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Pohl S, Gluckman H. Management of hyperplastic tissue response following connective tissue grafting. J ESTHET RESTOR DENT 2024. [PMID: 38563127 DOI: 10.1111/jerd.13232] [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: 02/06/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE While connective tissue graft shrinkage is a well-documented post-transplantation reaction, there is a literature gap concerning hyperplastic tissue response. Despite its infrequent occurrence, investigation is warranted due to its capacity to compromise esthetics, disrupt lip dynamics, and promote food retention. Moreover, efforts to mitigate hyperplastic tissue response often prove challenging, and there is a potential risk of exacerbating gingival tissue rebound. CLINICAL CONSIDERATIONS This report presents a potential solution to managing tissue overgrowth after connective tissue grafting in five clinical cases. The patients underwent corrective surgery involving internal excision of excessive tissue while preserving the overlying mucosa. The surgical approach was tailored to excise hyperplastic tissue with minimal trauma, aiming to optimize esthetic outcomes. Subsequent follow-up assessments spanning 1-5 years demonstrated stable results, with no indications of relapse or recurrence of tissue overgrowth. CONCLUSIONS Within the limitations of this case series, surgical internal excision holds promise as a viable treatment modality for addressing post-transplantation hyperplastic tissue response. CLINICAL SIGNIFICANCE This case series addresses the challenge of uncontrolled tissue overgrowth following connective tissue grafting, a concern for which previous attempts have proven unsuccessful. Internal in-toto excision emerges as a promising approach for effectively eliminating overgrown tissue, offering potential advancements in the clinical management of this complication.
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Affiliation(s)
- Snjezana Pohl
- Department of Oral Medicine and Periodontology, University of Rijeka, Private Clinic Rident, Rijeka, Croatia
| | - Howard Gluckman
- Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
- Department of Oral Medicine and Periodontics, School of Dentistry, University of Western Cape, Cape Town, South Africa
- Dental School, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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2
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Balice G, Paolantonio M, Serroni M, De Ninis P, Rexhepi I, Frisone A, Di Gregorio S, Romano L, Sinjari B, Murmura G, Femminella B. Treatment of Multiple RT1 Gingival Recessions Using a Coronally Advanced Flap Associated with L-PRF or Subgingival Connective Tissue Graft from Maxillary Tuberosity: A Randomized, Controlled Clinical Trial. Dent J (Basel) 2024; 12:86. [PMID: 38667998 PMCID: PMC11049079 DOI: 10.3390/dj12040086] [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: 01/05/2024] [Revised: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface.
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Affiliation(s)
- Giuseppe Balice
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Michele Paolantonio
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Matteo Serroni
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Paolo De Ninis
- “Luisa D’Annunzio” Institute for High Culture, Pescara, Italy;
| | - Imena Rexhepi
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Alessio Frisone
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Stefania Di Gregorio
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Luigi Romano
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Bruna Sinjari
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Giovanna Murmura
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
| | - Beatrice Femminella
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy; (G.B.); (M.S.); (I.R.); (A.F.); (S.D.G.); (L.R.); (B.S.); (G.M.); (B.F.)
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Stuhr S, Nör F, Gayar K, Couso-Queiruga E, Chambrone L, Gamborena I, Kumar P, Avila-Ortiz G, Ganesan SM. Histological assessment and gene expression analysis of intra-oral soft tissue graft donor sites. J Clin Periodontol 2023; 50:1360-1370. [PMID: 37424138 DOI: 10.1111/jcpe.13843] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/18/2023] [Accepted: 06/11/2023] [Indexed: 07/11/2023]
Abstract
AIM To determine the structural and gene expression features of different intra-oral soft tissue donor sites (i.e., anterior palate, posterior palate, maxillary tuberosity and retromolar pad). MATERIALS AND METHODS Standardized mucosal tissue punch biopsies were collected from at least one donor site per subject. Histological processing was performed to determine tissue morphometry and quantify collagen composition. Site-specific gene distribution was mapped using targeted gene expression analysis and validated using real time polymerase chain reaction (qPCR). RESULTS A total of 50 samples from 37 subjects were harvested. Epithelial thickness did not differ between sites. However, lamina propria was thicker in the maxillary tuberosity (2.55 ± 0.92 mm) and retromolar pad (1.98 ± 0.71 mm) than in the lateral palate. Type I collagen was the predominant structural protein in the lamina propria (75.06%-80.21%). Genes involving collagen maturation and extracellular matrix regulation were highly expressed in the maxillary tuberosity and retromolar pad, while lipogenesis-associated genes were markedly expressed in the lateral palate. The retromolar pad showed the most distinct gene expression profile, and the anterior and posterior palate displayed similar transcription profiles. CONCLUSIONS Tissue samples harvested from the anterior and posterior palate differed morphologically from those from the maxillary tuberosity and retromolar pad. Each intra-oral site showed a unique gene expression profile, which might impact their biological behaviour and outcomes of soft tissue augmentation procedures.
