Wound healing dynamics, morbidity, and complications of palatal soft‐tissue harvesting

Periodontology 2000, Год журнала: 2022, Номер 92(1), С. 90 - 119

Опубликована: Дек. 30, 2022

Abstract Palatal‐tissue harvesting is a routinely performed procedure in periodontal and peri‐implant plastic surgery. Over the years, several surgical approaches have been attempted with aim of obtaining autogenous soft‐tissue grafts while minimizing patient morbidity, which considered most common drawback palatal harvesting. At same time, treatment errors during may increase not only postoperative discomfort or pain but also risk developing other complications, such as injury to greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, inadequate graft size quality. This chapter described complications techniques, together for reducing morbidity accelerating donor site wound healing. The role biologic agents, photobiomodulation therapy, local systemic factors, genes implicated healing are discussed.

Язык: Английский

---

Minimal invasiveness at dental implant placement: A systematic review with meta‐analyses on flapless fully guided surgery

Periodontology 2000, Год журнала: 2022, Номер 91(1), С. 89 - 112

Опубликована: Июль 30, 2022

Abstract Flapless and fully guided implant placement has the potential to maximize efficacy outcomes at same time minimize surgical invasiveness. The aim of current systematic review was answer following PICO question: “In adult human subjects undergoing dental (P), is minimally invasive flapless computer‐aided (either dynamic or static (sCAIP)) (I) superior flapped conventional (free‐handed (FHIP) cast‐based/drill partially (dPGIP)) surgery (C), in terms efficacy, patient morbidity, long‐term prognosis, costs (O)?” Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established question were included. Two authors independently searched for eligible studies, screened titles abstracts, performed full‐text analysis, extracted data from published reports, risk bias assessment. In cases disagreement, a third author took final decision during ad hoc consensus meetings. study results summarized using random effects meta‐analyses, which based (wherever possible) on individual (IPD). A total 10 manuscripts reporting five RCTs, involving 124 participants 449 implants, comparing sCAIP with FHIP/cast‐based (cPGIP), There no RCT analyzing (dCAIP) dPGIP. Intergroup meta‐analyses indicated less depth deviation (difference means (MD) = −0.28 mm; 95% confidence interval (CI): −0.59 0.03; moderate certainty), angular (MD −3.88 degrees; CI: −7.00 −0.77; high coronal −0.6 −1.21 0.01; low certainty) apical −0.75 −1.43 −0.07; three‐dimensional bodily deviations, postoperative pain −17.09 mm visual analogue scale (VAS); −33.38 −0.80; swelling −6.59 VAS; −19.03 5.85; very intraoperative discomfort −9.36 −17.10 −1.61) duration −24.28 minutes; −28.62 −19.95) than FHIP/cPGIP. Despite being more accurate FHIP/cPGIP, still resulted deviations respect planned position (intragroup meta‐analytic means: 0.76 depth, 2.57 degrees angular, 1.43 coronal, 1.68 position). Moreover, presented 12% group‐specific complication rate, resulting an inability place this protocol 7% cases. Evidence regarding clinically relevant (implant survival success, prosthetically biologically correct positioning), costs, currently scarce. When objective guarantee minimal invasiveness placement, clinicians could consider use sCAIP. proper case selection consideration safety margin are, however, suggested.

Язык: Английский

---

Impact of peri‐implant soft tissue characteristics on health and esthetics

Journal of Esthetic and Restorative Dentistry, Год журнала: 2023, Номер 35(1), С. 183 - 196

Опубликована: Янв. 1, 2023

Abstract Objective To review the impact of key peri‐implant soft tissue characteristics on health and esthetics. Main Considerations The keratinized mucosa width (KMW), mucosal thickness (MT), supracrestal height (STH) are essential components phenotype. An inadequate KMW (<2 mm) has been associated with local discomfort upon oral hygiene performance increased risk for onset diseases. A minimum buccal MT (≥2 is generally required to prevent esthetic issues related effect transmucosal prosthetic elements color can also contribute long‐term stability. STH directly marginal bone remodeling patterns during early healing process that follows connection components. Short STH, defined as <3 mm, consistently loss resulting from physiologic establishment seal. Insufficient may derive into fabrication unfavorable contours, which frequently results in unpleasing outcomes predisposes submarginal biofilm accumulation. Peri‐implant dehiscences (PISTDs) a type deformity often occur sites presenting KMW, MT, and/or deficiencies. PISTDs should be correctly diagnosed treated accordingly, usually by means multidisciplinary therapy. Conclusion Understanding different dimensional morphologic features fundamental make appropriate clinical decisions context tooth replacement therapy implant‐supported prostheses.

