SERBEST DİŞETİ GREFTİNİN PERİ-İMPLANT SAĞLIK ÜZERİNE ETKİSİ

Amaç: Keratinize doku, sağlıklı peri-implant mukozanın idamesi için önemlidir. Bu klinik çalışmanın amacı, yapışık keratinize dişeti olmayan implant destekli protez bölgesine serbest dişeti grefti prosedürünün ardından keratinize doku genişliğinin, periodontal parametrelerin değerlendirilmesi ve keratinize doku olmayan kontrlaterel implant destekli protez alanındaki klinik parametreler ile karşılaştırılmasıdır. Gereç ve Yöntemler: Bu randomize kontrollü çalışmaya simetrik bölgelere yapılmış peri-implant alanında keratinize doku eksikliği bulunan 15 hasta katıldı. Grup I (test grubu), implant destekli protezlerden sonra implant bölgelerinden birine serbest dişeti grefti yapılan 15 hastadan oluşmaktaydı. Grup II (kontrol grubu), aynı hastaların müdahale yapılmamış kontrlateral implant destekli protezlerinden oluşuyordu. Her iki grupta dişeti çekilmesi miktarı (RD), keratinize doku genişliği (KTW), sondalama cep derinliği (PD), klinik ataçman düzeyi (CAL) ve gingival kalınlık (GT) başlangıçta ve 12 ay sonra değerlendirildi ve karşılaştırıldı.Bulgular: Her iki grupta da peri-implant hastalığının belirtileri yoktu. Test gruplarında ameliyattan 6 ay sonra keratinize doku miktarı belirgin olarak arttı. KTW ve GT test gruplarında başlangıçtan 6 aya yükseldi (p <0.001). PI ve GI skorları kontrol gruplarında daha yüksek bulundu. Ameliyat sonrası altıncı ayında RD, PD ve CAL her iki grupta da benzerdi. Postoperatif altıncı ayda, KTW ve GT test grubunda daha iyi idi (p <0.001). RD, PD ve CAL her iki grupta benzerdi.Sonuç: Serbest dişeti grefti proseduru peri-implant bölgede keratinize doku oluşturmak için en güvenilir yöntemdir. Keratinize doku eksikliği peri-implant bölgede plak birikimine neden olmaktadır, bu durum peri-implant hastalıkların oluşması için risk teşkil etmektedir. Anahtar Kelimeler: Dental implant, Dişeti çekilmesi, Serbest dişeti grefti

Anahtar Kelimeler:

Dental implant, Dişeti çekilmesi, Serbest dişeti grefti

THE EFFECT OF FREE GINGIVAL GRAFT ON PERI-IMPLANT HEALTH

Purpose:. The aim of the clinical study was to evaluate the width of keratinized tissue and periodontal parameters after free gingival graft procedure in implant supported prosthesis area and comparisons of the contralateral implant supported prosthesis area without keratinized tissue.Methods: 15 patients with missing keratinized tissue in peri‑implant area participated in this randomized split mouth controlled study. Group I (test group) consisted of 15 patients receiving 15 free gingival grafts after implant‑supported prostheses. Group II (control group) consisted of the contralateral implant supported dentures of the same patients. Gingival recession depth (RD), keratinized tissue width (KTW), probing depth (PD), clinical attachment level (CAL) and gingival thickness (GT) were evaluated at baseline and after 12 months. Results: Both groups showed absence of signs and symptoms of peri‑implant disease. The amount of keratinized tissue significantly increased 6 months after surgery in test groups. KTW and GT were increased in test groups from baseline to 6 months (p<0.001). PI and GI scores were found higher in control groups. In postoperative sixth month RD, PD and CAL were similar in the both group. In postoperative sixth month, KTW and GT was better in test group (p<0.001). RD, PD and CAL were similar in the both group.Conclusions: The free gingival graft is an effective approach to increase the width of keratinized tissue of implant‑supported prosthesis. Lack of the peri implant keratinized tissue plays a critical role in the accumulation of bacterial plaque around the dental implants, this situation may increased risk of peri implant diseases. Keywords: Dental Implant, Gingival Recessions, Free Gingival Graft

Keywords:

