Palatal Soft Tissue Research Articles

Clinical precision of Aoralscan 3 and Emerald S on the palatal and dentition areas: evaluation for forensic applications

ObjectivesTo compare the precision (repeatability and intermediate precision) of palatal and dentition scans taken with two different intraoral scanners. MethodsThe maxillary arch of 23 individuals was scanned three times using the Aoralscan 3 (Shining 3D) and Emerald S (Planmeca), resulting in 6 scans per individual. The scans were segmented in Meshmixer into palatal and dentition areas. Each replicate of an individual was compared within the specific scanner (repeatability) and to the corresponding replicate of the other scanner (intermediate precision). The scans were aligned using the iterative closest-point algorithm in the Zeiss Inspect software. The mean absolute distance between the aligned surfaces was calculated. Statistical comparisons were made using Friedman's two-way analysis of variance. Data are presented in median (quartile 1; quartile 3) form. ResultsNo significant difference in repeatability was found between Emerald S and Aoralscan 3 for the palate (26 µm [22,26] vs. 22 µm [18,26]) and for dentition (37 µm [31,44] vs. 38 µm [35,48]. Intermediate precision of the palate (32 µm [26,43]) and dentition (72 µm [63; 80]) was significantly lower than the repeatability of Emerald S (p < 0.05, p < 0.001) and of Aorlascan 3 (p < 0.001, p < 0.001). Both precision types of both scanners were significantly lower for the dentition than for the palate (p < 0.001). ConclusionThe precision of the dentition scan is lower than that of the palate. The precision of the Aoralscan 3 is similar to that of the Emerald S scanner. Clinical significanceNovel intraoral scanners could be used with high precision for palatal soft tissue scans, expanding their clinical utility. Aligning scans from two different IOSs still has high precision, facilitating the interchangeable use of intraoral scanners for orthodontic, prosthetic, and forensic examinations.

Mapping optimal orthodontic implant sites in the palate using cone-beam computed tomography.

To measure the palatal soft tissue thickness and cortical bone density to determine safe regions for the placement of orthodontic mini-implants and to examine the influence of sex and age on soft tissue thickness and cortical bone density. Cone-beam computed tomography images of 42 patients (22 males and 20 females), including 21 adults and 21 adolescents, were examined in this study. The palatal soft tissue thickness and cortical bone density were measured at the coronal planes between the premolars (P4-5), between the second premolars and first molars (P5-6), and between the first molars and second molars (P6-7). The thickness of the soft tissue revealed similar coronal planes, but the bone density varied. The mean thickness was 3.8 mm at 0°-60° and 1.5 mm at 60°-90°. P4-5 had the highest bone density (>600 HU), decreasing toward P6-7 (<600 HU). Bone density decreased from 90° to 0° coronally, whereas the soft tissue thickness increased. Age, sex, and their interaction affected bone and soft tissues. In general, areas with a high bone density tended to have thin soft tissue coronally, thus the preferred implant site tends to be more anterior to the P4-5 plane and closer to 60°-90°. Considering individual variances, mapping of the recommended regions for palatal mini-implants is suggested.

Determination of Palatal Soft Tissue Thickness and Safe Zone for Palatal Soft Tissue Harvest Using CBCT: A Retrospective Study.

Our decision to conduct this study was motivated by the dearth of knowledge on geographical variations in the thickness of the palatal masticatory mucosa. The aim of the present study is to comprehensively analyze the palatal mucosal thickness and indicate the safety zone for palatal soft tissue harvesting using cone beam computed tomography (CBCT). Material and Methods. As this was a retrospective analysis of cases previously reported to the hospital, written consent was not acquired. The analysis was carried out on 30 CBCT images. Two examiners evaluated the images separately to avoid bias. Measurements were done from the midportion of the cementoenamel junction (CEJ) to the midpalatal suture in a horizontal line. Measurements were recorded from the maxillary canine, first premolar, second premolar, first molar, and second molar and were marked in axial and coronal sections at distances of 3, 6, and 9 mm from the CEJ. The relationship between palate soft tissue thickness in relation to each tooth, palatal vault angle, teeth, and the greater palatine grove was evaluated. Differences in the palatal mucosal thickness according to age, gender, and tooth site were evaluated. Categorical data were presented as frequencies and percentages. Numerical data are presented as mean and standard deviation values. They are explored for normality using Shapiro-Wilk's test. Data are normally distributed and are analyzed using one-way ANOVA followed by Tukey's post hoc test for independent variables and paired t-test for repeated measures. The significance level is set at p ≤ 0.05 for all tests. Statistical analysis is performed with R statistical analysis software version 4.1.3 for Windows. For sex and nationality, there was no significant association (p > 0.05), while for age, cases 35 years and older had significantly higher mucosal thickness than cases younger than 35 years old (p < 0.001). For all teeth, the association was statistically significant (p < 0.001). For the canine and first premolar, cases with deep angles had significantly higher mean values than those with moderate angles (p < 0.001). For other teeth, cases with deep angles had significantly higher mean values than other angles (p < 0.001). Palatal mucosal thickness varied significantly from the canine to the second molar; the most appropriate site for graft harvesting is the canine to second premolar area which is 9-12 mm from the midpalatal suture aspect and is considered a safe zone for harvesting palatal graft.

