Clinical Advances in Periodontics最新文献

{"title":"Rotated pedicled palatal flaps for primary closure in immediate post-extractive guided bone regeneration at maxillary molar locations: A case report of a new technique.","authors":"David Palombo, Mariano Sanz","doi":"10.1002/cap.70051","DOIUrl":"https://doi.org/10.1002/cap.70051","url":null,"abstract":"<p><strong>Background: </strong>Replacing severely compromised teeth with endo-periodontal lesions continues to pose a clinical challenge because of accompanying deficiencies in hard and soft tissues. While traditional staged protocols, involving vertical ridge augmentation and soft tissue grafting, are effective, they are complex, time-intensive, and often not well-received by patients. This case report presents a simplified approach that combines immediate guided bone regeneration (GBR) using a rotated pedicled palatal flap to achieve primary closure without requiring buccal flap advancement, thereby preserving vestibular depth and keratinized mucosa.</p><p><strong>Methods: </strong>Two systemically healthy, non-smoking male patients with grade 3 endo-periodontal lesions in the maxillary molar area underwent flapless extraction. This was followed by immediate guided bone regeneration (GBR) using deproteinized bovine bone mineral and a resorbable collagen membrane, which was sealed with a pedicled palatal flap. In both instances, this technique successfully stabilized the graft and achieved primary wound closure.</p><p><strong>Results: </strong>Implant placement was performed 6 months later with minimal intervention required. Follow-up evaluations at 3 years showed stable peri-implant tissues, satisfactory esthetic integration, and high patient satisfaction.</p><p><strong>Conclusion: </strong>This technique provides a viable alternative for the immediate reconstruction of severely compromised sockets when immediate implant placement is not feasible, minimizing surgical morbidity while maximizing soft tissue preservation. Further research is needed to validate its long-term efficacy and broader clinical applicability.</p><p><strong>Key points: </strong>The adoption of a rotated pedicled palatal flap can enable immediate GBR without buccal flap advancement, allowing primary closure while preserving vestibule depth and the existing width of keratinized mucosa. This simplified single-stage approach can reconstruct hard and soft tissues simultaneously in severely compromised extraction sockets where immediate implant placement is not possible, reducing treatment complexity, costs, and morbidity. Clinical outcomes at 3 years showed stable peri-implant tissues, minimal need for secondary interventions, and high patient satisfaction, suggesting this technique may offer a predictable and patient-friendly alternative to traditional staged protocols.</p><p><strong>Plain language summary: </strong>When a tooth is severely damaged by both infection and bone loss, dentists often need to remove it and rebuild the area before placing a dental implant. Traditional treatment usually requires several complex surgeries to restore bones and gums, which can be time-consuming and uncomfortable for patients. In this report, we describe a simpler, less invasive approach that allows reconstruction of both bone and gingiva after the extraction of a severely damaged tooth.","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 Suppl 1 ","pages":"S82-S96"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693384","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":"Innovations in microsurgery: The role of non-invasive blood perfusion imaging-A review and framework.","authors":"Amanda B Rodriguez, Oliver D Kripfgans, Diego Velásquez-Plata, Hsun-Liang Chan","doi":"10.1002/cap.70042","DOIUrl":"10.1002/cap.70042","url":null,"abstract":"<p><strong>Background: </strong>This review evaluates current literature on non-invasive blood perfusion imaging in periodontology, with a focus on applications in periodontal microsurgery.</p><p><strong>Methods: </strong>A hypothesis-building review was conducted by two reviewers from January 2022 to April 2025 across multiple databases.</p><p><strong>Results: </strong>Laser speckle contrast imaging (LSCI) and ultrasound (US) emerged as the most promising modalities. LSCI measures superficial gingival perfusion with high spatial resolution, demonstrating sensitivity to vascular dynamics and sex-related differences during tissue compression. US, using B-mode and color flow-based imaging, provides both anatomical and functional assessment of gingival and peri-implant tissues, showing correlations with inflammation and healing outcomes. Both techniques have been validated in clinical and preclinical settings as reliable tools for assessing perfusion during regenerative procedures. A clinical case illustrates the use of LSCI and US to evaluate blood perfusion in a grafted alveolar ridge.</p><p><strong>Conclusions: </strong>Blood perfusion is a key factor in wound healing, heavily influenced by surgical trauma and flap tension. Microsurgical techniques may improve outcomes by minimizing soft tissue trauma and preserving vascular integrity during flap procedures. LSCI and US together could offer complementary, real-time, chairside imaging to monitor perfusion, advancing personalized treatment strategies and improving prediction of healing outcomes in periodontal and peri-implant therapy.