This split-mouth trial investigated the efficacy of treating bilateral gingival recessions with either a xenogeneic cross-linked collagen matrix (CCM) or recombinant human platelet-derived growth factor-BB (rhPDGF-BB) with a bone allograft (AG). Ten patients were treated with a coronally advanced flap, either with CCM or rhPDGF-BB + AG. The primary outcome was percentage of mean root coverage (mRC) at 12 months. Additional outcomes included clinical and volumetric measurements; patient-reported outcome measures (PROMs) for pain, swelling, and esthetics; and ultrasonographic assessment of gingival thickness (GT) and position of the buccal bone. At 12 months, both groups showed significant improvements, with an mRC of 78.6% in the CCM group and 82.3% in the rhPDGF-BB + AG group. A 3D analysis of both groups showed comparable volumetric gain. CCM-treated sites displayed higher ultrasonographic echogenicity in GT (P < .01) than rhPDGF-BB + AG sites. The rhPDGF-BB + AG group showed greater reductions in the buccal bone dehiscence (mean: 2.03 mm; P < .01), less swelling during the first 3 days, and slightly greater mRC. CCM and rhPDGF-BB + AG were effective in treating multiple adjacent gingival recessions. CCM promotes greater gains in gingival thickness, while rhPDGF-BB + AG resulted in significantly less buccal bone dehiscenace.
This study analyzed articles published in The International Journal of Periodontics & Restorative Dentistry (IJPRD) through a bibliometric and altmetric review. In August 2025, a search was conducted in Scopus. Bibliometric data were extracted from all included studies. VOSviewer was employed to generate collaboration maps. Altmetric data were retrieved from Dimensions. A total of 3,001 articles were included. Articles were published between 1981 and 2025. There was a prevalence of research articles (n = 2,438), primarily case reports and series (n = 947). The United States stood out (n = 1,212) as a primary nation of origin for articles published, with the University of Michigan (n = 217) predominating. M. Nevins (n = 153) was the most productive author. Mendeley readers and X social media platform showed substantial interest in the publications. There has been a predominance of research articles over the years, particularly case reports, originating from the United States. Future submissions of systematic reviews are encouraged. Submissions from African and Oceanian countries are also encouraged.
Skeletal diagnosis and upper-airway health should be the foundation of risk assessment for the interdisciplinary patient, as the diagnosis impacts treatment planning and outcomes. Currently, there is an epidemic of dental arch deficiencies with multifactorial etiologies that contribute to dentofacial disharmony malocclusions. Assessing each dimension of the periodontal phenotype in the context of the planned intervention, termed phenotype-driven treatment planning (PDTP; as outlined in Part I of this series), offers an opportunity to evolve our treatment-planning concepts and allows for the selection of the appropriate management protocol and sequence of treatment. The purpose of this case series is to highlight the application of the recently introduced systematic process of PDTP and to build upon the existing evidence/reported advantages of phenotype modification for the interdisciplinary patient. This case series emphasizes a comprehensive diagnosis to achieve optimized periodontal phenotype dimensions in interdisciplinary dentofacial therapy. Establishing an accurate and comprehensive diagnosis coupled with the use of available innovations can help us identify how to address the etiology of our patients' problems with less compromise and compensation treatment, promoting systemic, structural, and functional health.
Exosomes, the smallest subset of extracellular vesicles, play a crucial role in cell signaling and communication throughout the body. Their regenerative potential has sparked tremendous interest, with over 5,000 articles on exosomes published yearly, primarily focused on in vitro and preclinical studies. However, to date, no study has investigated their use in humans for dental applications. In this first case report, horizontal ridge augmentation was performed using a novel combination of bone allografts, platelet-rich fibrin, and a specialized subset of exosomes (Periosomes). Implants were placed at 3 months postsurgery, during which a core biopsy sample was taken for histologic analysis. Additionally, CBCT scans were obtained at 1, 2, 3, and 6 months, revealing marked and progressive bone growth. To the authors' knowledge, this study represents the first documented use of exosomes in human alveolar bone regeneration. This case highlights the promising potential of exosomes in regenerative dentistry, opening new avenues for their application in guided bone re-generation procedures.
