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Huang JP, Wang YY, Dai A, Sun P, Ding PH. A combination technique of strip free gingival grafts and xenogeneic collagen matrix in augmenting keratinized mucosa around dental implants: a single-arm clinical trial. BMC Oral Health 2024; 24:634. [PMID: 38811896 PMCID: PMC11137898 DOI: 10.1186/s12903-024-04184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/26/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The aim of this study was to assess the outcomes of the combination technique of strip free gingival grafts (SFGG) and xenogeneic collagen matrix (XCM) in augmenting the width of keratinized mucosa (KMW) around dental implants, and compare its efficacy with the historical control group (FGG). METHODS Thirteen patients with at least one site with KMW ≤ 2 mm after implant surgery were included and received SFGG in combination with XCM. Another thirteen patients with the same inclusion and exclusion criteria from the previous trial received FGG alone. The same outcomes as the previous trial were evaluated. KMW, thickness of keratinized mucosa (KMT), gingival index (GI) and probing depth (PD) were measured at baseline, 2 and 6 months. Postoperative pain, patient satisfaction and aesthetic outcomes were also assessed. RESULTS At 6 months after surgery, the combination technique could attain 3.3 ± 1.6 mm of KMW. No significant change could be detected in GI or PD at 6 months compared to those at 2 months (p > 0.05). The postoperative pain and patient satisfaction in VAS were 2.6 ± 1.2 and 9.5 ± 1.2. The total score of aesthetic outcomes was 3.8 ± 1.2. In the historical FGG group, 4.6 ± 1.6 mm of KMW was reported at 6 months, and the total score of aesthetic outcomes was higher than the combination technique (4.8 ± 0.7 vs. 3.8 ± 1.2, p < 0.05). CONCLUSIONS The combination technique of SFGG and XCM could increase KMW and maintain peri-implant health. However, this combination technique was associated with inferior augmentation and aesthetic outcomes compared with FGG alone. TRIAL REGISTRATION This clinical trial was registered in the Chinese Clinical Trial Registry with registration number ChiCTR2200057670 on 15/03/2022.
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Affiliation(s)
- Jia-Ping Huang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Yi-Yu Wang
- Department of Prosthodontics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, 310006, Zhejiang, China
- Department of Stomatology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Anna Dai
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, Zhejiang, China
| | - Ping Sun
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, Zhejiang, China.
| | - Pei-Hui Ding
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, Zhejiang, China.
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Mohseni Salehi Monfared SH, Shirani G, Moslemi N, Noori F, Raee A. Reconstruction of lingual sulcus in a severely atrophic mandible using a modified approach as a pre‐prosthetic surgery: Case series. Clin Case Rep 2022; 10:e05500. [PMID: 35228888 PMCID: PMC8864570 DOI: 10.1002/ccr3.5500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/06/2022] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Gholamreza Shirani
- Department of Oral and Maxillofacial Surgery School of Dentistry Tehran University of Medical Sciences Tehran Iran
| | - Neda Moslemi
- Department of Periodontology School of Dentistry Tehran University of Medical Sciences Tehran Iran
| | - Faranak Noori
- Department of Endodontics School of Dentistry Tehran University of Medical Sciences Tehran Iran
| | - Amir Raee
- Department of Periodontology School of Dentistry Tehran University of Medical Sciences Tehran Iran
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Park S, Chao D, Blackwell KE, Jayanetti J. Modified vestibuloplasty of the zygomaticoalveolar crest to gain intradefect support for an obturator prosthesis. J Prosthet Dent 2021:S0022-3913(21)00658-2. [DOI: 10.1016/j.prosdent.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
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Adams DR, Petukhova Y, Halpern LR. The versatile "lip switch" or transitional flap vestibuloplasty combined with alveoloplasty and implant placement to treat atrophic mandibles with inadequate vestibules and attached tissue: A case series and review of the literature. SPECIAL CARE IN DENTISTRY 2020; 41:78-84. [PMID: 33270928 DOI: 10.1111/scd.12546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/AIMS The edentulous mandibular ridge and associated shallow vestibule are often seen as a challenge in the oral rehabilitation of patients. Dental implants can provide an improvement in mastication and patient satisfaction. The aim of this study is to utilize a preprosthetic mucosal flap combined with a repositional periosteal flap concomitant with an alveoloplasty and placement of endosteal implants as a single-stage procedure in the anterior mandible. This approach provides a valued alternative for dental rehabilitation in patients with poor masticatory efficiency using a conventional denture. METHODS Eight patients underwent the preprosthetic surgical plan in the oral surgery clinic of the dental school during a 1-year period. Age, sex, preoperative, and postoperative vestibular depth, as well as hard and soft tissue elements were measured (P < .05) at 4-6 months. RESULTS Mean age was 53 years ± 14.62 (N = 8). Anterior mandible height was 19 ± 4.8 mm. A significant difference was measured using a two-tailed Student's t-test between pre- and postoperative vestibular depths, respectively (3.9 mm vs 10.5 ± 0.96 mm; P < .01). CONCLUSIONS A lip switch vestibuloplasty combined with placement of two implants provide a one-stage procedure that is convenient, provides a shorter postoperative period, and can be financially affordable. Future research requires larger sampling to support this treatment as a standard of care.
