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BACKGROUND:Subepithelial connective tissue grafts are generally considered as the gold standard for soft tissue augmentation.However,it needs a second surgical site,which will prolong the surgical time and increase patients'pain. OBJECTIVE:To compare the histological and thickness changes of attached gingiva following grafting with different soft tissue substitutes in the labial region of the cuspids. METHODS:In three Beagle dogs,attached gingival augmentation was performed with double-layer allogeneic acellular dermal matrix membrane(AADM),bovine-derived acellular dermal matrices(BADM)combined with concentrated growth factor membrane or BADM combined with collagen sponge.Thickness of attached gingiva was measured before augmentation,and 1,2,3,and 4 months after augmentation.Histological analyses were performed after 4 months. RESULTS AND CONCLUSION:The mean values of attached gingival thickness and attached gingival thickness augmentation were higher in the double-layer AADM group than in the other two groups(all P<0.05)from the 1st to 4th month after surgery.At 1 month after surgery,the attached gingival thickness of the three groups increased significantly and then decreased.At 3 months after surgery,the BADM combined with collagen sponge group and the BADM combined with concentrated growth factor membrane group showed no significant difference in the attached gingival thickness of the graft area compared with that before surgery(P>0.05).At 4 months after surgery,the mean value of attached gingival thickness in the double-layer AADM group was still significantly increased compared with that before surgery(P<0.05).The value of attached gingival thickness was highest in the double-layer AADM group,followed by the BADM combined with collagen sponge group,and the lowest in the BADM combined with concentrated growth factor membrane group at 1-4 months after surgery.Histological analyses revealed that AADM was well integrated with the host gingival tissue,and new fibrous connective tissue and fibroblasts grew into the AADM.But the grafts in the other two groups were absorbed and the augmentation area was remodeled into a structure consistent with the surrounding host tissue.To conclude,AADM is superior to BADM combined with concentrated growth factor and BADM combined with collagen sponge with regard to gingival augmentation.
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ABSTRACT: A variety of periodontal plastic surgery techniques have been proposed to correct aesthetic and functional problems of periodontal tissues. The most common procedure uses the connective tissue graft from the palate. However, patient discomfort and the limited quantity of palatal tissue results in many cases where the surgeon uses connective tissue substitutes. In this case report, we describe the use of a human dermal matrix for gingival volume augmentation in the lower incisors with a novel modified VISTA technique stabilizing the flap with sutures and cyanoacrylates, avoiding comorbidity of a second surgical site. The follow up at 6 months showed an increase in gingival thickness and a reduction in recessions length.
Тема - темы
Humans , Female , Adult , Palate , Surgery, Plastic , Sutures , TissuesРеферат
Background: Which are the different ways of stabilizing connective tissue grafts (CTGs) for root coverage and gingival augmentation by means of placement of sutures? There are various defined and undefined ways of stabilizing CTGs depending on experience and personal preferences. Most of the techniques profess use of absorbable sutures in separate interrupted fashion (sutures at the corners of the graft wherever possible). Aim: This paper describes a new suturing method, “the lingually-tied horizontal mattress contouring suture,” for stabilization of CTGs with or without epithelialized collar at the recipient site, for use with papilla retention and sparing techniques to treat marginal tissue recessions. Methods and Material: The suturing technique is described in detail. It can be indicated for good number of root coverage cases, with additional objectives of gingival augmentation, specifically developed for papilla sparing and papillary buccal de-epithelialization recipient site preparations. Results: Over a period of last 16 years this suturing technique showed promising results in terms of graft stabilization and survival. The main advantage of this technique lies in the use of cost-effective nonabsorbable sutures that usually retain some amount of tension on the soft tissues longer. Conclusion: The primary objective of the suturing technique, per se, is to stabilize the CTG firmly along the contours of the root surface and to expedite a very close adaptation to the interdental soft tissues as well. The secondary objective of the article or publication is to disseminate the knowledge acquired through long periods of performance and observation for the benefit of the periodontal community as whole. Further validation is advocated.