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Background: Periodontal dressing has been advocated and showed some positive outcomes for placing over the surgical site after periodontal surgery. However, little is known about its effect on non-surgical therapy. Purpose: The aim of this review was to assess the clinical effect of periodontal dressing when used after non-surgical therapy. Material and methods: Two examiners performed an electronic search in several databases for relevant articles published in English up to November 2013. Selected studies were randomized human clinical trials (prospective or retrospective trials) with the clear aim of investigating the effect of periodontal dressing placement upon periodontal non-surgical mechanical therapy. Data were extracted from the included articles for analysis. Results: Three randomized clinical trials fulfilled the inclusion criteria and thus were included in the data analysis. Statistical analysis could not be carried out due to the lack of clear data of the included studies. However, descriptive analysis showed its effectiveness in improving clinical parameters such as gain of clinical attachment level and reduction of probing pocket depth. Conclusion: Placement of periodontal dressing right after non-surgical mechanical therapy can be beneficial in improving overall short-term clinical outcomes, although more controlled studies are still needed to validate this finding. [ABSTRACT FROM AUTHOR]

Background: The use of biologics may be indicated for alveolar ridge preservation (ARP) and reconstruction (ARR), and implant site development (ISD). The present systematic review aimed to analyze the effect 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), on the outcomes of ARP/ARR and ISD therapy (i.e., alveolar ridge augmentation [ARA] and maxillary sinus floor augmentation [MSFA])., Methods: An electronic search for eligible articles published from January 2000 to October 2021 was conducted. Randomized clinical trials evaluating the efficacy of ABPs, EMD, rhBMP-2, and rhPDGF-BB for ARP/ARR and ISD were included according to pre-established eligibility criteria. Data on linear and volumetric dimensional changes, histomorphometric findings, and a variety of secondary outcomes (i.e., clinical, implant-related, digital imaging, safety, and patient-reported outcome measures [PROMs]) were extracted and critically analyzed. Risk of bias assessment of the selected investigations was also conducted., Results: A total of 39 articles were included and analyzed qualitatively. Due to the high level of heterogeneity across studies, quantitative analyses were not feasible. Most studies in the topic of ARP/ARR revealed that the use of biologics rendered similar results compared with conventional protocols. However, when juxtaposed to unassisted healing or socket filling using collagen sponges, the application of biologics did contribute to attenuate post-extraction alveolar ridge atrophy in most investigations. Additionally, histomorphometric outcomes were positively influenced by the application of biologics. The use of biologics in ARA interventions did not yield superior clinical or radiographic outcomes compared with control therapies. Nevertheless, ABPs enhanced new bone formation and reduced the likelihood of early wound dehiscence. The use of biologics in MSFA interventions did not translate into superior clinical or radiographic outcomes. It was observed, though, that the use of some biologics may promote bone formation during earlier stages of healing. Only four clinical investigations evaluated PROMs and reported a modest beneficial impact of the use of biologics on pain and swelling. No severe adverse events in association with the use of the biologics evaluated in this systematic review were noted., Conclusions: Outcomes of therapy after post-extraction ARP/ARR and ARA in edentulous ridges were comparable among different therapeutic modalities evaluated in this systematic review. Nevertheless, the use of biologics (i.e., PRF, EMD, rhPDGF-BB, and rhBMP-2) in combination with a bone graft material generally results into superior histomorphometric outcomes and faster wound healing compared with control groups., (© 2021 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Background: The purpose of this review was aimed at providing the rationale supported with a series of cases to apply biologics to enhance orchestrating the healing process at implant removal sites., Summary: Implant removal is commonly applied on a daily basis, in particular, in cases that exhibit esthetic failures linked to inadequate implant position or in cases of advanced peri-implantitis. Implant removal sites differ substantially from tooth extraction sockets. Implants are ankylosed within the alveolar bone, which therefore have neither mechanoreception nor the elasticity provided by periodontal ligament fibers. As a result, the bone-to-implant contact must be disrupted by means of using a reverse-torque device to minimize trauma. It is possible that the surrounding bone provides limited vascularity, which may interfere with the healing and bone forming process within the socket. Therefore, the use of biologics may enhance this healing and accelerate bone formation in sites where implants are removed due to hopeless functional or esthetic prognoses., Conclusion: The use of biologics, in particular autologous blood-derived products, may enhance and boost the healing process to potentiate bone availability at a later stage during implant placement., (© 2022 American Academy of Periodontology.)

Titanium particles embedded on peri-implant tissues are associated with a variety of detrimental effects. Given that the characteristics of these detached fragments (size, concentration, etc.) dictate the potential cytotoxicity and biological repercussions exerted, it is of paramount importance to investigate the properties of these debris. This study compares the characteristics of particles released among different implant systems (Group A: Straumann, Group B: BioHorizons and Group C: Zimmer) during implantoplasty. A novel experimental system was utilized for measuring and collecting particles generated from implantoplasty. A scanning mobility particle sizer, aerodynamic particle sizer, nano micro-orifice uniform deposit impactor, and scanning electron microscope were used to collect and analyze the particles by size. The chemical composition of the particles was analyzed by highly sensitive microanalysis, microstructures by scanning electron microscope and the mechanical properties by nanoindentation equipment. Particles released by implantoplasty showed bimodal size distributions, with the majority of particles in the ultrafine size range (<100 nm) for all groups. Statistical analysis indicated a significant difference among all implant systems in terms of the particle number size distribution ( p < 0.0001), with the highest concentration in Group B and lowest in Group C, in both fine and ultrafine modes. Significant differences among all groups ( p < 0.0001) were also observed for the other two metrics, with the highest concentration of particle mass and surface area in Group B and lowest in Group C, in both fine and ultrafine modes. For coarse particles (>1 µm), no significant difference was detected among groups in terms of particle number or mass, but a significantly smaller surface area was found in Group A as compared to Group B ( p = 0.02) and Group C ( p = 0.005). The 1 first minute of procedures had a higher number concentration compared to the second and third minutes. SEM-EDS analysis showed different morphologies for various implant systems. These results can be explained by the differences in the chemical composition and microstructures of the different dental implants. Group B is softer than Groups A and C due to the laser treatment in the neck producing an increase of the grain size. The hardest implants were those of Group C due to the cold-strained titanium alloy, and consequently they displayed lower release than Groups A and B. Implantoplasty was associated with debris particle release, with the majority of particles at nanometric dimensions. BioHorizons implants released more particles compared to Straumann and Zimmer. Due to the widespread use of implantoplasty, it is of key importance to understand the characteristics of the generated debris. This is the first study to detect, quantify and analyze the debris/particles released from dental implants during implantoplasty including the full range of particle sizes, including both micro- and nano-scales.

