Miha Pirc

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.

This registry-based analysis provides a longitudinal overview of implant therapy within the maxillary esthetic zone over a 15-year period. The data suggest three developments: (1) increasing integration of digital workflows through CAIS; (2) a cautious tendency toward earlier implant placement protocols; (3) a gradual reduction in simultaneous guided bone augmentation.

Objectives: To systematically evaluate the influence of concave versus convex emergence profiles on midfacial mucosal stability in partially edentulous patients restored with implant‐supported single restorations. Materials and Methods: A systematic review and meta‐analysis of randomized controlled trials (RCTs) was conducted and registered in PROSPERO (CRD420251139042). An electronic search in MEDLINE (PubMed) and Embase was performed up to May 7, 2026. Eligible studies included RCTs comparing concave (test group) and convex (control group) transmucosal prosthetic designs and reporting midfacial mucosal level changes (mm). Data extraction and risk of bias assessment (RoB 2) were performed independently. A random‐effects meta‐analysis was conducted using weighted mean differences (MDs) and 95% confidence intervals (CIs). Heterogeneity was assessed using the I ² statistic and sensitivity analyses were performed to evaluate the robustness of the findings. Results: Four RCTs including 144 implants with a 12‐month follow‐up were included. Of these, 128 implants contributed to the quantitative synthesis, with 66 implants allocated to the concave/modified emergence profile group and 62 implants allocated to the convex/non‐concave emergence profile group. The pooled analysis demonstrated a mean difference of −0.31 mm (95% CI −0.63 to 0.02; p = 0.064), indicating a trend toward greater midfacial mucosal recession with convex emergence profiles compared with concave designs. Between‐study heterogeneity was low to moderate ( I ² = 28%), suggesting consistent findings across studies. Sensitivity analyses confirmed the direction of the effect, with pooled estimates ranging from −0.12 to −0.43 mm. Exclusion of one study resulted in a statistically significant difference favoring concave emergence profiles (−0.43 mm; 95% CI −0.70 to −0.16; p = 0.002). Conclusions: Convex emergence profiles are associated with a tendency toward increased midfacial mucosal recession. Concave profiles are preferable to support peri‐implant soft‐tissue stability. Clinical Relevance: Emergence profile design should be considered an integral component of prosthetic and surgical planning. The use of concave transmucosal contours during provisionalization and definitive restoration may contribute to improved peri‐implant soft tissue stability and enhanced esthetic outcomes.

Objectives: To compare the biological, technical, and esthetic outcomes of one‐piece and two‐piece dental implant systems after 15–17 years in the follow‐up of a previously conducted randomized clinical trial. Material and Methods: This study represents the 15–17‐year follow‐up of a previously conducted randomized clinical trial included 60 patients requiring dental implant therapy. They were randomly assigned to receive either a one‐piece (STM) or two‐piece (BRA) implant system. Final restoration delivery served as baseline, after which all patients entered a structured maintenance program. Clinical re‐evaluations were performed at 1, 5, 10, 12, 15, and 17 years. Biological, technical, radiographic, and esthetic parameters were assessed at each follow‐up visit using standardized clinical and radiographic protocols. Results: Thirty‐nine patients with 95 implants, all of whom had completed a 15‐ or 17‐year follow‐up visit, were included in the final analysis (STM: 22 patients/45 implants; BRA: 17 patients/50 implants), with a mean follow‐up of 16.4 ± 1.1 years. The cumulative implant survival rate was 95.0% (STM: 91.8%; BRA: 98.0%). Marginal bone levels at 15–17 years were 0.08 ± 1.15 mm (STM) and 1.53 ± 0.81 mm (BRA). Clinical parameters remained stable in both groups, although BOP was higher in the STM group. Peri‐implant mucositis was observed in 49.7% of all implants and peri‐implantitis in 13.3%, with higher rates in the STM group. Technical complications occurred in 28 implants (STM: 23; BRA: 5), with the STM group showing a higher complication rate (implant level: 35.4% vs. 5.8%). Esthetic observations included visible crown margins in 62 implants and mucosal shimmering in 54 implants, with no implant fractures reported. Conclusions: Both implant systems demonstrated favorable long‐term outcomes with high survival rates. While the one‐piece system showed superior marginal bone preservation, it was associated with a higher rate of technical complications. Trial Registration: ClinicalTrials.gov identifier: KEK‐ZH‐Nr 2014‐0201

