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Keywords = vestibular fenestration

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15 pages, 5366 KiB  
Case Report
Management of Vestibular Bone Fenestration with Periosteal Inhibition (PI) Technique During Alveolar Socket Preservation: A Case Report
by Andrea Grassi, Maria Eleonora Bizzoca, Lucia De Biasi, Rossella Padula, Ciro Annicchiarico, Gabriele Cervino, Lorenzo Lo Muzio and Filiberto Mastrangelo
Medicina 2024, 60(12), 1912; https://doi.org/10.3390/medicina60121912 - 21 Nov 2024
Viewed by 279
Abstract
Background and Objectives: The purpose of this case report is to examine the management of vestibular bone fenestration during alveolar socket preservation using the Periosteal Inhibition (PI) approach. Here, for the first time, the PI technique, which has been shown to be successful [...] Read more.
Background and Objectives: The purpose of this case report is to examine the management of vestibular bone fenestration during alveolar socket preservation using the Periosteal Inhibition (PI) approach. Here, for the first time, the PI technique, which has been shown to be successful in maintaining intact cortical bone, is examined in the context of a bone defect. Materials and Methods: After an atraumatic extraction of a damaged tooth, a vestibular bone fenestration was discovered in the 62-year-old male patient. To shield the defect, a non-resorbable PTFE membrane (OSSEO GUARD by Zimmer Biomet) was positioned between the mucosa and the fenestration site. A resorbable porcine gelatin sponge (SPONGOSTANTM) was used to achieve hemostasis, and a 5/0 PGCL absorbable suture was used to close the wound. A CBCT scan was performed, and a dental implant was inserted after 4 months. Results: After 4 months, the case demonstrated positive results, with full cortical remodeling and preservation of the original bone proportions. The fenestration completely healed, proving that the PI approach works even in the presence of bone flaws in cortical bone that is still intact. Conclusions: This is the first case report that shows that vestibular bone fenestration can be successfully treated with the PI approach. It has now been demonstrated that the procedure, which hitherto needed an undamaged cortical bone to work, can help bone abnormalities to repair completely. These results imply that the PI technique is a flexible and useful approach that provides predictable results in dental surgery for treating different types of alveolar bone abnormalities. Its use might be expanded with more study to include bone dehiscence treatment. Full article
(This article belongs to the Special Issue Advances in Soft and Hard Tissue Management Around Dental Implants)
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Figure 1

Figure 1
<p>CBCT images of the patient before the surgery: (<b>a</b>) frontal section, (<b>b</b>) transversal section, and (<b>c</b>) sagittal section.</p>
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<p>(<b>a</b>) Preoperative sites, (<b>b</b>) alveolar socket, (<b>c</b>) fenestration in the vestibular bone, (<b>d</b>,<b>e</b>) ptfe OSSEOGUARD membrane from Zimmer Biomet in place, and (<b>f</b>) SPONGOSTAN and sling suture.</p>
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<p>Tissue healing after 1 month: (<b>a</b>) occlusal view and (<b>b</b>) buccal view.</p>
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<p>CBCT images at 4 months after the surgery: (<b>a</b>) frontal section, (<b>b</b>) transversal section, and (<b>c</b>) sagittal section.</p>
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<p>Second surgical step: (<b>a</b>) incision for the envelope flap, (<b>b</b>) individualizing the membrane, (<b>c</b>) removing the membrane, (<b>d</b>) site preparation for the implant, (<b>e</b>) implant inserted, and (<b>f</b>) healing screw in place.</p>
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<p>Third surgical step: (<b>a</b>) Curvomax abutment occlusal view and (<b>b</b>) Curvomax abutment sagittal view. Perfect soft-tissue healing can be observed.</p>
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<p>Fourth surgical step: (<b>a</b>) prosthetic rehabilitation occlusal view and (<b>b</b>) prosthetic rehabilitation—sagittal view.</p>
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<p>Final endoral RX.</p>
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<p>(<b>a</b>) CBCT images before the surgery (sagittal section) and (<b>b</b>) CBCT images after 4 months (sagittal section).</p>
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<p>Tissue healing after 4 months (occlusal view).</p>
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<p>(<b>a</b>) CBCT pictures after a year (sagittal section) and (<b>b</b>) CBCT pictures after a year (coronal section).</p>
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9 pages, 2257 KiB  
Case Report
Technical Note on Vestibuloplasty around Dental Implants Using Erbium YAG Laser-Assisted Periosteal Fenestration (LA-PF)
by Kyeong-Ok Lim and Won-Pyo Lee
Medicina 2023, 59(10), 1884; https://doi.org/10.3390/medicina59101884 - 23 Oct 2023
Viewed by 2150
Abstract
Various vestibuloplasty techniques have been reported to increase the attached mucosa (AM) and vestibular depth around dental implants. However, these surgical methods have disadvantages, such as limitations in manipulation, necessity of suturing, postoperative discomfort, swelling, and pain. This study aimed to evaluate the [...] Read more.
Various vestibuloplasty techniques have been reported to increase the attached mucosa (AM) and vestibular depth around dental implants. However, these surgical methods have disadvantages, such as limitations in manipulation, necessity of suturing, postoperative discomfort, swelling, and pain. This study aimed to evaluate the efficacy of laser-assisted periosteal fenestration (LA-PF) in treating patients with a shallow vestibule and insufficient AM around dental implants. LA-PF was performed using an Erbium YAG laser (Er:YAG laser). First, a partial-thickness, apically positioned flap was used. A horizontal periosteal fenestration was performed using an Er:YAG laser to expose the bones. Periosteal suturing was not required. After 12 months, sufficient AM and deep vestibules were obtained and maintained. Thus, the LA-PF technique may be a simple and predictable treatment modality for shallow vestibules with insufficient AM around dental implants. Full article
(This article belongs to the Section Dentistry and Oral Health)
Show Figures

