Use Of Connective Tissue Graft Research Articles

Pre- and Postoperative Evaluation of Immediate and Early Implant Placement in Esthetic Areas with Pre-Extraction Facial Dehiscence: A Retrospective Clinical Study.

The clinical requirement for a good esthetic result for immediate implant placement is the absence of dehiscence in the anterior facial alveolar bone. In the presence of dehiscence, it is recommended to use a connective tissue graft in addition to immediate implant placement or to change to early implant placement. However, the literature focusing on dehiscence is scarce, and the influence of different placement times and combined use of connective tissue graft on postoperative esthetics in cases with dehiscence is unclear. Therefore, we quantitatively evaluated the pre-extraction dehiscence morphology and postoperative changes in the facial tissue of implants in three groups: immediate implant placement (Group I), immediate implant placement with connective tissue graft (Group IC), and early implant placement (Group E). To this end, 52 implants were obtained (20 in Group I, 16 in Group IC, and 16 in Group E). A wider dehiscence increases the risk of soft tissue regression, which was one reason for choosing early implant placement. A combination of immediate implant placement and connective tissue graft, or early implant placement, tended to result in less soft tissue regression due to the thicker postoperative facial soft tissue volume.

Multiple coronally advanced flap with a selective use of connective tissue graft: A 3-year prospective clinical and histological study.

The purpose of the present study was to prospectively evaluate the 3-year changes in the gingival dimensions following multiple coronally advanced flap (MCAF) with selective use of connective tissue graft (CTG). In addition, the secondary aim was to histologically identify the factors related to phenotype changes. Twenty patients treated with MCAF and site-specific application of a CTG were available for the 3-year follow-up. Outcome measures included complete root coverage (CRC), recession reduction, keratinized tissue width (KTW), marginal tissue thickness changes, and primary flap position. Biopsies were harvested at one of the sites treated with the adjunct of CTG. All sections were stained with hematoxylin and eosin, Masson trichrome, Verhoeff-van Gieson, tenascin, and alcian blue stain for semiquantitative evaluation. At 3 years, CRC was detected in 86% of sites treated with MCAF alone and 81% of sites treated with MCAF+CTG. The 47% of sites treated with MCAF+CTG presented an apical shift of primary flap from its original position. Linear regression showed a significant association between KTW change and the initial KTW in MCAF-treated sites, while both initial KTW and position of primary flap were statistically significantly associated factors with KTW changes in the MCAF+CTG group. In all the biopsies examined, there is always a marked and clear separation between the connective tissue of the gingival flap and the palatal connective tissue of the graft. The selective use of CTG is an effective treatment for multiple gingival recessions. Only a limited increase in KTW can be expected in a bilaminar technique if, during the healing phases, the connective tissue is maintained completely covered.

Root coverage with platelet-rich fibrin or connective tissue graft: a split-mouth randomized trial.

This study aimed to compare the use of connective tissue grafts (CTG) and platelet-rich fibrin (PRF) associated with the tunnel technique (TT) for the treatment of multiple gingival recessions (GR). Fourteen patients with multiple bilateral GR [type 1 recession (RT 1)] in the maxillary incisors, canines, and/or premolars were included. The TT was performed on both sides (split-mouth model); CTG (36 GR) was used on one side, and on the other, PRF (36 GR) was used. Clinical parameters, including recession depth (RD), probing depth, clinical attachment level (CAL), and keratinized gingiva thickness/width (GT/KTW), were obtained at baseline and after 1, 3, 6, and 16 months. Lower RD (0.81 ± 0.68 vs. 1.23 ± 0.71 mm) and CAL (2.54 ± 0.63 vs. 2.73 ± 0.82 mm) were observed for CTG compared to PRF after 16 months. Higher GT was obtained for CTG compared to PRF after 3 (1.81 ± 0.56 vs 1.43 ± 0.47 mm) and 6 months (1.67 ± 0.61 vs. 1.38 ± 0.55 mm, p < 0.05). The recession coverage (RC) was higher for CTG (55.42% ± 37.14) in comparison to PRF (29.53% ± 34.08) after 16 months (p < 0.05). Similarly, CTG presented a more complete coverage of the recession (15; 41.66%) than PRF (9; 24.32%). There were no significant differences between the groups in terms of surgery time, postoperative pain, or healing patterns. Greater esthetic satisfaction was obtained with CTG. It was concluded that CTG combined with TT showed clinical and esthetic results superior to those of PRF in multiple GR treatments.

