Combining antibiotic-loaded bone cement-based free vastus lateralis muscle-sparing flap with split-thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non-weight-bearing areas.

Diabetic foot ulcers (DFUs) present significant challenges due to their associated amputation rates, mortality, treatment complexity and excessive costs. Our earlier work introduced a wound surgical integrated treatment (WSIT) for DFUs, yielding promising outcomes. This study focuses on a specific WSIT protocol employing antibiotic-loaded bone cement (ALBC) in the first Stage, and free vastus lateralis muscle-sparing (VLMS) flaps and split-thickness skin grafts (STSGs) in the second stage to repair non-weight-bearing DFUs. From July 2021 to July 2023, seven DFU patients (aged 47-71 years) underwent this treatment. Demographic data, hospital stay and repair surgery times were collected. Histological and immunohistochemical analyses assessed angiogenesis, collagen deposition and inflammation. SF-36 questionnaire measured pre- and postoperative quality of life. Preoperative ultrasound Doppler showed that the peak blood flow velocity of the recipient area artery was significantly >30 cm/s (38.6 ± 6.8 cm/s) in all patients. Muscle flap sizes varied from 8 × 3.5 × 1 to 18 × 6 × 2 cm. The operation time of the repair surgery was 156.9 ± 15.08 minutes, and the hospital stay was 18.9 ± 3.3 days. Histological analysis proved that covering DFUs with ALBC induced membrane formation and increased collagen, neovascularization and M2 macrophages fraction while reducing M1 macrophages one. All grafts survived without amputation during a 7- to 24-month follow-up, during which SF-36 scores significantly improved. A combination of ALBC with free VLMS flaps and STSGs proved to be safe and effective for reconstructing non-weight-bearing DFUs. It rapidly controlled infection, enhanced life quality and foot function, and reduced hospitalization time. We advocate integrating this strategy into DFU treatment plans.

Accuracy of Computer-Guided Implantology with Pilot Drill Surgical Guide: Retrospective 3D Radiologic Investigation in Partially Edentulous Patients.

Background and Objectives: Implant placement with static navigation enables the reaching of a correct position of implants from an anatomical and prosthetic point of view. Different approaches of static navigation are described in the scientific literature, and the pilot-guided approach is one of the least investigated. The aim of the present study is the evaluation of the accuracy of implant insertion using a pilot drill template. Materials and Methods: Fifteen partially edentulous patients, requiring an implant rehabilitation of at least one implant, were enrolled. Pre- and post-operative low-dose CTs were acquired to measure the differences between final positions of implants and virtually planned ones. Three linear discrepancies (coronal, apical, and depth), two angular ones (bucco-lingual and mesio-distal), and the imprecision area were evaluated. Correlations between accuracy and rehabilitated jaws, sectors, and implant length and diameters were also analyzed. Results: Forty implants were inserted in fifteen patients using pilot drill templates. Mean coronal deviation was 1.08 mm, mean apical deviation was 1.77 mm, mean depth deviation was -0.48 mm, mean bucco-lingual angular deviation was 4.75°, and mean mesio-distal one was 5.22°. The accuracy was statistically influenced only by the rehabilitated jaw for coronal discrepancy and sectors and implant diameter for bucco-lingual angular deviations. Conclusions: The pilot drill template could represent a predictable solution to obtain a correct implant placement. Nonetheless, a safety margin of at least 2 mm should be respected during implant planning to prevent damages to anatomical structures. Therefore, the tool is helpful in order to prosthetically drive the implants; still, great attention must be paid in fully relying on this procedure when approaching dangerous structures such as nerves and vessels.

Digital Customized Titanium Mesh for Bone Regeneration of Vertical, Horizontal and Combined Defects: A Case Series.

Background and Objective: Guided bone regeneration allows new bone formation in anatomical sites showing defects preventing implant rehabilitation. Material and Methods: The present case series reported the outcomes of five patients treated with customized titanium meshes manufactured with a digital workflow for achieving bone regeneration at future implant sites. A significant gain in both width and thickness was achieved for all patients. Results: From a radiographic point of view (CBTC), satisfactory results were reached both in horizontal and vertical defects. An average horizontal gain of 3.6 ± 0.8 mm and a vertical gain of 5.2 ± 1.1 mm. Conclusions: The findings from this study suggest that customized titanium meshes represent a valid method to pursue guided bone regeneration in horizontal, vertical or combined defects. Particular attention must be paid by the surgeon in the packaging of the flap according to a correct method called the "poncho" technique in order to reduce the most frequent complication that is the exposure of the mesh even if a partial exposure of one mesh does not compromise the final outcome of both the reconstruction and the healing of the implants.

