International Journal of Periodontics & Restorative Dentistry, Pre-Print

This case series assessed the efficacy of Orthodontic Implant Site Development with Labial Root Torque (OISD-LRT) as a nonsurgical technique for addressing labial bone deficiencies in seven patients. The procedure involved strategically placing a multi-bracket of 2–3 mm apically on the hopeless teeth, gradually shifting them with Ni-Ti wires at the rate of 2 mm per month and maintaining overcorrection for 2 months before extraction. OISD-LRT consistently augmented tissue for flapless guided implant surgery, with an average treatment duration of 404Å}311.7 days. Cone-beam computed tomography (CBCT) scans at various stages revealed increases in both vertical and horizontal bone dimensions, especially in the sockets with complete labial bone loss. Despite inevitable post-extraction reductions in bone height and width, sufficient dimensions were maintained to ensure long-term implant stability. This case series highlights the effectiveness of OISD-LRT as a valuable method for horizontal bone augmentation, particularly in patients with labial bone deficiency. This approach provides a robust foundation for subsequent implant placement, showcasing its success in addressing challenging anatomical conditions and contributing to the broader field of implant dentistry. Keywords: alveolar ridge augmentation, case series, dental implantation, implants, orthodontic extrusion, torque

Introduction: Maxillary sinus floor augmentation is a procedure known for its long-term success and predictable outcomes. However, the perforation of the Schneiderian membrane remains the most common complication associated with this procedure. Objective: This systematic review aims to determine the presence of complications during maxillary sinus floor augmentation procedures using CAD-CAM surgical templates. Material and methods: An electronic search was carried out in MEDLINE (via PubMed), Web of Science, and Scopus. A descriptive analysis of the data was performed. Studies that have performed lateral sinus floor augmentation were included in the inclusion criteria. The CAD-CAM surgical template design and the intraoperative complications were registered. Results: A total of 13 studies were included. Seven were case reports, four were case series, and two were randomized clinical trials. A total of 94 lateral SFA procedures were included (84 using CADCAM templates and 10 without using templates). Three of the 84 maxillary sinus floor augmentation procedures using a CAD-CAM template presented intraoperative complications. Conclusions: Maxillary sinus floor augmentation performed by using CAD-CAM surgical templates could be related to low rates of complications, however, due to the heterogeneity of the articles included, more standardized studies are needed to confirm these outcomes.

Polynucleotides and Hyaluronic Acid (PN-HA) mixture showed several effects in modulation of healing process. The aim of this study was to assess the safety and clinical performance of PN-HA alone or in association with Deproteinized Bovine Bone Mineral (DBBM) with papillary preservation flaps (PPF) in the treatment of residual pockets. A total of 43 patients with 55 infra-bony defects were recruited; 30% were smokers. The mean baseline Probing Depth (PD) was 7.7 ±1.9 mm with a corresponding mean recession (Rec) of 1.9± 1.3 mm. The depth of infra-bony defect at the surgical measurement was 5.2±2.1 mm. DBBM was applied at 56% of the defects considered as not-containing based on clinical judgment. Healing was uneventful at all sites. After one year, PD reduction was 4.4±1.8 mm with a Rec increase of 1.0 ±0.8 mm. Detected bone fill at x-ray was 3.5 ± 1.9mm. The multilevel analysis showed that absence of smoking habits was associated with improved PD reduction (P =0.026) and bone gain (P= 0.039). PN-HA mixture is a safe product for periodontal surgery and seems to promote clinical benefit in the treatment of residual pockets associated to infra-bony defects. Keywords: case series, hyaluronic acid, intrabony defect, periodontal regeneration, periodontitis, polynucleotides

The present case series aims to investigate the use of polynucleotides mixed with hyaluronic acid (PNs-HA) in the form of gel to promote bone regeneration in horizontal alveolar defects. Overall, 6 adult patients underwent localized horizontal guided bone regeneration by means of xenogeneic bone substitute and a resorbable barrier with a staged approach. The graft consisted in a mixture of deproteinized bovine bone mineral (DBBM) particles and PNs-HA gel in a 3:1 ratio, respectively. The material was covered by a resorbable collagen membrane fixed with pins to the underlying bone. Implant placement was performed after 5 months. Healing proceeded uneventfully, and, upon re-entry, the graft appeared well vascularized and firmly attached to the recipient bone. Histologically, the regenerated bone appeared highly mineralized, well-organized in lamellae and totally embedding the residual granules of the biomaterial. Histomorphometric evaluations revealed that newly formed bone occupied on average 41.2% ± 12.4% of the analysed samples. Linear measurements performed on CBCT scans yielded an overall linear horizontal bone gain of 4.91 ± 0.88 mm. These data suggest that a mixture of DBBM and PNs-HA can be safely used to promote bone regeneration in case of horizontal alveolar defects. Keywords: alveolar defect, bone regeneration, hyaluronic acid, polynucleotides

Oral rehabilitation of the atrophic maxilla using prostheses anchored on zygomatic implants is a well-documented process. To prevent the risk of sinusitis and or oro-antral communications, the placement of zygomatic implants with an externalized path has been proposed. In these cases where the sealing of the implant neck depends exclusively on a hemidesmosomal junction, there is a risk of dehiscence of the soft tissue. This can lead to esthetic problems, bone resorption, oro antral communication, cellulitis, and even orbital infection. To avoid soft tissue recession when implants are placed in a buccal position to the remaining ridge, different procedures have been proposed, the simplest being a good buccal coverage of the implant by keratinized tissue. In this technical note, we propose the use of a double pedicle palatal flap to increase the keratinized tissue buccal to the implant and, at the same time, to facilitate the incision closure by initial intention.

This retrospective study reports on the survival of two-piece angulated prosthetic platform (APP) implants consecutively placed at a specialist periodontics clinic with a mean follow-up of 28.2 ± 15.6 months (range 4.0-71.0).  For 183 recalled patients that received 239 implants, modelled survival at follow-up up to 71 months was 99.2% and 91.1% at the patient and implant level respectively. The majority of patients were non-smokers and non-diabetics, with a quarter having a history of treated periodontitis. Eighty percent of patients received a single APP implant. Sixty-three percent of implants supported a single crown, 28% a fixed partial denture, and 9% a fixed complete denture.  Nearly all implants were placed either at the time of tooth extraction or after complete bone healing, in approximately equal numbers. Three quarters had adjunct bone grafting with a quarter having adjunct soft tissue grafting. For 210 surviving and restored implants with satisfactory intra-oral radiographs taken at last recall with a mean follow-up 28.4 ± 15.5 months (range 4.0-71.0), the mean radiographic bone levels were -0.70 ± 0.87 mm (range -3.60 - +2.15).  The results demonstrated clinically successful use of this unique geometry implant for multiple applications with acceptable short to medium term clinical outcomes. 

Primary wound closure is the most important factor in successful periodontal tissue regeneration when using biomaterials. However, in the distal region of the last molar, there is concern that direct surgical access to an intraosseous defect may induce the leakage of biomaterials, impair the blood supply, and make healing difficult. This case series introduces the last molar-entire pad preservation technique (L-EPPT), which was designed to preserve the gingiva of the last molar centrum and secure the operative field of the furcation and distal bone defects, thereby providing an optimal environment for wound healing for regenerative therapy. This technique for preservation of the distal gingiva was applied in two cases involving the combination of a buccal class II furcation defect and a 2–3-wall intrabony defect in the last molar for the use of a combination of bone graft and enamel matrix derivatives in periodontal regeneration. Clinical outcomes were recorded at 18 months (case 1) and 8 months (case 2) after surgery. In both cases, the class II furcation defects were completely closed, and the probing pocket depth was improved to < 3 mm with no bleeding on probing. Further research is warranted to verify the efficacy of this technique. Keywords: Periodontitis, Furcation defects, Regeneration, Enamel matrix derivatives, Alveolar bone grafting

Introduction: The interforaminal region is considered more favorable for implant placement than the posterior mandible in edentulous patients, mainly because of the interference of the inferior alveolar nerve with implant placement in the severely resorbed posterior mandible. However, complications in the interforaminal region may occur due to the presence of the mandibular incisive nerve. Objective: This scoping review aims to describe the mandibular incisive nerve anatomy related to the potential interference in implant therapy. Material and methods: A comprehensive literature search was conducted in the following databases: MEDLINE (via PubMed), Web of Science, and Scopus. This scoping review was structured according to the Joanna Briggs Institute method. Results: Thirteen studies were included in the review. All the studies were observational cohort anatomical studies, carried out mainly by CBCT and on cadavers. A total of 1471 patients/cadavers were studied. The mandibular incisive nerve was presented in 87-100% of the cases, with an average length of 9.97 mm and an average diameter of 1.97 mm. The mandibular incisive nerve may be damaged during drilling and implant placement, especially using implant lengths larger than 12 mm. Conclusions: Damage to the mandibular incisive nerve due to implant placement could be present, however, it is necessary to conduct more studies focusing on assessing mandibular incisive nerve damage to understand the clinical relevance of this nerve and its associated morbidities such as neurosensorial alterations. Due to the different anatomical characteristics of this nerve, CBCT analysis is recommended for implant therapy in the anterior mandible to prevent the described complications.

