Soft tissue enhancement around dental implants

Do different incision techniques for implant surgery affect gingival papilla height around dental implants? A retrospective study of 115 cases

BACKGROUND

Surgical incision designs are considered closely correlated to gingival papilla of dental implants. This study aims to explore whether different incision techniques for implant placement and second stage surgery affect gingival papilla height.

METHODS

Cases using different incision techniques (intrasulcular incisions or papilla sparing incisions) between November 2017 and December 2020 were selected and analyzed. A digital camera was used to capture images of gingival papilla at different time points. Ratio of papilla height to crown length using different incision techniques were measured and statistically compared.

RESULTS

A total of 115 papillae (68 patients) were eligible according to the inclusion/exclusion criteria. The average age was 39.6 years. Decreased postoperative papilla height were observed after implant placement surgery in all groups without statistical difference. However, for second stage surgery, intrasulcular incisions lead to more atrophy in gingival papilla compared to papilla sparing incisions.

CONCLUSIONS

Selection of incision techniques in implant placement surgery does not significantly affect papilla height. For second stage surgery, intrasulcular incisions significantly leads to more papilla atrophy compared with papilla sparing incisions. Trial registration KQCL2017003.

Comparison between Rolled and Nonrolled U-Shaped Flap in the Second Stage of Dental Implant Surgery: A Randomized Clinical Trial

Background. The presence of black triangles around the dental implant-supported prosthesis and the failure to construct adequate papillae around them bothers dental implantologists. Peri-implant surgical soft tissue management will improve esthetics, function, and implant survival. Aim. To compare the effects of rolled and nonrolled U-shaped flaps combined with a temporary crown in enhancing the soft tissue around dental implants. Materials and Methods. Forty patients were included in this study; all patients were operated on by the same maxillofacial surgeon at Al-Iraq specialized dental clinics from January 2019 to January 2020. Patients were divided randomly into two groups: group A: at the second stage of implant surgery, a U-shaped flap without rolling was used in conjunction with temporary crown placement; group B: at the second stage of implant surgery, a U-shaped flap with rolling was used in conjunction with temporary crown placement. Then, the temporary crown was fabricated for both groups and kept in place for one month. Two independent maxillofacial surgeons evaluated all patients two weeks after the cementation of the final zirconia crown for the implant soft tissue esthetic score. Results. The highest possible score assigned to the mesial papilla (2 scores) was present in 92.5% of the group A patients and only 77.5% of the group B patients. Moreover, we have found that alveolar bone contour is achieved perfectly (2 scores) in 70% of group A patients but only in 32.5% of group B patients. Conclusion. The U-shaped flap without rolling with a temporary crown is a simple technique. It has good results, especially when there is no severe resorption of the labial bone plate (in canine and premolar areas).

Associations among the anterior maxillary dental arch form, alveolar bone thickness, and the sagittal root position of the maxillary central incisors in relation to immediate implant placement: A cone-beam computed tomography analysis

Purpose

This study evaluated the associations of the dental arch form, age-sex groups, and sagittal root position (SRP) with alveolar bone thickness of the maxillary central incisors using cone-beam computed tomography (CBCT) images.

Materials and Methods

CBCT images of 280 patients were categorized based on the dental arch form and age-sex groups. From these patients, 560 sagittal CBCT images of the maxillary central incisors were examined to measure the labial and palatal bone thickness at the apex level and the palatal bone at the mid-root level, according to the SRP classification. The chi-square test, Kruskal-Wallis test, and multiple linear regression were used for statistical analyses.

Results

Significant differences were found in alveolar bone thickness depending on the arch form and SRP at the apex level. The square dental arch form and class I SRP showed the highest bone thickness at both levels of the palatal aspect. The taper dental arch form and class II SRP presented the highest bone thickness at the apex level of the labial aspect. No association was found between the dental arch form and SRP. Elderly women showed a significant association with thinner alveolar bone. Age-sex group, the dental arch form, and SRP had significant associations with alveolar bone thickness at the apex level.