Short-term "in vivo" study on cellular DNA damage induced by acrylic Andresen activator in oral mucosa cells.

OBJECTIVES: To analyse through comet assay and micronucleus test the viability and DNA damage occurred in buccal mucosa epithelial cells after a short-term exposure to Andresen activator resin monomers. SETTING AND SAMPLE POPULATION: Test group consisting of 26 subjects was treated with Andresen activator; 16 subjects who had never undergone orthodontic treatment were enrolled in the control group. MATERIAL & METHODS: Buccal mucosa samples were collected before treatment and after 7, 15, 30, 60 and 90 days. The analyses performed on the cells included the following: cellular viability, comet assay and micronucleus test. Mean ± SD were calculated for cellular viability, tail moment, tail intensity, tail length, micronuclei, binuclear and bud cells. Significance (P < 0.05) was evaluated with Dunnett's test. RESULTS: Cellular viability did not change during observational time, and its trend was similar to the controls. Tail moment and tail intensity significantly increased after 30 and 60 days, respectively, whereas tail length remained unchanged over time in the test group; the same parameters did not change in the control group. In the test group, micronuclei, binuclear and bud cells significantly increased after 30, 60 and 90 days, respectively. CONCLUSION: The resin monomers of the Andresen activator cause genotoxic effects detectable through comet assay and micronucleus test, but they do not produce clear cytotoxic effects after a 90 days exposure.

Clinical Success of Dental Implants Placed in Posterior Mandible Augmented With Interpositional Block Graft: 3-Year Results From a Prospective Cohort Clinical Study.

PURPOSE: The purpose of the present cohort study was to investigate the 3-year efficacy and clinical performance of implant-supported rehabilitations in posterior mandibles augmented with the sandwich osteotomy technique. MATERIALS AND METHODS: Twenty-three partially edentulous patients who developed atrophy of the posterior mandible (residual ridge height, 3 to 7 mm) were treated (32 surgical sites) with vertical bone augmentation using interpositional equine cancellous bone blocks and porcine corticocancellous bone particulate. All implants were placed 4 months after augmentation and were loaded with fixed dental prostheses. One side per patient was selected and followed for 3 years, and the patient was the unit of analysis. Linear radiographic vertical bone gain and peri-implant marginal bone loss were assessed; secondary outcomes-complication rates after surgery, prosthesis and implant failure rates, width of keratinized mucosa, and patient satisfaction-were evaluated. RESULTS: All patients reported postoperative paresthesia that resolved over a period of 2 months after the augmentation procedure. The mean vertical bone gain was 5.6 mm after 4 months. Ninety-one dental implants were positioned into the augmented areas. The global 3-year survival rate was 95.5%. The mean peri-implant marginal bone loss around implants was 1.06 ± 0.37 mm 3 years after loading, whereas the width of keratinized mucosa had an overall increase of 0.39 ± 0.36 mm. CONCLUSION: The results of the present 3-year study suggested high success rates for implants placed in areas augmented with the osteotomy sandwich technique. This surgical approach could be helpful in the presence of a low residual vertical height in the posterior mandible before implant placement.

Odontogenic Orofacial Infections.

Acute dental abscess is a frequent and sometimes underestimated disease of the oral cavity. The acute dental abscess usually occurs secondary to caries, trauma, or failed endodontic treatment. After the intact pulp chamber is opened, colonization of the root canals takes place with a variable set of anaerobic bacteria, which colonize the walls of the necrotic root canals forming a specialized mixed anaerobic biofilm. Asymptomatic necrosis is common. However, abscess formation occurs when these bacteria and their toxic products breach into the periapical tissues through the apical foramen and induce acute inflammation and pus formation. The main signs and symptoms of the acute dental abscess (often referred to as a periapical abscess or infection) are pain, swelling, erythema, and suppuration usually localized to the affected tooth, even if the abscess can eventually spread causing a severe odontogenic infection which is characterized by local and systemic involvement culminating in sepsis syndrome. The vast majority of dental abscesses respond to antibiotic treatment, however, in some patients surgical management of the infection may be indicated. In the present work, a retrospective analysis of the patients with dental orofacial infections referred to the Unit of Dentistry and Maxillofacial Surgery of the University of Verona from 1991 to 2011 has been performed.

