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Methods: Patients examined during postloading maintenance visits were included in this study. The presence of peri-implant mucositis, peri-implantitis and several patient- and implant-related independent variables was recorded. Statistical analysis was performed using the logistic regression analysis. The odds ratios (OR) of the potential association between each variable and the occurrence of peri-implant diseases were evaluated. Results: Among the 114 participants with 403 implants, peri-implantitis was found in at least one implant of nine individuals (7.89%), and a total of 13 implants were affected by peri-implantitis (3.22%). The univariate regression analysis revealed a statistically significant association between arch (OR = 4.81; 95% CI = 1.27-31.36) and soft tissue thickness (OR = 4.07; 95% CI = 1.33-13.73) with the occurrence of peri-implantitis. The multivariate analysis confirmed the significant impact of soft tissue thickness (OR = 3.60; 95% CI = 1.16-12.24). Conclusion: The occurrence of peri-implant diseases can be influenced by various factors. However, in order to accurately identify risk indicators, it is necessary to conduct long-term prospective studies.

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This study aimed to design a new surgical guide for controlling the mesiodistal distance between implant osteotomies and adjacent teeth as well as the osteotomy depth in partially edentulous patients. The guide kit was designed with design software and milled with a CNC (computer numerical control) router. The guide consisted of 2 components-stoppers and crown guides-for determining the drilling depth and mesiodistal position, respectively. The stoppers were designed in 7.5-, 9.5-, and 11.5-mm lengths, and the crown guides were fabricated with outer diameters of 5.0, 6.0, 7.0, and 8.0 mm. The accuracy of the guide was assessed by preparing a total of 20 implant osteotomies in 4 partially edentulous models and comparing the dimensions of the actual osteotomies to the values that were predicted to occur with the use of the surgical guides. Osteotomies were prepared using the 7.5-mm stopper with either the 7.0- or 8.0-mm crown guide. Cone beam computed tomography (CBCT) was used to obtain images for analysis of osteotomy-tooth mesiodistal distances, which were predicted to be 3.0 or 5.5 mm, depending on position; interosteotomy mesiodistal distances, which were predicted to be 3.0 mm; and osteotomy depth, which was predicted to be 11.5 mm. A 1-sample t test was used to determine if there were significant differences between the predicted values and the measurements of the guided osteotomies on the CBCT images of the mandibular models, and an independent t test was conducted to compare the results of 3.0- and 5.5-mm osteotomy-tooth distances (α = 0.05). Differences between the predicted and actual values of the interosteotomy mesiodistal distance (P = 0.516) and osteotomy depth (P = 0.847) were not statistically significant. The actual osteotomy-tooth mesiodistal distances were significantly different from the predicted values of 3.0 (P = 0.000) and 5.5 mm (P = 0.001), with higher mean differences of 0.46 and 0.60 mm, respectively. The designed guide had a high accuracy in achieving optimal linear interosteotomy mesiodistal distances and osteotomy depths, and the obtained mean values were clinically acceptable.

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Background: The use of bone graft materials has significantly increased. Given the inherent variations in structure and functionality between different grafting materials, this evaluated and compared the physical attributes of antler and bovine femur bone substitutes. Methods: In the present in vitro investigation, the surface morphological architecture of the two bone substitutes with different origins was assessed through scanning electron microscopy. Furthermore, the Brunauer-Emmett-Teller (BET) technique was employed to measure the porosity, specific surface area (SSA), and pore morphology. Results: Scanning electron microscopy observations indicated that the surface of the bovine particles appeared smoother, while the antler particles exhibited a rougher surface texture. The BET analysis revealed that both samples exhibited identical pore morphology. The SSA was 15.974 m2/g in the antler particles compared with 18.404 m2/g in the bovine sample. The total porosity volume in the antler and bovine femur bone substitutes were 0.2172 cm3/g and 0.2918 cm3/g, respectively. Additionally, the antler particles had a porosity percentage of 40%, whereas the bovine femur bone substitute showed a porosity percentage of 43.5%. Conclusion: Based on the results of this study, it seems that the two samples of bone grafting materials have comparable physical structures.

