Clinical Advances in Periodontics最新文献

{"title":"Intraoral Er:YAG laser-assisted de-epithelialization of autogenous gingival grafts for soft tissue management.","authors":"Dai Kawanabe, Ryutaro Kuraji, Yukihiro Numabe","doi":"10.1002/cap.70089","DOIUrl":"https://doi.org/10.1002/cap.70089","url":null,"abstract":"<p><strong>Background: </strong>The aim of this case series was to introduce intraoral Er:YAG laser-assisted de-epithelialization of autogenous gingival graft (EL-DGG) for root coverage and alveolar ridge augmentation.</p><p><strong>Methods: </strong>In conventional harvesting of de-epithelialized gingival grafts (DGGs) with a scalpel, the presence of residual epithelium has occasionally been observed, posing challenges to the reliable procurement of stable connective tissue grafts (SCTG). We utilized an Er:YAG dental laser, known for its minimal histological effect among dental lasers, to perform intraoral DGG in three cases involving root coverage or ridge augmentation.</p><p><strong>Results: </strong>Complete root coverage was achieved in the two root coverage cases. In the ridge augmentation case, horizontal and vertical dimensional gains of 1.56 and 0.74 mm, respectively, were observed. A portion of the CTG obtained from the peripheral trimmed area was biopsied and histologically examined. De-epithelialization of this area was performed using the same protocol as in the clinical procedure, including both Er:YAG laser irradiation and adjunctive rotary brush application, suggesting that epithelial removal was achieved in the examined sample with minimal damage to the underlying connective tissue layer of dense collagen fibers.</p><p><strong>Conclusions: </strong>By effectively eliminating epithelial remnants and preserving connective tissue thickness in palatal grafts, EL-DGG can offer more favorable clinical outcomes in root coverage and ridge augmentation compared to conventional graft-harvesting methods.</p><p><strong>Key points: </strong>Selective epithelial removal: Intraoral Er:YAG laser-assisted de-epithelialization enables selective removal of palatal epithelium while preserving dense subepithelial connective tissue thickness. Histologic and clinical validation: Histologic analysis confirmed complete epithelial elimination with minimal lamina propria damage, resulting in stable root coverage and soft tissue augmentation. Advantage in thin phenotypes: This technique allows predictable graft harvesting even in thin palatal mucosa, supporting phenotype modification and ridge augmentation procedures.</p><p><strong>Plain language summary: </strong>Gum tissue taken from the roof of the mouth is commonly used to cover exposed tooth roots or rebuild areas where soft tissue has been lost. However, when preparing these grafts with a scalpel, small remnants of the surface epithelial layer may remain, while removing too much tissue can reduce the thickness and quality of the connective tissue needed for treatment. In this case series, we used an Er:YAG laser to remove the epithelial layer directly from the palate before harvesting the graft. This approach was used in three patients: two received treatment for exposed tooth roots, and one received soft tissue augmentation in an area with a missing tooth. Complete root coverage was achieved in both ","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765656","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":"Hope for hopeless teeth - three-year interdisciplinary management of stage IV grade C periodontitis: A case report.","authors":"Kathleen Chloe M Mascardo, Min Jeong, David M Kim","doi":"10.1002/cap.70095","DOIUrl":"https://doi.org/10.1002/cap.70095","url":null,"abstract":"<p><strong>Background: </strong>Advanced periodontitis associated with infrabony defects often requires surgical intervention when nonsurgical periodontal therapy proves to be insufficient. Combination regenerative therapy, including guided tissue regeneration, has been shown to facilitate periodontal regeneration and improve clinical outcomes in a predictable manner.</p><p><strong>Methods: </strong>A 57-year-old female presented to the Division of Periodontology at Harvard School of Dental Medicine with complaints of tooth mobility and gingival bleeding. Comprehensive periodontal and radiographic examinations were performed to determine disease severity and extent. Initial periodontal therapy included patient education, oral hygiene instructions, nonsurgical scaling and root planing, and occlusal adjustment. Due to persistent deep periodontal pockets and infrabony defects, full-mouth osseous surgery and open flap debridement, combined with regenerative therapy using bone grafts and biologic agents, were subsequently performed. The patient was enrolled in supportive periodontal therapy at 3-month intervals thereafter.</p><p><strong>Results: </strong>At the 1-year follow-up, significant clinical improvements were observed, including reductions in probing depths, furcation involvement, and tooth mobility. Radiographic evaluation demonstrated bone fill at infrabony defect sites treated with combination regenerative therapy. These outcomes were maintained over a 3-year follow-up period with strict supportive periodontal therapy during orthodontic treatment.</p><p><strong>Conclusions: </strong>Within the limitations of a single case report, this case highlights the potential effectiveness of surgical periodontal therapy combined with regenerative techniques in the interdisciplinary management of generalized stage IV, grade C periodontitis with infrabony defects.