Journal Club- October 2025
Impact of Buccal Bone Arch Contour on Bone Remodeling and Esthetics in Guided Bone Regeneration: A Retrospective Study. Zuo M, Zhang H, Xie Z, Zhou Y. Clin Implant Dent Relat Res. 2025 Oct;27(5):e70086. doi: 10.1111/cid.70086. PMID: 40910667.
Correlation of Implant Location to Marginal Bone Level Changes in Single-Unit Restorations: A Retrospective Study, B. G. Ayyildiz, H. Ayyildiz, and T. F. Tözüm, Clinical Implant Dentistry and Related Research 27, no. 5 (2025): e70092, https://doi.org/10.1111/cid.70092.
Partial-Full-Thickness Tunnel Technique with Palatal Vertical Incisions and Supracrestal Sling Sutures for Papilla Reconstruction and Root Coverage in the Esthetic Zone: A Technical Case Report. Kuo PJ, Chen BJ, Rasperini G, Tsai YW, Wu TH, Do JH. Int J Periodontics Restorative Dent. 2025 Jul 11;0(0):1-24. doi: 10.11607/prd.7778. Epub ahead of print. PMID: 40644575.
Papilla Reconstruction via Incision and Submucosal Mobilization (PRISM): A Technique Illustration. Mourlaas J, Cortasse B, Tavelli L. Int J Periodontics Restorative Dent. 2025 Aug 18;0(0):1-20. doi: 10.11607/prd.7815. Epub ahead of print. PMID: 40824381.
Sinus Floor Elevation With Platelet-Rich Fibrin From Horizontal Centrifugation and Xenograft: Randomized Clinical Trial. Reis G. G. D., Denardi R. J., de Souza S. L. S., et al. Clinical Implant Dentistry and Related Research 27, no. 5 (2025): e70093, doi:10.1111/cid.70093.
Apical horizontal incision with periosteum graft wall technique for periodontal regeneration: A case study. Shiraishi K, Chiou LL, Haga T, Hamada Y, Cortellini P. Clin Adv Periodontics. 2025; 1-8. doi:10.1002/cap.10339.
Endpoints of Periodontal Therapy in Elderly Patients With Stage III/IV Periodontitis and Their Oral Health-Related Quality of Life Following 10 Years of Supportive Periodontal Therapy. Bumm CV, Gaenesch S, Nagler F, Frasheri I, Schwendicke F, Pitchika V, Ern C, Heym R, Wetzel C, Folwaczny M, Werner N. J Clin Periodontol. 2025 Oct;52(10):1398-1409. doi: 10.1111/jcpe.14198. Epub 2025 Jul 6. PMID: 40619347; PMCID: PMC12420083.
Impact of implant-abutment connection design on biological and mechanical outcomes in posterior single-tooth restorations: A randomized clinical trial. Rubianes-Porta L, Traver-Méndez V, Ghiorghiu R, Piera-Auguet J, Subirà-Pifarré C, Figueiredo R, Valmaseda-Castellón E, Camps-Font O. J Prosthet Dent. 2025 Oct;134(4):1140-1147. doi: 10.1016/j.prosdent.2025.06.022. Epub 2025 Jul 15. PMID: 40664594.
Effect of Tooth Splinting on Clinical Outcomes following Periodontal Regenerative Therapy in Teeth with Mobility Degree 1 or 0: A Propensity Score-Matched Analysis. Mikami, R., Ishimaru, M., Mizutani, K., Shioyama, H., Matsuura, T., Aoyama, N., Suda, T., Kusunoki, Y., Takeda, K., Anzai, T., Takahashi, K., Matsuo, K., Aida, J., Izumi, Y., Aoki, A., & Iwata, T. (2025). Journal of Clinical Periodontology, 52(9), 1254–1262. doi:10.1111/jcpe.14190.
Cost Effectiveness of Two Short Implants Versus One Short Implant With a Cantilever in the Posterior Region: 7.5-Year Follow-Up of a Randomised Controlled Trial. Strauss, F. J., Schiavon, L., Naenni, N., Kraus, R. D., Sáenz-Ravello, G., Müller, N., Jung, R. E., & Thoma, D. S. Journal of Clinical Periodontology 2025 Sep 21, Advance online publication doi:10.1111/jcpe.70039.
Pre-Emptive Analgesia for Periodontal and Implant-Related Surgery: A Systematic Review and Meta-Analysis, Gousias C, Alsuwaiyan Z, Fial A, Han S, Tatakis DN, Kofina V. J Clin Periodontol. 2025;52(8):1167-1195. doi:10.1111/jcpe.14157.
Prosthetic Outcomes in Stage III/IV Periodontitis Patients With 20–29 Years of Supportive Periodontal Care. Eger, T., F. Wörner, N. Lingwal, and P. Eickholz. 2025. Journal of Clinical Periodontology 1–10. https://doi.org/10.1111/jcpe.70036.
Inverted T-Shape Connective Tissue Graft for Interdental Papilla Reconstruction: A Clinical Case Series. Alrmali AE, Cury VF, Latimer J, Miller Jr PD, Wang HL. Journal of Esthetic and Restorative Dentistry (2025): 1–10, doi:10.1111/jerd.70035.
Periosteal Fenestration Procedure in Apically Positioned Flap Increases the Attached Mucosal Width: An In Vivo Experimental Study. Hong I, Jeong S, Shin HJ, Thoma DS, Strauss FJ, Lee JS. J Clin Periodontol. 2025 Sep;52(9):1362-1371. doi: 10.1111/jcpe.14188.
Impact of Collagen Membrane in Vertical Ridge Augmentation Using Ti-Reinforced PTFE Mesh: A Randomised Controlled Trial. Urban, I. A., Serroni, M., Dias, D. R., Baráth, Z., Forster, A., Araújo, T. G., Saleh, M. H. A., Cucchi, A., & Ravidà, A. (2025). Journal of Clinical Periodontology, 52(4), 575–588. doi:10.1111/jcpe.14129.
Stability of Augmented Bone and Its Influencing Factors After Simultaneous Guided Bone Regeneration With Implant Placement in the Posterior Mandible: A Retrospective Study. Chen, X., W. Qi, S. Wang, et al. 2025. Journal of Clinical Periodontology 52, no. 10: 1430–1441. doi:10.1111/jcpe.14206.
Abstracts
Topic: Contour-GBR-Implant
Authors: Zuo M, Zhang H, Xie Z, Zhou Y.
Title: Impact of Buccal Bone Arch Contour on Bone Remodeling and Esthetics in Guided Bone Regeneration: A Retrospective Study.
Source: Clin Implant Dent Relat Res. 2025 Oct;27(5):e70086.
DOI: 10.1111/cid.70086.