Use of Connective Tissue Graft and Coronally Advanced Flap in Areas of Buccal Contour Concavities for Nonsubmerged Implant Placement.

There is a lack of scientific evidence concerning the best timing of soft tissue management around implants, as well as a divergence of topics concerning optimal procedures. The objective of this study is to evaluate the gain in buccal contour and soft tissue stability after a surgical technique combining nonsubmerged implant placement with submarginal connective tissue graft (CTG) and coronally advanced flap (CAF). Seven patients (4 males and 3 females) underwent surgery for transmucosal implant placement in partially edentulous areas showing mild to moderate buccal contour concavities using a technique combining CTG and CAF. The following parameters were evaluated: keratinized tissue height (KTH), soft tissue thickness (STT), and vertical soft tissue level (VSTL) at T0 (before surgery), T1 (6 months after surgery), T2 (12 months after surgery) and T3 (2 years after surgery). After two years, we observed an increase of 78.5% in buccal KTH, 64% in STT, and 24% in VSTL. No implant presented any sign of mucositis or bone loss. Non-submerged implant placement using an "envelope flap design" in addition to CTG and CAF is beneficial.

The Combined Use of Connective Tissue Grafts and Platelet Rich Fibrin for Soft Tissue Augmentation Around Immediate Dental Implants

The Combined Use of Connective Tissue Grafts and Platelet Rich Fibrin for Soft Tissue Augmentation Around Immediate Dental Implants

Analysis of buccal gingival thickness in maxillary implants and its relation to gingival biotype

Objectives: This study aimed to evaluate vestibular gingival thickness in unitary implants located in the anterior maxilla through a cone beam tomography. Material and methods: After visual classification of the gingival biotype of the 32 patients selected for this study (16 patients with thin biotype and 16 patients with thick biotype) measurements of the vestibular tissue thickness were made at 2, 4 and 6 mm from the gingival margin in the apical direction in the most longitudinal transverse cut of the implant and the contralateral tooth through tomographic cone beam examination for soft tissue. The data of age and gender of the patients, mean buccal wall thickness of the implants and contralateral natural teeth, and the use of connective tissue graft (CTG) were tabulated for descriptive analysis. Results: For thin gingival biotype, mean vestibular gingival thickness varied between 1.26 ± 0.31 mm (teeth) and 2.65 ± 0.93 mm (implant), and for thick biotype varied from 1.77 ± 0.58 mm (teeth) and 3.01 ± 0.96 mm (implant). The use of CTG increased the buccal thickness of thick biotype when compared to thin biotype without CTG. Conclusions: It was not possible to establish a direct relationship between the classification of the gingival biotype of the contralateral teeth and the gingival biotype of the implants installed in the anterior region of the maxilla, but CTG was shown to be efficient in increasing gingival tissue thickness.

Connective tissue graft vs porcine collagen matrix after immediate implant placement in esthetic area: A randomized clinical trial.

The use of connective tissue graft (CTG) with immediate implant placement and provisionalisation have shown promising results. It is not clear if the same outcome could be achieved using porcine-derived collagen matrix (PDCM) as grafting material. This study aimed to assess the esthetic and functional outcomes of immediate temporization of immediately placed fully tapered implants combined with bone and soft tissue augmentation, using either a CTG or a PDCM, in fresh extraction sockets of the anterior sites. Patients with a failing anterior tooth were included in this study. After extraction, they received an immediate implant with simultaneous hard and soft tissue augmentation and immediate provisional restoration. Patients were randomly assigned to one of the group. Soft tissue augmentation in the control group (CTG) consisted of a CTG, whereas PDCM was used in the test group. After 4 months, definitive restorations were delivered, and pink esthetic score (PES) was evaluated at T1, prosthetic delivery, and at 12-month follow-up (T2). In addition, crestal bone change, probing depth, bleeding on probing, plaque index, bleeding on provisional removal, and implant stability quotient were also recorded. A total of 45 patients received the intended treatment (22 controls and 23 tests) 45 implants totally, with no implant failures at T2. PES mean ± SD after 1 year was noted to be 12.9 ± 1.2 for the CTG group and 12.1 ± 1.3 for the PDCM group (p=0.507). Within the limits of this trial, both treatment protocols resulted in comparable esthetic outcomes, with results showing PES >12 and stable clinical parameters after 1 year of follow-up.

