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Bressan E, Zucchelli G, Tommasato G, Pesce P, Canullo L, Grusovin MG. Consensus Report by the Italian Academy of Osseointegration on the Importance of Peri-Implant Soft Tissues. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1393. [PMID: 39336434 PMCID: PMC11433715 DOI: 10.3390/medicina60091393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/12/2024] [Accepted: 08/21/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: The influence of the quantity and quality of peri-implant soft tissue on implant health and long-term maintenance is controversial. This consensus aimed to assess the importance of peri-implant soft tissue by analyzing four aspects: the role of keratinized mucosa (KM), the efficacy of specific collagen matrix, the influence of abutment material, and soft-tissue thickness. Materials and Methods: Active members of the Italian Academy of Osseointegration (IAO) participated in the consensus. Four systematic reviews were conducted, and their results were discussed to provide guidelines on the importance of soft tissue around implants. The first review evaluated the effect of KM on soft-tissue health, peri-implant bone loss, and patient-related variables. The second one analyzed if there was a specific type of matrix that provided better results in terms of peri-implant buccal soft-tissue thickness and keratinized mucosa width compared to autogenous soft-tissue graft. The third review evaluated the influence of different abutment materials on the soft tissues, and the fourth assessed the effect of soft-tissue thickness on peri-implant marginal bone loss (MBL). Results and Conclusions: The agreements reached by the assembly were as follows: the presence of supra-periosteal keratinized tissue is considered to favorably influence peri-implant health and aesthetics but had no relation to preventing bone crest resorption unrelated to infection. It facilitates patient cleaning around implants and reduces patient-reported pain. The free gingival graft (FGG) is considered the best in terms of supra-periosteal KM increase. Connective tissue grafts (CTG) perform better than volume-stable collagen matrices to increase soft-tissue thickness. Collagen matrices reduce surgical time and patient morbidity and can give better camouflaging. The influence of abutment material (titanium or zirconia) on MBL remains controversial, and no conclusion could be reached on this issue. Peri-implant soft-tissue health and recession seem not to be influenced by abutment material, but data are limited to zirconia and titanium. Although this systematic review highlighted the absence of a correlation between soft-tissue thickness and MBL, the assembly failed to find a consensus on this issue.
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Affiliation(s)
- Eriberto Bressan
- Department of Neurosciences, School of Dentistry, University of Padova, Via Giustiniani 2, 35100 Padova, Italy;
| | - Giovanni Zucchelli
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, 40126 Bologna, Italy;
- Department of Biomedical, Surgical, and Dental Sciences, University of Milano, 20122 Milan, Italy
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy; (P.P.); (L.C.)
| | - Grazia Tommasato
- Department of Biomedical, Surgical, and Dental Sciences, University of Milano, 20122 Milan, Italy
| | - Paolo Pesce
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy; (P.P.); (L.C.)
| | - Luigi Canullo
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy; (P.P.); (L.C.)
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Yu X, Wu C, Wang F, Ni J, Wu Y, Li C. Dimensional changes in free gingival grafts at implant sites in the reconstructed mandible: a retrospective study. Clin Oral Investig 2024; 28:467. [PMID: 39107492 DOI: 10.1007/s00784-024-05860-7] [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: 05/29/2024] [Accepted: 07/29/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVE To evaluate the dimensional changes in free gingival grafts (FGG) at implant sites in mandibular reconstruction patients. METHODS Patients who received FGG 4 months after implant placement in the reconstructed mandible with no keratinized mucosa (KM) present were invited for re-examination after 36.7 ± 16.8 months (3.06 ± 1.4 years). Immediately after graft extraction (T0), graft width (GW), graft length (GL), graft thickness (GT), graft dimension (GD), and vertical bone height were documented. Re-examination (T1) included clinical examinations (GW, GL, GD, peri-implant probing depths, and modified Sulcus Bleeding Index), radiographic examination (marginal bone level), and medical chart review. RESULTS Twenty patients and 62 implants (47 in fibula flaps and 15 in iliac flaps) were included. A significant decrease in GW (51.8%), GL (19.2%), and GD (60.2%), were found between T0 and T1 (p < .001). The univariate analysis showed that GW change was not significantly associated with reconstruction technique, baseline GL, baseline GT, baseline GD, implant location, or type of prosthesis. Implant survival rate of 100% was observed at follow-up. CONCLUSIONS Within the limitations of the study, free gingival grafts at implant sites in the reconstructed mandible undergo dimensional change that result in a reduction of approximately 60% of the original graft dimension. Graft width decreased over 50%. CLINICAL RELEVANCE FGG is the standard of care intervention for increasing the amount of KM around implants. This study was the first to evaluate the dimensional change in FGG at implant sites in mandibular reconstruction patients after a medium-term follow-up. CLINICAL TRIAL REGISTRATION Clinical trial registration is not applicable as this study comprehends a retrospective analysis.
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Affiliation(s)
- Xinbo Yu
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Chunlan Wu
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Feng Wang
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jing Ni
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqun Wu
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
- National Center for Stomatology, Shanghai, China.
- National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Shanghai Research Institute of Stomatology, Shanghai, China.
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Chaolun Li
- Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
- National Center for Stomatology, Shanghai, China.
- National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Shanghai Research Institute of Stomatology, Shanghai, China.
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.
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Atieh MA, Shah M, Hakam A, Alshaali S, Kasouha R, Tawse-Smith A, Alsabeeha NHM. Xenogeneic Collagen Matrix Versus Free Gingival Graft for Augmenting Peri-Implant Keratinized Mucosa Around Dental Implants: A Systematic Review and Meta-Analysis. Clin Exp Dent Res 2024; 10:e932. [PMID: 38973200 PMCID: PMC11228352 DOI: 10.1002/cre2.932] [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: 04/01/2024] [Revised: 06/10/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVES There is a growing evidence to suggest augmenting peri-implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta-analyses was to evaluate the clinical and patient-reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment. MATERIAL AND METHODS Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. RESULTS Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri-implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval -0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri-implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG. CONCLUSIONS Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short-term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfort or shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review.
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Affiliation(s)
- Momen A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, UAE
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- School of Dentistry, University of Jordan, Amman, Jordan
| | - Maanas Shah
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, UAE
| | - Abeer Hakam
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, UAE
| | - Suhailah Alshaali
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, UAE
| | - Reem Kasouha
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, UAE
| | - Andrew Tawse-Smith
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Moslemi N, Dolatabadi A, Mohseni Salehimonfared S, Goudarzimoghaddam F. Double vertical interrupted suture for optimal adaptation and stabilization of free gingival graft around dental implants: a case report. J Med Case Rep 2024; 18:291. [PMID: 38918876 PMCID: PMC11202392 DOI: 10.1186/s13256-024-04611-2] [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: 10/25/2023] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Free gingival graft is commonly used to augment the keratinized mucosa and vestibular depth around dental implants. The proper suturing technique is fundamental to achieve a successful result following free gingival graft. However, there are limited studies that focus on the details of the suturing methods to optimize graft adaptation. The purpose of this technical note is to describe a new suturing technique for optimal approximation and stabilization of free gingival graft around dental implants. CASE PRESENTATION Here, we present a 53-year-old Persian female with peri-implantitis and lack of keratinized mucosa around mandibular implants who was a candidate for free gingival graft. A new suturing technique, double vertical interrupted suture, was conducted in the interimplant areas. In addition, the suspensory cross-mattress sutures were added to ensure the adaptation of the graft over the implants. The proposed suturing technique is useful for soft tissue augmentation around multiple implants with concave or uneven recipient bed. CONCLUSION The present article describes a novel suturing technique for good adaptation and fixation of free gingival graft around dental implants.
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Affiliation(s)
- Neda Moslemi
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
- Dental Research Institute, Dental Research Center, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Dolatabadi
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Goudarzimoghaddam
- Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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Jankowski T, Jankowska A, Kazimierczak N, Kazimierczak W, Janiszewska-Olszowska J. The Significance of Keratinized Mucosa in Implant Therapy: Narrative Literature Review and Case Report Presentation. J Clin Med 2024; 13:3501. [PMID: 38930030 PMCID: PMC11204484 DOI: 10.3390/jcm13123501] [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: 04/21/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Implant treatment in patients who require teeth extraction due to periodontitis presents a significant challenge. The consideration of peri-implantitis is crucial when planning the placement of dental implants. The predictability of implant treatment relies on the suitability of both hard and soft tissue quality. The aim of this article is to present a case report demonstrating a secure treatment protocol for implant procedures in patients with periodontitis requiring the extraction of all teeth, soft tissue management targeted at increasing the keratinized mucosa zone, and the provision of a reliable prosthetic solution. The secondary objective is to review the relevant literature regarding the significance of keratinized mucosa surrounding dental implants and its association with the occurrence of peri-implantitis. Case presentation: A 65-year-old female with generalized periodontitis, stage IV grade C and very poor oral hygiene came for treatment and rehabilitation of the lower jaw. CBCT revealed periodontal lesions and labio-lingual ridge dimensions in the region of teeth 34-44 from 8.0 to 10.2 mm. The first surgery included teeth extraction and periodontal lesions enucleation with simultaneous placement of four implants in the positions of teeth 32, 34, 42, 44. The second-stage surgery involved increasing the keratinized mucosa using two free gingival grafts. Conclusions: The present case report described the treatment process of the patient with periodontitis, including immediate implantation in the infected region, soft tissue augmentation using free gingival grafts and the ultimate placement of a bar-retained overdenture for final restoration. After two years of observation, despite questionable hygiene, no symptoms of gingival inflammation were detected. Furthermore, there is limited information in the literature regarding the correlation between inadequate keratinized gingiva and the occurrence of peri-implantitis.
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Affiliation(s)
- Tomasz Jankowski
- Private Practice Dental Clinic Jankowscy, Ul. Czerwonego Krzyża 24, 68-200 Żary, Poland;
| | - Agnieszka Jankowska
- Private Practice Dental Clinic Jankowscy, Ul. Czerwonego Krzyża 24, 68-200 Żary, Poland;
| | - Natalia Kazimierczak
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland; (N.K.); (W.K.)
| | - Wojciech Kazimierczak
- Kazimierczak Private Medical Practice, Dworcowa 13/u6a, 85-009 Bydgoszcz, Poland; (N.K.); (W.K.)