Reviewer: Daeoo Lee
Type: Retrospective
Keywords: buccal bone, contour, anterior maxilla, implant
Purpose: To evaluate the stability of augmented bone via GBR (at the time of implant placement) in the esthetic zone and to identify correlation between buccal bone arch contours with subsequent bone remodeling and prosthetic outcomes.
Material and methods: A total of 66 implants site from 66 patients were analyzed for the study. CBCT were taken pre-operatively, immediately post-surgery, and at a follow-up (>1 year) appointment. Surgery consisted of placing implant in an anterior region; bone grafts (Bio-Oss) placed on the buccal bone defect and was covered with collagen membrane (Bio-Gide). Analysis was performed regarding buccal bone wall thickness, buccal bone arch contour, and bone augmentation related metrics (bone gain, resorption, augmentation efficiency). Augmentation efficiency is defined as a slope describing linear regression between augmentation of the bone and bone gain.
Results: Augmentation efficiency at varying level (coronal-apical 0mm/2mm/4mm/6mm) was determined to be 0.62/0.71/0.75/0.55 respectively. No significant differences in terms of buccal bone wall at follow up were observed between implant placed inside the bone arch contour or outside the bone arch contour; bone augmentation outside the contour usually resorbed back to the contour level. The level of bone graft needed to restore ideal contour is to exceed contour by at least 1mm. Buccal bone wall thickness, mucosal marginal level and pink esthetic score fared better for implant placed 3mm lingually from contour compared to implant placed 2-3mm lingually.
Conclusions: Based on the study, implant placement of at least 2mm palatal from the contour and overbulking by at least 1mm from contour is ideal considering augmentation efficiency.
Topic: marginal bone loss around implants
Authors: Ayyildiz BG, Ayyildiz H, Tözüm TF.
Title: Correlation of Implant Location to Marginal Bone Level Changes in Single-Unit Restorations: A Retrospective Study.
Source: Clin Implant Dent Relat Res. 2025 Oct;27(5):e70092.
DOI: 10.1111/cid.70092.
Reviewer: Daeoo Lee
Type: Retrospective (16mo-92mo)
Keywords: marginal bone level (MBL), implant, single-unit
Purpose: To analyze the effect of emergence angle (EA) and emergence profiles (EP) to the marginal bone level depending on different locations (molar, premolar, anterior).
Material and methods: A total of 237 patients with 536 implants were included in the study. Periapical radiographs were taken at follow up appointments. Radiographically, EA, EP, mesial and distal MBL were calculated. Statistical analysis was performed to determine cut-off value for EA with optimal sensitivity of detecting presence of MBL.
Results: The cut-off EA value to predict presence of mesial MBL was 36.422°, 29.703°, and 25.12° for molar, pre-molar and anterior incisors respectively. For distal MBL, EA cut-off point for anterior incisors could not be determined. EA cut-off points for detecting distal MBL was 36.88° and 31.74° for molar and premolar, respectively. In terms of EP, there were no significant effect on MBL depending on location of the implant.
Conclusions: Based on the study, different EA cut-off point should be utilized for different locations.
Topic: Papilla reconstruction
Authors: Kuo PJ., Chen BJ., Rasperini G., Tsai YW., Wu TH., Do JH.
Title: Partial-Full-Thickness Tunnel Technique with Palatal Vertical Incisions and Supracrestal Sling Sutures for Papilla Reconstruction and Root Coverage in the Esthetic Zone: A Technical Case Report
Source: Int J Periodontics Restorative Dent. 2025 Jul 11;0(0):1-24
DOI: 10.11607/prd.7778
Reviewer: Cyrus J Mansouri
Type: Case report
Keywords: connective tissue graft; papilla; periodontal surgery; root coverage.
Purpose: To present a novel surgical approach for utilizing labial vestibular incisions and palatal marginal vertical incisions to create a partial-full-thickness tunnel for connective tissue graft (CTG) supported root coverage and papilla of recession type 2 (RT2) defects. The technique also utilizes supra-crestal sling (SCS) sutures, optimizes blood supply, maximizes wound stability, resulting in significant papilla augmentation and complete root coverage.
Material and methods: Surgical technique: following scaling of root surfaces, multiple vertical incisions in the labial vestibular mucosa were made, apical to the papilla of the treated teeth to a depth of 0.8-1 mm and avoiding contact with the underlying bone. These incisions were made 1 mm apical to the MGJ and extended 5-6 mm apically. An ophthalmic blade was used to perform superficial partial-thickness dissection and connect each vertical incision to create a confluent supra-periosteal tunnel. A 15C blade when then inserted into the tunnel to create a horizontal incision within the tunnel to support the full-thickness / sub-periosteal tunnel coronal to the MGJ. The periosteum was elevated full thickness to the papilla and base of the palatal papilla using a periosteal elevator. On the palatal side, a marginal vertical incision was made 7-10 m in length at the mid-palatal surface of the tooth on each side of the papilla to be augmented. A full thickness dissection was performed to connect the labial and palatal site tunnels. This enhances papilla mobility and is critical to create recipient space under the papilla for CTG positioning and coronal advancement of the interdental tissue. The root surfaces were prepared with 24% EDTA and enamel matrix derivative prior to CTG insertion. CTG was harvested from the lateral palate, 3 mm apical to the gingival margin in the area of the canine to second molar. Graft dimensions were at least the distance from the papilla tip to the contact point and 1.5 mm in thickness. Grafts were de-epithelialized intraorally, harvested with a 15C, and donor site was dressed with a collagen sponge and palatal stent without any sutures. The CTG was placed into the tunnel and secured with SCS sutures with 6-0 Nylon. SCS design: needle passed from palatal to labial side through one embrasure of the tooth and then went through the sulcus to exit at the vertical incision, engaging one end of the CTG, and the needle was then returned to the original sulcus from the vertical incision. The needle was then passed to the distal embrasure on the palatal side to emerge on the labial. The needle then entered the sulcus to emerge from the vertical incision and engage the other end of the CTG. The needle was then returned to the original vertical incision and original sulcus. The CTG was directed with the use of a periosteal elevator to position the ends of the CTG to the interdental space prior to suture tying. If the CTG was fully submerged, no additional suturing was performed. When partially exposed, a coronally anchored suture was positioned mid-coronally and bonded to the tooth. A modified vertical mattress suture in the papillary region secured at the bonded contact may also be necessary for coronal displacement if CTG is still exposed. For multiple adjacent recession, multiple CTG should be used to wrap around the tooth in a U-shape or J-shape for the remaining adjacent teeth. Vertical incisions were only sutured with a single suture if margins were wide open, otherwise if well-approximated, no suture was placed. Two non-smoker and systemically healthy patients with thin or medium periodontal soft tissue phenotype were treated. Recession depth, pocket depth, clinical attachment level, and papilla condition were measured prior to and after treatment. Papilla condition was assessed by the Nordland and Tarnow classification. Each treated site was from teeth 9-11. Follow-up was 10-12 months.
