Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration

Treatment of Submucous Alveolar Cleft With Hard- and Soft-Tissue Reconstruction in the Aesthetic Zone: A Case Report

OBJECTIVE

This case report offers information on accurate diagnostic and soft- and hard-tissue reconstruction periodontal surgery deal with "black triangles" in the aesthetic zone of anterior teeth caused by submucous alveolar cleft, which is rare and easily overlooked.

CLINICAL CONSIDERATIONS

Vertical and horizontal bone augmentation was conducted via guided tissue regeneration and alveolar bone grafting (ABG) at the cleft site where favorable bone grafting conditions were absent. A customized, vascularized interpositional periosteal-connective tissue (VIP-CT) flap was applied as the barrier membrane to maintain the stability of bone replacement graft and provide soft-tissue foundation for gingival papilla growth. Adjustment on the contact point position of the anterior teeth and the shapes of crowns induced growth of the gingival papillae with resin restoration. The radiological and clinical parameters, and smiling photographs demonstrated a satisfactory treatment outcome.

CONCLUSIONS

When the inflammation and local alveolar bone destruction in the anterior area are disproportionate, submucous alveolar cleft should be considered a potential etiology. Surgical treatment combined with resin restoration substantially improved the affected area.

CLINICAL SIGNIFICANCE

The hard- and soft-tissue defects can be improved through ABG and VIP-CT flap in a single surgery.

Operative Times, Costs and Patient-Related Outcome Measures in Vertical Ridge Augmentation With Customised Reinforced PTFE Mesh Versus CAD/CAM Titanium Mesh: Secondary Analysis of a Randomised Clinical Trial

AIM

This secondary analysis of a randomised clinical trial aimed to investigate vertical ridge augmentation (VRA) by comparing complication rates (primary outcome), times, costs and patient-reported outcome measures (PROMs) between customised Ti-reinforced PTFE mesh and customised CAD/CAM titanium mesh.

MATERIALS AND METHODS

Patients with vertical bone defects were randomly assigned to alveolar bone augmentation using either Ti-PTFE mesh or Ti mesh (T0). After 6-9 months, barriers were removed, and computer-guided surgery was performed to place implants in the augmented sites (T1). Complications, times, costs and PROMs (anxiety, pain, anti-inflammatory drug dosage, limitations in daily functions) were assessed and analysed.

RESULTS

Forty-eight of 50 patients completed the bone augmentation surgery as per protocol. The estimated difference in healing complications was -0.04% (CI: -0.22 to 0.13), confirming the non-inferiority of Ti meshes to PTFE meshes. The estimated differences were -3.50 min (CI: -23.49 to 16.49) for total operative time (p = 0.688); €17.37 (-77.25 to 111.99) for costs (p = 0.130); -0.17 (CI: -0.80 to 0.47) for anti-inflammatory drug usage (p = 0.299); 0.56 (CI: -1.97 to 0.85) for pain levels (p = 0.565); and -0.13 (CI: -0.61 to 0.36) for limitations in daily functions (p = 0.528), on the day after surgery.

CONCLUSION

Outcomes were favourable, which encourage the use of both medical devices with low complication rates and both digital approaches, resulting in favourable operative times and PROMs.

Efficacy of soft tissue augmentation in the maxillary esthetic region: A 5-year randomized controlled trial

BACKGROUND

Soft tissue grafting at dental implant sites has been proposed to enhance esthetic outcomes. A xenogeneic collagen matrix (XCM) was introduced as an alternative grafting material to connective tissue. Only short-term results are yet available.

METHODS

Sixty patients were treated in a randomized controlled trial with a connective tissue graft (n = 20, CTG group), an XCM (n = 20, XCM group), or received no graft (n = 20, NG group). The grafts were placed at the time of implant placement in a preserved alveolar ridge. The primary outcome was a change in mid-buccal mucosal level (MBML) after 5 years (T60). Secondary outcomes were marginal bone level, clinical peri-implant parameters, esthetics, and patient satisfaction.

RESULTS

At T60, mean changes in MBML were -0.41 ± 1.20 mm, -0.30 ± 1.22 mm, and -0.61 ± 1.72 mm in the CTG, XCM, and NG groups (p = 0.78), respectively. Also, regarding the secondary outcome variables, no significant between-group differences were observed.

CONCLUSIONS

Soft tissue grafting at single implant placement after alveolar ridge preservation, either with a CTG or  XCM, does not result in a better esthetic outcome and should not be considered as a standard procedure.

PLAIN LANGUAGE SUMMARY

Implant placement in case of a failing tooth is a favorable treatment option. However, since the extraction socket is often associated with a large bone defect, alveolar ridge preservation with bone grafts prior to implant placement is often needed. To compensate for possible soft tissue defects, the application of a CTG or an XCM has been proposed. The question has arisen whether the use of an XCM will give a better outcome than a CTG. Furthermore, are both soft tissue augmentation therapies accompanied by a better esthetic result than performing no soft tissue therapy at all? Therefore, a 5-year study was carried out in which 60 patients with a failing tooth in the frontal region of the upper jaw were treated with removal of the tooth and restoring the gap with bone graft and sealing the socket with mucosagraft from the tuberosity region. At the time of implant placement 5 months thereafter, 20 patients received a CTG, 20 patients received an XCM, and 20 patients no soft tissue therapy. After 5 years, it appeared that there was no difference between the 3 soft tissue treatment procedures. Thus, implant placement combined with soft tissue grafting in preserved alveolar ridges does not result in a better esthetic outcome.

Alveolar ridge preservation in periodontally compromised molars with buccal or lingual bone defects: A retrospective case series

STATEMENT OF PROBLEM

Alveolar ridge preservation aims to limit alveolar resorption and promote bone formation after tooth extraction. However, evidence for its application in periodontally compromised molars with bone defects is limited.

PURPOSE

The purpose of this retrospective study was to evaluate the radiographic and clinical outcomes of alveolar ridge preservation in periodontally compromised molars with buccal or lingual bone wall deficiencies.

MATERIAL AND METHODS

This study included 65 participants. Radiographic measurements were made using cone beam computed tomography before extraction and at least 5 months after surgery. Factors influencing radiographic outcomes were analyzed, changes in keratinized tissue width assessed, and implant treatment outcomes evaluated. Paired t tests or Wilcoxon signed-rank tests were used to compare continuous variables before and after surgery. Linear regression analyses were conducted to identify influencing factors.

RESULTS

Significant increases were observed in central bone height (Maxilla: +4.69 mm, P<.001; Mandible: +7.82 mm, P<.001) and ridge width at 1 mm (Maxilla: +5.46 mm, P<.001; Mandible: +5.91 mm, P<.001) and 3 mm (Maxilla: +5.55 mm, P<.001; Mandible: +4.70 mm, P<.001) from the higher alveolar crests after alveolar ridge preservation. The height of socket bone walls significantly influenced the radiographic outcomes. Adequate keratinized tissue width was maintained (5.70 ±2.00 mm). Implant placement without additional bone augmentation was feasible in 69.5% of participants, with only 6.5% requiring staged bone augmentation.

CONCLUSIONS

Alveolar ridge preservation in periodontally compromised molar extraction sites with buccal or lingual bone wall deficiencies created favorable hard and soft tissue conditions, thereby facilitating implant placement.

Biomaterials for Reconstructive Treatment of Peri-Implantitis

Peri-implantitis is a pathological condition affecting the tissues surrounding dental implants, marked by inflammation of the peri-implant connective tissue and progressive loss of supporting bone. With strong evidence indicating a bacterial origin, effective treatment approaches should employ anti-infective strategies. Due to the limited success of non-surgical approaches, surgical therapy-offering direct access to contaminated implant surfaces-is often necessary. This narrative review aims to summarize the available biomaterials and their effectiveness in the reconstructive management of peri-implantitis. Reconstructive techniques should be employed in cases with contained defect morphology. While the ideal biomaterial for bone regeneration in these cases remains uncertain, bone substitutes with low resorption rates tend to yield more favorable outcomes compared to autogenous bone. Comparative studies have not demonstrated clear clinical advantages from the adjunctive use of barrier membranes. Current evidence also does not support definitive conclusions regarding the benefits of adding biologics to reconstructive treatments.

Long-Term Clinical Outcomes and Risk Indicator Analyses of Narrow-Diameter Implants in the Posterior Jaw: A Retrospective Cohort Study of 10 to 27 Years

OBJECTIVES

To assess the long-term clinical outcomes and patient satisfaction with narrow-diameter implants (NDIs) in the posterior jaws and to identify the risk indicators for NDI failure.

MATERIALS AND METHODS

This retrospective study reviewed 479 patients with 666 NDIs (diameter ≤ 3.5 mm) -supported fixed prostheses in posterior jaws, with a minimum 10-year follow-up. Implant survival, success, complications, demographics, and implantation characteristics were collected. Risk indicators for posterior NDI failure were analyzed using multilevel Cox regression analyses with mixed effects. Patient satisfaction and oral health impact profile (OHIP) were surveyed in a random 10% sample.

