Journal Club- January 2025
A multi-centre randomized controlled trial on alveolar ridge preservation with immediate or delayed implant placement: Need for soft-tissue augmentation. Cosyn J, Seyssens L, De Bruyckere T, De Buyser S, Djurkin A, Eghbali A, Lasserre JF, Tudts M, Younes F, Toma S. J Clin Periodontol. 2024 Dec;51(12):1644-1655. doi: 10.1111/jcpe.13911. Epub 2023 Dec 12. PMID: 38084405.
Systemic Antibiotic Prophylaxis Adjunctive to Surgical Reconstructive Peri-Implantitis Treatment: A Retrospective Study. Ramanauskaite A, Saltzer I, Padhye N, Begic A, Obreja K, Dahmer I, Schwarz F. Clin Implant Dent Relat Res. 2024 Dec 15. doi: 10.1111/cid.13429. Epub ahead of print. PMID: 39676072.
A 30-year retrospective cohort outcome study of periodontal treatment of stages III and IV patients in a private practice. Fardal, Øystein et al. Journal of Clinical Periodontology vol. 52,1 (2025): 102-112. doi:10.1111/jcpe.13877
Airflowing as an adjunctive treatment for periodontitis: A randomized controlled trial. Alsuwaidi, Salem et al. Journal of Periodontology vol. 95,11 (2024): 1048-1059. doi:10.1002/JPER.24-0099.
Wide Restorative Emergence Angle Increases Marginal Bone Loss and Impairs Integrity of the Junctional Epithelium of the Implant Supracrestal Complex: A Preclinical Study. Strauss FJ, Park JY, Lee JS, Schiavon L, Smirani R, Hitz S, Chantler JGM, Mattheos N, Jung R, Bosshardt D, Cha JK, Thoma D. J Clin Periodontol. 2024 Dec;51(12):1677-1687. doi: 10.1111/jcpe.14070. Epub 2024 Oct 9. PMID: 39385502; PMCID: PMC11651719.
Extended Platelet-Rich Fibrin as a Membrane for Lateral Window Sinus Lifts: A Case Series. Estrin NE, Basma H, Espinoza AR, Pinto MAC, Pikos MA, Miron RJ. Clin Implant Dent Relat Res. 2024 Dec 13. doi: 10.1111/cid.13427. Epub ahead of print. PMID: 39671152.
The Anatomy of the Mandibular Incisive Canal and Its Influence in Implant Therapy: A Scoping Review. Peña-Cardelles JF, Markovic J, Alanezi A, Hamilton A, Gallucci GO, Lanis A. Int J Periodontics Restorative Dent. 2024 Nov 15;44(6):709-719. doi: 10.11607/prd.6826. PMID: 38198437.
Effect of immediate all-digital restoration of single posterior implants: The SafetyCrown concept on patient-reported outcome measures, accuracy, and treatment time- A randomized clinical trial. Waltenberger L, Reich S, Zwahlen M, Wolfart S. Clin Implant Dent Relat Res. 2024 Dec;26(6):1135-1148. doi: 10.1111/cid.13374. Epub 2024 Aug 19. PMID: 39161052; PMCID: PMC11660521.
Retrospective Study on 57 Direct Interproximal Restorations with Supracrestal Tissue Attachment Violation: Follow-ups Between 10 and 23 Years. Pradella S, Morellini C, Formentini D, Del Fabbro M. Int J Periodontics Restorative Dent. 2024 Nov 15;44(6):663-672. doi: 10.11607/prd.6778. PMID: 38198431.
Sinus Bone Graft Stability and Implant Survival Following Transalveolar Sinus Floor Elevation in Severely Atrophic Maxilla: A Retrospective Study With 5-8 Years of Follow-Up. Mao Y, Shen Y, Dai J, Lu T, Wu Y, Shi Y, He F. Clin Oral Implants Res. 2024 Dec 18. doi: 10.1111/clr.14392. Epub ahead of print. PMID: 39695349.
Alveolar Ridge Regeneration With Open Versus Closed Healing in Damaged Extraction Sockets: A Preclinical In Vivo Study. Choi, J. W., Park, J. Y., Cha, J. K., Hieu, P. D., Jung, H. D., & Kim, C. S. Clinical Oral Implants Research, 28 Oct. 2024, 10.1111/clr.14376. doi:10.1111/clr.14376.
Performance and Strength Characteristics of Suture Knots in Periodontal Microsurgery: An In Vitro Study. Ariceta A, Casco ME, Kurlander P, Forti F, Camarano A, Volfovicz R, Chan HL, Velásquez-Plata D. Int J Periodontics Restorative Dent. 2024 Nov 15;44(6):653-661. doi: 10.11607/prd.6899. PMID: 37677083.
Impact of Glycine Powder Air-Abrasive Debridement on Peri-Implant Mucositis: A Randomized Control Trial of Clinical, Microbial, and Immunological Changes. Partido B, Saraswat S, Kumar PS. Clin Oral Implants Res. 2024 Sep 28. doi: 10.1111/clr.14361.
Long-term treatment outcomes of single maxillary buccal peri-implant soft tissue dehiscences: A 10-year prospective study. Roccuzzo A, Mancini L, Marruganti C, Ramieri G, Salvi GE, Sculean A, Roccuzzo M. Clin Implant Dent Relat Res. 2024 Feb;26(1):150-157. doi: 10.1111/cid.13273. Epub 2023 Sep 10. PMID: 37691144.
Ten-year follow-up after peri-implantitis treatment using resective surgery: A case report. César Neto, J. B., Dos Reis, I. N. R., Lazarin, R. O., Naenni, N., Villar, C. C., & Pannuti, C. M. (2024). Clinical Advances in Periodontics, 10.1002/cap.10310. Advance online publication. https://doi.org/10.1002/cap.10310.
The Impact of Membrane Stabilization for Alveolar Ridge Preservation in Periodontally Compromised Extraction Sockets: A Non-Inferiority Randomized Controlled Trial. Lee, S. J., Lee, J., Suh, H., Ko, Y. C., Urban, I., & Koo, K. T. (2024). Journal of Clinical Periodontology, 10.1111/jcpe.14092. Advance online publication. https://doi.org/10.1111/jcpe.14092.
Abstracts
Topic: soft tissue augmentation with immediate or delayed implants
Authors: Cosyn J, Seyssens L, De Bruyckere T, De Buyser S, Djurkin A, Eghbali A, Lasserre JF, Tudts M, Younes F, Toma S
Title: A multi-centre randomized controlled trial on alveolar ridge preservation with immediate or delayed implant placement: Need for soft-tissue augmentation.