Purpose: To evaluate the impact of implant surface characteristics on the initiation, progression and treatment outcomes of peri-implantitis based exclusively on in vivo investigations., Materials and Methods: A literature search was conducted by two independent reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify animal studies comparing at least two different implant surfaces affected by experimental peri-implantitis, with distinct characteristics and with or without subsequent surgical treatment that aims to arrest disease progression. The parameters evaluated included both radiographic (e.g., marginal bone level) and clinical (e.g., probing depth, bleeding on probing) aspects to determine changes in disease progression and treatment outcomes., Results: No statistically significant differences were found among the different implant surfaces during the initiation of peri-implantitis. On the other hand, the progression and treatment outcomes of peri-implantitis displayed statistically significant differences among the different implant systems, with turned surfaces reporting less bone loss during the progression period and greater bone gain after treatment., Conclusions: Implant surface characteristics play a critical role in the progression and treatment outcomes of peri-implantitis. Turned implant surfaces demonstrated the least amount of bone loss after ligature removal and recorded the most favourable treatment outcomes.

Background: The aim of this 1-year prospective clinical trial was to compare clinical parameters and marginal bone levels (MBLs) around tissue level implants with a partially smooth collar between patients with thin (≤2 mm) and thick (>2 mm) vertical mucosal phenotypes., Methods: Thirty patients needing a single dental implant were recruited and allocated to thin (n = 14) or thick (n = 16) phenotype groups. Post-restoration, clinical (probing depth, recession, width of keratinized mucosa, bleeding on probing, suppuration, implant mobility, plaque index, and gingival index) and radiographic bone level measurements were recorded at different timepoints for 1 year., Results: Twenty-six patients (13 per group) completed the 1-year examination. No implants were lost (100% survival rate). There were no significant differences (P >0.05) between thin and thick vertical mucosal phenotypes for any clinical parameter or for the radiographic MBL., Conclusions: Tissue level implants at 1 year of function placed in thin vertical mucosa achieved similar clinical parameters and radiographic MBLs as those in thick tissue. The formation of the peri-implant supracrestal tissue height plays a key role in MBL than mucosal thickness in tissue level implant., (© 2020 American Academy of Periodontology.)

Background: The nasopalatine canal (NPC) is of special importance when considering implant therapy in the maxillary central incisors' region., Purpose: To investigate the incidence of NPC perforation in relation to virtual immediate implant placement., Materials and Methods: A search through the cone beam computed tomography (CBCT) database of The University of Oklahoma-College of Dentistry was conducted. First, canal related measurements were conducted. Second, digital prosthetic planning was performed. Then, immediate implants were virtually placed and additional measurements were performed. Perforation rate was assessed. Last, data obtained was statistically analyzed., Results: A total of 217 scans fulfilled the inclusion criteria. Only 8% of cases showed NPC perforation. The perforation occurred at mid-third of the implant or at the mid and apical third in 33% and 22% of the cases, respectively. A statistically significant association was found between perforation of NPC and bone width palatal to the root of the central incisor (P < .0001) as well as canal angulation (P = .0196). NPC angulation (°) and palatal bone width (mm) predisposed to a higher risk of perforation. Only 27.78% of the perforations could be overcome by the installation of shorter implants., Conclusions: Low incidence of NPC perforation could be expected when immediately placing implants in the maxillary incisor region., (© 2019 Wiley Periodicals, Inc.)

Objectives: This study aimed to compare two different soft tissue replacement grafts in their ability to treat gingival recession defects and successfully integrate with the surrounding tissues., Methodology: Nine beagle dogs were included and followed up to 10 weeks. Sites for intervention were allocated to one of the grafting materials investigated. Treatment consisted of coronally advanced flap combined with one of the two soft tissue substitutes on a previous surgically created defect. Materials employed were porcine-derived acellular dermal matrix (ADM) [Novomatrix™ (Test)] and collagen-based matrix (CBM) [Mucograft® (Control)]. Animals were sacrificed at 2, 6, and 10 weeks postoperatively and compared using descriptive histology and histomorphometric outcomes., Results: Macroscopic findings were similar between test and control groups at all intervals. After 10 weeks, both groups demonstrated successful incorporation of the grafting materials without signs of rejection and with comparable tissue integration. The histomorphometric data were similar between groups at 2 weeks; however, the test group provided greater root coverage and increase in tissue thickness than the control at 6- and 10-weeks post surgically., Conclusions: Both porcine-derived ADM and CBM revealed similar histological outcomes with successful integration and absence of adverse events. Test group provided superior outcomes regarding root coverage and increase in tissue thickness.

