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Kofina V, Monfaredzadeh M, Rawal SY, Dentino AR, Singh M, Tatakis DN. Guided bone regeneration-associated tissue swelling: A digital three-dimensional assessment. J Prosthet Dent 2024:S0022-3913(24)00635-8. [PMID: 39366838 DOI: 10.1016/j.prosdent.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 09/06/2024] [Accepted: 09/07/2024] [Indexed: 10/06/2024]
Abstract
STATEMENT OF PROBLEM Postoperative swelling following guided bone regeneration (GBR) may affect the dimensions of interim restorations and/or delivery timing. However, quantitative assessment of post-GBR swelling or its evaluation for possible impact on regenerative outcomes is lacking. PURPOSE The purpose of this prospective clinical study was to quantify post-GBR swelling and correlate it with clinical parameters and outcomes. MATERIAL AND METHODS Participants (n=25) undergoing standardized extraction and GBR protocol were recruited. Site-specific swelling was measured as ridge width, height, and volume changes based on intraoral scans recorded preoperatively, immediately postoperatively (IP), and at 2 days, 7 days, 14 days, and 4 months. The parameters and outcomes assessed were gingival and mucosal thickness, flap advancement, surgery duration, wound opening, and bone gain. The Friedman 2-way analysis of variance by ranks was performed, and the Spearman correlation coefficients (ρ) were computed (α=.05). RESULTS Ridge width and height peaked at 2 days (2.1 mm for both from IP; P<.001 for both) and reached IP levels by 7 days and 14 days (P>.999 and P=.888, respectively). At 4 months, both decreased significantly compared with IP (-4.2 mm and -1.9 mm respectively, P<.001). Volume increases peaked at 2 days (19%, P<.001), and peak swelling (2 days) preceded maximum wound opening (7 days). Bone width at 4 months was correlated with gingival thickness (ρ=0.45, P=.043), mucosal thickness (ρ=0.51, P=.021), and flap advancement (ρ=0.58, P=.008). CONCLUSIONS Following GBR, site-specific swelling peaked on postoperative day 2 and subsided by day 7 (width) or 14 (height). Soft tissue thickness and flap advancement affected post-GBR bone width.
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Affiliation(s)
- Vrisiis Kofina
- Assistant Professor and Graduate Periodontics Director, Department of Surgical Sciences, School of Dentistry, Marquette University, Milwaukee, Wisconsin.
| | - Morvarid Monfaredzadeh
- Graduate student, Department of Surgical Sciences, School of Dentistry, Marquette University, Milwaukee, Wisconsin
| | - Swati Y Rawal
- Professor and Director for Graduate Studies, Department of Surgical Sciences, School of Dentistry, Marquette University, Milwaukee, Wisconsin
| | - Andrew R Dentino
- Emeritus Professor, Department of Surgical Sciences, School of Dentistry, Marquette University, Milwaukee, Wisconsin
| | - Maharaj Singh
- Associate Research Professor, College of Nursing, Marquette University, Milwaukee, Wisconsin
| | - Dimitris N Tatakis
- Professor, Department of Oral and maxillofacial Surgery, Oral Medicine and Periodontology, College of Dentistry, University of Jordan, Amman, Jordan; and previously Professor and Postdoctoral Program Director, Division of Periodontology, College of Dentistry, The Ohio State University (OSU), Columbus, Ohio
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Neira P, Moreno X, Caric Y, Strauss FJ, Cavalla F. Two-Step Periosteal Releasing Incision for Tension-Free Flap Closure After Implant Placement With Simultaneous Guided Bone Regeneration. J ORAL IMPLANTOL 2024; 50:317-321. [PMID: 38703005 DOI: 10.1563/aaid-joi-d-24-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
We evaluated the effect of periosteal-releasing incisions on flap displacement in anterior maxillary sites following implant placement and simultaneously guided bone regeneration. Thirty patients, each requiring a single dental implant and guided bone regeneration in the maxillary esthetic zone, were recruited. After full-thickness flap elevation, the displacement of the flap was measured under a standardized tension of 1 Ncm. Then, a 2-step periosteal releasing incision was placed in the internal aspect of the flap, and the displacement was remeasured using the same standardized tension. Keratinized tissue width and mucosal thickness at the surgical site were recorded. Patient-reported outcomes were assessed at the 7- and 14-day recall visits. Flap displacement (primary outcome) was calculated before and after periosteal-releasing incisions. Multivariable linear regression models were used to evaluate the influence of mucosal thickness on flap displacement and adjusted for Keratinized tissue width. Primary wound closure was achieved in all patients. The mean difference in flap coronal displacement before and after the periosteal-releasing incisions was 8.2 mm (p < .0001). Adjusted regression models showed no association between mucosal thickness and keratinized tissue width with the amount of flap displacement (p = .770). Patient-reported outcome measures for pain, swelling, and bleeding amounted to 1.28 ± 1.93, 1.36 ± 1.87, and 0.0 ± 0.0 at 7 days and 0.11 ± 0.57, 0.56 ± 1.03, and 0.0 ± 0.0 at 14 days, respectively. Periosteal-releasing incisions using the 2-step procedure described here are a predictable technique to obtain coronal flap displacements >8 mm without increased surgical complications.
