Soft tissue augmentation P-SU-033 with a collagen-based 3D ... · dental implant surgery, soft...
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IMPLANT THERAPY OUTCOMES; SURGICAL ASPECTS Presented at • 45 patients (20 male, 25 female, mean age 41.3 ± 13.07 years) received 50 implants and were followed for 1.8 ± 1.3 years (range: 3 months - 4.5 years) • Stable peri-implant tissue volume from pre-op to post-op independent of the time of follow-up (n=26 sites; -0.15 ± 1.18 mm for all data points; Spearman’s rank correlation: ρ=0.150, P=0.073; Fig 3) • Healthy matrix integration (n=3 sites; healthy vascularization and no signs of inflammation; elastin remnants could be detected in 2 biopsies after 62 and 96 days) • Excellent soft tissue health (92% of implant sites had a Jemt-papilla-index of 3, 70% of implant sites has ≥ 3 mm of keratinized mucosa, 78% of implants had no bleeding on probing) • Low complication rate (only 2 exposed matrices at 1 week post-surgery, resulting in a matrix exposure rate of 4%) • 100% implant survival and success P-SU-033 Soft tissue augmentation with a collagen-based 3D matrix with directed pore channels Bastian Wessing 1 , Bouke Boekema 2 , and Oscar González-Martín 3 1 Dental Practice Clinic, Luisenhospital, Aachen, Germany 2 Association of Dutch Burn Centres, Beverwijk, The Netherlands 3 University Complutense of Madrid, Madrid, Spain, and The University of Iowa School of College & Dental Clinics, Iowa City, USA Following tooth extraction, the buccal side of the alveolar ridge often undergoes physiological resorption. 1 During dental implant surgery, soft tissue augmentation with gingival grafts is used to enhance esthetics by maintaining or reconstructing a convex contour of the alveolar ridge. 2,3 Autologous grafts are common but pose several disadvantages, including the need for multiple surgical sites, postsurgical discomfort, and limited availability of tissue volumes, which has led to the development of alternative graft substitutes. 4-6 The aim of this retrospective study was to evaluate the clinical performance of a porcine-derived native collagen-elastin-based three-dimensional matrix with a modified interconnecting pore structure (CMG) used for soft tissue volume augmentation. This retrospective analysis demonstrated that CMG promotes soft tissue health and maintains adequate soft tissue thickness when used simultaneously with implant placement. The histological findings demonstrate excellent biocompatibility of CMG and indicate this matrix as a valid alternative to autologous grafts. Further well-designed randomized clinical studies are encouraged to validate these early promising results. 1. Schropp L, Wenzel A, Kostopoulos L, Karring T. Int J Periodontics Restorative Dent 2003;23(August):313-23. 2. Silverstein LH, Kurtzman D, Garnick JJ, Trager PS, Waters PK. Implant Dentistry 1994;3(Winter):231-4. 3. Silverstein LH, Lefkove MD. J Oral Implantol 1994;20:135-8. 4. Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R. J Clin Periodontol 2002;29(9):848-54. 5. Harris RJ, Miller R, Miller LH, Harris C. Int J Periodontics Restorative Dent 2005;25(5):449-59. 6. Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. J Periodontol 2006;77(12):2070-9. Background and Aim Methods and Materials Results Conclusion References This retrospective study included patients who received dental implants with simultaneous soft tissue volume augmentation using CMG (Mucomaix, Matricel GmbH, Herzogenrath, Germany; distributed as creos TM mucogain by Nobel Biocare since 10.2018) between 28.09.2013 and 06.09.2018 at a single dental practice. The implants included NobelActive (n=31), NobelParallel CC (n=13), NobelReplace CC (n=3), NobelReplace straight Groovy (n=2), and NobelPearl (n=1) (Nobel Biocare AB, Gothenburg, Sweden). Change in tissue thickness was evaluated from 4-8 linear measurements taken from superimposed 3D scans of casts prepared from polyether impressions (Impregum™ Penta™, 3M ESPE) taken before implant surgery and before fabrication of the final restoration (Fig 1). Available histologies were analyzed for