Rationale for Gingival Tissue Augmentation and Vestibuloplasty Around Teeth and Dental Implants
Soft tissue augmentation procedures have long-standing tradition of clinical use to improve the width and thickness of sites lacking an adequate band of keratinized tissue (KT). Regarding the importance of KT, it has long been suggested that a minimum 2 m
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Leandro Chambrone, Francisco Salvador Garcia Valenzuela, and Luciano Oliveira
10.1 T he Dilemma of Whether or Not to Augment the Band of Keratinized Tissue As defined by the American Academy of Periodontology (AAP), gingiva [1] is a term that designates “the fibrous investing tissue, covered by keratinized epithelium that immediately surrounds a tooth and is contiguous with its periodontal ligament and with the mucosal tissues of the mouth.” Microscopically, the oral epithelium of the gingiva presents four layers with the corneum stratum consisting of squamous keratinocytes that are believed to serve as a “mechanical barrier” against mechanical/environmental trauma to the gingival tissues (Fig. 10.1). For instance, in a recent systematic review, Chambrone and Tatakis [2] evaluated the long-term outcomes of untreated buccal gingival recessions through the assessment of potential factors influencing the development and progression of these defects. These authors found that (1) within individuals presenting good oral hygiene standards, approximately 80% of the untreated gingival recessions progressed/worsened (i.e., experienced recession depth increase) during long-term follow-up and (2) the keratinized tissue (KT) band appears as an important component in preventing such detrimental
L. Chambrone (*) School of Dentistry, Ibirapuera University (Unib), São Paulo, Brazil Unit of Basic Oral Investigation (UIBO), School of Dentistry, El Bosque University, Bogota, Colombia Department of Periodontics, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, IA, USA F. S. G. Valenzuela Perioteam Training Center, Irapuato, Mexico L. Oliveira Division of Implant Dentistry, Pontifical Catholic University, Rio de Janeiro, Brazil © Springer Nature Switzerland AG 2020 S. Nares (ed.), Advances in Periodontal Surgery, https://doi.org/10.1007/978-3-030-12310-9_10
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Fig. 10.1 Microscopically, the human buccal gingiva is formed by four epithelial layers (i.e., basale, spinosum, granulosum, and corneum) and a connective tissue layer. Note that the corneum stratum (red arrow) is no longer seen in an apical direction beyond the mucogingival junction (black arrow)
changes in the gingival margin position overtime (i.e., sites lacking KT seemed to be more prone to additional clinical attachment loss) [2]. Regarding to the importance of KT, it has long been suggested that a minimum 2 mm band of KT (with at least 1 mm of attached tissue) appears to be required to preserve the health of periodontal tissues [3]. Furthermore, the dilemma as to the need to augment the band of KT was thoroughly reviewed by the AAP in 2015 during its most recent Regeneration Workshop. According to the authors of that systematic review [4] and the base of evidence available to October 2013, there are unprecise definitions on the least extent of KT necessary to maintain periodontal stability (i.e., there are no specific dimensions fully acceptable in the literature). On the other hand, clinical data included in t
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