OBJECTIVES:To evaluate the effect of the width of the buccal gap on the alveolar process reduction after immediate implant placement (IIP) at maxillary central incisor sites, compared to contralateral pristine tooth sites. MATERIAL AND METHODS:Twenty-eight subjects who were treated with IIP to replace a maxillary central incisor and presented a pristine contralateral tooth site were included in this retrospective cohort study. The width of the gap between the implant and the inner walls of the socket was measured and grafted with deproteinized bovine bone mineral (DBBM). Subjects were divided into 2 groups: wide gap: > 2 mm (n = 14); Narrow gap: ≤ 2 mm (n = 14). CBCT scans were obtained after a mean follow-up of 6 (± 4) years and evaluated by a calibrated examiner. Dimensional measurements of the healed alveolar ridge (implant site) and alveolar process (tooth site) were compared between the two groups. RESULTS:The Narrow gap group showed significantly greater ridge resorption (41.1% ± 20.2%) in relation to the corresponding pristine tooth sites than the wide gap group (8.5% ± 11%). The width of the alveolar ridge at 3 and 5 mm below the crest and the height of the buccal wall were also significantly reduced in the narrow gap group. CONCLUSIONS:A buccal gap > 2-mm wide grafted with DBBM after IIP may preserve more than 90% of the dimensions of the alveolar process. Conversely, a grafted narrow gap frequently results in significantly reduced ridge preservation.

Placing immediate implants in the esthetic zone poses significant challenges. Implants should be placed with consideration to hard and soft tissues to optimize long-term implant and cosmetic success. In this case report, two maxillary central incisors were extracted at two different time points 5 years apart due to horizontal root fractures. Implants were placed according to immediate single-tooth guidelines using two different surgical and loading approaches, as risk assessment factors changed in the time between the first implant placement (right central incisor) and second implant placement (left central incisor). For the first implant placement, the treatment technique included the 10 Keys approach, a checklist of diagnostic, surgical, and restorative guidelines used to pursue long-term success for single-tooth treatment with immediate implant placement and provisionaliza- tion, socket management, and connective tissue grafting. The second implant placement included partial extraction therapy (PET) and conventional healing, as well as immediate implant placement after root shield preparation, an allograft, growth factors, platelet-rich fibrin, and contour management. At the 7-year and 2-year follow-ups, radiographic and clinical results were satisfactory.

Peri-implantitis is a biofilm-mediated inflammatory condition associated with progressive loss of supporting tissue and poses a significant challenge to clinicians worldwide. Because limited efficacy is associated with nonsurgical therapy, surgical intervention is often required to manage this disease. This article focuses on operator factors when treating peri-implantitis and presents a stepwise approach to eight essential keys for successful regenerative/reparative treatment of peri-implantitis defects. These keys are aimed at optimizing clinical outcomes for diverse patient needs and defect anatomies. They include evaluating operator experience, risk assessment, and implant restorative design, as well as nonsurgical and surgical therapies such as the use of biologics and biologic derivatives, the postoperative protocol, and a patient-specific periodontal maintenance program. By adhering to these eight keys, clinicians can achieve successful long-term outcomes in the regenerative treatment of peri-implantitis defects.

AIM:Different approaches have been proposed for implant placement following tooth extraction. A Consensus conference was organised to provide expert-based recommendations for the treatment of the postextraction site in the aesthetic zone in conjunction with implant therapy. METHODS:A panel of eight experts with a documented longstanding clinical and research experience in the field of implant therapy in the aesthetic zone were invited to participate in a structured survey. Participants were asked to select their preferred treatment approach for different clinical scenarios of the postextraction site from a list of different treatment options. Results were summarised and discussed in person at a 2 day consensus conference. Based on the outcome, treatment recommendations were phrased and are reported here. RESULTS:The group agreed that in case of an intact alveolus, immediate implant placement with immediate prosthetics represents the reference choice if proper primary stability can be achieved and the buccal bone plate is present. A bone-to-implant gap more than 2 mm should be seeked and grafted. Alveolar ridge preservation and early placement with contour augmentation may represent an alternative. If the alveolus is compromised, a staged approach (early or delayed placement) with bone augmentation may be preferred. CONCLUSIONS:The characteristics of the site, in terms of the available bone volume, the integrity of the buccal bone plate and the periodontal phenotype are determining factors in the therapeutic choice. Therefore, case selection based on well-defined selection criteria is extremely important and is the adequate way to guide the clinician in choosing the most appropriate approach to postextraction site management and timing for implant placement.

