Parobreda

30/08/2026

13/08/2026

Suturing or wrapping a pork roast? 🐷🧵

Looking at this picture, I have to admit: it bears a suspicious resemblance to a pork tenderloin tied up for Sunday dinner.

But underneath all those sutures lies an interesting surgical question:

How much work should a suture actually be doing?

My philosophy is simple:

A suture should hold tissue in position — not pull tissue into position.

If we need a 3-0 suture to force our flap into place, perhaps the problem isn’t the strength of our suture. Perhaps we haven’t mobilised our flap enough.

There is some interesting science behind this.

Burkhardt & Lang measured the force required for primary wound closure. Once closing forces exceeded 0.1 N — roughly 10 grams — the incidence of wound dehiscence increased dramatically.

That is remarkably little force.

So why use a suture strong enough to tow a car?

For periodontal microsurgery, my preference is 6-0 monofilament. Thin enough to minimise tissue trauma, monofilament to reduce bacterial wicking, and — importantly — it discourages us from compensating for excessive flap tension with a stronger thread.

Then there is timing.

I prefer to leave sutures in place for at least 10 days in mucogingival and regenerative procedures. Early removal may look tempting when everything appears beautifully closed after a week, but biologically the wound is still gaining strength. Remove the mechanical support too early and we may simply pull apart what we worked so carefully to put together.

So here’s one for discussion:

6-0 or 3-0?
Monofilament or braided?
7 days or 10–14 days?

And perhaps the most important question:

If your flap needs a thick suture to stay closed… should it have been closed like that in the first place?

Think deeper. Treat better.

05/08/2026

If deeper implant placement is considered the solution to avoid GBR, where is the evidence that biology has changed?

Every few years a new concept promises to simplify implant surgery by avoiding bone augmentation.

The question is not whether surgery becomes easier.

The real question is:

What happens to the peri-implant tissues over the next 10 or 20 years?

Decades of experimental and clinical research have shown that peri-implant bone remodels according to biological principles—not marketing concepts.

When a rough implant surface or implant-abutment interface is intentionally positioned too deep, marginal bone remodels until a stable biological dimension is established. This often results in a deeper peri-implant sulcus, making plaque control and long-term maintenance more challenging.

The easiest surgery is not always the best biology.

Sometimes guided bone regeneration is not overtreatment.

Sometimes it is simply the price we pay for creating a more maintainable peri-implant environment.

Long-term success is determined by biology—not by how easy the surgery was.

This is why, for more than 20 years, ParoBreda has chosen an implant system with long-term scientific documentation over short-term marketing promises.

Our choice remains Nobel Biocare.

Because biology always wins.

31/07/2026

Free gingival graft or tunnel technique?

Both procedures are predictable when the indication is correct.

In our daily practice, however, we often notice an interesting difference.

A tunnel procedure combined with connective tissue graft generally provides the most natural colour match and excellent esthetics.

A free gingival graft, on the other hand, frequently results in a wider zone of keratinized tissue and a remarkably stable, thick soft-tissue phenotype.

That observation is supported by current evidence. Tunnel and connective tissue graft techniques excel in root coverage and esthetics, whereas free gingival grafts remain extremely effective when increasing the amount of keratinized tissue and converting a thin phenotype into a more robust one.

The most beautiful result is not always the strongest one.

What would you choose in this patient?


ThinkDeeperTreatBetter

25/07/2026

Treatment is not about treating an X-ray.

Five years ago this implant showed bleeding on probing and an 8 mm pocket. Because of the patient’s age (85 years) and bisphosphonate use, surgical intervention was intentionally avoided.

Five years later:
• no bleeding on probing
• clinically stable
• radiographically stable

This case does not prove that bisphosphonates prevent peri-implantitis progression.

It reminds us that treatment decisions should be based on the whole patient—not just pocket depth or radiographic appearance.

Sometimes careful maintenance is the most appropriate treatment.

18/07/2026

When loosening is more than just loosening…

In 2012, two narrow-platform NobelActive implants were placed in the posterior mandible.

Early marginal bone remodeling occurred around one implant. Despite the reduced bone level, the situation remained remarkably stable for many years.

Two years ago, the crown on the distal implant became loose. It was retightened, but the radiograph showed something important: the crown appeared to seat deeper than the neighboring restoration. In retrospect, this was probably not simple screw loosening, but an early sign of damage to the implant connection or an existing longitudinal crack.

