scholarly journals Slow Orthodontic Teeth Extrusion to Enhance Hard and Soft Periodontal Tissue Quality before Implant Positioning in Aesthetic Area

2012 ◽  
Vol 6 (1) ◽  
pp. 137-142 ◽  
Author(s):  
C Maiorana ◽  
S Speroni ◽  
A S Herford ◽  
M Cicciù
Keyword(s):  
Soft Tissue ◽  
Surgical Techniques ◽  
Bone Defects ◽  
Soft Tissue Augmentation ◽  
Radiographic Evaluation ◽  
Tissue Quality ◽  
Implant Positioning ◽  
Awkward Position ◽  
Aesthetic Results ◽  
Immediate Implant

Approaching bone defects of jaws treatments, hard and soft tissue augmentation could be considered as a goal for clinicians when performing dental implant placement. The increase in patients who want cosmetic treatment puts practitioners in an awkward position when choosing the best therapy to obtain the most desirable results. A private dentist referred a young patient to the Department of Implantology in Milan in order to place implants in the upper jaw. Radiographic evaluation of the two upper anterior incisors confirmed that the teeth had a poor prognosis The anterior ridge volume was clinically analyzed and several therapeutic choices were evaluated. Rapid extractions and immediate implant positioning were not considered due to the vertical and horizontal components of the bone defect. Therefore, the surgical team decided on increasing the bone volume by using slow orthodontic teeth extrusion technique. After 3 months of orthodontic treatment, the angular intra-bony defects of 1.1 tooth was completely healed. Implant guided positioning, associated with a small bone graft, showed optimal results at the time of healing screw placement. The soft tissue conditioning was obtained by a provisional acrylic crown. The final application of two integral ceramic crowns showed excellent aesthetic results. Radiographic investigation at a 24 month follow-up confirmed the integration of the dental implants and the recovery of the bone defects. Several safe surgical techniques are available today for reconstructing atrophic jaws. However, the same technique applied on the posterior area did not give the same predictable results as in the anterior areas of the jaw.

scholarly journals Evaluation and Management of Failed Shoulder Instability Surgery

2017 ◽  
Vol 11 (1) ◽  
pp. 897-908 ◽  
Author(s):  
António Cartucho ◽  
Nuno Moura ◽  
Marco Sarmento
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Bone Defects ◽  
Glenoid Bone Loss ◽  
Rotator Cuff Tears ◽  
Bone Block ◽  
Salvage Procedure ◽  
Tissue Quality ◽  
Contact Sports

Background: Failed shoulder instability surgery is mostly considered to be the recurrence of shoulder dislocation but subluxation, painful or non-reliable shoulder are also reasons for patient dissatisfaction and should be considered in the notion. Methods: The authors performed a revision of the literature and online contents on evaluation and management of failed shoulder instability surgery. Results: When we look at the reasons for failure of shoulder instability surgery we point the finger at poor patient selection, technical error and an additional traumatic event. More than 80% of surgical failures, for shoulder instability, are associated with bone loss. Quantification of glenoid bone loss and investigation of an engaging Hill-Sachs lesion are determining facts. Adequate imaging studies are determinant to assess labrum and capsular lesions and to rule out associated pathology as rotator cuff tears. CT-scan is the method of choice to diagnose and quantify bone loss. Arthroscopic soft tissue procedures are indicated in patients with minimal bone loss and no contact sports. Open soft tissue procedures should be performed in patients with small bone defects, with hiperlaxity and practicing contact sports. Soft tissue techniques, as postero-inferior capsular plication and remplissage, may be used in patients with less than 25% of glenoid bone loss and Hill-Sachs lesions. Bone block procedures should be used for glenoid larger bone defects in the presence of an engaging Hill-Sachs lesion or in the presence of poor soft tissue quality. A tricortical iliac crest graft may be used as a primary procedure or as a salvage procedure after failure of a Bristow or a Latarjet procedure. Less frequently, the surgeon has to address the Hill-Sachs lesion. When a 30% loss of humeral head circumference is present a filling graft should be used. Conclusion: Reasons for failure are multifactorial. In order to address this entity, surgeons must correctly identify the causes and tailor the right solution.

scholarly journals Use of Collagen Matrix for Augmentation of the Peri-implant Soft Tissue at the Time of Immediate Implant Placement