This study aimed to evaluate the long-term effectiveness of single-visit full-mouth non-surgical therapy in managing patients with progressive periodontitis during supportive periodontal therapy (SPT), with tooth loss due to periodontitis (TLP) as the primary outcome. Secondary objectives included assessing changes in probing depth (PD) and identifying risk factors associated with TLP. A retrospective analysis was conducted using patient records from the University of Michigan School of Dentistry. Included were 283 patients (mean age: 53.2 years) with periodontal breakdown during SPT (PiKS) who underwent single-visit full-mouth ultrasonic instrumentation. The primary outcome was TLP over a mean follow-up of 19.4 years. Secondary outcomes included changes in PD (≥ 5 mm and ≥ 6 mm) and identification of risk factors for tooth loss. Statistical analyses used multilevel binary logistic regression with generalized estimating equations (GEE) and linear regression models. Among 283 patients (mean age: 53.2 years), the mean TLP was 0.9 teeth per patient over a mean follow-up of 19.4 years. Factors significantly associated with TLP included diabetes (OR = 2.41; p = 0.013), current smoking (OR = 2.13; p = 0.025), higher periodontitis Grades B and C (OR = 3.31; p = 0.001), and Stages III-IV (OR = 8.67; p = 0.001). Baseline pocket depths (PD) ≥ 5 mm (OR = 1.13; p = 0.002) and ≥ 6 mm (OR = 1.29; p = 0.001) were also associated with higher TLP. Each additional annual SPT visit reduced the TLP risk by half (OR = 0.50; p = 0.003). PD ≥ 5 mm showed minimal increase change (0.16; p = 0.02), while depths ≥ 6 mm actually decreased (-0.10; p = 0.01). Single-visit full-mouth non-surgical therapy is effective for long-term management of PiKS, with low tooth loss rates. Diabetes, smoking, advanced periodontitis stage/grade, and deeper baseline pockets are key predictors of TLP. Frequent SPT visits significantly mitigate tooth loss risk. During (SPT) appointments, prevalent practice involves the full-mouth instrumentation of persistent periodontal pockets to disrupt microbial populations and consequently reduce the inflammatory response responsible for disease progression. This study investigates the efficacy of single-visit full-mouth instrumentation as a potential alternative to standard practices in controlling periodontal disease during SPT, which have potential benefits for patients, including reduced treatment time, improved adherence to maintenance therapy, and comprehensive management of periodontal disease. By minimizing the number of visits, this approach may enhance patient compliance while reducing the risk of reinfection from untreated sites between sessions, ultimately contributing to better long-term periodontal stability. Factors such as deeper baseline probing depths and crucial risk elements for TLP—including diabetes, smoking, and advanced stages (III-IV) and grades (B and C) of periodontitis, can play a role in TLP. Additionally, this study provides valuable insights into the customization of more intensive interventions for patients at higher risk. Our findings highlight the importance of frequent SPT visits, with each additional annual visit halving the risk of TLP. The observed reduction in PD of ≥ 6 mm following treatment indicates the significant potential of comprehensive debridement for enhancing long-term periodontal stability. This evidence supports the implementation of tailored, intensive SPT schedules, particularly for patients identified as having higher risks, thereby contributing to improved clinical outcomes in periodontal disease management.

