Clinical application of the surgical navigation template construction for soft tissue transplantation to increase the width of the added keratinized gingiva

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BACKGROUND: In surgical periodontology, modifications of soft tissues help achieve a series of important tasks: increase the area of keratinized attached gums, increase the volume of soft tissues, and consequently improve the biological and esthetic state of soft tissues. To achieve these goals, the most common method is the extraction and transplantation of tissue grafts from the hard upper palate. To date, no design of a surgical navigation template allows taking a gingival graft by pre-programmed parameters. The article justifies the necessity of the development and clinical application of a navigational surgical template made with modern digital technologies and used in operations modifying the frontal oral cavity with the transplantation of free gingival grafts from the hard upper palate.

AIM: To develop and apply in clinical practice a navigational surgical template for a programmable sampling of a free gingival graft for vestibuloplasty in patients with periodontal diseases.

MATERIALS AND METHODS: With the use of modern digital technologies, the designs of individual surgical navigation templates for the intake and transplantation of free mucosal transplantation during vestibuloplasty were developed. The developed templates are used in clinical practice.

RESULTS: For vestibuloplasty, navigational surgical templates for the extraction and transplantation of free gingival graft were developed and manufactured using modern digital technologies. As a result of this development, patents were obtained for the inventions “Guiding template for soft tissue transplantation” and “Method of gum transplantation.” The case study demonstrates the benefits of using the aforementioned navigational surgical templates. The invented method makes it possible to obtain donor tissues procured from an anatomically harmless portion of the hard upper palate. Moreover, the surgical templates make it possible to produce a recipient bed identical in shape and size to the removed donor transplant tissue, thereby making it possible to avoid the necessity of adapting the transplant in an artificial recipient bed outside the oral cavity and reducing the time spent by donor tissue detachment from any real oral cavity.

CONCLUSIONS: Taking into account the positive results of the clinical testing of the proposed technology, a randomized study is warranted to evaluate the effectiveness of vestibuloplasty with a free gingival graft using a surgical navigation template in comparison with a similar operation performed using classical technology. It is necessary to identify the statistical significance of the obtained clinical results of treatment.

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About the authors

Elina D. Tkachenko

Peoples’ Friendship University of Russia

Author for correspondence.
ORCID iD: 0000-0002-1895-510X
Russian Federation, Moscow

Samvel V. Apresyan

Peoples’ Friendship University of Russia

ORCID iD: 0000-0002-3281-707X

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Alexander G. Stepanov

Peoples’ Friendship University of Russia

ORCID iD: 0000-0002-6543-0998

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow


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Supplementary files

Supplementary Files
1. Fig. 1. The state of the soft tissues of the vestibule of the patient’s oral cavity before the start of treatment

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2. Fig 2. Computer simulation of a navigational surgical template for the preparation of a recipient

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3. Fig. 3. Computer simulation of a navigational surgical template for collecting a mucosal graft from the hard palate

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4. Fig. 4. Printed digital impressions and templates on a 3D printer in a clinic setting

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5. Fig. 5. Trying on the vestibular surgical guide

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6. Fig 6. Trying on the palatal surgical guide

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7. Fig. 7. Using a vestibular template, the boundaries of the recipient bed are outlined with a scalpel

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8. Fig. 8. Split flap and muscle fibers are displaced apically

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9. Fig. 9. Free mucosal graft from the hard palate

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10. Fig. 10. Fixation of the free gingival graft on the recipient bed

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11. Fig. 11. Examination 14 days after surgery, removal of sutures

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12. Fig. 12. Examination 90 days after surgery

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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