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In addition to the proper selection of techniques, appropriate treatment sequencing and prioritization are prerequisites for successful periodontal and implant procedures. The aim of this study was to provide evidence-based time frames for various procedures pertaining to periodontal and implant treatment. A literature review was conducted to collect data on tissue healing; in areas in which data were lacking, the viewpoints of experienced clinicians were solicited to establish a consensus. This review reports recommended time frames for the healing processes associated with surgical crown-lengthening procedures (both functional and esthetic), fresh socket management, alveolar ridge management, soft tissue management, sinus floor augmentation, implant loading, and peri-implant defect management.

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Many patients require edentulous ridge augmentation for dental implant placement. The main objective of this study was to evaluate the results of maxillary edentulous ridge augmentation exclusively with xenograft materials with and without simultaneous sinus floor elevation. This study reports the data retrieved from the records of 16 patients. The treatment outcome was assessed at least 6 months, postoperatively. Paired samples t-test or Wilcoxon Signed Rank test was used to compare the pre-and postoperative ridge dimensions. Dental implants were placed simultaneously in 7 patients, while 9 patients underwent delayed implant placement. In total, 68 implants were placed, and 12 patients also underwent maxillary sinus floor augmentation. A significant bone gain was achieved in both horizontal and vertical dimensions of edentulous maxillary ridges (P < 0.001). Ridge width increased by an average of 4.35 ± 1.90 mm (95% CI: 3.84 to 4.85 mm) while ridge height in areas of sinus floor augmentation increased by 8.19 ± 2.91 mm (95% CI: 7.33 to 9.05 mm). Within the study limitations, it appears that maxillary ridge augmentation according to the guided bone regeneration (GBR) protocols with exclusive use of xenograft particulate materials can provide optimal bone quantity for dental implant placement.

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OBJECTIVE: The occurrence of peri-implant soft tissue dehiscence, especially in the esthetic zone, can be challenging. This study sought to investigate how the passage of time affects the outcomes of treatment for peri-implant soft tissue dehiscence coverage. MATERIALS AND METHODS: A literature search was performed up to April 2023 via PubMed, Scopus, and Web of Science to retrieve studies reporting the data on peri-implant soft tissue dehiscence of at least 2-time points (baseline and follow-up). Clinical trials with a minimum of 5 participants, reporting at least 1 primary outcome, and with a minimum follow-up of 3 months were included. The primary outcomes were the changes in dehiscence depth, complete coverage, and mean coverage at different time points. RESULTS: Seven studies with 112 participants and 119 implants were included. Dehiscence depth increased insignificantly between 3 to 6 months. Although the dehiscence depth increased from 6 to 12 months in the tunnel group, it decreased in the coronally advanced group, and a slight decrease was observed from 12 to 72 months. Soft tissue thickness was the predictor for soft tissue margin stability. However, no significant relationship was found between the baseline dehiscence depth and complete coverage. CONCLUSIONS: Within the limitations of this study, it seems prudent to wait at least 6 months to achieve a stable soft tissue margin. CLINICAL SIGNIFICANCE: The occurrence of peri-implant soft tissue dehiscence, especially in the esthetic zone, can be a challenging complication. It is important not only to achieve coverage but also to ensure that the treatment results remain stable in the long term, in order to satisfy both patients and clinicians. A reasonable approach would be to wait for at least 6 months to achieve a stable soft tissue margin.

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OBJECTIVE: The purpose of this study was to assess the feasibility of phenotype modification in orthodontic patients using combined bone and soft tissue grafting substitutes. CLINICAL CONSIDERATION: The surgical procedure was conducted on 18 patients (3 males, 15 females). Periodontal phenotype modification was conducted using demineralized freeze-dried bone allograft and a xenogeneic collagen matrix. The following parameters were recorded for each tooth at baseline and 12-month follow-up: O'Leary plaque index (PI), probing depth (PD), bleeding on probing (BOP), gingival thickness (GT), keratinized tissue width (KTW), gingival recession (GR), and vestibular depth (VD). The results showed a statistically significant increase in GT (2.02 ± 0.39 mm), KTW (1.11 ± 0.82 mm), and VD (0.18 ± 1.16 mm) (p < 0.05). GR was also significantly decreased (1.02 ± 0.99 mm) (p < 0.05). CONCLUSION: Within the limitation of this study, the proposed approach enhanced the periodontal condition in orthodontic patients. However, further studies with a larger sample size are needed to ensure long-term stability. CLINICAL SIGNIFICANCE: Hard and soft tissue conditions have paramount importance for long-term periodontal stability. Phenotype modification in orthodontic patients can diminish the probability of adverse consequences and result in optimal esthetic outcomes. The proposed technique using combined bone and soft tissue substitutes indicated promising results and could be recommended in orthodontic patients with thin periodontal phenotypes.

