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Purpose: To describe the emerging evidence concerning etiologic factors and pathophysiologic mechanisms involved in peri-implant inflammatory diseases. Materials and Methods: An electronic search for articles published until November 2022 was conducted in MEDLINE by three independent reviewers to identify the manuscripts’ reporting data on etiologic factors and pathophysiologic mechanisms associated with peri-implant diseases. Results: Current evidence suggests that peri-implant mucositis and peri-implantitis are inflammatory conditions linked to a microbial challenge. However, in recent years there has been increasing evidence indicating that certain peri-implant inflammatory conditions may not be primarily related to biofilm-mediated infectious processes but rather to other biologic mechanisms, such as a foreign body response. Conclusions: Current evidence in the dental and medical literature opens new avenues for a more complex interpretation of the etiopathogenetic factors involved in peri-implant diseases. A better understanding of various factors related to the host response, including dysbiosis mechanisms associated with changes in microbiota composition, is necessary for a more precise physiopathologic characterization of these diseases. Keywords: dental implant, foreign body response, microbial biofilm, peri-implant diseases, peri-implant infection

Maxillary sinus grafting is a predictable regenerative technique to facilitate maxillary posterior implant placement when there is insufficient vertical bone height inferior to the maxillary sinuses to allow placement of implants of adequate dimensions. It enables an increase in vertical bone height, which makes implant placement easier. Maxillary sinus mucosal membrane perforation is one of the most common intraoperative complications during maxillary sinus grafting and may result in extrusion of graft material into the sinus. When this occurs, the mucociliary function of the maxillary sinus may expel the extruded graft material through its natural ostium, though graft particles may remain in the sinus or possibly occlude the natural ostium. After grafting, transient maxillary sinus mucosal oedema may occur. A postoperative CBCT scan may reveal varying degrees of sinus opacification, namely partial, subtotal or total. Although it is always possible to identify graft material, which may enter the sinus as a result of membrane perforation that might not even be visible to the implantologist during the surgical procedure, it is challenging to assess whether sinus opacification is due to mucosal thickening or mucus accumulation. The aim of the present case series was to offer a pragmatic approach to managing asymptomatic patients whose CBCT scans demonstrated partial, subtotal or total maxillary sinus opacification with bone graft particles that seemed to have been extruded into the sinus. Keywords: maxillary antrum, maxillary sinus elevation, maxillary sinus grafting, osteomeatal complex, osteomeatal unit, sinus membrane perforation, sinus mucosa, sinus opacification, transient swelling The authors declare no conflicts of interest relating to this study.

Ziel: In der vorliegenden retrospektiven Studie sollten die klinischen Ergebnisse von festsitzendem, auf den Prinzipien der biologisch orientierten Präparationstechnik (BOPT) basierenden Zahnersatz über mittlere bis lange Beobachtungszeiträume ausgewertet werden. Material und Methoden: Die Behandlungsdokumentation von Patienten, die zwischen Januar 2007 und Dezember 2014 festsitzend rehabilitiert worden waren, wurden retrospektiv ausgewertet. Patienten, deren Akten die Einschlusskriterien erfüllten, wurden außerdem zu einer abschließenden Kontrolluntersuchung einbestellt. Ausgewertet wurden die parodontalen Parameter, das Vorliegen von Gingivarezessionen sowie die aufgetretenen technischen und biologischen Komplikationen. Ergebnisse: Insgesamt 58 Patienten wurden per Recall eingeladen. Von diesen konnten 52 Patienten mit 220 überkronten Zähnen ausgewertet werden (Ausfallrate: 13,8 %). Die durchschnittliche Beobachtungsdauer waren 9,3 Jahre (Spannweite 5 bis 13 Jahre): 14 Patienten (114 überkronte Zähne) waren 5 bis 8 Jahre, 36 Patienten (106 überkronte Zähne) 9 bis 13 Jahre nachbeobachtet worden. Die prothetische Überlebensrate betrug 99,6 %. An Komplikationen waren eine Wurzelfraktur (0,4 %) und vier Verblendkeramikabplatzungen (1,8 %) dokumentiert. Sechs Zähne (2,7 % der untersuchten Kronen) zeigten eine Gingivarezession von < 1 mm und 13 Zähne (24 Stellen) wiesen eine Sondierungstiefe von 4 mm auf (5,9 % der prothetischen Kronen/1,8 % der sondierten Stellen). Schließlich wurde an 20 Stellen (1,5 %) bzw. 7 Zähnen (3,2 %) Sondierungsbluten beobachtet. Schlussfolgerungen: Die Präparation nach den BOPT-Regeln (d. h. mit vertikaler, kantenfreier Präparation) führte mittel- bis langfristig zu einem gesunden Parodont und stabiler Gingiva. Das prothetische Behandlungsergebnis blieb dauerhaft erhalten. Keywords: biologisch orientierte Präparationstechnik, BOPT, parodontale Gesundheit, Gingivarezession, Weichgewebestabilität, retrospektive Studie

