Andrea Ravidà

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.

Aim: To critically appraise the methodological quality and historical evolution of prognostic models for periodontitis. Materials and Methods: A systematic search was conducted in three databases. Eligible studies were classified as conceptual tools, category‐based tools and data‐driven models. Category‐based and data‐driven models were evaluated with PROBAST. Risk of bias (ROB) was compared across four domains: Participants, Predictors, Outcome and Analysis. Results: Twenty‐seven studies were included. Prognostic methods evolved from qualitative risk categories and expert‐based classifications towards quantitative, individualised probability estimates generated through multivariable statistical and machine‐learning models, alongside progressive improvements in outcome definition, prediction time and risk expression formats. Conceptual tools were not evaluable under PROBAST due to the absence of empirical data. Category‐based tools showed limitations in predictor handling and validation rather than bias per se. Data‐driven models demonstrated progressive refinement: earlier studies lacked consistent validation, whereas recent models more frequently report internal validation, calibration metrics and external validation. However, all studies except one were classified as high ROB. Domain‐level assessment showed strengths in the Participants domain but persistent limitations in the Analysis domain. Methodological improvements after TRIPOD were modest. Conclusion: Prognostic models reflect distinct methodological profiles across design type. Conceptual and category‐based frameworks remain clinically relevant historically, while data‐driven models represent the contemporary standard but retain important methodological gaps. Trial Registration: PROSPERO number: CRD42024525505

Objectives: Vertical ridge deficiency remains one of the most challenging conditions in preimplant surgery. Several techniques aim to restore lost vertical alveolar height, each with specific indications and limitations. Although these procedures often yield favorable short‐term outcomes with stable bone levels, their long‐term performance is crucial for determining true clinical value. Materials and Methods: A systematic search of three databases identified 614 records, of which 35 studies met the eligibility criteria of a minimum of 5 years of follow‐up that performed vertical ridge augmentation. This review applied a domain‐based evaluation framework derived from the Implant Dentistry Core Outcome Set and Measurement (ID‐COSM) and the Bone Augmentation Core Outcome Set (BA‐COSM). Implant survival and marginal bone loss were synthesized using random‐effects models with inverse‐variance weighting, with analyses stratified by follow‐up duration and vertical ridge augmentation approach. Results: Implants placed in vertically augmented bone showed high long‐term success, with survival rates of 96% at 5 years, 94% at 10 years, 98% at 15 years, and 95% at 20 years. Marginal bone levels remained stable, with a mean bone loss of 0.67 mm at 5 years and 0.72 mm at 10 years, 1.52 mm at 15 years and 1.53 mm at 20 years. Conclusions: Vertical ridge augmentation techniques support predictable implant survival and bone stability. However, heterogeneous reporting of outcomes limits comparability. A standardized, domain‐based framework enhances evidence synthesis and clinical relevance in implant dentistry.

Objective: To evaluate the incomplete success rate (ISR) of non‐surgical periodontal therapy (NSPT) performed by registered dental hygienists, considering periodontitis staging and grading and multiple tooth‐ and patient‐level factors. Methods: Data from patients with periodontitis treated by registered dental hygienists at the University of Michigan were analysed. A complete medical history, periodontal chart and full‐mouth radiographs were collected before NSPT (T0), and clinical periodontal parameters were recorded at re‐evaluation (T1). Tooth‐level ISR (tISR) was defined as the percentage of teeth with residual pocket depth (PD) > 4 mm [Condition 1 (C1)], or PD of 5 mm with bleeding on probing, or PD ≥ 6 mm [Condition 2 (C2)]. Patient‐level ISR (pISR) was calculated as the percentage of patients with at least one tooth meeting the criteria for C1 or C2 at T1. Multivariate analyses assessed the impact of staging, grading and other tooth‐ and patient‐level factors on ISR outcomes following NSPT. Results: A total of 1818 teeth from 133 patients were re‐evaluated 113.2 ± 85 days after NSPT. The tISR was 28.6% and 20.6% for C1 and C2, respectively; while the pISR was 75.9% and 65.4%. Factors linked to higher tISR for both C1 and C2 included baseline PD and multi‐rooted teeth. Smokers and former smokers had more teeth with pathological sites under C1. Higher tISR under C2 was observed in cases presenting radiographic bone loss > 33%. Advanced stage of periodontitis significantly predicted higher pISR for C1, with Stage III‐IV patients over twice as likely to exhibit higher pISR than Stage II (OR = 2.35; p = 0.042). Conclusion: Advanced periodontitis stage at T0 significantly predicts higher pISR values, particularly for C1. tISR after NSPT is influenced by baseline PD, number of roots for both conditions and smoking for C1.

Aims: To externally validate the potential applicability of the 2018 classification of periodontal diseases as a risk assessment tool, through the use of a nomogram built on a multivariate predictor model.Materials and Methods: Data from 459 patients with periodontitis, across four cohorts (three in the United States, and one in the United Kingdom), were retrospectively analysed. After staging and grading periodontitis before active periodontal therapy (APT), patients were categorised by the model as having ‘low tooth loss’ (≤ 1 teeth lost due periodontal reasons [TLP]) or ‘high tooth loss’ (≥ 2 TLP) at a 10‐year follow‐up. Model discrimination was evaluated using the area under the receiver operating characteristic (AUC‐ROC) curve. Calibration was assessed through calibration plots, calibration‐in‐the‐large (CITL), calibration slope and the expected:observed (E:O) ratio. Recalibration methods, including Temperature Scaling, Isotonic Regression and Beta Calibration, were also tested.Results: The original nomogram yielded an aggregate AUC‐ROC 0.72 but showed poor calibration. Isotonic recalibration improved the AUC‐ROC to 0.77 and enhanced calibration metrics, achieving an E‐statistic of 1.00, CITL of 0.00 and a calibration slope of 1.00.Conclusion: A nomogram based on the components of the 2018 periodontal disease classification can serve as a prognostic tool with cross‐site applicability across clinical settings in industrialised countries, accurately predicting the 10‐year risk of tooth loss due to periodontitis from the initial assessment conducted before the start of APT.

Aims: This non‐inferiority randomised clinical trial aimed to compare vertical bone gain (VBG), volumetric bone changes and incidence of complications after vertical ridge augmentation (VRA) using perforated titanium‐reinforced dense‐polytetrafluoroethylene (PTFE) mesh covered by a collagen membrane (CM) or used alone. Materials and Methods: Thirty patients with vertical bone defects were randomly assigned to receive VRA with either PTFE + CM or PTFE alone. Meshes were removed after 9 months. Clinical assessments included complication rates, pseudo‐periosteum type and bone density. VBG, effective regeneration rate and the need for additional augmentation were evaluated using CBCT reconstructions. Results: Non‐inferiority of PTFE alone compared with PTFE + CM was not demonstrated for absolute and relative VBG (4.5 ± 2.1 mm vs. 4.1 ± 2.7 mm, 79.2% ± 16.6% vs. 85.8% ± 10.6%, respectively), effective regeneration rates (69.3% ± 17.9% vs. 72.3% ± 16.4%, respectively) or complication rates (6.7% in both groups). A higher incidence of type 1 pseudo‐periosteum was observed in the PTFE + CM group. Conclusion: The non‐inferiority of PTFE alone compared with PTFE + CM for absolute VBG was not established. However, both techniques led to comparable outcomes for VBG, complication rates and bone density. The higher incidence of type 1 pseudo‐periosteum and lacking bone volume in the PTFE + CM group suggests that adding a collagen membrane may help prevent soft tissue ingrowth. Trial Registration: Clinicaltrials.gov identification number: NCT04843488

Introduction: This study aimed to investigate the combined effect of trans‐mucosal abutment height (TmAH) and restorative emergence angle (REA) on marginal bone loss (MBL) around bone‐level implants.Methods: Implant radiographs 12–18 months after crown placement (T0) and at least one year later (T1) were retrospectively analyzed. Sites were separated into four groups: Long/Narrow‐Angle (LN) with TmAH > 2 mm and REA < 30°, Long/Wide‐Angle (LW) with TmAH > 2 mm and REA ≥ 30°, Short/Narrow‐Angle (SN) with TmAH < 2 mm and REA < 30°, and Short/Wide‐Angle (SW) with TmAH < 2 mm and REA ≥ 30°. MBL was calculated, and multiple linear regression analysis was performed to control for patient‐level and implant/prosthesis‐level factors.Results: 192 implants pertaining to 119 patients were included. Group significantly influenced MBL experience (p < 0.001). Group SW experienced on average 0.48 mm (95% CI: 0.25–0.71, p < 0.001), 0.43 mm (95% CI: 0.18–0.68, p = 0.001), and 0.25 mm (95% CI: 0.00–0.45, p = 0.013) greater MBL compared to Groups LN, LW, and SN, respectively. Group was also a significant factor impacting the development of peri‐implantitis (p = 0.041), with Group SW displaying a roughly 4× greater likelihood of having peri‐implantitis (PI) diagnosed compared to Groups LN (OR: 4.04; p = 0.091) and LW (OR: 4.19; p = 0.013). Every 1 mm increase in TmAH significantly decreased the likelihood of MBL > 0 mm (OR = 0.63; p = 0.003).Conclusions: Abutment height > 2 mm may play a role in reducing PI and MBL related to ≥ 30° REA around bone‐level implants. REA was found to only be a significant factor when TmAH is less than 2 mm.

