OBJECTIVES:The 1st Global Consensus for Clinical Guidelines (GCCG) in Implant Dentistry introduced an innovative, evidence-based approach to developing patient-centered and practical recommendations for the rehabilitation of the edentulous maxilla. Within this framework, Group 1 aimed to formulate clinical recommendations on the number of implants required, timing of implant placement, and timing of loading. MATERIALS AND METHODS:Group 1 followed the S2k-level guideline framework of the Association of the Scientific Medical Societies in Germany (AWMF), using a structured nominal group technique. The evidence base included three systematic reviews evaluating clinician-reported outcomes (ClinROs) and patient-reported outcomes (PROs), supplemented by structured single-round international surveys involving expert clinicians, patients, and cross-disciplinary experts. Survey content covered diagnostics, treatment planning, clinical procedures, and maintenance care. Draft recommendations were discussed during the in-person consensus meeting in Boston (June 16-18, 2025) and finalized through anonymous plenary voting. Consensus was defined as ≥ 75% and ≤ 95% agreement and strong consensus as > 95% agreement. RESULTS:Group 1 formulated 12 clinical recommendations across the workflow domains of diagnostic tools, treatment planning, and treatment procedure. During plenary voting, three of these recommendations reached strong consensus, and nine achieved consensus. The number of voters per recommendation ranged from 61 to 90, with an average of 83. CONCLUSIONS:This consensus report provides structured, evidence-based recommendations on implant number, placement timing, and loading protocols for rehabilitation of the edentulous maxilla. These guidelines are intended to support individualized, patient-centered care while also identifying priority areas for future research.

PURPOSE:To evaluate the clinical and radiographic outcomes of two implants placed using either an immediate loading (IL) or delayed loading (DL) protocol to support a nonsplinted, Locator-retained mandibular overdenture. MATERIALS AND METHODS:Twelve eligible patients were enrolled, with six in the IL group and six in the DL group. Clinical and standardized radiographic examinations were conducted to assess implant survival and peri-implant hard and soft tissue health. Patientreported outcomes (PROs) were collected, and the incidence and nature of prosthetic complications were documented. RESULTS:The data for the 5-year follow-up of the randomized controlled trial (RCT) were reported in a previous publication. No statistically significant difference in radiographic bone levels (ΔRBL) was observed between IL and DL groups during the 5- to 12-year or 0- to 12-year intervals. One implant was lost in the DL group in the 5- to 12-year period, resulting in a cumulative implant survival rate (CSR) of 96% for DL and 100% for IL at 12 years. At the 12-year follow-up, no significant differences were observed between IL and DL groups with respect to clinical outcomes such as probing pocket depth (PPD), plaque score (PS), keratinized tissue width (KTW), and apical migration of the free gingival margin (GM). PROs related to patient comfort and satisfaction were similar in the IL and DL groups. Major prosthetic complications occurred in 50% of patients, while 92% experienced at least one minor prosthetic issue. A temporal trend of increased radiographic bone loss, decreased KTW, and increased apical migration of the GM from baseline to 12 years was noted in both the IL and DL groups. CONCLUSIONS:Both IL and DL protocols demonstrated comparable long-term patient comfort, patient satisfaction, and clinical and radiographic performance when applied to two nonsplinted, Locator-retained implants supporting a mandibular overdenture. Within the limitations of the present investigation, IL may represent a reliable and potentially favorable treatment approach for mandibular overdentures in appropriately selected cases. Significant prosthetic complications were noted in both groups, which highlights the importance of regular recall and prosthetic maintenance for long-term success.

This single-center pilot randomized clinical trial compared ridge dimensional changes following alveolar ridge preservation (ARP) with allograft (AG) versus xenograft (XG) in non molar sites with buccal dehiscence defects. 12 patients (6 per group) needing a single rooted tooth extraction were included. After extraction, sockets were grafted with the assigned bone substitute, covered with an absorbable membrane and collagen matrix. Cone beam computed tomography (CBCT) scans were taken at two time points: immediately post surgery and six months later. The need for additional bone augmentation at the time of implant placement was evaluated using implant planning software. Six months after ARP, AG demonstrated significantly better ridge width preservation (0.41 mm vs. 1.78 mm for XG, measured at 2 mm below the crest; p = 0.007). A trend favoring XG for better preservation of buccal and palatal/lingual ridge height was observed, though differences were not statistically significant (p = 0.11 and 0.58, respectively). Only one site (8.3%), from the AG group, required additional bone augmentation at implant placement. This pilot clinical trial suggests allograft and xenograft were both able to minimize dimensional changes when used for ARP in non-molar extraction sites with buccal dehiscence defect. Allograft may be more effective in minimizing ridge width reduction 2 mm from the crest while the xenograft appears to better preserve ridge height. Both bone graft materials are effective in reducing the need for additional bone augmentation; however, larger clinical studies are needed to confirm these findings.