Effect of periodontal phenotype characteristics on post-extraction dimensional changes of the alveolar ridge: A prospective case series.

This study was primarily aimed at assessing the effect that specific periodontal phenotypical characteristics have on alveolar ridge remodelling after tooth extraction. Patients in need of extraction of a non-molar maxillary tooth were enrolled. Baseline phenotypical characteristics (i.e., mid-facial and mid-palatal soft tissue and bone thickness, and supracrestal soft tissue height [STH]) were recorded upon extraction. A set of clinical, digital imaging (linear and volumetric), and patient-reported outcomes were assessed over a 14-week healing period. A total of 78 subjects were screened. Forty-two subjects completed the study. Linear and volumetric bone changes, as well as vertical linear soft tissue and alveolar ridge volume (soft tissue contour) variations, were indicative of a marked dimensional reduction of the alveolar ridge over time. Horizontal facial and palatal soft tissue thickness gain was observed. Thin facial bone (≤1 mm) upon extraction, compared with thick facial bone (>1 mm), was associated with greater linear horizontal (-4.57 ± 2.31 mm vs. -2.17 ± 1.65 mm, p=.003) and vertical mid-facial (-0.95 ± 0.67 mm vs. -4.08 ± 3.52 mm, p < 0.001) and mid-palatal (-2.03 ± 2.08 mm vs. -1.12 ± 0.99 mm, p=0.027) bone loss, as well as greater total (-34% ± 10% vs. 15% ± 6%, p < 0.001), facial (-51% ± 19% vs. 28% ± 18%, p=0.040), and palatal bone volume reduction (-26% ± 14% vs. -8% ± 10%, p < 0.001). Aside from alveolar bone thickness, STH was also found to be a predictor of alveolar ridge resorption since this variable was directly correlated with bone volume reduction. Patient-reported discomfort scores progressively decreased over time, and the mean satisfaction upon study completion was 94.5 ± 0.83 out of 100. Alveolar ridge remodelling is a physiological phenomenon that occurs after tooth extraction. Post-extraction alveolar ridge atrophy is more marked on the facio-coronal aspect. These dimensional changes are more pronounced in sites exhibiting a thin facial bone phenotype (Clinicaltrials.gov NCT02668289).

The Posterior Extension of the Palatal Rugae as an Anatomical Constraint for Soft Tissue Grafts in a Saudi Arabian Population.

Background The purpose of this study was to investigate the distal extension of the palatal rugae area as an anatomical constraint on the harvesting of palatal soft tissue grafts in a Saudi Arabian population. Additionally, factors that could affect or predict the extension were considered. Methods Three hundred seventy-four (374) dental casts from Saudi nationals currently residing in Riyadh (170 males and 204 females) were included. Two independent observers used a standardized probeto measure the posterior extent of the rugae on each stone castbilaterally on a horizontal base. A sharp graphite pencil was used to mark the measurements from the origin of the rugae to their terminal ends on the cast, and a magnification lens was used to identify them. Using this technique, the most posterior extension of the rugae was marked and then analyzed. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar, and logistic regression was used to seethe association of this extension with other factors. Results The asymptotic chi-squared (p = 0.0002) McNemar tests revealed that the posterior distal extension of the rugae was not the same on both sides.A normal approximation test for the left side with 95% confidence intervals (CIs) with the "rugael extension proximal to the mesial end of the upper second premolar"category considered "success"found that the proportion of upper second premolars with rugael extensions proximal to the mesial end was not significantly different to the proportion of rugael extensionsbeyond the mesial end of the upper second premolars (95% CI: 48.69%-58.79%,p= 0.147). Conversely, the proportion of the upper second premolars with rugael extensions proximal to the mesial end was significantly lower than that beyond the mesial end on the right (95% CI: 35.92%-45.89%,p= 0.00004).Gender, age, and palatal shape did not significantly affect the posterior extension of palatal rugae. Conclusions The palatal rugae on the left side of a sample of the Saudi Arabian population do not considerably extend beyond the upper second premolarmesial aspect, which may provide reliablesoft tissue grafts for esthetic mucogingival surgery.

