Disease recurrence during supportive therapy following peri-implantitis treatment: A retrospective study.

AIM: Supportive therapy is key to prevent disease recurrence after peri-implantitis treatment. The primary objective was to quantify disease recurrence during supportive peri-implant therapy (SPIT) after peri-implantitis treatment. A secondary objective was to assess the success/failure of cumulative interceptive supportive therapy (CIST) after peri-implantitis treatment. METHODS: Compliers (whether regular or erratic) with SPIT after peri-implantitis treatment during ≥12 months were retrospectively evaluated. CIST was prescribed whenever residual pockets ≥6 mm concomitant with profuse bleeding on probing (disease recurrence) were identified. Patient- and implant-related factors were analyzed to explore their associations with disease recurrence and the need for CIST. RESULTS: Disease recurrence was considered in 28 patients (40 implants). Of these, 14 patients (23 implants) further demonstrated radiographic evidence of progressive bone loss (≥1 mm). This represented an overall disease recurrence following peri-implantitis treatment of ~20% and ~ 10% at patient and implant levels, respectively. Smokers, patients diagnosed at baseline with periodontitis grade C, and males were significantly more prone to exhibit recurrence. Patients undergoing CIST due to instability were not likely to respond favorably (~70% continued to exhibit residual pockets). CONCLUSION: Disease recurrence during SPIT following peri-implantitis treatment on selected cases is ~20%. Patients undergoing CIST due to instability are not likely to respond favorably.

Supportive therapy following peri-implantitis treatment: A retrospective study on compliance.

BACKGROUND: The compliance rate with supportive therapy following peri-implantitis treatment (SPIT) remains unknown. The present retrospective study was carried out to assess the compliance rate and the factors influencing compliance in a private practice setting. MATERIALS AND METHODS: Patients were divided into three groups according to compliance rate: regular compliance (RC ≥2 SPIT/year), erratic compliance (EC <2 SPIT/year), and non-compliance (NC <1 SPIT/year). Overall, 17 patient- (n = 8) and site-related variables (n = 9) were explored as potential confounders of compliance. The Chi2 test was applied to assess the association between categorical variables and determine the odds ratio (OR). RESULTS: The study comprised 159 patients restored with 1075 implants, of which 469 were treated for peri-implantitis and met the inclusion criteria. A total of 57.2% were RC, 25.8% EC, and 17% NC. The multivariate analysis showed that smoking and grade C periodontitis reduced the likelihood of RC (OR = 0.28, p < .001) when compared to complete edentulism or non-smoking. Moreover, age demonstrated being associated with follow-up when SPIT was interrupted in EC and NC (OR = 0.94, p = .007). CONCLUSION: Comprehensive information, provided prior to peri-implantitis treatment, regarding the importance of adhering to SPIT after peri-implantitis treatment to achieve/maintain peri-implant health, resulted in ~60% regular compliance rate (NCT05772078).

Peri-implantitis and maxillary sinus membrane thickening: A retrospective cohort study.

OBJECTIVE: The objective of this study is to investigate the association of peri-implantitis (PI) and sinus membrane thickening and to assess the resolution of membrane thickening following intervention (implant removal or peri-implantitis treatment) aimed at arresting PI. MATERIALS AND METHODS: Forty-five patients with 61 implants in the posterior maxillary region were retrospectively included in the study. Twenty-four patients were diagnosed with peri-implantitis (PI) and 21 had peri-implant health (PH). Cone-beam computed tomography (CBCT) scans were evaluated to assess maxillary sinus characteristics, including membrane thickening, sinus occupancy and ostium patency. The CBCT scans taken 6 months after intervention aimed at arresting disease (implant removal or treatment of PI) in the PI group were also appraised and compared to baseline scans. RESULTS: At baseline, all parameters evaluating membrane thickness disorders yielded significant differences between groups (p < .001). Patients with posterior maxillary implants diagnosed with PI were 7× more likely to present membrane thickening compatible with pathology when compared to patients with healthy implants (OR = 7.14; p = .005). Furthermore, the likelihood was 6x greater in implants diagnosed with PI to exhibit moderate membrane thickening (OR = 6.75, p = .001). The patients receiving interventions aimed at arresting PI experienced significant enhancement in all radiographic parameters related to the sinus cavity at the 6-month follow-up (p < .001), though these variations were similarly independent of whether treatment consisted of PI treatment or implant removal. CONCLUSIONS: Maxillary sinus membrane thickening and the permeability/obstruction of the ostium are frequently associated with the presence of PI in posterior implants. Interventions targeting disease resolution effectively reduce membrane thickness to levels compatible with maxillary sinus health.