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BACKGROUND: The novel two-stage technique presented in this study is based on guided bone regeneration for three-dimensional bone augmentation. METHODS AND RESULTS: The proposed technique was performed to augment an atrophic alveolar ridge in the maxilla and mandible. This method is based on using an autogenous bone plate, a mixture of allogeneic bone graft and injectable -platelet-rich fibrin, and a bioresorbable barrier membrane. Based on the cases presented in this study, sufficient osseous regeneration was achieved to place dental implants in an ideal position. CONCLUSION: Within the limitations of the present study, it seems that in situ shell technique could be a beneficial method to augment the extremely atrophied ridges with less morbidity and shorter operative time. KEY POINTS: Why is this case new information? The cases presented a new technique using in situ autogenous plates for ridge augmentation. What are the keys to the successful management of this case? The keys to the successful management of these cases are proper flap management and less traumatic bony plate preparation. What are the primary limitations to success in this case? The primary limitation to success in this technique would be a need for high surgical skills to conduct the procedure accurately.

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PURPOSE: This systematic review and meta-analysis was performed to investigate if there was a significant association between the number of cigarettes smoked per day and the results of root coverage procedures. METHODS: Electronic search was performed through PubMed, Web of Science, Embase, and Scopus until January 2023. Studies were included if evaluated the outcomes of periodontal plastic surgery procedures for the treatment of gingival recession in smokers. Statistical evaluation was conducted using random-effects method to analyze the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CI). RESULTS: From a total of 4494 references, 15 studies were considered relevant to be included in this study. The results showed that 44.39% sites had complete root coverage (CRC) at 6 months (non-smokers: 54.06%, < 10 cigarettes/day: 48%, 10-20 cigarettes/day: 19.56%, ≥ 20 cigarettes/day: 50%). Mean root coverage at 6 months were as follows: non-smokers: 74.94% ± 16.71%, < 10 cigarettes/day: 84.20% ± 2.24%, 10-20 cigarettes/day: 75.30% ± 14.69%, ≥ 20 cigarettes/day: 68.75% ± 26.51%. A significant difference was revealed between non-smokers and individuals who smoked 10-20 cigarettes/day in terms of CRC at 6 months: OR = 0.15 (95% CI = 0.03 to 0.71; P = .017). However, no significant difference was detected comparing 10-20 and ≥ 20 cigarettes/day. CONCLUSION: As there was not enough data available, any definitive conclusions about the connection between an increase in the amount of cigarettes consumed per day and the results of root coverage procedures could not be reached. Further research is required with comparative studies involving individuals who smoke varying numbers of cigarettes.

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Dental implants are currently the preferred choice to restore function and esthetics. Nonetheless, explantation is sometimes inevitable in cases with advanced bone loss, implant fracture, or improper implant position. This study aimed to propose an algorithm for reimplantation at sites of previous failure. There is limited evidence on the replacement of failed implants, most of which are case reports or clinical trials with a small number of patients. To the best of the authors' knowledge, this is the first study proposing a clinical-decision algorithm to help clinicians manage implant failures with new implants. There are a variety of reasons contributing to implant failure: The etiologic factor of failure and the morphology of the residual defect have paramount importance on implant removal techniques and subsequent treatment modalities. There is no consensus on a distinct protocol to replace failed implants. However, the clinicians and patients should know that placing a new implant in an area with a history of failure, regardless of early or late implant failure, may have a lower survival rate.

