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Rationale for Gingival Tissue Augmentation and Vestibuloplasty Around Teeth and Dental Implants

  • Leandro Chambrone
  • Francisco Salvador Garcia Valenzuela
  • Luciano Oliveira
Chapter

Abstract

Soft tissue augmentation procedures have long-standing tradition of clinical use to improve the width and thickness of sites lacking an adequate band of keratinized tissue (KT). Regarding the importance of KT, it has long been suggested that a minimum 2 mm KT band (with at least 1 mm of tissue attached) appears to be required to preserve the health of periodontal tissues. Gingival augmentation might positively influence the biologic remodeling of periodontal dimensions associated with the aging process. Therefore, the use of free gingival grafts can produce more beneficial keratinized tissue band proportions and reduce gingival recession depth over time. Thus, this chapter will focus on the clinical use of the most current and common surgical approaches advocated to augment the attached gingiva and peri-implant mucosa.

Keywords

Keratinized tissue Free gingival graft Alveolar ridge Periodontal biotype Vestibuloplasty Surgical grafts Peri-implant mucosa 

References

  1. 1.
    American Academy of Periodontology (2001) Glossary of periodontal terms, 4th edn. American Academy of Periodontology, Chicago, 56pGoogle Scholar
  2. 2.
    Chambrone L, Tatakis DN (2016) Long-term outcomes of untreated buccal gingival recessions: a systematic review and meta-analysis. J Periodontol 87:796–808CrossRefGoogle Scholar
  3. 3.
    Lang NP, Löe H (1972) The relationship between the width of keratinized gingiva and gingival health. J Periodontol 43:623–627CrossRefGoogle Scholar
  4. 4.
    Kim DM, Neiva R (2015) Periodontal soft tissue non-root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol 86:S56–S72CrossRefGoogle Scholar
  5. 5.
    Agudio G, Cortellini P, Buti J, Pini Prato G (2016) Periodontal conditions of sites treated with gingival augmentation surgery compared with untreated contralateral homologous sites: an 18- to 35-year long-term study. J Periodontol 87:1371–1378CrossRefGoogle Scholar
  6. 6.
    Agudio G, Chambrone L, Prato GP (2017) Biologic remodeling of periodontal dimensions of areas treated with gingival augmentation procedure (GAP). A 25-year follow-up observation. J Periodontol 88:634–642CrossRefGoogle Scholar
  7. 7.
    Thoma DS, Buranawat B, Hämmerle CHF, Held U, Jung RE (2014) Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol 41(Suppl 15):S77–S91CrossRefGoogle Scholar
  8. 8.
    Chambrone L (ed) (2015) Evidence-based periodontal and peri-implant plastic surgery: a clinical roadmap from function to aesthetics. Springer International Publishing AG, Basel, pp 219–245CrossRefGoogle Scholar
  9. 9.
    Groeger SE, Meyle J (2015) Epithelial barrier and oral bacterial infections. Periodontol 2000 69:46–67CrossRefGoogle Scholar
  10. 10.
    Lin G-H, Chan H-L, Wang H-L (2013) The significance of keratinized mucosa on implant health: a systematic review. J Periodontol 84:1755–1767CrossRefGoogle Scholar
  11. 11.
    Brito C, Tenenbaum HC, Wong BKC, Schmitt C, Nogueira-Filho G (2014) Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature. J Biomed Mater Res B Appl Biomater 102:643–650CrossRefGoogle Scholar
  12. 12.
    Schmitt CM, Moest T, Lutz R, Wehrhan F, Neukam FW, Schlegel KA (2016) 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 27:e125–e133CrossRefGoogle Scholar
  13. 13.
    Nevins M, Nevins ML, Kim SW, Schupbach P, Kim DM (2011) The use of mucograft collagen matrix to augment the zone of keratinized tissue around teeth: a pilot study. Int J Periodontics Restorative Dent 31:367–373PubMedGoogle Scholar