The aim of the present clinical report is to introduce a novel surgical procedure, the “Apical Tooth Replantation with Surgical Intrusion Technique” (ATR-SIT) for managing teeth with hopeless prognosis compromised with a severe endodontal-periodontal lesion, pathologic tooth migration, and gingival recession. Two cases are presented managing teeth diagnosed with a hopeless prognosis. ATR-SIT involves tooth extraction, extra-oral root debridement, root surface conditioning, apicectomy, retrograde filling and the application of enamel matrix derivatives prior to reimplantation. Following reimplantation, the teeth are covered with a combination of autogenous bone chips and bone substitute materials, covered with resorbable membranes. Following ATR-SIT, the patients received either orthodontic treatment or tooth-supported fixed dental prostheses. The described ATR-SIT effectively improved the initially hopeless prognosis of the teeth and maintained periodontal health over time, evidenced by favourable clinical and radiographic outcomes. ATR-SIT might be a potential alternative to tooth extraction of hopeless teeth in patients with stage IV periodontitis. Keywords: Endo-periodontal lesion, Stage Ⅳ periodontitis, Periodontal regeneration, Tooth replantation, Gingival recession, Hopeless tooth, Pathologic tooth migration

Background: Current concepts in periodontology emphasize an important distinguishing aspect of the interproximal attachment, assigning its major influential significance as a key diagnostic and prognostic factor. A complete regeneration of the interproximal clinical attachment has become a primary determinant of the periodontal success. Since mid - 20th century have been published numerous articles on root coverage procedures but mostly for non-proximal gingival recessions. When it comes to the interdental area, literature does not inspire the same level of confidence. Objectives: This study is aimed to introduce an innovative 3D – Tunneling Surgical Technique for the gingival papilla reconstruction and supra-alveolar interproximal attachment regeneration. Materials and Methods: The technique is described step by step and shown on three selected clinical cases of multiple bilateral adjacent gingival recessions type 2 and 3 in the lower anterior area with follow - up results of up to 6.5 years. Results: A total of 18 proximal, mid-buccal and mid-lingual recessions were treated simultaneously. Mean root coverage up to 88.9% has been achieved in the proximal area. Conclusion: Within its limits, this study demonstrates a possibility of treating gingival recessions with deficient papilla in the mandibular anterior region, achieving a significant clinical improvement with the long-term stability.

Regenerative periodontal surgery is an effective procedure for the treatment of intrabony defects. Various flap designs preserving the defect-associated interdental papilla have been proposed to improve early wound stability. This case report describes the long-term results of a regenerative treatment in severely compromised mandibular canine using entire papilla preservation technique. Surgical access was provided by a single buccal vertical incision without any papilla incision. Combination of autogenous bone harvested from the same surgical site and recombinant human fibroblast growth factor-2 was applied to non-contained intrabony defect following the granulation tissue removal. Surgical site was closed with single interrupted sutures. The clinical outcomes and 5-year stability of pocket closure with no increase in gingival recession show the potential of entire papilla preservation technique with the use of combined biomaterials.

Bone reconstruction surgeries such as the autogenous and allogenic shell techniques where cortical laminates are used to regenerate bone defects, requires time and expertise to adapt and fix the laminated cortical blocks onto the defect area. This case report illustrates the process of customizing and fixing an allogenic cortical laminate (ACL) to reconstruct a horizontal bone defect with guided surgical stents. Two types of surgical stents were designed: one to aid in cutting a prefabricated ACL into the desired shape for the defect to be regenerated, and the other type of stent, was used to assist in the positioning and fixation of the resulting laminates. These stents enabled the clinician to regenerate a horizontal defect with reduced surgical time, increased precision and safety during laminate fixation. After 5 months of healing a dental implant could be placed in the regenerated site. The use of surgical stents in this type of bone regeneration surgeries can be helpful specially in more complex bone defects where precision is key. Further clinical studies are needed to validate this technique. Keywords: bone regeneration, dental implants, alveolar bone loss

Fifty-seven interproximal restorations invading the supracrestal tissue attachment were evaluated over a mean period of 15 years (10-23 years) in terms of crestal bone loss. The distance from the cavity margin to the bone was measured at T0 and controlled using X-rays and a measurable landmark. The mean bone loss in the vertical dimension was 0.46 mm, with a 96.49% survival rate. Smoking habits (p = 0.02) and tooth type (p = 0.03) significantly affected the bone loss. The proposed technique could help the clinician in adopting a minimally invasive approach in the treatment of heavily compromised teeth. Future research with rigorous study designs would be interesting to guide the clinical decision making.

This study evaluated the impact of using calcium-hydroxide or the antioxidant agents on the bond strength of adhesive restorations to bleached dentin. Forty teeth were prepared and allocated into 8 groups according to the surface treatment after bleaching (application or not of calcium hydroxide, 10% sodium ascorbate and 5% sodium thiosulphate for 10min), and the time of final restoration (immediate or after 7-days). Sodium perborate with 20% hydrogen peroxide was applied for 3 weeks using a developed artificial pulp chamber, with replacement every week. Composite resin restoration was performed and microtensile test was performed. Then, specimens were analyzed using a stereomicroscope and SEM. Data was submitted to Kruskal-Wallis and Dunn tests (p<0.05). The bond strength of non-bleached teeth was similar to the groups restored after 7 days of bleaching (p<0.05). The lowest values of bond strength were showed by groups restored immediately after bleaching (p<0.05). In all groups, there was a considerable predominance of adhesive fractures. Delaying the final restoration of teeth submitted to nonvital bleaching for 7 days permits an increase in bond strength. The immediate restoration of bleached teeth after the use of 10% sodium ascorbate or 5% sodium thiosulfate for 10 minutes showed unsatisfactory results. Clinical relevance Irrespective of the dentin protocol applied before adhesion, a satisfactory and an unsatisfactory result of bond strength values will be obtained delaying the final restoration or immediately performing the final restoration, respectively. Therefore, after nonvital tooth bleaching, clinicians should always delay the final restoration for a minimum period of 7 days. Keywords: Artificial pulp chamber; Bleaching agents; Tensile strength; Tooth bleaching

The use of Artificial Intelligence (AI) is rapidly expanding. While it comes with some drawbacks, it also offers numerous advantages. One significant application of AI is chatbots, which utilize natural language processing and machine learning to provide information, answer queries, and assist users. AI has various applications and dentistry is no exception. The authors conducted an experiment to assess the application of AI, particularly OpenAI's ChatGPT and Google Apps Script, in various stages of information gathering and manuscript preparation in parallel with conventional human-driven approaches. AI can serve as a valuable instrument in manuscript preparation; however, relying solely or predominantly on AI for manuscript writing is insufficient if the goal is to produce a high-quality article for publication in a peer-reviewed, high-impact journal that can contribute to the advancement of science and society.

