The Inlay-Graft Technique to Create Papillae between Implants

Second-stage surgery in the posterior maxilla to enhance and thicken the keratinized gingiva - a case report

PURPOSE

Bone augmentation and implant placement often lead to a coronal shift of the soft tissue. Therefore replacement of the mucogingival border during second-stage surgery is required. Different techniques have been described in the literature.

MATERIAL AND METHODS

In this case report a new technique for second-stage surgery from a combination of a modified roll flap, an apically repositioned split thickness flap and thick free gingival grafts between the implants will be described for predictable gain of keratinized mucosa around and between dental implants.

RESULTS

Stable soft tissue conditions between the implants and buccal in the posterior maxilla could be gained showing almost no post-surgical resorption.

CONCLUSION

With this modified technique for second-stage surgery functional and esthetic results can be achieved.

Hyaluronic Acid: Ray of Hope for Esthetically Challenging Black Triangles: A Case Series

Purpose

The purpose of this study is to evaluate the clinical efficacy of enhancing deficient interdental papilla with hyaluronic acid gel injection.

Materials and Methods

Eight patients (three males and five females) were included. Patients had papillary deficiency in the upper anterior area. Prior to treatment, photographic images were taken for each patient. After the administration of a local anesthetic, a 23G needle was used to inject <0.2 mL of a commercially available and Food and Drug Administration-approved hyaluronic acid gel this treatment was repeated up to 2-3 times. Clinical photographic measurements of the black triangle area (BTA), black triangle height, and black triangle width were undertaken before the treatment and during follow-up. The interdental papilla reconstruction rate was calculated to determine the percentage change of the BTA between the initial and final examinations of the interdental papilla by means of injectable hyaluronic acid gel were evaluated.

Results

Eight sites had complete interdental papilla reconstruction and six sites showed improvements ranging from 78.5 ± 19.83%. More specifically, when contact point and the bone crest reached 6 mm, virtually complete interdental papilla reconstruction was achieved.

Conclusions

The results from this study are encouraging and present evidence that small papillary deficiencies between teeth can be enhanced by the injection of a hyaluronic acid gel.

The association between radiographic embrasure morphology and interdental papilla reconstruction using injectable hyaluronic acid gel

Purpose

The purpose of this study was to evaluate the clinical efficacy of enhancing deficient interdental papilla with hyaluronic acid gel injection by assessing the radiographic anatomical factors affecting the reconstruction of the interdental papilla.

Methods

Fifty-seven treated sites from 13 patients (6 males and 7 females) were included. Patients had papillary deficiency in the upper anterior area. Prior to treatment, photographic and periapical radiographic standardization devices were designed for each patient. A 30-gauge needle was used with an injection-assistance device to inject a hyaluronic acid gel to the involved papilla. This treatment was repeated up to 5 times every 3 weeks. Patients were followed up for 6 months after the initial gel application. Clinical photographic measurements of the black triangle area (BTA), height (BTH), and width (BTW) and periapical radiographic measurements of the contact point and the bone crest (CP-BC) and the interproximal distance between roots (IDR) were undertaken using computer software. The interdental papilla reconstruction rate (IPRR) was calculated to determine the percentage change of BTA between the initial and final examination and the association between radiographic factors and the reconstruction of the interdental papilla by means of injectable hyaluronic acid gel were evaluated.

Results

All sites showed improvement between treatment examinations. Thirty-six sites had complete interdental papilla reconstruction and 21 sites showed improvement ranging from 19% to 96%. The CP-BC correlated with the IPRR. More specifically, when the CP-BC reached 6 mm, virtually complete interdental papilla reconstruction via injectable hyaluronic acid gel was achieved.

Conclusions

These results suggest that the CP-BC is closely related to the efficacy of hyaluronic acid gel injection for interdental papilla reconstruction.

Soft tissue considerations in implant site development

Healthy soft tissue surrounding a dental implant is essential for health, function, and esthetics. The development of the tooth includes the formation of a biologic connection between the living tissues that has to be created during the healing process after placement of the implant. The success of dental implants is dependent on the establishment of a soft-tissue barrier that is able to shelter the underlying osseous structures and the osseointegration surrounding the implant body. The esthetics of a dental implant prosthesis depends on the health and stability of the peri-implant mucosa. Understanding of soft-tissue healing and maintenance around dental implants is paramount for implant success. This article discusses the soft-tissue interface, aspects of soft-tissue health, and esthetics during treatment planning and therapy.

I-shaped incisions for papilla reconstruction in second stage implant surgery

PURPOSE

Pink gingival esthetic especially on the anterior teeth has been an important success criterion in implant-supported restoration. Inter-implant papillae are a critical factor for implant esthetics, and various techniques for inter-implant papilla reconstruction have been introduced. The aim of this study is to suggest and evaluate a surgical technique for reconstructing inter-implant papillae.

METHODS

A 28-year-old man had an implant placed on the #13 and #14 area. Four months after implant placement, a second stage surgery was planned for inter-implant papilla reconstruction. At the time of the abutment connection, I-type incisions were performed on the #13i & #14i area followed by full-thickness flap elevation and connection of a healing abutment on underlying fixtures without suture.

RESULTS

Two weeks after the second stage implant surgery, soft tissue augmentation between the two implants was achieved.

CONCLUSIONS

I-shaped incisions for papilla reconstruction performed during the second stage implant surgery were useful for inter-implant papilla reconstruction and showed a good esthetic result.