A New Radiologic Protocol and a New Occlusal Radiographic Index for Computer-Guided Implant Surgery.

A minimum interarch space of 40 mm along the planned direction of the implant is physically mandatory to allow computer-guided implant placement with the NobelGuide technique. The aim of this paper was to describe a novel radiologic protocol and a new occlusal radiographic index that give the clinician the possibility of identifying patients with limited interarch space. Three patients undergoing NobelGuide treatment of the edentulous upper jaw were selected as candidates for this study. In the first patient, the radiographic occlusal index was built using an addition silicone material to occupy the space between the 2 arches forced into the maximum opening position. In the other 2 patients different silicone materials were used and 2 interpositional wedges were placed in between 2 silicone bites to ensure maximum mouth opening. In the first patient, the bite made with addition silicone alone resulted in distinct noise on computer tomography since the patient was not forced to achieve his maximum opening position. In the second patient the mandibular addition silicone was still quite visible, while in the third patient the condensation silicone was invisible and the quality of the image was excellent with the possibility of measuring maximum opening position and virtually predicting interference with the opposite arch. The new radiological occlusal index made with condensation silicone (Sandwich Index) proved to be effective in reproducing the maxillary forced maximum opening position during the initial planning phase, preventing errors in the inclusion or exclusion of patients suitable for NobelGuide treatment.

Surgical Treatment of Oroantral Communications.

BACKGROUND: Oroantral communication (OAC) can be defined as a pathologic space created between the maxillary sinus and the oral cavity.This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons.Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region.The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula. OBJECTIVE: To evaluate an alternative technique for the treatment of oro-antral fistula, using a combined therapeutic ear nose and throat/intraoral approach. METHODS: Twelve consecutive patients affected by complicated OAC were included in this study.The protocol consisted of: clinical, endoscopic, and radiological preoperative evaluation (panoramic tomogram and computed tomography); systemic antibiotic and steroid therapy for 2 weeks before surgery; one-stage surgical procedure consisting of Functional Endoscopic Sinus Surgery technique associated with the closure of the OAC by a titanium mesh and a mucoperiosteal flap; postoperative antibiotic and cortisone-based therapy.A titanium mesh was used to obtain an optimal support and stabilization of soft tissues.Follow-up consisted of weekly clinical evaluation during the first month, a clinical evaluation at 1, 3, 6, 12, 24 months and a nasal endoscopy at 3, 8, 24 weeks after surgery. A second surgical step took place to remove the mesh, after a period of healing, which went from 6 to 18 months. Samples were harvested from the surgical site after mesh removal for histological analysis. RESULTS: At 1 month follow-up, in 10 patients of 12, the Valsalva manoeuvre was negative, same result at the 3rd month follow-up, although in 11 of 12 patients. In 5 of 12 patients, the mesh was exposed. The histological analysis confirmed the formation of a pseudo-periosteum layer.One patient failed because the mesh lost its stability. The patient was operated again 8 months later and new mesh was fixed into place. CONCLUSION: The current study showed that one-stage, combined endoscopic and intraoral approach represents a feasible and minimally invasive procedure for the long-term effective treatment of chronic complicated OACs.The main advantage of the use of a titanium mesh to guide the regeneration is that it assures a predictable healing, mechanic scaffold, tissues stability and allows a possible following oral rehabilitation.

Gene Expression of Human Mesenchymal Stem Cells Cultured on Titanium Dental Implant Surfaces.

OBJECTIVE: The study shows how the influence of titanium surfaces on human mesenchymal stem cells differentiates toward osteocytes lineage and how, after growth, on machined titanium disk or etched titanium disk, changes, in gene expression for RUNX1, CTNNB1, SP7, and DLX5. METHODS: Genes were analyzed by means of quantitative real-time polimerase chain reaction. Osseo genic lineage differentiation was also tested by means of the catenin-ß1 immunofluorescence, induced osteoblasts, which represented the internal control. RESULTS: The RUNX1 and SP7 expressions in the induced osteoblasts prove to be different, compared with cells cultured on metallic supports. Moreover, the levels of expression of the runt-related transcription factor 1 and the osterix appeared more down-regulated in cells that grew on a machined titanium surface. In the present experimental model, mRNA expression of DLX5 and CTNNB1 in human mesenchymal stem cells, cultured on each of the titanium surfaces, showed no differences, compared with osteoblast-induced cells. The immunofluorescence scores, for protein expression of beta-catenin in human mesenchymal stem cell treated cells, illustrates significantly improved results with the etched surface. CONCLUSIONS: Present results suggested that different titanium surfaces might induce some differences in terms of gene expression. The only gene analyzed, which proved significant differences between the 2 titanium supports, was SP7; however, the other 3 genes indicating the existence of differences between the 2 titanium groups.

