Colgajo de reposición coronal, con y sin injerto de tejido conectivo, para tratar recesiones gingivales / Coronally repositioned flap with and without connective tissue graft to treat gingival recession

Introducción: Las recesiones gingivales son afecciones de las encías, que son muy frecuentes y podrían provocar repercusiones estéticas, hipersensibilidad dentinaria y tener más tendencia a la formación de lesiones cervicales. Es necesario recubrir la superficie radicular mediante técnicas regenerativas periodontales. Objetivo: Comparar la cantidad de recubrimiento radicular, la profundidad al sondaje y el nivel de inserción clínica, empleando las técnicas de colgajo de reposición coronal, con y sin injerto de tejido conectivo, en pacientes con recesiones gingivales Miller I y II. Métodos: Se incluyeron un total de 16 pacientes con recesiones gingivales Miller clase I y II, de los cuales se seleccionaron 50 piezas dentarias tratadas quirúrgicamente para cubrir las recesiones. Se utilizaron las técnicas de colgajo de reposición coronal, con y sin injerto de tejido conectivo. Las mediciones clínicas fueron comparadas al inicio y a los tres meses posoperatorios. Resultados: Al tercer mes poscirugía los resultados del recubrimiento radicular, profundidad al sondaje y el nivel de inserción clínica para la técnica colgajo de reposición coronal con injerto de tejido conectivo, fueron 0,96 ± 1,33; 0,87 ± 0,63; 1,83 ± 1,7 y para la técnica colgajo de reposición coronal fueron 1,44 ± 1,19; 1,04 ± 0,52; 2,48 ± 1,48, respectivamente. Al comparar el recubrimiento radicular intergrupo no se encontraron diferencias significativas (p = 0,11). Sin embargo, al comparar la profundidad al sondaje intergrupo (p = 0,04), el nivel de inserción clínica intergrupo (p = 0,001) y todas las mediciones clínicas intragrupo (p = 0,001), se encontraron diferencias significativas. Conclusiones: La técnica de colgajo de reposición coronal, con y sin injerto de tejido conectivo, demostró diferencias significativas en la profundidad al sondaje y el nivel de inserción clínica en recesiones gingivales Miller I y II. No se alcanzaron diferencias significativas para el recubrimiento radicular en ambas técnicas a los 3 meses de seguimiento(AU)

Introduction: Gingival recession is a very common gum condition which may result in aesthetic alterations and dentin hypersensitivity, and increase the probability of cervical lesions. It is necessary to cover the root surface using periodontal regeneration techniques. Objective: Compare the amount of root coverage, probing depth and clinical insertion level, using coronally repositioned flap techniques with and without connective tissue graft in patients with Miller I and II gingival recessions. Methods: A total 16 patients with Miller class I and II gingival recessions were included in the study, from whom 50 teeth were selected which had been treated surgically to cover the recessions. The techniques used were coronally repositioned flap with and without connective tissue graft. Clinical measurements were compared at the start of the postoperative period and three months later. Results: Three months after surgery, root coverage, probing depth and clinical insertion level were 0.96 ± 1.33; 0.87 ± 0.63; 1.83 ± 1.7, respectively, for coronally repositioned flap with connective tissue graft, and 1.44 ± 1.19; 1.04 ± 0.52; 2.48 ± 1.48, respectively, for coronally repositioned flap. Root coverage intergroup comparison did not find any significant differences (p = 0.11). However, intergroup comparison of probing depth (p = 0.04) and clinical insertion level (p = 0.001), and all the intragroup clinical measurements (p = 0.001) did find significant differences. Conclusions: Coronally repositioned flap technique with and without connective tissue graft showed significant differences in terms of probing depth and clinical insertion level in Miller I and II gingival recessions. At three months' follow-up, no root coverage significant differences were observed for either technique(AU)

Injerto de tejido conectivo subepitelial y colgajo reposicionado coronal modificado para tratamiento de recesiones periodontales / Subepithelial connective tissue graft and a modified coronal repositioned flap for treatment of periodontal recessions

