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Background: Emerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG., Aim: The present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period., Materials and Methods: The study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes., Results: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of - 0.14 ± 0.27 mm and - 0.04 ± 0.40 mm in the CM group, and - 0.08 ± 0.29 mm and - 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: - 0.03 ± 0.22 mm, FGG: - 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001)., Conclusions: CM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics., (© 2023. The Author(s).)

This clinical report details a novel surgical modification at the time of maxillectomy to improve obturator function. A vestibuloplasty and split thickness skin graft of the zygomaticoalveolar crest created a denture-bearing surface that, when engaged, provided support and stability for the obturator prosthesis. This report outlines the surgical and prosthodontic procedures and the results achieved., (Copyright © 2021 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose of the study: to study the features of microhaemodynamics and oxygenation in soft tissues in the area of the plastically reconstructed jaw after the vestibuloplasty., Materials and Methods: The study included 40 patients aged 20 to 65 (21 males and 19 females). The patients were divided into two groups: I group (14 patients) - patients after reconstructive surgery with the use a fibula autograft without the inclusion of a musculocutaneous «islet»; II group (26 patients) - patients after reconstructive surgery with the use a fibula autograft with the inclusion of a musculocutaneous «islet». To correct the prosthetic bed soft tissues, all patients underwent vestibuloplasty with the use of a free dermal autograft. To study microcirculation in tissues, the laser Doppler flowmetry (LDF) method was used. Microcirculation status was assessed by microcirculation index characterizing the level of tissue blood flow; parameter «σ,» which determines the oscillability of the flow of red blood cells and by coefficient of variation, characterizing vasomotor activity of microvessels. According to the Wavelet analysis of LDF-grams the blood flow bypass was determined. An oxygenation study was carried out in the tissues of the plastically restored jaw by optical tissue oximetry, the results of which determined the oxygenation index and the specific oxygen consumption index., Results: According to LDF data after vestibuloplasty, it was found that in I group, the microcirculation in soft tissues of the plastically reconstructed jaw restored in 21 days, and in II group in 2 months, which persisted at 6 months. In I group, the level of oxygenation and specific oxygen consumption normalized in 21 days, and in II group in 2 months, which persisted at 6 months., Conclusion: Based on the results of this functional study, it was found that before vestibuloplasty microcirculation and oxygenation indices in II group patients were lower than those in I group patients. After vestibuloplasty with the use of a free dermal autograft, microcirculation indices in II group patients restored in 2 months, while in I group patients those indices restored in 21 days.

Objectives: The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen matrix (XCM) versus subepithelial connective tissue graft (SCTG) to increase soft tissue thickness at implant site., Materials and Methods: The study was a randomized, parallel-group controlled investigation. Thirty patients underwent buccal soft tissue thickness augmentation at the stage of implant placement by two different methods: SCTG (control group) and XCM (test group). Primary outcome was the amount of buccal soft tissue thickness gain, 3 months after the intervention. Secondary outcomes were the operation time, the amount of keratinized mucosa (KM), pain syndrome (PS), and patients' quality of life (QL). Histologic evaluation was also performed., Results: The amount of soft tissue thickness gain was 1.55±0.11 mm in SCTG group, and 1.18±0.11mm in XCM group. The difference between the SCTG and XCM was -0.366 (-0.66 to -0.07; p=0.016). Operation time with XCM was 8.4 (3.737 to 13.06) min shorter than that with the SCTG (p=0.001). KT, PS, and QL for both groups were not statistically significantly different at any time point (p>0.05). At histological examination, the general picture in both groups was similar. No significant differences between the studied groups in most indices, except for the average and maximum formation thickness, cellularity of the basal, mitotic activity and also maximum length of rete ridges., Conclusion: Within limitations, this study demonstrates that the use of SCTG provides a statistically significant superior soft tissue thickness gain than XCM for soft tissue augmentation procedures around implants., Clinical Relevance: XCM can be used as the method of choice for increasing the thickness of soft tissues., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The aim of the present study was to investigate temporal and spatial blood flow patterns following vestibuloplasty procedures using a collagen matrix (CM) to get an insight into the timing and direction of neovascularization in the CM., Methods: Five patients were treated using a modified apically repositioned flap combined with a CM. Intraoral photographs and blood flow measurements by laser speckle contrast imaging were taken for 12 months. Thirty regions of interest in the graft and the surrounding mucosa were evaluated. The clinical parameters were assessed after 6 and 12 months. VEGF expression was analyzed in the wound fluid on days 2 and 4., Results: At 6 months, the mean width of keratinized gingiva increased, but the thickness was unchanged. Scar formation was observed in all cases. Perfusion in the graft began to increase at the lateral and coronal edges and then spread concentrically toward the center. The apical side showed a significant delay in perfusion, the highest VEGF expression, and wound fluid production as well as the most abundant scar formation., Conclusions: Neovascularization occurs mainly from the lateral and coronal edges, which may limit the extent of the surgical area. Abundant scar formation may be explained by increased VEGF expression induced by prolonged ischemia in this area., (© 2019 The Authors. Oral Diseases published by John Wiley & Sons Ltd.)

