atrophies at maxillary lateral incisor edentulous gaps are necessary.
... Soft tissue augmentation procedures have widely been used for surgical correction of localized alveolar ridge defects, for pre-prosthetic site development and for ridge preservation (Seibert & Salama 1996;Studer et al. 2000). Several methods using autogenous grafts have been described for pontic site development in partially edentulous patients (Prato 2004; Thoma et al. 2009). These techniques include subepithelial connective tissue grafts (Garber & Rosenberg 1981), onlay grafts (Seibert 1983b), connective tissue pedicle grafts (Scharf & Tarnow 1992) and their modifications (Sclar 2003;Kim et al. 2012). ...
Article
Objectives To test whether or not vascularized interpositional periosteal-connective tissue grafts are as successful as free subepithelial connective tissue grafts in augmenting volume defects in the anterior maxilla.Material and methodsTwenty subjects with Seibert class 1 ridge defects in the anterior maxilla were randomly, equally assigned to augmentation by vascularized interpositional periosteal-connective tissue graft (test) or free subepithelial connective tissue graft (control). Clinical periodontal parameters at teeth adjacent to the gap were recorded, and conventional impressions were taken prior to surgery (baseline = t0) and 1 (t1), 3 (t3) and 6 (t6) months after surgery. The casts were optically scanned, digitized and analyzed for ridge contour changes in the augmented area. Data were subjected to nonparametric statistics.ResultsThe contour changes in labial distance between baseline and follow-up for the control group were (median, range) 1 mm, 0.37–1.45 (t0–t1); 1.18 mm, 0.39–1.40 (t0–t3); and 0.63 mm, 0.28–1.22 (t0–t6) and for test group 1.21 mm, 0.74–2.47 (t0–t1); 1.26 mm, 0.50–1.71 (t0–t3); and 1.18 mm, 0.16–1.75 (t0–t6). Significantly less shrinkage of the graft was observed in the test group after 6 months (P = 0.03). Clinical periodontal parameters at the neighboring teeth were stable over the follow-up period and did not differ between groups.Conclusions Augmentation of single tooth gaps with moderate ridge defects in the anterior maxilla was successfully performed using both techniques. However, after 6 months, sites treated by the pediculated graft were superior in maintaining the initially augmented volume and showed less shrinkage of the graft. This could be attributed to better perfusion of the pediculated graft.
... The installation of implants into sockets immediately after tooth extraction has further been advocated as a possible preventive procedure to reduce alveolar bone resorption (Pini Prato et al. 2004). However, it has clearly been demonstrated that bone resorption occurs irrespective of the simultaneous installation of an implant (e.g. ...
Article
Aim: To evaluate the soft tissue and the dimensional changes of the alveolar bony crest at sites where deproteinized bovine bone mineral (DBBM) particles, concomitantly with the placement of a collagen membrane, were used at implants installed into sockets immediately after tooth extraction. Material and methods: The pulp tissue of the mesial roots of 3 P 3 was removed in six Labrador dogs, and the root canals were filled. Flaps were elevated bilaterally, the premolars hemi-sectioned, and the distal roots removed. Recipient sites were prepared in the distal alveolus, and implants were placed. At the test sites, DBBM particles were placed in the residual marginal defects concomitantly with the placement of a collagen membrane. No treatment augmentation was performed at the control sites. A non-submerged healing was allowed. Impressions were obtained at baseline and at the time of sacrifice performed 4 months after surgery. The cast models obtained were analyzed using an optical system to evaluate dimensional variations. Block sections of the implant sites were obtained for histological processing and soft tissue assessments.
... This can be performed prior to implant placement, simultaneously with second stage surgery or post insertion of the final reconstruction. Moreover, in order to compensate for hard and soft tissue deficits in localized defects, soft tissue volume augmentation is mainly indicated for esthetic reasons and to facilitate oral hygiene in pontic areas (Seibert, 1983a, Pini-Prato et al., 2004. In these sites, the classic procedures include the use of free gingival grafts (FGG), subepithelial connective grafts (SCTG) and various types of roll and pedicle flaps (Seibert, 1983b, Studer et al., 2000, Batista et al., 2001, Cho, 1998, Breault et al., 2004. ...
Article
To review the dental literature in terms of efficacy of soft tissue augmentation procedures around dental implants and in partially edentulous sites. A Medline search was performed for human studies augmenting keratinized mucosa (KM) and soft tissue volume around implants and in partially edentulous areas. Due to heterogeneity in between the studies, no meta-analyses could be performed. Nine (KM) and eleven (volume) studies met the inclusion criteria. An apically positioned flap/vestibuloplasty (APF/V) plus a graft material [free gingival graft (FGG)/subepithelial connective tissue graft (SCTG)/collagen matrix (CM)] resulted in an increase of keratinized tissue (1.4-3.3 mm). Statistically significantly better outcomes were obtained for APF/V plus FGG/SCTG compared with controls (APF/V alone; no treatment) (p < 0.05). For surgery time and patient morbidity, statistically significantly more favourable outcomes were reported for CM compared to SCTGs (p < 0.05) in two randomized controlled clinical trials (RCTs), even though rendering less keratinized tissue. SCTGs were the best-documented method for gain of soft tissue volume at implant sites and partially edentulous sites. Aesthetically at immediate implant sites, better papilla fill and higher marginal mucosal levels were obtained using SCTGs compared to non-grafted sites. An APF/V plus FGG/SCTG was the best-documented and most successful method to increase the width of KM. APF/V plus CM demonstrated less gain in KM, but also less patient morbidity and surgery time compared to APF/V plus SCTG based on two RCTs. Autogenous grafts (SCTG) rendered an increase in soft tissue thickness and better aesthetics compared to non-grafted sites.
... To achieve a good prosthetic emergence profile, several of the surgical techniques that have been described can be used in the different stages of an implant treatment. [8][9][10][11] Careful surgical handling of the soft tissues when exposing the implants and placing the healing abutments (second surgery), helps with obtaining the best possible results. 12 But even so, there is a loss of volume of the tissues as they become weaker and more rigid after each procedure. ...
Article
Full-text available
It is currently accepted that success in implant-supported restorations is based not only on osseointegration, but also on achieving the esthetic outcome of natural teeth and healthy soft tissues. The socalled "pink esthetic" has become the main challenge with implant-supported rehabilitations in the anterior area. This is especially difficult in the cases with two adjacent implants. Two components affect the final periimplant gingiva: a correct bone support, and a sufficient quantity and quality of soft tissues. Several papers have emphasized the need to regenerate and preserve the bone after extractions, or after the exposure of the implants to the oral environment. The classical implantation protocol entails entering the working area several times and always involves the surgical manipulation of peri-implant tissues. Careful surgical handling of the soft tissues when exposing the implants and placing the healing abutments (second surgery) helps the clinician to obtain the best possible results, but even so there is a loss of volume of the tissues as they become weaker and more rigid after each procedure. The present study proposes a new protocol that includes the connective tissue graft placement and the soft tissues remodeling technique, which is based on the use of the ovoid pontics. This technique may help to minimize the logical scar reaction after the second surgery and to improve the final emergence profile.
... Soft tissue augmentation with autogenous grafts is a widely used procedure in a variety of disciplines in dentistry. [1][2][3] The most common surgical approach to increase the soft tissue volume involves the autogenous subepithelial connective tissue graft. 4,5 Autogenous grafting procedures present several disadvantages, mainly resulting from the harvesting procedure, which lead to increased patient morbidity. ...
Article
Full-text available
Autogenous soft tissue augmentation procedures around natural teeth and dental implants are performed daily by clinicians. However, patient morbidity is often associated with the second surgical site; hence, research is moving toward an era where matrices may substitute autogenous grafts. The aim of this study was to assess the soft tissue response to a collagen matrix in an animal model. Nine pigs were included in this study. Each animal received four collagen matrices, two for each mandible. Three cohorts were included in the study: group A, where the matrix was applied as an onlay on a partial-thickness flap; group B, where the matrix was inserted under a partial-thickness flap; and group C, where the matrix was inserted in an inverted position under a full-thickness flap. Sacrifice occurred at 7, 15, and 30 days postoperatively for histologic assessment. The collagen matrix was seen in place for the first 2 weeks, and it was completely replaced by healthy connective tissue within 30 days in the inlay cohorts. No inflammatory adverse reactions were noticed in any specimen, resulting in optimal integration of the device. This study showed an optimal integration within 30 days postoperative of the placement of experimental collagen matrix in the soft tissues of an animal model. Its proven safety in this model provides an optimal starting point for further research projects considering its clinical applications.
... It is indicated in partially and fully edentulous patients to increase the soft tissue volume around dental implants predominantly for aesthetic reasons (Bichacho 1998, Price & Price 1999, Kinsel & Capoferri 2008. In addition, autogenous soft tissue grafting procedures have also been proposed to surgically correct localized alveolar defects, as pre-prosthetic site development, and as ridge preservation procedures (Seibert 1983, Studer et al. 2000, Jung et al. 2004, Prato et al. 2004, Fickl et al. 2009b. ...
