International Journal of Periodontics & Restorative Dentistry, Pre-Print

Impairment or loss of interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and aesthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This article presents a novel surgical approach that applies the principles of the Connective Tissue Graft (CTG) wall technique to enhance papilla volume when interdental clinical attachment loss is present in the aesthetic zone. The case of a 35-year-old woman with an RT3 recession defect associated with loss of interdental hard and soft tissues is discussed. The patient underwent a procedure involving palatal incisions, application of amelogenins, and a trapezoidal shape CTG fixed at the base of the papilla under a coronally advanced flap. This approach aimed to stabilize the blood clot and prevent soft tissue collapse into the defect area, enhancing the position and volume of the interdental papilla. Results at 6- and 12-months follow-up indicated significant improvement in papilla appearance and complete root coverage. This case suggests that the modified CTG wall technique can effectively treat buccal and interdental gingival recessions associated with horizontal or infrabony defects. Further clinical trials are necessary to confirm these findings and establish the most effective approach for interdental papilla reconstruction. Keywords: interdental papilla, connetive tissue graft, periodontal therapy, amelogenins, connective tissue graft-wall technique, papilla reconstruction

Background: The necessity of a minimum volume of keratinized tissue around implants to maintain tissue stability remains a matter of debate. The aim of this case series is to showcase the outcome and long-term maintenance of dental implants that received soft tissue augmentation. Case Presentation: Three cases of second stage following dental implant placement were evaluated for amount of keratinized tissue. Based on the Ono-Nevins classification described here, treatment was rendered including keratinized tissue grafting. The cases were followed for 10, 18 and 28 years. Each case demonstrated maintenance of soft and hard tissue profile around the dental implants with no incidence of peri-implantitis as evidenced on clinical examination and use of peri-apical radiographs. Conclusion: Soft tissue management around dental implants may play a key role in long-term maintenance of peri-implant health and prevention of peri-implantitis. Keywords: periodontal disease, dental implant, peri-implantitis, soft tissue graft, case series

The purpose of this technical report is to describe a modified tunnel surgical approach and connective tissue graft (CTG) stabilization technique for the treatment of gingival recessions with interproximal clinical attachment loss (ICAL). The partial-full-thickness (PFT) tunnel technique utilizes multiple vestibular incisions to facilitate creation of a split-mucoperiosteal tunnel that enhances tissue passivity and allows for coronal advancement of soft tissue with minimal tension. The supra-crestal sling (SCS) suture engages only the CTG, independent of the overlying tissue and stabilizes the CTG around the buccal and proximal root surfaces. The treatment approach of PFT tunnel preparation and CTG stabilization with the SCS suture was designed to optimize blood supply and maximize wound stability, resulting in complete root coverage with satisfactory clinical outcomes in RT2 and RT3 gingival recession. It is suggested that the PFT tunnel preparation with graft stabilization via the SCS suture has the potential to treat recessions with anatomical limitations associated with ICAL. Keywords: Connective Tissue Graft, Periodontal Surgery, Root Coverage, Papilla

Aim: to assess clinical and radiographical outcomes of single tooth posterior implants with a dehiscence defect treated with or without guided bone regeneration (GBR). Methods: In a randomized clinical trial of 59 patients, single-tooth posterior implants were placed. For the subanalysis of 16 patients with a buccal dehiscence defect (≤ 5mm), the implants were randomly assigned to GBR or spontaneous healing (SH). In 8 patients, the implants were surrounded by native bone (Native bone). A transmucosal healing approach was chosen for all sites. Patients were examined at restoration delivery (RD) and at one year (1y). Measurements included: soft tissue thickness (STT), bone tissue thickness (BTT) and buccal contour, based on cone-beam computed tomography (CBCT), optical scans, clinical parameters. All data were analyzed descriptively. Results: The mean STT at implant shoulder (IS) showed a gain of 0.15 mm (Q1: - 0.16, Q3: 0.49) for the GBR group and 0.03 mm (Q1: -0.49, Q3: 0.13) for the SH group. The mean BBT 1 mm below IS showed a loss of 0.25 mm (Q1: -0.85, Q3: -0.09) for the GBR group and 0.04 mm (Q1: -0.14, Q3: 0.17) for the SH group. All peri-implant soft tissue parameters indicated healthy peri-implant tissues with no clinically relevant differences between the groups. Patient-reported outcomes regarding pain one day after surgery were similar among the study groups. Conclusions: The present sub-analysis resulted in a similar buccal contour and similar radiographic outcomes as well as peri-implant health for sites treated with or without GBR. Keywords: Dental implant, guided bone regeneration, buccal bone dehiscence, spontaneous healing

This prospective, preliminary controlled clinical trial investigates the comparative effectiveness of platform-switching (PS) versus traditional butt-joint or platform-matching (PM) implant-abutment connections on peri-implant crestal bone stability. Utilizing a split mouth design, 10 systemically healthy patients (n= 20 implants) had adjacent non-restorable maxillary anterior teeth replaced with two different implants (butt-joint connections and platform-switching interfaces). Patients underwent alveolar ridge preservation, followed by implant placement: platform-matching implants were inserted at crestal bone level, and platform-switching implants were placed 1mm subcrestally. Customized Zirconia crowns were then fabricated for both systems. Outcome measures included bleeding on probing (BOP), probing pocket depth (PPD), and marginal bone loss (MBL), which were evaluated through standardized periapical radiographs over 3-year timeframe. Results showed significantly higher initial MBL in the PM group (0.86 ± 0.13 mm) compared to the PS group (0.34±0.29 mm) [p value: p<0.01]. Moreover, at the three-year follow-up, the crestal bone levels remained above the implant shoulder until the third year of the study for the PS subcrestal group (PS: -0.15±0.39 mm) and slightly below the implant platform in the PM crestal group (PM: 0.55±0.19). After 3 years, the PS group also exhibited lower mean BOP percentages (12%) than the butt-joint group (17%). This study suggests that subcrestal placement with PS and internal connections can provide better long-term peri- implant bone preservation, thereby potentially improving implant success and aesthetic outcomes in the anterior maxillary region. Keywords: dental implant, abutment, dental implant-abutment connection, platform-switching, platform-matching, implant-supported dental prostheses, marginal bone levels

