Dentistry Journal

Research

32 pages, 667 KB

Open AccessArticle

Clinical Status and Salivary aMMP-8 Evaluation of 0.12% Chlorhexidine Versus MicroRepair^® ABX Mouthwash in the Non-Surgical Management of Plaque-Induced Gingivitis: A Randomized Controlled Trial

by Andrea Scribante, Maurizio Pascadopoli, Matteo Pellegrini, Cinzia Casu, Eva Massazzi and Andrea Butera

Dent. J. 2026, 14(6), 383; https://doi.org/10.3390/dj14060383 - 20 Jun 2026

Viewed by 395

Abstract

Objectives: To compare the adjunctive efficacy of a MicroRepair^® mouthwash containing an antibacterial complex (ABX), composed of cetylpyridinium chloride, magnolol, and honokiol, with 0.12% chlorhexidine (CHX) in the management of generalized plaque-induced gingivitis, assessing clinical periodontal parameters, salivary activated matrix metalloproteinase-8 [...] Read more.

Objectives: To compare the adjunctive efficacy of a MicroRepair^® mouthwash containing an antibacterial complex (ABX), composed of cetylpyridinium chloride, magnolol, and honokiol, with 0.12% chlorhexidine (CHX) in the management of generalized plaque-induced gingivitis, assessing clinical periodontal parameters, salivary activated matrix metalloproteinase-8 (aMMP-8) levels, and patient-reported outcomes over 6 months. Methods: A randomized, controlled, parallel-group clinical trial included 40 systemically healthy adults with generalized gingivitis and was reported in accordance with CONSORT 2025 guidelines. Following professional oral hygiene according to the Guided Biofilm Therapy (GBT) protocol, participants were randomly allocated to ABX or 0.12% CHX, used twice daily for 14 days. Clinical parameters, including Full-Mouth Bleeding Score (FMBS, primary outcome), Full-Mouth Plaque Score (FMPS), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (REC), and Modified Lobene Stain Index (MLSI), were recorded at baseline, 2 weeks, 1, 3, and 6 months. Salivary aMMP-8 levels were assessed at baseline and 2 weeks. Heavy smokers were excluded, and smoking status was evaluated as a potential covariate. Non-parametric tests were applied (p < 0.05). Results: Both groups showed significant reductions in FMBS and FMPS over time (p < 0.05), with no intergroup differences for the primary outcome at any follow-up at the patient level. Patient-level analyses did not reveal consistent differences across secondary parameters. At the tooth level, lower FMPS values were observed in the trial group at 2 weeks and 1 month (p < 0.05), with earlier PPD reduction. CAL, and REC remained stable. Salivary aMMP-8 levels decreased significantly in both groups without intergroup differences. Patient-reported outcomes were comparable. Smoking status was balanced between groups and was not significantly associated with treatment allocation or the main clinical outcomes. Conclusions: No significant differences were observed between ABX and CHX for the main clinical and molecular outcomes, supporting its potential use as an adjunct in gingivitis management. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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20 pages, 6832 KB

Open AccessArticle

Management of Advanced Peri-Implantitis with Staged Explantation and Delayed Re-Implantation in the Esthetic Zone

by Alexandru Spînu, Felicia Manole, Alexandru Burcea, Cristina-Crenguţa Albu, Adrian Argint, Lavinia-Florica Mărcuț, Roxana Daniela Brata, Alexia Manole and Claudia Florina Bogdan-Andreescu

Dent. J. 2026, 14(4), 212; https://doi.org/10.3390/dj14040212 - 7 Apr 2026

Cited by 1 | Viewed by 893

Abstract

Background/Objective: Advanced peri-implantitis presents a significant challenge in contemporary implant dentistry and sometimes necessitates implant removal when regenerative therapies are no longer reliable. Protocols for staged bone reconstruction, re-implantation, and definitive prosthetic rehabilitation following peri-implantitis continue to evolve. This study aims to present [...] Read more.

