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Adamska P, Stasiak M, Dąbrowski W, Pylińska-Dąbrowska D, Adamski ŁJ, Zedler A, Kozłowska E, Studniarek M. Soft Tissue Retraction Maneuver in Cone Beam Computed Tomography Prior to Crown-Lengthening Procedure-A Technical Note. J Clin Med 2024; 13:3668. [PMID: 38999234 PMCID: PMC11242734 DOI: 10.3390/jcm13133668] [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: 05/07/2024] [Revised: 06/05/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the retraction techniques in cone beam computed tomography (CBCT) prior to CCL, highlighting the significant enhancement in procedural accuracy and predictability that these techniques offer. Methods: Clinical and radiological examinations should be performed before a CCL procedure. It is necessary to determine the length of the tooth crowns, the periodontal pockets' depth, and the phenotype of the gingiva. The ideal CBCT examination should be performed with soft tissue retraction. This can be achieved using retractors or cotton rolls. Results: Retraction of the lips, cheeks, and tongue allows one to assess the marginal gingiva, the cemento-enamel junction, and the alveolar bone. A detailed plan of the CCL procedure, which involves retraction, ensures both the aesthetic appeal and the achievement of a newly defined gingival zenith, enhancing the overall visual harmony. Conclusions: Compared with conventional radiographic imaging, the soft tissue retraction maneuver in CBCT prior to CCL surgery offers an effective approach to the evaluation and diagnosis of soft and hard tissue. This is because of the detailed planning of the aesthetic CCL procedure. Such an approach leads to superior aesthetic outcomes in dentistry, contributing to the advancement of aesthetic dentistry through a harmonious blend of art and science.
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Affiliation(s)
- Paulina Adamska
- Division of Oral Surgery, Faculty of Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
| | - Marcin Stasiak
- Division of Orthodontics, Faculty of Medicine, Medical University of Gdańsk, 42c Aleja Zwycięstwa, 80-210 Gdańsk, Poland;
| | - Wojciech Dąbrowski
- Department of Dental Prosthetics, Faculty of Medicine, Medical University of Gdańsk, 18 Orzeszkowej Street, 80-204 Gdańsk, Poland; (W.D.); (D.P.-D.)
| | - Dorota Pylińska-Dąbrowska
- Department of Dental Prosthetics, Faculty of Medicine, Medical University of Gdańsk, 18 Orzeszkowej Street, 80-204 Gdańsk, Poland; (W.D.); (D.P.-D.)
| | - Łukasz Jan Adamski
- Private Dental Practice Łukasz Adamski, 3B Stawiska, 83-431 Stary Bukowiec, Poland;
| | - Adam Zedler
- Division of Oral Surgery, Faculty of Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
| | - Ewa Kozłowska
- Institute of Manufacturing and Materials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdańsk University of Technology, 11/12 Gabriela Narutowicza Street, 80-233 Gdańsk, Poland;
| | - Michał Studniarek
- Department of Radiology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego Street, 80-214 Gdańsk, Poland;
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Torra-Moneny M, Mauri-Obradors E, Egido-Moreno S, Valls-Roca-Umbert J, Marí-Roig A, López-López J. Association of Connective Tissue Grafts in Immediate Implants: Systematic Review and Meta-Analysis. Dent J (Basel) 2024; 12:183. [PMID: 38920885 PMCID: PMC11202705 DOI: 10.3390/dj12060183] [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: 05/03/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The increase in soft tissue (ST) around implants can benefit peri-implant health and aesthetic results. The objective was to compare the gingival and esthetic health benefits of immediate implant placement (IIP) with simultaneous or delayed connective tissue graft (CTG) compared to IIP without CTG. METHODS A systematic review was carried out by two reviewers in Medline-Pubmed, Scopus, and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were considered. Randomized Clinical Trials (RCTs) that were published between April 2017 and February 2024 were used. Studies that analyzed the performance of a simultaneous or deferred CTG after the placement of an implant in the aesthetic zone, with or without immediate provisionalization, without previous regeneration, with a follow-up of 6 months, and that were performed in humans were included. RESULTS Quantitative analysis was performed using data provided by the RCTs. The five RCTs that were selected analyzed a total "n" of 245 subjects who met the inclusion criteria and focused on the subject of the study. In the quantitative analysis, four RCTs were included. The studies evaluated buccal gingiva levels when placing the IIP with and without CTG, obtaining a mean buccal gingiva level difference of 0.09 mm (95% CI: -0.54 to 0.72, p = 0.05), statistically not significant, but with a favorable trend. CONCLUSIONS The use of CTG associated with the II can maintain the gum level but not increase the volume. CTG is favorable for achieving successful esthetic results when immediate placement of an implant with a provisional prosthesis is planned.
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Affiliation(s)
- Marta Torra-Moneny
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08907 Barcelona, Spain; (M.T.-M.); (E.M.-O.); (J.V.-R.-U.); (A.M.-R.)
| | - Elisabet Mauri-Obradors
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08907 Barcelona, Spain; (M.T.-M.); (E.M.-O.); (J.V.-R.-U.); (A.M.-R.)
| | - Sonia Egido-Moreno
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08907 Barcelona, Spain; (M.T.-M.); (E.M.-O.); (J.V.-R.-U.); (A.M.-R.)
| | - Joan Valls-Roca-Umbert
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08907 Barcelona, Spain; (M.T.-M.); (E.M.-O.); (J.V.-R.-U.); (A.M.-R.)
| | - Antonio Marí-Roig
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08907 Barcelona, Spain; (M.T.-M.); (E.M.-O.); (J.V.-R.-U.); (A.M.-R.)
