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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. 

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.

Ultrathin ceramic veneers are a viable therapeutic option to manage esthetic challenges in the anterior zone. Proper conditioning of the intaglio surface of porcelain veneers is essential to achieve an adequate bonding. In clinical practice, this is typically done with chemical etching using an acid-containing agent, such as hydrofluoric (HF) acid. While it is well established that the etching effect is time- and acid concentration-dependent, little is known regarding the impact of etching time and the veneer fabrication method. The purpose of this pilot study was to evaluate the effect that different etching time protocols have on the intaglio surface characteristics of ultrathin ceramic veneers fabricated with either the platinum foil technique or the refractory die technique using scanning electron microscopy (SEM). Several replicas of an ultrathin feldspathic ceramic veneer for a maxillary central incisor were fabricated. Individual specimens were processed according to different intaglio surface etching protocols: no etching, etching for 90 seconds, etching for 120 seconds, and etching for 150 seconds, using 9.6% HF acid. It was observed that the 120 seconds etching protocol resulted in a favorable microroughness surface pattern in the platinum foil group. This pattern was comparable to that obtained by etching the intaglio of veneers fabricated with the refractory die technique by applying HF acid for 90 seconds. Increasing the etching time to 150 seconds did not result in a more favorable roughness pattern.

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

Severe alveolar ridge deficiencies in concomitance with periodontal attachment loss can represent a serious clinical challenge in the context of implant therapy. The present case report describes the management of a complex defect in the esthetic zone via ridge augmentation and periodontal regenerative therapy using a biologic material. A systemically healthy 55-year-old man diagnosed with peri-implantitis around an implant in the maxillary left central incisor position and with severe bone loss on the mesial aspect of the maxillary left lateral incisor underwent several surgical interventions to achieve simultaneous vertical ridge augmentation and periodontal regeneration. These interventions included implant removal, bone augmentation using a composite bone graft (autogenous bone + xenograft particles), and a bioactive protein (recombinant human platelet-derived growth factor), soft tissue augmentation using connective tissue grafts, and peri-implant keratinized mucosa width augmentation via a labial gingival graft strip and a xenogeneic collagen matrix. Substantial gains in vertical bone and clinical attachment were achieved, which allowed for delayed implant placement and subsequent completion of tooth replacement therapy with an implant-supported prosthesis. The present case report demonstrates how simultaneous vertical ridge augmentation and periodontal regeneration can be achieved to manage a challenging clinical situation. Key factors to consider in this type of scenario are proximal bone level, tooth mobility, surgical flap design and management, biomaterial selection, and proper treatment sequencing.

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed. Keywords: consensus, dental implants, maxillary sinus, nasal fossae Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

Purpose: To evaluate the incidence of ultrathin ceramic veneer fractures with different preparation protocols over a period of 36 months and the possible relationship with local- and patient-related factors. Materials and Methods: Adult patients who received ceramic veneers for improvement in smile esthetics were selected from a private practice pool. Restorations were grouped as conventional (prep) or ultrathin ceramic veneers following either a minimal preparation (min-prep) or no tooth preparation (no-prep) protocol. After veneer bonding, all patients were followed up at intervals of 6 months up to 36 months. A panel of clinical outcomes was recorded, and patient satisfaction was assessed at 36 months. Results: The study sample was formed by 49 patients who received a total of 194 veneers. Twelve veneers were prep, 125 were min-prep, and 57 were no-prep. Total fracture occurrence was 9.8% in 13 participants. No fractures were observed in prep veneers, while 16 out of 125 min-prep and 3 out of 57 no-prep veneers had fractures. Most fractures (13 out of 19) occurred early, within the first 12 months after bonding. Out of 194 veneers, only 1 had a catastrophic failure (0.5%), 3 had large (≥ 1 mm) chippings (1.5%), and 15 had minor (< 1 mm) chippings (7.7%). A generalized estimating equation model revealed that the odds of veneer fracture were significantly higher in men (odds ratio [OR] = 11.29), in patients who exhibited tooth wear at baseline (OR = 5.54), and in central (OR = 13.56) and lateral (OR = 10.43) incisors compared to canines and premolars. All participants indicated that they would not change to a different restorative protocol in order to have a thicker restoration and possibly less risk of fracture. Conclusion: Ultrathin ceramic veneers are a viable cosmetic dentistry treatment option that involve minimal or no tooth preparation. However, a tendency for increased early fractures was observed in the min-prep group.

Purpose: Simplified and predictable immediate single-tooth replacement therapy can be optimised by leveraging recent advances in digital workflows that combine static surgical guidance and customised prosthesis design and fabrication. The present case report illustrates a novel approach to successfully executing immediate single-tooth replacement therapy via static computer-aided immediate implant placement and digital provisionalisation utilising angulated screw access, with a 1-year follow-up after delivery of the definitive restoration. Materials and methods: A healthy 27-year-old woman with congenital agenesis of the mandibular second premolars and who required replacement of the mandibular left second premolar underwent immediate single-tooth replacement therapy via computer-aided, restrictive implant placement and provisionalisation using custom prosthetic components designed prior to the surgical intervention being performed. Results: After a 6-month healing period, the provisional crown was replaced with the definitive restoration. After 1 year, the peri-implant keratinised mucosa demonstrated vertical gain in the mid-buccal portion and stability in the interproximal aspects, and no changes in marginal bone level were observed. Conclusions: The present case report demonstrates the successful application of novel digital tools to facilitate both surgical and prosthetic aspects of immediate single-tooth replacement therapy. Digital workflows can optimise the clinical efficiency and predictability of tooth replacement therapy with dental implants by reducing surgical and restorative chair time and increasing patient satisfaction. Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study. Keywords: CAD/CAM, computer-aided surgery, dental implant, digital dentistry, guided implant surgery, immediate loading, immediate placement, prosthetic procedure, prosthodontics

This study evaluated a panel of clinical, dimensional, volumetric, implant-related, histomorphometric, and patient-reported outcome measures (PROMs) following reconstruction of dehiscence defects in extraction sockets with a minimally invasive technique using particulate bone allograft and a nonresorbable dense polytetrafluoroethylene (dPTFE) membrane. Subjects (n = 17) presenting severe buccal dehiscence defects at the time of single-rooted tooth extraction participated in the study. The mean vertical dimension of the dehiscence defects at baseline was 5.76 ± 4.23 mm. Subjects were followed up at 1, 2, 5, and 20 weeks postoperatively. The dPTFE barrier was gently removed at 5 weeks. CBCT and intraoral scans were obtained at baseline and at 20 weeks. A bone core biopsy sample was harvested at 24 weeks (before implant placement). Linear radiographic measurements revealed a mean increase in buccal bone height from baseline to 20 weeks (5.66 ± 5.1 mm; P < .0001). A total alveolar bone volume gain of 9.12% was observed. Although approximately half of the sites required some degree of additional bone augmentation at the time of implant placement, all implants were placed in a favorable restorative position with adequate primary stability. Histomorphometric analyses revealed a mean mineralized tissue area of 31.04% ± 15.22%, and the proportions of remaining allograft material and nonmineralized tissue were 16.23% ± 10.63% and 52.71% ± 9.53%, respectively. All implants survived up to 12 months after placement. PROMs were compatible with minimal discomfort at different postoperative stages and a high level of overall satisfaction upon study completion. This study demonstrated that the reconstructive procedure employed was successful and predictable in treating large, postextraction alveolar ridge deformities to optimize tooth replacement therapy with implant-supported prostheses.