Source: J Clin Periodontol. 2024 Dec;51(12):1644-1655.
DOI: 10.1111/jcpe.13911
Reviewer: Amber Kreko
Type: clinical study
Keywords: delayed, dental implant, immediate, single tooth, soft tissue
Purpose: To assess whether immediate implant placement or delayed implant placement will affect need for soft tissue augmentation and to identify risk factors for horizontal and vertical soft tissue loss. It is hypothesized that immediate placement reduces the need for soft tissue augmentation due to the support of the mucosa from provisional implant crowns.
Material and methods: Sixty patients with a failing tooth in the maxillary anterior were included. Patients were randomly assigned to two groups: 30 patients received alveolar ridge preservation with immediate implant placement (test group) and 30 patients received alveolar ridge preservation with delayed implant placement (control group). Immediate implants received a provisional crown and delayed implants were placed 6 months after extraction. Soft tissue was evaluated for need for augmentation, changes in the buccal profile, recession, and thickness at 6 month follow up by intra-oral exams and CBCT.
Results: One implant failed in the test group and two patients dropped out in the control group. It was determined that 24.1% of the test group and 35.7% of the control group needed soft tissue augmentation. There was a 0.53mm in test group and 0.87mm loss of buccal soft tissue profile. Midfacial recession was 0.58mm in the test group and 1.05mm in the control group.
Conclusions: Soft tissue augmentation was required more frequently for delayed implant placement but the result was not statistically significant. Patients with thin buccal soft tissues, with buccal bone dehiscence and treated with a delayed approach had more soft tissue loss based on the soft tissue changes found in the study.
Topic: systemic antibiotics and peri-implantitis
Authors: Ramanauskaite A, Saltzer I, Padhye N, Begic A, Obreja K, Dahmer I, Schwarz F.
Title: Systemic Antibiotic Prophylaxis Adjunctive to Surgical Reconstructive Peri-Implantitis Treatment: A Retrospective Study.
Source: Clin Implant Dent Relat Res. 2024 Dec 15
DOI: 10.1111/cid.13429
Reviewer: Amber Kreko
Type: clinical study
Keywords: dental implants, surgical reconstructive peri-implantitis treatment, systemic antibiotics
Purpose: To evaluate if oral systemic antibiotics after surgical reconstructive peri-implantitis treatment had any clinical efficacy.
Material and methods: Seventy implants with peri-implantitis in 49 patients were included. All patients received peri-implantitis treatment. Nonsurgical therapy with Er:YAG laser or airflow was done. After 2-6 weeks, full thickness flaps were reflected. Granulation tissue was removed and the implant surface was decontaminated with a titanium brush. Natural bone mineral (BioOss) was placed in defects and covered with resorbable collagen membrane (Bio-Gide). Flaps were sutured with nonresorbable sutures. Patients were divided into three groups for an antibiotic regime: 27 patients (38 implants) received a single preoperative shot of 2g amoxicillin, 12 patients (19 implants) received postoperative 500mg amoxicillin 3x daily for 3 days, and 10 patients (13 implants) did not receive any antibiotics. Mean probing depths, bleeding on probing, plaque, suppuration, and deepest probing depth values were assessed at baseline, 6 months, and 1 year.
Results: At 12 months, the mean probing depth reduction was 1.74mm for the no antibiotics group, 1.91 for the pre-op antibiotics group, and 1.13 for the post-op antibiotics group. No significant difference was found between the groups. Bleeding of probing was reduced 60% in the no antibiotics group, 59.3% in the pre-op antibiotics group, and 83.3% in the post-op antibiotics groups. Again, no significant difference was found. Disease resolution was 61.5% in the no antibiotics group, 73.7% in the pre-op antibiotics group, and 89.5% in the post-op antibiotics group. Comparable results were found for plaque, suppuration, and max probing depth reduction.
Conclusions: This study did not find there was an additional clinical benefit of oral systemic antibiotics with reconstructive peri-implantitis treatment. However, it did show a tendency toward a higher disease resolution suggesting that clinical benefits may depend on the severity of the disease.
Topic: Periodontal treatment outcome
Authors: Fardal, Øystein et al
Title: A 30-year retrospective cohort outcome study of periodontal treatment of stages III and IV patients in a private practice
Source: Journal of Clinical Periodontology vol. 52,1 (2025): 102-112.
DOI: 10.1111/jcpe.13877
Reviewer: Tam Vu
Type: Clinical (Retrospective)
Keywords: periodontal treatment, maintenance, outcomes, long term, tooth loss, prognostic factors
Purpose: To study patients with stage III and IV periodontitis over 30 years in private practice.
Material and methods: Patients referred to private practice between 1986 to 1990 were examined, diagnosed, treated, maintained and evaluated for at least 30 years. Tooth loss and dropouts were recorded.
Results: There were 386 patients included in this study, 8955 teeth studied, 117 patients were smokers, with an average follow up time of 16.3 years. A total of 103 patients completed more than or equal to 30 years of treatment. 283 patients dropped out for various reasons (deceased, medical, moving, unknown).
Tooth loss due to periodontal reasons fell into low-loss (0-3 teeth), 1.05 average teeth (65 patients); moderate-loss (4-6 teeth), average teeth 4.83 teeth (18 patients); and high-loss (≥7 teeth), 11.9 average teeth (20 patients). Low-loss group mainly showed loss in the molar regions, while high-loss distribution were similar in all types of teeth. Over time, 44.5% of tooth loss happened in high-loss group between 16 and 20 years, and an additional 26.1% between 21 and 30 years. Low-loss group saw 45.6% tooth loss between 21 and 30 years. Important prognostic factors for tooth loss includes: close relatives with periodontitis, starting periodontal therapy before age 35, diabetes, smoking, and number of teeth with poor prognosis.
Conclusion: Majority of stage III and IV periodontitis patients can be successfully treated and maintained for over 30 years, with the initial 10-15 years showing the most stable period. Tooth loss and prognostic factors affect patients differently, as some patients who have same characteristics and treatment ended up losing more teeth.