Purpose: Vestibuloplasty is a frequently performed surgical procedure to create or increase soft tissue mucosal sealing around dental restorations. Collagen matrices have exhibited comparable clinical results as free gingival grafts in the context of intraoral tissue augmentation. However, the process of matrix vascularization, the basic requirement for local healing, is incompletely understood. Therefore, this study investigated collagen matrix perfusion in a clinical intraoral setting., Materials and Methods: In a prospective cohort study, vestibuloplasty was performed during implant exposure using prefabricated collagen matrices. Matric perfusion was determined intraoperatively and at days 2, 5, 7, 14, 30, and 90 using a laser Doppler spectrophotometer measuring oxygen saturation, relative amount of hemoglobin, blood flow, and blood velocity as primary outcome variables. These parameters were compared with perfusion of the oral mucosa surrounding the matrices. Statistical analysis was performed by applying variance and regression models., Results: In 10 patients (average age, 60.9 yr), vestibuloplasty was performed exclusively in the anterior mandible. Blood flow and tissue oxygen saturation in the augmented zones markedly increased until postoperative day 5 and approximated perfusion values of the adjacent mucosa at the following 2 time points. Likewise, matrix oxygen saturation markedly increased until day 7 and subsequently converged to perfusion parameters of the surrounding mucosa at the following time points., Conclusion: Flow signals in incorporated collagen matrices occurred on day 2 after vestibuloplasty and further increased until days 5 to 7. Therefore, matrix perfusion mainly occurs within the first postoperative week, converging to perfusion levels of the surrounding mucosa with minimal alterations during the following course., (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: This work aimed to investigate the effectiveness and predictability of different treatment modalities for gain of keratinized tissue (KT) in fully edentulous jaws prior to dental implant placement: apically positioned flap (APF), APF plus xenogeneic collagen matrix (XCM), and APF plus free gingival graft (FGG)., Materials and Methods: In fully edentulous patients with insufficient zones of KT at the prospective implant positions, four treatment modalities were performed in the lower jaw: APF, XCM, FGG, and an untreated control group (control). APF and XCM were applied in the first molar positions, FGG and control in the canine positions. Assessed outcomes up to 3 months post-surgery included changes in width of KT (over a 3-month period), histomorphometric analysis of harvested soft-tissue biopsies (at 3 months postoperatively), and patient-reported outcomes measures (PROMs)., Results: For the primary outcome, changes in KT width demonstrated an increase of 1.93 ± 1.6 mm (APF), whereas XCM and FGG showed an increase of 4.63 ± 1.25 mm and 3.64 ± 2.01, respectively. Histomorphometric analyses revealed a thickness of the epithelium ranging between 375 ± 122 μm (APF), 410 ± 116 μm (XCM), 336 ± 122 μm (FGG), and 413 ± 109 μm (control). All biopsies showed a regular muco-periosteal structure with a keratinized epithelium of comparable thickness in all groups., Conclusion: All three methods were suitable to increase the width of KT, although APF alone rendered roughly 50% less gain compared to XCM and FGG., Clinical Relevance: The use of XCM in conjunction with an APF represents a valuable treatment option for the gain of keratinized tissue in edentulous sites.

Objectives: This work aimed to comparatively evaluate the three modalities of vestibuloplasty around implants in the posterior mandible., Materials and Methods: Forty patients who presented with a shallow vestibule and insufficient keratinized gingiva were divided into three groups: apically positioned flap only (APF group), APF with free gingival graft (FGG group), and APF with collagen matrix (CM group). The width of KT was measured at baseline, immediately after surgery (T0), and 6 months (T6) and 12 months after surgery (T12). An esthetic evaluation (color match, contour, and texture) was conducted., Results: Most of the shrinkage occurred within 6 months. The FGG group demonstrated less shrinkage of KT up to 12 months compared to the APF and CM groups. The APF and CM groups exhibited a prolonged and similar rate of shrinkage. The APF and CM groups also showed significantly better esthetic profiles., Conclusions: Within the limitations of the present study, FGG may be the most predictable modality for increasing KT in the posterior mandible, but it should be emphasized that the posterior mandible does not require high esthetics., Clinical Relevance: The effect of apically positioned flap and collagen matrix may be diminished by several factors in posterior mandible, such as low vestibule and high muscle pull. For increasing the dimension of keratinized tissue in posterior mandible, conventional free gingival graft may be more predictable compared to other options.

Rationale: With respect to improving the quality of oral rehabilitation, the management of keratinized mucosa is as important as bone condition for implant success. To enhance this management, a natural teeth-retained splint based on a patient-specific 3-dimensional (3D) printed mandible was used in vestibuloplasty to provide sufficient keratinized mucosa around dental implants to support long-term implant maintenance., Patient Concerns: A 28-year-old male patient had a fracture of the anterior andible 1 year ago, and the fracture was treated with titanium., Diagnoses: The patient had lost mandibular incisors on both the sides and had a shallow vestibule and little keratinized mucosa., Interventions: In the first-stage implant surgery, 2 implants were inserted and the titanium fracture fixation plates and screws were removed at the same time. During second-stage implant surgery, vestibuloplasty was performed, and the natural teeth-retained splint was applied. The splint was made based upon a patient-specific 3D-printed mandible. At 30-day follow-up, the splint was modified and reset. The modified splint was removed after an additional 60 days, and the patient received prosthetic treatment., Outcomes: After prosthetic treatment, successful oral rehabilitation was achieved. Within 1 year and 3 years after implant prosthesis finished, the patient exhibited a good quantity of keratinized gingiva., Lessons Subsections: The proposed splint is a simple and time-effective technique for correcting soft tissue defects in implant dentistry that ensures a good quantity of keratinized mucosa.

Objectives: Attached peri-implant gingiva has proven to have an influence on the long-term stability of dental implants. In patients with head and neck cancer, a functional peri-implant gingiva is even more of critical importance. The aim of the presented prospective study was to investigate a three-dimensional xenogeneic collagen matrix for augmentation around dental implants in patients with former head and neck cancer., Material and Methods: Eight patients presenting with insufficient peri-implant gingiva underwent vestibuloplasty on 51 implants using a xenogeneic collagen matrix. The clinical performance and the shrinking tendency of the matrix were analyzed in a cohort study. Furthermore, eight biopsies from the augmented regions were examined histologically to determine the biomaterial-related tissue reaction., Results: Initially after vestibuloplasty, a mean width of attached gingiva of 4.4 ± 0.94 mm could be achieved. At clinical follow up investigation 6 months after vestibuloplasty, a mean width of 3.9 ± 0.65 mm attached peri-implant gingiva with a mean shrinking tendency of 14 % could be detected. Histological analysis of the biopsies revealed a well integrated collagen22 matrix covered with epithelium. Within the compact layer, mononuclear cells were observed only, while the spongious layer was infiltrated with a cell-rich connective tissue., Conclusion: Within its limits, the presented study revealed that the investigated collagen matrix is suitable to enlarge the peri-implant attached gingiva in head and neck cancer patients without adverse reactions or a multinucleated giant cell-triggered tissue reaction., Clinical Relevance: The application of the investigated three-dimensional collagen matrix in vestibuloplasty achieved a sufficient amount of peri-implant attached gingiva in head and neck cancer patients. The favorable tissue reaction and the low shrinking tendency make the collagen matrix a promising alternative to autologous tissue grafts.

