Journal Club- August 2025
Orthodontic Implant Site Development Using Labial Root Torque: A Case Series with CBCT Analysis. Tanno T, Hasuike A, Naito K, Ishikura C, Funato A. Int J Periodontics Restorative Dent. 2025 Apr 25;45(3):357-367. doi: 10.11607/prd.7094. PMID: 38363184.
Decision Tree for Reconstructive Treatment of Peri-implantitis Defects. Urban IA, Chen Z, Wang HL. Int J Periodontics Restorative Dent. 2025 Jul 11;45(5):439-449. doi: 10.11607/prd.7205. PMID: 38820277.
The Laterally Stretched/Coronally Advanced Flap (LAST/CAF) with Connective Tissue Graf Variation to Treat Deep-Wide and Multiple Deep-Narrow Defects. Case Report and Technical Description. Carranza N, Bugiolachi J, Rojas M, Perrote A. Int J Periodontics Restorative Dent. 2025 May 5;0(0):1-20. doi: 10.11607/prd.7467. Epub ahead of print. PMID: 40324815.
Abutment-free Tissue-Level Implants for Personalized Monolithic Zirconia Implant Crowns: A Retrospective Cohort Study. Ionescu A, Marin M, Bayrich N, Fennema P, Nicolescu MI, Jung RE, Dodi A. Int J Oral Maxillofac Implants. 2025 Jul 23;0(0):1-26. doi: 10.11607/jomi.11144. Epub ahead of print. PMID: 40699608.
Clinical Outcomes of Periodontal Regenerative Therapy with Double-Sided Entire Papilla Preservation (DEPP) Technique for Intrabony Defects: A Case-Series with 12-Month Follow-Up. Ogawa Y, Aslan S, Goto H, Kawanabe D, Nagai T, Maekawa S, Ishikawa T, Saito A, Cortellini P, Imamura K. DOI: 10.11607/prd.7532, PubMed ID (PMID): 40036298 March 4, 2025,Pages 1-28.
Root coverage in deep recessions with apex involvement: Long-term case study. Neto Cesar JB, Lazarin R, Freitas VM, Matheus HR, Sekiguchi RT, Romito GA. Clin Adv Periodontics. 2025 Jul 17. doi: 10.1002/cap.10345. Epub ahead of print. PMID: 40674248.
Changes in Osseous Morphology Following Non-Surgical Periodontal Therapy: A Possible Paradigm Shift for the Treatment of Intrabony Defects? Nibali L, Cortellini P. J Clin Periodontol. 2025 Jun;52(6):836-842. doi: 10.1111/jcpe.14141. Epub 2025 Mar 13. PMID: 40081317; PMCID: PMC12082770.
Surface Decontamination on the Reconstructive Therapy of Peri-Implantitis: A Multicenter Randomized Clinical Trial. Monje A, Navarro-Mesa S, Soldini C, Zappalá G, Peña P, Navarro JM Sr, Pons R. Clin Implant Dent Relat Res. 2025 Aug;27(4):e70075. doi: 10.1111/cid.70075. PMID: 40693504; PMCID: PMC12281608.
Comparison of the Histological Structure of an Anterior as well as a Posterior Biopsy From the Human Palate: A Comparative Study. Bienz, S. P., Kuonen, J., Hüsler, J., Gadzo, N., Hitz, S., Jung, R. E., & Thoma, D. S. (2025). Journal of Clinical Periodontology, 52(5), 727–735. doi:10.1111/jcpe.14133.
Combined Effect of Abutment Height and Restoration Emergence Angle on Peri-Implant Bone Loss Progression: A Retrospective Analysis. Misch, J., Abu-Reyal, S., Lohana, D., Mandil, O., Saleh, M. H. A., Li, J., Wang, H. L., & Ravidà, A. (2025). Clinical oral implants research, 36(5), 600–612. doi:10.1111/clr.14408.
Interdisciplinary Management of Open Interproximal Embrasures. Ogawa Y. , Zuhr O., Avila-Ortiz, G. Journal of Esthetic and Restorative Dentistry (2025): 1–11. doi:10.1111/jerd.70015.
Combined Effect of Abutment Height and Restoration Emergence Angle on Peri-Implant Bone Loss Progression: A Retrospective Analysis. Misch, J., Abu-Reyal, S., Lohana, D., Mandil, O., Saleh, M. H. A., Li, J., Wang, H. L., & Ravidà, A. (2025). Clinical Oral Implants Research, 36(5), 600–612. doi:10.1111/clr.14408.
Premature Bone Resorption in Vertical Ridge Augmentation: A Systematic Review and Network Meta-Analysis of Randomised Clinical Trials. Alotaibi, F. F., Buti, J., Rocchietta, I., Mohamed Nazari, N. S., Almujaydil, R., & D’Aiuto, F. (2025). Clinical Oral Implants Research, 36(7), 787–801. doi:10.1111/clr.14435.
Peri-implant tissue stability: The PROS concept. Misch J, Alrmali AE, Galindo-Fernandez P, Saleh MHA, Wang HL.Int J Oral Implantol (Berl). 2025 Mar 6;18(1):73-84. PMID: 40047364.
Radiographic changes in the maxillary sinus following closed sinus augmentation. Simonsen JO, Mills MP, Mealey BL, Hachem LE, Geha H, Font K, Powell CA J Periodontol. 2025 Jul 17. doi: 10.1002/jper.11376. Epub ahead of print. PMID: 40674412.
Threshold for Implant Removal in Peri-implantitis Defects. Is There Any? Zimmer JM, Misch JE, Nava P, Sabri H, Calatrava J, Wang HL.J Oral Implantol. 2025 Apr 1;51(2):210-217. DOI: 10.1563/aaid-joi-D-24-00098.
Do Intrabony Defects Have a Worse Clinical Response to Step 2 of Periodontal Therapy and Repeated Subgingival Instrumentation Compared to Suprabony Defects? A Systematic Review. Marini L, Cuozzo A, Mainas G, Antonoglou G, Pilloni A, Nibali L. Int J Periodontics Restorative Dent. 2025 Jul 11;45(5):509-521. doi: 10.11607/prd.7235. PMID: 39058940.
Indications and Regenerative Techniques for Lateral Window Sinus Floor Elevation With Ridge Augmentation. Scaini, R., Saleh, M. H. A., Lai, H-C., Sangiorgi, M., Zucchelli, G., Testori, T. Clinical implant dentistry and related research, 27(3), e70007. DOI: 0.1111/cid.70007
Marginal Bone Changes at Bone-Level Implants With Narrow or Standard Diameter Abutments: 1-Year Results of a Randomised Controlled Trial. Liñares, A., Maceiras, L., Nóvoa, L., González, A., Rodríguez, B., Batalla, P., Leira, Y., Blanco, J. 2025. Clinical Oral Implants Research 1–11. DOI:10.1111/clr.70005.
Abstracts
Topic: Ortho-Implants
Authors: Tanno T, Hasuike A, Naito K, Ishikura C, Funato A.
Title: Orthodontic Implant Site Development Using Labial Root Torque: A Case Series with CBCT Analysis.
Source: Int J Periodontics Restorative Dent. 2025 Apr 25;45(3):357-367.
DOI: 10.11607/prd.7094. PMID: 38363184.
Reviewer: Daeoo Lee
Type: Retrospective case series (Private practice, Japan)
Keywords: orthodontics, extrusion, torque, labial bone resorption, bone wall, buccal
Purpose: To assess “Orthodontic implant site development with labial root torque” (OISD-LRT) technique for preparing tooth sites for dental implant non-surgically, in order to remedy thin labial bone.
Material and methods: Total of seven patients with Elian type II or III consented for the case series study. Patients received their treatment in a private practice setting located in Japan (Tochigi). CBCT images were taken at baseline, immediately post extraction, and crown placement. The steps for orthodontic treatment includes positioning multibracket device 2-3mm apically relative to adjacent teeth. The tooth was moved at a rate of 2mm per month. The bracket was repositioned 2-3mm away from gingival margin after about a month. Tooth movement and bracket repositioning was repeated over several months to move the tooth apically. Towards the end of orthodontic treatment, overcorrection was performed by positioning the bracket 2-3mm beyond the attachment level of adjacent teeth. Retention was maintained when the tooth was positioned almost perpendicularly for 2 months. After tooth extraction implant was placed flapless and guided.
