Clinical and experimental dental researchFazli Rabi, Naveed Sadiq, Muhammad Jamil, Sadia Asif Samdani, Waqas Naseem, Ferdous Bukhary, Umar Hussain, Alessandra Campobasso, Nikolaos Pandis
OBJECTIVE: This study aimed to compare the clinical effects of chlorhexidine (CHX) and essential oil-containing mouthwash (EOM) on periodontal health in patients undergoing fixed orthodontic treatment over a 3-month follow-up period. MATERIAL AND METHODS: This double-blinded, parallel-arm randomized-controlled clinical trial with a 1:1 allocation ratio was conducted at the Department of Orthodontics, Saidu College of Dentistry, Swat, Pakistan. Sixty participants aged 13-40 years undergoing fixed orthodontic treatment were randomly allocated to receive either 0.12% chlorhexidine mouthwash or Listerine essential oil mouthwash, dispensed in identical coded containers to ensure blinding. Participants were instructed to rinse with 10 mL of the assigned mouthwash twice daily for 30 s for 3 months while maintaining routine oral hygiene practices. The primary outcomes were the plaque index and the gingival index. Tooth staining was assessed as a secondary outcome (harm). Clinical outcomes, including the plaque index, the gingival index, and the stain index, were recorded at baseline, 1, 2, and 3 months by a calibrated examiner. Data were analyzed using generalized estimating equation models to evaluate longitudinal changes between groups, with statistical significance set at p ≤ 0.05. RESULTS: The gingival index showed a significant change over time (Wald p = 0.02), with no statistically significant overall difference between the CHX and Listerine groups (Wald p = 0.07). The plaque index was significantly higher in the CHX group than in the Listerine group (Wald p < 0.001). The stain index was also significantly higher in the CHX group than in the Listerine group (Wald p < 0.001). CONCLUSION: Both mouthwashes were associated with changes in periodontal health during fixed orthodontic treatment. Compared with CHX, EOM was associated with significantly lower plaque index and stain index scores, whereas no statistically significant overall difference between groups was observed for the gingival index. TRIAL REGISTRATION: This trial was retrospectively registered at ClinicalTrials.gov (Identifier: NCT07119840).
Journal of visualized experiments : JoVEMiaomiao Yang, Danping Wang, Liping Jiang, Yani Lin
Adjunctive antimicrobials can enhance non-surgical periodontal therapy by suppressing residual pathogens within deep periodontal pockets. This article presents a reproducible, chairside protocol for delivering a biodegradable 14% doxycycline gel as an adjunct to scaling and root planing (SRP) in adults with stage III or IV periodontitis. The workflow includes participant screening and informed consent, randomization to three arms (SRP plus doxycycline gel; SRP plus placebo gel; SRP alone), allocation concealment, standardized full-mouth debridement, and blinded gel delivery using a blunt cannula with a base-to-margin filling approach. Postoperative instructions and scheduled follow-ups at 1, 3, and 6 months are described to support consistency across operators and visits. Clinical outcomes include probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), and bleeding on probing (BOP). Site-specific microbiological sampling targets red-complex organisms (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) using sterile paper points followed by quantitative laboratory analysis with pre-defined quality controls. Examiner calibration, instrument sterility checks, and protocol stopping points are specified to strengthen fidelity and safety. Representative results show that adjunctive doxycycline gel is most likely to yield incremental benefit at deeper residual sites, with between-group differences at full-mouth averages expected to be smaller, consistent with prior evidence on locally delivered antimicrobials after meticulous SRP11-13. This protocol is designed to be video-capturable and readily implemented in clinical research and advanced periodontal training.
OBJECTIVE: To preliminarily evaluate the clinical efficacy of Bletilla striata-Litsea cube-batoothpaste in patients with plaque-induced gingivitis and its impact on inflammatory factors in gingival crevicular fluid. METHODS AND MATERIALS: In a randomised clinical trial, 80 patients with plaque-induced gingivitis were randomly allocated to receive either Bletilla striata-Litsea cubeba toothpaste (experimental group) or negative control toothpaste (control group). Following a 2-week washout period, periodontal indices including the Turesky-modified Quigley-Hein Plaque Index (TmQHI) and Sulcus Bleeding Index (SBI), along with inflammatory cytokines (IL-1β, IL-6, TNF-α) quantified from gingival crevicular fluid (GCF) samples of the right mandibular first molars, were assessed at baseline (0 week), 4, 8, and 12 weeks. Statistical analyses employed repeated-measures analysis of variance (ANOVA) for longitudinal comparisons and independent samples t-tests for inter-group comparisons at identical time points, with statistical significance defined as α = 0.05. RESULTS: The experimental group exhibited significant TmQHI and SBI reductions at 8 and 12 weeks (p 0.05) versus delayed changes in controls. IL-1β decreased significantly at 8 and 12 weeks with lower levels than controls (p 0.05); IL-6 declined earlier in the experimental group, while TNF-α reductions were comparable between groups. CONCLUSION: Compared with control, the novel toothpaste achieved earlier and greater improvements in periodontal indices and specific inflammatory mediator levels in plaque-induced gingivitis.
Oral health & preventive dentistryGaoming Yan, Haiping Song, Huan Lou
PURPOSE: Micro-RNA (miRNA) is an emerging biomarker for periodontal disease. To determine its diagnostic value in peri-implantitis (PI) and its relationship with inflammatory factors, this study focused on miR-144-3p, potentially providing a much-needed new biomarker for PI. MATERIALS AND METHODS: A total of 98 healthy subjects and 114 PI patients were included in this study. Clinical parameters such as plaque index (PLI), sulcus bleeding index (SBI), probing depth (PD), full-mouth plaque scores (FMPS), clinical attachment level (CAL), and bleeding on probing/suppuration were recorded and compared. The quantification of miR-144-3p was performed using RT-qPCR. The ROC curve assessed the diagnostic value. The chi-squared test was utilized to analyze associations between the clinicopathological characteristics of PI and miR-144-3p level. Risk factors for PI were analyzed using logistic regression. HGFs were treated with LPS as the PI model. miR-144-3p was overexpressed or inhibited by transfection into the PI model. Then, cell viability and inflammatory factors were detected in the PI model. RESULTS: Compared to controls, PI patients had statistically significantly higher PLI, SBI, PD, FMPS, CAL, and a higher rate of bleeding on probing/suppuration. The miR-144-3p level was increased and had high diagnostic value in PI. The presence of miR-144-3p was a risk factor for PI. In addition, the miR-144-3p level was closely related to clinical indicators in PI. In the PI model, overexpression of miR-144-3p reduced proliferation and increased inflammatory factor levels, while inhibition of miR-144-3p increased proliferation and reduced inflammatory factor levels. CONCLUSION: miR-144-3p correlated with clinical parameters such as PLI, SBI, PD, FMPS, CAL, and bleeding on probing/suppuration and participated in PI by regulating cell viability and inflammatory factors, supporting its potential as a clinically relevant biomarker for PI.
Swiss dental journalAdrian C Frey, Noah C Walser, Patrick R Schmidlin
Pathologic tooth migration (PTM), tooth flaring, and severe mobility are frequent clinical problems in stage IV periodontitis and can cause major aesthetic and functional impairment. Conventional correction often requires prolonged interdisciplinary periodontal-orthodontic treatment. This case series introduces the PIANO protocol (Periodontal Immediate Adhesive Nonsurgical Orthorepositioning), a splint-assisted approach combining orthorepositioning with immediate stabilization during step 2 periodontal therapy. Three patients with generalized stage IV, grade C periodontitis, anterior PTM, and grade III mobility were treated. Before local anaesthesia, the affected teeth were moved with gentle digital pressure towards the closest passively achievable functional and aesthetic position. Movement was discontinued if resistance or discomfort occurred. The teeth were then adhesively splinted, premature occlusal contacts were adjusted, and nonsurgical periodontal therapy was performed. At 6 months, all treated teeth remained clinically stable and responded positively to pulp sensibility testing. Periodontal inflammation had resolved, no residual pathological probing depths were detected, and radiographs showed defect fill compatible with osseous repair. Patient-reported outcomes were favourable, particularly for aesthetics, function, and willingness to undergo the procedure again. No pulpal complications or splint failures occurred. Within the limitations of this three-patient case series, the PIANO protocol provided rapid aesthetic and functional improvement while facilitating periodontal treatment of grade III mobile teeth. It may represent a minimally invasive adjunct for selected patients seeking rapid aesthetic improvement and a time- and cost-efficient treatment option.
OBJECTIVES: Diet-related inflammatory processes have been implicated in the development of oral and periodontal diseases; however, data in pediatric populations remain limited. The Children's Dietary Inflammatory Index (C-DII) is a validated tool designed to assess the inflammatory potential of diet in children. This cross-sectional study aimed to evaluate the association between dietary inflammatory potential and oral-periodontal health parameters in children. MATERIALS AND METHODS: A total of 300 systemically healthy children aged 6-14 years were included. Sociodemographic characteristics and oral hygiene habits were recorded. Clinical examinations assessed DMFT/dmft, Plaque Index (PI), Gingival Index (GI), and Bleeding on Probing (BOP). Dietary intake was evaluated using three-day dietary records, and C-DII scores were calculated after energy standardization per 1000 kcal. Statistical analyses were performed using Jamovi (version 2.3.28), with significance set at p < 0.05. RESULTS: C-DII scores showed a significant negative correlation with DMFT (p = 0.035) and a positive correlation with PI (p = 0.030). Quartile comparisons demonstrated significant differences in PI (p = 0.007), GI (p = 0.02), and BOP (p = 0.034) among children aged 6-10 years. In the 11-14-year group, GI (p = 0.002) and BOP (p = 0.01) values differed significantly across C-DII quartiles. CONCLUSIONS: Higher dietary inflammatory potential was associated with less favorable periodontal parameters in children. These findings suggest that proinflammatory dietary patterns may be linked to early periodontal changes. CLINICAL RELEVANCE: Assessment of dietary inflammatory potential may help identify children at increased periodontal risk and support preventive nutritional strategies in pediatric dental care.