- Maxillofacial Surgery Service, Bellvitge University Hospital, 08907 Barcelona, Spain
- Oral Health and Masticatory System Group, Institut d’Investigació Biomédica de Bellvitge IDIBELL (Bellvitge Institute of Biomedical Research), 08907 Barcelona, Spain
| | - José López-López
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08907 Barcelona, Spain; (M.T.-M.); (E.M.-O.); (J.V.-R.-U.); (A.M.-R.)
- Maxillofacial Surgery Service, Bellvitge University Hospital, 08907 Barcelona, Spain
- Oral Health and Masticatory System Group, Institut d’Investigació Biomédica de Bellvitge IDIBELL (Bellvitge Institute of Biomedical Research), 08907 Barcelona, Spain
- Medical Surgical Area of the Dental Hospital, University of Barcelona (HOUB), 08907 Barcelona, Spain
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Radiographic and Histomorphologic Evaluation of the Maxillary Bone after Crestal Mini Sinus Lift Using Absorbable Collagen—Retrospective Evaluation. Dent J (Basel) 2022; 10:dj10040058. [PMID: 35448052 PMCID: PMC9024729 DOI: 10.3390/dj10040058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: After tooth extraction, the alveolar bone loses volume in height and width over time, meaning that reconstructive procedures may be necessary to perform implant placement. In the maxilla, to increase the bone volume, a mini-invasive surgery, such as a sinus lift using the crestal approach, could be performed. Methods: A crestal approach was used in this study to perform the sinus lift, fracturing the bone and inserting collagen (Condress®). The single dental implant was placed in the healed bone after six months. Results: The newly formed bone was histologically analyzed after healing. Histomorphological analyses confirmed the quality of the new bone formation even without graft biomaterials. This is probably due to the enlargement of the space, meaning more vascularization and stabilization of the coagulum. Conclusion: Using just collagen could be sufficient to induce proper new bone formation in particular clinical situations, with a minimally invasive surgery to perform a sinus lift.
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Wychowański P, Starzyńska A, Adamska P, Słupecka-Ziemilska M, Sobocki BK, Chmielewska A, Wysocki B, Alterio D, Marvaso G, Jereczek-Fossa BA, Kowalski J. Methods of Topical Administration of Drugs and Biological Active Substances for Dental Implants-A Narrative Review. Antibiotics (Basel) 2021; 10:919. [PMID: 34438969 PMCID: PMC8388631 DOI: 10.3390/antibiotics10080919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
Dental implants are, nowadays, established surgical devices for the restoration of lost teeth. Considered as an alternative for traditional prosthetic appliances, dental implants surpass them in reliability and patient feedback. Local drug delivery around the implants promotes osseointegration and reduces peri-implantitis. However, there are currently no methods of a multiple, precise topical administration of drugs to the implant area. Engineering coatings on the implants, drug application on carriers during implantation, or gingival pockets do not meet all requirements of dental surgeons. Therefore, there is a need to create porous implants and other medical devices that will allow a multiple drug delivery at a controlled dose and release profile without traumatic treatment. Due to the growing demand for the use of biologically active agents to support dental implant treatment at its various stages (implant placement, long-term use of dental superstructures, treatment of the peri-implant conditions) and due to the proven effectiveness of the topical application of pharmacological biologically active agents to the implant area, the authors would like to present a review and show the methods and devices that can be used by clinicians for local drug administration to facilitate dental implant treatment. Our review concludes that there is a need for research in the field of inventions such as new medical devices or implants with gradient solid-porous structures. These devices, in the future, will enable to perform repeatable, controllable, atraumatic, and repeatable injections of active factors that may affect the improvement of osteointegration and the longer survival of implants, as well as the treatment of peri-implantitis.
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Affiliation(s)
- Piotr Wychowański
- Department of Oral Surgery, Medical University of Warsaw, 6 St. Binieckiego Street, 02-097 Warsaw, Poland;
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland; (P.A.); (B.K.S.)
| | - Paulina Adamska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland; (P.A.); (B.K.S.)
| | - Monika Słupecka-Ziemilska
- Department of Human Epigenetics, Mossakowski Medical Research Center, Polish Academy of Sciences, 5 Pawińskiego Street, 02-106 Warsaw, Poland;
| | - Bartosz Kamil Sobocki
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland; (P.A.); (B.K.S.)
- International Research Agenda 3P—Medicine Laboratory, Medical University of Gdańsk, 3a Marii Skłodowskiej-Curie Street, 80-210 Gdańsk, Poland
| | - Agnieszka Chmielewska
- Faculty of Material Science and Engineering, Warsaw University of Technology, 141 Wołoska Street, 02-507 Warsaw, Poland;
- Department of Materials Science and Engineering, The Ohio State University, 140 W 19th Ave, Columbus, OH 43210, USA
| | - Bartłomiej Wysocki
- Center of Digital Science and Technology, Cardinal Stefan Wyszyński University in Warsaw, Woycickiego 1/3 Street, 01-938 Warsaw, Poland;
- Additive Manufacturing Research Center, College of Engineering, Youngstown State University, Youngstown, OH 44555, USA
| | - Daniela Alterio
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20141 Milan, Italy; (D.A.); (G.M.); (B.A.J.-F.)
| | - Giulia Marvaso
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20141 Milan, Italy; (D.A.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 7 Festa del Perdono Street, 20112 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20141 Milan, Italy; (D.A.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 7 Festa del Perdono Street, 20112 Milan, Italy
| | - Jan Kowalski
- Department of Periodontology and Oral Medicine, Medical University of Warsaw, 6 St. Binieckiego Street, 02-097 Warsaw, Poland;
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