During supportive periodontal care, teeth with Class III furcation involvement are at a higher risk of loss. When performing surgery on molars with through-and-through furcation defects, elevating the flaps on both sides of the tooth may result in tissue wall loss, gingival recession, and exposure of the furcation entrance. This case report presents the Single Buccal Envelope Flap with Connective Tissue Graft (CTG) Wall Technique for the treatment of mandibular Class III furcation defects. We used a single-flap approach for the buccal side, while preserving the lingual side as an intact soft tissue wall. After thorough debridement of the furcation area, fibroblast growth factor-2 was first applied to the tooth surface and then mixed with autogenous bone, which was grafted into the defect. A CTG was placed on the buccal side, followed by buccal flap suturing. Preoperatively, the probing depths at the furcation sites were 7 mm and 9 mm on the buccal and lingual sides, respectively. At 12 months postoperatively, these were reduced to 4 mm and 3 mm, respectively. The radiographic comparison with preoperative images revealed bone regeneration within the defect area. Furthermore, the furcation entrance remained unexposed and stable during the 12-month follow-up period.

This prospectively-collected longitudinal service evaluation assessed the outcomes of periodontal regenerative surgery performed by periodontology trainees in the MClinDent program at Guy's Hospital, London. The primary aim was to evaluate 12-month clinical outcomes, with secondary aims to explore predictors of success and (reported separately) assess the feasibility of predicting defect morphology radiographically.

This prospective clinical case series investigates whether pre-extractive interradicular implant bed preparation for immediate implant placement in molar sites provides technical advantages with regard to sufficient implant primary stability and correct implant positioning without being disadvantageous in terms of survival and success rates.

This case series evaluated the laterally positioned multiple papilla flap (LPMPF) combined with a connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions (MAGRs) with a 10-year follow-up. Seventeen systemically healthy, non-smoking adults with RT1 MAGRs were treated. Recession depth (REC), Keratinized tissue width (KTW), percentage of root coverage (RC), achievement of complete root coverage (CRC) and Root Coverage Esthetic Score (RES) were assessed 1, 5, and 10 years after the surgery. At 1 year, mean RC was 92.8% with 80% CRC; outcomes remained stable over time, with 91.5% RC (p = 0.457) and 66% CRC at 10 years (p = 0.172). REC significantly decreased from 2.37 ± 1.16 mm at baseline to 0.19 ± 0.44 mm at 1 year (p < 0.001), with no significant change at 5 or 10 years (p = 1.000). KTW significantly increased from 1.46 ± 0.69 mm at baseline to 2.75 ± 1.08 mm at 1 year (p < 0.001) and remained stable thereafter (p = 1.000). Esthetic outcomes were consistently high (RES ≥ 8.8) and stable across timepoints (p = 0.839). Baseline REC and KTW were not associated with RC or CRC (p > 0.1); greater baseline REC correlated with lower RES at 1 year only (ρ = -0.410; p = 0.003). Within the limitations of the present study, LPMPF + CTG appears to be a reliable treatment for MAGRs, providing favorable long-term outcomes in terms of esthetics and root coverage over a decade.

This case report introduces a novel open-source-based digital workflow for esthetic crown lengthening (ECL) utilizing a customized 3D-printed surgical guide. A 35-year-old female patient with excessive gingival display underwent ECL planned through an integrated model combining intraoral scanning and cone-beam computed tomography data. Virtual simulation enabled precise measurement of periodontal structures, and a surgical guide termed the gingivectomy with osseous resective surgery template (GORST) was designed using free software. The GORST integrated a gingivectomy guiding line and bone reduction windows, allowing soft and hard tissue management in a single stent. Surgical execution followed the preoperative plan accurately, resulting in significant esthetic improvement with elongated clinical crowns, symmetrical gingival contours, and no postoperative hypersensitivity. This workflow offers a cost-effective, predictable approach for esthetic periodontal surgery while also reducing the surgical time. Further clinical studies are warranted to validate its broader applicability.

Rehabilitation of severely atrophic maxillae with zygomatic implants requires wide surgical access and precise soft tissue management to minimize dehiscence and promote long-term stability. The ZAGA Concept emphasizes individualized incision and flap design based on anatomical and prosthetic parameters.

Periodontitis stage IV may be characterized by pathological tooth migration (PTM) which, when orthodontic correction is needed, represents the conditions to define the type 2 phenotype according to the EFP Clinical Practice Guideline. Here, 4 clinical cases of patients with stage IV type 2 periodontitis and deep intrabony defects adjacent to the migrated teeth are presented. After successful steps 1 and 2 of periodontal treatment, the intrabony defects were subjected to regenerative periodontal surgery, and active orthodontic movement began early (2-4 weeks) after surgery. Follow-ups of up to 24 months demonstrate the effectiveness of interdisciplinary periodontal-orthodontic treatment in controlling inflammation, regenerating intrabony defects, realigning pathologically migrated teeth and thereby restoring esthetics and function for the patient.

