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The aim of this study was to investigate the inter- and intra-examiner agreement among international experts on the diagnosis of gingival recession defects using the 2018 Classification of Gingival Recession Defects and Gingival Phenotype as proposed in the 2017 World Workshop.Standardized intraoral photographs from 28 gingival recession defects were evaluated twice by 16 expert periodontists. Recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ), and presence of root steps (RS) were recorded and used for the analysis. Intra- and inter-examiner agreements were calculated for individual variables and for the overall classification. Intraclass correlation coefficient with 95% CI was used for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT.Overall intra- and inter-examiner agreements were highest for KTW (0.95 and 0.90), lowest for GT (0.75 and 0.41), with the other variables in between (RD: 0.93 and 0.68, RS: 0.87 and 0.65, RT: 0.79 and 0.64, CEJ: 0.75 and 0.57). Overall intra- and inter-examiner agreements for the matrix were 62% and 28%, respectively. Significant effects existed between one variable's measurement and other variables' agreements.The 2018 Classification of Gingival Recession Defects and Gingival Phenotype is clinically reproduceable within the examiners, and when the variables forming the matrix are analyzed individually. The between-examiner agreement for the complete matrix showed lower reproducibility. The agreement was highest for KTW and RD, and least for GT.

The aim of this review is to address the potential applications of allogenous dermal matrix (ADM), as an alternative to subepithelial connective tissue graft (SCTG), in promoting periodontal phenotype modification (PPM) of challenging periodontal-orthodontic clinical scenarios.The rationale behind the need of changing thin to thick gingival tissues is associated to the superior and more stable treatment outcomes promoted by PPM therapy. PPM, via soft tissue grafting, leads to clinical and histological changes of the pre-established original genetic conditions of the gingiva. Although SCTG-based procedures are recognized as the "gold standard" for the treatment of sites requiring root coverage and gingival augmentation, ADM has been recognized as the most suitable alternative to SCTG, particularly in clinical scenarios where the use of autogenous grafts is not possible. Thus, ADM is considered an optimal option for the treatment of patients with a history (or in need) of orthodontic tooth movement, due its two-fold potential indication: (1) the promotion of periodontal soft tissue phenotype modification; and (2) its use, as a barrier membrane, in hard tissues augmentation procedures.ADM is a viable option for soft tissue augmentation, as well as for treatment approaches involving buccal bone gain.Periodontal phenotype modification therapy, when applied in challenging periodontal-orthodontic clinical scenarios, promotes root coverage and prevents the onset and development clinical attachment loss.

A biologic is a therapeutic agent with biological activity that is administered to achieve an enhanced regenerative or reparative effect. The use of biologics has progressively become a core component of contemporary periodontal practice. However, some questions remain about their safety, indications, and effectiveness in specific clinical scenarios. Given their availability for routine clinical use and the existing amount of related evidence, the goal of this American Academy of Periodontology (AAP) best evidence consensus (BEC) was to provide a state-of-the-art, evidence-based perspective on the therapeutic application of autologous blood-derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet-derived growth factor BB (rhPDGF-BB), and recombinant human bone morphogenetic protein 2 (rhBMP-2). A panel of experts with extensive knowledge on the science and clinical application of biologics was convened. Three systematic reviews covering the areas of periodontal plastic surgery, treatment of infrabony defects, and alveolar ridge preservation/reconstruction and implant site development were conducted a priori and provided the foundation for the deliberations. The expert panel debated the merits of published data and exchanged experiential information to formulate evidence-based consensus statements and recommendations for clinical practice and future research. Based on an analysis of the current evidence and expert opinion, the panel concluded that the appropriate use of biologics in periodontal practice is generally safe and provides added benefits to conventional treatment approaches. However, therapeutic benefits and risks range based on the specific biologics used as well as patient-related local and systemic factors. Given the limited evidence available for some indications (e.g., gingival augmentation therapy, alveolar ridge preservation/reconstruction, and implant site development), future clinical studies that can expand the knowledge base on the clinical use of biologics in periodontal practice are warranted.

The aim of this systematic review was to assess the efficacy of three biologics, namely autologous blood-derived products (ABPs), enamel matrix derivatives (EMD) and recombinant human platelet-derived growth factor BB (rhPDGF-BB), in root coverage and gingival augmentation therapy.The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021285917). After study selection, data of interest were extracted. A network meta-analysis (NMA) was conducted to assess the effect of different surgical interventions on the main clinical outcomes of interest (i.e., mean root coverage [MRC%], complete root coverage [CRC%], keratinized tissue width [KTW], gingival thickness [GT] change, and recession depth [RD] reduction).A total of 48 trials reported in 55 articles were selected. All studies reported on the treatment of gingival recession defects for root coverage purposes. Forty-six treatment arms from 24 trials were included in the NMA. These arms consisted of treatment with coronally advanced flap (CAF) alone, EMD + CAF, platelet-rich fibrin (PRF) + CAF, and subepithelial connective tissue graft (SCTG) + CAF. Regarding MRC%, SCTG+CAF was associated with a significant higher estimate (13.41%, 95% CI [8.06-18.75], P 0.01), while EMD+CAF (6.68%, 95% CI [-0.03 to 13.4], P = 0.061) and PRF+CAF (1.03%, 95% CI [-5.65 to 7.72], P = 0.71) failed to show statistically significant differences compared with CAF alone (control group) or with each other. Similarly, only SCTG+CAF led to a significantly higher CRC% (14.41%, 95% CI [4.21 to 24.61], P 0.01), while treatment arms EMD + CAF (13.48%, 95% CI [-3.34 to 30.32], P = 0.11) and PRF+CAF (-0.91%, 95% CI [-15.38, 13.57], p = 0.81) did not show significant differences compared with CAF alone or with each other. Differences in the CI of PRF+CAF (symmetrical around a zero adjunctive effect) and EMD+CAF (non-symmetrical) suggest that EMD could have some additional value compared with PRF. Treatment with SCTG+CAF led to a statistically significant higher RD reduction (-0.39 mm, 95% CI [-0.55 to 0.22], P 0.01), however EMD+CAF (-0.13 mm, 95% CI [-0.29 to 0.01], P = 0.08) and PRF+CAF (-0.06 mm, 95% CI [-0.23 to 0.09], P = 0.39) failed to show significant differences compared with CAF or with each other. While SCTG+CAF was associated with a statistically significant higher gain of KTW (0.71 mm, 95% CI [0.48 to 0.93], P 0.01), EMD+CAF (0.24 mm, 95% CI [-0.02 to 0.51], P = 0.08) and PRF+CAF (0.08 mm, 95% CI [-0.23 to 0.41], P = 0.58) did not result into significant changes compared with CAF alone or with each other. Regarding the use of rhPDGF-BB+CAF, although available studies have reported equivalent results compared with SCTG+CAF, evidence is very limited.The use of ABPs, EMD, or rhPDGF-BB in conjunction with a CAF for root coverage purposes is safe and generally promotes significant improvements respective to baseline clinical parameters. However, the adjunctive use of ABPs and EMD does not provide substantial additional improvements in terms of clinical outcomes and patient-reported outcome measures to those achieved using CAF alone, when baseline KTW is2 mm. Both PRF+CAF and EMD+CAF rendered inferior MRC%, CRC%, RD reduction, and KTW gain compared with SCTG+CAF, which should still be considered the gold-standard in root coverage therapy. Although some studies have reported equivalent results for rhPDGF-BB+CAF compared with the gold-standard intervention, limited evidence precludes formal comparisons with CAF or SCTG+CAF that could be extrapolated to guide clinical practice.