Results: A total of four gingival recessions and four interdental defects were treated. All defects were RT2 and papilla class III at baseline. Complete root coverage (CRC) was achieved at all sites. Following treatment, 3 of 4 papillae were completely reconstructed with normal papilla classification and one was a Class I papilla. Mean reduction of recession was 1.45 mm, mean clinical attachment level was 1.46 mm, and mean proving depth was 2.08 mm.
Conclusion: Combining the partial-full-thickness tunnel technique with palatal vertical incisions effectively facilitates passive tissue mobilization without requiring papillary incisions. The CTG, secured by SCS sutures, allows maintenance of the papilla in a coronally advanced position. The approach shows promise for root coverage a papilla reconstruction in the esthetic zone.
Topic: Papilla reconstruction
Authors: Mourlass J., Cortasse B., Tavelli L.
Title: Papilla Reconstruction via Incision and Submucosal Mobilization (PRISM): A Technique Illustration
Source: Int J Periodontics Restorative Dent. 2025 Aug 18;0(0):1-20
DOI: 10.11607/prd.7815
Reviewer: Cyrus J Mansouri
Type: Case series
Keywords: connective tissue graft; papilla; periodontal surgery; root coverage.
Background: Kazarian et al. was used for the two-dimensional classification of the papilla. Type A: fully preserved papilla. Type B: buccal and lingual slopes are present with a concave proximal defect and visible CEJ. Type C: apical displacement of the buccal slope and interproximal col with CEJ visible. Type D: apical displacement of the lingual slope and proximal col with visible CEJ. Type E: buccal and lingual slopes and col are apically displaced with CEJ visible.
Purpose: To introduce a tunnel-like surgical technique for papilla reconstruction via incision and submucosal mobilization (PRISM) in esthetically deficient type C or E papillae.
Material and methods: Three patients with 7 total sites were included in the report. All patients were non-smokers and systemically healthy with no active diagnosis of periodontitis and presence of at least one compromised papilla. Visual analog scale was used to assess patient perception of esthetics and comfort. Digital impressions were created pre- and post-op and superimposed to measure volumetric changes (horizontal papilla gain and vertical occlusal gain). Regarding surgical design, an intrasulcular incision was made with a microsurgical blade at least 1 tooth from the papilla of interest. Tunneling knives were inserted into the sulcus to elevate the keratinized tissue to the mucogingival junction (MGJ) full thickness. A full thickness 5-mm vestibular incision was made below the base of the compromised papilla, extending from keratinized tissue into mucosa. Split-thickness incisions were made through the vestibular access to create superficial and deep incisions and release the tissue. The papilla was elevated full thickness by access of the vestibular incision. Roots were mechanically treated with micro-curettes and chemically by EDTA and enamel matrix derivative. One CTG from the lateral palate was harvested 4 mm in height for the buccal recession. A second CTG was harvested from the maxillary tuberosity and stabilized below the deficient papilla with a horizontal mattress suture. Double-cross sling sutures were used to coronally advance the released tissue, passing through both buccal and proximal CTGs. The vertical incision was closed with simple interrupted sutures. Each patient was prescribed 1 g Amoxicillin TID for 6 days, prednisolone 60 mg QD for 4 days, and paracetamol 1 g TID for 2 days. Suture removal was performed after 15 days.
Results: All subjects healed uneventfully with no complications within the 6-month follow-up. Donor sites healed with minimal discomfort. The 6-month clinical exam demonstrated consistent improvement in papillary architecture. Volumetric analysis of the superimposed STL files showed 0.8-1.7 mm of vertical gain and 0.8-1.4 mm of horizontal gain. A marked enhancement in comfort and esthetic was observed in patient-reported outcomes.
Conclusion: A tunnel-like surgical approach was used for three-dimensional augmentation of deficient interdental papillae in the esthetic zone. The technique has the potential to improve patient-reported outcomes and may represent a valuable addition to the clinician’s therapeutic options.
Topic: Horizontal Platelet Rich Fibrin
Author: Reis G. G. D., Denardi R. J., de Souza S. L. S., et al.
Title: Sinus Floor Elevation With Platelet-Rich Fibrin From Horizontal Centrifugation and Xenograft: Randomized Clinical Trial
Source: Clinical Implant Dentistry and Related Research 27, no. 5 (2025): e70093,
DOI: 10.1111/cid.70093.
Type: Clinical Study
Reviewer: Veronica Xia
Keywords: sinus augmentation, deproteinized bovine bone, platelet rich fibrin
Purpose: The purpose of this article was to examine the effects of using horizontal centrifugation-prepared platelet rich fibrin (H-PRF) in combination with deproteinized bovine bone mineral (DBBM) for sinus augmentation.
Materials and Methods: Thirteen patients needing maxillary sinus augmentation were included in this split mouth randomized clinical trial. Sinuses were randomly assigned to either the control group, utilizing sinus augmentation with DBBM, or the experimental group, including sinus augmentation with DBBM combined with H-PRF. Eight tubes of venous blood were obtained, six tubes for solid H-PRF and two tubes for liquid H-PRF. Lateral window procedure was completed with complete elevation of the Schneiderian membrane and placement of grafting material. The control group consisted of DBBM was placed with BioGide membrane overtop of the graft and closure. The test group involved grafting with DBBM combined with fragmented solid H-PRF and liquid H-PRF (DBBM+H-PRF), covered with BioGide, and primary closure was obtained. 500mg Amoxicillin every 8 hours for 7 days, ibuprofen and arginine 1155mg twice a day for 5 days, and sodium dipyrone 500mg every 6 hours for up to 7 days, and 0.12% chlorhexidine gluconate twice a day for 15 days was prescribed.
4 months of healing elapsed, updated cone beam computed tomography (CBCT) scans were taken, and implants were planned. Implants (Helix GM Acqua—Neodent) were placed flapless and bone cores were retrieved for microcomputed tomography (micro-CT), histological and histomorphometric analysis. Uncovery procedures were completed 6 months after implant placement and prosthesis fabrication was then completed.
Results: 49 implants were placed in 13 patients, with a survival rate at 6 months of 100% and 95.83% for the control and test groups respectively. 24 bone core samples were obtained and submitted for analysis. More remaining bone substitutes percentages were seen in the DBBM alone group. A higher bone volume fraction and connectivity density were noted in the DBBM+H-PRF group. A higher percentage of newly formed bone (NFB) was noted in the DBBM+H-PRF group compared to the DBBM alone group, 51.33% +/- 6.17% and 45.68% +/- 6.65% respectively. Residual graft material was not significantly different between groups, DBBM+H-PRF (21.85% +/- 8.93%) compared to DBBM alone (24.09 +/- 11.79%). DBBM+H-PRF samples showed a larger proportion of osteogenic areas.