Objectives: The aim was to compile the current knowledge about the efficacy of different soft tissue correction methods around osseointegrated, already uncovered and/or loaded (OU/L) implants with insufficient soft tissue conditions. Procedures to increase peri-implant keratinized mucosa (KM) width and/or soft tissue volume were considered., Materials and Methods: Screening of two databases: MEDLINE (PubMed) and EMBASE (OVID), and manual search of articles were performed. Human studies reporting on soft tissue augmentation/correction methods around OU/L implants up to June 30, 2016, were considered. Quality assessment of selected full-text articles to weight risk of bias was performed using the Cochrane collaboration's tool., Results: Overall, four randomized controlled trials (risk of bias = high/low) and five prospective studies (risk of bias = high) were included. Depending on the surgical techniques and graft materials, the enlargement of keratinized tissue (KT) ranged between 1.15 ± 0.81 and 2.57 ± 0.50 mm. The apically positioned partial thickness flap (APPTF), in combination with a free gingival graft (FGG), a subepithelial connective tissue graft (SCTG), or a xenogeneic graft material (XCM) were most effective. A coronally advanced flap (CAF) combined with SCTG in three, combined with allogenic graft materials (AMDA) in one, and a split thickness flap (STF) combined with SCTG in another study showed mean soft tissue recession coverage rates from 28 to 96.3 %. STF combined with XCM failed to improve peri-implant soft tissue coverage., Conclusions: The three APPTF-techniques combined with FGG, SCTG, or XCM achieved comparable enlargements of peri-implant KT. Further, both STF and CAF, both in combination with SCTG, are equivalent regarding recession coverage rates. STF + XCM and CAF + AMDA did not reach significant coverage., Clinical Relevance: In case of soft tissue deficiency around OU/L dental implants, the selection of both an appropriate surgical technique and a suitable soft tissue graft material is of utmost clinical relevance.

For ideal implant rehabilitation, an adequate bone volume, optical implant position, and stable and healthy soft tissue are required. The reduction of alveolar bone and changes in its morphology subsequent to tooth extraction will result in insufficient amount of bone and adversely affect the ability to optimally place dental implants in edentulous sites. Preservation of alveolar bone volume through ridge preservation has been demonstrated to reduce the vertical and horizontal contraction of the alveolar bone crest after tooth extraction and reduce the need for additional bone augmentation procedures during implant placement. In this case, a patient presented with a mandible molar of severe periodontal disease, the tooth was removed as atraumatically as possible and the graft material of Bio-Oss was loosely placed in the alveolar socket without condensation and covered with Bio-Gide to reconstruct the defects of the alveolar ridge. Six months later, there were sufficient height and width of the alveolar ridge for the dental implant, avoiding the need of additional bone augmentation and reducing the complexity and unpredictability of the implant surgery. Soft tissue defects, such as gingival and connective tissue, played crucial roles in long-term implant success. Peri-implant plastic surgery facilitated development of healthy peri-implant structure able to withstand occlusal forces and mucogingival stress. Six months after the implant surgery, the keratinized gingiva was absent in the buccal of the implant and the vestibular groove was a little shallow. The free gingival graft technique was used to solve the vestibulum oris groove supersulcus and the absence of keratinized gingiva around the implant. The deepening of vestibular groove and broadening of keratinized gingiva were conducive to the long-term health and stability of the tissue surrounding the implant. Implant installation and prosthetic restoration showed favorable outcome after six months.

Objectives: Porcine collagen matrices are proclaimed being a sufficient alternative to autologous free gingival grafts (FGG) in terms of augmenting the keratinized mucosa. The collagen matrix Mucograft ® (CM) already showed a comparable clinical performance in the early healing phase, similar histological appearance, and even a more natural appearance of augmented regions. Predictability for long-term stability does not yet exist due to missing studies reporting of a follow-up >6 months., Material and Methods: The study included 48 patients with atrophic edentulous or partially edentulous lower jaw situations that had undergone an implant treatment. In the context of implant exposure, a vestibuloplasty was either performed with two FGGs from the palate (n = 21 patients) or with the CM (n = 27 patients). Surgery time was recorded from the first incision to the last suture. Follow-up examinations were performed at the following time points: 10, 30, 90, and 180 days and 1, 2, 3, 4, and 5 years after surgery. The width of keratinized mucosa was measured at the buccal aspect of each implant, and augmented sites were evaluated in terms of their clinical appearances (texture and color)., Results: The groups showed similar healing with increased peri-implant keratinized mucosa after surgery (FGG: 13.06 mm ± 2.26 mm and CM: 12.96 mm ± 2.86 mm). The maximum follow-up was 5 years (5 patients per group). After 180 days, the width of keratinized mucosa had decreased to 67.08 ± 13.85% in the FGG group and 58.88 ± 14.62% in the CM group with no statistically significant difference. The total loss of the width of keratinized mucosa after 5 years was significant between the FGG (40.65%) and the CM group (52.89%). The CM group had significantly shorter operation times than the FGG group. Augmented soft tissues had a comparable clinical appearance to adjacent native gingiva in the CM group. FGGs could still be defined after 5 years., Conclusions: The FGG and the CM are both suitable for the regeneration of the peri-implant keratinized mucosa with a sufficient long-term stability. With the CM, tissue harvesting procedures are invalid, surgery time can be reduced, and regenerated tissues have a more esthetic appearance., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Vestibuloplasty involves a series of surgical procedures designed to restore alveolar ridge height by lowering the muscles attached to the buccal, labial, and lingual aspects of the jaws. The technique is indicated in cases of insufficient vestibular depth that may result from atrophy of the alveolar ridge and/or high attachment of muscle or movable mucosa. This article focuses on a carbon dioxide (CO2) laser vestibular extension procedure performed in a patient with Klinefelter syndrome, which is caused by a chromosomal abnormality. The 10,600-nm CO2 laser is shown to offer several advantages over a conventional scalpel and other laser wavelengths for soft-tissue pre-prosthetic surgery, including vestibular extension.

