Background CAD/CAM zirconia barriers represent an advanced option for guided bone regeneration (GBR) in three‐dimensional defects, integrating mechanical stability, biocompatibility, and digital precision. The objectives of this case series were to evaluate, clinically, histologically, and three‐dimensionally, the use of customized zirconia barriers designed using CAD/CAM technology in GBR procedures. Methods and Results Three patients with severe maxillary bone atrophy were included and treated with GBR using customized zirconia barriers. Digital planning was performed based on cone beam computed tomography and intraoral scanning, followed by CAD/CAM design and fabrication of the barriers. The defects were regenerated using a mixture of autogenous bone and xenograft. After the healing period, implants were placed using guided surgery, and bone biopsies were obtained for histological analysis. Bone gains were evaluated through linear and volumetric digital analysis based on three‐dimensional model superimposition. All surgeries were completed without complications, allowing implant placement in all cases without the need for additional augmentation procedures. Mean horizontal bone gains of 6.17 mm at the crestal level and mean vertical gains of 2.62 mm were recorded, with maximum values of up to 5.11 mm. Volumetric analysis revealed bone gains of 797.158 mm 3 (case 1), 459.718 mm 3 (case 2), and 1416.870 mm 3 (case 3). Histological analysis demonstrated vital, well‐vascularized newly formed bone undergoing active remodeling, with no evidence of inflammation. Conclusions Customized zirconia barriers demonstrated favorable clinical and histological outcomes in GBR. The digital workflow, combined with three‐dimensional analysis, allowed a precise and reproducible evaluation of bone changes. KEY POINTS This case series presents a comprehensive clinical protocol for guided bone regeneration using customized zirconia barriers, based on prosthetically driven planning, individualized barrier design, graft stability, and meticulous peri‐implant soft tissue management, including histological analysis of the regenerated tissue. The incorporation of a standardized digital protocol for linear and volumetric analysis enabled an objective, reproducible, and precise evaluation of dimensional changes in the alveolar ridge. Plain language summary Significant bone loss in the upper jaw can prevent dental implants from being placed in the correct position. In these situations, rebuilding the lost bone is necessary to achieve a stable long‐term outcome. This case series describes the use of customized zirconia barriers designed to fit each bone defect and support bone regeneration. After the healing period, all treated defects showed sufficient bone gain to allow implant placement according to the original prosthetic treatment plan. Histological analysis confirmed the formation of new bone, while a standardized digital measurement protocol provided an objective and reproducible assessment of the bone changes achieved after treatment. These findings suggest that customized zirconia barriers may represent a promising alternative for the management of complex bone defects, although studies involving larger numbers of patients are needed to confirm these results.
Abstract Background Gingival enlargements may manifest with similar presentations, and their management may be particularly challenging in the esthetic zone when surgical removal leads to residual soft‐tissue defects that compromise the function and esthetics. This case report describes the management of a lobular capillary hemangioma (LCH) that required a definitive diagnosis, complete surgical excision, and esthetic reconstruction of the gingival and papillary tissues. Methods A 21‐year‐old woman presented with a progressively enlarging gingival swelling and spacing between the left maxillary anterior teeth. On examination, a soft, nontender, sessile growth was observed, with positive diascopy and palpable pulsations, raising suspicion of a vascular lesion. The lesion was completely excised and submitted for histopathologic examination, which identified it as an LCH. A gingival unit graft (GUG) was simultaneously placed to reconstruct the soft‐tissue architecture. Results The patient healed uneventfully with a satisfactory outcome and soft‐tissue graft integration. Conclusions The case underscores the need for meticulous treatment planning when managing pathological gingival lesions in the esthetic zone. Immediate soft‐tissue reconstruction using a GUG following lesion excision may help restore marginal and papillary gingival architecture and achieve favorable functional and esthetic outcomes. Key points Accurate diagnosis of lobular capillary hemangioma requires correlation of clinical findings with histopathologic examination Surgical excision in the esthetic zone should consider the potential loss of marginal and papillary soft tissues Simultaneous gingival unit grafting can help reconstruct gingival and papillary architecture and achieve favorable esthetic outcomes following lesion excision Plain language summary This report presents the management of a gingival lobular capillary hemangioma associated with prominent vascular clinical features and highlights how careful clinical assessment, definitive histopathologic diagnosis, and immediate soft‐tissue reconstruction can facilitate favorable functional and esthetic rehabilitation following lesion excision.
