Effects of extended guided bone regeneration on the labial alveolar wall of adjacent teeth in the anterior maxilla: a retrospective cohort study

Purpose: This study evaluated the pathological effects of single posterior implant-supported fixed prostheses on adjacent and antagonistic teeth and investigated the influence of systemic diseases, occlusal conditions, implant site, and patient sex.Materials and Methods: A retrospective observational study was conducted on 100 patients who had received a single posterior implant and were followed for at least one year at Gangneung-Wonju National University Dental Hospital. Clinical and radiographic assessments compared adjacent and antagonistic teeth at the implant site (ex-perimental group) with the corresponding contralateral teeth (control group). Parameters included tooth cracks, cusp fractures, alveolar bone status, treatment history, and occlusal contact assessed using the Shimstock test. Associations with systemic diseases, occlusal contact, sex, and implant position were also analyzed. Statistical analysis was performed using the chi-square test with a significance level of 0.05.Results: The distal adjacent tooth at the implant site showed significantly higher mobility than the control group (p<0.05). In patients without unilateral mastication, periapical lesions in antagonistic teeth (p<0.05) and cracks in adjacent teeth (p<0.05) were more frequent. Diabetic patients demonstrated a significantly higher prevalence of alveolar bone loss and treatment history in both adjacent and antagonistic teeth (p<0.05). When no occlusal contact was present on the implant-antagonistic tooth, less alveolar bone loss was observed (p<0.05), whereas cusp fractures in adjacent teeth were more common. Male patients showed a higher frequency of cusp fractures and cracks in adjacent teeth (p<0.05).Conclusion: Single posterior implant-supported fixed prostheses can induce pathological changes in adjacent and antagonistic teeth. Implant treatment planning should consider systemic health, occlusal dynamics, sex-related differences, and long-term maintenance.

Maximizing aesthetics on single implants

To our acknowledgment, there were limited clinical studies about the guided bone regeneration (GBR) for both vertical and horizontal augmentation at the same time using titanium mesh (Ti-mesh) with simultaneous implant placement in the esthetic zone. Meanwhile, studies that specially evaluate resorption and long-term stability of the augmented labial bone after loading were also rare. Therefore, this study introduced a newly designed L-shaped Ti-mesh used for GBR with simultaneous implant placement and evaluated the bone augmentation effectiveness, resorption, and long-term stability of peri-implant bone with this newly designed L-shaped Ti-mesh. Twelve patients (16 implants) who had underwent a GBR procedure using L-shaped Ti-mesh with simultaneous implants placement were reviewed in this study. Complications, implant success, and survival rate were recorded and calculated. Furthermore, the bone gain values, labial bone resorption, and remaining labial bone volume were measured by cone beam CT (CBCT) during 13-41 months follow-up. After GBR using L-shaped Ti-mesh, the average bone gain values were 3.61 ± 1.50 mm vertically and 3.10 ± 2.06 mm horizontally. The implant success and surviving rate were 93.75% and 100%, respectively during the longest 41 months follow-up. The vertical labial bone resorption was -0.81 ± 1.00 mm, horizontal labial bone resorption was -0.13 ± 1.19 mm at the top of the implants. The remaining labial bone thickness was 2.24 ± 1.29 mm at the top of the implants and 2.86 ± 1.08 mm at the 2 mm apically from the implant tops after loading. There was still 1.13 ± 1.18 mm vertical labial bone remaining above the top of implants for approximately 87.5% sites. GBR using L-shaped Ti-mesh with simultaneous implant placement (one-step surgery) in the esthetic zone could achieve predictable results for vertical and horizontal bone augmentation at the same time. Meanwhile, L-shaped Ti-mesh could preferably reconstruct and reduce the labial bone resorption to achieve long-term esthetics. This newly designed L-shaped Ti-mesh may offer predictable and excellent outcomes for the implant restoration in the esthetic zone.