- Department of Radiology and Diagnostic Imaging, Collegium Medicum, Nicolaus Copernicus University in Toruń, Jagiellońska 13-15, 85-067 Bydgoszcz, Poland
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Lim HC, Strauss FJ, Shin SI, Jung RE, Jung UW, Thoma DS. Augmentation of keratinized tissue using autogenous soft-tissue grafts and collagen-based soft-tissue substitutes at teeth and dental implants: Histological findings in a pilot pre-clinical study. J Clin Periodontol 2024; 51:665-677. [PMID: 38268024 DOI: 10.1111/jcpe.13949] [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: 10/11/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
AIM To histomorphometrically assess three treatment modalities for gaining keratinized tissue (KT) at teeth and at dental implants. MATERIALS AND METHODS In five dogs, the distal roots of the mandibular second, third and fourth premolars were extracted. Dental implants were placed at the distal root areas 2 months later. After another 2 months, KT augmentation was performed at both distal (implants) and at mesial root (teeth) areas in the presence (wKT groups) or absence (w/oKT groups) of a KT band at the mucosal/gingival level. Three treatment modalities were applied randomly: apically positioned flap only (APF), free gingival grafts (FGGs) and xenogeneic collagen matrices (XCMs). A combination of the above produced six groups. Two months later, tissue sections were harvested and analysed histomorphometrically. RESULTS The median KT height and length were greatest at implants with FGG in both wKT (3.7 and 5.1 mm, respectively) and w/oKT groups (3.7 and 4.6 mm), and at teeth with FGG in wKT groups (3.7 and 6.1 mm) and with APF in the w/oKT groups (3.9 and 4.4 mm). The XCM and APF produced more favourable results at teeth than at implants. CONCLUSIONS FGG was advantageous in gaining KT, especially at implants.
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Affiliation(s)
- Hyun-Chang Lim
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
- Department of Periodontology, Kyung Hee University, College of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
- Faculty of Dentistry, Universidad Finis Terrae, Santiago, Chile
| | - Seung-Il Shin
- Department of Periodontology, Kyung Hee University, College of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
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Quispe-López N, Gómez-Polo C, Zubizarreta-Macho Á, Montero J. How do the dimensions of peri-implant mucosa affect marginal bone loss in equicrestal and subcrestal position of implants? A 1-year clinical trial. Clin Implant Dent Relat Res 2024; 26:442-456. [PMID: 38282266 DOI: 10.1111/cid.13306] [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: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION There is evidence that the apico-coronal implant position and the mucosal phenotype can affect the extent of peri-implant bone loss. This clinical trial analyzes the bone remodeling and marginal bone loss that occur around conical-connection implants placed equicrestally and subcrestally, assessing the effect of the peri-implant soft-tissue phenotype. METHODS Fifty-one patients received 56 implants of distinct diameters (3.5 mm Ø n = 6; 4.3 mm Ø n = 41; 5 mm Ø n = 9) in the posterior part of the maxilla or mandible. The implants were placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, depending on the initial supracrestal tissue height (STH). After 3 months of non-submerged healing, single metal-ceramic screw-retained implant-supported crowns were placed. Longitudinal measurements of STH, mucosal thickness and keratinized mucosa width (KMW) were made at the time of implant placement (T0), crown placement (T1), and after 3 (T2) and 6 months (T3) of prosthetic loading. At each of these points, a radiographic evaluation of bone remodeling and marginal bone loss was also performed. RESULTS STH was significantly greater for implants placed >1 mm subcrestally than for those placed 1 mm subcrestally. After 12 months of follow-up, a very significant (p < 0.001) loss of KMW was observed, in addition to a marginal bone loss of 0.08 ± 0.1, 0.15 ± 0.2, and 0.14 ± 0.2 mm in the groups placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, respectively. After the multiple linear regression, marginal bone loss was found to depend primarily on KMW (β = -0.43), while also being affected by STH (β = 0.32) and implant diameter (β = -0.28). CONCLUSIONS Marginal bone loss may be influenced by the position with respect to the bone crest, as well as the KMW, STH, and implant diameter. However, more well-controlled studies are needed to verify these above-mentioned findings with different implant designs and connections.
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Affiliation(s)
- Norberto Quispe-López
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Cristina Gómez-Polo
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Javier Montero
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
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Wang TY, Guo JY, Zhou Z, Li SY, Li SB, Xu SL. The quality of life after keratinized mucosa augmentation around dental implants using xenogenic collagen matrix with or without stent. Technol Health Care 2024; 32:3153-3166. [PMID: 38820029 DOI: 10.3233/thc-231863] [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: 06/02/2024]
Abstract
BACKGROUND The substitution of missing teeth with implants is a dependable and anticipated therapeutic approach. Despite numerous studies affirming long-term success rates, there exists a spectrum of potential biological and aesthetic complications. OBJECTIVE The primary objective of this study was to assess patient responses subsequent to surgical interventions, with a specific emphasis on the utilization of xenogenic collagen matrix (XCM), both with and without the application of a stent secured over healing abutments, in the context of keratinized gingival mucosa augmentation. The principal aim was to evaluate and draw comparisons between the clinical outcomes resulting from these two procedural approaches, with a particular focus on critical parameters encompassing post-operative complications, patient comfort, and the overall efficacy in achieving successful keratinized tissue augmentation. METHODS Sixty patients were selected for this study. The patients were divided into three groups: A, B, and a control group, with each group comprising 20 participants. We used XCM in experimental group A, XCM covered with surgical stent in experimental group B, and free gingival graft (FGG) in the control group. After the surgical procedure, patients were required to complete a visual analogue scale (VAS) questionnaire for post-operative complications, and a quality of life (QOL) questionnaire on days 1, 3, and 7. RESULTS Patients in the experimental groups A and B demonstrated markedly improved outcomes when compared with the control group. Assessments conducted on days 1, 3, and 7 demonstrated diminished levels of pain, bleeding, and swelling in both experimental groups, with experimental group B showing the least discomfort. The incorporation of XCM, either with or without stents, was associated with a reduction in analgesic consumption, underscoring its favorable influence on post-operative comfort, notwithstanding the exception of halitosis in experimental group B. CONCLUSION Using XCM with or without a stent for keratinized tissue augmentation has better post-operative outcomes associated with reduced swelling, bleeding, and pain based on the QOL survey. This study provides data to support the clinical application of XCM and stents.
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Affiliation(s)
- Tong-Yue Wang
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Jin-Yuan Guo
- Department Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Zhen Zhou
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Shi-Yi Li
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Shao-Bing Li
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
| | - Shu-Lan Xu
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China
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Lim HC, Kim CH, Yoon H, Lee S, Chung JH, Shin SY. Keratinized tissue augmentation using collagen-based soft tissue substitute with/without epidermal growth factor on buccally positioned implants: a pilot preclinical study. Clin Oral Investig 2023; 27:7899-7908. [PMID: 37989966 DOI: 10.1007/s00784-023-05382-8] [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: 05/06/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To investigate the effect of epithelial growth factor (EGF) with collagen matrix (CM) on the gain of KT for buccally positioned implants in dogs. MATERIALS AND METHODS In five dogs, four implants were placed buccally with the whole part of KT excision on the buccal side (two implants per each hemi-mandible). After one month, KT augmentation was performed: 1) free gingival grafts (FGG), 2) collagen matrix (CM) only, 3) CM soaked with 1 μg/g of EGF, and 4) CM soaked with 10 μg/g of EGF (n = 5 in each group). The experimental animals were sacrificed three months post-KT augmentation. Clinical, histologic, and histomorphometric analyses were performed. RESULTS The clinical KT zone was the highest in group FGG (5.16 ± 1.63 mm). Histologically, all groups presented buccal bony dehiscence. Regarding newly formed KT, no specific difference was found among the groups, but robust rete pegs formation in some specimens in group FGG. Histomorphometric KT height (4.66 ± 1.81 mm) and length (5.56 ± 2.25 mm) were the highest in group FGG, whereas similar increases were noted in the rest. The buccal soft tissue thickness at the coronal part of the implant did not exceed 2 mm in all groups. CONCLUSION All groups presented increased KT zone, but FGG treatment was more favored. The addition of EGF to CM appeared not to enhance KT formation. CLINICAL RELEVANCE FGG treatment was more favorable to re-establish the KT zone than other treatment modalities.
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Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea.
| | - Chang-Hoon Kim
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Heejun Yoon
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Sunmin Lee
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jong-Hyuk Chung
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung-Yun Shin
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
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10
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Tzovairis A, Leretter M, Vandenberghe B, Rossi R. The Poncho Lamina Technique: A Protocol for Hard and Soft Tissue Augmentation in Atrophic Ridges Receiving Adjacent Implants. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1994. [PMID: 38004043 PMCID: PMC10673391 DOI: 10.3390/medicina59111994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
The current scientific knowledge and guidelines in bone and soft tissue augmentation suggest the use of staged surgical workflows as the gold standard of regenerative procedures during implant therapy. In this context, the process is always the same, regardless of the techniques applied: an alternate series of surgical acts that follow one another after the completion of a specific period of osseointegration or graft maturation. As a result, the overall surgical treatment is often long and invasive and induces scar tissue formation. This article proposes a novel, fast, and less-invasive biphasic protocol with the use of a well-documented cortical barrier mounted on healing screws that are further replaced by customized abutments at an early second stage. Two cases are reported, one for an upper maxillary edentulous area and the other for a mandibular, with a total of four implants placed. The results at 4 months postop showed an optimal soft tissue configuration for both cases, with adequate cervical profile generation and a sufficient supracrestal complex height above the implant platforms. Significant bone gains were also recorded through CBCT data collection, either with alveolar width measurements on axial slices, the superposition of pre-op and post-op datasets, or 3D visualization after bone volume segmentation.
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Affiliation(s)
| | - Marius Leretter
- Department of Prosthodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | | | - Roberto Rossi
- Department of Prosthodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Private Practice, 16121 Genova, Italy
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11
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Lin IP, Chang CC, Tu CC, Lai CL, Su FY. Efficacy of free gingival grafting to augment keratinized mucosa around dental implants in posterior regions after restorative procedures: A retrospective clinical study. J Prosthet Dent 2023; 130:715-722. [PMID: 35000695 DOI: 10.1016/j.prosdent.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/22/2023]
Abstract
STATEMENT OF PROBLEM Data on the shrinkage of free gingival grafts (FGGs) vary. Most studies have analyzed grafts in nonmolar sites because of measurement limitations and have addressed the changes in grafts and keratinized mucosa width (KMW) only in the early healing phase. PURPOSE The purpose of this retrospective clinical study was to assess the dimensional changes of an FGG in the posterior regions and their influencing factors, with the aim of obtaining sufficient and stable KMW after restoration. MATERIAL AND METHODS A total of 77 implants in 40 participants who had undergone an FGG surgery were recruited. Graft sizes during surgery and the surface areas of keratinized mucosa at the follow-up visit after restorations were compared by digital analysis and verified by clinical measurements and photographs. The association between shrinkage and the graft sizes, implant location, and sex and age of the participants was evaluated. The influence of the shrinkage of FGG on the KMW after restoration was analyzed by multivariable linear regression with generalized estimating equation (GEE) models. RESULTS The mean ±standard deviation shrinkage of FGG around implants in the posterior regions was 24.76 ±14.77%, and the mean ±standard deviation KMW was 4.16 ±1.77 mm at the follow-up visit. Larger grafts had a statistically higher shrinkage ratio (P<.001). No statistically significant difference was found regarding the effect of implant location, sex, and age on the shrinkage of FGG and final KMW (P>.05). The mean ±standard deviation follow-up period after restoration was 12.45 ±7.73 months CONCLUSIONS: Free gingival grafting was found to be a predictable treatment approach for augmentation of KMW around implants in the posterior region after the fabrication of prostheses as long as grafts of sufficient size were placed. Stable outcomes were shown in the study participants in the follow-up period of up to 3 years.
