Augmentation of soft tissue defects

  • Traumatic soft tissue defect
  • Regenerated soft tissue with mucoderm®
Oral and dental soft tissue defects can be the result of traumas or surgical ablations that prevalently cause the loss of the original anatomical soft tissue structure. Moreover, soft tissue changes negatively affect the aesthetic appearance and therewith the patient satisfaction. Depending on the size of the defect, tissue deformations can nowadays be aesthetically corrected by a combination of bone and soft tissue augmentation or by soft tissue reconstruction and microsurgical techniques alone [1,2,3]. A soft tissue substitute such as the mucoderm® matrix is an ideal alternative to treat soft tissue defects either in combination with bone grafting materials or in particular situations also for open healing.
Treatment of an endo-perio-lesion and soft tissue augmentation with mucoderm® - Dr. A. Eslava Vanegas
Treatment of an endo-perio-lesion and soft tissue augmentation with mucoderm® - Dr. A. Eslava Vanegas

Clinical situation before surgery

mucoderm® for soft tissue augmentation after resective surgery - Dr. Dr. P. Kämmerer
Soft tissue augmentation after resective surgery- Kämmerer

Initial clinical situation

Augmentation of a traumatic soft tissue defect with mucoderm® - Dr. F. Rathe
Augmentation of a traumatic soft tissue defect-Rathe

Initial clinical situation with traumatic loss of tooth 21

Soft tissue thickening with mucoderm® - Dr. G. de Deus
Soft tissue thickening with mucoderm® - Dr. G. de Deus

Initial clinical view of the case. Soft tissue dehiscence around implants 26.

GBR together with soft tissue augmentation with mucoderm® and maxresorb® - Dr. S. Scherg
GBR together with soft tissue augmentation with mucoderm® and maxresorb® - Scherg

Longitudinal fracture on the root resected tooth 21 with visible buccal fistula

Rehydration

mucoderm® should be rehydrated in sterile saline or blood for a few minutes to ensure its flexibility.

Fixation

Immobilization of the matrix to the wound bed can be achieved using all known suturing techniques.

Exposure

In general, exposure of the matrix should be avoided. In case of a resective surgery where no tissue for covering exists, mucoderm® may be left exposed for healing. A close fixation with the surrounding tissue is necessary to allow its revitalization. A bacterial resorption from the oral side will take place, but blood vessels and cells will grow into the matrix concurrently, using the scaffold for the formation of new soft tissue.

After-care

Any mechanical trauma of the treated site must be circumvented. Patients should be instructed not to brush their teeth at the respective side for ~4 weeks following surgery. Plaque prevention may be achieved by mouth rinsing with 0.2% chlorhexidine solution.
mucoderm® for reconstructing of soft tissue defects
mucoderm® zur Rekonstruktion von Weichgewebedefekten - Dr. F. Rathe

Following rehydration of mucoderm® in sterile saline solution or blood, the matrix can be placed in/onto the defect and fixed using all known suturing techniques. Proper closing of the flap ensures the revitalization of the matrix and regeneration of the soft tissue. If mucoderm® is used instead of FGG for open-healing please note that bacterial resorption will likely reduce the degradation time of the matrix and revascularization must be ensured through close contact with the surrounding tissue.

[1] Borgonovo et al. Open Dent J. 6: 94-8
[2] Fernandes and Yetzer. Oral Maxillofac Surg Clin North Am; 25(2):241-9
[3] Yilmaz et al. J Craniofac Surg. 19(1): 227-34