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Autogenous soft tissue grafting is a commonly performed procedure in periodontal and implant surgery. Reharvesting a connective tissue graft (CTG) from the same palatal donor site is often required, but little is known about the volumetric changes that occur after harvesting a free gingival graft and how long the palatal mucosa takes to regain its original form and thickness. This study evaluated the volumetric changes that occur at the palatal donor site after harvesting a soft tissue graft with a noninvasive digital technology. Nineteen patients needing a CTG for a single site were enrolled. Intraoral digital scans of the palatal donor sites were obtained at baseline and at 1, 3, 6, and 12 months. The digital scans were imported and analyzed with an imaging software to evaluate volumetric changes. Average volume losses of 5.82 ± 2.63 mm

Several soft tissue graft materials have been utilized over the years as alternatives to the autogenous connective tissue graft for reducing patient morbidity. In particular, a novel volume-stable xenogeneic collagen matrix (VXCM) has recently been introduced for soft tissue augmentation at implant sites. The VXCM is porous in nature, and its mechanical properties suggest utilizing a specific flap approach when treating multiple adjacent gingival recessions (MAGRs). Herewith, a minimally invasive surgical technique is described in combination with VXCM for treatment of MAGRs. Five patients with 16 MAGRs were treated with this approach. All sites healed uneventfully, and patients reported minimal discomfort. At 6 months, the technique resulted in a mean root coverage of 94.73%, and complete root coverage was achieved in 13 sites (81.25%). The proposed minimally invasive approach may have potential to enhance flap blood supply and graft vascularization, promoting rapid healing with minimal postoperative discomfort. In addition, this approach can result in satisfactory clinical, esthetic, and patient-reported outcomes. Future adequately powered clinical trials are needed to validate the findings of this preliminary report.

Purpose To compare the accuracy of different modalities of implant placement-static fully guided, static half-guided, and freehand surgery-through meta-analysis. Materials and methods A thorough electronic and manual systematic search was conducted to identify applicable randomized clinical trials (RCTs) for evaluating the implant positioning accuracy between different static implant navigation surgeries. The coronal and apical horizontal deviation, vertical deviation, apical angle, and chair time were estimated as the weighted mean differences and standard deviation with confidence intervals. A P value of .05 was set for statistical significance. Results Based on the 10 RCTs that met the inclusion criteria for the quantitative analyses, results from the meta-analyses demonstrated the following: (1) a coronal deviation significant difference favoring the fully guided approach compared with the half-guided (weighted mean difference of -0.51 mm) and freehand approaches (weighted mean difference of -1.18 mm); (2) a significant weighted mean difference between the fully guided and half-guided approaches in relation to the apical deviation (weighted mean difference of -0.75 mm); (3) the vertical comparison did not yield significant weighted mean differences between the fully guided and half-guided techniques (-0.23 mm) and lacked statistically significant difference between the fully guided and freehand techniques (weighted mean difference of -0.17 mm); (4) the apical angle deviation demonstrated a significant weighted mean difference in favor of the fully guided approach compared with the half-guided group (weighted mean difference of -3.63 degrees); and (5) the comparison of chair time between the investigated groups did not exhibit a significant difference in any of the techniques. Conclusion Static fully guided implant navigation surgery has the highest accuracy for transmitting the presurgical positioning planning to the patient, followed by static half-guided surgery, while the freehand implant placement provides the least accuracy.

Several techniques involving the harvesting of a soft tissue graft from the palate have been proposed for regenerating keratinized mucosa (KM) at implant sites. However, patient morbidity and poor esthetic outcomes are considered the main drawbacks of these approaches. Therefore, the aim of this study was to describe and evaluate a new technique for harvesting keratinized tissue from the adjacent labial site (labial gingival graft [LGG]), in combination with a xenogeneic collagen matrix (XCM) or a connective tissue graft (CTG). Eighteen patients were enrolled and participated in this case series. The primary outcomes were KM gain after 12 months and patient-reported satisfaction, esthetics, and morbidity using a visual analog scale (VAS). All treated sites healed uneventfully, showing a mean KM gain of 6.8 ± 2 mm. The average VAS score for patient satisfaction and the self-reported esthetic outcomes were 95.6 ± 6.9 and 93.4 ± 9.2, respectively, and the score for morbidity was 22.8 ± 22.3. However, the VAS score for morbidity dropped to 8.7 ± 8.4 when CTG-treated subjects were excluded. Higher esthetic results were observed when XCM was used instead of CTG and when LGG was harvested from the anterior region of the implant site (P < .05 for both comparisons). LGG with XCM or CTG is a viable technique for regenerating KM at implant sites with high patient satisfaction and esthetics and low morbidity outcomes.

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), that was fixed on the buccal aspect of the ridge using titanium screws, and a mixture of particulate autogenous bone graft and porcine hydroxyapatite. Cone-beam computed tomography (CBCT) scans were taken at baseline and 6 months after bone augmentation. The healing was uneventful, with no intra- or post-operative complications. Twenty-seven dental 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 xenogeneic cortical bone lamina and particulate bone graft can be an effective approach for horizontal bone augmentation prior to implant placement.