Journal Club- November 2025
Effect of Dental Implant Design on Stability During Early Healing: A Randomised Controlled Trial. Charoenniwassakul, R., S. Aruncharoensuk, K. Subbalekha, N. Mattheos, S. Jiaranuchart, and A. Pimkhaokham. 2025. Journal of Clinical Periodontology 1–12. DOI:10.1111/jcpe.70052.
Graftless Sinus Floor Elevation Using the Lateral or Transcrestal Approach. A Randomized Clinical Trial With One Year Follow-Up. Fettouh, A. I. A., Ghallab, N. A., Adel, N., Nasser, R., Gamal, N., Samy, M., & Shemais, N. (2025). Clin Oral Implants Res. 2025 Oct 10. doi: 10.1111/clr.70055.
Clinical Performance of Narrow Versus Standard Diameter Dental Implants: A Comparative Retrospective Split-Mouth Study. Raz P, Kantzuker O, Slutzkey G, Beitlitum I. The International Journal of Oral & Maxillofacial Implants, 03 Oct 2025, 0(0):1-21. DOI: 10.11607/jomi.11490
Conservative Mucogingival Management of External Cervical Root Resorption Using Bioceramic Repair Materials: A Case Series. Sforza F, Cerutti F, Stefanini M, Marzadori M, Scarano A, Qorri E, Romano R, Pedullà E, Bugea C. Int J Periodontics Restorative Dent. 2025 Oct 22;0(0):1-24. doi: 10.11607/prd.7916. Epub ahead of print. PMID: 41124437.
Reduced prevalence of periodontitis in antidepressant users: Findings from a large-scale US sample. Martínez M, Fraguas D, Figuero E, D´Aiuto F. J Periodontol. 2025; 111. DOI: 10.1002/jper. 70014.
Intentional replantation of periodontally compromised teeth with concentrated growth factors. Ayappali Kalluvalappil N, Kumar RS, Hassan TH. Clin Adv Periodontics. 2025 Oct 14. doi: 10.1002/cap.70017. Epub ahead of print. PMID: 41085111.
Pre-Surgical Risk Assessment for Sinus Membrane Perforation: A Retrospective Cohort Study. Ninneman S, Dung SZ, Testori T, Daubert DM, Wang IC, Badr N, Hsu YT. Clin Oral Implants Res. 2025 Oct 8. doi: 10.1111/clr.70054. Epub ahead of print. PMID: 41063408.
Volume-Stable Collagen Matrix as a Recombinant Human Bone Morphogenetic Protein-2 Carrier for Maxillary Sinus Augmentation: An Experimental In Vivo Study. Kim CE, Park SH, Paeng KW, Tavelli L, Wu DT, Thoma DS, Jung RE, Jung UW, Cha JK. J Clin Periodontol. 2025 Oct 18. doi: 10.1111/jcpe.70054. Epub ahead of print. PMID: 41109210.
The Trouser Technique: A Novel Approach for Peri-Implant Soft Tissue Augmentation. Pavón P, Fons-Badal C, Pérez-Rostoll N, Alonso-Pérez-Barquero J, Solá-Ruiz MF, Agustín-Panadero R. J Clin Med. 2025 Jul 14;14(14):4974. doi: 10.3390/jcm14144974. PMID: 40725671.
Treatment of Mandibular Class III/IV Furcation Defects with a Combination Plastic Regenerative Technique: A Case Series. Suzuki E, Katayama A, Funato A, Rasperini G. Int J Periodontics Restorative Dent. 2024 Jul 26;44(4):398-407. doi: 10.11607/prd.6656. PMID: 37552182.
Impact of Marginal Misfit in Implant-Supported Fixed Dental Prostheses on Peri-Implant Bone Levels: A Retrospective Quantitative Analysis. Couso-Queiruga, E., Ramseier, C. A., Chappuis, V., M, S. F. M. J., Buser, D., Brägger, U., & Salvi, G. E. (2025). Clinical oral implants research, 10.1111/clr.70053. Advance online publication. DOI:10.1111/clr.70053.
The connective tissue cube for treatment of papillary deficiencies: A case report. Carvelli, G., Kotsailidi, E. A., Tsigarida, A., Benzaquen, S., Chochlidakis, K., Ercoli, C., & Caton, J. G. (2025). Clinical advances in periodontics, DOI:10.1002/cap.10371. Advance online publication.
Pouch versus non-pouch technique for repairing the maxillary sinus membrane large perforation in rhesus monkey. Liao Y, Wu J, Xia L, et al. J Periodontol. 2025;96(9):1004-1014. doi:10.1002/JPER.24-0717.
Operative Times, Costs and Patient-Related Outcome Measures in Vertical Ridge Augmentation With Customised Reinforced PTFE Mesh Versus CAD/CAM Titanium Mesh: Secondary Analysis of a Randomised Clinical Trial. Cucchi, A., Bettini, S., Tedeschi, L., Franceschi, D., Urban, I., Fiorino, A. and Corinaldesi, G. (2025) J Clin Periodontol, 52: 971-982. DOI:10.1111/jcpe.14185.
Aesthetics and patient‐reported outcomes in periodontology and implant dentistry: Consensus report. Tonetti M, Sanz M, Cairo F, Nart J, Chapple I, Aimetti M, Aroca S, Avila‐Ortiz G, Blanco J, Bujaldón A et al. 2025. Journal of Clinical Periodontology. 52(9):1222-1244. doi:10.1111/jcpe.14182.
Implantoplasty vs. Rotating Titanium Brushes in the Surgical Treatment of Peri-Implantitis: A 1-Year Randomised Controlled Clinical Trial. Park SH, Kim DB, Kim DM, Sanz-Martin I, Sanz-Sanchez I, Derks J, Cha JK. J Clin Periodontol. 2025 Oct 21. doi: 10.1111/jcpe.70056. Epub ahead of print. PMID: 41117707.
Peri-Implant Supracrestal Tissue Characteristics Related to Abutment Materials: A Comparative Histomorphometry Study, M. Borie, D. Bosshardt, L. Liegeois, et al., Clinical Implant Dentistry and Related Research 27, no. 5 (2025): e70083, DOI:10.1111/cid.70083.
Schneiderian Membrane Elevation up to 8 mm by Transcrestal Technique Using Hollowed Osteotomes: A Human Cadaver Study. Coutant, J. C., Naveau, A., Lauverjat, Y., & Ella, B. (2025). Clinical implant dentistry and related research, 27(5), e70096. DOI:10.1111/cid.70096.
Abstracts
Topic: Implant stability
Authors: Charoenniwassakul R, Aruncharoensuk S, Subbalekha K, Mattheos N, Jiaranuchart S, Pimkhaokham A.
Title: Effect of Dental Implant Design on Stability During Early Healing: A Randomised Controlled Trial.
Source: J Clin Periodontol. 2025 Oct 29.
DOI: 10.1111/jcpe.70052
Reviewer: Daeoo Lee
Type: RCT
Keywords: implant, macro design, stability, early
Purpose: To compare the stability of cylindrical and tapered implant during the early healing phase.
Material and methods: 68 patients with 90 implants were recruited for the study. Group 1 (45 implants) received cylindrical implant with non-cutting threads (BL) and group 2 (45 implants) received tapered implants with cutting V-shaped threads (BLX). Implants were placed in the posterior sites. The surgical process consisted of reflecting a full thickness flap and placing the implants using a guided protocol. Healing abutment was placed and flaps were sutured. In terms of data collection, the maximum insertion torque (MIT) was recorded at the time of placement. Implant stability quotient (ISQ) using Osstell device was measured at the time of placement (T1) and at 6 weeks post-op(T8). Implant stability test (IST) which measures damping capacity (or ability to dissipate mechanical vibration) using Anycheck device was measured at T1 and weekly up to 6weeks (T8). Statistical analysis was performed.