Background/Objective: Advanced peri-implantitis presents a significant challenge in contemporary implant dentistry and sometimes necessitates implant removal when regenerative therapies are no longer reliable. Protocols for staged bone reconstruction, re-implantation, and definitive prosthetic rehabilitation following peri-implantitis continue to evolve. This study aims to present a clinical case of advanced peri-implantitis with vertical interproximal bone loss managed with a staged surgical and prosthetic approach and review current concepts in implant removal, bone regeneration, re-implantation, and soft-tissue management. Methods: A patient with peri-implantitis affecting two maxillary implants underwent treatment over one year. The initial surgical stage included removal of the failing implants and reconstruction of the defects using guided bone regeneration with a composite graft of 50% xenogeneic bone substitute and 50% autogenous bone, covered by a barrier membrane. After six months of healing, a second surgical stage was performed, involving placement of two new implants in positions 2.2 and 2.4, additional bone augmentation, and soft tissue grafting to enhance soft tissue volume and the width of keratinized gingiva following mucogingival line rebounce. After an additional six months of osseointegration, full maxillary prosthetic rehabilitation was completed in August 2025. Results: Clinical and radiographic assessments demonstrated successful bone regeneration, stable implant integration, adequate peri-implant soft-tissue conditions, and favorable functional and esthetic outcomes at follow-up. The case is discussed in the context of current evidence regarding indications for implant removal, regenerative strategies after explantation, timing of re-implantation, and the importance of keratinized gingiva and prosthetic design in long-term peri-implant health. Conclusions: Staged explantation, guided bone regeneration, delayed re-implantation, and comprehensive soft-tissue and prosthetic management may represent a viable treatment strategy in selected cases of advanced peri-implantitis. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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17 pages, 5048 KB

Open AccessArticle

Differential Attachment of Engineered Oral Soft Tissues to Implant Surfaces

by Nour Jalaleddine, Emilia Barker, Kirsty Franklin, Mohamed Jamal, Momen A. Atieh, Zaid H. Baqain and Keyvan Moharamzadeh

Dent. J. 2026, 14(3), 150; https://doi.org/10.3390/dj14030150 - 6 Mar 2026

Cited by 1 | Viewed by 871

Abstract

Background/Objectives: The formation of a soft tissue seal through mucosal integration around dental implants is critical for potentially achieving long-term peri-implant health and clinical success. Understanding how different implant and abutment surfaces interact with individual layers of the oral mucosa remains limited. [...] Read more.

Background/Objectives: The formation of a soft tissue seal through mucosal integration around dental implants is critical for potentially achieving long-term peri-implant health and clinical success. Understanding how different implant and abutment surfaces interact with individual layers of the oral mucosa remains limited. This study aimed to compare the differential attachment of tissue-engineered oral epithelium, connective tissue, and full-thickness human oral mucosa to various implant and abutment materials and surface topographies. Methods: Sand-blasted, large-grit, acid-etched (TiZr-SLA), machined TiZr (TiZr-M), machined zirconia (ZrO₂-M), polished zirconia (ZrO₂-P), and machined PEEK rods, along with commercially available titanium and ZrO₂ healing abutments, were inserted into 3D oral mucosal models following a 4-mm punch biopsy. Inflammation was induced using Escherichia coli lipopolysaccharide. Analyses included histology, PrestoBlue viability assay, scanning electron microscopy, and ELISA quantification of cytokines IL-1β, IL-6, and IL-8. Results: Epithelial attachment was greater on TiZr-SLA, ZrO₂-P, and PEEK-M (p < 0.05 and p < 0.01) surfaces compared with TiZr-M and ZrO₂-M. TiZr-SLA exhibited the highest connective tissue attachment (p < 0.05). Commercial titanium and ZrO₂ healing abutments demonstrated the highest post-pull PrestoBlue viability and overall soft tissue attachment. SEM confirmed cell retention on all implant surfaces. Elevated IL-1β levels were detected in models exposed to ZrO₂-M and PEEK-M, whereas IL-6 and IL-8 levels were not influenced by any material or surface topography. Conclusions: In vitro epithelial and connective tissue responses are influenced by implant material, surface topography, and design. Rough TiZr-SLA surfaces promote superior connective tissue attachment, while smooth commercial abutments support optimal overall soft tissue integration. These findings highlight the importance of surface engineering in preclinical optimization of peri-implant soft tissue attachment. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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13 pages, 1289 KB

Open AccessArticle

Disinfection Strategies for Implant-Related Prosthetic Materials: An In Vitro Evaluation of Citric Acid, Chlorhexidine and Polyethylene Glycol

by Eduardo Escaf-Robles, Aritza Brizuela-Velasco, Daniel Robles-Cantero, Saray Fernández-Hernández, Javier Gil and Hector de Llanos-Lanchares

Dent. J. 2026, 14(1), 8; https://doi.org/10.3390/dj14010008 - 22 Dec 2025

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Abstract

Background/Objectives: There is evidence of possible contamination of prosthetic components originating from dental laboratories. The aim of this study is to investigate the disinfectant effect of citric acid and polyethylene glycol on implant-prosthetic materials in comparison with an untreated control and chlorhexidine. [...] Read more.

