RESUMO
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 «islet¼; II group (26 patients) - patients after reconstructive surgery with the use a fibula autograft with the inclusion of a musculocutaneous «islet¼. 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,¼ 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.
Assuntos
Procedimentos Cirúrgicos Ortognáticos , Vestibuloplastia , Masculino , Feminino , Humanos , Autoenxertos , Vestibuloplastia/métodos , Hemodinâmica , Transplante Autólogo , Microcirculação/fisiologia , Fluxometria por Laser-Doppler/métodosRESUMO
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.
Assuntos
Implantes Dentários , Lasers de Estado Sólido , Procedimentos de Cirurgia Plástica , Humanos , Vestibuloplastia/métodos , Lasers de Estado Sólido/uso terapêutico , Retalhos CirúrgicosRESUMO
BACKGROUND: Emerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG. AIM: The present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period. MATERIALS AND METHODS: The study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes. RESULTS: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of - 0.14 ± 0.27 mm and - 0.04 ± 0.40 mm in the CM group, and - 0.08 ± 0.29 mm and - 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: - 0.03 ± 0.22 mm, FGG: - 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001). CONCLUSIONS: CM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics.
Assuntos
Implantes Dentários , Gengivoplastia , Vestibuloplastia , Animais , Colágeno/uso terapêutico , Gengiva/transplante , Gengivoplastia/métodos , Suínos , Vestibuloplastia/métodos , HumanosRESUMO
OBJECTIVES: This study aimed to evaluate the influence of vestibuloplasty on the clinical success and survival of dental implants in head and neck tumor patients. MATERIALS AND METHODS: A retrospective single-center study was conducted. All patients received surgical therapy of a tumor in the head or neck and underwent surgical therapy and, if necessary, radiotherapy/radiochemotherapy. Patients with compromised soft tissue conditions received vestibuloplasty using a split thickness skin graft and an implant-retained splint. Implant survival and success and the influence of vestibuloplasty, gender, radiotherapy, and localizations were evaluated. RESULTS: A total of 247 dental implants in 49 patients (18 women and 31 men; mean age of 63.6 years) were evaluated. During the observation period, 6 implants were lost. The cumulative survival rate was 99.1% after 1 year and 3 years and 93.1% after 5 years for patients without vestibuloplasty, compared to a survival and success rate of 100% after 5 years in patients with vestibuloplasty. Additionally, patients with vestibuloplasty showed significantly lower peri-implant bone resorption rates after 5 years (mesial: p = 0.003; distal: p = 0.001). CONCLUSION: This study demonstrates a high cumulative survival and success rate of dental implants after 5 years in head and neck tumor patients, irrespective of irradiation. Patients with vestibuloplasty showed a significantly higher rate of implant survival and significantly lower peri-implant bone resorption after 5 years. CLINICAL RELEVANCE: Vestibuloplasty should always be considered and applied if required by the anatomical situations to achieve high implant survival/success rates in head and neck tumor patients.
Assuntos
Reabsorção Óssea , Implantes Dentários , Neoplasias de Cabeça e Pescoço , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Implantação Dentária Endóssea , Vestibuloplastia , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Prótese Dentária Fixada por ImplanteRESUMO
BACKGROUND: The aim of this study is to compare wound healing and vestibular depth gain in individuals undergoing vestibule deepening surgery using diode laser and conventional technique and to further investigate the possible wound healing effect of low-level laser therapy (LLLT). MATERIAL AND METHODS: 52 systemically healthy individuals with insufficient vestibular depth in the region of teeth 33-43 in the lower jaw were included. Following nonsurgical periodontal treatment, patients were divided into four groups as follows: a) diode laser (L); b) diode laser + LLLT; c) conventional surgery and d) conventional surgery + LLLT. Vestibular depth and horizontal wound size measurements of the individuals were recorded using digital calipers. Reepithelization was evaluated via an image analysis program. RESULTS: Vestibular depth measurements were found to be higher in the conventional surgery groups compared to that of diode laser groups after the operation, while the results were not statistically different between groups (p >0.05). Reepithelization area did not differ between groups in the evaluated time periods (p >0,05). On the other hand, horizontal wound shrinkage was significantly higher in the conventional surgery group than that of diode laser. CONCLUSIONS: Within the limits of this study, both methods yielded in vestibule depth gain. On the other hand, LLLT did not have an additional positive effect on mucosal wound healing. As a clinical relevance, the results are valuable for clinicians in terms of showing that suturing of the mucosal flap formed following vestibule deepening should not be necessary in laser assisted surgery for attaining more vestibule depth.
