Half- and full-grafting alveolar ridge preservation with different sealing materials: A three-arm randomized clinical trial.

OBJECTIVE: The objective of this study is to investigate the effect of different alveolar ridge preservation (ARP) approaches on bone resorption and their potential for facilitating implant placement. MATERIALS AND METHODS: Patients who underwent one or two tooth extractions with a desire for restoration were included in the study. The participants were randomly assigned to one of three groups for ARP. The groups were as follows: (1) Half grafting of bovine bone mineral (DBBM-C) covered with non-resorbable dense polytetrafluoroethylene (dPTFE) membrane (Test 1 group); (2) Half grafting of bovine bone mineral (DBBM-C) covered with collagen membrane (Test 2 group); and (3) Full grafting with collagen membrane (DBBM-C + Collagen membrane) as the Control group. After 6-month healing period, the evaluation encompassed clinical, radiographic, implant-related outcomes, and the factors contributing to hard and soft tissue alterations. RESULTS: Enrollment in this study comprised 56 patients. At the 6-month follow-up, radiographic analysis in computed beam computed tomography images was conducted for 18, 19, and 19 patients with 18, 20, and 20 tooth sites in Test 1, Test 2, and Control groups, respectively. Additionally, a total of 15, 17, and 17 patients with 15, 18, and 17 implants were evaluated. Based on radiographic analysis, all groups showed limited ridge resorption at 1 mm from crest horizontally (Test 1: 1.29 ± 1.37; Test 2: 1.07 ± 1.07; Control: 1.54 ± 1.33 mm, p = 0.328), while the Control group showed greater radiographic bone height gain in mid-crestal part vertically (Test 1: 0.11 ± 1.02; Test 2: 0.29 ± 0.83; Control: -0.46 ± 0.95 mm, p = 0.032). There were no significant intergroup differences in terms of keratinized mucosal width, bone density, insertion torque, and the need of additional bone graft. However, the use of a dPTFE membrane resulted in a significantly higher vertical mucosal thickness (Test 1: 2.67 ± 0.90; Test 2: 3.89 ± 1.08; Control: 2.41 ± 0.51 mm, p < 0.001). CONCLUSIONS: The study showed comparable dimensional preservation with limited vertical shrinkage, while thin buccal bone plate, non-molar sites, and large discrepancy between buccal and palatal/lingual height may contribute to greater shrinkage. Thicker mucosa with dPTFE membrane required further investigation for interpretation. CLINICAL TRIAL REGISTRATION NUMBER: NCT06049823. This clinical trial was not registered prior to participant recruitment and randomization.

Treatment of Multiple Recessions Associated with Noncarious Cervical Lesions: A Case Series.

Gingival recessions with noncarious cervical lesions (NCCLs), also called combined defects, are common problems, and patients often seek treatment due to esthetic concerns or dentin hypersensitivity. This case series evaluates the effectiveness of the non-coronally advanced flap (CAF) technique combined with restorative treatment for Miller Class III gingival recessions with NCCLs. A total of 16 combined defects were included. The combined defect height (CDH), recession depth (RD), pocket depth (PD), keratinized tissue width (KTW), and presence of dentin hypersensitivity were recorded at baseline and 6 months postsurgery. The mean root coverage (mRC) was 83%, and 50% of defects presented complete root coverage (CRC). In the group with an initial KTW ≥ 2 mm, mRC and CRC were significantly higher. Further randomized controlled studies with larger sample sizes are needed to verify the prognostic factor of combined non-CAF techniques and restorative treatment for gingival recessions with NCCLs.

Depth of mucosal tunnel in peri-implant health during 12-month follow-up in patients with controlled periodontitis.

