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Multilayered Connective Tissue Grafting Technique to Improve Aesthetics after Failed GBR: A Clinical Case Report of 16 Months Follow-Up.

ABSTRACT: Objective:This case report describes soft-tissue management after a failed GBR procedure to enhance the soft-tissue quality, quantity, and aesthetic outcomes. Case Presentation. A 38-year-old patient visited the Dental Clinic of the Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, for a chief complaint of unsatisfactory aesthetics of the anterior maxillary area. Dental history disclosed failed preimplant vertical bone augmentation with GBR procedure in the area of the left maxillary central incisor resulting in a severe gingival recession of adjacent teeth and compromised soft-tissue quantity and quality and severe ridge atrophy (class III). Multilayered connective tissue grafting technique, in a two-step mucogingival surgery, was used to cover the gingival recessions, reach even gingival margin, and reconstruct the defect. Frenectomy was done after the second mucogingival surgery to relieve the muscle attachment. A definitive cantilever bridge was placed to restore the left and right maxillary central incisors, and a satisfactory aesthetic outcome was reached. Conclusions:Multilayered connective tissue grafting technique might be successful in correcting soft-tissue quantity and quality in class III ridge defects.

SUBMITTER: Villa G

PROVIDER: S-EPMC7396066 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Multilayered Connective Tissue Grafting Technique to Improve Aesthetics after Failed GBR: A Clinical Case Report of 16 Months Follow-Up.

Villa Gabriele G Bellucci Gionata G Magnolo Simone S Asa'ad Farah F

Case reports in dentistry 20200722

<h4>Objective</h4>This case report describes soft-tissue management after a failed GBR procedure to enhance the soft-tissue quality, quantity, and aesthetic outcomes. <i>Case Presentation</i>. A 38-year-old patient visited the Dental Clinic of the Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, for a chief complaint of unsatisfactory aesthetics of the anterior maxillary area. Dental history disclosed failed preimplant vertical bone augmentation with GBR procedure in the area of ...[more]

PMID: 32774937

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Project description:To overcome the serious shortage of donor corneas for transplantation, alternatives based on tissue engineering need to be developed. Decellularized corneas are one potential alternative, but their densely packed collagen architecture inhibits recellularization in vitro. Therefore, a new rapid method of recellularizing these constructs to ensure high cellularity throughout the collagen scaffold is needed. In this study, we developed a novel method for fabricating corneal constructs by using decellularized porcine corneal sheets assembled using a bottom-up approach by layering multiple sheets between cell-laden collagen I hydrogel. Corneal lenticules were cut from porcine corneas by cryosectioning, then decellularized with detergents and air-dried for storage as sheets. Human corneal stromal cells were encapsulated in collagen I hydrogel and cast between the dried sheets. Constructs were cultured in serum-free medium supplemented with ascorbic acid and insulin for 2 weeks. Epithelial cells were then seeded on the surface and cultured for an additional week. Transparency, cell viability, and phenotype were analyzed by qPCR, histology, and immunofluorescence. Constructs without epithelial cells were sutured onto an ex vivo porcine cornea and cultured for 1 week. Lenticules were successfully decellularized, achieving dsDNA values of 13?±?1.2?ng/mg dry tissue, and were more resistant to degradation than the collagen I hydrogels. Constructs maintained high cell viability with a keratocyte-like phenotype with upregulation of keratocan, decorin, lumican, collagen I, ALDH3A1, and CD34 and the corneal epithelial cells stratified with a cobblestone morphology. The construct was amenable to surgical handling and no tearing occurred during suturing. After 7 days ex vivo, constructs were covered by a neoepithelium from the host porcine cells and integration into the host stroma was observed. This study describes a novel approach toward fabricating anterior corneal substitutes in a simple and rapid manner, obtaining mature and suturable constructs using only tissue-derived materials.

Dataset Information

Multilayered Connective Tissue Grafting Technique to Improve Aesthetics after Failed GBR: A Clinical Case Report of 16 Months Follow-Up.

Publications

Multilayered Connective Tissue Grafting Technique to Improve Aesthetics after Failed GBR: A Clinical Case Report of 16 Months Follow-Up.

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