International Journal of Periodontics & Restorative Dentistry, 03/2025

The use of artificial intelligence (AI) is rapidly expanding. While it comes with some drawbacks, it also offers numerous advantages. One significant application of AI is chatbots, which utilize natural language processing and machine learning to provide information, answer queries, and assist users. AI has various applications, and dentistry is no exception. The authors conducted an experiment to assess the application of AI, particularly OpenAI’s ChatGPT, used with Google Apps Script in various stages of information gathering and manuscript preparation in parallel with conventional human-driven approaches. AI can serve as a valuable instrument in manuscript preparation; however, relying solely or predominantly on AI for manuscript writing is insufficient if the goal is to produce a high-quality article for publication in a peer-reviewed, high-impact journal that can contribute to the advancement of science and society.

Periodontal bony defects are classified as supraosseous (suprabony) or infraosseous (infrabony) according to the location of the base of the defect compared to the coronal part of the residual alveolar crest. Infraosseous defects are generally considered more challenging to treat and are thought to be associated with a higher risk of periodontal progression. The emergence and advancement of regenerative periodontal procedures have improved clinicians’ ability to manage infraosseous defects. However, limitations still exist. This paper reviews the definitions of periodontal osseous defects and provides a new classification framework for infraosseous defects, relating them to the chances of successful regenerative procedures and therefore to their treatment planning options. Infraosseous defects are hereby divided into intrabony and interroot defects. Factors affecting treatment response—such as the number of walls, depth, and extension into buccal and lingual surfaces— are added to the classification framework. Palabras clave: bone loss, infrabony, periodontitis, suprabony

Placing immediate implants in the esthetic zone poses significant challenges. Implants should be placed with consideration to hard and soft tissues to optimize long-term implant and cosmetic success. In this case report, two maxillary central incisors were extracted at two different time points 5 years apart due to horizontal root fractures. Implants were placed according to immediate single-tooth guidelines using two different surgical and loading approaches, as risk assessment factors changed in the time between the first implant placement (right central incisor) and second implant placement (left central incisor). For the first implant placement, the treatment technique included the 10 Keys approach, a checklist of diagnostic, surgical, and restorative guidelines used to pursue long-term success for single-tooth treatment with immediate implant placement and provisionaliza- tion, socket management, and connective tissue grafting. The second implant placement included partial extraction therapy (PET) and conventional healing, as well as immediate implant placement after root shield preparation, an allograft, growth factors, platelet-rich fibrin, and contour management. At the 7-year and 2-year follow-ups, radiographic and clinical results were satisfactory. Palabras clave: dental implants, esthetics, immediate dental implant loading, socket shield technique

This study aimed to collect data on implant survival, bone volume maintenance, and complications associated with the socket shield technique. The socket shield technique was introduced in 2010. Since then, several systematic reviews have been published that show good clinical outcomes. So far, the behavior of the buccal bone plate is not completely understood. The present study involved the placement of 23 implants in 20 patients using the socket shield technique. AstraTech EV im- plants were used, and no bone substitutes or connective tissue grafts were applied. Patients were monitored for 18 months, recording implant survival, volumetric bone analysis on CBCT scans, interproximal bone levels, bone sounding, pink esthetic scores, and complications. Prosthetic procedures were also described, including temporary and final restorations. Using the socket shield technique, a cumulative implant survival rate of 95.7% was obtained after 18 months, with a significant but limited reduction in buccal bone thickness (BBT) after implant placement. One implant did not integrate, and two shields were partially exposed. The mean pink esthetic score at 1 year postloading was 12.93 ± 1.22. The study suggests that the socket shield technique can result in a limited reduction of the buccal bone volume, with a high implant survival rate. Reentry studies are recommended to investigate the causes of bone resorption. Palabras clave: bone preservation, dental implant, immediate implant, implant survival, partial extraction, socket shield

