Alveolar regeneration of the post-extraction site with cortical deficiency using the Lamina Socket Sealing technique: A retrospective study with clinical, radiographic and histomorphometric analysis. Part 1/2.

PURPOSE: This retrospective observational study aims to evaluate the outcome of a new alveolar ridge preservation (ARP) technique, "Lamina Socket Sealing" (LSS) technique, using a porcine barrier. METHODS: 36 subjects with maxillary premolars to be extracted and extensive alveolar wall defects were enrolled and treated. Porcine-derived barriers and mesenchymal membrane were used to seal the extraction socket with alveolar particulate graft. The outcome variables were: radiographical bone changes and clinical outcomes. RESULTS: 36 subjects, 21 females and 15 males were treated. The change in mm (mean + SE) of horizontal ridge width from baseline to 4 months after surgery at the coronal level of the alveolus was +1.25 ± 0.20 mm (P< 0.05), mean level was +0.34 ± 0.1 mm (P< 0.05) and at the apical level was +0.08 ± 0.17 mm (P> 0.05) which was not statistically significant. The buccal and palatal height changes in mm (mean + SE) from baseline to 4 months after surgery were respectively 1.21 ± 0.17 mm for the buccal wall (P< 0.05) and 1.06 ± 0.24 mm for the palatal wall (P< 0.05). The bone volume of all sites allowed for the placement of the planned implants. CLINICAL SIGNIFICANCE: The alveolar ridge preservation technique (Lamina Socket Sealing) using resorbable heterologous cortical lamina with flapless approach allowed not only the preservation of the damaged post-extraction socket, but also minimal ridge augmentation, according to the principles of guided bone regeneration.

A new technique of alveolar bone augmentation: "Pack into Bone". A retrospective case-series study.

PURPOSE: To provide an overview of an innovative surgical approach to guided bone regeneration, the Pack Into Bone (PIB) technique. METHODS: Twenty subjects, eight men and 12 women, aged 34 to 68 (mean 51.5) were selected. They were treated with the PiB technique, and upon re-entry surgery, performed 8 months postoperatively, implants were placed, and bone samples were collected by using trephine burs for histological and histomorphometric analysis purposes. RESULTS: Mean ridge width varied between 4.71 (W0) mm and 7.37 mm (W1), measured 8 months postoperatively, with a mean W augmentation of 2.69 mm ± 0.19. Mean height ranged between 8.0 mm (H0) and 11.15 mm (H1), measured 8 months after surgery with a mean augmentation of 3.53 mm ± 0.14 (P< 0.05). CLINICAL SIGNIFICANCE: Stability and versatility are the pillars of the PIB technique compared to common GBRs. The PIB technique is effective and reduces the difficulty in stabilizing the graft, is more feasible for operators, and decreases morbidity for the subjects.

Enhancing early-stage healing responses through the modified "Poncho" technique in customized titanium mesh-mediated bone regeneration: A soft tissue management approach-case series.

RATIONALE: Soft tissue management is critical in bone augmentation surgery to prevent wound dehiscence. Several strategies for passive tissue primary closure have been explored. This article introduces a flap design known as the modified "Poncho" technique (MPT), integrated with customized titanium mesh-mediated bone regeneration, and investigates the healing quality during the initial stages of an incision. PATIENT CONCERNS: The cohort consisted of 5 patients undergoing customized bone regeneration procedures, concerned primarily with the successful integration and healing of the augmented bone site without complications such as wound dehiscence or infection. DIAGNOSIS: All patients were diagnosed with insufficient bone volume requiring augmentation to support future dental implants, necessitating the use of customized titanium mesh for guided bone regeneration. INTERVENTIONS: The MPT was detailed and applied during the customized bone regeneration procedures. Postoperative evaluations included recording complications and using Landry's healing index at intervals of 3, 7, 14, and 30 days post-surgery to assess the technique's performance in early wound closure. OUTCOMES: The study found that 95.7% of surgery sites experienced uneventful soft tissue healing within the observation period. Only 1 of 23 sites exhibited partial wound dehiscence at postsurgical days 14 and 30, accompanied by mild inflammation. The Landry's healing index increased from 3 ±â€…0.47 to a final value of 4.69 ±â€…1.06, indicating substantial improvement in healing over time. LESSONS: The MPT shows promise as an innovative approach for promoting passive and predictable primary wound closure beneath a digitally customized titanium mesh for bone regeneration, demonstrating a high rate of successful healing and minimal complications during the early postoperative phase.