Язык: Английский

---

Overview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications

Zeitschrift für Medizinische Physik, Год журнала: 2023, Номер 33(3), С. 336 - 386

Опубликована: Март 13, 2023

Ultrasound is a non-invasive, cross-sectional imaging technique emerging in dentistry. It an adjunct tool for diagnosing pathologies the oral cavity that overcomes some limitations of current methodologies, including direct clinical examination, 2D radiographs, and cone beam computerized tomography. Increasing demand soft tissue has led to continuous improvements on transducer miniaturization spatial resolution. The aims this study are (1) create comprehensive overview literature ultrasonic relating dentistry, (2) provide view onto investigations with immediate, intermediate, long-term impact periodontology implantology. A rapid review was performed using two broad searches conducted PubMed database, yielding 576 757 citations, respectively. rating established within citation software (EndNote) 5-star classification. search citations allowed high sensitivity whereas subsequent added specificity. critical applications ultrasound dentistry provided focus role as developing dental diagnostic reviewed. Specific uses such hard imaging, longitudinal monitoring, well anatomic physiological evaluation were discussed. Future efforts should be directed towards transition ultrasonography from research tool. Moreover, dedicated effort needed introduce education community ultimately improve quality patient care.

Язык: Английский

---

Do soft tissue augmentation techniques provide stable and favorable peri‐implant conditions in the medium and long term? A systematic review

Clinical Oral Implants Research, Год журнала: 2023, Номер 34(S26), С. 28 - 42

Опубликована: Сен. 1, 2023

Abstract Objectives To review the available literature on medium‐ and long‐term effects of soft tissue augmentation (STA) at implant sites to explore different approaches clinical‐, patient‐reported, health‐related parameters. Materials Methods A comprehensive electronic manual search was performed identify prospective clinical studies that assessed (≥36 months) outcomes following STA, including number maintaining peri‐implant health developing disease, incidence complications, stability clinical, volumetric, radiographic parameters, patient‐reported outcome measures (PROMs). Results Fifteen were included in qualitative analysis. STA with either a bilaminar‐ or an apically positioned flap (APF) approach, combination autogenous grafts (free gingival graft [FGG] connective [CTG]) substitutes (acellular dermal matrix [ADM] xenogeneic cross‐linked collagen [CCM]). An overall high survival rate observed. Most augmented maintained medium long term, mucositis peri‐implantitis ranging from 0% 50% 7.14%, respectively. The position margin APF + FGG bilaminar involving CTG CCM found be stable over time. No substantial changes reported for plaque score/index, bleeding probing/bleeding index, probing depth between early time points visits. CTG‐based procedures resulted increased dimension keratinized mucosa width (KMW) mucosal thickness (MT)/volumetric time, when compared follow‐ups. described marginal bone levels grafted professionally esthetic results points. Conclusions Implants received showed relatively low term. Augmented seem maintain level while non‐augmented implants may exhibit apical shift margin. favorable obtained are increase KMW MT expected CTG‐augmented sites.

Язык: Английский

---

Diagnostic methods/parameters to monitor peri‐implant conditions

Periodontology 2000, Год журнала: 2024, Номер 95(1), С. 20 - 39

Опубликована: Июнь 1, 2024

The diagnostic accuracy of clinical parameters, including visual inspection and probing to monitor peri-implant conditions, has been regarded with skepticism. Scientific evidence pointed out that primary tools (chairside) seem be highly specific, while their sensitivity is lower compared use in monitoring periodontal stability. Nonetheless, given the association between pocket depth at teeth implant sites aerobic/anaerobic nature microbiome, it seems plausible for indicative disease progression or tissue In addition, understanding inflammatory diseases, reasonable advocate bleeding, erythema, ulceration, suppuration might reliable indicators pathology. Nevertheless, single spots bleeding on may not reflect disease, since implants are prone exhibit related force. On other side, smokers lacks owing decreased angiogenic activity. Hence, dichotomous scales general population, contrast indices feature profuseness time after probing, lead false positive diagnoses. definitive distinction mucositis peri-implantitis, though, relies upon radiographic progressive bone loss can assessed by means two- three-dimensional methods. Accordingly, objective this review evaluate existing parameters/methods conditions.

