{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:35:03Z","timestamp":1786444503132,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Correction of peri\u2010implant bone dehiscence (PIBD) and optimization of the peri\u2010implant soft\u2010tissue phenotype are critical for long\u2010term peri\u2010implant tissues stability. A simplified, one\u2010stage, transmucosal variant of the subperiosteal peri\u2010implant augmented layer (sSPAL) technique was appraised and evaluated.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Eight systemically healthy patients with posterior mandibular edentulous sites showing an overt dehiscence received tissue\u2010level implants combined with sSPAL using particulate deproteinized bovine bone mineral within a periosteal pouch. Clinical (keratinized mucosa, marginal soft\u2010tissue level, probing depth (PD), and bleeding\/suppuration) and radiographic (peri\u2010implant bone dehiscence, buccal bone thickness (BBT), and interproximal bone levels) parameters were assessed at 12 months.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n At the 12\u2010month follow\u2010up, all treated patients exhibited complete resolution of PIBDs and a BBT of \u22651.5\u00a0mm. Moreover, all implants presented a keratinized mucosa height \u22652\u00a0mm associated with stable soft\u2010tissue margins, shallow PDs, minimal bleeding, and no suppuration.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Within the limitations of this preliminary case series, sSPAL appears to be a feasible approach to modify the peri\u2010implant phenotype by both reconstructing the hard\u2010tissue component and providing adequate dimensions of the soft\u2010tissue component.<\/jats:p>\n <\/jats:sec>\n \n Key points<\/jats:title>\n \n \n \n The study was performed in order to assess whether and to what extent sSPAL may allow to manage both hard\u2010 and soft\u2010peri\u2010implant phenotype components;<\/jats:p>\n <\/jats:list-item>\n \n The isolation of the coronal full\u2010thickness portion of the flap as well as a careful dissection of the periosteal layer taking care of maintaining its integrity are of paramount importance in order to successfully perform the surgical procedure. Finally, the adaptation of the flap should allow for the displacement of the full\u2010thickness portion of the flap around the healing abutment in order to create adequate dimension of the soft\u2010tissue peri\u2010implant phenotype;<\/jats:p>\n <\/jats:list-item>\n \n The absence of at least 6\u00a0mm of keratinized tissue above the edentulous ridge as well as a limited thickness of the mucosa lining the bone crest, thus not ensuring adequate dimensions of the soft\u2010tissue phenotype on both buccal and lingual aspects of the implant, may represent a contraindication for the execution of sSPAL.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Plain Language Summary<\/jats:title>\n The present study pointed out the use of a novel surgical technique, namely the simplified subperiosteal peri\u2010implant augmented layer technique (sSPAL), aimed at managing both hard and softperi\u2010implant tissues in a single surgical intervention. The procedure derives from a published and validated two\u2010stage technique (SPAL technique) aimed at correcting a peri\u2010implant bone dehiscence (PIBD) simultaneously with implant placement. The present pilot study involved eight patients presenting one implant each that was treated with the sSPAL. No implant presented a PIBD at the 12\u2010month CBCT examination, whereas seven of eight patients presented adequate (\u22652\u00a0mm) dimensions of the peri\u2010implant soft tissues. Therefore, despite taking into account the limitations of the present study due to its exploratory nature, it can be concluded that sSPAL may represent a valuable, simplified alternative to the conventional two\u2010stage SPAL technique.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cap.70085","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:03:20Z","timestamp":1786442600000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Simplified SPAL technique to provide adequate peri\u2010implant phenotype: A pilot study"],"prefix":"10.1002","author":[{"given":"Leonardo","family":"Trombelli","sequence":"first","affiliation":[{"name":"Research Centre for the Study of Periodontal and Peri\u2010Implant Diseases University of Ferrara Ferrara Italy"},{"name":"Operative Unit of Dentistry (AUSL) Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Franzini","sequence":"additional","affiliation":[{"name":"Research Centre for the Study of Periodontal and Peri\u2010Implant Diseases University of Ferrara Ferrara Italy"},{"name":"Operative Unit of Dentistry (AUSL) Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0204-3816","authenticated-orcid":false,"given":"Mattia","family":"Severi","sequence":"additional","affiliation":[{"name":"Research Centre for the Study of Periodontal and Peri\u2010Implant Diseases University of Ferrara Ferrara Italy"},{"name":"Operative Unit of Dentistry (AUSL) Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0501.2011.02214.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12802"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.13126"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.19-0716"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.14029"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13823"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.13414"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.24-0083"},{"issue":"1","key":"e_1_2_10_10_1","first-page":"11","article-title":"Bone augmentation at implant dehiscences and fenestrations. 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