Regeneration of combined severe periodontal defects and vertical ridge defects using recombinant human platelet-derived growth factor-BB: A case series.

Dental implants are a reliable treatment option for restoring missing teeth, but adequate bone quantity and quality are crucial for success. This case series presents four cases treated by different clinicians, all following very similar concepts for combined periodontal and vertical ridge augmentation using recombinant human platelet-derived growth factor-BB. All cases involved a severe periodontal defect requiring either extraction of the adjacent tooth or periodontal regeneration. Different bone grafts and membrane types were utilised. Although true periodontal regeneration cannot be said categorically to have occurred due to a lack of histological evidence, the clinical and radiographic findings suggest almost complete bone fill in all cases. This case series demonstrates that combined periodontal and vertical ridge augmentation using recombinant human platelet-derived growth factor-BB could be successful, but proper case selection and patient preparation for the possibility of multiple surgical procedures are recommended. Conflict-of-interest statement: At the time of preparing this manuscript, Dr Saleh was a clinical advisor for Lynch Biologics, Franklin, TN, USA. The other authors declare that they have no conflicts of interest relating to this study.

Comparative Effectiveness of an Autologous Dentin Matrix for Alveolar Ridge Preservation.

An urgent issue is the preservation or reconstruction of the volume of bone tissue in planning and surgical treatment in the fields of medicine, such as traumatology, orthopedics, maxillofacial surgery and dentistry. After tooth extraction, resorption of the bone tissue of the alveolar crest of the jaws occurs, which must either be further eliminated by performing additional operations or using osteoplastic material for socket preservation at the extraction stage. Background and Objectives: The aim of the study was a comparative analysis of various osteoplastic materials used to preserve the volume of bone tissue in the preimplantation period. Materials and Methods: As part of the study, 80 patients were treated, who underwent socket preservation using xenografts, plasma enriched with growth factors, an autologous dentin matrix (ADM) and hydroxyapatite. Results: The results of the treatment 16 weeks after removal were comprehensively analyzed using a morphometric analysis of the bone's volume, cone beam tomography and morphological examination of burr biopsy specimens, as well as by determining the stability of the installed implant at different stages of treatment. Conclusions: The lowest level of bone tissue resorption according to the CBCT data was noted in the ADM and xenograft groups. It should be noted that the use of osteoplastic material in jaw surgery when reconstructing alveolar defects is an essential procedure for preventing the atrophy of bone tissue.

Comparison of clinical efficacy between autologous partially demineralized dentin matrix and deproteinized bovine bone mineral for bone augmentation in orthodontic patients with alveolar bone deficiency: a randomized controlled clinical trial.