Objectives: The aim of this systematic review was to evaluate the efficacy of different soft tissue augmentation/correction methods in terms of increasing the peri-implant width of keratinized mucosa (KM) and/or gain of soft tissue volume during second-stage surgery., Materials and Methods: Screening of two databases, MEDLINE (PubMed) and EMBASE (OVID), and hand search of related articles, were performed. Human studies reporting on soft tissue augmentation/correction methods around submucosally osseointegrated implants during second-stage surgery up to July 31, 2015 were considered. Quality assessment of the selected full-text articles was performed according to the Cochrane collaboration's tool to assess the risk of bias., Results: Overall, eight prospective studies (risk of bias: high) and two case series (risk of bias: high) were included. Depending on the surgical technique and graft material used, the enlargement of keratinized tissue (KT) ranged between -0.20 and 9.35 mm. An apically positioned partial-thickness flap/vestibuloplasty (APPTF/VP) in combination with a free gingival graft (FGG) or a xenogeneic graft material (XCM) was most effective. Applying a roll envelope flap (REF) or an APPTF in combination with a subepithelial connective tissue graft (SCTG), mean increases in soft tissue volumes of 2.41 and 3.10 mm, respectively, were achieved. Due to the heterogeneity of study designs, no meta-analysis could be performed., Conclusions: Within the limitations of this review, regarding the enlargement of peri-implant KT, the APPTF in the maxilla and the APPTF/VP in combination with FGG or XCM in the lower and upper jaw seem to provide acceptable outcomes. To augment peri-implant soft tissue volume REF in the maxilla or APPTF + SCTG in the lower and upper jaw appear to be reliable treatment options., Clinical Relevance: The localization in the jaw and the clinical situation are crucial for the decision which second-stage procedure should be applied.

The purpose of the study was to assess the changes in the width and quality of keratinized tissue created in the area of vestibuloplasty on the lower jaw. Preliminary results of the study showed that autotransplantation method allows creating proper buffer zone with the desired mucosa thickness and is particularly justified in cases of "washing board" effect. However, the method is technically more demanding and is more expensive and painfull for patients. The use of alternative materials of artificial origin, such as "Mucograft" and "Tachocomb" simplifies the execution of operation, thereby reducing operational risk, but often does not lead to the formation of a fully keratinized gingiva.

Background: Scientific data and clinical observations appear to indicate that an adequate width of attached mucosa may facilitate oral hygiene procedures thus preventing peri-implant inflammation and tissue breakdown (eg, biologic complications). Consequently, in order to avoid biologic complications and improve long-term prognosis, soft tissue conditions should be carefully evaluated when implant therapy is planned. At present the necessity and time-point for soft tissue grafting (eg, prior to or during implant placement or after healing) is still controversially discussed while clinical recommendations are vague., Objectives: To provide a review of the literature on the role of attached mucosa to maintain periimplant health, and to propose a decision tree which may help the clinician to select the appropriate surgical technique for increasing the width of attached mucosa., Results: The available data indicate that ideally, soft tissue conditions should be optimized by various grafting procedures either before or during implant placement or as part of stage-two surgery. In cases, where, despite insufficient peri-implant soft tissue condition (ie, lack of attached mucosa or movements caused by buccal frena), implants have been uncovered and/or loaded, or in cases where biologic complications are already present (eg, mucositis, peri-implantitis), the treatment appears to be more difficult and less predictable., Conclusion: Soft tissue grafting may be important to prevent peri-implant tissue breakdown and should be considered when dental implants are placed. The presented decision tree may help the clinician to select the appropriate grafting technique.

Oral findings in patients with ectodermal dysplasia (ED) include complete or partial hypodontia, anodontia, loss of vertical dimension of occlusion, protuberant lips, malformed and widely spaced conical-shaped teeth, and underdeveloped alveolar ridges. These patients present a substantial challenge in dental treatment. This case report presents oral rehabilitation of a 22-year-old male patient diagnosed with ED using an implant tooth-supported telescopic partial denture at the mandible and a tooth-supported telescopic partial denture at the maxilla. Implants in the mandible were placed at the sites of the right and left lateral incisor teeth. Following implant placement, the remaining buccal bone dehiscence was filled with deproteinized bovine bone graft and covered with resorbable membrane. To manage the vestibular insufficiency and to increase the keratinized mucosa in maxilla, bilateral acellular dermal matrix allograft was used on the right and left buccal aspects. The treatment described here improved the patient's functional and esthetic status while significantly restoring his oral health and self-esteem.

