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Purpose: Alveolar ridge split (ARS) is ridge augmentation to mitigate ridge width loss that typically follows tooth extraction. This study aimed to determine the efficacy of ARS on alveolar ridge horizontal dimensional changes and the survival rates of implants placed into the same sites. Materials and Methods: An electronic and manual search was conducted for English articles published up to January 1, 2021. The PICO (problem, intervention, comparison, outcome) model for quantitative studies was established to address the following two focused questions: (1) What are the effects of the ARS technique on increasing alveolar width and implant survival?; and (2) what are the factors that influence the efficacy of the ARS technique? The outcome measures in this systematic review and meta-analysis were mean alveolar ridge gain—horizontal (buccolingual) in millimeters from baseline (initial presentation) to final assessment (minimum of 12 weeks after ARS), implant survival rate, and patient-reported complication rate. The risk of bias was evaluated using the ROBINS-I assessment tool for non-randomized interventional studies. Weighted means were calculated, and pooled effects and 95% confidence intervals (95% CI) were depicted on forest plots. Publication bias was assessed by funnel plot and Rosenthal Statistics. A sensitivity analysis was undertaken to assess the primary outcome. Results: Overall, 35 studies met the inclusion criteria and were included in the systematic review. The mean alveolar ridge gain for ARS was 3.06 mm (95% CI: 3.01 to 3.12 mm). A mean gain of 2.99 mm (95% CI: 2.93 to 3.04 mm) was found after sensitivity analysis, excluding one article with a high risk of bias. There were no significant differences in ridge width in the group with bone graft (mean difference [95% CI] of 2.97 mm [2.91 to 3.03 mm]) and in the group without bone graft (mean difference [95% CI] of 3.06 mm [2.92 to 3.20 mm]). The ARS technique demonstrated a 98.17% implant survival rate in 4,446 implants, 4,103 of which were placed at the time of ARS with a 97.72% implant survival rate, and 343 placed in a delayed approach with a 99.14% implant survival rate. The risk of bias was low in 14.2%, low to moderate in 68.5%, moderate in 11.4%, and severe/moderate in 5.7% of the included studies. Conclusions: ARS shows a high implant survival rate in narrow alveolar ridges, adequate horizontal alveolar ridge dimensional gain regardless of adding grafting material, and minimal patient-reported complications. [ABSTRACT FROM AUTHOR]

Complications that occur after maxillary sinus floor augmentation (MSA) can be divided into early and late complications. Early complication is a side effect that occurs during the MSA procedure or during the initial healing period. Usually, late complication refers to a side effect that occurs after 3 weeks of MSA. However, in the longer term, there are cases that occur during the follow-up period after the prosthesis is delivered, and most of them present with peri-implantitis. In the present two cases, sinus graft complications occurred 1–2 years after prosthesis delivery but were independent of peri-implantitis and had atypical features showing asymptomatic results. Although the route of the infection source is unclear, the lesions were presumed to be caused by slow and delayed inflammation of oral bacteria infiltrating the bone graft area of the maxillary sinus. Within the limitations of present case reports, bone defects were successfully managed with a guided bone regeneration (GBR) procedure that included thorough defect degranulation, surface decontamination of exposed implant, and regrafting. Periodic monitoring of radiographic images is required for the detection of unusual sinus graft complications in sinus-augmented sites. [ABSTRACT FROM AUTHOR]

This investigation was designed to evaluate the efficacy of an erbium, chromiumdoped yttrium, scandium, gallium and garnet (Er,Cr:YSGG) laser (laser group) compared to conventional mechanical debridement (control group) in the treatment of peri-implantitis. In a double-blinded, randomized, controlled clinical trial, 32 patients with 88 implants with peri-implantitis were randomly assigned to either group. Statistical analyses were performed at 9 months for both groups. The lasertreated group showed a statistically significant reduction in probing depth (PD) compared to the control group (P = .04), but no statistically significant differences were observed for clinical attachment level gain (P = .29) or reduction of bleeding on probing (P = .09). In the subgroup analysis, mandibular single implants with screw-retained restorations treated with Er,Cr:YSGG demonstrated a statistically significant decrease in PD (P < .05) compared to all other groups. A complete resolution of peri-implantitis was achieved in 21% of implants in the test group and 5% of implants in the control group. Er,Cr:YSGG laser is an efficacious therapeutic tool to treat peri-implantitis, achieving greater PD reduction than conventional mechanical debridement alone. Er,Cr:YSGG laser also showed increased benefits in the treatment of mandibular, screw-retained, and single-unit implants compared to the sole use of conventional mechanical debridement. [ABSTRACT FROM AUTHOR]