Results: Seven patients (5F, 2M) completed the study. A total of eight sockets were treated with OISD-LRT. Overall, healing was uneventful. The orthodontic treatment took on average 404 days (± 311.7 days). Baseline CBCT revealed mean vertical bone height (VBH) to be 17.67mm; Horizontal Ridge Width at the apex (HBW1) was measured to be 9.09mm, HBW at 2.5mm coronal level (HBW2) was measured to be 7.40mm, and HBW at 5.0mm coronal level (HBW3) was 6.32mm. Post OISD-LRT, increase in HBW2 and HBW3 was observed (HBW2 0.80 ± 3.78 mm, HBW3 1.10 ± 4.81 mm). Post extraction, sufficient bone height and width were maintained for long-term implant stability
Conclusions: OISD-LRT may be an effective method for preparing a tooth site with labial bone loss (Elian II/III) for implant placement.
Topic: Peri-Implantitis Classification
Authors: Urban IA, Chen Z, Wang HL.
Title: Decision Tree for Reconstructive Treatment of Peri-implantitis Defects.
Source: Int J Periodontics Restorative Dent. 2025 Jul 11;45(5):439-449.
DOI: 10.11607/prd.7205. PMID: 38820277.
Reviewer: Daeoo Lee
Type: Classification
Keywords: Peri-implantitis, walls, defects, regeneration, morphology, outcome
Purpose: The article proposes a decision tree for reconstructive therapy based on peri-implantitis defects morphology.
Background: Previous classifications proposed by various authors highlight the role of defect morphology with circumferential defects yielding better result after regeneration therapy. GBR is the most frequently reported technique for addressing peri-implantitis defects. Healing approach is divided into either submerged and nonsubmerged protocol.
Material and methods: The decision tree is a modification of prior classification (Monje 2019). The decision tree is suited for implants that have been placed in the ideal position in the first place (centrally within a ridge). There are total of 5 classes: Class I (4-wall infraosseous defect), Class II (3-wall infraosseous defect + 1-wall dehiscence), Class III (2-wall infraosseous defect), Class IV (1-wall infraosseous defect), and Class V (Supracrestal defect).
Results: Class I prevalence rate is ~26%. GBR therapy is recommended with either submerged/nonsubmerged healing for complete bone regeneration. Class II prevalence rate is 38%. Fixated(tacked) membrane with submerged approach yielded best results and therefore is recommended. Class III prevalence rate is 18%. Complete regeneration is not as predictable compared to the previous class. GBR technique with titanium frame is preferred. Class IV prevalence rate is 12%. Tacked resorbable membrane may provide favorable results. Class V prevalence rate is 9%. Biologics (rhBMP-2) combined with osteoinductive/osteoconductive bone grafts material barriered with Ti-reinforced PTFE membrane might yield favorable outcome.
Conclusions: The decision tree may serve as a guide to help clinicians select treatment option based on defect morphology.
Topic: Root coverage
Authors: Carranza N., Bugiolachi J., Rojas M., Perrote A.
Title: The Laterally Stretched/Coronally Advanced Flap (LAST/CAF) with Connective Tissue Graf Variation to Treat Deep-Wide and Multiple Deep-Narrow Defects. Case Report and Technical Description
Source: Int J Periodontics Restorative Dent. 2025 May 5;0(0):1-20.
DOI: 10.11607/prd.7467
Reviewer: Cyrus J Mansouri
Type: Case report
Keywords: case report; gingival recession; microsurgery; mucogingival surgery.
Purpose: To describe a hybrid technique combining lateral stretching (LS) of the apical flap portion with limited coronal advancement of the flap (CAF) to minimize graft exposure and avoiding excessive coronal displacement of the mucogingival junction (MGJ) for deep and wide gingival recessions.
Material and methods: Two clinical situations are described and illustrated to introduce the technique in detail. Procedures were performed by a single experienced surgeon using microsurgical technique and a surgical microscope. The treatment strategy was performed in single deep-wide recessions (depth ≥ 4 mm) and multiple adjacent deep-narrow recessions (depth ≥ 4 mm and width < 4 mm). Treatment concept involves determining desired level of coronal advancement, lateral stretching of the apical component of the recession defect, and limited coronal advancement to maintain the level of the mucogingival junction (MGJ) and keratinized tissue width (KTW). This strategy may reduce graft exposure, improve vascularization, and allow us of smaller connective tissue grafts (CTGs). The first step was to select the vector of coronal displacement and place oblique incisions at each papilla according to the depth of the recession depth (1-3 mm typically). A partial thickness envelope flap was raised for the entire surgical flap unless the phenotype is thin, where the flap should be converted the full thickness to preserve flap dimensions and survivability. Periosteal incisions were made beyond the MGJ to release the flap while leaving 0.5-1.5 mm of connective tissue attached to the bone. Then, a submucosal muscle release was performed 1-2 mm apical to the CEJ with blunt dissection (deep and shallow incisions). Papillae were de-epithelialized, root surfaces prepared mechanically and chemically (using Prefgel and Emdogain product), and the flap was laterally stretched in the apical portion using double-cross mattress and simple sutures. A CTG was harvested using a double blade technique from the palatal donor tissue with a target of 1 mm in thickness. The graft was adapted to the decipient bed using 7-0 PGA absorbable sutures. Sling sutures were performed with 6-0 Resolon to coronally advance the flap over the CTG.
Results: Case 1 was a 38-year-old male with deep-wide (≥4 mm) buccal recession at tooth 11 and adjacent shallow defects. Uneventful healing resulted in complete root coverage and increased KTW at 6 months follow-up. Case 2 was a 37-year-old female post-op orthodontics therapy presenting with contiguous deep-narrow RT2 recessions, high frenum, and thin papillae. Uneventful healing resulted in complete root coverage and KTW gain at 3 months.
Conclusion: The LA + CAF + CTG technique is a hybrid technique that allowed for an envelope flap approach to achieving root coverage on wide/deep single recessions and multiple contiguous deep-narrow defects while simultaneously augmenting the KTW and maintaining the MGJ.
Topic: Restorative connection to the implant
Authors: Ionescu A., Marin M., Bayrich N., Fennema P., Nicolescu MI., Jung RE., Dodi A.
Title: Abutment-free Tissue-Level Implants for Personalized Monolithic Zirconia Implant Crowns: A Retrospective Cohort Study
Source: Int J Oral Maxillofac Implants. 2025 Jul 23;0(0):1-26.
DOI: 10.11607/jomi.11144.
Reviewer: Cyrus J Mansouri
Type: Retrospective study
Keywords: abutment-free implants, tissue-level, zirconia crown, peri-implant bone loss, CBCT, digital workflow
Background: Tissue-level implants are often restored with stock Ti-base abutments. Despite high success, mechanical and biological drawbacks do exist. These include compromised esthetics, especially in thin phenotypes, crown debonding from abutment over time, limited soft tissue customization with prefabricated emergence profiles, and presence of an additional micro-gap. Zirconia abutments may have an esthetic advantage but demonstrate reduced mechanical resistance and interface wear. This article presents an abutment-free tissue-level implant (matrix®, TRI Dental Implants AG), allowing direct connection of a monolithic zirconia crown to the implant. Widespread digital workflow adoption allows full customization of the emergence profile and esthetics.
Purpose: To assess peri-implant bone stability between abutment-free tissue-level implants and conventional tissue-level implants restored with Ti-base abutments over 12 months. Secondary aim: document patient-reported oral health outcomes.
