Introduction to Amniotic Membranes in Maxillofacial Surgery-A Scoping Review

Background: Amniotic membrane (AM) holds significant promise in various medical fields due to its unique properties and minimal ethical concerns. This study aims to explore the diverse applications of the human amniotic membrane (HAM) in maxillofacial surgery. Methodology: A comprehensive search was conducted on databases, namely Google Scholar, PubMed, and Scopus, from January 1985 to March 2024. Articles in English, Polish, and Spanish were included, focusing on keywords related to amniotic membrane and oral surgery. Results: Various preservation methods for HAM were identified, namely fresh, decellularized, cryopreserved, lyophilized, and air-dried formats. Clinical studies demonstrated the efficacy of HAM in repairing oral mucosal defects, vestibuloplasty, oronasal fistula closure, cleft palate treatment, bone defect repair, and medication-related osteonecrosis of the jaw (MRONJ). Surgeon evaluations highlighted the ease of handling but noted challenges in suturing and stability during application. Conclusions: Amniotic membranes offer a versatile and effective option in maxillofacial surgery, promoting wound healing, reducing inflammation, and providing a scaffold for tissue regeneration. Further research, including randomized trials and comparative studies, is warranted to validate the efficacy and optimize the utilization of HAM in clinical practice.

Electrophoretically Co-Deposited Collagen-Lactoferrin Membranes with Enhanced Pro-Regenerative Properties for Oral Soft Tissue Regeneration

The quality of soft tissue defect regeneration after dental surgeries largely determines their final success. Collagen membranes have been proposed for the healing of such defects, but in some cases, they do not guarantee a sufficient volume of the regenerated tissue and vascularization. For this purpose, lactoferrin, a protein with natural pro-regenerative, anti-inflammatory, and pro-angiogenic activity, can be added to collagen. In this article, we used a semipermeable barrier-assisted electrophoretic deposition (SBA-EPD) method for the production of collagen-lactoferrin membranes. The membrane structure was studied by SEM, and its mechanical properties were shown. The lactoferrin release kinetics were shown by ELISA within 75 h. When tested in vitro, we demonstrated that the collagen-lactoferrin membranes significantly increased the proliferation of keratinocytes (HaCaT) and fibroblasts (977hTERT) compared to blank collagen membranes. In vivo, on the vestibuloplasty and free gingival graft harvesting models, we showed that collagen-lactoferrin membranes decreased the wound inflammation and increased the healing rates and regeneration quality. In some parameters, collagen-lactoferrin membranes outperformed not only blank collagen membranes, but also the commercial membrane Mucograft®. Thus, we proved that collagen-lactoferrin membranes produced by the SBA-EPD method may be a valuable alternative to commercially used membranes for soft tissue regeneration in the oral cavity.

Technical Note on Simplified Free Gingival Graft Using Tack Fixation (sFGG)

Free gingival graft (FGG) is the gold standard procedure for the reliable augmentation of lost keratinized mucosa (KM) around dental implants. This conventional surgical approach has its drawbacks, including limitations in manipulation, the requirement for suturing, postoperative discomfort, and pain. This case report aimed to evaluate the efficacy of a simplified free gingival graft (sFGG) in addressing the issue of inadequate keratinized mucosa around dental implants. Fixation tacks were used to perform the sFGG procedure. Initially, a partial-thickness flap was created and apically repositioned. The gingival graft was harvested from the palate with a narrow profile and securely affixed to the recipient site using 5 mm long fixation tacks. Significant gains in keratinized mucosa were achieved and successfully maintained within 1 year. Consequently, the sFGG technique emerges as a simple and reliable treatment approach for managing inadequate keratinized mucosa around dental implants.

Technical Note on Vestibuloplasty around Dental Implants Using Erbium YAG Laser-Assisted Periosteal Fenestration (LA-PF)

Various vestibuloplasty techniques have been reported to increase the attached mucosa (AM) and vestibular depth around dental implants. However, these surgical methods have disadvantages, such as limitations in manipulation, necessity of suturing, postoperative discomfort, swelling, and pain. This study aimed to evaluate the efficacy of laser-assisted periosteal fenestration (LA-PF) in treating patients with a shallow vestibule and insufficient AM around dental implants. LA-PF was performed using an Erbium YAG laser (Er:YAG laser). First, a partial-thickness, apically positioned flap was used. A horizontal periosteal fenestration was performed using an Er:YAG laser to expose the bones. Periosteal suturing was not required. After 12 months, sufficient AM and deep vestibules were obtained and maintained. Thus, the LA-PF technique may be a simple and predictable treatment modality for shallow vestibules with insufficient AM around dental implants.

