Tobias Fretwurst

Background: To report 24‐month clinical and 3D outcomes of single and multiple RT1 and RT2 gingival recessions treated with the modified coronally advanced tunnel (MCAT) technique and an L‐PRF‐functionalized porcine dermal matrix (PDM), as long‐term data on PDM in root coverage are scarce. Methods: Patients with single or multiple RT1 and RT2 recessions in the maxilla or mandible were treated with MCAT and L‐PRF‐functionalized PDM. Conventional impressions taken preoperatively and at 24 months were poured as casts, digitized, and aligned as standard tessellation language (STL) files for quantitative analysis. Outcomes were recession depth (RD), mean and complete root coverage (mRC, cRC), mean recession reduction (mRR), and gingival thickness (GT). Mixed linear models accounting for patient‐level clustering were used. Results: Eighty‐three teeth in 20 patients were available for 24‐month analysis. Healing was uneventful. Mean baseline RD was 1.31 ± 0.86 mm. At 24 months, mRC was 80.17 ± 56.68%, cRC 34.78%, and mRR 1.01 ± 0.84 mm. Mean GT gain was 0.22 ± 0.40 mm. Root coverage and GT changes were similar for RT1 and RT2 defects and were not influenced by tooth type or jaw. Conclusions: Within the limitations of this prospective single‐arm clinical trial, MCAT with a leukocyte‐ and platelet‐rich fibrin (L‐PRF) ‐functionalized PDM provided stable 24‐month root coverage and modest GT gain in RT1 and RT2 gingival recessions. These descriptive findings support the clinical applicability of this CTG‐sparing approach and underline the need for randomized controlled trials with patient‐reported outcomes to compare it with connective tissue grafting. Plain language summary: Gum recession, where the gum pulls away and exposes the tooth root, can cause sensitivity, esthetic concerns, and tissue loss. In this study we treated 83 teeth in 20 adults with gum recession using a minimally invasive tunnel technique combined with a soft tissue replacement material made from porcine (pig) skin that was coated with a blood concentrate prepared from the patient. We followed the teeth for 2 years and used 3‐dimensional (3D) digital models made from dental casts to measure changes in gum position and thickness. On average, exposed root surfaces were reduced by about 80%, and in roughly one third of teeth the roots were fully covered again. The gums also became slightly thicker. Healing was uncomplicated, and results were similar in different tooth types and positions. Because this approach does not require taking a small piece of tissue from the roof of the mouth (connective tissue graft), it may reduce surgical discomfort while still providing stable coverage of exposed roots. However, direct comparisons with the current gold standard, connective tissue grafting, in randomized controlled trials are still needed to confirm these findings and to better understand patient‐reported benefits such as pain and satisfaction.

Objectives: The 1st Global Consensus for Clinical Guidelines (GCCG) in Implant Dentistry introduced an evidence‐based, patient‐centered framework for rehabilitating the edentulous maxilla. Working Group 3 aimed to develop clinical recommendations on advanced diagnostic imaging, soft and hard tissue augmentation, and management of complications. Materials and Methods: Recommendations were developed following the S2k‐level guideline framework of the AWMF and a structured nominal group technique. The evidence base included two systematic reviews on clinician‐reported outcomes (ClinROs) and patient‐reported outcomes (PROs), supplemented by single‐round international surveys of expert clinicians, patients, and cross‐disciplinary experts. Survey content addressed diagnostics, treatment planning, clinical procedures, and maintenance care. Draft recommendations were discussed at the in‐person consensus meeting in Boston (June 16–18, 2025) and finalized through anonymous plenary voting. Consensus thresholds were predefined as ≥ 75% but ≤ 95% agreement for consensus and > 95% agreement for strong consensus. Results: Working Group 3 formulated four clinical recommendations spanning advanced diagnostic imaging, augmentation techniques, and complication management. All four recommendations reached consensus. Voting participation per recommendation ranged from 68 to 88 (mean 79) out of a possible 105 participants. Conclusions: The Working Group 3 consensus statements offer practical guidance on surgical procedures and complication management in the rehabilitation of the edentulous maxilla. These recommendations are grounded in current evidence, interdisciplinary clinical practice, and patient perspectives. Furthermore, important evidence gaps, particularly in standardized patient‐reported outcome measures (PROMs), long‐term outcomes, and maintenance protocols, highlight key priorities for future clinical research.