Medicina (Kaunas, Lithuania)Mehmet Durdu, Derya Gursel Surmelioglu, Gorkem Kervancioglu, Merve Yilmaz, Zeyneb Merve Özdemir, Hasan Ulusal
Background and Objectives: Smoking is known to modulate the periodontal inflammatory response, and dental bleaching agents can transiently alter local and systemic cytokine levels. The aim of this study was to evaluate cytokine levels in both saliva and gingival crevicular fluid (GCF) in non-smoking and ex-smoking patients, before and after in-office dental bleaching performed using chemically activated or diode-laser-activated protocols. Materials and Methods: This prospective, longitudinal, split-mouth clinical study included 40 participants allocated to two smoking-status groups (non-smokers and ex-smokers, cessation ≥ 5 years). For each participant, one maxillary hemi-arch received chemically activated bleaching and the contralateral side received diode-laser-activated bleaching, applied in two sessions one week apart. Plaque index (PI), gingival index (GI), and bleeding index (BI) were recorded, and IL-6 and TNF-α levels were measured in saliva and GCF using ELISA at baseline, after each session, and two weeks after treatment. Results: A non-significant increase was observed in GI and BI after two weeks compared with baseline (p > 0.05), while a significant decrease was observed in PI in the ex-smoker group (p < 0.05). A transient increase in TNF-α and IL-6 levels was observed in saliva and GCF samples following bleaching, and TNF-α/IL-6 levels were consistently lower in the ex-smoker group across all measurements. Conclusions: Bleaching was associated with a temporary alteration of periodontal indices and cytokine levels irrespective of smoking history. Smoking history was independently associated with lower cytokine levels, regardless of bleaching application, supporting the relevance of considering smoking history when interpreting the inflammatory impact of bleaching activation methods.
BMC oral healthBaocheng Yao, Shiyu Qiu, Chengyi Wang, Qiao Ling, Ning Ma
OBJECTIVE: To evaluate the clinical and radiographic outcomes of second molars (M2s) affected by external root resorption (ERR) following impacted third molar (M3) removal, and to assess the influence of adjunctive guided bone regeneration (GBR). METHODS: This retrospective cohort study included patients presenting with ERR of M2s associated with impacted M3s who underwent M3 extraction with or without concurrent GBR. Cone-beam computed tomography (CBCT) was used to assess ERR progression and distal alveolar bone levels before surgery and at least 6 months postoperatively. Pulp sensibility was also evaluated. Changes in distal bone height were compared between groups. Generalized estimating equations (GEE) were used to evaluate the association between treatment modality and bone gain while adjusting for baseline defect severity and potential confounders. Interaction analysis was performed to assess whether the effect of GBR varied according to baseline defect severity. RESULTS: The Wilcoxon signed-rank test revealed no significant pre- to post-treatment change in root length among teeth with root length alteration (Z = 0.110, 95% CI - 0.185 to 0.380, P = 0.457), nor in the vertical dimension of the defect among teeth without root length alteration (Z = 0.033, 95% CI - 0.248 to 0.283, P = 0.785), supporting the radiographic stability of the resorptive defect following M3 removal. Regarding pulpal status, excluding one tooth that had undergone preoperative root canal treatment, all remaining teeth (64/64, 100%) maintained positive pulp sensibility at the final follow-up, as assessed by cold testing. The between-group difference was 2.03 mm (Hodges-Lehmann estimate, 95% CI, 0.56-3.82 mm), with significantly greater bone gain in the GBR group (6.32 ± 2.67 mm) compared with the Extraction-Only group (4.08 ± 3.50 mm), P = 0.007. After adjustment for baseline defect severity and other covariates, treatment modality remained a significant predictor of distal bone gain in the GEE model with exchangeable correlation structure (QIC = 1123.229), with GBR associated with greater bone gain compared with extraction alone (β = 2.244, 95% CI, 0.612-3.875, P = 0.007). To assess the robustness of this estimate to potential unmeasured confounding, the E-value was calculated: the E-value for the point estimate was 3.25, while the E-value for the lower bound of the 95% CI was 1.68. The interaction term between treatment modality and baseline distal bone height was not statistically significant (β = 0.008, 95% CI (-0.229, 0.245), P = 0.945), suggesting that the effect of GBR on distal bone gain did not vary significantly across the range of baseline defect severities observed. CONCLUSION: Among M2s with available follow-up, no radiographic progression of ERR was detected following M3 removal. The findings do not support routine prophylactic root canal treatment in asymptomatic M2s with preserved pulp sensibility. However, spontaneous periodontal recovery of ERR-associated distal defects appeared incomplete. Adjunctive GBR was associated with enhanced distal bone regeneration. CLINICAL RELEVANCE: External root resorption of second molars associated with impacted third molars appears to stabilize after extraction of the third molar, with preservation of pulp sensibility. However, the distal bone defect frequently persists radiographically without full resolution. Guided bone regeneration was associated with greater radiographic bone gain in affected second molars.
Clinical oral investigationsPasquale Santamaria, Francesco Fanelli, Rohan Mangalpara, Thamara Kumar, Sarah Van Der Lith, Giuseppe Troiano, Luigi Nibali
AIM: To evaluate patterns of interdental brush (IB) use across different stages and grades of periodontitis and to examine associations with socioeconomic, demographic, and behavioural factors. METHODS: This cross-sectional study included 375 adults referred for secondary periodontal care at Guy's and St Thomas' Hospital (London, UK). Periodontal status was classified using the 2018 periodontal classification. Participants completed a 10-item questionnaire on IB use and perceived barriers. Area-level household income was estimated using postcode-linked national statistics. Associations were analysed using chi-squared tests and multivariable logistic and ordinal regression models. RESULTS: Daily IB use (63.0%) was significantly associated with periodontitis stage (p<0.001) but not grade. Patients with Stage III-IV periodontitis had higher odds of daily IB use (OR=3.11, 95% CI 1.88-5.15, p<.001). Higher income and older age were positively associated with IB use, while current smoking was a strong negative predictor (OR=0.31, 95% CI 0.15-0.67). Common barriers included pain, discomfort, and cost. CONCLUSIONS: A distinct profile of periodontal patients who are less likely to use IBs regularly was characterised by early-stage disease, younger age, lower income, and current smoking status. Dissatisfaction driven by practical, financial, and environmental concerns highlights the need for tailored preventive advice and personalised interdental cleaning strategies to improve adherence.
International journal of oral implantology (Berlin, Germany)Margherita G Liguori, Franz J Strauss, Alessandro Crea, Daniel S Thoma, Leonardo Mancini, Enrico Marchetti
PURPOSE: To evaluate the medium-term clinical, radiographic and aesthetic outcomes of polished-collar implants placed with simultaneous horizontal guided bone regeneration and transmucosal healing after a minimum follow-up period of 3 years. MATERIALS AND METHODS: Patients treated with implant placement and simultaneous guided bone regeneration between January 2021 and November 2022 were screened. Inclusion criteria included placement of a polished-collar implant, horizontal guided bone regeneration and transmucosal healing. Baseline was defined as 7 to 14 days after delivery of the final prosthetic restoration and follow-up was performed after at least 3 years. The primary outcome was change in marginal bone level. Secondary outcomes included probing depth, bleeding on probing, plaque control record, keratinised tissue, midfacial recession and Pink Esthetic Score. Non-parametric tests were applied. RESULTS: Twenty patients (12 men, 8 women) were included, with a mean follow-up period of 42.0 ± 5.2 months. Mean marginal bone level was 1.06 ± 0.55 mm at baseline and 1.10 ± 0.52 mm at follow-up (change in marginal bone level -0.08 ± 1.02 mm). Fifty percent of implants showed no bone loss or slight gain, 45% 1 mm loss and 5% between 1.0 and 1.5 mm; no implants showed loss ≥ 1.5 mm. Probing depth, bleeding on probing, keratinised tissue and midfacial recession remained unchanged (P > 0.05), while plaque control record increased (P = 0.013). Pink Esthetic Score improved from 10.40 ± 1.79 to 11.90 ± 1.80 (P 0.001). Implant survival rate was 100%. Peri-implant health was observed in 85% of cases and mucositis in 15%, with no peri-implantitis. CONCLUSION: Simultaneous horizontal guided bone regeneration with transmucosal healing around polished-collar implants resulted in stable marginal bone levels and favourable clinical and aesthetic outcomes after 3 years of loading. CONFLICT-OF-INTEREST STATEMENT: The authors declare that there are no conflicts of interest relating to this study.
Frontiers in cellular and infection microbiologyRong Li, Fei Du, Junli He, Zhijuan Luo, Rongyu Yang, Jianguo Liu, Yanchun Wang, Cuiling Zhou, Min Huang, Liming He
The field of periodontology is undergoing a paradigm shift from traditional microbiology to systems biology, driven by advancements in multi-omics and single-cell technologies. Despite the rapid surge in publications, a Web of Science Core Collection (WoSCC)-based bibliometric and scientometric analysis mapping the evolutionary trajectory and emerging frontiers of these technologies in periodontal research remains needed. We performed a bibliometric and scientometric analysis of literature published from 2000 to 2025, with records from early 2026 used only as an exploratory frontier update, using the Web of Science Core Collection (WoSCC). Data visualization and network analysis were conducted using VOSviewer, CiteSpace, and the R-bibliometrix package. Additionally, Latent Dirichlet Allocation (LDA) topic modeling was employed to extract underlying research themes from unstructured text data. A total of 559 eligible publications were identified, showing a marked growth trend. China and the United States emerged as the dominant contributors. The evolutionary trajectory was delineated into three distinct phases: foundational exploration, multi-omics integration, and the single-cell resolution era. LDA modeling identified nine core topics, focusing on local host-microbiome interactions, systemic interconnections, and periodontal regeneration-related research. Keyword bursts highlighted "single-cell RNA sequencing (scRNA-seq)," "microenvironment," and "macrophage polarization" as active current frontiers. The field appears to be transitioning within the WoSCC-indexed literature from descriptive microbiome studies toward functional multi-omics and single-cell-resolution analysis, providing an exploratory knowledge-map-based reference for future precision diagnostics and regenerative research in periodontology.
