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.

[The choice of coating materials for vestibuloplasty and pre- and postoperative use of pain and sedative medications depending on patient emotional features]. / Vybor pokrovnykh materialov pri provedenii vestibuloplastiki i primenenie obezolivayushchikh sredstv v zavisimosti ot psikhoemotsional'nykh osobennostei patsientov.

The purpose of the message was the comparison of change in the width and quality of keratinized tissue created in the lower vestibuloplasty area. Preliminary results of the case-control study involving 71 patients showed that autotransplantation managed to create the necessary buffer zone with the desired thickness of the mucosa and is particularly justified in cases of «washing board effect¼. However, the method is technically complicated and more expensive and painfull for patients. The use of alternative materials of artificial origin, such as «Mucograft¼ and bloodstatic and desinfecting sponge simplifies the procedure technique thereby reducing operational risk but often does not lead to the formation of a fully keratinized gingiva.

Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures.

BACKGROUND: Subepithelial connective tissue grafts (CTGs) and free gingival grafts (FGGs) are common periodontal procedures with similar indications; however, they may differ regarding patient outcomes. Reports on postoperative periodontal patient outcomes are limited. The aim of this observational trial was to compare patient-based outcomes for CTGs and FGGs. METHODS: Patients who received CTG or FGG completed postoperative questionnaires at 3 days and 3 weeks to assess pain, number of analgesic pills taken, and number of days pills were taken. Postoperative pain was assessed using a visual analog scale (VAS). RESULTS: Twenty-three subjects (12 CTGs and 11 FGGs) completed the study. Differences between CTG and FGG groups in VAS pain scores at 3 days did not reach statistical significance. The proportion of subjects reporting pain in the palate at 3 days was significantly greater for FGG (P <0.05). There were no significant intergroup differences at 3 weeks. For the FGG group, 3-week VAS pain scores were less than the 3-day ones (P <0.01). For the entire study population, the number of days analgesic pills were taken, total number of analgesic pills taken, and number of pills taken from day 3 to the end of the study correlated with the 3-week pain scores. CONCLUSIONS: FGG is associated with a greater incidence of donor site pain compared to CTG at the early postoperative period. Longer-term pain after soft tissue grafting is associated with greater analgesic usage. There is an opportunity to improve the postoperative protocols of soft tissue grafting, particularly for FGG.

Epithelial inclusion cyst after free gingival graft: a case report.

There have been few case reports of cystic lesions occurring after gingival grafting. There are three reports of this type of sequela after connective tissue grafting, but this is the first known case of a cystlike lesion developing secondarily to a free gingival graft procedure. The bulky tissue, which had developed under the previously grafted area, was properly excised under local anesthesia. The small specimen removed was sent for histologic analysis. A new gingival graft was performed immediately after the lesion enucleation, as the cystic lesion had dislocated the earlier graft. The surgical wound healed uneventfully, and no recurrence was seen 18 months later The microscopic sections showed a cystic cavity lined with an orthokeratinized, hyperplastic, stratified squamous epithelium covered with fibrous connective tissue. The development of a cystlike lesion following a free gingival graft is, to date, an unpublished event. The fact that most cystic lesions appear in the mandibular lateral incisor-canine-first premolar area deserves further consideration.

Vertical and horizontal dimensional evaluation of free gingival grafts in the anterior mandible: a case report series.

The shrinkage of free gingival grafts (FGGs) is a well-known clinical phenomenon but there are limited studies demonstrating the dimensional changes during healing in FGGs. The aim of the study is to examine the shrinkage of FGG in both horizontal and vertical dimensions and calculate the changes in the surface area of the graft at early and delayed periods of healing. The FGG procedure was applied to 15 consecutive patients in their mandibular anterior area. The graft sizes and areas were measured and the shrinkage of the graft was calculated at baseline and days 10, 21 and 180. Hemorrhage, sense alteration and pain symptoms were also examined. Change in the horizontal direction was not statistically significant during the whole study period (p > 0.05). However, there was a statistically significant reduction in the vertical direction in all visits, except day 10 (p < 0.05). Calculated graft area was also significantly reduced during the study period at all time-points compared to the baseline (p < 0.001). At day 10, 4 (26.7%) recipient sites and 5 (33%) donor sites demonstrated paresthesia. Only one (0.07%) recipient site demonstrated paresthesia at day 21 where the donor site resulted with an uneventful healing. At day 10, 5 (33%) patients demonstrated bleeding at their donor regions and resulted with a complete cessation of bleeding at day 21. Pain symptom was found in 8 (53.3%) recipient sites where 3 (20%) donor regions presented pain symptom at day 10. Graft shrinkage in the vertical dimension seems to affect the clinical outcomes of the FGG procedure. However, the influence of horizontal graft shrinkage was minimal.

Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 2: Histological evaluation.

BACKGROUND: A number of surgical procedures are effective in covering denuded root surfaces. The first paper in this series evaluated the subepithelial connective tissue graft and the coronally advanced flap with enamel matrix derivative (EMD). That paper revealed no significant difference in the percent of root coverage between the two treatments (P = 0.82). There is limited human histological evidence of the type of attachment achieved with these types of procedures. This paper presents a human case report detailing the histological nature of the attachment of these two treatments to the root surfaces previously exposed by recession. METHODS: One patient presented with two hopeless teeth that were randomized to receive either a subepithelial connective tissue graft or a coronally advanced flap plus EMD. The surgery was accomplished in accordance to the protocol previously described. The teeth and a small collar of tissue were removed at 6 months and underwent histological analysis. RESULTS: Histological evaluation of the subepithelial connective tissue graft revealed a connective tissue attachment between the tooth and graft, and no histological evidence of cementum, bone, or periodontal ligament (PDL) and, therefore, regeneration. In addition, there appeared to be some resorption of the dentin adjacent to the graft. Histological evaluation of the coronally advanced flap with EMD revealed new cementum, organizing PDL fibers and islands of condensing bone at a constant distance from the root surface. CONCLUSIONS: The subepithelial connective tissue graft in this study was found to have adhered to the root surface primarily by a connective tissue attachment with some evidence of root resorption. The coronally advanced flap with EMD was found histologically to have all the tissues necessary for regeneration: new cementum, organizing PDL fibers, and islands of condensing bone. These histologic sections strongly suggest that enamel matrix derivative works in a biomimetic fashion by mimicking the natural process of tooth development.

Correction of the ptotic chin.

Where there is extensive stripping of the mentalis muscle from the mandible during vestibuloplasty procedures the chin tissues often become lax and droop, giving an unsightly ptotic defect. If this soft-tissue defect is combined with excessive chin tissue an excisional surgical procedure is required. This article describes a surgical procedure to produce an acceptable chin profile.

Complications of grafting in the atrophic edentulous or partially edentulous jaw.

Complications of ridge reconstruction can delay healing or even cause total failure of the procedure, making implant placement impossible. Most intraoperative complications, such as insufficient material for a graft or inadequate range of a soft tissue flap, are the result of poor treatment planning or execution. Postoperative infection is usually associated with onlay, veneer, and J grafts and dehiscence. Resorption of the graft can range from minor (exposure of the heads of the fixation screws) to total. Retraction of a soft tissue flap is most likely where the vestibule is shallow or the muscle pull is great. It is important to discuss the risks and consequences of all potential complications with the patient before informed consent is obtained. This measure will help prevent another complication, patient dissatisfaction with the results of surgery.

[Risk patients in dentistry]. / Rizikóbetegek a sztomatológiai gyakorlatban.

Authors study the risk diseases in dental practice. They analyze the possible complications and the methods of their prevention in each risk group. They take deal with the importance of antibiotic prophylaxis, the problems of local anaesthesia and the management of patients who suffer from coagulation disturbances. They present the management of risk patients in two cases. They emphasize the importance of anamnestic history in every case before dental treatment.

Treatment of the edentulous mandible with a vestibuloplasty combined with Intramobil Zylinder implants: a 5-year follow-up.

The long-term success of endosseous implants is related to healthy peri-implant tissues. Attached keratinized mucosa does not seem important for the prevention of soft tissue complications. Prevention of muscle attachment near the implants, however, seems more decisive for maintaining a favourable peri-implant environment. We treated 150 patients from 1990-91 with two Intramobil Zylinder implants and modified vestibuloplasty, 65 of whom were randomly selected for evaluation at 1 year; 48 of the 65 were also seen at 5 years. The vestibuloplasty was done by the technique of Pichler and Trauner, to prevent muscle pull and to create a thin layer of mucosa around the implants, and endosseous osseointegrated implants were inserted. The results show an adequately depended vestibulum with no muscle pull around the implants and significantly lower pocket depth after 5 years of follow-up compared with similar studies.

[Conditions of the successful outcome of mucogingival surgery during orthodontic treatment]. / Conditions de la réussite des interventions de chirurgie muco-gingivale au cours du traitement orthodontique.

