Soft Tissue Healing Research Articles

The Clinical Efficacy and Safety of ErhBMP-2/BioCaP/β-TCP as a Novel Bone Substitute Using the Tooth-Extraction-Socket-Healing Model: A Proof-of-Concept Randomized ControlledTrial.

This first randomized controlled trial in humans aimed to assess the efficacy and safety of low-dosage Escherichia coli-derived recombinant human bone morphogenetic protein 2 (ErhBMP-2)-incorporated biomimetic calcium phosphate coating-functionalized β-TCP (ErhBMP-2/BioCaP/β-TCP) as a novel bone substitute using the tooth-extraction-socket-healing model. Forty patients requiring dental implants after single-root tooth extraction were enrolled in this study and randomly assigned into three groups: ErhBMP-2/BioCaP/β-TCP (N = 15), β-TCP (N = 15) and natural healing (N = 10). New bone volume density from histomorphometric analyses was evaluated 6 weeks post-operatively as the primary outcome, and other histomorphometric analyses, alveolar bone and soft-tissue changes were the secondary outcomes. Safety parameters included adverse events, soft-tissue healing, oral health impact profile, serum BMP-2 concentrations and other laboratory tests. The findings revealed a significant increase in new bone volume density in patients treated with ErhBMP-2/BioCaP/β-TCP compared to those receiving β-TCP alone. The required bone augmentation procedures during implant placement surgery in the ErhBMP-2/BioCaP/β-TCP group were significantly less than in the natural healing group. There were no significant differences in safety parameters among the three groups. This clinical trial primarily proved the safety and efficacy of ErhBMP-2/BioCaP/β-TCP as a promising bone substitute.

Alveolar Ridge Regeneration With Open Versus Closed Healing in Damaged Extraction Sockets: A Preclinical InVivo Study.

The objective of this study was to compare open versus closed healing of soft and hard tissue following alveolar ridge preservation (ARP) procedures in damaged extraction sockets. ARP was performed in five mongrel dogs using collagenated deproteinized bovine bone mineral (cDBBM) and a resorbable non-cross-linked collagen membrane (NCCM) in damaged extraction sockets, with each socket entrance left either open (open group) or closed (closed group). Clinical wound epithelization at the socket entrance and the dimensions of keratinized tissue were evaluated over time. Additionally, the augmented ridge dimensions and new bone formation were assessed radiographically and histologically at 8 weeks after surgery. The dimensions of the socket entrance gradually decreased in the open group, and wound epithelization was almost complete within 4 weeks. The mucogingival junction was maintained more apically in the open group than in the closed group (0.14 ± 0.40 mm vs. -0.86 ± 0.71 mm [mean ± SD], p < 0.05). The augmented ridge dimensions did not differ significantly between the open and closed groups (93.1% ± 5.4% vs. 88.3% ± 11.2%, p > 0.05). Histological analyses revealed no significant differences in the amount of newly formed bone. However, membrane resorption in the crestal region was more pronounced in the open group. Open and closed healing approaches for ARP in extraction sockets with damaged buccal wall resulted in similar ridge dimensions and new bone formation. However, there was less reduction of the buccal bone crest and wider keratinized tissue width after open healing.

Treatment of proximal phalangeal fracture with miniature combined external fixator

To investigate the clinical effect of limited open reduction treatment of proximal phalangeal fracture with miniature external fixator combined with small incision. Between January 2020 and December 2022, 29 patients with proximal phalangeal fracture were treated with micro external fixator combined with small incision in fracture plane, including 23 males and 6 females, aged from 19 to 62 years old with an average of (36.2±21.0) years old. Five patients with open phalangeal fracture were treated with stageⅠsurgery, 24 cases of closed phalangeal fracture were treated with elective surgery. At the 6 month follow-up, the curative effect was evaluated according to the total active flexion scale (TAFS) of the American Hand Surgery Association. The fracture healing, nail path, local soft tissue healing, and complications were observed. All the 29 patients were followed up for 6 to 10 months with an average of(8.3±2.1) months, 3 patients had delayed fracture healing, 1 patient had distal skin numbness, symptoms were relieved after nutritional nerve treatment, no external fixator broken nails, no infection, the nail path and small incision healing was good, bone healing was achieved at the end of follow-up. Fracture healing time ranged from 10 to 24 with an average of (13.7±3.1) weeks. Six months after operation, according to the TAFS standard, 19 cases (227.68±4.23) were excellent, 7 cases (203.86±14.32) were good, and 3 cases (170.33±7.32) were poor. The micro-combined external fixator combined with limited incision with small incision can be used in the treatment of proximal phalangeal fracture. The operation is simple and beneficial to early functional exercise, small extensor tendon irritation, convenient second-stage removal, and high rate of excellent and good functional score in recovery period.

