Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Ridge Augmentation Procedure Using Connective Tissue Graft in Esthetic Zone - A Case Report

Srinivasan Sivaprakasam, Vijay Karuppiah*, Ramaprabha Govindaraj

Division of Periodontia, Rajah Muthiah Dental College and Hospital, Annamalai University

Abstract: A common issue in tooth replacement is the ability to reestablish normal form and architecture of the hard and soft tissues before prosthesis. This is especially challenging in the anterior zone, where the replacement of a missing tooth must not only function, but esthetically match the contours of the hard and soft tissue of the adjacent natural dentition. A case report has been presented over here for a patient with class III alveolar ridge defect in the maxillary anterior region corrected with soft tissue ridge augmentation using connective tissue graft followed by a metal ceramic fixed prosthesis for the replacement of missing upper central incisor.

Keywords: soft tissue ridge augmentation, connective tissue, fixed partial denture

Received October 26, 2013; Revised November 10, 2013; Accepted November 15, 2013

Citation: Srinivasan Sivaprakasam, Vijay Karuppiah, Ramaprabha Govindaraj, Ridge Augmentation Procedure Using Connective Tissue Graft in Esthetic Zone - A Case Report. International Journal of Dental Science and Research, 1 (2). 45-47. January 2013. doi:10.12691/ijdsr-1-2-5

1. Introduction

Alveolar bone resorption is the normal physiologic response following tooth removal. Residual ridge defects present important challenges for aesthetic dentistry [1]. Prosthetic tissue replacement has been one method of replacing tissue loss. Alternatively, surgical soft-tissue augmentation techniques have been effective in developing soft-tissue architectures that facilitate aesthetic restorations. Soft-tissue ridge augmentations using palatal grafts have been thoroughly documented in the management of residual ridge deformities [2].

Seibert (1983) classified three types of ridge deformities,

1. Class I: Bucco-lingual loss of tissue contour with a normal apicocoronal height.

2. Class II: Apico-coronal loss of tissue with normal bucco-lingual contour.

3. Class III: A combination of bucco-lingual and apico-coronal loss.

Abrams et al studied the prevalence of anterior ridge deformities in the mandibular and maxillary arches of partially edentulous patients and reported the presence of defects in 91% of the cases. Class III defects were the most prevalent (55.8%), followed by Class I defects (32.8%) and Class II defects (2.9%) [3].

2. Treatment Options Based on Defect Classification and Type of Donor Tissue

Connective tissue grafts give excellent color match of the surrounding tissue, due to good blood supply well received by the recipient site. They can be well stabilized by periosteal suturing. The ridge augmentations with connective tissue have stability ranging from 7 to 12 years [4]. This case report describes the use of subepithelial connective tissue graft technique to correct buccolingual loss of contour with normal apicocoronal height. The procedure enhanced the final prosthetic restoration, fixed partial denture, significantly improving resortation esthetics.

Table 1. Type of the defect and choice of treatment according to the type of defect

3. Case Presentation

A patient by name Meenakshi age 35 reported to our dental outpatient Department of Periodontics, Rajah Muthiah Dental College and Hospital with the chief complaint of replacing her missing anterior teeth 21. Her past dental history revealed that she had a history of trauma three years back, following which the teeth were extracted.

A thorough clinical and radiographic examination revealed a Siebert’s Class III defect in the edentulous region. She presented with a moderate horizontal and a severe vertical ridge defect and there was a short clinical crown in relation to 11 (Figure 1). Since the patient elected not to have an implant instead go for conventional fixed partial denture, augmenting the defect with soft tissue graft was decided. Routine introral periapical radiograph, and blood investigations was done and was found to be normal. Further examination revealed that patient’s palate had sufficient tissue thickness to serve as a donor site.

