Gustavo Avila‐Ortiz

Background: The objectives of this Workshop were to evaluate the efficacy of scaffolding technologies for horizontal and vertical ridge augmentation; to evaluate the efficacy of substitute scaffolds for soft tissue augmentation in the context of implant therapy; to evaluate the efficacy of cells and/or biologics combined with scaffolds for alveolar bone regeneration; to evaluate the efficacy of cells and/or biologics combined with scaffolds for soft tissue regeneration in the context of implant therapy; and to evaluate emerging technologies and personalized strategies for improving hard and/or soft tissue defects around natural teeth and dental implants. Methods: The Workshop discussions were informed by five specifically commissioned systematic reviews from the following three Working Groups: Working Group 1 – Use of scaffolds for bone and soft tissue regeneration; Working Group 2 – Use of cells and/or biologics combined with scaffolds for hard and soft tissue regeneration; and Working Group 3 – Current, emerging, and personalized approaches for periodontal and peri‐implant tissue regeneration. The Workshop participants were informed by the compiled evidence from the five systematic reviews within each Working Group to address pertinent issues to inform clinical practice, research, and the public community. Results: The consensus among the Workshop group participants was that cellular therapies and biologics, alone and in combination with scaffolding technologies, offer strong potential in regenerating tissues around teeth and dental implants. There was variability in treatment outcomes depending on the overall evidence and the efficacy of these technologies, as well as on the specific defects and patient‐based constraints. The consensus report detailed the results and implications of the findings, demonstrating the value of these technologies in improving clinical and patient‐reported outcomes. Conclusions: Current regenerative approaches lead to long‐term stable outcomes at natural teeth as well as dental implant sites; novel technologies can benefit patients by enhancing longer‐term stability of teeth and implants to promote the health of the oral cavity and dentition; and artificial intelligence–enabled modeling can contribute to the identification of relevant features at the individual (as opposed to population) level, empowering patients to be active participants in their journeys and improving science‐to‐public communication.

Background: To analyze the effect of autogenous soft tissue grafts or substitute scaffolds on the outcomes of soft tissue augmentation (STA) performed in the context of implant therapy. Methods: The protocol of this PRISMA 2020‐compliant systematic review was registered in PROSPERO (CRD42024611477). Articles reporting the findings of randomized controlled trials (RCTs) that met the eligibility criteria were identified through a literature search. Following final article selection, data were extracted, including relevant clinician‐ and patient‐reported outcomes and experiences (CROs and PROs/PREs). Risk of bias assessment was performed using the RoB2 tool. Network meta‐analyses (NMA) were performed when feasible to compare the performance of different techniques. Results: Forty RCTs were selected. Risk of bias assessment revealed that the methodological quality of the selected studies was generally high. Although CROs and PROs/PREs were inconsistently reported, it was possible to conduct five sets of NMA regarding mucosal thickness (MT) and keratinized mucosa width (KMW) changes. These analyses revealed that the use of an autogenous connective tissue graft in a bilaminar approach is the best treatment for MT augmentation regardless of the timing, while the application of a free mucosal graft over a partial‐thickness vascular bed is generally the best to obtain KMW gains. Alternatively, other treatment options involving the use of specific types of substitute scaffolds were considered as viable alternatives given their similar performance, particularly in terms of MT gain. Additionally, it was found that, compared with autogenous soft tissue grafts, the use of substitute scaffolds is consistently associated with lower postoperative discomfort. Conclusions: Autogenous soft tissue grafts should be considered as the primary choice to achieve predictable MT and KMW gains in the context of implant therapy. The use of specific substitute scaffolds may render similar STA outcomes with lower postoperative morbidity.