Formation and stability of mucogingival junction on teeth without clinically detectable mucogingival junction secondary to vestibular extension procedure done for multiple adjacent teeth: A clinical study

Context

There are very limited data on the postsurgical formation of a mucogingival junction (MGJ) on teeth without its clinical detectability.

Aims

The purpose of this study was to assess the formation and stability of MGJ on teeth without clinically detectable MGJ secondary to vestibular extension procedures for multiple adjacent teeth evaluated 6 months postoperatively.

Settings and Design

This prospective interventional single-arm clinical study was conducted in the department of Periodontology, which was approved by the institutional ethical committee, MUHS, Nashik, and registered with the Clinical Trial Registry of India.

Materials and Methods

This trial included 22 participants aged between 18 and 50 years of either gender, including teeth without clinically detectable MGJ along with adjacent teeth having detectable MGJs. The following clinical parameters were taken at baseline, presurgical, immediate postsurgical, 1-month and 6-month follow-ups: plaque index, gingival index, and position of MGJ. gingival margin level, probing depth, width of keratinized gingiva, width of attached gingiva, clinical attachment level, and vestibular depth.

Statistical Analysis Used

Descriptive statistics included mean, median, mode, etc., and the inferential statistics done were analysis of variance along with post hoc Tukey and independent sample tests.

Results

Apical shift of MGJ was observed from baseline to 6 months secondary to split-full-split repositioning MGJ with vestibular extension procedure, which was statistically significant (P < 0.05). The formation of MGJ was delineated by clinical and biochemical methods at sites with nondetectable MGJ. The coronal migration of MGJ at 6 months as compared to 1 month was not statistically significant (P > 0.05). The MGJ remained stable at 6 months postoperatively at detectable and nondetectable sites.

Conclusion

Within the limitations of this study, we can conclude that there is a definite formation of MGJ in participants without clinically detectable MGJ treated with "split-full-split MGJ-repositioning vestibular extension procedure." The MGJ, which formed apically at a 1-month postsurgical visit compared to the presurgical position, remained stable for 6 months to 1-year follow-up period at both detectable and nondetectable sites.

The use of platelet-rich fibrin in vestibuloplasty: A 36-month follow-up technique report

INTRODUCTION

Vestibuloplasty is a mucogingival procedure that aims to increase the vestibule and the amount of keratinized tissue (KT) around teeth and dental implants. Currently, the gold standard in this procedure is still represented by free gingival grafts (FGGs); however, they require a second surgical site, which means more morbidity for the patient and a higher risk of surgical complications, as well as surgical time and chromatic alteration of the recipient area.

CASE PRESENTATION

This is a description of the vestibuloplasty technique with platelet-rich fibrin (PRF) in a 35-year-old female patient with a thin gingival phenotype and no medical history of interest. The reason for consultation was tooth sensitivity during brushing and the presence of recessions in the fifth sextant.

CONCLUSIONS

The use of PRF as a graft biomaterial in vestibuloplasty is a valid and effective option as an alternative to secondary epithelialization of the surgical site, as well as to FGGs, with acceptable results in terms of KT gain and root coverage, and with minimal postoperative discomfort.

KEY POINTS

Why is this case new information? The use of PRF is an interesting option as an alternative to second-intention healing, as FGGs in vestibuloplasty. What are the keys to successful management of this case? The most important part of the membranes is the part that was in close relation to the erythrocyte fraction in the blood collection tube, so this part must be oriented toward the recipient bed. A minimum of four membranes should be obtained, overlapping one on top of the other. What are the primary limitations to success in this case? The stability of the PRF.

[Assessment of microhaemodynamics and oxygenation in tissues after the vestibuloplasty with the use of a free dermal autograft in patients after the reconstructive jaw surgery with the use of the revascularized autografts]

Purpose of the study: to study the features of microhaemodynamics and oxygenation in soft tissues in the area of the plastically reconstructed jaw after the vestibuloplasty.