Extensive keratinized tissue augmentation during implant rehabilitation after Le Fort I osteotomy: using a new porcine collagen membrane (Mucoderm).

The aim of this study was to test a new collagen matrix (Mucoderm) positioned during oral implant abutment connection. A patient previously treated with Le Fort I for bone augmentation and 8 implants showing minimal amount of keratinized tissue was selected for an extensive keratinized tissue augmentation and deepening of the oral vestibule by apically positioning a split palatal flap and palatal grafting with Mucoderm. Clinical data at 9 and 14 days and 1 and 2 months showed resorption of the collagen graft, augmentation of the keratinized tissue around the implants, and deepening of the vestibule, with minimal morbidity and reduced surgical treatment time. However, some vestibular keratinized tissue contraction was evident. The new collagen matrix may be a promising material as a substitute for an autologous gingival/connective tissue graft. Despite the preliminary results of this innovative article, before drawing any general conclusion, the benefit of the procedure should be further evaluated by prospective clinical trials.

Posttraumatic use of dental implants immediately after tooth extraction: clinical study.

PURPOSE: Root fracture is a combined injury of cementum, dentin, and pulp. Many of these traumas remain untreated, mistreated, or overtreated. It leads to a more complicated treatment in case of tooth loss. Many different treatment procedures, with a very changeable success rate, have been proposed for years to treat teeth with root fractures. The objective of the following clinical studies was to evaluate the clinical effectiveness of implants placed in fresh extraction sites to treat teeth with horizontal root fracture. METHODS: The study group included 25 patients (15 men and 10 women) between the ages of 20 and 65 years. After an initial examination and a treatment planning, all of the patients underwent periodontal treatment, which was deemed necessary to favor wound healing. All the 25 teeth were extracted because of horizontal root fracture located at the level of the middle third. The second-stage surgery was performed 6 months after the initial procedure. The following clinical parameters, presence or absence of mobility, presence or absence of pain, and presence or absence of suppuration, were evaluated in each patient at 6 and 12 months after implant placement. Radiographs were taken using the standard method to evaluate the marginal bone loss. RESULTS: The healing period was uneventful for all patients. All implants had osseointegrated. After 12 months, patients were asymptomatic and showed no signs of infection or bleeding when probed. CONCLUSIONS: On the basis of this study, implants placed right after tooth extraction are a valid treatment procedure, which induces predictable results as treatment of fractured teeth.

Exploring the potential of calcium-based biomaterials for bone regeneration in dentistry: a systematic review.

INTRODUCTION: Regenerative medicine emerged as a promising strategy for addressing bone defects, with several bone grafts currently being used, including autografts, allografts, xenografts and alloplasts. Calcium-based biomaterials (CaXs), a well-known class of synthetic materials, have demonstrated good biological properties and are being investigated for their potential to facilitate bone regeneration. This systematic review evaluates the current clinical applications of CaXs in dentistry for bone regeneration. EVIDENCE ACQUISITION: A comprehensive search was conducted to collect information about CaXs and their applications in the dental field over the last ten years. The search was limited to relevant articles published in peer-reviewed journals. EVIDENCE SYNTHESIS: A total of 72 articles were included in this scoping review, with eight studies related to periodontology, 63 in implantology and three in maxillofacial surgery respectively. The findings suggest that CaXs hold promise as an alternative intervention for minor bone regeneration in dentistry. CONCLUSIONS: Calcium-based biomaterials have shown potential as a viable option for bone regeneration in dentistry. Further research is warranted to fully understand their efficacy and safety in larger bone defects. CaXs represent an exciting avenue for researchers and clinicians to explore in their ongoing efforts to advance regenerative medicine.

High-Density Dermal Matrix for Soft Tissue Augmentation Using a Matrix Tissue Graph Technique-A Comprehensive Multicenter Analysis of 20 Implants: A 1-Year Follow-Up Retrospective Study.

