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 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).
BMC oral healthJaylane K Ghonima, Mohy El-Din El-Rashidy, Gehan Kotry, Samir R Nouh, Dina Nagui, Eman Thabet, Salma E El-Habashy
BACKGROUND: Furcation defects are considered among the most challenging periodontal lesions to regenerate given the complexity of the periodontal apparatus, inaccessibility and the limited blood supply to the area. The aim of the current study was to create and characterize a novel ternary hydrogel composed of hyaluronic acid (HA), chitosan (CS) and polyvinyl alcohol (PVA) and to evaluate its potentials in periodontal regeneration of furcation defects in dogs. MATERIALS AND METHODS: A composite hydrogel scaffold composed of hyaluronic acid, chitosan and polyvinyl alcohol was successfully prepared and characterized in terms of SEM, swelling and mechanical behaviors, FTIR analysis as well as biocompatibility assay and direct cell-scaffold interactions. In an in vivo study, thirty-two critical size class II furcation defects were created in eight mongrel dogs and randomly allocated to group I, hydrogel group and group II, negative control group. Histological analysis and histomorphometric evaluation of percentage of newly formed bone area were used to evaluate the regenerative potential of the novel hydrogel after one and three months, postoperatively. RESULTS: The prepared hydrogel was cytocompatible, had proper degradation rate, water uptake and mechanical strength as well as ease of handling clinically. Histologic results of the hydrogel group revealed superior bone, periodontal ligament and cementum formation compared to the negative control group at both time points. The hydrogel group showed a statistically significant increase in the percentage of newly formed bone surface area compared to the negative control group. CONCLUSIONS: The novel ternary hydrogel prepared using hyaluronic acid, chitosan and polyvinyl alcohol showed adequate cytocompatibility and mechanical properties. The in vivo results support that the novel scaffold might be effective for periodontal regeneration in furcation defects in dogs.
OBJECTIVES: We aimed to evaluate the clinical and radiographic effectiveness of locally applied insulin versus hyaluronic acid (HA), each combined with absorbable collagen sponge (ACS), using the single flap approach (SFA) in the management of periodontal intra-bony defects. MATERIALS AND METHODS: 21 periodontitis patients with intra-bony defects were randomly assigned to 3 groups: group I (SFA + insulin + ACS; n = 7), group II (SFA + HA + ACS; n = 7), and group III (SFA + ACS; n = 7). Primary outcome was clinical attachment level (CAL), assessed at baseline and 6 months postoperatively; secondary outcomes included probing pocket depth (PPD), measured at baseline and 6 months; postoperative pain, using visual analogue scale (VAS) at 24 and 48 h; and radiographic parameters, including radiographic linear defect depth (RLDD) and bone density, assessed at baseline and 6 months. RESULTS: PPD and CAL improved significantly over time in all groups (P < 0.001), with no intergroup differences. VAS scores were significantly lower in the insulin and HA groups than in controls at 24 h (P = 0.004) and 48 h (P = 0.007), with the lowest scores in the insulin group (P = 0.008). RLDD decreased significantly in all groups (P < 0.001), with a greater reduction in HA + ACS compared to insulin and controls at 6 months (P = 0.027). Bone density increased significantly over time in insulin + ACS (P < 0.001) and HA + ACS (P = 0.022), with no change in the ACS group (P = 0.860), with non-significant intergroup differences. CONCLUSION: In the management of periodontal intrabony defects, SFA with both insulin and HA soaked in collagen sponge showed favorable clinical and radiographic improvements. CLINICAL RELEVANCE: Local insulin may represent a promising, simple, and cost-effective biomaterial in periodontal treatment; however, more studies are needed. CLINICAL TRIAL REGISTRATION: NCT05746676.