EXPERIENCE OF USING ENAMEL MATRIX PROTEIN IN COMBINATION WITH A CORONARY ADVANCED FLAP AND A CONNECTIVE TISSUE GRAFT TO ELIMINATE GUM RECESSION

The article presents the experience of complex managing a patient with gum recession in the area of the maxillary premolars. Periodontal treatment of gum recession consisted of initial therapy, including supra- and subgingival scaling, root planing, pharmacotherapeutic support (broad-spectrum antiseptics, drugs that stimulate regeneration), surgical combined method based on the use of enamel matrix protein to stimulate regenerative processes. The clinical material Emdogaine is a combination of an enamel matrix derivative and propylene glycol alginate, which performs the function of a carrier. Biora company has been producing it for more than 20 years (Emdogain, BIORA): now the rights to this material belong to Straumann). This preparation was developed to stimulate regeneration of periodontal tissues. Amelogenin is a specific enamel protein capable of stimulating regeneration of lost periodontal tissues by influencing cell differentiation. Dental cement is an osteoid connective tissue that covers the roots of teeth and serves to attach periodontal fibers. Application of an enamel matrix derivative to the sanitized root surface leads to regeneration of non-cellular cement and to the formation of periodontal tissues, which was observed in our study. Transplantation of free connective tissue grafts to eliminate gum recessions makes it possible to effectively eliminate gum recession in most clinical cases (complete root coverage, an increase in the level of clinical attachment from the keratinized attached gum area). In our clinical case, free grafts were obtained in the donor area of the maxillary tuberosity. Transplantation of free connective tissue grafts provides an aesthetic result and is currently considered a standard technique for eliminating gum recession. According to the clinical study, a combined use of connective tissue grafts and the enamel matrix derivative, an additional use of enamel matrix derivative enabled to obtain a satisfactory result and to improve the appearance of the dentition. Such combined surgeries are indicated in an aesthetically significant area. The described materials, methods and stages of patient's follow up can serve as the basis for the protocol of managing patients with gum recession.

In Vitro Biodegradation Pattern of Collagen Matrices for Soft Tissue Augmentation.

Collagen matrices have become a great alternative to the use of connective tissue grafts for soft tissue augmentation procedures. One of the main problems with these matrices is their volume instability and rapid degradation. This study has been designed with the objective of examining the degradation of three matrices over time. For this purpose, pieces of 10 × 10 mm2 of Fibro-Gide, Mucograft and Mucoderm were submitted to three different degradation tests—(1) hydrolytic degradation in phosphate buffer solution (PBS); (2) enzyme resistance, using a 0.25% porcine trypsin solution; and (3) bacterial collagenase resistance (Clostridium histolyticum)—over different immersion periods of up to 50 days. Weight measurements were performed with an analytic microbalance. Thickness was measured with a digital caliper. A stereomicroscope was used to obtain the matrices’ images. ANOVA and Student–Newman–Keuls tests were used for mean comparisons (p < 0.05), except when analyzing differences between time-points within the same matrix and solution, where pair-wise comparisons were applied (p < 0.001). Fibro-Gide attained the highest resistance to all degradation challenges. The bacterial collagenase solution was shown to constitute the most aggressive test as all matrices presented 100% degradation before 14 days of storage.

Efficacy of different surgical techniques for peri-implant tissue preservation in immediate implant placement: a systematic review and meta-analysis.