Background: In this multicenter case series analysis, the authors present successful instances of 20 single-screw-retained and implant-supported prosthetic rehabilitation samples. Methods: A high-density heterologous dermal matrix (Derma® Osteobiol by Tecnoss, Torino, Italy) was employed with a specific technique named the matrix tissue graft (MTG) in all these cases characterized by an inadequate initial supra-crestal tissue height (thin if 1 mm or medium if 2 mm) to enhance the peri-implant soft tissues both vertically and horizontally. Results: The implants were deemed successful in all cases, yielding a success proportion of 100% (one-sided 97.5% confidence interval = 83.2-100%). The buccal and lingual gains were, respectively, 2.2 ± 0.38 mm (range 1.7-3.22 mm) and 0.83 ± 0.33 mm (range 0.1-1.5 mm). These measurements were calculated as the maximum distance between two superimposed .stl file models (derived from two different IOS devices) scanned before implant placement and 1 year after dermal matrix healing. Conclusions: An outstanding vertical and horizontal gain was obtained using this heterologous derma matrix placed above the bone crest and surrounding the dental implants.

Bi-layered collagen nano-structured membrane prototype (collagen matrix 10826(®)) for oral soft tissue regeneration: an "in vitro" study.

AIM: To evaluate fundamental cell functions, such as adhesion, IL-6 production and proliferation of human gingival keratinocytes cultured on a newly engineered collagen matrix (CM-10826) and to assess the degree of specific biocompatibility of this new device. MATERIALS AND METHODS: Primary cultures of human keratinocytes were derived "in vitro" from biopsies of independent donors. Their true epithelial origin was ensured by the expression of cytokeratin 14. Adhesion, proliferation and production of IL-6 cytokine was then measured in the presence or absence of CM-10826 activity or of its relevant components. RESULTS: Functional tests revealed that keratinocytes adhered to CM-10826 and up-regulated their basal IL-6 production. The type of keratinocytes used expressed cytokeratin 14. Proliferation experiments demonstrated that the best cellular response was observed in the presence of Collagen I, the main component of CM-10826. No undesired effects were observed as for keratinocyte viability, morphology or differentiation. CONCLUSIONS: Our results demonstrate that CM-10826 has a favourable biological effect on the "in vitro" response of gingival keratinocytes in terms of IL-6 production, cell growth and adhesion. These findings may encourage a possible use of this collagen membrane as a tissue which, alone, may substitute for autologous gingival grafts thereby overcoming the limitations of autologous tissue.

The use of computer-guided flapless dental implant surgery (NobelGuide) and immediate function to support a fixed full-arch prosthesis in fresh-frozen homologous patients with bone grafts.

The behavior of fresh-frozen homologous bone (FFB) when used in combination with computer-guided implant surgery has not been investigated yet, and there is a lack of clinical evidence in the literature. The purpose of this retrospective study is to evaluate the implant survival and related fixed full-arch prostheses at the 1- to 5-year follow-up when performed with immediate function using a flapless surgical procedure and computer-aided technology (NobelGuide; Nobel Biocare AB, Goteborg, Sweden) in patients previously treated with FFB grafts. Furthermore, the related values of torque and complications observed were analyzed and discussed. Clinical charts of patients with edentulous arches treated with FFB grafts and NobelGuide system with at least 1 year follow-up were reviewed retrospectively.A total of 65 patients met the criteria of inclusion, receiving a total of 342 implants and 77 full-arch prostheses, with a mean follow-up of 32.87 months (range, 1-5 years). Survival of implants and prostheses was high, reaching 96.5% and 95%, respectively. Factors significantly related to failure of the implants were smoking, position of the implant as last distal abutment, and fracture of basal maxillary bone. Prostheses survival was influenced by bruxism, failure of multiple implants, and torque level of implant equal to 0 at implant insertion. All implants and prostheses failures occurred in the first year. A higher torque level at implant insertion did not correspond to a lower risk of implant failure.Within the limitations of our retrospective study, this treatment modality was predictable with high survival rates and high insertion torque. However, a few implant and prosthetic failures were found, together with several complications.

Guided bone regeneration with autogenous block grafts applied to Le Fort I osteotomy for treatment of severely resorbed maxillae: a 4- to 6-year prospective study.

