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Investigation of the palatal mucosa thickness and volume for soft tissue grafting - a digital approach
EAO Online Library. SEIDEL A. Oct 9, 2018; 232522; P-BR-120
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Grafting of soft tissue is an essential part in implant & plastic periodontal surgery. The palate is the preferred donor site for both free gingival graft & subepithelial connective tissue graft. The surgeon’s decision where to harvest is mainly based on the amount of tissue that is necessary to meet the indication. The area of upper lateral incisor to second molar is considered the best graft site according to tissue thickness, although this varies between individuals & within the same patient.With our 3D investigation method, the aim was to determine the best harvesting area for autologous tissue grafts of the palate regarding the tissue thickness and volume.10 patients were scanned with CBCT (3D eXam, Kavo dental GmbH, Biberach, Germany) applying 0.3 mm³ voxel, 8.9 s scan time, 120 kV and 18.54 mAs. In addition, an impression with a scan optimized material was taken (Identium® Scan, Kettenbach GmbH, Eschenburg, Germany). The impressions were digitized with a high resolution industrial scanner (Atos SO II, GOM mbh, Braunschweig, Germany). To generate 3D bone models, the obtained DICOM dataset was converted into STL files (Impact View 4.4.1, CT Imaging GmbH, Erlangen, Germany). For data analysis, a CAD software (GOM Inspect, GOM Gmbh, Braunschweig, Germany) precisely superimposed bone and gingiva models using a registration algorithm and the discrepancies were evaluated. The areas of interest were set at right and left palate, from lateral incisor up to first molar and subdivided in 5 parts. This three-dimensional method of analysis allows tissue thickness evaluation as well as volumetric measurements.The deviation between the models’ surface was evaluated at the areas of interests for all 10 patients. The mean value of the tissue thickness was analysed for each of the 5 subdivided sections for right and left palate. The highest mean values were observed at section 3 and 4 with 3.1 mm. The lowest values were found in area 1 (2.0 mm). The standard deviation was 0.9 mm to 1.1 mm. The highest volume is found in section 4 with 266,9 mm³.Regarding the mucosa thickness and volume, the ideal place for harvesting grafts is at section 3 and 4 which equal the level around second premolar. The section starting from lateral incisor to first premolar is the least profitable. By using our digital evaluation method, the best possible donor site can be defined for each patient individually.
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