Journal Club- March 2026
Immediate Loading of Four Guided Nonsplinted Implants Supporting a Maxillary Overdenture: A Prospective Clinical Trial. Salman A, Choi D, Chertok N, Davila C, Agusto M, Kordusky B, Schincaglia GP. Int J Oral Maxillofac Implants. 2026 Feb 3;41(1):140-150. doi: 10.11607/jomi.11265. PMID: 40245307.
Abutment-Free Tissue-Level Implants for Personalized Monolithic Zirconia Implant Crowns: A Retrospective Cohort Study. Ionescu A, Marin M, Bayrich N, Fennema P, Nicolescu MI, Jung RE, Dodi A. Int J Oral Maxillofac Implants. 2026 Feb 3;41(1):109-119. doi: 10.11607/jomi.11144. PMID: 40699608.
Effect of the Buccal Gap Width on Alveolar Process Reduction Following Immediate Implant Placement: A Retrospective CBCT Study. Araújo, M. G., D. R.Dias, P.Wang, and R. A.Levine. 2026. Clinical Oral Implants Research1–13. Doi: 10.1111/clr.70106.
Contour Augmentation Simultaneous to Immediate Implant Placement in Compromised Sockets: A Retrospective Study. Monje A, Osorio J, Garcia-Torres JA, Lozada J, Kan JY. Int J Periodontics Restorative Dent 2026. Doi: 10.11607/prd.8013.
Reconstructive Peri-Implantitis Surgery Using an Internally Beveled Vestibular Incision for Multilayer Wound Closure. Gülnergiz E, Abraha SM, Hürzeler M, Zuhr O. J Esthet Restor Dent. 2026 Feb 19. doi: 10.1111/jerd.70124. Epub ahead of print. PMID: 41714819.
Muscle Evicted Tunneling Approach (META) with Crossed Belt & Suspenders Sutures (CBS) for Mandibular Incisor Root Coverage: A Proof of Concept.Ronco V, Akhondi S, Rendon A. Int J Periodontics Restorative Dent. 2026 Feb 4;0(0):1-20. doi: 10.11607/prd.8025. Epub ahead of print. PMID: 41637148.
Comparison of Five Osteotomy Protocols on Implant Stability and Postoperative Anxiety: A Randomized Controlled Trial. Konuklu R, Küçükkurt S. Clin Implant Dent Relat Res. 2026 Feb;28(1):e70125. doi: 10.1111/cid.70125. PMID: 41664595.
Peri-Implant Reconstruction With Autogenous Bone and Electrolytic Therapy: A Randomized Controlled Clinical Trial. Puisys A, Akhondi S, Vindasiute-Narbute E, Zvirblis T, Gallucci GO, Pedrinaci I. Clin Implant Dent Relat Res. 2026 Apr;28(2):e70123. doi: 10.1111/cid.70123. PMID: 41788049.i
Comparing Small Buccal Dehiscence Defects Treated With or Without Guided Bone Regeneration: A Subanalysis of an RCT. Zuercher AN, Mühlemann S, Ruales-Carrera E, Hjerppe J, Jung RE, Thoma DS. Int J Periodontics Restorative Dent. 2025 Nov 7;45(6):772-783. doi: 10.11607/prd.7138. PMID: 39453621.
To Remove or Not Remove Non-Conventional Dental Implants? Eleven-Year Retrospective Study on Implant Outcomes. Manor Y, Joachim MV, Oz I, Braun RA, Ronen G, Ben-Izhack G. Clin Implant Dent Relat Res. 2026 Feb;28(1):e70112. doi: 10.1111/cid.70112. PMID: 41540600; PMCID: PMC12808859.
Effect of Early Radiographic Bone Loss Before Loading on Implant-Related Outcomes: A Long-Term Retrospective Study. Moser, D., E. Ozgur, J. Tjokro, et al. 2026. Clinical Oral Implants Research 1–10. Doi: 10.1111/clr.70112.
Peri-implant Buccal and Lingual Keratinized Mucosa Augmentation Following Bone Reconstruction. Urban, I. A., Akhondi, S., Mancini, L., & Tavelli, L. (2026). Int J Periodontics Restorative Dent. 2026 Feb 4;0(0):1-21. doi: 10.11607/prd.7906. Epub ahead of print. PMID: 41637149.
Impact of the Buccal Dehiscence Morphotype on the Regenerative Strategy in Immediate Implant Placement. Jan C, Thomas B. J Esthet Restor Dent. 2026 Jan 23. doi: 10.1111/jerd.70115. Epub ahead of print. PMID: 41578628.
Safety and Feasibility of Extended Platelet-Rich Fibrin as a Solo Barrier Membrane for Ridge Preservation: A Case Series. Estrin NE, Tran TB, Espinoza AR, Ahmad P, Farshidfar N, Holmes R, Zhang Y, Miron RJ. Clin Exp Dent Res. 2026 Feb;12(1):e70282. doi: 10.1002/cre2.70282. PMID: 41510683; PMCID: PMC12784283.
Prosthetic factors influencing the prevalence of peri-implant diseases and marginal bone loss in static computer-assisted implant sites: A cross-sectional study. Sirirattanagool P, Asavanamuang P, Jain S, et al. J Periodontol. 2026;97:47–61. Doi: 10.1002/jper.11387.
When Is a Discrepancy in Crestal Bone Height Level for Adjacent Dental Implants Significant? A Retrospective Study with a Minimum Follow-up of 1 Year. Kasabreh NS, Malaikah S, Khurshid H, Khan MQ, Wang HL. Int J Oral Maxillofac Implants. 2026 Feb 3;41(1):61-68. doi: 10.11607/jomi.11208. PMID: 40699609.
Twenty-four month clinical outcomes of modified coronally advanced tunnel technique with leukocyte- and platelet-rich fibrin–functionalized porcine dermal matrix for single/multiple gingival recessions. Würflein E, Herrman K, Sculean A, et al. J Periodontol. 2026 Feb 26. doi: 10.1002/jper.70093. Epub ahead of print. PMID: 41744043.
Effect of Connective Tissue Graft as an Adjunct to Guided Bone Regeneration in the Surgical Treatment of Peri-Implantitis: A Dual-Center Randomized Controlled Trial. Holtzman, L. P., Milinkovic, I., Vuckovic, M., Malpassi, C., Cuppini, M., Solderer, A., Aleksic, Z., & Cordaro, L. (2026). Clin Oral Implants Res. 2026 Jan 31. doi: 10.1111/clr.70093. Epub ahead of print. PMID: 41618697.
Abstracts
Topic: Maxillary overdenture
Authors: Salman, A., Choi, D., Chertok, N., Davila, C., Agusto, M., Kordusky, B., & Schincaglia, G. P.
Source: (2026).
Title: Immediate Loading of Four Guided Nonsplinted Implants Supporting a Maxillary Overdenture: A Prospective Clinical Trial
DOI: 10.11607/jomi.11265
Type: Prospective
Keywords: overdenture, non-splinted, survival, Straumann, Roxolid BLX, Novaloc attachment
Purpose: To evaluate implants placed and immediately loaded for maxillary overdentures.
