A Review of Dental Suturing for Optimal Soft-Tissue Management
Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS
Labial Bone Thickness in Area of Anterior Maxillary Implants Associated with Crestal Labial Soft Tissue Thickness
Soft tissue problems (ie, gingival recessions) are common in implantology and are often associated with thin soft tissue biotypes or buccally placed implants. Goaslind described 2 types of biotypes commonly found in the natural dentition: thick and thin. It has been suggested that thicker soft tissue biotypes are associated with less tissue recession, higher crestal bone levels, and better aesthetics. A thin tissue biotype has been shown to be more prone to tissue recession. Gingival recession is always associated with alveolar bone dehiscences. Furthermore, there is evidence that thick soft tissue may be protective against crestal bone loss (ie, tissue thickness of ,2.5 mm resulted in crestal bone loss of 1.45 mm vs. thicker tissues had 0.26 mm). This protective effect occurred, despite the supracrestal position of the implant-abutment interface.
Soft Tissue Cone-Beam Computed Tomography: A Novel Method for the Measurement of Gingival Tissue and the Dimensions of the Dentogingival Unit
The purpose of the
present study was to develop a soft tissue cone-beam computed tomography (ST-CBCT) to
improve soft tissue image quality and allow the determination of the dimensions and relationships
of the structures of the dentogingival unit. Two separate CBCT scans were obtained from
three patients with different periodontal biotypes. The first was a scan following standard
methods; however, for the ST-CBCT the patients wore a plastic lip retractor and retracted their
tongues toward the floor of their mouths.
The Management of Immediate Implant Placement to Optimize Aesthetic Outcome in the Anterior Maxilla
Following tooth extraction the implant surgeon may select between various implant placement timing and loading protocols. Ideally these are to be determined prior to extraction, be it immediate, early, or late placement. Immediate implant placement even in the aesthetic zone is a literature supported treatment modality with success comparable to alternative placement protocols. Meticulous restorative treatment planning of a tooth destined
for extraction is essential. Selecting the appropriate implant and techniques may preserve and ensure natural aesthetics. Utilizing the patient’s own tooth crown can better provisionalize the implant with a ‘walk out as you walk in’
The Evolving Role of Soft Tissue Enhancement in Esthetic Reconstructive Dentistry
Soft tissue grafting techniques, new regenerative materials and bioactivators will be highlighted. The expanding role of allograft materials (Perioderm), platelet rich in growth factors (PRGF, PRF), and when to utilize them will be suggested. The ability of these combined protocols to alter the soft tissue profile around natural teeth, implants, and dentulous ridges, will be reviewed as to its critical role in "Complete Esthetics".
Functional Gingival Grafts in Anterior Implant Therapy - Part 1 of 2
Dr. Richard Martin outlines his approach to simultaneous gingival grafting following extraction to preserve or enhance the critical labial gingival margins around implant restorations in the esthetic zone.
Papilla Management in a Severe Periodontal and Cosmetic Deformity; The Wedge Palatal Graft Technique
Bone defects and periodontal disease can create challenging defects in the anterior area. When we have such severe defects as the one presented here, it´s essential to plan in advance and to be sure of what is possible to correct with bone grafting and with soft tissue management. The key question in this clinical case is to be able to place the soft tissue graft exactly where you want it to heal. In our clinical practice we use routinely PRGF ENDORET grafts, not only as vehicle for particulate graft transportation, but also as a biological enhancer of both osteointegration and soft tiss
Modern Crown Lengthening: Classification and Clinical Application
Crown lengthening procedures are indicated to provide adequate tooth structure in case of subgingival tooth fracture or caries, uneven gingival level, un-esthetic short crowns due to the tooth wear, inadequate axial height, altered passive eruption ,forced eruption of a single or multiple teeth and finally in case of gingival smile.
The treatment modality for esthetic crown lengthening procedure should be based on detail diagnosis in each case because of the multifactorial etiology and because of the type of therapy selected by the clinician, will have a direct implication for the esthetic result.
Esthetic Zone Reconstruction: Synergy of Hard and Soft Tissue Grafting
The loss of alveolar ridge contour in the esthetic zone compromises both esthetics and function. This clinical presentation will focus on the application of both hard and soft tissue grafting in the esthetic zone implementing state of the art interactive CT diagnosis and treatment planning for optimal esthetic implant reconstruction.
Emphasis will be on indications, graft and harvest site assessment, timing, and use of bioactive modifiers including BMP, PRGF and PDGF. The surgical protocol utilizing allogeneic and autogenous grafts in conjunction with connective tissue grafts, acellular dermis matrix, and related soft tissue procedures to avoid functional and esthetic pitfalls will be featured. Pre and post-grafting prosthetic workup, interactive CT graft assessment and perio prosthetic driven implant planning, stent driven implant placement, and computer milled abutment fabrication including guided surgery will be included.
A Review of Clinical Applications for Soft Tissue Allografts & Autografts: Solutions for Teeth, Implants, and Dentures
The presentation focuses on the clinical applications for acellular dermal graft (ADG) materials. ADGs have been commonly presented and discussed to provide solutions for treating gingival recession. Compared to autogenous grafts, they have the advantage of minimizing pain, discomfort, and surgery time for patients by avoiding an intraoral donor site such as the palate. In addition to treating gingival recession, ADGs also have uses in bone grafting surgeries such as socket grafting and ridge augmentations (GBR) when they are utilized as a barrier membrane. Finally, ADGs can be combined with bone grafting materials to aid in the augmentation of edentulous ridges to aid denture support. While this last application is less common, it's use is worthy of discussion.
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