Restoring periodontally compromised teeth in esthetic zones through dental implant rehabilitation poses significant challenges due to the loss of supporting tissues. This case report describes a staged treatment strategy designed for a 48-year-old woman with advanced chronic periodontitis of the esthetic zone. This approach combined various advanced techniques, including periodontal regeneration, orthodontic implant site development with labial root torque, guided bone regeneration, and soft tissue augmentation. The innovative orthodontic implant site development with labial root torque technique was employed to harness healthy palatal periodontal ligament cells by strategically applying labial root torque in the horizontal labial-palatal direction. This technique uses healthy palatal periodontal ligament cells, which benefits overall periodontal health. The procedure involved gradually shifting hopeless teeth at a rate of 2 mm per month using nickel-titanium wires, thereby maintaining overcorrection for 2 months before extraction. Following successful orthodontic implant site development with labial root torque, the next phase involved guided bone regeneration using a honeycomb-structured titanium membrane. This set the stage for implant placement 6 months later, ensuring a stable foundation for subsequent prosthetic intervention. Soft tissue augmentation was then meticulously performed using an artificial collagen dermis infused with fibroblast growth factor-2, contributing to the overall esthetic outcome. Final prosthesis integration revealed a harmonious blend with the adjacent teeth and gums, underscoring the success of this multidisciplinary approach. This case report provides valuable insights into severe periodontitis in the esthetic field. Our findings highlight the importance of continuously researching and improving procedures for optimal patient care.

Guided bone regeneration (GBR) is frequently used in oral implantology. It is unclear to what extent GBR affects the periodontium of adjacent teeth. Therefore, the present study quantifies changes in the proximal gingiva and bone levels at these teeth in 30 patients. Staged surgery involved a standard GBR treatment, randomly using resorbable membranes with a bone substitute or non-resorbable membranes with or without a bone substitute, followed by fixture installation at 6 months and abutment connection a further 6 months later. The data were sampled at each surgery and analysed using MANOVA. Twelve months after GBR, there was on average a small but statistically significant amount of proximal gingival recession (0.75 mm) and bone resorption (0.34 mm) observed, of which 50% was the result of GBR surgery. No significant differences were found between the different GBR treatment modalities. It is concluded that GBR treatment may have a small negative effect on the levels of the free gingival margin and alveolar bone at adjacent teeth, which is in most patients not clinically relevant.

When encountering a buccal bone defect during implant placement, guided bone regeneration (GBR) is a well-accepted method for bone reconstruction. However, it is still unclear if the esthetic and patient-reported outcomes are comparable to implants placed in native bone. The purpose of this prospective trial was to compare implants placed with a GBR procedure for a small (≤ 4 mm) buccal defect with implants placed completely in native bone (control). Patients were allocated to the GBR group or control group during implant placement in the esthetic zone. Implants were placed after at least 12 weeks of healing of the extraction sockets. A buccal bone defect of ≤ 4 mm resulted in allocation to the GBR group. Follow-up was performed until 12 months after loading. Outcome measurements were as follows: esthetic scores, patient-reported outcome measurements, implant survival and complications, clinical indices, and radiographic measurements. In total, 45 patients were included, of which 23 underwent a GBR procedure after implant placement, and in 22 patients no GBR was necessary. No significant differences in esthetic outcomes were seen between the two groups. At the final follow-up, a mean pink esthetic score (PES) of 7.8 (SD: 1.5) was seen for the GBR group and 8.4 (SD: 1.4) for the control group. Regarding the white esthetic score (WES), a mean of 9.1 (SD: 1.0) was found for both groups. Patients of both groups were equally satisfied with their mucosa and crown. A mean visual analog score (VAS) for the soft tissues of 8.6 (SD: 1.0) in the GBR group and 8.8 (SD: 0.9) for the control group was noted. A mean VAS of 9.2 (SD: 0.8) was noted for the crown in the GBR group and 8.6 (SD: 2.0) in the control group. Implant survival was 100%, and there were no significant differences in complications, plaque/bleeding/gingiva indices, width of attached mucosa, and marginal bone loss. Implants placed in the esthetic zone with GBR or complete native bone coverage showed successful esthetic outcomes and satisfied patients with predictable clinical and radiographic parameters after more than 1 year of loading. Within the limits of this study, GBR for a small buccal bone defect seems to be a reliable technique with good esthetics and patient-reported outcomes.

