Optiminization of regeneration at the stages of soft tissue augmentation using a collagen matrix

Lack of adequate width and thickness of periodontal or peri-implant soft tissues can compromise the aesthetics, function or survival of teeth and dental implants. Biomaterials are widely used in dentistry to overcome the disadvantages of autogenous tissue transplantation. The advantage of using biomaterials is that there is no need for re-surgery and that they are available in large quantities. The most widely used biomaterial for soft tissue augmentation is collagen, as it is believed to best mimic the natural cellular environment of the extracellular matrix, although other biomaterials are also candidates for soft tissue regeneration. Collagen matrices differ in composition, three-dimensional structure, elasticity and mechanical stability. Aim. is to review the literature on the optimization of regeneration at the stages of soft tissue augmentation using a collagen matrix.

Secondary Treatment of Facial Asymmetry in Hemifacial Microsomia

Hemifacial microsomia is most often diagnosed at birth and comprises varying degrees of malformations of one side of the face. Depending on the malformations involved, multiple procedures are required as primary treatment approaches, often embedded in an interdisciplinary concept from birth to adolescence. However, with regard to the symmetry of the face, soft tissue and bony discrepancies between the normal and the affected side often remain recognizable or even persist after surgery, resulting in lasting disturbed facial harmony. Such patients may have a high burden of disease. In our case report, we present the clinical course of a 39-year-old female with hemifacial microsomia, who was suffering persistent facial asymmetry after primary treatment comprising surgery on the mandible and soft tissue augmentation with the use of a free muscle flap. By means of virtual planning tools and patient-specific implants for genioplasty and bony augmentation in a first step followed by soft tissue augmentation with autologous fat cells in a second step, a very satisfactory result was achieved for both patient and medical staff. Hence, for secondary treatment of facial asymmetry in adulthood, a combined and step-by-step therapy addressing both soft and hard tissue seems to be the key to success.

Tissue Augmenting Palatoplasty for the Treatment of Velopharyngeal Insufficiency

Purpose Persistent velopharyngeal insufficiency (VPI) following primary palatoplasty remains a difficult problem to treat. This study evaluates speech outcomes following revision palatoplasty with tissue augmentation using buccal myomucosal flaps (BMF) as an alternative to pharyngoplasty for patients with VPI. Methods A retrospective single-center review of revision palatoplasty with tissue augmentation at a tertiary pediatric hospital Cleft-Craniofacial Center between January 2017 and March 2021 was conducted. Patients with a history of previous palatoplasty, a diagnosis of persistent or recurrent VPI, and comprehensive pre- and postoperative speech evaluations who underwent revision palatoplasty with BMF were included. Results Twenty patients met inclusion criteria (35% female, 20% syndromic). Mean age at the time of revision palatoplasty with BMF was 9.7 years. Preoperatively, all patients had stigmatizing speech and received the recommendation for speech surgery; the mean Pittsburgh Weighted Speech Score (PWSS) was 14.3 ± 4.9. The mean postoperative PWSS at the most recent assessment was 4.2 ± 2.3, representing a statistically significant improvement from preoperative scores ( P < .001). Mean follow-up time was 8.9 months. Following revision palatoplasty with BMF, only one patient has received the recommendation for further speech surgery. No complications were noted. Conclusion In patients with VPI following primary palatoplasty, revision palatoplasty with tissue augmentation offers an alternative to pharyngoplasty. This approach preserves dynamic velopharyngeal function, improves speech outcomes, and should be considered an option when treating patients with post-primary palatoplasty VPI.

Hard and Soft Tissue Augmentation with Single-Implant Restoration in the Esthetic Zone

The removal of the central incisor of the upper jaw is a challenging process, since the restoration of a single implant in the esthetic zone is of great responsibility. When tooth extraction with immediate implant placement is not possible, modern protocols imply the use of the socket preservation technique. This method of preserving socket properties significantly reduces changes that occur during the healing process of the postextracted area and along with soft tissue augmentation allows to achieve a satisfying aesthetic result. The aim of present case report is to assess capabilities of socket preservation concept and application of soft tissue augmentation in the anterior maxillary region. The treatment steps of a 35-year-old woman who needed to remove tooth 11 with further dental implant placement are described. The clinical case is of interest because after socket preservation and soft tissue augmentation, an acceptable aesthetic result was not reached. However, additional soft tissue augmentation made it possible to achieve the desired result, which was stable for 7 years.

Hyaluronic Acid Fillers: Where We Have Been and Where We Are Going

Since the approval of the United States’ first hyaluronic acid (HA) filler in December 2003, HA fillers have become mainstays of soft tissue augmentation due to their favorable safety profile and minimally invasive treatment nature. The past two decades have not only brought an expansion in the popularity of HA fillers, but also in the number of available HA filler products and indications for cosmetic enhancement. Accordingly, HA filler injection has become one of the most commonly performed cosmetic procedures worldwide. The progression of HA filler products is a study in both biomedical engineering advancements, as well as evolving concepts of beauty and cosmesis. In this chapter, we review the history of these products, including their composition and indications for use. We then explore the prospect of HA fillers for the future of esthetic medicine, as they remain a vital component of nonsurgical soft tissue augmentation.