OBJECTIVES: This study aimed to evaluate asprosin, adropin, and irisin levels in gingival crevicular fluid (GCF) across different periodontal conditions and to analyze their relationship with clinical periodontal parameters. MATERIALS AND METHODS: A total of 122 systemically healthy participants (25-60 years) were divided into four groups: healthy periodontium (n = 30), gingivitis (n = 30), Stage I-II periodontitis (n = 32), and Stage III-IV periodontitis (n = 30). Clinical parameters recorded included probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), and gingival index (GI). GCF samples were collected, and asprosin, adropin, and irisin levels were measured by ELISA. Statistical analyses included ANOVA/Kruskal-Wallis with post hoc tests, Pearson correlations, and receiver operating characteristic (ROC) analysis. RESULTS: Asprosin levels were significantly higher in Stage III-IV periodontitis compared with other groups (p < 0.05). Adropin and irisin levels were higher in the healthy group, although not statistically significant. Asprosin correlated positively with PI, PD, CAL, and BOP, while irisin correlated negatively with PI. ROC analysis indicated that asprosin had diagnostic potential for distinguishing between advanced periodontitis and other conditions. CONCLUSIONS: Elevated GCF asprosin levels were found to be associated with periodontitis severity, whereas adropin and irisin were related to periodontal health. More research is needed to understand the role of irisin, asprosin, and adropin in periodontal pathogenesis. CLINICAL RELEVANCE: This study provides novel insights into the potential role of asprosin, adropin, and irisin as biomarkers of periodontal status. Elevated GCF asprosin levels were associated with advanced periodontitis, reflecting the inflammatory burden of the disease. Conversely, higher levels of adropin and irisin were associated with better periodontal health, suggesting protective or homeostatic functions. These findings indicate that GCF asprosin, adropin, and irisin levels may serve as promising adjunctive diagnostic indicators for distinguishing between periodontal health and disease. Future longitudinal studies are needed to validate their prognostic value and to clarify their mechanistic involvement in periodontal pathogenesis.
AIMS: To evaluate the effects of subgingival air polishing (glycine powder) or minocycline hydrochloride on periodontal parameters and inflammatory levels in residual periodontal pockets following periodontal endoscope-assisted scaling and root planing. METHODS: This single-center, randomized controlled trial (RCT) enrolled 80 patients with periodontitis(Stage II-IV, Grade A-C), who were randomly assigned at the patient level to four groups: scaling and root planing alone (SRP group), endoscope-assisted SRP (E-SRP group), endoscope-assisted SRP plus minocycline hydrochloride (E-SRP + M group), or endoscope-assisted SRP plus subgingival air polishing (E-SRP + AP group). The primary outcome was mean reduction in probing depth (PD) at 6 months post-intervention in residual pockets (PD ≥ 4 mm at baseline). Periodontal parameters, including probing depth (PD), bleeding index (BI), and clinical attachment loss (CAL), were assessed at 6 weeks, 3 months, and 6 months post-intervention. Inflammatory factors [levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP)] and Porphyromonas gingivalis (P. gingivalis) abundance were quantified at 1, 2, 3, 4, 6 weeks, 3 months, and 6 months post-intervention. Linear mixed-effects models (LMM) with Bonferroni correction for multiple comparisons were used for longitudinal continuous outcomes, and exact P-values, effect sizes (Cohen's d), and 95% confidence intervals (95% CI) were reported. RESULT: Levels of P. gingivalis, IL-6, TNF-α, and CRP in deep periodontal pockets showed a slight increase following endoscope-assisted SRP. However, these levels, as well as the bacterial load, remained significantly lower than those in the SRP-alone group. Additionally, periodontal indices demonstrated greater improvement in the endoscope-assisted group compared to the SRP-alone group at the 6-week follow-up. Comparison between the combination therapy groups (endoscope-assisted SRP plus either minocycline hydrochloride or subgingival air polishing) and the endoscope-assisted SRP-alone group revealed that the combination therapies were superior in reducing both bacterial load and inflammatory factor levels within the first 4 weeks. This superior efficacy extended to periodontal indices after 6 weeks. No significant difference was observed between the two combination therapy groups at any time point. A ≥1 mm reduction in PD was defined as a clinically significant improvement (per 2022 EFP guidelines), with 89.2% of sites in combination therapy groups achieving this at 6 months, vs. 71.7% in the E-SRP group and 55.2% in the SRP group. CONCLUSIONS: Combining E-SRP with glycine air polishing or local minocycline improved periodontal conditions, suppressed early biofilm and inflammation, and promoted healing of deep residual pockets. Both treatments produced equivalent outcomes at all follow-up time points, with stage-specific therapeutic effects observed among patients at different periodontal stages. The 4-week early adjunct approach is practicable in clinical settings and aligns with 2022 EFP guidelines. Based on the present results, glycine air polishing is a reasonable option for Stage II patients, while local minocycline may be better suited for advanced periodontitis. This study provides preliminary data to support early adjunct therapy following E-SRP. The choice of adjunctive therapy should be tailored to individual patient characteristics (e.g., antibiotic sensitivity, periodontitis stage/grade).
