International Journal of Periodontics & Restorative Dentistry, 02/2025

A mixture of polynucleotides and hyaluronic acid (PN-HA) has shown several modulating effects in the healing process. This study aimed to assess the safety and clinical performance of PN-HA alone or in association with deproteinized bovine bone mineral (DBBM) with papillary preservation flap (PPFs) in the treatment of residual pockets. A total of 43 patients with 55 infrabony 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 infrabony defect depth at the surgical measurement was 5.2 ± 2.1 mm. DBBM was applied at 56% of the defects, as they were determined to be noncontained defects based on clinical judgment. Healing was uneventful at all sites. After 1 year, PD reduction was 4.4 ± 1.8 mm, with a Rec increase of 1.0 ± 0.8 mm. The radiographic bone fill was 3.5 ±1.9 mm. The multilevel analysis showed that an absence of smoking habits was associated with improved PD reduction (P = .026) and bone gain (P = .039). PN-HA mixture is a safe product for periodontal surgery and seems to promote clinical benefits in the treatment of residual pockets associated with infrabony defects. Parole chiave: case series, hyaluronic acid, intrabony defect, periodontal regeneration, periodontitis, polynucleotides

Regenerative periodontal surgery is an effective procedure for the treatment of intrabony defects. Various flap designs that preserve defect-associated interdental papillae have been proposed to improve early wound stability. This case report describes the long-term results of a regenerative treatment in a severely compromised mandibular canine using the entire papilla preservation technique. Surgical access was provided by a single buccal vertical incision without any papilla incision. A combination of autogenous bone harvested from the same surgical site and recombinant human fibroblast growth factor-2 was applied to a noncontained intrabony defect following the removal of granulation tissue. The surgical site was closed with single interrupted sutures. The clinical outcomes after 5 years showed stable pocket closure without any increase in gingival recession, highlighting the potential of the entire papilla preservation technique with the use of combined biomaterials. Parole chiave: guided tissue regeneration, papilla preservation technique, periodontitis, recombinant human fibroblast growth factor-2, surgical flaps, wound healing

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 biomaterial leakage, 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 two- to three-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 (< 3 mm) with no bleeding on probing. Further research is warranted to verify the efficacy of this technique. Parole chiave: alveolar bone grafting, enamel matrix derivatives, furcation defects, periodontitis, regeneration

Surface decontamination in the reconstructive therapy of peri-implantitis is of paramount importance to achieve favorable outcomes. The objective of this single-center study, derived from a large multicenter clinical trial, was to analyze the electrolytic method (EM) as an adjunct to mechanical decontamination and compare it to hydrogen peroxide (HP), also used as an adjunct to mechanical decontamination, in the reconstructive therapy of peri-implantitis. At the 12-month follow-up (T2), 19 patients (n = 23 implants) completed the study. None of the tested modalities demonstrated superiority in the assessed clinical parameters. Only mucosal recession showed higher stability in the EM group. Similarly, radiographic marginal bone level gain and defect angle changes at T2 did not differ between the evaluated strategies. Notably, disease resolution was ~16% higher for the EM group; however, differences were not statistically significant. Additionally, it was demonstrated that pocket depth and the intrabony component depth at baseline were predictors of disease resolution. EM combined with mechanical instrumentation results in a safe and effective surface decontamination modality in the reconstructive therapy of peri-implantitis. This strategy resulted in a disease resolution rate of ~91%. Parole chiave: biologic complication, decontamination, dental implants, implant complication, peri-implantitis

This study clinically evaluated the efficacy of two different home tooth-whitening protocols to determine which one is more effective by applying the whitening gel every 48 hours or every 72 hours for 6 weeks. The differences in tooth sensitivity were also analyzed. A sample of 72 patients were randomly divided into four groups: In group A (n = 24), 16% carbamide peroxide (Pola Night, SDI Limited) was applied every 48 hours for 6 weeks; in group B (n = 24), 16% carbamide peroxide was applied every 72 hours for 6 weeks; in group C (control; n = 12), a placebo gel without peroxide (glycerin gel) was applied every 48 hours for 6 weeks; and in group D (control; n = 12), a placebo gel without peroxide (glycerin gel) was applied every 72 hours for 6 weeks. To compare the groups, color measurements were made using a spectrophotometer. For statistical analysis, ANOVA with Bonferroni test was used. The confidence interval (CI) was set at 95% (P ≤ .05). No statistically significant differences were found between applying 16% carbamide peroxide every 48 hours and every 72 hours for 6 weeks (P > .05). The study concluded that 16% carbamide peroxide was equally effective when applied using both protocols. Parole chiave: carbamide peroxide, dental bleaching, esthetic dentistry, tooth whitening

The present case series aims to investigate the use of polynucleotides mixed with hyaluronic acid (PN-HA) in a gel form to promote bone regeneration in horizontal alveolar defects. Overall, six adult patients underwent localized horizontal guided bone regeneration by means of xenogeneic bone substitute and a resorbable barrier with a staged approach. The graft was a mixture of deproteinized bovine bone mineral (DBBM) particles and PN-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 reentry, the graft appeared well vascularized and firmly attached to the recipient bone. Histologically, the regenerated bone appeared highly mineralized and well-organized in lamellae, and the residual biomaterial granules were completely embedded. Histomorphometric evaluations revealed that newly formed boneoccupied an average of 41.2% ± 12.4% of the analyzed 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 PN-HA can be safely used to promote bone regeneration in cases of horizontal alveolar defects. Parole chiave: alveolar defect, bone regeneration, hyaluronic acid, polynucleotides

A prospective clinical pilot study was carried out to evaluate a novel macroimplant design with a 12-degree angled platform. Twelve patients were enrolled in an immediate implant placement procedure with immediate esthetic rehabilitation to replace an anterior maxillary tooth and were treated with implants having an inverted body-shift design with a 12-degree angled neck. Only type I sockets (according to the Elian classification) were considered eligible for the study. The implant was placed at the center of the socket to optimize the alveolar bone and idealize the prosthetic emergence profile. There were no implant failures after 1 year of loading. Regarding the horizontal and vertical hard tissue changes, there was a statistically significant median overall horizontal change of –0.99 mm at 1 mm and –0.61 mm at 3 mm. On the other hand, outcomes were stable at 5 mm, and there was no statistical significance. The median pink esthetic score at the 1-year follow-up was 11.5. This implant may be useful in immediate tooth replacement at maxillary anterior postextraction sockets. Nevertheless, comparative studies with conventional implants should be performed. Parole chiave: Co-Axis implant, implant angulation, inverted body-shift design, marginal bone loss, success rate

Oral rehabilitation of the atrophic maxilla using prostheses anchored by zygomatic implants (ZIs) is a well-documented process. To prevent the risk of sinusitis and/or oroantral communication, the placement of ZIs with an externalized path has been proposed. In cases where sealing the implant neck depends exclusively on a hemidesmosome junction, there is a risk of dehiscence in the soft tissue that can lead to esthetic problems, bone resorption, oroantral communication, cellulitis, and even orbital infection. To avoid soft tissue recession in implants placed buccal to the remaining ridge, the simplest procedure is to ensure good buccal coverage of the implant via keratinized tissue. Use of a double pedicle palatal flap is proposed to increase the keratinized tissue buccal to the implant while facilitating the incision closure by primary intention.

Maxillary sinus floor augmentation (SFA) is a procedure known for its long-term success and predictable outcomes. However, sinus membrane perforation remains the most common complication associated with this procedure. This systematic review aims to determine the presence of complications during maxillary SFA procedures using CAD/CAM surgical templates. 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 performed lateral SFA were included, and the CAD/CAM surgical template design and the intraoperative complications were registered. A total of 13 studies (7 case reports, 4 case series, and 2 randomized clinical trials) and a total of 94 lateral SFA procedures (84 using CAD/CAM templates and 10 without templates) were included. Three of the 84 maxillary SFA procedures using a CAD/CAM template presented intraoperative complications. Maxillary SFA performed using CAD/CAM surgical templates could be related to low rates of complications. However, due to the heterogeneity of the included articles, more standardized studies are needed to confirm these outcomes. Parole chiave: CAD/CAM surgical templates, complications, guided surgery, maxillary sinus floor augmentation

Bonded fixed retainers are frequently used nowadays as the main—and often the only—retention protocol after orthodontic treatment. The expectations for long-lasting lifetime stability of the occlusion led orthodontists to seek the ultimate retention protocol with minimal patient compliance, including fixed retainers. However, fixed retainers have many disadvantages and risks that should be considered in advance. Different failures of fixed retainers are described and categorized, and the workflow for the retreatment of poor occlusion after relapse, despite the fixed retainers, is described. Three case presentations (open bite, root movement, and maxillomandibular protrusion) are described, and all received clear aligner treatment. A revised retention protocol is suggested. Parole chiave: clear aligners, fixed retainers, retention, stability