International Journal of Periodontics & Restorative Dentistry, 06/2024

This study aimed to determine the correlation between gingival stippling (GS) and other phenotypic characteristics. Adult subjects in need of CBCT scans and comprehensive dental treatment in the anterior maxilla were recruited. Facial gingival thickness (GT) and buccal bone thickness (BT) were assessed utilizing CBCT. Standardized intraoral photographs were obtained to determine keratinized tissue width (KTW), presence of GS in all facial and interproximal areas between the maxillary canines, and other variables of interest, such as gingival architecture (GA), tooth shape, and location. Statistical analyses were conducted to assess different correlations among recorded variables. A total of 100 participants and 600 maxillary anterior teeth constituted the study population and sample, respectively. Facial GS was observed in 56% of men and 44% of women, and it was more frequently associated with flat GA, triangular and square/tapered teeth, central incisors, and men. Greater mean GT, BT, and KTW values were observed in facial areas that exhibited GS. Interdental GS was present in 73% of the sites, and it was more frequently observed in men, in the central incisor region, and when facial GS was present. Multilevel logistic regression revealed a statistically significant association between the presence of GS and KTW, BT measured at 3 mm apical to the bone crest, and tooth type. This information can be used to recognize common periodontal phenotypical patterns associated with specific features of great clinical significance. Keywords: dentition, gingiva, oral mucosa, periodontium, permanent, phenotype

Gingival fenestration is a relatively uncommon soft tissue lesion in which the root apex is exposed in the oral environment after the destruction of the overlying buccal bone plate and mucosa. At present, no clear etiology or treatment guidelines exist for gingival fenestration. This article reports three successfully treated cases of gingival fenestration associated with chronic periapical infection and can help contribute to treatment guidelines for gingival fenestration. All cases were treated with apicoectomy in conjunction with a connective tissue graft (CTG), and the first steps of each case were as follows: endodontic therapy with root-end resection and retrograde filling, then regenerative surgical therapy. However, slightly different regenerative treatment methods were used during the operation according to the different patient conditions. In Case 1, gingival fenestration in the mandibular left first premolar was treated using a xenograft and CTG. In Case 2, gingival fenestration in the maxillary left lateral incisor was treated using advanced platelet-rich fibrin (A-PRF) and CTG. In Case 3, gingival fenestration in the mandibular left second premolar was treated using CTG. Endodontic treatment was combined with periodontal surgery to achieve predictable results. After 13 to 25 months of follow-up, all cases showed well-healed gingival fenestrations and no discomfort. These three cases show the possibility of using apical excision combined with a CTG and/or bone graft/A-PRF in the treatment of gingival fenestration. Reporting these three cases may help advance the field of gingival fenestration treatment. Keywords: apical surgery, bone graft, connective tissue graft, gingival fenestration, platelet-rich fibrin, root canal therapy

This study is aimed to investigate the types of knot failure (untying or breaking) and the tension required to break different suture diameters. A total of 150 knots were fabricated using polyamide sutures with diameters of 6/0, 7/0, and 8/0. The studied knots were either squared or slipped with different numbers of throws (2, 3, 4, 5, and 6), and the following data were recorded: type of failure (untied or broken), number of throws, the tension required to untie or break each knot, slippage, and elongation of the knot. The knots were created in a standardized way with a device and weights, then subjected to a controlled tension. The knots that became untied were: 1=1, 1×1, 2=1, and 2×1, whereas the remaining knots broke. Notably, at least three throws were required to prevent untying, but separately, as in 1=1=1 or 1×1×1. The mean tension needed to break the knots in 6/0, 7/0, and 8/0 sutures were 3.1, 1.3, and 0.6 N, respectively (P < .05), and they were independent of the knot type. The results from this study demonstrate that the knots with geometries of 2=2/2×2 and 1=1=1/1×1×1 were secure, and having additional throws does not increase their security. Further, tensile strength reduces with decreased suture size. Keywords: knots, periodontal microsurgery, sutures, wound healing