OBJECTIVE: To introduce a practical, evidence-based and prognosis-oriented conceptual decision aid for the management of Class II furcation involvement, integrating defect-specific regenerative potential with long-term maintenance feasibility. MATERIALS AND METHODS: A structured narrative review of the literature on Class II furcation involvement regeneration, prognostic factors, and long-term maintenance outcomes was conducted using PubMed, EBSCO, and Scopus databases. Variables with documented influence on regenerative outcomes or long-term tooth survival were extracted and grouped into two conceptual axes: a Morphological Regenerability Score, capturing defect anatomy, and a Maintenance Accessibility Score, capturing site-related and patient-related factors. Scoring ranges and thresholds were derived from the magnitude and consistency of reported effect sizes. RESULTS: The Morphological Regenerability Score integrates five defect-related variables (vertical furcation involvement component, root divergence at crestal bone, furcation entrance width, defect location and root trunk length) with modifiers for mobility, cervical enamel projections, exposed furcation entrance, and enamel pearls, spanning - 5 to 9 points. The Maintenance Accessibility Score integrates seven maintenance-related variables (plaque control, supportive periodontal treatment compliance, smoking, diabetes control, site/operator accessibility, endodontic status and tissue phenotype), spanning 0 to 13 points. Midpoint thresholds (MRS ≥ 5; MAS ≥ 7) define four clinical quadrants guiding case selection between regeneration, staged treatment strategy, non-surgical or resective approaches, and extraction. CONCLUSIONS: The proposed framework consolidates heterogeneous evidence on Class II furcation involvement prognosis and proposed treatment strategies into a single transparent decision aid. Prospective validation is required before routine clinical adoption. CLINICAL RELEVANCE: This framework supports evidence-based, individualised decision-making for Class II furcation involvement based on defect regenerability and long-term maintenance, and highlights modifiable risk factors that should be addressed before attempting regenerative surgery.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerJana Krapež, Marko Polajnar, Klemen Leopold, Jakob Peterlin, Attila Šarvari, Mitjan Kalin, Aleš Fidler
PURPOSE: To test whether ultrasonic (US) scaling-induced hard-tissue surface loss on irradiated teeth depends on irradiation dose, type of scaler tip, angulation and orientation and tooth region. METHODS: In vitro study on 24 human molars irradiated with 0, 30, or 70 Gy. US scaling was robot-standardized (force 1 N, tips G6 and P20, angulation 15° and 45°, orientation back and lateral) with medium power and water spray. Surface loss was graded on intraoral scans by three blinded observers on a six-band ordinal 0-5 scale (increasing with loss depth) and analyzed with cumulative-logit ordinal mixed models for median and maximum depth. RESULTS: 30 Gy significantly increased the odds of deeper surface loss with the back orientation (median: β = 2.43, p = 0.039; max: β = 2.10, p = 0.022); no 70 Gy contrast reached significance, indicating a dose-threshold effect. The G6 tip increased the odds of deeper damage substantially more than P20 across both depth outcomes (all p < 0.001), and 45° angulation together with the back orientation further amplified peak damage. The root was more susceptible than the crown (β ≈ 2.95, p < 0.001). CONCLUSIONS: US instrumentation of irradiated teeth produced dose- and technique-dependent hard-tissue surface loss. Slim periodontal tips (P20) used at shallow angulation (15°) with a lateral orientation were associated with minimal surface loss across all doses and positions, whereas wider tip (G6) at 45° with the back orientation produced consistent measurable wear, amplified on the root and by prior irradiation.
