Clinical Advances in Periodontics最新文献

{"title":"Free gingival graft-assisted regenerative therapy in a site with limited keratinized tissue: A case study.","authors":"Eiichi Suzuki, Akihiko Katayama, Akiyoshi Funato","doi":"10.1002/cap.70057","DOIUrl":"https://doi.org/10.1002/cap.70057","url":null,"abstract":"<p><strong>Background: </strong>The width of keratinized tissue (KTW) is considered to be one of the factors contributing to successful regenerative outcomes in intrabony defects, as it helps establish a stable peri-defect soft tissue environment. Limited KTW and shallow vestibular depth may compromise wound healing and reduce the predictability of regenerative therapy. To address these anatomical limitations, a staged approach involving free gingival grafting (FGG) prior to regenerative procedures has been proposed as a viable strategy. This case study presents a periosteal flap approach that enables simultaneous regenerative therapy and FGG in a one-stage procedure. This technique facilitates stabilization of the blood clot and combined hard- and soft-tissue regeneration in defects with insufficient KTW width and shallow vestibular depth.</p><p><strong>Methods: </strong>A 48-year-old female patient presented with an intrabony defect on the buccal aspects of teeth #2 to #4, with a maximum probing pocket depth (PPD) of 8 mm and KTW of 0-3 mm. A one-stage regenerative therapy was performed using recombinant human fibroblast growth factor 2 and carbonate apatite in combination with FGG. The clinical course was monitored for 3 years.</p><p><strong>Results: </strong>At the 3-year follow-up, regenerative therapy resulted in improvements in PPD and clinical attachment level, with PPD reduced to ≤3 mm, accompanied by radiographic evidence of stable bone fill at the treated site. A marked increase in KTW was also observed, and a sufficiently deep vestibule was achieved. Stable soft tissue conditions were maintained throughout the entire observation period.</p><p><strong>Conclusions: </strong>A one-stage regenerative therapy combined with FGG achieved stable hard and soft tissue regeneration in an intrabony defect with limited KTW and shallow vestibular depth, with favorable outcomes maintained for 3 years.</p><p><strong>Plain language summary: </strong>When the gum is too thin and the area for treatment lacks firm tissue, long-term stability after regenerative surgery can be difficult to achieve. This report describes a technique that uses gum grafting and regeneration in a single surgery. Compared to the traditional step-by-step approach, which separates the gum graft and the regenerative procedure into two stages, this one-stage method may help shorten the overall treatment time and reduce the burden on the patient. However, it may not be suitable for every case, and careful evaluation is needed.</p><p><strong>Key points: </strong>One-stage regenerative therapy combined with a free gingival graft can simultaneously address both soft tissue deficiency and intrabony defects, offering a practical alternative to traditional staged approaches. Preservation of the periosteum without vertical or periosteal-releasing incisions may promote vascular integrity and wound stability during periodontal regenerative procedures. This technique may reduce total treatmen","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tooth autotransplantation following extraction of periodontally hopeless teeth in a periodontitis patient.","authors":"Alessandro Rizzi, Giorgia Astolfi, Roberto Farina, Leonardo Trombelli","doi":"10.1002/cap.70060","DOIUrl":"https://doi.org/10.1002/cap.70060","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study is to report clinical outcomes of autogenous tooth transplantation (ATT) of fully developed third molars following the extraction of periodontally hopeless teeth as a part of the treatment of a stage III, grade C, molar-incisor pattern (MIP) periodontitis case.</p><p><strong>Methods: </strong>A 24-year-old female with stage III, grade C, MIP periodontitis was treated at Operative Unity of Dentistry, Azienda Unità Sanitaria Locale, Ferrara. Despite steps I and II of periodontal therapy, deep pockets and severe mobility remained at maxillary and mandibular right first molars, which were scheduled for extraction due to a hopeless periodontal prognosis. At the time of extraction, the maxillary and mandibular right third molars (18 and 48) were transplanted in the severely compromised sockets of 16 and 46, respectively. The patient received supportive periodontal care with a 4-month frequency.</p><p><strong>Results: </strong>At 24 months, both transplanted teeth efficiently contributed to the masticatory function. The monitoring of periodontal parameters showed periodontal depth (PD) ≤ 4 mm, and the bone level amounted to more than 50% of the root length at both sites. A clinical attachment loss of 5 mm was recorded only at the buccal site of the donor tooth 48. No signs of root resorption or endodontic lesions were present. Overall, the number of pockets with PD ≥ 4 decreased from 32 to 4, and the full mouth bleeding score from 76% to 32%.</p><p><strong>Conclusions: </strong>ATT can be a viable option to replace periodontally hopeless teeth in patients with severe periodontitis, contributing to the overall improvement of periodontal conditions.