Figure 1

Figure 1
<p>(<b>A</b>) Panoramic radiograph and (<b>B</b>) clinical condition at the initial examination. (<b>C</b>) Panoramic radiograph after (<b>C</b>) vertical ridge augmentation and (<b>D</b>) the final prosthesis. (<b>E</b>) Frontal and (<b>F</b>) occlusal view after the final prosthesis. Peri-implant soft tissue condition of (<b>G</b>) right and (<b>H</b>) left molar area after the final prosthesis.</p>
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<p>(<b>A</b>,<b>B</b>) Buccal view immediately after performing laser-assisted periosteal fenestration (LA-PF). (<b>C</b>,<b>D</b>) Clinical view at 12 months after LA-PF. Increased AM was observed around the implants.</p>
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<p>A 65-year-old woman with deficient attached mucosa (AM) in #36, 37 implants (<b>A</b>) Occlusal and (<b>B</b>) buccal view at the initial examination. (<b>C</b>) Buccal view immediately after performing partial-thickness, apically positioned flap (APF). (<b>D</b>) Buccal view immediately after free gingival graft (FGG). (<b>E</b>) Healing condition at 1 week postoperatively. (<b>F</b>) Clinical view of #36, 37 implants at 4.5 months after FGG. Postoperative relapse was observed.</p>
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<p>The laser-assisted periosteal fenestration (LA-PF) technique was performed in the same patient as in <a href="#medicina-59-01884-f003" class="html-fig">Figure 3</a>. (<b>A</b>) Occlusal and (<b>B</b>) buccal view at the initial examination. (<b>C</b>) Occlusal and (<b>D</b>) buccal view immediately after performing LA-PF. (<b>E</b>) Healing condition at 1 week postoperatively. (<b>F</b>) Clinical view at 2 months postoperatively. (<b>G</b>) Clinical view of #36, 37 implants at 1 year after LA-PF. (<b>H</b>) Clinical view of #36, 37 implants at 3 years after LA-PF. Increased attached mucosa remained stable for 3 years postoperatively.</p>
Full article ">Figure 4 Cont.
<p>The laser-assisted periosteal fenestration (LA-PF) technique was performed in the same patient as in <a href="#medicina-59-01884-f003" class="html-fig">Figure 3</a>. (<b>A</b>) Occlusal and (<b>B</b>) buccal view at the initial examination. (<b>C</b>) Occlusal and (<b>D</b>) buccal view immediately after performing LA-PF. (<b>E</b>) Healing condition at 1 week postoperatively. (<b>F</b>) Clinical view at 2 months postoperatively. (<b>G</b>) Clinical view of #36, 37 implants at 1 year after LA-PF. (<b>H</b>) Clinical view of #36, 37 implants at 3 years after LA-PF. Increased attached mucosa remained stable for 3 years postoperatively.</p>
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