Increase In Soft Tissue Thickness Research Articles

Double Chin Concerns afterEn Bloc Mandibular U-ShapedOsteotomy: Submental-Cervical Soft Tissue Changes and Anterior Belly of Digastric Muscle Assessment.

To assess submental-cervical soft tissue changes afteren bloc mandibularU-shapedosteotomy and examine alterations in the anterior belly of digastric muscle (ABDM). A retrospective study analyzed 20 patients who underwent en bloc mandibularU-shaped osteotomy from 2018 to 2023. Preoperative (Tp) and long-term follow-up (Tf) CT data were collected for analysis, measuring mandibular volume, soft tissue thickness at menton (Mes) and cervicale (C), and ABDM parameters (length, cross-sectional area (CSA), volume, distance from centroid point to the mandibular margin). Correlation analyses were performed to investigate the connection between soft tissue thicknesschanges, ABDM changes, and mandibular osteotomy volume. Long-term follow-up revealed a significant increase in soft tissue thickness at the Mes and C points after U-shaped mandibular osteotomy, especially at the C point. The adaptive length of ABDM decreased, CSA increased, and volume decreased, but the ABDM centroid point shifted downward relative to the mandibular margin, indicating drooping protrusion. The increment of soft tissue thicknesswas moderately positively correlated with the amount of osteotomy, and the decrement of ABDMlength and volume were slightly positively correlated with the amount of osteotomy. The degree of soft tissue relaxation afterU-shaped osteotomy is related to the extent of osteotomy. Notably, the protrusion of ABDM relative to the mandibular margin affects submental-cervical contour aesthetics. Prior to U-shaped osteotomy, it is crucial to assess the soft tissue condition of the patient's lower face, and the individualized design of the osteotomy volume should be carried out cautiously and safely. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Three-dimensional computed tomography analysis of airway volume in growing class II patients treated with Frankel II appliance

ObjectiveThe purpose of this retrospective study was to assess the airway volume changes associated with the use of Frankel appliance (FR II) in Class II malocclusion patients using three-dimensional cone beam computed tomography (3D CBCT) imaging.Materials and methodsThe sample consisted of 31 Class II malocclusion patients (mean age 9.24 ± 1.93 years old, 17 males (54.8%) and 14 females (45.2%)) treated with FR II appliance by the same orthodontist for an average of 9 months ± 20 days. CBCT images were taken before and after treatment and upper airway volume changes were measured using Dolphin 3D software version11.0 (Dolphin Imaging, Chatsworth, CA) and statistically compared.ResultsAirway volume of nasal cavity, nasopharynx, oropharynx, hypopharynx and the total airway volume significantly increased after the use of FR II appliance. In addition, significant increase was reported in maxillary base, inter-molar, inter-premolar and inter-canine width. Significant increase in soft tissue thickness was only recorded opposite to CV2.ConclusionThe use of the FR II appliance in growing subjects with Class II malocclusion led to a significant increase in the upper airway volume in addition to the anticipated dental and skeletal transverse expansion effects.

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КОЛЛАГЕНОВОГО МАТРИКСА ПРИ МЕНЕДЖМЕНТЕ МЯГКИХ ТКАНЕЙ В ОБЛАСТИ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ ВО ФРОНТАЛЬНОМ ОТДЕЛЕ ВЕРХНЕЙ ЧЕЛЮСТИ

