Tissue Dehiscence Research Articles

Wound Healing Complications Following Guided Bone Regeneration for Ridge Augmentation: A Systematic Review and Meta-Analysis.

The rate of developing soft tissue complications that accompany guided bone regeneration (GBR) procedures varies widely, from 0% to 45%. The present review was conducted to investigate the rate for resorbable versus nonresorbable membranes and the timing of soft tissue complications. Electronic and manual literature searches were conducted by two independent reviewers using several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles published through July 2015, with no language restriction. Articles were included if they were clinical trials aimed at demonstrating the incidence of soft tissue complications following GBR procedures. Overall, 21 and 15 articles were included in the qualitative and quantitative synthesis, respectively. The weighted complication rate of the overall soft tissue complications, including membrane exposure, soft tissue dehiscence, and acute infection/abscess, into the calculation was 16.8% (95% CI = 10.6% to 25.4%). When considering the complication rate based on membrane type used, resorbable membrane was associated with a weighted complication rate of 18.3% (95% CI: 10.4% to 30.4%) and nonresorbable membrane with a rate of 17.6% (95% CI: 10.0% to 29.3%). Moreover, soft tissue lesions were reported as early as 1 week and as late as 6 months based on the included studies. Soft tissue complications after GBR are common (16.8%). Membrane type did not appear to significantly affect the complication rate, based on the limited number of data retrieved in this study. Technique sensitivity (ie, soft tissue management) may still be regarded as the main component to avoid soft tissue complications and, hence, to influence the success of bone regenerative therapy.

Safety and performance of a novel collagenated xenogeneic bone block for lateral alveolar crest augmentation for staged implant placement

To evaluate the performance and safety of placing a collagenated xenogeneic bone block (CXBB) graft for the lateral bone augmentation of the alveolar crest prior to implant placement. In patients with single or multiple tooth gaps and a severe horizontal collapse of the alveolar ridge, a ridge augmentation procedure was performed using CXBB fixated with osteosynthesis screws to the atrophic bone crest and complemented with deproteinized bovine bone mineral particles (DBBM) and a native bilayer collagen membrane (NBCM). Patients were examined with CBCT prior to and 24weeks after the augmentation. Twenty-six weeks postoperatively, a re-entry procedure was performed to evaluate the bone width and availability for adequate implant placement. Fifteen patients received 28 CXBB, and in 13 patients, a re-entry procedure was performed. Eleven patients (84.6%) gained enough bone volume for implant insertion without additional contouring or secondary bone augmentation. The mean crest width at baseline was 2.83mm (SD 0.57), and the mean crest width at re-entry was 6.90mm (SD 1.22), with a mean ridge width increase of 4.12mm (SD 1.32). Soft tissue dehiscence occurred during the follow-up in 5 of 14 patients (35.7%) at various time points. In addition, there was a high incidence of early implant loss (30.8% [patient-based]). CXBB achieved significant horizontal crestal width gains allowing a secondary implant placement in the majority of the patients. However, the occurrence of soft tissue dehiscence may notably affect the outcome of the subsequent implant therapy.

Histomorphometric and immunohistochemical evaluation of collagen containing xenogeneic bone blocks used for lateral bone augmentation in staged implant placement

BackgroundThe osteoconductive properties of collagen containing xenogeneic bone blocks (CCXBB) remain unclear. The aim of this prospective single-arm clinical study was to assess the histological outcomes of CCXBB blocks used as bone replacement grafts for lateral bone augmentation procedures.MethodsIn 15 patients with severe horizontal alveolar ridge resorption, lateral augmentation procedures were performed using CCXBB as bone replacement grafts. Twenty-six weeks postoperatively, a re-entry procedure was performed to evaluate the bone width for adequate implant placement and two histological specimens were retrieved from each patient, one being processed for ground sectioning and the other for decalcified paraffin-included sections. In non-decalcified sections, the relative proportions occupied by bone, biomaterials, and connective tissue present in the biopsies were identified. In de-calcified sections, structures and cells positive for osteopontin (OPN), tartrate-resistant acid phosphatase activity (TRAP), osteocalcin (OSC), and alkaline phosphatase (ALP) were assessed.ResultsSoft tissue dehiscence occurred during the follow-up in 5 out of 15 patients (33.3%). The mean crest width at baseline was 2.78 mm (SD 0.57) and the mean crest width at re-entry was 6.90 mm (SD 1.22), with a mean ridge width increase of 4.12 mm (SD 1.32). Twenty-six bone biopsies were obtained from 13 patients. Histomorphometric analysis showed a mean of 26.90% (SD 12.21) of mineralized vital bone (MVB), 21.37% (SD 7.36) of residual CCXBB, 47.13% (SD 19.15) of non-mineralized tissue, and 0.92% of DBBM. The immunohistochemical analysis revealed a large number of OPN-positive cells 8.12% (SD 4.73), a lower proportion of TRAP positive multinuclear cells 5.09% (SD 4.91), OSC-positive cells 4.09% (SD 4.34), and a limited amount of ALP positive cells 1.63% (SD 2).ConclusionsCCXBB achieved significant horizontal crestal width allowing for staged implant placement in most of the patients. In light of the histological outcomes and implant failures, special attention must be placed to prevent soft tissue dehiscence when CCXBB is used in severe atrophic alveolar crests.

