Journal Club- September 2025
Does Retention of Periosteum at the Palatal Donor Site During Subepithelial Connective Tissue Graft Harvesting Influence Wound Healing and Morbidity? A Randomized Controlled Trial. Yadav VS, Makker K, Haidrus R, Ali M, Dawar A, Pandey J, Sati HC, Khan MA. Int J Periodontics Restorative Dent. 2025 Aug 19;0(0):1-27. doi: 10.11607/prd.7814. Epub ahead of print.
The Slice Harvesting Technique for Tuberosity Soft Tissue Grafts: A Case Report. Ronco V. Int J Periodontics Restorative Dent. 2025 Feb 13;0(0):1-19. doi: 10.11607/prd.7465. Epub ahead of print. PMID: 39946743.
Effectiveness of Restoration Strategies for Posterior Missing Teeth With Dental Implants: A Retrospective Study. Gao J, Tang X, Deng C, Zhao X, Qu Y, Yang X, Wu Y, Xiang L, Man Y. Clin Oral Implants Res. 2025 Aug;36(8):978-990. doi: 10.1111/clr.14444. Epub 2025 May 1. Erratum in: Clin Oral Implants Res. 2025 Aug 31. doi: 10.1111/clr.70039. PMID: 40312793.
Surgical Strategies for Implantation in Cases of Large Incisive Foramen: A Pilot Case Series Study. Martins da Rosa JC, de Oliveira Rosa ACP, Urban I. Int J Periodontics Restorative Dent. 2025 Jul 11;0(0):1-20. doi: 10.11607/prd.7376. Epub ahead of print. PMID: 40644576.
Osseointegration in the Absence of Primary Stability: An Experimental Preclinical Mandibular Minipig Overpreparation In Vivo Model. Gill T, Ooi H, Tezulas E, Petrie A, Rawlinson S, Roccuzzo M, Shahdad S. Clin Oral Implants Res. 2025 Jul 23. doi: 10.1111/clr.70006. Epub ahead of print. PMID: 40698516.
Do Systemic Antibiotics Offer Benefits to the Surgical Treatment of Peri-Implantitis? A Systematic Review With Meta-Analyses. Antonoglou GN, Papageorgiou SN, de Albornoz AC, Payer M, Stavropoulos A. J Clin Periodontol. 2025 Aug 27. doi: 10.1111/jcpe.70021.
Convex Versus Concave Emergence Profile of Implant-Supported Crowns in the Aesthetic Zone: 3-Year Results of a Randomized Controlled Trial. Endres J, Strauss FJ, Siegenthaler M, Naenni N, Jung RE, Thoma, DST. J Clin Periodontol. Published online August 20, 2025. doi:10.1111/jcpe.70018
A Comparative Study on the Accuracy of Implant Placement Using 3D-Printed and Milled Guides Without Metal Sleeves. Ballesteros J, Vásquez S, Revilla-León M, Gómez-Polo M. Clin Implant Dent Relat Res. 2025;27(4):e70072. doi:10.1111/cid.70072
Peri-implant Tissue Changes Around Maxillary Anterior Immediate Tooth Replacement With and Without Socket- Shield: 1-Year Randomized Controlled Clinical Trial. Liao HC, Kan JYK, Rungcharassaeng K, Lin GH, Chen J, Zuhr O, Hürzeler M, Lozada J. Int J Oral Maxillofac Implants. 2025 Jul 25;40(4):459-467. doi: 10.11607/jomi.11308. Epub 2025 May 21. PMID: 40711987.
Treatment of Peri-implant Mucositis: An AAP/AO Systematic Review and Meta-analysis. Lin GH, Chambrone L, Rajendran Y, Avila-Ortiz G. Int J Oral Maxillofac Implants. 2025 Jun 6;(4):49-72. doi: 10.11607/jomi.2025suppl2. PMID: 40476896.
Efficacy of Nonreconstructive Surgical Treatment of Peri-implantitis: An AAP/AO Systematic Review and Meta-analysis of Access Flap Versus Osseous Surgery Procedures. Saleh, M. H. A., Misch, C., Alrmali, A., & Neiva, R. (2025). The International journal of oral & maxillofacial implants, (4), 73–90. Doi:10.11607/jomi.2025suppl3.
Surgical- and implant-related factors and onset/progression of peri-implant diseases: An AO/AAP systematic review. Monje, A., Barootchi, S., Rosen, P. S., & Wang, H. L. (2025). Journal of periodontology, 96(6), 542–561. Doi:10.1002/JPER.24-0083.
Efficacy of Decontamination Methods for Biofilm Removal from Dental Implant Surfaces and Reosseointegration: An AAP/AO Systematic Review on Peri-implant Diseases and Conditions. Ravidà A, Dias D, Lemke R, Rosen P, Bertolini M. Int J Oral Maxillofac Implants. 2025;(4):91-160. PMID: 40476898.
AO/AAP consensus on prevention and management of peri-implant diseases and conditions: Summary report. Wang, H. L., Avila-Ortiz, G., Monje, A., Kumar, P., Calatrava, J., Aghaloo, T., Barootchi, S., Fiorellini, J. P., Galarraga-Vinueza, M. E., Kan, J., Lin, G. H., Ravida, A., Saleh, M. H. A., Tavelli, L., AO/AAP Consensus Participants, & Rosen, P. S. (2025). Journal of periodontology, 96(6), 519–541. DOI:10.1002/JPER.25-0270.
Discrepancy in Crestal Bone Height Level for Adjacent Dental Implants, When is it Significant? A Retrospective Study With a Minimum of 1-Year Follow-Up. Kasabreh NS, Malaikah S, Khurshid H, Khan MQ, Wang HL. Int J Oral Maxillofac Implants. 2025 Jul 23;0(0):1-25. doi: 10.11607/jomi.11208. Epub ahead of print. PMID: 40699609.
Deep Margin Elevation: Current Evidence and a Critical Approach to Clinical Protocols—A Narrative Review. Karageorgiou, A., Fostiropoulou, M., Antoniadou, M., & Pappa, E. (2025). Adhesives, 1(3), 10. https://doi.org/10.3390/adhesives1030010.
Evidence Supports the Use of Short Implants as a Graftless Solution – A Narrative Review. Block M. S. (2025). The International journal of oral & maxillofacial implants, 0(0), 1–29. Advance online publication. https://doi.org/10.11607/jomi.11188.
Chairside vs Prefabricated Sealing Socket Abutments for Posterior Immediate Implants: A Randomized Clinical Trial. Gnusins, V., Akhondi, S., Zvirblis, T., Pala, K., Gallucci, G. O., & Puisys, A. (2025). Clinical implant dentistry and related research, 27(4), e70076. https://doi.org/10.1111/cid.70076.
Topic: Palatal donor site
Authors: Yadav VS, Makker K, Haidrus R, Ali M, Dawar A, Pandey J, Sati HC, Khan MA.
Title: Does Retention of Periosteum at the Palatal Donor Site During Subepithelial Connective Tissue Graft Harvesting Influence Wound Healing and Morbidity? A Randomized Controlled Trial.
Source: Int J Periodontics Restorative Dent. 2025 Aug 19;0(0):1-27.
DOI: 10.11607/prd.7814. Epub ahead of print.
Reviewer: Daeoo Lee
Type: RCT
Keywords: CTG, harvest, donor site, single incision
Purpose: To evaluate the healing after subepithelial connective tissue graft (SCTG) is harvested using a single incision technique, depending on whether a deeper tissue layer (the periosteum) is included or left behind.
Material and methods: Thirty-four patients were recruited for the study. The patients were divided into two groups: group 1 is SCTG harvested with periosteum (SCTGP+) and group 2 is SCTG harvested without periosteum (SCTGP-). Single incision harvest technique was performed by making 15mm horizontal incision. Tissue thickness was measured at 1mm, 3mm and 6mm apical from the horizontal incision using an endodontic spreader. The harvest stie was sutured using 6-0 polypropylene sutures. Patients were evaluated at 1-, 2-, 3-, 4-, 6-, and 8-weeks post-op. Evaluation criteria include early healing index (EHI), delayed healing (DB), sensation loss (SL). There are 5 categories for the EHI which are determined by evaluating presence of fibrin and necrosis: EHI 1 indicates complete flap closure, EHI 2 indicates complete flap closure with fibrin line, EHI 3 indicates complete flap closure with minimal fibrin clot, EHI 4 indicates incomplete flap closure with partial necrosis, and EHI 5 indicates incomplete flap closure with complete necrosis. Patients were also asked to report on pain score (0-10). Statistical analysis was performed.