Background/Objectives: There is evidence of possible contamination of prosthetic components originating from dental laboratories. The aim of this study is to investigate the disinfectant effect of citric acid and polyethylene glycol on implant-prosthetic materials in comparison with an untreated control and chlorhexidine. Methods: A total of 720 disks made of three different materials (titanium grade V, zirconia coated with feldspathic ceramic, and PMMA) contaminated with three bacteria (Staphylococcus aureus, Enterococcus faecalis, and porphyromonas gingivalis) were analyzed. Four treatment groups were tested: citric acid, polyethylene glycol, chlorhexidine and an untreated control group. Two assessment periods (3 and 21 days of incubation) were used, with bacterial metabolic activity measured using the resazurin reduction test and then analyzed by electron microscopy. Results: The results show that chlorhexidine has a superior inhibitory effect on all materials and bacterial strains in the short-term evaluation (3 days), while citric acid and polyethylene glycol showed higher efficacy after 21 days. Citric acid also exhibits differential effects when applied to grade V titanium. These differences were statistically significant at p < 0.05. Conclusions: There is evidence to recommend chlorhexidine for the disinfection of laboratory prosthetic components, but the enhanced effect of citric acid on grade V titanium and its long-term efficacy make it clinically promising candidate. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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13 pages, 1050 KB

Open AccessArticle

The Correlations Between Diabetes Mellitus and Oro-Maxillofacial Disorders: A Statistical Perspective

by Ionut Catalin Botezatu, Mihaela Salceanu, Ana Emanuela Botez, Cristina Daniela Dimitriu, Oana Elena Ciurcanu, Claudiu Topoliceanu, Elena-Carmen Cotrutz and Maria-Alexandra Martu

Dent. J. 2025, 13(8), 373; https://doi.org/10.3390/dj13080373 - 18 Aug 2025

Cited by 2 | Viewed by 2168

Abstract

Background/Objectives: The goal of this research was to determine the prevalence and distribution of the oro-maxillofacial pathologies in patients with diabetes mellitus and to determine the correlation between diabetes mellitus and oro-maxillofacial disorders. Methods: The retrospective study group consisted of 6868 patients [...] Read more.

Background/Objectives: The goal of this research was to determine the prevalence and distribution of the oro-maxillofacial pathologies in patients with diabetes mellitus and to determine the correlation between diabetes mellitus and oro-maxillofacial disorders. Methods: The retrospective study group consisted of 6868 patients (mean age 49.84 ± 22.79 years) admitted in Oral and Maxillofacial Surgery Department between 2018 and 2024. Qualitative data were analyzed by Chi-square (χ²) test. Odds Ratio (OR) and Relative Risk (RR) were measured for each oro-maxillofacial pathology. Quantitative data were analyzed by Student’s T-test. Results: Among patients with diabetes mellitus (DM), the estimated risk of malignant tumors was 5.29 times higher (RR = 5.29; p = 0.001) compared to the non-DM group, with 15.0% of diabetic patients affected, versus 1.4% in the non-diabetic group. The probability of periodontal disease in diabetic patients was 4.66 times higher (RR = 4.66; p = 0.001), affecting 5.5% of the DM group, compared to only 0.6% in the non-DM group. Diabetic patients had a likelihood 3.53 times higher (RR = 3.53; p = 0.001) of developing apical periodontitis, with 5.3% of the DM group affected, in contrast to 1.0% of the non-DM group. The presence of root remnants was 1.43 times more likely (RR = 1.43; p = 0.001) in diabetic patients, with 9.0% of the DM group affected, compared to 6.1% in the non-DM group. Conclusions: The strong correlation between diabetes and oral pathologies, particularly malignancies and periodontal disease, underscores the need for early screening, preventive care, and targeted management strategies for diabetic patients. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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Review

