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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

Objectives To evaluate the relationship between gingival phenotype and tooth location based on selected index teeth ("Ramfjord") and assess possible differences between women and men. Material and methods Thirty-six women and 20 men voluntarily participated in this investigation with an average age of 23 years (min: 19; max: 37). Gingival phenotypes (GP) were assessed by transparency of a periodontal probe through the buccal gingival margin. Results A comparable and similar GP on all index teeth was only found in seven out of the 56 subjects, that is, thin or thick only: Five participants (three male/two female) showed a uniform and constantly thick and two females a constantly thin GP. While the majority of molars (94.6%; p = 0.006) showed a thick GP, premolars (61.6%; p = 0.09) as well as incisors (70.5%; p = 0.046) were predominantly categorized as thin. In addition, significantly thicker GP was in general observed for maxillary teeth (p = 0.001) but without differences between genders (p = 0.722). Conclusion No constant GP can be expected within one dentition. The use of the "Ramfjord teeth" may serve as a quick overview and reliable method to screen GP distribution.

Destruction of the alveolar bone in the jaws can occur due to periodontitis, trauma or following tumor resection. Common reconstructive therapy can include the use of bone grafts with limited predictability and efficacy. Romosozumab, approved by the FDA in 2019, is a humanized sclerostin-neutralizing antibody (Scl-Ab) indicated in postmenopausal women with osteoporosis at high risk for fracture. Preclinical models show that Scl-Ab administration preserves bone volume during periodontal disease, repairs bone defects surrounding dental implants, and reverses alveolar bone loss following extraction socket remodeling. To date, there are no studies evaluating Scl-Ab to repair osseous defects around teeth or to identify the efficacy of locally-delivered Scl-Ab for targeted drug delivery. In this investigation, the use of systemically-delivered versus low dose locally-delivered Scl-Ab via poly(lactic-co-glycolic) acid (PLGA) microspheres (MSs) was compared at experimentally-created alveolar bone defects in rats. Systemic Scl-Ab administration improved bone regeneration and tended to increase cementogenesis measured by histology and microcomputed tomography, while Scl-Ab delivered by MSs did not result in enhancements in bone or cemental repair compared to MSs alone or control. In conclusion, systemic administration of Scl-Ab promotes bone and cemental regeneration while local, low dose delivery did not heal periodontal osseous defects in this study.

OBJECTIVE. Alveolar bone defects can be highly variable in their morphology and, as the defect size increases, they become more challenging to treat with currently available therapeutics and biomaterials. This investigation sought to devise a protocol for fabricating customized clinical scale and patient-specific, bioceramic scaffolds for reconstruction of large alveolar bone defects. METHODS. Two types of calcium phosphate (CaP)-based bioceramic scaffolds (alginate/β-TCP and hydroxyapatite/α-TCP, hereafter referred to as hybrid CaP and Osteoink™, respectively) were designed, 3D printed, and their biocompatibility with alveolar bone marrow stem cells and mechanical properties were determined. Following scaffold optimization, a workflow was developed to use cone beam computed tomographic (CBCT) imaging to design and 3D print, defect-specific bioceramic scaffolds for clinical-scale bone defects. RESULTS. Osteoink(™) scaffolds had the highest compressive strength when compared to hybrid CaP with different infill orientation. In cell culture medium, hybrid CaP degradation resulted in decreased pH (6.3) and toxicity to stem cells; however, OsteoInk(™) scaffolds maintained a stable pH (7.2) in culture and passed the ISO standard for cytotoxicity. Finally, a clinically feasible laboratory workflow was developed and evaluated using CBCT imaging to engineer customized and defect-specific CaP scaffolds using OsteoInk(™). It was determined that printed scaffolds had a high degree of accuracy to fit the respective clinical defects for which they were designed (0.27 mm morphological deviation of printed scaffolds from digital design). SIGNIFICANCE. From patient to patient, large alveolar bone defects are difficult to treat due to high variability in their complex morphologies and architecture. Our findings shows that Osteoink(™) is a biocompatible material for 3D printing of clinically acceptable, patient-specific scaffolds with precision-fit for use in alveolar bone reconstructive procedures. Collectively, emerging digital technologies including CBCT imaging, 3D surgical planning, and (bio)printing can be integrated to address this unmet clinical challenge.

Destruction of the alveolar bone in the jaws can occur due to periodontitis, trauma or following tumor resection. Common reconstructive therapy can include the use of bone grafts with limited predictability and efficacy. Romosozumab, approved by the FDA in 2019, is a humanized sclerostin-neutralizing antibody (Scl-Ab) indicated in postmenopausal women with osteoporosis at high risk for fracture. Preclinical models show that Scl-Ab administration preserves bone volume during periodontal disease, repairs bone defects surrounding dental implants, and reverses alveolar bone loss following extraction socket remodeling. To date, there are no studies evaluating Scl-Ab to repair osseous defects around teeth or to identify the efficacy of locally-delivered Scl-Ab for targeted drug delivery. In this investigation, the use of systemically-delivered versus low dose locally-delivered Scl-Ab via poly(lactic-co-glycolic) acid (PLGA) microspheres (MSs) was compared at experimentally-created alveolar bone defects in rats. Systemic Scl-Ab administration improved bone regeneration and tended to increase cementogenesis measured by histology and microcomputed tomography, while Scl-Ab delivered by MSs did not result in enhancements in bone or cemental repair compared to MSs alone or control. In conclusion, systemic administration of Scl-Ab promotes bone and cemental regeneration while local, low dose delivery did not heal periodontal osseous defects in this study.

