Wednesday, May 26, 2010

A Comparison between Alloderm and Free Gingival Graft

Alloderm and Free gingival grafts are placed on either apical or coronal region at the recessed gingival margin, where these grafts are used to enhance the smile and reduce tooth exposure which gives unpleasant appearance. A free gingival graft is used to increase the zone of attached gingival tissue. In this procedure, the tissue is obtained from the patient itself and used on the site of gum recession. The tissue obtained can be either from the palate of the patient or some other oral tissues from the patient’s mouth. It is then placed on the area where there is exposed root surface or wall defects, and which can have single or multiple defects. There is hardly any damage to the donor due to tissue removal.

The main function of the free gingival graft is to increase the thickness of the gum tissue. This process is indicated when there is gingival recession or a part of the soft tissues is displaced due to trauma. It also covers root surfaces exposed due to severe gum recession. In this technique, an incision is made at the mucogingival junction without touching the periosteum. An Aluminum foil template at the recipient site is used as patterns, and the graft is placed directly on the bone tissue and is allowed to heal for two weeks.

An Alloderm or acellular derma matrix is a processed graft obtained from donated human tissues which is later processed to be used in any patient. Alloderm is made up of a matrix of collagen which helps in cell production and also contains elements which provide blood supply to the surrounding areas. It can be used for root coverage for multiple teeth. And it has very good epithelial tissue which helps in maintaining the esthetics. The cells produce and cause pigmentation like the natural tissues, and give good contour. We can also treat several defects in a single surgery with alloderm graft as there are no limitations on the amount of tissue obtained unlike the free gingival graft obtained from the palate which has limitations.
There are several advantages of the alloderm against free gingival margin graft. Firstly, no palatal tissue is required from the patient. Secondly, multiple surgical procedures can be performed on the patient without any limitation on the tissue requirement. Irrespective of the age of the patient and the medical fitness of the patient, the surgery can be performed as the palatal tissues are not required from the patient. With Alloderm, the height of the mandible over denture is maintained. Alloderm was previously used in major body burns for plastic surgeries, but today it is extensively used in dentistry as well.

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Sunday, May 09, 2010

Significance of Esthetic Buccal Flap (EBF) in Implant Surgery

Although dental implantology has tremendously advanced in the last decade, there are still a few flaws and backdrops in the procedures when it comes to perfect esthetic appearance, especially for those who want to have natural appearance immediately after implant surgery. For such people, a flapless implant surgery has come into being recently. It was discovered in order to rectify the flaws of other implant procedures and to deal with those factors which flap designs in implant surgeries. But these procedures are not able to correct the vertical and horizontal wall defects of one wall or more, and are also not able to correct dehiscence or fenestrations without disturbing the esthetics.
Hence, a new Flap design was introduced in the implant surgery which aimed at maintaining maximum esthetic appearance while rectifying other defects as well at the same time, and this flap design is known as Esthetic Buccal Flap (EBF). It is best preferred for single missing tooth or multiple missing teeth where the adjacent soft tissues and bony structures are intact. And is more preferred in the anterior region so as to achieve perfect harmony with the implant position, bone level, soft tissue esthetics and tooth form and color. It can satisfy all these factors and give good esthetics without any scar tissue formation.

When a prosthesis or implant is inserted in the jaw bone, after a gap of 6 months or more, a clinical assessment is done to check for the progress and regeneration of bone, and its adaptability to the surrounding structures. An assessment of mid buccal probing height is also done together with the detection of any present signs of scar tissue, based on which a soft tissue adaption is preferred.

The height of the soft tissue remains the same before and after the surgery, the papillae and the probing dept also appears to be the same after the surgery, and there will be no sign of any scar tissue. Thus, Esthetic buccal flap along with rightly guided bone augmentation allows perfect esthetics in implant surgery which also rectifies any wall defects as well. The esthetic buccal flap in implant surgeries helps to get a normal gingival appearance after the implants are placed.

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