BACKGROUND: The association between thickness of peri-implant mucosa, known as mucosal tunnel (MT) and related clinical parameters in bone-level implants has not been investigated. METHODS: Posterior implants, in patients with controlled periodontitis, were evaluated at different time intervals: during uncovering surgery (T0 ), 2-month after uncovering surgery (T2M ) and 12-month after placement (T12M ). Clinical parameters including vertical soft tissue height (VSTH), MT, tooth-implant discrepancy of bone level (DBL), pocket depth (PD), peri-implant marginal bone loss (MBL), emergence profile and emergence angle (EA) were collected, and the correlation were assessed at different time points. RESULTS: Forty-two patients with 60 implants were recruited, and 81.7% of the patients were Stage III-IV, Grade B-C generalized periodontitis. MT presented no significant difference in PD, VSTH, and MBL. Periodontitis Grade C and absence of bone regeneration were significant predictors for deep MT (>3 mm), and 5.850 less EA at mesial side of implants (p = 0.02).The regression of analysis implied the increase of DBL 1 mm would cause 0.26 mm deeper MT, 1.7 times higher risk of having deep MT (p = 0.041; OR = 1.731; 95% CI:1.02-2.93) and 2.1 times higher risk of having circumferential PD > 4 mm (p = 0.019; OR = 2.1; 95% CI:1.13-3.92). CONCLUSIONS: In bone-level implants, a correlation between MT and clinical parameters at 12-month follow-up was not found. However, history of periodontitis Grade C, absence of bone regeneration and tooth-implant discrepancy of bone level might define the depth of MT. Additionally, the depth of MT played a critical role in determining restorative design.

Soft tissue phenotype modification impacts on peri-implant stability: a comparative cohort study.

OBJECTIVES: Soft tissue phenotype modification (STPM) could be performed to maintain peri-implant health. Therefore, the aim of the study was to analyze tissue alteration around implants following soft tissue phenotype modification during implant uncovering surgery. MATERIALS AND METHODS: Patients who had STPM (either pouch roll or modified roll technique) during implant second-stage surgery with at least 12-month follow-up were included. Clinical and radiographic parameters including mucosal tissue thickness (MTT), recession (REC), keratinized mucosa width (KMW), probing pocket depth (PPD), marginal bone loss (MBL), emergence profile, and emergence angle were extracted from 2-week, 2-month, and 12-month visits after second-stage surgery. RESULTS: Twenty-eight patients with 33 implants that fulfilled the inclusion criteria were included. After soft tissue phenotype modification, at 2 weeks, REC was negatively correlated to mean MTT at mid-buccal site (r = - 0.41, p = 0.018) and borderline correlated at mid-lingual site (r = - 0.343, p = 0.051). Stable KMW was maintained from 2 weeks to 12 months with minimal shrinkage rate (3 ~ 14%). MBL change was limited (0.24 ~ 0.47 mm) after STPM. All implants had shallow PPD (≤ 3 mm) with the absence of bleeding on probing. Emergence angle at the mesial side, however, was significantly correlated to surgical techniques, which indicated pouch roll technique would have 6.96 degrees more than modified roll technique (p = 0.024). CONCLUSIONS: Soft tissue phenotype modification, either pouch roll or modified roll technique, during uncovering surgery resulted in favorable clinical outcomes. Thin mucosal tissue thickness and pouch roll technique are the factors related to more recession at 2 weeks. Pouch roll technique could influence the restorative design by having a wide emergence angle at the mesial side. CLINICAL RELEVANCE: Modified and pouch roll techniques during uncovering surgery were viable methods to yield favorable peri-implant health, while the preciseness of pouch roll technique was required to avoid mucosal recession and inadequate restorative design.

The Impact of Implantoplasty in Regenerated and Nonregenerated Treatment Modalities in Peri-implantitis: A Systematic Review and Meta-analysis.