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Affiliation(s)
- I-Ping Lin
- Clinical Instructor/Director, Division of Periodontology, Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan, ROC; Lecturer, Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC
| | - Chung-Chieh Chang
- Clinical Instructor, Division of Periodontology, Department of Dentistry, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan City, Taiwan, ROC.
| | - Chia-Chun Tu
- Graduate student, Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC
| | - Chao-Lun Lai
- Director, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC
| | - Fang-Ying Su
- Statistical Technician, Department of Medical Research, National Taiwan University Hsin-Chu Branch, Hsinchu, Taiwan, ROC
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12
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Stefanini M, Barootchi S, Sangiorgi M, Pispero A, Grusovin MG, Mancini L, Zucchelli G, Tavelli L. Do soft tissue augmentation techniques provide stable and favorable peri-implant conditions in the medium and long term? A systematic review. Clin Oral Implants Res 2023; 34 Suppl 26:28-42. [PMID: 37750532 DOI: 10.1111/clr.14150] [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: 11/17/2022] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES To review the available literature on the medium- and long-term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different approaches on clinical-, patient-reported, and health-related parameters. MATERIALS AND METHODS A comprehensive electronic and manual search was performed to identify prospective clinical studies that assessed the medium- and long-term (≥36 months) outcomes following STA, including number of sites maintaining peri-implant health and number of sites developing peri-implant disease, incidence of complications, stability of the clinical, volumetric, and radiographic parameters, and patient-reported outcome measures (PROMs). RESULTS Fifteen studies were included in the qualitative analysis. STA was performed with either a bilaminar- or an apically positioned flap (APF) approach, in combination with autogenous grafts (free gingival graft [FGG] and connective tissue graft [CTG]) or substitutes (acellular dermal matrix [ADM] and xenogeneic cross-linked collagen matrix [CCM]). An overall high survival rate was observed. Most of the augmented implant sites maintained peri-implant health in the medium and long term, with the incidence of peri-implant mucositis and peri-implantitis ranging from 0% to 50% and from 0% to 7.14%, respectively. The position of the soft tissue margin following APF + FGG and bilaminar approaches involving CTG or CCM was found to be stable over time. No substantial changes were reported for plaque score/index, bleeding on probing/bleeding index, and probing depth between early time points and following visits. CTG-based STA procedures resulted in a stable or increased dimension of keratinized mucosa width (KMW) and mucosal thickness (MT)/volumetric outcomes over time, when compared with early follow-ups. Most of the included studies described stable marginal bone levels at the grafted implant sites over time. No substantial changes for patient-reported outcomes and professionally assessed esthetic results were reported at different time points. CONCLUSIONS Implants that received STA showed overall high survival rate and relatively low incidence of peri-implantitis in the medium and long term. Augmented sites seem to maintain the level of soft tissue margin and marginal bone over time, while non-augmented implants may exhibit apical shift of the soft tissue margin. The overall favorable early outcomes obtained with STA are maintained in the medium and long term, with an increase in KMW and MT that may be expected over time at CTG-augmented sites.
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Affiliation(s)
- Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Matteo Sangiorgi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alberto Pispero
- Department of Biomedical, Surgical and Dental Sciences, Milano University, Milan, Italy
| | | | - Leonardo Mancini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Dentistry, Università Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Tavelli
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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13
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Shiba T, Komatsu K, Watanabe T, Takeuchi Y, Nemoto T, Ohsugi Y, Katagiri S, Shimogishi M, Marukawa E, Iwata T. Peri-implantitis management by resective surgery combined with implantoplasty and Er:YAG laser irradiation, accompanied by free gingival graft: a case report. Ther Adv Chronic Dis 2023; 14:20406223231174816. [PMID: 37324409 PMCID: PMC10265339 DOI: 10.1177/20406223231174816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
The optimal method for decontamination of implant surfaces for peri-implantitis treatment remains controversial. In recent years, erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation and implantoplasty (IP) (i.e. mechanical modification of the implant) have been reported to be effective in decontaminating implant surfaces during the surgical treatment. Also, a lack of adequate keratinized mucosa (KM) around the implant is known to be associated with more plaque accumulation, tissue inflammation, attachment loss, and mucosal recession, increasing the risk of peri-implantitis. Therefore, free gingival graft (FGG) has been recommended for gaining adequate KM around the implant. However, the necessity of acquiring KM for the treatment of peri-implantitis using FGG remains unclear. In this report, we applied the apically positioned flap (APF) as resective surgery for peri-implantitis treatment in conjunction with IP and Er:YAG laser irradiation to polish/clean the implant surface. Furthermore, FGG was conducted simultaneously to create additional KM, which increased the tissue stability and contributed to the positive results. The two patients were 64 and 63 years old with a history of periodontitis. The removal of granulation tissue and debridement of contaminated implant surfaces were performed with Er:YAG laser irradiation post flap elevation and then modified smooth surfaces mechanically using IP. Er:YAG laser irradiation was also utilized to remove the titanium particles. In addition, we performed FGG to increase the width of KM as a vestibuloplasty. Peri-implant tissue inflammation and progressive bone resorption were not observed, and both patients maintained good oral hygiene conditions until the 1-year follow-up appointment. Bacterial analysis via high-throughput sequencing revealed proportional decreases in bacteria associated with periodontitis (Porphyromonas, Treponema, and Fusobacterium). To the best of our knowledge, this study is the first to describe peri-implantitis management and bacterial change before and after procedures by resective surgery combined with IP and Er:YAG laser irradiation for peri-implantitis treatment, accompanied by FGG for increasing KM around the implants.
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Affiliation(s)
- Takahiko Shiba
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku 1138510, Tokyo, Japan
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Keiji Komatsu
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Takayasu Watanabe
- Department of Chemistry, Nihon University School of Dentistry, Chiyoda-ku, Japan
| | - Yasuo Takeuchi
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Bunkyo-ku 1138510, Tokyo, Japan
| | - Takashi Nemoto
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Yujin Ohsugi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Sayaka Katagiri
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Masahiro Shimogishi
- Department of Regenerative and Reconstructive Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Eriko Marukawa
- Department of Regenerative and Reconstructive Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
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14
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Stefanini M, Marzadori M, Sangiorgi M, Rendon A, Testori T, Zucchelli G. Complications and treatment errors in peri-implant soft tissue management. Periodontol 2000 2023; 92:263-277. [PMID: 36594486 DOI: 10.1111/prd.12470] [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: 05/08/2022] [Revised: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 01/04/2023]
Abstract
Inadequate quality, quantity, or aesthetics of the peri-implant soft tissues can result from a combination of factors related to the outcome of treatments performed before, during, or after implant placement. In this paper, we describe in detail the treatment errors that can pave the way for the onset of mucositis or give rise to soft tissue complications such as peri-implant soft tissue discoloration or dehiscence, graft exposure, or scar formation. By tracing the error back to the planning or surgical stage, clinical insights on surgical soft tissue management are provided to avoid or treat complications that affect the status of the peri-implant soft tissues. Mastering the learning curve and knowing the limitations of each technique are fundamental for preventing added treatment failures that can result in increased patient morbidity and overall discontent.
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Affiliation(s)
- Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Matteo Marzadori
- Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Matteo Sangiorgi
- Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Alexandra Rendon
- Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Tiziano Testori
- Section of Implant Dentistry and Oral Rehabilitation, IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
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15
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Gurbuz E, Ceylan E, Yurttas M. Evaluation of the significance of keratinized mucosa on peri-implant tissue health: a prospective clinical trial. Aust Dent J 2023. [PMID: 36856539 DOI: 10.1111/adj.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The effect of keratinized mucosa on peri-implant tissue health is still inconclusive. This study aimed to evaluate the importance of keratinized mucosa and investigate the impact of the free gingival graft procedure on peri-implant health. METHODS At prosthesis delivery, the implants were allocated into three groups, based on the width of keratinized mucosa (KM) and patients' agreement on the free gingival graft procedure: KMS (KM ≥2 mm), KMD (KM <2 mm), and FGG (KM <2 mm initially and having surgically increased keratinized mucosa). Modified plaque index (mPI), probing depth (PD), modified bleeding index (mBI), KM, and marginal bone loss (MBL) were assessed at the baseline, 6-, 12-, and 24-month follow-up periods. RESULTS Of the 47 patients, 17 belonged to the KMS group, 17 belonged to the KMD, and the remaining 13 patients belonged to the FGG. KMD demonstrated significantly fewer mPI and higher mBI than KMS and FGG at 6 and 12 months. At 24 months, MBL did not differ between the groups; however, PD was significantly greater in the KMD group. CONCLUSIONS Implants with inadequate keratinized mucosa had higher bleeding and pocket depth values despite less plaque accumulation. According to the results, soft tissue grafting should be performed as early as possible. © 2023 Australian Dental Association.