Preeclampsia (PE) is a leading cause of morbidity and mortality in pregnancy with elusive etiology. Patients with PE are thought to be associated with a higher rate of periodontal diseases (PDs) and changes of oral bacteria with targeted PCR techniques. However, few studies have investigated the associations between oral microbiome dysbiosis and secondarily disseminated microbes in the placenta simultaneously in patients with PE. The association between detected microbiome in placenta and systemic inflammation in PE is also unclear. We enrolled 54 pregnant patients with and without PE and PD, and profiled the subgingival and placenta microbiome by the V4 region of 16S rRNA gene sequencing. Systemic inflammatory markers tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), lipopolysaccharide binding protein (LBP), and interleukins 6 and 8 (IL-6 and IL-8) in blood were measured by ELISA. We found that PD significantly increased the risk of PE after adjusting for age and smoking status (OR = 2.26, 95% CI = 1.14–4.48, p = 0.024). A combined group of oral-associated bacteria Veillonella , Fusobacterium , Haemophilus , Granulicatella , Streptococcus, Gemella , and Neisseria in placenta had a significantly higher prevalence in women with PE compared to women without PE (53.8% vs. 19.0%, p = 0.018), with the highest prevalence in patients with both PE and PD (58.8%). The relative abundance of Haemophilus, Veillonella , and Fusobacterium in subgingival samples was significantly higher in patients with PE than those without PE. The relative abundance of Haemophilus in subgingival samples was associated with increased risk of PE (OR = 2.11, 95% CI = 1.11–4.52, p = 0.032). Proinflammatory cytokine analysis showed that PE patients with PD had higher blood IL-8 levels than PE patients without PD ( p = 0.026). CRP, LBP, and TNF-α showed no statistical difference in patients with and without PE or PD. Blood IL-6 levels were significantly higher in patients with detectable placenta microbiome compared to those without placenta microbiome ( p = 0.028). Together, our data suggest a potential oral origin of the placental microbiota present in patients with PE, and the microbiota detected in placenta is associated with increased IL-6 level in the blood.

PURPOSE:To compare the standard 360-degree CBCT acquisition protocol to the low dose 180-degree CBCT protocol for implant planning.MATERIALS AND METHODS:Two groups of patients, each consisting of 35 patients, were included in the study. The first group was imaged with the conventional 360-degree CBCT protocol, and the second group was imaged with the low dose 180-degree CBCT protocol. The primary outcome of this study was the number of scans that needed to be repeated due to poor image quality. In addition, six secondary parameters were evaluated quantitatively and qualitatively.RESULTS:The results showed that there was no need to repeat any of the CBCT scans that were obtained in either group, which showed that 360-degree and 180-degree protocols had comparable image quality. As for the secondary parameters, the results showed that the evaluators were able to evaluate the six chosen parameters in a comparable manner.CONCLUSION:The 180-degree low dose CBCT scan is a viable option for dental implant treatment planning in the posterior mandible as it provides comparable and adequate information regarding accuracy of measurements, identification of critical structures, evaluation of bone quality, and any pathology.

Restoration of edentulous sites with dental implants is increasingly becoming a popular choice. Cross-sectional 3-dimensional imaging using cone-beam computed tomography (CBCT) provides a better depiction of the implant site to help the clinician plan the procedure better. In spite of the advantages, radiation dose will always remain a concern. The evolution of lower-dose protocols is ongoing, but whether those acquisition protocols yield comparable diagnostic information is still not well established. The objective of this study was to evaluate the diagnostic efficacy of a low-dose, 180° rotational CBCT acquisition protocol for evaluating a potential implant site in comparison with a conventional 360° rotational acquisition. Ten dentate and partially edentulous dry human skulls providing 82 randomized implant sites-40 in the maxilla and 42 in the mandible-were chosen for this study. Each skull was imaged using a 360° and a 180° rotational acquisition on a J. Morita Accuitomo CBCT scanner. Evaluation of cortical and trabecular bone, height, width, and proximity to critical structures, such as the inferior alveolar nerve canal and the maxillary sinus, were measured. An oral surgeon and an oral radiologist rated the diagnostic efficacy of the scans by evaluating the above characteristics. Statistical evaluation of the data with linear regression showed significant agreement between both protocol measurements. Kappa analyses yielded a good interobserver agreement. In this proof-of-concept study, CBCT imaging using the lower-dose, modified arc, and 180° acquisition protocol shows comparable results to the conventional 360° protocol for preoperative implant assessment.