RESUMEN Introducción: La recesión periodontal es un problema mucogingival frecuente, de origen multifactorial que usualmente se asocia a hipersensibilidad dentinaria, caries radicular y problemas estéticos. La cobertura radicular es parte integral de su tratamiento quirúrgico. Las técnicas bilaminares con injerto de tejido conectivo subepitelial son las más predecibles. Objetivo: Describir los resultados clínicos obtenidos al realizar en recesiones periodontales múltiples, injerto de tejido conectivo subepitelial cubierto por colgajo reposicionado coronal modificado. Presentación del caso: Paciente masculino, blanco, obrero, de 43 años, con antecedentes personales y familiares de salud que acudió al Servicio de Periodoncia de la Clínica Estomatológica "III Congreso del PCC", Matanzas, Cuba, por "cambio de posición de la encía en algunos dientes". Clínicamente existía exposición radicular en los dientes 13, 53 y 14, ausencia del 12, higiene bucal adecuada, no presencia de bolsas periodontales. Se diagnosticó recesión periodontal clase I de Miller localizada en dichos dientes. Para su tratamiento quirúrgico se realizó injerto de tejido conectivo subepitelial y colgajo desplazado coronal sin incisiones verticales de 11 a 15. A la semana, se retiró sutura de zona donante, se observó buena cicatrización. Se citó a los siete días para retirar cemento quirúrgico y sutura de la zona injertada; existía discreto edema, materia alba, biopelícula y cobertura radicular completa del 13, 53 y 14. Al año del procedimiento, las superficies expuestas estaban completamente cubiertas con tejido gingival posicionado en 13 y 53, ganancia de encía insertada y armonía de color entre sitio injertado y área adyacente. El 14 mostró 1 mm de raíz expuesta. Conclusiones: La técnica empleada, cubrió totalmente la superficie radicular del 13, del 53 y parcialmente la raíz del 14. Se obtuvo incremento de encía queratinizada, óptimo aspecto estético y buena evolución posoperatoria(AU)

ABSTRACT Introduction: periodontal recession is a frequent mucogingival problem, of multifactorial origin that is usually associated to dentin hypersensibility, radicular caries and esthetic problems. Root coverage is an integral part of its surgical treatment, considering bilaminar techniques with subepithelial connective tissue graft as the most predictable ones. Objective: to describe the clinical results obtained when making a sub epithelial connective tissue graft covered by a modified coronal repositioned flap, in multiple periodontal recessions. Case presentation: a male, white, worker patient, aged 43 years, with health personal and family antecedents, who assisted the Periodontics service of the Dental Clinic "III Congreso del Partido", of Matanzas, Cuba, for "a change of the gum position in some teeth". Clinically, there it was a root exposition of the 13, 53 and 14 teeth, lack of the 12 one, adequate oral hygiene and absence of periodontal´s pockets. A Miller´s Class I periodontal recession located in those teeth was diagnosed. A subepithelial connective tissue graft and coronally advanced flap was performed without vertical incisions from 11 to 15 teeth. After a week, the suture of the donor zone was retired, showing good healing. He was cited at the seventh day to retire surgical cement and suture form the grafted zone, observing a discrete edema, debris, biofilm and complete root coverage of the 13, 53 and 14 teeth. At the year after the procedure, the exposed surface was completely covered with gingival tissue positioned in the 13 and 53 teeth, with a gaining of inserted gum and color harmony between the grafted site and adjacent areas. The 14 tooth showed 1 mm of exposed root. Conclusions: the used technique totally covered the root of the 13 and the 53, and most of the root of the 14 tooth, reaching an increase of the keratinized gum, and optimal esthetic aspect and post-surgery evolution(AU)

Reconstrução estética com instalação imediata de implante / Aesthetic reconstruction with immediate implant installation ­ case report