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Affiliation(s)
- Patricio Neira
- San Camilo Hospital, San Felipe, Chile
- School of Dentistry, University of Chile, Chile
| | - Ximena Moreno
- San Camilo Hospital, San Felipe, Chile
- School of Dentistry, University of Chile, Chile
| | - Yakov Caric
- San Camilo Hospital, San Felipe, Chile
- School of Dentistry, University of Chile, Chile
| | - Franz Josef Strauss
- School of Dentistry, University of Chile, Chile
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Faculty of Dentistry, Universidad Finis Terrae, Santiago, Chile
| | - Franco Cavalla
- San Camilo Hospital, San Felipe, Chile
- School of Dentistry, University Andres Bello, Chile
- School of Dentistry, University of Chile, Chile
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Roccuzzo M, Roccuzzo A, Marruganti C, Fickl S. The importance of soft tissue condition in bone regenerative procedures to ensure long-term peri-implant health. Periodontol 2000 2023; 93:129-138. [PMID: 37277923 DOI: 10.1111/prd.12496] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
Bone regenerative procedures have been widely proved to be a reliable treatment option to re-create the ideal pre-implant clinical conditions. Nevertheless, these techniques are not free from post-operative complications which might result in implant failure. Consequently, as demonstrated by the increasing recently published evidence, a careful pre- and intra-operative flap evaluation to ensure an ideal and hermetic tension-free wound closure is of paramount importance to successfully treat bony defects. In this respect, several surgical interventions mainly aimed to increase the amount of keratinized mucosa either to allow an optimal healing after a reconstructive procedure or to establish an optimal peri-implant soft tissue seal have been proposed. The present review summarizes the level of evidence on the surgical clinical aspects which have an impact on the soft tissue handling associated with bone reconstructive procedures and on the importance of soft tissue conditions to enhance and maintain peri-implant health in the long-term.
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Affiliation(s)
- Mario Roccuzzo
- Private Practice, Torino, Italy
- Division of Maxillo-Facial Surgery, University of Torino, Torino, Italy
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Oral and Maxillo-Facial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Department of Restorative, Pediatric and Preventive Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Crystal Marruganti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Stefan Fickl
- Private Practice, Fürth, Germany
- Department of Periodontology, Julius-Maximilians-University Würzburg, Würzburg, Germany
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4
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Kofina V, Monfaredzadeh M, Rawal SY, Dentino AR, Singh M, Tatakis DN. Patient-reported outcomes following guided bone regeneration: Correlation with clinical parameters. J Dent 2023; 136:104605. [PMID: 37419383 DOI: 10.1016/j.jdent.2023.104605] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Postoperative oral health-related quality of life is procedure-dependent and may vary during early healing. There is scarce evidence on patient-reported outcome measures (PROMs) after extraction and guided bone regeneration (GBR) or on the clinical parameters influencing PROMs. This prospective observational study aimed to evaluate PROMs during the first 2 weeks following extraction and GBR and correlate them with clinical parameters. METHODS Patients undergoing extraction and GBR (bone graft and resorbable membrane) at a single tooth-bound site were recruited. PROMs (pain, swelling, difficulty of mouth opening, and OHIP-14) were recorded immediately preoperatively, and at 2, 7, and 14 days postoperatively. Flap advancement, gingival and mucosal thickness, duration of surgery, and wound opening were the clinical parameters assessed. RESULTS Twenty-seven patients were included. All PROMs peaked on postoperative day 2, decreased subsequently and were significantly correlated with each other. Although 41-56% of patients reported moderate to severe pain, swelling, or mouth opening difficulty on day 2, most patients experienced mild or no symptoms throughout the postoperative period. Pain, swelling and difficulty of mouth opening were determinants of OHIP-14 and were correlated with all OHIP-14 domains during different time points. Wound opening peaked on day 7. Flap advancement, soft tissue thickness, wound opening, duration of surgery and preoperative PROMs affected postoperative PROMs. CONCLUSIONS Within the limitations of the present study, postoperative symptoms after guided bone regeneration are worst on day 2 and oral health-related quality of life is significantly impacted by pain, swelling, difficulty of mouth opening, surgery duration and flap advancement. CLINICAL SIGNIFICANCE This is the first study to report PROMs following extraction and GBR with particulate bone graft and resorbable membrane in preparation for implant placement. It will help guide both practitioners and patients on what should be the anticipated experiences following such a routinely performed surgery.
