Search Results (204)

Guided bone regeneration (GBR) is a widely used clinical approach for managing bone defects associated with periodontal disease in dogs, employing barrier membranes to selectively direct tissue regeneration. The performance of these membranes is influenced by composition, structural design, and degradation behavior, which together determine biological responses and clinical outcomes. Biodegradable GBR membranes, fabricated from natural polymers, synthetic polymers, or composite materials, offer advantages over non-biodegradable membranes, including controlled resorption, elimination of secondary surgery, and the potential for delivery of bioactive agents. Preclinical studies in dogs have demonstrated that GBR membranes can promote periodontal regeneration, including bone and cementum formation and space maintenance; however, optimization of degradation behavior remains critical to align membrane resorption with tissue healing in some cases. Clinical studies in dogs with naturally occurring periodontal disease remain scarce, and only two biodegradable membranes (Ossiflex^® and Doxirobe^®) are commercially approved for veterinary use, while all others are applied off-label. These limitations highlight the need for more adaptable and cost-effective regenerative strategies, including membranes that can be customized to different defect sizes and multifunctional membranes incorporating bioactive agents that will offer an advanced regenerative potential and improved predictability in veterinary periodontal therapy. Full article

Background/Objectives: Dental implant and guided bone regeneration (GBR) procedures rely on successful bone healing and remodeling. Systemic metabolic factors, including vitamin D deficiency and elevated low-density lipoprotein cholesterol (LDL-C), may adversely affect osseointegration and bone regeneration. This study aimed to investigate the association between implant/GBR failure and serum vitamin D and LDL-C levels. Methods: A retrospective clinical study was conducted on 40 patients treated with dental implants and/or GBR procedures between 2023 and 2025 in the Eastern Province of Saudi Arabia. Twenty patients with failed outcomes and twenty patients with successful outcomes were included. Smokers, immunocompromised patients, individuals with a history of radiotherapy or chemotherapy, and patients with uncontrolled diabetes mellitus (HbA1c > 6.5%) were excluded. Failure was defined as progressive bone loss, loss of osseointegration, implant mobility, graft resorption, or persistent infection and was categorized as early or late failure. Serum vitamin D and LDL-C levels were obtained after treatment and analyzed using bivariate and exploratory multinomial logistic regression analyses. Results: Significant differences in serum vitamin D and LDL-C levels were observed among failure groups. Mean vitamin D levels were highest in the non-failure group (91.3 ± 47.9 nmol/L), followed by early failure (53.3 ± 33.7 nmol/L) and late failure (28.3 ± 11.3 nmol/L) (p = 0.001). Mean LDL-C levels increased progressively from the non-failure group (107.0 ± 26.8 mg/dL) to early failure (137.6 ± 47.3 mg/dL) and late failure groups (161.3 ± 57.0 mg/dL) (p = 0.003). Vitamin D status and LDL-C category were significantly associated with failure type (p = 0.001 and p = 0.012, respectively). Conclusions: Lower serum vitamin D levels and higher LDL-C levels were associated with implant and GBR failure, particularly in late failure cases. However, because serum vitamin D and LDL-C levels were measured after treatment outcomes and the study was limited by its retrospective design and relatively small sample size, these findings should be interpreted with caution and do not establish a causal relationship. Larger prospective studies are needed to determine whether preoperative assessment and optimization of vitamin D and lipid status may improve implant and regenerative treatment outcomes. Full article