Abstract Introduction Gingival recession (GR) defects in the mandibular anterior region represent a particularly challenging scenario in periodontal plastic surgery, owing to a thin soft tissue phenotype, minimal keratinized tissue, limited vestibular depth, and the frequent presence of a prominent labial frenum. While significant advances have been made in root coverage procedures for the anterior mandible, simultaneously addressing these coexisting anatomical factors in a single, minimally invasive procedure remains a clinical challenge. Methods This technique report describes the combined application of the tunneled coronally advanced flap (TCAF) with the internal frenectomy–vestibular incision subperiosteal tunnel access (IF‐VISTA) and connective tissue graft for the treatment of multiple mandibular anterior GRs in two systemically and periodontally healthy, non‐smoking patients. The TCAF framework guided site‐specific papilla management, while the IF‐VISTA provided internal frenectomy, vestibular deepening, and expanded subperiosteal access through a single minimally invasive incision. Results Healing was uneventful, with limited postoperative morbidity. At 10–12 months, complete root coverage was observed at most treated sites in the two cases, accompanied by an increase in soft tissue phenotype, papilla fill, and resolution of dentinal hypersensitivity. Conclusions The TCAF + IF‐VISTA combination addresses, within a single procedure, the multiple anatomical factors most commonly compromising outcomes in the mandibular anterior region, including mandibular midline frenum pull, limited vestibular depth, and restricted surgical access. The synergy between the two approaches facilitates tension‐free flap advancement, precise graft insertion, simultaneous frenulum elimination, and preservation of papillary integrity. Prospective controlled studies are needed to validate the long‐term outcomes and reproducibility of this technique. Key points The combination of tunneled coronally advanced flap (TCAF) with the internal frenectomy–vestibular incision subperiosteal tunnel access (IF‐VISTA) allows clinicians to address, in a single surgical procedure, the multiple anatomical factors most commonly associated with mandibular anterior gingival recessions, including limited vestibular depth, high mandibular midline frenum insertion, and restricted surgical access. The internal frenectomy component of IF‐VISTA eliminates the mandibular midline frenum attachment through a closed, scarless approach, avoiding the morbidity associated with conventional open frenectomy while simultaneously enhancing coronal flap mobility and tension‐free tissue advancement. The TCAF decision‐making framework allows site‐specific adaptation of the flap design—selectively incising or tunneling each papilla based on its morphology and the local anatomy—making this combined approach flexible and adaptable to varying clinical presentations in the mandibular anterior region. Plain language summary Gum recession occurs when the gum tissue pulls away from the teeth, exposing the root surface, and can cause sensitivity, esthetic concerns, and long‐term damage to the tooth and surrounding tissues. In the lower front teeth, treating gum recession is particularly difficult because the gum tissue in this area is naturally thin, there is limited space between the gum and the lip, and a small band of tissue called the frenum is often attached too high and pulls on the gum, making it harder to achieve stable results. This report describes a surgical approach that combines two existing techniques into a single minimally invasive procedure: one technique guides how the gum tissue is managed around each tooth individually, while the other removes the frenum from the inside without leaving visible scars. A small piece of tissue taken from the roof of the mouth is also used to reinforce and thicken the gum. In two patients treated with this approach, most teeth showed complete gum coverage and improved tissue thickness at 10 to 12 months after surgery, with minimal discomfort during recovery. Future studies with larger patient groups are needed to confirm these promising results.