Fourteen years after placement, the implant eventually fractured. After removal, the crack through the implant wall was clearly visible.

This case raises several questions:

Could the direct contact between a full-zirconia restoration and a narrow titanium conical connection have contributed to fretting, deformation and fatigue?

Would a titanium base or a one-abutment–one-time concept have better protected the implant connection?

And is the more uniform implant-wall design of the N1 mechanically more resistant than the conventional NobelActive NP connection?

We do not yet have enough independent comparative evidence to answer all these questions conclusively. Implant fractures are usually multifactorial: narrow implant diameter, posterior loading, loss of crestal bone, repeated micromovement, restorative design and occlusal forces may all contribute.

The lesson for me is clear:

Repeated loosening—or a restoration that suddenly seats deeper—should never simply be retorqued without further investigation.

We must continue to question our previous treatments, recognize early warning signs and adapt our protocols as materials and implant designs evolve.

In implantology, learning never stops.

ZirconiaAbutment TiBase OneAbutmentOneTime ProstheticComplications CriticalThinking

11/07/2026

Is soft tissue thickness the missing piece of the puzzle?

A fascinating new longitudinal study by Tavelli et al. (Journal of Periodontology, 2026) reports that mucosal thickness measured 3 mm apical to the soft tissue margin (MT3) was the strongest predictor of long-term peri-implant soft tissue stability.

📌 MT3 ≥ 2.23 mm
→ 100% soft tissue stability over 5 years in this cohort.

This raises an interesting question.

If peri-implant soft tissue thickness is the key determinant of long-term stability, could preserving that tissue become just as important as creating it?

The Nobel Biocare N1 concept with a 2.5 mm Base and a true One Abutment One Time workflow is designed to minimize disruption of the peri-implant soft tissue compartment by avoiding repeated abutment disconnection.

While this study did not evaluate the N1 system or the One Abutment One Time concept directly, it makes me wonder whether these biological principles may be complementary:

✅ Adequate soft tissue volume (MT3 ≥ 2.23 mm)
+
✅ Preservation of that tissue through a definitive transmucosal base from day one

Could this combination further improve long-term soft tissue stability?

I’d love to hear your thoughts.

📖 Tavelli L. et al.
Protective factors and critical mucosal thickness for the stability of the peri-implant soft tissue margin over 5 years.
Journal of Periodontology, 2026.

NobelBiocare N1 OneAbutmentOneTime EvidenceBasedDentistry DigitalDentistry Implantology

05/06/2026

From Biology to Digital Precision

Single tooth replacement in the esthetic zone is never just about placing an implant. It is about respecting biology, preserving tissue architecture, and creating a seamless transition from surgery to restoration.

In this case, a Nobel Biocare N1 implant was restored using the N1 Base concept, allowing us to maintain a stable transmucosal interface from day one. The provisional crown was designed and printed in-house with the Springray Midas printer, providing an immediate and highly efficient temporary solution during tissue maturation.

The combination of:
✔️ Minimally invasive implant placement
✔️ Tissue-friendly N1 Base workflow
✔️ Chairside digital design
✔️ High-resolution 3D printing with Midas

allowed us to quickly move from surgery to a customized provisional restoration while supporting optimal soft tissue development.

The provisional phase is often underestimated. In reality, it is where the emergence profile is sculpted, peri-implant tissues are guided, and the foundation for the final esthetic result is established.

Digital dentistry is not about replacing biology—it is about supporting it with greater precision, predictability, and efficiency.

23/05/2026

Two different patients. Same surgical approach. Completely different starting points — yet both achieved the goal: resolving the mucogingival defect.

Interestingly, you would expect the more challenging case to show less root coverage than the easier one. Not this time.

That’s exactly why we love periodontal plastic surgery. It never stops fascinating us how soft tissues respond and heal.

Sometimes the “hopeless” recession defects surprise you the most. Biology does not always follow our expectations. Predictability in mucogingival surgery is not only about defect morphology — tissue phenotype, vascularity, flap management and wound stability can completely change the outcome. Root coverage percentages matter, but the true endpoint remains long-term tissue stability, patient comfort and harmonious soft tissue integration.

15/05/2026

Replacing a congenitally missing lateral with the N1 implant system from Nobel biocare.
Focus on tissue preservation, emergence profile and long-term stability in a demanding aesthetic zone.

Minimal dimensions. Maximum biological respect.