Guided bone regeneration (GBR) heavily relies on barrier membranes, with collagen being the clinical standard material. Human amniotic epithelial cells (hAECs) represent a promising, non-controversial stem cell source with substantial osteogenic and immunomodulatory potential. This study aimed to comparatively evaluate the structural characteristics of three commercial collagen membranes (Biocollagen^®, Derma^®, and VantyColl^®) and their influence on the biological behavior, viability, and osteogenic differentiation of hAECs and hFOB 1.19 human fetal osteoblasts. The microarchitecture was assessed via scanning electron microscopy (SEM). Biological response was evaluated over 14 days, using MTT assays, calcium and phosphorus quantification, alkaline phosphatase (ALP) activity, and quantitative real-time PCR (qRT-PCR) for osteogenic markers (Runx2, Osterix, ALP, and OPN). SEM revealed a dense lamellar structure for Biocollagen^®, a fibrillar and oriented architecture for Derma^®, and a highly porous network for VantyColl^®. Both cell types adhered to and proliferated on all membranes. Derma^® provided the best long-term proliferative support for both lineages. Conversely, VantyColl^® induced robust early osteoblastic differentiation, marked by exceptional upregulation of Osterix (24.93-fold) and Runx2 (2.64-fold), though it exhibited diminished long-term hAEC viability. Ultimately, collagen membrane microarchitecture dictates cell fate; dense fibrillar networks (Derma^®) favor sustained growth and late matrix maturation (OPN), whereas high-porosity scaffolds (VantyColl^®) amplify early osteoinductive cascades. Full article

Based on the growing use of guided bone regeneration (GBR) for implant rehabilitation in atrophic alveolar ridges, the choice of barrier membrane remains a critical factor for clinical success. This review aimed to evaluate the clinical effectiveness of titanium-reinforced dense polytetrafluoroethylene (d-PTFE-Ti) membranes compared with resorbable collagen membranes in vertical ridge augmentation. A literature review was conducted using PubMed, Cochrane Library, and ScienceDirect databases. Clinical studies published since 2014 involving human subjects undergoing GBR procedures with either d-PTFE-Ti or collagen membranes were included. Nine studies met the inclusion criteria, including randomized clinical trials and cohort studies. The selected studies indicated that both membrane-based approaches were effective in promoting bone regeneration and enabling implant placement. Titanium-reinforced d-PTFE membranes may offer mechanical advantages in space maintenance and dimensional stability, particularly in larger vertical defects; however, the available comparative evidence did not demonstrate a consistent statistically significant superiority over collagen-based approaches. Within the limitations of the available evidence, both strategies appear to provide clinically predictable outcomes, and membrane selection should be individualized according to defect morphology and treatment requirements. Full article

Background: Management of post-extraction sockets with buccal dehiscence in the esthetic zone remains clinically challenging, particularly when immediate implant placement is indicated. Conventional approaches often rely on guided bone regeneration (GBR) with biomaterials, which may increase surgical complexity and morbidity. This case report evaluates the clinical and radiographic outcomes of a fully autologous approach combining leukocyte- and platelet-rich fibrin (L-PRF) and connective tissue graft (CTG) in conjunction with immediate implant placement. Methods: A 50-year-old healthy patient presenting with a fractured maxillary lateral incisor and buccal bone dehiscence underwent atraumatic extraction, immediate implant placement, and simultaneous site management using L-PRF membranes and CTG. Clinical and radiographic evaluations were performed at baseline (T0) and after 12 months (T1). Cone-beam computed tomography (CBCT) was used to assess horizontal bone thickness (HBT) at multiple apico-coronal levels and vertical evaluation parameters, including nasal floor–crest distance (NF–AC). Clinical outcomes included probing pocket depth (PPD), keratinized tissue width (KT), gingival thickness (GT) and patient-reported outcome measures (PROMs). Results: Radiographic analysis demonstrated increased HBT at all levels (+1.4 mm at 9 mm, +3.1 mm at 12 mm, +3.2 mm at 15 mm, and +2.6 mm at 18 mm). NF-AC showed a marked increase (+2.7 mm) and substantial reduction in the buccal dehiscence defect. Clinically, KT increased by +2.0 mm and GT by +1.8 mm. Healing was uneventful, with minimal postoperative discomfort and high patient satisfaction. Conclusions: Within the limitations of a single case report, the combined use of L-PRF and CTG with immediate implant placement was associated with favorable clinical and radiographic outcomes. These preliminary findings suggest that a fully autologous, biologically driven approach may represent a potential alveolar ridge preservation strategy and a biomaterial-sparing alternative to conventional GBR in carefully selected cases. Further controlled studies are required to confirm these observations and define the indications and limitations of this approach. Full article

