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To identify the factors associated with buccal peri-implant soft tissue dehiscences (BSTDs) and their frequency of occurrence.Randomized controlled trials, controlled clinical trials, cohort studies, and case series assessing the frequency of occurrence of BSTD were included. BSTD was defined as an apical migration of the peri-implant soft tissues of ≥1 mm from the baseline examination (final restoration) or in comparison with the adjacent or contralateral natural tooth. Frequency distributions of BSTD related to the presence or absence of any surgical, prosthetic, or anatomic factor that may have contributed to the development of BSTD were recorded. Random-effects meta-analyses using odds ratios (OR) were performed to investigate the association of certain factors with the development of BSTD.Twenty-four articles were finally included belonging to 22 clinical investigations. Patients at higher risk of developing BSTD were associated with thin biotype (OR = 2.85 [1.40, 5.8], n = 5, p = .003) and with buccally placed implants (OR = 14.37 [4.58, 45.14], n = 3, p ≤ .001). Patients without connective tissue grafting (CTG) had greater odds of developing BSTD (OR = 9.00 [3.11, 26.02], n = 5, p ≤ .001), while buccal bone plate thickness of1 mm and immediately placed implants were not associated with greater BSTD (OR = 1.29 [0.35, 4.77], n = 2, p = .704 and OR = 1.56 [0.46, 5.26], n = 4, p = .477, respectively). The frequency of occurrence of BSTD varied across the included studies with a range from 0% to 61%.Thin tissue biotype and buccally placed implants were associated with BSTD, whereas CTG seemed to have a protective effect. Thin buccal plates and immediately placed implants did not demonstrate a higher risk of BSTD.

Open and closed sinus lifting procedures are predictable methods to augment the bone needed for appropriate implant placement in the posterior maxilla in cases where available bone is limited. However, these techniques may give rise to complications and associated comorbidities. In the case of open sinus lifting, perforation of the Schneiderian membrane during osteotomy is the most common complication, with an incidence rate of around 20%-25%. Apart from those complications associated with oral surgery in general (such as swelling or hematoma), there are specific complications of open sinus lifting procedures that may arise less frequently (chronic rhinosinusitis, hemorrhage, or ostium blockage by overfilling) but which may nevertheless compromise the viability of the graft and/or the implants and cause substantial discomfort to the patient. Closed sinus lifting is a less invasive approach that allows transcrestal placement of the implants in cases where there is sufficient residual bone height. However, it may also be associated with specific complications, including membrane perforation, benign paroxysmal positional vertigo, and implant displacement to the sinus cavity. New technologies have been proposed to reduce these complications and comorbidities associated with conventional sinus lifting procedures, such as the use of piezoelectric devices and hydraulic sinus lift or reamer burs. The evidence supporting their effectiveness and safety, however, is still lacking. A detailed medical history together with a thorough radiographic and clinical examination are essential prior to any kind of bone regenerative augmentation involving the maxillary sinus. Moreover, it is recommended to employ the most appropriate surgical technique for the specific characteristics of the case and, at the same time, accommodating the experience and skills of the surgeon.

Bone-regenerative interventions aiming to restore deficient alveolar ridges, such as the use of block grafts or through the application of guided bone-regeneration principles, have reported positive outcomes in the published scientific literature. These interventions, however, are invasive, and hence, intraoperative and/or postoperative complications may occur. The types of complications and their severity may vary from the exposure of the biomaterial (membrane or graft) to postsurgical infections, neurosensorial disturbances, occurrence of hemorrhage, and pain, etc. The aim of the present narrative review was to search the available scientific evidence concerning the incidence of these complications, their effect on treatment outcomes, their clinical management and, finally, strategies aimed at prevention. Exposure of the barrier membrane or the block graft is the most common complication associated with oral regenerative interventions. To manage these complications, depending on the extent of the exposure and the presence or absence of concomitant infections, therapeutic measures may vary, from the topical application of antiseptics to the removal of the barrier membrane or the block graft. Regardless of their treatment, the occurrence of these complications has been associated with patient selection, with compliant patients (eg, nonsmokers) having a lower reported incidence of complications. Similarly, surgical factors such as correct flap elevation and a tensionless closure are of obvious importance. Finally, to prevent the incidence of complications, it appears prudent to utilize whenever possible less invasive surgical interventions.

AIM To assess the changes in peri-implant soft tissue levels after the surgical treatment of peri-implantitis. METHODS Randomized controlled trials, controlled clinical trials, cohort studies and case series, evaluating the changes in the position of the mucosal margin before and after surgical treatment of peri-implantitis, were searched. Secondary outcomes were changes in keratinized mucosa (KM), radiographic bone levels, probing depths (PD), plaque indices, bleeding on probing and patient perception. Meta-analyses were performed to determine weighted mean differences (WMD) or effects (WME). RESULTS Twenty-six articles, reporting 20 investigations, were included. Reconstructive approaches yielded significantly less increase in mucosal recession, when compared to access flaps (n = 3, WMD = -1.35 mm, 95% confidence interval [CI] [-2.62; -0.07], p = .038). When comparing among reconstructive surgical interventions similar outcomes were observed irrespective of the use of a barrier membrane (n = 3, WMD = -0.01 mm, 95% CI [-0.15; 0.13], p = .917). When considering the effects over time, limited mucosal recession was observed after reconstructive procedures (n = 23, WME = 0.389 mm, 95% CI [0.204; 0.574]), p = .001), while increased recession was reported with either resective or access flap surgery (n = 6, WME = 1.21 mm, 95% CI [0.70; 1.72], p =

Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria's organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes.

Immediate implant placement in molar sites has the potential to improve the patient experience by reducing the number of appointments and the overall treatment time. However, primary closure remains a technical challenge. The present prospective case series evaluated the soft tissue contours and the radiographic bone levels of 17 patients who received immediate implants in molar sites and a digitally customized CAD/CAM sealing socket abutment. At the 2-year follow-up, the mean buccal tissue contours at the most coronal portion were reduced horizontally by an average of 1 mm at 1, 2, 3, and 4 mm below the gingival margin. A mean 0.53-mm apical migration of the gingival margin was seen, and the mean interproximal bone level at the 2-year follow-up was 0.89 mm. The use of CAD/CAM-generated customized healing abutments in immediate molar sites yielded minimal hard and soft tissue changes at the 2-year follow-up.

Objectives This in vitro investigation was aimed to evaluate the cleaning ability of four mechanical devices designed for decontaminating implant surfaces. Material and methods Ninety-six implants were coated with permanent ink and inserted into 3D-printed resin blocks simulating three different intraosseous defect configurations (types Ib, Ic, and Ie). The four tested mechanical decontamination devices (air-polishing with glycine powder, rotating titanium brush, polyetheretherketone [PEEK]-coated ultrasonic tip, and stainless steel ultrasonic tip) were randomly applied onto the 5 mm exposed implant surface. Standardized photographs were taken from a frontal perspective and with a 30° angle coronally and apically to the implant axis. The area with remnant ink on the implant surface was calculated. Results Although none of the groups achieved complete ink removal, air-polishing with glycine and titanium brushes demonstrated a higher cleaning ability when compared with ultrasonic devices either with standard or PEEK tips for all three defect configurations. For the three tested models, the best cleaning ability in all groups was shown on implant surfaces without facing an intraosseous wall. Titanium brush was the most effective when the intraosseous walls existed. Cleaning effectiveness diminished in the threads located in the apical third, especially when using air-polishing and ultrasonic devices. Conclusions Titanium brushes and air-polishing devices were more effective in removing artificial biofilm using this in vitro model, although their effectiveness was influenced by the presence of the intrabony component.

OBJECTIVES To systematically assess the literature and report on (1) the frequency of occurrence of buccal soft tissue dehiscence (BSTD) at implants, (2) factors associated with the occurrence of BSTD and (3) treatment outcomes of reconstructive therapy for the coverage of BSTD. MATERIALS AND METHODS Two systematic reviews addressing focused questions related to implant BSTD occurrence, associated factors and the treatment outcomes of BSTD coverage served as the basis for group discussions and the consensus statements. The main findings of the systematic reviews, consensus statements and implications for clinical practice and for future research were formulated within group 3 and were further discussed and reached final approval within the plenary session. RESULTS Buccally positioned implants were the factor most strongly associated with the risk of occurrence of BSTD, followed by thin tissue phenotype. At immediate implants, it was identified that the use of a connective tissue graft (CTG) may act as a protective factor for BSTD. Coverage of BSTD may be achieved with a combination of a coronally advanced flap (CAF) and a connective tissue graft, with or without prosthesis modification/removal, although feasibility of the procedure depends upon multiple local and patient-related factors. Soft tissue substitutes showed limited BSTD coverage. CONCLUSION Correct three-dimensional (3D) positioning of the implant is of utmost relevance to prevent the occurrence of BSTD. If present, BSTD may be covered by CAF +CTG, however the evidence comes from a low number of observational studies. Therefore, future research is needed for the development of further evidence-based clinical recommendations.

33 p.-4 fig.-4 tab., AIM:The objective of this in vivo experimental study to evaluate the regenerative potential of a cell therapy combining allogenic periodontal ligament-derived cells within a xenogeneic bone substitute in a similar experimental model., METHODS:In nine beagle dogs, critical size 6-mm supra-alveolar periodontal defects were created around the PIII and PIV. The resulting supra-alveolar defects were randomly treated with either 1.4 × 106 allogenic canine periodontal ligament-derived cells seeded on de-proteinized bovine bone mineral with 10% collagen (DBBM-C) (test group) or DBBM-C without cells (control group). Specimens were obtained at 3 months, and histological outcomes were studied., RESULTS:The histological analysis showed that total furcation closure occurred very seldom in both groups, being the extent of periodontal regeneration located in the apical third of the defect. The calculated amount of periodontal regeneration at the furcation area was comparable in both the test and control groups (1.93 ± 1.14 mm (17%) versus 2.35 ± 1.74 mm (22%), respectively (p = .37). Similarly, there were no significant differences in the amount of new cementum formation 4.49 ± 1.56 mm (41%) versus 4.97 ± 1.05 mm (47%), respectively (p = .45, CONCLUSIONS:This experimental study was unable to demonstrate the added value of allogenic cell therapy in supra-crestal periodontal regeneration., This study was partially supported through an Osteology Foundation Advanced Research Grant (10- 012).

Background To study the differences between shallow and residual periodontal pockets in patients with periodontitis (Stages III and IV) after non-surgical periodontal treatment. Methods Twenty patients diagnosed of periodontitis who were scheduled for periodontal surgery were included. In each patient, a palatal shallow site (≤3 mm) and a residual site (≥5 mm) were selected and GCF samples were processed by Luminex® analysis to determine the concentrations of interleukins (IL-1β, IL-6, IL-10, and IL-17a). During the periodontal surgery gingival biopsies were collected and processed for histo-morphometric and immunohistochemical evaluation to determine the extent of connective tissue inflammatory infiltrate (CTII) using the following markers (CD4, CD5, CD8, CD14, CD19, Elastase, and Syndecan). Mean differences between shallow and residual pockets samples, as well as correlations between GCF cytokine concentrations, area of CTII, and cellularity of the CTII were calculated. Results A total of 15 patients were finally included, with analysis of 30 histological specimens and 30 GCF samples. Residual pockets presented significantly higher mean GCF volume, higher mean area of CTII and higher concentrations of IL-1β and IL-6 in GCF than shallow pockets. A significant correlation was detected between IL-10 levels and the CTII area, IL-10 and the percentage of Syndecan, and the area of CTII and the percentages of CD14 and Syndecan. Conclusions The concentration of GCF cytokines did not correlate with the area of CTII measured histologically. A residual CTII and elevated concentrations of proinflammatory cytokines and cells were present in all sites 2 months after non-surgical treatment. The lack of healthy controls does not allow to establish differences between both groups.

Objectives There is a need of more studies on whether low primary implant stability would negatively influence the success of implant therapy. Therefore, this retrospective study analyses outcomes of implants placed with low primary stability and factors that may be related to implant failures. Material and methods This retrospective study included 156 patients, restored with 169 implants that presented manual rotation within an observed follow-up time of a minimum of 34 days and a maximum of 9.28 years. Descriptive statistics, survival analyses (life tables and Kaplan-Meier estimates) and radiographic assessment based on marginal bone level measurements were performed. This original study was adherent to STROBE guidelines. Results Seven implants failed in seven patients, rendering cumulative survival rates of 94.74% (95% CI: 89.11-97.50) and 94.33% (95% CI: 88.30-97.30) at implant and patient levels, respectively. Kaplan-Meier estimates showed implant loss was found only in advanced surgery group (7 implant loss in 82 implants) when compared with simple surgery group (no implant loss in 87 implants; p = 0.005). Conclusions Within the limitations of this retrospective study, implant placement with low primary stability might not negatively affect either the survival rates or marginal bone level changes of implants provided that a protected and unloaded healing is guaranteed.

Objective To evaluate the influence of implant and prosthetic components on peri-implant tissue health. A further aim was to evaluate peri-implant soft-tissue changes following surgical peri-implantitis treatment. Materials and methods Group discussions based on two systematic reviews (SR) and one critical review (CR) addressed (i) the influence of implant material and surface characteristics on the incidence and progression of peri-implantitis, (ii) implant and restorative design elements and the associated risk for peri-implant diseases, and (iii) peri-implant soft-tissue level changes and patient-reported outcomes following peri-implantitis treatment. Consensus statements, clinical recommendations, and implications for future research were discussed within the group and approved during plenary sessions. Results Data from preclinical in vivo studies demonstrated significantly greater radiographic bone loss and increased area of inflammatory infiltrate at modified compared to non-modified surface implants. Limited clinical data did not show differences between modified and non-modified implant surfaces in incidence or progression of peri-implantitis (SR). There is some evidence that restricted accessibility for oral hygiene and an emergence angle of >30 combined with a convex emergence profile of the abutment/prosthesis are associated with an increased risk for peri-implantitis (CR). Reconstructive therapy for peri-implantitis resulted in significantly less soft-tissue recession, when compared with access flap. Implantoplasty or the adjunctive use of a barrier membrane had no influence on the extent of peri-implant mucosal recession following peri-implantitis treatment (SR). Conclusions Prosthesis overcontouring and impaired access to oral hygiene procedures increases risk for peri-implantitis. When indicated, reconstructive peri-implantitis treatment may facilitate the maintenance of post-operative peri-implant soft-tissue levels.