Clinical oral investigationsAli Batuhan Bayırlı, Sevda Kurt Bayrakdar, Mehmetcan Uytun, Muhammet Burak Yavuz, Gurbet Alev Öztaş Şahiner, Alican Kuran, Özer Çelik, İbrahim Şevki Bayrakdar,…
OBJECTIVES: To evaluate the agreement between radiographic bone level measurements generated by a deep learning model and those derived from expert periodontist annotations on panoramic radiographs. MATERIALS AND METHODS: In this retrospective single-center radiographic study, periodontal bone loss was segmented by a YOLOv8x-based deep learning model and independently manually segmented by four periodontists. The artificial intelligence (AI)- and periodontist-generated segmentations were converted into point clouds for radiographic bone level measurements, and the overall agreement and that for six tooth regions was assessed using Bland-Altman analysis, with additional error and association metrics calculated. RESULTS: Across 2,037 teeth, the mean absolute error (MAE) between the AI-derived and periodontist consensus measurements was 5.08% points of root length. The measurements revealed a strong association (Pearson's r = 0.80, Spearman's ρ = 0.80). Agreement was highest in the upper anterior region (MAE = 4.42; R² = 0.75; r = 0.90) and lowest in the lower molar region (MAE = 7.66; R² = 0.26; r = 0.65). Bland-Altman analysis revealed a mean bias of 1.61% points, with wide limits of agreement across all regions. CONCLUSION: AI-derived measurements were strongly associated periodontist consensus measurements, with only a small systematic difference. However, the limits of agreement, particularly in the molar regions, were too wide to support the use of AI-derived measurements for individual tooth-level assessment without clinician oversight. CLINICAL RELEVANCE: The evaluated deep learning system may facilitate radiographic bone level assessment on panoramic radiographs but currently requires clinician oversight, especially in the molar regions.
Scientific reportsSara I Eid, Zahraa M Ahmed, Olfat G Shaker, Naglaa El-Wakeel
This study investigated gingival crevicular fluid (GCF) levels of prolactin hormone (PRL) in stage III periodontitis (P) patients with type 2 diabetes mellitus (T2DM) before and 3 months after non-surgical periodontal treatment (NSPT). In this case-controlled trial, 80 subjects were divided into 4 groups: group I: healthy control; Group II: systemically healthy stage III P patients; Group III: stage III P patients with controlled T2DM; Group IV: stage III P patients with uncontrolled T2DM. All P patients received NSPT. Three months after NSPT, PRL levels were assessed using enzyme-linked immunosorbent assay (ELISA) as a primary outcome. Secondary outcomes were: pocket depth, clinical attachment loss, and gingival index measurements. At baseline, group IV showed the highest mean PRL levels, followed by Groups III and II, whereas group I showed the least mean values (p < 0.001). After 3 months, NSPT significantly improved all tested periodontal parameters except the gingival index (p < 0.001). NSPT reduced the PRL GCF levels in all P groups, with groups II and III showing significantly lower mean PRL levels than group IV (p < 0.001). PRL levels in groups II and III were significantly higher than those observed in group I at baseline. Elevated GCF levels of PRL seem to be linked to the disease process of P associated with T2DM. NSPT significantly reduced these levels. PRL could represent a valuable biomarker for periodontal inflammation associated with T2DM.Trial registration: Clinicaltrials.gov. Identifier NCT06941246.on 23 April 2025.
Journal of periodontologyGustavo Avila-Ortiz, Sandra Stuhr, Miha Pirc, Emilio Couso-Queiruga, Franz J Strauss, Leandro Chambrone, Daniel Thoma, Ronald Jung
BACKGROUND: To analyze the effect of autogenous soft tissue grafts or substitute scaffolds on the outcomes of soft tissue augmentation (STA) performed in the context of implant therapy. METHODS: The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42024611477). Articles reporting the findings of randomized controlled trials (RCTs) that met the eligibility criteria were identified through a literature search. Following final article selection, data were extracted, including relevant clinician- and patient-reported outcomes and experiences (CROs and PROs/PREs). Risk of bias assessment was performed using the RoB2 tool. Network meta-analyses (NMA) were performed when feasible to compare the performance of different techniques. RESULTS: Forty RCTs were selected. Risk of bias assessment revealed that the methodological quality of the selected studies was generally high. Although CROs and PROs/PREs were inconsistently reported, it was possible to conduct five sets of NMA regarding mucosal thickness (MT) and keratinized mucosa width (KMW) changes. These analyses revealed that the use of an autogenous connective tissue graft in a bilaminar approach is the best treatment for MT augmentation regardless of the timing, while the application of a free mucosal graft over a partial-thickness vascular bed is generally the best to obtain KMW gains. Alternatively, other treatment options involving the use of specific types of substitute scaffolds were considered as viable alternatives given their similar performance, particularly in terms of MT gain. Additionally, it was found that, compared with autogenous soft tissue grafts, the use of substitute scaffolds is consistently associated with lower postoperative discomfort. CONCLUSIONS: Autogenous soft tissue grafts should be considered as the primary choice to achieve predictable MT and KMW gains in the context of implant therapy. The use of specific substitute scaffolds may render similar STA outcomes with lower postoperative morbidity.
Journal of periodontologyShayan Barootchi, Lorenzo Tavelli, Hamoun Sabri, William V Giannobile, Darnell Kaigler
BACKGROUND: Regenerative therapies have become central to periodontics and implant dentistry and are becoming more widely applied to reconstruct supporting bone and associated soft tissues. With increased recognition of the benefits of using biomimetic materials as scaffolds in contemporary regenerative technologies, the field is seeking to develop and optimize predictable, personalized regenerative strategies for hard and soft tissue reconstruction. This review aims to: (1) evaluate the current evidence on these approaches in the context of hard and soft tissue deficiencies around teeth and implants, (2) assess the clinical utility of these approaches, and (3) propose a framework for integrating these regenerative technologies into daily clinical practice. METHODS: Applicable research on the treatment of hard and /or soft tissue deficiencies around teeth and dental implants were conducted. For soft tissue regeneration, data from eligible randomized clinical trials (RCTs) reporting the outcomes of gingival (for teeth, as gingival thickness [GT]) and mucosal thickness (implants, MT) with a bilaminar approach were analyzed using a mixed models network meta-analysis. A meta-analysis could not be performed to evaluate personalized, emerging technologies for bone regeneration given the lack of comparable clinical studies and as such, an alternative evaluative approach was undertaken and involved a qualitative assessment of the relevant literature highlighting innovations in these emerging modalities. RESULTS: A total of 78 RCTs were included for a quantitative analysis on soft tissue regeneration. Fifty-four reported the outcomes of GT with a bilaminar approach (a total of 2952 teeth), and 24 assessed MT around implants (851 implants). The analysis of GT for natural dentition showed that bilaminar approaches with any of the explored soft tissue grafts (connective tissue graft (CTG), human acellular dermal matrix (hADM), first generation collagen matrix (CMX), "volume stable" collagen matrix (VCMX) yield a statistically significant increase in GT (compared with untreated sites), with the highest estimate for CTG, followed by VCMX, hADM, pADM, and CMX. Similarly, the analysis of MT around implants also showed a significant increase for all the investigated treatment groups, compared with untreated sites. No other significant differences were noted among the other treatment groups of (VCMX, hADM, and pADM). For the qualitative assessment of emerging technologies for bone regeneration, early investigational studies have been conducted evaluating the use of computer aided personalized scaffold design and manufacturing, stem cell transplantation, stem cell secretome delivery, and artificial intelligence. To date, there are limited controlled studies evaluating these approaches but the results of studies which have been conducted demonstrate safety, efficacy, and favorable patient-reported outcomes. Clinical translation of these emerging, personalized technologies for hard tissue regeneration will largely depend upon feasibility and cost effectiveness. CONCLUSIONS: For the treatment of dento-alveolar deficiencies within the hard or soft tissue structures around teeth and implants, we found that autogenous soft tissue grafts as well as soft tissue grafting substitutes are generally effective to yield a significant increase in the soft tissue thickness of the treated sites. In the regeneration of hard tissue, emerging, personalized strategies have demonstrated promising early outcomes, yet additional longitudinal, controlled studies are required before these modalities can be considered for widespread clinical adoption. PLAIN LANGUAGE SUMMARY: Dentists and researchers are looking to find new ways to help the gums and bone around teeth and dental implants heal and grow back. In this review, we looked at 78 studies that tested different methods for improving gum tissue thickness as well as rebuilding the bone that supports teeth and implants. We found that using a patient's own gum tissue is still the most effective way to thicken and strengthen the gums. However, newer materials made from collagen or donated tissue can work almost as well and are easier for patients because they do not require tissue to be taken from the mouth. Around dental implants, all of these options helped increase gum tissue thickness, which may lower the risk of future disease and improve the look and long-term success of treatment. For rebuilding bone, early research on stem cells, 3D-printed materials, and products that help the body to heal on its own looks very promising, but larger studies are needed to confirm the results. Overall, this research shows that regenerative dentistry is moving toward more comfortable, less invasive, and more personalized treatments that can improve healing, appearance, and long-term stability.
Journal of periodontologyMariano Sanz, Sašo Ivanovski, José Nart, Frank Schwarz, Hom-Lay Wang, Tara L Aghaloo, Bilal Al-Nawas, Gustavo Avila-Ortiz, Shayan Barootchi, Juan Blanco, Gonza…
BACKGROUND: The objectives of this Workshop were to evaluate the efficacy of scaffolding technologies for horizontal and vertical ridge augmentation; to evaluate the efficacy of substitute scaffolds for soft tissue augmentation in the context of implant therapy; to evaluate the efficacy of cells and/or biologics combined with scaffolds for alveolar bone regeneration; to evaluate the efficacy of cells and/or biologics combined with scaffolds for soft tissue regeneration in the context of implant therapy; and to evaluate emerging technologies and personalized strategies for improving hard and/or soft tissue defects around natural teeth and dental implants. METHODS: The Workshop discussions were informed by five specifically commissioned systematic reviews from the following three Working Groups: Working Group 1 - Use of scaffolds for bone and soft tissue regeneration; Working Group 2 - Use of cells and/or biologics combined with scaffolds for hard and soft tissue regeneration; and Working Group 3 - Current, emerging, and personalized approaches for periodontal and peri-implant tissue regeneration. The Workshop participants were informed by the compiled evidence from the five systematic reviews within each Working Group to address pertinent issues to inform clinical practice, research, and the public community. RESULTS: The consensus among the Workshop group participants was that cellular therapies and biologics, alone and in combination with scaffolding technologies, offer strong potential in regenerating tissues around teeth and dental implants. There was variability in treatment outcomes depending on the overall evidence and the efficacy of these technologies, as well as on the specific defects and patient-based constraints. The consensus report detailed the results and implications of the findings, demonstrating the value of these technologies in improving clinical and patient-reported outcomes. CONCLUSIONS: Current regenerative approaches lead to long-term stable outcomes at natural teeth as well as dental implant sites; novel technologies can benefit patients by enhancing longer-term stability of teeth and implants to promote the health of the oral cavity and dentition; and artificial intelligence-enabled modeling can contribute to the identification of relevant features at the individual (as opposed to population) level, empowering patients to be active participants in their journeys and improving science-to-public communication.
