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Following implant placement, a soft tissue barrier will form at the healing abutment connection called peri-implant mucosa. The dimension of this anatomical structure seems to play a key role in maintaining long-term peri-implant and marginal bone level stability. In its early stages, soft tissue healing is a process involving many cellular and molecular events. Enamel matrix derivative (EMD) may improve and accelerate soft tissue wound healing and inflammatory resolution. In the present split-mouth randomized clinical trial, EMD was used to influence the early phase of soft tissue healing around dental implants placed with a single-stage approach into a completely healed ridge. A total of 60 implants were placed in 30 patients (2 implants per patient, one in the test group and one in the control group). In the test sites, EMD was administered around the healing abutment before soft tissues were sutured. Soft tissue healing index (HI) and secondary endpoints (clinical, radiographic, and patientreported outcomes) were measured. Better outcomes were recorded in patients receiving EMD for all parameters. The present results support the use of EMD to improve and accelerate soft tissue wound healing around implants.

A fully tapered implant was recently introduced to increase primary stability and to be used in challenging situations. Twenty single implants were inserted in maxillary postextraction sockets, from premolar to premolar, and immediately restored. Marginal bone level (MBL) and probing depth (PD) were evaluated over a 12-month follow-up period. All implants osseointegrated, achieving a success rate of 100%. The difference in MBL between implant placement and 1 year later was 0.20 ± 0.04 mm, while PD was 2.82 ± 0.51 mm at 1 year. The data reported here support the use of a fully tapered implant for immediate placement and immediate provisionalization for single-tooth replacements in the esthetic area.

This study evaluated the radiographic alterations that occur in immediate postextraction implants and in delayed implants inserted in a preserved ridge. In group A, an implant was placed immediately after tooth extraction, grafting the bone-to-implant gap. In group B, alveolar ridge preservation was performed after tooth extraction, and delayed implant placement was performed 4 months later. The final follow-up was 1 year after prosthetic loading in both groups. The marginal bone level (MBL) was measured at implant insertion (T1), at loading (T2), and at the final follow-up, 12 months after prosthetic loading (T3). At tooth extraction (T0) and T3, the horizontal ridge width (HW) was measured on CBCT scans at three different levels. No statistically significant differences in MBL or HW were found between the two study groups. The outcomes suggest that it is possible to maintain MBL and alveolar bone volumes regardless of whether the procedure is performed through immediate postextraction implant placement or through delayed implant placement in a preserved ridge.

Soft tissue changes were evaluated over a period of 1 year in 48 patients who required extraction of a single tooth in the anterior maxillary arch (premolar to premolar) and its replacement with an implant. The patients were randomly divided into two groups: In group A, an immediate postextraction implant was placed, and the bone-to-implant gap was filled with bovine bone mineral; in group B, the alveolar ridge preservation technique was performed after extraction, and the implant was placed 4 months later. On the day of tooth extraction (T0) and 1 year after tooth extraction (T1), the soft tissue horizontal width, mesial and distal papillary levels, midfacial gingival level, and Pink Esthetic Score were evaluated in both groups. No significant differences were observed between the groups in any of the considered parameters. Statistically significant differences were found in the soft tissue horizontal width between T0 and T1. The clinical results of the two procedures were similar and comparable over time. When evaluating the stability of the soft tissue contour, and considering the specific indications of the two techniques, it is possible to choose either an immediate implant or an alveolar ridge preservation technique with staged placement.

Ten patients with a diagnosis of generalized chronic periodontitis underwent nonsurgical periodontal therapy performed with the exclusive use of ultrasonic instrumentation and air polishing with erythritol powder. For each patient, four pockets with probing depths (PDs) of 4 to 10 mm were selected as experimental sites, and air polishing was performed either before (Group A) or after (Group B) ultrasonic scaling. PDs and clinical attachment levels significantly improved over a 12-month observation period. No significant difference was observed between the use of air polishing before or after ultrasonic instrumentation. The present clinical protocols could represent a suitable treatment for cause-related periodontal therapy.

The purpose of this randomized clinical study was to evaluate the efficacy of platform-switching (PS) vs platform-matching (PM) implants when paired with a newly designed marginless abutment (MA) vs a conventional abutment (CA) in maintaining peri-implant tissue stability. Marginal bone level (MBL) and probing depth were measured up to 1 year postloading. Eighty implants were inserted in 42 patients and randomly assigned to one of four groups, each with a different implant/abutment configuration: Group 1 (PM+CA), Group 2 (PM+MA), Group 3 (PS+CA), and Group 4 (PS+MA). Data were collected at implant placement (T0), abutment placement (T1), final crown placement (T2), and 1 year postloading (T3). At the 1-year follow-up, MBL was more stable in Groups 3 and 4 compared to Groups 1 and 2. These results suggest that the role played by the implant-abutment connection (PS vs PM) is more important than the type of abutment preparation (MA vs CA).

Soft tissue contour changes were evaluated in 20 patients who underwent immediate implant placement with provisional restoration. The bone-to-implant gap was accurately grafted with xenograft prior to implant placement, and enamel matrix derivative was applied prior to delivery of an immediate screw-retained restoration. No significant differences were observed between baseline and 1 year after implant placement in soft tissue contour measurements and the Pink Esthetic Score. Furthermore, no differences were observed between thin or thick biotypes. It was shown that the use of immediate single-tooth implants with immediate restoration resulted in the maintenance of the soft tissue contour and esthetics when compared to pretreatment independently from the soft tissue phenotype.