PURPOSE: To investigate the impact of implantoplasty (IP) with or without regenerative procedures on treatment outcomes of peri-implantitis. MATERIALS AND METHODS: Electronic and manual literature searches were conducted for clinical trials published up to October 2020 that evaluated clinical outcomes (at least 6-month follow-up) after peri-implantitis treatment involving IP. The implant survival rate and clinical parameters (eg, probing depth [PD], bleeding on probing [BOP], marginal bone loss [MBL], clinical attachment level [CAL], and mucosal recession [REC]) at baseline and follow-ups were extracted from original articles for qualitative analyses. Risk ratio and weighted mean difference with 95% CI were calculated using a random-effects model. RESULTS: Out of 322 studies, 17 (9 randomized controlled trials, 4 controlled clinical trials, and 4 case series) were included in the present study. The regeneration group presented a 97% (95% CI: 0.95 to 1.00) implant survival rate, and the nonregeneration group showed a 94% (95% CI: 0.90 to 0.98) survival rate. Both groups revealed similar outcomes in PD and BOP reductions and soft tissue REC. However, the regeneration group had more favorable results in MBL. CONCLUSION: Data from this study suggested that applying implantoplasty during a regeneration or nonregeneration surgical approach resulted in a high implant survival rate and peri-implantitis resolution. Although no differences were found in the majority of clinical parameters in both groups, the regenerative approach resulted in more radiographic bone fill than the nonregenerative treatment.

The predictive performance of surgical treatment in upper molars with combined bony defect and furcation involvement: a retrospective cohort study.

BACKGROUND: To evaluate the impact of combined defects, bony destruction and furcation involvement, on disease resolution after surgery in terms of pocket elimination, absence of inflammation, furcation improvement and predictive performance. METHODS: Combined bony (intrabony (+) or (-)) and furcation defects (FI degree 1 or 2) at maxillary molars in patients diagnosed as periodontitis stage III to IV, being through periodontal surgery and at least 6 months follow-up were retrospectively screened. Cumulative predictability (CR, %), failure of treatment and the change of clinical parameters from baseline at pre-operative visit to the latest maintenance care, including pocket depth (PD), horizontal and vertical furcation involvement (FI) were analyzed. Failure of treatment with low predictability was defined as residual PD > 4 mm with bleeding on probing during maintenance period. RESULTS: Thirty-three patients with fifty-one combined defects were included. Statistical analysis showed significant overall PD reduction and FI improvement (p < 0.001). Combined FI degree 2 with intrabony (+) defects revealed more horizontal furcation improvement compared with FI degree 2 with suprabony defect (p = 0.007). However, type of combined defects was not relevant to CR (p = 0.702) and PD reduction (p = 0.707). Among all parameters, baseline PD with proximal FI degree 2 was indicated to failure of treatment. CONCLUSIONS: Different types of combined defects, deep baseline pocket and proximal FI degree 2 would compromise the predictability of treatment outcomes in upper molars. Nevertheless, the combination of surgical treatment and strict maintenance care could still yield high predictability and survival rate. TRIAL REGISTRATION: retrospectively registered.

Assessment of a Novel Alveolar Ridge Preservation Concept in Dehiscence Sockets: A Pilot Study.

In this prospective pilot study on ridge preservation (RP), a collagen sponge was placed to fill the bottom half of the socket, followed by a sequence of bone graft, collagen membrane, and a sponge placed on top. Twelve patients with 13 hopeless posterior teeth were included. Changes in bone dimension (including variations of horizontal ridge width [HRW] and bone height [BH]) between the time immediately postextraction (T0) and 6 months later (T6M) were evaluated through CBCT. The soft tissue was assessed using a wound healing index (WHI) at 2 weeks (T2W), 2 months (T2M), and 6 months (T6M) postsurgery. Measured at three parallel levels (1, 3, and 5 mm apical to the crest of the palatal plate), the mean HRW changes (T0 to T6M) ranged from 0.47 to 1.05 mm. Statistically significant negative correlations were observed between WHI (T6M) and midcrestal BH change. This proposed RP technique showed favorable outcomes regarding HRW and BH, even in periodontally compromised dehiscence sockets.

Grafted bone remodeling following transcrestal sinus floor elevation: A cone-beam computed tomography study.