Journal of periodontologyEduardo Montero, Zhaozhao Chen, Nerea Sánchez, Javier Sanz Esporrin, Hom-Lay Wang, George A Mandelaris
BACKGROUND: The aim of this systematic review is to evaluate the efficacy of cell-based therapies and biologically enhanced scaffolds for peri-implant soft tissue regeneration, including the increase in soft tissue thickness (STT) and/or keratinized mucosa (KM) augmentation. METHODS: A systematic literature search was conducted in Ovid MEDLINE, EMBASE, and Dentistry and Oral Sciences Source until August 2025. A focused question was developed: "In patients with soft tissue defects requiring soft tissue augmentation procedures prior to, at the time of implant placement or after it, what is the efficacy of combining cell therapy and/or biological treatments with a soft tissue scaffold compared to the use a soft tissue scaffold without cells and/or biologics, or no scaffold, on the increase of STT and/or KM in clinical trials or prospective case series?". Post-operative morbidity, interproximal bone level changes, clinical peri-implant outcomes or patient-reported outcome measures (PROMs) were collected. Risk of bias was assessed using RoB 2.0, ROBINS-I and the National Institutes of Health (NIH) Study Quality Assessment Tool. RESULTS: Ten publications were included (six randomized clinical trials [RCTs] and four prospective case series). The use of free gingival grafts (FGGs) lead to significantly greater KM augmentation when compared with platelet-rich fibrin (PRF) membranes (weighted mean difference [WMD] = -2.0; 95% confidence interval [CI]: -3.3, -0.8; p < 0.001) although PRF membranes significantly increased the amount of KM when compared to no scaffold/graft (n = 2; WMD = 1.1 mm; 95% CI: 0.2, 2.1; p = 0.017) and seem to increase also STT. Available data on other biologics (e.g., recombinant human platelet-derived growth factor BB [rhPDGF-BB]) are scarce. No studies evaluating cell therapies were identified. CONCLUSIONS: PRF membranes are effective in increasing the KM and STT around dental implants, even if KM augmentation by means of autogenous grafts lead to superior outcomes. There is a lack of evidence on cell-based therapies or other biologics for their use in soft tissue regeneration around dental implants.
Journal of applied oral science : revista FOBPavitra Jayakumar, Sharmistha Vijay, Debopriya Chatterjee, Setu Mathur
AIM: The intricate architecture of multirooted teeth challenges access to the furcation for treatment. This study aimed to assess the clinical and radiographic efficacy of oxygen-releasing oral gel and 0.8% hyaluronic acid gel along with hydroxyapatite bone graft to treat Class II furcation defects. METHODOLOGY: Overall, 45 (one site per participant, aged from 20 to 60 years) mandibular molars with periodontitis (stage II and stage III, grade A and B) and class II buccal furcation defects were treated in this study. Selected sites were randomly divided into three groups. In group 1, placebo gel was placed after open flap debridement (OFD), in group 2- 0.8% hyaluronic acid gel + hydroxyapatite bone graft was placed after OFD, and, in group 3, oxygen-releasing oral gel + hydroxyapatite bone graft was placed after furcation defect OFD. Clinical parameters such as gingival index, plaque index, relative vertical clinical attachment level, relative horizontal clinical attachment level, and probing pocket depth were recorded at baseline and six months later. Radiographic measurements-intra bony defect & % bone fill-were measured and calculated by cone beam computed tomography. Results: The mean reduction in intra bony defect was highest in Group 3 (1.433±0.594), followed by Groups 2 (1.000 ± 0.000) and 1 (0.700±0.414). Group 1 showed the lowest mean bone fill (34.69%±12.14), which was significantly lower than in Groups 2 (46.87%±4.71) and 3 (50.93%±4.62), with p-values of (p<0.001) in both comparisons. CONCLUSION: Within the limitations of this study, its results imply that oxygen-releasing gel along with hydroxyapatite bone graft in surgical periodontal therapy to treat class II furcation defects has shown superior regenerative potential. Clinical Trial Register: CTRI/2025/02/081311.
Background and Objectives: Caries experience, plaque accumulation, gingival inflammation, and periodontal screening findings may coexist as manifestations of a shared oral-health burden. We examined whether these routinely recorded indicators form distinct multivariable profiles or primarily represent ordered levels along a common burden continuum in children and adolescents. Materials and Methods: This secondary exploratory analysis included 638 participants from a multicenter cross-sectional clinical database: 407 aged 6-12 years and 231 aged 13-19 years. Permanent-dentition Decayed, Missing, and Filled Teeth score, Plaque Index, Gingival Index, and Community Periodontal Index were standardized and analyzed separately by age stratum. Unsupervised K-means clustering compared solutions containing two to five groups to summarize participant-level patterns without imposing predefined clinical categories. Hierarchical Ward classification assessed algorithmic concordance; principal component analysis and a composite standardized burden score assessed dimensionality. Sensitivity analyses excluded the periodontal index or treated it as ordinal with Gower-distance partitioning around medoids, and 1000 repeated 80% subsamples assessed sampling stability using the adjusted Rand index. Results: A single principal component explained 91.0% of variance at 6-12 years and 91.8% at 13-19 years, with all four indicators loading strongly on the same dimension. Ordered cluster membership correlated closely with the composite burden score (Spearman ρ = 0.942 and 0.939; both p < 0.001). The retained low-, intermediate-, and high-burden groupings were highly consistent when the periodontal index was excluded or treated as ordinal and under repeated subsampling. In adolescents, a two-group alternative preserved the low- and high-burden extremes while dividing the intermediate group, indicating that the number of groups changes descriptive granularity rather than revealing a separate phenotype. Conclusions: The principal new finding is that four commonly used oral-health indicators converge on one dominant participant-level burden dimension rather than defining distinct clinical phenotypes. This supports an integrated epidemiological description of cumulative oral-health burden while cautioning against interpreting data-driven groups as diagnostic or treatment categories. The numerical group distributions are sample-specific and require external and longitudinal validation before being transferred to other populations or clinical decision-making.
Annals of work exposures and healthBrie Hawley Blackley, Jennifer Franko, Jean Cox-Ganser, Caroline P Groth, Tammy Chipps, Scott Young, Fotinos Panagakos, Aidan Davis, Mohammed Abbas Virji
Routine dental procedures can expose dental providers to aerosols associated with potential acute or chronic respiratory health effects. High-volume suction (HVS) systems can potentially mitigate aerosols generated during routine dental procedures; however, few studies to date have evaluated HVS systems' aerosol exposure mitigation efficiency during procedures with patients. This study reports the aerosol mitigation efficiency of 5 commercially available HVS systems [standard high-volume evacuation (HVE), 3 intraoral HVS systems (Systems A-C), and 1 modified HVE (System D)] when used during dental procedures utilizing a high-speed handpiece (ie crown preparations) or ultrasonic scaler. Direct-reading instruments measured aerosol size distribution, aerosol number concentrations (thoracic [PM10]), and aerosol mass concentrations (respirable [PM4] and thoracic [PM10]) while using each of the 5 HVS systems during high-speed handpiece (n = 26) or ultrasonic scaling procedures (n = 25). Background and procedure aerosol measurements were collected in the (i) operatory near the dentist and (ii) hallway outside the operatory. Factors including (i) HVS flow rate, (ii) procedure duration, (iii) crown preparation tooth location, and (iv) ultrasonic scaler type and mouth quadrant(s) treated were recorded. Ratios of procedure-to-background aerosol concentrations were calculated, and multiple linear regression models were fit accounting for covariates to determine if an HVS system reduced mean aerosol number concentrations to levels no different from background concentrations (ratio 95% lower confidence limit ≤1). The percentage frequency of how often PM4 or PM10 mass measurements were reduced to concentrations below average background concentrations was also calculated for each HVS system. Standard HVE, System A, and System D reduced aerosol number concentrations to background concentrations during both procedure types. Additionally, standard HVE reduced aerosol mass concentrations to background most often during either procedure type. However, none of the 5 HVS systems fully reduced aerosol mass to background levels during high-speed handpiece procedures, despite all HVS flow rates being greater than a flow rate previously reported as sufficient for aerosol capture during high-speed handpiece procedures. Further, the effect of HVS flow rate on PM10 number ratios during either procedure type varied across HVS systems. Future studies are needed to identify factors that can improve HVS systems' aerosol mitigation efficiency, including HVS flow rate ranges needed to sufficiently mitigate aerosol exposures during common patient procedures.
