Releasing Incisions Research Articles

Do immediately placed implants have better outcomes when placed with a minimal split-thickness envelope flap?

Design Randomised, controlled, single-blind, single-centre clinical trial.Case selection Adult patients in need of a single tooth extraction in the anterior maxillary and premolar region. Full mouth plaque scores below 25% and bleeding scores below 10%, with no active periodontal disease. As assessed by cone beam computed tomography; intact buccal plate, adequate mesiodistal space and adequate quality of bone.Data analysis Patients had immediate implant placement following extraction, either with a flap with no vertical releasing incision (control group) or a minimal split-thickness envelope flap (test group). The trial compared clinical, radiographic, aesthetic and patient-reported outcomes of immediately placed implants. Primary outcomes were measured using the pink (PES) and white (WES) aesthetic score. JMP Pro 13 was the statistical software used. Statistical comparisons were conducted at a 0.05 level of significance.Results In total, 28 patients were enrolled in the study, after exclusions. The total PES and WES scores were similar in the control and test groups. Implant survival and success rate after 12 months was 100%. Buccal plate thickness at 12 months post-loading was 2.78 mm in the control group and 2.54 mm in the test group, so there was no statistically significant difference between them. The majority of patients in both groups responded as 'positive' in the patient satisfaction questionnaire and visual analogue scale.Conclusions When comparing PES/WES scores, success/modified success rate, survival, mean buccal plate resorption and patient satisfaction, there were no differences between immediate implants placed with a flap or with a minimal split-thickness envelope flap.

Laparoscopic Peritoneal Pull through Vaginoplasty with Ovarian Hitching to Facilitate Transvaginal Oocyte Retrieval for Mrkh Syndrome

<h3>Study Objective</h3> Video demonstration of laparoscopic peritoneal pull through vaginoplasty using the midline bands and mobilization of ovaries in the pelvis to facilitate transvaginal oocyte retrieval in a case of MRKH. <h3>Design</h3> Interesting case video. <h3>Setting</h3> Lithotomy. <h3>Patients or Participants</h3> Case of MRKH Syndrome. <h3>Interventions</h3> Laparoscopy. Bladder and rectum was dissected away from midline band between the Uterine buds. NeoVagina created vaginally making a U-shaped incision at the perineum. Peritoneal flaps made using the midline band. This band was cut. The vaginal vault opened using a sponge on holder inserted through the neovagina. The right and left peritoneal flaps were pulled down to the introitus to line the anterolateral part of neovagina and stitched at the end, smooth surface facing out. Releasing incisions made around the ureter, to prevent kinking.The rectovaginal peritoneal was brought down and stitched at the introitus to line the posterior surface of vagina. The neoapex made by passing a circumferential suture of the peritoneum. A mould made was inserted in the neovagina. Ovaries were mobilized into the pelvis and hitched in the POD, after making releasing incisions over the infundibulopelvic and the round ligament to facilitate transvaginal oocyte retrieval. <h3>Measurements and Main Results</h3> Post surgery mould kept for 4 days. A vaginal dilator for 3 to 6 months. Tranvaginal oocyte retrieval planned after 12 weeks. Now 6 weeks post-surgery and can use the vaginal dilator 10 hrs/day. <h3>Conclusion</h3> A peritoneal pull through vaginoplasty can be performed for a case of MRKH using the peritoneum covering the midline band for lining the anterolateral surface of neovagina and rectovaginal peritoneal lining the posterior surface of neovagina. Since this patient needs IVF and surrogacy, the oocyte retrieval in a case of MRKH is a challenge since the ovaries are high at the pelvic brim. The ovaries can be mobilized into the pelvis and a tranvaginal oocyte retrieval can be performed.