Aims: This cross‐sectional ‘case–control’ pilot study aimed to compare the size of periodontal wounds, periodontal status and total inflammatory burden between pregnant women with type 1 diabetes mellitus (T1DM) and non‐diabetic pregnant women. Methods: Fifteen T1DM pregnant women and 15 healthy pregnant women were included. Clinical parameters (probing pocket depths (PPD), plaque index (PI), bleeding on probing (BOP)), periodontal pathogenic bacteria, glycosylated haemoglobin (HbA1c), high‐sensitive C‐reactive protein (hs‐CRP), tumour necrosis factor alpha (TNFα), nitrous oxides (NOx) and interleukin‐6 (IL‐6) levels were evaluated. Total inflammatory burden and surface area of periodontal wounds (deep (DBPW) and total bleeding periodontal wounds (TBPW)) were calculated. Results: Pregnant women with type 1 diabetes mellitus (T1DM) exhibited significantly larger deep bleeding periodontal wounds (DBPW: 5.50 ± 4.43 cm ² vs. 3.02 ± 1.91 cm ² ) and total bleeding periodontal wounds (TBPW: 6.31 ± 4.32 cm ² vs. 3.88 ± 1.75 cm ² ) compared to healthy pregnant women. The T1DM group also had higher plaque index (PI) (26.9 vs. 13.5), more bleeding sites on probing (BOP) (29.8 vs. 19.9) and higher glycosylated haemoglobin (HbA1c) levels (5.8 vs. 5.1). In the test group, age and duration of T1DM were positively associated with periodontal wound size and total inflammatory burden, with the duration of T1DM also linked to increased BOP. Conclusions: Pregnant women with T1DM are prone to larger periodontal wounds and greater total periodontal inflammatory burden as compared to non‐diabetic pregnant women. Close monitoring and preventive measures are crucial to prevent complications during pregnancy and delivery.

Objective: To review the biological and clinical relevance of prosthetic design, specifically the emergence profile and restorative angle in influencing peri‐implant tissue health, and to illustrate how biologically driven prosthetic modifications can resolve inflammation and support peri‐implant stability. Overview: This narrative review synthesizes current evidence on the anatomy and function of the implant supracrestal complex, focusing on how restorative contour, abutment height, and emergence geometry impact soft tissue adaptation and marginal bone maintenance. It integrates recent findings from histological, clinical, and preclinical studies and highlights the role of CAD/CAM workflows in achieving biologically favorable restorations. A clinical case report illustrates the correction of peri‐implant inflammation and bone loss through the redesign of a concave, polished emergence profile on a taller titanium base. Conclusions: Restorative angle and emergence profile are critical, modifiable elements of implant‐supported prostheses. When designed in accordance with biological parameters, they contribute significantly to tissue health and long‐term esthetic outcomes. Suboptimal designs may promote plaque accumulation and inflammation, even in compliant patients. Biologically oriented, digitally guided prosthetic designs represent a key strategy in preventing peri‐implant disease. Clinical Significance: Long‐term peri‐implant health depends not only on surgical accuracy but also on biologically driven prosthetic design. Contours that respect the dimensions of the soft tissue complex, particularly concave, polished emergence profiles supported by adequately tall abutments, promote soft tissue stability, facilitate hygiene, and minimize the risk of inflammation or recession. While digital workflows offer precision in prosthetic design, clinicians must still apply sound biological principles and clinical judgment when planning and executing implant‐supported restorations. A biologically driven approach, based on a clear understanding of peri‐implant anatomy and guided by common sense, is essential for achieving predictable and esthetically successful outcomes.