Comparison of Tunnel and Crestal Incision Techniques in Reconstruction of Localized Alveolar Defects.

The aim of this study was to compare the complication rates of recipient sites prepared using two incision techniques: crestal and tunnel. In this prospective study, patients underwent augmentation procedures (68 patients; 75 sites) by the same surgeon that were performed consecutively using the crestal incision technique (27 horizontal, 10 vertical; crestal group) or the tunnel incision technique (27 horizontal, 11 vertical; tunnel group). Autogenous bone block grafts were harvested with a piezoelectric surgical device, and the grafts were fixed at the recipient sites by two titanium screws in both groups. The authors evaluated minor exposure, transient paresthesia, major exposure, permanent paresthesia, gingival recession at adjacent teeth, surgery time, and visual analog scale pain scores. Soft tissue dehiscence and graft failure were significantly lower in patients undergoing the tunnel technique. The tunnel incision technique significantly decreased soft tissue exposure, the most common complication of augmentation procedures with autogenous onlay bone grafts. This technique should be considered an alternative to the crestal incision technique for preparation of the recipient site.

Implant-guided supracrestal alveolar bone growth using scaffolds, BMP-2, and novel scaffold-retaining device.

To evaluate the efficacy of various scaffold systems and a Ti scaffold-retaining device with and without non-glycosylated rhBMP-2 (BMP-2) for increasing the vertical alveolar bone growth in the intra-oral mini-pig model. Forty-eight Straumann Bone Level implants with hydrophilic (SLActive) surfaces were partially embedded in mandibles of 12 adult mini-pigs with the shoulder of the implant located 3mm above the bone crest. Twenty-four implants were placed in conjunction with BMP-2 (50μg) incorporated within resorbable scaffolds. Twenty-four additional control implants were placed with scaffolds only. Scaffolds were placed around the implant and stabilized with a newly developed Ti "umbrella" scaffold retainer. Scaffolds included (i) HA-coated collagen (Healos); (ii) biphasic HA/β-TCP crystals (Straumann Bone Ceramic, SBC); and (iii) SBC crystals infused with polyethylene glycol (PEG) hydrogel. Eight test and control pairs for each scaffold group were implanted. At 9weeks, soft tissue healing was assessed and the extent of new vertical bone was evaluated with microCT and histomorphometry. microCT analysis revealed a mean of 167±47mm3 new supracrestal mineralized tissue volume formation around the test sites where BMP-2 was released from the scaffold whereas the control group (no BMP-2) showed a significantly lower mineralized tissue volume of 106±55mm3 . The SBC+BMP-2 group had the highest mineralized tissue volume of 189±36mm3 . Histomorphometry showed bone-to-implant contact of 54.5% for the test groups and 33.3% for the control groups and new vertical bone growth of 2.2±1.0 and 1.0±0.9mm, respectively. The SBC+BMP-2 group again demonstrated the best outcome (2.7±0.4mm). The qualitative scoring of soft tissue dehiscence showed that the presence of BMP-2 yielded far superior outcomes, 0.63 vs. 1.75 for all control implant sites (with scores ranging from 0, reflecting no soft dehiscence, to 4, showing a completely exposed umbrella). The release of BMP-2 from a SBC scaffold adjacent to a hydrophilic, rough Ti implant and scaffold retention umbrella consistently regenerated the greatest volume and height of new vertical bone along the length of the implant.