Material and methods: A retrospective chart review was conducted for patients electing for tooth replacement via dental implants from October 2018 – October 2022. Each hopeless tooth was treated with extraction followed by immediate or delayed dental implant insertion. Surgical protocol included minimally traumatic extraction was performed with preservation of socket walls. Implants were placed flapless and fully-guided into fresh extraction sockets, buccal gaps were grafted with xenograft, and sites were covered with a collagen membrane. A delayed approach was performed was implant placement was deemed unpredictable. Implant platforms were 3.7, 4.5, or 4.8 mm in diameter (matrix® abutment-free, 3.7 or 4.5 mm platform and TRI Octa conventional tissue-level, 4.8 mm platform with Ti-base). Outcome measures included buccal wall height and alveolar ridge width measured to the nearest millimeter on mid-cross sectional slice of the tooth visualized on DICOM file obtained by CBCT. Measurements were performed at baseline (pre-implant insertion), pre-loading, and at 12-months post-loading. Non-inferiority between therapies was studied with a margin set at 0.5 mm for bone volume change. Patient reported outcome measures (PROMs) were collected using the Oral Health Impact Profile (OHIP-14) questionnaire at the 12-month follow-up visit to assess oral health-related quality of life after rehabilitation with a dental implant.
Results: Retrospective chart review revealed 53 patients with 100 implant sites treated by abutment-free tissue-level implants (n = 41 patients, 50 sites) or conventional tissue-level implants with stock Ti-bases (n = 32 patients, 50 sites). Mean follow-up was 12 months. No implants were lost and no complications were found in either group. Buccal bone loss at one-year was -0.21 mm for the abutment-free implants and -0.65 mm for conventional implants (difference 0.44 mm, not found to be significantly different). Change in alveolar ridge width was -0.02 mm for the abutment-free group and -0.36 mm for the conventional group (difference of 0.34 mm). Non-inferiority was found in all bone measurements. For PROMs, the OHIP-14 surgery had a mean score of 4.0 (0-19), with patients reporting occasional painful aching (11%) and occasional diet dissatisfaction (9%).
Conclusion: Abutment-free tissue-level implants were non-inferior to conventional Ti-base restored tissue-level implants and may offer advantages in preserving buccal bone and ridge width over 1 year. Benefits may include reduced component complexity, number of micro-gaps, elimination of cementation, and improved digital customization. Long-term randomized trials are indicated to confirm these findings and assess complication profiles.
Topic: Treatment of Intrabony Defects
Author: Ogawa Y, Aslan S, Goto H, Kawanabe D, Nagai T, Maekawa S, Ishikawa T, Saito A, Cortellini P, Imamura K.
Title: Periodontal Regenerative Therapy with Double-Sided Entire Papilla Preservation (DEPP) Technique for Intrabony Defects: A Case-Series with 12-Month Follow-Up
Source: Int J Periodontics Restorative Dent.
DOI: 10.11607/prd.7532.
Type: Clinical Study
Reviewer: Veronica Xia
Keywords: intrabony defect, regenerative therapy, papilla preservation, biologics, clinical outcomes
Purpose: The purpose of this study is to present a case series using double-sided entire papilla preservation (DEPP) technique in periodontal regenerative therapy of intrabony defects.
Materials and Methods: This case series included 7 patients with Stage III, Grade A-C periodontitis, probing depth (PD) of >5mm, >3mm intrabody defect that was either a one and/or two wall defect extending buccolingually. Clinical examinations including bleeding on probing (BOP), PD, gingival recession (GR), and clinical attachment level (CAL) were recorded. Radiographic changes were analyzed postoperatively, focusing on radiographic bone fill (RBF).
All patients were subject to initial phase I therapy prior to periodontal surgery. Surgical therapy involved using the DEPP technique where a curved vertical incision extending to the mucogingival junction on the buccal and lingual surfaces was made on either the mesial or distal line angle of the tooth (depending on side of intrabony defect). A full thickness flap was elevated, with care to preserve interdental papilla while elevating. Granulation tissue was removed from intrabony surface and root planing on both buccal and lingual surfaces. Biologics such as recombinant human fibroblast growth factor 2 (rhFGF-2: REGROTH) or enamel matrix derivative (EMD: Emdogain) were applied to the root surface and premixed with a bone graft (either carbonate apatite-CO3Ap or deproteinized bovine bone mineral-DBBM). Bone graft material was placed into defect, and flap was closed. Final clinical parameters were measured at 12 months.
Results: Of the 7 patients included in this study, 2 received EMD with DBBM, 2 received rhFGF-2 with DBBM, and 3 received rhFGF-2 with CO3Ap granules). Statistically significant improvements were made in terms of mean PD reduction of 5.0+/-1.4mm and CAL gain of 5.3+/-1.8mm. Mean GR also reduced by 0.3+/-0.5mm, with no treated sites showing BOP. A mean RBF of 67-100% was observed at the treated sites. Overall, all sites were deemed to have successful treatment due to having PD </=4mm and CAL gain of >3mm at the 12 month follow up.
Conclusion: The use of DEPP in combination with regenerative therapy can be used to effectively treat intrabony defects with successful outcomes of PD </=4mm and CAL gain of >3mm.
Topic: Root Coverage
Author: Neto César JB, Lazarin R, Freitas VM, Matheus HR, Sekiguchi RT, Romito GA.
Title: Root coverage in deep recessions with apex involvement: Long-term case study.
Source: Clin Adv Periodontics.
DOI: 10.1002/cap.10345.
Type: Clinical Study
Reviewer: Veronica Xia
Keywords: root coverage, apex, apicoectomy, gingival recession, connective tissue graft
Purpose: The purpose of this article is to describe the method of either a laterally sliding flap (LSF) or modified double papilla flap (MDPF) with combination with a subepithelial connective tissue graft (SCTG) and apicoectomy in cases included gingival recessions (GR) extending to the apex.
Materials and Methods: This retrospective study included seven adults presenting with RT1/2 recessions, GR >/=5mm, probing depths (PD) 4 to 6mm with bleeding on probing (BOP). All patients received non-surgical therapy, followed by either LSF with SCTG or MDPF with SCTG. Endodontic treatment was complete the day before surgery.
MDPF modification included a vertical releasing incision one tooth away from the tooth requiring treatment, thus avoiding an incision directly over the periapical lesion. Oblique incisions adjacent to deep recession were made, connected by sulcular incisions terminating at vertical releasing incisions (VRI) at the interproximal areas of the adjacent teeth. The apex of the tooth with deep recession was exposed with a full-thickness flap and split thickness was performed to allow for flap mobility. Apicoectomy was performed, followed by SCTG placement over target tooth, stabilized with single interrupted sutures. Mesial and distal papillae of center tooth sutured to cover deep recession. Anatomical papillae were de-epithelialized, and flap was coronally advanced.
LSF included the de-epithelialization of the recipient papilla area on one side adjacent to the deep recession. On the opposing side, flap was reflected with VRI on one side to allow movement of the flap to cover adjacent recession. Full thickness flap reflected to expose apex, and apicoectomy was performed. SCTG placed over defect, flap was laterally repositioned over defect and SCTG.
All teeth were treated with apicoectomy, while only teeth with excessive root prominence were subject to odontoplasty. Patients were followed-up with every 3 months within the first year, with clinical parameters recorded at each visit.
Results: At final follow up visits, the mean recession depth (RD) was 0.57mm, with a mean reduction of 7.57mm. four of the seven pts achieved complete root coverage, while all remaining patients achieved partial root coverage. Mean root coverage was 90.71% overall. All patients exhibited an increased in keratinized tissue width (KTW) from 0.21mm to 4.71mm.
Conclusion: This study demonstrates that in the presence of deep GR, apex exposure, and pulpal necrosis, the use of SCTG and apicoectomy in combination with root coverage procedures can achieve root coverage in severe mucogingival defects.
Topic: Non-surgical Treatment
Author: Nibali, et al.
Title: Changes in Osseous Morphology Following Non-Surgical Periodontal Therapy: A Possible Paradigm Shift for the Treatment of Intrabony Defects?
Source: J Clin Periodontol. 2025 Jun;52(6):836-842
DOI: 10.1111/jcpe.14141
Reviewer: Ryan Higgins
Type: Review
Keywords: bone, non-surgical, periodontitis
Purpose: To review current concepts related to non-surgical periodontal therapy (NSPT), with a focus on expected healing outcomes.
Materials and Methods:
Wound Healing and Clinical Outcomes:
It is clear that NSPT results in profound changes to the periodontal pocket environment that can be measured by clinical parameters, microbiological outcomes, local inflammation, systemic inflammation, and patient-reported outcomes. Classic studies like Cobb 2002 which highlight initial shallow sites (PPD 4–6 mm) will show a mean PPD reduction of ≈ 1.29 mm and CAL gain of 0.55 mm and deep sites (PPD ≥ 7 mm) show mean PPD reduction of 2.16 mm and CAL gain of 1.19 mm. In more recent years similar results have emerged from the European Federation of Periodontology (EFP)-commissioned
systematic review, showing a mean PPD reduction of 1.4 mm at 6–8 months, subdivided into PPD reduction of 1.5 mm for shallow sites and 2.6 mm for deep sites at 3/4 months, with pocket closure (conversion to PPD < 5 mm) of 74% (Suvan et al. 2020).
Alveolar Bone Changes:
A new wave of studies starting with Hwang et al. 2008 have suggested that alveolar bone changes can occur after NSPT. Hwang found that an increase in radiographic density by subtraction radiography in 83% of treated areas, particularly in apical portions of the defects. A retrospective study also found that linear radiographic bone changes in 126 intrabony defects amounting to approximately 1-mm defect reduction at 12 months, with widening of the defect angle (Nibali et al. 2011). A series of studies about minimally-invasive non-surgical periodontal therapy (MINST) have been published showing principles of gentle defect debridement under magnification and minimum trauma to the soft tissues and in particular to the papilla in intrabony defects can result in PPD reductions and CAL gain are accompanied by reductions in radiographic defect depth up to 12 months post-treatment, generally ranging from 1.5 mm to ≈3 mm (Anoixiadou et al. 2022; Mehta et al. 2024; Nibali et al. 2018).
Implications for Treatment Protocols:
A systematic review investigated this aspect, in relation to regenerative surgery of intrabony defects (Nibali et al. 2015). Out of 293 included studies no included papers reported clinical and radiographic
data before and after NSPT (step 2) prior to periodontal surgery, showing that the non-surgical step of therapy was not considered important for the regenerative outcomes (Nibali et al. 2015).
The current understanding of a gradual change to osseous architecture of intrabony defects based on the evidence discussed above, suggests that surgical regenerative/reconstructive therapy of intrabony defects should only be conducted 6–12 months following NSPT, in order to allow for the healing to occur and the new osseous architecture to be established first.
The authors suggest a phased re-evaluation protocol after step 2 therapy, consisting of:
A review 1 month after step 2, to assess resolution of marginal inflammation and patient compliance (oral hygiene assessment and re-enforcement); re-evaluation 3 months after step 2 (when most soft tissues healing has occurred), to re-assess PPD and CAL, as well as oral hygiene and compliance; further re-evaluations 6 and 12 months after step 2 (when most hard tissues healing has occurred), to re-assess PPD, CAL, oral hygiene, compliance and radiographic osseous changes.
In cases of prevalently intrabony defects and in the absence of clear signs of marginal inflammation, suppuration or patient discomfort, the first re-evaluation including periodontal probing could be carried out at 6 months rather than 3 months.
Conclusions: The review suggests that following non-surgical periodontal therapy alveolar bone changes occur, particularly in intrabony defects, warranting reflection over a change in the current clinical protocols. That a re-evaluation after NSPT should be completed as far as 6 months after prior to surgical treatment.
Topic: Peri-implantitis Treatment
Author: Monje, et al.
Title: Surface Decontamination on the Reconstructive Therapy of Peri-Implantitis: A Multicenter Randomized Clinical Trial
Source: Clin Implant Dent Relat Res. 2025 Aug;27(4):e70075
DOI: 10.1111/cid.70075
Reviewer: Ryan Higgins
Type: RCT
Keywords: dental implant, endosseous implant complication, mucositis, peri-implant disease, peri-implantitis
Purpose: The objective of the study is to compare the clinical/radiographic outcomes and the rate of disease resolution of the adjunctive use of electrolysis (GS) or hydrogen peroxide (HP) for mechanical decontamination in the reconstructive treatment of peri-implantitis-related intrabony circumferential defects.
Materials and Methods: This study compared the effectiveness and safety of two methods to decontaminate crater-like and circumferential intrabony defects subjected to reconstructive therapy. Overall, 58 patients completed the study. Clinical evaluation was made at baseline (T0), 6months (T1) and 12months (T2), while radiographic assessment was carried out at T0 and T2. Disease resolution was the primary outcome, with criteria of absence of bleeding (BOP) and/or suppuration (SUP) upon gentle probing (~0.2N), probing pocket depths (PPD)≤5mm, no progressive radiographic bone loss beyond the standard error (SE ≥1mm). Parameters reported include PPD, modified sulcularBI (msBI), mucosal recession (MR), KM, suppuration grading index, intraoperative intrabony component.
Treatment started with full thickness flap, followed by debridement with steel curetes and NiTi brushes at 600 rpm for 2-3 minutes. Test group (GS) then received GalvoSurge for 2 min, followed by irrigation with saline. The control group (HP) received hydrogen peroxide (3%) for 2 min, followed by saline irrigation. Reconstructive therapy was then completed with back action chisel collecting autogenous bone chips mixed with anorganic bovine bone (creos) in a 1:1 ratio along with a collagen membrane (creos xenoprotect). For implants in the esthetic zone a CTG was also placed.
Results: Implant positions were 46% molars, 33.3% premolars, and 20.6% incisors. In turn, 55.6% of the implants were located in the maxilla, while 44.4% were located in the mandible. Mean intrabony defect depth was 3.98±0.91mm, with 46% being classified as Ib and 54% as Ic.
Mean PPD reduction from T0 to T2 was 3.15mm for GS and 3.31mm for HP with no significant difference between the groups. With regard to mSBI, the median reduction between T0 and T2 was −1.08 and −1.67 for the GS and HP groups, respectively. Statistical significance was reached.
Mucosal recession increased (p< 0.001) from T0 to T2 by 1mm, with no statistically significant difference between the groups.
Marginal bone level and radiographic defect angle increased (p<0.001) from T0 to T2. Marginal bone level increased 1.61±0.75mm for the GS group and 1.66±0.58mm for the HP group from T0 to T2. Mean gain for deepest MBL was 1.88±0.82 and 1.87±0.62mm for the GS and HP groups, respectively.
The disease resolution rate was 87.5% for the GS group and 64.5% for the HP group at T2 (p=0.08). No major postoperative complications were reported. The sensitivity and specificity, therefore, were 91.7% and 26.7%, respectively. The use of GS demonstrated a tendency towards the achievement of statistical significance with disease resolution (Wald Chi2 GEE=2.91; df=1; OR=3.76; 95% CI: 0.75–18.8; p=0.088).
Conclusions: Both electrolysis or hydrogen peroxide are effective in resolving peri-implantitis, in gaining radiographic marginal bone levels, and in enhancing clinical peri-implant conditions in the surgical reconstructive therapy.
Topic: Histology of the palatal soft tissue
Authors: Bienz S. et al.
Title: Comparison of the Histological Structure of an Anterior as well as a Posterior Biopsy From the Human Palate: A Comparative Study
Source: Journal of Clinical Periodontology, 2025; 52:727–735
DOI: 10.1111/jcpe.14133.