Robotic Uterosacral Ligament Suspension: Tips and Tricks to a Successful Suspension

<h3>Study Objective</h3> The objectives of this film are to review pelvic anatomy and levels of pelvic support, present a technique for uterosacral ligament suspension done robotically at the time of hysterectomy, and discuss suture choices for long-lasting support. We discuss important points to consider when performing the procedure, and suggest a technique that results in a reliable outcome. <h3>Design</h3> N/A. <h3>Setting</h3> Operating room with patient in reverse Trendelenburg and Da Vinci Xi robot docked. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Uterosacral Ligament Suspension with barbed delayed absorbable suture and serpentine stitches. <h3>Measurements and Main Results</h3> The correction of an apical defect can be accomplished with uterosacral ligament suspension, which can also decrease the severity of cystocele and rectocele. Starting with a peritoneal releasing incision can mobilize the ureter and avoids kinking of the ureter when tugging on the ligament. Suture choices include barbed delayed absorbable sutures and permanent sutures. Barbed delayed absorbable suture dissolves in 180 days, which is enough time to form scar tissue that will continue to support the suspension. Serpentine stitches along the ligaments are made and tightened to shorten the ligament, which fixes it to the vagina allowing for elevation of the apex. A McCall's culdoplasty can be done with the same suture, reducing enterocele. Finally, plicating the uterosacral ligaments at the end brings them to the midline and strengthens the suspension. <h3>Conclusion</h3> In conclusion, uterosacral ligament suspension at the time of robotic hysterectomy can correct uterovaginal prolapse. Barbed delayed absorbable suture is a viable alternative to permanent sutures due to scar formation. Peritoneal releasing incisions between the ureter and uterosacral ligament protect the ureter from kinking. Serpentine bites around the uterosacral ligaments result in secure cinching of the tissue, which contributes to a reliable suspension.

Closure of large lumbosacral defect using a combined method of bilateral bipedicle flap with lateral releasing incision and Integra® dermal regeneration template

BACKGROUND: Myelomeningocele is one of the most complex congenital malformations of the central nervous system. It is one of the most common types of spina bifida which involves a failure of neural tube closure. Reconstruction surgery for myelomeningocele had always been challenging for plastic and neurosurgeons.&#x0D; CLINICAL CASE: We report a case of a new-born with lumbosacral myelomeningocele who received treatment in the Hospital Universiti Sains Malaysia. The myelomeningocele was repaired by the neurosurgery team and subsequently, the child was left with huge lumbosacral skin defect. The large defect was successfully covered by using a combined method of bilateral bipedicle flap with lateral releasing incision and remaining lumbosacral and secondary defect resurfaced using Integra dermal regeneration template (DRT). We used ACTICOAT interfaced negative pressure wound therapy (NPWT) as our main dressing in preparing the wound bed for autologous epidermal graft. The result of our closure technique provides tension free closure.&#x0D; DISCUSSION: We incorporated bilateral bipedicle fasciocutaneous flap technique together with DRT for closure of the lumbosacral defect. The bilateral bipedicle flap with lateral releasing incision served to reduce tension on the skin at bilateral lumbar region. The DRT downsized the lumbosacral defect and NPWT dressing provided an optimal sterile environment in giving time for neodermis generation. The remaining secondary defect were also resurfaced utilizing DRT and autologous skin grafting.&#x0D; CONCLUSIONS: The outcome of surgery demonstrated that the combined use of bilateral bipedicle fasciocutaneous flap with lateral releasing incision and DRT with delayed skin grafting is safe, effective and provide long term stable and supple scar for large, exposed dura defect.

Root coverage with tunneling technique or modified advanced flap associated with acellular dermal matrix: results from 6 months randomized clinical trial.