Use of a Partial-thickness Flap for Guided Bone Regeneration in the Upper Jaw.

Guided bone regeneration (GBR) aims to restore adequate bone volume for the placement of implants in an ideal location. In this article, we analyze different surgical techniques for tissue management during GBR and a modified partial-thickness surgical approach. In a year's time span, five patients were enrolled in the study: Four women and one man (aged 44-59 years). In four patients, a GBR with simultaneous implant placement was adopted, whereas in another patient, a delayed implant placement was done. The flap was of full thickness and overturned on the side palatal with the aim of a retractor, thus exposing the bone crest. The graft material was covered and protected with a resorbable collagen membrane (Geistlich Bio-Gide®, Switzerland). The periosteal layer of the flap was then positioned above the resorbable membrane without traction. The sutures as vertical mattress were then positioned. Each patient received an intramuscular betamethasone dose (4 mg/50 kg) and antibiotic therapy for 7 days (amoxicillin + clavulanic acid 1 gm every 12 hours) and was instructed to maintain oral hygiene and appropriate wound cleaning. The patients were recalled at different times to monitor the healing. No cases of tissue dehiscence were observed during the period of wound healing. One patient, however, showed a delayed exposure 4 months after surgery. This occurrence was managed without complications for the patient. The design of proposed flap seems to be effective in controlling the risk of dehiscence during the healing time in the GBR. The vascular supply was rarely compromised. The results we obtained are encouraging even if further studies on this technique are needed. Lateral partial-thickness flaps seem to be effective in controlling tissue tension and consequently the risk of dehiscence. The incision vestibularly performed should favor the soft tissue healing.

Submerged Plateau Implants: A Practical Solution for Mandibular Posterior Region

ABSTRACT Introduction Placement of endosseous plateau implants represents a valid treatment in the setting of limited alveolar bone height. This study's objectives were to evaluate the effect of submerging and platform switching on crestal bone loss and redistribution of occlusal forces, the advantage of plateau design in providing more surface area for osseointegration, and the outcome of autogenous bone grafting from the implant osteotomy site as an alternate to exogenous bone graft. Materials and methods A prospective study of 10 patients with mandibular posterior edentulism was selected. Preoperative alveolar bone height (mean 11.87 mm) and width (8.22 mm) were measured on cone beam computed tomography. Two-staged implants were placed with 2.0 mm of submergence, which remained below the alveolar crest. The distribution of site according to bone quality and implant dimension was D2. Patients were followed up after 7 days for pain, infection, soft tissue dehiscence, and paresthesia followed by an average period of 1 year and evaluated for bone gain over implant shoulder, crestal bone loss, and peri-implant radiolucency. Results One-year postloading survival rates for submerged plateau implants was 100.0% in D2 bone, with no peri-implant radiolucency and statistically insignificant (~0–0.8 mm) crestal bone loss. Conclusion Submerged plateau implants have excellent survival rates and crestal bone level maintenance. The results of this study support the hypothesis that plateau implants can be successfully used in mandibular areas with limited bone height. How to cite this article Shukla DH, Anchlia SM, Patel NP, Nagavadiya V, Panwar RK, Domadiya HL. Submerged Plateau Implants: A Practical Solution for Mandibular Posterior Region. Int J Oral Implantol Clin Res 2017;8(1):5-11.

Management of peri-implant soft tissue defect with connective tissue graft - A case report

The use of dental implants to replace missing and nonrestorable teeth has increased significantly in the past two decades. The health of peri-implant tissues plays an important role in the long-term success of dental implants. Soft tissue dehiscence around dental implants has frequently been reported which may lead to poor oral hygiene, plaque accumulation, inflamed gingiva, compromised esthetics, and further progression to peri-implantitis. The coverage of exposed implants is aimed to provide adequate keratinized tissue around dental implant. Complete coverage of mucosal defect around the dental implants is still a challenging prospect. This case report describes correction of soft tissue defect and building up of keratinized tissue in relation to implant in the maxillary right first premolar region with subepithelial connective tissue graft along with coronally advanced flap.

Bone Ring Augmentation Around Immediate Implants: A Clinical and Radiographic Study.