Article
The aim was to test, whether or not soft tissue volume augmentation with a specifically designed collagen matrix (CM), leads to ridge width gain in chronic ridge defects similar to those obtained by an autogenous subepithelial connective tissue graft (SCTG). In six dogs, soft tissue volume augmentation was performed by randomly allocating three treatment modalities to chronic ridge defects [CM, SCTG and sham-operated control (Control)]. Dogs were sacrificed at 28 (n = 3) and 84 days (n = 3). Descriptive histology and histomorphometric measurements were performed on non-decalcified sections. SCTG and CM demonstrated favourable tissue integration, and subsequent re-modelling over 84 days. The overall mean amount of newly formed soft tissue (NMT) plus bone (NB) amounted to 3.8 ± 1.2 mm (Control), 6.4 ± 0.9 mm (CM) and 7.2 ± 1.2 mm (SCTG) at 28 days. At 84 days, the mean NMT plus NB reached 2.4 ± 0.9 mm (Control), 5.6 ± 1.5 mm (CM) and 6.0 ± 2.1 mm (SCTG). Statistically significant differences were observed between CM/SCTG and Control at both time-points (p < 0.05). Within the limits of this animal model, the CM performed similar to the SCTG, based on histomorphometric outcomes combining NB and NMT.
... tissue grafts, always keeping in mind the importance of preserving or recovering the initial pre-extraction tissue volume. 8,9 Despite the use of such techniques, the magnitude of bone loss after extraction of the four maxillary incisors may cause the anterior maxillary arch to lose its convexity and become straight. When this occurs, it may be difficult to place prosthetically guided implants, which should be the objective to guarantee an esthetic end result. ...
Article
Full-text available
Patients do not view dental implants as an object of desire but seek a way to replace teeth that will be as cost-effective and minimally traumatic as possible. Nowadays, anterior fixed partial dentures can provide an esthetic result that is difficult to distinguish from the natural dentition. Consequently, any implant-supported prosthesis will be compared to the esthetic and functional standards set by conventional tooth-supported restorations. The restoration of the four maxillary incisors by means of an implant-supported prosthesis is one of the most challenging situations in implant dentistry. The questions of how many implants should be placed and where they should be positioned are especially important for achieving a superior end result. This article proposes and describes the placement of two platform-switched implants in the central incisor positions as a means of achieving the correct biomechanical behavior of the prosthesis, along with the best possible esthetic results.
... It is indicated in partially and fully edentulous patients to increase the soft tissue volume around dental implants predominantly for esthetic reason (Kinsel and Capoferri 2008, Bichacho 1998, Price & Price 1999). In addition, autogenous soft tissue grafting procedures have also been proposed to surgically correct localized alveolar defects, as pre-prosthetic site-development, and as ridge preservation procedures (Jung et al. 2004, Prato et al. 2004, Seibert 1983, Studer et al. 2000, Fickl et al. 2009b). ...
Article
The aim was to test whether or not soft tissue augmentation with a newly developed collagen matrix (CM) leads to volume gain in chronic ridge defects similar to those obtained by an autogenous subepithelial connective tissue graft (SCTG). In six dogs, soft tissue volume augmentation was performed by randomly allocating three treatment modalities to chronic ridge defects (CM, SCTG, sham-operated control). Impressions were taken before augmentation (baseline), at 28, and 84 days. The obtained casts were optically scanned and the images were digitally analysed. A defined region of interest was measured in all sites and the volume differences between the time points were calculated. The mean volume differences per area between baseline and 28 days amounted to a gain of 1.6 mm (CM; SD+/-0.9), 1.5 mm (SCTG; +/-0.1), and a loss of 0.003 mm (control; +/-0.3). At 84 days, the mean volume differences per area to baseline measured a gain of 1.4 mm (CM; +/-1.1), 1.4 mm (SCTG; +/-0.4), and a loss of 0.3 mm (control; +/-0.3). The differences between CM and SCTG were statistically significant compared with control at 28 and 84 days (p<0.001). Within the limits of this animal study, the CM may serve as a replacement for autogenous connective tissue.
... mit einer konventionellen dreigliedrigen Brücke vorgesehen. Es wurde beschlossen, die Alveolarkammdefekte mit der Augmentation durch Weichgewebe zu kompensieren (Prato et al. 2004;Seibert & Louis 1996). Das SBGT stellt den Goldstandard für Augmentation von Weichgewebsvolumen dar (Bienz et al. 2017). ...
Article
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The present article illustrates treatment options after implant removal (explantation) as a result of peri-implantitis in the anterior maxilla. After explantation of a dental implant in the anterior maxilla, the esthetical as well as functional rehabilitation is a demanding undertaking, especially, if removable prosthetic treatment options are undesirable. The present article illustrates that depending on individual patient's demands, different treatment options might be considered. However, in order to achieve aesthetically pleasing outcomes by means of fixed partial dentures (FDPs), the practitioner as well as the patient have to adapt oneself to a complex, time-consuming, and multiphasic therapy. Therefore, a comprehensive planning and systematic approach represent a mandatory prerequisite.
... 6,7 It was suggested that expected aesthetic outcomes of implant therapy may be enhanced by manipulating or augmenting peri-implant soft tissues using periodontal plastic surgery. 8 In addition, several factors such as presence of pre-existing ridge deformities, quality and quantity of soft tissue over the ridge 9 and surgical strategies in implant placement/ uncovering were considered to be related to the final aesthetic outcomes of implant therapy. 10 The increasing demand over the years for highly esthetic results in all facets of dentistry has also influenced dental implants and has made achieving optimal esthetic results more challenging for the implant specialist and subsequently led to a greater consideration and study of all the contributing factors, both at the micro-and macroscopical level to achieve such a result. ...
... Immediately following tooth extraction, biological processes are initiated, which can lead to bone resorption and result in localized alveolar ridge defects (Araujo & Lindhe 2009, Van der Weijden et al. 2009). A number of surgical techniques were proposed to correct localized alveolar defects (Prato et al. 2004). Depending on the dimension and the location of the site and depending on the restorative treatment planning, the use of bone augmentation (Aghaloo & Moy 2007, Chiapasco et al. 2009, Jensen & Terheyden 2009, Milinkovic & Cordaro 2014 as well as soft tissue augmentation (Esposito et al. 2012, Eghbali et al. 2016De Bruyckere et al. 2015 or a combination of both procedures (Schneider et al. 2011 have been reported. ...
Article
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Aim: To test whether or not the use of a collagen matrix (VCMX) results in short-term soft tissue volume increase at implant sites non-inferior to an autogenous subepithelial connective tissue graft (SCTG) and, to evaluate safety and tissue integration of VCMX and SCTG. Methods: In 20 patients with a volume deficiency at single-tooth implant sites, soft tissue volume augmentation was performed randomly allocating VCMX or SCTG. Soft tissue thickness, patient-reported outcome measures (PROMs), and safety were assessed up to 90 days (FU-90). At FU-90 (abutment connection), tissue samples were obtained for histological analysis. Descriptive analysis was computed for both groups. Nonparametric tests were applied to test non-inferiority for the gain in soft tissue thickness at the occlusal site. Results: Median soft tissue thickness increased between BL and FU-90 by 1.8mm (Q1:0.5;Q3:2.0) (VCMX) (p=0.018) and 0.5mm (-1.0;2.0) (SCTG) (p=0.0.395) (occlusal) and by 1.0mm (0.5;2.0) (VCMX) (p=0.074) and 1.5mm (-2.0;2.0) (SCTG) (p=0.563) (buccal). Non-inferiority with a non-inferiority margin of 1mm could be demonstrated (p=0.020), the difference of the two group medians (1.3mm) for occlusal sites indicated no relevant, but not significant superiority of VCMX vs. SCTG (primary endpoint). Pain medication consumption and pain perceived were non-significantly higher in group SCTG up to day 3. Median physical pain (OHIP-14) at day 7 was 100% higher for SCTG than for VCMX. The histological analysis revealed well-integrated grafts. Conclusions: Soft tissue augmentation at implant sites resulted in a similar or higher soft tissue volume increase after 90 days for VCMX vs. SCTG. PROMs did not reveal relevant differences between the two groups. This article is protected by copyright. All rights reserved.
... Soft tissue augmentation is mainly indicated for both aesthetic reasons and good oral hygiene. 24 Besides the necessity of keratinized tissue presence, the best way for increasing keratinized tissue width is autogenous grafts such as FGG or SCTG procedures. The main disadvantage of autogenous tissue graft procedures are the morbidity associated with donor site and the subsequent healing process. ...
Article
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Objective: Long-term edentulousness causes big alterations in mandible such as keratinized tissue is reduced or lost and vestibular sulcus becomes too shallow. As a consequence, free gingival autograft is usually mandatory. The aim of this case report was to evaluate the effect of diode laser bio-stimulation on FGG procedure around dental implants in edentulous patients. Material and Methods: Three edentulous female patients (59 and 64 and 79 years old) were referred to our department in different time periods. All patients had serious alveolar bone loss because of prolonged edentulism. In clinical and radiographical examinations, it is observed that patients had lack of keratinized tissue around 6 dental implants placed in mandibular canine positions. The healing caps had been placed and there were severe soft tissue problems and disorientations and also ulcerations around healing caps. Patients were really uncomfortable and in pain because of ulcerated mucosa. Conventional vestibuloplasty and gingivectomy procedures were performed in one patient. The problem continued, lips covered healing caps again and patient was suffering from the pain again. After then in order to reduce the pain and stimulate soft tissue healing, diode laser biostimulation were performed in all three patients along with the FGG procedure. Totally six FGG procedures were performed in three patients. Results: Mild pain was observed in donor site and other than that there was no pain or discomfort in all patients. After 30 days, the keratinized tissues around dental implants were increased and the discomfort and pain were gone. Healing caps were placed again and the patients were treated successfully. Conclusion: Diode laser bio-stimulation reduced the post-surgical pain and discomfort caused by FGG procedure around dental implants in elderly patients.