A diminuição do tempo de tratamento com implantes osseointegrados, assim como a redução da complexidade do plano de tratamento e a otimização de protocolos minimamente invasivos, é um dos aspectos atuais em reabilitações com implantes. A instalação imediata de implantes em sítios pós-exodontia tem sido relatada na literatura como uma técnica previsível, permitindo a redução do tempo e do número de procedimentos para reabilitação protética. Este artigo relatou um caso clínico de reabilitação de um incisivo central superior perdido por reabsorção radicular, em que foi instalado um implante com confecção imediata de uma prótese temporária. No intuito de minimizar as alterações volumétricas inerentes ao processo de exodontia, além da utilização de um substituto ósseo entre a tábua óssea alveolar e o implante, foi utilizado enxerto de tecido conjuntivo removido do palato. A técnica possibilitou uma reabilitação estética e funcional adequada, e redução no tempo de tratamento com mínimo trauma ao paciente.

Decreasing treatment time with dental implants, as well as reducing the complexity of the treatment plan and optimize minimally invasive protocols, are current issues in rehabilitation with implants. Immediate implant placement in post-extraction sites have been reported in the literature as a predictable technique allowing to reduce the time and number of procedures for prosthetic rehabilitation. This is a case report of an upper central incisor lost due to root resorption, receiving an immediate implant and construction of a temporary prosthesis. In order to minimize volumetric changes inherent in the extraction process, besides the use of a bone substitute between alveolar bone plate and the implant, it was used connective tissue graft removed from the palate. The technique allowed an aesthetic and functional rehabilitation and appropriate reduction in treatment time with minimal tissue trauma.

Reconstrucción de la papila gingival alrededor del implante mediante técnica novedosa / Papilla reconstruction around the implant using novel technique

La reconstrucción de la estética gingival (rosada) es un tema importante en la odontología implanto-soportada moderna, y cualquier resultado estético comprometido se considera un fracaso. En la literatura se proponen variados enfoques quirúrgicos y no quirúrgicos para reconstruir la papila interdental perdida. En esta técnica modificada, el extremo distal del injerto pediculado fue dividido en dos partes creando una estructura bífida, que luego se colocó alrededor del pilar y suturó por vestibular. Esta técnica dio como resultado un aumento significativo de volumen de la papila en las direcciones coronaria y vestibular. El injerto de tejido conectivo pediculado subepitelial asociado con un colgajo coronalmente desplazado parece ser un abordaje viable para el tratamiento de la papila ausente, asociado con restauraciones implanto-soportadas.

Rebuilding the pink esthetic is an important issue in modern esthetic implant dentistry, and any compromised esthetic results following implant-supported restorations are considered failures. Several surgical and nonsurgical approaches are proposed in the literature to reconstruct the lost interdental papilla. In this modified technique the distal end of the pedicle graft was divided into two parts creating a bifid, which were then placed around the abutment and sutured on the facial aspect. This technique resulted in a significant gain of papillary volume in both coronal and facial directions. The subepithelial connective pedicle graft associated with a coronally advanced flap seems to be a viable approach for the treatment of missing papilla associated with implant-supported restorations.

Free Gingival Graft In The Treatment of Isolated Gingival Recessions : A Case Report.

Gingival recession is an intriguing and complex phenomenon. Recession frequently disturbs patients because of sensitivity and esthetics. Many surgical techniques have been introduced to treat gingival recession, including those involving connective tissue grafting, various flap designs, orthodontics, and guided tissue regeneration. This article describes a different clinical approach to treat gingival recession with emphasis on techniques that show promising results and root coverage.

Associação de prótese fixa, implantes e estética periodontal para reabilitação de pacientes parcialmente edêntulos / Association of fixed partial prosthesis, dental implants, and periodontal aesthetic procedures for rehabilitation of partially edentulous patients