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Affiliation(s)
- Sandra Stuhr
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Felipe Nör
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kareem Gayar
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Emilio Couso-Queiruga
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
- Unit of Basic Oral Investigations (UIBO), School of Dentistry, Universidad El Bosque, Bogotá, Colombia
- Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Iñaki Gamborena
- Private Practice, San Sebastian, Spain
- Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
- Department of Restorative Dentistry, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Purnima Kumar
- Department of Periodontics and 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
| | - Sukirth M Ganesan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
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Tavelli L, Barootchi S, Stefanini M, Zucchelli G, Giannobile WV, Wang HL. Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting. Periodontol 2000 2023; 92:90-119. [PMID: 36583690 DOI: 10.1111/prd.12466] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Palatal-tissue harvesting is a routinely performed procedure in periodontal and peri-implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft-tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics and 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
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Kashani H, Vora MV, Kuraji R, Fathi-Kelly H, Nguyen T, Tamraz B, Tran C, Kapila YL. Incision-free, coronally advanced flap with subepithelial connective tissue graft placed by the molar or canine access (MOCA) technique: 13 case series. Clin Adv Periodontics 2023; 13:11-20. [PMID: 35348310 DOI: 10.1002/cap.10195] [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: 09/17/2020] [Accepted: 01/23/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Root coverage procedures are not always predictable, and outcomes depend on several factors. This technique provides a predictable alternative to managing facial gingival recessions. CASE SERIES A new grafting technique is introduced that requires no incisions at the recipient site, thereby preserving the integrity of the local blood supply to optimize the healing process. The graft is placed through the gingival sulcus via a molar or canine access (MOCA) approach, and there is minimal tension on the coronally advanced flap through use of suspension sutures. Thirteen non-smoking patients, between the ages of 27 and 57, with Cairo RT1 facial recession were studied, with a follow-up period of 1-60 weeks. This paper explains the step-by-step technique and highlights 13 cases. CONCLUSION Complete root coverage was achieved in all 13 cases, although one case showed initial altered healing. While MOCA is technique sensitive, it provides optimal root coverage results. With no incisions at the recipient site, there is no uneven texture or scar formation, and healing proceeds with minimal interruption. Why is this case series new information? MOCA is a unique approach to introduce grafts into non-incised sites of recession that can be one, two, or three teeth away at molars or canines. Non-incised approach minimizes interruption to blood supply. Coronally advanced flaps are secured in place with composite-fastened suspension sutures for tension-free flap closure. What are the keys to successful management of these cases? Good quality and quantity of connective tissue graft Early diagnosis and treatment of recession Expert surgical technique What are the key limitations to the success of these cases? The quality of the donor site is variable among patients. A technique-sensitive approach Advanced recession might warrant a second surgery.
