Autogenous Soft Tissue Grafts Research Articles

Augmentation of keratinized tissue using autogenous soft-tissue grafts and collagen-based soft-tissue substitutes at teeth and dental implants: Histological findings in a pilot pre-clinical study.

To histomorphometrically assess three treatment modalities for gaining keratinized tissue (KT) at teeth and at dental implants. In five dogs, the distal roots of the mandibular second, third and fourth premolars were extracted. Dental implants were placed at the distal root areas 2 months later. After another 2 months, KT augmentation was performed at both distal (implants) and at mesial root (teeth) areas in the presence (wKT groups) or absence (w/oKT groups) of a KT band at the mucosal/gingival level. Three treatment modalities were applied randomly: apically positioned flap only (APF), free gingival grafts (FGGs) and xenogeneic collagen matrices (XCMs). A combination of the above produced six groups. Two months later, tissue sections were harvested and analysed histomorphometrically. The median KT height and length were greatest at implants with FGG in both wKT (3.7 and 5.1 mm, respectively) and w/oKT groups (3.7 and 4.6 mm), and at teeth with FGG in wKT groups (3.7 and 6.1 mm) and with APF in the w/oKT groups (3.9 and 4.4 mm). The XCM and APF produced more favourable results at teeth than at implants. FGG was advantageous in gaining KT, especially at implants.

Bacterial cellulose matrix and acellular dermal matrix seeded with fibroblasts grown in platelet-rich plasma supplemented medium, compared to free gingival grafts: a randomized animal study.

Mucogingival defects (MGDs), such as dental root recessions, decreased vestibular depth, and absence of keratinized tissues, are commonly seen in dental clinics. MGDs may result in functional, aesthetic, and hygienic concerns. In these situations, autogenous soft tissue grafts are considered the gold-standard treatment. This study compares the healing process of free gingival grafts (FGGs) to bacterial cellulose matrix (BCM) and human acellular dermal matrix (ADM) seeded with fibroblasts from culture supplemented with platelet-rich plasma in a rat model. Surgical defects were made in rats, which received the following treatments in a randomized manner: group I, negative control (defect creation only); group II, positive control (FGG); group III, BCM; group IV, BCM + fibroblasts; group V, ADM; and group VI, ADM + fibroblasts. Clinical, histological, and immunological analyses were performed 15 days after grafting. Clinical examinations recorded epithelium regularity and the presence of ulcers, erythema, and/or edema. The histological analysis revealed the degree of reepithelization, width, regularity, and presence of keratin. The Fisher exact statistical test was applied to the results (P<0.05). No groups showed ulcers except for group I. All groups had regular epithelium without erythema and without edema. Histologically, all groups exhibited regular epithelium with keratinization, and myofibroblasts were present in the connective tissue. The groups that received engineered grafts showed similar clinical and histological results to the FGG group. Within the limitations of this study, it was concluded that BCM and ADM can be used as cell scaffolds, with ADM yielding the best results. This study supports the use of this technical protocol in humans.

Therapeutic effectiveness of keratinized mucosa augmentation for functioning dental implants: A systematic review and meta-analysis.

This study aimed to provide the latest updates on the therapeutic effectiveness of keratinized mucosa (KM) augmentation using autogenous soft tissue grafts for dental implants retaining prostheses. A systematic search of electronic databases was conducted on autogenous soft tissue grafts to create and/or augment KM for functioning dental implants. Two investigators independently extracted data from the selected 11 clinical studies, including 290 participants, from the initially retrieved 573 publications. A lack of KM surrounding dental implants was associated with greater mucosal inflammation. A free gingival graft (FGG) was used to increase the KM width, and a connective tissue graft (CTG) was used to manage peri-implant mucosal recession (MR). The weighted mean gain in KM was 2.6 mm from the selected FGG studies, with a significant reduction in mucosal inflammation and no changes in crestal bone levels for up to 4 years. The weighted mean reduction in MR was 2 mm in selected CTG studies. A lack of KM negatively affects soft tissue health around dental implants. FGG was effective in increasing KM and reducing mucosal inflammation, whereas CTG was effective in decreasing MR.