</p><p><strong>Key points: </strong>Laser speckle contrast imaging (LSCI) and ultrasound (US) emerge as the leading non-invasive modalities for assessing periodontal tissue perfusion, with LSCI capturing superficial microvascular flow and US providing complementary anatomical and functional detail. Evidence from recent clinical and preclinical studies, and an illustrative case example, demonstrates that both technologies reliably evaluate perfusion during regenerative and microsurgical procedures, including grafted alveolar ridges. Because adequate perfusion is essential for wound healing, integrating LSCI and US into periodontal practice may support real-time, personalized, data-driven clinical decision making and help optimize outcomes in periodontal and peri-implant therapy.</p><p><strong>Plain language summary: </strong>This review examines the use of non-invasive imaging technologies to assess blood flow (perfusion) in periodontal tissues, with a focus on their application in periodontal microsurgery. A literature search covering studies published from January 2022 to April 2025 identified laser speckle contrast imaging (LSCI) and ultrasound (US) as the most promising modalities. LSCI provides high-resolution assessment of superficial gingival perfusion and is sensitive to vascular changes, while US, using B-mode and color Doppler, offers both anatomical and funct","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"S22-S34"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047513","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}

{"title":"Deliberate practice: The cornerstone of microsurgical therapy.","authors":"Diego Velásquez-Plata, Rino Burkhardt","doi":"10.1002/cap.70055","DOIUrl":"10.1002/cap.70055","url":null,"abstract":"<p><strong>Background: </strong>Effective use of the operating microscope in periodontal and implant procedures demands the acquisition of specialized skills. Clinicians must adapt to high-magnification workflows, requiring exceptional precision through bimanual instrumentation. This perspective article aims to explore the principles of deliberate practice by outlining its defining components and core characteristics and providing actionable guidance for the implementation of this approach.</p><p><strong>Methods: </strong>A conceptual analysis was conducted to evaluate the role of incorporating core principles of deliberate practice as a mechanism for developing and enhancing skills within microsurgical training workflows.</p><p><strong>Results: </strong>Adopting deliberate practice can significantly enhance skill development and accelerate the proficiency timeline in advanced periodontal and implant-related clinical protocols.</p><p><strong>Conclusions: </strong>The essential components of deliberate practice are identified and defined, and practicable frameworks for applying this approach are illustrated. Its benefits and limitations are also discussed.</p><p><strong>Key points: </strong>Deliberate practice is a structured-goal oriented approach designed to maximize skill development. Continuous feedback serves to refine methodologies, prevent stagnation, and ensure execution aligns with expert benchmarks of excellence. Sustained effort and mental engagement are the outcomes of consistency, dedication, and perseverance through periods of intense focus.</p><p><strong>Plain language summary: </strong>An operating microscope is used in periodontal and dental implant related procedures mainly because it allows dentists to see small details with great accuracy. Working under high magnification demands special training since small hand movements must be extremely precise. In order to overcome these challenges, there is a training approach called deliberate practice that can make the process more effective. This article explains how this method helps dentists improve their microsurgical skills, ultimately leading to better care and outcomes for patients.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 Suppl 1 ","pages":"S157-S164"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693920","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}

{"title":"Gingival odontogenic keratocyst presenting as pseudoinfection: Inclusion of demonstrative case report and review.","authors":"John K Brooks, Sami Abu Alhuda, Pareesa Malik, Jeffery B Price, Camille E Alexander, Ahmed S Sultan","doi":"10.1002/cap.10350","DOIUrl":"10.1002/cap.10350","url":null,"abstract":"<p><strong>Background: </strong>The peripheral odontogenic keratocyst (POKC) is a rare developmental odontogenic cyst and represents the soft tissue counterpart of the more common intraosseous variant. Although the majority of POKCs have been discovered on the gingiva, scant information is available in the periodontal literature.