MATERIALS AND METHODS

The study included 40 patients aged 20 to 65 (21 males and 19 females). The patients were divided into two groups: I group (14 patients) - patients after reconstructive surgery with the use a fibula autograft without the inclusion of a musculocutaneous «islet»; II group (26 patients) - patients after reconstructive surgery with the use a fibula autograft with the inclusion of a musculocutaneous «islet». To correct the prosthetic bed soft tissues, all patients underwent vestibuloplasty with the use of a free dermal autograft. To study microcirculation in tissues, the laser Doppler flowmetry (LDF) method was used. Microcirculation status was assessed by microcirculation index characterizing the level of tissue blood flow; parameter «σ,» which determines the oscillability of the flow of red blood cells and by coefficient of variation, characterizing vasomotor activity of microvessels. According to the Wavelet analysis of LDF-grams the blood flow bypass was determined. An oxygenation study was carried out in the tissues of the plastically restored jaw by optical tissue oximetry, the results of which determined the oxygenation index and the specific oxygen consumption index.

RESULTS

According to LDF data after vestibuloplasty, it was found that in I group, the microcirculation in soft tissues of the plastically reconstructed jaw restored in 21 days, and in II group in 2 months, which persisted at 6 months. In I group, the level of oxygenation and specific oxygen consumption normalized in 21 days, and in II group in 2 months, which persisted at 6 months.

CONCLUSION

Based on the results of this functional study, it was found that before vestibuloplasty microcirculation and oxygenation indices in II group patients were lower than those in I group patients. After vestibuloplasty with the use of a free dermal autograft, microcirculation indices in II group patients restored in 2 months, while in I group patients those indices restored in 21 days.

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.

[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.

An innovative technique to treat epulis fissuratum: A case report

The purpose of this article is to present a case demonstrating the treatment of epulis fissuratum due to a poorly adapted prosthesis using a single surgical procedure involving conventional excision and free gingival graft. We, herein, present a case involving a 58-year-old patient with epulis fissuratum. Treatment of this case was essential due to the masticatory problems. This technique can be effective to deepen the height of the residual alveolar ridge and to increase the amount of keratinized tissue.

Comparison of Vestibular Depth Relapse and Wound Healing After Reconstructive Preprosthetic Surgery Using Cryopreserved Amniotic Membrane and Acellular Dermal Matrix - A Comparative Study

Introduction:

The significance of membranes as wound dressing in oral surgeries has been reported by previous studies. The aim of the present split-mouth randomized clinical study was to assess and compare the wound dressing properties of acellular dermal matrix (ADM) and cryopreserved human amniotic membrane (AM) after reconstructive preprosthetic oral surgery.

Materials and Methods:

Twenty-eight patients with complete mandibular edentulism and resorbed alveolar bone were included. After taking mandibular impression, a clear acrylic splint with increased labial flange height was created. In each participant, labial vestibular depth was elevated using the Clark's technique. Subsequently, half of the exposed periosteum was covered with ADM while the other half was covered with cryopreserved human AM. Vestibule depth and relapse in the two sides were measured immediately after vestibuloplasty and at the end of the 1^st week, 2^nd week, 1^st month, and 3^rd months with graduations of 0.1 mm. Furthermore, after 3 and 7 days, samples were collected from graft material, and the macrophage population was analyzed by flow cytometry.

Results:

There was no significant difference in the relapse of vestibule depth between the two grafts at different time intervals. However, the frequency of wound-infiltrating macrophages (CD68⁺ cells) was significantly higher in areas covered by ADM after 3 and 7 days.

Discussion:

ADM is as effective as cryopreserved AM in terms of maintaining the postoperative vestibular depth. On the other hand, our results suggested that the onset of healing phase in ADM-covered areas occurs faster compared to the periosteum covered with cryopreserved human AM. This clinical trial showed significantly faster postoperative healing onset when ADM was used than when cryopreserved human AM was applied on the periosteum.

Periodontal condition of mandibular incisors treated with modified Kazanjian vestibuloplasty compared to untreated sites: A prospective study

BACKGROUND

A shallow vestibule, insufficient keratinized tissue width and pulling of marginal gingiva may be associated with gingival recession, plaque accumulation and gingivitis. Conventional techniques for treatment of gingival recession use autogenous or allogenic grafts. However, these methods result in soreness at the donor site and pose an economic burden, which may cause patients to withdraw from treatment. Alternative therapy is currently not available to treat such patients.

OBJECTIVES

The aim of this study was to evaluate changes in periodontal tissue at the mandibular incisors after vestibuloplasty, focusing on functional improvement of the existing soft tissue with no grafting.