Conclusion: The combination of DBBM with H-PRF for maxillary sinus augmentation results in more NFB than DBBM alone.
Topic: Regeneration of Endo-Perio Lesions
Author: Shiraishi K, Chiou LL, Haga T, Hamada Y, Cortellini P.
Title: Apical horizontal incision with periosteum graft wall technique for periodontal regeneration: A case study.
Source: Clin Adv Periodontics. 2025; 1-8.
DOI: 10.1002/cap.10339
Type: Case Study
Reviewer: Veronica Xia
Keywords: endo-perio lesion, bone loss, connective tissue graft, regeneration
Purpose: This case study involved the treatment of a hopeless tooth affected by an endo-periodontal lesion (EPL) via a vestibular access regenerative treatment method with placement of a connective tissue graft (CTG) involving the underlying periosteum. Both radiographic and clinical outcomes, in addition to an improved periodontal prognosis are described in the study.
Materials and Methods: This case involved a 35 year old female who presented with gingival edema associated with and migration of #9 following previously orthodontic treatment. The findings of #9 included class 2 mobility, probing depth (PD) of 11mm, being non-vital, and a significant amount of bone loss—all of which contributed the diagnosis of the tooth with an EPL and ultimately a hopeless prognosis.
Initial therapy involved both non-surgical endodontic and periodontal therapy; however, 9 months post-treatment, improvements were not observed. Orthodontic therapy was initiated to improve positioning of #9; however, the appearance of abscesses and an increased amount of bone loss was further observed. The patient was presented with the treatment option of extraction and implant placement but opted to attempt to maintain tooth with a surgical regenerative approach.
Two surgeries were performed to treat #9. The first surgery involved a horizontal vestibular incision 2-3mm apical to the extent of the boney defect with vertical releasing incisions directed towards the gingival margins to allow for improved access to the defect. Reflection of a full-thickness flap was completed to allow access for mechanical and chemical debridement of the defect and root surface with ultrasonic tips, hand instruments, and ethylenediaminotetraacetic acid (EDTA) 24%. Finally, enamel matrix derivative (EMD) was placed onto the tooth surface and the flap was closed with 7-0 polydioxanone absorbable monofilament sutures (PDS). Follow-ups were performed every 3 months after treatment, and a residual PD of 8mm was noted on the mesial surface of #9. A secondary surgery was performed with a vestibular horizontal and vertical releasing incisions were made, and a split-thickness flap was reflected—transitioning to a full-thickness flap in the area directly overlaying the root surface. The boney defect was then mechanically debrided, EDTA 24% and EMD applied, and freeze-dried bone allograft (FDBA) soaked in EMD was placed in the defect. A CTG including the underlying periosteum harvested from the tuberosity and sutured to periosteum adjacent to the boney defect. 7-0 PDS sutures were then used to stabilize the CTG and obtain primary flap closure and were then removed at 2 weeks post-surgery. The following medications were prescribed to the patient post procedure: loxoprofen 60mg 6 tabs as needed and cefcapene 300mg/day for 7 days.
During the course of treatment, #9 was splinted and minor occlusal adjustment was performed if needed.
Results: Overall, healing occurred uneventfully with no complications, and final zirconia crowns were placed on both #8 and 9. Papillae were maintained, PD were reduced to 3mm or less with an absence of bleeding on probing (BOP), and mobility was also reduced. Radiographically, both the defect and buccal dehiscence were resolved, and stability of bone levels was achieved at the 4 year follow-up.
Conclusion: Interdisciplinary treatment and periodontal regenerative approaches can be utilized in managing teeth with EPL and significant bone loss. Access via a vestibular horizontal incision can provide adequate access to the boney defect, and the utilization of a CTG including the underlying periosteum can aid favorable outcomes in the presence of a non-contained defect.
Topic: Periodontal Therapy in Elderly Patients
Authors: Bumm, C et al.
Title: Endpoints of Periodontal Therapy in Elderly Patients With Stage III/IV Periodontitis and Their Oral Health–Related Quality of Life Following 10 Years of Supportive Periodontal Therapy
Source: Journal of Clinical Periodontology 52, no. 10: 1398–1409.
DOI: 10.1111/jcpe.14198
Reviewer: Nicolas Lobo
Type: Prospective study
Keywords: multivariable analysis, oral health–related quality of life, periodontitis
Purpose: To evaluate different periodontal therapy endpoints and their long-term impact on disease stability and OHRQoL, testing the null hypothesis that clinical outcomes are not associated with patient-reported OHRQoL after SPT.
Materials and Methods: A total of 759 periodontitis patients were enrolled (2011–2016) and examined at baseline (T0), after initial non-surgical therapy and re-evaluation (T1, ~6 months). 47 patients were re-examined at long-term follow-up (T2, ~10 years). Therapy included oral hygiene instruction, professional plaque removal, and non-surgical instrumentation; no surgical treatment was performed. Outcomes included probing depth, BOP, mobility, furcation, OHRQoL (OHIP-14), prosthetic status (Stage IV), and patient factors (age, smoking, diabetes, SPT adherence, tooth migration). Periodontal endpoints were defined by EFP (No periodontal pockets > 4 mm with BOP or no deep periodontal pockets (≥ 6 mm)) and T2T (≤4 sites with PPD ≥5 mm).
Results: 47 periodontitis patients (mean age 71.7 years; 53% male; 8.5% smokers; 12.8% diabetic). Disease severity was mainly advanced: Stage III (40%) and Stage IV (60%), with most cases generalized. Periodontal grading was A (4%), B (66%), and C (30%). Nearly half had prosthetic rehabilitation, and 49% were compliant with SPT. Tooth migration was reported by 25.5%.
After initial therapy, only 1 patient met the EFP endpoint, 16 met T2T (34%), and most (64%) failed to achieve either. Over ~10 years, the median number of teeth decreased from 26 to 23 (median TL = 1). Sites with periodontal pockets reduced after therapy but increased again at long-term follow-up, with stability rarely maintained. Adjunctive antibiotics showed no long-term benefit. Tooth loss rates remained low, suggesting limited value of current clinical endpoints to predict 10-year stability.
OHRQoL (OHIP-14): Mean score was 4.9, indicating overall low impact on quality of life. Psychological discomfort (1.2) and physical pain (1.1) were the most affected domains, though generally mild. Subgroup analysis showed worse scores in smokers, females, Stage IV patients, non-prosthetically rehabilitated , and SPT non-compliant patients.
Clinical endpoints (EFP, T2T) were not significantly associated with OHRQoL, whereas tooth migration was strongly linked to poorer outcomes, reflecting functional and aesthetic burdens not captured by traditional measures. This underscores the need for a patient-centered approach that integrates functional and aesthetic concerns alongside clinical parameters in advanced periodontitis care.
Conclusions: Traditional clinical endpoints of periodontal therapy may not fully capture patient-perceived outcomes. Tooth migration, a key functional and aesthetic concern, significantly impacted OHRQoL, highlighting the need for a holistic, patient-centered approach that combines clinical and patient-reported outcomes to improve long-term satisfaction and quality of life.
Topic: Implant connection
Authors: Rubianes-Porta L et al.
Title: Impact of implant-abutment connection design on biological and mechanical outcomes in posterior single-tooth restorations: A randomized clinical trial
Source: J Prosthet Dent. 2025 Oct;134(4):1140-1147
DOI: 10.1016/j.prosdent.2025.06.022.
Reviewer: Nicolas Lobo
Type: RCT
Purpose: This study aimed to assess whether implant-abutment connection design (external hexagon [EC], internal hexagon [IC], or conical [CC]) influences vertical marginal bone loss in posterior single-unit implant-supported crowns, and secondarily, whether it affects the risk of biological or mechanical complications. The null hypothesis proposed no association between connection design and marginal bone loss.
Materials and Methods: This open-label RCT with three treatment arms compared EC, IC, and CC implant-abutment connections in partially edentulous adults (≥18 years) requiring single crowns in healed molar/premolar sites. Screw-shaped titanium implants (Biomimetic Ocean, Avinent) were placed free-hand, restored with screw-retained metal-ceramic crowns, and evaluated at baseline (T0), prosthesis delivery (T1), and 1-year post-loading (T2). The primary outcome was marginal bone level changes (DIB). Biological and mechanical failures, adverse events, probing depth, bleeding/suppuration, and plaque index were also recorded. Failures were categorized as early (pre-loading) or late (post-loading). Functional success was defined as crowns with stable loading after 12 months without marginal bone loss.
Results: This RCT found no significant differences in 1-year implant survival, marginal bone loss, or complication rates among the implant-abutment connections in posterior single-unit crowns (survival rates were 87.9% for EC, 95.9% for IC, and 86.8% for CC). All designs showed predictable short-term outcomes with similar bone remodeling patterns, despite inherent differences in platform switching. Most failures occurred during osseointegration. Minor mechanical complications (mainly screw loosening) were reported across groups. Probing depth increased slightly, and all groups showed progressive but comparable marginal bone loss While results contrast with prior meta-analyses favoring conical connections, the short follow-up, limited sample size, and controlled study conditions may explain the discrepancy. Overall, connection design did not influence short-term biological or mechanical outcomes
Conclusions: This randomized clinical trial found no significant differences in short-term survival rates, bone level changes, or complication risks among different implant-abutment connection designs (external, internal and conical) in posterior single-unit implant-supported crowns. However, the results should be interpreted cautiously due to the short follow-up period and the limited clinical experience of the operators.
Topic: Treatment of peri-implantitis
Authors: Mikami, R, et. al.
Title: Effect of Tooth Splinting on Clinical Outcomes following Periodontal Regenerative Therapy in Teeth with Mobility Degree 1 or 0: A Propensity Score-Matched Analysis
Source: Journal of Clinical Periodontology, 52(9), 1254–1262
DOI: 10.1111/jcpe.14190
Type: Propensity Score-Matched Analysis
Reviewer: Mahya Sabour
Keywords: regenerative therapy, mobility, EMD, splinting
Background: Propensity score matching (PSM) is a statistical technique to minimize bias found between control groups and interventions when using observational data while randomized allocation is not possible.
Purpose: to assess the effects of splinting on 1- and 3-year outcomes of regenerative therapy of intrabony defects with Enamel Matrix Derivative (EMD) on teeth with grade 1 or 0 mobility.
Materials and Methods: A secondary analysis of a previous cohort study of 312 patients, which reviewed probing depth (PD), clinical attachment level (CAL), and radiographic bone defect depth (RBD) over 3 years following regenerative therapy with EMD was conducted. Teeth with fremitus or mobility after occlusal adjustment were splinted prior to the surgery. Partially edentulous cases where the teeth were excessively loaded due to diminished occlusal support were also splinted even without mobility. All splints were completed within one month prior to the surgeries. Surgeries all included reflection of a full thickness flap, defect debridement, and EMD application to the roots. If non-contained defects were present, autologous bone was potentially added adjunctly. Prophylaxis was completed monthly for the first 6 months, followed by every three months. Splints were removed 6-12 months post-operatively.
Results: 74 sites (37 splinted and 37 non-splinted) were analyzed. After PSM, the standardized difference for all variables between the two groups was <0.1. Both groups before and after PSM, showed significant improvement in CAL, PD, and RBD at 1- and 3-year follow-ups compared to baseline. While mobility significantly improved in the splinting group before PSM, after PSM, mobility did not show significant changes in either group. The splinted teeth had significantly greater RBD gain at 3 years before PSM, while no significant differences were seen in any of the parameters after PSM at 1 and 3 years. RBD gain was 0.43mm higher at 1-year and 0.35mm higher at 3-year follow-up in the splint group, but this was not statistically significant. Tooth splinting did not significantly affect the outcomes of CAL, PD, and RBD changes at any time point. CAL gain differences after PSM were 0.36mm and 0.29mm at 1 and 3 years, respectively. Splinting might not have adjunct benefits for regenerative therapy of teeth with grade 1 or less mobility, after PSM was performed, adjusting for confounding factors (baseline PD, bone defect morphology and tooth mobility).
Conclusion: No statistically significant differences were seen in PD, CAL, and RBD gain in splinted or unsplinted teeth regeneratively treated with EMD, during a 3-year follow-up.
Topic: Peri-implant disease
Authors: Strauss, F. J., et al.
Title: Cost Effectiveness of Two Short Implants Versus One Short Implant With a Cantilever in the Posterior Region: 7.5-Year Follow-Up of a Randomised Controlled Trial.
Source: Journal of Clinical Periodontology, 10.1111/jcpe.70039. Advance online publication
DOI: 10.1111/jcpe.70039
Type: Randomised Controlled Trial
Reviewer: Mahya Sabour
Keywords: Dental implants, short implants, cantilevered restorations
Purpose: to compare outcomes as well as cost-effectiveness of two non-splinted adjacent short implants with a single short implant that supports a cantilever restoration over 7.5 years.