Jump to: Research, Other

14 pages, 427 KB

Open AccessReview

Crown Lengthening Procedures: Biological Foundations, Clinical Outcomes, and Contemporary Approaches in Flapless and Flap Techniques—A Narrative Review

by Blagovesta Yaneva, Aleksandra Pecheva and Meri Hristamyan

Dent. J. 2026, 14(7), 413; https://doi.org/10.3390/dj14070413 - 7 Jul 2026

Viewed by 380

Abstract

Background: Crown lengthening procedures are widely used in restorative and periodontal therapy to expose sufficient tooth structure for functional and esthetic rehabilitation. Traditionally performed using an open-flap approach, these procedures have evolved with the introduction of minimally invasive flapless techniques. This narrative review [...] Read more.

Background: Crown lengthening procedures are widely used in restorative and periodontal therapy to expose sufficient tooth structure for functional and esthetic rehabilitation. Traditionally performed using an open-flap approach, these procedures have evolved with the introduction of minimally invasive flapless techniques. This narrative review aims to summarize the biological foundations, clinical outcomes, and contemporary approaches associated with crown lengthening procedures, with particular emphasis on flapless and flap techniques, healing processes, technological advancements, and clinical decision-making considerations. Methods: A narrative literature review was conducted using electronic databases, including PubMed, Scopus, and Web of Science, to identify relevant publications on crown lengthening procedures. The search focused on studies addressing flapless and flap techniques, biological principles, healing dynamics, clinical outcomes, postoperative considerations, and contemporary approaches such as laser-assisted and digitally guided procedures. Titles and abstracts were screened for relevance, followed by full-text assessment of eligible articles. The study selection process was documented using a simplified PRISMA-style flow diagram to enhance transparency. Results: The reviewed literature suggests that flapless crown lengthening may be associated with reduced surgical time, less postoperative discomfort, faster healing, and preservation of soft tissue architecture in appropriately selected cases. However, its applicability appears to be influenced by anatomical factors, including bone morphology and the need for adequate visualization during osseous recontouring. Conventional flap techniques continue to be widely used and may offer improved surgical access and visibility, particularly in more complex situations requiring extensive bone modification. Although these procedures have been associated with longer healing periods and greater postoperative morbidity, the heterogeneity of the available evidence and the narrative nature of this review limit definitive comparisons between the two approaches. Conclusions: In conclusion, both flapless and flap crown lengthening procedures demonstrate high clinical efficacy when appropriately indicated. The choice of technique should be guided by case-specific factors, clinician expertise, and patient expectations. Further randomized controlled trials are recommended to strengthen the evidence base and establish standardized clinical guidelines. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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12 pages, 1062 KB

Open AccessReview

Vitamin D in Peri-Implant and Periodontal Tissue

by Felipe de Souza Duarte, Nathália Dantas Duarte, Gabriel Mulinari-Santos, Paula Buzo Frigério, Roberta Okamoto, Rogerio Leone Buchaim, Daniela Vieira Buchaim and João Paulo Mardegan Issa

Dent. J. 2025, 13(10), 448; https://doi.org/10.3390/dj13100448 - 30 Sep 2025

Viewed by 2899

Abstract

This review aims to provide an overview of the role of vitamin D in peri-implant and periodontal tissue. Electronic searches were carried out of the PubMed/Medline database. Since this is a narrative review, no systematic search, meta-analysis, or statistical analysis was performed. Vitamin [...] Read more.

This review aims to provide an overview of the role of vitamin D in peri-implant and periodontal tissue. Electronic searches were carried out of the PubMed/Medline database. Since this is a narrative review, no systematic search, meta-analysis, or statistical analysis was performed. Vitamin D plays a crucial role in bone balance and metabolism, contributing to reducing early implant failure and improving dental implant osseointegration. Vitamin D deficiency poses a challenge to clinical outcomes, and its supplementation can be an effective alternative to overcome this limitation. The results reported in this article show that vitamin D application on implants can improve the osseointegration, bone-to-implant contact, implant stability, and bone density. Moreover, vitamin D supplementation can increase RUNX2, ALP, OPN, and OCN expression, contributing to periodontal tissue health and its regeneration. Together, findings provide an overview of these topics and present future perspectives for clinical practice in dentistry. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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28 pages, 1016 KB