Statement of problem: Volumetric resorption of the alveolar ridge often occurs following tooth extraction in both horizontal and vertical directions. There is a specific lack of evidence for alveolar ridge reconstruction at molar and premolar sites with severe bone resorption. Purpose. This randomized and controlled trial aimed to use three dimensional and linear analyses to evaluate volumetric changes of the alveolar bone following alveolar ridge reconstruction (ARR) at molar and premolar sites with severe bone resorption as compared with non-assisted socket healing be implant placement. Material and Methods: A total of 31 patients (15 males and 16 females) with more than 50% of hard tissue loss in one or more socket walls were recruited and randomized into either a test group (ARR after extraction using deproteinized bovine bone mineral with 10% collagen (DBBM-C) and platelet-rich fibrin (PRF) with a resorbable collagen membrane) or a control group (natural healing after extraction). Then, the clinical, linear, volumetric implant-related and patient-reported outcomes were analyzed after a 4-month healing process. Results: Linear bone assessments revealed significantly greater gains of ridge width in the test group (25% in the mesial, mid-facial and distal aspects) and less reduction of vertical bone ridge than in the control group (P＜0.05). Furthermore, volumetric bone remodeling was significantly higher in the test group (ARR=35.1±34.9%, control=14.2±12.8%, P＜0.05). Patient-reported discomfort and keratinized mucosal changes were comparable between groups. Conclusions: Alveolar ridge reconstruction with a combination of DBBM-C, PRF, and a resorbable membrane at posterior sites with severe socket wall deficiency (＞ 50% bone loss) is a safe and more capable therapeutic method when compared with natural healing and non-assisted sockets. Clinical implications: Collectively, our analyses demonstrated that alveolar ridge reconstruction represents an efficient method to maintain and augment crestal bone at posterior extraction sites with severe bone defects when assessed after four months of healing. Keywords: Alveolar ridge; Bone augmentation

Introduction: Tooth extractions can result in alveolar bone dimensional changes, necessitating additional bone grafting for implant placement. Alveolar Ridge Preservation (ARP) aims to counteract post-extraction changes. This study evaluates the bone regenerative properties of a freeze-dried bone allograft (FDBA) and the clinical outcomes of implants in grafted extraction sites. Materials and Methods: This case series enrolled 33 patients undergoing single/multiple tooth extractions followed by ARP. Biopsies were harvested during implant placement for histologic and histomorphometric analysis. Clinical outcomes included marginal bone loss and Pink Esthetic Score (PES). Results: 25 patients completed the study. FDBA augmented sockets exhibited new bone formation adjacent to graft particles. Implants (n=25) showed 100% survival and success rates at 1 and 2 years. PES improved significantly over time (p<.001), while marginal bone loss did not significantly differ at 1 and 2 years (p=.096). Specimens showed trabecular bone, residual FDBA particles, and marrow spaces. High magnification revealed immature bone and woven bone bridges around graft particles. No inflammatory cells were observed. Conclusions: The case series provides valuable insights into ARP performed with FDBA; implants were placed after 3 months of healing without any additional bone augmentation, the histologic outcomes were favorable, and implants were successful after a 2-year period of follow-up.

Aims: Aim of this retrospective study was to evaluate the incidence of complications and to determine the long-term survival rate of teeth with severely compromised clinical crowns treated with minimally invasive crown lengthening (MICL) and restorative treatment. Methods: A sample of 112 teeth in 86 patients was treated with MICL and restorative dentistry. Endodontic and orthodontic therapy was applied when needed. Clinical outcomes were assessed at baseline, 1 year and long-term. Results: The application of MICL resulted in very limited radiographic bone resection (RBR, 1 ± 0.1 mm on average). Limited local inflammation and shallow probing depth were detected at 1 year (2.6 ± 0.5 mm) and long-term (2.9 ± 1.0 mm). Most of the teeth (76.8%) maintained dental and periodontal health over time. The negative events observed in 26 teeth were caries (8.9%), fractures (7.1%), endodontic problems (1.8%), periodontal problems (4.5%) and restoration problems / complications (0.9%). The survival rate was 90.2%. Conclusions: the outcomes of this long-term retrospective analysis (8.9 ± 0.9 years, range 8 to 10) show high tooth survival rates and low incidence of complications of teeth treated with MICL and restoration of the clinical crown. 

A clinical observation usually encountered after vestibuloplasty or interventions aiming at deepening the vestibule with or without simultaneous free epithelialized grafts in the posterior ridges is that they are subjected to major dimensional changes attributed to the buccinator fibers attachment. Hence, this study aimed at assessing the attachment of the buccinator muscles in relation to other anatomical landmarks. An ex-vivo study was performed in cadaver heads to explore the association of fibers attachment in relation to the distance from the crestal aspect of edentulous alveolar process (CAP) and the vestibular depth (VD), crestal band of keratinized mucosa (KM), and ridge height (RH). Interestingly, VD and KM were found to be strongly correlated. Likewise, VD/KM and CAP-BUC were further noted being correlated. CAP-BUC was negatively correlated with RH. Accordingly, the more atrophic the alveolar ridge (being more noticeable in the mandible) is, the shallower the vestibule, the lesser the crestal band of KM and the more crestal attachment of the buccinator muscular fibers. That might be the reason why whenever performing free epithelized graft in the posterior ridges to enhance the peri-implant soft tissue phenotype and deepening the vestibule, the graft is subjected to major dimensional changes. 

Dental implants have been commonly used to replace missing single teeth. However, esthetic rehabilitation of an adjacent tooth may also be required due to diastemas, crowding, or existing large direct restorations to improve the final esthetic outcome. With the advancements in ceramics and bonding techniques, minimally invasive esthetic approaches have become viable for compromised spacing issues. This case report describes a dental technique for the esthetic rehabilitation of compromised anterior spacing with a customized zirconia implant abutment at maxillary central incisor site and a partial ceramic veneer bonded to adjacent central incisor. Keywords: Anterior spacing; case report; implants; partial laminate veneer; prosthetic dentistry

The aim of this PRISMA-compliant systematic review was to analyze the evidence pertaining to disease resolution after treatment of peri-implant diseases (PROSPERO: CRD42022306999) with the following PICO question: what is the rate of disease resolution following non-surgical and surgical therapy for peri-implant diseases in adult human subjects? A literature search to identify studies that fulfilled a pre-established eligibility criteria was conducted. Data on primary therapeutic outcomes, including treatment success, rate of disease resolution and/or recurrence, as well as a variety of secondary outcomes was extracted and categorized. Fifty-five articles were included. Few studies investigated the efficacy of different non-surgical and surgical therapies to treat peri-implant diseases using a set of pre-defined criteria and with follow-up periods of at least one year. The definition of treatment success and outcomes of disease resolution differed considerably among the included studies. Treatment of peri-implant mucositis was most commonly reported to be successful in arresting disease progression for ≤60% of the cases, whereas most studies on peri-implantitis treatment reported disease resolution occurring in <50% of the fixtures. In conclusion, disease resolution is generally unpredictable and infrequently achieved after the treatment of peri-implant diseases. A great variety of definitions have been used to define treatment success. Notably, percentages of treatment success and disease resolution were generally underreported. The use of standardized parameters to evaluate disease resolution should be considered an integral component in future clinical studies. Keywords: Peri-implantitis, dental implant, diagnosis, peri-implant endosseous healing, tooth loss, outcome assessment.

The management of marked horizontal bone atrophy represents a critical challenge for traditional implantology procedures. For this purpose, clinicians have developed several protocols and procedure to allow the most suitable and accurate surgical and prosthetic implant rehabilitation. Despite the development of guided-bone regeneration methods or the use of small-diameter implants, the rehabilitation of thin bone areas represents a clinical dilemma for the medium- and long-term survival of implant-prosthetic therapies. This clinical case evaluates the use of wedge implants for the full arch rehabilitation of an atrophic maxilla with a thin ridge. This treatment choice allowed a minimally invasive rehabilitation, avoiding regenerative bone surgery, while respecting biological and prosthetic limits. Furthermore, the evaluation of ISQ and MBL values during the first year of follow-up allowed us to analyse the behaviour of this rehabilitation solution in full arch maxillary cases.

Successful bone augmentation relies on primary wound closure. Labial frenum is a soft tissue that connects the lip to alveolar mucosa or gingiva. However, frenum may exert biomechanical forces to the wound edge, causing wound instability. The aim of this study is to (1) review the frenum composition and classifications; (2) understand the significance of frenum in wound stability upon bone regeneration. An electronic search was conducted through the three online databases together with manual search on studies published until September 2022. A total of 300 articles were identified and 11 studies were included in this review. Two of the included six studies discovered that 35-37.5% of the labial frenum had muscle fibers. Other studies showed that labial frenum was mainly composed of connective tissue with elastic fibers. There are two widely used classifications for frenum based on morphology and position of attachment. No studies specifically evaluated the impact of frenum on bone regeneration. Frenum location intercorrelated with the amount of keratinized tissue, which could influence wound stability. A modified frenum classification for the edentulous ridge and a decision diagram to manage the frenum is proposed for research and evidenced practice.