This study compared two surgical techniques using acellular dermal matrix (ADM) for the treatment of multiple gingival recessions. Twenty patients, with bilateral RT1 gingival recessions, were selected. One side received a modified extended coronally advanced flap (MECAF), and the contralateral side a supra-periosteal flap (TUN). The evaluated parameters were probing depth (PD), relative clinical attachment level, gingival index, gingival recession height (GR), width of keratinized tissue, keratinized tissue thickness, and gingival recession area at baseline and 6 months postoperative. Pain was evaluated weekly, using a visual analog scale (VAS) during first month postoperative. Both groups were effective in reducing GR (ΔGR: MECAF 2.28 mm; TUN 1.93 mm), without significant differences. The % of root coverage was numerically superior favoring MECAF (MECAF 61.24%; TUN 56.07%), without significant differences between groups. VAS scale failed to provide differences between groups. Both treatment were effective in root coverage and might be valuable for the treatment of multiple gingival recessions. The use of vertical releasing incisions and a flap design including the papillae did not hamper root coverage. This study compared two techniques for use of ADM in large multiple gingival recessions. Within its limitations, both treatments successfully achieved root coverage and were able to reduce gingival recession. It is expected a partial root coverage when using these techniques in large gingival recessions. The study failed to provide significant differences between groups. The use of modified extended coronally advanced flap may be advisable for the treatment of multiple gingival recessions, specially involving large defects when using ADM, to avoid early matrix exposure.

Stapled VTEP (sVTEP), diastasis and the “swollen abdomen”

In the VTEP series, some patients declared that their abdomen was "somewhat swollen", and the authors suggested that this might be related to disruption of the posterior sheath due to the crossing. Following this observation, we decided to evaluate the systematic repair of the posterior sheath. In 50 consecutive patients operated for ventral hernias, the VTEP procedure was modified, using the linear stapler to perform simultaneous division and closure of the posterior sheath. Perioperative data and short-term results were prospectively assessed. Six (12%) complications occurred: one hematoma, one sudden death at home five days after surgery in a man with history of cardiac disease, and 4 cases of dehiscence of the staple line, which were successively reoperated by suture of the gap and posterior sheath release incision (PSR). With a mean follow-up of 7.5months (4-12) there were no recurrences and 2 cases of "swollen abdomen", in patients who undergone PSR. The "swollen abdomen" did not occur when the posterior sheath was repaired without PSR. Preoperative diastasis bulging present in 11 cases, was totally or partially corrected in 8 and 1 cases, respectively, and unchanged in 2 cases. The sVTEP procedure, can contribute to prevent the swollen abdomen and to diastasis correction. The PSR can prevent staple line disruption or permit tension-free repair of the dehiscence, but then, the newly created lateral gaps can finally entail the same drawback. Search for the best solution to treat the gap in the posterior sheath requires further studies.

Mini-transverse incision using a novel bush-hook versus conventional open incision for treatment of carpal tunnel syndrome: a prospective study

PurposeThis study aimed to investigate the outcomes of a mini-transverse incision with a bush-hook versus a conventional open incision for carpal tunnel release (CTR).MethodsThis was a prospective study. The decision to receive either technique (mini-transverse incision with a bush-hook or conventional open incision) was primarily based on patients’ choice. Patients’ symptom severity, functional status, and symptomatic pain were measured at pre-operation, 1 month, and 3 and 6 months postoperatively, and any relevant complications were recorded. Kelly’s scale was used to evaluate the overall clinical efficacy.ResultsEighty-nine patients were included in the open CTR group and 85 patients in the mini-transverse incision group. The mini-transverse incision group had a significantly smaller incision (4.4±0.6 vs 44.8±3.7 mm), shorter surgical time (7.8±1.9 vs 21.2±3.4 min), and shorter hospital stay (3.7±1.6 vs 5.9±2.0 days) than did the open CTR group. Both groups showed significant improvements from baseline levels (all P<0.001). At postoperative 1 month and 3 months, the transverse incision group showed a significantly better VAS, SSS, and FSS (all P<0.05), but the difference was non-significant at 6 months except for FSS (P=0.022). Also, mini-transverse incision showed a significantly reduced time to return to work and activities, trend to a higher rate of excellence, and good and fewer complications than did the open CTR.ConclusionsThe mini-transverse incision exhibited better performance in surgery-related measures, symptomatic remission, functional recovery, and postoperative morbidity, thus could be considered a promising technique alternative.

