Minimally invasive technique for gingival augmentation around dental implants

This article describes a soft tissue surgical modification--the trap door technique--used to enhance contemporary patient esthetic expectations and preserve periodontal health longitudinally. This surgical modification is greatly indicated for single-stage single and multiple implant surgery to preserve the integrity of the papillae and eliminate buccal soft tissue concavity. This procedure also addresses the issue of interproximal papillary development to obviate the presence of a black triangle. The technique is very effective in cases of minimal interproximal bone loss, it does not require autogenous bone harvesting, and is therefore less invasive and well accepted by the patient.     

Use of reactive soft tissue for primary wound closure during immediate implant placement: a two-year retrospective study

Sockets with both hard and soft tissue defects present a challenge for immediate implant placement. A modified technique harnessing the reactive soft tissue in the extraction socket for primary closure has been reported to contribute to hard and soft tissue augmentation after immediate implantation. The aim of this study was to evaluate the effects of this novel technique on the hard and soft tissues of sockets with both buccal bone and soft tissue defects (group B) and to compare the outcomes with those obtained for sockets with intact soft tissue but buccal bone dehiscence (group A). Thirty-two implants placed in the posterior region were included: 17 in group A, 15 in group B. The implants were inserted immediately utilizing reactive soft tissue from the socket for primary closure in both groups. The changes in buccal bone dimensions after 6 months were generally comparable between the two groups. A keratinized mucosa reduction of 0.56 mm in group A and keratinized mucosa gain of 0.67 mm in group B were observed at 6 months (P = 0.009). The bone and soft tissue levels were well maintained in both groups after 2 years. This technique may be a potential treatment method for tissue augmentation during immediate implantation in posterior sockets, even when a buccal bony defect and mucogingival recession need to be repaired at the same time.     

颊脂垫移植的组织学实验研究

目的　为了解无覆盖带蒂颊脂垫组织瓣修复口腔软组织缺损愈合过程中组织学的变化。方法　人为造成缺损区 ,用无覆盖带蒂颊脂垫移植修复口腔内组织缺损 ,观察 10周。结果　发现颊脂垫口腔面 6～ 8周完全上皮化 ;脂肪组织逐步被纤维组织取代。再生的粘膜呈粉红色 ,类似于正常的口腔粘膜 ,5 0 %的实验动物愈合后粘膜存在轻度瘢痕。结论　该组织瓣解剖恒定 ,易获取 ,供区与受区近 ,可在同一切口内完成 ,供区隐蔽 ,不影响外观及功能。此方法为修复口腔软组织缺损提供了一种新方法     

颊脂垫在口腔软组织缺损修复中的应用

目的:评价颊脂垫在口腔软组织缺损修复中的效果。方法:17例口腔不同部位肿瘤切除后,应用颊脂垫瓣修复软组织缺损并进行回顾性分析。结果:颊脂垫在组织缺损区愈合良好,未见并发症的发生,3～4周即可见上皮覆盖,组织缺损被修复。结论:颊脂垫瓣修复口腔软组织缺损,方法简单、易行,效果满意,值得推广。     

颊脂垫瓣在口腔黏膜下纤维性变术后缺损修复中的应用

目的：研究颊脂垫瓣在口腔黏膜下纤维性变（OSF）切除后组织缺损修复中的应用。方法：10例伴重度张口受限的OSF患者,应用颊脂垫瓣修复切除后遗留的组织缺损,观察颊脂垫瓣的愈合过程及修复效果。结果：术后9例患者张口度均大于3cm,颊脂垫瓣愈合良好,术后1周颊脂垫瓣明显水肿,组织瓣表面有薄层伪膜覆盖,1周后伪膜逐渐消失,2周后伪膜完全消失,2～3周后水肿明显消退,颊脂垫表面逐渐上皮化,6～8周再生的黏膜变得光滑,呈粉红色,类似于正常口腔黏膜。结论：颊脂垫瓣为修复OSF术后缺损提供了一种良好的手术方式,有利于改善张口受限症状。     