Survey on Patient Perception of At-Home Bacterial Biofilm Control in Relation to Peri-Implant Soft Tissue Health.

Bacterial biofilm control around dental implants is critical for the health of the peri-implant soft tissue and longevity of dental implants. The patient's role in regular biofilm removal around dental implants is just as important as that of the dental hygienist. The purpose of this study is to identify the relationship between at-home dental implant care and patients' perceptions of peri-implant soft tissue health. A 15-item paper survey was distributed to adult patients undergoing professional dental hygiene maintenance at a specialty dental practice within a 3-month period and had at least one dental implant. Survey items included participant demographics, patient-reported adjunctive aids for dental implants and patient perceptions of dental implant oral hygiene practices and peri-implant soft tissue health. There was a statistical difference between time spent cleaning dental implants and peri-implant soft tissue health. An association was found between patients who reported spending more time cleaning their dental implants and less bleeding (p = 0.046/54%), gingival inflammation (p = 0.026/58%) and gingival tissue redness (p = 0.036/53%). Additionally, patients who more frequently underwent professional dental hygiene maintenance perceived less gingival inflammation (p = 0.001/66%). To promote peri-implant soft tissue health and reduce oral biological complications, best practice guidelines should be implemented, including optimal at-home dental implant care and regular professional dental hygiene maintenance.

A New Era of Tooth Preparation and Gingitage Retraction Technique: A Case Report

The demand for procedures intended to improve dental aesthetics has increased recently. Preserving the teeth and surrounding soft structures to the greatest extent possible is preferred in this situation by both patients and dentists. When using fixed prostheses, maintaining the stability and health of soft tissues is a constant struggle. Bone tissue health and soft tissue health are directly correlated. The long-term efficacy of prosthetic therapy thus depends on preserving tissue health and being free of mucositis. This case report describes the successful application of the gingitage technique in a patient requiring aesthetic enhancement of the gingival margins surrounding dental restorations. The patient presented with uneven gingival contours and mild inflammation around subgingival margins of existing restorations, compromising both function and aesthetics. Results demonstrated significant improvements in gingival health, a more balanced gingival margin, and an enhanced aesthetic outcome. Follow-up assessments revealed stable gingival contours and an overall increase in patient satisfaction. This case report underscores the effectiveness of the gingitage technique as a minimally invasive solution for enhancing soft tissue aesthetics and supporting the longevity of dental restorations.

"Navigating the tides of recovery": early vs. delayed osteosynthesis for closed tibia fractures complicated by acute compartment syndrome - an analysis of one hundred and three cases.

In cases of closed tibia fractures with acute compartment syndrome (ACS), there is no established agreement on whether performing internal fixation at the time of closure or after healing of the fasciotomy wounds would affect the likelihood of non-union or infection risk. The study aims to compare fracture union rates, incidence of infection, and overall outcomes between early and delayed definitive fixation. Retrospective analysis of closed tibia fractures (AO/OTA 41, 42) with ACS between 2010 and 2019 with a minimum two years follow-up. The patients were grouped into group-1 (early-definitive fixation group) and group-2 (delayed-definitive fixation group). The patients were further subdivided into - 1A(early-plate osteosynthesis), 1B(early-intramedullary nail fixation), 2A(delayed-plate osteosynthesis), and 2B(delayed-intramedullary nail fixation). Incidence of ACS in closed tibia fractures was 3.85%. Of the 103 patients included, the patients with plate fixation had a significantly higher union rate in the delayed group (100% vs. 91.66%; P = 0.0001). Similarly, among patients with nail fixation, a significantly higher union rate was seen in the delayed group (96.30% vs. 85.19%; P = 0.0016). The overall incidence of infection was 22.3% (23/103). Moreover, infection was higher in the early definitive fixation group (30.16% vs. 10%; P = 0.016). With a lower incidence of infection and higher union rate among the delayed definitive fixation group, we propose to postpone the definitive fixation of closed tibia fractures complicated by ACS till the complete healing of fasciotomy wounds. This allows for adequate soft tissue healing and improvement in the biological environment of fracture, which boosts the chances of successful union and reduces infection risks.