Clinical and Histological Evaluation of Tissue Healing in Beveled or Perpendicular Vertical Releasing Incision

ObjectivesThe aim of this investigation was to evaluate the clinical and histological differences in wound healing between beveled and perpendicular vertical releasing incisions in dogs. Material and MethodsFour male mongrel dogs were used in this investigation. In each quadrant, a vertical releasing incision was made on either the mesial or the distal aspect of the cuspid teeth of each animal all on the same day. The sites were randomly selected to either receive a beveled incision or a perpendicular incision. A sulcular muco-periosteal flap was raised, reapproximated, and then sutured using 3-0 Vicryl. The animals were evaluated daily for the first week, and then at different time intervals during this investigation. One animal was killed at each time interval of 9, 14, 21, and 28 days after surgery. One animal was killed at each time interval, and a bone block consisting of the cuspid teeth and their surrounding bone and soft tissues was harvested, formalin fixed, and paraffin embedded. Samples were sectioned serially and stained with hematoxylin-eosin. Specimens were evaluated using a microscope with magnification ranging from ×10 to ×400 by a histopathologist. Four indices were used for histologic evaluation. ResultsAt day 9 after surgery, a visible groove was seen in the marginal tissues of both perpendicular and beveled incisions. At day 9, both of the histologic sections showed less organized connective tissue and capillary networks with no significant difference in inflammation. In the 14-day samples, a depression was still present at the perpendicular incision sites, but not in the beveled incision group, where the groove was not visualized at all.In the 21- and 28-day samples, irregular capillary arrangements were seen in the connective tissue of the perpendicular incision groups with completely healed epithelium. There were no statistically significant differences noted histologically between the beveled and perpendicular incision groups noted at 9, 14, 21, or 28 days (P > .05). ConclusionBased on these findings, it appears that clinical and histologic healing of beveled or perpendicular releasing incisions are similar 28 days after surgery.

The efficacy of transnasal palatal transillumination for the diagnosis of submucous cleft palate

BackgroundSubmucous cleft palate (SMCP) is a congenital abnormality with various clinical and anatomical features. Submucous cleft pathologies may be unrecognized during routine examinations. Current diagnostic techniques are constrained and unrevealing in presurgical patients. This prospective study aimed to evaluate transnasal palatal transillumination technique in diagnosis of SMCP at our institute hospital, during period from 2005-2020.Patients and methodsTwenty-one cases with SMCP were recruited with age range from 2-60 months. Transnasal palatal transillumination with controllable light intensity endoscope used to evaluate SMCP and cases were photo and video recorded.ResultsIn this study, 21 cases (13 males and 8 females) with SMCP were detected or confirmed by intranasal transnasal palatal transillumination. Frequency of SMCP patients at our institute was 3.39%. All patients presented with symptomatic complaints at diagnosis time, apart from 5 patients (23.8%) were diagnosed during cleft lip repair operations. Presenting symptoms were hypernasality (23.8%), delayed speech (23.8%), perforated palate with nasal escape of milk and food (14.3%), feeding difficulties (14.3%), and otitis media (4.8%). During intra-oral examination, all cases had a bifid uvula accompanied SMCP. Submucous cleft palate appeared as thin palate with central lucency. According to operative findings, operations done for repair were mostly two long palatal flaps (n = 13, 61.9%), von Langenbeck (n = 5, 23.8%), simple repair with lateral release incisions (n = 2, 9.6%), and simple repair without lateral release incision (n = 1, 4.8%).ConclusionsIntraoperative assessment of submucous cleft palate with transnasal palatal transillumination is easy and cheap method to avoid missing cases of SMCP.

