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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Combined application of roll flap and combination onlay-interpositional graft to enhance esthetics of maxillary anterior fixed partial denture: A case report</title><author><name sortKey="Oh, Sang Chun" sort="Oh, Sang Chun" uniqKey="Oh S" first="Sang-Chun" last="Oh">Sang-Chun Oh</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, College of Dentistry, Wonkwang University, Daejeon, Republic of Korea.</nlm:aff></affiliation></author><author><name sortKey="Cha, Dong Hee" sort="Cha, Dong Hee" uniqKey="Cha D" first="Dong-Hee" last="Cha">Dong-Hee Cha</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, College of Dentistry, Wonkwang University, Daejeon, Republic of Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Jae In" sort="Lee, Jae In" uniqKey="Lee J" first="Jae-In" last="Lee">Jae-In Lee</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, College of Dentistry, Wonkwang University, Daejeon, Republic of Korea.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26949490</idno><idno type="pmc">4769892</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769892</idno><idno type="RBID">PMC:4769892</idno><idno type="doi">10.4047/jap.2016.8.1.70</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000531</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000531</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Combined application of roll flap and combination onlay-interpositional graft to enhance esthetics of maxillary anterior fixed partial denture: A case report</title><author><name sortKey="Oh, Sang Chun" sort="Oh, Sang Chun" uniqKey="Oh S" first="Sang-Chun" last="Oh">Sang-Chun Oh</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, College of Dentistry, Wonkwang University, Daejeon, Republic of Korea.</nlm:aff></affiliation></author><author><name sortKey="Cha, Dong Hee" sort="Cha, Dong Hee" uniqKey="Cha D" first="Dong-Hee" last="Cha">Dong-Hee Cha</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, College of Dentistry, Wonkwang University, Daejeon, Republic of Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Jae In" sort="Lee, Jae In" uniqKey="Lee J" first="Jae-In" last="Lee">Jae-In Lee</name><affiliation><nlm:aff id="A1">Department of Prosthodontics, College of Dentistry, Wonkwang University, Daejeon, Republic of Korea.</nlm:aff></affiliation></author></analytic><series><title level="j">The Journal of Advanced Prosthodontics</title><idno type="ISSN">2005-7806</idno><idno type="eISSN">2005-7814</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>In the maxillary anterior region, reconstruction of the localized alveolar ridge defect is very important in enhancing the esthetics of fixed partial denture. A 40-year-old female patient presented with a chief complaint of the inconvenience and unesthetic problem of 3-unit maxillary anterior prosthesis due to alveolar ridge resorption. After removal of old prosthesis, intraoral examination revealed moderate (buccolingually 4 mm) ridge deficiency in missing tooth region, leading to the diagnosis of Class I alveolar ridge defect. One of the reconstruction techniques to overcome this problem might be a technique that combines two types of soft tissue augmentation techniques. The purpose of this paper was to demonstrate the new combined technique of roll flap and combination onlay-interpositional graft utilized to acquire sufficient dimension of recipient area by one time of operation and to present the esthetic improvement of fixed partial denture by using this procedure in case of maxillary anterior localized ridge defect.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Lazzara, Rj" uniqKey="Lazzara R">RJ Lazzara</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seibert, Js" uniqKey="Seibert J">JS Seibert</name></author><author><name sortKey="Salama, H" uniqKey="Salama H">H Salama</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seibert, Js" uniqKey="Seibert J">JS Seibert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yildirim, M" uniqKey="Yildirim M">M Yildirim</name></author><author><name sortKey="Hanisch, O" uniqKey="Hanisch O">O Hanisch</name></author><author><name sortKey="Spiekermann, H" uniqKey="Spiekermann H">H Spiekermann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Studer, S" uniqKey="Studer S">S Studer</name></author><author><name sortKey="Naef, R" uniqKey="Naef R">R Naef</name></author><author><name sortKey="Sch Rer, P" uniqKey="Sch Rer P">P