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INTRODUCCIÓN El error técnico más común durante la reconstrucción del ligamento cruzado anterior (LCA) es la ubicación incorrecta del túnel. Es incierto si un túnel tibial mal ubicado puede corregirse en el intraoperatorio. OBJETIVO Medir el desplazamiento del injerto de tejido blando con tornillos de interferencia tibial.MATERIALES Y MÉTODOS Estudio experimental ex vivo en 28 rodillas porcinas. Se cosechó el tendón flexor de la extremidad posterior, que fue duplicado y dimensionado para que pasara a través de un túnel tibial mal posicionado. Las muestras se dividieron en 4 grupos según el cuadrante de entrada (anterior [A], posterior [P], medial [M], o lateral [L]) de un tornillo de interferencia tibial de 9 mm con relación al injerto. Se ubicó una regla milimétrica en la meseta tibial, la cual fue fotografiada con una cámara EOS T6 (Canon Inc., Ota, Tokio, Japón), y la imagen fue digitalizada, y puesta en escala a tamaño. La distancia y dirección de los desplazamientos del injerto se midieron con Adobe Photoshop CC 2019 (San José, CA, EEUU). Se analizaron las diferencias medias entre los grupos por análisis de la varianza (analysis of variance, ANOVA, en inglés) unidireccional. El análisis estadístico se realizó con el programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, EEUU), versión 25.0 (p ≤ 0,05)).RESULTADOS La distancias medias de los desplazamientos del injerto fueron similares en todos los grupos: A 4,4 mm; P 4,6 mm; M 4,5 mm; y L 4,3 mm, sin diferencias estadísticamente significativas (p = 0,894). Las direcciones medias de los desplazamientos del injerto también fueron similares entre los 4 grupos: A 176° (desviación estándar [DE]: ± 15,4°); P 165° (DE: ± 16,6°); M 166° (DE: ± 12,1°); y L 169° (DE: ± 10,6°). No se encontraron diferencias estadísticamente significativas (p = 0.42).CONCLUSIONES Independientemente del cuadrante de entrada, se observó un desplazamiento constante del injerto hacia el lado opuesto cuando el tornillo tibial alcanzaba la superficie articular. Relevancia clínica: el tornillo tibial mal posicionado puede corregirse en el intraoperatorio con fijación proximal en cuadrante específico, y debe alcanzar la superficie articular para generar un desplazamiento efectivo del injerto. Sin embargo, no podemos predecir la magnitud de error en todos los túneles mal brocados, que debe ser evaluada caso a caso.
BACKGROUND The most common technical error during anterior cruciate ligament (ACL) reconstruction is incorrect tunnel placement. It remains unclear if a misplaced tibial tunnel may be corrected intraoperatively. AIM To measure the displacement of soft-tissue grafts with tibial interference screws. MATERIALS AND METHODS Ex-vivo experimental study in 28 porcine knees. The flexor tendon of the posterior limb was harvested, doubled and sized to fit through a 9-mm misplaced tibial tunnel. The specimens were divided into 4 groups according to the quadrant of entry (anterior [A], posterior [P], medial [M], or lateral [L]) of a 9-mm tibial interference screw in relation to the graft. A millimetric ruler was placed at the tibial plateau, which was photographed with a an EOS T6 (Canon Inc., Ota, Tokio, Japan) camera, and the image was digitalized and scaled to size. The length and direction of the graft displacements were measured with Adobe Photoshop CC 2019 (San José, CA, US). The mean differences among the groups were analyzed through one-way analysis of variance (ANOVA). The statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, US) software, version 25.0 (p 0.05) RESULTS The mean lengths of the graft displacements were similar among the groups: A 4.4 mm; P 4.6 mm; M 4.5 mm; and L 4.3 mm, without statistically significant differences (p » 0.894). The mean directions of the graft displacements were also similar among the groups: A 176° (standard deviation [SD]: 15.4°); P 165° (SD: 16.6°); M 166° (SD: 12.1°); and L 169° (SD: 10.6°). No statistically significant differences were found (p » 0.42). CONCLUSIONS Regardless of the entry quadrant, constant graft displacement to the opposite side was observed when the tibial screw reached the articular surface. Clinical relevance: a misplaced tibial tunnel may be corrected intraoperatively with a quadrantspecific screw, which must reach the articular surface to produce an effective graft displacement. Nevertheless, we cannot predict the magnitude of this error in every poorly-drilled tibial tunnel; it should be assessed case by case.