Clinical Outcome of a New Surgical Technique for the Treatment of Peri-Implant Dehiscence in the Esthetic Area. A Case Report

This study describes the clinical and esthetic outcome of n apical surgical treatment on peri-implant soft tissue dehiscence in an implant with a poor prognosis in the esthetic area. The patient presented a compromised situation of clinical attachment loss both in the 1.2 implant and in the adjacent teeth. A biphasic approach consisted firstly of a connective tissue graft accessed by apical and then, 11 months later, a palatal flap technique plus a connective tissue graft. After 20 months of healing, surgical approaches without vertical releasing incisions showed a gain in recession reduction over the implant ranging from 0.3 to 2.7 mm (CI 95%), in addition to a gain in width (2 mm) and thickness (2.3 mm) of the keratinized mucosa. With respect to the white esthetic score, 4 points were gained, and with respect to the pink esthetic score, 3 points were gained. With the use of the apical approach technique and the palatal flap technique, satisfactory results are obtained in the treatment of recessions on implants, improving the amount of keratinized mucosa and the esthetic result in an objective manner in the anterior area.

Separation of Thoracoomphalopagus Conjoined Twins. Use of Tissue Expanders and Abdominoplasty According to the San Martín Technique

We present a set of female thoracoomphalopagus conjoined twins who were separated at ten months of age. Tissue expanders were used to expand the available soft tissue to cover the defect. The abdominal wall was closed by making a release incision on the outer aspect of the anterior sheath of the rectus muscle, detaching the anterior sheath of the muscle fibers, and flipping it over towards the midline. Meshes of decellularized collagen matrix were used to close the thorax. They had no major complications and were discharged from the hospital 60 days later. The girls are currently 5 years old and lead a normal life according to their age. We believe that the use of tissue expanders combined with the mobilization of aponeurotic flaps through discharge incisions adds a useful tool for the treatment of these patients.

Adjuvant botulinum toxin for endoscopic management (preaponeurotic endoscopic repair) of severe diastasis recti

INTRODUCTION: Diastasis recti (DR) associated with midline hernias is common. Big size DR represents a clinical and cosmetic problem. Its repair is challenging, with intraoperative and postoperative risks. The adjuvant of botulinum toxin serotype A makes it possible to restoration of the linea alba by preaponeurotic endoscopic repair (REPA).METHODS: This was a retrospective study with prospective database. Between February 2019 and July 2020, six women were operated, with a mean age of 39 years and a diagnosis of DR >80 mm, with a body mass index of 27. All patients were infiltrated with 50 UR of botulinum toxin serotype A on each side, 30 days before the surgery.RESULTS: The intraoperative diagnosis of DR was 87.5 mm average, associated with midline hernias in 100%, with a mean transverse diameter of 24 mm (10–60 mm) Anatomical restoration of the linea alba was performed with a slow absorbable barbed suture. The wall was reinforced with 100% macroporous polypropylene mesh, with 83.3% atraumatic fixation and 16.6% absorbable traumatic fixation. The surgical time was 94 ± 15 min. Postoperative pain was 2/10 ± 1 according to the Visual Analog Scale, allowing a hospital stay of 18 ± 4 h. Return to work 18 ± 3 days. The mean follow-up was 9 (2–18) months by the clinical and ultrasound examination in 100%, without complications or recurrences.CONCLUSIONS: The application of botulinum toxin serotype A associated with endoscopic repair (REPA) allowed solving the big size DR and midline hernias with suture of the rectus sheath with less tension, associated with a reinforcement prosthesis, allowing a reduced hospitalization with a low level of postoperative pain, avoiding muscle release incisions, which are irreversible and not exempt from morbidity, added to the proven benefits of endoscopic access.

Clinical comparison of different flap advancement techniques to periosteal releasing incision in guided bone regeneration: A randomized controlled trial.