BACKGROUND: Transcrestal sinus floor elevation is a reliable procedure when additional bone height is needed for maxillary implant placement. However, the grafted bone undergoes remodeling and the dimensional stability of grafted bone height may be affected by several clinical factors, including graft material, sinus anatomy and the morphology of grafted space. METHODS: This retrospective study examined patients who had undergone transcrestal sinus floor elevation with synthetic biphasic calcium phosphate and single implant placement. The reduction of sinus graft height (GHR) after 6-8 months healing period was measured with cone-beam computed tomography (CBCT) images. Correlating factors, including vertical amount of implant protrusion (IP), sinus width, and the morphology of grafted space were analyzed by Spearman's correlation test. RESULTS: A total of 25 implant sites were analyzed. The mean GHR was 0.57 ± 0.49 mm, which was positively correlated with IP, vertical elevation height (VEH), and the ratio of vertical to horizontal elevation of the grafted space. However, GHR was not correlated with sinus width and mesial-distal or buccal-palatal width of the grafted space. CONCLUSIONS: Synthetic biphasic calcium phosphate used in transcrestal sinus floor elevation underwent shrinkages and graft remodeling. Grafted height reduction was associated with IP, VEH, and the ratio of vertical to horizontal elevation of the grafted space.

Comparison of 4 sinus augmentation techniques for implant placement with residual alveolar bone height ≤3 mm.

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Is History of Periodontal Disease Still a Negative Risk Indicator for Peri-implant Health Under Supportive Post-implant Treatment Coverage? A Systematic Review and Meta-analysis.

PURPOSE: Among all previous studies, history of periodontitis (HP) has been regarded as a negative indicator for peri-implant health. However, the role of HP under regular supportive post-implant treatment (SPT) has not yet been evaluated. The aim of this review was to evaluate whether HP remains a negative indicator even under regular SPT in terms of clinical outcomes. MATERIALS AND METHODS: Two independent reviewers conducted electronic and manual searches of the literature in English from January 2003 to May 2018. Human clinical studies including both patients with and without HP under SPT with more than 1-year follow-up and complete information about peri-implant conditions were included. Risk ratio (RR) for implant survival rate, weighted mean difference (WMD) for radiologic marginal bone loss, pocket depth, bleeding on probing, and Plaque Index were analyzed to compare the outcomes in patients with and without HP. RESULTS: Thirteen human studies fulfilling the inclusion criteria were selected. Based on the results of meta-analyses, in implants with a rough surface, even under the regular SPT, the HP group showed a lower implant survival rate (RR: 0.96, 95% confidence interval [CI]: 0.94 to 0.98, P < .001) and more radiologic marginal bone loss (WMD: 0.34 mm, 95% CI: 0.20 to 0.48, P < .001), pocket depth (WMD: 0.47 mm, 95% CI: 0.19 to 0.74, P < .001), and bleeding on probing (WMD: 0.08 mm, 95% CI: 0.04 to 0.11, P < .001) than the non-HP group. In implants with a machined surface, HP also showed a negative effect on bone loss (WMD: 0.88 mm, 95% CI: 0.65 to 1.11, P < .001). However, in implants with a machined surface, no statistical significance in survival rate was found between HP and non-HP patients (RR: 0.98, 95% CI: 0.92 to 1.04, P = .895). CONCLUSION: Within the limitations of this review, HP remains a negative indicator for implant survival even under regular supportive post-implant treatment coverage in rough-surfaced implants.

Cone-beam computed tomography assessment of Schneiderian membranes: Non-infected and infected membranes, and membrane resolution following tooth extraction: A retrospective clinical trial.