A Case Report of Periodontal Regeneration in Failing Tooth by Single Flap Approach Using Sticky Bone and Platelet-rich Fibrin Membrane

Periodontal regeneration aims to regenerate the diseased or lost periodontium. Regenerative periodontal therapy utilises growth factors, autogenous soft and hard tissue grafts for the purpose of regeneration. Platelet-rich Fibrin (PRF) is an autologous biomaterial which works on the principle of centrifugation. The injectable PRF (i-PRF) that is formed when centrifuged at low Revolutions Per Minute (RPM) produces an excellent matrix when mixed with bone graft called “sticky bone”. Sticky bone possesses the property of mouldability along with its inherent potential of bone formation. The PRF matrix also enhances the wound healing through the release of various growth factors. PRF membranes which are obtained at higher centrifugation levels also act as a substitute to augment the soft-tissues. The present case is that of a 45-year-old male, who underwent a one-year follow-up for the management of endodontic periodontal lesion in the lower left first molar with sticky bone and PRF membrane by single flap approach. The patient was periodically reviewed clinically and radiographically and prosthetic restoration was given on accessing the radiographic bone fill after six months. After six months there was a significant difference in the radiographic bone fill, along with the reduction in the probing pocket depth from 7 mm to 4 mm and clinical attachment from 9 mm to 7 mm. The results indicate that sticky bone and PRF membrane serves as a predictable source for the management of intrabony defects.

Stem-cell based soft tissue substitutes: Engineering of crosslinked polylysine-hyaluronic acid microspheres ladened with gingival mesenchymal stem cells for collagen tissue regeneration and angiogenesis.

The aim of this study was to construct crosslinked polylysine-hyaluronic acid microspheres (pl-HAM) ladened with gingival mesenchymal stem cells (GMSCs) and explore its biologic behavior in soft tissue regeneration. The effects of the crosslinked pl-HAM on the biocompatibility and the recruitment of L-929 cells and GMSCs were detected in vitro. Moreover, the regeneration of subcutaneous collagen tissue, angiogenesis and the endogenous stem cells recruitment were investigated in vivo. We also detected the cell developing capability of pl-HAMs. The crosslinked pl-HAMs appeared to be completely spherical-shaped particles and had good biocompatibility. L-929 cells and GMSCs grew around the pl-HAMs and increased gradually. Cell migration experiments showed that pl-HAMs combined with GMSCs could promote the migration of vascular endothelial cells significantly. Meanwhile, the green fluorescent protein-GMSCs in the pl-HAM group still remain in the soft tissue regeneration area 2weeks after surgery. The results of in vivo studies showed that denser collagen deposition and more angiogenesis-related indicator CD31 expression in the pl-HAMs+ GMSCs + GeL group compared with the pl-HAMs + GeL group. Immunofluorescence showed that CD44, CD90, CD73 co-staining positive cells surrounded the microspheres in both pl-HAMs + GeL group and pl-HAM + GMSCs + GeL group. The crosslinked pl-HAM ladened with GMSCs system could provide a suitable microenvironment for collagen tissue regeneration, angiogenesis and endogenous stem cells recruitment, which may be an alternative to autogenous soft tissue grafts for minimally invasive treatments for periodontal soft tissue defects in the future.

Morphological changes in alveolar bone thickness and height after orthodontic proclination or labial movement combined with autogenous soft tissue grafting: a CBCT evaluation

