The International Journal of Periodontics & Restorative Dentistry

Editors-in-Chief: Gustavo Avila-Ortiz & Oscar Gonzalez-Martin

This highly regarded, frequently cited journal integrates clinical and scientific data to improve methods and results of oral and maxillofacial implant therapy, compiles research, technology, clinical applications, reviews of the literature, and new developments in reconstructive dentistry and implant techniques. 

Editorial – Interdisciplinary Dentistry: A Founding Vision, An enduring Commitment

Avila-Ortiz, Gustavo / Couso-Queiruga, Emilio / Stevens, Clinton D. 

The Concept of Crown Shortening: Combination of Vertical Edgeless Preparation Technique and Modified Coronally Advanced Tunnel

Carcuac, Olivier / Yakubova, Nazifa

This case report describes an interdisciplinary approach to the esthetic rehabilitation of a 45-yearold woman bothered by her excessively long anterior teeth. Digital smile analysis guided treatment planning, ensuring optimal proportions and soft tissue integration. The vertical edgeless preparation technique was used to establish the correct vertical position of the finishing line, and a modified coronally advanced tunnel (MCAT) combined with modified (micro or split) connective tissue grafts was performed for root coverage and soft tissue augmentation. After uneventful healing, final ceramic restorations were delivered. The integration of a biologically oriented preparation technique and MCAT optimized periodontal and prosthetic outcomes, achieving a natural, harmonious smile. This approach highlights the synergy between periodontal plastic surgery and prosthodontics in an esthetically challenging case. Int J Periodontics Restorative Dent 2026;46(suppl):s5–s12. doi: 10.11607/prd.7720

The Supracrestal Soft Tissue Height as a Guide for Surgical Crown Lengthening Procedures

Gonzalez-Martin, Oscar / Sanz, Mariano

Surgical crown lengthening (SCL) is a predictable method of increasing the availability of supragingival tooth structure for biologic, esthetic, and/or restorative reasons. However, the literature demonstrates a lack of precision when performing this common procedure due to a number of factors. Among those factors, the use of standardized measurements and reference points will be presented, as well as the limitations inherent to the classical surgical protocol. This review discusses the importance of individualizing supracrestal soft tissue dimensions during SCL interventions and the use of appropriate diagnostic tools while taking into account the phenotypic characteristics of the patient in both functional and esthetic crown lengthening. Int J Periodontics Restorative Dent 2026;46(suppl):s15–s26. doi: 10.11607/prd.7653

Periodontal Behavior of Teeth with Noncarious Cervical Lesions Restored with a New BOPT Approach Using Composite Resin: A 1-Year Prospective Clinical Study

Rubén Agustín-Panadero, DMD, PhD / Carolina Agus, Dr med dent / Ignazio Loi, DDS, MD / Blanca Serra-Pastor, DDS, PhD / Jorge Alonso Pérez-Barquero, DDS, PhD / Martín Laguna Martos, DDS / Naia Bustamante-Hernández, DDS / Carla Fons-Badal, DDS, PhD

This clinical study aimed to examine the behavior and volumetric changes of periodontal tissues in teeth with noncarious cervical lesions (NCCLs) associated with gingival recession and treated with composite resin restorations using conventional and biologically oriented preparation techniques (BOPT) after 12 months of clinical service. A prospective clinical study was conducted to compare the gingival changes following the treatment of NCCLs with composite resin using the BOPT approach (test group) vs a conventional approach (control group). The pretreatment and 12-month posttreatment records included the following variables: Plaque Index (PI), Gingival Index (GI), gingival recession, probing depth, intraoral scans, and digitally calculated gingival thickness. The pre- and posttreatment scan files were subjected to software analysis to compare the dimensional gingival changes that occurred following treatment in both groups. A 1-year follow-up revealed a coronal gingival migration of 0.38 ± 0.49 mm in the control group and 1.16 ± 0.73 mm in the BOPT group (P < .001). Additionally, the change in gingival thickness was –0.16 ± 0.23 mm in the control group and 0.35 ± 0.15 mm in the BOPT group (P < .001). The periodontal parameters evaluated at baseline were found to be comparable between the two groups. Following treatment by both techniques, the periodontal health status remained unaltered. The BOPT approach associated with cervical composite restorations for NCCLs produces recovery of the gingival tissue. There was significant coronal gingival migration as well as horizontal thickening of the gingiva around the cervical emergence of the restorations. The BOPT approach using composite resin is a predictable technique for treating NCCLs that offers biologic advantages to the surrounding gingiva and achieves gingival stability. Int J Periodontics Restorative Dent 2026;46(suppl):s29–s42. doi: 10.11607/prd.7554