Background Managing periodontitis typically involves time-intensive biofilm removal. Single-visit full-mouth instrumentation presents a potential approach for controlling disease progression during supportive periodontal therapy (SPT). This study examines its efficacy and identifies factors contributing to tooth loss due to periodontitis (TLP) after such therapy. Methods Data from the University of Michigan School of Dentistry's patient charts were analyzed retrospectively. Included were patients with periodontal breakdown during SPT (PiKS) treated with single-visit full-mouth ultrasonic instrumentation. Periodontal status at baseline and follow-up were compared. Statistical analyses were conducted using multi-level binary logistic regression with generalized estimation equations (GEE) and linear regression models. Results Among 283 patients (mean age: 53.2 years), the mean TLP was 0.9 teeth per patient over a mean follow-up of 19.4 years. Factors significantly associated with TLP included diabetes (OR = 2.41; p = 0.013), current smoking (OR = 2.13; p = 0.025), higher periodontitis Grades B and C (OR = 3.31; p = 0.001), and Stages III-IV (OR = 8.67; p = 0.001). Baseline pocket depths ≥ 5mm (OR = 1.13; p = 0.002) and ≥ 6mm (OR = 1.29; p = 0.001) were also associated with higher TLP. Each additional annual SPT visit reduced the TLP risk by half (OR = 0.50; p = 0.003). Pocket depths ≥ 5mm showed minimal increase change (0.16; p = 0.02), while depths ≥ 6mm actually decreased (-0.10; p = 0.01). Conclusion Single-visit full-mouth instrumentation is effective for managing PiKS. Diabetes, smoking, severe periodontitis Stages, Grades, and deeper baseline pockets are predictors of TLP.

Background: A 10-year survival analysis was performed to assess the predictive validity of the periodontal risk score (formerly known as Miller-McEntire Periodontal Prognostic Index [MMPPI]) to predict long-term survival of periodontally diseased molars in a longitudinally assessed cohort. Materials and Methods: The MMPPI scores were computed at baseline by summarizing scores allocated for individual factors. The cohort was treated, followed up, and placed under regular periodontal maintenance. Molar survival data collected up to 10 years of follow-up were analyzed. Cox proportional regression was performed, and hazards ratio (HR) were computed for each prognostic factor and the MMPPI score. To estimate the predictive value of MMPPI, a receiver operating curve (ROC) curve analysis was performed. Results: From 1032 molars, 155 molars were extracted over the 10-year follow-up duration. Cox proportional hazard analysis showed significant hazard ratios for tooth loss for the component variables significant HR was noted for age: 4.92 (3.34:7.27), smoking: 1.74 (1.38–2.22), diabetes: 1.66 (1.49–1.86), molar type: 1.39 (1.15–1.67), probing depth: 2.00 (1.63–2.46), furcation: 2.64 (2.30–3.03), mobility: 3.45 (2.98–4.01), and total MMPPI score: 1.98 (1.85–2.12). ROC curve analysis showed an area under the curve value of 0.94 for the MMPPI index as a predictor of molar loss at 8 years, and the Youden index was maximized at the optimal cutoff point score of 7. Conclusions: All component scores of MMPPI showed significant hazard ratios at 10 years. These findings support the previous results from the 5-year analysis of this university-based cohort and warrant validation in independent cohorts.