This single-blinded, randomized prospective clinical trial evaluated the impact of suture removal timing on the clinical outcomes of root coverage procedures. Patients presenting with multiple gingival recessions were allocated into one of three groups based on the timing of suture removal postsurgery: 1 week (TSR1), 2 weeks (TSR2), or 3 weeks (TSR3). The measured primary outcomes included percentage of root coverage (%RC) and complete root coverage (CRC), among other clinical outcomes. Data were collected at baseline (immediately preoperative) and at 3 and 6 months postoperative. At 6 months, the %RC was 58.4% (TSR1), 91.5% (TSR2), and 75.7% (TSR3). TSR2 achieved a 28.9% higher %RC than TSR1, while no significant differences were found between TSR2 and TSR3. CRC was achieved in 38.2%, 78.6%, and 62.5% of the TSR1, TSR2, and TSR3 groups, respectively. TSR2 resulted in a 5.92-fold increase in CRC compared to TSR1, whereas no significant difference was observed between TSR2 and TSR3. This suggests that a 2-week period before suture removal may optimize root coverage outcomes. However, extending suture removal timing beyond 2 weeks did not confer additional benefits. These findings are specific to the use of polypropylene and coronally advanced graft plus connective tissue graft.
Oral implants require adequate bone support, which is often facilitated by bone augmentation when bone volume is insufficient. Autogenous bone (AB) has been considered the gold standard for such procedures due to its osteogenic properties, but it necessitates a second surgical site, which increases patient morbidity. This study was a randomized, double-blind, split-mouth clinical trial comparing leukocyte-platelet-rich fibrin (L-PRF) bone block grafts against a composite graft mixture of 50% AB with 50% deproteinized bovine bone mineral for vertical guided bone regeneration (GBR). The trial included six patients needing bilateral vertical GBR before implant placement. A dense polytetrafluoroethylene membrane was used for both test and control sites. The primary outcome measure was vertical bone height (VBH) gain, assessed via CBCT at 9 and 25 months postoperative. There was no significant difference in VBH gain between the test and control sites at any time points, with a mean VBH gain at implant placement of 4.6 ± 3.0 mm for test sites and 5.2 ± 2.7 mm for control sites. One year after implant loading, the VBH gain was 3.0 ± 2.8 mm for test sites and 3.8 ± 2.6 mm for control sites (P = .96). Complications were minimal and included one implant loss due to infection in a test site. The L-PRF bone block could be a viable alternative to the composite graft, potentially reducing the need for harvesting bone from a second surgical site. Future studies with larger sample sizes are needed to confirm these findings and to explore the biologic benefits of integrating the L-PRF bone block into bone graft materials for oral implantology.
As stability is a key determinant of successful regeneration, this paper introduces tack engagement as a novel alternative to conventional suturing techniques, aimed at improving the positioning and fixation of autogenous tissue grafts. Rigid tack engagement, a widely used technique in guided bone regeneration protocols for securing membranes, offers a stable and time-efficient solution that mitigates the risks of early graft displacement resulting from suturing or delayed volume changes due to physiologic healing processes or unintentional patient oral habits. Subperiosteal tissue tacking represents a promising alternative technique for managing small to moderate tissue defects, mitigating various biologic and practical obstacles. Within the limitations of this report, tacks provide a variety of practical benefits for tissue fixation, rendering them particularly useful in staged implant placement procedures. Further research is necessary to comprehensively assess the benefits and potential constraints of this innovative approach.
Sinus membrane perforations are among the most commonly reported intraoperative complications encountered during maxillary sinus floor elevation procedures performed via the lateral window approach. Large perforations (> 10 mm) can pose a major clinical challenge and often result in failed bone augmentation and poorer long-term implant survival. Because of these challenges, even a highly skilled oral implant surgeon with advanced training in implantology who faces such perforations may abandon grafting procedures in favor of a reentry approach. This article describes an approach to managing large perforations through the use of a collagen membrane stabilized by tacks on the mesial and lateral walls that is permissive to simultaneous bone augmentation.