A combination crown lengthening and implant placement guide.

Surgical procedures, including crown lengthening and implant placement, have become more predictable and less invasive because of the use of digital planning tools. A method combining a cone beam computed tomography and a digital scan with a virtual planning software program is described to fabricate a combination guide for both surgical esthetic crown lengthening and guided implant placement.

Selecting biomaterials in the reconstructive therapy of peri-implantitis.

Peri-implantitis is a pathogenic inflammatory condition characterized by progressive bone loss and clinical inflammation that may compromise the stability of dental implants. Therapeutic modalities have been advocated to arrest the disorder and to establish peri-implant health. Reconstructive therapy is indicated for bone defects exhibiting contained/angular components. This therapeutic modality is based upon the application of the biological and technical principles of periodontal regeneration. Nonetheless, the comparative efficacy of reconstructive therapy and nonreconstructive modalities remains unclear. Therefore, the aim of this narrative review is to address major clinical concerns regarding the efficacy, effectiveness, and feasibility of using biomaterials in peri-implantitis therapy. In particular, the use of bone grafting materials, barrier membranes, and biologics is comprehensively explored.

Influence of the abutment height on marginal bone level changes around two-piece dental implants: Meta-analysis and trial sequential analysis of randomized clinical trials.

BACKGROUND: The focused question was: "In systemically healthy individuals with at least one two-piece dental implant, what is the efficacy of long (≥2 mm; intervention) compared with short (<2 mm; comparison) shoulder height abutments in peri-implant marginal bone level (MBL) changes at <1 year and ≥1 year reported by randomized controlled clinical trials?" MATERIALS AND METHODS: An electronic and hand search was conducted to identify RCTs published up to August 2022. The primary outcome variable was changed in MBL from implant surgery to subsequent follow-ups. Mean values and standard deviations for each study were extracted. Weighted mean differences and 95% confidence intervals were calculated. Meta-analysis for MBL changes was performed through a random-effect restricted maximum-likelihood model at early (<1 year) and late (≥1 year) stages of bone remodeling. Publication bias and sensitivity tests were also applied. Subgroup analysis was performed to further explore possible sources of heterogeneity in the estimated treatment effect. Trial sequential analysis was performed to assess the required information and false-positive results. RESULTS: Six randomized clinical trials fulfilled the inclusion/exclusion criteria and were included in the qualitative and quantitative analysis with a follow-up range from 6 to 36 months after implant surgery. Meta-analysis revealed that long abutments significantly exhibited 0.27 mm (CI 95% -0.60, 0.06) and 0.33 mm (CI 05% -0.50, -0.16) lower MBL changes compared with short ones at <1 year and ≥1 year, respectively. Subgroup meta-analysis revealed that studies with implants placed in a more subcrestal position significantly exhibited less differences in MBL changes between long and short abutments. No meta-analysis was conducted for peri-implant clinical parameters, and soft-tissue changes provided that reported data were scarce. Trial sequential analysis revealed insufficient information size to provide a definitive answer on the effect of abutment height in MBL. CONCLUSIONS: It might be cautiously concluded that two-piece implants with long abutments (≥2 mm) may display a protective role against marginal bone loss when compared with short ones (<2 mm) at <1 year and ≥1 year. A more subcrestal implant position seemed to minimize the effect of the abutment height in terms of MBL.

