Int J Periodontics Restorative Dent. 2024;44(5):510-519. doi: 10.11607/prd.6731.
Implants with deficient papillae and black triangles are common findings. The treatment of these esthetic complications is considered to be challenging with limited predictability. Therefore, the present report aims to describe a novel technique for papilla augmentation: the 'iceberg' connective tissue graft (iCTG) after extraction and interproximal bone reconstruction in the anterior region. A 35-year-old patient presented with a hopeless tooth with interproximal clinical attachment loss extending to the apical third of the adjacent tooth. Interproximal bone reconstruction was performed through alveolar ridge preservation by directly applying recombinant human platelet-derived growth factor-BB (rhPDGF-BB) to the exposed root surface of the adjacent tooth. A mixture of autogenous bone chips (obtained from the ramus) and bovine bone xenograft particles (previously mixed with the growth factor) was also used. The patient was able to return for implant therapy only 2 years later, at which time an incomplete regeneration of the interproximal bone was observed. Therefore, to compensate the interproximal deficiency, the iCTG approach was utilized, involving a double layer of CTG with different origins. Two small grafts from the tuberosity were sutured to the mesial and distal ends of a wider CTG harvested from the palate, aiming to gain additional volume at the interproximal sites. The composite graft was then sutured on top of the implant platform, and the flap was then released and closed by primary intention. After conditioning the peri-implant tissues, the case was finalized with a satisfactory outcome. The described iCTG could be an effective approach for reconstructing peri-implant papillae following interproximal bone reconstruction.
牙间乳头和黑三角缺损较为常见。这些美学并发症的治疗具有挑战性，预测性有限。因此，本报告旨在描述一种新的牙间乳头增加技术：在前牙区拔牙和牙间骨重建后使用“冰山”结缔组织移植物（iCTG）。一位 35 岁的患者，一颗无望的牙齿出现邻面临床附着丧失，延伸至邻牙根尖三分之一。通过将重组人血小板衍生生长因子-BB（rhPDGF-BB）直接应用于邻牙暴露的牙根表面，进行牙槽嵴保存以进行牙间骨重建。还使用了自体骨屑（取自下颌支）和牛骨异种移植物颗粒（先前与生长因子混合）的混合物。患者仅在 2 年后才能进行种植体治疗，此时观察到牙间骨不完全再生。因此，为了补偿牙间缺损，采用了 iCTG 方法，涉及具有不同来源的双层 CTG。从结节处取两个小移植物，缝合到从腭部采集的更宽 CTG 的近中和远中末端，旨在在邻面部位获得额外的体积。然后将复合移植物缝合在种植体平台上方，然后释放并直接缝合皮瓣。在对种植体周围组织进行处理后，以满意的结果完成了该病例。所描述的 iCTG 可能是一种有效的方法，用于重建牙间骨重建后的种植体周围乳头。