Introduction: There are mixed results regarding the aesthetic advantage of immediate provisionalization of dental implants. Therefore, this study aimed to compare facial mucosal level of single immediately placed implants with and without immediate provisionalization., Methods: Single implants were immediately placed to replace a hopeless maxillary anterior or premolar tooth in 40 subjects. Each implant was randomly assigned to receive a non-occluding temporary crown or a healing abutment after implant placement. At 4 months, these implants were permanently restored and followed up for 12 months. Clinical and radiographic parameters were measured and compared., Results: The implant survival rate at 12 months in the test and control group was 90% and 100%, respectively. Mid-facial mucosal marginal level and papilla height changes were minimal within groups, and no significant differences were found between the two groups. The amount of marginal bone remodelling was modest, with no significant difference between the two groups. Radiographic bone changes were not statistically different between the groups, except for the vertical crestal bone resorption., Conclusion: Immediate implant placement with or without provisionalization can achieve stable vertical soft tissue level for 12 months as compared to pre-extraction level. However, immediate provisionalization was not able to improve the aesthetic outcome further., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The purpose of the present review was to evaluate the effect of different bone substitutes used for alveolar ridge preservation on the post extraction dimensional changes., Material and Methods: An electronic literature search in MEDLINE (PubMed), EMBASE (OVID) and Cochrane (CENTRAL) were performed, in addition to a manual search through all periodontics and implantology-related journals, up to December 2018. Inverse variance weighted means were calculated for all the treatment arms of the included trials for the quantitative analysis., Results: Forty randomized controlled trials were included in the quantitative analysis. Dimensional changes were obtained from clinical measurements and three-dimensional imaging. The average amount of horizontal ridge resorption was 1.52 (SD 1.29) mm (allograft), 1.47 (SD 0.92) mm (xenograft), 2.31 (SD 1.19) mm (alloplast) and 3.1 (SD 1.07) mm for unassisted healing. Similarly, for all the evaluated parameters, the spontaneous healing of the socket led to higher bone loss rate than the use of a bone grafting material., Conclusions: The utilization of a bone grafting material for alveolar ridge preservation reduces the resorption process occurring after tooth extraction. However, minimal differences in resorption rate were observed between allogeneic, xenogeneic and alloplastic grafting materials., (Copyright © Majzoub J, Ravida A, Starch-Jensen T, Tattan M, Suárez-López del Amo F. Published in the JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH (http://www.ejomr.org), 5 September 2019.)

Introduction: The task of Group II was to review and update the existing data concerning extraction socket preservation with or without membranes and soft tissue influence on post-extraction alveolar ridge preservation; extraction socket preservation using different biomaterials as bone grafts, growth factors, and stem cells. Special interest was paid to the dental implant placement outcomes within grafted sockets., Material and Methods: The main areas evaluated by this group were as follows: quantitative and qualitative assessment of the effect of different alveolar preservation techniques performed immediately after tooth extraction, with or without membranes and/or soft tissue grafting, and the use of different bone substitutes, stem cells or growth factors in the postextraction socket. Evaluation of the treatment outcomes of dental implants placed in the grafted sockets in terms of primary and secondary outcomes were assessed. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. TThe literature in the corresponding areas of interest was screened and reported following the PRISMA guidelines (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in the Preface chapter., Results: The results and conclusions of the review process are presented in the respective papers. Three systematic reviews and one systematic review and meta-analysis were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article., (Copyright © Galindo-Moreno P, Suárez-López del Amo F, Faria-Almeida R, Almeida BL, Astramskaite-Januseviciene I, Barootchi S, Borges T, Correia A, Correia F, Majzoub J, Padial-Molina M, Pranskunas M, Puisys A, Ramanauskaite A, Ravida A, Starch-Jensen T, Tattan M. Published in the JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH (http://www.ejomr.org), 5 September 2019.)

Purpose: To analyze the effect of crown-to-implant (C/I) ratio over survival rate, marginal bone loss, and prosthetic complications of dental implants., Materials and Methods: Electronic (PubMed, Ovid MEDLINE, and Cochrane Central) and manual searches for clinical trials with a minimum follow-up of 1 year were performed. Clinical and anatomical C/I ratios were obtained. Regression models were created to assess for potential correlation between C/I ratio (anatomical and clinical) and survival rate, marginal bone loss, or prosthetic complications. A subgroup analysis of 6-mm implants and a comparison of C/I ratios of > 1.5 versus ≤ 1.5 were also performed. The Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool For Randomized Controlled Trials were used to evaluate the risk of bias., Results: An overall moderate risk of bias was assessed among the selected articles. Linear regression analysis did not reveal a significant correlation between anatomical C/I ratios and survival rate (P = .905), marginal bone loss (P = 0.33), or prosthetic complications (P = .67). Similarly, no significant correlation to survival rate and marginal bone loss (P = 0.42, P = 0.84) was observed in the articles providing the clinical C/I ratios., Conclusion: Increased C/I ratio does not seem to be directly related with increased marginal bone loss and does not represent a biomechanical risk factor for the stability of the prosthesis and for the survival of dental implants.

Objectives: The outcomes of periodontal soft tissue root coverage procedures can be influenced by a variety of different factors. Following coronally advanced flap (CAF), the impact of marginal flap stability (MFS) through the employment of specific suturing techniques has not yet been investigated. The purpose of this study was to compare the MFS of CAF following three different suture techniques., Methods: Fifty-six CAF procedures were performed on seven fresh human cadaver heads. The MFS following simple interrupted, single sling or sling and tag (SAT) suture techniques were investigated through a specific tool involving a load cell-based recording device., Results: A highly statistically significant MFS was observed for sling and SAT sutures compared to the simple interrupted suture (p < 0.001). SAT suture technique was related to the greatest MFS (p < 0.001). The addition of sutures to the vertical releasing incision was able to provide a greater MFS compared to the suturing of the papillae alone (p < 0.001). No statistically significant difference was observed with regard to the suturing sequence between the two sling groups when the vertical incisions were sutured before or after the surgical papillae (p > 0.05). Linear regression model showed a positive correlation between thicker gingival tissue and MFS changes (p < 0.001)., Conclusions: Suturing technique highly affects the MFS following CAF on cadavers. Flap thickness was shown to be a positive predictor for flap stability., Clinical Relevance: Within the limitation of this study, the suturing of CAF with the SAT technique may provide higher MFS. However, clinical studies are necessary to validate these findings.

