Anterior maxillary defect reconstruction with a staged bilateral rotated palatal graft
Identifieur interne : 005175 ( Ncbi/Merge ); précédent : 005174; suivant : 005176Anterior maxillary defect reconstruction with a staged bilateral rotated palatal graft
Auteurs : Gyu-Un Jung [Corée du Sud] ; Eun-Kyoung Pang [Corée du Sud] ; Chang-Joo Park [Corée du Sud]Source :
- Journal of Periodontal & Implant Science [ 2093-2278 ] ; 2014.
Abstract
In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect.
We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture.
Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment.
The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.
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DOI: 10.5051/jpis.2014.44.3.147
PubMed: 24921059
PubMed Central: 4050232
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Anterior maxillary defect reconstruction with a staged bilateral rotated palatal graft</title><author><name sortKey="Jung, Gyu Un" sort="Jung, Gyu Un" uniqKey="Jung G" first="Gyu-Un" last="Jung">Gyu-Un Jung</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Pang, Eun Kyoung" sort="Pang, Eun Kyoung" uniqKey="Pang E" first="Eun-Kyoung" last="Pang">Eun-Kyoung Pang</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Park, Chang Joo" sort="Park, Chang Joo" uniqKey="Park C" first="Chang-Joo" last="Park">Chang-Joo Park</name><affiliation wicri:level="3"><nlm:aff id="A2">Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24921059</idno><idno type="pmc">4050232</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050232</idno><idno type="RBID">PMC:4050232</idno><idno type="doi">10.5051/jpis.2014.44.3.147</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001F05</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001F05</idno><idno type="wicri:Area/Pmc/Curation">001F05</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001F05</idno><idno type="wicri:Area/Pmc/Checkpoint">001615</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001615</idno><idno type="wicri:Area/Ncbi/Merge">005175</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Anterior maxillary defect reconstruction with a staged bilateral rotated palatal graft</title><author><name sortKey="Jung, Gyu Un" sort="Jung, Gyu Un" uniqKey="Jung G" first="Gyu-Un" last="Jung">Gyu-Un Jung</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Pang, Eun Kyoung" sort="Pang, Eun Kyoung" uniqKey="Pang E" first="Eun-Kyoung" last="Pang">Eun-Kyoung Pang</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Park, Chang Joo" sort="Park, Chang Joo" uniqKey="Park C" first="Chang-Joo" last="Park">Chang-Joo Park</name><affiliation wicri:level="3"><nlm:aff id="A2">Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author></analytic><series><title level="j">Journal of Periodontal & Implant Science</title><idno type="ISSN">2093-2278</idno><idno type="eISSN">2093-2286</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect.</p></sec><sec><title>Methods</title><p>We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture.</p></sec><sec><title>Results</title><p>Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment.</p></sec><sec><title>Conclusions</title><p>The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.</p></sec><sec><title>Graphical Abstract</title><p><graphic xlink:href="jpis-44-147-ab001.jpg" position="float" orientation="portrait"></graphic></p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Carlsson, Ge" uniqKey="Carlsson G">GE Carlsson</name></author><author><name sortKey="Bergman, B" uniqKey="Bergman B">B Bergman</name></author><author><name sortKey="Hedegard, B" uniqKey="Hedegard B">B Hedegard</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pietrokovski, J" uniqKey="Pietrokovski J">J Pietrokovski</name></author><author><name sortKey="Massler, M" uniqKey="Massler M">M Massler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kois, Jc" uniqKey="Kois J">JC 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Periodontal Implant Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Periodontal Implant Sci</journal-id><journal-id journal-id-type="publisher-id">JPIS</journal-id><journal-title-group><journal-title>Journal of Periodontal & Implant Science</journal-title></journal-title-group><issn pub-type="ppub">2093-2278</issn><issn pub-type="epub">2093-2286</issn><publisher><publisher-name>Korean Academy of Periodontology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24921059</article-id><article-id pub-id-type="pmc">4050232</article-id><article-id pub-id-type="doi">10.5051/jpis.2014.44.3.147</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Anterior maxillary defect reconstruction with a staged bilateral rotated palatal graft</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-5622-1126</contrib-id><name><surname>Jung</surname><given-names>Gyu-Un</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-2633-109X</contrib-id><name><surname>Pang</surname><given-names>Eun-Kyoung</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-6895-9854</contrib-id><name><surname>Park</surname><given-names>Chang-Joo</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul, Korea.