CATEGORY 68 AUSTRALASIAN DENTIST LINICAL A new approach in managing soft tissue volume deficiencies – Geistlich Fibro-Gide® Dr Michael Danesh Myer Treatment by: Dr Michael Danesh Myer Aim: Horizontal ridge deficiencies in the anterior maxilla can have a negative impact on aesthetics and the long-term maintenance and health of per-implant tissues. Such a deficiency is usually caused by both hard and soft tissue components. If the existing horizontal bone width allows for the correct Conclusion: The gold standard for managing soft tissue volume deficiencies is grafting with a subepithelial connective tissue graft (SCTG). However, a disadvantage of this therapy is the need to harvest donor tissue from the palate. There is a finite limit to the quantity of tissue that can be harvestedwhichmay also be of variable quality. Geistlich Fibro-Gide® now offers a convenient alternative that can result in a clinical outcome not too dissimilar to the SCTG, without the need for donor site surgery1. Geistlich Fibro-Gide® can Fig 1 Labial view of the pre-operative situation (site 22) just prior to soft tissue augmentation. The loss of labial ridge contour is commonly observed at extraction sites in which an alveolar ridge preservation procedure was not performed at the time of extraction with appropriate biomaterials. Fig 4 Geistlich Fibro-Gide®, a novel porcinederived, porous, volume-stable, collagen matrix was used to augment the soft tissues. It was customised to match the approximate dimensions of the defect, taking into account the volume expansion of the material once hydrated (up to 25% increase in volume). The margins are bevelled to help reduce tension on the flap margins when sutured. Fig 7 Incisal view of the primary wound closure. The flap has been coronally advanced to fully cover the Geistlich Fibro-Gide®. Wound closure of the relieving incisons has been achieved and the flap has been tightly adapted to the healing abutment. Fig 2 Incisal view of the pre-operative situation. A concave defect can be observed on the labial aspect. The dimensional alterations are caused by loss of both hard and soft tissue components. Fig 5 In this situation, the Geistlich Fibro-Gide® material was placed directly on the bone since a full thickness flap was raised for placing the implant. Adequate periosteal release is required to allow for sufficient coronal advancement of the flap to achieve tension-free water tight primary closure. The biomaterial must not be left exposed. Fig 8 Incisal view at 3 months post soft tissue augmentation. Note the significant improvement in the labial contour of the ridge and the healthy state of the keratinised soft tissues. Fig 3 The hard tissue situation just prior to implant site preparation. Adequate bone width is available for the prosthetically-driven implant position, however the concavity will remain, posing an aesthetic and maintenance concern. This concave defect can be managed by either bone augmentation, soft tissue augmentation, or combination. In this situation, soft tissue augmentation was the preferred option. Fig 6 After bleeding, the material becomes soft and more compressable but does swell around 25% by volume. The material maintains it’s volume, allowing blood vessels and fibroblasts to enter the porous structure of the material and encourage new soft tissue formation. Fig 9 Final crown placement. An excellent emergence profile has been achieved. Recent literature indicates that the clinical outcomes using Geistlich Fibro-Gide® remain stable between baseline and 5 years1 be used prior to implant therapy (i.e., site preparation), at the time of implant placement, or at implant uncovery. u References: 1. Soft tissue augmentation with a volume-stable collagen matrix or an autogenous connective tissue graft at implant sites: Five-year results of a randomized controlled trial post implant loading. Thoma D.S., Gasser T.J.W., Hammerle C.H.F., Strauss F.J., and Jung R.E. Journal of Periodontology. 2023; 94(2):230-243 prosthetically-driven placement of an implant (with sufficient surrounding crestal bone thickness), then the regenerative focus should be on the soft tissues.The aimof this procedure is to augment the soft tissue volume on the labial aspect of the upper left lateral incisor (22) implant site using a novel xenogeneic collagen matrix.
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