Application Of Palatal Roll Technique In Soft Tissue Augmentation Of Implant In Esthetic Zone

The development of dental implant technology urges not only the restoration of chewing function,but also the aesthetic reconstruction.Because of its special position and anatomical structure,the maxillary anterior area(also known as esthetic zone)faces more aesthetic risks when implant restoration is performed after teeth loss.Soft tissue defect is common complication,mainly manifested as gingival margin retreat,gingival papillary defects and gingival root surface crown deficiency.In order to restore the soft tissue defect and maintain the stability of implant,soft tissue augmentation is needed in clinic.Up to now,the transplantation of autogenous connective tissue is still the gold standard for the soft tissue augmentation around natural tooth and implant.In addition,lots of new technologies and improvement were put forward by scholars.Professor Abrams first described the technology,inserting the pedicled connective tissue flap without epithelium into the prepared labial tissue by rotating or flipping,to achieve a horizontal and vertical soft tissue augmentation.Professor Scharf and Professor Tarnow propose subsequently improvement of Professor Abrams’ technique to preserve donor’s epithelium tissue and reduce postoperative bone exposure and patient discomfort.The palatal roll technique in this study is exactly referenced to this.However,in practical application,the amount of soft tissue in the donor area,namely the palatal mucosal thickness in the maxillary anterior region,has a great influence on the difficulty of surgical operation and the augmentation effect after surgery.Therefore,it is of certain clinical significance to understand the mucosal thickness in this area.In addition,the flap by palatal roll technique belongs to the pedicled flap,which has a richer blood supply.In theory,the flap has stronger survival ability and less postoperative contraction.The technique avoids opening up the second operation area at the same time.So palatal roll technique has certain clinical application value.Part Ⅰ Analysis on palatal mucosal thickness in maxillary anterior zone by CBCTPurpose To understand the distribute rule of the palatal mucosal thickness in the maxillary anterior zone and provide reference for clinic by means of measuring and analyzing them by CBCT.Methods The CBCT images of 130 cases were selected to measure the mucosal thickness of palatal sides which are 3mm,6mm and 9mm from the gingival margin in the central incisor,lateral incisor and canine.SPSS 23.0 software was used to analyze and compare the distribution of left and right mucosal thickness.The distribution of different dental positions and different levels,and differences in mucosal thickness of different gender,age,and the palatal vault were also compared.Results Among all measured sites,the proportion of mucosal thickness less than 2mm was about 2.1%.The mucosal thickness of the corresponding sites on the left and right sides showed a symmetrical distribution.The mucosal thickness of the same tooth gradually thickened with the increasing distance from the gingival margin.At the same distance from the gingival margin,the mucosal thickness thickened from front to back.Gender had little effect on mucosal thickness.The mucosa of the elderly is thicker than that of the young.The mucosa of the high palatal vault is generally thicker than that of the low palatal vault.Conclusion Under the physiological condition,the palatal mucosa in the maxillary anterior region showed a symmetrical distribution.The mucosal thickness varied with different tooth positions and different gingival margins.Gender had little effect on mucosal thickness.Age and morphology of palatal vault had some effects on mucosal thickness.The part Ⅱ The early analysis of palatal roll technique in soft tissue augmentation in esthetic zonePurpose To observe and analyze the tissue healing of palatal roll technique for soft tissue augmentation in aesthetic area by non-traumatic method,and evaluate the early curative effect.Methods 38 cases which were selected from aesthetic area for single dental implant restoration have been taken submerged healing and delayed restoration.They were divided into 3 groups: palatal roll technique group(the pedicled group),palatal free connective tissue flap graft group(the free group)and conventional group.Using SPSS 23.0 software,the difference between the pedicled and free group were compared from the early survival rate of graft,thickness change of graft and pain evaluation.The aesthetic effects of the above 3 groups were evaluated from the aesthetic score.Results The survival rates of the free group and the pedicled group were91.67% and 100%,respectively.Both groups experienced a brief change from swelling to contraction.The third day was the peak of swelling.On the 45 th day,the contraction degree of the free group was greater than that of the pedicled group,and the contraction rates of the two groups were 34.3% and 16.6%,respectively.The postoperative pain in both groups was mild to moderate and lasted for 2 weeks,but the pain in the free group was slightly stronger than that in the pedicled group.The early aesthetic effect of the free group and the pedicled group was better than that of the conventional group.Conclusion In the maxillary esthetic zone,the palatal roll technique is a feasible method for labial soft tissue augmentation if the palatal mucosal thickness is allowed.