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Aims: To histologically compare osseointegration and crestal bone healing between newly introduced tapered, self‐cutting bone‐level test implants and tapered bone‐level control implants in sites with fully healed sites. Methods: Sixty‐six implants (33 test, 33 control) were placed 1 mm subcrestally in a minipig model and underwent qualitative histologic and quantitative histometric analyses after 3, 6 and 12 weeks of submerged healing. The primary and secondary outcomes were the bone‐to‐implant contact (BIC) and first bone‐to‐implant contact (fBIC). Outcomes between the test and control implants were statistically compared. Results: The BIC values of the test implants were comparable and non‐inferior over the time points studied, except for the 12 weeks time point which showed statistically significantly higher BIC values of the test (88.07 ± 5.35%) compared to the control implants (80.88 ± 7.51%) (p =.010). Similarly comparable and non‐inferior were the fBIC values, except for the 6‐week outcome, which showed statistically higher values for the test (−546.5 ± 450.80 μm) compared to the control implants (−75.7 ± 100.59 μm). fBIC results for the test implants were qualitatively more stable and consistent between test time points. Conclusion: Novel self‐cutting bone‐level test implants demonstrated superior osseointegration and similar bone levels compared to conventional bone‐level implants after a healing period of 12 weeks in healed ridges. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the clinical efficacy and the patient perception of subgingival debridement with either guided biofilm management (GBM) or conventional scaling and root planing (SRP) during supportive periodontal care (SPC). Methods: Forty‐one patients in SPC were randomly assigned to either treatment with GBM or SRP every 6 months. The primary outcome was the percentage of bleeding on probing (BoP) at 1 year. Moreover, pocket probing depths (PPD), recession, and furcation involvements were also measured. Full‐mouth and specific site analyzes were performed at baseline, 6 and 12 months of SPC. Patient comfort was evaluated using a visual analogue scale (VAS) at 12 months. Results: At 1 year, mean BoP percentage decreased from 12.2% to 9.0% (p = 0.191) and from 14.7% to 7.9% (p = 0.004) for the GBM and SRP groups, respectively. Furcation involved multirooted teeth but no through‐and‐through lesions were significantly fewer in the GBM than in the SRP group after 12 months (p = 0.015). The remaining parameters showed slight improvement in both groups without any statistically significant differences between the two groups after 1 year. Pain evaluation as patient reported outcome measures (pain evaluation) was in favor (p = 0.347) of the SRP group, while overall satisfaction was similar for both groups. Treatment time was not statistically significantly different between the two groups (p = 0.188). Conclusion: In well‐maintained SPC patients, SRP protocols resulted in significant clinical improvements in terms of BoP; however, for the other clinical improvements, similar efficacy for both GBM and SRP was observed. [ABSTRACT FROM AUTHOR]

Purpose: To histometrically compare the osseointegration and crestal bone healing of a novel tapered, self‐cutting tissue‐level test implant with a standard tissue‐level control implant in a submerged healing regimen. Materials and Methods: In a mandibular minipig model, implants were inserted and evaluated histometrically after a healing period of 3, 6, and 12 weeks. The primary outcome was the evaluation of bone‐to‐implant contact (BIC) and secondary outcomes were primary stability as per insertion torque and first BIC (fBIC). Outcomes for the test and control implants were compared using Wilcoxon signed‐rank tests and mixed linear regression models. Results: Insertion torque values were significantly higher for the test (50.0 ± 26.4 Ncm) compared to the control implants (35.2 ± 19.7 Ncm, p =.0071). BIC values of test implants were non‐inferior to those of control implants over the investigated study period. After 12 weeks, the corresponding values measured were 81.62 ± 11.12% and 90.41 ± 4.81% (p =.1763) for test and control implants, respectively. Similarly, no statistical difference was found for fBIC values, except for the 12 weeks outcome that showed statistically lower values for the test (−675.58 ± 590.88 μm) compared to control implants (−182.75 ± 197.40 μm, p =.0068). Conclusions: Novel self‐cutting tissue‐level implants demonstrated noninferior osseointegration and crestal bone height maintenance to the tissue‐level implants. Histometric outcomes between both implants demonstrated test implants were statistically noninferior to control implants, despite substantial differences in the bone engagement mechanism and resulting differences in insertion torque and qualitative bone healing patterns. [ABSTRACT FROM AUTHOR]