MATERIAL AND METHODS

Thirty patients with a shallow vestibule, minimal keratinized tissue width (KTW; ≤1 mm), gingival recession (REC) and pulling of gingiva underwent modified Kazanjian vestibuloplasty were included into the test group, whereas 27 patients did not undergo any surgery (control group). The probing pocket depth (PPD), clinical attachment level (CAL), gingival recession depth (GRD), and KTW were assessed at baseline and 12 months post-surgery.

RESULTS

The mean KTW, GRD and CAL values improved in the test group. A significant increase in mean KTW value (1.17 ±1.22 mm, p = 0.0406) was detected in the test group, while the control group showed a further reduction in mean KTW value (0.13 ±0.45 mm). The mean GRD value decreased from 2.09 ±1.78 mm to 1.22 ±1.46 mm (p = 0.0087) in the test group, whereas in controls the mean GRD value increased from 1.95 ±1.29 mm to 2.34 ±1.44 mm (p = 0.0164). The mean KTW value at 3, 6 and 12 months compared to baseline showed an increase in the test group, and the mean GRD and CAL values exhibited the potential to improve.

CONCLUSIONS

Sites treated with vestibuloplasty showed increased KTW, improvement in the gingival margin and CAL gain, whereas untreated sites showed continuous deterioration of the evaluated parameters. Vestibuloplasty may be recommended for patients avoiding major surgery for which functional improvement in tissue alone would provide a sufficient therapeutic outcome.

The versatile "lip switch" or transitional flap vestibuloplasty combined with alveoloplasty and implant placement to treat atrophic mandibles with inadequate vestibules and attached tissue: A case series and review of the literature

INTRODUCTION/AIMS

The edentulous mandibular ridge and associated shallow vestibule are often seen as a challenge in the oral rehabilitation of patients. Dental implants can provide an improvement in mastication and patient satisfaction. The aim of this study is to utilize a preprosthetic mucosal flap combined with a repositional periosteal flap concomitant with an alveoloplasty and placement of endosteal implants as a single-stage procedure in the anterior mandible. This approach provides a valued alternative for dental rehabilitation in patients with poor masticatory efficiency using a conventional denture.

METHODS

Eight patients underwent the preprosthetic surgical plan in the oral surgery clinic of the dental school during a 1-year period. Age, sex, preoperative, and postoperative vestibular depth, as well as hard and soft tissue elements were measured (P < .05) at 4-6 months.

RESULTS

Mean age was 53 years ± 14.62 (N = 8). Anterior mandible height was 19 ± 4.8 mm. A significant difference was measured using a two-tailed Student's t-test between pre- and postoperative vestibular depths, respectively (3.9 mm vs 10.5 ± 0.96 mm; P < .01).

CONCLUSIONS

A lip switch vestibuloplasty combined with placement of two implants provide a one-stage procedure that is convenient, provides a shorter postoperative period, and can be financially affordable. Future research requires larger sampling to support this treatment as a standard of care.

Vestibuloplasty following denture hyperplasia resection with diode laser

Denture hyperplasia is a common clinical finding in patients wearing dentures. In this case report, a patient who was treated for denture hyperplasia presented with a post operative complication which led to inadequate vestibular depth. Inadequate vestibule is a common challenge dental surgeons encounter while considering fixed or removable prosthesis and implants. Objective is to achieve acceptable retention and aesthetics for the prosthesis by increasing the vestibular depth and also to manage the complication encountered during the resection procedure. Several techniques have been employed to increase the vestibular depth and the width of attached gingiva in the literature. In this case the denture hypereplasia was resected using diode laser which resulted in bone necrosis and opening of the wound post surgically. This was managed with curettage and PRF application. Following this the patient presented with inadequate vestibular depth. Vestibuloplasty was performed with Diode laser to deepen the vestibular depth and augment keratinized tissue to facilitate prosthetic rehabilitation. Three months following vestibuloplasy, patient presented with adequate vestibule. At six months follow up there was sufficient keratinized tissue to facilitate prosthetic rehabilitation. This case presents a unique way of managing a complication encountered after denture hyperplasia resection followed by vestibuloplasty with diode laser. The results obtained were clinically acceptable. PRF provides excellent results when used for the management of surgical complications like wound exposure. Laser technique is optimal for the treatment of soft tissue defects and is proven to be ideal for vestibuloplasty.