</p><p><strong>Key points: </strong>Autogenous tooth transplantation may represent a viable alternative for the rehabilitation of sites severely compromised by periodontitis in molar-incisor pattern patients. The periodontal ligament of the donor tooth can induce bone formation and regenerate periodontal tissues.</p><p><strong>Plain language summary: </strong>This case report describes a 24-year-old woman affected by a severe and rapidly progressing form of periodontitis mainly involving the molars. Despite conventional periodontal therapy, two molars were considered hopeless and required extraction. As part of the rehabilitation plan, the patient's wisdom teeth were used as donor teeth and transplanted into the extraction sites through autogenous tooth transplantation (ATT). After 2 years of follow-up and regular supportive periodontal care, both transplanted teeth remained stable and functional, showing no signs of complications. Moreover, the patient's overall periodontal condition showed marked improvement. This case highlights that, in carefully selected patients, ATT can represent a viable alternative to conventional tooth replacement methods for managing advanced periodontitis.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-onset medication-related osteonecrosis of the jaw 11 years after IV bisphosphonates following implant placement.","authors":"Nikolaos Soldatos, Dave Chandra, Hongseok An, Ioannis Melakopoulos, Robin Weltman","doi":"10.1002/cap.70056","DOIUrl":"https://doi.org/10.1002/cap.70056","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Medication-related osteonecrosis of the jaw (MRONJ) is a recognized complication of intravenous (IV) bisphosphonate therapy, particularly following invasive dental procedures such as extractions or implant placement. Although the risk of MRONJ decreases after discontinuation of therapy, prolonged skeletal retention of bisphosphonates necessitates careful long-term evaluation and surgical planning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An American Society of Anesthesiologists (ASA) (II 72-year-old male with history of high-dose IV pamidronate therapy for multiple myeloma (last dose 11 years prior) presented for implant placement at tooth #18. Clinical and radiographic examination revealed a vertical root fracture with associated periapical pathology. The tooth was extracted, and ridge preservation was performed. Three and half months later, implant placement followed with the use of preoperative antibiotic prophylaxis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five months post-implant placement, the patient developed a lesion on the lingual vestibular aspect of site #18, characterized by purulence, bleeding, and exposed necrotic bone measuring approximately 10 × 2 mm, without radiographic appearance. Histopathologic evaluation confirmed MRONJ. The lesion was treated with conservative surgical debridement, followed by 0.12% chlorhexidine gluconate rinses twice daily for 2 weeks. Healing was allowed by secondary intention without sutures, and postoperative systemic antibiotic therapy was prescribed. Follow-up examinations at 2 and 4 weeks demonstrated complete clinical healing, with no recurrence observed at 6 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The risk of MRONJ may persist for more than 11 years after cessation of high-dose IV bisphosphonate therapy. The development of MRONJ, despite a C-terminal telopeptide (CTX) value traditionally considered favorable, underscores the limited predictive utility of CTX testing. Accordingly, management decisions should be guided by comprehensive clinical assessment and interdisciplinary communication rather than reliance on biochemical markers alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points/highlights: &lt;/strong&gt;Why is this case new information This case reports stage 2 medication-related osteonecrosis of the jaw (MRONJ) occurring 11 years after high-dose intravenous (IV) pamidronate cessation following extraction, ridge preservation, and implant placement, illustrating very late-onset disease that can arise adjacent to the surgical site, highlighting the limitations of serum C-terminal telopeptide testing, and emphasizing the need for long-term clinical vigilance and cautious surgical planning in patients with a remote history of bisphosphonate therapy. What are the keys to successful management of this case? Successful management relied on thorough risk assessment, informed consent, atraumatic surgery with antibiotic prophylaxis, early detection and conservative stage 2 MRONJ treatment, histopathologic c","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Neumann incision for implant placement in overdentures: Case series of a less invasive alternative.","authors":"Lucas Jardim da Silva, Laura Lourenço Morel, Luciana de Rezende Pinto, Otacílio Luiz Chagas-Júnior, Jamil Awad Shibli, Fernanda Faot","doi":"10.1002/cap.70044","DOIUrl":"https://doi.org/10.1002/cap.70044","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Conventional envelope flap techniques for implant placement in edentulous mandibles are associated with greater postoperative morbidity, especially in elderly patients or those with anatomical limitations. Minimally