Assuntos
Terapia a Laser , Terapia com Luz de Baixa Intensidade , Humanos , Terapia com Luz de Baixa Intensidade/métodos , Lasers Semicondutores/uso terapêutico , Vestibuloplastia , CicatrizaçãoRESUMO
OBJECTIVE: To evaluate the effects of ala vestibuloplasty on cardiopulmonary and lifestyle-related parameters in brachycephalic (BC) cats. STUDY DESIGN: Prospective cohort. ANIMALS: Client-owned BC cats (n = 19). METHODS: Cats were assessed preoperatively by airway computed tomography (CT), endoscopy, contrast echocardiography, cardiac biomarkers, and structured owner questionnaire. Ala vestibuloplasty was performed bilaterally, and blood values, imaging, and owner questionnaire responses were re-evaluated 8-20 weeks postoperatively. RESULTS: Cats were presented for predominantly respiratory clinical signs attributable to brachycephaly. Preoperatively, all cats had stenotic nares, prolonged normalized pulmonary transit time (nPTT) (mean 5.43 ± 1.10 s), and a hyperattenuating pulmonary pattern. No complications occurred following surgery. Postoperatively, nPTT (mean 3.89 ± 0.74 s, p < .001) and frequencies of sneezing (p = .002), snoring (p = .006), open-mouth breathing (p = .0004), and nasal discharge (p = .019) were decreased. Cats exhibited increased activity (p = .005), less frequent dyspnea during activity (p < .001), longer duration of activity before becoming dyspneic (p = .002), faster recovery from activity (p < .001), and decreased respiratory noise (p < .001). Median questionnaire scores improved from preoperative to postoperative (p < .001). CONCLUSION: Anatomic, echocardiographic, and CT changes were common in this cohort of clinically affected BC cats. Pulmonary blood flow and respiratory function were improved after surgery. CLINICAL SIGNIFICANCE: Stenotic nares are the predominant airway abnormality in BC cats. Ala vestibuloplasty is a safe procedure that improves cardiac and CT abnormalities and respiratory and other clinical signs in BC cats.
Assuntos
Doenças do Gato , Craniossinostoses , Animais , Gatos/cirurgia , Estudos Prospectivos , Vestibuloplastia/veterinária , Craniossinostoses/cirurgia , Craniossinostoses/veterinária , Pulmão , Respiração , Doenças do Gato/cirurgiaRESUMO
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.
Assuntos
Retração Gengival , Fibrina Rica em Plaquetas , Feminino , Humanos , Retração Gengival/cirurgia , Seguimentos , Vestibuloplastia , Resultado do TratamentoRESUMO
This clinical report details a novel surgical modification at the time of maxillectomy to improve obturator function. A vestibuloplasty and split thickness skin graft of the zygomaticoalveolar crest created a denture-bearing surface that, when engaged, provided support and stability for the obturator prosthesis. This report outlines the surgical and prosthodontic procedures and the results achieved.