Immediate implant placement may represent a possible treatment plan for single tooth restoration. This study evaluated the insertion of osseointegrated implants in intact fresh extraction sockets in the anterior maxilla. The bone-to-implant gap was accurately grafted with a bovine bone mineral prior to implant engagement, and an immediate screw-retained restoration was delivered. After 3 months, the provisional crown was replaced with the definitive ceramic crown. Marginal bone levels remained stable after 1 year. The horizontal ridge dimension was also evaluated at three levels using CBCT scans after 1 year. The horizontal width of the postextraction crest was well preserved independently from the thickness of the buccal bone plate at baseline.

Alveolar ridge preservation is of great importance for successful implant therapy. This study investigated the effects of a xenogeneic tridimensional collagen matrix (CM) in conjunction with deproteinized bovine bone mineral blended with 10% collagen (DBBM-C) on the healing of 12 intact extraction sockets in the esthetic area. Cone beam computed tomograpy examinations revealed nearly stable alveolar ridge dimensions (> 90% of the ridge horizontal dimension was preserved). New bone formation of approximately 45% and adequate resorption of the grafted material were histologically observed. Thus, application of CM together with DBBM-C using minimally invasive flapless approach can preserve the original ridge volume and support bone formation, contributing to adequate bone volume for implant insertion.

Forty-eight single dental implants were inserted 4 months after tooth extraction following ridge preservation (RP; n = 24) or spontaneous healing (EXT; n = 24). During surgery, 1 (7%) of 24 implants in the RP group and 14 (58%) of 24 in the EXT group required additional bone grafting, and the implant stability quotient value was similar in the two groups. The survival rate of the implants in both groups was 100% at the 1-year follow-up. The success rate was 95.83% in the RP group and 91.66% in the EXT group. No statistically significant differences in the marginal bone level were detected between the two groups. Similar outcomes of implants inserted in preserved or spontaneously healed ridges can be anticipated, but the use of an RP procedure reduces the need for further bone augmentation.

In the maxillary arch from premolar to premolar, 26 single dental implants were inserted in fresh extraction sockets and immediately provisionalized. The bone-to-implant gap was grafted with a bovine bone mineral. After 3 months, definitive ceramic crowns were placed. At baseline and after 1 year, the soft tissue horizontal width, mesiodistal papillary level, midfacial gingival level, and pink esthetic score were evaluated. No statistical differences were found between baseline and 1 year for all parameters. Immediate single-tooth implants, with immediate restoration, are capable of maintaining the soft tissue contour and esthetics compared to the pretreatment status.

In 48 postextraction sites, sockets were grafted with bovine bone mineral plus collagen membrane (test) or had spontaneous healing (control). After 4 months, horizontal ridge width reduction was 0.71 mm in the test group and 4.04 mm in the control group, while vertical ridge loss was 0.58 mm and 1.67 mm, respectively. No correlation was found between the thickness of the buccal bone wall and the alveolar bone loss in the test group, while an inverse correlation was found in the control group. Ridge preservation compensated for postextraction alveolar ridge resorption irrespective of the buccal plate thickness, whereas leaving the extraction socket undisturbed may result in alveolar bone loss.

Multiple adjacent recession defects were treated in 32 patients using a coronally advanced flap (CAF) with or without a collagen matrix (CM). The percentage of root coverage was 81.49% ± 23.45% (58% complete root coverage) for CAF sites (control) and 93.25% ± 10.01% root coverage (72% complete root coverage) for CM plus CAF sites (test). The results achieved in the test group were significantly greater than in the control group, indicating that CM plus CAF is a suitable option for the treatment of multiple adjacent gingival recessions.

After tooth extraction, varying amounts of bone resorption occur because of qualitative and quantitative changes at the edentulous site of the alveolar process. The aims of this randomized controlled clinical trial were (1) to compare the postextraction changes in residual ridge dimensions during spontaneous healing with those during socket preservation, (2) to analyze the histologic and histomorphometric aspects of the grafted sockets, and (3) to compare probing procket depth (PPD) and clinical attachment level (CAL) changes at teeth adjacent to extraction sites. Forty-eight teeth were extracted from 41 patients referred for extraction of 1 or more maxillary or mandibular premolars or molars. The edentulous sites were randomly assigned to the control (EXT, extraction alone) or experimental groups (SP, extraction and socket preservation). In the SP group, the sockets were filled with bovine bone mineral and covered with porcine collagen membrane. At baseline and after 4 months, PPD, gingival recession (REC), and CAL were measured at teeth adjacent to the edentulous sites. The changes in ridge dimensions from baseline to 4 months were assessed on dental casts. At 4 months, bone was harvested from the grafted areas in the SP group and the edentulous areas in the EXT group. PPD, REC, and CAL were comparable between groups. However, from baseline to 4 months, the SP group showed significantly less reduction in ridge width (1.04 ± 1.08 mm vs 4.48 ± 0.65 mm, P < .001) and height (0.46 ± 0.46 mm vs 1.54 ± 0.33 mm, P < .001). Histologically, the grafted sockets exhibited various stages of bone maturation and formation without inflammatory responses. No significant difference in the mineralized and nonmineralized fractions was noted between the groups. Socket preservation using bovine bone mineral and porcine collagen membrane considerably limits the amount of horizontal and vertical bone resorption when compared with extraction alone.