Background: After tooth loss, the posterior maxilla is usually characterized by limited bone height secondary to pneumatization of the maxillary sinus and/or collapse of the alveolar ridge that preclude in many instances the installation of dental implants. In order to compensate for the lack of bone height, several treatment options have been proposed. These treatment alternatives aimed at the installation of dental implants with or without the utilization of bone grafting materials avoiding the perforation of the Schneiderian membrane. Nevertheless, membrane perforations represent the most common complication among these procedures. Consequently, the present review aimed at the elucidation of the relevance of this phenomenon on implant survival and complications., Material and Methods: Electronic and manual literature searches were performed by two independent reviewers in several databases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to January 2018 reporting outcome of implant placement perforating the sinus floor without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material. The intrusion of the implants can occur during drilling or implant placement, with and without punch out Schneiderian. Only studies with at least 6 months of follow-up were included in the qualitative assessment., Results: Eight studies provided information on the survival rate, with a global sample of 493 implants, being the weighted mean survival rate 95.6% (IC 95%), after 52.7 months of follow-up. The level of implant penetration (≤ 4 mm or > 4 mm) did not report statistically significant differences in survival rate (p = 0.403). Seven studies provided information on the rate of clinical complications, being the mean complication rate 3.4% (IC 95%). The most frequent clinical complication was epistaxis, without finding significant differences according to the level of penetration. Five studies provide information on the radiographic complication; the most common complication was thickening of the Schneiderian membrane. The weighted complication rate was 14.8% (IC 95%), and penetration level affects the rate of radiological complications, being these of 5.29% in implant penetrating ≤4 mm and 29.3% in implant penetrating > 4 mm, without reaching statistical significant difference (p = 0.301)., Conclusion: The overall survival rate of the implants into the sinus cavity was 95.6%, without statistical differences according to the level of penetration. The clinical and radiological complications were 3.4% and 14.8% respectively. The most frequent clinical complication was the epistaxis, and the radiological complication was thickening of the Schneiderian membrane, without reaching statistical significant difference according to the level of implant penetration inside the sinus.

Purpose: This systematic review evaluated the mean survival rate and marginal bone loss (MBL) of dental implants with ≤ 6 mm in length, across a time frame of 5 years. The overall prosthetic and biologic complications were evaluated, and their survival rates obtained. In addition, the complication rates of the splinted vs nonsplinted implants were assessed., Materials and Methods: An electronic literature search in PubMed (MEDLINE) and EMBASE (OVID) and Cochrane were performed, in addition to a manual search through all periodontics and implantology-related journals, up to October 2017, to identify relevant articles., Results: Out of 515 potentially eligible articles, 19 investigations assessing a total of 910 extra-short (≤ 6 mm) implants were included and further evaluated. After 5 years of follow-up, a mean survival rate of 94.1% (90% in the maxilla and 96% in the mandible) and a maximum bone loss of 0.53 mm were demonstrated. Additionally, a statistically significant difference in terms of bone loss was observed between tissue-level (0.12 mm) and bone-level implants (0.36 mm) at 12 months (P < .01), but not between internal and external abutment connections (P = .17). The most commonly reported prosthetic complication was screw loosening. Finally, splinted implants showed less overall prosthetic complications (RR = 3.32; 95% CI: 1.9 to 5.7), screw loosening (RR = 15.2; 95% CI: 5.92 to 39.31), and implant failure (RR = 1.96; 95% CI: 0.8 to 4.8) than nonsplinted implants., Conclusion: Extra-short implants are a viable treatment alternative in ridges exhibiting atrophy, demonstrating a satisfactory survival rate, as well as a low rate of prosthetic and biologic complications across a 5-year follow-up. Additionally, splinting extra-short implants is associated with fewer prosthetic complications and lower implant failure rate compared with nonsplinted implants.

Background: The efficacy of Coronally Advance Flap (CAF) has been extensively evaluated and several parameters influencing the results, such as interproximal attachment loss, recession defect size, papilla dimension, flap thickness, have also been identified. However, the influence of tooth location has not been systematically investigated yet. Therefore, the aim of this systematic review was to evaluate the influence of tooth location on the outcomes of CAF., Methods: A literature search on PubMed, EMBASE, Cochrane libraries and hand-searched journal until September 2017 was performed to identify clinical studies reporting the outcome of CAF for localized gingival recessions (GRs) for each single tooth., Results: Eighteen articles reporting 399 localized GRs treated with CAF were included in the present systematic review. Canines and incisors were related to a higher mRC and CRC than premolars and molars (odds ratio 1.63) (p < 0.05), while the right side showed a higher CRC than the left side (odds ratio 1.60) (p < 0.05). No differences were found between maxillary and mandibular dentition (p > 0.05). The addition of a graft such as Connective Tissue Graft (CTG) with or without Enamel Matrix Derivative (EMD) was shown to enhance the outcomes compared to CAF alone (p < 0.05). CRC was negatively affected by initial clinical attachment level (p < 0.05), but not from the initial recession depth (p > 0.05)., Conclusions: Tooth location plays an important role on mRC and CRC following CAF. The addition of CTG or substitutes, especially with biological agents (EMD), enhance the clinical outcomes compared to CAF alone., (© 2018 American Academy of Periodontology.)