This study aimed to compare the short-term (3.7 ± 0.4 years) outcomes of full-arch immediately loaded fixed maxillary prostheses supported by conventional and unilateral single zygomatic implants vs those supported by two conventional and bilateral zygomatic implants. A retrospective analysis was conducted on patients suffering severe bone loss in the posterior maxilla. The success of zygomatic implants was defined following Offset-Rhinosinusitis-Infection-Stability (ORIS) criteria. The criteria used to define the success of standard dental implants were the absence of mobility, pain, discomfort, neurologic disorder, and persistent or chronic infection. The level of significance was .01. A total of 38 patients received 2 to 5 standard implants plus 2 zygomatic implants (bilateral), whereas 10 patients received 3 to 5 standard implants plus a single zygomatic implant (unilateral). In total, 108 standard and 76 zygomatic implants were placed in bilateral group patients, whereas 38 standard and 10 zygomatic implants were placed in unilateral group patients. The cumulative success rate for standard implants was 99% and 97.3% in the bilateral and unilateral groups, respectively. Four patients showed symptoms of acute rhinosinusitis (R-criterion): 1 in the unilateral group and 3 in the bilateral group. Following the O-criterion, just 2 implants in the bilateral group showed a success grade 1. One zygomatic implant in the bilateral group developed peri-implant mucositis with a success grade 3 (I-criterion). All zygomatic implants were checked individually and did not show any signs of mobility or rotation after applying forces to the implant (S-criterion). The ORIS criteria divided the implants into three groups according to the success grades I, II, and III: 32, 36, and 8 implants, respectively, for the bilateral group, and 6, 1, and 3 implants, respectively, for the unilateral group, with no significant difference between the two groups. No zygomatic implant failure occurred, and thus the same zygomatic implant success rate (100%) was recorded for both groups. A prosthetic failure was registered in the unilateral group. The overall prosthesis success rates were 89.5% and 70% in the bilateral and unilateral groups, respectively. A high degree of success was achieved for both groups treated with zygomatic implants, although in the unilateral group there was one failure of a standard implant placed in the posterior area. This suggests that the use of zygomatic implants could provide adequate support to fixed full-arch prostheses, even in the configuration with a single unilateral zygomatic implant.
This study aimed to assess the effectiveness of repeated subgingival instrumentation combined with 980-nm diode laser decontamination in the nonsurgical treatment of deep periodontal pockets. A total of 40 otherwise healthy patients with generalized periodontitis, encompassing 1,168 sites with deep pockets, were included. Baseline probing pocket depths (PPDs), bleeding on probing (BOP), gingival recession, clinical attachment level, and Plaque Index were recorded. Each patient underwent nonsurgical laser-assisted periodontal therapy and was enrolled in a maintenance program with 3-month recall visits during the first year of follow-up. In nonresponding sites, site-specific nonsurgical instrumentation was repeated during follow-up visits. The achievement of pocket closure (PPD ≤ 4 mm with negative BOP) was evaluated as the primary outcome. Changes in the above parameters were also measured at 3 months (T1) and 1 year (T2). Additionally, a logistic regression model was constructed to explore the association of pocket closure at T2 with several predictor variables. At the 3-month evaluation, 677 of the treated sites (57.96%) achieved pocket closure. This number increased significantly after 1 year, with 977 out of 1,168 sites (83.65%) requiring no further treatment. The logistic regression analysis indicated that a higher number of roots, older age, history of diabetes mellitus, and greater baseline PPD were associated with less pocket closure at T2. Within its limitations, the present study demonstrates that the outcomes of initial nonsurgical periodontal therapy can be further enhanced by repeated site-specific laser-assisted nonsurgical instrumentation, scheduled quarterly during the first year of follow-up.
