Histological Features and Biocompatibility of Bone and Soft Tissue Substitutes in the Atrophic Alveolar Ridge Reconstruction

The reconstruction of the atrophic alveolar ridges for implant placement is today a common procedure in dentistry daily practice. The surgical reconstruction provides for the optimization of the supporting bone for the implants and a restoration of the amount of keratinized gingiva for esthetic and functional reasons. In the past, tissue regeneration has been performed with autogenous bone and free gingival or connective tissue grafts. Nowadays, bone substitutes and specific collagen matrix allow for a complete restoration of the atrophic ridge without invasive harvesting procedures. A maxillary reconstruction of an atrophic ridge by means of tissue substitutes and its histological features are then presented

Protein-Signaled Guided Bone Regeneration Using Titanium Mesh and Rh-BMP2 in Oral Surgery: A Case Report Involving Left Mandibular Reconstruction after Tumor Resection

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is an osteoinductive protein approved for use in oral and maxillofacial defect reconstruction. Growth factors act as mediators of cellular growth on morphogenesis and mythogenesis phases. Utilized as recombinant proteins, these growth factors need the presence of local target cells capable of obtaining the required results. This cell population may be present at the wound site or added to scaffolding material before implantation at the surgical site

The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillofacial trauma

In recent years, recombinant human bone morphogenetic protein-2 (rhBMP-2) has been introduced as a therapeutic option in the treatment of several congenital and acquired craniofacial defects. Although there have been promising clinical results, the international literature still lacks complete guidelines, including limits and indications for the use of rhBMP-2. The possible indications for rhBMP-2 in patients undergoing facial trauma are discussed in this article

Vascularized connective tissue flap for bone graft coverage

Alveolar defects are characterized by missing soft and hard tissues. It is often necessary to combine secondary procedures to address the soft-tissue component. The authors describe a technique that uses a split-thickness flap design that is placed over the crest of the remaining ridge and extends in a palatal direction. This allows advancement of the flap with its exposed connective tissue over the bone graft and provides restoration of both bone and keratinized tissue. Seventeen patients with defects involving the anterior maxilla who required grafting procedures were including in this study. All patients had an autogenous bone graft (n \u200a=\u200a 17) combined with osseointegrated implants (n \u200a=\u200a 41). A split-thickness flap design was used at the time of bone graft placement (primary) in 9 patients and at the time of implant uncovering (secondary) in 8 patients. There were no cases of flap necrosis or dehiscence with exposure of the bone graft. All patients demonstrated an increase in keratinized tissue involving the peri-implant area. An apical repositioned split-thickness flap provides an increased zone of keratinized tissue with improved esthetics and implant maintenance. This technique can be performed simultaneously with the grafting procedure, thus avoiding extensive undermining of the adjacent soft tissue

Slow orthodontic teeth extrusion to enhance hard and soft peridontal tissue quality before implant positioning in esthethic area

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

Use of a porcine collagen matrix as an alternative to autogenous tissue for grafting oral soft tissue defects

Purpose: Soft tissue grafting is often required to correct intraoral mucosal deficiencies. Autogenous grafts have disadvantages including an additional harvest site with its associated pain and morbidity and, sometimes, poor quality and limited amount of the graft. Porcine collagen matrices have the potential to be helpful for grafting of soft tissue defects. Patients and Methods: Thirty consecutive patients underwent intraoral grafting to re-create missing soft tissue. Defects ranged in size from 50 to 900 mm2. Porcine collagen matrices were used to reconstruct missing tissue. Indications included preprosthetic (22), followed by tumor removal (5), trauma (2), and release of cheek ankylosis (1). Results: The primary efficacy parameters evaluated were the degree of lateral and/or alveolar extension and the evaluation of re-epithelialization and shrinkage of the grafted area. Overall, the percentage of shrinkage of the graft was 14% (range, 5%-20%). The amount of soft tissue extension averaged 3.4 mm (range, 2-10 mm). The secondary efficacy parameters included hemostatic effect, pain evaluation, pain and discomfort, and clinical evaluation of the grafted site. All patients reported minimal pain and swelling associated with the grafted area. No infections were noted. Conclusion: This porcine collagen matrix provides a biocompatible surgical material as an alternative to an autogenous transplant, thus obviating the need to harvest soft tissue autogenous grafts from other areas of the oral cavity

Clinical investigation of rhBMP-2 and simultaneous dental implants placement: Preliminary results

Background. Rebuilding atrophied alveolar ridges can present a significant challenge. There is a multitude of treatment options including guided bone regeneration, onlay block grafting, and distraction osteogenesis. Positioning of dental implants can be placed in an immediate or delayed fashion. An advantage of placing implants immediately is that the patient’s treatment course is shortened as well as the potential for maintaining soft tissue is present. Methods. The recent FDA approval of recombinant human bone morphogenic protein (rhBMP-2) has given clinicians an added treatment option for reconstructing localized alveolar defects. Several patients have been treated with dental implant and rhBMP-2 and the results were recorded by clinical and radiological exams. Results. The potential to reconstruct these challenging defects with a growth factor thus limiting or even avoiding a secondary harvest site is exciting. We describe our experience with the use of implants and bone morphogenic protein together. This study presents excellent results about the combination of using dental implants and growth factor for treating substantial bone defects. Conclusion. Our goal was to clinically evaluate the potential of a purpose designed titanium porous-oxide dental implant surface combined with rhBMP-2

Tissue fluorescence imaging (VELscope) for quick non-invasive diagnosis in oral pathology

Oral squamous cell carcinoma is the most common form of malignancy of the oral cavity; its incidence is increasing and latestage presentation is common. It is usually predated by oral premalignant disorders. For this reason, early diagnosis is fundamental to reduce the malignant transformation of oral premalignant disorders and for increase the survival rate for oral cancer. Scraping the surface of the lesion is useful for having cytological features of the investigated tissue. The features of smears of oral premalignant lesions are the keratinization growth (red, orange, brown), the increased nuclear area and so the nuclear hyperchromatism, the nuclear pleomorphism, and the chromatin clumping. All those features are essential for doing the right diagnosis. However, the oral disease should be recognized at the first view by the clinical investigation without touching the lesions avoiding possible alteration in the cells of the tissue. The current standard of incisional biopsy with histology is painful for patients and involves a delay, although histology is completed. The aim of this article is to evaluate the effectiveness of other available tests that are unobtrusive and provide immediate results like the tissue fluorescence imaging.Oral squamous cell carcinoma is the most common form of malignancy of the oral cavity; its incidence is increasing and late-stage presentation is common. It is usually predated by oral premalignant disorders. For this reason, early diagnosis is fundamental to reduce the malignant transformation of oral premalignant disorders and for increase the survival rate for oral cancer. Scraping the surface of the lesion is useful for having cytological features of the investigated tissue. The features of smears of oral premalignant lesions are the keratinization growth (red, orange, brown), the increased nuclear area and so the nuclear hyperchromatism, the nuclear pleomorphism, and the chromatin clumping. All those features are essential for doing the right diagnosis. However, the oral disease should be recognized at the first view by the clinical investigation without touching the lesions avoiding possible alteration in the cells of the tissue. The current standard of incisional biopsy with histology is painful for patients and involves a delay, although histology is completed. The aim of this article is to evaluate the effectiveness of other available tests that are unobtrusive and provide immediate results like the tissue fluorescence imaging