RESULTS

Over a mean follow-up of 14.0 ± 3.6 years, implant survival was 95.9% at the implant level and 94.6% at the patient level. Success rates were 93.5% at the implant level and 91.6% at the patient level. Multilevel Cox regression analysis identified an implant length of 10 mm or less (p = 0.001) and the use of single crowns (p = 0.005) as significant risk indicators for posterior NDI failure. Patients showed high satisfaction (4.54/5) with posterior NDIs, and the mean OHIP score of 1.15 reflected an acceptable level of oral health.

CONCLUSION

NDIs in the posterior jaws demonstrated robust long-term success and high patient satisfaction. An implant length of 10 mm or less and the use of single crowns are potential risk indicators for posterior NDI failure.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR2200062337 on 2022/08/02.

Role of hyaluronic acid in the treatment of peri-implant diseases: results of a meta-analysis

Peri-implantitis is an infectious-inflammatory disease that affects the tissues surrounding implants and is one of the main causes of implant failure. Hyaluronic acid (HA) is a natural polymer with multiple biomedical and cosmetic applications. The aim of this systematic review and meta-analysis was to evaluate its efficacy in the treatment of peri-implant disease.

Methods

In accordance with PRISMA, the question was established: is HA treatment effective as a sole or adjunctive therapy for the treatment of peri-implantitis? PubMed/Medline, Embase, Cochrane Central, Dentistry & Oral Sciences Source and Web of Science were searched until December 2024. Inclusion criteria were interventional studies (RCTs and case series), according to the PICOs strategy in subjects with peri-implant pathology (participants), treated with HA (intervention) compared to conventionally treated or untreated patients (control) and assessing response to treatment (outcomes).

Results

Thirty-two studies were obtained and four were selected. Risk of bias was assessed using the Cochrane Risk of Bias tool and methodological quality using the Joanna Briggs Institute tool. Meta-analysis of parameters was performed for pooled studies and for subgroups. The overall effect was in favour of the experimental group.

Conclusions

The use of HA as background or adjunctive therapy in peri-implantitis may be effective, although well-designed RCTs are warranted to validate the efficacy of the product.

Systematic Review Registration

Identifier (INPLANSY 2024100050).

Efficacy of Acellular dermal matrix simultaneous with implant placement: A systematic review and meta-analysis of clinical trials

PURPOSE

The vertical soft tissue thickness over the implant is essential for long-term procedure success and for biological integration of the suprabony soft tissue component, consequently, development of alternatives to autogenous soft tissue grafts such as allogeneic and xenogeneic grafts were needed. Acellular dermal matrix (ADM) is utilized to provide structural support for angiogenesis, revascularization and tissue remodeling in soft tissue augmentation, recession, and increasing the keratinized tissue width. At this point, the aim of this systematic review was to evaluate the amount of soft tissue height (STH) gained after augmenting the ADM in combination with the dental implants.

METHODS

A systematic search was performed in five databases. The primary outcome measure was STH change. Secondary outcomes included marginal bone loss (MBL) and pocket probing depth (PPD) at implant sites.

RESULTS

Six studies, with 200 participants, and reported pre- and post-operative mean of vertical tissue thickness, MBL, and PPD around implants were included in the meta-analysis. The pooled mean difference (MD) of STH was 0.84 (95 % CI:0.28 to 1.39) with a p-value < 0.0001. A total of three studies, reported MBL. The pooled MD of MBL around implants, comparing the mean change from baseline to 12 months. The random effect model revealed a MD of 0.07mm (95 % CI: -0.21 to 0.35 mm, p= 0.6325). Calculation of pooled MD of PPD at implant sites, comparing ADM groups to the control groups in three studies; the random effect model revealed a MD of -0.13mm (95 % CI: -0.47 to 0.22 mm, p= 0.4742).

CONCLUSION

While Acellular dermal matrix significantly improves vertical soft tissue thickness, it does not significantly impact marginal bone loss or pocket probing depth.

Guided transpositional bone blocks in esthetic zone: Surgical technique and case report

BACKGROUND

The ultimate objective of implant dentistry is to position the implant in a three-dimensional, prosthetic-driven location. This case highlights a guided approach for harvesting and positioning an autogenous bone block to restore a horizontal bone defect in the anterior maxilla.

METHODS

This case report describes a 55-year-old patient with horizontal bone deficiency in the anterior maxilla following teeth loss. Using specialized software, a surgical guide was designed to facilitate the harvesting of an autogenous bone block from the subnasal region in the same location where implants were planned to be placed. The graft was then repositioned and fixed with titanium screws, and the gaps were grafted with xenogenic bone particles and covered with an absorbable collagen membrane. After 6 months, the implants were placed, followed by prosthetic restoration.

RESULTS

A one-stage implant placement was performed after an uneventful healing period. The bone augmentation resulted in a ridge width of 8 mm for a net gain of 5 mm. After 4 months, the implants were loaded with a screw-retained zirconia bridge.

CONCLUSION

Guided transpositional bone blocks offer a predictable approach to treating horizontal bone defects in the esthetic zone. Utilizing digital planning and surgical guides enhances precision, making the result more predictable.

KEY POINTS

This case provides new information as it highlights a novel guided approach for harvesting and positioning an autogenous bone block to restore a horizontal bone defect in the anterior maxilla using a surgical guide. The keys to successful management of this case include using precise digital planning, the design and use of a surgical guide to accurately harvest the autogenous bone block, proper fixation of the graft and ensuring an uneventful healing period before implant placement and prosthetic restoration. The primary limitations to success in this case could involve the challenge of having adequate distance away from the nasal floor for harvesting and repositioning the autogenous bone block and potential complications during the healing period.

PLAIN LANUAGE SUMMARY

This report describes a modern technique for addressing bone loss in the upper front part of the mouth, crucial for placing dental implants correctly. A 55-year-old patient with insufficient bone was treated using a digital plan to precisely guide the movement of a bone piece from a nearby area to where it was needed. This guided approach involved designing a custom guide with computer software, securely attaching the bone, and using special materials to aid healing. After 6 months, the dental implants were successfully placed and fitted with new teeth, resulting in a stable and natural-looking outcome.

A 10-Year Follow-Up of Reconstructive Treatment of Peri-Implantitis Using Mineralized Dehydrated Allograft and Resorbable Membrane: A Retrospective Case Series

OBJECTIVES

To evaluate the 10-year clinical and radiographic outcomes of peri-implantitis intrabony defects treated with mineralized dehydrated bone allograft (MDBA) and resorbable membrane in patients undergoing a regular supportive peri-implant/periodontal therapy (STP).

MATERIALS AND METHODS

The original study participants were 34 (34 defects). After mechanical debridement and chemical decontamination of implant surfaces, intrabony defects were filled with MDBA and covered by a resorbable membrane. Patients were enrolled in a maintenance program with a recall interval of 6 months. The primary outcome was the absence of additional marginal peri-implant bone loss ≥ 1.0 mm after surgery. The composite outcome was no additional marginal peri-implant bone loss ≥ 1.0 mm and the absence of probing depth (PD) ≥ 5 mm, bleeding on probing and suppuration.

RESULTS

Of the original 34 implants, 20 completed the 10-year follow-up, and three failed. Related to the primary outcome, the mean peri-implant marginal bone level changed from 4.78 mm (SD 1.84) at baseline to 3.10 mm (SD 1.73) after surgery and 3.71 mm (SD 1.78) at the follow-up end point. According to the composite outcome for disease resolution, 19 of the 34 original implants were successfully treated at the 10-year follow-up with a statistically significant difference between 1 (31/34 implants) and 5 years (20/34 implants) (p = 0.003) and 1 and 10 years (p = 0.001) but not between 5 and 10 years (p = 1.000).

CONCLUSIONS

Ten years after the reconstructive treatment, followed by regular SPT, the cumulative successful treatment rate, according to the primary and the composite outcomes, was 58% (20/34 implants) and 53% (19/34) implants, respectively.

A randomised clinical trial comparing a surgical approach for treatment of peri-implantitis to non-surgical debridement with adjunctive diode laser therapy

OBJECTIVES

To evaluate the efficacy of non-surgical debridement with repeated diode laser application in comparison to surgical treatment for management of peri-implantitis.

MATERIALS AND METHODS

Forty patients diagnosed with peri-implantitis were randomised into two groups. The test group received mechanical debridement and repeated diode laser therapy at Days 0, 7 and 14. The control group received mechanical debridement at Day 0 followed by surgical treatment at Day 14. Clinical evaluations were performed at baseline, 3 and 12 months.

