Search Results (162)

Background: Gingival recession is a common condition involving apical displacement of the gingival margin, leading to root surface exposure and associated complications such as dentin hypersensitivity and root caries. Among the most effective treatment options are the tunneling technique (TUN) and the coronally advanced flap (CAF), both combined with connective tissue grafts (CTGs). This study aimed to evaluate and compare the clinical outcomes of TUN + CTG and CAF + CTG in terms of root coverage and keratinized tissue width (KTW) over a 6–12-month follow-up. Methods: A randomized, double-blind clinical trial was conducted following CONSORT guidelines (ClinicalTrials.gov ID: NCT06228534). Participants were randomly assigned to receive either TUN + CTG or CAF + CTG. Clinical parameters, including gingival recession depth (REC) and KTW, were assessed at baseline as well as 6 months and 12 months postoperatively using a calibrated periodontal probe. Statistical analysis was performed using descriptive statistics and linear mixed models to compare outcomes over time, with a significance level set at 5%. Results: Both techniques demonstrated significant clinical improvements. At 6 months, mean root coverage was 100% in CAF + CTG cases and 97% in TUN + CTG cases, while complete root coverage (REC = 0) was observed in 100% and 89% of cases, respectively. At 12 months, root coverage remained stable, at 99% in the CAF + CTG group and 97% in the TUN + CTG group. KTW increased in both groups, with higher values observed in the CAF + CTG group (3.53 mm vs. 3.11 mm in TUN + CTG at 12 months). No significant postoperative complications were reported. Conclusions: Both TUN + CTG and CAF + CTG are safe and effective techniques for treating RT1 and RT2 gingival recession, offering high percentages of root coverage and increased KTW. While CAF + CTG achieved slightly superior coverage and tissue gain, the TUN was associated with better aesthetic outcomes and faster recovery, making it a valuable alternative in clinical practice. Full article

Gingival recession is a common problem, particularly affecting oral health and esthetics, and its treatment involves surgical root coverage procedures. The aim of this narrative review is to evaluate the role of systemic antibiotic therapy in mucogingival surgery for recession treatment. The available literature does not support routine antibiotic use in systemically healthy patients undergoing recession coverage surgery. Indications for prophylactic antibiotics are restricted to individuals at high risk of infective endocarditis and immunocompromised patients with elevated susceptibility to surgical site infections. Although mucogingival surgeries are performed in a non-sterile environment, the risk of infection remains low when proper aseptic techniques and good preoperative tissue preparation are applied. The review emphasizes the importance of making clinical decisions that consider the patient’s health status and are aligned with current recommendations. It also emphasizes the necessity for prospective studies to evaluate antibiotics’ effect on recession coverage procedures outcome. To bridge the gap between contemporary evidence and clinical practice and to foster responsible use of antibiotics in periodontal plastic surgery, the authors of this review integrate current evidence and clinical guidelines into a practical tool designed to assist clinicians in making reasoned, evidence-based decisions. Full article