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 prospectively evaluated the effect of keratinized mucosa (KM) on the healing of the peri- implant tissues after resective surgical therapy for peri-implantitis. It addressed the question of whether the absence of KM has a negative effect on peri-implant tissue stability after treatment. Patients referred to a private practice for peri-implantitis treatment were surgically treated with resective flap surgery and implantoplasty. They were followed for 3 years and measurements at implant level included presence of plaque, bleeding on probing, probing pocket depth, radiographically visible bone loss and the presence and width of KM before therapy, 3 month post-operatively, 1 year, 2 years, and 3 years after the surgical intervention. All clinical parameters improved and marginal bone levels remained stable 3 years after therapy. The width of the KM decreased significantly after the therapy. Soft tissue recession was frequently observed. The absence of KM does not seem to have a negative effect on healing after therapy for the studied period of 3 years. The authors conclude that resective surgery combined with implantoplasty seems to be a reliable method for arresting the progression of peri-implantitis. Keywords: implantoplasty, keratinized mucosa, non-keratinized mucosa, osteoplasty, peri-implantitis, surgical therapy

Esthetic issues and phonetic disturbances frequently occur after periodontal regeneration of the anterior teeth, even if treatment is supposed to be successful. Conventional regenerative techniques are predominantly targeted at infrabony defects and often inadequately address the loss of the interdental papilla. This study introduces the papillary coronal anchorage technique, a novel modified tunnel surgical procedure, to facilitate the reconstruction of the interdental papilla. This method allows for coronal movement of the entire interdental papilla without incisions at the papilla to facilitate primary wound healing. Using a combination of bone grafts and recombinant human fibroblast growth factor 2 and anchoring the tunnel-like flap coronally using sutures, we successfully achieved a reconstruction of the infrabony defects as well as the interdental papilla. The papillary coronal anchorage technique is effective as it enables the simultaneous reconstruction of both the infrabony defect and the interdental papilla.

This paper introduces the Continuous Crossing Mattress Periosteal Suture Technique (CMPST), designed to enhance flap adaptation, and maintain the established apical displacement of the flap during various periodontal resective surgeries, particularly restorative-driven (or functional) crown lengthening in multiple teeth at anterior or posteriors areas. This suture technique securely positions the flap apically, just coronal to the bone, anchored at the periosteum, combining the advantages of both continuous and cross-compression sutures without compromising the esthetic results. By eliminating flap mobility, it ensures stable and intimate contact with underlying tissues. Further controlled studies are needed to assess the clinical applicability of this technique compared to other suture techniques. Keywords: Suture techniques, crown lengthening, esthetics, prosthodontics

The multiple coronally advanced flap (MCAF) and the modified coronally advanced tunnel technique (MCAT) are the most commonly used methods for treating multiple gingival recessions. However, treating multiple defects is very complex due to various biological and anatomical factors, and there is no clear guideline on the major or minor determinants that influence surgical decisions. The aim of the present commentary is to discuss a decision tree to suggest to clinicians the most relevant anatomical factors to take in to consideration when evaluating the choice between a MCAT and an MCAF. In the proposed decision-making process, the first crucial step involves the evaluation of the interdental clinical attachment loss (CAL), according to the new EFP/AAP classification. The next step is to assess the dimensions of the lateral keratinized tissue (LKT), that is the keratinized tissue located laterally to the recession defect. When LKT amount is insufficient, the size of the interdental papillae, including base, height, and coronal width, must also be evaluated. Keywords: mucogingival surgery, gingival recession, decision tree, connective tissue graft

Introduction: The innervation of the hard and soft tissues of the maxillary anterior area depends on the nasopalatine nerve. Due to its anatomy and closeness to implants in the esthetic area, it is essential to fully comprehend its traits and possible effects while performing implant placement procedures. Objective: To assess the prevalence of neurosensorial alteration and the survival and success rate of dental implants in a relationship with the nasopalatine canal. Material and methods: A comprehensive search of the literature was conducted in the following databases: MEDLINE, Web of Science, and Scopus. The articles included had to be case series, studies conducted in patients undergoing dental implant procedures in the incisive canal region or undergone dental implant procedures with incisive canal deflation or neurovascular lateralization. A quantitative synthesis using a meta-analysis software program was performed. Fixed- or random-effect models were applied based on the heterogeneity among studies. Results: Four studies were included. Neurosensorial alterations were presented in three out of four articles included. The range of neurosensorial alterations varied from 30% to 60%. A weighted mean of 29 % ± 13 % of neurosensorial alterations was calculated from the meta-analysis meanwhile a mean of 100 % of implant survival and 100% of implant success were found. In the results, please clarify that "29%±13%" represents the weighted mean calculated from the metaanalysis. Conclusions: Implants in the nasopalatine area are associated with high rates of survival and success being a safe procedure, however, clinicians should be aware that neurosensorial alterations may be present when placing implants in this area.