Materials and Methods: A 7.5-year follow-up of a previous randomised controlled trial (RCT) was conducted. 36 healthy patients with sufficient vertical bone height (>/=8mm in the mandible and >/=6mm in the maxilla) randomly received either a single (ONE-C) or two short implants (TWO) which were 6mm long and 4.1mm wide. The implant was placed in the site with the most favourable bone condition in the ONE-C group, which was generally the distal site, leading to a mesial cantilever. Minor bone dehiscence received GBR (Bio-Oss and Bio-Gide). The implants were restored with screw-retained crowns and in group function at 3-6 months: group TWO with 2 non-splinted single crowns and group ONE-C a single crown with a cantilever. Follow-ups were completed at 1-3 weeks after prosthesis delivery, followed by 6 months, 1, 3, 5, and 7.5 years. Maintenance visits were performed every 3-12 months.
Implant survival was defined as an implant remaining in place and stable when manually tested while reconstruction survival was when a prosthesis remained in place. The 2017 world workshop classification was used for peri-implant diseases and conditions.
Results: 18 implants were in the group ONE-C and 36 in the group TWO. 3 patients were lost to follow-up and 5 late implant failures were seen in group TWO. 15 patients in group ONE-C and 10 in group TWO were seen at 7.5 years. 3 late implant failures were seen in group ONE-C and 2 in group TWO and all were in the mandible. Failures in group TWO involved the distal implant. Patient-level implant survival rate at 7.5 years was 83.3% in group ONE-C and 86.6% in group TWO with no significant differences between them.
28 technical complications were seen in group ONE-C and 16 in group TWO with the most common being porcelain chipping (57%), and screw loosening (23%) – incidence was higher in group ONE-C at all time-points. No statistically significant differences were seen between groups in terms of plaque levels, bleeding on probing (BOP), or probing depth (significant increase at 3 years). There was a 47% incidence of peri-implant mucositis at 7.5 years in group ONE-C and 67% in group TWO, while a 7% incidence of peri-implantitis was seen in group ONE-C only (1 case). The mean marginal bone levels (MBL) at 7.5 years were 1.76+/- 0.83mm in group ONE-C and 1.65+/- 0.74mm in group TWO. The difference was only statistically significant between the two groups at 1 year. Cost effectiveness appeared similar for both treatments, and differences tended to suggest that group TWO provided slightly longer implant survivals but at higher costs. Group ONE-C is more cost-effective but has higher technical complications.
Conclusion: Both treatments had similar clinical and radiographic outcomes with short implants with a cantilever being more cost effective but having higher early complication and failure rates, potentially due to mechanical overload.
Topic: Analgesia
Author: Gousias C, Alsuwaiyan Z, Fial A, Han S, Tatakis DN, Kofina V
Title: Pre-Emptive Analgesia for Periodontal and Implant-Related Surgery: A Systematic Review and Meta-Analysis
Source: J Clin Periodontol. 2025;52(8):1167-1195
DOI: 10.1111/jcpe.14157
Type: Systematic review and meta-analysis
Reviewer: Pankti Rana
Keywords: analgesics, dental implants, pain, periodontitis, systematic review
Purpose: To determine whether pre-emptive analgesic medications, administered before periodontal and implant-related surgeries, effectively reduce post-operative pain compared to placebo. The authors also aimed to rank the effectiveness of different drugs and identify any adverse effects.
Materials/Methods: This systematic review and meta-analysis followed PRISMA guidelines. Randomized, placebo-controlled clinical trials involving adults undergoing periodontal or implant-related surgeries were included. Electronic searches were conducted in PubMed, Cochrane, and Web of Science, supplemented by manual reference checks. Two reviewers independently screened and extracted data, resolving disagreements with a third reviewer. Extracted variables included surgery type, sample size, analgesic regimen, timing, and pain outcomes at 1, 3, 6, 8, 24, and 72 hours. Pain reduction was assessed using standardized mean difference (SMD) on the Visual Analogue Scale (VAS). Random- or fixed-effects models were applied depending on heterogeneity. Risk of bias was evaluated with Cochrane’s RoB tool, and certainty of evidence was graded using GRADE. Statistical analyses, including network meta-analysis for drug ranking, were performed using R software.
Results: 18 were included in the systematic review (totaling 1008 patients), and 7 qualified for meta-analysis. Surgeries analyzed included periodontal flap, osseous, mucogingival, and implant placement. Interventions mainly involved NSAIDs, corticosteroids (dexamethasone), and acetaminophen, administered orally or parenterally pre-operatively. The meta-analysis found that pre-emptive analgesia significantly reduced post-operative pain, with the strongest effect at 3 hours (SMD −0.81, CI −1.03 to −0.58). Significant pain reduction was maintained up to 8 hours post-surgery (SMD −0.54, CI −0.79 to −0.28). Evidence quality was rated as moderate. Beyond 8 hours, differences between drug and placebo groups were no longer significant. Adverse effects were minimal and not consistently reported. NSAIDs and corticosteroids were consistently effective, however, duration of benefit is limited.
Conclusion: Pre-emptive analgesia can provide clinically meaningful pain reduction for up to 8 hours following periodontal and implant surgeries. The findings support the use of NSAIDs, corticosteroids, or acetaminophen given before surgery to improve patient comfort during the early post-operative period. However, the certainty of evidence was moderate, and further high-quality trials are needed to confirm long-term benefits and safety profiles.
Topic: Prosthetic considerations with periodontitis
Author: Eger, T., F. Wörner, N. Lingwal, and P. Eickholz
Title: Prosthetic Outcomes in Stage III/IV Periodontitis Patients With 20–29 Years of Supportive Periodontal Care
Source: Journal of Clinical Periodontology 1–10
DOI: 10.1111/jcpe.70036″>10.1111/jcpe.70036
Type: Retrospective cohort study
Reviewer: Pankti Rana
Keywords: periodontal care, partial fixed or removable dentures, periodontitis, tooth loss
Purpose: To study tooth loss (TL) in treated periodontitis (stage III/IV) patients undergoing supportive periodontal care with and without partial denture (PD) (removable [RPD], fixed PD [FPD], implant supported FPD [iFPD]) and10- year prosthetic outcomes.
Materials/Methods: This retrospective cohort study evaluated 233 patients with stage III or IV periodontitis. All patients underwent comprehensive periodontal therapy, including scaling and root planing, surgery when indicated, and systemic antibiotics in some cases, followed by long-term supportive periodontal care (SPC). Based on their prosthetic rehabilitation after treatment, patients were divided into two groups: a control group with no major prostheses (only small FPDs <5 units, no RPD or iFPD), those with FPDs ≥5 units, RPD retained with clasps (RPDC), RPD with double crowns (RPDD), and iFPD. The primary outcome measured was tooth loss over time, while the secondary outcome was the 10-year survival of prostheses. Patients were followed for an average of 21.7 years, and statistical analyses included negative binomial regression for tooth loss and logistic regression for prosthesis survival.