BackgroundAutogenous soft tissue grafting is indicated in thin gingival biotypes before orthodontic proclination or labial movements to increase the keratinized gingiva and prevent gingival recession. However, its effect on local alveolar bone remodeling is unclear. The aim of this study was to investigate the effects of autogenous soft tissue grafting on local alveolar bone after orthodontic proclination or labial movements.MethodsSixteen patients with a thin scalloped gingival biotype, narrow keratinized gingiva, or thin cortical bone requiring orthodontic proclination or labial movement of teeth were included. Cone-beam computed tomography (CBCT) images were obtained before grafting and at least 6 months after surgery. Sixty mandibular teeth were included, and the vertical bone level and horizontal labial bone thickness were measured. The results were compared using paired t-tests or Wilcoxon signed-rank test.ResultsThe horizontal labial bone thickness increased, especially at 6 mm below the cementoenamel junction (CEJ) in the mandibular central and lateral incisors (P < 0.05). The total alveolar bone area of the canines, first premolars, and second premolars increased at 3, 6, and 9 mm below the CEJ, respectively, and the differences were statistically significant (P < 0.05). Additionally, vertical bone height increased minimally on the labial side, but the differences were not statistically significant (P > 0.05).ConclusionsNew bone regeneration was observed on the labial (pressure) side after autogenous soft tissue grafting, which may represent a mechanism to effectively prevent gingival recession and maintain periodontal health.IRB approvalAll the experimental procedures involving humans in this study were approved by the Medical Ethics Committee of Xiangya Stomatological Hospital, Central South University ( No. 20190048).

Evaluation of bioactivity and biodegradability of a biomimetic soft tissue scaffold for clinical use: An in vitro study.

Autogenous soft-tissue graft is the gold-standard approach to augment oral soft tissues. However, tissue engineering is increasingly surveyed to overcome its substantial drawbacks, including the secondary site of operation, patient's pain and discomfort, limited tissue of donor site, and so on. Chitosan and gelatin have been utilized in this field over the years due to their great biological virtues. Zeolite, another remarkable candidate for tissue engineering, possesses outstanding biological and mechanical properties, thanks to its nanostructure. Therefore, this study aimed to investigate the biodegradability and DNA content of seeded human gingival fibroblasts on a New Chitosan-Gelatin-Zeolite Scaffold for the perspective of oral and mucosal soft tissue augmentation. DNA contents of the human gingival fibroblast cell line (HGF.1) seeded on the chitosan-gelatin (CG) and CGZ scaffolds were evaluated by propidium iodide staining on days 1, 5, and 8. Scaffolds' biodegradations were investigated on days 1, 7, 14, 28, 42, and 60. Although both scaffolds provided appropriate substrates for HGF.1 growth, significantly higher DNA contents were recorded for the CGZ scaffold. Among experimental groups, the highest mean value was recorded in the CGZ on day 8. CGZ showed a significantly lower biodegradation percentage at all time points. The incorporation of zeolite into the CG scaffold at a ratio of 1:10 improved the cell proliferation and stability of the composite scaffold. CGZ scaffold may offer a promising alternative to soft-tissue grafts due to its suitable biological features.

Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting.

Palatal-tissue harvesting is a routinely performed procedure in periodontal and peri-implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft-tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed.

Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta-analysis of patient-reported outcome measures.

The aim of this study was to compare patient-reported outcome measures (PROMs) of soft tissue substitutes versus autogenous grafts for soft tissue augmentation procedures at implant sites. Comprehensive and systematic literature searches were performed until December 2021. A focused question was formulated based on the Population, Intervention, Comparison and Outcome criteria (PICO): In patients with dental implants undergoing soft tissue augmentation (P), do soft tissue substitutes (I) compared to autogenous soft tissue graft (SCTG [subepithelial connective tissue graft]) (C) limit the post-operative morbidity and other patient reported-outcomes measures (O). Randomized controlled clinical trials, prospective-, retrospective- and case-series studies were included. Meta-analyses were performed whenever possible and the results were expressed as weighted mean differences (WMD). A total of 29 clinical studies were included. For mucosal thickness gain, soft tissue substitutes significantly reduced the pain perception compared to SCTG (n=4; WMD=14.91 Visual Analog Scale [VAS] units; 95% confidence interval [CI] 6.42-23.40; P< .0006) based on a 0-100 VAS scale. Based on a 0-10 VAS scale, a borderline significance of pain reduction was found when soft tissue substitutes were applied (n=4; WMD=1.62 VAS units; 95% CI 0.01-3.23; P= .05). For keratinized tissue gain, soft tissue substitutes significantly reduced the pain perception after keratinized tissue augmentation compared to SCTG based on a 0-100 VAS scale (n=2; WMD=21.43 VAS units; 95% CI 12.58-30.28; P< .0001). Based on the 0-10 VAS scale, soft tissue substitutes significantly reduced the pain as compared to SCTG (n=4; WMD=1.65 VAS units; 95% CI 0.66-2.64; P= .001). Regarding pain medication, soft tissue substitutes required less painkillers (n=6; WMD=1.56 tablets; 95% CI 1.22-1.91; P< .00001) after soft tissue augmentation. The surgery time was significantly reduced when soft tissue substitutes were used (n=5; WMD=10.9minutes; 95% CI 4.60-17.19; P< .00001). There were no significant differences in satisfaction, aesthetics, and quality of life (OHIP-14) between soft tissue substitutes and autogenous grafts following soft tissue augmentation at implants sites. Soft tissue substitutes, compared to autogenous grafts, significantly improve PROMs following soft tissue augmentation at implant sites. Soft tissue substitutes can reduce pain perception, amounts of painkillers and surgery time while achieving similar levels of patient´s satisfaction as autogenous grafts without impairing the clinical outcomes. The current evidence indicates that they constitute a valid and reliable alternative to minimize the invasiveness in soft tissue augmentation procedures at implant sites.