International journal of implant dentistryMohammed Mashhout Anas, Amr Mostafa Gabr, Yasser El-Makaky, Mohamed H Helal
BACKGROUND: Horizontal ridge deficiencies in the anterior maxilla frequently compromise ideal implant positioning and esthetic outcomes. This randomized controlled clinical trial evaluated the clinical performance of customized CAD/CAM zirconia membranes compared with conventional collagen membranes for guided bone regeneration (GBR) performed simultaneously with early implant placement. METHODS: Twenty systemically healthy patients requiring single-tooth replacement in the anterior maxilla underwent early implant placement (4-8 weeks after tooth extraction) combined with simultaneous contour augmentation using a composite graft of autogenous bone and deproteinized bovine bone mineral (1:1). Participants were randomly assigned to receive either a customized CAD/CAM zirconia membrane (test group, n = 10) or a double-layer collagen membrane (control group, n = 10). The primary outcome was horizontal bone gain (HBG) at 6 months, assessed by standardized CBCT superimposition. Secondary outcomes included soft tissue healing evaluated using the Modified Wound Healing Index (MWHI), membrane exposure (wound dehiscence), and patient-reported postoperative pain assessed using a visual analogue scale (VAS). RESULTS: All implants survived during the 6-month follow-up period (100% survival rate). Mean HBG was 6.18 ± 0.60 mm in the test group and 5.85 ± 0.37 mm in the control group, with no statistically significant difference between groups (p = 0.158). Membrane exposure occurred in all patients receiving customized zirconia membranes (10/10, 100%), whereas no membrane exposure was observed in the collagen membrane group (0/10, 0%). Despite the higher exposure rate, graft stability and horizontal bone regeneration were not adversely affected. Soft tissue healing was significantly more favorable in the collagen membrane group. Postoperative pain decreased significantly over time in both groups, with no significant intergroup differences. CONCLUSIONS: Customized CAD/CAM zirconia membranes achieved horizontal bone augmentation comparable to conventional collagen membranes when used for simultaneous GBR during early implant placement. Although customized zirconia membranes were associated with a substantially higher membrane exposure rate, regenerative outcomes and implant survival remained unaffected, indicating that customized rigid barriers may represent a predictable alternative for horizontal ridge augmentation while offering potential advantages in surgical precision and procedural efficiency. TRIAL REGISTRATION: ClinicalTrials.gov NCT06987149.
Brazilian oral researchClaudio Mendes Pannuti, Thaís Emilia da Silva, Sabrina Garcia de Aquino, João Paulo Steffens, Gustavo Giacomelli Nascimento, Fabio Renato Manzolli Leite
Cigarette smoking is a well-established risk factor for periodontitis, contributing to increased clinical attachment loss (CAL), alveolar bone loss, and impaired treatment response. As electronic cigarettes (ECs) are increasingly used as alternatives to combustible tobacco, questions remain regarding their adverse effects on oral and periodontal health. This critical review integrated evidence from experimental, cross-sectional, longitudinal and interventional studies to evaluate the relationship between EC use and periodontal health. Experimental and molecular studies supported biological plausibility for periodontal harm, indicating that aerosols can induce oxidative stress, upregulate pro-inflammatory mediators, and disrupt host-microbial interactions. Cross-sectional studies generally reported poorer periodontal conditions among EC users compared with never-smokers, including higher plaque index and periodontal probing depth, although results for CAL and alveolar bone loss were inconsistent. Comparisons between EC users and cigarette smokers often showed more favorable clinical parameters among EC users. Longitudinal evidence continued to be limited. The only prospective cohort study reported higher CAL among EC users than never-smokers and observed an increase in CAL over time exclusively in EC users. Interventional studies assessing response to periodontal therapy have yielded inconsistent results, with some suggesting a poorer treatment response among EC users and others finding no significant differences. Overall, there were Well-designed longitudinal studies with clearly defined exposure groups, standardized periodontal outcomes, and longer follow-up are needed to clarify whether EC use independently contributes to periodontal deterioration.
BMC oral healthRui Dong, Han Wu, Feifei Jin, Qiqi Yang, Tongzhuo Chu, Hui Song
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the second most prevalent chronic pediatric condition worldwide. Its core ADHD symptoms-inattention, hyperactivity, and impulsivity-impair oral hygiene behaviors, and first-line medications such as methylphenidate may further increase oral disease risk. However, systematic epidemiological data on oral health status of children with ADHD remain limited in China. This study aimed to investigate oral health status of children with ADHD and identify factors associated with adverse oral health outcomes in this population. METHODS: This case-control study included 130 children with ADHD and 143 age-matched healthy controls (6-12 years old) recruited from Dezhou Maternal and Child Health Hospital, Shandong Province, China, between July and December 2025. Oral examinations assessed dental caries (using the DMFT index for permanent teeth and dmft index for primary teeth, collectively reflecting the mixed-dentition caries burden), caries activity (Cariostat), periodontal status (Plaque Index [PI], Modified Gingival Index [MGI]), malocclusion, and dental trauma. Parent-reported questionnaires collected data on oral health behaviors, socioeconomic characteristics, and medication use. Between-group differences were analyzed using the Mann-Whitney U test, chi-square test, and Fisher exact test. Multivariate logistic regression with backward likelihood ratio selection was used to examine factors associated with adverse oral outcomes after adjusting for confounders. The English versions of the questionnaires are provided in Supplementary Files 1 and 2. RESULTS: The ADHD group had significantly higher overall dental caries prevalence (80.77% vs. 52.45%, P < 0.001), higher median DMFT+dmft scores (3 vs. 1, P < 0.001), higher plaque index (PI) scores (2 vs. 1, P < 0.001), higher modified gingival index (MGI) scores (2 vs. 1, P < 0.001), and higher Cariostat values (P < 0.0001) than the control group. In contrast, the fissure sealant rate was significantly lower in the ADHD group (6.15% vs. 47.29%, P < 0.001). Multivariate analysis showed that methylphenidate use (adjusted odds ratios [aOR] = 39.65, 95% CI: 15.79-271, P < 0.001) and frequent candy consumption (aOR = 84.54, 95% CI: 12.2-584, P < 0.001) were associated with higher odds of dental caries in the adjusted model. In contrast, a higher parental education level (college degree or above) was associated with lower odds of dental caries (aOR = 0.10, 95% CI: 0.014-0.684, P = 0.019). Perfunctory toothbrushing (aOR = 8.78, 95% CI: 3.12-24.71, P < 0.001) was associated with higher odds of poor oral hygiene (PI ≥ 2), whereas higher household income (aOR = 0.29, 95% CI: 0.12-0.74, P = 0.009) and twice-daily toothbrushing (aOR = 0.14, 95% CI: 0.05-0.43, P = 0.001) were associated with lower odds of poor oral hygiene (PI ≥ 2). For gingivitis (MGI ≥ 2), higher household income (aOR = 0.33, 95% CI: 0.13-0.84, P = 0.019) and parental supervision of toothbrushing (aOR = 0.11, 95% CI: 0.04-0.31, P < 0.001) were associated with lower odds of gingivitis, whereas longer disease duration (aOR = 11.30, 95% CI: 3.78-33.75, P < 0.001) was associated with higher odds of gingivitis. Notably, the wide confidence intervals for these adjusted odds ratios indicate limited precision for quantifying exact effect magnitudes, and the case-control design precludes causal inference; all reported associations should therefore be interpreted with caution. Children with ADHD in this cohort exhibited significantly poorer oral health than healthy controls, characterized by higher rates of dental caries, poorer oral hygiene, and more severe gingival inflammation. These adverse oral health outcomes were associated with ineffective oral hygiene practices, frequent high-sugar dietary habits, ADHD-related neurobehavioral characteristics, and socioeconomic factors. Comprehensive oral health interventions integrating preventive clinical care, behavioral support, family involvement, and socioeconomic assistance are urgently needed for this population.
BACKGROUND: Preterm prelabor rupture of membranes (PPROM) is a multifactorial obstetric complication that contributes significantly to neonatal morbidity and mortality. Recent evidence suggests that systemic inflammation and periodontal health are critical determinants in the etiology of PPROM. However, conventional predictive methods often fail to integrate multidomain data for early risk assessment. This study aimed to develop an ANN-based model to classify PPROM status by integrating hematological inflammatory markers, periodontal indices, and maternal behavioral factors. METHODS: A multilayer perceptron (MLP)-based artificial neural network (ANN) model was developed using data from 149 women (70 PPROM, 79 controls) and 24 input variables. Hematological parameters were derived from routine clinical blood tests obtained during late pregnancy or at hospital admission prior to delivery, while oral and periodontal indices were assessed within 24 h postpartum. Discriminative performance was evaluated using receiver operating characteristic (ROC) analysis (AUC, sensitivity, specificity), and mean squared error (MSE) was used as the training loss function. RESULTS: The ANN model demonstrated high predictive performance with an MSE of 0.049, an R2 value of 0.82, and an average deviation rate of -0.003%. These results indicate strong internal accuracy and suggest potential for generalizability. The model successfully captured complex, nonlinear relationships among biological and behavioral variables influencing PPROM risk. CONCLUSIONS: This study presents an interdisciplinary ANN framework integrating hematological, periodontal, and behavioral variables for delivery-period PPROM classification. The findings established in this study are characterized as associative given the postpartum collection of periodontal data, necessitating future prospective validation for clinical translation.
BACKGROUND: Dementia is a major public health issue. Emerging evidence suggests that periodontal disease and dental calculus are associated with increased risk of dementia or may serve as potential risk indicators. The role of dental scaling in prevention remains unclear. This study aimed to investigate whether regular dental scaling is associated with dementia risk across age groups. METHODS: We conducted a nested case-control study using data from the Taiwan National Health Insurance Research Database between 2000 and 2019. Cases were individuals with a first-time diagnosis of dementia during the study period, and controls were age-, sex-, and residence-matched individuals without dementia. Conditional logistic regression models were used to evaluate the association between dental scaling and the risk of dementia. A two-sided p-value < 0.05 was considered statistically significant. RESULTS: The study included 162,038 participants. After adjusting for potential confounders, dental scaling was associated with modestly lower odds of dementia (OR 0.95, 95% CI 0.92-0.98; p = 0.004). Subgroup analyses suggested that the association was more evident among individuals aged 50-64 years, females, and residents of the central and eastern regions. CONCLUSIONS: Regular dental scaling may be associated with a modest reduction in the risk of dementia, particularly in individuals aged 50-64 years and in females. Although the association was statistically significant, the observed effect size was modest and should be interpreted cautiously. Further prospective studies are needed to confirm these findings and investigate the underlying mechanisms.