A recent update in periodontal terminology includes a shift from the term “biotype”, replacing it with the term “phenotype”. Periodontal phenotype evaluation and diagnosis is possible when findings from both the clinical examination to establish the gingival phenotype are combined with assessment of the bone morphotype, commonly using Cone Bean Computed Tomography (CBCT) imaging technology. Such analysis is critical to treatment planning, particularly for interdisciplinary dentofacial therapy patients (IDT) whose treatment can often involve clinical interventions such as surgery, orthodontic tooth movement, and/or extensive restorative treatment. This paper highlights how this shift in terminology can also be considered an evolution of thought process, as phenotype offers a more comprehensive way to guide our planning at the foundational level, and offers an updated approach for diagnosing and treatment planning IDT patients. Being able to identify a patient with a seemingly intact periodontal phenotype that will become susceptible or deficient with planned intervention is critical. Until now, there has been no established protocol recommended for risk assessment regarding iatrogenic sequelae on the periodontium involving tooth movement. A systematic approach, Phenotype Driven Treatment Planning (PDTP), is introduced here, and an updated outcome of treatment termed optimized periodontal phenotype is suggested. Keywords: Periodontal phenotype; surgical orthodontics; gingival recession; accelerated orthodontics; bone augmentation

This case report shows how to reduce the overall treatment time of a three-dimensional ridge defect that required dental implants and soft tissue management to only 6 months. It highlights the utilization of pure autogenous bone including the sinus lift to shorten the re-entry time to just three months, and the subsequent soft tissue grafting during implant placement to avoid a third surgery. The patient presented with a horizontal and vertical hard tissue defect along with sinus pneumatization. After the bone augmentation, the soft tissue thickness was inadequate for implant placement, and the mucogingival line distorted due to flap advancement. Understanding the available hard tissue grafting techniques and biomaterials is essential for a correct treatment planning. Incorporating soft tissue management protocols into implant placement surgeries will reduce the number of surgeries and overall treatment time. Keywords: Case report, bone grafting, soft tissue grafting, sinus lift.

The primary goal of this pilot study was to evaluate, via 3D analysis, the scan body precision of an intraoral digital scan utilizing a custom multifunctional scan body compared to that of digitized stone models fabricated from a conventional open tray impression in the fully edentulous maxilla and mandible. The secondary goal of this study was to showcase a method for utilizing the scan body library to generate a fixed fiducial marker for the cross-mount of an edentulous arch. Comparative analysis was performed as a case-control study. A custom scan body was utilized to generate the positions of the titanium bases from the intraoral models and digitized stone models of three maxillary arches (All-On-6, All-On-5, and All-On-4) and two mandibular arches (both All-On-4). The titanium base positions were compared using advanced 3D inspection software. The mean ± SD deviation was 30.38 ± 17.78 μm (95% CI: [14.8 to 45.97 μm]), with mean deviations of 38.73 ± 19.24 μm (95% CI: 16.96 to 60.5 μm) in the maxilla and 17.85 ± 0.92 μm (95% CI: 16.58 to 19.12 μm) in the mandible. The present results were promising, showing that deviations between the intraoral impressions and the digitized stone models fell within established tolerance ranges. Initial studies showed promising results that the digital workflow could be implemented with success similar to the conventional approach. Using the scan body library to generate a fiducial marker successfully demonstrated an efficient method for cross-mounting the edentulous arch Keywords: All-on-Four, cross-mounting, digital dentistry, edentulous, full-mouth reconstruction, implants, intraoral scanning, prosthetic dentistry

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

The management of severe mucogingival deformities surrounding malpositioned implants represents a complex issue with a high risk of aesthetic failure. The present case report describes a mucogingival and restorative approach for the treatment of severe localized peri-implant tissue deficiencies with interproximal bone loss combined with an interproximal gingival recession on the adjacent natural tooth. This consists of maintaining a non-restorable malpositioned implant, submerging it through one or multiple vertical soft tissue augmentations, according to the defect severity, and delivering a tooth supported bridge involving the adjacent natural teeth. The step-by-step surgical technique adopted for implant submergence and vertical soft tissue grafting, as well as the subsequent surgical and prosthetic interventions, are described, presenting results at 5 years from implant submergence and 3 years from prosthetic finalization. Keywords: Implants, Periodontal Surgery, Prosthetic Dentistry, Gingival Recession, Mucogingival Surgery, Dental Implant, Case Report

This article introduces a novel 3D-printed guide for harvesting subepithelial connective tissue grafts (CTG) from the lateral palate. A digital simulation of CTG harvesting was conducted on a patient’s integrated model using a single incision technique. The model incorporates crucial anatomical information, such as the location of the greater palatine artery and palatal gingival thickness, ensuring that planned incisions avoid critical structures and that a donor tissue of sufficient size (length, width, thickness) is harvested. The guide was designed and 3D-printed to replicate the simulated procedures in the intraoral environment, enhancing surgical precision. During surgery, the CTG palate guide facilitates the successful harvesting of a graft of sufficient size, as preoperatively planned, without causing any complications. This study suggests that the CTG palate guide can reduce complications and surgical time while maximizing the dimensions of the donor tissue. Keywords: Digital Technology, Computer-Aided Design (CAD), Three-Dimensional Printing, Case Report, Graft Harvesting, Surgical Guides

If a prosthetically guided implant rehabilitation is to be carried out, the patient must have adequate bone volumes; as a result of bone resorption in the alveolar process, the latter are not always present. An effective technique in regenerative surgery involves the use of titanium mesh to recreate the missing bone volume. New generation meshes have been used in this study: they present a new texture with micro holes and they can have a space-creating effect and a barrier effect. The primary objective of the study is to measure the height and width of the regenerated bone following the use of a new generation customized titanium mesh. This retrospective case series involved 18 patients, with a total of 23 bone atrophies who have undergone bone regeneration surgery with titanium mesh and subsequently implants have been placed. We achieved a vertical gain of 5.1 ± 2.9 mm and a medium horizontal gain is 12.3 ± 2.6 mm, with an average volume obtained during regeneration is 3.2 ± 1.3 cm3; we report one failure (4.3%) and in 3 cases (13%) it was necessary to perform a second minor surgery. The mean follow-up of implants after loading was 22.3 ± 15.6 months. This study showed the innovation of new generation titanium mesh, with a micro-perforated texture that offers both a spacemaking effect and a partial barrier effect. This has led to excellent results in terms of regeneration, with a significant improvement in vertical and horizontal defects treated and reduction in operating time. Future studies with longer follow-up will be necessary.