Bone regeneration in alveolar bone dehiscences produced by jiggling forces

The aim of this experiment was to achieve support for the hypothesis that bone resorption, induced by jiggling forces, leaves a component within the supracrestal soft tissue with a capacity of reforming bone. The maxillary lateral incisors and first premolars and the mandibular second premolars in two monkeys were used in the study. Using metal pins inserted into the neighboring teeth as retainers, orthodontic elastics were stretched and placed alternately around the buccal and lingual surfaces of each experimental tooth in order to produce jiggling forces. After 5 months of continuous jiggling, when bone dehiscences were produced on the buccal aspect of the teeth, the elastics were removed. After repositioning of the teeth a split thickness flap was raised. On one side of the jaw the soft tissue within the bone dehiscences was removed. At the contralateral teeth a sham operation was performed maintaining the soft tissue within the bone dehiscences. The monkeys were sacrificed 6 months after surgery. Tissue blocks containing test and control specimens were dissected free and prepared for microscopic analysis. The length of the supracrestal connective tissue attachment and the amount of coronal bone regeneration were assessed in the histological sections. It was found that buccal alveolar bone, reduced in height by jiggling forces, regenerated after discontinuation of the forces. When the soft tissue within the buccal bone dehiscences produced by the jiggling forces was surgically removed, the coronal regeneration of the alveolar bone was markedly reduced. These observations suggest that bone resorption, induced by jiggling forces, leaves a soft tissue component with a capacity of forming bone.     

Stability of the mucosal topography around single-tooth implants and adjacent teeth: 1-year results

This study evaluated the soft tissue stability around 10 single-tooth implants. All cases were treated following the same protocol, which included guided bone regeneration and connective tissue grafting. One year after prosthesis insertion the soft tissue shrinkage on the buccal side of the implant crown was 0.6 mm on average. The soft tissue volume in the papilla area increased on average by 0.375 mm, and none of the papillae lost volume.     

Recurrent intraoral osseous choristoma. Report of a case

The osseous choristoma of buccal soft tissue (intraoral soft tissue osteoma) is a rare entity that is reported not to recur after removal. A case involving the first documented recurrence of such a lesion is reported, and a review of the literature is presented.     

Localized soft tissue ridge augmentation at phase 2 implant surgery: a case report

A case of congenitally missing maxillary lateral incisors is presented to illustrate a modification of Abrams's roll technique. Buccal releasing incisions are avoided by using an intrasulcular incision on the adjacent teeth. The tissue overlying the cover screw is transferred between the buccal cortical bone and the buccal masticatory mucosa, thus correcting the localized buccal ridge atrophy.     

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目的观察脱细胞真皮基质（ADM）修复颊部软组织缺损的疗效。方法选择2010年11月至2012年11月在安徽医科大学附属口腔医院就诊的颊部软组织缺损患者38例,其中20例应用异种ADM治疗,18例应用异体ADM治疗。随访6个月,观察患者缺损修复治疗效果,并对2种ADM在组织相容性、引导组织再生及补片成活情况等方面进行临床效果评价。结果应用异种ADM修复的患者,修复膜完全成活18例,大部成活2例,修复区表面颜色多为粉红色,质地柔软,瘢痕轻微;应用异体ADM修复的患者,修复膜完全成活17例,1例患者术后补片与创缘边缘有约0.8cm脱离区,补片与基底组织面贴合,补片色泽呈红色,愈合尚可。38例患者均未出现明显局部或全身反应,进食基本不受影响,无明显异物感,张口度未见明显改变。结论异种及异体ADM对颊部软组织缺损的修复效果均较为满意。     

Autotransplantation of Maxillary Third Molar with Its Attached Buccal Cortical Plate Combined with a Connective Tissue Graft

IntroductionTooth replacement often leads to insufficient vertical volume in the recipient socket bone. The aim of this novel report is to present a successful fully guided autotransplantation of a maxillary right third molar (tooth #1) with its attached buccal plate. The procedure was combined with a palatal connective tissue graft to reconstruct a buccal hard and soft tissue defect of an irreparable maxillary right first molar (tooth #3).MethodsA 45-year-old man complaining of pain in tooth #3 came to the clinic. Tooth #3 was non-restorable due to an extensive caries and a vertical root fracture of the mesiobuccal root, leading to a total loss of the buccal cortical plate. Guided autotransplantation of tooth #1 was completed by using 3-dimensional surgical templates for implant burs and a 3-dimensional-printed replica. After positioning the donor tooth, the cortical plate was fixed to the recipient socket with osteosynthesis screws. A connective tissue graft was also harvested to increase the band of keratinized gingiva and the thickness of the buccal soft tissue. At 6-month follow-up, the screws were removed, showing excellent regeneration throughout the buccal area.ResultsAt 3-year follow-up, the transplanted tooth was asymptomatic, with a natural bone level and no signs of replacement or inflammatory root resorption.ConclusionsThe use of a donor tooth and its attached bone cortical plate combined simultaneously with a connective tissue graft appears to improve hard and soft tissues in a single procedure.     