The aim is to comparatively analyze the using of collagen matrix and free connective tissue graft in soft tissue thickness increase in the area of dental implants in the anterior region of the upper jaw.
 Materials and methods. 30 patients with partial absence of teeth and soft tissue thickness deficit in the anterior part of the upper jaw took part in the study. In the 1st group (n = 15) a free connective tissue graft (CTG) from the hard palate was transplanted, in the 2nd group (n = 15) a collagen matrix (CM) was used. The primary endpoint was the amount of soft tissue thickness gain 3 months after surgery. Secondary endpoints were: duration of surgery, severity of collateral edema and pain, amount of analgesic medication consumed, quality of life assessment, width of keratinized attached gingiva, and soft tissue aesthetics.
 Results. 3 months after augmentation the increase in soft tissue thickness from the vestibular surface was 0.86 ± 0.25 mm and 0.77 ± 0.26 mm (p = 0.34), from the occlusal surface - 0.46 ± 0.14 mm and 0.37 ± 0.18 mm (p = 0.137) in patients of the 1st and 2nd groups, respectively. The use of CM was characterized by less prolonged surgery (p = 0.002), less pronounced postoperative pain on the 1st and 3rd day (p = 0.007; p = 0.023), less consumption of analgesic drugs on the 1st, 3rd and 5th day (p = 0.014; p = 0.033; p = 0.002) and less reduction of patients' quality of life in the first 7 days after surgery (p = 0.023). When analyzing the "Pink Esthetics Scale" (PES) in patients, group 2 showed more pronounced inconsistencies in the assessment of the zenith level (p < 0.001), less natural soft tissue contour (p < 0.001) and more significant deficit of the alveolar ridge (p < 0.001).
 Conclusion. Collagen matrixes make it possible to obtain soft tissue augmentation comparable with the use of CTG, to reduce the time of surgical intervention and to provide a more comfortable postoperative period. The use of autogenous grafts provides better results in terms of soft tissue aesthetics.

Profilometric analysis of cross-linked collagen matrix for soft tissue thickness augmentation in dental implants: A randomized controlled clinical trial

BACKGROUND: Dental implantation is an effective method for rehabilitating patients without teeth. The long-term survival of implants is influenced by various factors, one of which is the condition of the soft tissue surrounding the implant.
 AIM: To evaluate the effectiveness of cross-linked collagen matrix for soft tissue augmentation in the implant area.
 MATERIALS AND METHODS: Thirty-two patients with soft tissue thickness deficiency were examined. The patients were divided into two groups depending on the method of surgery. Group 1 received a cross-linked collagen matrix, whereas group 2 underwent the transplantation of a free connective tissue graft. The increase in soft tissue thickness was assessed 3 and 6 months after surgery.
 RESULTS: Soft tissue thickness 3 months after surgery increased by 1.77±0.61 and 1.26±0.41 mm in groups 1 and 2, respectively (p 0.001). Moreover, 6 months after surgery, soft tissue thickness increased by 1.11±0.44 and 1.43±0.81 mm compared with the initial value (p=0.012).
 CONCLUSION: The use of the collagen matrix increases the soft tissue thickness in the implant area; however, the effect size is lower than that obtained by autograft transplantation.

Comparative morphological assessment of crosslinked and non-crosslinked xenograft biointegration quality

Relevance. Autografts are nowadays the gold standard for soft tissue augmentation and gingival recession coverage. However, as this method has a number of significant disadvantages, xenografts of various origins are more frequently used in dental practice. The study aimed to conduct a comparative morphological assessment of crosslinked and non-crosslinked xenogenous scaffold biointegration quality at different healing times.Materials and Methods. The study used 108 Wistar rats (54 males, six months old, fat mass 462 ± 20; 54 females, six months old, fat mass 414 ± 7) and randomly divided them into three groups. Group 1 had a xenogenous collagen matrix (Mucograft) placed in the subperiosteal tunnel in the mandibular vestibule area; Group 2 had an acellular dermal collagen matrix (Mucoderm) implanted in the subperiosteal tunnel, group 3 had D-ribose crosslinked xenogenous scaffold (Ossix Volumax) placed in the subperiosteal tunnel.Results. The studied xenogenous materials showed different integration and biodegradation extents. By postoperative day 7, Group 1 (Mucograft) showed a more pronounced inflammation. Non-crosslinked collagen materials had almost completely resorbed by the 30th day of observation, while a crosslinked collagen matrix was detected as homogenous masses. By the 90th day, all groups demonstrated the formation of new connective tissue with different functional characteristics; only Group 3 histologically revealed microfragments of the graft.Conclusion. The study shows that the xenogenous crosslinked and non-crosslinked collagen membranes may promote an increase in soft tissue thickness to a different extent. However, it is essential to improve the available materials to reach an outcome comparable to the autologous soft tissue graft treatment result.