Preserving peri-implant tissues after immediate implant placement (IIP), especially in aesthetic zones, is a topic of interest. This systematic review investigated the effects of currently available surgical procedures for preserving peri-implant tissue or ensuring dimensional stability following immediate implant placement. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement's guidelines were followed, and articles were sought on the PubMed and Cochrane databases with no date restrictions. Only randomised clinical trials that evaluated changes in soft and hard tissues around immediately placed implants were included. Statistical analyses were performed, and the studies´ quality was assessed using the Cochrane Collaboration tool. The agreement between reviewers was assessed based on Cohen's kappa statistics. Of the 14 studies that met the inclusion criteria, 11 were analysed in the meta-analysis (kappa = 0.814; almost perfect agreement). The use of connective tissue grafts resulted in a significantly greater improvement of the facial gingival level (MD = -0.51; 95% CI: -0.76 to -0.31; p = < .001), and the placement of bone grafts significantly reduced the horizontal resorption of the buccal bone (MD = -0.59; 95% CI: -0.78 to -0.39; p < .001). Connective tissue grafts and bone grafts positively influence tissue preservation around immediately placed implants. Neither the flapless technique nor palatal implant positioning resulted in significant improvements to any of the investigated parameters. Additional longitudinal studies are required. This meta-analysis is useful for discerning the effects of soft tissue augmentation, bone grafting, the flapless technique, and palatal implant positioning on preserving peri-implant tissues after immediate implant placement.

Effectiveness of the Use of Simultaneous Connective Tissue Grafts and Immediate Post-Extraction Implant Placement: A Literature Review

In recent decades, pink aesthetics represents a relevant factor when evaluating long-term results in implant rehabilitation, mainly in the anterior sector. Immediate implant placement after dental extraction is an alternative for the rehabilitation of edentulous patients, and despite its high success rate, the presence of associated peri-implant tissue recessions has been evidenced within its main complications, and the use of connective tissue grafts are a tool that could preserve the stability of the peri-implant mucosa. The objective of this literature review is to assess the use of simultaneous connective tissue grafts with implant placement immediately after extraction as an alternative to improve peri-implant stability. Good results have been evidenced by applying this technique measured in the pink aesthetic score in scientific studies, benefiting those cases with a fine gingival phenotype. Likewise, fewer recessions of the peri-implant mucosa have been observed, which causes fewer associated complications and constitutes an alternative to achieve long-term stability, improvement of peri-implant tissues and better clinical results. However, it is important to take into account that the gingival phenotype is not the only element to consider in post-extraction implants, since the thickness and integrity of the vestibular cortex, the jumping distance, as well as the design of the implant and the three-dimensional positioning must be evaluated.

Recobrimento radicular com enxerto de tecido conjuntivo e fibrina rica em plaquetas: uma revisão crítica

Introdução: Cirurgias de enxerto gengival são realizadas para o recobrimento radicular. O uso de enxerto de tecido conjuntivo tem sido considerado como padrão ouro para o tratamento de recessão gengival, porém algumas dificuldades são encontradas nessa técnica.&#x0D; Objetivo: O objetivo desta revisão foi realizar uma análise crítica da literatura quanto à utilização do procedimento enxerto de tecido conjuntivo e da membrana de Fibrina Rica em Plaquetas para recobrimento da raiz exposta, frisando os benefícios e previsibilidade de sucesso de cada uma.&#x0D; Materiais e Métodos: Foi realizada uma busca nas bases PubMed, Scielo e Bireme, sendo incluídos estudos relevantes relacionados ao tema para síntese deste trabalho.&#x0D; Resultados: Foram selecionados 5 artigos para serem incluídos nessa revisão crítica, sendo 3 ensaios clínicos controlados randomizados, 1 ensaio clinico e 1 um relato de caso.&#x0D; Conclusões: O recobrimento radicular com uso de enxerto de tecido conjuntivo e fibrina rica em plaquetas apresenta resultados satisfatórios, devolvendo estética, saúde e regeneração dos tecidos gengivais e periodontais. Em relação à fibrina rica em plaquetas, há poucos casos na literatura quanto aos resultados clínicos à longo prazo.

