Table of Content

30 December 2025, Volume 30 Issue 6

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Forum on Soft Tissue Augmentation and Dental Implantation

Preface to the special topic: soft tissue augmentation and dental implantation

Editorial Board of Chinese Journal of Oral Implantology

2025, 30(6):  517-518.  DOI: 10.12337/zgkqzzxzz.2025.12.001

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Surgical techniques for peri-implant free epithelium-connective tissue grafting to augment keratinized mucosa

Zhao Lingzhou, Ma Chufan

2025, 30(6):  519-524.  DOI: 10.12337/zgkqzzxzz.2025.12.002

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In addressing insufficient peri-implant keratinized mucosa width (KMW)—a critical determinant of long-term implant stability and peri-implant tissue health—the peri-implant free epithelium-connective tissue grafting (FECTG) emerges as an efficacious surgical solution. This article presents technical refinements for FECTG implementation, advocating keratinized mucosa augmentation either prior to or concomitant with second-stage implant surgery to optimize surgical access and buccolingual keratinized tissue distribution. Maxillary cases benefit from palatal soft tissue transfer for buccal width enhancement, whereas mandibular cases demand meticulous technique due to lingual anatomical constraints, where improper handling may risk keratinized mucosa deficiency. The pivotal periosteal recipient bed preparation requires preservation of periosteal integrity to ensure vascularization, elimination of mobile soft tissue to enhance graft stability, and creation of a recipient bed slightly larger than the graft to facilitate suturing and promote early nutrient/oxygen diffusion. Graft fixation employs a dual-suture approach—coronal interrupted sutures coupled with external horizontal mattress sutures. Crucially, omitting sutures for apically positioned flaps streamlines the procedure, reducing operative time while lowering technical complexity. These evidence-based protocols may facilitate the broader clinical adoption of FECTG for peri-implant soft tissue augmentation.

Digitally guided tunnel soft tissue augmentation combined with temporary restoration contouring for pink esthetic reconstruction in multiple anterior teeth: a case report

Luo Lan, Wang Junlin, Chen Lin, Lai Xinru, Lin Jie, Zhou Ling, Zhao Wei

2025, 30(6):  525-531.  DOI: 10.12337/zgkqzzxzz.2025.12.003

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The loss of multiple consecutive anterior teeth frequently results in horizontal and vertical alveolar ridge resorption accompanied by soft tissue collapse, presenting formidable challenges for implant rehabilitation. Achieving ideal "pink esthetics" in the anterior esthetic zone represents a significant clinical difficulty. This case report describes an orchestrated multistage protocol for managing a patient with multiple missing maxillary anterior teeth. The first-stage surgical procedure employed digitally guided implant placement in conjunction with guided bone regeneration (GBR) to restore labial bone volume. During the second-stage procedure, a tunnel technique combined with connective tissue grafting was implemented to augment soft tissue thickness and optimize tissue architecture. Subsequently, an implant-supported provisional restoration, fabricated from a nanoceramic resin composite material, was utilized for progressive emergence profile conditioning, thereby establishing a harmonious and voluminous peri-implant soft tissue morphology. This multistage coordinated implant treatment ultimately achieved natural contours and harmoniously blended color comparable to those of natural teeth, resulting in optimal pink-and-white esthetic outcomes. This integrated treatment paradigm combines surgical augmentation with provisional restoration-guided gingival contouring: the tunnel technique provides minimally invasive precision in enhancing soft tissue profile and dimensional thickness, while the nanoceramic resin composite demonstrates excellent stability and adjustability characteristics, facilitating gradual gingival architecture maturation. This clinical protocol establishes a predictable and reliable treatment strategy for complex soft tissue management in anterior esthetic zone cases.

Aesthetic considerations for keratinized tissue augmentation around dental implants:a case series

Chen Gang

2025, 30(6):  532-535.  DOI: 10.12337/zgkqzzxzz.2025.12.004

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The augmentation of keratinized tissue around implant restorations in the esthetic zone must balance both functional and esthetic requirements. Free gingival grafts (FGGs) can effectively increase the width of keratinized mucosa but carry certain esthetic risks. Different types of connective tissue grafts also exhibit variations in color and texture after healing, which directly affect the final esthetic outcome of the restoration. This article analyzes a representative case of keratinized tissue augmentation following bone augmentation for dental implants and, through a review of the relevant literature, systematically discusses the esthetic considerations of various keratinized mucosal augmentation techniques around implant restorations, providing a clinical reference for esthetic zone implant therapy.