Open AccessReview

Sustainable Dental and Periodontal Practice: A Narrative Review on the 4R-Framework—Reduce, Reuse, Rethink, Recycle—And Waste Management Rationalization

by Federica Di Spirito, Francesco Giordano, Maria Pia Di Palo, Giuseppina De Benedetto, Leonardo Aulisio and Giovanni Boccia

Dent. J. 2025, 13(9), 392; https://doi.org/10.3390/dj13090392 - 28 Aug 2025

Cited by 9 | Viewed by 4300

Abstract

Background/Objectives: While dentistry plays a critical role in promoting oral health, it also contributes significantly to environmental degradation through high energy consumption, water usage, and reliance on disposable, non-recyclable materials. Periodontology, in particular, involves resource-intensive procedures such as full-mouth disinfection, frequent surgical [...] Read more.

Background/Objectives: While dentistry plays a critical role in promoting oral health, it also contributes significantly to environmental degradation through high energy consumption, water usage, and reliance on disposable, non-recyclable materials. Periodontology, in particular, involves resource-intensive procedures such as full-mouth disinfection, frequent surgical interventions, and aerosol-generating instrumentation. The aim of the present narrative review is to synthesize current knowledge and delineate feasible, evidence-informed strategies to operationalize sustainability across the full spectrum of periodontal treatment settings. Methods: The electronic search of the present narrative review was performed across PubMed/MEDLINE, Web of Science, BioMed Central, Scopus, CINAHL, and Cochrane Library databases. Results: The review identified actionable sustainability strategies across pre-workplace (e.g., eco-conscious procurement and transport reduction), workplace (e.g., energy- and water-saving technologies, digital workflows, and pollution control), and waste management (e.g., reuse protocols, recycling, and sustainable material selection). Particular emphasis was placed on the role of dental education, life cycle assessments, and digital innovations. Conclusions: The transition toward sustainable periodontology requires the adoption of evidence-based practices and leveraging digital innovation to reduce the environmental impact while maintaining high standards of care. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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18 pages, 3393 KB

Open AccessFeature PaperReview

The 2018 Classification of Periodontitis: Challenges from Clinical Perspective

by Marek Chmielewski, Andrea Pilloni, Alessandro Cuozzo, Giuseppe D’Albis, Gerarda D’Elia, Piero Papi and Lorenzo Marini

Dent. J. 2025, 13(8), 361; https://doi.org/10.3390/dj13080361 - 8 Aug 2025

Cited by 7 | Viewed by 7894

Abstract

Objectives: The objective of this narrative review was to evaluate the clinical challenges encountered in the application of the 2018 AAP/EFP Classification of Periodontitis. Methods: Electronic and manual searches were conducted to identify studies reporting diagnostic accuracy and inter- and intra-examiner [...] Read more.

Objectives: The objective of this narrative review was to evaluate the clinical challenges encountered in the application of the 2018 AAP/EFP Classification of Periodontitis. Methods: Electronic and manual searches were conducted to identify studies reporting diagnostic accuracy and inter- and intra-examiner agreement when using the 2018 Classification, both with and without the aid of implementation tools. Results: Eleven studies were included, encompassing a total of 459 clinical cases. Overall, 852 examiners participated, with 31 gold-standard examiners providing the reference diagnoses. General dentists often exhibited lower diagnostic accuracy and consistency compared to students and periodontal experts. Diagnostic challenges were observed in staging, particularly distinguishing between Stage III/IV and gingivitis/Stage I. Grading reliability was reduced in the absence of longitudinal data and high-level modifying factors. This review also explored difficulties in reporting ‘hopeless teeth’ and assigning the extent of periodontitis. Education, training, and implementation tools substantially improved diagnostic accuracy and consistency, increasing the agreement with reference diagnosis and strengthening inter- and intra-examiner agreement. Conclusions: The application of the 2018 Classification showed notable variability in diagnostic accuracy and inter- and intra-examiner agreement. Improving clinician experience and training and incorporating diagnostic aids and emerging AI technologies has the potential to enhance diagnostic accuracy and consistency, which are essential for precisely estimating periodontitis prevalence, interpreting research findings, and determining prognosis and treatment needs. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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14 pages, 520 KB

Open AccessReview

Activation of the Nrf2 Signaling Pathway as a Therapeutic Strategy Against Periodontal Disease: A Narrative Review

by Sarmistha Saha, Nadezhda Sachivkina, Ekaterina Lenchenko, Olga Pilshchikova and Alexandr Muraev

Dent. J. 2025, 13(7), 314; https://doi.org/10.3390/dj13070314 - 11 Jul 2025

Cited by 6 | Viewed by 4256

Abstract

Periodontitis (PD), is a chronic inflammatory disease of the periodontal system, which includes gingiva, periodontal ligament, alveolar bone, and tooth cement. It is becoming increasingly prevalent globally, and its implications for oral health are profound. The Nrf2 signaling pathway is crucial in managing [...] Read more.