The state of microhemodynamics and oxygenation in the mucous membrane of the alveolar ridge after gingival contouring during dental implantation

The results of a comparative assessment of the state of hemomicrocirculation and oxygen metabolism in the mucous membrane of the alveolar crest after contour plastics of the gums during dental implantation using a connective tissue graft from the upper jaw, a connective tissue transplant from the palate and the collagen matrix collagen matrix are presented. During contouring with the use of connective tissue graft (CTG) from the upper jaw and collagen matrix in the mucous membrane of the alveolar mandible, the level of tissue blood flow decreases, which characterizes the development of ischemia, which is stopped after 3 weeks, when using a connective tissue graft (CTG) from the palatine, the level of tissue blood flow rises, which indicates the development of hyperemia, which is stopped for more than 3 weeks. According to oximetry data after contouring with the use of various surgical techniques, the level of oxygenation and oxygen metabolism is reduced by 8-38%, which characterizes the development of hypoxia, which is stopped after 3 weeks when using CTG from the hillock of the upper jaw and collagen matrix for more than 3 weeks when applying CTG from the palatine.

Soft tissue changes after connective tissue grafts around immediately placed and restored dental implants in the esthetic zone: A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to evaluate the soft tissue outcomes of connective tissue graft (CTG) combined with immediate implant placement and restoration (IIPR) in the esthetic zone. Following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, randomized controlled trials (RCTs) were searched for in electronic databases and complemented by hand searching. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and data were analyzed using statistical software. A total of 180 studies were identified, of which, four trials were included with 144 implant sites in 144 participants. Overall meta-analysis showed that CTG in conjunction with IIPR had a significantly greater gingival thickness than IIPR alone. The IIPR with CTG had less recession and higher esthetic pink score compared to IIPR group, but the difference was not statistically significant. No significant differences in implant failure rate were found between IIPR with and without CTG. The use of CTG in conjunction with IIPR in the esthetic zone significantly improved the thickness of the gingival tissues compared to IIPR without CTG. No significant differences were observed in the level of soft tissues around immediately placed implants with or without CTG. The use of connective tissue graft with IIPR can be considered to improve the soft tissue profile and minimize mucosal recession in esthetic zone.

Enhancement of dental implants esthetics in the upper anterior zone by the use of connective tissue grafts: case series and literature review

Enhancement of dental implants esthetics in the upper anterior zone by the use of connective tissue grafts: case series and literature review

Comparison of Freeze-Dried and Solvent-Dehydrated Acellular Dermal Matrix for Root Coverage: A Randomized Controlled Trial.

The prevalence of gingival recession has been estimated at around 22.5% in people aged older than 29 years. Classic treatment approaches include the use of connective tissue grafts in combination with coronally advanced flaps (CAFs). To reduce morbidity and the need for a secondary surgical site, allograft materials are currently being used. Nevertheless, long-term randomized studies testing the efficacy of these materials are lacking. Hence, the aim of the present randomized controlled clinical trial was to compare two acellular dermal matrix (ADM) materials produced by different processing techniques, freeze-dried (FDADM) and solvent-dehydrated ADM (SDADM). At 12 months, both groups showed significant improvement in attachment level, recession depth, and recession width. A mean improvement in attachment level of 2.0 ± 1.08 mm for FDADM and 2.0 ± 0.70 mm for both SDADM was achieved (P = .002). Root coverage after 12 months was 80.66 ± 22.90% for FDADM and 80.97 ± 18.08% for SDADM. Hence, it was concluded that both FDADM and SDADM grafting materials can successfully achieve root coverage in Miller Class I and II recession defects for up to 12 months when used in combination with CAFs.

Periodontal plastic surgery.

The aim of the present article is to summarize current knowledge in terms of the etiology, diagnosis, prognosis and surgical treatment of gingival recession. Whilst the main etiological factors (i.e. toothbrushing trauma and bacterial plaque) are well established, challenges still remain to be solved in the diagnostic, prognostic and classification processes of gingival recession, especially when the main reference parameter - the cemento-enamel junction - is no longer detectable on the affected tooth or when there is a slight loss of periodontal interdental attachment. Root coverage in single type gingival recession defects is a very predictable outcome following the use of various surgical techniques. The coronally advanced flap, with or without connective tissue grafting, is the technique of choice. The adjunctive use of connective tissue grafts improves the probability of achieving complete root coverage. Surgical coverage of multiple gingival recessions is also predictable with the coronally advanced flap and the coronally advanced flap plus the connective tissue graft, but no data are available indicating which, and how many, gingival recessions should be treated adjunctively with connective tissue grafting in order to limit patient morbidity and improve the esthetic outcome. None of the allograft materials currently available can be considered as a full substitute for the connective tissue graft, even if some recent results are encouraging. The need for future studies with patient-based outcomes (i.e. esthetics and morbidity) as primary objectives is emphasized in this review.