Schärer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abrams, L" uniqKey="Abrams L">L Abrams</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Scharf, Dr" uniqKey="Scharf D">DR Scharf</name></author><author><name sortKey="Tarnow, Dp" uniqKey="Tarnow D">DP Tarnow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seibert, Js" uniqKey="Seibert J">JS Seibert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Coslet, Jg" uniqKey="Coslet J">JG Coslet</name></author><author><name sortKey="Rosenberg, Es" uniqKey="Rosenberg E">ES Rosenberg</name></author><author><name sortKey="Tisot, R" uniqKey="Tisot R">R Tisot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Orth, Cf" uniqKey="Orth C">CF Orth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Langer, B" uniqKey="Langer B">B Langer</name></author><author><name sortKey="Calagna, L" uniqKey="Calagna L">L Calagna</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Garber, D" uniqKey="Garber D">D Garber</name></author><author><name sortKey="Rosenberg, E" uniqKey="Rosenberg E">E Rosenberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seibert, Js" uniqKey="Seibert J">JS Seibert</name></author><author><name sortKey="Louis, Jv" uniqKey="Louis J">JV Louis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stimmelmayr, M" uniqKey="Stimmelmayr M">M Stimmelmayr</name></author><author><name sortKey="Allen, Ep" uniqKey="Allen E">EP Allen</name></author><author><name sortKey="Reichert, Te" uniqKey="Reichert T">TE Reichert</name></author><author><name sortKey="Iglhaut, G" uniqKey="Iglhaut G">G Iglhaut</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Allen, Ep" uniqKey="Allen E">EP Allen</name></author><author><name sortKey="Gainza, Cs" uniqKey="Gainza C">CS Gainza</name></author><author><name sortKey="Farthing, Gg" uniqKey="Farthing G">GG Farthing</name></author><author><name sortKey="Newbold, Da" uniqKey="Newbold D">DA Newbold</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Perenack, J" uniqKey="Perenack J">J Perenack</name></author><author><name sortKey="Wood, Rj" uniqKey="Wood R">RJ Wood</name></author><author><name sortKey="Block, Ms" uniqKey="Block M">MS Block</name></author><author><name sortKey="Gardiner, D" uniqKey="Gardiner D">D Gardiner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oliver, Rc" uniqKey="Oliver R">RC Oliver</name></author><author><name sortKey="Loe, H" uniqKey="Loe H">H Löe</name></author><author><name sortKey="Karring, T" uniqKey="Karring T">T Karring</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wiskott, Hwa" uniqKey="Wiskott H">HWA Wiskott</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Adv Prosthodont</journal-id><journal-id journal-id-type="iso-abbrev">J Adv Prosthodont</journal-id><journal-id journal-id-type="publisher-id">JAP</journal-id><journal-title-group><journal-title>The Journal of Advanced Prosthodontics</journal-title></journal-title-group><issn pub-type="ppub">2005-7806</issn><issn pub-type="epub">2005-7814</issn><publisher><publisher-name>The Korean Academy of Prosthodontics</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26949490</article-id><article-id pub-id-type="pmc">4769892</article-id><article-id pub-id-type="doi">10.4047/jap.2016.8.1.70</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Combined application of roll flap and combination onlay-interpositional graft to enhance esthetics of maxillary anterior fixed partial denture: A case report</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid" authenticated="true">http://orcid.org/0000-0001-5496-126X</contrib-id><name><surname>Oh</surname><given-names>Sang-Chun</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><name><surname>Cha</surname><given-names>Dong-Hee</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">http://orcid.org/0000-0002-3026-0693</contrib-id><name><surname>Lee</surname><given-names>Jae-In</given-names></name><xref ref-type="aff" rid="A1"></xref></contrib></contrib-group><aff id="A1">Department of Prosthodontics, College of Dentistry, Wonkwang University, Daejeon, Republic of Korea.