Three-dimensional anisotropic unified continuum model for simulating the healing of damaged soft biological tissues.

The soft biological tissues have the ability to heal and self-repair after damage or injury. During the healing process, damaged tissues are replaced by newly produced undamaged tissue to restore homeostasis. Computational modeling serves as an effective tool for simulating the healing process and understanding the underlying mechanisms. In previous work, we developed the first unified continuum damage model for the healing of soft biological tissues. However, the initial theory lacked generalizability to more realistic scenarios and applicability to biomechanical problems due to the simplicity of the isotropic constitutive model and two-dimensional simulations. Therefore, we further improve our approach by developing a three-dimensional anisotropic unified healing model to address more realistic challenges. By using the Holzapfel-Gasser-Ogden model as the hyperelastic term, the influence of the collagen fibers is considered and the reorientation of fibers in healing is simulated. Three numerical examples related to hypertension, aneurysm, and restenosis of the atherosclerotic artery after balloon angioplasty are presented to demonstrate the effectiveness of the proposed model. By comparing numerical solutions and reference solutions, we demonstrate the ability of the proposed model in simulating long-term tissue healing process and analyze the impact of anisotropic terms.

Effect of ultraviolet treatment on soft tissue healing and bacterial attachment to Titania-coated zirconia.

Zirconia is the most promising implant abutment material due to its excellent aesthetic effect, good biocompatibility and corrosion resistance. To obtain ideal soft tissue sealing, the implant abutment surface should facilitate cell adhesion and inhibit bacterial colonization. In this study, pre-sintered zirconia was placed in a suspension of titania (TiO2) and zirconium oxychloride (ZrOCl2) and heated in a water bath for dense sintering. A titania coating was prepared on the zirconia surface and subjected to UV irradiation. The surface morphology, elemental composition and chemical state of each group of samples were analyzed by scanning electron microscope (SEM), X-ray energy spectrometer (EDS), X-ray photoelectron spectroscopy (XPS) and X-ray diffraction (XRD). The responses of human gingival fibroblasts (HGFs) and common oral pathogens Streptococcus mutans (S. mutans) and Porphyromonas gingivalis (P. gingivalis) to modified zirconia were systematically assessed. Our findings demonstrated that the surface of titania-coated zirconia after UV irradiation produced a large number of hydroxyl groups, and its hydrophilicity was significantly improved. Meanwhile, the UV irradiation also greatly removed the hydrocarbon contaminants on the surface of the titania-coated zirconia. The UV-treated titania coating significantly promoted the proliferation, spreading, and up-regulation of adhesion-related genes and proteins of HGFs. Furthermore, the titania coating irradiated with UV could reduce the adhesion, colonization and metabolic activity of S. mutans and P. gingivalis. Therefore, UV irradiation of titania-coated zirconia can promote the biological behavior of HGFs and exert a significant antibacterial effect, which has broad clinical application prospects for improving soft tissue integration around zirconia abutments. &#xD.

A Contemporary Approach: Presentation of 4 Cases with the Entire Papilla Preservation (EPP) Technique

Regeneration of periodontal tissue is a primary goal of periodontal treatment. Periodontal regeneration approaches are widely used in the treatment of intraosseous defects. However, the success of these techniques depends on many factors, including surgical considerations. Failures in wound closure in the interdental region, which are surgical factors, have led to the development of papilla preservation techniques. The entire papilla preservation technique (EPP) maintains the integrity of the papilla associated with the defect. This technique stabilizes the blood clot with intact gingiva, preventing wound exposure and contamination. EPP is performed in intra-osseous defects through a short buccal vertical incision, without incising the papilla of the involved tooth. A full-thickness buccal flap is lifted from the incision to the relevant papilla and a tunnel extending under the papilla is prepared. The papilla is also lifted to full thickness. The defect is cleaned of granulation tissue and the wound is closed primarily with or without biomaterial application. In this report, we present 4 cases, 3 in the anterior maxilla and 1 in the mandibular premolar region, undergoing periodontal surgery with EPP with biomaterial application with a 3-month follow-up. In all cases, soft tissue healing was uncomplicated and radiographs showed bone filling at 3 months. EPP has a high success rate in periodontal regeneration by providing complete nutrition of the interdental papilla through natural, continuous vascular support in intraosseous defects.

