Surgical crown lengthening (SCL) is a predictable method of increasing the availability of supragingival tooth structure for biologic, esthetic, and/or restorative reasons. However, the literature demonstrates a lack of precision when performing this common procedure due to a number of factors. Among those factors, the use of standardized measurements and reference points will be presented, as well as the limitations inherent to the classical surgical protocol. This review discusses the importance of individualizing supracrestal soft tissue dimensions during SCL interventions and the use of appropriate diagnostic tools while taking into account the phenotypic characteristics of the patient in both functional and esthetic crown lengthening.

Peri-implant diseases, such as peri-implantitis, affect up to 47% of dental implant recipients, primarily due to biofilm formation. Current decontamination methods vary in efficacy, prompting interest in polymeric nanoparticles (NPs) for their antimicrobial and protein-specific cleaning properties. This study evaluated the efficacy of polymeric nanoparticles (NPs) in decontaminating titanium dental implants by removing proteinaceous pellicle layers and resisting recontamination. Titanium discs were treated with saline water, PrefGel ® , hydrogen peroxide (H 2 O 2 ), GUM ® Paroex ® , or polymeric NPs, and analysed using SEM, EDX, XPS, and contact angle measurements to assess changes in surface composition, morphology, and hydrophilicity. Polymeric NPs significantly reduced nitrogen levels compared to PrefGel® (mean reduction: 2.6%, p < 0.05), indicating effective protein removal. However, their carbon reduction efficacy was similar to that of other agents. SEM images revealed that polymeric NPs disaggregated larger protein aggregates but did not fully decontaminate the surface. Contact angle analysis showed changes in hydrophilicity consistent with other treatments. Hydrogen peroxide performed best overall, achieving the lowest carbon levels post-recontamination (mean reduction: 13%, p < 0.01). While polymeric NPs exhibited unique protein-specific cleaning potential, their overall performance was comparable to traditional agents. Residual contaminants, including carbon and oxygen, persisted on all treated surfaces, indicating enhanced cleaning strategies were needed. These findings highlight the potential of polymeric NPs as an innovative approach to implant decontamination, particularly for protein-specific biofilm control. However, their efficacy in broader applications remains like that of conventional methods. This research contributes to developing targeted decontamination protocols to manage peri-implant diseases and improve long-term implant outcomes.

Periodontal and craniofacial regeneration presents significant challenges owing to the complex tissue architecture, inadequate vascularization, and diminished stem cell populations within damaged tissues. Traditionally, autologous bone grafts or alternative bone substitute materials have been employed to address these conditions; however, these approaches are constrained by donor site morbidity, limited availability, and suboptimal regenerative efficacy. The advancement of mesenchymal stem/stromal cell (MSC) biology has accelerated the development of cell-based therapies in modern dentistry, which now focuses on biologically driven approaches to regenerate tissues. MSC-based therapies currently under investigation, both preclinically and clinically, show promise for improving tissue integration and healing processes of both soft and hard tissues, attributable to their multipotent nature, immunomodulatory properties, and paracrine signaling capabilities. Nevertheless, obstacles persist, including inconsistent standardization, limited scalability, regulatory hurdles, a paucity of controlled studies, and restricted biomaterial options. This review evaluates MSC-based treatments for periodontal and craniofacial reconstruction by discussing recent research findings and existing obstacles. This review also examines future prospects, such as advanced biofabrication methods, including 3D printing and bioprinting, which have the potential to improve personalized cell therapy for periodontal and craniofacial regeneration.

This study aimed to investigate the innate immune response of human macrophages to Porphyromonas gingivalis W83 using a novel in vitro infection model. The growth kinetics of P. gingivalis W83 were analyzed, revealing an exponential growth phase at 8 h (optical density = 0.70). To establish a reliable macrophage model, the differentiation of THP-1 monocytes into macrophages was optimized using low concentrations of phorbol 12-myristate 13-acetate (PMA). This approach induced enhanced adherence and morphological changes, with full differentiation achieved after 48 h of PMA treatment followed by 24 h of rest. Polarization towards the pro-inflammatory M1 phenotype was successfully induced with interferon-γ (IFN-γ) and lipopolysaccharide (LPS), as confirmed using cytokine profiling. Cytokine analysis using Luminex® technology demonstrated significant increases in interleukin (IL)-1β, tumor necrosis factor-α (TNF-α), and IL-6, indicating the effective activation of macrophages towards a pro-inflammatory phenotype. Building upon this macrophage model, this study investigated the interactions between macrophages and P. gingivalis W83 during its exponential growth phase. After a one-hour infection period, bacterial DNA quantification in supernatants and lysed macrophages revealed minimal levels of internalized or adherent bacteria, supporting the hypothesis that P. gingivalis effectively evades immune detection. These findings emphasize the utility of this model in uncovering the sophisticated immune evasion strategies employed by P. gingivalis, with significant implications for the development of targeted therapeutic interventions.