薄龈生物型患者前牙区的即刻种植即刻修复

目的 评估美学区不翻瓣即刻种植即刻修复+软组织增量技术在薄龈生物型患者中的临床应用效果。方法 选择12例薄龈生物型患者,上颌中切牙或侧切牙无法保留,进行不翻瓣即刻种植、即刻修复,4个月后进行软组织移植,再过3个月后完成最终修复。修复后随访1年,观察种植体周围软硬组织情况,统计种植体存留率、种植体唇侧骨板厚度、种植修复体与邻牙唇侧牙龈的协调性和患者主观满意度。结果 在观察期内,所有种植体均获得了良好的骨整合,存留率100%。CBCT测量,3例种植体唇侧骨板厚度大于1.5 mm,9例大于2 mm。10例种植修复体唇侧龈缘位置与邻牙协调无差异,2例轻度差异;全部12例种植修复体与邻牙牙龈颜色质地协调无差异。患者主观满意度VAS平均值为95。结论 不翻瓣即刻种植即刻修复+软组织增量是针对薄龈生物型患者美学区种植的有效技术,能减少美学并发症,获得稳定的美学效果以及很高的患者满意度。     

颊脂垫及其在口腔临床中应用研究进展

颊脂垫是一块位于颊部深层间隙、具有完整包膜的脂肪三角体,也是口腔颌面部解剖中相对容易获取的脂肪组织块。它是一种特殊类型的脂肪组织,具有填充、保护、滑动和缓冲的作用。尽管距离“颊脂垫”的首次描述已经过去200多年,但是外科医生们对其研究从未停止。目前,颊脂垫已普遍应用于口腔软组织缺损的修复,如黏膜缺损、口腔上颌窦瘘、慢性颊瘘、腭裂等,并且取得了令人满意的结果。有关颊脂垫的研究和新的运用也越来越多。文章就颊脂垫及其在口腔临床中应用研究进展做一综述。     

自体牙本质颗粒与Bio-Oss骨粉植入引导骨再生治疗牙周骨缺损效果比较

目的: 评价自体牙本质颗粒与Bio-Oss骨粉植入引导骨再生治疗牙周骨缺损的效果。方法: 选择2018年5月—2020年5月张掖人民医院收治的82例行引导骨再生治疗的牙周骨缺损患者,依照随机数表法分为实验组和对照组,每组41例。对照组植入Bio-Oss骨粉,实验组植入自体牙本质颗粒。比较2组患者牙周袋深度和附着丧失,颊侧软组织剖面、颊侧软组织厚度,红色美学评分,修复成功率及并发症。采用SPSS 22.0软件包对数据进行统计学分析。结果: 术后1个月和术后1年,2组患者牙周袋深度和附着丧失均显著降低（P<0.05）;且术后1年,2组患者牙周袋深度和附着丧失均低于术后1个月（P<0.05）。术后1个月和术后1年,实验组患者牙周袋深度和附着丧失显著低于对照组（P<0.05）。术后1个月和术后1年,2组患者颊侧软组织剖面显著高于术前（P<0.05）;术后1年,2组颊侧软组织剖面显著低于术后1个月（P<0.05）。术后1年,实验组患者颊侧软组织剖面显著高于对照组（P<0.05）。术后1个月和术后1年,2组患者颊侧软组织厚度显著高于术前。各时间点,2组患者颊侧软组织厚度相比,差异无统计学意义（P>0.05）。术后1个月和术后1年,2组患者红色美学评分显著高于术前（P<0.05）;且术后1年2组红色美学评分显著高于术后1个月（P<0.05）。术后1个月和术后1年,实验组患者红色美学评分显著高于对照组（P<0.05）。术后1年,实验组和对照组修复成功率分别为90.24%（37/41）和85.37%（35/41）,2组修复成功率相比,差异无统计学意义（P>0.05）。2组患者并发症发生率无统计学差异（P>0.05）。结论: 自体牙本质颗粒引导骨再生治疗牙周骨缺损患者,能够降低牙周袋深度和附着丧失,提高颊侧软组织剖面和红色美学评分,且修复成功率与Bio-Oss骨粉植入相当,是一种安全可靠的治疗方法。     

Lack of differential effect by Ultracaine (articaine) and Citanest (prilocaine) in infiltration anaesthesia

It has been claimed that anaesthesia of mandibular pulpal and lingual soft tissue, as well as maxillary palatal soft tissue, results following buccal infiltration of the local anaesthetic Ultracaine (articaine HC1). However, this has never been scientifically proven and the aim of this investigation was to test these claims by comparing articaine to a standard anaesthetic, Citanest (prilocaine HC1). In order to study this, a double blind, randomized trial was conducted in healthy adult volunteers. In these subjects, the ability to induce maxillary and mandibular anaesthesia following buccal infiltration with articaine (as compared to prilocaine given contralaterally), was determined by measuring sensation to electrical stimulation at the tooth, buccal and lingual soft tissue at each of the four non-carious, non-restored, second molars. Results showed that there were no statistically significant differences between articaine and prilocaine in their ability to induce anaesthesia for any tissue at any of the six sites (p greater than 0.05) as determined by chi-square analysis. Analysis of effect on sensation for 25 minutes post-administration also failed to demonstrate a difference between the two drugs. Therefore, these data are not consistent with superior anaesthesia efficacy by articaine at any site, including the mandibular pulpal, lingual or maxillary palatal tissues, in the second molars studied.     

