Research article Special Issues

Hard and soft tissue augmentation of vertical ridge defects with the “hard top double membrane technique”: introduction of a new technique and a case report

  • Received: 10 November 2021 Revised: 17 December 2021 Accepted: 24 December 2021 Published: 06 January 2022
  • Vertical ridge defects (VRD) of the jaws often require both bone and keratinized mucosa (KM) reconstruction. A new staged procedure is proposed to restore both hard and soft tissues in the VRD through a case report. A patient required the lower right second premolar and first molar rehabilitation. The first surgery aimed to restore the bone architecture through the use of a titanium reinforced dense-PTFE (TR-dPTFE) membrane, positioned and stabilized on top of tenting screws. This membrane didn't cover the whole defect, it just created an hard top that avoided the collapse of a collagen membrane that was placed over it. This resorbable membrane was stabilized with tacks and covered the whole defect, protecting a mixture of autogenous bone and porcine xenograft both lingually and buccally. The second surgery was performed after a 5 month healing time either to remove the tenting screws and the TR-dPTFE membrane, and to augment KM with a gingival graft harvested from the palate. Both regenerated hard and soft tissues were left to mature for 7 months before the third surgery. In this last stage implants insertion and healing abutments application were carried out in a straightforward way, since bone and KM had been previously restored. Two bone samples, harvested for histologic evaluation, stated a great amount of new bone formation. This new approach allowed inserting implants in matured and stable regenerated bone and augmented KM, avoiding the hard and soft tissue loss around implant neck that can affect the VRD treatments during healing.

    Citation: Fabrizio Belleggia. Hard and soft tissue augmentation of vertical ridge defects with the “hard top double membrane technique”: introduction of a new technique and a case report[J]. AIMS Bioengineering, 2022, 9(1): 26-43. doi: 10.3934/bioeng.2022003

    Related Papers:

  • Vertical ridge defects (VRD) of the jaws often require both bone and keratinized mucosa (KM) reconstruction. A new staged procedure is proposed to restore both hard and soft tissues in the VRD through a case report. A patient required the lower right second premolar and first molar rehabilitation. The first surgery aimed to restore the bone architecture through the use of a titanium reinforced dense-PTFE (TR-dPTFE) membrane, positioned and stabilized on top of tenting screws. This membrane didn't cover the whole defect, it just created an hard top that avoided the collapse of a collagen membrane that was placed over it. This resorbable membrane was stabilized with tacks and covered the whole defect, protecting a mixture of autogenous bone and porcine xenograft both lingually and buccally. The second surgery was performed after a 5 month healing time either to remove the tenting screws and the TR-dPTFE membrane, and to augment KM with a gingival graft harvested from the palate. Both regenerated hard and soft tissues were left to mature for 7 months before the third surgery. In this last stage implants insertion and healing abutments application were carried out in a straightforward way, since bone and KM had been previously restored. Two bone samples, harvested for histologic evaluation, stated a great amount of new bone formation. This new approach allowed inserting implants in matured and stable regenerated bone and augmented KM, avoiding the hard and soft tissue loss around implant neck that can affect the VRD treatments during healing.



    加载中

    Acknowledgments



    The author wishes to thank Mr. Ezio Bassotti from Catholic University of Sacred Heart, Rome, Italy, for bone biopsies' processing and staining.

    Conflict of interest



    The author declares no conflicts of interest in this paper.

