Use of a Partial-thickness Flap for Guided Bone Regeneration in the Upper Jaw (original) (raw)
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Journal of Periodontology, 2010
Background: Premature membrane exposure for guided bone regeneration may result in complications, such as inadequate bone regeneration, inflammatory reactions, and wound infection. This paper presents a clinical case of a novel incision‐flap design used to advance the flap to enhance tension‐free primary closure for the vertical ridge augmentation.Methods: A 61‐year‐old white man presented with the chief complaint of wanting to replace his posterior mandibular teeth. A severe alveolar bone deformity vertically and horizontally (Seibert Class III) was noticed, especially over the mental foramen area. A staged guided bone regeneration procedure prior to the implant installation was chosen as the most optimal treatment. A partial‐thickness flap, separating the mucosal flap from the periosteum overlying the alveolar bone, was used to advance the flap.Results: During the healing period, neither soft tissue dehiscence nor membrane exposure were noted. Clinical and radiographic evaluation ...
Use of acellular collagen matrix for the closure of the open oral wound in bone regeneration
Journal of Stomatology, Oral and Maxillofacial Surgery, 2018
Mucograft is collagen matrix was designed for use in open healing situations due to its compact outer layer. The technique presented in this article is an attempt to avail this attribute for covering open oral wound in guided bone regeneration (GBR) procedure. The essential idea of this technique is to avoid scoring of periosteum, submucosa and muscle layer for buccal flap advancement. Therefore, we used mucograft to cover bone substitute and barrier membrane in GBR surgical procedure. Thus, we avoided periostal-releasing incisions (PRI) and gained reposition of the flap to original level without impairing the attached keratinized gingiva. Buccal flap advancement in situations of shallow vestibulum, shortly attached gingiva and strong muscle pull may reduce or eliminate attached gingiva with an adverse effect on extended survival of placed implants. This technique promises to be beneficial for the preservation of the soft tissue around dental implants after GBR procedure.
2021
The outcomes of anterior implant restorations are governed by the position and stability of the implant, the contours of the soft tissue and the type of final restoration. Flap design plays a crucial role for the success of guided bone regeneration procedures at the time of implant placement. In this case report two patients were treated for single tooth replacement in the aesthetic zone by means of an implant supported prosthesis. Treatment included a crestal incision followed by a trapezoidal flap elevation in one patient and triangular flap elevation in the other patient. Clinical and radiographic assessment using CBCT of both the subjects confirmed a deficiency of labial plate; thereby requiring guided bone regeneration at the time of implant placement. Screw-retained provisional restoration was used to achieve a desirable emergence profile, followed by placement of a cemented crown six months thereafter. Patients were clinically and radiographically re-examined after intervals ...
Microsurgical Reconstruction of the Jaw With Fibular Grafts and Implants
Journal of Craniofacial Surgery, 2009
Reconstructive treatments for jaw defects are complex procedures that can combine multiple techniques including fibula free flap (FFF) grafting. The purpose of this retrospective study was to document and share our experience on mandibular and maxillar reconstruction with FFF followed by secondary dental rehabilitation using implant insertion. We reviewed 198 patients treated by FFF grafting for mandibular and/or maxillary defects in our department during the past 11 years (1996Y2007). A selection of 30 patients (18 males and 12 females, mean age of 46 y) with adequate criteria (hygiene, motivation, and prognosis) received secondary placement of osseointegrated implants. The implant success was clinically and radiographically evaluated. A total of 105 osseointegrated implants were placed in the grafted fibulas 5 months to 3 years after the reconstruction surgery. Only 4 implants were lost because of peri-implantitis (3 patients) and fibular fracture (1 patient); this corresponds to a 96.2% implant success rate. During the mean follow-up of 76 months, patient's satisfaction and functional and aesthetic results were evaluated. Radiologic findings indicated a low crest resorption around the implants despite an unfavorable crown-to-root ratio. The main difficulties in the reconstructions were lack of FFF height, absence of a vestibular groove, limitation of mouth opening, skin paddle thickness, and the reconstruction of surrounding tissues including the lip. Our management strategy is discussed. Prosthetic choice is fundamental to achieving patient-specific solutions. The prostheses used included sealed or screwed bridge, resin-bonded bridge, tooled bar, implant-borne denture, or implantstabilized dentures. Dental implants may be used even in situations involving an unfavorable crown-to-root ratio and implant position by using milled bar and overdenture. The FFF provides a consistent bone graft that allows a reliable and predictable restoration with dental implants, leading to a satisfactory functional and aesthetic restoration.
Research Reports in Oral and Maxillofacial Surgery, 2020
Objectives: To evaluate of the effectiveness of rehabilitation in patients following mandibulectomy and free fibula flap reconstruction with further endosteal implants. The patient cohort consisted of 27 patients years (14 males and 13 females) with lower jaw defects due to resection for tumors, were reconstructed with fibula-free flaps in a 6-year period (2015-2020). All patients underwent a thorough clinical laboratory, radiological examination according to a generally accepted scheme. Patients were evaluated by preoperative and postoperative outcome using computed tomography scan evaluation. The surgical procedure included: Segmentar resection of the lower jaw, reconstruction with fibula free flap. The implants were evaluated with measures of Resonance Frequency Analysis (RFA) during the follow-up periods using Osstell Mentor at time of implant placement, after 3 months. The mean RFA recordings of all 134 implants were 65 ISQ at implant placement respectively 73 ISQ after 3 months. After 4-6 months of healing, 152 dental implants were placed in non-irradiated fibular bone. Dental prosthetic rehabilitation was performed after 3-4 months of submerged healing. Patients had received implant-bridge and hybrid denture that provided ideal facial balance and occlusion. Postoperative clinical and radiographic controls were made regularly, the criteria for implant success were assessed. With dynamic observation, clinical and radiological indices were stable, of the 152 implants installed, 2 failed to osseointegrate and 5 after years of loading (peri-implantitis). Success rate of implants 5 years after was 96.1%. Conclusion: The reconstruction of the lower jaw defects after ablation of tumors with fibular flaps is a reliable method with good long-term results. In all 27 patients, fibula flaps provided adequate bone stock for implant placement. Implants placed in the reconstructed areas were demonstrated to integrate normally. The results showed that implant treatment is effective to improve patients' masticatory efficiency and an acceptable quality of life to the patient.
