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This paper introduces the Continuous Crossing Mattress Periosteal Suture Technique (CMPST), designed to enhance flap adaptation, and maintain the established apical displacement of the flap during various periodontal resective surgeries, particularly restorative-driven (or functional) crown lengthening in multiple teeth at anterior or posteriors areas. This suture technique securely positions the flap apically, just coronal to the bone, anchored at the periosteum, combining the advantages of both continuous and cross-compression sutures without compromising the esthetic results. By eliminating flap mobility, it ensures stable and intimate contact with underlying tissues. Further controlled studies are needed to assess the clinical applicability of this technique compared to other suture techniques. Keywords: Suture techniques, crown lengthening, esthetics, prosthodontics

Despite the various barrier membranes proposed, one of the main challenges for guided bone regeneration (GBR) is space maintenance for large defects as well as ensure adequate blood supply. The presented feasibility case series aims to introduce an original titanium frame (TF) design, customized for each defect, as a modification of well-known principles and materials for GBR, for an enhanced and more predictable horizontal and vertical bone augmentation. Three patients with significant horizontal defects were treated with pre-trimmed TFs to create needed space, a 50%-50% mixture of autograft and bovine xenograft was placed, and then covered with collagen membrane. After 8 months of healing, the sites were reopened, the titanium screws were removed with the frame. An average of 8.0 ± 1.0mm horizontal and 3.0 ± 0.0mm vertical bone gain was achieved at the time of re-entry and implant placement surgery. Bone core biopsy was obtained during the implant placement. Histomorphometric analysis revealed that 42.8% of the sample was new vital bone, 18.8% was residual bone graft particles, and 38.4% was bone marrow like structures. After 3-4 months from implant placement, the implants were restored with provisional crowns and then finalized with zirconia screw-retained crowns. This case series suggests that GBR utilizing TFs with or without collagen membranes can be considered a suitable approach for horizontal and vertical bone augmentation. However, based on only three reported cases, the result should be carefully interpreted.

Peri-implantitis, a common complication among patients receiving implant-supported restorative therapy, often requires surgical intervention for effective treatment. Understanding the specific configuration of 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 (Class 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 (such as soft tissue characteristics, prosthetic design, and implant position in three-dimensional 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. Keywords: bone regeneration, dental implants, peri-implant defect, peri-implantitis, reconstructive therapy

Successful bone augmentation relies on primary wound closure. Labial frenum is a soft tissue that connects the lip to alveolar mucosa or gingiva. However, frenum may exert biomechanical forces to the wound edge, causing wound instability. The aim of this study is to (1) review the frenum composition and classifications; (2) understand the significance of frenum in wound stability upon bone regeneration. An electronic search was conducted through the three online databases together with manual search on studies published until September 2022. A total of 300 articles were identified and 11 studies were included in this review. Two of the included six studies discovered that 35-37.5% of the labial frenum had muscle fibers. Other studies showed that labial frenum was mainly composed of connective tissue with elastic fibers. There are two widely used classifications for frenum based on morphology and position of attachment. No studies specifically evaluated the impact of frenum on bone regeneration. Frenum location intercorrelated with the amount of keratinized tissue, which could influence wound stability. A modified frenum classification for the edentulous ridge and a decision diagram to manage the frenum is proposed for research and evidenced practice.

Purpose: This systematic review and meta-analysis aimed to investigate the clinical outcomes of xenogeneic bone blocks (XBB) used for lateral ridge augmentation, specifically focusing on bone gain, graft survival, and implant survival. Materials and Methods: Data search was conducted in Pubmed, Embase, and ClinicalTrial.gov for randomized controlled trials (RCTs), and prospective cohort studies up to March 1, 2024. Horizontal bone gain (HBG), horizontal bone resorption (HBR), graft survival rate, and implant survival rate were analyzed. Cochrane Risk of Bias Tool 2 and Newcastle-Ottawa Scale were applied to assess the quality and risks of the included studies. Results: Four RCTs and five prospective cohortstudies, comprised 120 graft sites and 141 implants in total were included for the meta- analysis. Non-comparative analysis resulted in a weighted mean horizontal bone gain (HBG) of 4.38 mm and horizontal bone resorption (HBR) of 0.85 mm. Comparative analysis with data from 4 RCTs that paired xenogeneic bone block (XBB) with autogenous bone block (ABB) exhibited a statistically significant greater HBG in XBB, with a mean difference of 0.72mm (95% CI=0.067 to 1.382, p=0.031, I2=28.2%). The weighted graft survival rate for XBB was 91.3% (95% CI = 76.6% to 97.1%, I2 = 58.0 %), and the weighted implant survival rate was 84.3% (95% CI = 72.6% to 91.6%, I2 = 31.6 %). Histologically, mean percentage of mineralized vital bone in XBB ranged from 11.6% to 29.8%, and the resorption rate ranged from 7.3% to 21%. Conclusion: The utilization of xenogeneic bone block for lateral ridge augmentation demonstrates an acceptable survival rate and yields an adequate volume of bone for subsequent implant therapy. Nonetheless, the survival rate of implants placed in ridges augmented with xenogeneic blocks is less favorable when compared to those augmented with autogenous block grafts.