Язык: Английский

---

Anterior implant restorations with a convex emergence profile increase the frequency of recession: 12‐month results of a randomized controlled clinical trial

Journal Of Clinical Periodontology, Год журнала: 2022, Номер 49(11), С. 1145 - 1157

Опубликована: Июль 12, 2022

Abstract Aim To test whether the emergence profile (CONVEX or CONCAVE) of implant‐supported crowns influences mucosal margin stability up to 12 months after insertion final restoration. Materials and Methods Forty‐seven patients with a single implant in anterior region were randomly allocated one three groups: (1) CONVEX ( n = 15), provisional an crown both convex profile; (2) CONCAVE 16), concave (3) CONTROL no (healing abutment only) crown. All recalled at baseline, 6, months. The along clinical, aesthetic, profilometric outcomes as well time costs evaluated. predict presence recession, multivariable logistic regressions performed linear models using generalized estimation equations conducted for different outcomes. Results Forty‐four available post‐loading. frequency recession amounted 64.3% group CONVEX, 14.3% CONCAVE, 31.4% CONTROL. Regression revealed that was significantly associated recessions (odds ratio: 12.6, 95% confidence interval: 1.82–88.48, p .01) compared profile. Pink aesthetic scores 5.9 6.2 5.4 CONTROL, significant differences between groups .735). Groups increased appointments group. Conclusions use provisionals results greater loading. This is accompanied, however, by absence may not necessarily enhance Trial registration: German Clinical Trials Register; DRKS00009420.

Язык: Английский

---

Soft tissue features of peri‐implant diseases and related treatment

Clinical Implant Dentistry and Related Research, Год журнала: 2022, Номер 25(4), С. 661 - 681

Опубликована: Ноя. 29, 2022

Abstract Background The need for soft tissue grafting at implant sites preventing and treating peri‐implant diseases is a currently investigated debated topic. Purpose aim of this manuscript to explore the inflammatory mechanisms compartment, distinguish structural components phenotype their role on health, appraise clinical indications expected outcomes augmentation procedures diseased sites. Materials Methods This narrative review depicts biomarkers mediators in crevicular fluid utilized diagnose disease that have been shown be associated with modification resolution. impact phenotype, involving keratinized mucosa (KM) width, attached (AM), mucosal thickness (MT), supracrestal height (STH), esthetic, patient's comfort prevention are discussed. also illustrates use ultrasonography detection health/disease evaluation treatment following surgical therapies. Results Current evidence indicates inadequate KM AM MT can beneficial promoting health improving hygiene procedures. Treatment approaches from available literature combination conventional techniques mucositis or peri‐implantitis presented discussed detail. Conclusions Soft diseases. Clinical recommendations based disease, characteristics bone defect morphology provided comprehensive hard‐ soft‐tissue‐oriented disease.

Язык: Английский

---

Coronally advanced flap versus tunnel technique for the treatment of peri‐implant soft tissue dehiscences with the connective tissue graft: A randomized, controlled clinical trial

Journal Of Clinical Periodontology, Год журнала: 2023, Номер 50(7), С. 980 - 995

Опубликована: Март 20, 2023

To evaluate the efficacy of coronally advanced flap (CAF) versus tunnel technique (TUN) in covering isolated mid-facial peri-implant soft tissue dehiscences (PSTDs).Twenty-eight participants presenting with non-molar implants exhibiting PSTDs were enrolled and randomized to receive either CAF or TUN, both a connective graft (CTG). The primary outcome study was percentage mean PSTD coverage at 12 months. Secondary endpoints included frequency complete coverage, changes keratinized mucosa width (KMW) horizontal mucosal thickness (MT), as assessed transgingival probing, 3D optical scanning ultrasonography, professional aesthetic evaluation patient-reported measures (PROMs).At months, TUN groups 90.23% 59.76%, respectively (p = .03). CAF-treated sites showed substantially higher .07), together significantly greater gain KMW .01), increase MT .02), volumetric < .01) outcomes .01). Both interventions an improvement aesthetics reduction anxiety related appearance implant compared baseline, group obtaining scores .03 for PROMs).CAF + CTG resulted superior outcomes, MT, better PROMs than treatment (ClinicalTrials.gov NCT03498911).

Язык: Английский

---

The importance of soft tissue condition in bone regenerative procedures to ensure long‐term peri‐implant health

Periodontology 2000, Год журнала: 2023, Номер 93(1), С. 129 - 138

Опубликована: Июнь 5, 2023

Abstract Bone regenerative procedures have been widely proved to be a reliable treatment option re‐create the ideal pre‐implant clinical conditions. Nevertheless, these techniques are not free from post‐operative complications which might result in implant failure. Consequently, as demonstrated by increasing recently published evidence, careful pre‐ and intra‐operative flap evaluation ensure an hermetic tension‐free wound closure is of paramount importance successfully treat bony defects. In this respect, several surgical interventions mainly aimed increase amount keratinized mucosa either allow optimal healing after reconstructive procedure or establish peri‐implant soft tissue seal proposed. The present review summarizes level evidence on aspects impact handling associated with bone conditions enhance maintain health long‐term.

Язык: Английский

---