International Journal of Periodontics & Restorative Dentistry, 04/2025

Peri-implantitis is a common complication among patients receiving implant-supported restorative therapy, and it often requires surgical intervention for effective treatment. Understanding the specific configuration of the 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 (Classes 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 (including soft tissue characteristics, prosthetic design, and implant position in a 3D 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. Schlagwörter: bone regeneration, dental implants, peri-implant defect, peri-implantitis, reconstructive therapy

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. For this double-blind randomized trial with a splitmouth design, 40 participants were selected from a university dental clinic and randomly assigned to receive treatment via an Er,Cr:YSGG laser (2,780 nm) or surgical scalpel. Treatment duration was evaluated, and pain intensity and smile satisfaction were assessed postsurgery. The Dummett Oral Pigmentation Index (DOPI) was used to determine the initial severity of pigmentation and track both reduction and potential repigmentation over time. The Gingival Melanosis Record (GMR) was used to evaluate the presence and extent of pigmentation and monitor recurrence after 1 and 12 months. Both the Er,Cr:YSGG laser and surgical scalpel similarly reduced GMR and DOPI scores over time, without significant differences at 12 months (P > .05). Significant examiner variability was noted in GMR scoring (β = –1.2 for Examiner 2; P < .001). Power analysis indicated a higher confidence for detecting treatment effects in DOPI (75%) compared to GMR (55%). The Er,Cr:YSGG laser required longer surgery times (P < .001), treatment type did not influence postoperative pain levels, and patient smile satisfaction significantly improved (P < .001). Under the present conditions, the 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. Schlagwörter: dental esthetics, gingiva, laser therapy, lasers, melanin, pigmentation

Achieving initial implant stability at a molar extraction site can be challenging due to the bone width and quality, as well as 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 postextraction alveolar ridge preservation/regeneration with bone grafting. Immediate nonocclusal crown placement aids peri-implant tissue maturation for the desired outcome. This retrospective series introduces guidelines for treating sockets based on alveolar septum types. The approach involves immediate dentoalveolar restoration (IDR) and osseodensification (OD) with an autogenous graft for bone preservation. 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 CBCT examinations were performed. Socket width was measured and compared between timepoints. At the follow-up (mean: 23.58 ± 9.70 months), the mean preoperative and postoperative socket widths were 9.51 ± 0.40 mm and 11.16 ± 0.30 mm, respectively (17.35% increase; P < .05). IDR with OD is a predictable approach to treat molar sockets during implant placement. Schlagwörter: alveolar ridge augmentation, bone transplantation, case series, dental implant, immediate dental implant loading, minimally invasive surgical procedure

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 endodonticperiodontal lesions, the periodontal tissue regenerates poorly because of the significant loss of the periodontal ligament and cementum, poor tooth stability, and bone defect morphology that is unfavorable for bone regeneration. To overcome these difficult situations, osteotomy of the replantation bed and tooth replantation with horizontal rotation and deep placement may be performed. In the presented case, in order to improve periodontal regeneration, fibroblast growth factor-2 (FGF2) 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 FGF2 application and orthodontic extrusion. Schlagwörter: endodontic-periodontal lesions, FGF2, fibroblast growth factor-2, orthodontic tooth extrusion, periodontal regeneration, tooth replantation

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. Schlagwörter: case series, dental implants, single-tooth implant, smoking

This study aimed to assess the differential clinical response to step 2 of periodontal therapy and repeated subgingival instrumentation between teeth with suprabony and intrabony defects. Electronic and manual searches were performed to identify studies reporting the differential clinical outcomes of nonsurgical periodontal therapy (NSPT) in the 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. A total of 2,348 articles were initially screened, and a total of 5 articles were finally included. Regarding the primary outcome measure, two studies reported probing pocket depth (PPD) reductions at 6 months after step 2 of periodontal therapy, showing an opposite response of intrabony defects compared to suprabony defects (3.2 ± 1.9 mm intrabony vs 2.2 ± 1.7 mm suprabony in one study, and 0.48 ± 0.42 mm intrabony vs 0.72 ± 0.36 mm suprabony in the other), while one study reported no differences at 3 months. One study showed a negative association between the presence of an intrabony defect and PPD reduction at 9 months after nonsurgical step 3 (P < .05). 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. Schlagwörter: alveolar bone loss, bone resorption, nonsurgical periodontal debridement, periodontal pocket, periodontitis, therapeutics, treatment outcome

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 aims to provide an initial comparison between ATT (test group) and immediate implant treatment (IIT; control group) in terms of volumetric changes and patient-related outcome measures (PROMs). A total of 31 interventions (29 patients) were grouped into two similar cohorts. Measurements were made on the superimposed STL files before and at least 6 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. Volume reduction was 3 to 4 times less in the ATT group than in the ITT group (P < .05). Patients in the ATT group reported higher levels of perceived inflammation than the IIT group (P = .015), though patients rated satisfaction similarly between the two treatments (9+ on a scale of 1 to 10). Although this research should be considered an initial step and requires larger samples and follow-up, it supports the trend of including ATT as an alternative option to IIT in molar replacement. Schlagwörter: comparative clinical study, decision-making, dental autotransplantation, immediate single implant, molar

Digital implant planning—utilizing the convergence of digital surface scanners, CBCT scans, and advanced planning software—has transformed dental implantology. The merging of these datasets through triangulation of landmarks provides a detailed digital model of the dental arches, 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 present article presents a technique utilizing radiopaque markers to overcome scattering effects, ensuring accurate dataset superimposition in the mandible. Schlagwörter: CBCT, guided surgery, implants, scattering

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. Schlagwörter: All-on-4, cross-mounting, digital dentistry, edentulous, full-mouth reconstruction, implants, intraoral scanning, prosthetic dentistry