Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/iej.13783

Present Status and Future Directions - Surgical Endodontics.

The present umbrella review aimed to characterize the type and regimen of antibiotics administered locally and/or systemically, alone or in combination with surgical and nonsurgical treatments, for peri-implantitis and to evaluate and compare the associated clinical, radiographic, and crevicular peri-implant outcomes. The secondary objective was to determine the most effective antibiotic type, route of administration, regimen, and protocols (antibiotics alone or in combination with other approaches) for treating peri-implantitis. The study protocol, which was developed in advance under the PRISMA statement, was registered at PROSPERO (CRD42022373957). BioMed Central, Scopus, MEDLINE/PubMed, the Cochrane Library databases, and the PROSPERO registry were searched for systematic reviews through 15 November 2022. Of the 708 records found, seven reviews were included; three were judged of a critically low and four of low quality through the AMSTAR 2 tool. Locally administered antibiotics alone or as an adjunct to surgical or nonsurgical treatments for peri-implantitis showed favorable outcomes, albeit with limited evidence. The administration of systemically-delivered antibiotics in combination with nonsurgical or surgical treatments remained questionable. Local plus systemic antibiotics have not been shown to have durable efficacy. Due to the heterogeneity of reported antibiotic types, routes, regimens, and protocols, no definitive conclusions could be drawn regarding the most effective antibiotic use in treating peri-implantitis.

/pdf/local-and-systemic-antibiotics-in-peri-implantitis-206hshb6.pdf

Local and Systemic Antibiotics in Peri-Implantitis Management: An Umbrella Review

AIM
To answer the following PICO question: In systemically healthy humans with peri-implant mucositis (PiM), what is the efficacy of patient-performed or administered (by prescription) measures used adjunctively to submarginal instrumentation, as compared to submarginal instrumentation alone or combined with a negative control, in terms of reducing bleeding on probing (BOP), in randomized controlled clinical trials (RCTs) with at least 3-month follow-up?


MATERIAL AND METHODS
Three databases were searched until April 2022. Weighted mean differences (WMD) with 95% confidence intervals (CIs) and predictive intervals were calculated.


RESULTS
16 parallel RCTs corresponding to 14 studies with low/moderate risk of bias were included. Test groups showed greater reductions in BOP (%) than control groups (nstudies =16; npatients =650; WMD=14.25%; 95% CI [9.06; 19.45]; p<0.001; I2 =98.7%). The greatest WMD in BOP reductions (%) were obtained by antiseptics (ns =5; np =229; WMD=22.72%; 95% CI [19.40; 26.04]; p<0.001; I2 =94.8%), followed by probiotics (ns =6; np =260; WMD=12.11%; 95% CI [3.20; 21.03]; p=0.008; I2 =93.3%), and systemic antibiotics (ns =3; np =101; WMD=5.97%; 95% CI [1.34; 10.59]; p=0.012; I2 =58.1%). Disease resolution was scarcely reported (n=6).


CONCLUSIONS
Significant clinical improvements can be obtained when professional submarginal instrumentation is combined with patient-performed or administered (by prescription) adjunctive measures, although a complete disease resolution may not be achieved.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jcpe.13791

Efficacy of adjunctive measures in peri-implant mucositis. A systematic review and meta-analysis.

The aim of the study was to investigate the efficacy and safety of a digital template in the bone lid technique during enucleation of large mandibular cysts. Six patients were enrolled in this study. Patients' preoperative CT data were collected to design and produce the digital templates. The bone lids were located and cut under the guidance of the digital templates, and then replanted and fixed following cyst enucleation. Postoperative clinical symptoms were observed and recorded from postoperative days 1-7. The follow-up visits were set at 3, 6, and 12 months. The cystic lesions were exactly and fully exposed without the need for secondary bone removal. The contours of the mandibles recovered well, with excellent sealing of the defects. Apart from one case with postoperative infection and one case with 2-month numbness of the lower lip, no other complications occurred. Six months after the surgery, patients' appearance and function were well-restored. A digital template in the bone lid technique during enucleation of large mandibular cysts was effective and safe.

Precise locating and cutting of the bone lid with a digital template during the treatment of large mandibular cysts: A case series study.

Abstract Objective This systematic review aimed at assessing the effect of the repositioned bone lid on bone augmentation in lateral sinus lift in pre-clinical in vivo and clinical studies. Secondary aims were to report on the healing of the bone window and to assess the implant survival rate. Material and methods Animal and human studies comparing lateral maxillary sinus floor elevation in combination or not with the repositioned bone lid were retrieved from MEDLINE (PubMed), Web of Science and Cochrane online library. Studies published in English up to April 2022 and reporting on histological and/or radiographic outcomes were considered. Case reports, case series and reviews were excluded. A hand search was also conducted. Risk of bias was assessed and meta-analysis performed to investigate the effect of the bone lid on new bone formation. Results After screening, 5 animal studies (4 in rabbits, 1 in sheep) and 2 clinical studies (1 RCT, 1 case–control) were included. Meta-analysis confirmed a higher new bone formation in rabbits at 2 and 8 weeks using the bone lid. The two clinical studies investigated lateral sinus lift with concomitant implant placement and reported similar results and high short-term implant success rate in both test and control groups. Conclusions The meta-analysis provided moderate evidence that the repositioned bone lid favored the formation of new bone to a higher extent as compared to resorbable membranes in animal studies. Implant success seems not to be influenced by the technique in the short term. 