OBJECTIVES: To evaluate the effects of autologous free gingival graft (FGG), xenogeneic collagen matrix (XCM), and acellular dermal matrix (ADM) combined with apically positioned flap (APF) on buccal soft-tissue volume change and keratinized mucosa augmentation around dental implants. MATERIALS AND METHODS: Forty-four implants with buccal keratinized mucosa width (KMW) < 2 mm were randomly allocated to the FGG group, XCM group, or ADM group. The primary outcome was buccal soft-tissue volume change over a 12-month follow-up. Secondary outcomes included KMW, KMW shrinkage rate, mucosa thickness (MT), and peri-implant soft tissue health. Esthetic outcomes, postoperative pain, and patient satisfaction were further evaluated. RESULTS: Net buccal soft-tissue volume change decreased over time in all groups but remained significantly greater in the FGG group throughout follow-up. At 12 months, model-estimated net volume changes were 24.10 mm³ (95% CI: 2.69, 45.51) for FGG, 3.34 mm³ (- 19.77, 26.45) for XCM, and - 17.34 mm³ (- 40.45, 5.77) for ADM (P = 0.041), with FGG significantly exceeding ADM after Bonferroni adjustment. KMW decreased progressively in all groups, with no significant between-group differences at any time point. At 12 months, observed KMW was 2.93 ± 1.29 mm (FGG), 2.52 ± 0.51 mm (XCM), and 1.86 ± 0.82 mm (ADM). Using the immediately postoperative KMW as the reference, the 12-month KMW shrinkage rates were 56.25%, 61.44%, and 74.07%, respectively. FGG showed significantly greater mucosal thickness gain than ADM at 6 and 12 months (P < 0.05), while XCM did not differ significantly from either group. Esthetic outcomes, peri-implant parameters, patient satisfaction, and postoperative pain were comparable among groups (P > 0.05). CONCLUSIONS: FGG plus APF provided the most favorable maintenance of peri-implant buccal soft-tissue volume and thickness over 12 months. XCM showed intermediate performance, whereas ADM showed the greatest dimensional reduction. All three grafts showed stable peri-implant clinical parameters over 12 months, achieved acceptable esthetic outcomes, and yielded high patient satisfaction. CLINICAL RELEVANCE: For peri-implant soft-tissue augmentation with APF, FGG showed better maintenance of buccal soft-tissue volume and thickness than ADM over 12 months, while XCM showed intermediate performance. Graft selection should therefore consider the expected need for long-term dimensional stability. TRIAL REGISTRATION: This trial was registered in the Chinese Clinical Trial Registry with the registration number ChiCTR2100041688 ( https://www.chictr.org.cn/showproj.html?proj=66722 ) on January 1, 2021.
OBJECTIVE: Psychological stress has been widely investigated in periodontal diseases, however, its association with peri-implant conditions remains unclear. This study aimed to evaluate peri-implant crevicular fluid (PICF) levels of cortisol, dehydroepiandrosterone (DHEA) and interleukin-6 (IL-6) in peri-implant health and disease, together with anxiety and depression scores. MATERIALS AND METHODS: In this cross-sectional study, sixty-two individuals were classified as peri-implant healthy (Group H, n = 18), peri-implant mucositis (Group PM, n = 22), and peri-implantitis (Group PI, n = 22). Clinical parameters; gingival index (GI), probing depth (PD), bleeding on probing (BOP), keratinized tissue width (KTW), and marginal bone loss (MBL) were recorded. Psychological status was assessed using Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI). PICF cortisol, DHEA and IL-6 levels were quantified by enzyme linked immunosorbent assay (ELISA). RESULTS: GI, PD, and BOP differed significantly among groups (p< 0.01), with the highest values in Group PI; suppuration and MBL were detected only in this group. Peri-implantitis patients exhibited higher BDI scores and total amounts of cortisol in PICF than Group H (p<0.05), whereas cortisol concentrations were lower (p<0.01). IL-6 concentrations progressively declined from health to peri-implantitis (p< 0.01). Clinical parameters correlated positively with total cortisol and negatively with IL-6. CONCLUSION: Within the limitations of this study, peri-implantitis was associated with elevated PICF cortisol levels and higher depression scores, indicating a possible relationship between psychological factors and peri-implant inflammation. CLINICAL RELEVANCE: Psychological stress may modulate inflammatory responses in peri-implant diseases. Elevated cortisol in peri-implantitis highlights the importance of psychosocial assessment for maintaining long-term peri-implant health.
OBJECTIVES: To evaluate the long-term clinical and radiographic outcomes of periodontal regenerative therapy performed with adjunctive connective tissue grafting (CTG) for Class II furcation defects. MATERIALS AND METHODS: Fourteen isolated buccal Class II furcation defects in fourteen patients were treated with regenerative therapy using recombinant human fibroblast growth factor-2, carbonate apatite, and adjunctive connective tissue grafting. Clinical and radiographic parameters were assessed at baseline, 12, 36, and 60 months, and the gingival phenotypes were evaluated at baseline and at 60 months using a color-based phenotype probe. Data were analyzed using nonparametric statistical tests. RESULTS: Significant improvements in probing pocket depth and clinical attachment level were observed at 12 months and maintained through 60 months. Keratinized tissue width increased significantly over time, and radiographic evaluation demonstrated stable defect fill in most sites. Gingival recession tended to decrease. At 60 months, radiographic evidence of complete defect fill was observed in 13 of 14 sites (92.9%). CONCLUSIONS: Within the limitations of this retrospective exploratory study, favorable long-term clinical and radiographic outcomes with stable furcation conditions were observed following regenerative therapy performed with adjunctive CTG for Class II furcation defects. CLINICAL RELEVANCE: Regenerative therapy performed with adjunctive CTG may represent a clinically applicable approach for selected Class II furcation defects.