The aim of the study was to identify and report outcome measures and methods of assessment on soft-tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years.The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified and the frequency of reporting in the selected articles was calculated. Additionally, risk of bias assessments were performed for individual articles and primary outcomes.Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 reported non-RCTs, and 33 reported case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, esthetic, histologic, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft-tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed.Clinical research on peri-implant soft-tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally underreported but should be considered an integral methodological component in future clinical studies.

Different types of errors and complications may arise during and after the execution of periodontal or implant-related procedures. Some of the most relevant, although also controversial, and less commented, causative agents of errors and complications are methodological biases and bad interpretation of the evidence. Proper assessment of the literature requires of solid clinical knowledge combined with a systematic approach built on the recognition of common methodological biases and the avoidance of interpretive errors to critically retrieve, dissect, and judiciously apply available information for the promotion of periodontal and peri-implant health. This review addresses common types of methodological bias and interpretive errors that can alter the reader's perceptions on the real effect and potential ramifications of the reported outcomes of a given therapeutic approach due to bad interpretation of the available evidence: (1) types of methodological biases; (2) spin and interpretive bias; (3) interpretation pitfalls when assessing the evidence (4) choice of relevant endpoints to answer the question(s) of interest; and (5) balance between statistical significance and clinical relevance.

Autologous connective tissue graft (CTG) is generally considered the gold standard for peri-implant soft tissue phenotype modification and root coverage therapy. The presence of epithelial remnants in CTG has been associated with complications after soft tissue augmentation surgery. However, a specific method for de-epithelization that is patently superior has not been identified yet. This study aimed to evaluate the effectiveness of two different approaches to de-epithelialize CTG samples harvested from the posterior palate.Patients in need of periodontal or implant-related surgery that required harvesting a CTG from the posterior palate region were recruited. CTG samples harvested with an indirect approach were de-epithelialized using either an intraoral (IO group) or an extraoral (EO group) method. Tissue specimens were subsequently processed for histological analysis. The presence or absence of oral epithelial remnants was determined by two examiners using light microscopy.Twenty-four patients, who provided a total of 46 analyzable CTG samples, were enrolled in this study. Histological assessment revealed that 19 out of 22 samples in the IO group were free of epithelial remnants. In the EO group, 20 out of 24 samples did not exhibit epithelial residues. These results translate into 86.4% and 83.3% of epithelium-free samples in the IO and EO groups, respectively.Although the intraoral method may provide several practical advantages compared to the extraoral technique, both approaches for de-epithelialization of CTG samples harvested from the posterior palate region tested in this study were comparably effective. However, none of these methods ensured complete removal of the oral epithelium in a predictable manner, which should be taken into consideration in clinical practice. This article is protected by copyright. All rights reserved.

To evaluate the effectiveness of the use of adjuvant ozone therapy in the healing process of wounds resulting from periodontal and peri-implant surgical procedures by answering the following focused question: "Can adjuvant ozone therapy improve wound healing outcomes related to periodontal and peri-implant surgical procedures?".MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, without language restriction, for peer-reviewed articles published until 23 March 2022, in addition to manual search. Only controlled clinical trials (randomized or not) were considered. The risk of bias was evaluated by the Cochrane risk-of-bias tool for RCTs - version 1 (RoB1). Data were pooled into evidence tables and a descriptive summary was presented.Of the 107 potentially eligible records, only seven studies were included. Four addressed free/deepithelialized gingival grafts with a palatal donor area, two evaluated implant sites, and one comprised gingivectomy and gingivoplasty. A total of 225 patients were evaluated in the included studies, considering control and test groups (ozone and other adjuvant therapies for comparison). Ozone therapy had a positive effect on outcomes directly or indirectly related to periodontal/peri-implant surgical wound healing. Furthermore, it could also increase the stability of immediately loaded single implants installed in the posterior mandible.In general, ozone therapy seems to both accelerate the healing processes of periodontal/peri-implant wounds and increase the secondary stability of dental implants; however, considering the limited evidence available and the risk of bias in the included studies (none classified as low risk), a definitive conclusion cannot be drawn.

The occurrence of errors, complications, and adverse effects may occur as a consequence of single or multiple events related to the clinician and/or patient. Apparently, the amount of dental literature on these undesirable outcomes has not been as prolific as that obtained for conventional primary periodontal outcome measures. This review explores the potential reasons for the lack of studies reporting on errors and complications in periodontal and implant therapy, as well as other noteworthy methodological aspects, to enlighten their impact on the selection of the best (or most appropriate) "gold standard" periodontal/implant-related treatment options, and on the overall decision-making process. The following points were addressed: (a) the importance of reporting errors and complications in clinical research; (b) the adequate reporting of errors and complications in periodontology and dental implantology; and (c) efficacy trials vs effectiveness studies and their impact on the assessment and report of periodontal and implant treatment-related risks and complications.

