AimTo evaluate the non‐inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient‐reported outcomes (PROM).Material and methodsOne hundred and eighty‐seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient‐reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.ResultsAverage baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six‐month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8).ConclusionReplacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.

Conclusions: The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone. Furthermore, the sites treated with Er:YAG laser showed similar results of the sites treated with supragingival scaling.

Aim To report the 36‐month follow‐up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. Material and methods 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed‐up for 36 months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. Results No differences were observed between the randomized and the follow‐up population. Average baseline recession was 2.6 ± 1.0 mm. 3‐year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95% CI from −0.02 to 0.65 mm). The upper limit of the confidence interval was over the non‐inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6‐ and 36‐month follow‐up (difference 0.06 mm, 95% CI −0.17 to 0.29 mm). Conclusion CMX was not non‐inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision‐making.

Aim The modified minimally invasive surgical technique (M‐MIST) optimizes wound stability in the treatment of intrabony defects. Short‐term observations show similar results as with flap alone or adjunctive regenerative materials. This study aims to compare the stability of the long‐term outcomes, complication‐free survival, and costs of the three treatment options. Materials and Methods Forty‐five intrabony defects in 45 patients were randomized to M‐MIST alone (N = 15), combined with enamel matrix derivative (M‐MIST + EMD, N = 15), or EMD plus bone‐mineral‐derived xenograph (M‐MIST + EMD + BMDX, N = 15). Supportive periodontal care (SPC) and necessary re‐treatment were provided for 10 years. Results Three subjects were lost to follow‐up. Clinical attachment level differences between 1 and 10 years were −0.1 ± 0.7 mm for M‐MIST, −0.1 ± 0.8 mm for M‐MIST + EMD, and −0.3 ± 0.6 mm for M‐MIST + EMD + BMDX (p > .05 for within‐ and between‐group differences). Four episodes of recurrence occurred in the M‐MIST group, four in the M‐MIST + EMD group, and five in the M‐MIST + EMD + BMDX group. No significant differences in complication‐free survival were observed between the three groups (p = .47). Complication‐free survival was 7.46 years (95% confidence interval: 7.05–7.87) for the whole population. The M‐MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter‐group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M‐MIST alone. Conclusions Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M‐MIST alone or by adding a regenerative material in the context of a careful SPC programme. M‐MIST alone provided similar short‐ and long‐term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.

Objectives: Evaluate in a case series the clinical applicability of a regenerative approach for treatment of peri-implant lesions based on papilla preservation flaps (PPF) and minimally invasive surgery (MIST). Material and methods:Twenty-one deep peri-implant defects in 21 patients were surgically accessed applying PPF and MIST. The exposed implant surface was decontaminated with the sequential application of mechanical devices and chemical agents.Bone substitutes alone or in combination with a collagen barrier were applied, according to the anatomy of the peri-implant lesion. Clinical and radiographic measurements were collected at baseline, post-surgery, 1 and 5 years.Results: Primary wound closure was obtained in 100% of the sites and maintained in 90% of the sites at 1 week. Bleeding on probing (BOP) was reduced from 100% at baseline to 28.6% at 1 year and to 42.8% at 5 years. The 1-year pocket reduction was 3.9 ± 1 mm. Residual probing depths (PD) were 4.1 ± 0.9 mm. PD remained stable up to 5 years. The radiographic bone gain was 2.5 ± 1.2 mm (mesial) and 2.5 ± 1.1 (distal) at 1-year and 2.3 ± 1.3 mm (mesial) and 2.6 ± 1.4 mm (distal) at 5 years. The radiographic resolution of the defect was 70.4% ± 19% (mesial) and 70.2% ± 22% (distal) at 1 year and 64.2% ± 21% (mesial) and 67.7% ± 21% (distal) at 5 years. All implants survived up to 5 years. A composite outcome of disease resolution shows consistent 1-year clinical improvements at all the treated sites and substantial 5-year stability.Conclusions: PPF and MIST can be successfully applied for the regenerative treatment of peri-implant defects.