Periodontitis (PD), is a chronic inflammatory disease of the periodontal system, which includes gingiva, periodontal ligament, alveolar bone, and tooth cement. It is becoming increasingly prevalent globally, and its implications for oral health are profound. The Nrf2 signaling pathway is crucial in managing the relationship between inflammation and oxidative stress, making it vital for understanding this disease. Nrf2 interacts with key redox-sensitive inflammatory pathways, playing a vital role in the development of periodontitis. Acknowledging these dynamics underscores the importance of proactively addressing the complex aspects of periodontal disease. This review emphasizes its intricate interactions with redox-sensitive transcription factors vital for sustaining the self-perpetuating inflammatory processes underlying the disease. Additionally, it explores promising therapeutic strategies aimed at Nrf2 activation and encourages more effective management of PD. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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Other

Jump to: Research, Review

21 pages, 1317 KB

Open AccessSystematic Review

Comparison Between Natural Products and Chlorhexidine in Non-Surgical Periodontal Therapy: A Systematic Review of Randomized Clinical Trials

by Andrea Scribante, Matteo Pellegrini, Maurizio Pascadopoli, Valentino Natoli, Valentina Poma and Andrea Butera

Dent. J. 2026, 14(2), 110; https://doi.org/10.3390/dj14020110 - 13 Feb 2026

Cited by 4 | Viewed by 1356

Abstract

Objectives: To evaluate the clinical effectiveness and safety of natural products compared with chlorhexidine (CHX) as adjuncts to non-surgical periodontal therapy (NSPT) in patients with periodontitis. Materials and Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines [...] Read more.

Objectives: To evaluate the clinical effectiveness and safety of natural products compared with chlorhexidine (CHX) as adjuncts to non-surgical periodontal therapy (NSPT) in patients with periodontitis. Materials and Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD420251133219). Electronic searches of PubMed, Scopus, and Web of Science were performed to identify randomized controlled trials (RCTs) published between 2020 and 2025. Eligible studies included adult patients with periodontitis treated with NSPT, comparing CHX-based products with natural formulations (mouthwashes, gels, irrigants, or dentifrices). Data extraction included product type, concentration, mode of application, follow-up duration, and primary periodontal outcomes. Study quality was assessed using the NIH Quality Assessment Tool. Results: Thirteen randomized controlled clinical trials met the inclusion criteria. Natural products such as Curcuma longa, Morus alba, Spirulina platensis, Propolis, Triphala, and Lycium barbarum demonstrated improvements in clinical attachment level (CAL) and probing pocket depth (PPD) comparable to those obtained with CHX, along with significant reductions in bleeding on probing (BoP) and plaque index (PI). Probiotic- and ozone-based treatments also showed favorable clinical outcomes, with faster healing and fewer adverse effects, such as tooth staining and taste alteration. Follow-up periods ranged from 14 days to 3 months. Conclusions: Natural products appear to be safe and effective alternatives to CHX when used as adjuncts to non-surgical periodontal therapy, providing comparable clinical benefits with a lower incidence of side effects. Nevertheless, further large-scale, long-term randomized trials are needed to standardize formulations and concentrations and to confirm the durability of these clinical effects. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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12 pages, 2299 KB

Open AccessCase Report

Horizontal Ridge Augmentation with Xenogeneic Bone, Hyaluronic Acid, and Dermal Matrix by Tunnel Technique: A Case Series

by Giuseppe D’Albis, Marta Forte, Lorenzo Marini, Kezia Rachellea Mustakim, Andrea Pilloni, Massimo Corsalini and Saverio Capodiferro

Dent. J. 2026, 14(1), 25; https://doi.org/10.3390/dj14010025 - 4 Jan 2026

Cited by 1 | Viewed by 942

Abstract

Background: Several minimally invasive techniques have been introduced to augment horizontal ridge volume for prosthetically driven implant placement, utilizing different biomaterials to enhance regenerative outcomes. This article presents two clinical cases illustrating a tunneling approach for horizontal alveolar ridge augmentation using a [...] Read more.

