Platelet-rich fibrin (PRF) finds widespread application within the field of dentistry, notably in dental implantology, with the primary objective of augmenting the processes of healing, bone regeneration, and implant stabilization. PRF represents an autologous fibrin-based living biomaterial sourced from the patient's blood, encompassing platelets, growth factors, stem cells, and white blood cells. The PRF technique involves subjecting a blood sample from the patient to centrifugation, resulting in the separation of three distinct layers: red blood cells, platelet-rich fibrin (PRP), and platelet-poor fibrin (PPP). Subsequently, the dentist employs PRF to construct a resorbable membrane at the surgical site, functioning akin to a band-aid to expedite healing and mitigate postoperative swelling.

PRF manifests in diverse clinically applicable forms, including membranes, plugs (A-PRF, L-PRF), or injectable liquids (i-PRF). These formulations are incorporated or blended with bone substitutes to expedite tissue healing and foster bone regeneration. Empirical studies substantiate that PRF augments osseointegration during the initial phases of dental implant placement and augments the keratinized mucosa's width surrounding implants. Beyond this, PRF is harnessed to alleviate postoperative pain, facilitate tissue repair, and curtail overall healing durations.

The versatility of PRF extends to various dental implant procedures, encompassing ridge preservation, extraction sockets, socket augmentation for both early and delayed implant placement, sinus floor elevation, and guided bone regeneration. In summary, the integration of PRF into dental implantology endeavors to optimize implant stability, hasten the recovery process, and stimulate tissue and bone regeneration, thereby underpinning the success of dental implant treatments. Ongoing research endeavors persist in unraveling the complete scope of PRF's potential and its multifaceted applications within the domain of dentistry.

In contemporary implant dentistry, the focal point extends beyond mere osseointegration and bone regeneration (Dursun E et al; 2018). Patients now desire not only functional restoration but also implant rehabilitations that showcase natural aesthetics. A prevalent biological complication in the esthetic zone is mucosal recession, often attributed to various causes, with implant malpositioning notably standing out (Shraddha P Kochar et al; 2022). Soft tissue recession consistently precedes bone dehiscence, emphasizing the need for corrective measures, not just for aesthetic improvement but also to prevent or rectify the exposure of rough implant surfaces, a condition with potential peri-implantitis implications.

In this context, soft tissue augmentation emerges as a pivotal determinant for achieving a durable and aesthetically pleasing outcome over the long term. The spectrum of treatment options includes sophisticated techniques such as coronally advanced flaps (CAF), the tunnel technique (TT), or strategic implant submergence, with or without concurrent prosthetic modifications (Igor Ashurko et al; 2021). Moreover, a diverse array of soft tissue graft donor sites presents itself, each endowed with distinctive advantages (Robert A Levine et al; 2014).

Surgical soft tissue management in implant reconstruction involves two primary categories: augmentation for keratinized tissue width and enhancement of soft tissue thickness/volume (Daniel S. Thoma et al; 2021). Techniques aimed at augmenting keratinized tissue focus on establishing a band attached to the periosteum, deepening the vestibular fornix, and enhancing patient home care and plaque control. Conversely, soft tissue thickness augmentation techniques concentrate on creating or restoring supracrestal soft tissues around the implant, elevating their thickness and height from the bone crest to the mucosal margin using diverse connective tissue grafts. This is crucial for achieving a natural emergence profile in prosthetic restoration and ensuring aesthetically pleasing results, often implemented in anterior areas.

Strategic soft tissue management occurs before implant placement, concurrently with implant placement, and during second-stage surgery (Tarnow DP et al; 2014). Notably, post-prosthetic restoration, soft tissue augmentation can address complications that may arise, underscoring its versatility and relevance throughout the implant reconstruction process.

Precise implant placement emerges as a key factor in the emergence of mucosal recession, emphasizing the adverse impact of buccal implant position, with an approximately 35-fold increased risk of recession development (Stephen T. Chen et al; 2023). In cases where the implant shoulder extends beyond the ridge contour and adjustments through prosthetic modifications are impractical, treating such situations is deemed irrational. While attention often centers on bucco-oral positioning, the vertical placement of the implant is equally critical. For bone level implants, positioning the implant shoulder 3-4 mm below the anticipated mucosal margin is recommended, with case analysis utilizing analog or digital mock-ups as a prudent step.