Results: Between SCTGP+ group (2.88) and SCTGP- group (2.70) there were no statistically significant differences in terms of mean EHI score. In terms of necrosis presence, 35.2% (6/17) of the SCTGP+ group and 17.6% (3/17) of the SCTGP- group had necrosis; there were no statistically significant difference between the group in terms of necrosis. At each level (coronal to apical) of flap, negative correlation between EHI and flap thickness was found; in other words, poor healing is correlated with thin flap. Also, better healing scores (EHI: 1-3) were reported when flap thickness was greater than 1mm. Complete epithelization of the harvest site differed at the 2-week post-op (SCTGP+: 58.8%, SCTGP-: 76.5%; p=0.465). However, both groups had complete epithelization by the 4th week. There was no statistically significant difference in terms of pain score between the groups. In terms of loss of sensation, SCTGP+ group showed a quicker recovery (by 4th week) compared to SCTGP- group (by 8th week).
Conclusions: Within the limitation of the study, the two harvesting methods did not differ in terms of EHI. Also, method exhibited similar pain score. Therefore, the two methods are comparable.
Topic: Tuberosity-Harvesting site
Authors: Ronco V.
Title: The Slice Harvesting Technique for Tuberosity Soft Tissue Grafts: A Case Report.
Source: Int J Periodontics Restorative Dent. 2025 Sep 5;45(5):578-588.
DOI: 10.11607/prd.7465.
Reviewer: Daeoo Lee
Type: Case Report
Keywords: CTG, harvest, technique, tuberosity
Purpose: To describe CTG harvesting technique from the tuberosity tangentially to the ridge.
Background: Author’s reasoning for the new tuberosity harvest technique: first, the trapezoidal shape of CTG harvested with the distal wedge technique is poorly suited for recession coverage and requires significant reshaping; second, because the technique completely removes the peak of the tuberosity, they prevent the tissue from fully regenerating, which may complicate future harvesting from the site.
Material and methods: The harvesting technique involved three incisions. The first incision is made at an angle between 0 to 40 degrees relative to the perpendicular (buccal lingual) axis of the ridge. To maximize graft size, angle close to 0 is ideal, but a wider angle may be necessary to work around patient’s anatomy. The second incision is made parallel to the first incision about 2-3mm (could be smaller or greater) in thickness. The final incision is rotated toward the first incision to free the graft. The donor site does not require any sutures and will heal by secondary intention. The graft is removed of its epithelial layer for use. In the case of multiple grafts harvesting, the three-incision technique may be repeated posteriorly. From the author’s experience, leaving a section that is 2-3mm thick between harvest site is optimal for harvest site healing. The harvest graft was placed at recession site using tunnel approach. Patients were evaluated at 7 days, 14 days, 1 month, and 3 years.
Results: At the 7-day post-op, harvest site was healing uneventfully. Patient reports no pain nor bleeding. At 1-month post-op, surgical site reveals complete root coverage; the harvest site appears to be healing with traces of harvesting indentation. At 3-year post-op, surgical site reveal stability in terms of esthetic and position of the gingival margin; at the harvest site, complete regrowth is indicated.
Conclusions: The perpendicular tuberosity harvesting technique is a viable option for addressing recession coverage.
Topic: Restoring molar teeth
Authors: Gao J., Tang X., Deng C., Zhao X., Qu Y., Yang X., Wu Y., Xiang L., Man Y.
Title: Effectiveness of Restoration Strategies for Posterior Missing Teeth With Dental Implants: A Retrospective Study
Source: Clinical Oral Implants Research, 2025; 36:978–990
DOI: 10.1111/clr.14444
Reviewer: Cyrus J Mansouri
Type: Retrospective
Keywords: clinical research, patient-reported outcomes, shortened dental arch, statistics
Purpose: To assess the effectiveness of restoring only the first molar (M1) when both first and second molar (M2) teeth are lost.
Material and methods: Clinical data was collected from the Department of Oral Implantology at West China Hospital of Stomatology between July 2013 and August 2021. All patients received implants from a single operator. The two groups compared consisted of simultaneous implant restoration of both M1 and M2 (group 1) or restoration of M1 only. All patients had one baseline radiograph and at least one follow-up radiograph. Primary outcome of interest was implant survival. Secondary outcomes included complication-free survival rates (specifically peri-implantitis and technical complications), cumulative treatment costs, peri-implant conditions, and patient-reported outcomes measures (PROMs). Patients received a comprehensive maintenance program after functional loading of implants. Regular exams were conducted to assess peri-implant conditions, where implants were categorized into peri-implant health, peri-implant mucositis, and peri-implantitis. Radiological assessment was conducted with periapical radiographs to measure crestal bone levels (CBL) and marginal bone loss (MBL). MBL > 0.5 mm was considered an adverse event. PROMs were assessed by a questionnaire randomly sent to one third of the total participants. The questionnaire assessed eight categories of soft and hard food consumption with eight degrees of difficulty. Post-surgery pain was also assessed by a 10-point visual analogue scale. Discomfort following prosthetic connection, food impaction, and occlusal interference was also evaluated.
Results: A total of 247 patients with 283 partially edentulous posterior areas were identified for the study. Group 1 consisted of 195 areas and Group 2 consisted of 88 areas. No significant differences were found between groups regarding implant survival or complication-free survival. Four early failures were encountered in Group 1 (2.05%) and two in Group 2 (2.27%). Late implant failure occurred in 6 regions in group 1 (3.14%) and two in Group 2 (2.33%). Overall implant survival was 92.8% for Group 1 and 94% for Group 2. Technical complications included 1 case of severe ceramic chipping, 3 cases of abutment or screw fracture, 4 cases of abutment or screw loosening, 23 cases of loss of crown retention from abutment. Complication free survival rates were 65.5% and 75.8% for Groups 1 and 2, respectively. Restoring M1 only showed 1.7x lower cumulative costs and no peri-implantitis cases. Group 1 (M1 and M2 restored) had a 16.2% incidence of peri-implantitis over 3 years. Restoring of M1 was also a protective factor against more than 0.5 mm MBL. PROMs demonstrated no significant differences in chewing ability for soft and hard foods. Patients in Group 1 (M1 only) also reported lower post-surgery pain scores. Similar discomfort and food impaction rates were reported.
Conclusion: Restoring only the first molar in cases of missing first and second molar may be an effective and cost-efficient treatment option.
Topic: Implant placement into the incisive foramen
Authors: da Rosa JCM, de Oliveira Rosa ACP., Urban I.
Title: Surgical Strategies for Implantation in Cases of Large Incisive Foramen: A Pilot Case Series Study
Source: Int J Periodontics Restorative Dent. 2025 Jul 11;0(0):1-20.
DOI: 10.11607/prd.7376
Reviewer: Cyrus J Mansouri
Type: Case series
Keywords: case series, dental implant, alveolar ridge augmentation, cone-beam computed tomography, bone transplantation, tooth socket.
Purpose: To evaluate outcomes of a reconstructive technique utilizing autogenous bone grafting from the maxillary tuberosity (MT) for the management of extraction sockets adjacent to large incisive foramen (IF) in the anterior maxillary region. Specifically, to address the challenges associated with this implant placement.
Material and methods: A case series of four cases are presented. The technique described was employed when the ideal implant position could not be achieved due to localization of the IF. Following standard surgical procedures, the area of the incisive papilla was elevated in a full thickness flap and nasopalatine nerve excised from the canal. The canal was thoroughly emptied using serrated curettes and diamond bur, resulting in complete removal of the nasopalatine nerve and sphenopalatine artery and vein. Autogenous bone graft block and particulate was harvested from the MT using a trephine, piezo tip, or chisel. The size of the block graft closely matched the diameter of the IF and a length of 4-6 mm to functionally “cork” the canal. Particulate was first inserted and packed densely, followed by the placement of the bone block. Depending on the clinical situation, three surgical scenarios were encountered (depending on size of canal, extent of bone loss): 1) IF enucleation with small to medium reconstruction and immediate implant. Trephine bone cores or particulate bone from the MT used to fill IF and immediate implant insertion and provisionalization recommended. 2) IF enucleation and major reconstruction and immediate implant. Large bone volumes were harvested from multiple donor sites (bilateral MT or MT and mandibular ramus). 3) IF enucleation and delayed placement. When immediate implant insertion in the correct position was not feasible, canal reconstruction was performed with bone graft from MT and implant was installed after 3-months with immediate provisionalization. In some cases, the implant was intentionally placed into the incisive canal. Primary stability > 30Ncm was mandatory for immediate provisionalization. For cases of compromised post-extraction sockets and large IFs, flap surgery was performed on the palatal aspect alone for canal bone reconstruction. Flap surgery on the buccal aspect was deemed unnecessary, regardless of bone loss severity.