The assortment of periodontal and implant-related treatments has been continuously improved over the last 50 years. Once the decision-making process has been established and the treatment procedure applied, the partial or complete resolution of the problem (eg, periodontal probing depth reduction, clinical attachment level gain, gingival recession reduction, dental hypersensitivity decrease) and a diagnosis change with no or minimal occurrence of adverse events (ie, complications, harms, technical errors, or adverse/side effects) can be expected. The clear identification of the potential types of adverse effects, complications, or even errors is important for contemporary decision-making processes, as they may be related to different local, systemic, and technical aspects. This chapter focused on four core components: (a) providing periodontal definitions for errors, complications, harms, and side effects; (b) defining the types of risk and the clinical impact of adverse effects, errors, and complications in periodontal and peri-implant therapies; (c) evaluating the influence of accidental errors versus the lack of a proper treatment planning; and (d) reporting on the importance of establishing the "net benefit ratio" between the clinical improvements promoted by the therapy and the occurrence of potential adverse events.

Oral conditions are highly prevalent worldwide. Recent studies have been supporting a potential bidirectional association of oral disorders with systemic noncommunicable diseases (NCDs). Robust evidence supports the greater prevalence of oral conditions in people suffering from NCDs limiting the ability of oral self-care. As for the relationship with other NCDs, the lines of evidence have increased exponentially but not always with the proper coherence. This umbrella review of meta-analyses appraises the strength and validity of the evidence for the association between oral health and systemic health. An extensive search included systematic reviews that have provided meta-analytic estimates on the association of an oral condition with a NCD. The overall strength of evidence was found to be unfavorable and with methodological inconsistencies. Twenty-two NCDs, four types of cancer and circulating levels of CRP were strongly associated with oral diseases. Among the significant NCDs are diabetes mellitus, cardiovascular diseases, depression, neurodegenerative conditions, rheumatic diseases, inflammatory bowel disease, gastric helicobacter pylori, stroke, obesity, diabetes mellitus or asthma. Most evidence is unlikely to change which indicates a relatively robust consistency of the available body of evidence.

Aim To analyse the evidence pertaining to post-extraction dimensional changes in the alveolar ridge after unassisted socket healing. Materials and methods The protocol of this PRISMA-compliant systematic review (SRs) was registered in PROSPERO (CRD42020178857). A literature search to identify studies that fulfilled the eligibility criteria was conducted. Data of interest were extracted. Qualitative and random-effects meta-analyses were performed if at least two studies with comparable features and variables reported the same outcome of interest. Results Twenty-eight articles were selected, of which 20 could be utilized for the conduction of quantitative analyses by method of assessment (i.e. clinical vs radiographic measurements) and location (i.e. non-molar vs molar sites). Pooled estimates revealed that mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed clinically in non-molar sites was 2.73 mm (95% CI: 2.36-3.11), 1.71 mm (95% CI: 1.30-2.12) and 1.44 mm (95% CI: 0.78-2.10), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in non-molar sites was 2.54 mm (95% CI: 1.97-3.11), 1.65 mm (95% CI: 0.42-2.88) and 0.87 mm (95% CI: 0.36-1.38), respectively. Mean horizontal, vertical mid-facial and mid-lingual ridge reduction assessed radiographically in molar sites was 3.61 mm (95% CI: 3.24-3.98), 1.46 mm (95% CI: 0.73-2.20) and 1.20 mm (95% CI: 0.56-1.83), respectively. Conclusion A variable amount of alveolar bone resorption occurs after unassisted socket healing depending on tooth type.

To analyze the outcomes of static computer-aided implant placement (sCAIP) compared to partially guided (PGIP) and free-handed (FHIP) implant placement.This study was registered in PROSPERO (CRD42019131397). A comprehensive literature search was performed by two independent examiners. Only randomized controlled trials (RCTs) were selected. Treatment modalities included sCAIP, PGIP, and FHIP. Data pertaining to the outcomes of interest were extracted. Random-effects meta-analyses were feasible for a subset of outcomes.From an initial list of 2,870 records, fourteen articles for a total of ten RCTs were selected. Data from 7 of these studies allowed for the conduction of three meta-analyses comparing accuracy of implant placement across modalities. Survival rate up to 12 months post-loading was high (98%) and comparable between treatments (low-quality evidence). No tangible differences in terms of patient perception of intra- or postoperative discomfort were observed (low-quality evidence). Quantitative analyses revealed significantly lower angular (MD = 4.41°, 95% CI 3.99-4.83, p .00001), coronal (MD = 0.65 mm, 95% CI 0.50-0.79, p .00001), and apical (MD = 1.13 mm, 95% CI 0.92-1.34, p .00001) deviation values for sCAIP as compared to FHIP (8 studies, 383 patients, 878 implants, high-quality evidence). A similar discrepancy, in favor of sCAIP, was observed for angular deviation only as compared to PGIP (MD = 2.11°, 95% CI 1.06-3.16, p .00001).sCAIP is associated with superior accuracy compared to PGIP and FHIP.

OBJETIVO: Avaliar a falha e a taxa de contato osso-implante de implantes dentários colocados em indivíduos osteoporóticos. MÉTODOS: Estratégias de exame extensas foram criadas para classificar os estudos para esta revisão sistemática. O banco de dados MEDLINE ( via PubMed) e EMBASE foram examinados para estudos em inglês até maio de 2014. O exame apresentou uma combinação das palavras MeSH descritas a seguir: "osteoporose" ou "osteopenia" ou "deficiência de estrogênio" AND "implante" ou "implante dentário" ou "osseointegração". Avaliação das condições clínicas e / ou histológicas do peri-implante em indivíduos com osteoporose tratados com implantes dentários de titânio. O exame incluiu uma combinação dos termos MeSH descritos a seguir: "osteoporose" ou "osteopenia" ou "deficiência de estrogênio" AND "implante" ou "implante dentário" ou "osseointegração". RESULTADOS: Dos 943 artigos potencialmente elegíveis, 12 foram incluídos no estudo. Um total de 133 indivíduos com osteoporose, 73 indivíduos com diagnóstico de osteopenia e 708 indivíduos saudáveis ​​foram avaliados nesta revisão sistemática. Nesses sujeitos foram instalados 367, 205, 2981 implantes dentários em indivíduos osteoporóticos, osteopênicos e saudáveis, respectivamente. A taxa de falha do implante dentário foi de 10,9% nos indivíduos osteoporóticos, 8,29% nos osteopênicos e 11,43% nos saudáveis. O contato osso-implante obtido a partir de implantes recuperados variou entre 49,96% a 47,84%, para osteoporose e indivíduos não osteoporóticos. CONCLUSÃO: Os indivíduos osteoporóticos apresentaram maiores taxas de perda de implantes, no entanto, há uma evidência menor para fortalecer ou refutar a hipótese de que a osteoporose possa ter efeitos prejudiciais na cicatrização óssea. Consequentemente, as conclusões finais sobre o efeito da osteoporose na terapia com implantes dentários não podem ser feitas no momento. Não existem ensaios clínicos randomizados acessíveis para avaliação e a natureza retrospectiva dos estudos avaliados deve ser levada em consideração na interpretação deste estudo.