Conclusion

The patient’s age-sex group, dental arch form, and SRP were associated with alveolar bone thickness around the maxillary central incisors with varying magnitudes. Therefore, clinicians should take these factors into account when planning immediate implant placement.

[Evaluation of the clinical effectiveness of the use of a navigational surgical template in the vestibuloplasty protocol in patients with periodontal diseases]

THE AIM OF THE STUDY

Was to evaluate the clinical effectiveness of the use of a navigational surgical template in the vestibuloplasty protocol in patients with periodontal diseases.

MATERIALS AND METHODS

There were 48 people selected to participate in the study and randomly divided into 2 equal groups. The patients of the main group underwent vestibuloplasty procedure using a free gingival graft modeled using the developed protocol and a navigational surgical template. Patients in the control group underwent a similar operation using classical technology. The study assessed postoperative pain, the index of early wound healing, Doppler fluometry of the transplanted flap and flap morphometric measurements.

RESULTS

The results of all conducted studies confirmed the effectiveness of the developed clinical protocol.

CONCLUSION

According to objective and subjective assessments, the use of a surgical navigation template can reduce the time and invasiveness of vestibuloplasty surgery, make it more comfortable for the patient and get a more predictable clinical result.

Effect of mandibular residual ridge regularization on peri-implant wound healing when narrow diameter implants are used as overdenture retainers

STATEMENT OF PROBLEM

Alveolar ridge regularization involves the smoothing and minimal reduction of rough alveolar bone ridge to achieve adequate bone thickness around the implant. The effect of this procedure on peri-implant health is unclear.

PURPOSE

The purpose of this clinical study was to evaluate whether bone regularization affects the clinical and biological parameters of peri-implant health when narrow diameter implants are placed as mandibular implant overdenture retainers during initial healing and after occlusal loading.

MATERIAL AND METHODS

The need for mandibular ridge regularization in the anterior mandibular region was analyzed before the placement of 2 implants (2.9×10 mm, Facility; Neodent) in 21 participants provided with mandibular overdentures. Primary stability was measured by the insertion torque and implant stability quotient (ISQ). Clinical and biological evaluations measuring the plaque index, presence of calculus, probing depth, bleeding on probing index, gingival index, secondary stability (ISQ), and interleukine-1β (IL-1β) and tumor necrosis factor-α (TNF-α) concentrations in peri-implant crevicular fluid were measured during osseointegration on days 7, 15, 30, 60, and 90 and after loading on day 180 after implant placement. Multilevel mixed-effects linear regression analysis and the Kaplan-Meier test were used to analyze the data (α=.05).

RESULTS

The ISQ values showed significant differences on days 7 (P<.001) and 15 (P=.002) with higher values and on day 180 (P=.008) with a lower value compared with the baseline value in the ridge regularization group. Additionally, a significant decrease in probing depth was observed on days 60 (P=.008) and 180 (P=.027) compared with that on day 15 after implant placement. In the nonridge regularization group, significant decreases in probing depth were observed on days 30 and 180. Moreover, TNF-α levels in this group were significantly lower on days 30 (P=.001), 60, 90, and 180 (P<.001) when compared with the value on day 7 (P<.001). The ridge regularization group presented with significant differences in TNF-α and IL-1β levels on days 60 (P=.004) and 30 (P=.007), respectively, when compared with the values on day 7. The ISQ and probing depth in the ridge regularization group were associated with changes in TNF-α and IL-1β levels; furthermore, bone type, duration of edentulism, and mandibular bone atrophy were correlated with the clinical outcomes and TNF-α release. The implant survival rate was 67% in the nonridge regularization group and 100% in the ridge regularization group.

CONCLUSIONS

Mandibular ridge regularization appeared to be beneficial for peri-implant healing during the early stages and after 3 months of occlusal loading in patients with an atrophic ridge, prolonged time since edentulism, and poor bone quality.

Interimplant papilla reconstruction at second-stage surgery: A technique

Reconstructing an esthetic interimplant papilla remains challenging with implant-supported restorations, especially for patients with a thin gingival biotype. This technique report describes a modified approach to rebuilding an interimplant papilla by joining 2 elevated connective tissue flaps at the second-stage surgery.