Oral piercing habits are associated with various degrees of complications. Tongue piercing increases the risk of gingival recession and infrabony defects, subsequently leading to localized periodontitis. In the case presented, the patient had persistent swelling and suppuration around her mandibular anterior teeth attributed to tongue piercing jewelry that was placed approximately 12 years prior. Intraoral examinations revealed a localized deep pocket, purulent discharge, swelling, plaque accumulation, bleeding on probing, gingival recession, and teeth mobility. The patient was diagnosed with localized stage III, grade C periodontitis. Following full-mouth debridement and the placement of an extracoronal lingual splint, minimally invasive, papillae-sparing incisions were made, and regenerative therapy with bone allograft and collagen membrane was used to manage the infrabony defects. During the 18-month postoperative follow-up, complete soft-tissue healing was observed along with a significant reduction in pocket depth and the absence of bleeding on probing or suppuration. Radiographic evaluation showed evidence of bone fill. The reported case demonstrates how careful diagnosis and treatment planning are crucial for managing different periodontal defects and emphasizes the importance of proficient periodontal management, which can save teeth that would otherwise be extracted and replaced with implant therapy or fixed bridgework. [ABSTRACT FROM AUTHOR]

Introduction: Regeneration of the missing papilla adjacent to single implants in the esthetic zone has always been challenging, despite advances in vertical hard and soft tissue regeneration. Orthodontic tooth extrusion has been shown to effectively gain alveolar bone and gingival tissue. This retrospective study evaluated the effectiveness of orthodontic tooth extrusion on regenerating missing papilla between existing maxillary anterior single implant and its adjacent tooth. Methods: Patients who underwent orthodontic tooth extrusion to regenerate missing papilla adjacent to a single implant in the esthetic zone were included in this study. The gingival phenotype, orthodontic extrusion movement, proximal bone level, dento‐implant papilla level, facial gingival level, mucogingival junction level, and keratinized tissue width, of the extruded tooth were recorded at pre‐orthodontic extrusion (T0), post‐orthodontic extrusion and retention (T1), and latest follow‐up (T2). Results: A total of 17 maxillary single tooth had orthodontic tooth extrusion to regenerate missing papilla adjacent to 14 maxillary anterior single implants in 14 patients. After a mean follow‐up time of 48.4 months, implant success rate was 100% (14/14), with none of the orthodontically extruded teeth being extracted. After a mean extrusion and retention period of 14.3 months, a mean orthodontic extrusion movement of 4.62 ± 0.78 mm was noted with a mean proximal bone level gain of 3.54 ± 0.61 mm (77.0% efficacy), dento‐implant papilla level gain of 3.98 ± 0.81 mm (86.8% efficacy), and facial gingival tissue gain of 4.27 mm ± 0.55 mm (93.4% efficacy). A mean keratinized tissue width gain of 4.17 ± 0.49 mm with minimal mean mucogingival junction level change of 0.10 ± 0.30 mm were observed. The efficacy of orthodontic eruption movement on dento‐implant papilla gain was less in the thin (80.5%) phenotype group when compared with that in the thick (91.5%) phenotype group. Conclusions: Within the confines of this study, orthodontic extrusion is an effective, noninvasive method in regenerating mid‐term stable proximal bone and papilla adjacent to maxillary anterior single implants. Clinical Significance: This retrospective study presents a mid‐term result on orthodontic extrusion as a mean to regenerate dento‐implant papilla defect. The extended retention period following orthodontic extrusion showed stable and efficacious proximal bone and papilla gain. [ABSTRACT FROM AUTHOR]

