Rotational Flap to Enhance Buccal Gingival Thickness and Implant Emergence Profile in the Esthetic Zone: Two Cases Reports
Identifieur interne : 001F59 ( Pmc/Curation ); précédent : 001F58; suivant : 001F60Rotational Flap to Enhance Buccal Gingival Thickness and Implant Emergence Profile in the Esthetic Zone: Two Cases Reports
Auteurs : Mohammed Jasim Al-JubooriSource :
- The Open Dentistry Journal [ 1874-2106 ] ; 2017.
Abstract
Many techniques have been developed to enhance the gingival thickness, gingival level and emergence profile around the implant in the esthetic zone.
In this study, a buccal rotational flap was used to improve the implant site in the esthetic zone and increase gingival tissue thickness.
Two cases involved the use of a rotational flap during second-stage implant surgery, one case involved the use of a temporary crown with a healing abutment, and another case involved the use of a healing abutment.
The cases were followed up until the final crown was placed. The implant site was improved in 2 cases; the gingival thickness increased, the gingival level was enhanced and the emergence profile was developed.
Many factors affect the results of a rotational flap; some factors are surgical, while others are prosthetic, biological and anatomical.
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DOI: 10.2174/1874210601711010284
PubMed: 28839477
PubMed Central: 5543658
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Rotational Flap to Enhance Buccal Gingival Thickness and Implant Emergence Profile in the Esthetic Zone: Two Cases Reports</title><author><name sortKey="Al Juboori, Mohammed Jasim" sort="Al Juboori, Mohammed Jasim" uniqKey="Al Juboori M" first="Mohammed Jasim" last="Al-Juboori">Mohammed Jasim Al-Juboori</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28839477</idno><idno type="pmc">5543658</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543658</idno><idno type="RBID">PMC:5543658</idno><idno type="doi">10.2174/1874210601711010284</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">001F59</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001F59</idno><idno type="wicri:Area/Pmc/Curation">001F59</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001F59</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Rotational Flap to Enhance Buccal Gingival Thickness and Implant Emergence Profile in the Esthetic Zone: Two Cases Reports</title><author><name sortKey="Al Juboori, Mohammed Jasim" sort="Al Juboori, Mohammed Jasim" uniqKey="Al Juboori M" first="Mohammed Jasim" last="Al-Juboori">Mohammed Jasim Al-Juboori</name></author></analytic><series><title level="j">The Open Dentistry Journal</title><idno type="eISSN">1874-2106</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective:</title><p>Many techniques have been developed to enhance the gingival thickness, gingival level and emergence profile around the implant in the esthetic zone. </p></sec><sec><title>Introduction:</title><p>In this study, a buccal rotational flap was used to improve the implant site in the esthetic zone and increase gingival tissue thickness. </p></sec><sec><title>Methods:</title><p>Two cases involved the use of a rotational flap during second-stage implant surgery, one case involved the use of a temporary crown with a healing abutment, and another case involved the use of a healing abutment. </p></sec><sec><title>Result:</title><p>The cases were followed up until the final crown was placed. The implant site was improved in 2 cases; the gingival thickness increased, the gingival level was enhanced and the emergence profile was developed. </p></sec><sec><title>Conclusion:</title><p>Many factors affect the results of a rotational flap; some factors are surgical, while others are prosthetic, biological and anatomical.