Objectives: The presence of titanium (Ti) particles around dental implants has been reported in the literature for decades. The prospective presence of Ti debris on soft tissues surrounding dental implants has not been systematically investigated and remains to be explored. Hence, this review aimed to evaluate the origin, presence, characteristics, and location of Ti particles in relation to dental implants., Material and Methods: Literature searches were conducted by two reviewers independently based on the PRISMA guidelines. The systematic review identified studies on Ti particles derived from dental implants. We evaluated several parameters, including anatomical location, and the suspected methods of Ti particles release., Results: The search resulted in 141 articles, of which 26 were eligible and included in the systematic review of the literature. The investigations reported Ti and metal-like particles in the soft (i.e., epithelial cells, connective tissue, and inflammatory cells) and hard (bone crest and bone marrow) tissues around the dental implants. Shape and size of the particles varied. The current literature reported a size range from 100 nm to 54 µm identified by multiple particles identification methods., Conclusion: Ti particles surrounding peri-implant tissues are a common finding. Peri-implantitis sites presented a higher number of particles compared to healthy implants. The particles were mostly around the implants and inside epithelial cells, connective tissue, macrophages, and bone. Various mechanisms were described as causes of Ti release, including friction during implant insertion, corrosion of the implant surface, friction at the implant-abutment interface, implantoplasty, and several methods used for implant surface detoxification., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To investigate the effect of the apico-coronal implant position on early and late crestal bone loss (CBL), in bone and tissue level implants., Materials and Methods: Electronic and manual literature searches were conducted for controlled clinical trials reporting on CBL before and after functional loading of implants. Random effects meta-analyses were applied to analyze the weighted mean difference (WMD) and meta-regression was conducted to investigate any potential influences of select confounding factors., Results: Fourteen articles were included in the systematic review and 12 were included in the quantitative synthesis. For bone level implants, WMD comparing early CBL in equi and subcrestal placement was 0.15 mm (P = .18). For analyses of late CBL in bone level implants, equi and subcrestal placement revealed a 0.03 mm WMD (P = .88). Where in supra and subcrestal placement, WMD was 0.04 mm (P = .86). The comparison presented considerable heterogeneity between these two arms, where the P value for chi-square test presented as .006. Finally, for CBL between supra and equicrestal placement, WMD was -0.64 mm (P < .0001), favoring the supracrestal group. For tissue level implants, WM of early and late CBL in implants placed equi-crestally was 0.68 ± 0.12 mm and 0.69 ± 0.54 mm, respectively, where for implants placed sub-crestally, the WM of CBL was 1.72 ± 0.15 mm and 2.26 ± 0.63 mm, respectively., Conclusion: Within the limitations of this study, it is recommended to place tissue level implants equicrestally, and bone level implants subcrestally., (© 2018 Wiley Periodicals, Inc.)

Background: Peri-implant diseases are prevalent, with numerous therapies studied in an attempt to combat this condition. The present review aims to systematically evaluate the effectiveness of laser therapy with non-surgical or surgical therapy in managing peri-implant mucositis and peri-implantitis., Methods: An electronic search of three databases and a hand search of peer-reviewed journals for relevant articles published (in English) from January 1980 to June 2016 were performed. Human clinical trials of ≥ 10 patients with peri-implant diseases, treated with surgical or non-surgical approaches and laser therapy, and a follow-up period of ≥ 6 months, were included. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval for the recorded variables according to PRISMA guidelines. Risk of bias assessment was also performed for randomized controlled trials included., Results: From 22 articles selected, 11 were included in the meta-analyses. The outcomes of using lasers as a monotherapy could not be evaluated since no controlled studies were identified. Therefore, all reported results were the outcomes of applying lasers as an adjunct to surgical/non-surgical treatment. For the non-surgical approach, WMD of probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI), marginal bone level (MBL) and recession (REC) was 0.15 mm (P = 0.50), -0.10 mm (P = 0.32), 21.08% (P = 0.02), -0.07 (P = 0.002), -0.22 mm (P = 0.04) and -0.11 mm (P = 0.34), respectively. For the surgical approach with a long-term follow up, WMD of PD, CAL, BOP, and PI was 0.45 mm (P = 0.11), 0.22 mm (P = 0.56), 7.26% (P = 0.76) and -0.09 (P = 0.84), respectively., Conclusions: Current evidence shows laser therapy in combination with surgical/non-surgical therapy provided minimal benefit in PD reduction, CAL gain, amount of REC improvement, and PI reduction in the treatment of peri-implant diseases. Lasers when used as an adjunct to non-surgical therapy might result in more BOP reduction in the short term. However, current evidence allowed for analysis of only Er:YAG, CO 2 , and diode lasers. Studies on others failed to have controlled evidence supporting their evaluation., (© 2018 American Academy of Periodontology.)

Purpose: Owing to volumetric changes after tooth extraction, lateral ridge augmentation has become a common procedure prior or simultaneous to implant placement. Nonetheless, little is known with regard to the dimensional remodeling after healing of these lateral ridge augmentation procedures. Hence, the purpose of this systematic review was to assess the stability of bone grafting material between augmentation procedures and final healing, in terms of resorption rate., Materials and Methods: An electronic and hand literature search was conducted in several databases, such as the Cochrane Oral Health Group Trials Register, Embase, and Cochrane Central Register of Controlled Trials, up until February 2017. Only randomized controlled trials (RCTs) with a mean follow-up of at least 6 months after implant placement aiming to evaluate the stability of grafting material for lateral ridge augmentation were included and quantitatively analyzed., Results: A total of 35 articles were evaluated; however, only 17 RCTs met the inclusion criteria. A total of 15 studies reported information on bone resorption, leading to a total sample of 304 implants. The estimated overall mean horizontal bone gain at the time of regeneration was 3.71 ± 0.24 mm, with 4.18 ± 0.56 mm for the block graft technique and 3.61 ± 0.27 mm for guided bone regeneration (GBR). The estimated overall net bone gain at final re-evaluation (11.9 ± 7.8) was 2.86 ± 0.23 mm. The estimated mean (± SD) resorption after 6 months was 1.13 ± 0.25 mm, with 0.75 ± 0.59 mm for the block graft technique and 1.22 ± 0.28 mm for GBR. The implant survival rate was 97% to 100%., Conclusion: Regardless of the material used for regeneration, different degrees of graft resorption should be expected. Given the sample of investigations analyzed in this review, block grafts seemed to maintain the volume of the initial augmentation site more than GBR techniques. During the initial stages of healing, the GBR technique experienced more changes compared with block grafts. The resorption of the xenograft group was inferior compared with the combination of xenograft and autologous bone groups. Consequently, overcorrection of the horizontal defects should be performed to compensate for the resorption of the grafting materials.

