Antonio Barone

Aim: This randomized clinical trial evaluated soft tissue thickness (STT) around immediate implants with or without soft tissue augmentation using a volume‐stable collagen matrix (VCMX). Secondary outcomes included clinical, esthetic, volumetric, and patient‐reported outcomes. Materials and Methods: Participants received immediate implants in the anterior esthetic zone with (Test) or without (Control) simultaneous VCMX augmentation. Outcomes were assessed before surgery, immediately after surgery, and at 6 and 12 months. The primary outcome was STT. Within‐ and between‐group comparisons were performed using the Friedman rank test and Mann–Whitney U test, respectively. Secondary outcomes included mucosal level (ML), marginal bone level (MBL), esthetic and patient‐reported outcomes, and volumetric changes. Results: Thirty‐eight out of 40 patients completed the study. STT was significantly greater in the Test group at all follow‐ups ( p < 0.05). At 12 months, STT in the Test group increased significantly at 3 mm from the gingival margin (1.85 mm, SE 0.19, p < 0.0001) and non‐significantly at 6 mm (1.29 mm, SE 0.24, p = 0.0917), whereas STT in the Control group decreased non‐significantly at 3 mm (0.18 mm, SE 0.18, p = 0.6213) and at 6 mm (0.36 mm, SE 0.10, p = 0.1054). ML remained stable in the Test group but showed significant recession in the Control group. Selected esthetic and patient‐reported outcomes favored the Test group. MBL did not change significantly over time in either group. Volumetric analysis showed no significant change over time in the Test group, whereas the Control group showed significant shrinkage ( p = 0.0201). Conclusions: VCMX augmentation may improve soft tissue stability around immediate implants. Trial Registration: The study protocol was registered on September 20, 2021 in the ClinicalTrials.gov database (registration number: NCT05081284)

This narrative review provides a contemporary synthesis of lateral cephalometric radiography (LCR), addressing both its foundational principles and the impact of technological integration, with a focus on enhancing diagnostic reliability. A structured literature search (PubMed, up to September 2025) was conducted around five domains: LCR’s diagnostic role, acquisition methods, positioning errors, comparisons with cone-beam computed tomography (CBCT), and Artificial Intelligence (AI)-driven quality control. Precise patient positioning—maintaining symmetry and a horizontal Frankfort plane—is paramount, as common errors (tilting, rotation, nodding) introduce quantifiable inaccuracies in key measurements. While digital innovation, particularly deep learning models for automated landmark detection and error flagging, improves the consistency of workflow, current AI tools require validation and human oversight to manage limitations in generalizability. When contextualized against three-dimensional imaging, LCR maintains a favorable balance of diagnostic utility and lower radiation dose, supporting its selective, indication-based use in contemporary practice. Ultimately, this review suggests that adherence to a meticulous acquisition technique remains the cornerstone of reliable LCR analysis, even as AI and digital tools evolve to augment the clinician’s role.

Adequate peri-implant hard and soft tissue volume is critical for ensuring implant stability, long-term functionality, and optimal esthetic results. While autogenous connective tissue grafts (CTGs) remain the gold standard for soft tissue augmentation, volume-stable collagen matrices (VCMXs) have emerged as a promising alternative, offering key advantages such as eliminating donor-site morbidity, reducing postoperative pain, and improving patient acceptance. This review summarizes the evidence on VCMXs from studies published between 1995 and 2024, with a focus on mucosal thickness gain, soft tissue stability, and patient-reported outcomes. To date, the evidence on VCMXs is still conflicting. Randomized controlled trials indicate that VCMXs can effectively increase peri-implant mucosal thickness (ranging from 0.3 to 1.0 mm), although the included clinical studies are very heterogeneous in terms of follow-up time. According to the literature, CTGs demonstrate superior long-term volumetric stability, particularly in highly esthetic zones. On the other hand, VCMXs demonstrated comparable mid-term outcomes while offering reduced postoperative discomfort, as confirmed by multicenter noninferiority trials. While VCMXs may yield slightly inferior clinical outcomes compared to CTGs, their patient-centered benefits make them a viable and often preferable option for soft tissue augmentation in implant dentistry. In conclusion, current evidence supports the use of VCMXs as valuable tools in contemporary implant therapy, particularly for specific indications where their benefits outweigh limitations.