A total of 57 interproximal restorations invading the supracrestal tissue attachment were evaluated in terms of crestal bone loss over a mean period of 15 years (10 to 23 years). The distance from the cavity margin to the bone was measured at T0 (after the restoration; baseline) and controlled using radiographs and a measurable landmark. The mean vertical bone loss was 0.46 mm, with a 96.49% survival rate. Smoking habits (P = .02) and tooth type (P = .03) significantly affected bone loss. The proposed technique could help the clinician in adopting a minimally invasive approach in the treatment of heavily compromised teeth. Future research with rigorous study designs would be interesting to guide the clinical decision-making. Keywords: bone loss, crown lengthening, deep margins, direct restoration, prosthetic dentistry, restorative dentistry

Volumetric resorption of the alveolar ridge often occurs in both horizontal and vertical directions following tooth extraction. There is a specific lack of evidence for alveolar ridge reconstruction at molar and premolar sites with severe bone resorption. This randomized controlled trial used 3D and linear analyses to evaluate volumetric changes of the alveolar bone following alveolar ridge reconstruction (ARR) at molar and premolar sites with severe bone resorption as compared to unassisted socket healing before implant placement. A total of 31 patients (15 men, 16 women) with > 50% hard tissue loss in one or more socket walls were recruited and randomized into either a test group (postextraction ARR using deproteinized bovine bone mineral with 10% collagen [DBBM-C] and platelet-rich fibrin [PRF] with a resorbable collagen membrane) or a control group (natural healing after extraction). The clinical, linear, and volumetric implant-related and patient-reported outcomes were analyzed after 4 months of healing. Linear bone assessments revealed significantly greater ridge width gains in the test group (25% in the mesial, midfacial, and distal aspects) and less reduction of vertical bone ridge than in the control group (P < .05). Further, volumetric bone remodeling was significantly higher in the test group (35.1% ± 34.9% for ARR, 14.2% ± 12.8% for control; P < .05). Patient-reported discomfort and keratinized mucosal changes were comparable between groups. ARR with a combination of DBBM-C, PRF, and a resorbable membrane at posterior sites with a severe socket wall deficiency (> 50% bone loss) is a safe and more capable therapeutic method when compared to natural healing and unassisted sockets. Collectively, the present analyses demonstrate that ARR represents an efficient method to maintain and augment crestal bone at posterior extraction sites with severe bone defects when assessed after 4 months of healing. Keywords: alveolar ridge, bone augmentation

Tooth extractions can result in alveolar bone dimensional changes, necessitating additional bone grafting for implant placement. Alveolar ridge preservation (ARP) aims to counteract postextraction changes. This case series evaluates the bone regenerative properties of a freeze-dried bone allograft (FDBA) and the clinical outcomes of implants in grafted extraction sites. A total of 33 patients were enrolled, undergoing single/multiple tooth extractions followed by ARP. Biopsy samples were harvested during implant placement for histologic and histomorphometric analysis. Clinical outcomes included marginal bone loss and pink esthetic score (PES). Twenty-five patients completed the study. FDBA-augmented sockets exhibited new bone formation adjacent to graft particles. Implants (n = 25) showed 100% survival and success rates at 1 and 2 years. PES improved significantly over time (P < .001), while marginal bone loss did not significantly differ at 1 and 2 years (P = .096). Specimens showed trabecular bone, residual FDBA particles, and marrow spaces. High magnification revealed immature bone and woven bone bridges around graft particles. No inflammatory cells were observed. This case series provides valuable insights into ARP performed with FDBA (as implants were placed after 3 months of healing without any additional bone augmentation), the histologic outcomes were favorable, and implants were successful after a 2-year follow-up period. Keywords: allograft, alveolar ridge, case series, dental implants, histology, tooth extractions

