Periimplant soft tissues management in case of deficiency of thickness and width of keratinized tissue at the stage of dental implants uncovering. Clinical case

Introduction. Mucogingival surgery in the case of keratinized soft tissue deficiency is indicated to optimize the volume of the peri-implant soft tissue to reduce the risk of further complications (peri-implantitis, mucositis, peri-implant recession). A number of surgical methods for peri-implant soft tissue management are proposed, which makes it difficult to choose the optimal one for specific clinical situations. Aim of the study. Evaluation of surgical methods for peri-implant soft tissue management. Methods and materials. Clinical case presentation, patient F / 39 year old was rehabilitated with an implant-prosthetic in the dental clinic "Omni Dent" in the period 2021-2022. The patient had a deficiency of width of the keratinized soft tissue (LGK) as well as the thickness of the keratinized soft tissue (GGK). The stage of mucogingival surgery was decided to be performed after implant osseointegration. At the stage of uncovering the implants 14, 15, 24, 36, 3 mucogingival surgical methods were used: 1) at the level of the implants 14, 15 the apical positioned flap technique; 2) at the level of the implant 25 the pouch roll technique; 3) at the level of the implant 36, the free gingival graft from the palate. Study criteria: keratinized soft tissue width, thickness, trauma morbidity, complications. Dynamic monitoring 2-14 days, one month and 3 months - postoperatively. Results. The patient was monitored postoperatively in dynamics to evaluate 3 methods performed simultaneously comparing them according to the proposed criteria. Method 1: preoperative LGK - 3 mm, postoperative LGK - 6 mm; GGK pre- 1.5 mm, GGK post- 3 mm; moderate edema; moderate pain; difficult and long time to perform. Method 2 LGK pre- 4 mm, LGK post- 7 mm; GGK pre-2 mm, GGK post-4 mm; edema, insignificant pain; simple and short time to perform. Method 3 LGK pre- 3 mm, LGK post- 8 mm; GGK pre-2 mm, GGK post-4 mm; moderate edema; moderate pain in the donor and recipient area; difficult and long time to perform. Postoperative complications were not present. The choice of methods used in the study should be based on the analysis of several criteria and individualized to the clinical case despite the advantages and disadvantages. Conclusion. The technique of rotating flap (method 2) proved to be the method with the best results according to the established criteria, being followed by the technique of free gingival grafting from the palate (method 3), a good result but with more sacrifice. The last method with the apical positioned flap (method 1) did not show high efficiency obtaining minimum thickness difficult work and long time to perform, it is a method that requires a higher training and precision to perform

Reabilitarea protetică fixă a edentatului total cu utilizarea implanturilor zigomatice

