Injerto de Piel en Territorio Oral: Presentación de un Caso / Skin Graft in Oral Cavity. Case Report

RESUMEN: Los injertos de piel consisten en la toma de un segmento de epidermis y dermis logrando una separación completa del sitio dador y del aporte vascular, transfiriéndolos a un sitio receptor. Existen dos tipos de injertos de piel: de espesor parcial y de espesor total. En cavidad oral se utilizan en reconstrucción de lengua, piso de boca, mucosa bucal y defectos producto de maxilectomías. Se presenta el caso de un paciente sexo masculino 26 años que acudió por secuela de tejidos duros y blandos secundarios a trauma facial hace 7 años. Al examen se observó pérdida de fondo de vestíbulo en sector mandibular anteroinferior y pérdida de piezas anteroinferiores. Bajo anestesia general, se realizó vestibuloplastía más injerto de piel de espesor parcial abordando el antebrazo izquierdo de donde se tomó el injerto de piel con el dermatomo. Se llevó el injerto a boca posicionándolo con la dermis hacia la zona cruenta del sitio receptor, cubriendo la cara interna de labio denudada y fijándolo con sutura continua. Se instaló splint de acrílico en el área para mantener colgajos en posición fijándolo con 3 tornillos de 15 mm. Debemos considerar todos los requisitos funcionales de la cavidad oral al momento de planificar una reconstrucción. El injerto de piel de espesor parcial permite tener una buena resistencia, movilidad adecuada y menor contracción por cicatrización. El paciente evoluciona de manera satisfactoria con una clara mejoría en la función labial, en la morfología del vestíbulo oral y en su estética.

ABSTRACT: Skin grafts consist in taking a segment of dermis and epidermis, achieving a complete separation of the donor site and vascular supply, and transferring them to a receptor site. There are two types of skin grafts: split-thickness and full-thickness. In the oral cavity, they are used in tongue reconstruction, oral mucosa reconstruction, floor of mouth reconstruction and in defects product of maxillectomies. We present a case of a 26-year-old male patient who presented sequelae of hard and soft tissues secondary to facial trauma. Clinical examination showed a compromised vestibule and loss of anterior mandibular teeth. Under general anesthesia, soft tissue management consisting of vestibuloplasty and a split-thickness skin graft was performed. The skin graft was taken from the forearm with a dermatome. The graft was then taken to the mouth with the dermis towards the wounded area of the recipient site, covering the inner face of the denuded lip and fixing it with sutures. An acrylic splint was installed in the area to keep the flaps and skin graft in position, fixing it with three 15 mm screws. We must consider all functional requirements of the oral cavity when planning a reconstruction. The split-thickness skin graft allows for good resistance, adequate mobility and less contraction due to scars. The patient evolves with definite improvement in labial function, the morphology of the oral vestibule and in its aesthetic.

Vestibuloplastia peri-implantar associada à regeneração tecidual guiada no tratamento da peri-implantite / Peri-implant vestibuloplasty and guided tissue regeneration in the peri-implantitis treatment

Levando em consideração que a peri-implantite é de etiologia multifatorial, embora o fator determinante seja o biofilme dentário, é interessante buscar formas de minimizar as perdas ósseas ocorridas. Desta maneira, ainda que ressalvas possam ser feitas à possibilidade concreta de se obter uma regeneração tecidual guiada, pode-se entender como uma alternativa válida para buscar, pelo menos, estabilizar o processo de progressão desta perda. Concomitantemente a este procedimento, e tendo em vista a indicação de vestibuloplastia para melhor prevenção da recidiva de peri-implantite, foi possível obter um resultado favorável dentro do objetivo proposto, em uma única intervenção cirúrgica. Material e métodos: paciente do sexo feminino, com 68 anos de idade, fumante moderada (8-10 cigarros/dia), se apresentou com exsudato purulento na face mesiovestibular do implante 46. Debelada a fase aguda por meio de fisioterapia local, a paciente foi submetida à cirurgia peri-implantar visando à interceptação da perda óssea por meio de "regeneração tecidual guiada" associada à vestibuloplastia, com a utilização de enxerto gengival subepitelial. Resultados: foi possível obter estabilização da perda óssea, bem como diminuição na profundidade de sondagem, além da redução de exsudato no implante em discussão. Conclusão: além disso, a vestibuloplastia criou melhores condições anatômicas estruturais devido ao tecido ceratinizado obtido e, sobretudo, criou um favorável acesso à escovação em toda a extensão dos quatro implantes, antevendo- -se melhor possibilidade de preservação do resultado.