Patients underwent a postoperative maintenance program, clinical examinations, and completion of a questionnaire to assess changes in the neurosensory function of the nasopalatine nerve. Study outcomes included the extent of bone reconstruction, postoperative neurosensory function of the nasopalatine nerve, and overall patient satisfaction. Cases were followed for a mean of 24 months.
Results: The technique consistently resulted in predictable bone reconstruction, with either delayed or immediate implant insertion and provisionalization. IF enucleation and reconstruction of the damaged sockets resulted in no abnormal postoperative pain or altered sensation. The average satisfaction score was 5 (out of 5) and all participants expressed willingness to undergo the same procedure again, reflecting a high degree of confidence in the efficacy and safety from the patient’s perspective. Use of autogenous bone from the MT provided an optimal and simple solution for these cases of large IFs. All four implants remained stable and functional throughout the follow-up period.
Conclusion: The use of autogenous bone graft from the MT is a simple and effective approach for managing extraction sockets adjacent to a large IF and complex scenarios in the anterior maxilla. It is associated with favorable PROMs.
Topic: Primary Stability
Author: Gill T, Ooi H, Tezulas E, Petrie A, Rawlinson S, Roccuzzo M, Shahdad S.
Title: Osseointegration in the Absence of Primary Stability: An Experimental Preclinical Mandibular Minipig Overpreparation In Vivo Model.
Source: Clin Oral Implants Res. 2025 Jul 23.
DOI: 10.1111/clr.70006.
Type: Animal Study
Reviewer: Veronica Xia
Keywords: primary stability, ISQ, overpreparation, implants, bone to implant contact, osseointegration
Purpose: The purpose of this study was to determine if implants with Implant Stability Quotient (ISQ) readings of low primary stability (ie from an oversized osteotomy) will osseointegrate, and if there is a histological difference in the quality of osseointegration between no and high primary stability achieving implants.
Materials and Methods: Mandibular minipig models were used in this study, with 7 included in the 2-week time point and 8 included in the 8-week time point. Straumann implants, both the moderately rough super-hydrophilic surface (modSLA) and the relatively hydrophobic version (SLA) were included, with one type of implant surface used per hemi-mandible. Control (Group 1) and test (Group 2) sites were normal preparation and overpreparation respectively. Primary stability of implants was measured with ISQ values prior to cover screw placement and achievement of primary closure. Animals were sacrificed and histological analysis of implant site block sections was completed. Primarily, implant survival was assessed and evaluated by a lack of fibrous encapsulation and evidence of direct bone-to-implant contact (BIC). BIC was calculated at various levels: coronal (coronal 2mm of implant) and apical (from 2mm apical to implant shoulder to implant apex). Secondarily, implant surface abilities to allow for bone volume maintenance and apposition was evaluated.
Results: A total of 60 implants were placed in 15 animals. Initial ISQ values for Group 1 and 2 were 69.35 a.u. and 11.95 a.u. respectively, with a statistically significant lower values for Group 2. At 2 weeks post implant placement, both implant surfaces in Group 2 showed evidence of de novo bone formation contacting the implant surfaces. Thicker new bone was seen on modSLA surfaces, indicated an earlier start to bone formation. Group 1 BIC was directly related to engagement of implant threads to the existing initial bone. First BIC (fBIC) was more apical for SLA implants in Group 1. No significant differences were found in Group 1 and 2 total BIC (tBIC) at 2 and 8 weeks, with tBIC at 8 weeks being 79.15% and 82.78% respectively. In Group 2, modSLA implants showed significantly less apical BIC (aBIC) at both 2 and 8 weeks in group 2, with 8 week values of Group 1 vs Group 2 of modSLA implants being 78.57% vs 69.09% respectively.
Coronal BIC (cBIC) was 41.3% higher in Group 2 compared to Group 1 at 2 weeks and continued to 8 weeks post implant placement. At 8 weeks, cBIC of Group 2 was 79.37%, and cBIC of Group 1 was 42.96%. Within Group 2, bone area to total area (BATA) and perpendicular bone crest to implant shoulder to bone are to total area (pCIS-BATA) was significantly higher than Group 1 at both time points. fBIC was an average of 0.5mm more coronal in Group 2 compared to Group 1. Group 2 pCIS values were significantly higher than Group 2, indicating more maintenance of crestal bone levels, with differences only visible in SLA implants at 8 weeks compared to ModSLA implants.
Conclusion: All implants placed in oversized osteotomies with a lack of primary stability (ISQ of 12 a.u.) were able to osseointegrate successfully, with significantly more coronal BIC and maintenance of bone volume at the coronal 2mm of implants in the overprepared group.
Topic: Adjunct antibiotic and Peri-implantitis
Author: Antonoglou, G., Papageorgiou, S., Carrillo de Albornoz, A., Payer, M., & Stavropoulos, A.
Title: Do systemic antibiotics offer benefits to the surgical treatment of peri-implantitis? A systematic review with meta-analyses.
Source: J Clin Periodontol. 2025 Aug 27.
DOI: 10.1111/jcpe.70021.
Type: Systematic Review
Reviewer: Veronica Xia
Keywords: antibiotics, peri-implantitis, treatment success, bleeding on probing, suppuration, probing depth
Purpose: The purpose of this study was to evaluate the current evidence regarding the use of systemic antibiotics in conjunction to surgical peri-implantitis treatment and its effects on treatment outcomes. Furthermore, the influence of implant surfaces (ie turned vs modified) was also investigated in relation to disease resolution.
Materials and Methods: An electronic search was performed of 6 electronic databases, with the applicable inclusion and exclusion criteria applied to the search. This resulted in an initial 2047 articles obtained, which was further filtered to include a total of 7 articles.
Results: 7 articles were included in the study, four cohorts and three randomized controlled trials (RCTs). 595 patients were included from the 7 studies, with 69.4% of patients receiving systemic antibiotics. Surgical treatment of patients included: apically repositioned flap, open flap debridement, minimally invasive retraction, mechanical debridement (titanium brushed, rubber cup polishing, ultrasonic tips, air polishing), chemical decontamination (CHX, iodine, hydrogen peroxide, saline), and regenerative/resective treatment.
Adjunct antibiotic use included single-antibiotic or multi-antibiotic regimens. One study used azithromycin, three studies used amoxicillin, and remaining studies used metronidazole, metronidazole + amoxicillin, metronidazole + phenoxymethylpenicillin, metronidazole + clindamycin, ciprofloxacin, tetracycline, tetracycline + amoxicillin, clindamycin, penicillin V, and Augmentin,
Successful treatment outcomes were measured using probing depths (PD), bleeding on probing (BOP), radiographic bone loss (RBL), and suppuration on probing (SoP). Success criteria were different between studies, but varied between PD 4-5mm, lack of SoP, minimal to no BOP, and up to 2mm RBL after therapy.
The use of antibiotics was related to an increased odds ratio of short term (1-2 years) treatment success, odds ratio (OR) of 2.33. However, current evidence is unclear on influence of systemic antibiotic use on long term (3+ years) treatment success, with one study providing an OR of 0.69. Antibiotic use produced minimal effects on PD changes and slight improvements in RBL and BOP. SoP was significantly reduced in the presence of antibiotic use. Further analysis showed that antibiotics significantly improved parameters in implants with modified surfaces compared to non-modified implants.
Adverse effects such as nausea, diarrhea, headaches, and abdominal pain were noted following antibiotic use.
Conclusion: The use of systemic antibiotics in conjunction with surgical peri-implantitis treatment is associated with short-term improvements in clinical parameters and treatment success of modified surface implants.
Topic: Emergence Profile
Author: Endres, et al.
Title: Convex Versus Concave Emergence Profile of Implant-Supported Crowns in the Aesthetic Zone: 3-Year Results of a Randomized Controlled Trial.
Source: J Clin Periodontol. Published online August 20, 2025.
DOI: 10.1111/jcpe.70018
Reviewer: Ryan Higgins
Type: RCT
Keywords: aesthetic zone, emergence profile, implant-supported restoration, mucosal recession
Purpose: To evaluate the 3-year clinical and radiographic outcomes of implant-supported restorations with different emergence profiles (CONVEX vs. CONCAVE).