Bcakground: The deepithelialized free gingival graft (DGG) technique provides high-quality connective tissue grafts (CTGs) with predictable outcomes for recession coverage. This study evaluates a novel method of free gingival graft (FGG) deepithelialization using an Er,Cr:YSGG laser (LDEE) for treating multiple gingival recessions. Methods: A split-mouth study was conducted on 46 (n = 46) recessions in nine patients (23 per test and control group). Sites were randomized. Full-thickness palatal grafts were harvested with a scalpel. In the test group (LDEE), deepithelialization was performed extraorally using an Er,Cr:YSGG laser (2780 nm; 2.5 W, 83.3 mJ, 30 Hz, 600 µm tip). In the control group (DEE), a 15c scalpel was used. All CTGs were applied using the modified coronally advanced tunnel (TUN) technique. Clinical parameters—recession depth (RD), keratinized tissue width (KT), gingival thickness (GT), pocket depth (PD), clinical attachment loss (CAL), pink esthetic score (PES), approximal plaque index (API), mean root coverage (MRC), and complete root coverage (CRC)—were assessed at baseline (T0), 3 months (T1), and 6 months (T2). Results: Both LDEE and DEE groups showed significant improvements in RD, KT, GT, PD, and CAL over time (p < 0.001). At T1 and T2, KT was significantly higher in the LDEE group (T1: 3.73 ± 0.72 mm; T2: 3.98 ± 0.76 mm) compared to the DEE group (T1: 3.21 ± 0.61 mm; T2: 3.44 ± 0.74 mm; p < 0.05). Other parameters (RD, GT, PD, CAL) showed no statistically significant intergroup differences at any time point (p > 0.05). After 6 months, MRC was 95% and CRC 82.6% for LDEE, compared to 94.8% and 82.6% for DEE (p > 0.05). PES scores were similar between groups at all time points (p > 0.05). Conclusions: Both laser- and scalpel-deepithelialized grafts effectively treated gingival recessions. LDEE combined with TUN resulted in significantly greater KT width compared to DEE + TUN. Full article

Introduction: The scapholunate interosseus ligament (SLIL) is critical for wrist stability, with injuries causing carpal instability and potential scapholunate advanced collapse (SLAC). This technical note presents a novel ligament-sparing surgical technique for treating SLIL tears ranging from grade 2 to 4 of the Garcia-Elias classification. Materials and Methods: A retrospective study was performed on ten patients treated with this novel technique. The technique involves a dorsal approach to the wrist through a 5–7 cm incision ulnar to Lister’s tubercle. After exposing the scapholunate joint, reduction is performed using Kirschner wires (K-wires) as joysticks, followed by stabilisation with three K-wires through the scapholunate, scapho-capitate, and radio-lunate joints. Two 2.3 mm suture anchors with double sutures are placed where the reduction K-wires were removed. One pair of sutures connects the anchors and any remaining SLIL tissue, while the second pair create a shoelace-like capsulodesis. Post-operative care includes staged K-wire removal at one and two months, with progressive rehabilitation before returning to weight-bearing activities at six months. Results: All patients improved in pain and function. The technique addresses SLIL injuries by restoring both coronal alignment through ligament repair and sagittal alignment via dorsal capsulodesis. The use of suture anchors and direct repair preserves the native tissue while reinforcing the dorsal capsule–scapholunate septum complex, avoiding the need for tendon grafts or extensive bone tunnelling. Conclusions: This ligament-sparing technique offers several advantages, including absence of donor site morbidity, minimal damage to carpal cartilage and vascularity, and preservation of surgical options should revision be necessary. The procedure effectively addresses both components of scapholunate instability while maintaining a relatively straightforward surgical approach. Full article

Background/Objectives: Peri-implant mucosa plays a key role in both peri-implant health and aesthetics. Differences in contour and color between implants and natural teeth can negatively affect patient satisfaction, while soft tissue deficiency may lead to complications such as peri-implantitis. Peri-implant plastic surgery aims to improve these conditions. The objective of this study is to describe the trouser-shaped connective tissue graft technique designed to enhance vestibular and interproximal peri-implant tissue volume in a single surgical procedure, and to assess its effectiveness and morbidity. Methods: Ten patients requiring soft tissue augmentation in edentulous areas prior to delayed implant placement were selected. Intraoral scanning was performed before and 6 months after treatment to evaluate tissue thickness gain. Results: Significant soft tissue volume gain was observed at both the coronal (mean: 2.74 mm with a 95% confidence interval of 2.21–3.26 mm) and vestibular (mean: 2.79 mm with a 95% confidence interval of 2.24–3.35 mm) levels in all analyzed positions (p < 0.001). The procedure exhibited low morbidity, with minimal complications and discomfort reported by the patients. Conclusions: The trouser-shaped connective tissue graft technique is effective in increasing peri-implant soft tissue. It allows for vestibular and interproximal tissue augmentation in a single procedure, minimizing tissue contraction and morbidity. This technique could be a predictable and minimally invasive alternative for managing volume deficiencies in peri-implant tissues, particularly in aesthetic areas. Full article