The use of plasmatrix in peri-implant keratinized mucosa augmentation

Qiu Yun, Li Yongjun, Zhang Xiaoxin, Wang Yulan, Zeng Hao

2025, 30(6):  536-540.  DOI: 10.12337/zgkqzzxzz.2025.12.005

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An adequate width of peri-implant keratinized mucosa is crucial for reducing plaque accumulation, decreasing the incidence of peri-implant mucositis, and maintaining long-term implant health. Although various materials are currently available to widen the peri-implant keratinized mucosa, autografts are associated with considerable surgical trauma, whereas artificial substitutes are often limited by high costs. Plasmatrix,a centrifuged autologous blood product rich in growth factors and scaffold-like structures, offers advantages such as excellent biocompatibility, minimal donor-site morbidity, abundant availability, and low cost. Its application for peri-implant keratinized mucosa augmentation may help overcome the limitations of existing materials. Based on current evidence, this article presents the preparation protocol for plasmatrix and clinical experiences with its use in peri-implant keratinized mucosa augmentation, thereby providing practical guidance for clinicians.

Materials and surgical procedures for keratinized tissue augmentation at implant sites

Wan Peng

2025, 30(6):  541-548.  DOI: 10.12337/zgkqzzxzz.2025.12.006

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The clinical significance of peri-implant keratinized tissue (KT) has long been a matter of debate. Some studies indicate that the absence of peri-implant KT is not significantly associated with plaque control, peri-implant health status, or marginal bone loss. However, an increasing number of investigations have demonstrated that KT deficiency can promote plaque accumulation, leading to bleeding on probing (BOP), increased probing depth, mucosal recession, and even marginal bone loss. The 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions concluded that no consensus has yet been reached regarding the minimum width of KT required to maintain peri-implant health and prevent peri-implant diseases. In recent years, a growing body of implant-specific evidence has highlighted the critical role of KT in the long-term stability of peri-implant hard and soft tissues. Currently, commonly used clinical approaches for peri-implant KT augmentation include a standalone apically repositioned flap (APF), APF combined with an autologous free gingival graft (FGG), and APF combined with a xenogeneic collagen matrix (XCM). Among these, FGG is regarded as the gold standard for peri-implant KT augmentation because of its predictable outcomes; however, it requires a second surgical site and is associated with a relatively high risk of complications. Consequently, alternative substitute materials have been actively explored in an attempt to reduce patient morbidity while maintaining clinical efficacy. This article systematically reviews the key surgical steps, clinical outcomes, and indications of the main techniques used for peri-implant KT augmentation, providing both evidence-based and experience-based guidance for clinical decision-making.

Prevention and management of maxillary anterior peri-implant soft tissue dehiscence

Wang Miaozhen, Liu Feng, Liu Yan, Li Yi, Zhan Yaling, Liu Xinran

2025, 30(6):  549-556.  DOI: 10.12337/zgkqzzxzz.2025.12.007

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Peri-implant mid-facial recession, characterized by gingival recession, abutment exposure, and "black triangle" formation, critically compromises esthetic outcomes. Specific predisposing and precipitating factors are as follows: buccal bone dehiscence or fenestration, a thin periodontal phenotype, and insufficient or absent keratinized mucosa; improper case selection for immediate implant placement, overly buccal implant positioning, excessively large implant or abutment diameters, and over-contoured restorations; as well as aggressive tooth brushing and inflammatory stimuli from peri-implant diseases. Preventive strategies for mid-facial recession must be integrated throughout the entire implant treatment cycle. Preoperatively, CBCT is utilized for precise planning of implant placement, and digitally guided surgery may be selected for accurate implantation. In immediate implant cases, it is recommended to combine jump gap bone grafting and connective tissue graft (CTG) intraoperatively to thicken the soft tissue. For early or delayed implantation, the focus shifts to preserving existing tissue and reconstructing lost tissue. This involves using standardized guided bone regeneration (GBR) techniques and tension-free suturing during bone augmentation to rebuild lost support. During the prosthetic phase, provisional and final prostheses with appropriate emergence profiles and biocompatible materials are used to effectively shape and support the soft tissue. For managing the existing recession, a graded treatment protocol is proposed as follows. Mild recession (<2 mm): Tunnel technique + CTG. Severe recession (≥2 mm): coronally advanced flap (CAF) + CTG. Cases with loss of interdental papilla: connective tissue platform technique. In summary, achieving long-term stable aesthetics requires strict adherence to clinical protocols, control of iatrogenic factors, and a combination of evidence-based decision-making with precise surgical execution.