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Affiliation(s)
- Hooshang Kashani
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, California, USA
| | - Manali V Vora
- Center for Tobacco Control, Research and Education, University of California, San Francisco, California, USA
- Division of Periodontology, University of Connecticut, School of Dental Medicine, Farmington, Connecticut, USA
| | - Ryutaro Kuraji
- Department of Life Science Dentistry, The Nippon Dental University, Tokyo, Japan
- Department of Periodontology, The Nippon Dental University School of Life Dentistry, Tokyo, Japan
| | - Hoorshad Fathi-Kelly
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, California, USA
| | - Trung Nguyen
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, California, USA
| | - Beniel Tamraz
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, California, USA
| | - Christine Tran
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, California, USA
| | - Yvonne L Kapila
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, California, USA
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Soetebeer M, Jennes ME, Antonoglou G, Al-Nawas B, Beuer F. Effectiveness of soft tissue augmentation procedures for coverage of buccal soft tissue dehiscence around dental implants. A systematic review. Clin Oral Implants Res 2022; 33 Suppl 23:125-136. [PMID: 35274392 DOI: 10.1111/clr.13918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/05/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This systematic review evaluated the effectiveness of soft tissue augmentation procedures for complete coverage and mean coverage of buccal soft tissue dehiscence (BSTD) in patients with implant-supported restorations. METHODS Three databases were surveyed for randomized (RCTs), non-randomized controlled clinical trials (CCTs), cohort studies, case-control studies, and case series with a minimum of five patients per control or test group. Studies dealing with soft tissue augmentation procedures to cover BSTD-occurring during implant function and not due to the result of peri-implantitis-were included. Risk of bias was evaluated with RoB 2 or the National Institutes of Health's Quality Assessment. Whenever possible exploratory meta-analyses were performed to evaluate weighted mean effects (WME) for the different outcomes. The primary outcomes were percentage of complete coverage and mean coverage of BSTD. RESULTS Seven articles were included. Only one study was a RCT, with a high risk of bias. Meta-analyses showed that after 1 year (2 studies, n = 36 patients; WME = 70; 95% confidence interval [CI] = 50; 90; p = 0.23) as well as after 5 years (3 studies, n = 54 patients; WME = 70; 95%; CI = 60; 80; p = 0.44), complete coverage of BSTD could be achieved in 70% of the cases. CONCLUSION Based on limited evidence it can be concluded that BSTD can be substantially reduced with the use of soft tissue augmentation procedures. Further research with comparative trials using larger samples and longer follow-up periods is needed to study the stability of soft tissues in the long term.
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Affiliation(s)
- Maren Soetebeer
- Charité Center for Dental, Oral and Maxillary Medicine, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Berlin, Germany
| | - Marie-Elise Jennes
- Charité Center for Dental, Oral and Maxillary Medicine, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Berlin, Germany
| | - Georgios Antonoglou
- King´s College London, Faculty of Dentistry, Oral & Craniofacial Sciences University, London, UK
| | - Bilal Al-Nawas
- Johannes Gutenberg Universitat Mainz, Department of Oral and Maxillofacial Surgery, Mainz, Rheinland-Pfalz, Germany
| | - Florian Beuer
- Charité Center for Dental, Oral and Maxillary Medicine, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Berlin, Germany
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Puisys A, Auzbikaviciute V, Vindasiute-Narbute E, Zukauskas S, Razukevicus D, Dard MM. Full versus partial thickness flap to determine differentiation and over keratinization of non-keratinized mucosa. A 3-year split mouth randomized pilot study. Clin Exp Dent Res 2021; 7:1061-1068. [PMID: 34245136 PMCID: PMC8638318 DOI: 10.1002/cre2.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives It was shown, that Connective Tissue Grafts (CTG) retrieved from the tuberosity tends to determine hyperplastic responses and may induce a beneficial over‐keratinization of non‐keratinized mucosa. Clinically evaluate and compare CTG from tuberosity ability to increase soft tissue thickness and the keratinization potential after recipient area is either prepared using split or full thickness flap in edentulous mandible. Materials and methods Fourty implants were placed in 10 edentulous patients with atrophied mandible (Class IV of Misch) presenting less than 1.0 mm of keratinized tissue using a flapless approach and immediately restored with acrylic temporary bridge on multi‐unit abutments. The surgical sites were split‐mouth randomized and prepared as CTG recipients by a tunneling procedure. Twenty benefited of a partial thickness approach and 20 of a full thickness one. The CTG was placed buccally using partial thickness or full thickness flap according to the randomization schedule. The width of keratinized tissue (KT), the horizontal soft tissue thickness (STT), the marginal hard and soft tissue levels as well as the implant success parameters were collected and analyzed. Results After a 3 year follow‐up period the increase of KT was statistically significantly (p < 0.001) larger in the partial thickness group from 0.6(0.6) to 5.1(0.72) mm, while full thickness group showed very little improvement from 0.5(0.51) to 1(0.57) mm (p < 0.001). STT was significantly increased in both groups over time: from 2.4(0.88) to 5.4(0.68) mm in full thickness group and from 2.5(0.51) to 5.8(0.41) mm in partial thickness group without any significant difference between the groups. Conclusion The increase of soft tissue thickness by using CTG from tuberosity was found in both groups, while keratinization of non‐keratinized mucosa appeared more in the partial thickness group.