Guided Bone Regeneration (GBR) is a pivotal technique in dental and orthopedic applications for regenerating bone in areas of deficiency. Natural polymers such as collagen, chitosan, alginate, and gelatin have emerged as essential materials in GBR due to their biocompatibility, biodegradability, and bioactivity. These polymers not only provide a scaffold for bone regeneration but also support cellular adhesion, proliferation, and differentiation. Despite their benefits, challenges such as variable degradation rates, insufficient mechanical strength, and limited bioactivity hinder their optimal clinical use. To address these limitations, ongoing research focuses on enhancing the properties of natural polymers. Composite materials combining fast- and slow-degrading polymers are being developed to achieve consistent degradation rates. Surface modifications, including nanoscale texturing and growth factor coatings, are improving bioactivity. Nanotechnology further enhances the structural and therapeutic potential of GBR materials, while advancements in 3D bioprinting enable the creation of customized scaffolds with precise architecture. These innovations aim to bridge the gap between biological compatibility and clinical functionality, making natural polymers more adaptable and effective in GBR. This review highlights the mechanisms, challenges, and advancements in natural polymers for GBR, emphasizing their potential to transform bone regeneration into a more reliable and patient-centered approach. Full article

Background and Clinical Significance: Severe skeletal Class II malocclusion associated with periodontal compromise and posterior edentulism requires a carefully sequenced interdisciplinary treatment approach integrating orthodontic, surgical, periodontal, and prosthetic rehabilitation. Case Presentation: This case report describes the comprehensive interdisciplinary management of a 21-year-old female patient presenting with skeletal Class II malocclusion, severe mandibular retrognathia, vertical maxillary excess, labial incompetence, temporomandibular joint (TMJ) dysfunction and periodontal deficiencies. The treatment sequence involved occlusal splint therapy, pre-surgical orthodontic decompensation, bimaxillary orthognathic surgery using a segmental Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), postoperative orthodontic refinement with aligners, periodontal plastic surgery using the Zucchelli technique and guided bone regeneration (GBR) with implant placement in the posterior mandible. At the four-year follow-up, the patient demonstrated complete root coverage, stable skeletal correction, and satisfactory implant integration, with maintenance of functional and aesthetic outcomes over time. Conclusions: This report highlights the importance of precise preoperative planning and the synergy between orthodontics, orthognathic surgery and periodontics in achieving optimal functional and aesthetic results. Full article

Background/Objectives: The aim of this study was to compare the augmentation stability and clinical outcomes of L-shaped collagenated soft block bone substitutes (BBS) used in combination with either a self-assembly technology (SAT)-based physically crosslinked resorbable collagen membrane (RCM) or a conventional non-crosslinked RCM for peri-implant dehiscence defects. Methods: This retrospective cohort study included 30 patients who underwent guided bone regeneration (GBR) with simultaneous implant placement. The patients were treated with either a physically crosslinked membrane (PCM group, n = 15) or a non-crosslinked membrane (NCM group, n = 15). Clinical, radiographic, and profilometric parameters were evaluated at baseline, immediately post-GBR, and at re-entry surgery. Early wound healing complications and patient-reported outcomes were also assessed. Results: Both groups achieved significant defect resolution without severe adverse events. The mean reductions in defect width and height were 4.47 ± 1.82 mm (92.9%) and 4.07 ± 2.19 mm (89.4%) in the PCM group and 3.80 ± 1.59 mm (89.5%) and 4.13 ± 1.64 mm (86.9%) in the NCM group, respectively. Both groups showed comparable dimensional changes in hard and soft tissues, with no statistically significant differences in radiographic or profilometric outcomes. The incidence of wound healing complications, as well as patient-reported postoperative pain and swelling, were similar between the groups. Conclusions: Within the limitations of this retrospective pilot cohort study, SAT-based physically crosslinked RCMs used in combination with L-shaped soft BBS demonstrated clinical, radiographic, profilometric, and patient-reported outcomes similar to those observed with conventional non-crosslinked RCMs, without major short-term postoperative complications. These preliminary findings suggest that SAT-based RCMs may represent a feasible membrane option for GBR; however, these findings should be interpreted as preliminary and hypothesis-generating and should be confirmed in larger, adequately powered prospective clinical studies. Full article