To compare Double Flap Incision (DF), Coronally Advanced Lingual Flap (CALF), and Modified Periosteal Releasing Incision (MPRI) to Periosteal Releasing Incision (PRI) in flap advancement, postoperative complications in augmentation using titanium mesh. Forty patients with partially edentulous posterior mandibles were randomly assigned to the four groups. We evaluated: (a) Flap advancement in mm (Primary outcome). (b) Pain using the Numerical Rating scale (NRS). (c) Swelling using the Visual Analogue Scale (VAS). (d) Exposure in mm and exposure percentage at 1 week to 6 months. The CALF showed the highest mean flap advancement of 19.9 (±5.0) mm while the PRI showed the lowest; 10.2 (±1.7) mm. The difference between groups was statistically significant (P value <.0001). MPRI showed the highest pain score of 5.3 (±1.3) while the DF showed the lowest; 2.39 (±1.7). Swelling did not show a significant difference between groups. MPRI showed the highest exposure mean; 18.6 mm (±26.3) while CALF showed the lowest; 2.5 mm (±4.0). PRI showed the highest exposure percentage; 7.4% (±9.3) while CALF showed the lowest; 0.4% (±0.7). The difference between groups was insignificant. CALF reported highest advancement, least complications while PRI reported the highest complications.

Simplified protocol for horizontal and vertical post-extractive GBR with intentionally exposed PTFE membrane - Case series

Purpose: Post-extractive sites often need soft and hard tissue regeneration in order to place implants with optimal functional and aesthetic conditions. The author proposed several techniques for bone preservation and regeneration: most of them requires release incisions and coronally advanced flap to obtain primary closure, so regain a correct alignment of keratinized gingiva makes mandatory a further surgery with a connective tissue graft from secondary surgical site. Case report: Since May 2018 we applied with some adjustments Open Barrier Technique (proposed by E. Funakoshi, 2005) in 152 post-extractive alveolar preservation and GBR; after 3-6 months we placed 194 implants, with 100% success and survival rate. Conclusions: Our simplified protocol allows performing vertical and horizontal GBR in post-extractive sites without release incisions: non resorbable PTFE membrane protects wound and bone graft for 6-8 week; secondary healing ensures thick keratinized tissue and bone maturation, suitable to place implants after 3-6 months.

Influence of Different Incision Designs on Flap Extension: A Cadaveric Animal Model.

It is well known that wound dehiscence is one of the most frequent complications in guided bone regeneration. The main cause of this complication may be a lack of tension-free and primary wound closure. The aim of this study was to evaluate and compare the effect of periosteal releasing incisions (PRI) on the extension of 3 different flap designs: envelope, triangular, and trapezoidal. Twelve pig mandibles were used to quantify extension of the flap designs. The mandibles were equally and randomly distributed into the 3 flap groups. Each mandible was divided into 2 sides: 1 was subjected to a PRI and the other not. The flap was pulled with a force of 1.08 N, and the extension was recorded. The subgroups without PRI showed an average extension of 5.14 mm with no statistically significant differences among them (P = .165). The PRI provided an average extension of 7.37 mm with statistically significant differences among the subgroups (P < .001). The releasing incisions significantly increased flap extension in each flap design. The increase in extension of the trapezoidal flap with PRI was significantly greater than in the other subgroups. In cases where primary closure is required, surgeons should consider performing trapezoidal flaps with PRI in order to reduce tension.

Alveolar ridge split technique and immediate implant placement in atrophic maxilla. Case series