Material and methods: A total of 17 patients with edentulous maxillary arch were recruited for the study. Maxillary dentures of the patients were scanned with fiduciary markers radiographically. Gathered data was utilized to plan and design surgical guide for placing 3.75mm Straumann BLX implants with Novaloc abutments. Novaloc abutments allow angle (15°) correction. A total of 4 implants were placed per patient on the maxillary arch. Posterior implants were tilted to increase AP spread and to avoid maxillary sinus. If the insertion torque was less than 20Ncm, the patients were dropped from the study and were not immediately loaded. Implant stability quotient (ISQ) were read for each implants placed. Novaloc abutment was placed and torqued to 15Ncm. The abutments were picked up with the denture using resin. Occlusions were adjusted as needed. Post-op instructions included keeping the denture in place during the first week and being on soft food diet for two weeks. The patient was seen at 1, 2, 4, 12, 26, 52 weeks post-op for clinical and radiographic evaluations. CBCT scan was taken at the end of surgery to evaluate accuracy of the implant’s placement. PA’s were taken at the 6 and 12 month follow up to evaluate radiographic bone level change (RBLC). Statistical analysis was performed.
Results: Due to low insertion torque and complication with the denture, 3 patients dropped out from the study. Total of 14 patients remained in the study. 56 implants were placed and immediately loaded for maxillary overdenture. Two patients experienced single implant (per patient) failures at the 3 month follow up; implant survival rate was 96.4% at 12 month mark. The failed implants had adequate insertion torque (40 and 20) and ISQ values (70 and 65). In terms of RBLC, 74.1% of the implants were less than 0.5mm, 14.8% were between 0.5-1.0mm, 7.4% were between 1-1.5mm, and 3.7% were greater than 1.5mm. The implants that had RBLC value greater than 1.5mm were diagnosed with peri-implantitis at the 12 month mark. In terms of insertion torque, greater than 90% of the implants had an torque value greater or equal to 30Ncm. In terms of implant placement accuracy, the offset at the coronal and apical points were 0.852mm (range of 0.19-2.32mm) and 1.073mm (range of 0.266 -2.65mm) respectively.
Conclusions: Within the limitation of the study, immediately loaded non-splinted implants for maxillary overdentures appears to be a predictable treatment options for maxillary arch.
Topic: Implant-Abutment free
Authors: Ionescu, A., Marin, M., Bayrich, N., Fennema, P., Nicolescu, M. I., Jung, R. E., & Dodi, A
Title: Abutment-Free Tissue-Level Implants for Personalized Monolithic Zirconia Implant Crowns: A Retrospective Cohort Study.
Source: The International journal of oral & maxillofacial implants, 41(1), 109–119.
DOI: 10.11607/jomi.11144.
Type: Retrospective
Keywords: tissue level implant, abutment, abutment free, zirconia, Ti-Base
Purpose: To compare peri-implant bone levels between abutment free tissue level implants and tissue level implants with Ti-base abutment.
Material and methods: For the retrospective study, 53 consecutive patients who received at least one single implant were analyzed. The test group included 50 sites of abutment free tissue level implant (Matrix line, TRI Dental Implants); 3.7 or 4.5mm platform implants. The control group included 50 sites of conventional tissue level implants (Matrix line, TRI Dental Implants); 4.8mm platform implants. These implants were placed in varying scenarios. In the case of hopeless teeth needing to be replaced, the implant was either placed immediately or in staged approached. In the case of edentulous site, the implants were either placed guided(flapless) or placed with flap raised. The implants were loaded after 3 month if they were placed in edentulous site or in a site that had extraction and ridge preservation performed. The implants were loaded after 6 months in cases of immediate implant placement. For restoration, only single crowns were used for each implant. CBCT was utilized to evaluate bone resorption at 1 year post prosthetic loading. Statistical analysis was performed.
Results: The average follow-up period was 12 months after loading. No complications were reported for either group. At the 1-year follow-up, test group had 0.13mm of buccal bone loss compared to the test group’s loss of 0.34mm. Test group had 0.21mm lingual bone loss compared to control group’s loss of 0.65mm. In terms of ridge width reduction, the test group had 0.02mm reduction compared to 0.36mm reduction in the control group. Statistical significance in terms of difference in values was only achieved for lingual and ridge width reduction.
Conclusions: Within the limitation of the study, abutment free implant appears to preserve surrounding bone thickness better than conventional Ti-base abutment implants.
Topic: Buccal gap width on immediate implants
Authors: Araújo MG., Dias DR., Wang P., Levine RA.
Title: Effect of the Buccal Gap Width on Alveolar Process Reduction Following Immediate Implant Placement: A Retrospective CBCT Study
Source: Clinical Oral Implants Research, 2026; 0:1–13
DOI: 10.1111/clr.70106
Type: Retrospective study
Keywords: bone regeneration, cone-beam computerized tomography, single central maxillary incisor, tooth extraction
Purpose: To evaluate the impact of buccal gap width on the preservation of alveolar process dimensions during immediate implant placement (IIP) with socket grafting. The hypothesis was that the wider the gap, the more the space for bone particulate to maintain ridge dimension.
Material and methods: The study retrospectively reports 28 patients treated in an private office for a single failing maxillary central incisor. All procedures were performed by routine clinical care. All sites had an intact buccal socket wall after tooth extraction and IIP. All contralateral teeth were intact with a native pristine tooth for contralateral comparison. Complete photographic documentation and 2 -year CBCT post-op was performed for each site. All adjacent sites were also intact and contained pristine native teeth. All implant sites were prepared through a surgical guide and final implant position was 3-mm apical to the future mucosal margin. A healing abutment was connected and xenograft (Bio-Oss) was packed firmly into the buccal gap. For patients with gingival thickness < 1 mm, a connective tissue graft (CTG) was also applied within the buccal soft tissues. Standard post-op procedures were followed. Following a 3-month healing period, a provisional was connected and a final crown was placed 2-3 months later. A final CBCT scan was acquired after a mean of 6 years. Patients were categorized into 2 groups for analysis: wide gap group ( > 2 mm gap between implant and buccal wall at time of implant placement) and narrow gap group (≤ 2 mm gap). Cross-sectional measurements were made at the central sagittal position of the tooth and implant sites: height of the alveolar ridge at the buccal and palatal aspects, width of the alveolar ridge, thickness of the buccal bone, width of the basal bone, dimensional changes were compared to the contralateral site, with changes expressed as percentages. The primary outcomes of interest was the total reduction in cross-sectional area of the alveolar process. Secondary outcomes included changes in the cross-sectional area of the basal bone and linear changes in the height and width of the alveolar process, thickness of the buccal bone, and width of the basal bone.
Results: A total of 14 sites presents with a wide gap (> 2 mm) and 14 presented with a narrow gap (≤ 2 mm). The implants were in function for a mean of 6 years. A total of 64.3% of the wide gap group and 57.1% of the narrow gap group received a CTG following IIP. Cross sectional area between wide and narrow groups were significantly different, measuring 75.7 mm2 and 47.2 mm2, respectively. Reduction in alveolar process area was significantly higher in the narrow than wide group. Reductions were 41.1% for narrow and 8.5% for wide. Reduction decreased gradually from the coronal to the middle and apical thirds. Linear width was significantly reduced 1 mm below the ridge at both wide and narrow groups, by 48.4% and 71.2%, respectively. At 3 mm below the ridge, the linear reduction was only 7.4% for the wide group but 52.9% for the narrow group. At 5 mm below the ridge, reductions were 1.2% and 42.8% for wide and narrow, respectively. No significant differences in ridge height or palatal bone wall were found between groups. Width of basal bone was significantly lower for narrow gap (-13.5%) versus wide gap (+7%). Thickness of the buccal bone at wide gap was 2.1 mm and 0.5 mm at narrow gap. Subgroup analysis for use of CTG, implant design, and time in function showed no significant effect on alveolar process reduction.
