Advertising feature Delegates head to London to learn about the latest advances in soft tissue management
From treatment planning to clinical application
M
ore than ı30 delegates from all over the UK gath- ered to learn
about the latest advances in soft tissue management at the recent Osteology Sympo- sium London: Soft tissue management – from treatment planning to clinical application. Chaired by Professor Nikolaos Donos and Professor Mariano Sanz, the event featured an international faculty of experts who gave a series of scientific lectures and workshops. Several surgical techniques
can be used for periodontal plastic surgery to treat gingival recession and lack of kerati- nised tissues around the teeth or implants. Prof Donos outlined the options available and reviewed the evidence on success rates.
Soft tissue management around implants The most frequent soft tissue problems around implants are mucosal recessions, and areas of lack of keratinised tissue that may compromise mucosal stability. The gold standard for the treatment is auto- graft surgery. However, these techniques involve a second surgical site for harvesting the graft material, with a consequent increase in post- operative pain and morbidity. Allografts with soft tissue substitutes eliminate the need for a second surgical site, and studies show that patients generally experience lower levels of post-operative pain and reduced need for anal- gesia. Soft tissue substitutes are available in the form of cadaver-derived tissue (Allo- derm, LifeCell Corp) or
in terms of reducing patient morbidity and shorter surgical times, he said.
three-dimensional matrix of porcine type I collagen (Muco- graft, Geistlich Biomaterials). The efficacy of Mucograft
in augmenting the keratinised tissue around implants was assessed in a randomised controlled trial recently published by Prof Sanz and his teamı. The patients treated with Mucograft reported less pain, needed less pain medi- cation, and the surgical time was shorter, although these differences did not achieve statistical significance. The study concluded that Muco- graft was as effective and predictable as CTG for attaining a band of keratinised tissue around implants.
Covering multiple gingival recessions Predictable coverage of multiple gingival recession still presents a challenge, said Professor Anton Sculean of the University of Bern. The more extensive the recession, the less likely it is that treatment will achieve ı00 per cent root coverage. Recessions wider than 3mm and those 5mm deep or greater are less likely to have favourable results. “For successful root coverage you must select the right tech-
nique for the right patients,” Prof Sculean emphasised. The data from longitudinal
or randomised controlled studies are limited, but indi- cate that various modifications of the coronally advanced flap may give improved reces- sion depth, better clinical attachment and improved thickness and stability of soft tissue. The thicker the flap and the lower the tension on the flap, the better the result. Prof Sculean reviewed recent data on use of the modified coronally advanced tunnel, known as MCAT. This tech- nique, combined with enamel matrix derivative, connective tissue graft or collagen-based tissue substitutes (Mucograft), has recently been shown to produce predictable coverage of multiple recessions in Miller class I and II. The literature to date shows lower rates of complete root coverage with Mucograft compared with CTG, but Mucograft may represent a valuable alternative
REFERENCES
1 Lorenzo et al, Clin Oral Implants Res 2012, 23:316-24
2Horvath et al., Clin Oral Investig 2012, Jul 20, Epub ahead of print
Techniques for soft tissue management after tooth extraction What is the place of alveolar ridge preservation (ARP) after tooth extraction, and how predictable and effective is it? Is ARP a valid treatment modality, or is it over-treatment? We still only have partial answers to these questions, said Dr Nikos Mardas of UCL Eastman Dental Institute, London. The tooth socket heals like any other bony defect, with socket remodelling and growth of lamellar bone evident at 30 days post-extraction. Alveolar atrophy occurs and the alveolar ridge is lost, though the extent of atrophy does vary. A newly published systematic
review by the Eastman Perio- dontology group examined the effects of ARP compared with unassisted socket healing2. The authors concluded that post- extraction resorption of the alveolar ridge might be limited, but cannot be eliminated by ARP. Randomised controlled trials with unassisted socket healing and implant placement are needed. A comprehensive list of indications and contrain- dications for ARP has yet to be developed Dr Mardas said. A soft tissue ‘socket seal’
may promote better outcomes with ARP, but more evidence is needed to confirm this. Dr Mardas said that, in his opinion, it was indicated in patients who are willing to wait for treatment, in cases where implants are not going to be placed, and in cases where high levels of resorption are expected.
Scottish Dental magazine 37
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