Pier Gallo, DDS, PhD (c)/David D?az-B?ez, DDS, MS(c): Purpose: Vertical and horizontal guided bone regeneration with nonresorbable membranes is a regenerative alternative for treating bone defects in edentulous zones. Its indication and good outcomes have been confirmed by different authors; however, this procedure remains highly technique sensitive and might lead to complications. The purpose of this study was to describe the management of complications such as exposures and infections following vertical and horizontal guided bone regeneration with titanium-reinforced high-density polytetrafluoroethylene (PTFE) nonresorbable membranes carried out using a new management protocol for complications related to this type of membrane. Materials and Methods: Complications in vertical and horizontal guided bone regeneration were evaluated by the same surgeon in a private practice between 2010 and 2017. They were classified and managed according to whether they were exposures and/or infections, and also according to their size, sagittal location, and coronal position of the alveolar ridge of the exposures. Descriptive analyses were conducted to evaluate the influence of age, sex, clinical characteristics of the complication, time of appearance, location, membrane size, anatomical and sagittal location, pink ceramic use, and definitive restoration, both before and after management protocol application. Results: Eighty complications were evaluated. The sextant with the highest number of complications was the anterior maxilla (35/80, 43.75%), followed by the mandibular left side area (16/80, 20.00%). The majority (56/80, 70.00%) of all complications appeared before 2 months. In relation to the sagittal location of exposures, 43.64% (24/55) were located coronal to the alveolar ridge. Statistically significant differences were found between exposures with or without purulent exudate, related to the coronal location of the exposure (P < .05). Conclusion: A new protocol for managing complications with titanium-reinforced high-density PTFE nonresorbable membranes is proposed based on the follow-up of 80 complications. These steps can help prevent total graft loss, allowing patients to reach final rehabilitation without multiple additional surgeries. Infections continue to be the most common cause of bone loss in guided bone regeneration. Long-term results and follow-up studies are necessary to assess the stability of soft and hard tissues in patients rehabilitated using this complication management protocol.

Objectives: Culturable and unculturable microorganisms have been associated with periodontitis. Their differential proportions and composition have not been evaluated by their severity and complexity defined by stages in the 2018 AAP-EEP classification. Methods: One hundred eighty subgingival biofilm samples were collected in Spain and Colombia from subjects categorized as health/gingivitis: periodontitis stages I/II periodontitis stages III/IV. Target culturable microorganisms (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, and Eubacterium nodatum) and target unculturable microorganisms (Filifactor alocis, Eubacterium saphenum, Eubacterium brachy, Desulfobulbus oralis) were evaluated by quantitative PCR analysis. In addition, their differences and association with periodontal status were analyzed by ANCOVA and logistic regression models once adjusted to age, current smoking, and country. Results: P. gingivalis was significantly associated with periodontitis stages I/II, OR 2.44 (CI 95% 1.08–5.47) and stages III/V, OR 6.43 (CI 95% 2.43–16.9). T forsythia, OR 7.53 (CI 95% 2.07–27.4); D. oralis, OR 5.99 (CI 95% 2.71–13.23); F. alocis, OR 10.9 (CI 95% 4.56–23.2); E. brachy, 3.57 (CI 95% 1.40–9.11); and E. saphenum, 4.85 (CI 95% 1.99–11.7) were significantly associated only with stages III/IV periodontitis. P. gingivalis evidenced significant differences with the increase in the severity of the periodontal lesion: 2.97 colony forming unit (CFU)/μL (CI 95% 2.32–3.54) health/gingivitis, and 4.66 CFU/μL (CI 95% 4.03–5.30) and 5.90 CFU/μL (CI 95% 5.20–6.48) in stages I/II and III/IV respectively (p < 0.0001). Unculturable microorganisms only evidenced differences in concentration in stages III/IV compared with health-gingivitis (p ≤ 0.001). Conclusion: Culturable and unculturable are strongly associated with stages III/IV periodontitis. Classic culturable microorganisms are more sensitive to differentiate between stages of periodontitis in the quantitative analysis. Clinical relevance: Future interventional studies of periodontal disease should include Filifactor alocis, Eubacterium saphenum, Eubacterium brachy, and Desulfobulbus oralis as possible markers of therapy response and as indicators of progressive disease.

Background: The vertical increase of the alveolar ridge dimension using allograft or xenograft mixed with autogenous bone graft and covered by a nonabsorbable high‐density polytetrafluoroethylene (d‐PTFE) membrane is well documented in the literature.Purpose: The aim of this study was to assess vital mineralized tissue formation in vertical ridge augmentation (VRA) procedures using autogenous bone chips mixed either with an allograft or a xenograft.Methods: This prospective clinical trial recruited 16 partially edentulous patients to undergo vertical ridge augmentation in one or more sites, making up a total of 24 samples for histological evaluation. Patients were sequentially stratified into Group A (treated with a freeze‐dried bone allograft [FDBA] mixed with autogenous bone) or to Group B (treated with a bovine xenograft mixed with autogenous bone). Histological samples were analyzed according to the biomaterial used for VRA. Histological samples were obtained on the same day of membrane removal and implant placement.Results: Thirty‐three implants were placed in 16 sites of regenerated bone via VRA, 13 patients with ridge augmentation in the posterior mandible, and 3 patients with VRA in the anterior maxilla. Group A (FDBA + autogenous) and Group B (xenograft + autogenous) showed a percent vital mineralized tissue (VMT) area of 67.64 ± 16.84 and 60.93 ± 18.25, respectively. A significant difference between the two biomaterials was not observed.Conclusion: When mixed with autogenous bone, either allografts or xenografts may provide a successful augmentation. Either mixture could serve as reliable alternative in VRA for obtaining a high percentage of VMT.

Objective: To evaluate the in vitro antimicrobial and antibiofilm properties and the immune modulatory activity of cannabidiol (CBD) and cannabigerol (CBG) on oral bacteria and periodontal ligament fibroblasts (PLF). Methods: Cytotoxicity was assessed by propidium iodide flow cytometry on fibroblasts derived from the periodontal ligament. The minimum inhibitory concentration (MIC) of CBD and CBG for S. mutans and C. albicans and the metabolic activity of a subgingival 33-species biofilm under CBD and CBG treatments were determined. The Quantification of cytokines was performed using the LEGENDplex kit (BioLegend, Ref 740930, San Diego, CA, USA). Results: CBD-treated cell viability was greater than 95%, and for CBG, it was higher than 88%. MIC for S. mutans with CBD was 20 µM, and 10 µM for CBG. For C. albicans, no inhibitory effect was observed. Multispecies biofilm metabolic activity was reduced by 50.38% with CBD at 125 µg/mL (p = 0.03) and 39.9% with CBG at 62 µg/mL (p = 0.023). CBD exposure at 500 µg/mL reduced the metabolic activity of the formed biofilm by 15.41%, but CBG did not have an effect. CBG at 10 µM caused considerable production of anti-inflammatory mediators such as TGF-β and IL-4 at 12 h. CBD at 10 µM to 20 µM produced the highest amount of IFN-γ. Conclusion: Both CBG and CBD inhibit S. mutans; they also moderately lower the metabolic activity of multispecies biofilms that form; however, CBD had an effect on biofilms that had already developed. This, together with the production of anti-inflammatory mediators and the maintenance of the viability of mammalian cells from the oral cavity, make these substances promising for clinical use and should be taken into account for future studies.