BACKGROUND: It is common to see patients who need orthodontic treatment but with insufficient alveolar bone volume. However, safe and effective tooth movement requires sufficient alveolar bone width and height. The aim of this study is to compare the bone augmentation efficacy of Autologous Partially Demineralized Dentin Matrix (APDDM) and Deproteinized Bovine Bone Mineral (DBBM) in orthodontic patients with insufficient bone by using a randomized controlled clinical trial approach. MATERIALS AND METHODS: Twenty-seven orthodontic patients involving 40 posterior teeth alveolar sites (n = 40) with insufficient alveolar bone volume were randomly divided into a control group (n = 20) and an experimental group (n = 20). The patients in the experimental group were treated with APDDM, and those in the control group were treated with DBBM. After surgery, the adjacent teeth are moved toward the bone grafting sites according to the orthodontic treatment plan. Patients completed a postoperative response questionnaire by the Visual Analogue Scale (VAS) score to indicate pain and swelling in the bone grafted area at the time of suture removal; and CBCT scans were conducted before surgery, 6 months and 2 years after surgery to assess changes in buccal and central alveolar heights, as well as widths at the alveolar ridge apex and 3 mm, 5 mm below the apex, respectively. The CBCT image sequences were imported into Mimics 21.0 software in DICOM format. The data of the patients in both groups were collected and analyzed by SPSS 25.0. RESULTS: The VAS scores were significantly lower in the APDDM group than in the DBBM group (p < 0.05). Significant increases were observed in alveolar bone height and width at 6 months and 2 years postoperative (p < 0.05); At 2 years, the APDDM group exhibited a reduction in buccal crest height and in 3 mm, 5 mm width below alveolar ridge apex, relative to 6 months (p < 0.05), while the DBBM group showed a decrease only in the central height of the alveolar bone (p < 0.05). There was a significant bone augmentation increase found only 3 mm below the alveolar ridge apex in the APDDM group compared with the DBBM group among all 6 months group comparison (p < 0.05). At 2 years, the augmentation effects were similar across both groups (p > 0.05). CONCLUSION: Radiomics analysis indicates that APDDM serves as a viable bone augmentation material for orthodontic patients with insufficient alveolar bone volume, achieving comparable clinical efficacy to DBBM. Additionally, APDDM is associated with a milder postoperative response than DBBM. THE REGISTRATION NUMBER (TRN): ChiCTR2400084607.

Competence of allogenic demineralized tooth matrix in socket seal surgery for alveolar ridge preservation: a randomized control clinical trial.

OBJECTIVES: To assess and compare the clinical, radiological, and histological outcomes of socket seal surgery between two protocols: deproteinized demineralized tooth matrix (dpDTM) and freeze-dried bone allograft (FDBA) each covered with a free gingival graft. MATERIALS AND METHODS: Twenty extraction sockets in the anterior or premolar region were randomly allocated to either the dpDTM or FDBA protocol (n = 10 per group). Measurements of the alveolar ridge changes were obtained using an intraoral scanner and cone-beam computed tomography at 3 months post-operation. Three-month post surgery, the dental implant was installed (n = 5 per group), bone biopsies were obtained for histomorphometrical and micro-computed tomography analyses. Implant stability quotients (ISQs) were determined and compared at 3 months post-implant. RESULTS: Lower significant reductions in buccal alveolar ridge height and hard tissue volume were observed in dpDTM group compared to FDBA group at 3 months (0.25 ± 0.35 mm vs. 1.60 ± 0.66 mm [p = .000] and 9.64 ± 15.39% mm3 vs. 31.45 ± 18.11% mm3 [p = .010], respectively). At the same time, lower soft tissue volume reduction was detected in the dpDTM group compared to FDBA group (4.21 ± 5.25% mm3 vs. 5.25 ± 5.79% mm3). No statistically significant difference in the percentage of mineralized tissue formation was found between dpDTM group (53.39 ± 11.16%) and FDBA group (49.90 ± 3.27%). Even though the ISQ in the dpDTM group showed a higher value than the FDBA group at 3 months post-implant, the results were without statistical significance. CONCLUSIONS: Alveolar ridge preservation using dpDTM is an efficacious procedure for providing the conditions for the development of functional and esthetic implants.

Scalp-Split Technique: A Concept of Bone Splitting and Expansion for Thin Alveolar Ridges to Place Dental Implants.

Bone expansion is when the existing bone at the implant site is split and separated to create a gap to widen it. This article introduces a novel concept of bone expansion for the ultrathin alveolar ridges to place dental implants with zero wastage of existing natural bone in long-term edentulous arches. Instead of using twist drills and piezo surgery kits, the bone is split with a surgical scalpel blade to prevent natural bone wastage. The split helps to expand the bone horizontally by using expanders to accommodate the smaller diameter implants. This technique was applied to 12 individuals to rehabilitate their atrophic edentulous mandibles to facilitate the implant-supported overdentures, and it revealed that all the cases achieved successful osseointegration after placing implants following this method. The scalp-spilt technique is promising for providing implant-retained or implant-supported prostheses over ultrathin edentulous alveolar ridges.