vascularization, smooth muscle cells, endothelial adhesion, presence of macrophages, and CMG resorption. Implant survival rates and gingival health status were also evaluated. -3 -2 -1 0 1 2 3 4 5 0 2 4 6 8 10 12 14 16 Change in linear volume in 3D scans (mm) Interval between casts (months) Clinical Case Figure 3 Stability of augmented sites over time based on casts prepared from impressions taken before implant placement and prior to the preparation of the final restoration. A 20-year-old female with a congenital absence of the upper right lateral incisor (FDI position 12) received a NobelActive implant with simultaneous soft tissue augmentation using CMG. To access this poster online, please scan the QR code or visit: www.for.org/EAO2019_Wessing.pdf This study was supported by a Nobel Biocare Services AG grant number 2018-1583. Figure 4 Occlusal (left) and buccal (center) view before treatment. (Right) Full thickness flap on top of the ridge with implant placed and split thickness flap on buccal side. Figure 5 (Left) CMG placed underneath the buccal split flap and on top of the dental implant. (Center) Primary wound closure with palatal island flap to reduce the compression force of the buccal flap on the matrix. (Right) Buccal view at the time of re-entry after 82 days. Figure 6 (Left) Occlusal view of the emergence profile after soft tissue healing. (Center) Occlusal view of the final prosthetic. (Right) Buccal view of the final crown. Figure 2 Immunohistochemical staining (BA-4 antibodies) of a gingival biopsy from patient 43. Brown staining (arrows) indicates elastin remnants after 62 days of healing. Figure 1 Example of linear measurements (mm) between the pre- and post-operative vestibular profile in the augmented area and colored by loss (blue) or gain (red) of tissue. Original cast data from upper right lateral incisor (FDI position 12) in the study patient shown in the clinical case example in Figs 4-6.
Transcript of Soft tissue augmentation P-SU-033 with a collagen-based 3D ... · dental implant surgery, soft...
IMPLANT THERAPY OUTCOMES; SURGICAL ASPECTS
Presented at
• 45 patients (20 male, 25 female, mean age 41.3 ± 13.07 years) received 50 implants and were followed for 1.8 ± 1.3 years(range: 3 months - 4.5 years)
• Stable peri-implant tissue volume from pre-op to post-op independent of the time of follow-up (n=26 sites; -0.15 ± 1.18 mmfor all data points; Spearman’s rank correlation: ρ=0.150, P=0.073; Fig 3)
• Healthy matrix integration (n=3 sites; healthy vascularization and no signs of inflammation; elastin remnants could bedetected in 2 biopsies after 62 and 96 days)
• Excellent soft tissue health (92% of implant sites had a Jemt-papilla-index of 3, 70% of implant sites has ≥ 3 mm ofkeratinized mucosa, 78% of implants had no bleeding on probing)
• Low complication rate (only 2 exposed matrices at 1 week post-surgery, resulting in a matrix exposure rate of 4%)• 100% implant survival and success
P-SU-033Soft tissue augmentation with a collagen-based 3D matrix with directed pore channelsBastian Wessing1, Bouke Boekema2, and Oscar González-Martín3
1Dental Practice Clinic, Luisenhospital, Aachen, Germany2Association of Dutch Burn Centres, Beverwijk, The Netherlands3University Complutense of Madrid, Madrid, Spain, and The University of Iowa School of College & Dental Clinics, Iowa City, USA
Following tooth extraction, the buccal side of the alveolarridge often undergoes physiological resorption.1 Duringdental implant surgery, soft tissue augmentation with gingivalgrafts is used to enhance esthetics by maintaining orreconstructing a convex contour of the alveolar ridge.2,3
Autologous grafts are common but pose severaldisadvantages, including the need for multiple surgical sites,postsurgical discomfort, and limited availability of tissuevolumes, which has led to the development of alternativegraft substitutes.4-6 The aim of this retrospective study was toevaluate the clinical performance of a porcine-derived nativecollagen-elastin-based three-dimensional matrix with amodified interconnecting pore structure (CMG) used for softtissue volume augmentation.