Assessment of soft-tissue vs hard-tissue changes after isolated functional genioplasty

This study aimed to determine the vertical and horizontal soft-tissue vs hard-tissue changes after isolated functional genioplasty and to revisit hard-tissue remodeling at the symphysis. Seventy-five patients who underwent genioplasty as an isolated procedure at the end of their orthodontic treatment were divided into three groups on the basis of their age at surgery: < 15 years (group 1), 15-18 years (group 2) and ≥ 19 years (group 3). Patients were evaluated at three time points: immediately before surgery (T1), immediately after surgery (T2) and two years after surgery (T3). In addition, 25 patients who did not accept genioplasty, were age-matched with group 1, and had a follow-up radiograph two years after the end of their orthodontic treatment were used as a control group. From T2 to T3, group 1 showed less forward horizontal hard-tissue and soft-tissue changes at pogonion (Pg) than the control group; however, no difference was noted for vertical changes at Me & Me’. From T1 to T3, the horizontal hard-tissue and soft-tissue changes at Pg were 6.39 mm and 6.72 mm, respectively, for surgical groups. Vertical hard-tissue change at menton (Me) showed a reduction of 1.63 mm (95% confidence interval [CI], -3.37 to 0.11) and 3.89 mm (95% CI, -5.83 to -1.95) in nongrowing female and male patients, respectively. The vertical soft-tissue change reduction was similar for nongrowing male and female patients (1.7 mm [95% CI, -2.96 to -0.45]). Soft-tissue thickness change at Pg (0.33 mm) was not significant. In contrast, a small but significant increase in soft-tissue thickness was noted at Me (0.54 mm). Linear regressions were calculated for all groups and allowed for predicting long-term soft-tissue changes (T3-T1) using the amount of surgical displacement (T2-T1). The horizontal hard-tissue change was stable for nongrowing patients, and the horizontal soft-tissue change was 92% of hard-tissue. Vertical soft-tissue change is less predictable. Variation of soft-tissue thickness after genioplasty can be explained by skeletal changes and the achievement of an unforced labial occlusion. These results support the functional and esthetic benefits of this surgery. Comparison with the control group showed that genioplasty does not change the growth pattern, and bone remodeling is likely to explain the difference noted at Pg.

Soft and hard tissue changes after immediate implant placement with or without a sub-epithelial connective tissue graft: Results from a 6-month pilot randomized controlled clinical trial.

The present pilot RCT aimed to investigate the influence of a connective tissue graft (CTG) in combination with the immediate implant placement (IIP) on hard and soft tissue healing, without a bone replacement graft in the gap between the implant and the socket walls. Thirty patients requiring extraction of one anterior tooth (from premolar to premolar) were randomly assigned to one of the two treatment groups (test: IIP + CTG; control: IIP). Cone-beam computed tomography and optically scans were performed before tooth extraction and at 6-month follow-up. Then, DICOM files were superimposed in order to allow the evaluation of osseous ridge and buccal bone changes, while the superimposition of DICOM and Standard Tessellation Language files allowed for evaluating of soft tissue contour. For testing the differences between the two groups, the non-parametric test as Wilcoxon rank-sum test, was used. Twenty-six of the 30 enrolled patients attended the 6-month follow-up visit. The four patients of the control group that were lost to follow-up were analysed under the intention-to-treat principle. No statistically significant differences between the groups were observed for the vertical buccal bone resorption (p=.90), as well as for the horizontal buccal bone resorption at all measured levels. Significant differences were found between the test and control groups in the horizontal dimensional changes of osseous ridge at the most coronal aspect (p=.0003 and p=.02). Changes in tissue contour were between -0.32 and -0.04 mm in the test group and between -1.94 and -1.08 mm in the control group, while changes in soft tissue thickness varied between 1.33 and 2.42 mm in the test group and between -0.16 and 0.88 mm in the control group, with statistically significant differences for both variables at all measured levels. At 6months, the mean volume increase was 6.76 ± 8.94 mm3 and 0.16 ± 0.42 mm3 in the test and control groups, respectively, with a statistically significant difference. The findings of the present study indicate that the adjunct of a CTG at the time of IIP, without bone grafting, does not influence vertical bone resorption. Within the limits of this study, it can be suggested that the adjunct of a CTG at the time of IIP, without bone grafting, reduces the horizontal changes of the alveolar ridge. Moreover, it allows maintenance of the tissue contour due to an increase in soft tissue thickness.

The use of the connective tissue graft from the palate for vertical soft tissue augmentation during submerged dental implant placement: A case series.