Reconstruction of Sockets and Associated Maxillary Ridge Defect Using Suture Tenting, Synthetic Bone Graft, and Unique Macro Morphology Implants With an Immediately Loaded Provisional Bridge.

Immediate implant placement in the anterior maxilla remains complex, particularly when the labial cortical plate of the socket is deficient and there is an associated class IV ridge defect with both hard- and soft-tissue deficiencies. This case report describes a novel combination of polydioxanone (PDS) suture tenting to support a synthetic bone graft with simultaneous implant placement with implants featuring a body-shift design and subcrestal internal angle correction. In addition, the implants were immediately loaded with a four-unit provisional bridge at the time of surgery, thus reducing morbidity, costs, and total treatment time.

[Application of autogenous block bone graft in the reconstruction of severe alveolar crest defect].

Patients with severe alveolar ridge defects cannot be directly implanted and repaired, which seriously affects their quality of life. Onlay bone grafting is the main solution for severe alveolar ridge bone defect reconstruction, among which autogenous block bone grafting is the most widely used and is also the focus of clinical research on bone tissue reconstruction. This article expounds the characteristics and basic principles of autogenous bone block grafting, and comprehensively analyzes the selection of autogenous bone donor site, the principles of surgical operation, and the progress of bone graft techniques. In order to help surgeons make correct clinical decisions, increase the predictability of surgical effects, and improve the level of clinical diagnosis and treatment.

Concentrated growth factor and collagen as barrier materials in alveolar ridge preservation for posterior teeth: a prospective cohort study with one-year follow-up.

OBJECTIVES: This study aims to evaluate the efficacy of concentrated growth factor (CGF) membrane and collagen as barrier materials in sealing the alveolar socket in alveolar ridge preservation (ARP) in the posterior region during a one-year follow-up. METHODS: A total of 24 patients who underwent ARP in the posterior region were selected for inclusion and randomly assigned to the CGF group (12 cases) and Collagen group (12 cases). The patients in both groups underwent extraction of posterior teeth. The extraction sockets were filled with a bone substitute to the level of the pre-extraction buccal and lingual or palatal alveolar bone plates. The wounds in the CGF group were closed with a fabricated CGF overlaying the upper edge of the bone substitute material, whereas those in the Collagen group were closed with Bio-Oss Collagen. The implants were placed after 6 months. The evaluation was based on implant retention, re-grafting rate, and vertical and horizontal alveolar ridge bone volume changes measured by cone beam computed tomography (CBCT). Data were statistically analyzed using SPSS 28.0 software. RESULTS: No patient withdrew throughout the follow-up period. No implant failure and no severe peri-implant or mucosal soft tissue complications were observed. Six months after the operation, the degree of vertical alveolar ridge height resorption in the CGF group was lower than that in the Collagen group (P<0.05). There were no statistically difference between the groups at 1 year after the operation (P>0.05). The amount of bone reduction in horizontal alveolar ridge width showed no difference between the groups at 6 months and 1 year after surgery (P>0.05). CONCLUSIONS: CGF membrane and Bio-Oss Collagen as barrier materials for posterior ARP inhibited reduction in alveolar ridge bone mass.

The role of bone ring technique for bone augmentation in implant surgery: A Narrative Review.

Bone grafting with simultaneous implant placement using the novel bone ring technique was a procedure introduced with the intention of three-dimensional bone augmentation with simultaneous implant placement in both maxilla and mandible. A ring-shaped bone is placed in the socket, which is secured by an implant placed through the ring. The current narrative review was planned to provide a concise summary of the core concepts surrounding bone augmentation, to provide context for understanding the bone ring technique, and to highlight the basics of bone grafting and the origin of the technique to its advancement and its importance in the light of current literature.

[Harvesting of autologous bone graft for the mandible: from the hip or the jaw?] / Oogsten van autologe botgraft voor de mandibula: uit heup of kaak?

A 61-year-old edentulous patient presented with dental problems. Examination revealed a very narrow alveolar process in the symphysis area of the chin, with moderate vertical resorption. The decision was made for bone augmentation by means of harvesting an autologous bone graft from the alveolar process. This method can be carried out in an outpatient or day surgery unit and is much more cost effective and less invasive than harvesting an autologous bone graft from the hip area.