RESULTS

Thirty-six participants (test n = 17, control n = 19) completed the 12-month observation period. Laser treatment failed in 4 cases (23.5%); of which 3 implants lost osseointegration and one necessitated surgical treatment due to progressively increasing probing depths (PD) and bone loss. In comparison, the control group showed a 100% survival rate with a statistically significant difference between the two groups (p = 0.04). Therefore, thirty-two participants were examined at the final evaluation (test n = 13, control n = 19). Twenty-two implants (57.9%) showed complete disease resolution without significant differences between the groups. The test group reported significantly lower post-operative discomfort on the visual analogue scale (VAS). At 3 months, both groups showed clinical signs of healing with reduction in probing depths (PD) and bleeding upon probing. Surgical treatment resulted in significantly lower PDs (control 3.7 mm [3.2, 4.0], test 4.5 mm [3.8, 4.8]), but recession was significantly higher (control 0.5 mm [0.3, 1.2], test 0 mm [0.0, 0.3]). At the final reevaluation, PD values remained significantly lower in the control group; 3.3 mm [3.1, 3.9] compared to 4.3 mm [3.7, 4.8] for the test group, but the difference in mucosal recession fell below the level of significance. Marginal bone levels improved after one year without significant differences between the two groups (Test = 3.5 mm [2.8, 4.6] at baseline and 1.5 mm [1.0, 4.4] at one year, Control = 2.8 mm [2.5, 3.1] at baseline and 1.4 mm [1.0, 2.6] at one year).

CONCLUSION

Surgical approaches for management of peri-implantitis demonstrated significant benefits over laser therapy in terms of treatment success and PD reduction. Nevertheless, diode laser therapy, as described in this study, could represent a minimally invasive alternative for treatment of non-advanced peri-implantitis defects.

Effectiveness of a novel amine + zinc + fluoride toothpaste in reducing plaque and gingivitis: results of a six-month randomized controlled trial

OBJECTIVES

To evaluate the efficacy of a toothpaste containing amine compound, 0.5% zinc lactate, and 1400 ppm F (NaF) in comparison to a regular fluoride toothpaste containing 1450 ppm F as MFP/NaF (negative control). Plaque and gingivitis indices were determined over a 6-month period.

MATERIALS AND METHODS

In a randomized, double-blind, two-cell, parallel-group design on healthy adults from the Bangkok, Thailand area presenting with initial gingivitis (Löe-Silness gingival index ≥ 1) and visible plaque (Turesky Modification-Quigley-Hein index ≥ 1.5) were assigned test and negative control toothpastes and instructed to brush twice daily for two minutes.

RESULTS

Site-level (N = 10,778) and subject-level (N = 92) data indicated that the test toothpaste increased the number of healthy sites and improved gum health as compared to the negative control toothpaste. For the test group, after 6 months, the average reduction for plaque, gingival index, and gingival severity was 31.2%, 32.3%, and 49.3%, respectively. Average reductions were greater in the test group than the negative control group across all measures.

CONCLUSIONS

The amine + zinc + fluoride toothpaste significantly improved measures of plaque (12× more effective) and gingivitis (5× more effective) in comparison to a standard fluoride toothpaste, suggesting that the novel formulation with antibacterial active ingredients amine and zinc facilitates more effective plaque removal, and promotes gingival health.

CLINICAL RELEVANCE

These results suggest that daily use of amine + zinc + fluoride toothpaste can provide a significant improvement in managing plaque accumulation and bleeding associated with gingival inflammation especially for patients experiencing gingivitis.

CLINICAL TRIAL REGISTRATION

NCT06563518 (registration date: August 19, 2024).

Patient-Reported Outcome Measures Following Implant Placement With Simultaneous Horizontal Bone Augmentation

OBJECTIVES

This study aimed to evaluate the impact of implant placement with simultaneous bone augmentation on patients' willingness to repeat the procedure. Secondary outcomes included assessing patient-reported outcome measures, clinical- and surgical-related factors affecting treatment outcomes.

METHODS

Subjects who were currently undergoing or have undergone implant placement with simultaneous bone augmentation in the esthetic region (maxillary second premolar to second premolar) were assigned to three groups: Group A (short-term), Group B (1-5 years post-surgery), and Group C (> 5 years post-surgery). Clinical assessments, dichotomous questions, and visual analogue scales were used to evaluate therapeutic outcomes according to the group of interest.

RESULTS

One hundred and fifty patients completed the study (n = 50 per group). In Group A, 16% experienced wound dehiscence (membrane exposure < 3 mm), and 2% had postoperative bleeding, infection, swelling, or abscess. Flaps extending beyond three teeth significantly increased early membrane exposure (p = 0.04). Patient-reported postoperative discomfort (p < 0.001) and wound healing scores (p < 0.04) decreased over time. Willingness to repeat the procedure was 100%, 88%, and 98% in Groups A, B, and C, respectively, with satisfaction rates of 98.2 ± 7.5, 91.2 ± 10.6, and 95.2 ± 10.9. No significant differences were found between Groups B and C for functional or esthetic satisfaction. However, Group C reported higher satisfaction and comfort (p < 0.001). Younger adults and women reported greater postoperative discomfort than older adults and men.

CONCLUSIONS

Implant placement with simultaneous horizontal bone augmentation in esthetic areas shows a high willingness of patients to repeat the procedure in the short-, mid-, and long-term. Additionally, this therapeutic approach yields low rates of postoperative complications and discomfort, along with high patient satisfaction related to functional performance, esthetics, and overall comfort.

Simple-Challenging-Difficult (SCD) Difficulty Classification for Vertical Bone Augmentation

OBJECTIVE

To propose a new difficulty classification for vertical bone augmentation (VBA) based on different defect morphologies.

OVERVIEW

VBA procedures for dental implant placement present significant biological and technical challenges. Among the various techniques, guided bone regeneration (GBR) provides an optimal balance between the anticipated bone gain and the likelihood of postoperative complications. Understanding the specific configuration of defects and adjacent bone peaks is essential for tailoring treatment strategies and improving outcomes. The proposed Simple-Challenging-Difficult (SCD) difficulty classification was based on defect morphology (V-shaped, U-shaped, VV-shaped), including defect size (Height: < 5 mm, 5-8 mm, and > 8 mm), proximity of neighboring bony walls (Width: < 10 mm, 10-20 mm, and > 20 mm), as well as predictability of treatment outcomes.

CONCLUSIONS

The proposed difficulty classification for VBA serves as a guide for selecting the most appropriate GBR treatment modality and sequence for safe and predictable management of VBA in implant therapy. In addition, when determining the preferred treatment, it is again essential to consider site-specific and patient-related factors alongside the clinician's surgical experience and skill.

CLINICAL SIGNIFICANCE

Identifying defect patterns and bone peak structures is crucial, and the proposed classification assists in decision-making in VBA treatment.

Alveolar bone regeneration using a 3D-printed patient-specific resorbable scaffold for dental implant placement: A case report

BACKGROUND

This case report demonstrates the effective clinical application of a 3D-printed, patient-specific polycaprolactone (PCL) resorbable scaffold for staged alveolar bone augmentation.

OBJECTIVE

To evaluate the effectiveness of a 3D-printed PCL scaffold in facilitating alveolar bone regeneration and subsequent dental implant placement.

MATERIALS AND METHODS

A 46-year-old man with a missing tooth (11) underwent staged alveolar bone augmentation using a patient-specific PCL scaffold. Volumetric bone gain and implant stability were assessed. Histological analysis was conducted to evaluate new bone formation and graft integration.

RESULTS

The novel approach resulted in a volumetric bone gain of 364.69 ± 2.53 mm3, sufficient to reconstruct the original alveolar bone contour and permit dental implant placement. Histological analysis showed new bone presence and successful graft integration across all defect zones (coronal, medial, and apical), with continuous new bone formation around and between graft particles. The dental implant achieved primary stability at 35 Ncm-1, indicating the scaffold's effectiveness in promoting bone regeneration and supporting implant therapy. The post-grafting planned implant position deviated overall by 2.4° compared with the initial restoratively driven implant plan pre-bone augmentation surgery. The patient reported low average daily pain during the first 48 h and no pain from Day 3.

CONCLUSIONS

This proof-of-concept underscores the potential of 3D-printed scaffolds in personalized dental reconstruction and alveolar bone regeneration. It marks a significant step forward in integrating additive manufacturing technologies into clinical practice through a scaffold-guided bone regeneration (SGBR) approach. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000118707p).

GelMA-based moldable and rapid-curable osteogenic paste inspired by ceramic craft for alveolar bone defect regeneration

Alveolar bone defects pose a significant challenge in oral clinical treatments, impacting procedures such as dental implants, orthodontics, and oral restoration. Despite their frequent occurrence due to various causes, the effective restoration and reconstruction of alveolar bone defects remain a significant clinical challenge in dentistry. Existing treatments often rely on intrinsic blood coagulation to stabilize bone grafts, but they present limitations such as gradual clotting and reduced effectiveness in patients with coagulation dysfunction. Injectable gel holds promise as an alternative to coagulation-dependent bone graft matrices, but it also faces challenges, including low initial viscosity and dependence on the natural formation of the defect area during the curing process. Here, we present a ceramic-craft-inspired osteogenic (CIO) hydrogel, designed to achieve moldable and curable properties for bone defect regeneration. This injectable paste, composed of gelatin methacrylate (GelMA), nanoclay, and bone grafts, allows for local injection and manual shaping without the need for molds. The shaped hydrogel rapidly crosslinks within 15 s under UV irradiation, providing malleability, strength, and coagulation-independent bone graft stabilization. This approach offers a potential breakthrough in addressing the persistent clinical challenge of alveolar bone defect restoration.