Three-Dimensional Volumetric Analysis of the Palatal Donor Site Following Soft Tissue Harvesting.

Autogenous soft tissue grafting is a commonly performed procedure in periodontal and implant surgery. Reharvesting a connective tissue graft (CTG) from the same palatal donor site is often required, but little is known about the volumetric changes that occur after harvesting a free gingival graft and how long the palatal mucosa takes to regain its original form and thickness. This study evaluated the volumetric changes that occur at the palatal donor site after harvesting a soft tissue graft with a noninvasive digital technology. Nineteen patients needing a CTG for a single site were enrolled. Intraoral digital scans of the palatal donor sites were obtained at baseline and at 1, 3, 6, and 12 months. The digital scans were imported and analyzed with an imaging software to evaluate volumetric changes. Average volume losses of 5.82 ± 2.63 mm3 and 11.03 ± 5.47 mm3 were observed after 1 and 3 months, respectively. Only minor changes were observed at 6 and 12 months. Linear dimensional changes at 5 and 7 mm from the gingival margin were substantially higher than the changes at 3 mm for the 1- and 3-month interval comparisons compared to baseline. Graft dimension was associated with volume loss at 1 and 3 months (P < .01). After palatal harvesting, the donor site undergoes volumetric changes, mostly during the first 3 months, and is attenuated thereafter.

Immediate Implant Placement in Conjunction with Acellular Dermal Matrix or Connective Tissue Graft: A Randomized Controlled Clinical Volumetric Study.

Connective tissue grafts have become a standard for compensating horizontal volume loss in immediate implant placement. The use of new biomaterials like acellular matrices may avoid the need to harvest autogenous grafts, yielding less postoperative morbidity. This randomized comparative study evaluated the clinical outcomes following extraction and immediate implant placement in conjunction with anorganic bovine bone mineral (ABBM) and the use of a porcine acellular dermal matrix (ADM) vs an autogenous connective tissue graft (CTG) in the anterior maxilla. Twenty patients (11 men, 9 women) with a mean age of 48.9 years (range: 21 to 72 years) were included in the study and randomly assigned to either the test (ADM) or control (CTG) group. They underwent tooth extraction and immediate implant placement together with ABBM for socket grafting and either ADM or CTG for soft tissue augmentation. Twelve months after implant placement, the cases were evaluated clinically and volumetrically. All implants achieved osseointegration and were restored. The average horizontal change of the ridge dimension at 1 year postsurgery was -0.55 ± 0.32 mm for the ADM group and -0.60 ± 0.49 mm for the CTG group. Patients of the ADM group reported significantly less postoperative pain. Using xenografts for hard and soft tissue augmentation in conjunction with immediate implant placement showed no difference in the volume change in comparison to an autogenous soft tissue graft, and showed significantly less postoperative morbidity.

