Guided Soft Tissue Regeneration with Three-Dimensional Matrices: A Novel Technique to Enhance Volume Around Implants

Review Article

J Dent & Oral Disord. 2022; 8(1): 1175.

Guided Soft Tissue Regeneration with Three-Dimensional Matrices: A Novel Technique to Enhance Volume Around Implants

De Annuntiis C*

Department of Dentistry, Private Perio-Implant Practice, Rome

*Corresponding author: Carlo De Annuntiis, Department of Dentistry, Private Perio-Implant Practice, Rome

Received: June 21, 2022; Accepted: July 27, 2022; Published: August 03, 2022

Abstract

In recent years, the attention to the soft tissue is growing because both the clinicians and the patients have understood they are crucial in achieving not just a good aesthetic but furthermore a long stability of the underlying bone. Until less than a decade ago, the only one way to manage periodontal or peri-implant soft tissue was with autologous connective tissue harvested from the palate or from the tuberosity. Nowadays, several substitutes derived from animal allow to avoid a second surgery to obtain connective tissue. The present manuscript presents a new approach to the modern implantology in order to achieve better outcomes from an aesthetic and functional point of view using a new porcine derived matrix. The manuscript shows either a step by step description of a novel technique to enhance soft tissue around implants.

Introduction

During the last four decades of implantology, the scientific literature has focused on bone and his behavior around implants. Thanks to a huge quantity of publications, nowadays, we know very well the relationship between bone and implant from the extraction of the tooth to the placement of the fixture and during the integration process and the follow-up time [1-5]. The procedures of Guided Bone Regeneration (GBR) became a predictive procedure to ensure a long healthy life for the implant [6,7].

In recent years, the attention has switched to the soft tissue because both the clinicians and the patients have understood they are crucial in achieving not just a good aesthetic but furthermore a long stability of the underlying bone.

The present paper presents a novel technique to regenerate volume around implants enhancing soft tissue with a three-dimensional matrix derived from porcine.

Materials and Methods

A new acellular dermal matrix (NovoMatrixTM; LifeCell, Branchburg, NJ, USA) which consisted of tissue-engineered porcine material was used. Owing to the manufacturing process, this matrix is free of donor cells. At the same time, the structure of the source tissue remains virtually unchanged, thus supporting the ingrowth of cells and micro-vessels. Indeed, the process preserves many proteins, molecules and vessels: first of all, vascular channels are kept in order to provide a quick blood flow throughout the matrix enabling the first phases of revascularization; collagen is left to provide structure and tensile strength, elastin to ensure elasticity, hyaluronan to control tissue hydration, proteoglycans to guide revascularization and cell repopulation and fibronectin which is responsible for cell adhesion, migration, growth and differentiation.

Because of this preserved structure, the matrix seems to have a bio-potential in being grafted to a donor site and in order to achieve the best behavior from this matrix, the Author suggests always raising a split thick flap. In this way, it is possible to ensure to the matrix a double vascularization both from the inner side and from the covering flap. The aim of this novel technique is to recreate the typical convexity of a natural tooth even at implant side not recurring massive and more aggressive procedures of bone regeneration. Hence, the only requirement is having the proper bone support to fully cover the implant. Once the implant is correctly placed it is therefore possible to recreate the lack of volume using the following technique with a great advantage in terms of shorter chair-time, less compliance and after-effects for the patient, easier learning curve for the clinician and a very fast healing process.

The technique leads to the formation of a new thicker and stable amount of soft tissue, naming it GSTR which stands for Guided Soft Tissue Regeneration.

The amount of volume that can be regenerated depends on the number of layers of matrix used in each specific situation, considering that the matrix has a constant thickness of 1mm. In the Author’s experience soft tissue regenerations are frequent with double or triple layers: several data about the gain of volume and its stability over time will be shown in the Results paragraph.