ObjectivesTo evaluate the efficacy of the soft tissue augmentation vertically, using connective tissue graft from the palate, during submerged dental implant placement.Material and MethodsVertical soft tissue augmentation, using connective tissue graft from the palate, combining with submerged dental implant placement was performed for 50 patients (10 males and 40 females, mean age 57.22 years). Soft tissue thickness vertically was measured in the middle of the alveolar crest with the periodontal probe. After 3 months, healing abutments or multiunits were connected to the dental implants, augmented soft tissue thickness was measured vertically in the middle of the alveolar crest. The vertical soft tissue volume gain was calculated using analysis of variance descriptive analysis, significance set to p = .05.ResultsAll 50 autogenous connective tissue grafts from the palate healed successfully. The average thickness of the soft tissue grafts from the palate was 1.8 ± 0.41 mm. After 3 months, soft tissue thickness vertically increased from 2.27 ± 0.64 mm to 4.35 ± 0.64 mm. This difference between mean figures, between the groups, before and after soft tissue augmentation was found to be statistically significant F (263;477). The mean increase in soft tissue thickness was 2.08 ± 0.71 mm.ConclusionIt can be concluded that soft tissue augmentation vertically, using connective tissue graft from the palate can be successfully used for vertical soft tissue augmentation.

Assessment of soft-tissue vs hard-tissue changes after isolated functional genioplasty

This study aimed to determine the vertical and horizontal soft-tissue vs hard-tissue changes after isolated functional genioplasty and to revisit hard-tissue remodeling at the symphysis. Seventy-five patients who underwent genioplasty as an isolated procedure at the end of their orthodontic treatment were divided into 3 groups on the basis of their age at surgery:<15 years (group 1), 15-18 years (group 2), and ≥19 years (group 3). Patients were evaluated at 3 time points: immediately before surgery (T1), immediately after surgery (T2), and 2 years after surgery (T3). In addition, 25 patients who did not accept genioplasty, were age-matched with group 1, and had a follow-up radiograph 2 years after the end of their orthodontic treatment were used as a control group. From T2 to T3, group 1 showed less forward horizontal hard-tissue and soft-tissue changes at pogonion (Pg) than the control group; however, no difference was noted for vertical changes at Me & Me'. From T1 to T3, the horizontal hard-tissue and soft-tissue changes at Pg were 6.39 mm and 6.72 mm, respectively, for surgical groups. Vertical hard-tissue change at menton (Me) showed a reduction of 1.63 mm (95% confidence interval [CI], -3.37 to 0.11) and 3.89 mm (95% CI, -5.83 to -1.95) in nongrowing female and male patients, respectively. The vertical soft-tissue change reduction was similar for nongrowing male and female patients (1.7 mm [95% CI, -2.96 to -0.45]). Soft-tissue thickness change at Pg (0.33 mm) was not significant. In contrast, a small but significant increase in soft-tissue thickness was noted at Me (0.54 mm). Linear regressions were calculated for all groups and allowed for predicting long-term soft-tissue changes (T3-T1) using the amount of surgical displacement (T2-T1). The horizontal hard-tissue change was stable for nongrowing patients, and the horizontal soft-tissue change was 92% of hard-tissue. Vertical soft-tissue change is less predictable. Variation of soft-tissue thickness after genioplasty can be explained by skeletal changes and the achievement of an unforced labial occlusion. These results support the functional and esthetic benefits of this surgery. Comparison with the control group showed that genioplasty does not change the growth pattern, and bone remodeling is likely to explain the difference noted at Pg.

Clinical and histological evaluation of the use of acellular dermal matrix (ADM) membrane in peri-implant vertical soft tissue augmentation: A controlled clinical trial.

