Buccal Pedicle Flap Technique Combined With Porcine Collagen Matrix for Volumetric Augmentation of Peri-Implant Mucosa.

INTRODUCTION: A special interest has been raised regarding the role of the peri-implant mucosa as a critical factor for long-term maintenance of the artificial fixtures as well as the final esthetic outcome that may significantly affect patient satisfaction. It is then imperative to develop minimally invasive and easy-to-apply plastic surgical methods to increase the volume of the peri-implant mucosa. CASE PRESENTATION: The limited scientific evidence regarding possible techniques to treat esthetic soft tissue defects around endosseous implants is encouraging a preventive soft tissue augmentation of mucosa deficiencies and thin phenotypes. Several techniques have been proposed to augment the volume of the mucosa to achieve the so-called pink esthetics. Among these the buccal pedicle flap seems to be less invasive in terms of morbidity since it does not necessitate any soft tissue harvesting. Its low morbidity allows it to treat patients without the need of postoperative medications since it reduces pain, the risk of infections, alteration of the sensitivity of the donor site and significantly reduces the period of healing which is generally longer when associated with connective tissue grafts. A modified surgical approach is based on the combination of the buccal pedicle flap with a stable collagen matrix to boost a biomimetic peri-implant mucosa and generate a convex pink interface with the final restoration. CONCLUSION: The proposed modified buccal pedicle flap seems to be promising in terms of decreased morbidity and maintenance of the blood supply, and conducive to an increased patient acceptance rate.

Buccal Pedicle Flap Combined With Porcine Collagen Matrix: A Follow-Up of 2 Years on 40 Consecutive Cases.

INTRODUCTION: A thick peri-implant mucosa is of importance to prevent recession, color alterations, bone remodeling and promote "creeping attachment." A volume stable porcine cross-linked collagen matrix has been recently introduced for soft tissue regeneration and volume maintenance. The aim of this study was to investigate peri-implant soft tissue healing and stability on 40 consecutive patients treated with buccal pedicle flap combined with the use of the collagen matrix. CASE SERIES: The buccal pedicle flap combined with a volume stable collagen matrix was executed at second stage surgery. The average initial mucosa thickness was 1.32 mm whereas the average band of keratinized mucosa was 1.65 mm and the height 1.3 mm. Four months after surgical procedure and before delivering the final restoration, the peri-implant soft tissue measurements were significantly increased: the average band of keratinized mucosa was 5.10 mm, the mucosa thickness was 3.27 mm, and the mucosa height was 3.32 mm. After 2 years of follow-up, the superimposition of 3D models described an overall volumetric stability of the augmented mucosa with no signs of soft tissue collapse. CONCLUSION: The proposed modified buccal pedicle flap was demonstrated to perform well in terms of decreased morbidity, maintenance of blood supply, stabilization of the pedicle, superior haemostasis, and speed of treatment. No significant variations of the keratinized tissue were registered when the buccal pedicle flap was executed in conjunction with the collagen matrix that however provided color match with the surrounding tissue as well as an increased mucosa thickness.

A Novel Parallel-Walled Dental Implant with a Self-Tapping Apex, Conical Connection, and Platform Shifting: Short-Term Results from a Retrospective Multicenter Clinical Study.

This multicenter retrospective study assessed clinical and radiographic outcomes of 686 parallel-walled conical-connection implants consecutively placed in 281 partially and fully edentulous patients. Implants were placed in healed and postextraction sites and subjected to immediate, early, or delayed loading. With a mean follow-up of 10 ± 6.7 months, the implant survival rate was 97.7%, while mean marginal bone loss was 0.7 ± 1.5 mm between implant placement and 1 year (n = 290 implants) and 0.1 ± 0.6 mm between 1 and 2 years (n = 72 implants). Advanced patient age and longer implants were associated with fewer implant failures, while different crestal positions at implant placement were not associated with differences in implant survival or changes in marginal bone level over time.

The Influence of Mucosa Thickness and Quality on Single Implant Tissue Stability: A Prospective Controlled Clinical Trial.

This prospective controlled clinical trial investigated the possible correlation among mucosa thickness, mucosa height, and width of keratinized mucosa on the contour changes of the peri-implant soft tissue collar over a period of 12 months. Forty patients were selected to undergo implant placement. Impressions were taken with polyether impression material at delivery of the final restorations (baseline) and at 1, 3, 6, and 12 months. Master casts were fabricated and scanned using an indirect digitalization. Baseline and corresponding follow-up scans were then virtually superimposed and matched. At 1 year, 20 patients who received the buccal pedicle flap showed an average thickness increase of 1.49 mm (ρs = 0.95; range: 0.01 to 2.56 mm), whereas the 5 patients who received a connective tissue graft at second-stage surgery reported an average thickness increase of 0.33 mm (ρs = 0.70; range: -0.62 to 1.23 mm). Finally, the remaining 15 patients who did not receive any soft tissue grafting nor any type of plastic surgery showed an average mucosa thickness increase of 0.51 mm (ρs = 0.28; range: -2.33 to 2.52 mm).