Narrow diameter titanium-zirconium tissue-level implants supporting multi-unit FDPs in the anterior area: A 5-year prospective study.

BACKGROUND: Narrow diameter implants (NDIs) are used in cases of limited mesio-distal space, or if the alveolar ridge does not allow placement of a standard diameter implant. PURPOSE: The aim of this prospective case series study is to present the 5-year clinical-, radiological-, and patient-reported outcome measures (PROMs) of patients with partial edentulism in the anterior area of the jaws requiring the placement of two narrow diameter implants to support a 3- or 4-unit fixed partial denture (FPD). MATERIALS AND METHODS: Thirty partially edentulous patients missing 3 or 4 adjacent teeth in the anterior area of the jaws were included in the study. Two titanium-zirconium tissue-level NDIs were placed in each patient in healed anterior sites (60 implants). A conventional loading protocol was performed to provide a FPD. Implant survival, success, marginal bone-level changes (MBL), clinical parameters, buccal bone stability with CBCT, adverse events and PROMs were recorded. RESULTS: The survival and success rates for the implants were 100%. The mean MBL (±SD) after prosthesis delivery, and 5-year follow-up (mean 58.8 months; range: 36-60) was 0.12 ± 0.22 and 0.52 ± 0.46 mm, respectively. Decementation and screw loosening were the most frequent prosthetic complications, yielding a prosthetic survival and success rates of 100% and 80%, respectively. Patient satisfaction was high with a mean (±SD) score of 89.6 ± 15.1. CONCLUSIONS: The use of tissue-level titanium-zirconium NDIs supporting splinted multi-unit FPDs in the anterior area seems to be a safe and predictable treatment option after a 5-year follow-up period.

Digital evaluation of facial peri-implant mucosal thickness and its impact on dental implant aesthetics.

OBJECTIVE: The aim of the present study was to describe and compare the features of the buccal peri-implant mucosa to natural gingiva in the aesthetic area. MATERIAL AND METHODS: Forty-nine periodontally healthy patients were included in this cross-sectional study. Mucosal and gingival dimensions at the mid-facial aspect were evaluated clinically and radiographically. Color assessments were performed using a reflectance spectrophotometer, and patient aesthetic satisfaction was further checked. RESULTS: Implant sites revealed significant thicker mucosa when compared to tooth sites both at 1.5 (p < 0.001) and 3 mm (p < 0.001) apical to the mucosal margin. Both conventional and digital methods presented a good reliability. The spectrophotometric data revealed a statistically significant color difference between the peri-implant mucosa and the gingiva. However, there was no further significant relation between these color changes and the mucosal thickness. CONCLUSIONS: Peri-implant mucosa revealed a darkish, greenish, and bluish discoloration when compared to the gingiva. More satisfactory patient´s aesthetic evaluation was reported in sites with thicker and comparatively lighter mucosa when compared to the adjacent dentition. CLINICAL RELEVANCE: This article focuses on variables affecting color stability and aesthetics around dental implants. These can be assessed to identify the need for peri-implant phenotypic modification.

Could dietary restrictions affect periodontal disease? A systematic review.

OBJECTIVE: This review aimed at evaluating the possible benefits that caloric restriction (CR) may provide to periodontal disease progression and response to treatment. MATERIAL AND METHODS: Electronic search on Medline, Embase and Cochrane, and manual search were performed to identify pre-clinical and on human studies reporting the consequences of CR on clinical and inflammatory parameters related to periodontitis. Newcastle Ottawa System and SYRCLE scale were used to assess the risk of bias. RESULTS: Four thousand nine hundred eighty articles were initially screened, and a total of 6 articles were finally included, consisting of 4 animal studies and 2 studies in humans. Due to the limited number of studies and heterogeneity of the data, results were presented in descriptive analyses. All studies showed that, compared to the normal (ad libitum) diet, CR might have the potential to reduce the local and systemic hyper-inflammatory state as well as disease progression in periodontal patients. CONCLUSIONS: Within the existing limitations, this review highlights that CR showed some improvements in the periodontal condition by reducing the local and systemic inflammation related to the periodontitis and by improving clinical parameters. However, the results should be interpreted with caution since robust research such as randomized clinical trials is still missing. CLINICAL RELEVANCE: This review shows that some dietary/caloric restrictions approaches may have the potential to improve periodontal conditions and, in addition, highlights a need for human studies with a robust methodology in order to draw stronger evidence-based conclusions.