Clinical outcomes and considerations of concurrent soft tissue augmentation with immediate implant placement

Wang Bin, Jiang Yixuan, Man Yi

2025, 30(6):  557-565.  DOI: 10.12337/zgkqzzxzz.2025.12.008

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Immediate implant placement is a reliable treatment modality for replacing compromised teeth in the esthetic zone, offering advantages such as reduced treatment time and fewer surgical interventions. However, the surgical trauma associated with immediate implant placement induces remodeling of the alveolar bone and surrounding soft tissues, and subsequent changes in hard and soft tissue contours may pose esthetic risks. Concurrent soft tissue grafting performed at the time of immediate implant placement has emerged as a promising strategy to mitigate these risks and has recently become a focus of research. This review synthesizes recent evidence-based findings to discuss key considerations regarding clinical outcomes, material selection, and immediate restoration in the context of concurrent soft tissue grafting with immediate implant placement, thereby providing clinical decision-making support for practitioners.

Basic Research

Study on surface quality and corrosion resistance of Ti-6Al-4V alloy implant abutments by magnetic abrasive finishing

Xiong Lang, Su Hanqi, Hao Junjiang, Su Yucheng

2025, 30(6):  566-573.  DOI: 10.12337/zgkqzzxzz.2025.12.009

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Objective This study investigates the effects of magnetic abrasive finishing (MAF) technology on the surface morphology, roughness, hydrophilicity, and corrosion resistance of Ti-6Al-4V alloy dental implant abutments. It aims to clarify the role of different magnetic needle diameters in optimizing surface properties and provide a basis for clinical surface treatment processes. Methods Ti-6Al-4V alloy cylindrical specimens were divided into five groups: an untreated control group (control) and MAF-treated groups with magnetic needle diameters of 0.2 mm, 0.5 mm, 1.0 mm, and 1.5 mm (MAF_0.2, MAF_0.5, MAF_1.0, and MAF_1.5). MAF treatment was performed by changing only the magnetic needle diameter while keeping the other processing parameters constant. Surface morphology changes were observed using a scanning electron microscope (SEM), surface roughness was measured using an optical surface roughness meter, hydrophilicity was assessed using a contact angle measuring instrument, and electrochemical polarization testing was used to analyze the corrosion potential (E_corr), corrosion current density (i_corr), and polarization resistance (R_p) of each group of samples in artificial saliva. Results MAF treatment effectively removed original processing marks, reduced surface roughness, and improved hydrophilicity, with statistically significant differences between groups(P<0.05). In the MAF_1.0 group (magnetic needle diameter 1.0 mm, magnetic needle length 5.0 mm, magnetic pole rotation speed 40 Hz, grinding time 60 min), Ra decreased to(0.197 ± 0.022) μm, contact angle decreased to 78.03° ± 1.59°, E_corr increased to -0.5661 V,i_corr decreased to 0.0114 μA·cm^-2, and R_p increased to 8.97×10⁶ Ω·cm², all outperforming other treatment groups and the control group, demonstrating the best overall performance. Conclusion MAF technology can significantly improve the surface morphology, roughness, hydrophilicity, and corrosion resistance of Ti-6Al-4V alloy implant abutments. Magnetic needle treatment with a diameter of 1.0 mm is most effective in improving surface performance, providing an experimental basis for subsequent clinical evaluation.