Background: Alveolar ridge split technique (ARST) is a surgical procedure performed for horizontal ridge augmentation in cases of narrow crestal ridges. It is a biologically oriented technique, taking advantage of the osteogenic and osteoconductive dynamic of the native bone. Recently, the utilization of devices such as thin diamond disks or piezoelectric cutting devices has enhanced ARST success rate, reduced surgical time and patient's morbidity, regardless of bone quality. Aim/Hypothesis: The purpose of this poster is to present and discuss our experience in a series of clinical cases where ARST was performed for horizontal bone augmentation with simultaneous implant placement, using classical or piezoelectric-assisted surgical procedures. Materials and Methods: ARST was performed in 6 patients with 10 sites of horizontal defects. Under local anesthesia, a crestal incision was performed and a full thickness mucoperiosteal flap was reflected. Initial osteotomy was done using the classical technique in 6 cases (diamond disk, rotary burs), while a piezoelectric device was used to the remaining 4 cases. Osteotomes and chisels with gradually increasing dimensions were used to expand the alveolar ridge to facilitate the immediate placement of 18 implants, approximately 2 mm subcrestally in order to prevent marginal bone loss. The remaining space between bony plates was filled with allograft or xenograft and covered with collagen membrane in 9 cases, while in one case no bone graft or membrane were used. Primary closure without tension was achieved with periosteum releasing incisions of the buccal flap. Post-operative instructions included administration of antibiotic and analgesic, chlorhexidine solution, smoke cessation and thorough oral hygiene. Results: Sutures were removed 10 days postoperatively. Follow up was uneventful for 5 out of 6 patients. One patient did not comply with the postoperative instructions, applying poor oral hygiene and continuing smoking as before which resulted in exposure of the collagen-membrane the second week, leading to secondary wound closure compromising the augmentation. A new CBCT was performed 4 months following the split which revealed successful bone augmentation and implant osseointegration without any significant bone loss around the implants. Oral rehabilitation with either fixed or removable prosthetics was accomplished and the patients remain under systematic review. Conclusions and Clinical Implications: ARST is a predictable and reliable procedure characterized by its low invasiveness and morbidity. The major advantage is the simultaneous bone augmentation- implant placement, which provides reduced treatment time and cost. Piezoelectric devices make the split technique easier and safer, decreasing the risk of complications in the treatment of extremely atrophic crests. ARST's success and efficacy depends greatly on patient selection in order for the basic anatomical criteria to be fulfilled. Keywords: ridge splitting, horizontal bone augmentation, piezoelectric device

“Effects of flap modification on third molar extraction outcomes”-A randomised split mouth study

AimThe main purpose of this experimental study was to compare whether modifications in flap design influence the post-operative outcome of third molar surgeries. Materials and methodsThis study was designed as a randomized, single-blinded,split-mouth cross-over comparative study. The predictor variables were the flap type; Conventional Ward's was used to expose the tooth with a difference in the anterior release incision between the groups.Oblique anterior releasing incision and vertical anterior releasing incisions were used for the control and study group respectively.The primary outcome variables were pain measured using VAS (Visual analogue scale), swelling in mm; mouth opening measured in mm, periodontal probing depth in a mm, wound healing by modified Landry's score and surgical accessibility. Statistical significance was set at 5% (α = 0.05). ResultTwenty five patients with bilateral, mirror-image impacted mandibular third molars participated in the study.The study group was associated with moderate swelling that was not statistically significant. .The outcome variables i.e. pain, wound healing, mouth opening, and periodontal pocket depth had no statistical difference on comparing the two groups. In terms of accessibility, the control group was found to be better with the statistical significance of p = 0.00184. ConclusionModifying conventional Ward's design influences the degree of swelling and surgical accessibility. Vertical anterior releasing incision in conventional Ward's has no advantage over conventional Ward's with oblique anterior releasing incision.

Silicon Interpositional Arthroplasty for Temporo-mandibular Joint Ankylosis.

Temporo-mandibular joint (TMJ) ankylosis is characterized by a decreased mouth opening which affects mastication, speech, and facial aesthetic. Interpositional arthroplasty using autologous tissue is accepted treatment for TMJ Ankylosis; however, harvesting autologous tissue is associated with additional morbidity. In this article we report our results of silicon interpositional arthroplasty for TMJ ankylosis. 20 patients with TMJ ankylosis were included in the study. All patients underwent standard operative procedure using preauricular incision for release of TMJ ankylosis by excision of at least 1cm of bony block and insertion of 2cm thick silicon block in the joint space. Postoperatively early mobilization of TMJ was advised from 3rd day onwards. Post operative result was evaluated by assessing the mouth opening as inter incisor distance (IID). 20 patients (27 joints) of TMJ ankylosis were included in the study. There were 8 male and 12 female patients with age ranged from 3-35years. According to Sawhney classification bony ankylosis was present as Type-IV (n = 13 joints), Type-III (n = 12 joints) and Type-II (2 joints). Preoperative mean IID was 7.15mm and post operative mean IID was 43.5. There was no facial nerve paresis, malocclusion or recurrence but infection and extrusion of implant occurred in 1 case each. Silicon interpositional arthroplasty is an effective procedure for the treatment of TMJ Ankylosis; as it restores mouth opening and function, maintains the vertical ramus height, and prevents re-ankylosis without any donor site morbidity.