The aim of this randomized, controlled animal exploratory trial was to investigate the influence of local application of aminobisphosphonate pamidronate during the socket preservation procedure. Mandibular premolars were extracted in five G&ouml, ttingen minipigs. Two animals underwent socket preservation using BEGO OSS (n = 8 sockets) and three animals using BEGO OSS + Pamifos (15 mg) (n = 12 sockets). After jaw impression, cast models (baseline, eight weeks postoperative) were digitized using an inLab X5 scanner (Dentsply Sirona) and the generated STL data were superimposed and analyzed with GOM Inspect 2018 (GOM, Braunschweig). After 16 weeks, the lower jaws were prepared and examined using standard histological methods. In the test group (BEGO OSS + pamidronate), buccooral dimensional loss was significantly lower, both vestibulary (0.80 &plusmn, 0.57 mm vs. 1.92 &plusmn, 0.63 mm, p = 0.00298) and lingually (1.36 &plusmn, 0.58 mm vs. 2.56 &plusmn, 0.65 mm, p = 0.00104) compared with the control group (BEGO OSS). The test group showed a significant difference between vestibular and lingual dimensional loss (p = 0.04036). Histology showed cortical and cancellous bone in the alveolar sockets without signs of local inflammation. Adjuvant application of pamidronate during socket preservation reduces alveolar dimensional loss significantly. Further investigations with regard to dose&ndash, response relationships, volume effects, side effects, and a verification of the suitability in combination with other bone substitute materials (BSMs) are necessary.

To fully regenerate the periodontal tissues remains a challenge in our daily practice. Periodontal regeneration is a complex process involving a series of cellular and molecular events. In the last two decades, significant advances have been made in applying proteins and peptides to treat periodontal osseous defects. Several products are currently available and a few others are under development. Stem cell therapy has also been vigorously investigated for regenerating craniofacial tissues including periodontia. In this chapter, we review the current status of protein- and cell-based therapies for periodontal regeneration, with an emphasis on products that have been tested in clinical studies.

Objectives To explore whether placement of a soft cortical membrane can restore and regenerate the original alveolar ridge contour in deficient sockets. Materials and methods One Beagle dog was used in this proof-of-principle evaluation. In a first intervention, a standardized buccal dehiscence defect was artificially created at the distal roots of the 3rd and 4th mandibular premolars. Four weeks later, following endodontic treatment of the mesial roots, teeth were hemisected and the distal roots were extracted without raising a flap. A cortical membrane (Lamina®, Osteobiol) was placed outside of the bony envelope of the extraction socket to rebuild the buccal bone contour. Afterwards, sockets were filled with a collagen-modified porcine bone graft material (Gen-Os®, Osteobiol) to the level of the surrounding bone height. The socket orifice was closed with a porcine dermal matrix (Derma®). After four months, block specimens containing the socket-sites and remaining roots were retrieved, histologically processed and analyzed. Results Surgery and post-operative healing were uneventful. Histologically, bone formation under the membrane was found, i.e. bony protrusions and ossicles by osteoblasts could be identified. Concomitantly, the membrane showed clear signs of degradation. Bone substitute was well integrated in newly formed bone and resorption of particles was found. Conclusion Three major observations were made in the present proof-of-principle study: (i) regeneration of a compromised socket seems possible when applying the presented approach, (ii) the soft cortical membrane was sufficiently stable to allow for the establishment of the contour and to inhibit soft tissue invasion and (iii) the applied xenogenic graft material was undergoing remodelling processes while allowing adequate bone regeneration.

Ridge-Preservation with a ribose-crosslinked porcine collagen membraneKauffmann FM1, Fickl S11 Department of Periodontology, Julius-Maximilians-University, Wu00fcrzburg, GermanyBackgroundAfter tooth extraction remodelling processes of the extraction socket lead to a deficient bone volume in various cases. If implant placement is planned to reconstruct the edentulous areas, aesthetic problems are frequently seen. Especially in the anterior region these areas present a concave morphology and can lead to second stage surgery. Reducing the bone volume loss at the time of tooth extraction by means of immediate augmentation of the extraction socket (Socket-/Ridge Preservation) could help the surgeon to place the implant in a better position to avoid second stage surgery for the patient.Aim/HypothesisIt is known that volume loss after tooth extraction can be successfully reduced by Socket- and Ridge-Preservation techniques using a combination of bone substitutes covered with a punch graft from the palate. To avoid the second operation area, the author uses a slow-resorbing ribose-crosslinked porcine collagen membrane with comparable results.Materials and MethodsAfter tooth extraction, the extraction socket was cleaned, filled with a bone substitute and covered with a slow resorbing ribose-crosslinked porcine collagen membrane (OSSIXu00ae PLUS, REGEDENT GmbH, Dettelbach, Germany). No complete wound closure was performed. The membrane was exposed from the beginning. To guarantee a sufficient stabilization of the membrane for the healing period, the membrane was placed slightly underneath the elevated tissue. For suturing monofilament sutures were used (Seraleneu00ae, SERAG-WIESSNER GmbH & Co. KG, Naila, Germany). Sutures were removed after 7 days. After 5 months, the implant was placed. The surrounding tissue showed no inflammation or scars. Only a slight resorption was visible.ResultsDuring the ridge preservation procedure as well as during the implantation there were no complications. The membrane remained intact until full soft tissue closure. At reentry for implantation after 5 months, the texture of the membrane was still visible. This verifies the long resorption time of 4-6 months.ConclusionsRibose-Crosslinked porcine collagen membranes can be used for socket- as well as for ridge-preservation techniques. Due to the good clinical results, even after membrane exposure, the author considers the membrane as helpful and easy to use.