Palatal soft tissue thickness around dental implants and natural teeth in health and disease: A cross sectional study.

Previous studies focused on the influence of buccal mucosa thickness on peri-implant bone loss and inflammation, with inconclusive results. We observed substantially thicker palatal mucosal tissues at peri-implantitis sites. Therefore, we hypothesize that thick palatal peri-implant mucosa may be associated with deeper pockets and disease severity. To compare the thickness of the palatal tissue between natural teeth and implants in periodontal health and disease. Adult, non-smoker, healthy patients who visited our department for periodontal examination or treatment with restored implants in the posterior maxilla were recruited. Probing depth (PD), plaque index (PI), gingival index (GI) and radiographic measurements were recorded around implant and the contralateral tooth. Palatal tissue thickness was measured using a 30G needle that was inserted perpendicular into the mucosa at the bottom of the periodontal/peri-implant pocket and 3 mm coronally. Differences in the palatal tissue thickness between teeth and implants (in the same patient) was performed using t-test; as well as between peri-implantitis and non-peri-implantitis sites (among patients). Sixty patients were included. Thirty-four implants were diagnosed with peri-implantitis and 26 healthy/mucositis implants with corresponding 24 healthy/gingivitis teeth and 36 teeth with attachment loss. Mean PD was higher around implants (4.47 ± 1.57 mm) than teeth (3.61 ± 1.23 mm, p=0.001). The thickness of implants' palatal mucosa was higher than in teeth, at the base of the pocket and 3 mm coronally (4.58 ± 1.38 mm vs. 3.01 ± 1.11, p=0.000; 3.58 ± 2.15 vs. 1.89 ± 1.11, p=0.000, respectively). Mean palatal tissue thickness was 4.32 ± 2.35 mm for the peri-implantitis group while only 2.61 ± 1.39 in healthy implants, 3 mm coronal to the base of the pocket (p=0.001). Palatal thickness at peri-implantitis sites was higher (4.32 ± 2.35) compared to periodontitis sites (2.23 ± 0.93), p=0.000. Implant sites with palatal mucosa >4 mm (n=32) had deeper mean pockets (5.58 ± 1.98) compared with thinner (≤4 mm) sites (n=28) (4.48 ± 1.18, p=0.018). Thicker palatal tissue around implants is associated with deeper palatal pockets. Thick palatal tissue was found around implants diagnosed with peri-implantitis.

Evaluation of Palatal Rugae in Patients for Maxillary Dental Prostheses

Significance and importance of palatal soft tissue rugae increases many folds when replacement of missing maxillary teeth with conventional complete denture is part of treatment plane. Objectives: To quantify the shape and size of rugae in completely and partial edentulous arches in both males and females. Methods: A total of 200 patients were selected on the basis of inclusion and exclusion criteria and after obtaining informed consent, impression with Alginate impression material were made and poured to form dental casts. Pattern and shapes of rugae were delineated with graphite marker. Under a good source of light different shapes, thus outlined, were counted in number and measured in length, categorizing them in various shapes such as divergent, wavy, curved and straight. Age, arches were computed for frequency and measuring the mean with standard deviation. All data were computed by using SPSS (version 22). Results: Out of 200 patients, a male (n=89) to female (n=111) ratio of 0.80 was found with a mean age of 52.6 and standard deviation of 11.3. Partially edentulous cases were 51%, while the rest were completely edentulous. A total of 1367 rugae were found in both types of patients. Females had more number of rugae (n=773) than males (n=594). Similarly primary rugae were higher in numbers (n=1132) than secondary rugae (n=235) and the observed difference was statistically significant (p=0.001). Conclusions: It was concluded in this study that female and partially edentulous arches had more numbers of rugae as compared to males and completely edentulous arches respectively.