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

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.

Background: Dental autotransplantation (ATT) of mature teeth in adult patients has recently been supported by a growing body of evidence. Thus, ATT can be considered as an alternative to single implants for the replacement of a compromised tooth. This case series study aims to provide an initial comparison between ATT (test group) and immediate implant treatment (IIT standard group), in terms of volumetric changes and patient-related outcome measures (PROMs). Materials and Methods: Thirty-one interventions (29 patients) were grouped into two similar cohorts. Measurements were made on the superimposed STL files before and at least six months after treatment, and PROMs were obtained from a questionnaire in two follow-up checks. Data were analyzed using descriptive and inferential statistics. Adverse events and complications were also recorded. Results: Volume reduction was 3 to 4 times less in the ATT group than in the ITT group (p<0.05). Patients in the ATT group reported higher levels of perceived inflammation than the IIT group (p=0.015), although patients rated satisfaction similarly between the two treatments, above 9 on a scale of 1-10. Conclusions: Although this research should be considered an initial step requiring larger samples and follow-up, it supports the  trend of including ATT as an alternative option to IIT in molar replacement.

Endodontic–periodontal lesions are characterized by the involvement of the pulp and periodontal disease in the same tooth. Despite successful root canal treatment, if the majority of bone support has been lost from periodontitis, the tooth may have a poor prognosis. In severe endodontic–periodontal lesions, the periodontal tissue regenerates poorly because of the significant loss of the periodontal ligament and cementum, poor tooth stability, and bone defect morphology unfavorable for bone regeneration. To overcome these difficult situations, in this case, osteotomy of the replantation bed and tooth replantation with horizontal rotation and deep placement were performed. To improve periodontal regeneration, fibroblast growth factor (FGF) 2 was applied to the artificially made periodontal defect. In addition, orthodontic extrusion of the deeply replaced tooth was performed for potential coronal migration of the periodontal tissue. This case presents a unique multidisciplinary  method of treating severe endodontic–periodontal lesions using intentional replantation combined with FGF 2 application and orthodontic extrusion. Keywords: Tooth replantation; periodontal regeneration; FGF2; orthodontic tooth extrusion; endodontic–periodontal lesions

Aim: To assess the differential clinical response to step 2 of periodontal therapy and repeated subgingival instrumentation between teeth with suprabony and intrabony defects. Methods: Electronic and manual search were performed to identify studies reporting the differential clinical outcomes of non-surgical periodontal therapy (NSPT) in presence or absence of intrabony defects. The Cochrane Risk of Bias 2 and the Newcastle Ottawa scale were used to assess the risk of bias. Results: Two thousand three hundred forty-eight articles were initially screened, and a total of 5 articles were finally included. Regarding the primary outcome measure, two studies reported PPD reduction values at 6 months after step 2 of periodontal therapy, showing an opposite response of intrabony defects compared to suprabony defects (3.2 mm ± 1.9 versus 2.2 mm ± 1.7 and 0.48 mm ± 0.42 versus 0.72 mm ± 0.36, respectively), while one study reported no differences at 3 months. One study showed a negative association between the presence of intrabony defect and PPD reduction at 9 months after non-surgical step 3 (p < 0.05). Conclusion: Due to the limited number of studies and heterogeneity of the data, conflicting evidence emerged for the differential response to NSPT of intrabony and suprabony defects. Keywords: alveolar bone loss, bone resorption, non-surgical periodontal debridement, periodontal pocket, periodontitis, therapeutics, treatment outcome

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.

Periodontal bony defects are classified into ‘supraosseous’ (‘suprabony’) or ‘infraosseous’ (‘infrabony’) according to the location of the base of the defect compared to the coronal part of the residual alveolar crest. Infraosseous defects are generally considered more challenging to treat and are thought to be associated with a higher risk of periodontal progression. The emergence and advancement of periodontal regenerative procedures have improved the clinician’s ability to manage infraosseous defects. However, limitations still exist. This paper reviews the definitions of periodontal osseous defects and provides a new classification framework for infraosseous defects, relating them to the chances of success of regenerative procedures and therefore to their treatment planning options. Infraosseous defects are hereby divided into intrabony and inter-root defects. Factors affecting treatment response, such as number of walls, depth and extension into buccal and lingual surfaces are added to the classification framework. Keywords: bone loss, infrabony, periodontitis, suprabony

The growth in bone reconstructive surgery has been unsurpassed in recent decades. However, most bone regenerative products lack any potential for delivering site-specific morphologically driven augmentation. It was therefore the purpose of this study to evaluate the histological and clinical incorporation of a novel CAD CAM allogenic block bone graft for the reconstruction of complex 3- dimensional alveolar defects. In addition the clinical outcome of dental implants subsequently placed and loaded within these grafts was assessed with up to 5 years in function. Results demonstrated that 4 of the initial 17 blocks failed (23.5%). The remaining 13 blocks plus an additional two replacement blocks were fully or partially incorporated within the recipient bone site (79%). Of the 29 implants placed within the integrated blocks, no failures occurred with up to 5 years in function, with a recorded mean marginal bone loss by implant of -0.5mm. Keywords: Allogenic bone blocks, CAD CAM, Dental Implant, Digital Dentistry

