Aim: To assess the prognostic value of soft tissue phenotype modification following root coverage procedures for predicting the long‐term (10‐year) behaviour of the gingival margin.Materials and Methods: Participants from six randomized clinical trials on root coverage procedures at the University of Michigan were re‐invited for a longitudinal evaluation. Clinical measurements were obtained by two calibrated examiners. A data‐driven approach to model selection with Akaike information criterion (AIC) was carried out via multilevel regression analyses and partial regression plotting for changes in the level of the gingival margin over time and interactions with the early (6‐month) results of soft tissue phenotypic modification.Results: One‐hundred and fifty‐seven treated sites in 83 patients were re‐assessed at the long‐term recall. AIC‐driven model selection and regression analyses demonstrated that 6‐month keratinized tissue width (KTW) and gingival thickness (GT) influenced the trajectory of the gingival margin similarly in a concave manner; however, GT was the driving determinant that predicted significantly less relapse in the treatments, with stability of the treated gingival margin obtained beyond values of 1.46 mm.Conclusions: Among a compliant patient cohort, irrespective of the rendered therapy, the presence of at least 1.5 mm KTW and 1.46 mm GT was correlated with the long‐term stability of the gingival margin.

The ideal positioning of immediate implants in molar extraction sockets often requires the osteotomy to be in the interradicular septum, which can be challenging in some cases, with traditional site preparation techniques. Patients who had undergone molar tooth extraction and immediate implant placement at five different centers, and followed up between August 2015 and September 2020, were evaluated. Inclusion criteria were use of the osseodensification technique for implant site preparation. The primary outcome was septum width measurement pre-instrumentation and osteotomy diameter post expansion. Clinical outcomes, such as implant insertion torque (ISQ) and implant survival rate, were also collected. A total of 131 patients, who received 145 immediate implants, were included. The mean overall septum width at baseline was 3.3 mm and the mean osteotomy diameter post instrumentation was 4.65 mm. A total of ten implants failed: seven within the healing period and three after loading; resulting in a cumulative implant survival rate of 93.1%. This retrospective study showed that osseodensification is a predictable method for immediate implant placement with interradicular septum expansion in molar extraction sockets. Furthermore, it allowed the introduction of a new molar socket classification. In the future, well-designed controlled clinical studies are needed to confirm these results and further explore the potential advantages of this technique.

Theofilos Koutouzis, DDS, MS/Rodrigo Neiva, DDS, MS/Madhu Nair, DDS, PhD/J?rg Nonhoff, DDS, PhD/Tord Lundgren, DDS, PhD: Purpose: The aim of this study was to evaluate marginal bone levels, with cone beam computed tomography, on the buccal and lingual aspects of implants placed with the implant-abutment interface (IAI) at different positions in relation to the alveolar crest. Materials and Methods: Thirty patients in need of single-tooth rehabilitation were randomly assigned to three groups based on the position of the IAI in relation to the buccal aspect of the alveolar crest at the time of implant placement. Patients in groups 0, 1, and 2 had their implants placed level with the buccal crest or 1 or 2 mm apical to the buccal aspect of the alveolar crest, respectively. The implants were restored with screw-retained single crowns after 4 months. Marginal bone levels on the buccal and lingual aspects of the implants were evaluated at 12 months after implant placement. Results: All groups of implants demonstrated significantly different crestal positions. Group 2 implants maintained the greatest subcrestal position (1.33 ? 0.86 mm) compared to the implants of group 0 (?0.04 ? 0.18 mm) and group 1 (0.34 ? 0.44 mm). There were no differences between groups in the level of the first bone-to-implant contact relative to the implant platform. Implants of group 0 exhibited less buccal bone remodeling (?0.08 ? 0.25 mm) compared to group 1 (?0.65 ? 0.45 mm) and group 2 (?0.85 ? 0.75 mm) implants. For groups 1 and 2 implants, there was a significant negative correlation between buccal wall thickness following the osteotomy and the amount of buccal bone remodeling. Conclusion: In this study, different responses were seen in the buccal and lingual peri-implant bone for implants with platform-switched Morse taper connections placed with the IAI at different locations in relation to the alveolar crest.

Osseodensification is a new method of bone instrumentation for dental implant placement that preserves bulk bone and increases primary implant stability, and may accelerate the implant rehabilitation treatment period and provide higher success and survival rates than conventional methods. The aim of this retrospective study was to evaluate and discuss results obtained on immediate implant placement with immediate and delayed loading protocols under Osseodensification bone instrumentation. This study included private practice patients that required dental implant rehabilitation, between February 2017 and October 2019. All implants were placed under Osseodensification and had to be in function for at least 12 months to be included on the study. A total of 211 implants were included in the study, with a 98.1% total survival rate (97.9% in the maxilla and 98.5% in the mandible). For immediate implants with immediate load, 99.2% survival rate was achieved, and 100% survival rate for immediate implant placement without immediate load cases. A total of four implants were lost during this period, and all of them were lost within two months after placement. Within the limitations of this study, it can be concluded that Osseodensification bone instrumentation provided similar or better results on survival rates than conventional bone instrumentation.

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Background: Oroantral communication (OAC) can occur after a dental extraction. Occasionally, bony defects may persist despite successful soft tissue closure of the OAC. The absence of bone in these areas poses challenges for dental implant placement. This report describes a novel approach of vertical sinus elevation through the oroantral bony defect to address such scenarios. Methods: A 36‐year‐old male (Patient 1) and a 62‐year‐old female (Patient 2) presented with OACs in the first maxillary molar region. Vertical sinus elevation was achieved through the existing defect. This was followed by placement of corticocancellous bone allograft mixed with platelet‐rich fibrin (PRF) in the space surrounded by the elevated sinus membrane that was then covered with a resorbable collagen membrane. Implants were placed 9 and 6 months after the sinus lift in Patient 1 and Patient 2, respectively. Results: In both cases, substantial radiographic bone fill of the oroantral bony defect was achieved allowing successful placement of dental implants. Following insertion of final restorations, the patients were satisfied with the esthetic outcomes and reported improved oral function. Conclusions: Vertical sinus elevation through residual bony oroantral defects in conjunction with placement of bone allograft mixed with PRF yields sufficient alveolar bone for subsequent placement of dental implants. Key points: Elevation of the sinus membrane through an existing crestal defect resulting from an OAC allows the clinician to successfully elevated the sinus membrane for bone augmentation allowing eventual placement of an implant. The approach allows the clinician to achieve this goal without preparing a second window through a more invasive lateral approach. Plain language summary: Bone defects secondary to oroantral communications resulting from dental extractions may persist despite successful soft tissue closure. Such oroantral communication (OAC) pose challenges for dental implant placement. This report describes a technique for repairing oroantral bony defects and subsequent placement of dental implants. Two patients presented with OACs in the first maxillary molar region. Vertical sinus elevation with corticocancellous bone allograft and platelet‐rich fibrin, was achieved through the existing defect. Substantial radiographic bone fill of the oroantral bony defect was achieved and implants with final restorations were subsequently placed.