Dental Implant, Gingival Recessions, Free Gingival Graft,

PDF

___

Agudio G, Nieri M, Rotundo R, Cortellini P, Pini Prato G, 2008. Free gingival grafts to increase keratinized tissue: a retrospective long-term evaluation (10 to 25 years) of outcomes. Journal of periodontology, 79, 4, 587-94.
Baltacioglu E, Bagis B, Korkmaz FM, Aydin G, Yuva P, Korkmaz YT, 2015. Peri-Implant Plastic Surgical Approaches to Increasing Keratinized Mucosa Width. The Journal of oral implantology, 41, 3, e73-81.
Batal H, Yavari A, Mehra P, 2015. Soft tissue surgery for implants. Dental clinics of North America, 59, 2, 471-91.
Bengazi F, Lang NP, Caroprese M, Urbizo Velez J, Favero V, Botticelli D, 2015. Dimensional changes in soft tissues around dental implants following free gingival grafting: an experimental study in dogs. Clinical oral implants research, 26, 2, 176-82.
Bengazi F, Wennstrom JL, Lekholm U, 1996. Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clinical oral implants research, 7, 4, 303-10.
Bouri A, Jr., Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I, 2008. Width of keratinized gingiva and the health status of the supporting tissues around dental implants. The International journal of oral & maxillofacial implants, 23, 2, 323-6.
Boynuegri D, Nemli SK, Kasko YA, 2013. Significance of keratinized mucosa around dental implants: a prospective comparative study. Clinical oral implants research, 24, 8, 928-33.
Chung DM, Oh TJ, Shotwell JL, Misch CE, Wang HL, 2006. Significance of keratinized mucosa in maintenance of dental implants with different surfaces. Journal of periodontology, 77, 8, 1410-20.
Ericsson I, Lindhe J, 1993. Probing depth at implants and teeth. An experimental study in the dog. Journal of clinical periodontology, 20, 9, 623-7.
Gobbato L, Avila-Ortiz G, Sohrabi K, Wang CW, Karimbux N, 2013. The effect of keratinized mucosa width on peri-implant health: a systematic review. The International journal of oral & maxillofacial implants, 28, 6, 1536-45.
Hassani A, Sadrimanesh R, Vahdati SA, Sadr-eshkevari P, 2010. Free gingival graft immobilization: a pilot study on a newly designed stent. The Journal of oral implantology, 36, 2, 123-30.
Kim BS, Kim YK, Yun PY, Yi YJ, Lee HJ, Kim SG, Son JS, 2009. Evaluation of peri-implant tissue response according to the presence of keratinized mucosa. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 107, 3, e24-8.
Lin GH, Chan HL, Wang HL, 2013. The significance of keratinized mucosa on implant health: a systematic review. Journal of periodontology, 84, 12, 1755-67.
Metin M, Dolanmaz D, Alkan A, 2003. Evaluation of autogenous grafts used in vestibuloplasty. J Int Med Res, 31, 4, 335-9.
Palacci P, Nowzari H, 2008. Soft tissue enhancement around dental implants. Periodontol 2000, 47, 113-32.
Park JC, Yang KB, Choi Y, Kim YT, Jung UW, Kim CS, Cho KS, Chai JK, Kim CK, Choi SH, 2010. A simple approach to preserve keratinized mucosa around implants using a pre-fabricated implant-retained stent: a report of two cases. Journal of periodontal & implant science, 40, 4, 194-200.
Prato GP, Cairo F, Tinti C, Cortellini P, Muzzi L, Mancini EA, 2004. Prevention of alveolar ridge deformities and reconstruction of lost anatomy: a review of surgical approaches. The International journal of periodontics & restorative dentistry, 24, 5, 434-45.
Schneider D, Grunder U, Ender A, Hammerle CH, Jung RE, 2011. Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study. Clinical oral implants research, 22, 1, 28-37.
Prato GP, Cairo F, Tinti C, Cortellini P, Muzzi L, Mancini EA, 2004. Prevention of alveolar ridge deformities and reconstruction of lost anatomy: a review of surgical approaches. The International journal of periodontics & restorative dentistry, 24, 5, 434-45.
Schneider D, Grunder U, Ender A, Hammerle CH, Jung RE, 2011. Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study. Clinical oral implants research, 22, 1, 28-37.
Schrott AR, Jimenez M, Hwang JW, Fiorellini J, Weber HP, 2009. Five-year evaluation of the influence of keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clinical oral implants research, 20, 10, 1170-7.
Sezer B, Selcuk E, Erturk S, Gomel M, 2004. Comparison of autogenous mucosal grafts and collagen-based, solvent-preserved allografts for vestibuloplasty. Quintessence international, 35, 3, 234-9.
Sohn JY, Park JC, Cho KS, Kim CS, 2014. Simultaneous placement of an interpositional free gingival graft with nonsubmerged implant placement. Journal of periodontal & implant science, 44, 2, 94-9.
Speroni S, Cicciu M, Maridati P, Grossi GB, Maiorana C, 2010. Clinical investigation of mucosal thickness stability after soft tissue grafting around implants: a 3-year retrospective study. Indian J Dent Res, 21, 4, 474-9.
Thoma DS, Buranawat B, Hammerle CH, Held U, Jung RE, 2014. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. Journal of clinical periodontology, 41 Suppl 15, S77-91.
Ueda M, Hata KI, Sumi Y, Mizuno H, Niimi A, 1998. Peri-implant soft tissue management through use of cultured mucosal epithelium. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 86, 4, 393-400.
Wennstrom JL, Bengazi F, Lekholm U, 1994. The influence of the masticatory mucosa on the peri-implant soft tissue condition. Clinical oral implants research, 5, 1, 1-8.
Wennstrom JL, Derks J, 2012. Is there a need for keratinized mucosa around implants to maintain health and tissue stability? Clinical oral implants research, 23 Suppl 6, 136-46.