    [1] Jepsen S, Schwarz F, Cordaro L, et al. (2019) Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration. J Clin Periodontol 46: 277-286. https://doi.org/10.1111/jcpe.13121.
    [2] Dahlin C, Linde A, Gottlow J, et al. (1988) Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg 81: 672-676. https://doi.org/10.1097/00006534-198805000-00004. doi: 10.1097/00006534-198805000-00004
    [3] Cohen J, Lacroix P (1955) Bone and cartilage formation by periosteum; assay of experimental autogenous grafts. J Bone Joint Surg 37: 717-730. https://doi.org/10.2106/00004623-195537040-00005. doi: 10.2106/00004623-195537040-00005
    [4] Melcher AH, Accursi GE (1971) Osteogenic capacity of periosteal and osteoperiosteal flaps elevated from the parietal bone of the rat. Arch Oral Biol 16: 573-580. https://doi.org/10.1016/0003-9969(71)90060-4. doi: 10.1016/0003-9969(71)90060-4
    [5] Thoma D, Buranawat B, Hammerle C, et al. (2014) Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: A systematic review. J Clin Periodontol 41: S77-S91. https://doi.org/10.1111/jcpe.12220. doi: 10.1111/jcpe.12220
    [6] Buser D, Dula K, Hirt HP, et al. (1996) Lateral ridge augmentation using autografts and barrier membranes: a clinical study with 40 partially edentulous patients. J Oral Maxillofac Surg 54: 420-432. https://doi.org/10.1016/S0278-2391(96)90113-5. doi: 10.1016/S0278-2391(96)90113-5
    [7] Bouri A, Bissada N, Al-Zahrani MS, et al. (2008) Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 23: 323-326.
    [8] Chung DM, Oh TJ, Shotwell JL, et al.Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 77: 1410-1420. https://doi.org/10.1902/jop.2006.050393. doi: 10.1902/jop.2006.050393
    [9] Lin GH, Chan HL, Wang HL (2014) Effects of currently available surgical and restorative interventions on reducing midfacial mucosal recession of immediately placed single-tooth implants: A systematic review. J Periodontol 85: 92-102. https://doi.org/10.1902/jop.2013.130064. doi: 10.1902/jop.2013.130064
    [10] Brito C, Tenenbaum HC, Wong BK, et al. (2014) Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature. J Biomed Mater Res B Appl Biomater 102: 643-650. https://doi.org/10.1002/jbm.b.33042. doi: 10.1002/jbm.b.33042
    [11] Thoma DS, Naenni N, Figuero E, et al. (2018) Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic reviewand meta-analysis. Clin Oral Impl Res 29: 32-49. https://doi.org/10.1111/clr.13114. doi: 10.1111/clr.13114
    [12] Souza AB, Tormena M, Matarazzo F, et al. (2016) The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health. Clin Oral Implants Res 27: 650-655. https://doi.org/10.1111/clr.12703. doi: 10.1111/clr.12703
    [13] Warrer K, Buser D, Lang NP, et al. (1995) Plaque-induced peri-implantitis in the presence or absence of keratinized mucosa. An experimental study in monkeys. Clin Oral Implants Res 6: 131-138. https://doi.org/10.1034/j.1600-0501.1995.060301.x. doi: 10.1034/j.1600-0501.1995.060301.x
    [14] Thoma DS, Mühlemann S, Jung RE (2014) Critical soft-tissue dimensions with dental implants and treatment concepts. Periodontol 2000 66: 106-118. https://doi.org/10.1111/prd.12045. doi: 10.1111/prd.12045
    [15] Lin CY, Chen Z, Pan WL, et al. (2018) Impact of timing on soft tissue augmentation during implant treatment: A systematic review and meta-analysis. Clin Oral Impl Res 29: 508-521. https://doi.org/10.1111/clr.13148. doi: 10.1111/clr.13148
    [16] Ortak T, Ozdemir R, Uysal A, et al. (2005) Osteogenic capacities of periost grafts, periost flaps and prefabricated periosteal flaps: experimental study. J Craniofac Surg 16: 594-600. https://doi.org/10.1097/01.scs.0000168773.71356.62. doi: 10.1097/01.scs.0000168773.71356.62
    [17] Urban IA, Monje A, Wang HL (2015) Vertical ridge augmentation and soft tissue reconstruction of the anterior atrophic maxillae: a case series. Int J Periodontics Restorative Dent 35: 613-623. https://doi.org/10.11607/prd.2481. doi: 10.11607/prd.2481
    [18] Simion M, Rocchietta I, Kim D, et al. (2006) Vertical ridge augmentation by means of deproteinized bovine bone block and recombinant human platelet-derived growth factor-BB: a histologic study in a dog model. Int J Periodontics Restorative Dent 26: 415-423.
    [19] Mordenfeld A, Johansson CB, Albrektsson T, et al. (2014) A randomized and controlled clinical trial of two different compositions of deproteinized bovine bone and autogenous bone used for lateral ridge augmentation. Clin Oral Impl Res 25: 310-320. https://doi.org/10.1111/clr.12143. doi: 10.1111/clr.12143
    [20] Gamal AY, Iacono VJ (2013) Enhancing guided tissue regeneration of periodontal defects by using a novel perforated barrier membrane. J Periodontol 84: 905-913. https://doi.org/10.1902/jop.2012.120301. doi: 10.1902/jop.2012.120301
    [21] Carrion JA, Wang HH, Masselli J, et al. (2017) Enhanced lateral bone augmentation with a perforated resorbable barrier membrane. Clin Adv Periodontics 7: 152-158. https://doi.org/10.1902/cap.2017.160080. doi: 10.1902/cap.2017.160080
    [22] Ferretti C, Borsari V, Falconi M, et al. (2012) Human periosteum-derived stem cells for tissue engineering applications: The role of VEGF. Stem Cell Rev 8: 882-890. https://doi.org/10.1007/s12015-012-9374-7. doi: 10.1007/s12015-012-9374-7
    [23] Mitrano TI, Grob MS, Carrion F, et al. (2010) Culture and characterization of mesenchymal stem cells from human gingival tissue. J Periodontol 81: 917-925. https://doi.org/10.1902/jop.2010.090566. doi: 10.1902/jop.2010.090566
    [24] Cucchi A, Sartori M, Parrilli A, et al. (2019) Histological and histomorphometric analysis of bone tissue after guided bone regeneration with non-resorbable membranes vs resorbable membranes and titanium mesh. Clin Implant Dent Relat Res 21: 693-701. https://doi.org/10.1111/cid.12814.
    [25] Belleggia F, Gargari M (2019) The “Umbrella Technique”: a new procedure for hard and soft tissue augmentation in the vertical defects of the jaws. Oral Implantol (Rome) 12: 180-193.
    [26] Bartee BK (2001) Extraction site reconstruction for alveolar ridge preservation. Part 2: membrane-assisted surgical technique. J Oral Implantol 27: 194-197. https://doi.org/10.1563/1548-1336(2001)027<0194:ESRFAR>2.3.CO;2. doi: 10.1563/1548-1336(2001)027<0194:ESRFAR>2.3.CO;2
  • Reader Comments
  • © 2022 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(2966) PDF downloads(242) Cited by(0)

Article outline

Figures and Tables

Figures(21)

Other Articles By Authors

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog