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Several treatment-oriented classifications for the management of peri-implant marginal mucosal defects (PMMDs) have been published to date. While each classification provides valuable insights into key diagnostic and therapeutic aspects, there is a marked heterogeneity regarding the recommended clinical guidelines to achieve success in specific scenarios. The purpose of this review was to critically analyze and organize the similarities and differences enclosed in the available classifications linked with treatment recommendations on the management of PMMDs at single implant non-molar sites with the purpose of providing an overview of recommended interdisciplinary treatment options to facilitate clinical decision-making processes.

The study aimed to investigate the accuracy of diagnosing thin and thick gingival phenotypes (GP) by the transparency of the periodontal probe (TRAN) through the gingival sulcus. Eligible studies comparing TRAN to direct methods for gingival thickness (GT) measurement (reference tests) were searched in 4 databases (including MEDLINE and EMBASE), up to 2024. Quality assessment was carried out using QUADAS-2. Latent class meta-analysis for imperfect gold standard model was conducted considering the multiple thresholds (TSs) and landmarks adopted by the reference tests. The 10 studies included presented a low risk of bias and low applicability concerns. The summary sensitivity (SSe) ranged from 49% (95% CI:25.8-68%) with the TS 0.8mm, to approximately 53% (TSs 1 and 1.2mm); the summary specificity (SSp) ranged from 60% (95%CI: 42.4-82.6%) with the TS 1mm, to 68% (95% CI: 46.4-82.5%) with the TS 0.8mm. The highest SSe (67%) and SSp (76%) were found in the analysis grouping the same TS (0.8mm) and landmark (1mm from gingival margin). The assessment of GP using the TRAN could lead to inadequate diagnoses, especially in thin phenotype determination. Its accuracy is highly dependent on the TSs used to differentiate between thin and thick GPs and the apicocoronal landmark where the GT was obtained. Keywords: phenotype, gingiva, meta-analysis

This case report presents a papillary reconstructive surgical procedure based on the use of a double subepithelial connective tissue pedicle graft (SCTPG) in conjunction with a coronally advanced tunnel flap (CATF), for root coverage of gingival recession defects (GRD) with interproximal tissue loss and adjacent collapsed papillae. Two GRD (teeth #13 and #12) with interproximal tissue loss and collapsed papillae were treated by means of a bilaminar approach, based on the use of a palatal double SCTPG, rotated and inserted into a palatal-buccal tunnel flap at the level of mesial and distal papillae of maxillary right lateral incisor, associated to a CATF. Seven months after surgery, complete root coverage was achieved in both GRD. Concerning the reconstruction of tooth’s #12 papillae, the distance from the contact point to the tip of distal and mesial papillae decreased from 5 mm to 2 mm and from 4 mm to 2 mm, respectively. Overall, the patient was highly satisfied with the yielded outcomes. Within the limits of this case report, it could be demonstrated that the double SCTPG + CATF promoted prominent clinical and esthetical improvements to the baseline conditions of both GRD and collapsed papillae. Keywords: gingival recession, gingival surgery, connective tissue, papilla, esthetics, gingival reconstruction

This study aimed at characterizing the gingival thickness (GT) and determining correlations with other local phenotypical features. Cone-beam computed tomography scans from adult subjects involving the maxillary anterior teeth were obtained to assess buccal GT at different apico-coronal levels, periodontal supracrestal tissue height (STH), the distance from the cementoenamel junction to the alveolar bone crest (CEJ-BC), and bucco-lingual tooth dimensions in mm. A total of 100 subjects and 600 maxillary anterior teeth constituted the study sample. Variations in mean values of GT were observed as a function of apico-coronal level, tooth type, and gender. GT progressively increased apically. Maxillary central incisors and males generally exhibited thicker GT. Contrarily, females exhibited thinner GT and shorter STH. Tooth dimensions were negatively correlated with GT, as the narrower the tooth crown/root in the bucco-lingual dimension, the thicker the gingiva. GT at the level of the CEJ was dichotomized to differentiate between thin (<1mm) and thick (≥1mm) gingival phenotypes (GP). Teeth with a thin GP displayed greater CEJ-BC and buccolingual tooth width dimensions. Conversely, teeth with a thick GP generally exhibited taller STH and narrower tooth dimensions.

This PRISMA-compliant systematic review aimed to investigate the effect of supportive peri- implant care (SPIC) on peri-implant tissue health and disease recurrence following the non surgical and surgical treatment of peri-implant diseases. The protocol of this review was registered in PROSPERO (CRD42023468656). A literature search was conducted to identify investigations that fulfilled a set of pre-defined eligibility criteria based on the PICO question: what is the effect of SPIC upon peri-implant tissue stability following non-surgical and surgical interventions for the treatment of peri-implant diseases in adult human subjects? Data on SPIC (protocol, frequency, and compliance), clinical and radiographic outcomes, and other variables of interest were extracted and subsequently categorized and analyzed. A total of 8 studies, with 288 patients and 512 implants previously diagnosed with peri-implantitis were included. No studies including peri-implant mucositis fit the eligibility criteria. Clinical and radiographic outcomes were similar independently of specific SPIC features. Nevertheless, a 3-month recall interval was generally associated with a slightly lower percentage of disease recurrence. The absence of disease recurrence at the final follow-up period (mean of 58.7±25.7 months) ranged between 23.3% and 90.3%. However, when the most favorable definition of disease recurrence reported in the selected studies was used, mean disease recurrence was 28.5% at baseline, considered 1 year after treatment for this investigation, and increased to 47.2% after 2 years of follow-up. In conclusion, regardless of the SPIC interval and protocol, disease recurrence tends to increase over time after the treatment of peri-implantitis, occasionally requiring additional interventions. Keywords: dental implants; peri-implantitis; peri-implant mucositis; disease progression; risk factors

This study aimed to determine the correlation between gingival stippling (GS) and other phenotypic characteristics. Adult subjects in need of CBCT scans and comprehensive dental treatment in the anterior maxilla 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 were conducted to assess different correlations among recorded variables. A total of 100 participants and 600 maxillary anterior teeth constituted the study population and sample, respectively. Facial GS was observed in 56% of men and 44% of women, and it was more frequently associated with flat GA, triangular and square/tapered teeth, central incisors, and men. Greater mean GT, BT, and KTW values were observed in facial areas that exhibited GS. Interdental GS was present in 73% of the sites, and it was more frequently observed in men, in 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 3 mm apical to the bone crest, and tooth type. This information can be used to recognize common periodontal phenotypical patterns associated with specific features of great clinical significance. Keywords: dentition, gingiva, oral mucosa, periodontium, permanent, phenotype

Clinicians, researchers, and policymakers often rely on the available scientific evidence to make strategic decisions. Systematic reviews (SRs) occupy an influential position in the hierarchy of scientific evidence. The findings of wellconducted SRs may provide valuable information to answer specific research questions^1,2 and identify existing gaps for future research.³ Therefore, it is of supreme importance that SRs are published promptly, reducing as much as possible the time elapsed between the last date of the search for primary studies and the actual publication date. A study published in 2014 assessed the publication delay of SRs in orthodontics, revealing that the median time interval from the last search to publication was more than 1 year (13.2 months).⁴ Delays in the publication of SRs or original research articles may depend on author-related factors (eg, timing of resubmission after receiving feedback from reviewers) or journal-related factors (eg, time taken to process a submission).^5–7 Regardless of the reasons, clinical recommendations and translation of SR findings may be affected by publication delay. We assessed the extent of publication delay of systematic reviews in dentistry with the purpose of addressing its implications and presenting potential solutions.

Objective: To evaluate the effectiveness of the use of adjuvant ozone therapy in the healing process of wounds resulting from periodontal and peri-implant surgical procedures by answering the following focused question: “Can adjuvant ozone therapy improve wound healing outcomes related to periodontal and peri-implant surgical procedures?”. Method and materials: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, without language restriction, for peer-reviewed articles published until 23 March 2022, in addition to manual search. Only controlled clinical trials (randomized or not) were considered. The risk of bias was evaluated by the Cochrane risk-of-bias tool for RCTs – version 1 (RoB1). Data were pooled into evidence tables and a descriptive summary was presented. Results: Of the 107 potentially eligible records, only seven studies were included. Four addressed free/deepithelialized gingival grafts with a palatal donor area, two evaluated implant sites, and one comprised gingivectomy and gingivoplasty. A total of 225 patients were evaluated in the included studies, considering control and test groups (ozone and other adjuvant therapies for comparison). Ozone therapy had a positive effect on outcomes directly or indirectly related to periodontal/peri-implant surgical wound healing. Furthermore, it could also increase the stability of immediately loaded single implants installed in the posterior mandible. Conclusion: In general, ozone therapy seems to both accelerate the healing processes of periodontal/peri-implant wounds and increase the secondary stability of dental implants; however, considering the limited evidence available and the risk of bias in the included studies (none classified as low risk), a definitive conclusion cannot be drawn. (Quintessence Int 2023;54: 100–110; doi: 10.3290/j.qi.b3512007) Keywords: dental implants, ozone, ozone therapy, periodontal surgery, wound healing/surgery

Purpose: To evaluate the effectiveness of extra-short implants compared to standard-length implants in graft regions at different longitudinal follow-up times. Materials and Methods: A systematic review was performed, following PRISMA criteria. LILACS, MEDLINE/PubMed, Cochrane Library, and Embase databases, including gray literature and manual searches, were conducted without language or date restrictions. Study selection, risk of bias (Rob 2.0), quality of evidence (GRADE), and data collection were performed by two independent reviewers. Disagreements were resolved by a third reviewer. Data were combined using the random-effects model. Results: A total of 1,383 publications were identified, including 11 publications from 4 randomized clinical trials that evaluated 567 implants (276 extra-short and 291 regular implants with graft) in 186 patients. The meta-analysis showed that losses (risk ratio [RR]: 1.24; 95% CI: 0.53 to 2.89; P = .62; I2: 0%) and prosthetic complications (RR: 0.89; 95% CI: 0.31 to 2.59; P = .83; I2: 0%) were similar in both groups. Biologic complications were significantly higher in regular implants with graft (RR: 0.48; CI: 0.29 to 0.77; P = .003; I2: 18%), which also had lower peri-implant bone stability in the mandible at the 12-month follow-up (mean deviation [MD]: –0.25; CI: –0.36 to 0.15; P < .00001; I2 = 0%). Conclusion: Extra-short implants showed similar effictiveness compared to standard-length implants placed in grafted regions at different longitudinal follow-up times and present reduced biologic complications, shorter treatment times, and greater peri-implant bone crest stability. Int J Oral Maxillofac Implants 2023;38:29–36. doi: 10.11607/jomi.9990 Keywords: biomechanical phenomena, bone grafting, dental implants, implant-supported dental prosthesis, metaanalysis, systematic review

Making treatment decisions in dental implantology has evolved over the last five decades. These decisions and the clinical management of sites thereafter are selected based on recent changes, including the achievement of osseointegration, reestablishment of biologic width bone remodeling, the peri-implant soft tissue phenotype, the way peri-implantitis is defined, and advancements in digital technology. This article discusses these key aspects and their effects and influence on implant therapy.