</p><p><strong>Methods: </strong>A 69-year-old man presented with a painless, red fluctuant-like papular lesion on the maxillary anterior labial gingiva. The adjacent teeth had vital pulpal responses and normal gingival probing depths. A subtle radiolucency with corticated borders was evident overlying the apical third of the roots. The patient recalled receiving local anesthesia in this site 3 months ago in conjunction with dental restorative treatment.</p><p><strong>Results: </strong>An excisional biopsy was performed and pus-like material extruded from the surgical specimen. The histopathologic diagnosis was POKC.</p><p><strong>Conclusion: </strong>With the inclusion of this report, at least 31% (14/45) of cases of gingival OKC have mimicked infection by exhibition of a fluctuant consistency and/or extrusion of thick luminal fluid that contains keratin and resembles purulence. Due to the high recurrence rate, affected patients should be followed for at least 5-7 years.</p><p><strong>Key points: </strong>The gingival odontogenic keratocysts may be adherent to the overlying mucosa and warrant supraperiosteal dissection during excisional biopsy to reduce lesional recurrence. At least 31% of published cases of gingival odontogenic keratocysts have featured an infection-like clinical presentation. Due to the high rate of lesional recurrence, affected patients should undergo yearly follow-up clinical assessments for at least 5 years, as informed by the current evidence.</p><p><strong>Plain language summary: </strong>This article features a rare example of the peripheral odontogenic keratocyst (POKC) on the gingiva. The lesion was initially suspected to be an infection and appeared as a painless, red compressible growth on the maxillary anterior labial gingiva of an older adult male. A dental radiograph revealed a subtle radiolucency with corticated borders. A biopsy was performed to determine the diagnosis. Affected patients must continue to be monitored for lesional recurrence.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"190-196"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574431","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":"In vitro ultrastructure and biodegradation of activated plasma albumin gel derived from human samples: A prospective observational study.","authors":"Behzad Houshmand, Mohammadreza Talebi Ardakani, Farshad Armandei, Anahita Moscowchi, Ahmad Nazari, Jafar Ai, Mehdi Ekhlasmand Kermani, Hamoun Sabri","doi":"10.1002/cap.10330","DOIUrl":"10.1002/cap.10330","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In soft tissue regeneration, the clinical efficacy of fibrin membranes has been a pressing concern. The key to this efficacy lies in the stability of membrane and its controlled absorption. Human serum albumin, with its influence on the formation and stability of fibrin networks, could hold the key to developing a more stable alternative. This study investigates the ultrastructure and biodegradability of plasma albumin-activated gel, a potential game-changer in the field.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Blood samples were collected from the participants and centrifuged to obtain the concentrated growth factor. The poor platelet plasma syringe was placed inside the activated plasma albumin gel device. The ultrastructure of the membrane was examined using a scanning electron microscope (SEM). The weight difference was measured over 21 days to investigate the biodegradability of the samples.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-two samples were prepared from six individuals (three males and three females). Based on SEM images, activated albumin gel after 21 days in Hank's solution exhibited a significant decrease in density and evident signs of surface degradation. The weight was significantly reduced after 21 days (p &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In the present study, the investigation of the ultrastructure and biodegradability of activated albumin gel showed that, based on the observed weight difference, the amount of biodegradation is high, and it may be necessary to use a thicker membrane compared to the conventional thickness of the connective tissue graft.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Enhanced stability and biocompatibility: The study highlights plasma albumin-activated gel's potential as a soft tissue scaffold, demonstrating significant biodegradation and structural changes that support cell infiltration and nutrient exchange, essential for tissue regeneration. Controlled degradation profile: Plasma albumin gel offers a prolonged biodegradation period compared to conventional fibrin membranes, making it suitable for applications requiring stable, long-lasting scaffolds in soft tissue regeneration. Future clinical applications: Findings suggest that thicker plasma albumin membranes may be needed for optimal effectiveness, paving the way for further exploration in clinical trials and animal models to validate this approach in soft tissue grafting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;This study investigates plasma albumin-activated gel as a promising material for supporting soft tissue repair, particularly in periodontal regeneration. Traditional materials, such as fibrin membranes, are often used to aid healing, but their rapid breakdown can limit effectiveness in the body. Plasma albumin, a protein naturally found in human blood, might offer a more stable alternative by forming a longer-lasting structure. In this study, researchers processed blood samples from participants to cre","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"205-212"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13044491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848504","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}

