Massimo de Sanctis

Aim: Evaluate the efficacy of adjunctive mechanical/physical decontamination to non‐surgical submarginal instrumentation in patients with peri‐implantitis. Material and Methods: Patients with at least one implant diagnosed with peri‐implantitis were included in this 6‐month single‐masked randomized clinical trial with three parallel groups: non‐surgical submarginal instrumentation with titanium curettes (control); control plus erythritol air‐polishing (test 1) and control plus Er:YAG laser (test 2). Clinical variables were collected at baseline, 1, 3 and 6 months. The primary outcome was probing pocket depth (PPD) reduction. Secondary outcomes included bleeding on probing (BoP) reduction and endpoint of therapy (implants with PPD ≤ 5 mm, BoP ≤ 1 site, no suppuration). A multilevel logistic model was computed to evaluate the predictive value of implant‐ and patient‐level variables. Results: Forty‐seven patients (84 implants) were enrolled. PPD reductions were observed in all groups (mean: 1–1.4 mm at 1 month), remaining stable at 3 months, with slight relapse at 6 months. All treatments led to significant BoP reduction (24%–36%) at 1 month, with no further significant changes at later follow‐ups and no intergroup differences. Therapeutic endpoint rates were 12%–18%. Multilevel analysis suggested an association between the presence of ≥ 2 mm vestibular keratinized mucosa and the use of Er:YAG with higher odds of achieving treatment success. Healing was uneventful in all groups, except for one case of surgical emphysema associated with erythritol air‐polishing. Conclusion: Irrespective of the adjunctive treatment modality, achievement of peri‐implantitis therapeutic endpoint was limited across groups. Possible associations with treatment outcomes were observed; these findings require confirmation in larger studies. Trial Registration: ClinicalTrials.gov identifier: NCT03451981

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.

Aim: To assess the efficacy of Er:YAG laser (ERL) and erythritol powder air‐polishing (AP) in addition to the submarginal instrumentation in the non‐surgical treatment of peri‐implant mucositis (PM).Materials and Methods: Patients with at least one implant diagnosed with PM were included in the present 6‐month randomized clinical trial (RCT). Implants were randomly assigned to one of the three treatment groups after submarginal instrumentation: AP (test 1 group), ERL (test 2 group) or no adjunctive methods (control group). The primary and secondary outcomes were, respectively, bleeding on probing (BoP) reduction and, complete disease resolution (total absence of BoP) and probing pocket depth (PPD) changes. The patient and the implant were considered the statistical unit. A multivariate logistic regression analysis was performed.Results: A total of 75 patients were enrolled in the study. At each time point, significant BoP and PPD reductions were observed within each group. Intergroup analysis did not show statistically significant differences. Complete disease resolution ranged between 29% and 31%. The logistic regression showed that supramucosal restoration margin, PPD < 4 mm and vestibular keratinized mucosa (KM) significantly influenced the probability to obtain treatment success.Conclusion: The adjunctive use of AP and ERL in PM non‐surgical therapy does not seem to provide any significant or clinically relevant benefit in terms of BoP and PPD reductions and complete disease resolution, over the use of submarginal instrumentation alone. Baseline PPD < 4 mm, presence of buccal KM and supramucosal restoration margin may play a role in the complete resolution of PM.

Aim: The present pilot RCT aimed to investigate the influence of a connective tissue graft (CTG) in combination with the immediate implant placement (IIP) on hard and soft tissue healing, without a bone replacement graft in the gap between the implant and the socket walls.Materials and Methods: Thirty patients requiring extraction of one anterior tooth (from premolar to premolar) were randomly assigned to one of the two treatment groups (test: IIP + CTG; control: IIP). Cone‐beam computed tomography and optically scans were performed before tooth extraction and at 6‐month follow‐up. Then, DICOM files were superimposed in order to allow the evaluation of osseous ridge and buccal bone changes, while the superimposition of DICOM and Standard Tessellation Language files allowed for evaluating of soft tissue contour. For testing the differences between the two groups, the non‐parametric test as Wilcoxon rank‐sum test, was used.Results: Twenty‐six of the 30 enrolled patients attended the 6‐month follow‐up visit. The four patients of the control group that were lost to follow‐up were analysed under the intention‐to‐treat principle. No statistically significant differences between the groups were observed for the vertical buccal bone resorption (p = .90), as well as for the horizontal buccal bone resorption at all measured levels. Significant differences were found between the test and control groups in the horizontal dimensional changes of osseous ridge at the most coronal aspect (p = .0003 and p = .02). Changes in tissue contour were between −0.32 and −0.04 mm in the test group and between −1.94 and −1.08 mm in the control group, while changes in soft tissue thickness varied between 1.33 and 2.42 mm in the test group and between −0.16 and 0.88 mm in the control group, with statistically significant differences for both variables at all measured levels. At 6 months, the mean volume increase was 6.76 ± 8.94 mm³ and 0.16 ± 0.42 mm³ in the test and control groups, respectively, with a statistically significant difference.Conclusions: The findings of the present study indicate that the adjunct of a CTG at the time of IIP, without bone grafting, does not influence vertical bone resorption. Within the limits of this study, it can be suggested that the adjunct of a CTG at the time of IIP, without bone grafting, reduces the horizontal changes of the alveolar ridge. Moreover, it allows maintenance of the tissue contour due to an increase in soft tissue thickness.

