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Dental Tribune Middle East & Africa Edition

33Dental Tribune Middle East & Africa Edition | January - February 2014 implant tribune Soft Tissue Engineering With Native Collagen Matrixes By Dr. Hueskens M ucogingival sur- gery can be divid- ed into four objec- tives: - Increase of keratinized tissue around teeth and implants - Cover denuded root surfaces - Augmentation of papillae - Regeneration procedures as ridge augmentation. All these indication have been treated in the past with free gingival, or connected tissue grafts harvested from the pa- tients palate[1]. The fact that a second surgical site is neces- sary and that due to complica- tions as bleeding or pain- the procedure is not very comfort- able for the patient it is often refused. The amount of har- vested soft tissue material is very limited too.[2] Therefore the use of xenogenous materi- als can be an very interesting alternative and was well inves- tigated in the past [3] Since 2010 we have now three years of experience with colla- gen matrixes from native ori- gin (MucoMatrixX, Dentegris Germany). These matrixes are 1.2 to 1.7 in thickness and are available in the dimensions 15X20 mm, 20X30 mm and 30X40mm. As they come in a dry state they have to be rehy- drated before use. Therefore the MucoMatrixX is hydrated with sterile, physiological sa- line solution for about ten min- utes. It is bendable, sutureable and it can be shaped, both with scalpel or scissors. The matrix has two sides, one that shows little cuts is the bottom side, the upper side shows little pores. The time of resorption is six to twelve month. In the following cases we show how the collagen matrix works as a perfect substitute for both, free gingival and connected tissue graft. Case one: Increase of kerati- nized tissue around teeth. In the sequence is shown how a matrix is sutured on a recipi- ent site in region 45 to 47 (1a). Therefore a horizontal inci- sion at the mucogingival junc- tion is placed followed by a mucosal flap preparation.(1b) The fixation of the matrix was made by some single sutures that can be removed after four days post operation because of the fast revascularization of the graft (1c). The next pic- tures show the site after two weeks (1d) and six month post operation(1e). A perfect result of enlarging the keratinized tissue could be achieved. Case two. Root coverage. In this sequence is shown how the matrix is used to substi- tute a connected tissue graft to serve in a root coverage proce- dure in region 33 to 36 (2a) In this case the incision follows the sulkus and a mucosal flap (without lateral incisions), is performed (2b). A MucoMa- trixX in fitting shape is brought in. After coronal reposition- ing of the flap, it is fixed with vertical matrass sutures (2c). Picture 2d showing healing after three weeks, 2e after two years. Region 33 showing start- ing keratinization. Case three. Soft tissue ridge augmentation including re- inforcement of the distal and mesial papilla. This sequence shows the re- construction of the resorbed ridge after an extraction of tooth 12, due to a bridge 13 to 11 and 21 (3a). In this case af- ter a palatal incision a mucosal flap is prepared and enlarged direction labia (3b). Two layers of the matrix are positioned under the flap and the sutures fixing the flap (3c). The provi- sional shows the good primary success in reconstruction of the defect (3d/3e). The docu- mentation of the following healing period showing a per- fect long term treatment suc- cess. Remarkable is the gain of the papilla from picture 3g to picture 3h. Case four. Closure of the socket during an immediate implant placement proce- 1a 1b 1c 1d 1e > Page 40 2a 2b 2c 2d 3a 3b 3c 3d 2e

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