Assuntos
Implantes Dentários , Vestibuloplastia , Vestibuloplastia/métodos , Implantação de Prótese , Transplante de Pele , Ossos Faciais , Obturadores PalatinosRESUMO
A reabilitação do paciente com reabsorção severa do rebordo mandibular é uma questão desafiadora na prática cirúrgica devido aos problemas presentes em relação a retenção e estabilidade da prótese. Como consequência apresenta um vestíbulo lingual e vestibular raso, inserções musculares mais próximas ou no nível da crista do rebordo juntamente com a falta de mucosa aderida queratinizada, cujo são considerados fatores de risco para o sucesso em longo prazo dos implantes dentários. Para a eliminação dessas interferências é indicado a cirurgia, o objetivo deste estudo é descrever uma abordagem cirúrgica modificada de enxerto de mucosa palatina acompanhada de uma vestibuloplastia e sulcoplastia lingual simultâneo ao reposicionamento dos ductos das glândulas sublinguais, para aumentar a profundidade do vestíbulo lingual/bucal raso, corrigindo o posicionamento dos ductos das glândulas sublinguais e ganho de tecido queratinizado ao redor dos implantes dentários previamente instalados. Para tanto, a metodologia adotada foi uma revisão da literatura pertinente atualizada e descrição de um relato de caso clínico de uma paciente do sexo feminino, de 60 anos de idade, que se submeteu a cirurgia de enxerto de mucosa palatina, seguida de uma vestibuloplastia e sulcoplastia lingual simultaneamente ao reposicionamento dos ductos das glândulas sublinguais, com ancoragem externa em região interforaminal em mandíbula. Finalizando o tratamento com a entrega das próteses sobre os implantes do tipo protocolo em região inferior e nova prótese total removível superior. Concluiu-se ser o enxerto de mucosa palatina com ancoragem externa em região interforaminal, simultâneos a vestibuloplastia e sulcoplastia lingual se mostra como uma abordagem efetiva para aumentar a profundidade vestibular e lingual, com ganho de tecido queratinizado ao redor dos implantes, em rebordo mandibular gravemente reabsorvido. Além disso, proporciona o reposicionamento dos ductos das glândulas sublinguais.
The rehabilitation of the patient with severe resorption of the mandibular ridge is a challenging issue in surgical practice due to the present problems regarding retention and stability of the prosthesis. As it consequently presents a shallow lingual and buccal vestibule, muscle insertions closer to or at the level of the crest of the ridge together with the lack of adherent keratinized mucosa, which are considered risk factors for the long-term success of dental implants. For the elimination of these interferences, surgery is indicated, the objective of this study is to describe a modified surgical approach of grafting of the palatal mucosa accompanied by a vestibuloplasty and lingual sulcoplasty simultaneously with the repositioning of the ducts of the sublingual glands, to increase the depth of the lingual/buccal vestibule shallow, correcting the positioning of the ducts of the sublingual glands and gain of keratinized tissue around the previously installed dental implants. To this end, the methodology adopted was a review of the relevant updated literature and description of a clinical case report of a female patient, 60 years old, who underwent palatine mucosal graft surgery, followed by a vestibuloplasty and lingual sulcoplasty simultaneously with the repositioning of the ducts of the sublingual glands, with external anchorage in the interforaminal region of the mandible. Finishing the treatment with the delivery of the prostheses on the protocol-type implants in the lower region and a new upper removable total prosthesis. It was concluded that the graft of the palatal mucosa with external anchorage in the interforaminal region, simultaneous to vestibuloplasty and lingual sulcoplasty, is an effective approach to increase buccal and lingual depth, with gain of keratinized tissue around the implants, in severely affected mandibular ridges. reabsorbed. In addition, it provides repositioning of the ducts of the sublingual glands.
Assuntos
Próteses e Implantes , Suturas , Vestibuloplastia , Gengiva/cirurgia , Relatos de CasosRESUMO
OBJECTIVES: The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen matrix (XCM) versus subepithelial connective tissue graft (SCTG) to increase soft tissue thickness at implant site. MATERIALS AND METHODS: The study was a randomized, parallel-group controlled investigation. Thirty patients underwent buccal soft tissue thickness augmentation at the stage of implant placement by two different methods: SCTG (control group) and XCM (test group). Primary outcome was the amount of buccal soft tissue thickness gain, 3 months after the intervention. Secondary outcomes were the operation time, the amount of keratinized mucosa (KM), pain syndrome (PS), and patients' quality of life (QL). Histologic evaluation was also performed. RESULTS: The amount of soft tissue thickness gain was 1.55±0.11 mm in SCTG group, and 1.18±0.11mm in XCM group. The difference between the SCTG and XCM was -0.366 (-0.66 to -0.07; p=0.016). Operation time with XCM was 8.4 (3.737 to 13.06) min shorter than that with the SCTG (p=0.001). KT, PS, and QL for both groups were not statistically significantly different at any time point (p>0.05). At histological examination, the general picture in both groups was similar. No significant differences between the studied groups in most indices, except for the average and maximum formation thickness, cellularity of the basal, mitotic activity and also maximum length of rete ridges. CONCLUSION: Within limitations, this study demonstrates that the use of SCTG provides a statistically significant superior soft tissue thickness gain than XCM for soft tissue augmentation procedures around implants. CLINICAL RELEVANCE: XCM can be used as the method of choice for increasing the thickness of soft tissues.