Conclusion: Grafting a buccal gap wider than 2 mm following IIP may promote 90% preservation of ridge dimensions. A greater reduction in the alveolar process area was found with a narrow buccal gap vs wide buccal gap, with reductions of 41.1% vs 8.5%. Linear reductions were also significantly reduced with wide buccal gap, with only 7.4% and 1.2% reduction at 3- and 5-mm versus 52.9% and 42.8% reduction at 3- and 5-mm for the narrow gap group. A wide buccal gap may be crucial in maintaining robust ridge dimensions around dental implants.
Topic: Immediate implant placement with contour augmentation
Authors: Monje A., Osorio J., Garcia-Torres JA., Lozada J., Kan JY.
Title: Contour Augmentation Simultaneous to Immediate Implant Placement in Compromised Sockets: A Retrospective Study
Source: Int J Periodontics Restorative Dent 2026
DOI: 10.11607/prd.8013
Type: Retrospective study
Keywords: Immediate implant placement, dental implants, dental implantation, bone regeneration, guided bone regeneration, bone regeneration.
Purpose: To evaluate peri-implant tissue stability, prevalence of peri-implant disease, and patient reported outcome measures (PROMs) in patients receiving immediate implant placement (IIP) with simultaneous guided bone regeneration (GBR), with or without a simultaneous connective tissue graft (CTG).
Material and methods: A retrospective chart review was conducted to highlight subjects with hopeless teeth in the esthetic zone up until October 2025. Only sites with thin buccal bone which received guided bone regeneration simultaneous to implant insertion were included. Sockets were classified according to U-shape (extending interproximally) dehiscence, UU-shape dehiscence (severe interproximal loss), and fenestrations (with an intact coronal wall). Clinical measurements recorded at follow-ups included pocket depth (PD), bleeding on probing (BOP), mucosal recession (MR), keratinized mucosa (KM), and suppuration (SUP). Peri-implant disease status was classified. Crestal bone level (CBL), buccal bone thickness (BBT), palatal bone thickness (PBT) were measured radiographically. PROMs were examined by a 17-item questionnaire related to changes in quality in life. For the surgical procedure, teeth were removed with minimal trauma. One or two vertical incisions were used to raise a fill thickness flap. Implants were placed 4-6 mm from the palatal margin and healing or definitive abutments were connected. Autogenous bone chips were harvested and grafted directly on the implant surface. A resorbable xenograft (InterOss SigmaGraft) was applied over the autogenous bone and stabilized with a cross-linked collagen membrane (Ossix). Membranes were secured with periosteal sutures. A connective tissue graft was also placed over the membrane in cases of thin gingival phenotype. Primary closure was achieved and standard post-operative care was followed (amoxicillin 750 mg TID / 7days, Ibuprofen 600 mg q5-6h / 5 days. Sutures were removed after 2-3 weeks. Final abutments were torqued to 20 Ncm after two months.
Results: A total of 28 records (49 implants) met the inclusion criteria. Thin gingival phenotype was found in 8 patients, while 20 presented with thick gingival phenotype. Implant distribution was 24 maxillary incisors, 7 mandibular incisors, 4 maxillary canines, 12 maxillary premolars, and 2 mandibular premolars. Mean follow-up after prosthetic delivery was 22 months. A total of 26 sites exhibited a thin buccal wall (<1 mm), 9 presented with U-shaped dehiscences, 9 with UU-shaped dehiscences, 3 fenestrations, 1 V-shaped dehiscence, and 1 combined UU-shaped dehiscence with fenestration. No cases of peri-implantitis were detected, but 3 implants (6.1%) were diagnosed with peri-implant mucositis, and 93.9% of implants maintained peri-implant health. Mean crestal bone level was -0.08 mm, with 85.7% of implants exhibiting crestal levels coronal to the implant shoulder. A progressive increase in both buccal and palatal bone thickness toward the apical levels was detected. Mean BBT and PBT at the implant shoulder were 1.85 mm and 1.45 mm, respectively. Complete loss of buccal bone up to 5 mm was found in one mandibular incisor and total loss of palatal bone up to 5 mm was found in one maxillary incisor implant. Facial bone coronal to the implant shoulder was found in 91.8% of cases with a mean height of 1.46 mm. Patients reported high satisfaction levels with score of 4 and 5 (agree and strongly agree) regarding improved function, esthetics, self-confidence, and ease of cleaning. An overall improved quality of life was found.
Conclusion: Contour grafting with or without a connective tissue graft performed simultaneously to IIP was found to result in favorable clinical, radiographic, and PROMs. The approach demonstrated a high level of peri-implant health and stable CBL.
Topic: Incision Technique
Author: Gülnergiz E, Abraha SM, Hürzeler M, Zuhr O.
Title: Reconstructive Peri-Implantitis Surgery Using an Internally Beveled Vestibular Incision for Multilayer Wound Closure.
Source: J Esthet Restor Dent.
DOI: 10.1111/jerd.70124.
Type: Clinical Study
Keywords: vestibular incision, peri-implantitis, regeneration, primary healing
Purpose: The purpose of this study is to introduce the use of an internally beveled vestibular incision to allow for improved wound stability and primary healing.
Materials and Methods: Patients were treated with non-surgical debridement along with doxycycline into the peri-implant defect two weeks prior to the surgical procedure.
Initial incisions made were sulcular incisions around the implants needing treatment. At a level 3-4mm apical to the existing boney defect, an internally beveled horizontal incision was made within the buccal alveolar mucosa.
Full thickness flap was reflected and connected to area tunneled from the crestal portion. Granulation tissue was removed and implant was decontaminated. Autogenous bone was harvest as a block from the tuberosity and reshaped. Bone particulate packed and the boney plate was placed and stabilized over top with a fixation screw. A connective tissue graft was then harvested from the tuberosity and placed over the top of the bone graft. Wound closure was achieved in four steps via horizontal mattress sutures: first through the periosteal, then deep submucosal/muscular, and finally the superficial subepithelial connective tissue layers. Primary closure was obtained a continuous suture, which was then removed 1 week post-surgery. At 12 months post-surgery, radiographic bone fill and disease resolution were observed.
Discussion: Purpose of internally beveled incision allows for maintenance of primary closure via closure in layers, as well as leaving the papilla area undisturbed. This incision also allows for the maintenance of additional tissue that can be incorporated into the coronal flap.
Topic: Root Coverage
Author: Ronco V, Akhondi S, Rendon A.
Title: Muscle Evicted Tunneling Approach (META) with Crossed Belt & Suspenders Sutures (CBS) for Mandibular Incisor Root Coverage: A Proof of Concept.
Source: Int J Periodontics Restorative Dent. 2026 Feb 4;0(0):1-20.
DOI: 10.11607/prd.8025.