Background/Objectives: Guided bone regeneration (GBR) in dental applications requires scaffolds that possess balanced mechanical strength, controlled biodegradability, and excellent biological performance; therefore, this study aims to develop and evaluate a multilayered biofunctional dental membrane designed to enhance mechanical, biological, and antibacterial performance. Methods: The multilayered membrane was fabricated using sequential electrospinning and electrospraying techniques to form a polycaprolactone (PCL)/Collagen first layer and a polyvinyl alcohol (PVA)/Collagen/Hydroxyapatite (HAp) second layer, topped with a final electrospray coating of PVA/Amoxicillin. Characterization was performed via SEM, FTIR, and EDS, followed by evaluations of tensile properties, swelling behavior, hydrolytic degradation, in vitro drug release, disk diffusion antibacterial activity against Staphylococcus aureus and Escherichia coli, and 7-day L929 fibroblast cytocompatibility (ANOVA/Tukey, p < 0.05). Results: SEM, FTIR, and EDS analyses confirmed uniform nanofiber morphology, homogeneous HAp distribution, and successful integration of bioactive compounds. The membrane exhibited a maximum tensile strength of 15.17 N, strain of 25.24%, and stress of 2.16 MPa, while swelling reached ~100% within 2 h and degradation stabilized around 4% weight loss after 48 h. Drug release profiles showed a rapid amoxicillin release in the first 50 min, plateauing at approximately 4.5 mg/L by 350 min, with distinct antibacterial inhibition zones, and the PCL/Col–PVA/Col/HAp–PVA/Amox group demonstrated the highest cell viability (~140%) after 7 days, significantly exceeding the control groups (p < 0.01). Conclusions: These quantitative findings validate the fabricated multilayered membrane’s potential as a mechanically robust, biodegradable, antibacterial, and bioactive scaffold for advanced guided bone regeneration in dental applications. Full article

Background/Objectives: Titanium implants remain the gold standard in implant dentistry. However, growing interest in metal-free alternatives has led to increased use of zirconia implants. Despite encouraging short-term outcomes, evidence regarding the medium- to long-term survival of one-piece zirconia implants (O-PZIs) and associated risk factors remains limited. The aim of this retrospective cohort study was to evaluate the survival of O-PZIs over follow-up periods of up to 8 years and to explore variables potentially associated with implant failure. Methods: This retrospective observational cohort study was conducted at a private dental clinic (Madrid, Spain). A total of 307 O-PZIs placed in 196 patients between 2017 and 2021 were analyzed. Implant survival was assessed using Kaplan–Meier analysis, while associations between clinical variables and implant failure were explored using chi-square tests and multivariate Cox regression models (p < 0.05). The mean follow-up period was 61.37 ± 2.25 months. Results: After a mean follow-up of 61.37 ± 2.25 months (range: 39–96 months), 42 failures were recorded, resulting in a cumulative survival rate of 86.32% (CI 95%: 79.28–92.96%). Most failures (64.29%) occurred before prosthetic loading. Kaplan–Meier analysis revealed significantly lower survival for tapered implants (p < 0.001) and among smokers (p < 0.001). Multivariate analysis indicated that only simultaneous guided bone regeneration (GBR) was independently associated with implant failure (Exp(B) = 3.191; 95% CI: 1.299–7.840; p = 0.011). However, this association should be interpreted with caution due to the retrospective design, potential confounding, limited number of events, and lack of adjustment for clustering at the patient level. The discrepancies observed between statistical methods highlight the importance of time-to-event analyses in implant research. Conclusions: Within the limitations of this study, O-PZIs demonstrated acceptable medium- to long-term survival. Simultaneous GBR may be associated with increased risk of failure. However, these findings should be considered exploratory. Further prospective studies are required to confirm these results and to better define risk factors in ceramic implant therapy. Full article

