ABSTRACT
Las complicaciones del tejido blando periimplantar condicionan la apariencia estética y el pronóstico clínico de los implantes y son, en la actualidad, cada vez más diagnosticadas. Los defectos gingivales asociados a implantes dentales incluyen recesiones, fenestraciones o dehiscencias en la superficie mucosa vestibular, inflamación gingival, ausencia de encía insertada/queratinizada, falta de volumen y presencia de concavidades gingivales que generan sombras y oscuridad en la mucosa. La detección de éstas en forma temprana permite establecer un plan de tratamiento en busca de soluciones eficaces. Mediante la presentación de una serie de casos, abordaremos distintos procedimientos para aumento de los tejidos blandos periimplantarios y la corrección de defectos. La ganancia de encía queratinizada ha demostrado tener un impacto positivo en la estabilidad a largo plazo de todos los tejidos implantarios (AU)
Subject(s)
Humans , Dental Implantation, Endosseous , Esthetics, Dental , Gingiva/transplantation , Gingival Diseases , Mucous Membrane , Surgical Flaps , Tooth Extraction , Oral Surgical ProceduresABSTRACT
Clinical case of a 43-year-old female patient treated at the clinic of Universidad Nacional Mayor de San Marcos, Peru, in 2015 for aesthetic problems in the activation of a unitary implant placed at a distal and vestibular direction from the ideal position. the clinical examination revealed the vestibularization of the implant at the level of the upper right central incisor with the healing abutment visible above the gingival line and high gingival smile. connective tissue grafts and ovoid pontics were carried out in order to improve the characteristics of the peri-implant tissue. this clinical case evidenced an improvement of the soft tissue profile and patient satisfaction regarding her smile. the management of a vestibularized implant may be solved through the management of ovoid pontics and connective tissue grafts.
Subject(s)
Humans , Female , Adult , Dental Prosthesis/adverse effects , Dental Implantation, Endosseous/adverse effects , Dental Implantation, Endosseous/methods , Esthetics, Dental , Osseointegration , Patient SatisfactionABSTRACT
O objetivo deste trabalho foi apresentar o relato de um caso clínico no qual uma paciente de 52 anos, com ausência de tecido queratinizado na região de rebordo do elemento 46, previamente extraído, foi submetida à cirurgia de enxerto gengival livre para criar uma faixa de tecido queratinizado, antes da instalação do implante osseointegrado. Após três meses de cicatrização, foi constatado signifi cativo ganho de tecido queratinizado na região, tornando o sítio mais favorável à reabilitação com implante dentário. Dessa forma, foi seguido o planejamento inicial e instalado um implante na região, que foi reabilitado posteriormente. Diversos trabalhos têm mostrado que o selamento biológico proporcionado por uma adequada faixa de tecido queratinizado ao redor de implantes seria um pré-requisito para a saúde e o sucesso desses implantes no longo prazo. A revisão clínica e radiográfi ca com três anos de acompanhamento mostrou estabilidade do tecido peri-implantar e, consequentemente, o sucesso do tratamento proposto.
The aim of this study was to present a clinical case report where a 52-year-old patient, with absence of keratinized tissue in the ridge region of the previously extracted element 46, received a free gingival graft surgery to create a tissue band before the osseointegrated implant installation. After 3 months of healing, a signifi cant gain of keratinized tissue was observed in the region, making the site more amenable to rehabilitation with a dental implant. In this way, the initial planning was followed and an implant was installed in the region and the restoration delivered afterwards. Several studies have shown that biological sealing provided by a suitable range of keratinized tissue around implants would be a prerequisite for the health and success of these implants in the long run. The clinical and radiographic review with 3 years of follow-up showed stability of the peri-implant tissue and, consequently, the success of the proposed treatment.