Materials and Methods:
47 patients were enrolled in the study to receive a single implant in the aesthetic zone and were allocated into one of three groups: (1) CONVEX: customized provisional with a convex emergence profile (n = 15); (2) CONCAVE: customized provisional with a concave profile (n = 16); (3) Control: no provisional restoration (n = 16). Final crowns in groups CONVEX and CONCAVE were fabricated to replicate the emergence profile of the respective provisional restorations, all being screw retained.
Follow-ups were performed at baseline, 6 months, 1 year and 3 years. The primary outcome was mid-facial mucosal recession and secondary outcomes included clinical, radiographic and aesthetic outcomes as well as profilometric measurements.
Results: 42 patients completed the follow-up period in total. At 3 years, the frequency of mucosal recession amounted to 46.7% in group CONVEX, 13.3% in group CONCAVE and 40.0% in group Control. The CONVEX group was significantly more likely to show recessions at 3 years (odds ratios [ORs]: 7.3, 95% CI: 1.02–52.14, p = 0.048) when compared with the CONCAVE group. But no statistically significant difference in recession frequency was observed between the CONVEX and CONCAVE groups between the 1-and 3-year follow-ups (OR: 3.7, 95% CI: 0.30–46.09, p = 0.303).
At the 3-year follow-up, the mean recession amounted to 0.15 ± 1.10 mm (median: 0.25 mm) in the CONVEX group. Conversely, in both the CONCAVE group (−0.69 ± 1.43 mm; median: 0.00 mm) and Control group (−0.13 ± 1.06 mm; median: 0.00 mm) mean values were negative, indicating a coronal shift of the mid-facial mucosal margin. At 3 years follow-up, there were no significant differences in PD, BOP, plaque, PES, and MBL values between the groups.
Conclusions: Emergence profile design significantly influences soft tissue stability predominantly within the first year after crown insertion. Whenever clinically feasible, a CONCAVE profile is preferable in the aesthetic zone to maintain the level of the mid-facial mucosal margin and reduce the frequency of recessions.
Topic: Guides w/ vs. w/o sleeve
Author: Ballesteros, et al.
Title: A Comparative Study on the Accuracy of Implant Placement Using 3D-Printed and Milled Guides Without Metal Sleeves
Source: Clin Implant Dent Relat Res. 2025;27(4):e70072.
DOI: 10.1111/cid.70072
Reviewer: Ryan Higgins
Type: In Vitro study
Keywords: 3D printing, dental implants, metal sleeves, milling, sleeveless, static computer-aided implant placement
Purpose: To evaluate whether differences in accuracy of the implant positions exist for static computer aided implant placement based on the manufacturing process of surgical guides and the inclusion or not of metal sleeves.
Materials and Methods: 72 implants (6 per model) were placed in 12 models simulating a partially edentulous maxilla using 12 dentally supported surgical guides anchored with 2 anchor pins. The surgical guides were divided into three groups: additive manufactured with a metal sleeve (Group PS), additive manufactured without a metal sleeve (Group PNS), and subtractive manufactured without a metal sleeve (Group MNS). The internal drilling diameter was standardized for all groups (4.85 mm). Deviations between the planned virtual implant positions and the scanned postoperative models were assessed in three parameters: 3D deviations at the crest, 3D deviations at the apex, and angular deviations in the implant insertion axis.
Six tapered internal connection implants (3.75 mm in diameter, 11.5 mm in length) (Spiral implants; Alpha Bio Tec, Petah Tikva, Israel) were selected from the software library and planned (Implant Studio, 3Shape) for the following positions: right canine, first right premolar, second right premolar, left canine, first left premolar, and second left premolar. For the 3D printed additive manufacturing DLP 3D printer (Sprint Ray Pro 55; Los Angeles, CA, USA) with a 55-μm layer size. The guide’s thickness was 3 mm, the sleeve’s offset was 0.20 mm, and the offset to teeth and model was 0.20 mm. For the subtractive manufactured surgical guides, a 5-axis milling machine was used (Imes Core GmbH 150 Pro milling machine; Eiterfeld, Germany). Transparent polymethyl methacrylate (PMMA) discs (Anaxdent Clear; Eiterfeld, Germany) were used for guide fabrication.
Results: The overall 3D crestal and apical deviations, including all the groups, were 0.720 mm (IQR: 0.551 mm) and 0.925 mm (IQR = 0.721 mm), respectively. The mean angular deviation was 2.558° (IQR = 2.8°).
At the crest, the smallest 3D deviation was recorded in the MNS group (0.498 ± 0.337 mm) followed by the PNS group (0.660 ± 0.572 mm) and the PS group (1.028 ± 0.424 mm) (p < 0.05). No significant differences were found in vertical and depth deviations (Y and Z) at the crest.
At the apex, as well, the lowest deviation was observed in the MNS group (0.810 ± 0.544 mm) followed by the PNS group (0.840 ± 0.620) and the PS group (1.360 ± 0.990 mm) (p < 0.05). For depth deviations (Z), the PNS group showed the lowest deviations (PNS: median = 0.182 mm; IQR = 0.482), with significant differences between the PS (median = 0.568 mm; IQR = 1.225 mm) (p = 0.007). No significant differences were found in vertical deviations (Y) at the apex.
Best results regarding the angular deviation were obtained by the PNS group (1.44° ± 1.57°) with statistically significant differences with both the MNS group (2.90° ± 2.35°) and the PS group (3.88° ± 2.85°) (p < 0.05).
Conclusions: The manufacturing technique of surgical guides and the presence or absence of a metal sleeve influence the accuracy of the implant position in comparison with the planned one.
The position of implants placed using sleeve-free surgical guides was more accurate than that placed with guides featuring metal sleeves, especially in terms of 3D deviations at the implant crest and apex. No differences were observed between printed and milled sleeve-free guides in terms of 3D deviations at the crest and apex.
Angular deviations were reduced in the printed sleeve-free group compared to the other groups, highlighting the potential benefits of this approach for angular accuracy.
Sleeve-free guides provided the most consistent results, with the printed sleeve-free guides performing better in angular deviation when compared to milled versions.
Topic: Socket shield and mucosal changes
Authors: Liao HC, et al.
Title: Peri-implant Tissue Changes Around Maxillary Anterior Immediate Tooth Replacement with and without Socket- Shield: 1-Year Randomized Controlled Clinical Trial.
Source: Int J Oral Maxillofac Implants. 2025 Jul 25;40(4):459-467.
DOI: 10.11607/jomi.11308.
Reviewer: Nicolas Lobo
Type: RCT
Keywords: dental implants; facial mucosal profile and level; immediate tooth replacement; implant esthetics; socket-shield technique.
Purpose: To compare facial mucosal and profile changes after maxillary anterior single immediate implant placement and provisionalization (IIPP) with or without the socket shield (SS) technique, while also assessing implant success, peri-implant tissue outcomes, and complications.
Materials and Methods: The study involved 30 implants in 25 healthy adults with failing anterior teeth and intact buccal bone, randomly assigned to either immediate implant placement with socket shield (IIPP+SS) or without (IIPP-SS). In the test group, a C-shaped socket shield (1–1.5 mm thick, ≥6 mm long) was prepared, and implants were placed 4 mm apical to the gingival margin with ≥25 Ncm torque. Gaps were grafted (50:50 allograft/xenograft) and provisional screw-retained restorations were delivered, followed by final restorations after one year.
The primary outcome was buccal mucosal profile change; secondary outcomes included implant success, tissue phenotype, marginal bone level, facial mucosa and papilla position, and complications. Data were recorded preoperatively and at 2 weeks, 6 months, and 12 months. Marginal bone levels were measured radiographically, phenotype was categorized as thin (<1.1 mm) or thick (≥1.1 mm), and mucosal profile changes were analyzed volumetrically for soft and hard tissue zones.
Results: At 1 year, the overall implant success rate was 96.6% (100% for IIPP-SS, 93.3% for IIPP+SS). Marginal bone level changes were minimal in both groups, and facial mucosal level and papilla changes showed no significant differences. Facial mucosal profile changes were slightly less in IIPP+SS than IIPP-SS (–0.16 mm vs –0.70 mm), though the difference was only marginally significant and not clinically evident. Tissue phenotype had no significant effect. Both approaches effectively maintained mucosal levels when combined with proper implant positioning and grafting. Papilla preservation was more influenced by adjacent bone and embrasure form than by the SS technique. While IIPP+SS may help limit buccal profile changes in cases of high buccal resorption, its clinical advantage appears limited. The most common complication was external or internal SS exposure, related to SS positioning, which may be managed with connective tissue grafting, augmentation, or emergence profile adjustment.
