Autogenous Soft Tissue Grafts Research Articles

Impact of timing on soft tissue augmentation during implant treatment: A systematic review and meta-analysis.

To achieve a predictable esthetic and functional outcome, soft tissue augmentation has become popular in implant treatment. The aim of this systematic review and meta-analysis was to assess the influence of different timing for soft tissue augmentation during implant treatment on soft tissue conditions and its stability. Electronic and manual searches for articles written in English up to September 2017 were performed by two independent reviewers. Human clinical studies with the purpose of evaluating outcomes (at least 3-month follow-up) of autogenous soft tissue graft for augmentation during implant treatment, either simultaneous or after implant placement (staged), were included. Cumulative changes of keratinized tissue width (KTW), soft tissue thickness (STT), and mid-buccal mucosal recession (MR) data were analyzed with a random-effects model to compare the postoperative outcomes. Twenty-nine human studies (eight randomized clinical trials, six cohort studies, and 15 case series) that met the inclusion criteria were included. For the overall data, the weighted mean STT gain (1year after surgery) was 1.03mm (95% CI: 0.78-1.29mm), among which the simultaneous group was 1.12mm (95% CI: 0.75-1.49mm) and staged group (3-6months after implant placement) was 0.95mm (95% CI: 0.58-1.31mm). There was no statistically significant difference in KTW and MR between 3months and more than 3months after surgery. This review revealed that the stability of soft tissue, in terms of KTW and mid-buccal MR, can be obtained 3months after surgery. There is no difference between simultaneous and staged soft tissue augmentation during implant treatment, and both procedures significantly enhance KTW and STT.

The efficacy of a porcine collagen matrix in keratinized tissue augmentation: a 5-year follow-up study

BackgroundWhen keratinized tissue width around dental implants is poorly represented, the clinician could resort to autogenous soft tissue grafting. Autogenous soft tissue grafting procedures are usually associated with a certain degree of morbidity. Collagen matrices could be used as an alternative to reduce morbidity and intra-operatory times. The aim of this study was to assess the efficacy of a xenogeneic collagen matrix as a substitute for soft tissue grafting around dental implants.MethodsFifteen consecutive patients underwent a vestibuloplasty and keratinized tissue reconstruction around dental implants, both in the mandible and the maxilla, with a porcine collagen matrix. The so obtained keratinized tissues were measured and evaluated after 6 months and 1, 4, and 5 years.ResultsThe average gain of keratinized tissue was 5.7 mm. After 6 months, it was observed a resorption of 37%, after 1 year 48%, and after 5 years 59%. The mean gain of keratinized tissue after 5 years was 2.4 mm. Hemostatic effect and post-operative pain were evaluated too. All subjects referred minimal pain with no bleeding. No adverse reaction nor infection was noted.ConclusionsThe present study showed the efficacy of a porcine collagen matrix in keratinized tissue augmentation. 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.

Extraction socket sealing using palatal gingival grafts and resorbable collagen membranes

BackgroundSocket sealing surgery is performed for the preservation of the form and volume of the soft tissue by covering the resulting socket with autogenous soft tissue graft or membrane barriers. This procedure is usually necessary to improve the esthetic results of the maxillary anterior or premolar areas.MethodsThis study retrospectively investigated cases involving the open membrane technique or socket sealing surgery with a palatal gingival graft or collagen membrane where implant placement and bone grafting were performed immediately after tooth extraction. From January 2005 to December 2008, socket sealing surgery was performed in 24 patients, and 25 implants were placed.ResultsAll implants were successful in the follow-up period. In the palatal gingival graft group, the mean marginal bone loss was 1.17 mm during the mean follow-up period of 81.0 months. In the collagen membrane group, the mean marginal bone loss was 1.23 mm during the mean follow-up period of 76.9 months. There was no significant difference between the two groups.ConclusionsConsequently, socket sealing surgery is effective at minimizing the loss of soft tissue and alveolar bone.