This case report demonstrates long-term implant stability associated with focal cemento-osseous dysplasia (FCOD). The nature of the cementum-like tissue (CLT) of FCOD around the titanium surface of the implant is described clinically, radiologically, and histologically. A dental implant placed directly into the FCOD lesion was successfully integrated, and the stability was maintained for 15 years. However, at the 16-year follow-up, the implant and a sclerotic mass were removed due to peri-implantitis, and the entire specimen was evaluated with conventional histology and microcomputed tomography. The analysis revealed that the sclerotic mass attached to the implant was CLT that was free of any intervening soft tissue. The implant placed into the FCOD lesion achieved integration similar to that of conventional osseointegration. Rather than bone, the CLT was in direct contact with the titanium surface. The integrity of the union was maintained for up to 16 years. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to evaluate the radiographic changes in sinus mucosal thickness (SMT) in patients with mucosal thickening of odontogenic origin after maxillary molar extraction and lateral sinus augmentation with simultaneous surgical drainage and implant placement. Materials and Methods: Forty‐six patients were included in this study. The changes in SMT were evaluated using cone‐beam computed tomography images produced at four time points: before extraction (T0), before surgery (T1), immediately after surgery (T2), and after prosthesis delivery (T3), and statistical differences between time points were analyzed. The changes in SMT and augmented bone height (ABH) regarding the reason of extraction, smoking, ostial patency, and the presence of postoperative sinusitis were also evaluated. Results: Over time points, SMT gradually decreased (T0: 19.44 ± 9.22 mm, T1: 15.10 ± 8.89 mm, T2: 8.42 ± 6.01 mm, and T3: 4.16 ± 4.91 mm) (p <.05). Five out of 6 patients with ostial obstruction at T1 presented ostial patency at T3. Two patients developed postoperative sinusitis but recovered with medication. Ostial patency at T1, SMT at T1, and reason of extraction did not statistically significantly influence SMT at T3. SMT at T1 had no statistically significant impact on ABH change between T2 and T3. Conclusion: Sinus mucosal thickness was gradually reduced by extraction of compromised teeth and drainage during lateral sinus augmentation. The drainage contributed more to the reduction in SMT. [ABSTRACT FROM AUTHOR]

Background: This randomized, controlled clinical trial aimed to compare the differences in periodontal clinical outcomes, duration of the procedure, and patient's experience between conventional scaling and root planing and erbium-doped: yttrium-aluminum-garnet (Er:YAG) in the treatment of generalized moderate to severe chronic periodontitis or generalized Stages II or III, and Grade B periodontitis based on the Centers for Disease Control (CDC), American Academy of Periodontology (AAP), and European Federation of Periodontology (EFP) definitions.Methods: Thirty subjects were initially recruited. In a split-mouth fashion, right and left sides were randomly allocated into two treatment arms: conventional scaling and root planing (C-SRP) versus laser-assisted scaling and root planing (L-SRP). A blinded examiner recorded clinical measurements at baseline and 3 months. Duration of the procedure was also recorded for each visit, and the patient's experience was assessed with a questionnaire at baseline, 1, and 3 months.Results: The final sample consisted of 26 subjects. Both treatments resulted in overall improvement, but no significant differences were found between modalities for clinical attachment gain or probing depth reduction. The duration of the procedure was approximately half for L-SRP, and postoperative sensitivity was greater in C-SRP.Conclusions: The low-energy protocol with Er:YAG (50 mJ) used for the non-surgical treatment of moderate-severe chronic or Stage II-III, Grade B periodontitis performed in this study population was a treatment modality that yielded similar clinical improvements when compared to conventional scaling and root planing. [ABSTRACT FROM AUTHOR]

Severe atrophy of the maxillary anterior region may make implant placement difficult and, as a result, iatrogenic complications such as nasal floor perforation may occur. The purpose of the present case reports is to present radiographic and nasal endoscopic features in the anterior nasal floor when dental implants were inadvertently perforated into nasal cavities. Between 1996 and 2018, 4 patients recorded with anterior nasal floor perforation with dental implants were followed and reviewed with panoramic radiographs and cone-beam computerized tomography. Also, nasal endoscopic examinations were performed by one otolaryngologist. Four implants in 4 patients were included in this case report. All implants achieved osteointegration and survived for 5–23 years without clinical complications. Three implants did not show any mucosal thickening and only one had minor mucosal thickening as visible on the radiographs. Nasal endoscopy examinations revealed that 3 implants were covered with mucosa and one had threads exposed. Intraorally, only one had clinical signs of peri-implant mucositis. Dental implants that perforated into the anterior nasal floor did not show clinical, radiographic, and nasal endoscopic complications during the long-term follow-up period. Nasal endoscopy was a better diagnostic tool to evaluate the implants perforated into the nasal cavity than conventional panoramic or cone-beam computerized tomography. [ABSTRACT FROM AUTHOR]