Reviewer: Nicolas Lobo
Type: RCT
Keywords: histology; histomorphometry; palatal mucosa; subepithelial connective tissue graft; tissue composition
Purpose: To compare the histological composition of soft tissue biopsies obtained from the anterior (A) and posterior (P) areas of the human palate, to evaluate potential differences between donor sites for soft tissue grafting procedures
Materials and Methods: 20 healthy participants with good oral hygiene and adequate palatal space between the canine and first molar were enrolled. From each subject, four soft tissue samples were harvested using 6 mm diameter, 3 mm tall tissue punches at the level of the first premolar (A) and first molar (P) bilaterally. Histological analyses were performed to assess epithelial thickness (EP), lamina propria thickness (LP), and rete peg length. Additionally, the presence and distribution of collagen fibers (CF), elastic fibers, elastic connective tissue, loose connective tissue (LCT), and background tissue components were evaluated.
Results: The mean EP was 0.42 mm in A and 0.37 mm in P. In A, thickness ranged from 0.20 mm to 0.72 mm, while in P, it ranged from 0.19 mm to 0.53 mm. The mean thickness of the LP was 0.81 mm in A and 0.85 mm in P, with values varying between 0.6 mm and 1 mm across different locations. NSSD in LP thickness were observed between A and P. However, CF was significantly less abundant in the anterior region compared to the posterior region. On the contrary, LCT was significantly more prevalent in the anterior samples. The mean proportion of collagen fibers was 20% in A and 26% in P, indicating a significant difference between the two sites.
Conclusions: Although lamina propria thickness was similar across regions, distinct histological differences were observed between anterior and posterior palatal mucosa. The posterior palate exhibited a higher concentration of collagen fibers and a lower proportion of loose connective tissue, which may influence graft performance. These findings suggest that harvesting techniques such as single incision and trap door techniques should consider tissue composition, as increased submucosal content may negatively affect healing due to its glandular and fatty composition, potentially limiting plasmatic diffusion and vascularization.
Topic: Management of open embrasures
Authors: Ogawa Y. et al.
Title: Interdisciplinary Management of Open Interproximal Embrasures
Source: Journal of Esthetic and Restorative Dentistry, 2025; 0:1–11
DOI: 10.1111/jerd.70015
Reviewer: Nicolas Lobo
Type: Review
Keywords: esthetic dentistry; interdental papilla; open interproximal embrasures; periodontal regeneration
Purpose: To discuss key etiological and risk factors associated with the onset and progression of Open interproximal embrasures (OIE) and propose a systematic interdisciplinary approach for their management.
Discussion:
Risk and Etiologic Factors:
Bone Crest-to-Contact Area Distance (BC-CP): Strongly influences the presence of interproximal papilla. When BC-CP is ≤5 mm, papillary fill is nearly complete; beyond this, the likelihood decreases. Some research suggests a stricter threshold of ≤4 mm for full fill, likely due to differing measurement methods. Factors that increase BC-CP distance (and reduce papillary fill) include coronal displacement of contact areas (from misalignment or restorations) and apical bone loss
Interproximal Width: Negatively correlates with BC-CP height. Optimal papillary height occurs when width is ≤ 1.5 mm if BC-CP is ≤ 5 mm, or 2.0–2.5 mm if BC-CP is ≤ 4 mm. Wider embrasure areas are associated with OIE, and interproximal width is influenced by tooth form and root inclination.
Gingival Thickness: Thicker interproximal gingival tissue is associated with a higher likelihood of complete papillary fill. Sites with gingival thickness >1 mm achieve significantly better results than thinner sites. While buccal-lingual thickness alone may not be critical, overall gingival bulk plays a key role. Surgical enhancement using CTG is considered the gold standard, as it effectively increases tissue thickness and may promote creeping attachment.
Tooth Form: Significantly affects papillary fill. Square-shaped teeth with long contact areas and narrow interproximal spaces are more favorable. In contrast, triangular teeth and crowding are less ideal. Optimal design includes placing the contact point 4–5 mm from the bone crest and maintaining a crown width-to-length ratio under 0.87. In orthodontics, interproximal reduction (IPR) can help reshape teeth and lower the BC-CP by moving contact points gingivally, enhancing papillary fill.
Axial Root Inclination: Orthodontic correction of unfavorable axial root inclinations can reduce or eliminate OIE by improving contact areas and compressing interdental gingiva. Normal closed embrasures show a mean root convergence of 3.65°, while each 1° increase in divergence raises OIE risk by 14–21%. Tooth movement direction affects gingival morphology: lingual movement thickens facial tissue and increases papilla height, whereas labial movement thins and apically shifts it. Vertical discrepancies, attachment loss, and excessive proclination, increase BC-CP and can complicate or contraindicate treatment.
Therapeutic Protocols and Recommendations:
BC-CP: Unfavorable BC-CP often results from coronally displaced contact areas or apically shifted bone crests. In the first case, restorative or orthodontic treatment should aim for an ideal contact area 4–5 mm from the alveolar crest, with a CW/CL ratio < 0.87 and tooth-specific contact lengths ratio (central: 50%, lateral: 40%, canine: 30%). In the second case, surgical soft tissue gain is possible but unpredictable due to the papilla’s fragility and poor blood supply; techniques that avoid incisions in the interdental papilla are preferred over papillary incisions. Periodontal regeneration is indicated for vertical defects with infrabony components, while horizontal bone loss lacks predictable crest height augmentation methods. Orthodontic extrusion can improve BC-CP relationships and regenerate supporting structures, offering both functional and esthetic benefits.
Interproximal Width: Orthodontic treatment can help achieve favorable interproximal width and complete papillary fill, particularly when malocclusion, excessive interdental spacing, or diastema affect papilla morphology. It can also correct axial root inclination, and interproximal stripping can lengthen the contact area by repositioning its most apical point, further improving interproximal width.
Gingival Thickness: CTG is a reliable method for increasing gingival thickness, either from the palate, tuberosity, or edentulous sites. While autogenous grafts remain the gold standard, allografts, xenografts, and combined with biologics, show promising results. In papilla reconstruction, minimally invasive techniques that avoid papillary incisions, preserve tissue integrity, and create space for graft placement to coronally elevate the papilla are preferred.
Tooth Form: Prosthetic or restorative treatments can help achieve ideal tooth form but should be pursued only after other contributing factors to a natural appearance have been addressed.
Axial Root Inclination: Orthodontic treatment, guided by a full-mouth assessment and patient preferences, is key to optimizing axial root inclination. The aim is ideal root alignment, with slight interdental inclination sometimes benefiting papilla form, but excessive inclination should be avoided.
Conclusions: Effective management of OIE requires a well-coordinated interdisciplinary approach involving accurate diagnosis and treatment planning. Success depends on integrating periodontal, orthodontic, and prosthetic strategies tailored to each patient. Although focused on natural dentition, the discussed principles can also apply to restorations involving pontics and implants. Further research is needed to validate these concepts and recommendations.
Topic: Abutment Height and Emergence Angle
Authors: Misch, J., et. al.
Title: Combined Effect of Abutment Height and Restoration Emergence Angle on Peri-Implant Bone Loss Progression: A Retrospective Analysis.
Source: Clinical oral implants research, 36(5), 600–612
DOI: 10.1111/clr.14408
Type: Retrospective Study
Reviewer: Mahya Sabour
Keywords: Dental implant, abutment height, emergence angle, peri-implant bone loss, peri-implantitis
Purpose: To assess the effect of abutment height in terms of peri-implant bone response around bone level implants with various emergence angles.
Materials and Methods: Patients that received one or more bone level implants in the presence of opposing dentition and had radiographs taken at the crown placement, 12-18 months after crown placement (T0), and at minimum 1y follow up after T0 (T1) were included in the study. Various patient and implant data was collected. Implants that were removed, lost, mobile, or fractured were considered as failed. The restorative emergence angle (REA), trans-mucosal abutment height (TmAH), and marginal bone levels (at T0 and T1) were radiographically measured on the mesial and distal sites. Implants were classified as being positive or negative for peri-implantitis (PI) according to the 2017 World Workshop definition of peri-implantitis (PI) – progressive bone loss > 0.5mm, deepening probing depths (PD) in conjunction with clinical signs of inflammation related to BOP or suppuration. 4 study groups were created based on the REA and TmAH: long/narrow-angle (LN) with TmAH >2mm and REA <30, long/wide-angle (LW) with TmAH >2mm and REA >/=30, short/narrow-angle (SN) with TmAH <2mm and REA <30, and short/wide-angle (SW) with TmAH <2mm and REA >/=30.