The Pinhole Surgical Technique (PST) was first described in The International Journal of Periodon-tics & Restorative Dentistry in October 2012 in a case series involving 43 patients with 121 recession defects. Follow-up data were included for 37 patients with 85 Miller Class I and II recession defects over an average period of 20.0 ± 6.7 months. The current study provides a long-term follow-up as-sessment of 28 patients with 68 Miller Class I and II sites from the original study, with an average follow-up period of 173.8 ± 32.2 months (14.5 ± 2.7 years). The percentage of complete root cov-erage for Class I and II sites was 81.2% in the original study and 77.9% in this follow-up study. The mean root defect coverage was 94.0% ± 14.8% in the original study and 86.6% ± 27.4% in this fol-low-up study. Within the limitations of this study's design, PST demonstrates long-term predictabili-ty and effectiveness in achieving sustained root coverage over an average period of 14.5 years.
The adjunctive use of connective tissue grafts (CTGs) in the periodontal regeneration of intrabony defects has been proposed to prevent or limit postoperative gingival recession. However, there is limited evidence regarding the long-term clinical performance of this approach. This article presents the 5-year follow-up outcomes of a combination therapy using CTGs, bone substitutes, and biologic materials for the treatment of deep intrabony defects associated with gingival recession. Twelve healthy, nonsmoking patients with 12 deep intrabony defects participated in the study. Before undergoing the described treatment regimen, these patients had a baseline (immediately preoperative) mean clinical attachment loss of 9.9 ± 2.1 mm, a mean probing depth (PPD) of 7.8 ± 1.5 mm, and a mean buccal recession (REC) of 2.3 ± 1.8 mm. After 5 years, the mean clinical attachment level (CAL) gain was 5.7 ± 3.2 mm (P < .001), the mean reduction in PPD was 5.1 ± 1.6 mm (P < .001), and the mean reduction in REC was 1.2 ± 2.1 mm (P = .07). Of the sites, 91% achieved CAL gain ≥ 3 mm and PPD ≤ 4 mm. Compared to baseline, 7 out of 12 sites showed an REC reduction ≥ 1 mm, while 3 sites remained stable, and 2 sites experienced an increase in gingival recession depth (1 and 2 mm, respectively). Within the limitations of this case series, periodontal regenerative therapy incorporating the adjunctive use of a CTG was shown to be effective for treating deep noncontained periodontal intrabony defects and subsequently stabilizing or slightly improving the gingival margin over 5 years.
Bone augmentation procedures often lead to coronal displacement of the mucogingival junction, a deficiency of keratinized mucosa, and a reduction in soft tissue height. These challenges complicate the achievement of an ideal peri-implant phenotype. It is known that addressing both the quantity and quality of soft tissue is crucial for the long-term success and esthetics of implants. This report introduces a novel technique for peri-implant phenotype modification following bone augmentation, which combines a modified onlay graft (MOG) with an apically positioned flap (APF) performed simultaneously with implant placement. Two clinical cases are presented to demonstrate this approach, highlighting the restoration of the soft tissue environment through a single surgical intervention. The technique resulted in successful outcomes, including increased vestibular depth, keratinized tissue width, and vertical soft tissue volume. The MOG technique effectively manages soft tissue in post-bone augmentation scenarios, providing an ideal peri-implant phenotype and leading to stable, esthetic, and functional implant restorations. This method requires fewer surgical interventions than traditional alternatives, minimizing patient discomfort and enhancing overall treatment outcomes.
The integrity and phenotype of periodontal soft tissues significantly influence the outcome of sur-gical periodontal regenerative therapy. In cases with a thin gingival phenotype, treating infrabony defects surgically can worsen gingival recession and loss of papillae. This report outlines a surgical approach for addressing infrabony defects at sites with gingival recession and a thin phenotype. The treatment involves using a tunneled coronally advanced flap to obtain access for defect de-bridement, root instrumentation, graft placement, and tissue advancement for root coverage. A connective tissue graft is secured to the two teeth flanking the infrabony defect using two subperi-osteal sling sutures to create a buccal soft tissue wall and tent up the papilla overlying the defect, providing and maintaining the necessary space for biomaterial and clot stability. The treatment significantly improved interproximal clinical attachment levels, tissue phenotype, and root coverage at 1 year postsurgery. Treatment outcomes suggest that this approach may be used to effectively treat isolated infrabony defects associated with gingival recession.