Type: Case Report
Keywords: recession, RT2, muscle apicalization, coronal advancement, root coverage
Purpose: The purpose of this article is to introduce the muscle evicted tunneling approach (META) with the crossed belts &suspenders (CBS) approach in suturing. The META involved splitting the combination of splitting the mucosa and a myotomy with blunt instrumentation and apically positioning the muscle. The CBS approach allows for both lateral and coronal movement of the flap over recessions. The combination of approaches can be used to treat a variety of clinical scenarios such as single, wide, deep recession, with high muscle pull, shallow vestibule and minimal keratinized tissue.
Materials and Methods: This case included a 32 year old female with a singular recession at site #24. The recession presented at 3mm wide, 6mm deep, 2mm probing depth, shallow vestibule, and no attached keratinized tissue. Classification of the defect was Cairo RT2.
META was completed from #23 to 26, beginning with a 5mm vertical incision between #26 and 27, followed by partial thickness tunneling conducted supra-muscularly. In a deeper plane, the myotomy and apical positioning of the muscle was completed with the use a the tunneling knife placed within the supra-muscular tunnel and positioned perpendicularly to detach and apically displace the muscle 10mm. Partial thickness tunneling was then completely coronally, from both the vertical incision and sulcus of the recession, with full thickness in areas of thin tissue and at the papillae.
A connective tissue graft (CTG) from harvested from the palate after intraoral de-epithelialization and tunneled via the recession site. Sutures were used to position and stabilize the graft in a Suspender suture fashion at both ends of the (CTG) with one additional suture between #25 and #26.
CBS completed to allow for lateral and apical closure. Suture inserted at midfacial location of recession 2mm from the gingival margin without engaging the CTG and exited from same level on opposite side of the recession. The suture was then crossed over the buccal, overtop the contact, and looped under the contact from lingual to buccal. The suture is then crossed over the buccal and threaded under the contralateral contact and over the contact and finally tied. The final knot is placed over top of the crown. Additional suspender sutures are then added engaging both the flap and CTG to allow for coronal displacement.
Results: No complications were noted during healing, and sutures were moved on day 10. Follow-up was recorded at 6months and 1 year post-surgery with maintenance of complete root coverage, increase in attached mucosa, and preservation of vestibular depth.
Conclusion: The protocol of combining META with CBS allows for treatment of deep recessions in the anterior mandible.
Topic: Implant Stability
Author: Konuklu, et al.
Title: Comparison of Five Osteotomy Protocols on Implant Stability and Postoperative Anxiety: A Randomized Controlled Trial.
Source: Clin Implant Dent Relat Res. 2026 Feb;28(1):e70125
DOI: 10.1111/cid.70125
Type: RCT
Keywords: bone condensation, dental implants, drilling speed, immediate postoperative anxiety, insertion torque, osseodensification, osteotomy techniques, resonance frequency analysis
Purpose: To compare five different osteotomy techniques when preparing a site for an implant and how these techniques have an effect on implant stability as measured by insertions torque (IT) and the early implant stability quotient (ISQ).
Materials and Methods: One hundred patients (20 per protocol) were included in the study and were randomly assigned to one of the five various osteotomy protocols which includes a drilling speed of 800rpm (high-speed), 300rpm (moderate-speed), 50rpm (ultra-low speed), bone condensation (counter-clockwise 50rpm), and osseodensification (DENSAH at 1200rpm counter-clockwise).
Initial stability was recorded by gathering the data for insertion torque at time of placement. ISQ was then used at four time points including immediate, 1 week, 1 month, 2 months, and 3 months after the procedure. Patient VAS was also used to assess patient-reported anxiety.
All cases were completed using a tapered, rough-surfaced Ti implant (Implance, AGS Medikal).
In cases where IT was < 25Ncm the implant was submerged and the implant was not included in the analysis longitudinally (4 implants fell into this category) by a single provider. Implants were placed 1mm subcrestal via a freehand approach.
Results: For all implants included in the longitudinal analysis the IT was 30+ Ncm and ISQ > 80. The group that showed the greatest consistency in ISQ over time was the 300rpm (moderate-speed) drilling group. This group also had the greatest ISQ overall at 3 months. For greatest initial IT the 800rpm (high-speed) drilling group was superior, especially in cases of high-density bone. When looking at the osseodensification group there was ISQ gains during healing. The condensation group showed a decrease in ISQ values over time from 1 month to 2 months post-operatively.
A no correlation was found between IT and 3 month ISQ, and a weak-moderate positive correlation was found between IT and baseline ISQ. The patient VAS showed that all patients were less anxious after the procedure was completed. Highest residual anxiety was shown in the osseodensification group.
Conclusions: When comparing the various drilling protocols the 300rpm (moderate-speed) group showed the most consistent stability and highest ISQ over the 3-month follow-up period. The 800rpm (high-speed) group showed the highest IT values.
Topic: Peri-implantitis Treatment
Author: Puisys, et al.
Title: Peri-Implant Reconstruction With Autogenous Bone and Electrolytic Therapy: A Randomized Controlled Clinical Trial.
Source: Clin Implant Dent Relat Res. 2026 Apr;28(2):e70123
DOI: 10.1111/cid.70123
Type: RCT
Keywords: bone grafts, bone regeneration, dental implants, electrolysis, osseointegration, peri-implantitis, randomized controlled trials
Purpose: To assess if using adjunctive electrolytic therapy with autogenous tuberosity bone grafts to treat peri-implant defects via reconstructive therapy.
Materials and Methods: In the study 31 patients were included and randomly assigned to either the control group who received mechanical debridement and bone grafting or the test group who received mechanical debridement, electrolytic cleaning, and bone grafting to reconstructively treat peri-implantitis defects.
Both groups had granulation tissue removed with hand curettes, erythritol air-powder (Perioflow), thorough rinsing with CHX 0.12%/ metronidazole/ and saline solution. Grafting was then completed with bone harvested from the maxillary tuberosity and covered with resorbable collagen membrane + membrane pin stabilization. Periosteal release was performed and suturing with primary closure was achieved. After 6 months a second stage surgery was completed.
In the test group prior to bone grafting the electrolytic cleaning was completed via a 15 VDC at a current of up to 0.6 A applied at a rate of 100mL/min for 2 minutes to the sodium formate and hydroxycarboxylic acid solution that was applied via sponge-applicator to implant surface. This GalvoSurge system is designed to generate reactive oxygen species and hydrogen gas resulting in biofilm detachment.
Assessment was completed via radiographic assessment at baseline and 1 year post-op, as well as clinical parameters including BOP, GI, and PPD at mesial, buccal, distal, and lingual sites.
Results: Overall, both the control and test group statistically significantly improved BOP and GI along with PPD reduction with no significant differences between them. BOP had a mean reduction of 0.6 in control group and complete reduction in test group. Gingival index reduced by 1.8 in control and 1.6 in test group. PPD reduction of 4.5mm, 3.6mm, 4.3mm, and 2.7mm were found in the M,B,D,L sites in control and 3.7mm, 4.3mm, 3.5mm, and 3.2mm in the M,B,D,L sites in test group. Both groups successfully resolved suppuration at all implants.
When comparing the two groups clinically there was no significant difference in bone defect fill with an average mean bone gain 4mm in control vs. 4.3mm in test group at the mesial site (no significance), 3.8mm vs. 4.7mm at distal site (no significance), 3.6mm vs. 4.1mm at the buccal site (no significance), and 3.6mm vs. 4.4mm at the lingual site (no significance).