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Affiliation(s)
- E Gurbuz
- Faculty of Dentistry, Department of Periodontology, Kutahya Health Sciences University, Kutahya, Turkey
| | - E Ceylan
- Faculty of Dentistry, Department of Periodontology, Kutahya Health Sciences University, Kutahya, Turkey
| | - M Yurttas
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Kutahya Health Sciences University, Kutahya, Turkey
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16
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Carra MC, Blanc-Sylvestre N, Courtet A, Bouchard P. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol 2023. [PMID: 36807599 DOI: 10.1111/jcpe.13790] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
AIM This systematic review and meta-analysis aims to assess the efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients awaiting dental implant rehabilitation (primordial prevention) or in patients with dental implants surrounded by healthy peri-implant tissues (primary prevention). MATERIALS AND METHODS A literature search was performed without any time limit on different databases up to August 2022. Interventional and observational studies with at least 6 months of follow-up were considered. The occurrence of peri-implant mucositis and/or peri-implantitis was the primary outcome. Pooled data analyses were performed using random effect models according to the type of risk factor and outcome. RESULTS Overall, 48 studies were selected. None assessed the efficacy of primordial preventive interventions for PIDs. Indirect evidence on the primary prevention of PID indicated that diabetic patients with dental implants and good glycaemic control have a significantly lower risk of peri-implantitis (odds ratio [OR] = 0.16; 95% confidence interval [CI]: 0.03-0.96; I2 : 0%), and lower marginal bone level (MBL) changes (OR = -0.36 mm; 95% CI: -0.65 to -0.07; I2 : 95%) compared to diabetic patients with poor glycaemic control. Patients attending supportive periodontal/peri-implant care (SPC) regularly have a lower risk of overall PIDs (OR = 0.42; 95% CI: 0.24-0.75; I2 : 57%) and peri-implantitis compared to irregular attendees. The risk of dental implant failure (OR = 3.76; 95% CI: 1.50-9.45; I2 : 0%) appears to be greater under irregular or no SPC than regular SPC. Implants sites with augmented peri-implant keratinized mucosa (PIKM) show lower peri-implant inflammation (SMD = -1.18; 95% CI: -1.85 to -0.51; I2 : 69%) and lower MBL changes (MD = -0.25; 95% CI: -0.45 to -0.05; I2 : 62%) compared to dental implants with PIKM deficiency. Studies on smoking cessation and oral hygiene behaviors were inconclusive. CONCLUSIONS Within the limitations of available evidence, the present findings indicate that in patients with diabetes, glycaemic control should be promoted to avoid peri-implantitis development. The primary prevention of peri-implantitis should involve regular SPC. PIKM augmentation procedures, where a PIKM deficiency exists, may favour the control of peri-implant inflammation and the stability of MBL. Further studies are needed to assess the impact of smoking cessation and oral hygiene behaviours, as well as the implementation of standardized primordial and primary prevention protocols for PIDs.
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Affiliation(s)
- Maria Clotilde Carra
- U.F.R. d'Odontologie, Université Paris Cité, Paris, France.,Service of Odontology, Periodontal and Oral Surgery Unit, Rothschild Hospital (AP-HP), Paris, France.,Population-Based Epidemiologic Cohorts Unit, Inserm, UMS 11, Villejuif, France
| | - Nicolas Blanc-Sylvestre
- U.F.R. d'Odontologie, Université Paris Cité, Paris, France.,Service of Odontology, Periodontal and Oral Surgery Unit, Rothschild Hospital (AP-HP), Paris, France.,URP 2496, Université Paris Cité, Paris, France
| | - Alexandre Courtet
- U.F.R. d'Odontologie, Université Paris Cité, Paris, France.,Service of Odontology, Periodontal and Oral Surgery Unit, Rothschild Hospital (AP-HP), Paris, France
| | - Philippe Bouchard
- U.F.R. d'Odontologie, Université Paris Cité, Paris, France.,URP 2496, Université Paris Cité, Paris, France
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17
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Oh SL, Choi SK. Management of a prosthetic complication on an implant restoration placed when the patient was 10 years old: A case report. J Prosthodont 2023; 32:5-9. [PMID: 36272533 DOI: 10.1111/jopr.13614] [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: 09/01/2022] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
The use of dental implants in pediatric patients may create unique complications. A 38-year-old patient presented with a mobile, cement-retained implant crown due to an abutment screw loosening. The maxillary right central incisor implant was placed when the patient was 10 years old. Pus discharge from the peri-implant sulcus was observed. The mucosal margin of the implant was at the level of the mucogingival junction of neighboring teeth. Radiographically, the platform of the implant appeared to be at the level of the apical third of the adjacent roots. After removing the existing implant-retained crown, the inflamed peri-implant tissue covering the implant platform was removed and the stability of the implant was confirmed. A new screw-retained implant crown was made using an angulated screw channel to correct the labiopalatal angulation of the implant and allow for retrievability. Pink porcelain was used to match the mucosal margin of the implant crown to that of the maxillary left central incisor. This case report highlights the risk of implant placement in pediatric patients and agrees with previous reports that implants should be delayed until growth is complete.
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Affiliation(s)
- Se-Lim Oh
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Seung Kee Choi
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland
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18
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Galarraga‐Vinueza ME, Tavelli L. Soft tissue features of peri‐implant diseases and related treatment. Clin Implant Dent Relat Res 2022. [PMID: 36444772 DOI: 10.1111/cid.13156] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic. PURPOSE The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites. MATERIALS AND METHODS This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies. RESULTS Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail. CONCLUSIONS Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.
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Affiliation(s)
- Maria Elisa Galarraga‐Vinueza
- Department of Prosthodontics Tufts University School of Dental Medicine Boston Massachusetts USA
- School of Dentistry Universidad de las Américas (UDLA) Quito Ecuador
| | - Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology Harvard School of Dental Medicine Boston Massachusetts USA
- Center for Clinical Research and Evidence Synthesis in Oral TissuE RegeneratION (CRITERION) Boston Massachusetts USA
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor Michigan USA
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19
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Oh SL, Abrera-Crum L, Yang JS, Choi SK. New approach to expedite the delivery of the final crowns for teeth requiring crown lengthening surgery: a pilot study. BMC Oral Health 2022; 22:462. [PMID: 36324171 PMCID: PMC9632148 DOI: 10.1186/s12903-022-02491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/04/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The healing period from crown lengthening procedures (CLPs) often delays the final crown delivery. This study aimed to explore the feasibility of a new approach expediting the delivery of the final crowns for teeth requiring CLPs. METHODS Teeth requiring CLPs and single-crown restorations between the canine and the second molar were included. After the initial tooth preparation, a CLP was performed. In the experimental group, the final tooth preparation and final impression were made during the CLP; the final crown was then delivered at the suture-removal appointment. In the control group, the final impression was made 8 weeks after the CLP. The level of gingival margin (GM), pocket depth (PD), and crestal bone levels (CBLs) were compared between the two groups before CLPs (T0), at delivery of the crowns (T1), and at 12 months in function (T2). RESULTS Twenty-one lithium-disilicate crowns were delivered to 20 subjects and followed up. The mean interval between the CLPs and the delivery of crowns was 2.5 weeks for the experimental group and 12 weeks for the control group. No significant differences were observed between the two groups in the level of GM, PD, and CBLs at each time point. No significant treatment difference in crestal bone loss was observed between the two groups at T2 (Experimental = -0.11 mm, Control = -0.03 mm; p = 0.67). CONCLUSION Making the final tooth preparation and the final impression at the CLP significantly reduced the time between the CLP and the delivery of the final crown and showed comparable clinical outcomes.
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Affiliation(s)
- Se-Lim Oh
- grid.411024.20000 0001 2175 4264Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD USA
| | - Luz Abrera-Crum
- grid.411024.20000 0001 2175 4264Department of General Dentistry, School of Dentistry, University of Maryland, Baltimore, MD USA
| | - Ji Seung Yang
- grid.164295.d0000 0001 0941 7177Department of Human Development and Quantitative Methodology, College of Education, University of Maryland, College Park, MD USA
| | - Seung Kee Choi
- grid.411024.20000 0001 2175 4264Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD USA
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20
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Clinical Outcomes of Dental Implants with Two Different Internal Connection Configurations—A RCT. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of the present study was to highlight clinical and radiographical differences among implants sharing the same macro-geometry but with two different prosthodontic connections. Methods: Patients requiring at least 2 implants in the posterior area of the jaw were randomly divided into two groups (Conical (CS) and Internal Hexagonal (IH) connection). At implant surgery (T0), insertion torque, implant stability quotient (ISQ values recorded by resonance frequency analysis, RFA), and soft tissue thickness (STH) were assessed. A 1-abutment/1-time protocol was applied, and the prosthesis was realized following a fully digital workflow. At the 36-month follow-up periapical x-rays were taken. In order to statistically analyse differences among the two groups and the different variables, paired T-test was used. Linear regression analysis was conducted to analyze how marginal bone loss (MBL) was affected by other independent variables. A neural network created to predict the success (good or not good) of the implant itself was implemented. Results: 30 out of 33 patients (14 males, 16 females, mean age: 68.94 ± 13.01 years) (32 CS and 32 IH) were analyzed. No implants failed. Marginal bone loss at the 3-year time-point was 0.33 ± 0.34 mm and 0.43 ± 0.37 mm respectively for CS and IH with a significant difference between the two groups (p = 0.004). The presence of keratinized gingiva (p = 0.034) significantly influenced MBL. Conclusions: Both the implant connections investigated presented optimal clinical outcomes with minimal marginal bone loss; however, CS implants and implants with the presence of a greater width of keratinized tissue presented significantly lower MBL.
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21
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Al-Diasty Z, El-Meadawy S, Salem AS, Mowafey B. Onlay platelet-rich fibrin membrane versus free gingival graft in increasing the width of keratinized mucosa around dental implants: A split-mouth randomized clinical study. JOURNAL OF ADVANCED PERIODONTOLOGY & IMPLANT DENTISTRY 2022; 14:53-61. [PMID: 36714088 PMCID: PMC9871183 DOI: 10.34172/japid.2022.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/08/2022] [Indexed: 01/09/2023]
Abstract
Background. This study aimed to compare the use of the platelet-rich fibrin membrane (PRF) versus the free gingival graft (FGG) during the second stage of the dental implant to increase the amount of keratinized mucosa around dental implants. Methods. Fifteen patients with bilaterally missing teeth and deficient width of the keratinized mucosa (KM) were recruited for a spit-mouth randomized controlled trial. After implant placement on the control sides, onlay FGG was used, whereas, on the other side (study side), onlay PRF membranes were applied to augment the KM. One month and three months after augmentation, the increase in keratinized mucosa width, bone level around the implants, and soft tissue health were evaluated and compared. The shrinkage percentage was also calculated for both grafts. Results. There was a significant increase in the width of KM in the FGG and PRF groups; however, it was observed that FFG resulted in significantly better results than PRF, with no significant difference in peri-implant soft tissue health or bone level. Conclusion. Within the limitations of this study, it was concluded that the onlay PRF membrane could increase the keratinized mucosa width around dental implants with the advantages of a lower surgical time and less postoperative discomfort and pain for the patients in comparison to the FGG. However, FGG had a significantly higher ability to augment and increase keratinized mucosa around dental implants.