Objective: To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing/regeneration in intrabony defects. Method and mater-ials: Intrabony defects were surgically created in the mandible of three minipigs. Twelve defects were randomly treated with either rAmelX and carrier (test group) or with the carrier only (control group). At 3 months following reconstructive surgery, the animals were euthanized, and the tissues histologically processed. Thereafter, descriptive histology, histometry, and statistical analyses were performed. Results: Postoperative clinical healing was uneventful. At the defect level, no adverse reactions (eg, suppuration, abscess formation, unusual inflammatory reaction) were observed with a good biocompatibility of the tested products. The test group yielded higher values for new cementum formation (4.81 ± 1.17 mm) compared to the control group (4.39 ± 1.71 mm) without reaching statistical significance (P= .937). Moreover, regrowth of new bone was greater in the test compared to the control group (3.51 mm and 2.97 mm, respectively, P = .309). Conclusions: The present results provided for the first-time histologic evidence for periodontal regeneration following the use of rAmelX in intrabony defects, thus pointing to the potential of this novel recombinant amelogenin as a possible alternative to regenerative materials from animal origins. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between the baseline radiographic defect angle and the long-term clinical outcomes following periodontal regenerative therapy with enamel matrix derivative (EMD). Method and materials: Baseline periapical radiographs obtained from a cohort of patients treated with periodontal regenerative therapy were digitized and the radiographic angle width between the root surface and the bony wall of the adjacent intraosseous defect was calculated and reported (in degrees). Changes in pocket probing depth (PD) and clinical attachment level (CAL) were assessed and reported (in mm). Clinical outcomes were evaluated at baseline (T0), 6 months following therapy (T1), and at the latest follow-up (T2). Results: Thirty-eight defects in 26 patients enrolled in supportive periodontal care for a mean period of 10.4 years (range 8.0 to 15.5 years) were available for analysis. The mean PD change between T0 and T2 was 2.33 ± 1.66 mm at teeth with a defect angle width < 20 degrees and 0.86 ± 1.66 mm at teeth with a defect angle width > 30 degrees (P = .021). When the baseline radiographic angle width was < 20 degrees the probability of obtaining a CAL gain > 3 mm was 1.5-times higher (95% CI 0.19 to 13.8) at T1 and 2.5-times higher (95% CI 0.40 to 15.6) at T2 compared with defects with a radiographic angle width > 30 degrees. Conclusion: Within their limitations, these results indicate that pretherapeutic measurement of the radiographic defect angle width might provide relevant information on the short-/long-term clinical outcomes following regenerative periodontal therapy with EMD. [ABSTRACT FROM AUTHOR]

Following a comprehensive patient examination, including the assessment of periodontal and peri‐implant diseases as well as considering the patient's needs, a pretherapeutic prognosis for each tooth and implant is given. Teeth and implants with a secure pretherapeutic prognosis require simple procedures and may be regarded as secure abutments for function and with a doubtful pretherapeutic prognosis usually need a comprehensive therapy. Such teeth and implants must be brought into the category with a secure prognosis by means of additional therapy such as endodontic, restorative, and surgical procedures. Teeth and implants with a hopeless pretherapeutic prognosis should be extracted/explanted during the initial phase of cause‐related therapy (i.e., infection control). For example, teeth with vertical root fracture or unrestorable caries and implants