The peri-implant phenotype, introduced recently, highlights the importance of both soft and hard tissue dimensions ( Cho-Yong Lin et al; 2022). A thin peri-implant phenotype, characterized by limited mucosal thickness, soft tissue height, bone thickness, and buccal/oral bone plate dimensions, underscores the intricate interplay between these factors. Notably, soft tissue thickness appears to exert a more substantial influence on mucosal level than bone thickness in the short term.

Peri-implant soft tissue deficiency (PSTDef) is acknowledged as a potential concern, detectable as a grayish shimmer or dark shadow buccal to the implant (Giovanni Zucchelli et al; 2019). Correction of PSTDef is recommended before or during uncovering the implant due to enhanced accessibility. The selection between connective tissue grafts (CTG) and acellular dermal matrices (ADM) for modifying peri-implant phenotype depends on clinician preference, experience, and local factors.

The debate between coronally advanced flaps (CAF) and tunnel techniques (TT) for addressing periimplant soft tissue dehiscence (PSTDeh) lacks conclusive scientific evidence (Lorenzo Tavelli et al; 2023). While CAF may offer better access and flap mobility, TT minimizes scar formation and preserves papilla integrity. Additionally, re-submerging the implant by removing the reconstruction presents a third option, potentially contributing to keratinized mucosa gain.

In soft tissue management, autologous grafts remain the gold standard, with de-epithelialized connective tissue grafts (deepCTG) and tuberosity grafts (tuberCTG) gaining popularity in the past decade (Igor Ashurko et al; 2021).Their specific characteristics make them suitable for mucosal thickness (MT) and keratinized mucosa (KM) augmentation; however, careful consideration of potential esthetic implications, such as keloid-like healing or graft exposure, is crucial.

In conclusion, addressing mucosal recession and peri-implant soft tissue complications involves a comprehensive understanding of implant placement nuances, the peri-implant phenotype, and the choice of grafting techniques. Clinical recommendations include meticulous assessment of crownwidth to crown-length ratios, consideration of treatment predictability for shallow recessions, and a nuanced approach to graft selection based on specific clinical scenarios and characteristics.

The limited vertical dimension of alveolar bone in the posterior maxilla poses a challenge in implant dentistry, often stemming from periodontal damage or an enlarged maxillary sinus. However, advancements in material science have enabled the development of stronger, shorter implants (≤8mm) that demonstrate promising survival rates (Lemos et al., 2016). In such cases, implants may require sinus floor elevation (SFE), with lateral window and transalveolar approaches offering viable options, both exhibiting comparable success rates to implants placed in normal bone (Pjetursson & Lang, 2014; Jensen & Terheyden, 2009).

Lateral window SFE, well-suited for residual crestal bone heights of <5mm, is a well-established technique, often employed as a staged procedure prior to implant placement (Boyne & James, 1980). The effectiveness of SFE hinges on creating an optimal window, considering factors such as size, location, bone wall thickness, convexity, adjacent teeth, sinus septum, and arterial anastomosis (Stacchi et al., 2020). An "optimal" window should be large enough to provide adequate visualization and instrument access, without compromising graft retention or diminishing vital bone wall (Zaniol & Zaniol, 2017). A recommended window size for a single implant is 5mm vertically and 8-10mm horizontally, ideally positioned mesially and lower relative to the sinus (Zaniol & Zaniol, 2017).

Maintaining a thin bone wall (≤1mm) is advantageous, while the surgeon must carefully navigate the curvature and length of adjacent teeth to avoid complications. The presence of a sinus septum, encountered in approximately 30% of patients, poses a risk for membrane perforation, necessitating careful consideration in surgical planning (Testori et al., 2019). Addressing arterial anastomoses is crucial to prevent intraoperative bleeding, particularly the infraorbital artery, posterior lateral nasal artery, and the posterior superior alveolar artery (Rosano et al., 2009). Meticulous planning and execution, considering these anatomical parameters, contribute significantly to the success of sinus floor elevation procedures.

Guided sinus surgery has undergone significant advancements due to technological progress, effectively addressing challenges in implant dentistry associated with limited alveolar bone in the posterior maxilla. Prior to the widespread adoption of cone-beam CT (CBCT), surgeons relied heavily on their anatomical knowledge and surgical experience, with extraoral and intraoral X-rays providing limited insights into sinus size and surrounding structures. Surgical adjustments were made intraoperatively based on visual and tactile cues. The advent of CBCT imaging revolutionized surgical planning by providing detailed three-dimensional visualizations of anatomical structures, including intraosseous blood vessels and the sinus septum (Neugebauer et al., 2010). Modern planning software facilitates precise identification of the optimal lateral window (Neugebauer et al., 2010).