Catedra de stomatologie ortopedică „Ilarion Postolachi”, Catedra de chirurgie OMF şi implantologie orală „Arsenie Guţan”, Catedra de odontologie, paradontologie și patologie orală; USMF „Nicolae Testemiţanu”, Clinica „Emilian Coțaga”, IMSP Institutul Mamei și Copilului, Clinică stomatologică „Omni Dent”Background. Treatment of the full edentulous patients with severe atrophy is complex a problem for implant-prosthetic rehabilitation. The zygoma implants have been proposed to solve this problem. However, this complex method requires a detailed clinical study. Objective of the study. Evaluation of rehabilitation peculiarities of full edentulous patients with severe bone atrophy using zygomatic implants. Material and Methods. Eleven patients were included in the study (1 man and 10 women), aged between 47-65 years old (mean age 58.5 years), diagnosed with complete edentulism class III by Schroder, associated with severe bone atrophy. Patients were rehabilitated using Zygoma implants. Evaluation criteria: fixed morphological, functional and esthetical rehabilitation, comfort, rehabilitation time. Results. The primary stability was 30-35 N/cm in all cases which was enough for immediate implant loading with provisional fixed acrylic denture. Seven patients were evaluated 6 months after loading paying attention to soft periimplant tissue, contour and configuration of dental arches, position of lips and checks. Functional, esthetical, and hygienic conditions were also evaluated. These patients also received permanent prostheses: PFM (4), metal-composite (3). Five patients had satisfactory lip support with the fixed dentures, however, in two cases the overdenture would have been a better option. Conclusion. Implant-prosthetic rehabilitation of full edentulous patients with severe atrophy using zygoma implants provide a functional and esthetical comfort helping people to re-integrate into society. Despite that this method helps to avoid bone grafting but it requires a continuous study.Introducere. Tratamentul pacienților edentați total cu atrofie severă reprezintă o problemă complexă în reabilitarea implanto-protetică, iar pentru soluționarea impedimentelor posibile au fost propuse implanturile zigomatice. Complexitatea acestei metode necesită un studiu clinic detaliat. Scopul lucrării. Evaluarea particularităților reabilitării implanto-protetice a pacienților edentați cu atrofie severă, cu proteze fixe pe implanturi zigomatice. Material și Metode. Studiul a cuprins 11 pacienți (1 bărbat și 10 femei), cu vârsta între 47-65 de ani (vârsta medie – 58,5 ani), diagnosticați cu edentații totale, atrofii severe maxilare clasa III Schroder, reabilitați implanto-protetic, cu utilizarea implanturilor zigomatice. Criterii de evaluare: reabilitarea morfo-funcțională și estetică fixă, confortul, timpul de reabilitare. Rezultate. În toate cazurile stabilitate primară a fost de 30-35 N/cm postimplantar, oferind posibilitatea încărcării imediate cu proteză acrilică provizorie fixă. La 7 pacienți, după 6 luni de încărcare, s-a evaluat starea țesuturilor, conturul și configurația arcadelor dentare, a buzelor şi a obrajilor; aspectul funcțional și estetic şi condițiile de menținere a igienei orale. Reabilitarea la acești pacienți s-a efectuat cu lucrări protetice fixe definitive: metalo-ceramice (4) și metalo-compozite (3). La 5 dintre ei am obținut un suport al buzei consistent cu susținerea conturului feței, la 2 soluția unei proteze mobilizabile (overdenture) pe bară ar fi oferit un rezultat mai desăvârșit. Concluzii. Reabilitarea implanto-protetică fixă cu sprijin implantar zigomatic asigură confortul estetic, funcțional și de reintegrare socială a pacienților edentați cu atrofii severe, evitând procedurile extinse de grefări osoase, însă limitele indicate mai necesită un studiu continuu

EARLY ODONTECTOMY IN CASE OF BIFURCATION CYSTIC GRANULOMA AND IMPLANT-PROSTHETIC REHABILITATION WITH IMMEDIATE LOADING. CLINICAL CASE

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Formațiunile chistice periradiculare crescând formează defecte osoase masive, împiedicând reabilitarea implanto-protetică. Cauzate de perforații camerei pulpare nu se supun tratamentului conservativ. Pentru a anticipa dezvoltarea volumetrică poate fi recomandată înlăturarea lor prin odontectomie precoce. Scopul. Evaluarea țesuturilor postextracționale și justificarea intervenției radicale preventive în absența simptomelor clinici cu scopul creării condițiilor pentru tratamentul implantar. Aprecierea valorii adăugate a KP-3LM și A-PRF. Argumentarea implantării amânate în favoarea predictibilității. Materiale și metode. La pacientul B/38 radiologic s-a depistat prezența unui chistogranulom interradicular la d36 de apr. 3×9mm. S-a decis înlăturarea lui prin odontectomie, augmentare cu KP-3LM și A-PRF. Pentru asigurarea condițiilor aseptice s-a recurs la implantare peste 4 luni cu instalarea coroanei provizorii. Cea definitivă din Zr - peste 1 lună. Rezultate. Postextracțional lățimea procesului alveolar a scăzut cu 1,24mm, înălțimea - cu 1mm. Torque-ul la înserarea implantului ˃35 Nm. Coroana provizorie a permis recrearea papilelor interdentare și a spațiului biologic ˃3mm, a preîntâmpinat migrarea dinților adiacenți, ceea ce a permis instalarea coroanei din Zr în condiții satisfăcătoare. Reabilitarea estetică și funcțională a durat 5 luni, a decurs fără complicații, cu o satisfacție deplină a pacientului. Concluzii. În cazul formațiunilor chistice în regiunea bifurcației este indicată înlăturarea lor prin odontectomie anticipând complicațiile și creând condițiile favorabile pentru o eventuală reabilitare implanto-protetică. Folosirea a KP-3LM și A-PRF sporește viteza de vindecare și calitatea țesutului osos, preîntâmpină resorbția masivă postextracțională. Timpul necesar pentru vindecare mai lung în comparație cu implantarea imediată este acceptabil ținând cont de avantajele generale.Background. Growing periradicular cystic formations form massive bone defects, impeding implant-prosthetic rehabilitation. Caused by the pulp chamber perforation do not undergo conservative treatment. To anticipate the volumetric development, their removal by early odontectomy can be recommended. Objectives. Evaluation of postextraction tissues and justification of preventive radical intervention in the absence of clinical symptoms with the aim to create conditions for implant treatment. Assessing the added value of KP-3LM and A-PRF. Argumentation for delayed implantation in favor of predictability. Material and methods. In patient B/38 was detected radiologically the presence of an interradicular cystogranuloma at d36 of approx. 3×9mm. It was decided to remove it by odontectomy, augmentation with KP-3LM and A-PRF. To ensure aseptic conditions, implantation was delayed to over 4 months with the installation of the provisional crown. Definitive Zr crown was delivered over 1 month. Results. In postextraction period the width of the alveolar process decreased by 1,24mm, the height - by 1mm. The implant insertion torque ˃35 Nm. The provisional crown allowed the recreation of the interdental papillae and the biological space ˃3mm, prevented the migration of the adjacent teeth, which allowed the installation of the Zr crown in satisfactory conditions. Aesthetic and functional rehabilitation lasted 5 months, proceeded without complications, with full patient satisfaction. Conclusions. In case of cystic formations in bifurcation area, their removal by odontectomy should be considered, anticipating complications and creating favorable conditions for an implant-prosthetic rehabilitation. The use of KP-3LM and A-PRF increases the healing speed and quality of bone tissue, prevents massive post-extraction resorption. The longer healing time compared to immediate implantation is acceptable considering the overall advantages