{"title":"Impact of experience on microscope adoption in periodontics and implant dentistry.","authors":"Alina Ariceta, Eduardo Duarte, Roberto Volfovicz, Diego Velásquez-Plata","doi":"10.1002/cap.70014","DOIUrl":"https://doi.org/10.1002/cap.70014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This study investigates differences in difficulty using a microscope (OM) between professionals with less than 1 year of experience (Group 1 [G1]) and experienced professionals with over 5 years of practice in periodontics or implant dentistry (Group 2 [G2]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Twenty professionals were divided into two groups based on their experience. Each participant was instructed to perform three different exercises. Participants' ability to complete the exercises and the time required were evaluated. Additionally, they completed the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire. Its purpose is to assess the mental, physical, and temporal demands, the effort required, the level of frustration, as well as the participants' perception of the degree of success or failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both groups had an equal number of participants and completed three exercises. In Exercise 1, G1 was significantly faster than G2 (mean 0.54 min vs. 6.51 min). In Exercise 2, the time was similar for both groups (G1: mean 24.9 min vs. G2: mean 21.3 min). In Exercise 3, G2 was faster (mean 32.4 min vs. mean 24.6 min). In NASA-TLX, demand was significantly higher for G2. On the other hand, G1 had a higher perception of success in completing their tasks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;G1 found it easier to incorporate the microscope. The level of frustration and demand (physical and mental) was higher in G2. The perception of success in using this technology was greater in G1, and the time required to complete the exercises was shorter for G1 in Exercise 1 and similar for both groups in Exercises 2 and 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Both experienced and inexperienced professionals were able to complete all three exercises equally. Exercise 1 was completed faster by Group 1, whereas the times for Exercises 2 and 3 were similar. The level of difficulty in terms of mental demand, physical effort, time, and frustration was higher in experienced professionals. The perception of success in incorporating the OM was higher among professionals with less experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;This study compared the use of a microscope in clinical tasks between two groups of dental professionals: Group 1 (G1), with less than 1 year of experience, and Group 2 (G2), with over 5 years of experience in periodontics or implant dentistry. Twenty participants were divided equally and asked to complete three exercises using a microscope. Their performance, time taken, and perceived workload were assessed using the NASA-Task Load Index (NASA-TLX), which measures mental and physical effort, time pressure, frustration, and perceived success. In the first exercise, G1 completed the task much faster than G2. In the second, both groups had similar times, whereas in the third, G2 was quicker. However, G2 reported higher mental and physical demands and more f","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 Suppl 1 ","pages":"S14-S21"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693832","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":"Cone beam computed tomography of bone dimensions in periodontally accelerated osteogenic orthodontics: A retrospective study.","authors":"Trevor D Richmond, Ayman Al Dayeh, Mark Scarbecz, Sidney Stein, Jack Fisher, Vrushali Abhyankar","doi":"10.1002/cap.10351","DOIUrl":"10.1002/cap.10351","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Periodontally accelerated osteogenic orthodontics (PAOO) or surgically facilitated orthodontics involves corticotomies and bone grafts during orthodontic treatment. It aims to enhance the range and rate of tooth movement and improve alveolar bone dimension and gingival architecture. Limited evidence exists on bone dimension changes due to PAOO. This retrospective study assesses PAOO's effects on alveolar bone thickness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patient records from 15 arches treated with PAOO were compared to 15 age and sex-matched control arches treated without PAOO. Pre- and post-orthodontic cone-beam computed tomography images measured radicular bone thickness at central and lateral incisors in sagittal sections at 3, 6, 9, and 12 mm from the cemento-enamel junction (CEJ). The vertical distance of crestal