The importance of soft tissue condition in bone regenerative procedures to ensure long-term peri-implant health

The Modified Coronally Advanced Tunnel Technique for Coverage of Mucosal Recessions at Dental Implants

OBJECTIVES

To clinically evaluate the outcomes following surgical coverage of single peri-implant mucosal recessions in the aesthetic maxillary area by means of the modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG).

MATERIALS AND METHODS

Eleven systemically healthy non-smoking patients (8 females) each presenting a single peri-implant mucosal recession in the anterior maxillary region were consecutively treated with MCAT in conjunction with SCTG. In all cases, the facial recession was associated with an impaired aesthetic appearance. Before reconstructive surgery and at 12 months postoperatively, clinical and aesthetic parameters were assessed. The primary outcome variable was the mean mucosal recession coverage (MRC).

RESULTS

Healing was uneventful in all cases. At 12 months, statistically significant (p < 0.05) recession coverage (MRC 94.71%) and improvement of aesthetics (pink aesthetic score) was obtained at all implants. Complete RC was obtained in 10 out of the 11 patients (90.9%). The treatment was associated with a statistically significant gain of keratinized and attached mucosa (p < 0.05).

CONCLUSION

The present results demonstrate that single peri-implant mucosal recessions in the maxillary aesthetic area can be successfully treated with MCAT and SCTG.

Advances in the research of immunomodulatory mechanism of mesenchymal stromal/stem cells on periodontal tissue regeneration

Periodontal disease is a highly prevalent disease worldwide that seriously affects people's oral health, including gingivitis and periodontitis. Although the current treatment of periodontal disease can achieve good control of inflammation, it is difficult to regenerate the periodontal supporting tissues to achieve a satisfactory therapeutic effect. In recent years, due to the good tissue regeneration ability, the research on Mesenchymal stromal/stem cells (MSCs) and MSC-derived exosomes has been gradually deepened, especially its ability to interact with the microenvironment of the body in the complex immunoregulatory network, which has led to many new perspectives on the therapeutic strategies for many diseases. This paper systematically reviews the immunomodulatory (including bone immunomodulation) properties of MSCs and their role in the periodontal inflammatory microenvironment, summarizes the pathways and mechanisms by which MSCs and MSC-EVs have promoted periodontal regeneration in recent years, lists potential areas for future research, and describes the issues that should be considered in future basic research and the direction of development of "cell-free therapies" for periodontal regeneration.

An Integrated Dual-Layer Heterogeneous Polycaprolactone Scaffold Promotes Oral Mucosal Wound Healing through Inhibiting Bacterial Adhesion and Mediating HGF-1 Behavior

Recently, the high incidence of oral mucosal defects and the subsequent functional impairments have attracted widespread attention. Controlling scaffold geometry pattern has been proposed as a strategy to promote cell behavior and facilitate soft tissue repair. In this study, we innovatively construct an integrated dual-layer heterogeneous polycaprolactone (PCL) scaffold using melt electrowriting (MEW) technology. The outer layer was disordered, while the inner layer featured oriented fiber patterns: parallel (P-par), rhombic (P-rhomb), and square (P-sq). Our findings revealed that the P-rhomb and P-sq scaffolds exhibited superior surface wettability, roughness, and tensile strength compared to the pure disordered PCL scaffolds (P) and P-par. Compared to the commercial collagen membranes, the outer layer of PCL can effectively inhibit bacterial adhesion and biofilm formation. Furthermore, the P-rhomb and P-sq groups demonstrated higher gene and protein expression levels related to cell adhesion and cell migration rates than did the P and P-par groups. Among them, P-sq plays an important role in inducing the differentiation of gingival fibroblasts into myofibroblasts rich in α-smooth muscle actin (α-SMA). Additionally, P-sq could reduce inflammation, promote epithelial regeneration, and accelerate wound healing when used in full-thickness oral mucosal defects in rabbits. Overall, the integrated dual-layer heterogeneous PCL scaffold fabricated by MEW technology effectively inhibited bacterial adhesion and guided tissue regeneration, offering advantages for clinical translation and large-scale production. This promising material holds important potential for treating full-thickness mucosal defects in a bacteria-rich oral environments.