The nasal spine suture: A novel approach for membrane stabilization

BACKGROUND

Current evidence acknowledges guided bone regeneration (GBR) as a predictable therapeutic modality in the augmentation of a deficient alveolar ridge. Such deficiencies often reveal inadequate bone volume to support implant placement in a position amenable to prosthetic reconstruction. Additionally, an evolving body of literature demonstrates that membrane fixation may lead to improved clinical bone gain through positively influencing blood clot formation, stability, and the eventual osteogenic potential of the defect. Alternative benefits to membrane fixation, such as reduced graft displacement and reduction in wound micromotion, have also been cited as mechanisms for an increased regenerative response.

METHODS AND RESULTS

The aim of this report was to present a case, including diagnosis, treatment, and follow-up for the reconstruction of a horizontal ridge deficiency. The patient's deficiency in ridge volume was found to be a developmental sequelae of lateral incisor agenesis, resulting in an underdeveloped midfacial region of the alveolar process subjacent to sites #7 and #10. The fixation protocol outlined in this report demonstrated adequate horizontal ridge augmentation to facilitate future prosthetic reconstruction with the use of implants.

CONCLUSIONS

Numerous protocols have been established in an attempt to achieve effective barrier membrane stabilization for bone augmentation procedures. However, some techniques are poorly suited for the anatomically challenging region of the anterior maxilla. A case report describing the utilization of the anterior nasal spine for anchorage of a membrane-stabilizing suture may present a novel, safe, and effective technique for stabilizing the intended region of augmentation, as well as preventing graft migration beyond the membrane-maxilla interface. Key points Regarding guided bone regeneration (GBR) procedures, micromotion of the membrane or of the underlying particulate graft may negatively influence the volume of the augmented site. The ability to adequately stabilize the graft-membrane interface is recognized as a necessary prerequisite to predictably achieve optimal surgical outcomes. To the authors' knowledge, there is no clinical or scientific evidence regarding the use of the anterior nasal spine for membrane anchorage in maxillary GBR procedures, and thus a novel approach to membrane stabilization is introduced.

Comparative evaluation of autologous dental bone powder and deproteinized bovine bone mineral allografts for oral implant bone deficits

OBJECTIVE

To compare the effectiveness of autologous dental bone powder grafts with deproteinized bovine bone mineral (DBBM) allografts in oral implant bone deficiency.

METHODS

Between January 2021 and January 2023, we enrolled 120 patients with inadequate bone for oral implantation, dividing them into an experimental group and a control group (60 each). The experimental group received autologous dental bone powder grafts, while the control group received DBBM allografts. Wound healing was assessed using the early healing index (EHI) with 5 days of closure as the baseline timeline, as Grade I: full closure without a fibrin line, Grade II: closure with a fibrin line, and Grade III: closure with fibrin covering the incision. Additional outcomes included buccal and palatal alveolar bone height, alveolar bone width at 3 (W1), 7 (W2), and 11 mm (W3) below the top of the alveolar ridge, and bone density measured before and 3 months after tooth extraction. The altered shape of the alveolar bone at the extraction site was assessed at 3- and 6-months post-extraction. Implant success rate was also evaluated at 15 days and 1 month after implantation. Comparisons were made using independent t-tests, paired t-tests, χ² tests, and Z tests, as appropriate.

RESULTS

The experimental group had a lower wound healing time and a greater prevalence of EHI categorization class I compared to the control group (P < 0.05). Three months after tooth extraction, there was no statistically significant difference in buccal and palatal alveolar bone heights between the experimental group and the pre-treatment measurements (P > 0.05). However, the control group showed a decrease in buccal and palatal alveolar bone heights compared to the pre-treatment period, while the experimental group had greater bone heights than the control group (P < 0.05). Three months after extraction, the widths of W1, W2, and W3 decreased in both groups. However, the experimental group maintained greater widths compared to the control group (P < 0.05). At 3 months post-extraction, both groups showed an increase in alveolar bone density at the extraction site. Notably, the experimental group had a higher bone density compared to the control group as well as new bone contour score of the alveolar bone at the extraction site (P < 0.05). However, at 6 months after extraction, there was no statistically significant difference in the new bone contour score of the alveolar bone at the extraction site between the two groups (P > 0.05). There was no significant difference in the implant success rate between the two groups. (P > 0.05).

CONCLUSIONS

Autologous dental bone powder grafting promotes initial alveolar bone regeneration, enhances wound healing, and increases new bone density, providing favorable surgical conditions for dental implants. However, by 6 months, there was no significant difference in bone contour compared to DBBM allografts, indicating similar long-term clinical outcomes for both materials.

Proteomic Analysis of Human Serum Proteins Adsorbed onto Collagen Barrier Membranes

Collagen barrier membranes are frequently used in guided tissue and bone regeneration. The aim of this study was to analyze the signature of human serum proteins adsorbed onto collagen membranes using a novel protein extraction method combined with mass spectrometry. Native porcine-derived collagen membranes (Geistlich Bio-Gide®, Wolhusen, Switzerland) were exposed to pooled human serum in vitro and, after thorough washing, subjected to protein extraction either in conjunction with protein enrichment or via a conventional surfactant-based method. The extracted proteins were analyzed via liquid chromatography with tandem mass spectrometry. Bioinformatic analysis of global profiling, gene ontology, and functional enrichment of the identified proteins was performed. Overall, a total of 326 adsorbed serum proteins were identified. The enrichment and conventional methods yielded similar numbers of total (315 vs. 309), exclusive (17 vs. 11), and major bone-related proteins (18 vs. 14). Most of the adsorbed proteins (n = 298) were common to both extraction groups and included several growth factors, extracellular matrix (ECM) proteins, cell adhesion molecules, and angiogenesis mediators involved in bone regeneration. Functional analyses revealed significant enrichment of ECM, exosomes, immune response, and cell growth components. Key proteins [transforming growth factor-beta 1 (TGFβ1), insulin-like growth factor binding proteins (IGFBP-5, -6, -7)] were exclusively detected with the enrichment-based method. In summary, native collagen membranes exhibited a high protein adsorption capacity in vitro. While both extraction methods were effective, the enrichment-based method showed distinct advantages in detecting specific bone-related proteins. Therefore, the use of multiple extraction methods is advisable in studies investigating protein adsorption on biomaterials.

The efficacy of reconstructive therapy in the surgical management of peri-implantitis: A 3-year follow-up of a randomized clinical trial

AIM

To assess whether guided bone regeneration (GBR) treatment of peri-implantitis-related bony defects could improve healing compared to open flap debridement (OFD) at 36 months.

MATERIALS AND METHODS

In a multi-centre, randomized clinical trial, 32 individuals received OFD (control group [CG]) and 34 GBR treatment (test group [TG]). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP) suppuration (SUP), mucosal recession (MREC) and patient-reported outcomes (PROs) were evaluated at 36 months.

RESULTS

Fifty individuals attended a supportive peri-implant therapy program and completed the 36-month follow-up. GBR treatment resulted in an RDF of 2.13 ± 1.26 mm compared to 1.64 ± 1.54 mm following OFD (p = .18). No difference was found in PPD, BOP, SUP, REC or PROs between the groups. Successful treatment (no additional bone loss, PPD ≤ 5 mm, no BOP and no SUP) was achieved in 46.2% in TG and 20% in CG (p = .053). Treatment results obtained at 12 months were generally maintained up to 36 months. No significant changes were noticed between 12 and 36 months.

CONCLUSIONS

At 36 months, treatment results obtained at 1 year were sustained following both GBR and OFD in patients attending supportive peri-implant therapy. GBR resulted in more RDF and higher composite treatment success rate than OFD (ClinicalTrials.gov Identifier [NCT02375750]).

BSP Implementation of prevention and treatment of peri-implant diseases - The EFP S3 level clinical practice guideline

OBJECTIVES

to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients.

SOURCES

This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri‑implant diseases and conditions [2].

METHODOLOGY

The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly.

RESULTS AND CONCLUSION

Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public.

CLINICAL SIGNIFICANCE

The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri‑implant diseases.

Linear bone gain and healing complication rate comparative outcomes following ridge augmentation with custom 3D printed titanium mesh vs Ti-reinforced dPTFE. A randomized clinical trial

AIM

The aim of this randomized clinical trial was to compare the qualitative (linear alveolar ridge changes) and quantitative (healing complications) outcomes after guided bone regeneration (GBR) using a custom-made 3D printed titanium mesh versus titanium reinforced dense PTFE membrane for vertical and horizontal augmentation of deficient alveolar ridges.

Periodontists and stem cell-based therapy for alveolar bone regeneration: A national survey

BACKGROUND

Stem cell-based therapy for bone regeneration has received attention in medical settings but has not yet been used in clinical practice for treating alveolar bone defects. The objectives of this study were to explore whether periodontists had heard about this approach, and if so how, how interested they were to learn about it, which attitudes and behavioral intentions they had related to using stem cell-based grafting, and what they would like to know before using this approach.