Results: A total of 574 teeth (10.6%) were lost, corresponding to an average of 0.13 teeth per year. Patients with stage III disease lost teeth at a rate of 0.11 per year, while stage IV patients experienced a higher rate of 0.22 per year. By treatment group, the control group showed the lowest tooth loss rate (0.05 per year). In contrast, RPDC patients had the highest rate (0.40 per year), followed by RPDD patients (0.35 per year) and those with FPDs (0.23 per year). Patients with iFPDs demonstrated a comparatively lower rate of 0.15 per year, similar to controls. Multivariate analysis revealed that age, heavy smoking (>10 cigarettes/day), and use of RPDC, RPDD, or FPD were significantly associated with greater tooth loss, whereas iFPDs did not show a significant association. Prosthesis survival rates after 10 years were 67% for RPDCs, 75% for RPDDs, 93% for FPDs, and 83% for iFPDs. Despite generally good survival, peri-implantitis contributed to the loss of 30 out of 218 implants (14%) in 15 patients, with stage IV patients disproportionately affected.
Conclusion: Patients with stage III/IV periodontitis with RPDC, RPDD or FDP experienced higher long-term tooth loss compared to controls, while iFPD showed similar tooth loss rates to untreated controls. Age and heavy smoking were significant risk factors for tooth loss, but despite these factors, over 80% of all prosthetic restorations remained functional for at least 10 years.
Topic: Apically positioned flap with periosteal fenestration
Authors: Hong I, Jeong S, Shin HJ, Thoma DS, Strauss FJ, Lee JS
Title: Periosteal Fenestration Procedure in Apically Positioned Flap Increases the Attached Mucosal Width: An In Vivo Experimental Study.
Source: J Clin Periodontol. 2025 Sep;52(9):1362-1371
DOI: 10.1111/jcpe.14188.
Reviewer: John Kerns
Type: Animal study
Keywords: apically positioned flap, periosteal fenestration, free gingival graft, attached mucosa, keratinized mucosa, vestibular depth
Purpose: The purpose of this animal study was to assess the clinical and histological changes between an apically positioned flap (APF) with periosteal fenestration to an APF alone.
Background: Shallow vestibules and insufficient masticatory mucosal width (MM) are most often treated with an APF and free gingival graft (FGG). A technique of creating a periosteal fenestration might be beneficial in circumstances where clinicians wish to mitigate post-operative pain and bleeding from the autologous graft. Denuding the alveolus may result in new attached gingiva (scar-like) by inducing granulation tissue formation.
Methods: Six dogs underwent APF surgery. In a split-mouth design, each maxilla was divided into a control half, where an APF alone was performed, and the intervention half, where an APF and a periosteal fenestration was performed. 48 sites were measured clinically and through digital scans at baseline (T0), right after surgery (T1), and after eight weeks of healing (T8wk). Histological samples were taken at T8wk.
For the APF, a horizontal incision was made at the MGJ, and a partial thickness flap was raised. For the APF and fenestration group, the periosteum was denuded at the intended apical positioning level.
Results: A red, scar-like, attached tissue formed over the fenestration sites. The gain in MM width was significantly higher in the fenestration group vs. the control group as measured clinically (difference of 1.45mm, p=0.002) and digitally (1.46mm, p=0.002). Histologically, in the fenestration group, keratinized epithelium was formed near the coronal portion of the exposed site; but para-keratinized epithelium was formed more apically. Dense, scar-like connective tissue (CT) fibers from the fenestration site obstructed the horizontal, movable CT fibers from the vestibular mucosa. The width and percentage of non-keratinized attached mucosa (NKAM) was higher in the fenestration group by 0.97mm and 6.7% (p=0.007 and p=0.036).
Discussion: Overall, results showed that the width of attached MM was higher in the fenestration group than APF alone, but the increase is primarily characterized by NKAM rather than orthokeratinized epithelium. The extent of the NKAM prevented the coronal migration of the mucogingival line, which is relevant, considering previous studies have shown that APF alone is prone to relapse.
Dense CT fibers in NKAM run parallel to the alveolus and connect with attached gingiva. Considering wound healing occurs through the migration of epithelial cells from surrounding tissues, the coronal portion of the fenestration sites healed with epithelial cells from the firm, attached gingiva. However, the scar tissue prevented the migration of loose, mobile vestibular cells. This finding may be especially beneficial for peri-implant tissues, where there is an absence of PDL cells, and therefore repair healing over regeneration is prioritized. Nevertheless, this study did not use a positive control (FGG) and did not use implants, so suggested clinical benefits should be taken with caution.
Conclusion: APF with a periosteal fenestration improves attached gingival width via non-keratinized attached mucosa.
Topic: papilla reconstruction
Authors: Alrmali AE, Cury VF, Latimer J, Miller Jr PD, Wang HL.
Title: Inverted T-Shape Connective Tissue Graft for Interdental Papilla Reconstruction: A Clinical Case Series
Source: Journal of Esthetic and Restorative Dentistry (2025): 1–10
DOI: 10.1111/jerd.70035
Reviewer: John Kerns
Type: Case Series
Keywords: inverted T-Shape, connective tissue graft, papilla reconstruction, papilla, black triangle
Purpose: This case series assessed the outcomes of inverted T-shape connective tissue graft (CTG) treatment for interdental papillae reconstruction in RT2 and RT3 gingival defects.
Methods: Five individuals were treated with inverted T-shape CTGs, three of which presented with an RT2 defect, and two of which presented with an RT3 defect. These individuals had no bleeding on probing at the recipient site and a full mouth plaque score of <20%. After peripheral local anesthetic injection, a full thickness tunnel extending to the adjacent half of neighboring teeth was created on the buccal side without disturbing the papillae. The flap was split thickness beyond the mucogingival junction. Then, a 2mm interproximal supra-periosteal tunnel was made under the papilla.
A 1.5mm thick T-shape CTG was harvested from the palate (10mm length X 4mm width plus 3mm T extension). Suturing the graft included entering the tunnel through the lingual aspect of the papilla, exiting through the vestibular access or sulcus, engaging the CTG, re-entering the tunnel in the buccal access, and exiting via the lingual aspect. The graft was inserted through the sulcus, a lateral VISTA incision, or through the frenum, depending on the space between teeth, interproximal tissue quality, and the presence of a frenulum. Sutures to stabilize the graft included vertical double-cross mattress suspended at the contact point (adding composite if needed). In one instance, the “T” portion of the CTG was combined with a tuberosity graft for added thickness (“Iceberg” technique).
Generally, preserving blood supply while achieving adequate tissue mobility were crucial for success. Armamentarium included a surgical tunneling kit designed for tunneling in interproximal areas.
Results: Results were quantified at baseline and various follow-up intervals, ranging from 3 to 12 months, using the Jemt papilla index. In both RT3 cases, complete papilla fill was achieved (Jemt 2). In the three RT2 cases, partial fill was achieved (50-60% fill, Jemt 1-2).