Enhancing early-stage healing responses through the modified "Poncho" technique in customized titanium mesh-mediated bone regeneration: A soft tissue management approach-case series

RATIONALE

Soft tissue management is critical in bone augmentation surgery to prevent wound dehiscence. Several strategies for passive tissue primary closure have been explored. This article introduces a flap design known as the modified "Poncho" technique (MPT), integrated with customized titanium mesh-mediated bone regeneration, and investigates the healing quality during the initial stages of an incision.

PATIENT CONCERNS

The cohort consisted of 5 patients undergoing customized bone regeneration procedures, concerned primarily with the successful integration and healing of the augmented bone site without complications such as wound dehiscence or infection.

DIAGNOSIS

All patients were diagnosed with insufficient bone volume requiring augmentation to support future dental implants, necessitating the use of customized titanium mesh for guided bone regeneration.

INTERVENTIONS

The MPT was detailed and applied during the customized bone regeneration procedures. Postoperative evaluations included recording complications and using Landry's healing index at intervals of 3, 7, 14, and 30 days post-surgery to assess the technique's performance in early wound closure.

OUTCOMES

The study found that 95.7% of surgery sites experienced uneventful soft tissue healing within the observation period. Only 1 of 23 sites exhibited partial wound dehiscence at postsurgical days 14 and 30, accompanied by mild inflammation. The Landry's healing index increased from 3 ± 0.47 to a final value of 4.69 ± 1.06, indicating substantial improvement in healing over time.

LESSONS

The MPT shows promise as an innovative approach for promoting passive and predictable primary wound closure beneath a digitally customized titanium mesh for bone regeneration, demonstrating a high rate of successful healing and minimal complications during the early postoperative phase.

Mass spectrometry-based proteomic applications in dental implants research

Dental implants have been established as successful treatment options for missing teeth with steadily increasing demands. Today, the primary areas of research in dental implantology revolve around osseointegration, soft and hard tissue grafting as well as peri-implantitis diagnostics, prevention, and treatment. This review provides a comprehensive overview of the current literature on the application of MS-based proteomics in dental implant research, highlights how explorative proteomics provided insights into the biology of peri-implant soft and hard tissues and how proteomics facilitated the stratification between healthy and diseased implants, enabling the identification of potential new diagnostic markers. Additionally, this review illuminates technical aspects, and provides recommendations for future study designs based on the current evidence.

Bone Formation and Maintenance in Oral Surgery: The Decisive Role of the Immune System-A Narrative Review of Mechanisms and Solutions

Based on the evidence of a significant communication and connection pathway between the bone and immune systems, a new science has emerged: osteoimmunology. Indeed, the immune system has a considerable impact on bone health and diseases, as well as on bone formation during grafts and its stability over time. Chronic inflammation induces the excessive production of oxidants. An imbalance between the levels of oxidants and antioxidants is called oxidative stress. This physio-pathological state causes both molecular and cellular damage, which leads to DNA alterations, genetic mutations and cell apoptosis, and thus, impaired immunity followed by delayed or compromised wound healing. Oxidative stress levels experienced by the body affect bone regeneration and maintenance around teeth and dental implants. As the immune system and bone remodeling are interconnected, bone loss is a consequence of immune dysregulation. Therefore, oral tissue deficiencies such as periodontitis and peri-implantitis should be regarded as immune diseases. Bone management strategies should include both biological and surgical solutions. These protocols tend to improve immunity through antioxidant production to enhance bone formation and prevent bone loss. This narrative review aims to highlight the relationship between inflammation, oxidation, immunity and bone health in the oral cavity. It intends to help clinicians to detect high-risk situations in oral surgery and to propose biological and clinical solutions that will enhance patients' immune responses and surgical treatment outcomes.