METHODS

Anonymous survey data were collected from 481 members of the American Academy of Periodontology (response rate: 19.41%).

RESULTS

Responses showed 35.3% had heard about stem cell-based therapy, mostly from publications (9.6%) and meetings (8.3%); 76.1% wanted to learn about it through in-person continuing education (CE) courses, 68.6% in online CE courses, and 57.1% from manuals; 73% considered this approach promising; and 54.9% preferred it to traditional approaches. It was important to them that it would result in more bone volume (93%), better bone quality (90.4%), and accelerated healing (83.2%). Also, 60.1% considered it likely/very likely that they would adopt this approach, 54% that patients would prefer it, and 62.1% that it would benefit their practice. When asked what they would like to know about this approach, information about short- and long-term outcomes, cost, and logistical considerations were most frequently named.

CONCLUSIONS

These findings provide the basis to develop educational interventions for periodontists about this novel approach and inform future research activities aimed to translate this approach to clinical practice.

Impact of peri-implant keratinized mucosa width on the long-term reconstructive outcomes of peri-implantitis: A retrospective analysis with a follow-up up to 10 years

PURPOSE

To investigate the effect of mid-buccal peri-implant keratinized mucosa width (KMW) ≥2 mm or peri-implant KMW >0 mm and <2 mm on the long-term outcomes of peri-implantitis reconstructive treatment.

MATERIALS AND METHODS

Twenty-nine patients (40 implants; mean follow-up: 9.2 ± 1.4 years) with at least one implant affected by peri-implantitis and surgically treated through a reconstructive procedure followed by a submerged healing were included. Patients were categorized according to their initial KMW: Group 1 (KMW ≥2 mm) and Group 2 (KMW >0 mm and <2 mm). Peri-implant clinical and radiographic parameters and a dedicated composite outcome were assessed at different follow-up visits during supportive peri-implant therapy for up to 10 years. Regression analyses were utilized to identify possible risk/predictive indicators for probing pocket depth (PPD) change and treatment success at the latest follow-up.

RESULTS

The mean PPD did not exhibit any statistical difference from the baseline to the latest follow-up between the groups at both patient and implant levels. Long-term treatment success was 46.6% (Group 1) and 42.6% (Group 2) at patient level, it was 42.8% (Group 1) and 33.3% (Group 2), respectively, at implant level (p > 0.05). Group 1 demonstrated significantly higher vertical defect depth reduction than Group 2 (p = 0.018). Presence of buccal bony wall and mean PPD at the baseline were found to be associated with mean PPD change, while KMW at 6 months following surgery was identified as the only significant indicator for treatment success (p < 0.05).

CONCLUSION

Implants with KMW ≥2 mm did not present significantly better long-term clinical outcomes following reconstructive therapy than those exhibiting KMW >0 mm and <2 mm. However, KMW values at the end of healing phase following a submerged approach had a significant impact on long-term treatment success.

Surgical regenerative methods for peri-implantitis treatment: A systematic review and meta-analysis

Background

The purpose of this study was to review the literature on the efficacy of different surgical regenerative methods for peri-implantitis treatment.

Methods

A preliminary search was conducted in seven electronic databases. The studies included in the analysis implemented surgical regenerative treatment in at least one study group. Baseline and follow-up values for bleeding on probing (BoP), pocket depth (PD), plaque index (PI), bone level (BL), and bone gain (BG) were extracted. The standardized mean difference (SMD) was calculated using Cohen's d or Hedges' g, and a random-effects-restricted maximum likelihood (REML) method was applied for the meta-analysis.

Results

Fifteen studies were included in the qualitative synthesis. The meta-analysis was performed on six studies comparing regenerative techniques that involved bone grafts with those that did not. The overall effect size for using bone grafts at the one-year follow-up was 0.04 (95% CI: -0.26‒0.35; P=0.78) for BoP, -0.08 (95% CI: -0.42‒0.27; P=0.66) for PD, 0.37 (95% CI: 0.08‒0.65; P=0.01) for PI, -0.44 (95% CI: -0.84 to -0.03; P=0.03) for BL, and 0.16 (95% CI: -0.68‒1.01; P=0.70) for BG.

Conclusion

Various materials have been employed for peri-implant defect filling and coverage. A bone substitute did not significantly improve BoP, PD, and BG values, while PI and BL were significantly ameliorated at one-year follow-up. However, recommending a single unified protocol as the most effective for surgical regenerative treatment of peri-implantitis was not feasible.

Influence of physicochemical characteristics of calcium phosphate-based biomaterials in cranio-maxillofacial bone regeneration. A systematic literature review and meta-analysis of preclinical models

Objectives

Calcium phosphate-based biomaterials (CaP) are the most widely used biomaterials to enhance bone regeneration in the treatment of alveolar bone deficiencies, cranio-maxillofacial and periodontal infrabony defects, with positive preclinical and clinical results reported. This systematic review aimed to assess the influence of the physicochemical properties of CaP biomaterials on the performance of bone regeneration in preclinical animal models.

Methods

The PubMed, EMBASE and Web of Science databases were searched to retrieve the preclinical studies investigating physicochemical characteristics of CaP biomaterials. The studies were screened for inclusion based on intervention (physicochemical characterization and in vivo evaluation) and reported measurable outcomes.

Results

A total of 1532 articles were retrieved and 58 studies were ultimately included in the systematic review. A wide range of physicochemical characteristics of CaP biomaterials was found to be assessed in the included studies. Despite a high degree of heterogeneity, the meta-analysis was performed on 39 studies and evidenced significant effects of biomaterial characteristics on their bone regeneration outcomes. The study specifically showed that macropore size, Ca/P ratio, and compressive strength exerted significant influence on the formation of newly regenerated bone. Moreover, factors such as particle size, Ca/P ratio, and surface area were found to impact bone-to-material contact during the regeneration process. In terms of biodegradability, the amount of residual graft was determined by macropore size, particle size, and compressive strength.

Conclusion

The systematic review showed that the physicochemical characteristics of CaP biomaterials are highly determining for scaffold's performance, emphasizing its usefulness in designing the next generation of bone scaffolds to target higher rates of regeneration.

Comparison of Khoury's Bone Shell Technique vs Titanium-reinforced Polytetrafluoroethylene Membrane for 3D-bone Augmentation in Atrophic Posterior Mandible: A Randomized Clinical Trial

AIM

This study was designed to compare between the use of Khoury's bone shell technique vs titanium-reinforced PTFE membrane for 3D-ridge augmentation of atrophic posterior mandible.

MATERIALS AND METHODS

Sixteen patients were equally and randomly assigned to either the Khoury or PTFE group. In Khoury group, a mandibular bone block was harvested, split and then fixed to augment the mandibular defect using osteosynthesis screws. In PTFE group, augmentation was achieved using Titanium-reinforced PTFE membranes fixed with bone tacks/screws. A mixture of autogenous and xenogenic graft material at a 1:1 ratio was used in both groups. Vertical and horizontal bone gain were obtained using cone-beam computed tomography (CBCT). Preoperative dimensions were compared with the final dimensions obtained 6 months postoperatively.

RESULTS

No significant complications or neurosensory dysfunction were encountered. A solitary patient in the Khoury group experienced limited wound dehiscence, which was treated conservatively. For both groups, there were no significant differences between preoperative and postoperative vertical (p = 0.849 and 0.569) and horizontal (p = 0.778 and 0.367) dimensions.

CONCLUSION

No significant differences exist between the augmentation dimension which can be obtained using either Khoury of Ti-PTFE membranes.

CLINICAL SIGNIFICANCE

Both approaches are delicate and necessitate surgical expertise and experience. Both techniques can be used to achieve predictable augmentation results with a low rate of complications. How to cite this article: Shaker AES, Salem AS, El-Farag SAA, et al. Comparison of Khoury's Bone Shell Technique vs Titanium-reinforced Polytetrafluoroethylene Membrane for 3D-bone Augmentation in Atrophic Posterior Mandible: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):518-526.

Horizontal ridge augmentation in the maxillary aesthetic region using the autogenous circular cortical-lamina anchoring technique: A case series study

AIM

This case series aimed to evaluate the effectiveness of the autologous circular cortical lamina-anchoring (CCA) technique for horizontal bone augmentation in the maxillary aesthetic region.

MATERIALS AND METHODS

A total of 25 patients with 28 implants underwent horizontal bone augmentation using CCA followed by implant placement and crown delivery. The primary outcome measures were alveolar ridge width (ARW) and buccal bone thickness (BBT), whereas the secondary outcome measures included marginal bone loss (MBL), mid-facial mucosal margin loss (MML), clinical assessment of peri-implant and aesthetic parameters, patient-reported outcome measures (PROMs), and implant survival rates.