A Modified Technique of Tacking Acellular Dermal Matrix to Increase Keratinized Mucosa Around Dental Implants as an Alternative to a Free Gingival Graft: A Case Report

INTRODUCTION

Free autogenous graft was the gold standard to increase the keratinized mucosa (KM) and vestibular depth. The major downfall of this technique is the postoperative morbidity at the donor site. The purpose of this case report is to demonstrate a modified technique using acellular dermal matrix (ADM) to increase the KM around implants to achieve faster healing with less postoperative morbidity.

CASE PRESENTATION

Patient presented with inadequate keratinized tissue band and shallow vestibule at submerged implant sites bilaterally. Initially, surgical procedure of vestibuloplasty in conjunction with free gingival graft (FGG) was performed at one side. However, patient opted for the allograft as a substitute for the other side due to the postoperative discomfort from palatal donor site. On the left side, the FGG procedure was performed in a conventional way stabilizing with sutures. On the right side, the ADM was stabilized with tacks only at recipient site and left exposed. The new vestibule was established and stabilized with tacks.  A significant gain of KM and vestibule depth was observed at the site of using ADM when compared with baseline. For the site of using FGG, KM was increased. However, the vestibule was rebounded compared with the site of using ADM with tacks.

CONCLUSIONS

The use of ADM stabilized with tacks is a predictable procedure that can increase KM and establish stable vestibule around dental implants. It can lead to less chair time, faster healing, and reduced postoperative morbidity compared with autogenous soft tissue graft.

Comparative analysis of methods to increase the amount of keratinized mucosa before stage-two surgery: a randomized controlled study

OBJECTIVES

The aim of the present randomized controlled clinical trial was to evaluate the outcomes of the use of free gingival graft (FGG), of a collagen matrix and of vestibuloplasty to increase the amount of keratinized attached mucosa (KM) before healing abutment placement.

METHOD AND MATERIALS

The study was a randomized, parallel-group controlled investigation. All patients were treated to increase the KM width before placement of implant-supported prostheses. The implants were placed 3 to 6 months before the interventions. Three techniques were tested: an apically positioned flap (control group), FGG (test group 1), and use of a collagen matrix (test group 2). Biopsy was performed during healing abutment placement by means of a mucotome.

RESULTS

A total of 63 patients were recruited and treated, and 58 were available for follow-up visits. After 4 weeks, the KM width gain was 1.93 ± 0.85 mm, 4.85 ± 1.11 mm, and 3.03 ± 0.58 mm, respectively, for control group, test group 1, and test group 2. Postoperative pain was significantly higher in the FGG group than in the others. Edema and hyperemia decreased gradually during the first week without significant differences among groups.

CONCLUSION

Despite the limitations of the study, it was found that FGG was the most effective technique to augment the amount of KM in sites of implant placement. The use of a collagen matrix could be a viable alternative to diminish the intervention's impact on patients' postoperative quality of life.

Laser Vestibuloplasty for Peri-implant Gingiva Implementation in the Atrophic Mandible of a Medically Compromised Patient

Despite the good clinical outcomes of the conventional technique of vestibulopasty performed with a scalpel, patients frequently perceive pain and discomfort after surgery. Diode laser use in oral surgery is, instead, well tolerated as it is mini-invasive and with a very low occurrence of post-surgical complications. In addition, the lack of bleeding during surgery and the reduced/absent post-surgical edema makes diode laser surgery the most suitable for medically compromised patients. We report a case of vestibuloplasty performed by diode laser in a patient on therapy with warfarin and without drug discontinuation.

An alternative approach for vestibular extension using temporary coverage of epithelialized palatal grafts

An alternative approach was used to increase the buccal vestibular depth of two edentulous patients, using free epithelialized palatal grafts. Two edentulous patients presented with shallow vestibules and inadequate keratinized tissue width in the mandibular anterior region. These sites were treated with vestibuloplasty followed by placement of an epithelialized palatal graft. In order to minimize graft movement and possible mechanical trauma to the area, the graft was covered with the buccal flap during the initial stages of healing. The patients maintained an increase in the vestibular depth as well as the keratinized tissue width at 14 months and 5 years postoperatively. Successful outcomes in terms of increase in vestibular depth can be achieved with the use of epithelialized palatal graft that is covered during the initial stage of healing. The dental practitioner fabricating the complete denture should be aware of the advantages offered by this alternative surgical technique.