... Tooth replacement by means of dental implants is considered to be a predictable procedure in modern dentistry [1] . A key factor in predictably achieving good aesthetic and functional results in anterior restorations is to preserve or regain adequate tissue volume at the implant level [2] . From the point of view of soft tissues, several surgical techniques have been proposed to correct localised alveolar defects [3,4] . ...
Article
Full-text available
Soft tissue augmentation at the implant site is one of several techniques suggested in the case of soft and hard tissue deficiency after implant rehabilitation. The gold standard in this procedure is connective tissue graft (CTG), which is considered an autologous material with a high proliferative pattern. Today, several collagen matrices (VCMXs) are on the market as CTG substitutes and are recommended for this type of procedure. The aim of this case report is to compare the resorption process and the volume gain of two potential collagen matrices (VCMXA and VCMXB) of porcine origin for soft tissue augmentation around single implants. 3D analysis with dedicated software (GOM inspect® Braunschweig, Germany) was performed to understand the volumetric and surface changes on the vestibular aspect and the amount of resorbed biomaterial at 7 days from the surgery and at 3 months of follow up. Considering the limitation of the four included patients and the different surgical sites (13 and 17 for VCMXA and 26 and 25 for VCMXB), both VCMXs showed interesting results with respect to the baseline at 7 days (VCMXA gain, + 2.93 ± 1.65 mm; VCMXB, + 2.58 ± 1.11 mm); however, after 3 months of follow up, an important remodelling process was present in both treated sites (VCMXA, + 2.00 ± 0.99 mm; VCMXB, + 0.41 ± 0.73 mm). Soft tissue augmentation at the implant site resulted in a similar increase in volume for both the matrices. On the other hand, VCMXA seemed to preserve more volume at 3 months. Future randomised clinical trials are needed to confirm these results
... However, a systematic review has shown that about 7.1% of end osseous dental implants present soft tissue complications at 5 years of follow-up [3]. To avoid soft tissue complications, prevention and treatment of alveolar ridge deformities should be performed prior to implant placement in order to preserve or reconstruct the hard and soft tissue anatomy [4]. Moreover, the lack of Keratinized Tissue Width (KTW) can lead to plaque accumulation which increases the risk of peri-implantitis development [5,1]. ...
Article
Full-text available
Clinical classifications of the main mucogingival conditions around natural teeth and their treatments are largely reported in the literature. With the increased use of dental implants, peri-implant soft tissue complications may also be encountered. However, there is lack of information regarding the most appropriate treatment methods for soft tissue deficiencies around dental implants. This narrative review discusses the various clinical situations where soft tissue grafting at implant sites is required. A review of all available literature was performed and a decision tree for soft tissue grafting around implants was developed. The purpose is to provide a general guidance for clinicians in selecting the appropriate treatment for the management of peri-implant soft tissue deficiencies. The decision tree takes into consideration the aim of the treatment and illustrates different techniques according to the most recent literature. Furthermore, considerations on etiological factors for peri-implant soft tissue deficiencies are discussed. To the knowledge of the authors, there is no other manuscript that proposes surgical management of peri-implant soft tissue deficiencies at different stages of implant therapy.
... Dentistry discipline is focused on the prevention, diagnosis, and treatment of oral diseases and disorders and maintenance of oral health [3,[20][21][22]. This clinical activity is centered on hard and soft tissues, oral mucosa, teeth, maxillofacial bones, temporomandibular, and other supporting structures [23][24][25][26]. ...
Article
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Background: The academic scientific research in the field of dentistry has rapidly increased in the last 20 years under the pressure of the multidisciplinary technological advancements and the growing demand for new predictable and cost-effective techniques and materials. The aim of the present investigation was to analyze the academic scientific production conducted by Italian Academies and Dental Schools. Methods: The list of MED/28 academic researchers, associate and full professors, and academic affiliations was collected from the national database of CINECA to evaluate the scientific output of the Italian Universities. The complete list of scientific contributions and the bibliometric parameters were recorded in the Scopus database. Results: The scientific production of 37 Italian Universities, 416 researchers, and 23689 papers was evaluated. The measurement of total academic papers, citations, h-index, and relative citation ratio (RCR) was calculated. The study data showed an increase of the academic scientific production over the last 5 years. Conclusions: The results presented show how scientific research is increasingly pursued by dental clinicians.
... Entretanto, para o sucesso da ROG, o uso das membranas deve estar associado aos biomateriais de preenchimento 17 . Para que ocorra uma neoformação óssea completa, é fundamental que haja fonte de células osteogênicas e osso viável adjacente ao defeito, que exista uma fonte adequada de vascularização, que o local da ferida permaneça mecanicamente estável durante o processo de cicatrização e que um espaço apropriado seja mantido entre a membrana e a superfície óssea de origem 18 . ...
Article
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RESUMO O enxerto em bloco autólogo é considerado como o padrão-ouro para a reconstrução horizontal e / ou vertical das áreas anteriores. No entanto, avanços dos biomateriais e técnicas clínicas levaram a incorporação da regeneração óssea guiada (ROG) como uma alternativa potencial em casos onde a área doadora é deficiente e as vezes até mesmo ausentes. Desde a década de 1970 o conceito da ROG, consiste em impedir a migração de células indesejadas através da adaptação de uma membrana na área onde se necessita da regeneração óssea, assim o enxerto ósseo fica estável, evita se o colapso dos tecidos moles no defeito, e a migração de células não osteogênicas para o local acumulando fatores de crescimento. URBAN em 2011 através da ROG adicionou um potencial regenerativo na técnica onde se nomeou em técnica de Sausage baseado na associação de osso autógeno e osso heterógeno na proporção de 1:1 que são misturados e colocados sobre o defeito ósseo e recoberto com uma membrana. Esta técnica trouxe uma alternativa segura em casos onde não possuíamos área doadoras suficientes para utilizarmos a técnica de bloco autógeno. O objetivo deste artigo foi descrever um caso clínico onde utilizamos a técnica de Urban para a RGO na área vestibular anterior utilizando osso autógeno particulado associado ao osso heterógeno BIOSS na proporção de 1:1 e uma membrana reabsorvível; em um paciente com área doadora deficiente. Palavras-chave: Regeneração óssea. ROG. Membrana. Enxerto ósseo. Técnica sausage. ABSTRACT The autologous block graft is considered the gold standard for horizontal and / or vertical reconstruction of anterior areas. However, advances in biomaterials and clinical techniques have led to the incorporation of guided bone regeneration (ROG) as a potential alternative in cases where the donor area is deficient and sometimes even absent. Since the 1970s, the concept of ROG has been to prevent the migration of unwanted cells through the adaptation of a membrane in the area where bone
... To place an implant into the alveolar bone, it is imperative to have a sound and stable foundation of bone. Alveolar ridge deformities are very common and may arise due to several causes, including periodontal disease, traumatic extraction, periapical lesions and implant failure 1 . ...
Article
Full-text available
Alveolar ridge deformities can be caused by several factors. Managing alveolar deformities prior to implant placement is essential to increase bone width, height or both. Several techniques and materials are now available to perform ridge augmentation procedures. The postoperative exposure of the membrane is the most frequent postoperative complications of ridge augmentation procedures. The present case describes the horizontal ridge augmentation procedure and the outcome of surgical attempt to manage post-operative membrane exposure, and shows the unpredictability of managing postoperative membrane exposure surgically.
... The graft obtained was partially de-epithelialized and the exposed connective tissue was inserted in the pouch area like a wedge (inlay graft). Thus, the epithelialized part of the graft remained outside the pouch and sutured at the level of the epithelial surface of the surrounding tissues (14,17,19,28,29). ...
Article
Loss of dentition leads to functional and esthetic challenges that are determined by the anatomic features of the edentulous area. These features can complicate the prosthetic rehabilitation of such patients, especially in situations where optimal esthetic outcomes are desired. For these reasons, reconstructive plastic surgery procedures, aimed at restoring the alveolar ridge to its former dimensions, have become of great clinical interest. These reconstructive plastic surgery procedures frequently involve soft-tissue augmentation, performed to improve the quality and quantity of mucogingival tissue with the aim to achieve an ideal esthetic result. This review will focus on the description and expected outcomes of different surgical techniques for soft-tissue augmentation in edentulous areas, as described in the literature. Although more information from a larger number of studies and randomized controlled clinical trials is needed, it is possible to draw some conclusions, namely: pouch procedures are the first choice for soft-tissue augmentation, especially in high-demand esthetic areas; roll techniques are possible in shallow buccolingual soft-tissue augmentations; and onlay, inlay and combination grafts are less suitable for soft-tissue augmentation because of their poor esthetic results.