Figure 1. Siebert’s Class III defect in relation to 21

4. Surgical Procedure

Local anaesthesia was given in relation to upper anterior region and upper right palatal region. Following adequate anesthesia,two vertical realising incision was made in relation to mesial and distal aspect of 21. Both the vertical incisions are connected by a palatal incision. A full thickness flap was raised (Figure 2).

Figure 2. Reflection of full thickness flap in relation 21

A connective tissue graft measuring about 7mm x 5mm x 4mm was obtained from upper right; palatal Region. (Figure 3).

Figure 3. Connective tissue graft from palatal region in right side

Then the graft was positioned in the recipient site and it was secured by suturing with the flap. Then the flap was approximated by interrupted sutures along the vertical releasing incision and palatal aspect (Figure 4).

Figure 4.connective tissue Graft positioned in the recipient site and sutured

Periodontal pack was given followed by post operative instructions. Temporary removable partial denture was given. The patient was asked to report after one week. During the follow up period the healing was satisfactory and the sutures were removed. After three months considerable gain in the ridge both apicocoronally and buccolingualy was obtained. Fixed partial denture was done in relation to 11, 21, 22. Reasonable esthetic appearance was obtained (Figure 5).

Figure 5. post op check up after 3 months with fixed partial denture in relation to 11,21&22

5. Discussion

Alveolar ridge defects occur when the loss of teeth results in a dimensional loss of bone and soft tissue surrounding the alveolus. The extent of dimensional loss is related to the shape of the underlying bone present at the time of tooth removal.

Prosthetic treatment of localized alveolar ridge defect with a fixed prosthesis is associated with aesthetic problems like black interdental triangles and technical problems like difficulty to design aesthetic pontic. In the present case, the loss of ridge width was more evident with a little loss of ridge height; hence, an autogenous connective tissue graft was used to augment the ridge defect [5]. A connective tissue graft has a better chance of survival than free grafts over poor or non-vascularized areas such as a bone graft or a non-resorbable membrane.

Important factors to be considered for the long-term success of connective tissue transplants include primary fixation of the graft, the possibility of revascularization, and revitalization from the receptor site. Close contact to a well-vascularized receptor site positively influences the prognosis of such grafts. A subepithelial connective tissue graft between the split thickness flap and the alveolar ridge with its periosteum and connective tissue covering has a much better chance of survival than free grafts over poor or non-vascularized areas such as a bone graft or a non-resorbable membrane [6].

6. Conclusion

Connective tissue graft has high vascularity and esthetically appealing. However disadvantages such as the need for second operating site, resultant patient morbidity, the possibility of not being able to obtain a sufficient material and also obtaining the connective tissue graft needs technical skill. This clinical report suggests that soft tissue augmentation with autogenous connective tissue graft from the palate, in conjunction with a Fixed partial denture, is a viable treatment to provide esthetically acceptable contours to the alveolar ridge and an effective restoration.

References

[1]   | Schropp L, Wenzel A, Kostopoulos L, et al. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23:313-323.
[2]   | Gasparini DO. Double-fold connective tissue pedicle graft: a novel approach for ridge augmentation. Int J Pedodontics Restorative Dent 2004;24:280-7.
[3]   | Abrams H, Kopczyk R, Kaplan A. Incidence of anterior ridge deformities in partially edentulous patients. J Prosthet Comp Contin Dent Educ Dent 1993; 12; 548-561.
[4]   | Mishra N, Singh BP, Rao J, Rastogi P. Improving prosthetic prognosis by connective tissue ridge augmentation of alveolar ridge. Indian J Dent Res 2010;21: 129-31.
[5]   | Alaap D. Shah et al., Esthetic localized soft tissue ridge augmentation in a fixed partial denture – a case report. Journal of dental sciences. Volume 3 Issue 1, 11-13.
[6]   | Khoury F, Happe A. The palatal subepithelial connective tissue flap method for soft tissue management to cover maxillary defects: a clinical report. Int J Oral MaxillofacImplants 2000;15:415-8.