Blood flow kinetics of a xenogeneic collagen matrix following a vestibuloplasty procedure in the human gingiva-An explorative study

OBJECTIVES

The aim of the present study was to investigate temporal and spatial blood flow patterns following vestibuloplasty procedures using a collagen matrix (CM) to get an insight into the timing and direction of neovascularization in the CM.

METHODS

Five patients were treated using a modified apically repositioned flap combined with a CM. Intraoral photographs and blood flow measurements by laser speckle contrast imaging were taken for 12 months. Thirty regions of interest in the graft and the surrounding mucosa were evaluated. The clinical parameters were assessed after 6 and 12 months. VEGF expression was analyzed in the wound fluid on days 2 and 4.

RESULTS

At 6 months, the mean width of keratinized gingiva increased, but the thickness was unchanged. Scar formation was observed in all cases. Perfusion in the graft began to increase at the lateral and coronal edges and then spread concentrically toward the center. The apical side showed a significant delay in perfusion, the highest VEGF expression, and wound fluid production as well as the most abundant scar formation.

CONCLUSIONS

Neovascularization occurs mainly from the lateral and coronal edges, which may limit the extent of the surgical area. Abundant scar formation may be explained by increased VEGF expression induced by prolonged ischemia in this area.

Dental Rehabilitation for Free Fibula Flap-Reconstructed Mandible with Scar Contracture: A Technical Note

Dental rehabilitation with osseointegrated implants in reconstructed mandibles is a common procedure, but the technique still requires improvement, especially in its reliability and technical simplification. We herein report dental rehabilitation of a free fibula-reconstructed mandible with scar contracture. A vestibuloplasty technique with application of a polyglycolic acid (PGA) sheet is described. The implants were inserted into a viable fibula flap with severe scar contracture of the overlying epithelium resulting from vascular instability in skin paddle. Only the fibula periosteum was sutured after implant insertion; exposed surfaces were covered with a combination of PGA sheet and fibrin sealant. The area with PGA sheet coverage gradually healed with moderate contracture. The epithelium around the almost implants became immobilized. The implant-supported removable partial denture with custom titanium bar was acceptable. Dental rehabilitation is possible for reconstructed mandibles with severe scar contracture. Application of a PGA sheet may be useful for vestibuloplasty in patients with reconstructed mandibles.

Management of Shallow Vestibule with Reduced Attached Gingiva in Fixed Prosthetic Intervention

Shallow vestibule has long been considered a deterring factor in the use of removable dental prosthetics. The need for management in fixed prosthetic replacement is not widely discussed. Adequate attached gingiva is essential for continued proper oral hygiene. Muscular and fibrous traction leads to gingival recession, which can cause marginal leakage in a fixed prosthetic restoration. In the long-term, this causes the suprastructure to fail and, ultimately, the restoration also fails. Therefore, shallow vestibule with reduced attached gingiva should be identified in the diagnostic stage and should be effectively managed prior to restoration of lost tooth structure. This case report discusses the management of a shallow vestibule in a LeFort I fracture with emphasis on a fixed prosthetic replacement.

Natural teeth-retained splint based on a patient-specific 3D-printed mandible used for implant surgery and vestibuloplasty: A case report

RATIONALE

With respect to improving the quality of oral rehabilitation, the management of keratinized mucosa is as important as bone condition for implant success. To enhance this management, a natural teeth-retained splint based on a patient-specific 3-dimensional (3D) printed mandible was used in vestibuloplasty to provide sufficient keratinized mucosa around dental implants to support long-term implant maintenance.

PATIENT CONCERNS

A 28-year-old male patient had a fracture of the anterior andible 1 year ago, and the fracture was treated with titanium.

DIAGNOSES

The patient had lost mandibular incisors on both the sides and had a shallow vestibule and little keratinized mucosa.

INTERVENTIONS

In the first-stage implant surgery, 2 implants were inserted and the titanium fracture fixation plates and screws were removed at the same time. During second-stage implant surgery, vestibuloplasty was performed, and the natural teeth-retained splint was applied. The splint was made based upon a patient-specific 3D-printed mandible. At 30-day follow-up, the splint was modified and reset. The modified splint was removed after an additional 60 days, and the patient received prosthetic treatment.

OUTCOMES

After prosthetic treatment, successful oral rehabilitation was achieved. Within 1 year and 3 years after implant prosthesis finished, the patient exhibited a good quantity of keratinized gingiva.