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Affiliation(s)
- David R Adams
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Utah, Salt Lake City, Utah
| | - Yuliya Petukhova
- Department of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, Minnesota
| | - Leslie R Halpern
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Utah, Salt Lake City, Utah
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McLaurin WS, Krishnan D. Preprosthetic Dentoalveolar Surgery. Oral Maxillofac Surg Clin North Am 2020; 32:583-591. [PMID: 33004149 DOI: 10.1016/j.coms.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preprosthetic surgery remains a work horse of dentoalveolar surgery. Advances in rehabilitation of the edentulous mouth with the use of endosseous osseointegrating dental implants and dermal matrix substitutes have changed the narrative of traditional preprosthetic surgery while maintaining some fundamental principles. An outline of the basic techniques in preprosthetic dentoalveolar surgery is discussed in the setting of these technological and tissue engineering advances.
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Affiliation(s)
- Wallace S McLaurin
- Oral and Maxillofacial Surgery, University of Cincinnati Medical Center, 200 Albert Sabin Way ML 0461, Cincinnati, OH 45219, USA
| | - Deepak Krishnan
- Oral and Maxillofacial Surgery, University of Cincinnati Medical Center, 200 Albert Sabin Way ML 0461, Cincinnati, OH 45219, USA.
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Durham M, Brindis M, Egbert N, Halpern LR. Complex Dental Implant Cases: Algorithms, Subjectivity, and Patient Cases Along the Complexity Continuum. Oral Maxillofac Surg Clin North Am 2019; 31:219-249. [PMID: 30947848 DOI: 10.1016/j.coms.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Algorithms for predictable outcomes, or checklists in health care, have been widely supported due to their highly effective outcomes. This article shares "algorithmic roadmaps" to restore single-tooth, partially edentulous, and fully edentulous complex dental implant cases in the patient population. A review of the current literature is presented to provide systematic assessments followed by criteria in a checklist format that allows the surgeon and restorative dentist to determine whether a removable or fixed implant prosthesis is the best patient option. Several cases have been chosen to illustrate the algorithms the authors used to provide an optimized prognosis for surgical/restorative success.
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Affiliation(s)
- Mark Durham
- Prosthodontist, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA.
| | - Marco Brindis
- Louisiana State University, School of Dentistry, 1100 Florida Avenue, New Orleans, LA 70119, USA
| | - Nicholas Egbert
- Prosthodontist, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
| | - Leslie R Halpern
- Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
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Lipswitch vestibuloplasty combined with endosseous implant surgery. One stage versus two stages? JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Khalifa AK, Wada M, Ikebe K, Maeda Y. To what extent residual alveolar ridge can be preserved by implant? A systematic review. Int J Implant Dent 2016; 2:22. [PMID: 27878769 PMCID: PMC5120622 DOI: 10.1186/s40729-016-0057-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 11/16/2016] [Indexed: 12/02/2022] Open
Abstract
Background It has been reported that the load for (or to) implant-supported restoration may lead to bone remodeling as bone resorption and/or formation. While many authors supported the process of bone resorption, others elaborated bone apposition and increasing bone density close and remote to implant body (or fixture). This may suggest the role of the implant to reserve alveolar ridge from physiologic/pathologic resorption. The aim of this systematic review was to predict to how extend dental implants can preserve the residual alveolar ridge based on previous clinical investigations. Methods This systematic review based on the retrospective and prospective studies, randomized clinical trial, and case reports. The process of searching for proposed articles included PubMed, Ovid, and Web of Science databases, with specific inclusion and exclusion criterion. Results A total 2139 citations were identified. After expunging the repeated articles between databases and application of exclusion and inclusion criteria, 18 articles were found to meet the topic of this systematic review. Many of the articles reported bone preservation with implant-assisted restorations, and the rest denoted noticeable bone apposition. Conclusion According to the published clinical studies, the behavior of bone remodeling around implant predicts a sort of residual alveolar bone preservation.