Jaw bone regeneration in relation to position of dental implant
2015
Jaw bone regeneration in relation to position of dental implant Nawakamon Suriyan, Sirichai Kiattavorncharoen, Kiatanant Boonsiriseth, Dutmanee Seriwatanachai, Koravit Somkid, Raweewan Arayasantiparb, Lertrit Sirinnaphakorn, Dusit Sujirarat, Natthamet Wongsirichat Nawakamon Suriyan, Sirichai Kiattavorncharoen, Kiatanant Boonsiriseth, Dutmanee Seriwatanachai, Koravit Somkid, Raweewan Arayasantiparb, Lertrit Sirinnaphakorn, Dusit Sujirarat, Natthamet Wongsirichat 1 Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Email: nawakamons@hotmail.com 2 Oral Maxillofacial Surgery Department Faculty of Dentistry Mahidol University Email: sirichai.kia@mahidol.ac.th 3 Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University e-mail address: kiatanant.boo@mahidol.ac.th, 4 Department of Oral Biology, Faculty of Dentistry, Mahidol University, Email: dutmanee.ser@mahidol.ac.th 5 Department of Medical Science, Ministry of Public Health, B...
Implant Dentistry, 2017
To systematically review the effect and type of bone graft and guided bone regeneration around immediate implants on hard and soft tissue changes. Methods: Three electronic databases were searched up to June 2015. Outcomes consisted of hard and soft tissue dimensional changes. Results: Eight studies were included according to inclusion criteria. Immediate implants with bone grafting had superior soft tissue stability and preserved horizontal ridge dimension and buccal plate thickness, when compared to no grafting. The use of a barrier alone significantly decreased buccal plate resorption and the remaining defects around the implants, and the use of both bone graft and membrane aided in soft tissue preservation. The optimal type of bone graft material was a combination of cortical autogenous and synthetic particulate when compared to each separately, whereas no difference was found between demineralized allograft and hydroxyapatite in decreasing bone loss. Conclusions: Quantitative data analysis was not possible due to heterogeneity of the included studies. Further randomized clinical trials with homogenous samples and proper controls are needed to support the results of this report.
BMC Oral Health, 2023
Objectives To analyze morphological, volumetric, and linear hard tissue changes following horizontal ridge augmentation using a three-dimensional radiographic method. Methods As part of a larger ongoing prospective study, 10 lower lateral surgical sites were selected for evaluation. Horizontal ridge deficiencies were treated with guided bone regeneration (GBR) using a split-thickness flap design and a resorbable collagen barrier membrane. Following the segmentation of baseline and 6-month follow-up conebeam computed tomography scans, volumetric, linear, and morphological hard tissue changes and the efficacy of the augmentation were assessed (expressed by the volume-to-surface ratio). Results Volumetric hard tissue gain averaged 605.32 ± 380.68 mm 3. An average of 238.48 ± 127.82 mm 3 hard tissue loss was also detected at the lingual aspect of the surgical area. Horizontal hard tissue gain averaged 3.00 ± 1.45 mm. Midcrestal vertical hard tissue loss averaged 1.18 ± 0.81 mm. The volume-to-surface ratio averaged 1.19 ± 0.52 mm 3 / mm 2. The three-dimensional analysis showed slight lingual or crestal hard tissue resorption in all cases. In certain instances, the greatest extent of hard tissue gain was observed 2-3 mm apical to the initial level of the marginal crest. Conclusions With the applied method, previously unreported aspects of hard tissue changes following horizontal GBR could be examined. Midcrestal bone resorption was demonstrated, most likely caused by increased osteoclast activity following the elevation of the periosteum. The volume-to-surface ratio expressed the efficacy of the procedure independent of the size of the surgical area.
Clinical Implant Dentistry and Related Research, 2020
ObjectivesTo compare Double Flap Incision (DF), Coronally Advanced Lingual Flap (CALF), and Modified Periosteal Releasing Incision (MPRI) to Periosteal Releasing Incision (PRI) in flap advancement, postoperative complications in augmentation using titanium mesh.Material and methodsForty patients with partially edentulous posterior mandibles were randomly assigned to the four groups. We evaluated: (a) Flap advancement in mm (Primary outcome). (b) Pain using the Numerical Rating scale (NRS). (c) Swelling using the Visual Analogue Scale (VAS). (d) Exposure in mm and exposure percentage at 1 week to 6 months.ResultsThe CALF showed the highest mean flap advancement of 19.9 (±5.0) mm while the PRI showed the lowest; 10.2 (±1.7) mm. The difference between groups was statistically significant (P value <.0001). MPRI showed the highest pain score of 5.3 (±1.3) while the DF showed the lowest; 2.39 (±1.7). Swelling did not show a significant difference between groups. MPRI showed the highest...