Implants with deficient papillae and black triangle are common findings. The treatment of these esthetic complications is considered challenging, and with limited predictability. Therefore, the aim of the present report is to describe a novel technique for papilla augmentation (the "Iceberg" connective tissue graft [iCTG]) after extraction and interproximal bone reconstruction in the anterior region. A 35-year-old patient presented with a hopeless tooth with interproximal clinical attachment loss extending up the apical third of the adjacent tooth. Interproximal bone reconstruction was performed through alveolar ridge preservation by directly applying recombinant human platelet-derived growth factor-BB (rhPDGF-BB) to the exposed root surface of the adjacent tooth. A mixture of autogenous bone chips (obtained from the ramus) and bovine bone xenograft particles, previously mixed with the growth factor, was also used. The patient was able to come back for implant therapy only 2 years later. An incomplete regeneration of the interproximal bone was observed. Therefore, to compensate the interproximal deficiency, the iCTG approach, involving a double layer CTG with different origins, was utilized. Two small grafts from the tuberosity were sutured to the mesial and distal ends of a wider CTG harvested from the palate, aiming at gaining additional volume at the interproximal sites. The composite graft was then sutured on top of the implant platform, with the flap that was then released and closed by primary intention. After conditioning of the peri-implant tissues, the case was finalized with a satisfactory outcome. The described iCTG could be an effective approach for reconstructing peri-implant papilla following interproximal bone reconstruction.

Background: Multiple adjacent gingival recessions (MAGRs) are commonly treated with autogenous grafts. However, several intra- and post-surgical complications have been described following autogenous grafts, leading clinicians to explore the use of different biomaterials for the treatment of these conditions. The aim of the present study was to evaluate the root coverage outcomes of a novel porcine-derived acellular dermal matrix (PADM) in combination with the tunneled coronally advanced flap (TCAF) for the treatment of MAGRs. Methods: Ten patients with 33 type 1 recession defects (RT1) were treated with PADM, in combination with the tunneled coronally advanced flap (TCAF). The outcomes of interest included the mean root coverage (mRC), the frequency of complete root coverage (CRC), changes in keratinized tissue width, volumetric gain at the treated sites assessed with digital intraoral scanning, as well as patient-reported outcome measures. Results: All treated sites healed uneventfully, and no complications were noted throughout the study. At 6 months, a statistically significant reduction in recession was noted at the treated sites, exhibiting an overall mRC of 89.14 ± 19.15% and a CRC of 72.7%. The average volume gain after 6 months was 26.28 ± 11.71 in mm3 (Vol) and 0.63 ± 0.28 in mm (ΔD). The region-specific volumetric analysis revealed an overall higher linear dimensional gain at the Mid-Root aspect (ranging from 0.72 mm to 0.78 mm when assessed 1-4 mm apical to the cemento-enamel junction) compared to the other regions. Conclusions: The present study presents the clinical and volumetric outcomes of PADM, in combination with TCAF for the treatment of MAGRs. A significant amount of volumetric gain was also observed as a result of the treatment at 6 months, along with satisfactory, esthetic and patient-reported outcomes. Schlagwörter: Gingival recession, Acellular Dermal Matrix, Surgical flap, volumetric analysis, optical scanning

Performing soft tissue augmentation (STA) at implant sites to improve esthetics, patient satisfaction, and peri-implant health is common. Several soft tissue grafting materials can be used to increase soft tissue thickness at the second-stage surgery, including human dermal matrices and xenogeneic collagen scaffolds. This study assessed and compared the volumetric outcomes, from second-stage surgery to crown delivery, around implants that received STA with a xenogeneic cross-linked collagen scaffold (XCCS) vs nonaugmented implant sites. Thirty-one patients (31 implant sites) completed the study. Intraoral digital scans were taken at the second stage and prior to crown delivery, and the STL files were imported in an image-analysis software to assess volumetric changes. XCCS-augmented implants showed significantly greater volumetric changes compared to control sites, which showed volume loss. The mean thickness of the XCCS-augmented area was 0.73 mm. There was no difference in patient-reported esthetic evaluations between groups. STA with XCCS provided significantly greater volumetric outcomes compared to nonaugmented sites. Further studies are needed to evaluate the long-term behavior of the augmented peri-implant mucosa and the effects of STA on peri-implant health.