Aim: The use of recombinant human platelet-derived growth factor–BB (rhPDGF) has received Food and Drug Administration approval for the treatment of periodontal and orthopedic bone defects and dermal wound healing. Many studies have investigated its regenerative potential in a variety of other oral clinical indications. The aim of this systematic review was to assess the efficacy, safety, and clinical benefit of recombinant human platelet-derived growth factor (rhPDGF) use for alveolar bone and/or soft tissue regeneration. Material and Methods: Comprehensive electronic and manual literature searches according to the PRISMA guidelines were performed to identify interventional and observational studies evaluating the regenerative applications of rhPDGF-BB. The primary outcomes were the safety, efficacy, and overall clinical benefit of rhPDGF use in oral regenerative procedures. Results: Sixty-three human clinical studies (mean ± SD follow-up period of 10.7 ± 3.3 mo) were included in the qualitative analysis. No serious adverse effects were reported in any of the 63 studies, aside from the postoperative complications routinely associated with surgical therapy. Use of rhPDGF was shown to be beneficial when combined with allografts, xenografts, and alloplasts (the latter tricalcium phosphate [β-TCP]) for the treatment of periodontal defects and gingival recession. The use of rhPDGF also led to favorable clinical outcomes when combined with allografts or xenografts for guided bone regeneration (GBR) and alveolar ridge preservation. While favorable clinical results support the use of the combination of rhPDGF plus allograft or xenograft for GBR, ARP, and sinus floor augmentation, current data support the use of rhPDGF and alloplasts (e.g., β-TCP) only in periodontal defects and gingival recession. Conclusions: Based on the clinical evidence, rhPDGF is safe and provides clinical benefits when used in combination with bone allografts, xenograft, or β-TCP for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for GBR and ARP (PROSPERO CRD42020142446). Knowledge Transfer Statement: Clinicians should be aware that rhPDGF is a safe and effective approach for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for bone regeneration and alveolar ridge preservation. With consideration of cost and patient preference, this result could lead to more appropriate therapeutic decisions.

Objective To estimate the impact of nonsurgical periodontal treatment (NSPT) on patients’ oral health-related quality of life (OHRQoL). The focused question for this systematic review was: in adults patients with periodontitis, does NSPT improve oral health-related quality of life? Material and methods Five databases (PubMed, CIHNL, EMBASE, LILACS and CENTRAL) were searched up to April 2019 (PROSPERO CRD42018103393). Intervention trials and cohort studies assessing the OHRQoL data of adults with periodontitis, enduring non-surgical periodontal treatment (NSPT) were eligible for inclusion. Subgroup random-effects meta-analysis was conducted methodically. Results Overall, 491 studies were retrieved, out of which 19 met the inclusion criteria. Two randomized clinical trials (RCTs) and ten cohort studies were further analysed. Seven cohort studies were included in the statistical analysis. Subgroup meta-analyses of cohort studies revealed that NSPT improves in average 2.49 (95% CI 0.95–4.02), 8.94 (95% CI 6.89–10.99) and 6.49 (95% CI 5.11–7.88) OHRQoL levels at 1–2 weeks, 3–4 weeks and 6–12 weeks of post-treatment, respectively. Conclusions NSPT procedures greatly improve the oral health-related quality of life within a short time, remaining stable after 3 months of treatment. Clinical relevance This systematic review brings forward summary evidence that NSPT improves the OHRQoL in adults with periodontitis from a patient-centred perception and remain stable in the short term.

The aim of this systematic review and network meta-analysis (NMA) was to assess the efficacy of a bilaminar root coverage technique consisting of the combination of an autogenous subepithelial connective tissue graft (SCTG) and a coronally advanced flap (CAF) compared with the five most indicated alternative approaches for the treatment of single gingival recession defects (GRD).The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42020221362). Three electronic databases were searched up to September 30, 2021 to identify randomized controlled trials that involved the treatment of single GRD without interproximal tissue loss via root coverage procedures. A frequentist NMA was conducted for complete root coverage (CRC), mean root coverage (MRC), and keratinized tissue width (KTW) changes.A total of 38 studies reporting on 830 patients and 1,265 GRD were included. SCTG + CAF was ranked as the most efficient treatment approach for MRC, CRC, and KTW gain at 6 and 12 months after surgery, except for MRC at the 12-month follow-up where enamel matrix derivative plus CAF exhibited superior results.SCTG + CAF can be considered the gold standard for the treatment of single GRD.

Maintenance of adequate interproximal tissue height between an implant and a natural tooth or between adjacent implants represents an esthetic challenge in implant dentistry. The aim of this case report is to describe a modified technique referred to as the beyond the gap filling (BGF) approach designed to improve the horizontal and vertical components of the facial aspect and particularly the height of interproximal bone peaks around immediately placed implants into fresh extraction sockets.Four patients (five teeth) requiring anterior tooth extraction were treated with the BGF approach that included: (a) minimally traumatic tooth extraction; (b) immediate implant placement without flap elevation; (c) installation of a narrow profile healing abutment to protect the implant during grafting; (d) grafting with a construct with 90% bovine bone granules and 10% porcine collagen packed coronally to the facial and interproximal bone walls above the level of the bone crest; and (e) delivery of an immediate restoration.The current report suggests that the level/height of the interproximal bone crests between an implant and a natural tooth or between two adjacent implants can be improved by the BGF approach and, consequently, papilla height can be maintained in cases with a high risk of papilla height collapse and, consequently, esthetic outcomes can be maximized.The BGF is a simple technique to be used by clinicians to prevent significant papilla collapse in anterior immediate implants and consequently achieve maximum esthetic outcomes in implant dentistry.