invasive alternatives aim to preserve soft tissues and reduce complications, enhancing clinical predictability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A clinical study was conducted with ten fully edentulous patients, in whom 20 regular implants were placed in the interforaminal region without surgical guides. A modified Neumann incision with a mesial relaxing cut and partial-thickness \"L\"-shaped flap was used. Digital planning was performed using free software. Surgical time, number of anesthetic tubes, adverse events, flap healing, peri-implant inflammation (PI), gingival bleeding index (GBI), and probing depth (PD) were evaluated at 14, 30, 60, and 90 days postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;No surgical complications, such as dehiscence, infection, paresthesia, or early implant loss, were observed. All patients achieved primary wound healing. The mean surgical time was 44 min (range: 25-61 min), with an average of four anesthetic tubes per patient. GBI and PD remained low throughout follow-up, with few sites showing PD ≥ 4 mm. Healing scores and inflammatory parameters progressively improved over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The modified Neumann incision with mesial relaxing cut, guided by digital planning, proved to be a safe, predictable, and minimally invasive approach for implant placement in edentulous mandibles. This technique demonstrated favorable healing, reduced surgical time, and effective PI control, making it suitable for patients with systemic fragility or anatomical challenges.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;The modified Neumann incision with mesial relaxing cut allows for safe and direct visualization of the mental foramen with limited flap elevation, reducing surgical trauma and preserving soft tissue integrity. This technique demonstrated favorable healing outcomes and low postoperative morbidity, even in elderly patients and anatomically challenging mandibles, without the need for physical surgical guides. Digital preoperative planning using free software enhances precision and predictability, making the approach reproducible and applicable in daily clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;This study describes a new, less invasive surgical technique for placing dental implants in the lower jaw of patients who have lost all their teeth. The method, called the modified Neumann incision with a mesial relaxing cut, was tested in 10 patients who received 2 implants to support a mandibular overdenture. The technique allows the surgeon to see important anatomical structures, such as nerves, while reducing the amount of tissue that needs to be cut or lifted. Patients were followed for 3 months after surgery, and the healing process, inflammat","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flap perfusion of superficial split flap design for guided bone regeneration: A case report with ultrasonography.","authors":"Oscar Durán-Garnica, Karen Villarreal-Arizpe, Amanda Rodríguez, Oliver Kripfgans, Hsun-Liang Chan","doi":"10.1002/cap.70053","DOIUrl":"https://doi.org/10.1002/cap.70053","url":null,"abstract":"<p><strong>Background: </strong>Effective flap management is crucial for successful bone regeneration procedures. Traditional flap release has been performed by the deep split design; recently, the superficial split design revives for its proposed anatomical and biomechanical advantages. To understand the risk of this new flap management design on flap vitality, the aim of this case report is to investigate the perfusion of the flap with ultrasound.</p><p><strong>Methods: </strong>A single patient with an edentulous ridge exhibiting a horizontal bone deficiency underwent a regenerative procedure utilizing the superficial split technique (Secured Anatomy-Driven Flap Extension [SAFE] technique). Ultrasonography assessments were conducted before the surgery (baseline [BL]) and at days (D) 3, 10, 21, and at 5 months (MO) post-surgery. They included brightness-mode and color velocity/power (CV/CP) at the buccal flap. CV and CP cine loops (videos) were recorded to assess tissue perfusion by surrogate. Three distinct regions of interest were selected, i.e., keratinized mucosa (KM), lining mucosa (LM), and muscle (M).</p><p><strong>Results: </strong>KM perfusion (CV) increased significantly at D3, then decreased at D10 and D21. The 5MO value was insignificant from BL. LM perfusion non-significantly decreased at D3 and D10, and returned to BL at D21 and 5MO. Muscle perfusion showed a nonsignificant decreasing trend. CP showed nonsignificant changes post-surgery relative to BL for the three regions.</p><p><strong>Conclusion: </strong>Ultrasound could be able to longitudinally quantify post-surgery tissue perfusion with sufficient spatial resolution to assess KM, LM, and M separately. This pilot ultrasonography study may ease the concern that the superficial split flap design jeopardizes flap vitality.</p><p><strong>Key points: </strong>Preliminary ultrasound data suggested that the Secured Anatomy-Driven Flap Extension (SAFE) technique, based on the superficial split approach, does not jeopardize flap vitality. Ultrasound may be a valuable tool for monitoring oral wound healing and guiding treatment decisions.