To describe the methodology of the "L-shape" technique in guided bone regeneration (GBR) with simultaneous implant placement and report on the clinical, esthetic, and patient satisfaction outcomes up to 14 years of follow-up. Fourteen patients treated with the "L-shape" technique were included in this retrospective study. The L-shape technique was performed by trimming and placing a soft-type bone block made of deproteinized bovine bone mineral with 10% collagen at the buccal-occlusal aspect of the dental implant. The remaining gaps were filled with deproteinized bovine bone mineral granules and the augmented area was covered with a collagen membrane. The following parameters were recorded: probing depth (PD), bleeding on probing (BOP), plaque index (PI), keratinized tissue width (KT) and marginal bone level (MBL). Esthetic outcomes were assessed according to the pink esthetic score (PES) and the white esthetic score (WES). Patient satisfaction was evaluated by means of a numerical rating scale (0-10). The stability of each augmented site was assessed by measuring the volumetric changes between baseline (crown delivery) and the respective follow-up. A total of 13 maxillary incisors and one maxillary canine in 14 patients were included. The mean follow-up period was 7.7 ± 3.8 years. PES values amounted to 10.7 ± 3.3 and WES to 8.8 ± 1.4. Patient satisfaction reached 9.4 ± 0.8. Mean PD at implant sites were 2.7 ± 0.7 mm while BOP amounted to 15.0 ± 0.2% and Pl to 5.0 ± 0.0%. Volumetric analyses revealed minimal changes at the augmented sites irrespective of the region of interest. Radiographic MBL remained relatively stable. Within the limitation of the present study the L-shape augmentation procedure seems to be a reliable technique when performing GBR with simultaneous implant placement in the esthetic zone. Outcomes encompassed stable clinical and esthetic results accompanied by high levels of patient satisfaction. Future randomized controlled trials are warranted to confirm possible benefits of the L-shape technique over traditional approaches. The L-shapeappears to be a simple yet promising technique in GBR with simultaneous implant placement that can easily be translated into clinical practice.

Guided tissue regeneration has been shown to lead to periodontal regeneration, however, the mechanisms involved remain to be clarified. The present study was carried out to assess the expression of genes involved in the healing process of periodontal tissues in membrane-protected vs. nonprotected intrabony defects in humans. Thirty patients with deep intrabony defects (> or = 5 mm, two or three walls) around teeth that were scheduled for extraction were selected and randomly assigned to receive one of the following treatments: flap surgery alone (control group) or flap surgery plus guided tissue regeneration (expanded polytetrafluorethylene (e-PTFE) membrane) (test group). Twenty-one days later, the newly formed tissue was harvested and quantitatively assessed using the polymerase chain reaction assay for the expression of the following genes: alkaline phosphatase, receptor activator of nuclear factor-kappa B ligand, osteoprotegerin, osteopontin, osteocalcin, bone sialoprotein, basic fibroblast growth factor, interleukin-1, interleukin-4, interleukin-6, matrix metalloproteinase-2 and matrix metalloproteinase-9. Data analysis demonstrated that mRNA levels for alkaline phosphatase, receptor activator of nuclear factor-kappa B ligand, osteoprotegerin, osteopontin, bone sialoprotein, basic fibroblast growth factor, interleukin-1, interleukin-6, matrix metalloproteinase-2 and matrix metalloproteinase -9 were higher in the sites where guided tissue regeneration was applied compared with the control sites (p < 0.05), whereas osteocalcin mRNA levels were lower (p < 0.05). No difference was observed in interleukin-4 mRNA levels between control and test groups. Within the limits of this study, it can be concluded that genes are differentially expressed in membrane barrier-led periodontal healing when compared with flap surgery alone, and this may account for the clinical outcome achieved by guided tissue regeneration.

Background: The socket shield technique was created to protect periodontal ligament-related perfusion following tooth extraction to prevent alveolar bone resorption, which occurs as a result of a lack of blood flow caused by the loss of periodontal ligaments. Aim of this study: was to assess the socket shield method to the guided bone regeneration method for ridge preservation and quick implant insertion in the upper esthetic zone. Methods: This study was a randomized controlled clinical trial, Individuals were split into two groups, with one receiving immediate placement of ten dental implants in the maxillary aesthetic zone using the guided bone regeneration technique and the other receiving immediate placement of ten dental implants in the socket shield technique.Results: Socket shield technique showed a higher bone stability than guided bone regeneration. Socket shield technique showed a lower Change of bone width at loading than guided bone regeneration. Socket shield technique showed a lower Change in Buccal Bone height at loading than guided bone regeneration.Conclusion: socket shield showed a lesser bone change from loading at three months and six months than guided bone regeneration approach. The socket-shield approach has a smaller marginal bone loss and higher pink esthetic ratings than the traditional procedure. The socket shield approach is a dependable method to use in conjunction with inserting an implant right away in the aesthetic zone.