This retrospective analysis demonstrated that CMG promotessoft tissue health and maintains adequate soft tissue thicknesswhen used simultaneously with implant placement. Thehistological findings demonstrate excellent biocompatibility ofCMG and indicate this matrix as a valid alternative toautologous grafts. Further well-designed randomized clinicalstudies are encouraged to validate these early promisingresults.
1. Schropp L, Wenzel A, Kostopoulos L, Karring T. Int J Periodontics Restorative Dent 2003;23(August):313-23.
2. Silverstein LH, Kurtzman D, Garnick JJ, Trager PS, Waters PK. Implant Dentistry 1994;3(Winter):231-4.
3. Silverstein LH, Lefkove MD. J Oral Implantol 1994;20:135-8.4. Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R. J Clin
Periodontol 2002;29(9):848-54.5. Harris RJ, Miller R, Miller LH, Harris C. Int J Periodontics Restorative
Dent 2005;25(5):449-59.6. Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. J Periodontol
2006;77(12):2070-9.
Background and Aim
Methods and Materials
Results
Conclusion References
This retrospective study included patients who receiveddental implants with simultaneous soft tissue volumeaugmentation using CMG (Mucomaix, Matricel GmbH,Herzogenrath, Germany; distributed as creosTM mucogain byNobel Biocare since 10.2018) between 28.09.2013 and06.09.2018 at a single dental practice. The implants includedNobelActive (n=31), NobelParallel CC (n=13), NobelReplaceCC (n=3), NobelReplace straight Groovy (n=2), andNobelPearl (n=1) (Nobel Biocare AB, Gothenburg, Sweden).Change in tissue thickness was evaluated from 4-8 linearmeasurements taken from superimposed 3D scans of castsprepared from polyether impressions (Impregum™ Penta™,3M ESPE) taken before implant surgery and beforefabrication of the final restoration (Fig 1). Available histologieswere analyzed for vascularization, smooth muscle cells,endothelial adhesion, presence of macrophages, and CMGresorption. Implant survival rates and gingival health statuswere also evaluated.
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Interval between casts (months)
Clinical Case
Figure 3Stability of augmented sites over timebased on casts prepared fromimpressions taken before implantplacement and prior to the preparation ofthe final restoration.
A 20-year-old female with a congenital absence of the upper right lateral incisor (FDI position 12) received a NobelActive implantwith simultaneous soft tissue augmentation using CMG.
To access this poster online, please scan the QR code or visit:www.for.org/EAO2019_Wessing.pdf
This study was supported by a Nobel Biocare Services AG grant number 2018-1583.
Figure 4Occlusal (left) and buccal (center) viewbefore treatment. (Right) Full thicknessflap on top of the ridge with implant placedand split thickness flap on buccal side.
Figure 5(Left) CMG placed underneath the buccalsplit flap and on top of the dental implant.(Center) Primary wound closure withpalatal island flap to reduce thecompression force of the buccal flap onthe matrix. (Right) Buccal view at the timeof re-entry after 82 days.
Figure 6(Left) Occlusal view of the emergenceprofile after soft tissue healing. (Center)Occlusal view of the final prosthetic.(Right) Buccal view of the final crown.
Figure 2Immunohistochemicalstaining (BA-4 antibodies) ofa gingival biopsy from patient43. Brown staining (arrows)indicates elastin remnantsafter 62 days of healing.
Figure 1Example of linear measurements (mm) between the pre- andpost-operative vestibular profile in the augmented area andcolored by loss (blue) or gain (red) of tissue. Original cast datafrom upper right lateral incisor (FDI position 12) in the studypatient shown in the clinical case example in Figs 4-6.