Topic: Erythritol airflow
Authors: Alsuwaidi, Salem et al
Title: Airflowing as an adjunctive treatment for periodontitis: A randomized controlled trial
Source: Journal of Periodontology vol. 95,11 (2024): 1048-1059
DOI: 10.1002/JPER.24-0099
Reviewer: Tam Vu
Type: Clinical (RCT)
Keywords: periodontal therapy, periodontitis, erythritol airflowing, patient-reported outcomes
Purpose: To compare outcomes of subgingival instrumentation (SI) with erythritol airflowing (EAF) to SI alone when treating periodontitis.
Material and methods: Patient diagnosed with stage III to IV periodontitis, smoking ≤10 cigarettes per day, and controlled medical conditions were included. Patients were randomly assigned to test (SI with EAF) and control (SI alone) group. Patients were re-evaluated at 3 and 6 months. Primary outcome measured was changes in percentage of probing depths ≥5 mm, and secondary outcomes including full mouth bleeding score (FMBS), full mouth plaque score (FMPS), and probing depths.
Results: There were 32 patients included in the study, 16 in each group. SI with EAF and SI alone both significantly reduced FMBS, FMPS, PD, and percent of sites with PD ≥5 mm at 3 and 6 months. There was a significantly higher reduction in FMBS at 3 (p=0.12) and 6 months (p=0.09) in the SI with EAF group, and also a significantly higher reduction of percent of sites with PD ≥5 mm at 6 months (p=0.22) when compared to SI alone. Patient-reported outcomes were not significantly different between groups, however, the psychosocial aspect of treatment at 6 months favored the SI with EAF group.
Conclusion: The use of EAF in addition to SI did not provide significant improvement in clinical outcomes over 6 months. Patients found short-term physiological improvement in quality of life with EAF.
Topic: Implant Supracrestal Complex-restorative emergence angle
Authors: Strauss FJ, Park JY, Lee JS, Schiavon L, Smirani R, Hitz S, Chantler JGM, Mattheos N, Jung R, Bosshardt D, Cha JK, Thoma D.
Title: Wide Restorative Emergence Angle Increases Marginal Bone Loss and Impairs Integrity of the Junctional Epithelium of the Implant Supracrestal Complex: A Preclinical Study.
Source: J Clin Periodontol. 2024 Dec;51(12):1677-1687..
DOI: 10.1111/jcpe.14070
Reviewer: Daeoo Lee
Type: Longitudinal, preclinical, Animal (dogs)
Keywords: implant, emergence angle, supracrestal complex, marginal bone loss (MBL)
Purpose: To evaluate the impact of the emergence angle on initial marginal bone loss (MBL) and the supracrestal soft tissue surrounding dental implants.
Material and methods: Six (6) dogs were involved in the study. Premolars and molars on the posterior regions of the mandible were extracted. Alveoplasty was performed to flatten the ridge. Flaps were adapted to achieve primary intention. Three-month post extraction, four dental implants (3.8x7mm, bone level, Camlog Biotechnologies) were placed bilaterally with a minimum insertion torque of 15Ncm. Each implant also randomly received abutments with emergence angles of 20°, 40°, 60° or 80°. Post-surgically, NSAID(Meloxicam) and antibiotics (Cefazolin sodium) was administered once daily for 7 days. Six (6) months post-op all the dogs were euthanized. Clinical parameters including BOP and plaque index were gathered. Implant sites were resected and stored in formaldehyde/phosphate buffer. For analyzing MBL, periapical radiographs were taken at the baseline, 6, 9, 16, and 24 weeks post implant placement. Micro-CT (3d) scanning was performed on resected samples to determine corono-apical distance between the most apical portion of the implant shoulder and the first bone-to-contact (fBIC) point coronally. Synchrotron imaging or high resolution monochromatic X-ray imaging was performed on the 24 weeks post-op samples. Histological analysis was performed. Finally, statistical analysis was performed.
Results: All implants placed were osseointegrated and healed within normal limits. Radiographic analysis at the 24 weeks post-op revealed abutments with wider restorative angles had greater MBL. Specifically, the MBL for restorative angles of 20° and 40° were 0.07mm and 0.11mm respectively. The 60° group had 0.23mm of MBL and the 80° group had 0.38mm of MBL at the 24 weeks mark. Micro-CT analysis showed that the 20° group had the lowest fBIC value (Mesial: 0.10mm, Distal: 0.25mm, Buccal: 0.99mm) when compared to the 80° group which had the highest fBIC value (Mesial: 0.44mm, Distal: 0.52mm, Buccal: 1.66mm). In terms of clinical parameters at the 24 weeks mark, the 20° group had the least amount of BOP (14%). The 40° group had 25% of BOP, the 60° group had 31% of BOP, and the 80° group had 25% of BOP. In terms of amount plaque, group 20° and 40° had 66.6% while group 60° had 91.7% and group 80° had 100%. Histomorphometric analysis revealed there were no statistically significance difference between group when looking at median fBIC values. All samples from each group showed presence of keratinized oral epithelium however the quality of soft tissue varied based on the restorative angles. Group 20° and 40° had continuous and intact JE as well as organized connective tissue around the abutment. Group 60° and 80° had disorganized connective tissue comprising inflammatory cells. When looking at distance from inflammatory infiltrate to fBIC (buccal sites), group 20° had 1.69mm, group 40° 1.67mm, group 60° had 1.09mm and group 80° had 1.00mm.
Conclusions: Wide restorative angles lead to greater marginal bone loss (MBL) and compromise the integrity of the junctional epithelium around implant sites. Conversely, narrow restorative angles help reduce MBL and promote the formation of a continuous junctional epithelium, minimizing mucosal inflammation. Thus, maintaining a restorative angle as narrow as clinically feasible (< 40°) is advisable.
Topic: Extended PRF-Lateral sinus lifts
Authors: Estrin NE, Basma H, Espinoza AR, Pinto MAC, Pikos MA, Miron RJ.
Title: Extended Platelet-Rich Fibrin as a Membrane for Lateral Window Sinus Lifts: A Case Series.
Source: Clin Implant Dent Relat Res. 2024 Dec 13.
DOI: 10.1111/cid.13427
Reviewer: Daeoo Lee
Type: Multicenter case series
Keywords: platelet rich fibrin (PRF), sinus lift, lateral, membrane, heat, resorption
Purpose: To examine the reliability and safety of extended PRF (e-PRF) membrane to cover lateral window in sinus augmentation.
Background: e-PRF extends the typical resorption time of 2 weeks of PRF to 4-6month.