BACKGROUND: Cone-beam computed tomography (CBCT) presurgical assessment on the maxillary sinus can reduce the possibility of Schneiderian membrane perforation. This study examined Schneiderian membrane thickness (SMT) and its relationship with neighboring hard tissues for patients with and without membrane thickening. For patients with sinus infections, we evaluated dimensional changes of the SMT post-extraction relative to pre-extraction SMT and residual bone height (RBH). METHODS: CBCT images from 93 patients needing single-tooth implant reconstruction without (n = 83) and with (n = 14) odontogenic infected maxillary sinuses were assessed. SMT, RBH, and lateral wall thickness (LWT) were measured. Causes of extraction, RBH in the infection site, and retrospective post-extraction record of SMT were recorded for the thickened SMT group. RESULTS: Mean SMT for normal SMT group was 1.13 ± 0.43 mm, RBH was 6.26 ± 2.38 mm; upper and lower LWT was 1.85 ± 0.95 mm, and 3.07 ± 2.26 mm, respectively. RBH and LWT had no significant relationships with SMT. For thickened SMT group, mean values for SMT and RBH prior to extraction were 4.53 ± 2.46 mm and 1.97 ± 1.43 mm, respectively. Pre-extraction SMT had a moderately negative correlation with pre-extraction RBH. SMT resolution in thickened SMT group was observed by 2.80 ± 1.37 months post-extraction; post-extraction SMT was not significantly different from normal SMT group (p = .187). CONCLUSIONS: Within the limitation of the sample size, thickened SMT induced by odontogenic infection subsides about 3 months following tooth extraction, and further sinus lifting implant surgery may be considered.

The effect of supportive care in preventing peri-implant diseases and implant loss: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the influence of supportive treatment (SPT) during a maintenance period after implant placement on implant survival rate (SR) and incidence of peri-implant diseases. MATERIAL AND METHODS: A systemic literature search for studies published up to June 2018 was conducted by two independent reviewers using Pubmed/MEDLINE, EMBASE, and Cochrane Central databases. Clinical controlled trials (CCT) involved in SPT protocol with more than 1-year follow-up were included. Quantitative meta-analyses were carried out to analyze the risk ratio (RR) of SR, the incidence of peri-implantitis, and peri-implant mucositis between SPT and non-SPT groups. Any potential confounding factors were investigated using meta-regression. RESULTS: Nine CCTs fulfilled the criteria. To evaluate the influence of SPT on SR, peri-implantitis, and peri-implant mucositis, six of nine, three of nine, and three of nine articles were included in further meta-analysis, respectively. SPT group significantly showed higher SR (RR: 1.10; p < 0.001), lower prevalence of peri-implantitis (RR: 0.25; p < 0.001) and peri-implant mucositis (RR: 0.57; p < 0.001) than the non-SPT group. Meta-regression of the selected studies failed to find an association between SR, peri-implantitis, and peri-implant mucositis and confounding factors: application of chemical agents and the frequency of SPT. CONCLUSION: SPT can potentially improve peri-implant health in terms of SR, peri-implantitis, and peri-implant mucositis. Additionally, the correlation in recall interval and adjunctive use of chemical agents during SPT to peri-implant diseases and implant loss could not be found.

Effect of Platelet-Rich Fibrin on Ridge Preservation in Perspective of Bone Healing: A Systematic Review and Meta-analysis.

PURPOSE: Among all platelet concentrates, platelet-rich fibrin has been shown to possess fibrin, leukocytes, and a variety of growth factors that could promote wound healing. The purpose of this study was to compare the bone healing in natural healing sockets (control group) versus that in sockets under ridge preservation with platelet-rich fibrin alone (test group). MATERIALS AND METHODS: Searches were conducted via electronic and manual approaches for randomized controlled trials and controlled clinical trials published up to May 2018 that evaluated alveolar ridge outcomes (at least 1-month follow-up) in both natural healing sites and sites with platelet-rich fibrin placement alone for ridge preservation. Changes of ridge height and width, osteoblastic activity, and the number of sites were extracted from original articles for meta-analyses. Weighted mean difference and 95% confidence interval were calculated using a random-effects model. RESULTS: Eight human studies (six randomized controlled trials and two controlled clinical trials) that fulfilled the inclusion criteria were included in the study. Data obtained in the study showed a favorable outcome in platelet-rich fibrin for socket preservation, although the difference was not statistically significant when compared to the natural healing group with regard to alveolar bone height change (weighted mean difference: -0.28 mm, 95% confidence interval: -0.55 to 0.00, P = .051), alveolar bone width change (weighted mean difference: -1.73 mm, 95% confidence interval: -3.58 to 0.12, P = .067), or osteoblastic activity (weighted mean difference: -0.01 [unit], 95% confidence interval: -0.50 to 0.49, P = .982). CONCLUSION: This study revealed that platelet-rich fibrin alone in ridge preservation does not provide significant additional benefit when compared to natural healing sockets with regard to bone volume, bone density, and osteoblastic activity.

