Journal of Periodontal and Implant Science

Korean Academy of Periodontology (대한치주과학회)
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A retrospective comparison of 3 approaches of vestibuloplasty around mandibular molar implants: apically positioned flap versus free gingival graft versus modified periosteal fenestration

  • Lee, Won-Pyo (Department of Periodontology, School of Dentistry, Chosun University) ;
  • Lee, Kyoung-Hoon (Department of Periodontology, School of Dentistry, Chosun University) ;
  • Yu, Sang-Joun (Department of Periodontology, School of Dentistry, Chosun University) ;
  • Kim, Byung-Ock (Department of Periodontology, School of Dentistry, Chosun University)
  • Received : 2020.11.19
  • Accepted : 2021.05.28
  • Published : 2021.10.30
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Abstract

Purpose: This study aimed to clinically evaluate the efficacy of vestibuloplasty around lower molar implants using 3 different modalities: apically positioned flap alone (APF), APF with a free gingival graft (FGG), and APF with modified periosteal fenestration (mPF). Methods: Three different vestibuloplasty procedures during second-stage implant surgery were performed at the mandibular molar area in 61 patients with a shallow vestibule and insufficient keratinized tissue (KT). The clinical measurements of KT width were recorded at baseline, immediately after surgery (T0), 6 months after surgery (T6), and 12 months after surgery (T12). Soft tissue esthetic scores were measured. Results: An additional KT width gain from baseline to T12 of approximately 2 mm was obtained with FGG and mPF compared to that with APF. Shrinkage of the re-established tissue was lower with mPF and FGG than with APF, whereas the esthetic profile was better with APF and mPF than with FGG. Conclusions: Within the limitations of this study, mPF showed potential as a promising approach for vestibuloplasty around the lower molar implants compared to the traditional APF and FGG.

Keywords

Acknowledgement

The authors thank Dong-Su Lee (Professor, Department of Computer Science and Statistics, Chosun University, Gwangju, Korea) for statistical consulting and some of the data analysis.