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Affiliation(s)
- Ahmed Khalifa Khalifa
- Department of Prosthodontics, Faculty of Dentistry, Mansoura University, 68 ElGomhoria Street, ElMansoura, 35516, Egypt.,Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masahiro Wada
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshinobu Maeda
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Bassetti RG, Stähli A, Bassetti MA, Sculean A. Soft tissue augmentation procedures at second-stage surgery: a systematic review. Clin Oral Investig 2016; 20:1369-87. [PMID: 27041111 DOI: 10.1007/s00784-016-1815-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/28/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this systematic review was to evaluate the efficacy of different soft tissue augmentation/correction methods in terms of increasing the peri-implant width of keratinized mucosa (KM) and/or gain of soft tissue volume during second-stage surgery. MATERIALS AND METHODS Screening of two databases, MEDLINE (PubMed) and EMBASE (OVID), and hand search of related articles, were performed. Human studies reporting on soft tissue augmentation/correction methods around submucosally osseointegrated implants during second-stage surgery up to July 31, 2015 were considered. Quality assessment of the selected full-text articles was performed according to the Cochrane collaboration's tool to assess the risk of bias. RESULTS Overall, eight prospective studies (risk of bias: high) and two case series (risk of bias: high) were included. Depending on the surgical technique and graft material used, the enlargement of keratinized tissue (KT) ranged between -0.20 and 9.35 mm. An apically positioned partial-thickness flap/vestibuloplasty (APPTF/VP) in combination with a free gingival graft (FGG) or a xenogeneic graft material (XCM) was most effective. Applying a roll envelope flap (REF) or an APPTF in combination with a subepithelial connective tissue graft (SCTG), mean increases in soft tissue volumes of 2.41 and 3.10 mm, respectively, were achieved. Due to the heterogeneity of study designs, no meta-analysis could be performed. CONCLUSIONS Within the limitations of this review, regarding the enlargement of peri-implant KT, the APPTF in the maxilla and the APPTF/VP in combination with FGG or XCM in the lower and upper jaw seem to provide acceptable outcomes. To augment peri-implant soft tissue volume REF in the maxilla or APPTF + SCTG in the lower and upper jaw appear to be reliable treatment options. CLINICAL RELEVANCE The localization in the jaw and the clinical situation are crucial for the decision which second-stage procedure should be applied.
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Affiliation(s)
- Renzo G Bassetti
- Department of Oral and Maxillofacial Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland.
| | - Alexandra Stähli
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Mario A Bassetti
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
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Halperin-Sternfeld M, Zigdon-Giladi H, Machtei EE. The association between shallow vestibular depth and peri-implant parameters: a retrospective 6 years longitudinal study. J Clin Periodontol 2016; 43:305-10. [PMID: 26718112 DOI: 10.1111/jcpe.12504] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to retrospectively evaluate the association between shallow vestibular depth (VD) and peri-implant parameters. MATERIAL AND METHODS Peri-implant parameters were evaluated in 61 periodontal patients under regular supportive periodontal therapy. Clinical parameters included gingival index (GI), plaque index (PI), bleeding on probing (BOP), peri-implant pocket depths (PPD), mucosal recession (MR), relative attachment level (RAL), width and thickness of keratinized mucosa (KMW, KMT) and VD. Radiographic bone level (RBL) was measured on peri-apical radiographs. RESULTS Sites with shallow VD (≤ 4 mm) were associated with higher MR (0.91 mm versus 0.47 mm, p ≤ 0.009), higher RAL (4.23 mm versus 3.59 mm, p ≤ 0.0001) and higher RBL (2.18 mm versus 1.7 mm, p = 0.05) when compared with adequate vestibular depth sites (VD > 4 mm). Moreover, sites with shallow VD presented lower KMW compared with sites with adequate VD (1.24 mm versus 2.38 mm, respectively, p ≤ 0.0001). Slightly greater BOP, and GI were recorded for the shallow VD compared with adequate sites. According to multivariate analysis, factors that could predict RAL included: VD, GI, age, supporting periodontal therapy, implant type and design. CONCLUSIONS Based on this study, inadequate vestibular depth around dental implants may be associated with increased peri-implant bone loss and mucosal recession. Further prospective and intervention studies will be required to fully understand this phenomenon.