ObjectivesTo demonstrate how contemporary digitally driven workflow can enhance outcomes for complex esthetic dental cases, focusing on three distinct clinical scenarios involving implant placement, esthetic crown lengthening, and tooth autotransplantation (ATT).OverviewThree multidisciplinary clinical cases demonstrate our contemporary digital workflows, integrating diagnosis, treatment planning, patient communication, and guided execution. The first case involves replacing two anterior central incisors using digital planning, guided surgery, prefabricated customized healing abutments, and a digitally driven restorative process. The second case showcases an esthetic crown-lengthening procedure, where Multifunctional Anatomical Prototypes (MAPs) serve as both mock-up and surgical guides, enhancing patient communication on expected outcomes and ensuring precise tissue management to prevent soft tissue rebound. The final case features a tooth ATT, where virtual surgical planning and 3D-printed tooth replica and guides ensure predictability in the therapeutic outcome. These digitally enabled strategies underscore the predictability and customization achievable with contemporary dental technology.ConclusionsDental treatments in the esthetic zone require meticulous planning and precise execution to achieve controlled results that ensure patient satisfaction and long-term stability. Contemporary Digital Dentistry enhances predictability, creating a pathway that leads to success.

The Oral Reconstruction Foundation organized the International Expert Meeting (IEM) on January 24 to 25, 2025, in Malaga, Spain, inviting expert academicians and clinicians with the aim of establishing clinical recommendations for practitioners on two current topics of interest: (1) immediate implant placement and restorations in single-unit and multiunit FDPs-current evidence, indications, clinical protocols, and (2) immediate implant placement and restorations in full-arch situations-indications and limitations.

This study characterized the biological response of MG-63 cells to synthetic, hydroxyapatite scaffolds (HAsint) fabricated via fused filament fabrication. Scaffolds were compared to 2D plate-adherent cultures using six assays: cell morphology and distribution with scanning electron microscopy and confocal laser scanning microscopy; cell proliferation and cytotoxicity via WST-1 tetrazolium assay; relative osteogenic gene expression through reverse-transcription–quantitative polymerase chain reaction, and protein synthesis via multiplex immunoassay. Data were analyzed using one-way ANOVA. Results confirmed high cell viability and uniform distribution on HAsint scaffolds. Proliferation increased significantly over 7 days, though direct cytotoxicity also increased, likely due to the static conditions of the experiment and, subsequently, the high ion reprecipitation from scaffold degradation. Importantly, HAsint scaffolds significantly enhanced osteogenic marker expression of phosphatase alkaline (ALPL), osteopontin (OPN), and osteocalcin (OCN) genes, and elevated concentrations of interleukins (IL)-6, IL-8 and matrix metalloproteinase 1 compared to plate-adherent controls. It can be concluded that 3D-printed HAsint scaffolds support robust osteogenic differentiation and proliferation despite inducing a transient cytotoxic response in vitro. The marked upregulation of key osteogenic genes and proteins confirms the scaffolds’ bioactivity and highlights their potential for bone tissue engineering applications.