Wire Syndrome: Periodontal Complications and Management

Peter O. Cabrera, DDS / Cassandra McKenzie, MA, DDS, MS

Lingual wire retention is an internationally used modality for long-term orthodontic retention. Although generally safe, some wires become activated, leading to severe and sometimes irreversible periodontal complications. These complications are not widely known in the dental profession and have been generally described from an orthodontic perspective. The constellation of issues with activated wires has been referred to as Wire Syndrome. Although some patients are diagnosed within the first 5 years of orthodontic therapy completion, there is a subset of patients that is not diagnosed until much later than has been reported in the orthodontic literature. These patients are frequently referred to periodontists with a diagnosis of gingival recession. By the time the problem is identified, a significant amount of attachment loss has already occurred. The periodontal phenotype of the individual patient is a key determinant to the severity of attachment loss. Cases identified in periodontal practice over the course of 10 years are hereby presented, along with clinical observations and recommendations. Int J Periodontics Restorative Dent 2026;46(suppl):s45–s57. doi: 10.11607/prd.7592

Combined Perio-Ortho Treatment of Infrabony Defects in Stage IV, Type 2 Periodontitis Patients: A Case Series

Daniele Cardaropoli, DDS / Lorena Gaveglio, DDS, MSc / Christina Tietmann, DMD / Peter Wüllenweber, DMD / Conchita Martin, DDS, MSc, PhD / Ignacio Sanz Sanchez, DDS, MSc, PhD / Eric Kutschera, DMD, MSc / Søren Jepsen, DMD, MS / Karin Jepsen, DMD

Lingual wire retention is an internationally used modality for long-term orthodontic retention. Although generally safe, some wires become activated, leading to severe and sometimes irreversible periodontal complications. These complications are not widely known in the dental profession and have been generally described from an orthodontic perspective. The constellation of issues with activated wires has been referred to as Wire Syndrome. Although some patients are diagnosed within the first 5 years of orthodontic therapy completion, there is a subset of patients that is not diagnosed until much later than has been reported in the orthodontic literature. These patients are frequently referred to periodontists with a diagnosis of gingival recession. By the time the problem is identified, a significant amount of attachment loss has already occurred. The periodontal phenotype of the individual patient is a key determinant to the severity of attachment loss. Cases identified in periodontal practice over the course of 10 years are hereby presented, along with clinical observations and recommendations. Int J Periodontics Restorative Dent 2026;46(suppl):s45–s57. doi: 10.11607/prd.7592

Esthetic Solutions for Anterior Teeth: Composite Resins or Dental Ceramics?

Ronaldo Hirata, DDS, MS, PhD / Sidney Kina, DDS, MS / Rafaelly Cubas Camargo, DDS / João Luiz Bittencourt De Abreu, DDS, MS, PhD

This article reviews and contrasts composite resins and dental ceramics for anterior esthetic restorations, highlighting their fundamental properties, indications, and clinical performance. Composite resins excel in minor or localized cases—such as class III and IV cavities, minor contour modifications,
or closure of small diastemas—owing to their straightforward application, color-matching capabilities, and minimal tooth preparation requirements. However, they are vulnerable to issues like discoloration, wear, and marginal staining, and they often need periodic repolishing or repair. Dental ceramics demonstrate superior longevity, color stability, and resistance to wear, making them the preferred choice for extensive rehabilitations, larger restorations, and compromised teeth requiring crowns or bridges. While ceramics generally involve more invasive preparations and demand meticulous bonding procedures, their inert nature and high mechanical strength often result in outstanding long-term outcomes when properly executed. Clinical decision-making should account for factors such as tooth structure, occlusion, patient age and habits (eg, parafunctions), staining risk, and esthetic demands. Ultimately, striking the right balance between biology, function, and esthetics is essential to avoiding overtreatment and preserving natural dentition. Through illustrative case studies and a synthesis of relevant literature, this article provides practical guidelines for selecting the most appropriate material for each clinical scenario. Int J Periodontics Restorative Dent 2026;46(suppl):s71–s81. doi: 10.11607/prd.7656

Considerations and Concerns Regarding Monolithic Zirconia Restorations

Clinton D. Stevens, DDS / Augusto Robles, DMD, MS / Walter G. Renné, DMD / Marcela G. Alvarez, DDS, MSD / James C. Kessler, BS, DDS

After over a decade of use, there are persistent misunderstandings about monolithic zirconia (MZ) with respect to its characteristics and appropriate management. This leads to errors in its application that can negatively affect not only the efficiency and predictability of clinical workflows but also the long-term outcome for the patient. This article discusses the physical properties, manufacturing, and production of MZ restorations. Recommendations for their use based on currently available laboratory and clinical evidence and concerns regarding current trends are provided. Int J Periodontics Restorative Dent 2026;46(suppl):s83–s94. doi: 10.11607/prd.7847

Implant Malposition with Severe Anterior Periodontal Tissue Loss: An Interdisciplinary Treatment Strategy