Background: Several minimally invasive techniques have been introduced to augment horizontal ridge volume for prosthetically driven implant placement, utilizing different biomaterials to enhance regenerative outcomes. This article presents two clinical cases illustrating a tunneling approach for horizontal alveolar ridge augmentation using a combination of xenogeneic bone graft, hyaluronic acid, and an acellular dermal matrix. Methods: A single vertical incision was made mesial to the bone defect and a dermal matrix was suitably shaped and positioned into the subperiosteal tunnel. Subsequently, the bone graft was inserted between the dermal matrix and the buccal bone plate. Primary wound closure was achieved. After six months, implants were placed. For each patient, an optical scan was performed at baseline (T₀), at six months post-operative ridge augmentation surgery (T₁) and at two months post-implant insertion (T₂). A digital measurement of the horizontal ridge thickness was performed at each inserted implant site. Clinical parameters and patient postoperative morbidity were recorded. Results: The procedure was well tolerated by the patients. No postoperative clinical complications were observed. The mean tissue thickness achieved at T1 was recorded to be 13.3 mm. The same value was recorded at T2. Conclusions: This technique allowed the placement of prosthetically guided implants, with minimal morbidity and no observed complications. Further studies analyzing the histology of newly formed bone and performing three-dimensional radiological examinations to confirm the effectiveness of the surgical technique are warranted to validate these preliminary findings. Clinical Trial Number (NIH): NCT06424223 Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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24 pages, 1352 KB

Open AccessSystematic Review

The Effect of Adjunctive Antimicrobial Photodynamic Therapy in the Treatment of Peri-Implant Diseases: Systematic Review and Meta-Analysis

by Livia Nastri, Marco Annunziata, Pierluigi Mariani, Agostino Guida, Michele Giuseppe Pio Di Mare and Luigi Guida

Dent. J. 2025, 13(12), 567; https://doi.org/10.3390/dj13120567 - 1 Dec 2025

Viewed by 1093

Abstract

Background/Objectives: Peri-implant diseases may occur around osseointegrated implants and lead to implant loss. Treatment strategies focus on infection control with decontamination of implant surfaces/pockets. Mechanical debridement (MD) is necessary to reduce biofilm, although it may have limited effects. Antimicrobial photodynamic therapy (aPDT) [...] Read more.

Background/Objectives: Peri-implant diseases may occur around osseointegrated implants and lead to implant loss. Treatment strategies focus on infection control with decontamination of implant surfaces/pockets. Mechanical debridement (MD) is necessary to reduce biofilm, although it may have limited effects. Antimicrobial photodynamic therapy (aPDT) has been proposed to increase the potential of MD. The aim of this systematic review and meta-analysis is to evaluate aPDT in adjunct to MD versus MD as a single treatment. Methods: An electronic and hand literature search was performed in several databases up to March 2025 to include randomized controlled trials (RCTs). Risk of bias (RoB) was assessed by Cochrane Risk of Bias Tool for RCTs (RoB 2). A meta-analysis was performed with marginal bone level change (MBLc) as the primary outcome, and changes in probing depth (PD) and bleeding on probing (BOP) as secondary outcomes. Results: Eleven RCTs (1056 implants, 878 patients) were included. RoB was high: in 3 studies; some concerns: in 4 studies; low: in 4 studies. The included studies showed a high heterogeneity for MD/aPDT protocols and diagnostic criteria of peri-implant diseases. The meta-analysis revealed, for four studies, a significantly higher MBLc for test patients (M∆: 0.29, 95% CI 0.12, 0.46; p < 0.001) and a significantly higher BOP change (M∆ 5.59; 95% CI: 1.19, 9.86; p = 0.01). No significant difference was found at 6 months in terms of PD change between the test and control groups (M∆ 0.46; 95% CI −0.09, 1.02; p = 0.10). High heterogeneity (I² > 85%) for all three outcomes was found. Conclusions: High heterogeneity, diagnostic variability, and the low number of included studies increase the need of well-designed RCTs on the topic. Despite no conclusive evidence could be found, adjunctive aPDT showed a promising trend to improve MD results. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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21 pages, 5465 KB