</p><p><strong>Key points: </strong>Surgery periodontal therapy with guided tissue regeneration led to radiographic bone fill, reduced probing depths, and improvements in tooth mobility and furcation involvement, even in a severe stage IV grade C case. Success was strongly associated with strict supportive periodontal therapy and good oral hygiene adherence. Advanced periodontitis can have predictable long-term outcomes with proper interdisciplinary treatment and maintenance.</p><p><strong>Plain language summary: </strong>This case demonstrates successful interdisciplinary ortho-perio management of stage IV, grade C periodontitis with infrabony defects using surgical periodontal therapy and regenerative techniques. Significant reduction in probing depths, decreased tooth mobility and furcation involvement, and radiographic bone fill were observed following treatment. Favorable outcomes were maintained over a 3-year follow-up with supportive periodontal therapy.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765738","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":"Development and internal validation of a titanium ion-integrated diagnostic classification model for peri-implantitis.","authors":"Amar Ashok Thakare, Vaishali Mashalkar, Kavita Gupta, Rahul Tiwari, Harisha Dewan, Syed Shujaulla, Manish Sharma","doi":"10.1002/cap.70090","DOIUrl":"https://doi.org/10.1002/cap.70090","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Titanium release from dental implants has been implicated in peri-implantitis; however, its integration into multivariable models for disease classification remains limited. This study aimed to develop and internally validate a titanium ion-integrated model for the classification of peri-implantitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional analysis with prospective recruitment included 120 participants (60 healthy implants and 60 peri-implantitis). Titanium ion concentrations in peri-implant crevicular fluid (PICF) and serum were quantified using inductively coupled plasma mass spectrometry. Candidate predictors comprised PICF and serum titanium levels, implant surface area, functional duration, occlusal load, and age. Multivariable logistic regression was used to derive the Titanium Release Score. Model discrimination was assessed using receiver operating characteristic analysis, while calibration was evaluated using the Hosmer-Lemeshow test. Internal validation was performed through bootstrap resampling (1000 iterations).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Higher titanium concentrations in PICF (adjusted odds ratio [OR] = 1.52; 95% confidence interval [CI]: 1.22-1.90) and serum (adjusted OR = 1.79; 95% CI: 1.25-2.56) were associated with peri-implantitis. The model demonstrated good discriminative performance (area under the curve [AUC] = 0.87; 95% CI: 0.78-0.95). Internal validation showed an optimism-corrected AUC of 0.83. Calibration was acceptable (Hosmer-Lemeshow, p = 0.62).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The titanium-integrated model demonstrated good discrimination between peri-implantitis and healthy implants within the constraints of a cross-sectional design. Titanium ion levels were associated with disease status alongside implant-related variables. These findings support the potential role of titanium measurements as adjunctive biomarkers for disease classification rather than predictors of future risk; however, external validation and longitudinal studies are required before clinical application.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;A titanium ion-integrated classification model was developed to estimate peri-implantitis risk using peri-implant crevicular fluid, serum titanium levels, and implant variables. The Titanium Release Score demonstrated good discrimination (area under the curve 0.87) and acceptable calibration with stable performance after bootstrap validation. Titanium ion burden showed an independent associative value for peri-implantitis, supporting its role as a biologically relevant risk indicator.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Peri-implantitis is a common complication of dental implants that leads to inflammation and progressive bone loss. Early detection of implants at risk remains a clinical challenge. This study developed a classification model that combines titanium ion levels measured in peri-implant crevicular fluid and blood with implant-related fact","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708484","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":"Simplified SPAL technique to provide adequate peri-implant phenotype: A pilot study.","authors":"Leonardo Trombelli, Chiara Franzini, Mattia Severi","doi":"10.1002/cap.70085","DOIUrl":"https://doi.org/10.1002/cap.70085","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Correction of peri-implant bone dehiscence (PIBD) and optimization of the peri-implant soft-tissue phenotype are critical for long-term peri-implant tissues stability. A simplified, one-stage, transmucosal variant of the subperiosteal peri-implant augmented layer (sSPAL) technique was appraised and evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Eight systemically healthy patients with posterior mandibular edentulous sites showing an overt dehiscence received tissue-level implants combined