</p><p><strong>Plain language summary: </strong>Ultrasound imaging technology, being a superior modality for evaluating soft tissue characteristics and able to quantify blood perfusion, is becoming a promising research tool to study oral wound healing. This case report used dental ultrasound to monitor the blood flow of an oral wound for 5 months after a jawbone augmentation procedure. Ultrasound showed gum blood flow peaked at day 3 after the surgery and decreased exponentially until 5 months. Mucosa and muscle may have various blood perfusion recovery patterns than gum tissues that deserve further investigation.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nontechnical skills in periodontal and implant microsurgery - The hidden key factors.","authors":"Rino Burkhardt, Diego Velásquez-Plata","doi":"10.1002/cap.70024","DOIUrl":"https://doi.org/10.1002/cap.70024","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Periodontal and implant microsurgery demand more than technical expertise. To enhance safety and performance, mastery of nontechnical skills (NOTSS) is required. These skills encompass cognitive, social, and personal resources that complement surgical technique. NOTSS, originally developed in the aviation industry, are divided into cognitive skills, such as situation awareness (SA) and decision making; and interpersonal skills, including communication, teamwork, and leadership. In a microsurgical setup, the operator faces multiple sensorimotor challenges due to scaling difficulties, a restricted field of view, and misalignment between the physical workspace and the visual feedback plane. These factors increase cognitive workload and place greater demands on intraoperative SA, as well as its effective sharing with the chairside assistant. Because the surgeon is closely connected to the eyepieces, intraoperative nonverbal communication with team members is limited, placing much higher demands on the operator's leadership qualities. Briefings and debriefings help assign specific tasks to individual team members and distribute responsibilities, allowing execution to proceed implicitly and with minimal verbal exchange. The quality of NOTSS has a substantial impact on performance in periodontal and implant microsurgery and appears to underpin technical proficiency. KEY POINTS: Nontechnical skills for surgeons (NOTSS) include thinking skills and personal interactions that are required to accompany the appropriate level of surgical knowledge and technical competence in pursuit of surgical excellence. The NOTSS taxonomy is a generally accepted system for learning and assessing nontechnical skills in surgery. NOTSS are well documented in the scientific literature and have been shown to equip members of the surgical team with the necessary skills to reduce clinical errors, improve patient safety, and enhance final outcomes. PLAIN LANGUAGE SUMMARY: Microsurgery in periodontology and implant dentistry isn't just about steady hands and technical skills. Surgeons and their teams also need strong nontechnical skills to deliver safe and successful care. These nontechnical skills include things like: (1) accurate thinking and good judgment (cognitive skills), and (2) clear teamwork and leadership, as well as effective communication (interpersonal skills). Microsurgery presents specific challenges: Surgeons often work with small and delicate structures, deal with magnified views through microscopes, and must overcome the awkwardness between what they see and what they should finely execute with their hands. This means that surgeons must stay extremely alert during procedures and actively share relevant information with their assistants. However, because the surgeon is usually glued to the microscope, they can't easily communicate with the team using gestures or eye contact. This makes it even more important for the team to have assigned roles, discussed in ad","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 Suppl 1 ","pages":"S149-S156"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertex technique: A novel microsurgical technique for papilla reconstruction-Case study.","authors":"Fernando Solanes, Juan Carlos Durán, Carolina Alarcón, María Dolores de la Jara, Valeria Gómez, Cristian Aguilera","doi":"10.1002/cap.70028","DOIUrl":"10.1002/cap.70028","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Interdental papilla is key to gingival health and esthetics. Its loss leads to black triangles, which affects the smile's appearance and increases periodontal risks. Various treatments have been proposed, but papilla reconstruction remains challenging due to anatomical and vascular limitations. This case report aims to describe the vertex technique (VT), a novel approach combining tunneling with connective tissue and bone grafts for papilla reconstruction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;VT was performed on patients with papilla presence index (PPI) 3 and 4 defects and a thick gingival phenotype in the esthetic zone. A microsurgical approach was employed to create an interproximal tunnel, thereby minimizing tissue trauma and preserving the vascular supply. Custom-shaped connective tissue grafts were inserted to enhance soft tissue volume, while bone grafts targeted interproximal bone loss for additional