Journal of Oral Implantology February 2013 - (Page 69)

CLINICAL The Bis-Acryl Stent Dennis Flanagan, DDS* When placing dental implants, there may be a surgical flap to reposition. The flap can be sutured or held in place with a stent that protects the flap and maintains its position and immobility. Use of a bis-acryl stent may be preferable to sutures or other materials in many cases. Bis-acryl is easily applied from an auto-mixing gun. Stents may be preferable to sutures in that there is no ‘‘wicking effect,’’ where bacteria colonize the suture beneath the healing surgical wound. Additionally, many times there is no submucosa to suture to, and the sides of the wound may not allow appropriate flap positioning and immobility with sutures. In these situations an acryl stent may be placed for easy and proper flap positioning and healing. Key Words: tissue immobility, surgical flap, apically positioned flap, dental implant, healing INTRODUCTION A dental implant surgical flap may need to be repositioned appropriately and fixed into place to cover a surgical site or augment the zone of attached gingiva. This can be done with sutures, a stent, or both. Stents were first used in oral surgery by a 19th-century London dentist, Charles T. Stent (1807–1885).1 He used a custom-made ‘‘improved’’ gutta-percha molded material dressing to guide oral surgical wound healing. The eponymous term ‘‘stent’’ was then used by plastic surgeons in the 20th century. The term has been used to describe a device that guides, supports, or maintains healing tissue.2,3 Recently, the term has been used to describe a device that maintains patency of an artery or ureter or other anatomical conveyer. Contemporary stents are made from a multitude of materials. A stent is not a surgical template or guide. Stents can be made of several different kinds of materials and are produced by different manufacturers (Barricaid, Dentsply, Milford, Del; Coe-Pak, Coe Pak GC America, Alsip, Ill). Periodontal pack dressing can be a stent. A stent protects and immobilizes the postsurgical site and enhances keratinized tissue formation. The increased zone of keratinized tissue makes for a functional implant Private practice, Willimantic, Conn. * Corresponding author, e-mail: dffdds@comcast.net DOI: 10.1563/AAID-JOI-D-11-00129 outcome. A bis-acryl stent can be made immediately and easily to fixate a surgical flap as described herein. MATERIALS AND METHODS A fast and easy technique to create a stent is to use an auto-mix gun to prepare a fast-set provisional bis-acryl that sets in 2 minutes (Figure 1). First, the end of the mixing tip is cut off with crown and bridge scissors at the point where the mixing-spiral terminates, about 10 mm from the tip end (Figure 2). The cut tip is then compressed by the scissors or with a needle holder, creating a slot opening that causes the bis-acryl to be expressed as a thick ribbon. The bis-acryl is automatically combined in the auto-mix gun and expressed as a heavy, very soft, very viscous material that sets in 2 minutes. Before the acryl is placed, the wound flap is positioned appropriately for proper healing to maximize the creation of the most keratinized tissue or provide optimum site coverage (Figures 3 and 4). The surgical flap may need to be compressed against the submucosa or bone with a surgical sponge for 1–5 minutes to ensure its immobility and proper position during the placement of the stent. The cut mixing tip is directed at the distal-most area of the surgical site. The gun handle is squeezed to express the automatically mixed bis-acryl to the tip. The bis-acryl is expressed from the tip and Journal of Oral Implantology 69

Table of Contents for the Digital Edition of Journal of Oral Implantology February 2013

Could the Fountain of Youth Be All in Your Bones?
Vertical Bone Augmentation With Simultaneous Implant Placement Using Particulate
Evaluation of the Bone Healing Process Utilizing Platelet-Rich Plasma Activated by Thrombin
Effect of Model Parameters on Finite Element Analysis of Micromotions in Implant Dentistry
Peri-Implant Defect Augmentation With Autogenous Bone: A Study in Beagle Dogs
Would Nitric Oxide be an Effective Marker for Earlier Stages of Peri-Implant Disease? An
The Effect of Different Surface Treatments on Cement-Retained Implant-Supported
Effect of Rotating Osteotomes on Primary Implant Stability—An In Vitro Investigation
Horizontal Augmentation Through the Ridge-Split Procedure: A Predictable Surgical
The Bis-Acryl Stent
Clinical, Histological, and Histomorphometrical Analysis of Maxillary Sinus Augmentation
A Technique to Salvage a Single Implant-Supported Fixed Dental Prosthesis Having a
Ridge Expansion and Immediate Placement With Piezosurgery and Screw Expanders in
Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy
Technology in Maxillary Premolar Region: A New Strategy for Soft Tissue Management
Fracture of Anterior Iliac Crest Following Bone Graft Harvest in an Anorexic Patient: Case
A Technique for Constructing a New Maxillary Overdenture to a Nonretrievable Implant
Edentulous Maxillary Arch Fixed Implant Rehabilitation Using a Hybrid Prosthesis Made of

Journal of Oral Implantology February 2013

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