Collagen matrixes have been developed as possible connective tissue graft substitutes to overcome patient discomfort, undesired palatal healing, and the limited amount of donor tissue. The aim of this case series is to assess a coronally advanced flap (CAF) with a new volume-stable collagen matrix (VCMX) to treat single gingival recession (GR) associated with partially restored non-carious cervical lesions (NCCL). Twelve patients diagnosed with single GR RT1 + NCCL (B+) were included in this study and received a restorative – partial resin composite with apical margin 1 mm beyond the estimated cementoenamel junction (CEJ) – and a surgical approach – CAF+VCMX. Clinical and patient-centered assessments were recorded at baseline and 6 months postoperatively from ten patients. Significant recession reduction (RecRed:2.1mm), clinical attachment level gain (CAL:1.34mm), and combined defect coverage (CDC) of 51.67% were observed at 6 months. The estimate root coverage (RC) was 69.48%, obtained using the estimated CEJ. No difference in keratinized-tissue width (KTW) was observed over time. A gain in gingival thickness (GT) of 0.42 mm was observed after 6 months (p=.002) and an improvement in patient satisfaction due to better esthetics (p<.001). Within the present study’s limits, CAF plus VCMX provided significant improvement in treating single GR combined with partially restored NCCL (B+). Keywords: Gingival Recession. Heterografts. Tooth abrasion. Tooth cervix.

Objectives: The aim of this article is to introduce three treatments for patients with gingival fenestration as a result of chronic apical periodontitis. Gingival fenestration is a relatively uncommon soft tissue lesion in which the root apex is exposed in the oral environment after the destruction of the overlying buccal bone plate and mucosa. At present, no clear etiology or treatment guidelines exist for gingival fenestration. This article reports three successfully treated cases of gingival fenestration associated with chronic periapical infection. This report can help contribute to treatment guidelines for gingival fenestration. Methods: All cases were treated with apicoectomy in conjunction with a connective tissue graft (CTG). According to the different conditions of the patients, we used some slightly different treatment methods during the operation. In case 1, we treated gingival fenestration in the mandibular left first premolar by endodontic therapy with root-end resection and retrograde filling and regenerative surgical therapy using a xenograft and CTG. In case 2, we treated gingival fenestration in the maxillary left lateral incisor by endodontic therapy with root-end resection and retrograde filling in vitro and regenerative surgical therapy using advanced platelet-rich fibrin (A-PRF) and CTG. In case 3, we treated gingival fenestration in the mandibular left second premolar by endodontic therapy with root-end resection and retrograde filling and regenerative surgical therapy using CTG. Results: Endodontic treatment was combined with periodontal surgery to achieve predictable treatment results. After 13 to 25 months of follow-up, all cases showed that the gingival fenestration had healed well, and the patients had no discomfort. Conclusions: These three cases show the possibility of using apical excision combined with a CTG and/or bone graft/PRF in the treatment of gingival fenestration. Reporting these three cases may help advance the field of treatments for gingival fenestration. Keywords: gingival fenestration, root canal therapy, apical surgery, connective tissue graft, bone graft, platelet-rich fibrin.

Robotic systems have revolutionized various industries, and dentistry is no exception. Recently, due to the robust advancements in artificial intelligence and technology, there has been a significant evolution of dental robotic systems, ranging from surgeon controlled, robot-assisted operations, to more autonomous processes. The present clinical case report describes a 1-year follow-up of the successful use of an autonomous dental implant robot system with an osseodensification (OD) protocol for implant osteotomy preparation, maxillary sinus elevation, and simultaneous implant placement at the maxillary second premolar site. A prefabricated provisional prosthesis was delivered immediately after implant placement, with final prosthesis delivery at 3 months. The findings from this report demonstrate the integration and clinical augmentation of more autonomous protocols in the field of implant dentistry using dental robots. Keywords: Robotics surgery, Osseodensification, Maxillary sinus, Dental implant, Case report

Titanium has been proposed as a mesh material for GBR since the nineties. To overcome difficulties in shaping and adaptation to the defect, digital elaboration techniques were introduced to digitally print meshes capable of fitting the bone perfectly, reproduced through the CT scan of the patient. Five patients were included in this case series. CBCT data of patients were acquired and sent to the producer of the titanium mesh. 3-dimension regenerative surgery was performed with titanium meshes and a mix of Demineralized Bovine Bone Matrix (DBBM) and Autologous bone (1:1 ratio). Radiographic measures were evaluated on paraxial sections of the CBCT through a dedicated software. When possible, regenerated bone samples were obtained at implant insertion time. Four out of five regenerated areas healed without local and systemic complications. One mesh was removed after two months and two weeks because of exposition. Mean vertical bone gain was 4.3 ± 1.5 mm (range 2.5 – 7 mm). Two histologic samples were obtained. In sample n.1, Bone Tissue Area and  Graft Material Area were respectively 44.4% and 12.5%. In sample n.2, the same parameters were 15.6% and 16.9% respectively.

Objective: The purpose of this retrospective study was to assess facial and palatal alveolar wall thickness (AWT) in relation to sagittal root position (SRP) of maxillary anterior teeth using cone-beam computed tomography (CBCT). Methodology: 102 CBCT images (60 females, 42 males) of anterior maxillary teeth were reviewed. SRP was classified according to Kan’s classification, and AWT was evaluated at coronal (4 mm from the cementoenamel junction), mid-root, and apical (2 mm from the apex) levels of the facial and palatal. Secondary variables of sex, age and tooth type were analyzed. Results: The SRP distribution was 76.6% class I, 11.3% class II, 0.8% class III, and 11.3% class IV. AWT, from thickest to thinnest, was found in palatal apical>mid>coronal, followed by facial coronal>mid>apical. Conclusions: AWT was thickest in SRP class II, followed by class I and III, and least thick in class IV at all measured areas (P<.05). A significantly higher AWT was associated with class I in central incisors, class II in canine teeth and in males, and class IV in central incisors and canines. Keywords: Alveolar Process; Cone-Beam Computed Tomography; Dental Implants.

ChatGPT, an artificial intelligence (AI) chatbot can generate text prompts based on user input. This study investigated the possibility of generating adequate and relevant patient education and management documents in the context of dental implant surgery utilizing this tool. Methods: Twenty-seven (n=27) periodontists were surveyed on the accuracy and usefulness of AI-generated documents comprising patient information handouts on surgical risks and post-operative instructions sheets for dental implant placement either in smokers or patients with diabetes. They were also asked in a blinded fashion about their preferences between the generic dental implant placement consent form currently used at Boston University and two AI-generated consent forms: one generic and one tailored to patients with diabetes. Results: A vast majority of participants found that the information in the AI-generated forms was accurate, useful and would feel comfortable using them with their own patients. The AI-generated generic consent performed as least as well as the human-written one, while the personalized informed consent for patient with diabetes performed significantly better (p<0.001). Conclusions: Within the limitations of this study, ChatGPT was able to independently generate accurate and useful patient information and management documents.

Choosing between screw-retained and cement-retained restorations in the esthetic zone may have a significant implication on the restorative contour. This study analyzes the effect of facial-palatal implant positioning on the facial emergence angle of implant restorations in the maxillary anterior region. 133 maxillary anterior implant cases were captured with intraoral scans and used to create digital prosthetic designs. The facial emergence angle of the restoration and the depth of the implant were determined using images at the mid-facial cross-section. Simple logistic and linear regression models were used to analyze the interrelation between the emergence angle, depth, and retention methods. The average facial emergence angle for all restorations in this study was 34.4 degrees. A significant difference was found in emergence angle between screw-retained and cement-retained groups, with an average emergence angle of 37.3 degrees and 27.9 degrees, respectively. There is no difference in the mean depth between those two groups. There is a strong negative linear relationship between depth and emergence angle for the screw-retained group. Overall, implant positioning in the anterior maxilla has a significant influence on emergence angle. Facial emergence angle is significantly greater for implants in screw-retained position. This may be partially alleviated by deeper implant placement. Keywords: Dental implants, emergence angle, dental prosthesis, implant position

Sinus floor augmentation is one of the most used approaches to obtain sufficient bone availability to place dental implants in cases with severe bone atrophy in the posterior maxilla. Several bone substitutes are indicated for sinus augmentation but they may obtain different clinical outcomes. This study aims to compare bovine bone mineral (BBM) with freeze dried bone allograft (FDBA) in two- stage lateral window sinus grafting approach. 20 patients received a lateral window sinus lift with either FDBA or BBM. Post-operative graft height was measured with a cone-beam computerized tomography (CBCT). 6 months later implants were placed. Biopsies were taken for histological analysis and new CBCts were performed to measure graft height at this point. 6 months after procedure, there was a height reduction of 20,27 ± 4,94 % for the FDBA sample and 5,36 ± 2,41% for the BBM group. The histological analysis revealed a ratio of newly formed bone of 43,70 ± 5,29% for the FDBA and 38,11 ± 4,03% for the BBM group. The FDBA also showed a higher amount of residual biomaterial 17,25 ± 10,10% and connective tissue 14,63 ± 4,38% compared to the BBM 15,53 ± 5,42% and 13,11 ± 4,42%. The differences between groups were statistically significant for the height reduction and for the newly formed bone (p ≤ 0.05) but not for the residual biomaterial amount and the non-mineralized connective tissue (p ≥ 0.05). It could be concluded that the percentage of newly formed bone 6 months after performing a lateral window sinus lift using FDBA was significantly higher than when using BBM, although the graft height reduction was also significantly higher for the FDBA group. Keywords: Sinus Floor Augmentation, allografts, heterografts.

Purpose: To compare survival, marginal bone loss (MBL) and prosthetic complications of 4.5-mm extra-short implants and longer implants splinted to the same type of implant. Materials and Methods: A retrospective controlled cohort study was performed. The 4.5-mm extra-short group (study group; SG) included 48 consecutively placed implants that met inclusion criteria. Control group (CG) included 48 implants splinted to them. The same surgical team treated the 39 patients included, and all the implants were restored with a screw retained fixed restoration and intermediate abutments. Immediate and conventionally loaded implants were included. Results: All the implants were in function during the follow-up period (14 ± 3.4 SD and 17 ± 13 SD months for SG and CG). No differences in technical complications were observed between both groups (1 and 2 screw loosening for SG and CG; 2 fractures in provisional prosthesis for SG; p=0.310). Marginal bone stability was similar for SG and CG at mesial level (SG: Mean -0.01 ± 0.28 SD mm Vs CG Mean -0.18 ± 0.72 SD mm; p=0.270) and at distal level (SG: Mean 0.02 ± 0.39 SD mm Vs CG Mean -0.18 ± 0.68 SD mm; p=0.076). Conclusions: The same good clinical performance could be observed for 4.5-mm implants and longer implants under the same prosthesis. Keywords: short dental implants, extra-short implants, marginal bone stability.

Healing outcomes of periodontal and implant-related regenerative procedures are closely related to wound stability, which is partially determined by biomechanical properties and behaviors of oral mucosal tissues. Studies on soft tissue behaviors under biomechanical forces in oral regeneration models are scarce. The aims of this review article are to (1) contrast the microstructural differences between the attached gingiva (AM) and lining (LM) mucosa, (2) evaluate biomechanical behaviors of the two mucosal types,and (3) relate residual flap tension to the prevalence of wound opening after regenerative procedures. Results: Compositional and structural differences between the AM and LM explain the biomechanical property differences between AM and LM. Wound destabilizers, including tissue recoil stemming from its viscoelastic property, muscle pull, and inflammatory edema created after the flap releasing procedure for primary wound closure interfere with wound stability. Residual flap tension <0.05 N is a prerequisite for sustained wound closure. Tissues under stress can exert negative cellular changes, resulting in necrosis and wound dehiscence. Conclusion: Biomechanical properties and the variations between AM and LM dictate the degree of wound stability. Efforts should be made to reduce the negative impact of the potential destabilizers to optimize wound stability. Keywords: biomechanical properties, oral mucosa, viscoelastic, flap tension, regenerative procedures

This pilot case series histologically and histometrically investigated the influence of implant surface hydrophilicity on early osseointegration and peri-implant bone formation around simultaneously grafted immediate implants. Core biopsies of the hydrophilic test (SLAactive®) or hydrophobic control (SLA®) implants immediately placed in maxillary molar extraction sites and simultaneously grafted with mineralized cancellous bone allograft (MCBA) obtained at 3 weeks post-placement were histometrically compared for bone to implant contact, the quantity of graft material, new bone formation, tissue reaction, and inflammatory scores. Test implants showed a more pronounced implant-bone apposition, peri-implant bone formation and bone aggregate than control implants. Trabecular bone formation and maturation were also qualitatively advanced around test implants. These results indicate that the implant surface bone graft combination may affect peri-implant bone formation. 

Surface contaminants on customized implant abutments could trigger inflammatory response in the peri-implant tissues. The aim of this randomized controlled study was to assess the radiographic bone changes around implants restored with customized, platform-switched abutments, with and without autoclave treatment, 12 months after definitive restoration. Dental implants were placed 1 mm subcrestally in 64 systemically healthy patients (mean age 63.3 ± 10.0 years, 31 with history of periodontitis) to replace single or multiple missing teeth. According to a randomization list, abutments were subjected to steam and autoclave sterilization (43 implants, test group) or steam cleaning alone (44 implants, control group). Periapical standardized radiographs were taken at the time of implant insertion, prosthetic abutment connection and 12 months after definitive cement-retained restoration. All implants were clinically stable without any sign of infection at the 12-month follow-up. An average marginal bone loss of 0.25 ± 0.19 mm was found in the test group compared to 0.35 ± 0.23 mm in the control group without statistically significant difference, while the percentage of bleeding sites was significantly higher in the control group (8.7 ± 13.1% versus 19.1 ± 19.8%, P = .035). Autoclave treatment of customized abutments would seem to reduce the inflammatory response around subcrestally placed implants. Keywords: bone loss, platform switching, dental implant, subcrestal, sterilization

Background: This study is aimed to investigate the types of knot failure (untying or breaking) and the tension required to break different sutures diameters. Methods: One hundred and fifty knots were fabricated using polyamide sutures diameters of 6/0, 7/0, and 8/0. The studied knots were either squared or slipped with different numbers of throws (2, 3, 4, 5 and 6), and the following data were recorded: type of failure (untied or broken), number of throws, the tension required to untie or break each knot, slippage, and elongation of the knot. The knots were created in a standardized way. with a device and weights and then subjected to a controlled tension. Results: The knots that got untied were: 1=1, 1x1, 2=1, and 2x1, whereas the remaining knots  got broken. Notably, at least three throws were required to prevent untying, but separately, as in 1=1=1 or 1x1x1. The mean tension to break the knots of 6/0, 7/0, and 8/0 sutures were 3.1, 1.3, and 0.6 N, respectively (P < 0.05), and they were independent of the knot type. Conclusion: Results from this study demonstrated that the knots with geometries of 2=2/2x2 and 1=1=1/1x1x1 were secure, and additional throws does not increase their security. Furthermore, tensile strength reduces with decreased suture size.

The effects of buccal contour augmentation, for periodontally compromised teeth with horizontal bone loss, was assessed in this study. 30 subjects were divided into group A (open flap debridement [OFD] with buccal contour augmentation using deproteinized bovine bone mineral [DBBM]), jointly referred to as Contour augmentation for Periodontal Defects (CAPD); and group B (OFD alone). Bleeding on probing (BOP), clinical attachment level (CAL), probing depth (PD), gingival recession (GR), width (WKM) and thickness (TKM) of keratinized mucosa and labial cortical plate thickness were compared at baseline and 1-year. BOP, CAL, PD and GR did not show significant differences. TKM increased by 1.76 mm for group A, while decreased by 1 mm for group B. WKM increased from 2.86 ± 0.4 mm to 3.6 ± 0.71 mm (p<0.001) and 2.93 ± 0.32 mm to 3 ± 0.7 mm (p = 0.5) for groups A and B respectively, which showed a statistical significance. Labial cortical plate thickness increased from 0.94 ± 0.3 mm to 1.95 ± 0.54 mm (p<0.001) for group A, while decreased from 0.87 ± 0.45 mm to 0.68 ± 0.31 mm for group B. Visual analog scale score for pain perception showed no difference between the 2 groups. Contour augmentation (CAPD) with DBBM for periodontally compromised teeth improves WKM and TKM. Long-term analyses are needed to determine its benefits in daily clinical practice. 

Objectives: The aim of the present case series is to exhibit the long-term clinical and radiographic outcomes of resective surgery with adjunctive implantoplasty over a 6-to-11-year follow-up. Materials and Methods: Four patients presenting 4 implants diagnosed with peri-implantitis according a to an established case definition were included in the present case series. Subjects underwent resective surgery, a modified implantoplasty approach, and implant surface decontamination. Clinical and radiographic outcomes such as bleeding on probing (BOP), suppuration on probing (SoP), probing depth (PD), marginal recession (MR), modified plaque index (mPI), and marginal bone levels (MBL) were recorded over a long-term following surgical therapy. Results: Over 6-to-11-year follow-up, mean BOP, PD, and SoP scores amounted to 17 ±24%, 2.5 ±1.26 mm, and 0%, respectively. BOP scores were reduced in 17%, PD values in 2.5mm, and SoP scores in 100%. Radiographic analysis revealed a mean radiographic bone gain of 3.1 ± 1.84 mm. Peri-implant marginal bone loss surface area decreased by 5.7±3.77mm2 over the long-term follow-up. Conclusion: Resective therapy with adjunctive implantoplasty promoted favorable clinical and radiographic outcomes at peri-implantitis treated sites over a long-term period. Clinical Relevance: Diverse surgical approaches such as resective, reconstructive, and combined therapy have been proposed towards peri-implantitis treatment. A resective surgical approach with an adjunctive “modified” implantoplasty refers to the modification of the implant body into a constricted area to mimic a “waist” silhouette. This modified technique conforms an adequate concave smooth area that may favor the outcomes of resective surgical therapy for soft tissue adaptation, biofilm control, and possible peri-implant bone gain over the long term. 

This study aimed at determining the correlation between gingival stippling (GS) and other phenotypical characteristics. Adult subjects in need of cone-beam computed tomography scans (CBCT) and comprehensive dental treatment in the maxillary anterior region were recruited. Facial gingival thickness [GT] and buccal bone thickness [BT] were assessed utilizing CBCT. Standardized intraoral photographs were obtained to determine keratinized tissue width (KTW), presence of GS in all facial and interproximal areas between the maxillary canines, and other variables of interest, such as gingival architecture (GA), tooth shape, and location. Statistical analyses to assess different correlations among recorded variables were conducted. A total of 100 participants and 600 maxillary anterior teeth constituted the study population and sample, respectively. Facial GS was observed in 56% of males and 44% of females, and it was more frequently associated with flat GA, triangular and square/tapered teeth, central incisors, and males. Greater mean values of GT, BT, and KTW were observed in facial areas that exhibited GS. Interdental GS was present in 73% of the sites and it was more frequently observed in males, the central incisor region, and when facial GS was present. Multilevel logistic regression revealed a statistically significant association between the presence of GS and KTW, BT measured at 3mm apical to the bone crest, and tooth type. This information can be used in the recognition of common periodontal phenotypical patterns associated with specific features of great clinical significance. 

Mucogingival deformities around implants are frequent findings in clinical practice and often present as inadequate keratinized tissue and insufficient mucosal thickness. Phenotype modification therapy can increase peri-implant mucosal thickness and the amount of keratinized mucosa, improving the long-term clinical outcomes of implants. Free gingival graft (FGG) is considered the gold standard to increase keratinized mucosa; however, FGGs on lingual aspects of implants are less predictable due to technique sensitivity and often present with insufficient gain in tissue thickness ue to limited blood supply. The Semilunar Lingualized Apically Positioned Flap (SLAP) with subperiosteal tunnel connective tissue graft (CTG) can increase both peri-implant mucosal thickness and keratinized mucosal width circumferentially. SLAP consists of one full-thickness, semilunar incision within keratinized mucosa on the buccal, and two vertical releasing incisions mesial and distal of the implant, extending lingually into the alveolar mucosa. The tissue is apically positioned lingual to the implant, and sutured in place creating buccal space for CTG via buccal subperiosteal tunneling. SLAP is a minimally invasive and predictable approach in improving peri-implant mucosal phenotype. This case reports demonstrates gain in peri-implant mucosal thickness and the amount of keratinized mucosa over a 10-month period utilizing SLAP with subepithelial CTG. 

The aim of the present study was to compare by cone beam computerized tomography (CBCT) the influence of white and black ethnicity on the gingival and bone thickness. Eighty-four individuals, aged between 18 and 59 years old, of both genders, were divided into black (BG n=42) and white groups (WG n=42) and analyzed from June 2020 to April 2021. The gingival and bone thickness were measured using CBCT in all maxillary anterior teeth. T test, Mann-whitney, chi-square, Pearson's correlation and Spearman’s correlation were used for comparisons and correlations with a 5% significance level. The black individuals had mean gingival (1.45mm±0.29) and buccal bone plate (1.07mm±0.21) significantly (gingival: p<0.0001, bone: p=0.0002) thicker than white individuals (1.17mm±0.28 and 0.91mm±0.17, respectively). The variables presented greater values for the male individuals. A positive correlation between the thickness of buccal bone plate and gingiva for was found in two teeth in WG (left and right central incisor) and one tooth in BG (left canine). Moreover, a correlation between BBPT and GT immediately below alveolar bone crest (0 mm landmark) was found in four teeth in WG (left and right lateral incisor, left and right central incisor) and BG (left and right canine, left lateral incisor and left central incisor). The black ethnic showed to significantly influence the gingival and buccal bone plate thickness, with black individuals presenting thicker structures than whites. 

Introduction: Peripheral Giant Cell Granulomas (PGCGs) are benign oral cavity tumors, reactive in nature, caused by local trauma or irritation. Case presentation: A 51-year-old female patient presented with a soft tissue lesion related to implant site #19. Excisional biopsy was completed, and the soft tissue mass was diagnosed as a Peripheral Giant Cell Granuloma (PGCG). The biopsy led to absence of keratinized tissue and vestibular depth around the implant site. After the initial healing phase of the biopsy, a free gingival graft was completed and following the maturation of the soft tissue the cement retained implant supported prosthesis was converted into a screw retained implant supported prosthesis. Conclusion: With a combined periodontal and restorative approach increased KT, adequate vestibular depth, no recurrence of the PGCG was achieved as well as an easily accessible screw retained implant supported prosthesis.

The aim of this report is to describe a new sling suturing method with papillary anchorage that is found clinical applicable within the available conventional tunneling root-coverage procedures. Although caution is advised to not increase excessive tension on the fragile papilla tips, as they provide coronal and palatal suspension, it ascertains a firm and stable connection for the entire bucco-gingival-graft complex into the horizontal and vertical dimension of both single and multiple recession defects. This technical note described the "trapezoidal sling suture" technique, that allows fixation and stabilization for graft and flap around both natural teeth and implants. Keywords: suturing, gingival recessions, dental aesthetics

The aim of this present case series investigated the effect of a combination therapy utilizing connective tissue graft (CTG) in the treatment of periodontal regeneration of mandibular Class Ⅲ furcation involvement (FI). Six patients diagnosed with periodontitis stage Ⅲ or Ⅳ (grade A to C), presenting with Class Ⅲ or Ⅳ FI, were treated with fibroblast growth factor 2 and carbonate apatite in combination with CTG. The following clinical parameters were evaluated at baseline and after 6, 12 and 18 months: periodontal probing depth, clinical attachment level, furcation invasion, the radiographic vertical defect depth, and gingival phenotype. Significant improvements in clinical parameters were observed in all treated FI sites. Four Class Ⅲ Fls and one Class Ⅳ Fl obtained complete closure, and one Class Ⅳ furcation was improved to Class ?? . This case series showed the potential of administering combination regenerative therapy for changing the prognosis of hopeless teeth with severe furcation defects.

Implants with deficient papillae and black triangle are common findings. The treatment of these esthetic complications is considered challenging, and with limited predictability. Therefore, the aim of the present report is 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 up 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 come back for implant therapy only 2 years later. An incomplete regeneration of the interproximal bone was observed. Therefore, to compensate the interproximal deficiency, the iCTG approach, involving a double layer CTG with different origins, was utilized. Two small grafts from the tuberosity were sutured to the mesial and distal ends of a wider CTG harvested from the palate, aiming at gaining additional volume at the interproximal sites. The composite graft was then sutured on top of the implant platform, with the flap that was then released and closed by primary intention. After conditioning of the peri-implant tissues, the case was finalized with a satisfactory outcome. The described iCTG could be an effective approach for reconstructing peri-implant papilla following interproximal bone reconstruction.