Taking into account that the peri-implantitis is of multifactorial etiology, although the determining factor is the dental biofilm, it is interesting to look for ways to minimize the bone losses that have occurred. Thus, although safeguards can be made to the concrete possibility of obtaining a guided tissue regeneration, it can be understood as a valid alternative to seek to at least stabilize the process of progression of this loss. Concomitantly to this procedure and in view of the indication of vestibuloplasty for better prevention of recurrence of peri-implantitis, it was possible in a single surgical intervention to obtain a favorable result within the proposed objective. Material and methods: a 68-year-old female patient, moderate smoker (8-10 cigarettes/day) presented with purulent exudate on the mesiobuccal surface of the implant in the region of the 46. After the acute phase, through local physiotherapy, the patient underwent to peri-implant surgery aiming the interception of bone loss by means of "guided tissue regeneration" associated with vestibuloplasty with the use of subepithelial gingival graft. Results: it was possible to obtain a stabilization of the bone loss, as well as a decrease in the depth of probing, besides the reduction of exudate in the implant under discussion. Conclusion: the vestibuloplasty created better anatomical structural conditions due to the keratinized tissue obtained, and above all, the favorable access to brushing throughout the four implants, predicting a better possibility of preservation of the result.

Vestibuloplastía mandibular con la técnica de incisión labial/técnica de Kazanjian más la colocación de dos implantes mandibulares para la posterior rehabilitación con sobredentadura: reporte de un caso clínico / Mandibular vestibuloplasty with the labial incision/Kazanjian techniques plus placement of two mandibular implants for the further rehabilitation with overdentures: report of a clinical case

Los pacientes desdentados totales pierden con el pasar del tiempo la altura de proceso alveolar residual, lo que complica de manera importante una rehabilitación protésica adecuada , una de las formas de obtener la altura necesaria es la vestíbuloplastía de epitelización secundaria con incisión labial / técnica Kazanjian, así como también el uso de dos implantes mandibulares para una sobredentadura.

Coronally advanced flap in combination with acellular dermal matrix with or without enamel matrix derivatives for root coverage.

Background: Coverage of gingival recession defects has been considered as a subject of interest for dental practitioners. Aim: The present study was aimed to compare the clinical outcomes of root coverage (RC) procedures, using coronally advanced flap (CAF) in combination with acellular dermal matrix (ADM) with or without enamel matrix derivatives (EMD). Materials and Methods: A total of 36 Miller class I or II recession defects in 15 eligible patients were selected. The defects were randomly allocated to test (CAF+ADM+EMD) and control (CAF+ADM) groups. Recession depth (RD), recession width (RW), width of keratinized tissue (WKT), clinical attachment level (CAL), and the position of mucogingival junction (MGJ) were measured at baseline, two and six months after treatment. Statistical Analysis: Data were analyzed using repeated measures ANOVA and paired sample t-test with the patients as statistical unit. Results: At two-month follow-up, the mean RC for CAF+ADM+EMD and CAF+ADM was 82.75 ± 22 and 88.89 ± 22 percent, respectively. However, these values did not change significantly after six months. Both treatments led to significant RC (P < 0.001), whereas no significant differences were observed in WKT, CAL, and MGJ between the study groups. Conclusion: The application of EMD does not improve the clinical efficacy of ADM in combination with CAF in RC procedures.

Correcting the frenal pull and increasing the width of keratinized mucosa around endosseous implants using denudation procedure.

The frenum exerts a pull upon the tissue and can lead to the continuation of the lesion, and the keratinized tissue provides increased resistance to the periodontium. Various techniques have been used to deepen the vestibule and increase the keratinized mucosa. However, there is no case report on correcting the frenal pull and increasing the keratinized mucosa around dental implant using denudation procedure. This article presents a case of frenal pull that was corrected with denudation procedure with the incision line within the keratinized tissue.