Aim: To compare the prognostic performance of an artificial intelligence (AI) model with that of experienced clinicians in predicting tooth loss over a 10‐year period. Materials and Methods: An AI model trained on structured clinical and radiographic data was compared with 12 periodontists and 11 general dentists (GDs), who independently assigned prognostic scores (0–10 scale) to 300 teeth with known 10‐year outcomes. AI and clinician performance were evaluated under a fixed threshold and group‐specific optimal thresholds. Accuracy, sensitivity, specificity, predictive values, area under the receiver operating characteristic curve and calibration were used for comparison. Results: Using the fixed threshold (score > 5 = survival), clinicians achieved higher overall accuracy than AI (75.6% periodontists, 74.9% GDs, 69.2% AI; p < 0.05), with sensitivity low and comparable across groups (14.7%–22.7%). Using group‐specific optimal thresholds, AI achieved the highest accuracy for all‐cause tooth loss (67.5%) and performed comparably to GDs for periodontitis‐related tooth loss (76.2% vs. 76.3%). Calibration was substantially worse for AI (Brier score 0.247) than for periodontists and GDs (0.171, 0.170). Individually, AI performance overlapped with that of several clinicians. Conclusion: Clinicians outperformed AI under a fixed threshold, but AI performance was comparable to clinicians using optimal thresholds, situating AI within the range of experienced clinicians despite modest overall predictive ability.

Objectives: This cross‐sectional study primarily aimed at investigating the association between the transmucosal emergence geometry and the prevalence of peri‐implant diseases in bone‐ and tissue‐level implants (BL/TL). As secondary objectives, the association of other implant‐, prosthesis‐, and patient‐related variables with crestal bone levels (CBL) and additional radiographic findings was explored. Material and Methods: Patients with non‐molar single tooth implant‐supported prostheses were retrospectively identified for inclusion. Clinical and radiographic examinations were performed cross‐sectionally to assess peri‐implant diseases (peri‐implant mucositis, peri‐implantitis), emergence geometry at the transmucosal region (profile type, emergence angles at two levels, and prosthetic platform height), and peri‐implant radiographic variables, including CBL. Data were analyzed using multivariate regression. Results: A total of 332 implants (166 BL/166 TL) in 266 patients (60 ± 17 years) were evaluated at a mean of 11.2 ± 1.5 years after implant placement. Peri‐implant mucositis was significantly influenced by the crown emergence angle (Level 2; OR = 1.03, p = 0.01) and peri‐implantitis by implant diameter (OR = 3.82, p < 0.0001). Crown emergence angles > 30° in BL implants and > 48° in TL implants were consistently associated with peri‐implant diseases. Mean CBL was 0.54 ± 1.34 mm, with lower values in TL (−0.24 mm; p = 0.036), females (−0.27 mm, p = 0.029), and implants with greater platform height (−0.175 mm/mm, p = 0.01). Peri‐implant sheathing was detected in 13.4% of implants, showing no association with implant‐related characteristics. Conclusions: Wider crown emergence angles were associated with peri‐implant diseases, whereas wider implant diameters were associated with increased peri‐implantitis prevalence. TL implant design and greater platform height were associated with reduced CBL.

Objective: This narrative synthesizes current knowledge on the biological mechanisms, clinical challenges, and regenerative innovations for optimizing intraoral wound healing in the elderly. Methods: Narrative review of preclinical and clinical studies addressing age‐related changes in the four canonical wound‐healing phases (hemostasis, inflammation, proliferation, remodeling), tissue‐specific molecular pathways, systemic and local factors affecting repair, operative considerations, and emerging therapeutic modalities. Data sources included PubMed, Embase, and Cochrane databases through June 2025. Results: Aging compromises each repair phase. Hemostasis is prolonged by diminished platelet function and altered clot architecture. Inflammation is exacerbated by impaired neutrophil/phagocyte activity and persistent reactive oxygen species. Proliferation is slowed by reduced fibroblast proliferation and angiogenic signaling, while dysregulated matrix metalloproteinase activity impairs extracellular matrix remodeling. Tissue‐specific cues in oral mucosa, periodontal ligament, cementum, and bone are also altered with age. Compounding factors—including “inflamm‐aging,” malnutrition, polypharmacy‐induced xerostomia, cognitive decline, and frailty—further impede healing. Clinical optimization requires comprehensive preoperative risk and frailty assessments; medical/nutritional management; minimally invasive flap designs; tension‐free primary closure; streamlined surgical protocols to limit operative time; and postoperative monitoring with tailored communication. Emerging regenerative strategies—growth factors (PDGF, FGF), platelet concentrates, gene and cell‐based approaches (MSCs, exosomes), immunomodulatory scaffolds/agents, photobiomodulation, and AI‐driven risk dashboards—show promise for enhancing repair in aging populations. Conclusions: Effective oral wound healing in older adults demands a multidisciplinary, personalized approach that integrates meticulous perioperative care with novel regenerative modalities. Standardization and clinical validation of emerging therapies are essential to translate biological insights into improved patient outcomes.