Despite the various barrier membranes proposed, one of the main challenges for guided bone regeneration (GBR) is space maintenance for large defects as well as ensure adequate blood supply. The presented feasibility case series aims to introduce an original titanium frame (TF) design, customized for each defect, as a modification of well-known principles and materials for GBR, for an enhanced and more predictable horizontal and vertical bone augmentation. Three patients with significant horizontal defects were treated with pre-trimmed TFs to create needed space, a 50%-50% mixture of autograft and bovine xenograft was placed, and then covered with collagen membrane. After 8 months of healing, the sites were reopened, the titanium screws were removed with the frame. An average of 8.0 ± 1.0mm horizontal and 3.0 ± 0.0mm vertical bone gain was achieved at the time of re-entry and implant placement surgery. Bone core biopsy was obtained during the implant placement. Histomorphometric analysis revealed that 42.8% of the sample was new vital bone, 18.8% was residual bone graft particles, and 38.4% was bone marrow like structures. After 3-4 months from implant placement, the implants were restored with provisional crowns and then finalized with zirconia screw-retained crowns. This case series suggests that GBR utilizing TFs with or without collagen membranes can be considered a suitable approach for horizontal and vertical bone augmentation. However, based on only three reported cases, the result should be carefully interpreted.

Aim: To investigate the dimensional stability and quality of the alveolar ridge augmented using a synthetic bone block (SBB) at damaged extraction sockets. Materials and Methods: Four participants were included in whom socket augmentation was performed using SBB and a collagen membrane. Intraoral scan (IOS) was performed before extraction (baseline), immediately postoperative (IP), and at 6 months (6M). Cone-beam computed tomography (CBCT) was performed at IP and 6M. At 6M, a trephine biopsy was obtained during implant placement and the sample was observed using synchrotron. Profilometric change of soft tissue was measured from the IOS data, hard tissue dimensional change was measured from the CBCT data and the bone quality from synchrotron data. Results: There were minimal changes in the soft tissue profile between baseline and IP, baseline and 6M, and IP and 6M (0.11±1.08 and 0.02±0.8, and -0.65±0.82 mm3). Horizontal bone width measured at 1 mm increments from the augmented bone crest to 5 mm apically revealed only slight reduction (less than 1 mm) at all levels between IP and 6M. The augmented bone height was well maintained from IP until 6M (-0.21±0.53 mm). Synchrotron analysis revealed low to moderate bone quality after 6M (percentage new bone = 16.49±4.91). Conclusions: Augmentation of the damaged extraction socket using SBB is a viable technique, in which the dimensions of the augmented ridge can be maintained up to 6M. Further long term randomized clinical trial is needed. Keywords: alveolar ridge preservation, synthetic bone block, damaged extraction socket

Aim: To define immunophenotypes of stromal inflammatory and endothelial cells and fibroblasts 3-months post-augmentation of the peri-implant soft tissue using a porcine cross-linked collagen matrix (VCMX). Methods: Peri-implant soft tissue samples were obtained from 12 patients at the lining mucosa (LM) - masticatory mucosa (MM) junction, before and at 3-months post-augmentation. Immunohistochemical stains for identification of inflammatory cells [T (CD3) and B (CD20) lymphocytes, plasma cells (CD138)], macrophages (CD68-pro-inflammatory, CD163-anti-inflammatory/reparative), endothelial cells (CD31, CD34) and fibroblasts (CD90, TE-7), were performed. Differences in the mean positively-stained cells pre- and post-augmentation was analyzed by Wilcoxon Signed-Rank Test. Results: CD31+ endothelial cells showed increased mean numbers in MM2 compared to MM1 (p=0.025) and in LM2 compared to LM1 (p=0.047). CD163+ anti-inflammatory macrophages showed mean numbers in MM2 higher than MM1 (p=0.021) and in LM2 than LM1 (p=0.012). All other cell phenotypes showed insignificant changes between pre- and post-augmentation. Conclusion: This molecular study provided novel insight on the frequency of phenotypes of stromal cells in the wound healing process 3-months post-augmentation with VCMX, with anti-inflammatory CD163+ macrophages being predominant. This should be further investigated in order to find novel therapeutic approaches to modulate and promote the VCMX-related healing process. Keywords: soft tissue augmentation, mucosal thickness, collagen matrix, connective tissue, collagen fibers

Numerous surgical techniques have been developed as effective means to facilitate orthodontic treatment, although they may cause significant postoperative discomfort. Piezocision was established as a flapless and minimally invasive technique to accelerate orthodontic tooth movement by combining small vertical incisions and piezoelectric corticotomies. Computed tomography has been combined with the piezocision technique to fabricate computer-aided design and computer-aided manufacturing (CAD/CAM) surgical guides to prevent iatrogenic damage. A method to combine computer-assisted dynamic navigation with piezocision is introduced here. Cone-beam computed tomography was combined with motion-tracking technology to allow real-time tracing of the piezoelectric instruments during the surgical procedure. This technique delivers the location of piezoelectric knife in regard to roots and important anatomical structures to increase the safety and accuracy during corticotimies.

Bone graft materials are often used in implant treatment for optimizing functional and esthetic outcomes. The requirements for bone grafting materials should be that they must be able to maintain space for bone regeneration to occur and must be resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are chemically synthetic bone graft material that are similar to autologous bone mineral and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments using CO3Ap granules in combination with autogenous bone or CO3Ap granules separately. This report will show the clinical findings as well as radiographic and histological assessments in three cases of immediate implant placement, lateral GBR and vertical GBR. These results demonstrated, although it was a short-term report, that in histological findings CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules contributed to maintaining their morphology tissue around the implant. In this limited short-term case report, it was suggested that this bone substitute was effective. However, further clinical studies and long-term reports of this new biomaterial are needed.

Background: Gingival recession treatment is one of the major clinical challenges in periodontics, various surgical techniques were proposed to correct it. Most of these techniques are suitable for isolated recession sites and involve the harvesting of autogenous tissue graft; which increase patient morbidity and might result in inferior esthetics due to incision design. This study assessed the benefit of adding Platelets Rich Fibrin (PRF) to Vestibular Incision Subperiosteal Tunneling Approach (VISTA) in treating multiple gingival recession compared to using VISTA alone. Forty-one teeth with Miller Class I/II were randomized in a split mouth design. Multiple clinical parameters were tested including the change in gingival thickness over time, keratinized tissue width KTW and the gingival phenotype using the transparency of periodontal probe. Patient-centered outcomes were also assessed via Visual Analogue Scale VAS. Conclusion: Multiple Miller Class 1 and Class 2 recessions in the maxilla can be effectively treated with VISTA. However, when used in conjunction with PRF no significant differences were detected in any parameter. VISTA has been shown to be associated with a low level of pain for patients following surgery and can be used for patients with high esthetic demand. Int J Periodontics Restorative Dent 2023. doi: 10.11607/prd.6536

Background: Multiple adjacent gingival recessions (MAGRs) are commonly treated with autogenous grafts. However, several intra- and post-surgical complications have been described following autogenous grafts, leading clinicians to explore the use of different biomaterials for the treatment of these conditions. The aim of the present study was to evaluate the root coverage outcomes of a novel porcine-derived acellular dermal matrix (PADM) in combination with the tunneled coronally advanced flap (TCAF) for the treatment of MAGRs. Methods: Ten patients with 33 type 1 recession defects (RT1) were treated with PADM, in combination with the tunneled coronally advanced flap (TCAF). The outcomes of interest included the mean root coverage (mRC), the frequency of complete root coverage (CRC), changes in keratinized tissue width, volumetric gain at the treated sites assessed with digital intraoral scanning, as well as patient-reported outcome measures. Results: All treated sites healed uneventfully, and no complications were noted throughout the study. At 6 months, a statistically significant reduction in recession was noted at the treated sites, exhibiting an overall mRC of 89.14 ± 19.15% and a CRC of 72.7%. The average volume gain after 6 months was 26.28 ± 11.71 in mm3 (Vol) and 0.63 ± 0.28 in mm (ΔD). The region-specific volumetric analysis revealed an overall higher linear dimensional gain at the Mid-Root aspect (ranging from 0.72 mm to 0.78 mm when assessed 1-4 mm apical to the cemento-enamel junction) compared to the other regions. Conclusions: The present study presents the clinical and volumetric outcomes of PADM, in combination with TCAF for the treatment of MAGRs. A significant amount of volumetric gain was also observed as a result of the treatment at 6 months, along with satisfactory, esthetic and patient-reported outcomes. Keywords: Gingival recession, Acellular Dermal Matrix, Surgical flap, volumetric analysis, optical scanning