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Affiliation(s)
| | | | | | - Saulius Zukauskas
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dainius Razukevicus
- Faculty of Dentistry, Lithuania University of Health Science, Kaunas, Lithuania
| | - Michel M Dard
- College of Dental Medicine, Columbia University, New York, New York, USA
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8
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Oda N, Ono M, Sonoyama W, Morimoto T, Tosa I, Nousho S, Nakano K, Kuboki T. White discharge formation following a subepithelial connective tissue graft for anterior fixed partial denture pontics: a case report based on clinical and histological findings. J Prosthodont Res 2021; 66:184-192. [PMID: 34053972 DOI: 10.2186/jpr.jpr_d_20_00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PATIENT A 54-year-old woman presenting with anterior alveolar ridge resorption was submitted to a connective tissue graft (CTG) for esthetic improvement before rehabilitation with a fixed partial denture. Palate-harvested connective tissue was used as a graft after extra-oral removal of the epithelium. Unexpectedly, complete wound healing was not observed. Moreover, 6 months post-surgery, a white discharge was detected at the grafted site. The adjacent tooth showing a root fracture was initially associated with the symptoms and was then extracted. Concomitantly, the unhealed tissue at the grafted site was also excised, leading to temporary symptom resolution. However, the white discharge reappeared after 2 months. The excision area was expanded to remove the grafted tissue entirely, and the wound was completely healed. Since the alveolar ridge resorption had become larger compared to the preoperative condition, the patient was subjected to a second CTG, now using a connective tissue harvested from the palate by a single incision technique. The wound healed uneventfully, and the final prosthesis was delivered 6 months after soft tissu e stabilization. The patient has been followed-up for more than 28 months without any recurrence of white discharge. DISCUSSION Histopathological and cytological examination detected keratinized epithelial tissues and cells, respectively, in excised tissues and white discharge specimens. Consequently, a possible relationship between white discharge and residual epithelium in the harvested graft was strongly suspected. CONCLUSIONS Success of the CTG procedure requires careful method selection for tissue transplantation and treatment execution.
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Affiliation(s)
- Norimi Oda
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Mitsuaki Ono
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Wataru Sonoyama
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | | | - Ikue Tosa
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Shuji Nousho
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Takuo Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
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9
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Gamborena I, Sasaki Y, Blatz MB. Predictable immediate implant placement and restoration in the esthetic zone. J ESTHET RESTOR DENT 2021; 33:158-172. [PMID: 33522700 DOI: 10.1111/jerd.12716] [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: 11/08/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 01/02/2023]
Abstract
This article describes a comprehensive step-by-step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long-term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence.
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Affiliation(s)
- Iñaki Gamborena
- Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA.,Private Practice, San Sebastian, Spain
| | | | - Markus B Blatz
- Department of Preventive and Restorative Sciences, Digital Innovation and Professional Development, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
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10
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De Angelis P, De Angelis S, Passarelli PC, Liguori MG, Pompa G, Papi P, Manicone PF, D'Addona A. Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants. Int J Oral Maxillofac Surg 2020; 50:956-963. [PMID: 33279377 DOI: 10.1016/j.ijom.2020.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022]
Abstract
Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.