Subject(s)
Humans , Male , Female , Middle Aged , Connective Tissue/surgery , Connective Tissue/transplantation , Dental Implantation , Free Tissue Flaps/transplantation , Oral Surgical Procedures , Tissue Transplantation/methodsABSTRACT
Objective: To detect the peri-implant soft tissue with Florida probes, and to provide the clinical basis for choosing the appropriate clinical examination method, probing strength, and treatment of peri-implant soft tissue in the maintenance period. Methods: The common periodontal probes and Florida probes were used to examine the probing depth (PD) values in 62 patients who underwent implantation for more than 6 months for two times, and the contralateral teeth were natural teeth. The natural teeth and the implants were divided into inflammation group (n=32) and healthy group (n=30) according to whether the bleeding was probed. The coefficient of variation (CV) values of PD values of natural teeth and peri-implant soft tissues detected by two probes were compared. Results: There were no statistically significant differences in the PD values between natural teeth and implants of the patients measured by common periodontal probes in healthy and inflammation groups (P> 0. 05). There were no statistically significant differences in the PD values between natural teeth and implants of the patients measured by Florida probes in healthy and inflammation groups (P>0. 05). The CV value of PD value detected by Florida probes of the patients in healthy group was less than that detected by common periodontal probes (t=2. 489, P=0. 019); the CV value of PD value detected by Florida probes of the patients in inflammation group was less than that detected by common periodontal probe (t=2. 238, P = 0. 033). The CV value of PD value of implants of the patients in inflammation group was higher than that in healthy group (Z=3. 804, P0. 05). Conclusion: Both two probes have good reproducibility in probing the healthy and inflammatory sites of the natural teeth and implants. The Florida probes are more reproducible than the common periodontal probes in probing the healthy and inflammatory peri-implant soft tissues.
ABSTRACT
A good amount and width of keratinized tissue around implants has been associated with better peri-implant health, less bone loss and improved esthetics. The purpose of this case was to evaluate a new porcine xenograft (collagen matrix) used as an interpositional graft to augment thickness of the peri-implant mucosa. There are few studies using a collagen matrix as a substitute for subepithelial connective graft around implants. This case involved a clinical implant in teeth 15 in which it was made the most of it during placement of healing abutment by taking the opportunity to increase peri-implant mucosa with a collagen matrix. Thickness increased 1.5mm while the amount of keratinized mucosa was kept at 4mm. It is concluded that the collagen matrix of porcine origin is a good alternative to increase thickness of the peri-implant mucosa and reduce morbidity. It is easy to handle and suture as well.
Una buena cantidad y grosor de tejido queratinizado alrededor de implantes ha sido asociado con una mejor salud periimplantaria, menos pérdida ósea y una mejora en la estética. El propósito de este caso clínico fue evaluar un nuevo xenoinjerto de origen porcino (matriz de colágeno) al ser utilizada como un injerto interposicional para au¬mentar el grosor de la mucosa periimplantaria. Son pocos los estudios que utilizan la matriz de colágeno como sustituto del injerto conectivo subepitelial alrededor de implantes. El caso clínico incluyó un implante a nivel de la pieza 15, en el cual durante la colocación del pilar de cicatrización se aprovechó para engrosar la mucosa periimplantaria utilizando una matriz de colágeno. Se obtuvo un aumento de grosor de 1,5mm manteniéndose la cantidad de mucosa queratinizada de 4mm. Se concluyó que la matriz de colágeno de origen porcino es una buena alternativa para aumentar el grosor de la mucosa periimplantaria, además de reducir la morbilidad, ser de fácil manejo y de fácil sutura.
Subject(s)
Humans , Middle Aged , Collagen/therapeutic use , Esthetics, Dental , Dental Implantation, Endosseous/methods , Mouth Mucosa/surgery , Keratins , SwineABSTRACT
STATEMENT OF PROBLEM: Flapless implant surgery using a soft tissue punch device requires a circumferential excision of the mucosa at the implant site. To date, Although there have been several reports on clinical outcomes of flapless implant surgeries, there are no published reports that address the appropriate size of the soft tissue punch for peri-implant tissue healing. PURPOSE: In an attempt to help produce guidelines for the use of soft tissue punches, this animal study was undertaken to examine the effect of soft tissue punch size on the healing of peri-implant tissue in a canine mandible model. MATERIAL AND METHODS: Bilateral, edentulated, flat alveolar ridges were created in the mandibles of six mongrel dogs. After a three month healing period, three fixtures (diameter, 4.0 mm) were placed on each side of the mandible using 3 mm, 4 mm, or 5 mm soft tissue punches. During subsequent healing periods, the peri-implant mucosa was evaluated using clinical, radiological, and histometric parameters, which included Gingival Index, bleeding on probing, probing pocket depth, marginal bone loss, and vertical dimension measurements of the peri-implant tissues. RESULTS: The results showed significant differences (P or = 4 mm. CONCLUSION: Within the limit of this study, the size of the soft tissue punch plays an important role in achieving optimal healing. Our findings support the use of tissue punch that 1 mm smaller than implant itself to obtain better peri-implant tissue healing around flapless implants.