with sSPAL using particulate deproteinized bovine bone mineral within a periosteal pouch. Clinical (keratinized mucosa, marginal soft-tissue level, probing depth (PD), and bleeding/suppuration) and radiographic (peri-implant bone dehiscence, buccal bone thickness (BBT), and interproximal bone levels) parameters were assessed at 12 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At the 12-month follow-up, all treated patients exhibited complete resolution of PIBDs and a BBT of ≥1.5 mm. Moreover, all implants presented a keratinized mucosa height ≥2 mm associated with stable soft-tissue margins, shallow PDs, minimal bleeding, and no suppuration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Within the limitations of this preliminary case series, sSPAL appears to be a feasible approach to modify the peri-implant phenotype by both reconstructing the hard-tissue component and providing adequate dimensions of the soft-tissue component.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;The study was performed in order to assess whether and to what extent sSPAL may allow to manage both hard- and soft-peri-implant phenotype components; The isolation of the coronal full-thickness portion of the flap as well as a careful dissection of the periosteal layer taking care of maintaining its integrity are of paramount importance in order to successfully perform the surgical procedure. Finally, the adaptation of the flap should allow for the displacement of the full-thickness portion of the flap around the healing abutment in order to create adequate dimension of the soft-tissue peri-implant phenotype; The absence of at least 6 mm of keratinized tissue above the edentulous ridge as well as a limited thickness of the mucosa lining the bone crest, thus not ensuring adequate dimensions of the soft-tissue phenotype on both buccal and lingual aspects of the implant, may represent a contraindication for the execution of sSPAL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;The present study pointed out the use of a novel surgical technique, namely the simplified subperiosteal peri-implant augmented layer technique (sSPAL), aimed at managing both hard and softperi-implant tissues in a single surgical intervention. The procedure derives from a published and validated two-stage technique (SPAL technique) aimed at correcting a peri-implant bone dehiscence (PIBD) simultaneously with implant placement. The present pilot study involved eight patients presenting one implant each that was treated wit","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708547","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":"A novel split flap-roll technique for peri-implant soft tissue augmentation in the esthetic zone: A clinical case report.","authors":"Riolla Sanchia Dsouza, Sahana Purushotham, Saurav Shankar Das, Devanarayanan Nampoothiri","doi":"10.1002/cap.70091","DOIUrl":"https://doi.org/10.1002/cap.70091","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Peri-implant soft tissue thickness is a critical determinant of esthetic outcomes and long-term implant stability, particularly in the anterior maxilla.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 28-year-old systemically healthy male presented with a missing maxillary central incisor and a thin gingival biotype. Following implant placement, a modified split flap-roll technique was performed. The surgical approach involved splitting the flap into epithelial and connective tissue components, followed by mobilization and rolling of the connective tissue into a labial pouch to enhance tissue thickness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Soft tissue thickness increased from less than 2 mm pre-operatively to approximately 4 mm at 3 months, with stable maintenance of approximately 3 mm at 9 months. Improved gingival contour, emergence profile, and uneventful healing were observed throughout the follow-up period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The modified split flap-roll technique may serve as an alternative approach for peri-implant soft tissue augmentation. Within the limitations of this case report, favorable clinical outcomes were observed; however, further controlled studies are required to establish its predictability and clinical effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significance: &lt;/strong&gt;Modification of an existing roll flap technique Eliminates the need for a secondary donor site Allows soft tissue augmentation using a pedicled approach May provide an alternative option in selected cases KEY POINTS: The modified split flap-roll technique increased peri-implant soft tissue thickness from less than 2 mm to approximately 4 mm at 3 months, with stable maintenance at 9 months. The technique utilizes a pedicled connective tissue component, eliminating the need for a secondary donor site and potentially reducing patient morbidity. This approach may provide an alternative soft tissue augmentation option for selected esthetic-zone implant cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Dental implants placed in the front part of the upper jaw require healthy and adequate gum tissue to achieve a natural appearance and long-term stability. In some patients, the gum tissue around an implant is thin, which can affect both esthetics and treatment outcomes. This case report describes a modified surgical technique used to increase the thickness of the soft tissue around a dental implant