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This article presents a retrospective case series of implant site development using titanium mesh (Ti-mesh) in the maxilla. A total of 58 mesh procedures in combination with several different bone grafts (allograft, cellular allograft, and bovine xenograft) and biologics (including recombinant human platelet-derived growth factor, autogenous platelet-rich growth factor, and recombinant human bone morphogenetic protein-2) were performed in 48 patients. Ti-mesh guided bone regeneration procedures were performed 2 to 3 months after extraction of nonrestorable/hopeless teeth, and the implants were placed 6 to 8 months postaugmentation. The mean initial ridge width was 2.0 ± 1.0 mm, and the mean horizontal gain after Ti-mesh procedures was 4.7 ± 1.6 mm. The ridge width was first measured on the cross-sectional presurgical CBCT image and then confirmed clinically during surgical procedures. No statistical difference in the horizontal gain was found among different combinations of bone grafts and biomaterials. Ti-mesh exposure occurred 22% of the time. The middle-aged adults (odds ratio [OR] = 8.59; P = .046) and older adults (OR = 16.66; P = .02) had significantly higher chances of mesh exposure compared to young adults. While all implants were successfully placed, about 56% of the implants had2 mm of bone to the facial aspect of the osteotomy and received additional contour augmentation when placed in a prosthetically appropriate position for a screw-retained restoration. This study demonstrates that although Ti-mesh procedures result in significant bone regeneration in narrow alveolar ridges to predictably allow implant placement, the age-related mesh exposure rate and frequency of need for additional contour grafting should be discussed with patients.

Twenty patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a bioabsorbable polylactic acid membrane (PLA group) compared to an acellular dermal matrix membrane guided bone regeneration (ADMG group). An intrasocket corticocancellous allograft plus a facial overlay xenograft was used for both groups. Final crestal ridge width was significantly greater for the ADMG group (P < .05). Soft tissue thickness, conversely, was thicker for the PLA group. Vertical ridge height change increased significantly for the midbuccal site of the ADMG group. Histologic evaluation showed high percentages of vital bone for both groups.

The American Academy of Periodontology and the European Federation of Periodontology developed a new classification system for periodontal diseases in 2017. The next step in its widespread implementation involves training dental students to improve consistency in clinical decisions. This study conducted in 2020-2021 aimed to evaluate knowledge in periodontal diagnosis and treatment planning using the new classification, among first, second, third- and fourth-year dental students at Indiana University School of Dentistry (IUSD), University of Texas School of Dentistry at Houston (UTSD), and University of Louisville School of Dentistry (ULSD).A minimum of 20 dental students per class year from each of the three schools participated. Ten HIPPA de-identified case records and a questionnaire with a fixed list of answer options, comprising two demographic questions and two questions on diagnosis and treatment planning of each case, were presented to the participants. A group of three board-certified periodontists established the answers for all cases which were used to score the appropriateness of diagnosis and treatment planning among the participants.A total of 263 students participated. Overall, 22.6% of IUSD responses, 25.2% of UTSD, and 27.6% of ULSD responses were correct for diagnosis (no statistically significant differences). For the treatment plan, 64.9% of IUSD responses, 66.2% of UTSD, and 68.9% of ULSD responses were correct (no statistically significant differences).Based on the findings from our study, we suggest that additional training be considered to improve the understanding of the 2017 classification of periodontal and peri-implant diseases among dental students.

Twenty patients were randomly assigned to receive either a platform-switched or platform-matched implant to replace a single maxillary anterior tooth. Primary outcome variables were the implant interproximal bone loss, facial recession, and papilla fill at 12 months. The platform-switched group showed crestal bone loss of 0.1 ± 0.3 (mesial) and 0 mm (distal) while the platform-matched group showed losses of 0.6 ± 0.5 mm (mesial) and 0.7 ± 0.7 mm (distal) (P < .05). Facial recessions for the platform-switched and platform-matched groups were 0.1 ± 0.3 mm and 0.4 ± 0.8 mm, respectively.

The selection of surgical techniques and grafting materials is undoubtedly a critical component in the treatment of gingival recession defects. In order to provide top quality care, dental professionals are always in pursuit of treatment modality that provides maximal efficacy and predictability with minimal patient morbidity. The subepithelial connective tissue graft procedure, the gold standard, has been consistently proven to show excellent root coverage, but limited palatal tissue availability and potential morbidity associated with the harvesting process push dental practitioners to seek an alternative. The same holds true for peri-implant tissues—while autogenous grafts have served our purpose well, alternatives that can achieve similar results while avoiding a second intraoral wound (the donor sites) are preferred. The purpose of this review of recent studies is to evaluate the effectiveness and predictability of allografts and xenografts for root coverage procedures and around dental implants. The electronic database search was limited to the past 5 years and to the studies addressing root coverage procedures in the Miller class I and II gingival recession (even though the 2017 International Workshop suggested a new classification, the majority of research projects use the classic Miller classification). Search was also made for studies addressing soft tissue treatment around implants that were published during the same period. A total of 30 human clinical trials involving allografts (mainly acellular dermal matrix and placental membranes) and xenografts (porcine-derived collagen matrix) for treatment of gingival recession and a total of 19 clinical studies using allografts and xenografts to improve soft tissue quality around implants were selected. Based on the selected studies, acellular dermal matrix in combination with various flap designs appears to produce results similar to autogenous grafts in terms of mean root coverage and width of keratinized tissue. Other grafting materials, while less effective compared to autogenous grafts, still show some promise especially in patient-centered outcomes. For soft tissue quality improvement around implant sites, allografts and xenografts in general provide satisfactory clinical results. Multicenter, randomized clinical studies with large numbers of individuals and long-term outcomes may provide the most realistic answer for this topic.