Nonperforated polytetrafluoroethylene (PTFE) membranes are effectively utilized in guided bone regeneration (GBR) but may hinder cell migration due to limited interaction with the periosteum. This study compared bone regeneration using occlusive or perforated membranes combined with acellular collagen sponge (ACS) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in a canine mandibular model. Male Beagle dogs (n = 3) received two mandibular defects each to compare ACS/rhBMP-2 with experimental (perforated group) and control (nonperforated group) membranes (n = 3 defects/group). Tissue healing was assessed histomorphologically, histomorphometrically, and through volumetric reconstruction using microcomputed tomography. The perforated group showed increased bone formation and reduced soft tissue formation compared to the nonperforated group. For the primary outcome, histomorphometric analysis revealed significantly greater total regenerated bone in the perforated group (67.08% ± 6.86%) than the nonperforated group (25.18% ± 22.44%) (P = .036). Perforated membranes had less soft tissue infiltration (32.91% ± 6.86%) than nonperforated membranes (74.82% ± 22.44%) (P = .036). The increased permeability of membranes in the perforated group potentially enabled periosteal precursor cells to have greater access to rhBMP-2. The availability may have accelerated their differentiation into mature bone-forming cells, contributing to the stimulation of new bone production relative to the nonperforated group. Palabras clave: bone regeneration, implants, osteogenesis, periosteum, polytetrafluoroethylene

This case series assessed the efficacy of orthodontic implant site development with labial root torque (OISD-LRT) as a nonsurgical technique for addressing labial bone deficiencies in seven patients. The procedure involved strategically placing a multibracket device 2 to 3 mm apically on the hopeless teeth, gradually shifting them with Ni-Ti wires at the rate of 2 mm per month, and maintaining overcorrection for 2 months before extraction. OISD-LRT consistently augmented tissue for flapless guided implant surgery, with an average treatment duration of 404 ± 311.7 days. CBCT scans at various stages revealed increases in both vertical and horizontal bone dimensions, especially in the sockets with complete labial bone loss. Despite inevitable postextraction reductions in bone height and width, sufficient dimensions were maintained to ensure long-term implant stability. This case series highlights the effectiveness of OISD-LRT as a valuable method for horizontal bone augmentation, particularly in patients with labial bone deficiency. This approach provides a robust foundation for subsequent implant placement, showcasing its success in addressing challenging anatomical conditions and contributing to the broader field of implant dentistry. Palabras clave: alveolar ridge augmentation, case series, dental implantation, implants, orthodontic extrusion, torque

This retrospective study evaluated the clinical outcomes of lithium disilicate prostheses on teeth and implants. A total of 860 restorations, including crowns, veneers, and onlays, were delivered to 312 patients. Patients with uncontrolled gingival inflammation and/or periodontitis were excluded, while patients with occlusal parafunctions were included. The retrospective observational period ranged between 13 and 17 years. The mechanical and esthetic performance of the restorations were rated according to the modified California Dental Association (CDA) criteria. The recorded data were analyzed statistically. In total, 26 mechanical complications were noticed: 17 ceramic chippings, 5 core fractures, and 4 losses of retention. Mechanical complications occurred predominantly in posterior areas; monolithic prostheses showed the lowest percentage of structural problems. The clinical scores of layered and monolithic restorations were fully satisfactory according to the modified CDA rating. The cumulative survival and success rates ranged from 95.46% to 100% and 93.75% to 100%, respectively, up to the 17-year follow-up. Although patient selection and the rigorous application of validated clinical protocols were considered paramount, the use of lithium disilicate prostheses on teeth and implants was reported to be a viable and reliable treatment option in the long term. Palabras clave: adhesive restorations, dental ceramics, dental implant, lithium disilicate, onlay, prosthetic crown, veneer