Managementul țesuturilor moi periimplantare

Background. The absence of sufficient width and thickness of keratinized gingiva creates conditions for development of microbial flora with appearance of peri-implantitis. At the 2nd stage of implants surgery the intervention are performed on the mucogingival tissues in order to avoid further complications. Objective of the study. Assessment of the condition of soft peri-implant tissue and prove evidence of surgical interventions on the mucogingival substrate at the 2nd stage of implant surgery. Material and Methods. The study contains seven women with age between 24-64 years with medium of 43,23 years. The methods used: The vestibuloplasty, in combination with free gingival graftFGG on four patients; subepithelial graft on two of them and FGG on one patient, in sum were performed 22 implants. The data obtained from the clinic and radiologic research’s were operated in the programs: Sidexis 4.2 and Excel. Results. The medium height of the pre-operatively gum - 2,28mm, postoperatively- 6,28mm; medium thickness of the pre-operatively-1,14mm, post-operatively 3,28mm; buccal vestibule with the medium depth of pre-operatively - 2,4 mm post-operatively - 5,14mm. Donor zone: rough palatal 6 cases, tuberosity 1 case. Complications were not discovered in neither of cases. The displaying of the implants in 4 cases was followed by a surgery on the mucogingival substrate and in another 3 cases was performed delayed. Conclusion. At the 2nd stage of implant surgery, interventions at mucogingival substrate are indicated in order to obtain a morphofunctional and aesthetic long term results. Introducere. Absența lățimii și grosimii suficiente de gingie keratinizată, creează condiții benefice pentru multiplicarea florii microbiene cu apariția periimplatitei. La descoperirea implanturilor sunt efectuate intervenții chirurgicale asupra substratului muco-gingival pentru a reduce complicațiile ulterioare. Scopul lucrării. Evaluarea stării țesuturilor moi periimplantare și justificarea intervențiilor chirurgicale asupra suportului muco-gingival la etapa de descoperire a implanturilor. Material și Metode. Studiul a cuprins 7 femei cu vârsta 24-64 ani, cu media 43,23 ani. S-au utilizat metodele: vestibuloplastie cu grefă gingivală liberă la 4 paciente; grefă subepitelială la 2 și grefă gingivală liberă la o pacientă, efectuate în total 22 de implanturi. Datele obținute din măsurările clinice și radiologice au fost prelucrate în programele Sidexis4.2 și Microsoft Excel. Rezultate. Lățimea medie a gingiei preoperator- 2,28mm, post-operator- 6,28mm; grosimea medie pre-operator-1,14mm, post-operator 3,28mm; vestibulul bucal cu adâncimea medie pre-operator de 2,4 mm post-operator- 5,14mm. Zona donor: palatul dur 6 cazuri, tuberozitate 1 caz. Complicații nu au fost determinate nici într-un caz. Descoperirea implanturilor în 4 cazuri a fost însoțită de operația asupra substratului muco-gingival, iar în alte 3 cazuri s-a efectuat amânat. Concluzii. Intervențiile chirurgicale la etapa de descoperire a implanturilor în cazul insuficienței suportului muco-gingival sunt indicate pentru obținerea unui rezultat morfofuncțional și estetic de durată