OBJECTIVES: Heavy cigarette smoking is a risk factor for Grade C periodontitis according to the 2018 World Workshop classification. This study evaluated the diagnostic accuracy and smoking-driven modulation of salivary HIF-1α, MMP-8, and MMP-9 across four phenotypically defined cohorts: periodontally healthy non-smokers, Stage III Grade B non-smokers, periodontally healthy heavy smokers, and Stage III Grade C heavy smokers. MATERIALS AND METHODS: Eighty systemically healthy adults (n = 20/group) underwent full-mouth periodontal examination, including probing depth (PD), bleeding on probing (BOP%), clinical attachment level (CAL), plaque index (PI), and radiographic bone loss (RBL). Unstimulated whole saliva was analyzed for HIF-1α, MMP-8, and MMP-9 by ELISA. Statistical analyses included Kruskal-Wallis with Dunn-Bonferroni post-hoc, log-transformed GLM adjusted for age, sex, and BMI, and ROC analysis with 2000-iteration bootstrap 95% CIs. A secondary ROC analysis addressed the smoker subgroup (Grade C(S) vs. Healthy(S), n = 40). RESULTS: MMP-8 achieved an AUC of 0.855 (95% CI: 0.756-0.934; sensitivity 82.5%, specificity 85.0%) for distinguishing periodontitis from healthy controls and retained robust accuracy in smokers (AUC = 0.831; sensitivity 75.0%, specificity 90.0%), significantly outperforming MMP-9 (AUC = 0.702; ΔAUC = 0.154, p = 0.005). HIF-1α showed no diagnostic value (AUC = 0.453) but was independently suppressed by smoking (β=-0.394, p = 0.007), consistent with chronic PHD2/PHD3-mediated hypoxia adaptation. Notably, BOP% was significantly higher in Grade B (NS) (44.6 ± 25.3%) than in Grade C (S) (30.9 ± 16.5%), consistent with tobacco-induced vascular suppression of gingival bleeding. The BOP% difference between Grade B (NS) and Grade C (S) did not reach statistical significance after Bonferroni correction (p = 0.593), consistent with the known vasoconstriction-mediated suppression of gingival bleeding in heavy smokers. CONCLUSIONS: Salivary MMP-8 demonstrated clinically meaningful diagnostic accuracy (AUC = 0.855) maintained in heavy smokers despite suppressed bleeding (AUC = 0.831). Paradoxical HIF-1α suppression by smoking, independent of periodontal status, positions this marker as a mechanistic indicator of tobacco-driven hypoxia adaptation rather than a periodontitis diagnostic tool. CLINICAL RELEVANCE: In Grade C periodontitis patients where tobacco suppresses gingival bleeding, salivary MMP-8 provides adjunctive diagnostic value unaffected by this masking effect (smoker subgroup AUC = 0.831), supporting its use as a point-of-care adjunct where conventional bleeding-based indices underestimate inflammatory burden. The HIF-1α suppression phenotype in healthy smokers represents a novel tobacco-host interaction target warranting further mechanistic investigation.
BACKGROUND: Conventional cigarette smoking is associated with peri-implant disease, but longitudinal evidence for electronic cigarette (e-cigarette) exposure is limited. We compared 12-month peri-implant clinical and radiographic trajectories between e-cigarette users and conventional cigarette smokers and assessed unequal current exposure duration. METHODS: This single-center retrospective study included 328 patients with 452 implants (e-cigarette [EC] group, 152 patients/206 implants; conventional cigarette [CS] group, 176/246). Modified plaque index (mPLI), probing depth (PD), modified sulcus bleeding index (mSBI), bleeding on probing (BOP), mucosal recession (MR), keratinized mucosa width (KMW), and marginal bone level (MBL) were recorded at loading, 6 months, and 12 months while implants remained in situ. Patient-clustered generalized estimating equations (GEE) assessed group, time, and group-by-time effects. PD and change in MBL (ΔMBL) were prioritized. A post hoc sensitivity model additionally adjusted for current exposure duration; product-specific intensity variables were examined within groups. RESULTS: Continuous outcomes were available for 452, 448, and 440 implants at loading, 6 months, and 12 months, respectively; all 12 removals were entered into failure analyses. Current exposure duration was shorter among e-cigarette users (median, 3.0 vs. 12.0 years). At 12 months, mean PD was 3.18 versus 3.72 mm, and mean ΔMBL was 0.68 versus 1.01 mm. After duration adjustment, conventional cigarette exposure remained associated with greater PD (difference, 0.42 mm; 95% confidence interval [CI], 0.25-0.59; interaction P = 0.003) and ΔMBL (0.26 mm; 95% CI, 0.15-0.37; interaction P = 0.015). The crude mucositis association attenuated after parsimonious adjustment (odds ratio [OR], 1.72; 95% CI, 1.02-2.90; P = 0.043; adjusted odds ratio [aOR], 1.64; 95% CI, 0.98-2.75; P = 0.060). Peri-implantitis and post-loading failure comparisons were not statistically significant. CONCLUSIONS: Conventional cigarette exposure was associated with larger 12-month peri-implant changes than e-cigarette exposure. Unequal exposure duration, unmeasured previous smoking, self-reported exposure, device heterogeneity, informative implant removal, and absence of a never-smoker group limit causal and absolute-risk interpretation.
Oral health & preventive dentistryNathan E Estrin, Paras Ahmad, Savannah Laurey, Nima Farshidfar, Richard J Miron
BACKGROUND: Periodontitis is a chronic multifactorial inflammatory condition resulting in the gradual breakdown of periodontal supporting structures. Although non-surgical periodontal therapy (NSPT) is the gold standard first therapeutic option, its effectiveness can be limited in moderate-to-severe cases, hence necessitating the application of adjunctive therapies. Platelet-rich fibrin (PRF) and enamel matrix derivative (EMD) are among the most extensively utilised regenerative biomaterials; nevertheless, direct comparative evidence related to their adjunctive advantage in NSPT is scarce. AIM: This split-mouth randomised clinical trial compared the clinical effectiveness of EMD versus PRF as adjunct biological modalities to scaling and root planing (SRP) in the non-surgical management of Stage II/III and Grade A/B periodontitis. METHODS AND MATERIALS: Fifteen participants meeting the eligibility criteria were included, with thirteen completing the trial. Each patient contributed two interproximal sites randomly allocated to either adjunctive EMD or PRF after full-mouth SRP. Before the placement of biomaterial, EMD sites were treated with ethylenediaminetetraacetic acid (EDTA), whereas PRF was prepared utilising the standard horizontal centrifugation approach. Periodontal probing depth (PD), gingival margin (GM) position, clinical attachment level (CAL), and bleeding on probing (BOP) were measured at baseline and 6-month follow-up. RESULTS: Both biomaterials yielded significant intra-group improvements. Mean PD scores were reduced by 1.1 ± 0.6 mm in the EMD group and 1.2 ± 0.7 mm in the PRF group. CAL gains were 1.1 ± 0.7 mm and 1.1 ± 0.8 mm for EMD and PRF, respectively. GM levels remained stable across groups, and BOP markedly decreased (EMD: 77% to 23%; PRF: 85% to 31%). Intergroup comparisons revealed no statistically significant differences for PD (p > 0.999), GM (P = 0.174), or CAL (P = 0.556). Moreover, frequency distribution analysis showed that 100% of deep sites (≥ 6 mm) in the EMD group and 90% in the PRF group were reduced to 6 mm at 6 months. CONCLUSION: Both EMD and PRF showed comparable clinical outcomes as adjunctive regenerative biomaterials in NSPT to manage moderate periodontal pockets. These outcomes support the versatility of clinicians in selecting either biological option based on practitioner and patient preference, availability, and cost, while opening avenues for future studies investigating their application in more complex periodontal cases.
Journal of visualized experiments : JoVEKaro Parsegian, Manti Lehn, Amy DeStaffany, Nikola Angelov
Video‑assisted instruction can enhance the teaching and learning of periodontal instrumentation when visualization and content quality support clear demonstration of technique. This study aimed to describe the development of high‑resolution instructional videos demonstrating armamentarium and techniques on a typodont with simulated calculus, and to evaluate perceived usefulness among predoctoral dental students. The institutional review board determined that the study was exempt. Instructional videos were recorded in 8K resolution and demonstrated instrument selection, ergonomics, adaptation, angulation, and activation of strokes on a typodont with transparent gingiva and simulated supra‑ and subgingival calculus deposits. Perceived usefulness was evaluated through a brief anonymous survey with optional open-ended feedback. The same cohort was invited to evaluate both video sets, but anonymous responses could not be linked across surveys. Proportions were summarized with 95% Wilson score confidence intervals (CIs). Due to the study's descriptive design, no formal hypothesis testing was performed. Sixteen students completed the survey evaluating the previously used instructional videos; 37.5% rated them "Extremely useful" (95% CI [18.5, 61.4%]), and 50% rated them "Very useful." Fourteen students completed the survey evaluating the new videos; 64.3% rated them "Extremely useful" (9/14; 95% CI [38.8, 83.7%]), 28.6% "Very useful" (4/14), 7.1% "Slightly useful" (1/14), and no participant chose "Moderately useful" or "Not at all useful." All participants indicated they would refer to the new videos in the future. Descriptive categorization of 27 comments identified five recurring themes: clarity, zoom, technique, realism, and accessibility. Students valued improved resolution and close‑up views, while suggestions emphasized captions/written explanations and demonstrations on natural teeth. The findings further support the role of high-resolution instructional videos as useful adjuncts to preclinical periodontal instruction. Future studies should evaluate objective performance outcomes and explore additional content and accessibility features.