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STATEMENT OF PROBLEM: Whether placing implants to replace each missing tooth or using implant-supported fixed partial dentures provides better outcomes is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the success and survival rates of implants supporting single-unit and multiunit fixed prostheses by using conventional protocols for placement and loading in short- and long-term follow-ups. MATERIAL AND METHODS: An electronic search was conducted in PubMed, Scopus, and Web of Science for studies published up to March 17, 2022. Comparative studies that reported the success or survival rates of both single-unit and splinted multiunit prostheses were considered for qualitative and quantitative analyses. RESULTS: A total of 68 publications comprising 11 271 implants were included. Compared with the single prostheses, the splinted multiunit group showed no significant differences in implant success rates in the short-term (risk difference=-0.004; 95% confidence interval (CI)=-0.033 to 0.025; P=.780) and long-term (risk difference=0.003; 95% confidence interval (CI)=-0.029 to 0.034; P=.874) follow-ups. Significant statistical differences were also not found in terms of the survival rates of the 2 groups (short-term risk difference=-0.004; 95% CI=-0.031 to 0.023; P=.779, long-term risk difference=-0.002; 95% CI=-0.029 to 0.025; P=.887). CONCLUSIONS: Implants supporting single-unit or splinted multiunit prostheses seem to be a predictable treatment in terms of survival and success over short and long periods. Nonetheless, it seems that cantilever and nonsplinted multiunit prostheses should be used with more caution.

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STATEMENT OF PROBLEM: Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome. PURPOSE: The purpose of this systematic review and meta-analysis was to investigate the treatment outcome in terms of the implant survival rate and success parameters of immediate implant placement in compromised extraction sockets. MATERIAL AND METHODS: An electronic search was conducted in PubMed, Embase, Cochrane Library, and ISI Web of Science up to January 2021. Studies evaluating implant survival rate and main success parameters were included for a qualitative and quantitative analysis (risk ratio and mean difference). RESULTS: In total, 43 studies with analysis of 4825 sockets were included. Compared with the noncompromised sockets, the compromised group showed no significant differences in implant survival rates (risk ratio=0.992; 95% confidence interval (CI)=0.979 to 1.005; P=.246). No significant statistical differences were found in marginal bone level at ≤12 months (mean difference [MD]=0.033; 95% CI=-0.012 to 0.078; P=.154) or esthetic parameters. CONCLUSIONS: Immediate implant placement in compromised sites does not appear to decrease the survival and success rates. However, randomized clinical trials with large sample sizes should be conducted to draw a definite conclusion about the efficacy and safety of this treatment protocol in compromised sockets.

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Implant design and biomaterial composition are contributing factors in stress distribution throughout the implant body and the surrounding bone. The aim of this study was to evaluate the pattern of stress distribution using four different implant systems based on finite element analysis. This study was conducted using a cone beam computed tomography scan and four implant systems (ITI, SPI, 3i, and IDCAM); mandibular and implant models were constructed by a computer-aided design software (CATIA). Stress distribution under axial, mesio-distal, and combination static loading was assessed using finite element analysis in ABAQUS. The maximum von Mises stress value in dental implants was recorded for IDCAMs and IDCAMm implants considering all types of loading directions; however, these implant models showed the least stress distribution in the surrounding bone. The maximum stress occurred using combination followed by axial and mesio-distal loading. The stress distribution was concentrated, in all designs, at the level of the most coronal portion of the cortical bone. Within the limitations of the present study, it could be assumed that implant design may affect the distribution of stress in the implant body, and it could be used as a strategy to reduce stress concentration in the surrounding bone.

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Objective: The aim of this study was to evaluate the clinical and radiographic outcomes of the "vertically expander screw" (VES) technique as a novel approach for maxillary sinus floor elevation and simultaneous implant placement. Materials and Methods: Forty-four patients (26 females, 18 males) received 71 implants with simultaneous transalveolar sinus floor elevation via the VES technique. The threaded bone expanders were used to elevate the sinus floor as well as bone expansion. The patients were followed-up on a regular basis, and final clinical and radiographic examinations were performed at least 24 months following functional loading. Statistical analysis was conducted using the Chi-square test, the correlation coefficient, and the independent t test (p < 0.05, 95% confidence interval). Results: All implants showed successful osseointegration. The mean marginal bone loss (MBL; 0.38 ± 0.75 mm) at the site of premolars was not significantly different from the value at the site of molars (0.17 ± 0.50 mm). The mean intrasinus bone gain (IBG) was not significantly different (3.47 ± 1.22 mm and 4.11 ± 1.67 mm, respectively; p = 0.92). Evaluation of implant success index (ISI) score revealed no difference between the premolars and molars (p = 0.12). Conclusion: Despite the limitations of the present study, it seems that the VES technique and simultaneous implant placement in carefully selected cases may result in promising outcomes. Clinical Relevance: Insufficient alveolar bone height and poor bone quality often complicate implant placement in the edentulous posterior maxilla. The VES technique and simultaneous implant placement can bring about favorable clinical and radiographic outcomes and high survival rate in carefully selected cases.