Clinical Evaluation of the Nasopalatine Canal in Implant-Prosthetic Treatment: A Pilot Study

Implant-prosthetic rehabilitation of missing teeth in the anterior maxilla is often challenging due to ongoing bone resorption and remodeling events and may require regeneration procedures involving the nasopalatine canal (NPC). We describe a surgical approach with a block graft in relation to the NPC and evaluate clinical performance, sensory perception, and aesthetic result of the implant-prosthetic treatment over a two- to nine-year (mean: 3.5 years) follow-up. Ten implants (six in the right central incisor and four in the left central incisor) were, respectively, placed in 10 consecutive patients with bone defects affecting the NPC and unfavorable widening of the incisive foramen. Treatment stages included: (1) Diagnosis: evaluation of clinical-aesthetic parameters using Cone Beam Computed Tomography; (2) Surgery: block graft placement by palatine and incisal with simultaneous guided bone regeneration, and late (6–10 months) implant placement; (3) Prosthetics: placement of a screw-retained crown (torque of 32 N/cm). At treatment initiation, all the NPCs evaluated in our study were free of pathologies. Treatment evaluation included bone crest thickness, neurosensory status, patients’ treatment perception, and pink and white aesthetic scores (PES/WES). Pre-surgery, anterior ridge thickness at the level of the incisive foramen was (mean ± SD) 3.5 ± 2 mm, 5.4 ± 1.5 mm, and 6.1 ± 1.9 mm at heights of 4, 8, and 14 mm apical to the marginal bone crest, respectively. Post-treatment values were, respectively, 10.1 ± 2.0 mm, 10.5 ± 1.0 mm, and 13.4 ± 3.0 mm. The perception of treatment with the aesthetic pink and white indices (PES/WES) was an average of 7.5 and 7 points, respectively, out of a total of 10 each index, with a recovery of 100% of the neurosensory perception of the area. We propose that bone augmentation using block and particulate graft material can compensate for anatomical variations in the NPC, optimize implant’s three-dimensional positioning and improve facial contour, providing tissue and implant stability and good aesthetic outcomes.

Implant Angulation Effect on the Fracture Resistance of Monolithic Zirconia Custom Abutments: An In Vitro Study

PURPOSE

To investigate the fracture resistance and performance of zirconia when employed for the fabrication of implant abutments with different angulations, simulating anterior maxillary oral rehabilitation.

MATERIALS AND METHODS

Forty-five monolithic zirconia custom abutments of internal conical implant connection were CAD/CAM designed and fabricated. The specimens were divided into three groups (n = 15/group) according to implant-to-abutment angulation. The angulations used were; 0°, 15°, and 25°. The abutments were loaded until failure at 135° using the Universal Testing Machine (Instron, Canton, MA). Collected data were statistically analyzed using one-way ANOVA and post hoc Tukey test.

RESULTS

Mean (±standard deviation) load at fracture of the zirconia abutments for the three groups were 962.37 ± 93.81 N (Gr15) > 718.25 ± 93.71 N (Gr25) > 534.05 ±133.77 N (Gr0). Statistically significant difference (p < 0.0001) was found between all groups; Gr0 vs. Gr15, Gr0 vs. Gr25, Gr15 vs. Gr25.

CONCLUSIONS

Contrary to expectations, the non-angulated monolithic zirconia abutments presented the lowest fracture resistance values. Angulating the abutments 15 or 25 degrees, following the palatal resorption pattern of the premaxilla, significantly increased the in vitro fracture resistance.

Controlling fibroblast adhesion and proliferation by 1D Al2O3 nanostructures

The fibrotic encapsulation, which is mainly accompanied by an excessive proliferation of fibroblasts, is an undesired phenomenon after the implantation of various medical devices. Beside the surface chemistry, the topography plays also a major role in the fibroblast-surface interaction. In the present study, one-dimensional aluminium oxide (1D Al₂O₃) nanostructures with different distribution densities were prepared to reveal the response of human fibroblasts to the surface topography. The cell size, the cell number and the ability to form well-defined actin fibres and focal adhesions were significantly impaired with increasing distribution density of the 1D Al₂O₃ nanostructures on the substratum.