A randomized controlled study comparing guided bone regeneration with connective tissue graft to re-establish buccal convexity: One-year aesthetic and patient-reported outcomes.

To compare guided bone regeneration (GBR) with connective tissue graft (CTG) in terms of aesthetic and patient-reported outcomes (PROMs). Patients with a single tooth gap in the anterior maxilla and horizontal alveolar defect were enrolled in a single-blind RCT. All sites had a buccopalatal bone dimension of at least 6mm, received a single implant and were randomly allocated to the control (GBR) or test group (CTG) to re-establish buccal soft tissue convexity. Primary outcomes were Pink Esthetic Score (PES) and Mucosal Scarring Index (MSI) assessed after 1year. Secondary outcomes included PROMs registered during the early stages of healing and after 1year. Twenty-one patients were included per group (control: 11 females, mean age 51; test: nine females, mean age 48). Although there was no significant difference in the PES between the groups (control: 10.11; test: 10.48; p=.577), the MSI was significantly lower in the test (1.10) than in the control group (2.53) (p=.017). Based on descriptive statistics, the latter demonstrated wider scars, more colour mismatch and slightly more suture marks. However, these were not considered disturbing by the patients given similar VAS on soft tissue aesthetics (control: 84; test: 87). Oedema and haematoma were rated twice as high in the control group on at least two postoperative time points, and patients took more painkillers (7.10 vs. 4.86). OHIP-14 decreased in both groups between baseline and 1-year follow-up, indicative of less discomfort in daily life. Differences in MSI and PROMs between the groups may be explained by the need of a vertical releasing incision in order to achieve sufficient access for GBR, periosteal incisions and the use of biomaterials that may induce inflammation. GBR and CTG resulted in favourable aesthetic outcomes as assessed by professionals and patients. However, given additional vertical and periosteal incisions, GBR resulted in more scarring, postoperative discomfort and a higher need for painkillers.

Comparative clinical study between Tunnel and VISTA approaches for the treatment of multiple gingival recessions with acellular dermal matrix allograft

Introduction: Gingival recession results from apical migration of the gingival margin leading to root exposure with esthetical and functional problems. Treatment of gingival recession occurs through variable techniques as laterally positioned flaps, coronally advanced flaps, connective tissue graft, tunnel technique and guided tissue regeneration. Acellular Dermal Matrix allograft (ADM) is a safe alternative to autogenous grafts allows the treatment of multiple adjacent recessions. The tunnel technique (Tun) provides good vascularity with absence of the vertical releasing incision. Modification of tunnel technique, vestibular incision subperiosteal tunnel access (VISTA) preserve the papillary integrity and enhances patient’s compliance. Materials and Methods: A split mouth study design was done on ten patients having bilaterally symmetrical maxillary or mandibular two to three adjacent Miller Class I or II gingival recession defects on canine or premolars. In each patient, gingival recession will be treated with VISTA+ADM at the right side and TUN+ADM at the left side. Results: After 6 months follow-up period a statistical significant difference exists between (VISTA+ADM) and (Tun+ADM) sides regarding recession heights and clinical attachment level in favor of (VISTA+ADM) technique. Also a statistically significant difference exists between baseline and 6 months follow-up measurements within each group regarding recession height, clinical attachment level, width of keratinized gingiva and probing depth. Conclusion: Acellular Dermal Matrix allograft is recommended in treatment of multiple gingival recessions. The combination of VISTA+ADM technique found to be more efficient than Tun+ ADM in treatment of Miller class I and II gingival recessions and led to favorable root coverage.