Computer-assisted implant planning allows for a comprehensive treatment plan by combining radiographic data provided by a Cone Beam Computed Tomography (CBCT) with surface optical scan (IOs) data that includes patient intraoral situation and the intended restorative planning. Integrating a tailored restorative design with the patient’s anatomical conditions through virtual implant planning allows for an ideal bio-restorative treatment planning to maximize biological, functional, and esthetic outcomes. This article discusses dataset registration techniques that combine radiographic CBCT data with restorative information as the main path to create a virtual patient. The described techniques include the use of removable radiographic templates with radiopaque markers, dual scan technique, and direct digital file registration of intra-oral scans using anatomical references. Depending on the individual clinical situation, different factors must be considered to appropriately select methods that achieve an optimal registration of diverse datasets. An inherent challenge lies in the presence of scattering artifacts in CBCT scans. Two approaches are proposed for these situations – the use of chairside-fabricated composite resin markers or adhesive spot-markers fabricated for the use with CBCT scans. Both techniques exhibit limitations that need to be taken into consideration. Further approaches should be developed for situations involving scattering in CBCT. Keywords: computer-assisted surgery, data superimposition, digital imaging processing, digital workflow, dual technique, scattering

Background and Purpose: Gingival depigmentation impacts patient self-confidence and quality of life. This study compares the Er,Cr:YSGG laser to the traditional scalpel technique for reducing gingival hyperpigmentation, assessing their effectiveness and other relevant factors. Patients and Methods: We conducted a double-blind, randomized trial with a split-mouth design. Forty participants were selected from the university's dental clinic and randomly assigned to receive either the Er,Cr:YSGG laser (2780 nm) or surgical scalpel. Pain intensity and smile satisfaction were assessed post-surgery, and treatment duration was evaluated. The Dummett Oral Pigmentation Index (DOPI) was used to determine the initial severity of pigmentation and to track both reduction and potential repigmentation over time. The Gingival Melanosis Record (GMR) was used to evaluate the presence and extent of pigmentation and to monitor recurrence after 1 and 12 months. Results: Both the Er,Cr:YSGG laser and surgical scalpel similarly reduced GMR and DOPI scores over time, without significant differences at 12 months (p > 0.05). A significant examiner variability was noted in GMR scoring (β = -1.2 for Examiner 2; p < 0.001). Power analysis indicated a higher confidence for detecting treatment effects in DOPI (75%) compared to GMR (55%). Patient satisfaction with smile significantly improved (p < 0.001). Treatment type did not influence postoperative pain levels. The Er,Cr:YSGG laser required longer surgery times (p < 0.001). Conclusion: Under the conditions of the present study, both Er,Cr:YSGG laser and surgical scalpel were equally effective in reducing gingival hyperpigmentation. Although lasers offer better bleeding control and require less anesthesia than the scalpel technique, clinicians should also consider surgery duration, cost, and expertise when selecting a treatment method. Future research should focus on long-term outcomes and economic evaluations, utilizing standardized clinical measures. Keywords: Pigmentation, gingiva, Laser Therapy, Lasers, melanins, Esthetics, Dental

We report the successful treatment of multiple recession type (RT) 3 gingival recessions in periodontally compromised mandibular anterior teeth with limited keratinized tissue. A 35-yearold man with stage III, grade C periodontitis underwent a two-stage intervention. Initially, a modification of the connective tissue graft (m-CTG) wall technique was used as part of phenotype modification therapy. The CTG acted as a protective “wall,” securing space for periodontal regeneration, enhancing root coverage, soft tissue thickness, and keratinized mucosal width. Recombinant human fibroblast growth factor-2 and carbonate apatite promoted periodontal regeneration. This procedure successfully facilitated periodontal regeneration, resulting in the transition from RT3 to RT2 gingival recession and adequate keratinized mucosal width. Eighteen months later, the second surgery used a tunneled coronally advanced flap (TCAF) for root coverage. TCAF involved combining a coronally advanced flap and tunnel technique by elevating the trapezoidal surgical papilla and using a de-epithelialized CTG inserted beneath the tunneled flap. Root conditioning with ethylenediaminetetraacetic acid and enamel matrix derivative gel application were performed. Consequently, mean CAL gain was 5.3 mm, mean root coverage was 4.5 mm in height, and the gingival phenotype improved at the treated sites by the 12-month follow-up. This staged approach addresses the challenges of treating RT3 gingival recession with promising outcomes. Keywords: RT3, gingival recession, case report, T-CAF, periodontal regeneration, connective tissue graft, CTG wall

A 45-year-old female patient presented with a lack of inter-implant papilla after a partially edentulous anterior area was rehabilitated with dental implants. The soft tissue phenotype and inter-implant papilla was augmented using the “iceberg” connective tissue graft, followed by a second surgical procedure where a strip gingival graft was combined with a connective tissue graft inserted underneath a pouch prepared into the previous “iceberg” connective tissue graft at the level of the crest (“garage” approach), further enhancing soft tissue volume in that region. This technique aims to improve mucosal thickness and supracrestal tissue height while addressing esthetic concerns associated with multiple implant placements in the anterior region. The final esthetic outcome was excellent, harmonious soft tissue with appropriate thickness, symmetry with adjacent teeth, well-shaped interdental and inter-implant papilla with high patient satisfaction, making this approach a valuable addition to a surgeon’s armamentarium. Future clinical studies are needed to evaluate the performance of this novel approach.