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Affiliation(s)
- Vrisiis Kofina
- Department of Surgical Sciences, School of Dentistry, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-1881, USA.
| | - Morvarid Monfaredzadeh
- Department of Surgical Sciences, School of Dentistry, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-1881, USA
| | - Swati Y Rawal
- Department of Surgical Sciences, School of Dentistry, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-1881, USA
| | - Andrew R Dentino
- Department of Surgical Sciences, School of Dentistry, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-1881, USA
| | - Maharaj Singh
- College of Nursing, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-1881, USA
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, 4121 Postle Hall, 305 W 12th Ave, Columbus, OH 43210, USA
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Cairo F, Burkhardt R. Minimal invasiveness in gingival augmentation and root coverage procedures. Periodontol 2000 2023; 91:45-64. [PMID: 36694255 DOI: 10.1111/prd.12477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 01/26/2023]
Abstract
Minimally invasive surgical procedures aim at optimal wound healing, a reduction of postoperative morbidity and, thus, at increased patient satisfaction. The present article reviews the concept of minimal invasiveness in gingival augmentation and root coverage procedures, and critically discusses the influencing factors, technical and nontechnical ones, and relates them to the underlying biological mechanisms. Furthermore, the corresponding outcomes of the respective procedures are assessed and evaluated in relation to a possible impact of a minimized surgical invasiveness on the clinical, aesthetic, and patient-related results.
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Affiliation(s)
- Francesco Cairo
- Head Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Burkhardt
- Private Practice, Zurich, Switzerland.,Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, Hong Kong, SAR.,Department of Periodontics & Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Park WB, Ko JM, Han JY, Kang P. Flap Extension Technique Using Intrasocket Granulation Tissue in Peri-Implant Osseous Defect: Case Series. Medicina (B Aires) 2022; 58:medicina58111555. [PMID: 36363512 PMCID: PMC9698312 DOI: 10.3390/medicina58111555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 01/25/2023] Open
Abstract
A compromised extraction socket is characterized by severe bone resorption around neighboring teeth and is often occupied with thick intrasocket granulation tissue (IGT). Guided bone regeneration (GBR) is a procedure that can preserve the bone volume around extraction sockets, and it can also be combined with immediate implant placement. However, an early exposure of GBR sites is a possible complication because it increases the risk of infection and can inhibit successful bone regeneration. The purpose of these case series is to introduce a novel, surgical procedure that can prevent the exposure of GBR sites by using IGT for flap extension during immediate implant placement in compromised extraction sockets. The technique was successfully performed in six patients. For successful flap closure, the inner portion of the IGT was dissected so that the flap was properly extended with the base of IGT attached to the flap for blood supply. Periosteal releasing incisions were not performed. The IGT was first sutured to the palatal flap with resorbable sutures, and then the overlying flap was closed with additional sutures. There was no post-operative exposure of the surgical GBR site in any of the patients, and the location of the mucogingival junction remained unchanged. All grafted sites also achieved sufficient bone regeneration. Within the limitations, this case series demonstrates the potential use of IGT, a concept which was previously obsolete.