</aff><author-notes><corresp>Corresponding author: Sang-Chun Oh. Department of Prosthodontics, College of Dentistry, Wonkwang University, 77 Doonsan-ro, Seo-gu, Daejeon 35233, Republic of Korea. Tel. 82 42 366 1100: <email>scoh@wku.ac.kr</email></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>23</day><month>2</month><year>2016</year></pub-date><volume>8</volume><issue>1</issue><fpage>70</fpage><lpage>74</lpage><history><date date-type="received"><day>09</day><month>9</month><year>2015</year></date><date date-type="rev-recd"><day>26</day><month>11</month><year>2015</year></date><date date-type="accepted"><day>30</day><month>11</month><year>2015</year></date></history><permissions><copyright-statement>© 2016 The Korean Academy of Prosthodontics</copyright-statement><copyright-year>2016</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>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>In the maxillary anterior region, reconstruction of the localized alveolar ridge defect is very important in enhancing the esthetics of fixed partial denture. A 40-year-old female patient presented with a chief complaint of the inconvenience and unesthetic problem of 3-unit maxillary anterior prosthesis due to alveolar ridge resorption. After removal of old prosthesis, intraoral examination revealed moderate (buccolingually 4 mm) ridge deficiency in missing tooth region, leading to the diagnosis of Class I alveolar ridge defect. One of the reconstruction techniques to overcome this problem might be a technique that combines two types of soft tissue augmentation techniques. The purpose of this paper was to demonstrate the new combined technique of roll flap and combination onlay-interpositional graft utilized to acquire sufficient dimension of recipient area by one time of operation and to present the esthetic improvement of fixed partial denture by using this procedure in case of maxillary anterior localized ridge defect.</p></abstract><kwd-group><kwd>Reconstruction of localized alveolar ridge defect</kwd><kwd>Roll flap technique</kwd><kwd>Combination onlay-interpositional graft</kwd><kwd>Esthetic improvement of fixed partial denture</kwd></kwd-group><funding-group><award-group><funding-source country="KR"><institution-wrap><institution>Wonkwang University</institution><institution-id institution-id-type="CrossRef">http://dx.doi.org/10.13039/501100002569</institution-id></institution-wrap></funding-source></award-group></funding-group></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>In order to satisfy the high esthetic needs in the maxillary anterior region, it is crucial that there be a harmonious relationship between the teeth and the surrounding soft tissues.<xref rid="B1" ref-type="bibr">1</xref><xref rid="B2" ref-type="bibr">2</xref> However, alveolar ridge defects caused by trauma, tooth extractions, advanced periodontal disease, etc. lead to unnatural emergence profile and prolonged clinical crown length of maxillary anterior prosthesis. Hence, improvement of the localized alveolar ridge defect is vital in enhancing the esthetics of fixed partial denture, especially in the maxillary appearance zone.<xref rid="B3" ref-type="bibr">3</xref></p><p>Reconstructive techniques to augment the deformed alveolar ridge can be classified in two groups based on their coverage degree: soft tissue graft and hard tissue graft.<xref rid="B4" ref-type="bibr">4</xref> In general, soft tissue graft is widely used to get the natural emergence profile of pontics due to short healing period, more predictable result, and simple procedure. Studer et al.<xref rid="B5" ref-type="bibr">5</xref> described types of soft tissue augmentation as follows: 1) the roll flap technique<xref rid="B6" ref-type="bibr">6</xref> and modifications,<xref rid="B7" ref-type="bibr">7</xref> the onlay transplant technique<xref rid="B8" ref-type="bibr">8</xref><xref rid="B9" ref-type="bibr">9</xref> and modifications<xref rid="B10" ref-type="bibr">10</xref> and 3) the subepithelial connective tissue transplant technique<xref rid="B11" ref-type="bibr">11</xref> and modifications.<xref rid="B12" ref-type="bibr">12</xref></p><p>Roll flap technique<xref rid="B6" ref-type="bibr">6</xref> involves a de-epithelialized connective tissue pedicle flap. Advantages of this technique include maintaining the color and texture of the patient's soft tissue, and requiring only single operative site. However, this technique is recommended only for the Seibert Class I defect of mild severity due to limited supply of donor tissue. Combination onlay-interpositional graft<xref rid="B13" ref-type="bibr">13</xref> is a technique that is utilized mainly for buccolingual augmentation by inserting the de-epithelialized portion of graft into labial pouch of deformed ridge and could be also used for apicocoronal augmentation if the epithelialized section of transplant is positioned above the surface of the tissue surrounding the recipient site. It is consequently recommended for Seibert Class I, III ridge defect.