Soft tissue response to titanium healing abutments treated by Er: YAG laser or plasma spray: A randomized controlled feasibility clinical study with SEM and histological analysis.

Soft tissue seal around implants ensures stable osseointegration and a long-term survival of dental implants. Different surface modification and decontamination for implant abutments were endorsed in order to improve peri-implant soft tissue healing, such as laser, plasma spray, acid etching, and steaming. The aim of this study was to evaluate the response of peri-implant soft tissue to titanium abutments treated with Erbium-doped: Yttrium-Aluminum-Garnet (Er:YAG) laser versus plasma spray. Twenty-four patients who required implant placement in the maxillary arch participated in this study. Patients were divided into three groups, abutments treated with Er:YAG laser versus cold plasma spray and untreated abutments. Fourteen days following the implant abutment insertion, soft tissue peri-implant biopsies were taken for histological, histochemical, and immunohistochemical evaluation. Scanning electron microscopy was done for the abutments; plaque index (PI) and gingival index (GI) were assessed 14 days and 3 months following final restoration. Regarding the histological results, the least mean inflammatory cell count was in the plasma group (174.09 ± 40.67), followed by the laser group (654.27 ± 85.95) and the control group (852.00 ± 117.98), with statistically significant differences between them. The mean area fraction of collagen fibers showed the highest value in the plasma group (9.73 ± 1.91), followed by the laser group (3.25 ± 0.49), while the lowest value was found in the control group (1.17 ± 0.51). The immunohistochemical expression of E-cadherin was significantly higher and uniformly distributed in the plasma group (42.4 ± 11.2%) followed by the laser group (15.4 ± 4.07%) and the control group (6.8 ± 1.7%). SEM analysis of healing abutments showed fibroblast-like cells, which were more developed with dense fibers in the plasma group; laser group fibers showed fewer and more delicate fibers than the plasma group, while no fibers were detected in the control group. Within the limitations of this feasibility study, the present data concluded that plasma spray and Erbium: YAG laser can be used for abutment surface treatment to achieve better peri-implant soft tissue healing. Clinically and histologically, plasma spray showed a better effect on the peri-implant soft tissues by reducing the inflammatory reaction, promoting collagen fiber formation, higher fibroblast-like cell attachment, and upregulating E-cadherin expression than Erbium: YAG laser and control groups.

Complications and morbidity of the extended delto-pectoral approach in treating complex humeral shaft fractures with proximal metaphyseal extension using a long locking plate for internal fixation

Background Humeral shaft fractures account for up to 3% of all fractures, but complex forms of those fractures (type AO/OTA B or higher) are rare. Plate and screw fixation of the fracture are rated as consolidated from 80 to 97%. Reported complications include non-union, secondary radial nerve palsy and infection. Minimally invasive plate osteosynthesis (MIPO) should provide the same union rate as open reduction and internal fixation (ORIF) but potentially with fewer complications. The aim of our study was to review patients treated for complex humeral fractures with ORIF through an extended delto-pectoral approach using a long pre-contoured locking plate. The morbidity of the open approach, complication rates, union rate and clinical outcomes were assessed.Methods We performed a retrospective analysis of 26 consecutive complex humeral shaft fractures (7 males, mean age 59 years; 19 females, mean age 67 years) treated in our institution with a long pre-contoured locking plate between June/2011 and December/2017. Fracture healing was evaluated with standard radiographs. Eventual complications and the morbidity of the approach were assessed through chart review. The final clinical outcome and quality of life were assessed via telephone interview with DASH score and EQ-5D-3 L in 25 of the 26 patients included.Results There were no complications related to the open approach with uneventful wound healing in all cases without any infections. Mechanical complications occurred in 3 cases (11%): one tuberosity dislocation (revised) and two plate failures (one revised). Postoperative radial nerve palsy was observed in two patients (7%), of which one was transient, the other was persistent. The plate was removed in 4 cases (15%). The average radiological and clinical follow-up was 21 months (range: 12–56). At 12 months follow-up complete fracture healing was confirmed in 22 out of 26 cases and in three more patients after 18 months. After an average of 44 months, the mean DASH score was 35 (SD ± 15.83) points; the EQ-5D-3 L score 0.7 (SD ± 0.31).Conclusion ORIF with a long locking plate though an extended delto-pectoral approach is certainly still a viable option to treat complex humeral shaft fractures with good soft tissue and bone healing as well as good functional recovery. No increased morbidity was attributed to the open surgical approach. In our series, radial nerve palsy could not be completely avoided, accentuating the potential risk of this specific fracture in close proximity to the radial nerve.Trial registrationEthics Committee: Ethikkommission Ostschweiz (EKOS), Project ID: 2019-00323.