Abstract Background This study evaluated clinical, radiographic, and histologic outcomes of horizontal ridge augmentation using a layering technique with demineralized freeze‐dried bone allograft (DFDBA) internally and deproteinized bovine bone mineral (DBBM) buccally, covered by a native bilayer collagen membrane. Primary outcomes included horizontal bone gain, graft shrinkage, and vital bone formation. Methods In this prospective single‐arm study, adult patients requiring horizontal ridge augmentation prior to implant placement were treated with the layering technique (DFDBA and DBBM). Cone beam computed tomography scans were obtained preoperatively (T0), immediately postoperatively (Tim), and after 6–9 months (T2). Ridge widths were measured at 3, 5, and 7 mm apical to the crest. Linear mixed‐effects models assessed dimensional changes and the influence of the DFDBA:DBBM ratio on the outcomes. Bone core biopsies were collected at implant placement for histologic and histomorphometric analysis. Results Fifteen patients completed the study. Mean horizontal bone gain was 3.68 ± 1.20, 3.98 ± 1.56, and 3.91 ± 1.77 mm (all p < 0.001) at 3, 5, and 7 mm respectively. Linear graft shrinkage was 1.76 ± 0.95, 1.82 ± 1.11, and 1.72 ± 0.96 mm at the respective levels (all p < 0.001). A higher DFDBA:DBBM ratio significantly increased shrinkage at 3 mm ( p = 0.015). Histology ( n = 7) showed 30.97 ± 16.71% vital bone, 21.41 ± 10.63% residual graft, and 47.62 ± 18.51% marrow/connective tissue. Conclusion The DFDBA‐DBBM layering technique achieved significant horizontal bone gain with predictable modelling and favorable vital bone formation, supporting its use as a viable augmentation approach pending further comparative studies. Key points The layering technique of internal demineralized freeze‐dried bone allograft and outer deproteinized bovine bone mineral for guided bone regeneration predictably increased horizontal ridge width, resulting in approximately 3.6 ‐ 4 mm of horizontal bone gain. The technique demonstrated favorable dimensional stability with graft shrinkage of approximately 1.7–1.8 mm. The augmented sites showed clinically relevant amounts of vital bone formation (approximately 31%), supporting the biological effectiveness of the layered grafting strategy.
Abstract Background Management of inflammation at previously surgically treated periodontal sites represents a clinical challenge. Although surgical retreatment may be indicated in selected cases, a conservative non‐surgical approach may restore periodontal stability while avoiding the additional morbidity associated with repeated surgery. This case report describes the long‐term management of a previously surgically treated mandibular molar furcation using site‐specific non‐surgical retreatment combined with adjunctive application of a collagen‐based hydrogel. Methods A 45‐year‐old non‐smoking male with a history of stage III, grade B periodontitis presented with persistent inflammation at a previously surgically treated mandibular first molar. Clinical examination revealed a 4‐mm mid‐buccal probing depth associated with bleeding on probing and Grade II furcation involvement. Following comprehensive periodontal re‐evaluation, the site was managed by meticulous non‐surgical re‐instrumentation and adjunctive application of a collagen‐based hydrogel as a conservative alternative before considering surgical re‐intervention. The patient was subsequently enrolled in an individualized supportive periodontal care program. Results Bleeding on probing resolved within 25 days and remained absent throughout the 6‐year follow‐up. Probing depth progressively decreased from 4 to 2 mm, while the previously inflamed furcation site became clinically stable and maintainable without requiring additional periodontal surgery. Conclusions Within the limitations of a single case report, this case illustrates that a carefully executed conservative retreatment strategy, combining meticulous non‐surgical periodontal therapy, individualized supportive periodontal care, and adjunctive collagen hydrogel application, may successfully restore and maintain periodontal stability at a previously surgically treated furcation site while avoiding surgical re‐intervention. Controlled prospective studies are required to clarify the clinical contribution of adjunctive collagen hydrogels in the management of persistent periodontal defects. Key Points Non‐surgical re‐instrumentation may be considered before surgical re‐intervention in selected previously treated periodontal sites, provided that the clinical response is carefully re‐evaluated. Molar furcation anatomy may limit non‐surgical instrumentation; periodontal surgery remains indicated when adequate access and control of inflammation cannot be achieved through a conservative approach. In this case, periodontal stability was maintained for 6 years within an individualized supportive periodontal care program; the independent contribution of the adjunctive collagen hydrogel cannot be determined. Plain language summary Periodontal disease can leave areas around teeth that are difficult to keep healthy, particularly around the roots of molar teeth where the anatomy is complex. When inflammation persists after previous periodontal surgery, another surgical procedure may sometimes be necessary. This report describes a patient with inflammation around the root‐division area of a lower molar that had been surgically treated several years earlier. Before considering another operation, the area was carefully cleaned without surgery, and a collagen‐based gel was applied as an additional part of the treatment. The patient was closely monitored and received regular professional periodontal care. Bleeding resolved after treatment, the area became easier to maintain, and clinical stability was preserved over 6 years without additional surgery. This case illustrates that, in carefully selected situations, a conservative approach followed by appropriate monitoring may be considered before repeating periodontal surgery. However, this is the experience of a single patient, and it cannot determine whether the collagen gel contributed to the favorable outcome or whether similar results would occur in other patients.