support. The procedure emphasized careful flap management to optimize healing and graft stability. All patients were periodontally treated prior to surgery and were healthy at the time of the procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VT achieved significant papilla augmentation, reducing the visibility of the black triangles, and improving gingival esthetics, from PPI 3 or 4 to PPI 2 after treatment. The integration of connective tissue and bone grafts resulted in enhanced soft tissue volume and long-term stability observed over follow-up periods of 1‒5 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The VT offers a promising solution for interdental papilla defects PPI 3‒4, addressing both soft tissue and bone deficiencies. Its combination of microsurgical tunneling with grafting provides esthetic and stable results, expanding treatment options in periodontal plastic microsurgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Vertex technique (VT) combines microsurgical tunneling with connective tissue and bone grafts to reconstruct interdental papillae with high precision and minimal trauma. Significant esthetic improvement and stable papilla height were achieved in papilla presence index 3‒4 defects, with outcomes maintained over 1‒5 years. VT is indicated for healthy, periodontally treated patients with thick phenotypes, although it requires advanced skills and resources for proper execution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;This study introduces the vertex technique, a new method to fix gaps (black triangles) between teeth caused by the loss of the interdental papilla. These gaps not only affect the look of a smile but can also harm gums' health. The technique uses a microsurgical approach to insert connective tissue and bone grafts, improving both soft tissue volume and bone support. It was used on patients with severe defects in the esthetic zone. Results showed a significant improvement in appearance and long-term stability, with no complications. The vertex technique offers a promising solution for these peri","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"S47-S61"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periodontal microsurgery: Historical development and integration into periodontics.","authors":"Leonard S Tibbetts","doi":"10.1002/cap.70040","DOIUrl":"10.1002/cap.70040","url":null,"abstract":"<p><p>Periodontal microsurgery is a refined enhancement of the various types of periodontal and implant surgery using a binocular surgical microscope, with techniques, instruments and sutures borrowed from medicine. A continuing education program on periodontal microsurgery was first presented to the American Academy of Periodontology Annual Meeting in Orlando in 1992. It has taken over 30 years to gain the attention of the Academy membership due to the additional specialized training, equipment and practice necessary to become and remain proficient in microsurgical techniques. True periodontal microsurgery exceeds surgery using surgical loupes. An operating surgical microscope offers varying magnifications from two and a half to 25 times normal vision. This enhances the surgeon's ability to perform more accurate, smaller initial butt joint incisions, achieve uniform flap thickness, remove all tissue tags, perform the various types of periodontal and implant surgery, and precisely reposition the postsurgical tissues for primary closure. Proficient periodontal microsurgical treatment results in less patient discomfort, faster healing, more predictable treatment results, and better patient acceptance. KEY POINTS: The incorporation of microscopic magnification into periodontal practices, with the necessary and appropriate training and practice, results in improved visual acuity, ergonomic benefits, increased precision in flap design, surgical detailing, and suture closure. The increased precision results in faster and improved healing results and enhanced patient acceptance.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"S7-S13"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Horizontal platelet-rich fibrin versus advanced platelet-rich fibrin plus in gingival recession management.","authors":"Kavitha Sridhar, Anupama Tadepalli, Harinath Parthasarathy, Priyanka K Cholan, Lakshmi Ramachandran","doi":"10.1002/cap.10342","DOIUrl":"10.1002/cap.10342","url":null,"abstract":"<p><strong>Background: </strong>Newer generation platelet concentrates, such as advanced platelet-rich fibrin plus (A-PRF+) obtained following low-speed centrifugation concept and horizontal platelet-rich fibrin (H-PRF) obtained from swing out and bucket system, showed increased platelet entrapment and growth factor release in the in-vitro studies. This prospective study aimed to evaluate and compare the clinical outcomes of A-PRF+ and H-PRF membranes in the treatment of gingival recession defects. The objectives of this study were to compare the changes in the recession height (RH) and the mean root coverage percentage (MRC%) between and within the research groups.