Background: The rehabilitation of complex bone defects in the anterior maxilla presents significant challenges in restoring both function and esthetics. A multidisciplinary approach integrating guided bone regeneration (GBR) and connective tissue grafting (CTG) has proven effective in addressing such cases. Methods: This report describes the case of a 60-year-old female patient who presented with severe alveolar ridge resorption and peri-implant bone loss, necessitating an advanced regenerative strategy. The treatment protocol involved the use of autologous and xenogeneic bone grafts in combination with hyaluronic acid and polynucleotides to enhance osteogenesis and tissue integration. A six-month healing period was observed before histological and clinical evaluations were conducted. Results: The results demonstrated a significant increase in lamellar bone formation and vascularization in sites treated with biomodulators compared to conventional GBR techniques. Subsequently, CTG was employed to optimize peri-implant soft tissue volume and stability, leading to improved keratinized tissue thickness and enhanced esthetic outcomes. This case underscores the importance of a comprehensive surgical and prosthetic plan that integrates bone regeneration with mucogingival management for optimal results in implant rehabilitation. Additionally, histological analysis revealed that the incorporation of hyaluronic acid and polynucleotides resulted in improved cellular activity, reduced inflammatory responses, and enhanced overall bone quality. Conclusions: These results highlight the potential role of biomodulators in regenerative procedures. While the findings suggest promising clinical applications, further long-term studies are necessary to validate the outcomes and establish standardized protocols for the integration of advanced biomaterials in implantology. Full article

Background/Objectives: Guided bone regeneration (GBR) is a regenerative technique used to treat maxillary osseous defects to enable implant placement for prosthetic rehabilitation. It is generally performed with the use of barrier membranes and bone substitute materials of human or animal origin. Here, we report the clinical and histological outcomes of a horizontal GBR, treated using only synthetic biomaterials. Methods: A graft of nanocrystalline hydroxyapatite (NH) embedded in a silica gel matrix was used to fill a horizontal bone defect. The graft was covered with a titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membrane, and primary closure was completed and maintained for 10 months. Then, the site was re-opened for membrane removal and implant insertion. During implant bed preparation, a bone biopsy was obtained for histological evaluation. A metal–ceramic crown was fitted, and the 5-year follow-up after prosthetic loading showed clinical and radiographically healthy tissues. Results: Histological examination revealed good integration of the biomaterial into the surrounding tissues, which were composed of lamellar bone trabeculae and connective tissue. New bone formation occurred not only around the NH granules but even inside the porous amorphous particles. Conclusions: The combination of NH and the TR-dPTFE membrane produced good clinical and histological results, which remained stable for 5 years. Full article

Background: As the rehabilitation of the upper anterior maxilla primarily requires high predictability of successful aesthetic outcomes, procedures of immediate implant placement are frequently employed. The aim of this pilot study was to retrospectively evaluate the short-term outcomes of a protocol of immediate implant placement in fresh extraction sockets, followed by immediate non-functional provisional restorations. Methods: Patients were treated for the replacement of maxillary central or lateral incisors, or cuspid teeth with a single-crown locking-taper implant. Clinical and photographic records were retrospectively compared between the teeth prior to extraction (T0) and restorations one year after prosthetic loading (T1). Outcomes were analyzed using the Pink Esthetic Score (PES), according to the patient’s phenotype (thin/thick), with or without the use of connective tissue graft (CTG). Results: The overall mean PES of 25 implants treated was 9.24 ± 2.36 at T0 and 9.60 ± 1.70 at T1. Comparison of groups between T0 and T1 revealed significant PES variations (p = 0.04), with the best and the worst scores, respectively, registered for thin + CTG group (from 7.50 ± 1.91 to 9.75 ± 2.87) and thin group (from 11.33 ± 2.33 to 10 ± 0.89); moderate increases were assessed for thick group (from 8.44 ± 2.40 to 9.44 ± 2.12) and thick + CTG group (from 9.50 ± 1.04 to 9.33 ± 0.81). Conclusions: Within the limits of a short-term analysis of a small number of patients, immediate implant rehabilitation for aesthetic areas of the upper maxilla can be assumed as a safe and predictable protocol. Concomitant use of CTG seems to provide beneficial effects in thin phenotypes, not any additional value in thick phenotypes. Full article