Assuntos
Implantes Dentários , Humanos , Tecido Conjuntivo/transplante , Gengivoplastia/métodos , Vestibuloplastia/métodos , Colágeno/uso terapêutico , Gengiva/transplanteRESUMO
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.
Assuntos
Doenças Periodontais , Vestibuloplastia , Humanos , Doenças Periodontais/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento , CicatrizaçãoRESUMO
Vestibuloplasty is fundamental to restore an oral vestibule for immediate dental implantation in fibular free flap (FFF) for oral cancer patients undergoing mandibulectomy reconstruction. Double surgical team including reconstructive head and neck surgeon and a dental surgeon is fundamental. The first step of the vestibuloplasty is to identify the skin perforator. The second step is to thin the FFF skin island as much as necessary to facilitate: i-the reinset into the gingivobuccal sulcus while creating enough space in the oral vestibule for the future dental prosthesis and ii-the exposition of dental implants. The third step is to create a percutaneous access to the implants through the FFF skin paddle using a dermatologic punch while preserving a large oral vestibule. The fourth step is the skin reinsertion into the gingivobuccal sulcus and closure. Realizing vestibuloplasty before radiotherapy allows prevention of soft tissue contraction and osteoradionecrosis while reducing the necessary time for a complete dental rehabilitation and improving patient quality of life.
Assuntos
Implantes Dentários , Retalhos de Tecido Biológico , Neoplasias Bucais , Procedimentos de Cirurgia Plástica , Implantação Dentária , Humanos , Osteotomia Mandibular , Neoplasias Bucais/cirurgia , Qualidade de Vida , VestibuloplastiaRESUMO
OBJECTIVE: To describe the H-pharyngoplasty procedure, report the outcomes of dogs with brachycephalic obstructive airway syndrome (BOAS) treated with ala-vestibuloplasty and H-pharyngoplasty with a CO2 laser, and identify prognostic factors. ANIMALS: 423 dogs. PROCEDURES: Medical records of dogs admitted for BOAS from 2011 to 2017 were reviewed. Dogs were included if they were treated with ala-vestibuloplasty and H-pharyngoplasty with a CO2 laser. Signalment, physical examination findings, grades at admission of clinical signs associated with respiratory and digestive systems, diagnostic test results, postoperative treatments, and short-term follow-up results were extracted from medical records. Long-term follow-up of > 12 months was evaluated via questionnaire. Generalized ordered logistic regression was used for bivariable and multivariable analyses. RESULTS: Overall mortality rate was 2.6%. Median duration of follow-up was 36 months (12 to 91 months), and 341 (80.6%) dog owners completed the questionnaire. Major complications included respiratory distress (2.1%), heatstroke (0.5%), and bronchopneumonia (0.5%). No dogs required revision surgery. Improvement in signs associated with the respiratory and digestive systems was reported in 72% and 34% of the dogs, respectively, and owners' satisfaction was high (97.1%). Risk of death increased by 29.8% (95% CI, 11.8% to 50.7%) for every 1-year increase in age. CONCLUSION AND CLINICAL RELEVANCE: H-pharyngoplasty was possible in all dogs with BOAS, including those previously treated with conventional surgery and was associated with low morbidity and improved respiratory and digestive signs. H-pharyngoplasty combined with ala-vestibuloplasty may be an alternative treatment for even the most severely affected dogs.