This systematic review aimed to appraise the available evidence on the clinical characteristics produced by osseodensification drilling compared with the conventional drilling technique.Five databases (PubMed, Google Scholar, LILACS, EMBASE, and CENTRAL) were searched up to July 2020. Randomized clinical trials (RCTs) and nonrandomized studies of interventions (NRSIs) that compared osseodensification drilling with conventional drilling in humans were included. Random-effects meta-analyses of standardized mean difference (MD) with 95% confidence intervals (CI) and risk ratio were performed.Three NRSIs fulfilled the inclusion criteria, and all were scored as low risk of bias. Meta-analysis showed that the osseodensification drilling technique presented higher average implant stability quotient (ISQ) scores at baseline (MD: 13.1, 95% CI: 10.0 to 16.1, P.0001) than conventional drilling, with complete homogeneity (IThis systematic review showed that osseodensification presented consistently higher ISQ at baseline and at 4 to 6 months after implant placement compared with conventional drilling. However, these results should be carefully interpreted since only three studies were selected in this meta-analysis. In the future, RCTs will be necessary to confirm the consistency of these results.

The objective of this retrospective study was to compare the 7-year outcomes of coronally advanced flap with vertical incisions (CAF) and the envelope type of flap (e-CAF), using a subepithelial connective tissue graft (SCTG) in the treatment of multiple recession defects.Twenty-two patients (13 CAF and 9 e-CAF) with at least two adjacent recession defects in the esthetic zone contributed to a total of 50 sites (29 CAF and 21 e-CAF). Complete root coverage (CRC), mean root coverage (MRC), and keratinized tissue (KT) width were recorded over the course of the study.In the short term (8 months), CRC, MRC, and KT outcomes were similar between the groups (P.05). However, at the 3-year follow-up, the e-CAF group displayed significantly higher KT, MRC (100%), and CRC (100% at both tooth- and patient-levels) than the CAF group (MRC 91.43%; CRC 79. 31% at tooth -level and 69.23% at patient -level). Similarly, at the 7-year follow-up, statistically significan tly superior KT, MRC (94.24%), and CRC (87.71% at tooth-level and 77.78% at patient-level) values were recorded for the e-CAF group compared to the CAF group (MRC 68.98%; CRC 31.0 3% at tooth -level and 15.38% at patient -level).Despite similar treatment outcomes recorded by both surgical procedures in the short term, sites treated with e-CAF showed better stability of the gingival margin and superior KT width in the medium (3 years) and long term (7 years).

This systematic review aimed to assess whether the use of autologous platelet concentrates immediately after tooth extraction would prevent ORN in patients treated with radiotherapy (RT) for head and neck cancer (HNC). MEDLINE, Embase, Ovid, Scopus, Web of Science, CENTRAL Cochrane, and OpenGrey databases were searched (up to, and including, June 2021) by two independent reviewers to identify studies, followed by further manual search. As inclusion and exclusion criteria for the studies, only controlled clinical trials (randomized or not) were considered. The risk of bias of each included study was assessed using the Cochrane Risk of Bias Tool. Of the 129 potentially eligible studies, only 2 were included, both randomized controlled clinical trials; however, one used platelet-rich plasma and another leukocyte- and platelet-rich fibrin. Overall, both autologous platelet concentrates had no effect on the outcome assessed. The use of autologous platelet concentrates seems not to be beneficial for ORN prevention following tooth extractions in HNC patients treated with RT; however, according to the available evidence, a reliable statement cannot be made.

The aim of this pilot randomized controlled trial was to assess the efficacy of macro- and microsurgical procedures in removing the epithelial tissue layer of subepithelial connective grafts (SCTGs) harvested by the parallel incision method.Sixteen patients were randomized to receive macro-SCTG harvesting (n = 10, control group) or micro-SCTG harvesting (n = 10, test group) by the parallel incision technique. Histologic and histomorphometric analysis of the SCTG evaluated the percentage remnant of epithelium and connective tissue. The presence of remnant portions of the epithelium was identified in eight samples (three in the macro- and five in the microsurgery groups).Sixteen participants with 20 sites were included and 20 SCTG were collected and analyzed. SCTG harvested by microsurgical approaches displayed more portions of remnant epithelium compared to the conventional removal (50% versus 30%). There were no significant differences in mean remnant epithelial thickness for test (147.3 ± 89.3 μm) and control (209.0 ± 127.5 μm) groups (P = .57). Likewise, nonsignificant differences were identified in terms of the connective tissue thickness (macrosurgery: 1,511.0 ± 1,160.0 μm; microsurgery: 1,472.0 ± 1,063.0 μm) between groups (P = .96).The samples harvested by microsurgery had greater remaining epithelial portions than those harvested by macrosurger y, and similar connective layer thickness.