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Affiliation(s)
- Won-Bae Park
- Department of Periodontology, School of Dentistry, Kyung Hee University, Private Practice in Periodontics and Implant Dentistry, Seoul 02447, Korea
| | - Jung-Min Ko
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, NY 10032, USA
| | - Ji-Young Han
- Department of Periodontology, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Philip Kang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, NY 10032, USA
- Correspondence:
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Traboulsi-Garet B, González-Barnadas A, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Influence of Different Incision Designs on Flap Extension: A Cadaveric Animal Model. J ORAL IMPLANTOL 2021; 47:395-400. [PMID: 33031545 DOI: 10.1563/aaid-joi-d-20-00026] [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: 11/22/2022]
Abstract
It is well known that wound dehiscence is one of the most frequent complications in guided bone regeneration. The main cause of this complication may be a lack of tension-free and primary wound closure. The aim of this study was to evaluate and compare the effect of periosteal releasing incisions (PRI) on the extension of 3 different flap designs: envelope, triangular, and trapezoidal. Twelve pig mandibles were used to quantify extension of the flap designs. The mandibles were equally and randomly distributed into the 3 flap groups. Each mandible was divided into 2 sides: 1 was subjected to a PRI and the other not. The flap was pulled with a force of 1.08 N, and the extension was recorded. The subgroups without PRI showed an average extension of 5.14 mm with no statistically significant differences among them (P = .165). The PRI provided an average extension of 7.37 mm with statistically significant differences among the subgroups (P < .001). The releasing incisions significantly increased flap extension in each flap design. The increase in extension of the trapezoidal flap with PRI was significantly greater than in the other subgroups. In cases where primary closure is required, surgeons should consider performing trapezoidal flaps with PRI in order to reduce tension.
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Affiliation(s)
| | | | - Octavi Camps-Font
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Rui Figueiredo
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Cardoso MV, Lara VS, Sant'Ana ACP, Damante CA, Ragghianti Zangrando MS. Late complications after root coverage with two types of subepithelial connective tissue grafts, clinical and histopathological evaluation: A prospective cohort study. J Clin Periodontol 2021; 48:431-440. [PMID: 33340153 DOI: 10.1111/jcpe.13413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 01/15/2023]
Abstract
AIM This prospective cohort study evaluated late complications (LC) on recipient sites comparing two types of connective tissue grafts (CTG). MATERIALS AND METHODS Participants (n: 60) were treated with coronally advanced flap (CAF) plus CTG harvested by de-epithelialized technique (DE) (n:31) or two-parallel incision (PI) (n:29). Areas were evaluated to identify white discharge associated or not with gingival cul-de-sac. Patients were ordered in groups with (DE+and PI+) or without (DE- and PI-) LC. Biopsies for histopathological analysis in LC areas were proposed. RESULTS Six cases exhibited LC, 5 in DE graft (DE+) and 1 in PI graft (PI+) group; 2 were diagnosed at 3 months postoperatively, 3 at 6 months and one at 12 months. The relative risk for LC was 1.7 times greater for DE graft (p: 0.01; CI: 1.10 to 2.72; RR>1). Differences were not observed for clinical outcomes after both types of CTGs (p > 0.05). Biopsies showed deep invagination of the epithelial lining suggesting cyst-like area/ cavity with keratin content and consolidated in fibrous connective tissue. After 24 months biopsied areas presented no recurrence of LC, in non-biopsied patients the clinical condition remained unchanged. CONCLUSIONS Considering the limitations of this study, LC on recipient sites demonstrated no statistical difference between two types of CTG.
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Affiliation(s)
- Matheus Völz Cardoso
- Discipline of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Vanessa Soares Lara
- Discipline of Pathology and Oral Pathology, Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | - Carla Andreotti Damante
- Discipline of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Tay JRH, Lu XJ, Lai WMC, Fu JH. Clinical and histological sequelae of surgical complications in horizontal guided bone regeneration: a systematic review and proposal for management. Int J Implant Dent 2020; 6:76. [PMID: 33241468 PMCID: PMC7688776 DOI: 10.1186/s40729-020-00274-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022] Open
Abstract
It is not uncommon to encounter post-surgical complications after horizontal guided bone regeneration (GBR). The primary aim of this review was to evaluate the incidence and types of complications that occur after horizontal GBR and propose management strategies to deal with these clinical situations. A secondary aim was to conduct a histomorphometric review of the wound healing process at sites that experienced post-surgical complications after GBR. A keyword search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published in English from January 2015 to January 2020 was conducted for the primary aim and 23 studies were selected. A second search addressing the secondary aim was conducted, and five studies were included. Site-level analysis showed that the weighted mean incidence proportion of minor wound dehiscence and minor infections occurring at the augmented site was 9.9% [95% CI 6.4, 13.9, P < 0.01] and 1.5% [95% CI 0.4, 3.1, P = 0.21) respectively. Patient-level analysis showed minor and major complications occurring at a weighted mean incidence proportion of 16.1% [95% CI 11.9, 20.8, P = 0.01] and 1.6% [95% CI 0.0, 4.7, P < 0.01] respectively, while neurosensory alterations at the donor site was 7.0% [95% CI 1.3, 15.5, P < 0.01]. Subgroup analysis also revealed that the use of block grafts increased the incidence proportion of minor post-surgical complications, whereas a staged GBR procedure increased the incidence proportion of both minor and major post-surgical complications. Although exposure of the barrier membrane is often associated with less bone regeneration and graft resorption, the type of membrane used (resorbable or non-resorbable) had no statistically significant influence on any post-surgical complication. Histologically, a layer of fibrous connective tissue instead of bone is commonly observed at the interface between the native bone at the recipient site and the regenerated bone in cases with membrane exposure after GBR procedure. Minor wound dehiscence was the highest incidence proportion of post-surgical complications. Methods ranging from daily application of antiseptics, use of systemic antimicrobials, regular reviews, and total removal of the non-integrated biomaterials are commonly prescribed to manage these post-surgical complications in attempt to minimise the loss of tissue at the surgical site.