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kois, J C" uniqKey="Kois J">J.C. Kois</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Muller, H P" uniqKey="Muller H">H-P. Müller</name></author><author><name sortKey="Eger, T" uniqKey="Eger T">T. Eger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chang, M" uniqKey="Chang M">M. Chang</name></author><author><name sortKey="Wennstrom, J L" uniqKey="Wennstrom J">J.L. Wennström</name></author><author><name sortKey="Odman, P" uniqKey="Odman P">P. Odman</name></author><author><name sortKey="Andersson, B" uniqKey="Andersson B">B. Andersson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cardaropoli, D" uniqKey="Cardaropoli D">D. Cardaropoli</name></author><author><name sortKey="Tamagnone, L" uniqKey="Tamagnone L">L. Tamagnone</name></author><author><name sortKey="Roffredo, A" uniqKey="Roffredo A">A. Roffredo</name></author><author><name sortKey="Gaveglio, L" uniqKey="Gaveglio L">L. Gaveglio</name></author><author><name sortKey="Cardaropoli, G" uniqKey="Cardaropoli G">G. Cardaropoli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cranin, A N" uniqKey="Cranin A">A.N. Cranin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Le, B" uniqKey="Le B">B. Le</name></author><author><name sortKey="Burstein, J" uniqKey="Burstein J">J. Burstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Saade, J" uniqKey="Saade J">J. Saade</name></author><author><name sortKey="Sotto Maior, B S" uniqKey="Sotto Maior B">B.S. Sotto-Maior</name></author><author><name sortKey="Francischone, C E" uniqKey="Francischone C">C.E. Francischone</name></author><author><name sortKey="Bassani, M" uniqKey="Bassani M">M. Bassani</name></author><author><name sortKey="De Castro, A N" uniqKey="De Castro A">A.N. de Castro</name></author><author><name sortKey="Senna, P M" uniqKey="Senna P">P.M. Senna</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harris, R J" uniqKey="Harris R">R.J. Harris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oates, T W" uniqKey="Oates T">T.W. Oates</name></author><author><name sortKey="Robinson, M" uniqKey="Robinson M">M. Robinson</name></author><author><name sortKey="Gunsolley, J C" uniqKey="Gunsolley J">J.C. 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Hu ¨rzeler</name></author><author><name sortKey="Von Mohrenschildt, S" uniqKey="Von Mohrenschildt S">S. von Mohrenschildt</name></author><author><name sortKey="Zuhr, O" uniqKey="Zuhr O">O. Zuhr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Araujo, M G" uniqKey="Araujo M">M.G. Araújo</name></author><author><name sortKey="Lindhe, J" uniqKey="Lindhe J">J. Lindhe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vignoletti, F" uniqKey="Vignoletti F">F. Vignoletti</name></author><author><name sortKey="Matesanz, P" uniqKey="Matesanz P">P. Matesanz</name></author><author><name sortKey="Rodrigo, D" uniqKey="Rodrigo D">D. Rodrigo</name></author><author><name sortKey="Figuero, E" uniqKey="Figuero E">E. Figuero</name></author><author><name sortKey="Martin, C" uniqKey="Martin C">C. Martin</name></author><author><name sortKey="Sanz, M" uniqKey="Sanz M">M. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Open Dent J</journal-id><journal-id journal-id-type="iso-abbrev">Open Dent J</journal-id><journal-id journal-id-type="publisher-id">TODENTJ</journal-id><journal-title-group><journal-title>The Open Dentistry Journal</journal-title></journal-title-group><issn pub-type="epub">1874-2106</issn><publisher><publisher-name>Bentham Open</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28839477</article-id><article-id pub-id-type="pmc">5543658</article-id><article-id pub-id-type="publisher-id">TODENTJ-11-284</article-id><article-id pub-id-type="doi">10.2174/1874210601711010284</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Rotational Flap to Enhance Buccal Gingival Thickness and Implant Emergence Profile in the Esthetic Zone: Two Cases Reports</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>AL-Juboori</surname><given-names>Mohammed Jasim</given-names></name><xref ref-type="corresp" rid="cor1">*</xref></contrib><aff>Department of Periodontology, Al-Rafidain University College, Baghdad, Iraq.</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Address correspondence to this author at the Department of Periodontology, Al-Rafidain University College, Palestine Street, P.O Box 46036, Baghdad, Iraq; Tel: (+964)7714559551; E-mail: <email xlink:href="doctor_mohamed_2006@yahoo.com">doctor_mohamed_2006@yahoo.com</email></corresp></author-notes><pub-date pub-type="epub"><day>30</day><month>6</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2017</year></pub-date><volume>11</volume><fpage>284</fpage><lpage>293</lpage><history><date date-type="received"><day>20</day><month>12</month><year>2016</year></date><date date-type="rev-recd"><day>16</day><month>3</month><year>2017</year></date><date date-type="accepted"><day>12</day><month>5</month><year>2017</year></date></history><permissions><copyright-statement>© 2017 Mohammed Jasim AL Juboori.