Influence of abutment height on peri-implant marginal bone loss: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Whether abutment height can influence peri-implant marginal bone loss has not yet been determined. PURPOSE: The purpose of this systematic review and meta-analysis was to investigate the early and late marginal bone loss around implants with long and short abutment height. MATERIAL AND METHODS: Electronic (PubMed, EMBASE, and Cochrane) and hand literature searches were performed to identify articles published up to May 2018. A random-effects model was used to analyze the weighted mean difference of marginal bone loss between the long and short groups. Potential confounding factors, including implant/abutment connection, healing, and cement- or screw-retained restoration type, were investigated using meta-regression. RESULTS: Fourteen studies fulfilled the inclusion criteria, and 8 were further included in the meta-analysis. Around bone-level implants with a long abutment, marginal bone loss can be reduced significantly in both the early (-0.52 mm; 95% confidence interval [CI]: -0.79 to -0.24; P=.001) and late (-0.53 mm; 95% CI: -1.03 to -0.02; P=.041) period. Among tissue-level implants, however, and compared with the short-abutment group, more bone loss was found during the early stage in the long abutment (weighted mean difference: 0.28 mm; 95% CI: 0.03 to 0.54; P=.031). Meta-regression failed to find any association between confounding factors and early bone loss around bone-level implants. CONCLUSIONS: Within the limitation of this systematic review and meta-analysis, abutment height can influence early bone loss around bone-level implants. However, the evidence is insufficient to determine its impact on late bone loss around bone-level implants and early and late bone loss around tissue-level implants.

Controlling the Polarity of the Molecular Beam Epitaxy Grown In-Bi Atomic Film on the Si(111) Surface.

Synchrotron radiation core-level photoemission spectroscopy, scanning tunneling microscopy (STM), and first-principles calculations have been utilized to explore the growth processes and the atomic structure of the resulting films during the two-step molecular beam epitaxy (MBE) of In and Bi on the Si(111) surface. Deposition of 1.0-ML Bi on the In/Si(111)-(4 × 1) surface at room temperature results in Bi-terminated BiIn-(4 × 3) structures, which are stable up to ~300 °C annealing. By contrast, deposition of In on the ß-Bi/Si(111)-(√3 × âˆš3) surface at room temperature results in three dimensional (3D) In islands. In both cases, annealing at 460 °C results in the same In-terminated In0.75Bi/Si(111)-(2 × 2) surface. Our DFT calculations confirm that the surface energy of In-terminated In0.75Bi/Si(111)-(2 × 2) system is lower than that of Bi-terminated Bi0.75In/Si(111)-(2 × 2). These findings provide means for the control of the polarity of the MBE In-Bi atomically thick films.

Facial Fenestration and Dehiscence Defects Associated With Immediate Implant Placement Without Flap Elevation in Anterior Maxillary Ridge: A Preliminary Cone Beam Computed Tomography Study.

PURPOSE: To examine cone beam computed tomography (CBCT) anatomical findings, such as the concavity of the ridge and angulation of the tooth and alveolar ridge, either facial or palatal, in order to assess the potential clinical risks of performing flapless implant surgery. MATERIALS AND METHODS: CBCT images that met the inclusion criteria were examined. All images in maxillary anterior areas (canine to canine), facial bone thickness at 3 and 5 mm from the cementoenamel junction (CEJ), angulation of the tooth and alveolar ridge (Angle T: the angulation between the long axis of the tooth and the palatal plane; Angle D: the angulation between the long axis of the tooth and the midline of the ridge), the deepest point of facial concavity, the distance from the deepest point of facial concavity to the apex of the tooth and alveolar bone crest, nasopalatine canal, dehiscence, and fenestrations were measured and statistically analyzed. RESULTS: In total, 21 patients (12 women and 9 men) with a mean age of 55.9 years who met the inclusion criteria were included in the analysis. Data from 21 patients, 6 image sections per patient (total of 126 CBCT images) were analyzed. The mean value of facial bone thickness was 0.99 mm and 0.60 mm at 3 and 5 mm from CEJ, respectively. The distance from the deepest point of facial concavity to the apex of the tooth and alveolar bone crest was 2.79 and 11.29 mm, respectively. In canine areas, the mean values of facial bone thickness were larger at 3 mm but thinner at 5 mm. Also, canines were found to have a larger Angle D and a higher incidence of fenestration and dehiscence. CONCLUSION: Based on the findings, fenestration and a larger Angle D were associated with thinner facial bone thickness at 5 mm, and the tooth types also had an impact. Hence, for immediate implant surgery without flap elevation, besides anatomical structures, both angulation of the tooth and the alveolar ridge also need to be assessed.