Objectives: This 5‐year multicenter randomized clinical trial assessed the non‐inferiority of maxillary implant‐supported fixed complete dentures (FCDs) with four (4‐I) compared to six implants (6‐I) in terms of radiographic marginal bone level (MBL) changes after 5 years in function.Materials and Methods: Individuals were randomly assigned to the 4‐I or 6‐I groups. Follow‐ups occurred at 1, 3, and 5 years. At each visit, FCDs were unscrewed, clinical parameters (plaque index, bleeding on probing, pocket depth, and keratinized mucosa width) were recorded using a periodontal probe, periapical radiographs were obtained, and maintenance care was performed. MBL changes, incidence of techincal, prosthetic, and biological complications, treatments costs, and satisfaction were evaluated.Results: Of 47 patients rehabiliated with 233 implants, survival rates were 99.3% for 6‐I and 100% for 4‐I (one early failure; 6‐I group). No significant MBL differences were observed at 5 years between and within the groups. Both groups showed a decrease in keratinized mucosa width and experienced prosthetic and biological complications, but no peri‐implantitis. The 4‐I exhibited a significantly higher incidence of technical complications (16.6% vs. 0%) Cost analysis favored 4‐I for initial and total costs. Clinician and patient satisfaction varied, with 4‐I preferred aesthetically and 6‐I functionally, particularly in speaking ability at earlier follow‐ups.Conclusion: The use of FCDs supported by four implants is non‐inferior to six implants in terms of radiographic MBL changes after 5 years in function. Both groups demonstrated comparable survival rates and incidence of biological and prosthetic complications. The 4‐I was associated with higher technical complications and reduced overall treatment cost.Trial Registration: ClinicalTrials.gov identifier: NCT02405169

Objective: The objective of this study is to compare the effect of the location of recombinant human bone morphogenetic protein 2 (rhBMP‐2) from the native bone and the periosteum for vertical alveolar bone augmentation.Materials and Methods: Mandibular, chronic, standardized, bilateral, and vertical defects in 12 beagle dogs were evaluated using four modalities: a xenograft alone (XENO; n = 6); rhBMP‐2 alone (BMP; n = 6); a technique with rhBMP‐2 close to the host bone covered by xenograft (SAN; n = 6); and a technique with rhBMP‐2 close to the flap on top of the xenograft (LAS; n = 6). After 8 weeks, a series of in vivo inspections, fluorescence microscopy, histologic and histomorphometric evaluations, and micro‐CT analyses.Results: After 8 weeks of healing, new bone formation correlated with proximity of rhBMP to the perforated membrane with BMP and LAS (p = 0.024). The highest total bone volume was found in the LAS group (45.1% ± 13.3%), followed by the SAN group (35.2% ± 6.7%), BMP group (33.1% ± 11.8%), followed by the XENO group (23.1% ± 6.5%). The SAN group demonstrated frequent seroma formation. Blood vessel formation was more pronounced in the LAS + rhBMP group, with a significant increase of 27.1% compared to the XENO group (p = 0.02). Micro‐CT revealed a strong trend for higher bone volume in the BMP group (34.7%) compared to the XENO group (13.6%) (p = 0.06). Only rhBMP‐2 groups demonstrated bone formation above the perforated membrane.Conclusion: The location of rhBMP‐2 in relation to the biomaterial and periosteum influenced the effectiveness of vertical bone regeneration.

Objective: This study aimed to assess clinical efficacy of 4‐mm‐short implants in patients with posterior severe vertical bone atrophy in the medium‐ and long‐term follow‐up.Materials and Methods: Patients rehabilitated with 4‐mm‐short implants in the posterior atrophic jaws, with a minimum follow‐up of 3 years post‐loading, were included in the study. Data were collected for eligible patients, and marginal bone loss (MBL) for each implant was evaluated. The research outcomes were implant failure, MBL and complications.Results: A total of 212 patients with 496 implants were included, resulting in a mean follow‐up of 8.02 ± 2.17 years. The implant survival rate was 95.36% (95% CI: 93.12%–97.04%). More implant failures were observed in the maxilla (p = .02) and fewer failures were observed in patients undergoing more number of hygienic sessions per year (p < .001). The average MBL after 1‐year‐loading was 0.47 mm, increasing to 0.59 mm after 10 years; after 3 years no statistically significant increase in MBL was observed. Maxillary implants showed greater bone loss than mandibular ones (p < .001). More frequent professional oral hygiene sessions per year resulted being related with reduced MBL (p < .001).Conclusions: Four‐mm‐short implants showed high survival rates with an up to 10‐year follow‐up. Their use can offer a fixed prosthetic solution for patients with posterior vertical bone atrophy, minimizing surgical invasiveness, rehabilitative times and costs.