Gingival Graft Research Articles

A retrospective study of occlusal reconstruction in patients with old jaw fractures and dentition defects

PurposeThis study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects. MethodsPatients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled. Clinical treatment was classified into 3 phases. In phase I, techniques such as orthognathic surgery, microsurgery, and distraction osteogenesis were employed to reconstruct the correct 3-dimensional (3D) jaw position relationship. In phase II, bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions. In phase III, implant-supported overdentures or fixed dentures were used for occlusal reconstruction. A summary of treatment methods, clinical efficacy evaluation, comparative analysis of imageological examinations, and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects. All data are summarized using the arithmetic mean ± standard deviation and compared using independent sample t-tests. ResultsIn 15 patients with old jaw fractures and dentition defects (an average age of 32 years, ranging from 18 to 53 years), there were 7 cases of malocclusion of single maxillary fracture, 6 of malocclusion of single mandible fracture, and 2 of malocclusion of both maxillary and mandible fractures. There were 5 patients with single maxillary dentition defects, 2 with single mandibular dentition defects, and 8 with both maxillary and mandibular dentition defects. To reconstruct the correct 3D jaw positional relationship, 5 patients underwent Le Fort I osteotomy of the maxilla, 3 underwent bilateral sagittal split ramus osteotomy of the mandible, 4 underwent open reduction and internal fixation for old jaw fractures, 3 underwent temporomandibular joint surgery, and 4 underwent distraction osteogenesis. All patients underwent jawbone augmentation, of whom 4 patients underwent a free composite vascularized bone flap (26.66%) and the remaining patients underwent local alveolar bone augmentation. Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation (73.33%).The 15 patients received 81 implants, of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures. The survival rate of all implants was 93.82%. The final imageological examination of 15 patients confirmed that the malocclusion was corrected, and the clinical treatment ultimately achieved occlusal function reconstruction. The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy, phonetics, aesthetics, and comfort after treatment. ConclusionOcclusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment, consisting of 3D spatial jaw correction, alveolar bone augmentation and soft tissue augmentation, and implant-supported occlusal reconstruction, achieving satisfactory clinical therapeutic efficacy.

Immediate implant placement with immediate or delayed provisionalization in the maxillary aesthetic zone: A 10-year randomized trial.

To compare the marginal bone level of immediately placed implants, with either immediate or delayed provisionalization (IP or DP), in the maxillary aesthetic zone after 10 years of function. Participants with a failing tooth in the maxillary aesthetic zone were randomly assigned to immediate implant placement with either IP (n = 20) or DP (n = 20) after primary wound closure with a free gingival graft. The final restoration was placed 3 months after provisionalization. The primary outcome was change in marginal bone level. In addition, implant survival, restoration survival and success, peri-implant tissue health, mucosa levels, aesthetic indices, buccal bone thickness and patient satisfaction were evaluated. After 10 years, the mean mesial and distal changes in marginal bone level were -0.47 ± 0.45 mm and -0.49 ± 0.52 mm in the IP group and -0.58 ± 0.76 mm and -0.41 ± 0.72 mm in the DP group (p = .61; p = .71). The survival rate was 100% for the implants; for the restorations, it was 88.9% in the IP group and 87.5% in the DP group. Restoration success, according to modified USPHS criteria, was 77.8% in the IP group and 75.0% in the DP group. The prevalence of peri-implant mucositis was 38.9% and 35.7% and of peri-implantitis 0.0% and 6.3%, respectively, in the IP group and DP group (p = 1.0; p = .40). The Pink Esthetic Score and White Esthetic Score was 15.28 ± 2.32 in the IP group and 14.64 ± 2.74 in the DP group, both clinically acceptable (p = .48). The buccal bone thickness was lower in the DP group. Patient satisfaction was similar in both groups (p = .75). The mean marginal bone level changes after immediate implant placement with IP were similar to those after immediate placement with DP. Registered in the National Trial Register (NL9340).

Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review.

Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.

Root coverage with the restoration of non-carious cervical lesions: A systematic review and meta-analysis.