Background: Peri-implantitis is a challenging condition to manage and is frequently treated using non-surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri-implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5 mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri-implantitis.Methods: A multicenter, randomized, single-blind, two-arm, parallel Phase-3 study was conducted. Peri-implantitis patients with implant pocket depths (IPD) of 5-8 mm underwent subgingival implant surface debridement followed by repeated bi-weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12 weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24 weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24 week.Results: A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24 weeks, a significant reduction in IPD (P = 0.01) was measured in the ChxC group (1.76 ± 1.13 mm) compared with the control group (1.54 ± 1.13 mm). IPD reduction of ≥2 mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P = 0.03). Changes in gingival recession (0.29 ± 0.68 mm versus 0.15 ± 0.55 mm, P = 0.015) and relative attachment gain (1.47 ± 1.32 mm and 1.39 ± 1.27 mm, P = 0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were < 65 years exhibited significantly better responses (P < 0.02); likewise, non-smokers had similarly better response (P < 0.02). Both protocols were well tolerated, and no severe treatment-related adverse events were recorded throughout the study.Conclusions: Patients with peri-implantitis that were treated with an intensive treatment protocol of bi-weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2 mm as compared with bi-weekly supra-gingival plaque removal. [ABSTRACT FROM AUTHOR]

The aim of this case report is to present a clinical example of successful osseointegration of an implant placed immediately following' extraction of a mandibular left first molar (tooth No. 19) with a horizontal gap of more than 2 mm and implant threads exposed within the socket, with healing by secondary intention without flap closure, bone grafting, or barrier membrane placement. The healing was photographed every day for the first week to provide photodocumentation of early healing and then was subsequently photographed weekly for the first month and monthly for the first 6 months. The outcome showed that osseointegration of an implant placed immediately in a posterior extraction site is possible without having to graft the gap around the implant. [ABSTRACT FROM AUTHOR]

Introduction: This case report documents root coverage after using an acellular dermal matrix (ADM) combined with a tunneling procedure. The photographs and objective clinical measurements are presented to document a gain of new clinical attachment and subsequent creeping attachment. Case Presentation: A 50‐year‐old male who demonstrated around 6 mm of recessions on the direct facial of teeth #6 through #11 had a root coverage procedure using an ADM. After 24 months, >90% of the recession defects at all sites were eliminated. It was noted that creeping clinical attachment began to appear 6 months after initial therapy on teeth #7 through# 11. Conclusion: The delayed creeping attachment seems to be due to the time necessary to vascularize the ADM and the rate of vascularization may vary with different thicknesses of inserted ADM. [ABSTRACT FROM AUTHOR]

In recent years, studies have revealed a possible link between periodontitis and obstructive sleep apnea (OSA). Chronic periodontitis is characterized by the destruction of the supporting tissues of the teeth through complex cascades of inflammatory responses, and OSA seems to share common pathways, acting synergistically. This review article summarizes the literature on the potential association between a chronic oral infection such as periodontitis and OSA and discusses how clinicians can benefit their patients by understanding the commonalities and interplay that may exist between these two disorders.

Orthodontic extrusion or forced eruption has been a treatment modality used to improve future implant sites. A controlled force exerted on a tooth in a coronal direction can enhance both soft-and hard-tissue dimensions of implant recipient sites. However, this seemingly simple and effective treatment may, in fact, result in the loss of bone rather than gain if orthodontic mechanics are used improperly. Such unfavorable outcomes have been discussed in the literature along with various proposed techniques to overcome these poor results. This article is intended to evaluate these techniques and their results by elucidating possible reasons for complications in orthodontic extrusion cases. Also, mechanical aspects of orthodontic extrusion, such as various methods of bracket positioning and wire usage, will be discussed through a report of three clinical cases. [ABSTRACT FROM AUTHOR]

Systemic sclerosis (Scleroderma) is an autoimmune or connective tissue disorder that is characterized by fibrosis of skin, muscles, blood vessels, and other organs such as lungs, kidney and gastrointestinal tract. Scleroderma mainly affects women between the ages of 30 to 50 years and has shown to affect facial and oral structures, such as salivary glands, taste buds, jaw, teeth and periodontium. It can cause limited mouth opening (microstomia), dry mouth (xerostomia), malocclusion, mouth sores, mouth stiffness, jaw pain, periodontal diseases, and tooth loss. This paper reports on the effect of scleroderma on the periodontium of a 39-year-old female. [ABSTRACT FROM AUTHOR]