Biomechanical Characterization of a New Acellular Dermal Matrix for Oral Soft Tissue Regeneration

Objectives Acellular dermal matrices (ADM) are a suitable alternative to autogenous soft tissue grafts (ASG). The aim of this study was to analyze the biomechanical properties and architectural features of ASG and ADM. Materials and methods ASG were harvested from the hard palate of fresh frozen body donors as connective tissue grafts and compared to ADM of porcine origin (NovoMatrix, NM; mucoderm, MD). Maximum load (ML, Newton [N]) and expansion (E, [mm]) were measured after rehydration in saline solution by tensile strength measurement. Light microscopy (LM) and scanning electron microscopy (SEM) were performed to analyze the architectural features of ASG and ADM in high resolution. Results ASG demonstrated a significantly decreased ML compared to NM and MD (p < 0.0001 and p = 0.019). NM showed a significantly increased ML compared to MD (p = 0.001). ASG demonstrated a non-significantly reduced E compared to NM (p = 0.13) and a significantly increased E compared to MD (p = 0.025). NM showed an increased E compared to MD (p < 0.0001). LM and SEM highlighted the surface characteristics and internal structures of ASG and ADM, such as the surface compact layer of MD and the densely packed, parallel running and ordered collagen fibers of NM and MD. Conclusions Significant differences concerning the biomechanical properties and architectural features of ASG, and ADM were found. Clinical relevance Information about the biomechanical properties and architectural features of ASG and ADM can contribute to a better understanding of the clinical performance and extend the application area.

Peri-implant soft-tissue esthetic outcome after immediate implant placement in conjunction with xenogeneic acellular dermal matrix or connective tissue graft: A randomized controlled clinical study.

This randomized comparative study evaluated the clinical esthetic outcome of the peri-implant mucosa following extraction and immediate implant placement in conjunction with anorganic bovine bone mineral (ABBM) and the use of a porcine acellular dermal matrix (pADM) versus an autogenous connective tissue graft (CTG) in the anterior maxilla. Twenty patients (11 men, 9 women) with a mean age of 48,9 years (range 21-72) were included in the study and randomly assigned to either the test (pADM) or control group (CTG). They underwent extraction and immediate implant placement together with ABBM for socket grafting and either pADM or CTG for soft tissue augmentation. Twelve months after implant placement color measurements of the peri-implant mucosa and a reference tooth were performed using a spectophotometer and the color difference (ΔE) was calculated. The overall esthetic appearance of the peri-implant soft tissue was evaluated using the Pink Esthetic Score (PES). Statistical analysis was performed using Student's T-Test, the alpha was set to 0.05. All implants received osseointegration and were restored. The mean color difference of the peri-implant mucosa 1year after surgery amounted ΔE 4.06 ± 1.6 for the test group (pADM) and ΔE 3.58 ± 1.36 mm for the control group (CTG), showing no statistically significant difference (p=0.47). The mean PES of the pADM group was 11.4 ± 1.4 and for the CTG group 10.7 ± 1.5, showing no statistically significant difference (p=0.29). Twelve months after surgery, a porcine acellular dermal matrix for soft tissue augmentation in conjunction with immediate implant placement showed no difference in the overall esthetic appearance regarding color match and Pink Esthetic Score in comparison to autogenous soft tissue graft. Connective tissue grafts have become a standard in order to enhance the soft tissue quality and esthetic appearance in immediate implant placement. The use of new biomaterials like porcine acellular dermal matrices may avoid the need to harvest autogenous grafts resulting in simplified treatment and less postoperative morbidity.

EAO‐349 / OC‐SU‐006 | Effects of A‐PRF and CGF on palatal wound healing after autogenous soft tissue graft harvest

EAO‐349 / OC‐SU‐006 | Effects of A‐PRF and CGF on palatal wound healing after autogenous soft tissue graft harvest

The use of Nile Tilapia skin as an occlusive biological dressing for palatal wound healing: A case series