BACKGROUND: Precision periodontology integrates molecular diagnostics, genomics, and advanced imaging into clinical decision-making. Despite major advances in microbiome characterisation, host genetics, and inflammatory biomarkers, their translation into routine care remains limited. OBJECTIVES: To critically appraise current evidence on microbiome-based profiling, genetic and epigenetic markers, host-response biomarkers, and three-dimensional imaging in periodontology, and to propose a conceptual decision-support framework linking diagnostic outputs to potential therapeutic actions and future implementation research. MATERIALS AND METHODS: A narrative review searching PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library (2010-2025) using terms related to precision periodontology, subgingival microbiome, periodontitis genetics and epigenetics, salivary and GCF biomarkers, aMMP-8, CBCT, risk assessment, and artificial intelligence. Priority was given to meta-analyses, systematic reviews, longitudinal studies, and guideline documents. RESULTS: Microbiological testing has defined but narrow indications; single-SNP genotyping has not demonstrated clinical utility commensurate with cost; aMMP-8 point-of-care testing is among the most extensively investigated host-response tools and may have adjunctive value in selected monitoring and peri-implant scenarios; however, current evidence remains insufficient to support routine diagnostic implementation. CBCT may directly influence surgical decision-making through defect morphology characterisation. AI-based models show promise but lack prospective clinical validation. These conclusions are consistent with the 20th EFP Workshop Consensus Report. CONCLUSIONS: Precision periodontology currently operates in addition to, rather than in replacement of, conventional staging and grading. We propose a conceptual decision-threshold framework for the selective consideration of molecular and advanced imaging tools when their additive contribution may meaningfully inform management. This framework should be regarded as a research-oriented decision-support model rather than a validated clinical algorithm. CLINICAL RELEVANCE: Clinicians are provided with a structured, evidence-based framework that identifies specific clinical scenarios where molecular diagnostics, host-response biomarkers, and three-dimensional imaging may meaningfully modify periodontal treatment decisions, supporting the operationalisation of precision approaches in daily practice.
Journal of applied oral science : revista FOBMaria Eduarda Oliveira Rodrigues, Josy Lorena Peres da Silva Vilarinho, João Gabriel Jucá Chermont, Cristine Miron Stefani, Valéria Martins de Araújo Carneiro,…
OBJECTIVE: To investigate associations among periodontal parameters, glycated hemoglobin (HbA1c), and metabolic parameters in adults with and without type 2 diabetes mellitus (T2D). METHODOLOGY: A cross-sectional study included 74 adults diagnosed with periodontitis according to the current periodontal classification of 2018. Participants underwent a full-mouth periodontal examination, laboratory assessment, and Body Mass Index (BMI). Periodontitis was categorized into Stages I/II and Stages III/IV. HbA1c, lipid profile, high-sensitivity C-reactive protein (CRP), and insulin resistance (HOMA-IR) were assessed. Periodontal inflammatory burden was quantified using the Periodontal Inflamed Surface Area (PISA). Non-parametric tests and Spearman correlation analyses were performed, stratified by diabetes status (α=5%). RESULTS: Individuals with advanced periodontitis (Stages III/IV) had significantly higher HbA1c levels (6.8% vs. 5.8%; p=0.007), higher triglyceride concentrations (142.0 vs. 100.5 mg/dL; p=0.016), and lower HDL-cholesterol levels (46.0 vs. 52.0 mg/dL; p=0.012) than those in Stages I/II. Poor glycemic control (HbA1c >8.5%) and T2D duration ≥10 years were significantly associated with advanced stages (p<0.05). No significant differences were observed for BMI, LDL, total cholesterol (TC), CRP, or HOMA-IR between groups. In adults with T2D, PISA correlated positively with TC and LDL-cholesterol, whereas in non-diabetic individuals, PISA was associated primarily with triglycerides. CONCLUSIONS: Advanced periodontitis was associated with poorer glycemic control and a more atherogenic lipid profile, particularly characterized by elevated triglycerides and reduced HDL-cholesterol. The findings support periodontitis as a potential marker of systemic metabolic dysregulation and reinforce the importance of integrating periodontal care into cardiometabolic risk management strategies.
OBJECTIVE: The purpose of this study was to compare the alveolar ridge preservation (ARP) effect using reactive soft tissue (RST) for socket sealing to guided bone regeneration (GBR) with collagen membrane and sponge in type IV molar sockets. MATERIALS AND METHODS: This retrospective study included 40 sites. Bone regeneration outcomes were evaluated by comparing CBCT images preoperatively (T0), immediately postoperatively (T1), and at a 6-month follow-up (T2). Measurements included changes in horizontal ridge width, vertical ridge height, graft material retention rate, post-operative surgical complications, incidence of secondary bone grafting at implant placement, and short-term implant survival rate. RESULTS: Both groups showed a significant increase in horizontal bone width at 1 mm, 3 mm, and 5 mm below the crest, with no differences. From T2 to T1, the RST group demonstrated superior vertical stability at the crest center (gain of 0.34 mm vs. loss of 0.88 mm in controls, P = 0.023) and a higher graft material retention rate (92.84% vs. 68.04%, P = 0.003). No significant difference was found in the secondary bone grafting rate, and the short-term implant survival rate was 100% in both groups. CONCLUSIONS: RST combined with DBBM reduced ridge resorption in severe defect molar sites. It shows a better tendency in preserving vertical ridge height and graft retention compared to the GBR. CLINICAL RELEVANCE: Using RST for socket sealing achieves comparable bone preservation to the GBR in severe defect molars, while simplifying the surgical procedure and reducing costs.
Journal of applied oral science : revista FOBBurcin Cevik, Atanur Sarioglu, Tugrul Kirtiloglu, Bahattin Avci, Leman Tomak
OBJECTIVES: This study aimed to investigate the association between serum vitamin D3 levels and gingival crevicular fluid (GCF) osteocalcin and N-terminal telopeptide (NTx) levels in periodontally healthy patients and those living with periodontitis. METHODOLOGY: This study included 120 non-smoking males aged from 25 to 40 years (60 healthy patients and 60 with periodontitis). Each group was further subdivided into three subgroups according to serum 25-hydroxyvitamin D3 (25[OH]D3) levels: 0-10, 11-20, and 21-30 ng/mL. GCF samples were collected from the buccal sites of maxillary premolar or molar teeth. GCF osteocalcin and NTx levels were measured using enzyme-linked immunosorbent assay and statistically analyzed. RESULTS: Total osteocalcin levels were significantly higher in healthy individuals than in those with periodontitis (p<0.001). The lowest osteocalcin levels were found in patients with periodontitis with 0-10 ng/mL vitamin D3 (p=0.001). Total NTx levels showed no significant differences between groups (p=0.148), but among healthy individuals, NTx decreased with increasing vitamin D3 (p=0.049). CONCLUSION: Patients with periodontitis and severe vitamin D3 deficiency showed the lowest GCF osteocalcin levels, suggesting that vitamin D3 deficiency may be associated with further alterations in local bone turnover activity in periodontal disease. Further studies are needed to explain these relationships.ClinicalTrials.gov (Trial ID: NCT06871631).
The Journal of oral implantologyHisato Hotta, Yasunori Hotta, Koji Ito, Shinichi Komatsu, Takashi Saito, Yuji Teramoto
This report presents 2 cases of severe bone defects following the extraction of adjacent maxillary central and lateral incisors. In both cases, the teeth were extracted in the hospital's oral surgery department due to extensive apical periodontitis. Postoperatively, 3-dimensional bone defects were observed, including mesiodistal, labial, and palatal bone loss extending near the nasal floor. In the first case, 2 implants were placed using the guided bone regeneration (GBR) method with titanium mesh. Subsequently, during the second stage surgery, a minor GBR procedure was performed to improve the contour of the implant neck. In the second case, in which the bone defect was even more severe than in the first, a multi-GBR approach was selected. After the initial GBR procedure, insufficient bone formation was observed in the central area of the defect. To address this, the ice cream cone technique was employed to enhance bone regeneration. Subsequently, 2 implants were placed. After implant placement, a vertical concavity was observed between the necks of the 2 implants. To correct this, a second GBR procedure using titanium mesh was performed as in case 1. However, an interimplant black triangle was observed, and a vascularized interpositional periosteal-connective tissue flap was performed to eliminate it. Both cases have been followed for more than 6 years since the placement of the final prostheses with no significant findings in intraoral examinations or cone beam computerized tomography images. Esthetically, no interimplant black triangle was observed. In case 1, a satisfactory outcome was achieved by remaking the prostheses. However, in case 2, which had a more severe bone defect than case 1, the clinical crown length of the prostheses is slightly longer compared with the contralateral side.
Shanghai kou qiang yi xue = Shanghai journal of stomatologyYanwei Guo, Guangde Zhang, Lingbin Kong, Shimao Yang
PURPOSE: To investigate the synergistic effect of Erbium, Chromium: Yttrium-Scandium-Gallium-Garnet (Er,Cr:YSGG) laser combined with guided bone regeneration (GBR) on osteogenesis at the extraction site in rats with severe periodontitis, as well as its regulatory mechanism on the Wnt/β-catenin signaling pathway. METHODS: A total of 60 SD rats were used to establish a severe periodontitis model, and 50 rats were successfully modeled. They were randomly divided into 5 groups (n=10 in each group), group A (blank control, simple teeth extraction), group B (teeth extraction+Er,Cr:YSGG laser irradiation), group C (teeth extraction+bone powder+barrier membrane), group D (teeth extraction+Er,Cr:YSGG laser irradiation +bone powder), and group E (teeth extraction+Er,Cr:YSGG laser irradiation+GBR). At 4 and 8 weeks postoperatively, 5 animals from each group were sacrificed for subsequent experiments. CBCT was performed to detect bone mineral density (BMD) and bone volume/total volume (BV/TV). Histological observation was conducted. Enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qPCR) were used to detect β-catenin, Runx2 and other related factors. Meso scale discovery (MSD) technology was employed to determine the nuclear translocation of β-catenin and the phosphorylation level of GSK-3β. RESULTS: CBCT results showed that at 4 weeks postoperatively, the extraction sockets in groups A and B presented with a large area of low-density shadow, a small amount of fibrous callus was observed in group C and D, while group E had higher density of fibrous callus and local high-density shadow. At 8 weeks postoperatively, the bone defect still accounted for 60%-70% of the extraction socket in group A and B; new bone increased but bone powder was not fully degraded in group C and D; in group E, bone powder was basically degraded and new bone fused well with the surrounding bone. In terms of bone parameters, BMD and BV/TV in all groups increased with time. The BMD and BV/TV in group E were 0.51 g/cm3 and 36.14% at 4 weeks postoperatively and 0.57 g/cm3 and 43.23% at 8 weeks postoperatively, which were significantly higher than those in other groups at all time points(P＜0.05). The nuclear translocation rate of β-catenin in group E reached 58.7% at 8 weeks postoperatively, with high expression of osteogenic factors, while the levels of Dickkopf-related protein 1(DKK-1, 45.32 pg/mL) and phosphorylated GSK-3β/GSK-3β (0.21) were the lowest (P＜0.05). Histological results showed that group E had dense new bone and less inflammation, and the intergroup difference in osteogenic effect was group E ＞ groups C/D ＞ group B ＞ group A. CONCLUSIONS: Er,Cr:YSGG laser combined with GBR can down-regulate DKK-1 expression, inhibit GSK-3β activity, relieve the inhibition of the Wnt/β-catenin pathway and promote osteogenesis. This study can provide experimental evidences for the clinical treatment of periodontal bone defects.