Comparative Histological Analysis of Dentine-Derived Tooth Grafts in Maxillary vs Mandibular Socket Preservation: A Retrospective Study of 178 Cases.

(1) Background: In recent years, there has been a growing interest in tooth-derived materials as valuable alternatives to synthetic biomaterials for preventing alveolar ridge dimensional changes. This study aimed to evaluate the histological and clinical differences between alveolar ridge preservation procedures in the maxilla and mandible using demineralized dentin treated with Tooth Transformer®. (2) Methods: A total of 178 patients in good general health were enrolled, with 187 post-extractive sockets lacking buccal and/or palatal bone walls. Alveolar socket preservation procedures and histological evaluations were performed. The sites were divided into two groups: Group A (99 mandibular samples) and Group B (108 maxillary samples). After 5 months (±1 month), single bone biopsies were performed for histologic and histomorphometric analysis. (3) Results: Clinical outcomes demonstrated a good healing of hard and soft tissues with an effective maintenance of bone architecture in both groups. Histomorphometric analysis revealed a total bone volume of 50.33% (±14.86) in Group A compared to 43.53% (±12.73) in Group B. The vital new bone volume was 40.59% (±19.90) in Group A versus 29.70% (±17.68) in Group B, with residual graft dentin material volume at 7.95% (±9.85) in Group A compared to 6.75% (±9.62) in Group B. (4) Conclusions: These results indicate that tooth-derived material supports hard tissue reconstruction by following the structure of the surrounding bone tissue. A 6.8% difference observed between the maxilla and mandible reflects the inherent disparities in natural bone structures in these regions. This suggests that the bone regeneration process after tooth extraction adheres to an anatomical functional pattern that reflects the specific bone characteristics of each area, thus contributing to the preservation of the morphology and functionality of the surrounding bone tissue.

Marginal bone loss and soft tissue health around two-implant mandibular overdenture retained with milled versus selective laser melted cobalt chromium bar: a randomized clinical trial

BackgroundTo assess marginal bone loss and soft tissue health around two-implant mandibular overdenture retained with milled versus selective laser-melted cobalt chromium (Co-Cr) bars.MethodThis research was set to be a parallel, triple-blinded, randomised controlled trial. Twenty completely edentulous patients received new conventional complete dentures according to conventional techniques. Two implants were placed at mandibular canine areas bilaterally, and patients were randomly allocated into two equal groups: the milled Co-Cr bar group and the selective laser melted (SLM) Co-Cr bar group. Marginal bone loss (MBL), modified plaque index (mPI), modified gingival index (mGI), and probing depth (PD) were evaluated at 0-month (baseline), 6-month, and 12-month follow-up visits. Repeated measures ANOVA test and Bonferroni’s post-hoc test were used for parametric data as PD, while for non-parametric data as MBL, mGI, and mPI, Mann-Whitney U test and Friedman’s test were used. A P-value ≤ 0.05 was set as the statistical level of significance. The study protocol was approved by the Faculty Research Ethics Committee at Minia University (636 4/10/2022). Registration for the clinical trial was made retrospectively on clinicaltrials.gov with ID NCT06401200 at 04/30/2024.ResultsThe follow-up period (one year) was completed without a dropout. Regarding MBL, no statistically significant difference was found between the two groups throughout the study. However, the milled group showed significantly increased MBL from 0- to 6-month follow up period. In both groups, mPI increased significantly from 0- to 6-months post-loading. On the other hand, no statistically significant difference between the two groups was found regarding mPI and mGI throughout the study follow-up periods. The PD was significantly lower in the milled compared to the SLM group at the 6- and 12-month follow up period.ConclusionTwo-implant mandibular overdenture retained with milled or SLM Co-Cr bar can provide an acceptable treatment option for completely edentulous patients regarding marginal bone loss and soft tissue outcomes.

Horizontal Guided Bone Regeneration of the Posterior Mandible to Allow Implant Placement: 1-Year Prospective Study Results.