OBJECTIVES: The postpartum period is marked by significant biologic, social, and emotional changes that may affect maternal self-care, including oral health maintenance. This study explores the impact of periodontal inflammatory status on mental health status in postpartum women. METHOD AND MATERIALS: In this cross-sectional study, postpartum mothers were recruited within 6 weeks to 6 months after delivery. Clinical periodontal parameters and sociodemographic variables were measured, and mental health was assessed using the standard 38 items Mental Health Inventory. Multiple linear regression analysis was performed to examine the relationship between periodontal parameters and Mental Health Index (MHI) scores. Mediation analysis explored potential mediators affecting the association. RESULTS: In total, 128 mothers were recruited in the study. The study population was stratified into three categories according to the quartiles of the mean MHI scores. A statistically significant difference was seen in the periodontal parameters among the three groups (P .05). After adjusting for sociodemographic variables, bleeding on probing (β = -0.437) and clinical attachment loss (β = -0.470) remained the only statistically significant predictors of MHI. Both were negatively associated with MHI, indicating poorer mental health with worsening periodontal condition. Bleeding on probing significantly mediated the relationships between education, occupation, socioeconomic status, family characteristics, and mental health, accounting for approximately 70% to 90% of the total effect. CONCLUSION: Periodontal inflammation was identified as a mediating factor in the relationship between sociodemographic factors and mental health status during the postpartum period.
Clinical oral investigationsZeki Kacar, Ezgi Gurbuz, Mehmet Meric Ersoz, Emilio Couso-Queiruga, H Gencay Keceli
OBJECTIVES: The aim was to compare the outcomes of gingival phenotype modification achieved using a de-epithelialized gingival unit graft (DUG) and a de-epithelialized gingival graft (DGG) in the treatment of single gingival recession defects with a coronally advanced flap (CAF). MATERIALS AND METHODS: Subjects with bilateral RT1 gingival recession defects were recruited. The sites were randomly assigned to either the DUG or DGG group. The assessments were performed using clinical, linear, and volumetric digital measurements, as well as patient-reported outcome measures. Gingival thickness and mean root coverage were measured as the primary outcome variables. RESULTS: The study was completed with 15 patients and 30 gingival recession defects. At the 6-month follow-up, the change in gingival thickness (DUG: 2.39 ± 0.65 mm; DGG: 1.66 ± 0.50 mm) and digital linear dimension (DUG: 1.66 ± 0.47 mm; DGG: 1.13 ± 0.36 mm) were significantly greater in the DUG group than in the DGG group (p = 0.001 and p = 0.008, respectively). Mean and complete root coverage values were greater in the DUG group, though not significant (95% vs. 75% and 93.3% vs. 66.7%, respectively). Graft thickness was significantly greater in the DUG group (p = 0.027; 1.55 ± 0.50 mm and 1.10 ± 0.32 mm, respectively). No significant intergroup differences were observed in postoperative pain perception or bleeding. CONCLUSIONS: DUG demonstrated better root coverage and phenotype modification results. However, the baseline imbalance in graft thickness remains a potential confounder, and the findings should be interpreted cautiously. CLINICAL RELEVANCE: DUG may offer an alternative tissue for phenotype modification and root coverage in cases with limited soft tissue thickness in the recipient area. TRIAL REGISTRATION: ClinicalTrials.gov (identification number NCT05923294). https://clinicaltrials.gov/study/NCT05923294?cond=NCT05923294&rank=1 Date of Submission: June 20th, 2023.
