The influence of vertical ridge augmentation techniques on peri-implant bone loss: A systematic review and meta-analysis

The Inlay Technique in Alveolar Ridge Augmentation: A Systematic Review

Background/Objectives: Vertical ridge augmentation remains a critical challenge in implant dentistry for addressing inadequate alveolar bone height. The inlay technique, or sandwich osteotomy, has gained attention for its potential to improve graft vascularization and predictability. This systematic review aimed to evaluate the clinical outcomes of the inlay technique. Methods: A systematic search was conducted in Cochrane Library and Medline databases for studies published from 2015 to 2025 to capture the most recent studies and advancements specifically focusing on the inlay technique. Inclusion criteria encompassed observational and interventional studies, including randomized controlled trials (RCTs) and cohort and case series with a focus on outcomes related to the inlay technique. Key outcomes were extracted and analyzed, including implant survival rates, MBL, vertical bone gain, and surgical complications. Results: Eleven studies involving 352 patients and more than 612 implants were included, with a mean follow-up of 2.27 ± 2.69 years (range: 4 months to 8 years). The implant survival rates ranged from 84.5% to 100%. Mean vertical bone gain varied from 2.69 to 4.4 mm. Complications were fewer with the inlay technique compared to onlay and other grafting methods, with significantly reduced graft-related failures and soft tissue issues. Conclusions: The inlay technique shows good vertical bone augmentation with high implant survival rates and fewer complications compared to other reconstructive techniques. Longer follow-up studies are needed to support its value in managing vertically deficient ridges. Moreover, further studies with extended follow-up are required to evaluate long-term marginal bone loss.

The TACOS Technique: A Stepwise Protocol for Alveolar Ridge Augmentation Using Customized Titanium Mesh

Background: Alveolar ridge resorption following tooth loss poses a significant challenge for successful dental implant placement. In cases of severe atrophy, bone augmentation is required to restore sufficient bone volume. This technical note outlines a detailed, stepwise surgical protocol for horizontal and vertical alveolar ridge augmentation using customized titanium mesh. Materials and Methods: The procedure includes precise mesh fitting, autologous bone grafting, and the application of bioactive agents to promote bone regeneration. Emphasis is placed on the technique's feasibility, predictability, and the critical steps necessary for preventing complications. Results: The use of customized mesh ensures stability and improved bone regeneration outcomes, enabling clinicians to achieve successful implant placement even in severely atrophic ridges. Conclusions: The described protocol has demonstrated predictable results in both clinical and radiographic evaluations, offering an effective solution for complex bone augmentation cases.

Potential Impact of Microbial Variations After Peri-Implantitis Treatment on Peri-Implant Clinical, Radiographic, and Crevicular Parameters: A Systematic Review

Objectives: This systematic review evaluated concomitant trends in microbial (total biofilm load and pre-dominant pathogens' counts) and clinical, radiographic, and crevicular variations following (any) peri-implantitis treatment in partially vs. totally edentulous, systemically healthy, non-smoking adults and compared them to peri-implant mucositis treated sites. Methods: The study protocol, compliant with the PRISMA statement, was registered on PROSPERO (CRD42024514521). Findings from six randomized controlled trials (RCTs), evaluated through the ROBINS-2 tool, were qualitatively synthesized. Results: No data concerning total edentulism and treated peri-implant mucositis sites were retrieved from the included RCTs. Instead, as expected, in the partially edentulous subjects, peri-implantitis treatments effectively provided biofilm control, although Plaque Index (PI) tended to increase again over time. Notably, Bleeding on Probing (BoP) rose slightly after treatment but decreased markedly by three months, indicating, at least, a partial resolution of the infective-inflammatory process. Probing Depth (PD) showed a slower but consistent improvement throughout. Despite a return of PI levels by twelve months, BoP and PD continued to improve, underscoring the successful long-term outcomes of peri-implantitis treatment. Over time, variations in PI did not consistently reflect changes in predominant pathogenic species, especially at the 1-month follow-up; BoP aligned with predominant pathogens rather than total microbial biofilm load at the 1- and 3-month follow-ups, and PD did the same at the 3- and 6-month follow-ups, likely affecting peri-implantitis-associated microbiota. No data concerning crevicular parameters were retrieved in the included RCTs, and the extracted radiographic outcomes were not comparable. Conclusions: The impact of the microbial variations after peri-implantitis treatment on peri-implant clinical parameters highlight the critical role of dysbiosis, rather than total microbial load, in influencing inflammation and tissue destruction, emphasizing the need for targeted approaches to manage persistent pathogens and improve treatment efficacy.