The aim of this prospective case series was to evaluate the efficacy and safety of a xenogeneic cortical bone lamina utilized as a “shell” on the buccal aspect of narrow alveolar ridges for horizontal bone augmentation. Fifteen patients requiring multiple implant restorations at sites with moderate to severe horizontal bone deficiency were consecutively enrolled. Horizontal bone augmentation was performed using a xenogeneic cortical bone lamina (XCBL), which was fixed on the buccal aspect of the ridge using titanium screws, and a mixture of particulate autogenous bone graft and porcine hydroxyapatite. CBCT scans were taken at baseline and 6 months after bone augmentation. The healing was uneventful, with no intra- or postoperative complications. Twenty-seven implants were placed in the augmented sites. The calculated average horizontal bone gain from CBCT scans was 4.79 ± 1.64 mm, 5.59 ± 1.51 mm, and 5.79 ± 2.53 mm at 1-, 3-, and 5-mm reference points apical to the buccal bone crest, respectively. The present case series demonstrated that the shell technique with the XCBL and particulate bone graft can be an effective approach for horizontal bone augmentation prior to implant placement.

Implant esthetic complications can negatively affect a patient's perception of implant therapy and their quality of life. This article discusses the etiology, prevalence, and strategies for the treatment of peri-implant soft tissue dehiscences/deficiencies (PSTDs). Three common scenarios of implant esthetic complications were identified and described, in which PSTDs could be managed without removing the crown (scenario I), with the surgical-prosthetic approach (crown removal; scenario II), and/or with the horizontal and vertical soft tissue augmentation and submerged healing (scenario III).

Purpose: To describe a novel, noninvasive, intraoral optical scanning–based approach for characterising the buccolingual profile of peri-implant tissues using a 3D surface defect map. Materials and methods: Intraoral optical scans of 20 isolated dental implants with peri-implant soft tissue dehiscence in 20 subjects were captured. The digital models were then imported into image analysis software, where an examiner (LM) performed a 3D surface defect map analysis characterising the buccolingual profile of the peri-implant tissues in respect to the adjacent teeth. Ten linear divergence points that were 0.5 mm apart in a corono-apical direction were identified at the midfacial aspect of the implants. Based on these points, the implants were grouped into three different buccolingual profiles. Results: The method for creating the 3D surface defect map of isolated implant sites was outlined. Eight implants displayed pattern 1 (coronal profile of peri-implant tissues more lingual/palatal than their apical portion), six implants exhibited pattern 2 (opposite of pattern 1) and six sites showed pattern 3 (relatively uniform and “flat”). Conclusions: A novel method for assessing the buccolingual profile/position of peri-implant tissues using a single intraoral digital impression was proposed. The 3D surface defect map visualises the volumetric differences in the region of interest compared to the adjacent sites, allowing for objective quantification and reporting of profile/ridge deficiencies of isolated sites. Schlagwörter: dental implant, digital data, optical scanning, pilot study, STL file The authors do not have any financial interests, either directly or indirectly, in the products or information mentioned in this paper.