BACKGROUND Different procedures were proposed to augment soft tissue around dental implants. OBJECTIVE Aims of this Systematic Review (SR) were to evaluate (a) clinical benefit of soft tissue augmentation at implant sites (b) which is the best surgical procedure to augment soft tissue. MATERIALS AND METHODS Manual/electronic searches were performed to identify randomized controlled trials (RCTs). Change in keratinized tissue thickness (STT) and height (KT) were primary outcomes. Random effects meta-analyses were performed where suitable and expressed as weighted mean differences (MD) with their associated 95% confidence intervals (CI). RESULTS Fourteen RCTs accounting for 475 patients and 538 implants were included. Only five studies were judged at low risk of bias. In the single studies, soft augmentation lead to higher STT and KT compared to no augmentation. Considering primary outcomes, connective tissue graft (CTG) was more effective than xenogeneic collagen matrix (XCM) to improve STT (MD: -0.30 mm; 95% CI -0.43; -0.17; P

OBJECTIVE To evaluate the outcomes of excessively loaded implants. MATERIAL AND METHODS In five dogs, all mandibular premolars were extracted. After 3 months, six implants (three SLA® and three SLActive®) were placed (S). After 4 weeks, implants were restored: one single crown with stable occlusal contacts (SC), one crown and a cantilever unit with excessive occlusal contacts (OL), and a non-loaded implant (NL). Bleeding-on-probing (BoP), attachment level (AL), mucosal margin (GM) were assessed. Resonance frequency analysis (RFA) was assessed weekly. Standardized X-rays were taken at S, 4 and 24 weeks. RESULTS Similar findings were observed for SLA® and SLActive® implants regarding PlI, GI, GM, AL, and BL. No significant differences were detected between baseline and 24-weeks or between treatment modalities for all clinical parameters (p > .05). Six months after loading, RFA values were significantly greater than at implant placement. No significant differences between treatment modalities were found. Linear radiographic measurements yielded similar results between SLA® and SLActive® implants. SLA® OL implants yielded a statistically significant gain on peri-implant bone density over all other groups (p = .012). Radiographic results were confirmed by descriptive histology. Technically, loosened occlusal screws occurred in 13.3% (SC = 3.3%; OL = 10%), while abutment fractures totalized 23.3% (SC = 6.6%; OL = 16.6%). CONCLUSIONS Excessive occlusal load applied to implants (SLA® or SLActive®) restored with cantilevers did not cause loss of osseointegration or significant changes in their clinical, radiographic, or histologic outcomes. Early excessive occlusal load on SLA® implants promoted a gain in peri-implant bone density. Excessively loaded implants showed more technical complications.

BACKGROUND: The aim of this long-term case series was to assess the development/prevalence of non-carious cervical lesions (NCCLs) at sites that have and have not been treated with gingival augmentation following free gingival graft (FGG). METHODS: Fifty-two patients had at least one test and one control site: 1) test site showing absence of attached gingiva (AG) associated with gingival recession (GR) treated with FGG; and 2) contralateral site with or without AG. Patient/tooth/site-associated variables were recorded for each tooth/site at baseline (T0), 12 months after surgery (T1), during the follow-up period (T2) (15 to 20 years), and at the end of the follow-up period (T3) over 25 to 30 years. Mixed-effects logistic regression was used throughout the study. RESULTS: Forty-nine patients/130 sites were available for analysis at T2 whereas 44 patients/120 sites at T3. Twenty-two NCCLs >0.5 mm were restored in the test sites and in 35 in the untreated sites. The development of NCCL over time appeared associated with sites with attached KT

The aim of this systematic review (SR) was to assess whether toothbrushing‐based oral heath measure (OHM), performed in intensive care units, can reduce the risk of ventilator‐associated pneumonia (VAP). Dental biofilm removal has been considered important to prevent VAP. PUBMED, SCOPUS, WEB OF SCIENCE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to and including December 2018 to identify randomized clinical trials (RCT) on the use of toothbrushing procedures in the prevention of VAP. Search was conducted by two independent reviewers. The risk of bias of each included study was assessed using the Cochrane Collaboration's domain‐based, two‐part tool. Random effects meta‐analyses were conducted thoroughly.Search strategy identified 215 potentially eli‐gible articles, of which 12 RCT were included. All studies evidenced the importance of OHM in mechanically ventilated patients in order to prevent VAP. Seven RCT (58.3%) found some degree of positive association between toothbrushing, alone or associated to oral topical chlorhexidine (CHX), and a potential reduction of mechani‐cal ventilation‐related outcomes and dental biofilm/oral bacteria. However, pooled estimates did not identify an additional decrease of VAP incidence for any of the tested procedures (ie, toothbrushing + CHX versus swab/gauze cleaning + CHX or toothbrushing + CHX versus toothbrushing alone or + placebo). Toothbrushing does not seem to promote a reduction of VAP‐outcomes compared to swab/gauze clean‐ing, when topic CHX is applied for oral hygiene of patients submitted to mechanical ventilation

Background In this systematic review and meta-analysis, the authors examine the efficacy of antibiotic prophylaxis (AP) and specific antibiotic regimens for prevention of dental implant failure in patients who are healthy overall. Types of Studies Reviewed The authors independently conducted electronic database and manual searches to identify randomized controlled trials (RCTs). The authors selected articles on the basis of eligibility criteria and assessed for risk of bias by using the Cochrane Handbook. Implant failure was the primary outcome studied; perimucositis or implantitis, prosthetic failure, and adverse events were secondary outcomes studied. The authors conducted random effects meta-analysis for risk ratios of dichotomous data and used OpenMeta[Analyst] (Center for Evidence Synthesis, Brown School of Public Health) for qualitative assessment of administration schedules. Results With duplicates removed, the authors screened 1,022 abstracts, reviewed 21 full-text articles, and included 8 RCTs that included 2,869 implants in 1,585 patients. Meta-analysis results indicated that AP resulted in a statistically significantly lower number of implant failures for all regimens combined (implant, P = .005; patient, P = .002), as well as preoperative (implant, P = .01; patient, P = .007), pre- and postoperative (implant, P = .04), and postoperative AP only (implant, P = .02), compared with no antibiotics. The authors found no statistically significant differences in analysis of comparative antibiotic treatments or secondary outcomes. The authors identified confounding variables. Conclusions and Practical Implications Although meta-analysis results suggested that AP may reduce implant failure, definitive conclusions cannot be achieved yet. The overall nonsignificant differences reported in individual trials, limitations discussed, implant infection outcomes, and antibiotic-associated risks must be considered. Thus, the results for implant failure outcomes may not warrant the indiscriminate use of antibiotics in patients who are healthy who are receiving dental implants. Investigators must conduct large-scale RCTs to determine the efficacy of AP and various regimens, independent of confounding variables.