Conclusions: IIPP+SS showed a slight advantage in preserving the facial mucosal profile, but both approaches yielded comparable, clinically satisfactory biological, functional, and esthetic outcomes.
Topic: Treatment of Peri-implant Mucositis
Authors: Lin GH, et al.
Title: Treatment of Peri-implant Mucositis: An AAP/AO Systematic Review and Meta-analysis
Source: Int J Oral Maxillofac Implants. 2025 Jun 6;(4):49-72
DOI: 10.11607/jomi.2025suppl2
Reviewer: Nicolas Lobo
Type: Systematic Review / Meta-Analysis
Keywords: decontamination, dental implants, meta-analysis, osseointegration, systematic review
Purpose: to evaluate whether adjunctive therapies provide additional benefits over mechanical debridement alone in the treatment of peri-implant mucositis.
Materials and Methods: Systematic review included only RCT with adults diagnosed with peri-implant mucositis, at least 10 participants per group, and a follow-up of ≥3 months, comparing mechanical debridement alone versus adjunctive therapies (e.g., air-polishing, antibiotics, antiseptics, photodynamic therapy (aPDT), lasers). Outcomes assessed were pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BoP), marginal mucosa position changes, histologic/biomarker findings, and complete disease resolution.
Results: Across all studies, control groups received peri-implant debridement alone, while experimental groups added adjunctive therapy. Some single trials reported significant benefits: PD reduction (4 trials), CAL gain (1 trial), BoP reduction (2 trials), plaque reduction (7 trials). However, pooled meta-analyses (19 studies) showed: No significant improvements in PD or BoP when adjunctive treatments were added. No significant increase in complete disease resolution rates at implant level. In nonsmokers or patients with unclear smoking status, subgroup analyses confirmed: No benefit for PD reduction across any adjunctive subgroup. Only probiotics (notably Lactobacillus reuteri) showed additional BoP reduction (10.39% short-term). Chlorhexidine and other antimicrobials showed no consistent added benefit. In studies with smokers or vape users, adjunctive treatments (including aPDT) also failed to show consistent significant improvements in PD or BoP reduction, with results affected by high heterogeneity.
Overall, adjunctive therapies did not significantly improve clinical outcomes over debridement alone. This was consistent regardless of smoking status. The only reproducible signal was a modest BoP reduction from probiotics in nonsmokers, suggesting possible supportive effects in selected patients. The review highlighted that BoP alone should not define peri-implant mucositis; diagnosis must consider BoP in combination with other clinical signs (inflammation, PD changes, absence of progressive bone loss). Although plaque reduction was more frequently reported in adjunctive therapy groups, the authors stressed that effective biofilm control (both professional and patient-administered) is the key determinant in restoring peri-implant health. The findings agree with previous reviews, confirming that adjunctive modalities generally offer minimal or no added therapeutic value beyond standard peri-implant debridement. Nevertheless, peri-implant mucositis management requires ongoing maintenance programs; untreated disease may progress to peri-implantitis.
Conclusions: Peri-implant debridement alone generally improves PD and BoP in peri-mucositis, while adjunctive therapies do not provide significant added benefit regardless of smoking status, and complete disease resolution remains inconsistent with any treatment.
Topic: Treatment of peri-implantitis
Authors: Saleh, M.H.A, et. al.
Title: Efficacy of Nonreconstructive Surgical Treatment of Peri-implantitis: An AAP/AO Systematic Review and Meta-analysis of Access Flap Versus Osseous Surgery Procedures.
Source: The International journal of oral & maxillofacial implants, (4), 73–90.
DOI: 10.11607/jomi.2025suppl3
Type: Systematic Review and Meta-analysis
Reviewer: Mahya Sabour
Keywords: Dental implant, peri-implantitis, access flap, osseous surgery, non-reconstructive treatment
Purpose: Compare access flap procedures to osseous procedures in the nonreconstructive surgical treatment of peri-implantitis.
Materials and Methods: Databases were searched for prospective and controlled human studies published with minimum 6-months of follow-up and including minimum 10 patients per treatment.
Results: 15 randomized controlled trials (RCTs) were included in the final review. Peri-implantitis definition was either according to the 2017 World Workshop or using various radiographic and clinical criteria. All but one study involved non-surgical therapy before surgical treatment. 8 studies included patients with previous periodontal disease. One study did not perform surface decontamination while one study included implantoplasty.
PD reduction (PDR): the mean PDR in the flap group was 1.56mm at 3 months, 1.72mm at 6 months, and 1.27mm at 12 months, while that of the osseous group was 1.52mm at 3 months, 1.81mm at 6 months, and 1.88mm at 12 months. No differences were seen between the approaches at any time point. The reduction was significant at 6 and 12 months in the flap group and at 3,6, and 12 months in the osseous group.
BOP reduction: the mean reduction in the flap group was 26.4% at 3 months, 38.1% at 6 months, and 7.38% at 12 months, while that of the osseous group was 16.8% at 3 months, 22.4% at 6 months, and 18.9%. No differences were seen between the approaches at any time point.
Changes in radiographic marginal bone levels (MBLs): the mean MBL in the flap group was 0.46mm at 6 months, and 0.66mm at 12 months, while that of the osseous group was -0.14mm at 6 months, and -0.07mm. A significantly higher MBL was seen in the osseous group compared to the flap group at both 6 and 12 months, with a difference of 0.58mm and 0.73mm respectively.
Plaque index reduction: the mean reduction in the flap group was 0.48% at 3 months, while that of the osseous group was 2.12%, which was not a significant difference.
Covariates: sex and age were not associated with any differences in PD, MBL, or BOP. The proportion of current light smokers did not lead to differences in the PD or MBL changes, while it did show a difference in BOP – each additional 1% in rates of current smokers led to less BOP reduction (-1.17%). Previous severity of periodontitis was a statistically significant (not clinically) covariate for MBL changes – each additional 1% of bone loss due to periodontitis led to 0.006mm more MBL.
Conclusion: Both nonreconstructive surgical treatments (osseous and flap surgery) can effectively manage peri-implantitis, leading to improvements in PD and BOP. Changes in MBL are in slight favor of flap surgery. A weak inverse relationship was found between smoking and reduction in BOP and slightly higher MBL was found in patients with a periodontitis history. The results of this study failed to accumulate enough evidence showing a significant advantage of one approach vs the other.
Topic: Peri-implant disease
Authors: Monje, A., et al.
Title: Surgical- and implant-related factors and onset/progression of peri-implant diseases: An AO/AAP systematic review
Source: Journal of periodontology, 96(6), 542–561
DOI: 10.1002/JPER.24-0083
Type: Systematic review
Reviewer: Mahya Sabour
Keywords: Dental implants, complications, mucositis, peri-implant disease, peri-implantitis
Purpose: To highlight surgical- and implant-related factors involved in the onset and progression of peri-implant diseases.
Materials and Methods: Databases were searched for randomized control trials (RCTs), comparative prospective and retrospective cohorts, cross-sectional or case series on patients with implants, reporting on surgical confounders of peri-implant health and disease. Studies had minimum 10 patients and at least a 12-month follow-up period after the prosthesis delivery.
Results: 34 studies were included in the qualitative synthesis.
Surgical-related factors: The most frequent factor that was investigated was implant position and the follow-up periods ranged from 1 to 26 years. 7591 implants were assessed. Studies either used the World Workshop AAP/EFP definition or other case definitions based on bleeding on probing and/or suppuration and marginal bone loss from 0.6-3mm. Implant malpositioning in relation to the bone and adjacent teeth/implants was associated with peri-implantitis, but not mucositis. One study found that when inter-implant distance was <3mm, there was an. 8.6x higher chance of peri-implantitis compared to distances >/=3mm. The evidence was divided on subcrestal implant position and proximity to adjacent teeth. The benefit of connective tissue grafting to prevent peri-implant disease has been demonstrated, however some studies report a significant effect, while others show only benefits for peri-implant mucositis and not peri-implantitis. No significant impact was found in relation to staging (immediate, early, or delayed implant placement), however, some studies found higher risks for peri-implantitis in immediate placement. Higher risk of peri-implantitis only was seen in implants placed in regenerated bone, while Implants placed in limited ridge width had 2.9x higher risk of peri-implantitis development. A few studies suggested more favorable outcomes with less biological complications in guided implant placement, immediate implants with immediate restorations, and narrow implants.