OBJECTIVE: This study assessed the clinical efficacy of the combined Apically Incised Coronally Advanced Surgical Technique (AICAST), deproteinized bovine bone mineral, and a collagen membrane for guided tissue regeneration (GTR) in intrabony defects, and compared outcomes with the papilla preservation technique. METHODS: A single-center, parallel-arm, randomized controlled trial was conducted involving 26 patients with 39 deep intrabony defects in patients with periodontitis. The test group (n = 23 defects) received guided tissue regeneration (GTR) using the apically incised coronally advanced surgical technique (AICAST) combined with deproteinized bovine bone mineral and a collagen membrane. The control group (n = 16 defects) received GTR using the papilla preservation technique (PPT) with the same bone graft and membrane. The primary outcome was the change in clinical attachment level (CAL) at 12 months postoperatively. Secondary outcomes included changes in probing depth (PD), bleeding on probing (BOP), plaque index (PI), papilla tip (TP) position, radiographic new bone height (NB), supracrestal new bone (SUPRA-NB), and supracrestal attachment gain (SUPRA-AG), as well as early postoperative outcomes (wound closure score, VAS pain score, and PI at 1 and 2 weeks). Clinical parameters and cone-beam computed tomography measurements were obtained at baseline and at 3 and 12 months postoperatively. RESULTS: Both groups demonstrated statistically significant improvements at 3 and 12 months postoperatively in PD, BOP, PI, and CAL. The mean CAL gain at 12 months was 3.04 ± 1.10 mm in the test group and 2.88 ± 1.13 mm in the control group (between‑group difference: 0.16 mm; 95% CI: - 0.66 to 0.98; p = 0.702). At 1 and 2 weeks postoperatively, the test group exhibited significantly lower plaque index values compared with the control group (p = 0.023 and p = 0.020, respectively), indicating improved early postoperative plaque control. After 12 months, the papilla tip position demonstrated a statistically significant change in the test group (p = 0.012), whereas no significant change was observed in the control group (p = 0.764). Comparable outcomes were observed between groups with respect to new bone height, supracrestal bone formation, and clinical attachment gain. The mean increase in new bone height was 2.67 ± 1.66 mm in the test group and 3.30 ± 2.11 mm in the control group (p = 0.302). CONCLUSION: The combined AICAST and GTR approach was associated with significant improvements in clinical parameters in the management of intrabony defects. When compared to the conventional technique, this approach was associated with improved early plaque control and enhanced papillary position at 12 months, while achieving comparable regenerative outcomes. These findings support the use of AICAST as a viable surgical option for periodontal regeneration; further studies are warranted to evaluate its broader applicability and long-term efficacy.
Oral health & preventive dentistrySeda Selvi, Pınar Yılmaz Atalı, Ömer Birkan Ağralı, Beste Tacal Aslan, Özlem Özge Yılmaz, Tolga Polat, Korkut Ulucan
PURPOSE: This study evaluated the impact of gene polymorphisms in VDR and MMP3 on caries and the efficacy of genetic factors in a novel caries risk model. METHODS AND MATERIALS: After oral examination of male individuals (aged 20-44), a diagnosis was made according to the decayed, missing and filled teeth (DMFT) index: Group 1 'high caries risk' (DMFT ≥ 14); Group 2 'low caries risk' (DMFT ≤ 5) (n = 162). Participants' detailed anamneses were recorded. Periodontal indices, saliva buffering capacity/BC, salivary quantity of Streptococcus mutans/SM and Lactobacillus spp./LB were measured. After DNA isolation, genotyping of the MMP3 (rs679620) and VDR (rs731236) genes was conducted using real-time polymerase chain reaction (PCR). A stepwise regression analysis was conducted to evaluate the explanatory contributions of independent variables to DMFT variability. The results were considered significant at p 0.05. RESULTS: Significant differences were observed between the groups in terms of the plaque index, gingival index, probing depth, bleeding on probing, salivary flow rate, BC, salivary quantity of LB, frequency of consuming sugary foods/drinks, frequency of tooth brushing, and the use of preventive dental treatment (p 0.001). The MMP3 rs679620 polymorphism significantly affected caries risk (p 0.001), while the VDR polymorphism was not significant (p = 0.862). An explanatory regression model for caries experience, created by stepwise regression analysis, explained 61.1% of the DMFT. CONCLUSION: Adding genetic factors to the caries risk model may have a significant effect on the accuracy of the model.
Oral health & preventive dentistryAmmar Almarghlani, Hanin Alqurashy, Mohanad Alnahdi, Dalia Meisha, Ehab Azab, Hassan Abed, Rayan Sharka, Ali Alghamdi
PURPOSE: Vertical alveolar bone defects often require advanced augmentation techniques to enable successful implant placement. The aim of this study was to compare short-term vertical bone gain following two approaches: the bone-ring graft technique and guided bone regeneration (GBR) using a non-resorbable membrane in patients with vertical alveolar deficiencies. MATERIALS AND METHODS: A prospective cohort study was conducted involving 30 systemically healthy adult patients with posterior mandibular vertical bone defects measuring ≥4 mm. Participants were assigned to one of two treatment groups: Group A received the bone ring in conjunction with titanium implants and a resorbable collagen membrane; Group B was treated with allogeneic bone grafts and titanium-reinforced dense polytetrafluoroethylene (d-PTFE) membranes. Radiographic evaluations were performed at baseline, 1 week, 1 month, and 3 months postoperatively by cone-beam computed tomography (CBCT) and periapical radiographs. The primary outcome was vertical bone height gain. The data were analyzed using IBM SPSS Statistics Version 28.0. RESULTS: Group A demonstrated statistically significantly greater vertical bone gain at all postoperative intervals: 9.1 mm at 1 week, 10.6 mm at 1 month, and 9.7 mm at 3 months, compared to 7.8 mm, 7.0 mm, and 6.9 mm, respectively, in Group B (p 0.0001). Plaque index scores were comparable between groups, with no statistically significant differences observed in postoperative swelling or infection rates. However, membrane exposure was statistically significantly more frequent in Group B at all follow-up visits (p ≤ 0.02). CONCLUSION: The bone-ring graft technique was associated with greater vertical bone gain and a lower incidence of membrane exposure compared to GBR using a non-resorbable membrane. Further studies with longer follow-up are required to confirm these findings.