... Compromisos mucogingivales como recesiones de Miller clases I y II, pueden ser corregidas con alta predictibilidad antes del inicio de las preparaciones, diferentes técnicas mucogingivales han sido evaluadas para el manejo de estos defectos, siendo el colgajo posicionado coronal con injerto de tejido conectivo el de mayor éxito para el cubrimiento de recesiones (55). Los defectos de rebordes en zonas con compromiso estético también debe de ser corregidos previo a la realización de prótesis fija definitiva, atrofias de reborde Seibert clase I, II o III son sujetos de técnicas quirúrgicas periodontales que permiten el aumento de rebordes con tejidos blandos o duros (56,57), y el empleo de provisionales que, con el desarrollo de pónticos ovoides, favorecen los perfiles de emergencia de la restauración. ...
Article
Full-text available
One of the major successes in prosthodontics is the accuracy of the final restoration toensure the survival of the prosthesis, the precise reproduction of the preparation margins in impressions is a need for good quality marginal requirement. That's why the technique and impression materials, as well as the management of periodontal tissues are key in achieving success. Understanding the properties of each of the materials used for the impression making process and the timely diagnosis of previous periodontal condition (health, disease, periodontal biotype), and techniques available to the retraction or displacementof the gingival tissues, provide clinicians the tools necessary for making decisions and achieving the best aesthetic and functional results in fixed prosthesis. The purpose of this topic review is to propose a series of recommendations for clinical restorative from the periodontal approach, which to establish protocols for the diagnosis, planning and execution of their clinical cases, knowing the current techniques of gingival displacement and takes impression and its effects on the periodontium.
... Harvesting-free gingival graft (FGG) and subepithelial connective tissue graft (SCTG) have been the standard techniques used to increase soft-tissue volume [1,2]. Soft-tissue augmentation can be indicated in many conditions such as localized ridge defects, ridge preservation and as preprosthetic surgical technique [1][2][3][4]. Despite the anatomical and individual limitations that might hinder autogenous soft-tissue grafting, the common drawbacks of using autogenous tissue are generally due to the harvesting procedure and the prolonged healing time needed for the donor site which increases the patient's morbidity [5,6]. ...
Article
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Objective: Autogenous soft-tissue grafting is a commonly used procedure nowadays in dentistry. However, the prolonged healing time needed for the donor site leads to increase the patient’s pain and discomfort. Statin has been observed to be beneficial in reducing bacterial burden, improving epithelization and wound healing. The aim of this study was to evaluate intra-oral topical application of simvastatin/chitosan gel (10 mg/mL) over the palatal donor site following free gingival graft (FGG) procedure. Material and methods: Subjects indicated for FGG procedure were divided into four groups. Group I: Simvastatin suspension (S), group II: simvastatin/chitosan gel (SC), group III: chitosan gel (C), group IV: petroleum gel (P). Treatment was applied three times/day for the following 7 days. Wound healing was evaluated at day 3, 7 and 14 post-surgery. A visual analogue scale (VAS) was used to measure the experienced discomfort at 1, 3, 5, 7 and 14 days. Results: Statistical significant reduction in wound-healing scores was observed after 3 and 7 days for group II compared to other groups (p = .015). A significant reduction was also observed in VAS score for group II compared to other groups at day 1, 3, 5 and 7. Conclusion: Topical application of S/C gel could be used as a novel therapeutic modality that improved healing and reduced pain in the palatal donor site following FGG procedure.
... As for the augmentation of keratinized tissue, traditionally, the free gingival graft and the sub epithelial connective tissue graft have been described to increase soft tissue volume. Disadvantages of using autogenous tissue are mainly due to the harvesting procedure, which leads to a prolonged healing time at the donor site and therefore to an increased patient's morbidity [12] . In order to overcome these issues with autogenous tissue, alternatives techniques and materials of allogenic origin have been developed -acellular dermal matrix graft (ADMG; Alloderm™, Life Cell Corporation, The Woodlands, TX), human fibroblastderived dermal substitute (HF-DDS, Dermagraft, Advanced Tissue Sciences, Inc., LaJolla, CA, USA), and ahuman skin equivalent (BCT, Apligraf, Organogenesis, Canton, MA, USA). ...
Data
Full-text available
... As for the augmentation of keratinized tissue, traditionally, the free gingival graft and the sub epithelial connective tissue graft have been described to increase soft tissue volume. Disadvantages of using autogenous tissue are mainly due to the harvesting procedure, which leads to a prolonged healing time at the donor site and therefore to an increased patient's morbidity [12] . In order to overcome these issues with autogenous tissue, alternatives techniques and materials of allogenic origin have been developed -acellular dermal matrix graft (ADMG; Alloderm™, Life Cell Corporation, The Woodlands, TX), human fibroblastderived dermal substitute (HF-DDS, Dermagraft, Advanced Tissue Sciences, Inc., LaJolla, CA, USA), and ahuman skin equivalent (BCT, Apligraf, Organogenesis, Canton, MA, USA). ...
Article
Full-text available
Abstract: Soft tissue augmentation with autogenous grafts is widely used in various disciplines of dentistry. Indicated in partially and fully edentulous patients to augment areas with reduced width of keratinized gingiva, as well as to increase soft tissue volume. The following case report describes an unusual presentation of preprosthetic surgery, where ridge reconstruction was done using a free gingival auto graft. Keywords: Ridge reconstruction, vestibuloplasty, free gingival graft, soft tissue augmentation, pre-prosthetic surgery
... Compromisos mucogingivales como recesiones de Miller clases I y II, pueden ser corregidas con alta predictibilidad antes del inicio de las preparaciones, diferentes técnicas mucogingivales han sido evaluadas para el manejo de estos defectos, siendo el colgajo posicionado coronal con injerto de tejido conectivo el de mayor éxito para el cubrimiento de recesiones (55). Los defectos de rebordes en zonas con compromiso estético también debe de ser corregidos previo a la realización de prótesis fija definitiva, atrofias de reborde Seibert clase I, II o III son sujetos de técnicas quirúrgicas periodontales que permiten el aumento de rebordes con tejidos blandos o duros (56,57), y el empleo de provisionales que, con el desarrollo de pónticos ovoides, favorecen los perfiles de emergencia de la restauración. ...
Article
Full-text available
One of the major successes in prosthodontics is the accuracy of the final restoration to ensure the survival of the prosthesis, the precise reproduction of the preparation margins in impressions is a need for good quality marginal requirement. That’s why the technique and impression materials, as well as the management of periodontal tissues are key in achieving success. Understanding the properties of each of the materials used for the impression making process and the timely diagnosis of previous periodontal condition (health, disease, periodontal biotype), and techniques available to the retraction or displacement of the gingival tissues, provide clinicians the tools necessary for making decisions and achieving the best aesthetic and functional results in fixed prosthesis. The purpose of this topic review is to propose a series of recommendations for clinical restorative from the periodontal approach, which to establish protocols for the diagnosis, planning and execution of their clinical cases, knowing the current techniques of gingival displacement and takes impression and its effects on the periodontium.
... As for the augmentation of keratinized tissue, traditionally, the free gingival graft and the sub epithelial connective tissue graft have been described to increase soft tissue volume. Disadvantages of using autogenous tissue are mainly due to the harvesting procedure, which leads to a prolonged healing time at the donor site and therefore to an increased patient's morbidity [12] . In order to overcome these issues with autogenous tissue, alternatives techniques and materials of allogenic origin have been developed -acellular dermal matrix graft (ADMG; Alloderm™, Life Cell Corporation, The Woodlands, TX), human fibroblastderived dermal substitute (HF-DDS, Dermagraft, Advanced Tissue Sciences, Inc., LaJolla, CA, USA), and ahuman skin equivalent (BCT, Apligraf, Organogenesis, Canton, MA, USA). ...
Data
Full-text available
Soft tissue augmentation with autogenous grafts is widely used in various disciplines of dentistry. Indicated in partially and fully edentulous patients to augment areas with reduced width of keratinized gingiva, as well as to increase soft tissue volume. The following case report describes an unusual presentation of pre-prosthetic surgery, where ridge reconstruction was done using a free gingival autograft.
... Differences in the outcomes of the various studies might be due to the variation in several associated factors, that can alter the extent of dimension gain after soft tissue grafting procedure, like patient selection, defects characteristics, data collection, biochemical characteristics of grafted materials, surgical variation, and patient attitude towards the treatment. [20] CONCLUSION Within the limitations of this study, modifi ed connective tissue graft is a better option as compared to subepithelial connective tissue in pouch for the treatment of alveolar ridge defi ciency. ...