Open AccessCase Report

Modified Roll Flap Soft-Tissue Augmentation at Single-Stage Implant Placement: A Digital-Scan–Verified Case Report

by Kamen Kotsilkov, Hristina Maynalovska and Zdravka Pashova-Tasseva

Dent. J. 2025, 13(10), 483; https://doi.org/10.3390/dj13100483 - 21 Oct 2025

Viewed by 2402

Abstract

Background and Objectives: Adequate peri-implant soft tissue dimensions are essential for health, hygiene, and esthetics. When ridge volume is sufficient, phenotype modification may avoid bone grafting. This case report describes a pedicled roll flap performed concurrently with single-stage implant placement after spontaneous socket [...] Read more.

Background and Objectives: Adequate peri-implant soft tissue dimensions are essential for health, hygiene, and esthetics. When ridge volume is sufficient, phenotype modification may avoid bone grafting. This case report describes a pedicled roll flap performed concurrently with single-stage implant placement after spontaneous socket healing, without bone substitute, and assesses soft-tissue stability with serial intraoral scans. Clinical case: A single-tooth edentulous site underwent prosthetically driven, fully guided implant placement. A modified roll flap with vertical and palatal incisions was prepared; the de-epithelialized crestal connective tissue was elevated and rolled into a buccal envelope to augment thickness. No graft material was used. A provisional crown conditioned the emergence profile. Follow-up included photographs, radiographs, and intraoral scan superimpositions at 2 weeks, 3–4 months, 8 months, and 14 months after implant treatment. Healing was uneventful. Buccal soft-tissue thickness increased, keratinized mucosa was preserved, and midfacial levels remained stable. Emergence profile and papillae integrated harmoniously. Crestal bone levels were stable radiographically. Digital scans corroborated soft-tissue thickness maintenance. No donor-site morbidity occurred. Conclusions: In healed sockets with adequate bone, a modified pedicled roll flap at implant placement can thicken the peri-implant phenotype and achieve stable esthetic integration without bone substitutes. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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Open AccessCase Report

Electrolytic Cleaning as Part of Surgical Reconstructive Peri-Implantitis Treatment: A Case Series

by Jarno Hakkers, Henny J. A. Meijer, Yvonne C. M. de Waal and Gerry M. Raghoebar

Dent. J. 2025, 13(6), 237; https://doi.org/10.3390/dj13060237 - 26 May 2025

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Abstract

Background/Objectives: The aim of this study was to assess the workflow and evaluate the clinical, radiographic and patient-reported outcome measures of surgical reconstructive peri-implantitis treatment aided with an electrolytic cleaning device. Methods: This case series describes three patients that presented with peri-implantitis surrounding [...] Read more.

Background/Objectives: The aim of this study was to assess the workflow and evaluate the clinical, radiographic and patient-reported outcome measures of surgical reconstructive peri-implantitis treatment aided with an electrolytic cleaning device. Methods: This case series describes three patients that presented with peri-implantitis surrounding an implant in the anterior maxilla, eligible for surgical reconstructive peri-implantitis treatment. The implant crown was removed, and the patients were surgically treated during which an electrolytic cleaning device was used to clean the implant surface. Thereafter, the implant site was augmented using locally harvested bone and a bovine bone substitute. After 6 months of submerged healing, the implant crown was replaced. Follow-up visits were performed 3 and 6 months after restoration placement. Clinical and radiographical parameters, as well as Patient-Reported Outcome Measures (PROMs) and Pink Esthetic Scores (PESs) were collected. Results: The data collected indicate a positive trend with regard to peri-implant pocket depth, bleeding and suppuration scores, as well as the peri-implant marginal bone level for the evaluated cases six months postoperatively. PROMs with regard to pain experience varied between 4.5 and 5.9 on the Visual Analogue Scale (VAS). After 12 months, the PES increased in two cases and decreased in one case. Conclusions: This case series provides a comprehensive overview of the surgical reconstructive peri-implantitis treatment using an electrolytic cleaning device, highlighting promising results with regard to the aforementioned parameters. Full article

(This article belongs to the Special Issue Advances in Periodontal and Peri-Implant Tissues Health Management: 2nd Edition)

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