BACKGROUND:Regenerative approaches performed in periodontics seems to be efficient in treating intrabony defects. There are, however, many factors that may affect the predictability of the regenerative procedures. The present article aimed to propose a new risk assessment tool for treating periodontal intrabony defects by regenerative therapy. METHODS:Different variables that could affect the success of a regenerative procedure were considered based on their impact on (i) the wound healing potential, promoting wound stability, cells, and angiogenesis, or (ii) the ability to clean the root surface and maintain an optimal plaque control or (iii) aesthetics (risk for gingival recession). RESULTS:The risk assessment variables were divided into a patient, tooth, defect, and operator level. Patient-related factors included medical conditions such as diabetes, smoking habit, plaque control, compliance with supportive care, and expectations. Tooth-related factors included prognosis, traumatic occlusal forces or mobility, endodontic status, root surface topography, soft tissue anatomy, and gingival phenotype. Defect-associated factors included local anatomy (number of residual bone walls, width, and depth), furcation involvement, cleansability, and number of sides of the root involved. Operator-related factors should not be neglected and included the clinician's level of experience, the presence of environmental stress factors, and the use of checklists in the daily routine. CONCLUSIONS:Using a risk assessment comprised of patient-, tooth-, defect- and operator-level factors can aid the clinician in identifying challenging characteristics and in the treatment decision process.

OBJECTIVES:The aim of Working Group 4 was to address patient benefits associated with implant dentistry. Focused questions on (a) dental patient-reported outcomes (dPROs), (b) improvement in orofacial function, and (c) preservation of orofacial tissues in partially and fully edentulous patients following provision of implant-retained/supported dental prostheses were addressed.MATERIALS AND METHODS:Three systematic reviews formed the basis for discussion. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary of the 7th ITI Consensus Conference, taking place in 2023 in Lisbon, Portugal.RESULTS:Edentulous patients wearing complete dentures (CD) experience substantial improvements in overall dPROs and orofacial function following treatment with either complete implant-supported fixed dental prostheses (CIFDP) or implant overdentures (IODs). With respect to dPROs, mandibular IODs retained by two implants are superior to IODs retained by one implant. However, increasing the number of implants beyond two, does not further improve dPROs. In fully edentulous patients, rehabilitation with CIFDP or IOD is recommended to benefit the preservation of alveolar bone and masseter muscle thickness.CONCLUSIONS:Completely edentulous patients benefit substantially when at least the mandible is restored using an CIFDP or an IOD compared to CD. In fully edentulous patients, implant prostheses are the best option for tooth replacement. The availability of this treatment modality should be actively promoted in all edentulous communities, including those with limited access and means.

Although technique-sensitive, periodontal regeneration seems efficient in treating intrabony defects; nonetheless, complete success can be difficult to attain. Seven keys for successful periodontal regeneration of intrabony defects, presented herein, encapsulate an evidence-based treatment planning and surgical protocol for achieving predictable outcomes. Utilizing a step-by-step approach, the seven keys offer periodontists a checklist for treating intrabony defects and include protocols for the planning, surgical, and postoperative phases of the treatment. This article describes the use of the seven keys checklist to achieve predictable regenerative outcomes at short-term and long-term follow-ups. A case report demonstrates the application of these seven keys.

Periodontitis is a chronic, multifactorial inflammatory disease characterized by progressive destruction of the tooth-supporting apparatus. Determining tooth prognosis is of central importance in clinical practice to help both the clinician and patient understand the risks and benefits of treatment while shedding light on the patient's long-term periodontal prognosis and aiding in the development of an individualized treatment plan. Several indexing-type systems have been proposed for determining the prognosis of periodontally involved teeth. The periodontal risk score (PRS) is a simple, evidence-based, motivational tool that can be used in daily clinical practice in both healthy and periodontally involved patients. The PRS incorporates systemic and lifestyle prognostic factors to achieve superior predictive accuracy. With the PRS, patients are encouraged to achieve a target score (representing an "excellent" prognosis) that can be realistically attained through compliance with a periodontal maintenance plan. The purpose of this article is to present to clinicians how to implement this evidence-based tool into their daily practices and thus help patients improve their long-term periodontal prognosis.

