Use of Transalveolar Sutures in Conjunction With Grafting to Preserve Vestibular Depth and Augment Gingival Thickness Around Mandibular Implants

Immediate Teeth in Fibulas: Expanded Clinical Applications and Surgical Technique

PURPOSE

The placement of immediate implants and teeth during jaw reconstruction using a fibula free flap has increased in recent years. Modifications of traditional fibula reconstructive techniques are needed to maximize success. This technique has not been described in patients requiring simultaneous soft tissue reconstruction. Our patient cohort includes cases with malignant pathology and those requiring skin paddles.  With digital workflows and point-of-care 3D printing, surgery is no longer delayed weeks for prosthesis fabrication. The purpose of this case series is to demonstrate a single institution's experience with expanded clinical applications and surgical techniques that enable predictable outcomes for immediate teeth in fibula flaps.

MATERIALS AND METHODS

Ninety-five implants were placed in 22 patients undergoing fibula reconstruction of the jaw with immediate implants and an immediate dental prosthesis. Skin paddles were used in 10 patients while 12 patients had native mucosa. Six patients were treated for malignancies and underwent postoperative radiation. Implant success and complications were compared between implants with skin paddles and implants with native mucosa.

RESULTS

Of 95 implants, 92 implants integrated for a 97% integration rate. All 13 radiated implants in 4 patients integrated. All 36 implants adjacent to skin paddles in 10 patients integrated. Seven implants were lost in a delayed fashion 9 to 15 months postoperatively resulting in a 93% overall implant success rate. Of the 22 patients, diagnoses were benign pathology for 11 patients, malignant pathology for 6 patients, gunshot wounds for 3 patients, and osteoradionecrosis for 2 patients.

CONCLUSION

Immediate placement of dental prostheses on immediate implants during fibula reconstruction of the jaws can be performed with a high rate of predictability. This technique can be expanded to select patients needing skin paddles. Modifications of traditional fibula reconstructive techniques are helpful to minimize soft tissue and prosthetic challenges.

Oral Soft Tissue Grafting

The presence of healthy soft tissue at the tooth and implant interface correlates to long-term success and stability in function and esthetics. Grafting procedures utilizing various techniques can be performed during any stage of the implant or restorative therapy. Materials of autogenous, allogeneic, and xenogeneic sources are available for oral soft tissue grafting. This article describes the classifications of soft tissue defects, treatment modalities, and materials used to enhance soft tissue quality and quantity and to achieve optimal esthetics and function around teeth and implants.

Impact of timing on soft tissue augmentation during implant treatment: A systematic review and meta-analysis

BACKGROUND

To achieve a predictable esthetic and functional outcome, soft tissue augmentation has become popular in implant treatment.

OBJECTIVES

The aim of this systematic review and meta-analysis was to assess the influence of different timing for soft tissue augmentation during implant treatment on soft tissue conditions and its stability.

MATERIAL AND METHODS

Electronic and manual searches for articles written in English up to September 2017 were performed by two independent reviewers. Human clinical studies with the purpose of evaluating outcomes (at least 3-month follow-up) of autogenous soft tissue graft for augmentation during implant treatment, either simultaneous or after implant placement (staged), were included. Cumulative changes of keratinized tissue width (KTW), soft tissue thickness (STT), and mid-buccal mucosal recession (MR) data were analyzed with a random-effects model to compare the postoperative outcomes.

RESULTS

Twenty-nine human studies (eight randomized clinical trials, six cohort studies, and 15 case series) that met the inclusion criteria were included. For the overall data, the weighted mean STT gain (1 year after surgery) was 1.03 mm (95% CI: 0.78-1.29 mm), among which the simultaneous group was 1.12 mm (95% CI: 0.75-1.49 mm) and staged group (3-6 months after implant placement) was 0.95 mm (95% CI: 0.58-1.31 mm). There was no statistically significant difference in KTW and MR between 3 months and more than 3 months after surgery.

CONCLUSIONS

This review revealed that the stability of soft tissue, in terms of KTW and mid-buccal MR, can be obtained 3 months after surgery. There is no difference between simultaneous and staged soft tissue augmentation during implant treatment, and both procedures significantly enhance KTW and STT.