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Affiliation(s)
- Zeinab Al-Diasty
- Department of Periodontology, Faculty of Dentistry, Mansoura University, Egypt
| | - Samah El-Meadawy
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, Egypt,Corresponding author: Samah El Meadawy, E-mail:
| | - Ahmed S Salem
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt
| | - Bassant Mowafey
- Department of Oral Diagnosis and Oral Radiology, Faculty of Dentistry, Mansoura University, Egypt
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22
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Lin IP, Chen SH, Chang CC, Chang JZC, Sun JS, Chang CH. Morphology of Peri-Implant Tissues around Permanent Prostheses with Various Emergence Angles Following Free Gingival Grafting. J Prosthodont 2022; 31:681-688. [PMID: 35770466 DOI: 10.1111/jopr.13555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/03/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To analyze the tissue morphology around implant-supported prostheses by digital technology and to evaluate the effect of prosthetic contours on the changes in tissues following free gingiva graft procedure. MATERIAL AND METHODS A total of 53 implants in 32 patients receiving free gingiva grafts were selected. These had previously presented insufficient keratinized mucosa width (KMW). At the follow-up visits (mean: 16.66 ±9.97 months), the implant position and tissue condition were documented with an oral scanner. Vertical soft tissue thickness (VT), measured from the implant-abutment connection to the marginal tissues, and horizontal soft tissue thickness (HT), at the level of the platform, were calculated. The VT, HT and emergence angle (EA) of prostheses were assessed by 3Shape analyzing software. The final KMW was measured by clinical assessment. Marginal bone loss (MBL) was calculated in the follow-up bitewing radiographs. RESULTS The mean VT in the study was 2.65 ±0.75 mm at the mid-buccal sites, 3.74 ±1.22 mm at the mesial, 3.16 ±1.08 mm at the distal, and 2.53 ±0.92 at the mid-lingual aspects. The mid-buccal HT was 1.45 ±0.53 mm while the mid-lingual was 1.05 ±0.43 mm (P = 0.008). Interestingly, prostheses with mid-buccal EA>30∘ exhibited slightly lower VT, but higher HT, than the ones with EA≤30∘. Prostheses with proximal EA>30∘ displayed slightly more MBL, compared to prostheses with EA≤30∘. The mean KMW was 4.08 ±1.10 mm. CONCLUSIONS Free gingival grafting is a predictable treatment approach to augmenting soft tissue 3-dimensionally. Prostheses with EA≤30∘ were preferable for preserving the maximal VT and maintaining crestal bone stability. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- I-Ping Lin
- Division of Periodontology, Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Szu-Han Chen
- Division of Prosthodontics, Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chung-Chieh Chang
- Division of Periodontology, Department of Dentistry, Chang Gung Memorial Hospital Linkou Main Branch and Chang Gung University, Taoyuan City, Taiwan
| | | | - Jui-Sheng Sun
- Department of Orthopedics, China Medical University Hospital, Taichung City, Taiwan
| | - Chih-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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23
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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] [Abstract] [Key Words] [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
Abstract
Shallow lingual vestibule and lack of keratinized attached mucosa are considered risk factors for the long-term success of dental implants. This article describes a modified surgical approach accompanied by a free gingival graft to correct the shallow lingual/buccal vestibule and to increase the keratinized tissue around dental implants.
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Affiliation(s)
| | - Gholamreza Shirani
- Department of Oral and Maxillofacial SurgerySchool of DentistryTehran University of Medical SciencesTehranIran
| | - Neda Moslemi
- Department of PeriodontologySchool of DentistryTehran University of Medical SciencesTehranIran
| | - Faranak Noori
- Department of EndodonticsSchool of DentistryTehran University of Medical SciencesTehranIran
| | - Amir Raee
- Department of PeriodontologySchool of DentistryTehran University of Medical SciencesTehranIran
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24
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Park JS, Herr Y, Chung JH, Shin SI, Lim HC. Retrospective analysis of keratinized tissue augmentation using a xenogeneic collagen matrix for resolving peri-implant mucositis and peri-implantitis. J Periodontal Implant Sci 2022; 53:145-156. [PMID: 36468478 PMCID: PMC10133816 DOI: 10.5051/jpis.2200700035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/17/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The significance of keratinized tissue for peri-implant health has been emphasized. However, there is an absence of clinical evidence for the use of a xenogeneic collagen matrix (XCM) to manage peri-implant mucositis and peri-implantitis. Therefore, the purpose of this study was to investigate outcomes after keratinized tissue augmentation using an XCM for the management of peri-implant diseases. METHODS Twelve implants (5 with peri-implant mucositis and 7 with peri-implantitis) in 10 patients were included in this study. Non-surgical treatments were first performed, but inflammation persisted in all implant sites. The implant sites all showed a lack of keratinized mucosa (KM) and vestibular depth (VD). Apically positioned flaps with XCM application were performed. Bone augmentation was simultaneously performed on peri-implantitis sites with an intrabony defect (>3 mm). The following clinical parameters were measured: the probing pocket depth (PPD), modified sulcular bleeding index (mSBI), suppuration (SUP), keratinized mucosal height (KMH), and VD. RESULTS There were no adverse healing events during the follow-up visits (18±4.6 months). The final KMHs and VDs were 4.34±0.86 mm and 8.0±4.05 mm, respectively, for the sites with peri-implant mucositis and 3.29±0.86 mm and 6.5±1.91 mm, respectively, for the sites with peri-implantitis. Additionally, the PPD and mSBI significantly decreased, and none of the implants presented with SUP. CONCLUSIONS Keratinized tissue augmentation using an XCM for sites with peri-implant mucositis and peri-implantitis was effective for increasing the KMH and VD and decreasing peri-implant inflammation.
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Affiliation(s)
- Jung Soo Park
- Department of Periodontology, Korea University Anam Hospital, Seoul, Korea
| | - Yeek Herr
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, College of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jong-Hyuk Chung
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, College of Dentistry, Kyung Hee University, Seoul, Korea
| | - Seung-Il Shin
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, College of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hyun-Chang Lim
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, College of Dentistry, Kyung Hee University, Seoul, Korea
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25
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Paula DSD, Lima LVR, Cavalcante RB, Silva PGDB, Alves APNN, Silva BRD. Fixation of free gingival grafts with cyanoacrylate glues: A histomorphometric and immunohistochemical study. Saudi Dent J 2021; 33:1063-1070. [PMID: 34938051 PMCID: PMC8665204 DOI: 10.1016/j.sdentj.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 04/12/2021] [Accepted: 05/02/2021] [Indexed: 11/25/2022] Open
Abstract
Aim The objective of this study was to evaluate the inflammatory process resulting from the use of two cyanoacrylate-based adhesives to stabilize grafts. Methodology A total of 45 male Wistar rats were randomly divided into three groups (n = 15/group) treated with ethyl cyanoacrylate glue (TG1), octyl-2-cyanoacrylate glue (TG2) or suture threads (CG). After de-epithelialization in the anterior gingival region of the mandible, the graft was removed from the donor site (hard palate), taken to the recipient site and stabilized according to the protocol of each group. After 7, 14, and 45 days, the animals were euthanized. The graft area was analysed macroscopically, histologically, histochemically (Masson trichrome), and immunohistochemically positive cell count for TGF-β, α-SMA, RANKL, OPG, FGF, and IL-10. The Kruskal-Wallis/Dunn test (SPSS 20.0, p < 0.05) was used for analysis. Results There was no difference in the clinical parameters among the three groups, but TG1 showed the lowest mononuclear inflammatory cell count and the highest amount of total collagen. FGF immunoexpression was significantly higher for the CG group, but the TG2 showed a significant reduction in the RANKL/OPG ratio. Conclusion TG1 had a mild inflammatory response and a higher collagen deposition than other glues, and TG2 had a reduction in the RANKL / OPG ratio.
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Fickl S, Therese Kröger A, Dietrich T, Kebschull M. Influence of soft tissue augmentation procedures around dental implants on marginal bone level changes-A systematic review. Clin Oral Implants Res 2021; 32 Suppl 21:108-137. [PMID: 34642978 DOI: 10.1111/clr.13829] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This systematic review assessed the influence of soft tissue augmentation procedures on marginal bone level changes in partial or fully edentulous patients. MATERIAL AND METHODS We identified three relevant PICO questions related to soft tissue augmentation procedures and conducted a systematic search of four major electronic databases for clinical studies in systemically healthy patients receiving at least one dental implant and a minimum follow-up of one year after implant placement. The primary outcome was mean difference in marginal bone levels, and secondary outcomes were clinical and patient-related outcomes such as thickness of peri-implant mucosa, bleeding indices, and Pink Esthetic Score. RESULTS We identified 20 publications reporting on 16 relevant comparisons. Studies varied considerably and thus only two meta-analyses could be performed. This systematic review showed that: Soft tissue augmentation either for augmentation of keratinized mucosa or soft tissue volume inconsistently had an effect on marginal bone level changes when compared to no soft tissue augmentation, but consistently improved secondary outcomes. The combination soft and hard tissue augmentation showed no statistically significant difference in terms of marginal bone level changes when compared to hard tissue augmentation alone, but resulted in less marginal soft tissue recession as shown by a meta-analysis. Soft or hard tissue augmentation performed as contour augmentations resulted in comparable marginal bone level changes. CONCLUSIONS Peri-implant soft and hard tissues seem to have a bidirectional relationship: "Bone stands hard, but soft tissue is the guard".
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Affiliation(s)
- Stefan Fickl
- Department of Periodontology, Julius-Maximilians University Würzburg, Würzburg, Germany.,Private practice, Fürth, Germany
| | - Annika Therese Kröger
- Department of Oral Surgery, School of Dentistry, University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Thomas Dietrich
- Department of Oral Surgery, School of Dentistry, University of Birmingham, Birmingham, UK.,Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Moritz Kebschull
- Birmingham Community Healthcare NHS Trust, Birmingham, UK.,Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK.,Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, USA
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27
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Zheng C, Wang S, Ye H, Liu Y, Hu W, Zhou Y. Effect of free gingival graft before implant placement on peri-implant health and soft tissue changes: a randomized controlled trial. BMC Oral Health 2021; 21:492. [PMID: 34607597 PMCID: PMC8489082 DOI: 10.1186/s12903-021-01818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the clinical outcome and changes in posterior buccal soft tissue following implant restoration in groups with and without a free gingival graft (FGG) before implant placement. METHODS Twenty-six individuals who required implant restoration and displayed lack of keratinized mucosa (KM) were recruited and assigned to the FGG group (with FGG before implant placement) or Control group (without FGG before implant placement) randomly. A screw-retained conventional implant restoration was performed for each patient. Peri-implant soft tissue was captured by an intraoral scanner and analyzed by an image processing software. Clinical parameters (plaque index, gingival index, probing depth, and bleeding on probing) were assessed at baseline and 1, 3, 6, and 12 months. Buccal soft tissue changes (mucosal margin, soft tissue thickness, and width of keratinized mucosa) on the buccal side of implant site were assessed at 1, 3, 6, and 12 months. Two-way ANOVA and Bonferroni test were used to analyze significant difference between groups at each time point (α = 0.05). RESULTS The clinical parameters were lower in the FGG group than that in the Control group, although there were no significant differences between the two groups (P > 0.05). Peri-implant soft tissue collapsed and the changes (mucosal margin and soft tissue thickness) were significantly greater in the Control group than the FGG group (P < 0.05). Width of KM was larger in the FGG group than the Control group, although there was no significant difference between the two groups (P > 0.05). CONCLUSIONS Minimal peri-implant soft tissue changes occurred in two groups. Performing FGG before implant placement is a viable procedure to maintain peri-implant soft tissue but might not affect peri-implant health during 12 months follow-up. However, small sample size must be considered. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000037954; Date of registration: 6 September 2020).