Outcome indicators of non-surgical therapy of peri-implantitis: a prospective case series analysis.

OBJECTIVES: This study aims to identify patient and implant indicators influencing the non-surgical therapeutic outcomes of peri-implantitis at 6 months of follow-up. METHODS: This case series involved patients with at least one implant diagnosed with peri-implantitis according to the 2017 World Workshop criteria. Non-surgical therapy consisted of mechanical debridement of the peri-implant pockets combined with metronidazole 500 mg 3 times a day for 7 days. At baseline and at 6 months, clinical and radiographic variables were collected to calculate treatment success (probing pocket depth reduction to 5 mm without bleeding on probing or < 5 mm irrespective of bleeding on probing at all implant sites, and lack of bone loss progression). The primary outcome was treatment success (%) at 6 months. The influence of the patient and implant/prosthetic variables upon disease resolution was assessed through simple and multiple logistic regression analyses at patient and implant level, using generalized estimation equations models. RESULTS: A total of 74 patients and 107 implants were analyzed at 6 months. Disease resolution was established in 25.7% of the patients and 24.1% of the implants. Patients with stage IV and grade C periodontitis, inadequate oral hygiene at baseline, and wide diameter (≥ 4.5 mm) presented significantly greater treatment failure, whereas smokers and former smokers demonstrated a tendency toward failure. At 6 months, there was a significant decrease in probing pocket depth and bleeding on probing of 1.08 ± 1.06 mm and 14%, respectively. Radiographically, a significant gain in marginal bone level of 0.43 ± 0.56 mm was observed. CONCLUSION: Disease resolution after non-surgical treatment of peri-implantitis is negatively influenced by the loss of support of the adjacent periodontium, poor baseline oral hygiene, and wide diameter implants (≥ 4.5 mm). CLINICAL RELEVANCE: This study helps to discriminate the clinical situations in which non-surgical treatment is less likely to achieve treatment success at short term.

Influence of immediate postoperative gingival thickness and gingival margin position on the outcomes of root coverage therapy: A 6 months prospective case series study using 3D digital measuring methods.

BACKGROUND: To assess linear and volumetric changes following the treatment of gingival recessions (GRs) by means of a modified coronally advanced tunnel technique combined with acellular dermal matrix (MTUN + ADM). MATERIALS AND METHODS: Patients presenting GR type 1 (RT1) GRs underwent root coverage surgery consisting of MTUN + ADM. Clinical measurements were made, and intraoral scans were obtained at baseline, postoperatively, and 6 weeks, 3 and 6 months after surgery, to evaluate changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), recession area (RA), marginal gingival thickness (MGT), and mucosal volume (MV). The impact of patient-level and surgical-site variables upon percentage root coverage (% RC) and the likelihood of achieving complete root coverage (CRC) were explored. RESULTS: A total of 20 patients (n = 47 teeth) were treated. After 6 months, RD and RA decreased, while KTW, MGT, and MV increased. The mean % RC was 93% at 6 months and CRC was found on 72.3% of the sites at 6 months. The postoperative MGT changes at 1.5 and 3 mm were significantly correlated to % RC and CRC at 6 months. Each additional mm of postoperative gain of gingival thickness resulted in a 4-fold increase in the probability of achieving CRC. Additionally, gingival margin positioned ≥0.5 mm coronal to the cementoenamel junction immediately after surgery was a strong predictor of CRC. CONCLUSIONS: The MGT gain at 1.5 and 3 mm achieved in the immediate postoperative period is a significant predictor of CRC at 6 months when treating multiple GRs via MTUN + ADM. CLINICAL SIGNIFICANCE: The Scientific rationale for the study relies on the lack of 3D digital measuring tools in the assessment of soft tissue healing dynamics after root coverage therapy. The principal findings of this study can be summarized as follows: tooth type, tooth position, and post-operative gingival margin position and gingival thickness and volume changes are predictors of CRC. Therefore, the practical implications are that the more thickness and more coronal advancement achieved immediately after root coverage surgery, the higher chance of achieving CRC.