Impact of timing on soft tissue augmentation during implant treatment: A systematic review and meta-analysis.

BACKGROUND: To achieve a predictable esthetic and functional outcome, soft tissue augmentation has become popular in implant treatment. OBJECTIVES: The aim of this systematic review and meta-analysis was to assess the influence of different timing for soft tissue augmentation during implant treatment on soft tissue conditions and its stability. MATERIAL AND METHODS: Electronic and manual searches for articles written in English up to September 2017 were performed by two independent reviewers. Human clinical studies with the purpose of evaluating outcomes (at least 3-month follow-up) of autogenous soft tissue graft for augmentation during implant treatment, either simultaneous or after implant placement (staged), were included. Cumulative changes of keratinized tissue width (KTW), soft tissue thickness (STT), and mid-buccal mucosal recession (MR) data were analyzed with a random-effects model to compare the postoperative outcomes. RESULTS: Twenty-nine human studies (eight randomized clinical trials, six cohort studies, and 15 case series) that met the inclusion criteria were included. For the overall data, the weighted mean STT gain (1 year after surgery) was 1.03 mm (95% CI: 0.78-1.29 mm), among which the simultaneous group was 1.12 mm (95% CI: 0.75-1.49 mm) and staged group (3-6 months after implant placement) was 0.95 mm (95% CI: 0.58-1.31 mm). There was no statistically significant difference in KTW and MR between 3 months and more than 3 months after surgery. CONCLUSIONS: This review revealed that the stability of soft tissue, in terms of KTW and mid-buccal MR, can be obtained 3 months after surgery. There is no difference between simultaneous and staged soft tissue augmentation during implant treatment, and both procedures significantly enhance KTW and STT.

Strontium ranelate treatment in a postmenopausal woman with osteonecrosis of the jaw after long-term oral bisphosphonate administration: a case report.

Bisphosphonates (BPs) suppress bone resorption and increase bone strength, thus reducing the risk of fracture. Oral BPs are widely used for the prevention and treatment of osteoporosis and osteopenia. Here, we describe the case of a postmenopausal woman who took oral alendronate for >3 years for osteoporosis. The patient presented at the clinic with sharp jaw pain and swelling on the left mandible 4 months after extraction of the third molar. Clinical examinations identified an inflamed mucosal opening with pus over an area of necrotic bone. Initial images of cone beam computed tomography revealed a sequestrum at the extracted socket. The condition did not improve after 1 week of antibiotic treatment; therefore, the alendronate treatment was terminated and the patient was prescribed strontium ranelate instead. The patient gradually recovered and, at the 2-year follow-up, the site of BP-related osteonecrosis of the jaw healed completely as determined by both clinical and cone beam computed tomography measures. The bone mineral densities in the femoral neck and lumbar spine improved after 1 year, and were maintained at the 3-year follow-up. The serum C-terminal cross-linking telopeptide values also gradually increased from the initial 130 pg/mL to 320 pg/mL at the 3-year follow-up. Taken together, this case supports the use of strontium ranelate as an alternative treatment for postmenopausal women who receive long-term oral BP treatments and are at risk for serious complications of BP-related osteonecrosis of the jaw.