Results: BLX implants had a significantly higher MIT compared to BL implants (42.35 vs. 30.63). Statistically there were no differences between the BLX and BL in terms of ISQ value at the time of placement. However, at 6 weeks BL had a significantly higher ISQ value compared to BLX (75.2 vs. 72.23). In terms of IST, there was no significant difference between BL and BLX at the weekly follow ups other than at the 6 weeks follow up (BL:79.69; BLX:76.06). IST trends analysis for each implant revealed that BL group generally had a decreasing trend up to the 3-weeks mark and then gradually increased in value; BLX group had an increasing trend up to the 1-week post-op and then gradually dropped by the 3-weeks mark and then rebounded later on.
Conclusions: Within the limitation of the study, both types of implants exhibited consistent high stability during early healing phase.
Topic: Sinus-Implants
Authors: Fettouh AIA, Ghallab NA, Adel N, Nasser R, Gamal N, Samy M, Shemais N.
Title: Graftless Sinus Floor Elevation Using the Lateral or Transcrestal Approach. A Randomized Clinical Trial With One Year Follow-Up.
Source: Clin Oral Implants Res. 2025 Oct 10.
DOI: 10.1111/clr.70055.
Reviewer: Daeoo Lee
Type: RCT (1 year)
Keywords: implant, graftless, sinus lift
Purpose: To compare implant stability between a crestal sinus lift and a lateral window approach, both performed without the use of bone grafts.
Material and methods: Total of 26 patients for placement of 26 implants at posterior maxilla were recruited. The site of interest had residual bone height of 4-6mm. The control group was comprised of 13 patients to receive the implant using lateral sinus lift. The test group was comprised of 13 patients to receive implants using crestal lift approach. Surgically, full thickness flap was raised. For the crestal lift approach, after reaching 0.5-1mm of the sinus floor using osteotomy bur, sinus membrane was elevated using blunt apex implant (Zimmer TSV). As for the lateral window approach, after full thickness flap was elevated lateral antrostomy was prepared for membrane elevation. Afterwards, implant was inserted. A resorbable collagen membrane (Bio-Gide) was used to cover the window to act as a barrier. Implant stability was measured in terms of implant stability quotient (ISQ) using Osstell’s device. The ISQ was measured immediate post-op, at the time of crown delivery(~6mo) and after 12month post-op. CBCT was also taken at baseline and at 1-year post-op to analyze bone gain.
Results: The ISQ values for the lateral window approach at immediate post-op, at 6month, at 12-month post-op was 72.88, 75.65, and 80.92 respectively. The ISQ values for the crestal lift approach at immediate post-op, at 6-month, at 12-month post-op was 61.19, 74.34, and 80.19 respectively. No statistically significant difference was observed between the two approaches. In terms of pain, peak of discomfort reached 1 day after implant surgery and decreased at 3 days and 1 week after for all patients. In terms of bone gain measured via CBCT, lateral window approach yielded 3.64mm at 6month and 3.82mm at 12-month; no statistically significant difference between 6-month and 12-month. On the other hand, crestal lift approach yielded 1.66mm at 6-month and 2.42mm at 12-month.
Conclusions: Both techniques produce a reliable results (in terms of stability) for placing implants with residual bone height of 4-6mm.
Topic: Narrow diameter implant performance
Authors: Raz P., Kantzuker O., Slutzkey G., Beitlitum I.
Title: Clinical Performance of Narrow Versus Standard Diameter Dental Implants: A Comparative Retrospective Split-Mouth Study
Source: The International Journal of Oral & Maxillofacial Implants, 03 Oct 2025, 0(0):1-21.
DOI: 10.11607/jomi.11490
Reviewer: Cyrus J Mansouri
Type: Retrospective split-mouth study
Keywords: Narrow diameter; Dental implants; Implant diameter; Split mouth; Internal connection
Purpose: To compare clinical performance of narrow diameter implants (NDIs) versus standard diameter implants (SDIs) in a split-mouth study design over a three-year follow-up period.
Material and methods: A retrospective chart review was conducted to identify patients receiving a NDI and SDI between 2012 and 2022. Narrow diameter implants were 3.3 mm in diameter and SDI implants were 3.75-4.2 mm in diameter. Follow-up periods were at least 3-years in duration. Study patients were stratified into the following groups based on implant positions: 1. Homologous split mouth (NDI and SDI placed in contralateral tooth positions), 2. Different arches (NDI and SDI placed in different arches), 3. Same arch and segment (NDI and SDI located within the same dental arch and segment restored with splinted or single units), 4. Posterior or anterior. Dental implants consisted of MIS LANCE and SEVEN dental implants (internal hex with dual-acid etched and sandblasted surface). The NDI and SDI implant-abutment interface width was 1.6 and 2.2 mm, respectively. Surgical procedures were performed following general guidelines and manufacturers’ recommendations. Impressions were taken after 3-6 months of healing and restorations were single or splinted. All implants were inserted into healed sites with minimum 3 months of healing. Primary outcome of interest was implant survival rate, with secondary outcomes of peri-implant bone changes and the incidence of mechanical complications. Marginal bone levels (MBL) were evaluated from existing periapical radiographs.
Results: The final study population was composed of 43 patients with a mean age of 53 years. A total of 100 implants were studied (50 NDI and 50 SDI). The mean follow-up period was 4.2 years. Implants were placed more in the posterior (58%) than anterior (42%) and maxilla (62%) than mandible (38%). For prosthetic design, 54% were single crowns and 46% were splinted. No implant failures were encountered, with a 100% survival rate for all implants. Mean MBL was 0.836 mm for NDI and 0.877 mm for SDI. MBL was not significantly different between diameter types, between different arch locations, or between splinted/non-splinted. Most frequent MBL magnitude was between 0.5-1.0 mm. Regarding mechanical complications, all complications were experienced exclusively with screw-retained NDIs. No implant fractures were encountered, one NDI experienced abutment screw fracture, and two NDI experienced screw loosening. No mechanical complications were experienced with SDIs. A total of 38 implants were cement-retained.
Discussion: Interestingly, all mechanical complications occurred in the splinted anterior configurations, despite the theoretical advantage of splinting. Another implant clinical reality for NDIs relates to the frequent compromise in the correct restorative position due to reduced ridge widths, especially in the posterior regions and when placing NDIs, where the reduced diameter allows for placement that otherwise wouldn’t be possible with ridge augmentation. In this study, the compromised implant positioning did not seem to affect success rates of therapy. The results of this study may suggest preferential use of NDIs in the posterior regions, where axial loading occlusal schemes dominate. In contrast, careful occlusal management is paramount for NDIs in the presence of lateral forces typically found in the anterior regions.
Conclusion: NDIs demonstrate similar clinical performance in regard to implant survival and MBL over 3 years. NDIs are a reliable restorative option when space and/or bone is limited in the anterior or posterior jaws. Axial loading schemes in the posterior may be more amendable to NDIs, whereas lateral forces experienced in anterior regions may result in more mechanical complications and necessitate more careful occlusal design.
Topic: Cervical root resorption periodontal management
Authors: Sforza F., Cerutti F., Stefanini M., Marzadori M., Scarano A., Qorri E., Romano R., Pedulla E., Bugea C.
Title: Conservative Mucogingival Management of External Cervical Root Resorption Using Bioceramic Repair Materials: A Case Series
Source: Int J Periodontics Restorative Dent. 2025 Oct 22;0(0):1-24
DOI: 10.11607/prd.7916
Reviewer: Cyrus J Mansouri
Type: Case series
Keywords: external cervical root resorption; coronally advanced flap; connective tissue graft; bioceramic repair; pulp vital therapy
Purpose: To present clinical and radiographic outcomes from management of cervical root resorption by bioceramic repair and mucogingival surgery.