Technological advancements have also led to the development of computer-aided implant surgery (CAIS), enabling precise implant osteotomy and placement using CAD/CAM technology (Smitkarn et al., 2019; Tahmaseb et al., 2018). This principle has been applied to create surgical guides for lateral window sinus floor augmentation (Strbac et al., 2020; Zaniol et al., 2018).

The clinical application of sinus guides is exemplified in cases utilizing CBCT imaging and virtual study models imported into implant planning software (coDiagnostiX version 10.2, Dental Wings). The surgical guide is designed to align closely with the anterior and inferior borders of the maxillary sinus, ensuring adequate space for instrumentation at the target grafting area. The cut profile, drawn within the planning software, outlines the window, suggesting the superior extent of the mucoperiosteal flap for adequate exposure (Zaniol et al., 2018). While the guide does not physically guide instruments, it serves as a reference for the freehand creation of the window, offering flexibility due to its slim design. Surgical stability is maintained by covering the occlusal surface of all maxillary teeth.

Successful cases demonstrate the efficiency and safety of antrostomy with sinus guides. In one example, simultaneous sinus floor elevation (SFE) and implant placement are achieved using a surgical guide incorporating both features (Sun et al., 2020). Proper prosthetic setup precedes virtual implant placement, considering axial loading and a periodontally-friendly emergent profile design. The sinus window is strategically designed to allow easy access to the target area for SFE and grafting, taking into account anatomical characteristics.

In conclusion, the synergistic combination of advanced imaging, CAD/CAM technology, and 3D printing enhances precision in lateral window sinus floor augmentation. The meticulous planning facilitated by these tools reduces surgery time and improves safety, benefiting patients and justifying the investment in these technologies.

Introduction:

Laser therapy has emerged as a potential treatment for peri-implantitis, a condition marked by inflammation and bone loss around dental implants. Various laser types, including diode, Nd:YAG, Er:YAG, and CO2, have been investigated for their effectiveness in addressing peri-implantitis.

Benefits of Laser Therapy in Implantology:

The use of lasers in implantology offers several advantages over traditional methods. These include increased hemostasis, minimal damage to surrounding tissues, reduced swelling, infection, and postoperative pain. Additionally, lasers provide improved visibility during surgery, eliminating the need for tissue trauma associated with flap reflection and suture placement.

Efficacy of Laser Treatment:

Studies suggest that laser therapy, when used properly, is bactericidal, preserves implant surface morphology, and can stimulate new bone formation. Laser treatment has shown promising results in promoting bone gain, reducing bleeding on probing (BOP) and probing depth (PD), comparable to mechanical therapy (Papadopoulos et al; 2023). However, the need for statistically significant data is emphasized, with a call for further research to conclusively establish its efficacy.

Risks and Considerations:

While laser therapy shows promise, it is not without risks. Improper use can lead to thermal damage and bone necrosis, and there is a potential for implant surface alterations that may encourage bacterial adhesion. Disharmony in studies and short-term positive outcomes highlight the necessity for careful consideration of the risks and benefits before opting for laser therapy in peri-implantitis treatment.

Diode Lasers as an Adjunctive Treatment:

Diode lasers, particularly the 810-nm variant, have been explored as an adjunctive treatment for periimplantitis (Massimo Pisano et al; 2021). Studies indicate decreased probing pocket depth and negative bleeding on probing index with stable results after one year. However, the duration of positive clinical outcomes appears to be short-term, necessitating further research with long-term follow-up to establish their effectiveness.

Timeline for Diode Laser Treatment Results:

The timeframe for observing results from diode laser treatment varies, with some improvements reported after a few months. Studies highlight reductions in probing pocket depth and bleeding on probing index within three months and stable results after one year (Bassetti et al; 2013). However, the need for long-term follow-up is emphasized to substantiate the long-term efficacy of diode laser treatment for peri-implantitis.

Conclusion:

Laser therapy, particularly diode lasers, shows promise in the treatment of peri-implantitis by offering advantages such as improved hemostasis and minimal tissue damage. While studies indicate positive outcomes, further research with robust, long-term data is imperative to establish the efficacy and safety of laser therapy as a viable treatment option for this condition. As the field progresses, the potential for laser therapy to revolutionize peri-implantitis treatment warrants ongoing exploration and scrutiny.