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Affiliation(s)
- John Rong Hao Tay
- Discipline of Periodontics, National University Centre for Oral Health Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore.,Department of Restorative Dentistry, National Dental Centre Singapore, 5 Second Hospital Ave, Singapore, 168938, Singapore
| | - Xiaotong Jacinta Lu
- Discipline of Periodontics, National University Centre for Oral Health Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore
| | - Wei Ming Clement Lai
- Statistics Unit, National University Centre for Oral Health Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore
| | - Jia-Hui Fu
- Discipline of Periodontics, National University Centre for Oral Health Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore.
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Releasing incisions of the buccal periosteum adjacent to the lower molar teeth can injure the facial artery: an anatomical study. Surg Radiol Anat 2019; 42:31-34. [DOI: 10.1007/s00276-019-02319-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
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11
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Chackartchi T, Romanos GE, Sculean A. Soft tissue‐related complications and management around dental implants. Periodontol 2000 2019; 81:124-138. [DOI: 10.1111/prd.12287] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Tali Chackartchi
- Department of Periodontology Faculty of Dental Medicine Hadassah & Hebrew University Jerusalem Israel
| | - Georgios E. Romanos
- Department of Periodontology School of Dental Medicine Stony Brook University Stony Brook New York USA
| | - Anton Sculean
- Department of Periodontology School of Dental Medicine University of Bern Bern Switzerland
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12
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Zucchelli G, Tavelli L, Barootchi S, Stefanini M, Rasperini G, Valles C, Nart J, Wang H. The influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter re‐analysis study. J Periodontol 2019; 90:1244-1251. [DOI: 10.1002/jper.18-0732] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor SciencesUniversity of Bologna Bologna Italy
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Lorenzo Tavelli
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Shayan Barootchi
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor SciencesUniversity of Bologna Bologna Italy
| | - Giulio Rasperini
- Department of BiomedicalSurgical and Dental SciencesFoundation IRCCS Ca’ Granda PolyclinicUniversity of Milan Milan Italy
| | - Cristina Valles
- Department of PeriodontologySchool of Dentistry, UniversitatInternational de Catalunya Barcelona SC Spain
| | - José Nart
- Department of PeriodontologySchool of Dentistry, UniversitatInternational de Catalunya Barcelona SC Spain
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI USA
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13
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Use of acellular collagen matrix for the closure of the open oral wound in bone regeneration. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:446-449. [DOI: 10.1016/j.jormas.2018.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 01/18/2023]
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Baseline Biomechanical Properties of Epithelia prior to Tissue Expansion in Dogs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1773. [PMID: 29922558 PMCID: PMC5999427 DOI: 10.1097/gox.0000000000001773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 03/13/2018] [Indexed: 11/27/2022]
Abstract
Background: Soft-tissue deficiencies pose a challenge in a variety of disease processes when the end result is exposure of underlying tissue. Although multiple surgical techniques exist, the transposition of tissue from one location to another can cause donor-site morbidity, long incisions prone to dehiscence, and poor patient outcomes as a result. Use of tissue expansion prior to grafting procedures has been shown to have success in increasing available soft tissue to aid in repairing wounds. However, the current tissue expanders have biomechanical limits to the extent and rate of expansion that usually exceeds the tissue capacity, leading to incisional dehiscence or expander extrusion. Understanding the baseline biomechanical properties of the tissue to be expanded would provide useful information regarding surgical protocol employed for a given anatomical location. Therefore, the aim of this study was to test and compare the baseline (preexpansion) biomechanical