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Dental Tribune Canada Edition No.2, 2016

APRIL 2016 — Vol. 4, No. 2 IMPLANT TRIBUNE The World’s Dental Implant Newspaper · Canada Edition Graft lets surgeon improve gums’ support for existing implants Dental implants are usually needed when teeth are lost because of gum dis- ease or injury to the soft tissues that sup- port and protect the teeth. These same problems can affect the soft tissue that protects dental implants. These clinical soft-tissue issues can make it a challenge to place fixed dentures or crowns. An article in a recent issue of the Journal of Oral Implantology explains how a new- er type of xenograft can help improve the existing soft-tissue support for existing dental implants. A stent helps the oral surgeon properly place a soft-tissue graft that ensures the soft tissue stays in its de- sired position during the first few days of healing. It’s best to augment soft tissue before placing dental implants, but this is not always possible. The oral surgeon may discover after the implant surgery that additional soft tissue is required. Several types of soft-tissue grafts made of tissue from humans or another species, such as domestic pig, can be used. The author of this article used a porcine collagen xeno- graft to augment the existing soft tissue. Other researchers have studied the col- lagen xenograft and found it to be as ef- fective as other graft materials. However, previous studies typically used porcine collagen xenograft with natural teeth, not dental implants. The article outlines the process used to augment the gingival soft tissue of 11 patients who had fixed partial dentures or splinted crowns. All patients under- went the same procedure. The surgeon removed the stents five to seven days post-surgery and checked for healing. In the subsequent four to 12 weeks, the sur- geon evaluated how well the soft tissue had healed. In all cases, the surgeon controlled bleeding early-on to avoid the collec- tion of blood under the stent. The author placed the xenograft to cover the surgical wound, and then strategically placed a stent made of a bis-acryl material and quickly shaped the material before it hardened. The author noted the import- ance of using a piece of collagen that is 8 to 10 mm wide and as long as needed to fill the surgical wound. Narrower collagen pieces did not create enough supporting tissue for the implants. All patients healed uneventfully. How- ever, the new soft tissue was not the thick, protective type of keratinized tissue that ” See GRAFT, page B2 From the Journal of Oral Implantology Fig. 4: Bleeding is controlled with a saturated aqueous tranexamic acid tamponade. Fig. 5: Festooned segment of porcine collagen fits into the wound and is covered with the bis-acryl before the collagen becomes saturated with blood. Fig. 6: The bis-acryl is gingerly placed over the site directly from the mixing gun. The tip is cut and flattened to produce a ribbon of material to cover the site without significant creases or surface cavities.Fig. 7: Site at the first post-op week. Fig. 8: Site at eight post-op months. Photos and chart/Provided by Dr. Dennis Flanagan and the Journal of Oral Implantology Fig. 9: A maxillary left posterior site at one postoperative week (Patient JK). Fig. 1o: The maxillary left posterior site at 19 postoperative months. The tissue appears to be and seems to function as attached gingiva. Fig. 1: Implant-supported crowns with inadequate facial immobile tissue (Patient TW). Fig. 2: The facial mucosa is demonstrated with compression using a probe. Fig. 3: A partial-thickness surgical wound is created to accept the porcine collagen.

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