Influence of Timing on the Horizontal Stability of Connective Tissue Grafts for Buccal Soft Tissue Augmentation at Single Implants: A Prospective Controlled Pilot Study.

PURPOSE: The timing for soft tissue augmentation during implant therapy is still debated. Therefore, the present study clinically evaluated whether immediate versus delayed soft tissue augmentation procedures had an impact on the stability of peri-implant mucosal thickness (PMT). MATERIALS AND METHODS: Patients requiring a single implant posterior to the canines in association with soft tissue augmentation procedures at the buccal aspect of single implants using a connective tissue graft (CTG) were enrolled. Patients were randomly allocated to 2 different timing protocols: simultaneous implant and CTG placement (test group) or implant placement and then CTG placement after 3 months (control group). PMT was measured clinically at the mid-buccal aspect of the implant site by bone sounding with an endodontic K-file using customized acrylic stents. PMT measurements were recorded before and after implant placement and at 1, 2, 3, 4, 6, 9, and 12 months after implant insertion. Parametric statistical tests were used to compare PMT between the test and control groups at each study period and to evaluate changes in PMT over time. The level of significance was set at a P value less than .05. RESULTS: Fourteen implants placed in 14 patients were available for statistical comparison. At 12 months, the difference in PMT between the test and control groups was 0.12 ± 0.51 mm. This difference was not statistically significant (P = .54). A significant increase in PMT was observed from baseline to 12 months after implantation in the test (P = .004) and control (P < .001) groups. CONCLUSIONS: The present study indicated that changes in PMT after CTG placement were not influenced by the timing of soft tissue augmentation and remained stable up to 1 year after implant insertion.

Use of a Collagen Matrix as a Substitute for Free Mucosal Grafts in Pre-Prosthetic Surgery: 1 Year Results From a Clinical Prospective Study on 15 Patients.

BACKGROUND: The presence of keratinized tissue around dental implants is more than desirable either from a functional and aesthetic point of view, making soft tissue grafting a common practice in implant rehabilitation. Autogenous soft tissue grafting procedures are usually associated with high morbidity. Aim of this study was to assess the efficacy of a xenogeneic collagen matrix as a substitute for soft tissue grafting around dental implants. METHODS: 15 consecutive patients underwent a vestibuloplasty and grafting, both in the mandible and the maxilla, with a collagen matrix. RESULTS: The primary endpoint was to evaluate the resorption of the graft along with the re-epithelization grafted area. The percentage of the resorption was 44,4%, with a mean gain in vestibular height of 3 mm. Secondary endpoints evaluated the clinical appearance, the hemostatic effect and the post-operative pain. All subjects referred minimal pain with no bleeding. No adverse reaction nor infection were noted. CONCLUSION: This study showed that the used collagen matrix can find major interest in those patients who need a greater aesthetic outcome as the matrix has a perfect integration with the surrounding tissues. Furthermore it is strongly recommended for those patients who can bear little pain. CLINICAL SIGNIFICANCE: Post-operative morbidity of autologous grafts is the biggest concern of this type of surgery. The possibility to use a soft tissue substitute is a great achievement as morbidity decreases and bigger areas can be treated in a single surgery. The present study showed the efficacy of a collagen matrix as this kind of substitute.

Alveolar antral artery isolation during sinus lift procedure with the double window technique.

The sinus lift technique, introduced in 1976 by Tatum and subsequently described by Boyne in 1980, is nowadays considered a safe and reliable procedure for the rehabilitation of the atrophic upper posterior maxilla. The alveolar antral artery (AAA) is anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) and may be present in the sinusal antrostomy. The haemorrhage of this vascular bundle represents the second intra-operatory complication in term of frequency during sinus lift procedure. Purpose of this study was to illustrate and describe a new technique allowing the AAA isolation during sinus lift procedure in cases in which the artery is clearly present inside the surgical area, detectable through CT scan exam. Presence, course and possible identification of the alveolar antral artery are also discussed, according to the studies present in the literature.

Immediate distraction osteogenesis: the sandwich technique in combination with rhBMP-2 for anterior maxillary and mandibular defects.

The goal of this study was to demonstrate the technique and effectiveness of incorporating recombinant human bone morphogenetic protein-2 (rhBMP-2) to the established sandwich osteotomy technique. Although the success of the sandwich osteotomy procedure has been well documented, we hope to show that the addition of rhBMP-2 will enhance bone formation.We performed a sandwich osteotomy technique in patients who had been treated initially by grafting with suboptimal results. Only defects involving the anterior maxilla (3 patients) or the anterior mandible (1 patient) were included. There were 4 patients, 2 men and 2 women, with an age range of 19 to 62 years. The causes of the ridge deficiencies ranged from pathology to trauma. The height (distance) of distracted transport bone segment was measured. The amount of relapse was measured 6 months after the surgery.All patients exhibited a significant increase in bone height. The amount distracted was 6.75 mm (range, 5-11 mm). The amount of relapse was 8.5% (range, 0%-18%). Dental implants were placed in the reconstructed ridges in all patients. There were no instances of permanent paresthesia. Two patients had exposure of a portion of the hardware, which healed uneventfully.The sandwich osteotomy technique has proven to be an effective method for augmenting deficient alveolar ridges. The addition of rhBMP-2 may aid in its success rate by promoting osteogenesis at the osteotomy site, especially in multiple-operated patients where other traditional techniques have failed to gain the desired ridge height.