Impact of vertical alveoloplasty on changes in keratinized mucosa width following full-arch immediate implant placement and rehabilitations: A prospective case series.

PURPOSE: This prospective case series aimed to investigate the effect of vertical alveoloplasty on the changes in keratinized mucosa width (KMW) following full-arch immediate implant placement and rehabilitation. MATERIALS AND METHODS: A total of 17 potential edentulous patients were enrolled and received implant placement and full-arch implant-supported immediate rehabilitations. The main outcome was to analyze the effect of vertical alveoloplasty on the changes in KMW. The amount of vertical alveoloplasty during implant surgery as well as the changes in KMW at buccal aspects from the day of surgery to 6 months post-surgery were recorded on the implant-level using a periodontal probe. The secondary outcome was to analyze the other possible factors that affected the changes in KMW. The included factors were the initial KMW, the distribution of implants in the maxilla and mandible, the distribution of implants in the anterior and posterior regions, the distribution of implants in extraction sockets and healed ridges, and gender. Mann-Whitney non-parametric tests and multiple linear regression adjusted by generalized estimating equations (GEE) were used to statistically analyze the data. RESULTS: A total of 121 implant positions were analyzed. The KMW was 4.1± 2.0 mm on the day of the surgery and 4.1± 1.7 mm 6 months post-surgery. The mean changes in KMW following 6 months were -0.1± 1.6 mm (p = 0.824). From the results of GEE, the vertical amount of alveoloplasty had no significant effect on changes in KMW. Both initial KMW and the distribution of implants in the anterior and posterior regions had significant impacts on the changes in KMW (p < 0.0001). CONCLUSION: The amount of vertical alveoloplasty during implant surgery has no significant impact on the KMW. The KMW remained stable from baseline to 6 months after alveoloplasty, implant placement, and immediate rehabilitations in potential edentulous arches. The initial KMW and the distribution of implants in the anterior and posterior regions were the possible factors affecting changes in KMW.

Double layer graft technique for horizontal alveolar ridge augmentation with staged implant placement: radiographic histological and implant stability analysis-a case report.

INTRODUCTION: Horizontal ridge augmentation of a deficient alveolar bone site is performed either simultaneously with implant placement or in a staged approach prior to implant insertion. There are several available strategies for the augmentation of alveolar ridge deficiencies, including guided bone regeneration (GBR) through the use of barrier membranes. The success of the GBR approach mainly depends on the exclusion of soft tissue cells during bone remodeling. CASE PRESENTATION: A healthy 25-year-old male patient presented with a missing upper left central incisor after clinical and radiographic examination, the site showed a class III defect horizontal atrophy. The procedure performed was the horizontal alveolar ridge augmentation using resorbable pericardium membrane with double layer graft technique (DLT) where autogenous bone placed as a first layer of the graft followed by xenograft as a second layer, the membrane was fixed with titanium pins. A cone beam computed tomography (CBCT) was performed before, immediately and 6 month following the surgery. After 6 months during implant placement, a core biopsy specimen was retrieved, stored and prepared for histological evaluation, with assessment of primary implant stability. The radiographic analysis showed a horizontal width gain of about 4 mm, at 6 month following implant placement, the implant was successfully osteointegrated with stability assessment also done after 6 months from placement. CONCLUSION: DLT was successfully used for horizontal alveolar ridge augmentation, thus allowing a prosthetically driven implant placement. More cases assessing implant survival and success are needed to confirm the results of this case report.

Tomographic assessment of bone changes in atrophic maxilla treated by split-crest technique and dental implants with platelet-rich fibrin and NanoBone® versus platelet-rich fibrin alone: Randomized controlled trial.