Background: Achieving initial implant stability at the molar extraction site can be challenging due to bone width, quality, and anatomical limitations like the maxillary sinus and inferior alveolar nerve. The implant placement should achieve precise centralization with the interradicular septum to facilitate implant stabilization and preservation/regeneration of the alveolar ridge post-extraction with bone grafting. Immediate non-occlusal crown placement aids peri-implant tissue maturation for the desired outcome. This retrospective series introduces guidelines for treating sockets with alveolar septum types. The approach involves immediate dentoalveolar restoration (IDR) and osseodensification (OD) with an autogenous graft for bone preservation. Methods: A new protocol for the treatment of the molar interradicular septum during immediate implant placement and/or alveolar ridge preservation/reconstruction was applied in 12 cases. Preoperative and postoperative cone-beam computed tomographic examinations were performed. Socket width was measured and compared between timepoints. Results: The mean preoperative and postoperative (mean, 23.58 ± 9.70 months) socket widths were 9.51 ± 0.40 and 11.16 ± 0.30 mm, respectively (17.35% increase; p <0.05). Conclusion: IDR with OD is a predictable approach to the treatment of molar sockets during implant placement. Keywords: Immediate dental implant loading; Bone transplantation; Dental implant; Alveolar ridge augmentation; Minimally invasive surgical procedure; Case series.

This prospective case series aimed to evaluate the feasibility of using a volume collagen matrix for soft tissue augmentation to increase mucosal thickness in single implants in smokers who consume more than 10 cigarettes per day. Participants had single submerged implants necessitating soft tissue thickening. Soft tissue augmentation was done using a collagen matrix in the second-stage surgery. The primary outcome was soft tissue thickness at 90 days post-surgery. Secondary outcomes included median thickness at 30 and 60 days, changes in buccal soft tissue profile (digital measurements) at 30, 60, and 90 days, and oral health-related quality of life using OHIP-14 up to 90 days post-surgery. Pain levels via VAS scale and adverse effects were also assessed. Ten participants (4 men, 6 women) aged 45.2 ± 13.18 years initially smoked 10-20 cigarettes daily (average: 14.70 ± 3.47 cigarettes/day). After 90 days, median soft tissue thickness increased to 3.00 (2.00;3.00) mm. Buccal soft tissue profile (median change in ROI) increased by 0.40 (0.25;0.62) mm at 90 days. Pain levels decreased, and oral health-related quality of life improved significantly. No complications were reported. The collagen matrix significantly augmented buccal soft tissue thickness at implant sites in smokers (>10 cigarettes/day), with favorable outcomes and no complications. Keywords: smoking, dental implants, single-tooth, case series

This retrospective study aimed at evaluating the clinical outcomes of lithium disilicate prostheses onto teeth and implants. A total of 860 restorations were delivered to 312 patients, including crowns, veneers and onlays. Patients with uncontrolled gingival inflammation and/or periodontitis were excluded, whilst subjects with occlusal parafunctions were included. The retrospective observational period ranged between 13 to 17 years. The mechanical and esthetic performances of the restorations were rated according to the modified CDA criteria. The recorded data were analyzed statistically. In total, 26 mechanical complications were noticed: 17 ceramic chippings, 5 core fractures and 4 losses of retention. Mechanical complications occurred predominantly in posterior areas; monolithic prostheses showed the lowest percentage of structural problems. The clinical scores of layered and monolithic restorations were fully satisfactory according to the modified CDA rating. The cumulative survival and success rates ranged between 95.46-100% and 93.75-100% respectively up to 17 years of follow-up. Although patient selection and the rigorous application of validated clinical protocols were considered paramount, the use of lithium disilicate prostheses onto teeth and implants was reported to be a viable and reliable treatment option in the long-term.

The objective of this work is to report a restorative approach with composite resin applied in reverse in the aesthetic resolution of darkened anterior teeth. A 27-year-old female patient presented with the main complaint of dissatisfaction with the aesthetics of her smile due to dental darkening, a result of childhood trauma, without painful symptoms, pathological clinical signs or change in care. In the intraoral examination, a darkening of teeth 11 and 21 was observed, which radiographically showed thickening of the periodontal ligament, with disharmonious configuration of the marginal gingiva. From the clinical and radiographic characteristics, we opted for periodontal intervention for recovery and gingival levelling, followed by endodontic intervention and aesthetic restorative restoration. The restorative step was carried out sequentially by internal tooth bleaching, removal of dentin still pigmented after bleaching and enamel preservation. Soon after, it was restored in an alternative way and layered using a technique called reverse, using strips of polyethylene fiber over the dentin resin. The technique preserved the remaining enamel with the maintenance of the original remaining guides, proving to be a viable conservative alternative since of the diagnosis to the restorative conclusion in view of the longitudinal confirmation of the restorative efficacy after 1 year. Keywords: tooth discoloration, composite resins, biomimetics, dentistry, operative, tooth, nonvital.

Digital implant planning, utilizing the convergence of digital surface scanners, cone beam computer tomography (CBCT) scans, and advanced planning software, has transformed dental implantology. The merging of these data sets through triangulation of landmarks provides a detailed digital model of the jaws, facilitating precise implant positioning in edentulous areas. A critical step in this digital workflow is the accurate merging of DICOM files with STL/PLY/OBJ files, which underpins the design and fabrication of surgical templates for accurate implant placement. Errors in this phase can lead to implant mispositioning or damage to adjacent structures. Particularly in partial edentulism, the merging is based on the occlusal topography of the remaining teeth but scattering in the CBCT data—caused by interactions of radiation with radiodense materials—can complicate this process or even render it impossible. The manuscript presents a technique utilizing radiopaque markers to overcome scattering effects, ensuring accurate dataset superimposition in the mandible. Keywords: Implants, Scattering, CBCT, Guided Surgery