Post-extraction volumetric analysis of alveolar ridge contour using subepithelial connective tissue graft in esthetic zone: a randomized controlled clinical trial

OBJECTIVES

The aim of this randomized clinical trial was to assess the alveolar ridge contour after soft tissue augmentation using subepithelial connective tissue graft (SCTG) buccal to fresh extraction sockets in patients with thin buccal bone, versus minimally-traumatic extraction followed by spontaneous healing solely.

MATERIALS AND METHODS

Forty non-restorable maxillary teeth in the esthetic zone were randomly assigned into two groups: minimally-traumatic extraction with SCTG (test) and minimally-traumatic extraction followed by spontaneous healing (control). The outcomes assessed included linear volumetric change of buccal soft tissue contour, vertical tissue loss, gingival thickness (GT), and interdental papilla (IDP) height after 6 months.

RESULTS

The SCTG group showed a significant improvement (P < 0.001) in all outcomes after 6 months. The SCTG group showed a statistically significant (P < 0.001) gain in the buccal soft tissue volumetric change compared to the control group. The SCTG group showed a statistically significant increase in GT (P < 0.001) and IDP height (P < 0.05) after 6 months compared to the control group.

CONCLUSIONS

The use of SCTG buccal to extraction sockets in the anterior maxilla might be considered as a predictable approach for preserving the alveolar ridge contour.

CLINICAL RELEVANCE

SCTG buccal to extraction sockets might counteract post-extraction hard and soft tissue alterations in the esthetic zone.

Prevalence and risk factors of peri-implant diseases at patient-level: A cross-sectional study in Syria

OBJECTIVES

This research aims to assess the prevalence of peri-implant diseases and to analyze variables of the probable risk at the patient level associated with the occurrence of peri-implant diseases in Syrian patients.

MATERIALS AND METHODS

A cross-sectional study has been carried out on 142 patients with 380 dental implants placed between 2015 and 2021. Patients were invited by phone to return to Damascus University's Periodontology Department for clinical and radiological examination. A descriptive statistical analysis was implemented for the prevalence of peri-implant diseases at the level of the patients. Also, the peri-implant diseases' factors of risk were determined by the multivariate analytical model.

RESULTS

The prevalence rate of peri-implant mucositis and peri-implantitis in patients was 58.5% and 25.4%, respectively. Peri-implant disease is associated with multivariate risk indices, gender female (peri-implant mucositis [OR = 0.269; 95% CI: 0.131-0.552] and peri-implantitis [OR = 0.561; 95% CI: 0.561-0.216]), diabetes (peri-implant mucositis [OR = 3.4; 95% CI: 1.73-12.73]), periodontitis (peri-implant mucositis [OR = 2.409; 95% CI: 1.760-2.613], peri-implantitis [OR = 10.445; 95% CI: 4.097-26.629]).

CONCLUSIONS

Peri-implant diseases are common in the Syrian community. Several patient-level variables (gender female, diabetes, and periodontitis) are associated with peri-implant disease.

The Potential Value of Probiotics after Dental Implant Placement

Dental implantation is currently the optimal solution for tooth loss. However, the health and stability of dental implants have emerged as global public health concerns. Dental implant placement, healing of the surgical site, osseointegration, stability of bone tissues, and prevention of peri-implant diseases are challenges faced in achieving the long-term health and stability of implants. These have been ongoing concerns in the field of oral implantation. Probiotics, as beneficial microorganisms, play a significant role in the body by inhibiting pathogens, promoting bone tissue homeostasis, and facilitating tissue regeneration, modulating immune-inflammatory levels. This review explores the potential of probiotics in addressing post-implantation challenges. We summarize the existing research regarding the importance of probiotics in managing dental implant health and advocate for further research into their potential applications.