Application of soft tissue augmentation in labial contour aesthetics of anterior dental implants / 口腔疾病防治

@#After tooth extraction, labial contour collapses due to inevitable physiologic bone remodeling. To achieve optimal outcomes for pink esthetic treatment at anterior implant sites, bone or soft tissue augmentation has been advocated to maintain or reconstruct the labial tissue contour. When choosing soft tissue augmentation for esthetic restoration, it is necessary to strictly grasp the indications for surgery. Soft tissue augmentation to maintain or reconstruct the labial tissue contour could be considered in patients with healthy soft tissue and no bone defects or only mild horizontal bone defects. In immediate, early and late implant placement, the timing of soft tissue augmentation may vary. In immediate implantation, the labial bone plate is intact, so it is highly recommended to simultaneously manage soft tissue during implant placement. However, patients may have large bone defects with early or late implant placement. The risk of augmenting bone and soft tissue simultaneously is likely too high, and bone augmentation surgery is often performed at the first stage while soft tissue augmentation surgery is performed at the second stage. Therefore, soft tissue surgery is often carried out simultaneously with abutment connection. Currently, soft tissue augmentation is achieved mostly with adjacent autologous soft tissue grafts, such as free gingival grafts, subepithelial connective tissue grafts or pedicle palatal flaps, which are often accompanied by a second surgical area. The replacement of autogenous soft tissue grafting with new biological materials will become an inevitable trend. In this article, we analyze and summarize the indications, timing and different methods of soft tissue augmentation to maintain and reconstruct the labial contour.

Surgical techniques of peri-implant soft tissue recession / 中华口腔医学杂志

Peri-implant soft tissue recession may cause biological and aesthetic complications. Establishing and maintaining sufficient soft tissue around the implant is the basis for achieving long-term stability of implant restoration. This article reviews the research progress on the common causes, surgical treatment indications and techniques of peri-implant soft tissue recession. Available studies indicate that the subepithelial connective tissue graft can result in predictable outcomes when the peri-implant soft tissue recession is sallow.

Preenchimento cutâneo parte II ? utilizando um conector de três vias para suplementar o ácido hialurônico com lidocaína 2% com epinefrina: considerações clínicas / Soft tissue augmentation part II ? using a three-way connector to supplement hyaluronic acid filler with 2% lidocaine hydrochloric acid with epinephrine: clinical considerations

A dor durante e após o implante dérmico do gel de ácido hialurônico é uma queixa comum dos pacientes que se submetem ao preenchimento cutâneo. A adição de lidocaína ao preenchedor resulta em significativa redução da dor associada ao procedimento, mas devemos ter cuidado com possíveis alterações na característica da formulação original.

Foreign body reaction to soft tissue filler simulating atypical lipomatous tumor: Report of a case.

Injectable silicone or microimplant has been extensively used for the soft tissue augmentation. Here we report a case of cystic granulomatous reaction to injectable tissue filler, possibly liquid silicone, used for tissue augmentation in the buttocks. Patient presented with a progressive painful swelling in the lower back over L4-L5 and S1 lumbosacral region of 4-month duration. The lump was excised and microscopic examination revealed multiple cystic spaces of variable size lined by foreign body giant cells and macrophages. There were proliferating spindle cells admixed with many multivacuolated mononuclear cells simulating lipoblasts. These morphologic features were highly reminiscent of atypical lipomatous tumor. To our knowledge, this is the second recorded case from the Middle East of such an unusual foreign body reaction. The dermatologists and pathologists should be aware of this unsual lesion. Although rare, this reaction can have important esthetic implication and the patient should be informed about their risk.

Study on thermosensitivity of chitosan scaffold and on its effects on fibroblast proliferation in cell therapy for soft tissue augmentation

Traditional surgical method or injection using filler is performed for soft tissue augmentation. Surgical methods have disadvantage of surgical morbidity. Commercially available injectable materials have the disadvantages such as resorption, short-term effect. repeated application and hypersensitivity. Significant shortcoming of cell therapy using autologous fibroblasts is delay of treatment effect. Chitosan/betaglycerol phosphate (GP) solution has thermosensitive property and allows sol-gel transition at physiologic pH and temperature. These properties may resolve the delay of treatment effect. The purposes of this study are to evaluate the viscosity and pH changes of chitosan/betaGP solutions and to evaluate the effect of chitosan/betaGP solution on fibroblast proliferation and production of collagen. We measured the viscosity and pH as function of temperature, of the solution containing 1:0.7, 1:0.75, 1:0.8 chitosan (1, 10, 100, 700 kDa) /betaGP. Fibroblasts from ears of 5 rats were cultured in chitosan/betaGP solutions for 3 weeks. Cell proliferation and collagen contents were measured every week with WST (water-soluble tetrazolium salt) assay and Collagen assay respectively. The Results are 1) Chitosan(100 kDa<)/betaGP solution (1:0.75) showed sol-gel transition at physiologic pH and body temperature and injectable properties. It will enable to resolve the delay in treatment effect 2) Cell proliferation and total collagen contents of the control group were increased with time. However, these decreased after the 1st week in experimental group 3) Collagen contents in the experimental group are higher than that of control group. Chitosan/betaGP solution may provide favorable conditions for cell function