ObjectivesPeri-implantitis is mostly caused by a pathological biofilm that forms through complex processes, initiated by the formation of the salivary pellicle on implant surfaces. Understanding the nature of these pellicles and biofilm and how to remove them is important for preventing peri-implant infections and improving the success of dental implants. This study explores the characteristics of the salivary pellicle on titanium surfaces and assesses the effectiveness of different decontamination agents in eliminating the salivary pellicle and related microbial contaminations.Materials and MethodsTitanium surfaces were contaminated with salivary pellicles and pathological biofilms. The nature of the salivary pellicle was characterized using X-ray photoelectron spectroscopy (XPS), surface proteomics, contact angle measurements, and fluorescence microscopy. We tested six commonly used decontamination chemicals (chlorhexidine, essential oil-based mouthwash, citric acid, phosphoric acid, saline, and phosphate buffer saline) as well as newly proposed treatments such as surfactants and solvents (acetone, acetic acid, and Tween 20) for their capability to eliminate salivary pellicles and pathogenic biofilms from titanium surfaces.ResultsThe hydrophobic nature of the salivary pellicle on titanium surfaces limits the efficacy of commonly used hydrophilic solutions in removing pellicles and bacteria. Organic solvents and surfactants, particularly acetic acid and Tween 20, demonstrated superior effectiveness in removing the pellicle and biofilm. Acetic acid was notably effective in restoring surface composition, reducing microbial levels, and removing multispecies biofilms.ConclusionsThe use of surfactants and solvents could be a promising alternative for the treatment of biofilms on titanium surfaces. However, further studies are needed to explore their clinical applicability.

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.

AIM:To determine whether clinical parameters can serve as (i) predictive tools (before occurrence) and (ii) diagnostic tools (after occurrence) of peri-implant bone loss. MATERIALS AND METHODS:A representative cohort of 72 patients with 298 implants was evaluated at baseline and after a mean follow-up period of 3.9 years. Peri-implant bone loss > 1 mm between the two examinations represented the reference standard. The accuracy of the following clinical parameters in predicting (at baseline) or diagnosing (at follow-up) peri-implant bone loss was assessed: presence of bleeding (BoP) or suppuration (SoP) on probing, visual signs of redness or swelling, BoP extent (number of sites with BoP) and severity (modified Bleeding Index-mBI), probing pocket depth (PPD) at various cut-offs, peri-implant soft-tissue dehiscence (PISTD) and changes in PPD/PISTD over time. Predictive/diagnostic performance was evaluated using mixed model logistic regression analyses and reporting sensitivity, specificity, positive/negative predictive values and area under the curve (AUC) values. RESULTS:Bone loss > 1 mm was observed in 9.4% of implants and was frequently preceded by BoP (sensitivity = 96.4%; specificity = 7.4%). At follow-up, bone loss was always associated with the concomitant presence of BoP (sensitivity = 100.0%; specificity = 14.4%). In predicting the future occurrence of peri-implant bone loss, high sensitivity (94.4%) was also noted for visual redness at baseline, although its specificity was low (25.9%). Conversely, high specificity but low sensitivity was observed for BoP at 6 sites (sensitivity = 25.0%; specificity = 88.1%) and SoP (sensitivity = 14.3%; specificity = 91.5%). For diagnosing recent peri-implant bone loss, high specificity was noted for SoP (100.0%), profuse bleeding (91.9%), BoP at 6 sites (87.0%), PPD ≥ 6 mm (81.9%), changes in PPD (95.9%) and changes in PISTD (91.5%). However, all these parameters showed limited sensitivity. The best diagnostic accuracy was achieved using a combined criterion of site-specific PPD or PISTD increases > 1 mm over time (sensitivity = 82.1%; specificity = 70.0%; AUC = 0.76). CONCLUSIONS:Clinical signs considered indicative of peri-implant mucositis (presence of BoP, visual redness) usually precede peri-implant bone loss. Implants with a recent history of bone loss always present with concomitant BoP. However, the predictive/diagnostic value of detecting one or two spots of BoP is limited by its low specificity. Implants with BoP at six sites or SoP are more likely to exhibit bone loss over time. During follow-up, BoP at six sites, profuse bleeding, SoP, PPD ≥ 6 mm, or increases in PPD/PISTD over time have high specificity for diagnosis of recent peri-implant bone loss.

