This cross-sectional study aimed to evaluate the diagnostic accuracy, reliability, and reproducibility of visual digital image-based assessments of peri-implant keratinized mucosa width (KMW) and mucosal thickness (MT) compared with direct clinical measurements. Calibrated evaluators assessed KMW and MT, standardized intraoral photographs, and intraoral scans (IOS) obtained from adult patients with non-molar implant-supported prostheses. Diagnostic accuracy was determined using sensitivity, specificity, predictive values, diagnostic odds ratios (DOR), and receiver operating characteristic (ROC) curve analysis. Inter- and intra-observer agreement were assessed using Fleiss' kappa, weighted kappa, and intraclass correlation coefficients (ICC). Based on sample size calculation, a total of 60 patients with 60 non-molar implant-supported prostheses were included. Twenty calibrated evaluators with different professional backgrounds assessed 140 digital images, with 20 images repeated. This resulted in 2800 KMW and 2800 MT evaluations. Overall, a limited ability to distinguish inadequate from adequate KMW and thin from thick MT was shown when assessing digital images. Photographs tended to be associated with slightly higher sensitivity and specificity than IOS, with overall sensitivity ranging from 31.3% to 56.9% and specificity from 45.6% to 63.7% across modalities. ROC analysis confirmed poor discriminatory capacity for both imaging modalities, with area under the curve values ranging from 0.427 to 0.633. Inter-observer agreement was generally fair, whereas intra-observer reproducibility remained poor across evaluator groups and imaging modalities. In conclusion, visual assessment of peri-implant KMW and MT based on digital imaging demonstrated limited diagnostic accuracy and reproducibility compared with direct clinical measurements.

This split-mouth randomized controlled trial evaluated the effect of implant surface roughness (hybrid vs. moderately rough) on long-term crestal bone remodeling and peri-implant health. Oral Health-related Quality of Life (OHRQoL) was evaluated after 1 and 8 years. Twenty-four fully edentulous patients received a mandibular overdenture supported by two implants: one with a complete moderately rough (DCC) surface (Sa: 1.3 μm, Sdr: 60%) and one hybrid (MSC) implant, with a minimally rough machined surface (Sa: 0.9 μm, Sdr: 34%) at the coronal 3 mm. After 8 years, 19 patients (38 implants) were evaluated. Crestal bone loss (CBL) was measured radiographically at 1, 6, and 8 years. Plaque score, bleeding on probing (BoP), probing pocket depth (PPD), and OHRQoL (OHIP-14) were assessed at 1 and 8 years. There were no implant failures. CBL after 8 years was 0.43 mm (MSC) and 0.48 mm (DCC), with no significant difference (p > 0.05). Periodontal parameters were comparable, and the improvement in OHRQoL remained stable. Two-implant bar-retained mandibular overdentures showed high survival, stable bone levels, and sustained improvement in OHRQoL after 8 years. No differences were detected between both implant surfaces under the conditions of this study.

The accuracy of full-arch implant impressions is critical for prosthetic passivity and long-term clinical success. This study compared the trueness and repeatability of twelve digital impression systems (DIS), including nine intraoral scanners (IOS) and three stereophotogrammetric (SPG) systems, for a fully edentulous maxilla restored with eight multi-unit abutments (MUAs). Accuracy was assessed using a coordinate measuring machine-derived reference model and a clinically driven 'worst-MUA' approach, considering the suprastructure as a single functional unit. Trueness and repeatability were evaluated along vertical (Z), horizontal (XY), three-dimensional, and angular dimensions across five repeated acquisitions per system. Significant variability in both trueness and repeatability was observed among DIS. Median trueness deviations ranged from 0.009-0.042 mm (Z), 0.027-0.117 mm (XY), 0.026-0.107 mm (3D), and 0.140°-0.427° (angular). Median repeatability deviations ranged from 0.0014-0.0230 mm (Z), 0.0015-0.0380 mm (XY), 0.0016-0.0372 mm (3D), and 0.0217°-0.1558° (angular). Principal component analysis identified three performance clusters: high-performing systems (Itero Lumina, Imetric 4D, Shining 3D scan, Primescan2), intermediate systems (Shining 3D photogrammetry, Medit i900, Primescan, Panda Eletra, Medit i700, Nobel Fast Map), and low-performing scanners (Trios5, Trios6). Errors were more pronounced at terminal arch positions, on MUAs #1 and #8. These findings highlight the system-dependent nature of digital impression accuracy and demonstrate that several next-generation intraoral scanners achieved accuracy levels comparable to those of photogrammetric systems under the standardized in vitro conditions of this study.

The esthetic buccal flap, which allows access to the apical area of a tooth or extraction socket via a submarginal incision, was initially introduced for buccal fenestration defects correction during immediate implant placement. This case report describes its expanded use for ridge augmentation at the time of extraction when immediate implant placement is not indicated. The esthetic buccal flap was used for ridge augmentation in three patients with significant maxillary anterior hard tissue defects. At the time of implant placement, which was delayed five to six months, soft tissue augmentation was performed to enhance esthetic outcomes. After provisionalization, final restorations were delivered, and esthetics were assessed using the modified Pink Esthetic Score (mPES). All three cases obtained mPES scores of 9 or 10, which indicates excellent soft tissue contour, symmetry, and integration. Within the limitations of this case report, these results indicate that the esthetic buccal flap is a minimally invasive, soft tissue preserving technique that can be adapted to treat complex alveolar ridge defects. In combination with newer biomaterials and the use of a delayed implant procedure, this strategy provides predictable results for regenerative as well as esthetic success in difficult anterior cases.