The long-term risks and complications of bovine-derived xenografts: A case series

The frequency of dental implant related surgeries that involve soft tissue and bone augmentation procedures has increased significantly. Bovine-derived substitutes have been by far the most commonly used xenografts in dentistry. Albeit literature is replete with clinical studies in favor of bovine-derived graft materials, bibliographical data reporting on risks and clinical complications is scarce. Clinical impression and concern for patient safety led to the report we have provided. The aim of the present case series was to raise awareness on the long-term risks and late clinical complications of bovine-derived graft materials. Patients were referred to a private practice due to bone augmentation complications. Demographics, significant medical and dental findings are reported. Complications included sinus and maxillary bone pathoses, displacement of the graft materials, oroantral communications, implant failure, foreign body reactions, encapsulation, chronic inflammation, soft tissue fenestrations and associated cysts. Bovine-derived graft materials were not biodegradable. Resolution of the associated lesions and symptoms was achieved after the removal of the bone graft materials. The surgical removal of the xenograft materials may require advanced clinical skills because of the different configurations clinicians might encounter of the non-resorbed and migrated particles. The authors’ concern is that patient morbidity may not be reduced with xenografts, due to the inherent risks and associated complications. Clinicians seeking to provide functional and esthetic outcomes should be aware of the complications of the bovine-derived graft materials. The long-term safety of xenografts and their potential association with disease are valid concerns.

A novel classification of anterior alveolar arch forms and alveolar bone thickness: A cone-beam computed tomography study

Purpose

This study classified alveolar arch forms and evaluated differences in alveolar bone thickness among arch forms in the anterior esthetic region using cone-beam computed tomography (CBCT) images.

Materials and Methods

Axial views of 113 CBCT images were assessed at the level of 3 mm below the cementoenamel junction (CEJ) of the right and left canines. The root center points of teeth in the anterior esthetic region were used as reference points. Arch forms were classified according to their transverse dimensions and the intercanine width-to-depth ratio. The buccolingual alveolar bone thickness of each tooth was measured at 3 mm below the CEJ and at the mid-root level. Differences in the mean thicknesses among arch forms were analyzed.

Results

Anterior maxillary arches could be classified as long narrow, short medium, long medium, and long wide arches. Significant differences in buccolingual alveolar bone thickness among the arch groups were found at both levels. The long wide arches presented the greatest bone thickness, followed by the long medium arches, while the long narrow and short medium arches were the thinnest.

Conclusion

Arch forms were classified as long narrow, short medium, long medium, and long wide. The buccolingual alveolar bone thickness exhibited significant differences among the arch forms.

Factors affecting the complexity of dental implant restoration - what is the current evidence and guidance?

Objectives The aim of this paper is to identify the factors that affect the complexity of implant restoration and to explore the indices that help us to assess it. With this knowledge the growing number of clinicians restoring dental implants will have a better understanding of the available guidance and evidence base, and the differing levels of competence required.Study design A literature review was conducted. The selection of publications reporting on complexity was based on predetermined criteria and was agreed upon by the authors. After title and abstract screening 17 articles were reviewed. The articles that were utilised to form the ITI SAC tool and Cologne Risk Assessment we also included.Assessing complexity Two key guides are available: International Team for Implantology's Straight-forward Advanced Complex tool and the Cologne ABC risk score. While these guides help identify treatment complexity they do not provide a strong enough evidence base from which to solely base clinical decisions. The key patient factors are expectation, communication, the oral environment, aesthetic outcome, occlusion, soft tissue profile and the intra-arch distance, whereas the key technical factors are impression taking, type of retention, loading protocol and the need for provisional restorations. Human factors also have a significant effect on complexity, specifically, the experience and training of the clinician, team communication and the work environment.Conclusions There are many interconnecting factors that affect the complexity of dental implant restoration. Furthermore the two widely used indices for the assessment of complexity have been investigated, and although these offer a good guideline as to the level of complexity, there is a lack evidence to support their use. The development of evidence-based treatment and protocols is necessary to develop the current indices further, and these need to be expanded to include other critical areas, such as human factors. A practical guide to aid practitioners in reducing complexity has been proposed.