bone from CEJ was also measured. Fenestrations or dehiscence were quantified on buccal root surface cross-sections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 15 PAOO-treated arches, 10 were augmented on the compression side of tooth movement, while five were augmented on the tension side. In cases augmented on the compression side, the PAOO group showed a significant increase in the buccal radicular bone at 3, 6, and 9 mm from the CEJ. A significant loss in lingual crestal bone height was observed in the PAOO group. Additionally, there was a significant reduction in fenestrations and dehiscence in the PAOO group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Within our study's limitations, results suggest that PAOO increases alveolar bone thickness and reduces fenestration and dehiscence incidence when performed on the compression side of orthodontic movement. However, it is associated with lingual crestal bone loss. Further prospective studies with standardized protocols are needed to better define PAOO's efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Periodontally accelerated osteogenic orthodontics (PAOO) increases the thickness of alveolar bone when performed on the compression side of the orthodontic tooth movement. PAOO may prevent alveolar fenestrations and dehiscence of root surfaces after orthodontic treatment. PAOO may reduce orthodontic treatment time in select cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;With an improved awareness of dental esthetics and function, an increased number of adult individuals are seeking orthodontic therapy. Adult patients present with unique challenges for the treating orthodontist such as extensive restorative work, missing teeth, thin alveolar bone, and thin gingival tissues. This might result in increased recession, bone loss and fenestration, and dehiscence. Periodontally accelerated osteogenic orthodontics (PAOO) allows for quicker tooth movement, as well as increasing alveolar bone thickness to prevent subsequent hard and soft tissue deficiencies. In this retrospective study, we compared the effects of orthodontic treatment completed with and without PAOO on alve","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"223-231"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314274","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":"Implantoplasty combined with soft tissue grafting for the management of complex cases: A microsurgical approach.","authors":"João Batista César Neto, Rafael Lazarin, Henrique Rinaldi Matheus, Emerson Santiago, Giuseppe A Romito","doi":"10.1002/cap.70037","DOIUrl":"10.1002/cap.70037","url":null,"abstract":"<p><strong>Background: </strong>The treatment of peri-implantitis and/or peri-implant soft tissue dehiscence defects (PSTD) remains challenging. The incorporation of the operating microscope (OM) into surgical procedures might have changed the treatment landscape for such conditions around implants. The aim of this case series is to present three clinical cases in which the combination of connective tissue grafting (CTG) and implantoplasty was performed under microscopy and served as the key tools for managing complex cases.</p><p><strong>Methods: </strong>In this article, the authors illustrate three distinct cases in which the combination of CTG and implantoplasty was used as a single or double-staged approach for the treatment of PSTD, combined or not with peri-implantitis. Importantly, the OM was used as a critical tool to increase precision and reduce trauma.</p><p><strong>Results: </strong>Overall, all procedures successfully preserved implants up to 3 years in highly compromised conditions. The approaches achieved a reduction in mucosal recession of up to 2 mm and successfully increased the thickness of the soft tissues. In addition to the maximum precision combined with the lesser trauma, the OM was critical for allowing delicate flap elevation of extremely thin tissues, achieving the smoothest implant surface with minimal wear, and permitting intimate adaptation of the CTG to the recipient bed.</p><p><strong>Conclusion: </strong>The OM combined with advanced skills for surgeons facilitated critical steps of the surgical procedures. Microsurgery combined with implantoplasty and connective tissue grafting offers an effective alternative for managing supraosseous or exposed implant threads caused by peri-implant disease or poor implant positioning.</p><p><strong>Key points: </strong>Limited evidence supports implantoplasty with connective tissue grafting for complex implant complications, especially in esthetic areas. This case series shows implantoplasty aids decontamination and also reduces buccal implant volume, while connective tissue grafting enhances peri-implant soft tissue thickness. The microsurgical approach was fundamental to treatment success. It improved precision, minimized trauma, and promoted better healing and lower morbidity.</p><p><strong>Plain language summary: </strong>This group of cases shows that using a combination of implant surface polishing (implantoplasty) and soft tissue grafts, done with a precise microsurgical technique, can be an effective and less invasive way to treat complicated cases, without needing to remove the implant.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 Suppl 1 ","pages":"S97-S110"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693893","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}