Purpose: The etiology and progression of periimplant mucogingival defects are multifactorial. As such, the aim of this study was to discern and discuss the key long-term prognostic factors that change the balance of homeostasis/regeneration in periimplant mucogingival and recession defects., Materials and Methods: This report provides cases and a discussion of anatomical factors that affect the long-term maintenance of periimplant soft tissue., Results: The factors guiding long-term maintenance of the periimplant soft tissue apparatus are increasingly complex due to the additive combination of patient-related factors, anatomical variations, and unique material-host interactions., Conclusions: Severity and number of these contributing factors should be considered before implant placement and/or in the treatment of periimplant defects to achieve the best esthetic and functional outcome. In addition, assessment of prognostic factors should be used to provide the patient a realistic, long-term assessment of the esthetic and functional stability of both implant and the surrounding periimplant tissues.

Purpose: To evaluate the effect of titanium (Ti) particles on oral epithelial cell homeostasis and the potential of dental implants to release Ti debris upon insertion., Materials and Methods: Dental implants with varying surface treatments were employed to determine the feasibility of particle release during implant placement as well as the impact of free Ti debris on oral epithelial cells. Ti particles derived from implant surfaces were isolated and cultured in direct contact with normal oral epithelial cells for 48 hours. Further, cells were fixed and processed for immunofluorescence assay to detect the activation of the DNA damage response (DDR) using CHK2 and BRCA1 molecular markers. Positive cells demonstrating DNA damage were quantified and statistically analyzed., Results: Ti particles derived from implants containing phosphate-enriched titanium oxide (PETO), fluoride-modified (FM), and grit-blasted (GB) surface treatments were able to activate CHK2 and trigger the recruitment of BRCA1 in oral epithelial cells. Also, implants with GB surfaces were able to release Ti particles upon implant placement., Conclusion: The results indicate that Ti debris may be detached from the implant surface upon placement. Also, free Ti particles can trigger DDR signaling in oral epithelial cells. These findings suggest that Ti particles/debris released into a surgical wound may contribute to the disruption of epithelial homeostasis, and potentially compromise the oral epithelial barrier.

Purpose: The aim of the present study was to systematically evaluate the marginal bone loss (MBL), success, and survival of zirconia (Zi) implants and compare them with the widely studied titanium (Ti) implants., Materials and Methods: An electronic and manual literature search of several databases was performed by two independent reviewers for articles up to July 2015 that reported the use of Zi implants and survival, success, and MBL with at least 12 months' follow-up. In addition, random effects meta-analyses of selected studies were applied to analyze the weighted mean difference of survival, success, and MBL between groups. Meta-regression analysis was conducted to investigate any potential influence of confounding factors., Results: Twenty-one articles were included, analyzing a total of 1,948 Zi implants with a survival rate of 91.5% and a success rate of 91.6% for 1,250 Zi implants. In addition, three studies were included in the quantitative synthesis and were meta-analyzed for the comparison of survival between Zi and Ti implants, with Zi implants having an 89% greater risk of failure compared with Ti implants (OR = 1.89). There were no statistically significant differences (P = .968) in the success of Zi and Ti implants (odds ratio [OR] = 1.02; 95% confidence interval [CI], 0.47-2.20). MBL (± SD) for Zi implants was 0.89 ± 0.18 mm, which was greater than the MBL for Ti implants (mean difference = 0.14 mm). Also, survival of Zi implants (91.5%) was significantly lower than that of Ti implants (OR = 1.89). Metaregression analysis revealed a similar survival rate for one-piece versus two-piece implants. Similarly, no significant differences were found between immediate and delayed loading., Conclusions: The survival rate of Zi implants was significantly lower than that for the commonly used Ti implants. However, for certain clinical conditions, such as a thin tissue biotype or in the highly esthetic anterior area, Zi implants may offer some benefit when compared with Ti implants.

Purpose: The purpose of this systematic review was to evaluate long-term outcomes of regenerative procedures for treating peri-implantitis., Materials and Methods: Electronic searches of five databases and hand searches of journals were performed to identify human trials that had treated more than 10 periimplantitis lesions using a regenerative approach with a follow-up period of at least 36 months. To meet the inclusion criteria, studies had to report at least one of the following parameters: radiographic bone fill (RBF), probing depth (PD) reduction, clinical attachment level gain, bleeding on probing reduction, and mucosal level gain. The pooled weighted mean and the 95% confidence interval (CI) of each variable were estimated., Results: The searches yielded 1,412 records, and after evaluating titles, abstracts, and full texts, 5 case series and 1 controlled trial were included for quantitative data synthesis. Meta-analysis of the studies for the amount of RBF revealed a weighted mean of 2.41 mm (range, 1.46 to 3.30 mm) with 95% CI. For PD reduction, the weighted mean was 3.06 mm (range, 1.24 to 5.21 mm)., Conclusion: There is limited evidence in the literature reporting long-term results of the regenerative approach for treating peri-implantitis. Within the limits of this meta-analysis, regenerative treatment of peri-implantitis resulted in a mean radiographic defect fill of 2.41 mm after a minimum healing time of 36 months. However, this finding must be interpreted with caution, since it is difficult to discern between grafting material and newly formed bone.

Introduction: The task of Group 3 was to review and update the existing data concerning non-surgical, surgical non-regenerative and surgical regenerative treatment of peri-implantitis. Special interest was paid to the preventive and supporting therapy in case of peri-implantitis., Material and Methods: The main areas of interest were as follows: effect of smoking and history of periodontitis, prosthetic treatment mistakes, excess cement, overloading, general diseases influence on peri-implantitis development. The systematic review and/or meta-analysis were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was searched and reported using the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. The method of preparation of systematic reviews of the literature based on comprehensive search strategies was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic review and/or meta-analysis is presented in Preface chapter., Results: The results and conclusions of the review process are presented in the respective papers. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.

