Effect of Using a Plastic Stent with Apically Repositioned Flap in Peri-Implant Soft Tissue Augmentation: A Randomized Controlled Clinical Trial

Ahmed Hamdy, Hala K Abd El Gaber, Dalia M Ghalwash, Waleed M Abbas, Ahmed Hamdy, Hala K Abd El Gaber, Dalia M Ghalwash, Waleed M Abbas

Abstract

Objectives: This study aimed to clinically assess and compare the width of peri-implant keratinized mucosa following the use of a readymade plastic stent with apically repositioned flap versus conventional apically repositioned flap with papillary sparing incisions during single-stage implant placement protocol.

Materials and methods: A total of 20 patients were enrolled in this study. In the test group, a prefabricated implant-retained stent was clipped on the healing abutment after implant surgery to reposition the keratinized tissue buccoapically. In the control group, simple interrupted sutures were applied instead of using a stent. After the surgical procedure, the width of the buccal keratinized mucosa was measured at the mesial, middle, and distal aspects of the healing abutment. The change in the width of the buccal keratinized mucosa was assessed at 3 months and 6 months.

Results: No statistically significant difference was found between the stent group and control group in 6 months' interval where p=0.840, where both groups showed the same mean value of 4.70 ± 0.35 and 4.70 ± 0.63, respectively. The percent of change in the width of KM was found to be higher in the stent group than in the control group with no statistical significance.

Conclusion: The use of a readymade plastic stent in combined full/partial-thickness apically repositioned flap shows to be effective in increasing the width of KM compared to the conventional technique. This trial is registered with NCT03754894.

Conflict of interest statement

The authors report no conflicts of interest related to this study.

Copyright © 2021 Ahmed Hamdy et al.

Figures

Figure 1
Figure 1
Preoperative occlusal view showing insufficient attached zone around the edentulous space.
Figure 2
Figure 2
(a) Flap reflection and dental implant placement, (b) healing abutment in place and the flap was secured with the stent, (c) width of KM at 3-month follow-up, and (d) buccal view showing crown in place at 6-month follow-up.
Figure 3
Figure 3
Bar chart representing the width of keratinized gingiva for different groups at different time intervals.

References

    1. Narayan S., Singh P., Mohammed S., Patel R. K. V. Enhancing the zone of keratinized tissue around implants. The Journal of Indian Prosthodontic Society. 2015;15(2):183–186. doi: 10.4103/0972-4052.158083.
    1. Lin W.-S., Harris B. T., Morton D. Use of implant-supported interim restorations to transfer periimplant soft tissue profiles to a milled polyurethane definitive cast. The Journal of Prosthetic Dentistry. 2013;109(5):333–337. doi: 10.1016/s0022-3913(13)60311-x.
    1. Bouri A. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. The International Journal of Oral & Maxillofacial Implants. 2008;23(2):323–326.
    1. Greenstein G., Cavallaro J. The clinical significance of keratinized gingiva around dental implants. Compendium of Continuing Education in Dentistry. 1995;32(8):24–31.
    1. Gobbato L., Avila-Ortiz G., Sohrabi K., Wang C.-W., Karimbux N. The effect of keratinized mucosa width on peri-implant health: a systematic review. The International Journal of Oral & Maxillofacial Implants. 2013;28(6):1536–1545. doi: 10.11607/jomi.3244.
    1. Small P. N., Tarnow D. P. Gingival recession around implants: a 1-year longitudinal prospective study. The International Journal of Oral & Maxillofacial Implants. 2000;15(4):527–532.
    1. Linkevicius T., Apse P. Biologic width around implants. An evidence-based review. Stomatologija. 2008;10(1):27–35.
    1. Lang N. P., Löe H. The relationship between the width of keratinized gingiva and gingival health. Journal of Periodontology. 1972;43(10):623–627. doi: 10.1902/jop.1972.43.10.623.
    1. Adell R., Lekholm U., Rockler B., et al. Marginal tissue reactions at osseointegrated titanium fixtures. International Journal of Oral and Maxillofacial Surgery. 1986;15(1):39–52. doi: 10.1016/s0300-9785(86)80010-2.
    1. Reddy V. K., Parthasarathy H., Lochana P. Evaluating the clinical and esthetic outcome of apically positioned flap technique in augmentation of keratinized gingiva around dental implants. Contemporary Clinical Dentistry. 2013;4(3):319–324. doi: 10.4103/0976-237X.118378.
    1. Chung D. M., Oh T.-J., Shotwell J. L., Misch C. E., Wang H.-L. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. Journal of Periodontology. 2006;77(8):1410–1420. doi: 10.1902/jop.2006.050393.
    1. Huh J.-B., Yang K.-B., Choi J., Jeon Y.-C., Lee J.-Y., Shin S.-W. Effect of the use of a ready-made plastic stent on the peri-implant soft tissue. Acta Odontologica Scandinavica. 2013;71(3-4):841–847. doi: 10.3109/00016357.2012.734408.
    1. Kim C.-S., Duong H. P., Park J.-C., Shin H.-S. Preservation of keratinized mucosa around implants using a prefabricated implant-retained stent: a case-control study. Journal of Periodontal & Implant Science. 2016;46(5):329–336. doi: 10.5051/jpis.2016.46.5.329.
    1. Park J.-C., Yang K.-B., Choi Y., et al. A simple approach to preserve keratinized mucosa around implants using a pre-fabricated implant-retained stent: a report of two cases. Journal of Periodontal & Implant Science. 2010;40(4):194–200. doi: 10.5051/jpis.2010.40.4.194.
    1. Frisch E., Ratka-Krüger P., Ziebolz D. A new technique for increasing keratinized tissue around dental implants: the partially epithelialized free connective tissue graft. Retrospective analysis of a case series. Journal of Oral Implantology. 2015;41(4):467–472. doi: 10.1563/AAID-JOI-D-13-00006.
    1. Buser D., Mericske-Stern R., Dula K., Lang N. P. Clinical experience with one-stage, non-submerged dental implants. Advances in Dental Research. 1999;13(1):153–161. doi: 10.1177/08959374990130010501.
    1. Friedman N. Mucogingival surgery: the apically repositioned flap. Journal of Periodontology. 1962;33(4):328–340. doi: 10.1902/jop.1962.33.4.328.
    1. Fickl S. Tissue response following papilla-sparing and sulcular incisions in oral surgery--an experimental study. Clinical Oral Investigations. 2014;18:1313–1317. doi: 10.1007/s00784-013-1069110.1007/s00784-013-1069-1.
    1. Binderman I., Adut M., Zohar R., Bahar H., Faibish D., Yaffe A. Alveolar bone resorption following coronal versus apical approach in a mucoperiosteal flap surgery procedure in the rat mandible. Journal of Periodontology. 2001;72(10):1348–1353. doi: 10.1902/jop.2001.72.10.1348.
    1. Greenstein G., Tarnow D. Using papillae-sparing incisions in the esthetic zone to restore form and function. Compendium of Continuing Education in Dentistry. 2014;35(5):315–322.
    1. Bruschi G. B., Crespi R., Capparé P., Gherlone E. Clinical study of flap design to increase the keratinized gingiva around implants: 4-year follow-up. Journal of Oral Implantology. 2014;40(4):459–464. doi: 10.1563/AAID-JOI-D-11-00236.
    1. Belser U. C., Grütter L., Vailati F., Bornstein M. M., Weber H.-P., Buser D. Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores. Journal of Periodontology. 2009;80(1):140–151. doi: 10.1902/jop.2009.080435.

Source: PubMed

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