This case report aims to describe a restorative approach with composite resin applied in reverse in the esthetic resolution of darkened anterior teeth. A 27-year-old woman presented with the main complaint of dissatisfaction with the esthetics of her smile due to dental darkening (a result of childhood trauma) without painful symptoms, pathologic clinical signs, or change in care. The intraoral examination showed a darkening of teeth 11 and 21, which radiographically showed thickening of the periodontal ligament with disharmonious configuration of the marginal gingiva. From the clinical and radiographic characteristics, periodontal intervention was selected for recovery and gingival leveling, followed by endodontic intervention and esthetic restorative restoration. The restorative step was carried out sequentially, comprising internal tooth bleaching, removal of the dentin that was still pigmented after bleaching, and enamel preservation. Soon after, the teeth were restored in an alternative way and layered using a reverse technique, placing strips of polyethylene fiber over the dentin resin. The technique preserved the remaining enamel and maintained the preexisting anterior guidance, proving it a viable and conservative alternative to other restoration methods. Longitudinal success of the restorative efficacy was confirmed after 1 year. Palabras clave: biomimetics, composite resins, dentistry, nonvital, operative, tooth, tooth discoloration

The presence of adequate keratinized mucosa (KM) around dental implants and natural dentition is pivotal for the long-term success of dental restorations. Despite various techniques to augment KM, challenges persist in achieving stable, keratinized, and adherent mucosa, especially in the context of significant muscle pull or compromised tissue conditions. This study introduces a novel application of titanium pins for the fixation of free gingival grafts (FGGs) and apically repositioned flaps (APFs) during vestibuloplasty, aiming to overcome important limitations associated with traditional suturing methods, shorten the treatment time, and reduce patient morbidity. Three patients with insufficient KM width presented discomfort during oral hygiene care and showed inflammation around implant restorations and natural teeth. These patients underwent soft tissue augmentation using titanium pins—traditionally used in guided bone regeneration—to stabilize the FGGs and APFs. This method ensures intimate contact between the graft and the periosteum, which facilitates proper graft perfusion and revascularization, minimizes shrinkage, and reduces the risk of graft necrosis. A postoperative follow-up revealed successful graft integration, with minimal shrinkage and increased KM width and depth. The use of titanium pins allowed for reliable fixation in challenging surgical sites where traditional suturing methods were impractical due to the presence of extensive muscle pull and an unstable recipient bed. The application of titanium pins for the fixation of FGGs and APFs during vestibuloplasty provides a promising alternative to traditional suturing techniques, particularly in complex cases where the recipient bed is suboptimal for suturing. This method simplifies and shortens the procedure, offering a predictable outcome with increased mechanical stability and minimal graft shrinkage. Randomized clinical trials are recommended to further evaluate the efficacy of this technique. Palabras clave: apically repositioned flap, dental implants, free gingival graft, graft survival, periodontal surgery, titanium pins, vestibuloplasty

Creating an osteotomy through a remaining root to place a dental implant is a placement option that offers various advantages. These benefits include more precise drilling with reduced vibration in cases with limited available bone or with anatomical structures (such as the mental foramen and inferior alveolar nerve) in close proximity to the planned osteotomy, as well as facilitating the extraction of an ankylosed tooth following root canal treatment. This case report presents a detailed description of the surgical and restorative procedures involved in placing an implant in a mandibular premolar area. Palabras clave: mandibular premolar implant, mental foramen, osteotomy through the root

The purpose of this review was to evaluate the periodontal and peri-implant tissue responses to restorative approaches with and without a cervical finish line on teeth and dental implants. An electronic search was performed in PubMed/MEDLINE, Embase, Cochrane Library, LILACS, Web of Science, and Scopus databases and in the gray literature. Controlled clinical trials and prospective cohort studies were included. Analyzed outcomes included Gingival Index (GI), bleeding on probing (BOP), probing depth (PD), gingival thickness (GT), marginal stability (MS), and marginal bone loss (MBL). A meta-analysis was then performed in two parts: The first compared the results of restorations on teeth with and without a cervical finish line, and the second compared results of restorations on implant abutments with and without a cervical finish line. Regarding the tooth-based restoration analysis, 7 out of 1,388 selected articles were included in the systematic review, 2 of which were selected for the meta-analysis. For implant-based restorations on abutments with and without a cervical finish line, 6 out of 707 selected articles were included in the systematic review, with 3 included in the meta-analysis. No significant differences in periodontal and peri-implant indices were identified between either prosthetic approach in situations with and without cervical finish lines. Palabras clave: dental implant-abutment design, dental prosthesis, meta-analysis, periodontium, prosthodontic tooth preparation, systematic review