Teresa Pinho, DDS, PhD / Jorge André Cardoso, DDS, MClinDent / Paulo Campos, DDS, MSc / Manuel Neves, DDS, MSc

This case report describes the interdisciplinary management of a 58-year-old woman with a misaligned dental implant in the maxillary left lateral incisor region, causing esthetic and functional challenges. Initial assessments revealed significant bone loss around the compromised implant, an asymmetric smile, and excessive gingival display. The treatment included slow orthodontic extrusion to reposition adjacent teeth, promoting bone and periodontal regeneration, and orthodontic intrusion on the contralateral side to correct occlusal cant and improve gingival esthetics. Aligners with miniscrew anchorage ensured precise tooth movement and improved conditions for soft tissue grafting. Periodontal procedures enhanced tissue architecture and supported long-term stability, while the final prosthetic rehabilitation successfully restored function and esthetics, emphasizing the importance of interdisciplinary collaboration for complex cases. Int J Periodontics Restorative Dent 2026;46(suppl):s97–s112. doi: 10.11607/prd.7636

Pontic Site Development Following Tooth Extraction: A Clinical Study

Emilio Couso-Queiruga, Dr med dent, DDS, MS / Carlos Garaicoa-Pazmino, DDS, MS / Kim Martin, Dr med dent / Engin Ozgur, DDS / Manrique Fonseca, Dr med dent / Clemens Raabe, Dr med dent / Vivianne Chappuis, Dr med dent / Gustavo Avila-Ortiz, DDS, MS, PhD

This study evaluated the efficacy of alveolar ridge preservation (ARP) for pontic site development following nonmolar maxillary tooth extraction vs unassisted socket healing (USH). CBCT was employed to measure preextraction facial bone thickness (FBT). An ideal pontic was digitally predesigned according to the characteristics of the site before tooth extraction (baseline), which was captured with a surface scanner. Postextraction pontic modifications were analyzed by superimposing baseline and final scans. Additionally, changes in alveolar ridge width, the presence of a buccal soft tissue concavity, and the need for soft tissue augmentation were also assessed. Among 88 patients, USH sites required significantly more pontic modifications and exhibited greater horizontal ridge reduction compared to sites that underwent ARP (P < .001). ARP sites exhibited a lower prevalence
of buccal ridge concavity compared to USH sites (70.5% vs 88.6%, P = .06) and a lower need for soft tissue augmentation (46.5% vs 70.5%, P = .06). FBT at baseline was strongly negatively associated with more pontic modifications, greater horizontal ridge reduction, and increased need for soft tissue augmentation, regardless of the baseline therapy (P < .001), but not with the presence of a buccal soft tissue concavity (P = .06). These findings suggest that ARP therapy effectively mitigates postextraction dimensional changes, making it a viable approach for pontic site development. However, ancillary soft tissue augmentation may be required in certain cases to achieve optimal therapeutic outcomes. Int J Periodontics Restorative Dent 2026;46(suppl):s115–s126. doi: 10.11607/prd.7672

Replacement of the Missing Maxillary Lateral Incisor

J. William Robbins, DDS, MA / Marcela G. Alvarez, DDS, MSD / Hiro Tokutomi, CDT

The missing maxillary lateral incisor is one of the most common teeth to require replacement in the adolescent/young adult. A dental implant is a common method of replacing this tooth. However, there are significant disadvantages associated with this treatment. In the current environment where minimally invasive dentistry is emphasized, there are more conservative treatment options, which include canine substitution and the bonded bridge. This article discusses both treatments with an emphasis on diagnosis and treatment planning as well as technique recommendations. Int J Periodontics Restorative Dent 2026;46(suppl):s129–s140. doi: 10.11607/prd.7413

Use of 3D-Printed Direct-to-Multiunit Abutment Cylinders for Efficient All-On-X Provisionalization: A Case Report

Allan Queiroz, DMD / Michael DeFee, DMD, PhD / Clinton D. Stevens, DDS / Anthony S. Mennito, DMD / Rebeca Zechmann, DDS / Kuwerjit Singh Chani, BDS, MJDF, ClinImplantDip / Walter G. Renné, DMD

Digital dentistry has accelerated the precision and predictability of full-arch implant therapy, particularly through the use of stackable guide systems that coordinate bone reduction, implant placement, and prosthetic positioning. Immediate loading has simultaneously become a widely adopted strategy for edentulous rehabilitation. This case report describes a fully guided dual-arch reconstruction incorporating guided bone reduction, guided implant placement, and guided provisional prosthesis delivery using a four-part stackable guide system with novel 3D-printed direct-to–multiunit abutment (MUA) temporary cylinders. This approach increases material bulk around screw-access channels, eliminates on-site conversion procedures, and enables direct-to-MUA prosthesis delivery without same-day printing. Int J Periodontics Restorative Dent 2026;46(suppl):s143–s154. doi: 10.11607/prd.8043