Article
Full-text available
Background: Localized alveolar ridge defect may create physiological and pathological problems. Developments in surgical techniques have made it simpler to change the configuration of a ridge to create a more aesthetic and more easily cleansable shape. The purpose of this study was to compare the efficacy of alveolar ridge augmentation using a subepithelial connective tissue graft in pouch and modified connective tissue graft technique. Materials and methods: In this randomized, double blind, parallel and prospective study, 40 non-smoker individuals with 40 class III alveolar ridge defects in maxillary anterior were randomly divided in two groups. Group I received modified connective tissue graft, while group II were treated with subepithelial connective tissue graft in pouch technique. The defect size was measured in its horizontal and vertical dimension by utilizing a periodontal probe in a stone cast at base line, after 3 months, and 6 months post surgically. Analysis of variance and Bonferroni post-hoc test were used for statistical analysis. A two-tailed P < 0.05 was considered to be statistically significant. Results: Mean values in horizontal width after 6 months were 4.70 ± 0.87 mm, and 4.05 ± 0.89 mm for group I and II, respectively. Regarding vertical heights, obtained mean values were 4.75 ± 0.97 mm and 3.70 ± 0.92 mm for group I and group II, respectively. Conclusion: Within the limitations of this study, connective tissue graft proposed significantly more improvement as compare to connective tissue graft in pouch.
Chapter
This chapter discusses the proper selection of numerous techniques that must be based on the predictability of success that, in turn, is based on the criteria. Periodontal plastic surgical procedures should be performed in a plaque-free and inflammation-free environment to enable firm gingival tissue management. Maximum blood supply to the donor tissue is essential. Gingival augmentation apical to the area of recession benefits from a better blood supply than coronal augmentation because the recipient bed is entirely vascular (periosteum). The anatomy of the recipient and donor sites is an important consideration in selecting the proper technique. The presence or absence of vestibular depth is an essential anatomical criterion at the recipient site for gingival augmentation. Good anastomosis of the blood vessels from the grafted donor tissue to the recipient site requires a stable environment. This necessitates sutures that stabilize the donor tissue firmly against the recipient site.
Chapter
The definition of a “successful implant” has evolved over the years to include, beyond functional utility, high esthetic outcomes. Nowadays, a definition of a successful dental implant includes, among others, the patient’s and clinician’s esthetic satisfaction, which is achieved by a restoration that is in harmony with the surrounding teeth and tissues [1]. The final restoration should match the size, form, and color of the adjacent teeth and be framed by soft tissues consistent in color, shape, and texture [2] (Fig. 2.1).
Article
Useful in a variety of oral surgery procedures, piezosurgery has therapeutic features that include a micrometric cut (precise and secure action to limit tissue damage, especially to osteocytes), a selective cut (affecting mineralized tissues, but not surrounding soft tissues), and a clear surgical site (the result of the cavitation effect created by an irrigation/cooling solution and oscillating tip). Because the instrument's tip vibrates at different ultrasonic frequencies, since hard and soft tissues are cut at different frequencies, a selective cut enables the clinician to cut hard tissues while sparing fine anatomical structures (e.g., schneiderian membrane, nerve tissue). An oscillating tip drives the cooling-irrigation fluid, making it possible to obtain effective cooling as well as higher visibility (via cavitation effect) compared to conventional surgical instruments (rotating burs and oscillating saws), even in deep spaces. As a result, implantology surgical techniques such as bone harvesting (chips and blocks), crestal bone splitting, and sinus floor elevation can be performed with greater ease and safety.
Article
We report a case in which a series of connective tissue grafts were used to functionally and esthetically augment an alveolar ridge defect in the maxillary incisor area, which was subsequently treated with a fixed prosthesis. A 54-year-old woman presented with the chief complaint of gingival swelling in the maxillary anterior region. A significant gingival defect was observed, possibly due to the extraction of tooth #11 with a hopeless prognosis. The defect was classified as Seibert Class I, and was causing a psychologically negative effect on the patient. Correction of this deformity was necessary in order to place an appropriate fixed prosthesis. Periodontal plastic surgery employing a connective tissue graft was performed, although the initial outcome was not optimal. A total of four consecutive gingival augmentations were performed in order to obtain a better functional outcome and patient satisfaction. The clinical condition remained uneventful during the one year maintenance period. In Japan, the need for gingival augmentation is not yet so overt. However, demands for esthetic reconstruction and ease of maintenance care are growing. Although gingival augmentation is an important modality for long-term stability of the periodontal environment, appropriate diagnosis and treatment planning aimed at a clear treatment outcome are necessary. Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 56(2):209-216, 2014.
Chapter
The indications of alveolar ridge defects occur when the loss of substance compromises the positive outcome of a prosthetic restoration. This is particularly true in the aesthetic zone, and most of the time is caused by periodontal disease, careless tooth extraction, chronic infection, implant failure, congenital diseases, trauma, or neoplasm. In certain specific cases, procedures such as edentulous ridge expansion (ERE), distraction osteogenesis, and orthodontic treatment can be performed in conjunction with or in lieu of grafting. The hard tissue graft used will depend on the extent and severity of the defect and on the type of prosthetic restoration that will follow. The soft tissue graft technique is particularly well suited when a fixed partial denture restoration is planned. The hard tissue augmentation can be done with block grafts (autografts and allografts), particulate grafts (cortical and cancellous), xenografts, or synthetic materials.
Article
Full-text available
Alveolar process is an integral part of the periodontium lending osseous attachment to the teeth. However, being a tooth dependent anatomic structure, it develops in accordance with the developing tooth buds; moreover, it resorbs after tooth loss/extraction over a period of time. This physiologic phenomenon of resorption results in irregular and compromised ridge contour in various dimensions. Though the traditional prosthetic approaches to camouflage ridge defects are not obsolete; implant supported fixed prosthetic therapy is gaining a foothold in dental rehabilitation. Certain dimensional prerequisites for alveolar ridge are a must for implant success and survival. Present review outlines the interventions aimed at preservation of residual alveolar ridge and offers a comprehensive insight into regenerative materials that have been in use till date. Furthermore, it emphasizes upon the need for timely management of residual alveolar ridge for prompt rehabilitation of the patient.
Article
To evaluate the soft tissue and the dimensional changes of the alveolar bony crest at sites where deproteinized bovine bone mineral (DBBM) particles, concomitantly with the placement of a collagen membrane, were used at implants installed into sockets immediately after tooth extraction. The pulp tissue of the mesial roots of (3) P(3) was removed in six Labrador dogs, and the root canals were filled. Flaps were elevated bilaterally, the premolars hemi-sectioned, and the distal roots removed. Recipient sites were prepared in the distal alveolus, and implants were placed. At the test sites, DBBM particles were placed in the residual marginal defects concomitantly with the placement of a collagen membrane. No treatment augmentation was performed at the control sites. A non-submerged healing was allowed. Impressions were obtained at baseline and at the time of sacrifice performed 4 months after surgery. The cast models obtained were analyzed using an optical system to evaluate dimensional variations. Block sections of the implant sites were obtained for histological processing and soft tissue assessments. After 4 months of healing, no differences in soft tissue dimensions were found between the test and control sites based on the histological assessments. The location of the soft tissue at the buccal aspect was, however, more coronal at the test compared with the control sites (1.8 ± 0.8 and 0.9 ± 0.8 mm, respectively). At the three-dimensional evaluation, the margin of the soft tissues at the buccal aspect appeared to be located more apically and lingually. The vertical dislocation was 1 ± 0.6 and 2.7 ± 0.5 mm at the test and control sites, respectively. The area of the buccal shrinkage of the alveolar crest was significantly smaller at the test sites (5.9 ± 2.4 mm(2) ) compared with the control sites (11.5 ± 1.7 mm(2) ). The use of DBBM particles concomitantly with the application of a collagen membrane used at implants placed into sockets immediately after tooth extraction contributed to the preservation of the alveolar process.
Chapter
HistoryIndicationsArmamentariumSoft tissue graftClinical crown reduction using a connective tissue graftHard tissue graftCombination grafts: Hard and soft tissuesEdentulous ridge expansionSocket preservationReferences
Article
Various factors affect the central maxillary incisor papilla height (PH) and central clinically observable PH (COPH) such that a study of these factors and their interactions is needed. This study reports on an investigation of the factors associated with PH and COPH in patients with and without papilla recession. The central papilla was visually assessed in 450 adults using standardized periapical radiographs of maxillary central incisors. Various vertical and horizontal distances were measured including the lengths from the proximal cemento-enamel junction (pCEJ) to apical contact point (CP), bone crest (BC) to CP (BC-CP), BC to pCEJ (BC-pCEJ), and papilla tip (PT) to CP (PT-CP) and the interdental width at the pCEJ level (IW), width at the BC level (crest width [CW]), and width at the PT level (PTW). PH was defined as the length from the PT to BC, and COPH was defined as the length from the PT to pCEJ. Simple analyses for PH and COPH were performed, and significant variables were entered into multiple linear regression models. Among all study patients, papilla recession status and PT-CP were significant independent predictors of PH (both P <0.001). Age, papilla recession status, PT-CP, and BC-pCEJ were significant independent predictors of COPH (all P <0.001). Among patients with papilla recession, CW and PT-CP independently predicted PH (both P <0.001). All variables tested (except sex and CW) were significantly associated with COPH in patients with papilla recession, especially IW, PTW, PT-CP, and BC-pCEJ (P <0.001 for these variables). The effects of age and BC-pCEJ on COPH change differed in patients without and with recession, suggesting that the initial change in COPH was large but later slowed after recession occurred while there was no severe interdental bone loss progression. However, additional clinical study is needed to find out other variables that may decrease or ameliorate the severity of central papilla recession by restorative/prosthetic or orthodontic intervention and to confirm this possibility.
