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Objective: To evaluate the impact of suture removal timing on the clinical outcomes of root coverage procedures. Materials and Methods: In this single-blinded, randomized prospective clinical trial, patients presenting with multiple gingival recessions were allocated into three groups based on the timing of suture removal post-surgery: 1 week (TSR1), 2 weeks (TSR2), and 3 weeks (TSR3). Primary outcomes measured included Percentage of Root Coverage (%RC) and Complete Root Coverage (CRC), among other clinical outcomes. Data were collected at baseline and at 3 and 6 months postoperatively. Results: At 6 months, the %RC was 58.4% (TSR1), 91.5% (TSR2), and 75.7% (TSR3). TSR2 achieved a 28.9% higher %RC than TSR1, while no significant differences were found between TSR2 and TSR3. CRC was 38.2% (TSR1), 78.6% (TSR2), and 62.5% (TSR3). TSR2 resulted in a 5.92-fold increase in CRC compared to TSR1, whereas no significant difference was observed between TSR2 and TSR3. Conclusions: This suggests that a 2-week period before suture removal may optimize root coverage outcomes. However, extending suture removal timing beyond 2 weeks did not confer additional benefits.These findings are specific to the use of polypropylene and the CAF plus connective tissue graft. (ClinicalTrials.gov Identifier [NCT04826653]). Keywords: Root coverage, Gingival recession, Coronally advanced flap, Connective tissue graft

This PRISMA-compliant systematic review aimed to investigate the effect of supportive peri- implant care (SPIC) on peri-implant tissue health and disease recurrence following the non surgical and surgical treatment of peri-implant diseases. The protocol of this review was registered in PROSPERO (CRD42023468656). A literature search was conducted to identify investigations that fulfilled a set of pre-defined eligibility criteria based on the PICO question: what is the effect of SPIC upon peri-implant tissue stability following non-surgical and surgical interventions for the treatment of peri-implant diseases in adult human subjects? Data on SPIC (protocol, frequency, and compliance), clinical and radiographic outcomes, and other variables of interest were extracted and subsequently categorized and analyzed. A total of 8 studies, with 288 patients and 512 implants previously diagnosed with peri-implantitis were included. No studies including peri-implant mucositis fit the eligibility criteria. Clinical and radiographic outcomes were similar independently of specific SPIC features. Nevertheless, a 3-month recall interval was generally associated with a slightly lower percentage of disease recurrence. The absence of disease recurrence at the final follow-up period (mean of 58.7±25.7 months) ranged between 23.3% and 90.3%. However, when the most favorable definition of disease recurrence reported in the selected studies was used, mean disease recurrence was 28.5% at baseline, considered 1 year after treatment for this investigation, and increased to 47.2% after 2 years of follow-up. In conclusion, regardless of the SPIC interval and protocol, disease recurrence tends to increase over time after the treatment of peri-implantitis, occasionally requiring additional interventions. Keywords: dental implants; peri-implantitis; peri-implant mucositis; disease progression; risk factors

Surface decontamination in the reconstructive therapy of peri-implantitis is of paramount importance to achieve favorable outcomes. The objective of this single-center study, derived from a large multicenter clinical trial, was to analyze the electrolytic method (EM) as an adjunct to mechanical decontamination and compare it to hydrogen peroxide (HP), also used as an adjunct to mechanical decontamination, in the reconstructive therapy of peri-implantitis. At the 12-month follow-up (T2), 19 patients (n = 23 implants) completed the study. None of the tested modalities demonstrated superiority in the assessed clinical parameters. Only mucosal recession showed higher stability in the EM group. Similarly, radiographic marginal bone level gain and defect angle changes at T2 did not differ between the evaluated strategies. Notably, disease resolution was ~16% higher for the EM group; however, differences were not statistically significant. Additionally, it was demonstrated that pocket depth and the intrabony component depth at baseline were predictors of disease resolution. EM combined with mechanical instrumentation results in a safe and effective surface decontamination modality in the reconstructive therapy of peri-implantitis. This strategy resulted in a disease resolution rate of ~91%. Keywords: biologic complication, decontamination, dental implants, implant complication, peri-implantitis

The aim of this PRISMA-compliant systematic review was to analyze the evidence pertaining to disease resolution after the treatment of peri-implant diseases with the following PICO question: What is the rate of disease resolution following nonsurgical and surgical therapy for peri-implant diseases in adult human subjects? A literature search to identify studies that fulfilled preestablished eligibility criteria was conducted. Data on primary therapeutic outcomes, including treatment success and rate of disease resolution and/or recurrence, as well as a variety of secondary outcomes were extracted and categorized. A total of 54 articles were included. Few studies investigated the efficacy of different nonsurgical and surgical therapies to treat peri-implant diseases using a set of predefined criteria and with follow-up periods of at least 1 year. The definition of treatment success and disease resolution outcomes differed considerably among the included studies. Peri-implant mucositis treatment was most commonly reported to be successful in arresting disease progression for ≤ 60% of the cases, whereas most studies on peri-implantitis treatment reported disease resolution occurring in < 50% of the implants. Disease resolution is generally unpredictable and infrequently achieved after the treatment of peri-implant diseases. A great variety of definitions have been used to define treatment success. Notably, percentages of treatment success and disease resolution were generally underreported. The use of standardized parameters to evaluate disease resolution should be considered an integral component in future clinical studies. Keywords: dental implant, diagnosis, peri-implant endosseous healing, peri-implantitis, outcome assessment, tooth loss