Investigation of the palatal soft tissue volume: a 3D virtual analysis for digital workflows and presurgical planning

BackgroundIn mucogingival and implant surgery, an autologous soft tissue graft from the palate is the gold standard for reconstructing missing keratinised soft tissue and volume. Previously, presurgical measurements of the graft harvesting site were described with two-dimensional (2D) linear measurements. The present observational clinical study aimed to evaluate a three-dimensional (3D) measurement method for determining the present palatal soft tissue volume for each patient individually.MethodsPre-existing cone beam computed tomography (CBCT) scans of 20 patients were converted into 3D Standard Tessellation Language models of the bone surface. Intraoral impressions of the maxilla were taken and digitised to visualise the gingival surface. The resulting virtual models of bone (reference value) and gingival (actual value) surfaces were merged, with tooth surfaces used for registration. The region between the central incisors and the hard palate was subdivided into 5 regions of interest (ROIs). The distance between palatal bone and gingival surface was analysed both volumetrically and linearly, and the results were statistically evaluated for the ROIs.ResultsThe average gingival surface area on the palate was 19.1 cm2, and the mean volume was 58.2 cm3 (± 16.89). Among the ROIs, the mean linear value was highest in the most distal region, from the second molar to the hard palate (4.0 ± 1.09 mm) and lowest in the canine region (1.9 ± 0.63 mm). For mean distance, significant differences were found for the anterior palate and the most posterior palate in comparison with all other ROIs (p < 0.01). The volume measurements also declined significantly and steadily between the posterior (1.9 ± 1.0 cm3) and anterior palates (0.4 ± 0.2 cm3).ConclusionsBy merging digital data, palatal soft tissue could be quantified virtually. The results were reliable and comparable to previous findings with linear measurement methods. This 3D soft tissue volume analysis method fully exploited the diagnostic potential of data that are frequently collected for presurgical planning in oral surgery (i.e., CBCT + surface scans). This evaluation method might be useful for volumetric and linear measurements in other applications in anatomy and for determining palatal soft tissue dimensions in the planning stage before surgical interventions.Trial registrationThis observational clinical trial was retrospectively registered in the German Clinical Trials Register, reference number: DRKS00023918.

A 3D Digital Analysis of the Hard Palate Wound Healing after Free Gingival Graft Harvest: A Pilot Study in the Short Term.

Purpose: Within this context, this pilot study aimed to evaluate the healing dynamics process of the hard palate after free gingival graft harvesting in the short term (3 months), utilizing digital imaging technology and tridimensional analysis software. Furthermore, assessing the results found to verify the existence of a relationship between gender or age with tissue loss. Materials and Methods: For connective-tissue harvesting, fifteen patients with gingival recessions type (RT) 1 and RT2 were selected. On the surgery day (before the procedure) and after three months, palatal impressions were taken in all patients, and cast models were done for posterior model scanning. The following variables were analyzed: mean thickness alterations ( TA), maximum thickness loss (MTL), mean maximum thickness loss ( MTL), and volume alterations (VA). A descriptive and bivariate analysis of the data was done. The data were submitted for statistical evaluation and were significant if p < 0.05. Results: Fifteen patients were analyzed, 11 females (73.3%) and four males (26.7%). The patients’ average age was 28 ± 8.52 years (ranging between 16 and 48 years old). The palatal wound region’s mean thickness and volume changes were −0.26 mm (±0.31) and 46.99 mm3 (±47.47 mm3) at three months. There was no statistically significant result correlating age/gender with any variable evaluated. Conclusions: Connective tissue graft harvesting promoted changes with a standard volume and thickness loss of palatal soft tissue. A 3D digital evaluation was a non-invasive method with a reproducible technique for measuring thickness or volume after connective tissue is collected. There was no relationship between age/gender and any variables analyzed.