</p><p>A common problem of the connective tissue graft for alveolar ridge defect is that it requires multiple operations due to insufficient volume of donor tissue to reconstruct the alveolar ridge defect to its original dimension.<xref rid="B6" ref-type="bibr">6</xref></p><p>One of the alternatives to overcome this limit might be a technique that combines two types of soft tissue augmentation techniques, several of which have been reported. Seibert and Louis<xref rid="B13" ref-type="bibr">13</xref> presented a combination onlay-interpositional graft procedure as predictable soft tissue ridge augmentation in class III ridge defect. Stimmelmayr et al.<xref rid="B14" ref-type="bibr">14</xref> reported a combination epithelized-subepithelial connective tissue graft for closure and soft tissue augmentation of extraction site.</p><p>The purpose of this paper was to describe the new combined technique of roll flap and combination onlay-interpositional graft utilized to get sufficient dimension and contour of recipient area by one time of operation and to present the esthetic improvement such as the natural-looking emergence profile of fixed partial denture in case of localized maxillary anterior ridge defect.</p></sec><sec><title>CASE REPORT</title><p>A 40-year-old female presented with a chief complaint of the inconvenience and unesthetic problem of maxillary anterior prosthesis due to the space between pontic and underlying gingiva, the cocave gingival contour above pontic, and the color disharmony.</p><p>#21 tooth was extracted about 10 years ago and it was recovered by 3-unit (#11=#22) ceramo-metal restoration. Because of ridge resorption, edentulous area occurred about 2.0 mm space between pontic and gingiva. So inconveniences such as food residue and reduced esthetics were predicted (<xref ref-type="fig" rid="F1">Fig. 1</xref>).</p><p>After removal of old prosthesis, intraoral examination revealed moderate (buccolingually 4mm) ridge deficiency in missing tooth region, leading to the diagnosis of Class I alveolar ridge defect (<xref ref-type="fig" rid="F2">Fig. 2</xref>). Seibert<xref rid="B8" ref-type="bibr">8</xref> classified the localized ridge defect as Class I : horizontal or buccal tissue loss with normal ridge height, Class II: vertical or apicocoronal tissue loss with normal ridge width, and Class III: combined horizontal and vertical bone loss. Allen et al.<xref rid="B15" ref-type="bibr">15</xref> reported the classification of soft tissue defect as minor when less than 3 mm, moderate when 3 to 6 mm, and extensive when greater than 6 mm.</p><p>By considering bone level of adjacent teeth and donor site condition, the surgery plan was established to use the combined technique of roll flap and interpositional graft procedure to maximize ridge augmentation and reduce the number of surgery.</p><p>The area subjected to surgery was anesthetized by infiltration anesthesia using 2% Lidocaine with 1:100,000 epinephrine. After administering disinfection and local anesthesia, a partial-thickness crestal incision was made mesiodistally at the height of ridge, and was continued as sulcular incision to the distolabial surfaces of the abutment teeth. On palatal side of the ridge, the gingival surface was de-epithelialized in a trapezoid and the full-thickness rectangular pedicle with de-epithelialized connective tissue was made by a No. 15 scalpel blade. The subperiosteal soft tissue pocket was created on the labial surface of the deformed ridge. The de-epithelialized connective tissue pedicle raised from palate using sharp dissection was rolled and placed in this pocket (<xref ref-type="fig" rid="F3">Fig. 3</xref>).</p><p>After Roll procedure was completed, the donor site was prepared on the premolar palatal area of the maxillary left side for combination onlay-interpositional graft. The trapezoidal shaped transplant was made of the de-epithelialized and epithelialized part. The de-epithelialized connective tissue region of the graft was inserted into the pouch created within the deformed ridge. In order to position and immobilize this segment without any contact and subsequent delay, the transplant was immediately fixed with two separate suture materials prepared in advance on both ends of the bottom of the pouch. The epithelialized section of the graft was positioned above the surface of the surrounding tissue at the crest of the ridge. Since the viability of soft tissue graft is dependent on tight adaptation, immobility, and immediate transplantation for healing, the operator paid particular attention to this procedure (<xref ref-type="fig" rid="F4">Fig. 4</xref>). Sugicel was placed into the palatal wound to control hemorrhage after multiple suturing.