INTRODUCTION: Edentulism causes progressive bone resorption of the maxillae, which can lead to altered maxillo-mandibular relationships. The aim of the study was to evaluate the applicability of guided bone regeneration (GBR) to Le Fort I osteotomies with interpositional bone grafts for treatment of patients with severe maxillary atrophy. MATERIALS AND METHODS: Twenty consecutive patients characterized by severely atrophic maxillae were treated from January 2003 to January 2006 in order to resolve maxillary edentulism. All patients underwent pre-prosthetic surgery, including a Le Fort I osteotomy associated with autologous interpositional bone grafts to move the alveolar arch forward and to resolve the maxillary atrophy. Barrier membranes were also used to cover the bone grafts and the osteotomy line, favoring the healing process according to GBR principles. Maxilla advancement and alveolar crest augmentation were measured to assess the degree of reconstruction. A total of 154 implants were inserted in reconstructed maxillae 4 months after surgery and were restored with fixed full-arch dentures after another 4 months. Surgical and prosthetic complications were recorded and previously established implant success criteria were used to assess the success of this treatment protocol. RESULTS: The outcome of pre-prosthetic surgery and implant-supported rehabilitation was prospectively evaluated every year. All Le Fort I osteotomies were successfully carried out, with a mean maxilla advancement of 4.2 cm (range: 3.1-5 cm), which appeared to be stable during the follow-up. After a mean follow-up of 66.4 ± 18.4 months, only four implants failed according to the success criteria, yielding a cumulative success rate of 95.8%. DISCUSSION AND CONCLUSIONS: Le Fort I osteotomies with the use of barrier membranes to cover the interpositional bone grafts can be a predictable treatment for edentulous patients with severely resorbed maxillae. The study data suggest that this approach makes it possible to compensate for both sagittal and vertical discrepancies due to maxilla atrophy, with a minimum resorption of advanced maxillae and grafted bone. A GBR-based protocol seems to lead to high implant success rates, although further randomized controlled studies are needed to demonstrate the usefulness and advantageousness of GBR.

New collagen matrix to avoid the reduction of keratinized tissue during guided bone regeneration in postextraction sites.

For decades, there has been an ongoing controversy regarding the need for an "adequate" width of keratinized gingiva/mucosa to preserve periodontal and implant health. Today, the presence of a certain width of keratinized tissue is recommended for achieving long-term periodontal and implant success, and therefore, a new collagen matrix has been developed to enhance the width of keratinized gingiva/mucosa. During postextraction socket preservation, guided bone regeneration techniques require complete coverage of the barrier membrane to reduce the risk of infection, occasionally causing a reduction of the width of keratinized tissue. Using the new collagen matrix, it is possible to leave the membrane intentionally uncovered, without suturing the surgical flap above it, to avoid the reduction of such tissue.

Application of the "All-on-Four" concept and guided surgery in a mandible treated with a free vascularized fibula flap.

In this article, we describe the first case in the literature in which 3D computer-assisted treatment planning and guided surgery enabled a patient affected by extreme paraphysiologic mandibular bone atrophy to be treated with a free vascularized fibula flap and, after a period of healing, the flapless installation of 4 immediately loaded dental implants. The computer-fabricated surgical guide allowed placement of the implants according to the "All-on-Four" concept in a proper spatial preplanned position and by tilting 1 implant, avoiding an area of bone discontinuity. Additionally, this technique allowed the production of a prefabricated temporary prosthesis, delivered after implant insertion, which could be immediately loaded. The use of a fibula flap makes it possible to create greater bone thickness while computer-assisted treatment planning and guided surgery provide several advantages over the traditional technique.

A New Matrix for Soft Tissue Management.

Gingival recession is a mucogingival defect defined as the apical shifting of the gingival margin in relation to the CEJ. The use of connective tissue autografts allows for the obtention of very satisfactory results but is associated with undoubted disadvantages. The aim of the present work is to carry out a systematic review of the literature using a meta-analysis to investigate the clinical efficacy of xenogeneic collagen matrix (XCM) in the treatment of gingival recessions. This revision was carried out strictly following the guidelines published in the Cochrane Handbook. Thus, a meta-analysis was performed to calculate relative risks and standardized mean differences for each of the variables considered. The results of the meta-analysis show that CAF + CTG was statistically better than CAF + XCM in almost all the variables analyzed: complete root coverage (RR 0.46), mean root coverage (SMD -0.89), recession reduction (SMD -0.98), clinical attachment level (SMD -0.63) and gingival thickness (SMD -1.68). Meanwhile, CAF + XCM was slightly better than CAF alone in regard to: mean root coverage (SMD 0.51), recession reduction (SMD 0.47) and gingival thickness (SMD 0.56). It is possible to conclude that CAF + CTG still remains the gold standard in radicular coverage.