Material and methods: A total of ten patients presenting with external cervical root resorption were recruited. Each subject underwent analysis by cone beam computed tomography to diagnose and classify the cervical resorption. Clinical exam included measurement of recession (REC), gingival thickness (GT), keratinized tissue width (KTW), clinical attachment level (CAL), and probing depth (PD), measured at baseline, 12-months, and 3-years. Surgical protocol included flap elevation, debridement with and refinement with ultrasonic tips, repair using a bioceramic material, connective tissue graft sutured to the inner flap 2 mm from the gingival margin, and coronal flap advancement for closure. In presence of gingival recession, root surfaces were mechanically and chemically treated with curettes and 24% EDTA. Pulp vitality was preserved whenever possible with direct or indirect pulp capping with Biodentine, but root canal treatment was performed when necessary. Patients were prescribed 600 mg Ibuprofen, q8h for three days, chlorhexidine BID, and were put on a soft diet for two weeks. Suture removal was performed at 7-10 days. Follow-ups were made at 1-week, 1-month, 6-months, 12-months, and 3-years.
Results: All ten patients were included in the final analysis. Lesions treated were on maxillary incisors (6 lesions) and posterior teeth (4 lesions). Etiology was attributed to trauma in 5 cases, orthodontic treatment in 1 case, and idiopathic in 4 cases. No patients were symptomatic. All treated teeth presented as stable, functional, and asymptomatic after three years. Pulp vitality was maintained in eight cases at the final follow-up, which demonstrates biocompatibility of the bioceramic material. Only one site exhibited gingival recession following treatment. Mean REC decreased from 1.1 to 0.50 mm, GT increased from 1.04 to 1.95 mm, KTW increased from 3.90 to 4.00 mm, CAL decreased from 2.40 to 1.70 mm, and PD went from 1.40 to 1.55 mm from baseline to 3-year follow-up.
Conclusion: Favorable outcomes were found through the surgical approach for the management of external cervical root resorption. Pulp vitality, soft-tissue stability, and satisfactory esthetics were favorable clinical outcomes.
Topic: Depression and Periodontitis
Author: Martínez M, Fraguas D, Figuero E, D´Aiuto F.
Title: Reduced prevalence of periodontitis in antidepressant users: Findings from a large-scale US sample.
Source: J Periodontol. 2025; 1-11.
DOI: 10.1002/jper.70014
Type: NHANES
Reviewer: Veronica Xia
Keywords: depression, antidepressants, periodontal disease, prevalence, association
Purpose: The purpose of this article was to examine the relationship between periodontitis prevalence and usage of antidepressants.
Materials and Methods: This study utilized data collected from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. Periodontal parameters were collected via clinical examinations and diagnosis was based on the 2018 classification system. Presence of major depressive disorder (MDD) and antidepressant usage were assessed via a patient health questionnaire (PHQ-9).
Results: Of the 30.468 subjects included in survey, 9.839 received both periodontal examinations and questionnaires. The overall prevalence of periodontitis 73.9% of stage II or greater, with the following parameters showing an increased prevalence: males (16.0% vs 6.4%), non-Hispanic black (16.8%), separated/divorced (16.8%), age 50-69 (16.5%), current smokers (21.3%), no more than secondary education (19.1%), low income (16.7%), blood pressure >/= 140/90 (18.2% and 15.6% respectively), hemoglobin A1c levels >/= 5.7% (14.1%).
In subjects with antidepressant usage, the odds ratio (OR) for periodontitis decreased from 0.81 to 0.4, with more favorable associations in those with a greater severity of periodontal disease. subjects affected by MDD, increased severity of depression was related to an increased odds of periodontal disease – OR 1.53-1.59.
Conclusion: This evidence from this study proposes that a protective relationship may exist between antidepressant usage and periodontitis, with those taking antidepressants showing a lesser OR of presenting with periodontal disease. Possible mechanisms behind the relationships include anti-inflammatory effects of antidepressants, alternations in bone metabolism (favoring bone formation), or effects to decrease prevalence of systemic risk factors.
Topic: Management of Hopeless Teeth
Author: Ayappali Kalluvalappil N, Kumar RS, Hassan TH.
Title: Intentional replantation of periodontally compromised teeth with concentrated growth factors.
Source: Clin Adv Periodontics. 2025 Oct 14.
DOI: 10.1002/cap.70017.
Type: Clinical Study
Reviewer: Veronica Xia
Keywords: hopeless teeth, replantation, concentrated growth factors, anterior teeth
Purpose: The purpose of this article is to assess the outcomes relating to the use of concentrated growth factor (CGF) in conjunction with intentional replantation (IR) of anterior teeth that are periodontally compromised.
Materials and Methods: Patients were selected based on presentation with hopeless anterior teeth, having >50% bone loss and grade 2 or 3 mobility). 10 patients were included and subject to non-surgical periodontal therapy and re-evaluation prior to replantation procedure. In the presence of periapical pathology, endodontic treatment was performed intraorally.
Day of replantation, CGF clot, divided into a membrane and colloid, was obtained from blood drawn from the patient. Deproteinized bovine bone mineral (DBBM) was mixed with the CGF colloid. Hopeless teeth were then extracted, degranulated, and scaled. 12% ethylenediaminetetracacetic acid (EDTA) was applied to extracted root surfaces for 4 minutes and rinsed. Root end resections, removing 3mm from apex, were performed, followed by retrograde fill of pulpal canals with mineral trioxide aggregate (MTA). This extraoral time did not surpass 15 minutes. Immediately prior to replantation, sockets were lightly degranulated to obtain bleeding. DBBM-CGF was placed into socket and tooth was both replanted and stabilized with a splint for 4 weeks.
Postoperatively, patients instructed to take 500mg amoxicillin for 5 days, 0.12% chlorhexidine gluconate (CHX) for 10 days, as well as not to functional use the tooth for 3 months. Re-evaluations, including measurement of clinical parameters and radiographic analysis with cone beam computed tomography (CBCT), were completed periodically until 12 months post-procedure.
Results: When compared to baseline Grade 2 and 3 mobility, after 12 months, 6/10 cases presented with Grade 1 mobility, while 4/10 presented with Grade 0 mobility. The mean probing depth (PD) decreased from 6.7+/-0.9mm at baseline to 2.8+/-0.75mm at 12 months. Gingival index (GI) scores showed a signification reduction, no or minimal inflammation/bleeding, indicating soft tissue health.
CBCT analysis showed a gain in bone height of 2.58+/-0.43mm. Bone fill was noted at the apex of all teeth, and the presence of a periodontal ligament (PDL) space could also be noted in CBCTs.
Pain levels were also significantly improved from baseline to 12 months post-procedure, 6.1+/-0.7 to 0.6+/-0.5 respectively.
Conclusion: The use of IR in combination with CGF can result in improvements in clinical and radiographic parameters after a follow-up period of 12 months. Therefore, this procedure can be applied to maintain and save hopeless anterior teeth up to 12 months.
Topic: Sinus Membrane Perforation
Author: Ninneman, et al.
Title: Pre-Surgical Risk Assessment for Sinus Membrane Perforation: A Retrospective Cohort Study.
Source: Clin Oral Implants Res. 2025 Oct 8.
DOI: 10.1111/clr.70054
Reviewer: Ryan Higgins
Type: Retrospective Cohort
Keywords: intraoperative complications, sinus floor augmentation
Purpose: To evaluate a current risk assessment (RA) tool that aims to predict the chances of having a sinus membrane perforation (SMP) when completing a lateral-window sinus floor elevation (LSFE).
Materials and Methods: CBCT images and health records were used from 2005 to 2021 of patients who had a LSFE completed in order to perform analysis. Key risk factors were used to evaluate the effectiveness of the most widely accepted RA tool to date that was completed by Testori et al. 2020.
Results: The data set included 126 sinus lifts in 113 patients. Out of 113 patients 64 were males and 49 were females. 12 patients were smokers. Of these 113 patients there were 24 SMP’s that occurred in 23 patients (19% of LSFE’s).
When looking at the residual bone height present at the time of LSFE when there was a 1mm increase in this height the OR of an SMP occurring decreased by 23.7%. When looking at the initial bone height this study found that the cut-off between a high and low risk lift varied from the original RA. In the original RA the cut-off was 4mm residual bone height, bone from this study it the authors state that a 3mm RBH can be used to better separate between high and low risk of SMP.