The purpose of this prospective study was to evaluate the success rates and prosthetic complications of implants with a modified sandblasted and acid-etched (SLA) surface inserted for posterior single-implant crown restorations. Final crowns were placed 3 to 4 weeks after surgery, and patient follow-up spanned 10 years in a private practice setting. A total of 22 patients (8 women, 14 men) with 25 posterior implants placed (16 mandible, 9 maxilla) were selected, including only implants for posterior single-implant crowns with insertion torque values of ≥ 35 Ncm at placement. Twenty-one implants passed the reverse torque test at 3 to 4 weeks after implant placement, and final restorations were placed. Three patients (4 implants) had "spinners," and there was one patient dropout after completion of the final restoration. All patients were recalled for clinical exams, digital periapical radiographs, and clinical photos at short-term (≤ 5 years) and long-term (> 5 years) follow-up appointments. The Community Periodontal Index of Treatment Needs was also determined at the initial and follow-up visits. Crestal bone level was measured at crown placement (T1), short-term follow-up (T2; mean: 29.4 months), and long-term follow-up appointments (T3; mean: 114.4 months). Twenty patients (23 implants) returned for examination at T2, and 15 (18 implants) were available at T3. For the 17 implants available at all evaluations, statistically significant bone loss was found from T1 to T2 (0.23 ± 0.30 mm), and the mean crestal bone level appeared stable from T2 to T3. Based on clinical and radiographic findings, the success rate for the implants and restorations at T2 and T3 was graded as 100%. Therefore, it can be stated that an early loading protocol of 3 to 4 weeks using a modified SLA surface at premolar/molar single-tooth locations can result in favorable clinical and radiographic long-term results.

Changes in occlusal vertical dimension (OVD) and age have been found to affect Smile Index (SI, width/height of smile). Limited information is available regarding the aesthetic effects of these changes. The objective of this study was to evaluate the attractiveness of digitally manipulated smile images with differences in SI and incisal edge position (IEP) judged by respondents in different age groups. A total of 12 smile images were generated with varying SI (3·5, 5·3, 7·2, 9·0) and IEP (High, Medium, Low). Fifty respondents each in four age groups (15-24, 25-39, 40-54, 55+) evaluated the attractiveness of the 12 images using a 0-10 visual analog scale (VAS, 10 being most attractive). A repeated-measures three-factorial mixed model assessed differences. SI, IEP and age of respondents were found to significantly influence attractiveness score (P < 0·01 for all). With all age groups combined, SI = 7·2/IEP = Medium was most attractive (VAS = 7·22), followed by SI = 9·0/IEP = Medium, and SI = 5·3/IEP = Medium (VAS = 6·53 and 6·48, respectively). SI = 3·5/IEP = High and SI = 3·5/IEP = Low were least attractive (VAS = 1·99 and VAS = 2·58, respectively). Age group significantly influenced aesthetic perception, with younger respondents more critical in differences in SI and IEP. SI and IEP significantly influenced attractiveness of the smile in all respondent age groups. Low SI (i.e. 3·5) combined with high or low IEP was unattractive. Medium SI to high SI (i.e. 5·3-9·0) combined with medium IEP were considered attractive.

Introduction This case report describes the collaborative management of an extensive combined endodontic-periodontal lesion related to a long palato-radicular groove (PRG) on a maxillary lateral incisor. Cases with similar severity have been reported minimally in the endodontic journals but even less in the periodontal journals. This case report illustrates the result of multidisciplinary treatment of the combined lesions associated with PRG. Case presentation A 63-year-old patient presented with a periapical radiolucency on tooth #10. After evaluation, the patient was diagnosed with an endodontic-periodontal lesion associated with PRG. After being informed of a guarded prognosis, the patient consented to a surgical procedure in an effort to retain the tooth. Management of the case involved a combination of endodontic therapy, odontoplasty under dental operating microscopy to attempt to eliminate the root anomaly, and periodontal regenerative procedures with allografts and a resorbable barrier membrane. Clinical examination and the cone-beam computed tomography scan at a 2-year postoperative visit revealed a substantial reduction in probing depth and significant bone fill of the defect. Conclusions In the past, a long PRG in combination with a periapical lesion often resulted in extraction of the tooth. With accurate assessment of the etiology of the defect, patient education, and a multidisciplinary approach, teeth with a PRG may be retained with a stable outcome for years.