The European Federation of Periodontology (EFP), founded in 1991, is a non-profit organization comprising 43 national periodontal societies worldwide, representing over 18 000 professionals. Its mission is to promote periodontology and oral health globally. The EFP's strategic objectives include advancing the practice and development of periodontology, promoting scientific research, ensuring the integrity of the profession, and raising awareness of the link between periodontal and general health. These goals are pursued through initiatives such as EuroPerio, the EFP's flagship scientific congress held every 3 years, which attracts thousands of global participants, and European Workshops in Periodontology (EWPs), which foster evidence-based discussions and produce consensus reports. These workshops have produced landmark publications, including the new classifications of periodontal diseases and S3-level clinical practice guidelines for the treatment of periodontitis and peri-implant diseases. Additionally, the organization plays a central role in setting standards for postgraduate education in periodontology, accrediting programs across Europe and internationally, with 24 universities offering EFP-accredited programs as of 2024. The EFP also publishes the Journal of Clinical Periodontology, a key platform for disseminating scientific and clinical research. Through outreach campaigns in collaboration with global partners, the EFP aims to raise awareness of the links between periodontal health and systemic diseases, engaging medical professionals, international organizations, policymakers, and patient groups. A notable initiative is Gum Health Day, held annually on May 12, to promote public awareness of periodontal health. The EFP's activities have significantly contributed to the development of modern periodontology, both academically and clinically, with a substantial global impact.

ABSTRACT Objective Cell secretomes represent a promising strategy for periodontal and bone regeneration. The objective of this study was to characterize the secretome of human gingival fibroblasts (GF) from periodontally diseased tissues (GF‐perio) using proteomics. Materials and Methods Conditioned media of GF‐perio from periodontitis patients (n = 6, 48‐h serum‐free culture) were subjected to liquid chromatography with tandem mass spectrometry. Global profiles, differentially expressed proteins (DEPs), and functional/gene‐set enrichment (FEA) were analyzed using bioinformatics. Selected bone regeneration‐related proteins were additionally measured using a multiplex immunoassay. Conditioned media of GF from periodontally healthy subjects were used as a reference. Results Overall, 1833 proteins were detected in GF‐perio secretomes, including several growth factors, cytokines, chemokines, and extracellular matrix proteins important for wound healing and regeneration. Key bone‐related cytokines (FGF2, MCP1, GPNMB, MMP2, IL6, IL8) were confirmed by an immunoassay. Compared to the reference group, 127 exclusive proteins and 73 DEPs (p < 0.05) were identified in the GF‐perio group. FEA revealed significant enrichment of “exosome” and “cytoplasm” related cellular components in GF‐perio secretomes. Conclusion The secretome of GF from periodontally diseased tissues may hold therapeutic potential, with several proteins important for wound healing and regeneration, especially those related to exosome functions.

Objectives To assess the efficacy and safety of a cell-based therapy for 3D bone augmentation of severe alveolar bone defects prior to dental implant placement.Materials and Methods A Phase 2 randomized controlled clinical trial evaluated the safety and efficacy of a cell therapy using expanded autologous iliac crest-derived mesenchymal cells seeded on a synthetic bioabsorbable bone substitute covered with a non-resorbable membrane. The control group received an autogenous bone block graft. After 5 months, CBCT scans were compared to measure the bone volume changes achieved after the regenerative surgery. Subsequently, dental implants were placed in the regenerated areas.Results A total of 48 patients were included and randomized (36 patients in the test group and 12 in the control group). However, seven patients did not reach the minimum required number of expanded MSCs and were therefore unable to be treated. The tested intervention demonstrated significantly greater gains in bone volume, with a mean difference of 480.01 mm3 (p = 0.032). Similarly, the mean change in bone crest volume from baseline to 5 months was notably higher in the test group (1066.91 mm3) compared to the control group (586.9 mm3). Adverse reactions and patient morbidity were minor in both groups. Implants were placed on the regenerated bone, and all were integrated successfully in both groups.Conclusions The cell-based therapy resulted in significant changes in bone volume compared to the control treatment, enabling dental implants in all patients. The procedure was associated with minimal adverse effects and patient morbidity.Trial Registration ClinicalTrials.gov: NCT03373052, NCT04297813

