Evaluation of buccal bone resorption in immediate implant placement in thin versus thick buccal bone plates: An 18-month follow-up prospective cohort study.

OBJECTIVES: The current guidelines recommend that immediate implants be placed in patients with thick (>1 mm) buccal bone due to the inevitable tissue remodeling that follows tooth extraction. The aim of the current study was to investigate the effect of buccal bone thickness on bone resorption in immediate implant placement and compare two measuring techniques of the aforementioned resorption. MATERIALS: The present study was designed as a prospective nonrandomized, controlled clinical trial. A total of 30 implants were split between the two study arms, thin buccal bone and thick buccal bone. The primary outcome was to assess vertical bone changes radiographically by cone beam scans preoperatively, at 2 months and 18 months after implant placement in patients with thin and thick buccal plate. Secondary outcomes included the change in the thickness of the buccal bony plate, marginal bone loss, and pink esthetic score. RESULTS: Only 26 implants were statistically analyzed as one early failure was observed in each group. Furthermore, 2 patients of the thick group withdrew from the study. Cone beam computed tomography measurements revealed that at 2 months the vertical bone loss was 1.09 for the thin group and 0.85 for the thick group. The buccal bone plate resorption of the thin group was 0.39 mm while it was 0.52 mm for the thick group. The buccal bone plate was 1.25 mm in the thin group and 1.88 mm in the thick group. The PES did not show any significant difference with very good esthetic results. CONCLUSION: Within the limitations of the current study, the amount of buccal bone plate resorption and the subsequent thickness obtained after implantation in both groups suggest successful long-term results. The two measuring techniques have proven to be comparable and reliable in the measurement of buccal bony plate changes. https://classic. CLINICALTRIALS: gov/ct2/results?cond=&term=NCT04731545&cntry=EG&state=&city=&dist=.

Evaluation of advanced platelet-rich fibrin compared to subepithelial connective tissue graft in the surgical management of interdental papilla recession: a randomized controlled trial.

OBJECTIVES: The current study aims to compare advanced-platelet-rich fibrin membrane (A-PRF) to connective tissue graft (CTG) using Han and Takei's approach. MATERIALS AND METHODS: The defective papilla was randomly allocated to either the control group (CTG) or to the experimental group (A-PRF). Papilla height (PH) and percent change in the gingival black triangle (GBT) area were recorded at 1, 3, 6, 9, and 12 months. RESULTS: Thirty-two deficient IDPs with an initial papilla presence index (PPI) of 2 or 3 were included. At 12 months, the papilla-fill significantly increased in both groups (p < 0.001) without a significant difference between the study groups (p = 0.637). A mean gain in IDP height of 2.25 mm (± 0.97) in the CTG group and 1.86 mm (± 0.7) in the A-PRF group were recorded with a nonsignificant difference. Gingival black triangle fill showed a 57.98% fill in the CTG and 54.65% fill in the A-PRF group, with no statistically significant difference between the groups (0.956). Regarding postoperative pain patients, the CTG group consumed significantly more analgesics than the A-PRF group (11.75 ± 3.51 and 8 ± 3.08, respectively, with p = 0.003). CONCLUSION: Both CTG and A-PRF were found to be equally effective in increasing deficient IDP height with Han and Takei's surgical technique, with no significant difference. Within the current study's limitations, A-PRF seems to be a viable alternative to CTG in the treatment of GBTs. CLINICAL RELEVANCE: Multilayered A-PRF membrane can be used as a choice in the augmentation of receded papillae, using Han and Takei's technique.

Evaluation of Oversized Drilling on Implant Survival and Stability Versus Traditional Drilling Technique: A Randomized Clinical Trial.