  14. 14.
    Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M (2009) Clinical evaluation of a new collagen matrix (Mucograft ® prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol 36:868–876CrossRefGoogle Scholar
  15. 15.
    Schmitt CM, Tudor C, Kiener K, Wehrhan F, Schmitt J, Eitner S, Agaimy A, Schlegel KA (2013) Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study. J Periodontol 84:914–923CrossRefGoogle Scholar
  16. 16.
    Baer PN, Benjamin SD (1981) Gingival grafts: a historical note. J Periodontol 52:206–207CrossRefGoogle Scholar
  17. 17.
    Björn H (1963) Fri transplantation av gingiva propria. Sveriges Tandlak T 55:684Google Scholar
  18. 18.
    Sullivan HC, Atkins JH (1968) Free autogenous gingival grafts I. Principle of successful grafting. Periodontics 6:121–129PubMedGoogle Scholar
  19. 19.
    Olsson M, Lindhe J (1991) Periodontal characteristics in individuals with varying form of the upper central incisors. J Clin Periodontol 18:78–82CrossRefGoogle Scholar
  20. 20.
    Olsson M, Lindhe J, Marinello CP (1993) On the relationship between crown form and clinical features of the gingiva in adolescents. J Clin Periodontol 20:570–577CrossRefGoogle Scholar
  21. 21.
    Zweers J, Thomas RZ, Slot DE, Weisgold AS, Van der Weijden FG (2014) Characteristics of periodontal biotype, its dimensions, associations and prevalence: a systematic review. J Clin Periodontol 41:958–971CrossRefGoogle Scholar
  22. 22.
    Reiser GM, Bruno JF, Mahan PE, Larkin LH (1996) The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodontics Restorative Dent 16:130–137PubMedGoogle Scholar
  23. 23.
    Tallgren A (1972) The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years. J Prosthet Dent 27:120–132CrossRefGoogle Scholar
  24. 24.
    Hillerup S (1979) Profile changes of bone and soft tissues following vestibular sulcus extension by the operation of Edlan and Mejchar. Int J Oral Surg 8:340–346CrossRefGoogle Scholar
  25. 25.
    Araujo MG, Lindhe J (2005) Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 32(2):212–218CrossRefGoogle Scholar
  26. 26.
    Van der Weijden F, Dell’Acqua F, Slot DE (2009) Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol 36:1048–1058CrossRefGoogle Scholar
  27. 27.
    Araújo MG, Lindhe J (2009) Ridge alterations following tooth extraction with and without flap elevation: an experimental study in the dog. Clin Oral Implants Res 20:545–549PubMedGoogle Scholar
  28. 28.
    Atwood DA (1979) Bone loss of edentulous alveolar ridges. J Periodontol 50(4s):11–21CrossRefGoogle Scholar
  29. 29.
    Sikkerimath BC, Dandagi S, Gudi SS, Jayapalan D (2012) Comparison of vestibular sulcus depth in vestibuloplasty using standard Clark’s technique with and without amnion as graft material. Ann Maxillofac Surg 2:30–35CrossRefGoogle Scholar
  30. 30.
    Sanders B, Starshak TJ (1975) Modified technique for palatal mucosal grafts in mandibular labial vestibuloplasty. J Oral Surg 33:950–952PubMedGoogle Scholar
  31. 31.
    Clark HB (1953) Deepening of labial sulcus by mucosal flap advancement. J Oral Surg (Chic) 11:165–168Google Scholar
  32. 32.
    Obwegeser H (1964) Surgical preparation of the maxilla for prosthesis. J Oral Surg Anesth Hosp Dent Serv 22:127–134PubMedGoogle Scholar
  33. 33.
    Kazanjian VH (1935) Surgery as an aid to more efficient service with prosthetic dentures. J Am Dent Assoc 22:566–581Google Scholar
  34. 34.
    Fröschl T, Kerscher A (1997) The optimal vestibuloplasty in preprosthetic surgery of the mandible. J Craniomaxillofac Surg 25:85–90CrossRefGoogle Scholar
  35. 35.