Purpose:The purpose of this study was to evaluate the efficacy of bone ring augmentation technique for three-dimensional augmentation of severely defective sockets along with placement of immediate dental implants.Materials and Methods:A clinical study was conducted on 14 patients with 15 defective sockets requiring extractions and immediate implant placement. Following extraction, bone ring with an implant osteotomy, harvested from chin, was sculptured and fitted into the extraction socket. The bone apical to the socket was prepared for implant through the central osteotomy of the ring. Implant was then placed through the ring into the apical bone. After 6 months, prosthesis was placed. Clinical and radiographic examination was done to evaluate the soft tissue and crestal bone level around implants immediate postoperatively and at 1st, 3rd, 6th, and 9th month postoperatively.Results:Out of 15 grafted sockets, 14 showed an evidence of bone healing with no significant crestal bone resorption. One ring showed soft tissue dehiscence which underwent severe resorption at 6th month postoperative visit.Conclusion:The bone ring augmentation technique is an effective method for three-dimensional augmentation of severely defective sockets. This technique helps in reducing the overall treatment time by allowing grafting and placement of implant simultaneously in a single visit. However, longer observation periods are needed to draw more definite conclusions on the success of bone ring augmentation technique.

Comparative Evaluation of Clinical and Radiological Outcomes of Immediate and Delayed Dental Implant Rehabilitation: A Prospective Study

ABSTRACT Introduction The original implant surgical protocol proposed by Bran Mark et al involves open flap access, stepwise osteotomy of the bony ridge, and implant placement followed by good primary closure. Objectives To compare the radiographic marginal bone loss, pocket depth, clinical outcome associated with immediate and delayed implants, and success rates 2 years after the placement of implants. Materials and methods Totally 62 dental implants were placed in 42 patients. They were randomly selected to the immediate or delayed group. Among those selected, 30 were immediate implants and 32 were delayed implants. The width and depth of marginal bone defects around the implants were measured clinically just after placement and 3 months later at the abutment surgery. Bone healing and marginal bone changes were evaluated radiographically and clinical parameters evaluated were pocket depth, local infection, altered sensation, soft tissue dehiscence, pus discharge, implant mobility, and patient's satisfaction. All the collected data were subjected to statistical analysis using Statistical Package for the Social Sciences version 17 software. Statistical analysis was done using Z test. Results The results revealed that there was a significant difference in pocket depth and crestal bone loss in both groups. Mean pocket depth in immediate group was 3.285 mm and mean pocket depth in delayed group was 3.523 mm at 1 year. There were minimal crestal bone losses in the immediate group as compared with delayed implant group at 1-year follow-up. Also, there were reduced complications, such as local infection, altered sensation, soft tissue dehiscence, and pus discharge in immediate implant placement group and resulted in patient's satisfaction. Conclusion We conclude that the immediate dental implant placement is significantly superior over the delayed implant placement. How to cite this article Managutti AM, Tongya R, Prakasm M, Manvi S, Patel J, Shah D, Managutti S. Comparative Evaluation of Clinical and Radiological Outcomes of Immediate and Delayed Dental Implant Rehabilitation: A Prospective Study. Int J Oral Implantol Clin Res 2017;8(1):12-16.

A COMPARATIVE STUDY OF MANDIBULAR CYST ENUCLEATION USING THE PIEZOELECTRIC SURGERY VERSUS THE CONVENTIONAL TECHNIQUE

INTRODUCTION: piezosurgery device was originally developed for the atraumatic cutting of bone as it produces microvibrations and specific ultrasound frequency (25-29 kHz). This new ultrasonic cutting method will be an alternative to conventional methods of oral surgery. OBJECTIVES: This study compares the use of piezosurgery and conventional technique in mandibular radicular cyst enucleation and this was estimated by clinical and radiographic analysis. MATERIALS AND METHODS: This study was conducted on fourteen patients selected from the Out-patient Clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University. Patients with radicular cyst in jaw region were diagnosed clinically and radiographically. The patients were randomly divided into two groups, seven patients were treated using piezosurgery and other seven patients were treated using conventional surgical procedures. Intraoperative and postoperative evaluation was carried out to monitor soft tissue damage, manipulation complexity, pain, infection and tissue dehiscence at 1st, 2nd, 7th day and after one month postoperatively. The bone healing and bone density was determined radiographically after 3 and 6 months postoperatively using Cone Beam Computed tomography. RESULTS: no soft tissue damage or manipulation complexities were observed in both groups, less bleeding was observed intraoperatively in piezosurgery group. Healing was uneventful with no signs of dehiscence in piezosurgery group with lower pain score than in control group. There was a significant decrease in the surface area of the bone defect in the piezosurgery group compared to control group along the follow up period. The improvement in the bone density was greater in the piezosurgery group than in the control group, with percent of difference 33.42% on the 3rd month and 63.84% on the 6th month. CONCLUSIONS: Piezosurgery is effective in cyst enucleation as it accelerates bone healing and reduces intraoperative and postoperative complications