To determine the associations between the oral and placental microbiome in women with and without preeclampsia (PE) and periodontal disease (PD) An observational cohort study was performed from October 2019 - December 2020. Pregnant women were included if they were in labor, age 18-50, singleton gestation, ≥28 weeks. Exclusion criteria were: diabetes, inflammatory medical conditions, chronic antibiotic or steroid use ≥ 2 months, and fetal anomalies. PD was defined as ≥2 non-adjacent interproximal (NAIP) sites with CAL ≥3 mm, and ≥2 NAIP sites with PPD ≥ 4 mm, or ≥1 sites with PPD ≥5 mm. Oral, and placental samples were collected and bacterial profiles were characterized by metagenomics sequencing of V4 region 16S ribosomal RNA gene against negative controls. Alpha and beta diversity indices were computed. Non-parametric testing was performed to identify bacteria profiles that were different in each body site. A p-value of < 0.5 was considered statistically significant. 54 patients were eligible to participate. PD was confirmed in 19 (65.5%) women with PE vs 7 (28%) women without PE, p=0.007. Mild to moderate PD was found in 15 (77.8%) women with PE and severe PD was seen in 4 (66.6%) women with PE, p=0.539. A logistic regression model was performed to determine the association between development of PE and PD. The relationship between PD and PE remained after adjusting for age, preterm delivery and smoking status (OR 2.26 (1.14-4.48), p=0.024 (Table 1). Oral and placental sites all had distinct microbiomes after removing organisms found in negative controls. Most bacterial sequences on the placenta were from a combined group likely of oral origins and these microorganisms were also associated with PE, showing a higher prevalence and relative abundance in women with PE, p=0.04 (Figure 2). We found a resident microbiota in placentas of women with PE and PD. There was a higher prevalence and abundance of oral bacteria in the placenta microbiome of women with PE compared to women without.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

INTRODUCTION:Gingival recessions in the mandibular anterior sextant are a common clinical finding, but mucogingival treatment in this location is particularly challenging, due to several anatomical and surgical difficulties. In the present case series, a novel technique, called gingival pedicle with split-thickness tunnel (GPST), was retrospectively evaluated. CASE SERIES:Fifteen patients presenting with a single buccal RT1 or RT2 gingival recession of a depth of ≥3 mm in the mandibular anterior sextant were treated by means of the GPST technique. Clinical periodontal parameters at baseline and at the last follow-up evaluation visit (6-84 months) were compared. Early healing was uneventful in all cases, and no complications such as flap dehiscence or loss of connective tissue graft were observed. Mean root coverage (mRC) was 98.1% ± 7.38%, corresponding to a statistically significant recession reduction (ΔRD) of 4.53 ± 1.19 mm. Complete root coverage was achieved in 14 of 15 cases. The gain in keratinized tissue width amounted to 3.13 ± 0.99 mm and was statistically significant, whereas no significant change in periodontal probing depth was observed after treatment. CONCLUSION:In conclusion, treatment with GPST technique seems to achieve a favorable and predictable clinical improvement in gingival recessions on mandibular anterior teeth. Why are these cases new information? Limited information is available about the management of isolated deep labial recessions in the mandibular anterior teeth. A novel surgical approach, called GPST technique, is described in a case series to specifically address this type of defect. What are the keys to successful management of these cases? Horizontal incision ≥ RECwidth Cut-back preparation helps to mobilize the flap without tension. CTG width ≥ 3 times RECwidth CTG height ≥ RECdepth Proper graft and flap stabilization need to be achieved. What are the primary limitations to success in these cases? Limited mesio-distal dimensions, which do not allow to obtain a pedicle with adequate horizontal width Very thin biotype may not be suitable because of the risk of inadequate flap vascularization.