Material and methods: Three different clinics participated in the study (22 patients). For each patient, lateral osteotomy was created using a bur. Residual bone height (RBH) was determined by CBCT analysis. Clinicians were free to choose any type of bone materials (i.e., FDBA, FDBA + DBBM, or DBBM + autologous dentin) to be mixed with PRF for creating sticky bone. The protocol for making sticky bone include the steps of using two blue liquid-PRF tubes and two red solid-PRF tubes for horizontal centrifugation at 700 RCF for 8 min (Bio-PRF). PRF solid fragments from the red tubes was mixed with bone particles and liquid PRF drawn from the blue tubes. Each lateral window sinus utilized e-PRF membrane to cover opening of the window. The protocol for making e-PRF include using two blue liquid-PRF tubes to horizontally centrifuge at 700 RCF for 8 minutes. After centrifugation, platelet poor plasma (PPP) layer was drawn and placed in a 75°C setting for 10 minutes. During this process albumin content is denatured to produce plasma gel with 4-6 month working time. Liquid PRF drawn from the buffy coat layer of the second tube is drawn up to be mixed with the plasma gel to re-introduce albumen and autologous growth factor. The mixture was left for 10-15 minutes in a customized shaped tray ideally in a setting of 37°C. CBCT analysis was utilized for assessing bone level during second stage implant placement to assess bone changes from baseline.
Results: A total of 31 implants were placed. 100% of implant survived with no complications. Follow-up period ranged from 6 to 18 month (mean 10.8 months). The average RBH was 4.3mm and average bone gain was 8.0mm (3.9mm to 13.2mm).
Conclusions: The e-PRF membrane demonstrated reliability in terms of covering sinus opening during lateral window sinus lift procedure.
Topic: Incisive canal
Authors: Peña-Cardelles JF., Markovic J., Alanezi A., Hamilton A., Gallucci GO., Lanis A.
Title: The Anatomy of the Mandibular Incisive Canal and Its Influence in Implant Therapy: A Scoping Review
Source: Int J Periodontics Restorative Dent. 2024 Nov 15;44(6):709-719
DOI: 10.11607/prd.6826
Reviewer: Cyrus J Mansouri
Type: Scoping review
Keywords: dental implant, mandibular incisive canal, mandibular incisive nerve, neuropathy
Background: It is unclear whether damage to the mandibular incisive nerve (MIN) is associated with any morbidities.
Purpose: To describe the mandibular incisive nerve anatomy related to potential interferences in implant therapy.
Material and methods: A scoping review was performed to highlight knowledge voids and elucidate fundamental concepts in the available evidence. The Joanna Briggs Institute method was used employing population, concept, and context (PCC). Population: patients undergoing dental implant placement with cone beam computed tomography (CHCT) studies in the anterior area or cadavers studied to understand anatomical characteristics of the MIN. Concept: the MIN anatomy and its relationship to potential complications in implant therapy. Context: anatomical and radiologic research. An electronic database search was completed. Included studies should assess anatomical characteristics of the MIN, utilizing CBCT imaging on patients or cadavers. MIC diameter and length, trajectory, and any possible physical damage produced in patients or cadavers during implant placement procedures.
Results: A total of 14 studies were included in the review. All studies were observational of anatomical characteristics conducted by CBCT on patients or were cadaver studies. Nine used CBCT on patients. A total of 1,471 patients/cadavers were studies. The mandibular incisive canal (MIC) was present in 100% of samples in CBCT studies performed on cadavers. The canal is easier to detect in dentate than edentulous mandibles. MIC diameter ranged from 0.5-2.9 mm. Diameter may be greater in males. The course of the canal is reported close to the mandible’s buccal border and inferior margin. It has also been described 9.7 mm from the mandibular cortical border. Evidence is currently lacking to describe a safe zone for the MIN. MIC has been demonstrated to only be found in 2.7% of panoramic radiographs. However, a detection rate of 100% has been demonstrated by CBCT analysis in another study. Regarding damage to the MIN, one study found that at least 44% of implant placements passed through the MIN. However, neurovascular alterations due to the damage was not reported as the study was not performed on live patients. Another retrospective study reported on patients perceiving neurovascular alteration in the anterior region. CBCT analysis showed 100% of cases had MIN damage due to the implant passing through the MIC. A total of 30% of these cases are still experiencing altered sensations 2 years later.
Conclusion: Evidence for MIN damage due to implant placement is likely present in the literature. More studies are necessary to assess MIN damage, understand clinical relevance, associated morbidities. Due to different anatomical presentations, CBCT analysis assessing for MIC is recommended to prevent complications during implant placement in the anterior mandible.
Topic: Immediate provisionalization in the posterior
Authors: Waltenberger L., Reich S., Zwahlen M., Wolfart S.
Title: Effect of immediate all-digital restoration of single posterior implants: The SafetyCrown concept on patient-reported outcome measures, accuracy, and treatment time—A randomized clinical trial
Source: Clin Implant Dent Relat Res. 2024 Dec;26(6):1135-1148.
DOI: 10.1111/cid.13374
Reviewer: Cyrus J Mansouri
Type: Randomized clinical trial
Keywords: CAD/CAM, guided surgery, immediate restoration, OHRQoL, one-abutment/one-time, PROM, single implants, time assessment
Purpose: To assess the effect of a digital immediate restoration workflow on dental patient-reported outcome (dPRO), such as patient satisfaction and perception of healing, compared to the conventional restorative protocol. Feasibility of the treatment concept, implant accuracy, and treatment duration were also assessed.
Material and methods: Patients with a healed single edentulous posterior site were recruited for implant placement with or without immediate restoration. To allow for virtual planning, intraoral and cone beam computed tomography (CBCT) scans were performed to obtain standard tessellation language (stl) and Digital Imaging and Communication in Medicine (DICOM) files. Virtual planning was performed within the coDiagnostiX software, where scans were superimposed, a virtual tooth wax-up was performed, and the implant was placed in the correct position. The implant shoulder was planned 0.5 mm subcrestal. A Straumann BLX implant was used with diameter 3.75-4.5 mm and length 8-14 mm to achieve high primary stability. Drill guides were 3D printed with drill sleeves planned 4 mm above the implant shoulder. For the test group, a prefabricated definitive custom abutment was made of 3Y-TZP zirconia with cementation line placed 1 mm supragingival. Abutment was finished to a high-gloss with no stain or glaze. Following an adequate pre-op antibiotic dosage, a full thickness flap was raised, and implant preparation was performed fully guided, tailored to the patient’s bone density to aim for 35-50 Ncm insertion torque. Implants reaching an implant stability quotient (ISQ) of 70 and 35 Ncm torque qualified for immediate restoration in the test group. After placing a scan body and obtaining an intraoral scan, definitive abutments were placed and torqued to 15-20 Ncm. Screws were retightened later after osseointegration. Sites were closed with 5-0 polypropylene. The previous intraoral scan was modified to capture the abutment in place. A provisional polymethyl methacrylate (PMMA) restoration was fabricated without occlusal or proximal contacts and cemented using provisional cement (TempBond). A closure cap was placed in the control group. Oral-health related quality of life (OHRQoL) was measured using the oral health impact profile (OHIP-G14). The questionnaire contains 14 questions about impairments within the last 7 days, graded on a 5-point scale from “never” = 0 to “very often” = 4. Lower scores indicate a higher OHRQoL. Subjects were assessed at the first visit and before suture removal. dPROs were reported on a visual analog scale (VAS) from 0 to 100 with questions focusing on the stress from implant placement, stress from healing, overall satisfaction, importance of immediacy, and satisfaction with the provisional restoration. Implant placement accuracy was also measured.
Results: A total of 45 implants were placed in 39 participants, of which 23 were test sites and 22 were control sites. The mandibular first molar was the most restored site (62%). The complete provisionalization workflow was performed in 21/23 test sites (91.3%). A lack of primary stability precluded immediate loading in two cases. All implants survived the study period. One subject with a history significant for severe diabetes experienced local inflammation accompanied by screw loosening. The immediate restoration was removed, and a healing abutment was placed in this case. OHRQoL decreased in each group from surgery to 7-day follow-up, evidenced by OHIP-G14 scores increasing by 3.4 points in the test group and 3.5 in the control group. Regarding dPROs, patients did not rate immediate restoration as more stressful than implant placement alone, with VAS scores 14.1 and 18.5 in the test and control groups, respectively. Stress levels during healing and overall satisfaction with outcomes were also similar between groups. Regarding the rating of whether immediate loading is an advantage in the treatment process along with the omission of a second stage operation, subjects in the test group rated to workflow advantage significantly higher than the control group (VAS 93.8 and 74.6, respectively). For the importance of immediate restoration, test and control groups rated significantly different again (92.2 and 59.1, respectively). For the test group, overall satisfaction of immediate restoration was above 90 and cleansability rated 82.3. Analgesic use was similar between groups. Implant accuracy had 3.2 degree of deviation. Body deviation was 0.57 mm at the implant shoulder and 0.95 mm at the apex. Implant platform was 0.32 mm deeper than the planned position. Virtual implant planning did not take significantly more time for the test group. Abutment design took an average of 11 minutes. Surgery took approximately twice as long in the test group (61.9 min vs 31.9 min).
Conclusion: Implants were successfully placed in healed sites and restored with a definitive abutment and provisional crown in 21/23 cases (91.3%). OHRQoL measures were not significantly different in the healing period whether patients received an immediate restoration or not. Overall satisfaction was high in both groups. Patients who received the immediate restoration deemed the workflow more of an advantage and more important than subjects in the control group. The process increased chair time, however the need for a second-stage surgery and impression making was eliminated in the process.
Topic: Supracrestal Tissue Attachment Violation
Author: Pradella S, Morellini C, Formentini D, Del Fabbro M.
Title: Retrospective Study on 57 Direct Interproximal Restorations with Supracrestal Tissue Attachment Violation: Follow-ups Between 10 and 23 Years.
Source: Int J Periodontics Restorative Dent. 2024 Nov 15;44(6):663-672.
DOI: 10.11607/prd.6778.
Type: Clinical Study
Reviewer: Veronica Xia
Keywords: supracrestal tissue attachment, violation, bone loss
Purpose: The purpose of this study is to investigate a minimally invasive approach to treating severely decayed teeth, whose restorative margin potentially violates the supracrestal tissue attachment (STA). Furthermore, a 10 year examination of vertical bone loss following treatment was included.
Material and methods: This study included deep interproximal restorations on molars and premolars. To obtain isolation with rubber dams and clamps, either flapless (involving fiberotomy of supracrestal connective fibers) or a flap approach was utilized. No curettage was performed on the root surfaces to allow for reattachment of connective tissue. Cavity preparations were completed with burs, followed by placement of convex sectional matrix bands. Cavities were then treated with 37% orthophosphoric acid and Syntac Classic adhesive. Composite restorative material was placed and cured, and areas needing sutures were closed. These sites were then followed up for 10 years.
Results: 57 total restorations were included in the study. The flap approach was utilized at 12 sites, while the fiberotomy approach was completed at 45 sites. Follow up visits revealed that bone loss increased significantly when using an electric brush. There were no significant findings of associations between restorative distance from bone crest and vertical bone loss.
Conclusions: The average bone loss was very limited at 0.46mm, indicating that bone levels can remain stable if proper isolation, adhesion, and restorative protocols are performed—regardless of violation of the STA. Therefore, in sites with deep restorative margins, bone recession and surgery may be avoided.
Topic: Sinus Floor Elevation
Author: Mao Y, Shen Y, Dai J, Lu T, Wu Y, Shi Y, He F.
Title: Sinus Bone Graft Stability and Implant Survival Following Transalveolar Sinus Floor Elevation in Severely Atrophic Maxilla: A Retrospective Study With 5-8 Years of Follow-Up.
Source: Clin Oral Implants Res. 2024 Dec 18.
DOI: 10.1111/clr.14392.
Type: Retrospective Study
Reviewer: Veronica Xia
Keywords: sinus floor elevation, bone gain, residual bone height, implant survival
Purpose: The purpose of this study was to investigate the effectiveness and viability of grafting with transalveolar sinus floor elevation (TSFE), in terms of bone gain, at atrophic maxillary sites. Furthermore, implant survival factors were also examined.
Material and methods: Two protocols for sinus floor elevation (SFE) were utilized: the osteotome sinus floor elevation (OSFE) technique and the crestal approach sinus (CAS) technique. OSFE involved the use of a series of osteotomes to “infracture” the sinus floor, followed by verification of intact sinus membrane using the Valsalva maneuver, then placement of deproteinized bovine bone. When the sinus membrane perforation was noted, the lateral sinus floor elevation (LSFE) technique was utilized. The CAS approach involved the use of CAS kit drills to remove residual bone close to sinus floor, followed by introduction of sterile saline via a rubber pipe close to elevated sinus membrane. The Valsalva maneuver was completed, and bone was placed when no membrane perforation was detected. Implant survival at sites was measured by: no pain/discomfort, no peri-implant infection, no continuous radiolucency around implants, no detectable implant mobility. Radiographs were utilized to measure bone levels and bone loss.