Nowadays, upper denture instability secondary to severe maxillary atrophy is treated, in most cases, with dental implants. However, a significant number of patients cannot afford this procedure. Palatal bone deepening through a U-shaped osteotomy has been described previously. The procedure increases retention by improving the suction effect of the palate and prevents anteroposterior and lateral movement of the denture. By combining this procedure with a secondary epithelialization vestibuloplasty, the labial aspect of the ridge is also extended and it does not require a skin graft. This article describes a modification of the palatal vault osteotomy through the presentation of a case., (Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objectives: Patients with continuous bone defects of the mandible after ablative tumor surgery need bony reconstruction for proper function and aesthetics. Free microvascular reanastomized bone grafts provide a clinically proven option for such patients, yet the optimal source of donor tissue has not yet been established. The aim of this study was to evaluate and compare the bone volume stability of vascularized bone grafts, particularly in the early highly resorptive phase, from the iliac crest (DCIA) and the fibula and to assess the implantologic rehabilitations., Materials and Methods: Thirty-six patients with mandibular continuity defects due to tumor resection were reconstructed by the use of vascularized bone grafts; 21 patients received DCIA flaps and 15 patients received a composite free fibular flap, depending on the size and location of the defect. Bone resorption was assessed using digital panographs. Radiographs were taken immediately after bone reconstruction, 6 months postoperatively, prior to implant surgery, and at prosthetic loading., Results: After a mean observation period of 6 months, vertical bone resorption was 6.79% for the patients of the iliac crest group (DCIA), 10.20% after 11 months, and 12.58% after 17 months. Fibular grafts showed a bone resorption of 5.30% after a mean observation time of 6 months, 8.26% after 11 months, and 16.95% after 17 months. Eighteen patients received 71 implants for implant-retained dental reconstructions., Conclusions: Microvascular reanastomized bone grafts represent a reliable treatment option for reconstruction in cases of large defects of the mandible, with low graft resorption in the early healing phase. Additionally, the compared grafts provide sufficient bone volume to permit implant rehabilitation., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Aim: To review the dental literature in terms of efficacy of soft tissue augmentation procedures around dental implants and in partially edentulous sites., Methods: A Medline search was performed for human studies augmenting keratinized mucosa (KM) and soft tissue volume around implants and in partially edentulous areas. Due to heterogeneity in between the studies, no meta-analyses could be performed., Results: Nine (KM) and eleven (volume) studies met the inclusion criteria. An apically positioned flap/vestibuloplasty (APF/V) plus a graft material [free gingival graft (FGG)/subepithelial connective tissue graft (SCTG)/collagen matrix (CM)] resulted in an increase of keratinized tissue (1.4-3.3 mm). Statistically significantly better outcomes were obtained for APF/V plus FGG/SCTG compared with controls (APF/V alone; no treatment) (p < 0.05). For surgery time and patient morbidity, statistically significantly more favourable outcomes were reported for CM compared to SCTGs (p < 0.05) in two randomized controlled clinical trials (RCTs), even though rendering less keratinized tissue. SCTGs were the best-documented method for gain of soft tissue volume at implant sites and partially edentulous sites. Aesthetically at immediate implant sites, better papilla fill and higher marginal mucosal levels were obtained using SCTGs compared to non-grafted sites., Conclusions: An APF/V plus FGG/SCTG was the best-documented and most successful method to increase the width of KM. APF/V plus CM demonstrated less gain in KM, but also less patient morbidity and surgery time compared to APF/V plus SCTG based on two RCTs. Autogenous grafts (SCTG) rendered an increase in soft tissue thickness and better aesthetics compared to non-grafted sites., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This report describes the surgical and prosthetic reconstruction of a partial mandibular resection due to an osteomyelitic variant with a free fibula microvascular graft, dental implant placement, and reconstruction with a computer-aided design/computer-aided manufacturing (CAD/CAM) partial fixed dental prosthesis. A team composed of a prosthodontist, oral and maxillofacial surgeon, and otolaryngologist was required to treat and restore the patient to near normal comfort and function., (Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Dentists are often faced with extensively resorbed mandibular ridges with shallow buccal vestibule and high insertion of the mentalis muscle in relation to the crest of the ridge, causing the displacement of the prosthesis. Vestibuloplasty techniques aim at eliminating the muscle insertions, reposition the mucosa, and increase the area chapeável, giving more stability to the prosthesis. Among the techniques to deepen the vestibule are submucosal vestibuloplasties by secondary epithelialization and with mucosal and skin grafts. We will discuss vestibuloplasty by secondary epithelialization with emphasis on the so-called modified Kazanjian technique. This technique provides an appropriate result and does not require hospitalization, additional surgery at the donor, or prolonged periods without the use of prosthesis.

Background: A free gingival graft (FGG) is currently the gold standard for augmenting small areas of keratinized mucosa. The porcine collagen matrix (CM) represents an alternative to autologous tissue harvesting. This study aims to compare the CM versus FGGs for augmenting keratinized peri-implant mucosa based on clinical and histologic evaluations., Methods: The study included 14 patients who underwent a vestibuloplasty with either a FGG from the palate (n = 7) or the CM (n = 7). An implant-fixed vestibular retention splint was inserted for 30 days. Follow-up examinations were performed at 4, 10, 30, and 90 days after surgery. Width of keratinized mucosa was measured in the region of each implant (days 10, 30, and 90). After 90 days, a biopsy was harvested for histologic and immunohistologic analyses. To characterize newly formed soft tissue, the authors stained for tissue-and differentiation-specific markers, cytokeratin (CK) 5/6, 13, and 14, to detect presence or absence of keratinization., Results: The groups showed similar healing, with increased peri-implant keratinized mucosa. The CM group had overall significantly shorter operation times than the FGG group. Both groups showed similar overall shrinkage (32.98% CM versus 28.35% FGG). All biopsies showed a multilayered, keratinized, squamous epithelium. CKs 5/6 and 14 were detected in the basal and suprabasal layers, and spots of CK 13 were detected in the suprabasal layer., Conclusions: During the whole observation period, both groups showed comparable clinical and histologic outcomes. Within the limitations of the present study, CM seems to be a promising alternative for the regeneration of keratinized mucosa without tissue harvesting. Comparative long-term studies are needed to investigate changes over time.

Excessive soft tissue bulk, movement, chronic inflammation, and hypertrophy in periimplant areas pose challenges for long-term management of peri-implant soft tissues surrounding osteocutaneous flap reconstructions. A case history report is presented on the predictable establishment of stable peri-implant soft tissue and improved mentolabial sulcus depth in a patient treated for high-grade osteosarcoma of the mandible. Following surgical resection, reconstruction with osteocutaneous fibula free flap, and endosseous implant placement, a combined surgical and prosthetic approach was used through a lip switch vestibuloplasty and an implant-retained soft tissue conformer.

The paper presents short and long-term results of surgical treatment of 80 patients with insufficient attached gingiva. The procedures included vestibuloplasty and gingival plasty with perfluorane and free gingival and subepithelial connective tissue grafts. Proposed surgical treatment method with perfluorane proved to reduce the local inflammatory reaction greatly thus decreasing perioperative morbidity and increasing the long term efficacy of treatment.

Objective: Stereophotogrammetry (SPT) is a method in which three-dimensional coordinates are calculated from multiple two-dimensional projections. The purpose of this study was to compare the surface area changes between the secondary healing and grafting vestibuloplasty techniques in the mandible by using a stereophotogrammetric technique (SPT)., Patients and Methods: Thirteen patients were included in this study: six patients were managed by using full-thickness skin or palatal mucosa grafts (two full-thickness palatal mucosal grafts and four full-thickness skin grafts); the remaining seven patients, who did not accept a second surgery for graft harvesting, underwent secondary epithelization vestibuloplasties. Postoperative changes of surgical areas were measured by using SPT., Statistical Analyses: The Wilcoxon (intragroup comparisons) and Mann-Whitney U (intergroup comparisons) tests were used for analysis of data., Results: In the grafting vestibuloplasty group, the surface area gain was statistically significant (P < 0.05). In the secondary epithelization vestibuloplasty group, there was no significant difference (P > 0.05), with even decrease of surface area being noted in some cases., Conclusion: SPT is a valid method for measurement of intraoral soft tissue changes.