The purpose of this review was to evaluate the periodontal and peri-implant tissue responses to restorative approaches with and without cervical finish line on teeth and dental implants. An electronic search was performed in PubMed/MEDLINE, Embase, Cochrane Library, LILACS, Web of Science, and Scopus databases, and in the gray literature. Controlled clinical trials and prospective cohort studies were included. Analyzed outcomes included gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival thickness (GT), marginal stability (MS), and marginal bone loss (MBL). A meta-analysis was then performed in two parts: the first compared results of restorations on teeth with and without cervical finish line, and the second compared results of restorations on implant abutments with and without cervical finish line. Regarding the tooth-based restoration analysis, 7 out of 1,388 selected articles were included in the systematic review, and 2 were selected for the meta-analysis. For implantbased restorations on abutments with and without cervical finish line, 6 out of 707 selected articles were included in the systematic review, and 2 in the meta-analysis. No significant differences in periodontal and peri implant indexes were identified between both prosthetic approaches in situations with and without cervical finish lines. Keywords: Dental prosthesis; Prosthodontic tooth preparation; Dental implant-abutment design; Periodontium; Systematic review; Meta-analysis.

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 compare the electrolytic method (EM) used as an adjunct to mechanical decontamination, to hydrogen peroxide (HP) also used as an adjunct to mechanical decontamination, in the reconstructive therapy of peri-implantitis. At 12-month (T2) follow-up, 19 patients (Nimplants= 23) completed the study. None of the tested modalities demonstrated superiority in terms of the assessed clinical parameters. Only mucosal recession showed higher stability in the EM group. Alike, radiographic marginal bone level gain and defect angle changes at T2 did not differ between the evaluated strategies. Notably, disease resolution was ∼16% higher in the EM; however, differences did not reach statistical significance. Additionally, it was demonstrated that pocket depth and intra-bony component depth at baseline were predictors of disease resolution. In conclusion, the 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 ∼91% disease resolution rate.

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. Fixed retainers have many disadvantages and risks that should be considered in advance. Different failures of fixed retainers are described and categorized. The workflow for the retreatment of relapse caused in spite of the fixed retainers is described with 3 case presentations: Open bite, Root movement and Bimaxillary protrusion, all treated with clear aligner treatment (CAT). A revised retention protocol is suggested.

Introduction: The presence of adequate keratinized mucosa (KM) around dental implants and natural dentition is pivotal for the long-term success of dental restorations. Despite various techniques to augment KM, challenges persist in achieving stable, keratinized, and adherent mucosa, especially in the context of significant muscle pull or compromised tissue conditions. This study introduces a novel application of titanium pins for the fixation of free gingival grafts (FGG) and apically repositioned flaps (APF) during vestibuloplasty, aiming to overcome important limitations associated with traditional suturing methods and shorten the treatment time and patient morbidity. Methods: Three patients with insufficient KM width, presenting discomfort during oral hygiene and inflammation around implant restorations and natural teeth, underwent soft tissue augmentation using titanium pins traditionally used in guided bone regeneration (GBR) for the stabilization of FGGs and APFs. This method ensures intimate contact between the graft and the periosteum, facilitating proper graft perfusion and revascularization, minimizing shrinkage and the risk for necrosis of the graft. Results: Postoperative follow-up revealed successful integration of the grafts, with minimal shrinkage and increased width and depth of KM. The use of titanium pins allowed for reliable fixation in challenging surgical sites, where traditional suturing methods were impractical due to the presence of extensive muscle pull and an unstable recipient bed. Conclusion: The application of titanium pins for the fixation of FGGs and APFs during vestibuloplasty provides a promising alternative to traditional suturing techniques, particularly in complex cases where the recipient bed is suboptimal for suturing. This method simplifies and shortens the procedure, offering a predictable outcome with increased mechanical stability and minimal shrinkage of the graft. Randomized clinical trials are recommended to further evaluate the efficacy of this technique. Keywords: Free Gingival Graft, Dental Implants , Apically repositioned flap, Titanium pins, Vestibuloplasty, Graft Survival, Periodontal Surgery, Titanium Pins, Transplants

Peri-implantitis, a common complication among patients receiving implant-supported restorative therapy, often requires surgical intervention for effective treatment. Understanding the specific configuration of peri-implant bony defect and adjacent bone peaks is crucial for tailoring treatment strategies and improving outcomes. A decision tree for reconstructive peri-implantitis therapy has been developed based on the new classification of defect configurations (Class I to V), guiding clinicians in selecting treatment options, including biomaterials, techniques, and healing approaches. Furthermore, clinicians are encouraged to consider various factors such as local predisposing factors (such as soft tissue characteristics, prosthetic design, and implant position in three-dimensional perspective), clinical factors (surgeon skill and experience), and patient-related factors (such as local and systemic health, preferences, and cost) when evaluating reconstructive therapy options. Keywords: bone regeneration, dental implants, peri-implant defect, peri-implantitis, reconstructive therapy

Background: Non-perforated Polytetrafluoroethylene (PTFE) membranes are effectively utilized in guided bone regeneration (GBR) but may hinder cell migration due to limited interaction with the periosteum. This study compared bone regeneration using occlusive or perforated membranes combined with acellular collagen sponge (ACS) and recombinant human bone morphogenic protein-2 (rhBMP-2) in a canine mandibular model. Material and Methods: Male beagle dogs (n=3) received two mandibular defects each to compare ACS/rhBMP-2 with experimental (perforated group) and control (non-perforated group) membranes (n=3 defects/group). Tissue healing was assessed histomorphologically, histomorphometrically and through volumetric reconstruction using microcomputed tomography. Results: The perforated group showed increased bone formation and reduced soft tissue formation compared to the non-perforated group. For the primary outcome, histomorphometric analysis revealed significantly greater total regenerated bone in the perforated group (67.08 ± 6.86%) relative to the nonperforated group (25.18 ± 22.44%) (p = 0.036). Perforated membranes had less soft tissue infiltration (32.91 ± 6.86%) compared to non-perforated membranes (74.82 ± 22.44%) (p = 0.036). Conclusion: The increased permeability of membranes in the perforated group potentially enabled periosteal precursor cells greater accessibility to rhBMP-2. The availability may have accelerated their differentiation into mature bone-forming cells, contributing to the stimulation of new bone production, relative to the non-perforated group.  Keywords: Osteogenesis, periosteum, bone regeneration, polytetrafluoroethylene, implants