Results: 105 patients were included in the study, with an overall survival rate of 94%. At 1 year follow up, the marginal bone loss (MBL) was 0.67+/-0.37mm and endo-sinus bone gain (ESBG) was 6.6+/-1.76mm. At 8 years post-op, MBL was 0.65+/-0.14mm and ESBG was 5.88+/-1.77mm. 89.9% of sites with ESBG >/-4mm was observed at 5-8 years postop, and 58.59% of sites observed ESBG >/=6mm. At 8 years, the overall implant survival rate was at residual bone height (RBH) sites <4mm was 88% and at RBH sites 4-6mm was 98%, with a significantly lower survival when RBH <4mm. Regarding statistical analysis of ESBG, values were 0.68mm greater at first molar sites, 1.829mm lower when implant lengths were <10mm, and 0.723mm higher when using the water lift system.
Conclusions: Overall, TSFE is a viable and effective method of sinus augmentation in the atrophic maxilla. When RBH was 4-6mm, implant survival rates of 98% were present with favorable medium- and long-term results. In areas when RBH was <4mm, implant survival rates were significantly reduced at 88%. In terms of ESBG, positive correlations with first molar sites, SFE elevation methods, and implant length were noted.
Topic: Ridge Preservation
Author: Choi, et al.
Title: Alveolar Ridge Regeneration With Open Versus Closed Healing in Damaged Extraction Sockets: A Preclinical In Vivo Study
Source: Clinical Oral Implants Research
DOI: 10.1111/clr.14376
Reviewer: Ryan Higgins
Type: In Vivo Study
Keywords: alveolar ridge preservation, damaged extraction socket, animal experiment, non-cross-linked collagen membrane, open healing, primary closure
Purpose: To compare open versus closed healing of soft and hard tissue following alveolar ridge preservation (ARP) procedures in damaged extraction sockets
Materials and Methods: Five mongrel dogs received ARP using 100mg of collagenated deproteinized bovine bone mineral (cDBBM; Bio-Oss Collagen) and a resorbable non-cross-linked collagen membrane (NCCM; Bio-Guide) in damaged extraction sockets, with each socket entrance either left open (open group) or closed (closed group). The buccal bone plate defects were created to the length of the root to simulate the periodontally damaged extraction socket. Repositioning suturing was performed in the open group, while coronally positioned suturing was completed to achieve primary closure in the closed group. Suture materials were removed after two weeks.
Through the course of healing the clinical wound epithelization at the socket entrance and the dimensions of keratinized tissue were evaluated over time using intraoral scanners immediately postoperatively, and at 2,4, and 8 weeks. The augmented ridge dimensions and new bone formation were assessed radiographically and histologically at 8 weeks after surgery.
Results: The authors found that when investigating the dimensions of the socket entrance they gradually decreased in the open group, and wound epithelization was almost complete within 4 weeks. When comparing the mucogingival junction of each group it was found that the junction was maintained more apically in the open group than the closed group (0.14 ± 0.40 mm vs. −0.86 ± 0.71 mm [mean ± SD], p < 0.05). The reduction in ridge width did not differ significantly between the open group (18.2% ± 2.4%) and the closed group (15.7% ± 3.1%). There were no significant differences in terms of the vertical ridge changes between the open group (0.196 ± 0.084 and 0.028 ± 0.013 mm) and the closed group (0.226 ± 0.090 and 0.037 ± 0.014 mm) for the buccal and lingual areas.
The height of the buccal bone, both groups showed reduction compared to the pristine site (1.19 ± 0.46 and 1.49 ± 0.18 mm, respectively), and the reduction in height was significantly greater in the closed group. The augmented ridge dimensions did not differ significantly between the open and closed groups (93.1% ± 5.4% vs. 88.3% ± 11.2%, p > 0.05). The radiographic ridge width decreased significantly in the coronal region of both the open group (−18.1% ± 14.2%) and the closed group (−21.0% ± 7.9%), with no significant intergroup difference.
Histological analyses revealed no significant differences in the amount of newly formed bone. It is important to note though that there was more pronounced membrane resorption in the crestal region of the open group.
Conclusions: When comparing the open vs. the closed healing approaches for ARP in extraction sockets with damaged buccal walls there was similar ridge dimensions and new bone formation. The areas in which the open technique did provide better results was that of less reduction of buccal bone crest and wider keratinized tissue width after open healing.
Topic: Suture Knots
Author: Ariceta, et al.
Title: Performance and Strength Characteristics of Suture Knots in Periodontal Microsurgery: An In Vitro Study
Source: Int J Periodontics Restorative Dent. 2024 Nov 15;44(6):653-661.
DOI: 10.11607/prd.6899
Reviewer: Ryan Higgins
Type: In Vitro Study
Keywords: knots, periodontal microsurgery, sutures, wound healing
Purpose: The aim of this study was to investigate the types of know failure (untying or breaking) and the tension required to break different suture diameters.
Materials and Methods: Using 6/0,7/0,8/0 polyamide sutures, a total 150 knots were fabricated with either squared or slipped throws of 2,3,4,5, and 6. Ten types of knots were subjected to tension: 1=1, 1×1, 1=1=1, 1x1x1, 2=1, 2×1, 2=2, 2×2, 2=2=2, and 2x2x2 (= represents parallel of square knot, x represents crossed or slip knot). The data collected included the type of failure (untied or broken), number of throws, the tension required to untie or break each knot, slippage, and elongation of the knot. The knots were tied in a standardized way with a device and weights to which they were then subjected to a controlled tension.
Results: The knots that became untied were 1=1, 1×1, 2=1, and 2×1. The remaining knots did not untie, but broke. It was found that it took at least three throws to prevent untying (1=1=1 or 1x1x1). The mean tension needed to break the knots in 6/0,7/0,8/0 sutures was 3.1,1.3, and 0.6N respectively. The break tension was determined irrespective of the knot type. Among the sutures four types of knots (1=1, 2=1, 1×1, and 2×1) untied at 0.69N compared to the remaining six knot types that did not untie, but broke. The ANOVA test found that the type of knot significantly affected the final tension for 7/0 and 8/0 but not 6/0 sutures. The 2x2x2 and 2=2=2 knot types exhibited approximately 0.4N higher tension compared to the 1x1x1 and 1=1=1 in 7.0 sutures and the 0.3N for the 8/0 sutures.