LESSONS SUBSECTIONS

The proposed splint is a simple and time-effective technique for correcting soft tissue defects in implant dentistry that ensures a good quantity of keratinized mucosa.

Dental management and orofacial manifestations of a patient with Robinow Syndrome

Robinow syndrome (RS) is an extremely rare condition. Characteristic craniofacial findings of RS include a fetal facial appearance, ear abnormalities and oral findings. The aim of this case report was to evaluate the oral findings of a 26-year-old man with RS and to describe the dental treatments performed. The patient had short stature, vertebral anomalies, short and broad fingers, a fetal facial appearance, gingival hyperplasia, fissured tongue, caries and multiple impacted teeth. Periodontal and restorative dental treatments were performed under aseptic conditions with due precautions. No surgical treatment was performed to the impacted teeth because of the lack of symptoms.

Effect of Carbon Dioxide Laser on Increasing Vestibular Depth in Cleft Lip and Palate Patients

BACKGROUND

Shallow upper buccal sulcus deformity in cleft lip and palate patients is one of the common secondary deformities after primary cleft lip and palate repair; this deformity may prevent or complicate orthodontic and prosthodontic procedures causing aesthetic and functional problems. A number of methods are described to increase the anterior maxillary sulcus in these patients.

PURPOSE

This study assessed the use of a carbon dioxide laser (CO₂) to increase the sulcus depth.

METHOD

Fifteen patients with cleft lip and palate (eight unilateral and seven bilateral) were studied. The surgical procedure was performed using CO₂ laser. The vestibular depth and lip length were measured at three time points namely before surgery (T0), 1 week following surgery (T1), and 4 months following surgery (T2). After data collection, statistical analyses were done using PASW^® version 18 SPSS.

RESULTS

The mean values of vestibular depth were 9.46 ± 1.92, 13.83 ± 1.88, and 13.23 ± 1.76 mm for T0, T1, and T2, respectively. The vestibular depth significantly increased after 4 months of follow-up (p = 0.001). The mean amount of vestibular depth gain was not significantly different in unilateral and bilateral cleft groups (p = 0.908). The mean value of upper lip length increased by a mean of 1.23 mm and was statistically significant (p = 0.001).

CONCLUSIONS

Upper buccal sulcus reconstruction with CO₂ laser provides successful and stable results. CO₂ laser application is suggested as an alternative to conventional vestibuloplasty.

A noble method of using intravenous infusion set as a stent in localized lower posterior vestibuloplasty: A technical note

Vestibuloplasty is the procedure for shallow vestibule, prior to the prosthesis. Usually, vestibuloplasty is carried out in patients with completely edentulous arches. There are multiple techniques of vestibuloplasty described in the review of literature. However, it has not been emphasized on isolated shallow vestibule. This article describes our experience in the isolated or localized vestibuloplasty for a partially edentulous individual with a shallow vestibule pertaining to a single missing tooth.

Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft® ) versus the free gingival graft: a comparative prospective clinical trial

OBJECTIVES

Porcine collagen matrices are proclaimed being a sufficient alternative to autologous free gingival grafts (FGG) in terms of augmenting the keratinized mucosa. The collagen matrix Mucograft^® (CM) already showed a comparable clinical performance in the early healing phase, similar histological appearance, and even a more natural appearance of augmented regions. Predictability for long-term stability does not yet exist due to missing studies reporting of a follow-up >6 months.

MATERIAL AND METHODS

The study included 48 patients with atrophic edentulous or partially edentulous lower jaw situations that had undergone an implant treatment. In the context of implant exposure, a vestibuloplasty was either performed with two FGGs from the palate (n = 21 patients) or with the CM (n = 27 patients). Surgery time was recorded from the first incision to the last suture. Follow-up examinations were performed at the following time points: 10, 30, 90, and 180 days and 1, 2, 3, 4, and 5 years after surgery. The width of keratinized mucosa was measured at the buccal aspect of each implant, and augmented sites were evaluated in terms of their clinical appearances (texture and color).

RESULTS

The groups showed similar healing with increased peri-implant keratinized mucosa after surgery (FGG: 13.06 mm ± 2.26 mm and CM: 12.96 mm ± 2.86 mm). The maximum follow-up was 5 years (5 patients per group). After 180 days, the width of keratinized mucosa had decreased to 67.08 ± 13.85% in the FGG group and 58.88 ± 14.62% in the CM group with no statistically significant difference. The total loss of the width of keratinized mucosa after 5 years was significant between the FGG (40.65%) and the CM group (52.89%). The CM group had significantly shorter operation times than the FGG group. Augmented soft tissues had a comparable clinical appearance to adjacent native gingiva in the CM group. FGGs could still be defined after 5 years.