Peri-Implantitis-Associated Microbiota before and after Peri-Implantitis Treatment, the Biofilm "Competitive Balancing" Effect: A Systematic Review of Randomized Controlled Trials

This systematic review of RCTs aimed to characterize short- and long-term changes in peri-implantitis-associated microbiota (total biofilm microbial load and predominant pathogens' counts) following (any) peri-implantitis treatment in systemically healthy, non-smoking, partially/totally edentulous adults. The study protocol, compliant with the PRISMA statement, was registered on PROSPERO (CRD42024514521) before the literature search. Data from 11 RCTs, assessed through the ROBINS-2 tool, were qualitatively synthesized. No data were retrieved on total edentulism, healthy peri-implant/periodontal sites, treated mucositis, gingivitis, and periodontitis sites. Shortly after treatment, Prevotella intermedia, Fusobacterium nucleatum, and Peptostreptococcus micros prevailed, indicating early colonization, as after implant placement. After both surgical and non-surgical approaches, although not eradicated, the peri-implant total biofilm load, red- and orange-complex species, and Aggregatibacter actinomycetemcomitans counts generally decreased for up to about three months. However, one month after treatment, red-complex species and Prevotella intermedia increased, likely due to persistent tissue-invasive bacteria, unresolved pathological conditions (high probing depth values) favoring anaerobiosis and dysbiosis, and a qualitatively and quantitatively decreased biofilm community, competing and balancing the predominant pathogens (biofilm "competitive balancing" effect), thus allowing recolonization by more virulent bacteria. Red-complex bacteria gradually leveled off to baseline at the six- and twelve-month follow-ups. Fusobacterium nucleatum remained almost unchanged after treatment.

Microbiota of Peri-Implant Healthy Tissues, Peri-Implant Mucositis, and Peri-Implantitis: A Comprehensive Review

Understanding the microbiological profiles of peri-implant conditions is crucial for developing effective preventive and therapeutic strategies. This narrative review analyzes the microbial profiles associated with healthy peri-implant sites, peri-implant mucositis, and peri-implantitis, along with related microbiological sampling and analyses. Healthy peri-implant sites are predominantly colonized by Streptococcus, Rothia, Neisseria, and Corynebacterium species, in addition to Gram-positive cocci and facultatively anaerobic rods, forming a stable community that prevents pathogenic colonization and maintains microbial balance. In contrast, peri-implant mucositis shows increased microbial diversity, including both health-associated and pathogenic bacteria such as red and orange complex bacteria, contributing to early tissue inflammation. Peri-implantitis is characterized by even greater microbial diversity and a complex pathogenic biofilm. Predominant pathogens include Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, and unique species like Filifactor alocis and Fretibacterium fastidiosum. Additionally, less common species such as Staphylococcus and Enterobacteriaceae, contributing to disease progression through biofilm formation and increased inflammatory response, along with EBV and human cytomegalovirus with a still not defined role, and Candida albicans contribute to disease progression through biofilm formation, immune modulation, and synergistic inter-kingdom interactions. Future research should standardize diagnostic criteria, employ advanced molecular techniques, integrate microbial data with clinical factors, and highlight inter-kingdom interactions.