Aim: The present study was a retrospective medium- to long-term follow-up assessment of the clinical outcomes of patients rehabilitated with fixed prostheses according to the biologically oriented preparation technique (BOPT) principles. Materials and methods: Clinical records of patients rehabilitated between January 2007 and December 2014 were retrospectively assessed. Patients whose records met the inclusion criteria were also recalled for a hygiene visit. Data analyzed included the patients’ periodontal condition, the presence of gingival recessions as well as any technical or biologic prosthetic complication. Results: Fifty-eight patients were recalled; of these, 52 patients who had received 220 crowns were available for the evaluation (the dropout being 13.8%). The average follow-up was 9.3 years (range 5 to 13 years): 14 patients (114 prosthetic crowns) had a follow-up between 5 and 8 years, and 36 patients (106 prosthetic crowns) between 9 and 13 years. The prosthetic survival rate was 99.6%. One radicular fracture (0.4%) and four chippings of the veneering porcelain (1.8%) were recorded. Six teeth (2.7% of the examined prosthetic crowns) presented gingival recession of < 1 mm, and 13 teeth (24 sites) had a pocket probing depth of 4 mm (5.9% of the prosthetic crowns/1.8% of the sites). Finally, 20 sites (1.5%) in seven teeth (3.2%) showed bleeding on probing. Conclusions: Tooth preparation according to the BOPT principles (ie, with a vertical finishing line) resulted in medium- to long-term periodontal health and stability of the gingival tissue, and prosthetic success was maintained. Keywords: BOPT, periodontal health, gingival recession, soft tissue stability, retrospective study

Purpose: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. Materials and methods: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. Results: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. Conclusion: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable. Keywords: diagnostic procedure, implant dentistry, lateral window technique, pterygoid implants, sinus floor elevation, transcrestal sinus floor elevation, zygomatic implants The authors report no conflicts of interest relating to this study.

Implant-based rehabilitation is a clinical challenge, especially in the esthetic area. Numerous factors influence the outcome of the rehabilitation; however, the two main factors are the bone and soft-tissue deficiencies at the intended implant site. Peri-implant soft tissue complications can arise from a combination of factors that can be summarized as two categories: diagnostic errors and surgical planning management errors. Most of the complications can be corrected after each step of the treatment and even after the delivery of the prosthetic restoration with adequate soft tissue management in order to give the patient an esthetically pleasing outcome. The aims of this article were: to present the current literature, to propose a clinical checklist to guide clinicians in evaluating the prognosis of the treatment utilizing soft tissue grafting, and to illustrate a case series partially employing the proposed clinical checklist. The proposed checklist could be helpful in evaluating the prognosis of the treatment utilizing only soft tissue grafting. In clinical cases in which the prognosis is classified as good, soft tissue management could be a viable treatment option before attempting more radical procedures like implant removal. Keywords: connective tissue graft, coronal advanced flap, dental implant, mucosal recession, peri-implant soft tissue deficiency, peri-implant soft tissue recession, plastic peri-implant surgery, tunnel technique

Recently, the Low Window technique was proposed to facilitate sinus augmentation and reduce postsurgical patient discomfort. It was shown to be both safe and effective. This case series evaluates the postsurgical discomfort of patients undergoing Low Window sinus augmentation, the bone gain achieved, and whether these factors correlate with the osteotomy area. Records of patients (n = 26) who underwent a sinus elevation using the Low Window approach (n = 34 interventions), followed by implant placement and prosthetic rehabilitation (n = 97 implants), were assessed retrospectively. The analyzed outcomes were the medial, middle, and lateral bone gain ≥ 9 months after augmentation; pain at 5 to 6 hours postsurgery, evaluated on a visual analog scale (VAS; 0 to 100); pain, swelling, and hematoma formation every day up to 7 days postsurgery, evaluated by VAS; implant and prosthetic success and survival rates; and rate of complications. The average follow-up time was 62.1 ± 14.9 months. No intraoperative sinus membrane perforations or other complications occurred. Medial, middle, and lateral bone gains were 10.1 ± 1.7 mm, 11.6 ± 0.8 mm, and 10.7 ± 0.9 mm, respectively. At the last follow-up, the implant success rate was 99%. Postsurgical VAS pain 5 to 6 hours postsurgery was 12.3 ± 8.0 and decreased significantly thereafter. Swelling prevalence was 29.4% at 1 day postsurgery, 20.6% at 2 days, and 2.9% the following day. No swelling was observed from day 4 onward. Prevalence of hematoma was 8.8% for 2 days postsurgery, 2.9% the day after, and no hematoma was observed thereafter. Only the osteotomy area correlated with immediate postsurgical pain, but not with other discomfort outcomes or with bone gain. Low Window sinus elevation might allow bone gain and medium-term implant and prosthetic success rates similar to that of other access window designs. Prospective, comparative studies are needed to investigate whether the technique is more advantageous than traditional approaches.

Common challenges encountered for atrophic maxilla rehabilitation are the inadequate width and height of attached keratinized mucosa (AKM) and shallow vestibular depth. This study presents a buccally displaced palatal (BDP) flap technique to increase the tissue thickness and AKM width at the second-stage surgery and reestablish the correct fornix depth. The peri-implant pocket depths, modified Plaque Index score, modified sulcus Bleeding Index score, and soft tissue recession were evaluated 6 and 12 months after prostheses loading. A total of 52 implants were placed and analyzed, and no implant failures were found. No significant changes in peri-implant parameters were observed between 6 and 12 months, and mean recession was less than 0.2 mm after 12 months. Though this change was statistically significant, it was clinically irrelevant. The results demonstrate that adequately healthy peri-implant soft tissues and substantial dimensional stability of vestibular soft tissues at the 1-year follow-up were achieved with the BDP flap technique. The BDP flap could represent a viable option for increasing the width and the height of AKM and establishing the correct maxillary fornix depth.

Maxillary sinus wall fenestration at the lateral wall or floor of the sinus can result from many potential factors, such as the repair of oro-antral communication, Caldwell-Luc antrostomy, tooth extraction after an endodontic or periodontal infection that eroded the sinus wall, and the combination of sinus pneumatization and alveolar ridge resorption after teeth removal. When sinus wall fenestration is observed on radiographs, it usually indicates adhesion between the sinus membrane and buccal flap, which makes the reentry surgery for subsequent sinus augmentation challenging. To minimize surgical complications in these challenging scenarios, this paper presents a split-flap surgical technique for the management of soft tissue adhesion between the sinus membrane and alveolar mucosa when attempting a lateral window sinus augmentation.

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.