Objectives: The 1st Global Consensus for Clinical Guidelines (GCCG) in Implant Dentistry introduced an innovative, evidence‐based approach to developing patient‐centered and practical recommendations for the rehabilitation of the edentulous maxilla. Within this framework, Group 1 aimed to formulate clinical recommendations on the number of implants required, timing of implant placement, and timing of loading. Materials and Methods: Group 1 followed the S2k‐level guideline framework of the Association of the Scientific Medical Societies in Germany (AWMF), using a structured nominal group technique. The evidence base included three systematic reviews evaluating clinician‐reported outcomes (ClinROs) and patient‐reported outcomes (PROs), supplemented by structured single‐round international surveys involving expert clinicians, patients, and cross‐disciplinary experts. Survey content covered diagnostics, treatment planning, clinical procedures, and maintenance care. Draft recommendations were discussed during the in‐person consensus meeting in Boston (June 16–18, 2025) and finalized through anonymous plenary voting. Consensus was defined as ≥ 75% and ≤ 95% agreement and strong consensus as > 95% agreement. Results: Group 1 formulated 12 clinical recommendations across the workflow domains of diagnostic tools, treatment planning, and treatment procedure. During plenary voting, three of these recommendations reached strong consensus, and nine achieved consensus. The number of voters per recommendation ranged from 61 to 90, with an average of 83. Conclusions: This consensus report provides structured, evidence‐based recommendations on implant number, placement timing, and loading protocols for rehabilitation of the edentulous maxilla. These guidelines are intended to support individualized, patient‐centered care while also identifying priority areas for future research.

The 1st Global Consensus for Clinical Guidelines (GCCG) in Implant Dentistry introduced an innovative, evidence-based approach to developing patient-centered and practical recommendations for the rehabilitation of the edentulous maxilla. Within this framework, Group 1 aimed to formulate clinical recommendations on the number of implants required, timing of implant placement, and timing of loading. Group 1 followed the S2k-level guideline framework of the Association of the Scientific Medical Societies in Germany (AWMF), using a structured nominal group technique. The evidence base included three systematic reviews evaluating clinician-reported outcomes (ClinROs) and patient-reported outcomes (PROs), supplemented by structured single-round international surveys involving expert clinicians, patients, and cross-disciplinary experts. Survey content covered diagnostics, treatment planning, clinical procedures, and maintenance care. Draft recommendations were discussed during the in-person consensus meeting in Boston (June 16-18, 2025) and finalized through anonymous plenary voting. Consensus was defined as ≥ 75% and ≤ 95% agreement and strong consensus as > 95% agreement. Group 1 formulated 12 clinical recommendations across the workflow domains of diagnostic tools, treatment planning, and treatment procedure. During plenary voting, three of these recommendations reached strong consensus, and nine achieved consensus. The number of voters per recommendation ranged from 61 to 90, with an average of 83. This consensus report provides structured, evidence-based recommendations on implant number, placement timing, and loading protocols for rehabilitation of the edentulous maxilla. These guidelines are intended to support individualized, patient-centered care while also identifying priority areas for future research.