with mobility or unrestorable malposition fall into the category of hopeless units. The primary goal of periodontal and peri‐implant therapy should be to arrest disease progression. The latest consensus statement highlights that periodontitis can be successfully controlled and treated teeth can be retained for life. Nevertheless, for patients with uncontrolled contributing factors, the endpoints might not always be achievable, and low disease activity may be an acceptable therapeutic goal. Similarly, the management of peri‐implantitis frequently requires surgical intervention following nonsurgical therapy due to incomplete treatment outcomes. Different surgical modalities can be effective and lead to significant improvement; however, achieving complete resolution of peri‐implantitis is challenging, not always predictable, and can depend on multiple baseline factors. Therefore, this review aims at summarising available evidence on the rationale for incorporating systemic, lifestyle‐related, clinical, and radiographic prognostic factors into treatment planning of patients diagnosed with periodontal and peri‐implant diseases. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the potential of a novel synthetic carbonate apatite bone substitute (CO3Ap‐BS) on periodontal regeneration. Background: The use of various synthetic bone substitutes as a monotherapy for periodontal regeneration mainly results in a reparative healing pattern. Since xenografts or allografts are not always accepted by patients for various reasons, a synthetic alternative would be desirable. Methods: Acute‐type 3‐wall intrabony defects were surgically created in 4 female beagle dogs. Defects were randomly allocated and filled with CO3Ap‐BS (test) and deproteinized bovine bone mineral (DBBM) or left empty (control). After 8 weeks, the retrieved specimens were scanned by micro‐CT, and the percentages of new bone, bone substitute, and soft tissues were evaluated. Thereafter, the tissues were histologically and histometrically analyzed. Results: Healing was uneventful in all animals, and defects were present without any signs of adverse events. Formation of periodontal ligament and cementum occurred to varying extent in all groups without statistically significant differences between the groups. Residues of both bone substitutes were still present and showed integration into new bone. Histometry and micro‐CT revealed that the total mineralized area or volume was higher with the use of CO3Ap‐BS compared to control (66.06 ± 9.34%, 36.11 ± 6.40%; p =.014, or 69.74 ± 2.95%, 42.68 ± 8.68%; p =.014). The percentage of bone substitute surface covered by new bone was higher for CO3Ap‐BS (47.22 ± 3.96%) than for DBBM (16.69 ± 5.66, p =.114). Conclusions: CO3Ap‐BS and DBBM demonstrated similar effects on periodontal regeneration. However, away from the root surface, more new bone, total mineralized area/volume, and higher osteoconductivity were observed for the CO3Ap‐BS group compared to the DBBM group. These findings point to the potential of CO3Ap‐BS for periodontal and bone regeneration. [ABSTRACT FROM AUTHOR]

Bone exostosis is defined as a benign overgrowth of bone tissue of unclear origin. Rarely, bone exostosis might develop following soft tissue graft procedures like mucogingival surgical interventions (eg, FGG or subepithelial CTG). This aberration has been mainly associated with surgical trauma or fenestration of the periosteum but is still a matter of debate. The present paper (1) presents a clinical case with clinical, radiographic, and histologic findings at 30 years following application of an FGG to increase the gingival width and (2) provides a short literature review on this particular clinical condition. At the clinical examination, the FGG was firm to palpation, and the 3D images showed an area of increased radiopacity. Histologic analysis revealed localized thickening of the bone with an overlaying connective tissue covered by keratinized epithelium. The bony tissue was vital, had a convex shape, and contained many osteocytes and resting lines, demonstrating some moderate signs of bone remodeling. The connective tissue and keratinized epithelium displayed a regular thickness without any signs of inflammation. Taken together, the histologic findings failed to reveal any pathologic signs except for the presence of vital bone formed outside the bony envelope. It can be concluded that: (1) the development of a bone exostosis following a mucogingival procedure is a rare clinical sequela of uncertain etiology, and (2) surgical removal of the exostosis may be indicated accordingly with patient symptoms. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the healing of multiple adjacent type 1 and 2 gingival recessions (RT1 and RT2) treated with the modified coronally advanced tunnel (MCAT) or the laterally closed tunnel (LCT) in conjunction with a cross-linked hyaluronic acid and subepithelial palatal connective tissue grafts. Method and materials: Fifteen healthy patients exhibiting multiple adjacent mandibular or maxillary RT1 and RT2 of a depth of = 2mm, were treated with the MCAT or LCT in conjunction with cross-linked hyaluronic acid and subepithelial palatal connective tissue grafts. Results were assessed at baseline and after a minimum of 6 months. The primary outcome variable was root coverage. Esthetic outcomes were evaluated on photographs using the root coverage esthetic score. Results: Postoperative pain and discomfort were low and no complications occurred. Data analyses were performed at patient level. After a mean follow-up of 17 ± 5.4 months, statistically significant root coverage was obtained in all 15 cases (P < .0001). Complete root coverage was obtained in 3 out of 15 cases (20%). Root coverage amounted to > 95% in three patients, was between 90% and 95% in four patients, and reached 87.5% in another patient. In three further patients root coverage measured 75%, 77%, and 64.6%, respectively. Mean root coverage measured 85.1 ± 23.2%. Mean keratinized tissue width increased from 2.5 ± 1.0 mm to 3.7 ± 0.7 mm (P < .0001) from baseline to follow-up, while mean probing depth showed no statistically significant changes (1.3 ± 0.5 mm vs 1.5 ± 0.5 mm). The mean root coverage esthetic score was 7.9 ± 1.9, while in the three cases exhibiting complete root coverage, a maximum root coverage esthetic score (10) was given for all treated teeth. Conclusion: Within their limits, the present results indicate that the described treatment approach may lead to predictable root coverage of multiple mandibular and maxillary RT1 and RT2. [ABSTRACT FROM AUTHOR]

Background: Peri‐implant health is characterized by the absence of clinical signs of soft tissue inflammation. Peri‐implant diseases are initiated by the presence of bacterial biofilms and share a similar etiology as that involved in the onset of periodontal diseases. Purpose: To summarize available evidence on the physiopathology of peri‐implant diseases with emphasis on similarities and differences with periodontal diseases. Materials and Methods: Evidence on the biologic mechanisms involved in the pathogenesis of peri‐implant mucositis and peri‐implantitis were explored in the recent scientific literature. Results: Findings of studies in animals and in humans indicate that experimental peri‐implant mucositis leads to a larger inflammatory connective tissue infiltrate and to a higher frequency of bleeding sites around implants compared with teeth. Tissue destruction at experimental peri‐implantitis sites is more pronounced compared with that at experimental periodontitis sites. Although human periodontitis and peri‐implantitis lesions share similarities with respect to etiology and clinical features, they represent distinct entities from a physiopathologic point of view. Conclusions: Diagnosis of peri‐implant health requires a clinical examination to confirm absence of peri‐implant soft tissue inflammation. In order to make a correct diagnosis and select the appropriate therapeutic steps to manage peri‐implant diseases, knowledge of their pathogenetic mechanisms is required. [ABSTRACT FROM AUTHOR]

Aim: To compare mean bone level (mBL) changes around dental implants with one or two adjacent teeth after a function time of ≥10 years. Materials and Methods: One hundred thirty three periodontally compromised patients (PCPs) with 551 implants enrolled in supportive periodontal care (SPC) were screened. Implants were categorized either into group TIT (tooth‐implant‐tooth) or into group TIG (tooth‐implant‐gap). MBL changes from delivery of restoration (i.e., baseline) to follow‐up were calculated in millimeters and compared between implants and adjacent teeth. Survival rates and the need for surgical interventions during SPC were recorded. Results: Eighty seven patients with 142 implants