A simple approach to preserve keratinized mucosa around implants using a pre-fabricated implantretained stent: a report of two cases
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Purpose: There is no consensus regarding the relationship between the width of keratinized mucosa and the health of periimplant tissues, but clinicians prefer to provide enough keratinized mucosa around dental implants for long-term implant maintenance. An apically positioned flap during second stage implant surgery is the chosen method of widening the keratinized zone in simple procedures. However, the routine suture techniques used with this method tend to apply tension over the provisional abutments and decrease pre-existing keratinized mucosa. To overcome this shortcoming, a pre-fabricated implant-retained stent was designed to apply vertical pressure on the labial flap and stabilize it in a bucco-apical direction to create a wide keratinized mucous zone. Methods: During second stage implant surgery, an apically displaced, partial thickness flap with a lingualized incision was retracted. A pre-fabricated stent was clipped over the abutments after connecting to the provisional abutment. Vertical pressure was applied to displace the labial flap. No suture was required and the stent was removed after 10 days. Results: A clinically relevant amount of keratinized mucosa was achieved around the dental implants. Buccally displaced keratinized mucosa was firmly attached to the underlying periosteum. A slight shrinkage of the keratinized zone was noted after the healing period in one patient, but no discomfort during oral hygiene was reported. Clinically healthy gingiva with enough keratinized mucosa was achieved in both patients. Conclusions: The proposed technique is a simple and time-effective technique for preserving and providing keratinized tissue around dental implants
Abstract
Purpose: There is no consensus regarding the relationship between the width of keratinized mucosa and the health of periimplant tissues, but clinicians prefer to provide enough keratinized mucosa around dental implants for long-term implant maintenance. An apically positioned flap during second stage implant surgery is the chosen method of widening the keratinized zone in simple procedures. However, the routine suture techniques used with this method tend to apply tension over the provisional abutments and decrease pre-existing keratinized mucosa. To overcome this shortcoming, a pre-fabricated implant-retained stent was designed to apply vertical pressure on the labial flap and stabilize it in a bucco-apical direction to create a wide keratinized mucous zone. Methods: During second stage implant surgery, an apically displaced, partial thickness flap with a lingualized incision was retracted. A pre-fabricated stent was clipped over the abutments after connecting to the provisional abutment. Vertical pressure was applied to displace the labial flap. No suture was required and the stent was removed after 10 days. Results: A clinically relevant amount of keratinized mucosa was achieved around the dental implants. Buccally displaced keratinized mucosa was firmly attached to the underlying periosteum. A slight shrinkage of the keratinized zone was noted after the healing period in one patient, but no discomfort during oral hygiene was reported. Clinically healthy gingiva with enough keratinized mucosa was achieved in both patients. Conclusions: The proposed technique is a simple and time-effective technique for preserving and providing keratinized tissue around dental implants
참고문헌 (25)
- Adell R, "Marginal tissue reactions at osseointegrated titanium fixtures (I). A 3-year longitudinal prospective study", Int J Oral Maxillofac Surg, 15, pp.39~52 (1986)
- Lekholm U, "Marginal tissue reactions at osseointegrated titanium fixtures. (II) A cross-sectional retrospective study", Int J Oral Maxillofac Surg, 15, pp.53~61 (1986)
- Schou S, "Plaque-induced marginal tissue reactions of osseointegrated oral implants: a review of the literature", Clin Oral Implants Res, 3, pp.149~161 (1992)
- Warrer K, "Plaque-induced peri-implantitis in the presence or absence of keratinized mucosa. An experimental study in monkeys", Clin Oral Implants Res, 6, pp.131~138 (1995)
- Zarb GA, "The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto study. Part III: Problems and complications encountered", J Prosthet Dent, 64, pp.185~194 (1990)
- Adell R, "A 15-year study of osseointegrated implants in the treatment of the edentulous jaw", Int J Oral Surg, 10, pp.387~416 (1981)
- Block MS, "Factors associated with soft- and hardtissue compromise of endosseous implants", J Oral Maxillofac Surg, 48, pp.1153~1160 (1990)
- Buser D, "Tissue integration of nonsubmerged implants. 1-year results of a prospective study with 100 ITI hollow-cylinder and hollow-screw implants", Clin Oral Implants Res, 1, pp.33~40 (1990)
- Albrektsson T, "The long-term efficacy of currently used dental implants: a review and proposed criteria of success", Int J Oral Maxillofac Implants, 1, pp.11~25 (1986)
- Langer B, "Osseointegration: its impact on the interrelationship of periodontics and restorative dentistry:Part I", Int J Periodontics Restorative Dent, 9, pp.84~105 (1989)
- Langer B, "Overlapped flap: a surgical modification for implant fixture installation", Int J Periodontics Restorative Dent, 10, pp.208~215 (1990)
- Landi L, "Plastic surgery at the time of membrane removal around mandibular endosseous implants:a modified technique for implant uncovering", Int J Periodontics Restorative Dent, 21, pp.280~287 (2001)
- Reiser G, "The subepithelial connective tissue graft palatal donor site:Anatomic considerations for surgeons", Int J Periodontics Restorative Dent, 16, pp.130~137 (1996)
- Lang NP, "The relationship between the width of keratinized gingiva and gingival health", J Periodontol, 43, pp.623~627 (1972)
- de Trey E, "Influence of free gingival grafts on the health of the marginal gingiva", J Clin Periodontol, 7, pp.381~393 (1980)
- Hall WB, "Present status of soft tissue grafting", J Periodontol, 48, pp.587~597 (1977)
- Wennstrom JL, "The influence of the masticatory mucosa on the peri-implant soft tissue condition", Clin Oral Implants Res, 5, pp.1~8 (1994)
- Bengazi F, "Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study", Clin Oral Implants Res, 7, pp.303~310 (1996)
- Sclar AG, "Soft tissue and esthetic considerations in implant dentistry" (2003), Quintessence Publishing Co.
- Moore JR, "A modification of stent design for preprosthetic surgery", J Oral Surg, 28, pp.263~266 (1970)
- Sanders B, "Modified technique for palatal mucosal grafts in mandibular labial vestibuloplasty", J Oral Surg, 33, pp.950~952 (1975)
- Firtell DN, "A stent for a split-thickness skin graft vestibuloplasty", J Prosthet Dent, 36, pp.204~210 (1976)
- Hughes WG, "Simultaneous split-thickness skin grafting and placement of endosteal implants in the edentulous mandible: a preliminary report", J Oral Maxillofac Surg, 50, pp.448~451 (1992)
- Nystrom E, "Treatment of the severely resorbed maxillae with bone graft and titanium implants: histologic review of autopsy specimens", Int J Oral Maxillofac Implants, 8, pp.167~172 (1993)
- Brygider RM, "Custom stent fabrication for free gingival grafts around osseointegrated abutment fixtures", J Prosthet Dent, 62, pp.320~322 (1989)