The aim of this study was to clinically and histologically evaluate the efficacy of using acellular dermal matrix (ADM) for peri-implant vertical soft tissue augmentation at implant placement. Twenty patients were enrolled in this study. According to the initial thickness of vertical soft tissue, patients were assigned into the ADM group (≤2mm) or the control group (>2mm) prior to implant surgery +ADM grafting or implant surgery alone. Second-stage surgery was carried out 3months later, and a small piece of ridge membrane was harvested for histological and immunohistochemical evaluation. Vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF)-BB in peri-implant crevicular fluid (PICF) were also assessed 1week, 1month, and 5months after second-stage surgery. Clinical parameters were recorded to evaluate peri-implant health at 1week and 3months after implant restoration. All 20 implants healed uneventfully and successfully. Soft tissue thicknesses were comparable in the two groups at second-stage surgery (3.20±0.42mm vs. 3.50±0.58mm). In the ADM group, the mean increase in soft tissue thickness was 1.85±0.34mm. Histological and immunohistochemical outcomes showed no differences between the two groups. VEGF and PDGF-BB levels in PICF were significantly lower in the ADM group 1week after second-stage surgery (p<.01), yet they decreased in both groups later. The difference between the groups had disappeared by 5months after second-stage surgery. The clinical peri-implant parameters were good and stable by the end of the study (3months after restoration). Our results suggested that using ADM at implant placement was effective in increasing the thickness of peri-implant vertical soft tissue and achieved comparable clinical and histological performance to the control group. However, the incremental soft tissue showed inferior angiogenic ability in the early stage of wound healing.

Implants sites with concomitant bone regeneration using a resorbable or non-resorbable membrane result in stable marginal bone levels and similar profilometric outcomes over 5years.

To assess clinical and radiographic outcomes as well as the profilometric contour alterations of peri-implant hard and soft tissues around single implants treated with simultaneous guided bone regeneration (GBR) at 5years. Twenty-seven patients presenting with a single tooth gap in the esthetic zone received a two-piece implant. GBR was randomly performed using a resorbable (RES) or a non-resorbable membrane (N-RES) combined with a bone substitute material. Follow-up examinations were performed at baseline (BL=crown insertion), 1year (FU-1), 3years (FU-3), and at 5years (FU-5) including clinical and radiographic parameters as well as profilometric changes. Statistics were performed by means of parametric and nonparametric tests. At 5years, 20 out of 27 patients (9 RES, 11N-RES) were re-examined. Median values for probing depth changed insignificantly between BL and FU-5 in both groups. The median marginal bone levels were located 0.23mm (0.06; 0.46; RES) and 0.17mm (0.13;0.28; N-RES) below the implant shoulder at FU-5 (changes over time p<.05). The calculated median profilometric change between BL and FU-5 was -0.28mm (-0.53;-0.20; RES; p=.016) and -0.24mm (-0.43;0.08; N-RES; p=.102; intergroup p=.380). The horizontal bone thickness decreased significantly between re-entry and FU-5 for group RES at all measured levels (p<.05) measuring 0.87mm (0.0; 2.05) at the implant shoulder, whereas the decrease for group N-RES was insignificant (p=.031) with 0mm (0; 0.84) at the implant shoulder at 5years. Implants sites with concomitant GBR using a resorbable or non-resorbable membrane revealed stable marginal bone levels and clinical outcomes. Profilometric changes were clinically negligible over 5years. The observed change in hard tissue thickness was partially compensated by an increase in soft tissue thickness.

The effect of immediate implant placement on alveolar ridge preservation compared to spontaneous healing after tooth extraction: Soft tissue findings from a randomized controlled clinical trial.

To compare soft tissue dimensional changes and relative differences in soft and hard tissue volumes 4months after single-tooth extraction and three different treatment modalities: spontaneous healing (SH) and alveolar ridge preservation by means of a deproteinized bovine bone mineral and a collagen matrix, with (IMPL/DBBM/CM) or without (DBBM/CM) immediate implant placement. STL files from study casts obtained at baseline and after 4months were matched to calculate buccal soft tissue linear and volumetric changes. DICOM files from CBCTs were superimposed to STL files allowing the evaluation of soft tissue thickness at baseline and 4months. Mean horizontal reduction accounted for 1.46±0.20 (SH), 0.85±0.38 (DBBM-CM) and 0.84±0.30 IMPL/DBBM-CM, with no statistical differences. Soft tissue thickness had a significant mean increase of 0.95 for SH group, compared to a non-significant mean decrease for DBBM-CM (0.20) and IMPL/DBBM-CM groups (0.07). A preservation technique with DBBM-CM, with or without immediate implant placement, did not reduce the horizontal linear and volumetric changes at the buccal soft tissue profile significantly at 4months after tooth extraction when compared to spontaneous healing. This is due to a significant increase in soft tissue thickness in spontaneously healing sites.

Comparison between two different techniques for peri-implant soft tissue augmentation: Porcine dermal matrix graft versus tenting screw.

The thickness of the soft tissues around dental implants is crucial for both the preservation of the marginal bone and esthetic profile. Many authors have showed the thickened soft tissues favor a better peri-implant bone stability; however, different thickening techniques can be used for this aim. Forty-seven patients were enrolled in this study, each one had one implant included in this analysis. According to the thickening procedure, patients were assigned into group A (porcine dermal matrix, n=24) or B (healing abutment used as tenting screw to sustain the soft tissues, n=23), soft tissue thickness was measured after flap elevation in a standardized way. Sixmonths after implant placement, implants were uncovered and soft tissue thickness measured again. At second stage, 6months after implant placement, the mean vertical thickness was 3.01 ± 0.58mm in group A and 2.25 ± 0.53mm in group B. The difference between the two groups at 6months was significant (P<0.001). The mean vertical gain in group A was 1.33 ± 0.71mm, whereas it was 0.43 ± 0.55mm in group B. This difference was also statistically significant (P<0.001). The use of a healing abutment for "tenting effect" has limited efficacy to obtain a significant increase in soft tissue thickness. The use of a porcine dermal matrix at time of implant placement is effective to thicken peri-implant tissues.

Fat Mass Does Not Increase the Precision Error of Trabecular Bone Score Measurements

Introduction: Trabecular bone score (TBS) is an indirect index of trabecular microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry. Previous phantom study showed that an increase in soft tissue thickness does not affect TBS reproducibility. We investigated the effect of increasing body mass index (BMI) and waist circumference on TBS precision error on patients, compared to bone mineral density (BMD). Methodology: A population of postmenopausal Caucasian women was distributed in 3 different BMI (normal, overweight, and class I obesity), plus 2 further groups based on waist circumference diameter (≤88 cm and >88 cm, respectively). In vivo precision error was calculated on 30 consecutive subjects that were scanned 2 times, with patient repositioning, using the Hologic QDR-Discovery W densitometer. Coefficient of variation, percent least significant change, and reproducibility were calculated according to the International Society for Clinical Densitometry guidelines. Results: Ninety-five women aged 66 ± 10 (mean ± standard deviation) were included. No significant differences were found both for BMD and TBS precision errors, respectively, when comparing BMI groups and waist circumference groups. BMD reproducibility ranged from 95.9% (BMI > 30 kg/m2) to 97.5% (BMI < 25 kg/m2). TBS reproducibility ranged between 95.8% (BMI = 25–29.9 kg/m2, waist circumference > 88 cm) and 96.6% (BMI < 25 kg/m2). With the exception of obese group, a significant difference was found between BMD and TBS reproducibility, being that of TBS slightly lower than BMD. A significant decrease of TBS values was found between normal and obese subjects, as well as between waist circumference groups. Conclusions: TBS precision error is not affected by BMI and waist circumference differences. TBS reproducibility showed to be slightly lower than that of BMD, but this difference was mitigated in obese patients. A negative association was found between the amount of fat mass and TBS mean values.

Soft tissue augmentation at immediate implants using a novel xenogeneic collagen matrix in conjunction with immediate provisional restorations: A prospective case series.

Collagen matrices used around immediate implants may reduce morbidity although there is limited evidence on their performance. To evaluate soft and hard tissue changes when combining immediate implants, hard and soft tissue grafting, and an immediate provisional restoration. In 12 patients, immediate implants were placed in the anterior maxillary and first premolar area together with a xenogeneic bone substitute. Then a xenogeneic collagen matrix was placed under the buccal mucosal margin with an immediate provisional restoration. Study casts and clinical measurements were taken before extraction (Baseline/BS) at 6 months (6M) and 12 months (1Y) after implant placement. Files from the scanned casts were matched to calculate the linear and volumetric changes at the buccal tissues. Cone Bean Computed Tomographies (CBCTs) were taken prior to extraction and at 6M. The superimposed DICOM files allowed for assessing hard tissue changes and the superimposition of DICOM and STL files allowed for evaluating of soft tissue thickness at BS and 6M. After 6 months, the horizontal tissue contours decreased 0.66 ± 0.57 mm, concomitant with a horizontal bone loss of 1.31 ± 1.32 mm, measured 1 mm below the most coronal aspect of the ridge. In contrast, the soft tissue thickness, 1 mm below the gingival margin, increased 0.75 ± 1.12 mm. At 1-year, tissue contours had decreased 1.01 ± 0.67 mm compared to BS reaching statistical significance. The mean volume loss after 1Y was 20.43 ± 11.70 mm3 while the mean mucosal margin recession was 0.86 ± 0.67 mm. These changes had a limited clinical impact as the PES Scores remained stable. The tested protocol resulted in a significant reduction of the tissue contours and osseous ridge dimensions that was partially compensated by a non-significant increase in soft tissue thickness.