Results: 192 implants were placed in 54 male and 65 female patients, averaging 64.1 years of age. Mesial and distal implant sites were divided and 78 belonged to the LN, 61 to the LW, 83 to the SN, and 162 to the SW group. 55.5% of the patients were non-smokers, 34.5% former, and 10% current smokers. 16.8% had diabetes, and 52.9% had a history of periodontal disease. The follow up period averaged 7.43 years. The mean marginal bone loss (MBL) from T0 to T1 was 0.43 at the initial measurement and 0.44 at the second. NSD was found between the groups for age, gender, smoking, diabetes, history of periodontitis, radiographic follow-up, total follow-up, diameter, length, and type of implant, retention, splinted, maintenance/y during follow-ups, sector and arch of implant placement.
An REA >/=30 is significantly related to the MBL only when the TmAH is <2mm in bone-level implants.
Higher MBL was seen in short TmAH group implants (SN and SW > LN and LW) in addition to REA >/=30 compared to <30 in similar TmAH (SW > SN and LW > LN). Mean MBL was 0.26mm in the LN, 0.27mm in the LW, 0.46mm in the SN, and 0.79mm in the SW groups with a significant difference between groups. Significantly greater MBL in SW group compared to the other three groups, as well as the SN group compared to the LN group. NSD between LN and LW. Very low failure rate (5 cases), all associated with the SW group and a mean lifespan of 7.93y and failure due to severe PI. History of periodontitis, more frequent maintenances, and study groups were significant predictors for PI. Internal hex connections were protective as opposed to external hex.
PI had a 19.3% prevalence at the patient level and 18.8% at the implant level overall, with 11.4% in the LN, 8.6% in the LW, 14.3% in the SN, and 65.7% in the SW groups. In implants with TmAH > 2mm 4x less PI was seen, regardless of the REA. The study group is significantly related to PI development. The SW group had an OR of 4.19 for PI compared to LW and 4.04 compared to LN. TmAH is a significant covariate for MBL >0mm and every 1mm increase, reduces the odds of MBL by 37%. 70% of short TmAH groups had MBL > 0mm regardless of REA, while in longer TmAH groups, the REA became a more important factor and 35.1% of the LN and 47.5% of the LW group had MBL > 0mm.
Conclusion: An abutment height >2mm significantly reduces PI and MBL related to REA >/=30 in bone-level implants. REA plays a significant role only when TmAH <2mm are used. An inverse relationship exists between TmAH and MBL > 0mm while no significant relationship was seen with REA.
Topic: Vertical Ridge Augmentation
Authors: Alotaibi, F., et al.
Title: Premature Bone Resorption in Vertical Ridge Augmentation: A Systematic Review and Network Meta-Analysis of Randomised Clinical Trials.
Source: Clinical oral implants research, 36(7), 787–801.
DOI: 10.1111/clr.14435
Type: Systematic review and meta-analysis
Reviewer: Mahya Sabour
Keywords: Dental implants, complications, premature resorption, ridge augmentation
Purpose: To review the evidence on premature ridge resorption after different vertical ridge augmentation (VRA) techniques in staged implant placement cases.
Materials and Methods: Databases were searched for randomized control trials (RCTs) with minimum 3 month follow up on healthy patients that received any staged VRA procedure. Outcomes considered were relative premature bone resorption (PBR%) and need for additional bone grafting (NAG).
Results: 10 RCTs with 220 participants were included. VRA techniques were divided into seven treatment groups: onlay, onlay + barrier, inlay, GBR, cortical tenting (CT), tissue expansion + tunneling (TET), and distraction osteogenesis (DO). Bone materials included autogenous (7), xenogeneic (2), and a mix of both (2). The mean age range was 40 to 57y and patients were predominantly females. No participants had any medical conditions that would impair bone healing and smokers were excluded in two of the studies and included in five. Staging period for the studies ranged </=4 to 7 months.
The overall average PBR from 8 studies was 26%. Compared to onlay grafting, all other treatments had lower mean differences in PBR: Inlay grafting had 26.5% less, pre-augmentation soft-tissue expansion had 10% less, onlay + barrier had 6.9% less and GBR had 0.23% less PBR. Onlays, followed by DO and TET had the highest probability of being ranked the number one treatment.
Data from three studies showed that PBR was significantly higher in sites with healing complications (local infection, wound dehiscence, incomplete graft integration, and significant graft resorption) compared to those with uneventful healing, with a mean difference of 10%. One study showed that additional bone grafting was needed in 16.67% of groups with an onlay block covered with a titanium mesh compared to 41.67% in those without the mesh.
Conclusion: VRA techniques that preserve the periosteum such as inlay, DO, and TET lead to less PBR. In techniques with full flap elevation, volume loss at re-entry is possible and higher graft volumes should be considered to compensate for this issue.
Topic: Peri-implant tissue
Author: Misch J, Alrmali AE, Galindo-Fernandez P, Saleh MHA, Wang HL
Title: Peri-implant tissue stability: The PROS concept
Source: Intl J of Oral Implantology
DOI: PMID: 40047364
Type: Narrative review
Reviewer: Pankti Rana
Keywords: peri-implant health, tissue stability, prosthetic design, crestal bone preservation
Purpose: To offer a structured approach to implant placement using prosthetic design features in order to achieve predictable peri-implant tissue outcomes.
Discussion/Key principles: Platform switching involves using a smaller diameter abutment than that of the implant platform, which creates separation between the inflammatory infiltrate in the peri-implant connective tissue and the cervical bone around the implant. It allows for an increase in the volume of soft tissue, leading to increased peri-implant tissue stability. Reduced mucosal thickness below the mucosal margin is linked to an increased risk of soft-tissue dehiscence. Typical platform switching ranges from 1 to 1.5 mm, and implants with platform switching have displayed superior gingival margin levels and papilla height, with an average improvement of 1.06 mm in recession and 0.5 mm in papilla height. The reduction in abutment diameter should not exceed 0.37 mm, as larger offsets have no additional benefits.
Restorative abutment design plays a key role, as transmucosal abutment height (TAH) greater than 2 mm preserves peri-implant bone thickness, and longer abutments reduce marginal bone loss (MBL). Higher MBL is seen in divergent transmucosal components compared to convergent ones. The bone-level implant platform should be placed 3–4 mm apical to the mucosal margin. A 3 mm tissue thickness is sufficient to prevent discoloration with restorative material as well. The ideal abutment design for adequate surrounding tissue and aesthetic emergence consists of an A zone that is 1 mm convex, a B zone that is concave, and a C zone that is 2 mm straight.
An optimal connection is important, as a micro gap at the implant-abutment junction (IAJ) allows for bacterial infiltration and a localized inflammatory response, while micromovements at the IAJ lead to MBL. Internal conical connection has the lowest occurrence of micromovements and encourages better distribution of occlusal load. Crater- or saucer-like defects are formed due to bone remodeling from inadequate implant-abutment connections. Internal conical connection provided the best results for implant survival, peri-implant MBL and prosthetic complications 1-year post-op. Internal connection is better for bone preservation than external, and internal conical has shown less MBL than internal hex. A stable and precise fit between implant components results in less misalignment, uniform force distribution, greater implant stability, and improved osseointegration.
Subcrestal implant placement allows for better maintenance of biologic width and healthier peri-implant soft tissues as well as reduction in MBL. It also avoids excessive contours and biologically complicating emergence angles. Implant connection type determines subcrestal placement, and external connection implants are not suitable for subcrestal placement due to excessive MBL. Depth should not be exaggerated, as this can lead to deeper probing depths and bacterial accumulation when greater than 3 mm.