</p><p><strong>Methods: </strong>Forty-four systemically healthy patients diagnosed with 84 Cairo's RT 1 and RT 2 gingival recession defects in the maxillary anterior and premolars were randomly treated with a combination of the coronally advanced flap (CAF) and A-PRF+ membrane (n = 22 subjects) or H-PRF membrane (n = 22 subjects). Patients were reviewed at 3 and 6 months postoperatively. Parameters including RH, MRC%, complete root coverage (CRC), gingival thickness, keratinized tissue height, and root coverage esthetic scores were documented.</p><p><strong>Results: </strong>Both treatments resulted in a significant reduction in RH (p < 0.001). The CAF + A-PRF+ group demonstrated a reduction in RH from 2.47 ± 1.00 mm to 0.59 ± 0.52 mm and the MRC% was 76.33 ± 22.54%, at 6 months. In the CAF+H-PRF group, the mean RH decreased from 2.43 ± 1.01 mm to 0.38 ± 0.59 mm and the MRC% was 85.51 ± 19.87%. Three- and six-month intergroup analysis revealed statistically insignificant differences in the observed clinical parameters between the groups (p > 0.05).</p><p><strong>Conclusions: </strong>The study found that both CAF + H-PRF and CAF + A-PRF+ protocols resulted in similar clinical outcomes while treating maxillary gingival recession defects.</p><p><strong>Plain language summary: </strong>Numerous modifications have been proposed to improve the growth factor content in the platelet concentrates and thereby therapeutic potential. This study compared platelet-derived membranes obtained by two different spin protocols in the treatment of gum recession. Forty-four patients were treated with either platelet-derived membrane obtained by horizontal spin protocol (test group) or low-speed spin concept (control group). Both treatment methods resulted in satisfactory healing. At the end of 6 months, no differences were noted with regard to the changes in clinical measurements and root coverage percentage indicating similar clinical efficacy of both preparatory techniques.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"213-222"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing papillary incision design in molar periodontal regenerative therapy: A case study.","authors":"Shunichi Shibazaki, Satoru Morikawa, Yuichiro Ihara, Taneaki Nakagawa","doi":"10.1002/cap.70011","DOIUrl":"10.1002/cap.70011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;While the simplified papilla preservation flap is commonly recommended in the molar region, it may not be optimal when blood flow and microsurgical visibility are considered. This case study aimed to evaluate the relationship between surgical visibility and interdental incision designs in the molar region and to propose a decision-making framework for interdental papilla incision design based on the extent of flap elevation and blood supply.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Three cases of periodontal regenerative therapy in the molar regions were performed using different flap designs: extended flap with circumferential defect (3 mm depth) and minimally invasive surgical technique (MIST) and modified MIST (M-MIST) with combination defects (4 mm depth), both incorporating interdental incision designs with a buccal or palatal shift. Clinical parameters and radiographic outcomes were assessed at baseline and 6 months postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The initial probing pocket depths of 10, 9, and 8 mm were reduced to 4, 4, and 3 mm, respectively, with radiographic evidence of bone-filling in all cases. Cases using MIST and M-MIST demonstrated superior primary healing compared with the extended flap case. Interdental incision designs with a buccal or palatal shift improved visibility and operability during microsurgery in molar regions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This case study showed that buccal- or palatal-shifted interdental incision designs were effective for molar periodontal regenerative therapy under operating microscopes. The decision-making process for interdental incision designs should consider the inter-root distance as well as the extent of flap elevation and its impact on blood supply.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Buccal- or palatal-shifted interdental incision designs using an appropriate flap design can be successfully applied to molar regions. Microscope-enhanced visibility with buccal- or palatal-shifted interdental incision designs improves surgical precision and accessibility. Preservation of the blood supply is crucial for optimal wound healing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Successful periodontal regenerative therapy in molar regions requires adequate surgical access and preservation of the interdental papilla. Although various minimally invasive techniques are available, accessing deep bone defects in molar regions while maintaining blood supply to the papilla remains challenging. In this context, interdental papilla incision designs that shift the incision line to the buccal or palatal aspect-such as the papilla preservation technique, modified papilla preservation technique, and triangle papilla access approach-are considered to contribute to improved visibility in periodontal regenerative therapy in the molar region using the operating microscope (OM). Building on this, the present case study proposes a new decision-making framework for interdent","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 Suppl 1 ","pages":"S74-S81"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}