Implant-prosthetic rehabilitation of edentulous patients with angulated implants

Introduction. The edentulous prosthetic field with severe atrophy creates impediments to the desired surgical and prosthetic treatment. To overcome these shortcomings, the Fast and Fixed method of implantprosthetic rehabilitation was proposed, which uses the available bone substrate for the insertion of implants in the anterior maxillary sectors and the possibility of their immediate loading with fixed temporary dentures, later replaced by permanent ones. The multitude of clinical situations still makes it difficult to choose this method. Aim of the study. Evaluation of the particularities in implant-prosthetic rehabilitation of edentulous patients by the Fast and Fixed method. Methods and materials. The study included 37 patients (21 men and 16 women), aged 35-73 in the period 2017-2020 with a diagnosis of total edentulous or potential edentulous total uni or bimaxillary with severe atrophies in the lateral areas. 216 Sky Bredent implants have been inserted. The temporary fixed dentures were later replaced with permanent fixed prostheses with implant support by the Fast and Fixed method. Evaluation criteria: fixed morpho-functional and aesthetic rehabilitation, comfort, rehabilitation time. Results. In 32 cases the primary stability was ≥35 N/cm postimplantation offering the possibility of immediate loading with fixed temporary acrylic dentures. Patients presented at regular follow-up visits. The surgical stage took place without any peculiarities. During the osseointegration period, 4 temporary prosthesis fractured after 3 months, being immediately reconditioned. After 6 months of osseointegration, the patients were evaluated: the condition of the tissues, the contour and configuration of the dental arches, cheeks, lips; functional and aesthetic aspect; the conditions for maintaining oral hygiene, and patients who did not wear temporary dentures underwent second surgical stage. The rehabilitation of all patients was performed with definitive fixed prosthetic constructions: metal-ceramic (26) and metal-composite (17), bimaxillary being rehabilitated 6 patients. At 1 year after loading, 5 patients had tartar deposits on the surface of the final works, at 2 years the fracture of the ceramic plywood was det Conclusion. Fixed implant-prosthetic rehabilitation by the Fast and Fixed method is a viable solution for edentulous patients with bone deficiency in the lateral maxillary areas demonstrated according to the evaluated criteria. The indications for the use of the method as well as the long-term estimation require continuous study

Clinical case = crearea grosimii și lățimii gingiei keratinizate periimplantare, la maxilarul superior, la etapa de descoperire a implantelor. Caz clinic