PURPOSE: This study aimed to investigate the influence of oversized drilling on the stability of the implant and the bone response during osseointegration. MATERIALS AND METHODS: The trial was designed as a prospective, parallel-group randomized controlled clinical trial with 20 implants placed in the posterior region of the maxilla. The sample size was divided into two groups, 10 each, with implants being placed with manufacturer-recommended implant osteotomy preparation according to the manufacturer guidelines in one group (MR group) vs oversized osteotomy preparation (3 to 5 mm) in the other group (oversized drilling [OD] group). The implant stability was monitored for 3 months by means of resonance frequency analysis, while the crestal bone levels were recorded using parallel technique periapical radiography for 6 months. Patient-reported outcomes including pain, swelling, satisfaction, and implant survival were all monitored throughout the study. RESULTS: In the MR group, a mean decrease in implant stability quotient (ISQ) values was detected during the first 4 weeks, after which a gradual increase in values was recorded. In comparison, the OD group showed a rapid increase in ISQ value over the entire follow-up period from baseline and up to week 12. Regarding crestal bone level, follow-up showed a significant difference when comparing baseline and 6-month radiographs (P = .00) between the OD group, 0.908 mm ± 0.343, and the MR group, 1.3 ± 0.23 mm. CONCLUSION: Within the limitations of this study, the results suggest that the oversized osteotomy technique may lead to earlier implant stability and postsurgical recovery compared with the manufacturer-recommended technique for osteotomy preparation. However, further studies are needed to confirm these findings.

Disruption of Immune Homeostasis in Human Dendritic Cells via Regulation of Autophagy and Apoptosis by Porphyromonas gingivalis.

As fundamental processes of immune homeostasis, autophagy, and apoptosis must be maintained to mitigate risk of chronic inflammation and autoimmune diseases. Periodontitis is a chronic inflammatory disease characterized by oral microbial dysbiosis, and dysregulation of dendritic cell (DC) and T cell responses. The aim of this study was to elucidate the underlying mechanisms by which the oral microbe Porphyromonas gingivalis (P. gingivalis) manipulates dendritic cell signaling to perturb both autophagy and apoptosis. Using a combination of Western blotting, flow cytometry, qRT-PCR and immunofluorescence analysis, we show a pivotal role for the minor (Mfa1) fimbriae of P. gingivalis in nuclear/cytoplasmic shuttling of Akt and FOXO1 in human monocyte-derived DCs. Mfa1-induced Akt nuclear localization and activation ultimately induced mTOR. Activation of the Akt/mTOR axis downregulated intracellular LC3II, also known as Atg8, required for autophagosome formation and maturation. Use of allosteric panAkt inhibitor MK2206 and mTOR inhibitor rapamycin confirmed the role of Akt/mTOR signaling in autophagy inhibition by P. gingivalis in DCs. Interestingly, this pathway was also linked to induction of the anti-apoptotic protein Bcl2, decreased caspase-3 cleavage and decreased expression of pro-apoptotic proteins Bax and Bim, thus promoting longevity of host DCs. Addition of ABT-199 peptide to disrupt the interaction of antiapoptotic Bcl2 and its proapoptotic partners BAK/BAX restored apoptotic death to P. gingivalis-infected DC cells. In summary, we have identified the underlying mechanism by which P. gingivalis promotes its own survival and that of its host DCs.

Oral Pathobiont Activates Anti-Apoptotic Pathway, Promoting both Immune Suppression and Oncogenic Cell Proliferation.

Chronic periodontitis (CP) is a microbial dysbiotic disease linked to increased risk of oral squamous cell carcinomas (OSCCs). To address the underlying mechanisms, mouse and human cell infection models and human biopsy samples were employed. We show that the 'keystone' pathogen Porphyromonas gingivalis, disrupts immune surveillance by generating myeloid-derived dendritic suppressor cells (MDDSCs) from monocytes. MDDSCs inhibit CTLs and induce FOXP3 + Tregs through an anti-apoptotic pathway. This pathway, involving pAKT1, pFOXO1, FOXP3, IDO1 and BIM, is activated in humans with CP and in mice orally infected with Mfa1 expressing P. gingivalis strains. Mechanistically, activation of this pathway, demonstrating FOXP3 as a direct FOXO1-target gene, was demonstrated by ChIP-assay in human CP gingiva. Expression of oncogenic but not tumor suppressor markers is consistent with tumor cell proliferation demonstrated in OSCC-P. gingivalis cocultures. Importantly, FimA + P. gingivalis strain MFI invades OSCCs, inducing inflammatory/angiogenic/oncogenic proteins stimulating OSCCs proliferation through CXCR4. Inhibition of CXCR4 abolished Pg-MFI-induced OSCCs proliferation and reduced expression of oncogenic proteins SDF-1/CXCR4, plus pAKT1-pFOXO1. Conclusively, P. gingivalis, through Mfa1 and FimA fimbriae, promotes immunosuppression and oncogenic cell proliferation, respectively, through a two-hit receptor-ligand process involving DC-SIGN+hi/CXCR4+hi, activating a pAKT+hipFOXO1+hiBIM-lowFOXP3+hi and IDO+hi- driven pathway, likely to impact the prognosis of oral cancers in patients with periodontitis.