The other key risk factors included a correlation of SMP and age at the time of surgery with decreased risk in patients above 55.5-years old. The authors then completed a classification system combining RBH with age. It was found when RBH was ≥3.02mm, 7% of sinuses had SMP, when RBH < 3.02mm + the patient was > 55.5 years old, 23% of sinuses had SMP, and when RBH < 3.02mm + the patient was < 55.5 years old 60% of sinuses had SMP. When having both RBH < 3.02mm and being younger than 55.5 years old odds of having an SMP increased.
Of the other risk factors looked at by Testori et al. 2020, no others were found to have a statistically significant direct correlation to SMP risk within this patient population including septa, smoking, etc.
Conclusions: In comparison to the original RA tool, a new cutoff of 3.02mm for RBH and an age of 55.5 years are found to be critical thresholds for increased risk of SMP during LSFE. The current RA tool was found to be good overall, but could not be completely validated due to the small sample size and retrospective study design.
Topic: BMP-2 and Sinus Augmentation
Author: Kim, et al.
Title: Volume-Stable Collagen Matrix as a Recombinant Human Bone Morphogenetic Protein-2 Carrier for Maxillary Sinus Augmentation: An Experimental In Vivo Study
Source: J Clin Periodontol. 2025 Oct 18
DOI: 10.1111/jcpe.70054.
Reviewer: Ryan Higgins
Type: Retrospective Cohort
Keywords: bone morphogenetic protein-2, sinus floor elevation, volume-stable collagen matrix, animal experiment.
Purpose: To evaluate the effectiveness of using a volume-stable collagen matrix (VCMX) as a carrier for rhBMP-2 during sinus elevation procedures in comparison to absorbable collagen sponge (ACS).
Materials and Methods: Using 15 rabbits, bilateral sinus augmentation was completed using either VCMX or ACS both with and without rhBMP-2. The rhBMP-2 release kinetics were measured via an enzyme-linked immune assay for a 7-day period. At 4 weeks post treatment, a histological and radiographic analysis was completed with the parameters being investigated including total augmentation area, newly formed bone, residual graft material, and non-mineralized tissue area.
Results: When comparing VCMX to ACS in general the VCMX showed greater volumetric gains with a good dome-shaped augmentation compared to a flatter augmentation with ACS. When VCMX was used without rhBMP-2, the augmented area of new bone was 1.6mm, compared to 1.0mm when ACS was used alone. When VCMX was used with rhBMP-2, the augmented area of new bone was 3.9mm, compared to 1.8mm for ACS.
Overall outcomes revealed increased total augmented areas as follows: VCMX + rhBMP-2 > VCMX alone > ACS + rhBMP-2 > ACS alone. New formed bone was greatest with VCMX + rhBMP-2 > ACS + rhBMP-2 > VCMX alone > ACS alone. Residual graft material was greatest with VCMX alone. Non-mineralized tissue area was highest for VCMX + rhBMP-2.
When comparing the release pattern of rhBMP-2 using the two collagen forms, it was found that there were little differences between the two. One notable finding was that the peak release for VCMX was at 3 hours compared to ACS which was at 10 minutes. The cumulative rhBMP-2 concentration increased steadily with both VCMX and ACS until a plateau at 5 days post-op.
Conclusions: When completing a lateral sinus augmentation using adjunctive rhBMP-2 loaded onto VCMX there is increased bone regeneration (greater total augmented volume, new bone volume). The differences in results between VCMX and ACS are mainly attributed to the better space maintenance property of VCMX.
Topic: Peri-Implant soft tissue Augmentation
Authors: Pavon P, et al.
Title: The Trouser Technique: A Novel Approach for Peri-Implant Soft Tissue Augmentation
Source: J. Clin. Med. 2025, 14, 4974
DOI: 10.3390/jcm14144974
Reviewer: Nicolas Lobo
Type: Prospective study – Case series.
Keywords: connective tissue graft (CTG); peri-implant mucosa; tunneling; dental implants
Purpose: To explain the Trouser Technique, a connective tissue grafting approach designed to enhance peri-implant tissue volume both buccally and interproximally through a single surgical procedure.
Materials and Methods: 10 patients requiring soft tissue augmentation with a delayed implant approach were included. Inclusion criteria: edentulous anterior site in a periodontally stable patient, with ridge dimensions suitable for implant placement and presenting soft tissue volume deficiency. All patients exhibited a buccal concavity compromising the esthetic outcome of the implant crown. Implants were placed using a guided, flapless approach, with the platform positioned 0.5–1 mm subcrestal. A trouser-shaped CTG was harvested from the tuberosity. Morbidity was assessed using both a questionnaire and clinical evaluation.
This technique was designed to augment the soft tissue on both the buccal and interproximal areas at the time of implant placement. The CTG is ideally harvested from the tuberosity; if not feasible, a 1.5–3 mm de-epithelialized free gingival graft from the palate is recommended.
Three incision lines are made on the CTG and connected at the center to create a Y-shaped design: one central incision divides the graft in half, and two oblique incisions at 45° angles increase mobility of the split sections.The graft sections include a central area to correct the buccal deficiency and two split sections for the mesial and distal papillae. The recipient site is tunneled from the vestibular and papillary aspects, elevating the tissues from the palate toward the vestibular surface of the papilla.
The graft is inserted under the tunneled area and secured with non-resorbable sutures, which are not tied until the immediate restoration or healing abutment is placed to properly reposition the graft. After positioning, the sutures are tied. The restoration or healing abutment is then removed to verify graft adaptation from the inside. Finally, a sling suture with minimal tension is placed to stabilize the graft.
For the volumetric analysis, intraoral scans were compared, one taken before the procedure and another 6 months post-surgery. The area of interest was divided into 3 regions (buccal, mesial and distal papilla), and each region was further subdivided into three zones (mesial, mid, and distal). Two measurements were recorded: one at the coronal level and one at the buccal area.
Results: A total of 10 patients with 90 sections were analyzed. A statistically significant increase in soft tissue volume was observed after 6 months in all aspects of the samples. At the coronal level, the overall average augmentation was 2.74 mm; 2.79 mm at the buccal, 2.66 mm and 2.76 mm at the mesial and distal papilla respectively. In the subdivision analysis, the values were 2.63 mm, 2.83 mm, and 2.76 mm for the mesial, mid, and distal zones, respectively.
At the vestibular level, the overall augmentation was 2.79 mm, with 2.88 mm, 2.74 mm, and 2.77 mm at the buccal, mesial, and distal papilla, respectively. For the subdivision analysis, the values were 2.71 mm, 2.87 mm, and 2.81 mm for the mesial, mid, and distal zones.
Postoperative morbidity was low and manageable. A greater augmentation was noted in the mid-subdivision of the buccal aspect, likely due to the graft positioning, which left the largest volume in that area. A similar pattern was observed at the papilla, where the greatest thickness occurred at the emergence profile.
Discussion: The main advantage of this technique is that it allows simultaneous augmentation of both buccal and interproximal tissue volume in a single procedure. Additionally, the tunneling approach minimizes flap contraction. No clinical complications were reported related to the tunneling technique or the use of the tuberosity as a donor site.
Conclusions: The Trouser Technique with CTG is a safe and gentle method to fix the soft tissue volume around implants, especially in the esthetic zone. It thickens the soft tissue on both the buccal and interproximal areas in one procedure using one donor site, which means less discomfort and faster recovery for the patient.
Topic: Treatment of severe FI
Authors: Suzuki E et al.
Title: Treatment of Mandibular Class III/IV Furcation Defects with a Combination Plastic Regenerative Technique: A Case Series
Source: Int J Periodontics Restorative Dent. 2024 Jul 26;44(4):398-407.
DOI: 10.11607/prd.6656.
Reviewer: Nicolas Lobo
Type: Case Series
Purpose: To evaluate how combining fibroblast grow factors (FGF-2), carbonate apatite (CA), and a connective tissue graft (CTG) affect periodontal regeneration in mandibular furcation defects (FD) class III and IV.