Subject(s)
Animals , Tibia/surgery , Tibia/transplantation , Orthopedic Procedures/methods , Anterior Cruciate Ligament Reconstruction/methods , Swine , Bone Screws , Tissue TransplantationABSTRACT
RESUMEN: La pérdida de un diente resulta en la pérdida de volumen de tejidos duros y blandos lo que dificulta lograr resultados estéticamente satisfactorios. Con el fin de disminuir la morbilidad que provoca un injerto autólogo en el sellado del alveolo se puede reemplazar por una matriz reabsorbible de colágeno. El presente reporte de caso evaluó clínica e histológicamente una matriz colágena de porcino, en la regeneración de tejido blando, durante la instalación de un implante inmediato a una extracción dentaria. A los 6 meses clínicamente se obtuvo un tejido con una apariencia estética final óptima e histológicamente se evidenció la formación de un tejido epitelial y conjuntivo compatible con la de una mucosa normal.
ABSTRACT: Tooth loss results in loss of hard and soft tissue volume, making it difficult to achieve aesthetically pleasing results. In order to decrease the morbidity caused by an autologous graft in the alveolus seal, it can be replaced by a resorbable matrix of collagen. The present case report evaluated clinically and histologically a porcine collagen matrix, in soft tissue regeneration, during the installation of an implant immediately after dental extraction. At 6 months, clinically, a tissue with an optimal final aesthetic appearance was obtained and histologically, the formation of an epithelial and connective tissue compatible with that of a normal mucosa was evidenced.
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BACKGROUND: Insufficient amount of periodontal soft tissue always brings red-and-white aesthetic problems of natural teeth and restorations, leads to gingivitis and peri-implant inflammation. Cell scaffold complexes with different cell and material combinations can promote periodontal soft tissue regeneration, which is expected to replace autogenous grafts. OBJECTIVE: To review the research progress and breakthrough in the application of autologous or allogeneic fibroblasts, keratinocytes, and mesenchymal stem cells in periodontal soft tissue increment. METHODS: Literature retrieval was conducted in PubMed, CNKI, Wanfang, Sciencedirect, and Medline databases. The key words were “gingival recession, soft tissue augmentation, root coverage, subepithelial connective graft” in English and Chinese. Abstracts were read; conclusions were preliminarily screened; and studies and experiments unrelated to the topic of this paper were excluded. Finally, 61 articles were included for result analysis. RESULTS AND CONCLUSION: Mesenchymal stem cells show great potential in gingival papilla increment. Transplanting only fibroblasts or keratinocytes combined with collagen, chitosan, acellular dermal matrix and other scaffolds in soft tissue could not achieve the expected keratinized gingival increment. Although the combination of two kinds of cells and collagen matrix showed more optimistic results and the current scaffold materials had good plasticity and biocompatibility, co-culture of fibroblasts and keratinocytes is time-consuming and expensive, and the conformation of scaffold material is relatively single. How to solve these problems will be a long process.
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Research have indicated that inadequate keratinized tissue has a negative effect on patient oral hygiene, resulting in peri-implant inflammation. It has been recommended that an apically repositioned flap alone or in combination with autogenous soft tissue grafts can increase the width of keratinized mucosa around dental implants, which promotes long term peri-implant health. This review summarized research progress on augmentation techniques of keratinized tissue arround implants in recent years, so as to provide reference for clinical practice and research design in the future.