EVALUATION OF THE USE OF ULTRASONIC ACTIVATED POLY-D-L-LACTIC ACID PINS AND MESHES FOR HORIZONTAL SOFT TISSUE AUGMENTATION AROUND DENTAL IMPLANTS

INTRODUCTION: Horizontal ridge defects are a common consequence of tooth loss. They present an esthetic problem, especially if theedentulous site is in the maxillary esthetic zone and indicated for implant placement.A novel system using ultrasonic waves to activate pins and meshes made of completely resorbable poly-D-L-lactic acid has been recentlyintroduced. It is commonly used in the augmentation of alveolar ridge defects, but has not been tried for guided soft tissue augmentation.OBJECTIVES: clinical evaluation of the efficacy of ultrasonic activated poly-D-L-lactic acid pins and meshes for guided soft tissueaugmentation of horizontal defects present around dental implants.MATERIALS AND METHODS: study comprised of eight patients having localized horizontal soft tissue defects around dental implants.‘Guided soft tissue augmentation’ technique was applied to manage these defects using ultrasonic activated poly-D-L-lactic acid pins andmeshes. Patients recorded visual analogue scores for the first two weeks post-operatively. The augmented defects were evaluated for soft tissuethickness and pink esthetic score at one and three months post-operatively.RESULTS: there was a statistically significant increase in soft tissue thickness and fill in all treated defects together with an improvement ofthe pink esthetic score when compared to the baseline values. Patients had a mean visual analogue score of (0.0 ± 0.0) as of the fifth postoperativeday.CONCLUSIONS: augmentation of horizontal soft tissue defects using ultrasonic activated poly-D-L-lactic acid pins and meshes is a lessinvasive and effective clinical procedure to increase soft tissue thickness around dental implants together with the reconstruction of gingivalcontours to match those of adjacent natural teeth.KEYWORDS: dental implants, esthetics, horizontal ridge defects, SonicWeld®, soft tissue

Coronally advanced flap with or without porcine collagen matrix for root coverage: a randomized clinical trial.

The objective of this study is to clinically evaluate the outcomes following treatment of single gingival recessions with either coronally advanced flap technique (CAF) alone or combined with a porcine collagen matrix graft (CM). This is a randomized parallel design clinical trial, including forty patients with single Miller Class I or II gingival recession, with a depth≥2mm and located at upper canines or premolars. The patients were randomly assigned to receive either CAF or CAF+CM. The primary outcome variable was gingival recession reduction (Rec Red). Baseline recession depth was 3.14±0.51mm for CAF group and 3.16±0.65mm for CAF+CM group (p>0.05). Both groups showed significant Rec Red (p<0.05), up to 6months. Rec Red for CAF+CM was 2.41±0.73mm and was 2.25±0.50mm for CAF alone (p>0.05). Root coverage was 77.2% in the CAF+CM group and 72.1% in the CAF group (p>0.05). Complete root coverage (CRC) was found in 40% of the cases in the CAF+CM group and in 35% of the sites treated with CAF. Keratinized tissue thickness (KTT) was 0.26mm higher in CAF+CM group (p<0.05). It can be concluded that CAF+CM does not provide a superior recession reduction when compared to CAF; however, it may offer a small gain in KTT after 6months. CAF+CM can be suggested as a valid therapeutic option to achieve root coverage and some increase in soft tissue thickness after 6months.