Objectives: Ameloblastoma is a locally aggressive odontogenic tumor of the jaws characterized by a high recurrence rate. This work aims to present our clinical experience in managing patient oral rehabilitation following an extensive mandibular ameloblastoma, with a specific focus on mandibular reconstruction using a fibula free flap, followed by dental implant placement and prosthetic rehabilitation in a female patient. Additionally, we provide a comprehensive review of the current evidence on surgical management, reconstruction techniques, and long-term outcomes in ameloblastoma treatment. Methods: A 44-year-old female patient presented with a painless swelling in the left mandible. Orthopantomography (OPG) and computed tomography (CT) demonstrated a well-defined radiolucent lesion extending from the canine to the second premolar. An incisional biopsy was performed, and histopathological examination confirmed the diagnosis of mandibular ameloblastoma. The patient underwent segmental resection of the left mandibular body, followed by immediate reconstruction using a vascularized fibular free flap. Eighteen months postoperatively, four dental implants were placed. One implant failed during the osseointegration phase and was removed. Due to residual hard and soft tissue deficiency, prosthetic rehabilitation was achieved with a metal-reinforced resin overdenture, restoring both function and aesthetics. Results: At the three-year follow-up, clinical and radiographic examinations revealed no evidence of tumor recurrence. The patient remained asymptomatic, reporting neither pain nor functional discomfort. Prosthetic rehabilitation with the metal-reinforced resin overdenture was successfully completed, achieving satisfactory masticatory function and aesthetics. Conclusions: The use of the fibula free flap for mandibular reconstruction after ameloblastoma resection provides excellent flexibility, enabling effective bone integration of dental implants.

A thermosensitive collagen-based gel (TSV gel), containing type I and III collagen, has been developed to improve the handling and stability of bone graft materials. However, its direct effect on osteoblasts is not well understood. This in vitro study evaluated the biological response of human oral osteoblasts to four bone substitutes: OsteoBiol^® GTO^® (larger granules with 20% TSV gel), Gen-OS^® (smaller granules), Gen-OS^® combined with 50% TSV gel (Gen-OS^®+TSV), and TSV gel alone. Cell proliferation, adhesion, morphology, collagen and calcium deposition, alkaline phosphatase (ALP) activity, gene expression of osteogenic markers and integrins, and changes in pH and extracellular calcium and phosphate levels were investigated. All materials supported osteoblast activity, but Gen-OS+TSV and GTO showed the most pronounced effects. These two groups promoted better cell adhesion and proliferation, higher ALP activity, and greater matrix mineralization. GTO improved cell adhesion, while the addition of TSV gel to Gen-OS enhanced biological responses compared with Gen-OS alone. Integrins α2, α5, β1, and β3, important for cell attachment to collagen, were notably upregulated in Gen-OS+TSV and GTO. Both groups also showed increased expression of osteogenic markers such as BMP-2, ALP, and osteocalcin (OCN). Higher extracellular ion concentrations and a more alkaline pH were observed, particularly in conditions without cells, suggesting active ion uptake by osteoblasts. In conclusion, combining TSV gel with collagen-based granules improves the cellular environment for osteoblast activity and may support bone regeneration more effectively than using either component alone.

Amelanotic melanocytic nevi of the oral cavity are uncommon lesions that often present a diagnostic challenge for clinicians, primarily due to their nonspecific clinical appearance and the broad spectrum of possible differential diagnoses. These lesions can mimic a variety of benign and malignant conditions, requiring precise histopathological confirmation. The primary objective of this article is to present a comprehensive case report—tracing the course from initial presentation through diagnostic workup to final diagnosis—and to provide an overview of the current literature on oral amelanotic melanocytic nevi. We report the case of a 27-year-old female who presented with a small, exophytic mass located in the anterior mandibular gingival region. The lesion was asymptomatic and lacked pigmentation, adding to the diagnostic uncertainty. A range of differential diagnoses was considered, including pyogenic granuloma, peripheral ossifying fibroma, and squamous cell carcinoma. Due to the lesion’s limited size and accessibility, an excisional biopsy was performed under local anesthesia. Histopathological examination revealed an amelanotic melanocytic nevus, a rare variant characterized by the absence of melanin pigment, further complicating the clinical impression. The diagnosis was confirmed through immunohistochemical staining, which demonstrated melanocytic markers consistent with a nevus. The patient was followed up with for six months postoperatively, with no evidence of recurrence or malignant transformation. This case highlights the critical role of biopsy in achieving a definitive diagnosis, especially in lesions with atypical clinical presentations. It also underscores the importance of considering amelanotic melanocytic nevi in the differential diagnosis of nonpigmented oral lesions, as well as maintaining vigilance regarding the rare possibility of amelanotic melanoma.