Background and objective: Guided tissue regeneration (GTR) has been widely used for periodontal regeneration after intrabony defects, and Bio-Oss® can be used together with GTR for the stability of the space under the GTR membrane. Platelet-rich fibrin (PRF), as a kind of platelet concentrate with rich autologous biologic agent, has been also used to treat periodontal intrabony defects for periodontal regeneration. However, whether PRF can enhance the regenerative effect of GTR and Bio-Oss® is not reported. Subjects and methods: This is a randomized self-controlled trial. Fourteen patients with periodontal intrabony defects who will receive treatment in the Department of Periodontology, Peking University School and Hospital of Stomatology, China will be included in this study. The left or right intrabony defects of each patient will be randomly randomized to a test group and a control group. In the test group, GTR, Bio-Oss® and PRF will be used for the treatment of periodontal intrabony defects. In the control group, GTR and Bio-Oss® will be used for the treatment of periodontal intrabony defects. PRF used in the trial will be liquid PRF, which can form Bio-Oss®-PRF mixture with Bio-Oss®, making the use of PRF easier in periodontal surgery. This study was approved by the Ethics Committee of Peking University School and Hospital of Stomatology (PKUSSIRB-201629066) on November 4, 2016. Outcome measures: The primary outcome is clinical attachment level, which will be measured at baseline, as well as 6, 12 and 24 months after surgery. The secondary outcomes include (1) depth of intrabony defect, (2) vertical bone loss, (3) probing depth, (4) bleeding index and (5) time of bone graft filling in the surgery. Radiographic evaluation will be accomplished at baseline and at 12 and 24 months after surgery. Probing depth and bleeding index assessments will be performed at baseline, and at 6, 12 and 24 months after surgery. Discussion: If the regenerative effects of GTR, Bio-Oss®, and PRF in combination are superior to those of GTR combined with Bio-Oss®, then the trial results will provide clinical evidence for the treatment of periodontal intrabony defects. Trial registration: Chinese Clinical Trial Registry, ID: ChiCTR1900027581. Registered on November 19, 2019.

Clinical studies on immediate implant placement for a single anterior maxillary tooth with a facial bone wall defect are rarely reported. To study the clinical outcomes of immediate implant placement combined with flap surgery, guided bone regeneration and non-submerged healing for a single anterior maxillary tooth with a facial bone wall defect. Forty-five patients with a single failing tooth in the anterior maxillary region showing indications for extraction combined with a facial bone wall defect were treated by means of immediate implant placement combined with flap surgery, guided bone regeneration and non-submerged healing. During this study, the implant survival rate, soft and hard tissue dimension changes, pink aesthetic score (PAS), and patient aesthetic satisfaction were assessed at 1, 6, and 12 months post-operatively. At 12 months post-operatively, the survival rate of 45 implants was 100%. Mesial/distal papillary level reduction and midfacial soft tissue recession were measured as 0.53, 0.41, and 0.31 mm, respectively. The thickness of facial bone reduction measured by cone beam computed tomography was 0.94, 0.80, 0.85, 0.82, 0.45, and 0.41 mm at 6 different sites around the implant. The mean PAS and patient aesthetic satisfaction were determined to be 10.58% and 93%, respectively. The proposed surgical procedure is a valuable treatment strategy as assessed by preliminary clinical outcomes.

Acute traumatic defects in the esthetic zone pose a significant challenge in dental implant rehabilitation, requiring innovative techniques to achieve optimal functional and esthetic outcomes. This article investigates the use of a novel combination of root submergence and guided bone regeneration (GBR) to address these defects. The goal is to evaluate the potential of this integrated approach for achieving predictable bone regeneration and long-term tissue stability. Studies have shown significant improvements in soft-tissue contour, papilla preservation, and emergence profile when root submergence is employed. Despite these benefits, the integration of root submergence with GBR remains underexplored in the literature. This combination shows considerable potential for achieving predictable bone regeneration and sustaining tissue stability in the esthetic zone. The integration of root submergence with GBR offers a promising solution for managing traumatic defects in the esthetic zone by enhancing soft-tissue contours and facilitating predictable bone regeneration. However, additional clinical studies are needed to support the long-term success of this innovative approach in dental implant rehabilitation. The combined use of root submergence and GBR for treating acute traumatic defects in the esthetic zone represents a notable advancement in dental implant rehabilitation. This article presents a detailed analysis of the rationale, technique, and clinical outcomes of this approach, underscoring its importance in achieving optimal esthetic and functional outcomes for patients with complex clinical needs.