BackgroundTooth-level prognostic systems are valuable tools for treatment planning and risk assessment of periodontally involved teeth. Recently the Miller-McEntire prognosis index was found to outperform comparable systems. However, it had some limitations. The present study aimed to develop and evaluate the prognostic performance of a modified version that addresses most limitations of the previous model called the periodontal risk score (PRS). MethodsData were retrieved retrospectively from patients who received surgical and non-surgical periodontal treatment at a university setting. Data on medical history and smoking status at baseline and the last maintenance visit were collected. Both univariate and multivariate Cox proportional hazard regression models were used to analyze the prognostic capability for predicting tooth loss due to periodontitis (TLP) risk. ResultsA total of 6762 teeth (281 patients) were followed up for a mean period of 22.6 +/- 6.34 (10-47.6y) years. The PRS was successfully able to stratify the risk of TLP at baseline when the three different classes of association were compared for anterior and/or posterior tooth loss. After controlling for maintenance, age, and sex, the index showed an excellent predictive capacity for TLP with a Harrell C-index of 0.947. ConclusionsThe periodontal risk score (PRS) displayed excellent predictive capability for anterior as well as posterior tooth loss due to periodontitis. This system was able to predict long-term tooth loss with a very high accuracy in a population treated mainly by dental students and periodontics residents. The use of this/similar prognosis system is advisable as a means to establish tooth prognosis.

This article presents a retrospective case series of implant site development using titanium mesh (Ti-mesh) in the maxilla. A total of 58 mesh procedures in combination with several different bone grafts (allograft, cellular allograft, and bovine xenograft) and biologics (including recombinant human platelet-derived growth factor, autogenous platelet-rich growth factor, and recombinant human bone morphogenetic protein-2) were performed in 48 patients. Ti-mesh guided bone regeneration procedures were performed 2 to 3 months after extraction of nonrestorable/hopeless teeth, and the implants were placed 6 to 8 months postaugmentation. The mean initial ridge width was 2.0 ± 1.0 mm, and the mean horizontal gain after Ti-mesh procedures was 4.7 ± 1.6 mm. The ridge width was first measured on the cross-sectional presurgical CBCT image and then confirmed clinically during surgical procedures. No statistical difference in the horizontal gain was found among different combinations of bone grafts and biomaterials. Ti-mesh exposure occurred 22% of the time. The middle-aged adults (odds ratio [OR] = 8.59; P = .046) and older adults (OR = 16.66; P = .02) had significantly higher chances of mesh exposure compared to young adults. While all implants were successfully placed, about 56% of the implants had < 2 mm of bone to the facial aspect of the osteotomy and received additional contour augmentation when placed in a prosthetically appropriate position for a screw-retained restoration. This study demonstrates that although Ti-mesh procedures result in significant bone regeneration in narrow alveolar ridges to predictably allow implant placement, the age-related mesh exposure rate and frequency of need for additional contour grafting should be discussed with patients.

The aim of this cohort study was to assess the effect of connective tissue graft (CTG) following immediate implant placement (IIP) at maxillary central incisors on esthetic outcomes, buccal bone thickness, soft tissue dimensional alterations, and patient-centered outcomes. Twenty-eight patients treated with IIP at maxillary central incisor sites with approximately 6 ± 4 years in function were divided according to the use of CTG (n = 17) or no CTG (n = 11). The primary variable of the study was the Pink and White Esthetic Score (PES/WES), evaluated in photographs taken before and after implant placement. The thickness of the buccal bone, midbuccal mucosal level (MBML) changes, and patient satisfaction were assessed and compared between the two groups. The results showed similar PES/WES before IIP between the CTG and no-CTG groups (13.5 ± 3.7 and 12.6 ± 3.2, respectively). After IIP, the PES/WES value in the CTG group was significantly higher (15 ± 2.5) than in the no-CTG group (12.1 ± 3.1) (P = .012). No significant differences in the buccal bone thickness, MBML, or patient satisfaction were observed in CTG and no-CTG groups. This study found that CTG following IIP and socket grafting promoted better esthetic outcomes.