This essay is an expert opinion by 3 clinicians who feel the need for a clear phased approach capable of integrating all dental therapies for the care of patients suffering from multiple pathologies of the oral cavity. At the moment, the only guidelines available when treating interdisciplinary cases, i.e., patients with multiple overlapping pathologies (carious disease, periodontal disease, malocclusion, incongruous restorations, etc.), are those describing the proper sequence of periodontal therapy. The authors take inspiration from a method developed in the manufacturing world, the so called "lean management", and its tools to outline the sequence of therapy phases and the correct placement of the various activities within these phases. In the "lean healthcare”, it is the patient at the center of the attention and it is him/her who “pulls” the process with his/her health as the main value.

Placing immediate implants in the esthetic zone area poses significant challenges. Implants should be placed with consideration to hard and soft tissue management to optimize long term implant and cosmetic success. In this case report, two maxillary central incisors were extracted in two different time points, separated by 5 years because of horizontal root fractures. Implants were placed according to immediate single-tooth guidelines, using two different surgical and loading approaches, as risk assessment factors changed in the time between first immediate placement (#8) and second immediate placement (#9). These techniques included Partial Extraction Therapy (PET), the use of allograft and growth factors, connective tissue graft (CTG), platelet rich fibrin (PRF) and immediate and conventional loading. These were grouped as the “10 keys”, a checklist used to pursue long term success. After 6-year and 1-year follow-up, radiographic and clinical results were satisfactory.

A prospective clinical pilot study was carried out to evaluate a novel macroimplant design with a 12º angled platform. The implant is placed at the center of the socket, optimizing all the alveolar bone. In addition, the prosthetic emergence should be ideal, as it is corrected and emerges through the cingulate area. Twelve patients were enrolled in an immediate implant placement procedure with immediate aesthetic rehabilitation to replace an anterior maxillary tooth, and were treated with inverted body-shift design with 12º angled neck. Only type I sockets according to the Elian classification were considered eligible for the study. There were no implant failures after one 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 of -0.61 mm at 3 mm. On the other hand, stability was observed at 5 mm, since the result obtained was not statistically significant. The median pink esthetic score (PES) at one year of follow-up was 11.5. This implant may be useful in the immediate tooth replacement treatment of maxillary anterior post-extraction sockets, nevertheless, comparative studies with conventional implants should be carried out.  Keywords: Co-axis implant; implant angulation; success rate; marginal bone loss.

Objective: This study aims to collect data on implant survival, bone volume maintenance, and complications associated with the socket shield technique. Background data: The socket shield technique was introduced in 2010. Since then, several systematic reviews have been published, showing good clinical outcomes. The behaviour of the buccal bone plate is so far not completely understood. Methods: The study involved the placement of 23 implants using the socket shield technique in 20 patients. AstraTech EV implants were used, and no bone substitutes or connective tissue grafts were applied. Patients were monitored for 18 months, recording implant survival, volumetric bone analysis on CBCT scans, interproximal bone levels, bone sounding, pink esthetic scores, and complications. Prosthetic procedures were also described, including temporary and final restorations. Results: A 95.7% cumulative 18-month implant survival rate was obtained using the socket shield technique, with a significant but limited reduction in buccal bone thickness (BBT) after implant placement. One implant did not integrate and two shields were partially exposed. The mean pink esthetic score, 1 year after loading was 12.93 ± 1.22. Conclusion: The study suggests that the socket shield technique can result in limited reduction of the buccal bone volume, with a high implant survival rate. Re-entry studies are recommended to investigate the causes of bone resorption. Keywords: bone preservation, immediate implant, implant survival, oral implant, partial extraction, socket shield

This study aimed to clinically evaluate the efficacy of two different home whitening protocols and to determine which is more effective: applying the whitening gel every 48 hours or every 72 hours for 6 weeks. The differences in terms of tooth sensitivity are also analyzed. A sample of 72 patients was randomly divided into 3 groups of 24 (N=24). Group A: 16% carbamide peroxide applied every 48h for 6 weeks. Group B: 16% carbamide peroxide applied every 72h for 6 weeks. Group C (control group): a placebo gel without peroxide (glycerin gel) was applied every 48h for 6 weeks. To compare the groups, color measurements were made using a spectrophotometer and ANOVA test and Bonferroni test was used. The confidence level was set at 95% (p ≤ 0.05) and no statistically significant differences between applying 16% carbamide peroxide every 48h or every 72h for 6 weeks (p> 0.05) were found. The study concluded that carbamide peroxide 16% is equally effective applied with both protocols, obtaining the same results. Keywords: esthetic dentistry; dental bleaching; carbamide peroxide; whitening tooth.

The placement of a dental implant by creating the osteotomy through the remaining root can serve as a placement option that offers various advantages. These benefits include more precise drilling with reduced vibration in cases with limited available bone or with anatomical structures such as the mental foramen and inferior alveolar nerve in close proximity to the planned osteotomy, and facilitating the extraction of an ankylosed tooth following root canal treatment. This case report presents a detailed description of the surgical and restorative procedures involved in placing an implant in a mandibular premolar area. Keywords: mandible premolar implant, osteotomy through the root, mental foramen

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.

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

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

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.

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

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

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: 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.

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. 

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.

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.

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

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.

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.

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

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. 

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. 

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. 

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.

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

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: 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.  

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