</p><p>After the suturing had been completed, provisional prosthesis with ovate pontic was directly modified and placed in position (<xref ref-type="fig" rid="F5">Fig. 5</xref>). It was estimated that immediate placement of this provisional restoration would contribute to getting optimal ovate seat and desired labial relationship for natural emergence profile of fixed partial denture with lesser volume of graft soft tissue by supporting the tissue from inside. The sutures were removed at 1 week post-surgery after good healing state of operation site was checked (<xref ref-type="fig" rid="F6">Fig. 6</xref>). Healing in the recipient site had matured considerably by 6 weeks post-surgery. The final fixed partial denture was delivered at 7 weeks post-surgery (<xref ref-type="fig" rid="F7">Fig. 7</xref>). This prosthesis has been observed natural-looking emergence profile and stable alveolar ridge until about 18 months after the surgery (<xref ref-type="fig" rid="F8">Fig. 8</xref>).</p></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>The deformation in the alveolar ridge is related to loss of root structure and alveolar bone damaged by trauma or periodontal disease. Although there is no precise criteria to select the soft tissue graft or hard tissue graft up to date, the extent of alveolar ridge defect, the state of donor site, and whether installation of implant or not etc. should be comprehensively considered for ridge augmentation.<xref rid="B15" ref-type="bibr">15</xref></p><p>In addition, the estimation of healing period and amount of atrophy expected after grafting is required. Perenack et al.<xref rid="B16" ref-type="bibr">16</xref> reported that most atrophy occurred within the first 6 weeks after performing subepithelial connective tissue graft and about 40% of graft underwent contraction. Therefore, when conducting soft tissue augmentation, the size of the recipient tissue should be increased by 120-150%. Oliver et al.<xref rid="B17" ref-type="bibr">17</xref> mentioned that the healing of the free soft tissue graft took about 2 months through the periods of initial stage, revascularization, and tissue maturity stage. Studer et al.<xref rid="B5" ref-type="bibr">5</xref> reported that the definitive impression for final prosthesis should be taken at least 3, preferably 4, months postoperatively. Wiskott<xref rid="B18" ref-type="bibr">18</xref> mentioned that healing period of 6, preferably 8, months before proceeding with final restoration was necessary.</p><p>In this case, however, although final restoration was delivered at 7 weeks post-surgery, the natural-looking prosthesis with optimal emergence profile and contour was obtained and possible reasons are summarized as follows: 1) the transplant was immediately placed without any contact and subsequent delay such as removing fat layer or trimming graft on the glass plate after taking the graft. 2) The transplant was quickly stabilized and tightly adapted into position with two separate sutures prepared on both sides of the bottom of the pouch. 3) The provisional prosthesis with ovate pontic was promptly placed to get optimal ovate seat and to support the soft tissue from inside for the desired labial relationship of fixed partial denture.</p><p>Unfortunately desired contour of the interdental papilla between maxillary left central incisor and maxillary left lateral incisor was not optically recovered in this case. This was predicted to be a result of the inadequate flap design that the interdental papilla adjacent to the maxillary left lateral incisor was not completely included within the flap. 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A report of 21 cases</article-title><source>J Periodontol</source><year>1985</year><volume>56</volume><fpage>195</fpage><lpage>199</lpage><pub-id pub-id-type="pmid">2987473</pub-id></element-citation></ref><ref id="B16"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Perenack</surname><given-names>J</given-names></name><name><surname>Wood</surname><given-names>RJ</given-names></name><name><surname>Block</surname><given-names>MS</given-names></name><name><surname>Gardiner</surname><given-names>D</given-names></name></person-group><article-title>Determination of subepithelial connective tissue graft thickness in the dog</article-title><source>J Oral Maxillofac Surg</source><year>2002</year><volume>60</volume><fpage>415</fpage><lpage>421</lpage><pub-id