Article
This study tested the impact of Gluma Desensitizer on the tensile strength of zirconia crowns bonded to dentin. Human teeth were prepared and randomly divided into six groups (N = 144, n = 24 per group). For each tooth, a zirconia crown was manufactured. The zirconia crowns were cemented with: (1) Panavia21 (PAN), (2) Panavia21 combined with Gluma Desensitizer (PAN-G), (3) RelyX Unicem (RXU), (4) RelyX Unicem combined with Gluma Desensitizer (RXU-G), (5) G-Cem (GCM) and (6) G-Cem combined with Gluma Desensitizer (GCM-G). The initial tensile strength was measured in half (n = 12) of each group and the other half (n = 12) subjected to a chewing machine (1.2 Mio, 49 N, 5°C/50°C). The cemented crowns were pulled in a Universal Testing Machine (1 mm/min, Zwick Z010) until failure occurred and tensile strength was calculated. Data were analyzed with one-way and two-way ANOVA followed by a post hoc Scheffé test, t test and Kaplan-Meier analysis with a Breslow-Gehan analysis test (α = 0.05). After the chewing simulation, the self-adhesive resin cements combined with Gluma Desensitizer showed significantly higher tensile strength (RXU-G, 12.8 ± 4.3 MPa; GCM-G, 13.4 ± 6.2 MPa) than PAN (7.3 ± 1.7 MPa) and PAN-G (0.9 ± 0.6). Within the groups, PAN, PAN-G and RXU resulted in significantly lower values when compared to the initial tensile strength; the values of all other test groups were stable. In this study, self-adhesive resin cements combined with Gluma Desensitizer reached better long-term stability compared to PAN and PAN-G after chewing simulation.
Article
Objectives This study aimed to evaluate the biologic and structural phenotypes of the bone regenerated via the sandwich bone augmentation (SBA) technique, on buccal implant dehiscence defects.Material and Methods Twenty-six patients with one buccal implant dehiscence defect each were randomly assigned to two groups. Both groups received a standardized amount of mineralized cancellous and cortical allogenic bone graft. In the test group, a bovine pericardium membrane was placed over the graft, while no membrane was placed in the control group. After 6 months of healing, a bone core biopsy of the regenerated bone was harvested and processed for histologic, immunohistochemical, mRNA, and micro-computed tomography (μCT) analyses. Of the 26 bone core biopsies, only six cores from the test group and six cores from the control group were suitable for the analysis.ResultsBone volume (BV) in the test group was maintained, but tissue maturation appeared to be delayed. In contrast, tissue maturation appeared to be completed in the control group, but BV was compromised. Micro-CT analysis showed that specimens from the control group were more structured and mineralized compared with those from the test group. Histologic analysis showed more residual graft particles scattered in a loose fibrous connective tissue matrix with sparse bone formation in the test group, while the control group showed obvious vital bone formation surrounding the residual graft particles. Positive periostin (POSTN), sclerostin, and runt-related transcription factor-2 (RUNX2) immunoreactivities were detected in both the control and test groups. However, tartrate-resistant acid phosphatase (TRAP) positive was mostly noted in the control group. There were significant differences in POSTN, RUNX2 and VEGF expressions between the test and control groups.Conclusion These findings indicated that the SBA technique was an effective method in preserving adequate structural volume while promoting new vital bone formation. Use of the collagen barrier membrane has successfully maintained the volumetric dimensions of the ridge but might have slowed down the complete maturation of the outermost layer of the grafted site.
Article
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A new flap design, the coronally positioned palatal sliding flap, was used to cover barrier membrane placed over implants in one patient, and to provide localized ridge augmentation around implants in another patient. The method is a valid surgical approach because of the favorable risk-benefit ratio. The surgical technique is easy to to perform, and it is possible to obtain a sufficient sliding position of the palatal tissue. This new palatal flap design may be indicated for a variety of periodontal surgical procedures, including guided tissue regeneration and implant surgery.
Article
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The purpose of this study was to test the bone-forming capacity of demineralized freeze-dried bone (DFDBA) and autologous bone grafts in extraction sockets. Seven paired sites were grafted with either DFDBA or autologous bone. The sites were reentered between 3 and 13 months for the purposes of obtaining biopsies of the grafted sites and to place endosseous implants. Biopsies from 6 of the 7 grafted sites were evaluated for new bone formation. DFDBA sites revealed the presence of dead particles of DFDBA with no evidence of bone formation on the surfaces of the implanted particles and no evidence of osteoclastic resorption of the bone particles. Biopsies from the 6 autologous sites revealed vascular channels with woven and lamellar bone. Some specimens had retained cortical, non-vital bone chips. These bone chips were undergoing active osteoclastic resorption. The results of this study questions the use of DFDBA as a bone inductive graft material.
Article
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Resorbable membranes of poly(lactic acid) and poly(glycolic acid) (PLA/PGA) were compared to nonresorbable expanded polytetrafluoroethylene (e-PTFE) membranes in the treatment of defects around titanium dental implants placed in postextraction sockets. Two partially edentulous and three completely edentulous patients requiring implant-supported restorations participated. Sixteen Brånemark implants were placed into extraction sockets and covered with modified titanium cover screws, called harvest cover screws, which allow tissue biopsy at second-stage implant surgery. Seven defects were treated with PLA/PGA membranes, five were treated with e-PTFE membranes, and four were left untreated (control sites). After 6 months of healing, the harvest cover screws were retrieved and processed for light microscopy examination together with the regenerated tissues. Very little or no bone formation was detected in control specimens. The e-PTFE membranes were found to be the most effective barrier material, in that denser and a greater amount of regenerated bone was found. The PLA/PGA membranes produced some bone regeneration when compared to control sites, but to a lesser extent compared to e-PTFE sites.
Article
Full-text available
TEN PATIENTS WHO REQUIRED two or more anterior teeth extractions were utilized in this study. Extraction procedures were carried out with a full thickness surgical flap approach. After flap reflection, teeth were removed with a minimum of trauma to the surrounding bone. Following extraction silicone-based impression techniques were used to produce a model of the alveolar process and small metal pins were placed in the alveolus to be used as fixed points to make measurements of ridge dimensions. One socket was covered with an expanded polytetrafluoroethylene (ePTFE) barrier membrane (experimental site); the other socket was a conventional control. The soft tissue flaps were then mobilized using periosteal releasing incision and the wound closed with ePTFE mattress sutures. Six months following extraction, patients were treated with flap surgery to expose both extractions sites to remove the ePTFE membranes and to measure ridge dimensions using the pins as fixed points. Clinical and model measurements have shown statistically significant better ridge dimensions at experimental sites than at control (P < or = 0.05). Three patients with exposed membranes had similar dimensional changes as controls. Results from this study suggested that this improved technique offers a predictable alveolar ridge maintenance enhancing the bone quality for dental implant procedures and esthetic restorative dentistry.
Article
Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. This technique produced a concentration of human platelets of 338% and identified platelet-derived growth factor and transforming growth factor beta within them. Monoclonal antibody assessment of cancellous cellular marrow grafts demonstrated cells that were capable of responding to the growth factors by bearing cell membrane receptors. The additional amounts of these growth factors obtained by adding platelet-rich plasma to grafts evidenced a radiographic maturation rate 1.62 to 2.16 times that of grafts without platelet-rich plasma. As assessed by histomorphometry, there was also a greater bone density in grafts in which platelet-rich plasma was added (74.0% ± 11%) than in grafts in which platelet-rich plasma was not added (55.1% ± 8%; p = 0.005).
Article
Nine localized buccal ridge deformities were treated combining the use of barrier membranes and resorbable space-making material. After elevating flaps, the bone defects were completely filled with calcium carbonate and a fibrin-fibronectin sealing system (FFSS). Membranes (Gore-Tex aug-mentation material) were then shaped and positioned to cover the calcium carbonate overlapping the surrounding bone. The flaps were sutured, taking care to avoid any compression on the treated area. The membranes were removed 4 to 5 months postoperatively: in all cases the membranes were tightly adapted to the regenerated tissues and force was required to separate them from the underlying tissues. The defects were filled with hard, bone-like tissue. The histology from one case, taken 1 year post-operatively, confirmed the regeneration of bone and revealed the presence of a few residual particles of calcium carbonate in the sample. The clinical appearance of the treated areas was satisfactory for colour. texture and form. The horizontal deficiencies were almost completely resolved in all cases, while the vertical component showed incomplete filling in some cases.
Article
The difficulties to be encountered in lengthening a shortened limb, are found, in operation, to be greater as regards the fleshy parts, than as regards the bones. It is comparatively easy to remove the splinters of a fractured bone which is wrongly consolidated; to separate a curved bone; or to perform an oblique osteotomy, but a decided limit is arrived at in the correction of a displacement, or in the lengthening of the bones, by reason of the contraction, or resistance, of the muscles. Our supreme consideration must therefore be given in striving to overcome this resistance on the part of the muscles, without however damaging in any way the action of the tissues. This is the special subject on which I desire to enlarge, as it appears to me that this important part in the cure of deformity of the limbs, has never been sufficiently taken into consideration.