Materials and Methods: 6 patients diagnosed with stage III/IV periodontitis (grades A–C) presented with FD class III/IV, probing depths (PD) >5 mm, and PI and BOP <15%.
Patients underwent phase I therapy, which included occlusal adjustments or temporary splints to control tooth mobility or fremitus. Clinical parameters evaluated included PD, clinical attachment loss (CAL), keratinized tissue width (KT), gingival phenotype, gingival recession (GR), and furcation defect (FD), while radiographic measurements included the vertical defect depth (VDD) Measurements were taken 3 months after phase I therapy, and at 6, 12, and 18 months post-surgery.
Surgical procedure: After local anesthesia, bone sounding was performed, followed by flap reflection, full-thickness around the FD and split-thickness apically. After conditioning the defect (scaling and root planing, elimination of enamel projections or pearls), the site was treated with 0.3% FGF-2 and filled with CA (Cytrans GC). A divided CTG harvested from the palate was placed to cover both the buccal and lingual FD areas, extending 1–2 mm above the defect, and secured with resorbable sutures. Flaps were sutured coronally using a combination of an internal horizontal mattress suture at the base of the papilla and a single interrupted suture on top, both with non-resorbable material.
Postoperative instructions included avoiding brushing the treated area for 2 weeks and attending twice-weekly disinfection and plaque removal visits. Periodontal maintenance was scheduled every 2–3 months.
Results: After the procedure, 5 FD, including 4 class III and 1 class IV, showed complete resolution, while one was reduced to class I. All clinical measurements improved. At baseline, PD was 6.83 mm, CAL 8.33 mm, KT 1.83 mm, GR 1.5 mm, and VDD 3.6 mm. After 18 months of follow-up, PD was 2.7 mm, CAL 3.16 mm (mean gain: 5.16 mm), KT 3.16 mm, GR 0.54 mm, and VDD 0.52 mm.
Discussion: This case series presents a novel treatment approach combining FGF-2 as a molecular signaling stimulator, CA as a scaffold, and a CTG to enhance gingival thickness, thereby reducing FD exposure, improving wound stability (by absorbing tensile forces and minimizing their transmission to the clot), and promoting cell supply, for the treatment of mandibular FD class III/IV.
Conclusions: It is possible to effectively treat FD class III/IV using a combination of FGF-2, CA, and a CTG
Topic: Implant marginal misfit
Authors: Couso-Queiruga, E., et. al.
Title: Impact of Marginal Misfit in Implant-Supported Fixed Dental Prostheses on Peri-Implant Bone Levels: A Retrospective Quantitative Analysis.
Source: Clinical Oral Implants Research
DOI: 10.1111/clr.70053
Type: Retrospective analysis
Reviewer: Mahya Sabour
Keywords: Dental implants, marginal misfit, implant-supported prostheses, peri-implant bone level
Purpose: to assess the effect of marginal misfit on bone levels in implant-supported prostheses (ISP) and identify a threshold for a misfit gap.
Materials and Methods: Patients who had received tissue level implants with ISPs between 1997 and 2001 with periapical radiographs dating to minimum 10 years after prosthetic loading were chosen. All implants had polished necks and placed slightly subcrestal. Radiographs were used to measure the distance between the implant shoulder and crestal bone (DIB), and prosthetic gap categories (GapCAT) were labeled as “no gap” or “presence of gap”. The gap’s vertical dimensions (gapDIM) were also categorized as 0mm, >0 – <0.1mm, and >/=0.1mm.
Results: 301 patients (47.2% males, 52.8% females, mean age 50.6y) with 505 implants and a mean follow-up of 10.6 years were included. 87.8% were non-smokers, while 12.2% were smokers (mean 18.5 pack-y). 5% had diabetes, 3.4% osteoporosis, and 68.6% drank alcohol. 35.6% had a history of periodontitis and the mean maintenance schedule for implant care was 1.74 visits/year.
Implant diameters ranged from 3.3-4.8mm, platform diameters from 3.5-6.5mm, implant lengths from 6-14mm, and implant neck heights from 1.8-2.8mm. 355 implants did not receive additional bone grafting while the remaining required staged or simultaneous augmentation. The mean modified plaque index (mPLI) was 0.6+/-0.6, mean modified sulcus bleeding index (mSBI) 1.3+/-0.6, mean probing depth (PD) 3.3+/-1.1mm, and apical mucosal margin migration 0.4+/-1.3mm.
11 implants displayed excess cement. The mean DIB was 3.3+/-0.7mm and a GapCAT was found in 249 implants (159 were >0.1mm). The mean total GapDIM was 0.1+/-0.1mm (0.02-3.7 range). Statistically significantly lower DIB was seen in ISPs without gaps (3.22mm) vs. with gaps (3.43mm; P=0.0018). >/=0.1mm gaps showed significantly higher DIB (3.45mm) vs. gaps between > 0 and <0.1mm (3.36mm) or no gaps (3.22mm). every 0.1mm increase in gap dimension increased the DIB by 0.08mm.
Smoking and history of periodontitis were significantly associated with higher total DIB levels, while surgical technique – mainly transcrestal sinus floor elevation – was associated with lower DIB levels (potentially protective). Implant neck height, GapDIM, use of bone grafts, and diabetes were not significantly associated with total mean DIB values.
Conclusion: There is a strong association between peri-implant bone levels and the presence of vertical misfit gaps in ISPs. Gaps >/=0.1mm lead to significantly higher DIB compared to those without a gap.
Topic: Papillary Deficiency Treatment
Authors: Carvelli, G., et al.
Title: The connective tissue cube for treatment of papillary deficiencies: A case report
Source: Clinical Advances in Periodontics, 10.1002/cap.10371. Advance online publication.
DOI: 10.1002/cap.10371
Type: Case Report
Reviewer: Mahya Sabour
Keywords: connective tissue cube, papillary deficiency, gingival recession
Purpose: present a surgical technique in managing severely deficient papilla through regenerative and periodontal plastic surgical approaches.
Materials and Methods: The patient was a 64-year-old female with a history of localized stage III, grade C periodontitis, presenting with black triangle (Nordland and Tarnow Class III papilla) between the right maxillary canine and first premolar. Surgical treatment with a connective tissue wall technique had been performed 6-7 months prior. The site had probing depths (PDs) from 1-4mm, clinical attachment level (CAL) from 2-10mm and the contact point to the soft tissue measured 8mm, while the bone crest to the CEJ measured 2-6mm radiographically. Recessions on both teeth were RT3 (Cairo) and both had a favorable prognosis.
A single flap approach involving sulcular incisions from the mesial of the first molar to the mesial of the canine, along with a mesial vertical incision was performed. A simplified papilla preservation technique was used at the papilla of interest, while pushing the palatal portion of this soft tissue palatally to allow for access to the defect. The Zucchelli oblique incisions as well as split-full-split approach was used to prepare surgical and anatomic papillae. Degranulation and root scaling were performed, revealing a 4mm deep two-wall infrabony defect. 24% EDTA was applied, followed by enamel matrix derivative (EMD) gel, in addition to grafting with cortico-cancellous freeze-dried bone allograft. Anatomical papilla were de-epithelialized and a de-epithelialized free gingiva graft from the tuberosity was harvested and shaped into a cube to fill the mesiodistal space in the area of the defect and extend coronally to the CEJ. The graft was sutured to the palatal and the buccal flap coronally advanced.
The canine was originally palatally rotated, therefore 6 months later, an indirect veneer provisional was delivered to develop an ideal emergence profile on the distal while the mesial of the canine was restored with composite resin. Space was left between the contact point and existing papilla to allow for coronal soft tissue migration. During an additional 8-month period, the embrasure was gradually widened to allow for papilla development. 14 months after surgery, the papilla was stable and a definitive veneer was restored.