CONCLUSIONS

The FGG and the CM are both suitable for the regeneration of the peri-implant keratinized mucosa with a sufficient long-term stability. With the CM, tissue harvesting procedures are invalid, surgery time can be reduced, and regenerated tissues have a more esthetic appearance.

Thermoplastic vestibuloplasty: a novel technique for treatment of lip and cheek adhesion

Lip and cheek adhesion to the opposing alveolus with complete or partial loss of the vestibular dimension represents a challenging problem for reconstruction. It usually occurs due to primary inadequate vestibular soft tissue repair following complicated trauma cases, burns, and lesions of the oral cavity. Surgical removal of scar tissue and creation of new vestibule is complicated by readhesion between the opposing connective tissue surfaces. Skin grafts and acellular dermal matrix represent the most dominant modalities used to treat deficient vestibule dimensions, but they are difficult to fix and lack the required stability during healing. Several devices have been created in an attempt to keep the tissues apart but their complex anchorage methods seriously reduced their reliability and usage. We devised a simple and reliable technique "thermoplastic vestibuloplasty" (TV) that benefit from the inherent reepithelialization capabilities of the oral mucosa to prevent readhesion and to resurface the created vestibule with its exact tissue color and texture. In total, 10 patients suffering from complete or partial lip or cheek adhesion with concomitant loss of vestibule were surgically treated by excising scar tissue and creating a new vestibule, followed by TV technique. Pre and posttreatment results were compared in terms of vestibular length, lip or cheek mobility, and change by time in vestibular length from 2 weeks up to 3 months. Moreover, the patient satisfaction and outcomes were measured using visual analogue scale score. All patients tolerated the procedure without complication. The mean vestibule length and mobility significantly increased from 3.8 + 0.6 mm to 11.4 + 1.4 mm (p < 0.001) and from 0.3 to 2 (p < 0.001), respectively. Regarding the stability of the achieved vestibular length it decreased by 14% when compared from 2 weeks to 3 months postoperatively. TV technique is a new simple and reliable technique that can effectively prevent readhesion of opposing connective tissue surfaces until intrinsic reepithelialization can resurface the newly created vestibular tissues forming a stable vestibular length with excellent color and texture.

Periosteal fenestration vestibuloplasty procedure for sulcus deepening in a hemimandibulectomy patient following implant therapy

Ablative surgery of the jaws may be necessary when malignant disease or destructive benign disease occurs. Surgical reconstruction needs to include the restoration of masticatory function so that the quality of life after the operation is optimal. When resection includes part of the upper or lower jaw, the aim of reconstruction should encompass not only the restoration of aesthetics, speech and swallowing, but also the recreation of an alveolar ridge suitable for prosthetic rehabilitation of the dental occlusion. In the present case, depth of vestibule was inadequate following implant placement thereby severely compromising prosthetic rehabilitation. Hence vestibuloplasty was done with periosteal fenestration operation, which provided retention and stability of mandibular prosthesis and hence greatly improved his overall quality of life.

Comparison of vestibular sulcus depth in vestibuloplasty using standard Clark's technique with and without amnion as graft material

Introduction:

A number of materials are used as grafts in vestibuloplasty like mucosal and skin grafts with several advantages and disadvantages. To circumvent the disadvantages of these grafts, biological membranes such as amnion membranes are often recommended.

Materials and Methods:

The objective of this study was to clinically assess the vestibular sulcus depth in vestibuloplasty using Clark's technique with and without amnion as graft material. Twenty edentulous patients underwent mandibular labial vestibuloplasty using Clark's technique. Amnion was used as graft material in 10 patients (group I) and no grafts used in remaining 10 patients (group II). The vestibular depth was evaluated at time intervals of 1 week, 2 weeks, 1 month and 3 months, postoperatively.

Results:

Mean postoperative vestibular depth after 3 months in group I and II were 10.0 ± 3.13 mm and 7.8±0.63 mm, respectively. Mean of 2.2 ± 2.50 mm increase in depth was achieved after 3 months in Group I.

Conclusion:

Amnion graft is a viable and reliable option that promotes early healing and maintains postoperative vestibular depth.