2017 ◽  
Vol 18 (5) ◽  
pp. 386-391 ◽  
Author(s):  
Gregor-Georg Zafiropoulos ◽  
Gordon John
Keyword(s):  
Soft Tissue ◽  
Connective Tissue ◽  
Collagen Matrix ◽  
Good Alternative ◽  
Soft Tissue Augmentation ◽  
Implant Placement ◽  
Soft Tissue Thickness ◽  
Group I ◽  
Control Regimen ◽  
Immediate Implant

ABSTRACT Aim The aim of this study was to determine the treatment outcome of the use of a porcine monolayer collagen matrix (mCM) to augment peri-implant soft tissue in conjunction with immediate implant placement as an alternative to patient's own connective tissue. Materials and methods A total of 27 implants were placed immediately in 27 patients (14 males and 13 females, with a mean age of 52.2 years) with simultaneous augmentation of the soft tissue by the use of a mCM. The patients were randomly divided into two groups: Group I: An envelope flap was created and mCM was left coronally uncovered, and group II: A coronally repositioned flap was created and the mCM was covered by the mucosa. Soft-tissue thickness (STTh) was measured at the time of surgery (T0) and 6 months postoperatively (T1) using a customized stent. Cone beam computed tomographies (CBCTs) were taken from 12 representative cases at T1. A stringent plaque control regimen was enforced in all the patients during the 6-month observation period. Results Mean STTh change was similar in both groups (0.7 ± 0.2 and 0.7 ± 0.1 mm in groups I and II respectively). The comparison of STTh between T0 and T1 showed a statistically significant increase of soft tissue in both groups I and II as well as in the total examined population (p<0.001). The STTh change as well as matrix thickness loss were comparable in both groups (p>0.05). The evaluation of the CBCTs did not show any signs of resorption of the buccal bone plate. Conclusion Within the limitations of this study, it could be concluded that the collagen matrix used in conjunction with immediate implant placement leads to an increased thickness of peri-implant soft tissue independent of the flap creation technique and could be an alternative to connective tissue graft. Clinical significance The collagen matrix used seems to be a good alternative to patient's own connective tissue and could be used for the soft tissue augmentation around dental implants. How to cite this article Zafiropoulos GG, John G. Use of Collagen Matrix for Augmentation of the Peri-implant Soft Tissue at the Time of Immediate Implant Placement. J Contemp Dent Pract 2017;18(5):386-391.

scholarly journals Modular Reconstruction Systems – Final Solution for Critical Bone Defects Treatment

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 13
Author(s):  
M. Nica ◽  
R. Ene ◽  
Z. Panti ◽  
M. Popa ◽  
M. Pleniceanu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Mechanical Stability ◽  
Surgical Techniques ◽  
Hip Dislocation ◽  
Functional Results ◽  
Bone Defects ◽  
Implant Design ◽  
Modular Systems ◽  
Critical Bone Defects ◽  
Tissue Attachment

Abstract Introduction. The management of critical bone defects has experienced an unprecedented improvement in the last few decades. A good primary mechanical stability and versatility of the modular reconstruction systems allowed the conversion to universal setups and the expansion of indication. The progression and reliability of the reconstruction possibilities available nowadays are outlined using the experience of our department. Material and method. A retrospective review of critical bone defect cases and the reconstruction management using endoprosthetic systems is presented. Ten reconstruction surgeries performed in the last 18 months in our department were observed. The patients were 3 males and 7 females with a mean age of 45.3 (range 19 to 75). Modular systems were used for the reconstruction of bone defects subsequent to resections of benign or malignant musculoskeletal tumors (76%) and to non-neoplastic conditions (24%). Results. On the latest follow-up, all the patients were alive, with one case of tumoral recurrence. No aseptic loosening, soft tissue or structural failure were recorded following surgery, with one case under treatment for infection after it required an open procedure for a prosthetic hip dislocation. The early functional results were adequate in all cases, with good secondary stability and satisfactory quality of life. Conclusion. The evolution of endoprosthetic reconstruction surgery has improved the prognosis for many patients diagnosed with critical bone defects. Continuous advances in implant design, fixation, and soft tissue attachment combined with the improvement of surgical techniques will ensure a bright future for this type of procedures.

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