Reconstructive periodontal therapy with simultaneous ridge augmentation. A clinical and histological case series report

Treatment of intrabony periodontal defects with a combination of a natural bone mineral (NBM) and guided tissue regeneration (GTR) has been shown to promote periodontal regeneration in intrabony defects. In certain clinical situations, the teeth presenting intrabony defects are located at close vicinity of the resorbed alveolar ridge. In these particular cases, it is of clinical interest to simultaneously reconstruct both the intrabony periodontal defect and the resorbed alveolar ridge, thus allowing insertion of endosseous dental implants. The aim of the present study was to present the clinical and histological results obtained with a new surgical technique designed to simultaneously reconstruct the intrabony defect and the adjacently located resorbed alveolar ridge. Eight patients with chronic advanced periodontitis displaying intrabony defects located in the close vicinity of resorbed alveolar ridges were consecutively enrolled in the study. After local anesthesia, mucoperiosteal flaps were raised, the granulation tissue removed, and the roots meticulously scaled and planed. A subepithelial connective tissue graft was harvested from the palate and sutured to the oral flap. The intrabony defect and the adjacent alveolar ridge were filled with a NBM and subsequently covered with a bioresorbable collagen membrane (GTR). At 11–20 months (mean, 13.9 ± 3.9 months) after surgery, implants were placed, core biopsies retrieved, and histologically evaluated. Mean pocket depth reduction measured 3.8 ± 1.7 mm and mean clinical attachment level gain 4.3 ± 2.2 mm, respectively. Reentry revealed in all cases a complete fill of the intrabony component and a mean additional vertical hard tissue gain of 1.8 ± 1.8 mm. The histologic evaluation indicated that most NBM particles were surrounded by bone. Mean new bone and mean graft area measured 17.8 ± 2.8% and 32.1 ± 8.3%, respectively. Within their limits, the present findings indicate that the described surgical approach may be successfully used in certain clinical cases to simultaneously treat intrabony defects and to reconstruct the resorbed alveolar ridge

Healing of donor sites of connective tissue grafts harvested by the single incision technique: A randomized clinical trial evaluating the use of collagen hemostatic sponge with or without sutures

Background: The aim of this study was to evaluate the effect of suturing on the early wound healing of donor sites of subepithelial connective tissue grafts (SCTG), harvested by the single incision technique (SIT), following the application of a collagen sponge. Methods: Thirty-six patientswere randomized to receive a collagen spongewith or without sutures in the palatal donor sites following connective tissue grafting via the SIT. Outcome variables were early healing index (EHI) at 7, 14, and 30 days, self-reported pain using a visual analogue scale (VAS) recorded on the 0 to 100 scale at 7 and 14 days, and immediate and delayed bleeding. Results: No significant differences were found between groups at baseline. EHI index showed no differences between groups in all-time intervals. Eight subjects from suture group (SG) and 10 from no suture group (nSG) showed complete wound closure at day 14 (P >0.05) and at 30 days, complete closure was observed in 35 out of 36 patients. Four subjects from the SG and three from the nSG had immediate bleeding (P >0.05), while delayed bleeding was observed in two subjects from the SG and three from the nSG during the first week of healing (P >0.05). No differences were found in VAS scale between groups (SG, 36.2 ±} 24.8; nSG, 21.5 ±} 24.2, P >0.05). Conclusion: It can be concluded thatwhen a collagen sponge is placed in palatal donor areas of SCTG harvest by means of the SIT (incision length of ≈15 mm), sutured and non-sutured sites display similar earlywound healing outcomes and patient-reported outcomes

Patient experience of autogenous soft tissue grafting has an implication for future treatment: A 10‐ to 15‐year cross‐sectional study

BackgroundPatient- reported outcomes have received a great deal of interest in periodontal plastic procedures. However, their evaluation has mainly been short- term. Thus, the aim of this study was to evaluate the impact of soft tissue grafting procedures conducted over a decade ago on the willingness of a patients to undergo the surgery again.MethodsSubjects that received an autogenous soft tissue graft over 10 years ago were screened and invited for a survey. Their response was only analyzed if they were able to correctly identify the sites of the surgical procedures. Dichotomous questions and visual analogue scales (VASs) were used to assess self- reported pain, willingness to retreat and satisfaction.ResultsFifty- two patients were included in the analyses. Higher pain was reported for mandibular sites, and treated areas including - ¥ 3 teeth (P < 0.01). Willingness to retreatment was 84.6% and it was negatively associated with self- reported pain measures, the arch location (mandible), and number of treated sites (- ¥3 teeth) (P < 0.01). Mean satisfaction rate was 86.9 ± 13.65 (VAS) and showed a positive correlation with willingness to retreat (P < 0.01). Having a complete root coverage at the recall visit was also significantly associated with higher patient satisfaction scores (P < 0.01).ConclusionsPatient experience of previous autogenous soft tissue grafting has an influence on their decision to undergo future treatment. Willingness to retreat was negatively affected by mandibular sites, larger treated areas and the perceived pain, while presenting with complete root coverage was significantly associated with patient satisfaction.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167778/1/jper10653_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167778/2/jper10653.pd