Use of Scaffolding Tissue Biografts To Bolster Vesicourethral Anastomosis During Salvage Robot-assisted Prostatectomy Reduces Leak Rates and Catheter Times

BackgroundOne of the key factors contributing to morbidity associated with salvage radical prostatectomy is a significant vesicourethral anastomosis (VUA) disruption or postoperative tissue dehiscence in the region of the distal bladder neck that causes a large prolonged urinary leak, perineal pain, and delayed catheter removal. ObjectiveTo describe our surgical technique using a urinary bladder extracellular matrix (UB-ECM) scaffold incorporated into the base of the VUA and the distal bladder neck during salvage robot-assisted radical prostatectomy (sRARP) and to assess outcomes and safety. Design, setting, and participantsFrom March to July 2015, 15 patients underwent sRARP performed after primary therapy failure by a single surgeon. Two other groups were identified via analysis of propensity score matching. Group 2 (n=45) underwent sRARP with standard suturing without use of the graft. Group 3 (control group; n=45) underwent primary RARP with no graft placement. These two groups were compared group 1 (n=15), in which patients underwent sRARP and received the scaffold in a 1:3:3 match. Surgical proceduresRARP with use of a UB-ECM scaffold in the posterior aspect of the VUA and distal bladder neck. Outcome measurements and statistical analysisClinical data were prospectively collected in a customized database and retrospectively analyzed. Analysis of variance and Student's t-test were used to test the equality of means for continuous variables, while the χ2 test was used to test categorical variables. Results and limitationsThere were no anastomotic leaks in the control group, with an average catheter time of 6.3 d (5–7 d). However, a clinically significant VUA/bladder neck disruption was observed in 16 patients (35.5%) in group 2, with a median catheterization time of 17.4 d (9–47 d), while in group 1 only one patient (6.66%) had a significant anastomotic leak on cystography (p=0.045), with median catheterization time of 11.2 d (10–52 d) for this group (p<0.05). ConclusionsIncorporation of a UB-ECM scaffold into the base of the VUA and distal bladder neck should be considered as an option to decrease morbidity associated with sRARP since it decreased the rate of VUA disruption, enhanced healing, and reduced catheterization time. This technique could be a valuable tool for all surgeons performing sRARP. Patient summaryWe investigated the use of a scaffolding tissue graft when connecting the urethra to the bladder during salvage robot-assisted laparoscopic prostatectomy. This technique was found to be effective and safe.

Reconstruction of Extended and Morphologically Varied Alveolar Ridge Defects with the Titanium Mesh Technique: Clinical and Dental Implants Outcomes.

A sample of 24 patients with varied morphologic defects were treated with 34 titanium meshes and particulate bone and rehabilitated at least 8 to 9 months thereafter with the placement of 88 implants. Of the 34 meshes, 4 had to be removed before implant placement (11.76% total failure) and 20 were exposed due to soft tissue dehiscence (58.82% of complications): 4 (11.77%) prematurely (within 4 to 6 weeks) and 16 (47.05%) delayed (after 4 to 6 weeks), with no compromise in implant placement. None of the 88 implants was lost (100% implant survival), and 15 demonstrated increased bone loss, yielding a cumulative implant success rate of 82.9%. This technique appears useful in treating extended and morphologically varied alveolar defects.

Pre-augmentation soft tissue expansion improves scaffold-based vertical bone regeneration - a randomized study in dogs.