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Gingival and periodontal diseases have afflicted humans since the dawn of history. One of the most common esthetic and functional concerns associated with periodontal tissues is marginal tissue recession. About 75% of 30- and 31-year-old individuals exhibit gingival recession, mainly at facial surfaces. Various techniques have been introduced to the field of cosmetic periodontology since Grupe and Warren first described the “lateral positioned flap” to improve the appearance of one’s smile and boost confidence. Here, we present a case of sub epithelial connective tissue graft, one of the most versatile microsurgical procedures with a 65-98 mean percentage of root coverage, where limitation factors include amount of avascular root surface and interdental periodontal attachment levels.
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When an implant-supported maxillary full-arch fixed prosthesis is planned for patients with the horizontal and vertical bone resorption induced by periodontal disease, it is necessary to consider the masticatory function, esthetics and phonetics when placing implants. For this reason, thorough clinical and radiological diagnosis is necessary. Extensive bone and soft tissue grafting may be required as well. Since there is no clear guideline for proper number of implants, segment or splinting of substructure and method of retaining prosthesis, these should be considered during diagnostic process. This clinical report describes a patient who has experienced several tooth extractions and periodontal treatment due to severe periodontitis on maxilla and mandible. With bone and soft tissue graft before dental implant placement, the patient have satisfactory result in esthetic and functional aspect with the implant-supported maxillary full-arch fixed prosthesis opposing mandibular natural dentition.
Subject(s)
Humans , Bone Resorption , Dental Implants , Dentition , Diagnosis , Esthetics , Mandible , Maxilla , Periodontal Diseases , Periodontitis , Phonetics , Prostheses and Implants , Splints , Tissue Transplantation , Tooth Extraction , TransplantsABSTRACT
Fixed restoration using implants for patients with posterior partial edentulism is generalized technique. As patient demands increase, the functional and esthetic implant restoration to achieve similar results to lost natural teeth is becoming an important issue. It is inevitable to use customized CAD/CAM abutments rather than ready-made abutments for the creation of implant prosthesis which closely resembles natural teeth. Using CAD/CAM abutment made it possible to obtain natural emergency profiles for posterior implant prostheses, ensuring more comfortable, efficient management of oral hygiene. However, keratinized gingiva with sufficient width and height for a natural emergence profile is required to use a large diameter CAD/CAM abutment which ensures stability and esthetics of hard/soft tissue around the implants. In this case, for esthetical and functional implant zirconia prosthesis, soft tissue graft was performed and customized CAD/CAM abutments were used following ridge augmentation, sinus graft and implantation. Satisfactory results were obtained functionally and esthetically through periodic clinical evaluation, and I hereby report this case.
Subject(s)
Humans , Emergencies , Esthetics , Gingiva , Oral Hygiene , Prostheses and Implants , Regeneration , Tooth , TransplantsABSTRACT
PURPOSE: Anterior ridge defect after tooth extraction results in unfavorable appearance. Ridge augmentation procedures should be preceded by careful surgical-prosthetic treatment planning, and various techniques can be used in anterior ridge augmentation. MATERIALS AND METHODS: Three patients showed deformed ridges after tooth extraction. Three different techniques ; onlay-interpositional connective tissue graft; bovine hydroxyapatite graft with free connective tissue graft; bovine hydroxyapatite graft with resorbable collagen membrane following free connective tissue graft; were used for anterior ridge augmentation. RESULT: Soft tissue graft can be used in small amount of ridge defect, hard tissue graft combined with soft tissue graft can be used in large amount of ridge defect. After ridge augmentation, about three months of healing period, augmented tissue was stabilized. The final restoration was initiated after this healing period, and the tissue form was maintained stable. CONCLUSION: Careful diagnosis and surgical-prosthetic treatment planning with joint consultation prior to surgery should be performed in order to attain an optimal esthetic results.