Assess whether horizontal ridge augmentation with guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM), autologous bone, and a resorbable collagen membrane supports successful implant placement. This open, prospective, single-cohort, multicenter clinical study included patients with ridge defects that required GBR prior to implant insertion. The primary endpoint was radiologically assessed bone gain after 8 months post-GBR, measured at the center of planned implant sites. Secondary endpoints included implant survival and success, marginal bone levels (MBLs), MBL changes, and soft tissue health. Of 45 patients evaluated 8 months post-GBR, nine experienced dehiscence in the first 3 weeks of the healing period. GBR led to radiologically determined mean bone width gain of 4.0 ± 1.5 mm and 4.8 ± 1.7 mm, measured 1 and 3 mm from the top of the crest, respectively, allowing successful implant placement in 44 patients (97.8%). The cumulative implant survival and success rates were 98.9% and 95.5%, respectively. MBLs were stable: -1.18 ± 0.64 mm at definitive prosthesis placement (DPP) and - 1.07 ± 0.74 mm at 1 year. Soft tissue health and esthetics (plaque and bleeding indices, papilla, keratinized mucosa, and pink esthetic score) improved from DPP to 1 year. Patients were highly satisfied with implant function and esthetics, and their oral health-related quality of life improved. GBR using DBBM and a collagen membrane offered a safe and effective treatment option for horizontal ridge augmentation sufficient to support implant-based tooth rehabilitation. Registered at ClinicalTrials.gov NCT03028922 (registrations sites, as above listed affiliations, first posted January 23, 2017).

Total Ankle Arthroplasty Incision Management: What Matters? A Systematic Review

Modern advancements in total ankle arthroplasty techniques and implants have increased the popularity of this treatment for ankle osteoarthritis. The preeminent approach for ankle replacement involves an anterior incision, however, wound complications with this approach provide a persistent challenge to surgeons. The present study was conducted to synthesize current data on ankle replacement wound complications via an anterior approach. A systematic review was completed including studies published from 1993 to present that employed an anterior approach and had precise criteria for wound healing and revisions. Twenty-nine studies, with level 3 to 4 evidence and moderate to serious bias, were included for a total of 6,986 ankle arthroplasties. The rate of wound healing without any complication was 90.38%. Minor dehiscence occurred in 6.00% of cases, while major wounds or infections occurred in 3.62%. Across 2,966 implants, the rate of major wounds or infections decreased from 7.03% before 2013 to 4.75% after 2013 (p = 0.034). Limited comparisons involving simple suture closure to various adjunct wound management techniques including negative pressure wound therapy, 2-octyl cyanoacrylate, platelet-rich plasma, dehydrated human amniotic membrane allograft, non-invasive skin expansion strips, compression wound dressings, tranexamic acid, surgical helmets, tourniquets, ankle arthrodesis, and lateral approach ankle arthroplasty, yielded non-significant differences (p > 0.18). Therefore, contemporary techniques, patient selection, and current implants may be leading to better soft tissue healing. As ankle replacement continues to surge in popularity, further research is needed to evaluate causative factors in successful anterior incision healing. Level of Clinical Evidence3

The Impact Of Lipstick Use On Oral Health: A Review Of Potential Effects And Implications.

Cosmetic products, particularly lipsticks, are widely used across various populations. While the aesthetic effects of lipstick have been extensively discussed, the potential implications for oral health still need to be explored. This review examines the possible impacts of lipstick use on the oral microbiome, dental hygiene practices, and soft tissue health. Additionally, the review highlights behavioral changes induced by lipstick use that could affect oral care habits. The aim is to provide dental professionals with insights into how daily cosmetic habits, such as lipstick application, may influence oral health and hygiene practices

Endodontic Microsurgery with the Aid of Dynamic Navigation System Using Minimally Invasive Incision Approach in Anatomically Complex Scenarios: A Case Series

Endodontic microsurgery (EMS) is an alternative treatment option for previously treated teeth with persistent periapical disease, offering a favorable prognosis. However, it can be particularly challenging in anatomically complex cases, risking unintentional damage to adjacent critical structures. Dynamic navigation (DN), a computer-aided technique, facilitates precise presurgical planning and provides real-time guidance during operation. Integrating the DN technique into EMS procedures can enhance treatment accuracy and effectiveness. This report presents 4 cases involving a minimally invasive incision approach for DN-aided EMS in anatomically complex regions, all of which were completed without complications. After 3–12 months, patients presented asymptomatic, and radiographic examinations revealed complete healing or the periapical radiolucent area decreased in size. The DN technique contributed to reliably mitigating the risk of iatrogenic damage in complicated EMS scenarios. The minimally invasive incision approach not only provided sufficient visibility but also promoted favorable soft tissue healing, making it a valuable addition to surgical endodontics.

