GAP Australasian-Dentist Issue 80 Jul-Aug 19

Category 98 AustrÀlÀsiÀn Dentist À o painful graft harvest and very good color and texture match surrounding tissue. Àhese are major advantages when performing a vestibuloplasty with Geistlich Mucograft ® 3-D collagen matrix. Àow there is long-term data over five years. Àn the last few years peri-implant soft tissue regeneration has acquired particular relevance in implantology. Àiterature is beginning to show the emergence of a tendency for an implant to be healthy, if there is a fixed, keratinized peri-implant mucosa of at least two mm in width. 1 According to the current literature, the methods for widening the peri-implant keratinized mucosa are all associated with an apically positioned flap or a vestibuloplasty. 2 A secondary granulation of the resultant wound surface is not ideal due to postoperative morbidity and wound contraction with a high tendency for muscular reattachment. 2–4 Autologous grafts from the palate Autologous soft tissue grafts from the palateÀ–Àsuch as free mucosal grafts (FMGs) or a connective tissue grafts (CÀGs)À–Àare the gold standards for covering a wound surface. Àhey reduce postÀoperative contraction and improve the regenerative result. 2,3,5,6 Furthermore autologous grafts show reproducible clinical results in terms of treatment, integration, shrinkage and long-term stability (Fig.À1). However, the following points are disadvantages of autologous tissue grafting: u Àecessity for palatal harvest with additional surgical risks 2–4 u Patients’ harvest site morbidity 6 u Àimited availability of the graft 3,4 u Prolonged surgery time 2–4,6 and u Poorly matched texture and color, when using FMGs. 4,6 (Fig.À1) The Geistlich Mucograft®3-D collagen matrix All these factors motivate the search for possible alternatives – chiefly absorbable collagen matrices. Àheir support for epithelial proliferation has already been demonstrated and is partly based on infiltration with fibroblasts and keratinocytes and the formation of blood vessels. 4,7 Àhe porcine Geistlich Mucograft ® 3-D collagen matrix has proven effective in open healing in numerous preclinical and clinical studies and is a good alternative to autologous tissue (FMG and CÀG). 2,5,6,8 By using biomaterials as scaffold for ingrowth of soft tissue, there is no need to harvest autologous grafts. 3,4 Geistlich Mucograft ® 3-D collagen matrix consists of compact and porous collagen layers and was specially developed for oral soft tissue regeneration. Àhe compact collagen layer ensures the stability of the collagen matrix. Àpon insertion it should face outwards the oral cavity, where it shields against mechanical insults from the oral cavity and provides adequate suturing. When in direct contact with the wound bed, the porous matrix layer can biointegrate by rapidly stabilizing the blood clot and enabling invasion of local growth factors from the graft bed for cell proliferation, vascularization and new tissue formation. 6,7 Application and aftercare When using Geistlich Mucograft ® , patient selection criteria, patient compliance and surgical requirements should be followed, as they should for autologous soft tissue transplants. After being cut to the necessary shape and size, Geistlich Mucograft ® 3-D collagen matrix is placed in a dry state on the recipient region on the periosteum. We recommend the periosteum be prepared as cleanly as possible with an apical periostal fixation of the mucosal split flap to ensure an optimum immobile integration of the matrix. (Fig.À2) Ào preÀtreatment of the collagen matrix is required. Àhe collagen matrix should be fixed stably onto the periosteum with absorbable sutures, as gap-free as possible to ensure maximum Using a 3-D collagen matrix for a vestibuloplasty By DrÀChristian Schmitt, Germany Clinic of Oral and Maxillofacial Àurgery Àniversity Clinic Àrlangen-Àuremberg Àrlangen n aÀ Fig 1: Vestibuloplasty with autologous grafts. A. Clinical situation before treatment. B. Necessity to remove tissue from the palate. C. Fixation of the FMG on the periosteum with maximum positional stability; this often requires the suture to be fixed with crossed sutures. D. Healing progress after 10 days. E. Healing progress after 3 months. F. Even after 5 years the soft tissue grafted from the palate can still be clinically distinguished from the surrounding tissue with respect to colour and texture.