pub-id-type="pmid">11928100</pub-id></element-citation></ref><ref id="B17"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Oliver</surname><given-names>RC</given-names></name><name><surname>Löe</surname><given-names>H</given-names></name><name><surname>Karring</surname><given-names>T</given-names></name></person-group><article-title>Microscopic evaluation of the healing and revascularization of free gingival grafts</article-title><source>J Periodontal Res</source><year>1968</year><volume>3</volume><fpage>84</fpage><lpage>95</lpage><pub-id pub-id-type="pmid">4249992</pub-id></element-citation></ref><ref id="B18"><label>18</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Wiskott</surname><given-names>HWA</given-names></name></person-group><source>Fixed Prosthodontics: Principles and clinics</source><publisher-loc>Great Britian</publisher-loc><publisher-name>Quintessence</publisher-name><year>2011</year><fpage>243</fpage></element-citation></ref></ref-list></back><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><title>Pretreatment views of 3-unit fixed partial denture at the time of initial examination. (A, C) Lateral views and (B) frontal view showed the labial concavity of gingiva and the space between pontic and underlying gingiva.</title></caption><graphic xlink:href="jap-8-70-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><title>Labial view of a Class I ridge defect. Note moderate labial ridge deficiency with normal ridge height of missing tooth region.</title></caption><graphic xlink:href="jap-8-70-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><title>Roll flap procedure (A) a partial-thickness crestal incision was made mesiodistally at the height of ridge. (B) the gingival surface was de-epithelialized in a trapezoid on palatal side of the ridge. (C) the full-thickness rectangular pedicle with de-epithelialized connective tissue was made by a No. 15 scalpel blade. (D) The de-epithelialized connective tissue pedicle raised from palate using sharp dissection was rolled and placed in the pocket on the labial surface of the deformed ridge.</title></caption><graphic xlink:href="jap-8-70-g003"></graphic></fig><fig id="F4" orientation="portrait" position="float"><label>Fig. 4</label><caption><title>Combination onlay-interpositional graft procedure. (A) The donor site was prepared on the premolar palatal area. (B) The trapezoidal shaped transplant was made of the de-epithelialized and epithelialized part. (C) The transplant was immediately fixed with two separate sutures prepared in advance on both ends of the bottom of the pouch. (D) The epithelialized section of the graft was positioned above the surface of the surrounding tissue at the crest of the ridge.</title></caption><graphic xlink:href="jap-8-70-g004"></graphic></fig><fig id="F5" orientation="portrait" position="float"><label>Fig. 5</label><caption><title>Sutures and immediate placement of provisional restoration. (A) Occlusal view and (B) labial view showed both apical single-knot sutures to stabilize the transplant. (C) Provisional prosthesis with ovate pontic was directly modified and placed in position.</title></caption><graphic xlink:href="jap-8-70-g005"></graphic></fig><fig id="F6" orientation="portrait" position="float"><label>Fig. 6</label><caption><title>Healing state after 1 week post-surgery. (A) Labial view of recipitent site and (B) occlusal view of donor site showed good healing at 1 week post-surgery.</title></caption><graphic xlink:href="jap-8-70-g006"></graphic></fig><fig id="F7" orientation="portrait" position="float"><label>Fig. 7</label><caption><title>Recipient site and delivery of final restoration at 7 weeks post-surgery. (A) Labial view and (B) occlusal view showed good ovate seat but the trace of crestal incision line was remained at mesial side of lateral incisor. (C) Final prosthesis was zirconial all-ceramic restoration with ovate pontic. (D) Final restoration showed good emergence profile and no interference in function.</title></caption><graphic xlink:href="jap-8-70-g007"></graphic></fig><fig id="F8" orientation="portrait" position="float"><label>Fig. 8</label><caption><title>Labial view of final prosthesis after 18 months post-surgery. (A) Frontal view and (B) lateral view showed natural-looking emergence profile, stable alveolar ridge, and harmonious color.</title></caption><graphic xlink:href="jap-8-70-g008"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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