Article
A patient was left with a severe defect following the extraction of the right maxillary lateral and central incisors. A graft of epithelial and connective tissue was taken from the maxillary tuberosity and placed into the defect. This resulted in the filling of the defect and the correction of the esthetic problem.
Article
A modification of Abram's roll technique is described. A "trap-door" approach is used to reflect and preserve the epithelium that overlies the connective tissue pedicle; the epithelial pedicle is used to cover the donor site. Two case reports illustrate the technique.
Article
Insufficient bone volume can be a significant problem when placing dental implants. This clinical study was designed to evaluate bone regeneration potential at dehisced dental implant sites. Nineteen titanium dental implants with exposed threads were studied. To create a secluded space for bone formation, an expanded polytetrafluoroethylene (e-PTFE) membrane was placed over the exposed implant sites secured with an implant cover screw and completely covered with the flap. Three membranes perforated the overlying soft tissue during the healing time and were removed prematurely. The remaining membranes were removed after an uneventful healing period of 4.5 to 6 months. Fourteen of 19 dehisced implant sites were completely covered with newly formed bonelike tissue; 4 implants demonstrated partial bone fill at reentry and 1 implant showed partial fill with soft tissue. In five implant sites a reentry was performed between 6 and 9 weeks; nonmineralized fibrous tissue was found to fill the space under the membrane. At 16 of the 19 implant sites there were similar dehiscence-type defects that were evaluated as a group. These dehiscences varied from 2.0 to 9.0 mm. The percentage of bone fill at reentry ranged from 28.4% to 100% (mean 89.6%; SD 22.51; SE 5.63) and was highly significant (P < .0001). Six to 12 months after prosthesis connection, 12 of the 19 implants were available for radiographic interpretation and an average bone loss of 1.73 mm (SD = 0.43) was measured. This surgical application of an e-PTFE membrane suggested a viable clinical method for enhancing bone formation around dental implants.
Article
A severely damaged edentulous ridge frequently obviates the placement of dental implants or results in placing them at an angle that compromises the prosthetic restoration. This paper demonstrates the repair of severely resorbed edentulous ridges by a combination of bone allografting and the placement of a barrier membrane. The damaged edentulous ridge is treated first in this two-stage process. The implants are then installed at a second surgery.
Article
Lengthening of the mandible by gradual distraction was performed on four young patients (average age 78 months). The amount of mandibular bone lengthening ranged from 18 to 24 mm; one patient with Nager's syndrome underwent bilateral mandibular expansion. Following the period of expansion, the patients were maintained in external fixation for an average of 9 weeks to allow ossification. The patients were followed for a minimum of 11 months to a maximum of 20 months with clinical and dental examinations as well as photographic and radiographic documentation. The technique holds promise for early reconstruction of craniofacial skeletal defects without the need for bone grafts, blood transfusion, or intermaxillary fixation.
Article
A surgical technique for rehabilitation of severely resorbed edentulous maxillae using fixed prostheses or overdentures supported by osseointegrated fixtures in immediate autogenous corticocancellous bone grafts from the ilium is described. The results of the first 23 consecutively treated patients are reviewed. The mean observation time was 4.2 years (range 1 to 10 years). A total of 124 fixtures was originally placed into the grafts, supplemented with 16 fixtures inserted later into seven of the jaws. Throughout their observation period, 17 of the patients had continuously stable prostheses. The remaining five had overdentures, and one patient had resorted to a conventional complete denture. After 4 years, 12 of 16 patients had continuously stable prostheses. Corresponding values at 5 years were 7 of 8 patients. Calculated from the date of abutment connection, 82.1% and 81.6% of the original fixtures were clinically stable and radiographically osseointegrated after 4 and 5 years in function, respectively. From the date of fixture placement, the corresponding figures were 75.3% and 73.8%, respectively. The mean marginal bone loss after the first year of prosthesis function was 1.49 mm. The annual marginal bone loss thereafter was about 0.1 mm. The results indicate that this technique is worthwhile for patients with extreme maxillary atrophy and who cannot wear conventional complete dentures.
Article
The purpose of this study was to present the surgical procedures and the clinical results of guided tissue regeneration (GTR) treatment aimed at regenerating local jaw bone in situations where the anatomy of the ridge did not allow the placement of dental implants. 12 patients were selected for ridge enlargement or bony defect regeneration. A combined split- and full-thickness flap was raised in areas designated for subsequent implant placement. Following perforation of the cortical bone to create a bleeding bone surface, a PTFE membrane was adjusted to the surgical site in such a way that a secluded space was created between the membrane and the subjacent bone surface in order to increase the width of the ridge or to regenerate bony defects present. Complete tension-free closure of the soft tissue flap was emphasized. Following a healing period of 6 to 10 months, reopening procedures were performed and the gain of bone dimension was assessed. In 9 patients with 12 potential implant sites, a sufficient bone volume was obtained to allow subsequent implant placement. The gain of new bone formation varied between 1.5 and 5.5 mm. In 3 patients, acute infections developed which necessitated early removal of the membranes and no bone regeneration could be achieved. The results of the study indicate that the biological principle of GTR is highly predictable for ridge enlargement or defect regeneration under the prerequisite of a complication-free healing.
Article
This study was designed to evaluate the potential to reconstruct localized ridge defects with bone by preventing non-osteogenic extraskelatal connective tissue from participating in the process of healing following experimental ridge augmentation treatment procedures. Following the elevation of buccal muco-periosteal flaps, buccal, interproximal, and interradicular bone was removed to the apical level of the second and third premolar teeth and the teeth were extracted to create bucco-lingual ridge defects that averaged 13 mm x 7 mm x 3.5 mm in each quadrant of two adult beagle dogs. The defects were permitted to heal for 90 days. The defects did not fill in with new bone. Subsequently, buccal muco-periosteal flaps were elevated and a membrane was placed over the defect and positioned so that it rested on bone that was exposed adjacent to the defect. In two quadrants test support materials were used to ensure that a space was maintained between the surface of the defect and the membrane. One quadrant was maintained as a sham-operated control site, three sites received membranes and no supporting implants and two sites received supporting implants and no membranes. The surgical schedule was designed to yield sacrifice times of 8 to 12 weeks. In the three quadrants available for study that were covered with membranes, bone and/or non-mineralized connective tissue was found to fill all of the space that had been provided by the membrane. Histologic examination confirmed that the space was filled with young, actively growing bone by 90 days. No new bone formation (bone fill) was observed in the sham-operated control site.
Article
A clinical case--a follow-up clinical and histological study--is presented in this paper, which describes the use of resorbable hydroxylapatite [OsteoGen (H.A. Resorb), Impladent, Inc., & GBD Marketing Group, Inc., Medical Division, Valley Stream, NY 11580] for the repair of a large mandibular lesion, followed by the placement of an endosseous dental implant six weeks after the graft placement. A comparison of the histological results of four-month and 14-month bone biopsies of resorbable hydroxylapatite grafts is included in this report.
Article
To assess the influence of both the rate and the frequency of distraction on osteogenesis during limb elongation, a canine tibia was used with various combinations of distraction rates (0.5 mm, 1.0 mm, or 2.0 mm per day) and distraction frequencies (one step per day, four steps per day, 60 steps per day). The distractions were performed after both open osteotomy and closed osteoclasis. Histomorphic and biochemical studies were conducted on the elongated osseous tissue, fascia, skeletal muscle, smooth muscle, blood vessels, nerves, and skin. It was determined that distraction at a rate of 0.5 mm per day often led to premature consolidation of the lengthening bone, while a distraction rate of 2.0 mm per day often resulted in undesirable changes within elongating tissues. A distraction rate of 1.0 mm per day led to the best results. It was also observed that the greater the distraction frequency, the better the outcome. With optimum preservation of periosseous tissues, bone marrow, and blood supply at the time of osteotomy, stability of external fixation, and 1.0 mm per day of distraction in four steps, osteogenesis within the distraction gap of an elongating bone takes place by the formation of a physislike structure, in which new bone forms in parallel columns extending in both directions from a central growth zone. The growth plate that forms under the influence of tension-stress has features of both physeal and intramembranous ossification, yet is neither; instead, the distraction regenerated bone is unique, providing numerous applications in clinical traumatology, orthopedics, and other medical disciplines.
Article
Topographical aberrations in a residual edentulous ridge often prevent establishment of a satisfactory pontic/ridge relationship. An improved technique is described for predictable augmentation of localized alveolar-ridge deficiencies. Results are reported from 21 cases involving 26 sites. All 14 sites using fibrous connective tissue grafts demonstrated shrinkage, although an improvement in residual ridge contour was obtained. Hydroxylapatite implant material was placed in 12 sites with shrinkage seen in only two sites. Advantages, requirements for success and technical considerations of the improved technique are discussed.
Article
The efficacy of solid cones of hydroxylapatite ceramic implanted in fresh extraction sockets for the preservation of alveolar bone was evaluated. Ten experimental subjects (70 implants) and eight control subjects (63 extractions) were treated. After extraction, hydroxylapatite ceramic cones were inserted into the sockets at least 1 mm below the alveolar crest in the experimental group. Alveolar ridge resorption was measured on lateral cephalometric radiographs, and statistical analysis was performed. The follow-up periods ranged from 12 to 24 months (mean, 20.6 months). Thirty-seven of the 70 hydroxylapatite ceramic cone implants (53%) became exposed, and 19 cones (27%) had to be removed. It was concluded that hydroxylapatite ceramic cone implants placed in fresh extraction sockets do not significantly preserve alveolar bone.