Osteomas involving the facial skeleton: a report of 2 cases and review of the literature.

Osteomas are benign slow-growing tumors. These lesions are essentially restricted to the craniofacial skeleton and rarely diagnosed in other bones. The etiology is often multifactorial. It could be genetic or congenital, (Gardner syndrome) or related to endocrine disorders, chronic inflammatory processes, or traumas. In this work, the authors wanted to illustrate the correlation between the presence of multiple osteomas in the craniofacial skeleton and Gardner syndrome to underscore the importance of the role of the oral surgeon in the early identification of this pathology. Malignant evolution of intestinal lesions arising from Gardner syndrome can be avoided if diagnosed in an early stage. Two significant clinical cases are described and discussed. In the first one, a diagnosis of Gardner syndrome was made after colonoscopy.

Osteoplasty flap technique for repair of latent (30-year) post-traumatic frontal sinus mucocele: case report and review of the literature.

Mucoceles are benign, slow-growing lesions defined as mucus-filled pseudocystic formations. Paranasal mucoceles predominantly affect the frontal sinus (60% to 65%), followed in frequency by the ethmoidal (20% to 30%), maxillary (10%), and sphenoid (2% to 3%) sinuses. Mucoceles usually arise because of sinus ostium obstruction, preceded by infection, fibrosis, inflammation, trauma, surgery or tumors such as osteomas. Mucoceles arising from the frontal sinus present with a variety of clinical signs, including decreased visual acuity, visual field abnormalities, proptosis, ptosis, periorbital swelling, displacement of the globe, restricted ocular movements, and choroidal folds. We describe a case of orbital involvement from a mucocele of the frontal sinus 30 years after the initial trauma, with a review of the published data concerning the etiology, diagnosis, and treatment planning.

Recombinant human bone morphogenetic protein type 2 application for a possible treatment of bisphosphonates-related osteonecrosis of the jaw.

Bisphosphonates are a class of agents used for treating osteoporosis and malignant bone metastases treatment. Osteonecrosis of the jaws is the main complication in a subset of patients receiving these drugs. Based on a growing number of case reports and institutional reviews, bisphosphonate therapy can cause exposed and necrotic bone that is isolated to the jaw. This clinical investigation is aimed at analyzing the clinical effect of recombinant human bone morphogenetic protein type 2 (rhBMP-2) application in patients affected by bisphosphonates-related osteonecrosis of the jaws undergoing surgery for necrotic bone removal.A case review was made of 20 patients. The rhBMP-2 in all the cases reported here was used alone with the collagen carrier without concomitant bone materials. The cases involved osteonecrotic lesions of the upper and lower jaws. A total dose of 4 to 8 mg of rhBMP-2 was delivered to the surgical site in concentrations of 1.5 mg/mL (depending on the size of lesion). Patients were followed up over a period ranging 6 to 12 months.Patients had successful healing of the necrotic area. New bone formation in the surgical area could be clinically evaluated by palpation at the end of 3 to 4 months and confirmed by radiographic examination at the end of 12 months.This study indicated that the use of rhBMP-2 without concomitant bone grafting materials was useful in promoting healing of bisphosphonates-related osteonecrosis of the jaws. The use of growth factors, particularly rhBMP-2, should be considered a therapeutic choice in patients affected by osteonecrosis of the jaws related to bisphosphonate therapy.

Reconstruction of mandibular defects using bone morphogenic protein: can growth factors replace the need for autologous bone grafts? A systematic review of the literature.

Autogenous bone is still considered the "gold standard" of regenerative and reconstructive procedures involving mandibular defects. However, harvesting of this material can lead to many complications like increasing morbidity, expanding of the surgical time, and incomplete healing of the donor site. In the last few years many authors looked for the development of effective reconstruction procedures using osteoinductive factors without the need for conventional bone grafting. The first-in-human study involving the use of Bone Morphongenic Proteins (rhBMP) for mandibular reconstruction was performed in 2001 by Moghadam. Only few articles have been reported in the literature since then. The purpose of this study was to search and analyze the literature involving the use of rhBMP for reconstruction of mandibular defects. In all the studies reported, authors agree that the use of grown factors may represent the future of regenerative procedures with more research necessary for confirmation.