Background: The aims of the present multi‐center, randomized, controlled clinical trial were: 1) to compare the efficacy of the simplified papilla preservation flap with and without a barrier membrane in deep intrabony defects; 2) to evaluate the postoperative morbidity and surgical complications; and 3) to preliminarily test the impact of baseline tooth mobility on clinical outcomes.Methods: This parallel group, randomized, multi‐center, controlled clinical trial involved 112 patients in 8 periodontal practices in 4 countries. A deep intrabony defect in each patient was accessed with the simplified papilla preservation flap. In the test defects, a bioabsorbable membrane was positioned. Patients' experiences with the surgical procedure and postoperative period were evaluated with a questionnaire. Clinical outcomes included clinical attachment level (CAL) and probing depth (PD) changes.Results: Complete observations were available for 55 test and 54 control defects. CAL gains at 1 year were 3.5 ± 2.1 mm in the guided tissue regeneration (GTR) group and 2.6 ± 1.8 mm in the control group (P = 0.0117). CAL gains ≥4 mm were observed in 50.9% of GTR sites and 33.3% of control sites. A signifi‐cant center effect of 2.1 mm was observed (P = 0.01). Initial PD (P = 0.01) and baseline tooth mobility (P = 0.036) were significant covariates. During the procedure, 30.4% of test and 28.6% of controls reported feeling moderate pain, and subjects estimated the hardship of the procedure at 24 ± 25 visual analog scale (VAS) units in the test group, and at 22 ± 23 VAS in controls. In terms of the investigated outcomes, differences between test and control groups were not statistically significant. Among the postoperative complications, edema was most prevalent at week 1, and more frequently associated with the test treatment (P = 0.01). In the test group, 53.6% of membranes were exposed at week 3.Conclusions: The present study further supports the added benefits of guided tissue regeneration with respect to access flap alone in the treatment of deep intrabony defects, as well as the general efficacy of GTR in different clinical settings. Furthermore, our study indicates a possible influence of baseline tooth mobility on clinical outcomes. J Periodontol 2001;72:1702‐1712.

The use of xenogenic cortical bone laminas in Guided Bone Regeneration (GBR) has been well described in the literature over the past decade. These biomaterials present a very low degree of complications due to their nature (porcine or equine collagenated bone) and the fact that when they become exposed, they simply hydrolyze without major complications. One of the problems related to the first generation of these laminas was their extreme rigidity and return elasticity, often forcing clinicians to anchor them with pins and/or screws. A new generation of bone laminas called Flex Cortical Sheet (FCS) have recently been introduced with machine-made thicknesses of 0.2, 0.5, and 0.9 mm and increased flexibility and adaptability to ridge defects. This paper has the goal of presenting a case of vertical and horizontal reconstruction performed by means of a 0.5 mm FCS and showing the workflow necessary to successfully restore a complex situation. After 8 months of healing, the GBR resulted in a horizontal and vertical augmentation of 8 mm and 8 mm, respectively. The radiographic examination at 18 months demonstrated great stability of new bone around implants.

Claudio Gatti, MD, DDS/Fulvio Gatti, DDS/Maurizio Silvestri, DDS/Francesco Mintrone, DDS/Roberto Rossi, DDS, MSc/Gabriele Tridondani, DDS/Giacomo Piacentini, DDS/Paola Borrelli, DDS, PhD: Purpose: To compare the peri-implant radiographic crestal bone changes around implants placed at the subcrestal or crestal level. Materials and Methods: Systemically healthy patients with at least two missing teeth requiring implant-supported fixed prosthetic restorations were enrolled in the study. Implants were randomly placed either 1 mm subcrestally or at the bone crest level. Radiographic examination was performed using the long-cone parallel technique and customized film holders. Digital periapical radiographs were obtained at the time of implant placement (T₀), at the time of prosthesis delivery (T₁), and 12 months (T₂) after prosthetic loading. Marginal bone levels were measured at the mesial and distal aspects of each implant with digital image software. Results: A total of 54 implants were present for the radiographic analysis at the 12-month follow-up. No implant showed mechanical or biologic complications throughout the follow-up period. The implant survival percentage was 100%. After 1 year, the mean bone loss was 0.711 ? 0.721 mm in the subcrestal group and 0.224 ? 0.418 mm in the crestal group. Furthermore, only the subcrestal group showed statistically significant radiographic bone resorption at the end of the follow-up. Conclusion: Within the limitations of this study, implants placed at the crestal level showed greater peri-implant bone stability during the 1-year follow-up. Studies with larger samples and longer follow-up are needed to confirm the results of this investigation.

Altered passive eruption is described as a condition in which the relationship between teeth, alveolar bone, and the soft tissues creates an excessive gingival display and, in turn, in some circumstances, it may reveal a clinical aspect also known as the “gummy smile.” The surgical management of such cases is well understood and has been widely described, with mucogingival and osseous resective procedures being predictable surgical means leading to more balanced aesthetics and proper display of the teeth anatomy. The possible familial trait in case of passive eruption and therefore the possibility of recurrence of the same condition in families of siblings or parents of affected patients have been investigated in this study. 20 patients have been selected and treated in both a private practice and university settings and their immediate family trees were evaluated in order to understand the incidence of the condition. 65% of the treated patients had one or more family members with the same condition leading to seeking further investigation on the possible genetic correlation.