Assuntos
Obstrução das Vias Respiratórias , Craniossinostoses , Doenças do Cão , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/cirurgia , Obstrução das Vias Respiratórias/veterinária , Animais , Craniossinostoses/cirurgia , Craniossinostoses/veterinária , Doenças do Cão/cirurgia , Cães , Prognóstico , Estudos Retrospectivos , Vestibuloplastia/veterináriaRESUMO
BACKGROUND: The objective of this study was to compare patient-reported outcome measures (PROMs) and clinical outcomes after augmentation with xenogeneic collagen matrix (XCM) or free gingival graft (FGG) during different postoperative phases. METHODS: Forty-two patients (21 per group) with keratinized mucosa width (KMW) of < 2 mm at buccal implant sites in the posterior mandible were enrolled. All underwent vestibuloplasty and were allocated to either FGG (control) or XCM (test) group. Intraoperative morbidity of pain, stress, nausea, tolerance to time, and acceptance of surgery were evaluated immediately after surgery. The severity and duration of subjective pain, swelling, and bleeding were compared within a 2-week postoperative period. The willingness to retreat and satisfaction were assessed at 6 months. All PROMs were obtained using questionnaires and visual analog scales. The buccal KMW and other peri-implant parameters were also evaluated. RESULTS: No significant between-group differences were observed in PROMs immediately after surgery, except acceptance of surgery (0, 0-30.0 vs. 30, 0-50.0, p = 0.025). At 2 weeks, pain severity (46.7 ± 25.9 vs 61.9 ± 20.2, p = 0.040) and duration (5.52 ± 3.57 vs 8.48 ± 2.80, p = 0.005) were significantly lower in the test group, and pain perception during speaking and chewing was significantly higher for FGG, with no significant between-group differences in swelling and bleeding. At 6 months, the test group showed a higher willingness to retreat (76% vs 43%, p = 0.021); however, satisfaction with treatment outcomes was similar in both groups. At 6 months, the gain of KMW was significantly higher in FGG than in XCM (XCM: 1.57 ± 1.69 mm, FGG: 2.68 ± 1.80 mm, p = 0.003). Other peri-implant parameters did not show significant differences. CONCLUSIONS: Within the limitation of the present nonrandomized study, XCM demonstrated more positive PROMs than FGG during different postoperative phases, mainly for less pain perception during the early healing stage, but was inferior to FGG in terms of gain of KMW. For KMW augmentation in the posterior mandible, XCM may be indicated when patients can bear little pain. CLINICAL TRIAL REGISTRATION: ChiCTR1900022575 , date of registration: 17/4/2019, retrospectively registered.
Assuntos
Colágeno , Vestibuloplastia , Humanos , Mucosa Bucal , Medidas de Resultados Relatados pelo Paciente , Estudos ProspectivosRESUMO
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.
Assuntos
Retração Gengival , Vestibuloplastia , Tecido Conjuntivo/transplante , Seguimentos , Gengiva , Retração Gengival/cirurgia , Humanos , Incisivo , Estudos Prospectivos , Resultado do TratamentoRESUMO
PURPOSE: Vestibuloplasty with free gingival grafting is a frequently performed surgical procedure to generate sufficient keratinized mucosa (KM) around dental implants. Avascular porcine collagen matrices (CM) have been proclaimed to be sufficient substitutes as alternatives to free gingival grafts (FGGs). However, the process of graft integration and vascularization is still incompletely understood. METHODS: In 18 patients a vestibuloplasty in the lower edentulous jaw situation was performed during implant exposure, either with FGGs from the palate or a porcine CM (mucoderm). Tissue perfusion of the soft tissue grafts was measured using laser-doppler-spectrophotometer intraoperatively and on postoperative days 2, 5, 10, 30 and between days 60 and 90. With graft perfusion expressed by oxygen saturation [SO2%], the relative amount of hemoglobin [rHb], blood flow, and velocity [AU] was detected and compared between groups and the surrounding mucosa. RESULTS: Healing was uneventful in both groups, with mature KM around dental implants after healing. Blood flow and velocity significantly increased until postoperative day 10, comparable to perfusion values of the surrounded mucosa. Intergroup comparisons revelated no significant differences concerning the flow between CM and FGGs. Oxygen saturation also significantly increased within the first 5 postoperative days in both groups. Hemoglobin content did not show any differences during the investigated period. CONCLUSIONS: The perfusion mainly progresses within the first postoperative week with only minimal further detectable alterations until the final investigation, comparable in both groups. Although integration of FGGs (revascularized) and the CM (new tissue formation) is biologically different, both transplants show comparable perfusion patterns, leading to sufficient KM.