Background: Tooth loss results in hard- and soft-tissue volume loss over time. We compared the handling of three different soft tissue substitutes (STS) to the subepithelial connective tissue graft (SCTG) for soft tissue volume augmentation in a pig ex vivo model. Methods: Five dentists simultaneously shaped, placed and sutured randomized four graft types in single-tooth soft tissue defects created in pig mandibles. The STS, produced from slightly crosslinked collagen fibres (VCMX), were either 3 mm or 6 mm thick blocks or a newly developed pre-customized saddle-shape. Each graft type was handled 20 times. The time required for shaping, placement, and suturing was recorded. Dentists reported outcomes on the grafts’ handling were evaluated with a visual-analogue-scale (VAS). Statistical analysis included calculating means and medians and testing significance. Results: The mean time of 0.72 min for shaping the pre-customized saddle-shape STS was significantly lower than 1.31 min for SCTG, 1.73 min for 3 mm STS and 2.17 min for 6 mm STS. Placement/suturing time was similar for all grafts. The dentists mainly preferred the saddle-shape STS and the SCTG. Conclusions: The saddle-shape STS required less time for graft-shaping and, therefore, reduced the overall treatment time, suggesting a more efficient and less invasive workflow for soft tissue augmentation. Full article

Background: Advanced platelet-rich fibrin + (A-PRF+) represents a third generation of autologous platelet derivatives. Appropriate centrifugation conditions cause the formation of a clot containing platelets, which slowly release growth factors that influence healing. The objective of this article was to undertake a review of the available literature on the effectiveness of A-PRF+ use in hard tissue procedures. Materials and methods: In order to ensure the most accurate and relevant results, only randomized clinical trials regarding bone regeneration techniques/bone healing that compared the effect of the A-PRF+ addition in dentistry were included in this study. Articles taken into consideration for the review were published between the beginning of 2014 and 31 December 2024. The search of manuscripts for the review was conducted using the PubMed, Scopus, Google Scholar, and Cochrane databases. For this study, 10 articles focusing on A-PRF+ were qualified. Results: A-PRF+ was found to increase the post-surgical vertical and horizontal alveolar ridge dimensions. The bone formed in the surgical site presented a higher volume of vital and non-vital bone and a more optimal bone composition, at the same time providing a lower percentage of connective tissue inclusions. When combined with other grafting biomaterials, A-PRF+ enhanced their performance and integration. A-PRF+ did not have any significant effect on the mineral bone density compared with other grafting materials. Compared with PRF and other blood derived plasmas rich in growth factors, the performance of A-PRF+ was generally better, but often with no statistical significance. The treatment of periodontal defects measured by the reduction in pocket depth and clinical attachment level also fared better with the A-PRF+ addition, although there was no differences noted between A-PRF+ and biphasic calcium phosphate and xenograft. Finally, the A-PRF+ addition improved the primary implant stability in the evaluated studies. Conclusions: The A-PRF+ addition to the surgical protocols significantly enhanced the healing of the bone and when combined with biomaterials improved their integration and increased the implant insertion torque, improving the primary and secondary stability. It may be a viable alternative for patients that express their concern towards human- and animal-derived biomaterials. Full article