Robotic systems have revolutionized various industries, and dentistry is no exception. Recently, due to the robust advancements in artificial intelligence and technology, there has been a significant evolution of dental robotic systems, ranging from surgeon-controlled and robot-assisted operations to more autonomous processes. The present clinical case report describes a 1-year follow-up of the successful use of an autonomous dental implant robot system with an osseodensification protocol for implant osteotomy preparation, maxillary sinus elevation, and simultaneous implant placement at the maxillary second premolar site. A prefabricated provisional prosthesis was delivered immediately after implant placement, with final prosthesis delivery at 3 months. The findings from this report demonstrate the integration and clinical augmentation of more autonomous protocols in the field of implant dentistry using dental robots. Keywords: case report, dental implant, maxillary sinus, osseodensification, robotics surgery

The interforaminal region is considered more favorable for implant placement than the posterior mandible in edentulous patients, mainly because the inferior alveolar nerve can interfere with implant placement in the severely resorbed posterior mandible. However, complications in the interforaminal region may occur due to the presence of the mandibular incisive nerve. This scoping review aims to describe the mandibular incisive nerve anatomy related to the potential interference in implant therapy. A comprehensive literature search was conducted in the following databases: MEDLINE (via PubMed), Web of Science, and Scopus. This scoping review was structured according to the Joanna Briggs Institute method. Thirteen studies were included in the review. All of the studies were observational cohort anatomical studies, carried out mainly by CBCT and on cadavers. A total of 1,471 patients/cadavers were studied. The mandibular incisive nerve was present in 87% to 100% of cases, with an average length of 9.97 mm and an average diameter of 1.97 mm. The mandibular incisive nerve may be damaged during drilling and implant placement, especially when using implant lengths > 12 mm. Damage to the mandibular incisive nerve due to implant placement could be present, but it is necessary to conduct more studies focusing on assessing mandibular incisive nerve damage to understand the clinical relevance of this nerve and its associated morbidities, such as neurosensorial alterations. Due to the different anatomical characteristics of this nerve, CBCT analysis is recommended for implant therapy in the anterior mandible to prevent the described complications. Keywords: dental implant, mandibular incisive canal, mandibular incisive nerve, neuropathy

Choosing between screw-retained and cement-retained restorations in the esthetic zone may significantly impact the restorative contour. This study analyzes the effect of facial-palatal implant positioning on the facial emergence angle of implant restorations in the anterior maxilla. A total of 133 maxillary anterior implant cases were captured with intraoral scans and used to create digital prosthetic designs. The restoration facial emergence angle and the implant depth were determined using images at the midfacial cross section. Simple logistic and linear regression models were used to analyze the interrelation between the emergence angle, depth, and retention methods. The average facial emergence angle for all restorations in this study was 34.4 degrees. A significant difference in emergence angle was found between screw-retained and cement-retained groups, with averages of 37.3 degrees and 27.9 degrees, respectively. There was no difference in the mean depth between the two groups. A strong negative linear relationship between depth and emergence angle was seen for the screw-retained group. Overall, implant positioning in the anterior maxilla has a significant influence on emergence angle. Facial emergence angle is significantly greater for implants in a screw-retained position. This may be partially alleviated by deeper implant placement. Keywords: dental implants, dental prosthesis, emergence angle, implant position

ChatGPT, an artificial intelligence (AI) chatbot, can generate text prompts based on user input. This study investigated the possibility of utilizing this tool to generate adequate and relevant patient educational and management documents in the context of dental implant surgery. A total of 27 periodontists were surveyed on the accuracy and usefulness of AI-generated documents comprising informational handouts for patients on surgical risks and postoperative instruction sheets for dental implant placement in either smokers or patients with diabetes. These periodontists were also asked in a blinded fashion about their preferences between the generic implant placement consent form currently used at Boston University and two AI-generated consent forms, one generic and one tailored to patients with diabetes. A vast majority of participants found that the information in the AI-generated forms was accurate and useful, and they would feel comfortable using them with their own patients. The AI-generated generic consent form performed at least as well as the humanwritten one, while the personalized AI-generated consent form for patients with diabetes performed significantly better (P < .001). Within the limitations of this study, ChatGPT was able to independently generate accurate and useful informational and management documents for patients. Keywords: artificial intelligence, automation, consent, implants, patient education