When comparing the two groups radiographically there was a greater mean bone defect fill in the test group at the mesial site (4.6mm vs. 2.5mm). No statistical differences were found in distal site (3.5mm vs. 4.3mm).
Conclusions: When completing regenerative peri-implantitis therapy using mechanical debridement and bone graft vs. mechanical debridement, electrolytic therapy, and bone graft showed no significant differences. Both treatment options had a statistically significant radiographic and clinical improvement.
Topic: Implant Dehiscense
Authors: Zuercher A. et al.
Title: Comparing Small Buccal Dehiscence Defects Treated With or Without Guided Bone Regeneration: A Subanalysis of an RCT.
Source: Int J Periodontics Restorative Dent. 2025 Nov 7;45(6):772-783.
DOI: 10.11607/prd.7138
Type: RCT
Keywords: buccal bone dehiscence, dental implant, guided bone regeneration, spontaneous healing.
Purpose: To compare outcomes for single posterior implants in intact bone versus small defects (≤5 mm), evaluating the impact of GBR.
Materials and Methods: This sub-analysis of a parallel-group RCT included periodontally healthy patients with a single missing posterior tooth. Implants were placed using a delayed or late approach.
Based on post-placement assessment, sites with a buccal dehiscence ≤5 mm were assigned to Spontaneous Healing (SH) or GBR groups. Sites without dehiscence (n=8) formed the Native Bone (NB) group.
In the GBR group, defects were filled with DBBM to a 3.0 mm horizontal thickness at the implant shoulder, covered with a collagen membrane, and secured with resorbable pins. SH and NB groups received no additional treatment.
Healing abutments facilitated transmucosal healing. Postoperative care included antibiotics, chlorhexidine, and analgesics. Zirconia crowns (TiBase or custom abutments) were delivered at least 8 weeks post-impression.
At 1-year follow-up, clinical parameters (BOP, PD, KMW) and scans were recorded. Digital impressions were superimposed onto DICOM files. Using a cross-section perpendicular to the implant center, horizontal soft tissue thickness (STT) was measured 1, 2, and 3 mm apical to the gingival margin, and horizontal bone thickness (BTT) was measured at the implant shoulder and 1, 2, and 3 mm apical to it.
Results: Of 59 patients, 24 were analyzed (GBR: n=8; SH: n=8; NB: n=8).
At 1-year, median STT changes at the implant shoulder were +0.15 mm (GBR), +0.03 mm (SH), and +0.13 mm (NB). Mean BTT changes at 1 mm were -0.25 mm (GBR), -0.04 mm (SH), and -0.11 mm (NB), with final 1-year thicknesses of 2.87 mm, 2.25 mm, and 3.25 mm, respectively. Median buccal contour changes were -0.26 mm (GBR), +0.03 mm (SH), and -0.06 mm (NB).
Clinical parameters showed increased BOP% and PD in all groups. KMW increased in the GBR group but decreased in the SH and NB groups.
Discussion: Findings suggest SH exhibited greater buccal contour stability than GBR during the first year, with similar clinical outcomes at follow-up. While treating small dehiscences can prevent vertical bone loss, recession, and biological complications, untreated sites showed superior contour stability.
Peri-implant soft tissues may compensate for the absence of bone augmentation, leading to fewer contour changes compared to sites treated with bone substitutes. This underscores the critical role of soft tissue in maintaining peri-implant health. Additionally, using connective tissue grafts for posterior dehiscences yields volumetric and clinical results comparable to GBR.
Conclusions: After 1 year, implants with a small dehiscence (≤5mm) showed comparable clinical and radiographic results, regardless of whether GBR was performed.
Topic: Implant removal
Authors: Manor Y, et al.
Title: To Remove or Not Remove Non- Conventional Dental Implants? Eleven- Year Retrospective Study on Implant Outcomes
Source: Clinical Implant Dentistry and Related Research, 2026; 28:e70112
DOI: 10.1111/cid.70112
Type: Retrospective study
Keywords: blade implant, dental implant removal, pterygoid implant, root form implant, subperiosteal implant, techniques for implant removal, zygomatic implant
Purpose: This study examines complex dental implant removals, analyzing techniques, design-specific challenges, and the feasibility of reimplantation through case series.
Background:
Factors Affecting the Complexity of Dental Implant Removal
Removal complexity depends on implant design, location near vital structures, and the extent of osseointegration versus bone loss. Broken subperiosteal or blade implants are particularly difficult to remove and cause significant tissue defects.
Techniques for Dental Implant Removal
Bone removal via burs or piezosurgery is used when anti-torque fails. Sectional removal divides fractured or integrated implants to minimize bone damage, while guided removal uses surgical guides for precision and reduced trauma.
Management Strategies Following Implant Removal
Site preservation and tissue regeneration maintain bone and aesthetics for future placement. Comprehensive planning (evaluating bone quality and stability) is essential to minimize removal and complications
Stages of Treatment
Preoperative Evaluation: Assess medical history, implant stability, and infection signs. Use radiographs and CBCT to map anatomical relationships.
Anesthesia: Use local anesthesia, IV sedation, or general anesthesia based on case complexity and patient anxiety.
Clinical Procedure: precise execution to protect vital structures and minimize bone trauma.
Socket Management: Debride the site and perform bone or soft tissue grafting to support healing and future placement.
Postoperative Care: to provide pain management and hygiene protocols, with follow-up to monitor healing and plan future treatment.
Materials and Methods: The study included patients requiring removal of non-conventional implants due to complications. Non-conventional designs include blade, subperiosteal, zygomatic, pterygoid, and hollow/non-cylindrical implants
Results: 264 patients and 503 implants revealed that non-conventional types (subperiosteal, blade, and fractured root-form) are the most difficult to extract, resulting in longer procedures due to extensive tissue damage. These complex cases frequently require multidisciplinary consultations to manage bone grafting and evaluate potential reimplantation.
Blade Implant Removal through crestal approach is typically used to expose the implant, which is then detached from the bone using burs and piezosurgery before closing the soft tissue.
Zygomatic Implant Removal is a complex process requiring precise techniques, such as crestal or lateral window approaches. Because these implants rely on mechanical contact rather than osseointegration, they are loosened using controlled force to protect surrounding bone and vital structures. Often, these removals are caused by excessive mechanical stress or infection due to a lack of anterior support, which could be mitigated by adding additional implants to the prosthesis. Careful surgical planning and the preservation of adjacent vital structures are essential for the safe removal of these implants, which ultimately helps facilitate future rehabilitation and treatment options for the patient.
Conventional Implant Removal, due to fracture or infection, the surrounding anatomical structures are often compromised, making immediate bone grafting unfeasible. Additionally, removing implants located near the mental nerve carries a significant risk of nerve damage. Following the removal, it is essential to evaluate the patient for both hard and soft tissue loss to plan for future reconstruction.
Pterygoid Implant (zygomaticomaxillary) removal; these implants are used for severe maxillary bone loss, but may require removal due to failure or infection. Because they are located in a high-risk area, surgical removal via a transmucosal or intraoral approach carries significant risks, including excessive bleeding, nerve damage, or implant dislocation. The use of ultrasonic instruments to loosen the implant while avoiding heavy torque to avoid excessive stress in the area and reduce the potential trauma. Due to these complexities, removal is only recommended when alternatives like partial removal or monitoring the implant, are no longer viable.