The need to cover the exposed periostium has meant that a number of materials including mucosal and skin grafts are regarded as suitable for grafting in oral and maxillofacial surgery. To circumvent the disadvantages of other materials such as skin, biological membranes have been suggested as options, including fetal membrane. The objective of the present study was to evaluate the clinical efficacy of amnion as a graft material for vestibuloplasty, to increase the depth of the sulcus for complete rehabilitation with dentures in 10 patients with a follow up period of 3 months. Ten patients with deficient depth of the mandibular vestibular sulcus who were referred from the Department of Prosthodontics were listed for mandibular labial vestibuloplasty using Clark's technique followed by grafting with amnion over the denuded periostium. The vestibular depth was evaluated at the end of the 1st week, 2nd week, 4th week, and 3rd month postoperatively, and compared with the preoperative vestibular depth. We had no cases of graft necrosis either complete or partial. However, the reduction in the depth of the labial vestibule ranged from 17% to 50% after 3 months' follow up. A mean (SD) labial vestibular depth of 13.3 (1.8)mm was achieved immediately postoperatively, and 10.0 (3.1)mm at 3 months' follow up. We conclude that grafts of amniotic membrane are viable and reliable for covering of the raw surface, prevent secondary contraction after vestibuloplasty, and maintain the postoperative vestibular depth., (Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of the present study was to compare the application of alloderm and mucosal graft for vestibuloplasty. This randomized controlled trial with split mouth design was carried out on 20 edentulous patients. Patients underwent vestibuloplasty surgery with the Clark technique. Half of the prepared bed in each patient was covered with alloderm and the other half with mucosal graft. Vestibule depth (width of fixed tissue) and relapse in the two sides immediately after surgery, and 1, 3 and 6 months after surgery were measured and compared. Statistical analysis was carried out using the Kolmogorov-Smirnov, Student's paired t and Friedman tests. The width of the fixed tissue in the alloderm graft at 1, 3 and 6 month intervals was significantly lower than that in the autograft (P<0.05). The difference in relapse between the two grafts was not statistically significant at any time. The results of the study suggest that alloderm is as effective as mucosal grafts in vestibuloplasty., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. All rights reserved.)

Prosthodontic rehabilitation of a surgically resected/reconstructed jaw with a conventional tissue-borne dental prosthesis is often challenging, if not impossible, because of the suboptimal conditions of the soft and hard tissue topography/architecture of the reconstructed site. Placing dental implants in grafted bone to provide appropriate support, stability, and retention for prosthodontic rehabilitation offers the potential for improved oral function. There are, however, some clinical conditions for which an implant-supported removable prosthesis may be preferred to a fixed implant prosthesis. This clinical report describes the design and fabrication of a milled bar and a tooth- and implant-supported removable dental prosthesis for oral rehabilitation of a reconstructed mandible, which considers patient factors associated with oral and financial conditions, ease of oral hygiene procedures, and long-term maintenance., (Copyright 2010 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Periodontal reconstructive surgery procedures seek to correct mucogingival defects, including gingival recession. This case report describes the use of a subepithelial connective tissue graft (SCTG) associated with root-end fillings using mineral trioxide aggregate (MTA) for the treatment of Miller Class II recession with root apex exposure. A partial-thickness double pedicle flap was made, followed by root preparation with curette and bur finishing. The exposed root apex was removed and the canal was filled with MTA. An SCTG taken from the palate was placed over the root surface and covered with the double pedicle flap. Twelve months after treatment, a reduction from 11 mm to 1 mm in gingival recession was achieved, covering 91% of the root. Repair in the periapical region was determined with radiographs. A 1.0-mm probing depth was measured, and no bleeding was observed on probing. There was an adequate keratinized tissue band, along with esthetic tissue contour and coloration. This case report serves as an example of how the grafting of subepithelial connective tissue can be successfully accomplished in tandem with MTA for the treatment of isolated Miller Class II gingival recession with root apex exposure. (Int J Periodontics Restorative Dent 2009;29:445-449.).

This study was designed to demonstrate the use of the relatively novel tunneling technique for root coverage with acellular dermal matrix (ADM) to treat Miller Class I and II gingival recession defects. Five subjects with two to five adjacent buccal gingival recession defects were treated with ADM using the tunneling technique for root coverage. A calibrated, blinded examiner measured clinical parameters, including probing depth, clinical attachment level, width of keratinized tissue, recession depth, recession width at 1 mm apical to the cementoenamel junction, gingival tissue thickness at 1 mm and 3 mm apical to the gingival margin, Plaque Index, Gingival Index, and Wound Healing Index, at different time intervals. Patient discomfort was recorded 14 days postoperatively, and an overall quality assessment was recorded 180 days postoperatively. Results showed an average of 61% defect coverage (equal to 93.5% root coverage), and a 0.15-mm gain in tissue thickness was achieved 1 year postoperatively. This suggested that root coverage with ADM using the tunneling technique can be a viable alternative to traditional techniques, especially for multiple recession defects in maxillary premolar and anterior teeth.

The dental treatment of HIV-positive individuals has undergone a change from the management of HIV-associated oral lesions to routine comprehensive dental care. To the authors' knowledge, this is the first report in which palatal soft tissue grafts were used for vestibuloplasty in an HIV-positive patient with a shallow mandibular vestibule. No adverse sequelae were seen during follow-up.

Background: Coverage of gingival recession defects has been considered as a subject of interest for dental practitioners., Aim: The present study was aimed to compare the clinical outcomes of root coverage (RC) procedures, using coronally advanced flap (CAF) in combination with acellular dermal matrix (ADM) with or without enamel matrix derivatives (EMD)., Materials and Methods: A total of 36 Miller class I or II recession defects in 15 eligible patients were selected. The defects were randomly allocated to test (CAF+ADM+EMD) and control (CAF+ADM) groups. Recession depth (RD), recession width (RW), width of keratinized tissue (WKT), clinical attachment level (CAL), and the position of mucogingival junction (MGJ) were measured at baseline, two and six months after treatment., Statistical Analysis: Data were analyzed using repeated measures ANOVA and paired sample t-test with the patients as statistical unit., Results: At two-month follow-up, the mean RC for CAF+ADM+EMD and CAF+ADM was 82.75 +/- 22 and 88.89 +/- 22 percent, respectively. However, these values did not change significantly after six months. Both treatments led to significant RC (P < 0.001), whereas no significant differences were observed in WKT, CAL, and MGJ between the study groups., Conclusion: The application of EMD does not improve the clinical efficacy of ADM in combination with CAF in RC procedures.