Management and sequelae of dental implant removal.

Inappropriate and unnecessary implant therapy driven by an erroneous belief that dental implants provide enhanced function and esthetics over diseased or failing teeth has led to a growing burden of implant complications across the globe. Specifically, esthetic and biological complications frequently lead to the unfavorable prognosis of dental implants. Often, these cannot be managed predictably to improve the condition or satisfy patients' demands. In such circumstances, implant removal needs to be considered. Currently, minimally invasive methods based on reverse torque engineering are key to preserve peri-implant soft and hard tissues. Implant replacement is now feasible, as evidenced by the high survival rates of implants placed at previously failed sites. Notwithstanding these data, clinicians should still consider carefully the expendability of an implant and whether its replacement will satisfy the prosthetic, biomechanical, and esthetic demands of the patient. In the scenario where future implant placement is desired, protocols undertaken for soft/hard tissue grafting and implant placement should be based upon defect morphology and soft and hard-tissue characteristics. Currently, however, a lack of knowledge of the biological events and dimensional changes that arise following implant removal renders decision-making complex and challenging, and recommendations remain largely based upon empirical speculation. This chapter will review the indications for implant replacement for prosthetic, biomechanical, and esthetic complications, alongside considerations in decision-making, planning, implementation, and outcomes of implant replacement.

Intra- and inter-examiner reliability in classifying periodontitis according to the 2018 classification of periodontal diseases.

AIM: To evaluate the inter-examiner reliability in classifying periodontitis using the 2018 classification of periodontal diseases, when used by postgraduate students, academics, and specialist clinicians trained in European Federation of Periodontology (EFP) and American Academy of Periodontology (AAP) postgraduate-accredited programmes. MATERIALS AND METHODS: An online survey including five patients with periodontitis was sent twice to seven specialists in periodontology to provide the staging and grading characteristics. After agreeing on a "gold-standard" classification, the same questionnaire was sent to 16 EFP and 73 AAP postgraduate programmes, to be answered by their faculty, graduates, and students. The responses were compared with the gold-standard classification, and the inter-examiner agreement was calculated. RESULTS: One-hundred and seventy-four participants completed the survey. The inter-examiner agreement resulted in 68.7% in assigning the stage, 82.4% in assigning the grade, and 75.5% in assigning the extent. The academic position and the experience of the participants did not have any significant influence on classifying periodontitis as the gold standard. CONCLUSIONS: The use of the 2018 periodontitis classification resulted in high inter-examiner reliability when used by a specialist group of clinicians, postgraduate students, and academicians, irrespective of their current position and experience. Given the low response rate and potential selection bias, results pertaining to the use of this system in classifying periodontitis should be interpreted with caution.

Clinical outcomes and associated factors in the treatment of peri-implant mucositis, combining mechanical debridement and prosthesis modification: A 30-month follow-up prospective case series.