Massimo de Sanctis, DDM/Giovanna Laura Di Domenico, DDS/Alessandra Bandel, DDS/Chantal Pedercini, DDS/Davide Guglielmi, DDS: The aim of this present prospective study was to evaluate the outcomes of the multiple coronally advanced flap (MCAF) with a site-specific application of connective tissue graft (CTG) for the treatment of multiple gingival recession defects with or without the presence of noncarious cervical lesions (NCCLs). Analysis of periodontal conditions was performed in order to determine if the cementoenamel junction (CEJ) restorations could affect adequate plaque control as well as maintenance over time. A total of 93 gingival recessions were treated, 61% of which presented a NCCL restored with composite resin positioned 1 mm apical to the position of the anatomical CEJ. The surgical treatment involved MCAF+CTG for 54 sites and MCAF alone for 39 sites. At 12 months, complete root coverage (CRC) and periodontal parameters of restored and nonrestored teeth were assessed, and the differences between the two groups were not significant. It can be concluded that the proposed treatment modality does not produce a negative effect on periodontal condition and amount of CRC, thus resulting in a satisfactory esthetic result.

Aim: To assess the effectiveness, in terms of clinical performance and patient perception, of minimally invasive periodontal surgeries (MIPSs), and to compare MIPSs to traditional surgery in the treatment of periodontal infrabony defects.Materials and Methods: An electronic search and a manual search were carried out to identify studies investigating clinical (CAL, PPD, REC), radiographic (bone fill) and patient's centred (VAS) outcomes at least 6 months after MIPSs. A linear mixed‐effect model was used for meta‐analysis. Subgroup analyses were performed according to the study quality (RCT or case series). A meta‐analysis assessing differences in clinical parameters between MIPSs and traditional flaps was also performed.Results: Meta‐analysis from the 18 included studies revealed a PPD reduction of 4.24 mm (95% CI = 3.79–4.69 mm), a CAL gain of 3.89 mm (95% CI = 3.42–4.35 mm), a REC increase of 0.44 mm (95% CI = 0.11–0.77 mm), a radiographic bone fill gain of 58.25% (95% CI = 42.30%–74.21%) and a VAS value of 1.16 (95% CI = 0.78–1.54). Based on 2 RCTs, MIPSs are more effective than traditional surgery for PPD reduction (0.93 mm, 95% CI = 1.71–0.15) and CAL gain (1 mm, 95% CI = 1.75–.24).Conclusion: Minimally invasive periodontal surgeries may be considered for the treatment of periodontal infrabony defects. However, the real effect cannot be systematically evaluated due to the paucity of studies comparing MIPSs to traditional flap for periodontal reconstructive surgery.

The aim of this cross-sectional study is to (i) determine the prevalence, extent, severity, and distribution of gingival recessions and patient perception in a young population and (ii) to identify potential risk indicators.

Aim: To radiographically evaluate the effect of immediate implant placement plus alveolar ridge preservation (ARP) with a deproteneized bovine bone mineral and a collagen matrix (IMPL/DBBM/CM) as compared to ARP (DBBM/CM) or spontaneous healing (SH) on vertical and horizontal bone dimensional changes after 4 months of healing.Materials and methods: Thirty patients requiring extraction of one single‐rooted tooth or premolar were randomly assigned to IMPL/DBBM/CM, ARP DBBM/CM or SH. Cone‐beam computed tomography (CBCT) scans, performed before tooth extraction and after 4 months, were superimposed in order to assess changes in ridge height at the buccal and lingual aspect and in ridge width at 1 mm, 3 mm and 5 mm apical to the bone crest. Kruskal–Wallis test was applied for comparison of differences between groups.Results: No statistically significant differences between the groups were observed for the vertical bone resorption of the buccal and the lingual side, while significant differences were found between SH group (−3.37 ± 1.55 mm; −43.2 ± 25.1%) and both DBBM/CM (−1.56 ± 0.76 mm; −19.2 ± 9.1%) and IMPL/DBBM/CM (−1.29 ± 0.38 mm; −14.9 ± 4.9%) groups in the horizontal dimension at the most coronal aspect.Conclusion: Ridge preservation techniques using DBBM and CM reduce the horizontal bone morphological changes that occur, mostly in the coronal portion of the buccal bone plate following tooth extraction, when compared to spontaneous healing. This is true regardless of whether immediate implant placement is performed or not.

Aim: Reports regarding prevalence of peri‐implant diseases show widely varying prevalence rates, which can be explained partially by variable diagnostic criteria adopted. Furthermore, several different factors have been associated with peri‐implant diseases. Hence, the aim of this cross‐sectional study is to (a) determine the prevalence, extent and severity of peri‐implant diseases in patients enrolled in a university dental clinic and (b) to evaluate the association between peri‐implantitis and patient/implant‐related factors.Material and Methods: A total of 237 subjects from the Dental Department of Vita‐Salute San Raffaele University (Milan, Italy) with 831 implants with more than 1 year of follow‐up after loading were clinically evaluated. Implants showing bleeding on probing (BOP), with or without suppuration, and/or probing pocket depth (PPD) ≥ 4 mm, were radiographically analysed. Demographic and clinical data were collected to evaluate by multilevel regression analysis association with peri‐implantitis.Results: The prevalence of peri‐implant mucositis and peri‐implantitis was 38.8% and 35%, respectively. Patients with a FMBS > 25%, having ≥4 implants as well as implants with plaque, PPD ≥ 4 mm or less than 1 mm of keratinized mucosa presented higher odds ratios for peri‐implantitis.Conclusions: Peri‐implant diseases are frequent conditions affecting >70% of the patients. Several patient/implant‐related factors may influence the risk for peri‐implantitis.