Objective: To evaluate perceptions of scan‐free virtual video mock‐ups using the Orofacial Esthetic Scale (OES), comparing self‐assessments and evaluations of anonymized individuals by dental professionals and laypeople. Materials and Methods: This study was conducted at the Clinic of Reconstructive Dentistry, University of Zurich. Fifty participants (25 dental professionals and 25 laypeople) were video recorded under standardized conditions while smiling, turning from en face to profile, and speaking to simulate dynamic facial movements. Recordings were obtained using a clinical capture application linked to the device's native rear camera, and AI‐generated scan‐free virtual video mock‐ups were returned within minutes. Each participant rated their own mock‐up using the Orofacial Esthetic Scale (OES) and, in randomized order, evaluated five anonymized virtual mock‐ups generated from the software library (based on real patient recordings but fully de‐identified for privacy protection). Median OES scores were compared using Wilcoxon signed‐rank and Mann–Whitney U tests ( α = 0.05). Results: Fifty participants (25 dentists and 25 laypeople) were included. Overall, ratings improved from baseline to the scan‐free virtual video mock‐up for tooth color and alignment ( p = 0.003 and p = 0.014), while no significant changes were observed for the remaining items. In subgroup analyses, laypeople reported significant improvements in tooth color, alignment, form, and overall esthetics after Holm correction, whereas no differences were found among dentists. For mock‐up ratings, laypeople assigned higher scores than dentists across all OES items (all p < 0.05), except for tooth alignment and facial profile. When assessing anonymized mock‐ups of other individuals, laypeople consistently rated all eight items significantly higher than dentists. Conclusions: Within the limitations of this study, it was concluded that lay participants assigned higher esthetic ratings than dental professionals for virtual video mock‐ups of themselves and of unknown individuals. Comparisons between self‐evaluation and evaluation of anonymized individuals showed no consistent differences among dentists, while several item‐level differences were observed among lay participants. Compared with natural dentition, ratings for tooth color and tooth alignment increased after viewing the virtual mock‐up, while other items did not change significantly. Clinical Significance: These findings suggest that integrating simplified digital simulations with patient‐reported outcome measures enhances communication, aligns expectations, and supports patient‐centered shared decision‐making in prosthodontic and implant treatment planning.

Objective: The restoration of teeth with deep subgingival fractures poses a significant challenge, often requiring extensive interventions such as orthodontic extrusion or implant therapy. This manuscript aims to introduce and describe the substance‐gain extrusion technique (SGET) as a minimally invasive alternative that enables the preservation of natural dentition while optimizing biological and esthetic outcomes. By combining SGET with the biologically oriented preparation technique (BOPT), this approach seeks to address both functional and soft tissue stability concerns, providing a predictable restorative solution. Clinical Considerations: A 66‐year‐old patient presented with a failed anterior bridge and required a treatment approach that minimized surgical interventions due to pre‐existing medical conditions. Tooth 11 was extracted and replaced with an immediate implant, while tooth 21 was managed with SGET with the Benex system to achieve controlled coronal extrusion. Following stabilization, a fiber post and composite core were placed, and the tooth was prepared according to BOPT principles before final restoration with a zirconia crown. The contralateral incisor was rehabilitated with an implant‐supported crown. Clinical and radiographic evaluations at 6 months demonstrated successful preservation of the natural tooth with favorable esthetic and functional outcomes. Radiographs confirmed stable marginal bone levels, and the final photographs showed excellent soft tissue integration and patient satisfaction. Conclusions: The combination of SGET and BOPT provides a minimally invasive, cost‐effective, and time‐efficient alternative to implant therapy in cases involving significant tooth structure loss. Although long‐term clinical data remain limited, this approach shows promise in preserving natural dentition, enhancing soft tissue stability, and achieving predictable esthetic results.

Pirc M, et al. J Periodontal Implant Sci. 2025 Jan;55:e8. https://doi.org/10.5051/jpis.2402540127