INTRODUCTION There is limited evidence related to the long-term treatment outcomes of acellular dermal matrix graft (ADMG) plus coronally advanced flap (CAF) for the treatment of multiple recession defects. The aim of this case report is to assess the short- and long-term clinical outcomes of Miller Class I multiple gingival recession-type defects in the maxilla treated with ADMG plus CAF. CASE PRESENTATION A 36-year-old female patient smoking < five cigarettes per day presented multiple adjacent Miller Class I gingival recession in the left maxilla and was referred for treatment with chief complaints of dental hypersensitivity and esthetics. Root coverage was achieved by ADMG + CAF and the patient underwent a 10-year follow-up. CONCLUSIONS Within the limits of this case report, mean root coverage obtained at 6 months could not be maintained in the long term. A significant relapse was detected after 10 years, from 80% complete root coverage (CRC) at 6 months to 40% at 10 years. Monitoring, compliance, and reinstructions in oral hygiene techniques seem mandatory for minimizing relapse of gingival recessions after root coverage procedures.

The decision-making process for the treatment of recession-type defects is based on translation of the outcomes from randomized controlled trials and systematic reviews to clinical practice. Such an approach is capable of assisting researchers, clinicians, and patients to understand the mechanisms and effects of the treatment of different root-coverage procedures, as well as turning treatment options into usable and predictable tools to be applied in dental practice. This review explores: (a) the aspects related to the etiology of gingival recession; (b) the history of periodontal plastic surgery procedures used to achieve root coverage; (c) the main findings, implications of research, and practice of root-coverage procedures described from the current base of systematic reviews; (d) the role of the evidence produced in Latin American research centers; and (e) the outcomes of an individual patient data meta-analysis of randomized controlled trials evaluating the role of root coverage and restorative procedures in achieving complete root coverage of noncarious cervical lesions. The findings of the current base of evidence clearly indicate that all of the main periodontal plastic surgery procedures lead to improvements in initial clinical parameters, but subepithelial connective tissue grafts, either alone or associated with coronally advanced flaps, result in superior complete root coverage, long-term stability, and greater increase of keratinized tissue. Nonetheless, coronally advanced flaps, either associated with biomaterials (acellular dermal matrix grafts, enamel derivative proteins and xenogeneic collagen matrix) or used alone, provide satisfactory results and are suitable for use as secondary/alternative procedures to subepithelial connective tissue grafts.

Retrograde peri-implantitis (RPI) is a periapical lesion that develops after implant insertion in which the coronal portion of the implant achieves a normal bone-to-implant interface. The most common etiology of RPI is the presence of an adjacent endodontic lesion. In most of the case reports available in the literature, the diagnosis of RPI occurred between 1 week and 4 years after implant placement. This case report illustrates the treatment of RPI that occurred more than 15 years after implant loading, caused by endodontic infection of the adjacent tooth.

Background The aim of this study is to estimate the direct and indirect economic burdens of periodontal disease in the USA and in Europe. Methods We used the most recent data available for the USA and for Europe (32 European countries) to estimate the cost of periodontal disease. Global health, dental and periodontal expenditures were estimated. We tried to estimate the direct and the indirect costs of periodontitis. Indirect costs, those related to productivity losses, are a consequence of periodontal disease proper, plus edentulism and caries due to periodontal disease. Results In 2018, the aggregate cost in the USA was estimated at $3.49B and €2.52B in Europe. Indirect costs due to periodontal disease amounted to $150.57B (95% confidence interval [CI]: 103.32-189.87) in the USA countries and €156.12B (95% CI: 123.72-221.86) in Europe. The majority of the projected indirect costs were due to edentulism related to periodontal disease and periodontal disease. Indirect costs were the majority of the estimated economic impact with an average of 0.73% (95% CI: 0.50-0.93%) of annual gross domestic product in the USA and 0.99% (95% CI: 0.78-1.40%) in Europe. Conclusions Periodontal disease caused an estimated loss of $154.06B in the USA and €158.64B in Europe, in 2018. These results show that the economic burden of periodontal disease is significant and its indirect costs are impactful. This article is protected by copyright. All rights reserved.

Poor oral health in elite sport is a pressing issue, however little is known about the periodontal status of professional footballers. The aim of this study was to examine the prevalence of periodontitis in a group of professional footballers and its association with nutritional parameters and self-report non-traumatic injuries. Additionally, we assessed its association with anthropometric, dietary inflammatory load and self-reported muscular and/or articular injuries. Twenty-two professional footballers were evaluated at the beginning of the 2020–2021 season via full-mouth periodontal inspection, anthropometric measurements and the application of the dietary inflammatory index through a food intake measurement of 24 h dietary recall on two different days. Self-reporting non-traumatic muscular and articular injuries for the past 6 months were recorded from each athlete. Then we compared clinical measurements according to the periodontal status and we correlated age, periodontal and nutritional parameters. Overall, the prevalence of periodontitis was 40.9% and peri-implantitis was also observed. No significant differences were found regarding age or nutritional parameters according to the periodontal status. More non-traumatic muscular events in the past 6 months were found in the periodontitis group (55.6% vs. 38.4%), although the difference was non-significant. Both clinical attachment loss, periodontal pocket depth and the periodontal epithelial surface area revealed a significant moderate correlation with the percentage of fat mass, muscle mass, muscle mass index and total adipose folds. This group of professional footballers showed an alarming prevalence of periodontitis. Further studies shall examine whether periodontitis and periodontal treatment impact the performance of this group of athletes.

Objective This study aimed to conduct a systematic review of the use of a cell sheet formed by mesenchymal stem cells derived from dental tissues (ddMSCs) for periodontal tissue regeneration in animal models in comparison with any other type of regenerative treatment. Design PubMed and Scopus databases were searched for relevant studies up to December 2020. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Results Of the 1542 potentially relevant articles initially identified, 33 fulfilled the eligibility criteria and were considered for this review. Even with a wide variety of selected study methods, the periodontal tissue was always regenerated; this indicates the potential for the use of these cell sheets in the future of periodontics. However, this regeneration process is not always complete. Conclusion Despite the implantation, ddMSCs sheets have a great potential to be used in the regeneration of periodontal tissue. More in vivo studies should be conducted using standardized techniques for cell sheet implantation to obtain more robust evidence of the relevance of using this modality of cell therapy for periodontal tissue regeneration.