The buccal pedicle flap technique for periimplant soft tissue boosting.

A healthy and adequate band of keratinized periimplant mucosa is key to long-term biologic and esthetic success. Yet in about one-third of implant patients, its formation requires connective tissue graft procedures. Such procedures may be considered impractical for patients who need retreatment of failures, those who are not willing to go through multiple surgical steps, or those receiving multiple implants that would thus involve multiple connective tissue grafts. This article introduces the buccal pedicle fl ap technique, a new surgical approach for boosting the soft tissue around dental implants without connective tissue grafting. The technique is a minimally invasive surgical approach that can be performed as one-stage or two-stage surgery and can be applied in anterior and posterior areas as well as at single and multiple adjacent implants.

Clinical and microbiological determinants of ailing dental implants.

BACKGROUND: The failure of the host tissue to establish or maintain osseointegration around dental implants is due to either occlusal or parafunctional forces, premature loading, ill-directed stress, or microbial infection. The long-term failure rate of dental implants is generally 5-10%. Although a variety of etiologies of early peri-implant bone loss (from implant placement to 1-year post-loading) have been proposed, factors associated with late implant failures are less well understood but are probably related to both the peri-implant microbial environment and host factors. Discriminating between causes of implant failure is of importance for instituting a successful implant therapy. PURPOSE: The objective of this cross-sectional split-mouth study was to identify clinical, radiographic, and bacterial characteristics of peri-implant disease sites. MATERIALS AND METHODS: Fifteen patients with bilateral implants (Brånemark, Nobel Biocare AB, Göteborg, Sweden; and 3i implant systems, Implant Innovations Inc., Palm Beach Gardens, FL, USA) participated in the study. Sites with peri-implant (radiographic bone loss beyond the third implant thread) and peri-implant healthy tissues (radiographic bone level above the first implant thread) were identified in periapical radiographs using a long-cone paralleling projection technique. Microbiological identification was carried out using established anaerobic culture techniques. A descriptive statistics based on means and standard deviations was reported. RESULTS: Peri-implant bone loss was associated with the absence of radiographic crestal lamina dura, peri-implant pocket depth, pain on chewing, and the submucosal presence of the putative periodontopathogens Tannerella forsythia, Campylobacter species, and Peptostreptococcus micros. Pain was associated with P. micros, Fusobacterium species, and Eubacterium species. DISCUSSION AND CONCLUSION: The absence of radiographic crestal lamina dura and the presence of suspected major periodontal pathogens seem to be associated to peri-implantitis.

Cytomegalovirus-associated periodontitis and Guillain-Barré syndrome.

BACKGROUND: Guillain-Barré syndrome (GBS), an autoimmune disorder of the peripheral nervous system, is characterized by rapidly ascending neural paralysis, hyporeflexia, and areflexia. The polyneuropathy of the GBS affects one to four humans per 100,000 of the population annually throughout the world (adults and children). The pathogenesis of GBS remains unclear. However, there are increasing indications that the disease is triggered by a preceding well-established febrile infection by cytomegalovirus (CMV). The present report describes active CMV within the periodontium of a 37-year-old patient affected by GBS. METHODS: Real-time reverse transcriptase-polymerase chain reaction (real-time RT-PCR) was performed to detect CMV, Epstein-Barr virus-1 (EBV-1), herpes simplex 1 (HSV-1) and 2 (HSV-2) virus, and enteroviruses (polio-, coxsackie-, echo-, and enteroviruses 68 and 71) from periodontal sites demonstrating advanced attachment loss. Healthy sites and sites with inflamed gingival tissue were not included in the study. Anaerobic bacterial culture determined the occurrence of potential major periodontal pathogens. RESULTS: Real-time RT-PCR and microbiologic analysis revealed the presence of a dual infection of CMV and specific bacterial plaque. CMV, Porphyromonas gingivalis, Tannerella forsythensis, and Campylobacter species were associated with periodontitis active sites, loss of attachment, and gingival bleeding. Furthermore, periodontal sites infected by active CMV had no visible radiographic crestal lamina dura. CONCLUSIONS: The periodontium may serve as a reservoir for CMV and a source of viral replication. However, further research is needed to test whether viral replication in the periodontium precedes the GBS symptoms.