Catedra de chirurgie OMF şi implantologie orală „Arsenie Guţan”, Catedra de stomatologie ortopedică „Ilarion Postolachi”, USMF „Nicolae Testemiţanu”, Clinica „Emilian Coțaga”, IMSP Institutul Mamei și Copilului, Clinică stomatologică „Omni Dent”Background. The absence of sufficient width and thickness of keratinized soft tissue can cause periimplantitis. At the stage of implant uncovery, surgery can be performed on the mucogingival substrate to increase the volume of the keratinized gum, thus reducing peri-implant complications. Objective of the study. Evaluation condition of the peri-implant soft tissues and justification the surgical interventions on the mucogingival support at the stage of uncovery of implants at the upper jaw. Material and Methods. Clinical case presentation: F / 47 year old patient addressed at stageof uncovery of 14, 15, 17, 24, 25, 27 implants and the application of gingival healing cap. It is aprecienting a deficiency in the thickness and width of the keratinized gingiva. Bilateral periimplant gingivoplasty was performed with tuberosity-free gingival graft. Dynamic monitoring 10 days, 1, 3 months postoperatively. Results. Pre-operative gum width - 2.5 mm, post-operative - 6.0 mm; preoperative thickness-1.0 mm, postoperative 3.5 mm;. At the control visits in the gingivoplasty area, the soft tissues had a characteristic appearance for a healthy peri-implant keratinized gum, Follow up at 10 days 1, 3 months postoperatively (bleading, hyperemia, edema, purulent eliminations were no determinated). Conclusion. The surgical interventions at the stage of implant uncovery in case of insufficiency of the mucogingival support are indicated to obtain a morphofunctional and aesthetic result.Introducere. Absența lățimii și grosimii suficiente de gingie keratinizată, poate cauza periimplantita. La etapa de descoperire a implantelor pot fi efectuate intervenții chirurgicale asupra substratului mucogingival, pentru a crește volumul gingiei keratinizate, astfel reducând complicațiile periimplantare. Scopul lucrării. Evaluarea stării țesuturilor moi periimplantare și justificarea intervențiilor chirurgicale, asupra suportului mucogingival, la etapa de descoperire a implantelor la maxilarul superior. Material și Metode. Prezentarea unui caz clinic, pacient F/47 de ani s-a adresat pentru descoperirea implantelor 14, 15, 17, 24, 25, 27 și aplicarea conformatorilor gingivali. Se apreciază o deficiență a grosimii și lățimii gingiei keratinizate. S-a efectuat operația gingivoplastie periimplantară bilateral, cu grefă gingivala liberă din tuberozitate. Supravegherea în dinamică 10 zile, o lună și 3 luni - postoperator. Rezultate. Lățimea gingiei preoperator - 2,5 mm, postoperator- 6,0 mm; grosimea preoperator-1,0 mm, postoperator 3,5 mm;. La vizitele de control, în zona de gingivoplastie, țesuturile moi prezentau aspect caracteristic pentru gingie keratinizată periimplantară sănătoasă, suficientă atât la 10 zile, la o lună și la 3 luni - postoperator (lipsa hemoragiei, hiperemiei, edemului și a eliminărilor purulente). Concluzii. Intervențiile chirurgicale la etapa de descoperire a implantelor, în cazul insuficienței suportului mucogingival, sunt indicate pentru obținerea unui rezultat morfofuncțional și estetic de durată

Management of soft tissues around dental implants

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra de chirurgie OMF şi implantologie orală „Arsenie Guţan”, Chisinau, Republica Moldova, Catedra de stomatologie ortopedică „Ilarion Postolachi”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction: The absence of sufficient width and thickness of keratinized gingiva around dental implants creates conditions for development of microbial flora with appearance of peri-implantitis. At the 2nd stage of implants surgery the intervention are performed on the mucogingival tissues in order to avoid further complications. In case of soft tissue deficiency around dental implants selection of surgical soft tissue augmentation technique is verry important to obtain good aesthetic results. Basically, three different methods can be applied to augment peri-implant soft tissue: 1. Apically positioned flap/vestibuloplasty (in combination with a free gingival graft) FGG. 2. Mucogingival surgery with free gingival graft (FGG). 3. Soft tissue volume gain by means of a subepithelial connective tissue graft (SCTG). The recent systematic reviews concluded that an inadequate width of peri-implant keratinized tissue is associated with more plaque accumulation, signs of inflammation, soft tissue recession, and attachment loss. Purpose: Assessment of the condition of soft peri-implant tissue and prove evidence of surgical interventions on the mucogingival substrate at the 2nd stage of implant surgery. Material and methods: The study contains seven women with age between 24-64 years with medium of 43,23 years. The methods used: The vestibuloplasty, in combination with free gingival graft-FGG on four patients; subepithelial graft on two of them and FGG on one patient, in sum were performed 22 implants. The data obtained from the clinic and radiologic research’s were operated in the programs: Sidexis 4.2 and Excel. Results: The medium height of the pre-operatively gum - 2,28mm, post-operatively- 6,28mm; medium thickness of the pre-operatively-1,14mm, post-operatively 3,28mm; buccal vestibule with the medium depth of preoperatively - 2,4 mm post-operatively - 5,14mm. Donor zone: rough palatal 6 cases, tuberosity 1 case. Complications were not discovered in neither of cases. The displaying of the implants in 4 cases was followed by a surgery on the mucogingival substrate and in another 3 cases was performed delayed. Conclusions: At the 2nd stage of implant surgery, interventions at mucogingival substrate are indicated in order to obtain a morphofunctional and aesthetic long term results