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This study retrospectively evaluated the effect of soft tissue condition on peri-implant health. Clinical variables (Plaque Index, keratinized tissue width, gingival biotype, and vestibular depth) were recorded. Probing depth, soft tissue recession, bleeding on probing, and radiographic marginal bone loss were assessed in relation to independent variables. Statistical analysis was performed using Mann-Whitney U test or Kruskal-Wallis rank test and a logistic regression model at the implant level. A total of 139 implants in 43 patients were assessed. Bleeding on probing was recorded at 54.7% sites, which was significantly related to the biofilm accumulation. Gender, history of periodontal disease, patient adherence to recall visits, and the presence of plaque were associated with higher peri-implant probing-depth values. The maximum soft tissue recession was recorded at sites with a thin biotype and shallow vestibular depth (P = .0). The logistic regression analysis revealed that plaque (P = .002) and vestibular depth (P = .043) were significantly associated with peri-implantitis. Within the study limitations, patients with high plaque accumulation and shallow vestibular depth are more prone to peri-implant disease.

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Background. Recent advances in alternative medicine have led to the introduction of various new herbal products for treating gingivitis as the most prevalent gingival disease. The present study clinically evaluated the effect of a herbal mouthwash consisting of 5 herbal extracts (Myrtus communis, Quercus brantii, Punica granatum, Portulaca olerace, and Boswellia serrata) on periodontal indices. Methods. Fifty patients with plaque-induced gingivitis were included in this randomized, dou-ble-blinded clinical trial and divided into two groups. Following scaling and root planing (SRP), they were prescribed 0.2% chlorhexidine (CHX) (group 1) and herbal mouthwash (group 2) twice a day for 14 days. Both groups received saline mouthwash for the subsequent 14 days (wash-out time). Then, they used the mouthwashes in a cross-over manner for an additional two weeks. Probing pocket depth (PPD), gingival index (GI), bleeding on probing (BOP), and plaque index (PI) were recorded at baseline and after each period of mouthwash use. The data were analyzed by SPSS software, using generalized estimating equation (GEE) linear regression and paired t-test. P<0.05 was considered sta-tistically significant. Results. Both groups exhibited statistically significant improvements in the periodontal indices compared to the baseline (P<0.05); however, there were no significant differences between the two study groups in this regard. Conclusion. The experimental herbal mouthwash improved the periodontal condition in plaque-induced gingivitis after two weeks, comparable to the effect of %0.2 CHX mouthwash in terms of PPD, BOP, PI, and GI.

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OBJECTIVES: This retrospective study was aimed to compare the clinical and radiographic outcomes of implants with the same body design but different collar surface (laser-microtextured vs. not laser-microtextured) after functional loading. MATERIALS AND METHODS: Forty-three patients (29 females, 14 males) with 139 implants (60 laser-microtextured and 79 without laser microtexturing) were included in this study. Patients were consecutively included, and the data were collected during their implant maintenance visit. Clinical and radiographic parameters including probing depth (PD), bleeding on probing (BoP), and marginal bone loss (MBL) were recorded. In addition, the implant success index (ISI) score was determined. Statistical analysis was performed using the Mann-Whitney U test, the Kruskal-Wallis rank test, or the Pearson χ2 test, along with binary logistic regression (p < 0.05 was considered to be statistically significant). RESULTS: The median post-loading follow-up was 24 months with 100% survival rate. There was no significant differences in terms of mean PD (3.01 mm vs. 2.63 mm), mean MBL (0.54 vs. 0.49 mm), BoP (56.7% vs. 53.2%), and ISI score between laser-microtextured collars and implants without laser microtexturing. Logistic regression revealed arch as a significant predictor of peri-implantitis (p = 0.02). CONCLUSION: Within the limitations of this study, there was no statistically significant difference between the clinical and radiographic outcomes of implants with laser-microtextured and non-laser-microtextured collar designs. Clinical relevance Prospective studies with larger sample sizes and careful monitoring of implant placement protocols are needed for definite conclusions.