Objective Improvement over time in mean (MRC) and complete root coverage (CRC) reported in randomized controlled trials (RCTs) has been documented. Our objective was to assess the effect that the ROB has on relevant outcomes reported in RCTs evaluating the efficacy of a commonly performed root coverage procedure. Methods RCTs that involved the use of a bilaminar technique of coronally advanced flap with connective tissue graft were selected. The following data were extracted: MRC, CRC, whether conflict of interest was addressed (yes/no), adequacy of random sequence generation, allocation concealment, and blinding of outcome assessment. Trials were categorized into four groups as per different time periods: before Consolidated Standards of Reporting Trials (CONSORT) (before 1996), CONSORT (1997 to 2001), CONSORT 2001 (2002 to 2010), and CONSORT 2010 (2011 to 2019). Differences between group means were assessed using statistical analyses. Results The search yielded a total of 47 RCTs published between 1993 and 2019 that met the inclusion criteria. A trend toward lower ROB over time in the selected RCTs was observed. However, differences in MRC and CRC with respect to the degree ROB of included trials were not significant. Conclusions Degree of ROB did not influence MRC and CRC reported in the RCTs included in this investigation. This finding suggests that the observed improvement of clinical outcomes over time should be attributed to other factors, such as refinement of surgical techniques.

IntroductionPeriodontal disease is a pandemic condition and its severe form affects approximately 10% of the global population. Here, we present a forecast for the economic burden of periodontal disease in 32 European countries and in the United States of America (USA).Material and methodsIn an aggregate population-based cost analysis, taken as reference the most recent available data, we estimated the cost of periodontal disease. Under this, global health, dental and periodontal expenditures were estimated. Additionally, indirect estimates accounted for Disability-Adjusted Life Years (DALY) valued at per capita Gross Domestic Product (GDP), to estimate productivity losses, including periodontal disease, edentulism due to periodontal disease and caries due to periodontal disease.ResultsIn 2018 the aggregate cost in Europe was estimated at €17.00B and €2.35B more in the USA (€19.35B). Indirect costs due to periodontal disease amounted to €132.52B in European countries and €103.30B in the USA. The majority of the projected indirect costs were due to edentulism related to periodontal disease and periodontal disease. Indirect costs were the major portion of the estimated economic impact with an average of 0.66% of GDP in Europe and 0.50% in the USA. For the overall costs (direct and indirect), the value amounted to 0.75% of GDP in Europe and 0.60% in the USA.ConclusionPeriodontal disease caused a €149.52B loss in Europe and €122.65B in the USA, in 2018. These results show that the economic burden of periodontal disease is increasing.CLINICAL RELEVANCEScientific rationale for the studyConsidering the pandemic pattern of periodontal diseases we present a forecast for the economic burden of periodontal disease in 32 European countries and in the United States of America (USA).Principal findingsPeriodontal disease caused a €149.52B loss in Europe and €122.65B in the USA, in 2018. For the overall costs (direct and indirect), the value amounted to 0.75% of GDP in Europe and 0.60% in the USA.Practical implicationsThese results show that the economic burden of periodontal disease is increasing.

INTRODUCTION: The mandibular anterior lingual (MAL) keratinized tissue (KT) band is often insufficient in dimension

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Background The aim of this study was to evaluate the effect of suturing on the early wound healing of donor sites of subepithelial connective tissue grafts (SCTG), harvested by the single incision technique (SIT), following the application of a collagen sponge. Methods Thirty-six patients were randomized to receive a collagen sponge with or without sutures in the palatal donor sites following connective tissue grafting via the SIT. Outcome variables were early healing index (EHI) at 7, 14, and 30 days, self-reported pain using a visual analogue scale (VAS) recorded on the 0 to 100 scale at 7 and 14 days, and immediate and delayed bleeding. Results No significant differences were found between groups at baseline. EHI index showed no differences between groups in all-time intervals. Eight subjects from suture group (SG) and 10 from no suture group (nSG) showed complete wound closure at day 14 (P >0.05) and at 30 days, complete closure was observed in 35 out of 36 patients. Four subjects from the SG and three from the nSG had immediate bleeding (P >0.05), while delayed bleeding was observed in two subjects from the SG and three from the nSG during the first week of healing (P >0.05). No differences were found in VAS scale between groups (SG, 36.2 ± 24.8; nSG, 21.5 ± 24.2, P >0.05). Conclusion It can be concluded that when a collagen sponge is placed in palatal donor areas of SCTG harvest by means of the SIT (incision length of ≈15 mm), sutured and non-sutured sites display similar early wound healing outcomes and patient-reported outcomes.

Objective To assess clinical studies that compare synthetic or enriched natural materials to autologous osseous grafts among individuals with cleft lip and palate to determine which would be the substitute to autologous bone graft for alveolar cleft repair in humans. Materials and methods Randomized and controlled clinical trials on alveolar clefts treated with synthetic bone substitutes and autogenous bone grafts combined with osteoinductive factors compared with autogenous bone grafts alone (with ≥4-month follow-up and reporting clinical/radiographic data) were considered eligible. MEDLINE, EMBASE, and Central databases were searched for articles published until February 2020. Results Of 73 eligible articles, 15 were included. Some inductive factors along with iliac crest bone decreased bone reabsorption, preserved the generated bone height/width, and reduced the required autologous bone graft volume. Bone morphogenetic protein (BMP2) as an autologous bone graft substitute, demonstrated satisfactory alveolar defect healing, by avoiding autograft use. Many materials did not yield better outcomes than did autologous grafts; however, hydroxyapatite and collagen complex, hydroxyapatite agarose composite gel, acellular dermal matrix film, fibrin glue, platelet-rich plasma, and deproteinized bovine bone showed similar bone healing outcomes, being an alternative alveolar defect treatment. Conclusions BMP2, as an osteoinductive factor along with a synthetic matrix, yields satisfactory bone healing and avoids the need for autologous bone grafts. However, high-quality RCTs are necessary to determine the most effective and safe concentration and protocol of BMP2 utilization as a substitute for the autologous iliac crest bone grafting., Biotechnology; Protein engineering; Biomedical engineering; Dental surgery; Dentistry; Oral medicine; Alveolar cleft; Cleft lip; Substitute bone; Cleft lip repair; Transplants transplantation; Alveolar bone grafting; Cleft primary palate