</aff><aff id="A2"><label>2</label>Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, Seoul, Korea.</aff><author-notes><corresp>Correspondence: Chang-Joo Park. Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Korea. <email>fastchang@hanyang.ac.kr</email>, Tel: +82-2-2290-8646, Fax: +82-2-2290-8673</corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>05</day><month>6</month><year>2014</year></pub-date><volume>44</volume><issue>3</issue><fpage>147</fpage><lpage>155</lpage><history><date date-type="received"><day>23</day><month>4</month><year>2014</year></date><date date-type="accepted"><day>23</day><month>5</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014 Korean Academy of Periodontology</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>).</license-p></license></permissions><abstract abstract-type="graphical"><sec><title>Purpose</title><p>In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect.</p></sec><sec><title>Methods</title><p>We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture.</p></sec><sec><title>Results</title><p>Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment.</p></sec><sec><title>Conclusions</title><p>The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.</p></sec><sec><title>Graphical Abstract</title><p><graphic xlink:href="jpis-44-147-ab001.jpg" position="float" orientation="portrait"></graphic></p></sec></abstract><kwd-group><kwd>Alveolar ridge augmentation</kwd><kwd>Guided tissue regeneration</kwd><kwd>Palate</kwd><kwd>Surgical flaps</kwd></kwd-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Intraoral clinical view showing a fixed partial prosthesis including pink porcelain (A) and a radiographic view (B). Vertical deficiency on left maxillary central incisor area reached a radiographic root apex of the adjacent left maxillary canine (arrow).</p></caption><graphic xlink:href="jpis-44-147-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Clinical view; (A) The bottom of fissure was located on the arrow tip. (B) Note an atrophic incisive papilla (arrow). (C) After flap reflection, an end of the defect was approaching in a nearby anterior nasal spine. (D) Bone graft materials were placed in the defect site, and (E) covered by nonresorbable membrane. (F) The membrane was stabilized by titanium screw.</p></caption><graphic xlink:href="jpis-44-147-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>(A) Two parallel incision was made for rotated palatal subepithelial connective tissue graft. Superficial epithelial layer was raised and retracted posteriorly (B). The deep subepithelial layer was rotated anteriorly to cover the graft site (C). The donor and recipient sites were sutured (D).</p></caption><graphic xlink:href="jpis-44-147-g003"></graphic></fig><fig id="F4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>Flap necrosis was seen 2 weeks after stage 1 surgery (A), and the membrane exposure was found at 4 weeks postoperatively (B).</p></caption><graphic xlink:href="jpis-44-147-g004"></graphic></fig><fig id="F5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>At the time of membrane removal, contralateral rotated palatal subepithelial connective tissue graft were performed the same way as the stage 1 surgery. Then, temporary prosthesis was fixed.</p></caption><graphic xlink:href="jpis-44-147-g005"></graphic></fig><fig id="F6" orientation="portrait" position="float"><label>Figure 6</label><caption><p>Frontal view (A) and occlusal view (B) of 4 weeks after stage 2 surgery.</p></caption><graphic xlink:href="jpis-44-147-g006"></graphic></fig><fig id="F7" orientation="portrait" position="float"><label>Figure 7</label><caption><p>Preoperative (A) and postoperative models (B).</p></caption><graphic xlink:href="jpis-44-147-g007"></graphic></fig><fig id="F8" orientation="portrait" position="float"><label>Figure 8</label><caption><p>Frontal (A) and occlusal view (B) of 2 month after stage 2 surgery. Smooth and abundant alveolar ridge.</p></caption><graphic xlink:href="jpis-44-147-g008"></graphic></fig><fig id="F9" orientation="portrait" position="float"><label>Figure 9</label><caption><p>Final prosthetic restoration after 6 months frontal view (A) and occlusal view (B).</p></caption><graphic xlink:href="jpis-44-147-g009"></graphic></fig><fig id="F10" orientation="portrait" position="float"><label>Figure 10</label><caption><p>Comparison of periapical radiography before surgery (A) and 6 months after surgery (B).</p></caption><graphic xlink:href="jpis-44-147-g010"></graphic></fig></floats-group></pmc><affiliations><list><country><li>Corée du Sud</li></country><region><li>Région capitale de Séoul</li></region><settlement><li>Séoul</li></settlement></list><tree><country name="Corée du Sud"><region name="Région capitale de Séoul"><name sortKey="Jung, Gyu Un" sort="Jung, Gyu Un" uniqKey="Jung G" first="Gyu-Un" last="Jung">Gyu-Un Jung</name></region><name sortKey="Pang, Eun Kyoung" sort="Pang, Eun Kyoung" uniqKey="Pang E" first="Eun-Kyoung" last="Pang">Eun-Kyoung Pang</name><name sortKey="Park, Chang Joo" sort="Park, Chang Joo" uniqKey="Park C" first="Chang-Joo" last="Park">Chang-Joo Park</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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