ObjectiveSoft tissue (ST) dehiscence with graft exposure is a frequent complication of vertical augmentation. Flap dehiscence is caused by failure to achieve tension‐free primary wound closure and by the impairment of flap microcirculation due to surgical trauma.Soft tissue expansion (STE) increases ST quality and quantity prior to reconstructive surgery. We hypothesized that flap preconditioning using STE would reduce the incidence of ST complications after bone augmentation and that optimized ST healing would improve the outcome of bone regeneration.Materials and methodsSelf‐filling tissue expanders were implanted in mandibular bone defects in ten beagle dogs. After expansion, alloplastic scaffolds were placed for vertical bone augmentation in STE sites and in control sites without STE pre‐treatment. ST flap microcirculation was analysed using laser Doppler flowmetry. The incidence of graft exposures was evaluated after 2 weeks. Bone formation was assessed after 2 months, using histomorphometry and immunohistochemistry.ResultsTest sites showed significantly less impairment of perfusion and faster recovery of microcirculation after bone augmentation. Furthermore, no flap dehiscences occurred in STE sites. Bone regeneration was found in both groups; however, significantly greater formation of new bone was detected in test sites with preceding STE.ConclusionsPreconditioning using STE improved ST healing and bone formation after vertical augmentation. The combination of STE and the subsequent placement of alloplastic scaffolds may facilitate the reconstruction of severe bone defects.

Laparoscopic Repair of Cesarean Scar Defect “Isthmocele”

Study ObjectiveTo demonstrate the technique of laparoscopic repair of a large cesarean scar defect (isthmocele). DesignCase report (Canadian Task Force classification III). SettingCesarean scar defect, also known as an isthmocele, is the result of incomplete healing of the isthmic myometrium after a low transverse uterine incision performed for cesarean section. Although mostly asymptomatic, it may cause menstrual abnormalities (typically postmenstrual spotting), chronic pelvic pain, and secondary infertility. Scar tissue dehiscence, scar pregnancy, and abnormally adherent placenta are some of the obstetric complications associated with this defect. No standardized treatment has yet been accepted. Hysteroscopy and laparoscopy are the minimally invasive approaches currently used to repair the defect. InterventionA 40-year-old patient, G2P2, presented with postmenstrual spotting and secondary infertility for the past 2 years. She had a history of 2 previous cesarean deliveries. Transvaginal ultrasound revealed a large (2.5 × 1.5 cm) niche. Thickness of the myometrium over the defect was 3 mm. Laparoscopic repair of the uterine defect was performed. The bladder that was densely adherent to the lower uterine segment was freed by careful dissection. The defect was then localized with a sharp curette placed transcervically into the uterus. The curette was pushed anteriorly to delineate the margins of the defect and puncture the ceiling of the isthmocele cavity. The fibrotic tissue that formed the ceiling and the lateral borders of the defect was excised using laparoscopic scissors. Reapproximation of the edges was done with continuous nonlocking 3-0 V-Loc sutures. The procedure took 90 minutes, and there were no associated complications. Postoperative ultrasound performed in the second month after the operation showed a minimal defect measuring 0.5 cm, with a residual myometrial thickness of 7 mm. At the time of this writing, the patient was free of symptoms. ConclusionLaparoscopic repair, although not standardized, is a minimally invasive procedure that can be performed to treat uterine scar defects. Mobilization of the overlying bladder, resection of the isthmocele margins and secondary suturing of the remaining myometrial tissue appears to be an effective treatment option for affected patients.

Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study.

This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge. From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure. A total of 223 patients (132 women, 91 men; mean age 23.5years; range 17-65years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7% after GBR procedures, 25.9% after staged horizontal ridge augmentation, and 18.2% after staged vertical ridge augmentation. Infections were diagnosed in 2% after GBR procedures, 12.5% after sinus floor elevation (SFE) (transcrestal technique), 5% after staged SFE, 11% after staged horizontal ridge augmentation, and 9% after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2% after GBR procedures, 37% after staged horizontal ridge augmentation, and 9% after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7%), four after GBR procedures (1.6%), and two (12%) after staged vertical ridge augmentation. Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.