Background: Sinus-lift (SL) is a pre-prosthetic procedure with the objective of increasing bone height to achieve implant insertion primary stability in implant-supported prostheses. The biomechanical properties of SL augmentation materials are influenced by their origin, manufacture, bioactive substances addition, receiver, and surgical procedure. This systematic review provides insights into state-of-the-art SL biomaterials, focusing on autologous bone grafting as the gold standard. Methods: The study followed the PRISMA flow diagram, searching WoS (Web of Science), Embase, Cochrane, and PubMed databases using the search terms «sinus lift» OR «sinus augmentation» OR «bone graft» OR «bovine» OR «porcine» OR «autologous» OR «allogenic» OR «xenogeneic» OR «alloplastic» OR «hydroxyapatite» OR «β-tricalcium phosphate (β-TCP)» OR «equine» OR «PRF». Results: The highest bone gain was provided by Bioglass at 42%. Articles written between 2014 and 2024 in English or French, containing human studies and with full text available, were included. Participants were required to be in good general health, without acute, chronic, or congenital diseases, or substance abuse (drugs, alcohol, or nicotine). SL surgery was performed using the lateral approach, with no Schneiderian membrane perforation or postoperative complications. The network meta-analysis was conducted using the R statistical computing environment. To assess the inconsistency between direct and indirect evidence, we used a net heat plot. To evaluate heterogeneity across studies, we used the chi-squared-based Q-test and I² statistic. A significance level of 0.05 was applied throughout all analyses. Results: Allogeneic bovine bone and hydrox yapatite demonstrated the lowest resorption rates. Significant differences were found for residual graft and connective tissue between allogenous bovine bone (ABB) + AlB vs. β-TCP + PRF (p = 0.028); ABB + AlB vs. β-TCP (p = 0.034); ABB + AlB vs. BCP (p = 0.037). Meta-analysis showed that the overall heterogeneity was 51.8% (6.9–75%; p = 0.019), with significant heterogeneity within designs (p = 0.007) and no significant heterogeneity between designs (p = 0.39). AB had a better bone regeneration ratio compared to many of the other interventions, but only two passed the threshold of significance: A1B and B-TCP + AB. Conclusions: A grafting material’s superiority is determined by its new bone formation ratio, connective tissue integration, residual graft content, and bone resorptionratio. Although autologous bone grafting has exhibited superior bone regeneration compared to other biomaterials, it was not favored due to its unpredictable connective tissue concentration and bone resorption ratio. Additionally, autologous bone exhibited the fastest metabolic turnover among all grafting materials. Full article

Background/Objectives: The purpose of this study was to develop a digital workflow to incorporate the mucosal projection of the pathways of the greater palatal artery into a static surgical guide used for free gingival graft harvesting and connective-tissue grafting techniques. Methods: A cone-beam computed tomography file was uploaded and segmented using specific tools from digital design software. The artery pathways were identified and marked on cone-beam computed tomography. A standard tessellation file format was obtained and uploaded into three-dimensional mesh-processing software; this was merged into an intraoral scan file. New files were obtained and uploaded into three-dimensional modeling software. The final model with projections of the artery pathways was generated using specific tools. The digital model was uploaded into guided surgery planning software to design a digital surgical guide that could later be printed with the artery pathways marked on its surface. Results: The static surgical guide to the palatal mucosa could be used during a surgical approach for marking the safe-zone area against the artery pathways. Conclusions: The proposed technique is a viable method for visualization and marking the artery pathway projection on a static surgical guide when performing free gingival graft harvesting and connective-tissue grafting techniques. Full article