without taking tissue from another area of the mouth. A 28-year-old patient with a missing upper front tooth and thin gum tissue underwent implant placement combined with a split flap-roll procedure. During surgery, tissue from the same surgical site was carefully separated, rolled, and repositioned to create additional volume around the implant. The soft tissue thickness increased from less than 2 mm before treatment to approximately 4 mm after 3 months and remained stable at approximately 3 mm after 9 months. Healing was uneventful, and the fina","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686978","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 external root resorption following periodontal regenerative therapy using rhFGF-2 and DBBM: A case report.","authors":"Yoshimi Saito, Kentaro Imamura, Mayuri Ambiru, Hideto Aoki, Masahiko Nikaido, Atsushi Saito","doi":"10.1002/cap.70083","DOIUrl":"https://doi.org/10.1002/cap.70083","url":null,"abstract":"<p><strong>Background: </strong>Periodontal regenerative therapy using recombinant human fibroblast growth factor-2 (rhFGF-2) combined with deproteinized bovine bone mineral (DBBM) has demonstrated favorable and predictable clinical outcomes for intrabony defects. However, long-term outcomes and potential challenges following such combination therapies remain poorly documented.</p><p><strong>Methods: </strong>A 40-year-old woman with generalized stage III grade C periodontitis underwent periodontal regenerative therapy using rhFGF-2 combined with DBBM for a one-wall defect at the mandibular left first molar (#19).</p><p><strong>Results: </strong>Favorable periodontal healing was maintained for approximately 4 years. However, for tooth #19, the probing depth gradually increased at 5 years 2 months post-surgery, and the patient developed discomfort and pulpal symptoms by 6 years 2 months. Clinical examination revealed an agglomerate of DBBM particles and a palpable external root resorption lesion. The tooth was extracted due to irreversible pulpal involvement.</p><p><strong>Conclusion: </strong>This case illustrates that despite favorable early healing, periodontal regenerative therapy may lead to rare late-onset complications such as external root resorption. Long-term follow-up and careful consideration of biomaterial interactions are essential when employing combination regenerative approaches.</p><p><strong>Key points: </strong>Periodontal regenerative therapy using rhFGF-2 and DBBM achieved favorable clinical outcomes for 4 years before unexpected late-onset external root resorption developed. Long-term persistence and partial separation of DBBM particles, along with the response of macrophage- or osteoclast-lineage cells, are associated with a potential for delayed resorptive pathology on adjacent root surfaces. Clinicians should recognize the possibility of late complications and carefully consider biomaterial interactions when selecting regenerative strategies and informing patients.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686941","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":"Non-incised papillae surgical approach for intrabony defects utilizing advanced platelet-rich fibrin/xenograft composite.","authors":"Raksha Kumari, Triveni M Gowda, Rucha Shah, Gayathri Gv","doi":"10.1002/cap.70082","DOIUrl":"https://doi.org/10.1002/cap.70082","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The present study aimed to assess and evaluate the clinical and radiographic outcomes of the non-incised papilla surgical approach (NIPSA) with advanced platelet-rich fibrin (A-PRF)/xenograft composite to enhance periodontal regeneration in intrabony defects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 10 systemically healthy patients aged 25-55 years with 3- or 2-wall intrabony defects involving the buccal wall and defect depth ≥3 mm were selected. Microsurgical technique NIPSA was employed, and grafting was done using A-PRF/xenograft composite, followed by A-PRF membrane placement. The radiographic cone beam computed tomography measurements of total defect depth and bone density in Hounsfield-Units (HUs) were taken at baseline and at the end of 6 months. Clinical parameters, including probing depth, clinical attachment level, and gingival thickness, were recorded at baseline and at 6 months postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From baseline to 6-month study showed a mean reduction of 2.69 mm in probing depth and a mean gain of 2.68 mm in clinical attachment and 2.81 mm gain in gingival thickness. Radiographically, a mean reduction of 2.80 mm in total defect depth and gain in bone density from 22.20 to 507.10 HUs was observed. All the parameters showed clinical and statistical improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;NIPSA technique, along with the A-PRF/xenograft composite, can be an effective and minimally invasive regenerative procedure for the management of intrabony defects in the maxillary and mandibular anterior region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;To the best of our knowledge, this is the first study to demonstrate the effectiveness of the non-incised papilla surgical approach technique in combination with advanced platelet-rich fibrin (A-PRF)/xenograft composite for the management of 2- and 3- wall intrabony defects. Minimally invasive non-incised papillae preservation approach effectively maintained the integrity of soft tissues and graft