Recently, the use of type I collagen obtained from Nile Tilapia (Oreochromis niloticus) was proposed for the treatment of second and third-degree burning lesions and diabetic ulcers due to its occlusive and healing properties. The aim of this report is to describe the use of Nile tilapia skin as an occlusive barrier to protect palatal wounds after the removal of free autogenous soft tissue grafts. Two patients with a deficiency in the height of keratinized mucosa were indicated for treatment with free gingival grafts. The palatal donor area was covered with a Nile tilapia skin, stabilized by sutures. Seven days after surgery, patients returned for post-operative care. Patients’ reported outcomes were investigated by the use of a visual analogue scale and included pain, discomfort, impact on chewing and speaking. Analgesics consumption was also recorded. Standardized photographs were obtained to monitor wound healing. Patients were followed up for 30 days. Patients reported reduced pain levels, with low consumption of analgesics during the first week after surgery. No discomfort or difficulty in chewing or speaking was reported. No complications such as hemorrhage or edema were observed. These findings suggest that the Nile Tilapia skin may be an interesting alternative as an occlusive biological dressing in palatal wounds harvest of free gingival grafts.

Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet Laser for Root Conditioning and Reduction of Postoperative Morbidity in the Treatment of Gingival Recession Defects: A Randomized Controlled Clinical Trial.

Objective: This clinical trial evaluates the effect of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) root surface biomodification and laser harvesting of de-epithelialized gingival graft (DGG) on root coverage clinical outcomes and postoperative morbidity, and compares this to the conventional blade-harvested DGG method without Er,Cr:YSGG root surface biomodification in treatment of Miller's class I, II gingival recessions (GR). Background: The application of laser technology to enhance tooth root coverage clinical outcomes as well as the impact of laser on postoperative morbidity after harvesting autogenous soft tissue grafts requires further research. Methods: This study is a randomized, single-blinded controlled trial, including 24 volunteers with isolated GR defects. They were allocated into three treatment groups to receive one of the following three interventions: blade-harvested DGG (control group: B-DGG); Er,Cr:YSGG-harvested DGG and root surface biomodified [test 1 group: L-laser-harvested DGG (L-DGG)/laser root biomodification (LRB)]; and B-DGG and Er,Cr:YSGG root surface biomodification (test 2 group: B-DGG/LRB). Clinical and radiographic parameters were recorded at baseline (1 week before surgery) and 3, 6, and 9 months postoperatively. Results: Root coverage did not show a statistically significant difference between control and test groups. Statistically significant differences were found for Visual Analog Scale on the day of surgery and day 3 and 4 postoperatively, as well as pain medication on the day of surgery favoring the L-DGG group. Conclusions: The use of Er,Cr:YSGG laser in root surface biomodification improved root coverage outcomes at 9 months. Even these changes were not statistically significant from the control group; the L-DGG technique was associated with decreased postoperative morbidity in the palatal donor site.

Viability of Quercetin-Induced Dental Pulp Stem Cells in Forming Living Cellular Constructs for Soft Tissue Augmentation.

Autogenous gingival grafts used for root coverage or gingival augmentation procedures often result in donor site morbidity. Living cellular constructs as an exogenous alternative have been proven to be associated with lower morbidity. With the available background information, the present study aims to assess if quercetin-induced living cell constructs, derived from dental pulp stem cells, have the potential to be applied as a tool for soft tissue augmentation. The characterized dental pulp stem cells (positive for CD73, CD90, and negative for CD34, HLA-DR) were expanded in Dulbecco’s Modified Eagle’s medium (DMEM) supplemented with 10 mM quercetin. The handling properties of the quercetin-induced dental pulp stem cell constructs were assessed by visual, and tactile sensation. A microscopic characterization using hematoxylin and eosin staining, and qRT-PCR-based analysis for stemness-associated genes (OCT4, NANOG, SOX2, and cMyc) was also performed. Dental pulp stem cells without quercetin administration were used as the control. Dental pulp stem cell constructs induced by quercetin easily detached from the surface of the plate, whereas there was no formation in the control cells. It was also simple to transfer the induced cellular construct on the flattened surface. Microscopic characterization of the constructs showed cells embedded in a tissue matrix. Quercetin also increased the expression of stemness-related genes. The use of quercetin-induced DPSC living constructs for soft tissue augmentation could provide an alternative to autogenous soft tissue grafts to lower patient morbidity and improve esthetic outcomes.

