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Clinical and histologic evaluation of different approaches to gain keratinized tissue prior to implant placement in fully edentulous patients


Thoma, Daniel S; Alshihri, AbdulMonem; Fontolliet, Alain; Hämmerle, Christoph H F; Jung, Ronald E; Benic, Goran I (2018). Clinical and histologic evaluation of different approaches to gain keratinized tissue prior to implant placement in fully edentulous patients. Clinical Oral Investigations, 22(5):2111-2119.

Abstract

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.

Abstract

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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Center for Dental Medicine > Clinic for Fixed and Removable Prosthodontics
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2018
Deposited On:27 Feb 2018 19:01
Last Modified:11 May 2018 01:02
Publisher:Springer
ISSN:1432-6981
Additional Information:This is a post-peer-review, pre-copyedit version of an article published in Clinical Oral Investigations. The final authenticated version is available online at: https://doi.org/10.1007/s00784-017-2319-4
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s00784-017-2319-4
PubMed ID:29273847

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