The aim of this prospective study was to evaluate the efficacy of a cross-linked xenogeneic volume-stable collagen matrix (CCM) in treating gingival recessions (GRs) at teeth presenting with cervical restorations or noncarious cervical lesions (NCCLs). Fifteen patients with esthetic concerns for multiple sites with GRs and cervical restorations were consecutively enrolled. The sites were treated with a coronally advanced flap (CAF) design in combination with a CCM. When present, the previous restoration was removed, and the cementoenamel junction was reconstructed with a composite material. The CCM was stabilized on the root surface(s) previously occupied by the restoration. The CAF was sutured to completely cover the graft. Clinical measurements and intraoral digital and ultrasonographic scans were collected at baseline and at 3 and 6 months postsurgery. Limited postoperative discomfort was reported by patients during the healing. The mean root coverage at 6 months was 74.81%. Average increases in gingival thickness of 0.43 mm and 0.52 mm were observed when measured with ultrasonography 1.5 mm and 3 mm apical to the gingival margin, respectively (P < .05). Relatively high patient-reported satisfaction and esthetics were associated with the treatment outcomes. The treatment resulted in a significant reduction in dental hypersensitivity (mean: 33 VAS points). The present study demonstrated that CAF + CCM is an effective approach for treating GRs at sites with cervical restorations or NCCLs. Int J Periodontics Restorative Dent 2023;43:147–154. doi:

Severe alveolar ridge deficiencies in concomitance with periodontal attachment loss can represent a serious clinical challenge in the context of implant therapy. The present case report describes the management of a complex defect in the esthetic zone via ridge augmentation and periodontal regenerative therapy using a biologic material. A systemically healthy 55-year-old man diagnosed with peri-implantitis around an implant in the maxillary left central incisor position and with severe bone loss on the mesial aspect of the maxillary left lateral incisor underwent several surgical interventions to achieve simultaneous vertical ridge augmentation and periodontal regeneration. These interventions included implant removal, bone augmentation using a composite bone graft (autogenous bone + xenograft particles), and a bioactive protein (recombinant human platelet-derived growth factor), soft tissue augmentation using connective tissue grafts, and peri-implant keratinized mucosa width augmentation via a labial gingival graft strip and a xenogeneic collagen matrix. Substantial gains in vertical bone and clinical attachment were achieved, which allowed for delayed implant placement and subsequent completion of tooth replacement therapy with an implant-supported prosthesis. The present case report demonstrates how simultaneous vertical ridge augmentation and periodontal regeneration can be achieved to manage a challenging clinical situation. Key factors to consider in this type of scenario are proximal bone level, tooth mobility, surgical flap design and management, biomaterial selection, and proper treatment sequencing.

The present study introduces a novel "anatomic recession ratio" (ARR) and evaluates the clinical outcomes of using a tunnel technique (TUN) with a connective tissue graft (CTG) for root coverage (RC). Sixteen systemically healthy patients contributing a total of 33 recession types 1 and 2 were treated with TUN + CTG. The predictive value of a panel of baseline clinical parameters (ARR) on RC was evaluated 12 months postoperatively. At 12 months, mean recession depth decreased from 2.74 ± 0.22 mm to 0.46 ± 0.13 mm (P < .0001); 19 sites (58%) showed complete RC, and the mean RC rate was 88.85% ± 2.73%. The mean ARR value was 0.74 ± 0.3, revealing a positive correlation with RC (r²: 0.73, P < .0001). The 12-month esthetic evaluation resulted in a score of 8.52 ± 1.75 using the root coverage esthetic score. TUN + CTG is effective in reducing recession depth and obtaining good esthetic outcomes. Within the limits of the present study, it may be suggested that ARR has potential as an analytical baseline parameter for RC outcomes with TUN + CTG.

Maxillary sinus wall fenestration at the lateral wall or floor of the sinus can result from many potential factors, such as the repair of oro-antral communication, Caldwell-Luc antrostomy, tooth extraction after an endodontic or periodontal infection that eroded the sinus wall, and the combination of sinus pneumatization and alveolar ridge resorption after teeth removal. When sinus wall fenestration is observed on radiographs, it usually indicates adhesion between the sinus membrane and buccal flap, which makes the reentry surgery for subsequent sinus augmentation challenging. To minimize surgical complications in these challenging scenarios, this paper presents a split-flap surgical technique for the management of soft tissue adhesion between the sinus membrane and alveolar mucosa when attempting a lateral window sinus augmentation.