The 1st Global Consensus for Clinical Guidelines (GCCG) in Implant Dentistry introduced an evidence-based, patient-centered framework for rehabilitating the edentulous maxilla. Working Group 3 aimed to develop clinical recommendations on advanced diagnostic imaging, soft and hard tissue augmentation, and management of complications. Recommendations were developed following the S2k-level guideline framework of the AWMF and a structured nominal group technique. The evidence base included two systematic reviews on clinician-reported outcomes (ClinROs) and patient-reported outcomes (PROs), supplemented by single-round international surveys of expert clinicians, patients, and cross-disciplinary experts. Survey content addressed diagnostics, treatment planning, clinical procedures, and maintenance care. Draft recommendations were discussed at the in-person consensus meeting in Boston (June 16-18, 2025) and finalized through anonymous plenary voting. Consensus thresholds were predefined as ≥ 75% but ≤ 95% agreement for consensus and > 95% agreement for strong consensus. Working Group 3 formulated four clinical recommendations spanning advanced diagnostic imaging, augmentation techniques, and complication management. All four recommendations reached consensus. Voting participation per recommendation ranged from 68 to 88 (mean 79) out of a possible 105 participants. The Working Group 3 consensus statements offer practical guidance on surgical procedures and complication management in the rehabilitation of the edentulous maxilla. These recommendations are grounded in current evidence, interdisciplinary clinical practice, and patient perspectives. Furthermore, important evidence gaps, particularly in standardized patient-reported outcome measures (PROMs), long-term outcomes, and maintenance protocols, highlight key priorities for future clinical research.

Introduction: The aim was the immunohistological evaluation of a porcine dermal matrix (PDM) in comparison to a non‐augmented control group for peri‐implant tissue thickening. Materials and Methods: This human histological study involved the placement of PDM in the test group (20 patients) during implant placement, while the control group underwent implant placement without grafting (20 patients). Postoperative clinical evaluations were conducted, and biopsies were obtained after 3 months. Histomorphometric evaluation utilized H&E staining. Immunohistological analysis included CD31, PSR, TE‐7, CD3, CD20, CD138, and CD68. Results: A total of 40 patients (17 females, 23 males; 60.62 years) were included. Though more frequent gingival redness occurred during wound healing in the PDM, the groups showed no significant differences in epithelial thickness ( p = 0.63), rete ridges ( p = 0.53), papilla density ( p = 0.626), papilla complexity ( p = 0.053), vascularization ( p = 0.052), connective tissue morphology ( p = 0.127), collagen differentiation ( p = 0.41), and CD3 ⁺ ( p = 0.85) and CD138 ⁺ cells ( p = 0.33). The PDM group showed significantly more CD68 ⁺ cells ( p = 0.049) and CD20 ⁺ cells ( p = 0.046), which correlates with a potentially distinct immune response caused by the PDM. Conclusion: The PDM used in this study exhibited no significant differences regarding epithelial changes, vascularization, tissue morphology, and collagen differentiation compared to a healthy control sample 3 months after grafting. The PDM group demonstrated a significantly higher frequency of CD68 ⁺ and CD20 ⁺ cells. The noticeable interindividual variation in immunoprofiles and clinical relevance of these findings should be investigated in future research.

Objectives: To assess the efficacy of the modified coronally advanced tunnel technique (MCAT) with a porcine dermal matrix (PDM) after a 12‐month follow‐up. There are no other Clinical trials evaluating a PDM over the period of 12 months.Material and Methods: Patients with recession type (RT) 1 and RT 2 gingival recessions were treated with the MCAT and a novel PDM. Plaster casts (preoperative and 12 months postoperative) were scanned using a 3Shape Lab Scanner E3. The resulting STL files were imported and superimposed in the open‐source software GOM Inspect for analysis. Measurements included recession depth, mean root and total root coverage (mRC and cRC), mean recession reduction (mRR), and gingival thickness. Statistical analysis was performed using mixed linear models.Results: A total of 77 teeth (19 patients) were included in the study. Healing was uneventful in all patients. The mean preoperative recession depth was 1.26 mm ± 0.86 mm. mRC was 69.47% ± 61.90%, cRC was 29.79%, mRR was 0.87 ± 0.83 mm, and gingival thickness gain was 0.23 ± 0.24 mm, with comparable results for RT 1 and RT 2. Neither tooth type nor jaw type had any effect on root coverage.Conclusions: The modified coronally advanced tunnel technique in combination with the analyzed porcine dermal matrix demonstrated stable results for root coverage and gingival thickness after 12 months of follow‐up.Trial Registration: Deutsches Register Klinischer Studien/German Clinical Trial Register (DRKS); DRKS00023201.

