An allogeneic skin graft is derived from donated human skin. Grafts are used for a variety of soft tissue applications including gingival augmentation, visible root coverage, soft tissue ridge augmentation as well as to address soft tissue augmentation around dental implants. When a gingival graft is necessary, these grafts can be used to eliminate the need for an autograft.
Some acellular dermal allografts are processed using detergent and a sodium chloride solution, which removes the viable dermal cells as well as the epidermis while preserving the skin’s original dermal collagen matrix. By removing the cells, the likelihood of graft rejection or inflammation decreases. The tissue is disinfected with a solution consisting of detergents that have antiseptic and acidic reagents to ensure it passes the sterility standards as set forth by the United States Pharmacopeia Standard 71 (USP <71>). Once it is sterile, the tissue is freeze-dried, then cut to size and packaged using terminally sterilized materials. These acellular dermal allografts are available in a variety of sizes and thicknesses: These pieces of tissue just need to be rehydrated and they are ready to use.
An acellular dermal allograft is a soft tissue allograft developed from donated human tissue, which is typically obtained by dental professionals for use in procedures from tissue banks. The native framework of the allograft is maintained, allowing it to be used in a wide variety of applications beyond oral and periodontal surgery, including in cosmetic surgery procedures like lip augmentation and to treat moderate to severe burns. An acellular dermal allograft is extremely safe and effective when building soft tissue, but in rare cases, complications can occur as with any medical procedure. In studies, the only complication recorded was infection, which was treated with antibiotics and did not require graft extrusion. Minimal postoperative pain and swelling was noted, as well as the absence of immunogenicity. Acellular dermal allografts are a viable solution for the treatment of soft tissue deficits and to augment soft tissue where needed for structural or aesthetic purposes.
An acellular dermal matrix graft is similar to the cellular dermal allograft in that they are both derived through the process of removing cells from animal or human tissues while retaining portions of the extracellular matrix (ECM). However, unlike traditional xenografts and allografts, an acellular dermal graft is usually completely devoid of cells. The main components of ADM are elastic fibers and collagen bundles.
There are a variety of acellular dermal graft products available: For example, a regenerative tissue matrix is processed in such a way as to preserve the tissue’s biologic components while maintaining the structure of the dermis itself. Acellular dermal matrix graft products differ in the processing methods used to create them as well as in their size and thickness.
Grafts can be used for numerous soft tissue applications, including:
- Soft tissue ridge augmentation
- Gingival augmentation
- Soft tissue augmentation around implants
- Exposed root coverage
If a gingival graft is required, an acellular dermal graft can be used as an alternative to an autograft.
Acetaminophen reduces inflammation, which makes it ideal for dental implant care. This medication is an antipyretic and nonopioid analgesic that consists of p-aminophenol and acetic acid. While the actual mechanism responsible for providing the pain relieving and fever reducing benefits of acetaminophen is unknown, it is believed that this medication reduces the amount of prostaglandins the body produces: Prostaglandins are the chemicals produced in the brain that cause inflammation. Many patients choose to use acetaminophen for dental implant care following their procedure; however, unless directed by a physician, this medication should not be taken for a period longer than 10 days. Acetaminophen can be administered orally or rectally.
Adult dosage of acetaminophen for dental pain depends on the formula being used:
- Immediate release formulations of acetaminophen – 325 mg to 650 mg every 4 hours
- Extended release caplets – 1300 mg every 8 hours
- Maximum adult daily dosage of acetaminophen is 4 grams
An acid-etched implant is similar to a sandblasted implant in that acid etching creates a textured surface, versus the smooth surface of traditional implants. Acid-etching and sandblasting are done to improve the biological response to dental implants and increase the chances of implant success. By using an acid-etched dental implant, a periodontist can decrease the total treatment time required for the implant by minimizing the healing time for osseointegration establishment. The implant hardware is the first component during the dental implant process to interact with the patient, making it critical to ensure that the implant is well received. The possibility of implant rejection remains with any dental implant procedure, however, by using an acid-etched implant or an implant that has been otherwise treated to improve surface texture, the risk of rejection can be reduced. This helps shorten and improve the implant procedure overall, creating a positive patient experience.
An activating tool is a special tool used during the dental implant process to ensure that the fingers on abutments and impression copings are in the proper position before placing the implant. When in the correct position, the impression copings and abutments should “click” into place. An activating tool is typically marked in such a way to indicate where to activate the abutments on one end and the impression copings on the other end. The tool can also be used to deactivate the fingers of an abutment or an impression coping in the event that there’s no finger retention when the abutment is inserted and removed from the analog during waxing, finishing, or the application of porcelain. Once the crown or custom abutment has been completed, the fingers of the impression copings and abutments need to be reactivated. Once the clicking sound is heard, the component is considered seated.
In implant dentistry, precise measurements are incredibly important. Failure on the part of the periodontist to select the proper sizing of components for the patient can hinder healing and even contribute to the rejection of a dental implant. The actual implant length/diameter is the most exact and accurate measurement for the length and diameter of a dental implant. There are a wide variety of lengths and diameters available for a periodontist to choose from, and the optimal length/diameter of an implant depends greatly on each patient’s unique bone structure and where the implant is meant to be placed. For example, a periodontist will need to choose different lengths and diameters for implants placed in different parts of the mouth and in areas that have dense bone versus areas that have poor bone quality.
One of the most important aspects of implant dentistry is the surface topography of the dental implant itself. Dental implant surfaces are often modified using a variety of techniques and additives in an effort to improve healing and osseointegration by improving retention of the implant in the bone formation. One way to modify the surface topography of a dental implant is to sandblast it. Another way that is being used more often in the industry is adding different materials to the surface of an implant to change its texture. For example, an acid-etched implant is one form of added surface implant. However, there are a wide variety of added surface implants available and which type is used during a dental implant procedure largely depends on the preference of the treating periodontist and the unique needs of the patient, such as where the implant will be placed and the bone quality in that area.
Additive manufacturing is another term used for 3D printing and this technology has revolutionized the dental implant industry. Implants that have been produced using additive fabrication often have better retention rates and can promote healing and osseointegration even in areas with poor bone quality. Additive fabrication or additive manufacturing is commonly used in the area of dental prosthetics, especially for the purpose of producing cost-effective dentures. When used in the dental implant industry, additive manufacturing can help reduce the cost of dental implants and create more customized implant solutions. 3D printing or additive fabrication can be used to create completely custom implants for patients with shallow bone or poor bone quality, as well as creating crowns that are designed to perfectly match the patient’s existing teeth for the most natural look possible. Most periodontists today use components during their dental implant procedures that were created with the use of additive fabrication technology.
Additive manufacturing (AM) is defined by the American Society for Testing and Materials (ASTM) as the layer-upon-layer process of joining materials to create objects from STL files and 3D model data. Additive manufacturing does not use the traditional machining processes associated with subtractive manufacturing. The term additive manufacturing encompasses many technologies including subsets like 3D Printing, Rapid Prototyping (RP), Direct Digital Manufacturing (DDM), layered manufacturing and additive fabrication. In the dental industry, AM allows for the building of dentures, crowns, bridges, and other dental structures for oral repair and maintenance. Using a 3D model of the patient’s mouth, a dental appliance is created through AM to match the patient’s oral anatomy. Such appliances are often made of ceramic due to the material’s biocompatibility, aesthetics, mechanical function, and chemical stability. Utilizing AM allows dental professionals to provide safe and effective oral prostheses in a more cost effective and sustainable way.