Topical simvastatin gel as a novel therapeutic modality for palatal donor site wound healing following free gingival graft procedure

Objective: Autogenous soft-tissue grafting is a commonly used procedure nowadays in dentistry. However, the prolonged healing time needed for the donor site leads to increase the patient’s pain and discomfort. Statin has been observed to be beneficial in reducing bacterial burden, improving epithelization and wound healing. The aim of this study was to evaluate intra-oral topical application of simvastatin/chitosan gel (10 mg/mL) over the palatal donor site following free gingival graft (FGG) procedure.Material and methods: Subjects indicated for FGG procedure were divided into four groups. Group I: Simvastatin suspension (S), group II: simvastatin/chitosan gel (SC), group III: chitosan gel (C), group IV: petroleum gel (P). Treatment was applied three times/day for the following 7 days. Wound healing was evaluated at day 3, 7 and 14 post-surgery. A visual analogue scale (VAS) was used to measure the experienced discomfort at 1, 3, 5, 7 and 14 days.Results: Statistical significant reduction in wound-healing scores was observed after 3 and 7 days for group II compared to other groups (p = .015). A significant reduction was also observed in VAS score for group II compared to other groups at day 1, 3, 5 and 7.Conclusion: Topical application of S/C gel could be used as a novel therapeutic modality that improved healing and reduced pain in the palatal donor site following FGG procedure.

Long-Term Clinical and Radiographic Observation of Periimplant Tissues After Autogenous Soft Tissue Grafts: A 15-Year Retrospective Study.

The aim of this study was to evaluate the periimplant tissues after autogenous soft tissue graft (ASTG) during 15 years of follow-up. The clinical parameters, dimension of keratinized mucosa (KM), and marginal bone loss of 50 patients with 127 implants were followed up and their relationships were assessed at 15-year follow-up. In addition, clinical and radiographic parameters of 11 patients who had both autogenous soft tissue grafted (n = 21 implants) and nongrafted (n = 21 implants) sides were compared. The thickness of the KM was related to the width of the KM (P < 0.01) and mucosal recession (P < 0.05); however, there was no significant association between marginal bone loss and dimension of the KM. The autogenous soft tissue grafted group showed statistically significantly lower modified bleeding index, wider and thicker KM than the nongrafted group. However, the modified plaque index, probing depth, and marginal bone loss did not show any significant differences between 2 groups. This 15-year follow-up study shows that the thickness or width of KM is not related to the marginal bone loss around implants. However, it seems that ASTG can be beneficial for preventing mucosal recession and soft tissue inflammation around dental implants.

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.

Influence of porcine-derived collagen matrix on endothelial progenitor cells: an in vitro study.

Porcine-derived collagen matrix (PDCM) has been reported as a promising alternative to autogenous soft tissue grafts in periodontal plastic surgery. The aim of this study was to analyze the influence of a novel PDCM on endothelial progenitor cells (EPC) in vitro. EPC were isolated from human peripheral blood, cultured and transferred on the PDCM (mucoderm®). Tissue culture polystyrene surface (TCPS) served as control. Cell viability of EPC on PDCM was measured by a MTT and PrestoBlue® assay. Migration ability was tested using a Boyden migration assay. A ToxiLight® assay was performed to analyze the influence of PDCM on adenylate kinase (ADK) release and apoptosis rate of EPC. Using the MTT assay, EPC cultured on PDCM demonstrated a significantly increased cell viability compared to the control group at days 3, 6 and 12 (p each <0.001). According to the PrestoBlue® assay, EPC showed a significant increase of cell viability compared to the control group at 48, 72, and 96 h (p each <0.001). In the Boyden migration assay, a significantly increased EPC migration ability could be observed after 3-12 days (p each ≤0.001). No significantly increased apoptosis rate of EPC on PDCM could be observed with exception after 96 h (p each >0.05). Overall, our results suggest a good biocompatibility of PDCM without any cytotoxic effects on EPC, which might support a rapid revascularization and therefore a sufficient ingrowth of the PDCM.

In vitro and in vivo characterization of porcine acellular dermal matrix for gingival augmentation procedures