A doença periodontal é uma doença inflamatória crônica que resulta na destruição dos tecidos de suporte com consequente perda dental. A substituição dos dentes perdidos por restaurações implantossuportadas tem demonstrado ser um método de tratamento altamente previsível com bom prognóstico em longo prazo. Contudo, algumas sequelas da perda dentária inviabilizam a instalação de implantes osseointegrados em posição ideal, sendo, neste caso, necessários procedimentos regenerativos para tornar possível este tipo de reabilitação. Procedimentos menos invasivos, como próteses convencionais, surgem como uma opção terapêutica para reabilitação de casos em que não há estrutura óssea suficiente para implantes e não há aceitação de procedimentos invasivos por parte dos pacientes. Sendo assim, este trabalho teve como objetivo apresentar a resolução de uma reabilitação por meio de tratamento não invasivo e multidisciplinar. A paciente, gênero feminino, compareceu a clínica da faculdade apresentando próteses fixas mandibulares mal adaptadas bilateralmente, lesões endodônticas, recessão gengival nos dentes pilares e sensibilidade dentinária. Para a adequada resolução deste caso foi proposto à associação de implantes osseointegrados, prótese parcial fixa, exodontia e procedimentos periodontais estéticos, com a utilização de enxerto de tecido conjuntivo subepitelial. Após dois anos de pós-operatório, a paciente mostrou satisfação estética e mastigatória. Com base no caso apresentado, este trabalho discutiu os diversos fatores que podem afetar a escolha de uma determinada modalidade de tratamento, para a reabilitação de espaços edêntulos unitários.

Periodontitis is a chronic inflammatory disease that results in the destruction of teeth and their supporting tissues with subsequent tooth loss. The replacement of missing teeth for implant-supported restorations has proven to be a highly predictable treatment method with good long-term prognosis. However, some consequences of tooth loss prevents dental implant placement in an ideal position, where regenerative procedures are necessary for this type of rehabilitation. Less invasive procedures such as conventional prosthesis emerge as a therapeutic option in cases where there is enough bone structure for implants and patient´s non-acceptance for invasive procedures. Thus, this paper aims to present the resolution of rehabilitation through a noninvasive and multidisciplinary treatment. One female patient referred to the clinic presented maladaptive bilateral mandibular fixed prostheses, endodontic lesions, gingival recession, and root sensitivity. For proper resolution of this case, an association among osseointegrated implants, fixed partial prosthesis, tooth extraction, and aesthetic periodontal procedures with the use of subepithelial connective tissue graft was proposed. After two years, the patient shows excellent aesthetics and chewing. Within the limits of this scenario, this paper discusses the various factors that may affect the choice of a particular treatment modality for the rehabilitation of edentulous single spaces.

Facial Soft Tissue Augmentation using Autologous Fat Mixed with Stromal Vascular Fraction

BACKGROUND: Autologous fat grafting evolved over the twentieth century to become a quick, safe, and reliable method for restoring volume. However, autologous fat grafts have some problems including uncertain viability of the grafted fat and a low rate of graft survival. To overcome the problems associated with autologous fat grafts, we used uncultured adipose tissue-derived stromal cell (stromal vascular fraction, SVF) assisted autologous fat grafting. Thus, the purpose of this study was to evaluate the effect of SVF in a clinical trial. METHODS: SVF cells were freshly isolated from half of the aspirated fat and were used in combination with the other half of the aspirated fat during the procedure. Between March 2007 and February 2008, a total of 9 SVF-assisted fat grafts were performed in 9 patients. The patients were followed for 12 weeks after treatment. Data collected at each follow-up visit included clinical examination of the graft site(s), photographs for historical comparison, and information from a patient questionnaire that measured the outcomes from the patient perspective. The photographs were evaluated by medical professionals. RESULTS: Scores of the left facial area grafted with adipose tissue mixed with SVF cells were significantly higher compared with those of the right facial area grafted with adipose tissue without SVF cells. There was no significant adverse effect. CONCLUSIONS: The subjective patient satisfaction survey and surgeon survey showed that SVF-assisted fat grafting was a surgical procedure with superior results.