properties of different common expansion sites in dogs. Methods: Four samples measuring approximately 20 × 15 × 1 mm were harvested from 8 dogs. The samples were collected from the hard palate, alveolar mucosa, scalp, and chest of the animal and analyzed for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength using a Texture Technologies TA.XT texture analyzer with corresponding biomechanical measurement software. Samples were compared as to their baseline biomechanical properties prior to any soft-tissue expansion. Histological sections of the samples were analyzed using hematoxylin eosin in an attempt to correlate the histological description to the biomechanical properties seen during testing. Summary statistics (mean, standard deviation, standard error, range) are reported for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength and for the histological parameters by intraoral site. Analysis of variance was used to compare the biomechanical and histological parameters among the 4 locations while accounting for multiple measurements from each dog. Results: The scalp had significantly higher maximum stress (σmax) than chest, mucosa, and palate (P < 0.0001), with no differences among the other 3 locations (P > 0.63). Scalp site also had significantly higher maximum tangential modulus (ε) than chest, mucosa, and palate (P < 0.006), with no differences among the other 3 locations (P > 0.17). The locations did not have significantly different maximum tangential stiffness (k; P = 0.72). Histologically, 2 separate patterns of collagen disruption were evident. Conclusion: Although different results were obtained than theorized, this study showed that the scalp had the greatest resiliency to expand prior to tearing, and the highest tangential modulus, with all sites having statistically similar modulus of elasticity. Based on this study, the scalp could be expanded more aggressively compared with the other sites.
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Considerations for Incision and Flap Design With Implant Therapy in the Esthetic Zone. IMPLANT DENT 2018; 27:381-387. [DOI: 10.1097/id.0000000000000769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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16
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Zuhr O, Rebele SF, Cheung SL, Hürzeler MB. Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery. Periodontol 2000 2018; 77:123-149. [PMID: 29493018 DOI: 10.1111/prd.12214] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine.
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Yu H, Qiu L. Efficacy of the split-thickness labial flap method for soft tissue management in anterior ridge horizontal augmentation procedures: A clinical prospective study in the anterior maxilla. J Craniomaxillofac Surg 2017; 46:323-328. [PMID: 29242025 DOI: 10.1016/j.jcms.2017.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/18/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To introduce a novel method of split-thickness labial flap in maxillary anterior ridge horizontal augmentation and to evaluate its efficacy and morbidity. MATERIALS AND METHODS 230 patients were selected to receive either particulate or onlay grafting. A split-thickness labial flap was applied to cover the grafted area and close the wound. The incidence of postsurgical complications and the level of patient discomfort were evaluated. A visual analog scale was used to quantify the amount of pain and swelling in the patients. RESULTS In all 375 surgical sites, passive primary closure was achieved with the split-thickness labial flap method. Membrane exposure after surgery was seen in 6 cases in the onlay group and in 4 in the particulate group. No long-lasting pain (>1 week), paresthesia, or signs of infection occurred during the follow-up period of 6 months. The mean pain and swelling scores in the particulate graft group (2.75 ± 3.01 and 2.02 ± 2.51, respectively) were lower than the scores in the onlay graft group (3.18 ± 2.79 and 3.85 ± 2.25, respectively). CONCLUSIONS The flap advancement technique presented in this study facilitates clinically passive primary closure. This technique can be used successfully in both particulate and onlay horizontal graft procedures.
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Affiliation(s)
- Huajie Yu
- Fourth Division, Peking University Hospital of Stomatology, No. 41 East Fourth Ring Road, 100025, Beijing, China
| | - Lixin Qiu
- Fourth Division, Peking University Hospital of Stomatology, No. 41 East Fourth Ring Road, 100025, Beijing, China.