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Affiliation(s)
- Chaoling Zheng
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, People's Republic of China
- National Laboratory for Digital and Material Technology of Stomatology, National Clinical Research Center for Oral Diseases, Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Shimin Wang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, People's Republic of China
- National Laboratory for Digital and Material Technology of Stomatology, National Clinical Research Center for Oral Diseases, Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Hongqiang Ye
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, People's Republic of China
- National Laboratory for Digital and Material Technology of Stomatology, National Clinical Research Center for Oral Diseases, Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Yunsong Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, People's Republic of China.
- National Laboratory for Digital and Material Technology of Stomatology, National Clinical Research Center for Oral Diseases, Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China.
| | - Wenjie Hu
- Department of Periodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, People's Republic of China.
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, People's Republic of China
- National Laboratory for Digital and Material Technology of Stomatology, National Clinical Research Center for Oral Diseases, Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
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Koca-Ünsal RB, Ünsal G, Kasnak G, Fıratlı Y, Özcan İ, Orhan K, Fıratlı E. Ultrasonographic evaluation of the titanium-prepared platelet-rich fibrin effect in free gingival graft procedures. J Periodontol 2021; 93:187-194. [PMID: 34060090 DOI: 10.1002/jper.21-0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/25/2021] [Accepted: 05/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Complications after free gingival graft (FGG) operations are generally related to the donor site. The titanium-prepared, platelet-rich fibrin (T-PRF) placement in the donor site accelerate the wound healing and prevent postoperative complications such as pain and hemorrhage. We aim to evaluate the effect of T-PRF regarding vascularization and tissue thickness and to report the advantages of the ultrasonography (US) in FGG. METHODS Ten individuals were divided into two groups as T-PRF and control. While the T-PRF membrane was placed at the donor site in the T-PRF group, a gelatin sponge was placed in the control group. All patients underwent US examination in terms of vascularization and tissue thickness of left and right donor sites. The correlation between the right and left donor sites was analyzed with the Pearson correlation test. Tissue thicknesses and pulsatility index (PI) were analyzed with independent samples t-test. The results were evaluated statistically at the P <0.05 significance level. RESULTS The T-PRF group showed increased vascularity which can be interpreted to improve healing in soft tissue. However, not a difference, but a positively very high correlation was observed between the right and left tissue thicknesses (P = 0,00; r = +0902). CONCLUSIONS Evaluation of tissue thickness and vascularization density of donor sites with US not only increases clinical success rate but also reduces the risk of complications during surgery and postoperative pain in FGG. Studies evaluating T-PRF membrane as palatal dressing after FGG are only clinical, however, the efficiency of T-PRF was evaluated radiologically in this study for the first time.
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Affiliation(s)
- Revan Birke Koca-Ünsal
- Department of Periodontology, University of Kyrenia, Faculty of Dentistry, Kyrenia, Cyprus
| | - Gürkan Ünsal
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Nicosia, Cyprus.,DESAM Institute, Near East University, Nicosia, Cyprus
| | - Gökhan Kasnak
- Department of Periodontology, Faculty of Dentistry, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yiğit Fıratlı
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - İlknur Özcan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey.,Medical Design Application and Research Center, Ankara University, Ankara, Turkey
| | - Erhan Fıratlı
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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29
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Han Z, Wei Y, Wang C, Yang G, Hu W, Chung KH. Clinical evaluations of free gingival grafting before implant placement to increase keratinized tissue width in molar regions: A retrospective case series. Clin Oral Implants Res 2021; 32:799-807. [PMID: 33755996 DOI: 10.1111/clr.13748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the dimensional changes of the keratinized tissue width (KTW) in molar regions after augmentation by free gingival grafts (FGG) before implant placement. MATERIAL AND METHODS In seventeen patients, twenty implant sites in molar regions with KTW ≤3 mm at the buccal aspect received FGG 2 months before implant placement. KTW at the buccal aspect was measured before FGG (T0), immediately before implant placement (T1), at the time of impression taking for final prosthesis fabrication (T2), and at the end of the follow-up period after loading (T3, 12-48 months). Changes in KTW before and after FGG, as well as the alterations during the follow-up period after loading, were analyzed. Shapiro-Wilk test, paired Student's t test, and Wilcoxon signed-rank test were used for the data analysis at α = 0.05. RESULTS KTW at the buccal aspect of the alveolar ridge was observed with a significant gain of 5.9 ± 1.3 mm at T1 (p < .001). The shrinkage of KTW from T2 to T3 was 8.5%, which was limited but statistically significant (p = .008). KTW at the buccal aspect of implant restorations was 5.0 ± 1.5 mm at T3. CONCLUSIONS Within the limitations of the present study, our data suggest that using FGG to increase KTW in molar regions before implant placement had a predictable result. The buccal KTW had a limited reduction and was ≥3 mm with more than 12 months of follow-up after loading.
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Affiliation(s)
- Ziyao Han
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yiping Wei
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Cui Wang
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gang Yang
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wenjie Hu
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Kwok-Hung Chung
- Department of Restorative Dentistry, University of Washington, Seattle, WA, USA
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30
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Mayta-Tovalino F, Rosas J, Mauricio F, Luza S, Alvitez-Temoche D, Mauricio-Vilchez C. Management of Peri-implant Mucositis of Multiple Osseointegrated Implants Using a Modified Free Gingival Graft "Punch Technique" in the Total Edentulous Area: A Case Report. J Int Soc Prev Community Dent 2021; 11:109-113. [PMID: 33688481 PMCID: PMC7934821 DOI: 10.4103/jispcd.jispcd_292_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022] Open
Abstract
The purpose of this case report was to describe a technique to modify the free gingival graft by perforations within the graft to guarantee a horizontal increase in the keratinized mucosa in the anteroinferior sector of a total edentulous mandible after osseointegration of previously placed dental implants in a hybrid prosthesis protocol. A 71-year-old male underwent free modified gingival graft surgery with perforations at the level of each implant. At 3 months, the mucosa appeared to be healthy and keratinized, especially at a horizontal level around the implants previously diagnosed with mucositis, providing the patient with satisfactory results. Finally, the hybrid prosthesis was cleaned and polished due to the presentation of a hard plate at the level of the abutments. Within the limitations of this case report, further research is needed to evaluate the long-term efficacy of this modification to the free gingival graft.
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Affiliation(s)
- Frank Mayta-Tovalino
- Postgraduate Department, Faculty of Health Sciences, Universidad Cientifica del Sur, Lima, Peru.,Academic Department of Rehabilitative Stomatology, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - José Rosas
- Postgraduate Department, Faculty of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru.,Postgraduate Department, School of Dentistry, Universidad Privada San Juan Bautista, Lima, Peru
| | - Franco Mauricio
- Postgraduate Department, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Silvia Luza
- Postgraduate Department, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Daniel Alvitez-Temoche
- Academic Department of Rehabilitative Stomatology, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Cesar Mauricio-Vilchez
- Postgraduate Department, Faculty of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru
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31
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Preidl RHM, Reichert S, Coronel TV, Kesting M, Wehrhan F, Schmitt CM. Free Gingival Graft and Collagen Matrix Revascularization in an Enoral Open Wound Situation. J Oral Maxillofac Surg 2021; 79:1027-1037. [PMID: 33450192 DOI: 10.1016/j.joms.2020.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Vestibuloplasty with free gingival grafting is a frequently performed surgical procedure to generate sufficient keratinized mucosa (KM) around dental implants. Avascular porcine collagen matrices (CM) have been proclaimed to be sufficient substitutes as alternatives to free gingival grafts (FGGs). However, the process of graft integration and vascularization is still incompletely understood. METHODS In 18 patients a vestibuloplasty in the lower edentulous jaw situation was performed during implant exposure, either with FGGs from the palate or a porcine CM (mucoderm). Tissue perfusion of the soft tissue grafts was measured using laser-doppler-spectrophotometer intraoperatively and on postoperative days 2, 5, 10, 30 and between days 60 and 90. With graft perfusion expressed by oxygen saturation [SO2%], the relative amount of hemoglobin [rHb], blood flow, and velocity [AU] was detected and compared between groups and the surrounding mucosa. RESULTS Healing was uneventful in both groups, with mature KM around dental implants after healing. Blood flow and velocity significantly increased until postoperative day 10, comparable to perfusion values of the surrounded mucosa. Intergroup comparisons revelated no significant differences concerning the flow between CM and FGGs. Oxygen saturation also significantly increased within the first 5 postoperative days in both groups. Hemoglobin content did not show any differences during the investigated period. CONCLUSIONS The perfusion mainly progresses within the first postoperative week with only minimal further detectable alterations until the final investigation, comparable in both groups. Although integration of FGGs (revascularized) and the CM (new tissue formation) is biologically different, both transplants show comparable perfusion patterns, leading to sufficient KM.
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Affiliation(s)
- Raimund H M Preidl
- Resident, Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany.
| | - Sky Reichert
- Doctoral Student, Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
| | - Talisa V Coronel
- Doctoral Student, Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
| | - Marco Kesting
- Head, Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
| | - Falk Wehrhan
- Specialist For Oral Surgery and Oral- Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
| | - Christian M Schmitt
- Specialist For Oral Surgery, Department of Oral and Maxillofacial Surgery, University of Erlangen- Nuremberg, Erlangen, Germany
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Golmayo P, Barallat L, Losada M, Valles C, Nart J, Pascual-La Rocca A. Keratinized tissue gain after free gingival graft augmentation procedures around teeth and dental implants: A prospective observational study. J Clin Periodontol 2020; 48:302-314. [PMID: 33098670 DOI: 10.1111/jcpe.13394] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 09/04/2020] [Accepted: 10/12/2020] [Indexed: 12/01/2022]
Abstract
AIM The primary goal was to compare the amount of keratinized tissue width (KTW) gain after free gingival graft (FGG) procedures around implants and teeth after 6 and 12 months of healing. MATERIALS AND METHODS Patients with mucogingival defects (<2 mm of KT) around teeth and implants underwent a gingival augmentation procedure by means of a FGG. Clinical measurements were performed with an individual stent to determine keratinized tissue width (KTW), length (KTL), graft shrinkage (GS) and gingival margin position (GMP) at 2 weeks, 6 weeks, 3 months, 6 months and 12 months after surgery. RESULTS Twenty-nine patients (35 sites) participated in this prospective study. After surgery, KTW decreased and GS increased significantly in both treatment groups during the whole follow-up period, but the biggest changes were observed at 6 weeks. When comparing both treatment groups, implant sites showed significantly more reduction in KTW and more GS. Thus, at 12 months, KTW and GS reduced 2.03 ± 2.1 mm and 36.74 ± 38.2% in the teeth group and 2.91 ± 12.03 mm and 61.8 ± 36.25% around implants, respectively. CONCLUSIONS A significantly greater reduction in KTW and more GS might be expected at implant sites.