The progression of non-carious cervical lesions (NCCLs) leads to gingival recession (GR), which is restored with restorative materials, using different periodontal plastic surgery procedures. There is no consensus on which technique is superior to others. Therefore, the present systematic review aimed to assess the effectiveness of root coverage (RC) procedures in the restored and unrestored NCCLs in terms of clinical and patient-centered outcomes.We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) while searching 5 databases in addition to the gray literature. The Medical Subject Headings (MeSH) terms and keywords in the title and abstract fields, as well as in headings, were used to search the existing literature for the relevant publications on the effectiveness of RC procedures with the restoration of NCCLs over the past 3 decades (January 1990-July 2021). After applying the inclusion and exclusion criteria, 13 articles were read in full and critically analyzed. The quality analysis was performed using the Cochrane RevMan software.A total of 222 potentially relevant titles and abstracts were found after the initial electronic and manual search, and after removing duplicates. Applying the inclusion and exclusion criteria yielded 23 publications that were further analyzed for relevance and applicability. Following critical analysis, 13 publications were used for validity assessment and data extraction.In the teeth with NCCLs and GR, the restoration of NCCLs does not affect the percentage RC. However, it significantly decreases dentin hypersensitivity, and the patients' perception of esthetics and satisfaction.

3D-printed model for gingival flap surgery simulation: Development and pilot test.

To assess the feasibility of a realistic model for learning oral flaps using 3D printing technology. A mould was designed to reproduce the mandibular gingival mucosa, and a mandibular model was created using a three-dimensional printer for training undergraduate students to perform gingival flaps. After a short interview about its use, the participants were asked to use the simulator and provide feedback using a 5-point Likert questionnaire. The 3D-printed oral surgery flap training model was practical and inexpensive. The model was very realistic, educational and useful for hands-on training. 3D printing technology offers new possibilities for training in dental treatments that are currently difficult to replicate. The use of this simulator for oral flap surgery was well-received and considered promising by the participants.

A novel "microscrew with tie-down sutures" technique for FGG anchorage: A case report.

The most difficult and time-consuming step in the free gingival graft (FGG) for keratinized mucosa augmentation is the compression suture anchoring the FGG to the periosteum. In this article, a novel "microscrew with tie-down sutures" technique was proposed to anchor the FGG to the recipient site without the traditional trans-periosteum suture. This patient's keratinized mucosa width (KMW) around the healing abutments of teeth #29 and #30 was less than 1 mm. After an apically positioned flap (AFP) was prepared, two microscrews were placed at the buccal plate of the alveolar ridge bone, which is the coronal margin of the AFP. Then, the sutures winded between the microscrews and the healing abutments to anchor the FGG. In conclusion, the "microscrew with tie-down sutures" technique offers a feasible and simple alternative for the trans-periosteum compression suture, particularly in situations when the periosteum is fragile, thin, or injured.

Timing and surgery option of keratinized mucosa augmentation around implant site

In recent years, clinicians have paid more attention to the biological and esthetic effects of the 2 mm keratinized mucosa width (KMW) around dental implant. How to increase the keratinized mucosa is the focus of clinicians. While the free gingival graft (FGG) is still the gold standard of keratinized mucosa augmentation, alveolar ridge preservation (ARP), connective tissue graft (CTG) and apically positioned flap (APF) can also be used to obtain more than 2 mm keratinized mucosa width when they are used before implantation, with implantation, within the implant-healing phase, with second stage of implantation or after rehabilitation according to different indications. This article comprehensively summarizes the influencing factors of timing and surgical procedures for keratinized mucosa augmentation, providing guidance for clinicians to treat peri-implant keratinized mucosa deficiencies.