Recently, porcine acellular dermal matrix (PADM) has been proposed as a possible alternative to autogenous grafts in periodontal plastic surgery. The aim of the present study was to investigate the in vitro responses of four different oral cell lines cultured on a novel PADM. Furthermore, tissue reaction to PADM was evaluated histologically after subcutaneous implantation in mice. Human gingival fibroblasts (HGF), human osteoblast-like cells, human umbilical vein endothelial cells and human oral keratinocytes (HOK) were cultured and transferred on to the PADM. A tissue culture polystyrene surface served as the control. The viability of all tested cell lines on PADM was measured by using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide colorimetric assay and PrestoBlue(®) reagent. The ToxiLight(®) assay was performed to analyze the effect of PADM on adenylate kinase release. PADM was implanted into nude mice subcutaneously and subjected to histological analysis after 21 d. Using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide colorimetric assays, all tested cell lines cultured on PADM demonstrated a significant increase of viability compared to the control group (each p < 0.001) with the exception of HGF and HOK after 3 d (each p > 0.05). According to the PrestoBlue(®) analysis, all cell lines demonstrated a significant increase of viability compared to the control group at the particular points of measurement after 18 h (HGF p < 0.01; human osteoblast-like cells, human umbilical vein endothelial cells, HOK each p < 0.001). No significant cytotoxic effects of PADM on the tested cell lines could be observed, as assessed by changes in adenylate kinase release. Subcutaneous implantation of PADM into nude mice demonstrated good integration with surrounding tissues and significant revascularization of its collagen structure. Overall, the results suggest that PADM is a promising substitute for autogenous soft tissue grafts in periodontal surgery.

Radiographic evaluation of different techniques for ridge preservation after tooth extraction: a randomized controlled clinical trial

To evaluate the radiographic changes of the alveolar ridge following application of different ridge preservation techniques 6 months after tooth extraction. Four treatment modalities were randomly assigned in 40 patients: β-tricalcium-phosphate-particles with polylactid coating (β-TCP), demineralized bovine bone mineral with 10% collagen covered with a collagen matrix (DBBM-C/CM), DBBM-C covered with an autogenous soft-tissue graft (DBBM-C/PG) and spontaneous healing (control). Cone-beam computed tomography scans were performed after treatment and 6 months later. After 6 months, the vertical changes ranged between -0.6 mm (-10.2%) for control and a gain of 0.3 mm (5.6%) for DBBM-C/PG on the lingual side, and between -2.0 mm (-20.9%) for β-TCP and a gain of 1.2 mm (8.1%) for DBBM-C/PG on the buccal side. The most accentuated ridge width changes were recorded 1 mm below the crest: -3.3 mm (-43.3%, C), -6.1 mm (-77.5%, β-TCP), -1.2 mm (-17.4%, DBBM-C/CM) and -1.4 mm (-18.1%, DBBM-C/PG). At all three levels, DBBM-C with either CM or PG was not significantly differing (p > 0.05), while most other differences between the groups reached statistical significance (p < 0.05). Application of DBBM-C, covered with CM or PG, resulted in less vertical and horizontal changes of the alveolar ridge as compared with controls 6 months after extraction.

Revascularization of acellular human dermis (alloderm) in subcutaneous implantation

Background: Although autogenous soft tissue graft materials, such as fat, fascia, and dermis, are commonly used for subdermal and subcutaneous augmentation, their inherent disadvantages continue to inspire a search for an alternative biomaterial. Objective: This study investigated revascularization after subcutaneous implantation of Alloderm, an allograft derived from acellular human dermis, in a rabbit model. Methods: Alloderm was implanted under the skin in the ears of 8 adult female white rabbits. Harvesting took place after 3, 7, 14, and 28 days. Serial sections were stained and examined under light microscopy to assess vascular ingrowth, as determined by the number of vessels and their location of entry. Results: Postoperatively, minimal vessel ingrowth extending from all sides of the implantation site was visible in the grafts at 3 days. By 7 days, scattered vessels could be seen within the collagen bundles of the grafts. Further vessel ingrowth with nearly complete through-and-through vascularity was evident at 14 days. By 28 days, single-layer grafts were structurally intact, with identifiable vessels throughout the collagen bundles and no volume loss. Conclusions: Acellular human dermis is capable of complete revascularization within weeks after implantation. The orientation of the basement membrane has no impact on vascular ingrowth. The extent of revascularization in more complex grafts awaits further study.

Free autogenous soft tissue graft with the argon laser.

A sufficient amount of dense keratinized connective tissue attached to bone and the cervical area of the tooth is required for functional masticatory mucosa. Periodontal plastic surgery has furnished numerous reconstructive and regenerative techniques to correct the mucogingival defect. Laser technology has provided the ability for tissue fusion and incisions with better visual and mechanical access, decreased intraoperative time, improved hemostasis, and less postoperative discomfort. This article describes a technique for incisions and tissue fusion for gingival grafts with an argon laser.