Harvest graft substitute for soft tissue volume augmentation around existing implants: A randomized, controlled and blinded multicenter trial.

Background: Using a single-blind, randomized, controlled, multicenter, practice-based clinical trial, a volume-stable collagen matrix (VCMX) was compared with connective tissue graft (CTG) for soft tissue augmentation around existing dental implants.

Methods: Sixty patients (31 VCMX and 31 CTG) were included. The primary outcome was a soft tissue thickness change 3 mm below the gingival margin (GM).

Diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects and Gingival Phenotype: A multicenter inter- and intra-examiner agreement study.

Background: The aim of this study was to investigate the inter- and intra-examiner agreement among international experts on the diagnosis of gingival recession defects using the 2018 Classification of Gingival Recession Defects and Gingival Phenotype as proposed in the 2017 World Workshop.

Methods: Standardized intraoral photographs from 28 gingival recession defects were evaluated twice by 16 expert periodontists. Recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ), and presence of root steps (RS) were recorded and used for the analysis.

A Prospective, Randomized, Controlled, Multicenter Evaluation of Extraction Socket Management Comparing a Wound Dressing and a Soft Tissue Substitute.

Postextraction bone grafting and implant placement help preserve alveolar bone volume. Collagen wound dressings and soft tissue graft substitutes may help protect extraction socket bone grafts and provide better gingival contours. This randomized, controlled, multicenter, and double-blinded study was conducted to compare a control (wound dressing) and a test (soft tissue graft) substitute in nearly intact extraction sockets.

One-year clinical results of restorations using a novel self-adhesive resin-based bulk-fill restorative.

This prospective study assessed the dual-curing self-adhesive bulk-fill restorative Surefil one. The restorations were placed and reviewed by dental practitioners who are members of a practice-based research network in the United States. Seven practitioners filled 60 cavities (20 class I, 19 class II and 21 class V) in 41 patients with Surefil one without adhesive, according to the manufacturer's instructions.

A Novel Parallel-Walled Dental Implant with a Self-Tapping Apex, Conical Connection, and Platform Shifting: Short-Term Results from a Retrospective Multicenter Clinical Study.

This multicenter retrospective study assessed clinical and radiographic outcomes of 686 parallel-walled conical-connection implants consecutively placed in 281 partially and fully edentulous patients. Implants were placed in healed and postextraction sites and subjected to immediate, early, or delayed loading. With a mean follow-up of 10 ± 6.

Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial.

Background: The autogenous connective tissue graft (CTG) with coronally advanced flap (CTG+CAF) is the "gold standard" for recession defect coverage; however, researchers continue to pursue lower morbidity, more convenient and unlimited supply harvest graft substitutes, including those that could provide soft tissue volume augmentation.

Methods: A randomized, controlled, double-masked comparison of a volume-stable collagen matrix (VCMX) versus CTG was conducted at four clinical investigation sites. Single, contralateral, within patient matched-pair, RT1 recession defects were treated with VCMX+CAF (test) and CTG+CAF (control).

Randomized, controlled, clinical trial to evaluate a xenogeneic collagen matrix as an alternative to free gingival grafting for oral soft tissue augmentation: A 6- to 8-year follow-up.

Background: The purpose of this follow up study was to determine if a xenogeneic collagen matrix (CMX) is as effective as free gingival graft (FGG) in preventing further recession 6+ years following vestibuloplasty.

Methods: This study was a single-blind (examiner), randomized, controlled, split-mouth study of 30 subjects with insufficient zones of KT (< 2 mm), associated with at least two, paired teeth. The study utilized a within subject treatment comparison to examine non-inferiority according to primary and secondary endpoints 6+ years after therapy.

Interproximal attachment gain: The challenge of periodontal regeneration.

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects.

Implant Placement Under Dynamic Navigation Using Trace Registration: Case Presentations.

Trace registration is a new, alternative registration method for dynamic navigation implant surgery that eliminates the need for an artificial fiducial marker and stent to be present in the CBCT scan, substituting it with other high-contrast landmarks such as teeth, implants, or abutments. Clinical advantages include a streamlined, simplified workflow with fewer opportunities for error; elimination of presurgical steps associated with stent fabrication and imaging; and reduction in radiation risk. Sufficient high-contrast intraoral structures are a prerequisite for using this technique.

Histologic Evaluation of rhBMP-2 in an Extraction Site Model in the Esthetic Zone: A Series of 16 Cases Preparing for Implant Placement.

Growth factors have been used in numerous oral applications to aid in bone formation after tooth extraction. Bone morphogenetic proteins (BMPs) are members of the transforming growth factor-b superfamily and are involved in the differentiation of pluripotent mesenchymal cells, leading to new bone formation through osteoblastic induction. This study examined histologic wound healing following extraction and ridge preservation using recombinant human BMP-2 (rhBMP-2) and a collagen sponge.

Biologics-based regenerative technologies for periodontal soft tissue engineering.

This manuscript provides a state-of-the-art review on the efficacy of biologics in root coverage procedures, including enamel matrix derivative, platelet-derived growth factor, platelet concentrates, and fibroblast-growth factor-2. The mechanism of action and the rationale for using biologics in periodontal plastic surgery, as well as their anticipated benefits when compared with conventional approaches are discussed. Although the clinical significance is still under investigation, preclinical data and histologic evidence demonstrate that biologic-based techniques are able to promote periodontal regeneration coupled with the provision of tooth root coverage.

Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration.