Peri-implant mucosal dehiscence coverage with a modified semilunar coronary positioned flap in posterior maxilla: a case report

Soft tissue dehiscence around dental implant has frequently been observed and it may lead to poor oral hygiene, especially around crowns that exhibit contours with prominent convexity. The present case demonstrates a peri-implant mucosal dehiscence coverage with modified semilunar coronary positioned flap (CPF) in #15 and 16. A semilunar partial-thickness incision was performed 7–10 mm apical from the facial gingival margin. Then, intrasulcular partial-thickness incision was tunneled to the semilunar incision. The tunnel preparation was extended interproximally under each papilla due to improvement of flap extension. Then, the tunneled flap was coronary positioned with a coronary-anchored suturing technique. Sub-epithelial connective tissue graft (SCTG) from the palate was inserted from the semilunar incision to the inside of the coronary positioned flap and sutured to stabilize the SCTG and supplemental site. Significant mucosal gain was achieved without any complication. The soft tissue volume was maintained at 9 months post-surgery, and the cleanability was improved. This technique has the potential in improving the graft survival and mucosa gain around implants.

High structural stability of textile implants prevents pore collapse and preserves effective porosity at strain.

Reinforcement of tissues by use of textiles is encouraged by the reduced rate of recurrent tissue dehiscence but for the price of an inflammatory and fibrotic tissue reaction to the implant. The latter mainly is affected by the size of the pores, whereas only sufficiently large pores are effective in preventing a complete scar entrapment. Comparing two different sling implants (TVT and SIS), which are used for the treatment of urinary incontinence, we can demonstrate that the measurement of the effective porosity reveals considerable differences in the textile construction. Furthermore the changes of porosity after application of a tensile load can indicate a structural instability, favouring pore collapse at stress and questioning the use for purposes that are not “tension-free.”

Factors Associated with Orthodontic Tooth Movement in Periodontally Compromised Patients

There is no consistent relationship between malocclusion and periodontal disease but certain characteristics of malocclusion can promote a pathologic environment conducive to periodontal disease. One of the dramatic means available to improve the local environmental factors is through orthodontic tooth movement. The pretreatment periodontal conditions can include excessive tooth mobility, advanced crestal bone loss, infrabony defects, tipped molars, furcation involvement, and hard and soft tissue dehiscences. Movement of teeth in the presence of periodontal inflammation can result in an increased loss of attachment and irreversible crestal loss. Although absolute reduction in bone and attachment levels does not contraindicate orthodontic correction, it does increase the difficulty of delivering controlled orthodontic mechanics that would potentially minimize further bone loss. The present review article discusses the various factors that are associated with orthodontic tooth movement in periodontally compromised patients namely: 1) tooth movement into infrabony pockets; 2) tooth movement into compromised bone areas; 3) tooth movement through cortical bone; 4) extrusion (eruption); 5) intrusion; 6) tipping.

Three-dimensional v/s standard titanium miniplate fixation in the management of mandibular fractures – A randomized clinical study

PurposeThe aim of this study was to compare treatment outcomes using three-dimensional and standard titanium miniplates in the management of mandibular fractures. Material and methodsA prospective study of 30 patients with mandibular fractures. Patients were randomly categorized into 2 groups with 15 patients in each group; patients in Group I were treated with 2.0 mm 3-dimensional titanium miniplate and screws and patients in Group II were treated with 2.0 mm standard plates and screws. Clinical parameters evaluated were: intra-operative assessment of reduction, intra-operative and post-operative assessment of stability of occlusion, mobility of fracture fragments and need for intermaxillary fixation. Radiographic parameters included pre-operative evaluation of displacement of fracture fragments and post-operative evaluation of bone union and plate fracture at different time intervals. ResultsIn Group I, 3 patients (20%) and in Group II, 8 patients (53%) had gap between fracture fragments during reduction. Six patients (40%) in Group I and 8 patients (53%) in Group II had mildly deranged occlusion on the 7th post-operative day. Two patients (13%) in Group I and 6 patients (40%) in Group II needed IMF till the end of the 1st month. No patients showed tissue dehiscence at the end of 1st and 3rd month post-operatively. Infection was not observed in any patient post-operatively. Five patients (33%) from Group I had displaced fracture fragments and 10 patients (67%) had severely displaced fracture fragments pre-operatively. Seven (47%) patients from Group II had displaced fracture fragments and 8 (53%) had severely displaced fracture fragments pre-operatively. Nine patients (60%) in Group I and 6 patients (40%) in Group II showed radiographic evidence of bone union after the 3rd month post-operatively. ConclusionThe use of 3D miniplate is a viable option for fixation of mandibular fractures routinely. 3D titanium miniplates showed comparable results compared to standard titanium miniplates.