Objectives: The purpose of this paper was to systematically evaluate the effectiveness of non-surgical therapy for the treatment of peri-implant diseases including both, mucositis and peri-implantitis lesions., Material and Methods: An electronic search in two different databases was performed including MEDLINE (PubMed) and EMBASE from 2011 to 2016. Human studies reporting non-surgical treatment of peri-implant mucositis and peri-implantitis with more than 10 implants and at least 6 months follow up published in English language were evaluated. A systematic review was performed to evaluate the effectiveness of the different methods of decontamination employed in the included investigations. Risk of bias assessment was elaborated for included investigations., Results: Twenty-five articles were identified of which 14 were further evaluated and included in the analysis. Due to significant heterogeneity in between included studies, a meta-analysis could not be performed. Instead, a systematic descriptive review was performed. Included investigations reported the used of different methods for implant decontamination, including self-performed cleaning techniques, and professionally delivered treatment such as laser, photodynamic therapy, supra-/sub-mucosal mechanical debridement, and air-abrasive devices. Follow-up periods ranged from 6 to 60 months., Conclusions: Non-surgical treatment for peri-implant mucositis seems to be effective while modest and not-predictable outcomes are expected for peri-implantitis lesions. Limitations include different peri-implant diseases definitions, treatment approaches, as well as different implant designs/surfaces and defect characteristics.

Background: Multiple variables have been shown to affect early marginal bone loss (MBL). Among them, the location of the microgap with respect to the alveolar bone crest, occlusion, and use of a polished collar have traditionally been investigated as major contributory factors for this early remodeling. Recently, soft tissue thickness has also been investigated as a possible factor influencing this phenomenon. Hence, this study aims to further evaluate the influence of soft tissue thickness on early MBL around dental implants., Methods: Electronic and manual literature searches were performed by two independent reviewers in several databases, including Medline, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to May 2015 reporting soft tissue thickness at time of implant placement and MBL with ≥12-month follow-up. In addition, random effects meta-analyses of selected studies were applied to analyze the weighted mean difference (WMD) of MBL between groups of thick and thin peri-implant soft tissue. Metaregression was conducted to investigate any potential influences of confounding factors, i.e., platform switching design, cement-/screw-retained restoration, and flapped/flapless surgical techniques., Results: Eight articles were included in the systematic review, and five were included in the quantitative synthesis and meta-analyzed to examine the influence of tissue thickness on early MBL. Meta-analysis for the comparison of MBL among selected studies showed a WMD of -0.80 mm (95% confidence interval -1.18 to -0.42 mm) (P <0.0001), favoring the thick tissue group. Metaregression of the selected studies failed to demonstrate an association among MBL and confounding factors., Conclusion: The current study demonstrates that implants placed with an initially thicker peri-implant soft tissue have less radiographic MBL in the short term.

Purpose: The aim of this study was to analyze cone beam computed tomography (CBCT) densitometries of maxillary sinuses augmented with human bone allograft. In addition, previously obtained microradiographic specimens were used to verify the diagnostic potential of CBCT., Materials and Methods: A two-stage protocol was conducted in 21 consecutive patients, all with a crestal bone height < 2 mm. Mineralized human bone allograft particles were used to augment sinuses using a lateral window approach. A succession of CBCT scans of the maxilla were taken before surgery, immediately after sinus augmentation, and 6, 10, and 18 months after implant placement. Using virtual probes, CBCT images taken at 6, 8, and 10 mm from the crestal surface were processed with medical imaging software and expressed as gray level (GL)., Results: A total of 24 sinus augmentation procedures were performed in 21 patients. The average values of CBCT-GL ranged from 571 to 654, presenting the maximum value at 8 mm immediately after implant placement and the minimum value at 6 mm after 10 months. Furthermore, it was found that the graft mineral content decreased over time, completely disappearing between 10 and 11 months., Conclusion: CBCT and the medical imaging software employed for imaging visualization are reliable tools to study biomaterial behavior after sinus augmentation procedures. In addition, results from this study demonstrate that a complete resorption of human bone allograft is possible. Due to the limited sample size, further clinical and morphometric studies are needed.

Osteosynthesis screws and titanium or resorbable pins have been recommended for fixing guided bone regeneration (GBR) membranes and stabilizing the graft. However, the removal of fixation screws or pins often requires an additional surgical procedure. This article presents a periosteal suturing technique with resorbable sutures for the fixation of grafts and membranes in GBR in single implant sites. This technique avoids potential complications of using fixation screws or pins, such as perforation of the roots when inserting the pins, and eliminates the need for a second retrieval surgery.

Although some systemic conditions have been associated with peri-implant disease, local contributing factors largely remain to be determined. This study aimed at evaluating, based on clinical photographs obtained from peri-implantitis treatment publications, the possible local contributing factors involved in its development based upon a survey obtained from three experienced clinicians (> 20 years of expertise). Cohen's kappa index was used to test the interexaminer reliability. "Too-buccal implant position" was the only parameter to reach almost perfect interexaminer agreement (κ = 0.81). "Thin-tissue biotype" and "minimal presence of keratinized mucosa" demonstrated moderate agreement (κ = 0.43 and κ = 0.58, respectively). The rest of the parameters studied based on clinical photographs were fair or poor. Therefore, based on this clinicians' survey, implants too buccally placed, minimal or a lack of keratinized mucosa, and thin-tissue biotype might contribute to a higher susceptibility of developing peri-implantitis. These factors must be the focus of attention in future cross-sectional studies on the incidence of peri-implant diseases.

The prevalence of gingival recession has been estimated at around 22.5% in people aged older than 29 years. Classic treatment approaches include the use of connective tissue grafts in combination with coronally advanced flaps (CAFs). To reduce morbidity and the need for a secondary surgical site, allograft materials are currently being used. Nevertheless, long-term randomized studies testing the efficacy of these materials are lacking. Hence, the aim of the present randomized controlled clinical trial was to compare two acellular dermal matrix (ADM) materials produced by different processing techniques, freeze-dried (FDADM) and solvent-dehydrated ADM (SDADM). At 12 months, both groups showed significant improvement in attachment level, recession depth, and recession width. A mean improvement in attachment level of 2.0 ± 1.08 mm for FDADM and 2.0 ± 0.70 mm for both SDADM was achieved (P = .002). Root coverage after 12 months was 80.66 ± 22.90% for FDADM and 80.97 ± 18.08% for SDADM. Hence, it was concluded that both FDADM and SDADM grafting materials can successfully achieve root coverage in Miller Class I and II recession defects for up to 12 months when used in combination with CAFs.