Soft Tissue Alterations in Esthetic Postextraction Sites

Dimensional alterations of the facial soft and bone tissues following tooth extraction in the esthetic zone play an essential role to achieve successful outcomes in implant therapy. This prospective study is the first to investigate the interplay between the soft tissue dimensions and the underlying bone anatomy during an 8-wk healing period. The analysis is based on sequential 3-dimensional digital surface model superimpositions of the soft and bone tissues using digital impressions and cone beam computed tomography during an 8-wk healing period. Soft tissue thickness in thin and thick bone phenotypes at extraction was similar, averaging 0.7 mm and 0.8 mm, respectively. Interestingly, thin bone phenotypes revealed a 7-fold increase in soft tissue thickness after an 8-wk healing period, whereas in thick bone phenotypes, the soft tissue dimensions remained unchanged. The observed spontaneous soft tissue thickening in thin bone phenotypes resulted in a vertical soft tissue loss of only 1.6 mm, which concealed the underlying vertical bone resorption of 7.5 mm. Because of spontaneous soft tissue thickening, no significant differences were detected in the total tissue loss between thin and thick bone phenotypes at 2, 4, 6, and 8 wk. More than 51% of these dimensional alterations occurred within 2 wk of healing. Even though the observed spontaneous soft tissue thickening in thin bone phenotypes following tooth extraction conceals the pronounced underlying bone resorption pattern by masking the true bone deficiency, spontaneous soft tissue thickening offers advantages for subsequent bone regeneration and implant therapies in sites with high esthetic demand (Clinicaltrials.gov NCT02403700).

The use of acellular dermal matrix membrane for vertical soft tissue augmentation during submerged implant placement: a case series.

To evaluate the efficiency of acellular dermal matrix membrane to augment vertical peri-implant soft tissue thickness during submerged implant placement. Forty acellular dermal matrix-derived allogenic membranes (AlloDerm, BioHorizons, Birmingham, AL, USA) and 42 laser-modified surface internal hex implants (BioHorizons Tapered Laser Lok, Birmingham, AL, USA) were placed in submerged approach in 40 patients (15 males and 25 females, mean age 42.5 ± 1.7) with a thin vertical soft tissue thickness of 2 mm or less. After 3 months, healing abutments were connected to implants, and the augmented soft tissue thickness was measured with periodontal probe. The gain in vertical soft tissue volume was calculated. Mann-Whitney U-test was applied and significance was set to 0.05. All 40 allografts healed successfully. Thin soft tissue before augmentation had an average thickness of 1.54 ± 0.51 mm SD (range, 0.5-2.0 mm, median 1.75 mm), and after soft tissue augmentation with acellular dermal matrix, thickness increased to 3.75 ± 0.54 mm SD (range, 3.0-5.0 mm, median 4.0 mm) at 3 months after placement. This difference between medians was found to be statistically significant (P < 0.001). Mean increase in soft tissue thickness was 2.21 ± 0.85 mm SD (range, 1.0-4.5 mm, median 2.0 mm). It can be concluded that acellular dermal matrix membrane can be successfully used for vertical soft tissue augmentation.

Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review

To review the dental literature in terms of efficacy of soft tissue augmentation procedures around dental implants and in partially edentulous sites. A Medline search was performed for human studies augmenting keratinized mucosa (KM) and soft tissue volume around implants and in partially edentulous areas. Due to heterogeneity in between the studies, no meta-analyses could be performed. Nine (KM) and eleven (volume) studies met the inclusion criteria. An apically positioned flap/vestibuloplasty (APF/V) plus a graft material [free gingival graft (FGG)/subepithelial connective tissue graft (SCTG)/collagen matrix (CM)] resulted in an increase of keratinized tissue (1.4-3.3 mm). Statistically significantly better outcomes were obtained for APF/V plus FGG/SCTG compared with controls (APF/V alone; no treatment) (p < 0.05). For surgery time and patient morbidity, statistically significantly more favourable outcomes were reported for CM compared to SCTGs (p < 0.05) in two randomized controlled clinical trials (RCTs), even though rendering less keratinized tissue. SCTGs were the best-documented method for gain of soft tissue volume at implant sites and partially edentulous sites. Aesthetically at immediate implant sites, better papilla fill and higher marginal mucosal levels were obtained using SCTGs compared to non-grafted sites. An APF/V plus FGG/SCTG was the best-documented and most successful method to increase the width of KM. APF/V plus CM demonstrated less gain in KM, but also less patient morbidity and surgery time compared to APF/V plus SCTG based on two RCTs. Autogenous grafts (SCTG) rendered an increase in soft tissue thickness and better aesthetics compared to non-grafted sites.