were re‐evaluated after a mean observation time of 14.5 ± 3.5 years. The mBL at mesial implant sites in the TIT group increased −0.07 ± 0.92 mm and decreased in the TIG group 0.52 ± 1.34 mm, respectively (95% CI: 0.04/1.14, p =.037). At distal implant sites, the mBL in the TIT group increased −0.08 ± 0.84 mm and decreased 0.03 ± 0.87 in the TIG group, respectively (95% CI: −0.20/0.42, p =.48). The overall implant loss rate was 3.5% (n = 5; 2 TIT, 3 TIG), without a statistically significant difference between the two groups (95% CI: 0.18/7.07, p =.892). Tooth loss rates (TIT: 12.3%, TIG: 12.3%) were not statistically significantly different (OR = 1.00, p =.989). Conclusion: High tooth and implant survival rates were observed in PCPs. The presence of one or two adjacent teeth seemed to have no impact on marginal bone level changes. [ABSTRACT FROM AUTHOR]

Purpose: To longitudinally assess the prevalence of peri-implant health, peri-implant mucositis and peri-implantitis in a cohort of patients with and without history of periodontitis over a 20-year period. Materials and methods: Eighty-four patients who attended a specialist private periodontal practice were evaluated prospectively 10 and 20 years after prosthesis delivery. Following successful completion of periodontal/implant therapy, patients (172 implants) were enrolled on an individualised supportive periodontal care programme. Clinical and radiographic parameters were collected to assess the prevalence of peri-implant health and diseases. Prevalence of peri-implantitis and peri-implant mucositis was calculated based on the case definition set out in 2018. A multilevel logistic regression analysis was conducted to assess potential risk or protective factors. Results: The analysis was performed on 22 periodontally healthy and 62 periodontally compromised patients rehabilitated with 39 and 130 implants, respectively. The 10-year prevalence of periimplant health, peri-implant mucositis and peri-implantitis was 21.4%, 67.9% and 10.6%, respectively, whereas the 20-year prevalence was 29.8%, 47.6% and 33.3%, respectively. Non-compliant periodontally compromised patients showed a statistically significantly increased risk at 20 years of both peri-implant mucositis (odds ratio 11.1; 95% confidence interval 1.8–68.6) and peri-implantitis (bone loss and probing depth) (odds ratio 14.3; 95% confidence interval 1.8–32.9). High full-mouth plaque and bleeding scores were associated with higher odds of both peri-implant mucositis and peri-implantitis. Conclusions: Peri-implant diseases were prevalent in patients rehabilitated with dental implants and followed up for a period of 20 years. History of periodontal disease and a lack of compliance with a tailored supportive periodontal care programme were identified as risk factors for peri-implant diseases. [ABSTRACT FROM AUTHOR]

Aim: To histologically evaluate the influence of (1) loading and (2) grafting on osseointegration and peri‐implant soft‐tissue healing at immediately placed, self‐cutting progressive tissue‐level implants (TLX) in a minipig model. Materials and Methods: TLX implants (n = 56) were immediately placed following the extraction of the mandibular first and second premolars, bilaterally, in a total of n = 14 minipigs. In each animal, the implant sites were allocated to the following four groups: (1) unloaded with simultaneous grafting using a bovine bone mineral; (2) unloaded without grafting; (3) loaded with simultaneous grafting; and (4) loaded without grafting. Histomorphometric assessments at 4 and 12 weeks (n = 7 animals each) included primary (i.e., bone‐to‐implant contact [BIC]) and secondary outcome measures (e.g., first BIC [fBIC], junctional epithelium length [JE], connective tissue contact length [CTC], biological width [BW = JE + CTC]). Results: At 4 weeks, mean BIC values ranged from 74.5 ± 11.6% in Group 2 to 83.8 ± 13.3% in Group 1, and, at 12 weeks, from 75.5% ± 7.9% in Group 2 to 79.9 ± 8.6% in Group 1. Multivariate linear mixed regression did not reveal any associations between BIC and implant loading or grafting at 4 and 12 weeks. At 12 weeks, significantly higher fBIC values were noted in Group 2 when compared with Group 1. All groups showed comparable JE, CTC, and BW values. Conclusions: Implant loading and grafting had no major effects on osseointegration and peri‐implant soft tissue healing at TLX implants. [ABSTRACT FROM AUTHOR]