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Affiliation(s)
- Pilar Golmayo
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Lucía Barallat
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Meritxell Losada
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Valles
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Jose Nart
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Andrés Pascual-La Rocca
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
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Abstract
Peri-implant diseases are prevalent with a weighted mean prevalence rate of 43% across Europe and 22% across South and North America. Although the main etiologic agent is bacterial biofilm, a myriad of factors influence the initiation and progression of the disease. Unfortunately, the treatment of peri-implant diseases is at best favorable in the short term with a high rate of persistent inflammation and recurrence. Therefore, it is sensible to consider and control all potential factors that may predispose an implant to peri-implant tissue inflammation in an attempt to avoid the disease. This paper reviews recent evidence on factors that may predispose implants to peri-implantitis and measures that can be taken to prevent it.
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Affiliation(s)
- Jia-Hui Fu
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, USA
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Parvini P, Galarraga-Vinueza ME, Obreja K, Magini RDS, Sader R, Schwarz F. Prospective study assessing three-dimensional changes of mucosal healing following soft tissue augmentation using free gingival grafts. J Periodontol 2020; 92:400-408. [PMID: 33448379 DOI: 10.1002/jper.19-0640] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/10/2020] [Accepted: 07/07/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The present study aimed to assess the three-dimensional changes following soft tissue augmentation using free gingival grafts (FGG) at implant sites over a 3-month follow-up period. METHODS This study included 12 patients exhibiting deficient keratinized tissue (KT) width (i.e., <2 mm) at the vestibular aspect of 19 implants who underwent soft tissue augmentation using FGG at second stage surgery following implant placement. Twelve implants were considered for the statistical analysis (n = 12). The region of interest (ROI) was intraorally scanned before surgery (S0), immediately post-surgery (S1), 30 (S2) and 90 (S3) days after augmentation. Digital scanned files were used for quantification of FGG surface area (SA) and converted to standard tessellation language (STL) format for superimposition and evaluation of thickness changes between the corresponding time points. FGG shrinkage (%) in terms of SA and thickness was calculated between the assessed time points. RESULTS Mean FGG SA amounted to 91 (95% CI: 63 to 119), 76.2 (95% CI: 45 to 106), and 61.3 (95% CI: 41 to 81) mm2 at S1, S2, and S3, respectively. Mean FGG SA shrinkage rate was 16.3% (95% CI: 3 to 29) from S1 to S2 and 33% (95% CI: 19 to 46) from S1 to S3. Mean thickness gain from baseline (S0) to S1, S2, and S3 was 1.31 (95% CI: 1.2 to 1.4), 0.82 (95% CI: 0.5 to 1.12), and 0.37 (0.21 to 0.5) mm, respectively. FGG thickness shrinkage was of 38% (95% CI: 17.6 to 58) from S1 to S2 and 71.8% (95% CI: 60 to 84) from S1 to S3. Dimensional changes from S1 to S3 were statistically significant, P <0.017. Soft tissue healing was uneventful in all patients. CONCLUSIONS The present three-dimensional assessment suggests that FGG undergo significant dimensional changes in SA and thickness over a 3-month healing period.
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Affiliation(s)
- Puria Parvini
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany
| | - Maria Elisa Galarraga-Vinueza
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany.,Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil.,School of Dentistry, Universidad de las Américas, Quito, Ecuador
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany
| | - Ricardo de Sousa Magini
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University Frankfurt, Carolinum, Frankfurt, Germany.,Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Tavelli L, Barootchi S, Avila-Ortiz G, Urban IA, Giannobile WV, Wang HL. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: A systematic review and network meta-analysis. J Periodontol 2020; 92:21-44. [PMID: 32710810 DOI: 10.1002/jper.19-0716] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The peri-implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). Numerous approaches to augment soft tissue volume around endosseous dental implants have been investigated. To what extent PSP modification is beneficial for peri-implant health has been subject of debate in the field of implant dentistry. The aim of this systematic review was to analyze the evidence regarding the efficacy of soft tissue augmentation procedures aimed at modifying the PSP and their impact on peri-implant health. METHODS A comprehensive search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported findings on KMW, MT, and/or STH changes. The effect of the intervention on peri-implant health was also assessed. Selected articles were classified based on the general type of surgical approach to increase PSP, either bilaminar or an apically positioned flap (APF) technique. A network meta-analysis including only randomized-controlled trials (RCTs) reporting on PSP outcomes was conducted to assess and compare different techniques. RESULTS A total of 52 articles were included in the qualitative analysis, and 23 RCTs were included as part of the network meta-analysis. Sixteen RCTs reported the outcomes of PSP modification therapy with bilaminar techniques, whereas 7 involved the use of APF. The analysis showed that bilaminar techniques in combination with soft tissue grafts (connective tissue graft [CTG], collagen matrix [CM], and acellular dermal matrix [ADM]) resulted in a significant increase in MT compared to non-augmented sites. In particular, CTG and ADM were associated with higher MT gain as compared to CM and non-augmented sites. However, no significant differences in KMW were observed across different bilaminar techniques. PSP modification via a bilaminar approach utilizing either CTG or CM showed beneficial effects on marginal bone level stability. APF-based approaches in combination with free gingival graft (FGG), CTG, CM, or ADM showed a significant KMW gain compared to non-augmented sites. However, compared to APF alone, only FGG exhibited a significantly higher KMW gain. APF with any evaluated soft tissue graft was associated with with reduction of probing depth, soft tissue dehiscence and plaque index compared to non-augmented sites compared to non-augmented sites. The evidence regarding the effect of PSP modification via APF-based approaches on peri-implant marginal bone loss or preservation is inconclusive. CONCLUSIONS Bilaminar approach involving CTG or ADM obtained the highest amount of MT gain, whereas APF in combination with FGG was the most effective technique for increasing KMW. KMW augmentation via APF was associated with a significant reduction in probing depth, soft tissue dehiscence and plaque index, regardless of the soft tissue grafting material employed, whereas bilaminar techniques with CTG or CM showed beneficial effects on marginal bone level stability.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Istvan A Urban
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Private practice, Budapest, Hungary
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering & Biointerfaces Institute, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Clinical Performance of Short Expandable Dental Implants for Oral Rehabilitation in Highly Atrophic Alveolar Bone: 3-year Results of a Prospective Single-Center Cohort Study. ACTA ACUST UNITED AC 2020; 56:medicina56070333. [PMID: 32635173 PMCID: PMC7404768 DOI: 10.3390/medicina56070333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Oral health-related quality of life (OHRQOL) is compromised during the post-implant healing period, especially when vertical augmentation is required. A long-term trial sought to evaluate a short dental implant system with an apically expandable macro-design. Materials and Methods: Over 4.5 years, patients with limited vertical alveolar bone were consecutively recruited into this prospective cohort study. Implant success rate, OHRQOL (Oral Health Impact Profile (OHIP)-14), implant stability, and crestal bone changes were evaluated. Results: Data from 30 patients (mean age: 64.6 years, range 44–83) were analyzed, which related to 104 implants (53 in the maxilla, 51 in the mandible). Over the mean follow-up (42.6 ± 16.4 months), the implant success rate was 94.7% in the mandible (two implants lost) and 83.6% in the maxilla (four implants lost; p = 0.096), and the prosthetic success rate was 100%. The median OHIP-14 scores improved from 23 (interquartile range (IQR) 9–25.5) to 2 (IQR 0–5; p < 0.001). The mean implant stability quotient (ISQ) was 71.2 ± 10.6 for primary stability and 73.7 ± 13.3 (p = 0.213) for secondary stability, without significant maxilla-versus-mandible differences (p ≥ 0.066). Compared to the baseline, median crestal bone changes after loading were 1.0 mm (IQR 0–1.3) and 1.0 mm (IQR 0.2–1.2) in the maxilla and mandible (p = 0.508), respectively, at the end of the first year, 1.1 mm (IQR 0–1.3) and 1.0 mm (IQR 0.1–1.2) (p = 0.382), respectively, at the end of the second year, and 1.2 mm (IQR 0–1.9) and 1.1 mm (IQR 0.1–1.2) (p = 0.304), respectively, at the end of the third year. Conclusions: In patients with limited vertical bone height, short implants with optimized macro-design constitute a reliable method for functional rehabilitation, avoiding extensive alveolar bone augmentation.
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Wang Q, Tang Z, Han J, Meng H. The width of keratinized mucosa around dental implants and its influencing factors. Clin Implant Dent Relat Res 2020; 22:359-365. [PMID: 32378806 DOI: 10.1111/cid.12914] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/15/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A few evidence is available in the literature concerning the pattern of variation in the width of keratinized mucosa (KMW) around dental implants and factors that may affect the KMW. PURPOSE The purpose of this study is to investigate the KMW at the buccal aspect of dental implants and to analyze its influencing factors. MATERIALS AND METHODS The current study was a retrospective study conducted on 726 patients with 1252 dental implants. The following parameters were evaluated by reviewing the medical records of each patient, including the age, gender and smoking status of each patient, the reasons of teeth loss, the position of implants, the bone augmentation procedures, and the KMW. Binary logistic regression analysis with the generalized estimating equations was utilized to analyze the factors that may affect the KMW of dental implants. RESULTS The KMW of implants located in the maxilla was significantly higher than that of implants located in the mandible (P < .01), except for the upper and lower canines. The logistic regression analysis indicated that the risk of the implants presenting inadequate KMW (<2 mm) in the periodontitis-caused tooth loss group was 1.91 times of the non-periodontitis-caused tooth loss group. The risk of implants presenting inadequate KMW after receiving simple and complex bone augmentation procedures was 1.65 and 2.62 times of the risk of implants without bone augmentation, respectively. The longer the follow-up period, the higher the risk of implants presenting inadequate KMW will be. CONCLUSIONS The KMW at the buccal aspect of implants is related to the position of implants. Tooth loss due to periodontitis, the bone augmentation procedures, and the process of functional period would increase the risk of implants presenting an inadequate amount of keratinized mucosa.