Oral health & preventive dentistryScott Froum, Nathan E Estrin, Hyun Jae Cho, Nima Farshidfar, Paras Ahmad, Richard J Miron
PURPOSE: This pilot retrospective case series aimed to evaluate the 6-month clinical outcomes and safety of a combined regenerative protocol utilizing exosomes specifically designed for periodontal regeneration (Periosomes), with 90% anorganic bovine bone/10% collagen (ABBMC), and horizontal platelet-rich fibrin (H-PRF) for the treatment of advanced periodontal osseous defects. MATERIALS AND METHODS: This study analyzed stage-III (severe) periodontitis patients (from poor to hopeless prognosis) who underwent periodontal surgery using Periosomes with an ABBC/H-PRF scaffold with a 6-month follow-up. Complete periodontal charting, including probing depth (PD), gingival margin (GM), bleeding on probing (BOP), clinical attachment loss (CAL), gingival index (GI), plaque index (PI), and tooth mobility, was assessed at baseline and the follow-up. The study included 13 patients (8 females and 5 males) aged 29 to 73 years, with 23 periodontal defects of one-walled (60.9%) and two-walled (39.1%) defect morphology. RESULTS: The sites treated with Periosomes showed statistically significant reductions in PD from baseline to six months in one-walled defects (8.50 ± 2.41 mm to 3.14 ± 0.77; p 0.0001) and two-walled defects (7.56 ± 1.13 mm to 3.22 ± 0.44; p 0.0001) as well as in CAL from 9.14 ± 3.01 mm to 4.79 ± 2.17 (p 0.0001) in one-walled defects and from 7.22 ± 1.56 mm to 3.56 ± 1.01 (p 0.0001) in and two-walled defects. Furthermore, frequency distribution analysis found that 96% of sites attained residual PD 5 mm and 92% showed CAL gains ≥3 mm at the 6-month follow-up. CONCLUSION: The combined use of Periosomes, ABBMC, and H-PRF was associated with favorable short-term clinical improvements in advanced periodontal osseous defects with no reported adverse events. To our knowledge, this is the first human clinical study assessing the use of exosomes in periodontal regenerative therapy. However, controlled clinical trials with comparator groups and longer follow-up are necessary to evaluate the independent contribution of exosomes in periodontal regeneration.
Journal of dentistryKay-Arne Walther, Mehmet Ali Akdeniz, Bernd Wöstmann, Jonas Adrian Helmut Vogler
OBJECTIVES: The study aimed to evaluate the long-term correlation between periodontal parameters at implants and contra-lateral natural teeth over a follow-up period of up to 20 years in periodontitis patients undergoing supportive periodontal care (SPC). MATERIALS AND METHODS: This observational cohort study involved systemically healthy, non-smoking patients who received periodontal and implant therapy, followed by regular SPC. The following parameters were assessed at baseline (i.e. implant loading) and at 5, 10, 15 and 20 years: clinical attachment level (CAL), pocket probing depth (PPD), gingival margin (GM) and bleeding on probing (BOP). Intra- and inter-group differences over time between implants and teeth were analysed. Survival rates were calculated. RESULTS: 167 patients with 419 implants were included. Mean CAL increased significantly over time at implants and teeth (p ≤ 0.015), approximately doubling every five years. After 20 years, CAL loss amounted to 4.47±2.45 mm at implants and 4.38±2.64 mm at teeth. Implants demonstrated significantly greater PPD increases after 10 and 15 years compared with teeth (p ≤ 0.027), whereas differences in CAL between implants and teeth were largely non-significant beyond 5 years. Differences in GM and BOP were small and inconsistent. No association was observed between SPC frequency and changes in CAL or PPD. Implant survival was 100% and three contra-lateral teeth were lost over 20 years. CONCLUSIONS: In patients with treated periodontitis under regular SPC, implants and natural teeth exhibited comparable long-term clinical stability and survival. However, a non-linear progression of CAL loss occurs at teeth and implants, which SPC effectively limits but does not completely prevent. CLINICAL SIGNIFICANCE: For systemically healthy, non-smoking patients with treated periodontitis who attend SPC programme twice per year, implants can provide durable tooth replacement. Survival is comparable to that of contra-lateral teeth over 20 years. Clinicians should prioritise maintenance and monitoring, as CAL and PPD may progress despite overall excellent long-term survival.
Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric DentistrySwagata Saha, Manju Raman Nair, Kavita Rai, Prajna P Nayak, Suchetha Kumari N, Prajna Bhandary, Sharmila K P, Neevan D'souza
BACKGROUND: Children with Down Syndrome (DS) are at heightened risk for oral diseases due to their distinct physiological and immune characteristics. Matrix metalloproteinases (MMPs), particularly MMP-8 and MMP-9, are key mediators of periodontal tissue breakdown. Probiotics may provide a novel, well-tolerated alternative to conventional antiseptics by modulating these biomarkers. METHODS: This single-center, parallel-arm, randomized, single-blind pilot trial compared a sugar-free microencapsulated probiotic oral rinse against a 0.2% chlorhexidine digluconate rinse in children with DS. A total of 118 participants aged 6-14 years were enrolled; following attrition after oral rehabilitation, 40 children (20 per group) were allocated to intervention, and 15 participants per group completed all assessments. After individualized oral rehabilitation and oral health education, participants were randomized (1:1). Group 1 received probiotic rinse and Group 2 chlorhexidine rinse, both administered twice daily for two weeks. Primary outcomes were salivary MMP-8 and MMP-9 levels (enzyme-linked immunosorbent assay). Secondary outcomes were plaque index (PI), gingival index (GI), oral hygiene index-simplified (OHI-S), and bleeding on probing (BOP). Outcomes were assessed at baseline prior to oral rehabilitation (T0), two weeks after completion of oral rehabilitation (T1), two weeks following completion of the rinse protocol (T2), and six months post-rinse (washout period, T3) by blinded examiners. RESULTS: All 30 randomized participants completed the trial (15 per group). Both groups showed significant within-group reductions in MMP-8, MMP-9, PI, GI, OHI-S, and BOP at follow-up (p < 0.05). Between-group comparisons showed no significant differences in MMP levels, PI, GI or OHI-S at any interval. At six months, the probiotic group demonstrated a greater reduction in BOP compared with chlorhexidine (median difference -6.0; 95% CI [-9.0, -3.0]; p = 0.001). Given the two-week duration of rinsing, this isolated 6-month difference should be interpreted cautiously. HARMS: No systemic side effects or gastrointestinal symptoms were reported. Mild tooth staining occurred in two participants in the chlorhexidine group; no adverse effects were reported in the probiotic group. CONCLUSION: Both rinses demonstrated within-group improvements, although no significant between-group differences were observed in the primary biochemical outcomes. The probiotic rinse showed comparable short-term efficacy and better tolerability, but due to underpowering and design limitations, findings remain exploratory. Larger, adequately powered studies are required to determine true clinical effectiveness. TRIAL REGISTRATION: This study was a registered clinical trial with the Clinical Trials Registry of India (CTRI/2023/04/051447). The trial was prospectively registered, adhering to the WHO standards for clinical trial registration to ensure transparency and integrity in reporting health-related outcomes.
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)Robert A Horowitz, Gregori M Kurtzman, Hari S Prasad
Advances in regenerative dentistry have significantly improved the management of bone deficiencies present at, or resulting from, tooth extraction when implant placement or other prosthetic restoration is planned. The integration of biologic mediators, osteoconductive scaffolds, and resorbable barrier membranes has contributed to more predictable regenerative outcomes in appropriately selected cases. Growth factor-enhanced matrices may provide complementary biologic and structural properties that support site development. Xenografts offer long-term volumetric stability, while allografts demonstrate more active remodeling potential; when combined with biologic stimulation, these materials are intended to enhance angiogenesis, cellular recruitment, and graft incorporation. This article reviews the biologic mechanisms, clinical applications, and handling characteristics of these regenerative materials from clinical, radiographic, and histologic perspectives. When used individually or synergistically they support predictable hard- and soft-tissue regeneration, optimize implant site development, and enhance long-term implant stability and esthetic outcomes.