Clinical effectiveness of orange peel polymethoxy-flavonoids rich fraction as a palatal dressing material compared to Alveogyl: randomized clinical trial

This study assessed the clinical effectiveness of orange peel polymethoxy-flavonoids rich fraction (OPMF) solid dispersion as a palatal dressing material, compared with Alveogyl, in a randomized clinical trial. After harvesting free gingival grafts for 18 patients in three groups, the donor site in group I received OPMF; group II received Alveogyl; and group III received placebo dough material. The visual analog scale (VAS) pain score in group I showed the lowest value in week one without a significant difference. In week 2, there was a substantial decrease in pain in group I compared to group III. Week 4 showed reduced pain scores in all groups without significant differences. The results of the number of analgesic pills revealed, after 1 week, the lowest number of pills consumed in group I, with a considerable difference compared to group III. Healing process results showed that group I had the highest healing values in each interval, with a significant difference between group I and group III at 1 and 2 weeks. Color matching parameter showed slight differences between the groups’ readings in favor of group I in all intervals without a statistically significant difference. The results suggest OPMF as a palatal dressing material that facilitates hemostasis, pain relief, and palatal wound healing.

A modified geometric technique to increase peri-implant keratinized mucosa.

The free gingival graft (FGG) has been identified as the most effective method for increasing keratinized mucosa width (KMW). However, the challenge emerges in cases of extensive keratinized mucosa deficiency, where efficient utilization of the patient's limited keratinized tissue to achieve optimal results is crucial. This article introduces a modified geometric technique to address this clinical issue. Utilizing geometric principles, the modified technique involves dividing the rectangular graft into two triangular or trapezoidal sections, which are then reassembled to form an approximate diamond shape. Through strategic cut and splice, the graft is reshaped to suit the recipient site. Preliminary observations in cases employing the modified geometric technique have increased the KMW around implants. This method enhances graft utilization and offers a viable clinical option for surgical plans aimed at widening keratinized mucosa in instances of large-area KMW deficiency. This article proposed a modified method to increase KMW, which may be an optimal choice for patients with insufficient KMW in large area, avoiding the waste of limited graft, decreasing patient morbidity, and effectively widening keratinized mucosa.

Free gingival grafting technique for gingival recession coverage: A 6-month follow-up interventional study

Background: Both the practitioner and the patient frequently deal with gingival recession. In Miller’s Classes I and II mandibular gingival recession, the goal of this study was to evaluate the predictability of the free gingival graft (FGG), as a single-step operation in terms of root coverage and esthetics. Materials and Methods: 10 patients between the ages of 25 and 50 who were sent to the Department of Periodontics (3 men and 7 women) made up the study group. There were a total of 14 mandibular recession sites that were chosen. Recession depth (RD), recession width, probing depth (PD), clinical attachment level (CAL), width of attached gingiva (WAG), and visual analog scale (VAS) were assessed at baseline, 3 months, and 6 months post-operatively. Results: The mean RD was 3.13±2.0 mm at the baseline and decreased to 0.80±0.78 mm after 6 months. At baseline, the VAS was 3.52±0.81, and at 6 months after surgery, it had improved to a mean of 6±2.14. From a baseline WAG of 0.35±0.38 to 2.83±0.68 mm, there wasa significant increase with p<0.0001. Six months after surgery, there was an increase in CAL, from 5.63±1.12 to 1.28±0.76 mm. In addition, PD improved from 1.98±0.54 to 0.97±0.36 mm. Conclusion: FGG showed statistically significant gain in recession coverage and had good esthetic score. The technique produced a reliable single-step gain in WAG as well as root coverage in cases of Miller’s Classes I and II gingival recession.

Factors influencing intraoperative and postoperative complication occurrence: A series of 1135 periodontal and implant-related surgeries.