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Affiliation(s)
- P De Angelis
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - P C Passarelli
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - M G Liguori
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Pompa
- Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - P Papi
- Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - P F Manicone
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - A D'Addona
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Rojo E, Stroppa G, Sanz‐Martin I, Gonzalez‐Martín O, Nart J. Soft tissue stability around dental implants after soft tissue grafting from the lateral palate or the tuberosity area – A randomized controlled clinical study. J Clin Periodontol 2020; 47:892-899. [DOI: 10.1111/jcpe.13292] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 04/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ernest Rojo
- Department of Periodontology Universitat Internacional de Catalunya (UIC) Barcelona Spain
| | - Giorgio Stroppa
- Department of Periodontology Universitat Internacional de Catalunya (UIC) Barcelona Spain
| | - Ignacio Sanz‐Martin
- Department of Periodontology Universitat Internacional de Catalunya (UIC) Barcelona Spain
- Section of Post‐graduate Periodontology Faculty of Odontology University Complutense of Madrid Madrid Spain
| | - Oscar Gonzalez‐Martín
- Section of Post‐graduate Periodontology Faculty of Odontology University Complutense of Madrid Madrid Spain
- Periodontal‐Prosthesis Department School of Dental Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Jose Nart
- Department of Periodontology Universitat Internacional de Catalunya (UIC) Barcelona Spain
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12
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Tavelli L, Barootchi S, Greenwell H, Wang H. Is a soft tissue graft harvested from the maxillary tuberosity the approach of choice in an isolated site? J Periodontol 2019; 90:821-825. [DOI: 10.1002/jper.18-0615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/03/2018] [Accepted: 12/24/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Shayan Barootchi
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
| | - Henry Greenwell
- Department of PeriodonticsUniversity of LouisvilleSchool of Dental Medicine Louisville KY
| | - Hom‐Lay Wang
- Department of Periodontics & Oral MedicineUniversity of Michigan School of Dentistry Ann Arbor MI
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13
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Gluckman H, Du Toit J, Pontes CC, Hille J. Hyperplastic Response Following Soft Tissue Augmentation in the Esthetic Zone. Clin Adv Periodontics 2018; 9:50-54. [DOI: 10.1002/cap.10047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/12/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Howard Gluckman
- Private practice of periodontics and oral medicine – The Implant ClinicThe Implant & Aesthetic Academy Cape Town South Africa
| | - Jonathan Du Toit
- ResidentDepartment of Periodontics and Oral MedicineUniversity of Pretoria Pretoria South Africa
- The Implant & Aesthetic Academy Cape Town South Africa
| | | | - Jos Hille
- Department of Oral and Maxillofacial PathologyUniversity of the Western Cape Cape Town South Africa
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14
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Treatment of buccal soft tissue dehiscence around single implant: 5-year results from a prospective study. Clin Oral Investig 2018; 23:1977-1983. [DOI: 10.1007/s00784-018-2634-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
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15
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Structural and histological differences between connective tissue grafts harvested from the lateral palatal mucosa or from the tuberosity area. Clin Oral Investig 2018; 23:957-964. [DOI: 10.1007/s00784-018-2516-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
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16
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Rojo E, Stroppa G, Sanz-Martin I, Gonzalez-Martín O, Alemany AS, Nart J. Soft tissue volume gain around dental implants using autogenous subepithelial connective tissue grafts harvested from the lateral palate or tuberosity area. A randomized controlled clinical study. J Clin Periodontol 2018; 45:495-503. [DOI: 10.1111/jcpe.12869] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ernest Rojo
- Department of Periodontology; Universitat Internacional de Catalunya (UIC); Barcelona Spain
| | - Giorgio Stroppa
- Department of Periodontology; Universitat Internacional de Catalunya (UIC); Barcelona Spain
| | - Ignacio Sanz-Martin
- Department of Periodontology; Universitat Internacional de Catalunya (UIC); Barcelona Spain
- Section of Post-graduate Periodontology; Faculty of Odontology; University Complutense of Madrid; Madrid Spain
| | - Oscar Gonzalez-Martín
- Section of Post-graduate Periodontology; Faculty of Odontology; University Complutense of Madrid; Madrid Spain
- Periodontal-Prosthesis Department; University of Pennsylvania School of Dental Medicine; Philadelphia PA USA
| | - Antonio Santos Alemany
- Department of Periodontology; Universitat Internacional de Catalunya (UIC); Barcelona Spain
| | - José Nart
- Department of Periodontology; Universitat Internacional de Catalunya (UIC); Barcelona Spain
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17
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Wang CW, Li CC, Krawczyk W, Kim DM. Root Coverage Procedure With Connective Tissue Graft Harvested From a Distal Wedge: A Case Report. Clin Adv Periodontics 2016; 6:134-139. [PMID: 31535466 DOI: 10.1902/cap.2016.150070] [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: 10/18/2015] [Accepted: 01/10/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This case report illustrates the use of a connective tissue (CT) graft harvested from a distal wedge procedure for root coverage. The retromolar area could be an alternative donor site, especially when a distal wedge procedure is planned. This approach offers an alternative CT donor site for the treatment of a localized gingival recession (GR). CASE PRESENTATION A healthy 22-year-old female patient presented with a localized Miller Class II GR defect on a mandibular incisor (tooth #25) caused by trauma from a lip piercing. Probing depths of 6 mm were also noted bilaterally over the distal aspect of the mandibular second molars. A root coverage procedure was performed, together with a distal wedge procedure for pseudopocket reduction. A CT graft harvested from a distal wedge was used for the root coverage. Complete root coverage with stable follow-up was documented up to 2 years, 5 months. Tissue from a contralateral distal wedge was submitted for histologic evaluation. Histopathologic examination showed dense collagenous fibrous tissue with no inflammatory infiltrates. CONCLUSIONS Localized GR can be treated with a CT graft harvested from a distal wedge without significant inflammation. The mandibular retromolar area may serve as an alternative viable donor site in selected cases.