Implant-related factors: The most frequent factor that was investigated was the implant system and the follow-up periods ranged from 1 to 18 years. 4072 implants were assessed. Studies either used the World Workshop AAP/EFP definition or other case definitions based on bleeding on probing and/or suppuration and marginal bone loss from 0.5-2mm. Comparative studies did not show any implant macro- or micro-designs to be more superior than another. One study showed that tissue-level implants have 1/3 less risk for peri-implantitis compared to bone-level implants, but the difference was not statistically significant. One study showed that anodized and fluoride-treated surfaces have respectively 3.7x and 3.5x higher risk of peri-implantitis compared to sand-blasted acid-etched surfaces. When the restorative margins were <1.5mm from the bone, a 2.3x higher risk of peri-implantitis was found compared to those >/=1.5mm (tissue level or implants with transmucosal abutments). The data on laser-microgrooved collars was inconclusive.
Conclusion: Implant malpositioning has a notable impact on peri-implantitis development. A short distance between the prosthetic margin to the crestal bone may predispose to peri-implantitis, thus a tissue-level implant or transmucosal abutment use is favored.
Topic: Implant decontamination
Author: Ravidà A, Dias D, Lemke R, Rosen P, Bertolini M
Title: Efficacy of Decontamination Methods for Biofilm Removal from Dental Implant Surfaces and Reosseointegration: An AAP/AO Systematic Review on Peri-implant Diseases and Conditions
Source: Int J Oral Maxillofac Implants. 2025;(4):91-160.
DOI: 10.11607/ jomi.2025suppl4
Type: Systematic review
Reviewer: Pankti Rana
Keywords: dental implants, disinfection, efficiency, lasers, osseointegration, peri-implantitis
Purpose: To assess the evidence on the effectiveness of various decontamination methods in promoting reosseointegration, removing biofilm from implant surfaces, and evaluating their potential to cause adverse surface alterations.
Materials/Methods: The review assessed evidence from animal and human block biopsies, as well as ex vivo, in situ, and in vitro studies. Four study designs were considered: (A) in vivo animal and human biopsy studies, (B) ex vivo studies with explanted implants, (C) in situ studies where implants/discs were exposed in the oral cavity for biofilm accumulation, and (D) in vitro models using laboratory-induced biofilms. The primary questions addressed were whether implant reosseointegration is possible after peri-implantitis treatment, how effective mechanical, chemical, and electrolytic methods are at biofilm removal, and whether these approaches induce surface alterations.
Results: Total 121 publications included – 41 animal experiments, 5 human block biopsies studies, 17 ex vivo, 22 in situ experiments and 36 in vitro experiments. Evidence from in vivo studies indicated that systemic antibiotics without local decontamination were ineffective. Several studies demonstrated that reosseointegration (RO) or bone to implant contact (BIC) is possible following surface decontamination. Reported outcomes varied widely, with vertical bone gain ranging from minimal values to >2 mm in some cases. Air-powder abrasion (APA) and lasers (Er:YAG, CO2, Er,Cr:YSGG) most consistently showed potential to achieve reosseointegration, while soaked cotton pellets and curettes produced inconsistent results. Titanium brushes showed reosseointegration when combined with either NaOCl and CHX or CHX alone and one study showed reosseointegration in combination with titanium curettes and bone graft. Electrolytic cleaning showed successful RO with BIC values of 1.3-5.2mm but was investigated in very few studies. Ex vivo, in situ, and in vitro findings highlighted that APA, Er:YAG lasers, PEEK ultrasonic tips, and electrolytic cleaning were more effective at biofilm removal than gauze, plastic curettes, or cold atmospheric plasma. However, no method demonstrated clear superiority across comparable protocols.
Regarding surface integrity, cotton pellets, APA, Er:YAG lasers at specific settings, Er,Cr:YSGG lasers, electrolytic cleaning, and cold atmospheric plasma induced minimal alterations, while titanium/steel curettes, ultrasonic tips, and titanium brushes caused significant surface flattening or scratches. PEEK and plastic curettes left remnants, and implantoplasty intentionally altered surfaces. Biologic responses in cell culture favored APA, Er:YAG lasers, CAP, and combined protocols involving titanium brushes and UV-C, which supported osteoblast viability and adhesion. Chemical agents, particularly CHX, may impair osteoblastic responses when used in isolation.
Conclusion: Decontamination of implant surfaces is essential for resolving peri-implantitis and enabling potential reosseointegration, though no method has shown clear clinical superiority in terms of bone gain or reosseointegration when using the same biomaterials and techniques. Combining chemical and mechanical treatments does not significantly improve outcomes over mechanical methods alone. Laboratory studies demonstrate more effective biofilm removal with PEEK, air-powder abrasion (APA), Er:YAG lasers, and electrolytic cleaning, with minimal surface alterations seen using cotton pellets, APA, Er:YAG (<70 mJ/pulse), Er,Cr:YSGG lasers, electrochemical treatment, and cold atmospheric plasma. However, other instruments risk damaging surfaces or leaving remnants. Overall, an ideal protocol should fully eliminate biofilm without altering implant surfaces or releasing titanium particles, with electrolytic cleaning, APA, and Er:YAG laser therapy showing the most promise.
Topic: Peri-implantitis prevention
Author: Wang HL et al
Title: AO/AAP consensus on prevention and management of peri-implant diseases and conditions: Summary report
Source: J Periodontol. 2025 Jun;96(6):519-541
DOI: DOI:10.1002/JPER.25-0270
Type: Consensus report
Reviewer: Pankti Rana
Keywords: dental implant prosthetics, peri-implantitis, peri-implant mucositis, supportive peri-implant therapy
Purpose: The consensus aimed to synthesize current scientific evidence and expert opinion for the prevention and management of peri-implant diseases and provide clinicians with structured tools for risk assessment, treatment decision-making, and long-term maintenance.
Materials/Methods: Eight systematic reviews, supplemented by meta-analyses where possible, were conducted to evaluate systemic, surgical, prosthetic, and soft tissue–related risk factors, as well as nonsurgical and surgical therapeutic strategies. 44 international experts convened at a consensus conference, where findings were presented, critically appraised, and discussed. Recommendations were formulated through structured voting, with agreement levels classified as unanimous, strong consensus, consensus, simple majority, or no consensus.
Results: The results of the AO/AAP consensus highlight a comprehensive evaluation of risk factors and treatment strategies for peri-implant diseases (PID). At the patient level, systemic and behavioral risks such as history of periodontitis, smoking, uncontrolled diabetes, obesity, and erratic maintenance compliance were consistently linked to increased incidence of peri-implant mucositis and peri-implantitis. Implant- and site-specific contributors included malpositioning, inadequate inter-implant distance, excessive subcrestal placement, unfavorable prosthetic emergence profiles, and thin or insufficient keratinized mucosa. Meta-analyses reported peri-implant mucositis incidence of ~46–61% over 5–10 years, while peri-implantitis ranged from 12% at 5 years to 22% at 20 years. Prosthetic design factors, such as platform-matched abutments, abutment height <2 mm, convex profiles, and emergence angles >30°, were associated with higher marginal bone loss (MBL), while platform switching and concave abutments were protective. Soft tissue dehiscence emerged as a frequent long-term complication (up to 64% after 5 years), with thin tissues, inadequate keratinized mucosa, and buccal positioning identified as key risks. On the therapeutic side, peri-implant mucositis responded best to nonsurgical debridement, with adjunctive treatments (e.g., probiotics, lasers, antimicrobials) showing limited or inconsistent added benefit. For peri-implantitis, nonsurgical care offered modest improvements, but surgical approaches were necessary in advanced cases. Non-reconstructive surgical interventions, involving flap access for debridement with or without osseous resection, resulted in significant reductions in probing depth (PD) and bleeding on probing (BOP). Greater improvements in PD and marginal bone level (MBL) were observed when osseous resection was performed. Reconstructive procedures achieved greater pocket depth reduction and radiographic bone gain in cases of pronounced bone loss, particularly when particulate allografts or xenografts were used. However, both modalities struggled with long-term inflammation control. Implant surface decontamination remained central, but no single method proved superior. Air-polishing, Er:YAG lasers, and electrolytic cleaning showed promise with minimal surface damage whereas brushes and curettes led to surface alterations. Soft tissue modification in peri-implantitis surgery is best performed with or after surgical therapy. Autogenous tissue grafts are considered the gold standard for increasing keratinized mucosa, augmenting soft tissue volume, and deepening the vestibule, while substitutes are acceptable alternatives with lower agreement. In the esthetic zone, connective tissue grafting is often recommended alongside surgical treatment.