stability, both of which are critical factors for successful regenerative outcomes. A harmonious biomaterial A-PRF/xenograft composite graft utilizes the biological activity of PRFs with structural support of the graft material in escalating the regenerative treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;This study assessed a minimally invasive surgical procedure to help restore the bone and supporting tissues around teeth damaged by periodontal disease. Ten healthy adults with specific types of bone defects were treated using this procedure in the anterior region. A biologically active material prepared from the patient's own blood was combined with a bone graft to restore the defect. After 6 months, patients showed significant improvements such as increased gum attachment, gum thickness, and reduced pocket depth. In a three-dimensional scan, bone level and bone density were also increased. These changes indicate that the treated sit","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632728","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":"Mitigating thermal risk in guided implant surgery: Hollow-guide and alternative designs.","authors":"Brett E Weatherington","doi":"10.1002/cap.70080","DOIUrl":"10.1002/cap.70080","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The generation of heat during osteotomy preparation is a significant risk factor for thermal osteonecrosis, which may lead to implant failure. While static surgical guides enhance placement accuracy, they can physically obstruct the flow of external coolant, paradoxically increasing the risk for thermal injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;(1) Review of thermal necrosis and critical temperatures during osteotomy preparation. Advantages and disadvantages of static guided surgery. (2) Design and fabrication of static surgical guides with direct coolant channels to the osteotomy site. Variations include: Hollow-Guide, internal irrigation channels, external irrigation channels, and mesh-based guide fabrication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A new, simplified workflow is proposed to design and fabricate surgical guides for implant placement with the delivery of coolant directly to the osteotomy site with no obstruction and decreased risk of thermal injury and implant failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This report details a novel approach to mitigating thermal injury during guided dental implant surgery. The application of a patient-specific, three-dimensional-printed surgical guide featuring an integrated Hollow-Guide design bypasses conventional coolant obstruction by delivering sterile saline directly to the osteotomy site via segmentation and selective hollowing. A simple workflow is described to integrate multidirectional irrigation to the surgical site and reduce the risk of thermal injury, subsequent osteonecrosis, and implant failure. While traditional static guides serve as a passive positioning jig, the Hollow-Guide acts as an active therapeutic device during implant preparation and placement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Static surgical guides significantly improve implant placement accuracy, but impede traditional delivery methods of irrigation and coolants to the surgical site. Maintenance of bone temperatures below a critical threshold is necessary to prevent thermal necrosis and implant failure. A digital workflow has been proposed to allow for irrigation directly at the osteotomy site without the need for complex internal or external irrigation channels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Preparing the jawbone for dental implants generates significant heat from drilling. If the bone gets too hot, the tissue can die, ultimately leading to failure and loss of the implant. Dentists often use three-dimensional-printed surgical guides to ensure implants are placed in the correct anatomical position, but these templates can physically block external irrigation from reaching the drill site, increasing the risk of thermal damage. This article introduces a new design technique called the \"Hollow-Guide.\" This method modifies the surgical guide to include built-in channels that allow sterile water or saline to flow directly to the bone during drilling. By solving the problem of block","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320750","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":"Intentional replantation with apical periodontal ligament preservation: A case report.","authors":"Nuri Gerçek, Dilara Gizem Kılıçkaya, Zeynep Buket Dağ, Abdullah Cevdet Akman","doi":"10.1002/cap.70084","DOIUrl":"https://doi.org/10.1002/cap.70084","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intentional replantation (IR) is a conservative treatment option for compromised teeth when the viability of the periodontal ligament (PDL) can be preserved. Maintaining viable PDL cells and using bioactive agents such as ethylenediaminetetraacetic acid (EDTA), platelet-rich fibrin (PRF), and injectable platelet-rich fibrin (i-PRF) may enhance the regenerative potential of replanted teeth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 59-year-old female patient presented with Grade III mobility and extrusion of maxillary tooth #9 following trauma. Clinical examination revealed a probing depth of 10 mm with bleeding on probing. After initial periodontal therapy and root canal treatment, the tooth was atraumatically extracted for IR. The extraoral time was limited to 10 min. Root surface instrumentation and 24% EDTA conditioning were performed only on the cervical and middle thirds of the root, while the apical PDL region was preserved without decalcification or curettage to maintain cell viability. i-PRF and PRF were prepared from the patient's venous blood. i-PRF was applied into the socket to enhance biological activity, and PRF was placed on the buccal aspect to support soft-tissue healing. After replantation, the tooth was stabilized with a rigid splint.