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Soft-tissue management

The strip technique

03.04.2015
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Do large defects need large transplants? Not always. A new technique cleverly merges autologous tissue and collagen matrix. An interview with Prof. Istvan Urban.

Prof. Istvan Urban | Hungary

Prof. Urban, soft-tissue management is often a problem in horizontal augmentations. How do you handle this?

Prof. Urban: Advanced ridge augmentation procedures usually result in a severe displacement of the mucogingival line and vestibular loss. In the past we performed mucogingival surgery using epithelialized gingival grafts or free connective tissue grafts. We left these grafts to heal in an open healing environment because this is a prerequisite for the reformation of the vestibule and keratinized tissue.

Graft harvesting from the palatal mucosa, however, may be associated with significant patient morbidity. This was usually the treatment phase that patients did not like at all. When we heard of Geistlich Mucograft®, we were very interested in it because we saw potential for soft tissue regeneration – and because I was fed up with the big connective tissue grafts.

How do you use Geistlich Mucograft® to regenerate soft tissue?

Prof. Urban: First, I had to understand how the collagen matrix works: I like to think of it as a “cell collector”, which means it collects tissue cells from the neighboring soft tissue. If the neighboring tissue is only mucosa or mostly mucosa, we won’t regenerate more than just a few millimeters of keratinized tissue. Therefore, we had the idea to combine the matrix with an apically positioned autogenous strip gingival graft. The strip graft was originally described by my former teachers Dr. Thomas Han and Henry Takei, so I was very familiar with it.

By placing the strip graft on the apical end of the surgically created bed, we expected it to act as a barrier for the apical tissues of the alveolar mucosa, which are not capable of keratinizing. In this manner, the tissues from the lateral borders and from the strip graft would migrate and differentiate into keratinized mucosa within this three-dimensional scaffold of the matrix.

What are your experiences with the strip technique?

Prof. Urban: In a study of a prospective case series we found that we could in fact regenerate the amount of keratinized tissue needed.1 We achieved an average of 6.3 mm of keratinized tissue after one year. In the anterior maxilla, which was one of the major indications, it was even 7.8 mm.

We also found very favorable results for pain intensity: on a visual analogue scale of up to 10 – with 10 being the strongest pain – the average pain in the first week was 2.3, and it was 0 for the following weeks of healing. Ten out of the 20 patients did not take any pain medication, and one patient only needed medication for the palatal wound.

 

What are the clinical prerequisites for using the strip technique?

Prof. Urban: I like things to be both simple and reproducible. Both the Sausage TechniqueTM  and the strip technique using Geistlich Mucograft® are easy for clinicians with adequate surgical skills. Surgeons, however, should train for the techniques in hands-on courses. Live surgery and video tutorials will also help them to become more familiar with these options for tissue regeneration. 

Prof. Istvan Urban

Prof. Istvan Urban | Hungary

Department of Periodontology at the University of Szeged, School of Dentistry
Dental School at the Loma Linda University, California

References
  1. Urban IA, et al.: Int J Periodontics Restorative Dent 2015; 35(3): 345–53.

Illustration Header: Alessandro Holler / Quaint

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