Evaluation of potential mini-implant insertion sites for maxillary skeletal expander: A computerized tomography study

ABSTRACT Objective To estimate palatal bone thickness (PBT), inferior surface palatal bone density (ISPBD), superior surface palatal bone density (SSPBD), palatal soft tissue thickness (PST) and hard palate extension (HPE) in relation to maxillary dentition for maxillary skeletal expander (MSE) mini-implant insertion sites. Materials and Methods Computerized Tomography images of 40 subjects were selected (19 male, 21 female) with mean age 23.12 years. The measurements of PBT, ISPBD, SSPBD, and PST were made at 14 different levels from incisive foramen at 2 mm intervals using BlueSky software. HPE was measured in relation to the distal surface of the maxillary second molar tooth. Statistical analysis was used to compare and correlate variables. Result PBT, ISPBD, and SSPBD decrease from anterior to posterior region with a significant difference in PBT between anterior and posterior areas in the total sample and in males. PST showed no significant differences between anterior and posterior areas and between males and females. HPE located 4 mm anterior to the line tangent to the distal surface of the second molar. There was a positive relationship between PBT and PST in anterior regions of the palate and negative one in the posterior region. Conclusion PBT decreased in the posterior direction. Anatomical variables measured at sites 13–19 mm from incisive foramen support MSE insertion locations. A significant positive correlation between PBT and PST was found in the anterior region of the palate while a negative correlation between these parameters was documented posteriorly. However, no correlation was reported between PBT and ISPBD except at 5 mm, and no correlation was detected between PBT and PST.

Propylene mesh versus acrylic resin stent for palatal wound protection following free gingival graft harvesting: a short-term pilot randomized clinical trial

BackgroundProtection of the palatal wound is an essential step following harvesting a palatal soft tissue graft. The aim of the current pilot randomized clinical study was to assess the efficacy of using propylene mesh as protective sheet when compared to conventional custom made acrylic stent after harvesting a palatal graft. The primary outcome of this study was bleeding postoperatively and secondary outcomes were pain, healing profile of the donor site as well as patient satisfaction.MethodsBetween 2018 and 2019 we conducted a prospective randomized controlled trial of 24 patients with palatal defects. Two groups of 12 patients with 24 sites were included in this study and were treated with soft tissue grafting technique using free grafts harvested from the hard palate. The palatal wounds were protected with propylene mesh (test group) or custom-made acrylic palatal stent (control group). Participants were assessed for the amount and duration of bleeding, pain duration, and the risk of infection 2, 4, 6, 8, 14 days post-operatively. The trial had been registered in clinical trials.gov (NCT04348279).ResultsFour sites were excluded from the study as dropouts. The polypropylene mesh was more effective at reducing bleeding by (2.4 ± 1.075) and pain by (1.600 ± 0.516), while the custom-made acrylic stent reduced the bleeding (5.8 ± 1.22) and pain (7.100 ± 0.316). The decline in amount of bleeding amount (P value = 0.021) and its duration (P value = 0.001) achieved by the propylene mesh was statistically significant. There was no statistical significant difference in patient satisfaction and the duration of healing process between the 2 groups. However, the healing profile of the test group was statistically significant when compared with the control group (P value = 0.002).ConclusionsPropylene mesh is a promising material for protection of the palatal wound due to its light weight, limited bacterial wicking, tissue compatibility. Further studies are required to adequally assess the benefits of this material in periodontal plastic surgeries.

Distal extension of palatal rugae as a limitation for donor soft tissue grafts in a Jordanian population: A cross-sectional study

BackgroundThe purpose of the cross sectional study was to investigate the distal extension of the rugae area in a Jordanian (Middle Eastern) population, as an anatomical limitation influencing the surgical decision of harvesting a palatal soft tissue graft. Factors that may influence or predict the extension were also assessed.MethodsSixty periodontally healthy participants (29 males and 31 females) were included. Maxillary alginate impressions were made and casts were poured. The measurements were highlighted from the origin of the rugae (near mid palatine raphe) to the terminal end with a sharp graphite pencil on the cast and a magnification lens was used for identification. The most posterior extension of the rugae were marked on the casts and determined by a standardized periodontal probe. The normal approximation test for binomial distribution was used to determine the proportion of the subjects with rugael extensions beyond the mesial end of the upper second premolar and fisher’s exact test for the purpose of analysis of the association of this extension with other factors.ResultsIn almost half (41.7%) of the sample, the rugae extended distal to the upper second premolar, 23.3% extended to the mid-palatal of the upper second premolar, and 11.7% extended to the mesial of the upper second premolar. The implication is that 90.0% of the rugae reached the upper second premolar and 78.3% extended beyond its mesial aspect. The normal approximation test performed with 95% CI with the "rugael extension proximal to the mesial end of the upper 2nd premolar" considered to be the "success" category revealed that the proportion of the subjects with rugael extensions proximal to the mesial end of the upper second premolar was significantly lower than the proportion beyond the mesial end of the upper second premolar (95% CI of 11.2–32.0%, p = .00001). There was no significant difference between gender, smoking status, gingival phenotype and palatal shape with the posterior extension of palatal rugae.ConclusionsPalatal rugae in a sample of a Jordanian population extends beyond the mesial aspect of the upper second premolar which may cause a substantial limitation for graft harvesting from the palate. The hard palate of Jordanian patients may not be a reliable source of soft tissue grafts required for aesthetic mucogingival surgery. No significant association existed between the most posterior extent of palatal rugae and gender, gingival phenotype or palatal shape. Other possible sources should be explored.