Subject(s)
Animals , Dogs , Dental Implants , Epithelial Attachment , Hemorrhage , Mandible , Mucous Membrane , Periodontal Index , Vertical DimensionABSTRACT
El conocimiento acerca de la rehabilitación de dientes con implantes ha ido aumentando de manera potencial; los resultados favorables de la oseointegración superan el 90%, pero los conceptos para designar una restauración como exitosa cada vez se tornan mas estrictos. La estética gingival peri-implantar es ahora quien rige los parámetros de éxito o fracaso y la diferencia estructural del periodonto al rededor de un diente y de un implante es quien determina factores como la posición tridimensional, el pronóstico y el resultado estético final. Este caso reporta la rehabilitación de un incisivo central superior (considerado actualmente como el mayor reto estético) de una paciente de 22 años de edad que asiste a la clínica CES de Sabaneta (Antioquia). La corona del diente fue restaurada en varias ocasiones desde la edad de 12 años, después de sufrir un accidente de tránsito. La paciente presenta un resto radicular fracturado con caries activa en su porción cervical. La revisión de literatura incluye todos los parámetros dentales, óseos y gingivales que se tuvieron en cuenta para la colocación del implante, y su posterior rehabilitación con el sistema Procera. El tratamiento realizado fue la extracción atraumática del resto radicular, la colocación inmediata del implante, y la restauración final con una corona libre de metal utilizando el sistema Procera.
The knowledge about the rehabilitation of teeth with implants has grown up in a potential way; the favorable outcomes of Osseo integration exceed 90%, but the concepts to designate a restoration as successful have become stricter. Peri-implant gingival esthetics parameters currently determine failure or success, and the structural differences of the periodontum surrounding the tooth and implant are determining factors of three-dimensional position ofthe restoration, prognosis and final esthetic result. This case reports the rehabilitation of a central incisor of a 22 year old patient who consulted CES University Dental Clinic. Past Dental History revealed she had been treated and had the restoration and been repeated on several occasions since the age of 12 after suffering dento-alveolar trauma in an automobile accident. Oral examination showed that the patient presented a fractured root with decay on its cervical third. Treatment included a traumatic extraction of the root, immediate placementof an implant and a final restoration with a Procera all ceramic crown.
Subject(s)
Ceramics , Crowns , Dental Implants, Single-Tooth , GingivaABSTRACT
The aim of this study was to investigate the influence of peri-implant soft tissue and bone thickness on the early dimensional change of peri-implant soft tissue. Seventy-seven non-submerged implants of 39 patients which had been loaded more than 6 months were selected for the study. Following clinical parameters were measured; bucco-lingual bone width of the alveolar bone for implant placement before implant surgery; distance between implant shoulder and the first bone/implant contact at the surgery; presence of plaque, probing depth, bleeding on probing, width of keratinized mucosa, mucosa thickness, distance between implant shoulder and peri-implant mucosa, crown margin location at follow-up examination. The results showed that distance between implant shoulder and peri-implant mucosa (DIM) was correlated with probing depth and width of keratinized mucosa (p < 0.05). In addition, mucosa thickness was also correlated with probing depth (p<0.05). However, the bone width of alveolar bone and soft tissue thickness were not found to be correlated with DIM. It is important to understand the meaning of peri-implant tissue dimension in relation to dimensional changes of peri-implant soft tissue which designates appearance of implant-supported restorations. Future study is needed to elucidate the significance of the buccal bone thickness and soft tissue thickness with respect to the change of peri-implant soft tissue margin with the use of an instrument capable of measuring buccal bone thickness directly.
Subject(s)
Humans , Crowns , Follow-Up Studies , Hemorrhage , Mucous Membrane , ShoulderABSTRACT
Amlodipine, nifedipine, and felodipine are calcium channel blocking agents, which are cause of unwanted gingival overgrowth around natural teeth. Many studies has been performed about this unwanted effects. However, the exact etiology remains uncertain.Few reports and investigations can be found in the literature on drug-induced gingival overgrowth around dental implants. The present case reports that amlodipine-induced gingival overgrowth occurred in peri-implant sites, confirms clinical and histological features in hyperplastic peri-implant tissues. Clinical and histological features of amlodipine-induced gingival overgrowth around dental implants were similar to that of tissue around natural teeth.
ABSTRACT
Amlodipine, nifedipine, and felodipine are calcium channel blocking agents, which are cause of unwanted gingival overgrowth around natural teeth. Many studies has been performed about this unwanted effects. However, the exact etiology remains uncertain.Few reports and investigations can be found in the literature on drug-induced gingival overgrowth around dental implants. The present case reports that amlodipine-induced gingival overgrowth occurred in peri-implant sites, confirms clinical and histological features in hyperplastic peri-implant tissues. Clinical and histological features of amlodipine-induced gingival overgrowth around dental implants were similar to that of tissue around natural teeth.