OBJECTIVES: To evaluate the effectiveness of an acellular dermal matrix or a connective tissue autograft in the treatment of multiple adjacent gingival recessions through Meta-analysis. METHODS: Randomized controlled trials were screened in four electronic databases in English according to the inclusion and exclusion criteria until April 20, 2022. The main outcome indicators were keratinized gingival tissue width, recession depth, probing depth, clinical attachment level, complete root coverage, and root coverage esthetic score. RESULTS: Seven randomized controlled trials were included. After 12 months, the connective tissue graft in the control group could increase the keratinized gingival tissue width [mean difference (MD)=-0.28 (-0.47, -0.08), P=0.006], reduce the gingival recession depth [MD=0.23 (0.12, 0.35), P<0.000 1], and improve the complete root coverage [risk ratio=0.80, 95% confidence interval (0.69, 0.93), P=0.003] compared with the acellular dermal matrix in the experimental group. No significant difference was found in probing depth, clinical attachment level, and root coverage esthetic score between groups. CONCLUSIONS Connective tissue grafts have advantages in increasing the keratinized gingival tissue width, reducing the gingival recession depth, and improving the complete root coverage in surgeries for treating multiple adjacent gingival recessions. Acellular dermal matrices also have some clinical value in terms of operation simplicity and similar effectiveness.
Humans ; Gingival Recession/surgery* ; Acellular Dermis ; Surgical Flaps ; Esthetics, Dental ; Connective Tissue/transplantation*

Chondrosarcoma/surgery* ; Humans ; Neoplasms, Connective and Soft Tissue ; Soft Tissue Neoplasms

Humans ; Gingival Recession/surgery* ; Gingivoplasty/methods* ; Connective Tissue/transplantation* ; Treatment Outcome ; Gingiva/transplantation* ; Tooth Root

OBJECTIVE: To evaluate the type of wound healing following modified crown lengthening surgery in dog model to provide a biological basis for its clinical application. METHODS: Flap surgery, traditional crown lengthening procedure and modified crown lengthening procedure were performed on the right maxillary central incisor, the left maxillary central incisor and the left maxillary first lateral incisor respectively of five male beagle dogs. The right maxillary first lateral incisors with no surgical intervention were used as controls. Thirty-six weeks after the experimental procedure, tissue blocks were harvested and prepared for histological examination and analysis. RESULTS: Histometric examination of buccolingual sections stained with hematoxylin-eosin demonstrated that the type of wound healing in the flap surgery group was re-attachment, similar to the control group. For the traditional crown lengthening surgery group, all of the five beagle dogs had lamellar cementum defects on root surface, the wound healing of four beagle dogs was new attachment accompanied by new cementum formation at cementum defect areas and the suprac-restal connective tissue was functionally oriented perpendicular to the new cementum. The wound healing of the other beagle dog was long junctional epithelial attachment, in which the junctional epithelium extended to the apical terminus of the cementum defect. In the modified crown lengthening surgery group, four beagle dogs had cementum defects on root surface (two lamellar cementum defects and two shallow platform-like cementum defects), the wound healing of three beagle dogs was new attachment, however, the supracrestal connective tissue was parallel to the root surface. The type of wound healing of another one beagle dog was long junctional epithelial attachment. Wound healing of one beagle dog in this group could not be characterized due to incomplete dissection. CONCLUSION Wound healing in the modified crown lengthening surgery group was similar to the traditional crown lengthening surgery group, and two types of wound healing were observed: new attachment and long junctional epithelium attachment. Neither type of root treatment procedure (root planing or root reshaping) nor root surface defect pattern (the lamellar cementum defect or shallow platform-like cementum defect) influenced the observed type of wound healing.
Animals ; Connective Tissue ; Crown Lengthening ; Dogs ; Eosine Yellowish-(YS) ; Epithelial Attachment/pathology* ; Hematoxylin ; Male ; Tooth Root/surgery* ; Wound Healing

Objective: To investigate the diagnosis and surgical treatment of sinonasal phosphaturic mesenchymal tumor (PMT). Methods: The medical records of nine patients who had been diagnosed as sinonasal PMT in Department of Otorhinolaryngology Head and Neck Surgery, Shanghai JiaoTong University Affiliated Sixth People's Hospital between January 2015 and May 2020 were collected, including 4 males and 5 females, ranging from 36 to 59 years. The patient's previous history, clinical manifestations, imaging findings, laboratory results, surgical procedure, pathological results and postoperative follow-up data were analyzed by descriptive statistical analysis. Results: All patients presented hypophosphatemia and tumor-induced osteomalacia (TIO) with a disease course of 1 to 19 years. The imaging examination and intraoperative findings identified two cases with peripheral tissue infiltration, two cases with contralateral nasal cavity invasion, and one case with intracranial invasion. Five patients underwent unilateral endoscopic resection while two patients underwent bilateral endoscopic resection, and the remaining two patients underwent unilateral transorbital ethmoid artery ligation plus endoscopic tumor resection and endoscopic combined with transfrontal tumor resection (n=1 each). Expect for one case developed recurrence and intracranial involvement, the other patients achieved clinical remission and no recurrence was observed during the six-month follow-up. Conclusions: The diagnosis of sinonasal PMT needs combination of clinical manifestation, imaging, and pathological findings. Complete surgical excision and long-term postoperative follow-up are imperative.
China ; Female ; Humans ; Hypophosphatemia ; Male ; Mesenchymoma/surgery* ; Neoplasm Recurrence, Local ; Neoplasms, Connective Tissue/surgery* ; Retrospective Studies