To document the clinical and radiographic outcomes of a conservative mucogingival surgical protocol-combining coronally advanced flap, defect debridement, bioceramic repair material, and connective tissue graft-in the management of external cervical root resorption, with emphasis on soft-tissue stability, esthetics, and pulp vitality preservation.

The long-term success of implant-supported restorations depends on achieving both esthetic and biologic stability through proper management of the transmucosal space. This article introduces a novel concept for comprehensive surgical, restorative, and laboratory interpretation of the subgingival implant complex by dividing it into two functional compartments: the Biological Room (BR) and the Restorative Room (RR). The BR, located immediately coronal from the bone-to-implant contact, is responsible for peri-implant tissue integration which serves as a biologic barrier. This biologic barrier is achieved by the connective tissue and apical peri-implant epithelium which is populated by hemidesmosomal attachments. It must be managed using biocompatible materials (eg, titanium or zirconia) with specific surface properties (roughness 0.1-0.2 microns) to promote stable mucointegration. A minimum height of 2.0 mm is recommended for optimal hemidesmosomal function. The RR, located coronal to the BR, supports soft tissue architecture and esthetics and extends up to 3.0 mm. The prosthetic component in the RR is shaped to accommodate restorative needs and optimize the esthetic interface. Materials used here must balance esthetics, cleanability, and biocompatibility with highly polished surfaces to minimize plaque accumulation. This biologically driven framework enables clinicians and dental technicians to provide implant restorations that respect both esthetic and biologic principles, while promoting long-term peri-implant tissue health and clinical success. Previously, these concepts were described separately, but the Biological Room and Restorative Room concept serves as a guideline for all team members to achieve a desirable implant therapy.

The technical report described a novel treatment protocol for multiple recessions with anatomy- driven complexity from pre-operative evaluation, flap preparation, and the combination use of grafting materials. Clinical examination and cone-beam computed tomography were used to perform the comprehensive assessment before surgery. During surgical approach, sequentially combined bilaminar tunnel technique(cTUN) was performed. Firstly, tunneled coronally advanced flap (tCAF) was made at the most severe tooth sites, and the combination of modified tunnel technique with modified tunnel and vestibular incision subperiosteal tunnel access (mVISTA) was used to bypass the anatomic obstacles from two directions. Lastly, the de-epithelialized free gingival graft (DCTG) was sutured at coronal part for gingival recession coverage, and the volume-stable collagen matrix (VSCM) was placed at apical partially thickness flap to fill the concavities. When high complexity with anatomic difficulties was determined, the cTUN technique, combined tCAF and mVISTA approaches, effectively led to the preservation of flap integrity during flap preparation, favorable clinical outcomes of root coverage, and the stability of soft tissue at 6-month follow-up based on the reported cases.

This review evaluated the methodology, quality, and outcomes of systematic reviews (SRs) assessing the efficacy of treatments for molar class II furcation defects. An electronic search was conducted across Cochrane Library, Medline/PubMed, Scopus, and Web of Science. AMSTAR 2 and ROBIS tools were used. Eleven SRs, encompassing a total of 98 randomized clinical trials (RCTs) were included. Three SRs were rated as high quality and low to moderate risk of bias according to the AMSTAR 2 and ROBIS assessments, respectively. Most SRs were rated as moderate by both tools. Open flap debridement (OFD) alone demonstrated limited clinical benefit. Guided tissue regeneration (GTR), using either resorbable or non-resorbable membranes, showed greater efficacy, particularly when combined with bone grafting materials, resulting in superior horizontal and vertical attachment and bone level gains compared to OFD. The efficacy of adjunctive therapies including enamel matrix derivatives and platelet concentrates remains inconclusive. Regenerative techniques, especially GTR combined with grafting, appear to be the most effective treatment for class II furcation defects. The heterogeneity among the RCTs reported in the included SRs highlights the importance of standardized methodologies in future research to strengthen the evidence base and enhance clinical recommendations. This review was registered in PROSPERO (CRD420251029622).

This study aimed to characterize gingival thickness (GT) and determine correlations with other local phenotypic features. CBCT scans from adult subjects involving the maxillary anterior teeth were obtained to assess buccal GT at different apicocoronal levels, periodontal supracrestal tissue height (STH), the distance (CEJ-BC) from the cementoenamel junction (CEJ) to the alveolar bone crest (BC), and buccolingual tooth dimensions. A total of 100 subjects and 600 maxillary anterior teeth comprised the study sample. Variations in mean GT values were observed as a function of apicocor-onal level, tooth type, and gender. GT progressively increased apically. Maxillary central incisors and men generally exhibited thicker GT. Contrarily, women exhibited thinner GT and shorter STH. Tooth dimensions were negatively correlated with GT, as a narrower tooth crown/root in the buccolingual dimension indicated thicker gingiva. GT at the CEJ level was dichotomized to differentiate between thin (< 1 mm) and thick (≥ 1 mm) gingival phenotypes (GP). Teeth with a thin GP displayed great er CEJ-BC and buccolingual tooth width dimensions. Conversely, teeth with a thick GP generally exhibited taller STH and narrower tooth dimensions.