Results: 6 months after the surgery, CAL gain ranged 3 to 5mm with the highest gain at the line angles. A 4mm decrease in the contact point to interproximal soft tissue was seen and the crater was no longer present. A black triangle was still present at this time while no radiographic changes were seen from baseline.
Following provisionalization and restorative phase, the interdental papilla was nearly full and 4 months after the final restoration (18 months after surgery), stable results along with no progression in the recession or interproximal papilla blunting was noted. PDs ranged 3-4mm and no BOP present, while 1mm radiographic bone fill was observed.
Conclusion: The connective tissue cube technique combines periodontal plastic and regenerative surgery and has the potential to treat severe papillary deficiency.
Topic: Sinus perforation
Author: Liao Y, Wu J, Xia L, et al
Title: Pouch versus non-pouch technique for repairing the maxillary sinus membrane large perforation in rhesus monkey.
Source: J Periodontol. 2025;96(9):1004-1014
DOI: 10.1002/JPER.24-0717
Type: Experimental study
Reviewer: Pankti Rana
Keywords: sinus perforation; bone regeneration; sinus floor augmentation
Purpose: To evaluate the effectiveness of the pouch vs non-pouch technique in repairing large perforations of the maxillary sinus membrane and their effects on bone regeneration.
Methods: Five rhesus monkeys underwent bilateral sinus membrane elevation and controlled perforation. Each side was randomly assigned to either the pouch or non-pouch group. In the pouch technique, a resorbable collagen membrane covered the perforation and lined all sinus walls to form a pouch around the bone graft. In the non-pouch method, the same collagen membrane only covered the perforated site. Both sides were filled with an identical amount of deproteinized bovine bone mineral (DBBM). Computed tomography (CT) scans were performed at one and nine months to assess bone height, density, and graft volume. After nine months, all animals were euthanized for micro-CT and histomorphometric analysis.
Results: Both repair techniques achieved satisfactory bone regeneration without complications or sinus inflammation. CT analysis showed similar bone height, density, and membrane thickness in both groups, though the pouch method showed lower graft volume loss (13.25%) compared with the non-pouch technique (27.67%). The pouch group also exhibited a higher sphericity index. Micro-CT and histological findings confirmed that bone mineral density, bone volume fraction, and trabecular characteristics were comparable between techniques. Histomorphometry showed slightly higher but not statistically significant new bone formation in the non-pouch group. Both approaches produced mature and vascularized bone.
Conclusion: Both pouch and non-pouch methods were effective for repairing large sinus membrane perforations and promoting bone formation. However, the pouch technique provided greater graft stability and minimized volume loss.
Topic: Vertical ridge augmentation
Author: Cucchi, A., Bettini, S., Tedeschi, L., Franceschi, D., Urban, I., Fiorino, A. and Corinaldesi, G. Title: Operative Times, Costs and Patient-Related Outcome Measures in Vertical Ridge Augmentation with Customised Reinforced PTFE Mesh Versus CAD/CAM Titanium Mesh: Secondary Analysis of a Randomised Clinical Trial.
Source: J Clin Periodontol 2025 Jul;52(7):971-982
DOI: 10.1111/jcpe.14185
Type: Secondary analysis
Reviewer: Pankti Rana
Keywords: vertical ridge augmentation; titanium mesh; patient-reported outcomes
Purpose: To compare customized titanium-reinforced PTFE mesh and CAD/CAM titanium mesh for vertical ridge augmentation to determine differences in complications, operative time, costs, and patient-reported outcomes.
Methods: This double-blind, randomized clinical trial included adults with vertical bone defects requiring augmentation. Participants were randomly assigned to receive either a titanium-reinforced PTFE mesh or a customized titanium mesh, both covered with a collagen membrane. All surgeries were performed by the same surgeon, while patients and evaluators were blinded to group assignments. Operative times were tracked across preoperative, intraoperative, and total chairside phases, and costs were calculated from materials and procedure-related expenses. Patient-reported outcomes including anxiety, pain, medication use, daily functional limits, and satisfaction were recorded through validated questionnaires, while clinician stress and satisfaction were also assessed. Statistical analyses tested non-inferiority for complication rates and compared other outcomes across groups.
Results: Forty-eight patients completed the study. Healing complications were rare and comparable between groups (12.5% PTFE vs. 8.3% Ti mesh), confirming non-inferiority. Preoperative digital planning took longer for titanium meshes, but intraoperative and total surgical times were similar. The average procedure cost was €1200 for PTFE and €1272 for titanium mesh, showing no significant difference. Both groups reported significant reductions in anxiety and pain after surgery, minimal functional limitations by day 14, and high satisfaction with their treatment. Clinicians in both groups reported moderate preoperative stress but high postoperative satisfaction. Overall, the titanium mesh achieved similar safety, efficiency, and patient comfort as the reinforced PTFE mesh.
Conclusion: Both digital mesh systems proved equally safe and effective, with low complication rates and positive patient experiences. Titanium meshes required slightly more planning but offered similar outcomes overall.
Topic: Peri-Implantitis Treatment
Authors: Park SH, Kim DB, Kim DM, Sanz-Martin I, Sanz-Sanchez I, Derks J, Cha JK
Title: Implantoplasty vs. Rotating Titanium Brushes in the Surgical Treatment of Peri-Implantitis: A 1-Year Randomised Controlled Clinical Trial.
Source: J Clin Periodontol. 2025 Oct 21. Epub ahead of print.
DOI: 10.1111/jcpe.70056
Reviewer: John Kerns
Type: RCT
Keywords: Implantoplasty, Titanium brush, peri-implantitis, surface decontamination
Purpose: To compare implantoplasty to the use of titanium brushes in peri-implantitis treatment
Methods: 15 patients needing surgical peri-implantitis treatment were randomly assigned into treatment groups: implantoplasty (control) and titanium brush cleaning (test). Treatment was indicated if the site had a radiographic peri-implant bone loss minimum of 3mm, probing pocket depth (PPD) of at least 6mm, bleeding on probing (BoP) or suppuration at non-surgical periodontal therapy recall visit, and a supracrestal bone defect.
For the brush cleaning, a straight, rotating titanium brush under irrigation with saline was used. For the implantoplasty group, carbide burs and white Arkansas stone burs were used to remove the implant threads and the outermost exposed surface. In the latter group, the implants were then polished under saline irrigation.
Patients were prescribed 0.12% chlorhexidine to be rinsed twice daily for two weeks. Recall evaluations occurred at 3, 6, 9, and 12 months follow-up. PPD, BoP, plaque index, gingival index, and recession were assessed. Keratinized mucosa (KM), if exceeding 2mm in width, was identified as present. Patient reported outcomes (PROs) and patient reported experiences (PREs) were obtained. The EFP endpoint of peri-implantitis treatment was included in the primary outcome: implant was saved, PPD ≤5mm without suppuration and BoP at ≤1 point, and ≥0.5 mm additional bone loss occurred. Secondary outcomes were also assessed, including treatment duration and pocket closure (PPD ≤5mm at all sites around the implant).
Results: At six months, no statistically significant difference (NSSD) occurred between the test group (8/15 implants) and the control (6/15 implants) (p=1.00). Likewise, at 12 months, NSSD occurred (6/15 in the test group, 4/15 in the control group, p=0.70). Surgical time on surface treatment, however, was significantly shorter in the titanium brush group vs. the implantoplasty group (approx. 2.5min difference; p=0.006). NSSD occurred for PPD reduction, BoP, plaque index, gingival index, and recession. Marginal bone loss (MBL) change at 12 months was significantly different at 0.0mm (test) vs. 0.7mm increase (control) (p=0.03).
Although NSSD was seen in pocket closure, the presence of an adjacent implant affected by peri-implantitis and baseline PPD were both significantly, negatively correlated with pocket closure.
Generally, NSSD was seen in patient satisfaction PREs and PROs scores.