Objective: Abaloparatide (ABL) is a synthetic parathyroid hormone‐related protein analog developed as an anabolic drug to treat osteoporosis. ABL increases bone mineral density (BMD) of the long bones and spine; however, the influence of ABL on alveolar bone regeneration remains unknown. This study assessed the effects of systemic ABL administration on tooth extraction socket healing and dental implant osseointegration in a preclinical rodent model.Methods: Sprague‐Dawley rats received daily subcutaneous injection of ABL (25 μg/kg) or vehicle (VEH) at the time of maxillary first molar (M1) extraction surgery; animals underwent either: (1) unilateral M1 extraction followed by sacrifice at 10 or 42d or (2) bilateral M1 extraction followed by staged implant placement in osteotomies with standardized defects and sacrifice at 21 or 28d.Results: Micro‐computed tomography (micro‐CT) analysis demonstrated that ABL increased bone volume fraction (p = 0.004) and bone mineral density (BMD) (p = 0.006) of regenerated extraction sockets at 42d. Micro‐CT of the femur validated systemic effects of ABL, showing greater trabecular BMD after 6 (p < 0.01), 9 (p < 0.001), and 14 (p < 0.001) weeks of treatment. Histomorphometry confirmed a higher mineralized bone area with ABL treatment in extraction sockets at 42d (p = 0.03) and in the regenerated peri‐implant bone at 21d post‐implant placement (p = 0.01) compared to control.Conclusion: Systemic ABL administration enhances osteogenesis in extraction sockets prior to implant placement and accelerates peri‐implant bone formation in the early phase of healing in the present rodent model.

At present, a lack of consensus exists regarding the clinical impact of osteoporosis on alveolar bone metabolism during implant osseointegration. While limited preclinical and clinical evidence demonstrates a negative influence of osteoporosis on dental extraction socket healing, no preclinical studies offer data on the results of implant placement in 6-month-old, ovariectomized (OVX) Sprague–Dawley rats. This study aimed to investigate the outcomes of dental tooth extraction socket healing and implant placement in a rodent model of osteoporosis following daily vehicle (VEH) or abaloparatide (ABL) administration. Micro-CT and histologic analysis demonstrated signs of delayed wound healing, consistent with alveolar osteitis in extraction sockets following 42 days of healing in both the VEH and ABL groups. In a semiquantitative histological analysis, the OVX-ABL group demonstrated a tendency for improved socket regeneration with a three-fold greater rate for moderate socket healing when compared to the OVX-VEH group (43% versus 14%), however, this finding was not statistically significant (P=.11). No significant differences were observed between vehicle and test groups in terms of implant outcomes (BMD and BV/TV) at 14- and 21-days post-implant placement. Abaloparatide (ABL) significantly increased bone mineral density of the femoral shaft and intact maxillary alveolar bone sites in OVX animals, demonstrating the therapeutic potential for oral hard tissue regeneration. The present model involving estrogen-deficiency-induced bone loss demonstrated an impaired healing response to dental extraction and implant installation. Osteoporosis is a systemic disease that may negatively impact bone healing in the jaws. This study assesses extraction socket healing and dental implant placement in estrogen-deficient animals treated with a bone building drug, abaloparatide, compared to control.

Objectives: The incorporation of retromolar bone grafts used for alveolar ridge augmentation is not well understood. This prospective observational study aims to supply histomorphometrical data from bone graft biopsies taken at the time of retrieval and after a 3‐month healing period using patient‐matched biopsies.Materials and Methods: In 17 patients, trephine biopsies of the graft were acquired at the time of graft retrieval and after a 3‐month healing period. The biopsies were compared histomorphometrically regarding the number of osteocytes, appearance of osteocyte lacunae, quantity, surface area, and activity of the Haversian canals.Results: All grafts appeared clinically stable after screw removal and 17 implants were placed. Histomorphometric analysis revealed no significant difference in the number of osteocytes (p = .413), osteocyte lacunae (p = .611), the ratio of filled/empty osteocyte lacunae (p = .467) and active Haversian canals (p = .495) between the biopsies retrieved after a 3‐months healing period with those at the time of grafting. The only significant difference was noted in the mean surface area of the Haversian canals (p = .002). Specifically, the grafts post 3‐month healing showed a significantly larger mean area (0.069 mm²) compared to the time of grafting (0.029 mm²).Conclusion: This study demonstrates, compared to other data, a high rate of vital structures in retromolar bone block grafts after 3 months of healing, exhibiting the same histological features in comparison to the biopsies from the native alveolar ridge. Standard histomorphometrical parameters, e.g., the amount of filled or empty osteocyte lacunae for the description of the vitality of the graft need to be reappraised.