RESULTS

All 25 patients with 28 implants completed the treatment, no dropouts occurred. After CCA, the mean ARW at 1, 2, and 4 mm below the alveolar crest significantly increased from 2.38 ± 0.48, 2.85 ± 0.51, and 3.21 ± 0.53 mm to 6.80 ± 0.48, 6.99 ± 0.50, and 8.08 ± 0.52 mm, respectively. At the 3-year follow-up, the mean BBT0, BBT2, and BBT4 slightly decreased from 2.51 ± 0.26, 2.63 ± 0.31, and 2.75 ± 0.29 mm to 2.43 ± 0.27, 2.51 ± 0.30, and 2.64 ± 0.28 mm, respectively. Although the overall MBL was <0.15 mm, the results were statistically significant. The mean MML at the 3-year follow-up was 0.02 mm. All implant sites showed acceptable peri-implant and aesthetic outcomes. Incisions healed without complications, and no significant differences in PROMs observed at any time point. The 3-year follow-up showed a 100% implant survival rate.

CONCLUSION

The autologous CCA technique is a useful method for increasing ARW and maintaining BBT in the maxillary aesthetic region.

TPMS Microarchitectures for Vertical Bone Augmentation and Osteoconduction: An In Vivo Study

Triply periodic minimal surface microarchitectures (TPMS) were developed by mathematicians and evolved in all kingdoms of living organisms. Renowned for their lightweight yet robust attributes, TPMS structures find application in diverse fields, such as the construction of satellites, aircrafts, and electric vehicles. Moreover, these microarchitectures, despite their intricate geometric patterns, demonstrate potential for application as bone substitutes, despite the inherent gothic style of natural bone microarchitecture. Here, we produced three TPMS microarchitectures, D-diamond, G-gyroid, and P-primitive, by 3D printing from hydroxyapatite. We explored their mechanical characterization and, further, implanted them to study their bone augmentation and osteoconduction potential. In terms of strength, the D-diamond and G-gyroid performed significantly better than the P-primitive. In a calvarial defect model and a calvarial bone augmentation model, where osteoconduction is determined as the extent of bony bridging of the defect and bone augmentation as the maximal vertical bone ingrowth, the G-gyroid performed significantly better than the P-primitive. No significant difference in performance was observed between the G-gyroid and D-diamond. Since, in real life, the treatment of bone deficiencies in patients comprises elements of defect bridging and bone augmentation, ceramic scaffolds with D-diamond and G-gyroid microarchitectures appear as the best choice for a TPMS-based scaffold in bone tissue engineering.

Surgical treatment of peri-implantitis

As utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of which therapy is the most appropriate to maintain the implant. Since non-surgical approaches of peri-implantitis have shown limited effectiveness, the present paper describes different surgical treatment modalities, underlining their indications and limitations. The primary goal in the management of peri-implantitis is to decontaminate the surface of the infected implant and to eliminate deep peri-implant pockets. For this purpose, access flap debridement, with or without resective procedures, has shown to be effective in a large number of cases. These surgical treatments, however, may be linked to post-operative recession of the mucosal margin. In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and to achieve re-osseointegration.

Soybean Oil-Based 3D Printed Mesh Designed for Guided Bone Regeneration (GBR) in Oral Surgery

This study aims to obtain a cyto-compatible 3D printable bio-resin for the manufacturing of meshes designed from acquired real patients' bone defect to be used in future for guided bone regeneration (GBR), achieving the goal of personalized medicine, decreasing surgical, recovery time, and patient discomfort. To this purpose, a biobased, biocompatible, and photo-curable resin made of acrylated epoxidized soybean oil (AESO) diluted with soybean oil (SO) is developed and 3D printed using a commercial digital light processing (DLP) 3D printer. 3D printed samples show good thermal properties, allowing for thermally-based sterilization process and mechanical properties typical of crosslinked natural oils (i.e., E = 12 MPa, UTS = 1.5 MPa), suitable for the GBR application in the oral surgery. The AESO-SO bio-resin proves to be cytocompatible, allowing for fibroblast cells proliferation (viability at 72 h > 97%), without inducing severe inflammatory response when co-cultured with macrophages, as demonstrated by cytokine antibody arrays, that is anyway resolved in the first 24 h. Moreover, accelerated degradation tests prove that the bio-resin is biodegradable in hydrolytic environments.

Effect of a synthetic hydroxyapatite-based bone grafting material compared to established bone substitute materials on regeneration of critical-size bone defects in the ovine scapula

Lately, the potential risk of disease transmission due to the use of bovine-derived bone substitutes has become obvious, demonstrating the urgent need for a synthetic grafting material with comparable bioactive behaviour and properties. Therefore, the effect of a synthetic hydroxyapatite (HA) (Osbone®) bone grafting material on bone regeneration was evaluated 2 weeks, 1 month, and 3, 6, 12 and 18 months after implantation in critical-size bone defects in the ovine scapula and compared to that of a bovine-derived HA (Bio-Oss®) and β-tricalcium phosphate (TCP) (Cerasorb® M). New bone formation and the biodegradability of the bone substitutes were assessed histomorphometrically. Hard tissue histology and immunohistochemical analysis were employed to characterize collagen type I, alkaline phosphatase, osteocalcin, as well as bone sialoprotein expression in the various cell and matrix components of the bone tissue to evaluate the bioactive properties of the bone grafting materials. No inflammatory tissue response was detected with any of the bone substitute materials studied. After 3 and 6 months, β-TCP (Cerasorb® M) showed superior bone formation when compared to both HA-based materials (3 months: β-TCP 55.65 ± 2.03% vs. SHA 49.05 ± 3.84% and BHA 47.59 ± 1.97%; p ≤ 0.03; 6 months: β-TCP 62.03 ± 1.58%; SHA: 55.83 ± 2.59%; BHA: 53.44 ± 0.78%; p ≤ 0.04). Further, after 12 and 18 months, a similar degree of bone formation and bone-particle contact was noted for all three bone substitute materials without any significant differences. The synthetic HA supported new bone formation, osteogenic marker expression, matrix mineralization and good bone-bonding behaviour to an equal and even slightly superior degree compared to the bovine-derived HA. As a result, synthetic HA can be regarded as a valuable alternative to the bovine-derived HA without the potential risk of disease transmission.

Deep learning for the identification of ridge deficiency around dental implants

OBJECTIVES

This study aimed to use a deep learning (DL) approach for the automatic identification of the ridge deficiency around dental implants based on an image slice from cone-beam computerized tomography (CBCT).

MATERIALS AND METHODS

Single slices crossing the central long-axis of 630 mandibular and 845 maxillary virtually placed implants (4-5 mm diameter, 10 mm length) in 412 patients were used. The ridges were classified based on the intraoral bone-implant support and sinus floor location. The slices were either preprocessed by alveolar ridge homogenizing prior to DL (preprocessed) or left unpreprocessed. A convolutional neural network with ResNet-50 architecture was employed for DL.

RESULTS

The model achieved an accuracy of >98.5% on the unpreprocessed image slices and was found to be superior to the accuracy observed on the preprocessed slices. On the mandible, model accuracy was 98.91 ± 1.45%, and F1 score, a measure of a model's accuracy in binary classification tasks, was lowest (97.30%) on the ridge with a combined horizontal-vertical defect. On the maxilla, model accuracy was 98.82 ± 1.11%, and the ridge presenting an implant collar-sinus floor distance of 5-10 mm with a dehiscence defect had the lowest F1 score (95.86%). To achieve >90% model accuracy, ≥441 mandibular slices or ≥592 maxillary slices were required.

CONCLUSIONS

The ridge deficiency around dental implants can be identified using DL from CBCT image slices without the need for preprocessed homogenization. The model will be further strengthened by implementing more clinical expertise in dental implant treatment planning and incorporating multiple slices to classify 3-dimensional implant-ridge relationships.

Clinical and radiographic outcomes of a combined surgery approach to treat peri-implantitis

Peri-implant infra-bony defects are difficult to treat, and data on the management of peri-implantitis are lacking. The aim of this study was to evaluate the effect of a combined surgical approach to manage peri-implantitis: implantoplasty with xenogeneic bone grafting and a concentrated growth factor membrane. Two independent examiners analysed the medical records and radiographs taken before surgery and at the last follow-up. Data were analysed at the implant level; some patient-level data (age, sex, smoking habit) were also considered. Linear regression analysis with generalized estimating equations (GEE) was used to explore the effect of variables of interest (including marginal bone level (MBL)) on implantitis treatment success and resolution rates. The effect of the prosthesis type on postoperative clinical and radiographic parameters was also explored by GEE, with adjustment for age, sex, tooth site, location, follow-up duration, and implant length (model IV including all). Thirty patients with 72 implants were investigated. The implant survival rate was 100% over a mean observation period of 3.3 years (range 2-11 years). The treatment success rate (bone loss <0.5 mm, no bleeding on probing (BOP), no suppuration, probing depth (PD) < 5 mm) was higher in females than males (50% vs 19.0%; P = 0.008). At the last postoperative follow-up, the MBL (1.51 ± 1.07 vs 4.01 ± 1.13 mm), PD (3.61 ± 0.84 vs 6.54 ± 1.01 mm), and BOP (23.38 ± 23.18% vs 79.17 ± 15.51%) were significantly reduced when compared to pre-surgery values (all P < 0.001). Furthermore, a significantly higher PD reduction (β = -1.10 mm, 95% confidence interval -1.97 to -0.23 mm, P = 0.014) was observed for implants with a single crown than a full-arch prosthesis (GEE model IV). Preliminary clinical and radiographic data indicate that implantoplasty in combination with surgery could be an effective treatment option for peri-implantitis.