Discussion: These results generally concur with previous studies regarding pocket reduction, pocket closure, and low BoP scores following treatment. As noted in other studies (Monje, Pons et al. 2022; Romandini et al. 2024), the extent of MBL is an essential consideration for treatment success. Hence, the finding of no additional bone loss occurring with titanium brush technique may be important. At minimum, titanium brush cleaning demonstrated non-inferiority with respect to both the primary outcome and patient satisfaction scores. Nevertheless, this study has limited power with respect to the primary outcome measure and therefore should be interpretated with caution.
Conclusion: Titanium brush surface decontamination showed non-inferiority to implantoplasty in peri-implantitis treatment.
Topic: Soft tissue augmentation
Authors: Tonetti M, Sanz M, Cairo F, Nart J, Chapple I, Aimetti M, Aroca S, Avila‐Ortiz G, Blanco J, Bujaldón A et al.
Title: Aesthetics and patient‐reported outcomes in periodontology and implant dentistry: Consensus report.
Source: Journal of Clinical Periodontology. 2025. 52(9):1222-1244.
DOI: 10.1111/jcpe.14182.
Reviewer: John Kerns
Type: Consensus Report
Keywords: Treatment outcomes, gingival recession, soft tissue augmentation, buccal dehiscence, implant placement
Purpose: To evaluate current literature regarding soft tissue augmentation techniques for treatment of exposed root and implant surfaces with special reference to clinician and patient reported outcome scores.
Methods: A workshop organized by the European Federation of Periodontology (EFP), consisted of 40 experts to evaluate five commissioned systematic reviews, published in 2025. Soft tissue augmentation (STA) treatments for or during (i) gingival recession at single- and multi-rooted teeth, (ii) buccal peri-implant dehiscences, and (iii) immediate, early, delayed, and late implant placement were assessed and discussed.
Surgical Treatment of Single and Multiple Gingival Recession Defects (GRD)
Background information: Hypersensitivity, non-carious cervical lesions, and root caries, are potential complications of untreated, exposed root surfaces. Impaired or painful plaque control, esthetic concerns, incipient furcation involvement, and phenotype modification prior to orthodontic treatment are other potential treatment indications.
The following factors (and their associated risk for GRDs) are discussed: improper brushing (limited generalizability of existing evidence), thin phenotype (increased risk for GRD progression), submarginal restorative margins (possibly increased risk especially with a thin phenotype), orthodontics (direction of tooth movement and bucco-lingual gingival thickness may increase risk), and traumatic occlusion (limited evidence suggests no increase in risk for onset or progression). Sites with a thin phenotype are emphasized at being at greater risk of progression.
While 88% of those aged 65yrs and older and 50% of those aged 18-64 have gingival recession, most studies focus on RT1 defects. In the US, only about 12% have such defects, and only about 6% have them in the esthetic zone. However, most people do not report perceiving problems: In Nieri et al.’s 2013 survey, 92% of recessions were asymptomatic or unnoticed by patients.
The objectives for treatment include reduced or eliminated hypersensitivity, improved esthetics, decreased risk of recurrence and progression, improved plaque control, prevention of further tooth structure loss (caries, NCCLs), and modification of gingival phenotype. While clinician-reported outcomes for surgical treatment success re: esthetics and root coverage (MRC), patient reported outcomes for treatment success esthetically (visual analog scale, VAS) and MRC are not statistically significant.
Therapeutic Interventions for GRDs: Achieving complete root coverage with clinical attachment gain, despite this outcome’s unpredictability, is of utmost importance. Tissue quality and quantity, root position, and depth/width of the defect are important considerations for treatment.
For RT1 and RT2 single GRDs, CAF+CTG “can be considered the standard of care”. For RT1 and RT2 multiple GRDs, multiple-teeth CAF (MTCAF) or a tunnel flap (TF) with a CTG may be most effective. Other options for RT1 and RT2 defects include a free gingival graft (FGG) with or without an eventual CAF, a CAF, a laterally closed tunnel, or a laterally positioned flap (LPF). In maxillary single site cases, CAF or LPF approaches may be preferred; in mandibular, CAF/TF + CTG or LPF or FGG with eventual CAF. In maxillary multiple GRD cases, MTCAF may be preferred; in mandibular, MTCAF (+ site-specific CTG) or TF + CTG.
A strong predictor of long-term treatment stability is the status of keratinized tissue height/width and gingival thickness at 6mo post-op and baseline marginal thickness. Using a CTG with a flap may also improve stability, and a CTG + CAF (vs. flap alone) is strongly advised if baseline marginal thickness is <0.8mm.
Regarding material choice, while xenogeneic collagen matrices (CMX) + CAF are associated with less recovery times & patient morbidity and better tissue texture & contour, CTG + CAF has better root coverage and esthetic score outcomes. Adjunctive biologics (e.g. rh-PDGF, autologous blood products, enamel matrix derivatives, etc.) did not improve root coverage scores or clinician- and patient-reported esthetic and satisfaction scores.
Future Prospectives: Current patient reported outcome measurement scales are limited in validity and sensitivity.
Adjunctive Procedures to Immediate Implant Placement (IIP) Aiming to Increase Soft-Tissue Thickness/Height
Current meta-analysis and RCT evidence suggests CTG with IIP reduces recession and decreases the likelihood of poor esthetic outcomes, e.g. via pink esthetic score (PES) values. It is also associated with improved soft tissue thickness (0.4mm to 0.8mm) vs. no STA. However, based on RCTs, no changes in KM or MBL with STA were reported.
Patient reported outcomes (via visual analog scale [VAS]) were generally not affected by adjunctive CTG use. Similarly, patients report high satisfaction levels after STA treatment regardless of technique used when combined with IIP, and one study reported no improvement in oral health related quality of life (OHRQoL) when comparing STA vs. no STA with IIP. With exception to one study, STA for IIP did not affect post-operative pain, post-op complications, or implant failure rates. Specific STA techniques showed no statistical difference in esthetic outcomes. However, the preferred technique in assessed studies is a pouch/envelope + CTG.
VAS may not be appropriate for capturing the esthetic impact of STA, though. Additionally, the use of the papilla index (Jemt 1997) is “considered inappropriate and biased” for papilla assessment for STA and IIP. Indeed, none of the currently used outcome scores have been designed to assess the esthetic outcomes of STA specifically.
Indications for STA during IIP
STA may be indicated for instances of increased risk for recession, e.g. when the following are present: a thin buccal soft-tissue phenotype, minor dehiscences (<2mm) or fenestrations (<3mm), a thin buccal bone plate (<0.5mm), <2mm mid-facial recession prior to tooth extraction, the root and facial bone plate protruding beyond the bony envelope, and a patient with a high esthetic demand.
Soft Tissue Volume Augmentation (STVA) During Early, Delayed, Late Implant Therapy
NSSD in PES, PROs, and PREs were observed comparing CTG and no grafting. However, negative control groups scores may indicate that patient selection for such studies was not appropriate. Additionally, when comparing xenograft vs. CTG, SSD in PES scores occurred favoring CTGs, though these were clinically negligible. Xenograft vs. CTG comparisons in patient morbidity and esthetic complications had NSSD (VAS, p=0.39), but one study had lower pain scores with xenograft (weighted mean difference: -2.83, p=0.003). Comparisons with xenograft vs. no graft during implant placement resulted in NSSD for oral health patient impact profiles (OHIP), but a signficantly more positive patient OHIP for xenograft when comparing grafting materials (p=0.01). Concerns about validity of OHIP and other scores are again discussed.
When collectively assessing surgical designs for STVA around implants, no difference exists supporting a specific design. One clinical and histological study found evidence that tuberosity grafts provide better long-term stability due to more lamina propria.
When comparing grafting vs. no grafting for soft tissue thickness, a preferential, significant difference for grafting in increasing mucosal thickness was seen (WMD: 0.64mm, p=0.01). Similarly, autologous grafts were preferred to substitutes (WMD: 0.51mm, p<0.001). Re: increasing KM, NSSD was seen for autogenous grafting vs. no grafting (WMD: 0.38mm) or vs. substitutes (WMD: -0.09mm). Such results were also seen when assessing KM with esthetic outcomes. However, STVA was preferred vs. no grafting when assessing mucosal margin levels (WMD: 0.5mm), and specifically autogenous grafting was preferred vs. substitutes (WMD: 0.5mm). NSSD was seen in peri-implant health (via PPD, BoP) when comparing autogenous grafts vs. no grafts and autogenous grafts vs. substitutes.