Comparative study on the accuracy of different SmartX scanning strategies in full-arch implant prosthetic digital impressions

Gu Yanyan, Wang Yuzhuo, Fu Yuanfei, Wang Jie

2025, 30(6):  574-579.  DOI: 10.12337/zgkqzzxzz.2025.12.010

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Objective To evaluate the trueness of SmartX intraoral scanning (IOS) for full-arch digital implant impressions and to compare the impact of different scanning strategies on accuracy. Methods Scan bodies were arranged in two configurations (along-the-ridge and centripetal) on three all-on-6 maxillary models. SmartX IOS performed 60 scans (3 models × 2 strategies × 10 repetitions). Desktop scanner data served as a reference. IOS scans were compared against reference scans, assessing trueness and precision via distance/angular deviations between implant abutments and root mean square (RMS) errors. Results For along-the-ridge scans: distance deviation = 75.25 (45.35, 136.40) μm, angular deviation = 0.47°±0.22°, RMS = 88.05 (67.75, 99.88) μm. For centripetal scans: distance deviation = 113.90 (81.93,315.60) μm, angular deviation = 0.27°±0.18°, RMS = 93.75 (73.58, 98.85) μm. Mann-Whitney U and paired-samples t-tests indicated significant precision differences between strategies (P<0.05). Conclusion Both SmartX strategies produced clinically acceptable deviations below passive fit thresholds for full-arch digital impressions. Scanning strategy is one of the key factors affecting the impression precision of the system.

Antibacterial performance of 3D printed Ti-6Al-4V surfaces loaded with polydopamine-cinnamaldehyde

Song Nawei, Wei Zhaoming, Qu Chenxi, Liu Miao

2025, 30(6):  580-586.  DOI: 10.12337/zgkqzzxzz.2025.12.011

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Objective To successfully load polydopamine-cinnamaldehyde (PDA-CA) composite coatings onto the surface of 3D-printed Ti-6Al-4V specimens and to investigate their antibacterial properties and biocompatibility. Methods PDA-CA was deposited onto 3D-printed Ti-6Al-4V specimens. Untreated 3D-printed Ti-6Al-4V served as the blank control group, and sandblasted-acid-etched specimens served as the experimental control group. The experimental groups included a PDA group, a cinnamaldehyde (CA) group, and a PDA-CA group. The surface morphology was examined using scanning electron microscopy (SEM), elemental composition was analyzed by energy-dispersive spectroscopy (EDS), and hydrophilicity was evaluated via water contact angle measurements. MC3T3-E1 cells were inoculated onto specimen surfaces to assess biocompatibility, and Staphylococcus aureus and Escherichia coli were used to evaluate antibacterial properties. Results SEM results showed uniform substance coverage in the PDA-CA group. EDS results revealed the characteristic nitrogen (N) element in the PDA group and significantly increased carbon (C) and oxygen (O) contents-derived from cinnamaldehyde-in the PDA-CA group. The water contact angle measurements indicated hydrophilicity in all experimental groups. The PDA-CA group demonstrated markedly enhanced cinnamaldehyde loading, significantly superior antibacterial activitg compared with those of other groups, and good biocompatibility. Conclusion Successful loading of PDA-CA enhances the antibacterial properties of 3D-printed Ti-6Al-4V while maintaining favorable biocompatibility.

Clinical Research

Aesthetic outcomes of immediate implant restoration in the maxillary anterior region and its impact on bone volume and periodontal tissue health