Background: Ensuring a minimum peri-implant keratinized mucosa width (PIKM-W) is critical for maintaining dental implant health, as inadequate PIKM-W is associated with increased risks of plaque accumulation, mucosal inflammation, and peri-implantitis. While epithelialized connective tissue grafts (ECTGs) are considered the gold standard for soft tissue augmentation, they often lead to significant patient morbidity. Xenogeneic dermal matrices (XDMs) offer a less invasive alternative, but are prone to shrinkage, particularly in the mandible. The aim of this study was to evaluate a new surgical method to overcome these limitations with the combination of a narrow band of ECTG (autogenous strip graft, ASG) and an XDM to augment the PIKM-W in the posterior mandible. Methods: Twelve patients with a PIKM-W of less than 2 mm in the mandible underwent peri-implant soft tissue augmentation using this combined approach. Changes in the PIKM-W were measured preoperatively; immediately postoperatively; and at 1, 3, 6, 9, and 12 months. Graft remodeling (shrinkage or contraction) and PIKM thickness (PIKM-T) were also evaluated over time. Results: Preoperatively, the mean PIKM-W was 0.39 ± 0.40 mm and the PIKM-T was 1.36 ± 0.43 mm. At 6 months, the mean PIKM-W was 4.93 ± 0.98 mm and the PIKM-T was 2.88 ± 0.80 mm, with shrinkage of 39.2 ± 14.1%. By 12 months, the mean PIKM-W stabilized at 4.58 ± 1.28 mm and the PIKM-T stabilized at 2.83 ± 0.65 mm, with shrinkage of 42.2% ± 16.8%. Conclusions: There were statistically significant differences in clinical parameters between the baseline and 6 and 12 months (p < 0.05). This technique demonstrated the potential for stable augmentation of PIKM-W and PIKM-T over time, with manageable shrinkage. However, further studies with larger sample sizes are needed to confirm its clinical efficacy as an alternative for mandibular keratinized mucosa augmentation around implants. Full article

The study aimed to evaluate changes in buccal gingival contour following implant surgery using the simultaneous roll technique on Seibert class I defects, as determined by 3D intraoral scan data. Three patients requiring implant placement were recruited, and implants were placed using the roll flap technique. Digital impressions of the surgical site were obtained with a 3D intraoral scanner before surgery, after suture removal, and 4 months postoperatively. The results showed an overall increase in buccal gingival contour, with a maintained increase in soft tissue contour after 4 months. The study concluded that 3D scanning is a suitable method for assessing small changes in gingival contour, making it ideal for evaluating these changes. The roll flap technique was also found to effectively enhance the buccal gingival contour and soft tissue appearance around the implant collar. Full article

Introduction: Ehlers–Danlos Syndromes (EDSs) are a heterogeneous group of monogenic connective tissue disorders (e.g., joint hypermobility and dislocation, skin hyperelasticity and fragility, chronic pain, delayed wound healing process,, etc.). The primary objective of this study was to present a specialized therapeutic wound management process for a burn-injured female patient diagnosed with EDS. Case Presentation: A 34-year-old female patient presented with extensive thermal burns (biofireplace explosion). The patient had a family history of diagnosed EDS. Additionally, the patient was in a poor mental condition and, since 2020, had been undergoing pharmacotherapy with antidepressant and anti-anxiety medication. This might be the first such clinical observation in the world, but a correlation has been observed between psychiatric medication use and EDS wound healing impairment. During the hospitalization process, the patient underwent a series of surgeries aimed at the fastest and most effective closure of wounds. The patient, after 182 days of hospitalization in our facility, was discharged home. Materials and Methods: During the patient’s hospital stay, the patient underwent multiple procedures involving debridement of necrotic tissues. Additionally, allogeneic acellular dermal matrix (ADM) grafting was performed on the wounds, and a procedure was conducted in which skin was grafted using the MEEK technique. The in vitro cultured skin cells, as the advanced therapy medicinal products (ATMPs), were used. During the patient’s stay in the hospital, images were taken using low-energy laser speckle contrast analysis (LASCA) to asses microperfusion or lack thereof. The measurements were taken at intervals of several days. Conclusions: The treatment of burn wounds in patients with EDS requires a long hospitalization period. It also may require a multi-stage approach utilizing innovative preparations (e.g., ADMs and ATMPs). The assessment of wound healing progress can be performed using advanced equipment, such as laser speckle contrast analysis (LASCA). Full article