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BACKGROUND: Schneiderian membrane thickness may influence the final clinical outcome of sinus augmentation and dental implantation. Mucosal thickening has been regarded as a contributing factor for post-treatment complications. This study aimed to systematically review the available literature on the association between mucosal thickening and potential complications related to sinus augmentation and implant placement. METHODS: An electronic search was carried out in MEDLINE, Embase, and Web of Science by two independent reviewers. It was complemented by manual search of the reference lists of all relevant studies. The studies reporting on sinus augmentation and dental implantation in cases with preoperative mucosal thickening were considered eligible for this study. RESULTS: The initial search yielded 1032 articles. Five hundred and sixty-four records were screened by title and abstract, and 57 studies succeeded the inclusion criteria for full-text evaluation. Finally, 10 records remained for data extraction. The included studies assessed sinus augmentation and implantation procedures in 765 patients, 324 (42.3%) of them showed mucosal thickening. Increased membrane thickness did not significantly elevate the frequency of sinus augmentation complications. In addition, the overall implant survival rate was 99.03%. CONCLUSIONS: Within the limitations of the present study, the presence of mucosal thickening might not be a risk factor for sinus augmentation and implant survival rate.

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BACKGROUND: Improvement in implant design has made implant dentistry a challenging treatment modality worldwide. OBJECTIVES: This study aimed to investigate the efficacy of a xenogeneic collagen matrix in managing 3-4-millimeter gaps in flapless immediate implant placement. MATERIAL AND METHODS: Twenty-two patients received 39 immediate implants via the flapless approach. Patients with intact bony walls, buccal bone thickness ≥2 mm and a jumping distance of 3-4 mm were included in this study. The gap between the implant and the socket walls was filled with a xenogeneic collagen matrix (Collacone®). The final clinical and radiographic evaluations were performed at least 24 months following functional loading. RESULTS: There was no early or late failure, and the implants showed a 100% survival rate. The mean mesial (0.28 ±0.39 mm) and distal (0.28 ±0.39 mm) marginal bone loss (MBL) at the site of incisors was not significantly different from the values at the site of premolars and molars (0.30 ±0.42 mm and 0.34 ±0.48 mm, respectively). The evaluation of the implant success index (ISI) score revealed no difference between the mandible and the maxilla (p = 0.700), or incisors compared with premolars and molars (p = 0.420). The only significant difference was in terms of distal MBL, which was higher in the maxilla (0.39 ±0.49 mm) than in the mandible (0.12 ±0.23 mm) (p = 0.040). CONCLUSIONS: Within the limitations of this study, it seems that the application of a xenogeneic collagen matrix to manage 3-4-millimeter gaps in carefully selected cases may bring promising outcomes.

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PURPOSE: Peri-implantitis is a biofilm-induced pathological condition, and different approaches have been proposed to manage this condition. This study introduces a surgical technique in accordance with the concept of guided bone regeneration for implants with extensive peri-implant defects. METHODS: This pilot study was conducted on 7 patients with 11 implants (4 females and 3 males; 32 to 61 years). In this technique, we used a titanium mesh, a combination of autogenous bone, allogenic graft material, and acellular dermal matrix to reconstruct the peri-implant defects. All implants were placed submerged, and the second-stage surgery was conducted after 8 months. Soft tissue augmentation and vestibuloplasty were performed in the second-stage surgery, if required. RESULTS: The mean function time of implants was 60.5 ± 29.4 months. The mean baseline probing pocket depth was 5.7 ± 1.4 mm, and soft tissue recession was observed at two sites (18%). The mean recession and keratinized tissue width (KTW) values were 0.4 ± 0.8 mm and 3 ± 1.6 mm, respectively. The mean marginal bone loss and bone gain were 4.4 ± 1.2 mm and 2.9 ± 0.9 mm, respectively, which showed a significant improvement. CONCLUSION: Our preliminary evaluations showed favorable results in terms of radiographic defect fill and soft tissue condition. It appears that this technique may lead to promising outcomes in cautiously selected patients seeking to retain their failing implants. However, long-term results following functional loading are required before recommending this technique for daily practice.

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