Beware of chicken bones: An uncommon presentation of a foreign body in the palate

This paper describes a case of an intra-osseous foreign body impaction in the hard palate, a chicken bone fragment, in an adult male. The presentation mimicked that of an odontogenic lesion. Though palatal soft tissue foreign bodies in toddlers are well reported, the literature is sparse on cases involving adults. The location of the foreign body, and radiographic presentation, resulted in a diagnostic challenge to the attending clinician. This appears to be the first reported case of an animal bone presenting in this way in an adult.CPD/Clinical Relevance: The case highlights the importance of credible history reporting, 3D imaging and developing accurate differentials in the diagnostic pathway when faced with an atypical clinical presentation.

Radiological evaluation of the bone and soft tissue thicknesses of the palate for using a miniscrew-supported maxillary skeletal expander.

The purpose of this study was to determine the palatal bone and soft tissue thicknesses using a miniscrew-supported maxillary skeletal expander (MSE) in Class III malocclusion. The thicknesses of the palatal bone and soft tissue were measured in cone-beam computed tomography images obtained from 58 patients. All 20 points were crossing points between five levels, which were defined at 3mm intervals relative to the line connecting the central fossae of the first molar (Level 0), and 2mm and 4mm lateral to the anteroposterior reference line (AP line). The palatal bone was significantly thicker in males than females in the anterior palate up to Level 0, while there was no significant sex-related difference in the posterior palate. There was a tendency for the thickness to decrease in the posterior direction, except in females at 2mm lateral to the AP line. The palatal soft tissue was significantly thicker in males than females in all positions. At 2mm lateral to the AP line, the palatal soft tissue thickness decreased in the posterior direction. A 4mm lateral to the AP line, it initially decreased in the posterior direction, and then increasing again at Level - 6 (6mm posterior of Level 0). As the lateral distance from the AP line increased, the palatal bone thickness decreased while the palatal soft tissue thickness increased. These findings provide quantitative data on the palatal bone and soft tissue thicknesses for the miniscrew-supported MSE in the posterior palate.

Outcome measurements following palatal soft tissue graft harvesting: A review.

BackgroundFree gingival graft (FGG) and connective tissue graft (CTG) are two of the most commonly techniques performed in periodontal and peri-implant plastic surgery. Although several outcome measurements have been proposed for evaluation of palatal wound healing and patient morbidity, a comprehensive review about these variables is lacking. The objective of this review is to present comprehensive information about outcome measurements related to postoperative palatal wound healing and postoperative patient-reported morbidity after FGG or CTG procedures. Material and MethodsAn electronic search of English language dental literature in the Medline database via PubMed access was conducted from May 1994 to May 2020 following the PRISMA guidelines. Electronic search strategy complemented by hand search of impacting related dental journals, and the reference list of all included studies were used to complete data collection considering only clinical trials. Finally, inclusion criteria were applied to identify articles after full-text evaluation. ResultsA total of 111 articles were identified. After the exclusion of 34 articles based on title and abstract evaluation, 77 articles were full text screened. Following, 46 articles were excluded since they evaluated other surgical areas. Finally, 31 studies were selected and included for final evaluation. Outcome measurements were classified in variables collected by indexes and systems assessed professionally and patient-centered measurements. Visually-assessed measurements include indexes, photographs, bleeding and use of laboratory-aided measurements. Patients-centered outcomes comprise pain, discomfort and quality-of life, among others. ConclusionsThe most commonly used outcome measurements related to postoperative palatal wound healing are hydrogen peroxide test, tissue color match, visual inspection, and bleeding evaluation. Pain perception, analgesic consumption, discomfort sensation, burning sensation, and changes in feeling habits are the most commonly used outcome measurements related to postoperative patient-reported morbidity. Key words:Morbidity, patient comfort, periodontics, tissue harvesting, wound healing.