To evaluate whether Bio-Oss used as an adjunct to guided tissue regeneration (GTR) improves the healing of 1- or 2-wall intrabony defects as compared with GTR alone, and to examine whether impregnation of Bio-Oss with gentamicin may have an added effect. Sixty patients, with at least one interproximal intrabony defect with probing pocket depth (PPD) > or =7 mm and radiographic evidence of an intrabony component (IC) > or =4 mm, were treated at random with either a resorbable membrane (GTR), a resorbable membrane in combination with Bio-Oss impregnated with saline (DBB-), a resorbable membrane in combination with Bio-Oss impregnated with gentamicin (DBB+), or with flap surgery (RBF). All treatment modalities resulted in statistically significant clinical improvements after 1 year. Defects treated with GTR alone presented a probing attachment level (PAL) gain of 2.9 mm, a residual PPD (PPD12) of 4.9 mm, a radiographic bone level (RBL) gain of 3.1 mm, and a residual IC (IC12) of 2.7 mm. GTR combined with Bio-Oss did not improve the healing outcome (PAL gain: 2.5 mm; PPD12: 4.9 mm; RBL gain: 2.8 mm; IC12: 3.3 mm). Impregnation of the Bio-Oss with gentamicin 2% mg/ml resulted in clinical improvements (PAL gain: 3.8 mm; PPD12: 4.2 mm; RBL gain: 4.7 mm; IC12: 2.1 mm), superior to those of the other treatment modalities, but the difference was not statistically significant. Defects treated with only flap surgery showed the most inferior clinical response (PAL gain: 1.5 mm; PPD12: 5.1 mm; RBL gain: 1.2 mm; IC12: 4.2 mm) of all groups. The results failed to demonstrate an added effect of Bio-Oss implantation in combination with GTR on the healing of deep interproximal 1- or 2-wall, or combined 1- and 2-wall intrabony defects compared with GTR alone. Local application of gentamicin, on the other hand, improved the treatment outcome but not to an extent that it was statistically significant.

Some prior reports have suggested that guided tissue regeneration (GTR) procedures achieve only partial regeneration and induces the ankylosis rather than true attachment. Accordingly, others have developed an alternative procedure employing gelatine membrane compounded with bovine cementum particles (CGM) which has proven effective in stimulating a more physiologic form of attachment. This study was undertaken to perform a direct comparison of histological results when CGM and GTR membrane were used at comparable sites in the same monkey. Three monkeys with no periodontal disease were used. Following flap surgery, recession type defects were created on the buccal side of the maxillary lateral incisors and second premolars, and the cementum was removed from the root surface at an area corresponding to the bone crest. The right and left lateral incisors and second premolars were covered with CGM and GTR membrane, respectively. The GTR membranes were removed after 4 weeks. At 6 wks, the animals were sacrificed, and specimens were prepared for histological examination. More coronally placed true new attachment was observed following application of CGM to the planed root surfaces. Application of the GTR membrane resulted in formation of bone-like cementum and ankylosis, whereas CGM established true periodontal regeneration.

The dental rehabilitation of a patient following single-tooth extraction in the esthetic zone is often clinically challenging. The treatment option for this is implant-supported single crown which has the advantage that adjacent teeth do not have to be prepared, as in a fixed prosthesis. This article presents a case of immediate implant placement in relation to 22 and a guided bone regeneration approach with platelet-rich fibrin (PRF) and bone graft. After immediate implant placement, to compensate for the gap (jumping distance) between the implant surface and bone walls of the socket, we used bone grafts and PRF clot as well as PRF membrane to achieve guided bone regeneration. PRF, which is the second generation platelet concentrate, offers the surgeon an access to growth factors with a simple and available technology. These growth factors, which are autologous, nontoxic, and nonimmunogenic, enhance and accelerate the normal bone regeneration pathways. The case presented showed successful outcome with a 1 year follow-up period.