To analyze the effect of root coverage surgical therapy for the treatment of single gingival recession defects (GRD) in terms of clinician‐ and patient‐reported outcomes (CROs and PROs), with an emphasis on esthetic perception. The protocol of this PRISMA 2020‐compliant systematic review was registered in PROSPERO (CRD517050). Relevant articles reporting the outcomes of randomized controlled trials (RCTs) were identified through a literature search. After final article selection, according to specific eligibility criteria, data were extracted and categorized. Primary outcomes were clinician‐reported root coverage esthetic scores (RES) and patient‐reported esthetic perception and satisfaction using different assessment methods, such as standardized visual analog scales (VAS). Data were analyzed and the risk of bias in all included studies was assessed. Fifty‐eight articles pertaining to 50 different RCTs were selected. A total of 1820 subjects presenting 2219 single GRDs were treated. Key findings derived from the pooled estimates indicated that root coverage and gingival phenotype modification therapy positively influenced both RES and patient‐reported esthetic perception and satisfaction values. Compared to the use of a coronally advanced flap (CAF) alone (i.e., monolaminar technique), the use of a CAF in conjunction with a subepithelial connective tissue graft (i.e., bilaminar technique) had a positive impact on both RES and VAS values, whereas CAF in conjunction with soft tissue substitutes only had a beneficial effect on VAS values. Surgical approaches based on lateral flap displacement were associated with superior mean RES values compared to techniques involving coronal flap displacement. Meta‐regression analyses revealed a statistically significant positive association between mean root coverage and RES (i.e., the greater the percentage of root coverage, the higher the RES). Conversely, the association between patient‐reported esthetic perception and MRC was not statistically significant. In addition, it was observed that dentinal hypersensitivity can be substantially reduced with surgical root coverage therapy, regardless of the treatment modality. Surgical therapy for the correction of single GRDs had a positive effect on both clinician‐reported esthetic scores and patient‐reported esthetic perception and satisfaction. Bilaminar techniques are generally associated with superior results.

This systematic review analyzed the long‐term outcomes of alveolar ridge preservation (ARP) and alveolar ridge reconstruction (ARR) before delayed implant placement. Eight studies were included (one non‐randomized clinical trial, one prospective case series, four retrospective comparative studies, and two retrospective case series). Risk of bias assessment, using a modified Newcastle–Ottawa Scale, revealed one high‐quality study, four medium‐quality studies, and three with low methodological quality. In total, 333 patients underwent ARP or ARR, with the most common approach involving xenogeneic bone grafting and socket sealing with a collagen membrane, matrix, or dressing. Follow‐up ranged from 5 to 10 years. Due to methodological heterogeneity and limited data, quantitative analysis was not feasible. The implant survival rate was the most frequently reported outcome, followed by peri‐implant marginal bone level changes and peri‐implant disease incidence. Despite limited evidence, ARP and ARR appear to support favorable long‐term outcomes, particularly in implant survival and bone stability. Further well‐designed, large‐scale studies comparing different ARP and ARR modalities with other therapies are needed to guide clinical decision‐making.

Background: Aesthetics and patient‐reported experiences (PREs) and outcomes (PROs) influence treatment choices, but have been largely overlooked in periodontology and implant dentistry. This consensus conference evaluated these factors by focusing on gingival recession defects (GRDs), immediate or early/delayed implant placement and peri‐implant buccal soft‐tissue dehiscences.Methods: The workshop discussions were informed by five specifically commissioned systematic reviews covering PREs, PROs and clinician‐reported outcomes (CROs), including effectiveness, aesthetics and other concerns.Results: Following treatments such as coronally advanced flaps (CAFs) with a connective tissue graft (CTG) for root coverage (RC), a positive correlation was noted between clinician‐reported aesthetic scores and RC measures for GRDs. However, a corresponding correlation for patient‐reported aesthetic perceptions was not evident. In dental implant procedures, the addition of a CTG immediately after implant placement significantly mitigated the apical shift in the mid‐facial mucosal level. However, clinician‐ and patient‐reported aesthetic scores were not reflective of these changes. Neither set of scores captured the impact of grafting on improving peri‐implant soft‐tissue volume. In the treatment of peri‐implant dehiscences, soft‐tissue augmentation (STA), using CTG beneath CAF, resulted in favourable outcomes in clinician‐ and patient‐perceived aesthetics.Conclusions: Clinician and patient views provide complementary perspectives for evidence‐based clinical decision making. They need to be integrated into select interventions. Specific trials are needed encompassing PREs, PROs and CROs and reporting benefits and harms.