The prosthetic emergence profile is a factor potentially affecting marginal bone level around dental implants. The aim of this review is to provide a comprehensive analysis of the influence of the prosthetic emergence profile on peri-implant marginal bone-level stability. The marginal bone level is an important parameter in implant dentistry, reflecting the stability of dental implants, and it is a critical indicator of long-term implant success. Minimizing marginal bone loss around dental implants is a key factor for maintaining implant function, supporting peri-implant soft tissues, and achieving predictable aesthetic outcomes. The scientific literature presents various examples of evidence on the influence of emergence angle and prosthetic designs on marginal bone loss. Several studies suggest that emergence angles exceeding 30° and convex prosthetic designs may increase the risk of peri-implantitis and bone resorption, while others find no significant correlation. Moreover, several studies demonstrated the positive influence of taper joint connections on marginal bone stability. Although the current literature remains diverse, it is essential to prioritize cleanability and minimize plaque accumulation for a successful implant-prosthetic restoration. Proper maintenance and a continuous follow-up to monitor marginal bone loss are beneficial for obtaining stable and optimal long-term results.

Background: Sjögren’s disease (SD) is an autoimmune condition causing progressive salivary and lacrimal glands dysfunction following lymphocytic infiltration in the glandular tissue. SD patients are more prone to oral health impairment due to a reduction in salivary flow. This study evaluated the relationship between oral health, functional tests, and patient reported outcomes in a cohort of SD patients. Methods: Patients diagnosed with SD underwent complete dental examination, with the recording of the decayed–missing–filled teeth index (DMFT), probing pocket depth (PPD), full mouth bleeding score (FMBS), and full mouth plaque score (FMPS). Hyposalivation was assessed using the unstimulated whole saliva flow rate (UWS). Patients were administered the European League Against Rheumatism (EULAR) Sjögren’s Syndrome Patient Reported Index, EULAR Sjögren’s syndrome disease activity index, Oral Health Impact Profile-14 (OHIP-14), Patient Acceptable Symptom State questionnaires, and a visual analog scale for xerostomia (VASx). Results: Fifty patients in total were enrolled. Reduced UWS was associated with higher DMFT, FMBS, and FMPS. Significant correlation was observed for UWS with VASx and OHIP-14 (p < 0.05). Conclusions: Quality of life and oral health appear mildly impaired in SD patients as an effect of reduced salivary flow, with higher DMFT and tendency towards gingival inflammation and plaque accumulation.

The use of zirconia for full-arch Implant-Supported Fixed Complete Dental Prostheses (ISFCDPs) is common and reliable, with different techniques available for their design and fabrication. This retrospective study investigated prosthetic and implant survival/success rates and patients’ satisfaction for ISFCDPs produced with three different techniques: zirconia-on-titanium (milled zirconia arch glued to a titanium bar), progressive monolithic zirconia (entirely made of zirconia and directly screwed to the implants) and zirconia-on-zirconia (milled esthetic zirconia crowns glued to a milled high resistance zirconia frame). Fourteen patients (five males, nine females) aged 52–80 and treated with 14 ISFCDPs (86 implants) were included in this analysis. The mean follow-up at the time of recall was 36 months. Prosthetic and implant-related success rates were, respectively, 92.86% and 95.35%. No failures have been reported. One case of prosthetic chipping was observed; however, it was successfully repaired intraorally. Patients’ satisfaction was high: 78.57% were completely satisfied, 14.53% very satisfied and 7.14% satisfied. In conclusion, all the patients recommend treatment with ISFCDPs as full-arch prosthetic rehabilitation. The present study demonstrates positive clinical outcomes and high patients’ satisfaction. Further long-term, prospective studies with a larger cohort of patients are needed to confirm the advantages of the different prosthetic designs.

This study aimed to describe a case of simultaneous guided bone regeneration (GBR) and implant placement in a patient with prior aesthetic implant failure, focusing on achieving optimal aesthetic and functional outcomes, and to perform a literature review of the current evidence. A 38-year-old male presented with an improperly positioned implant at the level of the right upper central (tooth 2.1), leading to aesthetic and functional issues. The initial assessment included a panoramic radiograph revealing marginal bone loss and an enlarged peri-implant space, necessitating implant removal. Following implant removal and provisional restoration, the patient was re-evaluated for subsequent therapeutic treatments. The patient underwent orthodontic treatment to improve mesio-distal spacing, followed by surgical intervention involving GBR and simultaneous implant placement. The GBR procedure utilised bone substitutes and resorbable membranes, with soft tissue augmentation conducted subsequently. The surgical intervention involved local anaesthesia, flap design, defect assessment, and palatally oriented implant placement. GBR was then performed. After six months, implant uncovering and soft tissue augmentation were conducted. The implant was loaded with a screwed restoration following complete hard and soft tissue healing. The patient was monitored every six months for two years, then annually. At the 10-year follow-up, no signs of bone resorption or soft tissue inflammation were observed. This case demonstrated that GBR and simultaneous implant placement, with the application of advanced biomaterials, effectively promoted osseointegration and maintained aesthetic and functional stability over a decade.