Clinical outcomes following a combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement using either autogenous tooth roots or autogenous bone blocks

AIM

To assess and compare the short-term clinical outcomes following a combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement using either autogenous tooth roots (TR) or autogenous bone blocks (AB).

MATERIALS AND METHODS

A total of n = 27 patients (TR/AB: 13/14) exhibiting n = 31 implants (TR/AB: 14/17) were available for the analysis. Each subject had been allocated to a combined vertical and horizontal alveolar ridge augmentation using either (1) healthy TR (e.g., retained wisdom teeth), or (2) monocortical AB harvested from the retromolar area (i.e. external oblique line). Clinical parameters (e.g., bleeding on probing, BOP; probing pocket depth, PD; mucosal recession, MR) were recorded after a follow-up period of 16.03 ± 4.3 months following implant placement.

RESULTS

The survival rates amounted to 100% in both groups. TR and AB grafted sites were associated with similar changes in mean BOP (8.97 ± 27.73%; 11.90 ± 18.97%), PD (0.53 ± 0.49; 0.47 ± 0.67 mm), and MR (0.03 ± 0.13; 0.0 ± 0.02 mm) values. The incidence of peri-implant mucositis and peri-implantitis at the patient level amounted to 15.38% and 0.0% in the TR-, and 28.57% and 7.14% in the AB group.

CONCLUSIONS

Both surgical procedures were associated with peri-implant tissue health and stability on the short-term.

Clinical decision-making and management of stage IV periodontitis: A survey

OBJECTIVE

To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology.

METHODS

A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed.

RESULTS

A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy.

CONCLUSIONS

More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.

Etiology, pathogenesis and treatment of peri-implantitis: A European perspective

Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.

The influence of vertical ridge augmentation techniques on peri-implant bone loss: A systematic review and meta-analysis

INTRODUCTION

The primary aim of this systematic review was to investigate and compare the outcomes of different vertical ridge augmentation (VRA) techniques in relation to peri-implant bone loss (PBL), after at least 12 months of functional loading.

MATERIAL AND METHODS

The search was conducted to find all the studies about VRA and measurements of PBL with at least 12 months follow-up. Three pairwise meta-analysis (MA) was performed to completely evaluate the outcomes.

RESULTS

A total of 42 studies were included, of which 11 were randomized clinical trials (RCTs). RCTs were available only for guided bone regeneration (GBR), onlay, and inlay techniques. The weighted mean estimate (WME) of PBL value was found to be 1.38 mm (95% confidence interval [95% CI]: 1.10-1.66) after a mean follow-up of 41.0 ± 27.8 months. GBR, Inlay, Onlay, osteodistraction, and SBB represented in weight 32.9%, 30.6%, 25.0%, 7.6%, and 3.9%, respectively; and their WME (95% CI) were 1.06 (0.87-1.26) mm, 1.72 (1.00-2.43) mm, 1.31 (0.87-1.75) mm, 1.81 (0.87-1.75) mm, and 0.66 (0.55-0.77) mm, respectively. Among the secondary outcomes, the analysis was conducted for vertical bone gain, healing complication rate, surgical complication rate, implant survival, and success rate.

CONCLUSIONS

The primary findings of the meta-analysis, based on the changes between final and baseline values, showed that the peri-implant bone loss could be influenced by the type of intervention but there is a need to evaluate in RCTs the behavior of the peri-implant bone levels after long-term follow-up for all techniques.

Biological performance of a novel bovine hydroxyapatite in a guided bone regeneration model: A preclinical study in a mandibular defect in dogs

OBJECTIVES

This preclinical model study aims to evaluate the performance and safety of a novel hydroxyapatite biomaterial (Wishbone Hydroxyapatite, WHA) on guided bone regeneration compared to a commercially available deproteinized bovine bone mineral (Bio-Oss, BO).

MATERIAL AND METHODS

Twenty-four beagle dogs were allocated to three timepoint cohorts (4, 12, and 26 weeks) of eight animals each. In all animals, four critical-sized, independent wall mandibular defects were created (32 defects/cohort). Each animal received all four treatments, allocated randomly to separated defects: WHA + collagen membrane (M), BO + M, no treatment (Sham, Sh), and Sh + M. At each timepoint, the specimens were harvested for histologic and histomorphometric analyses to determine the newly formed bone and osteoconductivity.

RESULTS

At 4 weeks, bone regeneration was significantly higher for WHA + M (46.8%) when compared to BO + M (21.4%), Sh (15.1%), and Sh + M (23.1%) (p < 0.05); at 12 and 26 weeks, regeneration was similar for WHA and BO. Bone-to-material contact increased over time similarly for WHA + M and BO + M. From a safety point of view, inflammation attributed to WHA + M or BO + M was minimal; necrosis or fatty infiltrate was absent.

CONCLUSIONS

WHA + M resulted in higher bone regeneration rate than BO + M at 4 weeks. Both BO + M and WHA + M were more efficient than both Sh groups at all timepoints. Safety and biocompatibility of WHA was favorable and comparable to that of BO.

Efficacy of a Solution Containing 33% Trichloroacetic Acid and Hydrogen Peroxide in Decontaminating Machined vs. Sand-Blasted Acid-Etched Titanium Surfaces

This in vitro study assessed the efficacy of a solution containing 33% trichloroacetic acid (CCl3COOH; TCA) and hydrogen peroxide (H2O2) in decontaminating machined (MAC) and sand-blasted acid-etched (SBAE) titanium surfaces. A total of 80 titanium disks were prepared (40 MAC and 40 SBAE). Streptococcus sanguinis and Enterococcus faecalis strains were incubated on 36 samples, while the remaining 44 were kept as controls. Roughness analysis and scanning electron microscopy were used to evaluate the surface features before and after TCAH2O2 treatment. The viability of human adipose-derived mesenchymal stem cells (ASCs) after TCAH2O2 decontamination was assessed with a chemiluminescent assay along with cell morphology through fluorescent staining. TCAH2O2 preserved the surface topography of MAC and SBAE specimens. It also effectively eradicated bacteria on both types of specimens without altering the surface roughness (p > 0.05). Also, no significant differences in protein adsorption between the pristine and TCAH2O2-treated surfaces were found (p = 0.71 and p = 0.94). While ASC proliferation remained unchanged on MAC surfaces, a decrease was observed on the decontaminated SBAE specimens at 24 and 48 h (p < 0.05), with no difference at 72 h (p > 0.05). Cell morphology showed no significant changes after 72 h on both surface types even after decontamination. This study suggests TCAH2O2 as a promising decontamination agent for titanium surfaces, with potential implications for peri-implant health and treatment outcomes.

Diagnosis and Treatment of Periimplant Mucositis and Periimplantitis: An Overview and Related Controversial Issues

Periimplant mucositis and periimplantitis are common complications of dental implant. This article provides a comprehensive overview of the 2017 World Workshop's new definition, clinical and radiographic presentation, pathogenesis, risk factors, and classification of periimplant diseases. Also, the authors discuss various types of instruments, materials, and techniques commonly used for treatment of nonsurgical and surgical periimplantitis. Lastly, the authors include some controversial topics surrounding this subject.

Clinical outcomes following atrophic alveolar ridge reconstruction using collagenated xenogeneic bone block or autogenous bone block: One-year follow-up of a randomized controlled clinical

AIM

This investigation aimed to evaluate the 1-year survival of implants placed after staged lateral alveolar ridge augmentation using equine-derived collagenated xenogeneic bone blocks (CXBBs) or autogenous bone block (ABB).

MATERIALS AND METHODS

Fifty patients who underwent lateral augmentation in a previous trial were included. The primary outcome measure was implant survival at the 1-year follow-up, and secondary outcomes included implant success, peri-implant clinical and volumetric parameters, pink aesthetic scores (PES) and patient-reported outcome measures. Data analysis involved Fisher's exact test, the Mann-Whitney U-test and the Wilcoxon signed-rank test.

RESULTS

In this study, no late implant failures were observed. The cumulative survival rates were 78.6% for the CXBB group and 90.9% for the ABB group, with no difference between the groups. Similarly, the success rates were 53.6% and 63.6%, respectively, showing no significant difference. Peri-implant clinical and volumetric parameters indicated the presence of healthy peri-implant tissues surrounding implants placed in both CXBB- and ABB-augmented sites. PES were 8.5 and 11.0 for implants placed in CXBB- and ABB-augmented sites, respectively. Furthermore, patient satisfaction rates were high and similar between the groups.