References

  1. Longoni S, Tinto M, Pacifico C, Sartori M, Andreano A. Effect of peri-implant keratinized tissue width on tissue health and stability: systematic review and meta-analysis. Int J Oral Maxillofac Implants 2019;34:1307-17. https://doi.org/10.11607/jomi.7622
  2. Kungsadalpipob K, Supanimitkul K, Manopattanasoontorn S, Sophon N, Tangsathian T, Arunyanak SP. The lack of keratinized mucosa is associated with poor peri-implant tissue health: a cross-sectional study. Int J Implant Dent 2020;6:28. https://doi.org/10.1186/s40729-020-00227-5
  3. Tavelli L, Barootchi S, Avila-Ortiz G, Urban IA, Giannobile WV, Wang HL. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: a systematic review and network meta-analysis. J Periodontol 2021;92:21-44. https://doi.org/10.1002/JPER.19-0716
  4. Dalago HR, Schuldt Filho G, Rodrigues MA, Renvert S, Bianchini MA. Risk indicators for peri-implantitis. A cross-sectional study with 916 implants. Clin Oral Implants Res 2017;28:144-50.
  5. Romandini M, Lima C, Pedrinaci I, Araoz A, Soldini MC, Sanz M. Prevalence and risk/protective indicators of peri-implant diseases: a university-representative cross-sectional study. Clin Oral Implants Res 2021;32:112-22. https://doi.org/10.1111/clr.13684
  6. Allen PF, McMillan AS. A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures. Clin Oral Implants Res 2003;14:173-9. https://doi.org/10.1034/j.1600-0501.2003.140206.x
  7. Heberer S, Nelson K. Clinical evaluation of a modified method of vestibuloplasty using an implantretained splint. J Oral Maxillofac Surg 2009;67:624-9. https://doi.org/10.1016/j.joms.2008.09.029
  8. Kao SY, Yeung TC, Hung KF, Chou IC, Wu CH, Chang RC. Transpositioned flap vestibuloplasty combined with implant surgery in the severely resorbed atrophic edentulous ridge. J Oral Implantol 2002;28:194-9. https://doi.org/10.1563/1548-1336(2002)028<0194:TFVCWI>2.3.CO;2
  9. Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol 2013;84:1755-67. https://doi.org/10.1902/jop.2013.120688
  10. Halperin-Sternfeld M, Zigdon-Giladi H, Machtei EE. The association between shallow vestibular depth and peri-implant parameters: a retrospective 6 years longitudinal study. J Clin Periodontol 2016;43:305-10. https://doi.org/10.1111/jcpe.12504
  11. Friedman N. Mucogingival surgery: the apically repositioned flap. J Periodontol 1962;33:328-40. https://doi.org/10.1902/jop.1962.33.4.328
  12. Bjorn H. Free transplantation of gingival propria. Odontol Revy 1963;14:323.
  13. Schmitt CM, Moest T, Lutz R, Wehrhan F, Neukam FW, Schlegel KA. Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft®) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Implants Res 2016;27:e125-33. https://doi.org/10.1111/clr.12575
  14. Hillerup S. Healing reactions of relapse in secondary epithelization vestibuloplasty on dog mandibles. Int J Oral Surg 1980;9:116-27. https://doi.org/10.1016/s0300-9785(80)80048-2
  15. Froschl T, Kerscher A. The optimal vestibuloplasty in preprosthetic surgery of the mandible. J Craniomaxillofac Surg 1997;25:85-90. https://doi.org/10.1016/S1010-5182(97)80050-9
  16. Robinson R. Periosteal fenestration in mucogingival surgery. J West Soc Periodont 1961;9:107-11.
  17. Corn H. Periosteal separation-its clinical significance. J Periodontol 1962;33:140-53. https://doi.org/10.1902/jop.1962.33.2.140
  18. Wilderman MN. Repair after a periosteal retention procedure. J Periodontol 1963;34:487-503. https://doi.org/10.1902/jop.1963.34.6.487
  19. Yadav N, Khattak BP, Misra S, Sharma A. Comparative evaluation of the relative efficacy of the free mucosal graft and periosteal fenestration for increasing the vestibular depth - a clinical study. Contemp Clin Dent 2014;5:366-70. https://doi.org/10.4103/0976-237X.137951
  20. Lee WP, Kwon YS. Vestibuloplasty around dental implants using modified periosteal fenestration (mPF): case series. Implantology 2020;24:22-30. https://doi.org/10.32542/implantology.202003
  21. Thoma DS, Alshihri A, Fontolliet A, Hammerle CHF, Jung RE, Benic GI. Clinical and histologic evaluation of different approaches to gain keratinized tissue prior to implant placement in fully edentulous patients. Clin Oral Investig 2018;22:2111-9. https://doi.org/10.1007/s00784-017-2319-4
  22. Lim HC, An SC, Lee DW. A retrospective comparison of three modalities for vestibuloplasty in the posterior mandible: apically positioned flap only vs. free gingival graft vs. collagen matrix. Clin Oral Investig 2018;22:2121-8. https://doi.org/10.1007/s00784-017-2320-y
  23. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22:276-82. https://doi.org/10.11613/BM.2012.031
  24. Basegmez C, Ersanli S, Demirel K, Bolukbasi N, Yalcin S. The comparison of two techniques to increase the amount of peri-implant attached mucosa: free gingival grafts versus vestibuloplasty. One-year results from a randomised controlled trial. Eur J Oral Implantology 2012;5:139-45.
  25. Eufinger H, Gellrich NC, Sandmann D, Dieckmann J. Descriptive and metric classification of jaw atrophy. An evaluation of 104 mandibles and 96 maxillae of dried skulls. Int J Oral Maxillofac Surg 1997;26:23-8.
  26. Ueno D, Nagano T, Watanabe T, Shirakawa S, Yashima A, Gomi K. Effect of the keratinized mucosa width on the health status of periimplant and contralateral periodontal tissues: a cross-sectional study. Implant Dent 2016;25:796-801. https://doi.org/10.1097/ID.0000000000000483
  27. Chiu YW, Lee SY, Lin YC, Lai YL. Significance of the width of keratinized mucosa on peri-implant health. J Chin Med Assoc 2015;78:389-94. https://doi.org/10.1016/j.jcma.2015.05.001
  28. Schrott AR, Jimenez M, Hwang JW, Fiorellini J, Weber HP. Five-year evaluation of the influence of keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clin Oral Implants Res 2009;20:1170-7. https://doi.org/10.1111/j.1600-0501.2009.01795.x
  29. Bassetti RG, Stahli A, Bassetti MA, Sculean A. Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review. Clin Oral Investig 2017;21:53-70. https://doi.org/10.1007/s00784-016-2007-9
  30. Thoma DS, Buranawat B, Hammerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol 2014;41 Suppl 15:S77-91.
  31. Urban IA, Lozada JL, Nagy K, Sanz M. Treatment of severe mucogingival defects with a combination of strip gingival grafts and a xenogeneic collagen matrix: a prospective case series study. Int J Periodontics Restorative Dent 2015;35:345-53.