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18
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Safe New Approach to the Lingual Flap Management in Mandibular Augmentation Procedures. IMPLANT DENT 2017; 26:790-795. [DOI: 10.1097/id.0000000000000599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A preliminary randomized clinical trial comparing diode laser and scalpel periosteal incision during implant surgery: impact on postoperative morbidity and implant survival. Lasers Med Sci 2017; 33:19-25. [PMID: 28861729 DOI: 10.1007/s10103-017-2315-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/24/2017] [Indexed: 10/19/2022]
Abstract
The aim of this preliminary randomized clinical trial was to compare: (1) post-operative morbidity after application of laser or scalpel incision for flap advancement during implant surgery and bone grafting and (2) implant survival rate following flap advancement with laser or scalpel incision after 6 months of loading. Eighteen patients who were scheduled for dental implant placement and simultaneous bone grafting were randomly assigned to test or control groups. Diode laser (810 nm, 2 W, pulse interval 200 μs; pulse length 100 μs, 400-μm initiated fiber tip), or scalpel (control) was used to sever the periosteum to create a tension-free flap. Visual analogue scale (VAS) pain score, rate of nonsteroid anti-inflammatory drug (NSAID) consumption, intensity of swelling, and ecchymosis were measured for the six postsurgical days. Six months after loading, implant survival was assessed. VAS pain score (during the first four postoperative days), rate of NSAID consumption (during the first three postoperative days), and intensity of swelling (during the first five postoperative days) were significantly lower in the test group compared to the control group (All P values < 0.05). One patient in the control group experienced ecchymosis. All implants were successful in function. Application of laser for performing periosteal releasing incision reduced the incidence and severity of postoperative morbidity of the patients undergone implant surgery in conjunction with bone augmentation procedure. We did not find any detrimental effect of laser incision on the implant survival within 6 months of loading.
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González-Barnadas A, Camps-Font O, Espanya-Grifoll D, España-Tost A, Figueiredo R, Valmaseda-Castellón E. In Vitro Tensile Strength Study on Suturing Technique and Material. J ORAL IMPLANTOL 2017; 43:169-174. [PMID: 28301295 DOI: 10.1563/aaid-joi-d-16-00164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Suture technique and materials are important in preventing complications such as wound dehiscences. The purpose of this study was to determine the tensile strength of different suturing techniques, comparing several materials with different diameters. One hundred sixty sutures were performed using silk, e-PTFE, and 2 types of polyamide (monofilament and Supramid). Ten simple, 10 horizontal mattress, and 10 combinations of the two stitches were performed with 4-0 gauge of each material. Additionally, 10 simple sutures were performed with the 5-0 gauge of each material. The maximum tensile force resisted by each suture was recorded. When 5 mm of traction was applied, the polyamide monofilament resisted significantly better without untying or breaking compared with Supramid or silk, while the e-PTFE was superior to all the others. However, the force when e-PTFE 4-0 sutures untied or broke was lower than for either type of polyamide. The combined technique withstood a significantly higher tensile force before unknotting or breaking than did the simple and mattress stitches. The 5-0 gauges of silk and both types of polyamide showed lower tensile strengths than the 4-0 materials. Among the 5-0 sutures, Supramid showed a higher tensile strength than silk. The combined suture technique possessed greater tensile strength than did a simple or a horizontal mattress suture, and e-PTFE 4-0 withstood more traction without untying or breaking than did all the other materials, although at a lower tensile force. With the exception of e-PTFE, 4-0 sutures had greater tensile strength than did 5-0 sutures.
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Affiliation(s)
| | | | | | | | - Rui Figueiredo
- 2 Faculty of Dentistry, University of Barcelona; IDIBELL Institute, Barcelona, Spain
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21
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Plonka AB, Sheridan RA, Wang HL. Flap Designs for Flap Advancement During Implant Therapy: A Systematic Review. IMPLANT DENT 2017; 26:145-152. [PMID: 27893512 DOI: 10.1097/id.0000000000000510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Guided bone regeneration (GBR) procedures allow ridge augmentation before or at time of implant placement. GBR outcomes rely on primary passive tension-free wound closure, which may be achieved by a variety of flap designs and surgical procedures. A comprehensive literature review of flap design and management is provided, including material types, incision design, reflection, releasing, and suturing techniques. MATERIALS AND METHODS Two reviewers completed a literature search using the PubMed database and a manual search of relevant journals. Relevant articles from January 1990 to September 2015 published in the English language were considered. RESULTS A variety of flap designs aim to achieve primary passive closure during GBR were introduced. To facilitate case selection and treatment planning, flap designs have been categorized based on their ability to achieve minor (<3 mm), moderate (3-6 mm), and major (≥7 mm) degrees of flap advancement. CONCLUSIONS Techniques such as vertical releasing incisions, periosteal releasing incisions, and split-thickness flaps may be used alone or combined to achieve passivity during GBR. GBR complications may be prevented by imaging and preoperative planning and careful surgical technique especially flap advancement.