The Use of Leukocyte- and Platelet-Rich Fibrin During Immediate Postextractive Implantation and Loading for the Esthetic Replacement of a Fractured Maxillary Central Incisor

I mplant-supported restoration of the maxillary anterior segment that is biologically, functionally, and esthetically acceptable following traumatic injuries in the maxillary anterior segment is always complex. Careful extraction of the fractured root, residual labial bone preservation, proper flap design, ideal positioning of the implant, appropriate softtissue contour, and the crown emergence are all important steps necessary to achieve a predictable, stable, functional, and esthetic success. However, healing of the tissues is always difficult to control and the development of new techniques and materials to improve these treatments is still necessary. The use of platelet concentrates is an interesting approach. Platelet concentrates for surgical use are widely used and continuously investigated in oral and maxillofacial surgery. The objective is to gather platelet growth factors and to inject them on a surgical site to stimulate the healing process. A significant percentage of the literature is focused on the platelet-rich plasma (PRP) families. PRP is a liquid platelet suspension often activated into a platelet-rich gel (like fibrin glues). Another technology called leukocyteand platelet-rich fibrin (L-PRF) allows for the preparation of strong fibrin membranes enriched with cells (activated platelets, leukocytes, circulating cells) and platelet growth factors. This autologous healing biomaterial is free of additives (no anticoagulant during blood harvest, no chemicals for activation), simple, inexpensive, and quick to prepare (15 minutes for all steps). This technique is specifically adapted to the practical needs in daily implant dentistry. Several articles have reported the use of these L-PRF membranes for the stimulation of bone and 1 Private practice, Turin, Italy. 2 Private practice, Ra’anana, Israel. 3 Clarion Research Group, Clarion, Penn. Department of Restorative Dentistry, State University of New York at Buffalo, Buffalo, NY. 4 LoB5 Unit, Research Center for Biomineralization Disorders, School of Dentistry, Chonnam National University, Gwangju, South Korea. Department of Stomatology, Oral Surgery, and Dental and MaxilloFacial Radiology, School of Dental Medicine, University of Geneva, Geneva, Switzerland. * Corresponding author, e-mail: LoB5@mac.com DOI: 10.1563/AAID-JOI-D-12-CL.3802

A pre-prosthetic soft tissue augmentation using a simplified technique

Despite the increased demands for single tooth implants, many patients still opt for fixed partial dentures to close the edentulous spaces . Prior to the replacement of missing teeth, aesthetic and physiologic corrections of edentulous areas are critical pre-requisites. This case describes a simple method to enhance a localized buccal ridge defect and create an emergence profile in relation to the maxillary right premolar region, prior to the construction of a fixed partial denture. This technique involved using a connective tissue and platelet rich fibrin membrane for soft tissue augmentation, so as to obtain a natural form and maintain a healthy periodontium.Clinical Relevance to Interdisciplinary Dentistry Role of pre-prosthetic periodontal surgery to achieve improved aesthetics. Use of Connective tissue graft and PRF for a more predictable outcome. This simple technique enabled the simultaneous preparation and augmentation of the ridge.

LATERAL PEDICLE GRAFTS, A BEST ALTERNATIVE FOR FREE GINGIVAL AUTOGRAFTS – A CASE REPORT

Root coverage is achieved by many procedures like pedicle grafts, free gingival autografts and connective tissue grafts. Several studies states that Root coverage using connective tissue grafts has high success rate in wide-and-deep gingival recessions. Use of connective tissue grafts has disadvantages like creation of second surgical site and post operative colour harmony is less. For narrow and shallow gingival recession, Lateral pedicle grafts surgical technique provide complete root coverage with complete gain in attachment level and excellent post-operative colour harmony with adjacent tissues. Few clinical studies states that the success rate with Lateral pedicle graft is 70%, this surgical technique is preferred over free gingival autografts in narrow and shallow gingival defects. This case report present the predictability of root coverage by using Lateral pedicle grafts in narrow and shallow gingival recessions.