A Simplified Soft Tissue Management for Peri-implant Bone Augmentation

Farina

et al. 2020

Clin Adv Periodontics

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The efficacy of surgical regenerative procedures to treat peri-implantitis lesions has been extensively reviewed. Regenerative treatment showed a variable rate of success, in terms of pocket reduction, gain in bone support, and elimination of signs of infection/inflammation. The aim of the present case report is to illustrate the use of the sub-periosteal peri-implant augmented layer (SPAL) technique to correct peri-implantitis defects Case Presentation: Surgical treatment of three class Ib and one class Ic peri-implantitis lesions in three patients was performed by means of the SPAL technique. A partial-thickness flap was elevated, leaving the periosteal layer on the buccal cortical bone plate. The periosteal layer was in turn elevated to create a pouch, which was used to stabilize a bovinederived xenograft (deproteinized bovine bone mineral) at the peri-implant buccal bone defect. No barrier membrane was used. In case of insufficient dimensions of peri-implant mucosa, a connective tissue graft (CTG) was buccally positioned at the most coronal portion of the implant. Treatment resulted in substantial reconstruction of peri-implant support associated with reduced probing depth and absence of inflammation. Conclusions: SPAL technique with or without additional CTG may be a suitable option to obtain clinical remission of peri-implantitis defects associated with buccal bone dehiscence.

Section: Discussionmentioning

confidence: 99%

Section: Figure 2 Case #2 2a Through 2cmentioning

confidence: 99%

Sub‐Periosteal Peri‐Implant Augmented Layer Technique to Treat Peri‐Implantitis Lesions

Farina

et al. 2020

Clin Adv Periodontics

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“…To provide adequate dimensions of keratinized peri-implant mucosa, either an apically positioned flap or a free gingival graft was performed (Trombelli, Severi, Pramstraller, & Farina, 2019).…”

Section: Surgical Procedures-spal Groupsmentioning

confidence: 99%

“…who had been involved in previous studies on the SPAL technique (Trombelli, Severi, Pramstraller, Farina, 2019)…”

Section: Study Parameters 241 | Clinical Parametersmentioning

confidence: 99%

“…Recently, a simplified bone augmentation procedure, namely the Sub-periosteal Peri-implant Augmented Layer (SPAL) technique, based on the use of the periosteum as a barrier membrane and a graft as space-making "device" for bone augmentation concomitant to implant placement, has been described (Trombelli, Severi, Pramstraller, Farina, 2018). The effectiveness of this technique to correct a peri-implant bone dehiscence and/or to augment the thickness of peri-implant bone was previously reported (Trombelli, Severi, Pramstraller, Farina, 2019), and its application has also been explored in the treatment of peri-implantitis defects (Trombelli et al 2020). The aim of the present retrospective case series was to assess peri-implant tissue conditions on the short term in patients receiving SPAL technique compared to patients with adequate thickness (≥2 mm) of PBBP at implant placement.…”

Section: Introductionmentioning

confidence: 99%

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Peri‐implant tissue conditions at implants treated with Sub‐periosteal Peri‐implant Augmented Layer technique: A retrospective case series

Pramstraller

Clinical Oral Implants Res

et al. 2020

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Objectives: To assess peri-implant tissue conditions on the short term in patients receiving the Sub-periosteal Peri-implant Augmented Layer (SPAL) technique and in patients with adequate thickness (≥2 mm) of the peri-implant buccal bone plate (PBBP) at placement. Methods: Patients where either a dehiscence defect or thin PBBP at implant placement was corrected by SPAL technique (SPAL dehiscence and SPAL thin groups, respectively) and patients presenting a residual PBBP thickness ≥2 mm at implant placement (control group) were retrospectively selected. The number of peri-implant sites positive to bleeding on probing (BoP) at 6 months following prosthetic loading was the primary outcome. Also, height of keratinized mucosa, marginal soft tissue level, Plaque Index, peri-implant probing depth, suppuration on probing, and interproximal radiographic bone level (RBL) were evaluated. Results: Thirty-four patients (11 in the SPAL dehiscence group, 11 in the SPAL thin group, and 12 in the control group) were included. In each SPAL group, 10 patients (90.9%) showed peri-implant tissue thickness ≥2 mm at the most coronal portion of the implant at uncovering. The prevalence (number) of BoP-positive sites was 2, 1, and 0 in the SPAL dehiscence , SPAL thin , and control groups, respectively. RBL amounted to 0.3 mm in the SPAL dehiscence group, 0.2 mm in the SPAL thin group, and 0 mm in the control group. Conclusion: After 6 months of prosthetic loading, patients treated with SPAL technique show limited peri-implant mucosal inflammation in association with shallow PD and adequate KM. At implants receiving SPAL technique, however, interproximal RBL was found apical to its ideal position. K E Y W O R D S bone regeneration, dental implants, oral surgical procedures | 993 TROMBELLI ET aL.

Peri‐Implant Bone Augmentation by the Sub‐Periosteal Peri‐Implant Augmented Layer Technique and a Bovine‐Derived Bone Block: A Case Report

Ortensi

et al. 2021

Clin Adv Periodontics

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Background: When used with deproteinized bovine bone mineral (DBBM) delivered as a particulate, the subperiosteal peri-implant augmented layer (SPAL) technique was effective in completely correcting up to 92% of peri-implant buccal bone dehiscences. The use of a DBBM block (bDBBM), however, may result in an improvement of the peri-implant bone dehiscence as well as a relevant lateral bone augmentation since its mechanical properties may ensure a better dimensional stability at flap manipulation than particulate DBBM. The aim of the present a proof-of-principle case report is to investigate if SPAL may be successfully used to obtain bone augmentation at peri-implant dehiscence sites when used with bDBBM.Case presentation: Lateral bone augmentation was performed using the SPAL technique at two implants showing a buccal peri-implant bone dehiscence immediately after their placement. A partial-thickness flap was elevated, leaving the periosteal layer on the buccal cortical bone plate. The periosteal layer was, in turn, elevated to create a pouch, which was used to stabilize a bDBBM graft at the peri-implant buccal bone dehiscences. At re-entry, exposed implant surfaces were completely covered by new thick hard tissue up to their most coronal portion. A free epithelial-connective tissue graft was used to augment the peri-implant soft tissue phenotype. Conclusion:When used to accommodate bDBBM over the most coronal portion of an exposed implant, SPAL may successfully lead to an increase in peri-implant buccal tissue thickness. Clin Adv Periodontics 2021;0:1-6.