A Pilot Clinical Study on the Use of Differentiated Adipocyte Injection for Soft Tissue Augmentation

Several suspension biomaterials are available for soft tissue augmentation. Although these gel type implants have been shown to be relatively safe and convenient, their varying degrees of resorption require repeated percutaneous injections. Previous in vivo and in vitro studies have shown that the injection of cultured human adipocytes can produce a sufficient volume effect with extended in vivo stability. This pilot study was undertaken to evaluate the clinical efficacy of this method. Between November 2007 and January 2008, 5 patients were treated with implants of autologous differentiated adipocytes for wrinkle correction and forehead augmentation. The contour changes of the treatment sites were investigated in accordance with the passage of time, as was the occurrence of complications. The degree of patient satisfaction was also evaluated. The injected bioimplants remained in situ. Two weeks after injection, they began to show evidence of a soft tissue augmentation effect. All patients were satisfied with the overall results of this method, and no complications occurred during the follow-up period. The results obtained indicate that differentiated human adipocytes may be successfully injected as living grafts for long-term implants, and that this method is a well tolerated, effective way of performing soft tissue augmentation.

Ridge Augmentation Using Vascularized Interpositional Periosteal- Connective Tissue (VIP-CT) in Conjunction with Anterior Implant Placement in Maxilla: Report of Three Cases / 대한치주과학회지

PURPOSE: The aim of augmentation of the alveolar ridge is to restore absorbed alveolar ridges for future implant site or esthetic prosthodontic restoration. The present clinical report describes the anterior maxillary augmentation cases using a soft tissue rotated palatal flap, and considers various problems of before and after surgery. Method: First & second patients were treated by vascularized interpositional periosteal-connective tissue(VIP-CT) flap for horizontal soft tissue augmentation. Especially second patient was progressed with bone grafting at the same time. Third patient was treated by the same flap with bone graft and implant placement in single tooth missing premaxillary area. RESULT: The obtained horizontal augmentation width measured 0.5~2.7 mm. CONCLUSION: This technique constitutes a viable approach for augmentation the anterior sector of alveolar ridge with the placement of dental implants. But it needs correct diagnosis preparation and careful surgery skill.

Tissue Reaction in Response to Augmentation of Soft Tissue Defects According to the Dermis Graft Materials in Rabbits

The augmentation of soft tissue defects is one of the critical problems in the oral and maxillofacial surgery. Various types of graft materials, both autologous and non-autologous, have been used for the augmentation of soft tissue in the facial region. However, it is not easy to choose an ideal material for soft tissue augmentation because each has its advantages and disadvantages. An ideal graft material should meet the following criteria : it should not leave a scar at the area from which it was taken; should have less likelihood of causing infection; should feel natural after implanted; and should be not absorbed. Among the materials meeting these criteria, human dermis and artificial dermis are commonly used for clinical purposes. The present study was aimed to investigate and compare the resorption rate and the histological change following the use of the autologous dermis, the human homogenous dermis Alloderm(R), and the artificial dermis Terudermis(R) to reconstruct the soft tissue defect. Twenty mature rabbits of either sex, weighing about 2 kg, were used. Each rabbit was transplanted with the autologous dermis, Alloderm(R), and Terudermis(R) size 1 x 1-cm at the space between the external abdominal oblique muscle and the external abdominal oblique fascia. They were then divided into 4 groups (n=5 each) according to the time elapsed after the surgery: 1, 2, 4, and 8 weeks. The resorption rate was calculated by measuring the volume change before and after the transplantation, and H-E stain was preformed to observe the histological changes. The resorption rate after 8 weeks was 21.5% for the autologous dermis, 16.0% Alloderm(R), and 36.4% Terudermis(R), suggesting that Alloderm(R) is the most stable while Terudermis(R) is the most unstable. In microscopic examinations, the autologous dermis graft was surrounded by inflammatory cells and showed foreign body reactions. The epidermal inclusion cyst was observed in the autologous dermis graft. Terudermis(R) and Alloderm(R) demonstrated neovascularization and the progressive growth of new fibroblast. The results suggest that Terudermis(R) and Alloderm(R) can be availably for substituting the autologous dermis.

Microlipoinjection for deformity of hands in patients with Hansen's disease / 나학회지

The use of autologous fat with microlipoinjection is one of soft tissue augmentation and recently has been popular with the advent of tumescent liposuction. We performed this method successfully in 41 patients with atrophic, depressive change in the hands as a sequelae of Hansen's disease. Microlipoinjection using autologous fat has proven to be a safe and effective procedure for correcting tissue defects without significant complications.