AIM: To evaluate the clinical outcome and the associated factors of a treatment protocol for peri-implant mucositis. MATERIALS AND METHODS: Patients were evaluated 30 months after a treatment protocol including professional mechanical debridement and modification of the prosthesis contours to improve access for biofilm control. Clinical performance was assessed by means of probing with an electronic pressure-calibrated periodontal probe. The possible impact of implant- and patient-level factors on the changes in peri-implant mucosal inflammation measured with the modified bleeding index (mBI) was evaluated. RESULTS: Twenty patients and 61 implants were included in the analysis. At the final visit, 50% of the patients presented bleeding on probing, with a mean mBI of 0.22 (SD 0.27). The adjusted linear regression model showed a significant association between patient's compliance with supportive care visits (p = .006) and mucosal inflammation. Similarly, at the implant level, modified plaque index (p < .001) and an irregular use of interdental brushes (p = .017) had a significant impact on final mBI. CONCLUSIONS: Prosthesis modification when needed in association with non-surgical treatment may be an important intervention in the treatment of peri-implant mucositis. Compliance with supportive care visits and the regular use of inter-dental brushes were identified as important factors to achieve mucosal inflammation control.

Efficacy of soft tissue augmentation procedures on tissue thickening around dental implants: A systematic review and meta-analysis.

OBJECTIVES: The first focused question (FQ1) was: What is the efficacy of connective tissue graft (CTG), as compared to the absence of soft tissue grafting procedure, in terms of gain in peri-implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? The second focused question (FQ2) was: What is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri-implant STT reported by RCTs or CCTs? MATERIALS AND METHODS: A manual and electronic search was performed for each question to identify RCTs and CCTs published up to July 2020. The primary outcome variable was changes in peri-implant STT and secondary outcomes were marginal bone level (MBL), clinical parameters for the diagnosis of peri-implant health, changes in the position of peri-implant soft tissues, esthetic outcomes, and patient-related outcome measures (PROMs). For primary and secondary outcomes, data reporting mean values and standard deviations for each study were extracted. Weighted mean differences (WMDs) or standardized mean differences as well as 95% confidence intervals (CIs) and prediction intervals (PIs) were calculated. RESULTS: Eight trials were included to answer the first focused question and eight to answer the second one, providing data for 254 and 192 patients, respectively. For the first focused question, a statistically significant difference of 0.64 mm in STT was found in favor of the grafted group (n = 8; 95% CI [0.16; 1.13]; 95% PI [-1.06; 2.35]; p = .01). Moreover, sites treated with CTG exhibited statistically significant less recession than implants without a graft (n = 4; WMD = 0.50 mm; 95% CI [0.19; 0.80]; 95% PI [-0.70; 1.69]; p < .001). For the second focused question, the meta-analysis showed a statistically significant gain of STT in the CTG group when compared to soft tissue substitutes (n = 8; WMD = 0.51 mm; 95% CI [0.28; 0.75]; 95% PI [-0.09; 1.12]; p < .001). Furthermore, the use of CTG resulted in significantly higher pink esthetic score values (n = 3; WMD = 1.02; 95% CI [0.29; 1.74]; 95% PI [-3.67; 5.70]; p = .01) and less recession (n = 2; WMD = 0.50 mm; 95% CI [0.10; 0.89]; 95% PI [not estimable]; p = .014) when compared to soft tissue substitutes. No statistically significant differences between groups were observed for any of the following secondary variables: MBL, clinical parameters for the diagnosis of peri-implant health, position of the interproximal tissues, keratinized mucosa or PROMS (p > 0.05), except for medication intake, which was significantly higher when using CTG as compared to soft tissue substitutes (n = 2; WMD = 1.68; 95% CI [1.30; 2.07]; 95% PI [not estimable]; p < .001). CONCLUSIONS: Soft tissue augmentation procedures are efficacious on soft tissue thickening and, in particular, CTG demonstrated a significant STT gain when compared to no graft or soft tissue substitutes.

Ridge preservation in molar sites comparing xenograft versus mineralized freeze-dried bone allograft: A randomized clinical trial.