Restoration of Deformed Ala Caused by Cosmetic Alar Reduction: A Case Report

Cosmetically to correct large, thick and flaring ala, Weir method have been frequently used. But after excessive Weir excision, it causes tightened distal nose, lowered nasal tip, and unnatural shape of ala. A 32-years-old female patient suffered from the marked tightness of distal nose, lowered height of nasal tip, and mild dyspnea after Wier excision 1 year ago. She showed unnatural alar base shape with blunting of alar-facial groove angle up to 110 degree, and it rapidly slanted to the nasal tip. The incision was made along the previous operative scars at alar base, and release of tension were done. There was a 7mm gap in each side of both alar bases. The two wedge shaped composite grafts from the left helical rim were obtained, and insetted to the alar base gaps. Immediately after operation, she showed relief of dyspnea and tightness of nasal tip, and improved shape of distal nose. The 3 months postoperatively , mild hyperpigmentation of the grafted sites were noticed. The overall results were excellent. To correct the deformed ala and unnatural distal nose shape after excessive alar reduction using Wier excision, we present a technique of the composite auricular chondrocutaneous grafts at alar base.

Comparación de injerto de tejido conectivo y fascia en el tratamiento de defectos de reborde alveolar / Comparison of connective tissue and fascia in the treatment of maxillary ridge defects

Objetivo: comparar injertos de tejido blando autólogos y alógenos para el tratamiento de defectos clase I de Seibert. Métodos: se seleccionaron 18 sitios quirúrgicos, de 14 pacientes, y se asignaron aleatoriamente. Fueron asignados ocho sitios quirúrgicos para recibir injerto autólogo de tejido conectivo, y nueve para recibir injerto alógeno de fascia muscular. Se tomaron cuatro modelos diagnósticos para las mediciones, uno al inicio, y luego al primero, al segundo y al cuarto mes después de la cirugía. Adicionalmente, se realizaron seis biopsias del grupo de fascia. Resultados: el grupo control presentó una profundidad inicial promedio de 2,29 ± 0,55 mm, y el experimental, 3,50 ± 0,85 mm. La ganancia en espesor al primero, al segundo y al cuarto mes fue de 71,2, 46,52 y 28,5% en la fascia, y de 56,53, 38,31 y 38,1% en el tejido conectivo, respectivamente. La fascia se reabsorbió 28,8, 53,48 y 71,5%, al primero, al segundo y al cuarto mes, y el tejido conectivo se reabsorbió 43,47, 61,69 y 61,69%, respectivamente. No hubo diferencias significativas entre los dos grupos (p>0,05). El análisis histológico mostró presencia de tejido colágeno denso, poco celular, entremezclado con el tejido conectivo del huésped. La fascia tuvo una mayor tendencia a la reabsorción que el tejido conectivo, y la ganancia al cuarto mes en ambos fue similar. Sin embargo, el tejido conectivo fue más estable en el tiempo. La fascia mostró menor morbilidad,e histológicamente se observó presencia de este injerto después de 20 semanas. Conclusiones: la fascia humana constituye una alternativa de tratamiento para corregir defectos de reborde en el sector anterior.

Aim: Compare tissue grafting from autologous and allogenous sources for the treatment of Seibert Class I border defects. Methods: 18 surgical sites from 14 patients were selected and randomly assigned. 8 surgical sites received connective tissue grafts from autologous donor sites, and 9 surgical sites received allogenous muscular fascia grafts. 4 diagnostic casts were taken for comparative study (baseline, 1 month, 2nd month and 4th month postsurgical). In addition, 6 tissue punch biopsies were taken from the fascia group to determine presence of fascia tissue. ResultsThe control group showed an average tissue depth of 2.29 ± 0.55 mm and the experimental group showed 3.5 ± 0.85 mm, at baseline. Tissue gain for the fascia group was 71.2%, 46.52% y 28.5% for the 1st, 2nd and 4th months respectively, and the control group presented 56.53%, 38.31% y 38.1% respectively. There were not statistically significant differences between the two treatments (p>0,05). Histological analysis of the fasciagroup showed dense collagen tissue and host connective tissue at the 4th month. Fascia tissue grafts seemed to reabsorb faster than the connective tissue from the control group and the gain in tissue size at the 4th month was similar in both groups. The fascia tissue group, however, seemed to present less morbidity and was found in the histological samples at the 20 week postsurgical measurements. The connective tissue grafts were more stable in the treatment of Seibert I border defects. Conclusions: Human muscular fascia tissue could be an alternative treatment for the correction of Seibert class I border defects.