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Postoperative pain measured on the visual analog scale was 6 on day 1, 2 on day 3, and 0 on day 7. The initial 10 mm probing depth decreased to 4 mm at 1 month and 3 mm at 3 months, remaining stable throughout the 1-year follow-up. Radiographically, no ankylosis or root resorption was detected. The gingival index decreased from 2 to 0, and the periodontal tissues remained healthy and stable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This case demonstrates that IR performed with atraumatic extraction, a short extraoral period, and preservation of the apical PDL without decalcification can successfully retain a tooth with advanced mobility. The synergistic use of EDTA, PRF, and i-PRF created a favorable microenvironment for periodontal healing. This biologically oriented protocol represents one of the rare regenerative IR cases in which success was achieved without apical PDL decalcification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Preservation of viable periodontal ligament tissue is critical for successful intentional replantation. Limited apical socket preparation may facilitate passive reinsertion while minimizing compression of the apical periodontal ligament. Intentional replantation may be considered as a tooth-preserving treatment option in selected cases with trauma-related periodontal damage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Saving teeth with severe damage is often difficult, especially when there is both gum tissue destruction and a history of dental trauma. In this case report, a severely mobile upper front tooth was treated using intentional replantation, a procedure in which the tooth is carefully removed and then placed back i","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148320669","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":"Customized three dimensionally printed palatal stents: A randomized controlled clinical trial.","authors":"Mi-Seon Goh, Seong-Min Kim, Hyung-Keun You, Jong-Chan Choi, Dong-Woon Lee","doi":"10.1002/cap.70075","DOIUrl":"https://doi.org/10.1002/cap.70075","url":null,"abstract":"<p><strong>Background: </strong>Soft tissue grafts are commonly used in periodontal surgery around teeth and implants. However, few studies have examined donor-site pain through patient-reported outcomes following soft tissue grafting. This study aimed to minimize donor-site pain during autologous gingival grafting using a three-dimensionally (3D)-printed stent and evaluate its effectiveness from a patient-centered perspective.</p><p><strong>Methods: </strong>In this randomized controlled trial, 32 patients requiring autogenous gingival grafts were equally allocated to the control group (Omnivac stent) or the test group (3D-printed stent). Patient-reported outcomes were assessed using a visual analog scale (VAS) and the Oral Health Impact Profile-14 (OHIP-14) questionnaire on the day of surgery and at 1, 7, and 14 days postoperatively.</p><p><strong>Results: </strong>Data from 16 control and 14 test patients were analyzed (two patients were lost to follow-up). The test group reported significantly lower VAS scores than the control group. Despite a lack of statistically significant temporal differences, marked reduction was observed on the day of surgery and on postoperative day 7. OHIP-14 scores were significantly lower in the test group than in the control group across all time points. Analysis of the individual OHIP-14 items at different intervals revealed significant reductions in discomfort-specifically in pronunciation, taste, mastication, and daily activities-when using 3D-printed stents.</p><p><strong>Conclusions: </strong>This study applied 3D-printed stents to reduce donor-site discomfort after autogenous soft tissue grafting and evaluated their effectiveness using patient-reported outcomes. Although 3D-printed stents may not directly reduce postoperative pain, they help alleviate discomfort during routine oral functions and daily activities.</p><p><strong>Key points: </strong>This study focuses on the free gingival graft, one of the most frequently employed soft tissue grafts in periodontal practice. While autogenous gingival grafting on the palatal side is currently considered the gold standard, it causes additional pain and discomfort in patients. This study demonstrates that three-dimensional technology can be used to improve stent design to reduce patient pain and discomfort.</p><p><strong>Plain language summary: </strong>This randomized controlled trial demonstrates that compared with a conventional stent, a customized 3D-printed palatal stent significantly improves patient-reported comfort and oral function after autologous gingival grafting, thereby enhancing postoperative quality of life.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148285025","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}