In periodontology, it is widely recognized that evidence characterizing the incidence and effect of treatment complications is lacking. The objective of this study was to assess the influence of operator-, procedure-, patient-, and site-associated factors on intraoperative and postoperative complication occurrence. A single investigator reviewed records of patients treated by eight periodontics residents from July 2018 through June 2022. For each procedure, the investigator recorded each intraoperative and postoperative complication or indicated that no complication had occurred. These outcomes were analyzed against a panel of explanatory covariates. In addition, the severity of each postoperative complication was assessed using a standardized grading system. A total of 1135 procedures were included in the analysis. Intraoperative and postoperative complications were identified in 2.8% and 15.2% of procedures, respectively. The most common intraoperative complications were Schneiderian membrane perforation (1.3%) and gingival flap perforation/tear (1%), and the most common postoperative complications were dentin hypersensitivity (2.6%), excessive pain (2.5%), and infection (2.2%). Subepithelial connective tissue graft (odds ratio [OR]: 3.2, 95%confidence interval [CI]: 1.6, 6.1; p < .001), guided bone regeneration (OR: 3.0, 95% CI: 1.4, 6.5; p = .004), and guided bone regeneration with implant placement (OR: 3.1, 95% CI: 1.3, 7.6; p = .011) were associated with higher odds of postoperative complication, whereas lateral sinus elevation (OR: 102.5, 95% CI: 12.3, 852.9; p < .001), transalveolar sinus elevation (OR: 22.4, 95% CI: 2.2, 224.5; p = .008), open flap debridement (OR: 36.4, 95% CI: 3.0, 440.7; p = .005), and surgically facilitated orthodontic therapy (OR: 20.5, 95% CI: 1.2, 358.4; p = .039) were associated with higher odds of intraoperative complication occurrence. Consistent with previous reports, procedure type appears to be the predominant factor driving complication occurrence. As analyses of treatment complications increase, individualized risk-benefit assessments will become progressively meaningful for patients.

The Effect of Connective Tissue Graft Compared to Concentrated Growth Factor Graft on Buccal Peri-Implant Gingival Thickness: A 12-month Randomized Controlled Clinical Trial

BackgroundAttached gingival phenotype has a crucial impact on the implant's durability and its future success. PurposeThis study aims to measure and compare buccal peri-implant gingival thickness following grafting with connective tissue graft (CTG) and the concentrated growth factor graft (CGF).Study design, setting, sample: This is a split-mouth designed randomized controlled clinical study in which a total of 20 aged 18 to 55 have bilateral missing teeth in the maxillary premolar region with less than 2mm of healthy peri-implant gingival thickness. Patients were excluded if they were smokers, had poor oral hygiene, had uncontrolled widespread periodontal disease, or had a history of radiation treatment. The same surgical protocol was followed for each study participant, where an independent blinded medical practitioner assigned the first stage side to be treated with CTG, while the second stage side with CGF two weeks later. Exposure variableThe primary exposure variable of this study was the gingival grafting technique; CTG or CGF. Outcome variableThe primary outcome variable was the buccal peri-implant gingival thickness. Gingival thickness was measured at six different times; immediately before the procedure (T0), after 30 days (T1), after 45 days (T2), after 3 months (T3), after 6 months (T4), and after 12 months (T5). CovariatesThe covariates were age, sex general health, and periodontal status. AnalysisThe statistical analysis; repeated measures ANOVA test was used to compare the gingival thickness between the studied follow-up times within each group. The level of significance was set at ≤ 0.05. ResultsThe sample was composed of 40 treatment sites of 20 patients. The mean age of the sample was 32 years and 45% were male. The mean gingival thickness value of the CTG group was 1.62mm with a standard deviation (SD=0.18) compared to 1.28mm for the CGF group with (SD=0.20) and an overall P-value (0.001) at T5. Conclusions and relevanceCTG showed to have better gingival thickness than CGF in managing peri-implant buccal gingival thickness deficiency.

¨[Original in spanish] Update of techniques for the treatment of periodontal recessions.