Connective tissue grafts have been used successfully in the treatment of gingival recession. In the mid 80s and late 90s, the periodontal literature presented various techniques such as free gingival grafts, pedicle flaps, subepithelial connective tissue grafts, acellular dermal matrix grafts, and guided tissue regeneration to cover denuded root surfaces. Currently, connective tissue grafting is a reliable treatment for esthetic root coverage. This paper presents a qualitative assessment of a surgical technique that uses a connective tissue graft, including a portion of epithelium in the shape of the defect. This procedure enhances the healing of the covered root surface, increases the thickness of the soft tissue and improves esthetics. The criteria used for evaluation were: color, volume, texture, and blending. This evaluation demonstrated encouraging results from an esthetic viewpoint.

Predictable and optimal coverage of exposed root surfaces is an important goal in periodontal plastic surgery. In this report, recession coverage was performed as laterally sliding flap technique with the adjunctive use of enamel matrix derivative (EMD). The cases of 2 female patients with gingival recession on the maxillary canines are presented with 1-year follow-up observation. Initial vertical gingival recessions were 4.0 mm each, with a probing depth of 1.0 mm. The surgical procedure immediately produced a marked reduction in gingival recessions. In the course of healing, the soft tissue margin on the operated teeth showed some shrinkage in the first months. After 1 year, complete root coverage (100%) was observed, with a probing depth of 0.5 mm and 5.0-mm gain of clinical attachment in both cases, and there was 0.5-mm creeping tissue above the cemento-enamel junction. Within the limits of these cases, the results demonstrated the possibility of treating human buccal recessions with EMD plus laterally sliding flap, with predictable root coverage and clinical attachment gain.

In implant patients who have extended soft tissue deficiencies, split skin grafts have been performed for the prevention of peri-implant inflammation. The aim of this investigation was to assess a patient who received 2 interforaminal implants and a split skin graft 13 years prior. In addition to clinical, mycologic, and radiographic examinations, the condition of the split skin graft was evaluated using histologic analysis of 3 punch biopsies taken from the mucosa, grafted area, and border between both areas. The implants were found to have an overall good clinical condition. Fungal infection was not present. The histologic analysis revealed inflammation-free mucosal and submucosal tissue in all samples. In the area of the skin graft, the mucosa was not keratinized and showed an increased thickness of the submucosal connective tissue. For the patient under examination, an acceptable level of oral rehabilitation was achieved using a split skin graft. The follow-up investigation showed stable conditions for both the implants and the graft.

Purpose: Oral rehabilitation of resected tumor patients often requires, besides the use of dental implants, the improvement of the soft tissue condition. In this clinical report, we describe a simple and effective surgical and prosthetic treatment procedure to achieve adequate long-term soft tissue conditions., Materials and Methods: Seventeen tumor patients were selected for this evaluation. A total of 68 implants were placed in the mandible. At implant placement, a closed impression was taken from the implants for the fabrication of an implant-retained surgical splint. At second-stage surgery, vestibuloplasty by use of a split-thickness skin graft from the upper thigh was performed and an implant-retained splint was positioned. Pocket depths at the implants and the size of the graft were monitored over a period of 2 years. Statistical analysis by use of nonparametric 2-factorial analyses for repeated measures was performed., Results: The mean mesial and distal pocket depths remained stable and measured 2.56 mm and 2.64 mm, respectively, at 24 months postoperatively. The graft showed an overall shrinkage of 18.5% in the vertical direction and 10.4% in the horizontal direction after 24 months. The shrinkage of the vertical direction compared with the horizontal direction showed a significant difference (P= .035). The shrinkage tendency was less than that described in the literature., Conclusions: The applied method described an easy, sufficient surgical procedure that minimizes shrinkage and creates a denture-bearing area that is stable over the long term, thus representing an improvement over previous methods.

Purpose: To evaluate the long-term outcome of simultaneous split thickness skin graft (STSG) vestibuloplasty and endosseous implant placement for implant-supported overdentures in patients with shallow mandibular vestibules., Patients and Methods: This was a retrospective evaluation of 13 consecutive white male patients who underwent simultaneous mandibular vestibuloplasty with STSG combined with placement of 2 to 4 mandibular endosseous implants for construction of an implant-supported mandibular overdenture with a minimum of 2-year follow-up. Patients' charts were evaluated for implant survival and prosthetic success., Results: Thirteen male patients at an average age of 60.4 years who had undergone simultaneous STSG mandibular vestibuloplasty and endosseous implant placement in the anterior mandible, were followed for an average of 43 months and were retrospectively evaluated. A total of 40 implants (average of 3 implants per patient) were placed in the anterior mandible in preparation for an implant-supported overdenture placement. There were no complications in graft or recipient sites, implant placement, or overdenture construction. The endosseous dental implant integration rate was 97.5% and the prosthetic success rate was 100%., Conclusion: Simultaneous STSG mandibular vestibuloplasty for vestibular lengthening and placement of mandibular endosseous implants in preparation for mandibular implant-supported overdentures is a reliable method in patients with shallow mandibular vestibules.

Background: The aim of this study was to evaluate clinically, histologically, and ultrastructurally the integration process of the acellular dermal matrix used to increase the band of keratinized tissue while achieving gingival inflammation control., Methods: Ten patients exhibiting a mucogingival problem with bands of keratinized tissue

This study compared the results following treatment of gingival recessions by a coronally advanced flap procedure alone (CAF) or combined with a bioabsorbable membrane and a demineralized xenograft (GTRF). Sixteen nonsmokers with 20 Miller Class I or Class II buccal gingival recessions at canines or premolars were included in the study. Sites were randomly assigned to either CAF treatment (control, n = 10) or GTRF treatment (test, n = 10) and examined at baseline and at 6 months postoperatively. Both treatments resulted in a significant reduction in recession and gain in clinical attachment level; there was no significant difference between treatments. No differences were found in probing depths among or between the groups. The increase in keratinized tissue from baseline to 6 months was slightly greater for the GTRF group than for the CAF group, but without statistical significance. The test group experienced a statistically significant increase in gingival thickness from baseline to the 6-month evaluation, while little gain was detected in the control group; the between-group difference was statistically significant in favor of the test group. Both procedures offer a predictable, simple, and convenient means of root coverage in Miller Class I and II recession defects, but the GTRF-supported procedure resulted in more keratinized tissue and a significant increase in gingival thickness than the CAF-only approach.