It was noted that knots that broke first underwent elongation of the suture that results in ends/tails suffering slippage as the knot tightened and ultimately broke. Knots that did not break only their elastic zones were observed, indicating that no deformation occurred. There was no substantial evidence that different knot types have substantial differences in suture elongation, end slippage, and maximum force required to break once they are securely tied.
Conclusions: Knots that have the geometries of 2=2/2×2 and 1=1=1/1x1x1 were secure, and that having additional throws does not increase their security. It can also be concluded that tensile strength reduces with decreased suture size.
Topic: Treatment of Peri-Implant Mucositis
Authors: Partido B, et al.
Title: Impact of Glycine Powder Air- Abrasive Debridement on Peri- Implant Mucositis: A Randomized Control Trial of Clinical, Microbial, and Immunological Changes
Source: Clinical Oral Implants Research, 2024; 0:1–10
DOI: 10.1111/clr.14361.
Reviewer: Nicolas Lobo
Type: RCT
Keywords: clinical research; clinical trials; microbiology.
Purpose: To evaluate the efficacy of glycine powder in reducing clinical inflammation and reestablishing host-microbial balance.
Materials and Methods: This study involved recruiting 30 patients undergoing maintenance therapy at 3 months intervals. Implant sites with peri-implant mucositis were assessed clinically and radiographically. Inclusion criteria required a single unit implant crown, showing peri-implant mucosal inflammation indicated by bleeding on probing (BoP) and visible signs of inflammation, without any radiographic bone loss compared to a prior radiograph, while exclusions included factors like recent antibiotics, systemic conditions affecting oral health (hyperglycemia, pregnancy) untreated periodontitis, and peri-implantitis. A parallel-design, single-center, randomized controlled trial assigned subjects to glycine powder air-abrasive debridement (GPAD) or ultrasonic therapy. Treatments were standardized, and subjects received oral hygiene instructions reinforced verbally and in writing.
Clinical examinations included probing depths (PD), modified sulcus bleeding index (mSBI), and modified plaque index (mPlI). Biofilm and peri-implant crevicular fluid (PICF) samples were collected, processed for sequencing, and analyzed using advanced pipelines to evaluate microbial profiles. PICF cytokines were analyzed using multiplex bead-based assays to measure 27 inflammatory markers.
Results: This study compared the effects of glycine and ultrasonic therapy on peri-implant health in 30 participants, all of whom completed the study without dropouts. Both groups were demographically and clinically similar at baseline. While reductions in the mSBI at 6 months were non-significant for both groups, glycine therapy showed significant improvements from 1 week to 3 months, whereas ultrasonic therapy demonstrated improvements only at 1 and 3 weeks. PD significantly decreased in both groups at 1 week, but the reductions were sustained until 3 months with glycine therapy, compared to 3 weeks with ultrasonic therapy. Plaque levels significantly declined from 1 day to 6 weeks in both groups without intergroup differences. Glycine therapy also resulted in sustained reductions in mucosal inflammation and more pronounced improvements in microbiome diversity, including a reduction in pathogens like Fusobacterium nucleatum, from 1 week to 6 months. Additionally, glycine treatment significantly decreased pro-inflammatory markers (IL-1β, IL-2, IL-6, RANTES, VEGF) and increased anti-inflammatory IL-10 levels for up to 3 months, while ultrasonic therapy showed less pronounced and shorter-lasting effects.
Conclusions: Glycine therapy demonstrated more consistent and prolonged benefits across clinical, microbiological, and inflammatory outcomes compared to ultrasonic debridement, inducing earlier and more sustained changes in host-microbial interactions. However, the effects of both therapies were maintained for a maximum of 3 months.
Topic: Peri-Implant soft tissue dehiscences
Authors: Roccuzzo A. et al.
Title: Long-term treatment outcomes of single maxillary buccal peri-implant soft tissue dehiscences: A 10-year prospective study
Source: Clin Implant Dent Relat Res.2024;26:150–157
DOI: 10.1111/cid.13273
Reviewer: Nicolas Lobo
Type: Prospective study
Keywords: aesthetics, dental implants, peri-implant soft tissue, peri-implant soft-tissue dehiscence, PROMs, soft tissue graft
Purpose: To evaluate the results over 10 years of surgically treated shallow, isolated peri.implant soft tissue dehiscences (PSTD) at single-tissue level implant
Materials and Methods: This study evaluated 16 patients (mean age 53.1 ± 11.7 years; 3 smokers) treated for periodontal disease and rehabilitated with non-submerged implants (Straumann Tissue Level) in anterior and posterior areas, with no bone/soft tissue augmentation, before or concomitant with implant placement.
Inclusion criteria, including the presence of an implant-supported single unit crown in the maxillary area displaying an apical displacement of the mucosal margin without bidimensional radiographic evidence of interproximal bone loss and/or adjacent recession of the papillae, healthy systemic conditions and lack of supportive peri-implant care (SPC) program. Exclusions included presence of multiple adjacent, interproximal or PSTDs associated with incorrect implant positioning, deep probing depths and heavy smoking. Following baseline assessments of plaque, bleeding, probing depth, and tissue dehiscence, patients underwent tailored oral hygiene instruction and motivation to achieve compliance before surgery.
Surgical intervention involved a minimally invasive split-thickness flap with connective tissue grafting from the tuberosity area. Post-surgical care included enrollment in individualized supportive periodontal care (SPC) programs. Follow-ups at 5 and 10 years were conducted by a blinded examiner, measuring probing depths (PD), soft tissue recession, plaque (FMPS), bleeding (BoP), and full-mouth bleeding scores (FMBS). Aesthetic outcomes were assessed on photographs using a visual analog scale (VAS).
Results: At the 10-year follow-up, 12 patients completed the study, with SPC program proceeding without issues. Clinical outcomes showed substantial improvements in mucosal recession, decreasing from 1.9 mm ± 0.7 at baseline to 0.2 mm ± 0.3 at the 1-year follow-up and remaining stable over 10 years. Mean dehiscence coverage at 10-years was 89.6% ± 17.1%, with complete coverage in 58.3% of cases. Aesthetic outcomes improved significantly, with VAS scores increasing from 3.6 ± 0.6 at baseline to 8.5 ± 0.9 at 10 years. Clinical peri-implant parameters, such as PD and BoP, showed no significant changes across follow-ups. Patients reported high satisfaction, with a mean score of 9.5 ± 0.8 at 10 years. FMPS and FMBS remained stable, with no significant differences between baseline and 10 years. The study demonstrates sustained clinical and aesthetic benefits over a decade.