BACKGROUND:The effect of the buccal gap width on the clinical outcome of socket graft and immediate implant placement (IIP) at maxillary central incisor sites has not been investigated. Thus, the aim of the present study was to evaluate the effect of the width of the buccal gap on the thickness of the newly formed buccal wall. METHODS:Forty-two patients and 51 maxillary central incisor sites treated with IIP and ridge preservation by means of graft of the buccal gap at the maxillary central incisor region were included in the study. The width of the buccal gap was measured and filled with deproteinized bovine bone mineral. Implant sites were divided into two groups: wide gap (WG, >2 mm; n = 34) and narrow gap (NG, ≤2 mm; n = 17). After at least 1 year in function (5 ± 4), CBCT scans were obtained and assessed by a calibrated examiner. The thickness of the buccal and palatal bone walls, the percentage of the implant height covered by bone in the buccal and palatal aspects and the position of the buccal and palatal crests were compared between the two groups. A linear regression model was performed to assess predictors of the thickness of the buccal bone. RESULTS:The buccal bone was significantly thicker in the WG group than the NG group at all levels observed (overall 1.9 ± 0.9 mm and 0.5 ± 0.6 mm, respectively). The thickness of the palatal bone was similar between both groups (>2 mm). The percentage of the implant height covered by bone at the buccal aspect was significantly higher in the WG group (95 ± 16.6%) than in the NG group (59.4 ± 42.3%). The position of the buccal crest in relation to the implant shoulder was significantly more coronal (0.3 ± 2.2 mm) in the WG group than in the NG group (-4.7 ± 5.6 mm). The regression analysis model indicated that the width of the buccal gap was the only predictor of the thickness of the newly formed buccal bone wall (p < 0.001). CONCLUSION:Grafting of >2 mm-wide buccal gaps following IIP promoted a thicker buccal bone wall.

Background: This 5-year prospective survival analysis study aimed to examine the prognostic validity of a periodontal prognostic score specific for diseased molars: Miller–McEntire Periodontal Prognostic Index (MMPPI). Materials and Methods: One thousand and twenty-three molars were evaluated from 129 patients. The MMPPI scoring factors included age, smoking, diabetes, probing depth, mobility, molar type, and furcation involvement. MMPPI was computed as the sum of scores for all seven prognostic factors. Appropriate periodontal treatment and supportive periodontal therapy were provided. All patients were evaluated at baseline and annually posttreatment up to 5 years. Hazard risk ratios (HR) were computed for each prognostic factor, MMPPI scores assigned. The MMPPI score were then analyzed using Kaplan-Meier survival analyses. Results: A total of 31/1023 (0.3%) molars were extracted over the 5-year follow-up duration. Significant and positive hazard risk ratio (HR = 1.9) was noted for the total MMPPI score, validating its prognostic value for molar survival at 5 years prospectively. Kaplan–Meier survival analysis showed a significantly lower probability of molar survival with increasing MMPPI scores, where total score >8 showed worse survival probability over time. The hazard risk ratio was significant for individual prognostic factors: mobility (HR = 1.63), smoking (HR = 1.61), diabetes mellitus (DM) (HR = 1.4), molar type (1.97), and furcation involvement (2.22). Conclusions: The findings of the current study demonstrate significant prognostic validity of MMPPI scores for molar loss for 5 years, and a score >8 showed markedly worse molar survival probability in a well-maintained, university-based, prospective cohort. Mobility, smoking, DM, molar type, and furcation were component factors that were significant individual predictors.