Contemporary full-arch implant rehabilitation increasingly incorporates digital workflows and staged prototyping. However, delayed-loading cases continue to require a structured method for transferring prosthetic and biologic information during the transition from removable to fixed prostheses. This technique report introduces the QuadroJig protocol, an analog-driven, transdisciplinary workflow that enables simultaneous acquisition of implant position, occlusal relationships, esthetic parameters, and peri-implant soft-tissue dimensions. A stabilized intraoral construct derived from a flangeless denture duplicate permits vertical bone sounding to guide prosthetically driven periosteal mapping and execution at prosthetic loading, including gingivoplasty or selective flap modification when indicated. By reverse-engineering the prosthetic tissue junction, the protocol supports fabrication of a prototype-level prosthesis while preserving coordination between prosthetic design and peri-implant anatomy. The construct may be incorporated into either a conventional analog or a hybrid analog-digital workflow, allowing both clinical execution and digital verification. Consequently, the QuadroJig protocol serves as a prosthetic-periodontal co-acquisition and execution workflow, offering a practical approach to delayed full-arch rehabilitation, particularly in digitally underserved clinical arenas.

In tooth replacement therapy with implant-supported prostheses, optimal outcomes depend on a wide range of variables, including anatomic, phenotypic, surgical, and prosthetic factors. Adequate management of the restorative interface is particularly important for achieving predictable esthetic outcomes in the anterior maxilla and for maintaining long-term soft and hard tissue health and stability. This article describes an approach based on the use of intermediate multi-unit abutments on bone-level implants. A comprehensive workflow is presented, integrating digital planning, surgical protocols, and prosthetic strategies for both immediate and delayed implant placement. In immediate implant placement, these intermediate abutments may be used as adjuncts to ridge preservation and reconstructive procedures by facilitating provisional restoration and supporting peri-implant tissue stability. In delayed implant placement, they may promote bone preservation between adjacent implants, potentially reducing the remodeling associated with repeated retrieval and insertion of prosthetic components directly onto the implant platform. This therapeutic strategy may help maintain stable marginal bone levels, support long-term peri-implant tissue health, esthetics, and, in specific situations, compensate for suboptimal implant position.

The rehabilitation of worn dentition involves both indirect and direct techniques. Although direct techniques are becoming popular, standardized protocols are lacking and often the final esthetic and functional outcome is extremely technique sensitive. This article describes a new standardized approach to full-mouth direct rehabilitation using the "Composite Ball Technique.' The method offers improved stabilization of a transparent silicone index, ensures accurate transfer of the planned wax-up and facilitates composite excess removal during the restoration procedure.

This pilot split-mouth randomized clinical trial aimed to compare the stability of the gingival margin following esthetic clinical crown lengthening surgery performed with electronic scalpel versus conventional scalpel blade. Patients indicated for esthetic crown lengthening in non-molar area of the maxilla were selected. Gingivoplasty was performed using an electronic scalpel (test) and a conventional scalpel blade (control) in contralateral quadrants. Intraoral scanning was conducted preoperatively and postoperatively at 15 and 180 days. Gingival margin migration between 15 and 180 days of follow up was measured in millimeters using 3D model superimposition. Patient-reported outcomes were assessed using visual analogue scales. Fourteen patients were enrolled, and ten completed the 180-day follow-up. Gingival margin migration was minimal and comparable between groups, with no significant intra- or inter-group differences for any tooth type (p > 0.05). Median migration was 0.26 mm for the electronic scalpel group and 0.20 mm for the conventional scalpel group. Patient-reported outcomes were similar, with most participants reporting greater comfort with the electronic scalpel. Both electronic and conventional scalpels resulted in stable gingival margin positioning over 180 days, with minimal migration from early healing stages. These findings support the clinical use of either technique for esthetic crown lengthening procedures.

Full circumferential application of biologically oriented preparation concepts in prosthetic retreatment remains highly technique sensitive and may compromise prosthetic margin control. This concept-driven clinical report describes a mixed vertical preparation strategy that differentiates cervical objectives by tooth surface to balance periodontal tissue conditioning with prosthetic predictability. Based on a selective literature review and one illustrative clinical case, a vertical preparation performed according to Biologically Oriented Preparation Technique (BOPT) principles, combined with provisional-driven biologically oriented tissue conditioning, is confined to the vestibular surface where esthetic integration is most critical. A VertiPrep-type preparation is applied on proximal and palatal surfaces to preserve epithelial attachment and ensure a controlled prosthetic margin. The provisional restoration is central to the therapeutic mechanism, guiding soft tissue maturation over a 6 to 8-week healing period. Vestibular tissue conditioning allowed localized modulation of marginal tissue thickness. Proximal and palatal VertiPrep facilitated precise margin positioning and improved communication with the dental laboratory. This mixed vertical preparation approach represents a pragmatic option for selected crown retreatment scenarios, particularly when attempting to balance vestibular soft tissue conditioning with proximal/palatal margin control. Further prospective controlled studies are required to confirm its clinical predictability and long-term outcomes.