Article
Patients who present with severe maxillary bone loss secondary to trauma, congenital defect, or resorption secondary to prosthesis function provide a unique diagnostic and difficult treatment challenge. This article describes a prosthetic-surgical treatment approach utilizing threaded titanium cylindrical endosteal (Brånemark) implants in combination with iliac bone grafting in nine such patients. Five patients received implant and bone graft placement at the same surgical setting and four patients received the implant 6 to 18 months following bone graft placement. Treatment sequence, surgical technique, indications, and follow-up results are illustrated by abbreviated case reports of four patients.
Article
A technique has been described which can augment concavities and irregularities in edentulous ridges where cosmetics are important. Using the combination of temporary acrylic resin restorations and connective tissue autografts, unattractive con-cavities and ridge irregularities can be corrected.
Article
A review of a new plastic surgical procedure using autogenous grafts of dense connective tissue placed submucosally in anterior areas of collapsed, deformed edentulous ridges has been presented. This technique allows augmentation of an anterior, deformed edentulous ridge to a proper form, color, and texture before placement of a fixed prosthesis. Previous solutions to this problem have resulted in an esthetic compromise at best. Long-term follow-up shows good dimensional stability offering an acceptable solution to a difficult prosthetic problem.
Article
This study presents the clinical results of a surgical technique that expands a narrow ridge when its orofacial width precludes the placement of dental implants. In 170 people, 329 implants were placed in sites needing ridge enlargement using the endentulous ridge expansion procedure. This technique involves a partial-thickness flap, crestal and vertical intraosseous incisions into the ridge, and buccal displacement of the buccal cortical plate, including a portion of the underiying spongiosa. Implants were placed in the expanded ridge and allowed to heal for 4 to 5 months. When indicated, the implants were exposed during a second-stage surgery to allow visualization of the implant site. Occlusal loading was applied during the following 3 to 5 months by provisional prostheses. The final phase was the placement of the permanent prostheses. The results yielded a success rate of 98.8%.
Article
The principle of guided tissue regeneration has been successfully applied for the regeneration of bone in various jaw defects in human. The purpose of this study was to assess the bone volume regenerated using nonresorbable membrane barriers. Nineteen patients with jaw bone defects of various sizes and configurations were included in the study. Combined split-thickness/full-thickness mucosal flaps were elevated in the area of missing bone. The size of the defects was assessed by measuring the distance from a reference line between 2 adjacent teeth (cementoenamel junctions) to the alveolar crest (a) every 2 or 3 mm. In addition, the crestal width was measured. Consequently, the surface of the triangle formed by a and the width of the crest as well as the volume between all triangles were calculated geometrically. Following the placement of Gore-Tex augmentation material as a barrier, the distance (b) to the top of the membrane from the reference line was assessed, and the maximum possible volume for bone regeneration based on (a-b) and the width of the crest was calculated. At the time of membrane removal (3-8 months later), the same measurements were performed and the percentages of regenerated bone in relation to the possible volume for regeneration determined. In 6 patients in whom the membranes had to be removed early due to an increased risk for infection between 3 and 5 months, bone regeneration varied between 0 and 60%. In 13 patients in whom membranes were left for 6-8 months, regenerated bone filled 90-100% of the possible volume.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
This article reviews the limitations of drilling into soft bone to place endosseous implants. Differences among bone types and the anatomy of the maxilla are described. The osteotome technique, which is a new method of placing implants into maxillary bone without drilling, and the rationale for two other procedures, the osteotome sinus floor elevation and the ridge expansion osteotomy, are detailed. How osteotomes conserve osseous tissue and may improve bone density around the implant is also discussed. A pilot study that shows excellent results with several types of press-fit implants using the osteotome technique is provided. The author concludes that the osteotome technique is superior to drilling for many applications in soft maxillary bone. Furthermore, the osteotome technique allows more implants to be inserted in a greater variety of sites during a routine office procedure.
Article
A classification scheme that systematizes the wide range of regenerative potential of common extraction site topographies is presented. Within this system, the parameters for immediate implant placement and preliminary ridge augmentation are discussed. In addition, a new adjunctive role for orthodontic extrusion is introduced. This approach is intended to manipulate "hopeless" teeth to modify their local defect environments, thereby enhancing the predictability of subsequent implant placement at those sites.
Article
Replacement of anterior teeth with fixed or removable prostheses is often a compromise, because the resorbed residual ridge in the area of missing teeth cannot be ideally restored functionally and esthetically at the same time. To address this problem, 67 blocks of hydroxyapatite were placed subperiosteally to improve residual ridge resorption defects subsequent to loss of anterior teeth in 50 patients. The implants were evaluated clinically and radiographically for 6 months to 7 years after implantation. Results indicate that the suggested approach improves the esthetic results and the prognosis of fixed prostheses.
Article
Mucogingival surgery has evolved in the past decade into periodontal plastic surgery. Periodontal plastic surgery deals with those regenerative and reconstructive procedures designed not only to restore form and function but also to enhance esthetics. This paper reviews those techniques that currently comprise periodontal plastic surgery as well as the current literature pertinent to this topic. The role of the dental laser as well as its limitations will also be discussed.
Article
Lack of bone in localized areas of the jaws frequently poses a problem when placing oral implants. In this clinical study, we have tested an osteopromotive membrane technique for its ability to create bone over buccal fenestrations after fixture installation in the maxilla. 7 patients were selected by the use of CT-scan. Criteria for patient selection were that the alveolar crest should have a vertical height >13 mm and a facial-palatal concavity, where exposure at the central portion of the fixture could be anticipated. One fenestration, randomly chosen, in each patient was covered with an e-PTFE (expanded polytetrafluoroethylene) (Gore-Tex GTAM) membrane. Contralateral fenestrations served as controls (without the placement of a membrane). The amount of newly formed bone was calculated by photometric assessments. The results showed that the fixture fenestrations, treated with the membrane technique, demonstrated a significantly (p<0.005) higher amount of new bone formation compared to the controls, where little or no improvement had taken place at the fenestrations. The study conclusively shows that the membrane technique is a reconstructive technique, able to create new bone at localized bone fenestrations at titanium fixtures. Additionally, the study also demonstrates that the periosteum alone, in adult humans, is not capable of generating new bone at exposed titanium implants.
Article
Mandibular lengthening by distraction osteogenesis is a new method for use in treating congenital deformities or postsurgical bone defects. However, the use of extraoral transcutaneous pins in the mandible has disadvantages, such as facial scars and facial nerve or inferior alveolar nerve injury. The purpose of this study was to establish a new approach to distraction osteogenesis in the mandible by using osseointegrated implants and an intraoral device. Ten adult canines were used for this experiment. After extraction of the teeth and placement of two titanium implants in the left mandible, connection of the intraoral distraction device to the abutments, and corticotomy in the medial portion between implants were performed. Distraction was done at the rate of 1 mm per day to elongate 10 mm in length. Radiographic and histologic examinations showed that successful mandibular lengthening was achieved. New bone was primarily formed by intramembranous ossification and partial endochondral ossification. Titanium implants placed for anchorage of the device remained stable during the course of mandibular lengthening. Study results suggest that the intraoral device using osseointegrated dental implants can be used as a mechanism for distraction osteogenesis in the mandible.
Article
This study was carried out to evaluate the efficacy of poly(lactic acid) and poly(glycolic acid) (PLA/PGA) resorbable membranes in conjunction with autogenous bone grafts when used for the treatment of implant dehiscences and/or fenestrations. Nine patients with a total of 18 implants participated. Nine implants were associated with dehiscences, and 9 with fenestrations; 16 implants were in the maxilla, and 2 in the mandible. Nine defects were treated with PLA/PGA membranes (test group), and the nine were treated with expanded polytetrafluoroethylene (e-PTFE) membranes (control group). Second-stage surgery was performed after 6 to 7 months of healing. Overall results of the regenerative therapy of the 18 defects showed a highly significant (P < .001) defect reduction, with a 93.38% (SD = 15.88) bone fill. A slightly higher percentage of bone fill was found in the e-PTFE group (98.20%) than in the PLA/PGA group (88.56%), but the difference was not statistically significant (P = .207). This study demonstrated that resorbable PLA/PGA membranes can be equally effective as e-PTFE in the treatment of implant dehiscences and fenestrations when associated with autogenous bone chips.
Article
Esthetic reconstruction of large-volume Class III ridge deformities where bone and soft tissue have been lost buccolingually as well as apicocoronally continues to offer a major challenge in therapy to periodontists and to those engaged in advanced reconstructive dentistry. No single procedure is well suited for solving all problems in reconstructive surgery. A series of staged surgical procedures is frequently necessary to augment the ridge to its former dimensions. The authors have devised a combination onlay-interpositional graft procedure that appears to offer promise in solving many of the problems encountered in gaining predictable soft tissue ridge augmentation in Class III ridge defects.