Removal of Endosseous Screw- Type/ Root- Form Implants, they may need removal due to failure, infection, or discomfort. The process requires precise planning to preserve surrounding structures. If the implant is loose or has significant bone loss, a crestal approach using reversed torque is typically sufficient. For cases when reverse torque does not work, flap approach with trephines or ultrasonic instruments is used to minimize trauma. Bone grafting is often necessary afterward to repair the site.
Removal of Subperiosteal Implants, historically used for patients with low bone density, require removal due to complications like infection or prosthetic failure, necessitating careful surgical dissection and framework sectioning for easier removal. The procedure often results in soft tissue inflammation, requiring staged bone grafting and soft tissue grafting to prepare the site for future implant placement.
Conclusions: Clinicians can optimize care by understanding removal reasons, using proper techniques, and planning thoroughly. Prioritizing smart implant selection and long-term follow-up further reduces the need for complex removals.
Topic: early radiographic bone loss Authors: Moser, D. E., et. al. Title: Effect of Early Radiographic Bone Loss Before Loading on Implant-Related Outcomes: A Long-Term Retrospective Study
Source: Clinical Oral Implants Research 1–10.
DOI: 10.1111/clr.70112.
Type: Retrospective study
Keywords: Dental implants, radiographic bone loss, implant loading, peri-implantitis
Purpose: to evaluate the association between early radiographic bone loss (ERBL) and progressive bone loss, implant survival, and peri-implant disease.
Materials and Methods: Patients that had received dental implants between January 2000 and 2020 were chosen. ERBL was diagnosed when there was apical displacement of interproximal bone level, exposing the implant rough surface prior to the final prosthesis insertion. Various data was collected and radiographs were used to assess the crestal bone levels (CBL). Implant survival was defined as implant presence during at least the 5-year follow-up period.
Results: 261 implants (221 patients) were selected, with 87 implants in the ERBL group and 174 in those without ERBL. The following characteristics were seen in the groups, respectively: 29.8% vs. 14% smokers, 5.3% vs. 2.3% diabetic, 1.8% vs. 7% with osteoporosis or osteopenia, 28.6% vs. 27.1% taking SSRIs, PPIs, and other medications, and 34.6% vs. 39.8% with a history of periodontitis.
A mean -1.6+/-1mm ERBL was noted, which progressed to -2.3+/-1.7mm at the final follow up at 8.8 years. In the no ERBL group, the baseline CBL was -0.4+/-1.2mm which progressed to -0.5+/-1.2mm at the 11.5y follow up. A significant difference was seen between the two groups in terms of bone loss.
A 67.8% implant survival was seen in the ERBL group vs. 98.3% in the group without. The prevalence of peri-implant health was 17.3% in the group with ERBL and 35.6% in the group without, while that of peri-implant mucositis was 19.5% and 59.2% and that of peri-implantitis was 63.2% and 5.2%, respectively.
69.7% of implants in the ERBL group and 82.8% in the group without had BOP, while suppuration had a prevalence of 15.2% vs. 1.7%, respectively.
ERBL is considered the strongest predictor of future crestal bone loss (+1.46mm). Smoking (+0.61mm), each additional implant (+0.17mm), single crown restorations (+0.66mm), and bone level implants (+0.44mm) were also significantly associated with future bone loss, while female gender was protective (-0.40mm).
Conclusion: ERBL, male sex, smoking, multiple implants, single crown restoration, and bone level implants are significantly associated with future bone loss around implants. ERBL is considered the strongest predictor and is also associated with greater long-term peri-implantitis and implant failure rates (Higher ERBL, leads to higher risk)
Topic: Peri-implant keratinized mucosa
Authors: Urban, I. A., et. al.
Title: Peri-implant Buccal and Lingual Keratinized Mucosa Augmentation Following Bone Reconstruction.
Source: The International journal of periodontics & restorative dentistry, 0(0), 1–21. Advance online publication
DOI: 10.11607/prd.7906
Type: Clinical study
Keywords: Dental implants, peri-implant keratinized mucosa, augmentation
Purpose: to present the strip gingival graft (SGG) technique’s four variations for augmenting peri-implant keratinized mucosa (KM) and mucosal thickness (MT) in the mandible.
Discussion:
Posterior mandible: double SGG at the buccal and occlusal segments
This technique is used to augment the lingual KM around posterior implants. Shaping a single SGG to adapt to the sharp orientation change between the buccal/Lingual/occlusal portions of the bone is challenging and impacts graft adaptation and stabilization. Additionally, using a single SGG does not guarantee that adequate KM will be obtained to later split into buccal and lingual portions. Either two SGGs can be harvested or a single smaller FGG can be used to obtain both. One is then stabilized on the occlusal/lingual and another on the buccal. 3 months after healing, a mid-crestral split thickness incision is made via the Lingually Sliding Flap (LSF), uncovering the implants and repositioning the KM between the buccal and lingual. This technique is ideal in the presence of minimal KM and high lingual floor of the mouth, or when simultaneous augmentation of the KM is required.
Posterior mandible: lingualized de-epithelialized bed together with a SGG
This technique is used when minimal KM is present on the buccal only. Soft tissue augmentation is done on the lingual, either with a single or double SGG (small FGG). A 3-4mm area, extending coronally from the MGJ on the lingual aspect is de-epithelialized with a diamond bur (de-epithelialized bed (LDB)), implants uncovered, healing abutments placed, and a 2-3mm SGG harvested and sutured, using the buccal unelevated KM to stabilize. This technique might not be ideal in cases of extremely shallow lingual vestibule or unfavorable lingual anatomy, especially around the second molar.
Anterior mandible: LDB together with an SGG
This technique is ideal when occlusal and buccal KM is present but lingual is missing. An LDB is prepared with a diamond bur, extending 3mm coronally from the lingual MGJ. The SGG is stabilized through the intact and unelevated occlusal KM. A mid-crestal incision will then split the KM into buccal and lingual portions at the second stage surgery.
Anterior mandible: Buccal and lingual de-epithelialized beds, together with a double SGG
This technique is used when a 2-3mm band of KM is present on the occlusal only, making it difficult to split into sufficient buccal and lingual portions. A few weeks after implant placement, both a buccal de-epithelialized bed (BDB) extending 3-4mm coronally from the MGJ, as well as an LDB extending 2-3mm coronally from the MGJ are prepared. 2 SGGs harvested and sutured on the buccal and lingual, using the intact occlusal KM for stabilization. 2-3 months later, a mid-crestal incision will split the KM and expose implants.
Conclusion: The four proposed variations of the SGG technique can be used to augment and create a thick 360-degree band of KM around mandibular implants, especially on the lingual aspect.
Topic: Immediate Implant Placement
Authors: Jan C, Thomas B
Title: Impact of the Buccal Dehiscence Morphotype on the Regenerative Strategy in Immediate Implant Placement
Source: J Esthet Restor Dent. 2026 Jan 23
DOI: 10.1111/jerd.70115
Type: Narrative Review and Clinical Framework Proposal
Keywords: Immediate implant placement, compromised socket, scarf connective tissue graft
Purpose: To propose a classification and treatment framework for compromised sockets within the context of immediate implant placement (IIP).