颊部岛状皮瓣在口腔软组织缺损修复中的临床应用

目的 应用颊部岛状皮瓣修复口腔肿瘤根治性切除术后软组织缺损,并对其临床效果进行评定。方法 选择2006.07—2011.07口腔癌症患者23例,其中男13例,女10例,全部行病灶根治切除及颈淋巴清扫术,同期应用颊部岛状皮瓣修复舌、口底及其邻近组织缺损,皮瓣面积最大为10.4 cm×5.0 cm,最小为7.5 cm×3.5 cm,供区伤口直接拉拢缝合。术后观察皮瓣的成活、修复区外形及口腔与舌功能的恢复情况。结果 23例皮瓣均完全成活,创口一期愈合,术后外形满意,功能恢复良好,无明显面部畸形。结论 颊部岛状皮瓣是修复口腔内软组织缺损较为理想的组织瓣。     

自制拉钩在涡轮钻拔除下颌阻生智齿中的应用

涡轮钻法因创伤较小已逐渐取代传统的锤凿法在下颌智齿拔除术中得到提倡和应用.但使用涡轮钻时智齿远中和颊侧的软组织易卷入车针或受气流冲击造成损伤,引起术后肿胀、疼痛等并发症.为此,笔者将口腔局部托盘改装成拉钩,与传统的颊部拉钩相比可将涡轮钻与远中、颊侧软组织完全隔离,以保护软组织避免损伤.临床应用取得了较好的效果.     

Biomechanical behavior of oral soft tissues

Background: Little attention has been given to understanding the variation in biomechanical behavior of oral soft tissues, and this represents an obstacle for the development of biomaterials that perform with appropriate biomechanical characteristics. With this as our motivation, a uniaxial mechanical analysis was performed on lingual and buccal aspects of the attached gingiva, alveolar mucosa, and buccal mucosa to gain insight into human tissue performance and site‐specific mechanical variation. Methods: A discrete quantitative mechanical evaluation of each soft tissue region using tensile, dynamic compression, and stress relaxation analysis was conducted to correlate tissue structure with function as assessed histologically. Results: Results confirm the keratinized gingiva to have increased tensile strength (3.94 ± 1.19 MPa) and stiffness (Young modulus of 19.75 ± 6.20 MPa) relative to non‐keratinized mucosal regions, where densely arranged elastin fibers contribute to a tissue with increased viscoelastic properties. Dynamic compression analysis indicated the instantaneous modulus (E_int), steady modulus (E_s), and peak stress increased with loading frequency and strain amplitude, with the highest values found in the buccal attached gingiva. Conclusion: These investigations quantify the biomechanical properties of oral soft tissues and show region‐to‐region variation that details structure–function relationships and provides key parameters to aid development of biomaterials that perform with appropriate biomechanical properties.     

Buccal and coronal bone augmentation using forced eruption and buccal root torque: a case report

The following case report describes the buccal and coronal bone augmentation around an irretrievable tooth using forced eruption and buccal root torque for immediate nonsubmerged implant placement. A mandibular left second premolar with degree 2 mobility, severe buccal bone resorption, and interproximal angular bony defects was subjected to forced eruption and buccal root torque. Five months after this process, the tooth was displaced 15 mm coronally and the root apex faced buccally. Buccal and coronal bone augmentation and soft tissue enlargement were evident at reentry surgery. This technique enabled proper implant placement in a situation where the bone was compromised.     

Histologic evaluation of a threaded hydroxyapatite-coated root-form implant located at a dehisced maxillary site and retrieved from a human subject: a clinical report

This clinical report describes the microscopic analysis of a threaded hydroxyapatite-coated root-form implant retrieved from an 89-year-old subject after 10 months of service. The implant was never loaded and was removed because it was nonrestorable. Clinically, the buccal area of the implant was covered by soft tissue, whereas the palatal side was covered by bone. Light microscopic evaluation revealed tight contact between hydroxyapatite and bone with no sign of coating dissolution. Osteocytes were present, and Haversian canals were in close proximity to the implant surface. The buccal side of the implant demonstrated mild to moderate inflammatory infiltrate and signs of hydroxyapatite coating dissolution. These observations suggest that hydroxyapatite coatings can resist degradation in contact with bone but may be more prone to dissolution in contact with soft tissue.