</copyright-statement><copyright-year>2017</copyright-year><copyright-holder>Bentham Open.</copyright-holder><license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/legalcode"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: <uri xlink:type="simple" xlink:href="https://creativecommons.org/licenses/by/4.0/legalcode">https://creativecommons.org/licenses/by/4.0/legalcode</uri>. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Objective:</title><p>Many techniques have been developed to enhance the gingival thickness, gingival level and emergence profile around the implant in the esthetic zone. </p></sec><sec><title>Introduction:</title><p>In this study, a buccal rotational flap was used to improve the implant site in the esthetic zone and increase gingival tissue thickness. </p></sec><sec><title>Methods:</title><p>Two cases involved the use of a rotational flap during second-stage implant surgery, one case involved the use of a temporary crown with a healing abutment, and another case involved the use of a healing abutment. </p></sec><sec><title>Result:</title><p>The cases were followed up until the final crown was placed. The implant site was improved in 2 cases; the gingival thickness increased, the gingival level was enhanced and the emergence profile was developed. </p></sec><sec><title>Conclusion:</title><p>Many factors affect the results of a rotational flap; some factors are surgical, while others are prosthetic, biological and anatomical.</p></sec></abstract><kwd-group kwd-group-type="author"><title>Keywords</title><kwd>Esthetic zone</kwd><kwd>Gingival level</kwd><kwd>Emergence profile</kwd><kwd>Soft tissue</kwd><kwd>Flap</kwd></kwd-group></article-meta></front><floats-group><fig id="F1" fig-type="figure" position="float"><label>Fig. (1)</label><caption><p> Retained root 23 is extracted, and the socket is left to heal for 2 months before implant placement.</p></caption><graphic xlink:href="TODENTJ-11-284_F1"></graphic></fig><fig id="F2" fig-type="figure" position="float"><label>Fig. (2)</label><caption><p> Full-thickness flap is raised using crestal incision with papillary involvement to place an implant in the 23 area.</p></caption><graphic xlink:href="TODENTJ-11-284_F2"></graphic></fig><fig id="F3" fig-type="figure" position="float"><label>Fig. (3)</label><caption><p> Re-entry surgery is performed 3 months after implant placement and palatal rotational flap performed simultaneously with a temporary abutment and crown. A three-sided flap with a more palatally placed crestal incision and the papillae reserved is created. Two vertical incisions are made to the vestibule so that the flap could be freely rotated.</p></caption><graphic xlink:href="TODENTJ-11-284_F3"></graphic></fig><fig id="F4" fig-type="figure" position="float"><label>Fig. (4)</label><caption><p>After one month, the crown is modified by adding composite filling material to shape the emergence profile to mimic a natural tooth.</p></caption><graphic xlink:href="TODENTJ-11-284_F4"></graphic></fig><fig id="F5" fig-type="figure" position="float"><label>Fig. (5)</label><caption><p> Soft tissue adaptation occurred and an emergence profile was shaped when a provisional crown was used. Bleeding occurred after the provisional crown was removed, which is a sign that the lining mucosa was attaching to the crown structure.</p></caption><graphic xlink:href="TODENTJ-11-284_F5"></graphic></fig><fig id="F6" fig-type="figure" position="float"><label>Fig. (6)</label><caption><p>The permanent crown is placed, and gingival bulk is achieved. Still, gingival indentation persists at the vertical gingival incision, and partially loss of mesial and distal papillae is obvious.</p></caption><graphic xlink:href="TODENTJ-11-284_F6"></graphic></fig><fig id="F7" fig-type="figure" position="float"><label>Fig. (7)</label><caption><p> Periapical radiograph at the time the crown was placed shows a good crestal bone level.</p></caption><graphic xlink:href="TODENTJ-11-284_F7"></graphic></fig><fig id="F8" fig-type="figure" position="float"><label>Fig. (8)</label><caption><p>Six months after the permanent crown is placed, the papillae regenerate and fill the gap, and the indentation scar from the vertical incision starts to disappear.</p></caption><graphic xlink:href="TODENTJ-11-284_F8"></graphic></fig><fig id="F9" fig-type="figure" position="float"><label>Fig. (9)</label><caption><p>Socket grafting after 21 extraction. The bone graft is covered with a collagen membrane and secured with sutures.