AIM:To evaluate the clinical and microbiological effects of a Limosilactobacillus reuteri-based probiotic as an adjunct to subgingival instrumentation in untreated periodontitis patients with diabetes. METHODS:A 6-month, randomised, triple-blinded clinical trial was conducted involving 40 patients, receiving steps 1 and 2 of periodontal therapy, including subgingival instrumentation, and randomised to receive tablets containing L. reuteri or placebo, for 3 months. Clinical and microbiological outcomes as well as glycosylated haemoglobin (HbA1c) concentrations were evaluated at baseline and at 3 and 6 months after therapy. RESULTS:At 6 months, both groups showed statistically significant reductions in the primary outcome (mean probing depth), with reductions of 0.9 mm in the probiotic group and 0.8 mm in the placebo group, with no significant differences between them. Both groups exhibited reductions in HbA1c levels after 6 months, more in the probiotic group (-0.6% vs. -0.1%), with statistically significant inter-group differences (-0.5%; 95% confidence interval [-1.0; 0.0]; p < 0.001). Microbiological outcomes were similar. CONCLUSIONS:The adjunctive use of a L. reuteri-based probiotic did not provide additional clinical or microbiological benefits, compared to placebo, following subgingival instrumentation in patients with periodontitis and diabetes. However, statistically significant differences in HbA1c levels were observed, with larger reductions in the probiotic group, suggesting a potential systemic benefit. TRIAL REGISTRATION:The protocol was approved by the Clinical Research Ethics Committee (CEIC) of Hospital Clínico de San Carlos (internal code 19/101-R_X) and registered a priori in ClinicalTrials.gov (identifier NCT04069611).

The management of severe mucogingival deformities surrounding malpositioned implants rep-resents a complex issue with a high risk of esthetic failure. The present case report describes a mucogingival and restorative approach for the treatment of severe localized peri-implant tissue defi-ciencies with interproximal bone loss combined with an interproximal gingival recession on the ad-jacent natural tooth. This approach consists of maintaining a nonrestorable malpositioned implant, submerging it through one or multiple vertical soft tissue augmentations according to the defect severity, and delivering a tooth-supported bridge involving the adjacent natural teeth. The step-by-step surgical technique adopted for implant submergence and vertical soft tissue grafting, as well as the subsequent surgical and prosthetic interventions, are described, presenting results at 5 years from implant submergence and 3 years from prosthetic finalization.

ABSTRACTAimThis prospective cohort study aimed to evaluate the incidence and risk/protective factors of peri‐implantitis over time.MethodsA university‐representative cohort was evaluated at baseline and after a mean follow‐up time of 3.9 years. The main outcome was the incidence of peri‐implantitis, defined as bone loss > 1 mm between the two examinations in implants showing bleeding on probing. Putative risk/protective factors assessed at baseline were tested through multilevel (mixed‐effects) logistic regression analyses.ResultsA total of 73 patients with 322 implants were included. During the follow‐up period, 14 implants (4.3%) were lost in 9 patients (12.3%). Incidence of peri‐implantitis was observed in 22.2% of patients and 9.4% of implants. In the final multilevel multiple logistic regression model, the following factors were associated with occurrence of peri‐implantitis: periodontitis severity (stage IV periodontitis: OR = 41.29; 95% CI: 4.10–415.54), periodontal bone loss/age ratio (> 1: OR = 8.87; 95% CI: 1.47–53.73), smoking (current smokers: OR = 7.84; 95% CI: 1.83–33.50), sleep duration (> 7 h: OR = 19.97; 95% CI: 1.69–236.39), implant location (incisor: OR = 60.60; 95% CI: 4.04–908.33), restoration type (full‐arch fixed restorations: OR = 89.84; 95% CI: 3.66–2202.97), and restoration margin location (juxta‐marginal: OR = 14.17; 95% CI: 1.20–166.76). Keratinized tissue width assessed at baseline was not associated with incidence of peri‐implantitis.ConclusionApproximately one in five patients and one in 10 implants experienced incident peri‐implantitis over a nearly four‐year period. Periodontitis (Stage IV and Grade C), lifestyles (smoking and sleep duration), implant location, and prosthetic factors (restoration type and margin location) emerged as risk factors for peri‐implantitis.