Adequate alveolar bone volume is a prerequisite for predictable and long-term success in dental implant therapy. Physiological post-extraction remodeling frequently results in horizontal and vertical ridge deficiencies, which may compromise optimal implant placement. Guided bone regeneration (GBR) has become a cornerstone procedure in implant dentistry, with clinical outcomes largely influenced by the biological and mechanical characteristics of grafting materials. Different bone grafts and their combinations are currently clinically applicable, each exhibiting distinct osteogenic, osteoinductive, and osteoconductive properties, as well as varying resorption profiles and volumetric stability. This narrative review aims to analyze the biological principles of alveolar ridge augmentation, compare the properties of commonly used graft materials, evaluate clinical outcomes, and discuss emerging regenerative strategies. Literature published between 2000 and 2025 was assessed to synthesize current evidence regarding graft integration, bone formation, desorption dynamics, and clinical indications. Autogenous bone remains the gold standard due to its combined osteogenic, osteoinductive, and osteoconductive potential; however, its limitations have driven the development of alternative materials, including allografts, xenografts, alloplastic substitutes, demineralized tooth matrices, platelet concentrates, and customized scaffolds. While no single material is universally ideal, appropriate selection based on defect characteristics and clinical objectives is essential for predictable outcomes. Future research should prioritize long-term comparative trials, biomaterial standardization, and biologically enhanced regenerative approaches. Full article

Background/Objectives: This systematic review and meta-analysis evaluated the clinical effectiveness of regenerative surgical treatments compared with open flap debridement (OFD) in the management of peri-implantitis and, secondarily, assessed whether more advanced regenerative approaches, including guided bone regeneration (GBR), platelet-rich fibrin (PRF), and hyaluronic acid (HA), provide additional clinical benefit compared with bone grafting alone. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted in accordance with PRISMA guidelines and the PICO model, covering the period from 1993 to 2024. From 2119 identified articles, 63 full-text papers were reviewed, and 12 studies met all inclusion criteria. These studies compared regenerative treatments with OFD and bone grafting using clinical outcomes of probing pocket depth (PPD), radiographic bone level (RBL), bleeding on probing (BOP), suppuration (SUP), mucosal recession (REC), and clinical attachment level (CAL). Meta-analysis was performed using a random-effects model. Results: Regenerative treatments demonstrated superior outcomes in radiographic bone level gain compared with OFD (p < 0.001), while no statistically significant differences were observed for PPD (p = 0.77), BOP (p = 0.13), SUP (p = 0.42), REC (p = 0.14), or CAL (p = 0.96). Comparisons between bone grafting and other regenerative materials also showed no statistically significant differences. Conclusions: Regenerative procedures improved radiographic bone outcomes but did not consistently outperform OFD in soft tissue parameters, and no advanced regenerative modality demonstrated clear clinical superiority over bone grafting alone. Further high-quality randomized controlled trials with standardized methodologies are needed to establish clinical guidelines for peri-implantitis surgery. Full article