Purpose: The objective of this systematic review and meta-analysis was to examine the impact of titanium base supported single implant restorations on peri-implant conditions. Materials and Methods: Six randomized controlled trials (RCTs), comprising a total of 274 implants that met the inclusion criteria, were chosen for data analysis. A random effects model was employed for the metaanalysis. Results: Data from this study revealed that the Ti-base group exhibited a slightly but statistically significant increase in peri-implant marginal bone loss (difference in means = 0.088, 95% confidence interval = 0.003 to 0.17, p = 0.041) compared to the one-piece-abutment group. These effects were consistent in the subgroup analysis of regular-threaded implants comparing to the microthreaded subgroup. However, no significant differences were observed between the Ti-base group and the abutment group concerning probing depth (PD), bleeding on probing (BOP), and the risk of prosthetic-related complications. Conclusions: The utilization of Ti-base in single-implant supported restoration is associated with a slight increase in peri-implant marginal bone loss, while other periimplant health parameters show no significant correlation. Therefore, to determine the impact of Tibase on peri-implant condition of single implant-supported restoration is insufficient based on the findings of this meta-analysis.

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

Implants with deficient papillae and black triangles are common findings. The treatment of these esthetic complications is considered to be challenging with limited predictability. Therefore, the present report aims 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 to 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 return for implant therapy only 2 years later, at which time an incomplete regeneration of the interproximal bone was observed. Therefore, to compensate the interproximal deficiency, the iCTG approach was utilized, involving a double layer of CTG with different origins. Two small grafts from the tuberosity were sutured to the mesial and distal ends of a wider CTG harvested from the palate, aiming to gain additional volume at the interproximal sites. The composite graft was then sutured on top of the implant platform, and the flap was then released and closed by primary intention. After conditioning the peri-implant tissues, the case was finalized with a satisfactory outcome. The described iCTG could be an effective approach for reconstructing peri-implant papillae following interproximal bone reconstruction.

Purpose: To complete a reanalysis study of two similarly designed prospective controlled studies exploring prognostic factors associated with the surgical outcomes of reconstructive treatment of peri-implantitis. Materials and Methods: Individual patient data of both studies were gathered. The initial study employed a submerged healing approach via primary wound closure with implant suprastructure removal and complete coverage of grafted sites. The second study employed a nonsubmerged healing protocol in which healing abutments were kept in place and the implants were not fully submerged. Both studies measured all prognostic factors at similar time points throughout 1 year and included clinical defect fill (DF) and radiographic defect fill (RDF), reduction of pocket depth (PDR), and bleeding on probing (BoP). Multilevel regression was used for statistical assessment of outcomes relative to the impact of site, local, surgical, and patient-related variables. Results: Overall, 59 implants (30 submerged and 29 nonsubmerged) were treated. Statistically significant higher DF (on average 0.9 mm higher), RDF (1.7 mm), and PDR (1.3 mm) were observed when a submerged reconstructive approach was performed, whereas BoP reduction was similar. After controlling for treatment (submerged/ nonsubmerged), there were no other significant associations with patient-related (age, sex, smoking, prior periodontitis etc), or implant-related (previous prosthesis type, arch, keratinized tissue width [KTW], etc) factors. Conclusions: Within the study’s limitations, we conclude that a submerged reconstructive approach for surgical management of peri-implantitis leads to significantly enhanced clinical and radiographic outcomes when compared to a nonsubmerged approach. 

Multiple adjacent gingival recessions (MAGRs) are commonly treated with autogenous grafts. However, several intra- and postsurgical complications have been described following autogenous grafts, leading clinicians to explore the use of different biomaterials to treat 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. Ten patients with 33 type 1 recession defects (RT1s) were treated with PADM + 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), and patient-reported outcome measures. 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 mm³, and the mean distance between the surface/mean thickness of the reconstructed volume (DD) was 0.63 ± 0.28 mm. The region-specific volumetric analysis revealed an overall higher linear dimensional gain at the midroot aspect (range: 0.72 to 0.78 mm, assessed 1 to 4 mm apical to the cementoenamel junction) compared to the other regions. The present study presents the clinical and volumetric outcomes of PADM + TCAF for the treatment of MAGRs. A significant amount of volumetric gain was also observed at 6 months as a result of the treatment, along with satisfactory esthetic and patient-reported outcomes. Keywords: Gingival recession, Acellular Dermal Matrix, Surgical flap, volumetric analysis, optical scanning