</p></caption><graphic xlink:href="TODENTJ-11-284_F9"></graphic></fig><fig id="F10" fig-type="figure" position="float"><label>Fig. (10)</label><caption><p>Buccal contour concavity after 3 months period of implant placement.</p></caption><graphic xlink:href="TODENTJ-11-284_F10"></graphic></fig><fig id="F11" fig-type="figure" position="float"><label>Fig. (11)</label><caption><p>Healing one week after the palatal rotational flap is performed. Overcorrection is mandatory to compensate for soft tissue remodeling.</p></caption><graphic xlink:href="TODENTJ-11-284_F11"></graphic></fig><fig id="F12" fig-type="figure" position="float"><label>Fig. (12)</label><caption><p>Soft tissue healing one month after rotational flap. <bold>A</bold>, the normal contour of the implant buccal gingiva; <bold>B</bold>, thick and healthy gingival tissue around the implant after the healing abutment is removed.</p></caption><graphic xlink:href="TODENTJ-11-284_F12"></graphic></fig><fig id="F13" fig-type="figure" position="float"><label>Fig. (13)</label><caption><p>A permanent crown with a customized abutment is fabricated, a marked gingival augmentation can be appreciated.</p></caption><graphic xlink:href="TODENTJ-11-284_F13"></graphic></fig><fig id="F14" fig-type="figure" position="float"><label>Fig. (14)</label><caption><p>Periapical radiograph at the time the crown was placed shows a good crestal bone level.</p></caption><graphic xlink:href="TODENTJ-11-284_F14"></graphic></fig><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Palatal flap roll technique advantages and disadvantages.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th valign="top" align="center" scope="col" rowspan="1" colspan="1"><bold>Disadvantages</bold></th><th valign="top" align="center" scope="col" rowspan="1" colspan="1"><bold>Advantages</bold></th></tr></thead><tbody><tr><td valign="top" align="center" scope="row" rowspan="1" colspan="1">1-Does not change the gingival biotype, 2-Tissue loss may occur at the implant site, 3-Not applicable for multiple implants, 4-Does not improve the interdental papillae level, 5-May leave a scar at the esthetic zone</td><td valign="top" align="center" rowspan="1" colspan="1">1-Achieves a better emergence profile, 2-Less scar tissue formation, 3-Stable gingival margin, 4-No secondary site of surgery, 5-Mantains the blood supply to the rotated part, 6-Shorter healing period and faster tissue maturation, 7-No need for advanced professional skills, 8-Cost effective, 9-Tissue harmony around the implant</td></tr></tbody></table></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Factors, procedure and elements that contribute in successful rotational flap technique.</p></caption><table frame="border" rules="all" width="100%"><thead><tr><th valign="top" align="center" scope="col" rowspan="1" colspan="1"><bold>Surgical</bold></th><th valign="top" align="center" scope="col" rowspan="1" colspan="1"><bold>Prosthetic</bold></th><th valign="top" align="center" scope="col" rowspan="1" colspan="1"><bold>Biological</bold></th><th valign="top" align="center" scope="col" rowspan="1" colspan="1"><bold>Anatomical</bold></th></tr></thead><tbody><tr><td valign="top" align="center" scope="row" rowspan="1" colspan="1">1-Papillae-preserving flap</td><td valign="top" align="center" rowspan="1" colspan="1">1-Proper implant position (not ending with a ridge lab crown)</td><td valign="top" align="center" rowspan="1" colspan="1">1-Oral mucosal tissue changes according to the type of surface facing the implant</td><td valign="top" align="center" rowspan="1" colspan="1">1-Adequate width of keratinized mucosa on the buccal aspect</td></tr><tr><td valign="top" align="center" scope="row" rowspan="1" colspan="1">2-Avoiding a vertical cut on the keratinized mucosa</td><td valign="top" align="center" rowspan="1" colspan="1">2-Concave provisional crown at the cervical area</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">2-Adequate thickness of the rotated flap (>1.5 mm)</td></tr><tr><td valign="top" align="center" scope="row" rowspan="1" colspan="1">3-More palatal placement of the crestal incision</td><td valign="top" align="center" rowspan="1" colspan="1">3-Smooth crown surface</td><td valign="top" align="center" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"></td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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