BACKGROUND: This study evaluated the clinical benefits of adding NanoBone® with split-crest technique and simultaneous implant placement covered with platelet-rich fibrin membrane in horizontally deficient maxillary ridges in terms of crestal and horizontal bone changes and patient morbidity. METHODS: Forty patients indicated for maxillary ridge splitting and simultaneous implant placement were assigned randomly to the study groups: control group (Platelet Rich Fibrin membrane) and test group (Platelet Rich Fibrin membrane + Nanobone®). The Cone Beam Computed Tomography Fusion technique was utilized to assess crestal and horizontal bone changes after five months of the surgical procedure. Patient morbidity was recorded for one week post-surgical. RESULTS: Five months post-surgical, buccal crestal bone resorption was 1.26 ± 0.58 mm for the control group and 1.14 ± 0.63 mm for the test group. Lingual crestal bone resorption was 1.40 ± 0.66 mm for the control group and 1.47 ± 0.68 mm for the test group. Horizontal bone width gain was 1.46 ± 0.44 mm for the control group and 1.29 ± 0.73 mm for the test group. There was no significant statistical difference between study groups regarding crestal and horizontal bone changes and patient morbidity. CONCLUSIONS: The tomographic assessment of NanoBone® addition in this study resulted in no statistically significant difference between study groups regarding crestal and horizontal bone changes and patient morbidity. More randomized controlled clinical trials on gap fill comparing different bone grafting materials versus no grafting should be conducted. GOV REGISTRATION NUMBER: NCT02836678, 13th January 2017.

Ridge Preservation Combined With Open Barrier Membrane Technique in Case of Postextractive Oroantral Communication: A Case Series Retrospective Study.

After dental extraction, a physiological phenomenon of reabsorption of the dentoalveolar process is triggered, especially if periradicular lesions are present, which can sometimes be associated with oroantral communication in the upper posterior maxilla. To investigate a minimally invasive approach, 19 patients undergoing tooth extraction in the posterosuperior maxilla were recruited. All cases presented an oroantral communication with a diameter of 2-5 mm after tooth extraction and the alveolar process and, in some cases, with a partial defect of 1 or more bony walls. In these cases, a single surgical procedure was used to preserve the alveolar ridge using an open barrier technique with an exposed dense polytetrafluoroethylene membrane. The bottom of the extraction socket was filled with a collagen fleece. The residual bone process was reconstructed using a biomaterial based on carbonate-apatite derived from porcine cancellous bone. After 6 months, all patients were recalled and subjected to radiographic control associated with an implant-prosthetic rehabilitation plan. Data relating to the sinus health status and the average height and thickness of the regenerated bone were collected. Radiographic evaluation verified the integrity of the maxillary sinus floor with new bone formation, detecting a vertical bone dimension between 3.1 mm and 7.4 mm (average 5.13 ± 1.15 mm) and a horizontal thickness between 4.2 mm and 9.6 mm (average 6.86 ± 1.55 mm). The goal of this study was to highlight the advantage of managing an oroantral communication and, simultaneously, obtain the preservation and regeneration of the alveolar bone crest. The open barrier technique appears to be effective for the minimally invasive management of oroantral communication up to 5 mm in diameter in postextraction sites, with a good regeneration of hard and soft tissue.

Vitality of autologous retromolar bone grafts for alveolar ridge augmentation after a 3-months healing period: A prospective histomorphometrical analysis.

OBJECTIVES: The incorporation of retromolar bone grafts used for alveolar ridge augmentation is not well understood. This prospective observational study aims to supply histomorphometrical data from bone graft biopsies taken at the time of retrieval and after a 3-month healing period using patient-matched biopsies. MATERIALS AND METHODS: In 17 patients, trephine biopsies of the graft were acquired at the time of graft retrieval and after a 3-month healing period. The biopsies were compared histomorphometrically regarding the number of osteocytes, appearance of osteocyte lacunae, quantity, surface area, and activity of the Haversian canals. RESULTS: All grafts appeared clinically stable after screw removal and 17 implants were placed. Histomorphometric analysis revealed no significant difference in the number of osteocytes (p = .413), osteocyte lacunae (p = .611), the ratio of filled/empty osteocyte lacunae (p = .467) and active Haversian canals (p = .495) between the biopsies retrieved after a 3-months healing period with those at the time of grafting. The only significant difference was noted in the mean surface area of the Haversian canals (p = .002). Specifically, the grafts post 3-month healing showed a significantly larger mean area (0.069 mm2) compared to the time of grafting (0.029 mm2). CONCLUSION: This study demonstrates, compared to other data, a high rate of vital structures in retromolar bone block grafts after 3 months of healing, exhibiting the same histological features in comparison to the biopsies from the native alveolar ridge. Standard histomorphometrical parameters, e.g., the amount of filled or empty osteocyte lacunae for the description of the vitality of the graft need to be reappraised.