OBJECTIVES: The main objective of the study was to compare the dimensional ridge changes and the histological composition after the use of an allograft or xenograft and a resorbable membrane in ridge preservation in molar sites and to evaluate the influence of bone plate thickness on dimensional changes and the need of lateral sinus augmentation following ridge preservation. MATERIALS AND METHODS: Twenty-four patients in need of maxillary or mandibular first or second molar extraction and subsequent implant placement were included and randomly assigned to a group; allograft or xenograft, plus a collagen membrane. Cone-beam computed tomographies were obtained after molar extraction and after 5 months. A bone sample was harvested at the time of implant placement and analyzed by histomorphometry. RESULTS: Bone ridge was reduced significantly. Major changes in width occurred at 1 mm from the bone crest (-2.93 ± 2.28 mm) (p = .0002), while in height, the greatest reduction occurred at the buccal area (-1.97 ± 2.21 mm) (p = .0006). However, differences between groups were not significant. Thicker buccal bone plates exhibited less bone remodeling, while histologically, both biomaterials resulted in similar tissue composition. The resulting available bone height in the implant site measured 7.30 ± 3.53 mm initially and 6.8 ± 3.61 mm after 5 months which allowed implant placement without the need for lateral sinus augmentation in all cases. Still, 55% of the preserved areas needed transcrestal sinus lift. CONCLUSION: Ridge preservation in molar sites using a mineralized allograft or xenograft provides similar dimensional and histomorphometrical results after 5 months.

Effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures: Consensus report of group 2 of the SEPA/DGI/OF workshop.

OBJECTIVES: The aim of this study was to comprehensively assess the literature in terms of the effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures to increase the mucosal thickness with autogenous grafts or soft tissue substitutes. MATERIAL AND METHODS: Two systematic reviews (SR) were performed prior to the consensus meeting to assess the following questions. Review 1, focused question: In systemically healthy patients with an implant-supported fixed prosthesis, what is the influence of thin as compared to thick peri-implant mucosa on esthetic outcomes? Review 2, focused question 1: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of connective tissue graft (CTG), as compared to absence of a soft tissue grafting procedure, in terms of gain in peri-implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? Review 2, focused question 2: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri-implant STT reported by RCTs or CCTs? The outcomes of the two SRs, the consensus statements, the clinical implications, and the research recommendations were discussed and subsequently approved at the consensus meeting during the group and plenary sessions. CONCLUSIONS: There was a tendency of superior esthetic outcomes in the presence of a thick mucosa. The connective tissue graft remains the standard of care in terms of increasing mucosa thickness.

Local hormones and growth factors to enhance orthodontic tooth movement: A systematic review of animal studies.

BACKGROUND: Prolonged treatment times are the main reason capable of affecting patient compliance with orthodontic treatment. OBJECTIVES: A systematic review was made to determine whether the local administration of hormones and growth factors effectively enhances orthodontic tooth movement, and to identify possible adverse effects in animal studies. MATERIALS AND METHODS: Five databases (PubMed, Scopus, EMBASE, Web of Science and Cochrane Library) were checked for experimental studies reporting one of the following outcomes: orthodontic tooth movement, histological outcomes and side effects. After data extraction, orthodontic tooth movement linked to adjunctive substances was analysed using forest plots. The risk of bias and the quality of evidence were determined with the SYRCLE tool and the GRADE tool, respectively. RESULTS: Twenty-four studies were included in the systematic review. On a specific dose level, epidermal growth factor + liposomes, fibroblast growth factor and prostaglandin E2  + Ca were supported by a moderate level of evidence and rated as highly effective in increasing tooth movement in animal models. Likewise, there was histological evidence of increased bone remodelling after the administration of these substances. Other compounds were supported by a low to very low level of evidence. CONCLUSIONS: Hormones and growth factors may have a relevant impact upon orthodontic tooth movement rate. In specific formulations, prostaglandin E2 , fibroblast growth factor and epidermal growth factor showed promising results.

Modified coronally advanced tunnel versus epithelialized free gingival graft technique in gingival phenotype modification: a comparative randomized controlled clinical trial.