Background: Along the years, a remarkable variety of periodontal surgical protocols has been proposed, the focus of which has shifted from the mere resolution of a soft tissue defect to the performance of predictable and minimally invasive procedures. Initially, the free gingival graft was used. Subsequently, many different techniques were experimented, including those using soft tissue substitutes, such as the Alloderm membrane. Nowadays, the association of the connective tissue graft with the coronally advanced flap is considered the gold standard. Finally, the Pinhole technique, being a more conservative method in terms of tissue preservation and aesthetic outcome, was proposed. Objectives: The aim of this review was the comparison of the updated techniques for the treatment of multiple periodontal recessions, affecting both maxilla and mandible. The procedure outcome was assessed in terms of complete root coverage, recession reduction, gain in height and volume, aesthetic outcome, patient’s post-operative pain and morbidity of donor and recipient sites. Material and methods: Electronic and hand searches were performed to collect split- mouth studies, randomized controlled clinical trials, case series, pilot studies, periodontal books, case studies, systematic reviews and meta-analysis, including maxillary and mandibular multiple gingival recession defects of all four Miller’s classes, for its extensive evidence. Results: Thirty-four publications were included and data regarding the surgical techniques outcome were extracted from eighteen articles. The clinical evaluation analyzed the amount of complete root coverage, recession reduction and gain in height and volume, while the patient’s perspective was expressed in terms of aesthetic satisfaction and possible postoperative complications. Procedures in the last ten years showed better results in all the above-mentioned factors. Conclusion: Procedural predictability and long-lasting treatment stability embody the factors driving the technique election process and adding value to more updated procedures. Progress was observed both at an aesthetic level, by reducing the discrepancies between the surgical region and the surrounding tissue, and at a postoperative level, by reducing patient discomfort. The challenges inherent to this branch could soon find answers thanks to its prompt evolution, which allows for further advances to be conceived.

Comparison of bone tacks and sutures in free gingival graft procedures a clinical study

Objective The aim of the present study was to compare the efficacy of bone tacks and sutures in free gingival graft FGG stabilization during gingival augmentation procedures. Materials and Methods Twelve subjects participated in this study. One site in each subject was randomly assigned into each of the following experimental groups. In the test group, the FGG was stabilized with bone tacks whereas FGG procedure with conventional sutures was performed in the control group. Clinical parameters assessed were the width of keratinized gingiva and plaque index PI scores at baseline 1 month and 3 months. Surface shrinkage SS was recorded at 15 days 1 month and 3 months. Early wound healing score EHS was recorded postoperatively after an interval of 1 week. Results Bone tacks stabilized with FGG were effective in increasing the width of the keratinized gingiva but did not show any added advantage over sutures with no statistical difference between both groups p0.49. In both groups there was similar SS EHS and PI scores with no statistical significance difference between them p1.00. Conclusion This trial was conducted over a period of 3 months and it was observed that bone tacks can be used to stabilize the FGG during mucogingival procedures.

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.

One-stage jaw reconstruction and prosthetic rehabilitation with an iliac flap: a case report and literature review

BackgroundOne-stage jaw reconstruction with fibular flap and prosthetic rehabilitation restores bony and dental continuity simultaneously. It was also called as “jaw-in-a-day (JIAD)” technique. However, bone volume and height of fibular flap may be insufficient for dental implant insertion. The provision of a considerable amount of bone makes an iliac flap the ideal choice in these cases. We present the first case report to document the use of one-stage jaw reconstruction and prosthetic rehabilitation with the iliac flap.Case presentationWe modified the conventional JIAD workflow to make it suitable for iliac flap. Two cases were presented who both underwent segmental mandibulectomy for ameloblastoma. Virtual surgical planning was performed in all cases. The iliac crest was positioned upward to provide cortical bone for achieving primary stability of dental implants. Similar to the “all-on-4” procedure, the iliac bone was placed 12 to 15 mm below the occlusal plane to create adequate space for the implant-retained prosthesis. Immediate implant-based dental rehabilitation was performed at same stage. The surgery was successful in all cases without any short-term complications. In the first postoperative week, patients were given a liquid diet through a nasal feeding tube. The liquid diet is advised until 1 month after the surgery. Thereafter, a soft diet is recommended. Patients were advised to resume routine mastication and normal diet 3 months after the surgery. Peri-implantitis occurred in one patient, and additional gingival graft was required. Postoperative function and esthetics were satisfactory at the last follow-up visit.ConclusionsOne-stage jaw reconstruction and prosthetic rehabilitation with the iliac flap are safe and useful for restoring postoperative function and esthetics. It should be used in more cases with a longer follow-up in further studies.