This case report proposes a unique approach for managing Cairo gingival recession types 1 and 2 (RT1 and RT2, respectively) in the mandibular anterior region, where anatomical features such as a high frenal attachment or a shallow vestibule preclude the use of a coronally advanced flap. Three systemically healthy patients presenting with Cairo RT1 and RT2 gingival recessions were included. The recessions were managed with a staged approach of frenectomy followed by a modified tunnel in combination with connective tissue graft. Significant root coverage was achieved in all three cases. This treatment approach allows for root coverage, relief of frenal pull, keratinized tissue gain, and increased vestibular depth in very challenging Cairo RT1 and RT2 gingival recessions in mandibular anterior teeth. A short-term follow-up of 3 to 6 months showed stable results in all presented cases.

Objective: Preeclampsia (PE) is a leading cause of morbidity and mortality in pregnancy. This observational study aims to determine associations between oral and placental microbiome in women with and without preeclampsia and periodontal disease (PD) and evaluate systemic immune responses in patients with and without PE and PD. Population: Fifty-four pregnant patients with and without PE and PD were recruited. The microbiome profiles of both oral subgingival region and placenta were characterized by V4 region of 16S rRNA gene sequencing. Systemic inflammation markers tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), lipopolysaccharide binding protein (LBP), interleukins 6 & 8 (IL-6, IL-8) in blood were measured by ELISA. Results: PD significantly increased the risk of PE after adjustments for age, preterm delivery and smoking status (OR=2.26, 95% CI=1.14-4.48, p=0.024). A group of oral associated bacteria Veilonella, Fusobacterium, Haemophilus, Granulicatella, Streptococcus, Gemella and Neisseria in placenta had significantly higher prevalence in women with PE compared to women without PE (53.8% vs 19.0%, p=0.018), the highest prevalence in patients with both PE and PD (58.8%). Relative abundances of Haemophilus, Veillonella and Fusobacterium in oral samples were significantly higher in patient with PE than those without PE. Proinflammation cytokine analysis showed that PE patients with PD had higher blood IL-8 levels than PE patients without PD (p=0.028). Conclusion: Oral-like microbiome was identified in placenta more frequently in patients with PE than those without PE. Placental microbiome is associated with systemic inflammation. High abundances of Haemophilus in oral cavity is associated with increased risk of PE.

To evaluate the systemic immune response in patients with and without preeclampsia (PE) and periodontal disease (PD). An observational cohort study was performed from October 2019 - December 2020. Pregnant women were included if they were in labor, age 18-50, singleton gestation, ≥28 weeks. Exclusion criteria were: diabetes, inflammatory medical conditions, chronic antibiotic or steroid use ≥ 2 months, and fetal anomalies. PD was defined as ≥2 non-adjacent interproximal (NAIP) sites with CAL ≥3 mm, and ≥2 NAIP sites with PPD ≥ 4 mm, or ≥1 sites with PPD ≥5 mm. The serum cytokines levels: tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), lipopolysaccharide binding protein (LBP), interleukins 6 & 8 (IL-6, IL-8) were evaluated. Maternal blood was collected on admission. Cytokine plasma levels, expressed as medium fluorescence intensity (MFI), were compared using Kruskal–Wallis followed by Dunn's post-test where the p-value was adjusted for multiple testing using the Benjamini-Hochberg method, and if appropriate, a t-test for differences between means. Significant differences were considered at P < 0.05. 54 patients were eligible to participate. PD was confirmed in 19 (65.5%) women with PE vs 7 (28%) women without PE, p=0.007. Mild to moderate PD was found in 15 (77.8%) women with PE and severe PD was seen in 4 (66.6%) women with PE, p=0.539. A logistic regression model showed that an association between PD and PE remained after adjusting for age, preterm delivery and smoking status (OR 2.26 (1.14-4.48), p=0.024 (Table 1). Cytokine analysis showed no statistical difference in patients with and without PE or PD even after stratification for term deliveries. However, there were elevated levels of IL-6 in placental samples where bacteria was either positive for PE or PD, p= 0.028 (Figure 1). Systemic inflammation is one possible link between PE and PD with higher levels of IL-6 present on placental samples of women that were either PE+ or PD+.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Electronic nicotine product use is increasing in the U.S., but few studies have addressed its effects on oral health. The goal of this work was to determine the association between electronic nicotine product use and periodontal disease. Population Assessment of Tobacco and Health adult survey data from 2013–2016 (waves 1, 2 and 3) was used for the analysis. Longitudinal electronic nicotine product users used electronic nicotine products regularly every day or somedays in all three waves. Participants with new cases of gum disease reported no history of gum disease in wave 1 but reported being diagnosed with gum disease in waves 2 or 3. Odds ratios (OR) were calculated to determine the association between electronic nicotine product use and new cases of gum disease after controlling for potential confounders. Compared to never users, longitudinal electronic nicotine product users had increased odds of being diagnosed with gum disease (OR 1.76, 95% Confidence Interval (CI) 1.12–2.76) and bone loss around teeth (OR 1.67, 95% CI 1.06–2.63). These odds were higher for participants with a history of marijuana and a history of illicit or non-prescribed drug use. Our findings show that e-cigarettes may be harmful to oral health.

