An Enigmatic Soft-Tissue Creeping Phenomenon: The Spontaneous Peri-Implant Mucosa Margin and Papilla Growth, Part Two-A Scientifically Supported Hypothesis Article.

In our previous article, we observed and measured a spontaneous growth in the coronal direction of the keratinized tissues present around implants. This growth involved both free margins and interdental papillae, and we indicated our hypothesis on the probable cause of this still-unexplained phenomenon. The growth of oral soft tissues involves several other structures, such as the linea alba and tongue indentation. Our idea holds that growth of these tissues is generated by the negative intraoral pressure created in the oral phase of swallowing and the subsequent resting position, which through the resulting suction causes a shift of these soft structures in the gaps around the dental crowns. Other hypotheses have been suggested in the past to understand this phenomenon of soft tissue growth, which still lacks data supporting etiological evidence. The purpose of this article is to thoroughly analyze and verify our model by comparing the clinical observations with citations and examples from the literature, combined with notions of physiology, biology, and physics that help in clarifying these events. To better explain the mechanisms of oral soft tissue growth, photographs of clinical cases paradigmatic of the phenomenon are shown.

An enigmatic soft tissue creeping phenomenon: The spontaneous peri-implant mucosa margin and papilla growth. A retrospective clinical study.

OBJECTIVES: The aim of the present retrospective study was to evaluate papillae filling rate and buccal margins coronal growth in implant-supported prostheses which were over-contoured at the apical buccal third to form a rearmost collar zone, thus mimicking a false root. MATERIAL AND METHODS: The influence of adjacent elements, teeth, implants, or pontics was examined. One-hundred and three crowns have been assessed in photographs taken on 61 patients after prosthesis delivering and at last follow-up (mean 2.8 years). The Jemt index was adopted to evaluate papillae growth at the baseline and follow-up as follows: 0, absence of papilla; 1, less than half of interdental embrasure height; 2, more than half of interdental embrasure height; 3, fully papilla filled interdental embrasure. Index score 4, papilla hyperplasia was not included. Moreover, the coronal growth (or recession) of buccal mucosa in implant-supported crowns was assessed. RESULTS: At baseline, a total of 29 papillae had a 0 score, while only two scored 3 with complete papilla formation. On follow-up, only one papilla scored 0, while 46 scored 3 with complete interdental embrasures filling. The highest papilla score was registered from first year crown insertion and likewise in interdental embrasures located between two implants or implants and pontics. Moreover, the buccal margin growth was observed in almost 80% of crowns. Such findings seem to indicate that buccal margin and papilla around implant-supported crowns presented a coronal growth over time, especially during its first year. The average papilla growth between two implants was no lower than that observed in papilla present between implants and natural teeth. CONCLUSIONS: Recessed areas at collar of implant-supported prostheses appear to positively influence papillae and buccal margin growth, especially in its first year. Papilla growth between two implants was similar to that observed between implants and natural teeth.

Two-Stage Ridge Split at Narrow Alveolar Mandibular Bone Ridges.

PURPOSE: When the bone ridge is corticalized, the displacement of the buccal plate may result in an unintentional malfracture. The aim of this study was to report the results of a 2-stage atrophic alveolar ridge expansion performed with a sonic-air surgical instrument. MATERIALS AND METHODS: In this retrospective cohort study, the atrophic distal segments of the mandible were treated by a split-thickness flap approach and application of an alveolar ridge expansion performed in 2 surgical phases. A sonic-air surgical instrument was used. In the first surgical procedure, only basal corticotomies on the buccal plate were performed. In the second stage, sagittal and vertical osteotomies were added, aiming to facilitate the displacement of the buccal bone plate. Subsequently, implants were installed into the created space between the buccal and lingual plates. No bone substitutes were used. The width of the displaced buccal bone wall and the gaps that occurred mesially and distally to the implant were measured at the time of implant installation. Cone beam computed tomography scans were taken before the first and after the second surgical procedures, and the width of the alveolar crest at both observations and the width of the residual mesial and distal gaps after implant installation were measured. RESULTS: We included 10 patients (6 women and 4 men; aged 37 to 69 years) in the study, and 15 implants were installed in expanded narrow ridges. Clinically, the mean width of the buccal bone wall was 1.2 ± 0.2 mm and the gaps ranged between 2.8 and 3.2 mm. On the radiographic assessments, the mean initial width of the alveolar bone crest measured 4.1 ± 0.5 mm, reaching 6.8 ± 0.9 mm after ridge expansion (P < .01). CONCLUSIONS: The use of a modified edentulous ridge expansion in 2 stages allowed the installation of implants in narrow and corticalized alveolar ridges. We suggest that this technique is especially applicable in the distal segments of the mandible because of the low invasiveness, low risk of buccal plate fractures, reduced morbidity, and reduced costs.

Impacted canine extraction by ridge expansion using air scaler surgical instruments: a case report.

The presence of an impacted tooth interferes with ideal implant placement. In such cases, atraumatic extraction is recommended in order to avoid difficult and complex bone regeneration procedures. In the present case report, a novel surgical approach to extract a horizontally impacted canine using an edentulous ridge expansion (ERE) technique and air scaler surgical devices is described. A 74-year-old female patient had a maxillary left horizontally impacted canine. The tooth was extracted after elevating a partial-thickness flap and performing an ERE technique using air scaler surgical instruments. The impacted tooth was fragmented through the breach created in the expanded ridge, and the fragments were carefully removed. A suitably sized implant was placed at the time of surgery. The treated site healed without complication. The implant was integrated, successfully restored, and stable after a 3-year follow-up period. This case report demonstrates a novel surgical approach to extract an impacted canine through ridge expansion, using air scaler surgical devices that allow implant placement in an ideal position.

New surgical technique and distraction osteogenesis for ankylosed dental movement.

Dental ankylosis often presents a significant vertical alveolar defect that is an esthetic problem for prosthetic rehabilitation. Moreover, surgical-orthodontic treatment by corticotomies and distraction devices provides special attention to avoid the loss of blood supply to the segment; furthermore, gingival recessions may appear because the gingival tissues cannot proliferate as fast as the immediate repositioning of the tooth. This case report presents a surgical technique for buccal, palatal, and vertical movements, and examines the effects of a tooth/arch-borne tooth distractor appliance, for the alignment of ankylosed teeth. The slow movements of tooth and bone block and fine cut simplifies orthodontic treatment in patients and makes it possible to achieve complex movements in a relatively short period. The reported dislocation procedure allows a use of buccal-lingual vertical osteotomy with horizontal osteotomy to correct tooth positions via bony block movement maintaining gingival tissues in position. The used sonic saw have proven to be a valuable alternative to manual or rotating tools, oscillating saws, or piezoelectric units because it is faster and easier for surgical approach.