OBJECTIVE:A new passivation method for titanium dental implants has been studied, where the nanotextured layer features spikes that provide a high bactericidal capacity without compromising the degree of osseointegration of the dental implants. MATERIALS AND METHODS:This layer has been obtained through a sulfuric acid treatment with hydrogen peroxide. It has been characterized using electron microscopy, the roughness was determined by confocal microscopy and wettability and surface energy assessed through contact angle. The incorporation of hydrogen was assessed using a fusion spectrometer. Fatigue behavior was evaluated with a servo-hydraulic testing machine. The adhesion of human osteoblastic cells SaOs-2 at 3 and 7 days was measured, and the level of mineralization was analyzed by alkaline phosphatase levels. Bacterial colonization assays were conducted using four strains to assess their bactericidal capacity. Implants were inserted into rabbit tibiae. After 21 days, the animals were sacrificed, and bone index contact determined. RESULTS:A uniform surface created by nanospikes was obtained, exhibiting the same roughness as the control implant, no hydrogen was incorporated inside the titanium. The fatigue behavior showed no variation compared to the control. An increased wettability and higher surface energy compared to the control implant were noted. Enhanced osteoblastic adhesion was observed for the nanospikes surface in comparison with control at 3 days, with a significant level of alkaline phosphatase at 14 days, indicating a good degree of mineralization. The bactericidal capacity of nanospike surface is evidenced showing reductions ranging from 70 to 90%. In vivo tests demonstrate higher bone contact index values for dental implants with nanospikes (56%) compared to the control (41%). CONCLUSIONS:The surface formed by nanospikes maintains the mechanical properties of the control and improves the wettability of the surface which improves the behavior of the osteoblasts generating a better osseointegration. At the same time, it has a high bactericidal capacity that prevents microbiological colonization. CLINICAL RELEVANCE:Peri-implantitis has become one of the major problems for the success of implant dentistry and this new surface may be a solution for the prevention of the disease.

ABSTRACT Aim To study the differential presence of amyloid‐β and bacterial lipopolysaccharide (LPS) in freshly extracted titanium implants, either affected by peri‐implantitis (PI) or explanted by other causes, and to address a method for removal LPS and amyloid‐β from contaminated surfaces. Methods Twenty‐four explanted implants were harvested from patients with ( n = 12) or without ( n = 12) peri‐implantitis, and their surfaces were analyzed by attenuated total reflectance (ATR) and Fourier transform infrared spectroscopy (FTIR) to localize amyloid‐β and LPS. Presence of amyloid‐β on the implants surfaces was further analyzed by light microscopy after specific amyloid staining with Congo red. Titanium discs were contaminated with LPS and amyloid‐β, these discs as well as six contaminated implants were treated with 0.25% NaOCl to assess its decontamination ability. Results LPS and amyloid‐β were observed at PI affected implant surfaces, but not in implants extracted by other causes. 0.25% NaOCl application was an efficient method for removing LPS and amyloid‐β from titanium surfaces. Conclusions The concurrent presence of LPS and amyloid‐β on the surface of implants affected by PI was demonstrated and it may act as potential comediators of PI inflammatory process. Eliminating these products from implants surfaces is possible after a proteolytic agent (0.25% NaOCl) application.

Objectives: Digital protocols and bioactive materials may reduce complications and improve tooth autotransplantation (ATT) success and survival rates. This prospective study assesses the performance of a fully digital autotransplantation protocol of close-apex molars with the adjunctive application of Enamel Matrix Derivatives (EMD). Methods: Twelve adult patients with 13 hopeless molar teeth were replaced with autotransplantation of closed apex third molars. Outcomes, including success and survival rates, clinical, endodontic, radiographic, patientreported outcome measures (PROMs), and digital image assessments, were conducted over a two-year followup period. Results: Survival and success rates were 100% and 91.2%, respectively, with no progressive inflammatory or replacement root resorption (ankylosis) except for one tooth presenting radiographic furcation involvement. A significant probing depth reduction of 2.4 +/- 2.58 mm and CAL gains of 2.8 +/- 3.03 mm were observed in transplanted teeth compared to the hopeless receptor teeth. Radiographic bone levels remained stable throughout the study period (-0.37 +/- 0.66 mm), and digital image assessments showed minimal alveolar ridge width changes (-0.32 to -0.7 mm) and gingival margin changes (-0.95 to -1.27 mm) from baseline to last visit. PROMs indicated very high patient satisfaction. Conclusion: The use of a digital ATT protocol with adjunctive use of EMD in closed-apex third molars demonstrated promising short-term high success and survival rates. Additionally, this type of therapy adequately preserves the dimensions of the alveolar ridge in the receptor site. Clinical significance: This is the first prospective clinical study examining the effect of a digital tooth autotransplantation protocol combined with the application of EMD. It demonstrates that this approach is an effective treatment for replacing hopeless teeth and also validates the digital assessment of ATT alveolar ridge preservation at the recipient site.