The Safe Zone, the Danger Zone, and the Failure Zone
The safe zone is delineated vertically by 4mm below the facial soft tissue margin and horizontally by a buccal bone gap greater than 2mm. This zone permits “perfect” prosthetically driven implant placement with the ability to achieve ideal esthetic outcomes.
The danger zone is delineated vertically by 2mm coronal to and horizontally by 1mm buccal to the safe zone. Implant placement here may result in absence of bone around the implant shoulder, resulting in an incomplete and thin buccal bone wall, thin soft tissues, and possibly esthetic consequences.
The failure zone is delineated coronally by an additional 2mm to the danger zone and by the facial soft tissue margin; it is delineated buccally by the buccal bone wall. Implant placement here will result in facial recession and esthetic failure.
The Trimodal Approach in Intact Sockets
Flapless surgery, which preserves blood supply of the buccal bone thereby prohibiting buccal bone loss, is strongly recommended. The buccal bone gap is grafted with particulate or moldable bone graft to the level of the bone crest (e.g. deproteinized bovine bone). A 1-1.5mm thick connective tissue graft (CTG), either with typical 6mm or 3mm (“scarf”) thickness, is also placed. The restoration should be screw-retained with the pontic following the Esthetic Biological Contour (EBC) concept: the Esthetic-zone, Bounded-zone, and Crestal-zone. The E-zone corresponds with the area in contact with the sulcular epithelium which is 0.5mm and convex. The B-zone corresponds with the area in contact with the junctional epithelium and is 1mm and concave. The C-zone corresponds with the abutment of the provisional being at least 2mm with narrow emergence profile.
Healing of a Socket with a Buccal Dehiscence: The trimodal approach is insufficient to treat these sockets.
The Vertical Extent of a Buccal Dehiscence: Considering Elian and Chu classifications, Type I-a, II-b, and II-c can be treated for IIP with regeneration methods, but Type III sockets should not, which require at least soft tissue augmentation including coronal flap advancement, resulting in poor esthetic outcomes.
The Lateral Extent of a Buccal Dehiscence: A new classification is proposed based on the regenerative potential of a buccal dehiscence. Defects with the highest regenerative potential is the defect contained to the facial portion (C). A buccal defect which affects the mesial or distal areas of a tooth are limited in regeneration to the interproximal aspect (PC, partially contained). Defects with reduced regeneration potential on both sides is the non-contained defect (NC), where both mesial and distal areas are affected. Complete interproximal bone loss has no regeneration potential; these defects pose high risks for esthetic failure. They are categorized as extended defects and should not be treated with an IIP.
Regeneration of Types II-a-C and II-b-C: Modifications to the Trimodal Approach include having a buccal bone gap of 2.5-3mm, moldable bone graft materials, and 2-2.5mm thick CTG for sealing the regeneration chamber.
Regeneration of Types II-b-PC and II-c-C: A four-pillar approach is recommended with the addition of a non-supportive barrier (e.g. collagen membrane) against the facial soft tissues without a lateral or apical pouch.
Regeneration of Types II-B-NC, II-c-PC, II-c-NC: A four-pillar approach is recommended with a supportive barrier (e.g. cortico-cancellous shell from the tuberosity or porcine-derived supportive barrier) placed over the bony edges, a composite graft (moldable bone graft material with autogenous one chips), and soft tissue augmentation.
Conclusion: A buccal dehiscence combined with facial recession and extended defects precludes IIP, and other morphotypes that account for mesial and distal bone loss should be considered in clinical decision-making processes.
Topic: extended-PRF in Ridge Preservation
Authors: Estrin NE, Tran TB, Espinoza AR, Ahmad P, Farshidfar N, Holmes R, Zhang Y, Miron RJ
Title: Safety and Feasibility of Extended Platelet-Rich Fibrin as a Solo Barrier Membrane for Ridge Preservation: A Case Series
Source: Clin Exp Dent Res. 2026 Feb;12(1):e70282
DOI: 10.1002/cre2.70282
Type: Case Series
Keywords: e-PRF, extended-PRF, albumin-PRF, ridge preservation, socket preservation
Purpose: To assess the safety and applicability of extended platelet-rich fibrin (e-PRF) in alveolar ridge preservation.
Introduction: PRF membranes have not been commonly adopted in ridge preservation due to their associated two-week resorption time. However, by heating the platelet concentrates, i.e. denaturing proteins in the platelet-poor plasma, albumin-rich layer, the resorption time of the PRF membrane is extended to at least four months.
Methods: 22 patients with 22 extraction sockets underwent flapless ridge preservation with sticky bone (FDBA BioOss for cortico-cancellous allograft) for the bone graft and e-PRF for the barrier membrane. e-PRF was made according to protocols by Fujioka-Kobayashi et al. (2021) and Gheno et al. (2021). Patients were prescribed amoxicillin 500mg T.I.D. for one week and ibuprofen 800mg T.I.D. as needed for pain. CBCT’s were obtained immediately at surgery (T0) and three months post-op (T1). Horizontal ridge dimensions were recorded at 1, 3, and 5mm apical to the crest and perpendicular to a vertical reference point. Buccal and lingual heights and baseline buccal bone thickness were also measured. CBCT measurements were performed by a single oral and maxillofacial radiologist. Uncontrolled diabetics and immunocompromised patients were excluded.
Results: Of the extractions, 41% were in the maxilla, and 59% were in the mandible. 73% were molars and 27% were premolars. 68% of sockets had 4 walls, whereas 32% had 3 walls with a buccal dehiscence. The mean change in ridge width at 1mm, 3mm, and 5mm apical to the crest was -1.3, -0.9, and -0.7mm, respectively. The mean change in buccal height and lingual height was -1.3 and -0.9mm, respectively. No post-op complications or signs of infection were recorded.
Conclusion: Extended-PRF membranes can be used successfully and safely during ridge preservation as an alternative to collagen and PTFE membranes.
Topic: Prosthetics factors and peri-implantitis
Author: Sirirattanagool P, Asavanamuang P, Jain S, et al.
Title: Prosthetic factors influencing the prevalence of peri-implant diseases and marginal bone loss in static computer-assisted implant sites: A cross-sectional study.
Source: J Periodontol. 2026;97:47–61.
DOI: 10.1002/jper.11387
Type: Cross-sectional study
Keywords: prosthesis; dental implants; risk indicator; peri-implantitis; peri-implant mucositis
Purpose: To study marginal bone loss and peri-implant disease in static computer-assisted implant surgery and determine whether implant or prosthetic design factors are associated with these outcomes.
Methods: A cross-sectional analysis was conducted on 115 patients with 417 implants placed using a standardized digitally guided surgical protocol and loaded for at least one year. Clinical parameters such as probing depth, bleeding on probing, mucosal recession, and keratinized mucosa were recorded. Radiographs were used to assess marginal bone levels and prosthetic characteristics including emergence angle, abutment height, cantilever presence, implant surface, and interproximal contact levels. Statistical analyses were performed to determine associations between prosthetic factors and peri-implant disease or marginal bone loss.