The aim of the present study was to use cone-beam computerized tomography (CBCT) to assess horizontal bone augmentation using block grafts, harvested from either the iliac crest (IC) or mandibular ramus (MR) combined with particulate xenograft and a collagen membrane for in the severe maxillary anterior ridge defects (cases Class III-IV according to Cadwood and Howell's classification). Fourteen healthy partially edentulous patients requiring extensive horizontal bone reconstruction in the anterior maxilla were selected for the study. Nineteen onlay block grafts (from IC or MR) were placed. The amount of horizontal bone gain was recorded by CBCT at 3 levels (5, 7, and 11 mm from the residual ridge) and at the time of bone grafting as well as the time of implant placement (≈5 months). Both block donor sites provided enough ridge width for proper implant placement. Nonetheless, IC had significantly greater ridge width gain than MR (Student t test) (4.93 mm vs 3.23 mm). This was further confirmed by nonparametric Mann-Whitney test (P = .007). Moreover, mean pristine ridge and grafted ridge values showed a direct association (Spearman coefficient of correlation = .336). A combination of block graft, obtained from the IC or MR, combined with particulate xenograft then covered with an absorbable collagen membrane is a predictable technique for augmenting anterior maxillary horizontal ridge deficiency.

Purpose: Sinus floor elevation via the lateral window approach represents a reliable technique for augmenting bone volume in the atrophic posterior maxilla. However, controversy remains regarding the effect of placement of a barrier membrane over the lateral window. This histomorphometric meta-analysis sought to clarify the effect of barrier membranes in lateral window sinus augmentation., Materials and Methods: An electronic search of three databases and a hand search in implant-related journals for studies published through January 2013 in the English language was conducted. Randomized controlled trials, prospective human clinical studies, retrospective investigations, and case series reporting histomorphometric results after sinus elevation using the lateral window approach with at least six patients and a minimum follow-up period of 6 months were included., Results: The initial search yielded 1,040 articles, of which 94 were further evaluated for eligibility. Finally, 37 studies were chosen and separated into membrane (group 1) and no-membrane (group 2) groups. Similar vital bone formation was found in both groups: 32.36% for group 1 and 33.07% for group 2., Conclusion: Based does not influence the amount of vital bone formation after sinus augmentation. Additionally, the type of grafting material used and healing time did not influence the histomorphometric outcome.

The advancement of molecular mediators or biologic agents has increased tremendously during the last decade in periodontology and dental implantology. Implant site development and reconstruction of the lost periodontium represent main fields in which these molecular mediators have been employed and investigated. Different growth factors trigger different reactions in the tissues of the periodontium at various cellular levels. Proliferation, migration, and differentiation constitute the main target areas of these molecular mediators. It was the purpose of this comprehensive review to describe the origin and rationale, evidence, and the most current understanding of the following biologic agents: Recombinant Human Platelet-Derived Growth Factor-BB (rhPDGF-BB), Enamel Matrix Derivate (EMD), Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF), Recombinant Human Fibroblast Growth Factor-2 (rhFGF-2), Bone Morphogenic Proteins (BMPs, BMP-2 and BMP-7), Teriparatide PTH, and Growth Differential Factor-5 (GDF-5).

Background: The purpose of this multicenter randomly controlled clinical trial was to compare two acellular dermal matrix (ADM) materials produced by different processing techniques, freeze-dried (FDADM) and solvent-dehydrated (SDADM) ADM, in their ability to correct Miller Class I and II recession defects., Methods: Eighty individuals from four study centers, each with a single maxillary anterior Miller Class I or II recession defect were enrolled. Participants were randomly assigned and treated with coronally advanced flap (CAF) + FDADM (n = 42) or CAF + SDADM (n = 38). Gingival thickness, recession depth, recession width, probing depth (PD), clinical attachment level, gingival index, plaque index, patient discomfort, and wound healing index were recorded before surgery (day 0), immediately after surgery (day 1), and 2, 4, 12, 24, and 52 weeks postoperatively. The Student t test, paired t test, and Kruskal-Wallis one-way ANOVA were used to analyze the data., Results: When evaluating the clinical parameters after 1 year, both groups showed significant (P <0.05) improvement for most of the parameters evaluated when compared to baseline (day 0). For example, percentage of root coverage was 77.21% ± 29.10% for CAF + FDADM and 71.01% ± 32.87% for CAF + SDADM. Conversely, no significant differences were observed between the two materials for any clinical parameter tested or for patient satisfaction except PD on the mesial side of the defects (P = 0.03)., Conclusions: Both FDADM and SDADM can be used successfully to correct Miller Class I or II recession defects. There were no statistically significant differences between groups for any of the clinical parameters tested.

Background: With the increased use of short dental implants (<10 mm), a high crown/implant (C/I) ratio has become a common finding. However, the effect of the C/I ratio on the marginal bone loss (MBL) has not yet been examined extensively. Hence, the aim of the present systematic review is to explore the influence of the C/I ratio on the success rate and MBL of dental implants., Methods: Three electronic databases (PubMed, Ovid MEDLINE, and Cochrane Central) and a manual search for human trials with a minimal follow-up of 6 months are used for the present study. A statistical analysis of the influence of the C/I ratio was performed on the peri-implant MBL while considering follow-up period, type of implants, implant connection, and technical and biologic complications., Results: One hundred ninety-six potential articles were identified on the selected databases. Only 57 articles were selected for full-text evaluation. According to the inclusion criteria, a total of 13 articles were included in this systematic review. A significant negative association between the C/I ratio and the MBL was found (P = 0.012). However, no statistically significant difference was found (P >0.15) for potential effects regarding the observation period, the type of implant connection, or between both methods of evaluating the C/I ratio., Conclusions: Within the limitations of the present study, the C/I ratio of implant-supported restorations has an effect on peri-implant marginal bone level. Within the range of 0.6/1 to 2.36/1, the higher the C/I ratio, the less the peri-implant MBL.