Conclusions: The outcomes showed that the proposed surgical technique is a simple and reliable treatment option to treat the single maxillary PSTDs in selected cases. Over the long term, patients demonstrated stability in clinical parameters and high aesthetic satisfaction, highlighting the efficacy of the surgical and maintenance protocols.
Topic: Peri-implantitis treatment
Authors: César Neto, J.B., et. al.
Title: Ten-year follow-up after peri-implantitis treatment using resective surgery: A case report.
Source: Clinical Advances in Periodontics, 10.1002/cap.10310. Advance online publication
DOI: 10.1002/cap.10310
Type: Case report
Reviewer: Mahya Sabour
Keywords: Dental implants, peri-implantitis, resective surgery
Purpose: report the clinical and radiographic outcomes of a peri-implantitis case treated with implantoplasty, prosthetic modifications, and maintenance over a 10-year follow-up period.
Materials and Methods: Clinical Presentation:
A 50 year old female in good health presented with 6 maxillary implants supporting a full-arch fixed prosthesis opposing 3 mandibular partial fixed prostheses supported by 3 implants on the left and 4 on the right. Implants had external hexagon connections, smooth surfaces and were poorly positioned, interfering with proper oral hygiene. All implants were diagnosed with peri-implantitis. 2 maxillary implants were removed while the remaining were treated with access surgery, implantoplasty, and a new bar overdenture to facilitate hygiene. Mandibular implants were initially treated non-surgically, but two (#19 and 20) required surgical treatment via access flap, implantoplasty, minor osteotomy, and prosthesis adjustment after 3y due to increased PD, BOP, and increased radiographic bone loss.
Case Management:
Maintenance performed every 3-4 months with manual/ultrasonic debridement and air-abrasive powder. Localized subgingival instrumentation was completed in sites with PD>4mm and BOP or mineralized deposits. Prostheses were removed annually for inspection and cleaning. Radiographs were updated every 2-3y. Patient was compliant and adhered to oral hygiene instructions, however progressive radiographic bone loss and suppuration was seen around two (#30 and 31) mandibular implants at the last maintenance visit. Microsurgical treatment via ultrasonic instrumentation with diamond tips was used for decontamination and implantoplasty at these sites.
Results: All maxillary implants presented with PD<4mm, no BOP, or suppuration while #30 and 31 presented with BOP. All implants were radiographically stable over time with an average BOP of 17.5% at the last follow up, with the exception of #30 and 31 that were only clinically and not radiographically assessed. No negative mechanical impacts were seen from implantoplasty.
Conclusion: Favorable long-term clinical and radiographic results can be obtained in the treatment of peri-implantitis with a combined approach of implantoplasty and prosthesis replacement and/or recontouring to allow for adequate oral hygiene.
Topic: Alveolar Ridge Preservation
Authors: Lee, S.J., et al.
Title: The Impact of Membrane Stabilization for Alveolar Ridge Preservation in Periodontally Compromised Extraction Sockets: A Non-Inferiority Randomized Controlled Trial
Source: Journal of Clinical Periodontology, 10.1111/jcpe.14092. Advance online publication.
DOI: 10.1111/jcpe.14092
Type: Randomized Control Trial
Reviewer: Mahya Sabour
Keywords: Membranes, alveolar ridge preservation, extraction, soft tissue contour
Purpose: Primarily assess the effect of membrane stabilization with sutures on alveolar ridge preservation (ARP) outcomes in periodontally compromised extraction sites and secondarily assess alveolar ridge dimensional changes, wound healing, patient reported and histomorphometric outcomes.
Materials and Methods: 22 healthy patients with a single molar extraction socket presenting with >50% buccal and palatal/lingual walls but ideal soft tissue height were selected. Patients were randomly assigned to the test or control group. Test patients received deproteinized bovine bone material with 10% collagen (DBBM-C; Bio-oss collagen) placed into the socket, slightly below the gingival margin, followed by a native bilayer collagen membrane (NBCM; Bio-Gide) sutured above the buccal bone crest and extended and sutured to the Pa/Li flap to cover the graft. Control group patients received DBBM-C within the socket, followed by the placement of NBCM without membrane stabilization with sutures. A hidden-X suture was placed over the socket entrance in both groups.
Implants were placed at 4m and bone core biopsies obtained. Digital impressions and CBCT scans were taken at baseline (T0), immediately after ARP (T1), and 4m after surgery (T2). Hard and soft tissue dimensional changes were evaluated. Horizontal width changes were measured at 1,3, and 5mm below the bone crest (HW1, HW3, HW5) and volumetric changes assessed by analyzing 6 divided zones.
Results: All patients had an initially stable recovery while two in the test group required additional bone augmentation. One patient in the test group underwent early failure and one in the control group underwent late failure. HW3 changes were -7.14+/-3.17mm in the control and -4.87+/-2.61mm in the test group from T0 to T2 and the test group was not inferior to the control. HW3 and HW5 were both significantly smaller in the test group compared to relative values (P<0.05). No differences were seen in linear bone dimension changes at any time point.
NSD seen in the volumetric changes, except from T0 to T2 in the test group, which had significantly less change in zone 3 (3-5mm apical to the crest).
NSD between soft tissue height shrinkage in the control (-2.20+/-18.22mm) and test (-3.30+/-7.76mm) groups. NSD between the ratio of open wound area at 10d in the control (29.30%+/-10.88%) and test (27.94%+/-12.84%) groups. Membrane fixation had no significant influence on wound closure.
NSD between the groups in terms of patient reported pain and swelling. A significant reduction in pain sensation was seen in both groups from 8-12h post-op.
Histomorphometric results showed bone area of 36.15%+/-18.52% in the control group and 34.64%+/-10.14% in the test group. NSD between the groups in terms of bone components. Membrane stabilization did not lead to significant differences in bone proportion.
Conclusion: In periodontally compromised extraction sockets, ARP with membrane stabilization does not lead to inferior results in terms of soft tissue contour changes, compared to no membrane fixation.