Soft tissue augmentation of free gingival graft by cyanoacrylate adhesive in free mucosal graft surgery: a report of three cases

Soft tissue augmentation of free gingival graft by cyanoacrylate adhesive in free mucosal graft surgery: a report of three cases

Digitally designed stent-assisted soft-tissue management after jaw reconstruction: a prospective cohort study.

A digitally designed stent was invented to assist vestibuloplasty and free gingival graft (FGG) after jaw reconstruction. This study aimed to compare the effects of conventional soft-tissue management comprising vestibuloplasty combined with FGG and modified soft-tissue management using a digitally designed stent on the vestibular sulcus depth (VD), keratinised-tissue width (KTW) and peri-implant tissue health in patients undergoing jaw reconstruction. This prospective cohort study enrolled patients who underwent jaw reconstruction using a fibular flap, iliac flap, or onlay bone graft followed by implant-supported rehabilitation at the Peking University School and Hospital of Stomatology between May 2019 and July 2022. Patients in the stent group received digitally designed stents following vestibuloplasty combined with FGG for peri-implant soft-tissue management. Patients in the control group underwent a conventional vestibuloplasty combined with FGG. VD and KTW were evaluated immediately after implant loading (T2) and 1 year after implant loading (T3), and the atrophy rates of VD and KTW were calculated. Peri-implant clinical parameters were evaluated at T3. Comparisons between the groups were performed using the Mann-Whitney U test. The effects of age, sex, primary disease, reconstruction type, reconstructed jaw and the number and location of implants on VD and KTW were evaluated using linear regression analysis. There were no significant differences in the atrophy rates of VD and KTW between the stent and control groups at T2 and T3 (both P ≥ 0.05). There were no significant differences in peri-implant clinical parameters between the stent and control groups at T3 (P ≥ 0.05). Reconstruction type, location of implants and primary disease influenced VD, and reconstruction type and age influenced KTW. There was no significant difference in the maintenance of VD and KTW after jaw reconstruction between soft-tissue management using a digitally designed stent and the conventional method. Further, digitally designed stents do not affect peri-implant tissue health. Digitally designed stents can simplify clinical procedures without adverse effects on peri-implant tissue health, but they do not promote keratinized mucosa augmentation and vestibuloplasty.

Soft tissue augmentation of free gingival graft by cyanoacrylate adhesive in free mucosal graft surgery: a report of three cases

Soft tissue augmentation of free gingival graft by cyanoacrylate adhesive in free mucosal graft surgery: a report of three cases

Evaluation of Post-Operative Morbidity and Palatal Wound Healing after Implant Uncovering Surgical Procedure Performed with Apically Positioned Flap (APF) and Leukocyte and Platelet-Rich-Fibrin (L-PRF): An Original Technique.

Background and Objectives: Dental implants are recognized as an effective treatment in the management of edentulous patients; controversies surround the connection between the sufficiency of keratinized gingiva (KG) and peri-implant health. Maintaining an ample amount of peri-implant KG is crucial for minimizing gingival inflammation, highlighting the need for regular consideration of soft-tissue augmentation. Among the diverse periodontal plastic surgical procedures, the apically positioned flap (APF) is notable for its ability to enhance the width of keratinized tissue while minimizing patient morbidity. The aim of this study was to evaluate the effects of L-PRF on palatal wound healing and patient discomfort after surgery. Materials and Methods: Twenty patients with two adjacent submerged fixtures in the maxilla and buccal keratinized gingiva widths < 2 mm were treated with APF and L-PRF. Clinical evaluations were performed at 1, 2, 3, and 4 weeks post-surgery, focusing on parameters such as complete wound epithelialization (CWE), postoperative discomfort (D), changes in feeding habits (CFH), alteration of sensitivity (AS) around the wound area, and the consumption of analgesics. Results: Our data revealed CWE in 5 patients by the end of the second week, with the remaining 15 achieving CWE by the end of the third week. For D and CHF, a statistically significant improvement was recorded for all cases between the first and second weeks, as well as AS, although less substantial, by the third week. No significant changes were noted for AS over the initial two weeks. Conclusions: These findings suggest that L-PRF may enhance wound healing and decrease patient discomfort following APF for fixture uncovering.