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Affiliation(s)
- Chin-Wei Wang
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Chia-Cheng Li
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA
| | - Walter Krawczyk
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA
| | - David M Kim
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA
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18
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Roccuzzo M, Gaudioso L, Lungo M, Dalmasso P. Surgical therapy of single peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen. J Clin Periodontol 2016; 43:311-8. [DOI: 10.1111/jcpe.12516] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mario Roccuzzo
- Private practice; Torino Italy
- Division of Maxillofacial Surgery; University of Torino; Torino Italy
| | | | | | - Paola Dalmasso
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
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19
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Bertl K, Pifl M, Hirtler L, Rendl B, Nürnberger S, Stavropoulos A, Ulm C. Relative Composition of Fibrous Connective and Fatty/Glandular Tissue in Connective Tissue Grafts Depends on the Harvesting Technique but not the Donor Site of the Hard Palate. J Periodontol 2015; 86:1331-9. [DOI: 10.1902/jop.2015.150346] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Masaki C, Nakamoto T, Mukaibo T, Kondo Y, Hosokawa R. Strategies for alveolar ridge reconstruction and preservation for implant therapy. J Prosthodont Res 2015; 59:220-8. [PMID: 26022542 DOI: 10.1016/j.jpor.2015.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE In dental implant treatment, ridge preservation and immediate or early implant placement are recommended to minimize bone resorption after tooth extraction and achieve esthetic outcomes. However, there is no consensus concerning the efficacy of this surgical method. There is also no consensus on the efficacy of bone and soft tissue grafts and surgical methods for alveolar ridge reconstruction. STUDY SELECTION This paper reports ridge alteration in the anterior maxilla after tooth extraction, and summarizes the efficacy of various ridge preservation methods and immediate or early implant placement as alveolar ridge preservation methods to minimize bone resorption after tooth extraction. The advantages and complications of alveolar ridge reconstruction methods, and the efficacy and surgical method of soft tissue graft are reviewed. RESULTS The anterior maxilla is in the esthetic zone, and the thickness of the bone on the labial side around the natural tooth is less than 1mm in many cases. Therefore, it is impossible to prevent bone resorption completely, even if ridge preservation and immediate or early implant placement are performed after tooth extraction. It is necessary to obtain stable and long-term esthetics by combining connective tissue and free gingival grafts, in addition to hard tissue augmentation. CONCLUSIONS It is important to consider the burden and level of satisfaction of patients, such as in terms of donor site morbidity in hard and soft tissue grafting, and to pay attention to appropriate indications to avoid overtreatment.
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Affiliation(s)
- Chihiro Masaki
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Japan.
| | - Tetsuji Nakamoto
- Department of Prosthodontics, Graduate School of Oral & Maxillofacial Biology, School of Dentistry, Matsumoto Dental University, Japan
| | - Taro Mukaibo
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Japan
| | - Yusuke Kondo
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Japan
| | - Ryuji Hosokawa
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Japan
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21
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Roccuzzo M, Gaudioso L, Bunino M, Dalmasso P. Surgical treatment of buccal soft tissue recessions around single implants: 1-year results from a prospective pilot study. Clin Oral Implants Res 2013; 25:641-6. [DOI: 10.1111/clr.12149] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Mario Roccuzzo
- Private Practice; Torino Italy
- Department of Maxillofacial Surgery; University of Torino; Torino Italy
| | | | | | - Paola Dalmasso
- Department of Public Health and Microbiology; University of Torino; Torino Italy
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