CONCLUSIONS

Dental implants placed in both CXBB- and ABB-augmented ridges demonstrated no statistically significant differences in clinical, volumetric and aesthetic outcomes, along with high patient satisfaction rates.

Hard tissue stability outside the buccal bone arch contour after guided bone regeneration in the anterior maxilla: A retrospective cohort radiographic study

OBJECTIVES

To radiographically evaluate the stability of the bone substitute augmented outside the buccal bony arch contour in the maxillary esthetic zone.

MATERIALS AND METHODS

Patients who missed a single anterior tooth and received simultaneous GBR in implant surgery were included. The contralateral homonymous area of the implant site was horizontally mirrored as the individual bone arch contour. According to the relative position of the postoperative buccal grafts and bone arch contour at the implant shoulder, 62 patients were allocated into the outside-contour (OC) and inside-contour (IC) groups. Cone-beam computed tomography was performed before surgery, after implant insertion, before re-entry surgery, and at follow-up. The profilometric changes of the buccal bone plate were analyzed via the bone distance to the mirrored bony contour.

RESULTS

At the implant shoulder, the bone distance in the OC group was higher than that in the IC group, with statistically significant differences at re-entry surgery and follow-up. However, the bone grafts outside the bone arch contour were reduced into the contour after remodeling and showed more bone resorption than the IC group. At other vertical levels below the implant shoulder, bony grafting of overcontour 1-2 mm range was favorable to regenerate stable bone plates reaching the individual contour at follow-up.

CONCLUSIONS

The overaugmented bone outside the buccal bone arch contour tended to remodel into the original contour, which indicates that the anterior bone arch contour is worthy of careful observation for deciding buccolingual implant position and bone augmentation width.

Two adjacent implant-supported restorations in the aesthetic region: A 10-year prospective case series

INTRODUCTION

The treatment outcome of two adjacent implant-supported restorations in the maxillary aesthetic region was assessed regarding peri-implant soft and hard tissues, and satisfaction during a 10-year follow-up period.

METHODS

Twenty patients missing two adjacent teeth in the maxillary aesthetic region and treated with two implant-supported restorations were followed prospectively. The patients' clinical and radiographic parameters, as well as their satisfaction, were scored for a 10-year follow-up period.

RESULTS

Seventeen patients' data were available for the 10-year follow-up. The survival rate of the implants and restorations was 100%. The 10-year mean peri-implant bone change at the side facing the adjacent tooth was +0.11 ± 0.57 mm and at the side facing the adjacent implant was -0.08 ± 0.50 mm. The peri-implant soft tissues were healthy and the patients' satisfaction was high, but the papilla-index showed compromised inter-implant papillae and low Pink Esthetic Scores. These figures were of the same magnitude at all time points.

CONCLUSION

While it is difficult to obtain sufficient inter-implant papillae and satisfactory Pink Esthetic Scores, the initial treatment results remained stable and the patients were satisfied with the final result throughout the 10-year follow-up period.

Contemporary issues in the management of dental trauma

Contemporary diagnosis and management of traumatic dental injuries requires a multifaceted understanding of the pathological and psychological impact over a patient's lifetime. The legacy of dental trauma injuries can have repercussions for the dentition and supporting tissues, requiring complicated multidisciplinary clinical input. Foresight is required to ensure optimal aesthetic and functional outcomes. Mitigating risks and maximising benefits in patients presenting with polytrauma can be challenging, but if optimally managed at the acute presentation, the long-term burden to the patient and the clinician is reduced. This paper aims to discuss the contemporary clinical dilemmas, challenges and controversies related to the management of dental trauma.

Clinical efficacy of transcrestal sinus floor augmentation, in comparison with lateral approach, in sites with residual bone height ≤6 mm: A systematic review and meta-analysis

OBJECTIVE

This paper addressed two focused questions: Focused question 1 (Q1) "what is the clinical efficacy of transcrestal sinus floor augmentation (TSFA), as compared to lateral sinus floor augmentation (LSFA) in sites with residual bone height (RBH) ≤6 mm, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; Focused question 2 (Q2) "what is the estimated effectiveness of TSFA for outcomes in Q1, in RCTs, CCTs or cohort studies?"

MATERIALS AND METHODS

An electronic search (PubMed, EMBASE, The Cochrane Central Register of Controlled Trials) and hand search were conducted from January 1986 until December 2022. All eligible clinical studies expressly reporting TSFA in sites with RBH ≤6 mm were included. The data were extracted, and the risk of bias in individual studies was evaluated. Meta-analysis was performed whenever possible.

RESULTS

Seven RCTs were included for Q1 and 25 studies (9 RCTs, 2 CCTs, 14 single arm cohort studies) for Q2. Q1: Meta-analysis did not show significant difference in the implant survival, sinus membrane perforation and marginal bone loss between TSFA and LSFA groups. Q2: Meta-analysis showed TSFA had a high implant survival rate (96.5%, 95% CI: 93.2%-98.9%) at least 1 year after surgery, and limited sinus membrane perforation (5.4%, 95% CI: 2.7%-8.8%). The results also presented higher patient satisfaction for TSFA.

CONCLUSION

With the limitations of the present study (high risk of bias in individual studies), it can be concluded that there was no significant difference in implant survival, Schneiderian membrane perforation and MBL between two approaches in sites with RBH ≤6 mm.

Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis

AIM

To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness.

MATERIALS AND METHODS

Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models.

RESULTS

Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG.

CONCLUSIONS

VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.

Periplaneta americana extract promotes osteoblast differentiation of human alveolar bone marrow mesenchymal stem cells

OBJECTIVES

This study aims to investigate the effects of Traditional Chinese medicine, Periplaneta americana extract (PAE), on osteoblast differentiation of human alveolar bone marrow-derived mesenchymal stem cells (hABMMSCs).

MATERIALS AND METHODS

Human alveolar bone marrow-derived mesenchymal stem cells were treated with different concentrations of PAE. Cell Counting Kit-8 (CCK-8) assay and transwell migration assay were conducted to evaluate cell proliferation and migration, respectively. Alkaline phosphatase (ALP) staining, ALP activity assay, and Alizarin red S staining were performed to detect osteogenesis in hABMMSCs. In addition, real-time quantitative polymerase chain reaction (RT-qPCR) and western blot (WB) assay were performed to evaluate expression levels of osteogenic markers. Finally, RNA sequencing analysis and WB were carried out to elucidate the underlying mechanism.

RESULTS

A total of 0.1 mg/ml PAE promoted cell proliferation and migration. PAE also increased ALP activity and mineralized nodule formation of hABMMSCs. In addition, PAE upregulated the expression of osteogenesis-related genes (RUNX2, COL1A1, and BGLAP). RNA-sequencing analysis revealed that PAE activated the focal adhesion signaling pathway. Treatment with Defactinib, an inhibitor of FAK, attenuated the effects induced by PAE.

CONCLUSIONS

PAE could enhance osteoblast differentiation of hABMMSCs through focal adhesion signaling pathway, suggesting a therapeutic potential for the alveolar bone defect.

Complications following alveolar ridge augmentation procedures

Oral rehabilitation through implant supported dental restorations often requires a ridge augmentation procedure (RAP) prior to implant fixture placement since tooth extraction/loss results in alveolar ridge deficiencies. Although RAP-related surgical techniques and biomaterials have been in practice for several decades, outcomes are not always predictable. Post-surgical complications experienced during the early or late wound healing phases may jeopardize the targeted ideal ridge dimensions, required for implant fixture placement, and may have other consequences, such as negatively impacting the patient's quality of life. This review describes reported post-surgical complications following RAP under the following subtitles: complications by tissue type, complications in function and aesthetics, complications by healing time, complications by biomaterial type, and complications by surgical protocol modalities. Specifically, RAP performed by using particulate bone graft substitutes and related complications are explored. Modalities developed to prevent/manage these complications are also discussed.

Clinical efficacy of guided bone regeneration in peri-implantitis defects. A network meta-analysis

Guided bone regeneration (GBR) at peri-implantitis-related bone defects involves the placement of bone-filler particles in the intrabony defects and the application of a barrier membrane. The efficacy of different GBR-supported reconstructive measures as well as their potential superiority compared to non-GBR-supported treatment strategies for bone defects at peri-implantitis sites, however, remains unclear. Therefore, this analysis was designed to evaluate the long-term (≥12 months) clinical efficacy of GBR-supported reconstructive surgical therapy for peri-implantitis-related bone defects. In terms of resolving inflammation, the implementation of GBR protocols applying xenogenic bone substitutes yielded a higher reduction of bleeding on probing and probing depth value compared to the GBR protocol applying autogenous bone. Furthermore, for the changes in bleeding on probing and probing depths, GBR approaches using xenogenic bone showed superiority over the non-GBR treatments. Xenogenic bone with or without a barrier membrane was associated with improved radiographic bone levels and less soft tissue recession compared to the use of a GBR protocol implementing autogenous bone. Nonetheless, when interpreting this findings, the limited number of available studies with low to serious risk of bias and the short follow-up periods limited to 12 months should be considered.