/pdf/the-bone-lid-technique-in-lateral-sinus-lift-a-systematic-1yzwtez4.pdf

The bone lid technique in lateral sinus lift: a systematic review and meta-analysis

The Application of “Bone Window” Technique in Endodontic Microsurgery

Recurrent benign gingival lesions occurring in the anterior dentition are clinical dilemmas. While complete removal of such lesions is required to prevent recurrence, this can result in a poor esthetic outcome. Relative to this conundrum, this report discusses the diagnosis, psychological management and clinical treatment of two patients with recurring lesions on the facial gingiva of the mandibular and maxillary incisors, respectively. Patient A, a 55-year-old Caucasian female, presented with a recurrent peripheral ossifying fibroma (POF) and Patient B, a 76-year-old Caucasian male, presented with a recurrent pyogenic granuloma (PG). Both patients underwent multiple procedures and were ultimately treated without recurrence of their lesions. The efficacious surgical treatment of recurrent gingival lesions, such as POF and PG, requires an aggressive approach involving removal of the lesion as well as a 1.0 to 2.0 mm margin of normal tissue, underlying alveolar bone, and associated periodontal ligament. The rationale for this approach is explained stressing the potential periodontal and esthetic ramifications that were considered. In summary, when recurrent benign gingival lesions are localized to the anterior part of the mouth, the approach to their surgical removal should be modified to minimize the extent of gingival recession and other potential esthetic issues. Int J Periodontics Restorative Dent. doi: 10.11607/prd.6137.

A Periodontal Perspective on the Successful Treatment of Recurrent Benign Gingival Lesions Affecting the Anterior Dentition: Two Case Reports.

PURPOSE
To evaluate the cumulative survival rate (CSR) of implants placed by Chinese dentists who lacked structured training and to identify the dentist-related risk factors associated with implant failure.


MATERIALS AND METHODS
Data from 2,036 patients who underwent implant-supported restoration at a university-affiliated stomatology hospital were collected. CSR was regarded as the dependent variable. Patient-related characteristics (age, sex, insertion site, and surgical complexity) and dentist-related factors (experience, number of implant brands used, education level, sex, and specialty) were collected as independent variables. The chi-square test was used to identify dentist-related factors for implant failure after addressing patient-related potential confounders using propensity score matching (PSM). Dentist- and patient-related risk factors were further analyzed using multivariable logistic regression within the subgroups.


RESULTS
The CSRs were 98.48% for patients (with single or multiple implants) and 98.86% for implants after 48 to 60 months of observation. Dentists with < 5 years of experience and specialists in implant dentistry were significantly associated with implant failure after addressing potential patient-related confounders. Within the group of dentists with < 5 years of experience, complicated cases were the major risk factor. For the group of specialists in implant dentistry, < 5 years of experience and male patient were the major risk factors.


CONCLUSION
New dentists (< 5 years of experience) and specialists in implant dentistry are considered to be dentist-related risk factors for implant failure. This confirms that a learning curve exists for new specialists to reach the level of proficiency and expertise. Int J Oral Maxillofac Implants 2023;38:553-561. doi: 10.11607/jomi.9969.

Influence of Dentist-Related Risk Factors on Implant Survival Provided by Dentists Without Structured Training: Results of a Retrospective Cross-Sectional Study.

PURPOSE
This systematic review aimed to assess the clinical efficacy of antibiotics when used as an adjunct in treating peri-implant diseases.


MATERIALS AND METHODS
A systematic search of papers published between January 1980 and March 2020 was conducted. Randomized clinical trials with at least 10 patients who had peri-implant diseases, treated with or without adjunctive antibiotics in combination with surgical or nonsurgical therapies, and with a minimum of at least 3 months of follow-up were included. Meta-analyses were conducted to analyze weighted mean differences in probing depth reduction, radiographic bone level gain, and odds ratio of treatment success.


RESULTS
From the 856 articles identified, 10 articles met the inclusion criteria and were selected. Of these, 7 articles were used for the meta-analysis. The adjunctive use of antibiotics in the treatment of peri-implant diseases yielded significantly greater probing depth reduction (weighted mean differences = 0.56 mm at 3 months, P = .001; 0.77 mm at 6 months, P < .00001; 0.92 mm at 12 months, P < .00001), radiographic bone level gain (weighted mean differences = 0.64 mm, P = .03), and treatment success (odds ratio = 1.74, P = .04) compared to the same treatment without antibiotics.


CONCLUSION
Based on the existing evidence, the use of adjunctive antibiotics to treat peri-implant diseases, especially peri-implantitis, provided potential benefits in clinical outcomes for up to 12 months posttherapy.

Efficacy of Antibiotics Used as an Adjunct in the Treatment of Peri-implant Mucositis and Peri-implantitis: A Systematic Review and Meta-analysis.

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Papers

The Application of “Bone Window” Technique in Endodontic Microsurgery

A Periodontal Perspective on the Successful Treatment of Recurrent Benign Gingival Lesions Affecting the Anterior Dentition: Two Case Reports.

Influence of Dentist-Related Risk Factors on Implant Survival Provided by Dentists Without Structured Training: Results of a Retrospective Cross-Sectional Study.

Efficacy of Antibiotics Used as an Adjunct in the Treatment of Peri-implant Mucositis and Peri-implantitis: A Systematic Review and Meta-analysis.