Patient experience of autogenous soft tissue grafting has an implication for future treatment: A 10- to 15-year cross-sectional study.

Patient-reported outcomes have received a great deal of interest in periodontal plastic procedures. However, their evaluation has mainly been short-term. Thus, the aim of this study was to evaluate the impact of soft tissue grafting procedures conducted over a decade ago on the willingness of a patients to undergo the surgery again. Subjects that received an autogenous soft tissue graft over 10 years ago were screened and invited for a survey. Their response was only analyzed if they were able to correctly identify the sites of the surgical procedures. Dichotomous questions and visual analogue scales (VASs) were used to assess self-reported pain, willingness to retreat and satisfaction. Fifty-two patients were included in the analyses. Higher pain was reported for mandibular sites, and treated areas including ≥ 3 teeth (P<0.01). Willingness to retreatment was 84.6% and it was negatively associated with self-reported pain measures, the arch location (mandible), and number of treated sites (≥3 teeth) (P<0.01). Mean satisfaction rate was 86.9 ± 13.65 (VAS) and showed a positive correlation with willingness to retreat (P<0.01). Having a complete root coverage at the recall visit was also significantly associated with higher patient satisfaction scores (P<0.01). Patient experience of previous autogenous soft tissue grafting has an influence on their decision to undergo future treatment. Willingness to retreat was negatively affected by mandibular sites, larger treated areas and the perceived pain, while presenting with complete root coverage was significantly associated with patient satisfaction.

Topical phenytoin effects on palatal wound healing.

The clinical benefits of autogenous soft tissue grafts are countered by donor site morbidity. The aim of this prospective split-mouth clinical trial is to assess clinical, histological and patient outcomes following topical phenytoin (PHT) treatment of experimental palatal wounds. Systemically healthy adults were recruited. One 6mm diameter wound (posterior) and one 4mm diameter wound (anterior), each 1-1.5mm deep, were created on both sides of the palate. Wounds on one randomly chosen side received 10% phenytoin USP and contralateral wounds received carrier alone. Biopsies were harvested from anterior wounds (Day1 or Day5) and were routinely processed for histology. Posterior wounds were left undisturbed to clinically evaluate healing (using photographs and Healing Score Index) on Days1, 5, 14, and 21. Questionnaires were used to assess patient-centered outcomes. Data analysis was performed using generalized logistic and generalized linear mixed models. Twenty participants completed all visits. 30% of participants reported more pain on control side than the PHT side at Day1 (P=0.014). PHT treated sites were more likely to not exhibit swelling (OR=9.35; P=0.009) and to not experience pain on palpation (OR=6.278; P=0.007). PHT significantly and time-dependently affected granulation tissue appearance (P=0.004). Histologically, there were no significant differences between control and PHT, at any time point (P ≥ 0.853). The results of the present study, the first one to report on topical PHT as palatal wound treatment, suggest that PHT application on palatal wounds could result in improved healing outcomes.

State of the Art on Biomaterials for Soft Tissue Augmentation in the Oral Cavity. Part I: Natural Polymers-Based Biomaterials.

Oral soft tissue thickening or grafting procedures are often necessary to cover tooth recession, re-establish an adequate width of keratinized tissue, correct mucogingival deformities improving esthetics, prepare a site for an implant or prosthetics, for ridge preservation procedures, and soft tissue contouring around dental implants. Gingival recession and root or implant exposure are commonly associated and have led to mucogingival deficiencies that have traditionally been treated with free gingival grafts and autogenous soft tissue grafts. The latter represents the gold standard in acquiring a functionally adequate zone of keratinized attached gingiva. However, soft tissue substitutes are more usually employed because they lessen morbidity and abbreviate surgical time. This review is aimed at assessing oral soft tissue augmentation techniques and biomaterials used from existing literature, principally concerning scaffolds from both human and animal-based tissue derivatives matrices. In order to avoid the use of human donor tissue, the xenogenic collagen matrices are proposed for soft tissue augmentation. In general, all of them have provided the remodeling processes and enhanced the formation of new connective tissue within the matrix body.