Peri-implant soft tissue volume changes after microsurgical envelope technique with a connective tissue graft. A 5-year retrospective case series.

AIM: The aim of the present retrospective case series was to longitudinally assess soft tissue volume changes on the vestibular aspect of implants in relation to keratinized mucosa thickness (KMT) and width (KMW) after the application of the microsurgical envelope technique combined with a connective tissue graft (CTG). MATERIALS AND METHODS: A total of 12 healthy patients received 12 dental implants placed either in the posterior maxilla or mandible. The study involved the harvesting of 12 CTGs with a minimally invasive single-incision technique, grafted to the vestibular peri-implant soft tissue utilizing the envelope technique, followed by the insertion of 12 screw-retained IPS e.max crowns. RESULTS: The healing process was uneventful across all areas, and all patients were followed up for a period of 5 years. The evaluation of KMT showed the highest decrease in the first 6 weeks after surgery (5.5 ± 0.79 to 4.59 ± 0.62 mm), then dropped slightly to 4 ± 0.85 mm, after which it maintained at 4 ± 0.36 mm until the 2-year time point. Between the second and third years after surgery, a further decrease of 3.59 ± 0.42 mm was recorded for KMT, which then remained constant until the end of the 5-year research period. The observations regarding KMW were slightly different, with the measurements demonstrating the greatest decrease in first 6 weeks (from 2.5 ± 0.42 to 1.5 ± 0.42 mm), which was maintained until the 1-year time point. Between the first and second years after surgery, the KMW increased to 2 ± 0.60 mm and remained level for the next 3 years, at 2 ± 0.85 mm. CONCLUSIONS: The current research demonstrated the advantages of using a combination of a minimally invasively harvested CTG and the microsurgical envelope technique for a duration of 5 years.

From Minimally Invasive Tooth Extraction to Final Chairside Fabricated Restoration: A Microscopically and Digitally Driven Full Workflow for Single-Implant Treatment.

Technical advances in such fields as optical magnification (eg, loupes, microscopes), microsurgical instruments, bone and soft-tissue grafting materials, and digital dentistry have paved the way for dentists to be able to provide all the necessary specialties for a state-of-art single-tooth replacement treatment under one roof in their clinics, without having to involve a technical laboratory. This case report demonstrates a routine complete chairside digital workflow using minimally invasive and microscopic techniques in every stage of treatment, from tooth extraction and socket preservation, to implant insertion and soft-tissue management, to delivery of the final chairside digital zirconia full-anatomic supraconstruction. In addition to describing the intent of minimally invasive tooth extraction and socket preservation, this article illustrates how to perform a vestibular split rolling flap procedure and discusses its benefits. The goal of this digitally driven single-implant treatment was to achieve restoration as close as possible to the original condition.

Effectiveness of Two Differently Processed Bovine-Derived Xenografts for Alveolar Ridge Preservation with a Minimally Invasive Tooth Extraction Approach: A Feasibility Clinical Trial.

Xenogeneic-derived biomaterials are among the most routinely employed bone substitutes for immediate grafting of extraction sites as a modality of alveolar ridge preservation (ARP). The deproteinized bovine bone material is widely used and documented around the world. The present pilot clinical trial evaluated and compared the clinical and morphologic alterations of extraction sites after ARP using two commercially available yet differently processed bovine bone grafts. A total of 20 adjacent extraction sites in 10 patients were included. All sites received the exact same ARP therapy except for the type of bovine bone graft, which was randomly assigned between two adjacent extraction sockets in 10 patients (Group A received Bio-Oss particles and Group B received Cerabone particles). At all sites, healing was monitored at the time of surgery and at 1, 2, 3, and 4 months postoperative. All of the augmented extraction sites achieved successful implant therapy regardless of the bone graft material used for ARP. Six weeks after implant placement, second-stage/uncovering procedures were performed without complications. Intergroup comparisons of the crestal gingival healing process (CGHP), mean transversal crestal ridge resorption (MTRR), and mean implant primary stability (MIPS) were in favor of Group A sites (treatment with Bio-Oss particles).