AIM The purpose of this observational, post-trial follow up study, was to evaluate 60-month outcomes of a randomized controlled clinical trial, that compared immediate and delayed loaded two unsplinted implants, supporting a Locator retained mandibular overdenture. MATERIALS AND METHODS Patients from a randomized controlled clinical trial, treated with either immediate or delayed loading of two implants, supporting a Locator retained mandibular overdenture were recalled for 60-month evaluation. Patients underwent a clinical and radiographic examination to evaluate the peri-implant soft tissue parameters and bone. Prosthetic maintenance needs and complications were also recorded. RESULTS Twenty-three of the 30 patients were available for the 60-month follow-up. The mean radiographic bone level change measured using standardized periapical radiographs from baseline to 60 months was 0.89 mm (±0.74) and 0.18 (±0.41) for delayed loading and immediate loading groups respectively. A statistically significant difference was observed at 60-months with a smaller radiographic bone level change in the immediate loading group. No implants were lost between 12 and 60-months. At 60-months, per protocol implant survival rate was 100% for both the groups. No difference was found in the peri-implant soft tissue parameters and prosthetic needs between the groups. CONCLUSION Both immediate and delayed loaded implants supporting a Locator retained mandibular overdenture showed similar clinical outcomes. This article is protected by copyright. All rights reserved.

PURPOSE Implant-supported mandibular overdentures (OVDs) have been proposed as the gold standard for the treatment of edentulous mandibles. There is limited evidence on the clinical outcomes of immediate loading of two unsplinted implants supporting a mandibular OVD. The purpose of this randomized controlled trial was to evaluate the performance of two unsplinted implants supporting a Locator-retained mandibular OVD over 12 months loaded immediately or after a delay. MATERIALS AND METHODS Each patient received two implants 4.0 mm in diameter and 8 to 15 mm long. Locator-retained mandibular OVDs were connected to the implants either immediately (IL) or 3 months postsurgery (DL). The primary response variable was radiographic bone loss (RBL) at 6 and 12 months postsurgery. Implant length, insertion torque, implant failure, prevalence of maintenance visits, and prosthetic complications were also recorded. RESULTS Thirty participants (15 in the IL and 15 in the DL groups) were evaluated at 12 months. The implant cumulative survival rates were 100% and 93% for DL and IL, respectively. The mean RBL from baseline to 1 year was 0.54 (± 0.5) mm and 0.25 (± 0.5) mm for DL and IL, respectively. A statistically significant difference was observed at 12 months, with less RBL in the IL group. Insertion torque and implant length were not correlated with RBL. Also, no difference in frequency of maintenance visits and prosthetic complications was reported between the groups. CONCLUSION Immediate loading of two unsplinted implants supporting a Locator-retained mandibular OVD seems to be a suitable treatment option. Significantly less RBL was observed after 1 year of loading around IL implants than around DL implants. Furthermore, neither implant length nor insertion torque seemed to affect RBL 1 year after surgical placement.

Purpose This study was performed to evaluate the diagnostic efficacy of panoramic radiography and cone-beam computed tomography (CBCT) in detecting sinus pathology. Materials and Methods This study was based on a retrospective evaluation of patients who had undergone both a panoramic radiograph and a CBCT exam. A total of 100 maxillary sinuses were evaluated. Four examiners with various levels of expertise evaluated the images using a five-point scoring system. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of the two modalities. The image analysis was repeated twice, with at least two weeks between the evaluation sessions. Interobserver reliability was assessed using Cronbach's alpha, and intraobserver reliability was assessed using Cohen's kappa. Results Maxillary sinus pathology was detected in 72% of the patients. High interobserver and intraobserver reliability were observed for both imaging modalities and among the four examiners. Statistical analyses using ROC curves demonstrated that the CBCT images had a larger area under the curve (0.940) than the panoramic radiographs (0.579). Conclusion Three-dimensional evaluation of the sinus with CBCT was significantly more reliable in detecting pathology than panoramic imaging.