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Affiliation(s)
- Michal Halperin-Sternfeld
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - Hadar Zigdon-Giladi
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine- Technion, Israel Institute of Technology, Haifa, Israel
| | - Eli E Machtei
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine- Technion, Israel Institute of Technology, Haifa, Israel
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Abstract
Preprosthetic oral and maxillofacial surgery has changed dramatically over the last 3 decades. Surgical preparation for dentures has been displaced by site development for implants. Nonetheless, there is still a role to play for several preprosthetic procedures. In this article, historical context is provided, enduring concepts are reviewed, and procedures that remain relevant are described and discussed.
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Affiliation(s)
- Hillel Ephros
- Oral and Maxillofacial Surgery, Department of Dentistry, St. Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07503, USA.
| | - Robert Klein
- Oral and Maxillofacial Surgery, St. Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07503, USA
| | - Anthony Sallustio
- Prosthodontics and Maxillofacial Prosthetics, St. Joseph's Regional Medical Center, Paterson, NJ 07503, USA
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12
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Schmitt CM, Moest T, Lutz R, Wehrhan F, Neukam FW, Schlegel KA. Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft ® ) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Implants Res 2015; 27:e125-e133. [PMID: 25720794 DOI: 10.1111/clr.12575] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Porcine collagen matrices are proclaimed being a sufficient alternative to autologous free gingival grafts (FGG) in terms of augmenting the keratinized mucosa. The collagen matrix Mucograft® (CM) already showed a comparable clinical performance in the early healing phase, similar histological appearance, and even a more natural appearance of augmented regions. Predictability for long-term stability does not yet exist due to missing studies reporting of a follow-up >6 months. MATERIAL AND METHODS The study included 48 patients with atrophic edentulous or partially edentulous lower jaw situations that had undergone an implant treatment. In the context of implant exposure, a vestibuloplasty was either performed with two FGGs from the palate (n = 21 patients) or with the CM (n = 27 patients). Surgery time was recorded from the first incision to the last suture. Follow-up examinations were performed at the following time points: 10, 30, 90, and 180 days and 1, 2, 3, 4, and 5 years after surgery. The width of keratinized mucosa was measured at the buccal aspect of each implant, and augmented sites were evaluated in terms of their clinical appearances (texture and color). RESULTS The groups showed similar healing with increased peri-implant keratinized mucosa after surgery (FGG: 13.06 mm ± 2.26 mm and CM: 12.96 mm ± 2.86 mm). The maximum follow-up was 5 years (5 patients per group). After 180 days, the width of keratinized mucosa had decreased to 67.08 ± 13.85% in the FGG group and 58.88 ± 14.62% in the CM group with no statistically significant difference. The total loss of the width of keratinized mucosa after 5 years was significant between the FGG (40.65%) and the CM group (52.89%). The CM group had significantly shorter operation times than the FGG group. Augmented soft tissues had a comparable clinical appearance to adjacent native gingiva in the CM group. FGGs could still be defined after 5 years. CONCLUSIONS The FGG and the CM are both suitable for the regeneration of the peri-implant keratinized mucosa with a sufficient long-term stability. With the CM, tissue harvesting procedures are invalid, surgery time can be reduced, and regenerated tissues have a more esthetic appearance.