Indications for STVA for Early, Delayed, Late Implant Placement
The following are indications based on expert opinion: thin buccal/crestal tissue phenotype, soft tissue deficiency, hard tissue deficiency not involving the implant surface, and ridge contour deficiency.
Surgical Treatment of Buccal Peri-implant Soft Tissue Dehiscences (PSTD)
Reductions in PSTD depth following various STA techniques were approximately 2mm (93% coverage, and complete coverage in 71% of cases) with clinical attachment gains of 2.5mm. Soft tissue thickness and KM were also improved (1.66mm and 1.64mm, respectively). A CTG beneath a CTF, with or without vertical releasing incisions, achieved positive professionally assessed esthetic scores. Stable patient esthetic scores were also seen in as much as a 10yr follow-ups. Exposed metal remains a significant esthetic concern for patients compared to exposed root surfaces.
The presence of KM, and the absences of scar tissue and prominent frenum are important for PSTD management. Buccal implant position and angulation are negative determinants for treatment success, but the presence/absence of buccal bone on an implant does not appear to affect success for STA. Papillary height limits the coverage of the PSTD when interproximal soft-tissue loss is evident.
Regarding surgical technique, while both CAF + CTG and Tunnel + CTG improve PSTD outcomes, CAF + CTG has been shown to have superior PSTD coverage; but, this depends on site conditions and surgical expertise. A 2mm CTG thickness is normally sufficient for graft survival and discoloration masking, based on expert opinion.
Conclusion: Soft tissue augmentation for gingival recession, peri-implant dehiscences, and during implant placement should be performed based not only on expected dimensional changes but also clinician and patient reported esthetic outcomes. Esthetic outcome scores with improved validity in such scenarios are needed.
Topic: Abutment materials and their effects on the peri-implant soft tissue
Authors: Borie, M., Bosshardt, D., Liegeois, L., Lecloux, G., Haugen, H.J., Hede, D.V., Lambert, F.
Title: Peri- Implant Supracrestal Tissue Characteristics Related to Abutment Materials: A Comparative Histomorphometry Study
Source: Clinical Implant Dentistry and Related Research, August 2025
DOI: 10.1111/cid.70083
Reviewer: Malon Stratton
Type: Comparative study
Keywords: Dental implant, dental abutment, gingiva, implant-abutment design
Background: Integration of the mucosa to the transmucosal implant components serves a vital role in the long-term health of the implant. The peri-implant soft tissue is fragile and more prone to bacterial penetration and mechanical damage because of the arrangement of the collagen fibers running parallel to the implant surface. There are a variety of factors that can affect the soft tissue integration to the peri-implant surface. Among these is the materials for abutments (resin, titanium, and polyetheretherketone). Resin is controversial because of cytotoxicity reports. But some research indicates that proliferation and attachment of fibroblasts in resin abutments is similar to titanium abutments, along with similar soft tissue integration. Polyetheretherketone is another material that has been proven to enhance fibroblast viability, attachment, and proliferation to a greater extent than titanium. A recent report has highlighted the need for continual research to be conducted regarding the biological interaction of the abutment material and peri-implant soft tissues.
Purpose: This study seeks to evaluate and describe the peri-implant soft tissues (PIST) surrounding experimental abutments fabricated from titanium (Ti), dental resin (Re), and polyetheretherketone (PEEK).
Materials and Methods: Thirty bone-level implants were placed and received transmucosal healing abutments made from one of the tested materials. After 8 weeks of healing, the abutments along with the surrounding tissues were collected and processed for examination (histologically and histomorphometrically). Measurements included sulcus depth and the dimensions of epithelial and connective tissue attachment. Assessments were made of abutment surface features, inflammatory response, plaque accumulation, and peri-implant bone level alterations.
Results: Dimensions of various components of the PIST were similar among the three groups. The mean PIST dimensions measured 2.68 mm for Ti, 2.66 mm for Re, and 2.32 mm for PEEK. The mean sulcus depths were 0.71 mm for Ti, 0.74 mm for Re, and 0.68 mm for PEEK. The mean lengths of junctional epithelium were 1.82 mm for Ti, 1.56 mm for Re, and 1.53 mm for PEEK. The average thickness of the connective tissue (up to the abutment platform) measured 0.30 mm for Ti, 0.36 mm for Re, and 0.09 mm for PEEK. The resin group showed a significantly higher level of supramucosal biofilm accumulation.
Conclusion: The peri-implant soft tissues surrounding abutments made of Ti, Re, or PEEK appear to develop in a comparable manner. More extensive observation periods are necessary to assess potential long-term effects in using these materials.
Topic: New instrumentation for sinus elevation
Authors: Coutant, J.C., Naveau, A., Lauverjat, Y., Ella, B.
Title: Schneiderian Membrane Elevation up to 8 mm by Transcrestal Technique Using Hollowed Osteotomes: A Human Cadaver Study
Source: Clinical Implant Dentistry and Related Research, September 2025
DOI: 10.1111/cid.70096
Reviewer: Malon Stratton
Type: Clinical Study
Keywords: Schneiderian membrane, membrane elevation, hollowed osteotome, transcrestal approach
Purpose: The primary objective of this clinical study was to evaluate the detachment surfaces produced by elevation of the Schneiderian membrane by 4-8 mm in human cadavers with a residual bone height of 4 mm, utilizing the transcrestal technique with the new hollowed osteotomes. The secondary objective was to evaluate the membrane detachment amount in every direction around the site of the implants after both procedures.
Materials and Methods: The study was conducted in accordance with the CACTUS (Characteristics of Cadaver Training and Surgical Studies) guidelines. Thirty-four cadaver heads with type IV bone, residual bone heigh of 4 mm, and bilaterally posterior edentulous maxilla were selected based on cone beam computed tomography (CBCT) scans. The cadavers were randomly assigned to one of two experimental groups, with both maxillary sinuses of each head receiving the same treatment. Group 1 received sinus elevation of 4 mm and group 2 received sinus elevation of 8 mm. The procedure was performed at 68 sites using newly designed hollowed osteotomes (Magic Sinus Lifter, IBS Implant). This new generation of osteotomes has a hollow head which allows the forces to not be concentrated at one point, but to spread uniformly in all directions from the bone fragment. The membrane was lifted and detached from the maxillary osseous floor in a lower tensile strength and lower tear strength when compared to the classic osteotomes with dense tip. Postoperative CBCT scans were obtained to evaluate integrity of the membrane and to analyze the extent of membrane elevation in the mesiodistal and buccopalatal planes.
Results: Among the 68 sinus membrane elevations performed, perforations occurred in only 4 cases (2 in each experimental group). The differences in detachment surface between groups 1 and 2 demonstrated a strong linear correlation across all measured directions (ρ = 0.99). Statistical analysis using the Student’s t-test indicated significant differences in detachment surfaces between the two groups in every direction (p < 0.001). The ratio of detachment between Group 2 and Group 1 was consistent across directions (1.5 ≤ r ≤ 1.54). Overall, the transcrestal sinus membrane elevations of 4–8 mm achieved with hollowed osteotomes in cadaver specimens possessing 4 mm of residual bone height showed comparable procedural quality.
Conclusions: Using the new generation osteotome in a transcrestal approach enabled sinus membrane elevations of up to 8 mm in cadaver models, with a low rate of perforations. This innovative, hollowed osteotome allowed for controlled and predictable Schneiderian membrane elevation, demonstrating both safety and reproducibility. The transcrestal protocol may broaden the clinical applicability of the technique, particularly for single-implant cases and medically compromised patients for which the lateral window approach may pose excessive surgical risk.