Soft-tissue augmentation procedure with the use of a collagen matrix

Soft-tissue Regeneration

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Dr. Martina Stefanini, DDS, PhD

Soft-tissue augmentation procedure with the use of a collagen matrix

The Situation A 65-year-old male patient comes to our attention ­reporting a change in position and mobility of element 1.1.

The s­ ystemic medical history reports that he is suffering from type II diabetes mellitus and that he is on anticoagulant therapy due to atrial fibrillation. He does not smoke.

55% of the sites have plaque, and bleeding on probing is ­positive in 60% of the sites. The full intraoral x-ray set shows ­generalized h ­ orizontal bone resorption, and a final ­diagnosis of ­periodontitis stage 3 grade b is done.

The Risk Profile Low Risk

Medium Risk

High Risk

Patient’s health

I ntact immune system/ Non-smoker

Light smoker

I mpaired immune system/ Heavy smoker

Patient’s esthetic requirements

Low

Medium

High

Height of smile line

Low

Medium

High

Gingival biotype

Thick – “low scalloped”

Medium – “medium scalloped”

Thin – “high scalloped”

Shape of dental crowns

Rectangular

Infection at implant sight

None

Chronic

Acute

Bone height at adjacent tooth site

≤ 5 mm from contact point

5.5 –6.5 mm from contact point

≥ 7 mm from contact point

Restorative status of adjacent tooth

Intact

Width of tooth gap

1 tooth (≥ 7 mm)

Soft-tissue anatomy

Intact

Bone anatomy of the alveolar ridge

No defect

Triangular

Restored 1 tooth (≤ 7 mm)

2 teeth or more Compromised

Horizontal defect

Dr. Martina Stefanini, DDS,PhD Graduated in 2005 from the University of Bologna, Italy with a degree in dentistry She was awarded PhD in Medical Sciences in 2016 from the University of Bologna, Italy Since 2018 Researcher at the Departement of Biomedical and ­Neuromotor sciences, Bologna University. Since 2012 active member of the Italian Society of Periodontology (SIDP) Member of the NOGI (National Osteology Group Italy) Author of several publications in Pubmed and co-author of the book, ­Mucogingival esthetic surgery around implants, Zucchelli G. & Mazzotti C.

Vertical defect

“Soft-tissue augmentation procedure in a single edentulous ridge improves the esthetics of the prosthetic rehabilitation.

Geistlich Fibro-Gide® allows a stable increase in soft-tissue thickness, reducing the need for the palatal harvesting technique.”

1

2a

2b

The Approach 2c

4a

3

4b

4c

The aim of the therapy is to resolve the ­inflammatory signs in the whole mouth and the mucositis. ­Element 1.1 is should be e­ xtracted and rehabilitated with a prosthetic solution to ­restore both ­function and esthetics. A ­soft-­tissue ­augmentation p ­ rocedure with the use of Geistlich Fibro-Gide® will recreate the volume of the ­edentulous area ­improving the esthetics and the cleanability of the restoration.

The Outcome 5

6a

6b

7b

7a

7c

8a

8c

10a

The soft-tissue augmentation technique with coronally advanced flap, associated with a ­ ­collagen matrix allowed us to obtain a s­ ignificant increase in the volume of soft t­issues in the edentulous area with minimally ­invasive surgery.

Through the subsequent c­onditioning of the ­tissues, it was possible to obtain a s­ atisfactory esthetic result and adequate emergence profiles of the prosthetic rehabilitation.

7b

9

10b

1 Baseline clinical situation. | 2 Etiological treatment of the mucositis: supra and subgingival scaling with local antibiotics application. | 3 Provisional rehabilitation after tooth extraction. | 4 Clinical and r­ adiographic situation 6 months after tooth extraction. | 5 Elevation of split thickness and coronally advanced envelope to cover the collagen matrix positioned on the buccal aspect of the edentulous area. | 6 First intention wound healing closure. Short provisional restoration not in contact with the soft tissue. | 7 14 days post operative situation. | 8 9 months follow up pictures during undisturbed soft-tissue maturation. | 9 Soft-tissue conditioning phase through a new provisional restoration. | 10 Delivery of the definitive ­restoration. Note the soft-tissue increase obtained with the Geistlich F­ ibro-Gide® under the coronally advanced flap.

Keys to Success More details about our distribution partners: www.geistlich-biomaterials.com Manufacturer Geistlich Pharma AG Business Unit Biomaterials Bahnhofstrasse 40 6110 Wolhusen, Switzerland Phone +41 41 492 55 55 Fax +41 41 492 56 39 www.geistlich-biomaterials.com Affiliate Australia and New Zealand Geistlich Pharma Australia Pty Ltd. The Zenith – Tower A Level 21, Suite 21.01 821 Pacific Highway NSW 2067 Chatswood, Australia Phone +61 1800 776 326 Fax +61 1800 709 698 info@geistlich.com.au www.geistlich.com.au

Soft-tissue maturation after tooth extraction Flap management: coronally advanced flap Geistlich Fibro-Gide® collagen matrix to increase soft-tissue thickness First intention wound healing Prosthetic conditioning of the soft tissue after maturation Tailored periodontal supportive treatement

Geistlich Fibro-Gide® in association with coronally ­advanced flap is a safe procedure to increase soft-tissue volume in the edentulous.

Affiliate Great Britain and Ireland Geistlich Sons Limited 1st Floor, Thorley House Bailey Lane Manchester Airport Manchester M90 4AB, Great Britain Phone +44 161 490 2038 Fax +44 161 498 6988 info@geistlich.co.uk www.geistlich.co.uk

Distribution Canada HANSAmed Ltd. 2830 Argentia Road Unit 5–8 L5N 8G4 Mississauga, Canada Phone +1 800 363 2876 Fax +1 800 863 3213 orders@hansamed.net www.hansamed.net

REFERENCES 1

Marzadori M, Stefanini M, Mazzotti C, Ganz S, Sharma P, Zucchelli G. Soft-tissue augmentation procedures in edentulous esthetic areas. 2018 Jun;77(1):111-122.

2

Sanz-Martın I, Sailer I, Hammerle CH, Thoma DS. Soft tissue stability and volumetric changes after 5 years in pontic sites with or without soft tissue grafting: a retrospective cohort study. Clin Oral Implant Res 2016: 27 (Suppl. 8): 969–974.

3

Zucchelli G, Mazzotti C, Bentivogli V, Mounssif I, Marzadori M, Monaco C. The connective tissue platform technique for soft tissue augmentation. Int J Periodontics Restorative Dent 2012: 32 (Suppl. 6): 665–675.

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