It is well known that keratinized mucosa (KM) plays a crucial role in maintaining peri-implant health and esthetic outcomes. The strip gingival graft (SGG) technique, which involves an apically positioned flap (APF) in combination with an autogenous SGG and a xenogeneic collagen matrix (XCM), has demonstrated its efficacy in reestablishing an adequate amount of KM width at implant sites. Nevertheless, it is still unclear whether harvesting the SGG from the palate (pSGG) or from the buccal aspect (bSGG) of natural dentition affects the esthetic outcome at the augmented implant sites. Therefore, the objective of the present study was to compare the esthetic outcomes of dental implants augmented with either bSGG + XCM or pSGG + XCM. The present study was designed as a single-center retrospective study, assessing the esthetic and colorimetric outcomes of peri-implant KM augmentation with either pSGG + XCM or bSGG + XCM in a cohort of 49 subjects. The two groups were compared in terms of colorimetric outcomes, assessed on clinical photographs using specific software that was able to identify and quantify the predominant color within the peri-implant soft tissue. Colorimetric comparisons with adjacent untreated sites were also investigated. In addition, the Pink Esthetic Score (PES) and a subjective evaluation of the esthetics (SEE) were performed to further assess the esthetic outcomes of pSGG + XCM and bSGG + XCM. The colorimetric analysis did not show statistically significant differences among sites augmented with pSGG + XCM, sites augmented with bSGG + XCM, and untreated sites. Implants treated with bSGG + XCM showed significantly greater PES (in terms of shape of the mesial and distal papillae, level of the soft tissue margin, soft tissue contour, anatomy of the alveolar process, and final PES) and SEE compared to implants augmented with pSGG + XCM. The present study demonstrated that implant sites augmented with APF with either pSGG + XCM or bSGG + XCM did not show different colorimetric outcomes compared to adjacent untreated sites, while bSGG + XCM obtained superior professional and subjective esthetic scores compared to pSGG + XCM.
This retrospective study aimed to compare extended sinus elevation and extramaxillary surgical protocols for restoring severely atrophic maxillae with zygomatic implants (ZIs) and evaluate their clinical effectiveness. The study included patients who were treated at a dental clinic in Italy from 2012 to 2022 who received fixed screw-retained complete dentures supported by either two or four ZIs. The patients underwent a minimum 1-year follow-up after loading, following two protocols: the hybrid and the quad protocol. Digital planning incorporated CBCT scans, intraoral scans, and digital prosthetic plans within implant-planning software. Surgical techniques involved extended sinus elevation and extramaxillary techniques, using the ZAGA approach for ZI placement. The results showed that out of 19 patients with a mean age of 65.3 years, a total of 56 ZIs and 20 standard implants were used, with no failures observed in either the implants or the definitive prostheses, resulting in a 100% survival rate. According to the ORIS criteria, overall success was achieved in terms of implant stability, sinus health, peri-implant soft tissue condition, and prosthetic function. Only two ZIs (3.6%) exhibited minor gingival recession and moderate thread exposure, which were closely monitored through professional hygiene maintenance. Both the extended sinus elevation and extramaxillary protocols demonstrated comparable clinical outcomes and minimal complications in the restoration of severely atrophic maxillae with ZIs. However, further extensive studies involving larger, multicenter designs and longer follow-up periods are needed to validate and refine these outcomes.
Implantoplasty involves mechanically modifying the exposed implant surface by removing macro- and microstructures and is typically considered a resective approach. The potential for bone regen-eration with implantoplasty alone has not yet been studied. This research aimed to evaluate long-term changes in peri-implant bone levels without using regenerative materials. A total of 56 patients (70 implants) were included in the study and were followed for up to 10 years, with a mean observa-tion time of 59 months (~5 years). The implants were evaluated retrospectively through radiograph-ic and clinical (bleeding on probing and suppuration) analyses. Of the 70 implants, 11 (15.7%) were lost due to disease recurrence and additional bone loss. One implant (1.4%) experienced up to 1.0 mm of bone loss, 15 implants (21.4%) showed no change in marginal bone levels (MBLs), and 43 implants (61.5%) gained bone up to 4.8 mm, all without the use of any graft material or membrane. The overall mean MBL change for the remaining 59 implants at the end of the follow-up period (84.3%) was a gain of 1.27 mm. Implantoplasty alone without osseous surgery, flap repositioning, or use of a graft material or membrane may be a viable option for managing peri-implantitis defects. However, future randomized clinical trials with larger sample sizes are necessary to validate current findings.