Lip repositioning with or without myotomy: A randomized clinical trial.

BACKGROUND: Lip repositioning is a conservative surgical method for the correction of excess gingival display (EGD) by limiting the upward retraction of the lips. Lip repositioning presents a simple method for the treatment of gummy smile. The aim of this randomized clinical trial (RCT) was to assess lip repositioning, compared to lip repositioning with muscle severance for efficacy in treatment of EGD and resultant stability. METHODS: A single-blinded, controlled, parallel-group RCT was performed. Twenty patients with EGD were enrolled in the study, treated with lip repositioning with and without muscle severance. Participants were assessed for EGD reduction, changes in lip length and result stability at 3, 6 and 12 months. Additionally, pain, swelling and satisfaction, were assessed. RESULTS: Classic lip repositioning was found capable of reducing EGD by 2.73 mm (SD ± 1.281), while lip repositioning with muscle severance offered an improved reduction in EGD with a mean reduction of 3.57mm (SD ± 1.62). Lip length, swelling and pain scores were found comparable between the two techniques. CONCLUSION: Lip repositioning is an effective method for treating EGD, however, muscle severance provides a more stable result at 12 months when compared to the classical technique. More studies are necessary to fully assess this procedure.

Lip repositioning for the treatment of excess gingival display: A systematic review.

BACKGROUND: Lip repositioning is a conservative surgical technique used to treat excess gingival display. An array of modifications has been introduced to the technique over time and as studies show the technique and its modifications to be successful, there is little standardized information for clinicians to make informed decisions when choosing this technique for the treatment of patients with excessive gingival display (EGD). OBJECTIVES: To review the current literature on the topic of lip repositioning for the treatment of excessive EGD, exploring outcome, and result longevity. METHODS: A structured systematic search was carried out using the Ovid database and Web of Science to identify published studies on lip repositioning technique. Search was restricted to studies in the English language, describing a surgical intervention. Case reports were included as the number of published studies was limited. RESULTS: The electronic search identified 93 articles, hand search identified 1 article, and reference search identified 1 article. After excluding duplicates and screening articles, a total of 22 articles met the inclusion criteria. An estimated mean improvement of 3.4 mm (95% confidence interval, 3.0-3.8 mm) was found possible with lip repositioning. Data analysis was performed using only 4 studies, amounting to a total of 33 patients. Potential risk of bias was identified in some of the studies included. CONCLUSIONS: Despite the limited available studies on lip repositioning, an estimated mean improvement of 3.4 mm was found to be possible with surgical lip repositioning, suggesting that the technique could be used successfully to treat EGD. However, more studies are necessary to properly evaluate the treatment approach and stability of the technique. CLINICAL SIGNIFICANCE: Recently, the demand for esthetics has significantly increased, driven by increased patient awareness and the search for an ideal smile. Creating the perfect smile is an intricate process that requires a multidisciplinary approach, with careful consideration of the lips and the gingival outline. Excess gingival display results in an unaesthetic smile, lip repositioning offers a comparatively simple solution for this problem. While the quality literature on this topic is limited statistical analysis of collected studies show that an estimated mean improvement of 3.4 mm can be achieved with surgical lip repositioning.