Clinical comparison of vestibular split rolling flap (VSRF) versus double door mucoperiosteal flap (DDMF) in implant exposure: a prospective clinical study.

BACKGROUND AND AIM: Dental implant patients are frequently required to undergo a second-stage/uncovery procedure to expose the implant fixture. The aim of the present prospective study was to evaluate the clinical outcomes of the vestibular split rolling flap (VSRF) versus the double door mucoperiosteal flap (DDMF) techniques at adjacent posterior implant sites during the second-stage procedure. MATERIALS AND METHODS: A total of 44 uncovered posterior dental implants in 10 healthy patients were treated at the second stage. All the mesial implants were assigned to the VSRF technique (group A) and the distal implants to the DDMF technique (group B). Soft tissue measurements were performed as vestibular keratinized mucosal width (KMW) and vestibular mucosal thickness (MT) over a period of 1 year, assessed at four different intervals. RESULTS: Healing was uneventful at all sites. There were no patient dropouts in the entire study time frame. The clinical comparison of the adjacent implants showed overall higher MT measurements at 12 months for group A (2.5 ± 0.2 mm) compared with group B (1.00 ± 0.3 mm), and for KMW measurements for group A (2.5 ± 0.2 mm) compared with group B (2.0 ± 0.3 mm). CONCLUSIONS: The VSRF technique described in the present article is a reliable method for performing an implant uncovery. If the technique is applied according to the indication and with a minimally invasive protocol, it is preferable to other conventional exposure techniques due to its ability to provide enhanced soft tissue volume around the implant, which can in turn benefit the health, esthetics, function, and long-term stability of the peri-implant tissue.

Comparison of the minimally-invasive roll-in envelope flap technique to the holding suture technique in implant surgery: A prospective case series.

OBJECIVE: The peri-implant soft tissue phenotype plays a role in the long-term success of dental implants, thus, creating the need for the application of different techniques for the management of its adjacent soft tissues. The aim of this case series was to describe and evaluate the clinical outcomes of the microsurgical roll-in-envelope flap (RIE) approach, in comparison with a more commonly used method for manipulation of the peri-implant soft tissues, namely the holding-suture flap (HS) technique. MATERIALS AND METHODS: 10 posterior dental implants in 10 healthy individuals were selected and randomly assigned treatment by each of the mentioned groups relative to the flap design. Mucosal thickness was measured at the time of the surgery and at 6 and 12 weeks, serving as the main outcome. RESULTS: The healing was uneventful at all sites without any patient drop-outs. The comparison of two groups revealed a three-fold reduction in the mucosal thickness in HS group compared to RIE. CONCLUSIONS: In presence of sufficient periimplant supporting tissues and when indicated, the RIE flap seems to yield superior outcomes reducing pain/discomfort compared to connective tissue grafts.

Modified 3-Dimensional Alveolar Ridge Augmentation in the Anterior Maxilla: A Prospective Clinical Feasibility Study.

Vertical and horizontal reconstruction of the alveolar ridge, especially in the anterior maxilla, is considered a clinical challenge for dentists. There is still a lack of a standard technique to address the hurdles in 3-dimensional bone regeneration in the anterior maxilla. In this clinical feasibility study, we aimed to modify Khoury's technique by combining the conventional guided bone regeneration standards with the principles of this technique. The autogenous bone blocks were harvested from the retromolar area and grafted into the deficient anterior maxillae by mini-screws, and the gap was filled with xenogenic bone particles. The grafted site was covered with multilayered resorbable collagen membranes. Cone-beam computerized tomographic scans were obtained at the 6-month follow-ups, and the changes in ridge width and height were measured. Five subjects with multiple missing teeth at the anterior maxilla were included. The radiographic outcomes of the 6-month follow-ups revealed 1.2 mm of height and 3.5 mm of width gain. Between the 4- and 6-month visits, approximately 2 mm resorption in height and 0.3 mm in width occurred. No complications occurred. The proposed modification for Khoury's technique can serve as a feasible method in the 3-dimensional reconstruction of the anterior maxilla without additional autogenous bone particles.