This study evaluated the color-masking and relative translucency parameter (RTP) of increasing dentin thicknesses from different resin composites, with or without opacifiers, on a veneer dental preparation and resin disks. Artificially darkened lateral incisors with 1-mm-thick veneer preparations were used for the different materials: IPS Empress Direct (ED; Ivoclar Vivadent) with or without ED Opaque (Ivoclar Vivadent), and Essentia (ES; GC) with or without ES Masking Liner (GC). For the RTP test, disk-shaped specimens were made and evaluated with a spectrophotometer (VITA Easyshade) against black and C4 backgrounds. Color differences (ΔE00) were calculated using the CIEDE-2000 formula. The dentin layer thickness presented no influence on the ΔE00 values (P > .05) of the ED group with opacifier; without opacifier, 0.3-mm dentin thickness presented higher ΔE00 values than 0.8-mm dentin layer (P = .000). For the ES group, with and without opacifier, there was a significant decrease in ΔE00 with the increase of dentin thickness (P < .05). All ED groups presented lower ΔE00 values than the ES groups (P < .05). All groups showed perceptible color differences, but some ED groups showed acceptable values. For RTP comparisons, a decrease in the ΔE00 value was observed with the increase of dentin thickness (P < .05). ED groups with opacifier presented significantly lower ΔE00 values than ES groups (P < .05). A significant decrease in ΔE00 values was observed for all groups with an opacifier (P < .05). ED combinations with 0.3-mm thickness and opacifier and with 0.6-mm thickness or higher without opacifier were sufficient to mask a C4 background, while ES combinations could not acceptably mask the substrate, according to the determined acceptability threshold. Dentin thickness significantly increases at the same pattern that the ΔE00 value decreases. A black background promoted greater ΔE00 values than a C4 background.
Tooth autotransplantation is a reliable procedure with high long-term success and survival rates and shows many advantages over dental implants, particularly for young patients in craniofacial devel-opment. Nonetheless, insufficient bone availability at the recipient site is a key limitation. This study aimed to establish the feasibility of tooth autotransplantation combined with staged or simultaneous bone regeneration to address complex cases. Two young patients with missing teeth due to hypodon-tia or trauma and who were deemed unsuitable for implants were treated. Both complex cases were addressed through autologous tooth autotransplantation, either in conjunction with simultaneous guided bone regeneration or into a previously regenerated crest. The 5-year follow-up for the auto-transplanted canine and more than 20-year follow-up for the autotransplanted premolar revealed satisfactory results. These teeth played pivotal roles in restoring both function and esthetics in young patients. Additionally, tooth vitality was preserved throughout the follow-up period, with no compli-cations noted. Tooth autotransplantation in combination with previous or simultaneous guided bone regeneration proved to be effective in restoring function and esthetics in complex situations in young patients.
Interproximal attachment plays a crucial role in diagnosing periodontal conditions and predicting their prognosis due to its significant impact. The loss of interproximal attachment, often accompanied by papilla loss, can lead to phonetic, functional, and esthetic challenges. However, existing literature provides limited data on treatment outcomes for interdental papilla reconstruction and root coverage. This technical case report presents a novel surgical approach utilizing labial mucosal vertical incisions and palatal marginal vertical incisions to facilitate creation of a partial-full-thickness (PFT) tunnel. Then, connective tissue grafts (CTGs), stabilized by supra-crestal sling (SCS) sutures, are used to support and coronally advance the soft tissue overlying the graft to obtain root coverage and enhance papilla height and volume. This technique optimizes blood supply and maximizes wound stability, resulting in significant papilla augmentation and complete root coverage. It is suggested that PFT tunnel preparation via labial mucosal vertical incisions and palatal marginal vertical incisions, combined with CTG stabilization via the SCS suture, has the potential to treat gingival recessions with deficient papilla in the maxillary esthetic zone.