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Affiliation(s)
- Qi Wang
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhihui Tang
- Department of oral and maxillofacial surgery, The Second Clinic of Peking University School and Hospital of Stomatology, Beijing, China
| | - Jie Han
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Huanxin Meng
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
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Radaelli MTB, Federizzi L, Nascimento GG, Leite FRM, Boscato N. Early‐predictors of marginal bone loss around morse taper connection implants loaded with single crowns: A prospective longitudinal study. J Periodontal Res 2020; 55:174-181. [DOI: 10.1111/jre.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 08/13/2019] [Accepted: 09/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Manuel T. B. Radaelli
- Department of Prosthodontics Meridional Center of Dentistry Studies Passo Fundo Brazil
| | - Leonardo Federizzi
- Department of Prosthodontics Meridional Center of Dentistry Studies Passo Fundo Brazil
| | - Gustavo G. Nascimento
- Section of Periodontology Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
| | - Fábio R. M. Leite
- Section of Periodontology Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
| | - Noéli Boscato
- Graduate Program in Dentistry School of Dentistry Federal University of Pelotas Pelotas Brazil
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Oh SL, Ji C, Azad S. Free gingival grafts for implants exhibiting a lack of keratinized mucosa: Extended follow-up of a randomized controlled trial. J Clin Periodontol 2020; 47:777-785. [PMID: 32096243 DOI: 10.1111/jcpe.13272] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/02/2020] [Accepted: 02/21/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study is an extended follow-up of a randomized controlled trial that evaluated 18-month outcomes following free gingival grafts (FGGs) around implants with <2 mm keratinized mucosa (KM) compared to implants without KM augmentation. MATERIALS AND METHODS Follow-up data were obtained over 48 months from 18 implants in the FGG group (11 subjects) and 8 implants in the no-surgery group (7 subjects) within the control group. FGGs were performed after 18 months for 8 implants in the control group; these 8 implants constituted a delayed FGG group (5 subjects). The width of KM, mucosal recession (MR) and crestal bone level (CBL) were obtained. RESULTS The increased width of KM and the reduced MR following FGGs were maintained for 48 months in the FGG group, which exhibited less MR than the no-surgery group. The amount of crestal bone loss (0.4 ± 0.4 mm) in the no-surgery group was significantly greater than that in the FGG group (0 ± 0.4 mm) at 48 months. In the delayed FGG group, reduced MR and no significant differences in CBL were observed compared with the pre-graft measurements. CONCLUSIONS FGGs can be a practical treatment option to maintain CBL around implants with limited KM.
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Affiliation(s)
- Se-Lim Oh
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Chao Ji
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.,Department of Periodontology, Faculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Salar Azad
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
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Cairo F, Barbato L, Selvaggi F, Baielli MG, Piattelli A, Chambrone L. Surgical procedures for soft tissue augmentation at implant sites. A systematic review and meta‐analysis of randomized controlled trials. Clin Implant Dent Relat Res 2019; 21:1262-1270. [DOI: 10.1111/cid.12861] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical MedicineUniversity of Florence Florence Italy
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical MedicineUniversity of Florence Florence Italy
| | - Filippo Selvaggi
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical MedicineUniversity of Florence Florence Italy
| | - Maria G. Baielli
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical MedicineUniversity of Florence Florence Italy
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological SciencesG. D'Annunzio University of Chieti‐Pescara Chieti Italy
- Chair of Biomaterials EngineeringCatholic University of San Antonio of Murcia (UCAM) Murcia Spain
- Villaserena Foundation for Research Città Sant'Angelo, Pescara Italy
| | - Leandro Chambrone
- School of DentistryIbirapuera University (Unib) São Paulo Brazil
- Unit of Basic Oral Investigation (UIBO), School of DentistryEl Bosque University Bogota Colombia
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Zucchelli G, Tavelli L, McGuire MK, Rasperini G, Feinberg SE, Wang HL, Giannobile WV. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. J Periodontol 2019; 91:9-16. [PMID: 31461778 DOI: 10.1002/jper.19-0350] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/27/2019] [Accepted: 08/10/2019] [Indexed: 12/14/2022]
Abstract
This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed.
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Affiliation(s)
- Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Michael K McGuire
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Private practice, Houston, TX, USA.,Department of Periodontics, University of Texas, Dental Branch Houston and Health Science Center at San Antonio, San Antonio, TX, USA
| | - Giulio Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Stephen E Feinberg
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Engineering, College of Engineering and Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
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Patarapongsanti A, Bandhaya P, Sirinirund B, Khongkhunthian S, Khongkhunthian P. Comparison of platelet-rich fibrin and cellulose in palatal wounds after graft harvesting. ACTA ACUST UNITED AC 2019; 10:e12467. [PMID: 31560455 DOI: 10.1111/jicd.12467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022]
Abstract
AIM The aim of the present study was to compare patient morbidity and healing outcomes of free gingival graft (FGG) harvesting at palatal donor sites and after using platelet-rich fibrin (PRF) and oxidized regenerated cellulose (ORC). FGG harvesting leaves open palatal wounds, which heal by secondary intention. Patients might experience discomfort or pain during the first 2 weeks of healing. METHODS Eighteen participants requiring two FGG were recruited. The test and control sites were covered with PRF membrane and ORC. The complete epithelialization of the palatal wound, the percentage of wound healing, and postoperative pain were evaluated, 1, 3, and 7 days and 2, 3, and 4 weeks after surgery. RESULTS Similar wound size reduction at 1 week (test: 36.87%, control: 38.78%) was found. At 2 weeks, the majority of the test group (88.89%) showed complete epithelialization, whereas 66.67% of the control group had complete epithelialization (P = .228). Pain was more prevalent in the control group (27.77%) than in the test group (11.1%) on day 1. None of the participants reported any pain or discomfort at the test sites on day 3. CONCLUSIONS PRF seems to reduce patient morbidity, but there is no difference in palatal wound healing (P > .05).
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Affiliation(s)
- Arada Patarapongsanti
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Panwadee Bandhaya
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Benyapha Sirinirund
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Sakornratana Khongkhunthian
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Pathawee Khongkhunthian
- Center of Excellence in Dental Implantology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Korkis S, Thompson TN, Vizirakis MA, Lamble M, Zimmerman D, Neely AL, Kinaia BM. Stabilization Techniques for Soft Tissue Grafting Around Dental Implants: Case Report. Clin Adv Periodontics 2019; 9:192-195. [PMID: 31497932 DOI: 10.1002/cap.10071] [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: 12/14/2018] [Accepted: 03/19/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Implants that lack keratinized tissue (KT) have been associated with increased plaque accumulation, gingival inflammation or hue of metal showing through the tissue. Free gingival grafts (FGGs) are a predictable treatment for minimal or lack of KT. FGGs can increase the zone of KT around teeth and implants alike. Despite predictability of FGGs, stabilizing the graft around implants can be challenging, but is critical for success. Little information is available regarding ways to stabilize FGGs around implants. Acrylic or composite stents are a viable option for obtaining graft stability and support during the healing process. CASE PRESENTATION This case report highlights the practicality of using acrylic or composite stents for FGG stabilization with successful outcomes. Two patients presented with dental implants, with minimal or lack of KT requiring soft tissue augmentation. FGGs were harvested from the palate and fitted around implant carriers allowing stabilization and adequate suturing. Custom-made acrylic or composite stabilization stents were fabricated to fit around implant carriers, which were screwed into the implant platform, and hollowed out internally to provide space for the graft. Postoperative visits showed healthy, stable zones of KT in both cases. CONCLUSION The customized acrylic or composite stents allowed stabilization of the FGGs with successful outcome.
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Affiliation(s)
- Samuel Korkis
- Division of Graduate Education, University of Detroit Mercy School of Dentistry, Detroit, MI, USA
| | - Tamika N Thompson
- Division of Graduate Education, University of Detroit Mercy School of Dentistry, Detroit, MI, USA
| | | | | | | | - Anthony L Neely
- Division of Graduate Education, University of Detroit Mercy School of Dentistry, Detroit, MI, USA.,Private Practice, Southfield, MI, USA
| | - Bassam M Kinaia
- Division of Graduate Education, University of Detroit Mercy School of Dentistry, Detroit, MI, USA.,Private Practice, Sterling Heights, MI, USA
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Grischke J, Karch A, Wenzlaff A, Foitzik MM, Stiesch M, Eberhard J. Keratinized mucosa width is associated with severity of peri‐implant mucositis. A cross‐sectional study. Clin Oral Implants Res 2019; 30:457-465. [DOI: 10.1111/clr.13432] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/29/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Jasmin Grischke
- Department of Prosthetic Dentistry and Biomedical Materials Science Hannover Medical School Hannover Germany
| | - Annika Karch
- Institute for Biostatistics Hannover Medical School Hannover Germany
| | - Andreas Wenzlaff
- Department of Prosthetic Dentistry and Biomedical Materials Science Hannover Medical School Hannover Germany
| | - Magdalena Marta Foitzik
- Department of Prosthetic Dentistry and Biomedical Materials Science Hannover Medical School Hannover Germany
| | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Materials Science Hannover Medical School Hannover Germany
| | - Jörg Eberhard
- The School of Dentistry, Charles Perkins Centre, Westmead Centre for Oral Health The University of Sydney Sydney New South Wales Australia
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Imano MH, Cunha EJ, Storrer CLM, Deliberador TM. A modified free gingival graft technique for gaining vertical and horizontal soft tissue augmentation. J Indian Soc Periodontol 2019; 23:77-80. [PMID: 30692749 PMCID: PMC6334554 DOI: 10.4103/jisp.jisp_156_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The aim of this case report was to describe a modified free gingival graft technique for gaining vertical and horizontal soft-tissue growth in the posterior region of the mandible before installation of dental implants. Patient A.A., a 38-year-old female, received a modified free gingival graft in the posterior region of the mandible. After 90 days, an increase, both horizontally and vertically, of the gingival tissue was observed, and the patient was satisfied with the result. The dental implant was installed, and a 3-mm of the vertical gain of keratinized gingiva was observed. Further research is needed to evaluate the effectiveness of this technique before prosthetic dental implantation.
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Donovan TE, Marzola R, Murphy KR, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2018; 120:816-878. [DOI: 10.1016/j.prosdent.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023]
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Thoma DS, Alshihri A, Fontolliet A, Hämmerle CHF, Jung RE, Benic GI. Clinical and histologic evaluation of different approaches to gain keratinized tissue prior to implant placement in fully edentulous patients. Clin Oral Investig 2017; 22:2111-2119. [DOI: 10.1007/s00784-017-2319-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 12/15/2017] [Indexed: 11/28/2022]
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