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Affiliation(s)
- Christian M Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Tobias Moest
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Falk Wehrhan
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Friedrich W Neukam
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Karl Andreas Schlegel
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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13
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Barakat K, Ali A. Thermoplastic vestibuloplasty: a novel technique for treatment of lip and cheek adhesion. Craniomaxillofac Trauma Reconstr 2014; 7:258-62. [PMID: 25383145 DOI: 10.1055/s-0034-1375171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 09/29/2013] [Indexed: 10/25/2022] Open
Abstract
Lip and cheek adhesion to the opposing alveolus with complete or partial loss of the vestibular dimension represents a challenging problem for reconstruction. It usually occurs due to primary inadequate vestibular soft tissue repair following complicated trauma cases, burns, and lesions of the oral cavity. Surgical removal of scar tissue and creation of new vestibule is complicated by readhesion between the opposing connective tissue surfaces. Skin grafts and acellular dermal matrix represent the most dominant modalities used to treat deficient vestibule dimensions, but they are difficult to fix and lack the required stability during healing. Several devices have been created in an attempt to keep the tissues apart but their complex anchorage methods seriously reduced their reliability and usage. We devised a simple and reliable technique "thermoplastic vestibuloplasty" (TV) that benefit from the inherent reepithelialization capabilities of the oral mucosa to prevent readhesion and to resurface the created vestibule with its exact tissue color and texture. In total, 10 patients suffering from complete or partial lip or cheek adhesion with concomitant loss of vestibule were surgically treated by excising scar tissue and creating a new vestibule, followed by TV technique. Pre and posttreatment results were compared in terms of vestibular length, lip or cheek mobility, and change by time in vestibular length from 2 weeks up to 3 months. Moreover, the patient satisfaction and outcomes were measured using visual analogue scale score. All patients tolerated the procedure without complication. The mean vestibule length and mobility significantly increased from 3.8 + 0.6 mm to 11.4 + 1.4 mm (p < 0.001) and from 0.3 to 2 (p < 0.001), respectively. Regarding the stability of the achieved vestibular length it decreased by 14% when compared from 2 weeks to 3 months postoperatively. TV technique is a new simple and reliable technique that can effectively prevent readhesion of opposing connective tissue surfaces until intrinsic reepithelialization can resurface the newly created vestibular tissues forming a stable vestibular length with excellent color and texture.
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Affiliation(s)
- Khaled Barakat
- Faculty of Dentistry, Oral and Maxillofacial Surgery, Minia University
| | - Aya Ali
- Department of Periodontology, Minia University, Cairo, Egypt
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Cortell-Ballester I, Figueiredo R, Gay-Escoda C. Lowering of the mouth floor and vestibuloplasty to support a mandibular overdenture retained by two implants. A case report. J Clin Exp Dent 2014; 6:e310-2. [PMID: 25136438 PMCID: PMC4134866 DOI: 10.4317/jced.51402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/09/2014] [Indexed: 11/05/2022] Open
Abstract
In Oral Implantology most of the procedures are predictable and have high success rates. The use of osseointegrated implants as a therapeutic option for the rehabilitation of patients with severe mandibular atrophy has decreased the need for pre-prosthetic surgery Nevertheless, complications may occur during implant surgery and also once the prosthesis has been placed. This paper describes the case of a totally edentulous patient with an upper complete removable denture and an implant-retained overdenture with two implants in the intermentonian region. During clinical examination, the implant abutments were totally covered by soft tissue since the floor of the mouth was elevated. The panoramic radiography showed severe mandibular atrophy. Vestibuloplasty was performed together with the lowering of the floor of the mouth under general anesthesia and nasotracheal intubation to expose the implants. A new prosthesis was fabricated for the patient to prevent recurrence and improve the patient's chewing ability as it formed a physical barrier against soft tissue migration on prosthetic attachments. Key words:Vestibuloplasty, lowering of the mouth floor, complications in oral implantology.
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Affiliation(s)
- Isidoro Cortell-Ballester
- DDS. Master in Oral Surgery and Orofacial Implantology, School of Dentistry, University of Barcelona, Spain
| | - Rui Figueiredo
- DDS. Associate Professor of Oral Surgery. Professor of the Master degree program in Oral Surgery and Orofacial Implantology. School of Dentistry of the University of Barcelona. Researcher of the IDIBELL Institute. Barcelona, Spain
| | - Cosme Gay-Escoda
- DDS, MD, PhD. Chairman and Professor of Oral and Maxillofacial Surgery. School of Dentistry of the University of Barcelona. Coordinator/Researcher of the IDIBELL Institute. Oral and Maxillofacial Surgeon of the Teknon Medical Center, Barcelona, Spain
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Schmitt CM, Tudor C, Kiener K, Wehrhan F, Schmitt J, Eitner S, Agaimy A, Schlegel KA. Vestibuloplasty: Porcine Collagen Matrix Versus Free Gingival Graft: A Clinical and Histologic Study. J Periodontol 2013; 84:914-23. [DOI: 10.1902/jop.2012.120084] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A new submerged split-thickness skin graft technique to rebuild peri-implant keratinized soft tissue in composite flap reconstructed mandible or maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:e4-9. [DOI: 10.1016/j.tripleo.2011.06.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/21/2011] [Indexed: 11/23/2022]
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