To assess the efficacy of three mechanical decontamination methods in four types of commercially available implants.Ninety-six implants of four commercial brands with different designs (regarding thread depth and thread pitch) were soaked in a surrogate biofilm (ink) and air-dried. Circumferential standardized peri-implant defects with 6 mm in depth and 1.55 mm in width were custom-made with a 3D printer. Stained implants were inserted in the defects and instrumented with three different methods: a titanium brush (TNB), a metallic ultrasonic tip (IST) and an air abrasive (PF). Standardized photographs were taken vertically to the implant axis (flat view), and with angulations of 60° (upper view) and 120° (lower view) to the implant long axis. The percentage of residual stain (PRS) was calculated with the image analysis software. Scanning electron microscope evaluations were performed on the buccal aspect of the implants at the central level of the defect.The efficacy of PF was significantly inferior to the TNB and IST in all implant designs, while there were no significant differences between TNB and IST. IST showed significantly higher PRS in the implant with the highest thread pitch, while the TNB had the highest PRS in the implant with a marked reverse buttress-thread design. The micro-thread design had the lowest values of PRS for all decontamination methods. The apically facing threads represented the areas with highest PRS for all implant designs and decontamination methods.Thread geometry influenced the access of the decontamination devices and in turn its efficacy. Implants with lower thread pitch and thread depth values appeared to have less residual staining.Clinicians must be aware of the importance of thread geometry in the decontamination efficacy.

(1) Background: To investigate the effect of a xenogeneic collagen matrix (CMX) seeded with autologous gingiva-derived mesenchymal cells (GMSCs) when combined with a coronally advanced flap (CAF) in the treatment of localized gingival recession type 1 (RT1). (2) Methods: Dehiscence-type defects were created in seven dogs. GMSCs were isolated, transfected with a vector carrying green fluorescent protein (GFP) and expanded. Once chronified, the defects were randomly treated with (1) CAF plus the combination of CMX and GFP+ GMSCs, (2) CAF plus CMX with autologous fibroblasts, (3) CAF plus CMX and (4) CAF alone. Histological and clinical outcomes at 2- and 6-week healing periods were analyzed and compared among groups. (3) Results: Histologically, the addition of autologous cells to the CMX resulted in reduced inflammation and a variable degree of new cementum/bone formation. CMX plus GMSCs resulted in greater mean recession reduction (1.42; SD = 1.88 mm) and percentage of teeth with recession reduction of ≥2 mm (57%) when compared to the other groups, although these differences were not statistically significant. (4) Conclusions: The histometric and clinical results indicated a positive trend favouring the combination of CMX and GMSCs with the CAF when compared to the groups without cells, although these differences were not statistically significant., This research was funded by the Osteology Foundation (grant-Project 12-063).

Background Collagen matrices used around immediate implants may reduce morbidity although there is limited evidence on their performance. Purpose To evaluate soft and hard tissue changes when combining immediate implants, hard and soft tissue grafting, and an immediate provisional restoration. Material and methods In 12 patients, immediate implants were placed in the anterior maxillary and first premolar area together with a xenogeneic bone substitute. Then a xenogeneic collagen matrix was placed under the buccal mucosal margin with an immediate provisional restoration. Study casts and clinical measurements were taken before extraction (Baseline/BS) at 6 months (6M) and 12 months (1Y) after implant placement. Files from the scanned casts were matched to calculate the linear and volumetric changes at the buccal tissues. Cone Bean Computed Tomographies (CBCTs) were taken prior to extraction and at 6M. The superimposed DICOM files allowed for assessing hard tissue changes and the superimposition of DICOM and STL files allowed for evaluating of soft tissue thickness at BS and 6M. Results After 6 months, the horizontal tissue contours decreased 0.66 ± 0.57 mm, concomitant with a horizontal bone loss of 1.31 ± 1.32 mm, measured 1 mm below the most coronal aspect of the ridge. In contrast, the soft tissue thickness, 1 mm below the gingival margin, increased 0.75 ± 1.12 mm. At 1-year, tissue contours had decreased 1.01 ± 0.67 mm compared to BS reaching statistical significance. The mean volume loss after 1Y was 20.43 ± 11.70 mm3 while the mean mucosal margin recession was 0.86 ± 0.67 mm. These changes had a limited clinical impact as the PES Scores remained stable. Conclusions The tested protocol resulted in a significant reduction of the tissue contours and osseous ridge dimensions that was partially compensated by a non-significant increase in soft tissue thickness.