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Affiliation(s)
- Alexandra B Plonka
- *Resident, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI. †Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
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Moslemi N, Khorsand A, Torabi S, Shahnaz A, Soleimani Shayesteh Y, Fekrazad R. Periosteal Releasing Incision With Diode Laser in Guided Bone Regeneration Procedure: A Case Series. J Lasers Med Sci 2016; 7:259-264. [PMID: 28491263 DOI: 10.15171/jlms.2016.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Periosteal releasing incision (PRI) is nearly always essential to advance the flap sufficiently for a tension-free flap closure in bone augmentation procedures. However, hematoma, swelling, and pain are recognized as the main consequences of PRI with scalpel. The aim of this case series was to investigate the effectiveness of laser-assisted PRI in guided bone regeneration (GBR) procedure. In addition, postoperative hematoma, swelling, and pain and implant success were assessed. Methods: Seventeen patients needed GBR were included in this study. Diode laser (940 nm, 2 W, pulse interval: 1 ms, pulse length: 1 ms, contact mode, 400-μm fiber tip) was used in a contact mode to cut the periosteum to create a tension-free flap. Facial hematoma, swelling, pain, and the number of consumed nonsteroidal anti-inflammatory drugs (NSAIDs) were measured for the six postoperative days. Six months after implant loading, implant success was evaluated. Results: Minimal bleeding was encountered during the procedure. A tension-free primary closure of the flap was achieved in all cases. The clinical healing of the surgical area was uneventful. None of the patients experienced hematoma, ecchymosis, or intense swelling after surgery. The mean value of maximum pain (visual analogue scale - VAS) was 20.59 ± 12.10 mm (mild pain). Patients did not need to use NSAID after four postoperative days. All implants were successful and functional and none of them failed after 6 months of implant loading. Conclusion: This study revealed the effectiveness of laser-assisted PRI in GBR procedure. This technique was accompanied with minimal sequelae at the first postoperative week. All implants were successful and no complication was noted during the course of this study.
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Affiliation(s)
- Neda Moslemi
- Laser Research Center of Dentistry, Dental Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Khorsand
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Torabi
- Department of Periodontics, School of Dentistry, Ghazvin University of Medical Sciences, Ghazvin, Iran
| | - Aysan Shahnaz
- Department of Periodontics, School of Dentistry, Ghom University of Medical Sciences, Ghom, Iran
| | | | - Reza Fekrazad
- Laser Research Center in Medical Sciences (LRCMS), Department of Periodontics, Faculty of Dentistry, AJA University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Alani A, Bishop K. Peri-implantitis. Part 3: current modes of management. Br Dent J 2016; 217:345-349. [PMID: 25303581 DOI: 10.1038/sj.bdj.2014.858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/09/2022]
Abstract
Peri-implantitis is an inflammatory condition fuelled by the presence of bacteria on the implant surface. As such, in a similar manner to periodontal disease management, the removal of biofilm from the implant surface should result in regression of the disease process. The optimal manner with which this is achieved has yet to be realised. This may be unsurprising due to the relative surface complexity of the implant surface when compared to natural tooth root. Other management strategies include surface decontamination, the removal of implant threads known as implantoplasty, and in severe cases the need to explant. Favourable defects can be reconstructed utilising guided bone regeneration techniques. The current review appraises some of the techniques for the management of peri-implantitis.
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Affiliation(s)
- A Alani
- Department of Restorative Dentistry, Kings College Hospital, Denmark Hill, London, SE5 9RS
| | - K Bishop
- Department of Restorative Dentistry, Maxillofacial Unit, Morriston Hospital, Swansea, SA6 6NL
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Hur Y, Bui MN, Griffin TJ, Ogata Y. Modified Periosteal Releasing Incision for Flap Advancement: A Practical Technique for Tensionless Closure. Clin Adv Periodontics 2015. [DOI: 10.1902/cap.2014.140009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Burkhardt R, Lang NP. Fundamental principles in periodontal plastic surgery and mucosal augmentation - a narrative review. J Clin Periodontol 2014; 41 Suppl 15:S98-107. [DOI: 10.1111/jcpe.12193] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Rino Burkhardt
- The University of Hong Kong; Prince Philip Dental Hospital; Hong Kong SAR and University of Zurich; Zurich Switzerland
| | - Niklaus P. Lang
- The University of Hong Kong; Prince Philip Dental Hospital; Hong Kong SAR and University of Zurich; Zurich Switzerland
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