The purpose of this prospective study was to evaluate the success rates and prosthetic complications of implants with a modified sandblasted and acid-etched (SLA) surface inserted for posterior single-implant crown restorations. Final crowns were placed 3 to 4 weeks after surgery, and patient follow-up spanned 10 years in a private practice setting. A total of 22 patients (8 women, 14 men) with 25 posterior implants placed (16 mandible, 9 maxilla) were selected, including only implants for posterior single-implant crowns with insertion torque values of ≥ 35 Ncm at placement. Twenty-one implants passed the reverse torque test at 3 to 4 weeks after implant placement, and final restorations were placed. Three patients (4 implants) had "spinners," and there was one patient dropout after completion of the final restoration. All patients were recalled for clinical exams, digital periapical radiographs, and clinical photos at short-term (≤ 5 years) and long-term (> 5 years) follow-up appointments. The Community Periodontal Index of Treatment Needs was also determined at the initial and follow-up visits. Crestal bone level was measured at crown placement (T1), short-term follow-up (T2; mean: 29.4 months), and long-term follow-up appointments (T3; mean: 114.4 months). Twenty patients (23 implants) returned for examination at T2, and 15 (18 implants) were available at T3. For the 17 implants available at all evaluations, statistically significant bone loss was found from T1 to T2 (0.23 ± 0.30 mm), and the mean crestal bone level appeared stable from T2 to T3. Based on clinical and radiographic findings, the success rate for the implants and restorations at T2 and T3 was graded as 100%. Therefore, it can be stated that an early loading protocol of 3 to 4 weeks using a modified SLA surface at premolar/molar single-tooth locations can result in favorable clinical and radiographic long-term results.

Ten keys for successful esthetic-zone single immediate implants encapsulate in an evidence-based manner the treatment planning and replacement of single hopeless teeth in the maxillary anterior sextant. These include two treatment-planning, five surgical, and three prosthetic keys, which, collectively, aim to minimize soft- and hard-tissue complications for an optimal esthetic implant restoration. The Straightforward, Advanced, and Complex (SAC) classification is designed to aid clinicians in the treatment planning of dental implant cases. As per this classification, cases are stratified by the degree of surgical and restorative risk and complexity for both the surgical and prosthetic phases of treatment. A technique-sensitive and skill-demanding task, the replacement of multiple adjacent teeth in the esthetic zone poses significant challenges for clinicians and is considered a complex SAC procedure surgically and restoratively. This article presents a case report on the replacement of multiple adjacent teeth in the esthetic zone, demonstrating the use of 10 key principles to achieve an optimal esthetic outcome.

A proper diagnostic and treatment planning process for dental implant rehabilitations should include a checklist of key factors to help clinicians avoid potential complications. Such a checklist should encompass evaluation of the soft- and hard-tissue volume buccal to each implant, as this has been shown to aid in maintaining marginal bone levels long-term. Thus, as part of surgical planning, a decision to augment the soft tissue should be considered. The autogenous palatal graft has long been considered the "gold standard" for soft-tissue augmentation; however, the benefits of this approach should be weighed against the potential complications associated with a secondary surgical site as well as the patient's desire for as pain-free an experience as possible. The volume-stable collagen matrix (VSCM) is a promising material with favorable healing characteristics and volume thickness maintenance of up to 3 years in current literature. This article presents two cases that demonstrate the clinical advantages of a VSCM over the use of autogenous palatal grafts as part of the authors' "10 Keys" principles of augmenting the volume and thickness of peri-implant tissues.

Gingival augmentation therapy is intended to create a healthy band of attached keratinized tissue to inhibit further gingival recession, facilitate plaque control, and improve patient comfort. Although an effective treatment for gingival augmentation procedures, the often-used autogenous epithelialized palatal graft has several drawbacks, including the need for a second surgical site to harvest the graft, the risk of such complications as damage to neurovascular tissue and poor healing of the donor site, and potential color and texture discrepancies of the grafted site. The use of a resorbable xenogeneic collagen-based matrix may be considered as a treatment alternative to augment soft tissue. The authors describe the application of such a graft that is made from purified porcine type I and type III collagen and processed without the addition of chemical cross-linkers. Two cases are presented that demonstrate the clinical advantages of this material compared to autogenous palatal grafts when augmenting the width and thickness of attached keratinized gingiva.