Liu Qing, Lin Yong

2025, 30(6):  587-593.  DOI: 10.12337/zgkqzzxzz.2025.12.012

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Objective To investigate the aesthetic outcomes of immediate implant restoration in the maxillary anterior region and the impact on bone volume and periodontal tissue health. Methods This study adopted a prospective cohort study design. Patients who presented to the Department of Stomatology of Puyang Oilfield General Hospital between January 2023 and January 2025 with severe maxillary anterior tooth defects and who were scheduled for extraction followed by implant restoration were included in this study. Based on the patients' wishes, personal conditions, and clinical evaluation, the final treatment plan was determined. The patients were divided into two groups: those who received immediate implant restoration were included in the immediate implantation group (n=55), and those who received delayed implant restoration after tooth extraction site preservation were included in the delayed implantation group (n=55). The alveolar bone resorption indicators, aesthetic indicators, patient subjective satisfaction, periodontal tissue health, and complications were compared between the two groups. Results Six months after immediate restoration, the bone resorption in the immediate implantation group was lower than that in the delayed implantation group (P<0.05); six months after permanent restoration, there was no statistically significant difference in bone resorption between the two groups (P>0.05). Six months after immediate restoration, the pink esthetic score (PES) and visual analog scale (VAS) scores of the immediate implantation group were higher than those of the delayed implantation group (P<0.05). At 1 month postoperatively, the immediate implantation group had a lower probing depth (PD) but a higher modified sulcus bleeding index (mBI) than the delayed implantation group (P<0.05). At 3 months post-surgery and 6 months after permanent restoration, PD improved significantly in both groups compared with their 1-month values (P<0.05), with the immediate implantation group maintaining lower PD (P<0.05). No significant difference in mBI was observed between the two groups at 3 months post-surgery and 6 months after permanent restoration (P>0.05). The incidence of complications was lower in the immediate implantation group (P<0.05). Conclusion In anterior tooth restoration, both immediate implant placement and delayed implant placement can achieve ideal long-term aesthetic outcomes. Immediate implant placement effectively controls early alveolar bone resorption, better maintains peri-implant soft tissue stability, provides superior early aesthetic results and patient satisfaction, and significantly reduces the risk of postoperative adverse reactions.

Case Reports

Application of digital modular surgical guide in implant rehabilitation of an edentulous patient: a case report

Hu Yuping, Jiao Xin, Tian Hongjuan, Luo Haixia, Cheng Yuqi, Ge Zhenlin

2025, 30(6):  594-598.  DOI: 10.12337/zgkqzzxzz.2025.12.013

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The application of static surgical guides significantly enhances the accuracy and predictability of implant surgery in edentulous jaws. However, when monolithic guides are used in complex bone reduction procedures, osteotomy and implant placement often need to be performed in separate stages, leading to suboptimal treatment efficiency. This article reports a case of full-arch implant rehabilitation in a completely edentulous patient. A fully digital modular surgical guide was utilized for the mandible. Its modular design allowed for staged intraoperative assembly and use, enabling integrated guidance for both bone reduction and implant placement. Additionally, based on the digitally planned pick-up technique, the temporary prosthesis was designed and fabricated preoperatively, followed by immediate loading after surgery. The definitive prosthesis was delivered six months later using a digital impression. A three-year follow-up showed favorable implant osseointegration, stable restorative outcomes, and high patient satisfaction both functionally and esthetically. This digital modular guide protocol effectively improved the efficiency and clinical outcomes of complex edentulous jaw rehabilitation and may serve as a reference for the management of similar cases.

Digital surgical guide-assisted immediate implant placement combined with the socket-shield technique in the anterior esthetic zone: a case report

Liu Mengqi, Xiao Weiwei, Bu Xiaoling, Gong Lingling, Feng Bo

2025, 30(6):  599-603.  DOI: 10.12337/zgkqzzxzz.2025.12.014

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This article reports a case of immediate implant placement in the esthetic zone of the anterior maxilla using a digital surgical guide combined with the socket-shield technique. The anterior esthetic region demands high precision in implant positioning, as minor deviations may lead to esthetic complications. The digital guide enables prosthetically driven implant placement through precise control of the insertion position. Meanwhile, to address the collapse of the buccal bundle bone following tooth extraction, the socket-shield technique preserves the facial root fragment to maintain the blood supply to the periodontal ligament-bundle bone complex, thereby maximizing the preservation of the alveolar bone contour and gingival esthetics.

Reviews

Clinical research progress on transcrestal sinus floor elevation in maxillary sinuses with an inclined sinus floor

Liu Lupeng, Xiao Huijuan

2025, 30(6):  604-609.  DOI: 10.12337/zgkqzzxzz.2025.12.015

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Maxillary sinus floor elevation (MSFE) is the most commonly used technique to manage insufficient vertical bone height in the posterior maxilla. Surgical approaches include transcrestal sinus floor elevation (TSFE) and lateral window sinus floor elevation (LSFE). The choice of procedure is influenced by various anatomical and clinical factors. This article reviews current clinical evidence and techniques related to TSFE in maxillary sinuses with an inclined sinus floor.