Experience with use of Expanded Polytetrafluoroethylene(Gore-tex(R)) in Cosmetic Facial Surgery

To date, for facial soft tissue augmentation, numerous implant materials have been used, including autogenous, homogenous, and alloplastic grafts. Among these, the porous material, Gore-tex(R) has a pore (0.5-30 microns, average 22 microns) which allows sufficient but limited soft tissue ingrowth to anchor implants, but not so much to make removal difficult or destructive to adjacent structures. In addition, this material has some advantage: non-carcinogenic, non-allergic, less capsule formation and reduced chance of infection due to high vascularity. In the past years Gore-tex(R) has found multiple applications in facial plastic and reconstructive surgery. However this alloplastic material can be associated with potentially severe complications and side effects such as soft tissue reaction, infection, extrusion, exposure, etc. There have been also adverse criticism of Gore-tex(R) : relative difficulties in postoperative removal, in carving implant, higher infection and extrusion rates in scarred tissue and thicker implant as well as postoperative volume reduction. In order to analyze results depending on the implantation site, the presence of scar on recipient site, thickness and type of implant, a retrospective chart review of 56 patients(69 cases) was undertaken of all patients who underwent facial soft tissue augmentation with Gore-tex(R) graft from November 1998 to November 2001 in a wide variety of situations. All cases were categorized as either primary(normal recipient site) or secondary(scarred recipient site) cases and the thickness of each graft used in millimeters was recorded. Postoperative follow up revealed a stable implant material with no major complications relating to the graft material and no differences in developing complications according to the implantation site, the presence of scar, thickness and type of implant. All patients were highly satisfied with their results.

Absorption Rates of Various-thickness Human Acellular Dermal Grafts(SureDerm(R))

The human acellular dermal graft provides safe and lasting volume gain for soft tissue augmentation in the face. However, variable amounts of the graft are gradually reabsorbed in the host tissue. The purpose of this experiment is to evaluate the absorption rates of the implanted acellular dermal grafts (SureDerm(R)) and to estimate the amount of overcorrection in the soft tissue augmentation. Twenty-eight New Zealand white rabbits were divided into 4 groups. A 2.0x 2.5 cm sized subcutaneous pocket was created on the dorsal surface of the ear. 10x10 mm sized SureDerm(R) sheets, each 1 mm, 2 mm, 3 mm and 4 mm in thickness were implanted into the pockets. Ear thickness was measured by Thickness Gauze at the time of pre-operative, immediate post-operative, 4, 8 and 12 weeks after implantation. Full thickness ear was harvested in 4, 8 and 12 weeks and examined histologically for graft thickness, host tissue ingrowth, neocollagen synthesis and inflammatory reaction. Ear thickness was mildly increased due to swelling and inflammatory reaction in the initial 4 weeks in all groups and then was decreased in 12 weeks by 84%. However, there was a significant decrease in the thickness of the graft itself (43%). There was no significant difference in the ear thickness among the groups (p<0.05) with time. Histological analysis of implanted SureDerm(R) sheets demonstrated progressive neovascularization, fibroblast infilteration, neocollagen bundle synthesis and organization. Our experimental study suggests that the absorption rate of SureDerm(R) is quite uniform regardless of the thickness of the graft. The amount of overcorrection is relatively predictable and 18% of overcorrection seems to be needed for satisfactory result.

Microvasclar Free Tissue Transfer for Aesthetic Facial Contouring

The facial contour deformity can cause significant handicaps in social life and a psychological stress to the patient. From January 1991 to November 1998, ten patients were operated on for correction of facial contour deformities with three types of free flap: deepithelialized scapular (n = 6), deepithelialized groin (n = 3) and omental free flap (n = 1). The distribution of diseases were Romberg's disease (n = 3), hemifacial microsomia (n = 2), facial lipodystrophy (n = 1), sequelae after surgery (n = 3) and post-traumatic deformity (n = 1). The patient ages ranged from 12 to 42 years. An incision was made at preauricular (n = 3) or submandibular area (n = 7). After making a subcutaneous pocket just above SMAS, the flap was placed within the pocket. The microvascular anastomosis was performed using superficial temporal vessel (n = 3) or facial vessel (n = 6) as a recipient. The flap margin was sutured to the fascia or periosteum and fixed by bolster sutures to reduce gravitational migration. There were no flap loss. Flap revisions consisting of minor contour corrections were performed in eight patients. A stable restoration of facial contour was achieved in all patients. Microvascular free tissue transfer has the advantages that it can be used on the irradiated bed and restore a large defect of facial contour. The deepithelialized groin free flap is suitable for correction of generalized defect of facial contour such as hemifacial microsomia because of its abundance of fatty tissue. In the deepithelialized scapular free flap, the dorsal thoracic fascia can be folded and tailored into variable width and thickness to correct subtle deformity of facial contour such as Romberg's disease or facial lipodystrophy. The omental free flap is not considered the first choice in facial contouring surgery as it requires laparotomy and has a greater tendency to gravitational migration.

Microlipoinjection for Soft Tissue Augmentation

No abstract available.