    Hillerup S, Eriksen E, Solow B (1989) Reduction of mandibular residual ridge after vestibuloplasty. A two-year follow-up study comparing the Edlan flap, mucosal and skin graft operations. Int J Oral Maxillofac Surg 18:271–276CrossRefGoogle Scholar
  36. 36.
    Heberer S, Nelson K (2009) Clinical evaluation of a modified method of vestibuloplasty using an implant-retained splint. J Oral Maxillofac Surg 67:624–629CrossRefGoogle Scholar
  37. 37.
    Edlan A (1973) Pre-prosthetic surgery—a new technique in the edentulous lower jaw. Trans Int Conf Oral Surg 4:191–194PubMedGoogle Scholar
  38. 38.
    Ivanovski S, Lee R (2018) Comparison of peri-implant and periodontal marginal soft tissues in health and disease. Periodontol 2000 76:116–130CrossRefGoogle Scholar
  39. 39.
    Hassell TM (1993) Tissues and cells of the periodontium. Periodontol 2000 3:9–38CrossRefGoogle Scholar
  40. 40.
    Wennstrom J, Lindhe J, Nyman S (1981) Role of keratinized gingiva for gingival health. Clinical and histologic study of normal and regenerated gingival tissue in dogs. J Clin Periodontol 8:311–328CrossRefGoogle Scholar
  41. 41.
    Ericsson I, Lindhe J (1984) Recession in sites with inadequate width of the keratinized gingiva. An experimental study in the dog. J Clin Periodontol 11:95–103CrossRefGoogle Scholar
  42. 42.
    Nevins M (1986) Attached gingiva—mucogingival therapy and restorative dentistry. Int J Periodontics Restorative Dent 6:9–27PubMedGoogle Scholar
  43. 43.
    Maynard JG, Wilson RD (1979) Physiologic dimensions of the periodontium significant to the restorative dentist. J Periodontol 50:170–174CrossRefGoogle Scholar
  44. 44.
    Friedman N (1962) Mucogingival surgery: the apically repositioned flap. J Periodontol 33:328–340CrossRefGoogle Scholar
  45. 45.
    Carnio J, Camargo PM, Passanezi E (2007) Increasing the apico-coronal dimension of attached gingiva using the modified apically repositioned flap technique: a case series with a 6-month follow-up. J Periodontol 78:1825–1830CrossRefGoogle Scholar
  46. 46.
    Lindhe J, Berglundh T (1998) The interface between the mucosa and the implant. Periodontol 2000 17:47–54CrossRefGoogle Scholar
  47. 47.
    Strub JR, Gaberthüel TW, Grunder U (1991) The role of attached gingiva in the health of peri-implant tissue in dogs. 1. Clinical findings. Int J Periodontics Restorative Dent 11:317–333PubMedGoogle Scholar
  48. 48.
    Bengazi F, Wennström JL, Lekholm U (1996) Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clin Oral Implants Res 7:303–310CrossRefGoogle Scholar
  49. 49.
    Wennström JL, Bengazi F, Lekholm U (1994) The influence of the masticatory mucosa on the peri-implant soft tissue condition. Clin Oral Implants Res 5:1–8CrossRefGoogle Scholar
  50. 50.
    Warrer K, Buser D, Lang NP, Karring T (1995) Plaque-induced peri-implantitis in the presence or absence of keratinized mucosa. An experimental study in monkeys. Clin Oral Implants Res 6:131–138CrossRefGoogle Scholar
  51. 51.
    Gobbato L, Avila-Ortiz G, Sohrabi K, Wang C-W, Karimbux N (2013) The effect of keratinized mucosa width on peri-implant health: a systematic review. Int J Oral Maxillofac Implants 28:1536–1545CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Leandro Chambrone
    • 1
    • 2
    • 3
  • Francisco Salvador Garcia Valenzuela
    • 4
  • Luciano Oliveira
    • 5
  1. 1.School of Dentistry, Ibirapuera University (Unib)São PauloBrazil
  2. 2.Unit of Basic Oral Investigation (UIBO)School of Dentistry, El Bosque UniversityBogotaColombia
  3. 3.Department of PeriodonticsCollege of Dentistry and Dental Clinics, The University of IowaIowa CityUSA
  4. 4.Perioteam Training CenterIrapuatoMexico
  5. 5.Division of Implant DentistryPontifical Catholic UniversityRio de JaneiroBrazil

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