Assuntos
Implantes Dentários , Animais , Colágeno , Gengiva/cirurgia , Humanos , Suínos , Vestibuloplastia , CicatrizaçãoRESUMO
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.
Assuntos
Arcada Edêntula , Vestibuloplastia , Alveoloplastia , Implantação Dentária Endóssea , Prótese Dentária Fixada por Implante , Humanos , Lactente , Arcada Edêntula/cirurgia , Lábio , Mandíbula/cirurgia , Pessoa de Meia-IdadeRESUMO
Data sources PubMed, the Cochrane Oral Health Group Trials Register and Embase. Additionally, issues of the following journals between 2000 and April 2019 were hand-searched: Journal of Clinical Periodontology, Journal of Periodontology, International Journal of Periodontology and Restorative Dentistry, European Journal of Oral Implantology, Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, and Clinical Oral Implants Research.Study selection Only randomised controlled trials (RCTs) involving soft tissue augmentation at dental implant sites were considered for inclusion. The selection was restricted to RCTs published in English language with at least ten patients per group and a minimum follow-up period of three months. A PICO method was used to organise the inclusion criteria and soft tissue augmentations were clustered into three groups; that is, before prosthetic treatment, after prosthetic treatment and at immediate implant placement.Data extraction and synthesis The screening of titles and abstracts was carried out by two reviewers and disagreements were moderated by a third reviewer. Eligibility was determined using full texts and data were extracted using purposefully designed forms. The Cochrane handbook for systematic reviews of interventions toolkit was used to assess the risk of bias. The studies were grouped according to the type of intervention and subjected to quantitative data synthesis. Continuous outcome measures were assessed using random-effects meta-analyses and pooled estimates were expressed as weighted mean differences (MDs) along with 95% confidence intervals (CIs).Results Following initial electronic and hand-searches, 2,119 studies were screened for title and abstract, and 32 studies were considered for full-text screening. Only 14 RCTs met the inclusion criteria and the remaining 18 studies were excluded from the systematic review. The included studies described soft tissue augmentation for 538 implants placed in 475 patients. Three studies (68 patients; 78 implants) reported improved soft tissue thickness with xenogenic collagen matrix (XCM) augmentation compared to no augmentation at the implant sites before prosthetic treatment (high/unclear risk of bias). One study (28 patients; 41 implants) reported improved height of keratinised tissue (KT) and marginal bone levels (MBLs) with free gingival graft (FGG) compared to no augmentation at the implant sites after prosthetic treatment (unclear risk of bias). Three RCTs (126 patients; 126 implants) focused on connective tissue grafting (CTG) and bone grafting versus no grafting in conjunction with immediate implant placement after tooth extraction (unclear risk of bias). There was no difference in MBLs in any of the studies, while one study showed superior soft tissue thickness (STT). Four RCTs (129 patients; 133 implants) compared different augmentation techniques before prosthetic treatment. Only one study showed improved STT with CTG compared to XCM (low risk of bias). Finally, three RCTs (124 patients; 160 implants) compared different augmentation techniques after prosthetic treatment (high/unclear risk of bias). FGG was observed to be superior to acellular dermal matrix (ADM) and vestibuloplasty to improve KT. Meta-analyses did not favour CTG to improve MBLs at extraction sites but CTG was superior to XCM to improve STT before prosthetic treatment.Conclusions Notwithstanding the limitations of the systematic review, soft tissue augmentation significantly enhances the amount of soft tissue at the implant site. CTG at the extraction site also improves subsequent bone level of the implants. Moreover, CTG before prosthetic treatment is superior to XCM to improve thickness of peri-implant soft tissues. However, these findings are based on short-term follow-up and future studies with improved methodology are required to establish the long-term benefits of soft tissue augmentation at the dental implant sites.
Assuntos
Implantes Dentários , Tecido Conjuntivo , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Extração Dentária , VestibuloplastiaRESUMO
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.