{"title":"A microsurgical approach to implant mechanical rescue.","authors":"Charles A Mastrovich","doi":"10.1002/cap.70038","DOIUrl":"https://doi.org/10.1002/cap.70038","url":null,"abstract":"<p><p>The purpose of this paper is to describe and illustrate the value of using a microsurgical approach when resolving an implant mechanical rescue case (internally retained implant component fragments). Four cases involving screw retrieval issues are reviewed to demonstrate how microscopic visualization clarifies a diagnostic algorithm to determine correct treatment protocols. Microscopic visualization then continues to contribute an extreme advantage for guidance and predictability during treatment. When accompanied with appropriate tooling choices, the combination offers improved consistency and a significantly higher level of treatment success. PLAIN LANGUAGE SUMMARY: The purpose of this paper is to describe the clinical advantages of incorporating a microsurgical approach when diagnosing and recovering failed dental implant components, such as fractured screws, stripped screws, or other small internal components. When accompanied with appropriate tooling choices, the combination offers improved consistency and a significantly higher level of treatment success.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 Suppl 1 ","pages":"S142-S148"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693849","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":"Microsurgical regenerative approach to intrabony defects.","authors":"Pierpaolo Cortellini, Simone Cortellini","doi":"10.1002/cap.70033","DOIUrl":"https://doi.org/10.1002/cap.70033","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Periodontal regeneration is a validated treatment for intrabony defects, aiming to restore lost periodontal tissues through pocket depth reduction, clinical attachment, and bone gain with minimal recession. Despite its proven efficacy, outcomes vary widely due to patient-related factors (e.g., oral hygiene and smoking), defect characteristics, and surgical techniques. Minimally invasive approaches, supported by magnification and microsurgical tools, have enhanced surgical precision and clinical predictability. This paper presents a stepwise surgical protocol for minimally invasive periodontal regeneration. Key components include incision design based on papilla width and height, careful debridement with preservation of supracrestal fibers, and tailored flap designs that ensure optimal access while preserving soft tissue integrity. Regenerative materials are selected based on defect morphology to promote clot stability and space maintenance. Advanced suturing strategies, particularly modified internal mattress sutures, enable passive primary closure and stable wound sealing. Microsurgical instruments and monofilament sutures further contribute to atraumatic tissue handling and precise closure. Successful regeneration depends on meticulous surgical execution, appropriate material selection, and integration into a comprehensive treatment plan including long-term supportive care. This technique-driven approach optimizes regenerative outcomes and improves prognosis for compromised teeth. KEY POINTS: The precision in flap design and papilla preservation is critical. Selecting the incision type based on papilla width and height, and preserving supracrestal fibers whenever possible, minimizes tissue trauma and maximizes regenerative potential. The application of minimally invasive, microscope-assisted approaches improves outcomes. Smaller flaps, careful debridement, and precise regenerative material placement enhance wound stability, reduce surgical trauma, and promote optimal healing. The primary closure and suture stability determine success. Achieving tension-free, face-to-face wound closure with appropriate microsurgical suturing techniques is essential for protecting the regenerative site during early healing. PLAIN LANGUAGE SUMMARY: Periodontal regeneration is a treatment used to rebuild the tissues that support teeth, which can be lost because of gum disease. The aim is to reduce deep gum pockets, restore the gum's attachment to the tooth, and regrow bone, while keeping gum recession as small as possible. Results can vary between patients due to factors such as oral hygiene, smoking, the type of bone defect, and the surgical method. Recent minimally invasive techniques, supported by magnification and microsurgical tools, have improved precision and predictability. This paper describes a step-by-step surgical approach. It includes designing small, precise incisions depending on the shape of the gum, cleaning the defect carefully while preserv","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"16 Suppl 1 ","pages":"S111-S122"},"PeriodicalIF":0.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693864","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}