Conclusion: The consensus highlighted systemic risk factors for PID, including history of periodontitis, smoking, uncontrolled diabetes, obesity, and excessive alcohol use, along with local factors such as implant malposition, inadequate spacing, and unfavorable soft tissue phenotypes. Prevention requires thorough pretreatment assessment and tailored strategies. For treatment, manual debridement is central for peri-implant mucositis and the first step in peri-implantitis management, with adjuncts applied as needed. Non-reconstructive surgery can effectively reduce probing depth and bleeding, while reconstructive approaches with grafts and membranes are indicated in favorable bone conditions. Long-term success depends on supportive peri-implant therapy, including patient education and maintenance.
Topic: adjacent implants
Authors: Kasabreh NS, Malaikah S, Khurshid H, Khan MQ, Wang HL
Title: Discrepancy in Crestal Bone Height Level for Adjacent Dental Implants, When is it Significant? A Retrospective Study With a Minimum of 1-Year Follow-Up
Source: IJOMI. 2025 Jul 23;0(0):1-25
DOI: doi: 10.11607/jomi.11208
Reviewer: John Kerns
Type: retrospective cohort
Keywords: splinting, crestal bone height, marginal bone loss, adjacent implants
Purpose: The purpose of this retrospective study was to assess how crestal height affects marginal bone loss amount in splinted and non-splinted adjacent implants.
Methods: Chart records at a university periodontics clinic were obtained via convenience sampling and searched for implants placed posteriorly, concurrently with at least one adjacent implant, generally 1-2mm sub-crestal, and in healthy patients. Implants which did not have opposing dentition or needed vertical bone augmentation prior to placement were excluded. Implants were divided into splinted and non-splinted groups, and their radiographs at three intervals were reviewed: during the time of final prosthetic delivery (T0), during follow-ups from one to three years later (T1), and at the latest follow-up on record (T2). Marginal bone height at the mesial of the most posterior implant and the distal of the most anterior implant were recorded. Crestal bone height level (CBHL) was measured as the vertical distance between the two implant platforms. Marginal bone loss (MBL) and marginal bone loss progression (MBL/year) was measured and calculated.
Results: In the 56 patients included, 120 total implants were placed: 84 implants (70%) were non-splinted, and 36 implants (30%) were splinted. 41 implants were placed in the premolar region, and 79 implants were placed in the molar region. Linear regression modeling showed that MBL was not statistically correlated with the number of adjacent implants placed, smoking, arch in which they were placed, a history of periodontitis, whether placed at bone or tissue level, and whether the prosthesis was cement or screw-retained.
CBHL differences were divided into subgroups: less than or equal to 0.75mm, 0.76-1.25mm, 1.26-1.75mm, and >1.75mm. In non-splinted implants per each CBHL subgroup, the mesial MBL of the most posterior implant and distal MBL of the most anterior implant were the following, respectively (mm/yr): 0.8 and 0.9, 1.0 and 1.0, 1.0 and 1.0, 1.3 and 1.2. In splinted implants per each CBHL subgroup, the MBLs were the following (mm/yr): 0.2 and 0.3, 0.2 and 0.1, 0.9 and 0.1, and 0.2 and 0.2.
In the non-splinted group, a significant weak-moderate correlation between CBHL and MBL existed from T0-T2 (mesial of posterior-most implant: Pearson’s r=0.33, p=0.0003; distal of anterior-most implant: r=0.33, p=0.004). One mm of additional CBHL corresponded to mean MBL increase of 0.82mm on the mesial (95% CI: 0.29-1.35) and 0.78mm on the distal (95% CI: 0.25-1.30).
In the splinted group, there was no significant correlation between CBHL and MBL (mesial of posterior-most implant: r=0.32, p=0.39; distal of anterior-most implant: r=0.19, 0.58).
Linear regression models showed more MBL of non-splinted implants than splinted implants under the same CBHL difference (p<0.0001, beta coefficient for mesial measurements = 1.73mm more MBL, for distal measurements = 1.79mm more MBL).
Discussion: Previous research by these authors concluded that MBL was higher in non-splinted groups versus splinted groups, and they theorized that splinting reduces stress on surrounding peri-implant bone. However, another similar retrospective literature found that more MBL occurred in splinted versus non-splinted groups, suggesting inadequate oral hygiene was at fault. Existing systematic reviews and meta-analyses differ in results, either finding no statistical difference between splinted and non-splinted groups for biological complications and prosthesis-level complications or that splinted implants fared better. This study supports results indicating splinted implants offer superior results when assessing MBL at differing CBHL’s. This may be due to additional force vectors at play when implants are placed at different bone heights, and that splinting distributes such stresses as a unified structure.
Specific to this study, in the non-splinted group, implants exhibit more MBL progression when CBHL differences are greater than 1.75mm; yet, in the splinted group, MBL is more stable at such CBHL differences. When adjusting for CBHL’s, non-splinted implants showed more MBL compared to splinted implants. When any CBHL existed, non-splinted implants demonstrated more MBL progression. However, because of the inherent limitations associated with the study being retrospective, more prospective research is needed.
Conclusion: When posterior implants are placed at differing crestal bone height levels, splinting them may elicit less progression of marginal bone loss compared to not splinting them. Crestal bone height levels may be a potential factor for marginal bone loss.
Topic: deep margin elevation (DME)
Authors: Karageorgiou A, Fostiropoulou M, Antoniadou M, Pappa E
Title: Deep Margin Elevation: Current Evidence and a Critical Approach to Clinical Protocols—A Narrative Review
Source: Adhesives. 2025; 1(3):10.
DOI: doi.org/10.3390/adhesives1030010
Reviewer: John Kerns
Type: narrative review
Keywords: deep margin elevation, crown lengthening, biologic width
Purpose: This narrative review seeks to summarize existing literature on the techniques and effectiveness of Deep Margin Elevation (DME), a conservative restorative technique used to raise subgingival margins coronally by using composite resin.
Methods: Three researchers used a modified PICO framework to search PubMed, the Cochrane Library, and Scopus from January 1998 (the year of technique introduction) until February 2025. Studies were excluded if they failed to provide discuss DME in a restorative context or if they were not in English.
Among 59 analyzed studies, 11 were clinical experimental studies, 23 were in vitro studies, 20 were systematic and narrative reviews, 2 were case reports, 2 were finite element analyses, and one was a clinical technique description paper were also included. Most clinical studies were small scale studies and only two had a greater than 5-year follow-up.
Results: A dental professional would use DME to generally avoid surgical crown lengthening (SCL) and orthodontic extrusion. DME evolved from the open-sandwich technique, in which glass ionomer cement (GI) or resin-modified glass ionomer cement (RMGI) is placed at the cervical margin to lift the margin equigingivally or higher. The technique was initially proposed by Dietschi and Spreafico in 1998 and was later made popular by Magne and Spreafico in 2012, when they suggested using resin instead of GI or RMGI at the cervical elevation layer. GI and RMGI have been shown to be subject to greater dissolution and mechanical degradation than resin when intra-oral. The technique was primarily used for indirect restorations but now is also used for definitive.
DME is indicated when deep cervical proximal margins extend subgingivally, but remain within the junctional epithelium. Various literature debates the extent to which highly polished and flush resin placed using DME may invade the junctional epithelium attachment. Yet, biologic width generally should not be violated, so at least 2.04mm above crestal bone should remain prior to using DME protocol.
When performing DME, complete and stable isolation with rubber dam is essential to avoiding contamination. DME is therefore only indicated when such isolation is feasible. To perform DME, a modified metal matrix (2-3mm in width) or a partial metal matrix within a circumferential metal matrix (matrix-in-matrix technique) may be used to achieve flush margins and proper emergence profile. Both flush margins and proper emergence profile are essential for maintaining periodontal health.
Also, composite resin is to be placed incrementally, and low-viscosity composite is preferred such as pre-heated composite (55 degrees C). Bulk-fill flowable and bioactive composites has been associated with less microleakage. Self-curing resin cements generally fare poorly in such restorations due to propensity for microgaps. Adhesive protocol has been described as selective enamel etch where applicable and self-etching, followed by immediate dentinal sealing.
Regarding failure rates, restorations with DME have been shown to have a 95.9% five-year survival rate, and there has been no statistically significant difference in longevity between restorations with DME and without DME. However, long-term studies are lacking.
Discussion: Since deep margins typically extend below the cemento-enamel junction, selective enamel etching and self-etch adhesives seem to be optimal compared to total etch techniques. GI and RMGI cements historically exhibited worse marginal integrity and weaker bond strengths versus composite.