Biofluorescence imaging system (BIS) Guided surgery for MRONJ: A Case Series on the Preservation of Teeth and Implants: Biofluorescence imaging system guided MRONJ surgery

The decision of surgical margin for Medication-Related Osteonecrosis of the Jaw (MRONJ) surgery is challenging. Recently, a method involving biofluorescence imaging system (BIS) has been reported for its application in MRONJ surgery to live detection of pathologic bone tissue from vital bone, which cannot be distinguished during conventional surgery. This case series aimed to assess the outcomes of adjacent teeth and implants near the lesion site in MRONJ patients who underwent BIS-guided MRONJ surgery. This retrospective study was assessed the radiographic and clinical outcomes of seven patients who underwent MRONJ surgery with BIS guidance but chose not to remove adjacent teeth or implants near the lesion. A total of seven patients (1 male, 6 females, 77.2 ± 4.7 years) were included in the study. Four implants and four teeth adjacent to the lesion were preserved. Over an average duration of 8.7 months, all subjects exhibited normal soft tissue healing and function without any complications. In conclusion, the BIS guided MRONJ surgery can be considered a minimally invasive and effective approach.

Autologous platelet concentrates in alveolar ridge preservation: A systematic review with meta-analyses.

In order to evaluate the therapeutic advantages of various autologous platelet concentrates (APC) as a single biomaterial during alveolar ridge preservation (ARP), a systematic review with meta-analyses was conducted. PubMed, EMBASE, Web of Science, and Scopus were screened for randomized controlled trials (RCTs) that were released prior to 2024. The selected papers compared an APC with either unassisted healing (blood clot) or another biomaterial during ARP (third molars were not included). The outcome parameters included alveolar bone dimension alterations, soft tissue healing, and post-op pain intensity. The search yielded 35 papers (33 studies), one applying platelet-rich plasma (PRP), six using plasma rich in growth factors (PRGF), and 28 using leukocyte- and platelet-rich fibrin (L-PRF). These studies showed a large heterogeneity (e.g., outcome parameters, timing, surgical approach, and inclusion criteria), which hindered drawing strong conclusions. In most studies, however, ARP with PRP, PRGF, and L-PRF alone produced faster soft tissue healing, less post-extraction pain, less alveolar ridge resorption, more socket bone fill, and a higher bone density when compared to unassisted (spontaneous) healing. The ultimate benefit appears to be significantly influenced by the surgical approach. Limited literature exists comparing APC with other biomaterials for ARP, resulting in inconclusive data. APC application for ARP is a promising strategy to improve soft and hard tissue healing and reduce post-extraction pain.

Enhancing early-stage healing responses through the modified "Poncho" technique in customized titanium mesh-mediated bone regeneration: A soft tissue management approach-case series.

Soft tissue management is critical in bone augmentation surgery to prevent wound dehiscence. Several strategies for passive tissue primary closure have been explored. This article introduces a flap design known as the modified "Poncho" technique (MPT), integrated with customized titanium mesh-mediated bone regeneration, and investigates the healing quality during the initial stages of an incision. The cohort consisted of 5 patients undergoing customized bone regeneration procedures, concerned primarily with the successful integration and healing of the augmented bone site without complications such as wound dehiscence or infection. All patients were diagnosed with insufficient bone volume requiring augmentation to support future dental implants, necessitating the use of customized titanium mesh for guided bone regeneration. The MPT was detailed and applied during the customized bone regeneration procedures. Postoperative evaluations included recording complications and using Landry's healing index at intervals of 3, 7, 14, and 30 days post-surgery to assess the technique's performance in early wound closure. The study found that 95.7% of surgery sites experienced uneventful soft tissue healing within the observation period. Only 1 of 23 sites exhibited partial wound dehiscence at postsurgical days 14 and 30, accompanied by mild inflammation. The Landry's healing index increased from 3 ± 0.47 to a final value of 4.69 ± 1.06, indicating substantial improvement in healing over time. The MPT shows promise as an innovative approach for promoting passive and predictable primary wound closure beneath a digitally customized titanium mesh for bone regeneration, demonstrating a high rate of successful healing and minimal complications during the early postoperative phase.