The dome technique: a new surgical technique to enhance soft-tissue margins and emergence profiles around implants placed in the esthetic zone

Achieving symmetry of the soft-tissue margins between anterior maxillary dental-implant restorations and adjacent teeth is a therapeutic challenge for both the implant surgeon and the restorative dentist. This article describes a modified procedure utilizing autogenous connective-tissue grafts to improve primarily buccal soft-tissue margins and secondarily inter-proximal tissues around tooth-bound single dental implants. This technique has the advantage of allowing for coronal augmentation of the peri-implant soft tissue while maximizing the blood supply to the area by using tunneling-technique principles. A detailed description of the technique and a case with a stable result over 24 months after crown placement is presented.

Peri-implant plastic surgery techniques to hard and soft tissue augmentation in implant rehabilitation

This report presents the clinical results of peri-implant plastic surgical approaches for hard and soft tissues before and during the implant placement in a patient with vertical ridge deformation and a shallow vestibule sulcus, and the subsequently performed prosthetic rehabilitation. The surgical approaches used in this case reduced the crown-height space and crown-to-implant ratio and ensured that the implants were placed in their ideal positions, and peri-implant tissue health was maintained. In conclusion, developments in the peri-implant plastic surgery enable the successful augmentation of hard and soft tissue defects and provide the implant-supported fixed prosthetic rehabilitation.

Soft-Tissue Enhancement Combined With Biologically Oriented Preparation Technique to Correct Volumetric Bone Defects: A Clinical Case Report

The aim of the present case report was to illustrate how to obtain an ideal alveolar ridge contour by means of peri-implant soft-tissue management combined with the prosthetic approach of the biologically oriented preparation technique (BOPT). A patient presenting a moderate vertical and horizontal bone loss in the posterior maxilla was treated with sinus floor elevation and simultaneous implant placement. During the reentry procedure, the horizontal defect was corrected with an apically repositioned flap combined with a connective tissue graft. To increase the volume of the interimplant papillae, a pedunculated flap originating from the primary flap was turned within the interimplant space. BOPT one-time abutments have been employed to maximize the space available for the papilla-like tissues. A focused and combined surgical and prosthetic procedure has permitted enhancement of both peri-implant esthetics and function without the need for further invasive and costly bone regeneration techniques.

Esthetic Management of Compromised Ridge in the Anterior Maxilla, a Modified Prosthetic Approach

Replacing a missing tooth with an implant, especially in the esthetic zone has been increasing demand for the patient. Placing dental implants in the esthetic zone, especially in the compromised ridge with thin gingival thin biotype is considered to be the ultimate challenge for many dentists. This case report illustrates the implant placement in the traumatic anterior maxilla with thin gingival biotype (Class IV) and a modified approach in prosthetic placement.

Technique for soft tissue closure in surgeries for fixed implant-supported prostheses in the edentulous maxilla

A technique is presented that can be used as a straightforward, quick, and minimally invasive solution to improve soft tissue closure for surgeries involving bone reduction for fixed implant-supported prostheses in the edentulous maxilla.

Transplant vs implant in a patient with agenesis of both maxillary lateral incisors: A 9-year follow-up

INTRODUCTION

Agenesis of a maxillary lateral incisor occurs in about 2% of the population. Treatment options should adapt to natural biologic changes in a lifelong perspective.

METHODS AND RESULTS

A young woman with bilateral agenesis of the maxillary lateral incisors was treated with transplantation of a developing maxillary third molar on one side and a dental implant on the contralateral side, after orthodontic space opening. The periodontal examination, including bacterial testing of the transplant, the implant, and the control central incisor, was performed 9 years after the treatment. A radiologic assessment was also performed. The transplanted tooth did not differ from a natural incisor, except for the pulp obliteration, and the total bacteria count was higher at the implant site. The periodontal tissues around the implant showed progressive signs of recession.