The incorporation of artificial intelligence (AI) into digital technology has profoundly enhanced the field of dental implantology in all phases of treatment from diagnosis through planning, surgery and restoration. With specific attention to planning and surgery, static computer-aided implant surgery (sCAIS) has become a widely accepted workflow by streamlining implant placement and restoration. However, during the placement of immediate implants, users of sCAIS can often experience specific limitations due to the anatomical complexity of post-extraction sockets, including their morphology, angulation, and the heterogeneity of surrounding bone density in relation to the planned implant position. These clinical factors can adversely influence the trajectory and stability of the surgical drill leading to its deflection resulting in deviations from the planned implant path. Such inaccuracies can lead to suboptimal implant positioning, compromising primary stability, esthetic outcomes, and ultimately, long-term clinical success. This article introduces an AI-assisted modification to the traditional sCAIS guide design workflow by introducing a pilot drill surgical guide (SocketFit Guide (SFG)) to minimize these risks when working with immediate implants. The design of the SFG incorporates the use of AI-driven virtual segmentation of anatomical structures during the digital planning phase. Through virtual tooth extraction, the AI algorithm accurately delineates the alveolar socket boundaries, enabling the design of the SFG with an extension and more apically positioned guide sleeve. Moving the pilot drill closer in proximity to the planned osteotomy site allows for more control over the drill trajectory minimizing deflection.

The aim of this study was to evaluate the success rate and marginal bone loss (MBL) of 6 mm wide-diameter (WD) implants placed in mandibular and maxillary molar sites with immediate non-functional provisionalization with cement-retained single crowns in posterior molar sites up to 10.5 year follow up.

The integrity of periodontal soft tissues during healing plays a critical role in the success of surgical periodontal regenerative therapy. Wound dehiscence can lead to compromised regenerative outcomes and gingival recession. This manuscript introduces the use of the partial-full-thickness (PFT) tunnel for periodontal regeneration of multiple adjacent infrabony defects. The PFT tunnel technique maintains intact interdental papillae, enables access to defects, and facilitates coronal advancement of the soft tissue. When combined with palatal vertical incision this approach also enables treatment of bony defects that extend toward the palatal aspect. Placement of biomaterials in osseous defects displaces the overlying soft tissue coronally, thereby creating and maintaining space for clot stabilization and tissue regeneration. It also leads to significant enhancement in interproximal clinical attachment levels, probing depth reduction, and root coverage. Preliminary clinical outcomes indicate that this technique could be an alternative option for treating multiple infrabony defects.

After over a decade of use, there are persistent misunderstandings about monolithic zirconia (MZ) with respect to its characteristics and appropriate management. This leads to errors in its application that can negatively affect not only the efficiency and predictability of clinical workflows, but also the long-term outcome for the patient. This article discusses the physical properties, manufacturing and production of MZ restorations. Recommendations for their use based on currently available laboratory and clinical evidence and concerns regarding current trends are provided.

Biocompatibility has been defined by Williams as “the ability of a biomaterial to perform its desired function with respect to a medical therapy, without eliciting any undesirable local or systemic effects in the recipient…and optimizing the clinically relevant performance of that therapy”.1 Monolithic zirconia (MZ) is often described as the most biocompatible ceramic option for indirect dentistry.2 This assertion is typically presented with no attached citations, implying that it is a generally known fact. The purpose of this commentary is to explore the biocompatibility of MZ not only as it relates to localized cellular response, but also within the context of the broader stomatognathic system.

To estimate the feasibility of immediate (IIP) and early (EIP) implant placement based on retrospectively collected intra-oral radiographic data, and to compare their 'estimated' feasibility to the 'true' feasibility based on optimal virtual implant planning in CBCT software.

This retrospective case report documents the successful use of a mineralized allograft hydrated by a combination of recombinant human platelet derived growth factor-BB and enamel matrix derivative to regenerate the buccal furcations of two adjacent maxillary molars. Twelve years later, despite the complete fill with bone in both furcations, the second molar developed a resorptive lesion near the furcation area requiring its removal. The surgical procedure to replace it with a dental implant enabled visual inspection of the furcations on both teeth and histologic evaluation of the second molar's complete furcation fill. The findings from this case present the potential to regenerate a stable new attachment apparatus. The histologic findings further elucidate both the long term fate of this graft-biologic combination which did not completely turnover to host bone as well as the contribution that it may play in guided tissue regenerative therapy.