Does Peri-Implant Mucosa Have a Prognostic Value?

Peri-implant mucosal enhancement using leukocyte platelet rich fibrin under Sohn's poncho technique: A randomized controlled clinical trial

BACKGROUND

A biological seal that protects the implant from any biological or external impingement is created by the supracrestal attached tissues. Sohn's poncho technique is a technique that utilizes a healing abutment at the implant site to stabilize the platelet rich fibrin (PRF) membrane. Thus, the aim of this study is to evaluate the efficacy of Sohn's poncho technique used for placement of leukocyte PRF (L-PRF) membrane in improving the peri-implant mucosal thickness and width of keratinized mucosa as well as in the acceleration of healing process compared to the peri-implant mucosa surrounding healing abutments placed without the L-PRF membrane.

METHODS

A split mouth randomized controlled clinical trial was designed in which implants were placed in the mandibular posterior region. Healing abutment is placed along with the L-PRF membrane at the test site using Sohn's poncho technique and at control site conventional healing abutment placement was done at second stage. The thickness of peri-implant mucosa as primary outcome and the Width of keratinized tissue and healing as secondary outcomes were measured and assessed at various time intervals.

RESULTS

Statistically significant difference was seen in inter-group analysis when peri-implant mucosal thickness (3.8 ± 0.4 mm vs. 2.3 ± 0.4 mm) and width of keratinized mucosa (3.6 ± 0.6 mm vs. 2.7 ± 0.3 mm) in test and control groups respectively and intragroup analysis of test and control groups at 4 weeks and 6 weeks' time points. The control group showed faster healing when compared to the test group.

CONCLUSION

Sohn's poncho technique in combination with L-PRF has the potential to improve the thickness of peri-implant mucosa and the width of keratinized mucosa around implants.

The quality of life after keratinized mucosa augmentation around dental implants using xenogenic collagen matrix with or without stent

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.

Fibrin immobilization vestibular extension (FIVE): A case series

AIMS

The objective of the present case series is to report on the rationale, surgical technique and outcome of a protocol for peri-implant mucosal phenotype modification therapy, referred to as "fibrin immobilization vestibular extension (FIVE)".

MATERIAL AND METHODS

The protocol utilized entailed apical positioning and stabilization of peri-implant flap with modular screws. The screws were also used for the immobilization of solid matrix platelet-rich fibrin to fill the gap created between apically positioned flap and the crestal margin of the flap.

RESULTS

A total of 30 patients (12 male, 18 females) with 93 implants were treated with FIVE protocol for various indications, including for vestibular extension following alveolar ridge augmentation (N = 6), preprosthetic (N = 9), postprosthetic (N = 2), and peri-implantitis (N = 13). The keratinized mucosal width preoperatively was 1.67 mm with 95% confidence interval [CI] (1.46, 1.88). Immediately following FIVE surgery, the vestibule was extended to 9.10 with 95% CI (8.44, 9.76). At 3 months, 4.9 mm (95% CI: 4.5-5.2 mm) of peri-implant keratinized mucosal width was present. The keratinized mucosal width remained relatively stable thereafter and was 4.0 mm (95% CI: 3.5-4.5 mm) at 3 years post-FIVE surgery. When overall group means across all time points were analyzed, maxilla had mean of 6.1 mm (95% CI: 5.8-6.5) versus mandible exhibited mean of 5.1 mm (95% CI: 4.6-5.6 mm). The mean of maxilla was significantly higher than that of the mandible (p < 0.0001) across all time points. Treatment of peri-implantitis with FIVE lead to significant pocket reduction and wide band of keratinized mucosa. Seven of 38 implants in 3 of 13 peri-implantitis patients were removed due to advanced peri-implantitis.

DISCUSSION

The present case series provides proof-of-principle data for efficacy of FIVE for peri-implant phenotype modification therapy that generated attached keratinized mucosa in a variety of applications. This protocol provides an alternative to procedures involving harvesting of autogenous mucosal graft.