Eutectic mixture of Local Anaesthetic (EMLA) an alternative for painful palatal nerve blocks: Randomised controlled trial

The purpose of this study is to compare the efficacy of EMLA to Palatal nerve blocks in providing anaesthesia to the palatal soft tissues during extraction. Seventy patients who reported for extraction of maxillary premolar and maxillary molar tooth were included in this study. These patients were divided into two groups randomly. One group consisted of patients receiving EMLA (Eutectic mixture of Lidocaine and Prilocaine) over the palatal soft tissues adjacent to the tooth with a cotton swab, and the other group consisted of patients receiving 0.4 – 0.6 ml of 2% lignocaine with 1;2,00,000 dilution adrenaline slightly anterior to the greater palatine foramen with a syringe. The mean score VAS while applying EMLA cream in group A was 0.00. In contrast, while giving palatal nerve block in group B, it was 4.09 that was statistically significant using the independent sample t-test. Likewise, the mean VAS score while extraction in the EMLA group was 0.11, whereas in palatal nerve block group was 0.00 that was not statistically significant using independent sample t-test. EMLA may be advantageous in providing palatal soft tissue anaesthesia during prophylactic extraction, thereby avoiding painful palatal nerve blocks.

Palatal Soft Tissue Thickness on Maxillary Posterior Teeth and Its Relation to Palatal Vault Angle Measured by Cone-Beam Computed Tomography

Objective Analyzing palatal soft tissue thickness in cone-beam computed tomography (CBCT) images and evaluating the relationship between tissue thickness and palatal vault angulation. Methods Out of 1,737 CBCT images, fifty-six images met the inclusion criteria and were included in this cross-sectional study. The palatal vault angle on the maxillary first molar was measured and divided the images into 3 groups. The soft tissue thickness between the maxillary first premolar and second molar was measured at a distance of 3, 6, 7, 8, and 9 mm from the cementoenamel junction. All the image measurements were performed using CBCT-viewer software. Result In this study, 56 CBCT images with full permanent maxillary posterior teeth and absence of light scattering were found. The mean age of the patients was 31.59 ± 13.92 years. The moderate and deep palatal vault angle patterns had the greatest and least prevalence, respectively. The average thickness on shallow, moderate, and deep palatal vault groups was 4.02 ± 0.58, 3.75 ± 0.73, and 3.43 ± 0.38 mm, respectively. Furthermore, the mean palatal mucosal thickness was statistically different between the deep and shallow palatal vault angle groups (p < 0.05, power of test 0.8). Based on the Pearson correlation coefficient, there was a negative correlation between the palatal mucosal thickness and palatal vault angle (p < 0.05, power of test 0.85). Conclusion A negative correlation between the palatal mucosal thickness and palatal vault angle was observed. Furthermore, this study suggested that the shape of the palatal vault can be one of the supporting data for evaluating the graft dimensions.

Effect of vertical soft tissue thickness on clinical manifestation of peri-implant tissue in patients with periodontitis

To observe and investigate the effect of vertical soft tissue thickness on the peri-implant tissue condition and the prevalence of peri-implant disease in patients with history of periodontitis. Among 210 patients who showed initial interest of implant therapy, 92 patients were included in this study and received implant surgery during 2010 and 2015. Sixty-six patients with 66 implants finally came back for T2 evaluation. Prior to the implant therapy, all the patients had received periodontal treatment. During the implant placement surgery, the distance from palatal soft tissue edge to the alveolar crest, which was defined as vertical soft tissue thickness (VT), was measured after the buccal full thickness flap was elevated. According to the cut off point which was adopted from the operating characteristic curve, 66 implants within 66 patients were divided into two groups, which were called normal group (VT≤4.5 mm) and thick group (VT>4.5 mm), respectively. Information of the patient's general status, periodontal situation and implant information were recorded. After a follow-up period of 42.9 months, the parameters of peri-implant tissue and condition of peri-implant disease were recorded. Mann-Whitney U test as well as Chi-square test were used to compare the parameters between two groups. Moreover, Kaplan-Meier method was chosen to draw the event(peri-implantitis)-free survival curve. The survival rate of the implants was 100%. At the end of the follow-up examination(T2), the parameters including max PDi, mean PDi, max BIi, mean BIi, mean MBL, MBL at distal side, MBL at mesial side, mean PLIi presented significantly higher values in thick group than in normal group (P < 0.05). Moreover, the prevalence of peri-implantitis and peri-implant disease (peri-implant mucositis & peri-implantitis) in thick group was respectively 34.8% and 73.9%, which was significantly higher than 2.3% and 48.8% respectively in normal group (P<0.05). The prevalence of peri-implant mucositis did not show significant difference in the two groups. In addition, Kaplan-Meier analysis showed that there was significant difference between the event-free survivals of the two groups. The vertical soft tissue thickness around implants in patients with periodontitis has a significant effect on the health of the peri-implant tissue. Excessive vertical soft tissue thickness may result in deeper peri-implant probing depth as well as more peri-implant marginal bone loss, and eventually increase the risk of peri-implant disease. The vertical remodeling of soft tissue may be a new direction to indicate the role of periodontitis in peri-implant tissue condition. Moreover, the biological mechanism of the association between soft tissue thickness and peri-implantitis risk as well as effective approaches to prevent the adverse effect of excessive soft tissue thickness on peri-implant tissue is necessary to be investigated.