A clinical observation usually encountered after vestibuloplasty, or after interventions aiming to deepen the vestibule with or without simultaneous free epithelialized grafts in the posterior ridges, is that the vestibule can be subjected to major dimensional changes attributed to the buccinator fiber attachment. Therefore, this study aimed to assess the attachment of the buccinator muscles in relation to other anatomical landmarks. An ex vivo study was performed in cadaver heads to explore the association of fiber attachment in relation to the distance from the crestal aspect of the edentulous alveolar process (CAP) and the vestibular depth (VD), crestal band of keratinized mucosa (KM), and ridge height (RH). Interestingly, VD and KM were found to be strongly correlated. Likewise, VD/ KM and CAP–BUC (CAP to the most coronal insertion of the buccinator muscle) were also correlated. CAP–BUC was negatively correlated with RH. Accordingly, the more atrophic the alveolar ridge (ie, more noticeable in the mandible), the shallower the vestibule, the smaller the crestal band of KM, and the greater crestal attachment of the buccinator muscular fibers. This may be the reason why the graft is subjected to major dimensional changes whenever a free epithelialized graft is performed in the posterior ridges to enhance the peri-implant soft tissue phenotype and deepen the vestibule. Keywords: bone atrophy, buccinator muscle, gingival graft, keratinized mucosa

Background: The treatment of advanced peri-implantitis–related bone defects is often associated with ineffective efforts to halt disease progression. The objective of this case series was to evaluate the performance of reconstructive therapy for the management of advanced peri-implantitis using recombinant human platelet-derived growth factor-BB as an adjunctive biological agent. Materials and methods: A prospective case series study on advanced intrabony peri-implantitis bone defects (≥ 50% bone loss) was performed. Clinical and radiographic variables were collected at baseline (after non-surgical therapy) and 12 months after surgical treatment. Implant surface decontamination of the intrabony component was carried out using titanium brushes and the electrolytic method. Before grafting, recombinant human platelet-derived growth factor-BB was applied on the implant surface. A mixture of mineralised allograft and xenograft hydrated with recombinant human platelet-derived growth factor-BB and covered by a collagen barrier membrane was used for reconstructive therapy. Disease resolution was defined as an absence of bleeding on probing, pocket depth 6 mm and no radiographic evidence of progressive bone loss. Descriptive statistics were performed to assess the effect of treatment on the clinical and radiographic variables. Results: A total of 10 patients exhibiting 13 advanced peri-implantitis-related bone defects were included. Implant survival at the 1-year follow-up was 100%. No major complications occurred during the early healing phase. All the clinical parameters, with the exception of keratinised mucosa, and radiographic parameters yielded statistical significance. In particular, mean pocket depth decreased by 4.5 mm and the mean Sulcus Bleeding Index was reduced by 1.8. Radiographic intrabony defects displayed a significantly narrower, shallower and less angled configuration at the 1-year follow-up. The disease resolution rate at implant level was 61.5%. Conclusion: The surgical reconstructive strategy involving the use of recombinant human platelet-derived growth factor-BB proved to be safe and effective for treating advanced peri-implantitis–related bone defects. Keywords: growth factors, guided bone regeneration, peri-implantitis AM receives fees for lecturing and participating in other education-related events from Straumann (Basel, Switzerland) and SigmaGraft (Fullerton, CA, USA). MHAS was a scientific consultant for Lynch Biologics (Franklin, TN, USA) at the time of inception of this study. The other authors declare no conflicts of interest relating to this study.

Purpose: To assess site-related features of peri-implantitis occurring adjacent to teeth and its association with the proximal periodontal bone level. Materials and Methods: Periapical radiographs were collected from partially edentulous patients exhibiting peri-implantitis adjacent to teeth. The following variables were quantified: intrabony defect width (DW), implant marginal bone loss (MBLi), tooth marginal bone loss (MBLt), implant-tooth distance (ITd), intrabony defect angulation (DA), adjacent periodontal bone peak height (ABPh), and implant-tooth angulation (ITa). A correlation matrix using the Spearman correlation coefficient was created to explore the dependence of these variables. Univariate linear regression analysis was carried out by means of generalized estimating equations (GEE), using MBLt as dependent variable. Results: Overall, 61 patients and 84 implants were included in this study, consisting of a total of 105 implant sites facing adjacent teeth. This resulted in 515 linear and 194 angular measurements. A total of 11 different statistically significant associations were demonstrated between the different variables analyzed. Moreover, the univariate regression analysis revealed significant positive associations between MBLt and MBLi (P = .013) and between MBLt and periodontitis (PD) (P = .014). These associations were confirmed in the multivariate model. Conclusions: Teeth adjacent to untreated peri-implantitis lesions are associated with proximal loss of periodontal support. This finding is more remarkable in scenarios that display short implant-tooth distance. Keywords: peri-implantitis, peri-implant diseases, dental implant, periodontal disease, periodontitis

The goal of this section ist o bring our readers eye-catching and high quality images related to novel techniques, clinical challenges and emerging trends relevant to esthetic dentistry. The section portrays the clinical image, the photographer, the camera and a short caption of the story behind the photograph.

Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria’s organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes. Keywords: dental implant, dental implantation, peri-implant endosseous healing, peri-implantitis Conflict-of-interest statement: The authors declare that they have no direct conflicts of interest. Dr Monje owns royalties to a peri-implantitis kit that includes burs for mechanical detoxi