Shanghai kou qiang yi xue = Shanghai journal of stomatologyJun Huang, Kun Wang, Lin Xiao
PURPOSE: To evaluate the effects of different timing of fixed orthodontics on enamel demineralization and periodontal conditions. METHODS: A total of 180 patients with fixed orthodontic treatment admitted from January 2021 to December 2023 were selected and divided into three groups according to the duration of orthodontic treatment: group A (n=60) with a treatment period of less than 6 months, group B (n=60) with a treatment period between 6 to 12 months, and group C (n=60) with a treatment period between 12 to 18 months. The enamel demineralization was evaluated by International Caries Detection and Assessment System (ICDAS), and ICDAS score was obtained. The periodontal status was evaluated by bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL) and plaque index (PI). The correlation between enamel demineralization (ICDAS score) and changes of periodontal status (BOP, PD, CAL, PI) was analyzed by Pearson correlation analysis. The influencing factors of enamel demineralization in patients undergoing fixed orthodontics were analyzed by multivariate logistic regression analysis. RESULTS: There was no significant difference in the severity of enamel demineralization among the three groups (P＞0.05). The total incidence of enamel demineralization (group A ＜ group B ＜ group C) was significantly different from the ICDAS score (group A ＜ group B ＜ group C)(P＜0.05). There were significant differences in BOP, PD, CAL and PI among the three groups, and all were group A ＜ group B ＜ group C(P＜0.05). ICDAS score was moderately positively correlated with BOP and PD, weakly to moderately positively correlated with CAL, and highly positively correlated with PI (P＜0.05). The correction time, PI, frequency of high-diet and local application of fluoride were independent influencing factors of enamel demineralization in patients undergoing fixed orthodontics (P＜0.05). CONCLUSIONS: A long duration of fixed orthodontics will increase the risk of enamel demineralization and affect periodontal health of patients. PI, frequency of high-glucose diet and local application of fluoride can affect enamel demineralization. Personalized plans and regular follow-up programs should be formulated based on the individual conditions of patients, and oral hygiene guidance and prevention should be strengthened.
OBJECTIVES: This study aimed to evaluate the available clinical evidence on the use of ozonated gels and oils in the management of periodontitis. MATERIAL AND METHODS: Embase, SCOPUS, Web of Science, PubMed, and Google Scholar were searched up to May 13, 2025. Original peer-reviewed randomized controlled trials (RCTs) in English that investigated patients with periodontitis were included. Study characteristics, methods of ozone application, conclusions, and reported complications were extracted. Pooled mean differences of clinical indices were compared between the ozone therapy groups (adjunctive or monotherapy) and control groups (placebo or CHX). Primary outcomes included clinical indices such as probing pocket depth (PPD), plaque index (PI), and gingival index (GI), whereas secondary outcomes comprised clinical attachment level (CAL), clinical attachment loss (CAtL), bleeding on probing (BoP), and sulcus bleeding index (SBI). RESULTS: Of the 962 records, 19 clinical studies were included in the qualitative synthesis and 18 RCTs in the quantitative synthesis. For periodontitis, ozonated compounds significantly reduced PPD when used as an adjunct to subgingival instrumentation (MD = -0.780; p < 0.0001) and reduced clinical attachment loss (CAL) (MD = -0.457; p = 0.001) compared with subgingival instrumentation alone. No statistically significant differences were observed in PI or GI outcomes with ozonated compounds as an adjunct to subgingival instrumentation compared with subgingival instrumentation alone, although sensitivity analyses indicated some instability in the results. Follow-up periods ranged from 4 to 12 weeks across outcomes (8-12 weeks for GI), with most studies reporting 12-week follow-up. No consistent differences were found between ozone and CHX in terms of PPD, CAL, PI or BoP. No adverse effects were reported in the studies. CONCLUSIONS: Ozonated gels and oils were associated with favorable periodontal outcomes, particularly when used as adjuncts to subgingival instrumentation, and no major adverse effects were reported. However, the evidence is limited by short-term follow-up and methodological heterogeneity.
Clinical implant dentistry and related researchYulan Wang, Jian Zhang, Runfa Wu, Gang Fu, Yan Xu, Zhe Yi, Qiang Li, Yangsheng Zhao, Ming Shen, Yufeng Zhang
OBJECTIVES: This multicenter prospective cohort study follows a 1-year period after a previously published randomized controlled trial, comparing the radiographic and clinical outcomes of implants placed with simultaneous guided bone regeneration (GBR) using bioceramic (BC) versus xenograft (BO). MATERIALS AND METHODS: Patients from the previous trial were recalled 1 year after crown delivery. The follow-up data focused on the buccal bone stability evaluated by CBCT and implant survival rate, Probing Depth (PD), Bleeding on Probing (BOP), Plaque Index (PI), and patient satisfaction through Oral Health Impact Profile-5 (OHIP-5). RESULTS: Out of 150 enrolled patients in a previous trial, a total of 97 patients completed the 1-year follow-up: 44 in the BC group and 53 in the BO group. The implant survival rate was 100% in both groups. Change in horizontal buccal bone thickness (△HBBT) at 1 year post-crown delivery versus immediately post-surgery was -0.28 ± 0.10 mm for the BC group and -0.91 ± 0.09 mm (mean ± standard error) for the BO group, with the BC group exhibiting less bone resorption along the implant than the BO group (p = 0.0000). No significant differences were observed in PI, BOP, or PD. Patient satisfaction remained high in both groups. CONCLUSIONS: GBR with bioceramic demonstrated stable radiographical bone on the buccal side of the implant 1 year after crown delivery.
Clinical and experimental dental researchRobert Chan, Hugo Lau, Michael Liao, Jiwoo Park, Aaron Ting, Yi Yang Xu, Tulio Fernandez-Medina
OBJECTIVES: Autologous platelet concentrates (APCs) have emerged as biologically active adjuncts in guided tissue regeneration (GTR), aiming to enhance the treatment of intrabony periodontal defects through the local release of growth factors. Despite growing interest, the clinical benefits of combining APCs with bovine-derived bone grafts (BBG) in the treatment of intrabony periodontal defects remain uncertain. This systematic review aimed to evaluate the clinical efficacy of incorporating APCs alongside GTR and BBG in managing intrabony defects. MATERIALS AND METHODS: A comprehensive electronic literature search was conducted across PubMed, Ovid MEDLINE, Scopus, Cochrane, and Web of Science. Inclusion criteria included randomised control trials involving systemically healthy adults with periodontal intrabony defects > 3 mm. Studies were screened based on predefined inclusion and exclusion criteria, and the methodological quality and risk of bias were assessed using the Cochrane Risk of Bias 2.0 tool. RESULTS: The initial search identified 214 articles, from which eight full-text studies were screened for eligibility. Five randomised controlled trials met the inclusion criteria. One study reported potential clinical benefits with adjunctive APC use, while the remaining trials showed no statistically significant improvements. All included studies demonstrated concerns regarding risk of bias, primarily due to the absence of predefined protocols, and only one study provided trial outcomes beyond 12 months. Overall, the APC groups exhibited slightly greater mean gains in clinical attachment level (0.1-1.0 mm) and probing pocket depth reduction (0.1-0.8 mm) at 12 months compared with controls. CONCLUSION: The adjunctive use of APCs with bovine-derived bone grafts and guided tissue regeneration did not result in statistically significant improvements in clinical attachment level gain or probing pocket depth reduction. Future studies with standardised methodologies, larger sample sizes, and extended follow-up durations are needed to clarify the long-term efficacy of APCs in periodontal regenerative therapy.
Clinical and experimental dental researchSonja Henny Maria Derman, Laura de Boni, Edwin Mulder, Stefan Möstl, Julia Jagel, Teresa Kruse, Anna Greta Barbe
AIMS: To investigate longitudinal alterations in oral hygiene, gingival inflammation, and salivary secretion during a 60-day head-down tilt bed rest (HDTBR) protocol as a validated ground-based analog of microgravity. MATERIALS AND METHODS: Twenty-four healthy volunteers participated in a 60-day, 6° HDTBR study conducted under strictly controlled conditions. Oral health assessment safety measures were performed at baseline, mid-head-down tilt (HDT), end-HDT, and post-recovery. RESULTS: Plaque accumulation and gingival inflammation increased, with increases from baseline to end-HDT in the Quigley-Hein Plaque Index (1.8 ± 0.4 to 2.3 ± 0.4; p < 0.01), Gingival Index (0.8 ± 0.4 to 1.2 ± 0.2; p < 0.001), and bleeding on probing (BoP) (18.4 ± 11.6% to 35.1 ± 16.6%; p < 0.001). BoP partially recovered post-HDT, while QHI and GI remained elevated compared with baseline. Periodontal Screening Index scores shifted toward higher grades during HDT without evidence of destructive periodontal breakdown. The unstimulated salivary flow rate remained unchanged throughout. CONCLUSIONS: Prolonged gravitational unloading induces a plaque-driven deterioration of gingival health in systemically healthy individuals, likely related to impaired mechanical plaque control and microcirculatory changes rather than salivary dysfunction. Gingival tissues appear to be sensitive biomarkers of adaptation to unloading conditions, supporting the need for optimized oral hygiene and adjunctive preventive strategies during future long-duration space missions. TRIAL REGISTRATION: German Clinical Trial Registry (DRKS00033882, registration date 03-15-2024, https://www.drks.de/search/de/trial/DRKS00033882/details).