Discussion: Specific benefits of this technique includes the volume and stability achieved by using the T-shape and the maintenance of the blood supply by using the tunnel approach. Improvements seen in this series are similar to upper ranges of previously reported gains from other techniques. This technique is appropriate for patients with a large diastema, otherwise large papillae, a thick biotype, and at least 1.5mm of interproximal soft tissue to ensure predictability. Success was observed in some cases for at least 24 months and can be performed in conjunction with composite restorations to minimize black triangle appearances.
Conclusion: The inverted T-CTG technique can be beneficial for treating RT2 and RT3 defects with simultaneous interproximal papilla reconstruction.
Topic: Vertical Ridge Augmentation using PTFE Mesh
Authors: Urban, I.A., Serroni, M., Dias, D.R., Baráth, Z., Forster, A., Araújo, T.G., Saleh, M.H.A., Cucchi, A., Ravidà, A.
Title: Impact of Collagen Membrane in Vertical Ridge Augmentation Using Ti-Reinforced PTFE Mesh: A Randomised Controlled Trial.
Source: Journal of Clinical Periodontology, February 2025
DOI: 10.1111/jcpe.14129
Reviewer: Malon Stratton
Type: RCT
Keywords: alveolar bone loss, alveolar ridge augmentation, bone regeneration, cone‐beam computed tomography, dental implants.
Purpose: The objective of this study was to assess whether PTFE mesh alone is non-inferior to PTFE mesh covered with a collagen membrane (CM) in vertical ridge augmentation (VRA) procedures, with absolute vertical bone gain (VBG) as the primary outcome.
Materials and Methods: Thirty patients presenting with vertical bone defects were randomly allocated to undergo VRA using either PTFE mesh with a collagen membrane or PTFE mesh alone. These fifteen sites were treated with PTFE alone: nine sites were in the posterior mandible, four in the posterior maxilla, one in the anterior mandible and one in the anterior maxilla. For the PTFE and CM group, six sites were in the posterior mandible, two in the posterior maxilla, one in the anterior mandible and six in the anterior maxilla. Mesh removal and implant placement was performed after nine months. Clinical evaluations included complication rates, pseudo-periosteum characteristics, and bone density. CBCT reconstructions were used to assess VBG, effective regeneration rate, and the need for additional augmentation.
Results: Non-inferiority of PTFE mesh alone compared with PTFE mesh combined with a collagen membrane was not confirmed for either absolute or relative VBG (PTFE alone: 4.47 ± 2.1 mm and 79.2% vs. PTFE and CM: 4.11 ± 2.7 mm and 85.8%), effective regeneration rate (69.3% vs. 72.3%) or complication rate (6.7% in both groups). The baseline vertical defect size significantly influenced absolute VBG. For each 1 mm increase in defect size, an additional 0.93 mm gain in VBG was noted. A larger bone gain was noted in posterior teeth, and in patients younger compared to older. The ERR values were determined to be NSSD. However, the PTFE + CM group showed a higher frequency of type 1 pseudo-periosteum formation. A significantly higher probability of high bone density was found in the mandible, but neither of the two treatment groups demonstrated a strong influence on the new formed bone.
Conclusions: Non-inferiority of PTFE mesh alone compared with PTFE mesh combined with a collagen membrane for VBG was not demonstrated. Nonetheless, both approaches yielded similar results in terms of VBG, complication rates, and bone density. The higher occurrence of type 1 pseudo-periosteum and reduced bone volume observed in the PTFE + CM group indicate that incorporating a collagen membrane may aid in limiting soft tissue ingrowth.
Topic: Bone Stability following Implant Placement with GBR
Authors: Chen, X., Qi, W., Wang, S., Xu, A., Lu, H., Shen, X., He, F.
Title: Stability of Augmented Bone and Its Influencing Factors After Simultaneous Guided Bone Regeneration with Implant Placement in the Posterior Mandible: A Retrospective Study.
Source: Journal of Clinical Periodontology, June 2025
DOI: 10.1111/jcpe.14206
Reviewer: Malon Stratton
Type: Clinical study
Keywords: alveolar crest dimensions, bone resorption, dental implants, guided bone regeneration
Purpose: Given that the posterior mandible poses a higher risk for implant loss due to heavy occlusal forces, thick cortical bone, and high bone density, this study aims to evaluate the stability of augmented bone and the factors influencing it following simultaneous guided bone regeneration (GBR) and implant placement in this region.
Materials and Methods: A total of 102 patients were included in the study with 165 implants placed. CBCT images were collected at the following stages during treatment: pre-operative (T0), immediate post-operative (T1), post-healing (T2), and latest follow-up (T3). The assessed values included buccal bone width, buccal bone height, bone distance (BD), and augmented bone volume (ABV). Bone augmentation range was classified into the following categories: inside-contour group (IC, BD ≤ 0 mm) and outside contour group (OC, BD > 0 mm) based on BD values at the implant shoulder level at T1. Factors influencing the augmented bone volume resorption rate (ABV%) were analyzed as well.
Results: The follow-up period of this study was 12-88 months. During this period, the mean ABV% was 47.56% over 12-88 months follow up, with most resorption occurring during the healing period. At T2 and T3, the buccal bone contour in the OC group approached the individual phenotypical dimension (IPD), while the buccal bone contour in the IC group further reduced inwards. This indicates that although bone augmentation outside the IPD tends to resorb towards the IPD, over-augmentation might be more beneficial for maintaining the buccal bone arch contour compared with IC grafting. It was also reported that 1-2 mm of over-augmentation was necessary to maintain the ideal arch contour reaching the IPD. The OC group reported higher ABV% compared to the IC group. BD of the IC group was less than 0, and 0-1 mm of the OC group was less than 0. BD of the 1-2 and > 2 mm OC groups was near 0 at T3. The factors significantly influencing ABV% were bone augmentation range, non-contained defects, and 2-mm healing abutments.
Conclusions: Simultaneous GBR with implant placement in the posterior mandible demonstrated consistent volumetric stability of the augmented bone. OC grafts resorbed toward each patient’s phenotypical dimensions, whereas a 1–2 mm over-augmentation was beneficial for maintaining a bone arch contour reaching IPD, while increasing the bone augmentation range beyond 2 mm did not provide additional benefits. This finding was consistent with other studies recommending bone grafting of 1-2 mm over-contour range. Bone augmentation range has been identified as the most significant factor affecting ABV%, confirming that IPD serves as the GBR procedure’s limiting boundary. Volumetric stability was reduced in non-contained defects, while the use of 2-mm healing abutments enhanced stability compared with cover screws due to reducing soft-tissue collapse at the coronal aspect and preserving the space for bone regeneration.