Conclusion: The key principles of the PROS concept include platform switching, restorative abutment design, optimal (conical) implant-abutment connection, and subcrestal implant placement. These elements work together to promote peri-implant tissue stability, improve predictability of crestal bone preservation, and lower the risk of peri-implantitis leading to successful long-term clinical outcomes.
Topic: Sinus Augmentation
Author: Simonsen JO, Mills MP, Mealey BL, Hachem LE, Geha H, Font K, Powell CA
Title: Radiographic changes in the maxillary sinus following closed sinus augmentation
Source: J of Periodontology
DOI: 10.1002/jper.11376
Type: Prospective clinical study
Reviewer: Pankti Rana
Keywords: Sinus augmentation, osseodensification, 3D imaging, freeze dried bone allograft
Purpose: To assess how accurately 3D imaging detects graft changes compared to 2D imaging, and to evaluate graft material distribution and resorption from baseline to six months after implant placement and transcrestal sinus lift.
Material and Methods: 22 patients who were partially edentulous, required sinus augmentation, and had at least 5 mm residual bone height (RBH) beneath the maxillary sinus were included. All patients were non-smokers, and if diabetic, had an A1c ≤ 7. Periapical radiographs (PA) and cone-beam computed tomography (CBCT) scans were taken pre-operatively. A transcrestal approach using the osseodensification protocol with freeze-dried bone allograft (FDBA) was performed, and the integrity of the sinus membrane was confirmed clinically. Immediately post-operatively, PA images were taken using a bite registration, and low-volume CBCT scans were obtained. On PA, the parameters assessed included RBH, implant protrusion length (IPL), apical graft height (AGH), endo-sinus bone gain reduction (ESBG), and elevated membrane apex reduction (EMA). In addition to these parameters, CBCT was used to assess sinus angle (SA), morphology of the sinus floor, graft contact walls (GCW), and sinus membrane thickness (SMT). Both modalities were repeated six months post-operatively for comparison.
Results: RBH was greater than 5 mm in all 22 sites. Radiographs at 6 months post-op were compared to initial baseline. Both PA and CBCT evaluations showed a significant reduction in vertical dimension. On the PA, there was an AGH reduction of 55.9%, ESBG of 29.6% and EMA of 8.4%. The CBCTs showed slightly higher reductions with AGH reduction of 60.4%, ESBG of 32.6% and EMA of 12.2%. A paired t-test showed no statistically significant difference between the modalities (p = 0.2168), though CBCT provided more precise visualization, detecting medial and lateral graft displacement in 70% of patients—findings unlikely to be seen on PA.
Discussion: Anatomical variations, implant position, and the rotational mechanics of the osseodensification protocol influenced graft movement. The dimensional reduction of mineralized FDBA may limit apical bone coverage in the transcrestal approach, potentially impacting long-term implant stability. While standardized PAs can provide adequate diagnostic information, CBCT offers superior assessment of graft distribution, albeit with higher radiation exposure.
Conclusion: CBCT or a 3D model shows slightly improved performance compared to a 2D model like the PA radiograph. A significant reduction in the bone graft was observed 6 months post-op with CBCT revealing a slightly higher change compared to PA. Grafts remained stable at 6 months, but long-term clinical trials are needed to evaluate the dimensional stability of FDBA.
Topic: peri-implantitis
Authors: Zimmer J., Misch J., Nava P., Sabri H., Calatrava J., Wang HL.
Title: Threshold for Implant Removal in Peri-Implantitis Defects. Is There Any?
Source: Oral Implantol. 2025 Apr 1;51(2):210-217.
Doi: 10.1563/aaid-joi-D-24-00098
Reviewer: John G. Kerns
Type: Narrative Review
Keywords: peri-implantitis, explantation, peri-implant bone loss
Purpose: To review the latest literature to devise guidance for peri-implantitis management, including explanation indications.
Methods: A narrative review was conducted using PubMed and Cochrane searches for articles published up to September 2024. Clinical trials, case series, and systematic reviews with adult patient populations were included in searches, while animal studies, case reports, and non-English papers were excluded.
Results: Three randomized controlled trials, three retrospective studies, a questionnaire-based study, and a systematic review were assessed.
Discussion: Several expert opinions have introduced various scales and decision trees to stratify peri-implantitis management based on bone loss and mobility. The included studies expanded on previously suggested guidelines. Various studies have shown that implants with more than 50% bone loss have greatly increased risk of failure due to treatment unpredictability and high disease recurrence rates. Collectively, these studies suggest that explantation is prudent in peri-implantitis cases where less than 50% bone remains. To assess bone levels, 8mm probing depths with 50% bone loss is considered advanced peri-implantitis. This categorization is dependent on analysis of radiographs and clinical/patient factors in addition to probing, as probing alone is insufficient as a diagnostic tool. Patient-specific factors include systemic conditions, oral hygiene, treatment cost and time, and patient expectations. Additionally, mobile implants are not osseointegrated and therefore should be explanted. Other indications for explantation include fractured implants and, in a multi-unit prosthesis, implants whose removal will not compromise long-term prognosis of the prosthesis.
Conclusion: Implants affected by peri-implantitis are indicated for explantation due to poor prognosis if less than 50% bone remains, though other prosthetic and patient factors are to be considered. Any mobile implants are to be explanted.
Topic: Intrabony (vertical) defects
Authors: Marini L., Cuozzo A., Mainas G., Antonoglou G., Pilloni A., Nibali L.
Title: Do Intrabony Defects Have a Worse Clinical Response to Step 2 of Periodontal Therapy and Repeated Subgingival Instrumentation Compared to Suprabony Defects? A Systematic Review
Source: Int J Periodontics Restorative Dent. 2025 Jul 11;45(5):509-521.
Doi: 10.11607/prd.7235
Reviewer: John G. Kerns
Type: Systematic Review
Keywords: nonsurgical periodontal therapy, intrabony defect, suprabony defect, vertical defect, horizontal defect
Purpose: The purpose of this systematic review was to elucidate whether intrabony defects, as compared with suprabony defects, have worse therapeutic outcomes after non-surgical periodontal therapy (NSPT).
Methods: The PICO methodology was used in conjunction with the following focus question to guide literature searches: “In patients with periodontitis, are step 2 of periodontal therapy and repeated subgingival instrumentation on sites with intrabony defects different from step 2 of periodontal therapy and repeated subgingival instrumentation on sites with suprabony defects in terms of clinical outcomes at reevaluation?” Randomized control trials, cohort studies, cross-sectional studies, and prospective studies published until December 2023 with adult populations were included. Studies were excluded if they used patient populations categorized by periodontitis associated with systemic conditions. There were no restrictions on the type of instrumentation used. Study bias was assessed using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa guidelines.
Results: Of 5,016 studies identified using search methodology, five studies were included: a retrospective cohort study, a multi-level analysis of an RCT, two RCTs, and a prospective cohort study. Mean age of study participants was 47 years old. Intrabony defects were identified using radiographs in all studies, but three studies defined the defect as a vertical defect of >3mm; one study defined it, summarized here, as >2mm vertically; and one defined it assessing the angle between the tooth root and the interdental bone between 25 and 37 degrees. A reduction in probing pocket depth (PPD) was the main clinical parameter for treatment evaluation. Only one study evaluated clinical attachment loss as a secondary parameter. Only one performed the NSPT as reinstrumentation, as the rest used NSPT as their initial treatment.
NSPT was found to better improve PPD of intrabony pockets compared to suprabony pockets in an RCT (3.2mm intrabony vs. 2.2mm suprabony), albeit with a high risk of bias. The opposite results were found in the prospective cohort study with medium bias risk (0.48mm intrabony vs. 0.72mm suprabony) and the retrospective cohort study. No difference was found in the multilevel analysis of an RCT study. Finally, in an RCT with medium risk of bias, a negative association was found between presence of intrabony defects and PPD reduction (P<0.05). The last study was the only one to evaluate specifically treatment of intrabony versus suprabony defects, doing so after nine months.