The present article focuses on the properties and indications of scaffold-based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and peri-implant plastic surgical reconstruction. The different processing methods for the creation of cell-free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECM-based scaffold technologies in periodontal and peri-implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts.

Living cell-based regenerative medicine technologies for periodontal soft tissue augmentation.

The cultivation of human living cells into scaffolding matrices has progressively gained popularity in the field of periodontal wound healing and regeneration. Living cellular constructs based on fibroblasts, keratinocytes alone or in combination have been developed and used as alternatives to autogenous soft tissue grafts in keratinized tissue augmentation and in root coverage procedures. Their promising advantages include reduced patient morbidity, unlimited graft availability, and comparable esthetics.

Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction.

This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus.

A Prospective, Case-Controlled Study Evaluating the Use of Enamel Matrix Derivative on Human Buccal Recession Defects: A Human Histologic Examination.

Background: Connective tissue grafts (CTGs) and coronally advanced flaps (CAFs) do not regenerate periodontal attachment apparatus when used to treat gingival recessions (GRs). Instead of generating new bone, cementum, and inserting periodontal ligament fibers, CTG+CAF repairs through a long epithelial junction and connective tissue attachment. Enamel matrix derivatives (EMDs) have demonstrated proof-of-principle that periodontal regeneration can be achieved, although data are limited.

Long-Term Results Comparing Xenogeneic Collagen Matrix and Autogenous Connective Tissue Grafts With Coronally Advanced Flaps for Treatment of Dehiscence-Type Recession Defects.

Background: Although connective tissue grafts with coronally advanced flaps (CTG + CAF) have been deemed the gold standard for recession defect treatment, to provide adequate recession coverage, the periodontal profession continues to pursue lower-morbidity, patient-preferred substitutes that are more convenient and of unlimited supply.

Methods: Using a randomized, controlled, and masked contralateral comparison of matched-pair, within-patient recession defects, collagen matrix (CMX) + CAF therapy was compared with CTG + CAF at 6 months and 5 years. The primary efficacy endpoint was percentage of root coverage (RC).

Evaluation of Premature Membrane Exposure and Early Healing in Guided Bone Regeneration of Peri-Implant Dehiscence and Fenestration Defects With a Slowly Resorbing Porcine Collagen Ribose Cross-Linked Membrane: A Consecutive Case Series.

Introduction: Guided bone regeneration (GBR) is a well-known and accepted procedure for effective treatment of oral bony defects that is dependent on sustained barrier membrane function for adequate new bone formation. Cross-linking between collagen fibrils with various agents has proven to be effective in prolonging membrane integrity and function, both critical to positive bone regenerative outcomes. Overlying mucosal dehiscence with membrane exposure may lead to less than adequate new bone formation.

Esthetic outcomes in relation to implant-abutment interface design following a standardized treatment protocol in a multicenter randomized controlled trial--a cohort of 12 cases at 1-year follow-up.

The design of an implant-abutment interface may have an impact on the peri-implant soft tissue esthetics. In an ongoing randomized controlled trial (RCT) with 141 participants, the authors evaluated the peri-implant tissue responses around three different implant-abutment interface designs used to replace single teeth in the esthetic zone. The aim of this report is to describe the treatment protocol utilized in this ongoing RCT by (1) demonstrating in detail a clinical case treated under this protocol and (2) reporting peri-implant soft tissue responses in a cohort of 12 representative cases from the RCT at 1-year follow-up.

Periodontal Soft Tissue Root Coverage Procedures: Practical Applications From the AAP Regeneration Workshop.

Focused Clinical Question: How should gingival recession (GR) defects be managed based on current evidence? Summary: The purpose of this practical application is to illustrate the management of GR defects with a primary outcome goal of complete root coverage. The consensus in dental literature and among expert clinicians is that root coverage may be attained through the application of different procedures and that outcomes are generally measured by reduced defect depth, gain in clinical attachment, and an increase in keratinized tissue (KT). These procedures may include the use of: 1) subepithelial connective tissue graft (SCTG); 2) coronally advanced flap; 3) free gingival graft; and 4) soft tissue graft substitutes (acellular dermal matrix and xenogeneic collagen matrix materials) and biologics (recombinant human platelet-derived growth factor and enamel matrix derivative).

Periodontal soft tissue root coverage procedures: a consensus report from the AAP Regeneration Workshop.

Background: Management of gingival recession defects, a common periodontal condition, using root coverage procedures is an important aspect of periodontal regenerative therapy. The goal of the periodontal soft tissue root coverage procedures group was to develop a consensus report based on the accompanying systematic review of root coverage procedures, including priorities for future research and identification of the best evidence available to manage different clinical scenarios.

Methods: The group reviewed and discussed the accompanying systematic review, which covered treatment of single-tooth recession defects, multiple-tooth recession defects, and additional focused questions on relevant clinical topics.

Evidence-based alternatives for autogenous grafts around teeth: outcomes, attachment, and stability.

Although the use of autogenous harvested tissues has proven to be the gold standard for soft tissue augmentation procedures involving root coverage or generation of keratinized tissue, harvest site morbidity and limited supply have prompted clinicians to seek graft alternatives. Using a hierarchy of evidence, the author reviews both clinical and patient-reported results for harvest graft substitutes and, considering his own research experience, reviews autogenous graft substitute outcomes, attachment, and stability over time. Overall, when the goal is keratinized-tissue generation, living cellular constructs and xenogeneic collagen matrices have provided acceptable clinical results, but with better esthetics and patient preference than autogenous free gingival grafts.