Results: Among the implants examined, 37.4% were healthy, 57.8% presented peri-implant mucositis and a 4.8% exhibited peri-implantitis. Removable prostheses were significantly associated with peri-implantitis, with overdenture-supported implants showing an odds ratio of 2.16 compared with fixed restorations. For marginal bone loss, higher interproximal contact level and greater emergence angle was significantly associated with greater mesial bone loss, while greater emergence angle, higher interproximal contact level and distal cantilever were significant on the distal side. Overall bone levels were also significantly related to short mucosal abutment height and implant surface treatments.
Conclusion: Peri-implant disease and bone loss are influenced by restoration and abutment design, with removable prostheses and unfavorable prosthetic features linked to higher risk, highlighting the importance of careful planning and follow-up.
Topic: Crestal bone height on adjacent implants
Author: Kasabreh NS, Malaikah S, Khurshid H, Khan MQ, Wang HL.
Title: When Is a Discrepancy in Crestal Bone Height Level for Adjacent Dental Implants Significant? A Retrospective Study with a Minimum Follow-up of 1 Year.
Source: Int J Oral Maxillofac Implants. 2026;41(1):61-68.
DOI: doi:10.11607/jomi.11208
Type: Retrospective study
Keywords: crestal bone height; neighboring implants; peri-implantitis; splinted implant crowns
Purpose: To determine whether vertical differences in crestal bone height between adjacent implants influence marginal bone loss over time and to compare this effect between splinted and non-splinted implant-supported restorations.
Methods: Patient records and radiographs from individuals treated with at least two adjacent posterior implants were reviewed. Implants were categorized based on whether their prostheses were splinted or non-splinted, and the vertical discrepancy between implant platforms was grouped into four ranges of crestal bone height level (CBHL) difference. Radiographic measurements of marginal bone levels were taken at prosthesis placement (T0), between one and three years (T1), and at the most recent visit (T2). Statistical analysis assessed changes in bone levels over time.
Results: The study included 56 patients with a total of 120 implants; 70% were restored with non-splinted prostheses. More than 80% implants were placed in the mandible. In the non-splinted group, marginal bone loss increased as the CBHL difference between adjacent implant platforms became greater. Both mesial bone loss at the posterior implant and distal bone loss at the anterior implant followed this trend. A significant association was observed between increasing CBHL discrepancy and marginal bone loss over time. Each additional 1mm of height discrepancy was associated with 0.82 mm of mesial bone loss at the posterior implant and 0.78 mm of distal bone loss at the anterior implant. In contrast, the splinted group showed lower overall bone loss and no significant correlation between CBHL differences. When the two prosthetic designs were compared directly, non-splinted implants demonstrated 1.73 mm greater bone loss on the mesial side and 1.79 mm greater bone loss on the distal side (p<0.001) than splinted implants with same difference in CBHL.
Conclusion: Vertical discrepancies in crestal bone height between adjacent implants appear to contribute to marginal bone loss in non-splinted implants. CBHL should be considered during implant planning, although additional studies are needed to confirm the findings.
Topic: Gingival Recession Treatment using a Modified Coronally Advanced Tunnel with L-PRF and PDM
Authors: Würflein E, Herrman K, Sculean A, et al.
Title: Twenty-four month clinical outcomes of modified coronally advanced tunnel technique with leukocyte- and platelet-rich fibrin–functionalized porcine dermal matrix for single/multiple gingival recessions.
Source: Journal of Periodontology, 2026
DOI: 10.1002/jper.70093
Type: Clinical trial
Keywords: Gingival recession, L-PRF, coronally advanced tunnel technique, porcine dermal matrix, root coverage
Purpose: This study aims to evaluate the 24-month clinical and 3D outcomes of single and multiple RT1 and RT2 gingival recessions managed with the modified coronally advanced tunnel (MCAT) approach combined with an L-PRF–functionalized porcine dermal matrix (PDM), addressing the lack of long-term data on PDM use in root coverage treatments.
Materials and Methods: Patients presenting with single or multiple RT1 and RT2 gingival recessions in the maxilla or mandible underwent treatment using the MCAT technique combined with an L-PRF enhanced PDM. Conventional dental impressions were taken before surgery and at 24 months, cast, digitized, and converted into STL files for quantitative analysis. Assessed outcomes included recession depth (RD), mean and complete root coverage (mRC, cRC), mean recession reduction (mRR), and gingival thickness (GT).
Results: A total of 83 teeth from 20 patients were included in the 24-month follow-up analysis, with healing proceeding without complications. The mean baseline recession depth was 1.31 mm. At 24 months, mRC was 80.17%, cRC was 34.78%, and mRR was 1.01 mm. GT increased by an average of 0.22 mm. Improvements in root coverage and GT were comparable between RT1 and RT2 recessions and were not affected by tooth type or jaw location.
Conclusions: The MCAT technique combined with an L-PRF enhanced PDM achieved stable root coverage and modest increases in GT over 24 months for RT1 and RT2 recessions. These results highlight the clinical potential of this approach that avoids connective tissue harvesting and emphasizes the need for randomized controlled trials with patient-reported outcomes to directly evaluate its performance against conventional connective tissue grafting.
Topic: CTG Effects on Treatment of Peri-Implantitis
Authors: Holtzman, L.P., Milinkovic, I., Vuckovic, M., Malpassi, C., Cuppini, M., Solderer, A., Aleksic, Z., Cordaro, L.
Title: Effect of Connective Tissue Graft as an Adjunct to Guided Bone Regeneration in the Surgical Treatment of Peri-Implantitis: A Dual-Center Randomized Controlled Trial.
Source: Clinical Oral Implants Research, 2026
DOI: 10.1111/clr.70093
Type: Randomized Controlled Trial
Keywords: Connective tissue graft, guided bone regeneration, peri-implantitis, dental implants
Purpose: The purpose of this randomized controlled trial was to assess whether the addition of a connective tissue graft (CTG) to guided bone regeneration (GBR) enhances clinical and radiographic outcomes in the surgical treatment of peri-implantitis.
Materials and Methods: Thirty-two patients diagnosed with peri-implantitis were randomly allocated to two groups of treatment regimens; GBR combined with a connective tissue graft as the test group or GBR alone, being the control. Clinical and radiographic outcomes were evaluated at baseline, 6 months, and 12 months. The primary outcome was clinical attachment level (CAL) changes. Additional outcomes evaluated were probing pocket depth (PPD), bleeding on probing (BoP), plaque index (PI), width of keratinized mucosa (KMW), mucosal thickness (MT), gingival recession (REC), presence of suppuration (SUP), marginal bone level (MBL), bone defect configuration, and overall disease resolution (DR).
Results: After 12 months, the test group showed significantly greater clinical attachment gain than the control group: 3.21 mm vs. 1.65 mm. Both groups experienced significant reductions in PPD, with the test group demonstrating a larger improvement than the control group: 3.25 mm vs. 1.97 mm. The increase in KMW was also significantly larger in the test group, 2.25 mm, compared with the control group 0.26 mm. REC, MT, BoP, PI, SUP, and bone defect morphology values were not statistically significant among the two groups. MBL improved significantly in both groups with greater bone gain observed in the test group. However, DR was similar between the two groups.
Conclusion: GBR leads to significant improvements in peri-implant clinical outcomes after one year. The addition of a CTG results in greater gains in CAL and KMW and may contribute to improved bone levels. However, its effect on overall disease resolution is still unclear. Further long-term studies are needed to validate these results.