Discussion: The European Federation of Periodontology’s advisement of NSPT for second stage of treatment (after supragingival plaque removal and mitigation of risk factors) led to an occasionally made statement that NSPT has only a limited impact on intrabony defects. However, the studies included in this review failed to elicit enough homogeneity, in both methodology and results, to be conclusive about such a claim. Specifically, study design, follow-up time, type of periodontitis treated, presence of smokers, and use of adjunctive therapies differed in the included studies’ methodologies.
In general, while intrabony defects should be considered as part of NSPT treatment when considering prevalence rates, too few studies discriminated between treatment outcomes of intrabony and suprabony defects. More studies are needed to draw more robust conclusions about this topic.
Conclusion: Current literature on differences in treatment outcomes from NSPT for intra- and supra-bony defects are too few, too heterogenous, and too contradictory in results. In this review, NSPT was associated with worse clinical outcomes for intrabony defects compared to suprabony defects in two studies, with better outcomes in one study, and with no difference in another.
Topic: Lateral Window Sinus Floor Elevation
Authors: Scaini, R., Saleh, M. H. A., Lai, H-C., Sangiorgi, M., Zucchelli, G., Testori, T.
Title: Indications and Regenerative Techniques for Lateral Window Sinus Floor Elevation with Ridge Augmentation
Source: Clinical Implant Dentistry and Related Research. 23 January 2025
DOI: 10.1111/cid.70007
Reviewer: Malon Stratton
Type: Narrative Review
Keywords: alveolar ridge augmentation, sinus floor augmentation, complications, dental implants
Purpose: This article explores the multifactorial considerations influencing the success of lateral window sinus elevation, focusing on systemic and local conditions, surgical planning, procedural execution, and postoperative management.
Discussion: A detailed analysis was conducted on the impact of systemic conditions, including smoking, diabetes, osteoporosis, radiotherapy, cardiovascular disease, antiresorptive and antiangiogenic medications, chronic alcoholism, immunocompromised states, and oxidative stress, on sinus augmentation and implant outcomes.
Smoking isn’t a strict contraindication but increases post-op complication risk. Poorly controlled diabetes impairs healing and osseointegration, so hygiene and antibiotics are essential. Osteoporosis doesn’t directly cause implant failure but may delay healing and reduce stability. Extended healing time, site under-preparation, or wider implants are recommended. Patients on antiresorptive or antiangiogenic drugs must be monitored closely per AAOMS guidelines to minimize MRONJ risk. Radiotherapy raises implant failure risk, especially with xerostomia. Success depends on dose, location, and bone condition, with precautions based on exposure level. Steroids, immunomodulators, and antiretrovirals are not contraindications. In HIV+ patients, implants are generally safe if CD4+ >250 cells/mm³ and risk factors like smoking and poor hygiene are controlled. Implants should be delayed at least six months after major cardiac events. Antibiotic prophylaxis is advised to prevent endocarditis. Anticoagulated patients require an INR 2.0–4.0 to protect patients for surgery. Alcohol may delay bone healing and increase infection risk. While oxidative stress isn’t a direct contraindication, lowering reactive oxygen species may improve bone healing around implants.
Maxillary sinus pathologies (sinusitis) must be resolved before sinus elevation. A standardized Digital Surgical Planning protocol was introduced which combines CBCT, intraoral scanning, virtual wax-ups, and guided implant placement to enhance precision, reduce invasiveness, and improve outcomes. Lateral window antrostomy techniques were reviewed, including flap design and instrumentation (piezoelectric or rotary). The flap follows a coronally advanced design with a scalloped incision and vertical release. A split-thickness approach preserves the periosteum; muscle release allows passive coronal advancement. Implants are placed 3–3.5 mm apical to the planned gingival margin, with ≥2 mm of soft tissue required at the transmucosal level. Connective tissue grafting is recommended when thickness is inadequate to support long-term stability and prevent dehiscence.
Proper access during lateral antrostomy is critical for safe Schneiderian membrane elevation. Ideally, the window is ~3 mm posterior to the anterior sinus wall and slightly above the floor, often spanning septa to improve access and reduce perforation risk. Larger windows improve visibility but may compromise vascular supply. Window designs include hinge, island, and modified techniques. Testori’s approach for All-on-Four uses a small window near the anterior wall to allow greater posterior implant angulation. The Simplified Antrostomy Design begins with a 3×6 mm window that can be extended. The Low Window technique places the osteotomy flush with the sinus floor, reducing risk of vessel injury and membrane perforation in narrow sinuses. Rotary tools, as used in Boyne’s original 1980 technique, had high membrane perforation rates (20–25%). Piezoelectric surgery significantly reduces this risk (3.6–5%) by selectively cutting bone while sparing soft tissue. For thin lateral walls, an outline technique is used; for thick walls, osteoplasty is preferred due to lower perforation rates. Membrane elevation should proceed laterally to medially, using sharp elevators and accessing both sides of septa when present. Perforations should be covered with collagen or L-PRF membranes.
For grafting, fully filling the sinus with osteoconductive particulate materials ensures volume retention and graft stability. Flap closure begins with interrupted periosteal sutures at vertical incisions, progressing coronally to reduce tension. A sling suture around the mesial tooth stabilizes the papilla, and additional interrupted or sling sutures ensure flap adaptation. Post-op protocols include antibiotics, corticosteroids, and nasal decongestants to reduce infection and swelling. Amoxicillin-clavulanic acid is the most common antibiotic. M corticosteroids help control edema, and nasal decongestants aid in sinus drainage and sinusitis prevention.
Conclusions: The lateral window sinus elevation has proven effective for over 40 years and remains important despite newer, less invasive methods like the transcrestal approach. It has become simpler and can now be done in-office without the need for bone harvesting. This technique offers better access to anatomical challenges, allows for multiple implants in one surgery, and works regardless of bone height. It also enables immediate management of complications like membrane tears. To provide optimal care, practitioners should master various methods, keeping the lateral window approach essential in implant dentistry.
Topic: Marginal Bone Level Changes in Implants With Narrow vs Standard Transmucosal Abutments
Authors: Liñares, A., Maceiras, L., Nóvoa, L., González, A., Rodríguez, B., Batalla, P., Leira, Y., Blanco, J.
Title: Marginal Bone Changes at Bone-Level Implants With Narrow or Standard Diameter Abutments: 1 -Year Results of a Randomized Controlled Trial
Source: Clinical Oral Implants Research. 8 July 2025
DOI: 10.1111/clr.70005
Reviewer: Malon Stratton
Type: Randomized Controlled Trial
Keywords: bone loss, marginal bone levels, abutment, implants
Purpose: The objective of this study was to examine implants restored with standard or narrow diameter transmucosal abutments and assess variations in the implant marginal bone levels over 12 months following placement of the final prothesis.
Material and Methods: Twenty-eight patients were included in this study. The patients were divided into two groups, each allocated with 14 individuals who were partially edentulous. The control group’s implants, 17 total, were restored with 4.1 mm diameter tapered abutments. The test group’s implants, 21 total, were restored with 2.9 mm diameter tapered abutments. The transmucosal abutments were placed the same day as implant placement. The main variable being tested and examined was the radiographic variation in implant bone levels, 12 months post-delivery of the final prosthesis. This was calculated by measuring the distance from the first bone-implant contact to the shoulder of the implant. Other variables examined were complications (biological or mechanical), patient-reported outcomes, evaluation of esthetics, peri-implant criteria, and papilla index.
Results: Out of the twenty-eight individuals who began the study, twenty-two patients completed the study making it to all follow-up visits. The difference in radiographic bone level, over the course of 12 months post-delivery, resulted in a decrease of the distance from the first bone-implant contact to the shoulder of the implant. The control group showed an average of 0.21 +/- 0.34mm and the test group showed 0.16 +/- 0.31mm. These numbers indicate no statistical difference between the control and test groups. Also, the other variables being tested showed no statistical differences.
Conclusions: While there were limitations within the study, no statistically significant differences were noted among the narrow vs. standard diameter abutments during the 12-month follow-up period. In addition, no significant differences were noted clinically, regarding complications, or patient experienced outcomes.