JIACD
The Journal of Implant & Advanced Clinical Dentistry
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Artificial Gingiva (Pink Porcelain) VS Surgery: Whats best?
As an implantologist and a dental surgeon for 20 years I have done my share of pontic development sites either via a bridge or a implant and cantilever.
I find connective tissue harvested from the maxillary tuberosity works great because it is dense and fibrous.
My issue with Artifical gingiva is not all labs are created equal and some pink porcelain is better then others.
My question is what is the best lab to do the artificial gingiva procedure?
Allograft rolled up works well for pontics
Alloderm soft tissue allograft rolled up and placed under the tissue works for pontic development. You definitely get shrinkage over time.
Bioderm, VIPCT, CT, vs Artificial Gingiva
Yes I think artificial gingiva has it place and can save a patient a surgery. Yet I believe this can create hygiene problems for the patient.
I much rather do a pontic development surgery then do artificial gingiva. I just don't see the amount of shrinkage over time that others do.
Bioderm, VIPCT, CT, vs Artificial Gingiva. Response
Perioplasticsurgeon;
This technique is not for every case, I agree. But in severe Class 3 type vertical defects, I believe it is the technique of choice.
As for saving a surgery, as you mention, it saves much more than that. It saves the patient often at least a few sophisticated augmentation surgeries, pain, swelling, increased case cost and an increased failure rate from an esthetic standpoint.
The surgeon still has work to do when choosing Artificial Gingiva;
1. implants must be placed with proper depth and with screw access towards the lingual.
2. the ridge must be augmented in the horizontal dimension
3. there must be keratinized gingiva and vestibular depth
"Pontic" Design in these cases is also critical.
As for Type 2 horizontal Defects, I do not utilize this technique and prefer as you do to treat it surgically whether for a pontic or implant.
When using tuberosity tissue for the pontic site I do not see shrinkage of the tissue overtime either.
Dr. S
Artificial gingiva is it a hygiene nightmare?
I have seen the article and the cases look great my concern is that it is a hygiene nightmare. As it is we have patients that cant keep things clean. Isnt something like that a problem for a patient.
Artificial gingiva is it a hygiene nightmare? Response
Tim;
We have reviewed these cases over the past 4 years and are in the process of collecting the data for a follow-up publication on this technique as your question needs to be addressed. We have been very pleased by the follow-ups and hygiene recall. The patients have done as well, if not better, than most of our standard implant cases on their perio recall. This is not surprising to us as the technique requires less implants and a flat ridge form with positive contact on seating. This allows for a fairly straight forward hygiene issue for most patients.
If you read through the articles and want more info on how this is planned ansd performed clinically, there is a hands-on course in Atlanta at DentalXP for both docs and lab technicians.
Give it a try
Dr. S
Artifical Gingiva a couple of questions please????
Dr. Salama,
First I have seen the article but have not read it yet. Its on my desk along with a stack of other things I need to do. Im sure you can relate.
I seen the cases and they look impressive. Is a a pink porcelain? What lab are you using? Whats the cost? Difficult for patient to keep clean?
Is it reducing surgery in you office.
I went to those links and it said file not found. Am I doing something wrong? Do I need to pay for the membership first which I am happy to do.
Thanks
Dean
Artifical Gingiva a couple of questions please???? Reply
Dean;
It is a combination of Pink Porcelain and Pink Composite Resin.
We use our own in-house lab but any good lab can perform it just give them the article to read. Part 3 coming out this next issue in IJPRD highlights the Lab phase.
It does not reduce the need for surgery in my office but directs it towards attainable goals and objectives which are mentioned in the articles Part 1 & 2.
Basically, horizontal bone grafting, vestibular depth extension, keratinized gingiva and implants placed with screw access lingual to the future incisal edge.
Yes, I would highly recommend joining www.dentalxp.com, it's a great site.
As for the links, my apologies, here is another way to get to Part 1 & 2;
http://www.dentalxp.com/dental-articles.aspx
just scroll down, you will see them below articles by Ziv Mazor on Balloon Sinus Lift.
Good Luck
Dr. S
"BioDerm", "VIP", CTG or Artificial Gingiva for Class 3 Defects
Ok. Lots of discussions on this forum about different ways to manage the Class 3 Horizontal-Vertical Ridge defect, especially in the esthetic zone.
Here is my take on all the above mentioned;
1. Bioderm technique; nice adjunct but still some unpredictable shrinking of tissue over time.
2. "VIP" flap, why?? Even if you are talented enough to perform it, it remains unneccesary and unpredictable with much donor site discomfort and a high risk of palatal necrosis. Not a big fan. By the time you rotate the flap almost 90 degrees to bring it around to the defect it has very little blood supply left from the pedicle anyhow.