Soft-tissue management is critical for guided bone regeneration (GBR), yet conventional titanium meshes lack the ability to regionally regulate fibroblast behavior where opposite biological responses are needed. Here, we fabricated two femtosecond-laser patterned stripe topographies on titanium using a unidirectional scanning strategy with parameter tuning, generating LSFL with a periodicity of 820 ± 30 nm and micro-grooves with a periodicity of 4.7 ± 0.1 μm. Surface morphology and physicochemical properties were characterized by SEM/AFM, XPS, microhardness testing, and wettability measurements. Human gingival fibroblasts (HGF-1) were used to assess adhesion, cytoskeletal organization, spreading area, and proliferation (CCK-8). The submicron LSFL promoted robust fibroblast adhesion, aligned cytoskeletal organization, larger spreading areas, and higher proliferation, whereas the micro-groove surface markedly restricted spreading and was associated with poorer cytoskeletal organization and lower proliferation. Alternating patterned regions further demonstrated geometry-driven spatial selectivity, with preferential cell occupation on LSFL stripes. These findings support a fabrication-ready surface-engineering strategy to synchronize rapid soft-tissue sealing while restricting unwanted fibroblast advancement at defined regions, offering a promising route toward more predictable GBR outcomes. Full article

In implant treatment in the aesthetic zone, high aesthetic quality is required in addition to functionality and long-term stability when reconstructing defects in peri-implant tissues. Post-traumatic cases often present with extensive loss of both hard and soft tissues, making the selection of an appropriate grafting method essential. This report describes a case in which an interpositional gingival graft (IGG) and a strip gingival graft (SGG) were combined to regenerate peri-implant soft tissue following guided bone regeneration (GBR), maintaining favorable tissue morphology and aesthetics for six years. The patient was a 53-year-old woman who suffered trauma after falling down stairs, resulting in a fractured bridge in the right maxillary canine region and crown fracture. The traumatized tooth was extracted, and GBR was performed to restore hard tissue volume. Subsequently, IGG and SGG were used to improve soft tissue thickness, interproximal papilla height, and a healthy mucogingival junction (MGJ). A cantilever implant prosthesis was selected as the final restoration. Over six years, no gingival recession or marginal bone loss was observed, and excellent aesthetic stability was maintained. A mini-review of published reports on IGG and SGG demonstrated their efficacy in enhancing soft tissue volume. The findings of this case suggest that a comprehensive approach—including bone augmentation, soft tissue grafting, and prosthetic design—can provide predictable, long-term aesthetic and functional outcomes in complex post-traumatic cases (223). Full article

This study aimed to quantify horizontal and vertical bone gain using superimposition of preoperative and postoperative cone beam computed tomography (CBCT) in severe alveolar ridge defects treated with a modified guided bone regeneration (GBR) technique based on customized titanium occlusive barriers with a window design, combined with autologous blood clot and β-tricalcium phosphate (β-TCP). In this prospective case series, 13 patients (28 defects) were treated. Customized titanium barriers were digitally designed based on CBCT data and manufactured by laser sintering. The barriers were fixed over the defects and filled with a mixture of an autologous blood clot and β-TCP, providing an osteoconductive scaffold within a stable regenerative compartment. A standardized window-based follow-up protocol was applied during healing, including irrigation and controlled deepithelialization. Primary outcomes were horizontal and vertical bone gain, assessed by pre- and postoperative CBCT superimposition. Histological evaluation was performed at the time of implant placement. After 8 months, significant bone gain was observed, with a mean horizontal gain of 4.50 ± 2.02 mm and a mean vertical gain of 4.40 ± 2.82 mm (p < 0.0001), confirmed by linear mixed-effects models and patient-level sensitivity analyses (p < 0.001). Histological analysis revealed well-vascularized newly formed bone with active osteoblasts and no inflammatory response. Keratinized gingiva formation was observed at all sites. One minor complication (mild screw loosening) was recorded and successfully resolved. This study is presented as a prospective case series; therefore, the results should be interpreted as exploratory evidence and do not allow direct comparisons or conclusions regarding equivalence or superiority over other GBR techniques. The present report specifically evaluates the regenerative phase prior to functional loading; therefore, although implants were placed according to protocol, implant survival and long-term functional outcomes were not assessed and cannot be inferred from these data. Within the limitations of this prospective case series, customized titanium occlusive barriers with a window design demonstrated promising results for horizontal and vertical bone augmentation and keratinized gingiva formation, without the need for autologous bone grafts or primary wound closure. Full article