Influence of vertical soft tissue thickness on occurrence of peri-implantitis in patients with periodontitis: a prospective cohort study.

The influence of vertical soft tissue thickness on health of peri-implant tissue has been addressed in few studies; thus, further research is needed. To evaluate the influence of vertical soft tissue thickness on the risk of peri-implantitis and peri-implant condition in patients with a history of periodontitis. A total of 92 patients with a history of periodontitis were included in this study. During the implant placement, the distance from palatal soft tissue edge to the alveolar crest, which was defined as vertical soft tissue thickness, was measured. The characteristics of patients and implants were recorded at baseline (T1). After more than 2 years follow-up period, 65 patients with 159 implants finally came back for T2 evaluation, and parameters of peri-implant tissue were recorded. The associations of vertical soft tissue thickness with peri-implant parameter and occurrence of peri-implantitis were analyzed using the generalized estimating equation accompanying linear regression and logistic regression. In addition to conventional multivariate analysis, a propensity score for adjustment was used to reduce confounding bias. At follow-up examination (T2), survival rate at implant-level was 98.8%. The peri-implant parameters, including peri-implant probing depth and marginal bone loss, increased significantly with the increasing of soft tissue thickness (P < 0.05) after adjusting for a propensity score. In multivariate analysis adjusted for different confounding factors and propensity score, the odd ratios were all approximately 2.5, which meant that the risk of peri-implantitis increased 1.5 times for 1 mm increase of soft tissue thickness. The excessive vertical soft tissue thickness around implants in patients with history of periodontitis has an adverse influence on health of the peri-implant tissue. This observation raises an important question on the association between vertical soft tissue thickness during implant surgery and history of periodontitis. Effective approaches to prevent the adverse effect of excessive soft tissue thickness on peri-implant tissue are necessary to be further investigated.

Oral Soft Tissue Regeneration Using Nano Controlled System Inducing Sequential Release of Trichloroacetic Acid and Epidermal Growth Factor.

The effect of nano controlled sequential release of trichloroacetic acid (TCA) and epidermal growth factor (EGF) on the oral soft tissue regeneration was determined. Hydrophobically modified glycol chitosan (HGC) nano controlled system was developed for the sequential release of TCA and EGF, and the release pattern was identified. The HGC-based nano controlled release system was injected into the critical-sized defects created in beagles' palatal soft tissues. The palatal impression and its scanned body was obtained on various time points post-injection, and the volumetric amount of soft tissue regeneration was compared among the three groups: CON (natural regeneration control group), EXP1 (TCA-loaded nano controlled release system group), EXP2 (TCA and EGF individually loaded nano controlled release system). DNA microarray analysis was performed and various soft tissue regeneration parameters in histopathological specimens were measured. TCA release was highest at Day 1 whereas EGF release was highest at Day 2 and remained high until Day 3. In the volumetric measurements of impression body scans, no significant difference in soft tissue regeneration between the three groups was shown in two-way ANOVA. However, in the one-way ANOVA at Day 14, EXP2 showed a significant increase in soft tissue regeneration compared to CON. High correlation was determined between the histopathological results of each group. DNA microarray showed up-regulation of various genes and related cell signaling pathways in EXP2 compared to CON. HGC-based nano controlled release system for sequential release of TCA and EGF can promote regeneration of oral soft tissue defects.