A low-filled composite, while able to seal well, is more susceptible to polymerization shrinkage compared to higher viscosity materials. Preheated bulk-fill composite has been shown to be successful in in-vitro and limited clinical data.
Dental professionals should consider the biomechanical environment of the restoration, including occlusal forces. Oblique loading, for example, has been shown to be stronger around deep cervical restorations. Therefore, bond strength should not be the only factor in determining bonding and composite-type protocols, as materials with an elastic modulus comparable to dentin (e.g. high-filled flowable composites) are important for offering stress-buffering capabilities.
While long-term data is lacking, mid-term outcomes are favorable. Dentition with DME has not been shown to have an increased risk of secondary caries. However, clinical trials with follow-ups beyond five years are needed.
Regarding periodontal health, most studies agree that flush margins, a highly polished finish, adequate isolation, ideal emergence profile, non-impingement of CT attachment, and optimal OH are essential to restorative success. Yet, evidence is lacking in which direct comparison of DME versus SCL and orthodontic extrusion is performed.
Conclusion: DME is a technique for conservative management of deep sub-gingival margins and is an alternative to crown lengthening and orthodontic extrusion, so long as >0.5mm of the junctional epithelium is not invaded. Ability to achieve isolation, composite and bonding protocols, assessment of occlusal forces, and patient oral hygiene practices are important considerations for technique success.
Topic: short implants vs augmentation
Author: Block, MS.
Title: Evidence Supports the Use of Short Implants as a Graftless Solution – A Narrative Review.
Source: International Journal of Oral and Maxillofacial Implants, March 2025.
DOI: 10.11607/jomi.11188
Reviewer: Malon Stratton
Type: Narrative Review
Keywords: bone loss, bone augmentation, bone grafting, short implant, short implant failures, splinted short implants, short implant survival
Purpose: The purpose of this narrative review is to prove the success of using short dental implants in patients with minimal bone volume to avoid grafting procedures. This review should guide clinicians on when to use short implants (less than 8.5 mm in length) and when grafting with a longer implant is more advantageous.
Material and Methods: This investigation consisted of an analytical review of published studies presenting clinical outcomes with a minimum follow-up of one year. The search was conducted through PubMed, covering the years 1990 to 2023. Eligible studies for inclusion were retrospective or prospective in design. The primary predictor evaluated was the placement of short implants for fixed prostheses. The primary outcome variable was implant status, categorized as either survived or failed. Additional variables considered included the type of restoration, whether short implants were splinted or used as single-tooth replacements (covariates), and the timing of implant failure, classified as occurring within one year or after one year.
Results: A total of 50 publications were collected and reviewed to address specific clinical questions. Of these, 18 studies with retrospective or prospective data qualified for detailed analysis, 11 focusing on single implant restorations and 7 on splinted implant restorations from Pubmed.gov. Following application of exclusion criteria, the dataset comprised 1,683 implants. Among these, 853 (50.7%) were single short implants, and 830 (49.3%) were splinted short implants. Failure was observed in 62 single implants (7.3%) and 36 splinted implants (4.3%). For implants longer than 8 mm, 565 were reported, with 11 failures (1.9%). Statistical analysis showed significant differences (p < 0.05) when comparing splinted versus single restorations for both short and long implants, except when comparing splinted and single long implants. Evaluation of covariates based on restoration type and implant length revealed that short implants were more prone to failure after functional loading (p < 0.05). In contrast, longer implants demonstrated no significant variation in failure rates between early and extended loading periods.
Discussion: Several questions were answered throughout this narrative review. What is the overall success using implants that are short? It was reported that close to 90% were deemed successful based on retrospective and prospective references. Does the crown-to-implant ratio correlate with marginal bone loss on short implants. The answer is no because there was no correlation found to marginal bone loss attributed to the crown-to-implant ratio that was greater than three. Does splinting short implants correlate to implant success? Yes, because the success rates were similar to longer implants. Can a clinician use short implants rather than place longer implants with sinus grafting? Many studies found that short implants, when splinted to other implants, had similar success rates compared to longer implants placed into sinus grafts. Do single restorations on short implants have long term success? Many reports stated that single short implants have a higher risk for failure compared to single longer implants. Why is there an increased peri-implant disease state with short implants? In ridges with limited bone height, the peri-implant mucosa has less attached and keratinized gingiva due to the lack of vertical ridge. Late failure is more common in the presence of a non-ideal environment. What is the success rate of using short implants in augmented ridges? A ridge augmentation procedure is ideal for those patients with short or narrow ridges, and placement of short implants splinted together had high success rates.
Conclusion: Evidence from peer-reviewed studies indicates that splinted short implants demonstrate success rates comparable to those of longer implants. However, single short implants were associated with a higher likelihood of failure secondary to loss of integration over time. Short implants can be used while splinted to other implants to avoid sinus grafting.
Topic: prefabricated abutments for posterior immediate implants
Author: Gnusins, V., Akhondi, S., Zvirblis, T., Pala, K., Gallucci, G.O., & Puisys, A.
Title: Chairside vs Prefabricated Sealing Socket Abutments for Posterior Immediate Implants: A Randomized Clinical Trial.
Source: Clinical Implant Dentistry and Related Research, June 2025.
DOI: 10.1111/cid.70076
Reviewer: Malon Stratton
Type: Randomized Controlled Trial
Keywords: Dental abutment, immediate implant, tooth socket
Purpose: This randomized clinical trial evaluated differences in soft tissue height, probing depth, and buccal contour volume reduction after immediate implant placement, comparing chairside composite Sealing Socket Abutments (SSAs) vs. prefabricated zirconia SSAs in posterior sites.
Background: Immediate implant placement protocols have become more accepted over the years, for both anterior and posterior extraction sites. Recent literature has confirmed success in both areas. Research highlights the preservation of peri-implant soft and hard tissue, better outcomes for the pink esthetic score, and favors marginal tissue stability while food impaction incidence is reduced. While both anterior and posterior sites for immediate implant placement have become more popular, the molar region poses greater difficulty in controlling heavy occlusal forces. Finelle et al. in 2017 introduced the Sealing Socket Abutment (SSA) concept to reduce the risk of immediate restoration in the posterior area following extraction, while maintaining the benefits of immediate implant placement. The purpose was to support soft tissue healing by sealing the socket with a custom abutment that creates the proper emergence profile while maintaining the buccal contour. SSAs are typically fabricated chairside with flowable composite resin. However, recently there has been emerging evidence that polished zirconia may offer soft tissue behavior benefits in subgingival applications.
Material and Methods: A total of 47 patients indicated for posterior tooth extraction with immediate implant placement were randomly allocated to two groups: 24 were allocated to the composite Sealing Socket Abutment (CS) group, which received chairside-fabricated abutments, and 23 were distributed zirconia Sealing Socket Abutments (ZR), which received prefabricated abutments. Implants were inserted immediately post-extraction using static computer-assisted implant surgery (sCAIS). Cone-beam computed tomography was employed to evaluate Supra-Platform Tissue Height (SPTH) and Total Horizontal Tissue (THT) changes over a 3-month healing interval. Clinical parameters assessed included implant survival, probing pocket depth (PPD), bleeding on probing (BOP), and plaque index (PI), while volumetric measurements were obtained through digital impression analysis.
Results: SPTH remained unchanged over the 3-month period, with mean variations of 0.17 mm reduction in the CS group and 0.44 mm reduction in the ZR group, showing no statistically significant difference (p > 0.05). Total Horizontal Tissue (THT), however, demonstrated a significant reduction in both groups. The CS group exhibited a decrease of 1.00 mm, while the ZR group showed a slightly greater reduction of 1.17 mm (p < 0.001). Probing pocket depth (PPD) increased in the CS group from 2.8 mm to 3.7 mm on the palatal/lingual side and from 2.5 mm to 3.2 mm on the buccal side (p = 0.026). In contrast, the ZR group demonstrated a reduction in PPD from 3.1 mm to 2.7 mm palatally/lingually, with buccal measurements remaining essentially unchanged (2.6 mm to 2.7 mm) (p = 0.001). Bleeding on probing (BOP) decreased significantly in the CS group from 42.3% to 7.7% (p = 0.009), while the ZR group maintained consistently low values, showing a modest decline from 17.4% to 4.4% (p = 0.346).
Conclusions: The two treatment approaches produced similar overall results. Zirconia abutments were associated with reduced probing depths, whereas composite abutments demonstrated less tissue volume loss. In both groups, SPTH remained stable. Future studies are needed to determine early differences in PPD influencing long-term peri-implant tissue health.