OBJECTIVES: The gingival thickness (GT) and keratinized tissue (KT) height are defined as the gingival phenotype. Both the modified coronally advanced tunnel technique (MCAT) and free gingival grafts (FGG) are used in modifying the gingival phenotype. This study aims to compare MCAT and FGG in gingival phenotype modification. MATERIALS AND METHODS: One hundred and forty recessions in 50 patients with thin and insufficient keratinized tissue at the anterior mandible were treated with either MCAT or FGG. GT, KT height, recession depth, recession width, probing depth, and clinical attachment level were evaluated at baseline and 6 weeks, 6 months, and 12 months. GT change, KT change, root coverage (RC), clinical attachment gain, and complete root coverage (CRC) were calculated. The wound healing index, tissue appearance, patient expectations, aesthetic, and dentin hypersensitivity were assessed at baseline and 6 months. RESULTS: All periodontal variables showed significant change from baseline to 12 months in both groups (p < 0.05). While FGG resulted in more KT change (p < 0.001), all MCAT sites showed at least 2 mm KT change in 12 months. MCAT resulted in greater GT change (p < 0.05) and RC (p < 0.003). In contrast, there was no significant inter-group CRC difference (p = 0.523). All patient-based variables were favorable to MCAT (p < 0.05), except dentin hypersensitivity (p = 0.225). CONCLUSIONS: Both techniques were successful in terms of gingival phenotype modification in the anterior mandible. Additional GT increase, RC, and patient-based outcomes favored MCAT, though KT change proved greater with FGG. CLINICAL RELEVANCE: Clinicians may choose MCAT for higher GT increase whereas FGG for more KTC. TRIAL REGISTRATION NUMBER: NCT04690140 and date: 12/26/2020.

Exploring the Expression of Pro-Inflammatory and Hypoxia-Related MicroRNA-20a, MicroRNA-30e, and MicroRNA-93 in Periodontitis and Gingival Mesenchymal Stem Cells under Hypoxia.

Hypoxia associated with inflammation are common hallmarks observed in several diseases, and it plays a major role in the expression of non-coding RNAs, including microRNAs (miRNAs). In addition, the miRNA target genes for hypoxia-inducible factor-1α (HIF-1α) and nuclear factor of activated T cells-5 (NFAT5) modulate the adaptation to hypoxia. The objective of the present study was to explore hypoxia-related miRNA target genes for HIF-1α and NFAT5, as well as miRNA-20a, miRNA-30e, and miRNA-93 expression in periodontitis versus healthy gingival tissues and gingival mesenchymal stem cells (GMSCs) cultured under hypoxic conditions. Thus, a case-control study was conducted, including healthy and periodontitis subjects. Clinical data and gingival tissue biopsies were collected to analyze the expression of miRNA-20a, miRNA-30e, miRNA-93, HIF-1α, and NFAT5 by qRT-PCR. Subsequently, GMSCs were isolated and cultured under hypoxic conditions (1% O2) to explore the expression of the HIF-1α, NFAT5, and miRNAs. The results showed a significant upregulation of miRNA-20a (p = 0.028), miRNA-30e (p = 0.035), and miRNA-93 (p = 0.026) in periodontitis tissues compared to healthy gingival biopsies. NFAT5 mRNA was downregulated in periodontitis tissues (p = 0.037), but HIF-1α was not affected (p = 0.60). Interestingly, hypoxic GMSCs upregulated the expression of miRNA-20a and HIF-1α, but they downregulated miRNA-93e. In addition, NFAT5 mRNA expression was not affected in hypoxic GMSCs. In conclusion, in periodontitis patients, the expression of miRNA-20a, miRNA-30e, and miRNA-93 increased, but a decreased expression of NFAT5 mRNA was detected. In addition, GMSCs under hypoxic conditions upregulate the HIF-1α and increase miRNA-20a (p = 0.049) expression. This study explores the role of inflammatory and hypoxia-related miRNAs and their target genes in periodontitis and GMSCs. It is crucial to determine the potential therapeutic target of these miRNAs and hypoxia during the periodontal immune-inflammatory response, which should be analyzed in greater depth in future studies.