The reconstruction of alveolar ridge defects can be challenging, especially when the lesion is large, non-contained, and located in the esthetic region. The present report describes the guided bone regeneration (GBR) procedure and prosthetic rehabilitation of a severe perforation defect in the anterior maxilla. Clinical and radiographic evaluation of the lesion indicated an endodontic-periodontal origin, and biopsy results confirmed the absence of malignancy. GBR was performed with the use of cortical mineralized freeze-dried bone allograft (FDBA) combined with recombinant human platelet derived growth factor BB (rhPDGF-BB) and a resorbable collagen membrane without the use of tenting or fixation screws. At six months post-GBR, cone beam computed tomography (CBCT) revealed adequate bone fill for the placement of 4.1 x 10 mm or 4.1 x 12 mm dental implants. The implant surgery was fully guided with a two-stage approach. After a ten-month of healing phase, the implants were loaded with a screw-retained porcelain bridge. The staged GBR approach using a combination of FDBA, rhPDGF-BB, and a resorbable membrane without the use of tenting or fixation screws resulted in significant bone fill, successful implant placement, and a functional and esthetic implant-supported prosthesis. Keywords: Alveolar Bone Loss, Bone Regeneration, Dental Implant, Case Report

Following implant placement, at healing abutment connection, a soft tissue barrier defined peri-implant mucosa will form. The dimension of this anatomical structure seems to play a key role in maintaining long- term peri-implant and marginal bone level stability. In its early stages, soft tissue healing is a process involving many cellular and molecular events. Enamel Matrix Derivative (EMD) may improve and fasten soft tissue wound healing and inflammatory resolution. In the present split-mouth randomized clinical trial, EMD was used to influence the early phase of soft tissue healing around dental implants placed with a single-stage approach into a completely healed ridge. A total of sixty implants were inserted in thirty patients. In the test group, EMD was administered around the healing abutment before soft tissues were sutured. Soft tissue healing index (HI), together with secondary endpoints (clinical, radiographic and PROMs), was measured. Better outcomes were recorded in patients receiving EMD when considering all parameters. Data here presented supports the use of EMD improve and accelerate soft tissue wound healing around implants.

Background: The idea of minimally invasive non-surgical treatment (MINST) is to remove the etiology with minimal damage to the healthy periodontium and provide the ideal healing environment. In this case series, the novel protocol of laser-assisted minimally invasive non-surgical therapy (LAMINST) is introduced that combines the benefit of minimally invasive and the dental laser to maximize the therapeutic potential. Method: 25 patients (32 teeth) with advanced periodontal disease have enrolled in the study. All the patients have received periodontal treatment by following the laser-assisted minimally invasive non-surgical therapy protocol. Treated sites were evaluated by comprehensive Periodontal examination at the baseline and 6-month re-evaluation, including probing depth (PD), Recession, clinical attachment level (CAL), bleeding on probing (BOP), presence of plaque, and mobility. The diagnosis and prognosis of each tooth were assigned based on the Periodontal evaluation. Result: All the cases were diagnosed as Stage III and Grade C Periodontitis according to the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The average probing depth reduction 6 months after completion of LAMINST was 4.44 mm and improved clinical attachment level by 4.38mm. There was the mobility of 1 (6 teeth), 2 (9 teeth), and 3 (3 teeth) in the beginning, and all of them decreased to 1 (5 teeth) or none (13 teeth). The prognosis was assigned based on McGuire and Nunn's system. The initial prognosis for teeth was assigned to hopeless (5) (15 teeth), questionable (4) (13 teeth), poor (3) (4 teeth), and it has improved to questionable (5 teeth), poor (12 teeth), fair (13 teeth), and good (2 teeth). Initially, there were 179 BOP sites. After treatment, it decreased to 12 sites. The plaque was found in 173 sites before the treatment and has reduced to 9 sites after the treatment. Conclusion: All clinical parameters such as PD, CAL, BOP, presence of plaque, and mobility are improved by receiving the laser-assisted minimally invasive non-surgical therapy protocol. The application of LAMINST may overcome the traditional limitation of non-surgical treatment, such as poor accessibility.  

The primary aim of this study was to evaluate the efficacy of alveolar ridge preservation (ARP) therapy compared with unassisted socket healing (USH) in attenuating interproximal soft tissue atrophy. Adult subjects that underwent maxillary single-tooth extraction with or without ARP therapy were included in this study. Surface scans and cone beam computed tomography were obtained to digitally assess interproximal soft tissue height changes and measure facial bone thickness (FBT), respectively. Logistic regression models were conducted to investigate the individual effect of demographic and clinical variables. Ninety-six subjects (USH=49; ARP=47) constituted the study population. Linear soft tissue assessments revealed a significant reduction of the interproximal soft tissue over time within and between groups (P<.0001). ARP therapy significantly attenuated interproximal soft tissue height reduction compared to USH (USH mesial: -2.0±0.9mm vs. ARP mesial: -1.0±0.5mm / USH distal -1.9±0.7mm vs. ARP distal: -1.1±0.5mm; P<.0001). Thin FBT (≤1mm) upon extraction was associated with greater interproximal soft tissue atrophy compared with thick FBT (>1mm), independently of the treatment received (P<.0001). Nevertheless, ARP therapy resulted in better preservation of interproximal soft tissue height especially in thin bone phenotype by a factor of 2 for the mesial site (+1.3mm) and a factor of 1.6 (+0.9mm) for the distal site. This study demonstrated that ARP therapy largely attenuates interproximal soft tissue dimensional reduction after maxillary single-tooth extraction compared with USH. Keywords: tooth extraction, bone resorption, alveolar ridge preservation, digital image processing, dental implants

Objective: The introduction of a new collagen substitute, that potentially will reduce the invasiveness of the two techniques, by avoiding the need for a second surgical site, i.e., the donor site, need to be evaluated in relation with the surgical procedure that could benefit the most by the utilization of such a matrix. The aim of this study was to compare the clinical outcomes following treatment of RT 1 multiple adjacent gingival recessions (MAGRs) using the modified coronally advanced tunnel technique (MCAT) or the multiple coronally advanced flap (MCAF) in conjunction with a new volume stable xenogeneic collagen matrix (VXCM). Secondarily, the study evaluated whether patients report a preference in terms of discomfort between the two surgical techniques. Methods: Twenty patients requiring treatment of MAGRs were randomly assigned to one of the two treatment groups (group A: MCAF+VCMX; group B: MCAT+VCMX). The following measurements were recorded at baseline (i.e. prior to surgery), at 6 and 12 months: gingival recession depth (REC), probing pocket depth (PPD), keratinized tissue width (KTW) and gingival thickness (GT). Post-operative pain and discomfort were recorded using a visual analogue scale (VAS) at 1 week. The primary outcome variable was mean root coverage (mRC), secondary outcomes were complete root coverage (CRC), change in KTW and GT, patient discomfort and satisfaction, and duration of surgery. Results: Healing was uneventful in both groups. At 12 months, both treatments resulted in statistically significant improvements of REC and GT compared with baseline (p < 0.05). The mRC measured 79.95 ± 29.92% at MCAF group, whereas 64.74 ± 40.5% MCAT group (p = 0.124). CRC was found at 65.6% of MCAF-treated sites and at 52% of MCAT-treated sites (p=0.181). Conclusions: Similar clinical results should be expected when MAGRs are treated with MCAF or MCAT, with the adjunct of VCMX.

This technical report describes the simplified subperiosteal sling (SPS) suture for connective tissue graft (CTG) stabilization in root coverage and phenotype modification of single and multiple recession defects via the vestibular incisional subperiosteal tunnel access (VISTA). The simplified SPS suture engages the CTG only and stabilizes it to the tooth in the coronal most position inside the subperiosteal tunnel independent of the overlying gingival tissue. The simplified SPS suture differs from the original SPS suture in that it engages the CTG first, and the needle and tail of the suture are knotted before the suture is introduced into the subperiosteal tunnel. This allows the needle to pass through the subperiosteal tunnel only once from the vestibular access to the intended gingival sulcus. When multiple teeth are treated, only one simplified SPS suture traverses the vestibular access at a time as the CTG is incrementally advanced into the tunnel. This prevents suture entanglement and improves the practical application of the technique.