CONCLUSIONS

Both tooth transplants and dental implants for replacing missing maxillary incisors can be effective in the long term. This report supports natural tooth substitution rather than implant placement for dental agenesis in the anterior maxilla.

Histological Features and Biocompatibility of Bone and Soft Tissue Substitutes in the Atrophic Alveolar Ridge Reconstruction

The reconstruction of the atrophic alveolar ridges for implant placement is today a common procedure in dentistry daily practice. The surgical reconstruction provides for the optimization of the supporting bone for the implants and a restoration of the amount of keratinized gingiva for esthetic and functional reasons. In the past, tissue regeneration has been performed with autogenous bone and free gingival or connective tissue grafts. Nowadays, bone substitutes and specific collagen matrix allow for a complete restoration of the atrophic ridge without invasive harvesting procedures. A maxillary reconstruction of an atrophic ridge by means of tissue substitutes and its histological features are then presented.

Concomitant Correction of a Soft-Tissue Fenestration with Keratinised Tissue Augmentation By Using A Rotated Double-Pedicle Flap During Second-Stage Implant Surgery- A Case Report

Soft tissue deficiencies and defects around dental implants have been observed frequently. Soft-tissue defects after implant procedures originate from the process of modelling of periimplant mucosa and often cause aesthetic disharmony, food debris accumulation and soft tissue shrinkage. Periimplant mucogingival surgery focuses on creating an optimum band of keratinized tissue resulting in soft tissue architecture similar to the gingiva around natural teeth. A 23-year-old male reported to the Department of Periodontology with a complaint of gum soreness, foul smell and food accumulation at a site where a 3.75 x 11.5mm implant was placed previously. On clinical examination, fenestration of tissue above the cover screw was observed and there appeared to be a keratinized tissue of 1mm surrounding the implant. The case was managed by use of a rotated double-pedicle flap during second-stage implant surgery to correct the soft-tissue fenestration defect and to obtain a keratinized periimplant soft tissue. A periosteal bed was prepared by giving a horizontal incision at the mucogingival junction to a depth of 4 mm. Two split-thickness keratinized pedicles were dissected from the mesial and distal interproximal tissues near the implant. After rotation, both the pedicles were sutured to each other mid-buccally and the pedicles were rigidly immobilized with sutures. At 1 month, there was a 3mm band of stable and firm keratinized tissue over the underlying tissues. The procedure resulted in an aesthetic improvement due to enhanced soft tissue architecture and optimum integration between the peri-implant soft tissue and the final prosthesis.

Adjunctive Orthodontic Applications in Dental Implantology

Implant placement is often necessitated for replacement of teeth with pathologically damaged alveolar bone due to periodontitis or traumatic injury. Surgical augmentation of resorbed bone has many limitations, including lower efficacy of vertical augmentation than horizontal augmentation, as well as morbidity associated with grafting procedure. Orthodontic therapy has been proposed as a useful method for augmenting the resorbed alveolar bone and reforming aesthetically appealing gingival margin, prior to implant placement. This narrative review summarizes the available evidence for the application of orthodontic strategies that can be used as adjunct in selected cases to augment bone volume for the future implant site and maintain space for the prosthetic parts of the implant. These are (1) orthodontic extrusion of compromised teeth to generate vertical bone volume and enhance gingival architecture, (2) tooth preservation and postponing orthodontic space opening to maintain bone volume in future implant site, (3) orthodontic implant site switching to eliminate the deficient bone volume or risky implant sites, and (4) the provision of a rigid fixed-bonded retainer to maintain the implant site. Although there are no randomized controlled clinical trials to evaluate the efficacy of orthodontic therapy for implant site development, clinical case reports and experience document the efficacy of orthodontic therapy for this application.