Volumetric assessment of volume stable collagen matrix in maxillary single implant site development: A randomized controlled clinical trial.

INTRODUCTION: The stability of soft tissue volume around dental implants is an important factor for the final esthetic outcome. The main objective of this study was to compare volume stable collagen matrix (VCMX) versus connective tissue graft (CTG) in the augmentation of soft tissue profiles in single implant sites with a class I Siebert ridge defect. MATERIALS AND METHODS: Twenty patients (14 females and 6 males) were enrolled in the present study. After implant placement and augmentation of the buccal defect by VCMX or CTG, post-operative evaluation of the volumetric changes at the augmented implant site was carried out at 3, 6, and 9 months as primary outcome, clinical and radiographic soft tissue thickness were carried out at baseline and 9-month intervals, visual analog scale (VAS) and oral health impact profile-14 (OHIP14) were recorded 2 weeks after the surgery. RESULTS: A statistically significant difference in soft tissue volume was found between baseline and 3, 6, and 9 months postoperatively in both groups with the highest value at 9 months (136.33 ± 86.80) (mm3) in VCMX and (186.38 ± 57.52) (mm3) in CTG. Soft tissue thickness was significantly increased in both groups at 9 months in comparison to baseline. However, there was a significantly higher increase in soft tissue thickness at 9 months in CTG (3.87 ± 0.91) than in VCMX (2.94 ± 0.31). Regarding the radiographic soft tissue thickness, there was a statistically significant increase in both groups at 9 months in comparison to baseline. However, there was a statistically higher increase in the radiographic soft tissue thickness at 9 months in CTG (3.08 ± 0.97) than in VCMX (2.37 ± 0.29). VAS showed a statistically lower value in VCMX (0.4 ± 0.7) than CTG (2.8 ± 1.48). The OHIP recorded lower values in the VCMX group than the CTG group with no statistical significance. In addition, there was no difference in the PES between the two groups. CONCLUSION: The present study showed that CTG and VCMX were both effective in soft tissue augmentation around implants in the esthetic zone. However, CTG proved more efficient in increasing peri-implant soft tissue volume and mucosal thickness around single implants at a 9-month follow-up period. VCMX was associated with less pain or discomfort and reduced patient morbidity, as reflected by the significantly reduced VAS value in the VCMX group.

A Strip Free Gingival Graft and a Xenogeneic Collagen Matrix to Increase Keratinized Tissue After Vertical Bone Augmentation.

After vertical bone augmentation (VBA) surgery, loss of both keratinized tissue (KT) and vestibule depth (VD) take place. This article evaluated KT gain, patient satisfaction, and aesthetic outcomes after a modified apically repositioned flap (ARF) in combination with a strip-free gingival graft (FGG) harvested from the palate and a xenogeneic collagen matrix (XCM) to correct mucogingival distortion (MGD) after VBA. This technique minimizes patient morbidity by reducing the need for extensive masticatory mucosa grafts. The study included 12 patients with ≤3 mm KT after vertical augmentation procedures. Keratinized tissue gain and tissue thickness were measured. Patient morbidity and aesthetic outcomes were also evaluated. Twenty-four months after surgery, significant VD gain was observed, obtaining a vertical KT augmentation of 5.38 ± 2.06 mm, although tissue thickness increase was only 0.42 ± 0.42mm. Regarding patient satisfaction, aesthetic results evaluating tissue color and texture were satisfactory; the pain was slight, obtaining a score of 2.10 ± 1.13 out of 10, measured using a Visual Analogue Scale (VAS). The present retrospective case series study shows that using an apically repositioned flap combined with a strip FGG and an XCM might offer a valid means of achieving KT gain.