This case report describes a technique that uses a palatal mucosal graft and an acrylic resin postoperative stent in an attempt to increase the layer of keratinized tissue around osseointegrated implants in an atrophic mandible. During second-stage surgery, a split-thickness labial flap is reflected and apically repositioned by being sutured onto the periosteum and connective tissue. A palatal mucosal graft is then sutured onto the recipient site. The stent is worn for at least 4 weeks following surgery. This procedure helps to eliminate mobility of the mucosa in the area, deepen the vestibule, and prevent muscle reinsertion.

Background: Severely resorbed mandibles often present a short band of keratinized tissue associated with a shallow vestibule. As a result, prominent muscle insertions are present, especially in the mental region of the mandible. This case report describes the deepening of the vestibular sulcus in an atrophic mandible by combining free gingival grafts harvested from the palate and a postoperative acrylic resin stent screwed on osseointegrated implants placed at the anterior region of the mandible., Study Design: During the second-stage surgery, a split-thickness labial flap was reflected and apically sutured onto the periosteum. Two free gingival grafts were obtained and then sutured at this recipient site. A previously custom-made acrylic stent was then screwed onto the most distally positioned implants. To document the procedure's stability over time, a metal ball was placed in the most apical part of the vestibule and standardized cephalometric radiographs were taken before and 6 months after the procedure. Linear measurements of vestibular depths over the observation time were realized using specific software for radiographic analysis., Results: The proposed technique augmented the band of attached masticatory mucosa, deepened the vestibule and prevented the muscle reinsertion. The difference between the 2 measurements of vestibular depths was 9.39 mm (initial 20.88 mm, final 11.49 mm) after a 6-month postoperative period., Conclusion: The technique, in combination with palatal mucosal graft and use of a postoperative stent, decreased the pull of mentalis muscle and provided a peri-implantally stable soft tissue around implants.

The frenum exerts a pull upon the tissue and can lead to the continuation of the lesion, and the keratinized tissue provides increased resistance to the periodontium. Various techniques have been used to deepen the vestibule and increase the keratinized mucosa. However, there is no case report on correcting the frenal pull and increasing the keratinized mucosa around dental implant using denudation procedure. This article presents a case of frenal pull that was corrected with denudation procedure with the incision line within the keratinized tissue.

We describe a combination of 3 surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity and quality. In these situations, we have performed 3 minimally invasive, safe, and reliable surgical procedures: buccal bone graft with bone harvested from the mandibular molar region, submucous vestibuloplasty using artificial dermis, and bone-added osteotome sinus floor elevation under endoscopic control. These modified procedures can be performed in the office setting under outpatient local anesthesia and may minimize patient discomfort and reduce postoperative complications.

Aim: To evaluate the healing outcome of soft tissue dehiscence coverage at implant sites., Material and Methods: Ten patients with one mucosal recession defect at an implant site and a contralateral unrestored clinical crown without recession were recruited. The soft tissue recessions were surgically covered using a coronally advanced flap in combination with a free connective tissue graft. Healing was studied at 1, 3 and 6 months post-operatively., Results: Soft tissue dehiscences were covered with a coronal overcompensation of the flap margin up to 1.2 mm after the procedure. After 1 month, the coverage shrank to a mean of 75%, after 3 months to 70% and after 6 months to 66%., Conclusions: The implant sites revealed a substantial, clinically significant improvement following coronal mucosal displacement in combination with connective tissue grafting, but in none of the sites, a could complete implant soft tissue dehiscence coverage be achieved.

The lower labial frenum attached to the free gingival margin can promote local tension, resulting in tissue ischemia, promoting the development of gingival recession, as well as complicating oral hygiene, resulting in a local biofilm accumulation and chronic inflammation. In such cases, periodontal surgery is recommended and the local anatomic characteristics will be improved as early as school age. In this case report, a 7 years old patient had the lower labial frenum repositioned. After this procedure, the suture of the mucosa to the periosteum was performed around the surgical wound to provide local healing by secondary intention. This case report suggests that early diagnosis and surgical treatment of the lower labial frenum in school age children is fundamental in eliminating etiological factors, reestablishing normal anatomic characteristics and preventing periodontal diseases.

Background: Subepithelial connective tissue grafts (CTGs) and free gingival grafts (FGGs) are common periodontal procedures with similar indications; however, they may differ regarding patient outcomes. Reports on postoperative periodontal patient outcomes are limited. The aim of this observational trial was to compare patient-based outcomes for CTGs and FGGs., Methods: Patients who received CTG or FGG completed postoperative questionnaires at 3 days and 3 weeks to assess pain, number of analgesic pills taken, and number of days pills were taken. Postoperative pain was assessed using a visual analog scale (VAS)., Results: Twenty-three subjects (12 CTGs and 11 FGGs) completed the study. Differences between CTG and FGG groups in VAS pain scores at 3 days did not reach statistical significance. The proportion of subjects reporting pain in the palate at 3 days was significantly greater for FGG (P <0.05). There were no significant intergroup differences at 3 weeks. For the FGG group, 3-week VAS pain scores were less than the 3-day ones (P <0.01). For the entire study population, the number of days analgesic pills were taken, total number of analgesic pills taken, and number of pills taken from day 3 to the end of the study correlated with the 3-week pain scores., Conclusions: FGG is associated with a greater incidence of donor site pain compared to CTG at the early postoperative period. Longer-term pain after soft tissue grafting is associated with greater analgesic usage. There is an opportunity to improve the postoperative protocols of soft tissue grafting, particularly for FGG.

This clinical report describes the management of chronic, proliferative inflammatory epithelial and fibrous hyperplasia following loss of a mandibular implant-retained prosthesis. A classic surgical technique was used. The patient was referred to the oral surgeon for sialodochoplasty and sulcoplasty. With a combination of surgery and prosthodontic management with a conforming surgical stent, a satisfactory denture foundation was created, allowing for fabrication of an implant-retained definitive prosthesis.