A Novel Method to Cover Metal Display in Implants Using a Modified Free Gingival Graft: A Case Report

INTRODUCTION

Correction of an esthetic failure in the anterior esthetic zone is difficult, especially after placement of the final restoration. This case report describes a novel technique to cover metal display with a graft that combines the advantages of the free gingival and the subepithelial connective tissue grafts.

CASE PRESENTATION

A patient presented to the author's private practice with marked metal display leading to compromised esthetics. To cover the metal display, it was decided to increase the amount of soft tissue surrounding the implant. A free gingival graft was obtained from the palate with two de-epithelialized extensions to ensure adequate blood supply and excellent color match. The graft was adapted to the recipient site, which included a previously prepared bed and two pouches. The pouches accommodated the de-epithelialized extensions. The clinical outcome exhibited superior results in both volume and quality of the gained soft tissue.

CONCLUSION

The technique described in this case report could be considered as a method to cover metal display in the esthetic zone to improve the volume and quality of the tissue.

Peri-Implant Plastic Surgical Approaches to Increasing Keratinized Mucosa Width: Which to Use and When?

The long-term efficacy of adequate keratinized mucosa (&gt;2 mm) in dental implants is controversial. Peri-implant plastic surgeries are currently used because they increase keratinized mucosa width (KMW), helping to regain peri-implant health and maintaining it over the long-term. We present the clinical findings using free-gingival-graft (FGG) and free-periosteal-graft (FPG) techniques in peri-implant plastic surgery for implant rehabilitation patients. We included 20 patients with implant indications of inadequate KMW (KMW &lt; 2 mm for postimplantation) in the maxilla and mandible. All underwent clinical and radiographic measurements and a treatment protocol was prepared for implant rehabilitation and subsequent peri-implant plastic surgery. A decision as to whether and when FGG or FPG techniques would be used was made. FGG/FPG was performed pre-implantation (before monocortical block-bone augmentation) or postimplantation (before/during/after stage 2 surgery). KMW was ≥ 2 mm after application of FGG/FPG pre- or post-implantation. Moreover, peri-implant tissue health was regained/maintained in all cases from 6 months to 4 years. Peri-implant plastic surgery techniques can prevent hard- and soft-tissue problems after implant rehabilitation and during treatment of developing problems. However, surgical design and timing, and an interdisciplinary perspective determine the success of peri-implant plastic surgery.

Use of porous space maintainers in staged mandibular reconstruction

The success of mandibular reconstructions depends not only on restoring the form and function of lost bone but also on the preservation of the overlying soft tissue layer. In this case study, 5 porous polymethylmethacrylate space maintainers fabricated via patient-specific molds were implanted initially to maintain the vitality of the overlying oral mucosa during staged mandibular reconstructions. Three of the 5 patients healed well; the other 2 patients developed dehiscences, likely due to a thin layer of soft tissue overlying the implant. The results presented provide evidence that a larger investigation of space maintainers fabricated using this method is warranted.

Combined soft and hard tissue peri-implant plastic surgery techniques to enhance implant rehabilitation: a case report

This case report presents an implant-aided prosthetic treatment in which peri-implant plastic surgery techniques were applied in combination to satisfactorily attain functional aesthetic expectations. Peri-implant plastic surgery enables the successful reconstruction and restoration of the balance between soft and hard tissues and allows the option of implant-aided fixed prosthetic rehabilitation.

Creeping attachment involving dental implants: two case reports with a two-year follow-up from an ongoing clinical study

Introduction. This paper describes case reports where coronal growth of soft tissue on implant threads was observed after surgery for soft tissue graft. This phenomenon is known as “creeping attachment.” Methods. Two patients were submitted to gingival graft procedure including subepithelial connective tissue graft and masticatory mucosal graft. A two-year follow-up appointment was performed. Results. After a two-year follow-up gingival growth over titanium surfaces characterizing the “creeping attachment” phenomenon was observed. This gingival growth happened over abutment and threads surfaces. Conclusion. The creeping attachment phenomenon is possible over titanium surfaces and has not yet been reported in the relevant literature over this kind of structure.

Modified ridge splitting and bone expansion osteotomy for placement of dental implant in esthetic zone

Ridge splitting with bone expansion is a technique of manipulation of bone to form receptor site for implant without removing any bone from the implant site. Maxillary bone has inherent quality of flexibility which can bemolded to desire location by using series of instrument namely chisels and osteotome. This further improves quality of bone all around implant, at the crest and apex both. This article describes a report of a clinical case with management of bucco-palatal ridge defect with modified ridge splitting and expansion osteotomy technique using chisel and osteotomes in an esthetic zone.

Peri-implant esthetics assessment and management

Providing an esthetic restoration in the anterior region of the mouth has been the basis of peri-implant esthetics. To achieve optimal esthetics, in implant supported restorations, various patient and tooth related factors have to be taken into consideration. Peri-implant plastic surgery has been adopted to improve the soft tissue and hard tissue profiles, during and after implant placement. The various factors and the procedures related to enhancement of peri-implant esthetics have been discussed in this review article.

Soft tissue considerations in implant site development

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

The effect of platelet-rich plasma on healing of palatal donor site following connective tissue harvesting: a pilot study in dogs

BACKGROUND

Peri-implant plastic surgery includes soft tissue enhancement by connective tissue grafting. The palatal donor site provides peri-implant keratinized mucosa and soft tissue height. Platelet-rich plasma (PRP) contains growth factors that may enhance early healing.

PURPOSE

The present animal study investigated the effect of PRP on wound healing of palatal donor site after connective tissue harvesting.

MATERIALS AND METHODS

In 12 mongrel dogs, bilateral palatal connective tissues of 10 × 15 mm were harvested. At test site, PRP was applied into the wound, and the contralateral site served as control. The healing was evaluated clinically and histologically at 1 week, 2 weeks, and 4 weeks after surgeries. Exact binomial probability and Wilcoxon signed-rank test were used to compare the clinical and histologic measurements.

RESULTS

No statistically significant differences between PRP and control sites were measured with regard to clinical healing (p = 1.000) and histologic variables, including inflammatory cells (p = .750), collagen fibers (p = .375), and granulation tissue (p = .500) at any time interval.

CONCLUSION

The addition of PRP to palatal mucosal wound sites did not accelerate wound healing.

Minimally invasive treatment for papillae deficiencies in the esthetic zone: a pilot study

BACKGROUND

The presence of papillary deficiencies adjacent to dental implants or teeth presents an esthetic concern for the dental team and patients.

PURPOSE

The aim of this pilot project is to evaluate a new method for reducing or eliminating small papillary deficiencies. The use of a commercially available gel was evaluated as a possible method for enhancing deficient papillae.

MATERIALS AND METHODS

Eleven patients, seven females and four males, with an average age of 55.8 years (ranging from 25 to 75 years) with 14 treated sites are included in this pilot study. Patients had a minimum of one papillary deficiency in the esthetic zone. Prior to treatment photographs were either taken at a 1:1 ratio or converted to a 1:1 ratio using a commercially available program. A standardization photographic device was not used. After administration of a local anesthetic, a 23-gauge needle was used to inject less than 0.2 mL of a commercially available and Food and Drug Administration-approved gel of hyaluronic acid 2-3 mm apical to the coronal tip of the involved papillae. Patients were seen every three weeks and treatment was repeated up to three times. Patients were followed from 6 to 25 months after initial gel application. A computer program measured changes in pixels between initial and final treatments. A formula was derived to determine percentage change in the negative space between initial and final examinations.

RESULTS

Each site was individually evaluated. Three implant sites and one site adjacent to a tooth had 100% improvement between treatment examinations. Seven sites improved from 94 to 97%, three sites improved from 76 to 88%, and one site adjacent to an implant had 57% improvement.

CONCLUSION

Results from this pilot study are encouraging and present evidence that small papillary deficiencies between implants and teeth can be enhanced by injection of a hyaluronic gel. Improvements were maintained for a range of 6 to 25 months.