For the last twenty years the mucogingival surgical technics, particularly displaced flaps, have brought gingival tissue when it is missing improving the periodontic outcome of orthodontic treatment. The displaced flaps are indicated where is a deficient attached gingiva or for uncovering retained cuspids. This state of the art is done both for the surgical and orthodontic care that are necessary as well as for the possible problems and complications after surgery.

The use of a new bilayer artificial dermis for vestibular extension.

In this study we evaluated the usefulness of a new bilayer artificial dermis (TERUDERMIS; Terumo Corporation, Japan) for vestibular extension. It is composed of a collagen sponge with the silicone layer which is sloughed off as the mucous membrane heals. We have used it for vestibular extension in 50 patients. The material was effective in nearly all patients in promoting haemostasis, relieving pain, inducing granulation, promoting rapid epithelialization, and preventing contracture. There were no side-effects. The greatest problem with such materials in the past has been contracture at the vestibular extension area. However, we found that the degree of contracture was similar to that seen with autogenous mucosa or free skin graft. Our results indicate that the material might be useful for vestibular extension.

The prevalence of altered sensation associated with implant surgery.

Trauma to branches of the mandibular nerve may occur during oral surgical procedures and result in varying degrees of altered sensation. Since mandibular implant surgery involves mucoperiosteal flap elevation and bone removal during site preparation, complications involving altered sensation are to be expected. This study replicated a retrospective questionnaire study carried out in Toronto, Canada, and showed that the prevalence of altered sensation in implant patients in Adelaide, Australia (36%) was consistent with that found in Toronto (37%). These data reflect the incidence of altered sensation reported for similar oral surgical procedures and suggest that further characterization of this complication following mandibular implant surgery is necessary.

Soft tissue profile changes after mandibular vestibuloplasty. A two-year follow-up study comparing the Edlan flap, mucosal and skin graft methods.

It is the aim of the present study to examine the pattern of postoperative changes in the soft tissue profile of 50 edentulous patients after 3 common types of mandibular vestibuloplasty, the Edlan flap operation (n = 15), the buccal mucosal graft (n = 19), and the skin graft vestibuloplasty (n = 16). The soft tissue profile changes were recorded on lateral cephalometric radiographs taken preoperatively, and after 1, 3, 6, 12, and 24 months post surgery. The 3 groups did not differ with respect to clinical features or presurgical cranio-facial morphology. Neither was any significant difference in postoperative profile changes found between the groups. The surgery gave rise, directly and indirectly, to a number of changes in the facial soft tissue profile many of which were interrelated. The chin thickness increased by 2.3 mm, and the lower lip height exhibited a reduction of 1.8 mm at 1 month after surgery as a direct consequence of the operation. After 3 months the profile changes were mostly associated with the reduction of the anterior face height (overclosure).

Skin graft vestibuloplasty exostosis. A report of two cases.

Two cases of exostosis developing after mandibular vestibuloplasty and floor-to-mouth lowering with split thickness skin graft are presented, one with multiple recurrences. The lesion is clinically and microscopically described. Hypotheses with respect to the development of this phenomenon are proposed.

Considerations in placement of implants through existing split-thickness skin graft vestibuloplasty: a case report.

Many edentulous patients who previously have undergone vestibuloplasty with split-thickness skin grafting to improve denture stability and function seek additional help with dental implants. Problems encountered following the placement of four endosseous root-form dental implants in one such patient are presented. The anatomic and surgical considerations as well as methods available to circumvent these problems are discussed.

Preprosthetic mandibular vestibuloplasty with split-skin graft. A 2-year follow-up study.

17 patients with lower denture malfunction problems related to insufficient residual ridges had a vestibuloplasty with split-skin graft performed in the mandible under local analgesia on an out-patient basis. The patients were followed-up for 2 years and records of vestibular extension showed a maximum of relapse at the 1-month control (24%). Most of the lost extension was regained at the 6-month check, and the 2-year outcome was 92% of the surgically-created vestibular sulcus extension as a mean value of records obtained at the midline and canine regions. A comparison with a previous study on buccal mucosal graft vestibuloplasty led to the conclusion that free grafts of skin and buccal mucosa prevent a relapse equally well under the same circumstances. 13 patients were satisfied with the improvement achieved, 3 reported fair, and 1 was dissatisfied with the result of the operation. The split-skin graft underwent a change of appearance in 5 cases interpreted as a skin graft candidosis. Indication of this condition accelerating the residual ridge resorption is discussed.