Osteogenesis imperfecta is a heterogeneous group of connective tissue diseases that is predominantly characterized by bone fragility and skeletal deformity. Two siblings with undiagnosed type I osteogenesis imperfecta underwent orthognathic surgery for the treatment of facial asymmetry and mandibular prognathism. The authors report two cases of combined orthodontics and orthognathic surgery in patients with type I osteogenesis imperfecta, mandibular prognathism, and facial asymmetry.
Congenital Abnormalities ; Connective Tissue Diseases ; Facial Asymmetry ; Humans ; Orthodontics ; Orthognathic Surgery ; Osteogenesis Imperfecta ; Osteogenesis ; Prognathism ; Siblings

PURPOSE: Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner. METHODS: Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software. RESULTS: Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554). CONCLUSION A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.
Adult ; Compartment Syndromes ; prevention & control ; Connective Tissue ; physiopathology ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Fractures, Comminuted ; physiopathology ; surgery ; Humans ; Knee ; physiopathology ; Male ; Middle Aged ; Range of Motion, Articular ; Tibial Fractures ; physiopathology ; surgery ; Treatment Outcome

BACKGROUND: Fibrous dysplasia (FD) is characterized by the replacement of normal bone by abnormal fibro-osseous connective tissue and typically treated with surgical contouring of the dysplastic bone. When dysplastic lesions involve occlusion, not only is surgical debulking needed, orthognathic surgery for correction of dentofacial deformity is mandatory. However, the long-term stability of osteotomized, dysplastic bone segments is a major concern because of insufficient screw-to-bone engagement during surgery and the risk of FD lesion re-growth. CASE PRESENTATION: This case report reviewed two patients with non-syndromic FD that presented with maxillary occlusal canting and facial asymmetry. Le Fort I osteotomy with recontouring of the dysplastic zygomaticomaxillary region had been performed. The stability of osseous segments were favorable. However, dysplastic, newly formed bone covered the previous plate fixation site and mild bony expansion was observed, which did not influence the facial profile. Including the current cases, 15 cases of orthognathic surgery for FD with dentition have been reported in the literature. CONCLUSION: The results showed that osteotomy did not appear to significantly reduce the long-term stability of the initial fixation insufficiency of the screw to the dysplastic bone. However, based on our results and those of the others, long-term follow-up and monitoring are needed, even in cases where the osteotomized segment shows stable results.
Connective Tissue ; Dentition ; Dentofacial Deformities ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Orthognathic Surgery ; Osteotomy

PURPOSE: The purpose of this study was to propose a technique for periodontal biotype modification through thickening of the entire facial aspect using a volume-stable collagen matrix and autogenous subepithelial connective tissue graft (CTG) for the treatment of gingival recession. METHODS: Four systemically healthy patients showing Miller class I or class II gingival recession in the mandibular incisor area were included in this study. Full-mouth scaling and root planing procedures were performed at least 4 weeks prior to periodontal plastic surgery. A split-thickness flap with a horizontal intrasulcular incision and 2 vertical incisions was used in cases 1–3, and the modified tunnel technique was used in case 4 for coronal advancement of the mucogingival complex. After the exposed root surfaces were debrided thoroughly, double-layered volume-stable collagen matrix was placed on the apical part of the recession and a subepithelial CTG harvested from the palatal area was placed on the coronal part. The amount of root coverage at 3 months postoperatively was evaluated in cases 1–3, and facio-lingual volumetric changes were analyzed in cases 1 and 2. RESULTS: Healing was uneventful in all 4 cases and complete root coverage was shown in cases 1–3. In case 4, reduction of gingival recession was observed at 3 months after surgery. In cases 1 and 2, a comparison of stereolithographic files from the preoperative and postoperative time points demonstrated that the entire facio-lingual volume had increased. CONCLUSIONS: The surgical technique suggested herein, using a volume-stable collagen matrix and autogenous subepithelial CTG, may be an effective method for periodontal biotype modification through thickening of the entire facial aspect for the treatment of gingival recession.
Collagen ; Connective Tissue ; Gingival Recession ; Humans ; Incisor ; Methods ; Root Planing ; Surgery, Plastic ; Transplantation ; Transplants

PURPOSE: Autogenous bones are frequently used because of their lack of antigenicity, but good osteoconductive and osteoinductive properties. This study evaluated the biological behavior of perforated and nonperforated cortical block bone grafts. METHODS: Ten nonsmoking patients who required treatment due to severe resorption of the alveolar process and subsequent implant installation were included in the study. The inclusion criteria was loss of one or more teeth; the presence of atrophy of the alveolar process with the indication of reconstruction procedures to allow rehabilitation with dental implants; and the absence of systemic disease, local infection, or inflammation. The patients were randomly divided into two groups based on whether they received a perforated (inner surface) or nonperforated graft. After a 6-month healing period, a biopsy was performed and osseointegrated implants were installed in the same procedure. RESULTS: Fibrous connective tissue was evident at the interface in patients who received nonperforated grafts. However, full union between the graft and host bed was visible in those who had received a perforated graft. CONCLUSIONS: We found that cortical inner side perforations at donor sites increased the surface area and opened the medullary cavity. Our results indicate an increased rate of graft incorporation in patients who received such perforated grafts.
Alveolar Process* ; Alveolar Ridge Augmentation* ; Atrophy ; Autografts ; Biopsy ; Connective Tissue ; Dental Implants ; Humans ; Inflammation ; Rehabilitation ; Surgery, Oral ; Tissue Donors ; Tooth ; Transplants*