3. CTG (palatal tissue) alone is great for root coverage but not enough for these style defects. Palatal connective tissue has a high lipid content and is not very dense and therefore shrinks when utilized for ridge defects. If you are going to use a tissue graft for these defects then your best bet is autogenous TUBEROSITY tissue. It has low lipid content, high fibrous density and low morbidity. It does not shrink because of this. Unlike the Bioderm technique (Bio-OSS and Dermis Tissue) the material used is also FREE! You can take a look at a video on this simple technique at;
http://www.dentalxp.com/video/autogenous-soft-tissue-ridge-97874.aspx
4. Artificial Gingiva; For SEVERE Class 3 defects this is the most predictable, low morbidity, least expensive and most effecient technique available. It does not rely upon the skills of the surgeon or the patient's ability to heal from massive interventions. I am proud to say I was one of the primary authors of this technique just recently published in the IJPRD in multiple Parts 1-3.
You can download Parts 1 and 2 of these articles for free on www.dentalxp.com at the following 2 links;
http://www.dentalxp.com/article/prosthetic-gingival-reconstruction-a-112...
http://www.dentalxp.com/article/prosthetic-gingival-reconstruction-the-1...
This technique has changed my practice entirely and allows me to sleep well at night when treating this large style defects. Believe me it's worth the read.
Good luck
Dr. S
Bioderm technique for pontic development is interesting
I dont have the magic bullit on this. I agree with the author that soft tissue alone may shrink especially in large defects. This technique may reduce shrinkage, will need to try in some cases.
Bioderm technique will it work for implants or just pontics
I read the bioderm article: http://www.nxtbook.com/nxtbooks/specops/jiacd_200910/#/32
It looks like it works great for pontic site development for a bridge but will it work for implants papilla development or for even GBR for implant placement?
Pontic Development: Bioderm techniques works well
Did the bioderm technique about 6 weeks ago the patient got great results. Will submit some pictures. Its was great no second site needed.
Cheers!
Ridge plumping for pontics: Bioderm, CTG or VIP techniques
I have now done all 3 techniques and the work very well. The Bioderm is nice because I dont need to go to the palate. I have not seen the VIP leave aa defect in the palate as other suggested happens.
Can you elaborate?
Whats are peoples views on Pink porcelain?
What are peoples views pink porcelain as oppose to doing pontic development? There was a good article in this months IJPRD on that topic.
No reason to do a VIP CT: CTG by itself is predictable
I dont see the reason to do a VIP. Connective tissue grafts traditionally allow one to build up the pontic site.
The Bioderm technique looks like a nice adjunct to my procedures.
VIP-CT grafts for pontics and implant soft tissue
I have done many VIP grafts and have not seen the defect you speak of. Its no difference from a regular CTG grafted except it is still attached to the palate to maintain blood supply. Please explain the defects you see?
Pontic development via the bioderm technique
I just read the BioDerm technique and I have to give kudos to the authors. What a neat technique that looks simple to use in pontic development without going to a second surgical site.
Its is a recommended read for all:
http://www.nxtbook.com/nxtbooks/specops/jiacd_200910/#/32
Allen has a good article as well.
Pontic Site Development: VIP CT graft
I myself use the VIP CT graft. You can read about it in Sclars book. It is a great technique for augmenting the pontic or implant soft tissue. Advantage in that you are maintaining blood supply to your graft.
You cannot learn everything through a book
Sclar's book is good, yes. However, you cannot learn everything by simply reading a book. The VIP flap should only be attempted by skilled and experienced dental surgeons. If you screw it up, you will end up with a huge palatal defect that could compromise other sites. I know many experienced periodontists and oral surgeons that will not even think about attempting a VIP flap. Think about it...these people cut tissue everyday. VIP is not for the weekend warrior.
Bio Derm Technique for Pontic development: It works
I actually tried this on a case after I read the jiacd article. It works. I got pretty nice results without a second surgical site.
I used to use only Connective tissue. This is a good technique.
Pontic site Development via the Bio-Derm Technique
I used to use CTG alone for pontic development but after reading the new JIACD I love the concept of the Bio-Derm Technique.
http://www.nxtbook.com/nxtbooks/specops/jiacd_200910/#/32
Bravo
Bio Derm Technique for pontic development
Very well done article with geat case presentation. I think he really prooved his point.
The way I do it is via connective tissue graft.
I definitely will try this technique.